IOM Committee Members Respond to Endocrine Society Vitamin D Guideline
Notice bibliographique
Résumé
The recent publication of the Endocrine Society clinical practice guideline, “Evaluation, Treatment, and Prevention of Vitamin D Deficiency,” has generated considerable controversy. Although there are some agreements in this new guideline with the Institute of Medicine (IOM) Committee’s 2011 “Report on Dietary Reference Intakes for Calcium and Vitamin D,” there are substantial differences between these 2 guidelines. These disagreements on several important issues generate confusion for clinicians, researchers, and the public. In this commentary, members of the IOM committee address a number of conclusions in the Endocrine Society guideline that are not supported by adequate evidence and are in need of reconsideration. Disagreements of the Committee with The Endocrine Society guideline relate to whether targeted serum 25OHD levels are different for the general and at-risk populations, on how vitamin D deficiency should be defined, and on who constitutes a population at risk versus the general population. Targeted serum 25OHD levels: The guideline does not provide adequate evidence for the assertion that serum levels of 25OHD at 30 ng/mL or higher would be beneficial for at-risk populations (patients with specific underlying conditions such as osteoporosis, kidney or liver dysfunction, malabsorption syndromes, obesity, and pregnancy) compared with the general population. The guideline conclusion with respect to serum 25OHD levels and calcium absorption was based in large part on a single small study published in 2003 evaluating 34 subjects who did not undergo formal calcium absorption tests. The guideline did not include more appropriate data from trials evaluating more than 1000 subjects who underwent formal calcium absorption tests. The overall data from these larger studies contradict the 2003 study and show that calcium absorption reaches near maximum between serum 25OHD levels of 8 to 20 ng/mL. Definition of vitamin D deficiency: The guideline mistakenly concludes that vitamin D is beneficial for a large segment of our population only when serum levels are at 30 ng/mL 25OHD and more and that individuals with serum 25OHD levels less than 20 ng/mL are deficient in vitamin D. The assertion that vitamin D deficiency is present for serum levels of 25OHD in the general population that are less than 20 ng/mL is inconsistent with data showing that a serum level of 16 ng/mL is adequate in 50% of the general population. In addressing the question of insufficient levels of vitamin D, the guideline includes a selected subgroup of available data with no explanation for inclusion of these studies and the exclusion of others. Who constitutes a population at risk versus the general population? The intent of the guideline was to target those with disease and high-risk populations not covered by the IOM report, but in doing so, it inappropriately includes some conditions that are considered to be part of the general population. The IOM committee believes that a systematic evidence-based approach assessing the evidence for both benefits and risks of supplementation for individuals with underlying health conditions is needed. The current Endocrine Society guideline does not reflect an evidence-based approach and needs to be reexamined.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,069 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».