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Presentation on theme: "VITAMIN D DEFICIENCY Review article"— Presentation transcript:

New England Journal of Medicine, July 19, 2007 Michael F. Holick, M.D.Ph.D. Prepared by Cendrella Hojeily, MD.

2 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

3 What are the sources of Vitamin D?




Vit D deficiency: 25(OH)D<20ng/ml Vit D intoxication: 25(OH)D>150ng/ml Journal Percentage Category Place Vit(OH)D Mayo Clin Proc, 2006 40-100% Elderly men & women US & Europe 25(OH)D<20ng/ml J Clin Endocrinol Metab, 2005 >50% Post- menopausal 25(OH)D<30ng/ml Arch Pediatr Adolesc Med, 2004 52% Hispanic & African American adolescents Boston J Am Diet Assoc, 2005 48% Caucasian pre-adolescent girls Maine Am J Med, 2002 32% Healthy students, physicians, residents Boston Hospital Am J Clin Nutr, 2005 30-50% General population Saudi Arabia, UAE, Australia, Turkey, India, Lebanon N Eng J Med, 2006 78-80% Pregnant women & their children Philadelphia



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

11 Osteoporosis and fracture
Journal Intake: Ca/Vit D vs placebo Risk of fracture N Engl J Med, 1992 1200mg Ca + 800 IU Vit D daily for 3 years Hip fx: 43% Non vert fx: % Metaanalysis 400 IU Vit D daily No benefit Women’s Health 400 IU Vit D+1000mg Ca daily Am J Clin Nutr, 2006 IU Vit D Hip fx: 26% Non vert fx: 23% Record Trial, 2005 800 IU Vit D daily (no exclusion criteria) 25(OH)D: 15-24 No benefit?

12 Proximal weakness 800 IU Vit D/day  reduces the risk of fall by 35% (OR0.65/CI 0.4-1).Am J clin Nutr, 2006 400 IU Vit D/day  no benefit. Am J Clin Nutr, 2006 800 IU Vit D + Ca/day  reduces the risk of fall by 72% (OR: 0.28/ CI ). J Amgeriatr soc, 2007

13 Cancer and Vit D People living at higher latitudes are at increased risk for cancer J of Steriod Biochem Mol Bio, 2005 Journal Condition Incidence of cancer J Natl Cancer Inst, 2006 Vit D deficiency: 25(OH)D < 20 30-50% 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

14 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, 2004 400 IU MS + OA + RA % Lancet, 2001 2000 IU DMI % (children) Diabetes Care, 2006 1200 Ca IU vs. < 600 Ca IU DMII %

15 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

16 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

17 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



20 Vit D Intoxication 25(OH)D > 150ng/ml
Caused by ingestion of > 50,000 IU/day Caution: people predisposed to hypercalcemia (granulomatous diseases)

21 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

22 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


24 “You’ve got a rare condition called ‘good health
“You’ve got a rare condition called ‘good health.’ Frankly, we’re not sure how to treat it.”

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