I was reading that the recommendations for vitamin D supplementation have changed. I am so confused! Does this mean there is new data? Am I supposed to be taking vitamin D or not? What about my kids?
—Anonymous
You are correct that last month the Endocrine Society, a large international organization of endocrinologists, published new guidelines regarding vitamin D supplements in the general population. These guidelines are meant to help doctors know how to advise their patients about vitamin D supplementation.
You pose a very important question: why were these guidelines released now? In this particular case, it was because there were no pre-existing guidelines for the populations included in these guidelines. There is no new data triggering the release of these guidelines. In fact, if you read them carefully, the guidelines are based on very little data, and much of that data is flawed.
Previous guidelines have addressed infants and adults over age 18 at high risk of vitamin D deficiency. The new guidelines address people ages 1 and older at typical risk for vitamin D deficiency.
The new guidelines do not recommend testing vitamin D levels in this population at all. The authors note that ideal levels of vitamin D in the blood have not been established in healthy individuals. This is a recommendation based on a lack of evidence rather than new evidence or even high-quality data.
All guidelines include some indication of the certainty of the evidence — essentially an assessment of the quantity and quality of the data on which the recommendation is based. The Endocrine Society uses a “+” system. Each recommendation is rated from “+” to “++++,” with “++++” indicating that the recommendation is supported by a lot of high-quality evidence and “+” indicating that the recommendation is based on little or no high-quality evidence.
The guidelines recommend routine supplementation for kids ages 1 to 18 years old. The authors’ justification for this recommendation is to prevent rickets. However, they do point out that supplementation can be in the form of fortified foods (most milk products in the U.S. are fortified with vitamin D), a multivitamin, or a vitamin D supplement. They also do not recommend a specific amount of the vitamin. The authors give this recommendation just “++,” meaning their confidence in the recommendation is low.
For people ages 19 to 75, the guidelines do not recommend routine vitamin D supplementation. Depending on the age range, the authors rate these recommendations from “+” to “+++.” Finally, they recommend routine supplementation for people over age 75. They note that there may be a mortality benefit to vitamin D supplementation in this age group. They give this recommendation a rating of “+++.”
I would also urge you to remember that guidelines are just that — guidelines. They are not intended to be followed slavishly but to aid doctors in their decision-making. That said, given the level of evidence cited, these particular guidelines will not have a big impact on my clinical practice.
The upshot: There are new recommendations regarding vitamin D supplementation in people ages 1 and over. They are not based on new data, and many of the recommendations in this publication are not based on high-quality evidence.
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