Abstract
med, who plans to continue prescribing 800 to 1000 IU of vitamin D for her patients. Holick goes further, recommending 1000 IU of vitamin D per day for children and 2000 to 3000 IU for adults. That some laboratories use clinical reference values above 30 ng/mL as the cut point for adequate vitamin D was also worrisome to the IOM committee, which declared an “urgent need” to standardize the assay and develop consensus reference values. “There is no central authority to set standards for these tests, and some labs are declaring people deficient in vitamin D when their blood levelswouldsuggest theyarenot,” saidRoss. Nor should physicians routinely order the assay for all their patients, according to the committee. “In the last couple of years we’ve seen a dramatic increase in the vitamin D assay as part of routine medical care, and this is probably to a great degree unnecessary,” said oncologist Steven K. Clinton, MD, PhD, professor of internal medicine at Ohio State University and member of the IOM committee. “Physicians should judge the risk of low vitamin D in each individual patient and then decide whether the assay should be ordered.” Clinton also stressed that the IOM’s recommendations are for the general, healthy population and do not pertain to people with medical conditions that can cause malabsorption of vitamin D and calcium. In evaluating vitamin D’s “purported” role in preventing numerous diseases, the IOM committee said the paucity of randomized clinical trials and conflicting evidence from observational studies led it to conclude that the nutrient’s links to outcomes other than bone health is “best described as hypotheses of emerging interest.” Added Ross, “We describe the biological plausibility that vitamin D may have an effect on certain cancers, for example, and we know that in animal models there are some good data. But we were not able to take the currently available clinical data and use that information to define DRIs.”
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