Eleven studies had years- and you can sex-matched up control

Services of Integrated Knowledge

This new flowchart of one’s study choice processes is actually revealed into the Fig. 1. There had been 19 eligible books (sixteen instance–manage studies and you may around three get across-sectional training), involving 2699 subjects (1585 AA instances and you can 1114 control) [20,21,twenty two,23,24, twenty-seven,twenty-eight,30,31,30,thirty-two,33,34,thirty-five,36,37,38,39,40]. The fresh try size of the fresh integrated knowledge varied away from 43 to help you 756, and book day regarding 2012 so you’re able to 2019. Brand new provided studies had been of eight regions, namely Egypt, India, Israel, Italy, Nepal, Pakistan, Poultry, and Us. Seventeen, thirteen, and six studies considering investigation on serum twenty-five(OH)D membership, supplement D deficiency, and you may solution calcium supplements top, correspondingly. Detailed features of integrated research is described into the Dining table step 1. The fresh built-in top-notch the fresh provided situation–handle and you can mix-sectional education are ranked as the high (sTables step one and you can dos in the additional procedure).

Heterogeneity and you will Guide Bias

During pooled meta-analysis, inter-study heterogeneity (I 2 > 50%) was found in vitamin D level (I 2 = %, p < 0.001, Fig. 2), vitamin D deficiency (I 2 = %, p < 0.001, Fig. 3), and serum calcium level (I 2 = %, p < 0.001, Fig. 4). Therefore, the pooled meta-analysis for these factors was conducted using the random-effects model.

No proof of book czy fitness singles dziaÅ‚a bias try understood regarding meta-data regarding gel nutritional D level (Begg’s shot, p = 0.650; Egger’s shot, p = 0.756) and you will vitamin D deficiency (Begg’s attempt, p = 0.583; Egger’s sample, p = 0.257). Artwork evaluation of harness plots of land shown no proof guide bias getting solution nutritional D membership and you will supplement D deficiency (sFigs. dos and cuatro from the supplementary thing). Ergo, these study showed that there clearly was no book prejudice about establish meta-data, in addition to efficiency have been statistically robust.

Meta-analysis Performance

According to inter-study heterogeneity by Q test and I 2 test, the pooled analysis was conducted using the random-effects model for vitamin D level, vitamin D deficiency, and calcium level. Among the 17 studies with serum 25(OH)D level data, the results showed that patients with AA had significantly lower mean serum 25(OH)D level compared with controls (WMD 9.08, 95% CI ? , ? 6.50, p < 0.001, Fig. 2).

Among the 13 studies with vitamin D deficiency data, the meta-analysis suggested that patients with AA were more likely to have vitamin D deficiency with a pooled OR of 4.14 (95% CI 2.34, 7.35, p < 0.001, Fig. 3). Among the six included studies with serum calcium level data, the findings revealed that patients with AA did not have a statistically lower mean serum calcium level compared with controls (WMD ? 0.17, 95% CI ? 0.40, 0.06, p = 0.143, Fig. 4).

Subgroup Research

For serum 25(OH)D levels, similar statistically significant findings were obtained for subgroup analyses of study design (WMD of case–control ? 9.05, 95% CI ? , ? 5.63; WMD of cross-sectional ? 9.82, 95% CI ? , ? 7.72), sample size (WMD of > 100: ? 8.35, 95% CI ? , ? 5.51; WMD of ? 100: ? 9.59, 95% CI ? , ? 5.74), and male ratio (WMD of > 1/2: ? 7.79, 95% CI ? , ? 4.11; WMD of ? 1/2: ? , 95% CI ? , ? 7.13) (Table 2). However, inconsistent results were found for matched control (WMD of matched control ? , 95% CI ? , ? 8.78; WMD of non-matched control ? 3.18, 95% CI ? 8.35, 1.99), mean age (WMD of > 25 years ? , 95% CI ? , ? 7.24; WMD of < 25 years ? 3.18, 95% CI ? 8.35, 1.99), country (WMD of Nepal ? 9.68, 95% CI ? , 0.26, WMD of India ? 8.73, 95% CI ? , ? 5.87; WMD of Turkey ? 3.37, 95% CI ? , 3.94; WMD of Egypt ? , 95% CI ? , ? 7.39; WMD of Pakistan ? 9.00, 95% CI ? , ? 2.45; WMD of Israel ? , 95% CI ? , ? 2.95) (Table 2). These findings suggested that matched control, mean age, and country might contribute to a high degree of inter-study heterogeneity in serum vitamin D level.

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