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      Associations of vitamin D status with all-cause and cause-specific mortality in long-term prescription opioid users

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          Abstract

          Objective

          This study aimed to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) concentrations and mortality in long-term prescription opioid users.

          Methods

          The study included 1856 long-term prescription opioid users from the National Health and Nutrition Examination Survey (NHANES, 2001–2018). Mortality status were determined by matching with the National Death Index (NDI) records until December 31, 2019. Multivariable Cox proportional hazard models were constructed to assess the association.

          Results

          Over a median follow-up period of 7.75 years, there were 443 cases of all-cause mortality, including 135 cardiovascular disease (CVD) deaths and 94 cancer deaths. After multivariable adjustment, participants with serum 25(OH)D concentrations within 50.00 to <75.00 nmol/L and ≥ 75 nmol/L had a lower risk of all-cause mortality, with hazard ratios (HRs) of 0.50 (95% confidence interval [CI] 0.29, 0.86) and 0.54 (95% CI 0.32, 0.90), respectively. Nevertheless, no significant association was found between serum 25(OH)D concentrations and the risk of CVD or cancer mortality. The RCS analysis revealed a non-linear association of serum 25(OH)D concentration with all-cause mortality ( p for non-linear = 0.01). Per 1-unit increment in those with serum 25(OH)D concentrations <62.17 nmol/L corresponded to a 2% reduction in the risk of all-cause mortality (95% CI 0.97, 1.00), but not changed significantly when 25(OH)D concentrations ≥62.17 nmol/L.

          Conclusion

          In conclusion, a non-linear association existed between serum 25(OH)D concentrations and all-cause mortality in long-term prescription opioid users. Maintaining serum 25(OH)D concentrations ≥62.17 nmol/L may be beneficial in preventing all-cause mortality in this population.

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          Most cited references44

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          Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

          The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes. Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.
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            2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

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              Vitamin D Deficiency

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                Author and article information

                Contributors
                Role: Role: Role: Role: Role: Role:
                Role: Role: Role:
                Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/2723193/overviewRole: Role: Role: Role:
                Journal
                Front Nutr
                Front Nutr
                Front. Nutr.
                Frontiers in Nutrition
                Frontiers Media S.A.
                2296-861X
                18 June 2024
                2024
                : 11
                : 1422084
                Affiliations
                [1] 1Department of Anesthesiology and Perioperative Medicine, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital , Zhengzhou, Henan, China
                [2] 2Department of Anesthesiology, Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong, China
                Author notes

                Edited by: Francesca Gorini, National Research Council (CNR), Italy

                Reviewed by: Dina Keumala Sari, Universitas Sumatera Utara, Indonesia

                Patricia Borges Botelho Gamba, University of Brasilia, Brazil

                Michael Wong, University of Hawaii Cancer Center, United States

                *Correspondence: Zhenhua Hu, Huzh371@ 123456126.com
                Article
                10.3389/fnut.2024.1422084
                11217488
                38957870
                6c15bede-9ae7-4263-8725-1fbebda598c9
                Copyright © 2024 Dai, Wu, Wang and Hu.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 23 April 2024
                : 07 June 2024
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 45, Pages: 9, Words: 6119
                Funding
                The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
                Categories
                Nutrition
                Original Research
                Custom metadata
                Clinical Nutrition

                prescription opioids,pain,mortality,nhanes,25-hydroxyvitamin d

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