A Meta-Analysis of High Dose, Intermittent Vitamin D Supplementation among Older Adults

Zheng, Ya Ting; Cui, Qi; Hong, Yi; Yao, Weirong

doi:10.1371/journal.pone.0115850

Cited by 49 publications

(45 citation statements)

References 34 publications

(61 reference statements)

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“…This viewpoint was articulated in response to a well‐publicized study that showed that older women who received annual bolus dosing of 500,000 IU vitamin D for 3–5 years experienced more falls and fractures than the placebo group . On the other hand, a systematic review and meta‐analysis of vitamin D intervention trials concluded that high‐dose, intermittent vitamin D therapy did not affect all‐cause mortality among these older adults ≥65 years of age, nor was there any impact (benefit or adverse effect) observed regarding fractures or fall prevention, when compared to either no treatment or placebo . Of note, one study involving a single intramuscular injection of 600,000 IU revealed significant beneficial effects on functional neuromuscular performance, reaction time, and balance after 6 months, although muscle strength or incidence of falls did not improve .…”

Section: Interventions To Reduce the Prevalence Of Vitamin D Deficienmentioning

confidence: 99%

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Roth

Abrams

Aloia

et al. 2018

Annals of the New York Academy of Sciences

373

319

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Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.

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Section: Interventions To Reduce the Prevalence Of Vitamin D Deficienmentioning

confidence: 99%

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Roth

Abrams

Aloia

et al. 2018

Annals of the New York Academy of Sciences

373

319

View full text Add to dashboard Cite

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“…Twelve reviews including 8-42 trials indicated that vitamin D may reduce falls risk, increase muscle strength and improve function, though evidence was mixed. [115][116][117][118][119][120][121][122][123][124][125][126] Some individual reviews suggested that vitamin D may be more effective when calcium is added 118,124 or in deficient populations, 120 while evidence was mixed regarding the effects of dose. 121,122 Long-term supplementation may be required for effects on mortality.…”

Section: Nutritionmentioning

confidence: 99%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

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Background Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. Objectives (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Design Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Intervention development Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Feasibility RCT Single-blind RCT, individually randomised to ‘HomeHealth’ or treatment as usual (TAU). Setting Community settings in London and Hertfordshire, UK. Participants A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Main outcome measures Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. Results We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Conclusions Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. Future work A large, definitive RCT of the HomeHealth service is warranted. Study registration This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.

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“…Several trials using high-dose, intermittent vitamin D report an increase rather than a decrease in both falls and fractures [21]. This negative effect was observed in patients taking 500 000 once a year [4], and even 60 000 IU once a month [22].…”

Section: An Overview Of Evidencementioning

confidence: 99%

Vitamin D, bones and muscle: myth versus reality

et al. 2017

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ObjectivesEvidence regarding the efficacy and dosing of vitamin D on fall and fracture prevention, with or without calcium, is characterised by uncertainty.MethodsA panel of experts was organised at the First Australasian Conference on Sarcopenia and Frailty in Melbourne, Australia, in November 2016 to provide an interpretation of the current evidence and to give their opinions regarding the supplementation of vitamin D in three hypothetical cases.Results and ConclusionThe authors conclude that (i) target serum 25(OH)D concentration should be 50 to 60 nmol/L year round, with a conservative upper limit <100 nmol/L; (ii) change in serum concentrations at any given dose is highly variable among individuals; (iii) dosing interval may need to be <2 months to have a continuous benefit; (iv) a loading dose can raise levels to target quickly, but there is no evidence yet that this has any positive effect on falls or fracture outcomes; and (v) a maintenance dose of 1000 IU/day, or given as an equivalent dose weekly or monthly, is sufficient for most individuals.

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A Meta-Analysis of High Dose, Intermittent Vitamin D Supplementation among Older Adults

Cited by 49 publications

References 34 publications

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Vitamin D, bones and muscle: myth versus reality

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