成人血清维生素D水平与2型糖尿病及糖尿病前期的关系：一项流行病学研究的系统评价和剂量反应荟萃分析

Serum vitamin D levels in relation to type-2 diabetes and prediabetes in adults: a systematic review and dose-response meta-analysis of epidemiologic studies.

作者信息

Mohammadi Sobhan, Hajhashemy Zahra, Saneei Parvane

机构信息

Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Crit Rev Food Sci Nutr. 2022;62(29):8178-8198. doi: 10.1080/10408398.2021.1926220. Epub 2021 Jun 2.

DOI:10.1080/10408398.2021.1926220

PMID:34076544

Abstract

BACKGROUND

Findings of observational studies that investigated the relationship between vitamin D deficiency and abnormal glucose homeostasis were contradictory. This meta-analysis of epidemiologic studies evaluated the association of vitamin D status and risk of type-2 diabetes (T2D) and prediabetes in adults.

METHODS

A systematic search was conducted on all published articles in five electronic databases (including MEDLINE/PubMed, EMBASE, Institute for Scientific Information, Scopus and Google scholar), up to August 2020. Twenty-eight prospective cohort and nested case-control studies and 83 cross-sectional and case-control investigations that reported relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for abnormal glucose homeostasis in relation to serum vitamin D levels in adults were included in the analysis.

RESULTS

In prospective studies, high versus low level of vitamin D was respectively associated with significant 35%, 30% and 51% decrease in risk of T2D (RR:0.65; 95%CI: 0.55-0.76; 27 effect sizes), combined T2D and pre-diabetes (RR:0.70; 95%CI: 0.52-0.95; 9 effect sizes) and pre-diabetes (RR:0.49; 95%CI: 0.26-0.93; 2 effect sizes). These inverse associations were significant in almost all subgroups. Dose-response analysis in prospective studies showed that each 10 ng/ml increase in serum vitamin D levels resulted in 12% and 11% reduced risk of T2D (RR:0.88; 95%CI: 0.83-0.94) and combined T2D and prediabetes (RR:0.89; 95%CI: 0.87-0.92), respectively. In cross-sectional and case-control studies, highest versus lowest level of serum vitamin D was linked to reduced odds of T2D (OR:0.64; 95%CI: 0.57-0.72; 42 effect sizes) and combined T2D and pre-diabetes (OR:0.79; 95%CI: 0.74-0.85; 59 effect sizes); but not pre-diabetes (OR:0.64; 95%CI: 0.17-2.37; 11 effect sizes).

CONCLUSION

This meta-analysis of epidemiologic studies disclosed that serum vitamin D level was reversely associated with the risk of T2D and combined T2D and prediabetes in adults, in a dose-response manner. However, the association was not remarkable for pre-diabetes.

摘要

背景

关于维生素D缺乏与葡萄糖稳态异常之间关系的观察性研究结果相互矛盾。这项流行病学研究的荟萃分析评估了成年人维生素D状态与2型糖尿病（T2D）和糖尿病前期风险之间的关联。

方法

对截至2020年8月在五个电子数据库（包括MEDLINE/PubMed、EMBASE、科学信息研究所、Scopus和谷歌学术）中发表的所有文章进行了系统检索。纳入分析的有28项前瞻性队列研究和巢式病例对照研究，以及83项横断面研究和病例对照研究，这些研究报告了与成年人血清维生素D水平相关的葡萄糖稳态异常的相对风险（RRs）或比值比（ORs）及95%置信区间（CIs）。

结果

在前瞻性研究中，维生素D水平高与低相比，T2D风险显著分别降低35%、30%和51%（RR：0.65；95%CI：0.55 - 0.76；27个效应量），T2D和糖尿病前期合并风险降低（RR：0.70；95%CI：0.52 - 0.95；9个效应量），糖尿病前期风险降低（RR：0.49；95%CI：0.26 - 0.93；2个效应量）。这些反向关联在几乎所有亚组中均显著。前瞻性研究中的剂量反应分析表明，血清维生素D水平每升高10 ng/ml，T2D风险降低12%，T2D和糖尿病前期合并风险降低11%（RR：0.88；95%CI：0.83 - 0.94）和（RR：0.89；95%CI：0.87 - 0.92）。在横断面研究和病例对照研究中，血清维生素D水平最高与最低相比，T2D几率降低（OR：0.64；95%CI：0.57 - 0.72；有42个效应量），T2D和糖尿病前期合并几率降低（OR：0.79；95%CI：0.74 - 0.85；59个效应量）；但与糖尿病前期无关（OR：0.64；95%CI：0.17 - 2.37；11个效应量）。