Does Vitamin D Sufficiency Equate to a Single Serum 25-Hydroxyvitamin D Level or Are Different Levels Required for Non-Skeletal Diseases?
Nutrients 2013, 5(12), 5127-5139; doi:10.3390/nu5125127
Simon Spedding 1,* , Simon Vanlint 2, Howard Morris 1,3 and Robert Scragg 4
1 Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
2 Discipline of General Practice, School of Population Health, University of Adelaide, Adelaide, SA 5005, Australia
3 SA Pathology, PO Box 14, Rundle Mall, Adelaide, SA 5000, Australia
4 School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
Have noticed that some health problems require very high levels to treat
- Multiple Sclerosis 150 ng, Ato0immune 100 ng,
More vitamin D also needed to treat than to prevent, Perhaps due to
- Genes are altered by the disease (Cancer for example) which restrict the amount of vitamin D getting to the cells
- Disease consumes Vitamin D
- Disease makes for poor gut function, which reduces the amount of vitamin D getting to the blood
Objective: Clarify the concept of vitamin D sufficiency, the relationship between efficacy and vitamin D status and the role of Vitamin D supplementation in the management of non-skeletal diseases. We outline reasons for anticipating different serum vitamin D levels are required for different diseases. Method: Review the literature for evidence of efficacy of supplementation and minimum effective 25-hydroxyvitamin D (25-OHD) levels in non-skeletal disease. Results: Evidence of efficacy of vitamin supplementation is graded according to levels of evidence.
Minimum effective serum 25-OHD levels are lower for skeletal disease, e.g.,
- rickets (25 nmol/L),
- osteoporosis and fractures (50 nmol/L), than for
- premature mortality (75 nmol/L) or non-skeletal diseases, e.g.,
- depression (75 nmol/L),
- diabetes and cardiovascular disease (80 nmol/L),
- falls and respiratory infections (95 nmol/L) and
- cancer (100 nmol/L).
Conclusions: Evidence for the efficacy of vitamin D supplementation at serum 25-OHD levels ranging from 25 to 100 nmol/L has been obtained from trials with vitamin D interventions that change vitamin D status by increasing serum 25-OHD to a level consistent with sufficiency for that disease. This evidence supports the hypothesis that just as vitamin D metabolism is tissue dependent, so the serum levels of 25-OHD signifying deficiency or sufficiency are disease dependent.