Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline
Demay MB, Pittas AG, Bikle DD, Diab DL, Kiely ME, Lazaretti-Castro M, Lips P, Mitchell DM, Murad MH, Powers S, Rao SD, Scragg R, Tayek JA, Valent AM, Walsh JME, McCartney CR
The Journal of clinical endocrinology and metabolism · 318 citations
How it was studied
- Design
- Expert or government fact sheet (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Independent funding
- Government
- U.S. Department of Defense
- Nonprofit
- Endocrine Society
- University or hospital
- Michigan State University
- Government
- European Commission
- Government
- Enterprise Ireland
- Government
- Science Foundation Ireland
- Government
- National Institutes of Health
- University or hospital
- College of Engineering, Michigan State University
- Nonprofit
- The Endocrine Society
Based on 9 listed funder(s).
Publication
- Published
- 2024-04-25 · J Clin Endocrinol Metab · vol. 109 · issue 8 · pp. 1907–1947
- Publisher
- Oxford University Press
- Cited
- 547 citations · more than 100% of similar papers · 153.3× the field average
- Impact
- Top 10% most cited in its field
- References
- 281 works
- Access
- Open access (repository copy) · OTHER-OA
- Research areas
- Vitamin D Research Studies · Biotin and Related Studies · Vitamin K Research Studies
- Keywords
- Vitamin D and neurology, Medicine, Guideline, Cholecalciferol, Ergocalciferol, vitamin D deficiency, Prediabetes, Population, Vitamin, Disease, Internal medicine, Physiology, Intensive care medicine, Endocrinology, Diabetes mellitus, Environmental health, Pathology, Type 2 diabetes
- MeSH
- humans, vitamin d deficiency, vitamins, vitamin d, endocrinology, pregnancy, dietary supplements, adolescent, adult, child, societies, medical, female, male
16 authors
From US, IE, BR, NL, NZ
- Marie B. Demay · correspondingHarvard University; Massachusetts General Hospital
- Anastassios G. PittasTufts Medical Center
- Daniel D. BikleSan Francisco VA Medical Center; University of California, San Francisco; University of California San Francisco Medical Center
- Dima L. DiabUniversity of Cincinnati; University of Cincinnati Medical Center
- Mairead E KielyUniversity College Cork; Infant
- Marise Lazaretti‐CastroUniversidade Federal de São Paulo
Abstract
Background
Numerous studies demonstrate associations between serum concentrations of 25-hydroxyvitamin D (25[OH]D) and a variety of common disorders, including musculoskeletal, metabolic, cardiovascular, malignant, autoimmune, and infectious diseases. Although a causal link between serum 25(OH)D concentrations and many disorders has not been clearly established, these associations have led to widespread supplementation with vitamin D and increased laboratory testing for 25(OH)D in the general population. The benefit-risk ratio of this increase in vitamin D use is not clear, and the optimal vitamin D intake and the role of testing for 25(OH)D for disease prevention remain uncertain.
Objective
To develop clinical guidelines for the use of vitamin D (cholecalciferol [vitamin D3] or ergocalciferol [vitamin D2]) to lower the risk of disease in individuals without established indications for vitamin D treatment or 25(OH)D testing.
Methods
A multidisciplinary panel of clinical experts, along with experts in guideline methodology and systematic literature review, identified and prioritized 14 clinically relevant questions related to the use of vitamin D and 25(OH)D testing to lower the risk of disease. The panel prioritized randomized placebo-controlled trials in general populations (without an established indication for vitamin D treatment or 25[OH]D testing), evaluating the effects of empiric vitamin D administration throughout the lifespan, as well as in select conditions (pregnancy and prediabetes). The panel defined "empiric supplementation" as vitamin D intake that (a) exceeds the Dietary Reference Intakes (DRI) and (b) is implemented without testing for 25(OH)D. Systematic reviews queried electronic databases for publications related to these 14 clinical questions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of evidence and guide recommendations. The approach incorporated perspectives from a patient representative and considered patient values, costs and resources required, acceptability and feasibility, and impact on health equity of the proposed recommendations. The process to develop this clinical guideline did not use a risk assessment framework and was not designed to replace current DRI for vitamin D.
Results
The panel suggests empiric vitamin D supplementation for children and adolescents aged 1 to 18 years to prevent nutritional rickets and because of its potential to lower the risk of respiratory tract infections; for those aged 75 years and older because of its potential to lower the risk of mortality; for those who are pregnant because of its potential to lower the risk of preeclampsia, intra-uterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality; and for those with high-risk prediabetes because of its potential to reduce progression to diabetes. Because the vitamin D doses in the included clinical trials varied considerably and many trial participants were allowed to continue their own vitamin D-containing supplements, the optimal doses for empiric vitamin D supplementation remain unclear for the populations considered. For nonpregnant people older than 50 years for whom vitamin D is indicated, the panel suggests supplementation via daily administration of vitamin D, rather than intermittent use of high doses. The panel suggests against empiric vitamin D supplementation above the current DRI to lower the risk of disease in healthy adults younger than 75 years. No clinical trial evidence was found to support routine screening for 25(OH)D in the general population, nor in those with obesity or dark complexion, and there was no clear evidence defining the optimal target level of 25(OH)D required for disease prevention in the populations considered; thus, the panel suggests against routine 25(OH)D testing in all populations considered. The panel judged that, in most situations, empiric vitamin D supplementation is inexpensive, feasible, acceptable to both healthy individuals and health care professionals, and has no negative effect on health equity.
Conclusion
The panel suggests empiric vitamin D for those aged 1 to 18 years and adults over 75 years of age, those who are pregnant, and those with high-risk prediabetes. Due to the scarcity of natural food sources rich in vitamin D, empiric supplementation can be achieved through a combination of fortified foods and supplements that contain vitamin D. Based on the absence of supportive clinical trial evidence, the panel suggests against routine 25(OH)D testing in the absence of established indications. These recommendations are not meant to replace the current DRIs for vitamin D, nor do they apply to people with established indications for vitamin D treatment or 25(OH)D testing. Further research is needed to determine optimal 25(OH)D levels for specific health benefits.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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