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Zhang X, Chen Z, Xiang Y, Zhou Y, Tang M, Cai J, Xu X, Cui H, Feng Y, Xu R. The Association between Serum Level of Vitamin D and Inflammatory Biomarkers in Hospitalized Adult Patients: A Cross-Sectional Study Based on Real-World Data. Mediators Inflamm 2024; 2024:8360538. [PMID: 38549715 PMCID: PMC10978080 DOI: 10.1155/2024/8360538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/16/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
Objective The association between vitamin D status and inflammation remains unclear in hospitalized patients. Materials and Methods We performed the current study based on real-world data from two teaching hospitals. Serum level of vitamin D (assessed by 25-hydroxyvitamin D) was evaluated within 2 days after admission. All the patients were further classified into three groups: deficiency (<12 ng/mL), insufficiency (12-20 ng/mL), and adequate (≥20 ng/mL). White blood cell (WBC) count, serum level of C-reactive protein (CRP), and procalcitonin were also measured and used to evaluate inflammation. Other potential covariates were abstracted from medical records. Charlson comorbidity index (CCI) was calculated to assess the severity of disease. Results A total number of 35,528 hospitalized adult patients (21,171 men and 14,357 women) were included. The average age and BMI were 57.5 ± 16.2 years and 23.4 ± 3.7 kg/m2, respectively, while medium vitamin D level was 16.1 ng/mL (interquartile range: 11.4 ng/mL, 21.6 ng/mL) and median CCI was one point (interquartile range: 0 point, two points). The prevalence of deficiency and insufficiency was 28.0% and 40.5%. Multivariate linear regression model showed that serum level of vitamin D was significantly associated with WBC and CRP but not associated with procalcitonin. Each standard deviation (≈7.4 ng/mL) increase in vitamin D was associated with a decrease in WBC by 0.13 × 109/mL (95% CI: 0.2 × 109/mL, 0.06 × 109/mL) and 0.62 mg/L (95% CI: 0.88 mg/L, 0.37 mg/L) for CRP. Subgroup analysis and sensitivity analysis (excluding those whose eGFR <60 ml/min/1.73 m2, those whose daily calorie intake <1,000 kcal, and those who were recruited from Xin Hua hospital) generated similar results. Conclusions The deficiency and insufficiency of vitamin D in the hospitalized adult patients was very common. However, the results should be interpreted with caution for limited representation of the whole inpatients. Low level of vitamin D was associated with inflammatory biomarkers, which provide the evidences to early intervention for lower the risk of infection.
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Affiliation(s)
- Xiaomin Zhang
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Zhiqi Chen
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yi Xiang
- Department of Clinical Nutrition Center, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yiquan Zhou
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Molian Tang
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jun Cai
- Department of Clinical Nutrition, Long Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200031, China
| | - Xinyi Xu
- University of Michigan, LSA 500 S, State Street, Ann Arbor, MI 48109, USA
| | - Hongyuan Cui
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Yi Feng
- Department of Clinical Nutrition Center, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Renying Xu
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
- Department of Nutrition, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Rachman A, Iriani A, Priantono D, Rumondor BB, Betsy R, Juanputra S. The correlation between serum 25-hydroxy-vitamin D levels and anti-SARS-CoV-2 S-RBD IgG and neutralizing antibody levels among cancer patients receiving COVID-19 vaccines. Front Nutr 2022; 9:1066411. [PMID: 36583218 PMCID: PMC9792493 DOI: 10.3389/fnut.2022.1066411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction During the coronavirus disease 2019 (COVID-19) pandemic, vitamin D has been established as an immune-modulator that reduces pro-inflammatory damage which effectively diminish the severity of COVID-19. Vitamin D also has a significant effect against influenza and dengue and increase the seroconversion following influenza vaccination. To date, the role of vitamin D in optimizing the efficacy of COVID-19 vaccines remains unclear. This study aimed to analyze the correlation between serum 25-hydroxy-cholecalciferol or 25(OH)D levels and anti-SARS-CoV-2 S-RBD IgG and neutralizing antibody levels among cancer patients. Methodology A multicenter cross-sectional study was conducted among solid and hematologic cancer patients who were vaccinated with two doses of the same types of COVID-19 vaccines (either mRNA, non-replicating viral vector, or inactivated) within 6 months. Result The median serum 25(OH)D level in 119 cancer patients was 36.36 [IQR = 30.30] ng/mL. The seropositivity of S-RBD IgG and NAb reached 93.3 and 94.1%, respectively. The S-RBD IgG level was significantly higher in the sufficient group (median = 414.07 [1,441.83] AU/mL) than in the deficient group (median = 91.56 [652.00] AU/mL) (p-value = 0.049). Among non-chemotherapy subjects, the anti-SARS-CoV-2 S-RBD IgG levels had a significant positive correlation with 25(OH)D levels (p-value = 0.03; R = 0.588). The NAb levels also showed significantly positive correlation with 25(OH)D level (p-value = 0.005; R = 0.561). The 25(OH)D levels were positively correlated with S-RBD IgG levels among subjects younger than 60 years old (p-value = 0.047; R = 0.136). However, serum 25 (OH)D levels showed no such correlation with S-RBD IgG levels among subjects older than 60 years old (p-value = 0.933; R = 0.136). Conclusion Both anti-SARS-CoV-2 S-RBD IgG and NAb levels developed moderate correlation with 25(OH)D levels among subjects treated without chemotherapy. The S-RBD IgG levels also had positive correlation with 25(OH)D levels among subjects younger than 60 years old. Thus, we recommended cancer patients to maintain serum 25(OH)D levels above 30 ng/mL (75 nmol/L) to enhance the efficacy of COVID-19 vaccines.
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Affiliation(s)
- Andhika Rachman
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Anggraini Iriani
- Department of Clinical Pathology, YARSI University, Jakarta, Indonesia
| | - Dimas Priantono
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Bayu Bijaksana Rumondor
- Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Rachelle Betsy
- Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Samuel Juanputra
- Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Helde Frankling M, Klasson C, Björkhem-Bergman L. 25-Hydroxyvitamin D in Cancer Patients Admitted to Palliative Care: A Post-Hoc Analysis of the Swedish Trial 'Palliative-D'. Nutrients 2022; 14:nu14030602. [PMID: 35276963 PMCID: PMC8840761 DOI: 10.3390/nu14030602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study is to explore 25-hydroxyvitamin D (25-OHD) levels in patients with cancer in the palliative phase in relation to season, sex, age, tumor type, colectomy, and survival. To this end, we performed a post-hoc analysis of ‘Palliative-D’, a randomized placebo-controlled, double-blind trial investigating the effect of daily supplementation with 4000 IU of vitamin D for 12 weeks on pain in patients in palliative cancer care. In the screening cohort (n = 530), 10% of patients had 25-OHD levels < 25 nmol/L, 50% < 50, and 84% < 75 nmol/L. Baseline 25-OHD did not differ between seasons or tumor type and was not correlated with survival time. In vitamin D deficient patients supplemented with vitamin D (n = 67), 86% reached sufficient levels, i.e., >50 nmol/L, after 12 weeks. An increase in 25-OHD was larger in supplemented women than in men (53 vs. 37 nmol/L, p = 0.02) and was not affected by season. In the placebo-group (n = 83), decreased levels of 25-OHD levels were noted during the study period for patients recruited during the last quarter of the year. In conclusion, cancer patients in palliative phase have adequate increase in 25-OHD after vitamin D supplementation regardless of season, age, tumor type, or colectomy.
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Affiliation(s)
- Maria Helde Frankling
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Thoracic Oncology Center, Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Correspondence:
| | - Caritha Klasson
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-112 19 Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-112 19 Stockholm, Sweden
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Gnagnarella P, Muzio V, Caini S, Raimondi S, Martinoli C, Chiocca S, Miccolo C, Bossi P, Cortinovis D, Chiaradonna F, Palorini R, Facciotti F, Bellerba F, Canova S, Gandini S. Vitamin D Supplementation and Cancer Mortality: Narrative Review of Observational Studies and Clinical Trials. Nutrients 2021; 13:nu13093285. [PMID: 34579164 PMCID: PMC8466115 DOI: 10.3390/nu13093285] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/14/2022] Open
Abstract
Several studies have investigated the beneficial effects of vitamin D on survival of cancer patients. Overall evidence has been accumulating with contrasting results. This paper aims at narratively reviewing the existing articles examining the link between vitamin D supplementation and cancer mortality. We performed two distinct searches to identify observational (ObS) studies and randomized clinical trials (RCTs) of vitamin D supplementation (VDS) in cancer patients and cohorts of general population, which included cancer mortality as an outcome. Published reports were gathered until March 2021. We identified 25 papers published between 2003 and 2020, including n. 8 RCTs on cancer patients, n. 8 population RCTs and n. 9 ObS studies. There was some evidence that the use of VDS in cancer patients could improve cancer survival, but no significant effect was found in population RCTs. Some ObS studies reported evidence that VDS was associated with a longer survival among cancer patients, and only one study found an opposite effect. The findings do not allow conclusive answers. VDS may have the potential as treatment to improve survival in cancer patients, but further investigations are warranted. We strongly support investment in well-designed and sufficiently powered RCTs to fully evaluate this association.
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Affiliation(s)
- Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
- Correspondence: ; Tel.: +39-0257489823
| | - Valeria Muzio
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50139 Florence, Italy;
| | - Sara Raimondi
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (C.M.); (S.C.); (C.M.); (F.F.); (F.B.); (S.G.)
| | - Chiara Martinoli
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (C.M.); (S.C.); (C.M.); (F.F.); (F.B.); (S.G.)
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (C.M.); (S.C.); (C.M.); (F.F.); (F.B.); (S.G.)
| | - Claudia Miccolo
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (C.M.); (S.C.); (C.M.); (F.F.); (F.B.); (S.G.)
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, 25121 Brescia, Italy;
| | - Diego Cortinovis
- SC Oncologia Medica, Asst H S Gerardo Monza, 20900 Monza, Italy; (D.C.); (S.C.)
| | - Ferdinando Chiaradonna
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (R.P.)
| | - Roberta Palorini
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, 20126 Milan, Italy; (F.C.); (R.P.)
| | - Federica Facciotti
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (C.M.); (S.C.); (C.M.); (F.F.); (F.B.); (S.G.)
| | - Federica Bellerba
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (C.M.); (S.C.); (C.M.); (F.F.); (F.B.); (S.G.)
| | - Stefania Canova
- SC Oncologia Medica, Asst H S Gerardo Monza, 20900 Monza, Italy; (D.C.); (S.C.)
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (S.R.); (C.M.); (S.C.); (C.M.); (F.F.); (F.B.); (S.G.)
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Vitamin D: Promises on the Horizon and Challenges Ahead for Fighting Pancreatic Cancer. Cancers (Basel) 2021; 13:cancers13112716. [PMID: 34072725 PMCID: PMC8198176 DOI: 10.3390/cancers13112716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Pancreatic cancer is an almost universally lethal cancer, largely due to its late diagnosis, early metastasis, and therapeutic resistance. This highlights the need to develop novel and effective intervention strategies to improve the outcomes of patients with pancreatic cancer. Vitamin D is one of the hottest topics in cancer research and clinics because of its pleiotropic functions on the hallmarks of cancer. Here we critically review past and current efforts that define the effects of vitamin D on the risk, incidence, patient survival, and mortality of pancreatic cancer. We also provide overviews on the opportunities and challenges associated with vitamin D as an economic adjunct to improve the efficacy of immunotherapy and chemo- or radiotherapy for pancreatic cancer. Abstract Pancreatic cancer has a dismal prognosis, while its incidence is increasing. This is attributed, in part, to a profound desmoplastic and immunosuppressive tumor microenvironment associated with this cancer and resistance to current available therapies. Novel and effective intervention strategies are urgently needed to improve the outcomes of patients with pancreatic cancer. Vitamin D has pleiotropic functions beyond calcium–phosphate homeostasis and has been extensively studied both in the laboratory and clinic as a potential preventive agent or adjunct to standard therapies. Accumulating evidence from ecological, observational, and randomized controlled trials suggests that vitamin D has beneficial effects on risk, survival, and mortality in pancreatic cancer, although controversies still exist. Recent advances in demonstrating the important functions of vitamin D/vitamin D receptor (VDR) signaling in the regulation of stromal reprogramming, the microbiome, and immune response and the emergence of checkpoint immunotherapy provide opportunities for using vitamin D or its analogues as an adjunct for pancreatic cancer intervention. Many challenges lie ahead before the benefits of vitamin D can be fully realized in pancreatic cancer. These challenges include the need for randomized controlled trials of vitamin D to assess its impact on the risk and survival of pancreatic cancer, optimizing the timing and dosage of vitamin D or its analogues as an adjunct for pancreatic cancer intervention and elucidating the specific role of vitamin D/VDR signaling in the different stages of pancreatic cancer. Nevertheless, vitamin D holds great promise for reducing risk and improving outcomes of this disease.
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Kapała A, Szlendak M, Grochowska E. Cross-sectional observational study - Investigation of vitamin D concentration in Caucasian cancer patients. what is the adequate dose of vitamin D for these patients? Clin Nutr 2021; 40:3852-3858. [PMID: 34130032 DOI: 10.1016/j.clnu.2021.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/27/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS Vitamin D impairs tumour-related transformation and supports the anticancer function of the immune system. Currently, there are no guidelines on vitamin D supplementation devoted solely to cancer patients. The primary objective of the study was to evaluate the frequency of vitamin D deficiency in Caucasian cancer patients and to characterize the clinical factors that predispose individuals to decreased vitamin D concentration. Secondly, the study aimed to estimate the dose of vitamin D supplementation that would prevent deficiencies in patients with cancer. METHODS In the presented cross-sectional study the population consisted of 500 consecutive Caucasian patients with a diagnosis of neoplastic disease, some of which declared long-term vitamin D supplementation in various doses. Serum vitamin D concentration was measured once in all patients and clinical data were obtained from the hospital database. The frequencies of vitamin D deficiency were compared to certain clinical variables by appropriate statistical tests. The dose of vitamin D substitution in cancer patients was estimated using the receiver operating characteristic (ROC) curve. RESULTS Vitamin D deficiency was diagnosed in 66.8% of patients with cancer and even in 31.6% who declared vitamin D supplementation. Older age, male gender, diagnosis of head and neck cancer or squamous cell carcinoma and body mass loss were identified as factors that predispose to vitamin D deficiency. The dose of vitamin D that would prevent deficiency in Caucasian patients with cancer was set at 2250 IU daily. CONCLUSIONS Vitamin D deficiency was very common in Caucasian patients with cancer, even in terms of vitamin D supplementation. The greatest predisposition was related to elder age, male gender, diagnosis of head and neck or squamous cell carcinoma and body mass loss. The dose of vitamin D supplementation in cancer patients should probably be higher than in the general population.
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Affiliation(s)
- Aleksandra Kapała
- Department of Clinical Nutrition, Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Str.5, 02781, Warsaw, Poland.
| | - Małgorzata Szlendak
- Department of Oncology, Medical University of Warsaw, 02-097, Warsaw, Poland.
| | - Ewelina Grochowska
- Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Str.5, 02781, Warsaw, Poland.
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Chandler PD, Chen WY, Ajala ON, Hazra A, Cook N, Bubes V, Lee IM, Giovannucci EL, Willett W, Buring JE, Manson JE. Effect of Vitamin D3 Supplements on Development of Advanced Cancer: A Secondary Analysis of the VITAL Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2025850. [PMID: 33206192 PMCID: PMC7675103 DOI: 10.1001/jamanetworkopen.2020.25850] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Epidemiologic and trial data suggest that vitamin D supplementation may reduce metastatic cancer and cancer mortality, reflecting shared biological pathways. OBJECTIVE To follow up on the possible reduction in cancer death in the Vitamin D and Omega-3 Trial (VITAL) with an evaluation of whether vitamin D reduces the incidence of advanced (metastatic or fatal) cancer and an examination possible effect modification by body mass index. DESIGN, SETTING, AND PARTICIPANTS VITAL is a randomized, double-blind, placebo-controlled, 2 × 2 factorial clinical trial of vitamin D3 (cholecalciferol, 2000 IU/d) and marine omega-3 fatty acids (1 g/d). This multicenter clinical trial was conducted in the United States; participants included men aged 50 years or older and women aged 55 years or older who were free of cancer and cardiovascular disease at baseline. Randomization took place from November 2011 through March 2014, and study medication ended on December 31, 2017. Data for this secondary analysis were analyzed from November 1, 2011, to December 31, 2017. INTERVENTIONS Vitamin D3 (cholecalciferol, 2000 IU/d) and marine omega-3 fatty acids (1 g/d) supplements. MAIN OUTCOMES AND MEASURES For the present analysis, the primary outcome was a composite incidence of metastatic and fatal invasive total cancer, because the main VITAL study showed a possible reduction in fatal cancer with vitamin D supplementation and effect modification by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) for total cancer incidence reduction for individuals with normal BMI, but not for individuals with overweight or obesity. Secondary analyses included examination of BMI (<25, 25 to < 30, and ≥30) as effect modifiers of the observed associations. RESULTS Among 25 871 randomized VITAL participants (51% female; mean [SD] age, 67.1 [7.1] years), 1617 were diagnosed with invasive cancer over a median intervention period of 5.3 years (range, 3.8-6.1 years). As previously reported, no significant differences for cancer incidence by treatment arm were observed. However, a significant reduction in advanced cancers (metastatic or fatal) was found for those randomized to vitamin D compared with placebo (226 of 12 927 assigned to vitamin D [1.7%] and 274 of 12 944 assigned to placebo [2.1%]; HR, 0.83 [95% CI, 0.69-0.99]; P = .04). When stratified by BMI, there was a significant reduction for the vitamin D arm in incident metastatic or fatal cancer among those with normal BMI (BMI<25: HR, 0.62 [95% CI, 0.45-0.86]) but not among those with overweight or obesity (BMI 25-<30: HR, 0.89 [95% CI, 0.68-1.17]; BMI≥30: HR, 1.05 [95% CI, 0.74-1.49]) (P = .03 for interaction by BMI). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, supplementation with vitamin D reduced the incidence of advanced (metastatic or fatal) cancer in the overall cohort, with the strongest risk reduction seen in individuals with normal weight. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01169259.
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Affiliation(s)
- Paulette D. Chandler
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wendy Y. Chen
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Oluremi N. Ajala
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aditi Hazra
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy Cook
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vadim Bubes
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward L. Giovannucci
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Walter Willett
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Julie E. Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Vitamin D deficiency in oncology practice—more roads to cross. Support Care Cancer 2019; 27:4385. [DOI: 10.1007/s00520-019-05024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
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