Is there a reverse J-shaped association between 25-hydroxyvitamin D and all-cause mortality? Results from the U.S. nationally representative NHANES Journal Article

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Authors: Sempos, C. T.; Durazo-Arvizu, R. A.; Dawson-Hughes, B.; Yetley, E. A.; Looker, A. C.; Schleicher, R. L.; Cao, G; Burt, V.; Kramer, H; Bailey, R. L.; Dwyer, J. T.; Zhang, X; Gahche, J.; Coates, P. M.; Picciano, M. F.
Article Title: Is there a reverse J-shaped association between 25-hydroxyvitamin D and all-cause mortality? Results from the U.S. nationally representative NHANES
Abstract: CONTEXT: A reverse J-shaped association between serum 25-hydroxyvitamin D (25[OH]D) concentration and all-cause mortality was suggested in a 9-year follow-up (1991-2000) analysis of the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). OBJECTIVE: Our objective was to repeat the analyses with 6 years additional follow-up to evaluate whether the association persists through 15 years of follow-up. PARTICIPANTS: The study included 15 099 participants aged >/= 20 years with 3784 deaths. MAIN OUTCOME MEASURE: Relative risk (RR) of death from all causes was adjusted for age, sex, race/ethnicity, and season using 2 Poisson regression approaches: traditional categorical and cubic splines. Results were given for 9 25(OH)D levels: /= 120 nmol/L. RESULTS: The reverse J-shaped association became stronger with longer follow-up and was not affected by excluding deaths within the first 3 years of follow-up. Similar results were found from both statistical approaches for levels /= 120 nmol/L. RESULTS: The reverse J-shaped association became stronger with longer follow-up and was not affected by excluding deaths within the first 3 years of follow-up. Similar results were found from both statistical approaches for levels 1 compared with the reference group. The nadir of risk was 81 nmol/L (95% CI, 73-90 nmol/L). For 25(OH)D >/= 120 nmol/L, results (RR, 95% CI) were slightly different using traditional categorical (1.5, 1.02-2.3) and cubic splines approaches (1.2, 0.9-1.4). The association appeared in men, women, adults ages 20 to 64 years, and non-Hispanic whites but was weaker in older adults. The study was too small to evaluate the association in non-Hispanic black and Mexican-American adults. CONCLUSIONS: A reverse J-shaped association between serum 25(OH)D and all-cause mortality appears to be real. It is uncertain whether the association is causal.
Journal Title: The Journal of clinical endocrinology and metabolism
Volume: 98
Issue: 7
ISSN: 1945-7197; 0021-972X
Publisher: Unknown  
Journal Place: United States
Date Published: 2013
Start Page: 3001
End Page: 3009
Language: eng
DOI/URL:

10.1210/jc.2013-1333
Notes: LR: 20131121; GR: 5R37 HL045508-17/HL/NHLBI NIH HHS/United States; GR: AG10353/AG/NIA NIH HHS/United States; JID: 0375362; 21343-40-8 (25-Hydroxyvitamin D 2); P6YZ13C99Q (Calcifediol); OID: NLM: PMC3701270 [Available on 07/01/14]; PMCR: 2014/07/01 00:00; 2013/05/10 [aheadofprint]; ppublish