Presentation on theme: "VITAMIN D DEFICIENCY Review article New England Journal of Medicine, July 19, 2007 Michael F. Holick, M.D.Ph.D. Prepared by Cendrella Hojeily, MD."— Presentation transcript:
VITAMIN D DEFICIENCY Review article New England Journal of Medicine, July 19, 2007 Michael F. Holick, M.D.Ph.D. Prepared by Cendrella Hojeily, MD.
What is Vitamin D? A compound required in tiny amounts for metabolic reactions in an organism Fat soluble Maintains normal blood levels of calcium and phosphorus
What are the sources of Vitamin D?
DEFINITION AND PREVALENCE OF VITAMIN D Vit D deficiency: 25(OH)D<20ng/ml Vit D intoxication: 25(OH)D>150ng/ml JournalPercentageCategoryPlaceVit(OH)D Mayo Clin Proc, % Elderly men & women US & Europe 25(OH)D<20ng/ml J Clin Endocrinol Metab, 2005 >50% Post- menopausal US & Europe 25(OH)D<30ng/ml Arch Pediatr Adolesc Med, % Hispanic & African American adolescents Boston25(OH)D<20ng/ml J Am Diet Assoc, % Caucasian pre-adolescent girls Maine25(OH)D<20ng/ml Am J Med, % Healthy students, physicians, residents Boston Hospital 25(OH)D<20ng/ml Am J Clin Nutr, % General population Saudi Arabia, UAE, Australia, Turkey, India, Lebanon 25(OH)D<20ng/ml N Eng J Med, % Pregnant women & their children Philadelphia25(OH)D<20ng/ml
OSTEOPOROSIS AND FRACTURE 33% of women y/o have OP 66% of women > 80 y/o have OP 47% of women > 50 y/o will have one osteoporotic fracture 22% of men > 50 y/o will have one osteoporotic fracture
Osteoporosis and fracture Journal Intake: Ca/Vit D vs placebo Risk of fracture N Engl J Med, mg Ca IU Vit D daily for 3 years Hip fx: 43% Non vert fx: 32% Metaanalysis 400 IU Vit D daily No benefit Women’s Health 400 IU Vit D+1000mg Ca daily No benefit Am J Clin Nutr, IU Vit D Hip fx: 26% Non vert fx: 23% Record Trial, IU Vit D daily (no exclusion criteria) 25(OH)D: No benefit?
Proximal weakness Proximal weakness 800 IU Vit D/day reduces the risk of fall by 35% (OR0.65/CI 0.4-1). Am J clin Nutr, IU Vit D/day no benefit. Am J Clin Nutr, IU Vit D + Ca/day reduces the risk of fall by 72% (OR: 0.28/ CI ). J Amgeriatr soc, 2007
Cancer and Vit D People living at higher latitudes are at increased risk for cancer J of Steriod Biochem Mol Bio, 2005 JournalCondition Incidence of cancer J Natl Cancer Inst, 2006 Vit D deficiency: 25(OH)D < % increase (colon, prostate, breast) J Steroid Biochem Mol Bio, 2005 Intake: 6-94 IU vs IU Decrease in colorectal cancer p < 0.05 J Natl Cancer Inst, 2005 Sunlight exposure 40% decrease in NHL, Decrease in melanoma mortality
Diseases and Vit D Living at higher altitudes increases the risk of DMI, MS, and Crohn’s Toxicology, 2002 African-Americans are at higher risk of developing TB Science, 2006 Journal Intake (per day) Risk Neurology, IU MS + OA + RA 42% Lancet, IU DMI 81% (children) Diabetes Care, Ca IU vs. < 600 Ca IU DMII 33%
Cardiovascular and Vit D Living at higher altitudes increases risk of HTN/CAD. Prog Biophys Mol Bio, 2006 Vit D deficiency a/w CHF + inflammatory factors (CRP). Annal Cardiology, 2003 Patients with HTN exposed to UVB 3x/week for 3 months 25(OH)D increases and BP becomes normal (reduced by 6 mmHg: both systolic and diastolic). Lancet, 1998
Vit D deficiency and Psychiatric Disorders Vit D deficiency has been linked to increase incidence of schizophrenia and depression. Schizophr Res, 2002 Maintaining sufficient Vit D in utero and in early life may be important for brain dev as well as for maintenance of mental function later in life. J Chem Neuroanat, 2005
Vit D deficiency and Lung Function Men and women with 25(OH)D>35ng/ml have 176 ml increase in the forced expiratory volume in 1 second. Chest, 2005 Children of women who had Vit D deficiency during pregnancy are at increased risk for wheezing illnesses. Am J Clin Nutr, 2007
Vit D Intoxication 25(OH)D > 150ng/ml Caused by ingestion of > 50,000 IU/day Caution: people predisposed to hypercalcemia (granulomatous diseases)
CONCLUSION Serum 25-hydroxyVitamin D is not only a predictor of bone health, but is also an independent risk predictor for cancer and other chronic diseases 1,25(OH)D should never be used for detecting Vit D deficiency
DISCUSSION Should we use 25(OH)D as a screening test? –25(OH)D assay is costly and may not be always available so screening is not recommended! Adequate Vit D intake is recommended 800 IU Vit D/day guarantees Vit D sufficiency unless there are other conditions
“You’ve got a rare condition called ‘good health.’ Frankly, we’re not sure how to treat it.”