No health benefits of vitamin D3, omega-3s and exercise in elderly: JAMA

In adults aged 70 or older with no major comorbidities, treatment with vitamin D, omega-3s, or strength-training exercise does not seem to improve a range of physical and cognitive outcomes.

The effect of vitamin D on blood pressure was tested in this trial based on preclinical studies documenting that vascular smooth muscle cells, endothelial cells, and cardiomyocytes expressed the vitamin D receptor. Additional preclinical evidence showed that vitamin D regulates the reninangiotensin-aldosterone system via suppression of renin gene expression and that vitamin D receptor–knockout mice have hypertension. However, clinical trials of vitamin D and hypertension have shown mixed results .

Although Vitamin D,omega-3 fatty acids, and exercise may prevent age-related chronic diseases, the findings of the recent study do not support the use of vitamin D, omega-3, or a strength-training exercise program for these clinical outcomes among relatively healthy older adults.

Researchers sought to carry out a study to test whether vitamin D, omega-3s, and a strength-training exercise program, alone or in combination, improved 6 health outcomes among older adults. The 6 primary outcomes were change in systolic and diastolic blood pressure (BP), Short Physical Performance Battery (SPPB), Montreal Cognitive Assessment (MoCA), and incidence rates (IRs) of nonvertebral fractures and infections over 3 years.

The study was designed as a double-blind, placebo-controlled, 2 × 2 × 2 factorial randomized clinical trial among 2157 adults aged 70 years or older who had no major health events in the 5 years prior to enrollment and had sufficient mobility and good cognitive status. Patients were recruited between December 2012 and November 2014, and final follow-up was in November 2017.

Participants were randomized to 3 years of intervention in 1 of the following 8 groups: 2000 IU/d of vitamin D₃, 1 g/d of omega-3s, and a strength-training exercise program (n = 264); vitamin D₃ and omega-3s (n = 265); vitamin D₃ and exercise (n = 275); vitamin D₃ alone (n = 272); omega-3s and exercise (n = 275); omega-3s alone (n = 269); exercise alone (n = 267); or placebo (n = 270).

On data analysis, the following facts emerged.

• Among 2157 randomized participants (mean age, 74.9 years; 61.7% women), 1900 (88%) completed the study.
• Median follow-up was 2.99 years. Overall, there were no statistically significant benefits of any intervention individually or in combination for the 6 end points at 3 years.
• For instance, the differences in mean change in systolic BP with vitamin D vs no vitamin D and with omega-3s vs no omega-3s were both −0.8 (99% CI, –2.1 to 0.5) mm Hg, with P < .13 and P < .11, respectively; the difference in mean change in diastolic BP with omega-3s vs no omega-3s was –0.5 (99% CI, –1.2 to 0.2) mm Hg; P = .06); and the difference in mean change in IR of infections with omega-3s vs no omega-3s was –0.13 (99% CI, –0.23 to –0.03), with an IR ratio of 0.89 (99% CI, 0.78-1.01; P = .02).
• No effects were found on the outcomes of SPPB, MoCA, and incidence of nonvertebral fractures).
• A total of 25 deaths were reported, with similar numbers in all treatment groups.

Based on the results , the research team noted that "Among adults without major comorbidities aged 70 years or older, treatment with vitamin D₃, omega-3s, or a strength-training exercise program did not result in statistically significant differences in improvement in systolic or diastolic blood pressure, nonvertebral fractures, physical performance, infection rates, or cognitive function. These findings do not support the effectiveness of these 3 interventions for these clinical outcomes."

For full article follow the link: i:10.1001/jama.2020.16909

Primary source:JAMA