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VITAMIN D DEFICIENCY

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

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VITAMIN D DEFICIENCY

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  1. 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.

  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?

  4. DEFINITION AND PREVALENCE OF VITAMIN D • Vit D deficiency: 25(OH)D<20ng/ml • Vit D intoxication: 25(OH)D>150ng/ml

  5. OSTEOPOROSIS AND FRACTURE • 33% of women 60-70 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

  6. Osteoporosis and fracture

  7. 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 0.1-0.7). J Amgeriatr soc, 2007

  8. Cancer and Vit D • People living at higher latitudes are at increased risk for cancer J of Steriod Biochem Mol Bio, 2005

  9. Diseases and Vit D • Living at higher altitudes increases the risk of DMI, MS, and Crohn’sToxicology, 2002 • African-Americans are at higher risk of developing TB Science, 2006

  10. 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

  11. 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

  12. 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

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

  14. 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

  15. 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

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

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