Conclusions
Many of the vitamin D randomised controlled trials described in this Personal View were performed in the healthiest and wealthiest groups in the population. Therefore, future research studies need to be performed in underserved populations who often have very low concentrations of vitamin D (ie, less than 25 nmol/L [10 ng/mL]), poor nutrition, and a high burden of chronic diseases. Subgroup analysis of patients from these clinical studies with serum 25(OH)D concentrations of less than 25 nmol/L (10 ng/mL) suggest a relationship with type 2 diabetes, upper respiratory infections, and asthma, but additional trials in these groups are needed. New trials will only be possible with multicentre studies or consortia using a common protocol. Currently, studies are most often restricted to universities and pharmaceutical companies that have the resources to support large dose finding studies.
For the general population, evidence suggests that the generally accepted vitamin D RDA of 600–800 IU per day should be continued. This recommendation is partly because larger doses that increase serum 25(OH)D concentrations to over 75 nmol/L (30 ng/mL) have not reduced disease burden and, in fact, appear to have caused harm in the older population. Using this guideline there should be no need to measure serum 25(OH)D concentrations in the healthy population. Testing can instead be focused on people at higher risk, with diseases that could affect vitamin D metabolism—eg, patients with malabsorption syndromes, individuals on steroid therapy, or older people who are housebound—when measurement of serum 25(OH)D can be clinically helpful.
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