slide1
Download
Skip this Video
Download Presentation
نقش ويتامين D در سلامت

Loading in 2 Seconds...

play fullscreen
1 / 77

نقش ويتامين D در سلامت - PowerPoint PPT Presentation


  • 160 Views
  • Uploaded on

نقش ويتامين D در سلامت. فروزان صالحي دفتر بهبود تغذيه جامعه شهريور 1393. ویتامین D. محلول در چربی Sunshine vitamin هورمون یا ماده مغذی؟ پیش سازهای ویتامین :D (7-دهیدرو کلسترول و ارگوسترول). ویتامین D. انواع : ويتامين D 2 (گياهي: ارگوكلسيفرول)

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' نقش ويتامين D در سلامت' - skyler-little


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

نقش ويتامين D در سلامت

فروزان صالحي

دفتر بهبود تغذيه جامعه

شهريور 1393

slide2
ویتامین D
  • محلول در چربی
  • Sunshine vitamin
  • هورمون یا ماده مغذی؟
  • پیش سازهای ویتامین :D (7-دهیدرو کلسترول و ارگوسترول)
slide3
ویتامین D
  • انواع:
    • ويتامين D2 (گياهي: ارگوكلسيفرول)
    • ويتامين D3 (جانوري: كوله‌كلسيفرول)
  • وظيفه اصلی:
  • اهميت در تنظيم غلظت كلسيم، فسفر و متابوليسم استخواني
  • ساير وظايف:
    • اثرات ضد سرطاني (در سلول‌هاي خوني، پستان، ريه، رحم و كولون)
    • تمايز سلولي در برخي بافتها
slide8
منابع
  • نور آفتاب
  • 90 درصد نياز از تابش مستقيم نور خورشيد فراهم مي‌شود
  • بهترين ساعت روز: 10 تا 15
  • بهترين: فصل تابستان
  • بهترين عرض جغرافيايي: استوا
  • دستها، بازوها؛صورت، گردن و پاها:

به ميزان نصف تا ثلث زماني كه پوست مي‌سوزد!

  • حداقل 2 بار در هفته (3 تا 4 بار )
  • بهترین طول موج 300-270
slide9
منابع غذایی
  • روغن جگر ماهی
  • ماهی های چرب (شاه ماهی herring، خالمخالی mackerel و آزاد salmon)
  • زردۀ تخم مرغ
  • کره
  • جگر
  • شیر و لبنیات
  • سفرۀ غذایی ایران به طور معمول از نظر ویتامین D فقیر است!
slide10

3 oz smoked salmon = 583 IU

3 oz light tuna, canned in oil = 229 IU

1 large, whole egg = 29 IU

slide11
دریافت های غذایی مرجع (DRIs)
  • µg0/025= IU 1
  • در شیرخوارگی و کودکی: µg5
  • دریافت کافی (AI) برای بزرگسالان 51 سال به بالا: µg 10 (IU400)
  • برای 71 سال به بالا µg 15 (IU600)
  • حد قابل تحمل (UL): شیرخواران µg 25 (IU1000)؛ بزرگسالان µg 50 (IU2000) در روز
adequate daily intake of vit d
Adequate daily intake of Vit D

The recommendation adequate intakes for vitamin D are inadequate, and, in the absence of exposure to sunlight, a minimum of 1000IU vitamin D is required to maintain a health concentration of 25(OH)D in the blood. -Holick MF

slide13
روشهای ارزیابی وضع تغذیۀ ویتامین D
  • اندازه گیری سطح سرمی 1, 25(OH)2D؟؟
  • اندازه گیری سطح سرمی 25(OH)D
  • RIAو HPLC
  • Bone alkaline phosphatase (BALP)
  • استئوکلسین
  • کلسیم تام و یونیزه، فسفات
slide15

یک میلیارد نفر در دنیا دچار کمبود ویتامین د یا ویتامین د ناکافی (در حاشیه کمبود) هستند

  • در امریکا و اروپا 40 تا 100 درصد افراد مسن در جامعه دچار کمبود ویتامین د هستند
  • حتی در آفتابی ترین مناطق دنیاکمبود ویتامین د شایع است در کشورهای آفتابی مثل عربستان سعودی، امارات، استرالیا ، ترکیه، هندوستان و لبنان 30 تا 50 درصد بچه ها و بزرگسالان کمبود ویتامین د داشتند
slide16
افراد درمعرض کمبود ویتامین D
  • افرادی که مدت طولانی به دور از نور خورشید هستند
  • ساکنان مناطق با عرض جغرافیایی شمالی
  • ساکنان مناطق با آلودگی سنگین هوا
  • افراد با لباس های کاملاً پوشیده
  • افراد شب کار
  • افراد با پوست تیره
  • سالمندان
  • کودکان شیرخوار
  • استفاده ار کرم های ضد آفتاب با SPFبالای 8
slide18
عوارض کمبود ویتامینD
  • ریکتز (در کودکان)
  • استئومالاسی (در بزرگسالان)
  • استئوپروز؟

در كنار كاهش فعاليت بدني، قطع هورمون‌هاي جنسي و دريافت ناكافي كلسيم)

slide19
ریکتز
  • کمبود ویتامین D
  • نقص در تولید 25(OH)D3
  • افزایش متابولیسم 25(OH)D3
  • نقص در تولید 1,25(OH)2D3
  • مقاومت به 1,25(OH)2D3
slide20
ریکتز
  • عوامل جغرافیایی
  • عوامل فرهنگی
  • عوامل اجتماعی
  • وضع تغذیۀ مادر باردار
  • فقر شیر مادر از نظر ویتامین D
  • رنگ پوست
slide24
ویتامین D و سرطان
  • تاثیر بر روی شیوع سرطان و مرگ ناشی از آن
  • مکانیسم اثر:
  • کاهش رشد سلول های سرطانی
  • افزایش تمایز سلولی
  • تحریک مرگ سلولی

دستگاه گوارش، پروستات، پستان، لنفوم، آندومتر و ریه

june 2007 american journal of clinical nutrition
June, 2007 American Journal of Clinical Nutrition
  • Women who regularly took vitamin D3 and calcium had a 60% reduction in all-cancer incidence compared with a group taking placebo and a 77% reduction when the analysis was confined to cancers diagnosed after the first 12 months.
vitamin d colon cancer research
Vitamin D & Colon Cancer Research
  • Third National Health and Nutrition Examination Survey
    • Epidemiologic study
    • 16,818 participants
    • Examined blood levels of vitamin D
    • Results
      • Blood levels 80nmol/L or higher reduced risk by 72%
lung cancer
Lung cancer

1,25(OH)2D:

  • inhibits proliferation and induces differentiation of lung cancer cell lines (Higashimoto, et al., 1996, Guzey, et al., 1998)
  • inhibits metastatic growth and locoregional recurrence of lung cancer cells in mice (Wiers, et al., 2000)
lung cancer1
Lung cancer
  • 456 patients with early stage NSCLC
    • Median age – 69
    • 96% Caucasian
  • Data collection:
    • Season of surgery
    • Food frequency questionnaire
    • Recurrence free survival (RFS)
    • Overall survival (OS)

Zhou, et al., 2005

breast cancer
Breast cancer

1,25(OH)2D:

  • inhibits cell proliferation, induces differentiation & apoptosis, and inhibits angiogenesis in normal and breast cancer cells (Colston, et al, 1989, Saez, et al, 1993, Mantell, et al., 2000)
  • suppresses high-fat diet-induced mammary tumorigenesis in rats (Jacobson, et al., 1989, Xue, 1999)
breast cancer1
Breast cancer
  • Inverse association between vitamin D & calcium intake and breast density
  • Inconclusive results in studies looking at VDR genetic polymorphisms and breast cancer
  • Inverse association between high sunlight exposure and breast cancer risk
  • Association may be stronger for premenopausal than postmenopausal women due to interactions between vitamin D, the VDR, estrogen and insulin-like growth factor-I (IGF-I)

Cui & Rohan, 2006

breast cancer2
Breast cancer
  • Case-control study – 972 women with newly-diagnosed breast cancer & 1,135 healthy controls
  • Interviews regarding vitamin D-related exposures, e.g. outdoor activities, use of sunscreen, dietary contributions

Knight, 2007

breast cancer3
Breast cancer
  • More frequent sun exposure during adolescence was associated with a 35% reduction in breast cancer risk later in life
  • Lower risk also linked to cod liver oil and milk intake > 10 glasses / week
  • Milder protection seen for people age 20 – 29
  • No protection for people over age 45
breast cancer4
Breast cancer
  • Epidemiologic study of different regions of Norway, each with a different annual UV exposure
  • Prognosis 15 – 25% better for women diagnosed / treated in the summer vs. winter

<get this article: Breast Cancer Research and Treatment, May>Knight , 2007

endometrial cancer
Endometrial cancer

Is ultraviolet B irradiance inversely associated with incidence rates of endometrial cancer: an ecological study of 107 countries.

Mohr, et al, 2007

endometrial cancer1
Endometrial cancer
  • Objective: perform an ecological analysis of the relationship between low levels of ultraviolet B irradiance and age-standardized incidence rates of endometrial cancer by country, controlling for known confounders
endometrial cancer2
Endometrial cancer
  • 107 countries:
    • UVB irradiance
    • cloud cover
    • intake of energy from animal sources
    • proportion overweight
    • skin pigmentation
    • cigarette consumption
    • health expenditure
    • total fertility rates
  • vs. age-standardized incidence of endometrial cancer
endometrial cancer3
Endometrial cancer
  • Association found between endometrial cancer incidence rates and:
    • Low UVB irradiance
    • High intake of energy from animal sources ( IGF-I?)
    • Per capital health expenditure
    • Proportion of population overweight
pancreatic cancer
Pancreatic cancer
  • Prospectively collected diet and lifestyle data
    • Nurses’ Health Study – 75,427 women
    • Health Professionals Follow-up Study – 46,771 men
  • Pancreatic cancer risk 41% lower among those who consumed > 600 IU of vitamin D / day vs. those who consumed < 150 IU / day

Skinner, et al., 2006

multiple sclerosis vitamin d
Multiple Sclerosis, Vitamin D

U.S. nurses taking the most vitamin D had a relative risk of MS of 0.66 vs. least vitamin D

Fish consumption also reduces the risk of MS. Fish is a good source of vitamin D.

multiple sclerosis prevention by vitamin d
Multiple Sclerosis: Prevention by Vitamin D

Itestimate that 40-70% of MS in the U.S. could have been prevented through adequate vitamin D, especially in winter

This is the season when infectious diseases are most common; MS appears to be caused by infectious disease

Circulating vitamin D levels are lowest in winter

other diseases that uvb vitamin d helps prevent
Other Diseases that UVB/Vitamin D Helps Prevent

Muscle pain, weakness

Progression of rheumatoid and osteo-arthritis

Type 1 diabetes mellitus in infancy

Type 2 diabetes mellitus

Body, brain disorders during fetal development

Irritable bowel syndrome, Crohn’s disease

High blood pressure, heart disease

Tuberculosis

associations of low vitamin d status with chronic disease
Associations of low vitamin D status with chronic disease

Osteopathy

Myopathy

Infection

Inflammatory and autoimmune disease

Hypertension, cardiovascular disease and diabetes mellitus

Cancer

type 2 diabetes
Type 2 Diabetes
  • Altered vitamin D and calcium homeostasis may play a role in development of type 2 diabetes
  • Low serum levels of 25(OH)D are associated with impaired pancreatic β cell function and insulin resistance
  • High calcium intake is inversely associated with body weight
type 2 diabetes1
Type 2 Diabetes
  • Nurses’ Health Study – 83,779 women (98% Caucasian)
  • Daily intake of >1,200 mg calcium & >800IU vitamin D was associated with a 33% lower risk of type 2 diabetes compared with an intake of <600 mg calcium & <400 IU vitamin D

Pittas, et al., 2006

type 1 diabetes
Type 1 Diabetes
  • Birth-cohort study in Finland – all women due to give birth in 1966 enrolled
  • 10,366 children born alive and followed to one year; 81 diagnosed with Type 1 diabetes
  • Children who regularly took recommended dose of vitamin D (2000 IU) had a RR of 0.22 compared with those who did not.
  • Children suspected of having rickets had a RR of 3.0 compared with those not suspected.

Hopponen, et al., 2001

metabolic syndrome
Metabolic Syndrome
  • Third National Health & Nutrition Examination Survey (NHANES III)
    • 8,421 men and non-pregnant women > 20 years of age and had fasted > 8 hrs
  • Unadjusted prevalence of metabolic syndrome - 21.9%
metabolic syndrome1
Metabolic Syndrome
  • After adjustments for known risk factors, odd of metabolic syndrome decreased progressively across increasing concentrations of 25(OH)D
  • Relative risk compared with bottom quintile of vitamin D level:
    • 2nd quintile – 0.85
    • 3rd quintile – 0.75
    • 4th quintile – 0.62
    • 5th quintile – 0.46

Ford, et al., 2005

pulmonary copd
Pulmonary / COPD
  • Third National Health & Nutrition Examination Survey (NHANES III)
    • 14,000 subjects
    • Dose-response correlation between percent predicted FEV1 and FVC values and circulating 25(OH)D
    • Plausibility: vitamin D shown to prevent experimental inflammatory diseases in mice including allergic asthma

Black, et al., Chest, 2005

congestive heart failure
Congestive Heart Failure
  • RCT of vitamin D + calcium vs. placebo + calcium x 9 months in subjects with CHF
    • 93 subjects completed study
    • Anti-inflammatory cytokine interleukin 10 significantly higher
    • Suppressed release of TNF-α
    • No difference in survival but blood levels not optimized

Schleithoff, et al., 2006

hypertension
Hypertension
  • Prospectively followed two cohorts:
    • Nurses’ Health Study – 1198 women
    • Health Professionals Follow-up Study – 613 men
  • Relative risk of hypertension:
    • < 15 ng/mL vs > 30 ng/mL 25(OH)D
      • Men: RR = 6.13
      • Women: RR = 2.67
maternal vitamin d status
Maternal Vitamin D Status

Association of low intake of milk and vit D during pregnancy with decreased birth weight.

C.A. Mannion, Katherine Gray-Donald, kristine G. Koski. CMAJ April 25, 2006

-Women between ages 19-45yrs

-In Calgary

-</= 250 ml of milk = low birth weight

-milk or vit D independent predictor of BW

-1 cup milk = 41 gm increase in BW

-1 Mcg increase in dietary vit D = 11 gm increase in BW

maternal vitamin d
Maternal vitamin D….

Maternal vitamin D status during pregnancy and childhood bone mass at age 9yrs.

M.K. Javaid, SR Crozeir at al. Lancet Jan 7 2006

-198 children born in 1991-92 in South Hampton UK

-children were followed up at age 9yrs

-31% mother had insufficient and 18% had deficient serum vit D during late pregnancy

-decrease vit D in mothers = decrease bone mineral content in children at age 9 yrs

-mother’s exposure to UV rays and use of vit d predicted vit d and childhood bone mass

breastfed infants
Breastfed infants

Vitamin D deficiency in breastfed infants in Iowa.

Ekhard E. Ziegler, Bruce w. Hollis, Steven E Nelson and Janice M. Jeter. Pediatrics 2006

-84 breastfed infants

-blood samples and dietary records were taken

-35 infants were unsupplemented

-49 infants were either supplemented with formula or vit D

-10% were vit D deficient

-Marked seasonal affect more so in the unsupplemented group

-mainly but not exclusively during winter and occurred in light and dark skinned infants

1979 1981
1979 - 1981
  • Vitamin D receptors found in malignant melanoma cells and myeloid leukemia cells
  • 1,25(OH)2D inhibited melanoma cell proliferation and induced myeloid cell differentiation
d 5 2 1391
شيوع كمبود ودرحاشيه كمبود ويتامين D درزنان باردار 5 ماهه و بالاتر برحسب شهر و روستا- مطالعه پورا 2 -سال1391
d 1391 1380
مقایسه شيوع كمبود وكمبود حاشيه‌اي ويتامينD در زنان باردار،1391-1380
23 15 1391 1380
مقایسه شيوع كمبود وكمبود حاشيه‌ايي در کودکان 23-15 ماهه ، 1391-1380
goals in maintaining vitamin d levels
Goals in Maintaining Vitamin D Levels
  • Prevent disease of deficiency – rickets, osteomalacia
  • Prevent complications of insufficiency – impaired calcium absorption and increased bone resorption
  • Minimize risks of future disease – cancer, cardiopulmonary diseases, diabetes, other immune-related diseases
key clinical recommendation
Key clinical recommendation
  • Daily vitamin D supplementation of 800 to 1,000 IU is a reasonable dose for adults. Levels of 25-OH vitamin D should be maintained > 32 ng per mL (80 nmol per L) to maximize bone health.
  • The (AAP) has doubled the recommended intake of vitamin D to 400 IU per day for infants, children, and adolescents.
  • In patients with severe vitamin D deficiency, 50,000 IU of vitamin D should be given daily for one to three weeks, followed by weekly doses of 50,000 IU.
slide69

After repletion of body stores, 800 IU of vitamin D daily or 50,000 IU of vitamin D once or twice monthly is adequate maintenance therapy.

  • Patients with no sun exposure, malabsorption, or those taking antiepileptic drugs may require larger maintenance doses of vitamin D (i.e., up to 50,000 IU one to three times week.
  • In critically ill patients, albumin-adjusted calcium levels underestimate true or ionized hypocalcemia. Therefore, measured ionized calcium levels are recommended, particularly in patients who are being treated in an intensive care unit.
  • If calcium supplementation alone fails to maintain normal serum levels, the patient is vitamin D deficient or resistant and may benefit from a trial of calcitriol (Rocatrol).
  • Vitamin D toxicity is very uncommon, and there is a wide safety margin at these higher supplement doses.
supplementation adults canada
Supplementation (adults) Canada

To correct deficiency: 50,000 IU vitamin D weekly x 8 weeks, reassess and repeat if necessary

maintenance adults
Maintenance (adults)
  • To maintain recommended levels: 800 - 1000 IU / day if not getting enough sun exposure to maintain vitamin D levels or 50,000 IU 1-2 times monthly
slide72
مکمل یاری
  • در گروه سني 24-0 ماهه : از 3 تا 5 روز بعد از تولدIU/Day 400 مكمل ويتامين "د" داده شود
  • در گروه سني 6-2 ساله : هر 2 ماه یک بار IU 50000 مگا دوز ويتامين "د" داده شود كه معادلIU/Day 800 مي‌باشد.
  • در گروه سني12-7 ساله : هر 2 ماه یک بار IU 50000 مگا دوز ويتامين "د" داده شود.
  • در گروه سني70-12 ساله: هر ماه یک بار مگا دوزIU 50000 ويتامين "د" داده شود.
  • در گروه سني 70 سال به بالا : هر 2 هفته یک مگا دوزIU 50000 ويتامين "د" داده شود.
slide74
مسمومیت با ویتامین D
  • هيپركلسيمي،
  • پرادراري و پرنوشي،
  • رسوب کلسیم در بافت هاي نرم ـ
  • تهوع، استفراغ،
  • بي‌اشتهايي در اثر رسوب در دستگاه عصبي
slide75
غنی سازی شیر
  • افزودن 200 واحد ویتامین D به شیر
  • شیر استرلیزه و پاستوریزه
  • ارائه سه نوبت شیر غنی شده
ad