Clinician Article
Association between vitamin D supplementation and mortality: systematic review and meta-analysis.
PMID: 31405892
-
Internal MedicineRelevance - 6/7
Newsworthiness - 6/7 -
Family Medicine (FM)/General Practice (GP)Relevance - 6/7
Newsworthiness - 5/7 -
General Internal Medicine-Primary Care(US)Relevance - 6/7
Newsworthiness - 5/7 -
Public HealthRelevance - 6/7
Newsworthiness - 4/7
Abstract
OBJECTIVE: To investigate whether vitamin D supplementation is associated with lower mortality in adults.
DESIGN: Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES: Medline, Embase, and the Cochrane Central Register from their inception to 26 December 2018.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials comparing vitamin D supplementation with a placebo or no treatment for mortality were included. Independent data extraction was conducted and study quality assessed. A meta-analysis was carried out by using fixed effects and random effects models to calculate risk ratio of death in the group receiving vitamin D supplementation and the control group.
MAIN OUTCOME MEASURES: All cause mortality.
RESULTS: 52 trials with a total of 75 454 participants were identified. Vitamin D supplementation was not associated with all cause mortality (risk ratio 0.98, 95% confidence interval 0.95 to 1.02, I2=0%), cardiovascular mortality (0.98, 0.88 to 1.08, 0%), or non-cancer, non-cardiovascular mortality (1.05, 0.93 to 1.18, 0%). Vitamin D supplementation statistically significantly reduced the risk of cancer death (0.84, 0.74 to 0.95, 0%). In subgroup analyses, all cause mortality was significantly lower in trials with vitamin D3 supplementation than in trials with vitamin D2 supplementation (P for interaction=0.04); neither vitamin D3 nor vitamin D2 was associated with a statistically significant reduction in all cause mortality.
CONCLUSIONS: Vitamin D supplementation alone was not associated with all cause mortality in adults compared with placebo or no treatment. Vitamin D supplementation reduced the risk of cancer death by 16%. Additional large clinical studies are needed to determine whether vitamin D3 supplementation is associated with lower all cause mortality.
STUDY REGISTRATION: PROSPERO registration number CRD42018117823.
Clinical Comments
General Internal Medicine-Primary Care(US)
I think most providers are aware of the reduction in cancer mortality.
General Internal Medicine-Primary Care(US)
A lot of physicians still test and treat for Vitamin D deficiency, often using outdated high thresholds, while many others treat empirically. There is probably little harm from this, but probably also little benefit as demonstrated in this review.
General Internal Medicine-Primary Care(US)
Many individuals take vitamin supplements hoping to improve their health or prevent future adverse health outcomes. This research informs decision-making around the value of vitamin D supplementation.
Internal Medicine
I wonder whether we will ever get the message across that for average risk people, we really owe them an apology for spending so much time talking about vitamin D. I wonder which vitamin will be the next distraction? Sorry for the cynicism, but we have real health issues that go unaddressed.
Internal Medicine
I would be suspicious of bias in the cancer death data.
Public Health
Well done systematic review showing the `decline` of Vitamin D. As more research is done, the initial enthusiasm for Vitamin D supplementation has progressively declined. I am unimpressed by the subgroup analyses and doubt that large trials looking specifically at cancer or the difference between D2 and D3 will ever show much of a positive benefit.
Public Health
Very nicely done meta-analysis. The big findings were no overall reduction in mortality, but a significant decrease in cancer mortality. Also very interesting is the suggestion that D3 might have an effect vs D2.
Register for free access to all Professional content
RegisterOur Content
About
Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.
