生物与医学2020bmj.com
补充维生素D预防急性呼吸道感染
Vitamin D supplementation to prevent acute respiratory tract infections (2017)
入门 · 约 45 分钟读完前置知识：流行病学基础、荟萃分析概念
导读
这篇 2017 年发表于 BMJ 的荟萃分析研究了补充维生素 D 能否预防急性呼吸道感染。作者汇总了 25 项随机对照试验数据，结论是维生素 D 补充总体上能降低急性呼吸道感染的风险，尤其是对原本严重缺乏维生素 D 的人群保护效果更明显。
HN 关注点：该论文在新冠疫情初期被重新讨论，HN 读者关注维生素 D 与免疫系统的关系、补充剂量的争议，以及这类营养学研究证据的可信度。
HN 评论精选
这几条评论里：质疑 1 补充 2 亲历 1
亲历亲历者称补维生素 D 后几乎不再感冒，并建议全家补充以防缺乏
我患有过敏性哮喘，以前经常感冒。今年开始每天补充 2000 IU 维生素 D 后，免疫系统似乎恢复正常了：过去 10 个月只得了几乎察觉不到的轻微感冒，而以前仅冬季就会得 2 次严重感冒或流感，要卧床好几天。当然我无法确定是维生素 D 的功劳，还是减肥、多走路、冷水锻炼甚至安慰剂效应——变量没有隔离好。三周前全家都得流感，唯独我没中招。现在因为新冠疫情，我让全家都开始补维生素 D。夏天可能不需要，但冬天晒不到太阳。维生素未必能防新冠，但缺乏维生素 D 可能放大伤害，而且人体能耐受较大剂量，补了没坏处。
bad_user查看英文原文
I suffer from allergic asthma and tend to catch colds quite frequently. This year I started supplementing with 2000 UI of vitamin D daily and it's as if my immune system started functioning normally, in the last 10 months I only caught a really light cold that I could barely notice, whereas before this the winter season alone would bring 2 severe cold or flu episodes that would knock me down for several days. I can't really say if it's the vitamin D, or other changes in my life, like losing some weight or walking more, or the cold exposure I've been practicing (primarily because I heard it burns calories :-)), it might be even placebo, I haven't isolated these variables well, but my wife and close ones are amazed by the transformation. E.g. 3 weeks ago everyone in my household got the flu, except for me. So now I got everyone in my household on vitamin D, especially b/c of this coronavirus scare. During summer time we might not need it, but the sun doesn't see us during winter. And vitamins are probably no defense against the coronavirus, but a deficiency could amplify the damage (as vit D has a role in our immune system) so it's best to ensure that we aren't deficient. Also we tolerate large doses of vitamin D, so it can't hurt.
补充认为现行维生素 D 推荐剂量过时，成人应每天补充 8000 IU 以上
推荐引用 NCBI 上的另一项研究（https://www.ncbi.nlm.nih.gov/pubmed/28768407），摘要指出：建议 1 岁以下配方奶喂养儿童每天摄入 1000 IU、6 个月以上母乳喂养儿童 1500 IU、1 岁以上儿童 3000 IU、年轻人及成人约 8000 IU，急需采取行动保护全球人口免受维生素 D 缺乏之害。简言之，药剂师和标签上给的推荐摄入量已过时，且源于一个统计错误。成人每天应摄入 8000 IU 以上，而不是许多几十年没更新知识的专业人士仍相信的约 1000 IU。
neuronic查看英文原文
May I mention the following research on NCBI: https://www.ncbi.nlm.nih.gov/pubmed/28768407 I will simply quote from the abstract: > This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency. Essentially, the recommended intake that pharmacists and labels tell you is outdated and founded in a statistical error. Adults are recommended to take >8,000IU every day and not ~1,000IU as still believed by many professionals who last updated their brainbase decades ago.
补充指出该领域受 Pauling 维生素神话影响，但安慰剂效应若有效也无所谓
作为外行，我觉得'大剂量维生素防病'这个领域的研究被 Linus Pauling 的遗产污染了——他无疑是天才，但其发表的文献主张维生素 C 大剂量可降低 75% 的癌症死亡率。我想我们知道如何避免这种麻烦：提出假设并检验。麻烦在于安慰剂效应并非坏事——如果你做的事让你觉得能改善健康而且确实有效，管它有没有化学机制呢，有效就行！
mherdeg查看英文原文
As a layperson it feels to me like research in the "megadose on vitamins to prevent illness" area is kind of tainted by the legacy of Linus Pauling, who was no doubt a genius in his fields and whose published literature advocated the position that vitamin C megadose would reduce cancer deaths by 75% ( https://www.theatlantic.com/health/archive/2013/07/the-vitamin-myth-why-we-think-we-need-supplements/277947/ ). I guess we know how to avoid the trouble -- make hypotheses and test them. The trouble there is that the placebo effect is not a bad thing -- if you're doing things which you think will improve your wellness and it works, who cares whether there's a chemical mechanism? It works!
质疑质疑荟萃分析结论，认为阳性结果主要由几项小规模旧研究驱动
我有点困惑。几乎所有随机对照试验（如 Vox 的报道）不是都表明对健康人基本没有可测量的效果吗？所有'正面'故事都依赖有混杂因素的观察性研究吧？编辑：看论文的图 2，结果看起来相当随机，几乎完全由 4-5 项样本小（<250 人）且年代久的研究驱动。
jpdus查看英文原文
I am a bit perplexed. Haven't almost all randomized/controlled trials shown (e.g. [1]) that there is basically no measurable effect for healthy people? All "positive" stories are relying on observational studies with the usual confounders, right? EDIT: Look at figure 2 in the Paper. Looks pretty random to me. Result is almost exclusively driven by 4-5 small (<250 participants) and old studies. [1] https://www.vox.com/2018/10/4/17933880/vitamin-d-health-sun-diet
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