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Frauenheilkunde up2date 2017; 11(03): 247-262
DOI: 10.1055/s-0043-112871
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Georg Thieme Verlag KG Stuttgart · New York

Vitamin D in Klinik und Praxis

Armin Zittermann
,
Stefan Pilz
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Publication History

Publication Date:
26 July 2017 (online)

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Erratum: Vitamin D in Klinik und PraxisFrauenheilkunde up2date 2017; 11(03): e1-e1
DOI: 10.1055/s-0043-118759

Zusammenfassung

Vitamin-D-Mangel und seine Konsequenzen – seit Jahren schon ein sehr präsentes Thema. Nicht zu Unrecht: In der Allgemeinbevölkerung verfehlt die kutane Vitamin-D-Synthese besonders im Winter deutlich die Zufuhrempfehlung. Klar ist, aufgrund der vielfältigen Wirkungen wird Vitamin D auch in Zukunft weiter an Bedeutung gewinnen. Der CME-Beitrag hilft Ihnen, in der Informationsflut die Relevanz des Themas für Klinik und Praxis zu bewahren.

Abstract

Vitamin D is unique among the vitamins, since its major source is skin synthesis by solar UVB exposure, whereas dietary intake plays only a minor role. In the general population, cutaneous vitamin D synthesis is clearly below the recommended amount. Dietary vitamin D does not fill this gap. Severe vitamin D deficiency results in rickets in infants and osteomalacia in adults. In the absence of endogenous vitamin D synthesis (e.g. during winter), oral supplements should ensure adequate daily vitamin D intake, where appropriate. This is particularly true for nursing home residents, non-European migrants and dark-skinned people.

Kernaussagen

  • Ausgeprägter Vitamin-D-Mangel führt bei Säuglingen und Kleinkindern zu Rachitis und bei Erwachsenen zu Osteomalazie.

  • Bei Senioren reduziert Vitamin D das Sturz- und Frakturrisiko und vermutlich auch die Mortalität.

  • Wahrscheinlich vermindert Vitamin D in der Allgemeinbevölkerung auch das Risiko für Infektionen des oberen Respirationstrakts.

  • Defizitäre Blutspiegel an 25-Hydroxyvitamin D sind in allen Bevölkerungsgruppen nach dem Säuglingsalter weitverbreitet, v. a. im Winterhalbjahr. Besondere Risikogruppen für einen Vitamin-D-Mangel stellen Pflegeheimbewohner und nichteuropäische Migrantinnen dar.

  • Bei fehlender UVB-Exposition ist die tägliche Einnahme eines Vitamin-D-Präparats in Höhe von 20 µg die effektivste Maßnahme, eine adäquate Vitamin-D-Versorgung sicherzustellen. Eine hoch dosierte, intermittierende Vitamin-D-Einnahme kann nicht empfohlen werden [45].

Schlüsselwörter

Vitamin D - Defizit - Toxizität - Supplemente - Frakturen - Mortalität

Key words

vitamin D - deficit - toxicity - supplements - fractures - mortality
 

  • Literatur

  • 1 Holick MF. Bioavailability of vitamin D and its metabolites in black and white adults. N Engl J Med 2013; 369: 2047-2048
    CrossrefPubMedGoogle Scholar
  • 2 Wang TJ, Zhang F, Richards JB. et al. Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Lancet 2010; 376: 180-188
    CrossrefPubMedGoogle Scholar
  • 3 Schlingmann KP, Kaufmann M, Weber S. et al. Mutations in CYP24A1 and idiopathic infantile hypercalcemia. N Engl J Med 2011; 365: 410-421
    CrossrefPubMedGoogle Scholar
  • 4 Hintzpeter B, Scheidt-Nave C, Müller MJ. et al. Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr 2008; 138: 1482-1490
    CrossrefPubMedGoogle Scholar
  • 5 Hintzpeter B, Mensink GB, Thierfelder W. et al. Vitamin D status and health correlates among German adults. Eur J Clin Nutr 2008; 62: 1079-1089
    CrossrefPubMedGoogle Scholar
  • 6 Zittermann A, von Helden R, Grant W. et al. An estimate of the survival benefit of improving vitamin D status in the adult german population. Dermatoendocrinol 2009; 1: 300-306
    PubMedGoogle Scholar
  • 7 Kramer J, Diehl A, Lehnert H. Epidemiologische Untersuchung zur Häufigkeit eines Vitamin-D-Mangels in Nordeutschland. Dtsch Med Wochenschr 2014; 139: 470-475
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Schilling S. Epidemic vitamin D deficiency among patients in an elderly care rehabilitation facility. Dtsch Arztebl Int 2012; 109: 33-38
    PubMedGoogle Scholar
  • 9 Pilz S, Dobnig H, Tomaschitz A. et al. Low 25-hydroxyvitamin D is associated with increased mortality in female nursing home residents. J Clin Endocrinol Metab 2012; 97: 653-657
    CrossrefPubMedGoogle Scholar
  • 10 Mahlstedt J, Moka D. Vitamin D-Mangel und sekundärer Hyperparathyreoidismus im Ruhrgebiet (Nordrhein-Westfalen/Deutschland). Nuklearmediziner 2009; 32: 1-8
    Google Scholar
  • 11 Spiro A, Buttriss JL. Vitamin D: An overview of vitamin D status and intake in Europe. Nutr Bull 2014; 39: 322-350
    CrossrefPubMedGoogle Scholar
  • 12 Engelsen O. The relationship between ultraviolet radiation exposure and vitamin D status. Nutrients 2010; 2: 482-495
    CrossrefPubMedGoogle Scholar
  • 13 Wortsman J, Matsuoka LY, Chen TC. et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000; 72: 690-693
    CrossrefPubMedGoogle Scholar
  • 14 Rock CL, Emond JA, Flatt SW. et al. Weight loss is associated with increased serum 25-hydroxyvitamin D in overweight or obese women. Obesity (Silver Spring) 2012; 20: 2296-2301
    CrossrefPubMedGoogle Scholar
  • 15 Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung. Referenzwerte für die Nährstoffzufuhr. 1. Aufl Neustadt an der Weinstraße: Neuer Umschau Buchverlag; 2013. (5. korrigierter Nachdruck).
    Google Scholar
  • 16 Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Hrsg. Institute of Medicine of the National Academies, Food and Nutrition Board. Dietary Reference Intakes Calcium Vitamin D. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Washington, D.C: The National Academies Press; 2010
    Google Scholar
  • 17 Holick MF, Binkley NC, Bischoff-Ferrari HA. et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911-1930
    CrossrefPubMedGoogle Scholar
  • 18 European Food Safety Authority. Scientific Opinion on the Tolerable Upper Intake Level of vitamin D. EFSA Journal 2012; 10: 2813
    Google Scholar
  • 19 Godar DE, Pope SJ, Grant WB. et al. Solar UV doses of adult Americans and vitamin D(3) production. Dermatoendocrinol 2011; 3: 243-250
    CrossrefPubMedGoogle Scholar
  • 20 Max Rubner-Institut, Bundesforschungsinstitut für Ernährung und Lebensmittel. Nationale Verzehrstudie II, Ergebnisbericht Teil 2; 2008. Im Internet: http://www.was-esse-ich.de/uploads/media/NVSII_Abschlussbericht_Teil_2.pdf (Stand: 17.11.2015)
    Google Scholar
  • 21 Pérez-López FR, Pasupuleti V, Mezones-Holguin E. et al. Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2015; 103: 1278-1288.e4
    CrossrefPubMedGoogle Scholar
  • 22 Elder CJ, Bishop NJ. Rickets. Lancet 2014; 383: 1665-1676
    CrossrefPubMedGoogle Scholar
  • 23 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281
    CrossrefPubMedGoogle Scholar
  • 24 Priemel M, von Domarus C, Klatte TO. et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res 2010; 25: 305-312
    CrossrefPubMedGoogle Scholar
  • 25 Linseisen J, Bechthold A, Bischoff-Ferrari HA. et al. Vitamin D Prävention ausgewählter chronischer Krankheiten. Bonn: Stellungnahme der Deutschen Gesellschaft für Ernährung e.V.; 2011
    Google Scholar
  • 26 Chung M, Lee J, Terasawa T. et al. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2011; 155: 827-838
    CrossrefPubMedGoogle Scholar
  • 27 Bischoff-Ferrari HA, Willett WC, Orav EJ. et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 2012; 367: 40-49
    CrossrefPubMedGoogle Scholar
  • 28 Sanders KM, Stuart AL, Williamson EJ. et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010; 303: 1815-1822
    CrossrefPubMedGoogle Scholar
  • 29 Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ. et al. Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial. JAMA Intern Med 2016; 4: 1-10 [Epub ahead of print]
    CrossrefGoogle Scholar
  • 30 Zittermann A, Iodice S, Pilz S. et al. Vitamin D deficiency and mortality risk in the general population: a meta-analysis of prospective cohort studies. Am J Clin Nutr 2012; 95: 91-100
    CrossrefPubMedGoogle Scholar
  • 31 Bjelakovic G, Gluud LL, Nikolova D. et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2014; (01) CD007470 DOI: 10.1002/14651858.CD007470.pub3.
    CrossrefPubMedGoogle Scholar
  • 32 Chowdhury R, Kunutsor S, Vitezova A. et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 2014; 348: g1903
    CrossrefPubMedGoogle Scholar
  • 33 Afzal S, Brøndum-Jacobsen P, Bojesen SE. et al. Genetically low vitamin D concentrations and increased mortality: Mendelian randomisation analysis in three large cohorts. BMJ 2014; 349: g6330
    CrossrefPubMedGoogle Scholar
  • 34 Bergman P, Lindh AU, Björkhem-Bergman L. et al. Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2013; 8: e65835
    CrossrefPubMedGoogle Scholar
  • 35 Beveridge LA, Struthers AD, Khan F. et al. D-PRESSURE Collaboration. Effect of Vitamin D Supplementation on Blood Pressure: A Systematic Review and Meta-analysis Incorporating Individual Patient Data. JAMA Intern Med 2015; 175: 745-754
    CrossrefPubMedGoogle Scholar
  • 36 Vimaleswaran KS, Cavadino A, Berry DJ. et al. Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study. Lancet Diabetes Endocrinol 2014; 2: 719-729
    CrossrefPubMedGoogle Scholar
  • 37 Brown J, Nunez S, Russell M. et al. Hypocalcemic rickets and dilated cardiomyopathy: case reports and review of literature. Pediatr Cardiol 2009; 30: 818-823
    CrossrefPubMedGoogle Scholar
  • 38 Shedeed SA. Vitamin D supplementation in infants with chronic congestive heart failure. Pediatr Cardiol 2012; 33: 713-719
    CrossrefPubMedGoogle Scholar
  • 39 Gotsman I, Shauer A, Zwas DR. et al. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail 2012; 14: 357-366
    CrossrefPubMedGoogle Scholar
  • 40 Ford JA, MacLennan GS, Avenell A. et al. RECORD Trial Group. Cardiovascular disease and vitamin D supplementation: trial analysis, systematic review, and meta-analysis. Am J Clin Nutr 2014; 100: 746-755
    CrossrefPubMedGoogle Scholar
  • 41 Sempos CT, Vesper HW, Phinney KW. et al. Vitamin D Standardization Program (VDSP). Vitamin D status as an international issue: national surveys and the problem of standardization. Scand J Clin Lab Invest Suppl 2012; 243: 32-40
    Google Scholar
  • 42 Cashman KD, Seamans KM, Lucey AJ. et al. Relative effectiveness of oral 25-hydroxyvitamin D3 and vitamin D3 in raising wintertime serum 25-hydroxyvitamin D in older adults. Am J Clin Nutr 2012; 95: 1350-1356
    CrossrefPubMedGoogle Scholar
  • 43 Godar DE, Landry RJ, Lucas AD. Increased UVA exposures and decreased cutaneous Vitamin D(3) levels may be responsible for the increasing incidence of melanoma. Med Hypotheses 2009; 72: 434-443
    CrossrefPubMedGoogle Scholar
  • 44 Hirvonen T, Sinkko H, Valsta L. et al. Development of a model for optimal food fortification: vitamin D among adults in Finland. Eur J Nutr 2007; 46: 264-270
    CrossrefPubMedGoogle Scholar
  • 45 Zheng YT, Cui QQ, Hong YM. et al. A meta-analysis of high dose, intermittent vitamin D supplementation among older adults. PLoS One 2015; 10: e0115850
    CrossrefPubMedGoogle Scholar