Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.
Nutrients. 2013 Dec 16;5(12):5127-39. doi: 10.3390/nu5125127.
Clarify the concept of vitamin D sufficiency, the relationship between efficacy and vitamin D status and the role of Vitamin D supplementation in the management of non-skeletal diseases. We outline reasons for anticipating different serum vitamin D levels are required for different diseases.
Review the literature for evidence of efficacy of supplementation and minimum effective 25-hydroxyvitamin D (25-OHD) levels in non-skeletal disease.
Evidence of efficacy of vitamin supplementation is graded according to levels of evidence. Minimum effective serum 25-OHD levels are lower for skeletal disease, e.g., rickets (25 nmol/L), osteoporosis and fractures (50 nmol/L), than for premature mortality (75 nmol/L) or non-skeletal diseases, e.g., depression (75 nmol/L), diabetes and cardiovascular disease (80 nmol/L), falls and respiratory infections (95 nmol/L) and cancer (100 nmol/L).
Evidence for the efficacy of vitamin D supplementation at serum 25-OHD levels ranging from 25 to 100 nmol/L has been obtained from trials with vitamin D interventions that change vitamin D status by increasing serum 25-OHD to a level consistent with sufficiency for that disease. This evidence supports the hypothesis that just as vitamin D metabolism is tissue dependent, so the serum levels of 25-OHD signifying deficiency or sufficiency are disease dependent.
阐明维生素 D 充足的概念、疗效与维生素 D 状态之间的关系，以及维生素 D 补充在非骨骼疾病管理中的作用。我们概述了为什么预计不同疾病需要不同的血清维生素 D 水平的原因。
回顾文献中关于补充维生素的疗效和非骨骼疾病中最小有效 25-羟维生素 D（25-OHD）水平的证据。
根据证据水平对维生素补充的疗效证据进行分级。骨骼疾病（如佝偻病[25nmol/L]、骨质疏松症和骨折[50nmol/L]）的最小有效血清 25-OHD 水平低于非骨骼疾病（如抑郁症[75nmol/L]、糖尿病和心血管疾病[80nmol/L]、跌倒和呼吸道感染[95nmol/L]和癌症[100nmol/L]）。
从通过增加血清 25-OHD 至与该疾病充足相一致的水平来改变维生素 D 状态的维生素 D 干预试验中获得了血清 25-OHD 水平在 25 至 100nmol/L 范围内补充维生素 D 的疗效证据。这一证据支持了这样一种假设，即正如维生素 D 代谢是组织依赖性的，因此表示缺乏或充足的血清 25-OHD 水平是疾病依赖性的。
