Vitamin D deficiency factors and When to investigate Vitamin D level?
In adults, vitamin D deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL (50 nmol per L), and vitamin D insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng per mL (50 to 75 nmol per L).
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Vitamin D deficiency can result
from the following:
- Elderly: In older age body has a decreased ability to synthesize vitamin D from exposure to the sun. There can be as much as 25% reduced production over the age of 70.
- Children: School Children between the ages of 11-18 years were more likely to be overweight or obese when they were deficient in vitamin D. As body weight increased (measured by BMI) the level of vitamin D decreased.
- Inadequate exposure to sunlight - This causes a deficiency in cutaneously synthesized vitamin D; adults in nursing homes or health care institutions are at a particularly high risk.
- Vitamin D malabsorption problems - People who have undergone resection of the small intestine are at risk for this condition; diseases associated with vitamin D malabsorption include Crohn’s disease or Celiac disease and Cystic fibrosis.
- Kidney and liver diseases leads to an inadequate level of active vitamin D in the body.
- Minimal amounts of vitamin D in human breast milk - The American Academy of Pediatrics recommends vitamin D supplementation starting at age 2 months for infants fed exclusively with breast milk.
- Medications - A wide variety of medications, including antifungal medications, anticonvulsants, glucocorticoids, and medications to treat AIDS/HIV, can enhance the breakdown of vitamin D and lead to low levels.
- A body mass index greater than 30 is associated
with lower vitamin D levels. Vitamin D deficiency is more likely in obese
people.
The following groups are at a
particularly high risk of vitamin D deficiency:
- infants and children aged <5 years
- pregnant and breastfeeding women, particularly teenagers and young women
- older people aged >65 years
- people who have no or limited exposure to the sun of
sufficient intensity to induce cutaneous vitamin D synthesis, including
people who:
- cover their skin for cultural reasons
- are confined indoors
- individuals who have darker skin (e.g. people of South
Asian ethnic origin).
Profound vitamin D deficiency is
responsible for a significant burden of morbidity and mortality for people
within these groups, and many of them may not be aware that they are at a high
risk.
When to Test?
If patients have symptoms, signs,
or abnormal laboratory results suggesting vitamin D deficiency (e.g. myalgia,
proximal myopathy, clinical or radiological features of rickets or
osteomalacia, hypocalcaemia, or secondary hyperparathyroidism) then their vitamin
D status should be tested, irrespective of whether or not they belong to an
at-risk group.
Health professionals:
May prescribe a vitamin D supplement
Should recommend vitamin D supplement use among at-risk
groups;
Should help to develop better awareness of the importance of
vitamin D
Health professionals do not need to routinely test vitamin D status in
asymptomatic people. Empiric vitamin D supplementation without testing can be
justified for patients who have no overt risk factors or evidence of deficiency
but are thought to have inadequate sun exposure or dietary intake.
https://www.guidelinesinpractice.co.uk/nutrition/vitamin-d-deficiency-people-at-risk-need-access-to-supplements/352598.article
https://www.nice.org.uk/guidance/PH56
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/339349/SACN_Update_on_Vitamin_D_2007.pdf
https://emedicine.medscape.com/article/128762-overview
https://www.aafp.org/afp/2009/1015/p841.html
https://www.endocrine.org/clinical-practice-guidelines/vitamin-d-deficiency
https://my.clevelandclinic.org/health/articles/15050-vitamin-d--vitamin-d-deficiency
Note: For
informational purposes only. Consult your textbook for advising your patients.
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