普通人群中25-羟维生素D水平与死亡风险
25-hydroxyvitamin D levels and the risk of mortality in the general population.
作者信息
Melamed Michal L, Michos Erin D, Post Wendy, Astor Brad
机构信息
Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Ullmann 615, Bronx, NY 10461, USA.
出版信息
Arch Intern Med. 2008 Aug 11;168(15):1629-37. doi: 10.1001/archinte.168.15.1629.
BACKGROUND
In patients undergoing dialysis, therapy with calcitriol or paricalcitol or other vitamin D agents is associated with reduced mortality. Observational data suggests that low 25-hydroxyvitamin D levels (25[OH]D) are associated with diabetes mellitus, hypertension, and cancers. However, whether low serum 25(OH)D levels are associated with mortality in the general population is unknown.
METHODS
We tested the association of low 25(OH)D levels with all-cause, cancer, and cardiovascular disease (CVD) mortality in 13 331 nationally representative adults 20 years or older from the Third National Health and Nutrition Examination Survey (NHANES III) linked mortality files. Participant vitamin D levels were collected from 1988 through 1994, and individuals were passively followed for mortality through 2000.
RESULTS
In cross-sectional multivariate analyses, increasing age, female sex, nonwhite race/ethnicity, diabetes, current smoking, and higher body mass index were all independently associated with higher odds of 25(OH)D deficiency (lowest quartile of 25(OH)D level, <17.8 ng/mL [to convert to nanomoles per liter, multiply by 2.496]), while greater physical activity, vitamin D supplementation, and nonwinter season were inversely associated. During a median 8.7 years of follow-up, there were 1806 deaths, including 777 from CVD. In multivariate models (adjusted for baseline demographics, season, and traditional and novel CVD risk factors), compared with the highest quartile, being in the lowest quartile (25[OH]D levels <17.8 ng/mL) was associated with a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%. The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.
CONCLUSION
The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population.
背景
在接受透析的患者中，使用骨化三醇、帕立骨化醇或其他维生素D制剂进行治疗与死亡率降低相关。观察数据表明，低25-羟维生素D水平（25[OH]D）与糖尿病、高血压和癌症有关。然而，血清25(OH)D水平低是否与普通人群的死亡率相关尚不清楚。
方法
我们在来自第三次全国健康和营养检查调查（NHANES III）并与死亡率档案相链接的13331名20岁及以上具有全国代表性的成年人中，测试了低25(OH)D水平与全因、癌症和心血管疾病（CVD）死亡率之间的关联。参与者的维生素D水平于1988年至1994年收集，并对个体进行被动随访直至2000年以获取死亡率信息。
结果
在横断面多变量分析中，年龄增加、女性、非白人种族/族裔、糖尿病、当前吸烟以及较高的体重指数均与25(OH)D缺乏（25(OH)D水平处于最低四分位数，<17.8 ng/mL[要转换为纳摩尔每升，乘以2.496]）的较高几率独立相关，而更多的体育活动、维生素D补充剂以及非冬季则与之呈负相关。在中位8.7年的随访期间，有1806人死亡，其中777人死于心血管疾病。在多变量模型中（针对基线人口统计学、季节以及传统和新型心血管疾病风险因素进行了调整），与最高四分位数相比，处于最低四分位数（25[OH]D水平<17.8 ng/mL）与全因死亡率增加26%相关（死亡率比值，1.26；95%置信区间，1.08 - 1.46），人群归因风险为3.1%。心血管疾病和癌症死亡率的调整模型显示风险较高，但无统计学意义。
结论
25(OH)D水平的最低四分位数（<17.8 ng/mL）与普通人群的全因死亡率独立相关。
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