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Vitamin D Loading dose - 20,000 IU daily is not enough if obese, etc. (Cancer) great table and chart – Oct 2016

Appropriate vitamin D loading regimen for patients with advanced lung cancer.

Nutr J. 2016 Oct 6;15(1):84.
Hoffer LJ1, Robitaille L2, Swinton N3, Agulnik J2,3, Cohen V2,3, Small D2,3, Pepe C2,3, Eintracht S4.

  • 1Lady Davis Institute for Medical Research, McGill University and Jewish General Hospital, 3755 Cote Sainte Catherine, Montreal, QC H3T 1E2, Canada. l.hoffer at mcgill.ca.
  • 2Lady Davis Institute for Medical Research, McGill University and Jewish General Hospital, 3755 Cote Sainte Catherine, Montreal, QC H3T 1E2, Canada.
  • 3Pulmonary Oncology Peter Brojde Lung Cancer Centre, Jewish General Hospital, Montreal, Canada.
  • 4Department of Diagnostic Medicine, Jewish General Hospital, Montreal, Canada.
VitaminDWiki Summary

20,000 IU for 14 days, followed by 10,000 IU
Yet again we see that a fixed dose dose not help about half ot the people
See also VitaminDWiki

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Normal weight     Obese     (50 ng = 125)

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Vitamin D response

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Table 4 - Other Loading Dose studies

Table 4 Early time-point effects of oral vitamin D loading on plasma 25(OH)D concentrations of adults

First author, year

Number

Study population

BMI

Intervention

Time point

Mean 25(OH)D

Range or SD

[reference]

concentration

Weisman et al., 1986 [60]

13

Elderly

n.a.

100,000 IU in one dose

Baseline

29

14 days

88

SD 14

Ilahi et al., 2008 [54]

30

Healthy volunteers

27

100,00 IU in one dose

Baseline

27

7-21 daysa

105

SD 20

Romagnoli, 2008 [56]

8

Elderly nursing home

n.a.

300,000 IU in one dose

Baseline

33

3 days

120

n.a

7 days

128

30 days

152

Martineau et al., 2009 [55]

56

Normalvolunteers

n.a.

100,000 IU vitamin D2 in one

Baseline

34b

dose

7 days

102

50-140

11

Active tuberculosis

n.a.

100,000 IU vitamin D2 in one

Baseline

23b

dose

7 days

133

70-250

Cipriani et al., 2010 [61]

48

Healthy volunteers

24

600,000 IU in one dose

Baseline

35

3 days

193

SD ~68

15 days

193

30 days

155

Amrein et al., 2011 [57]

12

Critically ill

29

540,000 IU in one dose

Baseline

35

3 days

88

n.a.

7 days

96

Rossini et al., 2012 [58]

13

Elderly

29

100,000 IU in one dose

Baseline

66

7 days

85

SD ~20

14 days

83

30 days

84

12

29

300,000 IU in one dose

Baseline

64

7 days

96

SD ~20

14 days

95

30 days

86

12

29

600,000 IU in one dose

Baseline

54

7 days

156

SD ~30

14 days

152

30 days

129

Grossmann et al., 2012 [59]

15

Adults with cystic fibrosis

18.5

250,000 IU in one dose

Baseline

76

and acute illness

7 days

145

SD 34

Roth et al., 2012 [62]

34

Non-pregnant women

n.a.

70,000 IU in one dose

Baseline

54

7 days

79

~45-125

14 days

75

~40-140

27

Pregnant women

n.a.

70,000 IU in one dose

Baseline

39

7 days

67

~45-100

14 days

71

~50-120

De Jong et al., 2013 [63]

14

Elderly acute hip fracture

n.a.

150,000 IU as 50,000 IU/day

Baseline

30

for 3 days

7 days

81

47-108

54

n.a.

350,000 IU as 50,000 IU/day

Baseline

31

for 7 days

7 days

131

86-243

Table 4 Early time-point effects of oral vitamin D loading on plasma 25(OH)D concentrations of adults (Continued)

Drincic et al., 2013 [64]

20

Obese

38

10,000 IU per day

Baseline

58

7 days

80

n.a.

21 days

106

Cantor, 2014 [65]

18

Internal medicine

n.a

356,000 IU as 300,00 IU

Baseline

22

patients

followed by 4000 IU/day

14 days

102

50-202

32

n.a.

206,000 IU as150,000 IU

Baseline

55

followed by 4000 IU/day

14 days

108

58-185

Kearns et al., 2015 [66]

14

Healthy volunteers

24

250,000 IU in one dose

Baseline

41

5 days

102

70-149

Oliveri et al., 2015 [67]

11

Healthy volunteers

22

100,000 IU in one dose

Baseline

41

SD 12

7 days

105

11

21

100,000 IU vitamin D2 in one

Baseline

41

SD 28

dose

7 days

92

Rousseau et al., 2015 [68]

29

Healthy volunteers

n.a.

100,000 IU in one dose

Baseline

54

7 days

100

64-167

20

Acute burn injury

n.a.

100,000 IU in one dose

Baseline

18

7 days

48

12-84

Tukvadze et al., 2015 [69]

100

Active tuberculosis

n.a.

50,000 IU three times weekly

Baseline

35

14 days

175

n.a.

28 days

225

Present study

80

Lung cancer

26

20,000 IU/day for 14 days

Baseline

48

then 10,000 IU/day

14 days

106

16-238

21 days

116

15-258

BM! body mass index (kg/m2). 25(OH)D concentrations are expressed in nmol/L

aThe concentration peaked on day 7 and remained approximately constant throughout day 21

b Sum of 25(OH)D2 and 25(OH)D3


BACKGROUND:
Most patients attending cancer clinics have hypovitaminosis D. Correcting or preventing this abnormal condition could mitigate the emotional and physical complications of their disease, but clinical trials of vitamin D therapy in this setting are hindered by the unavailability of safe, effective and practical loading dose regimens.
METHODS:
In this single arm open-label pharmacokinetic trial, outpatients with advanced lung cancer consumed 20,000 IU vitamin D daily with the largest meal of the day for 14 days followed by 10,000 IU per day for a further 7 days. Plasma concentrations of 25-hydroxyvitamin D 25(OH)D, parathyroid hormone, calcium, vitamin C and C-reactive protein were measured on protocol days 0, 14 and 21, and serum vitamin D binding protein (VDBP) concentrations on days 0 and 21. As a secondary objective, preliminary information was obtained regarding clinical effects of rapid vitamin D loading on mood and symptoms by administering appropriate questionnaires two times at baseline and after 14 and 21 days of vitamin D therapy.
RESULTS:
Of the 91 patients enrolled in the study, 85 % had hypovitaminosis D and 41 % had hypovitaminosis C. Plasma VDBP concentrations were in the normal range. The vitamin D load increased the average plasma 25(OH)D concentration to 116?\ ± 34 nmol/L (mean ± SD); the median concentration was 122 nmol/L (interquartile range 103-134); VDBP concentrations did not change. Final plasma 25(OH)D concentrations were subnormal (<75 nmol/L) for 13 % of the patients and sub-target (<120 nmol/L) for 44 % of them. In most cases, subnormal and sub-target 25(OH)D concentrations were attributable to obesity and/or a low baseline 25(OH)D concentration. Mood and symptom scores did not change significantly throughout the 3-week protocol.
CONCLUSION:
Hypovitaminosis D and C are very common in outpatients with advanced lung cancer. A vitamin D load of 20,000 IU per day for 14 days failed to achieve the target concentration in 44 % of the participants in this trial. These results suggest that a loading dose of 30,000 IU per day for 14 days would be safe and effective for patients who are obese or at risk of severe hypovitaminosis D. The preliminary nature of the study design, and the failure to achieve target 25(OH)D concentrations for a large proportion of the patients, do not allow any firm conclusion about the clinical effects of correcting hypovitaminosis D in this patient population. Nevertheless, no evidence was obtained that partial correction of hypovitaminosis D greatly improved mood, reduced distress or relieved cancer-related symptoms.

This trial was registered at clinicaltrials.gov as NCT01631526.
PMID: 27716304 DOI: 10.1186/s12937-016-0203-8

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