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Previous observational studies suggested that vitamin D may control the absorption of iron (Fe) by inhibition of hepcidin, but the causal relevance of these associations is uncertain. Using placebo-controlled randomisation, we assessed the effects of supplementation with vitamin D on biochemical markers of Fe status and erythropoiesis in community-dwelling older people living in the 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, Fe, 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 Fe status or erythropoiesis. Geometric mean concentrations were similar in vitamin D3 arms v. placebo for hepcidin (20·7 [se 0·90] v. 20·5 [1·21] ng/ml), sTfR (0·69 [0·010] v. 0·70 [0·015] µg/ml), ferritin (97·1 [2·81] v. 97·8 [4·10] µg/l) and sTfR–ferritin ratio (0·36 [0·006] v. 0·36 [0·009]), respectively, while arithmetic mean levels were similar for Fe (16·7 [0·38] v. 17·3 [0·54] µmol/l), transferrin (2·56 [0·014] v. 2·60 [0·021] g/dl) and TSAT% (26·5 [0·60] v. 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 Fe status of older adults.
In June 2016 the UK shocked the world by voting to leave the European Union. In our previous book (Brexit: Why Britain Voted to Leave the European Union) we told the story of what happened in the referendum and why it produced a leave vote. This book is a sequel to the earlier one and examines what happened after the decision was made looking at events up to the point that the UK formally left the EU in January 2020. This was a period of unprecedented political and electoral turmoil in British politics which for a period looked like it could shatter the party system. It encompassed three elections and three different Prime Ministers and unprecedented volatility in both Parliamentary and electoral politics. The book maps out the twists and turns of the Brexit process, both at the level of the political elites and among the mass public. It then goes on to examine the long-run antecedents of this momentous decision, using data that goes back more than fifty years. Finally, it speculates about the economic and poltical consequences of Brexit for the future, while taking into account the Covid Pandemic which itself added to the turmoil in British politics.
In June 2016 the UK shocked the world by voting to leave the European Union. In our previous book (Brexit: Why Britain Voted to Leave the European Union) we told the story of what happened in the referendum and why it produced a leave vote. This book is a sequel to the earlier one and examines what happened after the decision was made looking at events up to the point that the UK formally left the EU in January 2020. This was a period of unprecedented political and electoral turmoil in British politics which for a period looked like it could shatter the party system. It encompassed three elections and three different Prime Ministers and unprecedented volatility in both Parliamentary and electoral politics. The book maps out the twists and turns of the Brexit process, both at the level of the political elites and among the mass public. It then goes on to examine the long-run antecedents of this momentous decision, using data that goes back more than fifty years. Finally, it speculates about the economic and poltical consequences of Brexit for the future, while taking into account the Covid Pandemic which itself added to the turmoil in British politics.