Vitamin D supplementation in a nursing home population

Abstract

To determine if daily supplementation of 2000 IU of vitamin D(3) is able to normalize the 25(OH)D(3) status in a nursing home population, a group particularly prone to Vitamin D insufficiency. A chart review was performed to retrospectively determine the 25(OH)D(3) level in each nursing home patient (N=68) who had received a minimum of 5 months of daily 2000 IU vitamin D(3) supplementation. 94.1% of nursing home residents had a 25(OH)D(3) level in excess of 80 nmol/L after a minimum of 5 months of daily 2,000 IU vitamin D(3) supplementation. No residents had 25(OH)D(3) levels in a toxic range. In order to improve health and well-being and to preclude preventable morbidity and mortality associated with 25(OH)D(3) insufficiency, all nursing home patients without contraindication should be routinely supplemented with (at minimum) 2000 IU of vitamin D(3) on a daily basis.

A Predictive Equation to Guide Vitamin D Replacement Dose in Patients

“…71 The likely causes of widespread deficiency are reduced exposure to sunlight because of decreased outdoor work and activity, increased attention to the role of sun exposure as a contributor to skin cancers and increased use of sunscreens, widespread overweight/obesity, and perhaps a reduction in the consumption of milk. [72][73][74][75][76][77][78] Overweight/obesity reduces serum concentrations of 25-hydroxyvitamin D through dilution of this fat-soluble vitamin in the adipose tissue; as presented here, overweight/obese individuals require higher replacement doses of vitamin D. 76 -78 The need for higher doses of vitamin D in nursing home patients is probably due to a lack of exposure to sun, since increased age was not a negative factor in the response to vitamin D treatment. 78 Using change as the dependent variable has been faulted by experts in statistical analysis.…”

“…[72][73][74][75][76][77][78] Overweight/obesity reduces serum concentrations of 25-hydroxyvitamin D through dilution of this fat-soluble vitamin in the adipose tissue; as presented here, overweight/obese individuals require higher replacement doses of vitamin D. 76 -78 The need for higher doses of vitamin D in nursing home patients is probably due to a lack of exposure to sun, since increased age was not a negative factor in the response to vitamin D treatment. 78 Using change as the dependent variable has been faulted by experts in statistical analysis. 79 However, the results of regression analyses were not meaningfully different when using change and posttreatment serum concentrations of 25-hydroxyvitamin D as the dependent variables.…”

“…Please note that compliance was not an issue in the nursing home; however, the data from nursing home patients indicated the need for even higher doses than those required by ambulatory patients. 78 In nursing home patients, among whom the administration of medication is better controlled, the same observation held true: generally recommended doses of vitamin D were inadequate for maintaining normal concentrations or correcting states of deficiency. It is noteworthy that the average increase in serum concentrations of 25-hydroxyvitamin D were only 1.9 ng/mL for each episode of treatment among nursing home patients, as shown in Table 3.…”

A Canadian response to the 2010 Institute of Medicine vitamin D and calcium guidelines

“…Accurate assessment had shown the vitamin D content of human milk in 'normal' lactating women to be less than 2.5 mg/l (3,7) . We had shown that lactating women exposed to UV light or given high oral doses of vitamin D to control hypoparathyroidism could produce milk that contained extremely high levels of antirachitic activity of up to 200 mg/l (8,9) . This increase in activity was almost totally due to the parent compound, vitamin D, gaining access to the milk and not the major circulating form, 25-hydroxyvitamin D (25(OH)D) (8,9) .…”

“…We had shown that lactating women exposed to UV light or given high oral doses of vitamin D to control hypoparathyroidism could produce milk that contained extremely high levels of antirachitic activity of up to 200 mg/l (8,9) . This increase in activity was almost totally due to the parent compound, vitamin D, gaining access to the milk and not the major circulating form, 25-hydroxyvitamin D (25(OH)D) (8,9) . But, how could this knowledge be applied to 'normal' women since it was 'well known' that intakes of vitamin D in excess of 50 mg/d would result in toxicity?…”