Recommendations of the Brazilian Society of
					Endocrinology and Metabology (SBEM) for the diagnosis and treatment of
					hypovitaminosis D

Maeda, Sergio Setsuo; Borba, Victoria Z. C.; Camargo, Marília Brasilio Rodrigues; Silva, Dalisbor Marcelo Weber; Borges, João Lindolfo Cunha; Bandeira, Francisco; Lazaretti-Castro, Marise

doi:10.1590/0004-2730000003388

Sergio Setsuo Maeda

Endocrinology Division, Federal University of São Paulo (Unifesp), Escola Paulista de Medicina, São Paulo, SP, Brazil

Victoria Z. C. Borba

Department of Medicine, Paraná Federal University (UFPR), Curitiba, PR, Brazil

Marília Brasilio Rodrigues Camargo

Endocrinology Division, Federal University of São Paulo (Unifesp), Escola Paulista de Medicina, São Paulo, SP, Brazil

Dalisbor Marcelo Weber Silva

Department of Medicine, Univille Medical School, Joinville, SC, Brazil

João Lindolfo Cunha Borges

Endocrinology Division, Brasília Catholic University (UCB), Brasília, DF, Brazil

Francisco Bandeira

Endocrinology Division, Agamenon Magalhães Hospital, University of Pernambuco (UPE), Escola de Medicina, Recife, PE, Brazil

Marise Lazaretti-Castro

Endocrinology Division, Federal University of São Paulo (Unifesp), Escola Paulista de Medicina, São Paulo, SP, Brazil

Correspondence to: Sergio Setsuo Maeda Rua Conselheiro Furtado, 847, ap. 93 01511-001 – São Paulo, SP, Brazil ssetsuo@terra.com.br

Disclosures: Sergio Setsuo Maeda has received grants and is speaker from Sanofi. Marília Brasilio Rodrigues Camargo has nothing to disclosure. Victória Zeghbi Cochenski Borba has received speaker fees from Mantecorp-Farmasa and Sanofi. Dalisbor Marcelo Weber Silva has received speaker fees from Mantecorp-Farmasa. Francisco Bandeira is consultant for Sanofi. João Lindolfo Cunha Borges has nothing to disclosure. Marise Lazaretti-Castro has received speaker and consultant fees from Sanofi and Mantecorp-Farmasa.

Food	Portion	Vitamin D content per portion
Wild salmon	100 g	~ 600-1,000 IU vitamin D₃
Fish farming salmon	100 g	~ 100-250 IU vitamin D₃
Canned sardine	100 g	~ 300 IU vitamin D₃
Canned mackerel	100 g	~ 250 IU vitamin D₃
Canned tuna	100 g	~ 230 IU vitamin D₃
Cod liver oil	5 mL	~ 400-1,000 UI vitamin D₃
Egg yolk	1 unit	~ 20 IU vitamin D₃
Fresh mushroom	100 g	~ 100 IU vitamin D₂
Sun dried mushroom	100 g	~ 1,600 IU vitamin D₂

Author, year	n	Population	Age (years) Average ± SD	Local, Latitude	25(OH)D (ng/mL) Average ± SD	25(OH)D (ng/mL) Cut off value	Prevalence (%)	Vitamin D intake or oral supplementation
Saraiva, 2005 (73) and 2007 (70)	420	Elderly, > 65 years		São Paulo, SP 23ºS				7% with oral supplementation: daily dose 125-1.000 IU 4% with supplementation
	177	Institutionalized 125 W and 52 M	76 ± 9		14.4 ± 9.2	< 10	41	10% with supplementation
	177	Institutionalized 125 W and 52 M	76 ± 9		14.4 ± 9.2	< 20	71
	243	From the community 168 W and 75 M	79 ± 6		19.6 ± 11.2	< 40	99
						< 10	16
						< 20	42
						< 40	96
Lips, 2006 (78)	151	Post-menopausal women with osteoprosis, > 41 years, in ambulatorial follow up	67	Vitória, ES 20ºS	32.4	< 20	15	Values not mentioned
Lips, 2006 (78)	151		67	Vitória, ES 20ºS	32.4	< 30	42	Values not mentioned
Maeda, 2007 (68)	121	Volunteers, 17-33 years, 72 W and 49 M	24 ± 2	São Paulo, SP 23ºS	31.2 ± 13.2	< 28.8	50	Without supplementation
Maeda, 2007 (68)	121	Volunteers, 17-33 years, 72 W and 49 M	24 ± 2	São Paulo, SP 23ºS	31.2 ± 13.2	< 40	75	Without supplementation
Silva, 2008 (72)	180	Endocrinology ambulatorial patients, 14-91 years, 165 W and 15 M	58	Belo Horizonte, MG 19ºS	39.6 ± 16.8	< 14	0.8	27% with oral supplementation: varied doses
Silva, 2008 (72)	180		58	Belo Horizonte, MG 19ºS	39.6 ± 16.8	< 32	42	27% with oral supplementation: varied doses
Peters, 2008 (64)	136	Adolescents, 16-20 years, 72 W and 64 M	18	Indaiatuba, SP 23ºS	29.2 ± 0.8	≤ 10	0	Average daily intake 140 IU
Peters, 2008 (64)	136	Adolescents, 16-20 years, 72 W and 64 M	18	Indaiatuba, SP 23ºS	29.2 ± 0.8	≤ 30	62	Average daily intake 140 IU
Russo, 2009 (77)	251	Post-menopausal volunteers with low bone mass, 50-85 years	67 ± 6	Rio de Janeiro, RJ 22ºS	26 ± 10.4	<10	2	Without supplementation
						< 20	27
						< 30	67
						< 40	92
Kuchuk, 2009 (79)	1.486	Post-menopausal women with osteoporosis, 50-85 years	-	Latitude 15°S-23ºS	28 ± 7.6	< 10	0.5	Values not mentioned
						< 20	12.5
						< 30	66
Lopes, 2009 (80)	415	Post-menopausal women with and without fractures	Without fracture: 72.1 ± 4.4	São Paulo, SP 23ºS	Without fracture: 20.7 ± 10.7	< 30	Without fracture: 82.3%	Supplementation users were excluded
Lopes, 2009 (80)	415	Post-menopausal women with and without fractures	with fracture: 74.6 ± 5.8	São Paulo, SP 23ºS	with fracture 16.9 ± 8.2	< 30	with fracture: 93.65%	Supplementation users were excluded
Maeda, 2010 (71)	99	Physical exercise practitioners, 2 hours a week of outdoors physical activity, 52 W and 47 M	67 ± 6	São Paulo, SP 23ºS	31.6 ± 12.4	< 10	3	7% with oral supplementation: 200-400 IU
Maeda, 2010 (71)	99		67 ± 6	São Paulo, SP 23ºS	31.6 ± 12.4	< 20	19	7% with oral supplementation: 200-400 IU
Unger, 2010 (67)	603	Volunteers: employees and students from USP, 18-80 years, 485 W and 118 M	47 ± 13	São Paulo, SP 23ºS	Median post winter: 21.4	< 30	77	Parameters not evaluated
Unger, 2010 (67)	603		47 ± 13	São Paulo, SP 23ºS	Post summer: increase of 10.6	< 30	77	Parameters not evaluated
Bandeira, 2010 (74)	93	Healthy post-menopausal women	65 ± 7	Recife, PE 8ºS	28.8 ± 14.8	< 20	24	Parameters not evaluated
Neves, 2012 (75)	91	The elderly with SAH, > 60 years, 81 W and 10 M	69 ± 7	João Pessoa, PB 7ºS	Adequate: 44.8 ± 12.5	< 20	4	Without supplementation
Neves, 2012 (75)	91	The elderly with SAH, > 60 years, 81 W and 10 M	69 ± 7	João Pessoa, PB 7ºS	Non-adequate: 24 ± 3.5	< 30	33	Without supplementation
Santos, 2013 (66)	234	Adolescents 7-18 years	13.0 ± 1.9	Curitiba, PR 25º	Varied from 20.8 to 22 in the studied tertiles	< 30	90,6	Without supplementation
Santos, 2013 (66)	234	Adolescents 7-18 years	13.0 ± 1.9	Curitiba, PR 25º	Varied from 20.8 to 22 in the studied tertiles	< 20	63,7	Without supplementation
Oliveira, 2013 (65)	160	Adolescents, 15-17 years, 71 W and 89 M	16	Juiz de Fora, MG 21ºS	-	≤ 10	1,3	Average daily intake 88 IU
Oliveira, 2013 (65)	160	Adolescents, 15-17 years, 71 W and 89 M	16	Juiz de Fora, MG 21ºS	-	≤ 30	70,6	Average daily intake 88 IU
Maeda, 2013 (69)	591	Volunteers, 17-100 years, 388 W and 203 M	Nursing homes: 76.2 ± 9.0	São Paulo, SP 23ºS	Nursing homes: 15.0 ± 11.9	< 10	19	6% with oral supplementation: 200-400 IU
			Community: 79.6 ± 5.3		community: 19.8 ± 11.0	< 20	47
			Exercise: 67.6 ± 5.4		Exercise: 31.5 ± 12.4	< 30	73
			young: 23.9 ± 2.8		young: 34.5 ± 14.0	< 30	73
Arantes, 2013 (76)	1.933	Post-menopausal women with low bone mass, 60-85 years	67 ± 5	Latitude 8°S-33°S	27.2 ± 8.4	≤ 30	68,3	Parameters not evaluated
Martini, 2013 (81)	636	Adolescents, adults and the elderly	-	São Paulo, SP 23ºS	M: 16.7	< 20	-	Intake varied from 108 to 140 IU/d
Martini, 2013 (81)	636	Adolescents, adults and the elderly	-	São Paulo, SP 23ºS	W: 19.2	< 20	-	Intake varied from 108 to 140 IU/d
Cabral, 2013 (82)	284	Men, skin phototype evaluated	69.4 ± 6.5	Recife, PE 8ºS	28.0 ± 13.6	< 20	31,5	2,5% took supplements
Cabral, 2013 (82)	284	Men, skin phototype evaluated	69.4 ± 6.5	Recife, PE 8ºS	28.0 ± 13.6	< 30	66,7	2,5% took supplements

Age groups	General population (IU)	Population at risk (IU)
0 – 12 months	400	400 – 1,000
1 – 8 years	400	600 – 1,000
9 – 18 years	600	600 – 1,000
19 – 70 years	600	1,500 – 2,000
> 70 years	800	1,500 – 2,000
Pregnant women 14 – 18 years	600	600 – 1,000
Pregnant women > 18 years	600	1,500 – 2,000
Lactating 14 – 18 years	600	600 – 1,000
Lactating > 18 years	600	1,500 – 2,000

[1] Correspondence to: Sergio Setsuo Maeda Rua Conselheiro Furtado, 847, ap. 93 01511-001 – São Paulo, SP, Brazil ssetsuo@terra.com.br

Brasil

Brasil

Recommendations of the Brazilian Society of Endocrinology and Metabology (SBEM) for the diagnosis and treatment of hypovitaminosis D

Objective

Materials and methods

Conclusion