Effect of 12-Week BMI-Based Vitamin D3 Supplementation in Parkinson’s Disease with Deep Brain Stimulation on Physical Performance, Inflammation, and Vitamin D Metabolites

Abstract

Parkinson’s disease (PD) is the second most common neurodegenerative disease. To manage motor symptoms not controlled adequately with medication, deep brain stimulation (DBS) is used. PD patients often manifest vitamin D deficiency, which may be connected with a higher risk of falls. We administered a 12-week vitamin D3 supplementation based on BMI (with higher doses given to patients with higher BMI) to investigate its effects on physical performance and inflammation status in PD patients with DBS. Patients were randomly divided into two groups: treated with vitamin D3 (VitD, n = 13), and supplemented with vegetable oil as the placebo group (PL, n = 16). Patients underwent functional tests to assess their physical performance three times during this study. The serum 25(OH)D3 concentration increased to the recommended level of 30 ng/mL in the VitD group, and a significant elevation in vitamin D metabolites in this group was found. We observed significant improvement in the Up and Go and the 6 MWT in the VitD group. In inflammation status, we noticed a trend toward a decrease in the VitD group. To conclude, achieving the optimal serum 25(OH)D3 concentration is associated with better functional test performance and consequently may have a positive impact on reducing falling risk in PD.

Effect of vitamin D supplementation on motor symptoms in Parkinson’s disease: a meta-analysis of randomized controlled trials

“…The titles and abstracts of 454 publications were reviewed after removing duplicate studies, and a further 442 non-relevant publications were excluded. For the remaining 12 publications, the full texts were retrieved for further assessment, and 8 RCTs involving 646 cases of PD were included in the qualitative and meta analyses ( 4 , 23 , 28 , 32–36 ). Six studies assessed vitamin D with or without calcium, one with probiotics, while one study assessed whey protein–based nutritional formula enriched with leucine and vitamin D. Dubose’s study ( 33 ) evaluated patients at 3 and 6 months, and the patients were divided into ON and OFF groups; where the “ON” medication state indicates that the patient shows a good response to medication and minimal symptoms, and the “OFF” medication state describes when medication is not working, we selected the ON groups at 6 months as object of study.…”

“…Vitamin D supplementation had no significant effect on UPDRS III scores in patients with PD (WMD, −0.56; 95% CI, −2.34 to 1.23; p = 0.014), and the heterogeneity between studies was significant ( I 2 = 65.0%) ( Figure 3A ). The 10/8 m walk test time was reported in two RCTsbefore and after vitamin D treatment ( 32 , 33 ), which showed no significant effect on the 10/8 m walk test time compared with the application of vitamin D alone (WMD = 0.59, 95% CI = [−0.46, 1.64]; p = 0.757), and the heterogeneity of this analysis was non-significant ( I 2 = 0%) ( Figure 3B ). TUG was reported in 4 RCTsbefore and after treatment ( 4 , 30 , 32 , 33 ), with no significant effect on TUG (WMD: −0.57, 95% CI: −1.45, 0.31, p = 0.030), with I 2 being 66.4% ( Figure 3C ).…”

“…The 10/8 m walk test time was reported in two RCTsbefore and after vitamin D treatment ( 32 , 33 ), which showed no significant effect on the 10/8 m walk test time compared with the application of vitamin D alone (WMD = 0.59, 95% CI = [−0.46, 1.64]; p = 0.757), and the heterogeneity of this analysis was non-significant ( I 2 = 0%) ( Figure 3B ). TUG was reported in 4 RCTsbefore and after treatment ( 4 , 30 , 32 , 33 ), with no significant effect on TUG (WMD: −0.57, 95% CI: −1.45, 0.31, p = 0.030), with I 2 being 66.4% ( Figure 3C ). Regarding 6-Minute walking test distance, the trend was significant, and beneficial effects were conferred.…”

“…Regarding 6-Minute walking test distance, the trend was significant, and beneficial effects were conferred. Two studies were added to the quantitative analysis for 6-Minute walking test distance ( 30 , 32 ), which revealed significant walking distance improvements (WMD: 24.85, 95% CI: 6.54 to 43.16, I 2 = 40.0%; Figure 3D ). Sato et al ( 35 ) study found that Vitamin D supplement inhibited bone mineral density loss and prevented hip and other non-vertebral fractures.…”

Effect of vitamin D supplementation on motor symptoms in Parkinson’s disease: a meta-analysis of randomized controlled trials

“…The titles and abstracts of 454 publications were reviewed after removing duplicate studies, and a further 442 non-relevant publications were excluded. For the remaining 12 publications, the full texts were retrieved for further assessment, and 8 RCTs involving 646 cases of PD were included in the qualitative and meta analyses ( 4 , 23 , 28 , 32–36 ). Six studies assessed vitamin D with or without calcium, one with probiotics, while one study assessed whey protein–based nutritional formula enriched with leucine and vitamin D. Dubose’s study ( 33 ) evaluated patients at 3 and 6 months, and the patients were divided into ON and OFF groups; where the “ON” medication state indicates that the patient shows a good response to medication and minimal symptoms, and the “OFF” medication state describes when medication is not working, we selected the ON groups at 6 months as object of study.…”

“…Vitamin D supplementation had no significant effect on UPDRS III scores in patients with PD (WMD, −0.56; 95% CI, −2.34 to 1.23; p = 0.014), and the heterogeneity between studies was significant ( I 2 = 65.0%) ( Figure 3A ). The 10/8 m walk test time was reported in two RCTsbefore and after vitamin D treatment ( 32 , 33 ), which showed no significant effect on the 10/8 m walk test time compared with the application of vitamin D alone (WMD = 0.59, 95% CI = [−0.46, 1.64]; p = 0.757), and the heterogeneity of this analysis was non-significant ( I 2 = 0%) ( Figure 3B ). TUG was reported in 4 RCTsbefore and after treatment ( 4 , 30 , 32 , 33 ), with no significant effect on TUG (WMD: −0.57, 95% CI: −1.45, 0.31, p = 0.030), with I 2 being 66.4% ( Figure 3C ).…”

“…The 10/8 m walk test time was reported in two RCTsbefore and after vitamin D treatment ( 32 , 33 ), which showed no significant effect on the 10/8 m walk test time compared with the application of vitamin D alone (WMD = 0.59, 95% CI = [−0.46, 1.64]; p = 0.757), and the heterogeneity of this analysis was non-significant ( I 2 = 0%) ( Figure 3B ). TUG was reported in 4 RCTsbefore and after treatment ( 4 , 30 , 32 , 33 ), with no significant effect on TUG (WMD: −0.57, 95% CI: −1.45, 0.31, p = 0.030), with I 2 being 66.4% ( Figure 3C ). Regarding 6-Minute walking test distance, the trend was significant, and beneficial effects were conferred.…”

“…Regarding 6-Minute walking test distance, the trend was significant, and beneficial effects were conferred. Two studies were added to the quantitative analysis for 6-Minute walking test distance ( 30 , 32 ), which revealed significant walking distance improvements (WMD: 24.85, 95% CI: 6.54 to 43.16, I 2 = 40.0%; Figure 3D ). Sato et al ( 35 ) study found that Vitamin D supplement inhibited bone mineral density loss and prevented hip and other non-vertebral fractures.…”

The Role of Vitamin D in Parkinson’s Disease: Evidence from Serum Concentrations, Supplementation, and VDR Gene Polymorphisms

“…A comprehensive summary of the study selection process is illustrated in the following Figure 2 . There were 35 articles about VitD status [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ], 8 clinical trials [ 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ], and 20 assessing VDR SNPs [ 40 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , …”

Effect of vitamin D supplementation on motor symptoms in Parkinson’s disease: a meta-analysis of randomized controlled trials

“…The titles and abstracts of 454 publications were reviewed after removing duplicate studies, and a further 442 non-relevant publications were excluded. For the remaining 12 publications, the full texts were retrieved for further assessment, and 8 RCTs involving 646 cases of PD were included in the qualitative and meta analyses ( 4 , 23 , 28 , 32–36 ). Six studies assessed vitamin D with or without calcium, one with probiotics, while one study assessed whey protein–based nutritional formula enriched with leucine and vitamin D. Dubose’s study ( 33 ) evaluated patients at 3 and 6 months, and the patients were divided into ON and OFF groups; where the “ON” medication state indicates that the patient shows a good response to medication and minimal symptoms, and the “OFF” medication state describes when medication is not working, we selected the ON groups at 6 months as object of study.…”

“…Vitamin D supplementation had no significant effect on UPDRS III scores in patients with PD (WMD, −0.56; 95% CI, −2.34 to 1.23; p = 0.014), and the heterogeneity between studies was significant ( I 2 = 65.0%) ( Figure 3A ). The 10/8 m walk test time was reported in two RCTsbefore and after vitamin D treatment ( 32 , 33 ), which showed no significant effect on the 10/8 m walk test time compared with the application of vitamin D alone (WMD = 0.59, 95% CI = [−0.46, 1.64]; p = 0.757), and the heterogeneity of this analysis was non-significant ( I 2 = 0%) ( Figure 3B ). TUG was reported in 4 RCTsbefore and after treatment ( 4 , 30 , 32 , 33 ), with no significant effect on TUG (WMD: −0.57, 95% CI: −1.45, 0.31, p = 0.030), with I 2 being 66.4% ( Figure 3C ).…”

“…The 10/8 m walk test time was reported in two RCTsbefore and after vitamin D treatment ( 32 , 33 ), which showed no significant effect on the 10/8 m walk test time compared with the application of vitamin D alone (WMD = 0.59, 95% CI = [−0.46, 1.64]; p = 0.757), and the heterogeneity of this analysis was non-significant ( I 2 = 0%) ( Figure 3B ). TUG was reported in 4 RCTsbefore and after treatment ( 4 , 30 , 32 , 33 ), with no significant effect on TUG (WMD: −0.57, 95% CI: −1.45, 0.31, p = 0.030), with I 2 being 66.4% ( Figure 3C ). Regarding 6-Minute walking test distance, the trend was significant, and beneficial effects were conferred.…”

“…Regarding 6-Minute walking test distance, the trend was significant, and beneficial effects were conferred. Two studies were added to the quantitative analysis for 6-Minute walking test distance ( 30 , 32 ), which revealed significant walking distance improvements (WMD: 24.85, 95% CI: 6.54 to 43.16, I 2 = 40.0%; Figure 3D ). Sato et al ( 35 ) study found that Vitamin D supplement inhibited bone mineral density loss and prevented hip and other non-vertebral fractures.…”

The Role of Vitamin D in Parkinson’s Disease: Evidence from Serum Concentrations, Supplementation, and VDR Gene Polymorphisms

“…A comprehensive summary of the study selection process is illustrated in the following Figure 2 . There were 35 articles about VitD status [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ], 8 clinical trials [ 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ], and 20 assessing VDR SNPs [ 40 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , …”

Effect of vitamin D supplementation on motor symptoms in Parkinson’s disease: a meta-analysis of randomized controlled trials

“…The titles and abstracts of 454 publications were reviewed after removing duplicate studies, and a further 442 non-relevant publications were excluded. For the remaining 12 publications, the full texts were retrieved for further assessment, and 8 RCTs involving 646 cases of PD were included in the qualitative and meta analyses ( 4 , 23 , 28 , 32–36 ). Six studies assessed vitamin D with or without calcium, one with probiotics, while one study assessed whey protein–based nutritional formula enriched with leucine and vitamin D. Dubose’s study ( 33 ) evaluated patients at 3 and 6 months, and the patients were divided into ON and OFF groups; where the “ON” medication state indicates that the patient shows a good response to medication and minimal symptoms, and the “OFF” medication state describes when medication is not working, we selected the ON groups at 6 months as object of study.…”

“…Vitamin D supplementation had no significant effect on UPDRS III scores in patients with PD (WMD, −0.56; 95% CI, −2.34 to 1.23; p = 0.014), and the heterogeneity between studies was significant ( I 2 = 65.0%) ( Figure 3A ). The 10/8 m walk test time was reported in two RCTsbefore and after vitamin D treatment ( 32 , 33 ), which showed no significant effect on the 10/8 m walk test time compared with the application of vitamin D alone (WMD = 0.59, 95% CI = [−0.46, 1.64]; p = 0.757), and the heterogeneity of this analysis was non-significant ( I 2 = 0%) ( Figure 3B ). TUG was reported in 4 RCTsbefore and after treatment ( 4 , 30 , 32 , 33 ), with no significant effect on TUG (WMD: −0.57, 95% CI: −1.45, 0.31, p = 0.030), with I 2 being 66.4% ( Figure 3C ).…”

“…The 10/8 m walk test time was reported in two RCTsbefore and after vitamin D treatment ( 32 , 33 ), which showed no significant effect on the 10/8 m walk test time compared with the application of vitamin D alone (WMD = 0.59, 95% CI = [−0.46, 1.64]; p = 0.757), and the heterogeneity of this analysis was non-significant ( I 2 = 0%) ( Figure 3B ). TUG was reported in 4 RCTsbefore and after treatment ( 4 , 30 , 32 , 33 ), with no significant effect on TUG (WMD: −0.57, 95% CI: −1.45, 0.31, p = 0.030), with I 2 being 66.4% ( Figure 3C ). Regarding 6-Minute walking test distance, the trend was significant, and beneficial effects were conferred.…”

“…Regarding 6-Minute walking test distance, the trend was significant, and beneficial effects were conferred. Two studies were added to the quantitative analysis for 6-Minute walking test distance ( 30 , 32 ), which revealed significant walking distance improvements (WMD: 24.85, 95% CI: 6.54 to 43.16, I 2 = 40.0%; Figure 3D ). Sato et al ( 35 ) study found that Vitamin D supplement inhibited bone mineral density loss and prevented hip and other non-vertebral fractures.…”

The Role of Vitamin D in Parkinson’s Disease: Evidence from Serum Concentrations, Supplementation, and VDR Gene Polymorphisms

“…A comprehensive summary of the study selection process is illustrated in the following Figure 2 . There were 35 articles about VitD status [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ], 8 clinical trials [ 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ], and 20 assessing VDR SNPs [ 40 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , …”