International Prevention Research Institute, Lyon, France; Strathclyde Institute of Global Public Health at International Prevention Research Institute, Lyon, France.
International Prevention Research Institute, Lyon, France; Strathclyde Institute of Global Public Health at International Prevention Research Institute, Lyon, France.
Lancet Diabetes Endocrinol. 2014 Jan;2(1):76-89. doi: 10.1016/S2213-8587(13)70165-7. Epub 2013 Dec 6.
Low serum concentrations of 25-hydroxyvitamin D (25[OH]D) have been associated with many non-skeletal disorders. However, whether low 25(OH)D is the cause or result of ill health is not known. We did a systematic search of prospective and intervention studies that assessed the effect of 25(OH)D concentrations on non-skeletal health outcomes in individuals aged 18 years or older. We identified 290 prospective cohort studies (279 on disease occurrence or mortality, and 11 on cancer characteristics or survival), and 172 randomised trials of major health outcomes and of physiological parameters related to disease risk or inflammatory status. Investigators of most prospective studies reported moderate to strong inverse associations between 25(OH)D concentrations and cardiovascular diseases, serum lipid concentrations, inflammation, glucose metabolism disorders, weight gain, infectious diseases, multiple sclerosis, mood disorders, declining cognitive function, impaired physical functioning, and all-cause mortality. High 25(OH)D concentrations were not associated with a lower risk of cancer, except colorectal cancer. Results from intervention studies did not show an effect of vitamin D supplementation on disease occurrence, including colorectal cancer. In 34 intervention studies including 2805 individuals with mean 25(OH)D concentration lower than 50 nmol/L at baseline supplementation with 50 μg per day or more did not show better results. Supplementation in elderly people (mainly women) with 20 μg vitamin D per day seemed to slightly reduce all-cause mortality. The discrepancy between observational and intervention studies suggests that low 25(OH)D is a marker of ill health. Inflammatory processes involved in disease occurrence and clinical course would reduce 25(OH)D, which would explain why low vitamin D status is reported in a wide range of disorders. In elderly people, restoration of vitamin D deficits due to ageing and lifestyle changes induced by ill health could explain why low-dose supplementation leads to slight gains in survival.
血清 25-羟维生素 D（25[OH]D）浓度低与许多非骨骼疾病有关。然而，低 25（OH）D 是健康不良的原因还是结果尚不清楚。我们对评估 18 岁及以上个体 25（OH）D 浓度对非骨骼健康结果影响的前瞻性和干预性研究进行了系统检索。我们确定了 290 项前瞻性队列研究（279 项关于疾病发生或死亡率，11 项关于癌症特征或生存），以及 172 项关于主要健康结果和与疾病风险或炎症状态相关的生理参数的随机试验。大多数前瞻性研究的研究者报告称，25（OH）D 浓度与心血管疾病、血清脂质浓度、炎症、葡萄糖代谢紊乱、体重增加、传染病、多发性硬化症、情绪障碍、认知功能下降、身体功能受损和全因死亡率之间存在中度至强的负相关。高 25（OH）D 浓度与癌症风险降低无关，结直肠癌除外。干预研究的结果并未显示维生素 D 补充对疾病发生的影响，包括结直肠癌。在包括 2805 名基线时 25（OH）D 浓度低于 50nmol/L 的个体的 34 项干预研究中，每天补充 50μg 以上的维生素 D 并没有显示出更好的效果。每天补充 20μg 维生素 D 对老年人（主要是女性）似乎略微降低了全因死亡率。观察性研究和干预性研究之间的差异表明，低 25（OH）D 是健康不良的标志。涉及疾病发生和临床过程的炎症过程会降低 25（OH）D，这可以解释为什么在广泛的疾病中报告维生素 D 状态低下。在老年人中，由于衰老和健康不良引起的生活方式改变导致的维生素 D 缺乏的恢复可以解释为什么低剂量补充会导致生存略有改善。
