| Objectives:To investigate the potential association between the nutritional status of vitamin A(VA)and vitamin D(VD)and the symptoms of chronic tic disorders(CTD)and Tourette syndrome(TS)and their comorbidity such as attention deficit hyperactivity disorder(ADHD),and then provide the theoretical evidence for nutritional intervention for children with tic disorder(TD).Methods:1.A total of 176 children with CTD and TS diagnosed according to DSM-5 in the Department of Developmental and Behavioral Pediatrics of the First Hospital of Jilin University from May 2017 to June 2020 were selected as the TD group,and 154 healthy children in the outpatient department during the same period were selected as the control group.2.Guardians of children in the TD group and the control group filled in the demographic questionnaire.In the TD group,the Yale Global Tic Severity Scale(YGTSS)was used to evaluate the tic severity of TD,and the teacher and parent versions of SNAP-IV scale were used to evaluate the co-occurrence of ADHD.The serum levels of VA and 25(OH)D were measured by high performance liquid chromatography and tandem mass spectrometer(HPLC MS/MS).3.Quantitative data conforming to a normal distribution were described as (?)±s and were statistically analyzed by ANOVA.The non-normal distribution quantitative data were expressed as P50(P25,P75),and the non-parametric Mann Whitney U test was used for statistical analysis.The count data were expressed as n(%).The chi-square test or Fisher’s exact test was used for categorical variables.Spearman correlation coefficient was used to evaluate the correlation between the total score and subscale scores of YGTSS and serum VA and 25(OH)D levels.Multivariate Logistic regression analysis was used to analyze the risk factors of TD and its comorbidity with ADHD.All data were analyzed by SPSS 25.0 statistical software.Results:1.Compared with the control group,the TD group had significantly higher serum levels of VA(1.09(1.02,1.23)μmol/L vs 1.23(1.05,1.40)μmol/L,Z=-4.13,P<0.001)and 25(OH)D(21.70(16.6,2.27.93)ng/m L vs 24.05(19.30,28.83)ng/m L,Z=-2.63,P=0.01],and the proportion of serum VA and VD deficiency in the case group was significantly higher than that in the control group(44.3% vs 27.9%),42.6% vs 28.6%).2.According to the diagnosis,the children in the TD group were divided into CTD group and TS group.The results showed that there were no significant differences in the serum level of serum VA [1.09(1.02,1.26)μmol/L vs 1.05(1.02,1.23)μmol/L,Z=-0.43,P=0.67] and 25(OH)D [21.60(16.68,27.60)ng/m L vs 21.70(15.89,28.30)ng/m L,Z=-0.02,P=0.99] between CTD group and TS group.3.According to the YGTSS scale,the children in the TD group were divided into mild,moderate,and severe TD groups.Compared with the control group,the children with mild,moderate to severe TD had a significant reduction in the serum level of VA level(P<0.05),and the children with moderate to severe TD had a significant reduction in the serum level of25(OH)D(P<0.05);Compared with mild TD,the serum level of 25(OH)D in children with moderate to severe TD was significantly decreased,but there was no statistically significant difference.There is a significant negative correlation between the serum level of 25(OH)D and motor tic scores in TD children.There was no significant correlation between the serum level of VA level and total score or subscale score of YGTSS.4.According to the serum levels of VA and 25(OH)D,the children in the TD group were divided into four subgroups: VA and VD insufficiency group,only VA insufficiency group,only VD insufficiency group,VA group and normal VD group.The results showed that there were significant differences in total tic scores and motor tic scores among the four subgroups(P<0.05).Compared with the other three groups,the total tic score and motor score of VA and VD co-deficiency group were higher,and the total tic score of VA and VD co-deficiency group was significantly higher than that of VA deficiency only group(Z=﹣2.28,P=0.02)and VD deficiency only group(Z=﹣3.04,P= 0.002).The motor score of VA and VD co-deficiency group was significantly higher than that of VA deficiency only group(Z=﹣2.44,P=0.015).5.According to whether the children in the TD group have the comorbidity of ADHD,they were divided into two subgroups: TD comorbidity ADHD group and TD non-comorbidity ADHD group.The results showed that compared with the group of TD non-comorbidity ADHD,the group of TD comorbid ADHD group had higher scores in YGTSS total score,tic total score,motor tic score and damage,but there was only a significant difference in motor tic scores(F=0.10,P=0.02).6.Compared with the group of TD non-comorbidity ADHD,the serum level of VA [1.03(0.98,1.16)μmol/L vs 1.09(1.02,1.26)μmol/L,Z=-2.45,P=0.015],25(OH)D [18.90(15.29,24.22)ng/m L vs 23.88(17.50,30.40)ng/m L,Z=-3.15,P= 0.002)is significantly reduced,and the proportion of children with VD deficiency was significantly increased(58.5% versus32.2%;P<0.05)。7.The results of multivariate logistic regression analysis showed that the serum level of VA(Adjusted OR=0.22;95%CI: 0.08-0.61;P=0.004),age(Adjusted OR=0.73;95%CI: 0.59-0.91;P=0.004),and daily dairy intake(>300 m L)(Adjusted OR=0.43;95%CI: 0.25-0.74;P=0.002)were risk factors for TD after adjusting BMI and daily sunshine time.After adjusting for BMI,daily dairy intake,and daily sunlight exposure,the serum level of VA(Adjusted OR=0.10;95%CI: 0.02-0.70;P=0.02)and age(Adjusted OR=3.14;95%CI: 2.03-4.84,P<0.001)were risk factors for comorbid ADHD in TD.Conclusions:1.The serum levels of VA and 25(OH)D in the children with TD were lower than those in healthy children,and the prevalence of VA deficiency and/or VD deficiency was higher than that in healthy children.2.Deficiency or insufficiency of VA and/or VD was inversely associated with the severity of TD.3.Low VA levels were associated with TD and the presence of comorbidity with ADHD.4.Children with TD,especially those with TD with comorbid ADHD,should be concerned about their VA and VD nutritional status.The roles and mechanisms of VA and VD in TD need to be furtherly studied. |
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