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The relationship between vitamin A and risk of fracture: meta-analysis of prospective studies.

Abstract

Osteoporotic fracture is a significant cause of morbidity and mortality and is a challenging global health problem. Previous reports of the relation between vitamin A intake or blood retinol and risk of fracture were inconsistent. We searched Medline and Embase to assess the effects of vitamin A (or retinol or beta-carotene but not vitamin A metabolites) on risk of hip and total fracture. Only prospective studies were included. We pooled data with a random effects meta-analysis with adjusted relative risk (adj.RR) and 95% confidence interval (CI). We used Q statistic and I(2) statistic to assess heterogeneity and Egger's test to assess publication bias. Eight vitamin A (or retinol or beta-carotene) intake studies (283,930 participants) and four blood retinol level prospective studies (8725 participants) were included. High intake of vitamin A and retinol were shown to increase risk of hip fracture (adj.RR [95% CI] = 1.29 [1.07, 1.57] and 1.40 [1.03, 1.91], respectively), whereas beta-carotene intake was not found to increase the risk of hip fracture (adj.RR [95% CI] = 0.82 [0.59, 1.14]). Both high or low level of blood retinol was shown to increase the risk of hip fracture (adj.RR [95% CI] = 1.87 [1.31, 2.65] and 1.56 [1.09, 2.22], respectively). The risk of total fracture does not differ significantly by level of vitamin A (or retinol) intake or by blood retinol level. Dose-response meta-analysis shows a U-shaped relationship between serum retinol level and hip fracture risk. Our meta-analysis suggests that blood retinol level is a double-edged sword for risk of hip fracture. To avoid the risk of hip fracture caused by too low or too high a level of retinol concentration, we suggest that intake of beta-carotene (a provitamin A), which should be converted to retinol in blood, may be better than intake of retinol from meat, which is directly absorbed into blood after intake.

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  • Authors+Show Affiliations

    ,

    Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

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    Source

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Female
    Humans
    Male
    Middle Aged
    Osteoporotic Fractures
    Prospective Studies
    Publication Bias
    Risk Factors
    Vitamin A

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    24700407

    Citation

    Wu, Ai-Min, et al. "The Relationship Between Vitamin a and Risk of Fracture: Meta-analysis of Prospective Studies." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 29, no. 9, 2014, pp. 2032-9.
    Wu AM, Huang CQ, Lin ZK, et al. The relationship between vitamin A and risk of fracture: meta-analysis of prospective studies. J Bone Miner Res. 2014;29(9):2032-9.
    Wu, A. M., Huang, C. Q., Lin, Z. K., Tian, N. F., Ni, W. F., Wang, X. Y., ... Chi, Y. L. (2014). The relationship between vitamin A and risk of fracture: meta-analysis of prospective studies. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 29(9), pp. 2032-9. doi:10.1002/jbmr.2237.
    Wu AM, et al. The Relationship Between Vitamin a and Risk of Fracture: Meta-analysis of Prospective Studies. J Bone Miner Res. 2014;29(9):2032-9. PubMed PMID: 24700407.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The relationship between vitamin A and risk of fracture: meta-analysis of prospective studies. AU - Wu,Ai-Min, AU - Huang,Chao-Qun, AU - Lin,Zhong-Ke, AU - Tian,Nai-Feng, AU - Ni,Wen-Fei, AU - Wang,Xiang-Yang, AU - Xu,Hua-Zi, AU - Chi,Yong-Long, PY - 2014/01/03/received PY - 2014/03/16/revised PY - 2014/03/26/accepted PY - 2014/4/5/entrez PY - 2014/4/5/pubmed PY - 2015/4/22/medline KW - BETA-CAROTENE KW - DOSE-RESPONSE KW - HIP FRACTURE KW - META-ANALYSIS KW - OSTEOPOROTIC FRACTURE KW - RETINOL KW - VITAMIN A SP - 2032 EP - 9 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J. Bone Miner. Res. VL - 29 IS - 9 N2 - Osteoporotic fracture is a significant cause of morbidity and mortality and is a challenging global health problem. Previous reports of the relation between vitamin A intake or blood retinol and risk of fracture were inconsistent. We searched Medline and Embase to assess the effects of vitamin A (or retinol or beta-carotene but not vitamin A metabolites) on risk of hip and total fracture. Only prospective studies were included. We pooled data with a random effects meta-analysis with adjusted relative risk (adj.RR) and 95% confidence interval (CI). We used Q statistic and I(2) statistic to assess heterogeneity and Egger's test to assess publication bias. Eight vitamin A (or retinol or beta-carotene) intake studies (283,930 participants) and four blood retinol level prospective studies (8725 participants) were included. High intake of vitamin A and retinol were shown to increase risk of hip fracture (adj.RR [95% CI] = 1.29 [1.07, 1.57] and 1.40 [1.03, 1.91], respectively), whereas beta-carotene intake was not found to increase the risk of hip fracture (adj.RR [95% CI] = 0.82 [0.59, 1.14]). Both high or low level of blood retinol was shown to increase the risk of hip fracture (adj.RR [95% CI] = 1.87 [1.31, 2.65] and 1.56 [1.09, 2.22], respectively). The risk of total fracture does not differ significantly by level of vitamin A (or retinol) intake or by blood retinol level. Dose-response meta-analysis shows a U-shaped relationship between serum retinol level and hip fracture risk. Our meta-analysis suggests that blood retinol level is a double-edged sword for risk of hip fracture. To avoid the risk of hip fracture caused by too low or too high a level of retinol concentration, we suggest that intake of beta-carotene (a provitamin A), which should be converted to retinol in blood, may be better than intake of retinol from meat, which is directly absorbed into blood after intake. SN - 1523-4681 UR - https://www.unboundmedicine.com/medline/citation/24700407/full_citation L2 - https://doi.org/10.1002/jbmr.2237 DB - PRIME DP - Unbound Medicine ER -