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The relationship between vitamin A and risk of fracture: meta-analysis of prospective studies.
J Bone Miner Res 2014; 29(9):2032-9JB

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.

Authors+Show Affiliations

Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.No 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
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 -