Vitamin D

Vitamin D- calciferol
• Not an essential nutrient
– Body synthesizes
• Sunlight
• Precursor from cholesterol
• Activation of vitamin D
– Two hydroxylation reactions
• Liver adds OH-
• Kidneys add OH-
Vitamin D Synthesis and Activation
 Vitamin D Roles in the Body
– Active form of vitamin D is a hormone
• Binding protein carries it to target organs
• Ca / P absorption to maintain serum levels
• Bone growth
– Ca, Mg, P, Fl absorption preferably from GI
– Bones resorbed to maintain serum levels
• Parathyroid hormone, calcitonin, calbindin
• Other roles
– Enhances or suppresses gene activity
 Vitamin D Deficiency
• Overt deficiency signs are relatively rare
– Insufficiency is quite common
• Contributory factors
– Dark skin, breastfeeding without supplementation,
lack of sunlight, not using fortified milk
• D deficiency → less calbindin transp. prot.→
low calcium absorption → calcium
deficiency→ rob the bones for calcium
 Vitamin D Deficiency
• Rickets in children
– Prevalence >50% Mongolia, Tibet, Netherlands
– Bones fail to calcify normally, bend when supporting
weight
– Beaded ribs
• Osteomalacia (adult rickets)
– Poor mineralization of bones
– Bones are soft, flexible, brittle, and deformed
Fontanel Anterior fontanel
A fontanel is an normally closes
open space in the by the end of the
top of a baby’s second year.
skull before the
bones have
grown together. Posterior fontanel
In rickets, closing normally closes
of the fontanel is by the end of the
delayed. first year.
 Vitamin D Deficiency
• Osteoporosis
– Loss of calcium from bones
• Reduced density results in fractures
• Elderly
– Vitamin D deficiency is especially likely
• Skin, liver, kidneys lose ability to make and activate vitamin
D
• Drink less milk
• Too much time indoors, sunscreen outdoors
• Drugs that deplete Vitamin D
Vitamin D Deficiency Contributes to Osteoporosis

• Bone metabolism is influenced by many factors, including

vitamin D levels, hormones, genetics, your body weight
and your activity levels. Osteoporosis, meaning "porous
bones," results from a relative lack of osteoblast activity
in comparison to osteoclast activity. Over time, this
imbalance leads to a decrease in bone density with a
concurrent rise in fracture risk. In adults, vitamin D
deficiency leads to a reduction in osteoblast activity,
thereby decreasing the rate of bone construction.
 National Academy of Science Vitamin D Recommendations

• In response to concerns that Americans are consuming too little

vitamin D, the National Academy of Sciences reviewed its
recommendations and offered new guidelines in November 2010.
According to the NAS, adults up to age 70 need no more than
600 IU of vitamin D daily to maintain health, and those over 70
need no more than 800 IU. However, many experts, including
those at the University of Miami Miller School of Medicine and
the University of Toronto, believe that even these
recommendations are too low for most age groups and that all
elderly adults should receive at least 2,000 IU of vitamin D daily.
 Considerations and Recommendations

• Many of vitamin D's functions, including its influences on

immune function and glucose and lipid metabolism, are
just beginning to come to light. As new discoveries unfold
-- including advances in osteoporosis research – National
Academy of Science dietary guidelines for vitamin D may
change. Current guidelines reflect an upward adjustment
from those devised in 1997, but some researchers still
feel these recommendations are inadequate.
 Considerations and Recommendations

• If you are an adult under age 70 who

wishes to prevent osteoporosis, your
daily vitamin D-3 intake should be at
least 600 IU, and if you are older than
70, 800 IU. Consult your physician
about the vitamin D-3 dosage that is
best for you.
 Vitamin D Toxicity

• Most likely of vitamins to have toxic effects

• Toxicity raises blood calcium concentrations
– Forms stones in soft tissues, esp. kidneys
– May harden blood vessels
Skin Exposure is
what it takes
to make Vitamin D

↑
What’s the
point?
 Vitamin D Sources
• Few food sources
– Oily (fishy-tasting) fish and egg yolks
– Fortified milk
• Sun exposure for 10-20 min (not 2 hrs) per day
– Dark skin or SPF >8 reduces D synthesis
– No risk of D toxicity from too much sun
– Latitude, season, time of day,
– Overcast, smog, fog
Vitamin D Synthesis and Latitude