Review of vitamin D recommendations around the world

Created April 2017

Comparative analysis of nutritional guidelines for vitamin D

Nature Reviews Endocrinology (2017), Published online 07 April 2017

doi:10.1038/nrendo.2017.31

Roger Bouillon

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Red = severe deficiency, must be corrected

Orange = mild deficiency, should be corrected

Green = sufficient, no more is needed

(Optimal is not shown)

Endocrine Society Recommentations

IOF = International Osteoporosis Foundation 📄 IOF Position statement of 2010 is on VitaminDWiki

AGS = American Geriatric Society Recommendations

Number of countries recommending each dose for infants and children/youths

                age 0-1                                 age 4-18

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Most countries continue to believe that only low levels of vitamin D are needed, so they only recommend low doses of vitamin D * Reasons for low response to vitamin D * Is 50 ng of vitamin D too high, just right, or not enough * Supplementing Vitamin D * Optimal vitamin D supplementation strategies (D3 - weekly or monthly) – Feb 2017 by Bouillion * He failed to mention: * The need to check for adverse reactions before supplementation * Vitamin D is needed by adults (he only mentions children and seniors) * Starting with loading dose - achieving a good level in weeks instead of months * Injections – which can be made less often than monthly * Increased dose needed for obese, darker skins, diseases which consume Vit. D, etc. * Other forms of Vitamin D for those with gut problems * Target level to be achieved (30, 40, or 50 nanograms/mL) * Cofactors to be adjusted (Increase Magnesium, Omega-3, Vitamin K2; Decrease Calcium) * Genes which limit the Vitamin D which gets to the cells Infant-Child category starts with {include} {include}

Vitamin D is essential for calcium and bone homeostasis. Humans are largely dependent on UVB-radiation-induced photosynthesis of vitamin D, as few foods contain vitamin D. However, the same radiation that produces vitamin D is also carcinogenic, albeit with a long lag time, and causes DNA damage. In view of the increasing life expectancy, avoiding excessive sun exposure is prudent. Several groups of people have a shortfall between their requirements for vitamin D and their combined endogenous synthesis and intake from natural foods, and therefore need vitamin D supplementation. Governments and scientific societies are regularly updating their recommendations for intake of vitamin D, especially for groups that should (infants) or prefer to (especially elderly individuals) avoid direct sunlight. An overview of such guidelines is presented in this Review.

A fairly large consensus exists that all infants should receive 400 international units (IU) (10 μg) daily during their first year of life and that elderly individuals should have access to vitamin D supplementation (at recommended dosages varying from 400 IU to 800 IU daily in most governmental guidelines but at higher dosages in other guidelines).

All guidelines unanimously agree that serum levels of 25-hydroxyvitamin D (25OHD) <25 nmol/l (10 ng/ml) should be avoided at all ages. Children and adults who have limited sun exposure should receive vitamin D supplementation, but the recommended doses vary widely (from 200 IU to 2,000 IU daily) , in line with disagreement regarding the minimal desirable serum concentration of 25OHD (which varies from 25 nmol/l to >100 nmol/l ).

Tags: Consensus How much