维生素D补充剂对健康的影响:从随机对照试验和孟德尔随机化研究中得出的教训
Roger Bouillon1, Meryl S LeBoff2, Rachel E Neale3
1Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Mebabolism and Ageing, KU Leuven, Leuven, Belgium.
概括
维生素D补充剂对大多数健康成年人来说对骨健康或主要疾病没有好处. 建议针对特定群体提供有针对性的补充剂,重点是消除缺陷.
科学领域:
- 内分泌学 在内分泌学.
- 骨和矿物质的新陈代谢
- 营养科学 营养科学
背景情况:
- 维生素D对于平衡和细胞功能至关重要.
- 广泛推的维生素D补充剂缺乏对健康成年人骨和外骨益处的一致证据.
- 相互矛盾的数据需要严格的研究设计,如随机对照试验 (RCT) 和门德尔随机化 (MR) 来确定因果关系.
研究的目的:
- 审查最近的大型RCT和MR研究对维生素D补充对社区成年人的健康结果的影响.
- 澄清维生素D对骨健康,癌症,心血管疾病,免疫功能,多发性硬化症和死亡率的益处和风险.
- 为指导未来对维生素D补充策略的建议.
主要方法:
- 从大规模随机对照试验 (RCT) 的结果进行系统审查和综合.
- 包括门德尔随机化 (MR) 研究来评估因果关系.
- 专注于社区生活的成年人,并考虑特定人群的子组.
主要成果:
- 在一般健康人群中,维生素D补充剂并没有显著降低骨损失,骨折,跌倒,癌症发病率或心血管风险.
- 有证据表明,维生素D可能对癌症死亡率和免疫功能有好处,特别是在患有自身免疫疾病或多发性硬化症的人群中.
- 累积的数据表明,维生素D补充剂可能会减少全因死亡率.
结论:
- 目前的证据不支持广泛的维生素D补充剂用于骨健康或主要疾病预防,一般健康,维生素D补充的成年人.
- 维生素D补充的好处在特定人群中最为明显,包括那些患有自身免疫疾病,多发性硬化症或维生素D缺乏症的人群.
- 未来的战略应优先考虑针对有风险的个体提供有针对性的补充剂,以及全球努力消除维生素D缺乏.
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