Faculty Opinions recommendation of Is there a reverse J-shaped association between 25-hydroxyvitamin D and all-cause mortality? Results from the U.S. nationally representative NHANES.

Objective: The evidence regarding vitamin D status and mortality among diabetes is scarce. This study aimed to examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with all-cause and cause-specific mortality among adults with <a>diabetes mellitus</a>. Research Design and Methods: This study included 6329 adults with diabetes from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 2001-2014. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence (CIs) for mortality from all causes, cardiovascular disease (CVD), and cancer. Results: The weighted mean (95% CI) level of serum 25(OH)D was 57.7 (56.6, 58.8) nmol/L, and 46.6% had deficient vitamin D (<50 nmol/L [20 ng/mL]). <a>Higher </a>serum 25(OH)D levels were significantly associated with lower levels of glucose, insulin, HOMA-IR, HbA1c, blood lipids, and C-reactive protein at baseline (all Ptrend<0.05). During 55126 person-years of follow-up, 2056 deaths were documented, including 605 CVD deaths and 309 cancer deaths. <a>After multivariate adjustment, higher </a>serum 25(OH)D levels were significantly and linearly associated with lower all-cause and CVD mortality: there was a 31% reduced risk of all-cause mortality and a 38% reduced risk of CVD mortality per one unit increment in natural log-transformed 25(OH)D (both P<0.001). Compared with participants with 25(OH)D <25 nmol/L, the multivariate-adjusted HRs and 95% CI for participants with 25(OH)D >75 nmol/L were 0.59 (0.43, 0.83) for all-cause mortality (Ptrend=0.003), 0.50 (0.29, 0.86) for CVD mortality (Ptrend=0.02), and 0.49 (0.23, 1.04) for cancer mortality (Ptrend=0.12). Conclusions: In a nationally representative sample of US adults with diabetes, higher serum 25(OH)D levels were significantly associated with lower all-cause and CVD mortality. These findings suggest that maintaining adequate vitamin D status may lower mortality risk in individuals with diabetes.

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Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with diabetes mellitus

10.2337/figshare.12863750 ◽

2020 ◽

Author(s):

Zhenzhen Wan ◽

Jingyu Guo ◽

An Pan ◽

Chen Chen ◽

Liegang Liu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Vitamin D ◽

Vitamin D Status ◽

Hydroxyvitamin D ◽

All Cause Mortality ◽

Specific Mortality ◽

25 Hydroxyvitamin D ◽

Nationally Representative ◽

Reduced Risk ◽

Cvd Mortality

Objective: The evidence regarding vitamin D status and mortality among diabetes is scarce. This study aimed to examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with all-cause and cause-specific mortality among adults with <a>diabetes mellitus</a>. Research Design and Methods: This study included 6329 adults with diabetes from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 2001-2014. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence (CIs) for mortality from all causes, cardiovascular disease (CVD), and cancer. Results: The weighted mean (95% CI) level of serum 25(OH)D was 57.7 (56.6, 58.8) nmol/L, and 46.6% had deficient vitamin D (<50 nmol/L [20 ng/mL]). <a>Higher </a>serum 25(OH)D levels were significantly associated with lower levels of glucose, insulin, HOMA-IR, HbA1c, blood lipids, and C-reactive protein at baseline (all Ptrend<0.05). During 55126 person-years of follow-up, 2056 deaths were documented, including 605 CVD deaths and 309 cancer deaths. <a>After multivariate adjustment, higher </a>serum 25(OH)D levels were significantly and linearly associated with lower all-cause and CVD mortality: there was a 31% reduced risk of all-cause mortality and a 38% reduced risk of CVD mortality per one unit increment in natural log-transformed 25(OH)D (both P<0.001). Compared with participants with 25(OH)D <25 nmol/L, the multivariate-adjusted HRs and 95% CI for participants with 25(OH)D >75 nmol/L were 0.59 (0.43, 0.83) for all-cause mortality (Ptrend=0.003), 0.50 (0.29, 0.86) for CVD mortality (Ptrend=0.02), and 0.49 (0.23, 1.04) for cancer mortality (Ptrend=0.12). Conclusions: In a nationally representative sample of US adults with diabetes, higher serum 25(OH)D levels were significantly associated with lower all-cause and CVD mortality. These findings suggest that maintaining adequate vitamin D status may lower mortality risk in individuals with diabetes.

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Weight and skin colour as predictors of vitamin D status: results of an epidemiological investigation using nationally representative data

Public Health Nutrition ◽

10.1017/s1368980016000173 ◽

2016 ◽

Vol 20 (10) ◽

pp. 1857-1864 ◽

Cited By ~ 5

Author(s):

Sonali Rajan ◽

Tom Weishaar ◽

Bryan Keller

Keyword(s):

Vitamin D ◽

Body Weight ◽

Skin Colour ◽

Vitamin D Status ◽

Epidemiological Investigation ◽

Dietary Recommendations ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Nationally Representative ◽

The Impact

AbstractObjectiveCurrent US dietary recommendations for vitamin D vary by age. Recent research suggests that body weight and skin colour are also major determinants of vitamin D status. The objective of the present epidemiological investigation was to clarify the role of age as a predictor of vitamin D status, while accounting for body weight and skin colour, among a nationally representative sample.DesignWe calculated the mean serum 25-hydroxyvitamin D levels for the US population by age and weight, as well as by weight and race/ethnicity group. Multiple regression analyses were utilized to evaluate age and weight as predictors of vitamin D status: serum 25-hydroxyvitamin D levels with age alone, age and body weight, and age, body weight and their two-way interaction were modelled for the entire sample and each age subgroup. Graphical data were developed using B-spline non-linear regression.SettingNational Health and Nutrition Examination Survey (31 934 unweighted cases).SubjectsIndividuals aged 1 year and older.ResultsThere were highly significant differences in mean vitamin D status among US residents by weight and skin colour, with those having darker skin colour or higher body weight having worse vitamin D status. Although a significant factor, the impact of age on vitamin D status was notably less than the impact of body weight.ConclusionsVitamin D status varied predominantly by body weight and skin colour. Recommendations by nutritionists for diet and supplementation needs should take this into account if vitamin D-related health disparities are to be meaningfully reduced across the USA.

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Non-linear associations of 25-hydroxyvitamin D concentrations with risk of cardiovascular disease and all-cause mortality: Results from The Health Improvement Network (THIN) database

The Journal of Steroid Biochemistry and Molecular Biology ◽

10.1016/j.jsbmb.2019.105480 ◽

2019 ◽

Vol 195 ◽

pp. 105480 ◽

Cited By ~ 6

Author(s):

Francesca L Crowe ◽

Rasiah Thayakaran ◽

Neil Gittoes ◽

Martin Hewison ◽

G Neil Thomas ◽

...

Keyword(s):

Cardiovascular Disease ◽

Health Improvement ◽

Hydroxyvitamin D ◽

All Cause Mortality ◽

Non Linear ◽

25 Hydroxyvitamin D ◽

The Health Improvement Network

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Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2009.02359.x ◽

2009 ◽

Vol 57 (9) ◽

pp. 1595-1603 ◽

Cited By ~ 245

Author(s):

Adit A. Ginde ◽

Robert Scragg ◽

Robert S. Schwartz ◽

Carlos A. Camargo

Keyword(s):

Cardiovascular Disease ◽

Prospective Study ◽

Cardiovascular Disease Mortality ◽

Hydroxyvitamin D ◽

Disease Mortality ◽

All Cause Mortality ◽

25 Hydroxyvitamin D

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A Reverse J-Shaped Association of All-Cause Mortality with Serum 25-Hydroxyvitamin D in General Practice: The CopD Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2012-1176 ◽

2012 ◽

Vol 97 (8) ◽

pp. 2644-2652 ◽

Cited By ~ 160

Author(s):

D. Durup ◽

H. L. Jørgensen ◽

J. Christensen ◽

P. Schwarz ◽

A. M. Heegaard ◽

...

Keyword(s):

General Practice ◽

Hydroxyvitamin D ◽

All Cause Mortality ◽

25 Hydroxyvitamin D

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The Risk of All-Cause Mortality Is Inversely Related to Serum 25(OH)D Levels

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2012-1747 ◽

2012 ◽

Vol 97 (8) ◽

pp. 2792-2798 ◽

Cited By ~ 37

Author(s):

Walid Saliba ◽

Ofra Barnett ◽

Hedy S. Rennert ◽

Gad Rennert

Keyword(s):

Vitamin D ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Vital Status ◽

Hydroxyvitamin D ◽

All Cause Mortality ◽

General Population Cohort ◽

25 Hydroxyvitamin D ◽

Vitamin D Supplements

Abstract Context and Objectives: Vitamin D plays a key role in maintaining bone health, but evidence for its nonskeletal effects is inconsistent. This study aims to examine the association between serum 25-hydroxyvitamin D [25(OH)D] levels and all-cause mortality in a large general population cohort. Design, Participants, and Setting: Using the computerized database of the largest health care provider in Israel, we identified a cohort of subjects 20 years old or older with serum 25(OH)D levels measured between January 2008 and December 2009. Vital status was ascertained through August 2011. Results: Median follow-up was 28.5 months (interquartile range 23.8–33.5 months); 7,247 of 182,152 participants (4.0%) died. Subjects who died had significantly lower serum 25(OH)D levels (mean 44.8 ± 24.2 nmol/liter) than those alive at the end of follow-up (51.0 ± 23.2 nmol/liter), P < 0.001. After adjustment for age, gender, ethnicity, and seasonality, the hazard ratio (HR) for all-cause mortality was 2.02 [95% confidence interval (CI) 1.89–2.15] for the lowest serum 25(OH)D quartile (<33.8 nmol/liter) compared with the highest. After further adjustment for comorbidity, use of vitamin D supplements and statins, smoking, socioeconomic status, and body mass index, the HR was 1.81 (95% CI 1.69–1.95). This remained, even after adjustment for serum low-density lipoprotein, high-density lipoprotein, calcium level (corrected for serum albumin levels), and glomerular filtration rate, 1.85 (95% CI 1.70–2.01). The fully adjusted HR associated with being in the second 25(OH)D quartile (33.8–49.4 nmol/liter) was 1.25 (95% CI 1.16–1.34). Conclusions: All-cause mortality is independently and inversely associated with serum 25(OH)D levels at levels less than 50 nmol/liter.

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