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Int. J. Environ. Res. Public Health 2017, 14(9), 1043; doi:10.3390/ijerph14091043

The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies

1
School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China
2
College of Life Sciences, South-Central University for Nationalities, Wuhan 430074, China
3
Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
4
Department of Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
5
Department of Nutrition, The University of Tennessee, Knoxville, TN 37996, USA
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Received: 29 July 2017 / Revised: 5 September 2017 / Accepted: 6 September 2017 / Published: 10 September 2017
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
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Abstract

This meta-analysis evaluated the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk. Cohort studies published before July 2017 were selected through English-language literature searches in several databases. Relative risk (RR) with corresponding 95% confidence interval (CI) was used to evaluate the risk. Heterogeneity was checked by Chi-square and I2 test. Sensitivity analysis and publication bias were also performed. For the association between retinol intake and total fracture risk, we performed subgroup analysis by sex, region, case ascertainment, education level, age at menopause and vitamin D intake. R software was used to complete all statistical analyses. A total of 319,077 participants over the age of 20 years were included. Higher dietary intake of retinol and total vitamin A may slightly decrease total fracture risk (RR with 95% CI: 0.95 (0.91, 1.00) and 0.94 (0.88, 0.99), respectively), and increase hip fracture risk (RR with 95% CI: 1.40 (1.02, 1.91) and 1.29 (1.06, 1.57), respectively). Lower blood level of retinol may slightly increase total fracture risk (RR with 95% CI: 1.11 (0.94, 1.30)) and hip fracture risk (RR with 95% CI: 1.27 (1.05, 1.53)). In addition, higher β-carotene intake was weakly associated with the increased risk of total fracture (RR with 95% CI: 1.07 (0.97, 1.17)). Our data suggest that vitamin A intake and level may differentially influence the risks of total and hip fractures. Clinical trials are warranted to confirm these results and assess the clinical applicability. View Full-Text
Keywords: vitamin A; retinol; β-carotene; hip fracture; total fracture vitamin A; retinol; β-carotene; hip fracture; total fracture
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MDPI and ACS Style

Zhang, X.; Zhang, R.; Moore, J.B.; Wang, Y.; Yan, H.; Wu, Y.; Tan, A.; Fu, J.; Shen, Z.; Qin, G.; Li, R.; Chen, G. The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies. Int. J. Environ. Res. Public Health 2017, 14, 1043.

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