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Passende Bildauswahl !

Training. Passende Bildauswahl !. Essential nutrients for your health. &. What is a Food Supplement?. Contents. Key message Introduction Product information Key b enefits Posology & administration Recommendations Target group Bac kground information about vitamin D

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Passende Bildauswahl !

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  1. Training Passende Bildauswahl! Essential nutrients for your health &

  2. What is a Food Supplement?

  3. Contents Key message Introduction Product information Key benefits Posology & administration Recommendations Target group Background informationaboutvitamin D Vitamin D deficiency Good to know Complementary treatment References

  4. 1. Key message • Vitamin D, also known as sunshine vitamin, plays an important role in the development and maintenance of healthy bones. • Moreover, vitamin D has many other important functions in the body. • As vitamin D is mainly produced via endogenous synthesis by the body itself when the body is exposed to sunlight, many factors like a lack of sun exposure or dark skin color, might favor insufficient supply of vitamin D. & contain different amounts of vitamin D to specially meet the needs of vitamin D of infants and toddlers or adults.

  5. 2. Introduction • Vitamin D has a special position among all vitamins as it is the only vitamin that can be synthesized from the body itself by means of sunlight. 1 • Dependent on the time you spent outside, the body produces round about 80 - 90 % of the required vitamin D, the rest has to be supplied orally. 2, 3, 4, 5 • Vitamin D is involved in various metabolic processes 6, 7 • development and maintenance of normal bones • role in the process of cell division • normal function of the immune system • maintenance of a normal muscle function • normal absorption / utilization of calcium and phosphorus Vitamin D

  6. 3. Product information For normal bones, muscles and a normal immune system

  7. 3. Product information For normal bones, muscles and a normal immune system

  8. 4. Key benefits • Two different dosages vitamin D3 for different target groups •  for infants and toddlers for adults • For healthy muscles, bones, teeth and a healthy immune system • Easy administration for infants and children – 1 tablet per day • Complementary treatment with calcium active Denk supports the beneficial effects of vitamin D

  9. 5. Posology & administration INGREDIENTS INTAKE The recommended intake is 1 tablet per day with plenty of fluid. • RECOMMENDATIONS FOR INFANTS AND TODDLERS • Let the tablet dissolve on a spoonful of water and give this to the infant. • Ideally the tablet should be taken orally and during a meal.

  10. 6. Recommendations INTAKE RECOMMENDATIONS ACCORDING TO AGE GROUP 5, 8 * including pregnancy and lactation

  11. 6. Recommendations • By now, both Institute of Medicine (IOM) and German Nutrition Society (DGE) recommend a daily intake of 5, 8 • 400 IU (10 µg) vitamin D per day for infants aged 0 – 12 months • 600 IU (15 µg) [IOM] and 800 IU (20 µg) [DGE] for children aged 1 – 18 yrs • Human milk typically contains a vitamin D concentration of 25 IU per liter or less. Consequently, a supplement of 400 IU per day of vitamin D is recommended for all breastfed infants. 9, 10 • Nevertheless, according to the current recommendations, newborns should receive (at least) 500 IU vitamin D3 daily for the prevention of rickets. 11, 12 • Therefore, the dosage of 500 IU vitamin D3 per tablet D3 junior Denk ensures an adequate supply of vitamin D for children of all ages.

  12. 7. Target group Infantsandchildren Olderpeopleover 65 years People who do not get enough direct sun exposure (especially in autumn and winter) Dark-skinnedpeople Vegansandpersonswith a specialnutrientneed Obesepeoplewith a BMI ≥ 30

  13. 7. Target group VITAMIN D SUPPLY FOR Infantsandchildren1, 2 • Vitamin D requirements cannot ordinarily be met by human milk alone. • Vitamin D content of human milk is related to the mother‘s vitamin D status. RECOMMENDATION from American Association of Paediatrics: Exclusively and partially breastfed infants must be supplemented with 400 I.U. of vitamin D per day. 9

  14. 7. Target group VITAMIN D SUPPLY FOR People who do not get enough direct sun exposure (especially in autumnandwinter) 1, 2 • Women who wear long robes and head coverings for religious reasons. • Homebound individuals • People with occupations that limit sun exposure. •  Unlikeliness to obtain adequate • vitamin D from sunlight alone.

  15. 7. Target group VITAMIN D SUPPLY FOR Vegansandpersonswitha specialnutrientneed1, 2 Olderpeopleover 65 years1, 2 • Their skin cannot synthesize vitamin D as efficiently. • They are likely to spend more time indoors. • They may have inadequate intakes of the vitamin. Risk of an insufficient oral administration.

  16. 7. Target group VITAMIN D SUPPLY FOR Dark-skinnedpeople1, 2 • Larger amounts of the pigment melanin in the epidermal layer: • Darker skin • Reduced capacity to absorb much UV-B-radiation • Reduced capacity to produce vitamin D from sunlight • Impaired Vitamin D synthesis

  17. 7. Target group VITAMIN D SUPPLY FOR Obesepeoplewith a BMI ≥ 30 1, 2 • A body mass index ≥ 30 is associated with lower serum 25(OH)D levels compared with non-obese individuals. • Obese people may need larger than usual intakes of vitamin D to achieve 25(OH)D levels comparable to those of normal weight. • Obesity does not affect skin's capacity to synthesize vitamin D directly, but: • Greater amounts of subcutaneous fat • Increased storage of the fat soluble vitamin • Alteration of its release into the circulation.

  18. 8. Background informationaboutvitaminD Forms of vitamin D There are several forms of vitamin D in the diet. Physiologically important forms include 13 • Ergocalciferol(vitamin D2) (made by plants) • Cholecalciferol(vitamin D3) (mainly animal-based foods) Both ergocalciferol and cholecalciferol are metabolized in the body to 1,25(OH)D2 (=calcitriol), the active metabolite of vitamin D. 13, 14 But: Vitamin D3 is more efficacious at raising serum 25(OH)D (=calcidiol) concentrations, the precursor of 1,25(OH)D2, in comparison to vitamin D2. 15

  19. 8. Background informationaboutvitaminD Vitamin D productionandmetabolism • In the skin, ProD3 is broken by UVB radiation from the sun, forming PreD3 that isomerizes to Vitamin D3. 16, 17 • Vitamin D3 production depends on 16, 17 • Season and latitude • Time of daytime • Skin pigmentation • Clothing and weather • The main steps in vitamin D metabolism 16, 17 • Hydroxylation of vitamin D3 / D2 to Calcidiol • Hydroxylation of Calcidiol to Calcitriol (Cholecalciferol) (Calcidiol) (Calcitriol)

  20. 8. Background informationaboutvitaminD A global representation of vitamin D status in healthy populations 18 Vitamin D status in children 1-18 years Vitamin D status in adults > 18 years < 30 nmol/L associated with vitamin D deficiency, leading to rickets in infants and osteomalacia in adults. [1 nmol/L = 0,4 ng/mL]

  21. 9. Vitamin D deficiency • It is estimated that 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency. 1 < 20 ng/ml generally considered inadequate for bone and overall health in healthy individuals [1 nmol/L = 0,4 ng/mL] Reportedincidenceofvitamin D deficiencydefinedas a 25(OH)D < 20 ng/mLaround the globeincludingAustralia (AU), Canada (CA), China (CH), India (IN), Korea (KR), Malaysia (MA), Middle East (ME), Mongolia (MO), New Zealand (NZ), North Africa (NA), Northern Europe (NE), United States (USA). 19

  22. A vitamin D deficiency can occur when 2 the usual vitamin D intake is lower than recommended levels over time exposure to sunlight is limited the kidneys can not convert 25(OH)D to its active form absorption of vitamin D from the digestive tract is inadequate Classical Vitamin D Deficiency Diseases 20 Adults soft bones (osteomalacia) fragile bones (osteoporosis) Children rickets (a failure of bone tissue to properly mineralize) soft bones and skeletal deformities 9. Vitamin D deficiency

  23. 9. Vitamin D deficiency • Osteomalacia & Osteoporosis 21, 22 • Osteomalacia refers to a softening of the bones and results from a defect in the bone-building process. • Osteoporosis is a disease in which the density and quality of bone are reduced. • As bones become more porous and fragile, the risk of fracture is greatly increased. • The balance between bone resorption and deposition changes with age→ osteoporosis can develop • “Around the world, 1 in 3 women and 1 in 5 men are at risk of an osteoporotic fracture”

  24. 9. Vitamin D deficiency

  25. 9. Vitamin D deficiency • Rickets 23, 24 • Definition • Vitamin D promotes the absorption of calcium and phosphorus from the gastrointestinal tract. • A deficiency of vitamin D makes it difficult to maintain proper calcium and phosphorus levels in the bones, which can cause rickets. • Risk factors • Age (3-36 month old children) • Exclusive breast feedingwithout supplemental vitamin D • Premature birth • Dark skin Skeletal deformities bowlegs Bone pain Impaired growth Muscle cramps

  26. 10. Good to know Upper limits of Vitamin D 22 • Vitamin D toxicity can cause: • Weight loss • Polyuria • Heart arrhythmia • Raise levels of calcium -> vascular and tissue calcification

  27. Vitamin D3 is NOT recommended for 2 People who suffer from hypercalcemiaand or hypercalciuria People who suffer from renal insufficiency Vitamin D may increase the risk of hardening of the arteries in people with serious kidney disease This medications can influence the effect of vitamin D 2 Anticonvulsants Barbiturate (sleeping pills) Glucocorticoids • Triamcinolone (Triam-Denk) • Cortisone • Prednisone • Dexamethasone 10. Good to know

  28. 11. Complementary Treatment INDICATION: Bone Health + + + Glucocorticoids Zoledro-Denk Triamcinolone(Triam-Denk) Cortisone Prednisone Dexamethasone • Beneficial to the maintenance of bones, teeth and contributes to a normal muscle function • Significant benefit in osteoporosis as well as other conditions causing bone loss. • Strong inhibitor of osteoclastic bone resorption. • Calcium and vitamin D supplementation for all patients beginning glucocorticoid therapy.

  29. 12. References 1 Nair R (2012). Vitamin D: the “sunshine vitamin”. J PharmacolPharmacother. 3 (2): 118-126. 2 National Institutes of Health (2016): Vitamin D. Fact Sheet for Health Professionals. 3Trémezagues L (2010): Zur Bedeutung des Vitamin-D-Stoffwechsels in der humanen Haut. Hautarzt. 61: 478-486. 4Holick MF (1996): Vitamin D and Bone Health. Am In Nutr. 5 IOM (2011): Dietary Reference Intakes for Calcium and Vitamin D. 6 DeLuca HF (1986): The metabolism and functions of vitamin D. AdvExp Med Biol. 196. 361-375. 7 European Commission (2012): Commission regulation (EU) No 432/2012. 8 DGE (2018): Vitamin D (Calciferole) https://www.dge.de/wissenschaft/referenzwerte/vitamin-d/ 9 American Academy of Pediatrics (2008): Prevention of Rickets and Vitamin D deficiency in Infants, Children, and Adolescents. Pediatrics. 122. 1142 – 1152. 10 Center for Disease Control and Prevention (2017): Vitamin D Supplementation. 11 Deutsche Apotheker Zeitung (2017): Vitamin D – Tropfen oder Tabletten? 12 Deutsche Gesellschaft für Kinderendokrinologie und –diabetologie (2016): S1-Leitlinie Vitamin D Mangel-Rachitis. Portal der wissenschaftlichen Medizin.

  30. 12. References 13 Natural Medicines (2018): Vitamin D. Background. 14 Mayo Clinic (2018): Vitamin D. http://www.mayoclinic.org/drugs-supplements/vitamin-d/background/hrb-2006040015 Logan VF (2013): Long-term vitamin D3 supplementation is more effective than vitamin D2 in maintaining serum 25-hydroxyvitamin D status over the winter months. Brit J Nutr. 109 (6): 1082-1088. 16 Bikle DD (2014): Vitamin D Metabolism, Mechanism of Action, and Clinical Applications. Chem Biol. 21 (3): 319-329. 17 Lips P (2010): Worldwide status of vitamin D nutrition. J SterBiochemMol Biol. 121. 297-300. 18 Wahl DA (2012): A global representation of vitamin D status in healthy populations. International Osteoporosis Foundation and National Osteoporosis Foundation. https://www.iofbonehealth.org/facts-and-statistics/vitamin-d-studies-map 19Holick MF (2012): Guidelines for Preventing and Treating Vitamin D Deficiency and Insufficiency Revisited. J ClinEndocrinolMetab. 97 (4): 1153-1158. 20 ng/ml = 50 nmol/L 20 IFAS Extension University of Florida (2001): Facts about Vitamin D. http://edis.ifas.ufl.edu/pdffiles/FY/FY20700.pdf 21Sunyecz JA (2008) The use of calcium and vitamin D in the management of osteoporosis. TherClin Risk Management 4(4): 827-836. 22 International Osteoporosis Foundation (2018): Who‘s at risk? ttp://www.iofbonehealth.org/whos-risk 23 Mayo Clinic (2018): Rickets. 24 MedlinePlus (2018): Rickets.

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