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Vitamin D recommendations in clinical guidelines: A systematic review, quality evaluation and analysis of potential predictors.

International journal of clinical practice
November 1, 2021
David Fraile Navarro et al. (13 authors)
Journal ArticleSystematic ReviewHuman Study
Study Details

Study Goal

The researchers aimed to review the quality and recommendations of vitamin D nutritional and clinical practice guidelines and explore factors influencing their direction and strength.

Results Summary

The study found that 44.1% of guidelines recommended, 26.5% suggested, and 29.4% did not recommend vitamin D supplementation. Guidelines with higher editorial independence and overall quality scores were less likely to recommend or suggest supplementation.

Population

General adult population (guidelines reviewed).

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (8)
InterventionDirectionEndpointPopulationDosageImpactClaim #
vitamin D supplementation
no change
bone health
general adult population
-
recommended
#1
vitamin D supplementation
no change
bone health
general adult population
-
suggested
#2
vitamin D supplementation
no change
bone health
general adult population
-
did not recommend
#3
vitamin D supplementation
decrease
guideline recommendations
guidelines
median 68.8 vs 35.4; P = .001
less likely to recommend or suggest
#4
vitamin D supplementation
decrease
guideline recommendations
guidelines
58.3 vs 37.5; P = .02
less likely to recommend or suggest
#5
vitamin D supplementation
increase
guideline recommendations
guidelines
P = .034
associated with recommending or suggesting
#6
vitamin D supplementation
increase
guideline recommendations
guidelines
OR 1.09; CI95% 1.02 to 1.16; P = .006
independent predictor for recommending or suggesting
#7
vitamin D supplementation
increase
guideline recommendations
lower quality guidelines and those reporting conflicts of interest
-
more likely to promote
#8
Abstract

BACKGROUND: Vitamin D has been widely promoted for bone health through supplementation and fortification of the general adult population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and to explore predictive factors for their direction and strength. METHODS: We searched three databases and two guideline repositories from 2010 onwards. We performed a descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association between direction and strength of recommendations, AGREE II domains' scores and pre-specified characteristics. RESULTS: We included 34 guidelines, 44.1% recommended, 26.5% suggested and 29.4% did not recommend vitamin D supplementation. Guidelines that scored higher for "editorial independence" and "overall quality score" were less likely to recommend or suggest vitamin D supplementation (median 68.8 vs 35.4; P = .001 and 58.3 vs 37.5; P = .02). Guidance produced by government organisations and those that reported source of funding were associated with higher AGREE II scores. Unclear role of source of funding was associated with recommending or suggesting vitamin D supplementation (P = .034). Editorial independence was an independent predictor for recommending or suggesting vitamin D supplementation (OR 1.09; CI95% 1.02 to 1.16; P = .006). CONCLUSIONS: Policymakers, clinicians and patients should be aware that lower quality guidelines and those reporting conflicts of interest are more likely to promote vitamin D supplementation. Guideline organisations should improve the quality of their recommendations' development and the management of conflicts of interest. Users and editors should be aware of these findings when using and appraising guidelines.

Medical Subject Headings (MeSH)
AdultDatabases, FactualHumansVitamin DVitamins
Study Links
Quality Scores
SafetyNot Assessed
Efficacy45/10
Quality75/10
Citation Metrics
Total Citations5
Citations/Year1.3
Relative Citation Ratio0.45
NIH Percentile24.5%
Research Impact Scores
APT Score0.50
Weight Score2.26
Normalized Score0.53
Related Supplements
Vitamin D recommendations in clinical guidelines: A systemat... | Panacea Index