Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Center Mannheim, University of Heidelberg, 69120 Mannheim, Germany.
Department of Nephrology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
Nutrients. 2024 Aug 13;16(16):2679. doi: 10.3390/nu16162679.
Target values for 25-hydroxy vitamin D and 1,25(OH)D or 1,25-dihydroxy vitamin D remain a topic of debate among clinicians. We analysed data collected from December 2012 to April 2020 from two cohorts. Cohort A, comprising 455,062 subjects, was used to investigate the relationship between inflammatory indicators (white blood cell [WBC] count and C-reactive protein [CRP]) and 25(OH)D/1,25(OH)D. Cohort B, including 47,778 subjects, was used to investigate the connection between 25(OH)D/1,25(OH)D and mineral metabolism markers (phosphate, calcium, and intact parathyroid hormone [iPTH]). Quadratic models fit best for all tested correlations, revealing U-shaped relationships between inflammatory indicators and 25(OH)D and 1,25(OH)D. Minimal CRP and WBC counts were observed at 1,25(OH)D levels of 60 pg/mL and at 25(OH)D levels of 32 ng/mL, as well as of 42 ng/mL, respectively. iPTH correlated inversely with both 1,25(OH)D and 25(OH)D, while phosphate as well as calcium levels positively correlated with both vitamin D forms. Calcium-phosphate product increased sharply when 25(OH)D was more than 50 ng/mL, indicating a possible risk for vascular calcification. Multiple regression analyses confirmed that these correlations were independent of confounders. This study suggests target values for 25(OH)D between 30-50 ng/mL and for 1,25(OH)D between 50-70 pg/mL, based particularly on their associations with inflammation but also with mineral metabolism markers. These findings contribute to the ongoing discussion around ideal levels of vitamin D but require support from independent studies with data on clinical endpoints.
目标值 25-羟维生素 D 和 1,25(OH)D 或 1,25-二羟维生素 D 仍然是临床医生争论的话题。我们分析了 2012 年 12 月至 2020 年 4 月从两个队列中收集的数据。队列 A 包括 455,062 例受试者，用于研究炎症指标（白细胞计数和 C 反应蛋白）与 25(OH)D/1,25(OH)D 之间的关系。队列 B 包括 47,778 例受试者，用于研究 25(OH)D/1,25(OH)D 与矿物质代谢标志物（磷酸盐、钙和完整甲状旁腺激素 [iPTH]）之间的关系。所有测试的相关性都最适合二次模型，表明炎症指标与 25(OH)D 和 1,25(OH)D 之间存在 U 型关系。在 1,25(OH)D 水平为 60 pg/mL 和 25(OH)D 水平为 32 ng/mL 时，观察到最小的 CRP 和白细胞计数，以及分别为 42 ng/mL。iPTH 与 1,25(OH)D 和 25(OH)D 呈负相关，而磷酸盐和钙水平与两种维生素 D 形式均呈正相关。当 25(OH)D 超过 50 ng/mL 时，钙-磷乘积急剧增加，表明血管钙化的风险可能增加。多元回归分析证实，这些相关性不受混杂因素的影响。本研究根据 25(OH)D 与炎症的关联以及与矿物质代谢标志物的关联，建议 25(OH)D 的目标值为 30-50ng/mL，1,25(OH)D 的目标值为 50-70pg/mL。这些发现有助于围绕维生素 D 的理想水平进行持续讨论，但需要来自具有临床终点数据的独立研究的支持。
