Divisions of Clinical Epidemiology and Aging Research and Preventive Oncology, German Cancer Research Center, Heidelberg, Germany.
Am J Clin Nutr. 2013 Apr;97(4):782-93. doi: 10.3945/ajcn.112.047712. Epub 2013 Feb 27.
Serum 25-hydroxyvitamin D [25(OH)D] concentration has been linked to mortality in several studies, but appropriate cutoffs to define risk categories are under debate.
We aimed to conduct a repeated-measurements analysis on the association of serum 25(OH)D concentrations with all-cause and cause-specific mortality, with particular attention given to the shape of dose-response relations.
Concentrations of 25(OH)D were measured in n = 9578 baseline and n = 5469 5-y follow-up participants of the ESTHER study, which is a German population-based cohort aged 50-74 y at baseline. Deaths were recorded during 9.5 y of follow-up (median). Restricted cubic splines were used to assess dose-response relations, and Cox regression with time-dependent variables was used to estimate hazard ratios.
During follow-up, 1083 study participants died; of those, 350 individuals died of cardiovascular diseases, 433 individuals died of cancer, and 55 individuals died of respiratory diseases. The overall mortality [HR (95% CI)] of subjects with vitamin D deficiency [25(OH)D concentrations <30 nmol/L] or vitamin D insufficiency [25(OH)D concentrations from 30 to 50 nmol/L) was significantly increased [1.71 (1.43, 2.03) and 1.17 (1.02, 1.35), respectively] compared with that of subjects with sufficient 25(OH)D concentrations (>50 nmol/L)]. Vitamin D deficiency was also associated with increased cardiovascular mortality [1.39 (95% CI: 1.02, 1.89)], cancer mortality [1.42 (95% CI: 1.08, 1.88)] and respiratory disease mortality [2.50 (95% CI: 1.12, 5.56)]. The association of 25(OH)D concentrations with all-cause mortality proved to be a nonlinear inverse association with risk that started to increase at 25(OH)D concentrations <75 nmol/L.
In this large cohort study, serum 25(OH)D concentrations were inversely associated with all-cause and cause-specific mortality. In particular, vitamin D deficiency [25(OH)D concentration <30 nmol/L] was strongly associated with mortality from all causes, cardiovascular diseases, cancer, and respiratory diseases.
多项研究表明血清 25-羟维生素 D [25(OH)D] 浓度与死亡率相关，但目前对于定义风险类别的合适切点仍存在争议。
我们旨在对血清 25(OH)D 浓度与全因和特定原因死亡率的相关性进行重复测量分析，并特别关注剂量-反应关系的形状。
本研究纳入了 n = 9578 名基线和 n = 5469 名随访 5 年的 ESTHER 研究参与者，该研究是一项德国基于人群的队列研究，参与者基线年龄为 50-74 岁。在 9.5 年的随访期间记录了死亡人数（中位数）。采用限制性立方样条评估剂量-反应关系，采用时间依赖性变量的 Cox 回归估计危险比。
在随访期间，共有 1083 名参与者死亡；其中，350 人死于心血管疾病，433 人死于癌症，55 人死于呼吸系统疾病。维生素 D 缺乏症（25(OH)D 浓度 <30 nmol/L）或维生素 D 不足症（25(OH)D 浓度 30-50 nmol/L）患者的总体死亡率[风险比（95%置信区间）]显著增加[1.71（1.43，2.03）和 1.17（1.02，1.35）]，与 25(OH)D 浓度充足（>50 nmol/L）的患者相比。维生素 D 缺乏症还与心血管疾病死亡率增加相关[1.39（95%置信区间：1.02，1.89）]、癌症死亡率增加[1.42（95%置信区间：1.08，1.88）]和呼吸系统疾病死亡率增加[2.50（95%置信区间：1.12，5.56）]。25(OH)D 浓度与全因死亡率之间呈非线性反比关系，风险从 25(OH)D 浓度<75 nmol/L 开始增加。
在这项大型队列研究中，血清 25(OH)D 浓度与全因和特定原因死亡率呈负相关。特别是，维生素 D 缺乏症[25(OH)D 浓度<30 nmol/L]与全因、心血管疾病、癌症和呼吸系统疾病死亡率密切相关。
