Pittas Anastassios G, Lau Joseph, Hu Frank B, Dawson-Hughes Bess
Division of Endocrinology, Diabetes and Metabolism, Tufts-New England Medical Center, Boston, MA 02111, USA.
J Clin Endocrinol Metab. 2007 Jun;92(6):2017-29. doi: 10.1210/jc.2007-0298. Epub 2007 Mar 27.
Altered vitamin D and calcium homeostasis may play a role in the development of type 2 diabetes mellitus (type 2 DM). EVIDENCE ACQUISITION AND ANALYSES: MEDLINE review was conducted through January 2007 for observational studies and clinical trials in adults with outcomes related to glucose homeostasis. When data were available to combine, meta-analyses were performed, and summary odds ratios (OR) are presented.
Observational studies show a relatively consistent association between low vitamin D status, calcium or dairy intake, and prevalent type 2 DM or metabolic syndrome [OR (95% confidence interval): type 2 DM prevalence, 0.36 (0.16-0.80) among nonblacks for highest vs. lowest 25-hydroxyvitamin D; metabolic syndrome prevalence, 0.71 (0.57-0.89) for highest vs. lowest dairy intake]. There are also inverse associations with incident type 2 DM or metabolic syndrome [OR (95% confidence interval): type 2 DM incidence, 0.82 (0.72-0.93) for highest vs. lowest combined vitamin D and calcium intake; 0.86 (0.79-0.93) for highest vs. lowest dairy intake]. Evidence from trials with vitamin D and/or calcium supplementation suggests that combined vitamin D and calcium supplementation may have a role in the prevention of type 2 DM only in populations at high risk (i.e. glucose intolerance). The available evidence is limited because most observational studies are cross-sectional and did not adjust for important confounders, whereas intervention studies were short in duration, included few subjects, used a variety of formulations of vitamin D and calcium, or did post hoc analyses.
Vitamin D and calcium insufficiency may negatively influence glycemia, whereas combined supplementation with both nutrients may be beneficial in optimizing glucose metabolism.
维生素D和钙稳态的改变可能在2型糖尿病（2型DM）的发生发展中起作用。
对截至2007年1月的MEDLINE进行检索，纳入关于成人葡萄糖稳态相关结局的观察性研究和临床试验。当有数据可合并时，进行荟萃分析，并给出汇总比值比（OR）。
观察性研究显示，低维生素D状态、钙或乳制品摄入量与2型DM或代谢综合征患病率之间存在相对一致的关联[OR（95%置信区间）：2型DM患病率，非黑人中25-羟维生素D最高与最低水平相比为0.36（0.16 - 0.80）；代谢综合征患病率，乳制品摄入量最高与最低水平相比为0.71（0.57 - 0.89）]。同时也存在与2型DM或代谢综合征发病率的负相关[OR（95%置信区间）：2型DM发病率，维生素D和钙联合摄入量最高与最低水平相比为0.82（0.72 - 0.93）；乳制品摄入量最高与最低水平相比为0.86（0.79 - 0.93）]。维生素D和/或钙补充剂试验的证据表明，联合补充维生素D和钙可能仅在高危人群（即葡萄糖不耐受人群）中对预防2型DM有作用。现有证据有限，因为大多数观察性研究为横断面研究且未对重要混杂因素进行校正，而干预性研究持续时间短、纳入受试者少、使用多种维生素D和钙制剂或进行事后分析。
维生素D和钙缺乏可能对血糖产生负面影响，而联合补充这两种营养素可能有利于优化葡萄糖代谢。
