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Conservative Vitamin D Consensus from Central Europe - April 2022

Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement

Nutrients 2022,14, 1483. https://doi.org/10.3390/nu14071483
Pawel Pludowski1'* , Istvan Takacs 2, Mihail Boyanov 3 , Zhanna Belaya 4 , Camelia C. Diaconu 5 ,
Tatiana Mokhort6 , Nadiia Zherdova 7, Ingvars Rasa 8, Juraj Payer 9 and Stefan Pilz 1

Abstract:

Vitamin D deficiency has a high worldwide prevalence, but actions to improve this public health problem are challenged by the heterogeneity of nutritional and clinical vitamin D guidelines, with respect to the diagnosis and treatment of vitamin D deficiency. We aimed to address this issue by providing respective recommendations for adults, developed by a European expert panel, using the Delphi method to reach consensus. Increasing the awareness of vitamin D deficiency and efforts to harmonize vitamin D guidelines should be pursued. We argue against a general screening for vitamin D deficiency but suggest 25-hydroxyvitamin D (25(OH)D) testing in certain risk groups. We recommend a vitamin D supplementation dose of 800 to 2000 international units (IU) per day for adults who want to ensure a sufficient vitamin D status. These doses are also recommended for the treatment of vitamin D deficiency, but higher vitamin D doses (e.g., 6000 IU per day) may be used for the first 4 to 12 weeks of treatment if a rapid correction of vitamin D deficiency is clinically indicated before continuing, with a maintenance dose of 800 to 2000 IU per day. Treatment success may be evaluated after at least 6 to 12 weeks in certain risk groups (e.g., patients with malabsorption syndromes) by measurement of serum 25(OH)D, with the aim to target concentrations of 30 to 50 ng/mL (75 to 125 nmol/L).

Table 4. Statement regarding screening of vitamin D deficiency in adults

Screening of vitamin D deficiency should be considered in the following patients/individuals or condition
Osteoporosis; Osteomalacia; Musculoskeletal pain; Chronic kidney disease; Hepatic failure; Malabsorption syndromes (e.g., cystic fibrosis, inflammatory bowel diseases, bariatric surgery, radiation enteritis); Hyperparathyroidism; Chronic treatment with medications that influence vitamin D metabolism (e.g., antiseizure medications, glucocorticoids, AIDS-medications, antifungal agents, cholestyramine); Chronic autoimmune diseases (e.g., multiple sclerosis, rheumatoid arthritis); Pregnant and lactating women; Institutionalized or hospitalized patients; Older adults (>65 years) in general; Older adults with history of falls or nontraumatic fractures; Granuloma-forming disorders (e.g., sarcoidosis, tuberculosis, histoplasmosis, berylliosis, coccidiomycosis); Obesity (BMI > 30kg/m2); dark skin pigmentation.
25(OH)D is recommended as a laboratory marker for the diagnosis of vitamin D deficiency.

In patients with diagnosed vitamin D deficiency (25(OH)D <20 ng/mL (<50 nmol/L) ) and suspected related health issues, serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH), creatinine, and serum magnesium levels should be considered for evaluation; in particular in individuals with a 25(OH)D concentration of <10 ng/mL (<25 nmol/L).

  • A 25(OH)D concentration of <20 ng/mL (<50 nmol/L) is considered a vitamin D deficiency
  • A 25(OH)D concentration of >20 ng/mL (>50 nmol/L) and <30 ng/mL (<75 nmol/L) is considered as vitamin D insufficiency
  • A 25(OH)D concentration of 30-50 ng/mL (75-125 nmol/L) is considered as vitamin D sufficiency
  • A 25(OH)D concentration of >50-60 ng/mL (125-150 nmol/L) is considered as safe but not as a target level
  • A 25(OH)D concentration of >60-100 ng/mL (150-250 nmol/L) is considered as area of uncertainty with potential benefits or risks.
  • A 25(OH)D concentration of >100 ng/mL (250 nmol/L) is considered as oversupply/vitamin D toxicity

Overall agreement 100%, consensus endorsed

Table 5. Statement regarding prevention of vitamin D deficiency in adults
  • In healthy adults without other risk factors, a supplementation of 800-2000 IU/day, for those who want to achieve a targeted/measured 25(OH)D concentration, should be considered during wintertime (mainly November-April) due to insufficient endogenous dermal vitamin D synthesis and depending on the body weight.
  • Due to decreased skin synthesis in elderly (>65 years), a supplementation of 800-2000 IU/day is recommended throughout the year.
  • In hospitalized/institutionalized individuals, a supplementation of 800-2000 IU/day is recommended throughout the year.
  • Women planning a pregnancy should start or maintain the vitamin D supplementation as recommended for healthy adults without other risk factors (800-2000 IU/day). The vitamin D supplementation should be continued throughout pregnancy and lactation.
  • In certain patients/individuals or conditions 2-3 times higher vitamin D dosages, without using vitamin D doses above the UL of 4000 IU/day, are recommended for prevention compared to healthy adults without other risk factors:
    • Malabsorption (e.g., cystic fibrosis, inflammatory bowel diseases, bariatric surgery, radiation enteritis)
    • Obesity (BMI > 30 kg/m2)
    • Dark skin pigmentation
  • As vitamin D metabolites are stored in fat and other tissues and gradually released into the blood circulation,
    • a daily or weekly or monthly supplementation regimen is equally effective and safe, if monthly doses are not exceedingly high, for the prevention of vitamin D deficiency.
  • A tailored approach for vitamin D administration, involving the patients' preferences of the supplementation regimen (daily, weekly, monthly) might enhance the adherence to preventive vitamin D supplementation.
  • For the prevention of vitamin D deficiency, the supplementation of oral cholecalciferol (vitamin D3) is recommended.
Table 6. Statement regarding treatment of vitamin D deficiency in adults.
  • It is recommended to initiate a vitamin D deficiency treatment at a 25(OH)D concentration of <20 ng/mL (<50 nmol/L). At a concentration of <30 ng/mL (<75 nmol/L) a treatment may be considered.
  • Individuals with diagnosed vitamin D deficiency can be initially treated with higher vitamin D dosages compared to the preventive dosages recommended for the general population, if a rapid correction of the 25(OH)D concentration is clinically indicated. As initial dose for the treatment of vitamin D deficiency in patients without other risk factors, a dosage of 6000 IU, equivalent to a daily dosage, is recommended.
  • In certain individuals or conditions, higher vitamin D dosages, up to 10,000 IU, equivalent to a daily dosage, are recommended for treatment compared to healthy adults without other risk factors (Endocrine Society recommendation) [14]:
    • Malabsorption (e.g., cystic fibrosis, inflammatory bowel diseases, bariatric surgery, radiation enteritis)
    • Chronic treatment of medications that influence vitamin D metabolism (e.g., antiseizure medications, glucocorticoids, AIDS-medications, antifungal agents, cholestyramine)
    • Obesity (BMI > 30 kg/m2)
  • A treatment duration of 4-12 weeks is recommended, depending on the severity of vitamin D deficiency.
  • A tailored approach for vitamin D administration, involving the patients' preferences of the treatment regimen (daily, weekly, monthly) might enhance the adherence to the therapy.
  • As soon as a 25(OH)D concentration of 30-50 ng/mL (75-125 nmol/L) is achieved, a maintenance dose of 800-2000 IU/day is recommended, that can also be used as an initial treatment dose if there is no requirement for a rapid correction of vitamin D deficiency.
  • Approx. 6-12 weeks after start of the treatment, the effectiveness may be evaluated by measurement of the 25(OH)D concentration particularly in certain risk groups with e.g., malabsorption syndrome.
  • For the treatment of vitamin D deficiency in adults, oral cholecalciferol (vitamin D3) is preferred.
  • Calcifediol may be used instead of vitamin D in certain conditions, including obesity or malabsorption.
  • Calcitriol and active vitamin D analogues may be considered in special patient groups.
  • In certain risk groups (e.g., patients with severe malabsorption), parenteral vitamin D treatment can be considered.
Calcifediol ($$ and generally only by prescription)

Some experts argue that calcifediol (=25(OH)D3, calcidiol) may also be used to correct vitamin D deficiency in certain conditions. The use of calcifediol seems to be more justified in obese people, people with malabsorption syndromes, people with liver disease, patients suffering from chronic kidney disease (stage 3 or 4), and those in all conditions where rapid correction of vitamin D deficiency is required [82-84]. Furthermore, calcifediol use may also be beneficial in patients taking medications that disrupt the hepatic cytochrome P-450 enzyme system, including those taking glucocorticoids, anticonvulsants, anticancer drugs, or antiretroviral drugs [82-85]. The increase in serum 25(OH)D is markedly reduced in patients with obesity (high BMI) and in patients with malabsorption syndromes treated with cholecalciferol, but with calcifediol, the 25(OH)D increase is not significantly different according to BMI or according to the presence, or absence, of malabsorption syndromes. Moreover, the increase in serum 25(OH)D is faster, and the dose-response curve is more linear with the use of calcifediol versus vitamin D3, and when stopping treatment, the decline in 25(OH)D concentration is faster after calcifediol compared to vitamin D3 [75,82-84]. While accumulating evidence suggests that calcifediol may be an attractive alternative to "native" vitamin D, due to the lack of experience with this molecule in Central and Eastern European countries, at this stage, we continue to recommend vitamin D3 (cholecalciferol) [75]. Cholecalciferol and calcifediol appear, so far, as equal molecules in the fight with vitamin D deficiency. However, RCT data are still missing on the superior benefit of calcifediol versus vitamin D, with reference to hard clinical outcomes, but more data on this topic may be available in the future [75,84,85].
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References
  1. Bouillon, R.; Marcocci, C.; Carmeliet, G.; Bikle, D.; White, J.H.; Dawson-Hughes, B.; Lips, P.; Munns, C.F.; Lazaretti-Castro, M.; Giustina, A.; et al. Skeletal and Extraskeletal Actions of Vitamin D: Current Evidence and Outstanding Questions. Endocr. Rev. 2019, 40,1109-1151. [CrossRef] [PubMed]
  2. Pilz, S.; Zittermann, A.; Trummer, C.; Theiler-Schwetz, V.; Lerchbaum, E.; Keppel, M.H.; Grubler, M.R.; Marz, W.; Pandis, M. Vitamin D testing and treatment: A narrative review of current evidence. Endocr. Connect. 2019, 8, R27-R43. [CrossRef]
  3. Maretzke, F.; Bechthold, A.; Egert, S.; Ernst, J.B.; Melo van Lent, D.; Pilz, S.; Reichrath, J.; Stangl, G.I.; Stehle, P.; Volkert, D.; et al. Role of Vitamin D in Preventing and Treating Selected Extraskeletal Diseases—An Umbrella Review. Nutrients 2020,12, 969. [CrossRef] [PubMed]
  4. Zittermann, A.; Trummer, C.; Theiler-Schwetz, V.; Lerchbaum, E.; Marz, W.; Pilz, S. Vitamin D and Cardiovascular Disease: An Updated Narrative Review. Int. J. Mol. Sci. 2021, 22, 2896. [CrossRef] [PubMed]
  5. Bouillon, R.; Manousaki, D.; Rosen, C.; Trajanoska, K.; Rivadeneira, F.; Richards, J.B. The health effects of vitamin D supplementation: Evidence from human studies. Nat. Rev. Endocrinol. 2021,18, 96-110. [CrossRef]
  6. Pilz, S.; Zittermann, A.; Obeid, R.; Hahn, A.; Pludowski, P.; Trummer, C.; Lerchbaum, E.; Perez-Lopez, F.R.; Karras, S.N.; Marz, W. The Role of Vitamin D in Fertility and during Pregnancy and Lactation: A Review of Clinical Data. Int. J. Environ. Res. Public Health 2018,15, 2241. [CrossRef]
  7. Holick, M.F. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev. Endocr. Metab. Disord. 2017,18,153-165. [CrossRef]
  8. Gaksch, M.; Jorde, R.; Grimnes, G.; Joakimsen, R.; Schirmer, H.; Wilsgaard, T.; Mathiesen, E.B.; Njolstad, I.; Lochen, M.L.; Marz, W.; et al. Vitamin D and mortality: Individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS ONE 2017,12, e0170791. [CrossRef]
  9. Cashman, K.D.; Dowling, K.G.; Skrabakova, Z.; Gonzalez-Gross, M.; Valtuena, J.; De Henauw, S.; Moreno, L.; Damsgaard, C.T.; Michaelsen, K.F.; Molgaard, C.; et al. Vitamin D deficiency in Europe: Pandemic? Am. J. Clin. Nutr. 2016,103,1033-1044. [CrossRef]
  10. Saponaro, F.; Saba, A.; Zucchi, R. An Update on Vitamin D Metabolism. Int. J Mol. Sci. 2020,21, 6573. [CrossRef]
  11. Pilz, S.; Trummer, C.; Pandis, M.; Schwetz, V.; Aberer, F.; Grubler, M.; Verheyen, N.; Tomaschitz, A.; Marz, W. Vitamin D: Current Guidelines and Future Outlook. Anticancer Res. 2018, 38,1145-1151. [CrossRef]
  12. Ross, A.C.; Manson, J.E.; Abrams, S.A.; Aloia, J.F.; Brannon, P.M.; Clinton, S.K.; Durazo-Arvizu, R.A.; Gallagher, J.C.; Gallo, R.L.; Jones, G.; 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, 53-58. [CrossRef]
  13. Buttriss, J.L.; Lanham-New, S.A.; Steenson, S.; Levy, L.; Swan, G.E.; Darling, A.L.; Cashman, K.D.; Allen, R.E.; Durrant, L.R.; Smith, C.P.; et al. Implementation strategies for improving vitamin D status and increasing vitamin D intake in the UK: Current controversies and future perspectives: Proceedings of the 2nd Rank Prize Funds Forum on vitamin D. Br. J. Nutr. 2021,1-21. [CrossRef]
  14. Holick, M.F.; Binkley, N.C.; Bischoff-Ferrari, H.A.; Gordon, C.M.; Hanley, D.A.; Heaney, R.P.; Murad, M.H.; Weaver, C.M.; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 2011, 96,1911-1930. [CrossRef]
  15. Giustina, A.; Bouillon, R.; Binkley, N.; Sempos, C.; Adler, R.A.; Bollerslev, J.; Dawson-Hughes, B.; Ebeling, P.R.; Feldman, D.; Heijboer, A.; et al. Controversies in Vitamin D: A Statement from the Third International Conference. JBMR Plus 2020, 4, e10417. [CrossRef]
  16. Bouillon, R. Comparative analysis of nutritional guidelines for vitamin D. Nat. Rev. Endocrinol. 2017,13, 466-479. [CrossRef]
  17. Fraile Navarro, D.; Lopez Garcia-Franco, A.; Nino de Guzman, E.; Rabassa, M.; Zamanillo Campos, R.; Pardo-Hernandez, H.; Ricci- Cabello, I.; Canelo-Aybar, C.; Meneses-Echavez, J.F.; Yepes-Nunez, J.J.; et al. Vitamin D recommendations in clinical guidelines: A systematic review, quality evaluation and analysis of potential predictors. Int. J. Clin. Pract. 2021, 75, e14805. [CrossRef]
  18. Dai, Z.; McKenzie, J.E.; McDonald, S.; Baram, L.; Page, M.J.; Allman-Farinelli, M.; Raubenheimer, D.; Bero, L.A. Assessment of the Methods Used to Develop Vitamin D and Calcium Recommendations—A Systematic Review of Bone Health Guidelines. Nutrients 2021,13, 2423. [CrossRef]
  19. Rosen, C.J.; Abrams, S.A.; Aloia, J.F.; Brannon, P.M.; Clinton, S.K.; Durazo-Arvizu, R.A.; Gallagher, J.C.; Gallo, R.L.; Jones, G.; Kovacs, C.S.; et al. IOM committee members respond to Endocrine Society vitamin D guideline. J. Clin. Endocrinol. Metab. 2012, 97,1146-1152. [CrossRef]
  20. Pludowski, P.; Holick, M.F.; Grant, W.B.; Konstantynowicz, J.; Mascarenhas, M.R.; Haq, A.; Povoroznyuk, V.; Balatska, N.; Barbosa, A.P; Karonova, T.; et al. Vitamin D supplementation guidelines. J. Steroid Biochem. Mol. Biol. 2018,175,125-135. [CrossRef]
  21. Pludowski, P.; Karczmarewicz, E.; Bayer, M.; Carter, G.; Chlebna-Sokol, D.; Czech-Kowalska, J.; Debski, R.; Decsi, T.; Dobrzanska, A.; Franek, E.; 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, 319-327. [CrossRef]
  22. Takacs, I.; Benko, I.; Toldy, E.; Wikonkal, N.; Szekeres, L.; Bodolay, E.; Kiss, E.; Jambrik, Z.; Szabo, B.; Merkely, B.; et al. Hungarian consensus regarding the role of vitamin D in the prevention and treatment of diseases. Orv. Hetil. 2012,153 (Suppl. 2), 5-26. [CrossRef]
  23. German Nutrition Society (DGE). New reference values for vitamin D. Ann. Nutr. Metab. 2012, 60, 241-246. [CrossRef]
  24. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies). Scientific opinion on dietary reference values for vitamin D. EFSA J. 2016,14, 4547. [CrossRef]
  25. Pigarova, E.A.; Rozhinskaya, L.Y.; Belaya, J.E.; Dzeranova, L.K.; Karonova, T.L.; Ilyin, A.V.; Melnichenko, G.A.; Dedov, I.I. Russian Association of Endocrinologists recommendations for diagnosis, treatment and prevention of vitamin D deficiency in adults. Probl. Endocrinol. 2016, 62, 60-84. (In Russian) [CrossRef]
  26. Rusinska, A.; Pludowski, P.; Walczak, M.; Borszewska-Kornacka, M.K.; Bossowski, A.; Chlebna-Sokol, D.; Czech-Kowalska, J.; Dobrzanska, A.; Franek, E.; Helwich, E.; et al. Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland-Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel with Participation of National Specialist Consultants and Representatives of Scientific Societies—2018 Update. Front. Endocrinol. 2018, 9, 246. [CrossRef]
  27. Rudenko, E. National Regulation about Methods of Diagnosis, Prevention and Differentiated Treatment of Vitamin D Deficiency; Ministry of Health of the Republic of Belarus: Minsk, Belarus, 2013.
  28. Borissova, A.-M.; Boyanov, M.A.; Popivanov, P.R.; Kolarov, Z.; Petranova, T.P.; Shinkov, A.D. Recommendation for Diagnosis, Prevention and Treatment of Vitamin D Deficiency; Bulgarian Society of Endocrinology: Sofia, Bulgaria, 2019.
  29. Payer, J.; Killinger, Z.; Jackuliak, P.; Kuzma, M. Postmenopausal osteoporosis: Standard diagnostic and therapeutic practice. Clin. Osteol. 2018, 23, 18-27.
  30. Cesareo, R.; Attanasio, R.; Caputo, M.; Castello, R.; Chiodini, I.; Falchetti, A.; Guglielmi, R.; Papini, E.; Santonati, A.; Scillitani, A.; et al. Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement: Clinical Management of Vitamin D Deficiency in Adults. Nutrients 2018, 10, 546. [CrossRef]
  31. Rockwell, M.; Kraak, V.; Hulver, M.; Epling, J. Clinical Management of Low Vitamin D: A Scoping Review of Physicians' Practices. Nutrients 2018,10, 493. [CrossRef]
  32. Zittermann, A.; Pilz, S.; Berthold, H.K. Serum 25-hydroxyvitamin D response to vitamin D supplementation in infants: A systematic review and meta-analysis of clinical intervention trials. Eur. J. Nutr. 2020, 59, 359-369. [CrossRef]
  33. Munns, C.F.; Shaw, N.; Kiely, M.; Specker, B.L.; Thacher, T.D.; Ozono, K.; Michigami, T.; Tiosano, D.; Mughal, M.Z.; Makitie, O.; et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J. Clin. Endocrinol. Metab. 2016,101, 394-415. [CrossRef] [PubMed]
  34. Grossman, Z.; Hadjipanayis, A.; Stiris, T.; Del Torso, S.; Mercier, J.C.; Valiulis, A.; Shamir, R. Vitamin D in European children- statement from the European Academy of Paediatrics (EAP). Eur. J. Pediatr. 2017,176, 829-831. [CrossRef] [PubMed]
  35. Diamond, I.R.; Grant, R.C.; Feldman, B.M.; Pencharz, P.B.; Ling, S.C.; Moore, A.M.; Wales, P.W. Defining consensus: A systematic review recommends methodologic criteria for reporting of Delphi studies. J. Clin. Epidemiol. 2014, 67, 401-409. [CrossRef] [PubMed]
  36. Rosenfeld, R.M.; Nnacheta, L.C.; Corrigan, M.D. Clinical Consensus Statement Development Manual. Otolaryngol. Head Neck Surg. 2015,153, S1-S14. [CrossRef]
  37. Cashman, K.D. Global differences in vitamin D status and dietary intake: A review of the data. Endocr. Connect. 2022,11, e210282. [CrossRef]
  38. Lips, P.; Cashman, K.D.; Lamberg-Allardt, C.; Bischoff-Ferrari, H.A.; Obermayer-Pietsch, B.; Bianchi, M.L.; Stepan, J.; El-Hajj Fuleihan, G.; Bouillon, R. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: A position statement of the European Calcified Tissue Society. Eur. J. Endocrinol. 2019,180, P23-P54. [CrossRef]
  39. Pludowski, P.; Ducki, C.; Konstantynowicz, J.; Jaworski, M. Vitamin D status in Poland. Pol. Arch. Med. Wewn. 2016,126, 530-539. [CrossRef]
  40. Avdeeva, V.A.; Suplotova, L.A.; Pigarova, E.A.; Rozhinskaya, L.Y.; Troshina, E.A. Vitamin D deficiency in Russia: The first results of a registered, non-interventional study of the frequency of vitamin D deficiency and insufficiency in various geographic regions of the country. Probl. Endokrinol. 2021, 67, 84-92. [CrossRef]
  41. Nikolova, M.G.; Boyanov, M.A.; Tsakova, A.D. Correlations of Serum Vitamin D with Metabolic Parameters in Adult Outpatients with Different Degrees of Overweight/Obesity Coming from an Urban Community. Acta Endocrinol. 2018,14, 375-383. [CrossRef]
  42. Burnett-Bowie, S.M.; Cappola, A.R. The USPSTF 2021 Recommendations on Screening for Asymptomatic Vitamin D Deficiency in Adults: The Challenge for Clinicians Continues. JAMA 2021, 325,1401-1402. [CrossRef]
  43. US Preventive Services Task Force; Krist, A.H.; Davidson, K.W.; Mangione, C.M.; Cabana, M.; Caughey, A.B.; Davis, E.M.; Donahue, K.E.; Doubeni, C.A.; Epling, J.W., Jr.; et al. Screening for Vitamin D Deficiency in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2021, 325,1436-1442. [CrossRef]
  44. Macova, L.; Bicikova, M. Vitamin D: Current Challenges between the Laboratory and Clinical Practice. Nutrients 2021,13,1758. [CrossRef]
  45. Binkley, N.; Dawson-Hughes, B.; Durazo-Arvizu, R.; Thamm, M.; Tian, L.; Merkel, J.M.; Jones, J.C.; Carter, G.D.; Sempos, C.T. Vitamin D measurement standardization: The way out of the chaos. J. Steroid Biochem. Mol. Biol. 2017,173,117-121. [CrossRef]
  46. Marcinowska-Suchowierska, E.; Kupisz-Urbanska, M.; Lukaszkiewicz, J.; Pludowski, P.; Jones, G. Vitamin D Toxicity—A Clinical Perspective. Front. Endocrinol. 2018, 9, 550. [CrossRef]
  47. Cappellani, D.; Brancatella, A.; Morganti, R.; Borsari, S.; Baldinotti, F.; Caligo, M.A.; Kaufmann, M.; Jones, G.; Marcocci, C.; Cetani, F. Hypercalcemia due to CYP24A1 mutations: A systematic descriptive review. Eur. J. Endocrinol. 2021,186,137-149. [CrossRef]
  48. Carlberg, C. Vitamin D: A Micronutrient Regulating Genes. Curr. Pharm. Des. 2019, 25,1740-1746. [CrossRef]
  49. Hanel, A.; Neme, A.; Malinen, M.; Hamalainen, E.; Malmberg, H.R.; Etheve, S.; Tuomainen, T.P.; Virtanen, J.K.; Bendik, I.; Carlberg, C. Common and personal target genes of the micronutrient vitamin D in primary immune cells from human peripheral blood. Sci. Rep. 2020,10,21051. [CrossRef]
  50. Krasniqi, E.; Boshnjaku, A.; Wagner, K.H.; Wessner, B. Association between Polymorphisms in Vitamin D Pathway-Related Genes, Vitamin D Status, Muscle Mass and Function: A Systematic Review. Nutrients 2021,13, 3109. [CrossRef]
  51. Bilezikian, J.P.; Formenti, A.M.; Adler, R.A.; Binkley, N.; Bouillon, R.; Lazaretti-Castro, M.; Marcocci, C.; Napoli, N.; Rizzoli, R.; Giustina, A. Vitamin D: Dosing, levels, form, and route of administration: Does one approach fit all? Rev. Endocr. Metab. Disord. 2021, 22,1201-1218. [CrossRef]
  52. Kupisz-Urbanska, M.; Pludowski, P.; Marcinowska-Suchowierska, E. Vitamin D Deficiency in Older Patients—Problems of Sarcopenia, Drug Interactions, Management in Deficiency. Nutrients 2021,13,1247. [CrossRef]
  53. Cashman, K.D. Vitamin D Requirements for the Future-Lessons Learned and Charting a Path Forward. Nutrients 2018,10,533. [CrossRef]
  54. Cashman, K.D.; Ritz, C.; Kiely, M.; Odin, C. Improved Dietary Guidelines for Vitamin D: Application of Individual Participant Data (IPD)-Level Meta-Regression Analyses. Nutrients 2017, 9, 469. [CrossRef]
  55. Pilz, S.; Hahn, A.; Schon, C.; Wilhelm, M.; Obeid, R. Effect of Two Different Multimicronutrient Supplements on Vitamin D Status in Women of Childbearing Age: A Randomized Trial. Nutrients 2017, 9, 30. [CrossRef]
  56. Calvo, M.S.; Whiting, S.J. Public health strategies to overcome barriers to optimal vitamin D status in populations with special needs. J. Nutr. 2006,136,1135-1139. [CrossRef]
  57. Mo, M.; Wang, S.; Chen, Z.; Muyiduli, X.; Wang, S.; Shen, Y.; Shao, B.; Li, M.; Chen, D.; Chen, Z.; et al. A systematic review and meta-analysis of the response of serum 25-hydroxyvitamin D concentration to vitamin D supplementation from RCTs from around the globe. Eur. J. Clin. Nutr. 2019, 73, 816-834. [CrossRef]
  58. Bacha, D.S.; Rahme, M.; Al-Shaar, L.; Baddoura, R.; Halaby, G.; Singh, R.J.; Mahfoud, Z.R.; Habib, R.; Arabi, A.; El-Hajj Fuleihan, G. Vitamin D3 Dose Requirement That Raises 25-Hydroxyvitamin D to Desirable Level in Overweight and Obese Elderly. J. Clin. Endocrinol. Metab. 2021,106, e3644-e3654. [CrossRef]
  59. Zittermann, A.; Ernst, J.B.; Gummert, J.F.; Borgermann, J. Vitamin D supplementation, body weight and human serum 25- hydroxyvitamin D response: A systematic review. Eur. J. Nutr. 2014, 53, 367-374. [CrossRef] [PubMed]
  60. Autier, P.; Gandini, S.; Mullie, P. A systematic review: Influence of vitamin D supplementation on serum 25-hydroxyvitamin D concentration. J. Clin. Endocrinol. Metab. 2012, 97, 2606-2613. [CrossRef] [PubMed]
  61. Cashman, K.D.; Ritz, C.; Adebayo, F.A.; Dowling, K.G.; Itkonen, S.T.; Ohman, T.; Skaffari, E.; Saarnio, E.M.; Kiely, M.; Lamberg- Allardt, C. Differences in the dietary requirement for vitamin D among Caucasian and East African women at Northern latitude. Eur. J. Nutr. 2019, 58, 2281-2291. [CrossRef] [PubMed]
  62. Cashman, K.D.; Kiely, M.E.; Andersen, R.; Gronborg, I.M.; Tetens, I.; Tripkovic, L.; Lanham-New, S.A.; Lamberg-Allardt, C.; Adebayo, F.A.; Gallagher, J.C.; et al. Individual participant data (IPD)-level meta-analysis of randomised controlled trials to estimate the vitamin D dietary requirements in dark-skinned individuals resident at high latitude. Eur. J. Nutr. 2021, 61,1015-1034. [CrossRef] [PubMed]
  63. Mazahery, H.; von Hurst, P.R. Factors Affecting 25-Hydroxyvitamin D Concentration in Response to Vitamin D Supplementation. Nutrients 2015, 7, 5111-5142. [CrossRef]
  64. Ramasamy, I. Vitamin D Metabolism and Guidelines for Vitamin D Supplementation. Clin. Biochem. Rev. 2020, 41,103-126. [CrossRef]
  65. Ish-Shalom, S.; Segal, E.; Salganik, T.; Raz, B.; Bromberg, I.L.; Vieth, R. Comparison of daily, weekly, and monthly vitamin D3 in ethanol dosing protocols for two months in elderly hip fracture patients. J. Clin. Endocrinol. Metab. 2008, 93, 3430-3435. [CrossRef]
  66. Takacs, I.; Toth, B.E.; Szekeres, L.; Szabo, B.; Bakos, B.; Lakatos, P. Randomized clinical trial to comparing efficacy of daily, weekly and monthly administration of vitamin D3. Endocrine 2017, 55, 60-65. [CrossRef]
  67. Mazess, R.B.; Bischoff-Ferrari, H.A.; Dawson-Hughes, B. Vitamin D: Bolus Is Bogus—A Narrative Review. JBMR Plus 2021, 5, e10567. [CrossRef]
  68. Jorde, R.; Grimnes, G. Serum cholecalciferol may be a better marker of vitamin D status than 25-hydroxyvitamin D. Med. Hypotheses 2018,111, 61-65. [CrossRef]
  69. Rothen, J.P.; Rutishauser, J.; Walter, P.N.; Hersberger, K.E.; Arnet, I. Oral intermittent vitamin D substitution: Influence of pharmaceutical form and dosage frequency on medication adherence: A randomized clinical trial. BMC Pharmacol. Toxicol. 2020, 21, 51. [CrossRef]
  70. Tripkovic, L.; Lambert, H.; Hart, K.; Smith, C.P.; Bucca, G.; Penson, S.; Chope, G.; Hypponen, E.; Berry, J.; Vieth, R.; 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, 95,1357-1364. [CrossRef]
  71. Bjelakovic, G.; Gluud, L.L.; Nikolova, D.; Whitfield, K.; Wetterslev, J.; Simonetti, R.G.; Bjelakovic, M.; Gluud, C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst. Rev. 2008, CD007470. [CrossRef]
  72. Holick, M.F.; Binkley, N.C.; Bischoff-Ferrari, H.A.; Gordon, C.M.; Hanley, D.A.; Heaney, R.P.; Murad, M.H.; Weaver, C.M. Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J. Clin. Endocrinol. Metab. 2012, 97, 1153-1158. [CrossRef]
  73. Heaney, R.P.; Armas, L.A. Quantifying the vitamin D economy. Nutr. Rev. 2015, 73, 51-67. [CrossRef] [PubMed]
  74. Pludowski, P.; Socha, P.; Karczmarewicz, E.; Zagorecka, E.; Lukaszkiewicz, J.; Stolarczyk, A.; Piotrowska-Jastrzebska, J.; Kryskiewicz, E.; Lorenc, R.S.; Socha, J. Vitamin D supplementation and status in infants: A prospective cohort observational study. J. Pediatr. Gastroenterol. Nutr. 2011, 53, 93-99. [CrossRef] [PubMed]
  75. Vieth, R. Vitamin D supplementation: Cholecalciferol, calcifediol, and calcitriol. Eur. J. Clin. Nutr. 2020, 74, 1493-1497. [CrossRef] [PubMed]
  76. Billington, E.O.; Burt, L.A.; Rose, M.S.; Davison, E.M.; Gaudet, S.; Kan, M.; Boyd, S.K.; Hanley, D.A. Safety of High-Dose Vitamin D Supplementation: Secondary Analysis of a Randomized Controlled Trial. J. Clin. Endocrinol. Metab. 2020,105,1261-1273. [CrossRef]
  77. Vieth, R. Vitamin D and cancer mini-symposium: The risk of additional vitamin D. Ann. Epidemiol. 2009,19, 441-445. [CrossRef]
  78. Nielsen, O.H.; Hansen, T.I.; Gubatan, J.M.; Jensen, K.B.; Rejnmark, L. Managing vitamin D deficiency in inflammatory bowel disease. Frontline Gastroenterol. 2019,10, 394-400. [CrossRef]
  79. Masood, M.Q.; Khan, A.; Awan, S.; Dar, F.; Naz, S.; Naureen, G.; Saghir, S.; Jabbar, A. Comparison of Vitamin D Replacement Strategies with High-Dose Intramuscular or Oral Cholecalciferol: A Prospective Intervention Study. Endocr. Pract. 2015, 21, 1125-1133. [CrossRef]
  80. Wylon, K.; Drozdenko, G.; Krannich, A.; Heine, G.; Dolle, S.; Worm, M. Pharmacokinetic Evaluation of a Single Intramuscular High Dose versus an Oral Long-Term Supplementation of Cholecalciferol. PLoS ONE 2017,12, e0169620. [CrossRef]
  81. Gupta, N.; Farooqui, K.J.; Batra, C.M.; Marwaha, R.K.; Mithal, A. Effect of oral versus intramuscular Vitamin D replacement in apparently healthy adults with Vitamin D deficiency. Indian J. Endocrinol. Metab. 2017, 21,131-136. [CrossRef]
  82. Sosa Henriquez, M.; Gomez de Tejada Romero, M.J. Cholecalciferol or Calcifediol in the Management of Vitamin D Deficiency. Nutrients 2020,12,1617. [CrossRef]
  83. Quesada-Gomez, J.M.; Bouillon, R. Is calcifediol better than cholecalciferol for vitamin D supplementation? Osteoporos. Int. 2018, 29,1697-1711. [CrossRef]
  84. Perez-Castrillon, J.L.; Duenas-Laita, A.; Brandi, M.L.; Jodar, E.; Del Pino-Montes, J.; Quesada-Gomez, J.M.; Cereto Castro, F.; Gomez-Alonso, C.; Gallego Lopez, L.; Olmos Martinez, J.M.; et al. Calcifediol is superior to cholecalciferol in improving vitamin D status in postmenopausal women: A randomized trial. J. Bone Miner. Res. 2021, 36,1967-1978. [CrossRef]
  85. Bischoff-Ferrari, H.A.; Dawson-Hughes, B.; Orav, E.J.; Staehelin, H.B.; Meyer, O.W.; Theiler, R.; Dick, W.; Willett, W.C.; Egli, A. Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial. JAMA Intern. Med. 2016,176,175-183. [CrossRef]
  86. Bollerslev, J.; Rejnmark, L.; Zahn, A.; Heck, A.; Appelman-Dijkstra, N.M.; Cardoso, L.; Hannan, F.M.; Cetani, F.; Sikjaer, T.; Formenti, A.M.; et al. European Expert Consensus on Practical Management of Specific Aspects of Parathyroid Disorders in Adults and in Pregnancy: Recommendations of the ESE Educational Program of Parathyroid Disorders. Eur. J. Endocrinol. 2022, 186, R33-R63. [CrossRef]
  87. Bischoff-Ferrari, H.A.; Willett, W.C.; Orav, E.J.; Lips, P.; Meunier, P.J.; Lyons, R.A.; Flicker, L.; Wark, J.; Jackson, R.D.; Cauley, J.A.; et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N. Engl. J. Med. 2012,367, 40-49. [CrossRef]
  88. Bolland, M.J.; Grey, A.; Avenell, A. Effects of vitamin D supplementation on musculoskeletal health: A systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol. 2018, 6, 847-858. [CrossRef]
  89. Carmel, A.S.; Bockman, R.S. Vitamin D and bisphosphonate response. Osteoporos. Int. 2014, 25, 2155. [CrossRef]
  90. Reid, I.R.; Horne, A.M.; Mihov, B.; Stewart, A.; Garratt, E.; Wong, S.; Wiessing, K.R.; Bolland, M.J.; Bastin, S.; Gamble, G.D. Fracture Prevention with Zoledronate in Older Women with Osteopenia. N. Engl. J. Med. 2018, 379, 2407-2416. [CrossRef]
  91. Li, S.; Xi, C.; Li, L.; Long, Z.; Zhang, N.; Yin, H.; Xie, K.; Wu, Z.; Tian, J.; Wang, F.; et al. Comparisons of different vitamin D supplementation for prevention of osteoporotic fractures: A Bayesian network meta-analysis and meta-regression of randomised controlled trials. Int. J. Food Sci. Nutr. 2021, 72, 518-528. [CrossRef]
  92. Ganmaa, D.; Enkhmaa, D.; Nasantogtokh, E.; Sukhbaatar, S.; Tumur-Ochir, K.E.; Manson, J.E. Vitamin D, respiratory infections, and chronic disease: Review of meta-analyses and randomized clinical trials. J. Intern. Med. 2021. [CrossRef]
  93. Iuliano, S.; Poon, S.; Robbins, J.; Bui, M.; Wang, X.; De Groot, L.; Van Loan, M.; Zadeh, A.G.; Nguyen, T.; Seeman, E. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: Cluster randomised controlled trial. BMJ 2021, 375, n2364. [CrossRef]
  94. Appel, L.J.; Michos, E.D.; Mitchell, C.M.; Blackford, A.L.; Sternberg, A.L.; Miller, E.R., 3rd; Juraschek, S.P.; Schrack, J.A.; Szanton, S.L.; Charleston, J.; et al. The Effects of Four Doses of Vitamin D Supplements on Falls in Older Adults: A Response- Adaptive, Randomized Clinical Trial. Ann. Intern. Med. 2021,174,145-156. [CrossRef]
  95. Zittermann, A.; Ernst, J.B.; Prokop, S.; Fuchs, U.; Dreier, J.; Kuhn, J.; Knabbe, C.; Birschmann, I.; Schulz, U.; Berthold, H.K.; et al. Effect of vitamin D on all-cause mortality in heart failure (EVITA): A 3-year randomized clinical trial with 4000 IU vitamin D daily. Eur. Heart J. 2017, 38, 2279-2286. [CrossRef]
  96. Gnagnarella, P.; Muzio, V.; Caini, S.; Raimondi, S.; Martinoli, C.; Chiocca, S.; Miccolo, C.; Bossi, P; Cortinovis, D.; Chiaradonna, F.; et al. Vitamin D Supplementation and Cancer Mortality: Narrative Review of Observational Studies and Clinical Trials. Nutrients 2021,13, 3285. [CrossRef]
  97. Charoenngam, N.; Holick, M.F. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients 2020,12,2097. [CrossRef]
  98. Hajhashemy, Z.; Shahdadian, F.; Moslemi, E.; Mirenayat, F.S.; Saneei, P. Serum vitamin D levels in relation to metabolic syndrome: A systematic review and dose-response meta-analysis of epidemiologic studies. Obes. Rev. 2021, 22, e13223. [CrossRef]
  99. Han, J.; Guo, X.; Yu, X.; Liu, S.; Cui, X.; Zhang, B.; Liang, H. 25-Hydroxyvitamin D and Total Cancer Incidence and Mortality: A Meta-Analysis of Prospective Cohort Studies. Nutrients 2019,11, 2295. [CrossRef]
  100. Hahn, J.; Cook, N.R.; Alexander, E.K.; Friedman, S.; Walter, J.; Bubes, V.; Kotler, G.; Lee, I.M.; Manson, J.E.; Costenbader, K.H. Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ 2022, 376, e066452. [CrossRef]
  101. Autier, P.; Boniol, M.; Pizot, C.; Mullie, P. Vitamin D status and ill health: A systematic review. Lancet Diabetes Endocrinol. 2014,2, 76-89. [CrossRef]
  102. Jolliffe, D.A.; Camargo, C.A., Jr.; Sluyter, J.D.; Aglipay, M.; Aloia, J.F.; Ganmaa, D.; Bergman, P; Bischoff-Ferrari, H.A.; Borzutzky, A.; Damsgaard, C.T.; et al. Vitamin D supplementation to prevent acute respiratory infections: A systematic review and meta-analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol. 2021, 9,276-292. [CrossRef]
  103. Sluyter, J.D.; Manson, J.E.; Scragg, R. Vitamin D and Clinical Cancer Outcomes: A Review of Meta-Analyses. JBMR Plus 2021,5, e10420. [CrossRef] [PubMed]
  104. Scragg, R.; Sluyter, J.D. Is There Proof of Extraskeletal Benefits from Vitamin D Supplementation from Recent Mega Trials of Vitamin D? JBMR Plus 2021, 5, e10459. [CrossRef] [PubMed]
  105. Jolliffe, D.A.; Greenberg, L.; Hooper, R.L.; Mathyssen, C.; Rafiq, R.; de Jongh, R.T.; Camargo, C.A.; Griffiths, C.J.; Janssens, W.; Martineau, A.R. Vitamin D to prevent exacerbations of COPD: Systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax 2019, 74, 337-345. [CrossRef]
  106. Li, X.; He, J.; Yu, M.; Sun, J. The efficacy of vitamin D therapy for patients with COPD: A meta-analysis of randomized controlled trials. Ann. Palliat. Med. 2020, 9, 286-297. [CrossRef] [PubMed]
  107. Forno, E.; Bacharier, L.B.; Phipatanakul, W.; Guilbert, T.W.; Cabana, M.D.; Ross, K.; Covar, R.; Gem, J.E.; Rosser, F.J.; Blatter, J.; et al. Effect of Vitamin D3 Supplementation on Severe Asthma Exacerbations in Children with Asthma and Low Vitamin D Levels: The VDKA Randomized Clinical Trial. JAMA 2020, 324, 752-760. [CrossRef]
  108. Zittermann, A.; Pilz, S.; Hoffmann, H.; Marz, W. Vitamin D and airway infections: A European perspective. Eur. J. Med. Res. 2016, 21,14. [CrossRef] [PubMed]
  109. Pilz, S.; Trümmer, C.; Theiler-Schwetz, V.; Grübler, M.R.; Verheyen, N.D.; Odler, B.; Karras, S.N.; Zittermann, A.; Marz, W. Critical Appraisal of Large Vitamin D Randomized Controlled Trials. Nutrients 2022,14, 303. [CrossRef]
  110. Neale, R.E.; Baxter, C.; Romero, B.D.; McLeod, D.S.A.; English, D.R.; Armstrong, B.K.; Ebeling, P.R.; Hartel, G.; Kimlin, M.G.; O'Connell, R.; et al. The D-Health Trial: A randomised controlled trial of the effect of vitamin D on mortality. Lancet Diabetes Endocrinol. 2022,10,120-128. [CrossRef]
  111. Zemb, P.; Bergman, P.; Camargo, C.A., Jr.; Cavalier, E.; Cormier, C.; Courbebaisse, M.; Hollis, B.; Joulia, F.; Minisola, S.; Pilz, S.; et al. Vitamin D deficiency and the COVID-19 pandemic. J. Glob. Antimicrob. Resist. 2020, 22,133-134. [CrossRef]
  112. Smaha, J.; Kuzma, M.; Jackuliak, P.; Payer, J. Vitamin D supplementation as an important factor in COVID-19 prevention and treatment: What evidence do we have? Vnitr. Lek. 2020, 66, 494-500. [CrossRef]
  113. Stroehlein, J.K.; Wallqvist, J.; Iannizzi, C.; Mikolajewska, A.; Metzendorf, M.I.; Benstoem, C.; Meybohm, P.; Becker, M.; Skoetz, N.; Stegemann, M.; et al. Vitamin D supplementation for the treatment of COVID-19: A living systematic review. Cochrane Database Syst. Rev. 2021, 5, CD015043. [CrossRef]
  114. Liu, Q.; Qin, C.; Liu, M.; Liu, J. Effectiveness and safety of SARS-CoV-2 vaccine in real-world studies: A systematic review and meta-analysis. Infect. Dis. Poverty 2021,10,132. [CrossRef]
  115. Pilz, S.; Chakeri, A.; Ioannidis, J.P.; Richter, L.; Theiler-Schwetz, V.; Trummer, C.; Krause, R.; Allerberger, F. SARS-CoV-2 re-infection risk in Austria. Eur. J. Clin. Investig. 2021, 51, e13520. [CrossRef]
  116. Pilz, S.; Theiler-Schwetz, V.; Trummer, C.; Krause, R.; Ioannidis, J.P.A. SARS-CoV-2 reinfections: Overview of efficacy and duration of natural and hybrid immunity. Environ. Res. 2022, 209,112911. [CrossRef

VitaminDWiki

Interview covering 30+ Vitamin D topics
Consensus Vitamin D category
71 Vitamin D consensus publications
11 reasons why doctors reluctant to accept vitamin D
Co-factors (such as Magnesium and Omega-3) not mentioned
Incorrectly states that loading doses should not be used

Overview Loading of vitamin D  A few examples

4,000 IU max - yet > 100 Amazon suppliers sell 5,000 IU capsules
  • And many also sell 10,000 IU and 50,000 IU capsules
No mention of getting more vitamin D to cells by activation of Vitamin D Receptor
No mention of other important forms of Vitamin D: topical, nanoemulsion, gut-friendly
No mention of taking vitamin D with biggest meal of the day
  • Staying in small intestine longer increases response by about 30%
No indication of health problems that require more than 40 ng of vitamin D
Vitamin D Treats
150 ng Multiple Sclerosis *
80 ng Cluster Headache *
Reduced office visits by 4X *
70 ngSleep *
60 ngBreast Cancer death reduced 60%
Preeclampsia RCT
50 ng COVID-19
T1 Diabetes
Fertility
Psoriasis
Infections Review
Infection after surgery
40 ng Breast Cancer 65% lower risk
Depression
ACL recovery
Hypertension
Asthma?
30 ng Rickets

* Evolution of experiments with patients, often also need co-factors

No prevention of health problems
  • They do not test until after the health problem already exists
No consideration that people lacking sun will need more vitamin D
  • Excessive Clothing, 2nd shift workers, unable to get outdoors,
Incorrectly states that Vitamin D test should be made again after 6-12 weeks
  • Responses to low vitamin D doses often do not plateau for 25+ weeks
Incorrectly states 800 IU can maintain a 50 ng level
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Conservative Vitamin D Consensus from Central Europe - April 2022        
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