Vitamin D and Health

Recommendations

Info

Study/Country Population Mean follow up Mean 25(OH)D (nmol/L) Results/comments Bladder cancer Mondul et al (2010) Finland Mondul et al (2012) US Melanoma Major et al (2012) Finland Afzal et al (2013) Denmark Van der Pols et al (2013) Australia Pancreatic cancer Stolzenberg-Solomon et al (2010) USA & China Men in the ATBC study (n=250 cases & 250 controls). Median (IQR) age (y) Cases: 59 (55-63)/Controls: 59y(56-63) Adults in the PLCO study (375 cases & 375 controls). Median (IQR) age (y) Cases: 64 (60-68)/Controls 64 (61-67) Men in ATBC study n=92 cases & 276 controls) Median (IQR) age (y): 57.5 (53.5-6) Participants in the Copenhagen City Heart Study (n=10,060; 78 cases) Adults in subtropical community (n=1191). Mean age: 54 y Participants from 8 cohort studies (VDPP) (n=952 cases & 1333 controls) Median (IQR) age (y): Cases:62y (56-68)/Controls: 62 (57-67) 20 y Not reported. OR (95% CI) 25(OH)D
Cardiovascular disease Table 40: Meta-analyses of RCTs and prospective studies of vitamin D supplementation/25(OH)D concentration on CVD risk Study Methods Results Conclusions RCTs Wang et al (2010) Bolland et al (2011) Ford et al (2014) Prospective studies Grandini et al (2010) Wang et al (2012) Selection criteria: Inclusion: RCTs & prospective studies. Exclusion: Case reports, ecological, cross-sectional & retrospective case-control studies. Studies that did not assess vitamin D/calcium supplement use or compare between recipients & non-recipients of vitamin D, calcium or a combination of supplements. Selection criteria: Inclusion: Trials comparing co-administered calcium and vitamin D with placebo. Exclusion: not reported. Selection criteria: Inclusion: RCTs with adults ≥60y & ≥1 y follow up; any vit D/analogue intervention; coadministration with other treatment; if comparator group received same treatment. Exclusion: Studies in which participants selected solely on the basis of renal impairment, steroid induced osteoporosis, or psoriasis. Selection criteria: Inclusion: Cohort studies reporting association between initial 25(OH)D concentration with cardiovascular event incidence or mortality. Studies investigating incident fatal or non-fatal myocardial infarction, acute coronary syndrome, coronary heart disease (CHD) or combined outcomes of cardiovascular & cerebrovascular diseases (stroke). Exclusion: Not in English; study population selected according to presence of a disease other than CVD. Exposure & disease status determined simultaneously. Studies which analysed clinical outcomes of peripheral arterial disease, congestive heart failure, atherosclerosis or stroke were included only if those outcomes were analysed in combination with CHD endpoints. Selection criteria: Inclusion: prospective studies on association between 25(OH)D at baseline & CVD risk. Exclusion: Ecological, cross-sectional or case control studies, case reports. Studies without 25(OH)D measurement or ascertainment of major clinical CVD events. Studies that did not compare CVD event rates between different 25(OH)D concentrations and studies of participants selected by confirmed medical conditions. RCTs: Vit D alone: 2 RCTs, 25 µg/d to 2,500µg/4 m RR = 0.90 (95% CI, 0.77-1.05) Vitamin D & calcium: 2 RCTs, 10 µg/d to 20 µg/d RR = 1.04 (95% CI, 0.92-1.18) Calcium and vitamin D supplements and CVD events: 3 trials (n=10,090) Myocardial infarction: RR = 1.21 (95% CI, 1.01-1.44) p=0.04 Stroke: RR = 1.20 (95% CI, 1.00-1.43) p=0.05 Myocardial infarction or stroke: RR = 1.16 (95% CI, 1.02-1.32) p=0.02 21 RCTs (n=13,033) Cardiac failure: HR = 0.82 (95% CI, 0.58-1.15) Myocardial infarction: HR = 0.96 (95% CI, 0.83-1.10) Stroke: HR = 1.07 (95% CI, 0.91-1.29) CVD incidence: 3 cohort studies & 1 nested case control study (n=5,253; mean age 59-79 y; follow up 5-10 y). RR 1.54 (95%CI 1.22, 1.95) p=0.47 CVD mortality: 5 cohort studies (n=24,387; mean age 45-75 y, follow up 6.2-27.1 y) RR 1.83 (95%CI 1.19, 2.79) p = 0.006 19 studies (n=65,994). Lowest vs highest 25(OH)D): Total CVD: RR = 1.52 (95% CI, 1.30-1.77) p=0.57 CVD mortality: RR 1.42 (95%CI 1.19, 1.71) CHD: RR 1.38 (95%CI 1.21, 1.57) Stroke: RR 1.64 (95%CI 1.27, 2.10) Slight significant reduction in CVD risk with vitamin D vs placebo. No significant reduction in CVD risk with vitamin D + calcium vs placebo. Vitamin D & calcium supplementation increased risk of myocardial infarction & stroke. Vitamin D supplementation may be protective for heart failure but not myocardial infarction or stroke. Inverse association between baseline 25(OH)D and cardiovascular risk suggested. Significant inverse association between 25(OH)D 20-60 nmol/L and CVD risk. 224
Page 1 and 2:
Vitamin D and Health i 2016
Page 3 and 4:
Contents Preface ..................
Page 5 and 6:
Preface The Scientific Advisory Com
Page 7 and 8:
Adviser (Ultraviolet radiation expo
Page 9 and 10:
Ms Gemma Paramor Lay representative
Page 11 and 12:
Metabolism S.5 Vitamin D is convert
Page 13 and 14:
Two studies reported an increase in
Page 15 and 16:
Recommendations S.35 Serum 25(OH)D
Page 17 and 18:
1.8 The terms of reference were: to
Page 19 and 20:
1.18 In assessing the evidence on v
Page 21 and 22:
there is not absolute correspondenc
Page 23 and 24:
Metabolism Absorption of dietary vi
Page 25 and 26:
UVB ▼ SKIN: ▼ Previtamin D 3
Page 27 and 28:
2.49 A number of studies have repor
Page 29 and 30:
using a bolus dose (I 2 =77%) compa
Page 31 and 32:
2.75 Another RCT 21 (Cashman et al.
Page 33 and 34:
3. Photobiology of vitamin D Ultrav
Page 35 and 36:
Erythema and skin cancer 3.10 Two m
Page 37 and 38:
CIE spectrum for photoconversion of
Page 39 and 40:
Effect of skin pigmentation on skin
Page 41 and 42:
increase in mean serum 25(OH)D conc
Page 43 and 44:
4. Measuring vitamin D exposure (fr
Page 45 and 46:
the authors cautioned care in the i
Page 47 and 48:
24,25(OH) 2 D 3 which can contribut
Page 49 and 50:
5. Relationship between vitamin D e
Page 51 and 52:
latitudes > 49.5 o N or S (which we
Page 53 and 54:
increase 25(OH)D concentrations > 5
Page 55 and 56:
22.5 nmol/L (IQR, 16.8-34.3) in sum
Page 57 and 58:
6.7 Although serum 25(OH)D concentr
Page 59 and 60:
calcium intake, although this is mo
Page 61 and 62:
Evidence considered (Tables 1-5, An
Page 63 and 64:
6.43 Preece et al. (1975) measured
Page 65 and 66:
irths (December-February) in the vi
Page 67 and 68:
large loss to follow-up 45 and, sin
Page 69 and 70:
6.81 A pilot RCT in India (Khadilka
Page 71 and 72:
Evidence considered (Tables 16-18,
Page 73 and 74:
Intervention studies 6.107 A 3-year
Page 75 and 76:
Compared with men in the top quarti
Page 77 and 78:
chair-rising test. Mean baseline se
Page 79 and 80:
heterogeneity among trials for dose
Page 81 and 82:
the 600 µg (24,000 IU) vitamin D 3
Page 83 and 84:
Bone health indices beyond rickets
Page 85 and 86:
Intervention studies 6.177 An RCT i
Page 87 and 88:
maternal serum 25(OH)D concentratio
Page 89 and 90:
Cancers 6.201 Ecological studies ha
Page 91 and 92:
(Gallicchio et al., 2010; Mondul et
Page 93 and 94:
6.226 A systematic review and meta-
Page 95 and 96:
Summary - CVD and hypertension 6.23
Page 97 and 98:
6.251 VDRs are expressed in cells o
Page 99 and 100:
10 nmol/L increase in cord blood 25
Page 101 and 102:
Evidence considered since IOM repor
Page 103 and 104:
difference was not significant (RR=
Page 105 and 106:
6.304 Out of 7 RCTs published subse
Page 107 and 108:
(300 µg/12,000 IU per capsule) for
Page 109 and 110:
serum 25(OH)D concentration in neon
Page 111 and 112:
linked specific VDR gene polymorphi
Page 113 and 114:
factors that affect cancer risk. Ob
Page 115 and 116:
As a result, cut-offs for deficienc
Page 117 and 118:
7.8 The IOM noted the paucity of lo
Page 119 and 120:
years) compared to the placebo grou
Page 121 and 122:
children (n=179) received weekly do
Page 123 and 124:
8. Dietary vitamin D intakes and se
Page 125 and 126:
Food FISH TABLE 1- Vitamin D conten
Page 127 and 128:
Serum/plasma 25(OH)D concentrations
Page 129 and 130:
Serum/plasma 25(OH)D concentration
Page 131 and 132:
9. Review of DRVs for vitamin D Bri
Page 133 and 134:
musculoskeletal health at serum 25(
Page 135 and 136:
Modelling the summer sunshine expos
Page 137 and 138:
9.30 Two possible approaches were c
Page 139 and 140:
FIGURE 8: Relation between serum 25
Page 141 and 142:
UK general population aged under 11
Page 143 and 144:
Summary & conclusions 9.59 The RNI
Page 145 and 146:
10. Overall summary and conclusions
Page 147 and 148:
tight homeostatic control. As a mar
Page 149 and 150:
10.30 Evidence from RCTs suggest th
Page 151 and 152:
Serum/plasma 25(OH)D concentration
Page 153 and 154:
10.53 An RNI of 10 µg/d (400 IU/d)
Page 155 and 156:
11. Recommendations 11.1 Serum 25(O
Page 157 and 158:
References Abnet CC, Chen Y, Chow W
Page 159 and 160:
Beadle PC, Burton JL & Leach JF (19
Page 161 and 162:
Brooke OG, Brown IR, Bone CD, Carte
Page 163 and 164:
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 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 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: Study/Country Population Mean follo
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
Page 273 and 274: Table 7: Average daily intake of vi
Page 275 and 276: Table 9: Average daily intake of Vi
Page 277 and 278: Table 11: Average daily intake of v
Page 281 and 282: Table 15: Average daily intake of V
Page 285 and 286: Serum/plasma 25(OH)D concentrations
Page 287 and 288: Table 20: UK - Adults and children
Page 289 and 290:
Table 22: Northern Ireland - adults
Page 291 and 292:
Table 24: England - adults 65 years
Page 293 and 294:
Table 26: UK - by month blood sampl
Page 295 and 296:
Table 29: English regions by season
Page 297 and 298:
Table 33: England - by ethnicity, a
Page 299 and 300:
Table 36: Scotland - by Body Mass I
Page 301 and 302:
Calcitonin A peptide hormone, produ
Page 303 and 304:
Osteoclast Osteocyte Osteoid Osteom
show all

Vitamin D and Health

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?