Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland—Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies—2018 Update

Abstract

IntroductionVitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland, an updated recommendation for the prevention, diagnosis and treatment of vitamin D deficiency.MethodsA systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations.ResultsThe updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care.ConclusionVitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there is a great necessity to implement a regular supplementation with recommended doses and to develop an effective strategy to alleviate vitamin D deficiency in the population. These updated recommendations are addressed to health professionals and the authorities pursuing comprehensive health policies and should also be included in public health programs aimed at preventing a broad spectrum of chronic diseases.

Beneficial Effect of Oligofructose-Enriched Inulin on Vitamin D and E Status in Children with Celiac Disease on a Long-Term Gluten-Free Diet: A Preliminary Randomized, Placebo-Controlled Nutritional Intervention Study

“…Participants were instructed to record a daily intake of the provided study product and any side effects during the trial on the observation chart provided to each participant at the first visit. Before the intervention, all subjects were receiving vitamin D supplements in a dose consistent with Polish guidelines (800 or 1000 IU per day) [15] and, importantly, this remained unchanged during the trial. Blood and urine samples for biochemical measurements were collected at baseline and on the last day of the study.…”

Vitamin D deficiency 2.0: an update on the current status worldwide

“…Some data suggest that a higher 25(OH)D level than 50 nmol/L (or 20 ng/mL) may be required for optimal risk reduction for various endpoints [41][42][43][44].…”

Vitamin D supplementation in theory and daily practice – implementation of new updated Polish recommendations on the example of one pediatric centre

“…Calcitriol acts as a transcription factor but it also impacts on many tissues in a "non classical way" using nuclear (VDR) and membrane receptors (MARRS), and regulates cellular proliferation and apoptosis. [2,[4][5][6]. Many studies showed that vitamin deficiency may be associated with an increased risk of cancer, diabetes, cardio-pulmonary diseases, metabolic and autoimmune disorders and even infections and mental illness [2].…”

“…For children (1-10 years) 600-1000 IU/ day, and for adolescents (11-18 years) 800-2000 IU/day based on body weight and the dietary vitamin D intake, except for healthy children and adolescents sunbathing with uncovered forearms and legs for at least 15 min between 10.00 a.m. and 3 p.m., without sunscreen, in the period from May to September. In this last group, supplementation is not necessary, although still recommended and safe [5,9,10]. In order to evaluate patients' vitamin D status, the guidelines recommend using the serum 25(OH)D level [11,12].…”

“…Deficiency is a clinical syndrome defined as a 25(OH)D serum level < 20 ng/ml, and insufficiency as a 21-29 ng/ml. Both of these clinical statuses are recommended for 25(OH)D treatment or supplementation, respectively [4,5].…”