Vitamin D Supplementation Linked to Reduction in Autoimmune Disease

Autoimmune diseases, characterized by an inflammatory autoimmune response to self-tissues, are the third leading cause of morbidity in the industrialized world and a leading cause of mortality among women. Autoimmune diseases (including rheumatoid arthritis, polymyalgia rheumatica, autoimmune thyroid disease, and psoriasis) are chronic conditions with increasing prevalence with age and major societal and economic burdens due to a lack of effective treatments.

Vitamin D supplementation, with or without omega-3 fatty acid supplementation, is associated with a significant reduction in the incidence of autoimmune disease, according to a study published online in The BMJ.

What this study adds

This trial of older adults in the United States found that vitamin D and omega 3 fatty acid supplementation for five years reduced incident autoimmune disease compared with no supplementation.
The clinical importance of this trial is high because these are well tolerated, non-toxic supplements, and other effective treatments to reduce the incidence of autoimmune diseases are lacking.

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Abstract

Objective To investigate whether vitamin D and marine derived long chain omega 3 fatty acids reduce autoimmune disease risk.

Design Vitamin D and omega 3 trial (VITAL), a nationwide, randomized, double blind, placebo controlled trial with a two-by-two factorial design.

Setting Nationwide in the United States.

Participants 25 871 participants, consisting of 12 786 men ≥50 years and 13 085 women ≥55 years at enrollment.

Interventions Vitamin D (2000 IU/day) or matched placebo, and omega 3 fatty acids (1000 mg/day) or matched placebo. Participants self-reported all incident autoimmune diseases from baseline to a median of 5.3 years of follow-up; these diseases were confirmed by extensive medical record review. Cox proportional hazard models were used to test the effects of vitamin D and omega 3 fatty acids on autoimmune disease incidence.

Main outcome measures The primary endpoint was all incident autoimmune diseases confirmed by medical record review: rheumatoid arthritis, polymyalgia rheumatica, autoimmune thyroid disease, psoriasis, and all others.

Results 25 871 participants were enrolled and followed for a median of 5.3 years. 18 046 self-identified as non-Hispanic white, 5106 as black, and 2152 as other racial and ethnic groups. The mean age was 67.1 years.

For the vitamin D arm, 123 participants in the treatment group and 155 in the placebo group had a confirmed autoimmune disease.

In the omega 3 fatty acids arm, 130 participants in the treatment group and 148 in the placebo group had a confirmed autoimmune disease.

Compared with the reference arm (vitamin D placebo and omega 3 fatty acid placebo; 88 with confirmed autoimmune disease), 63 participants who received vitamin D and omega 3 fatty acids, 60 who received only vitamin D, and 67 who received only omega 3 fatty acids had confirmed autoimmune disease.

Conclusions Vitamin D supplementation for five years, with or without omega 3 fatty acids, reduced autoimmune disease by 22%, while omega 3 fatty acid supplementation with or without vitamin D reduced the autoimmune disease rate by 15%. Both treatment arms showed larger effects than the reference arm (vitamin D placebo and omega 3 fatty acid placebo).

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