Bioavailable Vitamin D Redefines Vitamin D Deficiency

生物可利用维生素 D 重新定义维生素 D 缺乏症

• 批准号: 8331000
• 负责人: RAVI THADHANI
• 金额: $ 39.4万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-17 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8331000
• 关键词: Adult; Affect; African American; Bioavailable; Biological; Biological Assay; Biology; Blood specimen; Bone Density; Bone Diseases; Caucasians; Caucasoid Race; Clinical; Clinical Trials Design; Complex; Consensus; Data; Diabetes Mellitus; Diagnosis; Disease; Disease Outcome; End stage renal failure; Enrollment; Exhibits; Fracture; Future; General Population; Genes; Genetic Polymorphism; Healthcare; Hormones; Human; Individual; Interdisciplinary Study; Link; Longevity; Malignant Neoplasms; Measures; Minority; Neighborhoods; Osteoporosis; Outcome; Patients; Physiological; Population; Population Heterogeneity; Pregnant Women; Prevalence; Prophylactic treatment; Protein Binding; Public Health; Race; Reporting; Research; Resources; Risk; Supplementation; Testing; Therapeutic; Variant; Vitamin D; Vitamin D Deficiency; Vitamin D-Binding Protein; Work; base; cardiovascular disorder risk; cardiovascular infection; clinical decision-making; clinically relevant; cohort; cost; healthy aging; healthy volunteer; high risk; improved; innovation; novel; prevent; public health priorities; racial difference; young adult

DESCRIPTION (provided by applicant): Vitamin D deficiency has been associated with bone disease and a host of other major non-skeletal diseases including cardiovascular, infection, cancer and diabetes. Although supplementation may reduce risks, the definitions and cutoffs that establish clinically relevant vitamin D deficiency across racially diverse populations lack consensus. As a public health priority, it is critical to determine who needs to be treated to optimally affect disease outcomes. Blacks consistently have low 25-hydroxy vitamin D (25[OH] D) levels but paradoxically have higher bone mineral density (BMD) and lower osteoporosis risk than whites. Should blacks be treated with vitamin D to prevent osteoporosis? We propose to investigate a novel concept that vitamin D binding protein (VDBP), in the context of the "free hormone hypothesis," underlies the physiological mechanisms of this paradox. We recently reported in healthy young adults that VDBP levels: (1) directly correlate with total 25(OH)D levels; (2) inversely correlate with free- and bioavailable-25(OH)D; and, importantly, (3) vary with race. Preliminary data collected by our research team in patients with ESRD and in pregnant women are consistent with these observations. Others have shown that polymorphisms of the VDBP gene exhibit marked racial differences, suggesting that VDBP modulates vitamin D activity. It is therefore likely that all blacks do not have profound free and bioavailable vitamin D deficiency. We plan to determine the influence of circulating VDBP on bioavailable 25(OH) D by comparing stored blood samples from a large (n~2,200) population of black and white subjects enrolled in HANDLS (Healthy Aging in Neighborhoods of Diversity across the Life Span (available at http://handls.nih.gov) to test the following hypotheses: 1. Blacks have lower levels of VDBP and total 25(OH) D, but similar levels of free and bioavailable 25(OH) D as whites. 2. Free and bioavailable 25(OH)D levels are independently associated with BMD in blacks and whites, inversely and linearly associated with PTH levels, and these associations are stronger than those between total 25(OH)D and BMD. Our specific aims are to: (1) determine VDBP, total and bioavailable 25(OH)D, and PTH levels; and (2) test for associations between BMD, bioavailable 25(OH)D, and PTH compared to total 25(OH)D. PUBLIC HEALTH RELEVANCE: According to the standard definition, vitamin D deficiency is extremely common in the general population and has been linked with bone disease. Vitamin D, however, circulates in different forms, and this application will determine which specific forms of vitamin D are most strongly linked with bone mineral density in a large population of Blacks and Caucasians in the U.S., and therefore who would be most appropriate to treat for vitamin D deficiency.

描述（由申请人提供）：维生素 D 缺乏与骨骼疾病和许多其他主要非骨骼疾病有关，包括心血管、感染、癌症和糖尿病。尽管补充可能会降低风险，但在不同种族人群中确定临床相关维生素 D 缺乏症的定义和界限缺乏共识。作为公共卫生的优先事项，确定谁需要接受治疗以最佳地影响疾病结果至关重要。黑人的 25-羟基维生素 D (25[OH]D) 水平始终较低，但矛盾的是，他们的骨矿物质密度 (BMD) 高于白人，骨质疏松风险较低。黑人应该服用维生素 D 来预防骨质疏松症吗？我们建议研究一个新概念，即维生素 D 结合蛋白 (VDBP) 在“游离激素假说”的背景下是这一悖论的生理机制的基础。我们最近在健康年轻人中报道了 VDBP 水平：(1) 与 25(OH)D 总水平直接相关； (2) 与游离 25(OH)D 和生物可利用 25(OH)D 呈负相关；而且，重要的是，（3）因种族而异。我们的研究小组在 ESRD 患者和孕妇中收集的初步数据与这些观察结果一致。其他研究表明，VDBP 基因的多态性表现出明显的种族差异，表明 VDBP 调节维生素 D 活性。因此，并非所有黑人都存在严重的游离维生素 D 和生物可利用维生素 D 缺乏症。我们计划通过比较参加 HANDLS（生命周期多元化社区健康老龄化）的大量（n~2,200）黑人和白人受试者的储存血液样本，确定循环 VDBP 对生物可利用的 25(OH)D 的影响。可在 http://handls.nih.gov 上获取）来检验以下假设： 1. 黑人的 VDBP 和总 25(OH) D 水平较低，但游离和生物可利用的 25(OH)D 水平与白人相似 2. 游离和生物可利用的 25(OH)D 水平与黑人和白人的 BMD 独立相关，与 PTH 水平呈负相关和线性相关，并且这些相关性比那些相关性更强。我们的具体目标是： (1) 确定 VDBP、总 25(OH)D 和生物可利用的 25(OH)D 以及 PTH 水平； (2) 测试 BMD、生物利用度 25(OH)D 和 PTH 与总 25(OH)D 之间的关联。 公众健康相关性：根据标准定义，维生素 D 缺乏症在普通人群中极为常见，并且与骨病有关。然而，维生素 D 以不同的形式循环，该应用将确定维生素 D 的具体形式 在美国，维生素 D 与大量黑人和白种人的骨矿物质密度关系最为密切，因此这些人最适合治疗维生素 D 缺乏症。