Dawson-Hughes Bess
Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.
Am J Clin Nutr. 2004 Dec;80(Suppl 6):1763S-6S. doi: 10.1093/ajcn/80.6.1763S.
Vitamin D is acquired through diet and skin exposure to ultraviolet B light. Skin production is determined by length of exposure, latitude, season, and degree of skin pigmentation. Blacks produce less vitamin D3 than do whites in response to usual levels of sun exposure and have lower 25-hydroxyvitamin D [25(OH)D] concentrations in winter and summer. Blacks in the United States also use dietary supplements less frequently than do whites. However, blacks and whites appear to have similar capacities to absorb vitamin D and to produce vitamin D after repeated high doses of ultraviolet B light. There is a growing consensus that serum 25(OH)D concentrations of at least 75-80 nmol/L are needed for optimal bone health, on the basis of studies of older white subjects living in Europe and the United States. The studies show that increasing serum 25(OH)D concentrations to this level decreases parathyroid hormone (PTH) concentrations, decreases rates of bone loss, and reduces rates of fractures. Among US blacks, low 25(OH)D concentrations are associated with higher concentrations of PTH, which are associated with lower bone mineral density. Vitamin D supplements decrease PTH and bone turnover marker concentrations among blacks. These findings suggest that improving vitamin D status would benefit blacks as well as whites. On the basis of studies conducted in the temperate zone, the intake of vitamin D3 needed to maintain a group average 25(OH)D concentration of 80 nmol/L in winter is approximately 1000 IU/d. Broad-based vitamin D supplementation is needed to remove vitamin D insufficiency as a contributing cause of osteoporosis.
维生素D可通过饮食以及皮肤暴露于紫外线B光下获取。皮肤生成量取决于暴露时长、纬度、季节以及皮肤色素沉着程度。在日常日照水平下,黑人产生的维生素D3比白人少,且在冬季和夏季其25-羟基维生素D[25(OH)D]浓度较低。美国的黑人使用膳食补充剂的频率也低于白人。然而,黑人和白人在吸收维生素D以及在反复高剂量紫外线B照射后产生维生素D的能力上似乎相似。基于对生活在欧洲和美国的老年白人受试者的研究,越来越多的人达成共识,即血清25(OH)D浓度至少达到75 - 80 nmol/L才有助于实现最佳骨骼健康。研究表明,将血清25(OH)D浓度提高到这一水平可降低甲状旁腺激素(PTH)浓度、降低骨质流失率并减少骨折率。在美国黑人中,低25(OH)D浓度与较高的PTH浓度相关,而PTH浓度较高又与较低的骨矿物质密度相关。维生素D补充剂可降低黑人的PTH和骨转换标志物浓度。这些发现表明,改善维生素D状况对黑人和白人都有益。根据在温带地区进行的研究,冬季要使群体平均25(OH)D浓度维持在80 nmol/L所需的维生素D3摄入量约为1000 IU/天。需要广泛进行维生素D补充,以消除维生素D不足这一导致骨质疏松的因素。
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