human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Low vitamin D status increases the risk of death . Magnesium plays an essential role in vitamin D metabolism and low magnesium intake may predispose to vitamin D deficiency and potentiate the health problems . We investigated whether magnesium intake modifies the serum 25(OH)D3 concentration and its associations with mortality in middle-aged and older men . We included 1892 men aged 42–60 years without cardiovascular disease or cancer at baseline in 1984–1989 from the prospect i ve , population -based Kuopio Ischaemic Heart Disease Risk Factor Study .  Serum 25(OH)D3 was measured with the high-performance liquid chromatography using coulometric electrode array detection . Magnesium intake was assessed with 4-day food recording .  Deaths were ascertained by a computer linkage to the national cause of death register . Deaths due accidents and suicides were excluded . Cox proportional hazards regression models were used to analyze the associations . The multivariate-adjusted hazard ratio ( HR ) for death in the lowest ( < 32.1 nmol/L ) versus the highest ( > 49.4 nmol/L ) serum 25(OH)D3 tertile was 1.31 ( 95 % CI 1.07–1.60 , Ptrend = 0.01 ) . Stratified by the magnesium intake , the higher risk was observed only in the lower magnesium intake median ( < 414 mg/day ) ; HR = 1.60 ( 95 % CI 1.19–2.13 , Ptrend = 0.002 ) in the lowest versus the highest 25(OH)D3 tertile , whereas the corresponding HR = 1.07 , 95 % CI 0.75–1.36 , Ptrend = 0.63 ) in the higher magnesium intake median , P for interaction = 0.08 . In this cohort of middle-aged and older men  low serum 25(OH)D3 concentration was associated with increased risk of death mainly in those with lower magnesium intake Background Evidence of an inverse association between serum  25-hydoroxyvitamin D [ 25(OH)D ] and the risk of all-cause death and cardiovascular disease from prospect i ve studies is inconsistent . We tested the relationship between 25(OH)D and the risk among adult ethnic Chinese in Taiwan . Methods We conducted a community-based cohort study of 1816 participants ( age 60.2±10.2 yrs , 45.0 % women ) in the Chin-Shan Community Cardiovascular Cohort Study who were free of cardiovascular diseases at baseline and provided 25(OH)D measurements . Results During a median 9.6 ( interquartile range , 8.8- 10.5 ) years ’ follow-up period , totally 263 cases developed cardiovascular death events and 559 participants were documented to death from any cause . As 25(OH)D concentration increased , the incidence rates of cardiovascular events and all-cause death decreased progressively . 25(OH)D was inversely associated with all-cause death : the adjusted hazard ratio was 0.49 ( 95 % confidence interval [ CI ] , 0.25 - 0.97 ) for the third quartile and a significant J-shape relationship was found . The performance measures by integrated discriminative improvement showed significant improvement after adding 25(OH)D information ( 0.14 % , 95 % CI , 0.03 - 0.31 , P=0.050 , for all-cause death and 0.32 % , 95 % CI , 0.02 - 0.62 , P=0.018 for cardiovascular events ) . Conclusion These findings suggested a modest inverse association between 25(OH)D and the risk of all-cause death among diabetic participants and a good predictive factor in the community . Further studies to investigate the mechanism of vitamin D role on health effect are warranted CONTEXT Observational studies relating circulating 25-hydroxyvitamin D ( 25OHD ) and dietary vitamin D intake to cardiovascular disease ( CVD ) have reported conflicting results . OBJECTIVE Our objective was to investigate the association of 25OHD , dietary vitamin D , PTH , and adjusted calcium  with  CVD and mortality in a Scottish cohort . DESIGN AND SETTING The MIDSPAN Family Study is a prospect i ve study of 1040 men and 1298 women from the West of Scotl and recruited in 1996 and followed up for a median 14.4 yr . PARTICIPANTS Locally resident adult offspring of a general population cohort were recruited from 1972 - 1976 . MAIN OUTCOME MEASURES CVD events ( n = 416 ) and all-cause mortality ( n = 100 ) were evaluated . RESULTS 25OHD was measured using liquid chromatography-t and em mass spectrometry in available plasma ( n = 2081 ) . Median plasma 25OHD was 18.6 ng/ml , and median vitamin D intake was 3.2 μg/d ( 128 IU/d ) . Vitamin D deficiency ( 25OHD < 15 ng/ml ) was present in 689 participants ( 33.1 % ) . There was no evidence that dietary vitamin D intake , PTH , or adjusted calcium were associated with CVD events or with mortality . Vitamin D deficiency was not associated with CVD ( fully adjusted hazard ratio = 1.00 ; 95 % confidence interval = 0.77 - 1.31 ) . Results were similar after excluding patients who reported an activity-limiting longst and ing illness at baseline ( 18.8 % ) and those taking any vitamin supplements ( 21.7 % ) . However , there was some evidence vitamin D deficiency was associated with all-cause mortality ( fully adjusted hazard ratio = 2.02 ; 95 % confidence interval = 1.17 - 3.51 ) . CONCLUSION Vitamin D deficiency was not associated with risk of CVD in this cohort with very low 25OHD . Future trials of vitamin D supplementation in middle-aged cohorts should be powered to detect differences in mortality outcomes as well as CVD BACKGROUND AND AIMS Emerging evidence suggests that low levels of vitamin D may be an important risk factor for multiple chronic diseases and mortality , but the evidence is mixed . Vitamin D levels are associated with sun exposure , diet , and metabolic status . One potential explanation for the lack of consistent findings amongst various studies is that low vitamin levels may be associated with poor diets or other risk factors that we were not adequately controlled for in different analyses . METHODS Prospect i ve analysis of adults over the age of 35 in NHANES III data ( 1988 - 1994 ) with 20 year mortality follow-up . Sequential Cox proportional hazard models quartiles of 25OH vitamin D adjusted for age , season , geography , sociodemographic ( SD ) , CVD risk factors ( CVD ) and nutritional factors ( NF ) were performed . RESULTS Gender , race , diabetes , anti-hypertensive meds , income , taking  vitamin D supplements , physical activity , alcohol consumption , region , body mass index , blood pressure , creatinine , albumin , CRP , thyroxine , iron , RBC folate , vitamin A , E , alpha-carotene , and lycopene were all associated with different quartiles of vitamin D and as well as CHD and all-cause mortality and thus are important potential confounders of this relationship . Adjusting for the confounding factors , higher levels of vitamin D demonstrate an inverse relationship with all-cause mortality , but only the top quartile of vitamin D shows an inverse relationship with CHD mortality . CONCLUSIONS The highest quartile compared to the lowest quartile of 25OH vitamin D levels is inversely associated with CHD and all-cause mortality adjusting for multiple confounders . Whether supplementation of individuals with low vitamin D will result in similar benefits will require a r and omized clinical trial Evidence continues to mount that vitamin D reduces the risk and mortality rates of many types of disease . However , evidence from prospect i ve cohort studies is sometimes weaker than that from case – control and ecological studies . A suggested reason for this discrepancy is that , because serum levels of 25-hydroxyvitamin D [ 25(OH)D ] change over time , a single 25(OH)D concentration measurement taken at study enrollment does not reliably indicate 25(OH)D concentration related to the health outcome . To evaluate this suggestion further , this paper plots results from 12 prospect i ve cohort studies of all-cause mortality rate vs. follow-up time . The regression fit to the hazard ratio per 20-nmol/l increase in serum 25(OH)D concentration vs. time increased from 0.82 ( 95 % CI , 0.67–1.02 ) for 6 y to 0.96 ( 95 % CI , 0.90–1.01 ) for 14 y. The value extrapolated for zero follow-up time was 0.72 ( 95 % CI , 0.50–1.03 ) , giving a hazard ratio reduction 3.5 times higher than the st and ard result from the meta- analysis [ 0.92 ( 95 % CI , 0.89–0.95 ) ] . Using the example of the Vitamin D Pooling Project of Rarer Cancers , this paper also discusses follow-up time ’s effect in interpreting prospect i ve cohort studies of cancer outcome . This paper recommends that meta-analyses of prospect i ve cohort studies account for follow-up time and , if possible , that studies measure serum 25(OH)D concentration every 2–4 Background / Objectives : Vitamin D deficiency is associated with cardiovascular disease , osteoporosis , poor muscle strength , falls , fractures and mortality . Although older adults are at a higher risk of vitamin D deficiency , the relationship of serum 25-hydroxyvitamin D ( 25(OH)D ) with all-cause and cardiovascular disease mortality has not been well characterized in the elderly . We hypothesized that low serum 25(OH)D levels predicted mortality in older adults . Subjects/ Methods : Serum 25(OH)D  as well as all-cause and cardiovascular disease mortality were examined in 1006 adults , aged ⩾65 years , who participated in the InCHIANTI ( Invecchiare in Chianti , Aging in the Chianti Area ) study , a population -based , prospect i ve cohort study of aging in Tuscany , Italy . Serum 25(OH)D levels were measured at the time of enrollment in 1998–1999 , and participants were followed up for mortality . Results : During 6.5 years of follow-up , 228 ( 22.7 % ) participants died , of whom 107 died due to cardiovascular diseases . Compared with participants in the highest quartile of serum 25(OH)D ( > 26.5 ng/ml ) ( to convert to nmol/l , multiply by 2.496 ) , those in the lowest quartile ( < 10.5 ng/ml ) had increased risk of all-cause mortality ( Hazard Ratio ( H.R. ) 2.11 , 95 % Confidence Interval ( 95 % C.I. ) : 1.22–3.64 , P=0.007 ) and cardiovascular disease mortality ( H.R. 2.64 , 95 % C.I. : 1.14–4.79 , P=0.02 ) , in multivariate Cox proportional hazards models that adjusted for age , sex , education , season , physical activity and other potential confounders . Conclusions : Older community-dwelling adults with low serum 25(OH)D levels are at higher risk of all-cause and cardiovascular disease mortality BACKGROUND / OBJECTIVES : Although both frailty and low vitamin D have been separately associated with an increased risk for adverse health , their joined effects on mortality have not been reported . The current study examined prospect ively the effects of frailty and vitamin D status on mortality in US older adults . SUBJECTS/ METHODS : Participants aged ⩾60 years in The Third National Health and Nutrition Examination Survey with 12 years of mortality follow-up were included in the analysis ( n=4731 ) . Frailty was defined as meeting three or more criteria and pre-frailty as meeting one or two of the five frailty criteria ( low body mass index ( BMI ) , slow walking , weakness , exhaustion and low physical activity )  . Vitamin D status  was assessed by serum 25-hydroxyvitamin D ( 25(OH)D )  and categorized into quartiles . Analyses were adjusted for gender , race , age , smoking , education , latitude and other comorbid conditions . RESULTS : Serum 25(OH)D concentrations were lowest in participants with frailty , intermediate in participants with pre-frailty and highest in participants without frailty . The odds of frailty in the lowest quartile of serum 25(OH)D was 1.94 times the odds in the highest quartile ( 95 % confidence interval ( CI ) : 1.09–3.44 ) . Mortality was positively associated with frailty , with the risk among participants who were frail and had low serum 25(OH)D being significantly higher than those who were not frail and who had high concentrations of serum 25(OH)D 
    Output:
    
agent
The vast majority of studies reported inverse associations between 25(OH)D concentration and all-cause mortality .
This association appeared to be non-linear , with progressively lower mortality with increasing 25(OH)D up to a point , beyond which there was no further decrease .
There is moderate evidence that vitamin D status is inversely associated with cancer mortality and death due to respiratory diseases , while for cardiovascular mortality , there is weak evidence of an association in observational studies , which is not supported by the data from intervention or Mendelian r and omization studies .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Low vitamin D status increases the risk of death . Magnesium plays an essential role in vitamin D metabolism and low magnesium intake may predispose to vitamin D deficiency and potentiate the health problems . We investigated whether magnesium intake modifies the serum 25(OH)D3 concentration and its associations with mortality in middle-aged and older men . We included 1892 men aged 42–60 years without cardiovascular disease or cancer at baseline in 1984–1989 from the prospect i ve , population -based Kuopio Ischaemic Heart Disease Risk Factor Study .  Serum 25(OH)D3 was measured with the high-performance liquid chromatography using coulometric electrode array detection . Magnesium intake was assessed with 4-day food recording .  Deaths were ascertained by a computer linkage to the national cause of death register . Deaths due accidents and suicides were excluded . Cox proportional hazards regression models were used to analyze the associations . The multivariate-adjusted hazard ratio ( HR ) for death in the lowest ( < 32.1 nmol/L ) versus the highest ( > 49.4 nmol/L ) serum 25(OH)D3 tertile was 1.31 ( 95 % CI 1.07–1.60 , Ptrend = 0.01 ) . Stratified by the magnesium intake , the higher risk was observed only in the lower magnesium intake median ( < 414 mg/day ) ; HR = 1.60 ( 95 % CI 1.19–2.13 , Ptrend = 0.002 ) in the lowest versus the highest 25(OH)D3 tertile , whereas the corresponding HR = 1.07 , 95 % CI 0.75–1.36 , Ptrend = 0.63 ) in the higher magnesium intake median , P for interaction = 0.08 . In this cohort of middle-aged and older men  low serum 25(OH)D3 concentration was associated with increased risk of death mainly in those with lower magnesium intake Background Evidence of an inverse association between serum  25-hydoroxyvitamin D [ 25(OH)D ] and the risk of all-cause death and cardiovascular disease from prospect i ve studies is inconsistent . We tested the relationship between 25(OH)D and the risk among adult ethnic Chinese in Taiwan . Methods We conducted a community-based cohort study of 1816 participants ( age 60.2±10.2 yrs , 45.0 % women ) in the Chin-Shan Community Cardiovascular Cohort Study who were free of cardiovascular diseases at baseline and provided 25(OH)D measurements . Results During a median 9.6 ( interquartile range , 8.8- 10.5 ) years ’ follow-up period , totally 263 cases developed cardiovascular death events and 559 participants were documented to death from any cause . As 25(OH)D concentration increased , the incidence rates of cardiovascular events and all-cause death decreased progressively . 25(OH)D was inversely associated with all-cause death : the adjusted hazard ratio was 0.49 ( 95 % confidence interval [ CI ] , 0.25 - 0.97 ) for the third quartile and a significant J-shape relationship was found . The performance measures by integrated discriminative improvement showed significant improvement after adding 25(OH)D information ( 0.14 % , 95 % CI , 0.03 - 0.31 , P=0.050 , for all-cause death and 0.32 % , 95 % CI , 0.02 - 0.62 , P=0.018 for cardiovascular events ) . Conclusion These findings suggested a modest inverse association between 25(OH)D and the risk of all-cause death among diabetic participants and a good predictive factor in the community . Further studies to investigate the mechanism of vitamin D role on health effect are warranted CONTEXT Observational studies relating circulating 25-hydroxyvitamin D ( 25OHD ) and dietary vitamin D intake to cardiovascular disease ( CVD ) have reported conflicting results . OBJECTIVE Our objective was to investigate the association of 25OHD , dietary vitamin D , PTH , and adjusted calcium  with  CVD and mortality in a Scottish cohort . DESIGN AND SETTING The MIDSPAN Family Study is a prospect i ve study of 1040 men and 1298 women from the West of Scotl and recruited in 1996 and followed up for a median 14.4 yr . PARTICIPANTS Locally resident adult offspring of a general population cohort were recruited from 1972 - 1976 . MAIN OUTCOME MEASURES CVD events ( n = 416 ) and all-cause mortality ( n = 100 ) were evaluated . RESULTS 25OHD was measured using liquid chromatography-t and em mass spectrometry in available plasma ( n = 2081 ) . Median plasma 25OHD was 18.6 ng/ml , and median vitamin D intake was 3.2 μg/d ( 128 IU/d ) . Vitamin D deficiency ( 25OHD < 15 ng/ml ) was present in 689 participants ( 33.1 % ) . There was no evidence that dietary vitamin D intake , PTH , or adjusted calcium were associated with CVD events or with mortality . Vitamin D deficiency was not associated with CVD ( fully adjusted hazard ratio = 1.00 ; 95 % confidence interval = 0.77 - 1.31 ) . Results were similar after excluding patients who reported an activity-limiting longst and ing illness at baseline ( 18.8 % ) and those taking any vitamin supplements ( 21.7 % ) . However , there was some evidence vitamin D deficiency was associated with all-cause mortality ( fully adjusted hazard ratio = 2.02 ; 95 % confidence interval = 1.17 - 3.51 ) . CONCLUSION Vitamin D deficiency was not associated with risk of CVD in this cohort with very low 25OHD . Future trials of vitamin D supplementation in middle-aged cohorts should be powered to detect differences in mortality outcomes as well as CVD BACKGROUND AND AIMS Emerging evidence suggests that low levels of vitamin D may be an important risk factor for multiple chronic diseases and mortality , but the evidence is mixed . Vitamin D levels are associated with sun exposure , diet , and metabolic status . One potential explanation for the lack of consistent findings amongst various studies is that low vitamin levels may be associated with poor diets or other risk factors that we were not adequately controlled for in different analyses . METHODS Prospect i ve analysis of adults over the age of 35 in NHANES III data ( 1988 - 1994 ) with 20 year mortality follow-up . Sequential Cox proportional hazard models quartiles of 25OH vitamin D adjusted for age , season , geography , sociodemographic ( SD ) , CVD risk factors ( CVD ) and nutritional factors ( NF ) were performed . RESULTS Gender , race , diabetes , anti-hypertensive meds , income , taking  vitamin D supplements , physical activity , alcohol consumption , region , body mass index , blood pressure , creatinine , albumin , CRP , thyroxine , iron , RBC folate , vitamin A , E , alpha-carotene , and lycopene were all associated with different quartiles of vitamin D and as well as CHD and all-cause mortality and thus are important potential confounders of this relationship . Adjusting for the confounding factors , higher levels of vitamin D demonstrate an inverse relationship with all-cause mortality , but only the top quartile of vitamin D shows an inverse relationship with CHD mortality . CONCLUSIONS The highest quartile compared to the lowest quartile of 25OH vitamin D levels is inversely associated with CHD and all-cause mortality adjusting for multiple confounders . Whether supplementation of individuals with low vitamin D will result in similar benefits will require a r and omized clinical trial Evidence continues to mount that vitamin D reduces the risk and mortality rates of many types of disease . However , evidence from prospect i ve cohort studies is sometimes weaker than that from case – control and ecological studies . A suggested reason for this discrepancy is that , because serum levels of 25-hydroxyvitamin D [ 25(OH)D ] change over time , a single 25(OH)D concentration measurement taken at study enrollment does not reliably indicate 25(OH)D concentration related to the health outcome . To evaluate this suggestion further , this paper plots results from 12 prospect i ve cohort studies of all-cause mortality rate vs. follow-up time . The regression fit to the hazard ratio per 20-nmol/l increase in serum 25(OH)D concentration vs. time increased from 0.82 ( 95 % CI , 0.67–1.02 ) for 6 y to 0.96 ( 95 % CI , 0.90–1.01 ) for 14 y. The value extrapolated for zero follow-up time was 0.72 ( 95 % CI , 0.50–1.03 ) , giving a hazard ratio reduction 3.5 times higher than the st and ard result from the meta- analysis [ 0.92 ( 95 % CI , 0.89–0.95 ) ] . Using the example of the Vitamin D Pooling Project of Rarer Cancers , this paper also discusses follow-up time ’s effect in interpreting prospect i ve cohort studies of cancer outcome . This paper recommends that meta-analyses of prospect i ve cohort studies account for follow-up time and , if possible , that studies measure serum 25(OH)D concentration every 2–4 Background / Objectives : Vitamin D deficiency is associated with cardiovascular disease , osteoporosis , poor muscle strength , falls , fractures and mortality . Although older adults are at a higher risk of vitamin D deficiency , the relationship of serum 25-hydroxyvitamin D ( 25(OH)D ) with all-cause and cardiovascular disease mortality has not been well characterized in the elderly . We hypothesized that low serum 25(OH)D levels predicted mortality in older adults . Subjects/ Methods : Serum 25(OH)D  as well as all-cause and cardiovascular disease mortality were examined in 1006 adults , aged ⩾65 years , who participated in the InCHIANTI ( Invecchiare in Chianti , Aging in the Chianti Area ) study , a population -based , prospect i ve cohort study of aging in Tuscany , Italy . Serum 25(OH)D levels were measured at the time of enrollment in 1998–1999 , and participants were followed up for mortality . Results : During 6.5 years of follow-up , 228 ( 22.7 % ) participants died , of whom 107 died due to cardiovascular diseases . Compared with participants in the highest quartile of serum 25(OH)D ( > 26.5 ng/ml ) ( to convert to nmol/l , multiply by 2.496 ) , those in the lowest quartile ( < 10.5 ng/ml ) had increased risk of all-cause mortality ( Hazard Ratio ( H.R. ) 2.11 , 95 % Confidence Interval ( 95 % C.I. ) : 1.22–3.64 , P=0.007 ) and cardiovascular disease mortality ( H.R. 2.64 , 95 % C.I. : 1.14–4.79 , P=0.02 ) , in multivariate Cox proportional hazards models that adjusted for age , sex , education , season , physical activity and other potential confounders . Conclusions : Older community-dwelling adults with low serum 25(OH)D levels are at higher risk of all-cause and cardiovascular disease mortality BACKGROUND / OBJECTIVES : Although both frailty and low vitamin D have been separately associated with an increased risk for adverse health , their joined effects on mortality have not been reported . The current study examined prospect ively the effects of frailty and vitamin D status on mortality in US older adults . SUBJECTS/ METHODS : Participants aged ⩾60 years in The Third National Health and Nutrition Examination Survey with 12 years of mortality follow-up were included in the analysis ( n=4731 ) . Frailty was defined as meeting three or more criteria and pre-frailty as meeting one or two of the five frailty criteria ( low body mass index ( BMI ) , slow walking , weakness , exhaustion and low physical activity )  . Vitamin D status  was assessed by serum 25-hydroxyvitamin D ( 25(OH)D )  and categorized into quartiles . Analyses were adjusted for gender , race , age , smoking , education , latitude and other comorbid conditions . RESULTS : Serum 25(OH)D concentrations were lowest in participants with frailty , intermediate in participants with pre-frailty and highest in participants without frailty . The odds of frailty in the lowest quartile of serum 25(OH)D was 1.94 times the odds in the highest quartile ( 95 % confidence interval ( CI ) : 1.09–3.44 ) . Mortality was positively associated with frailty , with the risk among participants who were frail and had low serum 25(OH)D being significantly higher than those who were not frail and who had high concentrations of serum 25(OH)D 
    Output:
    