DR. AJAY H.

KANTHARIA

M.D.
CONSULTING PHYSICIAN & CARDIOLOGIST CRITICAL CARE PHYSICIAN HON. PHYSICIAN: Saifee Hospital Sir. H.N. Hospital Smt. Motiben B. Dalvi Hospital

Mysteries of Vitamin D

What is Vitamin D
Is it Vitamin ? Is it Hormone ? Is it single molecule?

What is Vitamin of Vitamin D D?  There are two main source  (1) Diet  (a) Vitamin D2 (ergocalciferol) Plant source  (b) Vitamin D3. (cholecalciferol) Animal source  (2) Sunlight .

 Exposure of skin to UVB light converts Provitamin D3 to Previtamin D3 which gets converted to Vitamin D3. .

there appears to be no difference in their biologic activity .  It is converted into 25-hydroxyvitamin D3. Once converted to calcidiol. vitamin D3 is stored in the liver. often called calcidiol. where it has a half-life of about 60 days. 25 (OH)D in the hepatocytes . adipose tissue and muscle. After synthesis in the skin or ingestion through the diet.

 Calcidiol is then converted in the kidney to 1.  Although there are more than 40 vitamin D metabolites identified.25(OH)2D …… Calcitriol. the predominate effects of vitamin D in the body are exerted through the actions of 1.25(OH)2D (calcitriol). .

What do we measure ? .

. so the abbreviation 25(OH)D is used. 25(OH) D2 from 25(OH) D3.What do we measure ?  Most assays for 25(OH)D cannot differentiate the two distinct forms.

What do we measure ?  The serum 25-hydroxyvitamin D . as well as the conversion of vitamin D from adipose stores in the liver . 25(OH)D level is the best indicator of overall vitamin D status because this measurement reflects total vitamin D from dietary intake and sunlight exposure.

How do we interpret the report ?  Earlier report mentioned a normal range. .

How do we interpret the report ?  Now it is classified as : .

more than 30 ng/ml (75nmol/L) .How do we Interpret report Deficiency :level less than 10 ng/mL (25 nmol/L) Insufficient : level between 10 to 30 ng/mL (25 to 75 nmol/L). Sufficient ..

activity and other aspects of the environment. time of year and day. skin pigmentation type. clothing. age. including latitude.Source of Vitamin D  (1) Sunlight  The skin synthesizes vitamin D3 from 7-dehydrocholesterol in response to ultraviolet B radiation in sunlight. This synthetic process depends on many factors. altitude. . weather.

with 25.5% of the body surface area exposed. from April to October at 12 PM EST an individual with type III skin. would need to spend 3 to 8 minutes in the sun to synthesize 400 IU of vitamin D. . In Boston.

) . There are well-known detrimental side effects of ultraviolet irradiation.  ( J Am Acad Dermatol 2010. Therefore. oral supplementation remains the safest way for increasing vitamin D status. Conclusions: Although it may be tempting to recommend intentional sun exposure based on our findings.e1-e9. if not impossible to titrate one’s exposure.62:929. it is difficult.

Source of Vitamin D  (2) Diet : .

.

Deficiency…. Why ?? ..

Low Levels of Vitamin D  Dark Skin  Obese  Poor Dietary intake  Malabsorbtion  Poor Exposure to sunlight  Drugs… Phynetoin. steroids .

Manifestations of Vitamin D Deficiency .

Manifestations of Vitamin D Deficiency .

Non Traditional Role of Vitamin D  Lowers Blood Pressure  Lowers insulin Resistance  Lower Risk of Cancers  Improves Immunity .

Vitamin D In CKD .

Am J Kidney Dis 45:1026–1033. . 2005. Hellman RN. Karp SL. et al: Prevalence of calcidiol deficiency in CKD: a cross-sectional study across latitudes in the United States.Subjects Within K/DOQI Target Ranges CKD 3 n = 65 (%) Calcidiol sufficient (>30 ng/mL) 29 CKD 4 n = 113 (%) 17 Calcidiol insufficient (10–30 ng/mL) Calcidiol deficient (<10 ng/mL) 57 14 58 26 Adapted from LaClair RE.

Vitamin D in Myalgia .

Vitamin D in Myalgia due to Statin .

.Vitamin D in Myalgia due to Statin  A study was conducted with specific aim to determine whether low serum 25 (OH) vitamin D (D2 + D3) (<32 ng/mL) was associated with myalgia in statin-treated patients and whether the myalgia could be reversed by vitamin D supplementation while continuing statins.

2 ng/mL (P . myalgic patients.4 to 48.Vitamin D in Myalgia due to Statin  Of the 82 vitamin.D–deficient. 0. while continuing statins. 38 were given vitamin D (50.000 units/week for 12 weeks). .0001) and resolution of myalgia in 35 (92%). with a resultant increase in serum vitamin D from 20.

Recommended dosage .

routine vitamin D supplementation (10–25 μg [400–1000 IU] daily) is recommended.. under age 50.e.Recommended dosage  In healthy adults at low risk for vitamin D deficiency (i. . without osteoporosis or conditions affecting vitamin D absorption or action).

many individuals may require supplementation at greater than 25 μg (1000 IU) daily . Supplementation with at least 20–25 μg (800–1000 IU) of vitamin D3 daily is recommended.Recommended dosage  Adults over 50 years of age who are at moderate risk for vitamin D deficiency. To achieve optimal vitamin D status (> 75 nmol/L).

.Recommended dosage  Doses up to 50 μg (2000 IU) per day are safe and do not require monitoring.

with monitoring of serum 25hydroxyvitamin D at one and three months.g..Recommended dosage  Treatment of severe deficiency (rickets or osteomalacia) requires higher doses. 1250 μg (50 000 IU) daily for two to four weeks. e. . then weekly or biweekly.

presenting as hypercalcemia and renal damage.  Toxic effects occur only with prolonged (at least several months) daily intake of more than 1000 μg (40 000 IU) .Safety and toxicity of vitamin D supplementation  Excessive use of vitamin D supplements has the potential to cause progressive accumulation and toxic effects.

Vitamin D and Calcium .

.Conclusion  Sunlight is inadequate source of Vitamin D  Diet is inadequate source of Vitamin D  Diet fortified with Vit D is required.  Calcium and Vitamin D are coprescribed  Vitamin D supplementation is essential and that too in higher dosage than accepted till now.

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