维生素D在青少年运动与甘油三酯关联中的中介效应: 前瞻性横断面研究

The Mediating Effect of Vitamin D on the Association Between Exercise and Triglyceride in Adolescents: A Prospective Cross-sectional Study

  • 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/m2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/m2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/m2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。

     

    Abstract:
    Objective To investigate the mediating role of vitamin D in the association between exerciseand 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. Spearman's 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. Spearman's 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/m2, 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/m2, 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/m2. 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.

     

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