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首页 vitD concensus

vitD concensus.pdf

vitD concensus

lucy1020
2012-02-02 0人阅读 举报 0 0 暂无简介

简介:本文档为《vitD concensuspdf》,可适用于自然科学领域

Maturitas()–ContentslistsavailableatSciVerseScienceDirectMaturitasjournalhomepage:wwwelseviercomEMASpmeFaustinoloreIreneLamstaSergeRoaDepartmentofObstetricsandGynecology,UniversidaddeZaragoza,FacultaddeMedicina,HospitalClínico,DomingoMiralsn,Zaragoza,SpainbDepartmentofObstetricsandGynaecology,MaterDeiHospital,B’KaraNXR,MaltacDepartmentofObstetricsandGynecology,IstanbulUniversity,CerrahpasaSchoolofMedicine,ValikonagiCadNo,Nisantasi,Istanbul,TurkeydMenopauseandMetabolicBoneDiseaseUnit,HôpitalPauledeViguier,FToulouseCedex,FranceeUniversityofPisa,DepartmentofObstetricsandGynecology,ViaRoma,Pisa,ItalyfndDepartmentofObstetricsandGynecology,UniversityofAthens,AretaieioHospital,GRAthens,GreecegDepartmentohDepartmentoiDepartmentojInstituteofEnkDepartmentolWomen’sCenarticlArticlehistory:ReceivedNoAcceptedNoKeywords:PostmenopausVitaminDCholecalciferoVitaminDErgocalciferolHydroxyviCalcidiolCalcitriolSunlightMortalityOsteoporosisIntroduVitaminulatescalcigastrointesotalrolein∗CorresponEmailadd(FRPérezLóp$–doi:jfLaboratoryMedicine,Children’sandWomen’sHealth,FacultyofMedicine,NorwegianuniversityofScienceandTechnology,NOTrondheim,NorwayfObstetricsandGynecology,StOlavsHospital,TrondheimUniversityHospital,NOTrondheim,NorwayfMedicine,CardiologyUnitandHeadCentreforGenderMedicine,KarolinskaInstitutetandKarolinskaUniversityHospital,ThoraxN:,SEStockholm,Swedendocrinology,ClinicalCenterofSerbia,BelgradeSchoolofMedicine,DrSubotica,Beograd,SerbiafObstetricsandGynecology,CHUSaintPierre,UniversitéLibredeBruxelles,Brussels,Belgiumtre,JohnRadcliffeHospital,OxfordOXDU,UKeinfovembervemberalwomenltaminDabstractIntroduction:ThereisemergingevidenceonthewidespreadtissueeffectsofvitaminDAims:ToformulateapositionstatementontheroleofvitaminDinpostmenopausalwomenMaterialsandmethods:LiteraturereviewandconsensusofexpertopinionResultsandconclusions:EpidemiologicalandprospectivestudieshaverelatedvitaminDdeficiencywithnotonlyosteoporosisbutalsocardiovasculardisease,diabetes,cancer,infectionsandneurodegenerativediseaseHowevertheevidenceisrobustforskeletalbutnotnonskeletaloutcomeswheredatafromlargeprospectivestudiesarelackingThemajornaturalsourceofvitaminDiscutaneoussynthesisthroughexposuretosunlightwithasmallamountfromthedietinanimalbasedfoodssuchasfattyfish,eggsandmilkVitaminDstatusisdeterminedbymeasuringserumhydroxyvitaminD(OH)DlevelsOptimalserum(OH)Dlevelsareintheregionof–ngmL(–nmolL)thoughthereisnointernationalconsensusLevelsvaryaccordingtotimeoftheyear(lowerinthewinter),latitude,altitude,airpollution,skinpigmentation,useofsunscreensandclothingcoverageRiskfactorsforlowserum(OH)Dlevelsinclude:obesity,malabsorptionsyndromes,medicationuse(eganticonvulsants,antiretrovirals),skinaging,lowsunexposureandthoseinresidentialcareFortifiedfoodsdonotnecessarilyprovidesufficientamountsofvitaminDRegularsunlightexposure(withoutsunscreens)formin,–timesaweek,inthemiddleofthedayinsummergeneratehealthylevelsTherecommendeddailyallowanceisIUdayincreasingtoIUdayinthoseagedyearsandolderSupplementationcanbeundertakenwitheithervitaminD(ergocalciferol)orvitaminD(cholecalciferol)withmonitoringdependingonthedoseusedandthepresenceofconcomitantmedicalconditionssuchasrenaldisease©ElsevierIrelandLtdAllrightsreservedctionDcomprisesagroupoflipophilichormonesthatregumhomeostasisthroughitsactionsonthekidney,tinaltract,skeletonandparathyroidItplaysapivmaintainingskeletalhealthThetwomajorformsdingauthorTel:fax:resses:faustinoperezunizares,ginebloghotmailcomez)arevitaminD(ergocalciferol)andvitaminD(cholecalciferol)VitaminDisproducedfromergosterolbyseveralorganisms:phytoplankton,invertebratesandfungiinresponsetoultraviolet(UV)irradiationThemajornaturalsourceofvitaminDiscutaneoussynthesisfromdehydrocholesterolthroughexposuretosunlightwithasmallamountfromthedietinanimalbasedfoodssuchasfattyfish,eggsandmilkTherearewideindividualvariationsinbothcutaneoussynthesisandgastrointestinalabsorptionofvitaminDTwohydroxylationsareneededtoobtainthebioactivehormone,dihydroxyvitaminDorcalcitriolIntheliver,thefirstmetabolizesvitaminDintohydroxyvitaminD(OH)Dseefrontmatter©ElsevierIrelandLtdAllrightsreservedmaturitasositionstatement:VitaminDandpostRPérezLópeza,∗,MarcBrincatb,CTamerErelc,Fbrinoudakif,MetteHMoeng,h,KarinSchenckGuzenbergk,MargaretReesllocatematuritasnopausalhealthnceTremollieresd,MarcoGambaccianie,fssoni,SvetlanaVujovicj,FRPérezLópezetalMaturitas()–orcalcidiolandthesecondproducescalcitriolinthekidneysandothertissues–BothvitaminDandvitaminDaresynthesizedcommerciallyandfoundindietarysupplementsorfortifiedfoodsCalcitrioparticipatesgenesInhofnoncalcduction,mantimicrobiptosis,,AssessmTherearcompoundsneededtosCurrencirculatingroidfunctiopotentthantargetcellseasesmoreseemtobeatwhichpationfrombstabilizedthHypovitoffvalues:andnbelownabsoluteleofthehadinsuffic–Severevtion,leadinvitaminDmenopausadiseaseswhcancer,diabRiskfacGeneralinducedskiobesity,masant,antiremorecommSinceviatinocytes,poorsunligorresidentyear(winteamountofeextensivecinterferencnaturaldarwithfair(wsunscreensskinaging,,whtosynthesis(OH)Dtorforvitamcoeliacdisease,Crohn’sdisease,gastrointestinalbypasssurgery,cysticfibrosiswithpancreaticinsufficiency)mayhavedifficultiesinabsorbingvitaminDwhereasthosewithrenalinsufficiencymayhaveanincreasedurinarylossof(OH)Dandlimitedcapaccalciconvationntireitriolditiotamiystemldhi)Dleplemcardlememenefferand(mednDreassdidtedreatmsysttrialnificionatamieopoongconuscquaracto<ithplemesbkoffingdswith)Dlelredorseeffe,atausasuggnontmenedbycludeedthhiselstimulatescalciumandphosphateabsorptionandinregulatingthetranscriptionofalargenumberofumans,locallysynthesizedcalcitriolhasawiderangeiotropicfunctionsincludingamongothers:insulinproyocardialcontraction,immunomodulation,monocytealaction,innateimmunity,cellproliferationandapo–entofvitaminDstatusemanyformsofthevitaminDinbloodToidentifytheseliquidchromatographyandmassspectrometryareeparateactiveformsfrominactiverelatedcompoundstlythebestavailableindicatorofvitaminDstatusisserum(OH)Dwhichismostcloselylinkedtoparathynandcalciumhomeostasis,althoughbiologicallylesscalcitriolInaddition,serum(OH)DistakenupbyandwoulddeterminetheriskofagerelatedchronicdisdirectlythancalcitriolAdequateplasma(OH)DlevelsbetweenngmLandngmL(ngmL=nmolL)rathyroidhormone(PTH)secretionandcalciumresorponeareminimized,andintestinalcalciumabsorptionisoughthereisnointernationalconsensus,aminosisDincludesthreecategoriesaccordingtocutinsufficiencyifserum(OH)DlevelsarebetweengmL,deficiencybelowngmL,andseveredeficiencygmL,,,butagainthereiscontroversyaboutvelsEventakingintoaccountsunnyregionsnearlyEuropeanpopulationdisplayssuboptimallevels(ient,deficientandseverelydeficientlevels)itamindeficiencyaffectsbonehealthandmusclefuncgtorickets,osteomalaciaandmyopathy,Lowlevelsarealsoprevalentamongosteoporoticpostlwomenandhavebeenassociatedtootherichincludeamongotherscardiovasculardisease(CVD),etes,infectionsandneurologicaldiseases,,,torsforhypovitaminosisDriskfactorsforhypovitaminosisDincludelowUVnsynthesis,darkskin,skinaging,poordietaryintake,labsorption,andcertainmedications(eganticonvultrovirals)FurthermorelowplasmavitaminDlevelsareoninwomenthaninmen,,taminDsynthesisdependsonUVactiononthekeritsdeficiencyiscommonespeciallyinindividualswithhtexposuresuchasthoselivingathigherlatitudesialcarehomesThus,latitude,altitude,timeofther),timeoftheday(earlymorningandlateafternoon),xposedskin,skinpigmentation,sunprotection(shade,lothingcover,sunscreenuse),andairpollutionmayewithvitaminDskinsynthesis,,PeoplewithkskinproducehalftoafifthofvitaminDthanthosehite)forasimilarlevelofsunexposureTheuseofmaydrasticallyreducecutaneoussynthesisInaddition,isassociatedwithlowerdehydrocholesterollevelsichisthevitaminDprecursorrequiredforskinphoisstoredinadiposetissue,andobesityisariskfacinDdeficiencyPatientswithmalabsorption(eg,ityforasantiinactivAtocalcConViAsfivefo(OHofsupquentDsuppsuppleTheinmentVitamiDdecpoundbetreaciumtrecenttrollednotsiginfarctViOstlemamDmayneuromacrossotherftions(thosewSupproductherisincludvidual(–(OHfalIUoffallsThecalciummenopresultsporoticDtreaobtainthatinreportfallsTtriolsynthesis,Chronicuseofcertaindrugs,suchulsants,mayreduce(OH)DlevelsduetoacceleratedofcalcitriolcausedbyincreasedexpressionofCYPtroviralagentsmayincreasetheconversionof(OH)DandaccelerateitscatabolismnsassociatedtolowvitaminDstatusnDandmortalityaticreviewofprospectivestudiesreportedatwotoghermortalityriskamongsubjectswithlowerserumvelsAsystematicreviewreportedtheeffectentationwithvitaminD,calcium,orbothonsubseiovasculareventsThisreviewconcludedthatvitaminntationmayreducecardiovascularriskwhilecalciumtationhasminimalcardiovasculareffectsctofvitaminDsupplementationhasbeenstudiedomisedtrialswhichhavecomparedvitaminDtreatianoftwoyears)versusplaceboornointerventiontreatmentdecreasedmortality,althoughonlyvitaminedmortalitysignificantlywhereasotherrelatedcomnotIthasbeenestimatedthatindividualsshouldtopreventonedeathVitaminDassociatedwithcalent,increasestheriskofnephrolithiasisAmoreematicreviewandmetaanalysisofrandomisedconsrelatedwithbonehealth,reportedthatvitaminDwasantlyassociatedtooutcomessuchasdeath,myocardialndstrokenD,bonemetabolismandfracturesroticfracturesarecommonandaserioushealthprobpostmenopausalwomenAdequatelevelsofvitamintributenotonlytoskeletalconservationbutalsotoularfunctionFracturerisksignificantlyincreasestilesofserum(OH)Dlevels,andisindependentofrsThus,womenwiththelowest(OH)DconcentranmolL,ngmL)hadhigherfractureriskthandothehighestlevels(>nmolL,ngmL)entationwithvitaminD(>IUday)andcalciumenefitsonbonemineraldensity(BMD)andreducesracturesascomparedtoplaceboAmetaanalysisoubleblindrandomisedcontrolledtrialsstudyingindiameanageofyearsorolderwhoreceivedvitaminDIUday)hadareductionintheriskoffallsIfserumvelsreachednmolL(ngmL)ormoretherewasauctionrateHowever,dailyvitaminDdosesoflessthanrum(OH)Dlevels<nmolLdidnotreducetheriskctivenessofIUdayofvitaminD,withorwithoutincreasingBMDandpreventingfracturesinpostlwomenhasbeenassessedinametaanalysisTheestthatvitaminDreducesfractureincidenceofosteovertebral,hip,andotherlocationsInaddition,vitamintbenefitsrelatedtofracturesaregreaterthanthosecalciumaloneAmorerecentsystematicreviewdmorethan,subjects,mostlyelderlyandfemale,atvitaminDtreatmentsignificantlyreducestheriskofffectismoreimportantinindividualswithlowvitaminFRPérezLópezetalMaturitas()–DstatusandinstudiesinwhichvitaminDwascomplementedwithcalciumVitaminDinsufficiencymayalsobeanimportantfactorinthediminishedresponsetobisphosphonatesseeninclinicalpracticeThus,postmngmL(ltimesmorewithlowerficientserunonresponItseemspreventBMfallsWhenbeaddedtoVitaminMusclemminDstatustrengthinatedwithlopredominanthelowerliingInhhavebeendifferentinhandgripstDlevelsweTheeffewithoutcalsystematictrialsPooleplementatio(OH)DleinvolvedinCardiovHypovitfactors,sucsity,periphinfarction,hInyoun(<nmolLriskofsystserum(OriskInado(nmolL)withreduceInadultsultrasoundthicknessCmeasuresoTheusehasbeenatheWomenInthisstud(IUdaymyocardialplementatiohealthThewomenwhDiabetesmellitusandvitaminDVitaminDisinvolvedintheregulationofinsulinsecretion,assuggestedbythepresenceofvitaminDreceptorsinpancreaticInaderseelyateincoho(Ojectsserumdisedby)levtedttedttamiminetastticaL(tedore,inshipetaansetive)Dleludedmbificancanc)DlecomhighestcaserorresedwlL(withmetdwinamenesivenDdenogroeatmtlyinisofthen,setedtongcelsatserrelalevenificrectalenopausalwomenwith(OH)Dbloodlevelsaboveowerlevelswereconsideredasinsufficient)werelikelytorespondtoosteoporosistherapythanthoselevelsInthisstudy,ofrespondershadinsufm(OH)DlevelsascomparedtoamongthosederstobisphosphonatetreatmentthatadequateamountsofcalciumandvitaminDmayDloss,andincreasemusclestrengthandreduceriskofosteoporosisispresent,vitaminDsupplementsshouldantiresorptivesorotherappropriatetreatmentsD,physicalfitnessandfrailtyassandstrengthdeclinesinagedindividualsandvitasmaycontributetothisinvolutionReducedmusclecreasestheriskoffallsinolderwomenandisassociwserum(OH)Dlevels,VitaminDdeficiencytlyaffectstheweightbearingantigravitymusclesofmbswhicharepivotalforposturalbalanceandwalkealthypostmenopausalwomen,serum(OH)Dlevelsrelatedtophysicalfitness,andisacommonfactorindicessuchasandroidfatmass,leanmass,balanceandrengthInindividualsagedandolder,vitaminreinverselyassociatedwithpoorphysicalperformancectofvitaminDsupplementationinadults,withorcium,onmusclestrengthhasalsobeenstudiedinareviewandmetaanalysisofrandomisedcontrolledddatashowedaconsiderableeffectofvitaminDsupnoverhipmusclestrengthonlyinsubjectswithserumvels<nmolL(ngmL)ThusvitaminDmaybemaintainingmusclestrengthasculardiseaseriskfactorsandvitaminDaminosisDhasbeenassociatedwithaseriesofriskhashypertension,glucoseandlipidmetabolism,obeeralarterydisease,coronaryarterydisease,myocardialeartfailureandstroke,gadultwomenbaseline(OH)Dinsufficiency,ngmL)wassignificantlyassociatedtoahigherolichypertensionAmetaanalysisreportedthatH)Dlevelswereinverselyassociatedtohypertensionse–responsemetaanalysisanincrementofngmLinserum(OH)Dlevelswassignificantlyassociateddbloodpressurelevels,serum(OH)Dlevelsareinverselyassociatedwithmeasuredintima–mediaandmaximalcarotidplaquealcium,PTHandcalcitriolwerenotassociatedwithfcarotidhealthofcalciumsupplements,withandwithoutvitaminD,ssociatedtocardiovasculareventsinareanalysisof’sHealthInitiativecohortandametaanalysis,ycalciumsupplements,withorwithoutvitaminD),increasedtheriskofcardiovascularevents,especiallyinfarction,suggestingthattheexcessofcalciumsupnmayhavenegativeconsequencesoncardiovascularrefore,thereisnowconcernaboutgivingcalciuminosedietisrepleteaswellasvitaminDisletsareinvpositivlipoprocenterlowerSublowerofthereduce(OHassociaassociaViVitaandmapoptongmassociaTherefrelatioAmbetweeofrela(OHforincbothcoasignibreast(OHriskasintheofbreaLowwerecdiagnonmociateddistantbyGooupforInotorecevitamiinwomplacebthattrnificananalysversusadditioassociaAmsislevhighescancerlowestandsigofcolohadaultswithoutdiabetesmellitus,serum(OH)Dlevelslyassociatedtofastingglucoseandinsulinlevels,andssociatedtoinsulinsensitivityindexandhighdensitycholesterollevelsInaUScrosssectionalmultirtstudy,onlydiabeteswassignificantlyassociatedwithH)Dandcalcitriollevelswhodevelopedtypediabetesinayearperiod,had(OH)DascomparedtothosewhoremainedfreeaseItwasestimatedthatthediabetesriskwouldbeforeachnmolL(ngmL)incrementinserumelsInaddition,serum(OH)DlevelswerepositivelyoinsulinsensitivityHighcalciumdietcontentwasnotodiabetesrisknD,breastcancerandcoloncancerDinducescelldifferentiationandinhibitsproliferationaticpotentialandhencemaybeconsideredasanantigent,AmetaregressionanalysisfoundthatanmolL)increaseinserum(OH)Dwassignificantlytoalowerriskforcolorectalandbreastcancertseemsthat(OH)Dlevelsdisplayaconsistentinversewiththesetwotypesofcancernalysisofobservationalstudiesreportedanassociationrum(OH)DlevelsandbreastcancerThesummaryrisksforangmL(nmolL)increaseofserumvelsanddecreasedbreastcancerriskweresignificantcase–controlstudies,nestedcase–controlstudiesandnedstudydesignsAnothermetaanalysisreportedtinverserelationshipbetweenvitaminDintakeanderriskInaddition,thehighestquartileofserumvelswasassociatedtoadecreaseinbreastcancerparedtothelowestquartileOntheotherhand,womenstquartileofcalciumintakedisplayedareductionncerriskascomparedtothelowestquartileum(OH)DlevelsmeasuredbeforechemotherapylatedtomoredeathsamongpostmenopausalwomenithbreastcancerandfollowedupforyearsHence,angmL)decrementinserum(OH)DlevelswasassoanincreaseindeathriskandaincreaseinriskofastasisTheseresultsaresimilartothosereportedetalinwomenwithearlybreastcancerfollowedanofyearstudypostmenop

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