The concurrent presence of fat in the gut enhances vitamin D absorption, but some vitamin D is absorbed even without dietary fat. The USPSTF evaluated 11 randomized clinical trials of vitamin D and/or calcium supplementation in a total of 51,419 healthy, community-dwelling adults aged 50 years and older who did not have osteoporosis, vitamin D deficiency, or prior fractures [75,76]. Levels of 1,25(OH)2D do not typically decrease until vitamin D deficiency is severe [2]. [, de Koning EJ, Lips P, Penninx BWJH, Elders PJM, Heijboer AC, den Heijer M, et al. [, Aloia JF, Rubinova R, Fazzari M, Islam S, Mikhail M, Ragolia L. Vitamin D and falls in older African American women: The PODA randomized clinical trial. Depression Arch Intern Med 2007;167:893-902. Studies show that 25(OH)D appears to be approximately five times more potent than the parent vitamin for raising serum 25(OH)D concentrations [17,20,21]. Vitamin D is required to maintain serum calcium concentration within the normal physiologic range for musculoskeletal health. Further research is needed to determine whether vitamin D inadequacy increases cancer risk, whether greater exposure to the nutrient can prevent cancer, and whether some individuals could have an increased risk of cancer because of their vitamin D status over time. women's college lacrosse workout program. Calcium plus vitamin D supplementation and the risk of breast cancer. [, Li X, Liu Y, Zheng Y, Wang P, Zhang Y. Both forms are well absorbed in the small intestine. Homebound individuals; people who wear long robes, dresses, or head coverings for religious reasons; and people with occupations that limit sun exposure are among the groups that are unlikely to obtain adequate amounts of vitamin D from sunlight [62]. JAMA 2006;296:2832-8. beef brisket wine pairing. Three trials conducted since that meta-analysis also found no effect of vitamin D supplementation on depressive symptoms. Vitamin D, Volume 2: Health, Disease and Therapeutics, Fourth Edition. However, some groups might need dietary supplements to meet their vitamin D requirements. [. Bone is constantly being remodeled. JAMA 2018;319:1592-9. [, Muller DC, Hodge AM, Fanidi A, Albanes D, Mai XM, Shu XO, et al. A randomized, double-blind, placebo-controlled trial. The impact of this form on vitamin D status is an emerging area of research. 290-2007-10055-I. Vitamin D is an important nutrient that aids a variety of functions in people of all ages, including bone health and metabolism. Excess amounts of vitamin D are toxic. However, higher serum 25(OH)D levels (at a cut point of 75 nmol/L [30 ng/mL]) were linked to a modestly higher risk of slow-growth prostate cancer and a more substantial lower risk of aggressive disease. Talk with your doctor or nurse about vitamin D at your child's next check-up if you have questions. Vitamin D status and weight loss: A systematic review and meta-analysis of randomized and nonrandomized controlled weight-loss trials. [, Sempos CT, Heijboer AC, Bikle DD, Bollerslev J, Bouillon R, Brannon PM, et al. Preventing multiple sclerosis: To (take) vitamin D or not to (take) vitamin D? Scientific Advisory Committee on Nutrition. Int J Obes (Lond) 2012;36:387-96. Vitamin D is essential for healthy bones and teeth. Nutr Rev 2019;77:890-902. One study included 1,119 men treated for prostate cancer whose plasma 25(OH)D levels were measured 4.9 to 8.6 years after their diagnosis. J Am Geriatr Soc 2019;67:1043-49. All adults should consume recommended amounts of vitamin D and calcium from foods and supplements if needed. Silva MC, Furlanetto TW. Prolonged exclusive breastfeeding without vitamin D supplementation can cause rickets in infants, and, in the United States, rickets is most common among breastfed Black infants and children [47]. No association between vitamin D supplementation and risk of colorectal adenomas or serrated polyps in a randomized trial. Cancer In contrast to 25(OH)D, circulating 1,25(OH)2D is generally not a good indicator of vitamin D status because it has a short half-life measured in hours, and serum levels are tightly regulated by parathyroid hormone, calcium, and phosphate [1]. Am J Epidemiol 2010;172:4-9. [, Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. [, Peterson L, Zeng X, Caufield-Noll CP, Schweitzer MA, Magnuson TH, Steele KE. A reverse J-shaped association between serum 25-hydroxyvitamin D and cardiovascular disease mortality: The CopD study. A dose-response analysis found that each 20 nmol/L [8 ng/mL] increase in 25(OH)D was associated with a 9% lower risk of both all-cause and prostate cancer-specific mortality. Lancet Diabetes Endocrinol 2018;6:834-5. A few studies have examined the effect of vitamin D supplementation on specific cancers. In 20132014, an estimated 3.2% of the U.S. adult population took supplements containing 100 mcg (4,000 IU) or more vitamin D [41]. In one Minnesota county, the incidence rate of rickets in children younger than 3 years in the decade beginning in 2000 was 24.1 per 100,000 [48]. The fifty bottles of 1000 IU vitamin D pills mentioned above would weigh in the ballpark of 2500 g. A typical vitamin D tablet weighs 150 mg and is >99.9% filling. [, Cashman KD, Seamans KM, Lucey AJ, Stocklin E, Weber P, Kiely M, Hill TR. 25-hydroxyvitamin D levels and risk of ischemic heart disease, myocardial infarction, and early death: Population-based study and meta-analyses of 18 and 17 studies. While some individuals may need vitamin D in supplemental . Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. The distinctive blue-black color which results from mixing starch and iodine is a simple and effective test. Other dairy products made from milk, such as cheese and ice cream, are not usually fortified in the United States or Canada. Another study randomized 100 community-dwelling men and women aged 60 years and older (most were White) with serum 25(OH)D levels of 50 nmol/L (20 ng/ml) or less to 800 IU vitamin D3 or placebo for 1 year [86]. However, the incidence of rickets is increasing globally, even in the United States and Europe, especially among immigrants from African, Middle-Eastern, and Asian countries [51]. Am J Clin Nutr 2017;106:481-90. However, as people ageand particularly in women during menopausebone breakdown rates overtake rates of bone building. Obtaining sufficient vitamin D from natural (nonfortified) food sources alone is difficult. Calcium plus vitamin D supplementation and the risk of fractures. Because vitamin D increases calcium absorption in the gastrointestinal tract, vitamin D toxicity results in marked hypercalcemia (total calcium greater than 11.1 mg/dL, beyond the normal range of 8.4 to 10.2 mg/dL), hypercalciuria, and high serum 25(OH)D levels (typically greater than 375 nmol/l [150 ng/mL]) [155]. [, Yao S, Kwan ML, Ergas IJ, Roh JM, Cheng T-YD, Hong C-C, et al. $12.99. The vitamin D reduced insulin resistance to a small but significant degree, especially in people taking more than 50 mcg (2,000 IU)/day who were vitamin D deficient at baseline, had good glycemic control, did not have obesity, and were of Middle Eastern ethnicity. Philadelphia: Lippincott Williams & Wilkins, 2014. [, Dawodu A, Tsang RC. Effects of atorvastatin on vitamin D levels in patients with acute ischemic heart disease. In a subsequent investigation for 4.9 years after the study's end, women who had taken the vitamin D and calcium supplements (many of whom continued to take them) had an 18% lower risk of in situ (noninvasive) breast cancer [100]. [, Moyer VA. Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive Services Task Force recommendation statement. Holick MF. Vitamin D is a fat-soluble vitamin produced by our body when our skin is exposed to ultraviolet rays from sunlight. Consumption of human milk alone does not ordinarily enable infants to meet vitamin D requirements, because it provides less than 0.6 to 2.0 mcg/L (25 to 78 IU/L) [1,56,57]. Elsevier, 2018. Vitamin D status in the United States remained stable in the decade between 20032004 and 20132014. Positive association between circulating 25-hydroxyvitamin D levels and prostate cancer risk: New findings from an updated meta-analysis. Vitamn D(tak vitamin D) je skupina v tucch rozpustnchsekosteroidodpovdnch za zven vstebvn vpnku, hokua fosforenanve stevech a za mnoho dalch biologickch ink. Vitamin D helps regulate the renin-angiotensin-aldosterone system (and thereby blood pressure), vascular cell growth, and inflammatory and fibrotic pathways [118]. [, Drinka PJ, Nolten WE. Office of Dietary Supplements, National Institutes of Health. Vitamin D supplementation and risk of toxicity in pediatrics: A review of current literature. Clinical trial evidence on older adults [, Logan VF, Gray AR, Peddie MC, Harper MJ, Houghton LA. Pages 41-78 in Feldman D, Pike JW, Bouillon R, Giovannucci E, Goltzman D, Hewison M, eds. b Some fortified foods and beverages are included. J Nutr 2016;146:855-6. N Engl J Med 2006;354:669-82. Nutritional rickets around the world: An update. [, Jorde R, Kubiak J. JAMA 2018;319:1600-12. [, Yetley EA. Serum vitamin D (25-hydroxyvitamin D) levels over 150 ng/ml (375 nmol/l) are a sign of vitamin D toxicity. Mushrooms are one of the best plant-based dietary sources of vitamin D outside of fortified milk alternatives. [, Lukert BP, Raisz LG. [, Shahvazi S, Soltani S, Ahmadi SM, de Souza RJ, Salehi-Abargouei A. Am J Clin Nutr 2012;95:1350-6. One recent clinical trial, for example, randomized 78 frail and near-frail adults aged 65 years and older to receive 20 mcg (800 IU) vitamin D3, 10 mcg 25(OH)D, or placebo daily for 6 months. In this procedure, part of the upper small intestine, where vitamin D is absorbed, is bypassed, and vitamin D that is mobilized into the bloodstream from fat stores might not raise 25(OH)D to adequate levels over time [66,67]. However, other, shorter (from 24 weeks to 5 years) clinical trials of vitamin D supplementation alone or with calcium in adults found greater risks of hypercalcemia and hypercalciuria, but not of kidney stones [162,163]. Nutrition 2015;31:421-9. The AAP also recommends 10 mcg (400 IU)/day supplemental vitamin D for all infants who are not breastfed and ingest less than 1,000 mL/day vitamin D-fortified formula or milk. Neurol Ther 2018;7:59-85. The USPSTF stated that, due to insufficient evidence, it was unable to assess the balance of benefits and harms of supplemental vitamin D to prevent cancer [117]. Nutr Metab Cardiovasc Dis 2016;26:663-73. Since 2014, however, several published studies and meta-analyses have found no relationship between 25(OH)D levels and prostate cancer risk [111,112]. [, Pathak K, Soares MJ, Calton EK, Zhao Y, Hallett J. Vitamin D supplementation and body weight status: A systematic review and meta-analysis of randomized controlled trials. Neurology 2012;79:2140-5. The Endocrine Society states, for example, that to maintain serum 25(OH)D levels above 75 nmol/L (30 ng/mL), adults might need at least 37.5 to 50 mcg (1,5002,000 IU)/day of supplemental vitamin D, and children and adolescents might need at least 25 mcg (1,000 IU)/day [11]. Vitamin D deficiency or insufficiency did not increase the risk of prostate cancer, and higher 25(OH)D concentrations were not associated with a lower risk. Osteoporosis is, in part, a long-term effect of calcium and/or vitamin D insufficiency, in contrast to rickets and osteomalacia, which result from vitamin D deficiency. In contrast, a meta-analysis of 6 trials in 49,282 older adults found that daily vitamin D (10 or 20 mcg [400 IU or 800 IU]/day) and calcium (800 or 1,200 mg/day) supplementation for a mean of 5.9 years reduced the risk of any fracture by 6% and of hip fracture by 16% [81]. 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