Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
Curr Opin Gastroenterol. 2012 Mar;28(2):139-50. doi: 10.1097/MOG.0b013e32835004dc.
PURPOSE OF REVIEW: To summarize recommendations from the 2011 US Institute of Medicine report (on vitamin D) and the new guideline from the US Endocrine Society with emphasis on treating and preventing vitamin D deficiency, including patients with inflammatory bowel disease and prior gastric bypass. RECENT FINDINGS: The US Institute of Medicine Recommended Dietary Allowance of vitamin D is 400 IU per day for children younger than 1 year of age, 600 IU per day for children at least 1 year of age and adults up to 70 years, and 800 IU per day for older adults. The US Institute of Medicine concluded that serum 25-hydroxyvitamin D [25(OH)D] of 20 ng/ml or more will cover the requirements of 97.5% of the population. The US Endocrine Society's Clinical Practice Guideline suggested that 400-1000 IU per day may be needed 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 to maintain 25(OH)D above the optimal level of 30 ng/ml. Patients with inflammatory bowel disease even in a quiescent state and those with gastric bypass malabsorb vitamin D and need more vitamin D to sustain their vitamin D status. SUMMARY: Difference in the recommendations from the US Institute of Medicine and the US Endocrine Society's Practice Guideline reflects different goals and views on current evidence. Significant gaps remain in the literature, and studies of vitamin D treatment assessing changes in outcomes at different 25(OH)D levels are needed.
目的综述:总结 2011 年美国医学研究所(关于维生素 D)报告和美国内分泌学会新指南的建议,重点是治疗和预防维生素 D 缺乏症,包括炎症性肠病和胃旁路手术患者。
最新发现:美国医学研究所建议儿童(年龄小于 1 岁)每天摄入维生素 D 推荐膳食允许量为 400IU,1 岁及以上儿童和成人每天摄入 600IU,70 岁及以上老年人每天摄入 800IU。美国医学研究所得出结论,血清 25-羟维生素 D [25(OH)D] 达到 20ng/ml 或更高,可满足 97.5%人群的需求。美国内分泌学会临床实践指南建议,年龄小于 1 岁的儿童每天需摄入 400-1000IU,1 岁及以上儿童每天需摄入 600-1000IU,19 岁及以上成年人每天需摄入 1500-2000IU,以保持 25(OH)D 水平高于 30ng/ml 的最佳水平。即使处于静止状态的炎症性肠病患者和胃旁路手术吸收不良的患者也需要更多的维生素 D 来维持其维生素 D 状态。
总结:美国医学研究所和美国内分泌学会实践指南的建议存在差异,这反映了对现有证据的不同目标和观点。文献中仍存在显著差距,需要研究不同 25(OH)D 水平下评估维生素 D 治疗对结局变化的影响。
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