Randomized controlled trials of vitamin D and cancer incidence: A modeling study

Although geographic ecological studies and observational studies find that ultraviolet B exposure and 25-hydroxyvitamin D [25(OH) D] concentrations are inversely correlated with 15 - 20 types of cancer, few randomized controlled trials (RCTs) of vitamin D support those findings. The poor design of some RCTs may account for that lack of support. Most vitamin D RCTs to date have considered the vitamin D dose, rather than initial, final, or changes in, serum 25(OH) D concentrations. Here a model is developed for use in designing and analyzing vitamin D RCTs with application to cancer incidence. The input variables of the model are vitamin D dose, baseline and achieved 25(OH) D concentrations, known rates of cancer for the population, and numbers of participants for the treatment and placebo arms is estimated - vitamin D dosage and numbers of participants are varied to achieve desired hazard ratio significance, using information from two vitamin D RCTs on cancer incidence conducted in Nebraska with good agreement between the model estimates and reported hazard ratios. Further improvements to the conduct of vitamin D RCTs would be to start the trial with a moderate bolus dose to achieve the desired 25(OH) D concentrations, and bloodspot 25(OH) D assay use in summer and winter annually to monitor seasonal and long-term changes in 25(OH) D concentration and compliance, and to allow dosage adjustment for achievement of desired vitamin D status.