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Abstract
Background: Vitamin D deficiency was associated with total mortality in previous epidemiological studies. Little is known about the effects of dietary vitamin D intake on mortality. We examined the association between mid-life dietary vitamin D intake and 45-year total mortality.
Methods: The Honolulu Heart Program is a longitudinal cohort study of 8006 Japanese American men in Hawaii aged 45 to 68 at baseline (1965–1968). Mid-life dietary vitamin D intake was calculated from 24-hour dietary recall using Nutritionist IV v3 software. We divided subjects into quartiles of dietary vitamin D. Total mortality data were available over 45 years through 2010.
Results: Age-adjusted total mortality rates were higher in the lower quartiles of dietary vitamin D intake compared to the highest (p for trend = 0.011). Using Cox regression, low dietary vitamin D was significantly associated with total mortality; quartile (Q) 1 hazard ratio (HR) = 1.14, 95% confidence interval (95% CI) = 1.07–1.22, p < 0.001; Q2 HR = 1.11, 95% CI = 1.04–1.18, p = 0.002; and Q3 HR = 1.08, 95% CI = 1.01–1.15, p = 0.027; Q4 = reference. After adjusting for age, kilocalories, cardiovascular risk factors, and prevalent chronic diseases, only Q2 remained significant (HR = 1.08, 95% CI = 1.00–1.15, p = 0.037). Among hypertensive subjects only, those in the lower 2 quartiles had higher total mortality; Q1 HR = 1.12, 95% CI = 1.01–1.25, p = 0.039, and Q2 HR = 1.13, 95% CI = 1.02–1.26, p = 0.025, compared to Q4. There was no significant relationship in subjects without hypertension.
Conclusions: Low dietary vitamin D intake in mid-life was a weak predictor of total mortality over 45 years of follow-up. We found a significant association between low dietary vitamin D intake and higher total mortality only among hypertensive subjects. Vitamin D may have cardioprotective effects.
Acknowledgments
None of the authors report conflicts of interest with commercial enterprises. The following coauthors have received grant support from the National Institutes of Health (C.L.B., R.C., G.W.R., R.D.A., K.M.). The following coauthor has also received grant support from the Department of Defense and Department of Veterans Affairs (G.W.R.). The following coauthor is an employee of the National Institutes of Health (L.L.).