Despite being a sun-drenched country, India continues to grapple with high rates of vitamin D deficiency. In a landmark publication, Dr. Sanjay Kalra and fellow experts present a 2025 consensus on how best to prevent and manage vitamin D deficiency in the Indian population. Published in the Indian Journal of Endocrinology and Metabolism, this document brings much-needed clarity and guidance to clinicians and public health professionals.
Vitamin D deficiency is a widespread health concern with implications for people across all age groups and geographic regions. A recent consensus from the Indian Academy of Pediatrics provides a comprehensive overview of the prevention and treatment of this deficiency, offering practical guidance tailored to the Indian context.
Why Vitamin D Matters?
Vitamin D plays a vital role in calcium and phosphorus metabolism, bone mineralization, and maintaining overall skeletal health. Deficiency can lead to rickets in children, osteomalacia in adults, and is increasingly being linked to various non-skeletal disorders such as autoimmune diseases, infections, cardiovascular disease, and certain cancers.
Prevalence in India
Despite abundant sunlight, vitamin D deficiency is widely prevalent in India, attributed to lifestyle factors such as staying indoors, use of sunscreens, cultural clothing habits, pollution, and skin pigmentation that reduces vitamin D synthesis. Studies indicate that 70%–100% of apparently healthy individuals in India have suboptimal levels of vitamin D.
29 ng/mL The consensus defines vitamin D sufficiency as serum 25(OH)D levels ≥30 ng/mL, insufficiency as 20–, and deficiency as <20 ng/mL. These thresholds guide both diagnosis and treatment. However, the aim of vitamin D3 therapy should be to achieve a physiological 25(OH) D level (40–60 ng/mL). Also, Vitamin D deficiency reflects a strong need to initiate vitamin D replacement.
Routine population-level screening isn’t recommended. Testing should be reserved for high-risk groups, including:
- Patients with osteoporosis, chronic kidney disease, malabsorption syndromes, cerebral palsy, neuromuscular disorders, Chronic liver disease, Endocrine diseases such as hyperparathyroidism and Chronic use of glucocorticoids, antiepileptic drugs, ketoconazole
- Elderly individuals
- Pregnant and lactating women
- Exclusively breastfed infants
- Adolescents
- People with limited sun exposure
Recommended Vitamin D Supplement regimens:
- The vitamin D supplement/replacement regimen in adults should be
- a. Vitamin D sufficiency – cholecalciferol 60,000IU, once a month
- b. Vitamin D insufficiency – cholecalciferol 60,000IU, once a week for 8 weeks (once sufficiency is achieved, transition to cholecalciferol 60,000 IU, once a month)
- ·c. Vitamin D deficiency: Cholecalciferol 60,000 IU, once a week for 12 weeks (once sufficiency is achieved, transition to cholecalciferol 60,000 IU, once a month). Children aged 3 years and above, including adolescents 11–18 years, with confirmed vitamin D deficiency should receive 60,000 IU of vitamin D once weekly for 6 weeks.
Supplementation Guidelines in special population:
Based on the consensus, here are the key supplementation recommendations:
- Pregnant and lactating women should receive 1200–2000 IU/day to meet both maternal and fetal needs and recommended to maintain 25(OH)D levels between 30–50 ng/mL.
- Children and adolescents during rapid growth phases are at increased risk and require consistent supplementation. Recommended dosage is as below:
- 0–6 months: 400 IU/day of cholecalciferol from birth, regardless of feeding.
- 6–12 months: 400–600 IU/day, depending on dietary vitamin D intake.
- 1–3 years: 600 IU/day for healthy children.
- 4–10 years: 600–1,000 IU/day based on body weight and diet, year-round.
- Elderly individuals, especially institutionalized or housebound, need higher doses due to poor skin synthesis and dietary intake. In patients with cardiometabolic disease, diabetes mellitus, cancer, and infectious diseases, it is recommended to monitor vitamin D supplementation to ensure a physiological range between 40 and 60 ng/mL.
- For those with deficiency, higher doses may be used under medical supervision. Vitamin D should be supplemented along with adequate calcium to ensure bone health.
Safety of Vitamin D supplementation:
A daily and cumulative (weekly, biweekly, monthly) dosing regimen of therapy with the use of Vitamin D to attain and maintain optimal 25(OH) D concentrations is complementary, effective, and safe.
To summarize, Vitamin D deficiency is a silent epidemic in India, with wide-ranging health consequences. The 2025 Indian Expert Consensus provides a clear roadmap for prevention, diagnosis, and treatment tailored to Indian needs. With a combination of lifestyle changes, targeted supplementation, and fortification, we can make significant strides in eliminating vitamin D deficiency and improving the nation’s health.
Key Takeaways
- Vitamin D deficiency is a silent epidemic in India.
- Prevention through sun exposure, diet, and supplementation is essential.
- National strategies should include public awareness campaigns, and vitamin D supplementation integration into existing health programs.
- Supplementation should be age-appropriate and individualized, especially in at-risk populations.
This consensus serves as a critical reminder that vitamin D sufficiency is fundamental to health and must be prioritized in clinical practice and public health initiatives alike.
Reference: Kalra, et al.: Consensus on vitamin D deficiency, Indian Journal of Endocrinology and Metabolism ¦ Volume 29 ¦ Issue 1 ¦ January-February 2025