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Kuznia S, Zhu A, Akutsu T, Buring JE, Camargo Jr CA, Cook NR, Chen LJ, Cheng TYD, Hantunen S, Lee IM, Manson JE, Neale RE, Scragg R, Shadyab AH, Sha S, Sluyter J, Tuomainen TP, Urashima M, Virtanen JK, Voutilainen A, Wactawski-Wende J, Waterhouse M, Brenner H, Schöttker B. Efficacy of vitamin D3 supplementation on cancer mortality: systematic review and individual patient data meta-analysis of randomised controlled trials. Ageing Res Rev 2023; 87:101923. [PMID: 37004841 DOI: 10.1016/j.arr.2023.101923] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
To evaluate the effect of vitamin D3 supplementation on cancer mortality in the general population and on prognosis in cancer patients, a systematic review and meta-analysis of randomised, placebo-controlled trials (RCTs) and individual patient data (IPD) was conducted. Overall, 14 RCTs with a total of 104,727 participants (2,015 cancer deaths) were identified and 7 RCTs, including 90% of all study participants (n=94,068), could be included in the IPD meta-analyses. The main meta-analysis of the 14 RCTs yielded a statistically non-significant reduction in cancer mortality by 6% (risk ratio (RR) [95%-confidence interval (95%CI)]: 0.94 [0.86-1.02]). Subgroup analyses revealed a 12% lower cancer mortality in the vitamin D3 group compared with the placebo group in 10 trials with a daily dosing regimen (RR [95%CI]: 0.88 [0.78-0.98]), whereas no mortality reduction was seen in 4 trials using a bolus regimen (RR [95%CI]: 1.07 [0.91-1.24]; p-value for interaction: 0.042). The IPD meta-analysis (RR [95%CI]: 0.93 [0.84; 1.02]) confirmed the finding of all trials. The IPD were used to test effect modification by age, sex, body mass index, ethnicity, baseline serum 25-hydroxyvitamin D concentration, adherence and cancer-related factors but no statistically significant findings were obtained in meta-analyses of all trials. When restricted to trials with daily dosing in a post-hoc analysis, adults aged ≥70 years (RR [95%CI]: 0.83 [0.77; 0.98]) and subjects with vitamin D3 therapy initiation before cancer diagnosis (RR [95%CI]: 0.87 [0.69; 0.99]) appeared to benefit most from daily vitamin D3 supplementation. Measurements of baseline 25-hydroxyvitamin D levels and inclusion of other than non-Hispanic White adults were too sparse in the trials to draw conclusions. Results for all-cause and cancer-specific survival of participants with cancer were comparable to those obtained in the general population for cancer mortality. In conclusion, vitamin D3 did not reduce cancer mortality in the main meta-analysis of all RCTs because the observed risk reduction by 6% was not statistically significant. However, a subgroup analysis revealed that vitamin D3 administered daily, in contrast to bolus supplementation, reduced cancer mortality by 12%.
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da Silva ABJ, Barros WMA, da Silva ML, Silva JML, Souza APDS, da Silva KG, de Sousa Fernandes MS, Carneiro ACBDF, Souza VDON, Lagranha CJ. Impact of vitamin D on cognitive functions in healthy individuals: A systematic review in randomized controlled clinical trials. Front Psychol 2022; 13:987203. [PMID: 36524160 PMCID: PMC9745323 DOI: 10.3389/fpsyg.2022.987203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022] Open
Abstract
Various functions in the central nervous system, such as growth, development, and cognition can be influenced by vitamins and minerals, which are capable of helping to maintain brain health and function throughout life. Cognition is understood as the aspects related to knowledge, learning, and understanding, as well as the ability to develop these functions. A possible association between low levels of vit D and deficit in the performance of cognitive functions in healthy humans or with some pathological condition is discussed. Because of this, the present systematic review analyzed only randomized clinical trials carried out in healthy non-athlete adults about intellectual and/or mental processes involving cognitive functions to identify whether these individuals with different levels of vit D are capable of interfering with the performance of the cognitive function. To do so, we adopted the PRISMA method criteria and registered it in the PROSPERO database. The search was performed in PubMed (MEDLINE), PsycINFO, Science Direct, Scopus, and Web of Science databases, 2,167 records were identified. The 5 most frequent cognitive domains in the selected studies were: processing speed, attention, verbal learning/memory, executive function, and general cognitive functions. We found that there are positive changes in the following domains: verbal memory and verbal working memory, learning memory, attention, executive function, and also cognitive function in general. We highlight the following suggestions for improvements that vitamin D supplementation may promote in the cognitive domains of healthy adults: a) low doses between 400 and 600 IU/d seem to be more effective when compared to doses between 2,400 and 5,000 IU/d and b) food fortification and enrichment with vit D, need further studies, as they seem to be more or as effective as synthetic supplementation. We evident that there is a need for trials that evaluate the control of vit D levels for healthy adult individuals is important, as they have the potential to minimize health problems, especially those involved in the reduction of cognitive abilities. Thus, the development of more clinical trials to obtain satisfactory answers on this topic needs to be encouraged. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021262413.
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Affiliation(s)
- Ana Beatriz Januário da Silva
- Programa de Pós-graduação em Neuropsiquiatria e Ciências do Comportamento, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brazil.,Centro Integrado de Tecnologias em Neurociência (CITENC), Centro Universitário Osman Lins (UNIFACOL), Vitória de Santo Antão, PE, Brazil
| | - Waleska Maria Almeida Barros
- Programa de Pós-graduação em Neuropsiquiatria e Ciências do Comportamento, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brazil.,Centro Integrado de Tecnologias em Neurociência (CITENC), Centro Universitário Osman Lins (UNIFACOL), Vitória de Santo Antão, PE, Brazil
| | - Mayara Luclécia da Silva
- Centro Integrado de Tecnologias em Neurociência (CITENC), Centro Universitário Osman Lins (UNIFACOL), Vitória de Santo Antão, PE, Brazil.,Programa de Pós-graduação Multicêntrico em Ciências Fisiológicas, Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória de Santo Antão, Brazil
| | - José Maurício Lucas Silva
- Centro Integrado de Tecnologias em Neurociência (CITENC), Centro Universitário Osman Lins (UNIFACOL), Vitória de Santo Antão, PE, Brazil.,Programa de Pós-graduação Multicêntrico em Ciências Fisiológicas, Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória de Santo Antão, Brazil
| | - Ana Patrícia da Silva Souza
- Programa de Pós-graduação em Neuropsiquiatria e Ciências do Comportamento, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brazil.,Centro Integrado de Tecnologias em Neurociência (CITENC), Centro Universitário Osman Lins (UNIFACOL), Vitória de Santo Antão, PE, Brazil
| | - Karollainy Gomes da Silva
- Programa de Pós-graduação em Neuropsiquiatria e Ciências do Comportamento, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brazil.,Centro Integrado de Tecnologias em Neurociência (CITENC), Centro Universitário Osman Lins (UNIFACOL), Vitória de Santo Antão, PE, Brazil
| | - Matheus Santos de Sousa Fernandes
- Programa de Pós-graduação em Neuropsiquiatria e Ciências do Comportamento, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | | | - Cláudia Jacques Lagranha
- Programa de Pós-graduação em Neuropsiquiatria e Ciências do Comportamento, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brazil.,Laboratorio de Bioquimica Geral, Molecular e do Exercicio-Universidade Federal de Pernambuco, Centro Acadêmico de Vitória (CAV)-UFPE, Vitória de Santo Antão, PE, Brazil
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Gáll Z, Székely O. Role of Vitamin D in Cognitive Dysfunction: New Molecular Concepts and Discrepancies between Animal and Human Findings. Nutrients 2021; 13:nu13113672. [PMID: 34835929 PMCID: PMC8620681 DOI: 10.3390/nu13113672] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE OF REVIEW increasing evidence suggests that besides the several metabolic, endocrine, and immune functions of 1alpha,25-dihydroxyvitamin D (1,25(OH)2D), the neuronal effects of 1,25(OH)2D should also be considered an essential contributor to the development of cognition in the early years and its maintenance in aging. The developmental disabilities induced by vitamin D deficiency (VDD) include neurological disorders (e.g., attention deficit hyperactivity disorder, autism spectrum disorder, schizophrenia) characterized by cognitive dysfunction. On the other hand, VDD has frequently been associated with dementia of aging and neurodegenerative diseases (e.g., Alzheimer's, Parkinson's disease). RECENT FINDINGS various cells (i.e., neurons, astrocytes, and microglia) within the central nervous system (CNS) express vitamin D receptors (VDR). Moreover, some of them are capable of synthesizing and catabolizing 1,25(OH)2D via 25-hydroxyvitamin D 1alpha-hydroxylase (CYP27B1) and 25-hydroxyvitamin D 24-hydroxylase (CYP24A1) enzymes, respectively. Both 1,25(OH)2D and 25-hydroxyvitamin D were determined from different areas of the brain and their uneven distribution suggests that vitamin D signaling might have a paracrine or autocrine nature in the CNS. Although both cholecalciferol and 25-hydroxyvitamin D pass the blood-brain barrier, the influence of supplementation has not yet demonstrated to have a direct impact on neuronal functions. So, this review summarizes the existing evidence for the action of vitamin D on cognitive function in animal models and humans and discusses the possible pitfalls of therapeutic clinical translation.
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Affiliation(s)
- Zsolt Gáll
- Department of Pharmacology and Clinical Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania
- Correspondence:
| | - Orsolya Székely
- Department of Nephrology/Internal Medicine, Mures County Clinical Hospital, 540103 Târgu Mureș, Romania;
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