Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.
Centre for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China.
Adv Nutr. 2022 Aug 1;13(4):1044-1062. doi: 10.1093/advances/nmab142.
Observational studies, randomized controlled trials (RCTs), and Mendelian randomization (MR) studies have yielded inconsistent results on the associations of vitamin D concentrations with multiple health outcomes. In the present umbrella review we aimed to evaluate the effects of low vitamin D concentrations and vitamin D supplementation on multiple health outcomes. We summarized current evidence obtained from meta-analyses of observational studies that examined associations between vitamin D concentrations and multiple health outcomes, meta-analyses of RCTs that investigated the effect of vitamin D supplementation on multiple health outcomes, and MR studies that explored the causal associations of vitamin D concentrations with various diseases (international prospective register of systematic reviews PROSPERO registration number CRD42018091434). A total of 296 meta-analyses of observational studies comprising 111 unique outcomes, 139 meta-analyses of RCTs comprising 46 unique outcomes, and 73 MR studies comprising 43 unique outcomes were included in the present umbrella review. Twenty-eight disease outcomes were identified by both meta-analyses of observational studies and MR studies. Seventeen of these reported disease outcomes had consistent results, demonstrating that lower concentrations of vitamin D were associated with a higher risk for all-cause mortality, Alzheimer's disease, hypertension, schizophrenia, and type 2 diabetes. The combinations of consistent evidence obtained by meta-analyses of observational studies and MR studies together with meta-analyses of RCTs showed that vitamin D supplementation was associated with a decreased risk for all-cause mortality but not associated with the risk for Alzheimer's disease, hypertension, schizophrenia, or type 2 diabetes. The results indicated that vitamin D supplementation is a promising strategy with long-term preventive effects on multiple chronic diseases and thus has the potential to decrease all-cause mortality. However, the current vitamin D supplementation strategy might not be an efficient intervention approach for these diseases, suggesting that new strategies are highly needed to improve the intervention outcomes.
观察性研究、随机对照试验（RCT）和孟德尔随机化（MR）研究在维生素 D 浓度与多种健康结果的关联方面得出了不一致的结果。在本伞式综述中，我们旨在评估低维生素 D 浓度和维生素 D 补充对多种健康结果的影响。我们总结了目前从观察性研究的荟萃分析中获得的证据，这些研究检查了维生素 D 浓度与多种健康结果之间的关联，从 RCT 的荟萃分析中获得了维生素 D 补充对多种健康结果的影响的证据，以及从 MR 研究中获得了维生素 D 浓度与各种疾病之间因果关系的证据（国际前瞻性系统评价注册处 PROSPERO 注册号 CRD42018091434）。本伞式综述共纳入了 296 项观察性研究的荟萃分析，包含 111 个独特的结局；139 项 RCT 的荟萃分析，包含 46 个独特的结局；73 项 MR 研究，包含 43 个独特的结局。通过观察性研究和 MR 研究的荟萃分析共确定了 28 种疾病结局。其中 17 种报告的疾病结局具有一致性结果，表明较低的维生素 D 浓度与全因死亡率、阿尔茨海默病、高血压、精神分裂症和 2 型糖尿病的风险增加相关。观察性研究和 MR 研究的荟萃分析的一致性证据以及 RCT 的荟萃分析相结合的结果表明，维生素 D 补充与全因死亡率降低相关，但与阿尔茨海默病、高血压、精神分裂症或 2 型糖尿病的风险无关。结果表明，维生素 D 补充是一种有前途的策略，对多种慢性疾病具有长期预防作用，因此有可能降低全因死亡率。然而，目前的维生素 D 补充策略可能不是这些疾病的有效干预方法，这表明需要新的策略来改善干预效果。
