The health effects of vitamin D supplementation: evidence from human studies

医学 孟德尔随机化 维生素D与神经学 维生素D缺乏 混淆 观察研究 佝偻病 糖尿病 内科学 随机对照试验 维生素 生理学 内分泌学 生物化学 化学 遗传变异 基因型 基因
作者
Roger Bouillon,Despoina Manousaki,Clifford J. Rosen,Katerina Trajanoska,Fernando Rivadeneira,J. Brent Richards
出处
期刊:Nature Reviews Endocrinology [Nature Portfolio]
卷期号:18 (2): 96-110 被引量:299
标识
DOI:10.1038/s41574-021-00593-z
摘要

Vitamin D supplementation can prevent and cure nutritional rickets in infants and children. Preclinical and observational data suggest that the vitamin D endocrine system has a wide spectrum of skeletal and extra-skeletal activities. There is consensus that severe vitamin D deficiency (serum 25-hydroxyvitamin D (25OHD) concentration <30 nmol/l) should be corrected, whereas most guidelines recommend serum 25OHD concentrations of >50 nmol/l for optimal bone health in older adults. However, the causal link between vitamin D and many extra-skeletal outcomes remains unclear. The VITAL, ViDA and D2d randomized clinical trials (combined number of participants >30,000) indicated that vitamin D supplementation of vitamin D-replete adults (baseline serum 25OHD >50 nmol/l) does not prevent cancer, cardiovascular events, falls or progression to type 2 diabetes mellitus. Post hoc analysis has suggested some extra-skeletal benefits for individuals with vitamin D deficiency. Over 60 Mendelian randomization studies, designed to minimize bias from confounding, have evaluated the consequences of lifelong genetically lowered serum 25OHD concentrations on various outcomes and most studies have found null effects. Four Mendelian randomization studies found an increased risk of multiple sclerosis in individuals with genetically lowered serum 25OHD concentrations. In conclusion, supplementation of vitamin D-replete individuals does not provide demonstrable health benefits. This conclusion does not contradict older guidelines that severe vitamin D deficiency should be prevented or corrected.
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