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Article(id=1324077883546805027, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509341, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1758643200000, receivedDateStr=2025-09-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614367614, onlineDateStr=2026-11-02, pubDate=1773072000000, pubDateStr=2026-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614367614, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614367614, creator=13701087609, updateTime=1793614367614, updator=13701087609, issue=Issue{id=1324077716676424398, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='1773072000000', pubDateStr='2026-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614327830, creator='13701087609', updateTime=1793614418028, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078095132655884, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078095132655885, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=840, endPage=847, ext={EN=ArticleExt(id=1324077883760714532, articleId=1324077883546805027, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Trends in vitamin D nutritional status among primary and secondary school students in Guizhou Province, 2012—2023, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the trends and influencing factors of vitamin D nutritional status among primary and secondary school students in Guizhou Province from 2012 to 2023, providing scientific basis for formulating nutritional improvement measures.

Methods

A multi-stage cluster sampling method was adopted to select one primary and one secondary school from each of the survey sites implementing the “Nutrition Improvement Program for Rural Compulsory Education Students” in Guizhou Province. A total of 9 830 students were surveyed with questionnaires and had their blood samples tested.The prevalence rates of each year were standardized using the population age structure of 2023. The Mann-Whitney U test was used to compare the differences in vitamin D levels between different genders, and the Kruskal-Wallis H test was used to compare the differences among different age groups. The Bonferroni method was used to correct the significance level for two-group comparisons. The Spearman rank correlation analysis was used to test the trend of vitamin D levels over the years. The quantile regression model was used to examine whether there were differences in the trend of vitamin D levels among different subgroups.

Results

Vitamin D levels among primary and secondary school students in Guizhou Province fluctuated between 2012 and 2023, but showed an overall upward trend (rs=0.048, P<0.001), rising from 21.1 ng/ml in 2012 to 22.6 ng/ml in 2023.The vitamin D levels of males were consistently higher than those of females (P<0.05). With increasing age, vitamin D levels showed a downward trend(P<0.05). Except for 2015, the serum 25(OH)D concentrations of the 12-14 and 15-17 age groups were lower than those of the 6-8 age group. The prevalence of vitamin D deficiency (VDD) and vitamin D inadequacy (VDI) was consistently higher in females than in males. The prevalence of VDD and VDI in each age group fluctuated, and in 2023, the prevalence of VDD and VDI in each age group was lower than in 2012. The quantile regression model results indicated that the rate of improvement in vitamin D levels over time was significantly slower in males than in females (β=-0.118, P=0.016). The average annual improvement rate in vitamin D levels was significantly higher in the 6-8 age group than in the 15-17 age group(β=0.261, P<0.001).

Conclusion

The prevalence of VDD and VDI among primary and secondary school students in Guizhou Province remains at a relatively high level. Specifically, targeted nutritional intervention strategies should be developed for females and older males to improve their vitamin D nutritional status.

, authors=Yan SUN, Hua GUO, Hong-bo LI, Sheng-nan WU, Yi-ya LIU, authorsList=Yan SUN, Hua GUO, Hong-bo LI, Sheng-nan WU, Yi-ya LIU, authorCompany=null, correspAuthors=Yi-ya LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077884993839919, articleId=1324077883546805027, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=2012—2023年贵州省中小学生维生素D营养状况变化趋势分析, columnId=1228016570031604578, journalTitle=现代预防医学, columnName=儿少卫生与妇幼保健, runingTitle=null, highlight=null, articleAbstract=
目的

探讨贵州省中小学生2012—2023年维生素D营养状况的变化趋势及影响因素分析，为制定营养改善措施提供科学依据。

方法

采用多阶段整群抽样的方法，在贵州省实施“农村义务教育学生营养改善计划”的调查点抽取小学初中各1所，共9 830名学生进行问卷调查和血液样本测定，采用2023年的人口年龄结构对每年的患病率进行标准化，采用Mann-Whitney U检验比较不同性别间维生素D水平的差异，采用Kruskal-Wallis H检验比较不同年龄组间的差异，两组比较采用Bonferroni法校正检验水平。采用Spearman秩相关分析检验维生素D水平随年份的变化趋势。采用分位数回归模型检验维生素D水平变化趋势在不同亚组间是否存在差异。

结果

贵州省中小学生维生素D水平在2012—2023年虽存在波动，但整体呈现上升趋势（rs=0.048, P<0.001），从2012年的21.1 ng/ml上升至2023年的22.6 ng/ml。男性的维生素D水平一直高于女性（P<0.05）。随着年龄的增长，维生素D水平呈下降趋势（P<0.05）。除2015年外，12～14 岁和15～17岁年龄组的血清25(OH)D浓度均低于6～8岁年龄组。女性维生素D缺乏（vitamin D deficiency,VDD）和维生素D不足（vitamin D inadequacy,VDI）始终高于男性，各年龄组的VDD和VDI患病率均有波动，2023年各年龄组VDD和VDI患病率均低于2012年。分位数回归模型结果显示，男性维生素D水平随时间的改善速率显著慢于女性（β=-0.118, P=0.016），6～8岁年龄组儿童维生素D水平的年均改善速度显著高于15～17岁年龄组（β= 0.261,P<0.001）。

结论

贵州省中小学生VDI和VDD的患病率仍处于较高水平，尤其针对女性和高年龄组男性需制定相应营养干预策略来改善维生素D营养状况。

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孙燕（1997—），女，硕士，主管医师，研究方向：人群营养与健康

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刘怡娅，E-mail:
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注：A为男性2012—2023年贵州省中小学生VDD和VDI患病率；B为女性2012—2023年贵州省中小学生VDD和VDI患病率；C为6～8 岁年龄组2012—2023年贵州省中小学生VDD和VDI患病率；D为9～11 岁年龄组2012—2023年贵州省中小学生VDD和VDI患病率；E为12～14 岁年龄组2012—2023年贵州省中小学生VDD和VDI患病率；F为15～17 岁年龄组2012—2023年贵州省中小学生VDD和VDI患病率。

, figureFileSmall=Frfspe2aCGDpbuLnPAYktg==, figureFileBig=Ge+hkoiHUHr6R65fDvtkYg==, tableContent=null), ArticleFig(id=1324077889280418648, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077883546805027, language=EN, label=Table 1, caption=

Gender and age distribution of primary and secondary school students in Guizhou Province, 2012—2023 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量2012年2013年2014年2015年2016年2017年2019年2021年2023年
性别
男性267 (49.4)180 (47.7)271 (50.2)90 (50.0)356 (49.9)323 (45.0)159 (44.2)1 571 (49.2)1 641 (51.2)
女性273 (50.6)197 (52.3)269 (49.8)90 (50.0)357 (50.1)394 (55.0)201 (55.8)1 625 (50.8)1 566 (48.8)
年龄组（岁）
6～8145 (26.9)123 (32.6)133 (24.6)44 (24.4)207 (29.0)163 (22.7)99 (27.5)704 (22.0)707 (22.1)
9～11204 (37.8)148 (39.3)170 (31.5)55 (30.6)210 (29.5)256 (35.7)120 (33.4)1 066 (33.4)1 093 (34.1)
12～14126 (23.3)62 (16.4)156 (28.9)51 (28.3)208 (29.2)209 (29.2)102 (28.3)1 048 (32.8)1 088 (33.9)
15～1765 (12.0)44 (11.7)81 (15.0)30 (16.7)88 (12.3)89 (12.4)39 (10.8)378 (11.8)319 (9.9)
总计5403775401807137173603 1963 207
), ArticleFig(id=1324077889360110425, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077883546805027, language=CN, label=表1, caption=

2012—2023年贵州省中小学生性别与年龄分布情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量2012年2013年2014年2015年2016年2017年2019年2021年2023年
性别
男性267 (49.4)180 (47.7)271 (50.2)90 (50.0)356 (49.9)323 (45.0)159 (44.2)1 571 (49.2)1 641 (51.2)
女性273 (50.6)197 (52.3)269 (49.8)90 (50.0)357 (50.1)394 (55.0)201 (55.8)1 625 (50.8)1 566 (48.8)
年龄组（岁）
6～8145 (26.9)123 (32.6)133 (24.6)44 (24.4)207 (29.0)163 (22.7)99 (27.5)704 (22.0)707 (22.1)
9～11204 (37.8)148 (39.3)170 (31.5)55 (30.6)210 (29.5)256 (35.7)120 (33.4)1 066 (33.4)1 093 (34.1)
12～14126 (23.3)62 (16.4)156 (28.9)51 (28.3)208 (29.2)209 (29.2)102 (28.3)1 048 (32.8)1 088 (33.9)
15～1765 (12.0)44 (11.7)81 (15.0)30 (16.7)88 (12.3)89 (12.4)39 (10.8)378 (11.8)319 (9.9)
总计5403775401807137173603 1963 207
), ArticleFig(id=1324077889452385114, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077883546805027, language=EN, label=Table 2, caption=

Distribution of serum 25(OH)D concentrations among primary and secondary school students in Guizhou Province, 2012—2023［ng/ml, M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量2012年2013年2014年2015年2016年2017年2019年2021年2023年H/Z值P值
总计21.1(17.8, 25.0)19.9(16.2, 24.1)22.9(19.6, 26.5)22.6(18.7, 26.4)21.4(17.0, 26.3)22.4(18.2, 26.5)25.3(21.1, 29.6)19.1(14.8, 23.9)22.6(18.2, 27.5)641.730<0.001
性别17.733<0.001
男性22.9(19.0, 26.9)22.8(18.9, 25.8)23.6(20.4, 27.3)24.7(20.4, 27.4)23.6(18.4, 27.9)23.8(20.2, 28.4)25.5(21.8, 30.0)20.1(15.8, 25.0)23.8(19.4, 28.5)
女性20.0(16.0, 23.0)17.9(15.0, 21.0)22.1(18.7, 26.0)20.6(17.0, 23.8)19.8(15.7, 23.7)20.5(17.0, 25.1)24.8(20.5, 29.3)18.3(13.9, 22.6)21.4(17.1, 26.0)
Z值6.3408.069-2.9814.0366.8496.5611.4868.384-9.258
P值<0.001<0.0010.003<0.001<0.001<0.0010.069<0.001<0.001
年龄组（岁）729.029<0.001
6～822.8(19.0, 26.0)22.5(18.3, 25.8)24.9(21.2, 28.0)23.8(19.8, 27.7)24.3(20.3, 28.2)23.3(20.9, 26.8)28.1(24.0, 31.6)22.1(17.3, 26.7)26.0(21.7, 30.4)
9～1122.0(18.9, 25.2)19.3(16.1, 24.2)*23.2(19.6, 27.4)22.2(16.8, 26.6)22.3(18.0, 27.3)*23.6(18.8, 28.4)26.0(21.7, 30.5)20.4(16.0, 24.8)*22.9(18.2, 27.6)*
12～1419.7(16.6, 23.4)*18.7(15.5, 22.6)*21.7(18.6, 25.4)*22.6(18.0, 25.6)18.7(14.8, 23.3)*20.2(16.7, 24.8)*22.5(18.4, 26.0)*17.2(13.0, 21.2)*20.8(16.5, 25.5)*
15～1719.0(15.0, 22.2)*17.1(13.6, 20.3)*21.6(19.8, 25.0)*21.3(18.7, 25.6)18.2(14.5, 22.6)*20.0(16.1, 25.3)*23.7(19.6, 27.4)*16.2(13.3, 19.8)*20.8(16.9, 24.9)*
H值35.08830.56816.8463.78989.79237.04337.486317.868264.736
P值<0.001<0.001<0.0010.285<0.001<0.001<0.001<0.001<0.001
), ArticleFig(id=1324077889565631323, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077883546805027, language=CN, label=表2, caption=

2012—2023 年贵州省中小学生血清 25(OH)D 浓度分布状况［ng/ml,M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量2012年2013年2014年2015年2016年2017年2019年2021年2023年H/Z值P值
总计21.1(17.8, 25.0)19.9(16.2, 24.1)22.9(19.6, 26.5)22.6(18.7, 26.4)21.4(17.0, 26.3)22.4(18.2, 26.5)25.3(21.1, 29.6)19.1(14.8, 23.9)22.6(18.2, 27.5)641.730<0.001
性别17.733<0.001
男性22.9(19.0, 26.9)22.8(18.9, 25.8)23.6(20.4, 27.3)24.7(20.4, 27.4)23.6(18.4, 27.9)23.8(20.2, 28.4)25.5(21.8, 30.0)20.1(15.8, 25.0)23.8(19.4, 28.5)
女性20.0(16.0, 23.0)17.9(15.0, 21.0)22.1(18.7, 26.0)20.6(17.0, 23.8)19.8(15.7, 23.7)20.5(17.0, 25.1)24.8(20.5, 29.3)18.3(13.9, 22.6)21.4(17.1, 26.0)
Z值6.3408.069-2.9814.0366.8496.5611.4868.384-9.258
P值<0.001<0.0010.003<0.001<0.001<0.0010.069<0.001<0.001
年龄组（岁）729.029<0.001
6～822.8(19.0, 26.0)22.5(18.3, 25.8)24.9(21.2, 28.0)23.8(19.8, 27.7)24.3(20.3, 28.2)23.3(20.9, 26.8)28.1(24.0, 31.6)22.1(17.3, 26.7)26.0(21.7, 30.4)
9～1122.0(18.9, 25.2)19.3(16.1, 24.2)*23.2(19.6, 27.4)22.2(16.8, 26.6)22.3(18.0, 27.3)*23.6(18.8, 28.4)26.0(21.7, 30.5)20.4(16.0, 24.8)*22.9(18.2, 27.6)*
12～1419.7(16.6, 23.4)*18.7(15.5, 22.6)*21.7(18.6, 25.4)*22.6(18.0, 25.6)18.7(14.8, 23.3)*20.2(16.7, 24.8)*22.5(18.4, 26.0)*17.2(13.0, 21.2)*20.8(16.5, 25.5)*
15～1719.0(15.0, 22.2)*17.1(13.6, 20.3)*21.6(19.8, 25.0)*21.3(18.7, 25.6)18.2(14.5, 22.6)*20.0(16.1, 25.3)*23.7(19.6, 27.4)*16.2(13.3, 19.8)*20.8(16.9, 24.9)*
H值35.08830.56816.8463.78989.79237.04337.486317.868264.736
P值<0.001<0.001<0.0010.285<0.001<0.001<0.001<0.001<0.001
), ArticleFig(id=1324077889653711708, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077883546805027, language=EN, label=Table 3, caption=

Quantile regression analysis of the median changes in serum 25(OH)D levels by gender (Quantile=0.5)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 β（95%CI）P值
截距0.21719.870（19.445～20.295）<0.001
时间0.0280.036（-0.019～0.090）0.201
性别 （参考组: 女性)
男性0.3623.394（2.685～4.104）<0.001
交互项
时间×男性0.041-0.118（-0.198～-0.037）0.004
), ArticleFig(id=1324077891293684573, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077883546805027, language=CN, label=表3, caption=

不同性别血清25(OH)D水平中位数变化趋势的分位数回归分析（Quantile=0.5）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 β（95%CI）P值
截距0.21719.870（19.445～20.295）<0.001
时间0.0280.036（-0.019～0.090）0.201
性别 （参考组: 女性)
男性0.3623.394（2.685～4.104）<0.001
交互项
时间×男性0.041-0.118（-0.198～-0.037）0.004
), ArticleFig(id=1324077891369182046, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077883546805027, language=EN, label=Table 4, caption=

Quantile regression analysis of the median changes in serum 25(OH)D levels by age group (Quantile=0.5)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 β（95%CI）P值
截距0.56819.671（18.557～20.786）<0.001
时间（每增加1年）0.072-0.086（-0.227～0.056）0.235
年龄组（参考组: 第四组）
第一组0.6253.154（1.929～4.378）<0.001
第二组0.6282.351（1.120～3.582）<0.001
第三组0.6540.030（-1.253～1.313）0.964
交互项
时间×第一组0.0810.261（0.102～0.419）0.001
时间×第二组0.0790.084（-0.072～0.239）0.292
时间×第三组0.0810.052（-0.107～0.211）0.521
), ArticleFig(id=1324077891453068127, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077883546805027, language=CN, label=表4, caption=

不同年龄组血清25(OH)D水平中位数变化趋势的分位数回归分析（Quantile=0.5）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 β（95%CI）P值
截距0.56819.671（18.557～20.786）<0.001
时间（每增加1年）0.072-0.086（-0.227～0.056）0.235
年龄组（参考组: 第四组）
第一组0.6253.154（1.929～4.378）<0.001
第二组0.6282.351（1.120～3.582）<0.001
第三组0.6540.030（-1.253～1.313）0.964
交互项
时间×第一组0.0810.261（0.102～0.419）0.001
时间×第二组0.0790.084（-0.072～0.239）0.292
时间×第三组0.0810.052（-0.107～0.211）0.521
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2012—2023年贵州省中小学生维生素D营养状况变化趋势分析
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孙燕 , 郭华 , 李洪波 , 吴胜男 , 刘怡娅
现代预防医学 | 儿少卫生与妇幼保健 2026,53(5): 840-847
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现代预防医学 |儿少卫生与妇幼保健 2026 , 53 (5) : 840 -847
2012—2023年贵州省中小学生维生素D营养状况变化趋势分析
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孙燕, 郭华, 李洪波, 吴胜男, 刘怡娅
作者信息
  • 贵州省疾病预防控制中心，贵州 贵阳 550004
通讯作者:
刘怡娅，E-mail:
作者简介:

孙燕（1997—），女，硕士，主管医师，研究方向：人群营养与健康

Trends in vitamin D nutritional status among primary and secondary school students in Guizhou Province, 2012—2023
Yan SUN, Hua GUO, Hong-bo LI, Sheng-nan WU, Yi-ya LIU
Affiliations
  • Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, China
出版时间: 2026-03-10 doi: 10.20043/j.cnki.MPM.202509341
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摘要
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目的

探讨贵州省中小学生2012—2023年维生素D营养状况的变化趋势及影响因素分析，为制定营养改善措施提供科学依据。

方法

采用多阶段整群抽样的方法，在贵州省实施“农村义务教育学生营养改善计划”的调查点抽取小学初中各1所，共9 830名学生进行问卷调查和血液样本测定，采用2023年的人口年龄结构对每年的患病率进行标准化，采用Mann-Whitney U检验比较不同性别间维生素D水平的差异，采用Kruskal-Wallis H检验比较不同年龄组间的差异，两组比较采用Bonferroni法校正检验水平。采用Spearman秩相关分析检验维生素D水平随年份的变化趋势。采用分位数回归模型检验维生素D水平变化趋势在不同亚组间是否存在差异。

结果

贵州省中小学生维生素D水平在2012—2023年虽存在波动，但整体呈现上升趋势（rs=0.048, P<0.001），从2012年的21.1 ng/ml上升至2023年的22.6 ng/ml。男性的维生素D水平一直高于女性（P<0.05）。随着年龄的增长，维生素D水平呈下降趋势（P<0.05）。除2015年外，12～14 岁和15～17岁年龄组的血清25(OH)D浓度均低于6～8岁年龄组。女性维生素D缺乏（vitamin D deficiency,VDD）和维生素D不足（vitamin D inadequacy,VDI）始终高于男性，各年龄组的VDD和VDI患病率均有波动，2023年各年龄组VDD和VDI患病率均低于2012年。分位数回归模型结果显示，男性维生素D水平随时间的改善速率显著慢于女性（β=-0.118, P=0.016），6～8岁年龄组儿童维生素D水平的年均改善速度显著高于15～17岁年龄组（β= 0.261,P<0.001）。

结论

贵州省中小学生VDI和VDD的患病率仍处于较高水平，尤其针对女性和高年龄组男性需制定相应营养干预策略来改善维生素D营养状况。

维生素D  /  学生  /  变迁
Objective

To investigate the trends and influencing factors of vitamin D nutritional status among primary and secondary school students in Guizhou Province from 2012 to 2023, providing scientific basis for formulating nutritional improvement measures.

Methods

A multi-stage cluster sampling method was adopted to select one primary and one secondary school from each of the survey sites implementing the “Nutrition Improvement Program for Rural Compulsory Education Students” in Guizhou Province. A total of 9 830 students were surveyed with questionnaires and had their blood samples tested.The prevalence rates of each year were standardized using the population age structure of 2023. The Mann-Whitney U test was used to compare the differences in vitamin D levels between different genders, and the Kruskal-Wallis H test was used to compare the differences among different age groups. The Bonferroni method was used to correct the significance level for two-group comparisons. The Spearman rank correlation analysis was used to test the trend of vitamin D levels over the years. The quantile regression model was used to examine whether there were differences in the trend of vitamin D levels among different subgroups.

Results

Vitamin D levels among primary and secondary school students in Guizhou Province fluctuated between 2012 and 2023, but showed an overall upward trend (rs=0.048, P<0.001), rising from 21.1 ng/ml in 2012 to 22.6 ng/ml in 2023.The vitamin D levels of males were consistently higher than those of females (P<0.05). With increasing age, vitamin D levels showed a downward trend(P<0.05). Except for 2015, the serum 25(OH)D concentrations of the 12-14 and 15-17 age groups were lower than those of the 6-8 age group. The prevalence of vitamin D deficiency (VDD) and vitamin D inadequacy (VDI) was consistently higher in females than in males. The prevalence of VDD and VDI in each age group fluctuated, and in 2023, the prevalence of VDD and VDI in each age group was lower than in 2012. The quantile regression model results indicated that the rate of improvement in vitamin D levels over time was significantly slower in males than in females (β=-0.118, P=0.016). The average annual improvement rate in vitamin D levels was significantly higher in the 6-8 age group than in the 15-17 age group(β=0.261, P<0.001).

Conclusion

The prevalence of VDD and VDI among primary and secondary school students in Guizhou Province remains at a relatively high level. Specifically, targeted nutritional intervention strategies should be developed for females and older males to improve their vitamin D nutritional status.

Vitamin D  /  Students  /  Trends
孙燕, 郭华, 李洪波, 吴胜男, 刘怡娅. 2012—2023年贵州省中小学生维生素D营养状况变化趋势分析. 现代预防医学, 2026 , 53 (5) : 840 -847 . DOI: 10.20043/j.cnki.MPM.202509341
Yan SUN, Hua GUO, Hong-bo LI, Sheng-nan WU, Yi-ya LIU. Trends in vitamin D nutritional status among primary and secondary school students in Guizhou Province, 2012—2023[J]. Modern Preventive Medicine, 2026 , 53 (5) : 840 -847 . DOI: 10.20043/j.cnki.MPM.202509341
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维生素D作为人体必需的关键营养素，其核心作用在于促进小肠对钙和磷的吸收，维持体内钙磷平衡，并调控骨代谢及骨组织形成。同时，它也参与调节皮肤细胞的增殖与分化，并对免疫功能具有调节作用[1]。全球约有10亿人缺乏维生素D，其中儿童和青少年是高危人群。2010—2012年开展的中国国民营养与健康调查的结果显示，中小学生群体中维生素D缺乏的患病率为53.2%[2]。儿童时期缺乏维生素D不仅会影响此阶段的生长发育，还会对成年后的健康产生深远影响[3]。具体而言，在儿童期，维生素D缺乏可导致钙磷代谢紊乱，引起佝偻病、生长迟滞和骨骼肌无力，并可能通过影响免疫细胞功能增加感染风险[4]，并与儿童焦虑和抑郁症状的加重存在关联[5]；进入成年后，幼年缺乏维生素D可能影响峰值骨量的达成，增加骨质疏松和骨折的发生风险，其影响机制更超出骨骼代谢范畴。研究表明，维生素D缺乏能负性调节肾素-血管紧张素系统[6]，这可能与高血压及心血管疾病的发生发展有关[7]。同时，维生素D/维生素D受体轴在调节脂肪组织稳态、炎症反应及胰岛素敏感性中也扮演重要角色[8]，这与代谢综合征以及自身免疫性疾病的风险增加密切相关。因此，在儿童及青少年阶段改善维生素D营养状况，不仅能够直接降低佝偻病等当前疾病负担，提升生活质量，对于预防远期骨质疏松、骨折及多种慢性病、提升未来人口健康素质具有重要意义[5]。相关研究表明，维生素D水平与性别、年龄和季节等因素有关[9]。我国于2011年实施农村义务教育学生营养改善计划（简称“营养改善计划”），旨在改善农村学生的营养状况。该计划在贵州省推行以来，学生营养状况已取得明显改善。研究显示，2023年贵州中小学生维生素D不足和缺乏的合计率为37.51%[10]。为深入探究 “营养改善计划” 对贵州省农村义务教育阶段学生营养状况的改善作用，本研究对2012—2023年贵州省参与该计划学生的维生素D水平展开分析，旨在为中小学生营养改善措施的制定提供科学支撑。
1　对象与方法
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1.1　对象
2012—2019年，贵州省的监测点为3个县，即册亨县、德江县和普定县。2021年，监测点扩大到9个即册亨县、德江县、福泉县、金沙县、湄潭县、普定县、三穗县、水城区和云岩区。2012—2023年均采用多阶段整群抽样，在每个监测点随机抽取一所小学和一所初中，每个年级随机抽取一个班级，每班40人，男女各半，每个监测点共抽取了360名学生，由于数据缺失，本研究的样本数量每年都有所不同。剔除性别、年龄等关键信息确实样本后，2012—2023年共纳入9 830名学生，其中2012年540人、2013年377人、2014年540人、2015年180人、2016年713人、2017年717人、2019年360人、2021年3 196人、2023年3 207人。本研究经中国疾病预防控制中心营养健康所伦理委员会批准（批件号：2021-018）, 均告知家长和学生研究内容和方案, 并签署了知情同意书。
1.2　方法
1.2.1　问卷调查
使用中国疾病预防控制中心营养与健康所自主研制的“农村义务教育学生营养改善计划营养健康状况监测学生调查表”收集包括年龄、性别等信息[11]。所有现场调查员均接受了统一培训，培训考核合格后参与正式调查，问卷初稿经由多学科专家（包括营养学、流行病学、统计学专家）研讨会审议，确保了问卷的专业性和内容效度。该调查表已被广泛应用于全国性的学生营养健康监测工作[12-13]。其稳定性和有效性在实践中得到了反复验证。
1.2.2　血液样本测定
在空腹条件下，采集5 ml静脉血样，于室温环境，离心半径 9 cm，3 000 r/min离心10 min，分离出的血清需避光保存，随后通过冷链方式运送至各县中心实验室。血清中维生素D含量由北京和合医疗诊断技术有限公司采用液相色谱 - 串联质谱法（LC-MS/MS）进行检测。参照《人群维生素D缺乏筛查方法（WS/T 677-2020）》标准[14]，血清 25（OH）D 水平<12 ng/ml 界定为维生素D缺乏（vitamin D deficiency,VDD），≥12～<20 ng/ml 界定为维生素D不足（vitamin D inadequacy,VDI），≥20 ng/ml 则为维生素D充足。
1.3　统计学处理
采用SAS 9.4软件进行统计分析。由于血清25（OH）D浓度不符合正态分布，血清25（OH）D浓度以以［M（P25，P75）］报告。采用Mann-Whitney U检验比较不同性别间维生素D水平的差异，采用Kruskal-Wallis H检验比较不同年龄组间的差异，年龄组的划分与我国义务教育阶段的学制以及《中国居民膳食营养素参考摄入量》中儿童青少年的阶段划分原则一致，两组间比较采用Bonferroni法校正检验水平。采用Spearman秩相关评估血清25(OH)D浓度与调查年份之间的相关性。采用分位数回归模型，以维生素D水平中位数为因变量。为便于解释，将调查年份转换为时间变量（Time，定义：2012年=0，此后每年增加1）。引入时间、性别（或年龄组）及它们的交互项作为自变量，检验“时间×性别”和“时间×年龄组”交互作用的统计学意义，以判断趋势在不同亚组间是否存在差异。检验水准α=0.05，双侧检验。
2　结果
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2.1　调查对象基本情况
2012—2023年分别调查540、377、540、180、713、717、360、3 196 和 3 207人。不同年龄组中，15～17岁年龄组人数最少。见表1。
2.2　2012—2023维生素D营养状况
贵州省中小学生维生素D中位数水平从2012年的21.1 ng/ml增至2023年的22.6 ng/ml，2021年维生素D水平最低，为19.1 ng/ml。与2012年相比，2023年男性与女性的维生素D中位数水平均升高，且男性的维生素D水平一直高于女性（P<0.05）。与2012年相比，2023年四个年龄段学生的维生素D中位数水平均升高，且随着年龄的增长，维生素D水平呈下降趋势（P<0.05）。除2015年外，12～14岁和15～17岁年龄组的血清 25(OH)D 浓度均低于6～8岁年龄组。见表2。
Spearman秩相关分析结果显示，维生素D水平与年份之间存在显著的正相关关系（rs=0.048, P<0.001），表明在研究期间，维生素D水平呈现上升趋势，见图1。维生素D不足率在2013年最高，为46.2%，随后有所下降，2023年降至32.2%。维生素D缺乏率在2021年最高，为11.4%，在2019年最低，为1.1%。见图2。
2.3　敏感性分析
为检验主要研究发现的稳健性，本研究进行了敏感性分析。首先，考虑到研究周期内调查范围的变化（2019年后新增调查县），我们调整了分析样本，仅对自2012年起即被持续调查的三个县的数据（2012—2019年）重新进行趋势分析。Spearman秩相关分析结果显示，在此子样本中，维生素D水平与年份之间依然存在显著的正相关关系（rs=0.135, P<0.001）。这一结果与基于全样本（2012—2023年）的分析结论（rs=0.048, P<0.001）在变化方向上完全一致，主要结论具有稳健性。
2.4　2012—2023VDD和VDI患病率
图3描述了2012—2023年按性别和年龄组别划分的6～17岁儿童和青少年VDD和VDI的患病率。2012年到2023年,女性各年的VDI和VDD患病率一直高于男性。
在6～8岁年龄组中，VDD的流行率从2012年的0.3%上升到2021年的3.0%，然后下降到2023年的0.5%，而VDI的流行率则从2012年的6.7%上升到2021年的7.0%，然后下降到2023年的3.4%。在9～11岁年龄组中，VDD的流行率从2012年的0.2%上升到2021年的1.1%，然后下降到2023年的0，而VDI的流行率则从2012年的6.7%上升到2021年的7.0%，然后下降到2023年的3.4%。在12～14岁年龄组中，VDD的流行率从2012年的0.9%上升到2021年的1.6%，然后下降到2023年的0.4%，而VDI的流行率则从2012年的5.4%上升到2021年的6.0%，然后下降到2023年的3.9%。在15～17岁年龄组中，VDD患病率从2012年的0.9%增至2021年的1.6%，2023年降至0.4%，VDI患病率从2012年的5.4%增至2021年的6.0%，2023年降至3.9%。
2.5　维生素D水平变迁趋势的性别与年龄差异
采用分位数回归模型（quantile = 0.5）分析维生素D水平中位数的变迁趋势，模型结果显示，时间与性别的交互项具有统计学意义（β=-0.118, P=0.004），表明不同性别的维生素D水平随时间的变化趋势不同。具体而言，男性维生素D水平随时间推移的年均变化幅度低于女性。此外，性别主效应显著（β=3.394, P<0.001），这表示在基线时期（2012年），男性的维生素D水平中位数即显著高于女性。见表3。
表4结果显示，时间与年龄组的交互项在6～8岁组（第一组）中具有统计学意义（β=0.261, P=0.001），表明该低年龄组维生素D水平随时间的年均变化幅度与参照组（15～17岁）存在差异。具体而言，6～8岁组维生素D水平随时间的年均上升幅度高于15～17岁组。对于9～11岁组（β=0.084, P=0.292）和12～14岁组（β=0.052, P=0.521），其与时间的交互作用均未显示出统计学意义。
3　讨论
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本调查分析了2012—2023年贵州省6～17岁儿童和青少年的维生素D营养状况。结果显示，贵州省中小学生维生素D水平在2012—2023年虽存在波动，但整体呈现上升趋势。VDD患病率从2.8%降至2.1%，VDI患病率从39.9%降至32.2%。2018—2021年西南地区的一项调查表明，该地区中小学生的维生素D缺乏率(19.2%)和不足率(37.2%)均超出本研究的发现[15]。在2021年中小学生维生素D水平降到最低（19.1 ng/ml），同年VDI患病率达到最高（11.4%），VDD患病率达到第二高峰（43.4%）。这可能与COVID-19全球大流行及相关的封锁隔离措施导致的户外活动骤减有关[16]。
研究表明，儿童和青少年的维生素D营养状况与日照、饮食、户外运动和当地经济水平有关[17]。本研究中VDD和VDI患病率较高，这一结果与贵州省独特的地理环境、经济发展水平和膳食结构密切相关。首先，贵州省位于我国西南部，属于亚热带湿润季风气候，云量较多、日照时间相对较短，这直接影响了皮肤通过紫外线照射合成内源性维生素D的效率[18]。一项涵盖西南地区128 960名儿童青少年的大规模研究进一步证实，该地区维生素D水平存在显著地域差异，其中贵州省儿童的维生素D水平在西南各省中最低，缺乏率最高（25.9%）[19]，这为地理气候因素的影响提供了直接证据。其次，贵州省经济发展水平相对滞后，居民家庭年收入普遍偏低[20]。经济条件的限制往往影响着膳食结构与营养质量，可能导致富含维生素D的动物性食物（如鱼类、蛋类、乳制品）摄入不足[21]。此外，当地的传统饮食模式以植物性食物为主，动物性食品消费频率较低[19]，而植物性食物中通常缺乏天然的维生素D，从而增加了维生素D缺乏的风险。然而，与北京市[22]、江苏省[23]相比，我省的 平均VDD 和 VDI 患病率处于较低水平。在本研究中，发现女性的维生素D水平低于男性，与其他研究结果一致[24-25]，这可能是青春期女性可能因审美观念更注重防晒，喜欢在阴凉处玩耍，在阳光下活动的时间较少，从而影响了皮肤中维生素D的合成，以及父母对女性防晒观念较强，女性自我保护意识较强，会定期涂抹防晒霜等原因导致内源性合成减少[26]。维生素D水平有随年龄增长而降低的趋势，一方面，这可能是由于我国维生素D补充的重点是婴幼儿，随着年龄的增长，家长对孩子维生素D的补充不够重视，以及学生的学习压力逐渐增大，户外活动时间减少，接触阳光的机会减少，体内维生素D的合成量随之减少所致[27]；另一方面，处于生长发育的第二个快速增长期的初中生，脂肪量的增加会结合维生素D代谢物，阻止被人体分解代谢，由此维生素D生物利用率会降低[28]，对维生素D的需求量会增高。
本研究基于中位数趋势模型结果显示，2012—2023年贵州省中小学生维生素D水平的改善并非一个均匀的过程，其变化速率在不同人口学特征群体间存在显著差异。一是，本研究揭示了维生素D水平变化趋势的性别异质性。结果显示，尽管在研究基线时期及整个观测期内，男性的维生素D水平中位数均高于女性，但其随时间推移的年均改善幅度却显著低于女性。原因可能是近年来女性健康意识的提升速度可能快于男性[29]，使其在防晒与补充之间更合理地寻求平衡[30]，以及虽然学校营养改善计划提供的奶制品等食物不分性别，但女生可能依从性更好[31]。二是，本研究还观察到维生素D改善趋势存在关键的年龄层差异。低年龄组（如6～8岁儿童）维生素D水平的年均改善速率显著高于高年龄组（15～17岁青少年）。可能是由于低年龄组儿童的生活与饮食更多由家长和学校统一安排，贵州省推行的“营养改善计划”（如学生营养餐）实施效果显著[32]；与之相反，高年龄组青少年面临巨大的学业压力，户外活动时间被严重挤占[14]，且自主选择食物的意愿更强，复杂的饮食习惯可能稀释了“营养改善计划”的干预效果[33-34]。除行为因素外，青春期青少年骨骼生长加速，对维生素D的生理需求量大增，这可能使其在相同摄入水平下更易呈现相对不足状态[19]。因此，高年龄组维生素D水平改善滞后，是户外活动减少、饮食复杂化等外因与青春期生理需求激增这一内因共同作用的结果。
本研究存在一些局限性。在设计层面，数据由多个横断面构成，限制了因果推断的强度，结果可能受到未充分控制的混杂因素干扰。在数据层面，部分信息通过问卷收集可能存在回忆偏倚，且不同年份的样本量不一致与调查间断可能对趋势评估的精确性产生一定影响。在推论层面，本研究主要针对贵州省特定学生群体，结论外推至其他人群时需谨慎。
综上所述，自2012年国家儿童营养改善计划实施以来，贵州省儿童的维生素D营养状况有了明显改善。但是VDD和VDI的患病率仍然相对较高，维生素D水平改善速度存在性别和年龄差异。因此，应根据本研究中中小学生维生素D水平偏低的原因，制定个性化、有针对性的干预措施，尤其是在女性和高年龄组男性中；加强食育文化建设，引导中小学生合理膳食；开展中小学生健康教育，号召中小学生尤其是女生多参加户外活动和体育锻炼；举办营养健康知识讲座，提高家长对孩子营养素缺乏和补充的认识。
基金
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  • 国家财政项目
  • 农村义务教育学生营养健康监测和膳食指导项目
  • 西南地区重点优势学科项目
  • 贵州省卫生健康委省级重点建设学科项目
文献
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参考文献 引证文献
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2026年第53卷第5期
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doi: 10.20043/j.cnki.MPM.202509341
  • 接收时间：2025-09-24
  • 首发时间：2026-11-02
  • 出版时间：2026-03-10
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  • 收稿日期：2025-09-24
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国家财政项目
农村义务教育学生营养健康监测和膳食指导项目
西南地区重点优势学科项目
贵州省卫生健康委省级重点建设学科项目
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    贵州省疾病预防控制中心，贵州 贵阳 550004

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刘怡娅，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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