Vitamin D and Health

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Study Methods Results Author’s conclusions Bischoff-Ferrari et al (2009) Selection criteria Inclusion: Oral vitamin D supplementation (D2 or D3); minimum follow-up 1y; > 1 fracture; mean age ≥ 65 y; double-blinded; adherence reported; explanation of how fractures ascertained. Exclusion: Uncontrolled trials; observational studies, animal studies; studies with patients following organ transplantation or stroke, receiving steroid therapy or with Parkinson’s disease or unstable health states. Outcome measure Nonvertebral or hip fracture. 12 double-blind RCTs (n=42,279) comparing oral vitamin D (± Ca) with calcium or placebo. Nonvertebral fractures (12 RCTs): RR = 0.86 (0.77-0.96) Evidence of heterogeneity (Q test: p=0.04); resolved after stratifying trials by received dose For 3 trials ≤ 10 µg, RR = 1.02 (0.92-1.15) (Q test, p=0.64) For 9 trials ≥ 10 µg, RR = 0.80 (0.72-0.89) (Q test, p=0.31) Hip fractures (8 RCTs): RR = 0.91 (0.78-1.05) Evidence of heterogeneity (Q test, p=0.08); resolved after stratifying trials by received dose For 3 trials ≤ 10 µg, RR = 1.09 (0.90-1.32) (Q test, p=0.81) For 5 trials ≥ 10 µg, RR = 0.82 (0.69-0.97) (Q test, p=0.18) Non-vertebral fracture prevention with vitamin D is dose dependent. A higher received dose of supplemental vitamin D (12-19 µg daily) should reduce nonvertebral fractures by at least 20% and hip fractures by at least 18%. Table 23: RCTs on vitamin D supplementation and increased fracture risk in adults ≥ 50y Study/country Population Intervention & duration Baseline 25(OH)D concentration (nmol/L) 12 m post intervention 25(OH)D concentration (nmol/L) Results Comments Sanders et al (2010) Victoria, Australia Women considered to be at high risk of fracture (n=2256) Age: 70+ y. 1. 12,500 µg D3 given as single annual dose orally. 2. Placebo Duration: 3-5 years (n=131) Median (IQR): 49 (40-63) ≥ 74 1. 9.5% 2. 5.3% 51-74 1. 44.5% 2. 33.32% 26-50 1. 41.9% 2. 57.9% ≤ 25 1. 4% 2. 3.5% Vitamin D vs placebo group: Incident rate ratio: 1.26 (95% CI, 1.00-1.59) (p=0.047) Significant increase in fracture with high dose of vitamin D3. 201
Table 24: Prospective studies on association between 25(OH)D concentration and fracture risk in adults ≥ 50y Study/Country Population Follow-up Cauley et al (2010) USA Cauley et al (2011) USA Community-dwelling men; age: ≥ 65 y Case cohort study Study sub-cohort: 1,606 randomly selected men from the Osteoporotic Fractures in Men Study (MrOS). 435 incident nonspine fractures (n=112 in sub-cohort) observed in whole cohort (n=5,995). Non-spine fracture analysis n=1,929 (n=1,494 subcohort and n=435 fracture cases) Hip fracture analysis n=1,665 (n=1,584 subcohort and n=81 hip fracture cases). Postmenopausal women (n=2,264; 1,132 cases; 1,132 controls) White (n=800) Black (n=762) Hispanic (n = 384) Asian (n=226) American Indian (n=92) Age: 50-79 y Mean baseline 25(OH)D concentration (nmol/L) 5.3 y No non-spine fracture subcohort 62.8 (19.6) Non-spine fracture patients 61.3 No hip fracture sub-cohort 62.8 (19.7) Hip fracture patients 52.8 (19.8) 8.6 y White women Cases: 58.9 (23.7) Controls: 62.6 (24.2) Black women Cases: 44.4 (22.2) Controls: 42.9 (20.5) Hispanic women Cases: 52.4 (20.7) Controls: 53.7 (21.2) Asian women Cases: 62.6±23.7 Controls: 61.9±25.0 American Indian women Cases: 48.4±25.2 Controls: 51.7±25.7 Results Relative Hazard of non-spine fracture by quartiles of 25(OH)D concentration (nmol/L) (Q1, 8-
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Vitamin D and Health i 2016
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Contents Preface ..................
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Preface The Scientific Advisory Com
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Adviser (Ultraviolet radiation expo
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Ms Gemma Paramor Lay representative
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Metabolism S.5 Vitamin D is convert
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Two studies reported an increase in
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Recommendations S.35 Serum 25(OH)D
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1.8 The terms of reference were: to
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1.18 In assessing the evidence on v
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there is not absolute correspondenc
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Metabolism Absorption of dietary vi
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UVB ▼ SKIN: ▼ Previtamin D 3
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2.49 A number of studies have repor
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using a bolus dose (I 2 =77%) compa
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2.75 Another RCT 21 (Cashman et al.
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3. Photobiology of vitamin D Ultrav
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Erythema and skin cancer 3.10 Two m
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CIE spectrum for photoconversion of
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Effect of skin pigmentation on skin
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increase in mean serum 25(OH)D conc
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4. Measuring vitamin D exposure (fr
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the authors cautioned care in the i
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24,25(OH) 2 D 3 which can contribut
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5. Relationship between vitamin D e
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latitudes > 49.5 o N or S (which we
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increase 25(OH)D concentrations > 5
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22.5 nmol/L (IQR, 16.8-34.3) in sum
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6.7 Although serum 25(OH)D concentr
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calcium intake, although this is mo
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Evidence considered (Tables 1-5, An
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6.43 Preece et al. (1975) measured
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irths (December-February) in the vi
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large loss to follow-up 45 and, sin
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6.81 A pilot RCT in India (Khadilka
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Evidence considered (Tables 16-18,
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Intervention studies 6.107 A 3-year
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Compared with men in the top quarti
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chair-rising test. Mean baseline se
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heterogeneity among trials for dose
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the 600 µg (24,000 IU) vitamin D 3
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Bone health indices beyond rickets
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Intervention studies 6.177 An RCT i
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maternal serum 25(OH)D concentratio
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Cancers 6.201 Ecological studies ha
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(Gallicchio et al., 2010; Mondul et
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6.226 A systematic review and meta-
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Summary - CVD and hypertension 6.23
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6.251 VDRs are expressed in cells o
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10 nmol/L increase in cord blood 25
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Evidence considered since IOM repor
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difference was not significant (RR=
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6.304 Out of 7 RCTs published subse
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(300 µg/12,000 IU per capsule) for
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serum 25(OH)D concentration in neon
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linked specific VDR gene polymorphi
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factors that affect cancer risk. Ob
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As a result, cut-offs for deficienc
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7.8 The IOM noted the paucity of lo
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years) compared to the placebo grou
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children (n=179) received weekly do
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8. Dietary vitamin D intakes and se
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Food FISH TABLE 1- Vitamin D conten
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Serum/plasma 25(OH)D concentrations
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Serum/plasma 25(OH)D concentration
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9. Review of DRVs for vitamin D Bri
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musculoskeletal health at serum 25(
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Modelling the summer sunshine expos
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9.30 Two possible approaches were c
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FIGURE 8: Relation between serum 25
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UK general population aged under 11
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Summary & conclusions 9.59 The RNI
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10. Overall summary and conclusions
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tight homeostatic control. As a mar
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10.30 Evidence from RCTs suggest th
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Serum/plasma 25(OH)D concentration
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10.53 An RNI of 10 µg/d (400 IU/d)
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11. Recommendations 11.1 Serum 25(O
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References Abnet CC, Chen Y, Chow W
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Beadle PC, Burton JL & Leach JF (19
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Brooke OG, Brown IR, Bone CD, Carte
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Clarke B (2008) Normal bone anatomy
Page 165 and 166: Diffey BL (2010) Modelling the seas
Page 167 and 168: Ganji V, Milone C, Cody MM, McCarty
Page 169 and 170: Heaney RP, Armas LA, Shary JR, Bell
Page 171 and 172: Javaid MK, Crozier SR, Harvey NC, G
Page 173 and 174: Lappe J, Cullen D, Haynatzki G, Rec
Page 175 and 176: Mantell DJ, Owens PE, Bundred NJ, M
Page 177 and 178: Murad MH, Elamin KB, Abu Elnour NO,
Page 179 and 180: Pirotta S, Kidgell DJ & Daly RM (20
Page 181 and 182: one mass, and renal function in the
Page 183 and 184: Sperati F, Vici P, Maugeri-Sacca M,
Page 185 and 186: Vervel C, Zeghoud F, Boutignon H, T
Page 187 and 188: Weisse K, Winkler S, Hirche F, Herb
Page 189 and 190: Annexes ANNEX (1) SACN working proc
Page 191 and 192: ANNEX (2) Studies considered in rel
Page 193 and 194: Cardiovascular disease Table 40 Tab
Page 195 and 196: Study/year/country Population Ricke
Page 197 and 198: Table 2: Observational studies on r
Page 199 and 200: Table 3: Before and after studies o
Page 201 and 202: Table 4: Case control studies on ri
Page 203 and 204: Table 5: Intervention studies on ri
Page 205 and 206: Table 7: Case reports of osteomalac
Page 207 and 208: Table 9: Cohort studies on associat
Page 209 and 210: Children and adolescents Table 11:
Page 211 and 212: Table 13: Intervention studies on e
Page 213 and 214: Table 16: RCTs on effects of vitami
Page 215: Table 22: Meta-analyses of trials o
Page 219 and 220: Table 25: Meta-analyses of RCTs on
Page 221 and 222: Table 27: Prospective studies on as
Page 223 and 224: Table 28: Meta-analyses of RCTs on
Page 225 and 226: Study Methods Results Author conclu
Page 227 and 228: NON-MUSCULOSKELETAL HEALTH OUTCOMES
Page 229 and 230: Table 32: Intervention studies on e
Page 231 and 232: Table 36: Observational studies on
Page 233 and 234: Table 38: Meta analyses of RCTs and
Page 235 and 236: Table 39: Prospective studies on 25
Page 237 and 238: Study/Country Population Mean follo
Page 239 and 240: Cardiovascular disease Table 40: Me
Page 241 and 242: Hypertension Table 42: Meta-analyse
Page 243 and 244: All-cause mortality Table 44: Syste
Page 245 and 246: Immune modulation Table 46: Systema
Page 247 and 248: Table 48: Intervention studies on v
Page 249 and 250: Reference/Country Population Follow
Page 251 and 252: Infectious disease Table 50: Meta-a
Page 253 and 254: Table 51: RCTs on vitamin D supplem
Page 255 and 256: Table 52: Observational studies on
Page 257 and 258: Neuropsychological functioning Tabl
Page 259 and 260: Abbreviations used in studies 25(OH
Page 261 and 262: Table 1: Percentage contribution of
Page 263 and 264: Table 2 (continued) Food group a Me
Page 265 and 266: Table 3 (continued) Food group Age
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Table 4 (continued) Food group a Ag
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Table 5 (continued) Food group a Na
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Table 6: Percentage contribution of
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Table 7: Average daily intake of vi
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Table 9: Average daily intake of Vi
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Table 11: Average daily intake of v
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Table 15: Average daily intake of V
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Serum/plasma 25(OH)D concentrations
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Table 20: UK - Adults and children
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Table 22: Northern Ireland - adults
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Table 24: England - adults 65 years
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Table 26: UK - by month blood sampl
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Table 29: English regions by season
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Table 33: England - by ethnicity, a
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Table 36: Scotland - by Body Mass I
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Calcitonin A peptide hormone, produ
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Osteoclast Osteocyte Osteoid Osteom
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Vitamin D and Health

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