Empiric vitamin D supplementation suggested for kids, elderly and those with prediabetes in new guidelines

A multidisciplinary panel of clinical experts developed new clinical guidelines for the use of vitamin D to lower the risk of various diseases in individuals without established indications for vitamin D treatment or 25-hydroxyvitamin D (25[OH]D) testing. The guidelines published in Journal of Clinical Endocrinology & Metabolism journal come in response to numerous studies that demonstrated associations between serum concentrations of 25(OH)D and a variety of common disorders, including musculoskeletal, metabolic, cardiovascular, malignant, autoimmune and infectious diseases.

Although a direct causal link between serum 25(OH)D concentrations and many disorders remains unproven, these links have led to widespread vitamin D supplementation and increased laboratory testing for 25(OH)D in the general population. The benefit-risk ratio of this increase in vitamin D use is still not completely clear, as are the optimal vitamin D intake levels and the role of 25(OH)D testing for disease prevention.

The panel with clinical experts and guideline methodology specialists identified 14 clinically relevant questions related to the use of vitamin D and 25(OH)D testing. This randomized placebo-controlled trials prioritized to evaluate the effects of empiric vitamin D administration throughout different stages of life, including during pregnancy and in individuals with prediabetes. The "Empiric supplementation" was defined as vitamin D intake exceeding the Dietary Reference Intakes (DRI) without prior 25(OH)D testing.

The panel utilized the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to assess the certainty of evidence and formulated recommendations. The guidelines suggest empiric vitamin D supplementation for specific groups based on potential health benefits:

• Children and adolescents, empiric vitamin D supplementation is recommended to prevent nutritional rickets and potentially lower the risk of respiratory tract infections.
  
• Adults aged 75 years and older were suggested to take vitamin D due to potential reduction in mortality risk.
• Pregnant women were recommended to take vitamin D for its potential to reduce the risk of preeclampsia, intra-uterine mortality, preterm birth, small-for-gestational-age birth and neonatal mortality.
• High-Risk prediabetes patients are advised to take vitamin D to potentially reduce the progression to diabetes.

However, the panel suggests against empiric vitamin D supplementation above current DRI levels to reduce the risk of disease in healthy adults younger than 75 years. They found no clinical trial evidence to support routine 25(OH)D screening for the general population, including the individuals with obesity or dark complexions and no clear evidence defining optimal 25(OH)D levels for disease prevention.

The recommendations of the panel are intended to be cost-effective, feasible and equitable by highlighting that in most situations, empiric vitamin D supplementation is acceptable to everyone. Despite the guidelines, the optimal doses for empiric vitamin D supplementation remain unclear due to variations in clinical trial dosages and the concurrent use of other vitamin D supplements in participants.

The panel advocates for targeted vitamin D supplementation for specific groups while discouraging the routine 25(OH)D testing in the general population without established indications. These guidelines do not replace current DRIs for vitamin D and underline the need for further research to discover optimal 25(OH)D levels for specific health benefits.

Source:

Demay, M. B., Pittas, A. G., Bikle, D. D., Diab, D. L., Kiely, M. E., Lazaretti-Castro, M., Lips, P., Mitchell, D. M., Murad, M. H., Powers, S., Rao, S. D., Scragg, R., Tayek, J. A., Valent, A. M., Walsh, J. M. E., & McCartney, C. R. (2024). Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. In The Journal of Clinical Endocrinology & Metabolism. The Endocrine Society. https://doi.org/10.1210/clinem/dgae290