Department of Preventive Medicine and Epidemiology, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA.
J Nutr. 2010 Mar;140(3):595-9. doi: 10.3945/jn.109.116681. Epub 2010 Jan 20.
The concentration or threshold of 25-hydroxyvitamin D [25(OH)D] needed to maximally suppress intact serum parathyroid hormone (iPTH) has been suggested as a measure of optimal vitamin D status. Depending upon the definition of maximal suppression of iPTH and the 2-phase regression approach used, 2 distinct clusters for a single 25(OH)D threshold have been reported: 16-20 ng/mL (40-50 nmol/L) and 30-32 ng/mL (75-80 nmol/L). To rationalize the apparently disparate published results, we compared thresholds from several regression models including a 3-phase one to estimate simultaneously 2 thresholds before and after adjusting for possible confounding for age, BMI, glomerular filtration rate, dietary calcium, and season (April-September vs. October-March) within a single data set, i.e. data from the Tufts University Sites Testing Osteoporosis Prevention/Intervention Treatment study, consisting of 181 men and 206 women (total n = 387) ages 65-87 y. Plasma 25(OH)D and serum iPTH concentrations were (mean +/- SD) 22.1 +/- 7.44 ng/mL (55.25 +/- 18.6 nmol/L) and 36.6 +/- 16.03 pg/mL (3.88 +/- 1.7 pmol/L), respectively. The 3-phase model identified 2 thresholds of 12 ng/mL (30 nmol/L) and 28 ng/mL (70 nmol/L); similar results were found from the 2-phase models evaluated, i.e. 13-20 and 27-30 ng/mL (32.5-50 and 67.5-75 nmol/L) and with previous results. Adjusting for confounding did not change the results substantially. Accordingly, the 3-phase model appears to be superior to the 2-phase approach, because it simultaneously estimates the 2 threshold clusters found from the 2-phase approaches along with estimating confidence limits. If replicated, it may be of both clinical and public health importance.
建议将 25-羟维生素 D [25(OH)D] 的浓度或阈值定义为最大抑制完整血清甲状旁腺激素 (iPTH) 的水平,作为衡量最佳维生素 D 状态的指标。根据 iPTH 最大抑制的定义和使用的 2 相回归方法,已经报道了单一 25(OH)D 阈值的 2 个不同聚类:16-20ng/mL(40-50nmol/L)和 30-32ng/mL(75-80nmol/L)。为了使看似不同的已发表结果合理化,我们比较了来自几个回归模型的阈值,包括 3 相模型,以便在单个数据集(即来自塔夫茨大学骨质疏松症预防/干预治疗研究站点的研究数据)中同时估计年龄、BMI、肾小球滤过率、膳食钙和季节(4 月至 9 月与 10 月至 3 月)调整前后的 2 个阈值,该数据集由 181 名男性和 206 名女性(总 n=387)组成,年龄为 65-87 岁。血浆 25(OH)D 和血清 iPTH 浓度分别为(平均值±标准差)22.1±7.44ng/mL(55.25±18.6nmol/L)和 36.6±16.03pg/mL(3.88±1.7pmol/L)。3 相模型确定了 2 个阈值,分别为 12ng/mL(30nmol/L)和 28ng/mL(70nmol/L);从评估的 2 相模型中也发现了类似的结果,即 13-20 和 27-30ng/mL(32.5-50 和 67.5-75nmol/L),以及以前的结果。调整混杂因素并没有实质性地改变结果。因此,3 相模型似乎优于 2 相方法,因为它同时估计了 2 相方法中发现的 2 个阈值聚类,同时还估计了置信区间。如果得到复制,它可能具有临床和公共卫生的双重重要性。