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. 2022 Nov 11;81(7):804–822. doi: 10.1093/nutrit/nuac091

Table 3.

Supplementation of vitamin D and its effect on raising vitamin D status

Reference type of study recruitment locations Country No. of participants Age, mean (SD), y Sex Type of vit D intervention; route of administration Duration 25(OH)D status: baseline, mean (SD), nmol/L 25(OH)D status: after intervention, mean (SD), nmol/L Main conclusions a

  • Schwalfenberg et al (2010)47

  • Retrospective chart review

  • 1 NH facility

 Canada

  • 68 P

  • 68 C

 80.7 (9.8) 49 F; 19 M

  • Vit D3;

  • Oral supp: ND; 2000 IU/d

 Minimum 5 mo (5–10 mo) NR

  • 5 mo

  • 119.4 (28.1) 25(OH)D3

 Daily supplementation with 2000 IU of vitamin D3 can achieve 25(OH)D levels of >80 nmol/L in most residents living in a nursing home setting, with no levels reaching a toxic range—thus confirming the utility of oral vitamin D supplementation to improve vitamin D status.

  • Chel et al (2011)48

  • Pilot intervention

  • Low and medium care wards of 1 psychogeriatric NH

 The Netherlands 8 C 79 (8) 5F; 3M

  • Half-body UVB:

  • 2-min half-body irradiation with UVB at 1.0 standard erythema dose (0.5 MED) once/wk

 8 wk 28.5 (NR) 46.5 (NR) An 8-week course of weekly, frontal half-body irradiation with UVB, at 0.5 MED, leads to an significant increase in 25(OH)D serum levels, but this period is too short to reach vitamin D sufficiency.

  • Dinizulu et al (2011)49

  • Observational

  • Long-term care institutions

 Ireland 63 P

  • Vit D: 82.1 (7.4)

  • Ca + vit D: 79.5 (7.2)

 63 F; 0 M

  • Vit D3:

  • supp: ND;

  • 800 IU/d, n = 19

  • 100 mg Ca + 800 IU/d, n = 41

 3 mo

  • Vit D: 25.3 (16)

  • Ca + vit D: 34.7 ± 23.7

  • Vit D: 78.5 (NR)

  • Ca + vit D: 69.2 (NR)

 Vitamin D alone appears as effective as combined calcium/vitamin D treatment in restoring serum vitamin D levels in older community dwelling and institutionalized patients. a prospective randomized trial would help confirm these findings.

  • Shin et al (2011)50

  • Retrospective chart review

  • n = 1 long-term care facility

 USA

  • 24 P

  • 24 C

  • Resp 80 (NR)

  • non-resp: 81 (NR)

 NR

  • Vit D3;

  • Oral supp: ND;

  • 2000 IU/d

 At least 12 wk

  • Mean (range)

  • resp (n = 14): 47 (34.5–67.5)

  • non-resp (n = 10): 96.75 (75–134.25)

  • Resp: 47.5 (28.5–63)

  • non-resp: 66 (44.5-73)

  • Some long-term care elderly patients respond to three months of vitamin D supplementation. The reason why some patients

  • did not respond cannot be determined from this study.

  • Ioannidis et al (2012)51

  • Cross-sectional

  • 4 Long-term care facilities

 Canada 102 P 83.2 (8.7) 70 F; 32 M

  • Vit D3:

  • NR

  • 0 IU/d, n = 50

  • 1–400 IU/d, n = 18

  • 401–800 IU/d, n = 9

  • >800 IU/d, n = 21

 N/A

  • 0 IU: 62.2 (27.5)

  • 1–400 IU: 72.8 (22.2)

  • 401–800 IU: 98.9 (26.3)

  • >800 IU: 96 (26.2)

 N/A Most residents taking more than 400 IU/d of vitamin D3 achieve optimal levels of 25(OH)D. Nevertheless, although vitamin D supplementation appears to clinically increase serum 25(OH)D levels, some residents in LTC homes are not taking adequate vitamin D supplementation and are not reaching the therapeutic target.

  • Sambrook et al (2012)52

  • Clustered RCT

  • 51 Aged-care facilities

 Australia

  • 602 P

  • 524 C

 86.4 427 F; 175 M

  • Sunlight vs sunlight + oral Ca supp vs control;

  • UV, n = 190

  • UV+, n = 207

  • usual care (control), n = 205

  • sunlight exposure was 30–40 min, 5 d/wk + Ca supplement: 600 mg/d

 12 mo

  • Baseline

  • total group: 32.9b

  • control: 33.2

  • UV: 36.2

  • UV+: 31.1

 NR Increased sunlight exposure did not reduce vitamin D deficiency or falls risk in frail older people. This public health strategy was not effective most likely due to poor adherence to the intervention.

  • Tellioglu et al (2012)53

  • Randomized prospective

  • 1 NH

 Turkey

  • 66 P

  • 62 C

  • IM: 75.5 (6.1)

  • oral: 75.3 (7.5)

 33F; 33M

  • Vit D3;

  • IM injection vs oral liquid poured on bread:

  • IM (n = 34): 600 000 IU;

  • Oral (n = 32): 600 000 IU

  • a single “megadose”

 12 wk

  • IM: 29.4 (7.6)

  • Oral: 37.17 (6.9)

  • IM: 125.85 (14.2)

  • Oral: 107.35 (13.4)

 In vitamin D deficient/insufficient elderly, a single megadose of cholecalciferol increased vitamin D levels significantly and the majority of the patients reached optimal levels. Although both administration routes are effective and appear to be safe, IM application is more effective in increasing 25(OH)D levels and balance performance.

  • Durvasula et al (2014)54

  • Secondary analysis of Sambrook et al52

  • 34 Residential aged-care facilities

 Australia

  • 397 P

  • 248 C

 86.4 (6.6) 179 F; 69 M Sunlight vs sunlight+oral Ca supplement; sunlight only and sunlight+Ca supplement participants from the previous RCT were included in analysis 6 mo 32.4 (22.9–50.6)b 34.6 (23.8–48.4)b Natural UVR exposure can increase 25OHD levels in older people in residential care, but depends on the season of exposure. However, due to inadequate sun exposure, 25OHD did not reach optimal levels.

  • Feldman et al (2014)55

  • Cross-sectional

  • 5 Residential care facilities

 Canada

  • 236 P

  • 236 C

 85 (7.7) 176F; 60M

  • vit D

  • NR

  • 20 000 IU/wk

 1 y NR

  • Mean (95%CI)

  • 102 (98–106)

  • Twelve months after implementation of a 20 000-IU/wk vitamin D protocol for older adults in residential care, mean 25OHD concentrations were high, and

  • there was no evidence of poor vitamin D status. Given the absence of demonstrated benefit of high 25OHD concentrations to the residential care population, dosages less than 20 000 IU/wk of vitamin D are recommended.

  • Veleva et al (2014)56

  • Cross-sectional patient file

  • Dementia care units in 1 NH

 The Netherlands

  • 71 P

  • 71 C

 83 (7) 46 F; 25 M

  • Vit D3 capsule vs drops:

  • capsule (n = 52): 5600 IU/wk

  • Drops (n = 19): 7500 IU/wk

 At least 3 mo NR

  • Total group: 77 (30)

  • capsules: 90 (22)

  • drops: 41 (8)

 In most of these residents, vitamin D supplementation once a week with cholecalciferol capsules containing 5600 IU (equivalent to 800 IU daily) resulted in vitamin D sufficiency (serum 25(OH)D ≥ 50 nmol/L).

  • Wijnen et al (2015)57

  • Open-label, single-center, randomized

  • NH residents recruited at outpatient clinic visit

 The Netherlands

  • 30 P

  • 22 C

 84 (76–87)b 17 F; 13 M

  • Vit D3:

  • Oral liquid supp

  • LD (n = 16): 2 × 50 000 IU/wk + monthly dose of 25 000 IU or 50 000 IU

  • DD (n = 14): 800 IU/d

 6 mo

  • LD: 27.1 (16.4–32.8)b

  • DD: 20.9 (15.9–29.6)

  • LD: 61 (54–72)b

  • DD: 44 (26–50)

  • In NH patients with severe 25OHD deficiency, an individualized calculated cholecalciferol LD is likely to be superior to a DD of cholecalciferol 800 IU in

  • terms of the ability to rapidly normalize vitamin D levels.

  • Schwartz et al (2016)58

  • Double-blinded RCT

  • 1 NH

 USA

  • 81 P

  • 72 C

 87.4 (8) 51 F; 30 M

  • Vit D3:

  • capsules (n = 20): 800 IU/d

  • n = 19 2000 IU/d

  • n = 20 4000 IU/d

  • n = 13 50 000 IU/wk

 16 wk Baseline (total group): 72.5 (9)

  • Postintervention (each group):

  • 800 IU: 82.5 (9)

  • 2000 IU: 85 (10)

  • 4000 IU: 107.5 (10)

  • 50 000 IU: 153.5 (6)

 25(OH) D increased linearly with 800-4000 IU/d and 50 000 IU/wk D3 without a ceiling effect. Data suggest some elderly will require over 800 IU/d D3 to ensure adequate vitamin D status.

  • Delomas et al (2017)59

  • Open- label, randomized single-blind controlled

  • 1 NH

 France

  • 111 P

  • 111 C

 85.1 (6.7) 77 F; 34 M

  • Vit D3:

  • Oral supp: vial of liquid (n = 53) Treatment: 4 × 100 000 IU every 2 wk

  • control (n = 58): if deficient (<25 nmol/L): 4 × 100 000 IU every 2 wk

  • if insufficient (25–50 nmol/L): 3 × 100 000 IU every 2 wk

  • if suboptimal (50–72.5 nmol/L): 2 × 100 000 IU every 2 wk

 6 wk NR

  • Treatment: 110.44 (15.4)

  • control: 89.5 (6.5)

 A single loading protocol is at least as effective and safe as tailored regimen in terms of the ability to rapidly normalize 25(OH)VitD values. The often required dosage of 25(OH)VitD is reasonably not necessary to initiate VitD supplementation protocol in this vulnerable population.

  • Mol et al (2018)60

  • Descriptive

  • 1 NH

 Turkey

  • 36 P

  • 29 C

 NR 22 F; 14 M

  • Vit D3 + butylhydroxyanisole in star anise oil;

  • oral drops: DDG (n = 12): 800 IU/d

  • WDG-moderate (n = 12): 5600 IU/wk

  • WDG-high (n = 12): 8000 IU/wk

 26 wk

  • Baseline

  • DDG: 47.41 (8.28)

  • WDG-moderate: 58.18 (12.67)

  • WDG-high: 66.83 (9.6)

  • DDG: 69.25 (9.72)

  • WDG-moderate: 70.25 (14.42)

  • WDG-high: 72.5 (7)

 Weekly (5600 IU/wk) moderate supplementation of Vitamin D could be more beneficial than weekly (8000/wk) high supplementation among nursing home residents.

  • Toren-Wielema et al (2018)61

  • Cross-sectional observation

  • 12 Somatic and psychogeriatric NHs

 The Netherlands

  • 204 P

  • 156 C

 Median (range): 85 (56–99)b 110F; 46M Vit D3: oral liquid ampoule, 1 × 200 000 IU LD + MD of 100 000 IU every 13 wk November 2015 to August 2016 (10 mo)

  • <4 MDs: 73 (29)

  • ≥4 MDs: 85 (27)

 N/A This standardized VDDR was not efficacious in obtaining and maintaining an adequate VDTL in this nursing home resident population.

  • Mueangpaisarn et al (2020)62

  • Double-blinded placebo-controlled trial

  • 2 Institutionalized NHs

 Thailand

  • 94 P

  • 85 C

  • STD: 77.9 (9.5)

  • HD: 81.5 (8.8)

 94 F; 0 M

  • Vit D2 capsules:

  • STD (n = 48): 40 000 IU/wk

  • HD (n = 46): 100 000 IU/wk

 12 wk

  • STD: 48.25 (6.2)

  • HD: 47.75 (6.5)

  • STD: 86.25 (8.1)

  • HD: 128.5 (19.5)

 Subjects who received high dose ergocalciferol achieved more optimal 25(OH)D levels than those who received standard dose. High dose ergocalciferol is preferred to optimize 25(OH)D levels in subjects with severe vitamin D deficiency.

  • Samefors et al (2020)63

  • Clustered RCT

  • NHs

 Sweden

  • 42P

  • 38C

  • I: 85.5 (12)b

  • CO: 87 (10)b

 23 F; 19 M

  • Sunlight exposure;

  • I: 20–30 min sunlight exposure, daily

  • CO: Usual living

 2 mo

  • Total group: 45 (28)b

  • I: 42.5 (23)b

  • CO: 52 (36)b

  • Total group: 64 (34)b

  • I: 53.5 (33)b

  • CO: 65 (35)b

 Active encouragement to spend time outdoors during summertime improved the levels of serum 25(OH)D and self-perceived mental health significantly in older people in nursing homes and could complement or replace oral vitamin D supplementation in the summer.

  • Okan et al (2022)64

  • RCT

  • 1 NH

 Turkey 40C 76 (6) 18 F; 22 M

  • Sunlight exposure:

  • I (n = 20): sunlight exposure 5 d/wk

  • CO (n = 20): no sunbathing offered

 4 wk

  • I: 60 (130

  • CO: 52.5 (10)

  • I: 80 (16)

  • CO: 55 (10)

 Sunlight exposure was a sufficient source to increase 25(OH)D in most elderly people living in the nursing home. Organizing sunbathing sessions as an independent nursing intervention is recommended for the elderly people living in nursing homes in order to prevent vitamin D deficiency and related consequences.

Data are presented as mean (standard deviation) unless otherwise indicated.

a

Quoted directly from the cited articles.

b

Median.

Abbreviations: 25(OH)D, 25-hydroxyvitamin D; C, completed; Ca, calcium; CO, control group; DD, daily dose; DDG, daily-dose group; F, female; HD, high dose; I; intervention group; IM, intramuscular; LD, loading dose; M, male; MD, maintenance dose; MED, minimal erythema dose; N/A, not applicable; ND, not defined; NH, nursing home; NR, not reported; P, participated; RCT, randomized control trial; Resp, responder; SD, standard deviation; signif, significant; STD, standard dose; Supp, supplement; USA, United States of America; UV, increased sunlight exposure; UV+, sunlight exposure + 600 mg Ca carbonate; UVB, ultraviolet B light; UVR, ultraviolet radiation; VDTL, vitamin D trough level; VDDR, vitamin D dosing regimen; vit, vitamin; WBV, whole-body vibration; WDG-high, weekly dose group–high; WDG-moderate, weekly dose group–moderate.