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Comparative analysis of nutritional guidelines for vitamin D

Key Points

  • Modern humans can expect to live a long life and therefore need to make a balanced choice between exposure to carcinogenic UVB radiation and maintaining an optimal vitamin D status

  • Most countries and many scientific societies have prepared or updated guidelines for vitamin D supplementation, with recommended dosages higher than before

  • All infants need a daily supplement of vitamin D (preferably 400 international units (IU) per day) during at least their first year of life; however, full implementation of this guideline is problematic in many countries around the world

  • A large consensus exists that nearly all elderly individuals need a vitamin D supplement; however, disagreement endures with regard to dosage or optimal concentration of 25-hydroxyvitamin D, and implementation is problematic

  • All children or adults lacking sufficient exposure to sunlight need a vitamin D supplement; however, no agreement has been reached regarding dosage, and implementation is poor

  • The WHO, supported by its member states, should implement a strategy to eradicate vitamin D (and calcium) deficiency-associated rickets

Abstract

Vitamin D is essential for calcium and bone homeostasis. Humans are largely dependent on UVB-radiation-induced photosynthesis of vitamin D, as few foods contain vitamin D. However, the same radiation that produces vitamin D is also carcinogenic, albeit with a long lag time, and causes DNA damage. In view of the increasing life expectancy, avoiding excessive sun exposure is prudent. Several groups of people have a shortfall between their requirements for vitamin D and their combined endogenous synthesis and intake from natural foods, and therefore need vitamin D supplementation. Governments and scientific societies are regularly updating their recommendations for intake of vitamin D, especially for groups that should (infants) or prefer to (especially elderly individuals) avoid direct sunlight. An overview of such guidelines is presented in this Review. A fairly large consensus exists that all infants should receive 400 international units (IU) (10 μg) daily during their first year of life and that elderly individuals should have access to vitamin D supplementation (at recommended dosages varying from 400 IU to 800 IU daily in most governmental guidelines but at higher dosages in other guidelines). All guidelines unanimously agree that serum levels of 25-hydroxyvitamin D (25OHD) <25 nmol/l (10 ng/ml) should be avoided at all ages. Children and adults who have limited sun exposure should receive vitamin D supplementation, but the recommended doses vary widely (from 200 IU to 2,000 IU daily), in line with disagreement regarding the minimal desirable serum concentration of 25OHD (which varies from 25 nmol/l to >100 nmol/l).

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Figure 1: Recommended daily dose of vitamin D supplementation in children.
Figure 2: Recommended daily dose of vitamin D supplementation in adults.
Figure 3: Recommendations for interpreting serum levels of 25OHD.

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Acknowledgements

The author thanks E. Van Herck for expert assistance.

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Correspondence to Roger Bouillon.

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The author has received small lectures fees from Amgen, Chugai, NovoNordisk and Teijin, and is co-inventor and co-owner of the Katholieke Universiteit (KU) Leuven (Belgium) patent on vitamin D analogues, which is licensed to Hybrigenix (France).

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Bouillon, R. Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol 13, 466–479 (2017). https://doi.org/10.1038/nrendo.2017.31

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