What are the recommended vitamin D supplementation guidelines for adults and children?

From the Guidelines

The recommended vitamin D supplementation for most adults is 600-800 IU (15-20 mcg) daily, with adults over 70 needing the higher end of this range, and for children, recommendations are 400 IU (10 mcg) daily for infants under 12 months and 600 IU (15 mcg) daily for children 1-18 years old, as supported by the most recent and highest quality study 1.

Key Considerations

• The ESPGHAN Committee on Nutrition recommends a total daily vitamin D intake of 400 IU/day for infants and 600 IU/day for children and adolescents 1.
• The Institute of Medicine recommends daily dietary vitamin D intake of 600 IU in adults aged 18 to 70 years and 800 IU in adults older than 70 years 1.
• Vitamin D supplementation is essential for calcium absorption and bone health, immune function, and may help prevent various chronic diseases.

Special Populations

• Preterm infants on PN should receive 200-1000 IU/day (or 80-400 IU/kg/day) of vitamin D, term infants up to 12 months of age 400 IU/day (or 40-150 IU/kg/day), and older children 400-600 IU/day 1.
• Paediatric patients receiving long-term PN should be monitored periodically for vitamin D deficiency, and additional supplementation with vitamin D should be provided if 25(OH) vitamin D serum concentrations are < 50 nmol/L 1.

Safety and Efficacy

• Prolonged daily intake up to 10,000 IU or up to serum concentrations of 25(OH)D of 240 nmol/L appears to be safe, while serum concentrations >375 nmol/L are associated with acute hypercalcaemia and hyperphosphataemia 1.
• Tolerable upper intake levels identified by the IOM are 1000 IU/day for infants ages 0-6 months, 1500 IU/day for infants ages 7-12 months, 2500 IU/day for children ages 1-3 years, 3000 IU/day for children ages 4-8 years, and 4000 IU/day for children and adolescents ages 9-18 years (and adults) 1.

From the Research

Vitamin D Supplementation Guidelines

The recommended vitamin D supplementation guidelines for adults and children vary based on factors such as age, health status, and risk of deficiency.

• For children younger than 1 year of age, the US Institute of Medicine recommends 400 IU per day 2.
• For children at least 1 year of age and adults up to 70 years, the recommended dose is 600 IU per day 2.
• For older adults, the recommended dose is 800 IU per day 2.
• The US Endocrine Society suggests higher doses, ranging from 400-1000 IU per day for children aged less than 1 year, 600-1000 IU per day for children aged 1 year or more, and 1500-2000 IU per day for adults aged 19 years or more 2.

Special Considerations

Certain populations may require higher doses of vitamin D due to increased risk of deficiency or malabsorption.

• Patients with inflammatory bowel disease or gastric bypass may need more vitamin D to sustain their vitamin D status 2.
• Obese or multi-morbidity and multi-treatment patients may require daily or weekly "high doses" of cholecalciferol, such as 7000 IU daily or 30,000 IU per week 3.
• The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases recommends daily vitamin D allowance ranging from 1,500 IU (healthy adults) to 2,300 IU (elderly with low calcium intake) 4.

Serum 25-Hydroxyvitamin D Levels

The serum 25-hydroxyvitamin D [25(OH)D] level is used to assess vitamin D repletion.

• The US Institute of Medicine concludes that a serum 25(OH)D level of 20 ng/ml or more will cover the requirements of 97.5% of the population 2.
• The US Endocrine Society suggests that a level of 30 ng/ml or more is optimal 2.
• Other studies suggest that a daily dose of 2000 IU (50 µg) of vitamin D may be sufficient to raise and maintain serum 25(OH)D concentrations above 50 nmol/L (20 ng/mL) and above 75 nmol/L (30 ng/mL) in >99% and >90% of the general adult population, respectively 5.