Vitamin D and Health

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ANNEX (4) Glossary 1α-hydroxycholecalciferol A synthetic analogue of 1,25-dihydroxyvitamin D. 1,25-dihydroxyvitamin D (1,25(OH) 2 D) 7-dehydrocholesterol (7-DHC) 25-hydroxyvitamin D (25(OH)D) Alfacalcidol Antigen B cell Biomarker Bone health indices Bone mineral content (BMC) Bone mineral density (BMD) Bone modelling Bone remodelling The main active metabolite of vitamin D in the body. Produced in the kidney from 25-hydroxyvitamin D. A sterol found in the skin of humans and animals that is converted to vitamin D 3 by the action of UVB rays in sunlight. A metabolite of vitamin D produced in the liver from vitamin D. Circulates in the blood and is a marker of exposure to vitamin D, reflecting vitamin D supply from cutaneous synthesis and the diet. Another name for 1α-hydroxycholecalciferol. Substance (usually foreign) that prompts the generation of antibodies and induces an immune response. See lymphocyte. A biochemical, physiological, or other indicator that is objectively measured to assess effects of normal biological processes, progress of a disease, illness, condition or response to an intervention. Biochemical markers that influence, predict or are associated with the processes of bone formation, bone resorption or other facets of bone metabolism. The mass of bone mineral in a skeletal unit (generally measured in grams (g), occasionally in g/cm cross-sectional width). The density of bone mineral in a skeletal unit (g/cm 3 ). When measured by single or dual-energy X-ray techniques it represents the mass of bone mineral measured within a scanned area (g/cm 2 ) and is not a true density measurement. The process of skeletal growth and development during childhood in which bone formation and resorption take place on different bone surfaces. Lifelong process of bone replacement and repair in which old bone is broken down (resorption) and replaced by new bone (formation or ossification) on the same bone surface. Calcidiol Another name for 25-hydroxyvitamin D. Calcifidiol Another name for 25-hydroxyvitamin D. 285
Calcitonin A peptide hormone, produced by the thyroid gland, involved in regulation of calcium homeostasis. Calcitriol Another name for 1,25-dihydroxyvitamin D. Cholecalciferol Another name for vitamin D 3 . Confounding variable (confounder) Dendritic cells Dietary Reference Values (DRV) Endocytosis Enterocyte Associated independently with both the health outcome under study and the exposure of interest. The effect of an association between an exposure and outcome is distorted by the presence of one or more (confounding) variables. Antigen-presenting cells of the immune system. They express receptors that enhance the uptake of antigens, which they present to T cells (see lymphocyte). DRVs describe the distribution of nutrient and energy requirements in a population. They comprise 3 estimates: Estimated Average Requirement (EAR): half of a group in a population will need more than this amount and half will need less; Reference Nutrient Intake (RNI): the intake that will be adequate to meet the needs of 97.5% of the population; Lower Reference Nutrient Intake (LRNI): the intake which will meet the needs of only 2.5% of the population. Uptake of extracellular material by invagination of the cell membrane which then breaks off to form a vesicle enclosing the material. Epithelial cell of the small intestine and colon, specialised for uptake of the products of digestion in the lumen and transport into the bloodstream. Ergocalciferol Another name for vitamin D 2 . Ergosterol Erythema Femur Estimated Average Requirement (EAR) Fibroblast growth factor 23 (FGF23) Fortification A plant sterol that is converted into vitamin D 2 by ultraviolet radiation. Reddening of the skin as a result of increased cutaneous blood flow. May be caused by sunburn. Longest and strongest bone in the human skeleton. Located in the thigh, extending from hip to knee. See Dietary Reference Values. A hormone that down-regulates 1,25 (OH) 2 D synthesis in the kidney. Addition of nutrients to foods during the manufacturing process. 286
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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
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10.53 An RNI of 10 µg/d (400 IU/d)
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11. Recommendations 11.1 Serum 25(O
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References Abnet CC, Chen Y, Chow W
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Beadle PC, Burton JL & Leach JF (19
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Brooke OG, Brown IR, Bone CD, Carte
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Clarke B (2008) Normal bone anatomy
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Diffey BL (2010) Modelling the seas
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Ganji V, Milone C, Cody MM, McCarty
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Heaney RP, Armas LA, Shary JR, Bell
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Javaid MK, Crozier SR, Harvey NC, G
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Lappe J, Cullen D, Haynatzki G, Rec
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Mantell DJ, Owens PE, Bundred NJ, M
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Murad MH, Elamin KB, Abu Elnour NO,
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Pirotta S, Kidgell DJ & Daly RM (20
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one mass, and renal function in the
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Sperati F, Vici P, Maugeri-Sacca M,
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Vervel C, Zeghoud F, Boutignon H, T
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Weisse K, Winkler S, Hirche F, Herb
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Annexes ANNEX (1) SACN working proc
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ANNEX (2) Studies considered in rel
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Cardiovascular disease Table 40 Tab
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Study/year/country Population Ricke
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Table 2: Observational studies on r
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Table 3: Before and after studies o
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Table 4: Case control studies on ri
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Table 5: Intervention studies on ri
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Table 7: Case reports of osteomalac
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Table 9: Cohort studies on associat
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Children and adolescents Table 11:
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Table 13: Intervention studies on e
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Table 16: RCTs on effects of vitami
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Table 22: Meta-analyses of trials o
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Table 24: Prospective studies on as
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Table 25: Meta-analyses of RCTs on
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Table 27: Prospective studies on as
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Table 28: Meta-analyses of RCTs on
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Study Methods Results Author conclu
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NON-MUSCULOSKELETAL HEALTH OUTCOMES
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Table 32: Intervention studies on e
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Table 36: Observational studies on
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Table 38: Meta analyses of RCTs and
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Table 39: Prospective studies on 25
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Study/Country Population Mean follo
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Cardiovascular disease Table 40: Me
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Hypertension Table 42: Meta-analyse
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All-cause mortality Table 44: Syste
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Immune modulation Table 46: Systema
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Table 48: Intervention studies on v
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Page 251 and 252: Infectious disease Table 50: Meta-a
Page 253 and 254: Table 51: RCTs on vitamin D supplem
Page 255 and 256: Table 52: Observational studies on
Page 257 and 258: Neuropsychological functioning Tabl
Page 259 and 260: Abbreviations used in studies 25(OH
Page 261 and 262: Table 1: Percentage contribution of
Page 263 and 264: Table 2 (continued) Food group a Me
Page 265 and 266: Table 3 (continued) Food group Age
Page 267 and 268: Table 4 (continued) Food group a Ag
Page 269 and 270: Table 5 (continued) Food group a Na
Page 271 and 272: Table 6: Percentage contribution of
Page 273 and 274: Table 7: Average daily intake of vi
Page 275 and 276: Table 9: Average daily intake of Vi
Page 277 and 278: Table 11: Average daily intake of v
Page 281 and 282: Table 15: Average daily intake of V
Page 285 and 286: Serum/plasma 25(OH)D concentrations
Page 287 and 288: Table 20: UK - Adults and children
Page 289 and 290: Table 22: Northern Ireland - adults
Page 291 and 292: Table 24: England - adults 65 years
Page 293 and 294: Table 26: UK - by month blood sampl
Page 295 and 296: Table 29: English regions by season
Page 297 and 298: Table 33: England - by ethnicity, a
Page 299: Table 36: Scotland - by Body Mass I
Page 303 and 304: Osteoclast Osteocyte Osteoid Osteom
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