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نقش ويتامين D در سلامت PowerPoint PPT Presentation


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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)

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نقش ويتامين D در سلامت

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D

D

1393


D

D

  • Sunshine vitamin

  • :D (7- )


D

D

  • :

    • D2 (: )

    • D3 (: )

  • :

  • :

    • ( )


The function of vitamin d

The function of vitamin D


D

  • 90

  • : 10 15

  • :

  • :

  • :

    !

  • 2 (3 4 )

  • 300-270


D

  • ( herring mackerel salmon)

  • D !


D

3 oz smoked salmon = 583 IU

3 oz light tuna, canned in oil = 229 IU

1 large, whole egg = 29 IU


D

(DRIs)

  • g0/025= IU 1

  • : g5

  • (AI) 51 : g 10 (IU400)

  • 71 g 15 (IU600)

  • (UL): g 25 (IU1000) g 50 (IU2000)


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


D

D

  • 1, 25(OH)2D

  • 25(OH)D

  • RIA HPLC

  • Bone alkaline phosphatase (BALP)


D

D


D

  • ( )

  • 40 100

  • 30 50


D

D

  • SPF 8


Cut off

Cut off


D

D

  • ( )

  • ( )

  • )


D

  • D

  • 25(OH)D3

  • 25(OH)D3

  • 1,25(OH)2D3

  • 1,25(OH)2D3


D

  • D


D

D

  • :


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, Crohns 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 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-

    • 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

-mothers 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

D


D 5 2 1391

D 5 - 2 -1391


D 1391 1380

D 1391-1380


D

D


D

D 6


D 15 23

D 15 23


23 15 1391 1380

23-15 1391-1380


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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.


D

  • 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


D

  • 24-0 : 3 5 IU/Day 400 ""

  • 6-2 : 2 IU 50000 "" IU/Day 800 .

  • 12-7 : 2 IU 50000 "" .

  • 70-12 : IU 50000 "" .

  • 70 : 2 IU 50000 "" .


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  • 200 D


D


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