缺乏維他命D與精神分裂症有關


  【24drs.com】新研究顯示,缺乏維他命D和精神分裂症風險增加有關。
  
  一篇涵蓋19篇研究、超過2,800名研究對象的新回顧顯示,缺乏維他命D者診斷有精神分裂症的風險,是沒有缺乏維他命D者的2倍以上;此外,診斷有精神分裂症者有65%的維他命D值較低。
  
  共同研究者、愛爾蘭Isfahan醫學科學大學營養暨食物科學院社區營養系副教授Ahmad Esmaillzadeh博士表示,根據之前的生態學和流行病學研究,這些病患的血清維他命D值本就被預期會比較低,令人驚訝的是,缺乏維他命D者的精神分裂症風險顯著增加2.16倍,這比率超乎原本預期。
  
  Esmailzadeh博士指出,這些研究結果支持維他命D對於腦部功能和心理健康的重要性。
  
  他表示,缺乏維他命D是全球議題,須更加關注血清維他命D值的評估,進行篩檢並對缺乏此維他命之風險較高者提供協助與支持;再者,這些研究結果也有助於醫師們治療精神分裂症患者。不過,還需要控制型臨床試驗來驗證維他命D補充品的效果。
  
  這篇研究線上登載於7月22日的臨床內分泌與代謝期刊。
  
  Esmailladeh博士指出,缺乏維他命D是比較普遍性的全球化議題,且和多種疾病有關,例如,之前的研究指出和憂鬱症有關。
  
  我們對維他命D在心理健康的角色感到興趣,因為有關血清維他命D值和精神分裂症的資料互有矛盾,也無相關的綜合性統合分析,所以我們決定進行此次研究。
  
  研究者檢視了發表於1988-2013年間的19篇研究資料,這些研究評估了成年精神分裂症患者的血清維他命D值,然後研究者進行了3篇個別的統合分析。
  
  納入的研究病患數分別介於17-848人,共有2,804人,此外,其中11篇研究是在歐洲國家進行,8篇在歐洲以外的國家進行。
  
  第一篇統合分析包括了其中13篇研究,檢視25-hydroxyvitamin D的平均值;第二篇分析包括8篇研究,檢視缺乏維他命D的盛行率;第三篇分析包括8篇探討風險比的研究。其中有些研究在不同的統合分析均有被納入。
  
  第一篇統合分析的結果顯示,相較於沒有精神分裂症者,有精神分裂症者的血清25-hydroxyvitamin D值的整體平均差異為-5.91 ng/ML (95%信心區間[CI],-10.68至 -1.14)。
  
  次組分析也顯示這兩組病患之間有顯著差異,特別是那些案例控制設計型研究、有包括住院病患,在歐洲或非歐洲國家進行的研究也是如此。
  
  不過,當只探討橫斷面設計型研究且/或包括門診病患時,平均差異就不再顯著。
  
  有趣的是,這些研究之間有一些異質性,有的是評估25-hydroxyvitamin D,有的是分析25-dihydroxyvitamn D3。
  
  研究者寫道,不過,敏感度分析結果顯示,這些研究都未顯著影響整體效益。
  
  第二篇統合分析中,研究者發現,患有精神分裂症者缺乏維他命D的整體盛行率為65.3% (95% CI,46.4% - 84.2%)。
  
  第三篇統合分析顯示,缺乏維他命D者同時患有精神分裂症的機率,是沒有缺乏維他命D者的2.16倍(95% CI,1.32 - 3.56)。
  
  研究者寫道,根據這些結果,我們發現缺乏維他命D和精神分裂症之間有強烈關連。
  
  Esmaillzadeh博士在新聞稿中指出,現在需要更多研究,以確認維他命D缺乏的盛行率以及對整體健康的影響。
  
  麻州波士頓大學醫學中心維他命D、皮膚暨骨科研究室、內分泌、營養暨糖尿病組醫學系博士Michael F. Holick表示,對多數人而言,這次分析根據了其他所有現有的流行病學數據,證實了我們長久以來的期待。
  
  
  未參與此次研究的Holick博士表示,研究者將曬太陽以及各變項的差異納入後進行分析,發現精神分裂症患者比較可能會缺乏維他命D,這和精神分裂症患者缺乏維他命D的風險上升的觀念一致。
  
  他指出,全球約有將近30%的孩童與成人缺乏維他命D,其中60%是缺少或不足。
  
  所以,我們建議全面補充維他命D。內分泌協會建議1歲以上孩童每天600-1000單位;成人每天800-2000單位;過重或肥胖者,須提高至2-3倍以治療或補足他們的不足。
  
  Holick博士指出,醫學研究院和內分泌協會都未對孕婦提出這類補充品的特定建議,不過,他建議每天從含維他命D的飲食,如牛奶,和正常的產前維他命攝取2000單位。
  
  他表示,最近一篇在南加州進行的研究指出,孕婦每天吃4000單位的維他命D會有相當足量且健康的25-hydroxyvitamin D,且無不良毒性。所以,4000單位應是耐受良好且可適用於孕婦。
  
  雖然不可能預防精神分裂症,希望可以降低它的風險。
  
  他表示,研究者目前的結論和多數文獻一致,缺乏維他命D之精神分裂症風險達2倍,這是最主要的訊息。
  
  缺乏維他命D是相當常見的,因此,醫師應積極治療這類病患,然後可實際改善病患對藥物的反應、覺得心情也更好,皆有助於病患的心理健康。
  
  資料來源: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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