Vitamin D Deficiency In Critical Illness
Similarly, critically ill patients have a very high prevalence of vitamin D deficiency, and low vitamin D levels are clearly associated with greater illness severity, morbidity, and mortality in both adult and pediatric intensive care unit patients, as well as medical and surgical ICUs . However, as in most other populations, the most important question remains unanswered: whether low vitamin D is an innocent bystander, simply reflecting greater disease severity, or represents an independent and modifiable risk factor amenable to rapid normalization through loading dose supplementation .
The question is meaningful, since in this subgroup of patients, many factors contribute to low levels: hemodilution, reduced production and conversion by the liver, reduced synthesis of vitamin D-binding protein, higher consumption during the acute phase of disease and systemic inflammation, and increased tissue demand and enhanced catabolism of metabolites. More data are emerging from basic science about the immediate and late effects of vitamin D supplementation on endocrine, autocrine, and paracrine and genomic targets.
Prevention Of Vitamin D Deficiency
Many people need to take vitamin D supplements. Getting enough exposure to sunlight may be difficult, especially because the skin also needs to be protected from sun damage. Natural foods rarely contains enough vitamin D to compensate for lack of sunlight.
Vitamin D supplements are particularly important for people who are at risk . To prevent deficiency, older people should usually take 20 micrograms of vitamin D daily in supplements. Higher doses are rarely needed.
Commercially available liquid milk is fortified with vitamin D in the United States and Canada. Many other countries do not fortify milk with vitamin D. Breakfast cereals may also be fortified.
In breastfed infants, starting vitamin D supplements at birth is particularly important because breast milk contains little vitamin D. Supplements are given until infants are 6 months old, when they begin to eat a more varied diet. For formula-fed infants, commercial infant formulas contain enough vitamin D.
Vitamin D Deficiency And Depression
If youre familiar with seasonal affective disorder , you may not be surprised to hear that vitamin D deficiency may be linked to a higher risk of depression. After all, the nickname for vitamin D is the sunshine vitamin, and thats not just because, as Harvard Medical School points out, many people generate much of the vitamin D they need thanks to sun exposure.
Vitamin D status is also connected to a sunny mood. There is research evidence that shows a relationship between mood and vitamin D levels, where deficient vitamin D levels are related to depression, says Byrn.
One of her Journal of Diabetes Research, found that vitamin D supplementation helped improve the mood of women with type 2 diabetes. All the women in the small study were given a high dose of vitamin D for six months. Byrn and her colleagues found there was a significant decrease in depression and anxiety and an improvement in mental health.
A meta-analysis published in April 2014 in Nutrients included research that suggested vitamin D supplements may in some cases be as effective as antidepressant medication, though more studies are needed.
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How Can I Get More Vitamin D
There are a few foods that naturally have some vitamin D:
- Fatty fish such as salmon, tuna, and mackerel
- Beef liver
- Mushrooms
- Egg yolks
You can also get vitamin D from fortified foods. You can check the food labels to find out whether a food has vitamin D. Foods that often have added vitamin D include:
- Milk
- Other dairy products, such as yogurt
- Soy drinks
Vitamin D is in many multivitamins. There are also vitamin D supplements, both in pills and a liquid for babies.
If you have vitamin D deficiency, the treatment is with supplements. Check with your health care provider about how much you need to take, how often you need to take it, and how long you need to take it.
Healthy People Wont Reduce Their Fracture Risk By Taking Calcium And Vitamin D Supplements Sarah Leyland
We know that healthy people living in the community wont reduce their fracture risk by taking calcium and vitamin D supplements, Leyland says. However, people who may not be getting enough such as those who are housebound or live in sheltered accommodation can benefit from these supplements.
Still, researchers havent found clear evidence of that, either. One meta-analysis examining the prevention of fractures in community, nursing home and hospital inpatient populations concluded that vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people. And some evidence suggests that high doses can actually result in an increased number of fractures and falls. One randomised study found that high-dose monthly vitamin D supplements increased the risk of falls among the elderly population by 20-30% compared to those on a lower dose.
D for disease
There is also conflicting research on the relationship between vitamin D and other diseases, even ageing.
One main claim is that vitamin D supplements will boost the immune system. Adrian Martineau, professor of respiratory infection and immunity at The London School of Medicine and Dentistry, Queen Mary University of London, who leads a research group on the effects of vitamin D on health, has found that vitamin D plays a role in improving respiratory infections.
One study found that vitamin D helps decrease the risk of respiratory infections though only slightly
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Recognition And Management Of Vitamin D Deficiency
PAULA BORDELON, DO MARIA V. GHETU, MD and ROBERT LANGAN, MD, St. Luke’s Family Medicine Residency Program, Bethlehem, Pennsylvania
Am Fam Physician. 2009 Oct 15 80:841-846.
Vitamin D deficiency affects persons of all ages. Common manifestations of vitamin D deficiency are symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain elicited with pressure over the sternum or tibia. A 25-hydroxyvitamin D level should be obtained in patients with suspected vitamin D deficiency. Deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL , and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng per mL . The goal of treatment is to normalize vitamin D levels to relieve symptoms and decrease the risk of fractures, falls, and other adverse health outcomes. To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that infants and children receive at least 400 IU per day from diet and supplements. Evidence shows that vitamin D supplementation of at least 700 to 800 IU per day reduces fracture and fall rates in adults. In persons with vitamin D deficiency, treatment may include oral ergocalciferol at 50,000 IU per week for eight weeks. After vitamin D levels normalize, experts recommend maintenance dosages of cholecalciferol at 800 to 1,000 IU per day from dietary and supplemental sources.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
SORT: KEY RECOMMENDATIONS FOR PRACTICE
What Is Vitamin D
The “sunshine” vitamin is a hot topic. You may have recently found out that you are deficient or know someone who is. It’s shocking for most people when they have never had a problem before and believe nothing has changed to make it a problem now. The truth is that a lot has changed, and vitamin D deficiency and insufficiency are now a global public health problem affecting an estimated 1 billion people worldwide.
The real dangers of excessive exposure to the sun and skin cancer have been greatly publicized and resulted in people covering up and using sunscreen when in the sun. We have also had a shift in spending less time outdoors because of increased work hours and more sedentary lives. As a result, vitamin D levels began dropping without most health care professionals realizing it. Researchers have been focusing on the consequences of vitamin D deficiency and have found an alarming number of health issues outside of its role with rickets. These include skeletal diseases like osteoporosis, certain cancers, cardiovascular disease, autoimmune diseases, infections, inflammatory bowel diseases, psychological disorders, cognitive disorders, obesity, and or mortality. Correcting vitamin D deficiency is not as simple as taking a pill or getting more sun. This article will teach you all that you need to know about the benefits of achieving and maintaining optimal vitamin D levels and how you can do it.
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What Does Your Diet Have To Do With Getting Enough Vitamin D
Vitamin D doesnt occur naturally in many foods. Thats why certain foods have added vitamin D. In fact, newer food nutrition labels show the amount of vitamin D contained in a particular food item.
It may be difficult, especially for vegans or people who are lactose-intolerant, to get enough vitamin D from their diets, which is why some people may choose to take supplements. It is always important to eat a variety of healthy foods from all food groups. The vitamin content of various foods is shown in the following table.
Vitamin D content of various foods
| Food | |
|---|---|
| Cheese, Swiss, 1 ounce | 6 |
It is important to check product labels, as the amount of added vitamin D varies when it is artificially added to products such as orange juice, yogurt and margarine.
Maternal Vitamin D Deficiency
Vitamin D deficiency is common, even among women in sunny climates. A recent meta-analysis suggests that 4095% of pregnant women are vitamin D deficient . Vitamin D deficiency during pregnancy has long been known to result in childhood rickets, but in the past 510 years, it has been shown that vitamin D deficiency can lead to increased rates of childhood respiratory infections and type 1 diabetes . Recent animal studies have extended the list of detrimental long-term outcomes of vitamin D deficiency during pregnancy to include vascular dysfunction, hypertension , and altered cardiac growth . Evidence is also emerging that maternal vitamin D deficiency impairs renal development, with offspring displaying delayed glomerular maturation and impaired renal function in male rat offspring .
Neil Binkley, … Hector F. DeLuca, in, 2020
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What Is The Outlook
The outlook is usually excellent. Both the vitamin levels and the symptoms usually respond well to treatment. However, it can take time for bones to recover and for symptoms such as pain to improve.
The complications of severe deficiency have been mentioned. Rickets can occur in children, and osteomalacia in adults. These diseases affect the strength and appearance of bones, and can lead to permanent bone deformities if untreated or if treatment is delayed.
As well as bone and muscle health, vitamin D deficiency is associated with a number of different conditions. These conditions include diabetes, coronary heart disease, breast cancer, bowel cancer, Alzheimer’s disease and many others. The exact significance of these associations isn’t yet properly understood.
Why Is Vitamin D Important
Much of the original interest in vitamin D centered on its bone benefits. Scientists discovered vitamin D in the 1920s while they were investigating why cod liver oil seemed to prevent the development of rickets and bone disease in children . The scientists soon determined that the lack of vitamin D led to bone malformations, especially in the arms and legs.
While vitamin Ds bone benefits are certainly important, most of the research in the last 15 years has concentrated on its immune advantages. Today, its understood that vitamin D receptors are found in many parts of the body totally unrelated to bone metabolism including the brain, heart, intestines, colon, prostate, breasts, and immune cells . We also know that vitamin D is important for turning on and off genes inside those cells .
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Interval Target Level And Dose
For some time, bolus dosing was en vogue because it was thought to be interesting for practical reasons. With the exception of critical care, bolus doses with long dosing intervals are not used. They are no longer recommended because of the higher risk of adverse effects associated with them . Moreover, the 2017 individual patient data meta-analysis by Martineau et al. showed a clear benefit for vitamin D on acute respiratory infection when daily or weekly dosing was used, but not with longer dosing intervals . In the intensive care, however, a typical daily dose is inefficient, and an upfront loading dose is necessary to improve vitamin D levels rapidly .
It is also important to note that different dosing regimes may have different effects on clinical outcomes. Because a daily dose leads to stable availability of various vitamin D metabolites, this could be an important explanation for many of the negative vitamin D intervention trials .
As there is no evidence that increasing the recommended daily dose of vitamin D supplementation up to 50g would cause severe side effects in the general population, and considering that 20g is the lowest dose consistently associated with a bone benefit, it seems reasonable to recommend a daily dose of 2050g . In general, a daily vitamin D of 800IU appears to be sufficient to achieve a target 25D level of at least 50nmol/L in most healthy individuals, whereas 2000IU is sufficient to achieve a level of at least 75nmol/L .
Vitamin D Deficiency: Symptoms Treatments Causes And More
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Vitamin D is an extremely important vitamin that has many important functions throughout your body .
Unlike other vitamins, vitamin D functions like a hormone. Many cells in your body have a receptor for it.
Your body makes it from cholesterol when your skin is exposed to sunlight.
Its also found in certain foods such as fatty fish and fortified dairy products, though its very difficult to get enough from your diet alone.
The Endocrine Society recommends that most adults get 1,5002,000 IUs of vitamin D daily (
4 ).
According to one review, 41.6% of adults in the United States are deficient. This number goes up to 69.2% in Hispanic adults and 82.1% in African American adults (
Here are some signs and symptoms of vitamin D deficiency.
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Is Vitamin D Always N D Is Extremely Low
D vitamin deficiency can result in a reduction in bone density, which can lead to osteoporosis and bone breaks due to low vitamin D levels. Deficiency of vitamin D can be linked to several chronic conditions as well. This is due to the risk of rickets in children. The bone becomes soft and bend during Rickets, a rare disease.
Correcting A Vitamin D Deficiency The Right Way
A vitamin D deficiency can be confirmed through a blood test. Levels of at least 20 to 24 ng/mL are required as a minimum for bone strength, though higher levels may be necessary for optimal health. Anything less than 20ng/mL is considered a deficiency.
Sunlight Therapy
For healthy people, direct sunlight exposure to the arms, face, hands and legs is recommended for 5 15 minutes, three times a week. It may take more sunlight exposure than this to correct a deficiency and many people find they need to take a vitamin D supplement in addition to increased time outdoors.
CAUTION: Speak to a practitioner for personal advice as any UV exposure can increase the risk of skin cancer.
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Exposure To Natural Sunlight
Sunlight is important for boosting vitamin D, but inappropriate sun exposure increases the risk of skin cancer.
For safe exposure to sunlight, a person should spend a short time outdoors each day without sunscreen and with their forearms, hands, or lower legs exposed to the sun.
When to do this and for how long will depend on the time of year, geographical location, and other factors.
People should ask their doctor about safe ways to increase sunlight exposure, especially if they have fair skin or conditions that affect the skin, such as psoriasis.
How can you get more vitamin D from the sun? Get some tips here.
The best ways to prevent a vitamin D deficiency are to eat foods that are rich in this nutrient and to spend some time outside each day.
Some tips for avoiding a deficiency include:
Maintaining a healthy body weight: Cycling or walking can provide both exercise and exposure to sunlight.
Treating medical conditions: People with health conditions that affect the absorption of nutrients may find that treating the underlying condition helps boost their levels of certain nutrients, including vitamin D.
Being proactive about preventive health: People with a family history of osteoporosis or vitamin D deficiency may wish to consider speaking to their doctor about screening.
How Prevalent Is Vitamin D Deficiency
How many people are at risk of vitamin D deficiency depends on how the deficiency is defined .
Nevertheless, its estimated that at least 40% of adult Americans have insufficient vitamin D levels , although certain populations are more vulnerable than others. People have an increased risk if they: are older than 50, have darker skin pigmentation, receive limited light exposure during the day, are pregnant, or are overweight .
Women are more likely to be vitamin D deficient than men . In addition, we also know that certain types of drugs can reduce vitamin D concentrations .
As we age, our skin synthesizes vitamin D less effectively. This one of the reasons why individuals older than 50 are at a higher risk for vitamin D deficiency.
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