Team: VITAL, aka the “Simply D best”

Base Article: Hahn J, Cook NR, Alexander EK, et al. Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ. 2022;376:e066452. Published 2022 Jan 26. doi:10.1136/bmj-2021-066452

Authors: RheumMadness Leadership Team

1. Eric A. Wilson, MD, second year internal medicine resident at Duke University,
2. Sabahat Usmani, MD, chief internal medicine resident at Weiss Memorial Hospital,
3. Laura Arneson, MD, second year rheumatology fellow at Northwestern University,
4. Meridith Balbach, MD, first year internal medicine resident at Vanderbilt University,
5. Courtney Bair, fourth year medical student at Duke University,
6. Lauren He, MD, first year rheumatology fellow at University of Michigan,
7. John B. Kellogg, MD, first year rheumatology fellow at Duke University,
8. Benjamin D. Lueck, fourth year medical student at Duke University,
9. Michael Macklin, MD, second year rheumatology fellow at University of Chicago,
10. Iman Qaiser, MD, rheumatologist at Choctaw Nation
11. Amanda Rodriguez, DO, second year internal medicine resident at Lankenau Medical Center,
12. Akrithi Updupa Garren, MD, rheumatologist at Medstar Washington Hospital Center,
13. Matthew Sparks, Associate Professor of Medicine at Duke University,
14. Lisa Criscione-Schreiber, Professor of Medicine at Duke University
15. Guy Katz, MD, Physician Investigator and Assistant in Medicine at Massachusetts General Hospital, 
16. David Leverenz, MD, MEd, Assistant Professor of Medicine at Duke University

Team Overview

In this mammoth (25,871 participants) RCT, investigators explore whether vitamin D and/or omega 3 fatty acid supplementation can ward of autoimmune disease. Older adults (men >50 and women >55) were randomized to receive vitamin D (2000 IU daily) plus omega 3 (1 g/day), vitamin D plus placebo, omega 3 plus placebo, or placebo alone. Then, the development of autoimmune diseases (RA, PMR, psoriasis, thyroid, IBD, or “other”) was assessed at 5 years. Those receiving vitamin D had a statistically significant reduction in the 5-year cumulative incidence of autoimmune disease (HR 0.78, 95% CI 0.61-0.99, NNT ~500). In the omega 3 fatty acid arm, there was no statistically significant change (HR 0.85, 95% CI 0.67-1.08).

Albeit an interesting finding, it is far from a slam dunk endorsement for vitamin D to prevent autoimmunity. This trial was limited to older adults; thus, the results are not generalizable to younger patients susceptible to conditions like SLE, scleroderma, etc. Despite the impressive number of enrollees, the cumulative incidence of new autoimmune disease was low (155 cases in the placebo group, 123 in the vitamin D group), resulting in high NNTs.

With so many caveats, why is this study practically perfect? Because it addresses the commonly asked question: “what can I take to stay healthy?” The VITAL study suggests vitamin D might help, particularly in men >50 and women >55, but it also allows us to keep our recommendations realistic. With a NNT of ~500, it’s clear that vitamin D is no panacea.

Want to learn more?

See the Q&A on theMednet.org about the following question: Do you recommend Vitamin D and omega 3 fatty acid supplementation for prevention of autoimmune disease?

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