Abstract
Objective: Compare vitamin D levels in opioid dependence and control
population and adjust for relevant confounding effects. Nuclear hormone
receptors (including the vitamin D receptor) have been shown to be key
transducers and regulators of intracellular metabolism and comprise an
important site of pathophysiological immune and metabolic dysregulation
potentially contributing towards pro-ageing changes observed in
opioid-dependent patients (ODPs). Design: Longitudinal prospective
comparing ODPs with general medical controls (GMCs). Setting Primary
care. Participants: Prospective review comparing 1168 ODP (72.5% men) and
415 GMC (51.6% men, p<0.0001). Mean ages were 33.92±0.31 (mean±SEM)
and 41.22±1.32 years, respectively (p<0.0001). Opioid use in the ODP
has been previously reported and shown to be typical. Interventions Nil.
Observational study only. Primary and secondary outcomes Serum vitamin D
levels and relevant biochemical parameters. Results: Vitamin D levels
were higher in the ODP (70.35±1.16 and 57.06±1.81 nmol/L, p<0.0001).
The difference in ages between the two groups was handled in an
age-matched case-control subanalysis and also by multiple regression.
Sexes were analysed separately. The age:status (or age:time:status) was
significant in case-control, cross-sectional and longitudinal analyses
in both sexes (p<0.05). Modelled vitamin D was 62.71 vs 57.81 nmol/L
in the two groups. Time-dependent mixed-effects models quadratic in age
outperformed linear-only models (p=0.0377). ODP vitamin D was shown to
vary with age and to correlate with alanine aminotransferase
establishing it as a biomarker of age in this group. Hepatitis C
seronegativity was significant in regression models (from p=0.0015).
Conclusion Vitamin D was higher in ODP in both sexes in bivariate,
cross-sectional, case-control and longitudinal analyses and was robust
to the inclusion of metabolic and immune biomarkers. That Hepatitis C
seronegativity was significant suggests opioid dependence has an effect
beyond simply that of its associated hepatitides. This finding may
relate to the accelerated ageing process previously described in opioid
dependence. © Article author(s) (or their employer(s) unless otherwise
stated in the text of the article) 2018. All rights reserved. No
commercial use is permitted unless otherwise expressly granted.
Original language | English |
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Article number | e016806 |
Number of pages | 15 |
Journal | BMJ (Open) |
Volume | 8 |
Issue number | 1 |
DOIs | |
Publication status | Published - 1 Jan 2018 |