Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs.
Study Goal
The researchers aimed to evaluate the effectiveness of vitamin D supplementation, often combined with calcium, in preventing fractures and falls, among other health outcomes.
Results Summary
The study found that vitamin D supplementation, particularly at doses ≥800 IU and with calcium, likely provides a 10-15% relative reduction in fractures and some benefit in reducing falls, though effects on fallers were unclear. No significant benefits were observed for cancer, respiratory infections, rheumatoid arthritis, multiple sclerosis, or depression.
Population
General population, with focus on outcomes like fractures, falls, and chronic diseases.
Effective Dosage
≥800 IU vitamin D (with calcium, though exact calcium dosage not specified).
Duration
Not specified in the abstract.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
vitamin D supplementation | decrease | fracture prevention | - | likely ∼10-15 % relative reduction | provides some benefit | #1 |
vitamin D supplementation | decrease | rate of falls | - | - | likely benefit | #2 |
vitamin D supplementation | decrease | mortality | - | ∼5 % | possible small relative reduction | #3 |
vitamin D supplementation | no change | prevention of cancer | - | - | does not support the use | #4 |
vitamin D supplementation | no change | prevention of respiratory infections | - | - | does not support the use | #5 |
vitamin D supplementation | no change | prevention of rheumatoid arthritis | - | - | does not support the use | #6 |
vitamin D supplementation | no change | treatment of multiple sclerosis | - | - | does not support | #7 |
vitamin D supplementation | no change | treatment of rheumatoid arthritis | - | - | does not support | #8 |
vitamin D supplementation | no change | improving depression/mental well-being | - | - | does not support | #9 |
mega-doses (≥300,000 IU) | increase | harms | - | - | appear to increase harms | #10 |
Over the past decade, a large body of observational evidence has suggested an association between lower vitamin D status (25-hydroxyvitamin D) and multiple acute and chronic disorders, including cancer, multiple sclerosis, depression and respiratory tract infections. This evidence has fostered the hypothesis that increasing vitamin D intake may treat and prevent such disorders. Our objective was to perform a critical analysis of the highest-level evidence for ten common beliefs regarding vitamin D for the prevention of falls, fractures and respiratory tract infections, the reduction of cancer incidence/mortality and overall mortality, and the prevention or treatment of depression/mental well-being, rheumatoid arthritis and multiple sclerosis, as well as maximum dosing and regular testing. We searched the Cochrane Database of Systematic Reviews and PubMed (up to August 2014) for randomized controlled trials and systematic reviews/meta-analyses based on those studies. All searches were performed, all evidence reviewed and each section written by at least two authors. The evidence shows that vitamin D supplementation provides some benefit in fracture prevention (likely ∼10-15 % relative reduction), particularly at a dose ≥800 IU and with calcium; a likely benefit in the rate of falls, though it is less clear whether the number of fallers changes; and a possible small (∼5 %) relative reduction in mortality. Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being. Regular testing of 25-hydroxyvitamin D is generally not required, and mega-doses (≥300,000 IU) appear to increase harms. Much of the evidence is at high risk of bias, with multiple flaws, including analyses of secondary endpoints, small and underpowered studies, inconsistent results and numerous other issues. Therefore, enthusiasm for a vitamin D panacea should be tempered.