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14 Conservative Vitamin D recommendations in Ukraine – Jan 2024

Ukrainian Consensus on Diagnosis and Management of Vitamin D Deficiency in Adults

Nutrients 2024, 16, 270. https://doi.org/10.3390/ nu16020270
Nataliia Grygorieva * , Mykola Tronko 2, Volodymir Kovalenko 3, Serhiy Komisarenko 4 , Tetiana Tatarchuk 5, Ninel Dedukh 1, Mykola Veliky 4®, Serhiy Strafun 6C , Yulia Komisarenko 7C , Andrii Kalashnikov 6 , Valeria Orlenko 2, Volodymyr Pankiv 8 , Oleg Shvets 9 , Inna Gogunska 10 and Svitlana Regeda 11

Vitamin D deficiency (VDD) is a global problem, however, there were no Ukrainian guidelines devoted to its screening, prevention, and treatment, which became the reason for the Consensus creation. This article aimed to present the Consensus of Ukrainian experts devoted to VDD management. Following the creation of the multidisciplinary Consensus group, consent on the formation process, drafting and fine-tuning of key recommendations, and two rounds of voting, 14 final recommendations were successfully voted upon. Despite a recent decrease in VDD preva­lence in Ukraine, we recommend raising awareness regarding VDD's importance and improving the strategies for its decline. We recommend screening the serum 25-hydroxyvitamin D (25(OH)D) level in risk groups while maintaining a target concentration of 75-125 nmol/L (30-50 ng/mL). We recommend prophylactic cholecalciferol supplementation (800-2000 IU/d for youthful healthy subjects, and 3000-5000 IU/d for subjects from the risk groups). For a VDD treatment, we recom­mend a short-term administration of increased doses of cholecalciferol (4000-10,000 IU/d) with 25(OH)D levels monitored after 4-12 weeks of treatment, followed by the use of maintenance doses. Additionally, we recommend assessing serum 25(OH)D levels before antiosteoporotic treatment and providing vitamin D and calcium supplementation throughout the full course of the antiosteoporotic therapy.
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Methodology of Consensus Development

The Consensus creation was performed by the multidisciplinary expert group consist­ing of 15 leading Ukrainian scientists who have extensive experience in studying vitamin D and related topics. The 1st (N.G.), 6th (N.D.), and 11th (V.O.) authors of this article were members of the Task Force group who coordinated the experts' work. Based on careful analysis of the current literature with a high level of evidence, the Task Force members formulated 14 recommendations regarding VDD epidemiology, its screening, prevention, therapy, and monitoring. Following the agreement on the formation pro­cess of the Consensus between experts, the Delphi method, which is widely used for guideline creation [23,24], was chosen. The voting was performed on the SurveyMonkey® (https://www.surveymonkey.com, San Mateo, CA, USA) platform using 9-point grading of agreement with the recommendations (1—strongly disagree, 3—disagree, 5—neutral, 7—agree, and 9—strongly agree). Before voting, the experts agreed that Consensus would be achieved when more than 75% of the experts were in agreement with a recommendation on a voting scale of 7 points or higher. Otherwise, voting was to be repeated after the experts' discussion and modification of the recommendation.
Two rounds of voting regarding each recommendation were held. The final Consensus recommendations are presented in the text of the article with their justification based on the current evidence before each recommendation.
Full version of the Consensus was presented for the first time in "Pain, Joints, Spine" journal [25] in Ukrainian for wider use by the medical community in Ukraine.

9= strongly agree, 7= agree, 5 = neutral
1 Recommend more Vitamin D Awareness

[Consensus voting scale (CVS) (agreement level (AL)): 9 (100%)]: Taking into account the high prevalence of VDD and VDI in the adult population of Ukraine, we recommend increasing awareness in the community about the current situation and positive pleiotropic (skeletal and extra-skeletal) effects of vitamin D in the human body to increase timely screening, adequate prevention, and treatment of VDD.

2 Levels – deficiency to toxicity

[CVS (AL): 9 (80%), 7 (13%), 5 (7%)]: We recommend using a serum level of total 25(OH)D as a laboratory marker for the diagnosis of VDD with the following criteria for determination of vitamin D status:
VDD: <50 nmol/L (<20 ng/mL);
VDI: >50 nmol/L (>20 ng/mL) and <75 nmol/L (<30 ng/mL);
Sufficient level of vitamin D: 75-125 nmol/L (30-50 ng/mL);
Safe but not target level of vitamin D: >125-150 nmol/L (>50-60 ng/mL);
Zone of uncertainty with potential benefits or risks for vitamin D: >150-250 nmol/L (>60-100 ng/mL);
Excess/toxicity zone of vitamin D: >250 nmol/L (>100 ng/mL).

3 High-Risk groups should be tested

[CVS (AL): 9 (80%), 7 (20%)]: We do not recommend assessment of 25(OH)D serum level in adults without apparent indications, but we recommend it in persons from the following risk groups:

  • Persons with dark skin pigmentation;
  • Obese subjects (body mass index > 30 kg/m2);
  • Pregnant and lactating females;
  • Older subjects (>60 years old);
  • Subjects with bone or muscle pain;
  • Older subjects with a high risk of falls and a history of low trauma fractures;
  • Patients with metabolic bone diseases (osteoporosis and osteomalacia);
  • Immobilized persons and subjects during prolonged hospitalization;
  • Patients with liver or kidney failure;
  • Patients with endocrine disorders
    (I and II types of diabetes mellitus; hyperparathyroidism; thyroid diseases, etc.);
  • Subjects with malabsorption syndromes
    (inflammatory bowel diseases, cystic fibrosis, enteritis after radiation, conditions after bariatric surgery, etc.);
  • Patients with chronic autoimmune diseases (rheumatoid arthritis, systemic lupus erythemato­sus, multiple sclerosis, etc.);
  • Patients with malignancy;
  • Subjects with granulomatous diseases (sarcoidosis, tuberculosis, histoplasmosis, berylliosis, coccidioidomycosis, etc.);
  • Persons with prolonged use of drugs with a negative impact on vitamin D metabolism
    (gluco­corticoids, anticonvulsants, hypocholesterolemic, antifungal medications, AIDS drugs, etc.).
4 Consider relationships to other serum ingredients

[CVS (AL): 9 (80%), 7 (20%)]: In subjects with VDD, we recommend interpretation of 25(OH)D levels together with serum level of calcium, phosphorus, parathyroid hormone, alkaline phosphatase, magnesium, and creatinine.

5 Daily or weekly dosing

[CVS (AL): 9 (67.7%), 7 (33.3%)]: For the prevention and treatment of VDD we recommend the prescription of the oral form (daily or weekly) of cholecalciferol (vitamin D3); alternatively (vegetarianism, veganism, etc.), we recommend the oral form of ergocalciferol (vitamin D2).

6 800-2000 IU in winter

[CVS (AL): 9 (66.7%), 7 (26.7%), 5 (6.6%)]: For healthy adults without diseases and conditions affecting vitamin D metabolism in the human body, we recommend the prescription of cholecalciferol at a dose of 800-2000 IU/d (depending on body weight) from October to April due to a decreased level of endogenous vitamin D synthesis in the skin during this period.

7 Some need 800-2000 IU all year long

[CVS (AL): 9 (87%), 7 (13%)]: For the elderly, immobilized persons, and subjects with prolonged hospitalization with limited functional activity, we recommend the prescription of cholecalciferol in the dose of 800-2000 IU/d during the year.

8 800-2,000 IU during pregnancy

[CVS (AL): 9 (87%), 7 (13%)]: For females planning a pregnancy we recommend the prescription of cholecalciferol at a dose of 800-2000 IU/d and continue cholecalciferol use throughout pregnancy and lactation.

9 Some conditions need 3,000 to 5,000 IU

[CVS (AL): 9 (80%), 7 (13%), 5 (7%)]: In the patients with diseases or conditions affecting vitamin D metabolism in the human body, we recommend the individual selection of a cholecalciferol prophylactic dose (3000-5000 IU/d) with achievement and maintenance of optimal 25(OH)D serum levels.

10 Néed 4,000 -7,000 IU if have condition and <20 ng of Vitamin D

[CVS (AL): 9 (66.7%), 7 (26.7%), 5 (6.6%)]: For subjects with confirmed VDD and without diseases or conditions affecting vitamin D metabolism, we recommend starting the treatment with higher doses (4000-7000 IU/d) of cholecalciferol compared to the prophylactic doses recommended for the overall population.

[CVS (AL): 9 (66.7%), 7 (26.7%), 5 (6.6%)]: For the subjects with confirmed VDD and diseases and conditions that affect vitamin D metabolism, we recommend starting the treatment using higher cholecalciferol doses (up to 10,000 IU/d) compared to doses recommended for healthy adults without additional risk factors.

12 If <20 ng, treat till >30 ng, then drop back to 800-2000 IU

[CVS (AL): 9 (73%), 7 (20%), 5 (7%)]: We recommend initiating the treatment of VDD at the serum 25(OH)D levels less than 50 nmol/L (<20 ng/mL). The treatment duration should be 4-12 weeks depending on the severity of VDD and other risk factors and should be continued until the target serum 25(OH)D level (75-125 nmol/L or 30-50 ng/mL) is reached. Afterward, we recommend using lower doses of cholecalciferol (800-2000 lU/d) to maintain optimal vitamin D status.

13 Only use active vitamin D for chronic hyperparathyroidism or CKD Bone problems

[CVS (AL): 9 (60%), 7 (27%), 5 (13%)]: We do not recommend active vitamin D metabolites for the treatment of VDD in subjects without diseases and conditions that affect vitamin D metabolism, however, we recommend them for the treatment of VDD in patients with chronic hyperparathyroidism or bone and mineral disorders associated with CKD.

14 Osteroporosis

[CVS (AL): 9 (66.7%), 7 (26.7%), 5 (6.6%)]: For patients with osteoporosis and its complications we recommend determining the serum 25(OH)D level before initiating antiosteoporotic therapy to improve its effectiveness and safety profile.

Conclusions

Despite a recently decreased frequency of VDD in the Ukrainian population, the expert group recommends raising awareness among the medical and public community regarding VDD's importance and improving the strategies for its decline. We recommend screening the serum total 25(OH)D level in separate risk groups while maintaining a goal concentra­tion of 75-125 nmol/L (30-50 ng/mL). Also, we recommend prophylactic cholecalciferol prescription (800-2000 IU/d for young, healthy subjects, and 3000-5000 IU/d for persons with diseases or conditions with negative effects on vitamin D metabolism). For the VDD treatment, the expert group recommends the short-term administration of higher cholecal­ciferol doses (4000-10,000 IU/d) with monitoring of 25(OH)D levels after 4-12 weeks of treatment, followed by the use of maintenance doses. Furthermore, we recommend the assessment of serum 25(OH)D levels before initiating therapy in patients with osteoporo­sis and providing a prescription of cholecalciferol (800-2000 IU/d) in combination with calcium (1000 mg/d of elemental calcium) throughout the full course of antiosteoporotic treatment (Table A1).

108+ Vitamin D Life pages have RECOMMEND in the title

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Items found: 108
Title Modified
Nutrient consumption – only 7% of recommended DRV of Vitamin D (German Children in this case) – Jan 2024 07 Feb, 2024
14 Conservative Vitamin D recommendations in Ukraine – Jan 2024 24 Jan, 2024
Vitamin D recommended for infants by 98% of Belgian pediatricians - 2024 04 Jan, 2024
Canadian Vitamin D recommendations not updated in 13 years - March 2023 18 Mar, 2023
Many pregnant women are deficient when taking the recommended amount of Vitamin D – Jan 2023 24 Jan, 2023
50,000 IU Vitamin D weekly is often recommended 30 Nov, 2022
Another Osteoporosis group fails to recommend Vitamin D, etc. (perhaps fears losing business) - Oct 2022 06 Oct, 2022
US children not getting enough vitamin D, recommends free milks and perhaps 3X increased fortification – Sept 2022 02 Oct, 2022
Florida A.G. recommends Vitamin D, Zinc, Quercetin, etc. to reduce risk of COVID - Dec 12, 2021 13 Dec, 2021
Cystic Fibrosis vitamin D recommendations are not enough - Dec 2021 09 Dec, 2021
15 Clinical guidelines now recommend vitamin D – Nov 2021 03 Nov, 2021
French recommended 200,000 IU of Vitamin D to stop COVID-19 - Jan 2021 24 Oct, 2021
Multiple Sclerosis treated by Vitamin D, recommends investigating high dose Coimbra - Oct 2021 07 Oct, 2021
Vitamin D recommended to fight COVID-19 by 2 groups – Dec 7, 2020 30 Sep, 2021
Wide variation in vitamin D recommendations (in this case, pregnant in Australia) – Aug 2021 23 Aug, 2021
Minimum National Vitamin D recommendations range from 200 to 4,000 IU – July 2021 15 Jul, 2021
Annweiler recommendations for Vitamin D for COVID-19, etc. often start with 200,000 - June 2021 22 Jun, 2021
Consensus recommends at least 20 ng of Vitamin D for childhood cancer (not nearly enough) – June 2021 08 Jun, 2021
Recommends vitamin D after hip fracture ( but not enough and no-bone building co-factors) – May 2021 21 May, 2021
Expert panel recommends Vitamin D for COVID-19, but fails recommend how much – May 2021 17 May, 2021
Pregnancy recommendations – huge differences in Vitamin D, Mg, iron, Iodine, DHA, etc – April 2021 13 Apr, 2021
Ireland - Vitamin D often less than 20 ng, recommends only 800 IU - April 2021 09 Apr, 2021
Vitamin D recommendations for COVID-19 – Spanish Geriatrics Society – March 2021 04 Mar, 2021
Vitamin D to prevent COVID- strange trial recommendations from the UK – Jan 2021 18 Jan, 2021
Vitamin D and COVID-19: Video and PDF by Dr. Grant (includes recommendations)- Nov 25, 2020 26 Nov, 2020
Vitamin D should fight COVID-19 (but Irish Consortium recommends only 1,000 IU) – Nov 21, 2020 21 Nov, 2020
French National Academy recommended 100,000 IU of Vitamin D to elderly to fight COVID-19 - May 2020 08 Nov, 2020
COVID-19 was killing dark-skinned doctors, then they got a Vitamin D recommendation 28 Oct, 2020
1,200 IU of Vitamin D now recommended if you consume 3,000 calories daily (FDA) – 2018 06 Oct, 2020
WHO recommends zero vitamin D during pregnancy, rest of the world disagrees – 2018, 2020 16 Aug, 2020
Weekly oral Vitamin D recommended before surgery (Bariatric in this case) – RCT June 2019 19 Jul, 2020
Vitamin D recommended for COVID-19 – yet another study – July 17, 2020 18 Jul, 2020
Vitamin D Recommendations around the world - IU and ng 12 May, 2020
Vitamin D should prevent COVID-19 (recommended dose takes 3 months to raise levels) - April 2020 03 Apr, 2020
A paltry 400 IU Vitamin D recommended during pregnancy - NICE UK Dec 2018 17 Dec, 2018
Alaska recommends more vitamin D: Infancy 800 IU, Pregnancy 1400 IU (avoid rickets) Sept 2018 15 Sep, 2018
Global Vitamin D recommendations - summer 2018 30 Aug, 2018
Vitamin D has been recommended for Cystic Fibrosis – a small dose helps a little – Aug 2018 11 Aug, 2018
Recommended increasing vitamin D for space flight – NASA Sept 2013 24 Jul, 2018
Less than half of health providers recommend 600 to 1000 IU of vitamin D (age 1-18) – May 2018 25 May, 2018
Children need vitamin D - good global overview, poor recommendations for Italian children - May 2018 16 May, 2018
Vitamin D recommendations by Italian Endocrinologists – 40 ng if pregnant, 30 ng if high risk – April 2018 27 Apr, 2018
Healthy pigs get at least 2 X more vitamin D than the govt recommends 01 Mar, 2018
Pregnancies helped by Vitamin D – recommendations and trials underway – review Dec 2017 02 Jan, 2018
IoM admits math mistake was made in 2009 in estimating Vitamin D, but will not change their recommendations – Nov 2017 22 Nov, 2017
Review of vitamin D recommendations around the world – April 2017 22 Nov, 2017
Turkey recommended 1200 IU Vitamin D during pregnancy, only 1 in 7 took more than 1,000 IU – Sept 2017 14 Sep, 2017
Canadian Paediatric Society – vitamin D recommendations unchanged since 2007 – Jan 2017 21 Aug, 2017
Infant-Child Vitamin D recommendations from NZ (many are wrong) – Feb 2017 13 Jul, 2017
Endocrine Society recommend higher vitamin D levels – June 2011 14 Apr, 2017
Do not expect a doctor to recommend a pill which will eliminate his job (vitamin D) 27 Feb, 2017
Review of the Benefits of Vitamin D and Recommendations – Jan 2017 09 Jan, 2017
Osteoporosis helped by Vitamin D, still not willing to recommend exact dose size – Nov 2016 23 Nov, 2016
Only 1 in 5 toddlers get recommended minimum vitamin D – Sept 2016 16 Sep, 2016
Calcitriol (active Vitamin D) recommended after kidney transplant – March 2014 28 Apr, 2016
Animals get a lot more vitamin D than minimum recommended for humans – 2016 31 Mar, 2016
Vitamin D recommendations barely help even bones – March 2016 23 Mar, 2016
Vitamin D recommendations should reduce Rickets (but not much else) - March 2016 23 Mar, 2016
Vitamin D Recommendations during Pregnancy, Lactation and Early Infancy – Nov 2011 14 Mar, 2016
Vitamin D deficiency and childhood obesity: interactions, implications, and recommendations (5,000 IU) – Feb 2016 05 Feb, 2016
Recommend 100 IU of vitamin D per kg of infant - Poland July 2011 04 Feb, 2016
World Health Organization considering new pregnancy Vitamin D recommendations - behind paywall Nov 2015 11 Nov, 2015
Chronic kidney with low vitamin D: 90 percent of pediatric nephrologists now recommend more D – Feb 2013 27 Oct, 2015
2,000 IU vitamin D recommended for pediatric rheumatology – May 2015 29 Sep, 2015
Pediatric rheumatologists – recommend 2,000 IU vitamin D supplementation – May 2015 29 Sep, 2015
Osteoporosis groups hide their vitamin D recommendations behind 40 dollar paywall – May 2015 03 May, 2015
Osteoporosis groups hide their synthetic vitamin D recommendations behind 40 dollar paywall – May 2015 03 May, 2015
Autism cured in a child with Vitamin D, Dr. Cannell comments and cofactor recommendations – March 2015 27 Mar, 2015
Cystic Fibrosis Foundation recommends vitamin D dose, patients are taking even more – March 2015 17 Mar, 2015
HIV children in UK – Vitamin D recommendations – Feb 2014 22 Jan, 2015
Polish conference recommended vitamin D levels from 30 to 60 ng – Oct 2012 30 Dec, 2014
Shape Magazine recommends a max of 1,000 IU of vitamin D (wrong) - Dec 2014 23 Dec, 2014
Recommended levels of vitamins and minerals - history RDA DRI 23 Dec, 2014
Child Bone health – (incorrect) recommendations by US Pediatric and Bone Health groups – Sept 2014 30 Sep, 2014
Vitamin D recommended for all animals (FEEDAP does not say how much) – Feb 2014 30 Sep, 2014
Child Bone health – recommendations by US Pediatric and Bone Health groups – Sept 2014 29 Sep, 2014
Institute of Medicine (which recommended low vitamin D) has many conflicts of interest – July 2014 15 Jul, 2014
There have been no studies of vitamin D testing resulting in less disease – so task force recommends that there be no testing June 2014 24 Jun, 2014
Cancer Council of Australia recommends 30 minutes of daily sunshine – June 2014 04 Jun, 2014
Tasmania Vitamin D official recommendation 20 up to 200 ng – March 2014 20 Mar, 2014
Governments recommend a small amount of vitamin D, people consume even less – March 2014 04 Mar, 2014
Task force for senior fall prevention finally recommends 800 IU of vitamin D – May 2012 16 Dec, 2013
5,000 IU recommended by Vitamin D Council - Dec 2013 16 Dec, 2013
Review of Vitamin D recommendations and knowledge – Oct 2013 28 Nov, 2013
HIV – recommend 100,000 IU vitamin D monthly to get levels 30 ng – May 2013 18 Oct, 2013
Japanese recommendations without RDA: Vitamin D about 200 IU, Vitamin K about 60 ug– May 2013 08 May, 2013
European Osteo group recommends 20-50 ng of vitamin D – Jan 2013 17 Jan, 2013
Most German skin cancer doctors recommend both sunscreen and vitamin D – Dec 2012 12 Dec, 2012
Nordic countries considering raising vitamin D to US recommended levels – Dec 2012 02 Dec, 2012
French Society of Paediatics Vitamin D recommendations – Jan 2012 15 Nov, 2012
Chief UK Medical Officer recommends only 280 IU for children - Jan 2011 12 Nov, 2012
Variety of vitamin D loading dose recommendations in the UK - 2011 28 Oct, 2012
Review of Parkinson's disease and vitamin D recommends use of active form – Aug 2012 29 Aug, 2012
Poland Vitamin D recommendations - 2009 23 Jun, 2012
OBGYN College in UK still recommends only 400 IU during pregnancy – Jan 2012 18 Jun, 2012
Review of vitamin D recommendations – April 2012 01 May, 2012
Piglets get more vitamin D than recommended by the govt, for piglets or humans – March 2012 27 Mar, 2012
When will it become a crime to fail to recommend or provide vitamin D 17 Mar, 2012
Vitamin D level recommendations - Bosomworth Jan 2011 06 Jan, 2012
Grade A recommendations for vitamin D - May 2009 07 Nov, 2011
NLM Vitamin D recommendations and interactions – Jan 2011 21 Oct, 2011
25 experts recommend vitamin D level of min 30 ng – Nov 2009 24 Sep, 2011
100 IU increases 1 ng vitamin D – recommend 3000 IU – Book 2011 27 Aug, 2011
Why the IOM Recommendations for Vitamin D Are Deficient – Mar 2011 26 Feb, 2011
Only 18 percent of Swedes got recommended amount of vitamin D – Feb 2011 09 Feb, 2011
Experts Recommend 10000 IU Upper Limit Vitamin D – 2007 17 Oct, 2010
Vitamin D books recommended by VitaminDResearch today 02 Jul, 2010
36% of pediatricians recommend adding vitamin D – Nov 2009 30 May, 2010



14 Conservative Vitamin D recommendations in Ukraine – Jan 2024        
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