Différence santé entre dosage minimal et optimal de vitam D

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Targeted 25-hydroxyvitamin D concentration measurements and vitamin D3 supplementation can have important patient and public health benefits
William B. Grant, European Journal of Clinical Nutrition volume 74, pages366–376(2020)

Over the past two decades, many studies reported the benefits of higher 25-hydroxyvitamin D [25(OH)D] concentrations for nonskeletal effects. Researchers found significant benefits in reducing risk of acute respiratory tract infections, many types of cancer, type 2 diabetes mellitus, premature death, and adverse pregnancy and birth outcomes. In addition, 25(OH)D concentrations are low for various reasons in several categories of people, including the obese, those with dark skin living at higher latitudes, the elderly, and those who do not eat much eggs, fish, meat, or vitamin D fortified milk. Measuring 25(OH)D concentrations is one way to both increase the awareness of vitamin D’s importance in maintaining good health and to encourage vitamin D supplementation or increased solar ultraviolet-B exposure to sustain well-being throughout life by reducing disease incidence. Although 20 ng/ml seems adequate to reduce risk of skeletal problems and acute respiratory tract infections, concentrations above 30 ng/ml have been associated with reduced risk of cancer, type 2 diabetes mellitus, and adverse pregnancy and birth outcomes. Thus, judicious testing of 25(OH)D concentrations could reduce disease incidence and make treatment expenditures more cost-effective.

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A Narrative Review of the Evidence for Variations in Serum 25-Hydroxyvitamin D Concentration Thresholds for Optimal Health
by William B. Grant Nutrients 2022, 14(3), 639;

Vitamin D3 has many important health benefits. Unfortunately, these benefits are not widely known among health care personnel and the general public. As a result, most of the world’s population has serum 25-hydroxyvitamin D (25(OH)D) concentrations far below optimal values. This narrative review examines the evidence for the major causes of death including cardiovascular disease, hypertension, cancer, type 2 diabetes mellitus, and COVID-19 with regard to sub-optimal 25(OH)D concentrations.

Evidence for the beneficial effects comes from a variety of approaches including ecological and observational studies, studies of mechanisms, and Mendelian randomization studies. Although randomized controlled trials (RCTs) are generally considered the strongest form of evidence for pharmaceutical drugs, the study designs and the conduct of RCTs performed for vitamin D have mostly been flawed for the following reasons: they have been based on vitamin D dose rather than on baseline and achieved 25(OH)D concentrations; they have involved participants with 25(OH)D concentrations above the population mean; they have given low vitamin D doses; and they have permitted other sources of vitamin D.

Thus, the strongest evidence generally comes from the other types of studies. The general finding is that optimal 25(OH)D concentrations to support health and wellbeing are above 30 ng/mL (75 nmol/L) for cardiovascular disease and all-cause mortality rate, whereas the thresholds for several other outcomes appear to range up to 40 or 50 ng/mL. The most efficient way to achieve these concentrations is through vitamin D supplementation. Although additional studies are warranted, raising serum 25(OH)D concentrations to optimal concentrations will result in a significant reduction in preventable illness and death.

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Traduction de l'étude

Un examen narratif des preuves de variations des seuils de concentration sérique de 25-hydroxyvitamine D pour une santé optimale
par William B. Grant Nutrients 2022, 14(3), 639 ;

La vitamine D3 a de nombreux avantages importants pour la santé. Malheureusement, ces avantages ne sont pas largement connus parmi le personnel de santé et le grand public. En conséquence, la plupart de la population mondiale a des concentrations sériques de 25-hydroxyvitamine D (25(OH)D) bien inférieures aux valeurs optimales. Cette revue narrative examine les preuves des principales causes de décès, notamment les maladies cardiovasculaires, l'hypertension, le cancer, le diabète sucré de type 2 et la COVID-19 en ce qui concerne les concentrations sous-optimales de 25(OH)D.

Les preuves des effets bénéfiques proviennent d'une variété d'approches, y compris des études écologiques et observationnelles, des études de mécanismes et des études de randomisation mendélienne. Bien que les essais contrôlés randomisés (ECR) soient généralement considérés comme la forme de preuve la plus solide pour les médicaments pharmaceutiques, les plans d'étude et la conduite des ECR réalisés pour la vitamine D ont pour la plupart été défectueux pour les raisons suivantes : ils ont été basés sur la dose de vitamine D plutôt que sur à la ligne de base et atteint des concentrations de 25(OH)D ; ils ont impliqué des participants avec des concentrations de 25(OH)D supérieures à la moyenne de la population ; ils ont donné de faibles doses de vitamine D ; et ils ont autorisé d'autres sources de vitamine D.

Ainsi, les preuves les plus solides proviennent généralement des autres types d'études. La conclusion générale est que les concentrations optimales de 25(OH)D pour soutenir la santé et le bien-être sont supérieures à 30 ng/mL (75 nmol/L) pour les maladies cardiovasculaires et le taux de mortalité toutes causes confondues, alors que les seuils pour plusieurs autres résultats semblent aller jusqu'à à 40 ou 50 ng/mL. Le moyen le plus efficace d'atteindre ces concentrations est la supplémentation en vitamine D. Bien que des études supplémentaires soient justifiées, l'augmentation des concentrations sériques de 25(OH)D à des concentrations optimales entraînera une réduction significative des maladies et des décès évitables.