Lotito Ashley, Teramoto Masaru, Cheung May, Becker Kendra, Sukumar Deeptha
Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA 19102, USA.
Division of Physical Medicine & Rehabilitation, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA.
Nutrients. 2017 Mar 6;9(3):241. doi: 10.3390/nu9030241.
Obesity is often associated with vitamin D deficiency and secondary hyperparathyroidism. Vitamin D supplementation typically leads to the reductions in serum parathyroid hormone (PTH) levels, as shown in normal weight individuals. Meanwhile, the dose of vitamin D supplementation for the suppression of PTH may differ in overweight and obese adults. We conducted a systematic review and meta-analysis of randomized controlled trials to determine the dose of vitamin D supplementation required to suppress PTH levels in overweight/obese individuals. We identified 18 studies that examined overweight or obese healthy adults who were supplemented with varying doses of vitamin D3. The primary outcomes examined were changes in PTH and serum 25-hydroxyvitamin D (25OHD) levels from baseline to post-treatment. The results of the meta-analysis showed that there was a significant treatment effect of vitamin D supplementation on PTH, total standardized mean difference (SMD) (random effects) = -0.38 (95% CI = -0.56 to -0.20), = -4.08, < 0.001. A significant treatment effect of vitamin D supplementation was also found on 25OHD, total SMD (random effects) = 2.27 (95% CI = 1.48 to 3.06) = 5.62, < 0.001. Data from available clinical trials that supplemented adults with D3 ranging from 400 IU to 5714 IU, showed that 1000 IU of vitamin D supplementation best suppressed serum PTH levels, total SMD = -0.58, while vitamin D supplementation with 4000 IU showed the greatest increase in serum 25OH levels. Vitamin D and calcium supplementation of 700 IU and 500 mg, respectively, also showed a significant treatment effect on the suppression of PTH with a total SMD = -5.30 (95% CI = -9.72 to -0.88). In conclusion, the meta analysis of available clinical trials indicates that 1000 IU vitamin D supplementation can suppress serum PTH levels, while 4000 IU of vitamin D was associated with the largest increase in serum 25OHD levels in the overweight and obese population.
肥胖常与维生素D缺乏及继发性甲状旁腺功能亢进相关。如在正常体重个体中所示，补充维生素D通常会使血清甲状旁腺激素（PTH）水平降低。同时，超重和肥胖成年人中用于抑制PTH的维生素D补充剂量可能有所不同。我们对随机对照试验进行了系统评价和荟萃分析，以确定超重/肥胖个体抑制PTH水平所需的维生素D补充剂量。我们纳入了18项研究，这些研究检测了补充不同剂量维生素D3的超重或肥胖健康成年人。所检测的主要结局是从基线到治疗后PTH和血清25-羟基维生素D（25OHD）水平的变化。荟萃分析结果显示，补充维生素D对PTH有显著治疗效果，总标准化均数差（SMD）（随机效应）=-0.38（95%CI=-0.56至-0.20），Z=-4.08，P<0.001。补充维生素D对25OHD也有显著治疗效果，总SMD（随机效应）=2.27（95%CI=1.48至3.06），Z=5.62，P<0.001。来自补充400 IU至5714 IU D3的成人的现有临床试验数据显示，补充1000 IU维生素D对血清PTH水平的抑制效果最佳，总SMD=-0.58，而补充4000 IU维生素D时血清25OH水平升高幅度最大。分别补充700 IU维生素D和5毫克钙对PTH的抑制也有显著治疗效果，总SMD=-5.30（95%CI=-9.72至-0.88）。总之，对现有临床试验的荟萃分析表明，补充1000 IU维生素D可抑制超重和肥胖人群的血清PTH水平，而补充4000 IU维生素D与血清25OHD水平的最大升高相关。
