Non classical effects of vitamin D Jean-Claude Souberbielle, hôpital Necker, Paris, France
|
|
- Marsha Richard
- 6 years ago
- Views:
Transcription
1 Non classical effects of vitamin D Jean-Claude Souberbielle, hôpital Necker, Paris, France
2 few significant dietary sources intestine UVB ( nm) skin 7-dehydrocholesterol Pre-vitamin D3 intestine (extremely) few significant dietary sources Vitamin D3 (cholecalciferol) Vitamin D2 (ergocalciferol)
3 few significant dietary sources intestine UVB ( nm) skin 7-dehydrocholesterol Pre-vitamin D3 intestine (extremely) few significant dietary sources Vitamin D3 (cholecalciferol) Vitamin D2 (ergocalciferol) liver 25OHD
4 few significant dietary sources intestine UVB ( nm) skin 7-dehydrocholesterol Pre-vitamin D3 intestine (extremely) few significant dietary sources Vitamin D3 (cholecalciferol) Vitamin D2 (ergocalciferol) parathyroids liver FGF23 PTH 1,25OH2D OHD 1 alpha hydroxylase 1,25OH2D Classical endocrine genomic effects intestine bone
5 few significant dietary sources intestine UVB ( nm) skin 7-dehydrocholesterol Pre-vitamin D3 intestine (extremely) few significant dietary sources Vitamin D3 (cholecalciferol) Vitamin D2 (ergocalciferol) liver 25OHD 24- hydroxylase + FGF23 1,25OH2D 24,25OH2D Calcitroic acid
6 few significant dietary sources intestine UVB ( nm) skin 7-dehydrocholesterol Pre-vitamin D3 intestine (extremely) few significant dietary sources Vitamin D3 (cholecalciferol) Vitamin D2 (ergocalciferol) parathyroids liver FGF23 PTH 1,25OH2D OHD 1 alpha hydroxylase 1,25OH2D Classical endocrine genomic effects intestine 24- hydroxylase + FGF23 1,25OH2D 24,25OH2D Calcitroic acid bone Serum 25OHD concentration (not 1,25OH2D!) is the marker of vitamin D status. This is a consensus!
7 Severe vitamin D deficiency induces rickets (osteomalacia in adults) Less severe deficiency (i.e. without any obvious mineralization defect) may favour/worsen osteoporosis and is associated with an increased fracture risk through shpt and increased risk of falls in the elderly
8 few significant dietary sources intestine UVB ( nm) skin 7-dehydrocholesterol Pre-vitamin D3 intestine (extremely) few significant dietary sources Vitamin D3 (cholecalciferol) Vitamin D2 (ergocalciferol) liver 25OHD 1 alpha hydroxylase Non classical genomic effects 1,25OH2D DNA VDR Numerous tissues including immune cells (monocytes, macrophages, T-cells ), cardiomyocytes, endothelial cells, breast, prostate, colon (normal and tumoral), brain, and much more
9 few significant dietary sources intestine UVB ( nm) skin 7-dehydrocholesterol Pre-vitamin D3 intestine (extremely) few significant dietary sources Vitamin D3 (cholecalciferol) Vitamin D2 (ergocalciferol) liver 25OHD FGF23 PTH 1,25OH2D alpha hydroxylase 1,25OH2D Non genomic effects VDR-MMARS Activation tyrosine kinases Intracellular Ca++ Several tissues including muscle; β cells
10 «classical» effects -stimulates absorption of calcium and phosphorus by the gut - direct effects on bone -effects on kidney -control of PTH secretion Favours bone mineralisation UI /day (+calcium) reduce RR of «non vertebral» fractures in the elderly Importance of «genetic» : SNP of VDR, CYP27B1, CYP24, DBP «non classical» effects Muscle IU/d (+calcium) reduce RR of falls in the elderly Immune System Cardiovascular health Cancers Morbidity of pregnancy (preeclampsia, gestational diabetes..) Renoprotection All-cause mortality Others
11 What is the «level of evidence»? (Evidence-based Medicine) -«ecologic» studies -«observational» studies (cross-sectional, longitudinal, retrospective, prospective ). Importance of statistical «adjustments» for confounders. Don t allow to conclude to a causal relationship!! -experimental studies animal models, cell culture May explain les méchanisms of action, but often use supra-physiologic dosages. Transposition of results to human being? -interventional studies (RCTs) Meta-analyses
12 Consequences of mutations of the VDR gene in humans and in transgenic mice (Exon 2 or 3) Vitamin D in human health: lessons from VDR null mice. Bouillon et al Endocr Rev 2008; 29: Alopecia Facial dysmorphy impaired intestinal calcium absorption hypocalcemic rickets growth failure hypertension with high renine cardiac hypertrophy increased sensitivity to autoimmunity and to oncogen- and chemocarcinogen-induced cancers Sensitivity to infections hypofertility Some of these anomalies are reversed by a rich calcium diet. Others are independent of calcium intake
13 Vitamin D and the immune system Hewison M. Vitamin D and innate and adaptative immunity Vitam Horm 2011; 86: 23-62
14 1-Vitamin D stimulates innate immunity Implication for the prevention of infectious diseases?
15 Activation of human TLR2/1 triggers a vitamin D receptor-dependent antimicrobial response Philip T. Liu* 1, Steffen Stenger* 2, Huiying Li 3, Linda Wenzel 2, Belinda H. Tan 1, Stephan Krutzik 1, Maria Teresa Ochoa 1, Jürgen Schauber 4, Kent Wu 1, Christoph Meinken 2, Manfred Wagner 5, Robert Bals 6, Andreas Steinmeyer 7, Ulrich Zügel 8, Richard L. Gallo 4, David Eisenberg 3, Martin Hewison 9, Bruce W. Hollis 10, John S. Adams 7, Barry R. Bloom 9 and Robert L. Modlin 1,11. Science 2006 ; 311 : ) Activation of Toll-like receptor 2/1 in monocytes/macrophages by specific proteins of Mycobacterium Tuberculosis induces the transcription of the VDR and CYP27B1 genes and expression of the proteins in the cytosol and ER respectively. If the extracellular 25OHD concentration is sufficient (>70 nmol/l), 25OHD enters the cells and is locally activated into 1,25OH2D which binds to the VDR. VDR associates with RXR, and the trimeric complex activates the gene coding for cathelicidin (LL37), an antimicrobial peptide able to induce bacterial destruction.
16 Vitamin D and respiratory infections (including TB) Observational data Poor vitamin D status is significantly associated with an increased risk of both upper and lower respiratory tract infections as reviewed in a recent meta-analysis (4 cross-sectional, 8 case-control, and 13 cohort studies of overall good quality); This was the case in adults as well as in children Jolliffe D et al. Vitamin D in the prevention of acute respiratory infection: Systematic review of clinical studies J Steroid Biochem Mol Biol 2013; 136:
17 Vitamin D and respiratory infections (including TB) Intervention studies Results from RCTs are conflicting. In the most recent meta-analysis, among 14 RCTs testing the effect of vitamin D supplementation on acute respiratory infection, 7 were «positive», and 7 were «null». Among these 14 trials, 6 were done in children (4 positive, and 2 «null») Among the «null» trials, vitamin D dose was small in some (i.e : 1400 IU/week), subjects were not vitamin D deficient in others, while administration of large bolus dose in others may have impaired the immune response Jolliffe D et al. Vitamin D in the prevention of acute respiratory infection: Systematic review of clinical studies J Steroid Biochem Mol Biol 2013; 136:
18 Vitamin D and HIV, HBV, HCV Observational data -Metha S et al AIDS 2011; 25: HIV pregnant untreated Tanzanian women. Increased risk of clinical progression during a 70-month follow-up period and of mother-to-child HIV transmission in those with 25OHD<32 ng/ml -Viard JP et al. AIDS 2011; 25: patients (83% on antiretroviral treatment) from the EUROSIDA cohort. Those in the lowest 25OHD tertile (<12 ng/ml) had an increased risk of AIDS-defining events and all cause deaths after multiple adjustment. -Terrier B et al Low 25-OH vitamin D levels correlate with severe fibrosis in HIV-HCV co-infected patients with chronic hepatitis. Journal of Hepatology 2011; 55:
19 Vitamin D and HIV, HBV, HCV Intervention studies Abu-Mouch S et al Vitamin D supplementation improves sustained virologic reponse in chronic hepatitis C (genotype 1)-naïve patients World J Gastroenterol 2011; 17: Nimer A, Abu-Mouch S Vitamin D improves viral response in hepatite C genotype 2-3 naïve patients World J Gastroenterol 2012; 18:
20 2-(many) Experimental data indicate that vitamin D plays a role in adaptive immunity -VDR, 1alpha-hydroxylase are found in immune cells (dendritic cells, B, and T cells, macrophages..) constitutively or after stimulation. -1,25OH2D blocks dendritic cell maturation -1,25OH2D influences T cell gene expression of cytokines required for antigen presentation to T cells (Il1, Il2, Il12, Il17, INFgamma) -1,25OH2D inhibits the expression of inflammatory cytokines (Il6, TNF alpha) and stimulates the expression of anti-inflammatory cytokines (Il10) => Vitamin D favours Th2 and Treg phenotypes versus Th1, Th17. Role of vitamin D in (some) auto-immune diseases?
21
22 Serum 25(OH)D levels & risk of Multiple Sclerosis Prospective nested case control study >7 million US military personel All ages 257 cases of MS vs 2x controls Elevated 25(OH)D levels in whites more protective at younger ages Individuals <20 years old with 25(OH)D >40 ng/ml had 91% reduction in MS risk vs. 25(OH)D <40 ng/ml (RR=0.09, 95%CI: , p=0.03) Munger KL. JAMA 2006;296:
23 145 MS patients; follow-up : 2.3 +/-0.6 yrs ; 25OHD measured bi-annually. Hazard ratio of relapse (adjusted for age, sex, BMI)
24 MS patients randomized to 20,000 IU D3/week for 1 year (n=35) versus placebo (n=33) AAR (annualized relapse rate) = 0.11 MS patients randomized To 20,000IU D3/week for 1 year (n=34) versus placebo (n=32). AAR =0,5
25 Vitamin D supplementation & risk of type 1 diabetes Finnish birth-cohort study (born 1966) Endpoint: type 1 diabetes by end ,366 children; 81 with type 1 diabetes Recommended supplementation during first year of life: 2,000 IU/day A daily dose of 2,000 IU was associated with a 78% reduced risk of developing type 1 diabetes compared to lower doses Hyppönen E. Lancet 2001;358:
26 Giulietti A et al Vitamin D deficiency in early life accelerates type 1 diabetes in Non-obese diabetic mice. Diabetologia 2004; 47: Control NOD male D-deficient male Control NOD female D-deficient female p<0.01 p=0.05
27 Vitamin D and complications of type 1 diabetes Joergensen C et al. Vitamin d levels, microvascular complications, and mortality in type 1 diabetes. Diabetes Care 2011; 34: patients DM1 median follow-up: 24 yrs 44 deaths 25OHD measured approx 3 yrs after the diagnosis, and before microalbulinuria HR for death if 25OHD <10th percentile) : 2.7 ( ) p=0.03 No association between severe vit D deficiency and albuminuria or rétinopathy
28 The panel on calcium and related nutrients quickly reached consensus that serum 25OHD was the correct functional indicator of vitamin D status...hence, on this point at least, there is consensus (notably, that was not the case as recently as 5-10 years ago). Heaney R. Editorial Vitamin D : how much do we need, and how much is too much. Osteoporosis Int (2000) 11 : ng/ml = 2.5 nmol/l It may be more appropriate to use health-based than population-based reference values for serum 25OHD i.e., reference limits based on avoidance of adverse health outcomes for the skeleton P Lips Endocrine Reviews (2001) 22 :
29 IOM vs Endocrine Society
30 Two groups released recently different recommendations on the use of vitamin D. Both groups acknowledged that their recommendations were based on «musculoskeletal health» IOM (Ross AC JCEM 2011) A 25OHD serum level of 50 nmol/l (20 ng/ml) is largely sufficient and «covers the requirements of at least 97.5% of the population» Endocrine Society (Holick M JCEM 2011) Vitamin D deficiency 25OHD<50 nmol/l (20 ng/ml) Vitamin D insufficiency 25OHD = nmol/l (20-30 ng/ml) Surprisingly, the two groups reached these different conclusions after the (extensive) analysis of virtually the same data Public health recommendations versus (individual) Patient care
31 Hilger J et al A systematic review of vitamin D status in populations Worldwide British Journal of Nutrition August 2013 If analysis restricted to European Children => Mean 25OHD = 50.6 nmol/l
32 What are the major determinants of vitamin D status? -Older age -Female gender -National policies fortification and dietary habits -Clothing practices -Skin pigmentation -Outdoor activities -BMI -Season Mithal et al, Osteoporosis Int 2009
33 Vitamin D intake recently recommended for children and adolescents by differents groups of experts IOM 1-18 years Ross AC et al. J Clin Endocrinol Metab 2011; 96: EAR: 400 IU/d (10 μg) RDI: 600 IU/d (15 μg) UL : 4000 IU/d (100 μg) (3000 IU/d 1-8 yrs) Endocrine Society 1-18 years Holick M et al. J Clin Endocrinol Metab 2011; 96: EAR : IU/d UL : 4000 IU/d Academy of Medicine (France) 0-18 years Bernard Salle et al May 2012 report EAR: IU/d (0-1 yr et yrs) IU/d (1-9 yrs) UL : 4000 IU/d Nutrition group of the French Society of Pediatrics (0-5 years and years) Vidailhet M et al Archives de pédiatrie 2012; 19: doses IU or IU in winter (november, february) for children 18 months-5 yrs and yrs old IU/d for breast-fed newborns (<18 months) or receiving non supplemented cow milk IU/d for newborns <18 months receiving vitamin D enriched milk EAR = Estimated Average Requirement RDI = Recommended Dietary Intake UL = Tolerable upper Intake level One can note that : -Mean vitamin D dietary intake in France : 92 IU/d -Official (AFSSA) EAR in France : 200 IU/d
34 Conclusions - Vitamin D deficiency is very frequent (in Europe mean 25OHD concentration in children is # 20 ng/ml) -Official RDI are often insufficient -Besides its classical effects on bone and mineral metabolism, vitamin D has many other potential effects on various organs. Indeed, VDR and the activating/inactivating enzyme machinery are present in almost all tissues. These «non-classical» effects are supported by many observational studies and experimental studies (animal models, cell culture ). However, results of RCTs are conflicting (positive or «null») precluding «evidence-based» recommendations. Nevertheless, all experts agree that being vitamin D deficient/insufficient is not good for health (in children and adults) and must be avoided. One remaining debate is the 25OHD level that defines vitamin D deficiency
35 Thank you for attention
IOM DRI Research Synthesis Workshop June 7-8, 2006
The Dietary Requirement for Vitamin D: Looking Beyond Bone Bruce W. Hollis, Ph.D. Medical University of South Carolina Charleston, SC Presentation: Dr. Bruce Hollis 1 Metabolism of Vitamin D Under Conditions
More informationVitamin D: Is it a superhero??
Vitamin D: Is it a superhero?? Dr. Ashraf Abdel Basset Bakr Prof. of Pediatrics 1 2 History of vitamin D discovery Sources of vitamin D and its metabolism 13 Actions of vitamin D 4 Vitamin D deficiency
More informationVitamin D: Conflict of Interest Statement Corporate. Outline 7/5/2016
Vitamin D: What s New and Not? Clifford J Rosen MD Maine Medical Center Research Institute rosenc@mmc.org Conflict of Interest Statement Corporate NO STOCKS or EQUITY Editor UpToDate, New England Journal
More informationVitamin D. Vitamin functioning as hormone. Todd A Fearer, MD FACP
Vitamin D Vitamin functioning as hormone Todd A Fearer, MD FACP Vitamin overview Vitamins are organic compounds that are essential in small amounts for normal metabolism They are different from minerals
More informationUpdate on vitamin D. J Chris Gallagher Professor of Medicine and Endocrinology Creighton University Omaha,Nebraska USA
Update on vitamin D J Chris Gallagher Professor of Medicine and Endocrinology Creighton University Omaha,Nebraska 68131 USA Cali, Colombia 2016 definitions DRIs are the recommended dietary reference intakes
More informationHellenic Endocrine Society position statement: Clinical management of Vitamin D Deficiency. Spyridon Karras MD, Phd Endocrinologist
Hellenic Endocrine Society position statement: Clinical management of Vitamin D Deficiency Spyridon Karras MD, Phd Endocrinologist Pregnancy We recommend a minimum intake of 600 international units of
More informationVitamin D in Cattle: Calcium and Beyond. Corwin D. Nelson, Ph.D. Assistant Professor of Physiology Department of Animal Sciences
OH HO OH Vitamin D in Cattle: Calcium and Beyond Corwin D. Nelson, Ph.D. Assistant Professor of Physiology Department of Animal Sciences Seminar Outline 1. Basics of vitamin D metabolism and genomic actions
More informationEmerging Areas Relating Vitamin D to Health
ILSI SEA Region Vit D Conference, Australia, June 2012 (www.ilsi.org/sea Region) Emerging Areas Relating Vitamin D to Health Peter R Ebeling MD FRACP NorthWest Academic Centre and Dept Endocrinology The
More informationVitamin D and Calcium Therapy: how much is enough
Vitamin D and Calcium Therapy: how much is enough Daniel D Bikle, MD, PhD Professor of Medicine VA Medical Center and University of California San Francisco DISCLOSURE Nothing to disclose 1 RECOMMENDATIONS
More informationThe Endocrine Society Guidelines
Vitamin D and Calcium Therapy: how much is enough DISCLOSURE Daniel D Bikle, MD, PhD Professor of Medicine VA Medical Center and University of California San Francisco Nothing to disclose RECOMMENDATIONS
More informationVitamin D Replacement ROCKY MOUNTAIN MEETING NOV 2013 BANFF W.COKE UNIVERSITY OF TORONTO
Vitamin D Replacement ROCKY MOUNTAIN MEETING NOV 2013 BANFF W.COKE UNIVERSITY OF TORONTO Disclosures: (Academic Mea Culpa) No financial conflicts I have no expertise re: Vitamin D. OBJECTIVES: 1) Review
More informationVitamin D and Inflammation
Vitamin D and Inflammation Susan Harris, D.Sc. Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University Boston, MA Vitamin D Liver 25(OH)D storage form nmol/l=ng/ml x 2.5 Renal 1,25(OH)
More informationVITAMIN D THE ICEBERG UNDER THE SURFACE. Robert P. Heaney, M.D., F.A.C.P. Creighton University Osteoporosis Research Center
VITAMIN D THE ICEBERG UNDER THE SURFACE Robert P. Heaney, M.D., F.A.C.P. Creighton University Osteoporosis Research Center DISCLOSURES Robert P. Heaney, M.D. no personal financial relationships to disclose
More informationImportance of Vitamin D in Healthy Ageing. Peter Liu, B Pharmacy Market Development Manager DSM Nutritional Products Asia Pacific 11 th November 2014
Importance of Vitamin D in Healthy Ageing Peter Liu, B Pharmacy Market Development Manager DSM Nutritional Products Asia Pacific 11 th November 2014 Healthy life expectancy the challenge! Life expectancy
More informationThe Vitamin D Gap. Vitamin D intake guidelines were established to prevent. Estimating an adequate intake of vitamin D. FEATURE VITAMIN D GAP
The Vitamin D Gap Estimating an adequate intake of vitamin D. By Laurence Montgomery, ND and George Tardik, ND Vitamin D intake guidelines were established to prevent rickets in children and osteomalacia
More informationVitamin D The hidden deficiency. Dr Pamela von Hurst Senior Lecturer Human Nutrition Director of the Massey Vitamin D Research Centre
Vitamin D The hidden deficiency Dr Pamela von Hurst Senior Lecturer Human Nutrition Director of the Massey Vitamin D Research Centre Overview Vitamin D what, where from, how much The New Zealand situation
More informationVitamin D in Pregnancy and Infancy
Vitamin D in Pregnancy and Infancy Charles B. Stephensen, Ph.D. USDA Western Human Nutrition Research Center and Nutrition Department, UC Davis Vitamin D Outline Metabolism of vitamin D Calcium Balance
More informationVitamin D Deficiency. Decreases renal calcium excretion. Increases intestinal absorption Calcium. Increases bone resorption of calcium
Vitamin D Deficiency Deborah Gordish, MD Assistant Professor of Clinical Internal Medicine Lead Physician Lewis Center Primary Care Associate Division Director General Internal Medicine The Ohio State
More informationIn 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
More informationDr Seeta Durvasula.
Dr Seeta Durvasula seeta.durvasula@sydney.edu.au 1 Avoid sun skin cancer risk Australia has highest rates of skin cancer in the world Epidemic of Vitamin D deficiency Lack of Vitamin D increases risk of
More informationSupplementary Information to Chapter 36
REVIEW ON VITAMIN-D NEW INSIGHTS Elmer Verner McCollum (1879-1967) was the first to discover the antirachitic vitamin which he named as vitamin D in the early part of 20th century (1919). He had earlier
More informationThe Impact of Life Style & Dietary Habits on Vitamin D status Among Young Emiratis. Fatme Al Anouti, Ph.D. Zayed University, Abu Dhabi
The Impact of Life Style & Dietary Habits on Vitamin D status Among Young Emiratis Fatme Al Anouti, Ph.D. Zayed University, Abu Dhabi The Sun-Shine Vitamin Vitamin D is unique because it can be synthesized
More informationUnderstanding Vitamin D: To D or not to D? Anastassios G Pittas, MD MS Tufts Medical Center
Understanding Vitamin D: To D or not to D? Anastassios G Pittas, MD MS Tufts Medical Center D2dstudy.org pittas@d2dstudy.org Disclosure: NIH funding Popularity of vitamin D RESEARCH CONSUMERS 40000 Publications
More informationFOCUS ON CARDIOVASCULAR DISEASE
The Consequences of Vitamin D Deficiency: FOCUS ON CARDIOVASCULAR DISEASE Vitamin D deficiency is a global health problem. With all the medical advances of the century, vitamin D deficiency is still epidemic.
More informationFOR CONSUMERS AND PATIENTS
AVAILABILITY OF VITAMIN D FOR CONSUMERS AND PATIENTS Prof. Heike A. Bischoff-Ferrari, MD, DrPH Centre on Aging and Mobility, University of Zurich Dept. of Rheumatology, University Hospital Zurich Overview
More informationVITAMIN D. Christina Nieuwoudt RD(SA) CCSSA/SASPEN 2018
VITAMIN D Christina Nieuwoudt RD(SA) CCSSA/SASPEN 2018 1 OBJECTIVES Why is it in the spotlight? Vit D and acute illness If it has a role how much should we give? Future 2 Why is it in the spotlight? FUNCTIONS
More informationThe discovery of Vitamin D and the elimination of rickets has been considered as one of Medicine s Greatest Achievements.
The discovery of Vitamin D and the elimination of rickets has been considered as one of Medicine s Greatest Achievements. SIR EDWARD MELLANBY 1 8 8 4-1 9 5 5 A D I E T C H A R A C T E R I S T I C O F S
More informationOverview. Musculoskeletal consequences of Vitamin D deficiency. Non-musculoskeletal associations of Vitamin D deficiency
Vitamin D Zulf Mughal Consultant in Paediatric Bone Disorders Department of Paediatric Endocriology Royal Manchester Children's Hospital Manchester M13 0JH Bone Study Day, 28 th September 2012 Overview
More informationVitamina D: un ormone multifunzione
Vitamina D: un ormone multifunzione Introduction And Infections Diego Peroni Clinica Pediatrica Universita di Ferrara Food Allergy Asthma Conclusions diego.peroni@unife.it Holick, M. F. J. Clin. Invest.
More informationESPEN Congress Prague 2007
ESPEN Congress Prague 2007 Key papers in the field of nutrition Dietitian Geila S Rozen Key Papers in the field of Nutrition ESPEN 2007 Prague Geila S Rozen Clinical Nutrition Dep. Rambam health campus
More informationHas the science of supplementation reached the breakthrough point?
IADSA Annual Week 19-21 June 2018 The Food Supplement Sector: Evolution and Evaluation Has the science of supplementation reached the breakthrough point? Manfred Eggersdorfer PhD Professor for Healthy
More informationVITAMIN D: MORE THAN GOOD FOR BONES
VITAMIN D: MORE THAN GOOD FOR BONES Daniel D Bikle, MD, PhD Professor of Medicine and Dermatology UCSF and SFVAMC Liver P Ca 1,25(OH)2D FGF23 Kidney P Ca PTH FGF23 1 SERUM LEVELS OF MAJOR VITAMIN D METABOLITES
More informationVitamin D & Cardiovascular Disease
Vitamin D & Cardiovascular Disease Disclosures None Vitamin D Objectives: Discuss the basics of vitamin D metabolism Discuss the role of vitamin D deficiency in the development of coronary disease Review
More informationVitamin D during pregnancy and breastfeeding
Vitamin D during pregnancy and breastfeeding Getting the right nutrients and eating well when you re pregnant or breastfeeding is important for your baby s growth and development. Vitamin D helps you to
More informationOutline. The Role of Vitamin D in CKD. Essential Role of Vitamin D. Mechanism of Action of Vit D. Mechanism of Action of Vit D 7/16/2010
Outline The Role of Vitamin D in CKD Priscilla How, Pharm.D., BCPS Assistant Professor National University of Singapore Principal Clinical Pharmacist National University Hospital (Pharmacy and Nephrology,
More informationVITAMIN D AND THE ATHLETE
VITAMIN D AND THE ATHLETE CONSIDERATIONS FOR THE PRACTITIONER Written by Bruce Hamilton, Qatar Vitamin D is a steroid hormone that has previously been given little attention, partially as a result of its
More informationObservational Studies vs. Randomized Controlled Trials
Observational Studies vs. Randomized Controlled Trials Edward Giovannucci, MD, ScD Harvard School of Public Health Harvard Medical School Boston MA 02115 (1)The relevance of observational data as compared
More informationVitamin D and Calcium
Vitamin D and Calcium American Association of Clinical Endocrinologists Marina Del Rey, CA September 15, 2018 Albert Shieh, MD MS Assistant Clinical Professor Department of Medicine Division of Endocrinology
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A A Diabetes Outcome Progression Trial (ADOPT), 194 Adaptive immunity, 129 131 ADOPT (A Diabetes Outcome Progression Trial), 194 Aging, vitamin
More informationOSTEOMALACIA UPDATE. Nothing to Disclose. Daniel D Bikle, MD, PhD Professor of Medicine University of California and VA Medical Center San Francisco
OSTEOMALACIA UPDATE Daniel D Bikle, MD, PhD Professor of Medicine University of California and VA Medical Center San Francisco Nothing to Disclose 1 Case History 59 YO WM referred for evaluation of diffuse
More informationDisclosure 7/2/2018. Consultant : Ultragenyx, Alexion, Ferrings. Research grant support: Ultragenyx, Shire, Amgen. Clinical Trial : Ultragynyx, Amgen
Pisit (Duke) Pitukcheewanont, MD, FAAP Clinical Director, Pediatric Bone Program, Center for Diabetes, Endocrinology & Metabolism Children s Hospital Los Angeles Professor of Clinical Pediatrics The Keck
More informationVITAMIN D IN HEALTH AND DISEASE
VITAMIN D IN HEALTH AND DISEASE Margus Lember University of Tartu, Estonia ESIM, Saas Fee, January 16, 2014 l It`s most healthy to live on the southern side of a mountain l Hippokrates of Kos 460-370 BC
More informationHow to Design, Conduct, and Analyze Vitamin D Clinical Trials
How to Design, Conduct, and Analyze Vitamin D Clinical Trials William B. Grant, PhD Sunlight, Nutrition and Health Research Center wbgrant@infionline.net Disclosure I receive funding from Bio-Tech Pharmacal,
More informationVitamin D: Vitamin D deficiency: 7/6/2010
Vitamin D: Nancy Eyler, MD, FACP Medical Director, Diabetes & Endocrinology Community Medical Center Missoula, MT Calcium and bone metabolism: Enhances intestinal absorption of both calcium and phosphorus
More informationVITAMIN D CRITICAL TO BONE HEALTH
VITAMIN D CRITICAL TO BONE HEALTH Vitamin D supplementation is now all the rage, as physicians are finally realizing that many diseases are caused by Vitamin D deficiencies. It will be helpful to know
More informationTheories: Reduced Milk Consumption. Case of the A Family. Physiology of Vitamin D. Why Is Everyone Vitamin D Deficient?
Case of the A Family Theories: Reduced Milk Consumption Osama A. 51 y/o male from Sudan; 4 children Oldest son Ahmed, tears ACL Soccer Youngest Son, Osman, fx Ulna cross St Second Son, Ayman, Fx Tib/Fib
More informationBeyond the Break Role of Vitamin D in Nutrition, Bone health and Osteoporosis Clinical: updates & practical considerations
Beyond the Break Role of Vitamin D in Nutrition, Bone health and Osteoporosis Clinical: updates & practical considerations Presenter: Hope Weiler, RD(CDO), PhD Date: March 4, 2016 Disclosures OC Consultant
More informationWelcome to mmlearn.org
Welcome to mmlearn.org VITAMIN D SUNSHINE VITAMIN INTRODUCTION Familiar with skeletal needs Rickets Osteoporosis Fractures INTRODUCTION Not as familiar other associations Immune system Cancer Cardiovascular
More informationVitamin D in pregnancy and lactation
Vitamin D in pregnancy and lactation October 2014 Dr Pamela von Hurst Co-Director, Vitamin D Research Centre Massey University Vitamin D 101 Metabolism Sources Measuring status Overview of presentation
More informationBenefits of Vitamin D for Cancer and Pregnancy/Birth Outcomes. William B. Grant, PhD Sunlight, Nutrition and Health Research Center, San Francisco
Benefits of Vitamin D for Cancer and Pregnancy/Birth Outcomes William B. Grant, PhD Sunlight, Nutrition and Health Research Center, San Francisco Disclosure I receive funding from Bio Tech Pharmacal, Inc.
More informationV t i amin i n D a nd n d Calc l iu i m u : Rol o e l in i n Pr P eve v nt n io i n and n d Tr T eatment n of o Fr F actur u es and n d Fa F ll l s
Vitamin D and Calcium: Role in Prevention and Treatment of Fractures and Falls Osteoporosis 21: New Insights In Research, Diagnosis, and Clinical Care Deborah Sellmeyer, MD Director, Johns Hopkins Metabolic
More informationVITAMIND. Frequently asked questions about Vitamin D in childhood
VITAMIND Frequently asked questions about Vitamin D in childhood Introduction Around the UK there are different recommendations for the prevention, detection and treatment of Vitamin D deficiency. The
More informationMEDICAL POLICY EFFECTIVE DATE: 08/21/14 REVISED DATE: 04/16/15, 06/16/16, 07/20/17 SUBJECT: SCREENING FOR VITAMIN D DEFICIENCY
MEDICAL POLICY SUBJECT: SCREENING FOR VITAMIN D DEFICIENCY A nonprofit independent licensee of the BlueCross BlueShield Association PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not
More informationZeenat Ali, PGY3 Joseph Grisanti, MD June 7 th, 2012
A Randomized Open Label Trial to Evaluate the Efficacy of Different Dosage Forms of Vitamin D in Patients with Vitamin D Deficiency, and the Effect of Food on Vitamin D Absorption. Zeenat Ali, PGY3 Joseph
More informationOsteoporosis and Nutrition Module 4 Speaking of Bones Osteoporosis For Health Professionals. Susan J Whiting University of Saskatchewan
Osteoporosis and Nutrition Module 4 Speaking of Bones Osteoporosis For Health Professionals Susan J Whiting University of Saskatchewan Learning Objectives Understand the 3 critical nutrients for bone:
More informationRENAL GRAND ROUNDS. Vitamin D- Beyond the bone. Dr Krishna Pakkivenkata. 9 th April 2010.
RENAL GRAND ROUNDS Vitamin D- Beyond the bone Dr Krishna Pakkivenkata. 9 th April 2010. Brief history Secosteroid. 1920 s-exposure to sunlight prevented rickets. 1936- structure of Vit D was discovered.
More informationHow to Design, Conduct, and Analyze Vitamin D Clinical Trials
How to Design, Conduct, and Analyze Vitamin D Clinical Trials William B. Grant, PhD Sunlight, Nutrition and Health Research Center wbgrant@infionline.net Disclosure I receive funding from Bio-Tech Pharmacal,
More information02/27/2018. Objectives. To Replace or Not to Replace: Nutritional Vitamin D in Dialysis.
To Replace or Not to Replace: Nutritional Vitamin D in Dialysis. Michael Shoemaker-Moyle, M.D. Assistant Professor of Clinical Medicine Objectives Review Vitamin D Physiology Review Current Replacement
More informationBAD TO THE BONE. Peter Jones, Rheumatologist QE Health, Rotorua. GP CME Conference Rotorua, June 2008
BAD TO THE BONE Peter Jones, Rheumatologist QE Health, Rotorua GP CME Conference Rotorua, June 2008 Agenda Osteoporosis in Men Vitamin D and Calcium Long-term treatment with Bisphosphonates Pathophysiology
More informationThe hart and bone in concert
The hart and bone in concert Piotr Rozentryt III Department of Cardiology, Silesian Centre for Heart Disease, Silesian Medical University, Zabrze, Poland Disclosure Research grant, speaker`s fee, travel
More informationVitamin D & Breast Cancer: New Research & Recommendations
Vitamin D & Breast Cancer: New Research & Recommendations JoEllen Welsh, PhD Empire Innovations Professor University at Albany Cancer Research Center Vitamin D Biology Pre-D3 7-dehydrocholesterol UV Cholecalciferol
More informationIS VITAMIN D IMPORTANT IN THE MANAGEMENT OF TUBERCULOSIS?
IS VITAMIN D IMPORTANT IN THE MANAGEMENT OF TUBERCULOSIS? Dr Heather Milburn Consultant Respiratory Physician Guy s & St Thomas NHS Foundation Trust READER IN Respiratory Medicine KING S College London
More informationVitamin D supplementation of professionally active adults
Vitamin D supplementation of professionally active adults VITAMIN D MINIMUM, MAXIMUM, OPTIMUM FRIDAY, SEPTEMBER 22 ND 2017 Samantha Kimball, PhD, MLT Research Director Pure North S Energy Foundation The
More informationVitamins. Nafith Abu Tarboush, DDS, MSc, PhD
Vitamins Nafith Abu Tarboush, DDS, MSc, PhD natarboush@ju.edu.jo www.facebook.com/natarboush Vitamins Organic compounds required by an organism in tiny amounts as a vital nutrient Cannot be synthesized
More informationREPORT 4 OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (A-09) Appropriate Supplementation of Vitamin D (Resolution 425, A-08) (Reference Committee D)
REPORT OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (A-0) Appropriate Supplementation of Vitamin D (Resolution, A-0) (Reference Committee D) EXECUTIVE SUMMARY Objective: To highlight key information and
More informationan intriguing association
Vitamin D deficiency, the novel disease?? An Vitamin effort to D focus and Diabetes on the evidence Mellitus: contrary to the tendency an intriguing association for generalized substitution Kalliopi Kotsa,
More informationVITAMIN D IN HEALTH & DISEASE. Boyd C.Hoddinott B Sc, MD, MPH Logan County Health Commissioner
VITAMIN D IN HEALTH & DISEASE Boyd C.Hoddinott B Sc, MD, MPH Logan County Health Commissioner Summary Foods in North America were fortified with vitamin D to reduce the occurrence of rickets. This appeared
More informationJ.Bacchetta has documented that she has received grants for research activities from Amgen, Crinex, Sandoz.
J.Bacchetta has documented that she has received grants for research activities from Amgen, Crinex, Sandoz. Epidemiological, immune and metabolic aspects of vitamin D in CKD Justine Bacchetta, MD, PhD
More informationMonocyte Innate Immune Response to Vitamin D
Monocyte Innate Immune Response to Vitamin D SIAM Life Science 2012 Session MS40 Signaling: Vitamin D in Monocytes and Receptor Clustering in Mast Cells Hewison and Adams laboratory UCLA-Orthopaedic Hospital
More informationVitamin D. Mrs Sophie Barnes FRCPath Consultant Clinical Scientist
Vitamin D Mrs Sophie Barnes FRCPath Consultant Clinical Scientist Learning objectives Biochemistry and physiology of vitamin D Causes and consequences of vitamin D deficiency Current and anticipated guidelines
More informationType 1 Diabetes and the Environment: a Focus on Dietary Factors
Type 1 Diabetes and the Environment: a Focus on Dietary Factors CHE Partnership Call November 12, 2014 Jill M. Norris, MPH, PhD Professor and Chair Department of Epidemiology Colorado School of Public
More informationTITOLO RELAZIONE Vitamina D e aspetti immunologici. DOCENTE Michele Miraglia del Giudice
TITOLO RELAZIONE Vitamina D e aspetti immunologici DOCENTE Michele Miraglia del Giudice ????? bone skin placenta adrenal glands Vitamin D Receptors (VDR) are present in different tissues intestine kidneys
More informationYOUR VITAMIN D CHEAT-SHEET
YOUR VITAMIN D CHEAT-SHEET When using the cutoff of 20 ng/ml (50 nmol/l) for vitamin D deficiency, according to data collected by the Centers for Disease Control (CDC), 90 million Americans are vitamin
More informationSteroid hormone vitamin D: Implications for cardiovascular disease Circulation research. 2018; 122:
Steroid hormone vitamin D: Implications for cardiovascular disease Circulation research. 2018; 122:1576-1585 November 20, 2010: Canadian and US government request the Institute of Medicine to provide a
More informationCalcium and Vitamin D Supplementation is an Ineffective Strategy for the Prevention of Fractures in Older People
Calcium and Vitamin D Supplementation is an Ineffective Strategy for the Prevention of Fractures in Older People For the Motion: Professor Roger Francis, Institute for Ageing and Health, Newcastle University,
More informationElecsys bone marker panel. Optimal patient management starts in the laboratory
bone marker panel Optimal patient management starts in the laboratory Complete solution for osteoporosis The most complete bone metabolism panel on a single platform bone marker assays are important diagnostic
More information17/11/57. Umaporn Suthutvoravut, M.D. Faculty of Medicine Ramathibodi Hospital
Vitamin i D and Child Health Umaporn Suthutvoravut, M.D. Department t of Pediatrics i Faculty of Medicine Ramathibodi Hospital Mahidol luniversity, it Thailand 1 Outline Vitamin i D and bone health h Vitamin
More informationVitamin D and Multiple Sclerosis: A Comprehensive Review
Neurol Ther (2018) 7:59 85 https://doi.org/10.1007/s40120-017-0086-4 REVIEW Vitamin D and Multiple Sclerosis: A Comprehensive Review Martina B. Sintzel. Mark Rametta. Anthony T. Reder Received: October
More informationVitamin D and inflammation
Vitamin D and inflammation Z Albar Rheumatology Division, Internal Medicine Department, University of Indonesia School of Medicine/Cipto Mangunkusumo General Hospital ABSTRACT The discovery that most body
More informationTHE SUNSHINE VITAMIN. Maureen Molini, MPH, RDN, CSSD University of Nevada Reno Student Health Services
THE SUNSHINE VITAMIN Maureen Molini, MPH, RDN, CSSD University of Nevada Reno Student Health Services Vitamin vs. Prohormone Technically not a vitamin since it isn t obtained solely through diet Synthesized
More informationWhen does prolonged vitamin D intake confer a risk for health?
When does prolonged vitamin D intake confer a risk for health? Glenville Jones, Ph.D Craine Professor of Biochemistry, Dept Biomedical & Molecular Sciences Professor, Department of Medicine Queen's University,
More informationClarifying which food formats and vitamin D forms are most effective for delivering vitamin D for immunity
Clarifying which food formats and vitamin D forms are most effective for delivering vitamin D for immunity Dr Simon Penson Head of Cereals and Ingredients Processing Campden BRI simon.penson@campdenbri.co.uk
More informationNutritional concepts for the prevention and treatment of osteoporosis: what, for whom, when? Objectives
Nutritional concepts for the prevention and treatment of osteoporosis: what, for whom, when? Bess Dawson-Hughes, MD Disclosures: Amgen, DSM, Nestle, Opko, Pfizer, Roche, Tricida Interrelationships of muscle
More informationFrancesco Bertoldo 2. Heike A. Bischoff-Ferrari 3 Olivier Bruyere 4. Luisella Cianferotti 1. John A. Kanis 7,8 Jean-Marc Kaufman 9.
Endocrine (2017) 56:245 261 DOI 10.1007/s12020-017-1290-9 POSITION STATEMENT/GUIDELINE Vitamin D supplementation in the prevention and management of major chronic diseases not related to mineral homeostasis
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testing_serum_vitamin_d_levels 9/2015 2/2018 2/2019 2/2018 Description of Procedure or Service Vitamin D,
More informationVitamin D Supplementation During Pregnancy and Infancy Reduces Sensitisation to House Dust Mite: a Randomised Controlled Trial
Vitamin D Supplementation During Pregnancy and Infancy Reduces Sensitisation to House Dust Mite: a Randomised Controlled Trial Cameron Grant, 1 4 Julian Crane, 3 Ed Mitchell, 1 Jan Sinclair, 4 Alistair
More informationVitamin D Hormone Du Jour
Vitamin D Hormone Du Jour J R Minkoff MD, FACP Endocrinology Clinical Professor of Family and Community Medicine UCSF Why Is Vitamin D Important? Musculo-skeletal effects Possible other effects Immunomodulatory
More informationYEAST A NATURAL SOLUTION
Lalmin Vitamin D Yeast: An All Natural Solution for Deficiency YEAST A NATURAL SOLUTION THE ROLE OF VITAMIN D Vitamin D refers to a group of fat-soluble vitamins, mainly the two forms called vitamin D2
More informationThe Human Cathelicidin LL37 Peptide has High Plasma Levels in B and C Hepatitis Related to Viral Activity but not to 25-Hydroxyvitamin D Plasma Level
The Human Cathelicidin LL37 Peptide has High Plasma Levels in B and C Hepatitis Related to Viral Activity but not to 25-Hydroxyvitamin D Plasma Level SIMONA ALEXANDRA IACOB 1, EUGENIA PANAITESCU 2, DIANA
More informationOsteoporosis and Nutrition Module 4 Speaking of Bones Osteoporosis For Health Professionals. Susan J Whiting University of Saskatchewan
Osteoporosis and Nutrition Module 4 Speaking of Bones Osteoporosis For Health Professionals Susan J Whiting University of Saskatchewan Learning Objectives Understand the 3 critical nutrients for bone:
More informationEndocrine Regulation of Calcium and Phosphate Metabolism
Endocrine Regulation of Calcium and Phosphate Metabolism Huiping Wang ( 王会平 ), PhD Department of Physiology Rm C516, Block C, Research Building, School of Medicine Tel: 88208252 Email: wanghuiping@zju.edu.cn
More informationVitamin D and Cardiovascular Disease
Vitamin D and Cardiovascular Disease Carrie W. Nemerovski, Pharm.D., Michael P. Dorsch, Pharm.D., Robert U. Simpson, Ph.D., Henry G. Bone, M.D., Keith D. Aaronson, M.D., and Barry E. Bleske, Pharm.D.,
More informationOPTIMISING NUTRITION IN CF ADULTS DR HELEN WHITE
OPTIMISING NUTRITION IN CF ADULTS DR HELEN WHITE MULTISYSTEM DISEASE Pancreatic insufficiency Nutritional status CF related diabetes Fat soluble vitamin status Bone health Greater complexity of care in
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testing_serum_vitamin_d_levels 9/2015 2/2017 2/2018 2/2017 Description of Procedure or Service Vitamin D,
More informationVitamin D Deficiency
Learning Objectives Vitamin D Deficiency 1. Summarize the basics of Vitamin D metabolism 2. Identify who to screen for Vitamin D Deficiency 3. Assess when to recommend Vitamin D Supplementation 4. Recognize
More informationEligibility The NCSF online quizzes are open to any currently certified fitness professional, 18 years or older.
Eligibility The NCSF online quizzes are open to any currently certified fitness professional, 18 years or older. Deadlines Course completion deadlines correspond with the NCSF Certified Professionals certification
More informationVitamin D and Health: Evolution, Biologic Functions, and Recommended Dietary Intakes for Vitamin D
Clinic Rev Bone Miner Metab (2009) 7:2 19 DOI 10.1007/s12018-009-9026-x ORIGINAL PAPER Vitamin D and Health: Evolution, Biologic Functions, and Recommended Dietary Intakes for Vitamin D Michael F. Holick
More information1/31/2011. Dietary Reference Intakes. for Vitamin D: the Evidence, Challenges and Implications
Dietary Reference Intakes (DRI) for Vitamin D: the Evidence, Challenges and Implications IOM Committee to Review Dietary Reference Intakes for Vitamin D & Calcium Patsy M. Brannon Graduate Field of Nutrition
More informationManaging Endocrine Related Issues after Bariatric Surgery. Jenny Tong, MD, MPH Division of Endocrinology March 3, 2018
Managing Endocrine Related Issues after Bariatric Surgery Jenny Tong, MD, MPH Division of Endocrinology March 3, 2018 Bariatric Surgery was Associated with Higher Remission Rate than Usual Care 72.3% 38.1%
More informationEvaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline
J Clin Endocrin Metab. First published ahead of print June 6, 2011 as doi:10.1210/jc.2011-0385 SPECIAL FEATURE Clinical Practice Guideline Evaluation, Treatment, and Prevention of Vitamin D Deficiency:
More information