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Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study.
Am J Clin Nutr. 2013 Apr; 97(4):782-93.AJ

Abstract

BACKGROUND

Serum 25-hydroxyvitamin D [25(OH)D] concentration has been linked to mortality in several studies, but appropriate cutoffs to define risk categories are under debate.

OBJECTIVE

We aimed to conduct a repeated-measurements analysis on the association of serum 25(OH)D concentrations with all-cause and cause-specific mortality, with particular attention given to the shape of dose-response relations.

DESIGN

Concentrations of 25(OH)D were measured in n = 9578 baseline and n = 5469 5-y follow-up participants of the ESTHER study, which is a German population-based cohort aged 50-74 y at baseline. Deaths were recorded during 9.5 y of follow-up (median). Restricted cubic splines were used to assess dose-response relations, and Cox regression with time-dependent variables was used to estimate hazard ratios.

RESULTS

During follow-up, 1083 study participants died; of those, 350 individuals died of cardiovascular diseases, 433 individuals died of cancer, and 55 individuals died of respiratory diseases. The overall mortality [HR (95% CI)] of subjects with vitamin D deficiency [25(OH)D concentrations <30 nmol/L] or vitamin D insufficiency [25(OH)D concentrations from 30 to 50 nmol/L) was significantly increased [1.71 (1.43, 2.03) and 1.17 (1.02, 1.35), respectively] compared with that of subjects with sufficient 25(OH)D concentrations (>50 nmol/L)]. Vitamin D deficiency was also associated with increased cardiovascular mortality [1.39 (95% CI: 1.02, 1.89)], cancer mortality [1.42 (95% CI: 1.08, 1.88)] and respiratory disease mortality [2.50 (95% CI: 1.12, 5.56)]. The association of 25(OH)D concentrations with all-cause mortality proved to be a nonlinear inverse association with risk that started to increase at 25(OH)D concentrations <75 nmol/L.

CONCLUSIONS

In this large cohort study, serum 25(OH)D concentrations were inversely associated with all-cause and cause-specific mortality. In particular, vitamin D deficiency [25(OH)D concentration <30 nmol/L] was strongly associated with mortality from all causes, cardiovascular diseases, cancer, and respiratory diseases.

Authors+Show Affiliations

Divisions of Clinical Epidemiology and Aging Research and Preventive Oncology, German Cancer Research Center, Heidelberg, Germany. b.schoettker@dkfz.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23446902

Citation

Schöttker, Ben, et al. "Strong Associations of 25-hydroxyvitamin D Concentrations With All-cause, Cardiovascular, Cancer, and Respiratory Disease Mortality in a Large Cohort Study." The American Journal of Clinical Nutrition, vol. 97, no. 4, 2013, pp. 782-93.
Schöttker B, Haug U, Schomburg L, et al. Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study. Am J Clin Nutr. 2013;97(4):782-93.
Schöttker, B., Haug, U., Schomburg, L., Köhrle, J., Perna, L., Müller, H., Holleczek, B., & Brenner, H. (2013). Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study. The American Journal of Clinical Nutrition, 97(4), 782-93. https://doi.org/10.3945/ajcn.112.047712
Schöttker B, et al. Strong Associations of 25-hydroxyvitamin D Concentrations With All-cause, Cardiovascular, Cancer, and Respiratory Disease Mortality in a Large Cohort Study. Am J Clin Nutr. 2013;97(4):782-93. PubMed PMID: 23446902.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study. AU - Schöttker,Ben, AU - Haug,Ulrike, AU - Schomburg,Lutz, AU - Köhrle,Joseph, AU - Perna,Laura, AU - Müller,Heiko, AU - Holleczek,Bernd, AU - Brenner,Hermann, Y1 - 2013/02/27/ PY - 2013/3/1/entrez PY - 2013/3/1/pubmed PY - 2013/5/7/medline SP - 782 EP - 93 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 97 IS - 4 N2 - BACKGROUND: Serum 25-hydroxyvitamin D [25(OH)D] concentration has been linked to mortality in several studies, but appropriate cutoffs to define risk categories are under debate. OBJECTIVE: We aimed to conduct a repeated-measurements analysis on the association of serum 25(OH)D concentrations with all-cause and cause-specific mortality, with particular attention given to the shape of dose-response relations. DESIGN: Concentrations of 25(OH)D were measured in n = 9578 baseline and n = 5469 5-y follow-up participants of the ESTHER study, which is a German population-based cohort aged 50-74 y at baseline. Deaths were recorded during 9.5 y of follow-up (median). Restricted cubic splines were used to assess dose-response relations, and Cox regression with time-dependent variables was used to estimate hazard ratios. RESULTS: During follow-up, 1083 study participants died; of those, 350 individuals died of cardiovascular diseases, 433 individuals died of cancer, and 55 individuals died of respiratory diseases. The overall mortality [HR (95% CI)] of subjects with vitamin D deficiency [25(OH)D concentrations <30 nmol/L] or vitamin D insufficiency [25(OH)D concentrations from 30 to 50 nmol/L) was significantly increased [1.71 (1.43, 2.03) and 1.17 (1.02, 1.35), respectively] compared with that of subjects with sufficient 25(OH)D concentrations (>50 nmol/L)]. Vitamin D deficiency was also associated with increased cardiovascular mortality [1.39 (95% CI: 1.02, 1.89)], cancer mortality [1.42 (95% CI: 1.08, 1.88)] and respiratory disease mortality [2.50 (95% CI: 1.12, 5.56)]. The association of 25(OH)D concentrations with all-cause mortality proved to be a nonlinear inverse association with risk that started to increase at 25(OH)D concentrations <75 nmol/L. CONCLUSIONS: In this large cohort study, serum 25(OH)D concentrations were inversely associated with all-cause and cause-specific mortality. In particular, vitamin D deficiency [25(OH)D concentration <30 nmol/L] was strongly associated with mortality from all causes, cardiovascular diseases, cancer, and respiratory diseases. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/23446902/Strong_associations_of_25_hydroxyvitamin_D_concentrations_with_all_cause_cardiovascular_cancer_and_respiratory_disease_mortality_in_a_large_cohort_study_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.112.047712 DB - PRIME DP - Unbound Medicine ER -