Vitamin D supplementation for prevention of mortality in adults
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C
The Cochrane database of systematic reviews · 106 citas
Etiquetas de revisión
Financiación no declaradaDatos neutrales que nuestra revisión registró sobre cómo se hizo este estudio. Describen el método, nunca si nos gusta el resultado.
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2011-07-04 · Cochrane Database Syst Rev · número 7 · pág. CD007470
- Editorial
- Elsevier BV
- Citado
- 158 citas
- Referencias
- 360 trabajos
- Acceso
- De pago
- Áreas de investigación
- Vitamin D Research Studies · Nutrition and Health Studies · Vitamin K Research Studies
- Palabras clave
- vitamin D supplementation, mortality prevention, vitamin D3, vitamin D2, alfacalcidol, 1,25-dihydroxyvitamin D3, calcium supplementation, kidney stones, hypercalcemia, falls in older adults, falls in children, vitamin D deficiency, vitamin D toxicity
- MeSH
- humans, cholecalciferol, hydroxycholecalciferols, calcitriol, ergocalciferols, vitamins, mortality, cause of death, dietary supplements, adult, aged, aged, 80 and over, middle aged, female, male, randomized controlled trials as topic
8 autores
- Goran Bjelaković🇷🇸University of Nis
- Lise Lotte Gluud🇩🇰Gentofte Hospital
- Dimitrinka Nikolova🇩🇰Copenhagen University Hospital; Rigshospitalet
- Kate Whitfield
- Jørn Wetterslev
- Rosa Giovanna Simonetti🇮🇹Ospedale Vincenzo Cervello
- Marko Bjelaković🇷🇸University of Nis
- Christian Nyfeldt Gluud🇩🇰Copenhagen University Hospital; Rigshospitalet
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
The available evidence on vitamin D and mortality is inconclusive.
Objectives
To assess the beneficial and harmful effects of vitamin D for prevention of mortality in adults.
Search strategy
We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science (to January 2011). We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials.
Selection criteria
We included randomised trials that compared vitamin D at any dose, duration, and route of administration versus placebo or no intervention. Vitamin D could have been administered as supplemental vitamin D (vitamin D(3) (cholecalciferol) or vitamin D(2) (ergocalciferol)) or an active form of vitamin D (1α-hydroxyvitamin D (alfacalcidol) or 1,25-dihydroxyvitamin D (calcitriol)).
Data collection and analysis
Six authors extracted data independently. Random-effects and fixed-effect model meta-analyses were conducted. For dichotomous outcomes, we calculated the risk ratios (RR). To account for trials with zero events, meta-analyses of dichotomous data were repeated using risk differences (RD) and empirical continuity corrections. Risk of bias was considered in order to minimise risk of systematic errors. Trial sequential analyses were conducted to minimise the risk of random errors.
Main results
Fifty randomised trials with 94,148 participants provided data for the mortality analyses. Most trials included elderly women (older than 70 years). Vitamin D was administered for a median of two years. More than one half of the trials had a low risk of bias. Overall, vitamin D decreased mortality (RR 0.97, 95% confidence interval (CI) 0.94 to 1.00, I(2) = 0%). When the different forms of vitamin D were assessed separately, only vitamin D(3) decreased mortality significantly (RR 0.94, 95% CI 0.91 to 0.98, I(2) = 0%; 74,789 participants, 32 trials) whereas vitamin D(2), alfacalcidol, or calcitriol did not. Trial sequential analysis supported our finding regarding vitamin D(3), corresponding to 161 individuals treated to prevent one additional death. Vitamin D(3) combined with calcium increased the risk of nephrolithiasis (RR 1.17, 95% CI 1.02 to 1.34, I(2) = 0%). Alfacalcidol and calcitriol increased the risk of hypercalcaemia (RR 3.18, 95% CI 1.17 to 8.68, I(2) = 17%). Data on health-related quality of life and health economics were inconclusive.
Authors' conclusions
Vitamin D in the form of vitamin D(3) seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent care. Vitamin D(2), alfacalcidol, and calcitriol had no statistically significant effect on mortality. Vitamin D(3) combined with calcium significantly increased nephrolithiasis. Both alfacalcidol and calcitriol significantly increased hypercalcaemia.
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