Shab-Bidar Sakineh, Bours Sandrine, Geusens Piet P M M, Kessels Alfons G H, van den Bergh Joop P W
Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Nutrition. 2014 Sep;30(9):975-85. doi: 10.1016/j.nut.2013.12.020. Epub 2014 Jan 10.
The aim of this study was to review factors that influence serum 25(OH)D when patients are given vitamin D supplements.
From a comprehensive search of all randomized controlled clinical trials with vitamin D3 supplementation available on PubMed up to November 2011, we selected 33 with 43 treatment arms that included at least 30 adult participants. The achieved pooled mean difference (PMD) and 95% confidence intervals (CIs) were calculated using the random-effects models. Meta-regression and subgroup analyses were performed for prespecified factors, including dose, duration, baseline serum 25(OH)D, and age.
With a mean baseline serum 25(OH)D of 50.4 nmol/L, PMD was 37 nmol/L (95% CI, 33-41) with significant heterogeneity among studies. Dose (slope: 0.006; P < 0.001), trial duration (slope: 0.21; P < 0.001), baseline serum 25(OH)D (slope: -0.19; P < 0.001), and age (slope: 0.42; P < 0.001) independently influenced vitamin D response. Similar results were found in studies with a mean baseline serum 25(OH)D <50 nmol/L. In subgroup analyses, the PMD was higher with doses ≥800 IU/d (39.3 nmol/L) after 6 to 12 mo (41.7 nmol/L), with baseline 25(OH)D <50 nmol/L (39.6 nmol/L), and in adults aged >80 y (40.5 nmol/L).
This meta regression indicates that a higher increase in serum levels of 25(OH)D in adults is found with a dose of ≥800 IU/d, after at least 6 to 12 mo, and even when baseline 25(OH)D is low and in adults >80 y.
本研究旨在回顾在患者补充维生素D时影响血清25(OH)D的因素。
通过全面检索截至2011年11月在PubMed上可获得的所有补充维生素D3的随机对照临床试验，我们选择了33项研究，其中有43个治疗组，每组至少有30名成年参与者。使用随机效应模型计算合并平均差（PMD）和95%置信区间（CI）。对预先设定的因素进行了Meta回归和亚组分析，这些因素包括剂量、疗程、基线血清25(OH)D和年龄。
平均基线血清25(OH)D为50.4 nmol/L，PMD为37 nmol/L（95%CI，33 - 41），各研究间存在显著异质性。剂量（斜率：0.006；P < 0.001）、试验疗程（斜率：0.21；P < 0.001）、基线血清25(OH)D（斜率：-0.19；P < 0.001）和年龄（斜率：0.42；P < 0.001）独立影响维生素D反应。在平均基线血清25(OH)D <50 nmol/L的研究中也发现了类似结果。在亚组分析中，剂量≥800 IU/d（39.3 nmol/L）、6至12个月后（41.7 nmol/L）、基线25(OH)D <50 nmol/L（39.6 nmol/L）以及80岁以上成年人（40.5 nmol/L）时的PMD更高。
该Meta回归表明，对于成年人，当剂量≥800 IU/d、至少6至12个月后，即使基线25(OH)D较低以及在80岁以上成年人中，血清25(OH)D水平的升高幅度更大。
