nach oben

European Journal of Nutrition

Erschienen in:

16.01.2019 | Original Contribution

Vitamin D supplementation increases adipokine concentrations in overweight or obese adults

Erschienen in: European Journal of Nutrition | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Vitamin D regulates adipokine production in vitro; however, clinical trials have been inconclusive. We conducted secondary analyses of a randomized controlled trial to examine whether vitamin D supplementation improves adipokine concentrations in overweight/obese and vitamin D-deficient adults.

Methods

Sixty-five individuals with a BMI ≥ 25 kg/m² and 25-hydroxyvitamin D (25(OH)D) ≤ 50 nmol/L were randomized to oral cholecalciferol (100,000 IU single bolus followed by 4,000 IU daily) or matching placebo for 16 weeks. We measured BMI, waist-to-hip ratio, % body fat (dual X-ray absorptiometry), serum 25(OH)D (chemiluminescent immunoassay) and total adiponectin, leptin, resistin, and adipsin concentrations (multiplex assay; flow cytometry). Sun exposure, physical activity, and diet were assessed using questionnaires.

Results

Fifty-four participants completed the study (35M/19F; mean age = 31.9 ± 8.5 years; BMI = 30.9 ± 4.4 kg/m²). After 16 weeks, vitamin D supplementation increased 25(OH)D concentrations compared with placebo (57.0 ± 21.3 versus 1.9 ± 15.1 nmol/L, p < 0.001). There were no differences between groups for changes in adiponectin, leptin, resistin, or adipsin in unadjusted analyses (all p > 0.05). After adjustment for baseline values, season, sun exposure, and dietary vitamin D intake, there was a greater increase in adiponectin (β[95%CI] = 13.7[2.0, 25.5], p = 0.02) and leptin (β[95%CI] = 22.3[3.8, 40.9], p = 0.02) in the vitamin D group compared with placebo. Results remained significant after additional adjustment for age, sex, and % body fat (p < 0.02).

Conclusions

Vitamin D may increase adiponectin and leptin concentrations in overweight/obese and vitamin D-deficient adults. Further studies are needed to clarify the molecular interactions between vitamin D and adipokines and the clinical implications of these interactions in the context of obesity.

Clinical trial registration

clinicaltrials.gov: NCT02112721

Nur mit Berechtigung zugänglich

Nakamura K, Fuster JJ, Walsh K (2014) Adipokines: A link between obesity and cardiovascular disease. J Cardiol 63(4):250–259. https://doi.org/10.1016/j.jjcc.2013.11.006 CrossRefPubMed

Bakhai A (2008) Adipokines—targeting a root cause of cardiometabolic risk. QJM: An Int J Med 101(10):767–776. https://doi.org/10.1093/qjmed/hcn066 CrossRef

Ouchi N, Parker JL, Lugus JJ, Walsh K (2011) Adipokines in inflammation and metabolic disease. Nat Rev Immunol 11(2):85–97. https://doi.org/10.1038/nri2921 CrossRefPubMedPubMedCentral

Kong J, Chen Y, Zhu G, Zhao Q, Li YC (2013) 1,25-Dihydroxyvitamin D3 upregulates leptin expression in mouse adipose tissue. The J Endocrinol 216(2):265–271. https://doi.org/10.1530/joe-12-0344 CrossRefPubMed

Okazaki R, Toriumi M, Fukumoto S, Miyamoto M, Fujita T, Tanaka K, Takeuchi Y (1999) thiazolidinediones inhibit osteoclast-like cell formation and bone resorption in vitro1. Endocrinology 140(11):5060–5065. https://doi.org/10.1210/endo.140.11.7116 CrossRefPubMed

Sun X, Zemel Michael B (2012) Calcium and 1,25-dihydroxyvitamin D3 regulation of adipokine expression. Obesity 15(2):340–348. https://doi.org/10.1038/oby.2007.540 CrossRef

Kelly KA, Gimble JM (1998) 1,25-dihydroxy vitamin D3 inhibits adipocyte differentiation and gene expression in murine bone marrow stromal cell clones and primary cultures*. Endocrinology 139(5):2622–2628. https://doi.org/10.1210/endo.139.5.5970 CrossRefPubMed

Menendez C, Lage M, Peino R, Baldelli R, Concheiro P, Dieguez C, Casanueva FF (2001) Retinoic acid and vitamin D(3) powerfully inhibit in vitro leptin secretion by human adipose tissue. J Endocrinol 170(2):425–431CrossRefPubMed

Liu E, Meigs JB, Pittas AG, McKeown NM, Economos CD, Booth SL, Jacques PF (2009) Plasma 25-hydroxyvitamin d is associated with markers of the insulin resistant phenotype in nondiabetic adults. J Nutr 139(2):329–334. https://doi.org/10.3945/jn.108.093831 CrossRefPubMedPubMedCentral

10.

Mousa A, Abell Sally K, Shorakae S, Harrison Cheryce L, Naderpoor N, Hiam D, Moreno-Asso A, Stepto Nigel K, Teede Helena J, Courten B (2017) Relationship between vitamin D and gestational diabetes in overweight or obese pregnant women may be mediated by adiponectin. Mol Nutr Food Res 61(11):1700488. https://doi.org/10.1002/mnfr.201700488 CrossRef

11.

Roth CL, Elfers C, Kratz M, Hoofnagle AN (2011) Vitamin d deficiency in obese children and its relationship to insulin resistance and adipokines. J Obes 2011:495101. https://doi.org/10.1155/2011/495101 CrossRefPubMedPubMedCentral

12.

Gomez JM, Maravall FJ, Gomez N, Navarro MA, Casamitjana R, Soler J (2004) Relationship between 25-(OH) D3, the IGF-I system, leptin, anthropometric and body composition variables in a healthy, randomly selected population. Hormone Metab Res 36 (1):48–53. https://doi.org/10.1055/s-2004-814103 CrossRef

13.

Tarcin O, Yavuz DG, Ozben B, Telli A, Ogunc AV, Yuksel M, Toprak A, Yazici D, Sancak S, Deyneli O, Akalin S (2009) Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metab 94(10):4023–4030. https://doi.org/10.1210/jc.2008-1212 CrossRefPubMed

14.

Vaidya A, Pojoga L, Underwood PC, Forman JP, Hopkins PN, Williams GH, Williams JS (2011) The association of plasma resistin with dietary sodium manipulation, the renin-angiotensin-aldosterone system, and 25-hydroxyvitamin D3 in human hypertension. Clin Endocrinol (Oxf) 74(3):294–299. https://doi.org/10.1111/j.1365-2265.2010.03922.x CrossRef

15.

Bellia A, Garcovich C, D’Adamo M, Lombardo M, Tesauro M, Donadel G, Gentileschi P, Lauro D, Federici M, Lauro R, Sbraccia P (2013) Serum 25-hydroxyvitamin D levels are inversely associated with systemic inflammation in severe obese subjects. Internal Emergency Med 8(1):33–40. https://doi.org/10.1007/s11739-011-0559-x CrossRef

16.

Vilarrasa N, Vendrell J, Maravall J, Elio I, Solano E, San Jose P, Garcia I, Virgili N, Soler J, Gomez JM (2010) Is plasma 25(OH) D related to adipokines, inflammatory cytokines and insulin resistance in both a healthy and morbidly obese population? Endocrine 38(2):235–242. https://doi.org/10.1007/s12020-010-9379-4 CrossRefPubMed

17.

Maggi S, Siviero P, Brocco E, Albertin M, Romanato G, Crepaldi G (2014) Vitamin D deficiency, serum leptin and osteoprotegerin levels in older diabetic patients: an input to new research avenues. Acta Diabetol 51(3):461–469. https://doi.org/10.1007/s00592-013-0540-4 CrossRefPubMed

18.

Minto C, Vecchio MG, Gregori D (2015) Effects of vitamin D supplementation on serum adiponectin: a metaregression analysis of clinical trials. FASEB J 29(1_supplement):LB347. https://doi.org/10.1096/fasebj.29.1_supplement.lb347 CrossRef

19.

Mousa A, Naderpoor N, Teede H, Scragg R, de Courten B (2018) Vitamin D supplementation for improvement of chronic low-grade inflammation in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 76(5):380–394. https://doi.org/10.1093/nutrit/nux077 CrossRefPubMed

20.

Belenchia AM, Tosh AK, Hillman LS, Peterson CA (2013) Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial. Am J Clin Nutr 97(4):774–781. https://doi.org/10.3945/ajcn.112.050013 CrossRefPubMed

21.

Dinca M, Serban M-C, Sahebkar A, Mikhailidis DP, Toth PP, Martin SS, Blaha MJ, Blüher M, Gurban C, Penson P, Michos ED, Hernandez AV, Jones SR, Banach M (2016) Does vitamin D supplementation alter plasma adipokines concentrations? A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res 107:360–371. https://doi.org/10.1016/j.phrs.2016.03.035 CrossRefPubMed

22.

Wamberg L, Kampmann U, Stodkilde-Jorgensen H, Rejnmark L, Pedersen SB, Richelsen B (2013) Effects of vitamin D supplementation on body fat accumulation, inflammation, and metabolic risk factors in obese adults with low vitamin D levels—results from a randomized trial. Eur J Intern Med 24(7):644–649. https://doi.org/10.1016/j.ejim.2013.03.005 CrossRefPubMed

23.

Mousa A, Naderpoor N, de Courten MPJ, Teede H, Kellow N, Walker K, Scragg R, de Courten B (2017) Vitamin D supplementation has no effect on insulin sensitivity or secretion in vitamin D–deficient, overweight or obese adults: a randomized placebo-controlled trial. Am J Clin Nutr 105(6):1372–1381. https://doi.org/10.3945/ajcn.117.152736 CrossRefPubMed

24.

de Courten B, Mousa A, Naderpoor N, Teede H, de Courten MPJ, Scragg R (2015) Vitamin D supplementation for the prevention of type 2 diabetes in overweight adults: study protocol for a randomized controlled trial. Trials 16:335. https://doi.org/10.1186/s13063-015-0851-6 CrossRefPubMedPubMedCentral

25.

WMA (2013) World Medical Association declaration of helsinki: ethical principles for medical research involving human subjects. JAMA: J Am Med Assoc 310(20):2191–2194. https://doi.org/10.1001/jama.2013.281053 CrossRef

26.

Hathcock JN, Shao A, Vieth R, Heaney R (2007) Risk assessment for vitamin D. Am J Clin Nutr 85(1):6–18CrossRefPubMed

27.

Ilahi M, Armas LA, Heaney RP (2008) Pharmacokinetics of a single, large dose of cholecalciferol. Am J Clin Nutr 87(3):688–691CrossRefPubMed

28.

Vieth R, Chan PC, MacFarlane GD (2001) Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 73(2):288–294CrossRefPubMed

29.

Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetic Med: J Br Diabetic Assoc 15 (7):539–553. https://doi.org/10.1002/(sici)1096-9136(199807)15:7%3C539::aid-dia668%3E3.0.co;2-s CrossRef

30.

Hanwell HE, Vieth R, Cole DE, Scillitani A, Modoni S, Frusciante V, Ritrovato G, Chiodini I, Minisola S, Carnevale V (2010) Sun exposure questionnaire predicts circulating 25-hydroxyvitamin D concentrations in Caucasian hospital workers in southern Italy. J Steroid Biochem Mol Biol 121(1–2):334–337. https://doi.org/10.1016/j.jsbmb.2010.03.023 CrossRefPubMed

31.

Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci sports Exerc 35(8):1381–1395. https://doi.org/10.1249/01.mss.0000078924.61453.fb CrossRefPubMed

32.

Baziar N, Jafarian K, Shadman Z, Qorbani M, Khoshniat Nikoo M, Abd Mishani M (2014) Effect of therapeutic dose of vitamin d on serum adiponectin and glycemia in vitamin d-insufficient or deficient type 2 diabetic patients. Iran 16(9):e21458. https://doi.org/10.5812/ircmj.21458 CrossRef

33.

Gannage-Yared MH, Chedid R, Khalife S, Azzi E, Zoghbi F, Halaby G (2009) Vitamin D in relation to metabolic risk factors, insulin sensitivity and adiponectin in a young Middle-Eastern population. Eur J Endocrinol 160(6):965–971. https://doi.org/10.1530/eje-08-0952 CrossRefPubMed

34.

Nimitphong H, Chanprasertyothin S, Jongjaroenprasert W, Ongphiphadhanakul B (2009) The association between vitamin D status and circulating adiponectin independent of adiposity in subjects with abnormal glucose tolerance. Endocrine 36(2):205–210. https://doi.org/10.1007/s12020-009-9216-9 CrossRefPubMed

35.

Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Al-Othman A, Draz HM, Yakout SM, Al-Saleh Y, Al-Yousef M, Sabico S, Clerici M, Chrousos GP (2013) Hypovitaminosis D associations with adverse metabolic parameters are accentuated in patients with Type 2 diabetes mellitus: a body mass index-independent role of adiponectin? J Endocrinol Investig 36(1):1–6. https://doi.org/10.3275/8183 CrossRef

36.

Friedman JM, Halaas JL (1998) Leptin and the regulation of body weight in mammals. Nature 395:763. https://doi.org/10.1038/27376 CrossRefPubMed

37.

Narvaez CJ, Matthews D, Broun E, Chan M, Welsh J (2009) Lean phenotype and resistance to diet-induced obesity in vitamin D receptor knockout mice correlates with induction of uncoupling protein-1 in white adipose tissue. Endocrinology 150(2):651–661. https://doi.org/10.1210/en.2008-1118 CrossRefPubMed

38.

Hajimohammadi M, Shab-Bidar S, Neyestani TR (2016) Vitamin D and serum leptin: a systematic review and meta-analysis of observational studies and randomized controlled trials. Eu J Clin Nutr. https://doi.org/10.1038/ejcn.2016.245 CrossRef

39.

Ghavamzadeh S, Mobasseri M, Mahdavi R (2014) The Effect of Vitamin D Supplementation on Adiposity, Blood Glycated Hemoglobin, Serum Leptin and Tumor Necrosis Factor-alpha in Type 2 Diabetic Patients. International journal of preventive medicine 5(9):1091–1098PubMedPubMedCentral

40.

Tabesh M, Azadbakht L, Faghihimani E, Tabesh M, Esmaillzadeh A (2014) Calcium-vitamin D cosupplementation influences circulating inflammatory biomarkers and adipocytokines in vitamin D-insufficient diabetics: a randomized controlled clinical trial. Journal of Clinical Endocrinology Metabolism 99(12):E2485–E2493. https://doi.org/10.1210/jc.2014-1977 CrossRefPubMed

41.

Shah S, Wilson DM, Bachrach LK (2015) Large Doses of Vitamin D Fail to Increase 25-Hydroxyvitamin D Levels or to Alter Cardiovascular Risk Factors in Obese Adolescents: A Pilot Study. The Journal of adolescent health: official publication of the Society for Adolescent Medicine 57(1):19–23. https://doi.org/10.1016/j.jadohealth.2015.02.006 CrossRef

42.

Maetani M, Maskarinec G, Franke AA, Cooney RV (2009) Association of Leptin, 25-Hydroxyvitamin D, and Parathyroid Hormone in Women. Nutrition cancer 61(2):225–231. https://doi.org/10.1080/01635580802455149 CrossRefPubMed

43.

Matsunuma A, Horiuchi N (2007) Leptin attenuates gene expression for renal 25-hydroxyvitamin D3-1α-hydroxylase in mice via the long form of the leptin receptor. Arch Biochem Biophys 463(1):118–127. https://doi.org/10.1016/j.abb.2007.02.031 CrossRefPubMed

44.

Laurikka A, Vuolteenaho K, Toikkanen V, Rinne T, Leppanen T, Tarkka M, Laurikka J, Moilanen E (2014) Adipocytokine resistin correlates with oxidative stress and myocardial injury in patients undergoing cardiac surgery. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 46(4):729–736. https://doi.org/10.1093/ejcts/ezt634 CrossRef

45.

Leivo-Korpela S (2014) Adipokines in Inflammatory Lung Diseases. University of Tampere, Finland

46.

Martel-Pelletier J, Raynauld JP, Dorais M, Abram F, Pelletier JP (2016) The levels of the adipokines adipsin and leptin are associated with knee osteoarthritis progression as assessed by MRI and incidence of total knee replacement in symptomatic osteoarthritis patients: a post hoc analysis. Rheumatology 55(4):680–688. https://doi.org/10.1093/rheumatology/kev408 CrossRefPubMed

47.

Brady SRE, Mousa A, Naderpoor N, de Courten MPJ, Cicuttini F, de Courten B (2018) Adipsin Concentrations Are Associated with Back Pain Independently of Adiposity in Overweight or Obese Adults. Frontiers in Physiology 9:93. https://doi.org/10.3389/fphys.2018.00093 CrossRefPubMedPubMedCentral

48.

Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Al-Othman A, Draz HM, Yakout SM, Al-Saleh Y, Al-Yousef M, Sabico S, Clerici M, Chrousos GP (2013) Hypovitaminosis D associations with adverse metabolic parameters are accentuated in patients with Type 2 diabetes mellitus: a body mass index-independent role of adiponectin? J Endocrinol Invest 36(1):1–6. https://doi.org/10.3275/8183 CrossRefPubMed

49.

Parikh S, Guo DH, Pollock NK, Petty K, Bhagatwala J, Gutin B, Houk C, Zhu H, Dong Y (2012) Circulating 25-hydroxyvitamin D concentrations are correlated with cardiometabolic risk among American black and white adolescents living in a year-round sunny climate. Diabetes care 35(5):1133–1138. https://doi.org/10.2337/dc11-1944 CrossRefPubMedPubMedCentral

50.

Zhang M, Gao Y, Tian L, Zheng L, Wang X, Liu W, Zhang Y, Huang G (2017) Association of serum 25-hydroxyvitamin D3 with adipokines and inflammatory marker in persons with prediabetes mellitus. Clinica chimica acta; international journal of clinical chemistry 468:152–158. https://doi.org/10.1016/j.cca.2017.02.022 CrossRefPubMed

51.

Kocot J, Dziemidok P, Kiełczykowska M, Kurzepa J, Szcześniak G, Musik I (2018) Is There Any Relationship between Plasma 25-Hydroxyvitamin D(3), Adipokine Profiles and Excessive Body Weight in Type 2 Diabetic Patients? International Journal of Environmental Research Public Health 15(1):19. https://doi.org/10.3390/ijerph15010019 CrossRef

52.

Ismail MM, Abdel Hamid TA, Ibrahim AA, Marzouk H (2017) Serum adipokines and vitamin D levels in patients with type 1 diabetes mellitus. Archives of medical science: AMS 13(4):738–744. https://doi.org/10.5114/aoms.2016.60680 CrossRefPubMed

53.

Stepien M, O’Mahony L, O’Sullivan A, Collier J, Fraser WD, Gibney MJ, Nugent AP, Brennan L (2013) Effect of supplementation with vitamin D(2)-enhanced mushrooms on vitamin D status in healthy adults. Journal of Nutritional Science 2:e29. https://doi.org/10.1017/jns.2013.22 CrossRefPubMedPubMedCentral

54.

Al Haj Ahmad RM, Al-Domi HA (2017) Vitamin D Insufficiency Predicts Elevated Levels of Complement 3 Independent of Insulin Resistance and BMI. Journal of nutritional science vitaminology 63(3):155–160. https://doi.org/10.3177/jnsv.63.155 CrossRefPubMed

55.

Gado KH, Gado TH, Samie RMA, Khalil NM, Emam SL, Fouad HH (2017) Clinical significance of vitamin D deficiency and receptor gene polymorphism in systemic lupus erythematosus patients. The Egyptian Rheumatologist 39(3):159–164. https://doi.org/10.1016/j.ejr.2016.11.003 CrossRef

56.

Mok CC, Birmingham DJ, Ho LY, Hebert LA, Song H, Rovin BH (2011) Vitamin D deficiency as marker for disease activity and damage in systemic lupus erythematosus: a comparison with anti-dsDNA and anti-C1q. Lupus 21(1):36–42. https://doi.org/10.1177/0961203311422094 CrossRefPubMed

57.

Alkhedaide AQH, Alshehri ZA, Soliman MM, Althumali KW, Abu-Elzahab HS, Baiomy AA (2016) Vitamin D3 supplementation improves immune and inflammatory response in vitamin D deficient adults in Taif, Saudi Arabia. Biomed Res 27(4):1049–1053

58.

Karimzadeh H, Shirzadi M, Karimifar M (2017) The effect of Vitamin D supplementation in disease activity of systemic lupus erythematosus patients with Vitamin D deficiency: A randomized clinical trial. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences 22:4. https://doi.org/10.4103/1735-1995.199089 CrossRef

59.

VicHealth (2015) A study of UV and vitamin D in Melbourne adults: Research summary. Victorian Health Promotion Foundation, Melbourne

60.

Shea MK, Booth SL, Massaro JM, Jacques PF, D’Agostino RB, Dawson-Hughes B, Ordovas JM, O’Donnell CJ, Kathiresan S, Keaney JF, Vasan RS, Benjamin EJ (2008) Vitamin K and Vitamin D Status: Associations with Inflammatory Markers in the Framingham Offspring Study. Am J Epidemiol 167(3):313–320. https://doi.org/10.1093/aje/kwm306 CrossRefPubMed

Titel: Vitamin D supplementation increases adipokine concentrations in overweight or obese adults
Publikationsdatum: 16.01.2019
Erschienen in: European Journal of Nutrition / Ausgabe 1/2020
Print ISSN: 1436-6207
Elektronische ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-019-01899-5

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

25.04.2024 | Hypotonie | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Vitamin D supplementation increases adipokine concentrations in overweight or obese adults

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial registration

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Update Innere Medizin

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial registration

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2020

Dietary changes and its psychosocial moderators during the university examination period

Beta-carotene, telomerase activity and Alzheimer’s disease in old age subjects

Hibiscus sabdariffa L. extract prolongs lifespan and protects against amyloid-β toxicity in Caenorhabditis elegans: involvement of the FoxO and Nrf2 orthologues DAF-16 and SKN-1

Determination of the prebiotic activity of wheat arabinogalactan peptide (AGP) using batch culture fermentation

An inverse association between the Mediterranean diet and bladder cancer risk: a pooled analysis of 13 cohort studies

Breast milk interleukin-7 and thymic gland development in infancy

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Update Innere Medizin