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Vitamin D daily maintenance doses recommended for the general population and the population at risk for the deficiency
Source publication
Objective:
The objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence.
Materials and methods:
The Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Braz...
Citations
... On the other hand, everyone agrees that 25(OHO)D plasma levels are the gold standard for vitamin D assessment [12] . Levels of 25(OH)D below 20 ng/mL are considered inadequate, levels between 20 and 29 ng/mL are insufficiency, and levels between 30 and 100 ng/mL are sufficiency, but there is some disagreement between experts on the exact numbers that should be used to determine appropriate vitamin D levels [13,14] . The target for high-risk people should be to achieve levels of 25(OH)D over 30 ng/mL, according to the Brazilian Society of Endocrinology and Metabolism (SBEM) [13] . ...
... Levels of 25(OH)D below 20 ng/mL are considered inadequate, levels between 20 and 29 ng/mL are insufficiency, and levels between 30 and 100 ng/mL are sufficiency, but there is some disagreement between experts on the exact numbers that should be used to determine appropriate vitamin D levels [13,14] . The target for high-risk people should be to achieve levels of 25(OH)D over 30 ng/mL, according to the Brazilian Society of Endocrinology and Metabolism (SBEM) [13] . Serum 25(OH)D levels that are low are thought to be linked to elevated parathyroid hormone (PTH) levels and an increased risk of death [15] . ...
... Levels of 25OHD were also found to be severe deficiency (<10ng/mL) in 17.2% of sample, followed by 28.5% who had moderate deficiency (10-15ng/mL), 19.5% who had mild deficiency (16-20ng/mL), 22.3% who had insufficient (21-30ng/mL), and 12.3% who had normal (31-100ng/mL) as shown in Table 1. (10)(11)(12)(13)(14)(15) 164.26±178.68 Mild deficiency (16)(17)(18)(19)(20) 176.19±190.07 ...
Background: Vitamin D and parathyroid hormone (PTH) play crucial roles in calcium homeostasis and bone metabolism. Understanding their levels and associations in the general population is essential for preventive and therapeutic interventions. Methods: A cross-sectional study was conducted to evaluate PTH and vitamin D levels among the general population. Data were collected over one year. A convenience sampling method was employed, and demographic information and laboratory results were obtained through standardized questionnaires and blood samples. Descriptive and inferential statistics were used for data analysis. Results: A total of 390 participants were included, with a predominance of females (65.9%). The mean age was 50.12 years, ranging from 8 to 89 years. Analysis of PTH levels revealed that 68.5% of participants had elevated levels (>65 pg/mL), while 26.4% had normal levels (15-65 pg/mL), and 5.1% had deficient levels (<15 pg/mL). Vitamin D deficiency was prevalent, with 17.2% severely deficient (<10 ng/mL) and 28.5% moderately deficient (10-15 ng/mL). A significant negative correlation was observed between vitamin D and PTH levels (p < 0.05), indicating higher PTH levels in individuals with severe vitamin D deficiency. Age was significantly associated with PTH levels (p < 0.05), with older individuals (>60 years) exhibiting higher mean PTH levels compared to younger age groups. Conclusion: This study highlights the high prevalence of vitamin D deficiency and its association with elevated PTH levels in the general population. The findings underscore the importance of monitoring and addressing vitamin D status, particularly in older individuals, to mitigate the risk of secondary hyperparathyroidism and related complications. Further research is needed to explore the underlying mechanisms and inform targeted interventions for optimizing vitamin D and PTH levels in diverse populations.
... It is increasingly recognized that vitamin D is an essential nutrient responsible for health maintenance of bones and muscles (6). Vitamin D deficiency, as reflected by low 25hydroxyvitamin D concentrations, is highly prevalent in children with obesity (7). ...
Background and objectives
Childhood obesity is highly prevalent worldwide. We aimed to assess whether serum 25-hydroxyvitamin D was associated with general/central obesity among US adolescents, and further to explore the mediatory impact of homeostasis model assessment of insulin resistance (HOMA-IR) on this association.
Methods
This study is cross-sectional in design. Study adolescents were enrolled from the National Health and Nutrition Examination Survey (NHANES), 2011–2018. Serum 25-hydroxyvitamin D categories associated with general (indexed by body mass index) and central (indexed by waist circumference to height ratio) obesity were regressed. The possible mediatory effect of HOMA-IR on this association was explored. The nonlinear and dose-response association was examined by restricted cubic spline (RCS) test.
Results
Total 2,696 adolescents were eligible for inclusion, and the mean age of all adolescents was 15.4 years. Overall, the percentage of general and central obesity was 38.0% and 38.6%, respectively. Compared with adolescents with sufficient vitamin D, adolescent with deficient and insufficient vitamin D intake were associated with general obesity and central obesity; fully-adjusted OR for general obesity was 1.602 (95% CI: 1.161–2.211) and 1.659 (1.385–1.986), and fully-adjusted OR for central obesity was 2.025 (1.445–2.837) and 1.557 (1.287–1.884), respectively, while there was no observable significance in adolescents with possibly harmful vitamin D. The proportion mediated by HOMA-IR was estimated to be 31.7% for global obesity and 50.3% for central obesity (both P < 0.05). More stratified analyses were presented, and identified that the association with general obesity was particularly present among Mexican American, while with central obesity among Non-Hispanic Black adolescents.
Conclusions
Our findings indicate that deficient or insufficient 25-hydroxyvitamin D concentrations were associated with the significant risk of general and central obesity among US adolescents, and approximately 30% and 50%, respectively, of these associations were mediated by HOMA-IR.
... 31,32 For vitamin D, the cut-off points were: <30 ng/ml for inadequate levels and >30 ng/ml for adequate levels. 33,34 The assessments were conducted by the study coordinator and a team of kinesiology, physiotherapy, and pharmacy professionals who were properly trained for data collection. The same professionals performed the evaluation of the same variable at both the pre and post-intervention moments. ...
Aim
This study aimed to compare the effects of Ballroom Dancing (BD) versus Walking Training (WT) on the physical fitness performance in physically independent older women with adequate or inadequate levels of vitamins B12 and D.
Methods
Forty-three sedentary women aged 68.5 ± 6.5 years, were allocated to the BD (n = 23) or WT (n = 20) groups. They took part in a 12-week intervention, performed 3 times a week, for about 50 minutes with moderate effort intensity. Data were collected through Short Physical Performance Battery (SPPB), 6 minutes Walk Test (6MWT), Hand Grip Test (HGT), Isokinetic tests for lower limbs and blood tests to detect serum levels of vitamins B12 and D.
Results
The BD group performed better after the intervention in relation to the WT in the Sit and Stand Test (SST) (BD pre = 3.1 score vs post = 3.8 score; WT pre = 2.8 score vs post = 3.4 score; P = .02) and in the Peak Torque 180° extension (PKTOQ 180° extension) (BD pre = 56.7 Nm vs post = 61.2 Nm, WT pre = 56.7 Nm vs post = 56.1; P < .01).
Conclusion
A time effect was observed in all other variables, with the exception of HGT. Both interventions improved physical fitness performance, regardless of the adequacy of vitamins B12 and D, but the older women from BD obtained significant improvements in more variables than the WT.
... Following the ophthalmologic examination, patients underwent blood tests to measure serum 25(OH)D levels using electrochemiluminescence analysis. Calcidiol deficiency was defined as a serum 25(OH)D concentration of less than 20 ng/mL in accordance with the guidelines of the Brazilian Society of Endocrinology and Metabolism (20) . ...
Purpose
This study aimed to investigate the correlation between serum vitamin D levels and disease activity in patients with noninfectious uveitis.
Methods
We conducted a prospective case-control study, assessing 51 patients with noninfectious uveitis, categorized into active (n=22) and inactive (n=29) groups, along with 51 healthy controls. Serum 25-hydroxy vitamin D [25(OH)D] levels were measured. The uveitis group also completed a questionnaire regarding sunlight exposure habits and vitamin D supplementation.
Results
Patients with inflammation-related uveitis exhibited low serum 25(OH)D levels in 68% of cases. The median 25(OH)D level in patients with active uveitis was 17.8 ng/mL (interquartile range [IQR], 15-21 ng/mL), significantly lower compared to the 31.7 ng/mL (IQR, 25-39 ng/mL) in patients with inactive uveitis (p<0.001) and the 27 ng/mL (IQR, 23-31 ng/mL) in the Control Group (p<0.001). Significantly, nearly all patients with uveitis taking vitamin D supplementation were in the Inactive Group (p<0.005). Moreover, reduced sunlight exposure was associated with active uveitis (p<0.003). Furthermore, patients with 25(OH)D levels below 20 ng/mL had ten times higher odds of developing active uveitis (p=0.001).
Conclusions
This study revealed a prevalent 25(OH)D deficiency among patients with noninfectious uveitis and suggested a link between low 25(OH)D levels and disease activity. To prevent future episodes of intraocular inflammation, vitamin D supplementation and controlled sunlight exposure could be viable options.
Keywords:
Vitamin D; 25-hydroxyvitamin D; Uveitis; Vitamin D deficiency; Immunity; Eye/immunology
... For serum albumin, the following classification was adopted (18): severe depletion: <2.4 mg/dL; moderate depletion: 2.4-2.9 mg/dL; mild depletion: 3.0-3.5 mg/dL and normal: >3.5 mg/dL. For 25OHD evaluation, the cutoff points recommended by the Brazilian Society of Endocrinology (19)(20)(21) and also the values updated by the Brazilian Society of Endocrinology (22) were used. The findings were expressed as "vitamin D status" (based on thresholds for categorizing patients as being deficient or not) and also as 25OHD concentration. ...
Objective
This study investigated the nutritional status, 25-hydroxyvitamin D (25OHD), albumin and risk factors associated with complications in patients with foot and ankle fragility fractures.
Subjects and methods
Prospective study, developed with patients who suffered fractures due to fragility of the foot and ankle (n = 108); the type of fractured bone, fracture mechanisms and classification were studied and also pseudoarthrosis, treatment, surgical dehiscence, anthropometry, 25OHD and albumin. The Chi-square or Fisher's exact test, Mann-Whitney and Kruskal-Wallis tests were used in the statistical analysis and the multiple logistic regression analysis was used to identify the risk factors associated with complications.
Results
The factors that, together, were associated with treatment complications were the level of 25OHD (p = 0.0055; OR = 0.868 [1,152]; 95% CI = 0.786; 0.959 [1.043;1.272]) and diabetes (p = 0.0034; OR = 30,181; 95% CI = 3.087; 295.036). The factors that, together, were associated with the presence of any complication, were age (p = 0.0139; OR = 1.058; 95% CI = 1.011; 1,106) and 25OHD level (p = 0.0198; OR = 0.917; 95% CI = 0.852; 0.986). There was a complication probability above 0.40 associated with lower 25OHD levels (values below 20 ng/mL) and older age (over 50 years).
Conclusion
Lower or abnormal levels of 25OHD were associated with pseudoarthrosis, and age and 25OHD were both risk factors for treatment complications in patients with foot and ankle fractures.
Keywords
25-hydroxyvitamin D (25OHD); albumin; treatment; complications; nutritional status; foot and ankle fractures
... Various studies on ecology have also shown that less exposure to sunlight may be associated with higher cancer prevalence and cancer deaths [3]. Considering this information, vitamin D deficiency is accepted as a general health problem because it can affect all periods of life and individuals in different continents and cause health problems such as serious diseases [12,13]. ...
... In the study, 25(OH)D levels obtained from a total of 349 people, 223 women and 126 men, were evaluated. The data were grouped by gender as male and female, by age as (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), , (46-65) and (66+) and by season as autumn, winter, spring and summer. ...
In recent years, there has been an increase in vitamin D tests in order to determine the prevalence and definition of vitamin D deficiency, which is clinically recognized to be associated with many diseases. The increase in vitamin-supported supplements is also related to this. This deficiency, which is tried to be prevented by taking precautions such as sun exposure, food and diet in local conditions, is tried to be prevented by health professionals with guidance, supervision and drug supplementation. This study covers the dates of 2022 and before. All patient data were randomly obtained from hospital automation (Göle state hospital) and then 25(OH)D levels were retropectively analyzed (Ardahan University Scientific Research and Publication Ethics Committee approval (Approval Date: 14.12.2022- No: E-67796128-000-2200037489). The findings of the study showed that vitamin D levels were insufficient (
... This condition is considered a global health problem, as low vitamin D levels are associated with an increased risk of various diseases and metabolic changes [5]. In Brazil, the Brazilian Society of Endocrinology and Metabology recommends serum levels above 20 ng/mL for the general healthy population and 30-60 ng/mL for at-risk groups such as the elderly, pregnant women, patients with osteomalacia, rickets, osteoporosis, secondary hyperparathyroidism, pre-bariatric patients, and inflammatory, autoimmune, and chronic kidney diseases [6]. ...
Background:
Hypovitaminosis D is a public health problem due to its implications for various diseases. Vitamin D has numerous functions, such as modulating the metabolism of cellular tissues, and it is expressed through the vitamin D receptor (VDR) gene that may influence gene expression modulation, which plays an important role in vitamin D metabolism.
Objective:
To evaluate the effect of the genotypes of BsmI single nucleotide polymorphism (SNP) of the VDR gene on VDR, SOD2, and CYP24A1 gene expression in individuals with low serum vitamin D levels.
Methods:
This was a cross-sectional analytical study. After signing the informed consent form, individuals were invited to participate and answered a structured questionnaire with identification data. Blood was collected for biochemical analysis, and vitamin D was measured by chemiluminescence; BsmI polymorphism was determined using real-time polymerase chain reaction (PCR) assays with TaqMan allelic discrimination, and gene expression was conducted by qRT-PCR using QuantiFast SYBR® Green PCR Master Mix. Data were analyzed using the SPSS 20.0 software, and differences were considered significant at p < 0.05.
Results:
98 individuals with vitamin D ≤ 20 ng/dL were evaluated, and the BsmI SNP of the VDR gene showed CYP24A1 overexpression and low SOD2 expression.
Conclusion:
BsmI SNP of the VDR gene can modulate the expression of the genes evaluated without interfering with serum levels.
... IUI/day in the month preceding hypercalcemia ( Table 2). Vitamin D doses above 4000 IU/day for prolonged periods, due to its deposition in fat, result in cholecalciferol concentrations of up to 150ng/mL [38]. Thus, acute use of high doses or chronic use of lower doses of vitamin D are related to hypercalcemia. ...
... CI= -0.81 to 0.03; ρ2= 0.25), which confirms the literature on reduced vitamin D in aging. However, the obtained mean vitamin D of 55.99ng/dL (Table 3) is higher than the recommended value of 30 ng/mL mentioned as ideal for bone benefit in endocrinology [38], evidencing the systematic use of vitamin D by the study patients. ...
Introduction: Hypercalcemia related to aesthetic intramuscular implants exclusively made of PMMA (polymethylmethacrylate) is a very rare condition. Late complications of these implants are related to poorly understood inflammatory triggers, which may reactivate stabilized implants, increase calcitriol production, and lead to hypercalcemia. Methods: Records of patients seen between 2022 and 2023 with a PMMA microsphere body implant and a subsequent diagnosis of hypercalcemia were searched. Medical history, medication use, data on PMMA implantation, and laboratory tests related to calcium metabolism were described and subjected to variable correlation analysis. The instituted treatments were described. Results: A total of 17 female patients with exclusive body PMMA implants confirmed by ultrasonography or MRI (Magnetic Resonance Image) developed hypercalcemia between 2017 and 2022. Prior renal disease, COVID-19 infection, vitamin D use, and anabolic steroid use correlated with laboratory changes in hypercalcemia. Larger PMMA implant volumes led to parathyroid hormone suppression. Conclusion: Patients with PMMA body implants may rarely present with hypercalcemia when variables such as renal disease before implantation, high doses of vitamin D or anabolic steroids are present. Based on the data presented and the available scientific literature, recommendations for patient investigation, implant volume limit, and patient follow-up after the procedure were made.
... Durante a exposição solar, os fótons UVB (ultravioleta B, 290-315 nm) penetram na epiderme e produzem uma fragmentação fotoquímica que resulta no pré-colecalciferol. Posteriormente, isomerização dependente da temperatura converte esse intermediário em vitamina D 3 ou colecalciferol 8 . ...
... Entretanto, IOM/EUA propõe como nível sérico adequado ≥50 nmol /L (20 ng/mL) para população em geral e ≥75 nmol / L (30 ng/mL) para populações de alto risco, em função de maiores benefícios em doenças osteometabólicas, prevenção do hiperparatiroidismo secundário, diminuição do risco de quedas e melhora da densidade mineral óssea. Estas recomendações foram adotadas pela Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) 8 . ...
... UI semanais ou 7.000 UI ao dia, durante 6 a 8 semanas. Caso os níveis adequados de 25(OH) D não sejam obtidos, um novo ciclo será proposto 2,8 . ...
Vitamina D representa de fato, um hormônio esteroide lipossolúvel com funções endócrinas, parácrinas e autócrinas. Este artigo buscou realizar revisão de aspectos fisiológicos, ambientais, nutricionais e genéticos relacionados a esta vitamina, classificação dos níveis séricos da forma circulante representativa do status, bem locais de armazenamento em tecidos. Sugestões são apresentadas, de acordo com literatura consultada, quanto a hábitos alimentares, exposição solar adequada, suplementação oral e/ou necessidade de doses de manutenção, riscos de toxicidade. Funções imunológicas, imunomoduladoras, participação a nível celular e tecidual em doenças autoimunes, tumorais, infecto-contagiosas, com ênfase ao SARS-CoV-2 também foram abordadas. Entre as inúmeras ações da vitamina D, houve destaque à participação no metabolismo musculoesquelético, ocorrência de quedas, particularmente entre os idosos, sistema nervoso central, com ênfase à cognição, demência, doença de Alzheimer. Aspectos consensuais ou controversos também foram abordados, bem como sugestões de novos estudos a nível mundial para esclarecimento de resultados questionáveis.
... Values below 20 ng/mL (50 nmol/L) are classified as deficient for the general population, and values between 20 and 29 ng/mL (50 and 74 nmol/L) are still considered insufficient for individuals at risk for osteoporosis according to criteria established by the Brazilian Society of Endocrinology and the Endocrine Society. 9,10 The treatment of vertebral fractures is mostly conservative and has as its main objective the consolidation of the fracture and aid in rehabilitation .2 Conservative treatment includes short rest periods, followed by immobilization with external orthoses, which can facilitate neuromuscular re-education and provide patient comfort. ...
... A single vitamin D dosage was taken on the first outpatient visit, and its values were interpreted according to criteria established by the Brazilian Society of Endocrinology and the Endocrine Society. 9,10 A questionnaire was also used to determine whether the patient had been previously diagnosed with osteoporosis and to check whether he or she had ever had a distal radius, spine, or proximal femur fracture. ...
... The serum vitamin D level ranged from 11.7 to 42.5 ng/mL, and the mean was 25.3 ± 5.9 ng/mL. Serum levels of this vitamin below normal, according to criteria established by the Brazilian Society of Endocrinology and the Endocrine Society, 9,10 was found in 75% of patients, with 19% classified as vitamin D deficient and 56% as vitamin D insufficient. Furthermore, 7.62% (8/105) of the patients had a previous diagnosis of osteoporosis, and 9.52% (10/105) reported the occurrence of previous fractures, two of which were hips, four spines, and four distal radius fractures. ...
Objectives
Evaluate the evolution of pain, functional capacity, and vitamin D levels in conservatively treated patients with low-energy spinal fractures.
Methods
Between January 2017 and March 2021, patients older than 40 years old affected by these fractures were selected and treated conservatively for six months. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores and Cobb angle were evaluated pre- and post-treatment. Serum vitamin D levels were also measured at the first outpatient visit, and it was investigated whether the patient had a previous diagnosis of osteoporosis or previous fractures.
Results
A total of 105 patients were analyzed, 70.5% of whom were women, with a mean age of 73.1 years. The average vitamin D level was 25.3 ng/mL, and hypovitaminosis was found in 75% of patients. Eight patients (7.62%) had a previous diagnosis of osteoporosis, and ten (9.52%) reported the occurrence of previous fractures. Regarding the VAS score, there was a mean reduction of 5.5 points of pain; for ODI, there was an average increase of 1 percentage point and an average increase of 4.3º of kyphosis in the fractured segment between pre- and post-treatment.
Conclusion
The treatment improved pain, and patients maintained their functional capacity. Low levels of vitamin D were associated with more complex fractures. Level of evidence III; Retrospective Study.
Keywords:
Spinal Fractures; Osteoporosis; Conservative Treatment; Vitamin D
