Vitamin D and Health

linked specific VDR gene polymorphisms with aggressive forms of periodontal disease (Hennig et al.,
1999; Yoshihara et al., 2001; Sun et al., 2002; Brett et al., 2005; Park et al., 2006; Meng et al., 2007;
Deng et al., 2011); as well as with chronic adult disease (Tachi et al., 2003; de Brito Junior et al., 2004;
Martelli et al., 2011). These studies suggest that the relationship between periodontal attachment
loss and serum 25(OH)D concentration is moderated by alterations in host immunity rather than a
direct impact on calcium metabolism and bone turnover in some members of the population.
Summary - Oral health
6.344 Low serum 25(OH)D concentration during tooth development results in alterations in the structure of tooth
enamel and dentine.
6.345 Evidence from RCTs on effects of vitamin D supplementation on periodontal disease is lacking.
6.346 Cross-sectional data show a positive association between serum 25(OH)D concentration and measures of
periodontal disease outcomes. One cohort study found an inverse association between serum 25(OH)D
concentration and tooth loss.
6.347 Evidence from genetic studies suggests that associations between vitamin D and periodontal disease are
influenced by changes in host immunity rather than through effects on calcium metabolism.
Age-related macular degeneration
6.348 Age-related macular degeneration (AMD) is a progressive chronic disease resulting in damage to the
central retina and is a major cause of visual impairment in older people. In the dry or atrophic form of
the condition, the retinal pigment epithelium degenerates leading to the development of drusen 78 .
The wet or exudative form of AMD is characterised by new blood vessel formation under the macular
region of the central retina, which results in plasma leakage, retinal haemorrhage, inflammation and
scarring. Risk factors for the development of AMD include advancing age, family history, race, genetic
mutations, sunlight exposure, hypertension, high dietary fat, obesity and smoking (Lim et al., 2012).
6.349 The pathogenesis of AMD is not clearly understood but angiogenesis is thought to play a role
(Rosenfeld et al., 2006); inflammation and immunological changes are also implicated (Zarbin, 2004;
Anderson et al., 2010). The potential role of vitamin D in the pathogenesis of AMD has been
investigated because of its inhibitory actions on angiogenesis (Mantell et al., 2000) and studies
suggesting an association between vitamin D and inflammation and immune function.
6.350 IOM Report: The IOM report did not consider age-related macular degeneration.
Observational studies
6.351 A protective association was found between serum 25(OH)D concentration and prevalence of early
(but not advanced) AMD in a nationally representative sample of adults in the US (n=7752; age, ≥ 40y)
(Parekh et al., 2007). The odds ratio for early AMD in adults in the highest (> 85 nmol/L) vs lowest
(< 42 nmol/L) quintile of serum 25(OH)D concentration was 0.64 (95% CI, 0.5-0.8; p trend