June 03, 2024 – Boston – The Endocrine Society’s latest guidelines recommend against routine vitamin D testing in healthy individuals, instead suggesting vitamin D supplementation only for specific high-risk groups. These guidelines were presented at the Endocrine Society’s annual meeting and published in the Journal of Clinical Endocrinology and Metabolism.
Focus on Targeted Supplementation
The guidelines emphasize that children aged 1-18 years, pregnant individuals, adults over 75 years, and those with prediabetes may benefit from daily vitamin D supplementation beyond the standard daily intake. The recommendations exceed the 2011 National Academy of Medicine (NAM) guidelines, which advised 600 IU/day for those aged 1-70 years and 800 IU/day for those older than 70.
Dr. Anastassios G. Pittas, a professor at Tufts University, clarified, “These guidelines are for people who are otherwise healthy and don’t have a specific indication for vitamin D supplementation.” He noted that individuals with conditions like osteoporosis were not the focus of these recommendations.
Evidence and Rationale
The guidelines are based on evidence from trials suggesting that higher vitamin D intake can help prevent rickets in children, reduce respiratory infections, lower mortality risk in the elderly, and decrease the likelihood of developing type 2 diabetes in prediabetic adults. However, the guidelines caution against exceeding the recommended daily intake for most adults under 75.
Dr. Marie B. Demay of Harvard Medical School highlighted the lack of large-scale clinical trials that could provide definitive answers about optimal vitamin D levels and intake. “We need extensive clinical trials and biomarkers to predict disease outcomes before they occur,” she said.
Controversial Stance on Screening
The recommendation against routine vitamin D screening is based on the premise that it often leads to unnecessary clinical decisions. Dr. Clifford J. Rosen, a senior scientist at Maine Medical Center Research Institute, stated, “Screening doesn’t improve quality of life. It’s not worthwhile in any age group.”
Rosen pointed out that since the 2011 NAM guidelines, new evidence has emerged about the benefits of vitamin D for older adults, children, and pregnant individuals. Yet, the fundamental issues remain largely the same.
Addressing the Gaps
Despite the strengths of the new guidelines, some experts expressed concerns about their scope. Dr. Simeon I. Taylor of the University of Maryland argued that the guidelines do not adequately address complex cases like chronic kidney disease or inflammatory bowel disease. He suggested that alternative testing strategies might provide better insights into vitamin D status.
Taylor also noted that the guidelines would be more valuable if they included advice for managing vitamin D in patients with osteoporosis or osteopenia. “Explicitly considering the value of measuring vitamin D binding protein-independent indices would strengthen these recommendations,” he added.
Skin Pigmentation and Vitamin D
The guideline authors also discussed the impact of skin pigmentation and race on vitamin D metabolism. They found no clinical trials directly assessing outcomes based on skin pigmentation, although race and ethnicity were often used as proxies in studies. The panel stressed the importance of distinguishing between biological and social determinants to enhance scientific rigor.
In summary, the new guidelines advocate for targeted vitamin D supplementation for specific at-risk groups while advising against routine testing for the general population. These recommendations reflect a careful consideration of current evidence and acknowledge the need for further research to address unresolved questions in vitamin D health outcomes.
#VitaminD #HealthGuidelines #EndocrineSociety #HealthResearch #Supplementation