Nutritional rickets among children in the United States: Review of cases reported between 1986 and 2003. doi: 10.1001/jamanetworkopen.2019.17789. Individuals with a body mass index (BMI) of 30 or more have lower serum 25(OH)D levels than nonobese individuals. [, Kahwati LC, Weber RP, Pan H, Gourlay M, LeBlanc E, Coker-Schwimmer M, Viswanathan M. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: Evidence report and systematic review for the US Preventive Services Task Force. Rickets occurred mainly in Black children who were breastfed longer, were born with low birthweight, weighed less, and were shorter than other children. Overall, the risk of CVD events was 10% lower for each 25 nmol/L (10 ng/mL) increase in serum 25(OH)D. Another large observational study that followed 247,574 adults from Denmark for 0–7 years found that levels of 25(OH)D that were low (about 12.5 nmol/L [5 ng/mL]) and high (about 125 nmol/L [50 ng/mL]) were associated with a greater risk of mortality from CVD, stroke, and acute myocardial infarction [121]. In addition, older adults are likely to spend more time than younger people indoors, and they might have inadequate dietary intakes of the vitamin [1]. [, Yao S, Kwan ML, Ergas IJ, Roh JM, Cheng T-YD, Hong C-C, et al. In addition to having an increased risk of vitamin D deficiency, people with these conditions might not eat certain foods, such as dairy products (many of which are fortified with vitamin D), or eat only small amounts of these foods. The effect of vitamin D supplementation on glycemic control in type 2 diabetes patients: A systematic review and meta-analysis. Statins Hansen D, Bazell C, Pelizzari P, Pyenson B. Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, et al. Global consensus recommendations on prevention and management of nutritional rickets. Next review due: 3 August 2023, oily fish – such as salmon, sardines, herring and mackerel, fortified foods – such as some fat spreads and breakfast cereals, breastfed babies from birth to 1 year of age should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D to make sure they get enough, formula-fed babies should not be given a vitamin D supplement until they're having less than 500ml (about a pint) of infant formula a day, as infant formula is fortified with vitamin D, children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D, are not often outdoors – for example, if you're frail or housebound, usually wear clothes that cover up most of your skin when outdoors. Most people in the world meet at least some of their vitamin D needs through exposure to sunlight [1]. Vitamin D. In: Erdman JW, Macdonald IA, Zeisel SH, eds. These differences are a result of an incomplete understanding of the biology and clinical implications of vitamin D, different purposes for the guidelines (e.g., for public health in a healthy population or for clinical practice), and/or the use in some guidelines of observational studies in addition to randomized clinical trials to establish recommendations [9,15]. The emerging issue of 25-hydroxyvitamin D in foods. However, the results did show an increased risk of pancreatic cancer with 25(OH)D levels of 100 nmol/L (40 ng/mL) or above [107]. The 'sunshine vitamin': benefits beyond bone? [, Pappa HM, Bern E, Kamin D, Grand RJ. The Dietary Guidelines for Americans describes a healthy eating pattern as one that: This fact sheet by the Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. Effects of orlistat on fat-soluble vitamins in obese adolescents. Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. You should take 10 micrograms (400 IU) of vitamin D a day between October and early March to keep your bones and muscles healthy. [, Singh P, Trivedi N. Tanning beds and hypervitaminosis D: A case report. This can weaken the bones and damage the kidneys and the heart. Calcium plus vitamin D supplementation and the risk of colorectal cancer. [, Keum N, Lee DH, Greenwood DC, Manson JE, Giovannucci E. Vitamin D supplementation and total cancer incidence and mortality: A meta-analysis of randomized controlled trials. Am J Clin Nutr 2008;88:558S-64S. However, a meta-analysis of 12 vitamin D supplementation trials (including 5 in which body composition measurements were primary outcomes) found that vitamin D supplements without calorie restriction did not affect body weight or fat mass when the results were compared with those of placebo [154]. [, Malihi Z, Wu Z, Stewart AW, Lawes CMM, Scragg R. Hypercalcemia, hypercalciuria, and kidney stones in long-term studies of vitamin D supplementation: A systematic review and meta-analysis. Screening for vitamin deficiency in adults: U.S. Preventive Services Task Force recommendation statement. The concurrent presence of fat in the gut enhances vitamin D absorption, but some vitamin D is absorbed even without dietary fat. [, Li X, Liu Y, Zheng Y, Wang P, Zhang Y. The trials administered different amounts of vitamin D (ranging from 10 mcg [400 IU]/day to 1,000 mcg [40,000 IU]/week). Vitamin D assays and the definition of hypovitaminosis D. Results from the First International Conference on Controversies in Vitamin D. Br J Clin Pharmacol 2018;84:2194-207. [, Tripkovic L, Wilson LR, Hart K, Johnsen S, de Lusignan S, Smith CP, et al. The FNB committee that established DRIs for vitamin D found that the evidence was inadequate or too contradictory to conclude that the vitamin had any effect on a long list of potential health outcomes (e.g., on resistance to chronic diseases or functional measures), except for measures related to bone health. A dose-response analysis found that each 20 nmol/L [8 ng/mL] increase in 25(OH)D was associated with a 9% lower risk of both all-cause and prostate cancer-specific mortality. Among the women with two or more serum 25(OH)D samples taken before diagnosis (which reduced random measurement variation), a 50 nmol/L increase in 25(OH)D was associated with a 41% reduced risk of MS, and 25(OH)D levels less than 30 nmol/L were associated with an MS risk that was twice as high as levels of 50 nmol/L or higher. [, Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. D, also known as Dlang, is a multi-paradigm system programming language created by Walter Bright at Digital Mars and released in 2001. In addition, studies have not consistently shown that vitamin D supplementation tempers the signs and symptoms of active MS or reduces rates of relapse. [, Weisberg P, Scanlon KS, Li R, Cogswell ME. [, Earthman CP, Beckman LM, Masodkar K, Sibley SD. [, Crockett SD, Barry EL, Mott LA, Ahnen DJ, Robertson DJ, Anderson JC, et al. Scientific Advisory Committee on Nutrition. Vitamin D supplementation had no effect on the incidence rate of myocardial infarction, angina, heart failure, arrhythmia, arteriosclerosis, stroke, venous thrombosis, or death from CVD. Association of vitamin D status with arterial blood pressure and hypertension risk: A mendelian randomisation study. The largest trial to date of vitamin D supplements for diabetes prevention randomized 2,423 men and women aged 25 years and older (mean age 60 years) with prediabetes who were overweight or obese (mean BMI of 32.1) to 100 mcg (4,000 IU)/day vitamin D3 or placebo for a median of 2.5 years [145]. Positive association between circulating 25-hydroxyvitamin D levels and prostate cancer risk: New findings from an updated meta-analysis. [, Kassi E, Adamopoulos C, Basdra EK, Papavassiliou AG. [, U.S. Preventive Services Task Force. Another reason is that animal foods contain some 25(OH)D. This form of vitamin D is not included in intake surveys and is considerably more potent than vitamins D2 or D3 at raising serum 25(OH)D levels [43]. One systematic review and meta-analysis of 11 randomized, controlled trials published through 2018 of vitamin D supplementation alone (10–20 mcg [400–800 IU]/day or more at least every week or as rarely as once a year) for 9 months to 5 years found that the supplements provided no protection from fractures in 34,243 older adults [82]. From supporting strong and healthy bones to maintaining your immune system, vitamin D is very important for a huge number of functions in the body. [, Lukert BP, Raisz LG. The study reports included 3–10 years of followup data. PMID: 31504098 [, Okereke OI, Reynolds III CF, Mischoulon D, Chang G, Vyas CM, Cook NR, et al. [, Simon AE, Ahrens KA. More information about assay standardization is available from the Vitamin D Standardization Program webpage. Ann Intern Med 2015;162:133-40. Preventing multiple sclerosis: To (take) vitamin D or not to (take) vitamin D? Vitamin D in foods: An evolution of knowledge. Old English lower case letter d, from 7th century replacement by Latin lower case d of the Anglo-Saxon Futhorc letter ᛞ. Vitamin D supplementation reduced cancer mortality rates by 13%, and most of the benefit occurred with daily supplementation. Other dairy products made from milk, such as cheese and ice cream, are not usually fortified in the United States or Canada. Public Health Nutrition 2020;23:1153-64. Studies of the effects of vitamin D supplements on hypertension have also had mixed findings. Three trials conducted since that meta-analysis also found no effect of vitamin D supplementation on depressive symptoms. UVB radiation does not penetrate glass, so exposure to sunshine indoors through a window does not produce vitamin D [29]. This U-shaped association was most pronounced for men with the most aggressive forms of prostate cancer. Increasing incidence of nutritional rickets: A population-based study in Olmsted County, Minnesota. However, the incidence of rickets is increasing globally, even in the United States and Europe, especially among immigrants from African, Middle-Eastern, and Asian countries [52]. J Am Soc Nephrol 2002;13:1608-14. U.S. Food and Drug Administration. Includes a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products. Thiazide diuretics Am J Clin Nutr 2004;80:1697S-705S. Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal bone mineralization and to prevent hypocalcemic tetany (involuntary contraction of muscles, leading to cramps and spasms). Food additives permitted for direct addition to food for human consumption; vitamin D2 mushroom powder. Although UVB exposure can produce vitamin D in infants, the American Academy of Pediatrics (AAP) advises parents to keep infants younger than 6 months out of direct sunlight, dress them in protective clothing and hats, and apply sunscreen on small areas of exposed skin when sun exposure is unavoidable [60]. In contrast, another meta-analysis of 30 clinical trials in 4,744 participants (mean age 54.5 years) that administered 5 mcg (200 IU) to 300 mcg (12,000 IU)/day vitamin D3 for a mean of 5.6 months showed that more than 20 mcg (800 IU)/day significantly reduced systolic and diastolic blood pressure in normal-weight participants who had hypertension [128]. Agency for Healthcare Research and Quality. Evidence Synthesis Number 118. These values, which vary by age and sex, include: An FNB committee established RDAs for vitamin D to indicate daily intakes sufficient to maintain bone health and normal calcium metabolism in healthy people. For example, a meta-analysis of 21 studies that included 11,941 men with prostate cancer and 13,870 controls found a 17% higher risk of prostate cancer for participants with higher levels of 25(OH)D [108]. Food If your doctor has recommended you take a different amount of vitamin D, you should follow their advice. Practitioner 1984;228:312-3. Use of vitamin D drops leading to kidney failure in a 54-year-old man. Leeds. For example, a 3-year trial in New Zealand randomized 5,110 adults (mean age 65.9 years) to a single dose of 5,000 mcg (200,000 IU) vitamin D3 followed by 2,500 mcg (100,000 IU) each month or a placebo for a median of 3.3 years [124]. A variety of foods and their vitamin D levels per serving are listed in Table 3. Vitamin D: moving forward to address emerging science. J Nutr 2014;144:654-9. [, Pittas A, Dawson-Hughes B, Sheehan P, Ware JH, Knowler WC, Aroda VR, et al. The FNB committee also noted that serum concentrations greater than 125 nmol/L (50 ng/mL) can be associated with adverse effects [1] (Table 1). Neurology 2017;89:1538-9. This is a fact sheet intended for health professionals. 25-hydroxyvitamin D response to graded vitamin D3 supplementation among obese adults. However, because research has been conducted on vitamin D and numerous health outcomes, this section focuses on seven diseases, conditions, and interventions in which vitamin D might be involved: bone health and osteoporosis, cancer, cardiovascular disease (CVD), depression, multiple sclerosis (MS), type 2 diabetes, and weight loss. [. The USPSTF also reviewed the seven published studies on the effects of vitamin D supplementation (two of them also included calcium supplementation) on the risk of falls in community-dwelling adults aged 65 years or older who did not have osteoporosis or vitamin D deficiency. Most of the studies described in this section measured serum 25(OH)D levels using various methods that were not standardized by comparing them to the best methods. In practice, however, people usually do not apply sufficient amounts of sunscreen, cover all sun-exposed skin, or reapply sunscreen regularly. D. The first hydroxylation, which occurs in the liver, converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as "calcidiol." A one-year trial to assess the value of orlistat in the management of obesity. 25-hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort. Vitamin D is involved in various brain processes, and vitamin D receptors are present on neurons and glia in areas of the brain thought to be involved in the pathophysiology of depression [130]. Obtaining sufficient vitamin D from natural (nonfortified) food sources alone is difficult. You may choose not to take a vitamin D supplement during these months. Cancer Epidemiol Biomarkers Prev 2014;23:1484-93. Children aged 1 to 10 years should not have more than 50 micrograms (2,000 IU) a day. BMC Public Health 2017;17:519. For example, three meta-analyses of clinical trial evidence found that vitamin D supplementation does not affect cancer incidence but does significantly reduce total cancer mortality rates by 12–13% [90-92]. Another source of vitamin D is dietary supplements. Vitamin D did not significantly prevent the development of diabetes in comparison with placebo. PLOS ONE 2014;9:e111265. Nutrients 2019;11,2295; doi:10.3390/nu11102295. Effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: A systematic review and meta-analysis. Int J Obes (Lond) 2012;36:387-96. Lancet Diabetes-Endocrinol 2014;2:719-29. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. Endocrinol Metab Clin North Am 2017;46:947-82. A study of cohorts that included 5,313 participants who developed lung cancer and 5,313 matched controls found no association between serum 25(OH)D levels and risk of subsequent lung cancer, even when the investigators analyzed the data by sex, age, race and ethnicity, and smoking status [104]. Effect of long-term vitamin D3 supplementation vs placebo on risk of depression or clinically relevant depressive symptoms and on change in mood scores: A randomized clinical trial. Intestinal absorption of vitamin D: A systematic review. the fourth letter of the English alphabet, a consonant. Another study that compared 200 male smokers in Finland with pancreatic cancer to 400 matched controls found that participants in the highest quintile of 25(OH)D levels (more than 65.5 nmol/L [26.2 ng/mL]) had a threefold greater risk of developing pancreatic cancer over 16.7 years than those in the lowest quintile (less than 32 nmol/L [12.8 ng/mL]) [106]. [, Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, et al. Post-treatment levels of plasma 25- and 1,25-dihydroxy vitamin D and mortality in men with aggressive prostate cancer. Long-term vitamin D3 supplementation is more effective than vitamin D2 in maintaining serum 25-hydroxyvitamin D status over the winter months. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D. Many tissues have vitamin D receptors, and some convert 25(OH)D to 1,25(OH)2D. [, Aloia JF, Li-Ng M, Pollack S. Statins and vitamin D. Am J Cardiol 2007;100:1329. JAMA Oncol 2017;3:351-7. [, Taylor CL, Roseland JM, Coates PM, Pehrsson PR. Women with 25(OH)D levels of less than 30 nmol/L (12 ng/mL) had a 43% higher MS risk than women with levels of 50 nmol/L (20 ng/mL) or higher. A meta-analysis of prospective studies that evaluated the association between serum 25(OH)D levels and cancer incidence (8 studies) or cancer mortality (16 studies) found that cancer risk decreased by 7% and cancer mortality rates decreased by 2% with each 20 nmol/L (8 ng/mL) increase in serum 25(OH)D levels [89]. Some people will not get enough vitamin D from sunlight because they have very little or no sunshine exposure. The AAP recommends 10 mcg (400 IU)/day vitamin D supplements for exclusively and partially breastfed infants starting shortly after birth and lasting until they are weaned and consume at least 1,000 mL/day vitamin D-fortified formula or whole milk [58]. A reverse J-shaped association between serum 25-hydroxyvitamin D and cardiovascular disease mortality: The CopD study. Breast cancer However, a meta-analysis of 7 cohort studies that included 7,808 men with prostate cancer found higher 25(OH)D levels to be significantly associated with lower mortality rates from prostate cancer or any other cause [115]. [, Aloia JF, Rubinova R, Fazzari M, Islam S, Mikhail M, Ragolia L. Vitamin D and falls in older African American women: The PODA randomized clinical trial. Association of serum level of vitamin D at diagnosis with breast cancer survival: A case-cohort analysis in the Pathways Study. However, a post hoc analysis showed a 62% lower incidence of diabetes among participants with low baseline serum 25(OH)D levels (less than 30 nmol/L [12 ng/mL]) who took the vitamin D supplement than among those who took the placebo [145,150]. Together with calcium, vitamin D also helps protect older adults from osteoporosis. [. Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. Nutritional rickets around the world: An update. Page last reviewed: 3 August 2020 [, Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. Individuals who have difficulty absorbing dietary fat might therefore require vitamin D supplementation [64]. J Clin Endocrin Metab 2013;98:4339-45. AHRQ Publication No. From about late March/early April to the end of September, the majority of people should be able to get all the vitamin D they need from sunlight on their skin. Vitamin D supplementation for the prevention of depression and poor physical function in older persons: The D-Vitaal study, a randomized clinical trial. Calcium plus vitamin D supplementation and the risk of breast cancer. One trial included 206 adults (mean age 52 years) who were randomized to take a bolus dose of 2,500 mcg (100,000 IU) vitamin D3 followed by 500 mcg (20,000 IU)/week or a placebo for 4 months [132]. The study included 25,871 men aged 50 years and older and women aged 55 years and older who had no history of cancer, and most had adequate serum 25(OH)D levels at baseline. Vitamin D fortification in the United States and Canada: Current status and data needs. Dietary supplements can contain vitamins D2 or D3. [, McDuffie JR, Calis KA, Booth SL, Uwaifo GI, Yanovski JA. [, Pittas A, Dawson-Hughes B, Staten M. The authors reply: Vitamin D supplementation and prevention of type 2 diabetes. Use of unstandardized 25(OH)D measures can raise questions about the accuracy of the results and about the validity of conclusions drawn from studies that use such measures and, especially, from meta-analyses that pool data from many studies that use different unstandardized measures [5,9,71]. The Endocrine Society states, for example, that to maintain serum 25(OH)D levels above 75 nmol/L (30 ng/mL), adults might need at least 37.5 to 50 mcg (1,500–2,000 IU)/day of supplemental vitamin D, and children and adolescents might need at least 25 mcg (1,000 IU)/day [11]. The association was substantially stronger in women. Br J Nutr 2013;109:1082-8. When a cop goes undercover to infiltrate a gang … The results showed that baseline serum 25(OH)D levels were inversely associated with total number of CVD events (including myocardial infarction, ischemic heart disease, heart failure, and stroke) and mortality risk [120]. These nutrients are needed to keep bones, teeth and muscles healthy. It concluded "with moderate certainty" that vitamin D supplementation does not reduce the numbers of falls or injuries, such as fractures, resulting from falls [78,79]. Am J Clin Nutr 2016;104:1151-9. [, Sempos CT, Heijboer AC, Bikle DD, Bollerslev J, Bouillon R, Brannon PM, et al. Another study included 2,259 healthy individuals aged 45 to 75 years who had had one or more serrated polyps (precursor lesions to colorectal cancer) that had been removed [102]. However, no 25(OH)D3 dietary supplements appear to be available to consumers on the U.S. market at this time [39]. [, Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, Gluud C. Vitamin D supplementation for prevention of cancer in adults. Explore the most dynamic Dungeons and Dragons Character experience ever. Cancer Epidemiol Biomarkers Prev 2019;28:900-8. Vitamin D helps regulate the renin-angiotensin-aldosterone system (and thereby blood pressure), vascular cell growth, and inflammatory and fibrotic pathways [118]. JAMA 2018;319:1600-12. A few studies have examined the effect of vitamin D supplementation on specific cancers. Although 25(OH)D functions as a biomarker of exposure, the extent to which 25(OH)D levels also serve as a biomarker of effect on the body (i.e., relating to health status or outcomes) is not clear [1,3]. JAMA 2017;317:2448-50.

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