Vitamin D, a pleiotropic steroid hormone, has attracted growing research interest in non-skeletal diseases in recent years. The consensus statement on the role of vitamin D in metabolic health, developed at the 8th International Conference on Controversies in Vitamin D, systematically summarizes the mechanisms and clinical evidence of vitamin D in sarcopenia, cardiovascular diseases, abnormal glucose metabolism, obesity, and metabolic syndrome. The statement emphasizes that low serum 25-hydroxyvitamin D [25 (OH) D] levels are closely associated with various metabolic abnormalities. However, the benefits of vitamin D supplementation remain controversial, particularly in the general population, where its efficacy is still unclear. Based on the full text of the consensus statement, this article provides a systematic interpretation of its development methods, key points, evidence base, and clinical implications. It also discusses the current clinical practice of related disciplines, aiming to provide a reference for clinicians in the rational use of vitamin D.
Citation： ZHAO Zhi, ZENG Yi. Interpretation of the Expert Consensus Statement on the Role of Vitamin D in Metabolic Health. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(6): 875-883. doi: 10.7507/1002-1892.202603096 Copy
Copyright ? the editorial department of Chinese Journal of Reparative and Reconstructive Surgery of West China Medical Publisher. All rights reserved
| 1. | Veldurthy V, Wei R, Oz L, et al. Vitamin D, calcium homeostasis and aging. Bone Res, 2016, 4: 16041. doi: 10.1038/boneres.2016.41. |
| 2. | Giustina A, Bilezikian JP, Adler RA, et al. Consensus statement on vitamin D status assessment and supplementation: whys, whens, and hows. Endocr Rev, 2024, 45(5): 625-654. |
| 3. | Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the prevention of disease: An endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2024, 109(8): 1907-1947. |
| 4. | Luo J, Quan ZY, Lin S, et al. The association between blood concentration of 25-hydroxyvitamin D and sarcopenia: A meta-analysis. Asia Pac J Clin Nutr, 2018, 27(6): 1258-1270. |
| 5. | Zittermann A, Ernst JB, Prokop S, et al. Effect of vitamin D on all-causemortality in heart failure (EVITA): A 3-year randomized clinical trial with 4000 IU vitamin D daily. Eur Heart J, 2017, 38(29): 2279-2286. |
| 6. | Cubbon RM, Lowry JE, Drozd M, et al. Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure. Eur J Nutr, 2019, 58(6): 2535-2543. |
| 7. | Scragg R, Stewart AW, Waayer D, et al. Effect of monthly high-dose Vitamin D supplementation on cardiovascular disease in the vitamin D assessment study: A randomized clinical trial. JAMA Cardiol, 2017, 2(6): 608-616. |
| 8. | Pittas AG, Dawson-Hughes B, Sheehan P, et al. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med, 2019, 381(6): 520-530. |
| 9. | Kahwati LC, Weber RP, Pan HL, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults evidence report and systematic review for the US preventive services task force. JAMA, 2018, 319(15): 1600-1612. |
| 10. | Montenegro KR, Cruzat V, Carlessi R, et al. Mechanisms of vitamin D action in skeletal muscle. Nutr Res Rev, 2019, 32(2): 192-204. |
| 11. | Cruz-jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31. |
| 12. | Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307. |
| 13. | Girgis CM, Brennan-speranza TC. Vitamin D and skeletal muscle: Current concepts from preclinical studies. JBMR Plus, 2021, 5(12): e10575. doi: 10.1002/jbm4.10575. |
| 14. | Latham CM, Brightwell CR, Keeble AR, et al. Vitamin D promotes skeletal muscle regeneration and mitochondrial health. Front Physiol, 2021, 12: 660498. doi: 10.3389/fphys.2021.660498. |
| 15. | Salles J, Chanet A, Guillet C, et al. Vitamin D status modulates mitochondrial oxidative capacities in skeletal muscle: role in sarcopenia. Commun Biol, 2022, 5(1): 1288. doi: 10.1038/s42003-022-04246-3. |
| 16. | Cummings SR, Kiel DP, Black DM. Vitamin D supplementation and increased risk of falling: A cautionary tale of vitamin supplements retold. JAMA Intern Med, 2016, 176(2): 171-172. |
| 17. | Giustina A, Di filippo L, Aleksova A, et al. Consensus statement on vitamin D role in metabolic health. Metab-clin Exp, 2026, 176: 156484. doi: 10.1016/j.metabol.2025.156484. |
| 18. | Cantorna MT, Lin YD, Arora J, et al. Vitamin D regulates the microbiota to control the numbers of RORγt/FoxP3+regulatory T cells in the colon. Front Immunol, 2019, 10: 1772. doi: 10.3389/fimmu.2019.01772. |
| 19. | Kawahara T, Suzuki G, Mizuno S, et al. Active vitamin D treatment in the prevention of sarcopenia in adults with prediabetes (DPVD ancillary study): A randomised controlled trial. Lancet Health Longev, 2024, 5(4): e255-e263. |
| 20. | Dent E, Morley JE, Cruz-jentoft AJ, et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, diagnosis and management. J Nutr Health Aging, 2018, 22(10): 1148-1161. |
| 21. | Gkekas NK, Anagnostis P, Paraschou V, et al. The effect of vitamin D plus protein supplementation on sarcopenia: A systematic review and meta-analysis of randomized controlled trials. Maturitas, 2021, 145: 56-63. |
| 22. | Houston DK, Marsh AP, Neiberg RH, et al. Vitamin D supplementation and muscle power, strength and physical performance in older adults: A randomized controlled trial. Am J Clin Nutr, 2023, 117(6): 1086-1095. |
| 23. | Bauer JM, Verlaan S, Bautmans I, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: A randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc, 2015, 16(9): 740-747. |
| 24. | Yang AL, Lv QQ, Chen F, et al. The effect of vitamin D on sarcopenia depends on the level of physical activity in older adults. J Cachexia Sarcopenia Muscle, 2020, 11(3): 678-689. |
| 25. | Antoniak AE, Greig CA. The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: A systematic review and meta-analysis. BMJ Open, 2017, 7(7): e014619. doi: 10.1136/bmjopen-2016-014619. |
| 26. | Dawson-hughes B. Effect of vitamin D on risk of falls and fractures—The contribution of recent mega-trials. Metab Open, 2024, 23: 100300. doi: 10.1016/j.metop.2024.100300. |
| 27. | Smith LM, Gallagher JC, Suiter C. Medium doses of daily vitamin D decrease falls and higher doses of daily vitamin D3 increase falls: A randomized clinical trial. J Steroid Biochem Mol Biol, 2017, 173: 317-322. |
| 28. | Dawson-hughes B, Wang J, Barger K, et al. Intra-trial mean 25(OH)D and PTH levels and risk of falling in older men and women in the Boston STOP IT trial. J Clin Endocrinol Metab, 2022, 107(5): e1932-e1937. |
| 29. | Dudenkov DV, Mara KC, Petterson TM, et al. Serum 25-hydroxyvitamin D values and risk of all-cause and cause-specific mortality: A population-based cohort study. Mayo Clin Proc, 2018, 93(6): 721-730. |
| 30. | Binkley N, Sempos CT, Borchardt G, et al. Association of standardized serum 25-hydroxyvitamin D with falls in post-menopausal women. Osteoporosis Int, 2025, 36(2): 255-264. |
| 31. | Zittermann A, Berthold HK, Pilz S. The effect of vitamin D on fibroblast growth factor 23: A systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr, 2021, 75(6): 980-987. |
| 32. | Zittermann A, Berthold HK, Pilz S. Correction: The effect of vitamin D on fibroblast growth factor 23: A systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr, 2022, 76(3): 488. doi: 10.1038/s41430-021-01019-9. |
| 33. | Khaw KT, Stewart AW, Waayer D, et al. Effect of monthly high-dose vitamin D supplementation on falls and non-vertebral fractures: secondary and post-hoc outcomes from the randomised, double-blind, placebo-controlled ViDA trial. Lancet Diabetes Endocrinol, 2017, 5(6): 438-447. |
| 34. | Lee SH, Yu S. Effectiveness of multifactorial interventions in preventing falls among older adults in the community: A systematic review and meta-analysis. Int J Nurs Stud, 2020, 106: 103564. doi: 10.1016/j.ijnurstu.2020.103564. |
| 35. | Burt LA, Billington EO, Rose MS, et al. Effect of high-dose vitamin D supplementation on volumetric bone density and bone strength: A randomized clinical trial. JAMA, 2019, 322(8): 736-745. |
| 36. | Cosentino N, Campodonico J, Milazzo V, et al. Vitamin D and cardiovascular disease: Current evidence and future perspectives. Nutrients, 2021, 13(10): 3603. doi: 10.3390/nu13103603. |
| 37. | Carbone F, Liberale L, Libby P, et al. Vitamin D in atherosclerosis and cardiovascular events. Eur Heart J, 2023, 44(23): 2078-2094. |
| 38. | Jaiswal V, Ishak A, Ang SP, et al. Hypovitaminosis D and cardiovascular outcomes: A systematic review and meta-analysis. Ijc Heart Vasc, 2022, 40: 101019. doi: 10.1016/j.ijcha.2022.101019. |
| 39. | Kim DH, Meza CA, Clarke H, et al. Vitamin D and Endothelial Function. Nutrients, 2020, 12(2): 575. doi: 10.3390/nu12020575. |
| 40. | Fang AP, Zhao Y, Yang P, et al. Vitamin D and human health: evidence from Mendelian randomization studies. Eur J Epidemiol, 2024, 39(5): 467-490. |
| 41. | Luo Q, Yan W, Nie Q, et al. Vitamin D and heart failure: A two-sample mendelian randomization study. Nutr Metab Carbiovasc Dis, 2022, 32(11): 2612-2620. |
| 42. | Cimmino G, Morello A, Conte S, et al. Vitamin D inhibits tissue factor and CAMs expression in oxidized low-density lipoproteins-treated human endothelial cells by modulating NF-κB pathway. Eur J Pharmacol, 2020, 885: 173422. doi: 10.1016/j.ejphar.2020.173422. |
| 43. | Saponaro F, Marcocci C, Zucchi R. Vitamin D status and cardiovascular outcome. J Endocrinol Invest, 2019, 42(11): 1285-1290. |
| 44. | Wan ZZ, Guo JY, Pan A, et al. Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with diabetes. Diabetes Care, 2021, 44(2): 350-357. |
| 45. | Padoan L, Beltrami AP, Stenner E, et al. Left ventricular adverse remodeling after myocardial infarction and its association with vitamin D levels. Int J Cardiol, 2019, 277: 159-165. |
| 46. | Manson JE, Cook NR, Lee IM, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med, 2019, 380(1): 33-44. |
| 47. | Virtanen JK, Nurmi T, Aro A, et al. Vitamin D supplementation and prevention of cardiovascular disease and cancer in the finnish vitamin D trial: A randomized controlled trial. Am J Clin Nutr, 2022, 115(5): 1300-1310. |
| 48. | Thompson B, Waterhouse M, English DR, et al. Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trial. BMJ, 2023, 381: e075230. doi: 10.1136/bmj-2023-075230. |
| 49. | Barbarawi M, Kheiri B, Zayed Y, et al. Vitamin D supplementation and cardiovascular disease risks in more than 83000 individuals in 21 randomized clinical trials: A meta-analysis. JAMA Cardiol, 2019, 4(8): 765-775. |
| 50. | Pei YY, Zhang Y, Peng XC, et al. Association of vitamin D supplementation with cardiovascular events: A systematic review and meta-analysis. Nutrients, 2022, 14(15): 3158. doi: 10.3390/nu14153158. |
| 51. | Zhang DD, Cheng C, Wang Y, et al. Effect of vitamin D on blood pressure and hypertension in the general population: An update meta-analysis of cohort studies and randomized controlled trials. Prev Chronic Dis, 2020, 17: 190307. doi: 10.5888/pcd17.190307. |
| 52. | Meng R, Radkhah N, Ghalichi F, et al. The impact of vitamin D supplementation on improving blood pressure: Evidence obtained from an umbrella meta-analysis. Clin Ther, 2023, 45(10): e208-e216. |
| 53. | Tang Q, Liu L, Chen M. Effects of vitamin D supplementation on patients with chronic heart failure: A meta-analysis. Nutr Clin Metab, 2024, 38(3): 168-178. |
| 54. | Virtanen JK, Hantunen S, Lamberg-allardt C, et al. The effect of vitamin D3 supplementation on atrial fibrillation in generally healthy men and women: The finnish vitamin D trial. Am Heart J, 2023, 264: 177-182. |
| 55. | Zhang YL, Li JW, Qiu Y, et al. Association between the circulating level of 25-hydroxyvitamin D and clinical results after cardiac surgery: A meta-analysis and systematic review. Front Cardiovasc Med, 2021, 8: 734504. doi: 10.3389/fcvm.2021.734504. |
| 56. | Sun R, Xu Y, Ji ZJ, et al. Update on the impact of lipid and glucose control on diabetic wound healing. Metab Open, 2025, 28: 100408. doi: 10.1016/j.metop.2025.100408. |
| 57. | Wolden-kirk H, Overbergh L, Christesen HT, et al. Vitamin D and diabetes: Its importance for beta cell and immune function. Mol Cell Endocrinol, 2011, 347(1-2): 106-120. |
| 58. | Zhang Y, Tan HW, Tang JJ, et al. Effects of vitamin D supplementation on prevention of type 2 diabetes in patients with prediabetes: A systematic review and meta-analysis. Diabetes Care, 2020, 43(7): 1650-1658. |
| 59. | Argano C, Mirarchi L, Amodeo S, et al. The role of vitamin D and its molecular bases in insulin resistance, diabetes, metabolic syndrome, and cardiovascular disease: State of the art. Int J Mol Sci, 2023, 24(20): 15485. doi: 10.3390/ijms242015485. |
| 60. | Santos RKF, Pereira RO, Brandao-lima PN, et al. Association among vitamin D receptor gene polymorphisms, metabolic control, and inflammatory markers in type 2 diabetes: A systematic review and meta-analysis. Nutr Rev, 2026, 84(3): 540-550. |
| 61. | Waterhouse M, Hope B, Krause L, et al. Vitamin D and the gut microbiome: a systematic review of in vivo studies. Eur J Nutr, 2019, 58(7): 2895-2910. |
| 62. | Song YQ, Wang L, Pittas AG, et al. Blood 25-hydroxy vitamin D levels and Incident type 2 diabetes. Diabetes Care, 2013, 36(5): 1422-1428. |
| 63. | Mccarthy K, Laird E, O’Halloran AM, et al. Association between vitamin D deficiency and the risk of prevalent type 2 diabetes and incident prediabetes: A prospective cohort study using data from The Irish Longitudinal Study on Ageing (TILDA). Eclinicalmedicine, 2022, 53: 101654. doi: 10.1016/j.eclinm.2022.101654. |
| 64. | Lu L, Bennett DA, Millwood IY, et al. Association of vitamin D with risk of type 2 diabetes: A Mendelian randomisation study in European and Chinese adults. PLoS Med, 2018, 15(5): e1002566. doi: 10.1371/journal.pmed.1002566. |
| 65. | Mansur JL. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med, 2019, 381(18): 1785-1785. |
| 66. | Pittas AG, Kawahara T, Jorde R, et al. Vitamin D and risk for type 2 diabetes in people with prediabetes a systematic review and meta-analysis of individual participant data from 3 randomized clinical trials. Ann Intern Med, 2023, 176(3): 355-363. |
| 67. | Farahmand MA, Daneshzad E, Fung TT, et al. What is the impact of vitamin D supplementation on glycemic control in people with type-2 diabetes: a systematic review and meta-analysis of randomized controlled trails. Bmc Endocr Disord, 2023, 23(1): 15. doi: 10.1186/s12902-022-01209-x. |
| 68. | Virtanen JK, Hantunen S, Kallio N, et al. The effect of vitamin D3 supplementation on the incidence of type 2 diabetes in healthy older adults not at high risk for diabetes (FIND): A randomised controlled trial. Diabetologia, 2025, 68(4): 715-726. |
| 69. | Di Filippo L, Giustina A. Vitamin D deficiency and type 2 diabetes: The dangerous link between two modern pandemics. J Clin Endocrinol Metab, 2025, 110(3): e905-e906. |
| 70. | Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr, 2000, 72(3): 690-693. |
| 71. | Drincic AT, Armas LAG, Van diest EE, et al. Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity, 2012, 20(7): 1444-1448. |
| 72. | Vimaleswaran KS, Berry DJ, Lu C, et al. Causal relationship between obesity and vitamin D status: Bi-directional mendelian randomization analysis of multiple cohorts. PLoS Med, 2013, 10(2): e1001383. doi: 10.1371/journal.pmed.1001383. |
| 73. | Pourshahidi LK. Vitamin D and obesity: current perspectives and future directions. Proc Nutr Soc, 2015, 74(2): 115-124. |
| 74. | Lu SQ, Cao ZB. Interplay between vitamin D and adipose tissue: Implications for adipogenesis and adipose tissue function. Nutrients, 2023, 15(22): 4832. doi: 10.3390/nu15224832. |
| 75. | Nimitphong H, Park E, Lee MJ. Vitamin D regulation of adipogenesis and adipose tissue functions. Nutr Res Pract, 2020, 14(6): 553-567. |
| 76. | Tobias DK, Luttmann-gibson H, Mora S, et al. Association of body weight with response to vitamin D supplementation and metabolism. Jama Netw Open, 2023, 6(1): e2250681. doi: 10.1001/jamanetworkopen.2022.50681. |
| 77. | Perna S. Is vitamin D supplementation useful for weight loss programs? A systematic review and meta-analysis of randomized controlled trials. Medicina, 2019, 55(7): 368. doi: 10.3390/medicina55070368. |
| 78. | Duan LZ, Han L, Liu Q, et al. Effects of vitamin D supplementation on general and central obesity: Results from 20 randomized controlled trials involving apparently healthy populations. Ann Nutr Metab, 2020, 76(3): 153-164. |
| 79. | Lee K, Kim J. Serum vitamin D status and metabolic syndrome: a systematic review and dose-response meta-analysis. Nutr Res Pract, 2021, 15(3): 329-345. |
| 80. | Qi KJ, Zhao ZT, Zhang W, et al. The impacts of vitamin D supplementation in adults with metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Front Pharmacol, 2022, 13: 1033026. doi: 10.3389/fphar.2022.1033026. |
| 81. | Wolters M, Marron M, Foraita R, et al. Longitudinal associations between vitamin D status and cardiometabolic risk markers among children and adolescents. J Clin Endocrinol Metab, 2023, 108(12): e1731-e1742. |
| 82. | Hajhashemy Z, Foshati S, Saneei P. Relationship between abdominal obesity (based on waist circumference) and serum vitamin D levels: A systematic review and meta-analysis of epidemiologic studies. Nutr Rev, 2022, 80(5): 1105-1117. |
| 83. | Alanouti F, Abboud M, Papandreou D, et al. Effects of vitamin D supplementation on lipid profile in adults with the metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Nutrients, 2020, 12(11): 3352. doi: 10.3390/nu12113352. |
- 1. Veldurthy V, Wei R, Oz L, et al. Vitamin D, calcium homeostasis and aging. Bone Res, 2016, 4: 16041. doi: 10.1038/boneres.2016.41.
- 2. Giustina A, Bilezikian JP, Adler RA, et al. Consensus statement on vitamin D status assessment and supplementation: whys, whens, and hows. Endocr Rev, 2024, 45(5): 625-654.
- 3. Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the prevention of disease: An endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2024, 109(8): 1907-1947.
- 4. Luo J, Quan ZY, Lin S, et al. The association between blood concentration of 25-hydroxyvitamin D and sarcopenia: A meta-analysis. Asia Pac J Clin Nutr, 2018, 27(6): 1258-1270.
- 5. Zittermann A, Ernst JB, Prokop S, et al. Effect of vitamin D on all-causemortality in heart failure (EVITA): A 3-year randomized clinical trial with 4000 IU vitamin D daily. Eur Heart J, 2017, 38(29): 2279-2286.
- 6. Cubbon RM, Lowry JE, Drozd M, et al. Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure. Eur J Nutr, 2019, 58(6): 2535-2543.
- 7. Scragg R, Stewart AW, Waayer D, et al. Effect of monthly high-dose Vitamin D supplementation on cardiovascular disease in the vitamin D assessment study: A randomized clinical trial. JAMA Cardiol, 2017, 2(6): 608-616.
- 8. Pittas AG, Dawson-Hughes B, Sheehan P, et al. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med, 2019, 381(6): 520-530.
- 9. Kahwati LC, Weber RP, Pan HL, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults evidence report and systematic review for the US preventive services task force. JAMA, 2018, 319(15): 1600-1612.
- 10. Montenegro KR, Cruzat V, Carlessi R, et al. Mechanisms of vitamin D action in skeletal muscle. Nutr Res Rev, 2019, 32(2): 192-204.
- 11. Cruz-jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
- 12. Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307.
- 13. Girgis CM, Brennan-speranza TC. Vitamin D and skeletal muscle: Current concepts from preclinical studies. JBMR Plus, 2021, 5(12): e10575. doi: 10.1002/jbm4.10575.
- 14. Latham CM, Brightwell CR, Keeble AR, et al. Vitamin D promotes skeletal muscle regeneration and mitochondrial health. Front Physiol, 2021, 12: 660498. doi: 10.3389/fphys.2021.660498.
- 15. Salles J, Chanet A, Guillet C, et al. Vitamin D status modulates mitochondrial oxidative capacities in skeletal muscle: role in sarcopenia. Commun Biol, 2022, 5(1): 1288. doi: 10.1038/s42003-022-04246-3.
- 16. Cummings SR, Kiel DP, Black DM. Vitamin D supplementation and increased risk of falling: A cautionary tale of vitamin supplements retold. JAMA Intern Med, 2016, 176(2): 171-172.
- 17. Giustina A, Di filippo L, Aleksova A, et al. Consensus statement on vitamin D role in metabolic health. Metab-clin Exp, 2026, 176: 156484. doi: 10.1016/j.metabol.2025.156484.
- 18. Cantorna MT, Lin YD, Arora J, et al. Vitamin D regulates the microbiota to control the numbers of RORγt/FoxP3+regulatory T cells in the colon. Front Immunol, 2019, 10: 1772. doi: 10.3389/fimmu.2019.01772.
- 19. Kawahara T, Suzuki G, Mizuno S, et al. Active vitamin D treatment in the prevention of sarcopenia in adults with prediabetes (DPVD ancillary study): A randomised controlled trial. Lancet Health Longev, 2024, 5(4): e255-e263.
- 20. Dent E, Morley JE, Cruz-jentoft AJ, et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, diagnosis and management. J Nutr Health Aging, 2018, 22(10): 1148-1161.
- 21. Gkekas NK, Anagnostis P, Paraschou V, et al. The effect of vitamin D plus protein supplementation on sarcopenia: A systematic review and meta-analysis of randomized controlled trials. Maturitas, 2021, 145: 56-63.
- 22. Houston DK, Marsh AP, Neiberg RH, et al. Vitamin D supplementation and muscle power, strength and physical performance in older adults: A randomized controlled trial. Am J Clin Nutr, 2023, 117(6): 1086-1095.
- 23. Bauer JM, Verlaan S, Bautmans I, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: A randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc, 2015, 16(9): 740-747.
- 24. Yang AL, Lv QQ, Chen F, et al. The effect of vitamin D on sarcopenia depends on the level of physical activity in older adults. J Cachexia Sarcopenia Muscle, 2020, 11(3): 678-689.
- 25. Antoniak AE, Greig CA. The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: A systematic review and meta-analysis. BMJ Open, 2017, 7(7): e014619. doi: 10.1136/bmjopen-2016-014619.
- 26. Dawson-hughes B. Effect of vitamin D on risk of falls and fractures—The contribution of recent mega-trials. Metab Open, 2024, 23: 100300. doi: 10.1016/j.metop.2024.100300.
- 27. Smith LM, Gallagher JC, Suiter C. Medium doses of daily vitamin D decrease falls and higher doses of daily vitamin D3 increase falls: A randomized clinical trial. J Steroid Biochem Mol Biol, 2017, 173: 317-322.
- 28. Dawson-hughes B, Wang J, Barger K, et al. Intra-trial mean 25(OH)D and PTH levels and risk of falling in older men and women in the Boston STOP IT trial. J Clin Endocrinol Metab, 2022, 107(5): e1932-e1937.
- 29. Dudenkov DV, Mara KC, Petterson TM, et al. Serum 25-hydroxyvitamin D values and risk of all-cause and cause-specific mortality: A population-based cohort study. Mayo Clin Proc, 2018, 93(6): 721-730.
- 30. Binkley N, Sempos CT, Borchardt G, et al. Association of standardized serum 25-hydroxyvitamin D with falls in post-menopausal women. Osteoporosis Int, 2025, 36(2): 255-264.
- 31. Zittermann A, Berthold HK, Pilz S. The effect of vitamin D on fibroblast growth factor 23: A systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr, 2021, 75(6): 980-987.
- 32. Zittermann A, Berthold HK, Pilz S. Correction: The effect of vitamin D on fibroblast growth factor 23: A systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr, 2022, 76(3): 488. doi: 10.1038/s41430-021-01019-9.
- 33. Khaw KT, Stewart AW, Waayer D, et al. Effect of monthly high-dose vitamin D supplementation on falls and non-vertebral fractures: secondary and post-hoc outcomes from the randomised, double-blind, placebo-controlled ViDA trial. Lancet Diabetes Endocrinol, 2017, 5(6): 438-447.
- 34. Lee SH, Yu S. Effectiveness of multifactorial interventions in preventing falls among older adults in the community: A systematic review and meta-analysis. Int J Nurs Stud, 2020, 106: 103564. doi: 10.1016/j.ijnurstu.2020.103564.
- 35. Burt LA, Billington EO, Rose MS, et al. Effect of high-dose vitamin D supplementation on volumetric bone density and bone strength: A randomized clinical trial. JAMA, 2019, 322(8): 736-745.
- 36. Cosentino N, Campodonico J, Milazzo V, et al. Vitamin D and cardiovascular disease: Current evidence and future perspectives. Nutrients, 2021, 13(10): 3603. doi: 10.3390/nu13103603.
- 37. Carbone F, Liberale L, Libby P, et al. Vitamin D in atherosclerosis and cardiovascular events. Eur Heart J, 2023, 44(23): 2078-2094.
- 38. Jaiswal V, Ishak A, Ang SP, et al. Hypovitaminosis D and cardiovascular outcomes: A systematic review and meta-analysis. Ijc Heart Vasc, 2022, 40: 101019. doi: 10.1016/j.ijcha.2022.101019.
- 39. Kim DH, Meza CA, Clarke H, et al. Vitamin D and Endothelial Function. Nutrients, 2020, 12(2): 575. doi: 10.3390/nu12020575.
- 40. Fang AP, Zhao Y, Yang P, et al. Vitamin D and human health: evidence from Mendelian randomization studies. Eur J Epidemiol, 2024, 39(5): 467-490.
- 41. Luo Q, Yan W, Nie Q, et al. Vitamin D and heart failure: A two-sample mendelian randomization study. Nutr Metab Carbiovasc Dis, 2022, 32(11): 2612-2620.
- 42. Cimmino G, Morello A, Conte S, et al. Vitamin D inhibits tissue factor and CAMs expression in oxidized low-density lipoproteins-treated human endothelial cells by modulating NF-κB pathway. Eur J Pharmacol, 2020, 885: 173422. doi: 10.1016/j.ejphar.2020.173422.
- 43. Saponaro F, Marcocci C, Zucchi R. Vitamin D status and cardiovascular outcome. J Endocrinol Invest, 2019, 42(11): 1285-1290.
- 44. Wan ZZ, Guo JY, Pan A, et al. Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with diabetes. Diabetes Care, 2021, 44(2): 350-357.
- 45. Padoan L, Beltrami AP, Stenner E, et al. Left ventricular adverse remodeling after myocardial infarction and its association with vitamin D levels. Int J Cardiol, 2019, 277: 159-165.
- 46. Manson JE, Cook NR, Lee IM, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med, 2019, 380(1): 33-44.
- 47. Virtanen JK, Nurmi T, Aro A, et al. Vitamin D supplementation and prevention of cardiovascular disease and cancer in the finnish vitamin D trial: A randomized controlled trial. Am J Clin Nutr, 2022, 115(5): 1300-1310.
- 48. Thompson B, Waterhouse M, English DR, et al. Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trial. BMJ, 2023, 381: e075230. doi: 10.1136/bmj-2023-075230.
- 49. Barbarawi M, Kheiri B, Zayed Y, et al. Vitamin D supplementation and cardiovascular disease risks in more than 83000 individuals in 21 randomized clinical trials: A meta-analysis. JAMA Cardiol, 2019, 4(8): 765-775.
- 50. Pei YY, Zhang Y, Peng XC, et al. Association of vitamin D supplementation with cardiovascular events: A systematic review and meta-analysis. Nutrients, 2022, 14(15): 3158. doi: 10.3390/nu14153158.
- 51. Zhang DD, Cheng C, Wang Y, et al. Effect of vitamin D on blood pressure and hypertension in the general population: An update meta-analysis of cohort studies and randomized controlled trials. Prev Chronic Dis, 2020, 17: 190307. doi: 10.5888/pcd17.190307.
- 52. Meng R, Radkhah N, Ghalichi F, et al. The impact of vitamin D supplementation on improving blood pressure: Evidence obtained from an umbrella meta-analysis. Clin Ther, 2023, 45(10): e208-e216.
- 53. Tang Q, Liu L, Chen M. Effects of vitamin D supplementation on patients with chronic heart failure: A meta-analysis. Nutr Clin Metab, 2024, 38(3): 168-178.
- 54. Virtanen JK, Hantunen S, Lamberg-allardt C, et al. The effect of vitamin D3 supplementation on atrial fibrillation in generally healthy men and women: The finnish vitamin D trial. Am Heart J, 2023, 264: 177-182.
- 55. Zhang YL, Li JW, Qiu Y, et al. Association between the circulating level of 25-hydroxyvitamin D and clinical results after cardiac surgery: A meta-analysis and systematic review. Front Cardiovasc Med, 2021, 8: 734504. doi: 10.3389/fcvm.2021.734504.
- 56. Sun R, Xu Y, Ji ZJ, et al. Update on the impact of lipid and glucose control on diabetic wound healing. Metab Open, 2025, 28: 100408. doi: 10.1016/j.metop.2025.100408.
- 57. Wolden-kirk H, Overbergh L, Christesen HT, et al. Vitamin D and diabetes: Its importance for beta cell and immune function. Mol Cell Endocrinol, 2011, 347(1-2): 106-120.
- 58. Zhang Y, Tan HW, Tang JJ, et al. Effects of vitamin D supplementation on prevention of type 2 diabetes in patients with prediabetes: A systematic review and meta-analysis. Diabetes Care, 2020, 43(7): 1650-1658.
- 59. Argano C, Mirarchi L, Amodeo S, et al. The role of vitamin D and its molecular bases in insulin resistance, diabetes, metabolic syndrome, and cardiovascular disease: State of the art. Int J Mol Sci, 2023, 24(20): 15485. doi: 10.3390/ijms242015485.
- 60. Santos RKF, Pereira RO, Brandao-lima PN, et al. Association among vitamin D receptor gene polymorphisms, metabolic control, and inflammatory markers in type 2 diabetes: A systematic review and meta-analysis. Nutr Rev, 2026, 84(3): 540-550.
- 61. Waterhouse M, Hope B, Krause L, et al. Vitamin D and the gut microbiome: a systematic review of in vivo studies. Eur J Nutr, 2019, 58(7): 2895-2910.
- 62. Song YQ, Wang L, Pittas AG, et al. Blood 25-hydroxy vitamin D levels and Incident type 2 diabetes. Diabetes Care, 2013, 36(5): 1422-1428.
- 63. Mccarthy K, Laird E, O’Halloran AM, et al. Association between vitamin D deficiency and the risk of prevalent type 2 diabetes and incident prediabetes: A prospective cohort study using data from The Irish Longitudinal Study on Ageing (TILDA). Eclinicalmedicine, 2022, 53: 101654. doi: 10.1016/j.eclinm.2022.101654.
- 64. Lu L, Bennett DA, Millwood IY, et al. Association of vitamin D with risk of type 2 diabetes: A Mendelian randomisation study in European and Chinese adults. PLoS Med, 2018, 15(5): e1002566. doi: 10.1371/journal.pmed.1002566.
- 65. Mansur JL. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med, 2019, 381(18): 1785-1785.
- 66. Pittas AG, Kawahara T, Jorde R, et al. Vitamin D and risk for type 2 diabetes in people with prediabetes a systematic review and meta-analysis of individual participant data from 3 randomized clinical trials. Ann Intern Med, 2023, 176(3): 355-363.
- 67. Farahmand MA, Daneshzad E, Fung TT, et al. What is the impact of vitamin D supplementation on glycemic control in people with type-2 diabetes: a systematic review and meta-analysis of randomized controlled trails. Bmc Endocr Disord, 2023, 23(1): 15. doi: 10.1186/s12902-022-01209-x.
- 68. Virtanen JK, Hantunen S, Kallio N, et al. The effect of vitamin D3 supplementation on the incidence of type 2 diabetes in healthy older adults not at high risk for diabetes (FIND): A randomised controlled trial. Diabetologia, 2025, 68(4): 715-726.
- 69. Di Filippo L, Giustina A. Vitamin D deficiency and type 2 diabetes: The dangerous link between two modern pandemics. J Clin Endocrinol Metab, 2025, 110(3): e905-e906.
- 70. Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr, 2000, 72(3): 690-693.
- 71. Drincic AT, Armas LAG, Van diest EE, et al. Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity, 2012, 20(7): 1444-1448.
- 72. Vimaleswaran KS, Berry DJ, Lu C, et al. Causal relationship between obesity and vitamin D status: Bi-directional mendelian randomization analysis of multiple cohorts. PLoS Med, 2013, 10(2): e1001383. doi: 10.1371/journal.pmed.1001383.
- 73. Pourshahidi LK. Vitamin D and obesity: current perspectives and future directions. Proc Nutr Soc, 2015, 74(2): 115-124.
- 74. Lu SQ, Cao ZB. Interplay between vitamin D and adipose tissue: Implications for adipogenesis and adipose tissue function. Nutrients, 2023, 15(22): 4832. doi: 10.3390/nu15224832.
- 75. Nimitphong H, Park E, Lee MJ. Vitamin D regulation of adipogenesis and adipose tissue functions. Nutr Res Pract, 2020, 14(6): 553-567.
- 76. Tobias DK, Luttmann-gibson H, Mora S, et al. Association of body weight with response to vitamin D supplementation and metabolism. Jama Netw Open, 2023, 6(1): e2250681. doi: 10.1001/jamanetworkopen.2022.50681.
- 77. Perna S. Is vitamin D supplementation useful for weight loss programs? A systematic review and meta-analysis of randomized controlled trials. Medicina, 2019, 55(7): 368. doi: 10.3390/medicina55070368.
- 78. Duan LZ, Han L, Liu Q, et al. Effects of vitamin D supplementation on general and central obesity: Results from 20 randomized controlled trials involving apparently healthy populations. Ann Nutr Metab, 2020, 76(3): 153-164.
- 79. Lee K, Kim J. Serum vitamin D status and metabolic syndrome: a systematic review and dose-response meta-analysis. Nutr Res Pract, 2021, 15(3): 329-345.
- 80. Qi KJ, Zhao ZT, Zhang W, et al. The impacts of vitamin D supplementation in adults with metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Front Pharmacol, 2022, 13: 1033026. doi: 10.3389/fphar.2022.1033026.
- 81. Wolters M, Marron M, Foraita R, et al. Longitudinal associations between vitamin D status and cardiometabolic risk markers among children and adolescents. J Clin Endocrinol Metab, 2023, 108(12): e1731-e1742.
- 82. Hajhashemy Z, Foshati S, Saneei P. Relationship between abdominal obesity (based on waist circumference) and serum vitamin D levels: A systematic review and meta-analysis of epidemiologic studies. Nutr Rev, 2022, 80(5): 1105-1117.
- 83. Alanouti F, Abboud M, Papandreou D, et al. Effects of vitamin D supplementation on lipid profile in adults with the metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Nutrients, 2020, 12(11): 3352. doi: 10.3390/nu12113352.