Seven years after the conclusion that evidence was insufficient to recommend screening for vitamin D deficiency in the general population, the US Task Force (USPSTF) reconsidered the problem – and came to the same conclusion.
In general, ‘the current evidence is insufficient to determine whether the screening for and treatment of asymptomatic low 25 (OH) D levels improves the clinical outcomes in adults in the community,’ the Task Force concludes in its statement and recommends’ n ‘I’ to for insufficient.
The statement was published online on April 13 JAMA.
In the absence of screening recommendations, clinicians may be best advised to focus on diet and supplementation for those at risk, said Anne R. Cappola, MD, of the Perelman School of Medicine at the University of Pennsylvania. , Philadelphia, said.
“Instead of asking the question of examining the general population for vitamin D deficiency, we should focus on ensuring that everyone consumes the recommended daily intake of vitamin D,” said Cappola, a co-author of the accompanying article. editorial, said Medscape Medical News.
No studies have directly assessed the benefits of screening
The latest USPSTF recommendation is based on a systematic review of the pros and cons of screening and early treatment for vitamin D deficiency in asymptomatic, non-pregnant adults 18 years or older in primary care, with no signs or symptoms of deficiency .
In the review, no studies were found that directly assessed the benefits of screening for vitamin D deficiency.
26 randomized clinical trials and one nested case-control study evaluated the effectiveness of treating vitamin D deficiency with supplementation.
And although observational studies have linked lower vitamin D levels to a multitude of conditions and risks, evidence of any benefit has been inconsistent, and none of the major results have been identified in asymptomatic adults – the focus of the Task Force recommendation.
“Among asymptomatic, community-dwelling populations with low vitamin D levels, evidence suggests that vitamin D treatment has no effect on mortality or the incidence of fractures, falls, depression, diabetes, cardiovascular disease, cancer, or adverse events,” he said. the reviews authors emphasize.
“The evidence is unconvincing about the effect of treatment on physical functioning and infection.”
1 out of 4 is Vitamin D deficiency
In terms of the further question of the possible harm to vitamin D screening of asymptomatic individuals, the main concern is the possibility of misclassification and over- or underdiagnosis due to inconsistent cut-off points and variability of different screening assessments, the review concludes.
With the rare exception of vitamin D toxicity due to supplementation being much higher than adequate, treatment with vitamin D supplementation seems relatively safe.
With a lack of consensus even on the basic cut-off for vitamin D deficiency, the National Academy of Medicine determined in 2011 that hydroxyvitamin D (25[OH]D) levels below 20 ng / ml are deficient for the health of the bone, without evidence of different thresholds for any other health condition.
Based on this cut-off, the National Health and Nutrition Examination Survey (NHANES) reported in 2014 that 25% of the U.S. population older than 1 year has vitamin D deficiency, and 18% of the population has 25 (OH) D levels of 12 to 19 ng / ml and 5% with very low levels (<12 ng / ml).
More work needed to endanger groups
Although the Task Force report did not investigate tests or treatment recommendations for symptomatic adults, the main risk factors that can help clinicians identify those with vitamin D deficiency, including obesity, little or no exposure to UVB light and older age.
In general, obesity is associated with a 1.3- to two-fold risk of having vitamin D deficiency, based on the criteria used, while non-Hispanic blacks are 2 to 10 times more likely to be deficient compared to with non-Spanish white patients, the Task Magnotas.
However, the effects of vitamin D deficiency in certain populations may differ. Non-Hispanic black people, although they have a higher incidence of lower vitamin D levels compared to white people, have lower fractures.
To address the various issues and gain a better understanding of the complexity of vitamin D deficiency, the Task Force calls for further research in key areas.
“More research is needed to determine whether total serum 25 (OH) D levels are the best measure of vitamin D deficiency and whether the best measure of vitamin D deficiency varies according to subgroups defined by race, ethnicity or gender, “indicates them.
Furthermore, “more research is needed to determine the cut-off point that defines vitamin D deficiency and whether the cut-off point according to specific clinical outcomes or by subgroups defined by race, ethnicity, or gender.”
No support for population-based selection in guidelines
As there is no conclusive evidence, no organizations currently recommend population studies for vitamin D deficiency in asymptomatic patients, and the American Society for Clinical Pathology endorses this view.
The Endocrine Association and the American Association of Clinical Endocrinologists (AACE) meanwhile recommend the screening for vitamin D deficiency in patients considered at risk.
The data show that there was an 80% increase in Medicare reimbursement volumes for vitamin D testing among clinicians from 2000 to 2010; however, it may have declined after the National Academy of Medicine reported on fixed deficiency levels, said Sherri-Ann M. Burnett-Bowie, managing director, MPH, Cappola’s editorial co-author.
Burnett-Bowie noted that she regularly tests her patients’ vitamin D levels, but most of her patients have osteoporosis or fractures.
“I do examine them for vitamin D deficiency, as optimizing their vitamin D will improve calcium absorption, which is important for treating osteoporosis.” Medscape Medical News.
As for the broader testing of asymptomatic patients in the general population, changes in screening are likely to depend on the development in the effects of treatment, she said.
“Given the challenge of finding benefits of vitamin D supplementation in those with a deficiency, it will probably be more difficult to find benefits from a broader screening,” she concluded.
The USPSTF and editorial reported no relevant financial ratios.
JAMA. Published on April 13, 2021. Statement, Review, Editorial
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