Serum 25-hydroxyvitamin D levels and incident diabetes mellitus type 2: a competing risk analysis in a large population-based cohort of older adults
Serum 25-hydroxyvitamin D levels and incident diabetes mellitus type 2: a competing risk analysis in a large population-based cohort of older adults
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DOI：
10.1007/s10654-013-9769-z
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发表时间：
2013-03-01
影响因子：
13.6
通讯作者：
Brenner, Hermann
中科院分区：
文献类型：
--
作者：
Schoettker, Ben;Herder, Christian;Brenner, Hermann
维生素D缺乏如何可能有助于糖尿病的发展提出了合理的机制，但纵向队列研究产生了异质性的结果。在7,791名年龄在50-74岁的德国人群队列中最初无糖尿病的受试者中，采用调整后的考克斯回归模型估计血清25-羟基维生素D（25（OH）D）五分位数与糖尿病发病率相关性的风险比（HR）和95%置信区间（CI）。用限制性三次样条曲线评估剂量-反应关系。此外，还对糖尿病和死亡的竞争风险进行了分析。在8年的随访中，829名研究参与者患上了糖尿病。在女性中，与25（OH）D五分位数3-5的女性相比，最低25（OH）D五分位数（HR，1.38; 1.09-1.75）的糖尿病风险显著增加，而第二五分位数（HR，1.24; 0.98-1.55）的糖尿病风险无显著增加。剂量-反应关系显示，在25（OH）D水平低于70 nmol/L（统计学显著性：低于40 nmol/L）时，风险开始增加，呈非线性负相关。在男性中，25（OH）D水平与糖尿病发病率无关。肾功能不全是一种效应修饰因子，如果受试者有肾功能不全，与五分位数3-5相比，25（OH）D五分位数1的糖尿病风险增加一倍以上，五分位数2的风险增加约1.5倍。观察到的相关性不受死亡竞争风险的影响。在这项老年人的大型队列研究中，女性血清25（OH）D水平与糖尿病发病率呈负相关，但男性则不然。在肾功能不全的受试者中，这种相关性特别强。
Plausible mechanisms of how vitamin D deficiency may contribute to the development of diabetes mellitus have been proposed but longitudinal cohort studies have yielded heterogeneous results. In 7,791 initially diabetes-free participants of a German population-based cohort, aged 50-74 years, adjusted Cox regression models were employed to estimate hazard ratios (HR) with 95 % confidence intervals (CI) for the association of serum 25-hydroxyvitamin D (25(OH)D) quintiles and incident diabetes. Dose-response relationships were assessed with restricted cubic spline curves. Additionally, analyses accounting for the competing risks of diabetes and death were performed. During 8 years of follow-up, 829 study participants developed diabetes. In women, diabetes risk was significantly increased in the lowest 25(OH)D quintile (HR, 1.38; 1.09-1.75) and non-significantly increased in the 2nd quintile (HR, 1.24; 0.98-1.55) compared to women in 25(OH)D quintiles 3-5. The dose-response relationship showed a non-linear inverse association with risk starting to increase at 25(OH)D levels below 70 nmol/L (statistically significant: below 40 nmol/L). In men, 25(OH)D levels were not associated with diabetes incidence. Renal dysfunction was an effect modifier with a more than doubled diabetes risk in 25(OH)D quintile 1 and an about 1.5-fold risk in quintile 2 compared to quintiles 3-5 if subjects had renal dysfunction. The observed associations were not influenced by the competing risk of death. In this large cohort study of older adults, serum 25(OH)D levels were inversely associated with incident diabetes in women but not in men. The association was particularly strong in subjects with renal dysfunction.