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Mashyne Training Slide
Mashyne Training Slide
What is Vitamin D?
Fat-soluble vitamin and serves as a hormone in the body.1 The only vitamin human body makes itself. Vitamin D is naturally present in few selective foods, such as oily fish & in very low amount in cow's milk.
Types of Vitamin D
Vitamin D3 (Cholecalciferol) Produced in skin with direct sunlight Preferred form of supplementation Vitamin D2 (Ergocalciferol) Found in plants Made by UVB radiation of ergosterol
Vitamin D Metabolism
Vitamin D Status
Vitamin D insufficiency, 25(OH)D levels <30ng/ml is prevalent, worldwide, especially in Middle East and South Asia.2
10
5 0 Depigmented subjects Pregnant women Sales Team Soldiers Physicians & Nurses Newborns Office staff Doctors
0-6 months
400-1000
12000-30000
6-12 months
400-1000
12000-30000
1000-2000
30,000-60,0000
1500-2000
45,000-60,000
MCQs
Q. 1 What is Vitamin D? (a) (b) (c) (d) Fat Soluble vitamin Hormone necessary for the body Water Soluble vitamin Both (a) & (b)
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Q. 2 Conversion of Vitamin D3 to 25(OH) vitamin D3 takes place in the (a) (b) (c) (d) Liver Heart Kidney All of the above
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Q. 3 The active form of Vitamin D is (a) (b) (c) (d) Cholecalciferol 25(OH) vitamin D3 Ergocalciferol Calcitriol
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Q. 4 What is the optimum level of Vitamin D in the body? (a) (b) (c) (d) 10 ng/ml 20 ng/ml > 30 ng/ml None of the above
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Q. 5 What is vitamin D Deficiency (a) (b) (c) (d) High level of Vitamin D in the Body Low level of Vitamin D in the Body Optimum level of Vitamin D in the Body None of the above
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Q. 6 How many Indians have Vitamin D Deficiency? (a) 20% (b) 30% (c)50% (d) More than 80%
Actions
Promotes osteoblastic activity (improves bone mineralization) Regulates osteoclastic activity. (reduces bone resorption) Inhibits parathyroid hormone secretion (Improves bone mineralization) Enhances Ca reabsorption Enhances Ca and phosphate transport (absorption) Strengthens muscles (Increases De Novo Protein Synthesis) Boosts immunity Decreases risk of recurrent infections.
Muscle Weakness
Musculoskeletal disorders
Osteomalacia
Hypertension
Occurrence
Adults
Elderly
Symptoms
Complications
Prognosis
Outcome
Osteoporosis
Fractures
Osteomalacia
Softening of bones due to insufficient vitamin D, or problems with metabolism of this vitamin.
Rickets
Osteomalacia
Osteoporosis
Osteoporosis
Weakening of Bones In osteoporosis, bones become weak, fragile and brittle due to loss of minerals like calcium They get fractured more easily than normal bone. 1 out of 8 males & 1 out of 3 females in India suffer from Osteoporosis
Normal Bone
Osteoporosis Society of India New Delhi
Osteoporosis
93 % of all patients With Musculoskeletal Disorders, suffering from persistence pain, were Vit D deficient
Low back pain 83% patients < 22.5ng/ml Osteoarthritis knee 48% patients < 30 ng/ml
Spondolysis
Osteomalacia
Osteoporosis
Muscle Weakness
Over 90% of Fractures occur after fall and fall rate increases due to poor muscle strength and function.1 Adequate dose of Vitamin D found to be useful in reduction of persistent non specific pain & Fractures
Medicographia. 2010;32(4):384-390
Stroke 2001;32:1673-7
Osteoblastic activity Osteoclastic activity calcium efflux from bone Risk of Fracture
OSTEOPOROSIS
Osteomalacia
PTH
Risk of falls
Osteoblastic activity Osteoclastic activity calcium efflux from bone Risk of Fracture
OSTEOPOROSIS
MCQs
Q. 1Vitamin D has the following actions on the body (a) (b) (c) (d) Increases bone mineralization Inhibits PTH secretion Increase calcium absorption from intestine All of the above
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Q. 2 What are Osteoblasts? (a) Cells which help bone formation (b) Cells which help bone resorption (c)Both (a) &(b) (d) None of the above
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Q. 3 Vitamin D Deficiency is associated with (a) (b) (c) (d) Osteomalacia Musculoskeletal Disorders Osteoporosis & Fractures All of the above
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Q. 4 What is Osteomalacia? (a) Softening of bones due to Vitamin D Deficiency (b) Breaking of bones (c) Indigestion (d) None of the above
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Q. 5 Rickets occur commonly in (a) (b) (c) (d) Pregnant Women Children Adults All of the above
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Q. 6 What is Osteoporosis? (a) Disease caused due to iron deficiency (b) Disease caused by bacterial infection (c) Disease in which bones become fragile resulting in fractures (d) None of the above
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Q. 7 Choose the correct statement
(a) Vitamin D Deficiency also affects Musculoskeletal health (b) Ca & Vitamin D Deficiency can cause fractures (c) Vitamin D supplements can cause fractures (d) Both (a) & (b)
Dosage Regimen
Vitamin D deficient ( < 10 ng /ml) population:
Prevention of Osteoporosis: 60,000 IU (1gm Sachet /Month)
The safe upper limit for vitamin D intake for the general adult population was set at 2,000 IU per day in 1997 Recent evidence indicates that higher intakes are safe and that some elderly patients will need at least this amount to maintain optimal Vitamin D levels. No toxicity reported with :Intake of 10000 IU/Day for 5 months
Dosage:
1 sachet/week for 8-12 weeks, followed by 1 sachet every month
Vitamin D stimulates transformation of fracture site stem cells to bone building osteoblast
Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials
Supplemental vitamin D in a dose of 700- 1000 IU a day reduced the risk of falling among older individuals by 19%
BMJ 2009;339:b3692
Ca 1200 mg/d
Dosage:
1 sachet/week for 8-12 weeks, followed by 1 sachet every month
Dosage:
1 sachet/week for 8-12 weeks, followed by 1 sachet every month
Dosage:
1 sachet/week for 8-12 weeks, followed by 1 sachet every month
100 80 60 40 20 0
Vitamin D 400 IU/day Vitamin D 600,000 Vitamin D 60,000 IU Injectable IU once in a w eek
76.2 57.1
High prevalence of vitamin D deficiency in India is a major contributor to Muscle weakness, musculoskeletal disorders Recurrent infections Osteomalacia Osteoporosis Rickets Vitamin D deficiency early in life predisposes to not only bone related disorders but also other chronic disorders Vitamin D supplementation with 60000 IU/month increases levels 25(OH)D by 20 ng/ml. Dose upto 10000 IU/day is safe to be used.
Summary
MCQs
Q.6 What are the advantages of Vitamin D oral supplement Vs. injection? (a) Higher absorption of Vitamin D with oral supplement (b) Better safety profile with oral supplement (c) Both (a) & (b) (d) None of the above
Questions ?
Lack of RBC Production Formation of immature RBCs Formation of more numbers of inactive RBCs
Vitamin D Deficiency
RBCs Malformation
(Inactive & Immature RBCs)
Future
Osteoporosis
Diabetes
CV diseases
Fatigue
To Tackle the Twin Epidemic All Indians with anemia require Vitamin D added to iron
MCQs
Q.1 Vitamin D Deficiency can cause (a) Reduced RBC production
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Q.2 Iron Deficiency Anemia can lead to (a) Reduced absorption of fats from intestine (b) Reduced absorption of glucose from intestine
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Q. 3 Vitamin D deficiency can cause IDA. IDA in turn lead to Vitamin D Deficiency. (a) Only 1 statement is true
st
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Q. 4 What is the Twin Epidemic? (a) Vitamin B + Iron Deficiency
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Q. 5 Twin Epidemic can cause
(a) Joint pain and weakness (b) Fatigue (c) Osteoporosis (d) All of the above
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Q. 5 Twin Epidemic can be tackled by (a) Vitamin D supplements alone
(b) Vitamin D + iron supplements (c)Vitamin C supplements (d) None of the above
84% of Indian Pregnant Women suffer from Iron Deficiency Anemia (IDA)1. 84% Indian women have 25(OH)D values < 22.5 ng/L.2
Parameter Mothers3 Infants 3
81.1%
66.7%
The Twin Epidemic in Pregnant & Lactating Women also affects their infants.
1. Plos One2010;5(1):e8770 2. Am J Clin Nutr. 1992;56:533-536
Pre-term birth
More than 2 fold increase in risk of preterm birth
Preeclampsia
Development of hypertension in Pregancy (PIH) along with excretion of protein in urine (proteinuria).
Maternal Mortality
Anemia (Even in Lactating Mothers)
Prevalence of Osteomalacia
Results in low back pain during pregnancy and post delivery
- Congenital rickets - Low birth weight - Poor postnatal growth - Neonatal Hypocalcemia - Compromised Immunity : recurrent infections - Perinatal Mortality - Impaired brain development
This twin epidemic (Vit.D & Iron Deficiency) affects MotherChildand Future Generations.
Epidemiology. 2009;20(5):720-726
Elemental Iron
Fulfills Iron requirement of the body
3. Anemia
Dimorphic & protein deficiency: Deficiency of iron, folic acid and/or Vit B12 Macrocytic: Due to deficiency of folic acid and/or Vit B12 4. Gestational Diabetes 5. Preeclampsia
How Much Folate & Vitamin B12 required in Pregnacy & Lactation ?
RDA for folic acid supplements in Pregnancy is 400-800 mcg/day.1
MCQs
Q. 1 Twin Epidemic in Pregnant Women can cause (a) Gestational Diabetes (b) Preeclampsia (c) Pre-term birth
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Q. 2 What is Gestational Diabetes? (a) Diabetes in Children
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Q. 3 What is Preeclampsia? (a) Development of Hypertension in Pregnancy (b) Diabetes in Pregnancy (c) Anemia in Pregnancy (d) None of the above
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Q. 4 Twin epidemic in infants causes (a) Low birth Weight
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Q. 5 Ideal dose of iron in Pregnancy & Lactation is (a) 50 mg (b) 100 mg (c) 500 mg (d) 1000 mg
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Q. 6 The iron salt with maximum bioavailability is (a) Ferrous sulphate (b) Ferrous gluconate (c) Ferrous ascorbate (d) Ferrous fumarate
Q. 7 What are the advantages of Ferrous Ascorbate? (a) Ascorbate enhances the absorption of iron from GI tract (b) It ensures highest hemoglobin rise
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Q. 8 How much Folic Acid is present in MASHYNE Tablets
(a) 0.5 mg (b) 1 mg (c) 2 mg (d) 5 mg