34 clinical practice Vitamin D guidelines, huge diversity

Updated page 15 Clinical guidelines now recommend vitamin D – Nov 2021

Vitamin D recommendations in clinical guidelines:

A systematic review, quality evaluation and analysis of potential predictors - Sept 2021

Int J Clin Pract. 2021 Sep 6;e14805. doi: 10.1111/ijcp.14805

D Fraile Navarro 1 2 3, A López-García-Franco 1 2, E Niño de Guzmán 4, M Rabassa 4, R Zamanillo Campos 5 6 7, H Pardo-Hernandez 8 9, I Ricci-Cabello 5 7 9, C Canelo-Aybar 10 11, J F Meneses-Echavez 12 13, J J Yepes-Nuñez 14 15, J Kuindersma 16, I Gich-Saladich 4 9 17, P Alonso-Coello 4 9

Background: Vitamin D has been widely promoted for bone health through supplementation and fortification of the general adult population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and explore predictive factors for their direction and strength.

Methods: We searched three databases and two guideline repositories from 2010 onwards. We performed a descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association between direction and strength of recommendations, AGREE II domains' scores and pre-specified characteristics.

Results: We included 34 guidelines,

• 44.1% recommended,

• 26.5% suggested, and

• 29.4% did not recommend vitamin D supplementation.

Guidelines that scored higher for "editorial independence" and "overall quality score" were less likely to recommend or suggest vitamin D supplementation (median 68.8 vs. 35.4; p=0.001), and median 58.3 vs. 37.5; p=0.02). Guidance produced by government organizations and those that reported source of funding were associated with higher AGREE II scores. Unclear role of source of funding was associated with recommending or suggesting vitamin D supplementation (p=0.034). Editorial independence was an independent predictor for recommending or suggesting vitamin D supplementation (OR 1.09; CI95% 1.02 to 1.16; p=0.006).

Conclusions: Policymakers, clinicians and patients should be aware that lower quality guidelines, and those reporting conflicts of interest are more likely to promote vitamin D supplementation. Guideline organizations should improve the quality of their recommendations' development and the management of conflicts of interest. Users and editors should be aware of these findings when using and appraising guidelines.

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Dose size needed by an individual varies a lot

1. Amount needed varies with obesity

2. Amount needed varies with age

   • Small bodies need small doses

   • Seniors need more - indoors a lot and poor UVB adsorption

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 when not use a gut-friendly form

• Reasons for low response to vitamin D - many of the above + others

• Is 50 ng of vitamin D too high, just right, or not enough

• Optimum category listing has items along with related searches

Dose size needed has increasing much faster than any consensus can ever be made

Vitamin D levels have been crashing since 1995 (Polish Children, Elite Military, etc)

43 reasons for Vitamin D deficiency

Incidence of 22 health problems related to vitamin D have doubled in a decade

Lack of any consensus

• Minimum National Vitamin D recommendations range from 200 to 4,000 IU – July 2021

• Consensus: Upper Limit of daily Vitamin D intake is still 4,000 IU (if you do not reduce Calcium) – Aug 2020

• Controversies and consensus in Vitamin D – 3rd Conference Sept 2019

30 most-recently changed items in Vitamin D Life Consensus Vitamin D

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Vitamin D Life pages with RECOMMEND in title (119 as of Sept 2021)

This list is automatically updated

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