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      Vitamin D deficiency: a global perspective Translated title: Deficiência de vitamina D: uma perspectiva global

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          Abstract

          Vitamin D is essential for the maintenance of good health. Its sources can be skin production and diet intake. Most humans depend on sunlight exposure (UVB 290­315 nm) to satisfy their requirements for vitamin D. Solar ultraviolet B photons are absorbed by the skin, leading to transformation of 7-dehydrocholesterol into vitamin D3 (cholecalciferol). Season, latitude, time of day, skin pigmentation, aging, sunscreen use, all influence the cutaneous production of vitamin D3. Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risk for other morbidities such as cardiovascular disease, type 1 and type 2 diabetes mellitus and cancer, especially of the colon and prostate. The prevalence of hypovitaminosis D is considerable even in low latitudes and should be taken into account in the evaluation of postmenopausal and male osteoporosis. Although severe vitamin D deficiency leading to rickets or osteomalacia is rare in Brazil, there is accumulating evidence of the frequent occurrence of subclinical vitamin D deficiency, especially in elderly people.

          Translated abstract

          A vitamina D é essencial para a manutenção da saúde. A sua fonte principal é a pele ou pode ser ingerida com a dieta. A maioria dos seres humanos depende da exposição solar para adquirir quantidades suficientes de vitamina D. A radiação ultravioleta tipo B transforma o 7-dehidrocolesterol em vitamina D3 (colecalciferol). A época do ano, latitude, pigmentação da pele, idade e uso de filtros solares são fatores que influenciam a produção cutânea. Deficiência de vitamina D pode causar raquitismo e osteomalacia, exacerbar a perda óssea na osteoporose, como também pode associar-se a várias morbidades como doenças cardiovasculares, diabetes mellitus tipo 1 e 2, câncer de próstata e de intestino grosso. A prevalência de hipovitaminose D tem sido relatada com grande freqüência mesmo em regiões de baixa latitude e deve ser considerada na avaliação da osteoporose. Embora a deficiência severa levando a osteomalacia possa ser vista raramente no Brasil, evidências se acumulam da freqüente ocorrência de deficiência subclínica, especialmente em idosos.

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          Most cited references35

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          Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial.

          Despite the high prevalence of hypovitaminosis D in children and adolescents worldwide, the impact of vitamin D deficiency on skeletal health is unclear. One hundred seventy-nine girls, ages 10-17 yr, were randomly assigned to receive weekly oral vitamin D doses of 1,400 IU (equivalent to 200 IU/d) or 14,000 IU (equivalent to 2,000 IU/d) in a double-blind, placebo-controlled, 1-yr protocol. Areal bone mineral density (BMD) and bone mineral content (BMC) at the lumbar spine, hip, forearm, total body, and body composition were measured at baseline and 1 yr. Serum calcium, phosphorus, alkaline phosphatase, and vitamin D metabolites were measured during the study. In the overall group of girls, lean mass increased significantly in both treatment groups (P < or = 0.05); bone area and total hip BMC increased in the high-dose group (P < 0.02). In premenarcheal girls, lean mass increased significantly in both treatment groups, and there were consistent trends for increments in BMD and/or BMC at several skeletal sites, reaching significance at lumbar spine BMD in the low-dose group and at the trochanter BMC in both treatment groups. There was no significant change in lean mass, BMD, or BMC in postmenarcheal girls. Vitamin D replacement had a positive impact on musculoskeletal parameters in girls, especially during the premenarcheal period.
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            Functional indices of vitamin D status and ramifications of vitamin D deficiency.

            Serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations are currently recognized as the functional status indicator for vitamin D. Evidence is reviewed that shows that serum 25(OH)D3 concentrations of < 80 nmol/L are associated with reduced calcium absorption, osteoporosis, and increased fracture risk. For typical older individuals, supplemental oral intakes of approximately 1300 IU/d are required to reach the lower end of the optimal range. Evidence of substantial problems in routine clinical measurement of serum 25(OH)D3 concentrations among patients is cited. There is great need for standardization and improved reproducibility and sensitivity of measurements of serum 25(OH)D3 concentrations.
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              Effects of different dress styles on vitamin D levels in healthy young Jordanian women.

              A A Mishal (2000)
              Jordan is a sunny Middle Eastern country where no vitamin D fortification of milk is undertaken, and where women wear dress styles that cover the body to a variable extent. This may produce variable effects on vitamin D, parathyroid hormone and bone mineralization. The aim of the present study was to evaluate the vitamin D and parathyroid hormone levels in healthy young women of child-bearing age, and to examine the effects of dress style and season, in a survey of the effects of these parameters on vitamin D metabolism, and the possible bone mineralization consequences. One hundred and forty-six subjects (22 men, 124 women) were selected, according to established inclusion criteria. Of the women, 21 wore Western-type dress styles (group 1), 80 wore dress styles covering the whole body but the sparing face and hands (group 2) and 23 wore dress styles covering the whole body including the face and hands (group 3). The study was conducted in summer and winter. All volunteers underwent initial interviews, answered a food frequency questionnaire, and underwent essential laboratory tests (serum 25-hydroxyvitamin D (25(OH)D) by radioimmunoassay, and serum parathyroid hormone (PTH) by chemiluminescent enzyme immunoassay). The 25(OH) D levels in groups 2 and 3 were significantly lower than in the men (p<0.05 in both comparisons). No significant differences were noted between women wearing different dress styles. PTH levels were in the upper limits of normal but failed to show statistical differences between study groups. The prevalence of hypovitaminosis D was 62.3% in the study groups as a whole. Dress styles covering the whole body, totally or nearly totally, have adverse effects on 25(OH)D levels and may produce a state of secondary hyperparathyroidism on the long run. Although Jordan enjoys plenty of sunshine, these data are suggestive of widespread hypovitaminosis D in Jordan.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                abem
                Arquivos Brasileiros de Endocrinologia & Metabologia
                Arq Bras Endocrinol Metab
                Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo )
                1677-9487
                August 2006
                : 50
                : 4
                : 640-646
                Affiliations
                [1 ] University of Pernambuco
                [2 ] Ministério da Saúde Brazil
                Article
                S0004-27302006000400009
                10.1590/S0004-27302006000400009
                ddf8e16a-dae0-4fb7-bc39-267aeeb512f7

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-2730&lng=en
                Categories
                ENDOCRINOLOGY & METABOLISM

                Endocrinology & Diabetes
                Vitamin D,Osteoporosis,Sunlight,Parathyroid hormone,Bone density,Vitamina D,Osteoporose,Luz solar,Paratormônio,Densidade óssea

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