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DY Vitamin Health: BONE AND BEYOND

Introduction

Vitamin D is also called vitamin D3 cholecalciferol o''; is a fat soluble vitamin. Humans depend on sun exposure to satisfy their need for vitamin D. It is UV-B, which are absorbed by 7-dehydrocholesterol in the skin that aids the conversion of previtamin D3 vitamin D3. Vitamin D is essential for the development of bones and also to improve the absorption of calcium and phosphorus in the intestine. Save the oscillation of calcium ions between bone and blood. Therefore, is a component of vitamin D is essential for all age groups in childhood for children who play an essential role in the development of bone, or their lack of results in bone deformity and rickets. In adults, deficiency results in softening of bones leading to osteomalacia. (Goldman, 2004).

The vitamin D3, once formed between the circulation and is converted to 25-hydroxyvitamin D3 in the liver, once released into circulation and then converted to its active form of vitamin D, 1, 25 – hydroxyvitamin D3 in the kidney. It is noteworthy that vitamin D deficiency is not recognized its failure and then take a form of epidemic in children and adults in the United States.

Research was conducted through the world to the conclusion that vitamin D plays a key role not only for bone health but also for various types of cancers, heart diseases, multiple sclerosis, diabetes type I, also in several autoimmune diseases including rheumatoid arthritis. Thus, maintaining adequate blood levels of 25-hydroxyvitamin D (30 ng / ml) is absolutely essential. Since vitamin D is essential to increase the intestinal absorption of calcium, is the appropriate level Blood is also necessary for the formation of 1 extrarenal? – Hydroxylase, which plays an essential role in the formation of 1, 25 – hydroxyvitamin D3 (Holick, 2004).

Production and use of vitamin D

When a person is exposed to previtamin D3 from sunlight and vitamin D3 forms that are biologically inert photoproducts. The vitamin D through diet or formed on the skin with the help of sunlight penetrate in the blood reaches the liver where it is metabolized to 25 (OH) D3 by vitamin D 25-hydroxylase (25-OHA). 25 (OH) D3 is again released Traffic is delivered to the kidneys and converted to 1,25 (OH) 2D3 in the presence enzyme 25 (OH) D3 1-hydroxylase (1-AHO). The renal production of active form of vitamin D is regulated by a variety of characteristics of phosphorus in serum (Pi) and PTH. The active form of vitamin D (1,25 (OH) 2D) is now able to manage calcium metabolism. It was observed that the enzyme 25 (OH) D 24-hydroxylase (24-OHA) enzyme that plays a crucial role in the creation of the active form of vitamin D, works in the threshold mechanism to maintain control over the production of 1,25 (OH) 2D3 and if it occurs in greater quantity, using the enzyme in the degradation of active vitamin D (Holick, 2004).

In addition, is also documented that the 1.25 (OH) 2D in May depress the activity of 1-AHO, and parathyroid hormone (PTH) can stimulate this activity. Many extra-renal tissues express also 1-AHO, these tissues include osteoclast bone, skin tissue, macrophages, placenta, colon tissue, brain tissue, the tissue prostate tissue and endothelial tissue of the parathyroid gland. The formation of extrarenal 1,25 (OH) 2D3 might be involved in differentiation and proliferation of cells and also in the immune response. Therefore, 1,25 (OH) 2D3 is essential for various physiological processes besides its role well known in the metabolism of calcium. In contrast with kidneys AHO 1, 1-AHO extrarenal not respond to stimulation of PTH. In addition, 1-AHO expression may vary physiological state of tissue and the disease progression (DeLuca, 2004).

Foods containing vitamin D

There are several Vitamin D resources, this includes the pure form of oil, cod liver, cooked salmon, mackerel, tuna and sardines canned in oil, sardines, margarine fortified bran flakes, eggs, lamb, liver. Fortified foods include milk and dairy products, especially cheese, orange juice and some breads and cereals (source of vitamin D foods with vitamin D).

As mentioned previously, the most high concentration of vitamin D affects the metabolic functions of the body, the WHO recommended intake dose of vitamin D by people belonging to different groups. Up to 50 years, during pregnancy and lactation, the requirement is 200 IU / d, the age group 51-65 is 400 IU / D 65 + age requirement is greater than 600 IU / d (vitamin D food sources of vitamin D).

Given the above evidence shows that vitamin D is the element most essential to support and maintain health and vigor of bone, because it is directly related to bone strength in the various activities skeletal and nonskeletal cancers that covers the body and depression (Lapp, 2009).

Symptoms of vitamin D

Decreased serum calcium and phosphate, because of insufficient intestinal absorption, causing a stimulation of parathyroid hormone (PTH) secretion restore the serum calcium and bone resorption.

Rickets

In children, poor calcification of osteoid and bone deformities as a result of the front leg, the enlarged head, the curvature of the spine, chest deformities and hepatosplenomegaly, characteristic of rickets. The reason is the lack of adequate mineralization of bone tissue, causing deformities and soft bones of the skeleton. Among children risk is prolonged exclusive breastfeeding without vitamin D Risk factors include strong use of sunscreens, and children placed in day care with exposure to sunlight is lowest. Rickets is more common in children Asia, Africa and Middle East (Davidson, 2002).

Osteomalacia

In adults, calcium loss and bone demineralization causes osteomalacia, characterized by sensitivity to bone pain and loss of bone density.

This disease is characterized by pain and discomfort especially in the lower back and thighs. Later, it spread to the arms and chest. This pain does not radiate to other areas. It is accompanied by local tenderness in the bone. Another key feature is the weakness of proximal muscles. This represents a difficulty climbing stairs and squatting.

Due to the deformation of the bones, the lordosis is a common representation. While walking, the patient shows a door duck. Pathologic fractures due to weight gain may occur. Despite all these signs and symptoms typical of chronic fatigue can sometimes be the only sign that represents (Eisman, 1988).

Osteoporosis

According to one estimate, approximately more than 25 million adults in the United States alone have or are at risk of developing this disease. This disease most often associated with inadequate intake of calcium, vitamin D is essential to reduce the absorption calcium

Summarizes the reduction of osteoporosis bone mass, but also reduces part of the bone microarchitecture and thus weakens bone tissue and amplify the risk of fracture. The incidence of osteoporosis and fractures related to osteoporosis increases with age in both sexes, showing a decrease in bone mass with age.

Osteoporosis has become a major health problem in developed countries. It is a condition that is frequent fractures and is expected to affect more women than men at some point in their lives. With advanced age of the bones become more sensitive leading to osteoporosis in older postmenopausal women not individuals, private clinics and chronic treatment with steroids. Natural rhythm of the body allows a constant remodeling of bone. In postmenopausal women, this relationship is altered resulting in a greater amount of bone absorption in place of bone turnover (Goldman, 2004).

Calcium and Vitamin D

Calcium 500 – 1000 mg per day of vitamin D daily 20 micrograms has an established role in deterring further fractures, regardless of whether or not BMD (bone mineral density) values are reduced. This treatment is effective in reducing the risk of fractures associated with hip fractures or other fractures in the community life of patients. (Davidson, 2002).

Reasons to watch insufficient vitamin D

  1. High penetration capability lactose intolerance causing adverse effects benign and consumption of dairy products, particularly in African-Americans.
  2. Decreased vitamin D consumption, equipped with food food, mainly liquid milk, cereals, dairy products, due to changing attitudes towards concern for the health and fat consumption.
  3. Inadequate consumption of foods rich in calcium than milk covers the poor, especially by young women's group of childbearing age, it decreased the concentration of vitamin D and calcium.
  4. Increased use of sunscreen with decreased exposure sun to avoid the risk of skin cancer is also one of the reasons why insufficient vitamin D
  5. Human milk is low in vitamin D, currently there is a greater predominance in the duration of breastfeeding after the inadequate intake of vitamin D. resulting a movement to lower concentrations of 25-hydroxyvitamin D in women.
  6. Because the air pollution in industrial areas, exposure UV radiation is reduced and poor eating habits and food availability of vitamin D causes the computer to each victim of the vitamin D.
  7. Rarely, the reduced absorption, increased demands on the body of vitamin D or increased secretion or practice of vegetarianism strictly leads to a deficiency in vitamin D.
  8. In some Arab countries, is compulsory for women in long dresses for religious purposes so that their exposure to sun is reduced leading to vitamin D. weak

(Looker, 2002; Kreiter, 2000; Nesby-O'Dell, 2002).

The Vitamin D and bone health (BMD, BMC, falls and fractures)

Vitamin D is responsible for forming and maintaining a healthy bone increasing calcium absorption in the intestine and calcium deposits in bones and maintains the optimal BMD (bone mineral density). Observer said that reduces the absorption of calcium is linked to vitamin D, causing a loss of bone and improves the chances of osteoporosis (a disease which represents a low BMD). Osteoporosis makes bones fragile individual people making them vulnerable to fractures (Cranney et al, 2007).

These data are recorded by Holick (2006) that vitamin D deficiency causes bone various issues related with abnormalities such as osteopenia, osteoporosis, osteomalacia, in addition to causing a further weakening of muscles and therefore increases the risk of falls and fractures. In such conditions, the recommended dose should be 1000 IU / d.

Recommendations to reduce the risk of fracture with Vitamin D and calcium on the basis of clinical studies

While vitamin D supplements, mostly accompanied by calcium, to obtain the desired results. According to a research study concluded that combined supplementation of both vitamin D3 and calcium in patients older than 62 has 85yrs resulted in reduced risk of a single grave, fractures, bone loss within the older population. The dose of vitamin D was given as 700-800 IU / day Calcium was given as 500-1200 IU / day.

It is now understood clearly the meaning and the crucial role that vitamin D is on maintaining a healthy bone. A number of studies and surveys have been conducted, which further strengthen this. Below we discuss some of these studies:

Skin Cancer and Vitamin D

On the day, people are now much more concerned sun exposure causes skin cancer. It is observed that chronic and extreme light in childhood and early stages of life that cause sunburn May lead to an increased risk for non-melanoma and basal cell carcinoma cell carcinoma (Veierod, 2003; Grodstein, 1995, Kennedy 2003). Various studies conclude that melanomas occurring in areas not exposed to sunlight indicating that the synthesis of vitamin D3 is low, people apply sunscreens that block UVB radiation responsible for the synthesis of vitamin D3 and therefore may allow the solar radiation can cause melanoma (Garland, 1993).

The actions of vitamin D Noncalcemic

It is known that vitamin D3 interacts with nuclear receptors hormones such as steroids. Upon entering the cell, which passes through the road network to the tubular base. At the heart to meet receiving vitamin D (VDR) and generates a set of genes to produce a response in vitamin D (Holick, 1999).

VDR is present in many body tissues, including osteoblasts small and large intestine, T cells and B? Of islet cells, brain, heart, skin, gonads, prostate, breast, and mononuclear cells (Holick, 1999). Studies show that when 1,25 (OH) 2D3, if fed with cells leukemic human and mouse origin, halting the spread and encourage adult macrophages (Tanka et al, 1982).

1,25 (OH) 2D3 arrived with antipropagation action has been demonstrated by clinical trials in the management of psoriasis. 1,25 (OH) 2D3 when applied topically, produced a remarkable progress in various diseases such as plate thickness, scaling and erythema (Holick, 1998). Therefore, it is now processing all in psoriasis.

1,25 (OH) 2D3 plays a key role in providing a stimulus for insulin production (Lee, 1994), which combines the activation of B cells and T (Tsoukas, 1984), direct effect on myocardial contractility (Weishaar, 1987), the effect on prevention of inflammatory bowel disease (CANTORNE, 2000) and stimulate the secretion of TSH.

VAD D and its association with the occurrence of autoimmune diseases and cancer

It is observed through various studies that people living in latitudes high receive less sun exposure, culminating in the vitamin D deficiency and represents the highest incidence of cancer mortality kindergarten in northern Europe (Grant, 2002).

Vitamin D and Autoimmune Diseases

Data from studies animal and human show that vitamin D prevents the development of diabetes mellitus type I, rheumatoid arthritis, hypertension, cancer of the colon, breast and prostate cancer, Crohn's disease, multiple sclerosis (Holick, 2004).

Vitamin D

The required amount of vitamin D is difficult to answer only food. D In some risk groups is necessary to provide vitamin-enriched foods or exposed to sunlight. Several groups at risk of vitamin D are:

  1. Breastfed infants:

Breast milk provides vitamin D concentration of 25 IU / L enough for the baby. The results of a recent study revealed that most cases of nutritional rickets have been found among young African-Americans within. According to AAP recommendations, we suggest that partial and infants exclusively breastfed should be supplemented by a daily dose of 400 IU.

  1. People with limited sun exposure:

These include:

  1. People only intended to stay in homes
  2. Northerners
  3. Dresses women long for religious
  4. People with the prevention of sun exposure at work

All these people should get the full recommended dose equivalent daily vitamin D 400 IU for the diseases they can prevent a deficiency in vitamin D.

  1. People with skin color darker:

These people have a greater amount of melanin pigments. Having an excess of pigment reduces the capacity to produce vitamin D in the skin from sun exposure. It is also suggested in some studies that older women suffering from the relatively dark skin are more likely to develop vitamin D deficiency, however, it seems that African-Americans have darker skin, despite low levels of vitamin D is needed to develop fewer osteoporotic fractures compared with Caucasians (Eisman, 1988).

  1. People with fat malabsorption:

Fat solubility of vitamin D requires a low fat food is absorbed by the intestine. People who have reduced ability to absorb vitamin D supplementation of the need to meet their demands. Some diseases that cause fat malabsorption include:

  1. Liver Diseases
  2. Fibrosis Cystic
  1. Obese people:

Obese people are also group low individual risk for vitamin D. Low is believed that this is true for people with a BMI> 30. With increasing obesity, the level of vitamin D in your body decreases. This is due to body fat. This is because a greater amount of subcutaneous fat of the vitamin to remove increasingly affecting its release into the circulation. BMI is inversely related to maximum serum concentrations of vitamin D, which sometimes even complete Oral these people making the retention of the vitamin in the largest pool of body fat.

  1. People with gastric bypass:

These people are prone to vitamin D by the small intestine, where Vitamin D is absorbed neglected. Therefore also require supplementation with oral vitamin D.

  1. Seniors:

Older people in groups at risk of extinction in the case of developing vitamin D deficiency because, with increasing age, skin loses its ability to synthesize vitamin D from the sun. In addition, it becomes a reduced ability to convert vitamin D into kidney hormone in vivo.

Conclusion

Initially, we thought vitamin D is necessary only to prevent rickets in children and osteomalacia in adults and osteoporosis in the group of elderly people and is responsible for bone health, but it is now an established fact that vitamin D is essential for metabolic processes. Vitamin D and reduced exposure to solar UVB increases the risk of several cancers or generalized type I diabetes, various autoimmune diseases such as multiple sclerosis and rheumatoid arthritis and schizophrenia. Studies show that vitamin D has been developed as a vital and necessary hormone, which acts as a marker of health and well-being of a individual. It is therefore important to maintain normal levels of vitamin D 75-125nmol / L. It is therefore imperative that we must obtain plasma 25 (OH) D controlled and should be part of routine examinations.

References

  1. CANTORNE, MT, Munsick, C, Bemiss C, Mahon BD., 2000. 1,25-dihydroxy prevents and improves the symptoms of inflammatory bowel disease experimental murine. disease J Nutr, 130, 2648-52.
  2. Davidson, 2002. Principles and Practice of Medicine, 19th edition, Churchill Livingstone.
  3. DeLuca HF. 2004. Overview of features and general physiological functions of vitamin D. Am J Clin Nutr 80, 1689-96S.
  4. Eisman, JA., 1988. "Osteomalacia". Baillieres Clin Endocrinol Metab 2 (1), 125-5
  5. Garland FC. Garland CF., Gorham ED., 1993. Rising trends in melanoma. One hypothesis on the effectiveness of sunscreens. epidemiologic Ann. 3 (4), 451.
  6. Goldman, A., 2004. Cecil Textbook of Medicine, 22th edition. Volume 2. Saunders: A fingerprint Elsvier.
  7. Grant WB. 2002. An estimate of premature cancer mortality in the United States because to inadequate doses of solar ultraviolet radiation UVB. Cancer, 94,1867-75.
  8. Grodstein F, Speizer FE, Hunter DJ., 1995. A Prospective study of incident squamous cell carcinoma of the skin in the Nurses Health Study. J Natl Cancer Inst 87:10616.
  9. Holick, MF., 1998. The effectiveness Clinical 1,25-dihydroxyvitamin D3 and its analogues in the treatment of psoriasis. Retinoids, 14, 12-7.
  10. Holick, MF., 1999. ed. Vitamin D: physiology, molecular biology and clinical applications. Totowa, NJ: Humana Press, 109-28.
  11. Holick, MF., 2004. Vitamin D: importance in preventing Cancer, type 1 diabetes, heart disease and osteoporosis. Am J Clin Nutr, 79, 362-71.
  12. Holick, MF, 2006. The role vitamin D for bone health and fracture prevention Osteoprors present. Rep., 4 (3), 96-102.
  13. Kennedy, C., Bajdik, CD., Willemze, R., de Gruijl, FR., Bavinck JN., 2003. The influence of painful sunburns and duration of sun exposure on the risk of actinic keratosis seborrheic warts, melanocytic nevi, atypical nevi and skin cancer. J Invest Dermatol 120, 1087-93.
  14. Lapp, JL., 2009. Vitamin D: bone health and beyond. American Journal of Lifestyle Medicine, Vol. 3 (5), 386-393.
  15. Lee S, Clark SA, Gill RK, Christakos, S., 1994. 1,25-dihydroxyvitamin D3 and function of pancreatic beta cells: the receptor for vitamin D, gene expression and secretion of insulin. Endocrinology, 134:1602-10
  16. Lips. P., Bouillon, R., Van Schoor, NM., Vanderschueren, S., Kuchuk, N., Mills, K., Boonen, S., R educe the risk of fractures with calcium and vitamin D. [online] 2009 [cited October 15, 2009]. Available at:

17.Kreiter, SR., Schwartz RP., Kirkman HN., Charlton, PA., Calikoglu, AS., Davenport ML. 2000. Nutritional rickets in the heart of Afro-Americans fed infants. J Pediatr, 137, 153-7.

18. Nesby-O'Dell S, Scanlon KS., Cogswell ME., Et al., 1988-1994. Hypovitaminosis D and determinants of HIV prevalence among African women American and white reproductive age: Third National Health and Nutrition Examination Survey, Am J Clin Nutr, 76, 187-92.

20. Tanaka, H., Abe E., Miyaura, C., et al. 1982. 1.25-Dihydroxycholeciferol human myeloid leukemia cell lines (HL-60): the presence of cytosol receptor and induction of differentiation. Biochem J, 204, 713-9.

22. Tsoukas, CD., Provvedine, DM., Manolagas, SC., 1984. 1,25-dihydroxyvitamin D3, a novel immune regualtory hormone. Science, 221, 1438-40.

23. Veierod, MB., Weiderpass, E., Thorn, M., et al. 2003. A prospective study of pigmentation, exposure sun, and the risk of melanoma in women. J Natl Cancer Inst 95:1530-8.

24. Weishaar RE., Simpson RU., 1987. Involvement vitamin D3 with cardiovascular function. II. Direct and indirect effects. Am J Physiol

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