缺乏维他命D与精神分裂症有关


  【24drs.com】新研究显示,缺乏维他命D和精神分裂症风险增加有关。
  
  一篇涵盖19篇研究、超过2,800名研究对象的新回顾显示,缺乏维他命D者诊断有精神分裂症的风险,是没有缺乏维他命D者的2倍以上;此外,诊断有精神分裂症者有65%的维他命D值较低。
  
  共同研究者、爱尔兰Isfahan医学科学大学营养暨食物科学院社区营养系副教授Ahmad Esmaillzadeh博士表示,根据之前的生态学和流行病学研究,这些病患的血清维他命D值本就被预期会比较低,令人惊讶的是,缺乏维他命D者的精神分裂症风险显著增加2.16倍,这比率超乎原本预期。
  
  Esmailzadeh博士指出,这些研究结果支持维他命D对于脑部功能和心理健康的重要性。
  
  他表示,缺乏维他命D是全球议题,须更加关注血清维他命D值的评估,进行筛检并对缺乏此维他命之风险较高者提供协助与支持;再者,这些研究结果也有助于医师们治疗精神分裂症患者。不过,还需要控制型临床试验来验证维他命D补充品的效果。
  
  这篇研究在线登载于7月22日的临床内分泌与代谢期刊。
  
  Esmailladeh博士指出,缺乏维他命D是比较普遍性的全球化议题,且和多种疾病有关,例如,之前的研究指出和忧郁症有关。
  
  我们对维他命D在心理健康的角色感到兴趣,因为有关血清维他命D值和精神分裂症的资料互有矛盾,也无相关的综合性统合分析,所以我们决定进行此次研究。
  
  研究者检视了发表于1988-2013年间的19篇研究资料,这些研究评估了成年精神分裂症患者的血清维他命D值,然后研究者进行了3篇个别的统合分析。
  
  纳入的研究病患数分别介于17-848人,共有2,804人,此外,其中11篇研究是在欧洲国家进行,8篇在欧洲以外的国家进行。
  
  第一篇统合分析包括了其中13篇研究,检视25-hydroxyvitamin D的平均值;第二篇分析包括8篇研究,检视缺乏维他命D的盛行率;第三篇分析包括8篇探讨风险比的研究。其中有些研究在不同的统合分析均有被纳入。
  
  第一篇统合分析的结果显示,相较于没有精神分裂症者,有精神分裂症者的血清25-hydroxyvitamin D值的整体平均差异为-5.91 ng/ML (95%信心区间[CI],-10.68至 -1.14)。
  
  次组分析也显示这两组病患之间有显著差异,特别是那些案例控制设计型研究、有包括住院病患,在欧洲或非欧洲国家进行的研究也是如此。
  
  不过,当只探讨横断面设计型研究且/或包括门诊病患时,平均差异就不再显著。
  
  有趣的是,这些研究之间有一些异质性,有的是评估25-hydroxyvitamin D,有的是分析25-dihydroxyvitamn D3。
  
  研究者写道,不过,敏感度分析结果显示,这些研究都未显著影响整体效益。
  
  第二篇统合分析中,研究者发现,患有精神分裂症者缺乏维他命D的整体盛行率为65.3% (95% CI,46.4% - 84.2%)。
  
  第三篇统合分析显示,缺乏维他命D者同时患有精神分裂症的机率,是没有缺乏维他命D者的2.16倍(95% CI,1.32 - 3.56)。
  
  研究者写道,根据这些结果,我们发现缺乏维他命D和精神分裂症之间有强烈关连。
  
  Esmaillzadeh博士在新闻稿中指出,现在需要更多研究,以确认维他命D缺乏的盛行率以及对整体健康的影响。
  
  麻州波士顿大学医学中心维他命D、皮肤暨骨科研究室、内分泌、营养暨糖尿病组医学系博士Michael F. Holick表示,对多数人而言,这次分析根据了其它所有现有的流行病学数据,证实了我们长久以来的期待。
  
  
  未参与此次研究的Holick博士表示,研究者将晒太阳以及各变项的差异纳入后进行分析,发现精神分裂症患者比较可能会缺乏维他命D,这和精神分裂症患者缺乏维他命D的风险上升的观念一致。
  
  他指出,全球约有将近30%的孩童与成人缺乏维他命D,其中60%是缺少或不足。
  
  所以,我们建议全面补充维他命D。内分泌协会建议1岁以上孩童每天600-1000单位;成人每天800-2000单位;过重或肥胖者,须提高至2-3倍以治疗或补足他们的不足。
  
  Holick博士指出,医学研究院和内分泌协会都未对孕妇提出这类补充品的特定建议,不过,他建议每天从含维他命D的饮食,如牛奶,和正常的产前维他命摄取2000单位。
  
  他表示,最近一篇在南加州进行的研究指出,孕妇每天吃4000单位的维他命D会有相当足量且健康的25-hydroxyvitamin D,且无不良毒性。所以,4000单位应是耐受良好且可适用于孕妇。
  
  虽然不可能预防精神分裂症,希望可以降低它的风险。
  
  他表示,研究者目前的结论和多数文献一致,缺乏维他命D之精神分裂症风险达2倍,这是最主要的讯息。
  
  缺乏维他命D是相当常见的,因此,医师应积极治疗这类病患,然后可实际改善病患对药物的反应、觉得心情也更好,皆有助于病患的心理健康。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7104&x_classno=0&x_chkdelpoint=Y
  

Vitamin D Deficiency Linked to Schizophrenia

By Deborah Brauser
Medscape Medical News

Vitamin D deficiency has been linked to an increased risk for schizophrenia, new research shows.

A review of 19 studies, which included more than 2800 participants, showed that those with vitamin D deficiency were more than twice as likely to be diagnosed with schizophrenia compared with their counterparts who were not vitamin D deficient.

In addition, 65% of the patients who had schizophrenia also had lower levels of vitamin D.

Coinvestigator Ahmad Esmaillzadeh, PhD, associate professor in the Department of Community Nutrition in the School of Nutrition and Food Science at the Isfahan University of Medical Sciences in Iran, told Medscape Medical News that although lower levels of serum vitamin D were expected in these patients because of earlier ecologic and epidemiologic studies, "we were surprised by the significant 2.16 times increased risk of schizophrenia in vitamin D deficient individuals. We did not expect such a significant increase," he added.

Dr. Esmailzadeh noted that the findings support the importance of vitamin D in brain function and psychological health.

"As vitamin D deficiency is a global issue, more attention should be drawn to assessment of serum vitamin D levels in order to screen and support individuals that are at higher risk of having deficiencies. Moreover, our findings might help psychiatrists in the healing process of patients with schizophrenia," he said.

"However, controlled clinical trials are needed to confirm the effects of vitamin D supplementation," he added.

The study was published online July 22 in the Journal of Clinical Endocrinology and Metabolism.

Global Issue

Dr. Esmailladeh noted that vitamin D deficiency is "relatively prevalent" globally and is associated with several disorders. For instance, previous studies have reported a link between these lower levels and depression.

"We were interested in the role of vitamin D in psychiatric health and, due to conflicting data on the association between serum levels of vitamin D and schizophrenia and no comprehensive meta-analysis in this regard, we aimed to conduct this study," he added.

The investigators examined data from 19 studies, published between 1988 and 2013, that assessed serum vitamin D levels in adult patients with schizophrenia. They then conducted 3 separate meta-analyses.

The number of patients in each study ranged from 17 to 848, for a total of 2804. In addition, 11 of the studies were conducted in European countries, and 8 were conducted in non-European countries.

The first meta-analysis included 13 of the studies and examined mean levels of 25-hydroxyvitamin D. The second included 8 studies and examined vitamin D deficiency prevalence; and the third included 8 studies and focused on odds ratios.

Some of the studies were included in overlapping meta-analyses.

First Meta-analysis

Results from the first meta-analysis showed an overall mean difference in serum 25-hydroxyvitamin D levels of -5.91 ng/ML in patients with schizophrenia vs those without (95% confidence interval [CI], -10.68 to -1.14).

Subgroup analyses also showed significant mean differences in levels between the 2 patient groups specifically in the studies that had a case-control design, included inpatients, and were conducted in either European or non-European countries.

However, the mean difference was no longer significant when examining just the studies that had a cross-sectional design and/or included outpatients.

Interestingly, there was some degree of heterogeneity between studies that assessed 25-hydroxyvitamin D vs 25-dihydroxyvitamn D3 biomarkers.

Still, "findings from the sensitivity analysis revealed that none of the studies significantly influenced the overall effect," write the researchers.

In the second meta-analysis, the investigators found that those with schizophrenia had a 65.3% overall prevalence of vitamin D deficiency (95% CI, 46.4% - 84.2%).

The third meta-analysis showed that the participants who were vitamin D deficient were 2.16 times more likely to also have schizophrenia than their counterparts who were not vitamin D deficient (95% CI, 1.32 - 3.56).

"Based on the findings, we found a strong association between vitamin D deficiency and schizophrenia," write the researchers.

"More research is [now] needed to determine how the growing problem of vitamin D deficiency may be affecting our overall health," added Dr. Esmaillzadeh in a release.

Suspicions Confirmed

"For the most part, this confirms what we've long been expecting, based on all of the other epidemiologic data out there," Michael F. Holick, MD, PhD, from the Department of Medicine; the Section of Endocrinology, Nutrition, and Diabetes; and the Vitamin D, Skin, and Bone Research Laboratory at Boston University Medical Center in Massachusetts, told Medscape Medical News.

The investigators "took into account sunlight exposure and a whole variety of variables and concluded that schizophrenic patients are more likely to be vitamin D deficient. And that is consistent with the concept that vitamin D deficiency is associated with increased risk for schizophrenia," said Dr. Holick, who was not involved with this research.

He noted that approximately 30% of children and adults around the world are vitamin D deficient ─ and 60% are deficient or insufficient.

"So we recommend vitamin D supplementation across the board. The Endocrine Society recommends for children 1 year and older, 600 to 1000 units a day; for adults, 800 to 2000 units a day; and for people who are overweight or obese, they need 2 to 3 times more to both treat and satisfy their deficiency," he said.

Dr. Holick noted that both the Institute of Medicine and the Endocrine Society do not have specific recommendations for this type of supplementation in pregnant women. However, he recommends 2000 units per day along with other dietary sources of vitamin D, such as milk, and normal prenatal vitamins.

"We know from a study recently done in South Carolina that pregnant women taking 4000 units of vitamin D a day had robust, healthy levels of 25-hydroxyvitamin D and no untoward toxicity. So 4000 units were easily tolerated and may be preferred by pregnant women," he said.

He added that although it may not be possible to prevent schizophrenia, there is hope to decrease the risk for the disorder.

"The [current] investigators conclude, which is consistent with a lot of literature, that there is a 2-fold higher risk of having schizophrenia based on being vitamin D deficient. And I think that is the major message," he said.

"Vitamin D deficiency is extremely common in this population. Therefore, physicians caring for these patients should be aggressive in treating the deficiency, and then they may actually improve how [patients] respond to their medication, making them feel better as their mood improves, all for the benefit of their mental health."

The study authors and Dr. Holick have reported no relevant financial relationships.

J Clin Endocrinol Metab. Published online July 22, 2014.

    
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