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FIGURE 6-1 Hazard ratios of risk of death according to baseline serum 25OHD level (subjects with serum 25OHD levels 39.1–82.0 nmol/L are the referent category).

FIGURE 6-1 Hazard ratios of risk of death according to baseline serum 25OHD level (subjects with serum 25OHD levels 39.1–82.0 nmol/L are the referent category).

NOTE: Model 1 is adjusted for age and gender; model 2 is adjusted for model 1 and taking five or more kinds of medicine and self-perceived health status; model 3 is adjusted for model 2 and having heart problem and/or diabetes at baseline; model 4 is adjusted for model 3 and sunlight exposure (i.e., season of blood sampling, sunbathing, and outdoor physical activity); model 5 is adjusted for model 3 and use of a supplement containing vitamin D; model 6 is adjusted for model 3 and variables in models 4 and 5.

SOURCE: Jia et al. (2007).

mortality (p = 0.03); however, a U-shaped or reverse-J-shaped relationship between serum 25OHD level and mortality was observed, with the lowest mortality at serum 25OHD levels below 50 nmol/L (see Figure 6-1). Visser et al. (2006) showed a similar pattern, with reduced mortality associated with higher than deficiency levels, but increased mortality at the highest blood 25OHD levels (see Figure 6-2). Melamed et al. (2008), using data from the Third National Health and Nutrition Examination Survey (NHANES III), also suggested a U-shaped or reverse-J-shaped risk curve with increasing risk at about 75 nmol/L (see Figure 6-3). The similar patterns emerging in these studies are of concern and are suggestive of at least a reverse-J-shaped curve, if not precisely a U-shaped curve for risk relative to serum 25OHD levels and all-cause mortality. Of note, Sambrook et al. (2004, 2006) found no relationship between mortality and the log of serum 25OHD levels in a sample (n = 842) of frail, institutionalized persons, most



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