Welcome to mmlearn.org

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Holly Brown
5 years ago
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2 Welcome to mmlearn.org

3 VITAMIN D SUNSHINE VITAMIN

4 INTRODUCTION Familiar with skeletal needs Rickets Osteoporosis Fractures

5 INTRODUCTION Not as familiar other associations Immune system Cancer Cardiovascular system Diabetes Impact on the Seniors

6 MAGNITUDE OF PROBLEM % elderly in US living at home 48% Caucasian girls in Maine 60% middle-aged British men autumn 90% middle-aged British men in winter

7 GOALS Understand actions of VD Know normal values Identify those at risk Diseases associated with low VD Treatment of VD Deficiency Vitamin D in the Seniors

9 RECEPTORS

10 VITAMIN D RECEPTORS Bone Brain Breast Colon Pancreas Immune cells Prostate

11 VITAMIN D AND BONE DISEASE Rickets Osteoporosis Fractures

12 VITAMIN D AND THE IMMUNE SYSTEM Vitamin D receptors on inflammatory cells T cells B cells Vitamin D deficiency Altered immune responses More autoimmune diseases More infections

13 DISORDERS ASSOCIATED WITH D DEFICIENCY Immune mediated diseases RA IDDM MS Respiratory disorders Common cold Flu Asthma

14 VITAMIN D AND CANCER Prevents cancer Decreases proliferation of cells VD >32 reduces breast and colon cancer by 50% VD> 46 reduces colorectal cancer by 66% Promotes cell maturation

15 VITAMIN D AND CARDIOVASCULAR DISEASE VD receptors Vascular smooth muscle Cardiac muscle cells Relationship between low VD levels Blood pressure Cardiovascular disease

16 OBESITY AND VITAMIN D Prevalence of obesity has tripled since 1980 Parallel increase Hypertension Hyperlipidemia Type II IDDM Higher rates of VD deficiency

17 MEASUREMENT 25 (OH) VD 3 - blood Easy to measure Correlates best with clinical disease

18 VITAMIN D LEVELS < 20 ng/ml deficient ng/ml insufficient > 30 ng/ml sufficient > 100 ng/ml excessive

19 SEASON, LATITUDE, TIME OF DAY Above 37 th parallel Thicker ozone layer, fewer rays penetrate Example: Boston inadequate VD 4 months of year Time of day Between 10 am and 3 pm

21 DISEASES AND DRUGS Fat malabsorption Crohn s Cystic fibrosis Celiac disease Anticonvulsants Phenobarbital Dilantin Carbamazepine Surgical removal of stomach or intestines

22 DARKER SKIN Melanin in epidermis Competes with 7-DOH for absorption of UVB Skin type 5/6 (dark skin) Need 3-10 times exposure to sunlight than type 2/3 (lighter skin) to produce equal VD

23 SUNSCREEN Absorb UVB Prevents interaction with 7 (OH) D3 Protection factor 8, reduces pre-vitamin D3 by 95% Protection factor 15 reduces pre-vitamin D3 by 99%

24 INADEQUATE INTAKE Few foods have adequate VD Fish/ Meat Fortified with vitamin D Dairy/cereal/orange juice Portabella mushrooms Tofu

25 SOURCES OF VITAMIN D

26 HOW MUCH VD DO WE NEED? 1997 Institute of Medicine NAS Infants and children 400 IU 400 IU up to age IU age IU above age IU daily if inadequate sun exposure

27 EVALUATION/TREATMENT Infants Chronic disease Overweight Diabetes Immune disorders Cancer Seniors

28 PREVENTION Exposure to sun 3-4 times per week Between 10 am and 3 pm minutes Longer darker skin, higher latitudes Ingest VD rich foods Dietary supplements

29 VITAMIN D AND SENIORS

30 WHY SENIORS HAVE VITAMIN D DEFICIENCY Diminished intake Diminished sunlight Reduced skin thickness Impaired intestinal absorption Impaired hydroxylation in liver and kidney

31 SENIORS Drugs which reduce vitamin D absorption Diseases which consume vitamin D Fatty livers Renal function declines

32 CONSEQUENCES OF D DEFICIENCY Muscle weakness Tire easily Difficulty climbing stairs Difficulty arising from chairs

33 AGING AND MUSCLE MASS Gradual loss of muscle mass and strength Functional impairment Need for assistance in daily activities Increased risk of falling and fractures

34 FALLS AND VITAMIN D 33% one fall per year 6-7% fracture French study nursing home Supplemented 43% fewer falls Fewer broken hips Improved bone density

35 ADVANTAGES OF VITAMIN D SUFFICIENCY Improves balance, Improves cognition, Reduces muscle loss, Reduces respiratory illnesses Reduces need for antibiotics

36 SUMMARY VD deficiency epidemic proportions VD necessary for many cellular functions Proper immune function Cardiovascular health Insulin metabolism Cancer prevention Bone health

37 AT RISK Overweight Dark skinned High latitudes Poor diets Autoimmune disorders Respiratory disorders Cancer Seniors

38 SUMMARY Get adequate sunlight Adequate Vitamin D in Diet Check blood every 6 months Preach the Vitamin D gospel

39 QUESTIONS?

In addition to bone health, emerging science reveals a non-skeletal benefit of vitamin D for several other health outcomes.

In addition to bone health, emerging science reveals a non-skeletal benefit of vitamin D for several other health outcomes. Vitamin D AT A GLANCE Introduction Vitamin D comprises a group of fat-soluble compounds that are essential for maintaining the mineral balance in the body. The vitamin D form synthesized in humans is called