New Vitamin D Guidelines by Endocrine Society- what they imply for Indians

Summary

In this insightful discussion, Dr. Amarish Mitl, Chairman and Head of Endocrinology and Diabetes at Max Health Care, addresses the recent guidelines released by the Endocrine Society on vitamin D's role in disease prevention. The guidelines, a significant departure from those of 2011, emphasize the overuse of vitamin D testing and advocate for supplementation without testing in specific groups, such as children up to 18 and the elderly above 75. Dr. Mitl highlights the importance of these recommendations in the Indian context, where vitamin D deficiency is prevalent despite abundant sunshine, and discusses the significance of supplementation in pre-diabetics and pregnant women.

Takeaways

• 😀 The new guidelines by the Endocrine Society focus on the prevention of disease rather than treatment, emphasizing the role of vitamin D in improving clinical outcomes.
• 🔍 Testing for vitamin D levels is deemed over-utilized and not strongly correlated with disease outcomes, suggesting that universal screening is not necessary.
• 👶 For children up to the age of 18, the guidelines recommend daily supplementation with a low dose of vitamin D without the need for testing, addressing the common deficiency in this age group.
• 👴 Individuals over 75 are advised to take a low dose of vitamin D daily as well, to reduce overall mortality and the risk of osteoporosis and fractures.
• ☀ Despite abundant sunshine, India has some of the lowest vitamin D levels globally due to cultural practices and high atmospheric pollution blocking UV rays.
• 🤰 The guidelines also advocate for vitamin D supplementation during pregnancy to improve outcomes, which is significant for India.
• 📉 The reference range for vitamin D is debated, with the guidelines suggesting that levels above 20 nanograms per mL are considered normal for bones and general health.
• 🚫 The guidelines discourage setting target levels of 30-50 nanograms per mL, as it may not be necessary and could lead to overtreatment.
• 💊 For pre-diabetics, vitamin D supplementation can slow the progression to diabetes, which is particularly relevant for India's large pre-diabetic population.
• 🥛 Fortification of milk and edible oil with vitamin D is recommended, as it can help address the widespread deficiency in countries like India.
• 👉 For the 50 to 75 age group, which is not excluded in the US guidelines, there is a suggestion to consider this age group for vitamin D supplementation in the Indian context due to specific health concerns.

Q & A

What are the new guidelines released by the Endocrine Society regarding vitamin D?

The new guidelines focus on the role of vitamin D for the prevention of diseases rather than treatment. They emphasize that improving vitamin D levels can lead to better clinical outcomes such as reduced risks of diabetes, heart disease, cancer, mortality, fractures, and osteoporosis.

Why were the guidelines updated in 2023 compared to the previous 2011 version?

The field of vitamin D research is dynamic, and since the last guidelines in 2011, there has been a significant amount of new data on the outcomes of vitamin D levels on various diseases, prompting the update.

According to the new guidelines, is testing for vitamin D levels recommended for the general population?

No, the guidelines suggest that testing for vitamin D levels is over-utilized and not very useful for the general population due to weak correlation between testing and disease outcomes.

What are the key takeaways from the guidelines regarding vitamin D testing and supplementation?

The key takeaways are that universal screening for vitamin D is not recommended, and for certain groups like children up to the age of 18 and elderly above 75, low-dose vitamin D supplementation is advised without the need for testing.

Why is vitamin D supplementation important for children up to the age of 18 according to the guidelines?

Vitamin D is crucial for bone development, and studies have shown that many school children are significantly deficient in vitamin D. Supplementation can help correct this deficiency and support bone health.

What is the recommended daily dosage of vitamin D for children according to the Indian context?

In the Indian context, the recommended daily dosage of vitamin D for children is around 1,000 units, which has been found to be effective in correcting deficiency.

Why might vitamin D levels be low in India despite abundant sunshine?

Two main reasons are that Indians generally avoid sun exposure due to heat and concerns about skin darkening, and atmospheric pollution in cities like Delhi prevents UV rays from reaching the skin effectively.

What does the guidelines say about vitamin D supplementation during pregnancy?

The guidelines now advocate for supplementing vitamin D throughout pregnancy to improve outcomes, which is a significant change from previous recommendations.

How do the guidelines view the use of vitamin D supplementation for pre-diabetics?

The guidelines suggest that supplementing pre-diabetics with vitamin D can slow down the conversion to diabetes, which is particularly relevant for countries like India with a high burden of pre-diabetes.

What is the position of the guidelines on the reference range for vitamin D levels?

The guidelines do not focus on the reference range debate, but it is generally accepted that levels above 20 nanograms per mL are considered normal or good for bones and outcomes, while levels below 10 or 12 nanograms per mL are considered deficient.

What is the potential risk of vitamin D toxicity from supplementation, and how can it be avoided?

The risk of vitamin D toxicity is very low with the recommended dosages of 1,000 to 2,000 units daily, as there is a large safety window. Toxicity is only a concern with extreme overuse or errors in supplementation.

Which age group between 50 to 75 years is considered important for vitamin D supplementation in the Indian context, and why?

The 50 to 75 age group is considered important in India due to the prevalence of bone disease in this demographic, the life expectancy, and the low baseline vitamin D levels, which differ from the US guidelines that exclude this group.