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维生素AD怎么补，意见不同听谁的？

发布日期：2024-08-03 18:25:00编辑：网络收集

宝宝出生后，都知道要补充维生素D。在做儿保的时候，有些医生会建议补充维生素AD，有些医生又会建议维生素AD和D交替补充。而最近，2024版的《中国儿童维生素A、维生素D临床应用专家共识》甚至建议维生素AD需要补充至18岁，面对这么多的“建议”，宝妈到底听谁的？维生素AD究竟要不要补，怎么补？

维生素A与维生素D的作用

维生素A和维生素D是与儿童健康密切相关的两种脂溶性维生素。

维生素A

是一种脂溶性化合物，称为视黄酸。维生素A有两种主要形式：维生素A原类胡萝卜素(β-胡萝卜素等)和已形成的维生素A。维生素A原类胡萝卜素存在于植物中。这些物质可以不同的转化率被哺乳动物代谢转化为维生素A。已形成的维生素A(视黄醇、视黄醛、视黄酸和视黄酯)是维生素A最活跃的形式，它主要存在于动物性食物中。已形成的维生素A(视黄醇)的常见食物来源有肝、肾、蛋黄和黄油。维生素A原(β-胡萝卜素)主要存在于绿叶蔬菜、甘薯和胡萝卜中。缺乏维生素A会导致一些眼部疾病（眼干燥症、夜盲症、视网膜病变等）、骨生长不良、非特异性皮肤病变、损伤免疫系统。

维生素D

是一种脂溶性维生素。食物很少天然含有维生素D(多脂鱼除外)，因此皮肤合成（阳光照射）是这种维生素的主要天然来源。来自膳食或皮肤合成的维生素D不具有生物活性，需要由酶催化成有活性的代谢产物。维生素D在肝脏中被酶催化成25-羟基维生素D，这是维生素D在血液循环中的主要形式，然后在肾脏中被催化成1,25-二羟维生素D，这是维生素D的活性形式。维生素D缺乏会导致生长发育阶段儿童发生佝偻病，也可导致所有年龄段人群出现骨软化症。

因为光照和饮食常不能充分补充维生素D，所以WHO和大多数国家指南都建议刚出生的婴儿即可开始常规补充维生素D补充剂到18岁，部分成年人也需要常规补充维生素D。

  • 不超过12个月的婴儿：充足的维生素D摄入量估计为每日400IU(10μg)；
  • 1-18岁儿童和70岁及以下成人：600IU/d(15μg/d)；
  • 71岁及以上成人：800IU/d(20μg/d)
  • 妊娠期及哺乳期女性：600IU/d(15μg/d)。

为什么对维生素A的补充会有不同意见？

WHO和大多数国家均不推荐6月龄内儿童常规补维生素A，建议6月龄以上儿童从膳食里摄入维生素A。但是我国的专家共识建议，新生儿出生后即可开始常规同时补充维生素A和D，2021年的共识建议补充A至3岁，D至18岁；而2024年的新共识更是直接建议同时补充A和D至18岁。

于是很多人会问，为什么针对维生素A的补充，我国的建议会和WHO还有美国等国家的建议不一样，甚至有部分内容完全相反呢？应该听谁的呢？我们需要详细解读一下国内和国外的不同建议。

中国儿科学教材中推荐的维生素A营养状况的判定标准，即血清维生素A浓度<0.7 μmol/L为缺乏，0.70～1.05 μmol/L为边缘型缺乏，≥1.05 μmol/L为正常。

2021年的指南中指出：基于中国居民营养与健康状况监测(2010—2013)结果，我国3～5岁儿童维生素A缺乏率为1.5%,其中城市为0.8%,农村为2.1%,农村显著高于城市；男童和女童的维生素A缺乏率分别为1.9%(城乡分别为0.8%和3.0%)和1.0%(城乡分别为0.8%和1.2%)，男女童维生素A缺乏率差异无统计学意义。我国3～5岁儿童维生素A边缘缺乏率为27.8%,其中城市为21.4%,农村为34.7%。

到了2024年，数据变为：北京大学公共卫生学院2017年的系统性评价结果显示，我国0～12岁儿童中维生素A缺乏率为5.16%，边缘缺乏率为24.29%。其中，5岁以下儿童维生素A缺乏率为9.23%，边缘缺乏率为31.53%，高于2010—2013年中国居民营养与健康状况监测报告的结果(3～5岁儿童维生素A缺乏率为1.5%,边缘缺乏率为27.8%)。

为什么三年时间，我们经济发展越来越好，儿童却越来越缺乏维生素A了呢？共识里给出了这样的解释:

维生素A存在于动物肝脏和红黄色蔬菜中，植物中的维生素A以维生素A原-类胡萝卜素的形式存在，其转化率存在吸收有饱和现象，可见膳食维生素A的摄入明显不能满足儿童生长的需要。学龄前、学龄期及青春期儿童膳食维生素A摄入量仍较低。

而国际上认为在资源丰富的国家，维生素A缺乏很少见。在资源丰富的国家，大多数膳食均含有足量的视黄醇和类胡萝卜素。而过量摄入植物源性维生素A基本不可能引起中毒。相比之下，已形成的维生素A(如，动物肝脏)的吸收和储存非常高效，如果摄入过量则会发生中毒。

根据夜盲症发病率，可以看出缺乏地区主要在撒哈拉以南非洲和南美洲，即使在这些地区，国际上也不再推荐在流行地区居住的新生儿、1-5月龄婴儿或产后母亲常规补充维生素A。数项大型研究和系统评价显示，常规补充维生素A没有一致的健康益处（如降低死亡率）。也正是因为许多大型研究的结果不一致，新生儿是否应补充维生素A一直备受争议。

WHO和国外很多指南，都将血清维生素A浓度<0.7 μmol/L设定为缺乏维生素A的参考界限，没有边缘缺乏的说法，国际上也曾提出将1.05μmol/L作为替代的参考界限，但是经过流行病学的统计，发现升高参考界限，可能会增加假阳性率（血清维生素A浓度低但肝脏储备充足），增加营养良好人群的过度诊断。另外，同时使用2个不同的标准，会令人困惑。所以，国际上从来没有将0.70～1.05 μmol/L做为边缘型缺乏的诊断标准。

综上所述，有足够的理由相信，资源丰富的家庭，建议6月龄以上儿童从膳食里摄入维生素A即可，从食物中摄入维生素A已经足够了。

家长如果打不定主意补充AD还是补充D的，看性价比即可，大多数AD的价格比D更高些，如果已经买了不是很贵的AD，不用过于纠结，继续吃就可以了。
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