 Welcome questions for her? Yeah. Is that all? Shouldn't I be worried about safety of this supplementation? Maybe yes. Ladies and gentlemen, my name is Zarytaj Manidi from the School of Population Health. I'm doing a research on safety of long-term, large-dose vitamin B supplementation. So I'm a part of a bigger group, Vida Study. Vida Study has started this work six years ago in 2010, when Professor Robert Sprague could get this 5 million dollars fund unprecedented in a scale for New Zealand. And around the world, it really randomized control trials to look into the impact of, health impact, of vitamin D supplementations on participants aged between 50 to 84. So what was the primary outcomes of Vida Study? It was to see whether supplements, vitamin D supplementations can decrease the risk of cardiovascular diseases in the first place. And secondly, whether it can decrease the risk of acute respiratory infections, falls, and fractures. But where does my study stand for? It had also some sub-studies. Safety was one of them. So as well as it's important to see whether there is a benefit, it's very important to see the side effects or safety part of these supplementations. Is there any side effects? So as I told you, it was a randomized control trial with two arms. From these 5,100 people, half of them were randomized to vitamin D, and the other half were randomized to control or placebo arm. But none of them knew which capsule they were taking because it was double blind ones. As well as them, even investigators didn't know that. So I wanted to see if side effects was weighing like this towards vitamin D or like this, or they were evenly distributed between these two. But what were my instruments? As I told you, it was a large randomized control trial with vitamin D supplementation. They gave all participants for three to four years 2.5 milligrams vitamin D3. Every month, with these monthly capsules that they were sending to participants, they also gave them this monthly questionnaire where they could report their health status, where I could get the side effects that they were reporting. As well as that, they had done this baseline, comprehensive baseline assessments, clinical and biochemical assessments, as well as interviews. In that interview, they asked them about their lifestyle, physical activity, sound exposure, and all the medical history that they had, and their medications. So all these databases helped me to have enough instruments to do further research. How about side effects? What kind of side effects should I be expecting? So I felt, OK, I have to go to the literature. But I did a systematic review of all randomized control trials that had at least given their participants six months of supplementation. I thought, OK, six months should be enough time to have any side effects reported. And also, I included all those studies. I took this from a, I included all those studies with vitamin D provided that they didn't give calcium in one arm if they haven't given this calcium in placebo arm. So moving on to my systematic review, I found 1800 articles. After exclusion, I ended up having 121 studies. I used information about side effects from these studies, entered it into a review manager. Review manager calculated the risk of the thing for me, a statistical thing. So as you can see, down there, it gave me risk ratio of giving, for example, in this instance, hypercalcemia, of giving supplementation and experiencing hypercalcemia. In this instance, it had increased hypercalcemia in overall these studies that reported hypercalcemia. The same thing, the same first blood for other outcomes like the motorological outcomes, gastrointestinal symptoms, and other, the same thing it gave me. So it was enough information for me to move on to my study. So what did I study? What did I find? In the preliminary results that I get, I found that 260 people in vitamin D versus 245 in placebo reported side effects. It was statistically significant, not an statistically significant difference. Actually, the scale was quite similar between two arms. But I thought, what about the time? Were there more participants reporting side effects? Later in the study or not? How about the difference between these two arms? So as you can see, the broken red line represents vitamin D, while the blue line represents placebo. On the y-axis, you can see frequency of side effects. It's quite similar, isn't it? It's very similar. I don't see any difference. If there is, so I thought, if there is side effects reported, it shouldn't be really related to vitamin D. So what else? I have to dig quite a lot into this research, using those databases, looking into lifestyle factors, variables, and other variables, and see whether probably there's sun exposure, socioeconomic factors, and other factors affected reporting these side effects. So that's me. That's my research. I would like to thank my supervisors and my colleagues and statisticians in the Department of Epidemiology and Biostatistics, School of Profession and Health. Thank you very much. Apologies for interrupting your presentations in touch. That's all right. We welcome questions now for her. Placibo is not actually a drug. It's quite similar to the drug we are giving them, so they can distinguish between these two. So any drug in interventional studies, they should have a placebo so that participants can't report something that is from their perception of knowing that they're on that drug. So it helps in clinical trials. You should go. Should I? You should go. I don't think so. No, no. It's quite old time. Yeah, that's right. I've got a question. Sorry, over here. How prevalent is the use of vitamin D supplements in New Zealand? I'm not quite sure, to be honest. I can't remember. I'm sure that I did a review, but to be honest, I don't have the answer to this question exactly. But I mean, it must be a problem that you'll study. It is a problem because about 65% of New Zealanders have normal vitamin D status, but other students don't have. And this vitamin D deficiency means about 35% have deficiency. It's amazing because we have really good sunlight here. But with the scare of getting skin cancer and high prevalence of skin cancer in New Zealand, people obviously don't go out as much as they have to get enough vitamin D. One of us is going to ask a screen question. Pretty much the fact is New Zealand's quite a dangerous environment when it comes to the sun. Yeah, exactly. If your research had proven that vitamin D supplementations were unsafe, was that a concern for you? Yeah, yeah, a concern for everyone, I guess. Yeah, yeah. But yeah, up to this point, vitamin D was quite safe. I mean, instead of going out, there's somebody being a bit more careful. To be honest, if you can be outside, I mean, I'm protected for 10 minutes every day, during 10 o'clock AM to 4 o'clock PM, you can get enough vitamin D from sun. And yeah, in real life, you are busy during that time, so you can't get out to sun. This leads to my question. In your performance, you had you putting on sunscreen, has the sun's safe message had a direct impact on vitamin D in New Zealand? Is there a direct correlation that we're fixing one problem and creating another? Yeah, yeah, actually, sunscreen can block the amount of UVB you can get from sun that helps your skin to make vitamin D into your body, yeah. It can blocks. It depends on how much sunscreen you apply, obviously, but yeah. But we don't have children with rickets, yeah. Yeah. Yeah. Thank you very much, Serene Touch, for that presentation.