JOURNAL CLUB
PRESENTATION
REVIEW ARTICLE
PRESENTATION- Dr. Keshav Garg 1st yr
Moderator- Dr. Seshasayana (M.D)
Prevention and Treatment Strategies
Screening :
• As per the Endocrine Society, screening of vitamin D deficiency is
recommended in individuals with rickets, osteomalacia, osteoporosis, chronic
kidney disease, hepatic failure, malabsorption syndromes, cystic fibrosis,
inflammatory bowel disease, Crohn’s disease, bariatric surgery, radiation
enteritis, and hyperparathyroidism.
• Further, it is recommended for African-American and adults, pregnant and
lactating women, older adults with history of falls, older adults with history of
non-traumatic fractures, obese children and adults, and people who are
suffering from granuloma.
• Recommendations of the Endocrine Society of India are in line with the
international guidelines.
• Universal screening is not recommended by the Endocrine Society of India
and target screening in at-risk population is advised.
• Competitive protein binding, immunoassay, high-performance Liquid
chromatography, combined high-performance liquid chromatography,
and mass spectrometry are currently available screening methods
used in routine testing of 25 hydroxyl vitamin D in clinical laboratories
Recommended Dietary Allowance and
Treatment Of Vitamin D Deficiency
• Indian Council of Medical research (ICMR) committee had
recommended outdoor physical activity to achieve adequate
vitamin D as the young growing children and adults in India
mainly in the urban areas.
• According to Institute of Medicine (IOM), adults of age 19 to 70
need a daily supplement of at least 400 IU of vitamin D, and
recommended dietary allowance of at least 600 IU.
• Obese adults need at least two to three times more vitamin D to
treat and prevent vitamin D deficiency.
• Endocrine Society of India recommends vitamin D supplementation
to combat high prevalence of vitamin D deficiency.
• The guideline for the treatment of vitamin D deficiency as per the
Endocrine Society Clinical Practice recommend treatment of vitamin
D deficiency with varying daily/weekly vitamin D2 or vitamin D3 for a
period of 6 weeks for different age groups.
• Balasubramanyam et al, reviewed the current guidelines available for
the treatment of vitamin D deficiency. The article reported that
varying daily/weekly doses of vitamin D2 or vitamin D3 for a period of
8-12 weeks for different age groups are required for the treatment of
vitamin D deficiency.
• Indian physicians often prescribe 60,000 IU (1500 μg) cholecalciferol
per week for 8 weeks for vitamin D deficiency.
• In a meta-analysis which included randomized controlled trials
(RCTs, n=1016), the effectiveness of vitamin D3
(cholecalciferol) was significant (p=0.0002) in increasing serum
25-hydroxyl vitamin D concentration as compared to vitamin D2
(ergocalciferol) (p=0.001).
• We have also shown that, regardless of whether
supplementation with vitamin D was in small daily doses or in
larger and more infrequent bolus dosages, the favoring toward
cholecalciferol was still evident.
• This differentiation between ergocalciferol and cholecalciferol is
due to the fact that once 1,24,25(OH)3 D2 has been formed,
ergocalciferol has been deactivated and, therefore, is
irretrievable.
• In contrast cholecalciferol [now 1,24,25(OH)3 D3] retains its
capacity to bind to the VDR and still requires an additional side-
chain oxidation to become deactivated.
• Thus, this additional step gives a vast advantage and potential
for cholecalciferol to remain biologically active and, thus,
maintain vitamin D status, which only strength the hypothesis
that cholecalciferol is the preferred substrate compared with
ergocalciferol.
Indian Academy of Pediatrics
Recommendation for Vitamin D
• Study found inverse associations between 25(OH) D concentrations during
fetal life with BMC and bone area in childhood, but these associations
were no longer significant after adjustment for childhood 25(OH)D status.
• This suggest that 25(OH)D concentrations during childhood might be more
relevant for bone outcomes than 25(OH) D concentrations during fetal life.
• In another randomized, double blind, placebo-controlled clinical trial
including 51 pregnant women, supplementation with 4400 IU of vitamin D3
enhanced broad-spectrum proinflammatory cytokine response of cord
blood mononuclear cells to a significant extent (p=0.0009).
• Study concluded by saying vitamin D exposure during fetal
development influences the immune system of the neonate,
which can contribute to protection from asthma-related,
including infectious, outcomes in early life.
• The Indian Academy of Pediatrics (IAP) observed the need for a
practice guideline which can be used by pediatricians for the
prevention and treatment of vitamin D in children and
adolescents
CONCLUSION
• Inadequate vitamin D levels may be responsible for the progression
of cardiovascular disorders, diabetes mellitus, PCOS, autoimmune
disorders, sleep disturbance and pain to a considerable extent.
• Therefore, more awareness is needed to combat the increasing
prevalence of vitamin D inadequacy through all age groups.
• Aggressive screening and treatment strategies are required for
vitamin D inadequacy.
• Adequate intake of vitamin D through supplementation can only be
achieved when one is educated appropriately regarding vitamin D
deficiency and its impact on various comorbidities adequately.
THANK YOU
