Petrana Martinekova, Mahmoud Obeidat, Mihaela Topala, Szilárd Váncsa, Dániel Sándor Veres, Ádám Zolcsák, Miheller Pál, László Földvári-Nagy, Peter Banovcin, Bálint Erőss, Péter Hegyi, Krisztina Hagymasi
{"title":"维生素D补充在慢性肝病中的作用：随机对照试验的系统回顾和荟萃分析。","authors":"Petrana Martinekova, Mahmoud Obeidat, Mihaela Topala, Szilárd Váncsa, Dániel Sándor Veres, Ádám Zolcsák, Miheller Pál, László Földvári-Nagy, Peter Banovcin, Bálint Erőss, Péter Hegyi, Krisztina Hagymasi","doi":"10.1093/nutrit/nuaf117","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>Vitamin D deficiency is highly prevalent in chronic liver disease. Although international societies recommend vitamin D supplementation in cases of proven deficiency, the impact of vitamin D on chronic liver disease remains uncertain.</p><p><strong>Objective: </strong>Our aim was to evaluate the effects of vitamin D supplementation in patients with chronic liver disease by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Data sources: </strong>We systematically searched PubMed, EMBASE and the Cochrane Library on July 2, 2024.</p><p><strong>Data extraction: </strong>Our primary outcomes involved survival, controlled attenuation parameter (CAP), liver stiffness measurement (LSM), and effects on changes in liver enzymes. Secondary outcomes included lipid profile and homeostasis model assessment of insulin resistance (HOMA-IR), among others. The pooled risk ratio (RR), mean difference (MD), and corresponding 95% CIs were calculated using the random-effects model.</p><p><strong>Data analysis: </strong>Forty-six RCTs were included, comprising 4084 patients. When we compared the vitamin D group with the control, the RR for overall survival was 1.14 (95% CI, 0.85-1.54; 4 RCTs) at 6 months and 0.99 (95% CI, 0.83-1.17; 4 RCTs) at the 12-month follow-up. Vitamin D supplementation did not result in a lower CAP (MD, -23.50 dB/m; 95% CI, -81.72 to 34.72; 3 RCTs) and LSM (MD, -0.65 kPa; 95% CI, -1.98 to 0.68; 3 RCTs). A significant reduction in HOMA-IR was observed in the vitamin D group (MD, -0.31; 95% CI, -0.62 to -0.01; 15 RCTs). Alanine aminotransferase (ALT) (MD, -4.98 IU/L; 95% CI, -8.28 to -1.68; 24 RCTs), aspartate aminotransferase (AST) (MD, -3.33 IU/L; 95% CI, -6.25 to -0.40; 23 RCTs), gamma-glutamyl transferase (GGT) (MD, -5.14 IU/L; -6.40; -3.88; 11 RCTs), triglycerides (MD, -7.59 mg/dL; 95% CI, -15.09 to -0.81), and insulin (MD -0.79 μIU/L; 95% CI, -1.36 to -0.21) were significantly reduced in the patients with vitamin D supplementation.</p><p><strong>Conclusion: </strong>Our results showed significantly reduced ALT, AST, GGT, triglycerides, insulin, and HOMA-IR in the vitamin D-supplemented group; however, the effect was modest. In addition, there were no differences in survival, CAP, or LSM. Further RCTs with adequate power are warranted to clarify the results.</p><p><strong>Systematic review registration: </strong>PROSPERO registration No. CRD42022370312.</p>","PeriodicalId":19469,"journal":{"name":"Nutrition reviews","volume":" ","pages":""},"PeriodicalIF":5.9000,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Role of Vitamin D Supplementation in Chronic Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.\",\"authors\":\"Petrana Martinekova, Mahmoud Obeidat, Mihaela Topala, Szilárd Váncsa, Dániel Sándor Veres, Ádám Zolcsák, Miheller Pál, László Földvári-Nagy, Peter Banovcin, Bálint Erőss, Péter Hegyi, Krisztina Hagymasi\",\"doi\":\"10.1093/nutrit/nuaf117\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Context: </strong>Vitamin D deficiency is highly prevalent in chronic liver disease. Although international societies recommend vitamin D supplementation in cases of proven deficiency, the impact of vitamin D on chronic liver disease remains uncertain.</p><p><strong>Objective: </strong>Our aim was to evaluate the effects of vitamin D supplementation in patients with chronic liver disease by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Data sources: </strong>We systematically searched PubMed, EMBASE and the Cochrane Library on July 2, 2024.</p><p><strong>Data extraction: </strong>Our primary outcomes involved survival, controlled attenuation parameter (CAP), liver stiffness measurement (LSM), and effects on changes in liver enzymes. Secondary outcomes included lipid profile and homeostasis model assessment of insulin resistance (HOMA-IR), among others. The pooled risk ratio (RR), mean difference (MD), and corresponding 95% CIs were calculated using the random-effects model.</p><p><strong>Data analysis: </strong>Forty-six RCTs were included, comprising 4084 patients. When we compared the vitamin D group with the control, the RR for overall survival was 1.14 (95% CI, 0.85-1.54; 4 RCTs) at 6 months and 0.99 (95% CI, 0.83-1.17; 4 RCTs) at the 12-month follow-up. Vitamin D supplementation did not result in a lower CAP (MD, -23.50 dB/m; 95% CI, -81.72 to 34.72; 3 RCTs) and LSM (MD, -0.65 kPa; 95% CI, -1.98 to 0.68; 3 RCTs). A significant reduction in HOMA-IR was observed in the vitamin D group (MD, -0.31; 95% CI, -0.62 to -0.01; 15 RCTs). Alanine aminotransferase (ALT) (MD, -4.98 IU/L; 95% CI, -8.28 to -1.68; 24 RCTs), aspartate aminotransferase (AST) (MD, -3.33 IU/L; 95% CI, -6.25 to -0.40; 23 RCTs), gamma-glutamyl transferase (GGT) (MD, -5.14 IU/L; -6.40; -3.88; 11 RCTs), triglycerides (MD, -7.59 mg/dL; 95% CI, -15.09 to -0.81), and insulin (MD -0.79 μIU/L; 95% CI, -1.36 to -0.21) were significantly reduced in the patients with vitamin D supplementation.</p><p><strong>Conclusion: </strong>Our results showed significantly reduced ALT, AST, GGT, triglycerides, insulin, and HOMA-IR in the vitamin D-supplemented group; however, the effect was modest. In addition, there were no differences in survival, CAP, or LSM. Further RCTs with adequate power are warranted to clarify the results.</p><p><strong>Systematic review registration: </strong>PROSPERO registration No. CRD42022370312.</p>\",\"PeriodicalId\":19469,\"journal\":{\"name\":\"Nutrition reviews\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2025-07-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nutrition reviews\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/nutrit/nuaf117\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nutrition reviews","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/nutrit/nuaf117","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
Role of Vitamin D Supplementation in Chronic Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Context: Vitamin D deficiency is highly prevalent in chronic liver disease. Although international societies recommend vitamin D supplementation in cases of proven deficiency, the impact of vitamin D on chronic liver disease remains uncertain.
Objective: Our aim was to evaluate the effects of vitamin D supplementation in patients with chronic liver disease by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).
Data sources: We systematically searched PubMed, EMBASE and the Cochrane Library on July 2, 2024.
Data extraction: Our primary outcomes involved survival, controlled attenuation parameter (CAP), liver stiffness measurement (LSM), and effects on changes in liver enzymes. Secondary outcomes included lipid profile and homeostasis model assessment of insulin resistance (HOMA-IR), among others. The pooled risk ratio (RR), mean difference (MD), and corresponding 95% CIs were calculated using the random-effects model.
Data analysis: Forty-six RCTs were included, comprising 4084 patients. When we compared the vitamin D group with the control, the RR for overall survival was 1.14 (95% CI, 0.85-1.54; 4 RCTs) at 6 months and 0.99 (95% CI, 0.83-1.17; 4 RCTs) at the 12-month follow-up. Vitamin D supplementation did not result in a lower CAP (MD, -23.50 dB/m; 95% CI, -81.72 to 34.72; 3 RCTs) and LSM (MD, -0.65 kPa; 95% CI, -1.98 to 0.68; 3 RCTs). A significant reduction in HOMA-IR was observed in the vitamin D group (MD, -0.31; 95% CI, -0.62 to -0.01; 15 RCTs). Alanine aminotransferase (ALT) (MD, -4.98 IU/L; 95% CI, -8.28 to -1.68; 24 RCTs), aspartate aminotransferase (AST) (MD, -3.33 IU/L; 95% CI, -6.25 to -0.40; 23 RCTs), gamma-glutamyl transferase (GGT) (MD, -5.14 IU/L; -6.40; -3.88; 11 RCTs), triglycerides (MD, -7.59 mg/dL; 95% CI, -15.09 to -0.81), and insulin (MD -0.79 μIU/L; 95% CI, -1.36 to -0.21) were significantly reduced in the patients with vitamin D supplementation.
Conclusion: Our results showed significantly reduced ALT, AST, GGT, triglycerides, insulin, and HOMA-IR in the vitamin D-supplemented group; however, the effect was modest. In addition, there were no differences in survival, CAP, or LSM. Further RCTs with adequate power are warranted to clarify the results.
期刊介绍：
Nutrition Reviews is a highly cited, monthly, international, peer-reviewed journal that specializes in the publication of authoritative and critical literature reviews on current and emerging topics in nutrition science, food science, clinical nutrition, and nutrition policy. Readers of Nutrition Reviews include nutrition scientists, biomedical researchers, clinical and dietetic practitioners, and advanced students of nutrition.
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