IOM Committee Members Respond to Endocrine Society Vitamin D Guideline
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.036 | 0.128 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.009 | 0.005 |
| Open science | 0.006 | 0.005 |
| Research integrity | 0.061 | 0.030 |
| Insufficient payload (model declined to judge) | 0.021 | 0.021 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".