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Accepted manuscript

Effect of supplementation with vitamin D on biochemical markers of iron status and erythropoiesis in older people: BEST-D trial

Published online by Cambridge University Press:  02 June 2025

Abigail A Lamikanra*
Affiliation:
National Health Service (NHS) Blood and Transplant, Oxford, UK. BRC- Haematology Theme and Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, UK.
Hoi Pat Tsang
Affiliation:
National Health Service (NHS) Blood and Transplant, Oxford, UK. BRC- Haematology Theme and Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, UK.
Alireza Morovat
Affiliation:
Department of Clinical Biochemistry, Oxford University Hospital Trust, Oxford, UK.
Harold Hin
Affiliation:
Hightown Surgery, Banbury, Oxfordshire UK Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.
Jonathan Emberson
Affiliation:
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.
Michael Hill
Affiliation:
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.
Robert Clarke
Affiliation:
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.
Jane Armitage
Affiliation:
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.
David J Roberts*
Affiliation:
National Health Service (NHS) Blood and Transplant, Oxford, UK. BRC- Haematology Theme and Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, UK. Department of Haematology, John Radcliffe Hospital, Oxford, UK.
*
Correspondence to: Dr Abigail A Lamikanra, e-mail: abi.lamikanra@nhsbt.nhs.uk and Professor David J Roberts, e-mail: david.roberts@nhsbt.nhs.uk Contact details: Dr Abigail A Lamikanra, NHSBT Blood and Transplant – Level 2, John Radcliffe Hospital, Oxford, OX3 9BQ, Tel: + 44 1865 387900; Prof David J Roberts, NHSBT Blood and Transplant – Level 2, John Radcliffe Hospital, Oxford, OX3 9BQ Tel: + 44 1865 387913
Correspondence to: Dr Abigail A Lamikanra, e-mail: abi.lamikanra@nhsbt.nhs.uk and Professor David J Roberts, e-mail: david.roberts@nhsbt.nhs.uk Contact details: Dr Abigail A Lamikanra, NHSBT Blood and Transplant – Level 2, John Radcliffe Hospital, Oxford, OX3 9BQ, Tel: + 44 1865 387900; Prof David J Roberts, NHSBT Blood and Transplant – Level 2, John Radcliffe Hospital, Oxford, OX3 9BQ Tel: + 44 1865 387913
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Abstract

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Previous observational studies suggested that vitamin D may control absorption of iron by inhibition of hepcidin, but the causal relevance of these associations is uncertain. Using placebo-controlled randomization, we assessed the effects of supplementation with vitamin D on biochemical markers of iron status and erythropoiesis in community-dwelling older people living in the United Kingdom (UK). The BEST-D trial, designed to establish the optimum dose of vitamin D3 for future trials, had 305 participants, aged 65 years or older, randomly allocated to 4000 IU vitamin D3 (n=102), 2000 IU vitamin D3 (n=102), or matching placebo (n=101). We estimated the effect of vitamin D allocation on plasma levels of hepcidin, soluble transferrin receptor (sTfR), ferritin, iron, transferrin, saturated transferrin (TSAT%), and the sTfR-ferritin index. Despite increases in 25-hydroxy-vitamin D, neither dose had significant effects on biochemical markers of iron status or erythropoiesis. Geometric mean concentrations were similar in vitamin D3 arms vs placebo for hepcidin (20.7 [SE 0.90] vs 20.5 [1.21] ng/mL), sTfR (0.69 [0.010] vs 0.70 [0.015] µg/mL), ferritin (97.1 [2.81] vs 97.8 [4.10] µg/L) and sTfR-ferritin ratio (0.36 [0.006] vs 0.36 [0.009]), respectively, while arithmetic mean levels were similar for iron (16.7 [0.38] vs 17.3 [0.54] µmol/L), transferrin (2.56 [0.014] vs 2.60 [0.021] g/dL), and TSAT% (26.5 [0.60] vs 27.5 [0.85]). The proportions of participants with ferritin <15 µg/L and TSAT<16% were unaltered by vitamin D3 suggesting that 12 months of daily supplementation with moderately high doses of vitamin D3 are unlikely to alter the iron status of older adults.

Type
Research Article
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society