Vitamin D and Health

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Table 43: Prospective studies of 25(OH)D concentration and hypertension risk Study/country Population description Mean Follow up Mean 25(OH)D (nmol/L) at baseline Results/ comments Wang et al (2013) USA Normotensive men (n=1,211); mean age, 57y 15.3 y Men who susbsequently developed hypertension Winter/spring: 57.9 (20.7) (n=59) Summer/fall: 74.9 (27.5) (n=308) Men who did not develop hypertension 55.9 (22.5) (n=58) 77.4 (26.2) (n=235) No significant difference in baseline 25(OH)D between men who developed hypertension & those who did not. Risk of incident hypertension according to 25(OH)D concentration Hazard ratios (95% CI) Q1: ref Q2 0.94 (0.69-1.27) Q3 0.69 (0.50-0.96) Q2 0.82 (0.60-1.13) (p trend: 0.43) 227
All-cause mortality Table 44: Systematic reviews of RCTs and prospective studies of vitamin D supplementation/25(OH)D concentration on all-cause mortality risk Study Methods Results Author’s conclusions Bjelakovic et al (2014) Chowdhury et al (2014) Schottker et al (2014) Selection criteria: Inclusion: RCTs of vitamin D (any type & any route) vs placebo/no intervention in the general population or patients in stable phase of disease. Exclusion: Patients with secondary induced osteoporosis or cancer, pregnant &lactating women. Selection criteria: Inclusion: Cohort studies on association of 25(OH)D with cause specific or all cause deaths in healthy adults. Randomised intervention studies which assessed effects of vit D supplements alone with placebo/no treatment & collected cause specific or all-cause mortality endpoints. Exclusion: no relevant exposure of outcome data, reviews, letter or editorials, case reports, in vitro/functional studies, non-adult population, inappropriate baseline population, non-randomised trials. Meta-analysis of individual participant data Selection criteria: Inclusion: Cohort studies with participants aged 50- 79 y Exclusion: Smokers, participants without 25(OH)D measurement, missing values for covariates used in main model, or lost to follow up due to unknown reasons. 56 trials (n=95,286); age range, 18-107 y; mean duration, 4.4 y). All trials RR = 0.97 (95% CI, 0.94-0.99) p=0.02 Vitamin D3 alone vs placebo/no intervention (13 trials, n=12609) RR = 0.92 (95% CI, 0.85-1.00) p=0.06; ; I 2 =0% Vitamin D3 + Ca vs placebo/no intervention (27 trials, n=63051) RR = 0.96 (95% CI, 0.92-0.99) p=0.03); Vitamin D2 alone vs placebo/no intervention (8 trials; n=17079) RR = 1.03 (95% CI, 0.96-1.12) p=0.37 ; I 2 =14% Vitamin D2 + Ca vs placebo/no intervention (5 trials; n=1307) RR = 1.0 (95% CI, 0.64-1.57) p=1.00 ; I 2 =11% Trials (n=45) which recruited participants on basis of 25(OH)D concentration: 25(OH)D < 50 nmol/L (26 trials): RR=0.95 (95% CI, 0.91-0.99) p=0.01; I 2 =0% 25(OH)D ≥ 50 nmol/L (19 trials): RR=0.95 (95 CI, 0.87-1.05); P=0.30; I 2 =0% Cohort studies: Bottom vs top thirds of baseline 25(OH)D 27 primary prevention cohorts (n=780,990); RR = 1.35 (95% CI, 1.22- 1.49) 41 secondary prevention cohorts (n=59,918); RR = 1.50 (95% CI, 1.36-1.65) All cohorts (n=840,908); RR = 1.44 (95% CI, 1.34-1.55) Association of 25(OH)D (nmol/L) with all cause mortality (based on 1ᵒ prevention cohorts) 52-72 vs ≥ 75: RR = 1.07 (95% CI, 1.01–1.15) 25-50 vs ≥ 75: RR = 1.20 (95% CI, 1.12–1.27)
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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
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Javaid MK, Crozier SR, Harvey NC, G
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Lappe J, Cullen D, Haynatzki G, Rec
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Mantell DJ, Owens PE, Bundred NJ, M
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Murad MH, Elamin KB, Abu Elnour NO,
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Pirotta S, Kidgell DJ & Daly RM (20
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one mass, and renal function in the
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Sperati F, Vici P, Maugeri-Sacca M,
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Vervel C, Zeghoud F, Boutignon H, T
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Weisse K, Winkler S, Hirche F, Herb
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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 and 238: Study/Country Population Mean follo
Page 239 and 240: Cardiovascular disease Table 40: Me
Page 241: Hypertension Table 42: Meta-analyse
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
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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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