Front Endocrinol (Lausanne). Crouzet B Phillips B ,

Endogenous vitamin D synthesis occurs primarily through…, Three children with rickets (reproduced,…, Three children with rickets (reproduced, with permission, from Wellcome Library, London. Steroid and xenobiotic receptor and vitamin D receptor crosstalk mediates CYP24 expression and drug-induced osteomalacia.  |  , Murad et al. 2.4 We suggest that pregnant and lactating women require at least 600 IU/d of vitamin D and recognize that at least 1500–2000 IU/d of vitamin D may be needed to maintain a blood level of 25(OH)D above 30 ng/ml (2|⊕⊕⊕○). , Holick MF, Clemens TL

evidence-based medicine; guideline; recommendation; vitamin D. Vitamin D endogenous synthesis and metabolism. In addition, age decreases the capacity of the skin to produce vitamin D3 (3). Willett WC Erwin PJ (91) suggests that this age group needs 2000 IU/d vitamin D to maintain a blood level above 30 ng/ml. Vitamin D sufficiency enhances calcium and phosphorus absorption by 30–40% and 80%, respectively (3, 10).

, Jongen MJ


, , Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. The Task Force commissioned the conduct of two systemic reviews of the literature to inform its key recommendations. , The Clinical Guidelines Subcommittee of The Endocrine Society deemed vitamin D deficiency a priority area in need of practice guidelines and appointed a Task Force to formulate evidence-based recommendations. Their daily regimen should at least include a prenatal vitamin containing 400 IU vitamin D with a supplement that contains at least 1000 IU vitamin D. During lactation, the mother needs to increase the efficiency of dietary absorption of calcium to ensure adequate calcium content in her milk. Püschel K

Holick MF Fu R 101 394–415.

, 2012.

, , Vitamin D intakes recommended by the IOM and the Endocrine Practice Guidelines Committee.

Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. This observation is consistent with what Jeans (75) observed in 1950, and it was the basis for recommending that children only need 200 IU/d of vitamin D. However, Markestad and Elzouki (76) reported that Norwegian infants fed formula containing 300 IU/d obtained blood levels of 25(OH)D above 11 ng/ml, which at the time was considered the lower limit of normal.

, , , , Several studies found associations between 25(OH)D levels and hypertension, coronary artery calcification, as well as prevalent and incident heart disease (137–140). , Beard MK Vitamin D and skin physiology: a D-lightful story. Recently, Priemel et al. , Abu Elnour NO , Epub 2010 Feb 1. , Cosponsoring Associations: Canadian Society of Endocrinology and Metabolism and National Osteoporosis Foundation.

, , The Task Force used consistent language and geographical descriptions of both the strength of recommendation and the quality of evidence using the recommendations of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. ,

In the past, children of all races obtained most of their vitamin D from exposure to sunlight and drinking vitamin D-fortified milk, and therefore, they did not need to take a vitamin D supplement (3, 84). Nutritional rickets among breast-fed black and Alaska Native children. However, to raise the blood level of 25(OH)D consistently above 30 ng/ml may require at least 1000 IU/d of vitamin D (2|⊕⊕⊕⊕). Vitamin D deficiency in a healthy group of mothers and newborn infants. , Persistence of vitamin D-deficiency rickets in Toronto in the 1990s. Sokoll LJ Ameri A , , , ,

Wong JB Zhou XY Short- and long-term safety of weekly high-dose vitamin D3 supplementation in school children. , Chen TC

-, Uday S, Fratzl-Zelman N, Roschger P, Klaushofer K, Chikermane A, Saraff V, Tulchinsky T, Thacher TD, Marton T, Högler W. Cardiac, bone and growth plate manifestations in hypocalcemic infants: revealing the hidden body of the vitamin D deficiency iceberg. , ,

Delmas PD The vitamin D receptor is present in most tissues and cells in the body (3, 12).

Jaeschke R , Demer LL, Poole KE de Papp AE, Lips P

Serum-25-hydroxycholecalciferol levels in children and adolescents. 3.3 For children aged 1–18 yr who are vitamin D deficient, we suggest treatment with 2000 IU/d of vitamin D2 or vitamin D3 for at least 6 wk or with 50,000 IU of vitamin D2 once a week for at least 6 wk to achieve a blood level of 25(OH)D above 30 ng/ml, followed by maintenance therapy of 600-1000 IU/d (2|⊕⊕⊕⊕). Pfeifer M , Wenzel L , Tsang RC, Feliciano ES Indications for 25(OH)D measurement (candidates for screening). ,

, , Amling M, Dawson-Hughes B We do not recommend prescribing vitamin D supplementation beyond recommended daily needs for the purpose of preventing cardiovascular disease or death or improving quality of life (2|⊕⊕⊕⊕). ,

, Hill S Thus, their 25(OH)D and calcium levels should be monitored carefully. Obese adults (BMI > 30 kg/m2) are at high risk for vitamin D deficiency because the body fat sequesters the fat-soluble vitamin. Numerous epidemiological studies have suggested that a 25(OH)D blood level above 30 ng/ml may have additional health benefits in reducing the risk of common cancers, autoimmune diseases, type 2 diabetes, cardiovascular disease, and infectious diseases. ,

, This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features! Similarly, individuals with levels below 15 ng/ml had a multivariable-adjusted hazard ratio of 1.62 (95% CI, 1.11–2.36) for incident cardiovascular events compared with those with levels above 15 ng/ml (137). Mason J , , Staehelin HB Prospective study of vitamin D supplementation and rickets in China. Wu K , Severe vitamin D deficiency in Swiss hip fracture patients. Vitamin D deficiency has been historically defined and recently recommended by the Institute of Medicine (IOM) as a 25(OH)D of less than 20 ng/ml. , Murad MH

Norquist JM , , van der Vijgh WJ, Chapuy MC , ,

Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. The effect of sun exposure on 25-hydroxyvitamin D concentrations in young healthy subjects living in the city of Sao Paulo, Brazil. Children of all ages are at risk for vitamin D deficiency and insufficiency (3, 29, 47, 77, 84–90), with the caveat that at present we do not know optimal serum 25(OH)D levels for any functional outcome. Shui QM Patients who do not show an increase in their blood level of 25(OH)D should be worked up for celiac disease or occult cystic fibrosis, assuming that they were compliant with treatment.
Results of these studies converge on a rate of rise in serum 25(OH)D at approximately 0.4 ng/ml/μg/d, which means that ingesting 100 IU/d of vitamin D increases serum 25(OH)D by less than 1 ng/ml approximately (101, 127).

, , , Holick MF, Lee JM Mehta SD Barker PJ

, Frank MP

Vieth R, Priemel M Preliminary data suggest that only after lactating women were given 4000–6000 IU/d of vitamin D was enough vitamin D transferred in breast milk to satisfy her infant's requirement (32).

, In addition, 42% of African-American girls and women aged 15–49 yr throughout the United States had a blood level of 25(OH)D below 15 ng/ml at the end of the winter (30), and 32% of healthy students and physicians at a Boston hospital had 25(OH)D below 20 ng/ml (31). Lanier K May J Hosking D Gunter EW , , , Increased use of clothing and sunscreen over sun-exposed areas and decreased consumption of vitamin D-fortified milk increases the risk for vitamin D deficiency (3, 31, 39, 103).

, Vitamin D is critical for bone and mineral metabolism, and it is established that vitamin D deficiency can cause rickets and osteomalacia. Khan A Schwartz RP In the United States, more than 50% of Hispanic and African-American adolescents in Boston (28) and 48% of white preadolescent girls in Maine had 25(OH)D below 20 ng/ml (29). In both groups, the serum 25(OH)D level should be monitored and vitamin D dosage adjusted to achieve a 25(OH)D level above 30 ng/ml. Dawson-Hughes B, Meier DE 2.3 We suggest that all adults aged 50–70 and 70+ yr require at least 600 and 800 IU/d, respectively, of vitamin D. Whether 600 and 800 IU/d of vitamin D are enough to provide all of the potential nonskeletal health benefits associated with vitamin D is not known at this time. ,

, , Scheidt-Nave C Interventions to raise vitamin D level and functional outcomes: a systematic review and meta-analysis. , Nicholson M, Gordon CM Magrini N They concluded that in conjunction with sufficient calcium intake, the dose of vitamin D supplementation should ensure that circulating levels of 25(OH)D reach a minimum threshold of 30 ng/ml to maintain skeletal health. Specker BL Falls in the elderly: a prospective study of risk factors and risk profiles. Stuck AE Although it has been suggested that aging may decrease the ability of the intestine to absorb dietary vitamin D, studies have revealed that aging does not alter the absorption of physiological or pharmacological doses of vitamin D (101, 104–106). Pilz S, März W, Cashman KD, Kiely ME, Whiting SJ, Holick MF, Grant WB, Pludowski P, Hiligsmann M, Trummer C, Schwetz V, Lerchbaum E, Pandis M, Tomaschitz A, Grübler MR, Gaksch M, Verheyen N, Hollis BW, Rejnmark L, Karras SN, Hahn A, Bischoff-Ferrari HA, Reichrath J, Jorde R, Elmadfa I, Vieth R, Scragg R, Calvo MS, van Schoor NM, Bouillon R, Lips P, Itkonen ST, Martineau AR, Lamberg-Allardt C, Zittermann A. , The metabolism of 25(OH)D to 1,25(OH)2D is enhanced in response to this new demand.