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Vitamin D supplementation in obesity and during weight loss: A review of randomized controlled trials

  • Author Footnotes
    1 Co-primary authors.
    Aya Bassatne
    Footnotes
    1 Co-primary authors.
    Affiliations
    Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
  • Author Footnotes
    1 Co-primary authors.
    Marlene Chakhtoura
    Correspondence
    Corresponding author at: Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box: 113-6044/C8, Beirut, Lebanon.
    Footnotes
    1 Co-primary authors.
    Affiliations
    Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
  • Randa Saad
    Affiliations
    Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
  • Ghada El-Hajj Fuleihan
    Affiliations
    Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
  • Author Footnotes
    1 Co-primary authors.
Published:January 04, 2019DOI:https://doi.org/10.1016/j.metabol.2018.12.010

      Highlights

      • Vitamin D doses ≥1600 IU/d may be needed in obese and in medical weight loss.
      • Vitamin D doses ≥2000 IU/d may be needed in bariatric surgery.
      • Vitamin D may protect against weight loss induced bone loss.
      • No data on fracture risk reduction with vitamin D during weight loss
      • No clear evidence for improvement in cardio-metabolic parameters with vitamin D

      Abstract

      Vitamin D deficiency is common in obese individuals and during weight loss. The recommended vitamin D doses in this specific population are higher than for healthy adults. We reviewed vitamin D supplementation trials in obesity, and during medical or surgical weight loss, and report the effects on 25-hydroxyvitamin D [25(OH)D] concentrations and other relevant outcomes.
      We conducted a systematic search in PubMed, Medline, Embase and the Cochrane library for relevant randomized controlled trials (RCTs) of oral vitamin D supplementation for at least 3 months in obese individuals without weight loss (OB), and those on medical weight loss (MWL) (2010–2018), and following bariatric surgery (Bar S) (without time restriction). Two reviewers screened the identified citations in duplicate and independently and performed full text screening. One reviewer completed data extraction.
      We identified 13 RCTs in OB, 6 in MWL and 7 in Bar S. Mean baseline 25(OH)D concentrations ranged between 7 and 27 ng/ml in OB, 15–29 ng/ml in MWL and 15–24 ng/ml in Bar S. In OB (Total N 2036 participants), vitamin D doses of 1600–4000 IU/d increased mean 25(OH)D concentrations to ≥30 ng/ml. Based on three trials during MWL (Total N 359 participants), vitamin D doses of 1200–4600 IU/d for 12 months increased 25(OH)D concentration to ≥30 ng/ml. In Bar S (Total N 615 participants), doses ≥2000 IU/d were needed to reach 30 ng/ml. The change in 25(OH)D concentration was inversely proportional to the administered dose, and to BMI and baseline level with doses of 600–3000 IU/day. With these doses, the change in 25(OH)D concentration [Δ25(OH)D] per 100 IU/d was 0.5–1.2 ng/ml.
      Three trials assessed bone mineral density as a primary outcome, but only one of them showed a protective effect of vitamin D against bone loss at all sites post-Bar S. There was no effect of vitamin D on weight loss. Data on extra-skeletal parameters, namely glycemic and vascular indices were mostly identified in OB, and findings were inconsistent.
      In conclusion, Vitamin D doses ≥1600–2000 IU/d may be needed to reach a 25(OH)D concentration of 30 ng/ml in obese individuals and following bariatric surgery. The optimal concentration in this population is unknown, and whether the above doses protect against weight loss induced bone loss and fractures still needs to be confirmed. There is no clear evidence for a beneficial effect of vitamin D supplementation on cardio-metabolic parameters in obese individuals, and data on such parameters with weight loss are very scarce. Well-designed long term RCTs assessing the effect of vitamin D supplementation during weight loss on patient important outcomes are needed.

      Keywords

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