Practice Guideline Insights: Vitamin D Deficiency Recommendations

· TGI - Health
Authors

 

Study Highlights

  • The guidelines were developed after examination of systematic reviews of vitamin D intake, and the authors also incorporated suggestions from members of The Endocrine Society after a draft document was posted on the society’s Web page.
  • Screening for vitamin D deficiency should only be done in high-risk patients, including patients with known bone disease, kidney disease, cirrhosis, and malabsorption syndromes. Pregnant women may be screened for vitamin D deficiency.
  • Clinicians should use a 25(OH)D level to screen for vitamin D deficiency. A level of 20 ng/mL or less constitutes vitamin D deficiency.
  • Infants younger than 1 year should receive at least 400 IU/day of vitamin D,
  • Older children and adolescents should receive at least 600 IU/day.
  • Adults between 19 and 65 years old should receive at least 600 IU/day of vitamin D.
  • Adults 65 years and older should receive at least 800 IU/day.
  • Pregnant women should receive at least 600 IU of vitamin D per day.
  • Obese children and adults should receive vitamin D at least 2 to 3 times more than the recommended daily values for individuals at a normal weight.
  • Very high doses of vitamin D are associated with hypercalcemia and other complications. The maintenance dose of vitamin D should not exceed 2500 IU/day for children between 1 and 3 years old, 3000 IU/day for children between 4 and 8 years old, and 4000 IU/day among individuals older than 8 years.
  • However, treatment of vitamin D deficiency requires higher doses of vitamin D (2000 IU/day for 6 weeks among infants, children, and adolescents; 6000 IU/day for 8 weeks among adults). In general, the dose of vitamin D in the treatment of deficiency should be approximately 50,000 IU/week.
  • Either vitamin D2 or D3 may be used to treat vitamin D deficiency.
  • Maintenance therapy after treatment of vitamin D deficiency requires higher doses of vitamin D (1500 – 2000 IU/day among adults

These recommended values are designed to maximize bone health, and the guidelines also recommend vitamin D to help prevent falls among older adults. However, the authors found insufficient evidence to recommend the use of vitamin D supplements for other health-related goals, such as cardiovascular disease prevention or improvement in the quality of life.

 

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Development of the clinical practice guideline was supported solely by The Endocrine Society. Dr. Holick has disclosed financial or business/organizational interests with Merck, Novartis, Nichols-Quest Diagnostics, Bayer, Aventis, Warner Chilcott, Amgen, the UV Foundation, DMI, and the Mushroom Council. A complete list of disclosures for the task force is listed with the original article.http://jcem.endojournals.org/content/early/2011/06/03/jc.2011-0385.abstract?rss=1

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