血清 25（OH）D 浓度、维生素 D 补充剂与 2 型糖尿病或糖尿病前期患者心血管疾病和死亡风险：系统评价和剂量反应荟萃分析。

Serum 25(OH)D Concentration, Vitamin D Supplementation, and Risk of Cardiovascular Disease and Mortality in Patients with Type 2 Diabetes or Prediabetes: a Systematic Review and Dose-Response Meta-Analysis.

机构信息

Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Am J Clin Nutr. 2023 Sep;118(3):697-707. doi: 10.1016/j.ajcnut.2023.07.012. Epub 2023 Jul 18.

DOI:10.1016/j.ajcnut.2023.07.012

PMID:37467897

Abstract

BACKGROUND

Evidence is uncertain about the association between serum 25-hydroxyvitamin D (25(OH)D) concentration and health outcomes in people with type 2 diabetes.

OBJECTIVES

We aimed to assess the association between vitamin D status and all-cause mortality and cardiovascular disease in people with type 2 diabetes.

METHODS

We did a systematic search in PubMed, Scopus, CENTRAL, and Web of Science until May 2022. We selected 1) cohort studies investigating the association between serum 25(OH)D concentration and mortality or cardiovascular disease in people with type 2 diabetes or prediabetes and 2) randomized trials of vitamin D supplementation in these patients. We used random-effects pairwise meta-analyses to calculate summary relative risks (RRs) and 95% confidence intervals (CI).

RESULTS

21 cohort studies and 6 randomized trials were included. Compared with sufficient vitamin D status (≥50 nmol/L), the RR of all-cause mortality was 1.36 (95% CI: 1.23, 1.49; n = 11 studies, GRADE = moderate) for vitamin D insufficiency (25 to <50 nmol/L), and 1.58 (1.33, 1.83; n = 16, GRADE = moderate) for deficiency (<25 nmol/L). Similar findings were observed for cardiovascular mortality and morbidity but not for cancer mortality. The certainty of evidence ranged from very low to moderate. Dose-response meta-analyses indicated nonlinear associations, with the lowest risk at 25(OH)D ∼60 nmol/L for all-cause and cardiovascular mortality. Supplementation with vitamin D did not reduce the risk of all-cause mortality (RR: 0.96, 95% CI: 0.79, 1.16; risk difference per 1000 patients: 3 fewer, 95% CI: 16 fewer, 12 more; n = 6 trials with 7316 participants; GRADE = low) or the risk of cardiovascular mortality and morbidity (very low- to low-certainty evidence).

CONCLUSIONS

Vitamin D deficiency and insufficiency are associated with a higher risk of all-cause and cardiovascular mortality in patients with type 2 diabetes or prediabetes. Vitamin D deficiency should be corrected in patients with type 2 diabetes to reach normal serum 25(OH)D concentrations, preferably 60 nmol/L.

SYSTEMATIC REVIEW REGISTRATION

This systemic review was registered at PROSPERO as CRD42022326429 (=https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=326429).

摘要

背景

关于血清 25-羟维生素 D（25（OH）D）浓度与 2 型糖尿病患者健康结果之间的关联，证据尚不确定。

目的

我们旨在评估维生素 D 状态与 2 型糖尿病患者全因死亡率和心血管疾病的关系。

方法

我们在 PubMed、Scopus、CENTRAL 和 Web of Science 进行了系统检索，检索截至 2022 年 5 月。我们纳入了 1）队列研究，调查血清 25（OH）D 浓度与 2 型糖尿病或糖尿病前期患者的死亡率或心血管疾病之间的关系，以及 2）这些患者中维生素 D 补充的随机试验。我们使用随机效应的两两荟萃分析来计算汇总相对风险（RR）和 95%置信区间（CI）。

结果

纳入了 21 项队列研究和 6 项随机试验。与充足的维生素 D 状态（≥50 nmol/L）相比，维生素 D 不足（25 至<50 nmol/L）的全因死亡率 RR 为 1.36（95%CI：1.23，1.49；n=11 项研究，GRADE=中度），维生素 D 缺乏（<25 nmol/L）的 RR 为 1.58（1.33，1.83；n=16 项研究，GRADE=中度）。心血管死亡率和发病率也有类似的发现，但癌症死亡率没有。证据的确定性范围从极低到中度。剂量-反应荟萃分析表明存在非线性关联，全因和心血管死亡率的最低风险出现在 25（OH）D 约 60 nmol/L 时。补充维生素 D 并不能降低全因死亡率的风险（RR：0.96，95%CI：0.79，1.16；每 1000 例患者的风险差异：3 例更少，95%CI：16 例更少，12 例更多；n=6 项试验，7316 名参与者；GRADE=低）或心血管死亡率和发病率的风险（极低至低确定性证据）。