Abstract
Vitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland, an updated recommendation for the prevention, diagnosis and treatment of vitamin D deficiency. A systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations. The updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care. Vitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there is a great necessity to implement a regular supplementation with recommended doses and to develop an effective strategy to alleviate vitamin D deficiency in the population. These updated recommendations are addressed to health professionals and the authorities pursuing comprehensive health policies and should also be included in public health programs aimed at preventing a broad spectrum of chronic diseases.
Highlights
Calcitriol [1,25-dihydroxycholecalciferol (1,25(OH)2D)], an active form of vitamin D, due to its action belongs to a broad group of hormones, being transcription factors of genes for target proteins
Biological action of calcitriol is mediated by the intracellular, highly specific vitamin D receptor (VDR)—a transcription factor modulated by a ligand that belongs to the family of genomic receptors for steroids, thyroid hormones and retinoids
It should be emphasized that at the general population level, vitamin D supplementation with use of daily doses that are recommended for a given age and body mass is safe and reasonable, whereas the incidence of vitamin D hypersensitivity seems to be low or at least it should be precisely investigated
Summary
Calcitriol [1,25-dihydroxycholecalciferol (1,25(OH)2D)], an active (hormonal) form of vitamin D, due to its action belongs to a broad group of hormones, being transcription factors of genes for target proteins. Biological action of calcitriol is mediated by the intracellular, highly specific vitamin D receptor (VDR)—a transcription factor modulated by a ligand that belongs to the family of genomic receptors for steroids, thyroid hormones and retinoids. In 2017 The Board of the Polish Society of Pediatric Endocrinology and Diabetes came up with an initiative on verifying and updating ruling recommendations on prevention and management of vitamin D deficiency, both in the general population and in the risk groups. In cooperation with the European Vitamin D Association (EVIDAS) and other scientific societies and National Consultants, the Expert Panel was constituted to elaborate current guidelines for supplementation and treatment with vitamin D, based on recent literature reviews, personal clinical experience and critical discussion
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