Comparative analysis of nutritional guidelines for vitamin D
Nature Reviews Endocrinology (2017), Published online 07 April 2017
doi:10.1038/nrendo.2017.31
Roger Bouillon
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Red = severe deficiency, must be corrected
Orange = mild deficiency, should be corrected
Green = sufficient, no more is needed
(Optimal is not shown)
Endocrine Society Recommentations
IOF = International Osteoporosis Foundation  IOF Position statement of 2010 is on VitaminDWiki
AGS = American Geriatric Society Recommendations
Number of countries recommending each dose for infants and children/youths
age 0-1 age 4-18
Most countries continue to believe that only low levels of vitamin D are needed, so they only recommend low doses of vitamin D
- Reasons for low response to vitamin D
- Is 50 ng of vitamin D too high, just right, or not enough
- Supplementing Vitamin D
- Optimal vitamin D supplementation strategies (D3 - weekly or monthly) – Feb 2017 by Bouillion
He failed to mention:
The need to check for adverse reactions before supplementation
Vitamin D is needed by adults (he only mentions children and seniors)
Starting with loading dose - achieving a good level in weeks instead of months
Injections – which can be made less often than monthly
Increased dose needed for obese, darker skins, diseases which consume Vit. D, etc.
Other forms of Vitamin D for those with gut problems
Target level to be achieved (30, 40, or 50 nanograms/mL)
Cofactors to be adjusted (Increase Magnesium, Omega-3, Vitamin K2; Decrease Calcium)
Genes which limit the Vitamin D which gets to the cells
Infant-Child category starts with
- No consensus on MINIMUM International Units (IU) for healthy infant of normal weight
- 400 IU Vitamin D is no longer enough
Was OK in the past century, but D levels have been dropping for a great many reasons.
FDA doubles the amount of vitamin D permitted in milk – July 2016 - No consensus: range is 600 to 1600 IU – based on many randomized controlled trials
- Review of 400 IU to 2000 IU daily and higher if non-daily
- Fewer pre-infants were vitamin D deficient when they got 800 IU – RCT Feb 2014
- 1600 IU was the conclusion of three JAMA studies
1000 IU recommended in France and Finland – 2013 - appears to be a good level - 5X less mite allergy after add vitamin D
- Child bone fractures with low vitamin D were 55X more likely to need surgery
- 75 % of SIDS had low vitamin D
- Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
- Infants have gotten free 400 IU of vitamin D in Turkey since 2005, More for longer would be even better – Feb 2022
- Preemies should have vitamin D supplements – reaching an agreement – April 2021
- Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021
Having a good level of vitamin D cuts in half the amount of:
- Asthma, Chronic illness, Doctor visits, Allergies, infection
Respiratory Tract Infection, Growing pains, Bed wetting
Need even more IUs of vitamin D to get a good level if;
- Have little vitamin D: premie, twin, mother did not get much sun access
- Get little vitamin D: dark skin, little access to sun
- Vitamin D is consumed faster than normal due to sickness
- Older (need at least 100 IU/kilogram, far more if obese)
- Not get any vitamin D from formula (breast fed) or (fortified) milk
Note – formula does not even provide 400 IU of vitamin D daily
Infants-Children need Vitamin D
- Sun is great – well known for 1,000’s of years.
US govt (1934) even said infants should be out in the sun - One country recommended 2,000 IU daily for decades – with no known problems
- As with adults, infants and children can have loading doses and rarely need tests
- Daily dose appears to be best, but monthly seems OK
- Vitamin D is typically given to infants in the form of drops
big difference in taste between brands
can also use water-soluable form of vitamin D in milk, food, juice, - Infants have evolved to get a big boost of vitamin D immediately after birth
Colostrum has 3X more vitamin D than breast milk - provided the mother has any vitamin D to spare - 100 IU per kg of infant July 2011, Poland etc.
More than 100 IU/kg is probably better 854 items in the category Infant/Child See also - 34 pages in VitaminDWiki had BREASTFE*in title as of Jan 2022
- "BIRTH DEFECTS" 172 items as of July 2016
- Stunting OR “low birth weight” OR LBW OR preemie OR preemies OR preterm 1940 items as of Oct 2018
- 153 VitaminDWiki pages contained PRETERM or PREEMIE in title as of Nov 2024
- "SUDDEN INFANT DEATH" OR SIDS 214 items as of Dec 2020
- Overview of Rickets and Vitamin D
- Youth category listing has
175 items along with related searches - Down's syndrome and low vitamin D - several studies
- Rett syndrome associated with low vitamin D, treated by Omega-3
Vitamin D is essential for calcium and bone homeostasis. Humans are largely dependent on UVB-radiation-induced photosynthesis of vitamin D, as few foods contain vitamin D. However, the same radiation that produces vitamin D is also carcinogenic, albeit with a long lag time, and causes DNA damage. In view of the increasing life expectancy, avoiding excessive sun exposure is prudent. Several groups of people have a shortfall between their requirements for vitamin D and their combined endogenous synthesis and intake from natural foods, and therefore need vitamin D supplementation. Governments and scientific societies are regularly updating their recommendations for intake of vitamin D, especially for groups that should (infants) or prefer to (especially elderly individuals) avoid direct sunlight. An overview of such guidelines is presented in this Review.A fairly large consensus exists that all infants should receive 400 international units (IU) (10 μg) daily during their first year of life and that elderly individuals should have access to vitamin D supplementation (at recommended dosages varying from 400 IU to 800 IU daily in most governmental guidelines but at higher dosages in other guidelines).
All guidelines unanimously agree that serum levels of 25-hydroxyvitamin D (25OHD) <25 nmol/l (10 ng/ml) should be avoided at all ages. Children and adults who have limited sun exposure should receive vitamin D supplementation, but the recommended doses vary widely (from 200 IU to 2,000 IU daily), in line with disagreement regarding the minimal desirable serum concentration of 25OHD (which varies from 25 nmol/l to >100 nmol/l).
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