Loading...
 
Toggle Health Problems and D

Mortality rate inversely associated with vitamin D level 20 years earlier – Oct 2013

Inverse association between circulating vitamin D and mortality--dependent on sex and cause of death?

Nutr Metab Cardiovasc Dis. 2013 Oct;23(10):960-6. doi: 10.1016/j.numecd.2013.05.005. Epub 2013 Oct 3.
Rohrmann S1, Braun J, Bopp M, Faeh D; Swiss National Cohort (SNC).
Collaborators (8)
Gutzwiller F, Bopp M, Egger M, Spoerri A, Zwahlen M, Kuenzli N, Paccaud F, Oris M.
1 Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland; Unit of Demography and Health Statistics, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland. Electronic address: sabine.rohrmann at ifspm.uzh.ch.

BACKGROUND AND AIMS:
In various populations, vitamin D deficiency is associated with chronic diseases and mortality. We examined the association between concentration of circulating 25-hydroxyvitamin D 25(OH)D, a marker of vitamin D status, and all-cause as well as cause-specific mortality.

METHODS AND RESULTS:
The study included 3404 participants of the general adult Swiss population, who were recruited between November 1988 and June 1989 and followed-up until the end of 2008. Circulating 25(OH)D was measured by protein-bound assay. Cox proportional hazards regression was used to examine the association between 25(OH)D concentration and all-cause and cause-specific mortality adjusting for sex, age, season, diet, nationality, blood pressure, and smoking status.

Per 10 ng/mL increase in 25(OH)D concentration, all-cause mortality decreased by 20% (HR = 0.83; 95% CI 0.74-0.92).
25(OH)D concentration was inversely associated with cardiovascular mortality in women (HR = 0.68, 95% CI 0.46-1.00 per 10 ng/mL increase), but not in men (HR = 0.97; 95% CI 0.77-1.23).
In contrast, 25(OH)D concentration was inversely associated with cancer mortality in men (HR = 0.72, 95% CI 0.57-0.91 per 10 ng/mL increase), but not in women (HR = 1.14, 95% CI 0.93-1.39). Multivariate adjustment only slightly modified the 25(OH)D-mortality association.

CONCLUSION:
25(OH)D was similarly inversely related to all-cause mortality in men and women.
However, we observed opposite effects in women and men with respect to cardiovascular and cancer mortality.

PMID: 24095147

References

  • Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281
  • Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 2008;8:685–698
  • Welsh J. Cellular and molecular effects of vitamin D on carcinogenesis. Arch Biochem Biophys. 2012;523:107–114
  • Guessous I, Bochud M, Bonny O, Burnier M. Calcium, vitamin D and cardiovascular disease. Kidney Blood Press Res. 2011;34:404–417
  • Zittermann A, Iodice S, Pilz S, Grant WB, Bagnardi V, Gandini S. Vitamin D deficiency and mortality risk in the general population: a meta-analysis of prospective cohort studies. Am J Clin Nutr. 2012;95:91–100
  • Durup D, Jorgensen HL, Christensen J, Schwarz P, Heegaard AM, Lind B. A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study. J Clin Endocrinol Metab. 2012;97:2644–2652
  • Saliba W, Barnett O, Rennert HS, Rennert G. The risk of all-cause mortality is inversely related to serum 25(OH)D levels. J Clin Endocrinol Metab. 2012;97:2792–2798
  • Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrlander C, et al. Cohort profile: the Swiss National Cohort–a longitudinal study of 6.8 million people. Int J Epidemiol. 2009;38:379–384
  • Bopp M, Braun J, Faeh D, Gutzwiller F. Establishing a follow-up of the Swiss MONICA participants (1984-1993): record linkage with census and mortality data. BMC Public Health. 2010;10:562
  • Wietlisbach V, Barazzoni F. Outcome and analysis of participation in the 2d MONICA survey (1988-1989) of cardiovascular risk factors. Schweiz Med Wochenschr Suppl. 1993;48:13–20 MEDLINE
  • Burnand B, Sloutskis D, Gianoli F, Cornuz J, Rickenbach M, Paccaud F, et al. Serum 25-hydroxyvitamin D: distribution and determinants in the Swiss population. Am J Clin Nutr. 1992;56:537–542 MEDLINE
  • Michaëlsson K, Baron JA, Snellman G, Gedeborg R, Byberg L, Sundström J, et al. Plasma vitamin D and mortality in older men: a community-based prospective cohort study. Am J Clin Nutr. 2010;92:841–848
  • Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168:1629–1637
  • Ginde AA, Scragg R, Schwartz RS, Camargo CA. Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all-cause mortality in older U.S. adults. J Am Geriatr Soc. 2009;57:1595–1603
  • Bolland MJ, Bacon CJ, Horne AM, Mason BH, Ames RW, Wang TK, et al. Vitamin D insufficiency and health outcomes over 5 y in older women. Am J Clin Nutr. 2010;91:82–89
  • Fiscella K, Franks P. Vitamin D, race, and cardiovascular mortality: findings from a national US sample. Ann Fam Med. 2010;8:11–18
  • Zhao G, Ford ES, Li C, Croft JB. Serum 25-hydroxyvitamin D levels and all-cause and cardiovascular disease mortality among US adults with hypertension: the NHANES linked mortality study. J Hypertens. 2012;30:284–289
  • Kilkkinen A, Knekt P, Aro A, Rissanen H, Marniemi J, Heliovaara M, et al. Vitamin D status and the risk of cardiovascular disease death. Am J Epidemiol. 2009;170:1032–1039
  • Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, et al. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168:1340–1349
  • Wang L, Song Y, Manson JE, Pilz S, März W, Michaelsson K, et al. Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcome. 2012;5:819–829
  • Fan C, Nieto FJ, Bautista LE, Fine JP. Vitamin D intake and cardiovascular mortality in the NHANES I epidemiological follow-up study cohort. J Diet Suppl. 2012;9:79–89
  • Cawthon PM, Parimi N, Barrett-Connor E, Laughlin GA, Ensrud KE, Hoffman AR, et al. Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men. J Clin Endocrinol Metab. 2010;95:4625–4634
  • Freedman DM, Looker AC, Chang SC, Graubard BI. Prospective study of serum vitamin D and cancer mortality in the United States. J Natl Cancer Inst. 2007;99:1594–1602
  • Fedirko V, Riboli E, Tjonneland A, Ferrari P, Olsen A, Bueno-de-Mesquita HB, et al. Prediagnostic 25-Hydroxyvitamin D, VDR and CASR polymorphisms, and survival in patients with colorectal cancer in Western European populations. Cancer Epidemiol Biomarkers Prev. 2012;
  • Shui IM, Mucci LA, Kraft P, Tamimi RM, Lindstrom S, Penney KL, et al. Vitamin d-related genetic variation, plasma vitamin D, and risk of lethal prostate cancer: a prospective nested case-control study. J Natl Cancer Inst. 2012;104:690–699
  • Tretli S, Schwartz GG, Torjesen PA, Robsahm TE. Serum levels of 25-hydroxyvitamin D and survival in Norwegian patients with cancer of breast, colon, lung, and lymphoma: a population-based study. Cancer Causes Control. 2012;23:363–370
  • Vrieling A, Hein R, Abbas S, Schneeweiss A, Flesch-Janys D, Chang-Claude J. Serum 25-hydroxyvitamin D and postmenopausal breast cancer survival: a prospective patient cohort study. Breast Cancer Res. 2011;13:R74
  • Cheng TY, Neuhouser ML. Serum 25-hydroxyvitamin D, vitamin A, and lung cancer mortality in the US population: a potential nutrient-nutrient interaction. Cancer Causes Control. 2012;23:1557–1565
  • Giovannucci E, Liu Y, Rimm EB, Hollis BW, Fuchs CS, Stampfer MJ, et al. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst. 2006;98:451–459
  • Jenab M, Bueno-de-Mesquita HB, Ferrari P, van Duijnhoven FJ, Norat T, Pischon T, et al. Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations:a nested case-control study. BMJ. 2010;340:b5500
  • Semba RD, Houston DK, Bandinelli S, Sun K, Cherubini A, Cappola AR, et al. Relationship of 25-hydroxyvitamin D with all-cause and cardiovascular disease mortality in older community-dwelling adults. Eur J Clin Nutr. 2010;64:203–209
  • Sokol SI, Tsang P, Aggarwal V, Melamed ML, Srinivas VS. Vitamin D status and risk of cardiovascular events: lessons learned via systematic review and meta-analysis. Cardiol Rev. 2011;19:192–201
  • Schottker B, Ball D, Gellert C, Brenner H. Serum 25-hydroxyvitamin D levels and overall mortality. A systematic review and meta-analysis of prospective cohort studies. Ageing Res Rev. 2012;
  • Grant WB. Effect of follow-up time on the relation between prediagnostic serum 25-hydroxyvitamin D and all-cause mortality rate. Dermatoendocrinol. 2012;4:198–202
  • Jorde R, Sneve M, Hutchinson M, Emaus N, Figenschau Y, Grimnes G. Tracking of serum 25-hydroxyvitamin D levels during 14 years in a population-based study and during 12 months in an intervention study. Am J Epidemiol. 2010;171:903–908
  • Vargas CM, Ingram DD, Gillum RF. Incidence of hypertension and educational attainment: the NHANES I epidemiologic followup study. First National Health and Nutrition Examination Survey. Am J Epidemiol. 2000;152:272–278MEDLINE

Probably the vitamin D tests were made 20 years before death, so could have little to do with the cause of death.
A whole lot can happen to vitamin D levels in 20 years
Can increase: example - Go on more sunny vacations
Can decrease: example - Become a shut-in (senior or nursing home)
Also – if people moved away they were probably not included in the study