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Considerations in Dietetic Counseling for Vitamin D

      Concerns about vitamin D deficiency and recommendations for vitamin D supplements have become very common in clinical practice in the past few years. Moreover, it is almost routine to order blood tests to screen for vitamin D status as part of a health care visit. A major clinical laboratory reported that since 2004, vitamin D laboratory tests increased by nearly eightfold,
      • Taylor C.L.
      • Thomas P.R.
      • Aloia J.F.
      • Millard P.S.
      • Rosen C.J.
      Questions about vitamin D for primary care practice: Input from an NIH conference.
      and the volume of Medicare reimbursement for vitamin D testing increased 83-fold between 2000 and 2010.
      • 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.
      However, evidence justifying such screening is limited. In 2014, the US Preventive Services Task Force stated that there was insufficient evidence to demonstrate benefit (or harm) from vitamin D screening among adults who were free of symptoms.
      • LeFevre M.L.
      Screening for vitamin D deficiency in adults: U.S. Preventive Services Task Force recommendation statement.
      At the same time, sales of vitamin D supplements have also increased dramatically,
      • Nutrition Business Journal
      NBJ’s Supplement Business Report 2014.
      and there is some evidence that the availability of high-dose vitamin D supplements is increasing.
      • Rooney M.R.
      • Harnack L.
      • Michos E.D.
      • Ogilvie R.P.
      • Sempos C.T.
      • Lutsey P.L.
      Trends in use of high-dose vitamin D supplements exceeding 1000 or 4000 international units daily, 1999-2014.
      These trends are concerning because evidence of the benefit of such practices is lacking, and the potential adverse effects associated with too much vitamin D are seemingly disregarded.
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