心房内平均 25(OH)D 浓度对糖尿病风险的影响，按种族和体重分层：D2d 研究的辅助分析。
Effect of intratrial mean 25(OH)D concentration on diabetes risk, by race and weight: an ancillary analysis in the D2d study.
机构信息
Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States.
出版信息
Am J Clin Nutr. 2023 Jul;118(1):59-67. doi: 10.1016/j.ajcnut.2023.03.021. Epub 2023 Mar 29.
BACKGROUND
Higher serum 25-hydroxyvitamin D [25(OH)D] is associated with lower type 2 diabetes risk. 25(OH)D varies due to skin pigmentation and weight.
OBJECTIVES
This analysis aims to determine whether the effect of vitamin D differs among people of color and those with overweight/obesity (who have higher diabetes risk) compared with individuals who are White or have normal weight.
METHODS
The D2d study is a randomized clinical trial in people with prediabetes that tested the effects of daily vitamin D 4000 IU vs. placebo on diabetes risk (median followup 2.5 y). We compared baseline and intratrial mean 25(OH)D concentrations, defined as the mean of all available annual 25(OH)D values, among groups defined by self-reported race and body mass index (BMI). We used Cox proportional hazards models to assess the associations between intratrial mean 25(OH)D and diabetes risk by race- and BMI-based groups.
RESULTS
Asian (n=130), Black (n=616), and White (n=1616) participants were included. Both baseline and intratrial mean 25(OH)D concentrations differed significantly by race groups (both P < 0.001) and were lower in Asian and Black vs. White participants, and in those with higher vs. lower BMI adjusted for race (both P < 0.001). Compared with those with lower concentrations, Black and White participants with intratrial mean 25(OH)D ≥ 40 ng/mL had significantly reduced diabetes risk [HR (95% CI): Black: 0.51 (0.29, 0.92); White: 0.42 (0.30, 0.60)] and with a similar reduction in diabetes risk among Asian participants: 0.39 (0.14, 1.11). Compared with those with lower concentrations, participants with baseline BMI < 40 kg/m who achieved intratrial mean 25(OH)D concentrations ≥ 40 ng/mL had a significantly reduced diabetes risk. There was no statistically significant interaction between intratrial 25(OH)D and race or between intratrial 25(OH)D and BMI on diabetes risk.
CONCLUSIONS
Among people with prediabetes, particularly for Black and White race groups and those with BMI < 40 kg/m, the optimal 25(OH)D concentration may be ≥ 40 ng/mL to optimize diabetes-prevention efforts. This trial was registered at clinicaltrials.gov as NCT01942694.
背景
较高的血清 25-羟维生素 D [25（OH）D]与较低的 2 型糖尿病风险相关。25（OH）D 因皮肤色素沉着和体重而异。
目的
本分析旨在确定与白人或体重正常者相比，维生素 D 的作用是否在有色人种和超重/肥胖者（糖尿病风险较高）中存在差异。
方法
D2d 研究是一项针对前驱糖尿病患者的随机临床试验，测试了每日补充维生素 D4000IU 与安慰剂对糖尿病风险的影响（中位随访 2.5 年）。我们根据自我报告的种族和体重指数（BMI），比较了各组的基线和室内平均 25（OH）D 浓度，定义为所有可用年度 25（OH）D 值的平均值。我们使用 Cox 比例风险模型，根据种族和 BMI 为基础的组评估室内平均 25（OH）D 与糖尿病风险之间的关联。
结果
纳入了亚洲（n=130）、黑种人（n=616）和白种人（n=1616）参与者。种族组之间的基线和室内平均 25（OH）D 浓度均有显著差异（均 P <0.001），且与白种人相比，亚洲人和黑种人的 25（OH）D 浓度较低，与更高的 BMI 相比，亚洲人和黑种人的 25（OH）D 浓度也较低（均 P <0.001）。与浓度较低的参与者相比，室内平均 25（OH）D 浓度≥40ng/mL 的黑种人和白种参与者的糖尿病风险显著降低[HR（95%CI）：黑种人：0.51（0.29，0.92）；白种人：0.42（0.30，0.60）]，且亚洲参与者的糖尿病风险也有类似的降低：0.39（0.14，1.11）。与浓度较低的参与者相比，基线 BMI <40kg/m2 的参与者，如果达到室内平均 25（OH）D 浓度≥40ng/mL，则糖尿病风险显著降低。在糖尿病风险方面，室内 25（OH）D 与种族或室内 25（OH）D 与 BMI 之间无统计学显著交互作用。
结论
在患有前驱糖尿病的人群中，特别是对于黑种人和白种人以及 BMI <40kg/m2 的人群，优化糖尿病预防措施的最佳 25（OH）D 浓度可能≥40ng/mL。该试验在 clinicaltrials.gov 上注册为 NCT01942694。
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