Vitamin D and calcium: a systematic review of health outcomes.

Mei Chung, Ethan M Balk, Michael Brendel, Stanley Ip, Joseph Lau, Jounghee Lee, Alice Lichtenstein, Kamal Patel, Gowri Raman, Athina Tatsioni, Teruhiko Terasawa, Thomas A Trikalinos
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Abstract

Background: Since the 1997 Dietary Reference Intake (DRI) values for vitamin D and calcium were established new data have become available on their relationship, both individually and combined, to a wide range of health outcomes. The Institute of Medicine/Food and Nutrition Board has constituted a DRI committee to undertake a review of the evidence and potential revision of the current DRI values for these nutrients. To support this review, several US and Canadian federal government agencies commissioned a systematic review of the scientific literature for use during the deliberations by the committee. The intent of providing a systematic review to the committee is to support transparency of the literature review process and provide a foundation for subsequent reviews of the nutrients.

Purpose: To systematically summarize the evidence on the relationship between vitamin D, calcium, and a combination of both nutrients on a wide range of health outcomes as identified by the IOM, AHRQ and technical expert panel convened to support the project.

Data sources: MEDLINE; Cochrane Central; Cochrane Database of Systematic Reviews; and the Health Technology Assessments; search limited to English-language articles in humans.

Study selection: Primary interventional or observational studies that reported outcomes of interest in human subjects in relation to vitamin D and/or calcium, as well as systematic reviews that met the inclusion and exclusion criteria. Cross sectional and retrospective case-control studies were excluded.

Data extraction: A standardized protocol with predefined criteria was used to extract details on study design, interventions, outcomes, and study quality.

Data synthesis: We summarized 165 primary articles and 11 systematic reviews that incorporated over 200 additional primary articles. Available evidence focused mainly on bone health, cardiovascular diseases or cancer outcomes. For many outcomes, it was difficult to draw firm conclusions on the basis of the available literature concerning the association of either serum 25(OH)D concentration or calcium intake, or the combination of both nutrients. Findings were inconsistent across studies for colorectal and prostate cancer, and pregnancy-related outcomes including preeclampsia. There were few studies for pancreatic cancer and immune function. Among trials of hypertensive adults, calcium supplementation lowered systolic, but not diastolic, blood pressure by 2-4 mm Hg. For body weight, the trials were consistent in finding no significant effect of increased calcium intake on weight. For growth rates, a meta-analysis did not find a significant effect on weight or height gain attributable to calcium supplement in children. For bone health, one systematic review found that vitamin D plus calcium supplementation resulted in small increases in BMD of the spine and other areas in postmenopausal women. For breast cancer, calcium intakes in premenopausal women were associated with a decreased risk. For prostate cancer, some studies reported that high calcium intakes were associated with an increased risk.

Limitations: Studies on vitamin D and calcium were not specifically targeted at life stages (except for pregnant and postmenopausal women) specified for the determination of DRI. There is large variation on the methodological quality of studies examined. Use of existing systematic reviews limits analyses that could be performed on this source of information.

Conclusions: The majority of the findings concerning vitamin D, calcium, or a combination of both nutrients on the different health outcomes were inconsistent. Synthesizing a dose-response relation between intake of either vitamin D, calcium, or both nutrients and health outcomes in this heterogeneous body of literature proved challenging.

维生素D和钙:健康结果的系统回顾。
背景:自从1997年维生素D和钙的膳食参考摄取量(DRI)值被确立以来,关于它们与广泛的健康结果之间的关系,无论是单独的还是综合的,已经有了新的数据。医学研究所/食品和营养委员会组成了一个DRI委员会,负责对这些营养素的现有DRI值的证据和可能的修订进行审查。为了支持这一审查,美国和加拿大的几个联邦政府机构委托对科学文献进行系统审查,供委员会审议期间使用。向委员会提供系统评价的目的是支持文献评价过程的透明度,并为后续的营养物质评价提供基础。目的:系统地总结由IOM、AHRQ和支持该项目的技术专家小组确定的维生素D、钙和这两种营养素的组合对广泛健康结果之间关系的证据。数据来源:MEDLINE;科克伦中央;Cochrane系统评价数据库;卫生技术评估;搜索仅限于人类的英语文章。研究选择:报告了与维生素D和/或钙相关的人类受试者结果的初级干预性或观察性研究,以及符合纳入和排除标准的系统评价。排除了横断面和回顾性病例对照研究。数据提取:采用具有预定义标准的标准化方案提取有关研究设计、干预措施、结果和研究质量的详细信息。数据综合:我们总结了165篇主要文章和11篇系统综述,其中包括200多篇额外的主要文章。现有证据主要集中在骨骼健康、心血管疾病或癌症结局方面。对于许多结果,很难根据现有文献得出关于血清25(OH)D浓度或钙摄入量或两种营养素组合的关系的确切结论。结直肠癌和前列腺癌以及妊娠相关结局(包括先兆子痫)的研究结果不一致。关于胰腺癌和免疫功能的研究很少。在高血压成人的试验中,补充钙降低了收缩压2-4毫米汞柱,但没有降低舒张压。对于体重,试验一致发现增加钙摄入量对体重没有显著影响。对于生长速度,一项荟萃分析没有发现补钙对儿童体重或身高增加的显著影响。对于骨骼健康,一项系统综述发现,补充维生素D和钙可以使绝经后妇女脊柱和其他部位的骨密度小幅增加。对于乳腺癌,绝经前妇女的钙摄入量与风险降低有关。对于前列腺癌,一些研究报告称,高钙摄入量与患病风险增加有关。局限性:关于维生素D和钙的研究并没有专门针对DRI测定所规定的生命阶段(孕妇和绝经后妇女除外)。研究的方法学质量存在很大差异。现有系统评价的使用限制了对这一信息来源的分析。结论:大多数关于维生素D、钙或两种营养素组合对不同健康结果的研究结果是不一致的。在这一异质性的文献中,合成维生素D、钙或两种营养素摄入与健康结果之间的剂量-反应关系证明是具有挑战性的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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