Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force
Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA
Annals of internal medicine · 257 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- U.S. Public Health Service
- Gobierno
- PHS HHS
- Subvenciones
- U.S. Public Health Service (290 2007 10055 I)
Según 2 financiadores declarados.
Publicación
- Publicado
- 2011-12-20 · Ann Intern Med · vol. 155 · número 12 · págs. 827–838
- Editorial
- American College of Physicians
- Citado
- 415 citas · más que el 100% de estudios similares · 33.4× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 99 trabajos
- Acceso
- De pago
- Áreas de investigación
- Vitamin D Research Studies · Bone health and osteoporosis research · Nutritional Studies and Diet
- Palabras clave
- vitamin D supplementation, calcium supplementation, cancer prevention, fracture prevention, 25-hydroxyvitamin D, colorectal cancer, prostate cancer, breast cancer, older adults, institutionalized elderly, dose-response relationship, USPSTF recommendations, vitamin D status, postmenopausal women
- MeSH
- humans, neoplasms, urinary calculi, calcium, 25-hydroxyvitamin d 2, vitamin d, age factors, sex factors, dietary supplements, advisory committees, united states, fractures, bone
5 autores
- Mei Chun Chung🇺🇸🇯🇵Tufts Medical Center; Fujita Health University
- Jounghee Lee🇺🇸🇯🇵🇰🇷Tufts Medical Center; Fujita Health University; Kyonggi University
- Teruhiko Terasawa🇺🇸🇯🇵Tufts Medical Center; Fujita Health University
- Joseph Lau🇺🇸🇯🇵Tufts University; Tufts Medical Center; Fujita Health University
- Thomas A Trikalinos🇺🇸🇯🇵Tufts University; Tufts Medical Center; Fujita Health University
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Studies suggest that vitamin D supplementation may reduce cancer and fracture risks.
Purpose
To examine the benefits and harms of vitamin D with or without calcium supplementation on clinical outcomes of cancer and fractures in adults.
Data sources
English-language studies identified from MEDLINE and the Cochrane Central Register of Controlled Trials through July 2011.
Study selection
Randomized, controlled trials (RCTs), prospective cohort studies, and nested case-control studies reporting incidence of or death from cancer and fracture outcomes.
Data extraction
Multiple reviewers extracted details about participant characteristics, including baseline vitamin D status and use of supplements; details of statistical analyses, including adjustments for confounding; and methodological quality. Differences were resolved by consensus.
Data synthesis
19 RCTs (3 for cancer and 16 for fracture outcomes) and 28 observational studies (for cancer outcomes) were analyzed. Limited data from RCTs suggested that high-dose (1000 IU/d) vitamin D supplementation can reduce the risk for total cancer, and data from observational studies suggested that higher blood 25-hydroxyvitamin D (25-[OH]D) concentrations might be associated with increased risk for cancer. Mixed-effects dose-response meta-analyses showed that each 10-nmol/L increase in blood 25-(OH)D concentration was associated with a 6% (95% CI, 3% to 9%) reduced risk for colorectal cancer but no statistically significant dose-response relationships for prostate and breast cancer. Random-effects model meta-analysis showed that combined vitamin D and calcium supplementation reduced fracture risk (pooled relative risk, 0.88 [CI, 0.78 to 0.99]) in older adults, but the effects differed according to study setting: institution (relative risk, 0.71 [CI, 0.57 to 0.89]) versus community-dwelling (relative risk, 0.89 [CI, 0.76 to 1.04]). One RCT showed adverse outcomes associated with supplementation, including increased risk for renal and urinary tract stones.
Limitations
Most trial participants were older (aged≥65 years) postmenopausal women. Observational studies were heterogeneous and were limited by potential confounders.
Conclusion
Combined vitamin D and calcium supplementation can reduce fracture risk, but the effects may be smaller among community-dwelling older adults than among institutionalized elderly persons. Appropriate dose and dosing regimens, however, require further study. Evidence is not sufficiently robust to draw conclusions regarding the benefits or harms of vitamin D supplementation for the prevention of cancer.
Primary funding source
Agency for Healthcare Research and Quality.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
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