Vitamin D3 Dose Requirement That Raises 25-Hydroxyvitamin D to Desirable Level in Overweight and Obese Elderly

Dania S Bacha, Maya Rahme, Laila Al-Shaar, Rafic Baddoura, Georges Halaby, Ravinder J Singh, Ziyad R Mahfoud, Robert Habib, Asma Arabi, Ghada El-Hajj Fuleihan, Dania S Bacha, Maya Rahme, Laila Al-Shaar, Rafic Baddoura, Georges Halaby, Ravinder J Singh, Ziyad R Mahfoud, Robert Habib, Asma Arabi, Ghada El-Hajj Fuleihan

Abstract

Context: Guidelines for the dosage of vitamin D supplementation vary widely globally.

Objective: To investigate the impact of 2 vitamin D doses, bracketed between the IOM recommended dietary allowance (RDA) and the upper tolerable limit, on vitamin D nutritional status in elderly individuals.

Methods: This post hoc analysis of data collected from a 12-month, double-blind, randomized control trial included 221 ambulatory participants (≥ 65 years) with a mean BMI of 30.2 kg/m2 and a mean baseline serum 25-hydroxyvitamin D [25(OH)D] level of 20.4 ± 7.4 ng/mL, who were recruited from 3 outpatient centers in Lebanon. All participants received 1000 mg of elemental calcium daily from calcium citrate plus the daily equivalent of either 600 IU or 3750 IU of vitamin D3.

Results: Mean 25(OH)D level at 12 months was 26.0 ng/mL with low dose and 36.0 ng/mL with high dose vitamin D3. The proportion of participants reaching a value ≥ 20 ng/mL was 86% in the low dose, and 99% in the high dose arms, with no gender differences. The increment of 25(OH)D per 100 IU/day was 1 ng/mL with the low dose, and 0.41 ng/mL with the high dose. Serum 25(OH)D levels at 1 year were highly variable in both treatment arms. Baseline 25(OH)D level and vitamin D dose-but not age, BMI, gender, or season-were significant predictors of serum 25(OH)D level post-intervention.

Conclusion: The IOM Recommended Dietary Allowance (RDA) of 600 IU/day does not bring 97.5% of ambulatory elderly individuals above the desirable threshold of 20 ng/mL. Country-specific RDAs are best derived taking into account the observed variability and predictors of achieved 25(OH)D levels.

Trial registration: ClinicalTrials.gov NCT01315366.

Keywords: IOM; RDA; desirable level; elderly; guidelines; vitamin D.

© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.

Figures

Figure 1.
Figure 1.
Change in each participant’s 25(OH)D level (ng/mL) from baseline to follow-up after 12 months of supplementation with low and high doses of vitamin D3. Median 25(OH)D levels in the low dose arm were 20 ng/mL and 25 ng/mL at baseline and after 12 months, respectively. Median 25(OH)D levels in the high dose arm were 18.5 ng/mL and 35 ng/mL at baseline and after 12 months, respectively.
Figure 2.
Figure 2.
Proportion of subjects with a serum 25(OH)D level ≥ 20 ng/mL and ≥ 30 ng/mL at baseline and after 1 year of supplementation with (A) low dose of 600 IU/day and (B) high dose of 3750 IU/day. †Paired t-test P value between baseline and after 1 year is <0.001. ‡Pearson chi-square P value between high and low doses is <0.001.
Figure 3.
Figure 3.
Dynamically fit sigmoidal curves illustrating the % of subjects reaching a spectrum of desirable serum 25(OH)D levels at 1 year overall (A), in the low dose arm (B), and the high dose arm (C).
Figure 4.
Figure 4.
A, Bland-Altman plot illustrating the overlap in delta 25(OH)D between the high dose and low dose arms. B, Corresponding Bland-Altman plot of the low dose arm showing regression analysis of the delta 25(OH)D ng/mL with changing baseline 25(OH)D levels (y = −0.60x + 18.0 [R2 = 30%]). C, Corresponding Bland-Altman plot of the high dose arm showing regression analysis of the delta 25(OH)D ng/mL with changing baseline 25(OH)D levels (y = −0.58x + 27.3 [R2 = 19%]).

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