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Review

Vitamin D supplementation: Pearls for practicing clinicians

Susan E. Williams, MS, RD, MD, CCD, FACE, FAND
Cleveland Clinic Journal of Medicine March 2022, 89 (3) 154-160; DOI: https://doi.org/10.3949/ccjm.89a.21021
Susan E. Williams
Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH; Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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    TABLE 1

    Minimum requirements for vitamin D as defined by the Endocrine Society guidelines

    Patient characteristicsMinimum requirementCommentsa
    Age 19–50600 IU/dayIncreasing and maintaining the 25(OH)D level consistently above 30 ng/mL may require at least 1,500–2,000 IU/day
    Age 51–70600 IU/dayTo maximize bone health and muscle function
    Age ≥ 65800 IU/dayFor the prevention of falls and fractures
    Pregnant and lactating female patients600 IU/dayAt least 1,500–2,000 IU/day may be needed to maintain a blood level of 25(OH)D above 30 ng/dL
    Adults with obesityGive at least 2 to 3 times more vitamin D to meet bodily requirements
    • ↵a With the recommendation not to exceed 4,000 IU daily maintenance dose.

    • IU = international units; 25(OH)D = 25-hydroxyvitamin D

    • Based on information in reference 10.

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    TABLE 2

    Vitamin D content of selected foods

    FoodMicrograms per servingInternational units per servingPercent of daily valuea
    Cod-liver oil, 1 tablespoon34.01,360170
    Trout (rainbow), farmed, cooked, 3 ounces16.264581
    Salmon (sockeye), cooked, 3 ounces14.257071
    Mushrooms, white, raw, sliced, exposed to ultraviolet light, ½ cup9.236646
    Milk, 2% milkfat, vitamin D fortified, 1 cup2.912015
    Soy, almond, and oat milks, vitamin D fortified2.5–3.6100–14413–18
    Ready-to-eat cereal, fortified with 10% of the daily valuea for vitamin D, 1 serving2.08010
    Sardines (Atlantic), canned in oil, drained, 2 sardines1.2466
    Egg, 1 large, scrambledb1.1446
    Liver, beef, braised, 3 ounces1.0425
    Tuna (light), canned in water, drained, 3 ounces1.0405
    Cheese, cheddar, 1 ounce0.3122
    • ↵a Daily value (DV) was developed by the US Food and Drug Administration to help consumers compare the nutrient contents of foods and dietary supplements within the context of a total diet. The DV for vitamin D is 20 μg (800 IU) for adults and children age 4 years and older. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet.

    • ↵b The vitamin D is in the yolk.

    • Based on information in reference 1.

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Cleveland Clinic Journal of Medicine: 89 (3)
Cleveland Clinic Journal of Medicine
Vol. 89, Issue 3
1 Mar 2022
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Vitamin D supplementation: Pearls for practicing clinicians
Susan E. Williams
Cleveland Clinic Journal of Medicine Mar 2022, 89 (3) 154-160; DOI: 10.3949/ccjm.89a.21021

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Vitamin D supplementation: Pearls for practicing clinicians
Susan E. Williams
Cleveland Clinic Journal of Medicine Mar 2022, 89 (3) 154-160; DOI: 10.3949/ccjm.89a.21021
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  • Article
    • ABSTRACT
    • VITAMIN D DEFICIENCY AND CURRENT RECOMMENDATIONS
    • HOW TO REPLACE VITAMIN D
    • CLINICAL SCENARIO 1: VITAMIN D2 OR D3?
    • CLINICAL SCENARIO 2: PHOTOTHERAPY TO COUNTER MALABSORPTION?
    • CLINICAL SCENARIO 3: VITAMIN D DEFICIENCY WITH HYPERCALCEMIA
    • CLOSING THOUGHTS
    • DISCLOSURES
    • REFERENCES
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