Vitamin D obtained from sun exposure, foods, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. CMAJ 2019;191:E390-4. The vitamin D content of human milk is related to the mother’s vitamin D status; studies suggest that the breastmilk of mothers who take daily supplements containing at least 50 mcg (2,000 IU) vitamin D3 have higher levels of the nutrient [58,59]. [, Anglin RES, Samaan Z, Walter SD, McDonald SD. Ann Oncol 2019;30:733-43. doi: 10.1001/jamanetworkopen.2019.17789. However, most evidence indicates that vitamin D3 increases serum 25(OH)D levels to a greater extent and maintains these higher levels longer than vitamin D2, even though both forms are well absorbed in the gut [33-36]. In Canada, milk must be fortified with 0.88–1.0 mcg/100 mL (35–40 IU), and the required amount for margarine is at least 13.25 mcg/100 g (530 IU). Preventive Medicine 2013;57:753-64. Cochrane Database Syst Rev 2014; 23(6):CD007469. [, Sowah D, Fan X, Dennett L, Hagtvedt R, Straube S. Vitamin D levels and deficiency with different occupations: A systematic review. Vitamin D might also have anti-inflammatory, immunomodulatory, proapoptotic, and antiangiogenic effects [1,87]. Beef liver, cheese, and egg yolks have small amounts of vitamin D, primarily in the form of vitamin D3 and its metabolite 25(OH)D3. One study comparing 738 men who developed pancreatic cancer to 738 matched controls found no relationship between serum 25(OH)D levels and risk of pancreatic cancer [105]. Am J Clin Nutr 2012;95:1350-6. It is also needed for bone growth and bone remodeling by osteoblasts and osteoclasts [1-3]. Cancer Epidemiol Biomarkers Prev 2019;28:900-8. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults. Overall, the available research suggests that consuming higher amounts of vitamin D or taking vitamin D supplements does not promote weight loss. In contrast to 25(OH)D, circulating 1,25(OH)2D is generally not a good indicator of vitamin D status because it has a short half-life measured in hours, and serum levels are tightly regulated by parathyroid hormone, calcium, and phosphate [1]. [, James WP, Avenell A, Broom J, Whitehead J. Google's free service instantly translates words, phrases, and web pages between English and over 100 other languages. The effect of vitamin D supplementation on glycemic control in type 2 diabetes patients: A systematic review and meta-analysis. Int J Cancer 2018;142:1189-201. Vitamin D 20 000 IU per week for five years does not prevent progression from prediabetes to diabetes. However, because research has been conducted on vitamin D and numerous health outcomes, this section focuses on seven diseases, conditions, and interventions in which vitamin D might be involved: bone health and osteoporosis, cancer, cardiovascular disease (CVD), depression, multiple sclerosis (MS), type 2 diabetes, and weight loss. J Nutr 2014;144:654-9. Monthly high-dose vitamin D supplementation does not increase kidney stone risk or serum calcium: Results from a randomized controlled trial. The results showed no significant differences in rates of progression to type 2 diabetes; in serum glucose, insulin, or hemoglobin A1c levels; or in measures of insulin resistance. No improvement in depressive symptoms by vitamin D supplementation: Results from a randomised controlled trial. Older women and men should consult their healthcare providers about their needs for both nutrients as part of an overall plan to maintain bone health and to prevent or treat osteoporosis. Treatment with vitamin D and calcium reduces bone loss after renal transplantation: a randomized study. The study reports included 3–10 years of followup data. Vitamin D assays and the definition of hypovitaminosis D. Results from the First International Conference on Controversies in Vitamin D. Br J Clin Pharmacol 2018;84:2194-207. [, Kahwati LC, Weber RP, Pan H, Gourlay M, LeBlanc E, Coker-Schwimmer M, Viswanathan M. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: Evidence report and systematic review for the US Preventive Services Task Force. [, Skversky AL, Kumar J, Abramowitz MK, Kaskel FJ, Melamed ML. It is also produced endogenously when ultraviolet (UV) rays from sunlight strike the skin and trigger vitamin D synthesis. Use of vitamin D drops leading to kidney failure in a 54-year-old man. Intake recommendations for vitamin D and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by expert committees of NASEM [1]. Similarly, the VITAL clinical trial described above found that vitamin D supplements did not significantly decrease rates of heart attacks, strokes, coronary revascularization, or deaths from cardiovascular causes [93]. However, because the extent and frequency of sunscreen use are unknown, the role that sunscreen may play in reducing vitamin D synthesis is unclear [1]. Post-treatment levels of plasma 25- and 1,25-dihydroxy vitamin D and mortality in men with aggressive prostate cancer. Environ Health Perspect 2017;125(7):077004. [. No. [, Wactawski-Wende J, Kotchen JM, Anderson GL, Assaf AR, Brunner RL, O'Sullivan MJ, et al. Am J Clin Nutr 2019;109:369-79. Diamond Hill Capital's Top 5 3rd-Quarter Buys, Analyst Provides Guidance for This Canadian Energy Company, RBC Capital’s Outlook for This Canada’s Energy Sector Company, Dominion (D) Q3 Earnings Surpass Estimates, Revenues Miss, Dominion Energy (D) Surpasses Q3 Earnings Estimates, Utility Stock Q3 Earnings Roster for Nov 5: DUK, D & More, 19 Election Stocks to Buy if Joe Biden Wins in 2020, Zacks Industry Outlook Highlights: NextEra Energy, Dominion Energy, Duke Energy Corp and Xcel Energy, 4 Electric Power Stocks to Tap Amid Coronavirus-Led Industry Woes. J Clin Endorcinol Metab 2015;100:2339-46. Intraday data delayed at least 15 minutes or per exchange requirements. Increasing incidence of nutritional rickets: A population-based study in Olmsted County, Minnesota. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Lancet Diabetes Endocrinol 2018;6:847-58. Global consensus recommendations on prevention and management of nutritional rickets. About 2.3 million osteoporotic fractures occurred in the United States in 2015 [74]. [. Including food 25-hydroxyvitamin D in intake estimates may reduce the discrepancy between dietary and serum measures of vitamin D status. Institute of Medicine, Food and Nutrition Board. The fortification of milk (a good source of calcium) and other staples, such as breakfast cereals and margarine, with vitamin D beginning in the 1930s along with the use of cod liver oil made rickets rare in the United States [30,51]. The U.S. Department of Agriculture’s (USDA’s) FoodData Central lists the nutrient content of many foods and provides a comprehensive list of foods containing vitamin D arranged by nutrient content and by food name. [, Calvo MS, Whiting SJ, Barton CN. Over time, bone density can decline, and osteoporosis can eventually develop [72]. However, no 25(OH)D3 dietary supplements appear to be available to consumers on the U.S. market at this time [39]. No association between circulating concentrations of vitamin D and risk of lung cancer: An analysis in 20 prospective studies in the Lung Cancer Cohort Consortium (LC3). Int J Obes Relat Metab Disord 2001;25:1154-60. [, Pappa HM, Bern E, Kamin D, Grand RJ. [, Holick MF. As a result, a finding can be falsely low or falsely high, depending on the assay used and the laboratory. Aloia JF, Talwar SA, Pollack S, Yeh J. Hypercalcemia, in turn, can lead to nausea, vomiting, muscle weakness, neuropsychiatric disturbances, pain, loss of appetite, dehydration, polyuria, excessive thirst, and kidney stones. Screening for vitamin D status is becoming a more common part of the routine laboratory bloodwork ordered by primary-care physicians, irrespective of any indications for this practice [6,53-55]. Most people in the United States consume less than recommended amounts of vitamin D. An analysis of data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) found that average daily vitamin D intakes from foods and beverages were 5.1 mcg (204 IU) in men, 4.2 mcg (168 IU) in women, and 4.9 mcg (196 IU) in children aged 2–19 years [40]. Similarly, in a review of data from nearly 250 studies published between 2009 and 2013, the Agency for Healthcare Research and Quality concluded that no relationship could be firmly established between vitamin D and health outcomes other than bone health [70]. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: A systematic review and meta-analysis. However, whether these lower levels in persons with dark skin have significant health consequences is not clear [14]. The USPSTF stated that, due to insufficient evidence, it was unable to assess the balance of benefits and harms of supplemental vitamin D to prevent cancer [117]. [, Beveridge LA, Struthers AD, Khan F, Jorde R, Scragg R, Macdonald HM, et al. Several studies published in 2014 suggested that high levels of 25(OH)D might increase the risk of prostate cancer. Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA. Lancet Diabetes Endocrinol 2018;6:834-5. Optimal serum concentrations of 25(OH)D for bone and general health have not been established because they are likely to vary by stage of life, by race and ethnicity, and with each physiological measure used [1,13,14]. Mayo Clin Proc 2013;88:720-55. [, Bolland MJ, Grey A, Avenell A. Breastfed infants [, Kristal AR, Till C, Song X, Tangen CM, Goodman PJ, Neuhauser ML, et al. Consumption of human milk alone does not ordinarily enable infants to meet vitamin D requirements, because it provides less than 0.6 to 2.0 mcg/L (25 to 78 IU/L) [1,57,58]. [. Clin Pharmacol Ther 2009;85:198-203. However, the incidence of rickets is increasing globally, even in the United States and Europe, especially among immigrants from African, Middle-Eastern, and Asian countries [52]. PMID: 31504098 [, Okereke OI, Reynolds III CF, Mischoulon D, Chang G, Vyas CM, Cook NR, et al. Vitamin D for health: A global perspective. [, Rajakumar K. Vitamin D, cod-liver oil, sunlight, and rickets: A historical perspective. Osteoporosis is most often associated with inadequate calcium intakes, but insufficient vitamin D intakes contribute to osteoporosis by reducing calcium absorption [1]. International Journal of Epidemiology 2019;48:1416-24. What constituted a "higher" level varied by study but was typically at least 75 nmol/L (30 ng/mL). For these reasons, vitamin D has been linked to heart health and risk of CVD. Yao P, Bennett D, Mafham M, Lin X, Chen Z, Armitage J, Clarke R. Vitamin D and calcium for the prevention of fracture: A systematic review and meta-analysis. Silva MC, Furlanetto TW. Get the latest research information from NIH: https://www.nih.gov/coronavirus, Have a question? Vitamin D supplementation had no effect on the incidence rate of myocardial infarction, angina, heart failure, arrhythmia, arteriosclerosis, stroke, venous thrombosis, or death from CVD. Cookie Notice. [, Durup D, Jorgensen HL, Christensen J, Tjonnland A, Olsen A, Halkjaer J, et al. People with dark skin The Endocrine Society states, for example, that to maintain serum 25(OH)D levels above 75 nmol/L (30 ng/mL), adults might need at least 37.5 to 50 mcg (1,500–2,000 IU)/day of supplemental vitamin D, and children and adolescents might need at least 25 mcg (1,000 IU)/day [11]. A meta-analysis of prospective studies that evaluated the association between serum 25(OH)D levels and cancer incidence (8 studies) or cancer mortality (16 studies) found that cancer risk decreased by 7% and cancer mortality rates decreased by 2% with each 20 nmol/L (8 ng/mL) increase in serum 25(OH)D levels [89]. Am J Clin Nutr 2016;104:1151-9. [, Sempos CT, Binkley N. 25-hydroxyvitamin D assay standardisation and vitamin D guidelines paralysis. Cancer Epidemiol Biomarkers Prev 2014;23:1484-93. Prostate cancer In addition to bone deformities and pain, severe rickets can cause failure to thrive, developmental delay, hypocalcemic seizures, tetanic spasms, cardiomyopathy, and dental abnormalities [46,47]. Pancreatic cancer Nutr Rev 2018;76:380-94. Researchers have not definitively identified serum concentrations of 25(OH)D associated with deficiency (e.g., rickets), adequacy for bone health, and overall health. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010. Endocrine Connections 2018;7:R294-303. Nutrients 2019;11,2295; doi:10.3390/nu11102295. Signs and symptoms of osteomalacia are similar to those of rickets and include bone deformities and pain, hypocalcemic seizures, tetanic spasms, and dental abnormalities [46]. [, Vimaleswaran KS, Cavadino A, Berry DJ, Jorde R, Dieffenbach AK, Lu C, et al. In contrast to the observational studies, clinical trials have provided little support for the hypothesis that supplemental vitamin D reduces the risk of CVD or CVD mortality. Vitamin D is necessary for building and maintaining healthy bones. [, Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. The company was founded by William W. Berry in 1983 and is headquartered in Richmond, VA. Experts have reached no firm consensus on whether vitamin D can help prevent MS given the lack of clinical trial evidence [142]. Levels of 1,25(OH)2D do not typically decrease until vitamin D deficiency is severe [2]. Statin medications reduce cholesterol synthesis. Benzinga The AAP recommends 10 mcg (400 IU)/day vitamin D supplements for exclusively and partially breastfed infants starting shortly after birth and lasting until they are weaned and consume at least 1,000 mL/day vitamin D-fortified formula or whole milk [58]. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. They also help reduce fracture rates in institutionalized older people. Three trials conducted since that meta-analysis also found no effect of vitamin D supplementation on depressive symptoms. [, Quesada-Gomez JM, Bouillon R. Is calcifediol better than cholecalciferol for vitamin D supplementation? [, Salzer J, Hallmans G, Nystrom M, Stenlund H. Wadell G, Sundstrom P. Vitamin D as a protective factor in multiple sclerosis. This is a fact sheet intended for health professionals. [, Kassi E, Adamopoulos C, Basdra EK, Papavassiliou AG. Vitamin D, calcium, and cancer: Approaching daylight? [, Scragg R, Stewart AW, Waayer D, Lawes CMM, Toop L, Sluyter J, et al. Office of Dietary Supplements, National Institutes of Health. Vitamin D supplements may interact with several types of medications. Diets low in vitamin D are more common in people who have milk allergy or lactose intolerance and those who consume an ovo-vegetarian or vegan diet [1]. BMC Proceedings, 2018;12(Suppl 6):6. Visit a quote page and your recently viewed tickers will be displayed here. Depression There are currently no items in this Watchlist. [, Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, et al. Pages 939-57 in Feldman D, Pike JW, Bouillon R, Giovannucci E, Goltzman D, Hewison M, eds. [, Aloia JF, Rubinova R, Fazzari M, Islam S, Mikhail M, Ragolia L. Vitamin D and falls in older African American women: The PODA randomized clinical trial. US Preventive Services Task Force recommendation statement. Am J Clin Nutr 2019;109:1578-87. For example, a 3-year trial in New Zealand randomized 5,110 adults (mean age 65.9 years) to a single dose of 5,000 mcg (200,000 IU) vitamin D3 followed by 2,500 mcg (100,000 IU) each month or a placebo for a median of 3.3 years [124]. For example, a meta-analysis included 34 observational studies that followed 180,667 participants (mean age greater than 50 years) for 1.3 to more than 32 years. U.S. Food and Drug Administration. : CD008422. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. Vitamin D plays a role in glucose metabolism. Plant milk alternatives (such as beverages made from soy, almond, or oats) are often fortified with similar amounts of vitamin D to those in fortified cow's milk (about 3 mcg [120 IU]/cup); the Nutrition Facts label lists the actual amount [24]. Calcium plus vitamin D supplementation and the risk of breast cancer. [, Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Observational studies have linked lower serum 25(OH)D levels to an increased risk of diabetes, but their results might have been confounded by the fact that many participants were overweight or obese and were therefore more predisposed to developing diabetes and having lower 25(OH)D levels [1]. Individuals with a body mass index (BMI) of 30 or more have lower serum 25(OH)D levels than nonobese individuals. [, Manson JE, Cook NR, Lee I-M, Christen W, Bassuk S, Mora S, et al. [, Taylor CL, Rosen CJ, Dwyer JT. Hypercalcaemia following vitamin D and thiazide therapy in the elderly. In one meta-analysis of 46 clinical trials that included 4,541 participants, vitamin D supplements (typically 40 mcg [1,600 IU]/day or less) for a minimum of 4 weeks had no significant effects on systolic or diastolic blood pressure [127]. At baseline, participants had an adequate mean serum 25(OH)D level of 60 nmol/L (24 ng/mL). Elsevier, 2018. [. Observational studies and clinical trials provide mixed evidence on whether vitamin D intakes or serum levels affect cancer incidence, progression, or mortality risk. U.S. Department of Health and Human Services. Most of the studies described in this section measured serum 25(OH)D levels using various methods that were not standardized by comparing them to the best methods. Vitamin D toxicity has been caused by consumption of dietary supplements that contained excessive vitamin D amounts because of manufacturing errors, that were taken inappropriately or in excessive amounts, or that were incorrectly prescribed by physicians, [155-157]. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. [, Weisberg P, Scanlon KS, Li R, Cogswell ME. Am J Clin Nutr 2019;110:1119-30. [, de Sevaux RGL, Hoitsma AJ, Corstens FHM, Wetzels JFM. [, Han J, Guo X, Yu X, Liu S, Cui X, Zhang B, Liang H. 25-hydroxyvitamin D and total cancer incidence and mortality: A meta-analysis of prospective cohort studies. The results showed no association between 25(OH)D levels or vitamin D dose and the risk of falling in the 184 participants who completed the study. Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals. Cancer Res 2006;66:10213-9. A case-control analysis of 1,695 cases of prostate cancer and 1,682 controls found no associations between 25(OH)D levels and prostate cancer risk [110]. Fat malabsorption is associated with medical conditions that include some forms of liver disease, cystic fibrosis, celiac disease, Crohn’s disease, and ulcerative colitis [1,64]. Most trials of the effects of vitamin D supplements on bone health also included calcium supplements, so isolating the effects of each nutrient is difficult. Older adults are at increased risk of developing vitamin D insufficiency, partly because the skin's ability to synthesize vitamin D declines with age [1,62]. JAMA 2017;317:2448-50. It added that no national professional organization recommends population screening for vitamin D deficiency. [, Mallard SR, Howe AS, Houghton LA. The vitamin D3 and calcium supplements did not reduce breast cancer incidence, and 25(OH)D levels at the start of the study were not associated with breast cancer risk [99].