Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Official recommendations for vitamin D through the life stages in developed countries

Abstract

Inadequate vitamin D nutritional status is prevalent worldwide and has been associated with autoimmune disorders, heart disease, deadly cancers, insulin resistance, inflammation, neurological disorders, adverse outcomes in pregnancy, and increased risk for mortality. Expert recommendations for vitamin D intake differ between governmental agencies and practice guidelines from medical societies due to differences in the definition of vitamin D deficiency, insufficiency and sufficiency based on serum 25-hydroxyvitamin D [25(OH)D] concentrations. In addition, separate health promotion bodies also provide targeted recommendations for the prevention of specific disorders such as reducing risk for developing some cancers and autoimmune diseases. We review and provide perspectives regarding various recommendations from the Institute of Medicine (IOM, United States) and Health Canada, the European Food Safety Authority (EFSA), the Scientific Advisory Committee on Nutrition (SACN; United Kingdom), the World Health Organization, the Endocrine Society and other expert groups by life stage as a guide intended for clinician use.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academies Press; 2011.

  2. Scientific Advisory Committee on Nutrition (SACN). Vitamin D and health. 2016. https://www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition.

  3. European Food Safety Authority (EFSA). Dietary reference values for vitamin D. EFSA Panel on Dietetic Products, Nutrition and Allergies. 2016. https://efsa.onlinelibrary.wiley.com/. https://doi.org/10.2903/j.efsa.2016.4547.

  4. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30.

    Article  CAS  PubMed  Google Scholar 

  5. Heaney RP. Toward a physiological referent for the vitamin D requirement. J Endocrinol Invest. 2014;37:1127–30.

    Article  CAS  PubMed  Google Scholar 

  6. Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N. Engl J Med. 2019;380:33–44.

    Article  CAS  PubMed  Google Scholar 

  7. Pittas AG, Dawson-Hughes B, Sheehan P, Ware JH, Knowler WC, Aroda VR, et al. Vitamin D supplementation and prevention of type 2 diabetes. N. Engl J Med. 2019;381:520–30.

    Article  CAS  PubMed  Google Scholar 

  8. Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK. Effect of high-dose vitamin d supplementation on volumetric bone density and bone strength: a randomized clinical trial. JAMA. 2019;322:736–45.

    Article  CAS  PubMed  Google Scholar 

  9. Multiple Sclerosis Society of Canada. Vitamin D recommendations (healthcare providers and scientific community). 2018. https://mssociety.ca/library/document/Vka6RXcnOizNm9sIwuWvroxejlhLqTJ8/original.pdf.

  10. Canadian Cancer Society. https://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-healthy-choices/eat-well/should-i-take-a-vitamin-d-supplement/?region=on.

  11. Muscogiuri G, Altieri B, Annweiler C, Balercia G, Pal HB, Boucher BJ, et al. Vitamin D: past, present and future perspectives in the prevention of chronic diseases. Eur J Clin Nutr. 2018;72:1221–5.

    Article  PubMed  Google Scholar 

  12. Manson JE, Bassuk SS, Buring JE, VITAL Research Group. Principal results of the VITamin D and OmegA-3 Trial (VITAL) and updated meta-analyses of relevant vitamin D trials. J Steroid Biochem Mol Biol. 2019;198:105522.

    Article  PubMed  Google Scholar 

  13. Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, rancomized clinical trial of safety and effectiveness. J Bone Min Res. 2011;26:2341–57.

    Article  CAS  Google Scholar 

  14. Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O’Beirne M, Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ. 2013;346:f1169.

    Article  Google Scholar 

  15. Cyprian F, Lefkou E, Varoudi K, Girardi G. Immunomodulatory effects of vitamin d in pregnancy and beyond. Front Immunol. 2019;10:2739.

    Article  CAS  PubMed  Google Scholar 

  16. Wagner CL, Baggerly C, McDonnell S, Baggerly KA, French CB, Baggerly L, et al. Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009−2011 rates. J Steroid Biochem Mol Biol. 2016;155:245–51.

    Article  CAS  PubMed  Google Scholar 

  17. Rodrigues MRK, Lima SAM, Mazeto GMFDS, Calderon IMP, Magalhães CG, Ferraz GAR, et al. Efficacy of vitamin D supplementation in gestational diabetes mellitus: systematic review and meta-analysis of randomized trials. PLoS ONE. 2019;14:e0213006.

    Article  CAS  PubMed  Google Scholar 

  18. Serrano-Díaz NC, Gamboa-Delgado EM, Domínguez-Urrego CL, Vesga-Varela AL, Serrano-Gómez SE, Quintero-Lesmes DC. Vitamin D and risk of preeclampsia: a systematic review and meta-analysis. Biomedica. 2018;38:43–53.

    Article  PubMed  Google Scholar 

  19. Palacios C, Kostiuk LK, Pena-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2019;7:CD008873.

    Google Scholar 

  20. McDonnell SL, Baggerly KA, Baggerly CA, Aliano JL, French CB, Baggerly LL, et al. Maternal 25(OH)D concentrations ≥40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center. PLoS ONE. 2017;12:e0180483.

    Article  PubMed  Google Scholar 

  21. Sablok A, Batra A, Thariani K, Batra A, Bharti R, Aggarwal AR, et al. 2015. Supplementation of vitamin D in pregnancy and its correlation with fetomaternal outcome. Clin Endocrinol. 2015;83:536e541.

    Article  Google Scholar 

  22. Mojibian M, Soheilykhah S, Fallah Zadeh MA, Jannati Moghadam M. The effects of vitamin D supplementation on maternal and neonatal outcome: a randomized clinical trial. Iran J Reprod Med. 2015;13:687e696.

    Google Scholar 

  23. Rostami M, Therani FR, Simbar M, Bidhendi R, Minooee S, Hollis BW, et al. Effectiveness of prenatal vitamin D deficiency screening and treatment program: a stratified randomized field trial. J Clin Endocrinol Metab. 2018;103:2936–48.

    Article  PubMed  Google Scholar 

  24. De-Regil LM, Palacis C, Lombardo LK, Pena-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2016;14:CD008873.

  25. Zhang Q, Cheng Y, He M, Li T, Ma Z, Cheng H. Effect of various doses of vitamin D supplementation on pregnant women with gestational diabetes mellitus: a randomized controlled trial. Exp Ther Med. 2016;12:1889e1895.

    Google Scholar 

  26. Hossain N, Kanani FH, Ramzan S, Kausar R, Ayaz S, Khanani R, et al. Obstetric and neonatal outcomes of maternal vitamin D supplementation: results of an open-label, randomized controlled trial of antenatal vitamin D supplementation in Pakistani women. J Clin Endocrinol Metab. 2014;99:2448–55.

    Article  CAS  PubMed  Google Scholar 

  27. Agarwal S, Kovilam O, Argrawal DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: a critical review. Crit Rev Food Sci Nutr. 2018;58:755–69.

    Article  CAS  PubMed  Google Scholar 

  28. Mirzakhani H, Litonjua AA, McElrath TF, O’Connor G, Lee-Parritz A, Iverson R, et al. Early pregnancy vitamin D status and risk of preeclampsia. J Clin Invest. 2016;126:4702–15.

    Article  PubMed  Google Scholar 

  29. Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG, et al. Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics. 2015;136:625–34.

    Article  PubMed  Google Scholar 

  30. Heaney RP, Recker RR, Grote J, Horst RL, Armas LA. Vitamin D(3) is more potent than vitamin D(2) in humans. J Clin Endocrinol Metab. 2011;96:E447–52.

    Article  CAS  PubMed  Google Scholar 

  31. Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89:5387–91.

    Article  CAS  PubMed  Google Scholar 

  32. Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014;348:g2035.

    Article  PubMed  Google Scholar 

  33. Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, et al. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012;95:1357–64.

    Article  CAS  PubMed  Google Scholar 

  34. Zhang Y, Fang F, Tang J, Jia L, Feng Y, Xu P, et al. Association between vitamin D supplementation and mortality: systematic review and meta-analysis. BMJ. 2019;366:l4673.

    Article  PubMed  Google Scholar 

  35. Holick MF. Vitamin D is not as toxic as was once thought: a historical and an up-to-date perspective. Mayo Clin Proc. 2015;90:561–4.

    Article  PubMed  Google Scholar 

  36. Kimball SM, Mirhosseini N, Holick MF. Evaluation of vitamin D3 intakes up to 15,000 international units/day and serum 25-hydroxyvitamin D concentrations up to 300 nmol/L on calcium metabolism in a community setting. Dermatoendocrinol. 2017;9:e1300213.

    Article  CAS  PubMed  Google Scholar 

  37. Dudenkov DV, Yawn BP, Oberhelman SS, Fischer PR, Singh RJ, Cha SS, et al. Changing incidence of serum 25-hydroxyvitamin D values above 50 ng/mL: a 10-year population-based study. Mayo Clin Proc. 2015;90:577–86.

    Article  CAS  PubMed  Google Scholar 

  38. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999;69:842–56.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Samantha M. Kimball.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kimball, S.M., Holick, M.F. Official recommendations for vitamin D through the life stages in developed countries. Eur J Clin Nutr 74, 1514–1518 (2020). https://doi.org/10.1038/s41430-020-00706-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-020-00706-3

This article is cited by

Search

Quick links