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Vitamin D regulates a wide array of genes involved in inflammation and immunity,

inconsistently associated with reduced risk of several autoimmune diseases in observational studies

Active form of vitamin D regulates genes, inflammation, acquired and innate immune responses

Dietary marine derived long chain omega 3 fatty acids decrease systemic inflammation in some autoimmune diseases

Evidence is needed on whether omega 3 fatty acids lower the risk of developing autoimmune disease

Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial

https://www.bmj.com/content/376/bmj-2021-066452

To investigate whether vitamin D and marine derived long chain omega 3 fatty acids reduce autoimmune disease risk.

Vitamin D and omega 3 trial (VITAL), a nationwide (US), randomized, double blind, placebo controlled trial

N = 25, 871

consisting of,

12, 786 men ≥50

13, 085 women ≥55

18,046 non- Hispanic white

5,106 black

2,152 as other racial and ethnic groups

Mean age was 67.1

INTERVENTIONS

Vitamin D (2000 IU/day) or placebo

Omega 3 fatty acids (1000 mg/day) or placebo

Participants self-reported all incident autoimmune diseases from baseline to a median of 5.3 years,

these diseases were confirmed by medical record review







In the vitamin D arm

Treatment group

123 developed an autoimmune disease

Placebo group

155 developed an autoimmune disease

Hazard ratio 0.78

P = 0.05

In the omega 3 fatty acids arm

Treatment group

130 developed an autoimmune disease

Placebo group

148 developed an autoimmune disease

P=0.19

CONCLUSIONS

Vitamin D supplementation for five years

with or without omega 3 fatty acids,

reduced autoimmune disease by 22%

Omega 3 fatty acid supplementation

with or without vitamin D,

reduced the autoimmune disease rate by 15%

(not statistically significant)

The clinical importance of this trial is high because these are well tolerated, non-toxic supplements,

and other effective treatments to reduce the incidence of autoimmune diseases are lacking

Autoimmune diseases

Rheumatoid arthritis

Polymyalgia rheumatica

Hashimoto’s thyroiditis, too little thyroid hormone)

Psoriasis

Type 1 diabetes mellitus

Multiple sclerosis

Lupus

Inflammatory bowel disease (Crohn’s Ulcerative colitis)

Addison’s (too little of cortisol)

Grave’s (too much thyroid hormone),

Myasthenia gravis

Pernicious anemia

Autoimmune vasculitis

Celiac disease (gluten protein from grains)

Inflammatory autoimmune response to self-tissues

Third leading cause of morbidity in the industrialized world

Chronic conditions

Increasing prevalence with age

Lack of effective treatments

More about the VITAL RCT

https://clinicaltrials.gov/ct2/show/NCT01169259

VITamin D and OmegA-3 TriaL (VITAL)

A randomized clinical trial, US based

N = 25,871

Investigating

Daily dietary supplements of vitamin D3 (2000 IU),

or omega-3 fatty acids (Omacor® fish oil, 1 gram),

reduces the risk of developing,

cancer

heart disease

stroke,

in people with no specific history

5-year intervention phase (study pill-taking, median 5.3 years) has ended

post-intervention observational follow-up, ongoing