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Serum 25-hydroxyvitamin D, mortality, and incident cardiovascular disease, respiratory disease, cancers, and fractures: a 13-y prospective population study.
Am J Clin Nutr. 2014 Nov; 100(5):1361-70.AJ

Abstract

BACKGROUND

Vitamin D is associated with many health conditions, but optimal blood concentrations are still uncertain.

OBJECTIVES

We examined the prospective relation between serum 25-hydroxyvitamin D [25(OH)D] concentrations [which comprised 25(OH)D3 and 25(OH)D2] and subsequent mortality by the cause and incident diseases in a prospective population study.

DESIGN

Serum vitamin D concentrations were measured in 14,641 men and women aged 42-82 y in 1997-2000 who were living in Norfolk, United Kingdom, and were followed up to 2012. Participants were categorized into 5 groups according to baseline serum concentrations of total 25(OH)D <30, 30 to <50, 50 to <70, 70 to <90, and ≥ 90 nmol/L.

RESULTS

The mean serum total 25(OH)D was 56.6 nmol/L, which consisted predominantly of 25(OH)D3 (mean: 56.2 nmol/L; 99% of total). The age-, sex-, and month-adjusted HRs (95% CIs) for all-cause mortality (2776 deaths) for men and women by increasing vitamin D category were 1, 0.84 (0.74, 0.94), 0.72 (0.63, 0.81), 0.71 (0.62, 0.82), and 0.66 (0.55, 0.79) (P-trend < 0.0001). When analyzed as a continuous variable and with additional adjustment for body mass index, smoking, social class, education, physical activity, alcohol intake, plasma vitamin C, history of cardiovascular disease, diabetes, or cancer, HRs for a 20-nmol/L increase in 25(OH)D were 0.92 (0.88, 0.96) (P < 0.001) for total mortality, 0.96 (0.93, 0.99) (P = 0.014) (4469 events) for cardiovascular disease, 0.89 (0.85, 0.93) (P < 0.0001) (2132 events) for respiratory disease, 0.89 (0.81, 0.98) (P = 0.012) (563 events) for fractures, and 1.02 (0.99, 1.06) (P = 0.21) (3121 events) for incident total cancers.

CONCLUSIONS

Plasma 25(OH)D concentrations predict subsequent lower 13-y total mortality and incident cardiovascular disease, respiratory disease, and fractures but not total incident cancers. For mortality, lowest risks were in subjects with concentrations >90 nmol/L, and there was no evidence of increased mortality at high concentrations, suggesting that a moderate increase in population mean concentrations may have potential health benefit, but <1% of the population had concentrations >120 nmol/L.

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Authors+Show Affiliations

Khaw KT
From the Department of Public Health and Primary Care, Institute of Public Health, School of Clinical Medicine (K-TK and RL) and the Medical Research Council Epidemiology Unit (NW), University of Cambridge, Cambridge, United Kingdom.
Luben R
From the Department of Public Health and Primary Care, Institute of Public Health, School of Clinical Medicine (K-TK and RL) and the Medical Research Council Epidemiology Unit (NW), University of Cambridge, Cambridge, United Kingdom.
Wareham N
From the Department of Public Health and Primary Care, Institute of Public Health, School of Clinical Medicine (K-TK and RL) and the Medical Research Council Epidemiology Unit (NW), University of Cambridge, Cambridge, United Kingdom.

MeSH

AdultAgedAged, 80 and overAscorbic AcidBody Mass IndexCardiovascular DiseasesFemaleFractures, BoneHumansIncidenceMaleMiddle AgedMotor ActivityMultivariate AnalysisProportional Hazards ModelsProspective StudiesRespiratory Tract DiseasesSocioeconomic FactorsUnited KingdomVitamin DVitamin D Deficiency

Pub Type(s)

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

Language

eng

PubMed ID

25332334

Citation

Khaw, Kay-Tee, et al. "Serum 25-hydroxyvitamin D, Mortality, and Incident Cardiovascular Disease, Respiratory Disease, Cancers, and Fractures: a 13-y Prospective Population Study." The American Journal of Clinical Nutrition, vol. 100, no. 5, 2014, pp. 1361-70.
Khaw KT, Luben R, Wareham N. Serum 25-hydroxyvitamin D, mortality, and incident cardiovascular disease, respiratory disease, cancers, and fractures: a 13-y prospective population study. Am J Clin Nutr. 2014;100(5):1361-70.
Khaw, K. T., Luben, R., & Wareham, N. (2014). Serum 25-hydroxyvitamin D, mortality, and incident cardiovascular disease, respiratory disease, cancers, and fractures: a 13-y prospective population study. The American Journal of Clinical Nutrition, 100(5), 1361-70. https://doi.org/10.3945/ajcn.114.086413
Khaw KT, Luben R, Wareham N. Serum 25-hydroxyvitamin D, Mortality, and Incident Cardiovascular Disease, Respiratory Disease, Cancers, and Fractures: a 13-y Prospective Population Study. Am J Clin Nutr. 2014;100(5):1361-70. PubMed PMID: 25332334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum 25-hydroxyvitamin D, mortality, and incident cardiovascular disease, respiratory disease, cancers, and fractures: a 13-y prospective population study. AU - Khaw,Kay-Tee, AU - Luben,Robert, AU - Wareham,Nicholas, Y1 - 2014/09/17/ PY - 2014/10/22/entrez PY - 2014/10/22/pubmed PY - 2015/2/24/medline SP - 1361 EP - 70 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 100 IS - 5 N2 - BACKGROUND: Vitamin D is associated with many health conditions, but optimal blood concentrations are still uncertain. OBJECTIVES: We examined the prospective relation between serum 25-hydroxyvitamin D [25(OH)D] concentrations [which comprised 25(OH)D3 and 25(OH)D2] and subsequent mortality by the cause and incident diseases in a prospective population study. DESIGN: Serum vitamin D concentrations were measured in 14,641 men and women aged 42-82 y in 1997-2000 who were living in Norfolk, United Kingdom, and were followed up to 2012. Participants were categorized into 5 groups according to baseline serum concentrations of total 25(OH)D <30, 30 to <50, 50 to <70, 70 to <90, and ≥ 90 nmol/L. RESULTS: The mean serum total 25(OH)D was 56.6 nmol/L, which consisted predominantly of 25(OH)D3 (mean: 56.2 nmol/L; 99% of total). The age-, sex-, and month-adjusted HRs (95% CIs) for all-cause mortality (2776 deaths) for men and women by increasing vitamin D category were 1, 0.84 (0.74, 0.94), 0.72 (0.63, 0.81), 0.71 (0.62, 0.82), and 0.66 (0.55, 0.79) (P-trend < 0.0001). When analyzed as a continuous variable and with additional adjustment for body mass index, smoking, social class, education, physical activity, alcohol intake, plasma vitamin C, history of cardiovascular disease, diabetes, or cancer, HRs for a 20-nmol/L increase in 25(OH)D were 0.92 (0.88, 0.96) (P < 0.001) for total mortality, 0.96 (0.93, 0.99) (P = 0.014) (4469 events) for cardiovascular disease, 0.89 (0.85, 0.93) (P < 0.0001) (2132 events) for respiratory disease, 0.89 (0.81, 0.98) (P = 0.012) (563 events) for fractures, and 1.02 (0.99, 1.06) (P = 0.21) (3121 events) for incident total cancers. CONCLUSIONS: Plasma 25(OH)D concentrations predict subsequent lower 13-y total mortality and incident cardiovascular disease, respiratory disease, and fractures but not total incident cancers. For mortality, lowest risks were in subjects with concentrations >90 nmol/L, and there was no evidence of increased mortality at high concentrations, suggesting that a moderate increase in population mean concentrations may have potential health benefit, but <1% of the population had concentrations >120 nmol/L. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/25332334/Serum_25_hydroxyvitamin_D_mortality_and_incident_cardiovascular_disease_respiratory_disease_cancers_and_fractures:_a_13_y_prospective_population_study_ DB - PRIME DP - Unbound Medicine ER -