Vitamin D: effects on health & disease during childhood

Transcription

1 Vitamin D: effects on health & disease during childhood Soodeh Razeghi Assistant Professor Department of clinical nutrition and dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences (SBMU)

2 Fuleihan et al. J Bone Miner Res 2015; 30(7): Classic function of vitamin D: maintain Calcium homeostasis The classical clinical consequence of vitamin D deficiency is osteomalacia, presenting as rickets in children. This remains a common problem in parts of the Middle East occurs when serum 25-hydroxyvitamin D levels are <25 nmol/l.

3 یافته ها Vitamin D need increases during childhood and adolescence due to the requirements of bone and LBM growth Therefore, Vitamin محل نمونه isحجم common in نمونه D deficiency دامنه سنی گیری مطالعه this age group نویسنده سال انجام کلیشادی و همکاران شیوع کمبود ویتامین :D 40 % CASPIAN-III نیستانی و همکاران نکوییه و همکاران غلظت 25 -هیدروکسی ویتامین D در پسران 10/6 در دختران 7/5 نانوگرم بر میلی لیتر شیوع کمبود ویتامین D در پسران %76/7 و دختران %91/6 وضعیت نامطلوب ویتامین D در زمستان %93.2 )%64.8 کمبود و %28.4 عدم کفایت( و در تابستان %30.8( %71.7 کمبود و %40.9 عدم کفایت( گزارش شده است تهران در 6 استان کشور برنامه ملی مراقبت و تغذیه NFNSP National Food and Nutrition ( )Surveillance Program توسط انستیتو تحقیقات تغذیه ای و صنایع غذایی کشور و دفتر بهبود تغذیه وزارت بهداشت درمان و آموزش پزشکی و با حمایت دفتر حمایت از کودکان سازمان ملل در حال انجام است Kelishadi et al. Nutrition 2014; 30(1): Neyestani et al. Public Health Nutr 2012;15(2): نیکویه و همکاران مجله علوم تغذیه و صنایع غذایی ایران 11)1(: , 3

4 Conditions associated with vitamin D deficiency Cardiovascular Respiratory Metabolic Infection Cancer Musculoskeletal Neurological Gastrointestinal Other Venous thromboembolism, heart disease, myocardial infarction, aortic dilatation, orthostatic hypotension Bronchiectasis, asthma, bronchiolitis, acute respiratory infection, lung injury, lung function, lung disease Metabolic syndrome, diabetes mellitus, diabetic nephropathy, infertility (male), chronic kidney disease, renal transplant Infections, leprosy Breast, past cancer of childhood, ovarian, lung Muscle strength, osteoarthritis, rheumatoid arthritis, juvenile arthritis, hip fracture Multiple sclerosis, cognition, myasthenia gravis, meningomyelocele, headache, stroke, depression, forensic psychiatric illness, spinal cord injury, Alzheimer's disease, falls Inflammatory bowel disease, chronic hepatitis, cirrhosis, pancreatitis psoriasis, burns, eczema, weight gain Reid IR, Archives of disease in childhood 2015:archdischild

5 Vitamin D recommendation during childhood and adolescence Institute of Medicine RDA = 600 IU (20 ng/ml) EAR = 400 IU (16 ng/ml) Endocrine Society Minimum 600 IU 1000 IU (30 ng/ml) Society for Adolescent Health and Medicine 600 IU for healthy adolescence 1000 IU for at risk adolescence 5

6 Supplementation

7 Atherosclerosis begins in childhood and cause cardiovascular disease in adulthood Therefore preventing from factors predisposing the individuals to CVD from early childhood is so important Vitamin D deficiency can induce atherosclerosis Dalla Pozza et al. Atherosclerosis 2015; 238(2):

8 After adjusting for confounding factors, the risk of abnormal cimt in adulthood is 70% higher among children with 25(OH)D less than 16 ng/ml Juonala et al. J Clin Endocrinol Metab 2015 ; 100(4):

9 There is an inverse relationship between Hypovitaminosis D and BMI, fat mass and PTH concentration in obese children Alemzadeh et al. Metabolism 2008; 57(2): Sharifi et al. Diabetes & metabolic syndrome 2013; 7(4):

10 Alemzadeh et al. Metabolism 2008; 57(2): Turer et al. Pediatrics 2013; 131(1): e

11 Effect of supplementation on 25(OH)D level in children & adolescence Sample size Vitamin D dose Duration of intervention results reference 35 obese adolescence 4000 IU/placebo 6 months 19.5 ng/ml increment v.s. 2.8 in placebo group Belenchia obese and 18 normal weight adolescence 58 obese adolescence 2000 IU 12 weeks 2000 IU/placebo 5.8 ng/ml increment in obese & 9.8 ng/ml increment in nonobese 12 weeks 5 ng/ml increment comparing to -1 ng/ml in placebo group Castaneda Nader adolescence 4000 IU/ 2000 IU/ 1000 IU/ 400 IU/ placebo 12 weeks 30.4 ng/ml increment in adolescents receiving 4000 IU/d comparing to -4.2 in placebo group Lewis

12 Effect of supplementation on 25(OH)D level in children & adolescence Sample size Vitamin D dose results Duration of intervention reference 53 adolescents 1000 IU/200 IU 340 adolescents 2000 IU/200 IU 50 postmen arch girls IU four times/year 157 adolescents 1000 IU/placebo 30.1 ng/ml increment 36 ng/ml increment v.s. 19 ng/ml in placebo 30 ng/ml increment v.s 11.2 in placebo group 26.7 ng/ml increment 11 weeks Putman months Maalouf months Khadikar months Rajakumar overweight & obese adolescents IU tow times/3m 20.1 ng/ml increament 24 weeks Shah

13 مکمل یاری ویتامین دی بر پروفایل انسولین و لیپید در کودکان و نوجوانان نویسنده - سال حجم نمونه دوز ویتامین دی مدت مداخله یافته ها سبب افزایش در انسولین حساسیت به انسولین و نسبت لپتین به آدیپونکتین شد سبب بهبود مقاومت به انسولین سندرم متابولیک و تری گلیسرید شد 4000 واحد 6 ماه دارونما واحد 12 هفته - Belenchia 35 نوجوان چاق 2013 Kelishadi نوجوان چاق و مبتال به سندرم متابولیک 13

14 Conclusion

15 Vitamin D supplementation Normalizing vitamin 25(OH)D level in children and adolescence Help to improve body weight, height, BMI, and waist circumference in children and adolescents have beneficial effect on insulin, glucose, cholesterol, TG, LDL-C, HDL-C, and insulin resistance index in children and adolescents 15

16 Have beneficial effect on PTH, calcium, and phosphors level in children & adolescents Have beneficial effect on cimt in overweight/obese children and adolescents Have beneficial effect on fat mass & fat free mass and in overweight/obese children and adolescents 16

17 Thanks