重新审视维生素 D 指南:文献批判性评估。

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-30 DOI:10.1016/j.eprac.2024.10.011
Michael F Holick
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引用次数: 0

摘要

2024 年指南为普通健康人群提供了维生素 D 对骨骼和骨骼外健康益处的建议。这与 2011 年指南形成了鲜明对比,后者为临床医生提供了如何评估和治疗维生素 D 缺乏症患者并预防复发的指导。2024 年指南》重点关注随机对照试验、被忽视的关联研究以及其他支持维生素 D 对骨骼和骨骼外健康益处的研究。《2024 年指南》建议对 1 至 18 岁的儿童和青少年、孕妇、糖尿病前期患者和 75 岁以上老人进行经验性维生素 D 治疗,以降低上呼吸道感染风险,改善妊娠相关结果,降低糖尿病风险,并改善死亡率。这些指导原则不适用于钙、磷酸盐、维生素 D 和骨代谢异常的人群,2011 年的指导原则已对此做出规定。对于 75 岁以下的非怀孕成年人,《指南》建议其膳食维生素 D 参考摄入量为 600 IUs 和医学研究所建议的 800 IUs。相关研究表明,要从维生素 D 中获得最大的骨骼外益处,包括降低儿童和成人上呼吸道感染、自身免疫性疾病、先兆子痫、低出生体重、新生儿龋齿和致命癌症的风险,25-羟基维生素 D 的循环浓度应至少为 30 纳克/毫升,《2011 年指南》建议的首选范围为 40-60 纳克/毫升。
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Revisiting Vitamin D Guidelines: A Critical Appraisal of The Literature.

The goal of this Review is to compare the 2024 and 2011 Endocrine Society's Clinical Guidelines on Vitamin D. The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines which provided clinicians with guidance for how to evaluate and treat patients with vitamin D deficiency and prevent recurrence. The 2024 Guideline focused on randomized controlled trials and ignored association studies and other studies that have supported the skeletal and extraskeletal health the benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy related outcomes, prediabetic patients to reduce risk of diabetes and to improve mortality in those over 75 years. These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D and bone metabolism which were provided in the 2011 Guidelines. For nonpregnant adults up to the age of 75 they recommend the Dietary Reference Intakes of 600 IUs, and 800 IUs as recommended by The Institute of Medicine. Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, preeclampsia, low birth weight, neonatal dental caries and deadly cancers that circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.

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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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