Insuring Against Worst Case Scenarios with Vitamin D
With the exception of elective surgery, most hospital admission are unexpected. Given the unexpected nature of emergencies, it would seem that one cannot really prepare. New evidence suggests that maintaining adequate circulating vitamin D concentrations may be an excellent form of insurance to modify the outcome of an emergency trip to the hospital.
Serum 25(OH)D concentrations of 4,344 adults hospitalized between 1993 and 2011 were analyzed with respect to 30d all-cause mortality. Patients with 25(OH)D concentrations <25 nmol/L had a ~2-fold greater risk of dying than those <50 nmol/L. A two-fold difference!
Previously, the same research group had reported vitamin D status predicted 30, 90, and 365 day mortality following intensive care unit admission (ICU).
Many reasons could explain the differences in mortality. Sepsis is more prevalent in ICU patients who are vitamin D deficient (<30 nmol/L) and insufficient (30-50 nmol/L). Patients having noncardiac surgery with with serum 25(OH)D concentrations <33 nmol/L are more likely to have complications.
Can these observations in hospitalized patients be applied elsewhere. The lowest all-cause mortality risk in the general population (non-hospitalized) is found with 25(OH)D concentrations between 50-60 nmol/L.
Too much much (or too little) of most things are not good. Serum 25(OH)D concentrations above 140 nmol/L may increase mortality risk. Be assured, supplementing with ≥1,000 IU vitamin D3 daily is unlikely to raise serum 25(OH)D concentrations above 100 nmol/L.
For most people, the risk of having serum 25(OH)D concentrations below 50 nmol/L is much greater than having levels above 100 nmol/L. Even better, get your 25-hydroxyvitamin D3 measured and be an informed consumer!
Amrein K, Litonjua AA, Moromizato T, Quraishi SA, Gibbons FK, Pieber TR, Camargo Jr CA, Giovannucci E, Chrisotopher KB. Increases in pre-hospitalization serum 25(OH)D concentrations are associated with improved 30-day mortality after hospital admission: A cohort study. 2015 Clin Nutr doi: S0261561415000953
Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, Christopher KB. Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. 2012 Crit Care Med doi: 10:1097/CCM.0b013e318206ccdf
De Haan K. Low serum 25-hydroxyvitamin D at critical care initiation is associated with sepsis and mortality in Dutch critically ill patients. 2015 Crit Care doi:10.1186/cc14445
Turan A, Hesler B, You J, Saager L, Grady M, Komatsu R, Kurz A, Sessler DI. The association of serum vitamin D concentration with serious complications after noncardiac surgery. 2014 Anesth Analges doi: 10.1213/ANE.0000000000000096
Durup D, Jorgensen HL, Christensen J, Schwarz P, Heegard AM, Lind B. A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: The CopD Study. 2012 JCEM doi: 10.1210/jc.2012.1176