Vesna Vasić, dr.med Tanja Mišmaš, dr.med
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1 Vesna Vasić, dr.med Tanja Mišmaš, dr.med
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4 1.. Roger Bouillon,*, Heike Bischoff- Ferrari, Walter Wille: - Vitamin D and Health: PerspecBves From Mice and Man, Journal of Bone and Mineral ResearchVolume 23, Issue 7, pages , July Sassan Pazirandeh, MD, David L Burns, MD Overview of vitamin D, 2012 (UpToDate) h:p:// of- vitamin- d?source=search_result&search=vitamin+d +uptodate&selectedtitle=1%7e150 (Accessed on October, ) 3. Holick MF, Binkley NC, Bischoff- Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evalua*on, treatment, and preven*on of vitamin D deficiency:. an Endocrine Society clinical prac*ce guideline. J Clin Endocrinol Metab Jul;96(7): Epub 2011 Jun 6. 4.Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in pabents with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003; 78: Holick MF. High prevalence of vitamin D inadequacy and implicabons for health. Mayo Clin Proc 2006; 81:353. ( PubMed) 7. Jackson C, Gaugris S, Sen SS, Hosking D. The effect of cholecalciferol (vitamin D3) on the risk of fall and fracture: a meta- analysis. QJM 2007; 100:185.(PubMed) 8. Bischoff- Ferrari HA, Dawson- Hughes B, Staehelin HB, et al. Fall prevenbon with supplemental and acbve forms of vitamin D: a meta- analysis of randomised controlled trials. BMJ 2009; 339:b3692.
5 9. Murad MH, Elamin KB, Abu Elnour NO, et al. Clinical review: The effect of vitamin D on falls: a systemabc review and meta- analysis. J Clin Endocrinol Metab 2011; 96: Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in pabents with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003; 78:1463.(PubMed) 11.. Jenab M, Bueno- de- Mesquita HB, Ferrari P, et al. AssociaBon between pre- diagnosbc circulabng vitamin D concentrabon and risk of colorectal cancer in European populabons:a nested case- control study. BMJ 2010; 340:b5500.(Pub Med) 12. ZipiBs CS, Akobeng AK. Vitamin D supplementabon in early childhood and risk of type 1 diabetes: a systemabc review and meta- analysis. Arch Dis Child 2008; 93: Munger KL, Levin LI, Hollis BW, et al. Serum 25- hydroxyvitamin D levels and risk of mulbple sclerosis. JAMA 2006; 296: Michael F. Holick, Vitamin D: A Millenium PerspecBve,Journal of Cellular Biochemistry 88: (2003) (PubMed) 15.Bouillon R.CliffordJ.Rosen,: Vitamin D and extraskeletal health, h:p:// contents/vitamin- d- and- extraskeletal- health (Accessed on October, )
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7 Receptorji za vitamin D in enzimi za njegovo aktivacijo so prisotni v večini tkiv in imajo vpliv na 3% genoma- ima tudi številne druge funkcije.
8 Priporočene dnevne doze so za otroke od rojstva- 18 let in odrasle 600ie Za starejše od 70 lest so 800 ie
9 - Neadekvatan vnos, intestinalne motnje (malapsorpcija maščob), zmanjšana fotoizomerizacija - okvarjena hidroksilacija v jetrah - okvarjena hydroksilacija v ledvicah - nesenzitivnost tarčnih organov na vitamin D (hereditarni Dvitamin rezistentni rahitis)
10 Glukokortikoidi, jemani dolgo v visokih dozah, inhibirajo intestinalno od vitamina D odvisno absorpcijo Ca in tako povzročajo osteomalacijo
11 Ustrezna izpostavljenost sončni svetlobi in povečana uporaba izdelkov z vitaminom D, bistveno zmanjša pojavnost pomanjkanja vitamina D. Vendar pa je pomanjkanje vitamina D še vedno pogosta težava v mnogih populacijah, zlasti pri starejših.
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13 - Akutna intoksikacija - Hiperkalcemija - Konfuzija - Poliuria in polidipsia - - Anoreksija in bruhanje - - Bolečine v mišicah Kronična intoksikacija - kostna demijenilizacija - bolečine
14 Mišična funkcija- mišična slabost- v randomiziranih študijah ni bilo dokazov da supstituciona th izboljša funkcijo, tveganje za padce- metaanalize zniža se relativno tveganjeza padce za 20% Karcinom- vpliv na celično proliferacijo in karcinome Women shealth Initiative- WHI- ni dokazala vpliv supstitucione terapije na kolorektalni karcinom
15 Kardiovaskularne bolezni in hipertenzija- korelacijo med deficitom vitamina D in tveganja za KŽB ni enostavno vzpostaviti zaradi številnih fakorjev, ki vplivajo na hipertenzijo in KŽB (Framingamska študija bolniki z nižjim vrednostima vitamina D- prvi dogodek v 5.4 leta )
16 Nevropsihijatrične funkcije- študije so dokazale vpliv vitamina D na prenatalni razvoj možganov ( deficit viša tveganje za nevropsihiatrijske motnje in shizofrenijo), niso dokazale vpliv na postnatalno funkcijo možgan
17 - Vitamin D nima samo vlogo v regulaciji homeostaze kalcijuma in kosti, ima in številne druge potencialno regulatorne funkcije na nivoju celic - - Ne priporočamo supstitucijsko terapijo z vitaminom D zdravi odrasli populaciji - - Supstituciona terapija je priporočljiva za osteoporozo in preprečevanje padcev - ( Grade 2C) - - Če je dokazan deficit vitamina D je indicirano zdravljenje
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