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Effects of vitamin D supplementation on markers for cardiovascular disease and type 2 diabetes: an individual participant data meta-analysis of randomized controlled trials

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Karin Ma Swart, University of Pennsylvania
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  • Paul Lips, Department of Internal Medicine, Endocrine Section, VU University medical center, Amsterdam, the Netherlands.
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  • Ingeborg A Brouwer, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
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  • Rolf Jorde, Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
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  • Martijn W Heymans, University of Pennsylvania
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  • Guri Grimnes, Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
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  • Martin R Grübler, University of Bern
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  • Martin Gaksch, Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.
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  • Andreas Tomaschitz, Medical University of Graz
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  • Stefan Pilz, Medical University of Graz
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  • Gudny Eiriksdottir, 1] Icelandic Heart Association, IS-201 Kopavogur, Iceland. [2] University of Iceland, IS-101 Reykjavik, Iceland.
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  • Vilmundur Gudnason, 1] Icelandic Heart Association, IS-201 Kopavogur, Iceland. [2] University of Iceland, IS-101 Reykjavik, Iceland.
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  • Louise Wamberg, Aarhus Universitet
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  • Lars Rejnmark
  • Christopher T Sempos, NIH Office of Dietary Supplements, Bethesda, MD.
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  • Ramón A Durazo-Arvizu, Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, Illinois, United States of America.
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  • Kirsten G Dowling, Cork Center for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences.
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  • George Hull, Cork Center for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences.
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  • Zuzana Škrabáková, Cork Center for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences.
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  • Mairead Kiely, Irish Center for Fetal and Neonatal Translational Research (INFANT).
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  • Kevin D Cashman, University College Cork
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  • Natasja M van Schoor, University of Pennsylvania

Background: Evidence from randomized controlled trials (RCTs) for the causal role of vitamin D on noncommunicable disease outcomes is inconclusive.

Objective: The aim of this study was to investigate whether there are beneficial or harmful effects of cholecalciferol (vitamin D3) supplementation according to subgroups of remeasured serum 25-hydroxyvitamin D [25(OH)D] on cardiovascular and glucometabolic surrogate markers with the use of individual participant data (IPD) meta-analysis of RCTs.

Design: Twelve RCTs (16 wk to 1 y of follow-up) were included. For standardization, 25(OH)D concentrations for all participants (n = 2994) at baseline and postintervention were re-measured in bio-banked serum samples with the use of a certified liquid chromatography-tandem mass spectrometry method traceable to a reference measurement procedure. IPD meta-analyses were performed according to subgroups of remeasured 25(OH)D. Main outcomes were blood pressure and glycated hemoglobin (HbA1c). Secondary outcomes were LDL, HDL, and total cholesterol and triglycerides; parathyroid hormone (PTH); fasting glucose, insulin, and C-peptide; and 2-h glucose. In secondary analyses, other potential effect modifiers were studied.

Results: Remeasurement of 25(OH)D resulted in a lower mean 25(OH)D concentration in 10 of 12 RCTs. Vitamin D supplementation had no effect on the main outcomes of blood pressure and HbA1c. Supplementation resulted in 10-20% lower PTH concentrations, irrespective of the 25(OH)D subgroups. The subgroup analyses according to achieved 25(OH)D concentrations showed a significant decrease in LDL-cholesterol concentrations after vitamin D supplementation in 25(OH)D subgroups with <75, <100, and <125 nmol of -0.10 mmol/L (95% CI: -0.20, -0.00 mmol/L), -0.10 mmol/L (95% CI: -0.18, -0.02 mmol/L), and -0.07 mmol/L (95% CI: -0.14, -0.00 mmol/L), respectively. Patient features that modified the treatment effect could not be identified.

Conclusions: For the main outcomes of blood pressure and HbA1c, the data support no benefit for vitamin D supplementation. For the secondary outcomes, in addition to its effect on PTH, we observed indications for a beneficial effect of vitamin D supplementation only on LDL cholesterol, which warrants further investigation. This trial was registered at www.clinicaltrials.gov as NCT02551835.

OriginalsprogEngelsk
TidsskriftThe American Journal of Clinical Nutrition
Vol/bind107
Nummer6
Sider (fra-til)1043-1053
Antal sider11
ISSN0002-9165
DOI
StatusUdgivet - 1 jun. 2018

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