Vitamin D and Health

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Study/Country Population Rickets diagnosis Mean 25(OH)D (nmol/L) & Ca (mg/L) concentrations Prentice et al (2008) Analysis of stored samples from children Radiographs reviewed and assessed by Active rickets (n=13): (n=46) who had presented with ricketslike Thacher et al (2000) method. 25(OH)D: 42.4 (28.6, 56.1)/Ca: 91 (84, 98.4) bone deformities. MRC Keneba and MRC Fajara in The Gambia. Ozkan et al (2009) Erzurum, Turkey Mean age (-1SD, +1SD) = 3.4 (1.9, 6.4) y Biochemical data from earlier study of local children (n=147) used as reference. Mean age: 4.0 (3.0, 5.3) Cases: children attending paediatric outpatient clinic (n=39). Mean age: 10±7.5 m Controls: age-matched children (n=28) in outpatient clinic with minor illness & serum 25(OH)D > 25nmol/L.) Patients classified as having active rickets (bone deformities plus biochemical indicators) or non-active rickets (bone deformities only). Identified through clinical signs & confirmed through radiological & laboratory examination. Clinical rickets diagnosed if 2 or more of following criteria present: craniotabes, rachitic rosary, bilateral widened wrists, frontal bossing, bowing legs, fractures, tetany, convulsion and Harrison's sulcus. Non-active rickets (n=33) 25(OH)D: 50.7 (37.9, 63.4)/Ca: 95 (89.6,100.4) Reference children (n=147) 25(OH)D: 95.0 (75.3, 114.6)/Ca: 92 (84.4, 99.6) Cases (n=39) 25(OH)D:14.5±7/Ca: 75±19 Controls (n=15) 25(OH)D:44.7±16.5/Ca: 95±90 Calcium intakes/other comments Ca intakes Majority prescribed Ca following presentation at clinic. Median dose over 6 months: 117 mg/d. Ca intakes not reported. Mean 25(OH)D concentration in cases diagnosed in summer months was higher than in those diagnosed in winter months. 187
Table 5: Intervention studies on rickets Study/Country Population Rickets diagnosis Treatment Mean 25(OH)D (nmol/L) & Ca (mg/L) concentrations Ca intakes/other comments Cesur et al (2003) Van, Turkey Patients (n=56) with nutritional VDDR Mean age 10.7 (6.1) m Age-matched controls (n=20). Mean age: 11.7 (8.0) m Based on history, clinical and laboratory findings plus left wrist x- ray. Stage of rickets determined according to serum CA, P & ALP concentrations Stage 1: serum Ca low, P normal Stage 2: serum Ca normal due to compensatory hyperparathyroidism Stage 3: both Ca & P low. Participants randomly assigned to vitamin D (single dose): Gp 1 (n=20): 3750 µg Gp 2 (n=20): 7500 µg Gp 3 (n=16): 15000 µg Patient group before treatment: 25(OH)D Stage 1: 15.8 (6.4) Stage 2: 15.4 (4.8) Stage 3: 14.7 (3.9) Ca: 78.2 (13.5) Control group Ca: 89.0 (4.6) Ca intakes not reported. Rajah et al (2008) Abu Dhabi, UAE Retrospective study of children (n=31) with nutritional rickets. Mean age: 17.3 (6.3) m Clinical & x-ray features of rickets & elevated ALP. Clinical features: widened wrists, frontal bossing, bowing of legs and costochondral thickenng.. Treated with 50-125 µg/d of D2 drops for 3 months and subsequently 10 µg/d for a variable period. Baseline: 25(OH)D: 30.8 (18.7) Ca: 91 (8)) Ca intakes not reported. Emel et al (2012) Bezmialem, Turkey Children (n=42) diagnosed with VDDR between October 2010-March 2011. Age: 5m- 3 y Clinical features of all patients: enlarged wrist & ankles (95%), failure to thrive (76%), muscle weakness (52%), bowing of tibia & femur (42%), frontal bossing (28%), delayed fontanel closure (14%), leg pain (14%), rachitic rosary (11%), Harrison grove (11%), seizures (2%). Group 1: 50 µg/d D3 for 6 wks Group 2: 3,750 µg single dose D3 Both groups received calcium lactate (50mg/kg/day) for first 2 wks of intervention. 25(OH)D (baseline) Group 1: 35.9 (12.7) Group 2: 34.2 (12.2) Calcium (baseline) Group 1: 99 (7) Group 2: 92 (7) Ca intake not reported. All received calcium lactate (50mg/kg/d) for 2 wks. 188
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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
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10. Overall summary and conclusions
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tight homeostatic control. As a mar
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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 and 196: Study/year/country Population Ricke
Page 197 and 198: Table 2: Observational studies on r
Page 199 and 200: Table 3: Before and after studies o
Page 201: Table 4: Case control 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
Page 247 and 248: Table 48: Intervention studies on v
Page 249 and 250: Reference/Country Population Follow
Page 251 and 252: 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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