Atherton K, Berry D J, Parsons T, Macfarlane G J, Power C, Hyppönen E
MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK.
Ann Rheum Dis. 2009 Jun;68(6):817-22. doi: 10.1136/ard.2008.090456. Epub 2008 Aug 12.
BACKGROUND: Identified aetiological factors for chronic widespread pain (CWP) are largely related to emotional and behavioural factors, but current management leads to modest improvement in symptoms. Vitamin D deficiency has been suggested as a new modifiable risk factor for CWP. OBJECTIVE: To examine the association between vitamin D status (measured by 25-hydroxyvitamin D (25(OH)D)) and CWP in a nationwide population sample of white British adults, accounting for potential mediating and confounding lifestyle factors. METHODS: 9377 participants born 1 week in March 1958, in England, Scotland or Wales and completing a biomedical assessment at age 45; 6824 eligible participants had data on 25(OH)D and completed pain manikins. RESULTS: Prevalence of CWP varied by 25(OH)D concentration in women but not in men, with the lowest prevalence observed for women with 75-99 nmol/l (14.4% for <25 nmol/l, 14.8% for 25-49 nmol/l, 11.6% for 50-74 nmo/l, 8.2% for 75-99 nmol/l and 9.8% for participants with > or =100 nmol/l). There was an interaction between 25(OH)D concentration and gender in relation to CWP (interaction, p = 0.006), which was not fully explained by differences in lifestyle or social factors (adjusted interaction, p = 0.03). For women, the association between 25(OH)D concentration and CWP persisted after full adjustment (odds ratio (OR) for <75 nmol/l vs 75-99 nmol/l 1.57, 95% CI 1.09 to 2.26), while no evidence for an association was apparent in men (OR = 1.03, 95% CI 0.75 to 1.43). CONCLUSION: Current vitamin D status was associated with CWP in women but not in men. Follow-up studies are needed to evaluate whether higher vitamin D intake might have beneficial effects on the risk of CWP.
背景:已确定的慢性广泛性疼痛(CWP)病因大多与情绪和行为因素有关,但目前的治疗只能使症状有适度改善。维生素D缺乏被认为是CWP一个新的可改变的风险因素。 目的:在一个全国性的英国白人成年人群样本中,研究维生素D状态(通过25-羟基维生素D(25(OH)D)测量)与CWP之间的关联,同时考虑潜在的中介和混杂生活方式因素。 方法:9377名参与者于1958年3月的某一周出生在英格兰、苏格兰或威尔士,并在45岁时完成了一次生物医学评估;6824名符合条件的参与者有25(OH)D的数据并完成了疼痛模拟评分。 结果:CWP的患病率在女性中随25(OH)D浓度而变化,在男性中则不然,25(OH)D浓度为75 - 99 nmol/l的女性患病率最低(<25 nmol/l的女性患病率为14.4%,25 - 49 nmol/l的为14.8%,50 - 74 nmol/l的为11.6%,75 - 99 nmol/l的为8.2%,≥100 nmol/l的参与者为9.8%)。在CWP方面,25(OH)D浓度与性别之间存在交互作用(交互作用,p = 0.006),生活方式或社会因素的差异并未完全解释这一现象(校正后的交互作用,p = 0.03)。对于女性,在完全校正后,25(OH)D浓度与CWP之间的关联仍然存在(<75 nmol/l与75 - 99 nmol/l相比的优势比(OR)为1.57,95%置信区间为1.09至2.26),而在男性中未发现明显关联证据(OR = 1.03,95%置信区间为0.75至1.43)。 结论:目前的维生素D状态与女性的CWP有关,与男性无关。需要进行后续研究以评估更高的维生素D摄入量是否可能对CWP风险产生有益影响。
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