Vitamin D and Health

Recommendations

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Reference/Country Population Description Follow-up Muscle strength measure Mean baseline 25(OH)D (nmol/L) (± SD) Results Houston et al (2012) USA Community dwelling adults (n=2641). Mean age: 74.7 ± 2.9 y 4y Short physical performance battery (SPPB): standing balance, chair-stands, timed walk). Modified physical performance battery (PPB): standing balance, leg stand, walk balance) Knee extensor strength Grip strength 1/3 < 50 2/3 < 75 Cross-sectional analysis: 25(OH)D < 50 vs ≥ 75 nmol/L associated with significantly poorer physical performance (p
Table 28: Meta-analyses of RCTs on vitamin D supplementation (+/- calcium) on risk of falls in adults ≥ 50y Study Methods Results Author conclusions Cameron et al (2012) Selection criteria: Inclusion: All randomised trials of falls reduction in people ≥ 65y in nursing care facilities or hospitals, including quasirandomised trials and those with inadequately concealed treatment allocation. Exclusion: Trials that reported only specific types of fall (e.g. injurious falls); trials that focused on intermediate outcomes (e.g. improved balance, strength). Outcome measure Rate of falls Risk of falling (no. of fallers) CARE FACILITIES 6 RCTs (n=5186; mean age 84y): D3 (2), D2 (3) (2 included Ca); multivitamin that included D3 plus Ca (1). Dose: 5-27.5 µg/d D2, 20 µg/d D3 Baseline 25(OH)D (nmol/L) (mean): 22; 25-40 (57% of participants); 30 (median); 49; 59 (median, 47) (5- 95th centile, 35-102); 36. Rate of falls 5 RCTs (n=4605); Rate Ratio (RaR) = 0.63 (0.46-0.86) (I2 = 72%) Vitamin D + calcium vs calcium (2 RCTs; n=747): RaR = 0.71 (0.56-0.90) (I 2 = 0%) Vitamin D2 vs usual care (no placebo) or placebo (2 RCTs; n=3765): RaR = 0.55 (0.19-1.64) (I 2 = 80%) Multivitamins (including D3 + Ca) vs placebo (1 RCT; n=91); RaR = 0.38 (0.20-0.71) Risk of falling (number of fallers) 6 RCTs; n = 5186); Risk Ratio (RR) = 0.99 (0.90-1.08) (I 2 = 12%) Vitamin D + calcium vs calcium (2 RCTs; n=747); RR = 0.85 (0.69-1.05) (I 2 = 0%) Vitamin D + calcium vs placebo (1 RCT; n=583); RR = 1.03 (0.90-1.18) Vitamin D2 vs usual care (no placebo) or placebo (2 RCTs; n=3765); RR = 0.80 (0.38-1.71) (I 2 = 58%) Multivitamins (including D3 + Ca) vs placebo 1 RCT (n=91); RaR = 0.82 (0.40-1.66) HOSPITAL Risk of falling Vitamin D + calcium vs calcium (1 RCT; n=203): RR=0.82 (0.59-1.14) In care facilities, vitamin D supplementation is effective in reducing rate of falls Authors state: Average serum vitamin D levels at baseline appeared to be low or very low in all 6 studies, therefore these results are only applicable to residents with low vitamin D levels. 208
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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
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Diffey BL (2010) Modelling the seas
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Ganji V, Milone C, Cody MM, McCarty
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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 and 216: Table 22: Meta-analyses of trials o
Page 217 and 218: Table 24: Prospective studies on as
Page 219 and 220: Table 25: Meta-analyses of RCTs on
Page 221: Table 27: Prospective studies on as
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
Page 267 and 268: Table 4 (continued) Food group a Ag
Page 269 and 270: Table 5 (continued) Food group a Na
Page 271 and 272: 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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