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Effects of vitamin D supplementation on cardiometabolic outcomes in children and adolescents: a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose

In observational studies, higher S-25-hydroxyvitamin D [S-25(OH)D] has been associated with a more favorable cardiometabolic profile in childhood, but results may be confounded. We examined effects of vitamin D supplementation on cardiometabolic outcomes in children and adolescents.

Methods

We systematically searched relevant databases for randomized controlled trials (RCTs) examining effects of vitamin D supplementation compared to placebo or a lower dose of vitamin D on blood glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), glycated hemoglobin, cholesterol [total, high-density, and low-density lipoprotein (LDL-C)], triglycerides, or blood pressure. We conducted random-effects meta-analyses of weighted mean differences in all participants and in subgroups of overweight/obese versus normal weight participants with or without baseline S-25(OH)D < 50 nmol/L. We also explored associations between responses in S-25(OH)D and outcomes by meta-regression.

Results

Fourteen RCTs with a total of 1088 participants aged 4–19 years were included. In the meta-analysis, vitamin D supplementation increased S-25(OH)D by 27 nmol/L [95% CI 16; 37] (P < 0.0001) and increased LDL-C by 0.11 mmol/L [0.02; 0.20] (P = 0.02) without any subgroup differences and a generally low to moderate heterogeneity. Vitamin D supplementation had no other effects. However, in the meta-regression analysis, HOMA-IR decreased by 0.51 points [− 0.97; − 0.04] per 10 nmol/L increase in the endpoint S-25(OH)D among overweight/obese participants (P = 0.04).

Conclusions

These results do not support the use of vitamin D supplementation for improving cardiometabolic health in childhood. Indicated beneficial effects on insulin resistance in those with obesity could be investigated further, while unfavorable effects on LDL-C may be a concern.

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Abbreviations

BG:

Blood glucose

BMI:

Body mass index

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressure

HbA1c:

Glycated hemoglobin

HDL-C:

High-density lipoprotein

HOMA-IR:

Homeostatic model assessment of insulin resistance

LDL-C:

Low-density lipoprotein

RCT:

Randomized controlled trial

SBP:

Systolic blood pressure

TC:

Total cholesterol

TG:

Triglycerides

T2D:

Type 2 diabetes

UL:

Tolerable upper daily intake level

SEM:

Standard error of the mean

S-25(OH)D:

Serum 25-hydroxyvitamin D

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Acknowledgements

HH, RPL, CR, CM, MVL, and CTD designed the research; HH and RPL conducted the research, i.e., searched, screened and evaluated literature, and extracted data; HH analyzed data and wrote the paper; MVL and CR provided statistical guidance. All authors critically reviewed and approved the final manuscript.

Funding

This work was conducted with funding from the Lundbeck Foundation (R180-2014-3481).

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Correspondence to Hanne Hauger.

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The authors declare that they have no conflict of interest.

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Hauger, H., Laursen, R.P., Ritz, C. et al. Effects of vitamin D supplementation on cardiometabolic outcomes in children and adolescents: a systematic review and meta-analysis of randomized controlled trials. Eur J Nutr (2020). https://doi.org/10.1007/s00394-019-02150-x

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Keywords

  • Vitamin D
  • Cardiovascular risk factors
  • Children
  • Adolescents
  • Randomized controlled trials