生物与医学2020borsche.de
维生素 D 缺乏与 COVID-19 死亡率
Vitamin D deficiency and Covid-19 mortality
入门 · 约 30 分钟读完前置知识：流行病学基础、相关性 vs 因果性
导读
这篇 PDF 文章（由两位软件开发者撰写，未经同行评审）声称维生素 D 缺乏与 Covid-19 死亡率之间存在强关联，暗示补充维生素 D 可能降低重症和死亡风险。评论普遍提醒：观察性关联不等于因果关系，维生素 D 水平更多是整体健康状况的代理指标，且大剂量补充有实际风险。
HN 关注点：疫情期间大家急于寻找可自行采取的预防措施，而维生素 D 是'观察性研究强相关、随机对照试验屡屡失败'的典型案例，引发关于营养学证据质量的争论。
HN 评论精选
这几条评论里：质疑 3 补充 1
补充大剂量补充维生素 D 会扰乱钙水平，是真实且常被忽视的健康风险
我妻子是甲状旁腺外科医生（甲状旁腺是调节颈部钙水平的腺体），她想恳请大家：如果补充维生素 D，请务必监测钙水平。她经常接诊被好心的医生开了高剂量维生素 D 的患者，结果钙水平紊乱，患者病得很重却不知道原因，他们的医生往往也不懂这些机制。这是真实的风险，可能有严重的长期后果，她最近见到这类病例越来越多。
conorh查看英文原文
I've mentioned this before, but my wife is a parathyroid surgeon (parathyroids are the glands that regulate the calcium in your neck) and would beg you to PLEASE monitor your calcium levels if you are supplementing with Vitamin D. She often sees patients on high doses of Vitamin D from well intentioned doctors, but with out of whack calcium levels because of it, and the patients can be very sick without understanding why. Often their doctors don't understand the processes either which is why they end up with her. I'll have her write a blog post about it at some point, but it is a real risk with possible severe long term consequences and she sees it a lot more often these days. She is getting her blog kicked off here (just yesterday actually) https://devaboone.com if you want to follow along.
质疑补充剂不等于自然合成，观察性关联不能推出补充有效的结论
这是一个值得注意的发现，但不能由此得出补充维生素 D 会大有裨益的结论。人体通过日晒自然生成维生素 D 时还伴随许多其他过程，而我们没有足够的科学证据证明纯补充剂能等同于此——这是营养学和流行病学的通病。不过 Covid 对代谢不健康人群的伤害远大于健康人群这一点仍被低估，这是又一个支持该观点的数据点。
ve55查看英文原文
Although this is a notable finding it's important to remember that it doesn't lead to the conclusion that supplementing vitamin D will be very beneficial here. When vitamin D is produced in the body naturally via exposure to sunlight there's a huge amount of other things that occur as well, and we don't have a ton of good science to back up if curing a vitamin D deficiency via supplementation of pure vitamin D is really nearly the same as getting it naturally, which is a common problem for supplementing things and nutritional science and epidemiology in general. The extent that covid harms those that are metabolically unfit in many different ways much more than those that are perfectly healthy is still pretty under-discussed imo though, and this is yet another good data point in favor of it, even if Vitamin D is much more of a different proxy than some of the other large correlations we see with covid mortality.
质疑作者无医学背景、未经同行评审，可信度存疑
这篇文章由不合格的作者（两名软件开发者）写得很糟糕，仅此一点就足以对结论敲响警钟。经过同行评审了吗？粗看之下，任何正规期刊都不会发表这项工作。如果作者的说法有任何真实性，他们最好的做法是与领域专家合作或提交给正规期刊评审。有人可能因伪科学作品而拿健康冒险。
batrachom查看英文原文
This article is (badly) written by un-qualified authors (two software developers). This would be enough to raise at least a few red flags on the conclusions drawn here. Has it even been peer reviewed? From a first look, there no way this work would have been published by any reputable journal. If there is any truth in what the authors claim, the best they could do is to work with field experts and/or submit their findings to a reputable journal for review and publishing. Someone's health might be on the line following pseudo-scientific works.
质疑RCT 屡次证明维生素 D 补充无效，相关性源于混杂的健康指标
维生素 D 因观察性研究证据而被无休止地宣传为多种疾病的治疗手段，但数亿美元的随机对照试验从未证明它对除佝偻病外的任何疾病有效。刚在 JAMA 发表的一项大型试验检验了它对抑郁症的疗效（观察性数据很充分），结果完全无效。维生素 D 与许多疾病相关却不致病，原因是其水平与社会经济地位、活跃生活方式、营养充足等健康指标高度相关。我们在维生素 D 上一次次浪费时间和金钱。
et2o查看英文原文
Vitamin D has been endlessly promoted as a treatment for many diseases due to evidence from observational studies, but hundreds of millions of dollars in randomized controlled trials have never demonstrated it to be effective for any disease except rickets. There was just a large trial published in JAMA [1] examining its effectiveness for depression given solid observational data. It was not at all effective. The reason that Vitamin D is associated with many diseases but is not causative for anything is that Vitamin D level is highly correlated with other metrics of health such as socioeconomic status, active lifestyle, nutritional sufficiency, etc. We are wasting our time and money looking at Vitamin D again and again and again. 1. https://jamanetwork.com/journals/jama/article-abstract/2768978
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