Table of contents
Evidence for a u-shaped relationship between prehospital vitamin d status and mortality: a cohort study.
J Clin Endocrinol Metab. 2014 Apr;99(4):1461-9. doi: 10.1210/jc.2013-3481. Epub 2014 Jan 13.
Amrein K 1, Quraishi SA, Litonjua AA, Gibbons FK, Pieber TR, Camargo CA Jr, Giovannucci E, Christopher KB.
1 Division of Endocrinology and Metabolism (K.A.), Department of Internal Medicine, and Division of Endocrinology and Metabolism (T.R.P.), Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; Department of Anesthesia, Critical Care, and Pain Medicine (S.A.Q.), Division of Pulmonary and Critical Care Medicine (F.K.G.), Department of Medicine, and Department of Emergency Medicine (C.A.C.), Massachusetts General Hospital, Boston, Massachusetts 02114; Channing Division of Network Medicine and Pulmonary and Critical Care Division (A.A.L.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115; and Departments of Nutrition and Epidemiology (E.G.), Harvard School of Public Health, and The Nathan E. Hellman Memorial Laboratory (K.B.C.), Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Objective: The objective of the study was to examine the association between prehospital serum 25-hydroxyvitamin D [25(OH)D]and the risk of mortality after hospital admission.
Design: We performed a retrospective cohort study of adults hospitalized for acute care between 1993 and 2011. Setting: The study was conducted at two Boston teaching hospitals.
Patients: A total of 24 094 adult inpatients participated in the study.
Intervention: There was no intervention.
Measurements: All patients had serum 25(OH)D measured before hospitalization.
The exposure of interest was 25(OH)D categorized as
- less than 10 ng/mL,
- 10-19.9 ng/mL,
- 20-29.9 ng/mL,
- 30-49.9 ng/mL,
- 50-59.9 ng/mL,
- 60-69.9 ng/mL, and
- 70 ng/mL or greater.
The main outcome measure was 90-day mortality. Adjusted odds ratios (ORs) were estimated by multivariable logistic regression with inclusion of potential confounders.
Results: After adjustment for age, gender, race (white vs nonwhite), patient type (surgical vs medical), season of 25(OH)D draw, and the Deyo-Charlson index, patients with 25(OH)D levels less than 30 ng/mL or 60 ng/mL or greater had higher odds of 90-day mortality compared with patients with levels of 30-49.9 ng/mL [adjusted OR (95% confidence interval) for 25(OH)D <10 ng/mL, 10-19.9 ng/mL, 20-29.9 ng/mL, 50-59.9 ng/mL, 60-69.9 ng/mL, and ≥70 ng/mL was
- 2.01 (1.68-2.40),
- 1.89 (1.64-2.18),
- 1.34 (1.16-1.56),
- 0.94 (0.69-1.26),
- 1.52 (1.03-2.25), and
- 1.69 (1.09-2.61),
respectively, compared with patients with 25(OH)D levels 30-49.9 ng/mL].
Limitations: A causal relationship between either low or high 25(OH)D levels and increased mortality can not necessarily be inferred from this observational study.
Conclusions: Analysis of 24 094 adult patients showed that 25(OH)D levels less than 20 ng/mL and 60 ng/mL or greater before hospitalization were associated with an increased odds of 90-day mortality. Although previous reports have suggested an association between low vitamin D status and mortality, these data raise the issue of potential harm from high serum 25(OH)D levels, provide a rationale for an upper limit to supplementation, and emphasize the need for caution in the use of extremely high doses of vitamin D among patients.
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25-hydroxyvitamin D and increased all-cause mortality in very old women: the Newcastle 85+ study. (May 2014)
J Intern Med. 2014 May 31. doi: 10.1111/joim.12273. [Epub ahead of print]
Granic A1, Aspray T, Hill T, Davies K, Collerton J, Ruiz CM, von Zglinicki T, Kirkwood TB, Mathers JC, Jagger C.
To investigate the associations between low and high concentrations of baseline serum 25-hydroxyvitamin D [25(OH)D] and all-cause mortality in very old (≥85 years) men and women over 6 years.
DESIGN, SETTING AND SUBJECTS:
Prospective mortality data from 775 participants in the Newcastle 85+ Study were analysed for survival in relation to 25(OH)D (season-specific quartiles and predefined cut-off values) and sex using Cox proportional hazards models. The models were fitted to the entire and restricted (non-users of vitamin D-containing supplements and medication) cohorts.
For the entire cohort, mortality was higher in both the lowest and highest 25(OH)D season-specific quartiles [SQ1: hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.01-1.69, P = 0.04; SQ4: HR 1.44, 95% CI 1.12-1.85, P = 0.004] compared with the combined middle quartiles (SQ2+SQ3), after adjustment for sociodemographic factors. The increased risk for the highest quartile remained significant after further adjustment for lifestyle variables (SQ4: HR 1.37, 95% CI 1.06-1.77, P = 0.02), and was seen only in women in sex-specific analyses. Similarly, in sensitivity analyses with predefined 25(OH)D cut-off values, the highest 25(OH)D concentration (≥75 nmol/L) was associated with a 2.4-fold increased risk of mortality in women (restricted cohort) after adjusting for all covariates.
Low and high season-specific 25(OH)D quartiles were associated with increased risks of mortality over 6 years in the very old; this effect was particularly noticeable in women, including those who reported taking vitamin D-containing supplements/medication.
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