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


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.

Download full-text


Available from: Michal Melamed, Dec 25, 2013
  • Source
    • "Low levels of vitamin D are a risk factor for osteoporosis, hypertension, cardiovascular disease (CVD), diabetes mellitus , infection, some autoimmune diseases, rickets, and some types of cancer [3,10e13]. In addition, low vitamin D levels are associated with high mortality [6]. An increase in vitamin D levels by 10 ng/mL was demonstrated in a meta-analysis to be associated with a decrease in mortality risk by 14% in patients with CKD [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Vitamin D is a hormone with a variety of functions, and its deficiency and insufficiency are commonly seen both in the general population and in patients with chronic renal disease. The aim of this study was to compare vitamin D levels in patients with chronic renal disease who are on hemodialysis, peritoneal dialysis, or no renal replacement therapy and patients who underwent renal transplantation. A total of 169 patients who had not used vitamin D for ≥1 year and who had no diabetes mellitus or proteinuria were included in the study. These included: 40 patients with renal transplantation, 40 patients on hemodialysis, 49 patients on peritoneal dialysis, and 40 patients with chronic renal failure stage 1, 2, 3, or 4. 25-Hydroxy vitamin D levels were evaluated in the sera of the patients. 25-Hydroxy vitamin D levels in patients with renal transplantation and in predialysis patients were 12.74 ± 10.24 ng/mL and 11.16 ± 12.25 ng/mL, respectively. The levels were 7.77 ± 6.71 ng/mL and 5.96 ± 4.87 ng/mL in patients on hemodialysis and peritoneal dialysis, respectively. Vitamin D levels are lower in patients on hemodialysis and peritoneal dialysis compared with the patients with renal transplantation for a variety of reasons. In this study, objective results were obtained supporting the administration of vitamin D supplements without glomerular filtration rate measurement in all patient groups with the diagnosis of chronic renal failure in accordance with the guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.
    Transplantation Proceedings 06/2015; 47(5):1405-1407. DOI:10.1016/j.transproceed.2015.04.036 · 0.98 Impact Factor
    • "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. "
    [Show abstract] [Hide abstract]
    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. http://authors.elsevier.com/a/1Rn4L3igGQGL5x
    Critical Reviews in Oncology/Hematology 05/2015; 96(1):91-99. DOI:10.1016/j.critrevonc.2015.05.006 · 4.03 Impact Factor
    • "Initially thought to play a limited role in bone and skeletal health [8], benefits now being ascribed to vitamin D include the prevention of some cancers, autoimmune disorders and possibly cardiovascular diseases [9] [10] [11]. Vitamin D deficiency may be independently associated with all-cause mortality in the general population [12] [13], suggesting it plays an important role in overall health and may be an important public health measure. Vitamin D status is determined using blood testing. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Online continuing medical education (CME) offers a number of advantages for physicians including flexibility with regards to location and timing of use. In order to effect physician practices and improve patient outcomes, it is important that the development of online CME is theory and evidence-based. This paper aims to describe the development of an online CME program for practising general practitioners (GPs) on vitamin D and sun health called "The ABC's of Vitamin D for GPs" using elements of design principles for physician-education web sites as a framework. The paper will also report the program's usability and acceptability pilot test results. The ABC's of Vitamin D program was developed following nine principles: needs assessment; evidence-based content development; multimodal program and modularisation; clinical cases; tailoring and interactivity; audit and feedback; credibility of the web site host; patient education materials; ease of use and navigation. Among the 20 GPs invited, acceptability and useability was tested with 12 GPs (60%) who agreed to participate and were interviewed following use of the program. The study was conducted between 2011 and 2013. An online CME program consisting of eight modules was constructed. Of the 12 participating GPs, most (n=11) reported that the program was clear and easy to understand, logical, easy to navigate, and took a reasonable amount of time (estimated between 1 and 3h) to complete. Eleven of 12 participants said they would use the program as an accredited CME activity and all participants indicated that the program was 'very or somewhat' likely to lead to changes in the advice patients are given. This study found that a theory and evidence based approach for the development of an online CME program for GPs was acceptable to users. Further research is needed to examine whether the online CME program is effective at changing GP practices and improving patient outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Medical Informatics 01/2015; 84(6). DOI:10.1016/j.ijmedinf.2015.01.006 · 2.00 Impact Factor
Show more