2012 version, followed by 2011 version - same authors

Vitamin D supplementation for cystic fibrosis.

Ferguson JH, Chang AB
Cochrane Database Syst Rev 2012.:CD007298.

Cystic fibrosis (CF) is a genetic disorder with multiorgan effects. In a subgroup with pancreatic insufficiency malabsorption of the fat soluble vitamins (A, D, E, K) may occur.
Vitamin D is involved in calcium homeostasis and bone mineralisation and may have extraskeletal effects.
This review examines the evidence for vitamin D supplementation in CF.
To assess the effects of vitamin D supplementation on the frequency of vitamin D deficiency, respiratory outcomes and vitamin D toxicity in the CF population.
We searched the Cochrane CF and Genetic Disorders Group
Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.
Most recent search: 15 February 2012.
Randomised and quasi-randomised controlled trials of vitamin D supplementation compared to placebo in the CF population regardless of exocrine pancreatic function.
Both authors independently assessed the 'risk of bias' of each included trial and extracted outcome data (from published trial information) for assessment of bone mineralization, growth and nutritional status, frequency of vitamin D deficiency, respiratory status, quality of life and adverse events.

Three studies are included, although only data from two were available (41 adults and children with CF).
One of these studies compared supplemental 800 international units (IU) vitamin D and placebo for 12 months in 30 osteopenic pancreatic insufficient adults;
both groups continued 900 IU vitamin D daily.

The other (abstract only) compared supplemental 1g calcium alone, 1600 IU vitamin D alone, 1600 IU vitamin D and 1g calcium and placebo in a double-blind randomised cross-over trial;
only 11 children (vitamin D and placebo groups) after six-months supplementation are included;
inclusion criteria, pancreatic sufficiency or disease status of participants are not defined.

There were no significant differences in primary or secondary outcomes in either study.
The studies are not directly comparable due to differences in supplementation, outcome reporting and possibly participant characteristics (eg severity of lung disease, growth and nutrition, pancreatic sufficiency).
There were no adverse events in either study.

The third study (abstract only) compared daily calcitriol (0.25 or 0.5 micrograms) with placebo in pancreatic insufficient children and young adults, only pre-intervention data were available.
There is no evidence of benefit or harm in the limited number of small-sized published trials.
Adherence to relevant CF guidelines on vitamin D should be considered until further evidence is available.

- - - - - - - - - - - - - - - - - - - - -

The use of regular vitamin D preparations for children and adults with cystic fibrosis

Ferguson JH, Chang AB
Published Online: November 9, 2011

Cystic fibrosis with pancreatic insufficiency can cause vitamins, such as vitamin D, to be inadequately absorbed leading to vitamin deficiencies. Lack of vitamin D (vitamin D deficiency) can cause specific problems such as bone deformity and bone fractures. It can also be associated with poorer general and respiratory health. Thus, people with cystic fibrosis are usually given regular vitamin D preparations from a very young age. However, excess vitamin D can also cause respiratory problems and problems with high calcium levels. The review contains three trials, but we could only extract data from two trials. We found no evidence to show whether giving vitamin D regularly to people with cystic fibrosis is beneficial or not. The authors are unable to draw any conclusions regarding the routine administration of Vitamin D supplements and recommend that until further evidence is available, local guidelines are followed regarding this practice.

Background: Cystic fibrosis (CF) is a genetic disorder with multiorgan effects. In a subgroup with pancreatic insufficiency malabsorption of the fat soluble vitamins (A, D, E, K) may occur.
Vitamin D is involved in calcium homeostasis and bone mineralisation and may have extraskeletal effects.
This review examines the evidence for vitamin D supplementation in CF.

Objectives: To assess the effects of vitamin D supplementation on the frequency of vitamin D deficiency, respiratory outcomes and vitamin D toxicity in the CF population.
Search strategy: We searched the Cochrane CF and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.

Most recent search: 14 March 2011.

Selection criteria: Randomised and quasi-randomised controlled trials of vitamin D supplementation compared to placebo in the CF population regardless of exocrine pancreatic function.

Data collection and analysis: Both authors independently assessed the 'risk of bias' of each included trial and extracted outcome data (from published trial information) for assessment of bone mineralization, growth and nutritional status, frequency of vitamin D deficiency, respiratory status, quality of life and adverse events.

Main results: Three studies are included, although only data from two were available (41 adults and children with CF).
One of these studies compared supplemental 800 international units (IU) vitamin D and placebo for 12 months in 30 osteopenic pancreatic insufficient adults; both groups continued 900 IU vitamin D daily.

The other (abstract only) compared supplemental 1g calcium alone, 1600 IU vitamin D alone, 1600 IU vitamin D and 1g calcium and placebo in a double-blind randomised cross-over trial; only 11 children (vitamin D and placebo groups) after six-months supplementation are included; inclusion criteria, pancreatic sufficiency or disease status of participants are not defined. There were no significant differences in primary or secondary outcomes in either study. The studies are not directly comparable due to differences in supplementation, outcome reporting and possibly participant characteristics (eg severity of lung disease, growth and nutrition, pancreatic sufficiency). There were no adverse events in either study.

The third study (abstract only) compared daily calcitriol (0.25 or 0.5 micrograms) with placebo in pancreatic insufficient children and young adults, only pre-intervention data were available.

Authors' conclusions: There is no evidence of benefit or harm in the limited number of small-sized published trials.
Adherence to relevant CF guidelines on vitamin D should be considered until further evidence is available.

Ferguson JH, Chang AB. Vitamin D supplementation for cystic fibrosis. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007298. DOI: 10.1002/14651858.CD007298.pub2
Assessed as up to date: August 31, 2011
- - - - - - - - - - - - - - -

Comment on high calcium levels

Many studies have shown that Calcium intake should be < 750 mg or perhaps < 500 mg when taking a lot of vitamin D.

See also VitaminDWiki

• All items in Cystic Fibrosis 52 items
• Search VitaminDWiki for Cystic "vitamin K" 408 web pages as of april 2013
• 3800 IU of vitamin D is not enough for most children with cystic fibrosis – Aug 2012 includes link to need for Vitamin K
• People with Cystic Fibrosis should have more than 35 ng of vitamin D – March 2011
  • unlikely to get a level of 35 ng with 1600 IU of vitamin D
• Reasons for low response by vitamin D level in the blood - several of which are in the following reference and graph
• Vitamin D and Cystic Fibrosis - 2010.PDF excellent study has the following graph
  as well as many tables summarizing the results of CF Random Controlled Trials