Written by Chrystal Moulton, Staff Writer.
Knowledge of the effects of vitamin D on health has grown considerably since its discovery in the 1930s.(1) Scientists and clinicians began to understand the importance of this key vitamin to skeletal health. Further research revealed the benefits of vitamin D don’t stop there, but expand to a wide range of functional systems.(1,2) Exactly how vitamin D functions with in these systems are still being determined.(1-3) However, given the wealth of knowledge on vitamin D, practitioners face a very pragmatic problem—applying it to clinical practice. Unlike other vitamins, cholecalciferol (vitamin D3) is produced by the body under UV-B radiation from the sun. (4,5) Nonetheless, based on physiological conditions, age, location, and skin tone, for some individuals vitamin D may be conditionally essential because they are not able to produce sufficient amounts of the active form needed to support optimal wellness. It is this sufficient value that has baffled clinicians and researchers alike. (3,4)
A group of 25 experts (3) from a various medical disciplines held a two-day conference to establish a range of circulatory vitamin D that is effective for maintaining optimal wellness in specific populations. In the meeting, they addressed 4 specific questions for clinical practice:
• Who should be tested for vitamin D deficiency?
• What is the recommended range of serum 25(OH)D?
• Who should be supplemented?
• When should testing be performed?
The panel held group sessions according specialty and reviewed available literature published by PubMed from 2000-2009. Vitamin D application was reviewed for oncological, immunological, cardiovascular, and orthopedic practices. Panel experts acknowledged the lack of randomized controlled trials available for non-classical conditions associated with vitamin D (i.e. autoimmune disease and diabetes). Nonetheless, recommendations were made based not only on evidence, but risk benefit assessments and their own clinical experience. All recommendations reached for vitamin D in relation to cardiovascular health, immunity, oncology, and musculoskeletal health were individually rated by each expert on a scale of 1to 5 (1- not at all agree, 5- fully agree). Scores for each topic was averaged and the means were displayed with each question.
At the end of the conference, researchers concluded that there are two kinds of individuals generally seen in practice. First, there are individuals whose vitamin D levels should be tested. These include persons at risk for bone loss due to treatment or conditions, hypertension, cardiovascular disease, elderly, and pregnant. And secondly, there are individuals who should be supplemented without testing. Researchers agreed those who are dark-skinned, over 65 years old regardless of health conditions, and institutionalized individuals should be supplemented 800 IU/day (according to randomized control trials reviewed) to ensure vitamin D level is maintained within a healthy range. Also, based on evidence from the controlled trials, experts concluded that the optimal range of vitamin D should be between 30-44 ng/ml serum. Furthermore, the panel recommended that levels of vitamin D should be monitored every 3 months and more (if necessary) at the physician’s own judgment.
All in all, although vitamin D’s causal link to various disease, fall risk, and even mortality is not exactly clear, vitamin D systemically greater than 30ng/ml in serum evidently has continued positive effects on health and wellness (1-5).
Source: Souberbielle, Jean-Claude, et al. “Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: recommendations for clinical practice.” Autoimmunity reviews 9.11 (2010): 709-715.
Copyright © 2013 Elsevier B.V. All rights reserved
Posted September 13, 2012.
Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.
References:
- Vitamin D, Chap 20. In: Modern Nutrition in Health and Disease, 10th Ed. Shils ME, Ed. Lippincott Williams & Wilkins, Philadelphia, 2006.
- Vitamin D: evolutionary, physiological and health perspectives. Holick MF. Curr Drug Targets. 2011 Jan;12(1):4-18.
- Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Souberbielle JC, et al. Autoimmun Rev. 2010 Sep;9(11):709-15. Epub 2010 Jul 1.
- Treatment for vitamin D deficiency: here and there do not mean everywhere. Ameri P, Bovio M, Murialdo G. Eur J Nutr. 2012 Mar;51(2):257-9; author reply 255-6.
- Vitamin D status: sunshine is nice but other factors prevail. Toss G, Magnusson P. Eur J Nutr. 2012 Feb 3. [Epub ahead of print].
