Fairfield Kathleen M, Fletcher Robert H
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
JAMA. 2002 Jun 19;287(23):3116-26. doi: 10.1001/jama.287.23.3116.
Although vitamin deficiency is encountered infrequently in developed countries, inadequate intake of several vitamins is associated with chronic disease.
To review the clinically important vitamins with regard to their biological effects, food sources, deficiency syndromes, potential for toxicity, and relationship to chronic disease.
We searched MEDLINE for English-language articles about vitamins in relation to chronic diseases and their references published from 1966 through January 11, 2002.
We reviewed articles jointly for the most clinically important information, emphasizing randomized trials where available.
Our review of 9 vitamins showed that elderly people, vegans, alcohol-dependent individuals, and patients with malabsorption are at higher risk of inadequate intake or absorption of several vitamins. Excessive doses of vitamin A during early pregnancy and fat-soluble vitamins taken anytime may result in adverse outcomes. Inadequate folate status is associated with neural tube defect and some cancers. Folate and vitamins B(6) and B(12) are required for homocysteine metabolism and are associated with coronary heart disease risk. Vitamin E and lycopene may decrease the risk of prostate cancer. Vitamin D is associated with decreased occurrence of fractures when taken with calcium.
Some groups of patients are at higher risk for vitamin deficiency and suboptimal vitamin status. Many physicians may be unaware of common food sources of vitamins or unsure which vitamins they should recommend for their patients. Vitamin excess is possible with supplementation, particularly for fat-soluble vitamins. Inadequate intake of several vitamins has been linked to chronic diseases, including coronary heart disease, cancer, and osteoporosis
尽管在发达国家维生素缺乏症并不常见，但几种维生素摄入不足与慢性病有关。
综述临床上重要的维生素，包括它们的生物学效应、食物来源、缺乏综合征、潜在毒性以及与慢性病的关系。
我们在MEDLINE上搜索了1966年至2002年1月11日发表的关于维生素与慢性病相关的英文文章及其参考文献。
我们共同审阅文章以获取最重要的临床信息，如有随机试验则重点关注。
我们对9种维生素的综述表明，老年人、纯素食者、酒精依赖者以及吸收不良患者摄入或吸收几种维生素不足的风险更高。孕早期过量摄入维生素A以及任何时候摄入脂溶性维生素都可能导致不良后果。叶酸水平不足与神经管缺陷和某些癌症有关。同型半胱氨酸代谢需要叶酸、维生素B6和维生素B12，它们与冠心病风险相关。维生素E和番茄红素可能降低前列腺癌风险。维生素D与钙一起服用时可降低骨折发生率。
某些患者群体维生素缺乏和维生素状态欠佳的风险更高。许多医生可能不知道维生素的常见食物来源，或者不确定应该为患者推荐哪些维生素。补充维生素时可能会过量，尤其是脂溶性维生素。几种维生素摄入不足与包括冠心病、癌症和骨质疏松症在内的慢性病有关
