[, Shahvazi S, Soltani S, Ahmadi SM, de Souza RJ, Salehi-Abargouei A. Vitamin D supplements and prevention of cancer and cardiovascular disease. Ann Intern Med 1990;112:352-64. A case-control analysis of 1,695 cases of prostate cancer and 1,682 controls found no associations between 25(OH)D levels and prostate cancer risk [109]. [. For example, a meta-analysis of 9 trials with a total of 4,923 adult participants diagnosed with depression or depressive symptoms found no significant reduction in symptoms after supplementation with vitamin D [130]. [, Earthman CP, Beckman LM, Masodkar K, Sibley SD. [, Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, et al. [, Seida JC, Mitri J, Colmers IN, Majumdar SR, Davidson MB, Edwards AL, et al. It added that no national professional organization recommends population screening for vitamin D deficiency. Most people in the world meet at least some of their vitamin D needs through exposure to sunlight [1]. Scientific Reports 2020;10:7736. Vitamin D might be involved in the pathophysiology of type 2 diabetes through its effects on glucose metabolism and insulin signaling as well as its ability to reduce inflammation and improve pancreatic beta-cell function [143,144]. Vitamin D bioavailability: State of the art. June 2, 2022
However, no 25(OH)D3 dietary supplements appear to be available to consumers on the U.S. market at this time [32]. [. For example, a meta-analysis included 34 observational studies that followed 180,667 participants (mean age greater than 50 years) for 1.3 to more than 32 years. [, Schenk JM, Till CA, Tangen CM, Goodman PJ, Song X, Torkko KC, et al. U.S. Food and Drug Administration. Various expert groupsincluding the American Association of Metabolic and Bariatric Surgery, The Obesity Society, and the British Obesity and Metabolic Surgery Societyhave developed guidelines on vitamin D screening, monitoring, and replacement before and after bariatric surgery [66,68]. Global consensus recommendations on prevention and management of nutritional rickets. However, women with vitamin D intakes higher than 15 mcg (600 IU)/day at the start of the trial and who received the supplements experienced a 28% increased risk of invasive (but not in situ) breast cancer. [, Yao S, Kwan ML, Ergas IJ, Roh JM, Cheng T-YD, Hong C-C, et al. A 2018 Cochrane review analyzed 12 such trials that had a total of 933 participants with MS; the reviewers judged all of these trials to be of low quality [136]. 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]. Int J Obes (Lond) 2012;36:387-96. Calcium plus vitamin D supplementation and the risk of colorectal cancer. Mushrooms provide variable amounts of vitamin D2 [17]. Pediatrics 2020;145:e20193574. PMID: 31504098 [, Okereke OI, Reynolds III CF, Mischoulon D, Chang G, Vyas CM, Cook NR, et al. J Clin Endocrinol Metab 2011;96:3838-45. [, Tripkovic L, Wilson LR, Hart K, Johnsen S, de Lusignan S, Smith CP, et al. One systematic review and meta-analysis of 11 randomized, controlled trials published through 2018 of vitamin D supplementation alone (1020 mcg [400800 IU]/day or more at least every week or as rarely as once a year) for 9 months to 5 years found that the supplements provided no protection from fractures in 34,243 older adults [81]. 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]) [154]. 
Paediatr Int Child Health 2017;37:84-98. A one-year trial to assess the value of orlistat in the management of obesity. The groups showed no significant differences in the incidence and recurrent rates of depression, clinically relevant depressive symptoms, or changes in mood scores. Borel P, Caillaud D, Cano NJ. June 2014. 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]. Curr Opin Endocrinol Diabetes 2002;9:87-98. J Am Geriatr Soc 2019;67:1043-49. The emerging issue of 25-hydroxyvitamin D in foods. The fortification of milk (a good source of calcium) and other staples, such as breakfast cereals and margarine, with vitamin D beginning in the 1930s along with the use of cod liver oil made rickets rare in the United States [28,50]. 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. An animals diet affects the amount of vitamin D in its tissues. No association between circulating concentrations of vitamin D and risk of lung cancer: An analysis in 20 prospective studies in the Lung Cancer Cohort Consortium (LC3). In addition, most steps in the metabolism and actions of vitamins D2 and D3 are identical. [, Sowah D, Fan X, Dennett L, Hagtvedt R, Straube S. Vitamin D levels and deficiency with different occupations: A systematic review. [, Taylor CL, Roseland JM, Coates PM, Pehrsson PR. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: A systematic review and meta-analysis. Overall, the available research suggests that consuming higher amounts of vitamin D or taking vitamin D supplements does not promote weight loss. Ask ODS
Overall, vitamin D supplementation, when compared with placebo administration, had no effect on relevant clinical outcomes, such as recurrent relapse or worsened disability. J Midwifery Womens Health 2019;64:276-88. Individuals who have difficulty absorbing dietary fat might therefore require vitamin D supplementation [63]. In addition, 26% of participants aged 25 years and 14% of those aged 611 years took supplements; rates increased with age from 10% of those aged 1219 years to 49% of men and 59% of women aged 60 and older. Am J Clin Nutr 2017;106:481-90. [, Yin L, Ordonez-Mena JM, Chen T, Schottker B, Arndt V, Brenner H. Circulating 25-hydroxyvitamin D serum concentration and total cancer incidence and mortality: A systematic review and meta-analysis. US Preventive Services Task Force recommendation statement. J Natl Cancer Inst 2019;111:158-69. N Engl J Med 2007;357:266-81. J Nutr 2020;150:73-81. [, Holick MF. Endocrine Connections 2018;7:R294-303. Excess amounts of vitamin D are toxic. The use of sunscreen also limits vitamin D synthesis from sunlight. Practitioner 1984;228:312-3. They also had different study durations (5 days to 5 years), mean participant ages (range, 22 years to 75 years), and baseline 25(OH)D levels; furthermore, some but not all studies administered concurrent antidepressant medications. [. Glucocorticoid-induced osteoporosis: pathogenesis and management. Some people are potentially at risk of inadequacy at 30 to 50 nmol/L (1220 ng/mL). Vitamin D supplementation reduced cancer mortality rates by 13%, and most of the benefit occurred with daily supplementation. People with obesity or who have undergone gastric bypass surgery
U.S. Preventive Services Task Force. [, Munger K, Hongell K, Aivo J, Soilu-Hanninen M, Surcel H-M, Ascherio A. J Clin Endorcinol Metab 2015;100:2339-46. [, Crowe M, Wollner L, Griffiths RA. Together with calcium, vitamin D also helps protect older adults from osteoporosis. Serum concentrations of 25(OH)D and health
Philadelphia: Lippincott Williams & Wilkins, 2014. JAMA 2017;317:2448-50. [, Gotfredsen A, Westergren Hendel H, Andersen T. Influence of orlistat on bone turnover and body composition. In fact, Black Americans might have a greater risk than White Americans of falls and fractures with daily vitamin D intakes of 50 mcg (2,000 IU) or more [14]. For example, three meta-analyses of clinical trial evidence found that vitamin D supplementation does not affect cancer incidence but does significantly reduce total cancer mortality rates by 1213% [89-91]. Neurology 2017;89:1538-9. Overall, clinical trials did not find that vitamin D supplements helped prevent or treat depressive symptoms or mild depression, especially in middle-aged to older adults who were not taking prescription antidepressants. Nutr Rev 2019;77:890-902. People with dark skin
However, clinical trials do not support a cause-and-effect relationship between vitamin D and weight loss. Signs and symptoms of osteomalacia are similar to those of rickets and include bone deformities and pain, hypocalcemic seizures, tetanic spasms, and dental abnormalities [45]. Cancer Epidemiol Biomarkers Prev 2019;28:900-8. Observational studies have linked lower serum 25(OH)D levels to an increased risk of diabetes, but their results might have been confounded by the fact that many participants were overweight or had obesity and were therefore more predisposed to developing diabetes and having lower 25(OH)D levels [1]. Vitamin D for the management of multiple sclerosis (review). Elsevier, 2018. Environ Health Perspect 2017;125(7):077004. AHRQ-Pub No. Int J Cancer 2018;142:1189-201. Vitamin D supplementation had no effect on the incidence rate of myocardial infarction, angina, heart failure, arrhythmia, arteriosclerosis, stroke, venous thrombosis, or death from CVD. J Am Coll Cardiol 2017;70:89-100. [, Pappa HM, Bern E, Kamin D, Grand RJ. [, Lehmann U, Hirche F, Stangl GI, Hinz K, Westphal S, Dierkes J. Bioavailability of vitamin D2 and D3 in healthy volunteers, a randomised placebo-controlled trial. In a cohort of 4,733 men, of which 1,731 had prostate cancer, those with 25(OH)D levels of 4570 nmol/L (1828 ng/mL) had a significantly lower risk of the disease than men with either lower or higher values [108]. Factors such as adiposity, skin pigmentation, vitamin D binding protein polymorphisms, and genetics contribute to differences in 25(OH)D levels between Black and White Americans. One clinical trial randomized 260 Black women aged 60 years and older (mean age 68.2 years) to receive 60 to 120 mcg (2,400 to 4,800 IU) per day vitamin D3 supplementation to maintain serum 25(OH)D levels above 75 nmol/L (30 ng/mL) for 3 years [83]. The combination of these diuretics with vitamin D supplements (which increase intestinal calcium absorption) might lead to hypercalcemia, especially among older adults and individuals with compromised renal function or hyperparathyroidism [166,174,175]. Cancer Epidemiol Biomarkers Prev 2014;23:1484-93. 
J Clin Endocrinol Metab 2014;99:3551-60. The investigators randomly assigned participants to receive either a bolus oral dose of 2,500 mcg (100,000 IU) vitamin D3 followed by 100 mcg (4,000 IU)/day or a placebo for 16 weeks. [, Crockett SD, Barry EL, Mott LA, Ahnen DJ, Robertson DJ, Anderson JC, et al. Some vitamin D3 is also converted to nonactive forms [1]. Vitamin D has other roles in the body, including reduction of inflammation as well as modulation of such processes as cell growth, neuromuscular and immune function, and glucose metabolism [1-3]. pii: E493. The AAP recommends 10 mcg (400 IU)/day vitamin D supplements for exclusively and partially breastfed infants starting shortly after birth and lasting until they are weaned and consume at least 1,000 mL/day vitamin D-fortified formula or whole milk [57]. Cardiovascular disease
Vitamin D is involved in various brain processes, and vitamin D receptors are present on neurons and glia in areas of the brain thought to be involved in the pathophysiology of depression [129]. [, Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. [. Increasing incidence of nutritional rickets: A population-based study in Olmsted County, Minnesota. Aloia JF, Talwar SA, Pollack S, Yeh J. Vitamin D had no significant effects on glucose homeostasis, insulin secretion or resistance, or hemoglobin A1c levels (a measure of average blood sugar levels over the previous 23 months), irrespective of the study population, vitamin D dose, or trial quality. 
Journal of AOAC International 2017;100:1223-4. Serum concentrations of 25(OH)D are reported in both nanomoles per liter (nmol/L) and nanograms per milliliter (ng/mL). Silva MC, Furlanetto TW. Thiazide diuretics
One systematic review and meta-analysis evaluated 35 clinical trials that included 43,407 adults with normal glucose tolerance, prediabetes, or type 2 diabetes who received a median of 83 mcg (3,332 IU)/day vitamin D supplements or placebo for a median of 16 weeks [147]. People who avoid all animal-sourced products can contact dietary supplement manufacturers to ask about their sourcing and processing techniques. [, Mheid IA, Quyyumi AA. Season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis. J Am Soc Nephrol 2002;13:1608-14. Vitamin D is also needed for the normal development and growth of muscle fibers. [, Keum N, Lee DH, Greenwood DC, Manson JE, Giovannucci E. Vitamin D supplementation and total cancer incidence and mortality: A meta-analysis of randomized controlled trials. Cochrane Database Syst Rev 2014; 23(6):CD007469. However, because research has been conducted on vitamin D and numerous health outcomes, this section focuses on seven diseases, conditions, and interventions in which vitamin D might be involved: bone health and osteoporosis, cancer, cardiovascular disease (CVD), depression, multiple sclerosis (MS), type 2 diabetes, and weight loss. [, O'Brien KM, Sandler DP, Taylor JA, Weinberg CR. In addition to bone deformities and pain, severe rickets can cause failure to thrive, developmental delay, hypocalcemic seizures, tetanic spasms, cardiomyopathy, and dental abnormalities [45,46]. Join the ODS Email List. Assessing vitamin D status by measuring serum 25(OH)D concentrations is complicated by the considerable variability of the available assays (the two most common ones involve antibodies or chromatography) used by laboratories that conduct the analyses [5,6]. In addition, the Food and Drug Administration (FDA) has approved UV-treated mushroom powder as a food additive for use as a source of vitamin D2 in food products [18]. Long-term vitamin D3 supplementation is more effective than vitamin D2 in maintaining serum 25-hydroxyvitamin D status over the winter months. JAMA Intern Med 2015;175:745-54. 
Many other countries around the world and some professional societies have somewhat different guidelines for vitamin D intakes [15]. Obesity does not affect the skins capacity to synthesize vitamin D. However, greater amounts of subcutaneous fat sequester more of the vitamin [1]. Among the women with two or more serum 25(OH)D samples taken before diagnosis (which reduced random measurement variation), a 50 nmol/L increase in 25(OH)D was associated with a 41% reduced risk of MS, and 25(OH)D levels less than 30 nmol/L were associated with an MS risk that was twice as high as levels of 50 nmol/L or higher. Osteoporosis is most often associated with inadequate calcium intakes, but insufficient vitamin D intakes contribute to osteoporosis by reducing calcium absorption [1]. A randomized controlled trial of vitamin D3 supplementation in African American women. The vitamin D paradox in Black Americans: A systems-based approach to investigating clinical practice, research, and public healthexpert panel meeting report. [, Creo AL, Thacher TD, Pettifor JM, Strand MA, Ficsher PR. 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 [161,162]. History of changes to this fact sheet, U.S. Department of Health & Human Services, Division of Program Coordination, Planning, and Strategic Initiatives, Strengthening Knowledge and Understanding of Dietary Supplements, My Dietary Supplement and Medicine Record, Analytical Methods and Reference Materials (AMRM), NIH Consortium for Advancing Research on Botanical and Other Natural Products (CARBON) Program, Computer Access to Research on Dietary Supplements (CARDS) Database, Dietary Supplement Ingredient Database (DSID), ODS Funding of Grants & Administrative Supplements: FAQ, Administrative Supplements for Validation Studies of Analytical Methods, Staff Bios, Publications, and Presentations, Federal Working Group on Dietary Supplements, Dietary Supplements in the Time of COVID-19, Food labeling: Revision of the Nutrition and Supplement Facts labels, The Surgeon General's Call to Action to Prevent Skin Cancer, Percent reporting and mean amounts of selected vitamins and minerals food and beverages and dietary supplements by gender and age, in the United States, 2015-2016, Usual nutrient intake from foods and beverages, by gender and age, Vitamin D and calcium: A systematic review of health outcomes (update), Associated with vitamin D deficiency, which can lead to rickets in infants and children and osteomalacia in adults, Generally considered inadequate for bone and overall health in healthy individuals, Generally considered adequate for bone and overall health in healthy individuals, Linked to potential adverse effects, particularly at >150 nmol/L (>60 ng/mL), Trout (rainbow), farmed, cooked, 3 ounces, Mushrooms, white, raw, sliced, exposed to UV light, cup, Milk, 2% milkfat, vitamin D fortified, 1 cup, Soy, almond, and oat milks, vitamin D fortified, various brands, 1 cup, Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 1 serving, Sardines (Atlantic), canned in oil, drained, 2 sardines, Tuna fish (light), canned in water, drained, 3 ounces, Beef, ground, 90% lean, broiled, 3 ounces. BMC Proceedings, 2018;12(Suppl 6):6. Studies examining the effects of supplemental vitamin D on muscle strength and on rate of decline in muscle function have had inconsistent results [55]. Cancer Epidemiol Biomarkers Prev 2014;23:1220-9. Considerations in dietetic counseling for vitamin D. J Acad Nutr Diet 2019;119:901-9. No. They also help reduce fracture rates in institutionalized older people. doi: 10.1002/14651858.CD007469.pub2. In the most recent meta-analysis, 10 randomized clinical trials (including the Vitamin D and Omega-3 Trial [VITAL] trial described below) that included 6,537 cancer cases provided 10 to 50 mcg (400 to 2,000 IU) vitamin D3 daily (six trials) or 500 mcg (20,000 IU)/week to 12,500 mcg (500,000 IU)/year boluses of vitamin D3 (four trials) [90]. J Natl Cancer Inst 2007;100:1581-91. Clinical trials, however, do not support these findings. The results showed no association between 25(OH)D levels or vitamin D dose and the risk of falling in the 184 participants who completed the study. Individuals taking these and other medications on a regular basis should discuss their vitamin D intakes and status with their healthcare providers. Studies of the effects of vitamin D supplements on hypertension have also had mixed findings. [, Drincic A, Fuller E, Heaney RP, Armas LAG. Nutr Metab Cardiovasc Dis 2016;26:663-73. 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. Brooks SPJ, Sempos CT.
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Paediatr Int Child Health 2017;37:84-98. A one-year trial to assess the value of orlistat in the management of obesity. The groups showed no significant differences in the incidence and recurrent rates of depression, clinically relevant depressive symptoms, or changes in mood scores. Borel P, Caillaud D, Cano NJ. June 2014. 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]. Curr Opin Endocrinol Diabetes 2002;9:87-98. J Am Geriatr Soc 2019;67:1043-49. The emerging issue of 25-hydroxyvitamin D in foods. The fortification of milk (a good source of calcium) and other staples, such as breakfast cereals and margarine, with vitamin D beginning in the 1930s along with the use of cod liver oil made rickets rare in the United States [28,50]. 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. An animals diet affects the amount of vitamin D in its tissues. No association between circulating concentrations of vitamin D and risk of lung cancer: An analysis in 20 prospective studies in the Lung Cancer Cohort Consortium (LC3). In addition, most steps in the metabolism and actions of vitamins D2 and D3 are identical. [, Sowah D, Fan X, Dennett L, Hagtvedt R, Straube S. Vitamin D levels and deficiency with different occupations: A systematic review. [, Taylor CL, Roseland JM, Coates PM, Pehrsson PR. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: A systematic review and meta-analysis. Overall, the available research suggests that consuming higher amounts of vitamin D or taking vitamin D supplements does not promote weight loss. Ask ODS
Overall, vitamin D supplementation, when compared with placebo administration, had no effect on relevant clinical outcomes, such as recurrent relapse or worsened disability. J Midwifery Womens Health 2019;64:276-88. Individuals who have difficulty absorbing dietary fat might therefore require vitamin D supplementation [63]. In addition, 26% of participants aged 25 years and 14% of those aged 611 years took supplements; rates increased with age from 10% of those aged 1219 years to 49% of men and 59% of women aged 60 and older. Am J Clin Nutr 2017;106:481-90. [, Yin L, Ordonez-Mena JM, Chen T, Schottker B, Arndt V, Brenner H. Circulating 25-hydroxyvitamin D serum concentration and total cancer incidence and mortality: A systematic review and meta-analysis. US Preventive Services Task Force recommendation statement. J Natl Cancer Inst 2019;111:158-69. N Engl J Med 2007;357:266-81. J Nutr 2020;150:73-81. [, Holick MF. Endocrine Connections 2018;7:R294-303. Excess amounts of vitamin D are toxic. The use of sunscreen also limits vitamin D synthesis from sunlight. Practitioner 1984;228:312-3. They also had different study durations (5 days to 5 years), mean participant ages (range, 22 years to 75 years), and baseline 25(OH)D levels; furthermore, some but not all studies administered concurrent antidepressant medications. [. Glucocorticoid-induced osteoporosis: pathogenesis and management. Some people are potentially at risk of inadequacy at 30 to 50 nmol/L (1220 ng/mL). Vitamin D supplementation reduced cancer mortality rates by 13%, and most of the benefit occurred with daily supplementation. People with obesity or who have undergone gastric bypass surgery
U.S. Preventive Services Task Force. [, Munger K, Hongell K, Aivo J, Soilu-Hanninen M, Surcel H-M, Ascherio A. J Clin Endorcinol Metab 2015;100:2339-46. [, Crowe M, Wollner L, Griffiths RA. Together with calcium, vitamin D also helps protect older adults from osteoporosis. Serum concentrations of 25(OH)D and health
Philadelphia: Lippincott Williams & Wilkins, 2014. JAMA 2017;317:2448-50. [, Gotfredsen A, Westergren Hendel H, Andersen T. Influence of orlistat on bone turnover and body composition. In fact, Black Americans might have a greater risk than White Americans of falls and fractures with daily vitamin D intakes of 50 mcg (2,000 IU) or more [14]. For example, three meta-analyses of clinical trial evidence found that vitamin D supplementation does not affect cancer incidence but does significantly reduce total cancer mortality rates by 1213% [89-91]. Neurology 2017;89:1538-9. Overall, clinical trials did not find that vitamin D supplements helped prevent or treat depressive symptoms or mild depression, especially in middle-aged to older adults who were not taking prescription antidepressants. Nutr Rev 2019;77:890-902. People with dark skin
However, clinical trials do not support a cause-and-effect relationship between vitamin D and weight loss. Signs and symptoms of osteomalacia are similar to those of rickets and include bone deformities and pain, hypocalcemic seizures, tetanic spasms, and dental abnormalities [45]. Cancer Epidemiol Biomarkers Prev 2019;28:900-8. Observational studies have linked lower serum 25(OH)D levels to an increased risk of diabetes, but their results might have been confounded by the fact that many participants were overweight or had obesity and were therefore more predisposed to developing diabetes and having lower 25(OH)D levels [1]. Vitamin D for the management of multiple sclerosis (review). Elsevier, 2018. Environ Health Perspect 2017;125(7):077004. AHRQ-Pub No. Int J Cancer 2018;142:1189-201. Vitamin D supplementation had no effect on the incidence rate of myocardial infarction, angina, heart failure, arrhythmia, arteriosclerosis, stroke, venous thrombosis, or death from CVD. J Am Coll Cardiol 2017;70:89-100. [, Pappa HM, Bern E, Kamin D, Grand RJ. [, Lehmann U, Hirche F, Stangl GI, Hinz K, Westphal S, Dierkes J. Bioavailability of vitamin D2 and D3 in healthy volunteers, a randomised placebo-controlled trial. In a cohort of 4,733 men, of which 1,731 had prostate cancer, those with 25(OH)D levels of 4570 nmol/L (1828 ng/mL) had a significantly lower risk of the disease than men with either lower or higher values [108]. Factors such as adiposity, skin pigmentation, vitamin D binding protein polymorphisms, and genetics contribute to differences in 25(OH)D levels between Black and White Americans. One clinical trial randomized 260 Black women aged 60 years and older (mean age 68.2 years) to receive 60 to 120 mcg (2,400 to 4,800 IU) per day vitamin D3 supplementation to maintain serum 25(OH)D levels above 75 nmol/L (30 ng/mL) for 3 years [83]. The combination of these diuretics with vitamin D supplements (which increase intestinal calcium absorption) might lead to hypercalcemia, especially among older adults and individuals with compromised renal function or hyperparathyroidism [166,174,175]. Cancer Epidemiol Biomarkers Prev 2014;23:1484-93. J Clin Endocrinol Metab 2014;99:3551-60. The investigators randomly assigned participants to receive either a bolus oral dose of 2,500 mcg (100,000 IU) vitamin D3 followed by 100 mcg (4,000 IU)/day or a placebo for 16 weeks. [, Crockett SD, Barry EL, Mott LA, Ahnen DJ, Robertson DJ, Anderson JC, et al. Some vitamin D3 is also converted to nonactive forms [1]. Vitamin D has other roles in the body, including reduction of inflammation as well as modulation of such processes as cell growth, neuromuscular and immune function, and glucose metabolism [1-3]. pii: E493. The AAP recommends 10 mcg (400 IU)/day vitamin D supplements for exclusively and partially breastfed infants starting shortly after birth and lasting until they are weaned and consume at least 1,000 mL/day vitamin D-fortified formula or whole milk [57]. Cardiovascular disease
Vitamin D is involved in various brain processes, and vitamin D receptors are present on neurons and glia in areas of the brain thought to be involved in the pathophysiology of depression [129]. [, Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. [. Increasing incidence of nutritional rickets: A population-based study in Olmsted County, Minnesota. Aloia JF, Talwar SA, Pollack S, Yeh J. Vitamin D had no significant effects on glucose homeostasis, insulin secretion or resistance, or hemoglobin A1c levels (a measure of average blood sugar levels over the previous 23 months), irrespective of the study population, vitamin D dose, or trial quality. Journal of AOAC International 2017;100:1223-4. Serum concentrations of 25(OH)D are reported in both nanomoles per liter (nmol/L) and nanograms per milliliter (ng/mL). Silva MC, Furlanetto TW. Thiazide diuretics
One systematic review and meta-analysis evaluated 35 clinical trials that included 43,407 adults with normal glucose tolerance, prediabetes, or type 2 diabetes who received a median of 83 mcg (3,332 IU)/day vitamin D supplements or placebo for a median of 16 weeks [147]. People who avoid all animal-sourced products can contact dietary supplement manufacturers to ask about their sourcing and processing techniques. [, Mheid IA, Quyyumi AA. Season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis. J Am Soc Nephrol 2002;13:1608-14. Vitamin D is also needed for the normal development and growth of muscle fibers. [, Keum N, Lee DH, Greenwood DC, Manson JE, Giovannucci E. Vitamin D supplementation and total cancer incidence and mortality: A meta-analysis of randomized controlled trials. Cochrane Database Syst Rev 2014; 23(6):CD007469. However, because research has been conducted on vitamin D and numerous health outcomes, this section focuses on seven diseases, conditions, and interventions in which vitamin D might be involved: bone health and osteoporosis, cancer, cardiovascular disease (CVD), depression, multiple sclerosis (MS), type 2 diabetes, and weight loss. [, O'Brien KM, Sandler DP, Taylor JA, Weinberg CR. In addition to bone deformities and pain, severe rickets can cause failure to thrive, developmental delay, hypocalcemic seizures, tetanic spasms, cardiomyopathy, and dental abnormalities [45,46]. Join the ODS Email List. Assessing vitamin D status by measuring serum 25(OH)D concentrations is complicated by the considerable variability of the available assays (the two most common ones involve antibodies or chromatography) used by laboratories that conduct the analyses [5,6]. In addition, the Food and Drug Administration (FDA) has approved UV-treated mushroom powder as a food additive for use as a source of vitamin D2 in food products [18]. Long-term vitamin D3 supplementation is more effective than vitamin D2 in maintaining serum 25-hydroxyvitamin D status over the winter months. JAMA Intern Med 2015;175:745-54. Many other countries around the world and some professional societies have somewhat different guidelines for vitamin D intakes [15]. Obesity does not affect the skins capacity to synthesize vitamin D. However, greater amounts of subcutaneous fat sequester more of the vitamin [1]. Among the women with two or more serum 25(OH)D samples taken before diagnosis (which reduced random measurement variation), a 50 nmol/L increase in 25(OH)D was associated with a 41% reduced risk of MS, and 25(OH)D levels less than 30 nmol/L were associated with an MS risk that was twice as high as levels of 50 nmol/L or higher. Osteoporosis is most often associated with inadequate calcium intakes, but insufficient vitamin D intakes contribute to osteoporosis by reducing calcium absorption [1]. A randomized controlled trial of vitamin D3 supplementation in African American women. The vitamin D paradox in Black Americans: A systems-based approach to investigating clinical practice, research, and public healthexpert panel meeting report. [, Creo AL, Thacher TD, Pettifor JM, Strand MA, Ficsher PR. 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 [161,162]. History of changes to this fact sheet, U.S. Department of Health & Human Services, Division of Program Coordination, Planning, and Strategic Initiatives, Strengthening Knowledge and Understanding of Dietary Supplements, My Dietary Supplement and Medicine Record, Analytical Methods and Reference Materials (AMRM), NIH Consortium for Advancing Research on Botanical and Other Natural Products (CARBON) Program, Computer Access to Research on Dietary Supplements (CARDS) Database, Dietary Supplement Ingredient Database (DSID), ODS Funding of Grants & Administrative Supplements: FAQ, Administrative Supplements for Validation Studies of Analytical Methods, Staff Bios, Publications, and Presentations, Federal Working Group on Dietary Supplements, Dietary Supplements in the Time of COVID-19, Food labeling: Revision of the Nutrition and Supplement Facts labels, The Surgeon General's Call to Action to Prevent Skin Cancer, Percent reporting and mean amounts of selected vitamins and minerals food and beverages and dietary supplements by gender and age, in the United States, 2015-2016, Usual nutrient intake from foods and beverages, by gender and age, Vitamin D and calcium: A systematic review of health outcomes (update), Associated with vitamin D deficiency, which can lead to rickets in infants and children and osteomalacia in adults, Generally considered inadequate for bone and overall health in healthy individuals, Generally considered adequate for bone and overall health in healthy individuals, Linked to potential adverse effects, particularly at >150 nmol/L (>60 ng/mL), Trout (rainbow), farmed, cooked, 3 ounces, Mushrooms, white, raw, sliced, exposed to UV light, cup, Milk, 2% milkfat, vitamin D fortified, 1 cup, Soy, almond, and oat milks, vitamin D fortified, various brands, 1 cup, Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 1 serving, Sardines (Atlantic), canned in oil, drained, 2 sardines, Tuna fish (light), canned in water, drained, 3 ounces, Beef, ground, 90% lean, broiled, 3 ounces. BMC Proceedings, 2018;12(Suppl 6):6. Studies examining the effects of supplemental vitamin D on muscle strength and on rate of decline in muscle function have had inconsistent results [55]. Cancer Epidemiol Biomarkers Prev 2014;23:1220-9. Considerations in dietetic counseling for vitamin D. J Acad Nutr Diet 2019;119:901-9. No. They also help reduce fracture rates in institutionalized older people. doi: 10.1002/14651858.CD007469.pub2. In the most recent meta-analysis, 10 randomized clinical trials (including the Vitamin D and Omega-3 Trial [VITAL] trial described below) that included 6,537 cancer cases provided 10 to 50 mcg (400 to 2,000 IU) vitamin D3 daily (six trials) or 500 mcg (20,000 IU)/week to 12,500 mcg (500,000 IU)/year boluses of vitamin D3 (four trials) [90]. J Natl Cancer Inst 2007;100:1581-91. Clinical trials, however, do not support these findings. The results showed no association between 25(OH)D levels or vitamin D dose and the risk of falling in the 184 participants who completed the study. Individuals taking these and other medications on a regular basis should discuss their vitamin D intakes and status with their healthcare providers. Studies of the effects of vitamin D supplements on hypertension have also had mixed findings. [, Drincic A, Fuller E, Heaney RP, Armas LAG. Nutr Metab Cardiovasc Dis 2016;26:663-73. 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. Brooks SPJ, Sempos CT.
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