One of the highlights of the recent Endocrine Society annual meeting in Boston was the release of new guidelines on the role of “vitamin D in disease prevention.”
These call for limiting vitamin D supplementation above the recommended daily intake for certain risk groups and advise against daily intake of 25-hydroxyvitamin D. [25(OH)D] Testing in healthy individuals.
Despite being close to the equator, Indians have been found to have low blood 25(OH)D (D) levels for a variety of reasons, including sun-avoidance behavior and extreme air pollution. Let’s look at some key points.
Should empirical vitamin D supplementation be used in children and adolescents (ages 1-18)?
For this group, the Panel Vitamin D supplementation Taking vitamin D is recommended to prevent nutritional rickets, which is still seen in India, and to lower the risk of respiratory infections. This includes fortified foods and supplements. A 2014 study showed that more than half of children in Delhi schools had vitamin D levels below 12ng/ml, which is very low. An Indian study found that 1000 IU per day was able to correct the deficiency.
Should adults under 50 take vitamin D supplements?
The committee recommended against routine vitamin D supplementation. However, given the high prevalence of osteoporosis and fractures, young age at onset, and low vitamin D levels in India, supplementation may be considered during winter, especially in sun-protected and urban areas.
Should adults over 75 take supplements?
For the general population in this age group, the panel recommends supplementation as it may reduce risk of mortality. This is independent of baseline vitamin D levels. A daily intake of 900-1000 units is recommended. This age group generally has a higher rate of bone disease/osteoporosis and a lower rate of healthy individuals. This should be decided by a physician based on medical condition.
How is your pregnancy?
The committee recommends taking Vitamin D supplements during pregnancy as it may reduce the risk of preeclampsia, intrauterine death, preterm birth, and neonatal death. This is independent of D levels. Researchers have tried a wide range of doses (600-5000 IU/day), but the optimal dose is yet to be determined. The average daily dose in trials was ~2500 IU/day. In the absence of studies to establish the optimal dose, ~2000 IU/day is a safe option for Indians during pregnancy.
What about vitamin D use in adults with prediabetes?
In addition to lifestyle changes, the committee recommended that adults with prediabetes take supplements to reduce the risk of progression to full-blown diabetes. A wide range of doses was used in the trials; a dose of about 2000 IU per day appears sufficient to achieve this effect. This is an important (and new) recommendation in India, where the prevalence and number of people with prediabetes is high (15.3%, 136 million people).
If indicated, should low doses of vitamin D be used daily or intermittently in higher doses?
For adults over 50 years of age who are indicated for vitamin D supplementation or treatment, the committee recommends taking a low dose of vitamin D daily. For Indians, taking 1,000-2,000 IU per day is a good option.
(With inputs from Prof S. Badada, Head, Endocrinology Department, PGI Chandigarh and Lt Gen RK Marwaha (Retd), Endocrinologist, DRDO, Delhi)
© Indian Express Ltd.
First uploaded: July 6, 2024, 7:45 AM
