Vitamins for chronic disease prevention in adults - Clinical applications
Vitamins for chronic disease prevention in adults - Clinical applications
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DOI：
10.1001/jama.287.23.3127
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发表时间：
2002-06-19
影响因子：
120.7
通讯作者：
Fairfield, KN
中科院分区：
文献类型：
--
作者：
Fletcher, RH;Fairfield, KN
维生素缺乏综合症，如坏血病和脚气病在西方社会并不常见。然而，某些维生素的摄入量低于最佳水平，高于引起典型维生素缺乏症的水平，是慢性病的风险因素，在一般人群中很常见，特别是老年人。叶酸水平低于最佳水平，沿着维生素B-6和B-12水平低于最佳水平，是心血管疾病、神经管缺陷、结肠癌和乳腺癌的危险因素;维生素D水平低导致骨质减少和骨折;抗氧化维生素（维生素A、E和C）水平低可能增加患几种慢性疾病的风险。大多数人不能仅通过饮食摄入最佳量的所有维生素。在随机试验的有效性得到有力证据之前，所有成年人服用维生素补充剂似乎是谨慎的。根据患者的具体特征（如年龄、性别和体力活动）定制多种维生素的内容，以及测试维生素水平以指导具体的补充实践的证据基础有限。医生应特别努力了解患者对维生素的使用情况，以确保他们正在服用他们应该服用的维生素，例如育龄妇女补充叶酸，并避免危险的做法，例如怀孕期间高剂量的维生素A或任何年龄的大剂量脂溶性维生素。
Vitamin deficiency syndromes such as scurvy and beriberi are uncommon in Western societies. However, suboptimal intake of some vitamins, above levels causing classic vitamin deficiency, is a risk factor for chronic diseases and common in the general population, especially the elderly. Suboptimal folic acid levels, along with suboptimal levels of vitamins B-6 and B-12, are a risk factor for cardiovascular disease, neural tube defects, and colon and breast cancer; low levels of vitamin D contribute to osteopenia and fractures; and low levels of the antioxidant vitamins (vitamins A, E, and C) may increase risk for several chronic diseases. Most people do not consume an optimal amount of all vitamins by diet alone. Pending strong evidence of effectiveness from randomized trials, it appears prudent for all adults to take vitamin supplements. The evidence base for tailoring the contents of multivitamins to specific characteristics of patients such as age, sex, and physical activity and for testing vitamin levels to guide specific supplementation practices is limited. Physicians should make specific efforts to learn about their patients' use of vitamins to ensure that they are taking vitamins they should, such as folate supplementation for women in the childbearing years, and avoiding dangerous practices such as high doses of vitamin A during pregnancy or massive doses of fat-soluble vitamins at any age.