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维生素 D 补充与认知-来自 D-Health 试验分析的结果。

Vitamin D supplementation and cognition-Results from analyses of the D-Health trial.

机构信息

Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia.

School of Public Health, University of Queensland, Brisbane, Australia.

出版信息

J Am Geriatr Soc. 2023 Jun;71(6):1773-1784. doi: 10.1111/jgs.18247. Epub 2023 Jan 30.

Abstract

BACKGROUND

Observational studies have consistently found a link between low serum 25-hydroxyvitamin D concentration and higher risk of cognitive impairment. Results from randomized controlled trials have been mixed, and few have been conducted in the general population.

METHODS

We recruited 21,315 community-dwelling Australians aged between 60 and 84 years to participate in the D-Health Trial, a randomized, double-blind, placebo-controlled trial. The intervention was monthly oral doses of 60,000 international units of vitamin D or placebo for 5 years. We assessed cognitive function in a randomly sampled group of participants aged ≥70 years using the Telephone Interview for Cognitive Status (TICS) at 2 and 5 years after randomization. The primary outcome for this analysis was TICS score; the secondary outcome was the proportion of people who had cognitive impairment (defined as TICS score ≤25). We analyzed data using mixed models (linear and logistic).

RESULTS

We interviewed 3887 participants at year 2 and 3614 participants at year 5. The mean TICS score at these time points was 32.3 and 32.2, respectively. Vitamin D supplementation did not affect cognitive function as measured by TICS score (mean difference between vitamin D and placebo groups 0.04; 95% CI -0.14 to 0.23), or alter risk of cognitive impairment (odds ratio 1.00; 95% CI 0.75 to 1.33).

CONCLUSIONS

Monthly bolus doses of vitamin D supplementation neither enhanced nor hindered cognitive function among older adults. Population-wide vitamin D supplementation of older adults that are largely vitamin D replete is unlikely to substantially benefit cognition.

摘要

背景

观察性研究一致发现血清 25-羟维生素 D 浓度低与认知障碍风险增加之间存在关联。随机对照试验的结果喜忧参半,且很少在普通人群中进行。

方法

我们招募了 21315 名年龄在 60 至 84 岁之间的居住在社区的澳大利亚人参加 D-Health 试验,这是一项随机、双盲、安慰剂对照试验。干预措施是每月口服 60000 国际单位的维生素 D 或安慰剂,持续 5 年。在随机分组后 2 年和 5 年,我们使用电话认知状态测试(TICS)评估≥70 岁的随机抽样参与者的认知功能。本分析的主要结局是 TICS 评分;次要结局是认知障碍(定义为 TICS 评分≤25)的人数比例。我们使用混合模型(线性和逻辑)分析数据。

结果

我们在第 2 年和第 5 年分别对 3887 名参与者和 3614 名参与者进行了访谈。这两个时间点的 TICS 评分均值分别为 32.3 和 32.2。维生素 D 补充并未影响 TICS 评分衡量的认知功能(维生素 D 组和安慰剂组之间的平均差异为 0.04;95%CI-0.14 至 0.23),也未改变认知障碍的风险(比值比 1.00;95%CI0.75 至 1.33)。

结论

每月大剂量补充维生素 D 既不能增强也不能阻碍老年人的认知功能。在很大程度上维生素 D 充足的老年人中进行广泛的维生素 D 补充不太可能对认知产生显著益处。

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