Department of Epidemiology and Biostatistics, International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, US.
J Clin Endocrinol Metab. 2020 Oct 1;105(10). doi: 10.1210/clinem/dgaa432.
Although an inverse association between vitamin D status and mortality has been reported in observational studies, the precise association shape and optimal vitamin D status remain undetermined.
To investigate the association between vitamin D status and risk of all-cause and cause-specific mortality and estimate optimal serum 25-hydroxyvitamin D [25(OH)D] concentrations.
Prospective cohort study.
UK Biobank.
365 530 participants who had serum 25(OH)D measurements and no history of cardiovascular disease (CVD), cancer, or diabetes at baseline (2006-2010).
All-cause and cause-specific mortality.
During a median follow-up of 8.9 (interquartile range: 8.3-9.5) years, 10 175 deaths occurred, including 1841 (18.1%) due to CVD and 5737 (56.4%) due to cancer. The multivariate analyses revealed nonlinear inverse associations, with a decrease in mortality risk appearing to level off at 60 nmol/L of 25(OH)D for all-cause and CVD deaths and at 45 nmol/L for cancer deaths. Compared to participants with 25(OH)D concentrations below the cutoffs, those with higher concentrations had a 17% lower risk for all-cause mortality (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.79-0.86), 23% lower risk for CVD mortality (HR: 0.77, 95% CI: 0.68-0.86), and 11% lower risk for cancer mortality (HR: 0.89, 95% CI: 0.84-0.95).
Higher 25(OH)D concentrations are nonlinearly associated with lower risk of all-cause, CVD, and cancer mortality. The thresholds of 45 to 60 nmol/L might represent an intervention target to reduce the overall risk of premature death, which needs further confirmation in large clinical trials.
尽管观察性研究报告了维生素 D 状态与死亡率之间的反比关系，但确切的关联形状和最佳维生素 D 状态仍未确定。
研究维生素 D 状态与全因和特定原因死亡率的关系，并估计最佳血清 25-羟维生素 D [25(OH)D] 浓度。
前瞻性队列研究。
英国生物库。
365530 名参与者，基线时（2006-2010 年）无心血管疾病（CVD）、癌症或糖尿病史，且有血清 25(OH)D 测量值。
全因和特定原因死亡率。
在中位随访 8.9 年（四分位间距：8.3-9.5 年）期间，发生了 10175 例死亡，其中 1841 例（18.1%）死于 CVD，5737 例（56.4%）死于癌症。多变量分析显示出非线性反比关系，死亡率风险似乎在 60 nmol/L 的 25(OH)D 时对于全因和 CVD 死亡以及在 45 nmol/L 时对于癌症死亡趋于平稳。与低于切点的 25(OH)D 浓度的参与者相比，浓度较高的参与者全因死亡率降低 17%（风险比[HR]：0.83，95%置信区间[CI]：0.79-0.86），CVD 死亡率降低 23%（HR：0.77，95%CI：0.68-0.86），癌症死亡率降低 11%（HR：0.89，95%CI：0.84-0.95）。
较高的 25(OH)D 浓度与全因、CVD 和癌症死亡率降低呈非线性相关。45 至 60 nmol/L 的阈值可能代表降低过早死亡总体风险的干预目标，但需要在大型临床试验中进一步证实。
