‘Don’t Skip’ for Vitamin D: New Endo Society Guidelines

BOSTON – The Endocrine Society’s new guideline calls for limiting vitamin D supplementation beyond the recommended daily allowance in certain risk groups and advises against the practice of 25-hydroxyvitamin D. [25(OH)D] test in healthy people.

The evidence-based document was presented on June 3, 2024 at the annual meeting of the Endocrine Society and simultaneously published in Journal of Clinical Endocrinology and Metabolism. It advises that people who may benefit from vitamin D supplementation include:

1. Children aged 1-18 to prevent rickets and reduce the risk of respiratory infections
2. Pregnant women reduce the risk of maternal and fetal complications
3. Adults over 75 years of age reduce the risk of dying
4. Adults with prediabetes have a reduced risk of type 2 diabetes

In those groups, the recommendation is for daily (rather than intermittent) vitamin D supplementation that is stronger than that recommended in 2011 by the National Academy of Medicine (NAM), then called the Institute of Medicine (IOM): 600 IU. /d for those aged 1-70 and 800 IU/d for those older than 70. The document acknowledges that the optimal dose for this population is unknown, but provides a range of doses used in trials cited as evidence of recommendations.

On the other hand, the document advises against more vitamin D than the recommended daily intake for healthy adults under the age of 75 and recommends against checking vitamin D levels. of blood in general, including those who are obese or dark.

Guideline author Anastassios G. Pittas, MD, professor of medicine at Tufts University School of Medicine, Boston, told Medscape Medical News“This guideline refers to people who are otherwise healthy, and there is no clear indication for vitamin D, such as people with osteoporosis.

Pittas also noted, “there isn’t one question and one answer about the role of vitamin D in health and disease, which is what people often want to know. There are questions. many, and we cannot answer them all.”

Panel chair Marie B. Demay, MD, professor of medicine at Harvard Medical School, said Medscape Medical News that the group was indeed limited by the lack of randomized clinical trial evidence to answer many important questions. “There is a lack of data on the definition of optimal levels and intake of vitamin D for the prevention of certain diseases… What we really need are large clinical trials and biomarkers so that we I can predict the consequences of death before it happens.”

In general, Demay said, “Suggestions are for people to stick with [NAM/IOM] A recommended diet, and there are certain people who can benefit from higher levels [those].”

Asked for comment, conference moderator Clifford J. Rosen, MD, director of Clinical and Translational Research and senior scientist at the Maine Medical Center Research Institute in Scarborough, Maine, noted that vitamin D testing is common. especially in medical practice, but the incentive is against it. doing so makes sense.

“When doctors measure vitamin D, then they have to decide what to do with it. That’s where questions about levels come in. And that’s a big problem. It really gets to the heart of the matter, because we don’t have data that there is anything about the test that allows us to improve the quality of life… It is possible that there is no benefit in any age group.”

Rosen, who was an author on the 2011 NAM/IOM dietary reference, said that since then, new information has emerged about the role of vitamin D in the death of adults over 75, who benefit children in relation to respiratory disease, and the potential benefit of vitamin D during pregnancy. Otherwise, I think we’re still talking about a lot of things that we’ve talked about since I was on the IOM platform 15 years ago… .”

However, Simeon I. Taylor, MD, professor of medicine at the University of Maryland, Baltimore, expressed disappointment that the document was limited to healthy people. “While we recognize the difficulties of controlling vitamin D levels in patients with several diseases, [such as] chronic kidney disease or inflammatory bowel disease, the new guidelines do not provide adequate guidance for practicing physicians in managing these complex patients. “

In addition, Taylor stated that the guidelines “do not clearly consider the literature that suggests that other testing methods may provide a more accurate understanding of vitamin D status. Just as the variation in levels of Thyroid-binding globulin has convinced endocrinologists not to rely on total thyroxine levels and vitamin D-binding protein levels must be calculated to interpret total 25(OH)D levels. It was useful to clearly consider the potential value of measuring independent indices of vitamin D. D status.”

Taylor also raised a similar point that an audience member made during the Q&A about patients with osteoarthritis or osteoporosis. “The value and utility of the new guidelines would be greatly enhanced by providing guidance on how to approach this important and very large group of people.”

Taylor said that the document has “several strengths, including the fact that they acknowledge the significant limitations of the quality of positive evidence from clinical trials.”

In an accompanying commentary, the guideline authors examine the issues of skin color and race as they relate to vitamin D metabolism, writing:

Pittas and Demay have no disclosures related to this clinical guideline. Rosen has no disclosures. Taylor serves as a consultant to Ionis Pharmaceuticals.

Miriam E. Tucker is a freelance journalist based in the Washington DC area. He is a regular contributor to Medscape, and other work is emerging The Washington PostNPR Guns blog, and Diatribe. She’s on X (formerly Twitter) @MiriamETucker.