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Current Recommended Vitamin D Intake May Not Be Optimal

The investigators suggest that with the current recommended daily allowance, the optimal level is not attainable for most. "Recent evidence suggests that vitamin D intakes above current recommendations may be associated with better health outcomes," write Heike A. Bischoff-Ferrari, from the Harvard School of Public Health in Boston, Massachusetts, and colleagues. "However, optimal serum concentrations of 25-hydroxyvitamin D [25(OH)D] have not been defined."

The authors review findings from studies that evaluated thresholds for serum 25(OH)D concentrations in relation to bone mineral density (BMD), lower extremity function, dental health, and risk of falls, fractures, and colorectal cancer.

For these end points, the most advantageous serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best range from 90 to 100 nmol/L (36–40 ng/mL). In most persons, these concentrations could not be reached with the currently recommended daily intakes of 200 IU vitamin D for younger adults and 600 IU vitamin D for older adults.

After comparing vitamin D intakes with achieved serum concentrations of 25(OH)D for the purpose of estimating optimal intakes, the authors suggest that an increase in the currently recommended intake of vitamin D is warranted for better bone health in younger adults and for all studied outcomes in older adults.

"An intake for all adults of >/=1000 IU (40 µg) vitamin D (cholecalciferol)/day is needed to bring vitamin D concentrations in no less than 50% of the population up to 75 nmol/L," the authors write. "The implications of higher doses for the entire adult population should be addressed in future studies…. Given the low cost, the safety, and the demonstrated benefit of higher 25(OH)D concentrations, vitamin D supplementation should become a public health priority to combat these common and costly chronic diseases."

Practice Pearls:
· PTH suppression and prediction of BMD and clinical outcomes of fracture, fall prevention, and dental health may be used to determine optimal 25(OH)D serum levels and vitamin D intake.

· The optimal 25(OH)D level based on clinical outcomes is between 90 and 100 nmol/L and the associated vitamin D intake recommended to maintain these levels for 50% of adults is 700 to 1000 IU/day.

Am J Clin Nutr. 2006;84:18-28

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