One of the highlights of the recently held annual conference of the Endocrine Society (US) in Boston was the release of new guidelines on the role of “Vitamin D for the prevention of disease.”
These call for limiting vitamin D supplementation beyond the daily recommended intake to specific risk groups and advise against routine 25-hydroxyvitamin D [25(OH)D] testing in healthy individuals.
Can we afford to do that? Despite being near the equator, Indians have been shown to have low blood levels of 25(OH)D (hereafter called D) due to various reasons, including sun-avoiding behaviour and extreme atmospheric pollution. Let us take a look at the key takeaways.
Should empiric vitamin D supplementation be used for children and adolescents (1-18 age group)?
For this group, the panel suggests vitamin D supplementation to prevent nutritional rickets (still seen in India) and potentially lower the risk of respiratory tract infections. This includes fortified foods or supplements. In a 2014 study, more than half the children in Delhi schools were shown to have D levels below 12ng/ml, which is very low. In Indian studies 1000 IU/day was able to correct the deficiency.
Should vitamin D supplements be used by adults
The panel was against routine vitamin D supplementation. However, in India, given the high prevalence and lower age for onset of osteoporosis/fractures and lower D levels, one could consider supplementation, particularly among those with poor sunlight exposure and during winter months in urban settings.
Should supplementation be used by adults ages >75 years?
For the general population in this age group, the panel suggested supplementation because of its potential to lower the risk of mortality. This is regardless of the baseline D level. Daily doses in the range of 900-1000 units/day have been recommended. This age group generally has a high percentage of bone disease/osteoporosis and a lower proportion of healthy people. Decisions should be taken by the physician in accordance with the disease condition.
What about pregnancy?
The panel recommends vitamin D supplements during pregnancy, given their potential to lower risk of preeclampsia, intra-uterine mortality, preterm birth and neonatal mortality. This is regardless of the D level. A wide range of doses (600-5000 IU/day) have been used by researchers and the optimal dose remains to be determined. The average daily dose in trials was ~2500 IU/day. In the absence of studies which establish optimum dose, ~2000 IU/day in pregnancy would be a safe bet for Indians.
What about vitamin D use by adults with prediabetes?
For adults with prediabetes, the panel suggested supplementation to reduce the risk of progression to full-blown diabetes in addition to lifestyle modification. A wide range of doses was used in trials. A dose of ~2000 IU daily is likely to be sufficient for this effect. This is an important (and new) recommendation in the Indian context, where the prevalence and number of people with prediabetes is high ( 15.3 per cent, 136 million).
Should a daily, lower-dose vitamin D vs intermittent higher-dose vitamin D be used where indicated?
In adults aged 50 years and older, who have indications for vitamin D supplementation or treatment, the panel suggests daily, lower-dose vitamin D. For Indians a daily dose of 1000-2000 IU/day is a good option.
(With inputs from Prof S. Bhadada, Chief of Endocrinology, PGI Chandigarh, and Maj Gen. (retd) R K Marwaha, endocrinologist, DRDO, Delhi)
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First uploaded on: 07-06-2024 at 07:45 IST
