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Vitamine D deficientie
- 1. Het vitamine D deficiëntie syndroom Dr. Yvo Sijpkens, internist-nefroloog (ysijp on twitter) Bronovo, Den Haag
- 2. Vitamine D is een (pre)hormoon! Vitamine D deficiëntie is een syndroom!
- 3. Vitamine D deficiëntie syndroom Patiënt
- 7. Lifeguards: 25(OH)D ~ 200 nmol/l
- 8. Vitamine D in normale bevolking
- 9. 25(OH)D in Bronovo bij diabetes
- 12. Vitamine D metabolisme Fysiologie
- 14. Vitamine D metabolisme Extrarenaal
- 16. Effecten actief vitamine D
- 18. Vitamine D receptor abundant aanwezig! Vitamine D heeft invloed op ca 2000 genen (6% genoom)!
- 19. Pleiotrope effecten vitamine D Remming: Proliferatie Renine Auto-immuun reacties Stimulatie: Differentiatie Insuline Immuniteit (cathelicidine)
- 20. Vitamine D deficiëntie syndroom Oorzaken
- 21. Vitamine D deficiëntie syndroom Copyright ©2008 BMJ Publishing Group Ltd. BMJ 2008;336:1318-1319
- 26. Vit D deficiëntie - nierinsufficiëntie
- 27. Vitamine D deficiëntie syndroom gevolgen
- 28. Vitamine D deficiëntie - gevolgen
- 29. Vitamine D deficiëntie diabetes
- 31. Vitamine D deficiëntie en diabetes type 2
- 32. Vitamine D deficiëntie en diabetes type 2
- 33. Vitamine D deficiëntie syndroom hypertensie
- 34. Vitamine D deficiëntie - hypertensie
- 35. Vitamine D deficiëntie - hypertensie
- 36. Cholecalciferol - bloeddrukverlaging J Clin Endocrinol Metab. 2001;86:1633-7
- 37. Vitamine D deficiëntie syndroom Hart- en vaatziekten
- 38. Vitamine D deficiëntie - HVZ
- 39. Vitamine D deficiëntie - HVZ Arch Intern Med. 2008;168:1340-9
- 40. Vitamine D deficientie - mortaliteit Arch Intern Med 2008;168:1629-1637.
- 41. Vitamine D deficiëntie bij DM – mortaliteit Diabetes Care 2010;33:2238 Totale mortaliteit Cardiovasculaire mortaliteit
- 42. Vitamine D deficiëntie bij CNS – mortaliteit Diabetes Care 2010;33:2238
- 43. Vitamine D deficiëntie - HVZ
- 44. Cholecalciferol – mortaliteit ↓ Arch Intern Med 2007;167:1730–7
- 46. Vitamine D deficiëntie syndroom Behandeling Streefwaarde
- 48. Vitamine D – minimale behoefte
- 51. Vit D behoefte afh. van UVB expositie
- 52. Indicatie Vitamine D suppletie
- 57. … vaste dosis?
- 58. Hoge dosis cholecalciferol is veilig! Vitamine D deficiëntie - HVZ
- 59. Hoge dosis calcium met D is niet veilig! Vitamine D deficiëntie - HVZ BMJ 2010;341
- 60. Eenmalig cholecalciferol 500.000 IU: too much!! > meer fracturen! JAMA 2010;303:1815
- 61. Vitamine D intoxicatie is zeldzaam? Cave combinatie cholecalciferol, alfacalcidiol en calcium
- 63. Niets nieuws onder de zon: voorkom het vitamine D deficiëntie syndroom!
Hinweis der Redaktion
- n vroeger.
- Voor zijn lengte heeft hij een redelijk normaal gewicht en buikomvang. Ondanks de medicatie heeft hij een systolische hypertensie. De lage pols wijst op gebruik van de bètablokker. Hart en longen zijn normaal. De souffles passen bij het bekende perifeer vaatlijden. Het laboratoriumonderzoek laat een lichte normocytaire anemie wat al doet denken aan de aanwezigheid van een gestoorde nierfunctie. Het creatininegehalte is inderdaad voor de leeftijd en spiermassa aan de hoge kant. Een creatinine boven de 110 umol/l betekent vrijwel zeker het bestaan van nierfunctieverlies. Gezien de normale natriumconcentratie is de osmoregulatie intact. Het kaliumgehalte is ondanks de ace-remming normaal. Zonder gebruik van een diuretica is het urinezuur toch verhoogd, wat een goede verklaring is voor de eerder doorgemaakte jichtaanvallen. Met een statine is het LDL cholesterol mooi laag. De urine teststrook laat 2+ eiwit zien, wat past bij macroalbuminurie. De negatieve Hb uitslag maakt de aanwezigheid van erytrocyturie en daarmee het bestaan van een glomerulonefritis minder waarschijnlijk.
- ent nationwide survey in the United Kingdom showed that more than 50% of the adult population have insufficient levels of vitamin D and that 16% have severe deficiency during winter and spring.
- Am J Hypertens. 2007 Jul;20(7):713-9. Links Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Scragg R , Sowers M , Bell C . School of Population Health, University of Auckland, Auckland, New Zealand. r.scragg@auckland.ac.nz BACKGROUND: Populations with low vitamin D status, such as blacks living in the US or UK, have increased blood pressure (BP) compared with whites. We analyzed the association between serum 25-hydroxyvitamin D (25OHD) and BP to determine whether low 25OHD explains any of the increased BP in blacks. METHODS: The Third US National Health and Nutrition Examination Survey (NHANES III) is a cross-sectional survey representative of the US civilian population during 1988 to 1994. Analyses were restricted to 12,644 people aged > or =20 years with measurements of BP and 25OHD, after excluding those on hypertensive medication. RESULTS: Adjusted mean serum 25OHD was lowest in non-Hispanic blacks (49 nmol/L), intermediate in Mexican Americans (68 nmol/L), and highest in non-Hispanic whites (79 nmol/L). When participants were divided into 25OHD quintiles, mean (standard error) systolic BP was 3.0 (0.7) mm Hg lower (P = .0004) and diastolic BP was 1.6 (0.6) mm Hg lower (P = .011) for participants in the highest quintile (25OHD > or =85.7 nmol/L) compared with the lowest (25OHD < or =40.4 nmol/L), adjusting for age, sex, ethnicity, and physical activity. Further adjustment for body mass index (BMI) weakened the inverse association between 25OHD and BP, which remained significant for systolic BP (P < .05). The inverse association between 25OHD and systolic BP was stronger in participants aged > or =50 years than younger (P = .021). Ethnic differences in 25OHD explained about half of the increased hypertension prevalence in non-Hispanic blacks compared with whites. CONCLUSIONS: Vitamin D status, which is amenable to intervention by safely increasing sun exposure or vitamin D supplementation, was associated inversely with BP in a large sample representative of the US population.
- J Clin Endocrinol Metab. 2001 Apr;86(4):1633-7. Links Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. Pfeifer M , Begerow B , Minne HW , Nachtigall D , Hansen C . Institute of Clinical Osteology Gustav Pommer, Clinic der Fürstenhof, 31812 Bad Pyrmont, Germany. iko-pyrmont@t-online.de Calcium supplementation is effective in reducing blood pressure in various states of hypertension, including pregnancy-induced hypertension and preeclampsia. In addition, calcitropic hormones are associated with blood pressure. The hypothesis is that short-term therapy with calcium and vitamin D(3) may improve blood pressure as well as secondary hyperparathyroidism more effectively than calcium monotherapy. The effects of 8 weeks of supplementation with vitamin D(3) (cholecalciferol) and calcium on blood pressure and biochemical measures of bone metabolism were studied. The sample consisted of 148 women (mean +/- SD age, 74 +/- 1 yr) with a 25-hydroxycholecalciferol (25OHD(3)) level below 50 nmol/L. They received either 1200 mg calcium plus 800 IU vitamin D(3) or 1200 mg calcium/day. We measured intact PTH, 25OHD(3), 1,25-dihydroxyvitamin D(3), blood pressure, and heart rate before and after treatment. Compared with calcium, supplementation with vitamin D(3) and calcium resulted in an increase in serum 25OHD(3) of 72% (P < 0.01), a decrease in serum PTH of 17% (P = 0.04), a decrease in systolic blood pressure (SBP) of 9.3% (P = 0.02), and a decrease in heart rate of 5.4% (P = 0.02). Sixty subjects (81%) in the vitamin D(3) and calcium group compared with 35 (47%) subjects in the calcium group showed a decrease in SBP of 5 mm Hg or more (P = 0.04). No statistically significant difference was observed in the diastolic blood pressures of the calcium-treated and calcium- plus vitamin D(3)-treated groups (P = 0.10). Pearson coefficients of correlation between the change in PTH and the change in SBP were 0.49 (P < 0.01) for the vitamin D(3) plus calcium group and 0.23 (P < 0.01) for the calcium group. A short-term supplementation with vitamin D(3) and calcium is more effective in reducing SBP than calcium alone. Inadequate vitamin D(3) and calcium intake could play a contributory role in the pathogenesis and progression of hypertension and cardiovascular disease in elderly women.
- Framingham Offspring Study 1739 subjects (mean 59 yr, 55% F, all C) No prior CVD Mean 25-OH-D 19.7 ng/mL 28% with 25-OH-D <15 ng/mL 9% with 25-OH-D <10 ng/mL 5.4 yr follow-up 120 developed first CV event
- Cox proportional hazards regression model ratios (including 95% confidence intervals [CI]) for cardiovascular mortality are shown for 25-hydroxyvitamin D (A) and 1,25-dihydroxyvitamin D (B) quartiles (Q) for the following 3 different statistical models (M): (1) M1 (unadjusted), (2) M2 (adjusted for age, sex, body mass index, and physical activity level), and (3) M3 (variables of M2 plus active smokers, diabetes mellitus, albumin level, cystatin C level, triglyceride level, N-terminal pro-BNP level, systolic and diastolic blood pressure, low-density lipoprotein and high-density lipoprotein cholesterol levels, and the use of statins, aspirin, -blockers, bronchodilators, and angiotensin-converting enzyme inhibitors) Arch Intern Med. 2008 Jun 23;168(12):1340-9. Links Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Dobnig H , Pilz S , Scharnagl H , Renner W , Seelhorst U , Wellnitz B , Kinkeldei J , Boehm BO , Weihrauch G , Maerz W . Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria. harald.dobnig@meduni-graz.at BACKGROUND: In cross-sectional studies, low serum levels of 25-hydroxyvitamin D are associated with higher prevalence of cardiovascular risk factors and disease. This study aimed to determine whether endogenous 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are related to all-cause and cardiovascular mortality. METHODS: Prospective cohort study of 3258 consecutive male and female patients (mean [SD] age, 62 [10] years) scheduled for coronary angiography at a single tertiary center. We formed quartiles according to 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels within each month of blood drawings. The main outcome measures were all-cause and cardiovascular deaths. RESULTS: During a median follow-up period of 7.7 years, 737 patients (22.6%) died, including 463 deaths from cardiovascular causes. Multivariate-adjusted hazard ratios (HRs) for patients in the lower two 25-hydroxyvitamin D quartiles (median, 7.6 and 13.3 ng/mL [to convert 25-hydroxyvitamin D levels to nanomoles per liter, multiply by 2.496]) were higher for all-cause mortality (HR, 2.08; 95% confidence interval [CI], 1.60-2.70; and HR, 1.53; 95% CI, 1.17-2.01; respectively) and for cardiovascular mortality (HR, 2.22; 95% CI, 1.57-3.13; and HR, 1.82; 95% CI, 1.29-2.58; respectively) compared with patients in the highest 25-hydroxyvitamin D quartile (median, 28.4 ng/mL). Similar results were obtained for patients in the lowest 1,25-dihydroxyvitamin D quartile. These effects were independent of coronary artery disease, physical activity level, Charlson Comorbidity Index, variables of mineral metabolism, and New York Heart Association functional class. Low 25-hydroxyvitamin D levels were significantly correlated with variables of inflammation (C-reactive protein and interleukin 6 levels), oxidative burden (serum phospholipid and glutathione levels), and cell adhesion (vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 levels). CONCLUSIONS: Low 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are independently associated with all-cause and cardiovascular mortality. A causal relationship has yet to be proved by intervention trials using vitamin D
- Arch Intern Med. 2007 Sep 10;167(16):1730-7. Links Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Autier P , Gandini S . International Agency for Research on Cancer, 150 cours Albert Thomas, F-69372 Lyon, France. autierp@iacr.fr BACKGROUND: Ecological and observational studies suggest that low vitamin D status could be associated with higher mortality from life-threatening conditions including cancer, cardiovascular disease, and diabetes mellitus that account for 60% to 70% of total mortality in high-income countries. We examined the risk of dying from any cause in subjects who participated in randomized trials testing the impact of vitamin D supplementation (ergocalciferol [vitamin D(2)] or cholecalciferol [vitamin D(3)]) on any health condition. METHODS: The literature up to November 2006 was searched without language restriction using the following databases: PubMed, ISI Web of Science (Science Citation Index Expanded), EMBASE, and the Cochrane Library. RESULTS: We identified 18 independent randomized controlled trials, including 57 311 participants. A total of 4777 deaths from any cause occurred during a trial size-adjusted mean of 5.7 years. Daily doses of vitamin D supplements varied from 300 to 2000 IU. The trial size-adjusted mean daily vitamin D dose was 528 IU. In 9 trials, there was a 1.4- to 5.2-fold difference in serum 25-hydroxyvitamin D between the intervention and control groups. The summary relative risk for mortality from any cause was 0.93 (95% confidence interval, 0.87-0.99). There was neither indication for heterogeneity nor indication for publication biases. The summary relative risk did not change according to the addition of calcium supplements in the intervention. CONCLUSIONS: Intake of ordinary doses of vitamin D supplements seems to be associated with decreases in total mortality rates. The relationship between baseline vitamin D status, dose of vitamin D supplements, and total mortality rates remains to be investigated. Population-based, placebo-controlled randomized trials with total mortality as the main end point should be organized for confirming these findings.
- Dagelijkse toediening van een of twee gecombineerde calciumcarbonaat/cholecalciferol tabletten met als streefwaarde een 25(OH)D-gehalte van meer dan 75 nmol/ kan een sterke stijging van het PTH met verhoogde botombouw voorkomen.Bij een tekort aan calcidiol, verlies van niermassa en hyperfosfatemie neemt in latere stadia van CNI de productie van calcitriol af. Behandeling met actief vitamine D, in de vorm van alfacalcidol is dan aangewezen om progressieve hyperparathyreoïdie te voorkomen.
- Dagelijkse toediening van een of twee gecombineerde calciumcarbonaat/cholecalciferol tabletten met als streefwaarde een 25(OH)D-gehalte van meer dan 75 nmol/ kan een sterke stijging van het PTH met verhoogde botombouw voorkomen.Bij een tekort aan calcidiol, verlies van niermassa en hyperfosfatemie neemt in latere stadia van CNI de productie van calcitriol af. Behandeling met actief vitamine D, in de vorm van alfacalcidol is dan aangewezen om progressieve hyperparathyreoïdie te voorkomen.