Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute & State University, Blacksburg, VA 24061, USA.
Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA 24016, USA.
Nutrients. 2018 Apr 16;10(4):493. doi: 10.3390/nu10040493.
The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Thirteen studies published between 2006 and 2015 across seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining a light on physicians’ practices in the face of uncertainty. Future research is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.
近年来，维生素 D 在预防和治疗非骨骼健康问题方面的作用引起了媒体和研究的广泛关注。与临床管理维生素 D 缺乏症（LVD）相关的成本呈指数级增长。然而，没有明确的证据支持维生素 D 筛查可以改善健康结果。权威机构和专业协会不建议对无症状或患 LVD 风险低的社区居住成年人进行人群维生素 D 筛查。为了评估在这种矛盾环境下医生管理 LVD 的模式，我们对三个电子数据库和灰色文献进行了范围综述。符合纳入标准的 38 份记录被总结在一个证据表中。7 个国家在 2006 年至 2015 年期间发表的 13 项研究表明，维生素 D 实验室检测及其相关费用持续增加。许多维生素 D 检测模式反映了筛查，而不是针对维生素 D 缺乏或不足高危人群的有针对性的检测。短期干预措施对于管理与 LVD 相关的不适当临床实践是有效的。在许多维生素 D 管理方面存在着广泛的变异性和争议，这突显了医生在面对不确定性时的实践情况。未来需要进行研究，为更好的临床指南提供信息，并评估实施措施，以鼓励成年人群中基于证据的 LVD 管理。
