Lucas Robyn, Neale Rachel
MBChB, PhD, Professor, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT.
Aust Fam Physician. 2014 Mar;43(3):119-22.
Vitamin D deficiency is thought to be common in Australia. It is unclear when vitamin D supplementation should be prescribed.
We assess the evidence that guides clinical decision-making on supplementation with vitamin D following a vitamin D test result.
Vitamin D assays are inconsistent and inaccurate and there is weak evidence around the level of 25-hydroxyvitamin D (25(OH)D) that is optimal. Evidence of links between vitamin D deficiency and disease come from observational studies and there is little support from randomised controlled trials of vitamin D supplementation. Where there is evidence of a link, increased risk is largely confined to very low 25(OH)D levels, with minimal health gains for 25(OH)D levels greater than 50 nmol/L. New evidence indicates that both high and low 25(OH)D levels may be associated with increased health risks. Taken together these considerations present a considerable challenge to clinical decision-making around treatment on the basis of 25(OH)D levels.
维生素D缺乏症在澳大利亚被认为很常见。目前尚不清楚何时应开具维生素D补充剂处方。
我们评估在维生素D检测结果后指导维生素D补充临床决策的证据。
维生素D检测方法不一致且不准确，关于最佳25-羟维生素D（25(OH)D）水平的证据不足。维生素D缺乏与疾病之间联系的证据来自观察性研究，维生素D补充剂的随机对照试验几乎没有提供支持。在有联系证据的情况下，风险增加主要限于极低的25(OH)D水平，25(OH)D水平大于50 nmol/L时健康获益极小。新证据表明，25(OH)D水平过高或过低都可能与健康风险增加有关。综合这些因素，基于25(OH)D水平进行治疗的临床决策面临巨大挑战。
