A A Ginde1, P Wolfe, C A Camargo, R S Schwartz. 1. Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA. adit.ginde@ucdenver.edu
Abstract
BACKGROUND: Vitamin D is associated with a variety of health outcomes, but the exact definition of vitamin D sufficiency remains controversial. AIM: We sought to define skeletal-related vitamin D sufficiency by estimating maximum PTH suppression in the U.S. population. METHODS: We performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES), 2003-2006. We examined the association between serum 25-hydroxyvitamin D (25OHD) level and serum PTH level in 14,681 participants aged ≥6 yr. We also evaluated the 25OHD-PTH association using 2 thresholds of hyperparathyroidism: PTH≥45 pg/ml and ≥75 pg/ml. RESULTS: The mean 25OHD level was 24 ng/ml and mean PTH was 42 pg/ml. PTH≥45 pg/ml was present in 35% of the population, while PTH≥75 pg/ml was present in 7%. The prevalence of 25OHD levels <40 ng/ml and <30 ng/ml was 95% and 77%, respectively. In both unadjusted and adjusted models, there was a strong inverse relationship between 25OHD and PTH. Compared to 25OHD≥40 ng/ml, the 25OHD-PTH association was 2.36 [95% confidence interval (CI), 2.08-2.67] times greater for 25OHD<5 ng/ml and 1.12 (95%CI, 1.07-1.17) times greater for 25OHD 30-39.9 ng/ml. Compared to 25OHD≥40 ng/ml, 25OHD levels of 20- 29.9 ng/ml [odds ratio (OR) 2.0 (95%CI, 1.4-2.8)] but not 30- 39.9 ng/ml [OR 1.1 (95%CI, 0.8-1.6)] were independently associated with PTH≥45 pg/ml. CONCLUSIONS: Optimal vitamin D status, defined by estimated maximum PTH suppression, does not occur until at least 25OHD levels ≥40 ng/ml. Using these thresholds, most of the U.S. population needs more vitamin D. Large, prospective studies are needed to determine optimal vitamin D supplementation.
BACKGROUND:Vitamin D is associated with a variety of health outcomes, but the exact definition of vitamin D sufficiency remains controversial. AIM: We sought to define skeletal-related vitamin D sufficiency by estimating maximum PTH suppression in the U.S. population. METHODS: We performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES), 2003-2006. We examined the association between serum 25-hydroxyvitamin D (25OHD) level and serum PTH level in 14,681 participants aged ≥6 yr. We also evaluated the 25OHD-PTH association using 2 thresholds of hyperparathyroidism: PTH≥45 pg/ml and ≥75 pg/ml. RESULTS: The mean 25OHD level was 24 ng/ml and mean PTH was 42 pg/ml. PTH≥45 pg/ml was present in 35% of the population, while PTH≥75 pg/ml was present in 7%. The prevalence of 25OHD levels <40 ng/ml and <30 ng/ml was 95% and 77%, respectively. In both unadjusted and adjusted models, there was a strong inverse relationship between 25OHD and PTH. Compared to 25OHD≥40 ng/ml, the 25OHD-PTH association was 2.36 [95% confidence interval (CI), 2.08-2.67] times greater for 25OHD<5 ng/ml and 1.12 (95%CI, 1.07-1.17) times greater for 25OHD 30-39.9 ng/ml. Compared to 25OHD≥40 ng/ml, 25OHD levels of 20- 29.9 ng/ml [odds ratio (OR) 2.0 (95%CI, 1.4-2.8)] but not 30- 39.9 ng/ml [OR 1.1 (95%CI, 0.8-1.6)] were independently associated with PTH≥45 pg/ml. CONCLUSIONS: Optimal vitamin D status, defined by estimated maximum PTH suppression, does not occur until at least 25OHD levels ≥40 ng/ml. Using these thresholds, most of the U.S. population needs more vitamin D. Large, prospective studies are needed to determine optimal vitamin D supplementation.
Authors: Allan G Need; Peter D O'Loughlin; Howard A Morris; Michael Horowitz; B E Christopher Nordin Journal: J Clin Endocrinol Metab Date: 2004-04 Impact factor: 5.958
Authors: Philip T Liu; Steffen Stenger; Huiying Li; Linda Wenzel; Belinda H Tan; Stephan R Krutzik; Maria Teresa Ochoa; Jürgen Schauber; Kent Wu; Christoph Meinken; Diane L Kamen; Manfred Wagner; Robert Bals; Andreas Steinmeyer; Ulrich Zügel; Richard L Gallo; David Eisenberg; Martin Hewison; Bruce W Hollis; John S Adams; Barry R Bloom; Robert L Modlin Journal: Science Date: 2006-02-23 Impact factor: 47.728
Authors: Anne C Looker; David A Lacher; Christine M Pfeiffer; Rosemary L Schleicher; Mary Frances Picciano; Elizabeth A Yetley Journal: Am J Clin Nutr Date: 2009-07-01 Impact factor: 7.045
Authors: Joan M Lappe; Dianne Travers-Gustafson; K Michael Davies; Robert R Recker; Robert P Heaney Journal: Am J Clin Nutr Date: 2007-06 Impact factor: 7.045
Authors: Claudie Berger; Linda S Greene-Finestone; Lisa Langsetmo; Nancy Kreiger; Lawrence Joseph; Christopher S Kovacs; J Brent Richards; Nick Hidiroglou; Kurtis Sarafin; K Shawn Davison; Jonathan D Adachi; Jacques Brown; David A Hanley; Jerilynn C Prior; David Goltzman Journal: J Bone Miner Res Date: 2012-06 Impact factor: 6.741
Authors: Caroline K Thoreson; Stephanie T Chung; Madia Ricks; James C Reynolds; Alan T Remaley; Vipul Periwal; Yanjun Li; Anne E Sumner Journal: Osteoporos Int Date: 2015-05-23 Impact factor: 4.507
Authors: Francesco Vierucci; Marta Del Pistoia; Margherita Fanos; Martina Gori; Giorgia Carlone; Paola Erba; Gabriele Massimetti; Giovanni Federico; Giuseppe Saggese Journal: Eur J Pediatr Date: 2013-12 Impact factor: 3.183
Authors: Elizabeth N Martin; Elizabeth M Haney; Jackie Shannon; Jane A Cauley; Kristine E Ensrud; Tony M Keaveny; Joseph M Zmuda; Eric S Orwoll; Stephanie Litwack Harrison; Lynn M Marshall Journal: J Bone Miner Res Date: 2015-03 Impact factor: 6.741
Authors: Mark D DeBoer; David R Weber; Babette S Zemel; Michelle R Denburg; Rita Herskovitz; Jin Long; Mary B Leonard Journal: J Clin Endocrinol Metab Date: 2015-08-04 Impact factor: 5.958