ビタミンDと幼児う蝕の関連性：系統的レビューとメタアナリシス

The Association Between Vitamin D and Early Childhood Caries: A Systematic Review and Meta-Analysis.

抄録

目的:

これまでの調査で、ビタミンD欠乏症の小児は幼児う蝕（ECC）に罹患する可能性が高いことが報告されている。この系統的レビューとメタアナリシスの目的は、1.ビタミンDの状態がECCの発生と本質的に関連しているかどうか、2.ECC予防のためのビタミンDの至適レベルを明らかにすることである。

PURPOSE: Previous surveys have reported that children with vitamin D deficiency were likely to suffer from early childhood caries (ECC). The aim of this systematic review and meta-analysis was to determine 1. whether the status of vitamin D is intrinsically related to the occurrence of ECC and 2. the optimal level of vitamin D for the prevention of ECC.

材料と方法:

PubMed、Web of Science、Cochrane、Embase、Google scholarのデータベースから対象文献を検索した。適格基準は、ECCの小児とそうでない小児のビタミンD状態を比較した観察研究とした。Newcastle-Ottawaツールを適用し、研究の選択、データ抽出、バイアスリスク評価を2人のレビュアーが独立して行った。メタ解析はCochrane CollaborationのReview Manager 5.4ソフトウェアを用いて行った。

MATERIALS AND METHODS: The database of PubMed, Web of Science, Cochrane, Embase and Google scholar were searched for targeted literature. The eligibility criteria were observational studies in which children with ECC were compared to children without ECC in terms of their vitamin D status. Applying the Newcastle-Ottawa tool, study selection, data extraction, and risk of bias assessment were performed by 2 reviewers independently. Meta-analysis was performed using the Cochrane Collaboration's Review Manager 5.4 software.

結果:

501の論文が電子データベースから検索され、最終的に11の研究がシステマティックレビューに含まれ、そのうち10の研究がメタ解析に供された。ECC群の25(OH)D値は、う蝕のない群と比較して統計学的に有意に低く（WMD = -13.96、95% CI: [-19.88,-8.03]、p < 0.001）、特にS-ECCとビタミンDとの関連については有意であった（WMD = -18.64、95% CI: [-20.06,-17.22]、p < 0.001）。地域別のサブグループ解析では、25(OH)Dレベルが50～75nmol/lの小児は、75nmol/lを超える小児よりもECCを発症する可能性が高いことが示された（OR = 1.42, 95% CI: [1.26,1.60], p < 0.001）：ビタミンD濃度は、う蝕のない小児よりもECCの小児で低く、S-ECCとビタミンDの相関はさらに強かった。ECCの発生および発症を予防するための至適25(OH)Dレベルは75nmol/l以上であった。従って、臨床医は初期う蝕の発症を全身的な観点からも捉えるべきである。

RESULTS: 501 articles were retrieved from the electronic databases; 11 studies were finally included in systematic review, 10 studies of which were submitted to meta-analysis. The 25(OH)D levels in the ECC group were statistically significantly lower compared with that in the caries-free group (WMD = -13.96, 95% CI: [-19.88,-8.03], p < 0.001), especially in regard to the association between S-ECC and vitamin D (WMD = -18.64, 95% CI: [-20.06,-17.22], p < 0.001). The subgroup analyses in terms of geographical region demonstrated that children with a level of 25(OH)D of 50-75 nmol/l were more likely to have ECC than those with over 75 nmol/l (OR = 1.42, 95% CI: [1.26,1.60], p < 0.001), with data from Asia and Europe combined for analysis Conclusions: The level of vitamin D was lower in children with ECC than in caries-free children, and the correlation between S-ECC and vitamin D was even stronger. The optimal 25(OH)D level for preventing occurrence and development of ECC was ≥ 75 nmol/l. Thus, clinicians should view the development of early caries also from a systemic perspective.