Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study
Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study
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DOI：
10.7326/0003-4819-125-5-199609010-00001
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发表时间：
1996-09-01
影响因子：
39.2
通讯作者：
Jacques, P
中科院分区：
文献类型：
--
作者：
McAlindon, TE;Felson, DT;Jacques, P
背景：有证据表明，骨的病理生理过程是膝骨关节炎预后的重要决定因素。维生素 D 摄入量低和血清水平低可能会损害骨骼对骨关节炎的有利反应，使患者易于病情进展。目的：确定膳食摄入量和血清维生素 D 水平是否可以预测 Framingham 研究参与者膝骨关节炎的发病率和进展。设计：前瞻性观察研究。背景：Framingham 研究。参与者：Framingham 心脏研究的参与者，在第 18 次检查时进行了膝部 X 光检查（在 1983 年至 1983 年之间进行） 1985 年）和第 22 次检查（1992 年至 1993 年之间进行），并接受了维生素 D 摄入量和血清水平的中期评估。 测量：维生素 D 摄入量和 25-羟基维生素 D 血清水平（根据调查问卷报告的饮食习惯和补充剂使用情况计算得出）在检查 20（1988 年至 1989 年）时进行了评估。使用改良的 Kellgren 和 Lawrence 量表（范围 0 至 4）对膝关节 X 光片进行骨关节炎的整体严重程度评分，并对骨赘和关节间隙狭窄的存在情况进行评分（范围 0 至 3）。第 18 次和第 20 次检查测量的协变量包括年龄、性别、体重指数、体重变化、受伤、体力活动、健康状况、骨矿物质密度和能量摄入量。 结果：556 名参与者（基线平均年龄 +/- SD，70.3 +/- 4.5 岁）进行了完整评估。 75个膝盖出现骨关节炎； 62 个膝关节出现进行性骨关节炎。维生素 D 的血清水平与维生素 D 摄入量呈适度相关 (r = 0.24)。对于维生素 D 摄入量（下三分位数与上三分位数相比，优势比为 4.0 [95% Cl，1.4 至 11.6]）和维生素 D 血清水平（下三分位数与上三分位数相比，优势比为 2.9 [Cl，1.0 至 8.2]），中三分位数和下三分位数的参与者的进展风险增加了三倍。通过关节间隙损失（比值比，2.3 [Cl，0.9 至 5.5]）和骨赘生长（比值比，3.1 [Cl，1.3 至 7.5]）评估，低血清维生素 D 水平也预示着软骨损失。基线后发生的膝骨关节炎与维生素 D 的摄入量或血清水平并不一致。结论：维生素 D 的低摄入量和低血清水平似乎均与膝骨关节炎进展风险增加相关。
Background: Evidence suggests that pathophysiologic processes in bone are important determinants of outcome in osteoarthritis of the knee. Low intake and low serum levels of vitamin D may compromise favorable responses of bone to osteoarthritis, predisposing patients to progression.Objective: To determine whether dietary intake and serum levels of vitamin D would predict the incidence and progression of osteoarthritis of the knee in participants of the Framingham Study.Design: Prospective observational study.Setting: The Framingham Study.Participants: Participants in the Framingham Heart Study who had knee radiography at examinations 18 (done between 1983 and 1985) and 22 (done between 1992 and 1993) and received interim assessments of vitamin D intake and serum levels.Measurements: Intake of vitamin D and serum levels of 25-hydroxyvitamin D, calculated on the basis of dietary habits and supplement use as reported on a questionnaire, were evaluated at examination 20 (1988 to 1989). Knee radiographs were given scores for global severity of osteoarthritis, using a modification of the scale of Kellgren and Lawrence (range, 0 to 4), and for the presence of osteophytes and joint-space narrowing (range, 0 to 3). Covariates measured at examinations 18 and 20 were age, sex, body mass index, weight change, injury, physical activity, health status, bone mineral density, and energy intake.Results: 556 participants (mean age at baseline +/- SD, 70.3 +/- 4.5 years) had complete assessments. Incident osteoarthritis occurred in 75 knees; progressive osteoarthritis occurred in 62 knees. Serum levels of vitamin D were modestly correlated with vitamin D intake (r = 0.24). Risk for progression increased threefold in participants in the middle and lower tertiles for both vitamin D intake (odds ratio for the lower compared with the upper tertile, 4.0 [95% Cl, 1.4 to 11.6]) and serum levels of vitamin D (odds ratio for the lower compared with the upper tertilee, 2.9 [Cl, 1.0 to 8.2]). Low serum levels of vitamin D also predicted loss of cartilage, as assessed by loss of joint space (odds ratio, 2.3 [Cl, 0.9 to 5.5]) and osteophyte growth (odds ratio, 3.1 [Cl, 1.3 to 7.5]). Incident osteoarthritis of the knee occurring after baseline was not consistently related to either intake or serum levels of vitamin D.Conclusions: Low intake and low serum levels of vitamin D each appear to be associated with an increased risk for progression of osteoarthritis of the knee.