Vitamin D yetersizliği ve eksikliğine güncel yaklaşım

Abstract

Vitamin D adipoz dokuda eriyen sekosteroid yapıda bir hormon olup en önemli etkisi kemik metabolizması ve serum kalsiyum dengesi üzerindedir. Vitamin D eksikliği ve yetersizliği kanser, enfeksiyöz hastalık, metabolik sendrom, hipertansiyon, miyokard enfarktüsü ve kardiyovasküler hastalık sonucu ölüm riskinin artması, multipl skleroz, romatoid artrit, tip I diyabet dahil olmak üzere bir çok otoimmün hastalıkların insidansı ve şiddeti ile ilişkilendirilmiştir. Vitamin D’nin optimal düzeyi hakkında bir fikir birliğine varılmamış olsa da çoğu araştırmacı tarafından 25(OH)D düzeyinin; 30 ng/mL’nin üzerindeki değer yeterli, 20 ile 30 ng/mL arasındaki değer yetersizlik, 20 ng/mL’nin altındaki değer eksiklik olarak kabul edilir. Ülkemizde vitamin D eksikliğinin sık görülmesi ve vitamin D eksikliğinin kanser, sistemik hastalıklar ve kemik sağlığı üzerine olumsuz etkilerinden dolayı bu derlemede, erişkinlerde D vitamini fizyolojisinin anlaşılması, vitamin D eksikliğinin tanımlanması ve tedavi sürecinde güncel yaklaşım sunmayı amaçladık.

Keywords

• Vitamin D eksikliği,yetersizliği,tanı,güncel tedavi

Current approach to vitamin D insufficiency and deficiency

Abstract

Vitamin D is a secosteroid hormone in adipose tissue which has a significant impact on the bone metabolism and serum calsium balance. Vitamin D deficiency and insufficiency associated with the incidence and severity of many autoimmune diseases including common cancers, infectious diseases, metabolic syndrome, hypertension, myocardial infarctions and increase of the risc of cardiovasculer illnesses, multipl sclerosis, rheumatoid arthritis and type 1 diabetes. Although there is no consensus on optimal level of vitamin D the most researches have accepted the level of 25(OH)D in the following order: the value above 30 ng/mL indicates competency, between 20-30 ng/mL indicates insufficiency, below 20 ng/mL indicates deficiency. In our country vitamin D deficiency is a common problem and it has a negative effects on cancer, systematic diseases, bone health therefore in our revieve we aimed to present the physiology of vitamin D in adults, define vitamin D deficiency and present the current approach in the treatment process.

Keywords

• Vitamin D deficiency,insufficiency,diagnosis,current treatment

References

1. 1. Bringhurst FR, Demay MB, Krane SM, Kronenberg HM. Boneand Mineral Metabolism in Health and Disease. In: Kasper DL,Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s Principles of Internal Medicine. 16th edition. New York:MCGraw-Hill Companies; 2005. p. 2238-86.
2. 2. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-281.
3. 3. Kurt A., Kennel MD., Matthew T.Drake MD,at all. Vitamin D deficiency in adults: when to test and how to treat. In Mayo Clinic Proceedings 2010; 85(8): 752-758.
4. 4. Pearce SHS, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ 2010;340:b5664.
5. 5. Hekimsoy Z, Dinç G, Kafesciler S, Onur E, Güvenç Y, Pala T, et al. Vitamin D status among adults in the Aegean region of Turkey. BMC Public Health 2010;10(1):782.
6. 6. Hyppönen E, Boucher BJ, Berry DJ, Power C. 25-hydroxyvitamin D, IGF-1, and metabolic syndrom at 45 years of age: a cross-sectional study in the 1958 British Birth Cohort. Diabetes 2008;57:298-305.
7. 7. Holick MF. Vitamin D: a D-lightful health perspective. Nutrition Reviews 2008;66(2):182-194.
8. 8. Wacker M, Holick MF. Vitamin D-Effects on Skeletal and Extraskeletal Health and the Need for Supplementation. Nutrients 2013;5:111-148.

9. 9. Holick MF, Krane SM, Potts JT. Calcium, phosphorus, and bone metabolism: Calcium-regulation hormones. In:Fauci AS, Braunwald E, Isselbacher KJ, et al (Eds). Harrison's principles of internal medicine. 14th ed. New York: McGraw-Hill; 1995:2214.
10. 10. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon MC, Hanley DA, Heaney RP et al. Evaluation ,Treatment, and Prevention of Vitamin D Defciency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011;96:1911-1930.
11. 11. Behzat Özkan, Hakan Döneray. D vitamininin iskelet sistemi dışı etkileri. Çocuk Sağlığı ve Hastalıkları Dergisi 2011; 54(2): 99-119.
12. 12. Thacher TD, Clarke BL. Vitamin D insuffciency. Mayo Clin Proc 2011; 86(1):50-60.
13. 13. Holmes EW, Garbincius J, McKenna KM. Analytical variability among methods for the measurement of 25-hydroxyvitamin D: stil adding to the noise. Am J Clin Pathol2013;140(4):550-560.
14. 14. Türkiye Endokrinoloji ve Metabolizma Derneği Osteoporoz ve Metabolik Kemik Hastalıkları Tanı ve Tedavi Kılavuzu 2018.
15. 15. Thacher TD, Fischer PR, Strand MA, Pettifor JM. Nutritional rickets around the world: causes and future directions. Ann Trop Pediatr 2006; 26(1): 1-16.
16. 16. Lane NE. Metabolic Bone Disease. In: Firestein GS, Budd RC, Harris ED, Mclnnes IB, Ruddy S, Sergent JS, editors. Textbook of Rheumatoogy Kelley’s, Saunders Elsevier; 2009. p.1579-99.
17. 17. Holick MF. Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging 2007;24:1017-29.
18. 18. Shea MK., Houston DK., Tooze JA., Davis CC., Johnson MA., Hausman DB et al. Correlates and prevalence of insufficient 25-hydroxyvitamin D status in black and white older adults: The health, aging and body composition study. J Am Geriatr Soc 2011;59:1165-1174.
19. 19. Holick MF. Vitamin D and bone health. J Nutr 1996;126:1159-64.
20. 20. Ross AC., Manson JE., Abrams SA., Aloia, J. F., Brannon PM., Clinton SK., et all.The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. The Journal of Clinical Endocrinology & Metabolism 2011; 96(1):53-58.
21. 21. Cosman F., De Beur SJ., LeBoff MS., Lewiecki EM., Tanner B., Randal S., & Lindsay R. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis international 2014; 25(10):2359-2381.