MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Clin Nutr. 2022 Feb;41(2):337-347. doi: 10.1016/j.clnu.2021.12.010. Epub 2021 Dec 10.
BACKGROUND & AIMS: Existing epidemiological studies explored the associations of circulating vitamins and mortality focusing on individual vitamin effects, and controversial findings were obtained. The joint effects of multiple vitamin co-exposure are worth studying. The study aimed to elucidate the associations of circulating vitamins and the joint effects of these vitamins' co-exposure with all-cause and cause-specific mortality risks.
We prospectively evaluated the associations of the concentrations of six kinds of vitamins (A, D, E, C, B12 and B9) in serum with risks for all-cause and cause-specific mortalities among U.S. adults. Mortality status and cause of death were determined by NHANES-linked public available files dated up to 31 December 2015. An unsupervised K-means clustering method was used to cluster the participants into several vitamin co-exposure patterns. The Cox proportional hazards model was used for statistical analysis.
A total of 1404 deaths occurred during a median of 10.9 years follow-up among 8295 participants. In multivariable adjustment, increasing levels of vitamin D were associated with reduced all-cause and cause-specific mortality risks. A J-shaped nonlinear exposure-response relationship was observed between all studied vitamins (except for vitamin D) and all-cause mortality risk. Four co-exposure patterns were generated based on the studied vitamins, as follows: low-level exposure (cluster 1), vitamin A/D exposure (cluster 2), water-soluble vitamin exposure (cluster 3) and high-level exposure (cluster 4). Compared with those in cluster 1, participants in cluster 2 had lower all-cause and cancer mortality risks, with hazard ratios (95% confidence intervals [CIs]) of 0.67 (0.53, 0.85) and 0.45 (0.29, 0.71), respectively.
The findings in this study indicated that high circulating vitamin D levels were associated with reduced mortality risk among U.S. adults. Vitamin co-exposure at moderate levels appropriately contributed to low all-cause and cancer mortality risks. Our findings provided a novel perspective for exploring the joint health effects of multivitamin co-exposure. Future investigations are needed to further unravel the underlying mechanisms of possible vitamin interactions.
现有的流行病学研究主要关注单一维生素的作用，探讨了循环维生素与死亡率之间的关联，得出的结果存在争议。多种维生素共同暴露的联合作用值得研究。本研究旨在阐明循环维生素与这些维生素共同暴露的联合作用与全因和特定原因死亡率风险的关系。
我们前瞻性评估了血清中 6 种维生素（A、D、E、C、B12 和 B9）浓度与美国成年人全因和特定原因死亡率风险之间的关系。死亡率状况和死因由截至 2015 年 12 月 31 日的 NHANES 链接公共可用文件确定。使用无监督 K-均值聚类方法将参与者分为几种维生素共同暴露模式。使用 Cox 比例风险模型进行统计分析。
在 8295 名参与者中，中位随访 10.9 年期间共发生 1404 例死亡。在多变量调整后，维生素 D 水平升高与全因和特定原因死亡率风险降低相关。在所有研究的维生素（除维生素 D 外）与全因死亡率风险之间观察到 J 形非线性暴露-反应关系。基于所研究的维生素，生成了 4 种共同暴露模式，如下所示：低水平暴露（簇 1）、维生素 A/D 暴露（簇 2）、水溶性维生素暴露（簇 3）和高水平暴露（簇 4）。与簇 1 相比，簇 2 中的参与者全因和癌症死亡率较低，风险比（95%置信区间 [CI]）分别为 0.67（0.53，0.85）和 0.45（0.29，0.71）。
本研究结果表明，美国成年人中循环维生素 D 水平较高与死亡率降低相关。适当的中等水平维生素共同暴露有助于降低全因和癌症死亡率。我们的研究结果为探索多种维生素共同暴露的联合健康效应提供了新视角。未来的研究需要进一步揭示可能的维生素相互作用的潜在机制。
