Hazai konszenzus a D-vitamin szerepéről a betegségek megelőzésében és kezelésében
Abstract
The metabolism of vitamin D is unique in the human body and its diverse effects are present in almost every organ. Vitamin D deficiency is one of the most prominent health issues in the civilized world. For the solution of this concern an extensive collaboration is imperative. Recognizing this necessity the most prominent Hungarian medical associations fighting with the effects of vitamin D deficiency worked out a collective consensus on the importance, diagnosis, prevention and suggested therapy of vitamin D deficiency. Along with the clinical guidelines of the different associations, the result of this consensus could serve as guidance for the practicing doctors in the prevention and therapy of vitamin D deficiency. In addition the consensus aims to direct the attention of decision-makers and the general public on the significance of this issue.
... MAVIDOS, the MAternal VItamin D Osteoporosis Study-among other things-investigated a maternal bone resorption marker (urinary C-terminal telopeptide of type I collagen/CTX), 25(OH)-vitamin D levels and the effects of gestational vitamin D supplementation (1000 IU/day) on resorption markers and BMD during pregnancy [93]. During the initial 14 weeks of gestation, there was no difference between the 25(OH)-vitamin D levels in the two groups (in nmol/L: placebo group, 44.1 ± 16.1; vitamin-D-supplemented group, 45.0 ± 16.3); however, these values indicate vitamin D deficiency (<50 nmol/L or <20 ng/mL) in both pregnant groups [94][95][96][97]. At 34 gestational weeks, maternal 25(OH)-vitamin D levels were significantly higher in the supplemented group compared to controls (in nmol/L: placebo group, 42.5 ± 20.6; vitamin-D-supplemented group: 66.0 ± 20.4). ...
... At 34 gestational weeks, maternal 25(OH)-vitamin D levels were significantly higher in the supplemented group compared to controls (in nmol/L: placebo group, 42.5 ± 20.6; vitamin-D-supplemented group: 66.0 ± 20.4). However, according to the numbers, 1000 IU/day vitamin D supplementation of the pregnant women resulted in only suboptimal (50-75 mmol/L or 20-30 ng/mL) and not optimal (75-125 nmol/L or 30-50 ng/mL) [94][95][96][97] vitamin D status. They observed that CTX showed a two-fold increase from 14 to 34 gestational weeks showing bone resorption in both groups, although this increase was lower in the vitamin-D-supplemented group compared to the placebo group [93]. ...
Polycystic ovary syndrome (PCOS) is one of the most common endocrine reproductive disorders in women. Vitamin D deficiency is also quite common in this condition. The degree of vitamin D deficiency correlates with the severity of PCOS. Both male and female vitamin D levels play a role in fertility and affect the outcomes of in vitro fertilization (IVF). Moreover, fertility and IVF indicators are improved by vitamin D not only in healthy women but in those diagnosed with PCOS. Both vitamin D deficiency and PCOS increase pregnancy-related complications. Vitamin D supplementation and optimal vitamin D levels decrease both maternal and fetal risk for complications and adverse events. Furthermore, vitamin D supplementation may ameliorate or even prevent pregnancy-related reversible bone loss in mothers. This review emphasizes the roles of vitamin D deficiency and vitamin D supplementation and their correlation with PCOS regarding reproductive health.
... Disease control in the asthmatic group was better than in the ACOS group (20.95 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] vs 15.60 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] -mean [range]). Additionally, we found a positive correlation between ACT total scores and serum 25(OH)D level (r=0.3913; ...
... Disease control in the asthmatic group was better than in the ACOS group (20.95 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] vs 15.60 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] -mean [range]). Additionally, we found a positive correlation between ACT total scores and serum 25(OH)D level (r=0.3913; ...
Introduction
The association between vitamin D and clinical parameters in obstructive lung diseases (OLDs), including COPD and bronchial asthma, was previously investigated. As asthma–COPD overlap syndrome (ACOS) is a new clinical entity, the prevalence of vitamin D levels in ACOS is unknown.
Aim
Our aim was to assess the levels of circulating vitamin D (25-hydroxyvitamin D [25(OH)D]) in different OLDs, including ACOS patients, and its correlation with clinical parameters.
Methods
A total of 106 men and women (control, n=21; asthma, n=44; COPD, n=21; and ACOS, n=20) were involved in the study. All patients underwent detailed clinical examinations; disease control and severity was assessed by disease-specific questionnaires (COPD assessment test, asthma control test, and modified Medical Research Council); furthermore, 25(OH)D levels were measured in all patients.
Results
The 25(OH)D level was significantly lower in ACOS and COPD groups compared to asthma group (16.86±1.79 ng/mL and 14.27±1.88 ng/mL vs 25.66±1.91 ng/mL). A positive correlation was found between 25(OH)D level and forced expiratory volume in 1 second (r=0.4433; P<0.0001), forced vital capacity (FVC) (r=0.3741; P=0.0004), forced expiratory flow between 25% and 75% of FVC (r=0.4179; P<0.0001), and peak expiratory flow (r=0.4846; P<0.0001) in OLD patient groups. Asthma control test total scores and the 25(OH)D level showed a positive correlation in the ACOS (r=0.4761; P=0.0339) but not in the asthma group. Higher COPD assessment test total scores correlated with decreased 25(OH)D in ACOS (r=−0.4446; P=0.0495); however, this was not observed in the COPD group.
Conclusion
Vitamin D deficiency is present in ACOS patients and circulating 25(OH)D level may affect disease control and severity.
... Az 1 éves kor alatti gyermekekkel tipikusan 1-2 órát, míg az idősebbekkel a legtöbben 2-4 órát töltenek a szabadban. Ez a bőrt érő napsugárzásnak, illetve a napsugarak UVB-spektrumának az endogén-Dvitamin-szintézisben betöltött szerepe miatt nagy jelentőségű [27]. ...
Introduction: Recent research findings support the assumption that the development of chronic diseases in adults is greatly influenced by the supply of nutrients in the uterus and the nutrition, nourishment of the early, toddler ages. Aim: The aim of the present study was to evaluate the nutritional habits of infants and toddlers aged 0–3 in Hungary, and to identify the most typical problems of their nutrition, to get to know and provide the necessary data for the modification and modernization of feeding/nutrition recommendations for infants and young children in Hungary. Method: The study was carried out with the professional coordination of the Hungarian Dietetic Association (MDOSZ) in the framework of industry research between June and August 2015, in the 0–3-year-old population, in the cities Budapest, Debrecen, Győr, Szeged and Pécs. The survey was conducted with anthropometric measurements and validated by three-day dietary log templates. Results: 18.6% of infants aged 4 to 12 months (n = 220) had values below 10th percentile, 10% were between 85–97th percentiles and 3% were above 97th percentile. 15% of children aged 12–24 months (n = 227) had a body mass index (BMI) below 10th percentile (underweight), 14% were between 85–97th percentile (overweight) and 2.6% had BMI over the 97th percentile (obese). 70% of 25–36-month-old children (n = 184) had normal BMI, 4% were overweight, 2% obese, 24% underweight. Based on the Hungarian reference value, 10.9% of the 4–12-month-old children, 20% of the 1–2-year-olds, 47% of the 2–3-year-olds were in high protein intake group. However, compared to the 2013’s reference values of the EFSA (European Food Safety Authority) recommendation, 100% of the children belong to the high protein intake group in all age groups. Conclusion: Although the EFSA recommendation – based on the WHO/FAO/UNU macro- and micronutrient intake values in 2007 – defines the recommended intake quantities, the results in the sample did not support its overall reliability. Orv Hetil. 2019; 160(50): 1990–1998.
... Daily maintenance dosing of vitamin D3 in clinical practice often fails to achieve optimal outcomes, assessed by the level of 25OHD, compared to the recent dosing recommendations. Over the past decade the daily dosing targets have been elevated from 600 IU/d to 1500-2000 IU/d and considered blood 25OHD concentration as a clinically important surrogate outcome that correlates with health and disease [8][9][10][11][12]. ...
Introduction: The primary objective of the study was to assess the safety and the efficacy of a “Slower Loading” dose of 30,000 IU vitamin D3 supplementation administered in a weekly schedule for 12 weeks in vitamin D deficient patients compared to the daily equivalent dose of 1000 IU/day regimens in a clinical trial.
Methods: This open label, randomized, controlled, multicenter clinical trial was performed during the spring and summer period enrolling adult subjects with 25O HD levels <20 ng/ml. In a sub-study presented here, subjects were randomized into two treatment groups using 30,0000 IU Vitamin D3 film tablets either in weekly (WD30K group, daily dose equivalent of 4286 IU/day) or a standard dose for maintenance treatment in a daily administration (SDD1K group, 1000 IU/day). Subjects in a control group received a similar 30,0000 IU Vitamin D3 film tablets in a once-permonth schedule (MD30K), dosing schedule for 12 weeks, (an equivalent to 1000 IU/day). The assessment of efficacy made by the changes in 25O HD and PTH levels in a throughout 12 weeks. Routine laboratory tests, serum and urinary calcium served for laboratory-safety assessments in every 4 weeks throughout the duration of the study.
Results: The baseline values of 25O HD at in group (WD30K, SDD1K and MD30K) were in similar range: 13.7 ± 3.7 ng/mL, 13.48 ± 3.9 ng/mL and 13.1 ± 4.3 ng/mL, respectively. A daily dose of 1000 IU for 12 weeks was effective in restoration of 25O HD values to above 20 ng/mL (50 nmol/L), however the median of the group failed to attain the 30 ng/mL (75 nmol/L) threshold. Dose-response was statistically different in the 4286 IU/day group compared to a 1000 IU/daily dose (p<0.001) for all study visits. Treatment efficiency assessed on two levels and for treatment duration of 8 and 12 weeks. The limit of 25 ng/mL was achieved by 95% of patients in 8 weeks with 30,000 IU/wk administration (vs. only 33% with 1000 IU/d) but more prominent difference observed with the limit of desired range (>30 ng/ml): 91% vs. 10% of subjects in after 8 weeks with 30,000 IU/wk and 1000 IU/d doses and 95% vs. 24% by end of the 12 weeks of treatment. The treatment-related increment potential was in a range of 2.26-2.92 ng/week for the weekly 30K dosing group compared to 1.32-1.70 ng/week for the 1000 IU/day standard maintenance dose group after 8 weeks.
Treatment with 30,000 IU doses of Vitamin D3 in a weekly administration for 12 weeks did not abolish serum calcium levels. No difference in frequency of laboratory adverse events and other safety parameters was observed compared to lower maintenance doses or to control group.
Conclusion: The safety of weekly loading oral doses of 30,000 IU vitamin D3 tablets was demonstrated and efficacy compared to the maintenance treatment with a daily dose equivalent of 1000 IU/d, in a daily or in monthly schedule in vitamin D deficient, adult population. Weekly administration of 30,000 IU loading dose for 12 weeks does not raise safety concern, but provides an effective tool for normalization of 25O HD levels to the desirable level of >30ng/mL in deficient patients.
A gyermekek táplálkozásával kapcsolatban kiemelten fontos a szülők tájékozottsága. Jelen tanulmány az
egészségtudatos táplálkozás szocioökonómiai összefüggéseiről ad képet a Komárom-Esztergom megyében élő
szülők gyermekétkeztetési szokásainak perspektívájából.
Célunk az egészségtudatos táplálkozás, ezen belül az
OKOSTÁNYÉR® mint hazai táplálkozási ajánlásban foglalt elvek követésének vizsgálata volt egy 591 fős mintán
készült online, kérdőíves felmérés eredményei alapján.
Vizsgáltuk, hogy az adott populációban az egészségtudatos táplálkozásról kialakult elképzelések milyen információforrásokból származnak. Eredményeink szerint nincs
szignifikáns kapcsolat a kutatásban részt vett szülők
OKOSTÁNYÉR®-ismerete és az ajánlásnak megfelelő étrend között. Ezzel szemben a szociodemográfiai tényezők
hatása jelentős, az anyagi helyzet (p=0,003) és az iskolai
végzettség (p<0,001) komoly hatást gyakorol a gyermekek étkezési szokásaira. Az egészséges táplálkozásról
szubjektíven – nem objektíven, a szakmai szempontokat
szem előtt tartva – vélekednek a szülők. A szakértői, reputációs információszerzés (pl. OKOSTÁNYÉR®) nem
játszik szerepet az egészségtudatos táplálkozásról kialakított elképzelésekben. A válaszadók a szakmailag hiteles
forrásokból kevésbé keresnek információt a gyermekeik
táplálkozási szokásainak kialakításához.
Kulcsszavak: gyermekek, szülők, egészségtudatos táplálkozás, információkeresés, táplálkozási ajánlás
Vitamin D deficiency has a high worldwide prevalence, but actions to improve this public health problem are challenged by the heterogeneity of nutritional and clinical vitamin D guidelines, with respect to the diagnosis and treatment of vitamin D deficiency. We aimed to address this issue by providing respective recommendations for adults, developed by a European expert panel, using the Delphi method to reach consensus. Increasing the awareness of vitamin D deficiency and efforts to harmonize vitamin D guidelines should be pursued. We argue against a general screening for vitamin D deficiency but suggest 25-hydroxyvitamin D (25(OH)D) testing in certain risk groups. We recommend a vitamin D supplementation dose of 800 to 2000 international units (IU) per day for adults who want to ensure a sufficient vitamin D status. These doses are also recommended for the treatment of vitamin D deficiency, but higher vitamin D doses (e.g., 6000 IU per day) may be used for the first 4 to 12 weeks of treatment if a rapid correction of vitamin D deficiency is clinically indicated before continuing, with a maintenance dose of 800 to 2000 IU per day. Treatment success may be evaluated after at least 6 to 12 weeks in certain risk groups (e.g., patients with malabsorption syndromes) by measurement of serum 25(OH)D, with the aim to target concentrations of 30 to 50 ng/mL (75 to 125 nmol/L).
We tested the hypothesis that the age-related decline in skin thickness may contribute to the age-related decline in serum 25-hydroxyvitamin D [25(OH)D]. We measured skinfold thickness on the back of the hand, serum 25(OH)D, height, and weight in 433 normal postmenopausal women. We also noted the average daily hours of sunlight in the month in which the observations were made and in the preceding 2 mo. Serum 25(OH)D was positively related to hours of sunlight (with a time lag of 2 mo) and to skin thickness, and negatively to body mass index (wt/ht²). Serum 25(OH)D fell significantly after age 69 y. Seasonal variation of serum 25(OH)D was greater in lean than in fat subjects, which we attributed to the larger fat mass and consequent larger pool size in the latter group. The results suggest that the tendency for serum 25(OH)D to fall with age is due in part to the age-related decline in skin thickness.
Background: Obesity is associated with vitamin D insufficiency and secondary hyperparathyroidism.
Objective: This study assessed whether obesity alters the cutaneous production of vitamin D3 (cholecalciferol) or the intestinal absorption of vitamin D2 (ergocalciferol).
Design: Healthy, white, obese [body mass index (BMI; in kg/m²) ≥ 30] and matched lean control subjects (BMI ≤ 25) received either whole-body ultraviolet radiation or a pharmacologic dose of vitamin D2 orally.
Results: Obese subjects had significantly lower basal 25-hydroxyvitamin D concentrations and higher parathyroid hormone concentrations than did age-matched control subjects. Evaluation of blood vitamin D3 concentrations 24 h after whole-body irradiation showed that the incremental increase in vitamin D3 was 57% lower in obese than in nonobese subjects. The content of the vitamin D3 precursor 7-dehydrocholesterol in the skin of obese and nonobese subjects did not differ significantly between groups nor did its conversion to previtamin D3 after irradiation in vitro. The obese and nonobese subjects received an oral dose of 50000 IU (1.25 mg) vitamin D2. BMI was inversely correlated with serum vitamin D3 concentrations after irradiation (r = −0.55, P = 0.003) and with peak serum vitamin D2 concentrations after vitamin D2 intake (r = −0.56, P = 0.007).
Conclusions: Obesity-associated vitamin D insufficiency is likely due to the decreased bioavailability of vitamin D3 from cutaneous and dietary sources because of its deposition in body fat compartments.
Vitamin D deficiency is now recognized as a pandemic. The major cause of vitamin D deficiency is the lack of appreciation that sun exposure in moderation is the major source of vitamin D for most humans. Very few foods naturally contain vitamin D, and foods that are fortified with vitamin D are often inadequate to satisfy either a child's or an adult's vitamin D requirement. Vitamin D deficiency causes rickets in children and will precipitate and exacerbate osteopenia, osteoporosis, and fractures in adults. Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases. A circulating level of 25-hydroxyvitamin D of >75 nmol/L, or 30 ng/mL, is required to maximize vitamin D's beneficial effects for health. In the absence of adequate sun exposure, at least 800–1000 IU vitamin D3/d may be needed to achieve this in children and adults. Vitamin D2 may be equally effective for maintaining circulating concentrations of 25-hydroxyvitamin D when given in physiologic concentrations.
Background: Numerous observational studies have found supplemental calcium and vitamin D to be associated with reduced risk of common cancers. However, interventional studies to test this effect are lacking.
Objective: The purpose of this analysis was to determine the efficacy of calcium alone and calcium plus vitamin D in reducing incident cancer risk of all types.
Design: This was a 4-y, population-based, double-blind, randomized placebo-controlled trial. The primary outcome was fracture incidence, and the principal secondary outcome was cancer incidence. The subjects were 1179 community-dwelling women randomly selected from the population of healthy postmenopausal women aged >55 y in a 9-county rural area of Nebraska centered at latitude 41.4°N. Subjects were randomly assigned to receive 1400–1500 mg supplemental calcium/d alone (Ca-only), supplemental calcium plus 1100 IU vitamin D3/d (Ca + D), or placebo.
Results: When analyzed by intention to treat, cancer incidence was lower in the Ca + D women than in the placebo control subjects (P < 0.03). With the use of logistic regression, the unadjusted relative risks (RR) of incident cancer in the Ca + D and Ca-only groups were 0.402 (P = 0.01) and 0.532 (P = 0.06), respectively. When analysis was confined to cancers diagnosed after the first 12 mo, RR for the Ca + D group fell to 0.232 (CI: 0.09, 0.60; P < 0.005) but did not change significantly for the Ca-only group. In multiple logistic regression models, both treatment and serum 25-hydroxyvitamin D concentrations were significant, independent predictors of cancer risk.
Conclusions: Improving calcium and vitamin D nutritional status substantially reduces all-cancer risk in postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00352170.
In utero or early-life vitamin D deficiency is associated with skeletal problems, type I diabetes, and schizophrenia, but the prevalence of vitamin D deficiency in U.S. pregnant women is unexplored. We sought to assess vitamin D status of pregnant women and their neonates residing in Pittsburgh by race and season. Serum 25-hydroxyvitamin D 125(OH)D) was measured at 4-21 wk gestation and predelivery in 200 white and 200 black pregnant women and in cord blood of their neonates. Over 90% of women used prenatal vitamins. Women and neonates were classified as vitamin D deficient [25(OH) < 37.5 nmol/L], insufficient [25(OH)D 37.5-80 nmol/L], or sufficient [25(OH)D > 80 nmol/L]. At delivery, vitamin D deficiency and insufficiency occurred in 29.2% and 54.1% of black women and 45.6% and 46.8% black neonates, respectively. Five percent and 42.1% of white women and 9.7% and 56.4% of white neonates were vitamin D deficient and insufficient, respectively. Results were similar at < 22 wk gestation. After adjustment for prepregnancy BMI and periconceptional multivitamin use, black women had a smaller mean increase in maternal 25(OH)D compared with white women from winter to summer (16.0 +/- 3.3 nmol/L vs. 23.2 +/- 3.7 nmol/L) and from spring to summer (13.2 +/- 3.0 nmol/L vs. 27.6 +/- 4.7 nmol/L) (P < 0.01). These results suggest that black and white pregnant women and neonates residing in the northern US are at high risk of vitamin D insufficiency, even when mothers are compliant with prenatal vitamins. Higher-dose supplementation is needed to improve maternal and neonatal vitamin D nutnture.
Objective: To determine the serum level of free 1,25-dihydroxyvitamin D [1,25-(OH) 2 D] in patients with vitamin D toxicity and to assess the in vitro effect of differing concentrations of vitamin D metabolites on the free serum levels of 1,25-(OH) 2 D. Design: 1) A case study of patients hospitalized with vitamin D toxicity after accidentally ingesting a veterinary vitamin D concentrate and 2) an in vitro experiment in which vitamin D metabolites in various concentrations were added to normal serum and their effect was noted on percentage of free 1,25-(OH) 2 D. Patients: 11 patients (age range, 8 to 69 years) were studied 10 to 40 days after hospitalization for hypercalcemia. Measurements: Serum total 25-hydroxyvitamin D (25-OHD) and 1,25-(OH) 2 D levels were measured by radioreceptor assays. The percentage of free 1,25-(OH) 2 D was measured by centrifugal ultrafiltration isodialysis and was used to calculate actual free 1,25-(OH) 2 D levels. In the in vitro studies, vitamin D metabolites [25-OHD; 24,25-(OH) 2 D; 25,26-(OH) 2 D; and 25-OHD-26,23 lactone] were added to normal serum in concentrations expected to occur with vitamin D toxicity. The percentage of free 1,25-(OH) 2 D was measured by isodialysis. Results: All patients presented with marked hypercalcemia (mean calcium level, 3.99±0.33 mmol/L). Serum 25-OHD levels ranged from 847 to 1652 nmol/L, and total 1,25-(OH) 2 D levels (mean, 106±86 pmol/L) were elevated in only three patients. The percentage of free 1,25-(OH) 2 D (mean, 1.023%±0.366%) was elevated in all nine patients in whom it was measured. Actual free 1,25-(OH) 2 D levels (mean, 856±600 fmol/L) were elevated in six of the nine patients. Total 1,25-(OH) 2 D levels were correlated with 25-OHD levels (r= 0.66; P=0.03), whereas total and free 1,25-(OH) 2 D levels were highly correlated (r=0.957; P<0.001). In the in vitro studies, the percentage of free 1,25-(OH) 2 D increased after 25-OHD or 24,25-(OH) 2 D was added. Conclusions: Although the patients had normal or near-normal total 1,25-(OH) 2 D values, most patients had elevated free 1,25-(OH) 2 D levels. These findings suggest that elevated free 1,25-(OH) 2 D levels might play a role in the pathogenesis of hypercalcemia in vitamin D toxicity
The initiation of the immunopathogenetic process that can lead to Type I (insulin-dependent) diabetes mellitus in childhood probably occurs early in life. Studies in vitro have shown that vitamin D3 is immunosuppressive or immunomodulating and studies in experimental models of autoimmunity, including one for autoimmune diabetes, have shown vitamin D to be protective. Seven centres in Europe with access to population-based and validated case registers of insulin-dependent diabetes patients participated in a case-control study focusing on early exposures and risk of Type I diabetes. Altogether data from 820 patients and 2335 control subjects corresponding to 85% of eligible patients and 76% of eligible control subjects were analysed. Questions focused on perinatal events and early eating habits including vitamin D supplementation. The frequency of vitamin D supplementation in different countries varied from 47 to 97% among control subjects. Vitamin D supplementation was associated with a decreased risk of Type I diabetes without indication of heterogeneity. The Mantel-Haenszel combined odds ratio was 0.67 (95% confidence limits: 0.53, 0.86). Adjustment for the possible confounders: a low birth weight, a short duration of breast feeding, old maternal age and study centre in logistic regression analysis did not affect the significant protective effect of vitamin D. In conclusion, this large multicentre trial covering many different European settings consistently showed a protective effect of vitamin D supplementation in infancy. The findings indicate that activated vitamin D might contribute to immune modulation and thereby protect or arrest an ongoing immune process initiated in susceptible people by early environmental exposures.