“Vitamin D — Minimum, maximum, optimum” Warsaw, Poland, Oct. 19-20, 2012
By William B. Grant, Ph.D., Sunlight, Nutrition, and Health Research Center, San Francisco, CA
A vitamin D conference, “Vitamin D — Minimum, maximum, optimum” was held in Warsaw, Poland, Oct. 19-20, 2012, to develop guidelines for vitamin D for Central and Eastern Europe. It was organized by Pawel Plodowski and Elzbieta Karczmarewicz. There were 550 attendees from Poland and other countries.
The international scientific committee included:
Belorussia (Ema Rudenka and Ludmila Yankovskaya)
Canada (Glenville Jones)
Germany (Berthold Koletzko)
Hungary (Tamas Decsi)
Israel (Yehuda Shoenfeld)
Poland (Twenty-seven members)
Switzerland (Heike Bischoff-Ferrari)
The Ukraine (Vladyslaw Povoroznyuk)
The UK (Graham Carter and Elina Hypponen)
The United Arab Emirates (Afrozul Haq)
The United States (Michael Holick and me)
Many other countries were represented including Australia, Finland, Kenya, Norway, Russia, and Scotland. Several dozen posters were also presented.
Non-skeletal effects including autoimmune diseases including multiple sclerosis and rheumatoid arthritis, cancer, diabetes mellitus, cardiovascular disease, chronic kidney disease, diabetes mellitus, immunity, musculoskeletal defects, rickets and adverse pregnancy outcomes were discussed. Adverse effects of high serum 25-hydroxyvitamin D [25(OH)D] were discussed with the conclusion that there is little verified evidence of harm below a daily intake of 10,000-20,000 IU/d vitamin D3 or serum 25(OH)D concentrations above 100 ng/ml. Graham Carter of DEQAS (Vitamin D External Quality Assessment Scheme) discussed the accuracy of 25(OH)D assays worldwide [Carter, 2012]. Papers by many speakers were published in two Polish journals, Standardy Medyczne/Pediatria (Standards of Medicine/Pediatrics) 2012;9(5): and Postepy Nauk Medycznych (Progress in Medicine) 2012;XXV(3). Henry Lahore is making many of the papers available at www.vitad.org in html format, which permits translation into any of 57 languages.
The committee included consideration of observational studies in addition to randomized controlled trials (RCTs), a significant contrast to the Institute of Medicine (IOM) which considered only RCTs and set the recommended 25(OH)D concentration at 20 ng/ml. Although Glenville Jones made the case for the IOM position here, that proposal received very little support from the scientific committee or others at the conference.
The primary recommendation was that the 25(OH)D concentration should be between 30-60 ng/ml. A paper by Lorenc et al. [2012] suggested the range be set at 30-80 ng/ml, but the conference decided there is a lack of evidence for higher concentrations for the time being. Committee members voted on many issues prior to the meeting, with the results presented at the end of the conference.
Given the care in assembling a scientific committee with a number of the world's leading vitamin D researchers, the recording of the presentations, the publication of speakers’ reviews, and the very large attendance, the recommendations from this conference should be considered author active and receive widespread acceptance. It will be interesting to see how the recommendations will be implemented.
As an aside, the reason that the IOM considered only RCTs is that they were following the principles of evidence based medicine. I prepared a paper for this conference that applied Hill's criteria for causality to vitamin D and cancer [Grant, 2012]. Many factors and studies can be considered with such criteria. You can read his original paper in its entirety.
For those interested in some of the short-comings of evidence based medicine, see Tarnished Gold, the Sickness of Evidence Based Medicine by Steve Hickey and Hilary Roberts, published in 2011. I believe that the Hill criteria are more suitable for public health recommendations than those relating evidence based medicine based primarily on RCTs
References
Carter G. 25-hydroxyvitamin D assays; the state we’re in. Standardy Medyczne/Pediatria. 2012;9:675-9.
Grant WB. A review of the evidence regarding the solar ultraviolet-B–vitamin D–cancer hypothesis. Standardy Medyczne/Pediatria. 2012;9:610-9.
Hill AB. The Environment and Disease: Association or Causation? Proceedings for the Royal Society of Medicine, 1965;58:295-300. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1898525
Lorenc RS, Karczmarewicz E, Kryskiewicz E, Pludowski P. Vitamin D provision and supplementation standards. Standardy Medyczne/Pediatria. 2012;9(5):595-604.
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Titles of papers presented at the conference
(mostly in Polish language)
- Vitamin D deficiency/insufficiency among residents of the Western Region of Belarus suffering from cardiovascular pathology
Snezhitskiy V.A., Yankovskaya L.V., Povorozniuk V.V., Balatskaya N.I., Lyalikov S.A., Kezhun L.V., Karaulko I.V. 578 - Vitamin D deficiency and insufficiency among Ukrainian population Povoroznyuk V.V., Balatska N.I., Muts V.Y., Klymovytsky F, Synenky O. 584
- To Screen or Not To Screen for 25-Hydroxyvitamin D: That is the D-lemma Michael F. Holick 590
- Vitamin D provision and supplementation standards Roman S. Lorenc, Elzbieta Karczmarewicz, Edyta Kryskiewicz, Pawet Ptudowski 595
- Vitamin D Safety: Its Mechanisms and Application Glenville Jones 605
- A review of the evidence regarding the solar ultraviolet-B-vitamin D-cancer hypothesis William B. Grant 610
- Disease associations of vitamin D in autoimmune disorders - prevention and therapy Howard Amital, Yehuda Shoenfeld 620
- Does Vitamin D influence the Development and the Course of Atopic Dermatitis? Zbigniew Samochocki 623
- Vitamin D and Multiple Sclerosis: mini review Katarzyna Kotulska, Matgorzata Bilska 626
- Vitamin D and rheumatoid arthritis Piotr Gtuszko 630
- Vitamin D in diabetes mellitus type 1, 2 and endocrinopathies in children Mieczystaw Szalecki, Monika Lech, Anna Malinowska 633
- Vitamin D in type 1 and type 2 diabetes in adulthood Waldemar Misiorowski 639
- Rickets updated Milan Bayer 645
- Vitamin D and musculoskeletal system Edward Czerwinski, Przemystaw Borowy, Anna Kumorek 649
- Vitamin D and intestinal malabsorption (cystic fibrosis, cholestasis, inflammatory bowel disease) Piotr Socha 655
- Vitamin D3, cardiovascular risk and arterial hypertension Anna Niemirska, Mieczystaw Litwin 659
- Vitamin D and chronic kidney disease during growth and maturation period Ryszard Grenda 665
- Vitamin D and urolithiasis Marek Tatataj 670
- 25-hydroxyvitamin D assays; the state we're in Graham D. Carter 675
- 3-epi-25(OH)D - a new metabolite, potential biological function, interference in laboratory assays
Grazyna Odrowqz-Sypniewska, Elzbieta Karczmarewicz, tukasz Paprotny, Pawet Ptudowski 680 - Vitamin D supplementation of pregnant and lactating women and their offspring Justyna Czech-Kowalska, Anna Dobrzanska 689
- Vitamin D supplementation in children and adolescents in Poland Danuta Chlebna-Sokot, Joanna Golec, Jolanta Karalus 701
- Vitamin D: Sources and Health Benefits Michael F. Holick 706
- Treatment of vitamin D deficiency in risk groups in adult patients - "a custom-made therapy" Ewa Marcinowska-Suchowierska 717