Review

Protean Manifestations of Vitamin D Deficiency, Part 1: The Epidemic of Deficiency

Authors: David S.H. Bell, MB

Abstract

Abstract: Just when vitamin deficiencies were thought to be a "thing of the past" a new vitamin deficiency-that of vitamin D has developed over the past 20 years. Vitamin D works like a hormone being produced primarily in one organ (the kidney) before circulating through the bloodstream to multiple organs where it has multiple effects. The increased prevalence of vitamin D deficiency is due to changes in modern lifestyle-mainly lack of exposure to sunlight and the increased prevalence of obesity that, results in sequestration of this fat-soluble vitamin in adipose tissue. Distance from the Equator and increasing age and skin pigmentation are additional risk factors. In pregnancy vitamin D deficiency can result in low birth weight, pre-term labor, pre-term birth, infections, and pre-eclamptic toxemia. While vitamin D deficiency is classically associated with rickets and osteomalacia, its effects are much more protean.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-281.
 
2. Office of Dietary Supplements, NIH Clinical Center, National Institute of Health. Dietary Supplement Fact Sheet. Vitamin D. 2007. Available at: http://dietary-supplements.info.nih.gov/factsheets/vitamind.asp.
 
3. Zehnder D, Bland R, Walker EA, et al. Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in the human kidney. J Am Soc Nephrol 1999;10:2465-2473.
 
4. Hewison M. Vitamin D and the immune system: new perspectives on an old theme. Endocrinol Metab Clin North Am 2010;39:365-379.
 
5. Devgun MS, Paterson CR, Johnson BE, et al. Vitamin D nutrition in relation to season and occupation. Am J Clin Nutr 1981;34:1501-1504.
 
6. Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006;84:18-28.
 
7. Prevention and management of osteoporosis. World Health Organ Tech Rep Ser 2003;921:1-164.
 
8. Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997;7:439-443.
 
9. Need AG, O'Loughlin PD, Morris HA, et al. Vitamin D metabolites and calcium absorption in severe vitamin D deficiency. J Bone Miner Res 2008;23:1859-1863.
 
10. Matsuoka LY, Ide L, Wortsman J, et al. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 1987;64:1165-1168.
 
11. Clemens TL, Adams JS, Henderson SL, et al. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3Lancet 1982;1:74-76.
 
12. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004;80(6 suppl):1678S-1688S.
 
13. Fiscella K, Franks P. Vitamin D, race, and cardiovascular mortality: findings from a national US sample. Ann Fam Med 2010;8:11-18.
 
14. Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;72:690-693.
 
15. Blum M, Dolnikowski G, Seyoum E, et al. Vitamin D(3) in fat tissue. Endocrine 2008;33:90-94.
 
16. Looker AC, Dawson-Hughes B, Calvo MS, et al. Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 2002;30:771-777.
 
17. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. in medical inpatients. N Engl J Med 1998;338:777-783.
 
18. Haney EM, Stadler D, Bliziotes MM. Vitamin D insufficiency in internal medicine residents. Calcif Tissue Int 2005;76:11-16.
 
19. Gordon CM, DePeter KC, Feldman HA, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 2004;158:531-537.
 
20. Tangpricha V, Pearce EN, Chen TC, et al. insufficiency among free-living healthy young adults. Am J Med 2002;112:659-662.
 
21. Lowe NM, Mitra SR, Foster PC, et al. Vitamin D status and markers of bone turnover in Caucasian and South Asian postmenopausal women living in the UK. Br J Nutr 2010;103:1706-1710.
 
22. Seth A, Marwaha RK, Singla B, et al. Vitamin D nutritional status of exclusively breast fed infants and their mothers. J Pediatr Endocrinol Metab 2009;22:241-246.
 
23. Looker AC, Pfeiffer CM, Lacher DA, et al. Serum 25-hydroxyvitamin D status of the US population: 1988-1994 compared with 2000-2004. Am J Clin Nutr 2008;88:1519-1527.
 
24. Stein EM, Yin MT, McMahon DJ, et al. Vitamin D deficiency in HIV-infected postmenopausal Hispanic and African-American women [published online ahead of print]. Osteoporos Int 2011;22:477-487.
 
25. Dawodu A, Wagner CL. Mother-child vitamin D deficiency: an international perspective. Arch Dis Child 2007;92:737-740.
 
26. Nesby-O'Dell S, Scanlon KS, Cogswell ME, et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr 2002;76:187-192.
 
27. Sabour H, Hossein-Nezhad A, Maghbooli Z, et al. Relationship between pregnancy outcomes and maternal vitamin D and calcium intake: a cross-sectional study. Gynecol Endocrinol 2006;22:585-589.
 
28. Scholl TO, Chen X. Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight. Early Hum Dev 2009;85:231-234.
 
29. Baker AM, Haeri S, Camargo CA Jr, et al. A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia [published online ahead of print]. J Clin Endocrinol Metab 2010;95:5105-5109.
 
30. Bodnar LM, Catov JM, Simhan HN, et al. deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 2007;92:3517-3522.
 
31. Wagner CL. Paper presented at Pediatric Academic Societies meeting; Vancouver, Canada; May 1, 2010: A2630-A2637.
 
32. Narchi H, Kochiyil J, Zayed R, et al. J Obstet Gynaecol 2010;30:137-142.
 
33. Gartner LM, Greer FR; Section on Breastfeeding and Committee on Nutrition. American Academy of Pediatrics. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003;111(4 pt 1):908-910.
 
34. Clarke E. Whistler and Glisson on rickets. Bull Hist Med 1962;36:45-61.
 
35. Mellanby E. An experimental investigation of rickets. Lancet 1919;1:407-412.
 
36. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: a meta-analysis. JAMA 2004;291:1999-2006.
 
37. Tanaka H, Abe E, Miyaura C, et al. 1 alpha,25-Dihydroxycholecalciferol and a human myeloid leukaemia cell line (HL-60). Biochem J 1982;204:713-719.
 
38. Tsoukas CD, Provini DM, Manolagar SC. 1.25 Dihydroxyvitamin D3: a novel immunoregulatory hormone. Science 1984;14:423-430.