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25-OH Vitamin D Levels in a Community Based Primary Care Office in Western New York. By Ryan Weber D.O. Background. Vitamin D has become widely studied and has been implicated in many diseases states.

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25 oh vitamin d levels in a community based primary care office in western new york

25-OH Vitamin D Levels in a Community Based Primary Care Office in Western New York

By

Ryan Weber D.O.

background
Background
  • Vitamin D has become widely studied and has been implicated in many diseases states.
  • More specifically, 25-OH vitamin D insufficiency and deficiency has been implicated in increased disease rates and severity.
background3
Background
  • Disease states that have been linked to low 25 OH vitamin D levels
    • Cancers – Hodgkin’s Lymphoma, prostate, colon, ovarian, breast, pancreatic.
    • Multiple Sclerosis
    • Osteoporosis
    • Type I DM
    • Crohn’s Disease
    • Schizophrenia/depression
background4
Background
  • Disease states that have been linked to low 25 OH vitamin D levels
    • CVD – Melamed and colleagues in the August 11/25, 2008 issue of the Archives of Internal Medicine.
    • when subgroups were analayzed, Melamed and colleagues found those with no history of CVD in the lowest quartile of 25(OH)D level had a stronger risk association with mortality.
background5
Background
  • WNY and some startling CVD statistics
    • CVA death in WNY is 23% higher than the national rate
    • CVD is the #1 cause of mortality in WNY
    • Niagara county is 2x the NYS average for coronary artery disease hospital admissions.
background6
Background
  • One would expect persons in WNY to have low levels of 25-OH vitamin D especially in winter months
    • A previous study in Boston (which is at a similar latitude to Buffalo) showed that winter sunlight is not sufficient to produce adequate amounts of vitamin D precursors in the skin.
background7
Background
  • This initial research may have implication for WNY
  • WNY has very high rates of disease such as CVD and cancer.
  • The WNY population is at risk for low vitamin D level due to the fact that it is at approximately 42° latitude.
this study
This Study
  • Introduction
    • My study attempts to see if 25-OH vitamin D insufficiency and deficiency is prevalent in a community based practice in the Buffalo New York area.
    • If the prevalence is high in this community cohort, perhaps it would justify further study
methods
Methods
  • from 10/12/07 – 10/30/08 serum 25-OH vitamin D levels were ordered on patients having routine preventative physicals
  • Ages 20-90 were eligible
  • Both males and females
  • All racial types
methods10
Methods
  • 109 serum 25-OH vitamin D levels were ordered
  • 75 patients were eligible for this study and had the blood work completed.
methods11
Methods
  • Exclusion criteria
    • Patients that had recently moved to western New York
    • Patients taking Bisphosphonates, Multivitamins, or OTC vitamin D supplements
    • Patients without insurance.
methods12
Methods
  • Definition of 25-OH vitamin D levels
    • ≥ 30 ng/ml = sufficient
    • 20-29 ng/ml = insufficient
    • < 20 = deficient
results
Results
  • It was found that out of the 75 participants 16 were classified as being 25-OH vitamin D deficient, while 29 participants were found to have insufficient 25-OH vitamin D levels, and 30 persons had sufficient levels.
  • With breakdown of the data into 3 month intervals, it was found that the highest percentage of 25-OH vitamin D insufficiency and deficiency was seen in the months October - June.
  • The total percentages for 25-OH vitamin D levels were also examined
results15
Results

21%

40%

39%

conclusion and discussion
Conclusion and discussion
  • Vitamin D insufficiency and Deficiency were very prevalent in this population with 60% of participants in these groups.
  • The months with lower amounts of sunlight showed the highest levels of deficiency and insufficiency
conclusion and discussion18
Conclusion and discussion
  • Limitations of this study
    • Small sample size
    • Lack of consensus values for adequate 25-OH vitamin D
    • Comparing results of this study to others is difficult due to wide ranges of vitamin D levels being defined as adequate.
conclusion and discussion19
Conclusion and discussion
  • It is clear that many causes for disease are multifactorial
  • Current attention has been given to vitamin D as a possible link to a variety of disease states.
  • Just attention has been given to preventative measures such as lipid levels, smoking cessation, blood pressure, in the primary care setting.
conclusion and discussion20
Conclusion and discussion
  • As more data regarding vitamin D is gathered it may be seen as a marker to be monitored for disease prevention
  • With this study vitamin D levels were shown to be insufficient or deficient in the majority of patients.
  • It would seem that in the WNY population vitamin D monitoring could be valuable in a primary care setting.
conclusion and discussion21
Conclusion and discussion
  • If in the future Vitamin D is definitively shown to be a factor in disease states, primary care providers may find benefit in routine screening and treatment of low vitamin D states.
thank you
Thank You
  • Dr. Andrew Harbison (mentor)
  • Dr. David Martinke
  • The staff at PCWNY