Kukana kwa insulini kumakhala ndi gawo lofunika kwambiri pa matenda a chiwindi chamafuta osaledzeretsa (NAFLD) .vitamini Dkuonjezera kukana kwa insulini kwa odwala omwe ali ndi NAFLD.Zotsatira zomwe zapezedwa zimabwerabe ndi zotsatira zotsutsana.Cholinga cha phunziroli chinali kuyesa zotsatira za mankhwala owonjezera a vitamini D pakuthandizira kukana kwa insulini kwa odwala omwe ali ndi NAFLD.Mabuku oyenerera anapezedwa ku PubMed, Google Maphunziro a akatswiri, COCHRANE ndi Science DirectVitamini DKuonjezera kumapangitsa kuti insulini iwonongeke kwa odwala omwe ali ndi NAFLD, omwe amadziwika ndi kuchepa kwa Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), ndi kusiyana kwakukulu kwa -1.06 (p = 0.0006; 95% CI -1.66 mpaka -0.45). Vitamini D yowonjezera yowonjezera mavitamini D a seramu ndi kusiyana kwakukulu kwa 17.45 (p = 0.0002; 95% CI 8.33 mpaka 26.56).Vitamini DKuonjezera kunachepetsa milingo ya ALT ndi kusiyana kwakutanthawuza kwa -4.44 (p = 0.02; 95% CI -8.24 mpaka -0.65) . Kuphatikizikako kumatha kuchepetsa HOMA-IR mwa odwala otere.Itha kugwiritsidwa ntchito ngati chithandizo chothandizira kwa odwala a NAFLD.
Nonalcoholic mafuta a chiwindi matenda (NAFLD) ndi gulu la matenda a chiwindi okhudzana ndi mafuta1. Amadziwika ndi kuchuluka kwa triglycerides mu hepatocytes, nthawi zambiri ndi necroinflammatory ntchito ndi fibrosis (steatohepatitis) 2. Ikhoza kupita patsogolo ku nonalcoholic steatohepatitis (NASH), fibrosis ndi cirrhosis.NAFLD imaonedwa kuti ndi chifukwa chachikulu cha matenda aakulu a chiwindi ndipo kufalikira kwake kukuwonjezeka, pafupifupi 25% mpaka 30% ya akuluakulu m'mayiko otukuka3,4.Kukana kwa insulini, kutupa, ndi kupsinjika kwa okosijeni kumaganiziridwa kuti ndizofunikira kwambiri Kukula kwa NAFLD1.
Matenda a NAFLD amagwirizana kwambiri ndi kukana kwa insulini.Kutengera chitsanzo chofala kwambiri cha "ma hypothesis awiri", kukana insulini kumakhudzidwa ndi ndondomeko "yoyamba". hepatocytes, kumene kukana kwa insulini kumaganiziridwa kuti ndi chifukwa chachikulu chomwe chimayambitsa chitukuko cha hepatic steatosis. "Kugunda koyamba" kumawonjezera chiopsezo cha chiwindi kuzinthu zomwe zimapanga "kugunda kwachiwiri". kutupa ndi fibrosis.Kupangidwa kwa proinflammatory cytokines, kusokonezeka kwa mitochondrial, kupsinjika kwa okosijeni, ndi lipid peroxidation ndizinthu zomwe zingathandize kuti chiwindi chiwonongeke, chopangidwa ndi adipokines.
Vitamini D ndi vitamini yosungunuka ndi mafuta yomwe imayang'anira fupa la homeostasis.Ntchito yake yakhala ikufufuzidwa kwambiri m'magulu osiyanasiyana osagwirizana ndi chigoba monga metabolic syndrome, insulin resistance, kunenepa kwambiri, mtundu wa 2 shuga ndi matenda okhudzana ndi mtima.Posachedwapa, a a umboni waukulu wa sayansi wafufuza mgwirizano pakati pa vitamini D ndi NAFLD.Vitamini D imadziwika kuti imayendetsa insulini kukana, kutupa kosatha ndi fibrosis.Choncho, vitamini D ingathandize kuteteza kupitirira kwa NAFLD6.
Mayesero angapo opangidwa mwachisawawa (RCTs) ayesa zotsatira za vitamini D zowonjezera pa insulini kukana.mwina kusonyeza phindu la insulini kukana kapena kusawonetsa phindu7,8,9,10,11,12,13.Ngakhale zotsatira zotsutsana, kufufuza kwa meta kumafunika kuti muwone zotsatira zonse za vitamini D. zakhala zikuchitika kale14,15,16.Kusanthula kwa meta ndi Guo et al.Kuphatikiza maphunziro asanu ndi limodzi omwe amawunika momwe vitamini D amagwirira ntchito pa insulin kukana amapereka umboni wokwanira kuti vitamini D ikhoza kukhala ndi phindu pa insulin sensitivity14.Komabe, meta ina- kusanthula kunapereka zotsatira zosiyana.Pramono et al15 anapeza kuti mankhwala owonjezera a vitamini D analibe mphamvu pa insulin sensitivity.Anthu omwe anaphatikizidwa mu phunziroli anali anthu omwe ali ndi chiopsezo cha insulini kukana, osati omwe amawaganizira makamaka NAFLD.Kuphunzira kwina kwa Wei et al ., kuphatikizapo maphunziro anayi, adapeza zomwezo.Kuwonjezera kwa Vitamini D sikunachepetse HOMA IR16. Poganizira zofufuza zonse zam'mbuyomu za kugwiritsa ntchito vitamini D zowonjezera insulini kukana, updated meta-analysis ikufunika pamodzi ndi mabuku owonjezera osinthidwa.Cholinga cha phunziroli chinali kuyesa zotsatira za vitamini D supplementation pa insulin kukana.
Pogwiritsa ntchito njira yofufuzira yapamwamba, tinapeza maphunziro a 207, ndipo titatha kubwereza, tinapeza nkhani za 199. Tinasiya zolemba za 182 poyang'ana mitu ndi ziganizo, ndikusiya maphunziro oyenerera a 17. Maphunziro omwe sanapereke chidziwitso chonse. zofunikira pakuwunika kwa meta kapena zomwe zolemba zonse sizinalipo sizinaphatikizidwe.Pambuyo poyang'ana ndi kuunika koyenera, tinapeza nkhani zisanu ndi ziwiri za ndondomeko yamakono yamakono ndi meta-analysis.Kuthamanga kwa phunziro la PRISMA kukuwonetsedwa mu Chithunzi 1. .
Tinaphatikizapo zolemba zonse za mayesero asanu ndi awiri olamulidwa mwachisawawa (RCTs) .Zaka zofalitsidwa za nkhanizi zinachokera ku 2012 mpaka 2020, ndi zitsanzo za 423 mu gulu lothandizira ndi 312 mu gulu la placebo. Gulu loyesera linalandira zosiyana siyana. Mlingo ndi nthawi ya zowonjezera za vitamini D, pamene gulu lolamulira linalandira malo a placebo. Chidule cha zotsatira za kafukufuku ndi makhalidwe a phunziro laperekedwa mu Table 1.
Chiwopsezo cha kukondera chinawunikidwa pogwiritsa ntchito njira ya Cochrane Collaboration ya chiopsezo cha kukondera.Nkhani zisanu ndi ziwiri zonse zomwe zaphatikizidwa mu phunziroli zidapambana kuwunika kwaubwino.Zotsatira zonse za chiopsezo cha kukondera kwa nkhani zonse zophatikizidwa zikuwonetsedwa mu Chithunzi 2.
Vitamini D supplementation imapangitsa kuti insulini iwonongeke kwa odwala omwe ali ndi NAFLD, omwe amadziwika ndi kuchepa kwa HOMA-IR. D supplementation inali -1.06 (p = 0.0006; 95% CI -1.66 mpaka -0.45) (chithunzi 3).
Malingana ndi chitsanzo cha zochitika zowonongeka (Chithunzi 4), kusiyana kwakukulu kwa seramu ya vitamini D pambuyo pa vitamini D kuwonjezereka kunali 17.45 (p = 0.0002; 95% CI 8.33 mpaka 26.56) . seramu vitamini D mlingo ndi 17.5 ng / mL.Panthawiyi, zotsatira za vitamini D supplementation pa chiwindi michere ALT ndi AST anasonyeza zotsatira zosiyana.Vitamini D supplementation anachepetsa milingo ALT ndi anaphatikizana kusiyana kusiyana kwa -4.44 (p = 0.02; 95% CI -8.24 mpaka -0.65) (Chithunzi 5) .Komabe, palibe zotsatira zomwe zinkawoneka pamagulu a AST, ndi kusiyana kwakukulu kwa -5.28 (p = 0.14; 95% CI - 12.34 ku 1.79) kutengera chitsanzo cha zotsatira zosasinthika ( Chithunzi 6).
Kusintha kwa HOMA-IR pambuyo pa vitamini D supplementation kunawonetsa kusiyanasiyana kwakukulu (I2 = 67%). Meta-regression kusanthula njira yoyendetsera (mkamwa kapena intramuscular), kudya (tsiku ndi tsiku kapena osati tsiku), kapena nthawi ya vitamini D yowonjezera (≤ Masabata a 12 ndi > masabata a 12) amasonyeza kuti nthawi zambiri amamwa mowa amatha kufotokozera kusiyana kwa mitundu (Table 2) . Zonse koma phunziro limodzi la Sakpal et al.11 inagwiritsa ntchito njira yapakamwa yoyendetsera ntchito.Kudya kwa tsiku ndi tsiku kwa vitamini D zowonjezera zomwe zimagwiritsidwa ntchito m'maphunziro atatu7,8,13.Kufufuza kwina kwachidziwitso mwa kusanthula kwapadera kwa kusintha kwa HOMA-IR pambuyo pa vitamini D supplementation kunasonyeza kuti palibe phunziro lomwe linali ndi udindo. kusiyanasiyana kwa kusintha kwa HOMA-IR (mkuyu 7).
Zotsatira zophatikizidwa za kafukufuku wamakono wamakono zapeza kuti chithandizo chowonjezera cha vitamini D chikhoza kupititsa patsogolo insulini kukana, chizindikiro chomwe chimachepetsedwa HOMA-IR kwa odwala omwe ali ndi NAFLD. Njira yoyendetsera vitamini D ikhoza kusiyana, ndi jekeseni wa intramuscular kapena pakamwa. .Kusanthula kwina kwa zotsatira zake pakuwongolera kukana kwa insulini kuti mumvetse kusintha kwa seramu ALT ndi AST milingo.
Kupezeka kwa NAFLD kumagwirizana kwambiri ndi insulini kukana.Kuwonjezeka kwa mafuta acids aulere (FFA), kutupa kwa minofu ya adipose, ndi kuchepa kwa adiponectin kumayambitsa chitukuko cha insulini ku NAFLD17.Serum FFA imakwezedwa kwambiri kwa odwala NAFLD, omwe pambuyo pake amatembenuzidwa. ku triacylglycerols kudzera munjira ya glycerol-3-phosphate.Chinthu china chanjira imeneyi ndi ceramide ndi diacylglycerol (DAG) .DAG imadziwika kuti imagwira nawo ntchito yopanga protein kinase C (PKC), yomwe imatha kuletsa insulin receptor threonine 1160, zomwe zimagwirizanitsidwa ndi kuchepa kwa insulini kukana.Kutupa kwa minofu ya adipose ndikuwonjezeka kwa proinflammatory cytokines monga interleukin-6 (IL-6) ndi tumor necrosis factor alpha (TNF-alpha) imathandizanso kuti insulini iwonongeke. Kuletsa kwa mafuta acid beta-oxidation (FAO), kugwiritsa ntchito shuga ndi mafuta acid synthesis.lopment of insulin resistance.Zokhudzana ndi vitamini D, vitamini D receptor (VDR) imapezeka m'maselo a chiwindi ndipo yakhala ikukhudzidwa ndi kuchepetsa njira zotupa mu matenda aakulu a chiwindi.Ntchito ya VDR imawonjezera kukhudzidwa kwa insulini mwa kusintha FFA.Kuwonjezerapo, vitamini D ali ndi anti-inflammatory and anti-fibrotic properties mu chiwindi19.
Umboni wamakono umasonyeza kuti kusowa kwa vitamini D kungakhale koyambitsa matenda a matenda angapo.Lingaliro ili limakhala loona pa mgwirizano pakati pa kusowa kwa vitamini D ndi insulin kukana20,21.Vitamini D imakhala ndi ntchito yake yomwe ingakhalepo mwa kuyanjana ndi VDR ndi vitamini D metabolizing enzymes. Izi zikhoza kukhalapo m'magulu angapo a maselo, kuphatikizapo maselo a pancreatic beta ndi maselo okhudzidwa ndi insulini monga adipocyte. sitolo yaikulu ya vitamini D m'thupi ndi minofu ya adipose.Imagwiranso ntchito ngati gwero lofunika kwambiri la adipokines ndi cytokines ndipo imakhudzidwa ndi kupanga kutupa kwadongosolo.Umboni wamakono umasonyeza kuti vitamini D imayang'anira zochitika zokhudzana ndi kutulutsidwa kwa insulini kuchokera ku maselo a pancreatic beta.
Chifukwa cha umboni uwu, vitamini D supplementation kuti apange insulini kukana kwa odwala a NAFLD ndi omveka.Malipoti aposachedwa akuwonetsa phindu la vitamini D pakuwonjezera kukana insulini.Ma RCT angapo apereka zotsatira zotsutsana, zomwe zimafunikira kuwunika kowonjezereka ndi meta-analyses.A posachedwa meta-analysis by Guo et al.Kuwunika mphamvu ya vitamini D pa kukana insulini kumapereka umboni wokwanira wakuti vitamini D ikhoza kukhala ndi zotsatira zopindulitsa pa insulin sensitivity.Anapeza kuchepa kwa HOMA-IR kwa -1.32;95% CI - 2.30, - 0.34.Maphunziro omwe anaphatikizidwa kuti ayese HOMA-IR anali maphunziro asanu ndi limodzi14.Komabe, umboni wotsutsana ulipo.Kuwunika mwadongosolo komanso kusanthula meta kumaphatikizapo 18 RCTs ndi Pramono et al kuwunika zotsatira za vitamini D supplementation. kukhudzidwa kwa insulini kwa anthu omwe ali ndi insulin kukana kapena chiopsezo cha insulini kukana kunasonyeza kuti vitamini D yowonjezera mphamvu ya insulini inalibe mphamvu, kusiyana kofanana -0.01, 95% CI -0.12, 0.10;p = 0.87, I2 = 0% 15. Komabe, ziyenera kuzindikirika kuti anthu omwe anayesedwa mu meta-analysis anali anthu omwe ali ndi chiopsezo cha insulini kukana (kunenepa kwambiri, kunenepa kwambiri, prediabetes, polycystic ovary syndrome [PCOS] ndi mtundu wosavuta. 2 matenda a shuga), osati odwala a NAFLD15.Kusanthula kwina kwa meta ndi Wei et al.Zomwe anapezazo zinapezedwanso.Pakuwunika kwa vitamini D mu HOMA-IR, kuphatikizapo maphunziro anayi, vitamini D supplementation sanachepetse HOMA IR (WMD) = 0.380, 95% CI - 0.162, 0.923; p = 0.169) 16. Poyerekeza deta zonse zomwe zilipo, ndondomeko yamakono yamakono ndi kusanthula meta imapereka malipoti owonjezera a vitamini D kupititsa patsogolo kukana kwa insulini kwa odwala NAFLD, mofanana ndi kusanthula meta. ndi Guo et al.Ngakhale kuti kusanthula kwa meta komweko kwachitika, kusanthula kwatsopano kwa meta kumapereka zolemba zosinthidwa zomwe zimaphatikizanso zoyeserera zoyendetsedwa mosintha mosasintha ndipo motero zimapereka umboni wamphamvu wa zotsatira za vitamini D supplementation pa insulin r.kukana.
Zotsatira za vitamini D pa kukana kwa insulini zimatha kufotokozedwa ndi udindo wake monga wolamulira wa insulin secretion ndi ma Ca2 +. Calcitriol ikhoza kuyambitsa mwachindunji kutsekemera kwa insulini chifukwa vitamini D reaction element (VDRE) ilipo mu insulin gene yolimbikitsa yomwe ili mu pancreatic Ma cell a beta.Osati kokha kulembedwa kwa jini la insulini, komanso VDRE imadziwika kuti imayambitsa majini osiyanasiyana okhudzana ndi mapangidwe a cytoskeleton, ma intercellular intercellular, ndi kukula kwa maselo a pancreatic cβ cell.Vitamin D yasonyezedwanso kuti imakhudza insulini kukana mwa kusintha Ca2 + flux.Popeza kuti calcium ndi yofunikira pazochitika zingapo za insulin-mediated intracellular mu minofu ndi minofu ya adipose, vitamini D ikhoza kukhudzidwa ndi zotsatira zake pa insulin resistance.Optimal intracellular Ca2 + miyeso ndi yofunikira kuti insulini igwire ntchito. Kafukufuku wapeza kuti kusowa kwa vitamini D kumayambitsa kuchuluka kwa Ca2 +, zomwe zimapangitsa kuchepa kwa ntchito ya GLUT-4, yomwe imakhudza insulin kukana26,27.
Zotsatira za vitamini D zowonjezera pakuwongolera kukana kwa insulini zinawunikidwanso kuti ziwonetsere momwe chiwindi chimagwirira ntchito, chomwe chinawonetsedwa ndi kusintha kwa ALT ndi AST. supplementation.Kusanthula kwa meta ndi Guo et al.kunawonetsa kuchepetsa malire a ALT, popanda zotsatira za AST, zofanana ndi phunziroli14.Kufufuza kwina kwa meta ndi Wei et al.2020 nayenso sanapeze kusiyana kwa serum alanine aminotransferase ndi magulu a aspartate aminotransferase pakati pa vitamini D supplementation ndi magulu a placebo.
Ndemanga zamakono zamakono ndi kusanthula kwa meta kumatsutsananso ndi malire.Kusiyana kwa kafukufuku wamakono wa meta kungakhale kokhudza zotsatira zomwe zapezeka mu phunziroli.Zotsatira zamtsogolo ziyenera kuthana ndi chiwerengero cha maphunziro ndi maphunziro omwe akukhudzidwa poyesa vitamini D supplementation chifukwa cha insulin kukana, makamaka kuyang'ana chiwerengero cha NAFLD, ndi homogeneity ya maphunziro.Chinthu china choyenera kuganizira ndi kuphunzira magawo ena mu NAFLD, monga zotsatira za vitamini D supplementation mu NAFLD odwala pazigawo zotupa, NAFLD chiwerengero cha ntchito (NAS) ndi kuuma kwa chiwindi. Pomaliza, vitamini D yowonjezera yowonjezera insulini kukana kwa odwala omwe ali ndi NAFLD, chizindikiro chomwe chinachepetsedwa HOMA-IR.Ikhoza kugwiritsidwa ntchito ngati chithandizo chothandizira odwala NAFLD.
Njira zovomerezeka zimatsimikiziridwa ndikugwiritsa ntchito lingaliro la PICO.Chikhazikitso chofotokozedwa mu Gulu 3.
Kuwunika kwakanthawi kwakanthawi komanso kusanthula kwa meta kumaphatikizapo maphunziro onse mpaka pa Marichi 28, 2021, ndikupereka zolemba zonse, kuwunika makonzedwe owonjezera a vitamini D kwa odwala omwe ali ndi NAFLD.Nkhani zokhala ndi malipoti amilandu, maphunziro apamwamba komanso azachuma, ndemanga, ma cadavers ndi mitundu ya anatomy. sizinaphatikizidwe pa phunziro lamakono.Nkhani zonse zomwe sizinapereke deta yofunikira kuti pakhale kusanthula kwa meta panopa sizinaphatikizidwenso.Kuteteza kubwereza kwachitsanzo, zitsanzozo zinayesedwa kwa nkhani zolembedwa ndi wolemba yemweyo mkati mwa bungwe lomwelo.
Kuwunikaku kunaphatikizapo maphunziro a odwala akuluakulu a NAFLD omwe amalandira chithandizo cha vitamini D. Kukana kwa insulini kunayesedwa pogwiritsa ntchito Homeostasis Model Assessment of Insulin Resistance (HOMA-IR).
Kulowetsedwa komwe kunkawunikiridwa kunali kayendetsedwe ka vitamini D.Tinaphatikizapo maphunziro omwe vitamini D amaperekedwa pa mlingo uliwonse, mwa njira iliyonse yoyendetsera, komanso kwa nthawi iliyonse. .
Chotsatira chachikulu chomwe chinafufuzidwa mu ndondomeko yamakono yamakono ndi kusanthula kwa meta kunali kukana kwa insulini.Pankhaniyi, tinagwiritsa ntchito HOMA-IR kuti tidziwe insulini kukana kwa odwala.Zotsatira zachiwiri zinaphatikizapo ma seramu a vitamini D (ng / mL), alanine aminotransferase (ALT). (IU / l) ndi aspartate aminotransferase (AST) (IU / l).
Tulutsani Zofunikira Zoyenera (PICO) m'mawu osakira pogwiritsa ntchito zida za Boolean (monga OR, NDI, OSATI) ndi magawo onse kapena mawu a MeSH (Mutu wa Nkhani Zachipatala). injini kupeza magazini oyenerera.
Kusankhidwa kwa maphunziro kunachitidwa ndi olemba atatu (DAS, IKM, GS) kuti achepetse mwayi wochotsa maphunziro omwe angakhale ofunikira.Pamene kusagwirizana kukuchitika, zisankho za olemba oyambirira, achiwiri ndi achitatu amaganiziridwa. zolemba.Kuwunika kwamutu ndi zosawerengeka kunkachitidwa kuti zisawononge maphunziro osayenera.Pambuyo pake, maphunziro omwe adadutsa kafukufuku woyamba adayesedwanso kuti awone ngati adakwaniritsa zofunikira zophatikizira ndi kuchotsedwa kwa ndemangayi.Zomwe zinaphatikizapo maphunziro adayesedwa bwino kwambiri asanaphatikizidwe komaliza.
Olemba onse adagwiritsa ntchito mafomu osonkhanitsira deta pakompyuta kuti asonkhanitse deta yofunikira kuchokera ku nkhani iliyonse.Detayo idasonkhanitsidwa ndikuyendetsedwa pogwiritsa ntchito pulogalamu ya Review Manager 5.4.
Zinthu za data zinali dzina la wolemba, chaka chofalitsidwa, mtundu wa maphunziro, chiwerengero cha anthu, mlingo wa vitamini D, nthawi ya vitamini D, kukula kwa chitsanzo, zaka, maziko a HOMA-IR, ndi masitepe oyambirira a vitamini D. HOMA-IR isanayambe komanso itatha utsogoleri wa vitamini D unachitika pakati pa magulu ochiritsira ndi olamulira.
Pofuna kuonetsetsa kuti zolemba zonse zomwe zikugwirizana ndi zoyenera kuwunikaku, zida zowunikira zowunikira zidagwiritsidwa ntchito.Njirayi, yopangidwira kuchepetsa kuthekera kwa tsankho pakusankhidwa kwamaphunziro, idachitidwa mwaokha ndi olemba awiri (DAS ndi IKM).
Chida chofunikira chowunikira chomwe chidagwiritsidwa ntchito pakuwunikaku chinali chiopsezo cha Cochrane Collaboration panjira yokondera.
Kuphatikizika ndi kusanthula kusiyana kwapakati mu HOMA-IR ndi opanda vitamini D kwa odwala omwe ali ndi NAFLD. Malinga ndi Luo et al., Ngati deta ikuwonetsedwa ngati yapakatikati kapena yamtundu wa Q1 ndi Q3, gwiritsani ntchito calculator kuti muwerenge tanthauzo. ndi Wan et al.28,29 Kukula kwa zotsatira kumanenedwa ngati kusiyana kwakukulu ndi 95% nthawi yodalirika (CI) .Kufufuza kunagwiritsidwa ntchito pogwiritsa ntchito zitsanzo zowonongeka kapena zowonongeka.Heterogeneity inayesedwa pogwiritsa ntchito chiwerengero cha I2, kusonyeza kuti chiwerengero cha kusiyana kwa zotsatira zomwe zinawonedwa pa maphunziro onse zinali. chifukwa cha kusiyanasiyana kwa zotsatira zowona, zomwe zili ndi makhalidwe> 60% zosonyeza kuti pali kusiyana kwakukulu. (phunziro limodzi pa nthawi linachotsedwa ndipo kusanthula kunabwerezedwa) p-makhalidwe <0.05 ankaonedwa kuti ndi ofunika.Kusanthula kwa Meta kunachitika pogwiritsa ntchito pulogalamu ya Review Manager 5.4, kusanthula kwachidziwitso kunkachitika pogwiritsa ntchito pulogalamu ya statistical software (Stata 17.0) za Windows), ndipo ma meta-regressions adachitidwa pogwiritsa ntchito Integrated Meta-Analysis Software Version 3.
Wang, S. et al.Vitamini D supplementation pochiza matenda a chiwindi amafuta osaledzeretsa amtundu wa 2 shuga: Protocols for the systematic review and meta-analysis.Medicine 99(19), e20148.https://doi.org/10.1097 /MD.0000000000020148 (2020).
Barchetta, I., Cimini, FA & Cavallo, MG Vitamin D supplementation and nonalcoholic mafuta a chiwindi matenda: panopa ndi zam'tsogolo.Nutrients 9 (9), 1015. https://doi.org/10.3390/nu9091015 (2017).
Bellentani, S. & Marino, M. Epidemiology ndi mbiri yakale ya matenda a chiwindi chamafuta osaledzeretsa (NAFLD).install.heparin.8 Supplement 1, S4-S8 (2009).
Vernon, G., Baranova, A. & Younossi, ZM Kuwunika mwadongosolo: Epidemiology ndi mbiri yachilengedwe ya matenda a chiwindi chamafuta osaledzeretsa komanso osamwa mowa steatohepatitis mwa akulu.Nutrition.Pharmacodynamics.There.34(3), 274-285.https:// doi.org/10.1111/j.1365-2036.2011.04724.x (2011).
Paschos, P. & Paletas, K. Njira yachiwiri yachiwopsezo cha matenda a chiwindi chamafuta osaledzeretsa: mawonekedwe osiyanasiyana achiwiri.Hippocrates 13 (2), 128 (2009).
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Nthawi yotumiza: May-30-2022