Serum Parathyroid Hormone Responses to Vitamin D Supplementation in Overweight/Obese Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Serum Parathyroid Hormone Responses to Vitamin D Supplementation in Overweight/Obese Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
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DOI：
10.3390/nu9030241
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发表时间：
2017-03-06
期刊：
影响因子：
5.9
通讯作者：
Sukumar D
中科院分区：
文献类型：
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作者：
Lotito A;Teramoto M;Cheung M;Becker K;Sukumar D
肥胖通常与维生素D缺乏和继发性甲状旁腺功能亢进有关。维生素D补充剂通常会导致血清甲状旁腺激素（PTH）水平降低，如正常体重个体所示。同时，补充维生素D抑制PTH的剂量可能在超重和肥胖的成年人中有所不同。我们对随机对照试验进行了系统回顾和荟萃分析，以确定抑制超重/肥胖个体PTH水平所需的维生素D补充剂量。我们确定了18项研究，这些研究检查了超重或肥胖的健康成年人，他们补充了不同剂量的维生素D3。检查的主要结果是PTH和血清25-羟基维生素D（25 OHD）水平从基线到治疗后的变化。荟萃分析结果显示，补充维生素D对PTH有显著的治疗效果，总标准化均值差（SMD）（随机效应）= −0.38（95% CI = −0.56至−0.20），t = −4.08，p < 0.001。维生素D补充剂对25 OHD也有显著的治疗效果，总SMD（随机效应）= 2.27（95% CI = 1.48 - 3.06）t = 5.62，p < 0.001。现有的临床试验数据显示，补充400 IU至5714 IU的维生素D可以最好地抑制血清PTH水平，总SMD =-0.58，而补充4000 IU的维生素D显示血清25 OH水平增加最多。分别补充700 IU和500 mg的维生素D和钙也显示出对PTH抑制的显著治疗效果，总SMD = −5.30（95% CI = −9.72至−0.88）。总之，现有临床试验的Meta分析表明，1000 IU维生素D补充剂可以抑制血清PTH水平，而4000 IU维生素D与超重和肥胖人群血清25 OHD水平的最大增加相关。
Obesity is often associated with vitamin D deficiency and secondary hyperparathyroidism. Vitamin D supplementation typically leads to the reductions in serum parathyroid hormone (PTH) levels, as shown in normal weight individuals. Meanwhile, the dose of vitamin D supplementation for the suppression of PTH may differ in overweight and obese adults. We conducted a systematic review and meta-analysis of randomized controlled trials to determine the dose of vitamin D supplementation required to suppress PTH levels in overweight/obese individuals. We identified 18 studies that examined overweight or obese healthy adults who were supplemented with varying doses of vitamin D3. The primary outcomes examined were changes in PTH and serum 25-hydroxyvitamin D (25OHD) levels from baseline to post-treatment. The results of the meta-analysis showed that there was a significant treatment effect of vitamin D supplementation on PTH, total standardized mean difference (SMD) (random effects) = −0.38 (95% CI = −0.56 to −0.20), t = −4.08, p < 0.001. A significant treatment effect of vitamin D supplementation was also found on 25OHD, total SMD (random effects) = 2.27 (95% CI = 1.48 to 3.06) t = 5.62, p < 0.001. Data from available clinical trials that supplemented adults with D3 ranging from 400 IU to 5714 IU, showed that 1000 IU of vitamin D supplementation best suppressed serum PTH levels, total SMD = −0.58, while vitamin D supplementation with 4000 IU showed the greatest increase in serum 25OH levels. Vitamin D and calcium supplementation of 700 IU and 500 mg, respectively, also showed a significant treatment effect on the suppression of PTH with a total SMD = −5.30 (95% CI = −9.72 to −0.88). In conclusion, the meta analysis of available clinical trials indicates that 1000 IU vitamin D supplementation can suppress serum PTH levels, while 4000 IU of vitamin D was associated with the largest increase in serum 25OHD levels in the overweight and obese population.