The impact of cholecalciferol supplementation on the systemic inflammatory profile: a systematic review and meta-analysis of high-quality randomized controlled trials

Eur J Clin Nutr. 2017 Aug;71(8):931-943. doi: 10.1038/ejcn.2017.67. Epub 2017 May 10.

Abstract

Causal links between vitamin D status [25(OH)D] and systemic inflammation were examined through a systematic review of randomized controlled trials (RCTs). Selected RCTs were ⩾12 weeks, conducted in adults free of acute inflammatory disease, and of high-quality (Jadad score ⩾3). Of 14 studies that met our criteria, 9 studies (15 study arms) permitted extraction of data. There was no effect on the weighted mean difference (WMD) of IL-6 (WMD (95% confidence interval)=0.1, (-0.166, 0.366) pg/ml, P=0.462) or C-reactive protein (CRP) (WMD=-0.324, (-1.007, 0.359) mg/l, P=0.352). Subgroup analyses of trials achieving ⩾80 nmol/l indicated a trend for lower CRP (WMD=-0.834, (-1.726, 0.058) mg/l, P=0.067), however heterogeneity was significant (I2=66.7%, P=0.017). Studies employing a low dose (<1000 IU/d) showed increased CRP (WMD=0.615, (0.132, 1.098), P=0.013). In contrast, ⩾1000 IU/d had a favourable effect on CRP (WMD=-0.939, (-1.805, -0.073), P=0.034) but heterogeneity was significant (I2=61.3%, P=0.017). Meta-regression indicated that older age predicted a significant decrease in IL-6 (β=-0.02, (-0.034, -0.006) pg/ml, P=0.013) and CRP (β=-0.06, (-0.103, -0.017), P=0.01), whereas a greater percentage of females (β=0.027, (0.011, 0.044), P=0.004) and longer study duration independently predicted a higher WMD for CRP (β=0.049, (0.018, 0.079), P=0.005). Available high-quality RCTs did not support a beneficial effect of cholecalciferol on systemic IL-6 and CRP. Future studies should consider the confounding effects of age, gender and study duration, while possibly targeting an achieved 25(OH)D ⩾80 nmol/l.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • Calcifediol / blood
  • Cholecalciferol / administration & dosage
  • Cholecalciferol / therapeutic use*
  • Dietary Supplements*
  • Evidence-Based Medicine*
  • Humans
  • Inflammation / blood
  • Inflammation / etiology
  • Inflammation / prevention & control*
  • Interleukin-6 / blood
  • Obesity / immunology
  • Obesity / physiopathology
  • Randomized Controlled Trials as Topic
  • Reproducibility of Results

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Biomarkers
  • IL6 protein, human
  • Interleukin-6
  • Cholecalciferol
  • C-Reactive Protein
  • Calcifediol