Vitamin D and Health

Recommendations

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Table 30: Pregnant women in North West London, by season Multi-ethnic sample of pregnant women in North West London 2008-2009 Month blood sample taken Serum 25-hydroxyvitamin D (nmol/L) July - September October - December January - March April - June Overall Median 38.0 38.0 26.0 32.0 35.0 Inter quartile range 22, 76 18, 66 12, 48 20, 60 19, 64 % below 25nmol/L 29 36 49 34 36 Bases (unweighted) 346 Source: McAree T, Jacobs B, Manickavasagar T et al. Vitamin D deficiency in pregnancy - still a public health issue. Matern Child Nutr. 2013. 9; 23-30. Table 31: Pregnant women in Southampton Pregnant women taking part in Southampton Women's Survey Serum 25-hydroxyvitamin D (nmol/L)** Median 62.0 Inter quartile range 43-89 % below 75nmol/L 63.4 % below 50nmol/L 35.1 Bases (unweighted) 977 *Mean age 30.4 years **Measured at 34 weeks gestation. Blood samples taken throughout year. Season of sampling was most important predictor of higher 25(OH)D concentration Source: Crozier SR, Harvey NC, Inskip HM et al Vi.tamin D status in pregnancy is associated with adiposity in the offspring: findings from the Southampton Women's Survey. AJCN. 2012. 96; 57-63 Table 32: Pregnant women* in South West England, by trimester ALSPAC study 1991 / 1992 Serum 25-hydroxyvitamin D (nmol/L)** 1st trimester 2nd trimester 3rd trimester Median 55.1 60.1 67.4 Inter quartile range 40.7 - 74.1 41.4 - 83.4 46.8 - 93.0 % below 50 nmol/L 34% % below 27.5 nmol/L 6% Bases (unweighted) 1035 879 2,046 *Mainly white European; mean age 29 years. **Blood samples collected throughout year. Source: Lawlor DA, Wills AK, Fraser A et al. Association of maternal vitamin D status during pregnancy with bone-mineral content in offspring: a prospective cohort study. Lancet. 2013; 381(9884): 2176-83. 281
Table 33: England – by ethnicity, adults (aged 16 years and over) Health Survey for England 2010 Ethnic Group Serum 25-hydroxyvitamin D (nmol/L) White Mixed Asian Black Other Mean 45.8 [31] 20.5 27.7 [22.4] Median 43.0 [24] 15.0 23.0 [18] % below 25 nmol/L 21 [52] 74.8 54.2 [63.9] Bases (unweighted) 3,548 [25] 135 72 [36] Table: 34: Asian children aged 2 years in England Asian Infant Feeding Survey 1996 Ethnic group Plasma 25-hydroxyvitamin D (nmol/L)* Bangladeshi Pakistani Indian Mean 42.1 36.2 42.2 Median 37.5 30.0 37.5 SD 21.30 19.60 22.50 Upper 2.5 th percentile 91.2 92.5 102.5 Lower 2.5 th percentile 16.5 14.5 14.7 % below 25 nmol/L 20 34 25 % below 20 nmol/L 13 18 13 % below 12.5 nmol/L 0 0 0 Bases (unweighted) 139 200 279 *Blood samples collected October/November 282
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Vitamin D and Health i 2016
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Contents Preface ..................
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Preface The Scientific Advisory Com
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Adviser (Ultraviolet radiation expo
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Ms Gemma Paramor Lay representative
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Metabolism S.5 Vitamin D is convert
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Two studies reported an increase in
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Recommendations S.35 Serum 25(OH)D
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1.8 The terms of reference were: to
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1.18 In assessing the evidence on v
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there is not absolute correspondenc
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Metabolism Absorption of dietary vi
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UVB ▼ SKIN: ▼ Previtamin D 3
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2.49 A number of studies have repor
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using a bolus dose (I 2 =77%) compa
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2.75 Another RCT 21 (Cashman et al.
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3. Photobiology of vitamin D Ultrav
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Erythema and skin cancer 3.10 Two m
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CIE spectrum for photoconversion of
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Effect of skin pigmentation on skin
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increase in mean serum 25(OH)D conc
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4. Measuring vitamin D exposure (fr
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the authors cautioned care in the i
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24,25(OH) 2 D 3 which can contribut
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5. Relationship between vitamin D e
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latitudes > 49.5 o N or S (which we
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increase 25(OH)D concentrations > 5
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22.5 nmol/L (IQR, 16.8-34.3) in sum
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6.7 Although serum 25(OH)D concentr
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calcium intake, although this is mo
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Evidence considered (Tables 1-5, An
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6.43 Preece et al. (1975) measured
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irths (December-February) in the vi
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large loss to follow-up 45 and, sin
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6.81 A pilot RCT in India (Khadilka
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Evidence considered (Tables 16-18,
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Intervention studies 6.107 A 3-year
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Compared with men in the top quarti
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chair-rising test. Mean baseline se
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heterogeneity among trials for dose
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the 600 µg (24,000 IU) vitamin D 3
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Bone health indices beyond rickets
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Intervention studies 6.177 An RCT i
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maternal serum 25(OH)D concentratio
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Cancers 6.201 Ecological studies ha
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(Gallicchio et al., 2010; Mondul et
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6.226 A systematic review and meta-
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Summary - CVD and hypertension 6.23
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6.251 VDRs are expressed in cells o
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10 nmol/L increase in cord blood 25
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Evidence considered since IOM repor
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difference was not significant (RR=
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6.304 Out of 7 RCTs published subse
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(300 µg/12,000 IU per capsule) for
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serum 25(OH)D concentration in neon
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linked specific VDR gene polymorphi
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factors that affect cancer risk. Ob
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As a result, cut-offs for deficienc
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7.8 The IOM noted the paucity of lo
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years) compared to the placebo grou
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children (n=179) received weekly do
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8. Dietary vitamin D intakes and se
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Food FISH TABLE 1- Vitamin D conten
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Serum/plasma 25(OH)D concentrations
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Serum/plasma 25(OH)D concentration
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9. Review of DRVs for vitamin D Bri
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musculoskeletal health at serum 25(
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Modelling the summer sunshine expos
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9.30 Two possible approaches were c
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FIGURE 8: Relation between serum 25
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UK general population aged under 11
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Summary & conclusions 9.59 The RNI
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10. Overall summary and conclusions
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tight homeostatic control. As a mar
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10.30 Evidence from RCTs suggest th
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Serum/plasma 25(OH)D concentration
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10.53 An RNI of 10 µg/d (400 IU/d)
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11. Recommendations 11.1 Serum 25(O
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References Abnet CC, Chen Y, Chow W
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Beadle PC, Burton JL & Leach JF (19
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Brooke OG, Brown IR, Bone CD, Carte
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Clarke B (2008) Normal bone anatomy
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Diffey BL (2010) Modelling the seas
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Ganji V, Milone C, Cody MM, McCarty
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Heaney RP, Armas LA, Shary JR, Bell
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Javaid MK, Crozier SR, Harvey NC, G
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Lappe J, Cullen D, Haynatzki G, Rec
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Mantell DJ, Owens PE, Bundred NJ, M
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Murad MH, Elamin KB, Abu Elnour NO,
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Pirotta S, Kidgell DJ & Daly RM (20
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one mass, and renal function in the
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Sperati F, Vici P, Maugeri-Sacca M,
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Vervel C, Zeghoud F, Boutignon H, T
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Weisse K, Winkler S, Hirche F, Herb
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Annexes ANNEX (1) SACN working proc
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ANNEX (2) Studies considered in rel
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Cardiovascular disease Table 40 Tab
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Study/year/country Population Ricke
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Table 2: Observational studies on r
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Table 3: Before and after studies o
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Table 4: Case control studies on ri
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Table 5: Intervention studies on ri
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Table 7: Case reports of osteomalac
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Table 9: Cohort studies on associat
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Children and adolescents Table 11:
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Table 13: Intervention studies on e
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Table 16: RCTs on effects of vitami
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Table 22: Meta-analyses of trials o
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Table 24: Prospective studies on as
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Table 25: Meta-analyses of RCTs on
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Table 27: Prospective studies on as
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Table 28: Meta-analyses of RCTs on
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Study Methods Results Author conclu
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NON-MUSCULOSKELETAL HEALTH OUTCOMES
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Table 32: Intervention studies on e
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Table 36: Observational studies on
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Table 38: Meta analyses of RCTs and
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Table 39: Prospective studies on 25
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Study/Country Population Mean follo
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Cardiovascular disease Table 40: Me
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Hypertension Table 42: Meta-analyse
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All-cause mortality Table 44: Syste
Page 245 and 246: Immune modulation Table 46: Systema
Page 247 and 248: Table 48: Intervention studies on v
Page 249 and 250: Reference/Country Population Follow
Page 251 and 252: Infectious disease Table 50: Meta-a
Page 253 and 254: Table 51: RCTs on vitamin D supplem
Page 255 and 256: Table 52: Observational studies on
Page 257 and 258: Neuropsychological functioning Tabl
Page 259 and 260: Abbreviations used in studies 25(OH
Page 261 and 262: Table 1: Percentage contribution of
Page 263 and 264: Table 2 (continued) Food group a Me
Page 265 and 266: Table 3 (continued) Food group Age
Page 267 and 268: Table 4 (continued) Food group a Ag
Page 269 and 270: Table 5 (continued) Food group a Na
Page 271 and 272: Table 6: Percentage contribution of
Page 273 and 274: Table 7: Average daily intake of vi
Page 275 and 276: Table 9: Average daily intake of Vi
Page 277 and 278: Table 11: Average daily intake of v
Page 281 and 282: Table 15: Average daily intake of V
Page 285 and 286: Serum/plasma 25(OH)D concentrations
Page 287 and 288: Table 20: UK - Adults and children
Page 289 and 290: Table 22: Northern Ireland - adults
Page 291 and 292: Table 24: England - adults 65 years
Page 293 and 294: Table 26: UK - by month blood sampl
Page 295: Table 29: English regions by season
Page 299 and 300: Table 36: Scotland - by Body Mass I
Page 301 and 302: Calcitonin A peptide hormone, produ
Page 303 and 304: Osteoclast Osteocyte Osteoid Osteom
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Vitamin D and Health

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