Association Between Serum Vitamin D Levels and Parkinson's Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Vitamin D is an important secosteroid which is involved the development and regulation of brain activity. Several studies have focused on exploring the relationship between serum vitamin D levels and Parkinson's disease (PD), but the conclusion remains ambiguous. Methods: We searched observational studies that explored the association between serum vitamin D levels and PD based on PubMed, EMBASE and Cochrane library from inception through to January 2018. The quality of included studies was evaluated by using Newcastle-Ottawa Scale (NOS). Statistical analysis of this meta-analysis was performed by Stata version 12.0 and R software. Results: Twenty studies with a total of 2,866 PD patients and 2,734 controls were included. Compared with controls, PD patients had lower serum vitamin D levels (WMD -3.96, 95%CI -5.00, -2.92), especially in higher latitude regions (WMD -4.20, 95%CI -5.66, -2.75). Assay methods contributed significantly to high heterogeneity. Furthermore, PD patients with deficient vitamin D levels had advanced risk (OR 2.08, 95%CI 1.35, 3.19) than those patients with insufficient ones (OR = 1.73, 95%CI 1.48, 2.03). In addition, serum vitamin D levels were also related to the severity of PD (WMD -5.27, 95%CI -8.14, -2.39) and the summary correlation coefficient showed strongly negative correlation (r = -0.55, 95%CI -0.73, -0.29). Moreover, the pooled correlation coefficient revealed that serum vitamin D levels were also negatively correlated to the Unified Parkinson's Disease Rating Scale III (UPDRS III) (r = -0.36, 95%CI -0.53, -0.16), but did not correlate with the duration of PD (P = 0.37) and age of patients (P = 0.49). Conclusion: Serum vitamin D levels are inversely associated with the risk and severity of PD. Our results provided an updated evidence of association between low vitamin D levels and PD and prompt the adjunctive therapeutic decisions about vitamin D replacement in PD.

Keywords: Parkinson's disease; meta-analysis; motor symptom; observational studies; vitamin D.

Figure 1

Flow diagram of search process and identified studies.

Figure 2

Forest plot of vitamin D levels between PD patients and controls divided by assay methods.

Figure 3

Forest plot of vitamin D levels between PD patients and controls divided by latitude.

Figure 4

Forest plot of insufficient vitamin D levels and risk of PD.

Figure 5

Forest plot of deficient vitamin D levels and risk of PD.

Figure 6

Forest plot of vitamin D levels in PD patients with different severity.

Figure 7

Forest plot of the correlation coefficient between vitamin D levels and different HYstages in PD patients.

Figure 8

Forest plot of the correlation coefficient between vitamin D levels and mUPDRS scores in PD patients.