Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia.
Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia.
Mult Scler Relat Disord. 2024 Oct;90:105804. doi: 10.1016/j.msard.2024.105804. Epub 2024 Aug 8.
Although there is evidence of a link between vitamin D status and risk of multiple sclerosis (MS), there has been no systematic review where the exposure measure was vitamin D deficiency rather than 25 hydroxy vitamin D (25(OH)D) concentration. We conducted an updated systematic review and meta-analysis to estimate the association between vitamin D deficiency, defined in most studies as a serum 25(OH)D concentration of < 50 nmol L, and MS.
We searched the MEDLINE, EMBASE, and CINAHL databases to identify relevant publications. We estimated the pooled odds ratio (OR) using a random effects model for the association between vitamin D deficiency and MS, overall and stratified by several factors, including whether or not studies included participants who were taking vitamin D supplements. We also analysed the association between mean 25(OH)D concentration and MS, and used meta-regression to assess the effects of vitamin D supplementation, latitude, age, ethnicity, vitamin D definition and seasonality on the OR estimates. The Newcastle-Ottawa Scale was used to assess study quality.
Results were pooled across 14 case-control studies published between 2007 and 2021 (n = 4130 cases, n = 4604 controls). Persons with vitamin D deficiency had a 54 % higher risk of multiple sclerosis than those with sufficient vitamin D status (OR 1.54; 95 % CI 1.05, 2.24). In studies that excluded participants taking vitamin D supplements (N = 7), the OR was 2.19 (95 % CI: 1.44, 3.35), whereas, in studies that did not exclude participants taking supplements, there was no increase in risk (OR 0.82; 95 % CI: 0.43, 1.58). Mean age (R = 27.4 %) and inclusion/exclusion of participants taking supplements (R = 33.4 %) contributed most to variability in the OR of vitamin D deficiency and MS.
Vitamin D deficiency is associated with an increased likelihood of multiple sclerosis. Maintaining sufficient vitamin D may be an important modifiable risk factor for MS.
尽管有证据表明维生素 D 状态与多发性硬化症 (MS) 的风险之间存在关联，但尚无系统评价将暴露测量指标定义为维生素 D 缺乏而非 25 羟维生素 D（25(OH)D）浓度。我们进行了一项更新的系统评价和荟萃分析，以评估大多数研究中定义为血清 25(OH)D 浓度<50nmol/L 的维生素 D 缺乏与 MS 之间的关联。
我们检索了 MEDLINE、EMBASE 和 CINAHL 数据库，以确定相关文献。我们使用随机效应模型估计了维生素 D 缺乏与 MS 之间的汇总比值比 (OR)，总体分析和按多种因素分层分析，包括研究是否包括服用维生素 D 补充剂的参与者。我们还分析了平均 25(OH)D 浓度与 MS 的关联，并使用元回归评估了维生素 D 补充剂、纬度、年龄、种族、维生素 D 定义和季节性对 OR 估计值的影响。纽卡斯尔-渥太华量表用于评估研究质量。
2007 年至 2021 年期间发表的 14 项病例对照研究（n=4130 例病例，n=4604 例对照）的结果在汇总分析中进行了合并。与维生素 D 充足状态的人相比，维生素 D 缺乏的人患多发性硬化症的风险高 54%（OR 1.54；95%CI 1.05，2.24）。在排除服用维生素 D 补充剂的参与者的研究中（N=7），OR 为 2.19（95%CI：1.44，3.35），而在未排除服用补充剂的参与者的研究中，风险没有增加（OR 0.82；95%CI：0.43，1.58）。平均年龄（R=27.4%）和纳入/排除服用补充剂的参与者（R=33.4%）对维生素 D 缺乏和 MS 的 OR 变异性贡献最大。
维生素 D 缺乏与多发性硬化症的发生几率增加相关。维持足够的维生素 D 可能是多发性硬化症的一个重要可改变的危险因素。
