Journal
BMJ-BRITISH MEDICAL JOURNAL
Volume 348, Issue -, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bmj.g3656
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Funding
- CHANCES project funded in the FP7 framework programme of DG-RESEARCH in the European Commission [242244]
- Baden-Wurttemberg state Ministry of Science, Research and Arts (Stuttgart, Germany)
- Federal Ministry of Education and Research (Berlin, Germany)
- Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (Berlin, Germany)
- German Cancer Aid [108250, 108426]
- Norwegian Research Council
- Helmholtz Zentrum Munchen
- German Research Center for Environmental Health - German Federal Ministry of Education and Research
- State of Bavaria
- German Federal Ministry of Education and Research
- German Research Foundation [TH-784/2-1, TH-784/2-2]
- Federal Ministry of Health
- University of Ulm
- German Diabetes Center
- Ministry of Innovation, Science, Research, and Technology of the state North Rhine Westphalia
- CHANCES
- EU
- Welcome Trust [064947, 081081]
- US National Institute on Ageing [R01 AG23522-01]
- Mac Arthur Foundation
- MRC [G0601463, MR/K023241/1] Funding Source: UKRI
- Medical Research Council [MC_CF023241, MR/K023241/1, G0601463] Funding Source: researchfish
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Objective To investigate the association between serum 25-hydroxyvitamin D concentrations (25(OH) D) and mortality in a large consortium of cohort studies paying particular attention to potential age, sex, season, and country differences. Design Meta-analysis of individual participant data of eight prospective cohort studies from Europe and the US. Setting General population. Participants 26 018 men and women aged 50-79 years Main outcome measures All-cause, cardiovascular, and cancer mortality. Results 25(OH) D concentrations varied strongly by season (higher in summer), country (higher in US and northern Europe) and sex (higher in men), but no consistent trend with age was observed. During follow-up, 6695 study participants died, among whom 2624 died of cardiovascular diseases and 2227 died of cancer. For each cohort and analysis, 25(OH) D quintiles were defined with cohort and subgroup specific cut-off values. Comparing bottom versus top quintiles resulted in a pooled risk ratio of 1.57 (95% CI 1.36 to 1.81) for all-cause mortality. Risk ratios for cardiovascular mortality were similar in magnitude to that for all-cause mortality in subjects both with and without a history of cardiovascular disease at baseline. With respect to cancer mortality, an association was only observed among subjects with a history of cancer (risk ratio, 1.70 (1.00 to 2.88)). Analyses using all quintiles suggest curvilinear, inverse, dose-response curves for the aforementioned relationships. No strong age, sex, season, or country specific differences were detected. Heterogeneity was low in most meta-analyses. Conclusions Despite levels of 25(OH) D strongly varying with country, sex, and season, the association between 25(OH) D level and all-cause and cause-specific mortality was remarkably consistent. Results from a long term randomised controlled trial addressing longevity are being awaited before vitamin D supplementation can be recommended in most individuals with low 25(OH) D levels.
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