24 Vitamin D global guidelines for children, huge diversity – Sept 2022

Evaluation of the clinical practice guidelines and consensuses on calcium and vitamin D supplementation in healthy children using the Appraisal of Guidelines for Research and Evaluation II instrument and Reporting Items for Practice Guidelines in Healthcare statement

Front Nutr. 2022 Sep 27;9:984423.doi: 10.3389/fnut.2022.984423
Lanzhi He 1 2 , Pengxiang Zhou 1 3 , Xin Zhou 4 , Shuxia Tian 1 5 , Jing Han 1 6 , Suodi Zhai 1 3

Background: This study aimed to assess the methodological and reporting quality of the guidelines and consensus on calcium and vitamin D supplementation in healthy children, and the consistency of these recommendations.

Methods: A systematic search of relevant guideline websites and databases, including PubMed, Embase, CNKI, WangFang, and SinoMed, was undertaken from inception to April 7, 2021, by two independent reviewers who assessed the eligible guidelines using the validated Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) tools. Overall, the between-reviewer agreement was evaluated using an intra-class correlation coefficient.

Results: A total of 24 guidelines and consensuses from 2002 to 2022 were identified from China, the United States, Canada, France, Australia, New Zealand, Europe, and other countries and regions. These were of mixed quality, and scored poorly in the rigor of development, editorial independence, and applicability of the domains of AGREE II. Among the seven domains of the RIGHT checklist, domain one (basic information) had the highest reporting rate (69.3%), whereas domain five (review and quality assurance) had the lowest reporting rate (11.5%). The overall quality of the included guidelines and consensuses was low.
Only 12 guidelines were recommended, with modifications. The recommended calcium intake for children of different ages varies greatly (400-1,150 mg/day).
Among the included guidelines and consensuses, a vitamin D (VD) prevention dose of 400 IU/day in infants was generally considered safe, and 25-hydroxyvitamin-D [25(OH)D] levels of <20 ng/mL (50 nmol/L) or 20-30 ng/mL (50-75 nmol/L) indicated VD deficiency or insufficiency.
However, the recommended amount of VD for children of different age groups and risk strata differed considerably (400-4,000 IU/day or 10-100 μg/day). The choice of VD2 or VD3 supplements and sunlight exposure also differed across the guidelines and consensuses.

Conclusion: There is considerable variability in calcium and VD guidelines and consensus development methods in calcium and VD supplementation for healthy children. Therefore, efforts are necessary to strengthen the methodological rigor of guideline development and utilize the best available evidence
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Vitamin D Life - Consensus Vitamin D category contains

• French pediatric consensus: 30 – 60 ng of Vitamin D – Feb 2022
• 15 Clinical guidelines now recommend vitamin D – Nov 2021
• 34 clinical practice Vitamin D guidelines, huge diversity – Nov 2021
• Minimum National Vitamin D recommendations range from 200 to 4,000 IU – July 2021
• Controversies and consensus in Vitamin D – 3rd Conference Sept 2019
• Vitamin D Consensus 4,000 to 10,000 IU, upper limit 100 ng – Italy 2018
• 4,000 IU of Vitamin D is OK - 19 organizations agree - 2018 six say 10,000 IU is OK
• 17 reasons why are doctors reluctant to accept vitamin D
  • Doctors and medical communities appear to be poor audiences to convince that vitamin D is good

Vitamin D Life - Optimum category contains

The RDA is barely enough for the bones to survive.
   Need an optimal level for the body to thrive

Example pages

• Is 50 ng of vitamin D too high, just right, or not enough
• More than 30 ng of vitamin D is needed for many diseases - Feb 2022 has

• Saudi study defines normal Vitamin D level to be 50 to 70 ng (diabetes, etc.) - June 2020
• Need 40 to 60 ng of Vitamin D – 48 scientists call for action – 2015
• Vitamin D RDA of 600 IU is not enough - global RCT meta-analysis March 2019
• Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
• 4 X fewer visits to Dr. after getting high level of vitamin D (Interview with transcript) - Jan 3, 2022
• Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
• Sports benefits from up to 50 ng of Vitamin – meta-analysis - Nov 2012
• Vitamin D of 32 to 60 ng is needed before, during, and after pregnancy – Dec 2012
• Hypothesis by Vitamin D Life – Vitamin D levels are no longer limited by evolution
• Vitamin D Life pages with HIGH-DOSE in title 57 as of Feb 2022

Dose size needed per individual varies by 4X

1. Amount needed varies with weight
   perhaps 100 IU per 1 kg infant, 1000 IU per 10kg child
2. Preemies need much larger doses (45 studies as of Oct 2022
   10% of all births are preemies - yet recommendations rarely consider preemies
3. Amount needed varies with skin color
4. Amount needed varies with genes
5. Amount needed varies with heallth problem to be prevented
6. Amount needed varies with heallth problem to be treated
7. Amount needed increases if poor gut if not use a gut-friendly form

See related in Vitamin D Life

• Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013 2013
• Predict Vitamin D - also predicting how dose size each person needs
• Huge variation in response to vitamin D supplementation – personal vitamin D response index – Dec 2016
• Reasons for low response to vitamin D
• 10 reasons for poor response to Vitamin D (race, binding protein, etc.) – Nov 2017
• Is 50 ng of vitamin D too high, just right, or not enough
• Vitamin D home fortification- don't wait 100 years for your govt
• VITAMIN D: Public Shouldn’t Wait For Doctors To Usher In New “Golden Era” Of Preventive Medicine
• Recommend 100 IU of vitamin D per kg of infant - Poland July 2011

11+ CALL FOR ACTION in Vitamin D Life titles

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