A randomized clinical trial in vitamin D-deficient adults comparing replenishment with oral vitamin D3 with narrow-band UV type B light: effects on cholesterol and the transcriptional profiles of skin and blood.
A randomized clinical trial in vitamin D-deficient adults comparing replenishment with oral vitamin D3 with narrow-band UV type B light: effects on cholesterol and the transcriptional profiles of skin and blood.
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DOI：
10.3945/ajcn.116.150367
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发表时间：
2017-05
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通讯作者：
M. Ponda;Yupu Liang;Jaehwan Kim;R. Hutt;K. Dowd;P. Gilleaudeau;M. Sullivan-Whalen;Tori Rodrick;Dong Joo Kim;I. Barash;M. Lowes;J. Breslow
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作者：
M. Ponda;Yupu Liang;Jaehwan Kim;R. Hutt;K. Dowd;P. Gilleaudeau;M. Sullivan-Whalen;Tori Rodrick;Dong Joo Kim;I. Barash;M. Lowes;J. Breslow
背景资料：维生素D缺乏定义为血清25-羟基维生素D [25（OH）D]浓度<20 ng/mL，与致动脉粥样硬化性脂质谱相关。然而，口服维生素D补充剂不会降低LDL-胆固醇浓度或升高HDL-胆固醇浓度。这种关联和因果关系之间的分离可能是由于口服维生素D未能模拟皮肤合成的维生素D对紫外线B（UVB）光的反应。目的：我们检验了以下假设：在维生素D缺乏的成年人中，与口服维生素D3补充的效果相比，通过UVB暴露补充维生素D会降低LDL-胆固醇浓度。设计：我们在维生素D缺乏的成年人中进行了一项随机临床试验，并比较了口服维生素D3（n = 60）和窄谱UVB暴露（n = 58）≤6个月的受试者之间的维生素D补充。口服维生素D3组和UVB组之间LDL-胆固醇浓度较基线的变化无差异（口服维生素D3的中位数减去UVB的中位数的差异：1.5 mg/dL; 95% CI：-5.0，7.0 mg/dL）。组内或组间总胆固醇或HDL胆固醇或甘油三酯的变化也无差异。然而，皮肤和血液的转录谱显示，口服维生素D3的免疫途径信号转导显着上调，但显着下调与UVB。结论：纠正维生素D缺乏症与口服维生素D3或UVB不改善血脂。除了胆固醇，这两种提高25（OH）D的方式对基因转录有不同的影响。本试验在clinicaltrials.gov上注册为NCT 01688102。
Background: Vitamin D deficiency, defined as a serum 25-hydroxyvitamin D [25(OH)D] concentration <20 ng/mL, is correlated with a more atherogenic lipid profile. However, oral vitamin D supplementation does not lower LDL-cholesterol concentrations or raise HDL-cholesterol concentrations. This uncoupling between association and causation may result from a failure of oral vitamin D to mimic the effect of dermally synthesized vitamin D in response to ultraviolet type B (UVB) light.Objective: We tested the hypothesis that, in vitamin D-deficient adults, the replenishment of vitamin D with UVB exposure would lower LDL-cholesterol concentrations compared with the effect of oral vitamin D3 supplementation.Design: We performed a randomized clinical trial in vitamin D-deficient adults and compared vitamin D replenishment between subjects who received oral vitamin D3 (n = 60) and those who received narrow-band UVB exposure (n = 58) ≤6 mo.Results: There was no difference in the change from baseline LDL-cholesterol concentrations between oral vitamin D3 and UVB groups (difference in median of oral vitamin D3 minus that of UVB: 1.5 mg/dL; 95% CI: -5.0, 7.0 mg/dL). There were also no differences within groups or between groups for changes in total or HDL cholesterol or triglycerides. Transcriptional profiling of skin and blood, however, revealed significant upregulation of immune pathway signaling with oral vitamin D3 but significant downregulation with UVB.Conclusions: Correcting vitamin D deficiency with either oral vitamin D3 or UVB does not improve the lipid profile. Beyond cholesterol, these 2 modalities of raising 25(OH)D have disparate effects on gene transcription. This trial was registered at clinicaltrials.gov as NCT01688102.