Vitamin D and Health

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Study/year/country Population Rickets diagnosis Mean 25(OH)D (nmol/L) & Ca (mg/L) concentrations Ca intake/other comments Brouwers et al (2010) Netherlands 2 brothers. South Asian ethnic origin, living in Netherlands (2 years) Patient 1 - age 12 y; presented with waddling gait, muscular weakness and bone pain Patient 2 -age 14y; presented with waddling gait and pain when climbing stairs Biochemical, clinical & radiographic evidence. Case 1 25(OH)D: 8/Ca: 76 Case 2 25(OH)D: 4/Ca: not reported Case 1: 100 mg/d Case 2: 330 mg/d Akin et al (2010) Kayseri, Turkey Male aged 23 m. Presented with recurrent febrile convulsions. Diagnosed as antiepileptic drug-induced Vitamin D deficiency rickets. Mild enlargement of wrists bilaterally but rachitic rosary, craniotabes, caput quadratum, & leg deformities not present. 25(OH)D: 4.5/Ca: 64 Ca intakes not reported. Pearson et al (2010) California, USA Male aged 16 m. Presented with weight loss, elevated alkaline phosphatase and PTH. Hispanic ethnicity. Clinical features of rickets - bow legs & mild frontal bossing. Radiographs consistent with early signs of rickets: widening & irregular metaphyses of distal femur & proximal tibia. 25(OH)D: 4.5/Ca: 89 Ca intakes not reported. Brinsmead et al (2011) Brisbane, Australia Girl aged 12 m Ethnicity, Indian; born Australia. Radiological appearance of wrist and knees consistent with rickets; tender and widened wrists; hypocalcaemia. 25(OH)D: 11.2/Ca: 69 Ca intakes not reported. Zurlo & Wagner (2012) Livingstone, US Male, aged 8 m. African American. Presented at Emergency Dept. with fever. X-rays showed flaring of ribs at costochondral junction (rachitic rosary), fraying & cupping of distal radial & ulnar metaphyses plus biochemical evidence. 25(OH)D: below threshold for detection. Ca: concentration not reported Ca intakes not reported. 181
Table 2: Observational studies on rickets Study/year/country Population Rickets diagnosis Mean 25(OH)D (nmol/L) & Ca (mg/L) concentrations Calcium intakes/other comments Dunnigan et al (1981) Glasgow, UK Ladhani et al (2004) London, UK South Asian children (n=189) aged 5-17 y in single GP practice. Ethnicity: South Asian Grouped according to vitamin D supplement use: Regular: at least 2x week, Intermittent: less frequently None Retrospective review of case records of children (n=65; 0-13y) diagnosed with hypocalcaemia or vitamin D deficiency rickets (1996-2001). 39 Asian, 24 Afro-Carribean, 2 Eastern European. Radiological signs of rickets Regular: 3 (5%) Intermittent: 8 (15%) None: 11 (14%) No. diagnosed with rickets (serum Ca
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Vitamin D and Health i 2016
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Contents Preface ..................
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Preface The Scientific Advisory Com
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Adviser (Ultraviolet radiation expo
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Ms Gemma Paramor Lay representative
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Metabolism S.5 Vitamin D is convert
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Two studies reported an increase in
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Recommendations S.35 Serum 25(OH)D
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1.8 The terms of reference were: to
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1.18 In assessing the evidence on v
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there is not absolute correspondenc
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Metabolism Absorption of dietary vi
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UVB ▼ SKIN: ▼ Previtamin D 3
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2.49 A number of studies have repor
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using a bolus dose (I 2 =77%) compa
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2.75 Another RCT 21 (Cashman et al.
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3. Photobiology of vitamin D Ultrav
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Erythema and skin cancer 3.10 Two m
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CIE spectrum for photoconversion of
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Effect of skin pigmentation on skin
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increase in mean serum 25(OH)D conc
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4. Measuring vitamin D exposure (fr
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the authors cautioned care in the i
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24,25(OH) 2 D 3 which can contribut
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5. Relationship between vitamin D e
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latitudes > 49.5 o N or S (which we
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increase 25(OH)D concentrations > 5
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22.5 nmol/L (IQR, 16.8-34.3) in sum
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6.7 Although serum 25(OH)D concentr
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calcium intake, although this is mo
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Evidence considered (Tables 1-5, An
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6.43 Preece et al. (1975) measured
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irths (December-February) in the vi
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large loss to follow-up 45 and, sin
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6.81 A pilot RCT in India (Khadilka
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Evidence considered (Tables 16-18,
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Intervention studies 6.107 A 3-year
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Compared with men in the top quarti
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chair-rising test. Mean baseline se
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heterogeneity among trials for dose
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the 600 µg (24,000 IU) vitamin D 3
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Bone health indices beyond rickets
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Intervention studies 6.177 An RCT i
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maternal serum 25(OH)D concentratio
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Cancers 6.201 Ecological studies ha
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(Gallicchio et al., 2010; Mondul et
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6.226 A systematic review and meta-
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Summary - CVD and hypertension 6.23
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6.251 VDRs are expressed in cells o
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10 nmol/L increase in cord blood 25
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Evidence considered since IOM repor
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difference was not significant (RR=
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6.304 Out of 7 RCTs published subse
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(300 µg/12,000 IU per capsule) for
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serum 25(OH)D concentration in neon
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linked specific VDR gene polymorphi
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factors that affect cancer risk. Ob
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As a result, cut-offs for deficienc
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7.8 The IOM noted the paucity of lo
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years) compared to the placebo grou
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children (n=179) received weekly do
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8. Dietary vitamin D intakes and se
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Food FISH TABLE 1- Vitamin D conten
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Serum/plasma 25(OH)D concentrations
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Serum/plasma 25(OH)D concentration
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9. Review of DRVs for vitamin D Bri
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musculoskeletal health at serum 25(
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Modelling the summer sunshine expos
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9.30 Two possible approaches were c
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FIGURE 8: Relation between serum 25
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UK general population aged under 11
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Summary & conclusions 9.59 The RNI
Page 145 and 146: 10. Overall summary and conclusions
Page 147 and 148: tight homeostatic control. As a mar
Page 149 and 150: 10.30 Evidence from RCTs suggest th
Page 151 and 152: Serum/plasma 25(OH)D concentration
Page 153 and 154: 10.53 An RNI of 10 µg/d (400 IU/d)
Page 155 and 156: 11. Recommendations 11.1 Serum 25(O
Page 157 and 158: References Abnet CC, Chen Y, Chow W
Page 159 and 160: Beadle PC, Burton JL & Leach JF (19
Page 161 and 162: Brooke OG, Brown IR, Bone CD, Carte
Page 163 and 164: Clarke B (2008) Normal bone anatomy
Page 165 and 166: Diffey BL (2010) Modelling the seas
Page 167 and 168: Ganji V, Milone C, Cody MM, McCarty
Page 169 and 170: Heaney RP, Armas LA, Shary JR, Bell
Page 171 and 172: Javaid MK, Crozier SR, Harvey NC, G
Page 173 and 174: Lappe J, Cullen D, Haynatzki G, Rec
Page 175 and 176: Mantell DJ, Owens PE, Bundred NJ, M
Page 177 and 178: Murad MH, Elamin KB, Abu Elnour NO,
Page 179 and 180: Pirotta S, Kidgell DJ & Daly RM (20
Page 181 and 182: one mass, and renal function in the
Page 183 and 184: Sperati F, Vici P, Maugeri-Sacca M,
Page 185 and 186: Vervel C, Zeghoud F, Boutignon H, T
Page 187 and 188: Weisse K, Winkler S, Hirche F, Herb
Page 189 and 190: Annexes ANNEX (1) SACN working proc
Page 191 and 192: ANNEX (2) Studies considered in rel
Page 193 and 194: Cardiovascular disease Table 40 Tab
Page 195: Study/year/country Population Ricke
Page 199 and 200: Table 3: Before and after studies o
Page 201 and 202: Table 4: Case control studies on ri
Page 203 and 204: Table 5: Intervention studies on ri
Page 205 and 206: Table 7: Case reports of osteomalac
Page 207 and 208: Table 9: Cohort studies on associat
Page 209 and 210: Children and adolescents Table 11:
Page 211 and 212: Table 13: Intervention studies on e
Page 213 and 214: Table 16: RCTs on effects of vitami
Page 215 and 216: Table 22: Meta-analyses of trials o
Page 217 and 218: Table 24: Prospective studies on as
Page 219 and 220: Table 25: Meta-analyses of RCTs on
Page 221 and 222: Table 27: Prospective studies on as
Page 223 and 224: Table 28: Meta-analyses of RCTs on
Page 225 and 226: Study Methods Results Author conclu
Page 227 and 228: NON-MUSCULOSKELETAL HEALTH OUTCOMES
Page 229 and 230: Table 32: Intervention studies on e
Page 231 and 232: Table 36: Observational studies on
Page 233 and 234: Table 38: Meta analyses of RCTs and
Page 235 and 236: Table 39: Prospective studies on 25
Page 237 and 238: Study/Country Population Mean follo
Page 239 and 240: Cardiovascular disease Table 40: Me
Page 241 and 242: Hypertension Table 42: Meta-analyse
Page 243 and 244: All-cause mortality Table 44: Syste
Page 245 and 246: Immune modulation Table 46: Systema
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Table 48: Intervention studies on v
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Reference/Country Population Follow
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Infectious disease Table 50: Meta-a
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Table 51: RCTs on vitamin D supplem
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Table 52: Observational studies on
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Neuropsychological functioning Tabl
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Abbreviations used in studies 25(OH
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Table 1: Percentage contribution of
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Table 2 (continued) Food group a Me
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Table 3 (continued) Food group Age
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Table 4 (continued) Food group a Ag
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Table 5 (continued) Food group a Na
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Table 6: Percentage contribution of
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Table 7: Average daily intake of vi
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Table 9: Average daily intake of Vi
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Table 11: Average daily intake of v
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Table 15: Average daily intake of V
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Serum/plasma 25(OH)D concentrations
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Table 20: UK - Adults and children
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Table 22: Northern Ireland - adults
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Table 24: England - adults 65 years
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Table 26: UK - by month blood sampl
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Table 29: English regions by season
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Table 33: England - by ethnicity, a
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Table 36: Scotland - by Body Mass I
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Calcitonin A peptide hormone, produ
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Osteoclast Osteocyte Osteoid Osteom
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