Vitamin D Deficiency

&
Aging
By Angela Misko,
Sodexo Dietetic Intern
Ice Breaker

Name
Favorite Outdoor Activity
Introduction
According to the CDC, data from NHANES reports of
the population were at risk for vitamin D inadequacy and
8% were at risk for deficiency in 2001-2006.
The National Institute of Health reports more than 40
million adults in the United States have or are at risk of
developing osteoporosis
Lack of sun exposure is widely accepted as the primary
cause of epidemic low vitamin D levels. However some
individuals obtain seemingly adequate UV exposure yet
are reported to have low levels of vitamin D.
Objectives
How prevalent is vitamin D deficiency among
healthy adults?
What could be the potential causes of this
deficiency?
What are the implications to healthcare
professionals?

Vitamin D
Forms:
Vitamin D2 (ergocalciferol) synthesized by plants
and is not produced by the human body.
Vitamin D3 (cholecalciferol) made in large
quantities in the skin when exposed to UV rays from
sunlight. It can also be ingested from animal sources.
Functions:
Gene transcription
Maintains calcium and phosphorous homeostasis

Dietary Sources of Vitamin D
Metabolism
Vitamin D Deficiency
Rickets in children
Osteomalacia in adults
Exacerbate osteoporosis and fractures
Whos at risk?
Darker skin
Older adults
Obese
IBD



Low Vitamin D Status Despite
Abundant Sun Exposure
The Journal of Clinical Endocrinology & Metabolism
2007
Objective: Document the 25(OH)D status of healthy
individuals with habitually high sun exposure
93 adults (30f & 63m) with a mean age of 24 years old
and mean BMI=24 in Honolulu, Hawaii in late March
Serum 25(OH)D concentration was measured using a
precise HPLC assay.
Low Vitamin D status=Circulating 25(OH)D conc. Less
than 30ng/ml
Limitations?
Conclusions
Variability in serum 25(OH)D concentration exists despite
sun exposure.
Possibly genetic differences exist in the amount of vitamin
D necessary to maintain optimal physiological function, or
genetic differences in the cytochrome P450 enzymes which
activate and degrade vitamin D.
Inadequate cutaneous production of D3, enhanced
cutaneous destruction of previtamin D3 or vitamin D3, down
regulation of cutaneous synthesis by sun-induced melanin
production, or abnormalities of transport from the skin to the
circulation.
A reduction in cutaneous concentration of 7-
dehydrocholesterol and a concomitant declining capacity of
the skin to make vitamin D occur with advancing age!

Factors Associated with Vitamin D Deficiency and
Inadequacy among Women of Childbearing Age in
the United States

The Journal of ISRN Obstetrics and Gynecology 2012
Examined the prevalence of vitamin D deficiency and
inadequacy among 1,814 women between 20-44 years of age.
Serum 25(OH)D concentration was measured using a
DiaSorin radioimmunoassay procedure.
Questionnaire/interviews of social, demographic, and medical
history obtained.
Vitamin D deficiency defined as less than 12ng/ml and
inadequacy defined as less than 20ng/ml based on the
Institute of Medicine.
More than 1/3 of women of childbearing age in the U.S. had
their vitamin D stats below an optimal level (i.e. >20ng/ml)
based on the new IOM definitions.

Conclusions
Multiple factors associated with suboptimal vitamin
D status in women of childbearing age.
Using the new definition, lower prevalence of
vitamin D deficiency, however still significant.
Higher 25(OH)D concentrations among pregnant
women are likely due to dietary supplement use and
milk consumption.
Having a history of diabetes or cardiovascular
disease and high BMI was significantly associated
with vitamin D deficiency independent of other
factors.

Prevalence of vitamin D deficiency during the
summer and its relationship with sun
exposure and skin phototype in elderly men
living in the tropics
The Journal of Clinical Interventions in Aging 2013
284 men aged 60 years in Brazil during summer
months (October-January)
Serum 25(OH)D levels were measured using a
DiaSorin Liaison analyzer. Questionnaire of
demographic, econmic, and medical history
obtained.
Approximately 1/3 of the participants presented with
levels <20ng/ml and 2/3 presented with levels
<30ng/ml.

Conclusion
Sun exposure in itself is not the preponderant factor in
the prevention of 25(OH)D deficiency.
Lower cutaneous production of vitamin D with aging, due
to the atrophic skin alterations with greater availability of
the precursor 7-dehydrocholesterol. 1,25-
dihydroxyvitamin D3 also diminishes as a result of the
decrease in kidney function with aging.
Individuals with darker skin produce less vitamin D than
those with lighter skin at normal levels of sun exposure.
In Brazil, there are currently no official recommendations
on the fortification of foods with vitamin D; in addition,
dietary sources of vitamin D are scant. Supplementation
is necessary among this population.

Implications for
Healthcare
Professionals
The common clinical recommendation to allow sun exposure
to the hands and face for 10-15 minutes may not ensure
vitamin D sufficiency.
Study 1- Because maximal 25(OH)D concentration produced
by natural UV exposure appeared to be approximately
60ng/ml, it seems prudent to use this value as an upper limit
when prescribing vitamin D supplementation.
Study 2- Should efforts to prevent vitamin D deficiency-linked
health outcomes should begin during routine check-ups and
gynecologic care?
Study 3- Skin color and aging play a major role in the bodys
ability to absorb vitamin D. Recommendations of vitamin D
supplementation may need to be more individualized based on
age and skin color.


Implications for
Healthcare
Professionals
Vitamin D is essential for skeletal health and
deficiency is a common health issue among adults
is agreed upon.
Great interest in the role that vitamin D can play in
many chronic diseases. Need further research!
Lack of consensus: The difference in definition of
vitamin D deficiency is still controversial.
The US Endocrine Society Guidelines
The Institute of Medicine
IOM vs. US Endocrine
Society
IOM US Endocrine Society
Definition Deficiency: <12ng/ml
Inadequacy: 12-
19ng/ml
Adequate: 20ng/ml
Harmful: >50ng/ml

Deficiency: <20ng/ml
Inadequacy: 21-
29ng/ml
Adequate: 30ng/ml

VITAL- The Vitamin D
and Omega-3 Trial
Randomized, double-blinded, placebo-controlled,
2x2 factorial trial of a general population of 25,000
U.S. adults
Exploring the relationship between vitamin D and
omega-3 fatty acids and risk of cancer and
cardiovascular disease
Subjects will receive 2,000 IU/day of vitamin D and
1 g/day omega-3 supplements for 5 years
Results by 2017

References
"Vitamin D." Types of Vitamin D. Siemens: 2013.
<http://www.healthcare.siemens.com/clinical-specialities/bone-
metabolism/vitamin-d/types-of-vitamin-d>.
Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer
G, Hollis BW, and Drezner MK. Low Vitamin D Status Despite Abundant
Sun Exposure. The Journal of Clinical Endocrinology & Metabolism.
2007:92(6):2130 doi:10.1210/jc.2006-2250
Zhao G, Ford ES, Tsai J, Li C, and Croft JB. Factors Associated with
Vitamin D Deficiency and Inadequacy among Women of Childbearing
Age in the United States. ISRN Obstetrics and Gynecology.
2012:691486 doi:10.5402/2012/691486
Cabral MA, Borges CN, Maia JMC, Aires CAM, and Banderia F.
Prevalence of vitamin D deficiency during the summer and its
relationship with sun exposure and skin phototype in elderly men living
in the tropics. Clinical Interventions in Aging. 2013(8):1347-1351.
Rollins, Genna. The Trials of Vitamin D: When Will Evidence Resolve
Conflicts About Its Benefits? Clinical Laboratory News: 2013. Volume
39, Number 7. American Association for Clinical Chemistry


References
Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-
Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Manson
JE, Mayne ST, Ross AC, Shapses SA, and Taylor CL. IOM
Committee Members Respond to Endocrine Society Vitamin D
Guideline. The Journal of Endocrinology and Metabolism. 2012:97
(4): 1146-1152. doi: 10.1210/jc.2011-2218
Mahan, L. Kathleen, S. Escott-Stump, and J. Raymond. Krauses
Food and the Nutrition Care Process. 13
th
ed. St. Louis: Elsevier
Inc, 2012.
WebMD. Are You Getting Enough Vitamin D? 2005-2013.
<http://www.webmd.com/food-recipes/guide/are-you-getting-
enough-vitamin-d?page=3>
National Institutes of Health: Office of Dietary Supplements.
Dietary Supplement Fact Sheet: Vitamin D. June 24, 2011
<http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/>