NCAA trainers are getting on board the Vitamin D train (40-50 ng)– Nov 2019

Vitamin D Practice Patterns in National Collegiate Athletic Association Division I Collegiate Athletics Programs.
J Athl Train. 2019 Nov 15. doi: 10.4085/1062-6050-21-19
Rockwell M1,2, Hulver M1,2, Eugene E3.

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Tests typically cost $50 to $100

• Note: Low-cost Vitamin D testers (two yes-no tests for 11 dollars) - 2024
  • being sold around the world. Hopefully, the FDA will approve for US sales in 2020

Variety of athletic programs covered in the survey

Abstract

CONTEXT:
Vitamin D status has been associated with performance, health, and well-being in athletic populations. The measurement of vitamin D status via 25-hydroxyvitamin D (25[OH]D) testing has increased in the general population, as has vitamin D supplement use. It is unclear if similar patterns exist in collegiate athletics programs.

OBJECTIVE:
To describe the clinical care related to the prevention, evaluation, and treatment of vitamin D deficiency and insufficiency given by sports medicine providers with National Collegiate Athletic Association (NCAA) Division I programs.

DESIGN: Cross-sectional study.

SETTING: Population-based online survey.

PATIENTS OR OTHER PARTICIPANTS: All NCAA Division I head athletic trainers.

MAIN OUTCOME MEASURE(S): Information related to 25(OH)D testing, vitamin D supplementation, vitamin D-related protocols and procedures, and characteristics of athletic programs and participants.

RESULTS:
We received 249 responses (72% response rate). Use of 25(OH)D testing was described by 68% of participants, with the most common indicators being health status/history (78%) and injury status/history (74%). One-fifth of participants stated that vitamin D testing was conducted as screening (without a specific cause or indication). Target blood vitamin D concentrations were highly variable. A range of 8 to 1660 annual vitamin D blood tests was reported at a cost of <$50 (8%), $51 to $100 (51%), $101 to $150 (20%), and >$150 (10%). Forty-two percent of programs covered the cost of vitamin D supplements. More than half of the participants commented that vitamin D blood testing and supplements were not a good use of program funds. In comparison with Football Championship Subdivision programs, Football Bowl Subdivision programs were more likely to conduct vitamin D testing and pay for vitamin D supplements, and their providers were more likely to believe that testing and supplements were a good use of program funds.

CONCLUSIONS:
A great deal of variability was present in vitamin D-related clinical practices among NCAA Division I athletics programs, which reflects existing contradictions and uncertainty in research, recommendations, and guidelines. Knowledge of current practice patterns is important in evaluating and establishing best practices, policies, and procedures for sports medicine and sports nutrition professionals in the collegiate setting.

Snips from the PDF

Key Points

• More than two thirds of National Collegiate Athletic Association Division I athletics programs conducted 25- hydroxyvitamin D (25[OH]D) testing and 42% purchased vitamin D supplements.
• Many aspects of clinical practice related to prevention, evaluation, and treatment of low vitamin D were highly variable among programs, including the 25(OH)D concentration considered adequate.
• More than half of head athletic trainers did not view 25(OH)D testing and vitamin D supplements as good uses of athletics program funds.

Table 1. Synopsis of Vitamin D Practice Patterns Survey Questions

• Whether the athletics program had a policy or procedures dedicated to vitamin D testing (ie, serum 25[OH]D testing) and treatment
• Whether vitamin D tests (ie, serum 25[OH]D) were conducted on any student-athletes
• Which student-athletes had vitamin D tests (ie, serum 25[OH]D)
• Indications for vitamin D tests (ie, serum 25[OH]D)
• Whether follow-up vitamin D tests (ie, serum 25[OH]D) were conducted if abnormal results were obtained on an initial test
• Target vitamin D (ie, serum 25[OH]D) concentration
• Individuals responsible for ordering vitamin D tests (ie, serum 25[OH]D)
• Cost of each vitamin D test (ie, serum 25[OH]D)
• Whether the athletics program covered the cost of vitamin D supplements
• Participants’ opinions about the appropriateness of the program’s target vitamin D (ie, serum 25[OH]D) concentration and the value of vitamin D tests (ie, serum 25[OH]D)

Only 20% had a formal Vitamin D protocol or policy

• ‘‘We used to get a vitamin D test on every athlete at physicals, but it seems like they were all coming back low, so now we just give out vitamin D supplements after practice.’’
• ‘‘For all of our teams that are primarily indoors for training, we provide vitamin D [supplements] prophylactically.’’

Three primary reasons were given for ordering a blood test

1. to evaluate deficiency,
2. assess toxicity, or
3. monitor treatment.

Target Vit D ng/mL	% Responses
<20	0
20-30	3
30-40	6
40-50	27
>50	13
Unsure	51

One-fifth of NCAA Division I collegiate athletics programs reported 25(OH)D screening for all athletes without a particular cause.

The American College of Sports Medicine and Academy of Nutrition and Dietetics joint position statement on nutrition and performance36 advised that ‘‘athletes with a history of stress fracture, bone or joint injury, signs of overtraining, muscle pain or weakness, and a lifestyle involving low exposure to UVB’’ may require 25(OH)D assessment.

Athletics programs may benefit from the development of strategic 25(OH)D testing and followup testing guidelines and protocols, particularly when budgetary resources are limited.

Furthermore, dosing strategies vary broadly in the

• form of vitamin D (D2 versus D3),
• mode of delivery (eg, tablet or capsule, spray, intramuscular injection),
• frequency of dosing (eg, daily, weekly, monthly), and
• amount of vitamin D (from 400 1U to 150 000 1U is available).32

Although evidence suggested that

• vitamin D3 was preferable to vitamin D2 and
• daily or weekly dosing was preferable to larger monthly doses,
• an optimal dosing strategy has not been described.

An alternative to 25(OH)D testing is blanket or routine supplementation (ie, providing vitamin D supplements broadly to athletes without individualization or knowledge of their 25[OH]D concentrations). This method has become more common among athletic populations, as noted by more than 15% of participants in this study.

The ingestion of 1000 to 2000 1U of vitamin D3 daily has been recommended for preventing LVD or maintaining the 25(OH)D concentration during autumn and the winter months, when UVB synthesis is low or nonexistent.46

Strengths of this study were the excellent response rate (72%), with nearly 250 head ATs from NCAA Division 1 collegiate athletics programs offering insight into their clinical practices related to vitamin D.

CONCLUSIONS

Overall, vitamin D is an accessible, low-risk, and fairly low- cost intervention with the potential to improve performance and health in athletes. Emerging research, controversial guidelines, and a paucity of athlete-specific recommendations are reflected in the large variability of vitamin D—related clinical care demonstrated by NCAA Division 1 athletics programs. With 68% of athletics programs regularly testing 25(OH)D concentrations and 42% covering the costs of vitamin D supplements, developing policies and procedures informed by the best evidence available is important. Knowledge of clinical practice patterns in the collegiate setting is critical for evaluating and establishing best practices, policies, and procedures for sports medicine and sports nutrition professionals.

REFERENCES

1. Farrokhyar F, Tabasinejad R, Dao D, et al. Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis. Sports Med. 2015;45(3):365—378.
2. Villacis D, Yi A, Jahn R, et al. Prevalence of abnormal vitamin D levels among Division 1 NCAA athletes. Sports Health. 2014;6(4):340-347.
3. Hildebrand RA, Miller B, Warren A, Hildebrand D, Smith BJ. Compromised vitamin D status negatively affects muscular strength and power of collegiate athletes. Int J Sport Nutr Exerc Metab. 2016;26(6):558—564.
4. Halliday TM, Peterson NJ, Thomas JJ, Kleppinger K, Hollis BW, Larson-Meyer DE. Vitamin D status relative to diet, lifestyle, injury, and illness in college athletes. Med Sci Sports Exerc. 2011;43(2):335— 343.
5. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266— 281.
6. Carswell AT, Oliver SJ, Wentz LM, et al. 1nfluence of vitamin D supplementation by sunlight or oral D3 on exercise performance. Med Sci Sports Exerc. 2018;50(12):2555—2564.
7. Geiker NRW, Hansen M, Jakobsen J, et al. Vitamin D status and muscle function among adolescent and young swimmers. Int J Sport Nutr Exerc Metab. 2017:27(5):399-407.
8. Home page. Choosing Wisely Web site. http://wwwchoosingwisely.org Accessed June 6, 2019.
9. Hamilton B, Whiteley R, Farooq A, Chalabi H. Vitamin D concentration in 342 professional football players and association with lower limb isokinetic function. J Sci Med Sport. 2014;17(1):139—143.
10. Koundourakis NE, Androulakis NE, Malliaraki N, Margioris AN. Vitamin D and exercise performance in professional soccer players. PLoS One. 2014;9(7):e101659.
11. Barker T, Henriksen VT, Martins TB, et al. Higher serum 25- hydroxyvitamin D concentrations associate with a faster recovery of skeletal muscle strength after muscular injury. Nutrients. 2013;5(4):1253—1275.
12. Rebolledo BJ, Bernard JA, Werner BC, et al. The association of vitamin D status in lower extremity muscle strains and core muscle injuries at the National Football League Combine. Arthroscopy. 2018;34(4):1280—1285.
13. Ruohola JP, Laaksi I, Ylikomi T, et al. Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men. J Bone Miner Res. 2006;21(9):1483—1488.
14. Close GL, Leckey J, Patterson M, et al. The effects of vitamin D(3) supplementation on serum total 25[OH]D concentration and physical performance: a randomised dose-response study. Br J Sports Med. 2013;47(11):692-696.
15. Close GL, Russell J, Cobley JN, et al. Assessment of vitamin D concentration in non-supplemented professional athletes and healthy adults during the winter months in the UK: implications for skeletal muscle function. J Sports Sci. 2013;31(4):344—353.
16. Wyon MA, Wolman R, Nevill AM, et al. Acute effects of vitamin D3 supplementation on muscle strength in judoka athletes: a randomized placebo-controlled, double-blind trial. Clin J Sport Med. 2016;26(4):279—284.
17. Wyon MA, Koutedakis Y, Wolman R, Nevill AM, Allen N. The influence of winter vitamin D supplementation on muscle function and injury occurrence in elite ballet dancers: a controlled study. J Sci Med Sport. 2014;17(1):8-12.
18. Jung HC, Seo MW, Lee S, Jung SW, Song JK. Correcting vitamin D insufficiency improves some, but not all aspects of physical performance during winter training in taekwondo athletes. Int J Sport Nutr Exerc Metab. 2018:28(6):635—643.
19. Owens DJ, Sharples AP, Polydorou I, et al. A systems-based investigation into vitamin D and skeletal muscle repair, regeneration, and hypertrophy. Am J Physiol Endocrinol Metab. 2015;309(12):E1019—1031.
20. Mielgo-Ayuso J, Calleja-Gonzalez J, Urdampilleta A, et al. Effects of vitamin D supplementation on haematological values and muscle recovery in elite male traditional rowers. Nutrients. 2018;10(12). doi: 10.3390/nu10121968.
21. Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008;23(5):741—749.
22. Lewis RM, Redzic M, Thomas DT. The effects of season-long vitamin D supplementation on collegiate swimmers and divers. Int J Sport Nutr Exerc Metab. 2013;23(5):431—440.
23. He CS, Fraser WD, Tang J, et al. The effect of 14 weeks of vitamin D3 supplementation on antimicrobial peptides and proteins in athletes. J Sports Sci. 2016;34(1):67—74.
24. Rockwell M, Kraak V, Hulver M, Epling J. Clinical management of low vitamin D: a scoping review of physicians’ practices. Nutrients. 2018;10(4):493.
25. Larson-Meyer DE. The importance of vitamin D for athletes. Gatorade Sports Science Institute Web site. https://www.gssiweb.org/sports-science-exchange/article/sse-148-the-importance-of-vitamin-d-for-athletes. Accessed June 6, 2019.
26. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911—1930.
27. Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96(1):53—58.
28. Larson-Meyer DE, Woolf K, Burke L. Assessment of nutrient status in athletes and the need for supplementation. Int J Sport Nutr Exerc Metab. 2018;28(2):139-158.
29. Owens DJ, Allison R, Close GL. Vitamin D and the athlete: current perspectives and new challenges. Sports Med. 2018;48(suppl 1):3—16.
30. Clinical utility of vitamin D testing: an evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(2):1—93.
31. LeFevre ML; US Preventive Services Task Force. Screening for vitamin D deficiency in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;162(2):133—140.
32. Pludowski P, Karczmarewicz E, Bayer M, et al. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe: recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013;64(4):319-327.
33. Lee EC, Fragala MS, Kavouras SA, Queen RM, Pryor JL, Casa DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res. 2017;31(10):2920—2937.
34. Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year metaanalysis. PLoS One. 2013;8(11):e78962.
35. Mafi JN, Parchman M. Low-value care: an intractable global problem with no quick fix. BMJ Qual Saf. 2018;27(5):333—336.
36. Thomas DT, Erdman KA, Burke LM. American College of Sports Medicine joint position statement. nutrition and athletic performance. Med Sci Sports Exerc. 2016;48(3):543—568.
37. Cannell JJ, Hollis BW Zasloff M, Heaney RP. Diagnosis and treatment >of vitamin D deficiency. Exp Opin Pharmacother. 2008;9(1):107—118.
38. Brown LL, Cohen B, Tabor D, Zappala G, Maruvada P, Coates PM. The vitamin D paradox in Black Americans: a systems-based approach to investigating clinical practice, research, and public health. Expert panel meeting report. BMC Proc. 2018;12(suppl 6):6.
39. Waldron JL, Ashby HL, Cornes MP, et al. Vitamin D: a negative acute phase reactant. J Clin Pathol. 2013;66(7):620—622.
40. Heller JE, Thomas JJ, Hollis BW, Larson-Meyer DE. Relation between vitamin D status and body composition in collegiate athletes. Int J Sport Nutr Exerc Metab. 2015;25(2):128—135.
41. Lai JK, Lucas RM, Banks E, Ponsonby AL; Ausimmune Investigator Group. Variability in vitamin D assays impairs clinical assessment of vitamin D status. Int Med J. 2012;42(1):43—50.
42. Major JM, Graubard BI, Dodd KW, et al. Variability and reproducibility of circulating vitamin D in a nationwide U.S. population. J Clinl Endocrinol Metab. 2013;98(1):97—104.
43. Hirche F, Stangl GI, Lehmann U, Hinz K, Westphal S, Dierkes J. Bioavailability of vitamin D(2) and D(3) in healthy volunteers, a randomized placebo-controlled trial. J Clin Endocrinol Metab. 2013;98(11):4339—4345.
44. Tripkovic L, Lambert H, Hart K, et al. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012;95(6):1357—1364.
45. Shieh A, Chun RF, Ma C, et al. Effects of high-dose vitamin D2 versus D3 on total and free 25-hydroxyvitamin d and markers of calcium balance. J Clin Endocrinol Metab. 2016;101(8):3070—3078.
46. Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439—455.

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