Impact of season and different vitamin D thresholds on prevalence of vitamin D deficiency in epidemiological cohorts-a note of caution
Impact of season and different vitamin D thresholds on prevalence of vitamin D deficiency in epidemiological cohorts-a note of caution
复制标题
DOI：
10.1007/s12020-017-1292-7
复制
发表时间：
2017-06-01
期刊：
影响因子：
3.7
通讯作者：
Moebus, Susanne
中科院分区：
文献类型：
--
作者：
Schramm, Sara;Lahner, Harald;Moebus, Susanne
我们调查了不同截止值对 25-羟基维生素 D [25-(OH)D] 缺乏症患病率的影响。我们使用了基于人群的 Heinz Nixdorf Recall 研究的 4149 名参与者（45-75 岁，50% 女性）的基线数据。血清 25-(OH)D 采用 Roche Cobas 测定法进行测定。计算四分位数（p25、p50 和 p75）。数据按月份、性别和年龄分层。根据“Dachverband Osteologie”、内分泌学会和国立卫生研究院的建议，我们使用 12、20 和 30 ng/ml 的 25-(OH)D 阈值来估计维生素 D 缺乏情况。总体而言，25-(OH)D 的中位数为 19.8 ng/ml（p25 = 14.4 ng/ml，p75 = 26.6 ng/ml），浓度最高7 月（p50 = 23.8 ng/ml、p25 = 18.2 ng/ml 和 p75 = 31.2 ng/ml），3 月最低（p50 = 15.8 ng/ml、p25 = 11.5 ng/ml 和 p75 = 20.6 ng/ml）。使用 < 12、< 20 ng/ml 和 < 30 ng/ml 的临界值时，维生素 D 缺乏症的患病率分别从 16%、51% 上升至 83%。就季节性差异而言，2 月/3 月维生素 D 缺乏症患病率上升至 92%（< 12：28%，< 20 ng/ml：71%），而 6 月/7 月维生素 D 缺乏症患病率下降至 71%（< 12：6%，< 20 ng/ml：30%）。 3 月份维生素 D 摄入量临界值 12 ng/ml 时，证明维生素 D 缺乏症诊断的机会比 6 月份高 6.4 倍，临界值 20 ng/ml 时，证明维生素 D 缺乏症诊断的机会高出 5.5 倍；临界值 30 ng/ml 时，证明维生素 D 缺乏症诊断的机会高出 3.1 倍。维生素 D 缺乏症的定义指南显示，患病率存在极大差异，范围为 6% 至 92%。考虑收集时间和之前的阳光照射对于减少研究偏差和改善临床护理决策非常重要。必须重新考虑维生素 D 阈值。
We investigated the impact of different cut-offs on the prevalence of 25-hydroxyvitamin D [25-(OH)D] deficiency.We used baseline data of 4149 participants (45-75 years, 50% women) of the population-based Heinz Nixdorf Recall study. Serum 25-(OH)D was measured with the Roche Cobas assay. Quartiles (p25, p50, and p75) were calculated. Data were stratified by months, sex, and age. According to the recommendations of 'Dachverband Osteologie', Endocrine Society and National Institute of Health we used 25-(OH)D thresholds of 12, 20, and 30 ng/ml to estimate vitamin D deficiency.Overall the median of 25-(OH)D was 19.8 ng/ml (p25 = 14.4 ng/ml, p75 = 26.6 ng/ml), with highest concentrations in July (p50 = 23.8 ng/ml, p25 = 18.2 ng/ml, and p75 = 31.2 ng/ml) and lowest in March (p50 = 15.8 ng/ml, p25 = 11.5 ng/ml, and p75 = 20.6 ng/ml). Prevalence of vitamin D deficiency rose from 16, 51 up to 83% using the cut-offs of < 12, < 20 ng/ml, and < 30 ng/ml, respectively. With respect to seasonal variance, prevalence of vitamin D deficiency rose to 92% in February/March using the cut-off < 30 ng/ml (< 12: 28%, < 20 ng/ml: 71%) whereas in June/July prevalence of vitamin D deficiency decreased to 71% (< 12: 6%, < 20 ng/ml: 30%). The chance to attest the diagnosis of vitamin D deficiency for cut-off 12 ng/ml in March is 6.4-fold higher than in June, for cut-off 20 ng/ml, 5.5-fold higher and for cut-off 30 ng/ml, 3.1-fold higher.Guidelines to define vitamin D deficiency revealed extremely different prevalence rates ranging between 6 and 92%. Accounting for collection time and antecedent sun exposure are important to reduce bias in research studies and improve decision-making in clinical care. Vitamin D thresholds have to be rethought.