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    Clinical Trial Results:
    Prevention of depression and poor physical function in older persons with vitamin D supplementation

    Summary
    EudraCT number
    2012-005332-29
    Trial protocol
    NL  
    Global end of trial date
    09 May 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    27 Jun 2022
    First version publication date
    27 Jun 2022
    Other versions
    Summary report(s)
    Trial results paper

    Trial information

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    Trial identification
    Sponsor protocol code
    D-Vitaal protocol version 4.0
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    D-Vitaal: 12/354, Netherlands Trial Register: NTR3845
    Sponsors
    Sponsor organisation name
    VU University Medical Centre
    Sponsor organisation address
    P.O. Box 7057, Amsterdam, Netherlands, 1007 MB
    Public contact
    Trial Coordinator: N.M. van Schoor; Sponsor: P. Lips, VU University Medical Centre, 0031 (0)204448439, nm.vanschoor@amsterdamumc.nl
    Scientific contact
    Trial Coordinator: N.M. van Schoor; Sponsor: P. Lips, VU University Medical Centre, 0031 (0)204448439, nm.vanschoor@amsterdamumc.nl
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    15 May 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    09 May 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    09 May 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of the D-Vitaal trial is to answer the following two questions: 1. Does vitamin D supplementation decrease depressive symptoms in older persons? 2. Does vitamin D supplementation improve physical performance and decrease functional limitations in older persons?
    Protection of trial subjects
    Careful health monitoring of participants during all follow-up moments (baseline, 2 weeks, 3 months, 6 months, 9 months, 12 months).
    Background therapy
    Ensuring sufficient calcium intake by either advising to take at least 3 dairy products per day or prescribing calcium tablets 500 mg/day.
    Evidence for comparator
    Not applicable, placebo was used as comparator.
    Actual start date of recruitment
    01 Feb 2013
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 155
    Worldwide total number of subjects
    155
    EEA total number of subjects
    155
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    42
    From 65 to 84 years
    113
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Recruitment commenced in May 2013 and ended in April 2015. 19% of the participants were recruited through general practitioners; 81% of participants were recruited through municipality registries in and around Amsterdam.

    Pre-assignment
    Screening details
    Recruitment: n ≈ 56,000 Screening questionnaire returned: n = 2312. Excluded: n = 1733 Screening interview conducted: n = 579. Excluded: n = 424 Randomized: n = 155 Reasons for exclusion: please refer to the flow chart (Figure 1) publication of the trial results: de Koning et al. (2019) Am J Clin Nutr. 2019; 110(5): 1119-1130.

    Period 1
    Period 1 title
    overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Data analyst, Assessor
    Blinding implementation details
    Randomization was performed by an independent pharmacist. Only this pharmacist knew the key to the medication numbers for the participants (intervention group or placebo group).

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Intervention group
    Arm description
    3 daily tablets of 400 IU/day vitamin D3 (=1200 IU/day) for 12 months
    Arm type
    Experimental

    Investigational medicinal product name
    vitamin D3
    Investigational medicinal product code
    Other name
    cholecalciferol
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    3 daily oral tablets of 400 IU vitamin D3 (cholecalciferol, Devaron) = 1200 IU/day.

    Arm title
    Placebo group
    Arm description
    3 daily tablets identical to intervention group for 12 months
    Arm type
    Placebo

    Investigational medicinal product name
    placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    3 daily oral placebo tablets, identical to tablets of intervention group but without vitamin D.

    Number of subjects in period 1
    Intervention group Placebo group
    Started
    77
    78
    Completed
    74
    71
    Not completed
    3
    7
         Adverse event, serious fatal
    1
    -
         perceived side effects by participant
    2
    3
         no longer motivated / too burdensome
    -
    4

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Intervention group
    Reporting group description
    3 daily tablets of 400 IU/day vitamin D3 (=1200 IU/day) for 12 months

    Reporting group title
    Placebo group
    Reporting group description
    3 daily tablets identical to intervention group for 12 months

    Reporting group values
    Intervention group Placebo group Total
    Number of subjects
    77 78 155
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    study sample: 155 persons aged 60-80 years.
    Units: years
        median (inter-quartile range (Q1-Q3))
    67.8 (65.4 to 71.7) 67.3 (63.4 to 72.0) -
    Gender categorical
    Units: Subjects
        Female
    45 44 89
        Male
    32 34 66

    End points

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    End points reporting groups
    Reporting group title
    Intervention group
    Reporting group description
    3 daily tablets of 400 IU/day vitamin D3 (=1200 IU/day) for 12 months

    Reporting group title
    Placebo group
    Reporting group description
    3 daily tablets identical to intervention group for 12 months

    Primary: the difference in the 12-mo course of the depressive symptoms score between the 2 treatment groups

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    End point title
    the difference in the 12-mo course of the depressive symptoms score between the 2 treatment groups
    End point description
    End point type
    Primary
    End point timeframe
    Baseline - 6 months - 12 months (all three time points were included in the linear mixed models analysis.
    End point values
    Intervention group Placebo group
    Number of subjects analysed
    75
    76
    Units: CES-D score
        arithmetic mean (standard error)
    6.49 ± 7.62
    6.38 ± 6.43
    Attachments
    See Table 2
    Statistical analysis title
    linear mixed models
    Statistical analysis description
    please refer to published paper on this trial: De Koning et al. (2019) Vitamin D supplementation for the prevention of depression and poor physical function in older persons: the D-Vitaal study, a randomized clinical trial. Am J Cl Nutr 110(5): 1119-1130.
    Comparison groups
    Intervention group v Placebo group
    Number of subjects included in analysis
    151
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    P-value
    < 0.05
    Method
    Mixed models analysis
    Parameter type
    Slope
    Point estimate
    -0.14
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.36
         upper limit
    2.08
    Notes
    [1] - 2-sided tests to investigate the difference between the intervention (vitamin D) and placebo group.
    Statistical analysis title
    Copy of linear mixed models
    Statistical analysis description
    please refer to published paper on this trial: De Koning et al. (2019) Vitamin D supplementation for the prevention of depression and poor physical function in older persons: the D-Vitaal study, a randomized clinical trial. Am J Cl Nutr 110(5): 1119-1130.
    Comparison groups
    Placebo group v Intervention group
    Number of subjects included in analysis
    151
    Analysis specification
    Pre-specified
    Analysis type
    other [2]
    P-value
    < 0.05
    Method
    Mixed models analysis
    Parameter type
    Slope
    Point estimate
    -0.14
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.36
         upper limit
    2.08
    Notes
    [2] - 2-sided tests to investigate the difference between the intervention (vitamin D) and placebo group.

    Primary: the difference in the 12-mo course of the functional limitation scores between the 2 treatment groups

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    End point title
    the difference in the 12-mo course of the functional limitation scores between the 2 treatment groups
    End point description
    End point type
    Primary
    End point timeframe
    Baseline - 6 months - 12 months (all three time points were included in the linear mixed models analysis.
    End point values
    Intervention group Placebo group
    Number of subjects analysed
    75
    76
    Units: LASA Functional Limitations Questionnair
        arithmetic mean (standard deviation)
    0.33 ± 1.19
    0.05 ± 1.16
    Attachments
    See Table 2
    Statistical analysis title
    linear mixed models analysis
    Statistical analysis description
    Please refer to published paper on this trial: De Koning et al. (2019) Vitamin D supplementation for the prevention of depression and poor physical function in older persons: the D-Vitaal study, a randomized clinical trial. Am J Cl Nutr 110(5): 1119-1130.
    Comparison groups
    Intervention group v Placebo group
    Number of subjects included in analysis
    151
    Analysis specification
    Pre-specified
    Analysis type
    other [3]
    P-value
    < 0.05
    Method
    Mixed models analysis
    Parameter type
    Slope
    Point estimate
    -0.11
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.42
         upper limit
    0.2
    Notes
    [3] - 2-sided tests to investigate the difference between the intervention (vitamin D) and placebo group.

    Primary: the difference in the 12-mo course of the physical performance score between the 2 treatment groups

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    End point title
    the difference in the 12-mo course of the physical performance score between the 2 treatment groups
    End point description
    End point type
    Primary
    End point timeframe
    Baseline - 6 months - 12 months (all three time points were included in the linear mixed models analysis.
    End point values
    Intervention group Placebo group
    Number of subjects analysed
    75
    76
    Units: SPPB score
        arithmetic mean (standard deviation)
    -0.18 ± 1.86
    -0.20 ± 2.36
    Attachments
    See Table 2
    Statistical analysis title
    linear mixed models analysis
    Statistical analysis description
    please refer to published paper on this trial: De Koning et al. (2019) Vitamin D supplementation for the prevention of depression and poor physical function in older persons: the D-Vitaal study, a randomized clinical trial. Am J Cl Nutr 110(5): 1119-1130.
    Comparison groups
    Intervention group v Placebo group
    Number of subjects included in analysis
    151
    Analysis specification
    Pre-specified
    Analysis type
    other [4]
    P-value
    < 0.05
    Method
    Mixed models analysis
    Parameter type
    Slope
    Point estimate
    -0.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.79
         upper limit
    0.38
    Notes
    [4] - 2-sided tests to investigate the difference between the intervention (vitamin D) and placebo group.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    baseline - 12 months.
    Adverse event reporting additional description
    Please refer to supplementary table 2 of the published paper on this trial. This table lists all (S)AEs, spearately for the intervention and placebo group.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    see published paper
    Dictionary version
    1
    Reporting groups
    Reporting group title
    Intervention group
    Reporting group description
    vitamin D group

    Reporting group title
    placebo group
    Reporting group description
    placebo

    Serious adverse events
    Intervention group placebo group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 77 (7.79%)
    10 / 78 (12.82%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    Vascular disorders
    Thrombosis
         subjects affected / exposed
    0 / 77 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    2 / 77 (2.60%)
    0 / 78 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    stroke
         subjects affected / exposed
    0 / 77 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac disorder
         subjects affected / exposed
    3 / 77 (3.90%)
    5 / 78 (6.41%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Eye disorder
         subjects affected / exposed
    0 / 77 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary haemorrhage
         subjects affected / exposed
    1 / 77 (1.30%)
    0 / 78 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Psychiatric disorders
    Psychiatric decompensation
         subjects affected / exposed
    0 / 77 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Fracture
         subjects affected / exposed
    0 / 77 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0.1%
    Non-serious adverse events
    Intervention group placebo group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    67 / 77 (87.01%)
    72 / 78 (92.31%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Precancerous disorder
         subjects affected / exposed
    0 / 77 (0.00%)
    1 / 78 (1.28%)
         occurrences all number
    0
    1
    Vascular disorders
    Cardiovascular disorder
         subjects affected / exposed
    16 / 77 (20.78%)
    18 / 78 (23.08%)
         occurrences all number
    16
    18
    Fluid retention
         subjects affected / exposed
    2 / 77 (2.60%)
    2 / 78 (2.56%)
         occurrences all number
    2
    2
    Immune system disorders
    Diabetes mellitus worsening
         subjects affected / exposed
    3 / 77 (3.90%)
    1 / 78 (1.28%)
         occurrences all number
    3
    1
    Social circumstances
    Traffic accident
         subjects affected / exposed
    3 / 77 (3.90%)
    2 / 78 (2.56%)
         occurrences all number
    3
    2
    Reproductive system and breast disorders
    Andrological disorder
         subjects affected / exposed
    2 / 77 (2.60%)
    2 / 78 (2.56%)
         occurrences all number
    2
    2
    Gynaecological disorder
         subjects affected / exposed
    1 / 77 (1.30%)
    1 / 78 (1.28%)
         occurrences all number
    1
    1
    Respiratory, thoracic and mediastinal disorders
    Pulmonary disease
         subjects affected / exposed
    12 / 77 (15.58%)
    13 / 78 (16.67%)
         occurrences all number
    12
    13
    Psychiatric disorders
    Mental health problem
         subjects affected / exposed
    9 / 77 (11.69%)
    12 / 78 (15.38%)
         occurrences all number
    9
    12
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    3 / 77 (3.90%)
    2 / 78 (2.56%)
         occurrences all number
    3
    2
    Animal bite
         subjects affected / exposed
    2 / 77 (2.60%)
    0 / 78 (0.00%)
         occurrences all number
    2
    0
    Nervous system disorders
    Balance disorder
         subjects affected / exposed
    5 / 77 (6.49%)
    9 / 78 (11.54%)
         occurrences all number
    5
    9
    Fatigue / malaise
         subjects affected / exposed
    5 / 77 (6.49%)
    11 / 78 (14.10%)
         occurrences all number
    5
    11
    neurological disorder
         subjects affected / exposed
    4 / 77 (5.19%)
    9 / 78 (11.54%)
         occurrences all number
    4
    9
    Sleep problem
         subjects affected / exposed
    1 / 77 (1.30%)
    5 / 78 (6.41%)
         occurrences all number
    1
    5
    Headache
         subjects affected / exposed
    2 / 77 (2.60%)
    1 / 78 (1.28%)
         occurrences all number
    2
    1
    Eye disorders
    Eye disorder
         subjects affected / exposed
    3 / 77 (3.90%)
    9 / 78 (11.54%)
         occurrences all number
    3
    9
    Skin and subcutaneous tissue disorders
    Skin problem
         subjects affected / exposed
    10 / 77 (12.99%)
    9 / 78 (11.54%)
         occurrences all number
    10
    9
    Hair loss
         subjects affected / exposed
    2 / 77 (2.60%)
    1 / 78 (1.28%)
         occurrences all number
    2
    1
    Renal and urinary disorders
    Urinary tract disorder
         subjects affected / exposed
    7 / 77 (9.09%)
    9 / 78 (11.54%)
         occurrences all number
    7
    9
    Endocrine disorders
    Vitamin B12 deficiency
         subjects affected / exposed
    1 / 77 (1.30%)
    0 / 78 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    Arthritis / tendinitis / musculoskeletal disorder
         subjects affected / exposed
    45 / 77 (58.44%)
    52 / 78 (66.67%)
         occurrences all number
    45
    52
    dental disorder
         subjects affected / exposed
    1 / 77 (1.30%)
    3 / 78 (3.85%)
         occurrences all number
    1
    3
    Fracture
         subjects affected / exposed
    1 / 77 (1.30%)
    1 / 78 (1.28%)
         occurrences all number
    1
    1
    Infections and infestations
    Ear/nose/throat disorder
         subjects affected / exposed
    5 / 77 (6.49%)
    4 / 78 (5.13%)
         occurrences all number
    5
    4
    Infectious disease
         subjects affected / exposed
    23 / 77 (29.87%)
    27 / 78 (34.62%)
         occurrences all number
    23
    27
    Metabolism and nutrition disorders
    Gastrointestinal disorder
         subjects affected / exposed
    18 / 77 (23.38%)
    15 / 78 (19.23%)
         occurrences all number
    18
    15
    Thyroid disorder
         subjects affected / exposed
    0 / 77 (0.00%)
    1 / 78 (1.28%)
         occurrences all number
    0
    1
    Weight loss/gain
         subjects affected / exposed
    2 / 77 (2.60%)
    1 / 78 (1.28%)
         occurrences all number
    2
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Dec 2013
    D-Vitaal Amendment 1.0, version: 1.0, date: 2013-12-17: This amendment contained changes to the study protocol that do not affect the safety of the participants or the investigational product. Main changes: 1. Addition of alternative recruitment strategies, due to disappointing inclusion results; 2. Two blood draws instead of three, to reduce the burden on respondents. This has no scientific consequences. 3. We moved questions from the interviews (baseline, 6 and 12 months) to a pre-fillable questionnaire to reduce interview time. 4. Addition of a short questionnaire on physical functioning to the screening, as the original questionnaire performs less well as a screening tool in this study population. 5. As an additional safeguard for respondent safety, we added a sentence to the informed consent form that the respondent gives permission for his/her primary care physician to be informed if any health problems come to light during the study.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    not applicable.

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/31340012
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