Daily supplementation with 15 μg vitamin D2 compared with vitamin D3 to increase wintertime 25-hydroxyvitamin D status in healthy South Asian and white European women: a 12-wk randomized, placebo-controlled food-fortification trial

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ABSTRACT

Background

There are conflicting views in the literature as to whether vitamin D2 and vitamin D3 are equally effective in increasing and maintaining serum concentrations of 25-hydroxyvitamin D [25(OH)D], particularly at lower doses of vitamin D.

Objective

We aimed to investigate whether vitamin D2 or vitamin D3 fortified in juice or food, at a relatively low dose of 15 μg/d, was effective in increasing serum total 25(OH)D and to compare their respective efficacy in South Asian and white European women over the winter months within the setting of a large randomized controlled trial.

Design

A randomized, double-blind, placebo-controlled food-fortification trial was conducted in healthy South Asian and white European women aged 20–64 y (n = 335; Surrey, United Kingdom) who consumed placebo, juice supplemented with 15 μg vitamin D2, biscuit supplemented with 15 μg vitamin D2, juice supplemented with 15 μg vitamin D3, or biscuit supplemented with 15 μg vitamin D3 daily for 12 wk. Serum 25(OH)D was measured by liquid chromatography–tandem mass spectrometry at baseline and at weeks 6 and 12 of the study.

Results

Postintervention in the 2 ethnic groups combined, both the vitamin D3 biscuit and the vitamin D3 juice groups showed a significantly greater absolute incremental change (Δ) in total 25(OH)D when compared with the vitamin D2 biscuit group [Δ (95% CI): 15.3 nmol/L (7.4, 23.3 nmol/L) (P < 0.0003) and 16.0 nmol/L (8.0, 23.9 nmol/L) ( P < 0.0001)], the vitamin D2 juice group [Δ (95% CI): 16.3 nmol/L (8.4, 24.2 nmol/L) (P < 0.0001) and 16.9 nmol/L (9.0, 24.8 nmol/L) (P < 0.0001)], and the placebo group [Δ (95% CI): 42.3 nmol/L (34.4, 50.2 nmol/L) (P < 0.0001) and 42.9 nmol/L (35.0, 50.8 nmol/L) (P < 0.0002)].

Conclusions

With the use of a daily dose of vitamin D relevant to public health recommendations (15 μg) and in vehicles relevant to food-fortification strategies, vitamin D3 was more effective than vitamin D2 in increasing serum 25(OH)D in the wintertime. Vitamin D3 may therefore be a preferential form to optimize vitamin D status within the general population. This trial was registered at www.controlled-trials.com as ISRCTN23421591.

Key Words

vitamin D
vitamin D2
vitamin D3
25-hydroxyvitamin D
randomized controlled trial
food fortification
healthy women
South Asian
white European

Abbreviations

D2B
placebo juice with biscuit supplemented with 15 μg vitamin D2
D2J
juice supplemented with 15 μg vitamin D2 with placebo biscuit
D3B
placebo juice with biscuit supplemented with 15 μg vitamin D3
D3J
juice supplemented with 15 μg vitamin D3 with placebo biscuit
EPD
estimated percentage difference
HPLC-MS/MS
HPLC–tandem mass spectrometry
IOM
Institute of Medicine
PTH
parathyroid hormone
RDA
Recommended Daily Allowance
SED
standard erythemal dose
25(OH)D
25-hydroxyvitamin D
25(OH)D2
25-hydroxyvitamin D2
25(OH)D3
25-hydroxyvitamin D3.

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Supported by the United Kingdom–based Biotechnology and Biological Sciences Research Council (BBSRC) as part of a BBSRC Diet and Health Research Industry Club grant (BB/I006192/1). The funder had no role in the design, implementation, analysis, or interpretation of the research. LT was the recipient of a Young Investigator Award at the 2014 National Osteoporosis Society Conference (Birmingham, United Kingdom) for the vitamin D2 compared with vitamin D3 findings. LRW received the Postgraduate Award at the 2016 Nutrition Society’s 75th Anniversary Conference (Dublin, Republic of Ireland) for vitamin D food fortification and the D2-D3 Study findings.