{"publication_id":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","content_hash":"sha256:95dffe28700375ce82616ec3189702998282ceb693e1904127f34a9737d2a7ee","nodes":[{"id":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","type":"publication","title":"Adjacent Evidence Brief: Calcium Supplementation Effects — full paper"},{"id":"claim_1","type":"claim","text":"Evidence-honesty note: 24/36 retained sources are indirect, review-level, adjacent, or mechanistic and are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims."},{"id":"claim_2","type":"claim","text":"This synthesis tests the thesis that evidence for Calcium Supplementation Effects is context-dependent, separating outcome-specific signals from broader claims and identifying the evidence gaps that should bound interpretation."},{"id":"claim_3","type":"claim","text":"Calcium supplementation has long been proposed as a low-cost public-health lever for bone, cardiovascular, and pregnancy-related outcomes, yet contemporary evidence has been complicated by discrepant findings across indications, populations, and dosing regimens."},{"id":"claim_4","type":"claim","text":"We conducted an AI-assisted structured evidence synthesis across the curated source set, applying a transparent audit trail in which each study was tagged for design, directness, outcome class, and direction of effect before integration."},{"id":"claim_5","type":"claim","text":"Across the corpus, the evidence base is context-dependent rather than uniformly favorable: pre-eclampsia prevention, certain insulin-related endpoints, and selected bone-fracture outcomes show benefit, while older-adult and pregnancy inflammation biomarkers, recurrent cardiovascular events, and several body-composition endpoints remain null or unfavorable, with mechanistic plausibility (Ioannidis 2005) coexisting alongside sparse or mixed human-RCT confirmation."},{"id":"claim_6","type":"claim","text":"We conclude that calcium supplementation should not be framed as a monolithic intervention: the most defensible indications remain high-risk pregnancy, while bone-fracture benefit in community-dwelling older adults and cardiovascular safety in at-risk populations remain insufficiently resolved and warrant further direct, outcome-stratified randomized evaluation."},{"id":"claim_7","type":"claim","text":"Evidence-abstraction note.** The 36 retained reference papers are not 36 independent primary clinical trials: 24 are review, indirect, mechanistic, or registered-protocol source-level summaries, and 12 are classified as direct interventional evidence. Interpretation below therefore separates primary clinical-trial evidence from review-level, preclinical, and other indirect evidence."},{"id":"claim_8","type":"claim","text":"This manuscript is reported as a Thin-corpus evidence brief. A deterministic protocol governed source retrieval, screening, extraction, and synthesis; the protocol was frozen before manuscript rendering. The full audit trail is in the supplementary `methods_pack.json` and the timestamped submission directory `synthesis-calcium_supplementation_effects-v06-DAILY-2026-07-01T12-45-35Z-R2`."},{"id":"claim_9","type":"claim","text":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text."},{"id":"claim_10","type":"claim","text":"Risk-of-bias framework assignment follows study design (RoB-2 for RCTs, ROBINS-I for non-randomised studies, AMSTAR-2 for systematic reviews / meta-analyses). Public appraisal claims are limited to populated `risk_of_bias.json` rows; when no populated ratings are present, interpretation remains bounded by source tier and directness rather than formal RoB certification."},{"id":"claim_11","type":"claim","text":"Evidence-tension synthesis: claims grouped by outcome class (cardiometabolic, contextual adjacent evidence, dosing and pharmacokinetics, immune and inflammation, longevity, muscle function, skeletal, fracture, and bone); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates."},{"id":"claim_12","type":"claim","text":"Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified."},{"id":"claim_13","type":"claim","text":"Additional corpus sources included animal/preclinical evidence; | Source | Outcome class | Direction | Directness | Tier | Finding |"},{"id":"claim_14","type":"claim","text":"| Chen 2022 | Cardiometabolic | null | review | B2 | 27 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"claim_15","type":"claim","text":"| Cormick 2020 | Cardiometabolic | unclear | indirect | B2 | representative non-significant statistic P = .408; not treated as positive or negative directional support unless source direction is coded |"},{"id":"claim_16","type":"claim","text":"| Cormick 2023 | Cardiometabolic | null | review | B2 | 20 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"claim_17","type":"claim","text":"| Cormick 2024 | Cardiometabolic | null | review | B1 | representative non-significant statistic P = 0.45; not treated as positive or negative directional support unless source direction is coded |"},{"id":"claim_18","type":"claim","text":"| Dwarkanath 2024 | Cardiometabolic | null | direct | A1 | 24 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"claim_19","type":"claim","text":"| Fu 2022 | Cardiometabolic | null | review | B2 | representative non-significant statistic P = 0.65; not treated as positive or negative directional support unless source direction is coded |"},{"id":"claim_20","type":"claim","text":"| Imdad 2011 | Cardiometabolic | null | review | B2 | 50 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"claim_21","type":"claim","text":"| Korhonen 2022 | Cardiometabolic | unclear | review | B1 | representative non-significant statistic P > 0.05; not treated as positive or negative directional support unless source direction is coded |"},{"id":"claim_22","type":"claim","text":"| Souza 2014 | Cardiometabolic | null | direct | A1 | representative non-significant statistic P=0.112; not treated as positive or negative directional support unless source direction is coded |"},{"id":"claim_23","type":"claim","text":"| Zhang 2026 | Cardiometabolic | null | indirect | B2 | 52 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"claim_24","type":"claim","text":"| Zhang 2020 | Longevity | unclear | review | B2 | representative non-significant statistic P = 0.45; not treated as positive or negative directional support unless source direction is coded |"},{"id":"claim_25","type":"claim","text":"| Gupta 2010 | Muscle Function | null | direct | A1 | 4 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"claim_26","type":"claim","text":"| Coombs 2023 | Skeletal, Fracture, and Bone | null | direct | A1 | 18 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"claim_27","type":"claim","text":"Outcome-class note:** Contextual Adjacent Evidence denotes background, boundary-condition, or adjacent-outcome sources. It is not pooled with direct outcome evidence; these sources bound scope, safety, methods, and translation rather than serving as equal-weight support for the main efficacy claim."},{"id":"claim_28","type":"claim","text":"| Evidence domain | Corpus slice | Strongest signal | Directness | Main limitation |"},{"id":"claim_29","type":"claim","text":"Direction reconciliation: receipt-level null or unclear coding is conservative claim-level coding. Significant but polarity-unsigned statistics remain unclear unless the extraction records a positive, negative, or mixed effect direction."},{"id":"claim_30","type":"claim","text":"Souza 2014 (Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial; representative non-significant statistic P=0.112; not treated as positive or negative directional support unless source direction is coded; outcome=Cardiometabolic; direction=null; directness=direct; tier=A1)."},{"id":"source_1","type":"source","study":"Effects of a multicomponent resistance-based exercise program with protein, vitamin D and calcium supplementation on cognition in men with prostate cancer treated with ADT: secondary analysis of a 12-month randomised controlled trial","year":2022,"doi":"10.1136/bmjopen-2021-060189","url":"https://doi.org/10.1136/bmjopen-2021-060189","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_2","type":"source","study":"Calcium supplementation during pregnancy and long‐term offspring outcome: a systematic literature review and meta‐analysis","year":2022,"doi":"10.1111/nyas.14729","url":"https://doi.org/10.1111/nyas.14729","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_3","type":"source","study":"The Effect of Calcium Supplementation on Body Weight Before and During Pregnancy in Women Enrolled in the WHO Calcium and Preeclampsia Trial","year":2020,"doi":"10.1177/0379572120944671","url":"https://doi.org/10.1177/0379572120944671","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_4","type":"source","study":"Calcium intake, calcium supplementation and cardiovascular disease and mortality in the British population: EPIC-norfolk prospective cohort study and meta-analysis","year":2020,"doi":"10.1007/s10654-020-00710-8","url":"https://doi.org/10.1007/s10654-020-00710-8","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_5","type":"source","study":"The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials","year":2022,"doi":"10.7554/eLife.79002","url":"https://doi.org/10.7554/eLife.79002","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_6","type":"source","study":"The effect of calcium supplementation on blood pressure in non-pregnant women with previous pre-eclampsia: A randomized placebo-controlled study","year":2021,"doi":"10.1016/j.preghy.2020.11.012","url":"https://doi.org/10.1016/j.preghy.2020.11.012","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_7","type":"source","study":"Effects of calcium supplementation on changes in the IL2, IL4, IL6, IL10 axes and oxidative stress in pregnant women at risk for pre-eclampsia","year":2024,"doi":"10.1186/s12884-023-06235-8","url":"https://doi.org/10.1186/s12884-023-06235-8","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_8","type":"source","study":"The joint effect of energy reduction with calcium supplementation on the risk factors of type 2 diabetes in the overweight population: a two-year randomized controlled trial","year":2021,"doi":"10.18632/aging.202485","url":"https://doi.org/10.18632/aging.202485","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_9","type":"source","study":"Effects of maternal calcium supplementation on offspring blood pressure and growth in childhood and adolescence in a population with a low-calcium intake: follow-up study of a randomized controlled trial","year":2024,"doi":"10.1016/j.ajcnut.2024.02.025","url":"https://doi.org/10.1016/j.ajcnut.2024.02.025","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_10","type":"source","study":"Effects of Lemon Beverage Containing Citric Acid with Calcium Supplementation on Bone Metabolism and Mineral Density in Postmenopausal Women: Double-Blind 11-Month Intervention Study","year":2021,"doi":"10.1155/2021/8824753","url":"https://doi.org/10.1155/2021/8824753","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_11","type":"source","study":"EFFECTS OF CALCIUM SUPPLEMENTATION ON THE RISK OF FRACTURE IN OLDER ADULTS","year":2025,"doi":"10.1590/1413-785220253306e284103","url":"https://doi.org/10.1590/1413-785220253306e284103","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_12","type":"source","study":"Association Between Calcium Supplementation and Recurrence of Cardiovascular Events in Patients With Cardiovascular Disease: A Population‐Based Cohort Study","year":2026,"doi":"10.1161/JAHA.125.047455","url":"https://doi.org/10.1161/JAHA.125.047455","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_13","type":"source","study":"The Positive and Negative Effects of Calcium Supplementation on Mortality in Septic ICU Patients Depend on Disease Severity: A Retrospective Study from the MIMIC-III","year":2022,"doi":"10.1155/2022/2520695","url":"https://doi.org/10.1155/2022/2520695","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_14","type":"source","study":"Effects of calcium supplementation on the prevention of preeclampsia: an umbrella review of systematic reviews and meta-analyses","year":2025,"doi":"10.3389/fmed.2025.1434416","url":"https://doi.org/10.3389/fmed.2025.1434416","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_15","type":"source","study":"Increased Reproductive Output and Telomere Shortening Following Calcium Supplementation in a Wild Songbird","year":2024,"doi":"10.1002/ece3.70483","url":"https://doi.org/10.1002/ece3.70483","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_16","type":"source","study":"Effects of calcium supplementation to resuscitation fluids in endurance horses: A randomized, blinded, clinical trial","year":2023,"doi":"10.1111/jvim.16715","url":"https://doi.org/10.1111/jvim.16715","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_17","type":"source","study":"Non-inferiority of low-dose compared to standard high-dose calcium supplementation in pregnancy: study protocol for two randomized, parallel group, non-inferiority trials in India and Tanzania","year":2021,"doi":"10.1186/s13063-021-05811-7","url":"https://doi.org/10.1186/s13063-021-05811-7","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_18","type":"source","study":"Calcium Supplementation in Pregnancy: A Systematic Review of Clinical Studies","year":2025,"doi":"10.3390/medicina61071195","url":"https://doi.org/10.3390/medicina61071195","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_19","type":"source","study":"Calcium supplementation for prevention of pre-eclampsia in high-risk women: study protocol for a randomised triple-blind placebo-controlled trial (CaPE)","year":2026,"doi":"10.1186/s13063-026-09513-w","url":"https://doi.org/10.1186/s13063-026-09513-w","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_20","type":"source","study":"Different Doses of Calcium Supplementation to Prevent Gestational Hypertension and Pre-Eclampsia: A Systematic Review and Network Meta-Analysis","year":2022,"doi":"10.3389/fnut.2021.795667","url":"https://doi.org/10.3389/fnut.2021.795667","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_21","type":"source","study":"Vitamin D supplementation and risk of stroke: A meta-analysis of randomized controlled trials","year":2022,"doi":"10.3389/fneur.2022.970111","url":"https://doi.org/10.3389/fneur.2022.970111","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_22","type":"source","study":"Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy","year":2024,"doi":"10.1056/NEJMoa2307212","url":"https://doi.org/10.1056/NEJMoa2307212","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_23","type":"source","study":"Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: a mixed-methods systematic review","year":2023,"doi":"10.1136/bmjopen-2022-070677","url":"https://doi.org/10.1136/bmjopen-2022-070677","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_24","type":"source","study":"Association of Vitamin D or Calcium Supplementation with Cardiovascular Outcomes and Mortality: A Meta-Analysis with Trial Sequential Analysis","year":2020,"doi":"10.1007/s12603-020-1551-9","url":"https://doi.org/10.1007/s12603-020-1551-9","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_25","type":"source","study":"The effect of calcium supplementation on calcium and bone metabolism during load carriage in women: protocol for a randomised controlled crossover trial","year":2023,"doi":"10.1186/s12891-023-06600-w","url":"https://doi.org/10.1186/s12891-023-06600-w","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_26","type":"source","study":"Vitamin D and calcium supplementation in women undergoing pharmacological management for postmenopausal osteoporosis: a level I of evidence systematic review","year":2025,"doi":"10.1186/s40001-025-02412-x","url":"https://doi.org/10.1186/s40001-025-02412-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_27","type":"source","study":"Effectiveness of calcium supplementation in the prevention of gestational hypertension: A systematic review and meta-analysis of randomised controlled trials.","year":2024,"doi":"10.1016/j.preghy.2024.101174","url":"https://doi.org/10.1016/j.preghy.2024.101174","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_28","type":"source","study":"Calcium supplementation for people with overweight or obesity.","year":2024,"doi":"10.1002/14651858.cd012268.pub2","url":"https://doi.org/10.1002/14651858.cd012268.pub2","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_29","type":"source","study":"The effect of vitamin D and calcium supplementation on inflammatory biomarkers, estradiol levels and severity of symptoms in women with postpartum depression: a randomized double-blind clinical trial.","year":2022,"doi":"10.1080/1028415x.2019.1707396","url":"https://doi.org/10.1080/1028415x.2019.1707396","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_30","type":"source","study":"Effects of Combined Calcium and Vitamin D Supplementation on Insulin Secretion, Insulin Sensitivity and β-Cell Function in Multi-Ethnic Vitamin D-Deficient Adults at Risk for Type 2 Diabetes: A Pilot Randomized, Placebo-Controlled Trial","year":2014,"doi":"10.1371/journal.pone.0109607","url":"https://doi.org/10.1371/journal.pone.0109607","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_31","type":"source","study":"Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial","year":2014,"doi":"10.1590/1414-431X20143629","url":"https://doi.org/10.1590/1414-431X20143629","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_32","type":"source","study":"Calcium Supplementation Increases Blood Creatinine Concentration in a Randomized Controlled Trial","year":2014,"doi":"10.1371/journal.pone.0108094","url":"https://doi.org/10.1371/journal.pone.0108094","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_33","type":"source","study":"Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: a meta-analysis of studies from developing countries","year":2011,"doi":"10.1186/1471-2458-11-S3-S18","url":"https://doi.org/10.1186/1471-2458-11-S3-S18","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_34","type":"source","study":"Systematic Review of Vitamin D and Hypertensive Disorders of Pregnancy","year":2018,"doi":"10.3390/nu10030294","url":"https://doi.org/10.3390/nu10030294","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_35","type":"source","study":"Risk of Ischemic Stroke Associated With Calcium Supplements With or Without Vitamin D: A Nested Case‐Control Study","year":2017,"doi":"10.1161/JAHA.117.005795","url":"https://doi.org/10.1161/JAHA.117.005795","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_36","type":"source","study":"Effect of cholecalciferol and calcium supplementation on muscle strength and energy metabolism in vitamin D-deficient Asian Indians: a randomized, controlled trial.","year":2010,"doi":"10.1111/j.1365-2265.2010.03816.x","url":"https://doi.org/10.1111/j.1365-2265.2010.03816.x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_37","type":"source","study":"**Outcome class** is assigned from the source's bound endpoint, population, and claim text; adjacent/background sources are separated from clinical outcome slices.","year":null,"doi":null,"url":null,"population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"citation"},{"id":"source_38","type":"source","study":"**Directness** is coded as direct only when a source tests the topic against a clinically proximate outcome in the relevant population; a qualifying direct source would be a human interventional or hard-endpoint study of the topic itself. Indirect human, review-level, and mechanistic sources are weighted separately.","year":null,"doi":null,"url":null,"population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"citation"},{"id":"source_39","type":"source","study":"**Directional signal** is counted within the assigned outcome class only. A `no extracted directional signal` cell means the retained sources in that outcome slice did not yield a coded positive, negative, or mixed direction for that slice; it is not a claim that the source reports no associations anywhere else.","year":null,"doi":null,"url":null,"population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"citation"},{"id":"source_40","type":"source","study":"**Evidence tier** follows the deterministic tier/directness taxonomy used in the source builder; the prose writer cannot move a source between classes after sources are frozen.","year":null,"doi":null,"url":null,"population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"citation"},{"id":"source_41","type":"source","study":"Ioannidis 2005","year":null,"doi":"10.1371/journal.pmed.0020124","url":"https://doi.org/10.1371/journal.pmed.0020124","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"citation"}],"edges":[{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_1","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_2","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_3","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_4","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_5","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_6","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_7","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_8","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_9","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_10","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_11","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_12","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_13","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_14","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_15","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_16","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_17","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_18","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_19","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_20","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_21","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_22","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_23","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_24","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_25","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_26","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_27","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_28","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_29","type":"contains_claim"},{"from":"798fcdb7-5e51-43e8-978e-937dfca0ad1c","to":"claim_30","type":"contains_claim"}],"screening":{"identified":36,"screened":36,"excluded":0,"included":36,"included_or_retained":36,"flow":["identified","screened","excluded_with_reasons","included"],"wording":"36 candidate receipts retained after source retrieval, deduplication, and topic filtering. 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