Guidelines and vitamin D status

Recommendations regarding vitamin D status are given in either nmol/L or ng/mL, depending on the institution or country providing the data. Around the world, there are slight variations in the cut-offs and definitions provided regarding vitamin D status. In order to minimize confusions, we developed the Zinzino guidelines of vitamin D status.

The Zinzino vitamin D guidelines

After extensive work and reviewing of the most up-to-date scientific literature and checking the world’s leading authorities in the area of vitamin D, we finally developed the Zinzino guidelines for all individuals around the globe. It is provided as a self-awareness tool for your convenience but is not intended to overrule any local regulation.

Zinzino guidelines	ng/mL	nmol/L
Critical Low	< 8	< 20
Deficient/Insufficient	9-19	21-49
Sufficient/Optimal	20-49	50-124
Elevated	50-59	125-149
High	60-79	150-199
Very High	80-160	200-399

Example of global guidelines

According to the National Institutes of Health (USA), the relationships between serum 25(OH)D concentration and health are as follows:

General Guidelines	ng/mL	nmol/L
Deficiency	< 12	< 30
Inadequate	12 to <20	30 to <50
Adequate	≥ 20	≥ 50
Potential adverse effects	> 50	> 125

Similarly, in the UK, vitamin D deficiency is defined as less than 25 nmol/L and associated with rickets and osteomalacia.

Values between 25-30 nmol/L are considered to represent insufficiency. The majority of research findings concur that serum 25(OH)D should be higher than 50 nmol/L, but some recommend even higher serum levels (e.g. higher than 75 or even 250 nmol/L).

The general consensus across the latest peer-reviewed research literature acknowledges the inherent individual variation that exists regarding vitamin D status, and whilst supporting the notion that above the level of 150 nmol/L there are possible adverse effects, it is more common for people to experience such effects when above values of 400 nmol/L.

At Zinzino, we have considered the strength and quality of the evidence in this area, and our classification table is far more detailed as it has been directly informed by these findings and recommendations.

Vitamin D deficiency

Vitamin D is mostly associated with strong and healthy bones as it enables the absorption of calcium from food. Lack of vitamin D is traditionally associated with rickets, osteomalacia and osteoporosis.

Many people have no symptoms, or their symptoms may be nonspecific and change over time.
Since the symptoms of vitamin D deficiency are often subtle and nonspecific, it’s important to get your blood levels tested if you suspect you may have a deficiency.

Common symptoms of vitamin D deficiency include:

Increased susceptibility to colds or flu
Changes in mood, including depression or anxiety
Fatigue and tiredness
Muscle weakness, or sore and painful muscles
Bone pain
Slow wound-healing
Bone loss
Hair loss

1,000,000,000 people

There is global concern about vitamin D deficiency, with one billion people, or 37% worldwide, estimated to be either vitamin D insufficient or deficient.

Vitamin D deficiency

Cut-off 50 (<50 nmol/L )

					IRAN & JORDAN

					CHINA

					EUROPE

					GLOBAL

					AFRICAN CONTINENT

					USA

					GHANA & SEYCHELLES

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Toxicity

Daily use of high-dose vitamin D supplements for several months is toxic and could lead to something called hypervitaminosis D or vitamin D toxicity.

This is a rare but potentially serious condition, leading to your body absorbing too much of the calcium in food. The build-up of calcium in the blood (hypercalcemia) can cause nausea, vomiting, weakness, and frequent urination. Undiagnosed vitamin D toxicity could also progress to bone pain and kidney problems (such as the formation of calcium stones).

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