14 signs of vitamin d deficiency in adults14 signs of vitamin d deficiency in adults

The USPSTF evaluated 11 randomized clinical trials of vitamin D and/or calcium supplementation in a total of 51,419 healthy, community-dwelling adults aged 50 years and older who did not have osteoporosis, vitamin D deficiency, or prior fractures [75,76]. Drug-vitamin D interactions: A systematic review of the literature. Brooks SPJ, Sempos CT. A condition in which the parathyroid gland produces too much parathryoid hormone and can cause problems with the bones and other organs. The analysis of 20152016 data also showed that 28% of all individuals aged 2 years and older in the United States took a dietary supplement containing vitamin D [39]. However, comparing vitamin D intakes to serum 25(OH)D levels is problematic. These include: 1. No studies have examined whether such screening for vitamin D deficiency results in improved health outcomes [55]. The concurrent presence of fat in the gut enhances vitamin D absorption, but some vitamin D is absorbed even without dietary fat. The USPSTF stated that, due to insufficient evidence, it was unable to assess the balance of benefits and harms of supplemental vitamin D to prevent cancer [117]. In practice, however, people usually do not apply sufficient amounts of sunscreen, cover all sun-exposed skin, or reapply sunscreen regularly. Endocrinol Metab Clin North Am 2017;46:947-82. To update its 2014 recommendation statement, the USPSTF commissioned a systematic review 26,27 of the evidence on screening for vitamin D deficiency, including the benefits and harms of screening and early treatment. [, Pittas A, Dawson-Hughes B, Sheehan P, Ware JH, Knowler WC, Aroda VR, et al. Overall, the risk of CVD events was 10% lower for each 25 nmol/L (10 ng/mL) increase in serum 25(OH)D. Another large observational study that followed 247,574 adults from Denmark for 07 years found that levels of 25(OH)D that were low (about 12.5 nmol/L [5 ng/mL]) and high (about 125 nmol/L [50 ng/mL]) were associated with a greater risk of mortality from CVD, stroke, and acute myocardial infarction [121]. Calcium is a mineral essential for healthy bones and is also important for muscle contraction, heart action, and normal blood clotting. fatigue, muscle weakness, and. Serum 25-hydroxyvitamin D concentrations and risk of prostate cancer: Results from the Prostate Cancer Prevention Trial. Borel P, Caillaud D, Cano NJ. Irregular heartbeats. If a healthcare professional finds that you have a deficiency, they may recommend the following options. Rickets. Pharmacotherapy 2002;22:814-22. If you're getting sick often, you may be deficient in vitamin D. Fatigue. Cancer JAMA 2020;324:471-80. Arch Intern Med 2005;165:1618-23. Am J Clin Nutr 2008;88:558S-64S. Because vitamin D increases calcium absorption in the gastrointestinal tract, vitamin D toxicity results in marked hypercalcemia (total calcium greater than 11.1 mg/dL, beyond the normal range of 8.4 to 10.2 mg/dL), hypercalciuria, and high serum 25(OH)D levels (typically greater than 375 nmol/l [150 ng/mL]) [155]. The goals of treating and preventing the lack of vitamin D are the same. [, Simon AE, Ahrens KA. Hansen D, Bazell C, Pelizzari P, Pyenson B. Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, et al. PLOS ONE 2014;9:e111265. [, Stolzenberg-Solomon RZ, Vieth R, Azad A, Pietinen P, Taylor PR, Virtamo J, et al. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D. Many tissues have vitamin D receptors, and some convert 25(OH)D to 1,25(OH)2D. Bone health and osteoporosis Vitamin D bioavailability: State of the art. Your doctor may consider vitamin D injections. Vitamin D helps regulate the renin-angiotensin-aldosterone system (and thereby blood pressure), vascular cell growth, and inflammatory and fibrotic pathways [118]. Increasing incidence of nutritional rickets: A population-based study in Olmsted County, Minnesota. JAMA Oncol 2017;3:351-7. Overall, clinical trials show that vitamin D supplementation does not reduce CVD risk, even for people with low 25(OH)D status (below 20 nmol/L [12 ng/mL]) at baseline [93,124]. Season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis. other information we have about you. Vitamin D also appears to play a role in insulin production and immune function and how this relates to chronic disease prevention and cancer but this is still being investigated. But where does it come from? For many people, consuming vitamin D-fortified foods and exposing themselves to some sunlight are essential for maintaining a healthy vitamin D status. Although UVB exposure can produce vitamin D in infants, the American Academy of Pediatrics (AAP) advises parents to keep infants younger than 6 months out of direct sunlight, dress them in protective clothing and hats, and apply sunscreen on small areas of exposed skin when sun exposure is unavoidable [59]. Curr Opin Gastroenterol 2008;24:176-83. Pediatrics 2020;145:e20193574. The effect of vitamin D supplementation on glycemic control in type 2 diabetes patients: A systematic review and meta-analysis. Vitamin D deficiency can occur for a number of reasons: You don't consume the recommended levels of the vitamin over time. However, FoodData Central does not include the amounts of 25(OH)D in foods. [, Calvo MS, Whiting SJ, Barton CN. Starting at age 70, the Recommended Dietary Allowance or RDA is 800 IU (20 mcg). Nutritional rickets among children in the United States: Review of cases reported between 1986 and 2003. Observational studies support an association between higher serum 25(OH)D levels and a lower risk of CVD incidence and mortality. [. J Clin Endocrinol Metab 2016;101:1647-55. [. Osteoporosis causes weakened bones and a higher-than-normal risk of fractures. Zbynek Pospisil/iStock. Here are 14 signs of vitamin D deficiency. However, no 25(OH)D3 dietary supplements appear to be available to consumers on the U.S. market at this time [32]. The vitamin D paradox in Black Americans: A systems-based approach to investigating clinical practice, research, and public healthexpert panel meeting report. Jones G. Vitamin D. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Thiazide diuretics (e.g., Hygroton, Lozol, and Microzide) decrease urinary calcium excretion. People with limited sun exposure However, a post hoc analysis showed a 62% lower incidence of diabetes among participants with low baseline serum 25(OH)D levels (less than 30 nmol/L [12 ng/mL]) who took the vitamin D supplement than among those who took the placebo [145,150]. Cancer. [, Rooney MR, Harnack L, Michos ED, Ogilvie RP, Sempos CT, Lutsey PL. [, Wactawski-Wende J, Kotchen JM, Anderson GL, Assaf AR, Brunner RL, O'Sullivan MJ, et al. [, Jorde R, Grimnes G. Vitamin D: No cure for depression. Evidence Synthesis Number 118. If we combine this information with your protected Am J Clin Nutr 2012;95:1357-64. In addition, the USPSTF recommended against supplementation with 10 mcg (400 IU) or less of vitamin D and 1,000 mg or less of calcium to prevent fractures in this population, but it could not determine the balance of benefits and harms from higher doses. Very limited evidence suggests no substantial differences in the bioavailability of vitamin D from various foods [19]. A dose-response analysis found that each 20 nmol/L [8 ng/mL] increase in 25(OH)D was associated with a 9% lower risk of both all-cause and prostate cancer-specific mortality. People with obesity or who have undergone gastric bypass surgery N Engl J Med 2007;357:266-81. LeBoff MS, Chou SH, Ratliff KA, Cook NR, Khurana B, Kim E, et al. [, Chalcraft JR, Cardinal LM, Wechsler PJ, Hollis BW, Gerow KG, Alexander BM, et al. The combination of high intakes of calcium (about 2,100 mg/day from food and supplements) with moderate amounts of vitamin D (about 19 mcg [765 IU]/day from food and supplements) increased the risk of kidney stones by 17% over 7 years among 36,282 postmenopausal women who were randomly assigned to take 1,000 mg/day calcium and 10 mcg (400 IU)/day vitamin D or a placebo [161]. doi: 10.3390/nu10040493. [, Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, Gluud C. Vitamin D supplementation for prevention of cancer in adults. RDAs for vitamin D are listed in both micrograms (mcg) and international units (IU); 1 mcg vitamin D is equal to 40 IU (Table 2). Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. Black Americans, for example, typically have lower serum 25(OH)D levels than White Americans. [, Jiang X, Dimou NL, Al-Dabhani K, Lewis SJ, Martin RM, Haycock PC, et al. Check with your health care provider . This U-shaped association was most pronounced for men with the most aggressive forms of prostate cancer. One nmol/L is equal to 0.4 ng/mL, and 1 ng/mL is equal to 2.5 nmol/L. A case-control analysis of 1,695 cases of prostate cancer and 1,682 controls found no associations between 25(OH)D levels and prostate cancer risk [110]. Vitamin D Deficiency: How Much Vitamin D Is Enough? [, Schenk JM, Till CA, Tangen CM, Goodman PJ, Song X, Torkko KC, et al. Again, the pattern was similar for the risk of inadequacy. [, Vogiatzi MG, Jacobson-Dickman E, DeBoer MD. To meet this level, choose foods that are rich in vitamin D. For example, choose fatty fish, such as salmon, trout, tuna and halibut, which offer higher amounts of vitamin D, or fortified foods, such as milk and yogurt. [, McNamara M, Rosenberger KD. It concluded "with moderate certainty" that vitamin D supplementation does not reduce the numbers of falls or injuries, such as fractures, resulting from falls [77,78]. In some cases, fortified foods and dietary supplements are useful when it is not possible otherwise to meet needs for one or more nutrients (e.g., during specific life stages such as pregnancy).". [, Lukert BP, Raisz LG. For example, a meta-analysis of 21 studies that included 11,941 men with prostate cancer and 13,870 controls found a 17% higher risk of prostate cancer for participants with higher levels of 25(OH)D [108]. Most participants had minimal or mild depression, had a low mean baseline 25(OH) level of 33.8 nmol/L (13.5 ng/mL), and were not taking antidepressants. Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%98%) healthy individuals; often used to plan nutritionally adequate diets for individuals. U.S. Preventive Services Task Force. Studies examining the effects of supplemental vitamin D on muscle strength and on rate of decline in muscle function have had inconsistent results [55]. If you feel fatigued often, then you might have a vitamin D deficiency. [, Pathak K, Soares MJ, Calton EK, Zhao Y, Hallett J. Vitamin D supplementation and body weight status: A systematic review and meta-analysis of randomized controlled trials. One study included 1,119 men treated for prostate cancer whose plasma 25(OH)D levels were measured 4.9 to 8.6 years after their diagnosis. A systematic review and meta-analysis of 15 weight-loss intervention studies that used caloric restriction, exercise, or both, but not necessarily vitamin D supplementation or other treatments, found that people who lost weight had significantly greater increases in serum 25(OH)D levels than those who maintained their weight [152]. In addition, studies provided different amounts of nutrients and used different dosing schedules. [, Gowda U, Mutowo MP, Smith BJ, Wluka AE, Renzaho AMN. include protected health information. The first hydroxylation, which occurs in the liver, converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as "calcidiol." Circulating vitamin D concentrations and risk of breast and prostate cancer: A Mendelian randomization study. A 2018 Cochrane review analyzed 12 such trials that had a total of 933 participants with MS; the reviewers judged all of these trials to be of low quality [137]. [, Aloia JF, Li-Ng M, Pollack S. Statins and vitamin D. Am J Cardiol 2007;100:1329. The impact of this form on vitamin D status is an emerging area of research. [, Jorde R, Sollid ST, Svartberg J, Schirmer H, Joakimsen RM, Njolstad I, et al. Breastfed babies dont get enough vitamin D from breast milk, so they need to take supplements. Pages 939-57 in Feldman D, Pike JW, Bouillon R, Giovannucci E, Goltzman D, Hewison M, eds. Vitamin D deficiency is the state of having inadequate amounts of vitamin D in your body, which may cause health problems like brittle bones and muscle weakness. Circulating concentrations of vitamin D in relation to pancreatic cancer risk in European populations. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) Children 1-13 years: 600 IU. Pale or yellowish skin. Circulating 25-hydroxyvitamin D concentration and risk of breast, prostate, and colorectal cancers: The Melbourne Collaborative Cohort Study. Magnesium helps activate vitamin D, so you can take this mineral. An analysis of NHANES 20092016 data found that only 20.5% of breastfed infants and 31.1% of infants who were not breastfed ingested these recommended amounts of supplements [60]. A healthcare professional can diagnose vitamin D deficiency through a blood test. Vitamin D is also needed for the normal development and growth of muscle fibers. Fortified foods provide most of the vitamin D in American diets [1,22]. Just like adults, children are considered to be deficient if their levels fall below 20 ng/mL (50 nmol/L) (6, 8, 9 An animals diet affects the amount of vitamin D in its tissues. The FNB committee also noted that serum concentrations greater than 125 nmol/L (50 ng/mL) can be associated with adverse effects [1] (Table 1). Am J Clin Nutr 2019;110:1119-30. The Lancet Diabetes & Endocrinology. About 2.3 million osteoporotic fractures occurred in the United States in 2015 [73]. Steroids The trials administered different amounts of vitamin D (ranging from 10 mcg [400 IU]/day to 1,000 mcg [40,000 IU]/week). Vitamin D and cardiovascular disease: Controversy unresolved. It allows your intestine to absorb calcium from dietary sources, and 2. In serum, 25(OH)D has a fairly long circulating half-life of 15 days [1]. [, Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Vitamin D 20 000 IU per week for five years does not prevent progression from prediabetes to diabetes. Vitamin D supplements and prevention of cancer and cardiovascular disease. J Natl Cancer Inst 2007;100:1581-91. No substantial between-group differences in fracture incidence were found by race, ethnic group, BMI, age, baseline 25(OH)D levels, or whether participants took supplemental calcium, were at high fracture risk, or had a history of fragility fractures. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. Terms of Use. AHRQ-Pub No. Most people in the world meet at least some of their vitamin D needs through exposure to sunlight [1]. However, clinical trials do not support a cause-and-effect relationship between vitamin D and weight loss. This helps protect older adults from osteoporosis. Journal of Nutrition Science 2018;7:1-7. Join the ODS Email List. Even though sunlight is a major source of vitamin D for some people, the FNB based the vitamin D RDAs on the assumption that people receive minimal sun exposure [1]. Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. More information about assay standardization is available from the Vitamin D Standardization Program webpage. For more information about building a healthy dietary pattern, refer to the Dietary Guidelines for Americans and the U.S. Department of Agriculture's MyPlate. Vitamin D deficiency or insufficiency did not increase the risk of prostate cancer, and higher 25(OH)D concentrations were not associated with a lower risk. Association of serum level of vitamin D at diagnosis with breast cancer survival: A case-cohort analysis in the Pathways Study. A randomized, double-blind, placebo-controlled trial. Vitamin A deficiency can lead to many complications, including: Eye problems: Vitamin A is a key factor in many functions of your eyes. Environ Health Perspect 2017;125(7):077004. The largest clinical trial, VITAL, to investigate the effects of vitamin D supplementation on the primary prevention of cancer in the general population gave 50 mcg (2,000 IU)/day vitamin D3 supplements with or without 1,000 mg/day marine omega-3 fatty acids or a placebo for a median of 5.3 years [93]. Association of glucocorticoid use and low 25-hydroxyvitamin D levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006. Effect of vitamin D supplementation on blood pressure: A systematic review and meta-analysis incorporating individual patient data. Severe asthma in children. For men with prostate cancer, whether vitamin D supplementation lengthens cancer-related survival is not clear. This article. The U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to assess the benefits and harms of screening for vitamin D deficiency in asymptomatic adults [6]. The results showed that baseline serum 25(OH)D levels were inversely associated with total number of CVD events (including myocardial infarction, ischemic heart disease, heart failure, and stroke) and mortality risk [120]. N Engl J Med 2019;381:1785-6. Obtaining sufficient vitamin D from natural (nonfortified) food sources alone is difficult. MedicineNet does not provide medical advice, diagnosis or treatment. In older adults, severe vitamin D deficiency (levels less than 10 ng/mL) may also contribute to an increased risk of falls. Vitamin D deficiency is associated with vascular dysfunction, arterial stiffening, left ventricular hypertrophy, and hyperlipidemia [119]. However, there are professional societies in the United States that feel that a level of at least 30 ng/ml is required for optimal skeletal health. [, McCullough ML, Zoltick ES, Weinstein SJ, Fedirko V, Wang M, Cook NR, et al. Vitamin D, calcium, and cancer: Approaching daylight? Jin, J. Vitamin D and calcium supplements for preventing fractures. Some of the most common risk factors for vitamin D deficiency are having dark skin. Vitamin D is a fat-soluble vitamin that plays a vital role in calcium absorption to give you healthy and strong bones. [, Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. What is Vitamin D Deficiency? Protects heart and blood health. [, Beveridge LA, Struthers AD, Khan F, Jorde R, Scragg R, Macdonald HM, et al. Problems sleeping well: This can be a sign of low vitamin D levels for a few reasons. Vitamin D supplementation for the prevention of depression and poor physical function in older persons: The D-Vitaal study, a randomized clinical trial. In addition, older adults are likely to spend more time than younger people indoors, and they might have inadequate dietary intakes of the vitamin [1]. However, because the extent and frequency of sunscreen use are unknown, the role that sunscreen may play in reducing vitamin D synthesis is unclear [1]. [, Bouillon R. Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol 2017;13:466-79. J Clin Endocrinol Metab 2011;96:3838-45. Preventive Medicine 2013;57:753-64. People with conditions that limit fat absorption [, Quesada-Gomez JM, Bouillon R. Is calcifediol better than cholecalciferol for vitamin D supplementation? Several studies published in 2014 suggested that high levels of 25(OH)D might increase the risk of prostate cancer. Laboratory and animal studies suggest that vitamin D might inhibit carcinogenesis and slow tumor progression by, for example, promoting cell differentiation and inhibiting metastasis. The emerging issue of 25-hydroxyvitamin D in foods. Depending on other health conditions, your doctor may also prescribe: Ensuring a normal vitamin D level in patients with fat malabsorption issues, including cystic fibrosis and Crohns disease, can be challenging and may require very high doses of supplements. Individuals with a body mass index (BMI) of 30 or more have lower serum 25(OH)D levels than individuals without obesity. Falling sick often Vitamin D plays a key role in the immune system, and so the lack of it can . Infertility: Vitamin A plays an important role in your reproductive system. Through nutritional supplements. These guidelines present evidence based recommendations on vitamin D screening, diagnosis, supplementation, and . Osteoporosis is, in part, a long-term effect of calcium and/or vitamin D insufficiency, in contrast to rickets and osteomalacia, which result from vitamin D deficiency. Role of vitamin D in atherosclerosis. If you are diagnosed with the condition and follow treatment recommendations, you will likely be able to increase your intake to an acceptable level, which should eliminate any symptoms or long-term problems. Vitamin D supplementation has no effect on insulin sensitivity or secretion in vitamin D-deficient, overweight or obese adults: A randomized placebo-controlled trial. Vitamin D Deficiency and COVID-19: Is There a Connection? The study included 25,871 men aged 50 years and older and women aged 55 years and older who had no history of cancer, and most had adequate serum 25(OH)D levels at baseline. However, it may increase the risk of long term health problems. Very high levels of vitamin D have not been shown to provide greater benefits. Am J Clin Nutr 2019;109:1578-87. [, Dibaba DT. U.S. Department of Health and Human Services. Importantly, not all observational studies found higher vitamin D status to be beneficial, and the studies varied considerably in study populations, baseline comorbidities, and measurement of vitamin D levels. [, Moyer VA. Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive Services Task Force recommendation statement. Mayo Clinic does not endorse companies or products. Washington DC: Wiley-Blackwell, 2012. Because vitamin D is fat soluble, its absorption depends on the guts ability to absorb dietary fat [4]. [, Creo AL, Thacher TD, Pettifor JM, Strand MA, Ficsher PR. There may be no symptoms and doctors dont routinely check vitamin D levels, so many people are deficient and dont realize it. The recommended daily allowance for vitamin D for children and adults is 600 IU (15 mcg) until age 70. The second hydroxylation occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as "calcitriol" [1]. August 12, 2022 However, the results did show an increased risk of pancreatic cancer with 25(OH)D levels of 100 nmol/L (40 ng/mL) or above [107]. Assessing the vitamin D status of the US population. In a trial in Norway, 511 men and women aged 2580 years (mean age 62 years) with prediabetes received 500 mcg (20,000 IU) vitamin D3 or a placebo each week for 5 years [149]. However, more than 20 mcg (800 IU)/day vitamin D3, when taken with calcium supplements, significantly increased blood pressure in participants with overweight and obesity. Vitamin D had no significant effects on glucose homeostasis, insulin secretion or resistance, or hemoglobin A1c levels (a measure of average blood sugar levels over the previous 23 months), irrespective of the study population, vitamin D dose, or trial quality. [, Sempos CT, Binkley N. 25-hydroxyvitamin D assay standardisation and vitamin D guidelines paralysis. Additionally, some people have health conditions that make it difficult for them to absorb vitamin D, including: It has been suggested that vitamin D deficiency may play a role in certain conditions, such as fibromyalgia, chronic fatigue syndrome, and multiple sclerosis. Find out which foods are the best source of this nutrient. Includes a variety of vegetables; fruits; grains (at least half whole grains); fat-free and low-fat milk, yogurt, and cheese; and oils. [, Keum N, Giovannucci E. Vitamin D supplements and cancer incidence and mortality: A meta-analysis. International Journal of Epidemiology 2019;48:1416-24. Serum concentrations of 25(OH)D and health In 20132014, an estimated 3.2% of the U.S. adult population took supplements containing 100 mcg (4,000 IU) or more vitamin D [41]. We dont feel that there is any measurable benefit when 25-hydroxyvitamin D levels exceed 50 ng/mL.. Vitamin D obtained from sun exposure, foods, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. Clinical management of low vitamin D: A scoping review of physicians' practices. [, Song Z-y, Yao Q, Zhuo Z, Ma Z, Chen G. Circulating vitamin D level and mortality in prostate cancer patients: A dose-response meta-analysis. Calcium plus vitamin D supplementation and the risk of colorectal cancer. The recommended amounts, in international units (IU), are: Birth to 12 months: 400 IU. https://www.ncbi.nlm.nih.gov/books/NBK56070/. information submitted for this request. N Engl J Med 2006;354:669-82. N Engl J Med 2019;381:520-30. Studies show that 25(OH)D appears to be approximately five times more potent than the parent vitamin for raising serum 25(OH)D concentrations [17,20,21]. In addition, studies have not consistently shown that vitamin D supplementation tempers the signs and symptoms of active MS or reduces rates of relapse. Vitamin A Fact Sheet | Vitamina A Hoja Informativa Vitamin D Vitamin D builds strong bones by helping the body absorb calcium 7. Mushrooms provide variable amounts of vitamin D2 [17]. A recognised consequence of low vitamin D is osteomalacia in adults. [, Yao S, Kwan ML, Ergas IJ, Roh JM, Cheng T-YD, Hong C-C, et al. They also had different study durations (5 days to 5 years), mean participant ages (range, 22 years to 75 years), and baseline 25(OH)D levels; furthermore, some but not all studies administered concurrent antidepressant medications. Calcium plus vitamin D supplementation and health outcomes five years after active intervention ended: The Women's Health Initiative. A review of 71 observational studies in adults with and without type 2 diabetes from 16 countries found a significant inverse relationship between vitamin D status and blood sugar levels in participants who did and did not have diabetes [146]. The actual prevalence of vitamin D deficiency depends on what is defined as a level of vitamin D in the blood that is considered sufficient to maintain musculoskeletal health. Consumption of human milk alone does not ordinarily enable infants to meet vitamin D requirements, because it provides less than 0.6 to 2.0 mcg/L (25 to 78 IU/L) [1,56,57]. Moderate use of commercial tanning beds that emit 2% to 6% UVB radiation is also effective [13,29]. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Vitamin D and calcium: A systematic review of health outcomes. A few studies have examined the effect of vitamin D supplementation on specific cancers. The second trial included 155 adults aged 6080 years who had clinically relevant depressive symptoms, no major depressive disorder, and serum 25(OH)D levels less than 50 to 70 nmol/L (20 to 28 ng/mL) depending on the season; in addition, they were not taking antidepressants [133,134]. Conclusions about vitamin D supplements and bone health Older adults are at increased risk of developing vitamin D insufficiency, partly because the skin's ability to synthesize vitamin D declines with age [1,61]. privacy practices. Rates of deficiency varied by race and ethnicity: 17.5% of non-Hispanic Blacks were at risk of vitamin D deficiency, as were 7.6% of non-Hispanic Asians, 5.9% of Hispanics, and 2.1% of non-Hispanic White people. Few people near the equator develop the disease, whereas the prevalence is higher further north and south. No studies have evaluated whether vitamin D supplements may benefit individuals under medical care for clinical depression who have low or deficient 25(OH)D levels and are taking antidepressant medication. Some mushrooms available on the market have been treated with UV light to increase their levels of vitamin D2.