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Should vitamin D supplements be recommended to prevent chronic diseases?

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h321 (Published 29 January 2015) Cite this as: BMJ 2015;350:h321

Severe Enduring Mental Illnesses are also Chronic Diseases

Severe, enduring mental illnesses are also chronic diseases. In Meyer HE et al’s paper, they have considered evidence in reaching the recommendation that vitamin D supplementation is not recommended for the prevention of chronic disease. [1] This evidence pertained to cancer, cardiovascular diseases, myocardial infarction, cerebrovascular disorder, fractures, respiratory tract diseases, diabetes mellitus, and multiple sclerosis. However, evidence for the role of vitamin D in mental illness does exist but was not considered by this paper. These mental health conditions such as depression may be comorbid with the considered conditions [2] and are associated with poorer prognoses. [3] Consideration or acknowledgment of these may have conveyed the full ramifications and implications of Vitamin D deficiency and possibly affected their recommendations.

The World Health Organisation estimates that by 2020, mental illness, in particular depression would outstrip most other chronic diseases to become the second leading cause of Disability Adjusted Life Years (DALYs) lost. “Worldwide it will be second only to ischaemic heart disease for DALYs lost for both sexes. In the developed regions, depression will then be the highest ranking cause of burden of disease.” [4] Approximately 25% of prevalent depression is thought to be chronic in nature. [5] In the 2000 Global Burden of Disease study, Schizophrenia accounted for 1.1% of the total DALYs and 2.8% of Years Lived with Disability (YLDs). [4] Hence any associations of Vitamin D with mental disorders, where existent needs to be factored into public health recommendations.

Anglin et al’s systematic review and meta-analysis was indicative of an association between depression and low Vitamin D levels. [5] However, supplementation with Vitamin D did not significantly improve depression [6, 7]; but these studies had low numbers of participants. Low level of Vitamin D is now thought to be a risk factor for psychosis [8, 9].

We appreciate that limited resources ought to be well managed. However, we were disappointed that instead of stressing that bigger studies are urgently needed to clarify these associations, the authors chose to emphasize the absence of evidence for supplementation. Absence of evidence does not necessarily mean the non-existence of causality or association.

References:
1. Meyer HE, Holvik K, Lips P. Should Vitamin D Supplements be Recommended to Prevent Chronic Diseases? BMJ 2015;350: h321.
2. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, Chronic Diseases, and Decrements in Health: Results from the World Health Surveys. The Lancet 2007;370(9590): 851-858.
3. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J. The Functioning and Well-being of Depressed Patients. Results from the Medical Outcomes Study. JAMA. 1989;262(7): 914-919.
4. World Health Organisation. The World Health Report 2001 Mental Health: New Understanding, New Hope. Geneva: World Health Organisation; 2001.
5. Rubio, JM, Markowitz JC, Alegría A, Pérez-Fuentes G, Liu S-M, Lin K-H, Blanco C. Epidemiology of Chronic and Nonchronic Major Depressive Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Depression and Anxiety 2011;28: 622–631. doi: 10.1002/da.20864. (accessed 25 July 2015).
6. Murray CJL, Lopez AD, eds. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Cambridge, Massachussets: Harvard School of Public Health on behalf of the World Health Organization and the World Bank; 1996.
7. Anglin RES, Samaan Z, Walter SD, McDonald SD. Vitamin D Deficiency and Depression in Adults: Systematic Review and Meta-analysis. British Journal of Psychiatry 2013;202(2): 100-107.
8. Kjærgaard M, Waterloo K, Wang CEA, Almås B, Figenschau Y, Hutchinson MS, Svartberg J, Jorde R. Effect of Vitamin D Supplement on Depression Scores in People with Low Levels of Serum 25-Hydroxyvitamin D: Nested Case–control Study and Randomised Clinical Trial. British Journal of Psychiatry 2012;201(5): 360-368.
9. Sanders KM, Stuart AL, Williamson EJ, Jacka FN, Dodd S, Nicholson G, Berk M. Annual High-dose Vitamin D3 and Mental Well-being: Randomised Controlled Trial. British Journal of Psychiatry 2011; 198(5): 357-364.
10. Cieslak K, Feingold J, Antonius D, Walsh-Messinger J, Dracxler R, Rosendale M, Aujero N, Keefe D, Goetz D, Goetz R, Malaspina D. Low Vitamin D Levels Predict Clinical Features of Schizophrenia. Schizophrenia Research 2014;59: 543-545.
11. Crews M, Lally J, Gardner-Sood P, Howes O, Bonaccorso S, Smith S, Murray RM, Forti MD, Gaughran F. Vitamin D Deficiency in First Episode Psychosis: A Case-control Study. Schizophrenia Research 2013;150: 533-537.

Competing interests: No competing interests

17 August 2015
Ilektra Adamidou
GPST1 doctor
Dr Itoro Udo (consultant in psychiatry)
Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR