Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
BMJ. 2019 Aug 12;366:l4673. doi: 10.1136/bmj.l4673.
To investigate whether vitamin D supplementation is associated with lower mortality in adults.
Systematic review and meta-analysis of randomised controlled trials.
Medline, Embase, and the Cochrane Central Register from their inception to 26 December 2018.
Randomised controlled trials comparing vitamin D supplementation with a placebo or no treatment for mortality were included. Independent data extraction was conducted and study quality assessed. A meta-analysis was carried out by using fixed effects and random effects models to calculate risk ratio of death in the group receiving vitamin D supplementation and the control group.
All cause mortality.
52 trials with a total of 75 454 participants were identified. Vitamin D supplementation was not associated with all cause mortality (risk ratio 0.98, 95% confidence interval 0.95 to 1.02, I=0%), cardiovascular mortality (0.98, 0.88 to 1.08, 0%), or non-cancer, non-cardiovascular mortality (1.05, 0.93 to 1.18, 0%). Vitamin D supplementation statistically significantly reduced the risk of cancer death (0.84, 0.74 to 0.95, 0%). In subgroup analyses, all cause mortality was significantly lower in trials with vitamin D supplementation than in trials with vitamin D supplementation (P for interaction=0.04); neither vitamin D nor vitamin D was associated with a statistically significant reduction in all cause mortality.
Vitamin D supplementation alone was not associated with all cause mortality in adults compared with placebo or no treatment. Vitamin D supplementation reduced the risk of cancer death by 16%. Additional large clinical studies are needed to determine whether vitamin D supplementation is associated with lower all cause mortality.
PROSPERO registration number CRD42018117823.
探讨维生素 D 补充剂是否与成年人死亡率降低有关。
对随机对照试验进行系统评价和荟萃分析。
从建库至 2018 年 12 月 26 日，检索 Medline、Embase 和 Cochrane 中央注册库。
纳入比较维生素 D 补充剂与安慰剂或不治疗死亡率的随机对照试验。独立进行数据提取和研究质量评估。采用固定效应和随机效应模型进行荟萃分析，计算接受维生素 D 补充剂组和对照组的死亡风险比。
全因死亡率。
共纳入 52 项试验，总计 75454 名参与者。维生素 D 补充剂与全因死亡率（风险比 0.98，95%置信区间 0.95 至 1.02，I=0%）、心血管死亡率（0.98，0.88 至 1.08，0%）或非癌症、非心血管死亡率（1.05，0.93 至 1.18，0%）均无相关性。维生素 D 补充剂可显著降低癌症死亡风险（0.84，0.74 至 0.95，0%）。亚组分析显示，与维生素 D 补充剂治疗相比，维生素 D 补充剂治疗试验的全因死亡率显著降低（P 交互=0.04）；无论补充维生素 D 还是维生素 D，全因死亡率均无显著降低。
与安慰剂或不治疗相比，单独使用维生素 D 补充剂与成年人的全因死亡率无关。维生素 D 补充剂可降低 16%的癌症死亡风险。需要开展更多的大型临床研究，以确定维生素 D 补充剂是否与全因死亡率降低有关。
PROSPERO 注册号 CRD42018117823。
