Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland—Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies—2018 Update

AimsTo audit the investigation, identification and treatment of Vitamin D deficiency within Men's Secure Services.BackgroundVitamin D and/or vitamin D deficiency has been suggested to play a role in the pathogenesis of mental illness. There is evidence that Vitamin D inadequacy is pandemic among rehabilitation patients in inpatient settings. Patients within secure hospitals are similarly considered to be at high risk, due to their limited solar exposure during often lengthy admissions. It has been suggested that these patients should be considered an ‘at-risk’ cohort, for whom Vitamin D supplementation should be routine. Men's secure services in Birmingham comprise of two medium secure units and a low secure rehabilitation unit. Here we present an audit of Vitamin D monitoring and treatment completed in 2019.MethodA three year retrospective review of electronic patient records, for all inpatients admitted within men's secure services as of 1 September 2019 (n = 188). Standards were based on the Trust accepted guidelines for management of Vitamin D deficiency.ResultKey findings included:- The majority of inpatients were Caucasian (43%) and African-Caribbean (24%). Ages ranged from 18 to 70, with a mean age of 39.Approximately two-thirds (65%) had been in hospital for over a year, of which 44% had been admitted for more than 3 years. The average length of admission was 885 days.Only 47% of patients had their Vitamin D level checked within the study period.Of those checked, 24% were tested within 1 month of admission. The mean duration between admission and Vitamin D testing was 464 days.Results ranged from 10.3 to 118.5nmol/L. A high rate of Vitamin D deficiency was identified (54%), whilst a further 16% had ‘inadequate’ levels.23% of those identified as requiring treatment did not receive any supplementation, whilst 59% of those with sufficient Vitamin D were prescribed treatment.Only 48% had their levels rechecked following treatment; of these, only 59% now had an adequate Vitamin D status.ConclusionThis audit demonstrates limited Vitamin D monitoring within male forensic inpatients. There was a high prevalence of Vitamin D insufficiency in this population, yet a substantial proportion of patients with identified deficiency were not prescribed any treatment. Ongoing monitoring and review of treatment effectiveness was poor. We argue that more consideration should be given to this population, with robust guidelines introduced for the treatment of this specific ‘at-risk group’.

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Vitamin D and Atherosclerotic Cardiovascular Disease

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-00194 ◽

2019 ◽

Vol 104 (9) ◽

pp. 4033-4050 ◽

Cited By ~ 6

Author(s):

Thomas F Hiemstra ◽

Kenneth Lim ◽

Ravi Thadhani ◽

JoAnn E Manson

Keyword(s):

Cardiovascular Disease ◽

Vitamin D ◽

General Population ◽

Vitamin D Deficiency ◽

Randomized Trials ◽

Cardiovascular Health ◽

Vitamin D Supplementation ◽

High Dose ◽

Atherosclerotic Cardiovascular Disease ◽

Vitamin D Levels

Abstract Context A large body of experimental and observational data has implicated vitamin D deficiency in the development of cardiovascular disease. However, evidence to support routine vitamin D supplementation to prevent or treat cardiovascular disease is lacking. Design and Results A comprehensive literature review was performed using PubMed and other literature search engines. Mounting epidemiological evidence and data from Mendelian randomization studies support a link between vitamin D deficiency and adverse cardiovascular health outcomes, but randomized trial evidence to support vitamin D supplementation is sparse. Current public health guidelines restrict vitamin D intake recommendations to the maintenance of bone health and prevention of fractures. Two recently published large trials (VITAL and ViDA) that assessed the role of moderate- to high-dose vitamin D supplementation as primary prevention for cardiovascular outcomes in the general population had null results, and previous randomized trials have also been generally negative. These findings from general population cohorts that are largely replete in vitamin D may not be applicable to chronic kidney disease (CKD) populations, in which the use of active (1α-hydroxylated) vitamin D compounds is prevalent, or to other high-risk populations. Additionally, recent trials in the CKD population, as well as trials using vitamin D analogs, have been limited. Conclusions Current randomized trials of vitamin D supplementation do not support benefits for cardiovascular health, but the evidence remains inconclusive. Additional randomized trials assessing larger numbers of participants with low baseline vitamin D levels, having longer follow-up periods, and testing higher vitamin D dosages are needed to guide clinical practice.

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Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe — recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency

Endokrynologia Polska ◽

10.5603/ep.2013.0012 ◽

2013 ◽

Vol 64 (4) ◽

pp. 319-327 ◽

Cited By ~ 158

Author(s):

Paweł Płudowski ◽

Elżbieta Karczmarewicz ◽

Milan Bayer ◽

Graham Carter ◽

Danuta Chlebna-Sokół ◽

...

Keyword(s):

At Risk ◽

Vitamin D ◽

General Population ◽

Vitamin D Deficiency ◽

Central Europe ◽

Practical Guidelines

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25-OHD response to vitamin D supplementation in children: effect of dose but not GC haplotype

Acta Endocrinologica ◽

10.1530/eje-21-0349 ◽

2021 ◽

Author(s):

Christine A. Simpson ◽

Jane H. Zhang ◽

Dirk Vanderschueren ◽

Lei Fu ◽

Teresita C. Pennestri ◽

...

Keyword(s):

At Risk ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Vitamin D3 ◽

Randomized Study ◽

Vitamin D Supplementation ◽

Children At Risk ◽

Double Blind ◽

Baseline Levels ◽

To Receive

Objective: GC/DBP effects on response to vitamin D supplementation have not been well-studied. Thus we assessed free and total 25-OHD after vitamin D treatment across the 6 common GC haplotypes. Design: This double-blind, randomized study compared two vitamin D3 doses in healthy, urban-dwelling 6-month to 10-year-old children at-risk for vitamin D deficiency. Randomization was stratified by GC haplotype. Methods: Children were randomized to receive 2800 or 7000 International Units of vitamin D3 weekly. 25-OHD and 1,25(OH)2D were sampled at baseline and after 1 and 6 months of supplementation. Results and Conclusions: 192 of 225 enrolled subjects completed the study. After one month, total 25-OHD increased with both doses, and were higher with 7000 IU/week (85.5 ± 22.8 nmol/L) compared to 2800 IU/week (76.8 ± 18.0 nmol/L), despite equivalent baseline levels. No further significant increase occurred at 6 months (89.8 ± 35.5 and 74.3 ± 18.3 nmol/L, respectively). Free 25-OHD similarly changed. 25-OHD differed among GC groups at baseline. Although no significant effects of individual GC haplotypes on incremental changes were evident, a trend towards an effect of combined “at risk” GC alleles on response was evident (P=0.06). Total 1,25(OH)2D showed modest increases, moreso with the larger dose. In urban-dwelling children at-risk for vitamin D deficiency, one month of vitamin D3 2800 IU/week increased 25-OHD across all GC haplotype groups, and somewhat enhanced with 7000 IU/week with no further significant increases after 6 months of supplementation. Free 25-OHD measures offer no monitoring advantage over total 25-OHD.

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Vitamin D Deficiency and Possible Role in Multiple Sclerosis

European Neurological Review ◽

10.17925/enr.2015.10.02.131 ◽

2015 ◽

Vol 10 (2) ◽

pp. 131 ◽

Cited By ~ 3

Author(s):

Michael F Holick ◽

Stuart Cook ◽

Gustavo Suarez ◽

Mark Rametta ◽

◽

...

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

General Population ◽

Serum Level ◽

Vitamin D Deficiency ◽

Sun Exposure ◽

Vitamin D Supplementation ◽

Protective Effects ◽

Bone Homeostasis ◽

Vitamin D Metabolism

Vitamin D is not only an essential nutrient for bone homeostasis but has also been implicated in many other disorders including cardiovascular disease (CVD) and autoimmune diseases. Here we review the problem of vitamin D deficiency and guidelines to help achieve adequate levels in both the general population and in multiple sclerosis (MS) patients and its role in MS and impact on treatment. Although there is a lack of consensus on vitamin D deficiency and insufficiency, they have been defined as a serum level of 25(OH)D <50 nmol/L or 52.5–72.5 nmol/L, respectively. Deficiency is common in all age groups. Vitamin D is probably involved in the prevention of a number of disease states and 25(OH)D is thought to regulate at least 2,000 genes. Vitamin D toxicity is very rare, with none seen at doses up to 20,000 IU/day. However, the majority of primary care clinicians are not aware of the recommended dose for vitamin D supplementation and optimum serum level in terms of patients with MS. Several organisations have concluded that vitamin D screening cannot be recommended in the general population. Guidelines have been published on treatment and prevention of vitamin D deficiency, particularly for at-risk groups and during pregnancy. There is much evidence for the protective effects of vitamin D in MS. A higher level of sun exposure and intake of vitamin D as well as of serum 25 (OH)D, are associated with a lower risk of MS. It also has a beneficial effect on the clinical course of MS, such as lowering the risk of relapses. Growing evidence indicates that the effects of interferon-beta are additively enhanced by 25(OH)D in MS and this may be due to its modulating vitamin D metabolism.

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The Impact of Obesity on the Association between Vitamin D Deficiency and Cardiovascular Disease

Nutrients ◽

10.3390/nu11102458 ◽

2019 ◽

Vol 11 (10) ◽

pp. 2458 ◽

Cited By ~ 4

Author(s):

Paschou ◽

Kosmopoulos ◽

Nikas ◽

Spartalis ◽

Kassi ◽

...

Keyword(s):

Cardiovascular Disease ◽

Vitamin D ◽

General Population ◽

Vitamin D Deficiency ◽

Strong Association ◽

Vitamin D Supplementation ◽

Obese Adults ◽

Increased Risk ◽

High Prevalence ◽

The Impact

The aim of this article is to review the literature regarding the relationship between vitamin D deficiency and cardiovascular disease (CVD) and its modification in the presence of obesity. Despite the strong association between vitamin D status and cardiovascular outcomes, vitamin D supplementation trials in the general population have failed to decrease the incidence of cardiovascular events and mortality. A comprehensive study of the published literature and a comparison with experimental data lead to the conclusion that obesity, due to its high prevalence and strong association with both vitamin D deficiency and CVD, may act as a critical confounder, which is responsible for the different results on this association. Adoption of a vitamin D preventive supplementation strategy for CVD is unlikely to yield any benefit to the general population. However, it might be particularly useful in obese adults with increased risk for CVD.

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Vitamin D Deficiency/Insufficiency and Challenges in Developing Global Vitamin D Fortification and Supplementation Policy in Adults

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000117 ◽

2012 ◽

Vol 82 (4) ◽

pp. 237-259 ◽

Cited By ~ 9

Author(s):

Moshe Ben-Shoshan

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Search Strategy ◽

Epidemiologic Studies ◽

Vitamin D Supplementation ◽

Vitamin D Status ◽

Societal Burden ◽

Time Period ◽

New Guidelines ◽

In Cis

This review summarizes studies discussing vitamin D status in adults and reveals that vitamin D deficiency/insufficiency is highly prevalent in adults and that current fortification and supplementation policies are inadequate. Background and aims: Studies suggest a crucial role for adequate vitamin D status in various health conditions including bone metabolism, cancer, cardiovascular diseases, and allergies. However, relatively little is known about poor vitamin D status and unmet needs in adults. This report aims to highlight the contribution of epidemiologic studies (through the identification of health effects and societal burden) to the development of vitamin D fortification and supplementation policies and reveal unmet global challenges in adults. Methods: In order to assess worldwide vitamin D status in adults, the search strategy combined the medical literature database MEDLINE (using PubMed) for the time period between January 1, 1980 and February 28, 2011, using the key words vitamin D deficiency and insufficiency, and included articles in which access to full text was possible and in which healthy adults were assessed according to one of four commonly used vitamin D threshold classifications. Results: This report reveals that vitamin D deficiency occurs in 4.10 % [95 % CI (confidence interval), 3.93 %, 4.27 %] to 55.05 % (54.07 %, 56.03 %) of adults, while insufficiency occurs in 26.07 % (24.82 %, 27.33 %) to 78.50 % (77.85 %, 79.16 %), depending on the classification used. However, lack of overlap in CIs and high value of I2 statistics indicate considerable heterogeneity between studies. Further, certain populations (i. e. dark-skinned individuals, immigrants, and pregnant women) may be at higher risk for poor vitamin D status. Conclusion: Current policies for vitamin D supplementation and fortification are inadequate and new guidelines are required to improve vitamin D status in adults.

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Vitamin D deficiency awareness and behaviour of the general population in Abha city: An internet based survey

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1541785830 ◽

2019 ◽

pp. 179-184

Author(s):

Shahid Aziz ◽

Fahad Alamri ◽

Mohammed Alzyedy ◽

Arif Alqahtani ◽

Ibrahim Asiri ◽

...

Keyword(s):

Vitamin D ◽

General Population ◽

Vitamin D Deficiency

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Vitamin D and Cardiovascular Disease: An Updated Narrative Review

International Journal of Molecular Sciences ◽

10.3390/ijms22062896 ◽

2021 ◽

Vol 22 (6) ◽

pp. 2896

Author(s):

Armin Zittermann ◽

Christian Trummer ◽

Verena Theiler-Schwetz ◽

Elisabeth Lerchbaum ◽

Winfried März ◽

...

Keyword(s):

Cardiovascular Disease ◽

Vitamin D ◽

High Risk ◽

General Population ◽

Vitamin D Deficiency ◽

Specific Gene ◽

Vitamin D Status ◽

Cvd Risk ◽

Severe Vitamin ◽

Increased Risk

During the last two decades, the potential impact of vitamin D on the risk of cardiovascular disease (CVD) has been rigorously studied. Data regarding the effect of vitamin D on CVD risk are puzzling: observational data indicate an inverse nonlinear association between vitamin D status and CVD events, with the highest CVD risk at severe vitamin D deficiency; however, preclinical data and randomized controlled trials (RCTs) show several beneficial effects of vitamin D on the surrogate parameters of vascular and cardiac function. By contrast, Mendelian randomization studies and large RCTs in the general population and in patients with chronic kidney disease, a high-risk group for CVD events, largely report no significant beneficial effect of vitamin D treatment on CVD events. In patients with rickets and osteomalacia, cardiovascular complications are infrequently reported, except for an increased risk of heart failure. In conclusion, there is no strong evidence for beneficial vitamin D effects on CVD risk, either in the general population or in high-risk groups. Whether some subgroups such as individuals with severe vitamin D deficiency or a combination of low vitamin D status with specific gene variants and/or certain nutrition/lifestyle factors would benefit from vitamin D (metabolite) administration, remains to be studied.

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