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Association between vitamin D supplementation and mortality: systematic review and meta-analysis.
BMJ 2019; 366:l4673BMJ

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.

Authors+Show Affiliations

Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China fangfang1057@outlook.com.Chinese University of Hong Kong, Shenzhen, Guangdong, China.Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.Sichuan University Library, Chengdu, Sichuan, China.University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

31405892

Citation

Zhang, Yu, et al. "Association Between Vitamin D Supplementation and Mortality: Systematic Review and Meta-analysis." BMJ (Clinical Research Ed.), vol. 366, 2019, p. l4673.
Zhang Y, Fang F, Tang J, et al. Association between vitamin D supplementation and mortality: systematic review and meta-analysis. BMJ. 2019;366:l4673.
Zhang, Y., Fang, F., Tang, J., Jia, L., Feng, Y., Xu, P., & Faramand, A. (2019). Association between vitamin D supplementation and mortality: systematic review and meta-analysis. BMJ (Clinical Research Ed.), 366, p. l4673. doi:10.1136/bmj.l4673.
Zhang Y, et al. Association Between Vitamin D Supplementation and Mortality: Systematic Review and Meta-analysis. BMJ. 2019 08 12;366:l4673. PubMed PMID: 31405892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between vitamin D supplementation and mortality: systematic review and meta-analysis. AU - Zhang,Yu, AU - Fang,Fang, AU - Tang,Jingjing, AU - Jia,Lu, AU - Feng,Yuning, AU - Xu,Ping, AU - Faramand,Andrew, Y1 - 2019/08/12/ PY - 2019/8/14/entrez PY - 2019/8/14/pubmed PY - 2019/8/16/medline SP - l4673 EP - l4673 JF - BMJ (Clinical research ed.) JO - BMJ VL - 366 N2 - 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/31405892/Association_between_vitamin_D_supplementation_and_mortality:_systematic_review_and_meta_analysis_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=31405892 DB - PRIME DP - Unbound Medicine ER -