摘要
目的探讨青少年群体中维生素D在运动与甘油三酯关联中的中介效应及其潜在分子机制。方法本研究为前瞻性横断面研究。采用便利抽样法,以2023年6月5日济宁市第七中学招募的2021级学生为研究对象。通过标准化问卷评估中等强度运动频率,化学发光法检测血清25-羟维生素D水平,全自动生化分析仪测定甘油三酯水平。采用Spearman秩相关分析法分析中等强度运动频率、甘油三酯和维生素D三者之间的相关性。采用Baron&Kenny因果分析法构建中介模型,同时校正年龄、性别、体质量指数(body mass index,BMI)、奶制品摄入、甜品摄入、快餐摄入等混杂因素,分析维生素D的中介效应,并根据BMI进行亚组分析。采用Bootstrap法和Sobel法双重验证中介效应的显著性。结果共入选符合纳入标准的青少年354名,其中女性142名(40.11%),男性212名(59.89%),中位年龄13.25(12.83,13.83)岁。Spearman秩相关分析法结果显示,中等强度运动频率与甘油三酯水平呈显著负相关(r=-0.21,P<0.001),维生素D与甘油三酯水平呈显著负相关(r=-0.30,P<0.001),中等强度运动频率与维生素D水平呈显著正相关(r=0.26,P<0.001)。中介模型显示,维生素D部分中介运动对甘油三酯的降低效应(52.22%,95%CI:-0.027~-0.009,P<0.001),校正混杂因素后效应仍显著(47.83%,95%CI:-0.019~-0.005,P<0.001)。亚组分析显示,在BMI<24 kg/m^(2)的青少年中,维生素D在中等强度运动频率和甘油三酯之间的中介效应占比为82.01%(95%CI:-0.022~-0.005,P=0.005),校正混杂因素后,中介效应占比为81.20%(95%CI:-0.022~-0.005,P=0.005),中介效应显著;在BMI≥24 kg/m^(2)的青少年中,未校正混杂因素时中介效应占比为3.38%(95%CI:-0.014~0.009,P=0.760),校正混杂因素后中介效应占比为7.51%(95%CI:-0.019~0.012,P=0.621),中介效应不显著。结论维生素D是青少年运动降低甘油三酯的重要中介因子,其中介效应独立于年龄、性别及饮食习惯,且在BMI<24 kg/m^(2)的青少年群体中尤为显著。其机制可能与维生素D调控脂代谢相关基因表达及抑制炎症通路有关,提示靶向维生素D信号通路或可作为青少年血脂代谢异常早期干预的分子策略。
Objective To investigate the mediating role of vitamin D in the association between exercise and triglyceride among adolescents,as well as its potential molecular mechanisms.Methods This prospective cross-sectional study utilized convenience sampling,enrolling 2021-grade students from Jining No.7 Middle School on June 5,2023.Moderate-intensity exercise frequency was assessed via standardized questionnaires,serum 25-hydroxyvitamin D levels were measured using chemiluminescence,and triglyceride levels were determined via fully automated biochemical analysis.Spearmans rank correlation analysis was employed to examine the relationships among moderate-intensity exercise,triglyceride,and vitamin D.A mediation model was constructed using the Baron&Kenny causal steps approach,adjusting for confounders including age,sex,body mass index(BMI),dairy intake,sweet food consumption,and fast-food intake.Subgroup analyses were performed based on BMI.The significance of the mediation effect was confirmed using both the Bootstrap and Sobel tests.Results A total of 354 adolescents meeting the inclusion criteria were enrolled,including 142 females(40.11%)and 212 males(59.89%),with a median age of 13.25(12.83,13.83)years.Spearmans analysis revealed a significant negative correlation between moderate-intensity exercise and triglyceride levels(r=-0.21,P<0.001),a significant negative correlation between vitamin D and triglyceride(r=-0.30,P<0.001),and a significant positive correlation between moderate-intensity exercise and vitamin D levels(r=0.26,P<0.001).The mediation model indicated that vitamin D partially mediated the triglyceride-lowering effect of exercise(52.22%,95%CI:-0.027 to-0.009,P<0.001),with the effect remaining significant after confounder adjustment(47.83%,95%CI:-0.019 to-0.005).Subgroup analysis showed that in adolescents with BMI<24 kg/m^(2),vitamin D accounted for 82.01% of the mediation effect between exercise and triglyceride(95%CI:-0.022 to-0.005,P=0.005),which remained significant after adjustment(81.20%,95%CI:-0.022 to-0.005,P=0.005).In contrast,among adolescents with BMI≥24 kg/m^(2),the mediation effect was nonsignificant before(3.38%,95%CI:-0.014 to 0.009,P=0.760)and after adjustment(7.51%,95%CI:-0.019 to 0.012,P=0.621).Conclusions Vitamin D serves as a key mediator in the triglyceride-lowering effect of exercise among adolescents,independent of age,sex,and dietary habits.This mediation effect is particularly pronounced in adolescents with BMI<24 kg/m^(2).The underlying mechanism may involve vitamin D-regulated lipid metabolism-related gene expression and suppression of inflammatory pathways,suggesting that targeting vitamin D signaling could be a potential molecular strategy for early intervention in adolescent dyslipidemia.
作者
黄箔钏
郭晓湲
汪雨彤
刘佳轩
潘慧
陈适
HUANG Bochuan;GUO Xiaoyuan;WANG Yutong;LIU Jiaxuan;PAN Hui;CHEN Shi(Department of Endocrinology,Key Laboratory of Endocrinology of National Health Commission,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《协和医学杂志》
北大核心
2025年第3期584-590,共7页
Medical Journal of Peking Union Medical College Hospital
基金
国家重点研发计划(2022YFC3600202)。
关键词
维生素D
运动
甘油三酯
中介效应
青少年
vitamin D
exercise
triglycerides
mediating effect
adolescent
