Vitamin D and Health

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Osteomalacia Table 6: Observational studies on osteomalacia Study/Country Population Osteomalacia diagnosis Mean 25(OH)D (nmol/L) & Ca (mmol/L) concentrations Preece et al (1975) Glasgow, Scotland Patients (n=35) of South Asian ethnic origin with overt rickets or osteomalacia 62% hypocalcaemic (Ca
Table 7: Case reports of osteomalacia Study/Country Population Osteomalacia diagnosis Mean serum 25(OH)D (nmol/L) & Ca (mg/L) concentrations Clark et al (1972) Newcastle upon Tyne, UK Patients: n=15; age 11-42y. South Asian, living in the UK ≥ 1y (mean 4.5 y). Presented with spontaneous pain, usually in legs, 4 seen following minor injury Blood relatives: n=18, age 8-48 y; 3 with symptoms of limb pain. Biochemical evidence of rickets and osteomalacia. 12/15 patients and 2/18 relatives had radiological evidence. 2/3 patients histological evidence. 25(OH)D: not reported Ca Patients: 84 Blood relatives: 92 Moncrieff & Fadahunsi (1974) Derby, UK Female (pregnant); age 30 y. South Asian ethnic origin. Presented with pain in sacrum & waddling gait during latter part of pregnancy Biochemical and clinical evidence of osteomalacia; x-ray of pelvis did not show osteomalacia. Mother (after delivery) 25(OH)D: 17.7/Ca: 82 Russell & Hill (1974) Manchester, UK De Torrente de la Jara et al (2004) Switzerland Cardinal & Gregory (2009) Cambridge, UK Thabit et al (2011) Ireland Mittal et al (2012) India Female (pregnant) - age 30 y; South Asian ethnic origin Presented with signs of pre-eclampsia at 37 weeks gestation (not treated) Infant - male, delivered spontaneously Female asylum seekers (n=11) from Bosnia, Afghanistan, Somalia, Albania, Ethiopia Presented with minimal exposure to sunlight & history of bone pain, proximal muscular weakness, change in gait, or fatigue. Female, age 75 y. White Schizophrenic, inpatient in psychiatric hospital for > 35 years; investigated due to persistent elevated alkaline phosphatase & intermittently low phosphate and calcium concentrations. Case 1: Male, age 31 y. S Asian ethnic origin, living in Ireland (5y). 2 day history of upper & lower limb tetany; unable to stand unaided due to progression of bilateral lower limb weakness. Case 2: Female, age 34 y. S Asian ethnic origin, living in Ireland (9 y). Pains pelvic region for 4y; proximal muscle weakness & difficulty walking, significant proximal myopathy & waddling gait. Male, age 41 y. Presented with gradually progressive quadriparesis over previous 6 m. No clinical evidence of osteomalacia at 37 weeks gestation; x-ray confirmed fetal rickets. 4 months after delivery: biochemical evidence of osteomalacia but x-ray normal Infant – wrist x-ray confirmed rickets. At 37 weeks gestation: 25(OH)D : 7.5/Ca: 72 4 months after delivery: 25(OH)D: 6.7/Ca: 76 Measurement of 25(OH)D concentration. 25(OH)D: 10.9 (3.8) Ca: 87.6 (3.6) Biochemical evidence of osteomalacia 25(OH)D: 10.5 Biochemical evidence. Case 1 25(OH)D: 5.5/Ca: 57.2 Case 2 25(OH)D: 16/Ca: 81.6 Based on symptoms. 25(OH)D: 20.3 Ca: 81.2 190
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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
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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 and 202: Table 4: Case control studies on ri
Page 203: Table 5: Intervention studies on ri
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
Page 253 and 254: 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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