HomeIngredientClinical and biomarker modifiers of vitamin D treatment response: the multi-ethnic study of atherosclerosis

Clinical and biomarker modifiers of vitamin D treatment response: the multi-ethnic study of atherosclerosis

December 4, 2021

Am J Clin Nutr. 2021 Nov 26:nqab390. doi: 10.1093/ajcn/nqab390. Online ahead of print.

ABSTRACT

BACKGROUND: Different 25-hydroxyvitamin D (25(OH)D) thresholds for treatment with vitamin D supplementation have been suggested, and are derived almost exclusively from observational studies. Whether other characteristics including race/ethnicity, body mass index (BMI), and estimated glomerular filtration rate (eGFR) should also influence the threshold for treatment is unknown.

OBJECTIVE: Identify clinical and biomarker characteristics that modify the response to vitamin D supplementation.

METHODS: 666 older adults in the Multi-Ethnic Study of Atherosclerosis (MESA) were randomized to 16 weeks of oral vitamin D3 (2000 IU/d; n = 499) or placebo (n = 167). Primary outcomes were changes in serum parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,25(OH)2D) concentrations from baseline to 16 weeks.

RESULTS: Among 666 participants randomized (mean age 72 years, 53% female, 66% racial/ethnic minority), 611 (92%) completed the study. Mean (SD) change in PTH was -3 (16) pg/mL with vitamin D3 vs 2 (18) pg/mL with placebo (estimated mean difference, -5 (95% CI: -8, -2) pg/mL). Within the vitamin D3 group, lower baseline 25(OH)D was associated with a larger decline in PTH in a non-linear fashion. With baseline 25(OH)D ≥30 ng/mL as the reference, 25(OH)D <20 ng/mL was associated with a larger decline in PTH with vitamin D3 supplementation (-10 (95% CI: -15, -6) pg/mL) whereas 25(OH)D 20-30 ng/mL was not (-2 (95% CI: -6, 1) pg/mL). A segmented threshold model identified a baseline 25(OH)D concentration of 21 (95% CI: 13, 31) ng/mL as an inflection point for difference in change in PTH. Race/ethnicity, BMI and eGFR did not modify vitamin D treatment response. There was no significant change in 1,25(OH)2D in either treatment group.

CONCLUSIONS: Of characteristics most commonly associated with vitamin D metabolism, only baseline 25(OH)D <20 ng/mL modified the PTH response to vitamin D supplementation, providing support from a clinical trial to use this threshold to define insufficiency. Clinicaltrials.gov NCT02925195.

PMID:34849546 | DOI:10.1093/ajcn/nqab390

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About The Author

Patrick Blanchard MD

Meet Dr. Blanchard Dr. Blanchard’s medical practice is an embodiment of Integrative health which brings conventional and complementary approaches together in a coordinated way. Conveniently located in sunny Florida and over the internet with ValiseMD’s secure HIPPA compliant telXmed servers. Since 1994, patients with a wide range of challenging medical problems have achieved optimum health using the best of natural medicine, judiciously combined with high-tech innovations. Breakthroughs are often achieved even after patients have consulted mainstream specialists and holistic practitioners. Dr. Blanchard is founder and CEO of ValiseMD, Inc. He is board certified in Family Medicine since 1994 and awarded Fellow of the American Academy of Family Physicians in 2001. He received the ‘Teacher of the Year’ award from the University of Kansas School of Medicine at completion of his residency in Family Medicine. He completed a fellowship at Wake Forest University in the field of vascular neurosonology. He holds a medical patent in the field of Gastroenterology. He holds an unrestricted license to practice medicine and surgery in Florida. He started his medical career as a Emergency Medical Technician, then as a Paramedic and later a Medical Doctor.