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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Article info
Publication history
Published online: January 04, 2019
Accepted:
December 29,
2018
Received in revised form:
December 27,
2018
Received:
November 7,
2018
Identification
Copyright
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