Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland

Abstract

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists’ voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20–30 ng/mL (50–75 nmol/L)], and optimal concentration [30–50 ng/mL (75–125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland.

Vitamin D Determinants, Status, and Antioxidant/Anti-inflammatory-Related Effects in Cardiovascular Risk and Disease: Not the Last Word in the Controversy

“…Although vitamin D toxicity is a very rare case, it can occur when an excess of supplements is taken (for values > 100 ng/mL–250 nmol/L, not achievable with sunlight exposure or regular food intake, but generally as a consequence of the unintentional assumption of extremely high doses) [ 203 ]. In any case, it is important that patients and physicians are conscious that this event can occur, requiring revision of the supplementation (e.g., reduction or cessation) until target 25(OH)D concentration is achieved again [ 204 ].…”

Evidence That Increasing Serum 25(OH)D Concentrations to 30 ng/mL in the Kingdom of Saudi Arabia and the United Arab Emirates Could Greatly Improve Health Outcomes

“…Nevertheless, we aimed to include the best available evidence up to 11 February 2023 to provide guidance for developing public health measures to reduce the health burden of vitamin D deficiency in KSA and the UAE, because substantial reductions in adverse health outcomes in Saudi Arabia and the UAE are likely to be achieved by raising the minimum serum 25(OH)D concentration to above 30 ng/mL. The U.S. Endocrine Society [ 4 ] and the consensus from vitamin D conferences in Poland [ 29 , 262 ] recommend daily intakes up to 2000 IU/d vitamin D 3 , while reviews from the U.S. Institute of Medicine in 2011 [ 3 ] and from the UK both demonstrate, and affirm, that 4000 IU/d is safe and results in greater health benefits. Food fortification with vitamin D can be effective, using a variety of foods including fats, dairy produce, and flour-based products [ 263 , 264 ] though supplementation is usually required in addition for those at high risk of deficiency such as the elderly, those with indoor life styles, shift workers, pregnant women, the obese, diabetics, dark-skinned individuals [ 255 , 265 ], and vegan/vegetarians [ 266 ].…”

Frequency of COVID-19 Infection as a Function of Vitamin D Levels

“…Our results are consistent with the effects of the large prospective intervention study CORONAVIT (phase 3, open-label, randomized controlled trial) conducted in the UK, which showed that the supplementation of vitamin D in subjects with suboptimal vitamin D status (<30 ng/mL; n = 2674) increased 25OHD concentrations; however, this was not associated with protection against COVID-19 [ 16 ]. Our results are also in keeping with the results of the metanalysis by Wang et al [ 17 ], where the authors, analyzing data from 16 studies (2756 patients), confirmed increased mortality, and an increased likelihood of hospital admissions and longer hospital stay, particularly in patients with more severe 25OHD deficiency (12 ng/mL cut-off was applied in seven studies, 20 ng/mL cut-off in eight studies, 25 ng/mL cut-off in one study, while a 30 ng/mL cut-off [ 13 , 14 ] was never applied). It should be noted, however, that several studies, e.g., [ 18 , 19 , 20 ], analyzed 25OHD in either hospitalized or symptomatic patients with COVID-19 infection, where these concentrations were indeed lower than in the general population or in age-matched controls.…”

“…25OHD sufficiency cut-offs were defined as 25OHD >20 ng/mL (50 nmol/L) [ 12 ] or as 25OHD > 30 ng/mL (75 nmol/L) [ 13 , 14 ]. The issue of whether a 20 ng/mL or 30 ng/mL cut-off should be applied for the Polish population was discussed in our previous study [ 15 ].…”