D-vitamiin roll tervises ja spordis. Mart Kull TÜ sisekliinik
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1 D-vitamiin roll tervises ja spordis Mart Kull TÜ sisekliinik
2 Lühidalt tänasest.. Meeldetuletus mis see D-vitamiin (Dhormoon) on ja mida organismis teeb? D-vitamiini ja osteoporoosi seosed D-vitamiin ja sport Kas Eestis on endiselt probleem D- vitamiini vähesusega?
3 Miks meile D-vitamiin?
4 D-vitamiin ja osteoporoos Ebapiisav kaltsiumi imendumine sooltest Tõusnud paratüreoidhormooni (PTH) tase Kiirenenud luu resorptsioon Ebapiisav tippluumass ja langenud luu mineraalne tihedus (LMT) Häiritud lihasfunktsioon, sagedane kukkumine Vähenenud osteoporoosi ravimite efektiivsus
5 D-vitamiin ja kukkumine Metaanalüüs: 5 RCT-d Uuritavad: 60+ eluaastat Jälgimisaeg: kuni 3 aastat Järeldus: D vitamiin (võrreldes kaltsiumiga või kaltsiumi + platseeboga) langetab kukkumise riski 22% NNT=15 Bischoff-Ferrari HA. JAMA. 2004; Pfeifer M et al. J Bone Miner Res.2000; Bischoff HA et al. J Bone Miner Res. 2003; Gallagher JC et al. J Clin Endocrinol Metab. 2001; Dukas L et al. J Am Geriatr Soc. 2004; Graafmans WC et al. Am J Epidemiol. 1996
6 D-vitamiin ja luumurrurisk 5a kestvusega RCT uuring n=2686 vanus a. 1.2 P< IU iga 4 kuu järel (e. ~ 800 IU/p) Nii naised kui mehed Suhteline murrurisk % 0.0 Ravimata (n=1341) Ravitud (n=1345) Trivedi D et al BMJ 2003;326:469.
7 Metaanalüüs: D-vitamiin ja murrud
8 D vitamiini vähesus (<75nmol/l) osteoporoosiga patsientidel N=2589 Levimus (%) % 71.4% 63.9% 60.3% 53.4% 57.7% Kõik Austraalia Lad.- Am. Aasia Lähis-Ida Euroopa Lips P et al. ASBMR
9 D-vitamiin ja sport Kas hüpovitaminoos põhjustab luustiku probleeme noorsportlastel? Kas D-vitamiini manustamine kiirendab luumurdude paranemist? Kas kiirendab lõikusjärgset taastumist? Kas parandab sooritusvõimet?
10 D-vitamiin ja juveniilsed osteokondroosid M. Osgood-Schlatter M. Scheuermann M. Sinding-Larsen-Johansen M. Perthes
11 M.Scheuermann 1909 dr. Schmorl: >95%-l nooremalt kui 18 kuuselt surnud lastest lahangul rahhiidi tunnuseid / Schmorli herniaid
12 Perthese tõbi Reieluu pea verevarustuse häire e. avaskulaarne nekroos
13 K-K, 13 a N
14 K-K, 13 a N PTH 6.11 ( pmol/l) Vitamiin D (25-OH) 69.6 (>75 nmol/l) Võtnud selleks ajaks 4 kuud 2500 IU D-vitamiini 2015 jaanuar
15 Röntgenis ja ka UH alusel tegemist Schlatteri tõvega
16 Sinding-Larsen-Johanseni s. Sagedaseim avaldumine vanuses 10-15a. Peamiselt aktiivselt spordiga tegelevatel noortel Valulikkus kohas kus patella kõõlus kinnitub patella alumisele küljele
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18 Tunnused, mis viitavad seosele D- vitamiini puudusega Lapse-noorukipõlve kasvuea haigused Teada tugev põhja-lõuna gradient levimuses Avalduvad kõige raskemalt kasvuspurdi perioodis Iselimiteeruvad haigused (tavaliselt vanuses kus kasvuplaadid sulguvad) Kõrgeimad esinemissagedus raporteeritud 20.saj alguses suurlinnades
19 Levimus (Perthes) Iga 10 kraadi kohta põhja suunal tõuseb haiguse esmashaigestumus-kordaja 50% Haigus praktiliselt puudub ekvatoriaalmaades Ann R Coll Surg Engl 2013;95:
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21 Quantitative measurements of iliac bone histology, serum parathyroid hormone levels, and clinical history show the presence of more advanced osteitis fibrosa in children with epiphysiolysis than in those without. The response to vitamin D therapy in most cases was good.
22 D-vitamiin ja kiirem luumurdude paranemine? Puuduvad veenvad andmed Skelley NW, Papp DF, Lee RJ, Sargent MC. Slipped capital femoral epiphysis with severe vitamin D deficiency. Orthopedics Dec 1;33(12):921. Kayali C et al. A rare complication after intertrochanteric fracture treated with proximal femoral nail: femoral neck insufficiency fracture. Eur J Orthop Surg Traumatol Jan 24
23 D-vitamiin ja väsimusmurrud RCT uuring: n=5200 ajateenijat 800 IU D-vitamiini ja 2g kaltsiumi vs PLC 309 väsimusmurdu (2 kuu vältel) Tulemus: 20% vähem väsimusmurde ravitute hulgas Lappe J et al. Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res May;23(5):741-9.
24 Postoperatiivne taastumine ja D-vitamiin Keha D-vitamiini tarve tõuseb post-op perioodis väga oluliselt! 5 päeva peale lõikust on D-vitamiini tase langenud 40%! Parim taastumine eesmise ristatisideme lõikuse järgselt oli grupis, kus D-vitamiin >75 nmol/l Reid D, et al. The relation between acute changes in the systemic inflammatory response and plasma 25- hydroxyvitamin D concentrations after elective knee arthroplasty. Am J Clin Nutr May; 93(5): Barker T, Martins TB, Hill HR, Kjeldsberg CR, Trawick RH, Weaver LK, Traber MG. Low Vitamin D Impairs Strength Recovery After Anterior Cruciate Ligament Surgery. Journal of Evidence-Based Complementary & Alternative Medicine. July, 2011.
25 Sportlik sooritusvõime? Bob Beamon 1968 a Mehhiko olümpia
26 Ajalugu Allen RM and Cureton TK. Effect of ultraviolet radiation on physical fitness. Arch Phys Med Rehab, 1945: Juht kontrolluuring UV lamp 10 nädalat vs mitte midagi 10 nädalat 19% parem aeroobne võimekus ja 50% vähem viirusinfektsioone Spellerberg AE. Increase of athletic effectiveness by systematic ultraviolet irradiation. Strahlentherapie, 1952: veenev efekt sooritusele ja 50% vähem vigastusi Kasu pole hooaja tippvormi hetkel! Ei tohi kasutada 24h enne sooritust!
27 D-vitamiin ja sooritusvõime Close GL et al. Assessment of vitamin D concentration in non-supplemented professional athletes and healthy adults during the winter months in the UK: implications for skeletal muscle function. J Sports Sci Oct 22. 5,000 IU per day of vitamin D3 for 8 weeks significant increases in: vertical jump height (P = 0.008) 10 meter sprint times (P = 0.008)
28 D-vitamiini vähesuse levimusandmed Eestist
29 Kull M., Kallikorm R., Lember M. BMC Public Health 2009 D-vitamiini tase Eestis täiskasvanute populatsioonipõhine uuring Suvel ~1/3 ja talvel >2/3 uuritutest D- vitamiini vähesus 8%-l talvel avitaminoos Toidulisandeid 2%
30 Asendusravi täiskasvanutel 25 (OH) D tase Annus >50 nmol/l IU/p nmol/l IU/p või IU/1-2x kuus <25 nmol/l IU/nädalas (2+2 kuud) või IU/päevas (kuni 4k) Päevane ohutu doos 4000 IU/p** * Holick MF, NEJM 2007; 357: ** Europen Food Safety Board 14.august.2012
31 the sun has a useful and important effect on the organism (especially the blood?). What this useful effect really was, I could not find; I have been working for this goal ever since but have not been able to find exactly what I have been seeking Niels Ryberg Finsen
32 Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. Compared to the highest sun exposure group, life expectancy of avoiders of sun exposure was reduced by years. In addition, we found no differences in all-cause or cutaneous malignant melanoma (MM) mortality between those who expose themselves to and those who avoid the sun.
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34 Tänan!
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