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Michal L. Melamed, MD, MHS; Erin D. Michos, MD, MHS; Brad Astor, PhD

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In reply

We agree with Zittermann and Grant that there are definite limitations to observational data, such as our recent report on the mortality risk associated with low 25(OH)D levels in the general population.¹ We agree that many of the factors we used in our analysis (not only hypertension and diabetes mellitus) may be mediators rather than confounders and therefore maybe should not be adjusted for, which is why we presented both unadjusted and adjusted results. As we tried to make clear, the apparent increased risk at higher 25(OH)D levels (>50 ng/mL), especially seen in women, requires additional study before being incorporated into any clinical recommendations, especially given the potential for residual confounding. It is also important to note that there were few participants at higher 25(OH)D levels and that results with few data points should be . . . [Full Text of this Article]

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RELATED ARTICLE

25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population
Michal L. Melamed, Erin D. Michos, Wendy Post, and Brad Astor
Arch Intern Med. 2008;168(15):1629-1637.
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25-Hydroxyvitamin D Levels and All-Cause Mortality
Armin Zittermann and William B. Grant
Arch Intern Med. 2009;169(11):1075-1076.
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