维生素D摄入量与血清25(OH)D水平的剂量反应关系:Meta分析

DOSE-RESPONSE RELATIONSHIP BETWEEN VITAMIN D INTAKE AND SERUM 25-HYDROXYVITAMIN D CONCENTRATION:A META ANALYSIS

目的 评价维生素D摄入对血清25(OH)D水平的影响及其剂量反应关系。方法 在Pubmed、Embase、Cochrane数据库中系统检索关于维生素D摄入与血清25(OH)D水平关系的随机对照试验研究的文献。选择紫外线指数(UVI)<3,日光照射皮肤合成维生素D可以忽略不计的试验。使用Cochrane质量评价工具对纳入文献进行质量评价,采用混合效应模型分析维生素D摄入与25(OH)D的剂量反应关系,采用Stata软件进行干预效果分析及亚组分析、敏感性分析和发表偏倚分析。结果 最终纳入18篇随机对照干预试验文献,共49组数据,1892人纳入分析(2014年之后的8篇研究23组数据1134人纳入分析,和2014年之前的10篇研究26组数据,758人纳入分析)。血清25(OH)D水平与维生素D总摄入量呈对数线性关联。未调整其他变量时,维生素D摄入量的对数(β=15.15,95%CI:12.43,17.88,P<0.0001)与血清25(OH)D水平呈正相关。维生素D干预组血清25(OH)D水平较对照组高31.62 nmol/L,95%CI为(27.06,36.19)(异质性为I2=97.9%,P<0.001)。结论 在无内源性维生素D合成情况下,维生素D补充可增加血清25(OH)D水平,维生素D摄入量与血清25(OH)D水平之间呈现对数线性关系。[营养学报,2022,44(5):417-425]

Objectives To evaluate the dose-response relationship between vitamin D intake and serum 25-hydroxyvitamin D(25(OH)D) concentration. Methods We searched Pubmed, Embase, and Cochrane databases for randomized controlled trials(RCT) on vitamin D intervention and serum 25(OH)D concentration. Trials with UV-index <3 at which there is negligible cutaneous vitamin D synthesis were included. Quality was assessed using the Cochrane Collaboration’s tool. The mixed effect model was used to analyse the relationship between vitamin D intake and serum 25(OH)D concentration after adjusting for potential confounders. Data were pooled and analysed using Stata software with random effects model. Publication bias was evaluated using the Begg’s test. Results Data from 18 RCT trails with 49arms,1892 subjects were included(After 2014: 8 trails with 23 arms,1134 participants;Before 2014: 10 trails with 26arms,758 participants). Total vitamin D intake and serum 25(OH)D concentration showed a log-linear dose-response relationship. In the unadjusted model, the logarithm of vitamin D intake(β=15.15,95%CI:12.43,17.88,P< 0.0001) was positively correlated with the serum 25(OH)D concentration. The pooled mean difference and 95% confidence intervals(CIs)in achieved mean serum 25(OH)D were 31.62(27.06,36.19) nmol/L(Test for heterogeneity:I2=97.9%,P<0.001).Conclusion Vitamin D intake can increase serum 25(OH)D concentration with a log-linear dose-response relationship under conditions of no cutaneous vitamin D synthesis. [ACTA NUTRIMENTA SINICA, 2022,44(5):417-425]