New recommendations on vitamin D intake for children, pregnant people, adults over 75 and those with high-risk prediabetes

In a recent study published in The Journal of Clinical Endocrinology & Metabolism, researchers developed therapeutic recommendations for utilizing vitamin D [cholecalciferol (vitamin D3) or ergocalciferol (vitamin D2)] to reduce the risk of illness in individuals who do not have documented grounds for vitamin D medication or 25-hydroxyvitamin D [25(OH)D] testing.

Background

Studies have linked serum 25-hydroxyvitamin D levels to various ailments, including metabolic, musculoskeletal, neoplastic, cardiovascular, viral, and autoimmune diseases. Although no causative relationship has been proven between blood 25-hydroxyvitamin D levels and numerous illnesses, these links have resulted in widespread vitamin D supplementation and increases in laboratory-based 25-hydroxyvitamin D testing in general populations.

The risk-benefit ratio of the rise in D vitamin usage is unclear, and the ideal vitamin D consumption and significance of 25-hydroxyvitamin D testing to prevent disease are unknown.

About the study

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

An inter-disciplinary panel, including several clinical specialists, identified 14 clinically crucial concerns about vitamin D supplementation and testing to reduce illness risk. The panel emphasized randomized and placebo-controlled studies in the general public and specific situations (pregnancy and prediabetes) to assess the impact of empirical vitamin D treatment across the life cycle. The panel determined empirical therapy as D vitamin administration beyond the Dietary Reference Intakes (DRIs) but not tested for 25-hydroxyvitamin D.

The researchers used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) technique to determine evidence certainty and provide recommendations. The strategy included a patient representative’s opinions, considering patient values, prices, and resources necessary, as well as the offered suggestions’ influence on health equities.

The technique uses evidence-to-decision (EtD) frameworks to guarantee relevant criteria examination when generating recommendations. The Guideline Development Panel (GDP) included content experts from various specialties (adult endocrinology, general internal medicine, obstetrics and gynecology, pediatric endocrinology, nutrition, and epidemiology), a patient representative, and a clinical practice guideline methodologist from the Mayo Evidence-Based Practice Centre.

The systematic search for evidence began in February 2022, with updates in December 2023. During an in-person panel discussion and a series of video conferences, the Guideline Development Panel assessed the balance of benefits and hazards and the other EtD criteria to decide the direction and strength of each recommendation. The researchers made draft recommendations available for external peer review and internally to Endocrine Society members. The Society’s Clinical Guidelines Committee, co-sponsoring organizations, the Board of Directors, and an expert reviewer evaluated the draft guideline document.

Results

The expert panel recommends empirical vitamin D supplements for children to protect against nutritional rickets due to its properties that reduce respiratory infection risk; for individuals aged ≥75 years due to its ability to lower mortality risk; and for pregnant women due to its effects on lowering preeclampsia, intrauterine fetal death, preterm delivery, small-for-gestational-age (SGA) birth risks.

Because vitamin D dosages in the clinical studies varied greatly and many individuals were permitted to continue vitamin D-based supplementation, the ideal amounts for empirical vitamin D administration for the general populations are unknown. For non-pregnant individuals over the age of 50 years who require vitamin D supplements, the panel recommends daily delivery rather than occasional high-dose usage.

The panel recommends empirical vitamin D supplementations over the existing dietary reference intake to reduce illness risk in healthy individuals aged below 75 years. There was no clinical research evidence that supported regular 25-hydroxyvitamin D screening in general populations, nor among individuals with adiposity or dark skin, and the team found no concrete evidence concerning optimum 25-hydroxyvitamin D levels required to prevent disease among the study populations; therefore, the panel recommends against regular 25-hydroxyvitamin D screening among all populations investigated. The panel concluded that empirical vitamin D treatment is cost-effective, practicable, and acceptable to healthy people and healthcare providers in most cases without detrimental impact on health equities.

According to the panel, one can obtain vitamin D through fortified meals, vitamin-based formulations, or supplements. Doses for children’s respiratory tract infections range from 300 to 2,000 international units (IU) or 7.50 to 50 μg per day. Adults aged ≤70 years should consume the Recommended Daily Allowance (600 IU or 15 µg), while those aged >70 years should consume 800 IU (or 20 µg) daily.

Vitamin D doses for pregnant women ranged between 600 IU and 5,000 IU/day, and they were administered daily or weekly. The panel recommended low-dose daily supplementation over intermittent, high-dose supplementation of the vitamin. Lifestyle changes are critical for individuals with prediabetes.