Advertisement

Sports Medicine

, Volume 47, Issue 11, pp 2323–2339 | Cite as

Effects of Vitamin D Supplementation on Serum 25-Hydroxyvitamin D Concentrations and Physical Performance in Athletes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

  • Forough Farrokhyar
  • Gayathri Sivakumar
  • Katey Savage
  • Alex Koziarz
  • Sahab Jamshidi
  • Olufemi R. Ayeni
  • Devin Peterson
  • Mohit Bhandari
Systematic Review

Abstract

Background

There is currently no systematic review examining the effects of vitamin D supplementation among athletes. A rigorous systematic review and meta-analysis is important to provide a balanced view of current knowledge on the effect of vitamin D on serum 25-hydroxyvitamin D [25(OH)D] concentrations and physical performance.

Objectives

This systematic review of randomized controlled trials (RCTs) evaluated the effects of oral vitamin D supplementation on serum 25(OH)D concentrations and physical performance in athletes.

Methods

Multiple electronic databases were searched, and study eligibility, methodological quality assessment, and data extraction were completed independently and in duplicate. Studies were stratified by baseline vitamin D sufficiency, season, and latitude. A cut-off of 30 ng/ml (75 nmol/l) of 25(OH)D was used for sufficiency. Absolute mean differences (AMDs) between vitamin D and placebo using random effects analysis, and heterogeneity using Q statistic and I 2 index, were calculated. AMD with 95% confidence interval (CI), p value, and I 2 are reported.

Results

In total, 13 RCTs (2005–2016) with 532 athletes (vitamin D 311, placebo 221) were eligible. A total of 433 athletes (vitamin D 244, placebo 189) had complete outcome data. Among athletes with baseline values suggesting insufficiency, vitamin D supplementation led to significant increases from 3000 IU (AMD 15.2 ng/ml; 95% CI 10.7–19.7, p < 0.0001, I 2 = 0%) and 5000 IU (AMD 27.8 ng/ml; 95% CI 16.9–38.8, p < 0.0001, I 2 = 78%) per day at >45° latitudes. Both doses led to sufficiency concentrations during winter months. Among athletes with baseline vitamin D suggesting sufficiency, serum 25(OH)D sufficiency was maintained from different doses at both latitudes. Of 13 included trials, only seven measured different physical performances and none demonstrated a significant effect of vitamin D supplementation during 12 weeks of follow-up.

Conclusion

Despite achieving sufficiency in vitamin D concentrations from ≥3000 IU supplementation, physical performance did not significantly improve. Between-study heterogeneity was large, and well-designed RCTs examining the effect of vitamin D supplementation on serum 25(OH)D concentrations, physical performance, and injuries in different sports, latitudes, ethnicities, and vitamin D status are needed.

Notes

Acknowledgements

The authors express their special gratitude to Ms. Laura Banfield, a professional librarian at the School of Health Sciences at McMaster University, for assisting Katey Savage in the systematic literature search strategy for the articles. The authors also express their gratitude to Zina Fathalla for her assistance with double-checking the collection of data.

Author contributions

This review was designed by Forough Farrokhyar, Olufemi Ayeni, Devin Peterson, and Mohit Bhandari; the search strategy was executed by Katey Savage; articles were screened for eligibility and quality by Gayathri Sivakumar, Katey Savage, Alex Koziarz, and Forough Farrokhyar; data were collected in duplicate and independently by Gayathri Sivakumar, Alex Koziarz, and Sahab Jamshidi, and analysed by Forough Farrokhyar; the manuscript was prepared by Forough Farrokhyar, reviewed by Mohit Bhandari, Olufemi Ayeni, and Devin Peterson for clinical relevance and implications, and edited and approved by all authors.

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Forough Farrokhyar, Gayathri Sivakumar, Katey Savage, Alex Koziarz, Sahab Jamshidi, Olufemi Ayeni, Devin Peterson, and Mohit Bhandari have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2017_749_MOESM1_ESM.pdf (4.7 mb)
Supplementary material 1 (PDF 4797 kb)
40279_2017_749_MOESM2_ESM.doc (64 kb)
Supplementary material 2 (DOC 63 kb)

References

  1. 1.
    Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84(1):18–28.PubMedGoogle Scholar
  2. 2.
    Tomlinson PB, Joseph C, Angioi M. Effects of vitamin D supplementation on upper and lower body muscle strength levels in healthy individuals. A systematic review with meta-analysis. J Sci Med Sport. 2015;18(5):575–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Ogan D, Pritchett K. Vitamin D and the athlete: risks, recommendations, and benefits. Nutrients. 2013;5(6):1856–68.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Thacher TD, Clarke BL. Vitamin D insufficiency. Mayo Clin Proc. 2011;86(1):50–60.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004;80(6 Suppl):1689S–96S.PubMedGoogle Scholar
  6. 6.
    Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81.CrossRefPubMedGoogle Scholar
  7. 7.
    Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab. 2010;95(2):471–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Misra M, Pacaud D, Petryk A, et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398–417.CrossRefPubMedGoogle Scholar
  9. 9.
    Prietl B, Treiber G, Pieber TR, et al. Vitamin D and immune function. Nutrients. 2013;5(7):2502–21.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016;101(2):394–415.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chang E, Kim Y. Vitamin D decreases adipocyte lipid storage and increases NAD-SIRT1 pathway in 3T3-L1 adipocytes. Nutrition. 2016;32(6):702–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Zittermann A, Frisch S, Berthold HK, et al. Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers. Am J Clin Nutr. 2009;89(5):1321–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Ross AC. The 2011 report on dietary reference intakes for calcium and vitamin D. Public Health Nutr. 2011;14(5):938–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Farrokhyar F, Tabasinejad R, Dao D, et al. Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis. Sports Med. 2015;45(3):365–78.CrossRefPubMedGoogle Scholar
  16. 16.
    Holick MF. Vtamin D is not as toxic as was once thought: a historical and an up-to-date perspective. Mayo Clin Proc. 2015;90(5):561–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Golden NH, Carey DE. Vitamin D in health and disease in adolescents: when to screen, whom to treat, and how to treat. Adolesc Med State Art Rev. 2016;27(1):125–39.PubMedGoogle Scholar
  18. 18.
    Viljakainen HT, Natri AM, Karkkainen M, et al. A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res. 2006;21(6):836–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Holick MF. The vitamin D epidemic and its health consequences. J Nutr. 2005;135(11):2739S–48S.PubMedGoogle Scholar
  20. 20.
    Willis KS, Peterson NJ, Larson-Meyer DE. Should we be concerned about the vitamin D status of athletes? Int J Sport Nutr Exerc Metab. 2008;18(2):204–24.CrossRefPubMedGoogle Scholar
  21. 21.
    Dao D, Sodhi S, Tabasinejad R, et al. Serum 25-hydroxyvitamin D levels and stress fractures in military personnel: a systematic review and meta-analysis. Am J Sports Med. 2014;43(8):2064–72.CrossRefPubMedGoogle Scholar
  22. 22.
    Tenforde AS, Sayres LC, Sainani KL, et al. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature. PMR. 2010;2(10):945–9.CrossRefGoogle Scholar
  23. 23.
    von Hurst PR, Beck KL. Vitamin D and skeletal muscle function in athletes. Curr Opin Clin Nutr Metab Care. 2014;17(6):539–45.CrossRefGoogle Scholar
  24. 24.
    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Angeline ME, Gee AO, Shindle M, et al. The effects of vitamin D deficiency in athletes. Am J Sports Med. 2013;41(2):461–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Backx EM, Tieland M, Maase K, et al. The impact of 1-year vitamin D supplementation on vitamin D status in athletes: a dose-response study. Eur J Clin Nutr. 2016;70(9):1009–14.CrossRefPubMedGoogle Scholar
  27. 27.
    Close GL, Russell J, Cobley JN, et al. Assessment of vitamin D concentration in non-supplemented professional athletes and healthy adults during the winter months in the UK: implications for skeletal muscle function. J Sports Sci. 2013;31(4):344–53.CrossRefPubMedGoogle Scholar
  28. 28.
    Close GL, Leckey J, Patterson M, et al. The effects of vitamin D3 supplementation on serum total 25[OH]D concentration and physical performance: a randomised dose-response study. Br J Sports Med. 2013;47(11):692–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Dubnov-Raz G, Livne N, Raz R, et al. Vitamin D supplementation and physical performance in adolescent swimmers. Int J Sport Nutr Exerc Metab. 2015;25(4):317–25.CrossRefPubMedGoogle Scholar
  30. 30.
    Guillemant J, Le HT, Maria A, et al. Wintertime vitamin D deficiency in male adolescents: effect on parathyroid function and response to vitamin D3 supplements. Osteoporos Int. 2001;12(10):875–9.CrossRefPubMedGoogle Scholar
  31. 31.
    He CS, Fraser WD, Tang J, et al. The effect of 14 weeks of vitamin D3 supplementation on antimicrobial peptides and proteins in athletes. J Sports Sci. 2016;34(1):67–74.CrossRefPubMedGoogle Scholar
  32. 32.
    Lewis RM, Redzic M, Thomas DT. The effects of season-long vitamin D supplementation on collegiate swimmers and divers. Int J Sport Nutr Exerc Metab. 2013;23(5):431–40.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Nieman DC, Gillitt ND, Shanely RA, et al. Vitamin D2 supplementation amplifies eccentric exercise-induced muscle damage in NASCAR pit crew athletes. Nutrients. 2014;6(1):63–75.CrossRefGoogle Scholar
  34. 34.
    Shanely RA, Nieman DC, Knab AM, et al. Influence of vitamin D mushroom powder supplementation on exercise-induced muscle damage in vitamin D insufficient high school athletes. J Sports Sci. 2014;32(7):670–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Silk LN, Greene DA, Baker MK, et al. Tibial bone responses to 6-month calcium and vitamin D supplementation in young male jockeys: a randomised controlled trial. Bone. 2015;8(81):554–61.CrossRefGoogle Scholar
  36. 36.
    Storlie DM, Pritchett K, Pritchett R, et al. 12-week vitamin D supplementation trial does not significantly influence seasonal 25(OH)D status in male collegiate athletes. Int J Health Nutr. 2011;2(2):8–13.Google Scholar
  37. 37.
    Todd JJ, McSorley EM, Pourshahidi LK, et al. Vitamin D supplementation using an oral spray solution resolves deficiency but has no effect on VO max in Gaelic footballers: results from a randomised, double-blind, placebo-controlled trial. Eur J Nutr. 2016 (epub).Google Scholar
  38. 38.
    Wyon MA, Wolman R, Nevill AM, et al. Acute effects of vitamin D3 supplementation on muscle strength in judoka athletes: a randomized placebo-controlled, double-blind trial. Clin J Sport Med. 2016;26(4):279–84.CrossRefPubMedGoogle Scholar
  39. 39.
    Huang M, Winters D. Application of ultra-performance liquid chromatography/tandem mass spectrometry for the measurement of vitamin D in foods and nutritional supplements. J AOAC Int. 2011;94(1):211–23.PubMedGoogle Scholar
  40. 40.
    Cashman KD, Fitzgerald AP, Kiely M, et al. A systematic review and meta-regression analysis of the vitamin D intake-serum 25-hydroxyvitamin D relationship to inform European recommendations. Br J Nutr. 2011;106(11):1638–48.CrossRefPubMedGoogle Scholar
  41. 41.
    Muir SW, Montero-Odasso M. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2011;59(12):2291–300.CrossRefPubMedGoogle Scholar
  42. 42.
    McNally JD, Iliriani K, Pojsupap S, et al. Rapid normalization of vitamin D levels: a meta-analysis. Pediatrics. 2015;135(1):e152–66.CrossRefPubMedGoogle Scholar
  43. 43.
    Black LJ, Seamans KM, Cashman KD, et al. An updated systematic review and meta-analysis of the efficacy of vitamin D food fortification. J Nutr. 2012;142(6):1102–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Lewis RD, Laing EM, Hill Gallant KM, et al. A randomized trial of vitamin D(3) supplementation in children: dose-response effects on vitamin D metabolites and calcium absorption. J Clin Endocrinol Metab. 2013;98(12):4816–25.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Gaffney-Stomberg E, Lutz LJ, Rood JC, et al. Calcium and vitamin D supplementation maintains parathyroid hormone and improves bone density during initial military training: a randomized, double-blind, placebo controlled trial. Bone. 2014;68:46–56.CrossRefPubMedGoogle Scholar
  46. 46.
    Duplessis CA, Harris EB, Watenpaugh DE, et al. Vitamin D supplementation in underway submariners. Aviat Space Environ Med. 2005;76(6):569–75.PubMedGoogle Scholar
  47. 47.
    Gasier HG, Gaffney-Stomberg E, Young CR, et al. The efficacy of vitamin D supplementation during a prolonged submarine patrol. Calcif Tissue Int. 2014;95(3):229–39.CrossRefPubMedGoogle Scholar
  48. 48.
    Lappe J, Cullen D, Haynatzki G, et al. Calcium and vitamin D supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008;23(5):741–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Stockton KA, Mengersen K, Paratz JD, et al. Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporos Int. 2011;22(3):859–71.PubMedGoogle Scholar
  50. 50.
    Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet. 2014;383(9912):146–55.CrossRefPubMedGoogle Scholar
  51. 51.
    Redzic M, Lewis RM, Thomas DT. Relationship between 25-hydoxyvitamin D, muscle strength, and incidence of injury in healthy adults: a systematic review. Nutr Res. 2013;33(4):251–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Wyon MA, Koutedakis Y, Wolman R, et al. The influence of winter vitamin D supplementation on muscle function and injury occurrence in elite ballet dancers: a controlled study. J Sci Med Sport. 2014;17(1):8–12.CrossRefPubMedGoogle Scholar
  53. 53.
    Davey T, Lanham-New SA, Shaw AM, et al. Low serum 25-hydroxyvitamin D is associated with increased risk of stress fracture during Royal Marine recruit training. Osteoporos Int. 2016;27(1):171–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Davids K, Baker J. Genes, environment and sport performance: why the nature-nurture dualism is no longer relevant. Sports Med. 2007;37(11):961–80.CrossRefPubMedGoogle Scholar
  55. 55.
    Dubnov-Raz G, Rinat B, Hemila H, et al. Vitamin D supplementation and upper respiratory tract infections in adolescent swimmers: a randomized controlled trial. Pediatr Exerc Sci. 2015;27(1):113–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of SurgeryMcMaster UniversityHamiltonCanada
  2. 2.Department of Health, Evidence and ImpactMcMaster UniversityHamiltonCanada
  3. 3.University of Western OntarioLondonCanada
  4. 4.Victoria HospitalCastriesSaint Lucia
  5. 5.HamiltonCanada

Personalised recommendations