The Journal of Clinical Endocrinology and Metabolism Journal Article

Vitamin D Status and Mortality

October 12, 2020

Xikang Fan, Jiayu Wang, Mingyang Song, Edward L Giovannucci, Hongxia Ma, Guangfu Jin, Zhibin Hu, Hongbing Shen, Dong Hang
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 10, 1 October 2020, dgaa432
https://doi.org/10.1210/clinem/dgaa432

Abstract

Context

Although an inverse association between vitamin D status and mortality has been reported in observational studies, the precise association shape and optimal vitamin D status remain undetermined.

Objective

To investigate the association between vitamin D status and risk of all-cause and cause-specific mortality and estimate optimal serum 25-hydroxyvitamin D [25(OH)D] concentrations.

Design

Prospective cohort study.

Setting

UK Biobank.

Participants

365 530 participants who had serum 25(OH)D measurements and no history of cardiovascular disease (CVD), cancer, or diabetes at baseline (2006–2010).

Main outcome measures

All-cause and cause-specific mortality.

Results

During a median follow-up of 8.9 (interquartile range: 8.3–9.5) years, 10 175 deaths occurred, including 1841 (18.1%) due to CVD and 5737 (56.4%) due to cancer. The multivariate analyses revealed nonlinear inverse associations, with a decrease in mortality risk appearing to level off at 60 nmol/L of 25(OH)D for all-cause and CVD deaths and at 45 nmol/L for cancer deaths. Compared to participants with 25(OH)D concentrations below the cutoffs, those with higher concentrations had a 17% lower risk for all-cause mortality (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.79–0.86), 23% lower risk for CVD mortality (HR: 0.77, 95% CI: 0.68–0.86), and 11% lower risk for cancer mortality (HR: 0.89, 95% CI: 0.84–0.95).

Conclusions

Higher 25(OH)D concentrations are nonlinearly associated with lower risk of all-cause, CVD, and cancer mortality. The thresholds of 45 to 60 nmol/L might represent an intervention target to reduce the overall risk of premature death, which needs further confirmation in large clinical trials.