Endocrine Society Releases Guidelines on Vitamin D for Disease Prevention

The Endocrine Society's annual meeting revealed guidelines on Vitamin D for disease prevention, emphasizing the restriction of vitamin D supplementation beyond the daily recommended intake to certain high-risk groups. Additionally, the guidelines advise against routine 25-hydroxyvitamin D [25(OH)D] testing in healthy individuals.

The guidelines were published in the Journal of Clinical Endocrinology and Metabolism.

A team of clinical experts, along with experts in guideline methodology and systematic literature review, identified and ranked 14 clinically relevant questions regarding the use of vitamin D and 25(OH)D testing to reduce disease risk. They prioritized randomized placebo-controlled trials in general populations (without a specific indication for vitamin D treatment or 25[OH]D testing), assessing the impacts of vitamin D supplementation across all age groups. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was employed to evaluate evidence certainty and inform recommendations.

The guidelines advised that people who may benefit from vitamin D supplementation include:

1. Children aged 1-18 years to prevent rickets and to potentially lower the risk for respiratory tract infections

2. Pregnant people to lower the risk for maternal and fetal or neonatal complications

3. Adults older than 75 years to lower the risk for mortality

4. Adults with prediabetes to lower the risk for type 2 diabetes

The guidelines also recommended daily (rather than intermittent) vitamin D supplementation at doses higher than those suggested by the National Academy of Medicine (NAM) in 2011: 600 IU/day for individuals aged 1-70 years and 800 IU/day for those over 70 years.

Based on the absence of supportive clinical trial evidence, the guidelines suggested against routine 25(OH)D testing in the absence of established indications. Further research is needed to determine optimal 25(OH)D levels for specific health benefits.

“The recommendations are that populations adhere to the [NAM/IOM] dietary recommended intakes, and there are certain populations that will likely benefit from levels of intake above [those]. New data have been released regarding the role of vitamin D in mortality in people older than 75 years, benefit in children with regard to respiratory illness, and the potential benefit of vitamin D in pregnancy. Although acknowledging challenges in managing vitamin D status in patients with several diseases, [such as] chronic kidney disease or inflammatory bowel disease, the new guidelines do not provide sufficient guidance for practicing physicians about how to manage these complex patients,” said the authors.

Reference: Marie B Demay, Anastassios G Pittas, Daniel D Bikle, Dima L Diab, Mairead E Kiely, Marise Lazaretti-Castro, Paul Lips, Deborah M Mitchell, M Hassan Murad, Shelley Powers, Sudhaker D Rao, Robert Scragg, John A Tayek, Amy M Valent, Judith M E Walsh, Christopher R McCartney, Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, 2024;, dgae290, https://doi.org/10.1210/clinem/dgae290