title: Does liver damage explain the inverse association between vitamin D status and mortality?
abstract: OBJECTIVE
  Several observational studies have linked vitamin D deficiency with an increased risk of all cause mortality. Vitamin D deficiency is common among patients with liver diseases. In a random sample of the general population, we investigated whether the inverse association between vitamin D status and all-cause mortality could be explained by liver damage as reflected by increased levels of liver enzymes.
  
  
  METHODS
  We included a total of 2649 persons examined in 1993e1994. Vitamin D status was assessed as serum 25-hydroxyvitamin D and liver enzyme levels were measured. Information on all-cause mortality was obtained from the Danish Central Personal Register until July 2011. Median follow-up time was 17.0 years, and there were 736 deaths.
  
  
  RESULTS
  Multivariable Cox regression analyses with age as underlying time axis and delayed entry showed lower mortality risk with higher vitamin D levels and this was essentially unaffected by adjustment for liver enzyme levels with hazard ratio, 0.96 (95% confidence interval, 0.93e0.99) for a 10 nmol/L higher vitamin D level.
  
  
  CONCLUSIONS
  The present study did not support our hypothesis that the well-known association between low vitamin D status and mortality is explained by liver damage as reflected by levels of liver enzymes.
authors.forename: Tea
authors.initials: T
authors.lastname: Skaaby
authors.forename: Lise Lotte N
authors.initials: LL
authors.lastname: Husemoen
authors.forename: Allan
authors.initials: A
authors.lastname: Linneberg
mesh_terms: D000410:Alanine Transaminase / Q000097:blood / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000097:blood / Q000378:metabolism; D002423:Cause of Death; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008099:Liver / Q000378:metabolism / Q000503:physiopathology*; D008107:Liver Diseases / Q000097:blood / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000401:mortality*; D005723:gamma-Glutamyltransferase / Q000097:blood / Q000378:metabolism
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase