Vitamin D and Health

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Table 54: RCTs of vitamin D supplementation and risk of cognition & dementia Study/ country Study population Intervention Mean baseline 25OHD (nmol/L) Post intervention 25(OH)D (nmol/L) Results Authors’ conclusions Przybelski et al (2008) US Nursing home residents with 25(OH)D ≤ 62.4 nmol/L (n=63) Mean age: Intervention gp: 86.2(±2.3) y Control gp: 87.4 (±0.9) y 1. D2 (1250 µg 3 x/wk) 2. No placebo or treatment Duration: 4 wks Unblinded study 1. 43.2 (3) 2. 86.9 (4.5) 1. 159 (8.5) 2. unchanged No difference between groups in results for timed walk test, animal fluency, clock drawing & neuropsychiatric inventory. Findings do not support role for vitamin D in normal cognition and mood. Stein et al (2011) Australia Community dwelling individuals with mild/moderate Alzheimer’s disease(AD) (n=32) Median age (IQR) = 77.5 (69-80) y All: D2 (25µg/d) throughout trial After 8 wks: 1. D2 (300 µg 3x/d, then 0- 2x/d to maintain 25(OH)D at 130-175 nmol/L in wks 2, 4 & 6) 2. Placebo Duration: 16 weeks Median (IQR): 49 (39-67) After run-in 8 wks, median (IQR): 1. 60 (56-70) 2. 64 (48-72) After further 8 wks, median (IQR) 1. 187 (160-240) 2. 72 (63-81) No change in AD assessment-scale cognitive subscale nor Disability Assessment in Dementia High dose vitamin D provides no benefit for cognition or disability. Rossom et al (2012) USA Participants in Women’s Health Initiative (WHI) calcium & vitamin D trial & the WHI Memory study (n=4143 women) Mean age:71y 1. Vitamin D3 (10 µg/d) & calcium carbonate (1000 mg/d) 2. Placebo Duration: 7.8 y 1. 50 (n=150) 2. 48 (n=143) Not reported. Vit D/Ca group vs placebo HR=0.94 (95% CI, 0.72- 1.24) p=0.72 Incidence of cognitive impairment did not differ between groups. 243
Abbreviations used in studies 25(OH)D ACE inhibitor AFB ALP ARI BMC BMD BP Ca CC CI DBP HR IQR IRR LTBI MD NCC OR P PTH RaR RCT RITD RR RTI SBP SD SMD SPPB TB TBIC URI URTI VDDR 25-hydroxyvitamin D Angiotensin-converting-enzyme inhibitor Acid-fast bacilli Alkaline phosphatase Acute respiratory infection Bone mineral content Bone mineral density Blood pressure Calcium Case-control study Confidence interval Diastolic blood pressure Hazard ratio Inter-quartile range Incident rate ratio Latent tuberculosis infection Mean difference Nested case control study Odds ratio Phophorus Parathyroid hormone Rate ratio Randomised controlled trial Rapid influenza diagnostic test Relative risk Respiratory tract infection Systolic blood pressure Standard deviation Standardised mean difference Short physical performance battery Tuberculosis Tuberculosis infection conversion Upper respiratory infection Upper respiratory tract infection Vitamin D deficiency rickets 244
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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
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ANNEX (2) Studies considered in rel
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Cardiovascular disease Table 40 Tab
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Study/year/country Population Ricke
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Table 2: Observational studies on r
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Table 3: Before and after studies o
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Table 4: Case control studies on ri
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Table 5: Intervention studies on ri
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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 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: Neuropsychological functioning Tabl
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
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Vitamin D and Health

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