Screening for Vitamin D Deficiency in Adults

Kahwati, Leila C.; LeBlanc, Erin S.; Weber, Rachel Palmieri; Giger, Kayla; Clark, Rachel; Suvada, Kara; Guisinger, Amy; Viswanathan, Meera

doi:10.1001/jama.2020.26498

Cited by 47 publications

(37 citation statements)

References 95 publications

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“…This review found minimal other recent synthesized evidence on the effect of multivitamin use, but another review concluded that observational studies suggest a possible lower breast cancer recurrence among breast cancer survivors using multivitamins . The findings for vitamin D in the current review are generally consistent with those from other reviews, for example, pooled estimates in the range of 0.93 to 0.97 that may not be statistically significant for all-cause mortality . In general, the statistical significance of an all-cause mortality benefit in pooled analyses is unstable, being sensitive to the number of included studies and which study aims are considered.…”

Section: Discussionsupporting

confidence: 77%

Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer

O’Connor

Evans

Ivlev

et al. 2022

JAMA

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IMPORTANCE Cardiovascular disease and cancer are the 2 leading causes of death in the US, and vitamin and mineral supplementation has been proposed to help prevent these conditions. OBJECTIVE To review the benefits and harms of vitamin and mineral supplementation in healthy adults to prevent cardiovascular disease and cancer to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed (publisher-supplied records only), Cochrane Library, and Embase (January 2013 to February 1, 2022); prior reviews. STUDY SELECTION English-language randomized clinical trials (RCTs) of vitamin or mineral use among adults without cardiovascular disease or cancer and with no known vitamin or mineral deficiencies; observational cohort studies examining serious harms. DATA EXTRACTION AND SYNTHESIS Single extraction, verified by a second reviewer. Quantitative pooling methods appropriate for rare events were used for most analyses. MAIN OUTCOMES AND MEASURES Mortality, cardiovascular disease events, cancer incidence, serious harms. RESULTS Eighty-four studies (N=739 803) were included. In pooled analyses, multivitamin use was significantly associated with a lower incidence of any cancer (odds ratio [OR], 0.93 [95% CI, 0.87-0.99]; 4 RCTs [n=48 859]; absolute risk difference [ARD] range among adequately powered trials, −0.2% to −1.2%) and lung cancer (OR, 0.75 [95% CI, 0.58-0.95]; 2 RCTs [n=36 052]; ARD, 0.2%). However, the evidence for multivitamins had important limitations. Beta carotene (with or without vitamin A) was significantly associated with an increased risk of lung cancer (OR, 1.20 [95% CI, 1.01-1.42]; 4 RCTs [n=94 830]; ARD range, −0.1% to 0.6%) and cardiovascular mortality (OR, 1.10 [95% CI, 1.02-1.19]; 5 RCTs [n=94 506] ARD range, −0.8% to 0.8%). Vitamin D use was not significantly associated with all-cause mortality (OR, 0.96 [95% CI, 0.91-1.02]; 27 RCTs [n=117 082]), cardiovascular disease (eg, composite cardiovascular disease event outcome: OR, 1.00 [95% CI, 0.95-1.05]; 7 RCTs [n=74 925]), or cancer outcomes (eg, any cancer incidence: OR, 0.98 [95% CI, 0.92-1.03]; 19 RCTs [n=86 899]). Vitamin E was not significantly associated with all-cause mortality (OR, 1.02 [95% CI, 0.97-1.07]; 9 RCTs [n=107 772]), cardiovascular disease events (OR, 0.96 [95% CI, 0.90-1.04]; 4 RCTs [n=62 136]), or cancer incidence (OR, 1.02 [95% CI, 0.98-1.08]; 5 RCTs [n=76 777]). Evidence for benefit of other supplements was equivocal, minimal, or absent. Limited evidence suggested some supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium]).CONCLUSIONS AND RELEVANCE Vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, with the exception of a small benefit for cancer incidence with multivitamin use. Beta carotene was associated with an increased risk of lung cancer and other harmful outcomes in persons at high risk of lung cancer.

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Section: Discussionsupporting

confidence: 77%

Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer

O’Connor

Evans

Ivlev

et al. 2022

JAMA

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“…Recent RCTs have not demonstrated the benefit in the use of vitamin D supplementation for the prevention of depression [ 39 ] or reduction of episodes of MDD [ 40 ]. In a recent US Preventive Services Task Force report, it was noted that populations with specific clinical conditions to evaluate treatment of deficiency for alleviation of their symptoms were not included [ 41 ]. Thus, the study of vitamin D for symptom relief in persons with chronic conditions is needed.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Supplementation for the Treatment of Depressive Symptoms in Women with Type 2 Diabetes: A Randomized Clinical Trial

Penckofer

Ridosh

Adams

et al. 2022

Journal of Diabetes Research

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Aim. To determine the efficacy and safety of vitamin D3 supplementation in reducing depressive symptoms in women with type 2 diabetes (T2D), depression, and low vitamin D. Methods. In this double-blind randomized active comparator-controlled trial, women with significant depressive symptoms as assessed by the Center for Epidemiologic Studies Depression (CES-D) scale received weekly oral vitamin D3 supplementation (50,000 IU) or an active comparator (5,000 IU) for 6 months. Assessments of vitamin D, 25-hydroxyvitamin D [25 (OH) D], and depression were measured at baseline, 3 months, and 6 months. Results. A total of 129 women were randomized, from which 119 completed the study (57 in lower dose and 62 in higher dose). Participants had an average 25 (OH) D and HbA1c of 20.8 ng/mL and 7.8%, respectively, at baseline. They were diverse (48% Black) and had a mean age of 50 and T2D for about 8 years. Upon completion of vitamin D3 supplementation, serum 25 (OH) D levels increased with 50,000 IU (+34 ng/mL) and 5,000 IU (+10 ng/mL). There was no difference in CES-D scores by treatment dose. Overall, depressive symptoms significantly improved over time with an average CES-D decline of 12.98 points (95% CI: −15.04 to −10.93; p < 0.001 ). Among women with moderate baseline depressive symptoms, those receiving the lower dose had nominally lower depression scores at follow-up than those in the higher dose cohort. Among women with severe baseline depressive symptoms, the improvement in follow-up depression scores was the same regardless of dose. Conclusions. There was no difference in the dosing effect of vitamin D3 supplementation for the treatment of depressive symptoms in women with T2D who present with significant symptoms and low vitamin D. Regardless of the dose, participants’ mood improved over time. Further study of vitamin D to target depressive symptoms in comorbid populations is needed.

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“…A recent systematic review did not find any studies directly evaluating the benefits of screening for vitamin D deficiency. 84 Hence, routine testing of vitamin D levels in community‐dwelling older adults may be undertaken upon careful consideration of feasibility and applicability, and in resource‐limited settings, a more targeted approach may be reasonable, for example, screening for suspected osteoporosis.…”

Section: Nutritional Supplementationmentioning

confidence: 99%

Roles of nutrition in muscle health of community‐dwelling older adults: evidence‐based expert consensus from Asian Working Group for Sarcopenia

Chen

Arai

Assantachai

et al. 2022

J cachexia sarcopenia muscle

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General muscle health declines with age, and in particular, sarcopenia-defined as progressive loss of muscle mass and strength/physical performance-is a growing issue in Asia with a rising population of community-dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is central to treatment of sarcopenia, there are currently few guidelines that have examined this specifically in the Asian population. Therefore, the Asian Working Group for Sarcopenia established a special interest group (SIG) comprising seven experts across Asia and one from Australia, to develop an evidence-based expert consensus. A systematic literature search was conducted using MEDLINE on the topic of muscle health, from 2016 (inclusive) to July 2021, in Asia or with relevance to healthy, Asian community-dwelling older adults (≥60 years old). Several key topics were identified:(1) nutritional status: malnutrition and screening; (2) diet and dietary factors; (3) nutritional supplementation; (4) lifestyle interventions plus nutrition; and (5) outcomes and assessment. Clinical questions were developed around these topics, leading to 14 consensus statements. Consensus was achieved using the modified Delphi method with two rounds of voting. Moreover, the consensus addressed the impacts of COVID-19 on nutrition, muscle health, and sarcopenia in Asia. These statements encompass clinical expertise and knowledge across Asia and are aligned with findings in the current literature, to provide a practical framework for addressing muscle health in the community, with the overall aim to encourage and facilitate broader access to equitable care for this target population.

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Screening for Vitamin D Deficiency in Adults

Cited by 47 publications

References 95 publications

Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer

Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer

Vitamin D Supplementation for the Treatment of Depressive Symptoms in Women with Type 2 Diabetes: A Randomized Clinical Trial

Roles of nutrition in muscle health of community‐dwelling older adults: evidence‐based expert consensus from Asian Working Group for Sarcopenia

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