Brown LaVerne L, Cohen Barbara, Tabor Derrick, Zappalà Giovanna, Maruvada Padma, Coates Paul M
1Office of Dietary Supplements, National Institutes of Health, Bethesda, MD USA.
2National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA.
BMC Proc. 2018 May 9;12(Suppl 6):6. doi: 10.1186/s12919-018-0102-4. eCollection 2018.
The Office of Dietary Supplements, the National Institute on Minority Health and Health Disparities, the National Institute on Aging, and the National Institute of Diabetes and Digestive and Kidney Diseases, all components of the U.S. National Institutes of Health, co-sponsored an expert panel meeting to discuss the vitamin D paradox in Black Americans. The paradox is that despite markedly low (or "deficient") measures of vitamin D status in Black Americans, the incidence of falls, fractures, or osteopenia are significantly lower compared to White American counterparts with similar vitamin D status. Six panelists were invited to engage in guided discussions on the state of the science with respect to key knowledge gaps impacting vitamin D status and bone health. They were also asked to reflect on best approaches for advancing the science. A central theme throughout the discussions was that there may be many factors that impact Vitamin D levels in Black Americans and understanding these factors may be key to understanding mechanisms for improving bone health in all populations. Data presented showed that although adiposity, skin pigmentation, vitamin D binding protein polymorphisms, and genetics all contributed to differences in 25(OH)D levels in Black vs. White Americans, no one factor alone could fully explain the vitamin D paradox in Black Americans. However, the panelists did agree that the paradox is significant and warrants further investigation. There was consensus that Black Americans gained no skeletal benefits from high doses of vitamin D supplementation, and that high levels of the biomarker of vitamin D status, serum 25-hydroxyvitamin D or 25(OH)D, in this population are almost certain to result in adverse effects. Some panelists proposed that additional studies are needed so that the Institute of Medicine (IOM) can better define the safe upper limits of vitamin D intake in this and other subpopulations. Others suggested a need for better, more generalizable biomarkers of bone health to advance the science.
美国国立卫生研究院下属的膳食补充剂办公室、国家少数民族健康与健康差异研究所、国家老龄问题研究所和国家糖尿病、消化和肾脏疾病研究所共同主办了一次专家小组会议，讨论美国黑人中的维生素D悖论。这一悖论是，尽管美国黑人的维生素D水平测量值明显较低（或“缺乏”），但与维生素D水平相似的美国白人相比，他们跌倒、骨折或骨质减少的发生率要低得多。六位小组成员受邀就影响维生素D水平和骨骼健康的关键知识空白方面的科学现状进行有引导的讨论。他们还被要求思考推进该科学的最佳方法。整个讨论的一个中心主题是，可能有许多因素影响美国黑人的维生素D水平，理解这些因素可能是理解改善所有人群骨骼健康机制的关键。所展示的数据表明，尽管肥胖、皮肤色素沉着、维生素D结合蛋白多态性和基因都导致了美国黑人和白人之间25(OH)D水平的差异，但没有一个因素能单独完全解释美国黑人中的维生素D悖论。然而，小组成员确实一致认为这一悖论很重要，值得进一步研究。大家一致认为，高剂量补充维生素D对美国黑人没有骨骼益处，而且在这一人群中，维生素D状态生物标志物血清25-羟基维生素D或25(OH)D的高水平几乎肯定会导致不良反应。一些小组成员提议需要进行更多研究，以便医学研究所（IOM）能够更好地确定这一人群和其他亚人群中维生素D摄入量的安全上限。其他人则建议需要更好、更具普遍性的骨骼健康生物标志物来推进该科学。
