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

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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The implications of vitamin D deficiency on COVID-19 for at-risk populations

Nutrition Reviews ◽

10.1093/nutrit/nuaa092 ◽

2020 ◽

Cited By ~ 2

Author(s):

Rosemary DeLuccia ◽

Deborah Clegg ◽

Deeptha Sukumar

Keyword(s):

At Risk ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Current Knowledge ◽

Viral Disease ◽

Overweight And Obesity ◽

Pharmacological Agents ◽

Optimal Dosing ◽

Populations At Risk ◽

Sufficient Vitamin

Abstract Novel coronavirus disease 2019 (COVID-19) has spread to > 10 000 000 individuals in a short time. With no pharmacological agents successfully implemented to control the outbreak, the use of less invasive nonpharmacological agents, such as vitamin D, are increasingly being studied. This purpose of this article is to determine the current knowledge about the risk of COVID-19 development for populations at risk for vitamin D deficiency, including individuals living with overweight and obesity, those of older age, and racial or ethnic minorities. Despite the documented impact of vitamin D on viral disease prevention, many subgroups at risk for contracting COVID-19 are also known to have increased rates of vitamin D deficiency. Because vitamin D is most commonly obtained from sunlight, when interpreted alongside the stay-at-home orders, the importance of identifying safe approaches to obtain sufficient vitamin D is apparent. Furthermore, elucidating the cause-and-effect relationship between vitamin D and COVID-19, including optimal dosing for COVID-19 outcomes, is also warranted for immediate investigation.

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Vitamin D monitoring and management within men's secure services

BJPsych Open ◽

10.1192/bjo.2021.885 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S337-S338

Author(s):

Jason Niblett ◽

Shay-Anne Pantall ◽

Anis Ahmed

Keyword(s):

At Risk ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Treatment Effectiveness ◽

Average Length ◽

Vitamin D Insufficiency ◽

Vitamin D Supplementation ◽

High Rate ◽

List Type ◽

Electronic Patient Records

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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Vitamin D deficiency rickets in five “at-risk” children

Pediatrics International ◽

10.1111/j.1442-200x.2011.03408.x ◽

2012 ◽

Vol 54 (1) ◽

pp. 152-155 ◽

Cited By ~ 3

Author(s):

Patrizia D'Eufemia ◽

Pasquale Parisi ◽

Mauro Celli ◽

Roberto Finocchiaro ◽

Mario Roggini ◽

...

Keyword(s):

At Risk ◽

Vitamin D ◽

Vitamin D Deficiency ◽

At Risk Children ◽

Deficiency Rickets

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Vitamin D Deficiency is Associated with Increased COVID-19 Severity: Prospective Screening of At-Risk Groups is Medically Indicated

10.21203/rs.3.rs-83262/v1 ◽

2020 ◽

Author(s):

Samuel H Pepkowitz ◽

Calvin J Hobel ◽

James M Mirocha MS ◽

Kimia.Sobhani ◽

Carissa A Huynh BS ◽

...

Keyword(s):

At Risk ◽

Vitamin D ◽

Immune System ◽

Vitamin D Deficiency ◽

Hospital Admissions ◽

Serum Vitamin ◽

Risk Groups ◽

Population Groups ◽

Serum Vitamin D ◽

Low Serum

Abstract Non-classical actions of Vitamin D are involved in regulation of the immune system including a role in mitigation of excessive inflammation. We hypothesized that vitamin D deficiency existing prior to SARS-CoV-2 infection could contribute to patients developing severe pulmonary compromise as a result of dysfunctional hyperinflammation. Serum vitamin D concentrations of patients experiencing such severe COVID-19 manifestations that they required ICU care at any point of their hospitalization were compared to serum vitamin D concentrations of patients achieving discharge without the need for any ICU care. Having serum vitamin D < 20 ng/mL was significantly associated with increased COVID-19 severity, p=0.001. It is conjectured that population groups know to have low serum vitamin D should be prospectively screened for deficiency and if found emergently treated. Such action could both decrease the maximum severity suffered by infected individuals and lessen the strain on medical resources by decreasing the percentage of COVID-19 hospital admissions requiring ICU care.

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Trends in the incidence of testing for vitamin D deficiency in primary care in the UK: a retrospective analysis of The Health Improvement Network (THIN), 2005–2015

BMJ Open ◽

10.1136/bmjopen-2018-028355 ◽

2019 ◽

Vol 9 (6) ◽

pp. e028355 ◽

Cited By ~ 12

Author(s):

Francesca L Crowe ◽

Kate Jolly ◽

Christine MacArthur ◽

Semira Manaseki-Holland ◽

Neil Gittoes ◽

...

Keyword(s):

Primary Care ◽

At Risk ◽

Vitamin D ◽

Ethnic Minority ◽

Vitamin D Deficiency ◽

Future Research ◽

Health Improvement ◽

Economically Deprived ◽

The Health Improvement Network ◽

The Uk

ObjectiveTo investigate trends in the incidence of testing for vitamin D deficiency and the prevalence of patients with circulating concentrations of 25-hydroxyvitamin D (25(OH)D) indicative of deficiency (<30 nmol/L) between 2005 and 2015.DesignLongitudinal analysis of electronic health records in The Health Improvement Network primary care database.SettingUK primary care.InterventionNone.ParticipantsThe analysis included 6 416 709 participants aged 18 years and older.Primary outcomesIncidence of having a blood test for vitamin D deficiency between 2005 and 2015, the prevalence with blood 25(OH)D <30 nmol/L and the effects of age, ethnicity and socioeconomic status on these measures were assessed.ResultsAfter a mean follow-up time of 5.4 (SD 3.7) years, there were 210 502 patients tested for vitamin D deficiency. The incidence of vitamin D testing rose from 0.29 per 1000 person-years at risk (PYAR) (95% CI 0.27 to 0.31) in 2005 to 16.1 per 1000 PYAR (95% CI 15.9 to 16.2) in 2015. Being female, older, non-white ethnicity and more economically deprived were all strongly associated with being tested. One-third (n=69 515) had 25(OH)D <30 nmol/L, but the per cent deficient among ethnic minority groups ranged from 43% among mixed ethnicity to 66% in Asians. Being male, younger and more economically deprived were also all associated with vitamin D deficiency (p<0.001).ConclusionsTesting for vitamin D deficiency increased over the past decade among adults in the UK. One-third of UK adults who had a vitamin D test performed in primary care were vitamin D deficient, and deficiency was much higher among ethnic minority patients. Future research should focus on strategies to ensure population intake of vitamin D, particularly in at-risk groups, meets recommendations to reduce the risk of deficiency and need for testing.

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