Not All That Glitters Is Gold: Questioning High-Dose Vitamin D Supplementation in Young Children
Indian Journal of Orthopaedics Letter to the Editor PDF behind paywall -https://doi.org/10.1007/s43465-025-01466-7
Berkay Yalçınkaya, Ahmet Furkan Çolak & Murat Kara
Summary by Perplexity AI
A recent systematic review and meta-analysis titled "Not All That Glitters Is Gold: Questioning High-Dose Vitamin D Supplementation in Young Children" critically examined the safety of high-dose vitamin D supplementation in children aged 0 to 6 years. The study aggregated data from 32 randomized clinical trials involving 8,400 children, assessing both daily and bolus (large, infrequent) dosing regimens ranging from 1,200 to 10,000 IU/day and single doses up to 600,000 IU 1 2 3.
Key findings:
- No increased risk of serious adverse events (SAEs): High-dose vitamin D supplementation was not associated with a higher risk of serious adverse events, such as hospitalization or death, compared to low-dose or placebo groups (Risk Ratio, 1.01; 95% CI, 0.73-1.39) 1 2 3.
- Clinical adverse events were rare: Mild symptoms like diarrhea, vomiting, and irritability were occasionally reported, but these were infrequent and not consistently linked to vitamin D supplementation 1.
- Biochemical abnormalities were uncommon: While some children in high-dose groups developed elevated blood vitamin D levels (above 100 ng/mL), this occurred in only about 1.3% of high-dose recipients, and these elevations did not typically result in significant clinical problems 1.
- No increased risk of hypercalcemia: The risk of high blood calcium (hypercalcemia), a key sign of vitamin D toxicity, was not higher in the high-dose groups (Risk Ratio, 1.18; 95% CI, 0.72-1.93) 2.
- Vitamin D toxicity is rare: Severe toxicity was not observed, but the study notes that extremely high doses (well above those studied) or manufacturing errors can lead to dangerous outcomes, underscoring the importance of monitoring and appropriate dosing 4.
Limitations and cautions:
- Long-term safety data are lacking: Most studies were short-term, so the effects of prolonged high-dose supplementation remain unclear 1.
- Variation in study populations and dosing: Differences in underlying health conditions, dosing regimens, and follow-up periods limit the ability to generalize findings to all children 1.
- Monitoring is advisable: While high-dose vitamin D appears safe in the short term for most children, monitoring blood levels may be warranted in children receiving long-term or high-dose supplementation, especially those with underlying health conditions 4 1.
Conclusion:
High-dose vitamin D supplementation (up to 10,000 IU/day or equivalent bolus doses) in young children is generally safe and not linked to an increased risk of serious adverse events or toxicity in the short term. However, the study emphasizes the need for caution, individualized assessment, and further research to clarify long-term safety and optimal dosing, as well as the importance of monitoring in certain cases 1
Reference
- 2 4.
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791031
- https://research.regionh.dk/en/publications/safety-of-high-dose-vitamin-d-supplementation-among-children-aged
- https://pubmed.ncbi.nlm.nih.gov/35420658/
- https://consensus.app/questions/childrens-vitamin-d/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9011124/
- https://www.research.ed.ac.uk/files/78986895/DaviesERJ_1_.pdf
- https://www.indianpediatrics.net/july2013/july-669-675.htm
- https://emedicine.medscape.com/article/128762-overview
- https://infantrisk.com/content/vitamin-d-supplementation-and-breastfeeding
- https://www.analesdepediatria.org/index.php?p=revista&tipo=pdf-simple&pii=S2341287925001711
VitaminDWiki - High-dose Vitamin D safe for children (10,000 IU daily, 600,000 IU bolus) – meta-analysis April 2022
See also