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EditorialsMake No Bones About It: Increasing Epidemiologic Evidence Links Vitamin D to Pulmonary Function and COPD
Section snippets
Evidence Supporting Biological Plausibility
Evidence is increasing that suggests an expanded role for vitamin D in health outcomes apart from its classic actions on the gut and bone. The vitamin D3 metabolite, 1,25-dihydroxyvitamin D3 and its synthetic analogs also have potent antiproliferative, differentiative, and immunomodulatory activities, exerting these effects through the vitamin D receptor (VDR). The authors cite evidence linking vitamin D to modulation of the formation of metalloproteinases and fibroblast proliferation, which is
Need for Further Epidemiologic Evidence
Consistency across studies provides a compelling basis for causal inferences in epidemiologic research. Examining the same hypothesized relationship between levels of vitamin D and pulmonary function in diverse populations will be important. Seeing a similar relationship across different studies involving different sample populations controlling for potential confounders in various ways, strengthens the case for causality. Observing a dose-response relationship, as suggested in the current
Shedding Light on Sociodemographic Factors and Lung Function
Nutritional habits, levels of nutrients, and dietary factors such as vitamin D intake can vary based on sociodemographic factors including gender, age, and socioeconomic status.21 Similarly, physical activity levels may differ across certain subgroups.22 It will be important for future studies to examine how the relationship between vitamin D and these other factors might explain differential effects on lung function and COPD risk in susceptible subgroups (eg, based on socioeconomic status,
Further Evidence of the Public Health Importance
Finally, in addition to the disturbing projected trends for COPD, epidemiologic studies have suggested that hypovitaminosis D is reemerging as an important public health problem in the United States and worldwide.25 It will be important to conduct other studies examining the relationship between vitamin D and lung function, as this would be a relatively simple low-cost intervention that would likely have high compliance to potentially prevent or slow the loss of lung function in susceptible
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