补充维生素D对肌肉质量、肌肉力量、肌肉功能的影响

　　为了探讨补充维生素D对中国老年人血清25羟维生素D水平、骨骼肌质量、强度和功能的影响，复旦大学附属华东医院、上海市老年医学临床重点实验室入组了85例血清维生素D水平小于20ng/mL的上海老年人，进行为期12个月的随机双盲对照研究，发现补充维生素D（800IU/d）可显著增加血清25羟维生素D水平，提高肌肉的力量和功能，改善生活质量。但是体重指数（BMI）、炎性细胞因子（IL-6、IL-10）、血钙磷水平无显著差异。

　　该研究摘要被2016年美国肠外肠内营养学会（ASPEN）临床营养周（CNW）评选为国际优秀摘要（International Abstract of Distinction）。

JPEN J Parenter Enteral Nutr. 2016;40(4):135-136.

Effects of Vitamin D Supplements on Muscle Mass, Muscle Strength, and Muscle Function in the Elderly in Shanghai, China.

Jianqin Sun, Huijing Bai, Min Chen, Danfeng Xu, Hua Xie, Jiemin Gan, Yiru Pan, Ru Li, Zhenghui Gao, Xiangling Lv, Jie Chen, Zhijun Bao.

Fudan University Affiliated Hua Dong Hospital, Shanghai, China; Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.

PURPOSE: To investigate the impact of vitamin D supplements on serum 25(OH)D level and skeletal muscle mass, strength, and function in the elderly population in China.

METHODS: The study was a randomized double-blind controlled study. Eight-five subjects (serum vitamin levels <20 ng/mL) were randomly divided into an intervention group (vitamin D, 800 IU; n = 41 people) and placebo group (n = 44 people). Intervention time was 12 months (48 weeks). Lifestyle remained unchanged during the intervention period. The subjects accepted the comprehensive assessment at 0, 6, and 12 months during the study. The assessment included change of skeletal muscle mass, dominant hand grip strength (HGS), and Short Physical Performance Battery (SPPB). Secondary end points were the changes in the quality of life, inflammatory cytokines (IL-6, IL-10), weight, BMI, waist, serum calcium, and phosphorus levels. Appendicular skeletal muscle mass (ASM) were measured by bioelectrical impedance analysis. The ASM index (ASM/height2) was calculated. Muscle strength was assessed by HGS. Muscle function was assessed by measuring SPPB. Serum 25(OH)D levels, IL-6, and IL-10 were measured by electrochemiluminescence immunoassay. The quality of life was evaluated by EuroQol Group-5D (EQ-5D) and EuroQol visual analog scale (EQVAS).

RESULTS: There was no difference in serum 25(OH)D level between the 2 groups at baseline (13.6 ± 3.6 vs 14.1 ± 3.7, P > .05). However, serum 25(OH)D levels in the intervention group was significantly higher than the placebo group at 6 months (35.9 ± 5.7 vs 27.5 ± 6.3 ng/mL, P < .05) and 12 months (24.0 ± 6.4 vs 14.6 ± 5.1 ng/mL, P < .05; see Table 22-1). HGS and SPPB in the intervention group were increased significantly as compared with the control group at 12 months (P < .05). But there was no statistical difference in the skeletal muscle mass (P > .05) between the 2 groups (see Table 22-1). After the intervention, EQ-5D and EQVAS were significantly higher in the intervention group than in the control group (P < .05), but IL-6 and IL-10 were not statistically different between 2 groups before and after the intervention. BMI, weight, and waist circumference did not change in both groups before and after the intervention (P > .05; see Table 22-2). In the multivariable linear regression models, adjusted for sex, age, protein intake, and regular exercise, VD supplements were significantly associated with HGS and SPPB (P < .05).

CONCLUSIONS: Vitamin D supplements were observed to increase serum 25(OH)D levels in the elderly (serum vitamin levels <20 ng/mL). Muscle strength, muscle function, and quality of life were also raised by vitamin D supplementation.

FINANCIAL SUPPORT: Chinese Nutrition Society-Dutch State Mining (CNS2013-034) Specialized Research Fund and Groupe Danone SA Nutritional Research and Education Fund (DIC2012-07).