REVIEW PAPER
Vitamin D: Between deficiency and excess – challenges for public health
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1
Uniwersytecki Szpital Kliniczny im. Jana Mikulicza-Radeckiego, Wrocław, Polska
2
Dolnośląski Szpital Specjalistyczny im. T. Marciniaka – Centrum Medycyny Ratunkowej, Wrocław, Polska
Corresponding author
Mateusz Łukasz Mendowski
Dolnośląski Szpital Specjalistyczny im. T. Marciniaka - Centrum Medycyny Ratunkowej, Gen. A.E. Fieldorfa 2, 54-049, Wrocław, Polska
Med Srod. 2023;26(1-2):2-7
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
Vitamin D requirements are not always met by diet and transdermal synthesis. The consequences of its deficiency include bone demineralization, immune system dysfunction, or muscle weakness and pain. Therefore, in many cases, adequate supplementation is recommended. However, an increased awareness of society and prevalence of supplementation frequently lead to its abuse.
The aim of the study is to highlight the issue of vitamin D supplementation in society with a particular focus on the causes and consequences of its excessive intake.
Brief description of the state of knowledge:
There is limited information on the prevalence of vitamin D intoxication. However, the available data indicate that the number of cases has increased in recent years. The reason for excess of vitamin D is the intake of very high doses of the vitamin, which may be caused by manufacturing errors and accidental or intentional overdose. It appears to be particularly dangerous when parents give excessive doses to their children. Hypervitaminosis D can lead to serious health consequences, including cardiac arrhythmias, kidney failure, neurological disorders, or even death. During supplementation, it is important to choose licensed preparations, which contain recommended dosages, as overuse of vitamin D not only has no benefit, but can also be harmful.
Summary:
Vitamin D is essential for normal body function. Both its insufficiency and excess should be considered harmful for human health. Only licensed products should be used for supplementation, as their dosage is consistent with the recommended guidelines of health organisations.
REFERENCES (57)
1.
Sizar O, Khare S, Goyal A, et al. Vitamin D Deficiency. Endocrinol Diabetes A Probl Approach. 2022;9781461486848:293–304.
2.
Cashman KD. Vitamin D Deficiency: Defining, Prevalence, Causes, and Strategies of Addressing. Calcif Tissue Int. 2020;106(1):14–29.
3.
Pfotenhauer KM, Shubrook JH. Vitamin D deficiency, its role in health and disease, and current supplementation recommendations. J Am Osteopath Assoc. 2017;117(5):301–305.
4.
Manson JE. Vitamin D and the heart: Why we need large-scale clinical trials. Cleve Clin J Med. 2010;77(12):903–910.
5.
Zmijewski MA. Vitamin D and Human Health. Int J Mol Sci. 2019;20(1). doi:10.3390/IJMS20010145.
6.
Chauhan K, Shahrokhi M, Huecker MR. Vitamin D. 2022. Treasure Island (FL).
7.
Pludowski P, Holick MF, Grant WB, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018;175:125–135.
8.
Taylor PN, Davies JS. A review of the growing risk of vitamin D toxicity from inappropriate practice. Br J Clin Pharmacol. 2018;84(6):1121.
9.
Galior K, Grebe S, Singh R. Development of Vitamin D Toxicity from Overcorrection of Vitamin D Deficiency: A Review of Case Reports. Nutrients. 2018;10(8). doi:10.3390/NU10080953.
10.
Alshahrani F, Aljohani N. Vitamin D: deficiency, sufficiency and toxicity. Nutrients. 2013;5(9):3605–3616.
12.
Płudowski P, Kos-Kudła B, Walczak M, et al. Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland. Nutrients. 2023;15(3). doi:10.3390/NU15030695.
13.
Liu W, Zhang L, Xu HJ, et al. The Anti-Inflammatory Effects of Vitamin D in Tumorigenesis. Int J Mol Sci. 2018;19(9). doi:10.3390/IJMS19092736.
14.
Galesanu C, Mocanu V. Vitamin D deficiency and the clinical consequences. Rev Med Chir Soc Med Nat Iasi. 2015;119(2):310–318.
15.
Siddiqee MH, Bhattacharjee B, Hasan M, et al. Risk perception of sun exposure and knowledge of vitamin D among the healthcare providers in a high-risk country: a cross-sectional study. BMC Med Educ. 2023;23(1):1–12.
16.
Taylor PN, Davies JS. A review of the growing risk of vitamin D toxicity from inappropriate practice. Br J Clin Pharmacol. 2018;84(6).
17.
Ponti L, Gabutti L, Faré PB, et al. Vitamin D Supply of Multivitamins Commercialized Online by Amazon in Western and Southern Europe: A Labeling Analysis. Nutrients. 2023;15(2). doi:10.3390/NU15020326/S1.
18.
Ronsoni MF, Santos H de C Dos, Colombo B da S, et al. Hypercalcemia and acute renal insufficiency following use of a veterinary supplement. J Bras Nefrol. 2017;39(4):467–469.
19.
Dudenkov DV, Yawn BP, Oberhelman SS, et al. Changing Incidence of Serum 25-Hydroxyvitamin D Values Above 50 ng/mL: A 10-Year Population-Based Study. Mayo Clin Proc. 2015;90(5):577.
20.
Ekwaru JP, Zwicker JD, Holick MF, et al. The Importance of Body Weight for the Dose Response Relationship of Oral Vitamin D Supplementation and Serum 25-Hydroxyvitamin D in Healthy Volunteers. PLoS One. 2014;9(11). doi:10.1371/JOURNAL.PONE.0111265.
21.
Pietras SM, Obayan BK, Cai MH, et al. Vitamin D2 treatment for vitamin D deficiency and insufficiency for up to 6 years. Arch Intern Med. 2009;169(19):1806–1808.
22.
Spiller HA, Good TF, Spiller NE, et al. Vitamin D exposures reported to US poison centers 2000–2014: Temporal trends and outcomes. Hum Exp Toxicol. 2016;35(5):457–461.
23.
Krajowa Rada Radiofonii i Telewizji. Emisja przekazów handlowych produktów zdrowotnych i leków w programach telewizyjnych. 2015;110–112.
24.
Wierzejska RE, Wiosetek-Reske A, Siuba-Strzelińska M, et al. Health-Related Content of TV and Radio Advertising of Dietary Supplements—Analysis of Legal Aspects after Introduction of Self-Regulation for Advertising of These Products in Poland. Int J Environ Res Public Health. 2022;19(13). doi:10.3390/IJERPH19138037/S1.
25.
Łyko M, Kruzel M, Kuś A, et al. Sun protection among university students in Poland: a survey of awareness and attitudes. Adv Dermatology Allergol Dermatologii i Alergol. 2021;38(6):961.
26.
Tran V, Janda M, Lucas RM, et al. Vitamin D and Sun Exposure: A Community Survey in Australia. Curr Oncol. 2023;30(2):2465–2481.
27.
Holman DM, Berkowitz Z, Guy GP, et al. The association between beliefs about vitamin D and skin cancer risk-related behaviors. Prev Med (Baltim). 2017;99:326.
28.
Tabbakh T, Wakefield M, Dobbinson SJ. Concerns about vitamin D and sun exposure behaviour among Australians. Health Promot J Austr. 2021;32(3):399–406.
29.
Patel S, Patel S, Shah RM, et al. Effects of sun protection on serum vitamin D deficiency. Photodermatol Photoimmunol Photomed. 2022. doi:10.1111/PHPP.12838.
30.
Passeron T, Bouillon R, Callender V, et al. Sunscreen photoprotection and vitamin D status. Br J Dermatol. 2019;181(5):916.
31.
Máčová L, Bičíková M. Vitamin D: Current Challenges between the Laboratory and Clinical Practice. Nutrients. 2021;13(6). doi:10.3390/NU13061758.
32.
Sowah D, Fan X, Dennett L, et al. Vitamin D levels and deficiency with different occupations: a systematic review. BMC Public Health. 2017;17(1). doi:10.1186/S12889-017-4436-Z.
33.
Wiciński M, Adamkiewicz D, Adamkiewicz M, et al. Impact of Vitamin D on Physical Efficiency and Exercise Performance—A Review. Nutrients. 2019;11(11). doi:10.3390/NU11112826.
34.
Oliosa PR, Oliosa EMR, Alvim R de O, et al. Association of sun exposure and seasonality with vitamin D levels in Brazilian children and adolescents. Rev Paul Pediatr. 2023;41:e2021361.
35.
Kara C, Gunindi F, Ustyol A, et al. Vitamin D Intoxication Due to an Erroneously Manufactured Dietary Supplement in Seven Children. Pediatrics. 2014;133(1):e240–e244.
36.
Araki T, Holick MF, Alfonso BD, et al. Vitamin D Intoxication with Severe Hypercalcemia due to Manufacturing and Labeling Errors of Two Dietary Supplements Made in the United States. J Clin Endocrinol Metab. 2011;96(12):3603–3608.
38.
LeBlanc ES, Perrin N, Johnson JD, et al. Over-the-counter and compounded vitamin D: is potency what we expect? JAMA Intern Med. 2013;173(7):585–586.
39.
Khadgawat R, Ramot R, Chacko KM, et al. Disparity in cholecalciferol content of commercial preparations available in India. Indian J Endocrinol Metab. 2013;17(6):1100.
40.
Garg S, Sabri D, Kanji J, et al. Evaluation of vitamin D medicines and dietary supplements and the physicochemical analysis of selected formulations. J Nutr Health Aging. 2013;17(2):158–161.
41.
Bell DA, Crooke MJ, Hay N, et al. Prolonged vitamin D intoxication: presentation, pathogenesis and progress. Intern Med J. 2013;43(10):1148–1150.
42.
Kara C, Gunindi F, Ustyol A, et al. Vitamin D intoxication due to an erroneously manufactured dietary supplement in seven children. Pediatrics. 2014;133(1). doi:10.1542/PEDS.2013-0711.
43.
Benemei S, Gallo E, Giocaliere E, et al. It’s time for new rules on vitamin D food supplements. Br J Clin Pharmacol. 2013;76(5):825.
44.
Marins TA port, Galvao T de FG, Korkes F, et al. Vitamin D intoxication: case report. Einstein. 2014;12(2):242.
45.
Jacobus CH, Holick MF, Shao Q, et al. Hypervitaminosis D associated with drinking milk. N Engl J Med. 1992;326(18):1173–1177.
46.
Blank S, Scanlon KS, Sinks TH, et al. An outbreak of hypervitaminosis D associated with the overfortification of milk from a home-delivery dairy. Am J Public Health. 1995;85(5):656.
47.
Narvaez J, Maldonado G, Guerrero R, et al. Vitamin D Megadose: Definition, Efficacy in Bone Metabolism, Risk of Falls and Fractures. Open Access Rheumatol Res Rev. 2020;12:105.
48.
Janoušek J, Pilařová V, Macáková K, et al. Vitamin D: sources, physiological role, biokinetics, deficiency, therapeutic use, toxicity, and overview of analytical methods for detection of vitamin D and its metabolites. Crit Rev Clin Lab Sci. 2022 Dec;59(8):517-554. doi: 10.1080/10408363.2022.2070595.
49.
Wan M, Patel A, Patel JP, et al. Quality and use of unlicensed vitamin D preparations in primary care in England: Retrospective review of national prescription data and laboratory analysis. 2020. doi:10.1111/bcp.14521.
50.
Kerstens PJ, van Ditzhuijsen TJ, van Tongeren JH. [Mega-dosages vitamin D: progressive medicine?]. Ned Tijdschr Geneeskd. 1990;134(40):1959–1961.
51.
Rocha PN, Santos CS, Avila MO, et al. Hypercalcemia and acute kidney injury caused by abuse of a parenteral veterinary compound containing vitamins A, D, and E. J Bras Nefrol ’orgao Of Soc Bras e Latino-Americana Nefrol. 2011;33(4):467–471.
52.
Rajakumar K, Reis EC, Holick MF. Dosing error with over-the-counter vitamin D supplement: A risk for vitamin D toxicity in infants. Clin Pediatr (Phila). 2013;52(1):82.
53.
Ketha H, Wadams H, Lteif A, et al. Iatrogenic vitamin D toxicity in an infant--a case report and review of literature. J Steroid Biochem Mol Biol. 2015;148:14–18.
54.
Bilbao NA. Vitamin D Toxicity in Young Breastfed Infants: Report of 2 Cases. Glob Pediatr Heal. 2017;4. doi:10.1177/2333794X17731695.
55.
Pandita KK, Razdan S, Kudyar RP, et al. ‘Excess gooD can be Dangerous’. A case series of iatrogenic symptomatic hypercalcemia due to hypervitaminosis D. Clin cases Miner bone Metab Off J Ital Soc Osteoporosis, Miner Metab Skelet Dis. 2012;9(2):118–120.
56.
Bansal RK, Tyagi P, Sharma P, et al. Iatrogenic hypervitaminosis D as an unusual cause of persistent vomiting: a case report. J Med Case Rep. 2014;8(1):74.
57.
Chowdry AM, Azad H, Najar MS, et al. Acute kidney injury due to overcorrection of hypovitaminosis D: A tertiary center experience in the Kashmir Valley of India. Saudi J Kidney Dis Transpl. 2017;28(6):1321–1329.