血浆 25-羟维生素 D 浓度与≥80 岁中国成年人全因死亡率呈负相关。
Plasma 25-Hydroxyvitamin D Concentrations Are Inversely Associated with All-Cause Mortality among a Prospective Cohort of Chinese Adults Aged ≥80 Years.
机构信息
Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China.
Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China.
出版信息
J Nutr. 2019 Jun 1;149(6):1056-1064. doi: 10.1093/jn/nxz041.
BACKGROUND
High concentrations of plasma 25-hydroxyvitamin D [25(OH)D], a marker of circulating vitamin D, have been associated with a lower risk of mortality in epidemiologic studies of multiple populations, but the association for Chinese adults aged ≥80 y (oldest old) remains unclear.
OBJECTIVE
We investigated the association between plasma [25(OH)D] concentration and all-cause mortality among Chinese adults aged ≥80 y.
DESIGN
The present study is a prospective cohort study of 2185 Chinese older adults (median age: 93 y). Prospective all-cause mortality data were analyzed for survival in relation to plasma 25(OH)D using Cox proportional hazards regression models, with adjustments for potential sociodemographic and lifestyle confounders and biomarkers. The associations were measured with HR and 95% CIs.
RESULTS
The median plasma 25(OH)D concentration was 34.4 nmol/L at baseline. Over the 5466 person-year follow-up period, 1100 deaths were identified. Men and women were analyzed together as no effect modification by sex was found. After adjusting for multiple potential confounders, the risk of all-cause mortality decreased as the plasma 25(OH)D concentration increased (P-trend <0.01). Compared with the lowest age-specific quartile of plasma 25(OH)D, the adjusted HRs for mortality for the second, third, and fourth age-specific quartiles were 0.72 (95% CI: 0.57, 0.90), 0.73 (95% CI: 0.58, 0.93), and 0.61 (95% CI: 0.47, 0.81), respectively. The observed associations were broadly consistent across age and other subgroups. Sensitivity analyses generated similar results after excluding participants who died within 2 y of follow-up or after further adjustment for ethnicity and chronic diseases.
CONCLUSIONS
A higher plasma 25-hydroxyvitamin D concentration was associated with a reduced risk of all-cause mortality among Chinese adults aged ≥80 y. This observed inverse association warrants further investigation in randomized controlled trials testing vitamin D supplementation in this age group.
背景
在多项人群的流行病学研究中，较高的血浆 25-羟维生素 D [25(OH)D] 浓度，即循环维生素 D 的标志物，与较低的死亡率相关，但对于 80 岁及以上的中国成年人（最年长的老年人），其关联仍不清楚。
目的
我们研究了中国 80 岁及以上成年人的血浆[25(OH)D]浓度与全因死亡率之间的关系。
设计
本研究是一项对 2185 名中国老年人（中位年龄：93 岁）的前瞻性队列研究。使用 Cox 比例风险回归模型分析前瞻性全因死亡率数据，根据血浆 25(OH)D 与生存的关系进行分析，调整了潜在的社会人口统计学和生活方式混杂因素和生物标志物。使用 HR 和 95%CI 进行关联测量。
结果
基线时的中位血浆 25(OH)D 浓度为 34.4 nmol/L。在 5466 人年的随访期间，有 1100 人死亡。由于未发现性别对效应的修饰作用，因此将男性和女性一起进行分析。在调整了多个潜在混杂因素后，随着血浆 25(OH)D 浓度的升高，全因死亡率的风险降低（P 趋势<0.01）。与最低年龄特异四分位数的血浆 25(OH)D 相比，第二、第三和第四年龄特异四分位数的死亡率校正 HR 分别为 0.72（95%CI：0.57，0.90）、0.73（95%CI：0.58，0.93）和 0.61（95%CI：0.47，0.81）。观察到的关联在不同年龄组和其他亚组中基本一致。在排除随访 2 年内死亡的参与者或进一步调整种族和慢性疾病后进行敏感性分析，得到了类似的结果。
结论
较高的血浆 25-羟维生素 D 浓度与中国 80 岁及以上成年人的全因死亡率降低相关。这种观察到的反比关联需要在针对该年龄组的维生素 D 补充的随机对照试验中进一步研究。
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