Autier Philippe, Gandini Sara
International Agency for Research on Cancer, 150 cours Albert Thomas, F-69372 Lyon, France.
Arch Intern Med. 2007 Sep 10;167(16):1730-7. doi: 10.1001/archinte.167.16.1730.
Ecological and observational studies suggest that low vitamin D status could be associated with higher mortality from life-threatening conditions including cancer, cardiovascular disease, and diabetes mellitus that account for 60% to 70% of total mortality in high-income countries. We examined the risk of dying from any cause in subjects who participated in randomized trials testing the impact of vitamin D supplementation (ergocalciferol [vitamin D(2)] or cholecalciferol [vitamin D(3)]) on any health condition.
The literature up to November 2006 was searched without language restriction using the following databases: PubMed, ISI Web of Science (Science Citation Index Expanded), EMBASE, and the Cochrane Library.
We identified 18 independent randomized controlled trials, including 57 311 participants. A total of 4777 deaths from any cause occurred during a trial size-adjusted mean of 5.7 years. Daily doses of vitamin D supplements varied from 300 to 2000 IU. The trial size-adjusted mean daily vitamin D dose was 528 IU. In 9 trials, there was a 1.4- to 5.2-fold difference in serum 25-hydroxyvitamin D between the intervention and control groups. The summary relative risk for mortality from any cause was 0.93 (95% confidence interval, 0.87-0.99). There was neither indication for heterogeneity nor indication for publication biases. The summary relative risk did not change according to the addition of calcium supplements in the intervention.
Intake of ordinary doses of vitamin D supplements seems to be associated with decreases in total mortality rates. The relationship between baseline vitamin D status, dose of vitamin D supplements, and total mortality rates remains to be investigated. Population-based, placebo-controlled randomized trials with total mortality as the main end point should be organized for confirming these findings.
生态学和观察性研究表明，维生素D水平低可能与包括癌症、心血管疾病和糖尿病等危及生命疾病的较高死亡率相关，这些疾病在高收入国家占总死亡率的60%至70%。我们研究了参与测试维生素D补充剂（麦角钙化醇[维生素D(2)]或胆钙化醇[维生素D(3)]）对任何健康状况影响的随机试验的受试者全因死亡风险。
使用以下数据库对截至2006年11月的文献进行无语言限制的检索：PubMed、ISI科学网（科学引文索引扩展版）、EMBASE和考克兰图书馆。
我们确定了18项独立的随机对照试验，包括57311名参与者。在经试验规模调整后的平均5.7年期间，共发生了4777例全因死亡。维生素D补充剂的每日剂量从300至2000国际单位不等。经试验规模调整后的平均每日维生素D剂量为528国际单位。在9项试验中，干预组和对照组之间血清25-羟维生素D存在1.4至5.2倍的差异。全因死亡的汇总相对风险为0.93（95%置信区间，0.87 - 0.99）。既没有异质性迹象，也没有发表偏倚迹象。汇总相对风险在干预中添加钙补充剂后未改变。
摄入普通剂量的维生素D补充剂似乎与总死亡率降低有关。基线维生素D水平、维生素D补充剂剂量与总死亡率之间的关系仍有待研究。应以总死亡率为主要终点组织基于人群的、安慰剂对照的随机试验来证实这些发现。
