Shraim Rasha, Brennan Margaret M, van Geffen Jos, Zgaga Lina
Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin D24 DH74, Ireland; Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin D08 W9RT, Ireland; The SFI Centre for Research Training in Genomics Data Sciences, University of Galway, Galway H91 CF50, Ireland.
Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin D24 DH74, Ireland.
J Steroid Biochem Mol Biol. 2025 Jun;250:106737. doi: 10.1016/j.jsbmb.2025.106737. Epub 2025 Mar 21.
25-hydroxyvitamin D (25OHD) is the principal biomarker of vitamin D status. Values below the assay detection limit (<10 nmol/L) are often reported as missing. Thus the most severely deficient participants are excluded from research which can lead to inaccurate findings such as underestimated prevalence of deficiency, overlooked risk factors, and biased evaluation of disease associations.
In total 369,626 individuals from the UK Biobank cohort were included in this study. Data on 25OHD concentration and relevant demographic and lifestyle factors such as age, supplement intake, diet, and time spent outdoors were used in the analyses. Ambient UVB radiation was approximated for each participant. 25OHD was evaluated as a categorical outcome and we reintroduced participants with 25OHD values < 10 nmol/L (conventionally reported as missing values) back to the dataset. Adjusted regression models were used to investigate the determinants of profound (25OHD <10 nmol/L) and severe (10-25 nmol/L) vitamin D deficiency and to assess disease associations (with 25-50 nmol/L as the reference category).
1,784 (0.48 %) individuals were profoundly deficient and a further 47,226 (12.78 %) individuals were severely vitamin D deficient. The proportions of profoundly and severely deficient were highest among Asians, 9 % and 47 %, respectively. Ambient UVB radiation was the second strongest predictor: comparing the lowest vs. highest quartile, the risk of profound deficiency was 17-fold increased and that of severe deficiency 7.5-fold increased. Use of vitamin D supplements substantially reduced risk of profound (4.4-fold) and severe (2.5-fold) deficiency, as did fish intake (5- and 1.9-fold, respectively). Profound deficiency was more strongly associated with chronic illness, diabetes, and emphysema compared to severe deficiency.
The prevalence of profound and severe vitamin D deficiency among Asian and Black ethnicities in the UK is high and requires targeted action. Solar radiation is potent in protecting against profound and severe vitamin D deficiency. Studies evaluating the relationship between vitamin D status and other health outcomes may be biased if profoundly deficient participants are excluded.
25-羟维生素D（25OHD）是维生素D状态的主要生物标志物。低于检测限的值（<10 nmol/L）通常报告为缺失值。因此，最严重缺乏的参与者被排除在研究之外，这可能导致不准确的结果，如低估缺乏的患病率、忽视风险因素以及对疾病关联的评估存在偏差。
本研究纳入了英国生物银行队列中的369,626名个体。分析中使用了25OHD浓度以及相关人口统计学和生活方式因素的数据，如年龄、补充剂摄入量、饮食和户外活动时间。估算了每位参与者周围环境中的紫外线B辐射量。将25OHD作为分类结果进行评估，并将25OHD值<10 nmol/L（传统上报告为缺失值）的参与者重新纳入数据集。使用调整后的回归模型来研究严重（25OHD<10 nmol/L）和重度（10 - 25 nmol/L）维生素D缺乏的决定因素，并评估疾病关联（以25 - 50 nmol/L作为参照类别）。
1784名（0.48%）个体严重缺乏，另有47226名（12.78%）个体重度维生素D缺乏。严重缺乏和重度缺乏的比例在亚洲人中最高，分别为9%和47%。周围环境中的紫外线B辐射是第二强的预测因素：比较最低四分位数和最高四分位数，严重缺乏的风险增加了17倍，重度缺乏的风险增加了7.5倍。使用维生素D补充剂可大幅降低严重（4.4倍）和重度（2.5倍）缺乏的风险，鱼类摄入量也有同样效果（分别为5倍和1.9倍）。与重度缺乏相比，严重缺乏与慢性病、糖尿病和肺气肿的关联更强。
英国亚洲和黑人种族中严重和重度维生素D缺乏的患病率很高，需要采取针对性行动。太阳辐射对预防严重和重度维生素D缺乏很有效。如果排除严重缺乏的参与者，评估维生素D状态与其他健康结果之间关系的研究可能会有偏差。
