Why the IOM recommendations for vitamin D are deficient

@article{Heaney2011WhyTI,
  title={Why the IOM recommendations for vitamin D are deficient},
  author={Robert Proulx Heaney and Michael F. Holick},
  journal={Journal of Bone and Mineral Research},
  year={2011},
  volume={26}
}
The IOM recommendations for vitamin D fail in a major way on logic, on science, and on effective public health guidance. Moreover, by failing to use a physiological referent, the IOM approach constitutes precisely the wrong model for development of nutritional policy. © 2011 American Society for Bone and Mineral Research. 
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377 Citations
Highly Influential Citations
6
Background Citations
154
Methods Citations
10
Results Citations
4

377 Citations

Vitamin D: The Great Debate

This article attempts to summarize the existing evidence about vitamin D and provide the reader with information about the appropriateness of vitamin D supplementation for both skeletal and nonskeletal health.

Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine.

Recommendations for a daily intake of 1500-2000 IU/d or serum 25OHD levels of 30 ng or higher for all adults or elderly subjects, as suggested by The Endocrine Society Task Force, are premature.

Calcium and vitamin D controversies.

  • D. Silver
  • Medicine, Biology
    Rheumatic diseases clinics of North America
  • 2011

Vitamin D and common sense.

  • N. BinkleyE. Lewiecki
  • Medicine
    Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry
  • 2011

Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management

Routine repeat vitamin D testing is not required and patients are encouraged to check serum adjusted calcium 4 weeks after treating with loading doses of vitamin D.

Vitamin D: Still a topical matter in children and adolescents. A position paper by the Committee on Nutrition of the French Society of Paediatrics

The aims of the present position paper were to summ published data on vitamin D in infants, children i.e., on metabolism, physiological effects, and make recommendations on supplementation after the evidence, which does not support vitamin D.

Vitamin D deficiency at the Arctic Circle – a study in food‐allergic adolescents and controls

Assessment of vitamin D status in food‐allergic adolescents eliminating milk, egg and/or fish compared with adolescents on normal diets found insufficient vitamin D synthesis in winter.

Vitamin D deficiency in anesthesia department caregivers at the end of winter

To test whether the vitamin D status of anesthesia department caregivers practicing at high Northern latitudes is compatible with current recommendations, the 25‐hydroxyvitamin D (25(OH)D) levels of…

Evidence-based D-bate on health benefits of vitamin D revisited

The Institute of Medicine made its recommendations based on a population-based model; the Endocrine Society's Practice Guidelines on Vitamin D was for the prevention and treatment of vitamin D deficiency, which helps explain the differences in the recommendations.

Challenges Ahead for a Rational Analysis of Vitamin D in Athletes

Analytical challenges concerning the analytical quantification of vitamin D for its optimal intake are outlined, namely, a comprehensive study of the variability of the assay before categorizing any method as the golden standard, assurance of sample comparability to draw meaningful correlations, and revision of the intake guidance based on appropriate statistical power analysis.
...

References

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A risk assessment based on relevant, well-designed human clinical trials of vitamin D shows the absence of toxicity in trials conducted in healthy adults that used vitamin D dose > or = 250 microg/d (10,000 IU vitamin D3) supports the confident selection of this value as the UL.

Seasonal Change in Osteoid Thickness and Mineralization Lag Time in Ambulant Patients

Seasonal changes in mineralization correlated inversely with serum 25‐hydroxyv vitamin D but not the more active metabolite, 1,25‐dihydroxyvitamin D, which implies that the latter is produced in bone.

Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial

Four monthly supplementation with 100 000 IU oral vitamin D may prevent fractures without adverse effects in men and women living in the general community.

Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials.

Oral vitamin D supplementation between 700 to 800IU/d appears to reduce the risk of hip and any nonvertebral fractures in ambulatory or institutionalized elderly persons and an oral vitamin D dose of 400 IU/d is not sufficient for fracture prevention.

Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials.

Nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose should reduce fractures by at least 20% for individuals aged 65 years or older.

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Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin D.

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The data demonstrate that pathologic mineralization defects of bone occur in patients with a serum 25(OH)D below 75 nmol/L and strongly argue that in conjunction with a sufficient calcium intake, the dose of vitamin D supplementation should ensure that circulating levels of 25( OH)D reach this minimum threshold to maintain skeletal health.

Environmental factors that influence the cutaneous production of vitamin D.

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It is now recognized that vitamin D insufficiency and vitamin D deficiency are common in elderly people, especially in those who are infirm and not exposed to sunlight or who live at latitudes that do not provide them with sunlight-mediated cholecalciferol during the winter months.

Ultraviolet-B radiation increases serum 25-hydroxyvitamin D levels: the effect of UVB dose and skin color.

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This paper contrasts Bradford Hill’s approach with a currently fashionable framework for reasoning about statistical associations – the Common Task Framework – and suggests why following Bradford Hill, 50+ years on, is still extraordinarily reasonable.