New Vitamin D Recommendations for Children, Pregnant Women, Adults 75 Years and Older, and People at High Risk for Prediabetes

In a recently published study, Journal of Clinical Endocrinology and MetabolismThe researchers developed therapeutic recommendations regarding vitamin D utilization. [cholecalciferol (vitamin D3) or ergocalciferol (vitamin D2)] Reduce risk of disease in individuals without a documented rationale for administering vitamin D medications or 25-hydroxyvitamin D [25(OH)D] test.

background

Studies have shown that serum 25-hydroxyvitamin D concentrations are associated with a variety of diseases, including metabolic, musculoskeletal, oncological, cardiovascular, viral, and autoimmune disorders. Although a causal relationship between blood 25-hydroxyvitamin D concentrations and many diseases has not been proven, these associations have led to widespread use of vitamin D supplements and an increase in laboratory testing for 25-hydroxyvitamin D in the general population.

The risk/benefit ratio of increased vitamin D use is unknown, as is the ideal vitamin D intake and the importance of 25-hydroxyvitamin D testing for disease prevention.

About the Research

In this study, the researchers developed guidelines for vitamin D supplementation to prevent disease.

An interdisciplinary committee including multiple clinical experts identified 14 clinically important concerns regarding vitamin D supplementation and testing to reduce disease risk. The committee emphasized randomized placebo-controlled trials in the general population and in specific settings (pregnancy and prediabetes) and evaluated the impact of empirical vitamin D treatment across the life cycle. The committee determined empirical treatment to be vitamin D dosing above the Dietary Reference Intakes (DRI) but did not test for 25-hydroxyvitamin D.

The researchers used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to determine the certainty of the evidence and present their recommendations, a strategy that included consideration of patient representatives’ opinions, patient values, price, resource needs, and the impact of the proposals on health equity.

This approach uses an evidence-based decision-making (EtD) framework to ensure consideration of relevant criteria when making recommendations.The Guideline Development Panel (GDP) includes content experts from various specialties (adult endocrinology, general internal medicine, obstetrics and gynecology, pediatric endocrinology, nutrition, and epidemiology), patient representatives, and clinical practice guideline methodologists from the Mayo Evidence-Based Practice Center.

The systematic evidence search began in February 2022 and was updated in December 2023. In in-person panel discussions and a series of video conferences, the Guideline Development Panel evaluated the balance of benefits and risks and other EtD criteria to determine the direction and strength of each recommendation. Researchers published draft recommendations for external peer review and internally to Endocrine Society members. The Society’s Clinical Guidelines Committee, co-sponsoring organizations, Board of Directors, and expert reviewers evaluated the draft guidelines.

result

Expert panels recommend empirical vitamin D supplementation for children to prevent nutritional rickets because of its properties to reduce the risk of respiratory infections, for individuals aged 75 years and older because of its ability to reduce mortality risk, and for pregnant women because of its effect on reducing the risk of preeclampsia, intrauterine fetal death, preterm birth, and small for gestational age (SGA).

Because vitamin D dosing in clinical trials has varied widely and many individuals were allowed to continue vitamin D-based supplements, the ideal amount of empirical vitamin D dosing for the general population is unknown. For nonpregnant individuals aged 50 years or older who require vitamin D supplements, the committee recommends daily administration rather than occasional high doses.

The committee recommends empirical vitamin D supplementation above existing dietary reference intakes to reduce the risk of disease in healthy people under 75 years of age. There is no clinical research evidence to support routine 25-hydroxyvitamin D screening in the general population, obese or dark-skinned people, and the research team found no specific evidence regarding the optimal 25-hydroxyvitamin D levels needed to prevent disease in the study population. Therefore, the committee does not recommend routine 25-hydroxyvitamin D screening in all populations examined. The committee concluded that empirical vitamin D treatment is cost-effective, feasible, and in most cases acceptable to healthy people and health care providers without adverse effects on health equity.

According to the committee, vitamin D can be obtained from fortified foods, vitamin-based preparations, and supplements. The dosage for children with respiratory infections is 300 to 2,000 international units (IU) or 7.50 to 50 μg per day. Adults under 70 years of age should get the recommended daily allowance (600 IU or 15 μg), and those over 70 years of age should get 800 IU (or 20 μg) per day.

Doses of vitamin D for pregnant women range from 600 IU to 5,000 IU per day, given daily or weekly. The committee recommends daily low-dose supplementation of the vitamin rather than intermittent high-dose supplementation. Lifestyle changes are essential for people with prediabetes.