Cholecalciferol

Vitamin D3 Supplements Do Not Lessen Cold, Influenza Risk.

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Supplementation with vitamin D3 does not reduce the incidence or risk for upper respiratory tract infection (URTI) in adults, according to a new randomized controlled trial published onlineSeptember 6 and in the November 15 print issue of Clinical Infectious Diseases.

Judy R. Rees, MPH, PhD, from the Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, and colleagues enrolled 2259 participants (age, 45 – 75 years) who were also taking part in a colorectal adenoma chemoprevention trial. Participants were randomly assigned to receive 1000 IU/day of vitamin D3, 1200 mg elemental calcium/day, both, or placebo. All participants were in good health and had serum 25-hydroxyvitamin D levels of 2 ng/mL or higher.

Among the 759 participants who completed the study, the researchers found no significant decrease in the rate ratio (RR) of URTI episodes between the treatment groups (RR, 0.93; 95% confidence interval [CI], 0.79 – 1.09) or winter days of illness (RR, 1.13; 95% CI, 0.90 – 1.43). There was also no decrease noted in composite syndromes of influenza-like illness (ILI; RR, 0.95; 95% CI, 0.62 – 1.46) or colds (RR, 0.93; 95% CI, 0.78 – 1.10).

“Vitamin D supplementation conferred no significant protection against colds, ILI, or any URTI overall, nor among those with the lowest baseline serum 25(OH) vitamin D, although participants whose baseline concentration was <12 ng/mL were specifically excluded from our trial,” note Dr. Rees and colleagues.

Participants were recruited from 11 clinical centers, and the study was conducted November 2009 through March 2011. URTI was defined as either ILI (fever and 2 or more of the following: sore throat, cough, muscle aches, or headache) or a cold (absence of ILI, 2 or more of the following on a single day: runny nose, nasal congestion, sneezing, sore throat, cough, and swollen or tender neck glands).

Throughout the study period, researchers administered semiannual telephone surveys to 2228 participants and found no decrease in the odds ratio (OR) of ILI (OR, 1.14; 95% CI, 0.84 – 1.54) or colds (OR, 1.03; 95% CI, 0.87 – 1.23) among patients receiving vitamin D3 supplementation. Baseline vitamin D status, body mass index, adherence, or influenza vaccination also provided no significant benefit.

The researchers acknowledge that self-selection of the 759 participants from the parent trial may have influenced results if participants dropped out early because of a lack of treatment effect. The study authors also note that self-reported adherence to study protocol and lack of laboratory conformation of URTI may also have affected the results.

Michael Gleeson, PhD, from the School of Sport, Exercise and Health Sciences, Loughborough University, Leucestershire, United Kingdom, told Medscape Medical News, “Although participant numbers were large, I suspect that this dose of vitamin D3 is insufficient to affect respiratory illness incidence in individuals who are not vitamin D deficient,” and that “an effect might be seen in a more illness-prone population such as athletes.” Dr. Gleeson was not affiliated with the study.

“The effects on URTI of supplementation in adults with vitamin D deficiency (<12 ng/mL) should be addressed in future trials,” conclude the study authors. Studies should also address at what dose of vitamin D3 affects “markers of immune function that are important in defense against respiratory infections,” added Dr. Gleeson.

Vitamin D and Calcium Supplementation to Prevent Fractures in Adults: U.S. Preventive Services Task Force Recommendation Statement .

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New U.S. Preventive Services Task Force (USPSTF) recommendation statement on vitamin D and calcium supplementation to prevent fractures in adults.

Methods

  • The USPSTF commissioned 2 systematic evidence reviews and a meta–analysis on vitamin D supplementation with or without calcium to assess the effects of supplementation on bone health outcomes in community–dwelling adults, the association of vitamin D and calcium levels with bone health outcomes, and the adverse effects of supplementation.
  • These recommendations apply to noninstitutionalized or community–dwelling asymptomatic adults without a history of fractures. This recommendation does not apply to the treatment of persons with osteoporosis or vitamin D deficiency.

Results

  • The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men. (I statement)
  • T he USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. (I statement)
  • The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1000 mg or less of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. (D recommendation)
  • The USPSTF concludes with moderate certainty that daily supplementation with 400 IU or less of vitamin D3 and 1000 mg or less of calcium has no net benefit for the primary prevention of fractures
  • The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific clinical preventive services for patients without related signs or symptoms.
  • It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment
  • The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Source: Annals of Internal Medicine