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Tripathi S, Nath M, Misra S, Kumar P. From A to E: Uniting vitamins against stroke risk-A systematic review and network meta-analysis. Eur J Clin Invest 2024; 54:e14165. [PMID: 38291560 DOI: 10.1111/eci.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/05/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND AIM Stroke represents a significant public health challenge, necessitating the exploration of preventive measures. This network meta-analysis aimed to assess the efficacy of different vitamin treatments compared to a placebo in preventing stroke. METHODS A systematic electronic search in databases including PubMed, EmBASE, Web of Science, clinicaltrials.gov, and Google Scholar until 31 May 2023 was conducted, to identify published studies investigating the association between vitamin intake and the risk of stroke. Pooled risk ratio (RR) with 95% confidence intervals (CIs) was calculated using a frequentist network meta-analysis. Furthermore, we ranked vitamins based on p-scores, facilitating a comparative assessment of their effectiveness in preventing stroke. RESULTS A total of 56 studies, including 17 randomized controlled trials (RCTs) and 39 cohort studies were analyzed. Direct estimates obtained from network meta-analysis, we found that vitamin A (RR: .81 [.72-.91]), vitamin B-complex (RR: .85 [.74-.97]), vitamin B6 (RR: 79 [.68-.92]), folate (RR: .86 [.75-.97]), vitamin C (RR: .77 [.70-.85]) and vitamin D (RR: .73 [.64-.83]) were significantly associated with a decreased stroke risk. However, no significant association was observed for vitamin B2, vitamin B12, and vitamin E. Subsequent to network meta-analysis, vitamins were ranked in decreasing order of their efficacy in stroke prevention based on p-score, with vitamin D (p-score = .91), vitamin C (p-score = .79), vitamin B6 (p-score = .70), vitamin A (p-score = .65), vitamin B-complex (p-score = .53), folate (p-score = .49), vitamin B2 (p-score = .39), vitamin E (p-score = .28), vitamin B12 (.13) and placebo (.10). CONCLUSION Our study has established noteworthy connections between vitamin A, vitamin B-complex, vitamin B6, folate, vitamin C, and vitamin D in the realm of stroke prevention. These findings add substantial weight to the accumulating evidence supporting the potential advantages of vitamin interventions in mitigating the risk of stroke. However, to solidify and validate these observations, additional research is imperative. Well-designed clinical trials or cohort studies are needed to further explore these associations and formulate clear guidelines for incorporating vitamin supplementation into effective stroke prevention strategies.
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Affiliation(s)
- Shashank Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manabesh Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Misra
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Pradeep Kumar
- Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India
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Rasouli MA, Darvishzadehdaledari S, Alizadeh Z, Moradi G, Gholami F, Mahmoudian A. Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 134000 Individuals in 29 Randomized Clinical Trials and 157000 Individuals in 30 Prospective Cohort Studies: An Updated Systematic Review and Meta-analysis. J Res Health Sci 2023; 23:e00594. [PMID: 38315909 PMCID: PMC10843321 DOI: 10.34172/jrhs.2023.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/09/2023] [Accepted: 11/02/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND According to the findings from observational studies and clinical trials assessing the effect of vitamin D supplements on cardiovascular diseases (CVDs), there are still contradictory results. This systematic review aimed to assess the effect of vitamin D supplements on CVDs considering cohort studies and clinical trials. Study Design: A systematic review. METHODS MEDLINE/PubMed, Science Direct, Embase, and Cochrane Library databases were reviewed by two reviewers independently until 2022. The study effect is risk ratio (RR) and 95% confidence interval (CI) according to Mantel Haenszel's random-effects model. Then, Stata version 14 was used for statistical analysis. RESULTS In clinical trial studies, the incidence of CVDs among the vitamin D-consuming group was not significantly different from that in the placebo group (RR: 0.99, 95% CI: 0.95-1.03; P=0.77; I 2=0%). CVD mortality was also not significantly different between the two groups (RR: 0.97, 95% CI: 0.90-1.05; P=0.72; I2=0%). In cohort studies, circulating 25 (OH) D increased the risk of CVD incidence by 31% (RR: 1.31, 95% CI: 1.19-1.45) and CVD mortality by 37% (RR: 1.37, 95% CI: 1.17-1.61). CONCLUSION According to current evidence from clinical trials, vitamin D supplementation should not be recommended for CVD prevention. However, there is a direct association between vitamin D deficiency and the incidence of CVDs as well as its mortality. According to the results of clinical trial studies carrying higher levels of scientific evidence, it can be concluded that vitamin D supplementation does not exert a significant effect on the incidence, mortality, and reduction of CVDs.
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Affiliation(s)
- Mohammad Aziz Rasouli
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Zeynab Alizadeh
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fatemeh Gholami
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ako Mahmoudian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Plasma 25-hydroxyvitamin D3 concentrations and incident risk of ischemic stroke among rural Chinese adults: New insight on ceiling effect. Nutrition 2022; 99-100:111627. [DOI: 10.1016/j.nut.2022.111627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 11/20/2022]
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Jani R, Mhaskar K, Tsiampalis T, Kassaw NA, González MÁM, Panagiotakos DB. Circulating 25-hydroxy-vitamin D and the risk of cardiovascular diseases. Systematic review and meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis 2021; 31:3282-3304. [PMID: 34656382 DOI: 10.1016/j.numecd.2021.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022]
Abstract
AIMS Circulating vitamin D is linked with the risk of cardiovascular disease (CVD). A meta-analysis has yet to explicitly explore correlation between vitamin D and the risk of CVD incidence and recurrent CVD. This meta-analysis examines the association between 25-hydroxy-vitamin D (25(OH)D) and the risk of CVD incidence (fatal, non-fatal, fatal and non-fatal combined events) and the risk of recurrent CVD (fatal, recurrent, and fatal and recurrent combined events). PROSPERO registration-CRD42021251483. DATA SYNTHESIS A total of 79 studies (46 713 CVD cases in 1 397 831 participants) were included in the meta-analysis, of which 61 studies examined the risk of CVD incidence events, and 18 studies examined risk of recurrent CVD events. The risk of CVD incidence events (RR = 1.34, 95% CI: 1.26-1.43, p < 0.001) and recurrent CVD events (RR = 1.86, 95% CI: 1.46-2.36, p < 0.001) was higher in the lowest than the highest category of circulating 25(OH)D. Dose-response analysis reported a linear association for every 10 ng/ml increment of 25(OH)D and non-fatal CVD incidence events (RR = 0.94; 95% CI = 0.89-0.98, p = 0.005), lower fatal recurrent CVD events (RR = 0.45; 95% CI = 0.32-0.62, p < 0.001) and lower combined recurrent CVD events (RR = 0.80; 95% CI = 0.65-0.97, p = 0.023). A non-linear association was observed between higher 25(OH)D and lower fatal CVD incidence events (P-nonlinear<0.001), lower combined CVD incidence events (P-nonlinear = 0.001), and lower non-fatal recurrent CVD events (P-nonlinear = 0.044). CONCLUSIONS The lowest category of circulating 25(OH)D was associated with a higher risk of CVD incidence events and recurrent CVD events.
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Affiliation(s)
- Rati Jani
- Faculty of Health, Department of Nutrition and Dietetics, University of Canberra, Australia.
| | | | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
| | - Nigussie A Kassaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia.
| | | | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
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Jang DG, Ryu SY, Park J, Choi SW. Low Muscle Mass Is Associated with Lower 25-Hydroxyvitamin D Level in All Age Groups of South Korean Adults: The 2009-2010 Korea National Health and Nutrition Examination Surveys (KNHANES). J Nutr Sci Vitaminol (Tokyo) 2021; 66:508-514. [PMID: 33390392 DOI: 10.3177/jnsv.66.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vitamin D plays pivotal role in bone mineral homeostasis. But the association of vitamin D with muscle mass remains obscure, especially among young adults. Therefore, we assessed the association between muscle mass and 25-hydroxyvitamin D (25[OH]D) in South Korean adults using data from the 2009-2010 Korean National Health and Nutrition Examination Survey (KNHANES). This study involved 12,324 (5,375 males and 6,949 females) participants in the 2009-2010 KNHANES aged 20 y or older. Appendicular skeletal muscle mass (ASM) was measured by dual X-ray absorptiometry. Low muscle mass was defined as an ASM divided by body mass index (BMI) (ASM [kg]÷BMI [kg/m2]) value of <0.789 in males and <0.512 in females. The vitamin D status was evaluated by assaying the serum 25(OH)D level. After adjustment for covariates, low muscle mass was significantly associated with lower 25(OH)D level (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.40-0.75 for 10.0-19.9 ng/mL vs. <10.0 ng/mL; OR, 0.47; 95% CI, 0.33-0.68 for 20.0-29.9 ng/mL vs. <10.0 ng/mL; and OR, 0.39; 95% CI, 0.24-0.64 for ≥30.0 ng/mL vs. <10.0 ng/mL). Moreover, low muscle mass was significantly associated with lower 25(OH)D level in all age groups. In conclusion, low muscle mass was significantly associated with lower 25(OH)D level in South Korean adults in all age groups.
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Affiliation(s)
- Dae-Geun Jang
- Department of Public Health, Graduate School of Chosun University
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School
| | - Jong Park
- Department of Preventive Medicine, Chosun University Medical School
| | - Seong-Woo Choi
- Department of Preventive Medicine, Chosun University Medical School
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Su C, Jin B, Xia H, Zhao K. Association between Vitamin D and Risk of Stroke: A PRISMA-Compliant Systematic Review and Meta-Analysis. Eur Neurol 2021; 84:399-408. [PMID: 34325429 DOI: 10.1159/000517584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have shown inconsistent results for associations between vitamin D and risk of stroke. We gathered the existing published articles and conducted this meta-analysis with the aim to explore the association between vitamin D and risk of stroke. METHODS We searched for articles exploring the association between vitamin D and risk of stroke and published before April 2021 in the following databases: PubMed, Web of Science, MEDLINE, EMBASE, and Google Scholar. All statistical analyses were made using STATA 12.0 software. Q test and I2 were applied to examine heterogeneities between studies. RESULTS For the association between serum levels of 25(OH) vitamin D and risks of stroke, the present analysis included 20 cohort studies (including 213,276 participants) and a case-control analysis (including 13,642 participants). Additionally, the analysis included 15 studies (including 41,146 participants given vitamin D supplementation and 41,163 participants given placebo) to evaluate the influence of vitamin D supplementation on risk of stroke. Higher circulating levels of 25(OH) vitamin D were associated with a reduced risk of stroke (odds ratio/relative risk = 0.78, 95% confidence interval [CI]: 0.70-0.86, I2 = 41.5%, p = 0.025). However, the present analysis showed that vitamin D supplementation did not influence the risk of stroke (hazard ratio = 1.05, 95% CI: 0.96-1.14, I2 = 2.3%, p = 0.425). CONCLUSIONS Our analysis indicated that lower circulating level of vitamin D was associated with an elevated risk of stroke, but extra supplement of vitamin D failed to show benefit in decreasing the risk of stroke. Further research and study are also needed to show the role of vitamin D in relation to stroke.
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Affiliation(s)
- Cen Su
- Department of Neurology, Fourth People's Hospital of Zhenjiang, Zhenjiang, China
| | - Biao Jin
- Department of Neurology, Fourth People's Hospital of Zhenjiang, Zhenjiang, China
| | - Haiping Xia
- Department of Neurology, Fourth People's Hospital of Zhenjiang, Zhenjiang, China
| | - Kangren Zhao
- Department of Neurology, Fourth People's Hospital of Zhenjiang, Zhenjiang, China
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Sipos M, Gerszi D, Dalloul H, Bányai B, Sziva RE, Kollarics R, Magyar P, Török M, Ács N, Szekeres M, Nádasy GL, Hadjadj L, Horváth EM, Várbíró S. Vitamin D Deficiency and Gender Alter Vasoconstrictor and Vasodilator Reactivity in Rat Carotid Artery. Int J Mol Sci 2021; 22:ijms22158029. [PMID: 34360792 PMCID: PMC8347553 DOI: 10.3390/ijms22158029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 01/07/2023] Open
Abstract
The vitamin-D-sensitivity of the cardiovascular system may show gender differences. The prevalence of vitamin D (VD) deficiency (VDD) is high, and it alters cardiovascular function and increases the risk of stroke. Our aim was to investigate the vascular reactivity and histological changes of isolated carotid artery of female and male rats in response to different VD supplies. A total of 48 male and female Wistar rats were divided into four groups: female VD supplemented, female VDD, male VD supplemented, male VDD. The vascular function of isolated carotid artery segments was examined by wire myography. Both vitamin D deficiency and male gender resulted in increased phenylephrine-induced contraction. Acetylcholine-induced relaxation decreased in male rats independently from VD status. Inhibition of prostanoid signaling by indomethacin reduced contraction in females, but increased relaxation ability in male rats. Functional changes were accompanied by VDD and gender-specific histological alterations. Elastic fiber density was significantly decreased by VDD in female rats, but not in males. Smooth muscle actin and endothelial nitric oxide synthase levels were significantly lowered, but the thromboxane receptor was elevated in VDD males. Decreased nitrative stress was detected in both male groups independently from VD supply. The observed interactions between vitamin D deficiency and sex may play a role in the gender difference of cardiovascular risk.
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Affiliation(s)
- Miklós Sipos
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary; (M.S.); (D.G.); (H.D.); (R.K.); (M.T.); (N.Á.); (S.V.)
| | - Dóra Gerszi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary; (M.S.); (D.G.); (H.D.); (R.K.); (M.T.); (N.Á.); (S.V.)
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (M.S.); (G.L.N.); (E.M.H.)
| | - Hicham Dalloul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary; (M.S.); (D.G.); (H.D.); (R.K.); (M.T.); (N.Á.); (S.V.)
| | - Bálint Bányai
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (M.S.); (G.L.N.); (E.M.H.)
| | - Réka Eszter Sziva
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary; (M.S.); (D.G.); (H.D.); (R.K.); (M.T.); (N.Á.); (S.V.)
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (M.S.); (G.L.N.); (E.M.H.)
- Workgroup for Science Management, Doctoral School, Semmelweis University, Üllői Street 22, 1085 Budapest, Hungary
- Correspondence:
| | - Réka Kollarics
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary; (M.S.); (D.G.); (H.D.); (R.K.); (M.T.); (N.Á.); (S.V.)
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (M.S.); (G.L.N.); (E.M.H.)
| | - Péter Magyar
- Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary;
| | - Marianna Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary; (M.S.); (D.G.); (H.D.); (R.K.); (M.T.); (N.Á.); (S.V.)
- Workgroup for Science Management, Doctoral School, Semmelweis University, Üllői Street 22, 1085 Budapest, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary; (M.S.); (D.G.); (H.D.); (R.K.); (M.T.); (N.Á.); (S.V.)
| | - Mária Szekeres
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (M.S.); (G.L.N.); (E.M.H.)
- Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Vas Street 17, 1088, Budapest, Hungary
| | - György L. Nádasy
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (M.S.); (G.L.N.); (E.M.H.)
| | - Leila Hadjadj
- Department of Translational Medicine, Faculty of Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary;
| | - Eszter Mária Horváth
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (M.S.); (G.L.N.); (E.M.H.)
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Üllői Street 78/a, 1083 Budapest, Hungary; (M.S.); (D.G.); (H.D.); (R.K.); (M.T.); (N.Á.); (S.V.)
- Workgroup for Science Management, Doctoral School, Semmelweis University, Üllői Street 22, 1085 Budapest, Hungary
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Yoo MY, Lee J, Chung JI, Yeo Y, Cho IY. The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea. Korean J Fam Med 2021; 42:303-309. [PMID: 34320798 PMCID: PMC8321912 DOI: 10.4082/kjfm.20.0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/03/2020] [Indexed: 12/31/2022] Open
Abstract
Background As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams. Methods A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps. Results About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006). Conclusion We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects.
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Affiliation(s)
- Mun Young Yoo
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungkwon Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji In Chung
- Department of Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yohwan Yeo
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Young Cho
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Miao H, Zhu H, Luan X, Huang G, Chen M, Yuan Z, Wang Z. Risk Factors of Vitamin D Deficiency in Chinese Ischemic Stroke Patients: A Cross-Sectional Study. Front Aging Neurosci 2021; 12:613498. [PMID: 33536895 PMCID: PMC7849025 DOI: 10.3389/fnagi.2020.613498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Lower serum vitamin D has been reported to be associated with stroke. This study aimed to analyze the risk factors of vitamin deficiency in Chinese stroke patients, and further analyze its impact in different gender and their clinical variables. Methods 982 stroke patients were enrolled. Laboratory parameters such as serum vitamin D, apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB), ApoA-I/ApoB, cholesterol (CH), fibrinogen (FIB), blood glucose (Glu), high-density lipoprotein (HDL), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were collected and recorded. The severity of stroke was assessed by National Institute of Health Stroke Scale (NIHSS) score. Based on their serum vitamin D level, patients were divided into three groups: Vitamin D deficiency (<50 nmol/L), vitamin D insufficiency (≥50–75 nmol/L) and vitamin D sufficiency (≥75 nmol/L) and differences were compared among the three groups. Statistical analyses were done to assess the risk factors for serum vitamin D deficiency in our ischemic stroke patients. Results Gender, NIHSS, and FIB showed significant differences among the vitamin D groups (P < 0.001 ∼ P = 0.002). The female gender (OR = 2.422, P < 0.001), severity of stroke using NIHSS (OR = 1.055, P = 0.008) and FIB (OR = 1.256, P = 0.005) were risk factors of vitamin D deficiency in ischemic stroke patients. In subgroup analysis, NIHSS was significantly associated with vitamin D deficiency in the male group (OR = 1.087, P = 0.002) and higher FIB group (OR = 1.078, P = 0.001). Conclusions The female gender, severity of stroke using NIHSS and FIB were risk factors for vitamin D deficiency in our incident stroke patients. NIHSS was more sensitive to vitamin D deficiency in male ischemic stroke patients. Besides, under higher FIB circumstance, the increasing NIHSS score was more related to the vitamin D deficiency. Levels of vitamin D in patients with ischemic stroke should be well monitored during the disease cascade.
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Affiliation(s)
- Hanpei Miao
- Department of Ophthalmology, Wenzhou Medical University, Wenzhou, China
| | - Hanyu Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meixia Chen
- Department of Neurology, The Yuhuan People's Hospital, Taizhou, China
| | - Zhengzhong Yuan
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Yarlagadda K, Ma N, Doré S. Vitamin D and Stroke: Effects on Incidence, Severity, and Outcome and the Potential Benefits of Supplementation. Front Neurol 2020; 11:384. [PMID: 32587562 PMCID: PMC7298071 DOI: 10.3389/fneur.2020.00384] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
Vitamin D serum level has been positively associated with improved cardiovascular health, especially with reduction of stroke risk. This systemic review summarizes and synthesizes findings from studies relevant to the relationship between vitamin D and stroke risk, severity, and outcome; potential mechanisms explaining such a relationship; and outcomes from vitamin D supplementation. The literature shows that vitamin D deficiency is a significant risk factor for ischemic stroke, with sun exposure, sex, age, race, diabetes, and genetics playing a role as well. Stroke severity and short- and long-term outcomes also worsen with vitamin D deficiency. The neuroprotective mechanisms by which vitamin D operates to mitigate stroke onset and outcomes have yet to be fully studied, but researchers have proposed several pathways, including promotion of certain neuroprotective growth factors, reduction of arterial pressure through vasodilation, and inhibition of reactive oxygen species. There is some evidence that vitamin D supplementation could lower stroke risk and improve recovery, though outcomes can also be negligible or negative. Although results are mixed and the limitations of vitamin D supplementation merit some caution, vitamin D overall plays a significant role in stroke health. Future research should further develop understanding of the neuroprotective mechanisms of vitamin D and study how supplementation could be administered effectively in stroke treatment.
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Affiliation(s)
- Keerthi Yarlagadda
- Doré Lab, Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
| | - Nicholas Ma
- Doré Lab, Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
| | - Sylvain Doré
- Doré Lab, Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
- Doré Lab, Departments of Neurology, Psychiatry, Pharmaceutics, Psychology, and Neuroscience, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
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11
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Su Y, Leung J, Lee J, Ho KF, Kwok T. The effect of physical activity on dose-relationship between serum 25-hydroxyvitamin D and cardiovascular health events in older adults. Nutr Metab Cardiovasc Dis 2020; 30:656-665. [PMID: 32151483 PMCID: PMC7203507 DOI: 10.1016/j.numecd.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/09/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Reverse J- or U-shaped associations between serum 25-hydroxyvitamin D (25[OH]D) concentrations and cardiovascular outcomes have been reported, which need clarifications in older adults. Physical activity, correlating with both serum 25[OH]D concentration and cardiovascular health, may have an effect on the dose-relationships. METHODS AND RESULTS At baseline, 2790 participants aged 65 years and over, free of vitamin D supplementation use, had assays for serum 25[OH]D concentrations and health related characteristics and measurements, were followed up for cardiovascular events and death by up to 7 and 15 years, respectively. The dose-response associations of serum 25[OH]D concentrations with cardiovascular events and mortality risk were examined using Cox regression models. After adjusting for physical activity and other covariates, serum 25[OH]D concentration was non-linearly associated with cardiovascular mortality risk (U-shaped, P = 0.009). According to the Institute of Medicine categories, the HR(95% CI) of cardiovascular mortality risk separately in deficient (<25 nmol/L), inadequate (25 to < 50 nmol/L) and potentially harmful (≥125 nmol/L) level was 1.67 (0.23, 12.01), 1.66 (1.25, 2.20) and 2.21 (0.30, 16.37), respectively. The risk of 25[OH]D inadequacy for cardiovascular mortality was significantly attenuated by increased physical activity, especially leisure activity (P for trend = 0.008 and 0.021, respectively). No significant finding was observed for incident cardiovascular events. CONCLUSION Both lower and higher serum 25[OH]D concentrations were associated with risk of cardiovascular mortality in Chinese community-dwelling older adults. Physical activity may attenuate the cardiovascular mortality risk of vitamin D inadequacy, but its role in individuals with higher 25[OH]D concentrations remains unclear.
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Affiliation(s)
- Yi Su
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jenny Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Geriatrics, Alice Ho Miu Ling Nethersole Hospital and Tai Po Hospital, Hong Kong SAR, China
| | - Kin-Fai Ho
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong SAR, China.
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12
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25-Hydroxyvitamin D level, vitamin D intake, and risk of stroke: A dose-response meta-analysis. Clin Nutr 2019; 39:2025-2034. [PMID: 31530422 DOI: 10.1016/j.clnu.2019.08.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS A growing number of studies have shown that vitamin D are related to the risk of stroke, however, the dose-response association between vitamin D and the risk of stroke is still unclear. Accordingly, we conducted a dose-response meta-analysis to evaluate the relationships between 25-hydroxyvitamin D [25(OH)D] level, vitamin D intake, and the risk of stroke by summarizing cohort studies. METHODS PubMed, Embase, Cochrane and the Web of Science database were searched for related studies. Cohort studies examining the influence of 25(OH)D level and vitamin D intake on stroke risk were summarized. Dose-response relationships were determined using a random-effect model. RESULTS Twenty cohort studies involving 217,235 participants were included. The pooled relative risk for the high-versus-low categories was 0.74 (95% CI: 0.66-0.83) for 25(OH)D level, and 0.75 (95% CI: 0.57-0.98) for vitamin D intake. In addition, there were non-linear relationships between 25(OH)D level, vitamin D intake, and stroke risk. The incidence of stroke was reduced to its lowest point, with a reduction of about 20%, when 25(OH)D level was about 50 nmol/L or vitamin D intake was about 12 μg/day. CONCLUSION 25(OH)D level and vitamin D intake were both inversely related to stroke risk, with a non-linear dose-response relationship.
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13
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Kouvari M, Panagiotakos DB. Vitamin D status, gender and cardiovascular diseases: a systematic review of prospective epidemiological studies. Expert Rev Cardiovasc Ther 2019; 17:545-555. [DOI: 10.1080/14779072.2019.1637255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Matina Kouvari
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Canberra, Australia
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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14
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Holmberg T, Möller S, Rothmann MJ, Gram J, Herman AP, Brixen K, Tolstrup JS, Høiberg M, Bech M, Rubin KH. Socioeconomic status and risk of osteoporotic fractures and the use of DXA scans: data from the Danish population-based ROSE study. Osteoporos Int 2019; 30:343-353. [PMID: 30465216 DOI: 10.1007/s00198-018-4768-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED There is a need of studies exploring the link between socioeconomic status and DXA scans and osteoporotic fracture, which was the aim of the present study. No differences in socioeconomic status and risk of osteoporotic fractures were found. However, women with further/higher education and higher income are more often DXA-scanned. INTRODUCTION Lower socioeconomic status is known to be associated with a range of chronic conditions and with access to health care services. The link between socioeconomic status and the use of DXA scans and osteoporotic fracture, however, needs to be explored more closely. Therefore, the aim of this study was to examine the relationship between socioeconomic status and both DXA scan utilization and major osteoporotic fractures (MOF) using a population-based cohort of Danish women and national registers. METHODS The study included 17,155 women (65-81 years) sampled from the Risk-stratified Osteoporosis Strategy Evaluation study (ROSE). Information on socioeconomic background, DXA scans, and MOFs was retrieved from national registers. Competing-risk regression analyses were performed. Mean follow-up was 4.8 years. RESULTS A total of 4245 women had a DXA scan (24.7%) and 1719 (10.0%) had an incident MOF during follow-up. Analyses showed that women with basic education had a lower probability of undergoing DXA scans than women with further or higher education (greater than upper secondary education and vocational training education) (subhazard ratio (SHR) = 0.82; 95% CI 0.75-0.89, adjusted for age and comorbidity). Moreover, women with disposable income in the low and medium tertiles had a lower probability of undergoing DXA scans than women in the high-income tertile (SHR = 0.90; 95% CI 0.84-0.97 and SHR = 0.88, 95% CI 0.82-0.95, respectively, adjusted for age and comorbidity). No association between socioeconomic background and probability of DXA was found in adjusted analyses. CONCLUSION The study found no differences in risk of osteoporotic fractures depending on socioeconomic status. However, women with further or higher education as well as higher income are more often DXA-scanned.
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Affiliation(s)
- T Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1355, Copenhagen K, Denmark.
| | - S Möller
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M J Rothmann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - A P Herman
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K Brixen
- Odense University Hospital, Odense, Denmark
| | - J S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1355, Copenhagen K, Denmark
| | - M Høiberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Hospital of Southern Norway, Kristiansand, Norway
| | - M Bech
- Department of Political Science, Aarhus University, Aarhus, Denmark
| | - K H Rubin
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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15
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Heath AK, Kim IY, Hodge AM, English DR, Muller DC. Vitamin D Status and Mortality: A Systematic Review of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030383. [PMID: 30700025 PMCID: PMC6388383 DOI: 10.3390/ijerph16030383] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 12/31/2022]
Abstract
Epidemiological evidence suggests that vitamin D deficiency is associated with increased mortality, but it is unclear whether this is explained by reverse causation, and if there are specific causes of death for which vitamin D might be important. We conducted a systematic review of observational studies investigating associations between circulating 25-hydroxyvitamin D (25(OH)D) concentration and all-cause or cause-specific mortality in generally healthy populations. Relevant studies were identified using PubMed and EMBASE searches. After screening 722 unique records and removing those that were ineligible, 84 articles were included in this review. The vast majority of studies reported inverse associations between 25(OH)D concentration and all-cause mortality. This association appeared to be non-linear, with progressively lower mortality with increasing 25(OH)D up to a point, beyond which there was no further decrease. There is moderate evidence that vitamin D status is inversely associated with cancer mortality and death due to respiratory diseases, while for cardiovascular mortality, there is weak evidence of an association in observational studies, which is not supported by the data from intervention or Mendelian randomization studies. The relationship between vitamin D status and other causes of death remains uncertain due to limited data. Larger long-term studies are required to clarify these associations.
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Affiliation(s)
- Alicia K Heath
- School of Public Health, Imperial College London, London W2 1PG, UK.
| | - Iris Y Kim
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
| | - Allison M Hodge
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria 3010, Australia.
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria 3010, Australia.
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
| | - David C Muller
- School of Public Health, Imperial College London, London W2 1PG, UK.
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16
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Intiso D, Fontana A, Copetti M, Di Rienzo F. Serum vitamin D deficiency in subjects with severe acquired brain injury and relationship with functional severity. Brain Inj 2018; 32:1817-1823. [PMID: 30339483 DOI: 10.1080/02699052.2018.1537512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Vitamin D may be important for the development and function of the nervous system. Low serum vitamin D levels have been detected in several neurological diseases. OBJECTIVE To ascertain the relationship between 25(OH)D serum level and disability in subjects with severe acquired brain injury (sABI). DESIGN Prospective cross-sectional study Methods: Consecutive subjects with sABI admitted to neuro-rehabilitation were enrolled. A sample of subjects from the neurological ward was considered the control group. Vitamin D serum levels and blood parameters were measured at admission. Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), and Level of Cognitive Functioning (LCF) were used in assessing disability. RESULTS A total of 104 subjects (34 F, 70 M; mean age 53.9 ± 15.2 years) were enrolled: 54 (19 F, 35 M) with sABI and 50 (15 F, 35 M) subjects as control group. Deficient mean serum levels of vitamin D (19.2 ± 9.4 ng/mL) were detected in the subjects with sABI and a significant inverse correlation between vitamin D serum levels and DRS score was detected (p = 0.04). CONCLUSION Subjects with sABI showed vitamin D deficiency that might correlate to disability severity. The reason is unclear and might represent a secondary phenomenon resulting from the inflammatory process.
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Affiliation(s)
- D Intiso
- a Unit of Neuro-rehabilitation, and Rehabilitation Medicine , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Foggia , Italy
| | - A Fontana
- b Unit of Biostatistics , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Foggia , Italy
| | - M Copetti
- b Unit of Biostatistics , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Foggia , Italy
| | - F Di Rienzo
- a Unit of Neuro-rehabilitation, and Rehabilitation Medicine , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Foggia , Italy
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17
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Tognon G, Rothenberg E, Petrolo M, Sundh V, Lissner L. Dairy product intake and mortality in a cohort of 70-year-old Swedes: a contribution to the Nordic diet discussion. Eur J Nutr 2017; 57:2869-2876. [PMID: 29080977 PMCID: PMC6267406 DOI: 10.1007/s00394-017-1556-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 10/03/2017] [Indexed: 01/01/2023]
Abstract
Introduction Conflicting results in the literature exist on the role of dairy products in the context of a Nordic Healthy Diet (NHD). Two recent Swedish studies indicate both negative and positive associations with total mortality when comparing key dairy products. There is no consensus about how to include these foods into the NHD. Purpose To study consumption of cheese and milk products (milk, sour milk and unsweetened yoghurt) by 70-year-old Swedes in relation to all-cause mortality. Methods Cox proportional hazard models, adjusted for potential confounders and stratified by follow-up duration, were used to assess the prediction of all-cause mortality by the above foods. The associations of fat from cheese and milk products with mortality were tested in separate models. Results Cheese intake inversely predicted total mortality, particularly at high protein intakes, and this association decreased in strength with increasing follow-up time. Milk products predicted increased mortality with stable HRs over follow-up. The association between milk products and mortality was strongly influenced by the group with the highest consumption. Fat from cheese mirrored the protective association of cheese intake with mortality, whereas fat from milk products predicted excess mortality, but only in an energy-adjusted model. Conclusion Based on our results, it may be argued that the role of dairy products in the context of a Nordic healthy diet should be more clearly defined by disaggregating cheese and milk products and not necessarily focusing on dairy fat content. Future epidemiological research should consider dairy products as disaggregated food items due to their great diversity in health properties. Electronic supplementary material The online version of this article (doi:10.1007/s00394-017-1556-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gianluca Tognon
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, SE 405 30, Gothenburg, Sweden.
| | | | - Martina Petrolo
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, SE 405 30, Gothenburg, Sweden
| | - Valter Sundh
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, SE 405 30, Gothenburg, Sweden
| | - Lauren Lissner
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, SE 405 30, Gothenburg, Sweden
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