25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population

Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Ullmann 615, Bronx, NY 10461, USA.
Archives of internal medicine (Impact Factor: 17.33). 08/2008; 168(15):1629-37. DOI: 10.1001/archinte.168.15.1629
Source: PubMed

ABSTRACT In patients undergoing dialysis, therapy with calcitriol or paricalcitol or other vitamin D agents is associated with reduced mortality. Observational data suggests that low 25-hydroxyvitamin D levels (25[OH]D) are associated with diabetes mellitus, hypertension, and cancers. However, whether low serum 25(OH)D levels are associated with mortality in the general population is unknown.
We tested the association of low 25(OH)D levels with all-cause, cancer, and cardiovascular disease (CVD) mortality in 13 331 nationally representative adults 20 years or older from the Third National Health and Nutrition Examination Survey (NHANES III) linked mortality files. Participant vitamin D levels were collected from 1988 through 1994, and individuals were passively followed for mortality through 2000.
In cross-sectional multivariate analyses, increasing age, female sex, nonwhite race/ethnicity, diabetes, current smoking, and higher body mass index were all independently associated with higher odds of 25(OH)D deficiency (lowest quartile of 25(OH)D level, <17.8 ng/mL [to convert to nanomoles per liter, multiply by 2.496]), while greater physical activity, vitamin D supplementation, and nonwinter season were inversely associated. During a median 8.7 years of follow-up, there were 1806 deaths, including 777 from CVD. In multivariate models (adjusted for baseline demographics, season, and traditional and novel CVD risk factors), compared with the highest quartile, being in the lowest quartile (25[OH]D levels <17.8 ng/mL) was associated with a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%. The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.
The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population.

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Available from: Michal Melamed, Dec 25, 2013
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    • "There is also increasing evidence of a link between lower levels of vitamin D and higher risk of cancer [9] [10]. A relevant correlation between low vitamin D serum levels and a higher risk of general mortality has been confirmed by independent clinical studies after eliminating potential confounded factors [11] [12]. Additionally a recent review and meta-analysis has further confirmed the inverse association of lower vitamin D serum levels with reduced specific Table 1 Terminology for vitamin D 3 and key metabolites. "
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    ABSTRACT: Vitamin D review and supplementation recommendations for women diagnosed with breast or ovary cancer have been defined in the context of bone health and cancer prognosis/risk taking as reference wider cancer patients and postmenopausal women. This specific group has been selected due to its higher osteoporosis risk versus postmenopausal women. Early vitamin D supplementation could help maintain bone health, as well as potentially enhance cancer survival rate. Factors considered for supplementation include daily dose, periodicity, chemical form, administration, and serum levels. Sufficient vitamin D serum levels are recommended to be above 30ng/ml (75nmol/l). Maintenance oral supplementation equivalent to a minimum daily dosage of 800-1000IU (20-25μg) cholecalciferol provided in a daily to monthly bases is preferred, also advised to start with higher dosages when vitamin D serum levels are <10ng/ml (25nmol/l). Calcidiol supplementation is more effective, making it advantageous for cases with very low or difficult to raise vitamin D serum levels. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Critical Reviews in Oncology/Hematology 05/2015; DOI:10.1016/j.critrevonc.2015.05.006 · 4.03 Impact Factor
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    • "In fact, epidemiological data show that vitamin D levels are substantially decreased in patients with HF, compared with controls [3] [4]. In different cohorts, it was confirmed that higher vitamin D levels are associated with more favorable outcomes in patients with HF [5]. "
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    ABSTRACT: Background Low plasma vitamin D levels have been associated with heart failure (HF). This research attempts to explain the role of vitamin D supplementation on myocardial function in elderly patients with HF. Methods and results Twenty-three chronic HF patients were randomized in a small parallel group, double-blind, placebo-controlled trial. All patients, with a mean age of 74 years and vitamin D levels < 30 ng/mL, received 800,000 IU (4,000 IU/daily) of cholecalciferol or placebo for six months. The outcomes measured at baseline and after six months were ejection fraction (EF) and other echocardiography parameters, carboxyterminal propeptide of procollagen type I (PIP), natriuretic peptides, lipid profile, renin, parathyroid hormone, blood pressure and body mass index (BMI). In 13 patients under active treatment for six months, mean plasma 25-hydroxy vitamin D concentrations (15.51 versus -1.40 ng/mL, p<0.001) and plasma calcium (from 9.3 to 9.6 mmol/L, p< 0.05) increased significantly. However, other biomarkers of bone metabolism did not differ between the treatment and placebo groups. EF increased significantly in the intervention group (6.71 versus -4.3 %; p < 0.001), and the serum concentration of PIP increased only in the placebo group after six months (1,140.98 versus -145 mcg/L; p < 0.05). Systolic blood pressure was lower after six months of cholecalciferol treatment (from 129.6 to 122.7 mm Hg, p < 0.05). No significant variations were observed for other parameters. Conclusions Six months of vitamin D supplementation significantly improves ejection fraction in elderly patients with heart failure and vitamin D deficiency.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 08/2014; 24(8). DOI:10.1016/j.numecd.2014.02.015 · 3.32 Impact Factor
    • "However, more and more focus is being shifted on non-classical actions of VitD, which include hormone secretion, cell cycle regulation and immunomodulation.[1] VitD deficiency has been independently proven to increase the risk of all-cause mortality in the general population.[34] However data is scanty regards its role in acute care setting. "
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    ABSTRACT: Introduction: Vitamin D (VitD) classically recognized for its role in the musculoskeletal system, has been implicated in myriad of conditions such as diabetes, immune dysfunction, cancers, heart disease, metabolic syndrome, etc. We studied the role of VitD in acute care setting and its correlation with mortality. Materials and Methods: A total of 85 consecutive consenting patients admitted in medical intensive care unit of tertiary care hospital who fulfilled the inclusion criteria were included. All patients were evaluated clinically, and blood samples were collected for hemogram, biochemical investigations including serum calcium, phosphorus, alkaline phosphatase, magnesium, along with 25(OH) VitD, 1,25(OH) VitD and intact parathormone levels. Simplified acute physiology score (SAPS II) was calculated for all patients. Results: VitD was deficient (<30 ng/ml) in 27 patients (32%). The overall mortality was more in VitD deficient group as compared to VitD sufficient group (74 vs. 41%; P < 0.05). The actual mortality in VitD deficient group was higher than the mortality predicted by SAPS II score (50 vs. 74%; P < 0.0507). VitD deficiency was also associated with more mortality among those requiring ventilator support (95% vs. 40%; P < 0.05) as well as with higher blood glucose (124.5 ± 29.7 vs. 94.8 ± 19.8: P < 0.01) levels. Conclusion: VitD deficiency was associated with increased mortality, poor ventilator outcomes, and increased blood glucose in critically ill patients.
    07/2014; 18(4):511-5. DOI:10.4103/2230-8210.137504
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