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Vitamin D Measurement: Clinical Practice and Research Implications

Published:November 24, 2022DOI:https://doi.org/10.1016/j.nurpra.2022.10.010

      Highlights

      • Emerging evidence identifies vitamin D’s role in extraskeletal health conditions.
      • Evidence-based vitamin D supplementation recommendations remain controversial.
      • Vitamin D laboratory assays are variable and not universally standardized.
      • Lack of assay standardization attenuates comparison and pooling of results.
      • Vitamin D measurement challenges impact nurses’ clinical and research decisions.

      Abstract

      Vitamin D is a complex vitamin that influences physiology and pathophysiology across the lifespan. Vitamin D research has increased exponentially in the last decade, influencing discussions about its measurement and appropriateness of the current clinical guidelines. This report summarizes the challenges related to vitamin D measurement, the impact of those challenges on clinical guidelines, and the implications for nurse practitioners providing clinical care and conducting research. Although the status of vitamin D measurement and clinical recommendations is still unresolved, nurse practitioners and researchers require an awareness of the current state of the science to make important clinical and research decisions.

      Keywords

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      References

        • Pereira M.
        • Dantas Damascena A.
        • Galvão Azevedo L.M.
        • de Almeida Oliveira T.
        • da Mota Santana J.
        Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis.
        Crit Rev Food Sci Nutr. 2022; 62: 1308-1316
        • Altieri B.
        • Cavalier E.
        • Bhattoa H.P.
        • et al.
        Vitamin D testing: advantages and limits of the current assays.
        Eur J Clin Nutr. 2020; 74: 231-247
        • Krist A.H.
        • Davidson K.W.
        • Mangione C.M.
        • et al.
        Screening for vitamin D deficiency in adults: US Preventive Services Task Force Recommendation Statement.
        JAMA. 2021; 325: 1436-1442
        • Shahangian S.
        • Alspach T.D.
        • Astles J.R.
        • Yesupriya A.
        • Dettwyler W.K.
        Trends in laboratory test volumes for Medicare Part B reimbursements, 2000-2010.
        Arch Pathol Lab Med. 2014; 138: 189-203
        • Balachandar R.
        • Pullakhandam R.
        • Kulkarni B.
        • Sachdev H.S.
        Relative efficacy of vitamin D2 and vitamin D3 in improving vitamin D status: systematic review and meta-analysis.
        Nutrients. 2021; 13: 3328
        • Gregor R.A.
        • Sebach A.M.
        Nurse practitioner-led vitamin D screening and supplementation program in rural primary care.
        J Nurse Pract. 2022; 18: 155-158
        • Kojecký V.
        • Matouš J.
        • Zádorová Z.
        • Gřiva M.
        • Kianička B.
        • Uher M.
        Vitamin D supplementation dose needs to be higher in patients with inflammatory bowel disease: interventional study.
        Vnitr Lek. 2019; 65: 470-474
        • Bouillon R.
        Comparative analysis of nutritional guidelines for vitamin D.
        Nat Rev Endocrinol. 2017; 13: 466-479
        • Pilz S.
        • Zittermann A.
        • Trummer C.
        • et al.
        Vitamin D testing and treatment: a narrative review of current evidence.
        Endocr Connect. 2019; 8: R27-R43
        • Bikle D.D.
        Vitamin D and bone.
        Curr Osteoporos Rep. 2012; 10: 151-159
        • Matthews S.W.
        • Heitkemper M.M.
        • Kamp K.
        Early evidence indicates vitamin D improves symptoms of irritable bowel syndrome: nursing implications and future research opportunities.
        Gastroenterol Nurs. 2021; 44: 426-436
        • Nair R.
        • Maseeh A.
        Vitamin D: The “sunshine” vitamin.
        J Pharmacol Pharmacother. 2012; 3: 118-126
        • Asif A.
        • Farooq N.
        Vitamin D Toxicity.
        in: StatPearls. StatPearls Publishing, 2022
        • Alonso N.
        • Zelzer S.
        • Eibinger G.
        • Herrmann M.
        Vitamin D metabolites: analytical challenges and clinical relevance.
        Calcif Tissue Int. 2022; (Published online March 3)https://doi.org/10.1007/s00223-022-00961-5
        • Geno K.A.
        • Tolan N.V.
        • Singh R.J.
        • Nerenz R.D.
        Improved recognition of 25-hydroxyvitamin D2 by 2 automated immunoassays.
        J Appl Lab Med. 2020; 5: 1287-1295
      1. DEQAS (Vitamin D External Quality Assessment Scheme).
        (Version: 1.04)
        https://www.deqas.org/
        Date: 2022
        Date accessed: June 20, 2022
        • Centers for Disease Control and Prevention
        Laboratory Quality Assurance and Standardization Programs. VDSCP: Vitamin D Standardization-Certification Program.
        (Published 2017. Updated July 6)
        https://www.cdc.gov/labstandards/vdscp.html
        Date: 2017
        Date accessed: June 20, 2022
        • Máčová L.
        • Bičíková M.
        Vitamin D: current challenges between the laboratory and clinical practice.
        Nutrients. 2021; 13: 1758
        • Makris K.
        • Bhattoa H.P.
        • Cavalier E.
        • et al.
        Recommendations on the measurement and the clinical use of vitamin D metabolites and vitamin D binding protein—a position paper from the IFCC Committee on bone metabolism.
        Clin Chim Acta. 2021; 517: 171-197
        • Bogh M.K.
        • Schmedes A.V.
        • Philipsen P.A.
        • Thieden E.
        • Wulf H.C.
        Vitamin D production after UVB exposure depends on baseline vitamin D and total cholesterol but not on skin pigmentation.
        J Invest Dermatol. 2010; 130: 546-553
        • Gutiérrez O.M.
        • Farwell W.R.
        • Kermah D.
        • Taylor E.N.
        Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey.
        Osteoporos Int. 2011; 22: 1745-1753
        • Ramasamy I.
        Vitamin D metabolism and guidelines for vitamin D supplementation.
        Clin Biochem Rev. 2020; 41: 103-126
        • Herrick K.A.
        • Storandt R.J.
        • Afful J.
        • et al.
        Vitamin D status in the United States, 2011-2014.
        Am J Clin Nutr. 2019; 110: 150-157
        • Holick M.F.
        • Binkley N.C.
        • Bischoff-Ferrari H.A.
        • et al.
        Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2011; 96: 1911-1930
        • Lin L.
        • Zhang L.
        • Li C.
        • Gai Z.
        • Li Y.
        Vitamin D and vitamin D receptor: new insights in the treatment of hypertension.
        Curr Protein Pept Sci. 2019; 20: 984-995
        • Dimitrov V.
        • White J.H.
        Species-specific regulation of innate immunity by vitamin D signaling.
        J Steroid Biochem Mol Biol. 2016; 164: 246-253
        • Waterhouse M.
        • Hope B.
        • Krause L.
        • et al.
        Vitamin D and the gut microbiome: a systematic review of in vivo studies.
        Eur J Nutr. 2019; 58: 2895-2910
        • Manson J.E.
        • Cook N.R.
        • Lee I.M.
        • et al.
        Vitamin D supplements and prevention of cancer and cardiovascular disease.
        N Engl J Med. 2019; 380: 33-44
        • Scragg R.K.R.
        Overview of results from the Vitamin D Assessment (ViDA) study.
        J Endocrinol Invest. 2019; 42: 1391-1399
        • Guirguis-Blake J.M.
        • Michael Y.L.
        • Perdue L.A.
        • Coppola E.L.
        • Beil T.L.
        Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force.
        JAMA. 2018; 319: 1705-1716
        • Clarke M.W.
        • Black L.J.
        • Hart P.H.
        • et al.
        The challenges of developing and optimising an assay to measure 25-hydroxyvitamin D in saliva.
        J Steroid Biochem Mol Biol. 2019; 194: 105437
        • Xiao Y.
        • Leung E.K.Y.
        Development and validation of a liquid chromatography mass spectrometry method for simultaneous measurement of 25(OH)D3, epi-25(OH)D3, 25(OH)D2, vitamin A, α-tocopherol, and γ-tocopherol.
        Am J Clin Pathol. 2022; 157: 15-22
        • Higashi T.
        • Shimada K.
        Application of Cookson-type reagents for biomedical HPLC and LC/MS analyses: a brief overview.
        Biomed Chromatogr. 2017; 31e3808
        • Zelzer S.
        • Le Goff C.
        • Peeters S.
        • et al.
        Comparison of two LC-MS/MS methods for the quantification of 24,25-dihydroxyvitamin D3 in patients and external quality assurance samples.
        Clin Chem Lab Med. 2022; 60: 74-81
        • Wise S.A.
        • Camara J.E.
        • Burdette C.Q.
        • et al.
        Interlaboratory comparison of 25-hydroxyvitamin D assays: Vitamin D Standardization Program (VDSP) intercomparison study 2—part 1 liquid chromatography—tandem mass spectrometry (LC-MS/MS) assays—impact of 3-epi-25-hydroxyvitamin D(3) on assay performance.
        Anal Bioanal Chem. 2022; 414: 333-349
        • Windrichova J.
        • Broz P.
        • Fuchsova R.
        • et al.
        Comparison of four routinely used vitamin D automated immunoassays.
        J Med Biochem. 2021; 40: 277-285
        • Lucas R.M.
        • Gorman S.
        • Black L.
        • Neale R.E.
        Clinical, research, and public health implications of poor measurement of vitamin D status.
        J AOAC Int. 2017; 100: 1225-1229
        • Calvo M.S.
        Monitoring vitamin D status and intake in the US population: essential to understanding the role of vitamin D in health.
        Am J Clin Nutr. 2019; 110: 6-7
        • Institute of Medicine (US)
        Committee to Review Dietary Reference Intakes for Vitamin D and Calcium.
        in: Ross A.C. Taylor C.L. Yaktine A.L. Del Valle H.B. Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press (US), 2011
        • Nowson C.A.
        • McGrath J.J.
        • Ebeling P.R.
        • et al.
        Vitamin D and health in adults in Australia and New Zealand: a position statement.
        Med J Aust. 2012; 196: 686-687
        • Paxton G.A.
        • Teale G.R.
        • Nowson C.A.
        • et al.
        Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement.
        Med J Aust. 2013; 198: 142-143
        • Nordic Council of Ministers
        Nordic Nutrition Recommendations 2012: Integrating Nutrition and Physical Activity.
        (Published 2012. Updated 2012)
        • German Nutrition Society
        New reference values for vitamin D.
        Ann Nutr Metab. 2012; 60: 241-246
        • Golden N.H.
        • Abrams S.A.
        Optimizing bone health in children and adolescents.
        Pediatrics. 2014; 134: e1229-e1243
        • Dawson-Hughes B.
        • Mithal A.
        • Bonjour J.P.
        • et al.
        IOF position statement: vitamin D recommendations for older adults.
        Osteoporos Int. 2010; 21: 1151-1154
      2. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on Vitamin D for Prevention of Falls and Their Consequences.
        J Am Geriatr Soc. 2014; 62: 147-152
        • Scientific Advisory Committee on Nutrition (SACN)
        Vitamin D and Health.
        (Published 2016)
        • Weggemans R.M.
        • Kromhout D.
        • van Weel C.
        New dietary reference values for vitamin D in the Netherlands.
        Eur J Clin Nutr. 2013; 67: 685
        • Turck D.
        • Bresson J.L.
        • Burlingame B.
        • et al.
        Dietary reference values for vitamin K.
        EFSA J. 2017; 15e04780
        • Sempos C.T.
        • Binkley N.
        25-Hydroxyvitamin D assay standardisation and vitamin D guidelines paralysis.
        Public Health Nutr. 2020; 23: 1153-1164
        • Minisola S.
        • Colangelo L.
        • Pepe J.
        • et al.
        Vitamin D screening.
        J Endocrinol Invest. 2020; 43: 1047-1051
        • Wise S.A.
        • Phinney K.W.
        • Tai S.S.
        • et al.
        Baseline assessment of 25-hydroxyvitamin D assay performance: a Vitamin D Standardization Program (VDSP) Interlaboratory Comparison Study.
        J AOAC Int. 2017; 100: 1244-1252
        • Rahme M.
        • Al-Shaar L.
        • Singh R.
        • et al.
        Limitations of platform assays to measure serum 250HD level impact on guidelines and practice decision making.
        Metabolism. 2018; 89: 1-7
        • Pludowski P.
        • Holick M.F.
        • Grant W.B.
        • et al.
        Vitamin D supplementation guidelines.
        J Steroid Biochem Mol Biol. 2018; 175: 125-135
        • Le Moigno J.M.
        • Annweiler G.
        • Karras S.N.
        • Llewellyn D.J.
        • Riou J.
        • Annweiler C.
        Clinical identification of older adults with hypovitaminosis D: feasibility, acceptability and accuracy of the ‘Vitamin D Status Diagnosticator’ in primary care.
        J Steroid Biochem Mol Biol. 2020; 197: 105523
        • Deschasaux M.
        • Souberbielle J.C.
        • Andreeva V.A.
        • et al.
        Quick and easy screening for vitamin D insufficiency in adults: a scoring system to be implemented in daily clinical practice.
        Medicine (Baltimore). 2016; 95e2783
        • Haq A.
        • Wimalawansa S.J.
        • Pludowski P.
        • Anouti F.A.
        Clinical practice guidelines for vitamin D in the United Arab Emirates.
        J Steroid Biochem Mol Biol. 2018; 175: 4-11
        • Grant W.B.
        • Wimalawansa S.J.
        • Holick M.F.
        • et al.
        Emphasizing the health benefits of vitamin D for those with neurodevelopmental disorders and intellectual disabilities.
        Nutrients. 2015; 7: 1538-1564
        • Wagner C.L.
        • Greer F.R.
        Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.
        Pediatrics. 2008; 122: 1142-1152
        • Rosen C.J.
        • Abrams S.A.
        • Aloia J.F.
        • et al.
        IOM committee members respond to Endocrine Society vitamin D guideline.
        J Clin Endocrinol Metab. 2012; 97: 1146-1152
        • Cesareo R.
        • Attanasio R.
        • Caputo M.
        • et al.
        Italian Association of Clinical Endocrinologists (AME) and Italian Chapter of the American Association of Clinical Endocrinologists (AACE) Position Statement: clinical management of vitamin D deficiency in adults.
        Nutrients. 2018; 10
        • Glendenning P.
        Measuring vitamin D.
        Aust Prescr. 2015; 38: 12-15
        • Giustina A.
        • Adler R.A.
        • Binkley N.
        • et al.
        Consensus statement from 2nd International Conference on Controversies in Vitamin D.
        Rev Endocr Metab Disord. 2020; 21: 89-116
        • Giustina A.
        • Bouillon R.
        • Binkley N.
        • et al.
        Controversies in vitamin D: a statement from the Third International Conference.
        JBMR Plus. 2020; 4e10417
        • Amrein K.
        • Scherkl M.
        • Hoffmann M.
        • et al.
        Vitamin D deficiency 2.0: an update on the current status worldwide.
        Eur J Clin Nutr. 2020; 74: 1498-1513
        • Heaney R.P.
        Guidelines for optimizing design and analysis of clinical studies of nutrient effects.
        Nutr Rev. 2014; 72: 48-54
        • Cianferotti L.
        • Bertoldo F.
        • Bischoff-Ferrari H.A.
        • et al.
        Vitamin D supplementation in the prevention and management of major chronic diseases not related to mineral homeostasis in adults: research for evidence and a scientific statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).
        Endocrine. 2017; 56: 245-261

      Biography

      Stephanie Binick, DNP, FNP-BC, is a NP at University of Washington Medical Center, Seattle, and can be contacted at [email protected] .

      Biography

      Sarah W. Matthews, DNP, FNP-BC, is an affiliate assistant professor, Kendra J.

      Biography

      Kamp, PhD, RN is an assistant professor, and Margaret Heitkemper, PhD, RN, is a professor and chairperson all at the School of Nursing, University of Washington, Seattle