Vitamin D status in apparently healthy uruguayan adults, in winter in Montevideo city
Keywords:
VITAMIN D, ADULTS, WINTER, URBAN POPULATION, VITAMIN D DEFICIENCY, PARATHYROID HORMONE, IONIZED CALCIUMAbstract
Objective: Determine the prevalence of the “Vitamin D Status” through the serum levels of total 25(OH) Vit D and its relationship with age, sex, ethnicity, BMI, usual sun exposure and parameters of the phosphate-calcium metabolism, in an adult population, of both sexes, asymptomatic and apparently healthy, in winter, in Montevideo (Latitude 34,50° S).
Material and methods: Cross-sectional, descriptive study where 175/331 outpatient subjects (95% ≤ 50), 102 men and 73 women (95% premenopausal), Caucasian (84%), usual sun exposure (43%), BMI (62% > 27 kg/m2). Total 25(OH) Vit D, Intact PTH (IPTH), ionized Calcium, magnesium, phosphate eIVFG were determined.
Results: serum levels of total 25(OH) Vt D: 89% <30 ng/mL; Deficiency (<14) 25,7%; Insufficiency (≥14 - <30) 63,4%; Sufficiency (≥30 - ≤80) 10,9%. Among categories, differences were highly significant, without association with any of the studied variables.
IPTH had a negative and highly significant correlation with ionized calcium but the inverse correlation with 25(OH) Vit D didn´t reach significance. Secondary hyperparathyroidism due to the deficit wasn’t found.
Conclusions: apparently healthy adults in winter had a very prevalent “Low Vitamin D Status”, without any significant association with the studied variables.
IPTH had different individual responses before distinct levels of 25(OH) Vit D; then it isn´t a good bio-marker of “Vitamin D status”.
Facing these results (in agreement with the bibliography) and the impossibility of a global screening (very costly test) ¿what to do?: ¿prophylactic supplementation at all ages?; ¿how; how much supplement; up to which level? ¿do >30 ng/mL levels protect similarly the osseus and the extra-osseus health? The controversy persists.
References
(1) National Institutes of Health. Office of Dietary Supplements. Vitamin D: fact sheet for health professionals. Bethesda: NIH, 2015. Disponible en: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Consulta: 14 julio 2016.
(2) Martin A, David V, Quarles LD. Regulation and function of the FGF23/Klotho endocrine pathways. Physiol Rev 2012; 92: 133-55. Disponible en: http://physrev.physiology.org/content/92/1/131.full-text.pdf%2BhtmlConsulta: 14 julio 2016.
(3) Holick MF, Chen TC. Vitamin D: a worldwide problem with health consequences. Am J Clin Nutr 2008; 87(4): 1080S-6S. Disponible en: http://ajcn.nutrition.org/content/87/4/1080S.full.pdf+html Consulta: 14 julio 2016.
(4) Beveridge LA, Struthers AD, Khan F, Jorde R, Scragg R, Macdonald HM,et al. Effects of vitamin D supplementation on blood pressure: a systematic review and meta-analysis incorporating individual patient data. JAMA Intern Med 2015; 175(5):745-54. Disponible en: http://archinte.jamanetwork.com/data/Journals/INTEMED/933831/ioi150010.pdf Consulta: 14 julio 2016.
(5) Davidson MB, Duran P, Lee ML, Friedman TC. High-dose vitamin D supplementation in people with prediabetes and hypovitaminosis D. Diabetes Care. 2013; 36(2):260-6. Disponible en: http://care.diabetesjournals.org/content/36/2/260.full.pdf Consulta: 14 julio 2016.
(6) Jorde R, Sollid ST, Svartberg J, Joakimsen RM, Njølstad I, Fuskevåg OM, et al. Vitamin D 20.000 UI per Week for five years does not prevent progression from pre-diabetes to diabetes. J Clin Endocrinol Metab 2016; 101(4):1647-55.
(7) Cheema MR, Chaudhry AY. Quality-of-life indicators and falls due to vitamin D deficiency. Int J Gen Med 2016, 9: 21-5. Disponible en: http://www.dovepress.com/getfile.php?fileID=29086 Consulta: 14 julio 2016.
(8) Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: a meta-analysis. Clin Exper Rheumatol 2016; 34(5):827-33.
(9) Dias De Castro F, Magalhães J, Boal Carvalho P, Moreira MJ, Mota P, Cotter J. Lower levels of vitamin D correlate with clinical disease activity and quality of life in inflammatory bowel disease. Arq Gastroenterol 2015; 52(4):260-5. Disponible en: http://www.scielo.br/pdf/ag/v52n4/0004-2803-ag-52-04-00260.pdf Consulta: 14 julio 2016.
(10) Health Quality Ontario. Clinical utility of vitamin d testing: an evidence-based analysis. Ont Health Technol Assess Ser. 2010; 10(2):1-93. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377517/pdf/ohtas-10-93.pdf Consulta: 14 julio 2016.
(11) Binkley N, Krueger D, Cowhill CS, Plum L, Lake E, Hansen KE, et al. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 2004; 89:3152-7. Disponible en: http://press.endocrine.org/doi/pdf/10.1210/jc.2003-031979 Consulta: 14 julio 2016.
(12) Schleicher RL, Sternberg MR, Looker AC, Yetley EA, Lacher DA, Sempos CT, et al. National Estimates of Serum Total 25-Hydroxyvitamin D and Metabolite Concentrations Measured by Liquid Chromatography-Tandem Mass Spectrometry in the US Population during 2007-2010. J Nutrition 2016; 146 (5):1051-61.
(13) Weishaar T, Rajan S, Keller B. Probability of Vitamin D Deficiency by Body Weight and Race/Ethnicity. J Am Board Fam Med 2016; 29(2):226-32.Disponible en: http://www.jabfm.org/content/29/2/226.full.pdf Consulta: 14 julio 2016.
(14) Hant FN, Bolster MB. Drugs that may harm bone: mitigating the risk. Cleve Clin J Med 2016 Apr; 83(4): 281-8. Disponible en: http://tinyurl.com/zm59aul Consulta: 14 julio 2016.
(15) van Orten-Luiten AC, Janse R, Dhonuskshe-Rutten RA, Witkamp RF. Vitamin D deficiency as adverse drug reaction? A cross-sectional study in Dutch geriatric outpatients. Eur J Clin Pharmacol 2016; 72:605-14. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834096/pdf/228_2016_ Article_2016.pdfConsulta: 14 julio 2016.
(16) Mendoza B. Deficiencia de Vitamina D: guías clínicas para su diagnóstico y tratamiento. Tend med 2013; 21(42):149-58.
(17) 17 . Mendoza B, Ronco A, Mintegui G, Belzarena MC. Serum vitamin D status among postmenopausal Uruguayan women. Osteoporos Int 2006; 17(Suppl 2): S1-S332.
(18) Mendoza B, Ronco A. Importancia de los niveles séricos de vitamina D3. Tend med 2001; 18:97-101.
(19) Silva L, Araújo E, Olascoaga A, Alallón W. Vitamina D en una población adulta mutual y comportamiento de la hormona paratiroidea. Rev Urug Patol Clin 2010; 53:46.
(20) Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporosis Int 2005; 16(7):713-6. Disponible en: http://www.direct-ms.org/pdf/VitDVieth/DawsonHughes%20Vieth%20Optimal%2025D.pdf Consulta: 14 julio 2016.
(21) Dawson-Hughes B. Vitamin D deficiency in adults: definition, clinical manifestations and treatment. UpToDate 2016. Disponible en: http://www.uptodate.com/contents/vitamin-d-deficiency-in-adults-definition-clinical-manifestations-and-treatment Consulta: 14 julio 2016.
(22) Krull M Jr, Kallikorm R, Tamm A, Lember M. Seasonal variance of 25-(OH) vitamin D in the general population of Estonia, a Northern European country. BMC Public Health 2009; 9:22.
(23) González G, Alvarado JN, Rojas A, Navarrete C, Velázquez CG, Arteaga E. High prevalence of vitamin D deficiency in Chilean healthy postmenopausal women with normal sun exposure: additional evidence for a worldwide concern. Menopause 2007; 14(3 Pt 1):455-61.
(24) Binkley N, Ramamurthy R, Krueger D. Low vitamin D status: definition, prevalence, consequences and correction. Endocrinol Metab Clin North Am 2010; 39 (2):287-301.
(25) Cashman KD, Dowling KG, Skrabáková Z, Gonzalez-Gross M, Valtueña J, De Henauw S, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr 2016; 103(4):1033-44. Disponible en: http://ajcn.nutrition.org/content/103/4/1033.long Consulta: 14 julio 2016.
(26) Oliveri B, Plantalech L, Bagur A, Wittich AC, Rovai G, Pusiol E, et al. High prevalence of vitamin D insufficiency in healthy elderly people living at home in Argentina. Eur J Clin Nutr 2004; 58:337-42.
(27) Nakamura K, Kitamura K, Takachi R, Saito T, Kobayashi R, Oshiki R, et al. Impact of demographic, environmental, and lifestyle factors on vitamin D sufficiency in 9084 Japanese adults. Bone 2015; 74:10-7.
(28) Arévalo CE, Núñez M, Barcia RE, Sarandria P, Miyazato M. (Vitamin D deficit in adult women living in Buenos Aires city) Medicina (Buenos Aires) 2009; 69(6):635-9. Disponible en: http://www.scielo.org.ar/pdf/medba/v69n6/v69n6a08.pdf Consulta: 14 julio 2016.
(29) Martini LA, Verly E Jr, Marchioni DM, Fisberg RM. Prevalence and correlates of calcium and vitamin D status adequacy in adolescents, adults, and elderly from the Health Survey-São Paulo. Nutrition 2013; 29(6):845-50.
(30) Brito A, Cori H, Olivares M, Mujica MF, Cediel G, López de Romaña D. Less than adequate vitamin D status and intake in Latin America and the Caribbean: a problem of unknown magnitude. Food Nutr Bull 2013; 34(1):52-64.
(31) Whiting Sj, Kohrt WM, Warren MP, Kraenzlin MI, Bonjour J-P. Food fortification for bone health in adulthood: a scoping review. Eur J Clin Nutr 2016; (10):1099-105.
(32) Sanders KM, Stuart AL, Williamson EJ, Simpson, JA, Kotowicz MA, Young D, et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010; 303(18):1815-22.
(33) Minisola S, Pacitti MT, Scarda A, Rosso R, Romagnoli E, Carnevale V, et al. Serum ionized calcium, parathyroid hormone and related variables: effect of age and sex. Bone Miner 1993; 23(3):183-93.
(34) Portale AA, Lonergan ET, Tanney DM, Halloran BP. Aging alters calcium regulation of serum concentration of parathyroid hormone in healthy men. Am J Physiol 1997; 272(1Pt 1): E 139-46.
(35) Paik JM, Farwell WR, Taylor EN. Demographic, dietary, and serum factors and parathyroid hormone in the National Health and Nutrition Examination Survey. Osteoporosis Int 2012; 23(6): 1727-36.
(36) Kroll MH, Bi C, Garber CC, Kaufman HW, Liu D, Caston-Balderrama A, et al. Temporal relationship between vitamin D status and parathyroid hormone in the United States. PLoS One 2015; 10(3): e0118108. Disponible en: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118108 Consulta: 14 julio 2016.
(37) Schleck ML, Souberbielle JC, Jandrain B, Da Silva A, De Niet S, Vanderbist F, et al. A randomized, double-blind, parallel study to evaluate the dose-response of three different vitamin D treatment schemes on the 25-hydroxyvitamin D serum concentration in patients with vitamin D deficiency. Nutrients 2015; 7(7):5413-22. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517004/pdf/nutrients-07-05227.pdf Consulta: 14 julio 2016.
(38) Holick MF, Binkley NC, Bischoff-Ferrari HA, Godon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Endocrinol Metab 2011; 96:1911-30. Disponible en: http://press.endocrine.org/doi/pdf/10.1210/jc.2011-0385 Consulta: 14 julio 2016.
(39) Binkley N, Gemar D, Engelke R, Gangnon R, Ramamurthy R, Krueger D, et al. Evaluation of ergocalciferol or cholecalciferol dosing, 1.600 UI daily or 50.000 UI monthly in older adults. J Clin Endocrinol Metab 2011; 96(4):981-8. Disponible en: http://press.endocrine.org/doi/pdf/10.1210/jc.2010-0015 Consulta: 14 julio 2016.
(40) U.S. Preventive Services. Task Force. Vitamin D deficiency: screening. Rockville, MD: USPSTF, 2016. Disponible en: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/vitamin-d-deficiency-screening?ds=1&s=Vitamin%20D%20Deficiency%20Screening Consulta: 28 octubre 2015.
