Non-skeletal health effects of vitamin D supplementation: A systematic review on findings from meta-analyses summarizing trial data.
Non-skeletal health effects of vitamin D supplementation: A systematic review on findings from meta-analyses summarizing trial data.
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DOI：
10.1371/journal.pone.0180512
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Jorde R
中科院分区：
文献类型：
--
作者：
Rejnmark L;Bislev LS;Cashman KD;Eiríksdottir G;Gaksch M;Grübler M;Grimnes G;Gudnason V;Lips P;Pilz S;van Schoor NM;Kiely M;Jorde R
大量观察性研究报告了低 25-羟基维生素 D (25OHD) 水平对非骨骼结果的有害影响。我们对补充维生素 D 对非骨骼影响的荟萃分析 (MA) 中包含的随机临床试验 (RCT) 的特征进行了系统的定量评价。我们确定了系统评价（SR），根据选定的非骨骼结果的随机对照试验的 MA 报告汇总数据。对于每项结果，我们总结了可用 SR 的结果，并仔细审查了随机对照试验中的一些预定义特征。我们确定了 54 项 SR，其中包括 210 项 RCT 的数据。大多数 MA 以及个别 RCT 报告了关于心血管疾病、2 型糖尿病、体重减轻和恶性疾病风险的无效发现。据报告，补充维生素 D 对抑郁症有 4 个 MA 中的 1 个，对血压有 9 个 MA 中有 2 个，对呼吸道感染有 7 个 MA 中有 3 个，对死亡率有 12 个 MA 中有 8 个有有益作用。大多数随机对照试验主要是为了确定骨骼结果，而非骨骼影响被评估为次要结果。只有三分之一的随机对照试验以低水平 25OHD 作为纳入标准，并且平均基线 25OHD 水平低于 50 nmol/L 仅出现在不到一半的分析中。已发表的随机对照试验大多是在 25OHD 水平不低的人群中进行的。大多数随机对照试验结果的 MA 并未显示出有益效果，这一事实并不能反驳低 25OHD 水平不利健康结果的观察结果所提出的假设。
A large number of observational studies have reported harmful effects of low 25-hydroxyvitamin D (25OHD) levels on non-skeletal outcomes. We performed a systematic quantitative review on characteristics of randomized clinical trials (RCTs) included in meta-analyses (MAs) on non-skeletal effects of vitamin D supplementation. We identified systematic reviews (SR) reporting summary data in terms of MAs of RCTs on selected non-skeletal outcomes. For each outcome, we summarized the results from available SRs and scrutinized included RCTs for a number of predefined characteristics. We identified 54 SRs including data from 210 RCTs. Most MAs as well as the individual RCTs reported null-findings on risk of cardiovascular diseases, type 2 diabetes, weight-loss, and malignant diseases. Beneficial effects of vitamin D supplementation was reported in 1 of 4 MAs on depression, 2 of 9 MAs on blood pressure, 3 of 7 MAs on respiratory tract infections, and 8 of 12 MAs on mortality. Most RCTs have primarily been performed to determine skeletal outcomes, whereas non-skeletal effects have been assessed as secondary outcomes. Only one-third of the RCTs had low level of 25OHD as a criterion for inclusion and a mean baseline 25OHD level below 50 nmol/L was only present in less than half of the analyses. Published RCTs have mostly been performed in populations without low 25OHD levels. The fact that most MAs on results from RCTs did not show a beneficial effect does not disprove the hypothesis suggested by observational findings on adverse health outcomes of low 25OHD levels.
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