New study recommends 2000 IU of vitamin D supplementation daily

In a recently published narrative review, nutrients, Researchers found evidence supporting the efficacy and safety of vitamin D supplementation at 2000 international units (IU), or 50 micrograms (μg) per day, for the prevention and treatment of vitamin D deficiency in the general adult population. are being discussed.

study: Vitamin D supplementation: A review of the evidence supporting the general adult daily dose of 2000 international units (50 μg) of vitamin D. Image credit: FotoHelin/Shutterstock.com

background

Vitamin D deficiency has many adverse clinical consequences, including poor musculoskeletal health manifested in diseases such as rickets and osteomalacia.

Additionally, vitamin D may be important in preventing other skeletal diseases such as cancer and diabetes.

Vitamin D is biologically inactive in the human body. Therefore, laboratory detection of vitamin D deficiency involves measuring serum concentrations of 25-hydroxyvitamin D (25(OH)D), a vitamin D metabolite that is utilized by the body. This includes UVB (sunlight) and food sources such as fish and mushrooms.

Worldwide, low serum 25(OH)D levels, i.e., <25–30 nmol/L and <50 nmol/L, occur in approximately 5–18% and 24–49% of people, respectively; The need is emphasized. We call for immediate action to reduce the burden of vitamin D deficiency around the world.

A dose of 50 μg per day may increase the entire 25(OH)D distribution to higher levels in certain populations. However, there are safety concerns with such doses, and higher strata of the distribution may also increase the risk of vitamin D overdose.

Furthermore, given the extra impact of vitamin D on skeletal health, the safety concerns of targeting 75 nmol/L (30 ng/mL) outweigh the 25(OH) needed for vitamin D prophylaxis. It is important to focus on achieving the D level. Optimal target serum 25(OH)D concentration for skeletal health.

The researchers therefore further investigated whether achieving serum 25(OH)D levels ≥50 nmol/L should be a goal.

Current vitamin D supplementation guidelines

Guidelines for vitamin D intake establish a target serum 25(OH)D concentration and determine the dose needed to achieve that level, assuming adequate intake of other nutrients and season (winter or summer). Recommended.

Therefore, current guidelines recommend a vitamin D intake of 400 to 800 IU per day. However, individuals from different ethnicities and regions may require higher intakes of 2008-2672 IU to achieve serum 25(OH)D levels of 50 nmol/L or higher.

What should the target serum 25(OH)D level be: 75 nmol/L (30 ng/mL) or 2000 IU (50 μg)?

Many observational studies have shown that serum 25(OH)D levels above 50 nmol/L can prevent rickets and osteomalacia, while concentrations above 75 nmol/L can improve health outcomes in diabetes and cancer. suggests that it is necessary.

The optimal concentration required may also vary depending on the study population and desired outcome.

Additionally, the authors note that randomized controlled trials (RCTs) testing 25(OH)D needs may be biased toward healthy people who may not be accurately representative of the general population, particularly obese patients. He pointed out that there is.

In fact, the optimal serum 25(OH)D concentration for most chronic diseases is just above 75 nmol/L (30 ng/mL).

Therefore, obese people, those with a high body mass index (BMI), and patients with malabsorption syndromes may require higher doses of vitamin D to increase serum 25(OH)D levels.

For some people, supplementing with 2000 IU of vitamin D daily does not meet the threshold, such as patients with inflammatory bowel disease who have increased disease activity.

Even drugs such as antiepileptic drugs can influence the reduction of serum 25(OH)D concentrations by modulating metabolism.

Vitamin D toxicity can lead to hypercalcemia when serum 25(OH)D concentrations exceed 150 ng/mL. Therefore, clinicians advise caution in those taking vitamin D supplements.

Recent RCTs such as the Vitamin D and OmegA-3 trial (VITAL) have shown the safety of using 2000 IU of vitamin D per day in the general adult population with no signs of vitamin D toxicity for 5.3 years. Data were collected to demonstrate the safety of this daily dose.

Additionally, a meta-analysis of 15 vitamin D RCTs found no increase in kidney stones with supplementation of 70 μg or more of vitamin D for at least 1 year.

Another meta-analysis found that supplementation with 3200 to 4000 IU of vitamin D daily for 6 months increased the risk of hypercalcemia, hospitalization, and falls. However, this did not occur in patients with chronic kidney disease.

conclusion

Given the heterogeneity of the dose response among individuals and the involvement of multiple clinical factors such as obesity and malabsorption, it is important to note that daily vitamin D intakes >800 IU (20 μg) Adhering to conservative dosage regimens may not adequately treat vitamin D deficiency. syndrome, and drugs that impair vitamin D metabolism.

This review found that daily vitamin D supplementation is more effective than intermittent bolus administration in adults. However, elderly people and people with illnesses are more likely to experience side effects from excessive intake of vitamin D, so caution should be taken.

In practical situations, clinicians should consider adjusting the vitamin D dosage according to the patient’s needs and characteristics.

Instead of following a “one-size-fits-all” approach, we may take an individualized treatment approach and prescribe a dose range of 800 to 2000 IU (20 to 50 μg).

This is a narrative review lacking a pre-registered systematic review. However, based on the evidence outlined in this review, the authors recommend using a daily vitamin D supplementation dose of 2000 IU to increase and maintain serum 25(OH)D concentrations above 50 nmol/L (20 ng/L). (50μg). >99% and >90% of the general adult population had >75 nmol/L (30 ng/mL) and >75 nmol/L (30 ng/mL), respectively.

Furthermore, they found no significant safety concerns with supplementing such doses for several years, even in individuals with sufficient vitamin D status at baseline.

This could be the perfect treatment to address the vitamin D pandemic in the general adult population.