维生素 D 补充与总癌症发病率和死亡率：随机对照试验的荟萃分析。
Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials.
机构信息
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Food Science and Biotechnology, Dongguk University, Goyang, South Korea.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
出版信息
Ann Oncol. 2019 May 1;30(5):733-743. doi: 10.1093/annonc/mdz059.
BACKGROUND
Previous meta-analyses of randomized controlled trials (RCTs) of vitamin D supplementation and total cancer incidence and mortality found inconsistent results, and most included trials administered generally low doses of vitamin D (≤1100 IU/day). We updated the meta-analysis by incorporating recent RCTs that have tested higher doses of vitamin D supplements.
MATERIALS AND METHODS
PubMed and Embase were searched from the inception to November 2018. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated using a random-effects model.
RESULTS
For total cancer incidence, 10 trials were included [6537 cases; 3-10 years of follow-up; 54-135 nmol/l of attained levels of circulating 25(OH) vitamin D [25(OH)D] in the intervention group]. The summary RR was 0.98 (95% CI, 0.93-1.03; P = 0.42; I2 = 0%). The results remained null across subgroups tested, including even when attained 25(OH)D levels exceeded 100 nmol/l (RR, 0.95; 95% CI, 0.83-1.09; P = 0.48; I2 = 26%). For total cancer mortality, five trials were included [1591 deaths; 3-10 years of follow-up; 54-135 nmol/l of attained levels of circulating 25(OH)D in the intervention group]. The summary RR was 0.87 (95% CI, 0.79-0.96; P = 0.005; I2 = 0%), which was largely attributable to interventions with daily dosing (as opposed to infrequent bolus dosing). No statistically significant heterogeneity was observed by attained levels of circulating 25(OH)D (Pheterogeneity = 0.83), with RR being 0.88 (95% CI, 0.78-0.98; P = 0.02; I2 = 0%) for ≤100 nmol/l and 0.85 (95% CI, 0.70-1.03; P = 0.11; I2 = 0%) for >100 nmol/l.
CONCLUSIONS
In an updated meta-analysis of RCTs, vitamin D supplementation significantly reduced total cancer mortality but did not reduce total cancer incidence.
背景
之前对维生素 D 补充剂与总癌症发病率和死亡率的随机对照试验（RCT）的荟萃分析得出的结果不一致，并且大多数纳入的试验给予的维生素 D 剂量通常较低（≤1100IU/天）。我们通过纳入最近测试更高剂量维生素 D 补充剂的 RCT 来更新荟萃分析。
材料与方法
从成立到 2018 年 11 月，在 PubMed 和 Embase 上进行了搜索。使用随机效应模型估算汇总相对风险（RR）和 95%置信区间（CI）。
结果
共有 10 项试验纳入了总癌症发病率的分析[6537 例；随访 3-10 年；干预组中循环 25（OH）维生素 D[25（OH）D]达到的水平为 54-135nmol/L]。汇总 RR 为 0.98（95%CI，0.93-1.03；P=0.42；I2=0%）。即使达到的 25（OH）D 水平超过 100nmol/L（RR，0.95；95%CI，0.83-1.09；P=0.48；I2=26%），结果仍为阴性。在测试的亚组中，包括即使达到的 25（OH）D 水平超过 100nmol/L（RR，0.95；95%CI，0.83-1.09；P=0.48；I2=26%）时，结果仍然为阴性。对于总癌症死亡率，共有 5 项试验纳入了分析[1591 例死亡；随访 3-10 年；干预组中循环 25（OH）D 达到的水平为 54-135nmol/L]。汇总 RR 为 0.87（95%CI，0.79-0.96；P=0.005；I2=0%），这主要归因于每日剂量（而非不频繁的大剂量）的干预措施。未观察到按循环 25（OH）D 达到的水平观察到的统计学显著异质性（P 异质性=0.83），RR 为≤100nmol/L 时为 0.88（95%CI，0.78-0.98；P=0.02；I2=0%），>100nmol/L 时为 0.85（95%CI，0.70-1.03；P=0.11；I2=0%）。
结论
在对 RCT 的更新荟萃分析中，维生素 D 补充剂显著降低了总癌症死亡率，但并未降低总癌症发病率。
Zotero 插件