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Neither vitamin D nor omega-3 fatty acid supplementation reduce the risk of frailty (VITAL)
Clinical Question
Does supplementation with vitamin D or omega-3 fatty acids reduce the risk of frailty in older adults?
Bottom line
This is an ancillary analysis of the VITAL study. Previous publications of the same study have reported no benefit of supplemental vitamin D or omega-3 fatty acids for reducing the risk of cardiovascular disease cardiovascular disease or cancer, atrial fibrillation, or fractures. This analysis also shows no benefit in reducing the risk of frailty. One other publication from the same trial showed an increased risk of depression with omega-3 fatty acid supplementation. It's definitely time to give up recommending this stuff. (LOE = 1b)
Overuse alert: This POEM aligns with the College of Family Physicians of Canada’s Choosing Wisely Canada recommendation: Don’t routinely measure vitamin D in low-risk adults.
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
Sometimes one large study shows up in multiple publications, with each report highlighting different outcomes of the same interventions. The results of this study have been reported in multiple previous POEMs (see the Bottom line for links). This is one more ancillary publication of the original VITAL trial. Neither vitamin D nor omega-3 supplements reduce the risk of frailty in elderly adults. Enough said.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Applicability to Canadians?
I believe this study was done in California, so perhaps this could explain the lack of effect of vitamin D on fractures?
Problem with the Vitamin D component of the VITAL
While I think we’ve probably been too liberal in our recommendations for vitamin D, I think the conclusions by the reviewers (Dr. Slawson, and whoever wrote the “bottom line”) are too heavy-handed, and missed what I feel is a serious flaw in the clinical trial. In VITAL-D, the subjects’ median baseline 25OHD level was around 75 nmol/L - higher than the level recommended by the Academy of Medicine and Health Canada (40-50 nmol/L) as indicative of adequate vitamin D exposure for the population being studied. Almost half the VITAL-D subjects were taking (and allowed to continue taking) up to 800 IU daily at entry to the study. And although the authors may have reported it somewhere, I can’t find any information as to how many of their subjects were taking additional vitamin D supplements up to 800 IU/day during or at the end of the study. Since the subjects were given permission to take that amount, I suspect a lot of them continued or started to take supplemental vitamin D up to 800 IU/day. To me, all of this means the study was basically looking at whether taking an additional 2000 IU/day is of any benefit to healthy men and women over age 50 who already have more than adequate amounts of vitamin D.
Vitamin supplementation in low risk adults
It is diffult to move away from recommending vitamin D in low risk adults, especially during the Canadian winter months, when we know natural level are low. I do not routinely measure vitamin D levels but share with colleagues the occasional unexpected low levels. Because there appears to be little harm in taking vitamin D, and different contrary evidence of benefit, I will probably not say don't take vitamin D but be more reserved in making the recommendation.
Vitamin supplementation in low risk adults
I agree with Dr. Mather. There are clinical situations where risk of vitamin D deficiency is higher, and potential for harm is increased if untreated. In those patients, 25-OH vitamin D measurements are appropriate.
Omega 3 Fatty Acids ineffective
Good to know. Many patients are recommended Omega 3 when there seems now to be little reason to do so.
vit D and omega fatty acid supplementation
? does not reduce frailty in the elderly