Vitamin D

Vitamin D deficiency in children and adults - causes, symptoms and procedures

The knowledge about the role of vitamin D in the human system so far has been limited only to its influence on the calcium-phosphate economy and the skeletal system. The last decade's research related to the discovery of the vitamin D receptor (VDR) made it possible to learn about the effect of vitamin D not only in bone metabolic processes, but also in immunological and anti-carcinogenic processes.

Make an appointment now - to the doctor treating vitamin D deficiency in our hospital

The action of vitamin D

The effect of vitamin D on the human body is very broad. Calcitriol, i.e. the active form of vitamin D3, is similar in structure to steroid hormones and thus has a hormone-like effect. It acts on target cells through the nuclear VDR receptor (vitamin D receptor), which, according to recent studies, is present not only in bone cells, renal tubules and intestinal epithelium, but also in most cells of the human body: in the heart, blood vessel wall. , brain, prostate, mammary gland, adrenal glands, pancreatic β cells, small intestine, large intestine, parathyroid glands, lymphocytes, macrophages, keratinocytes and cancer cells.

Vitamin D sources

Vitamin D belongs to the group of fat-soluble vitamins. Two forms are essential for its action: vegetable D₂ (ergocalciferol) and derived from animal sources D₃ (cholecalciferol), which are produced from ergosterol and 7 - dehydrocholesterol (7-DHC), respectively.
The basic, evolutionarily developed and abundant source of vitamin D3 is its biosynthesis from 7-DHC in the skin under the influence of ultraviolet B (UVB) radiation contained in sunlight, which is able to cover as much as 90% of the daily requirement for this substance. Pro-vitamin D3 in the skin undergoes complex transformations under the influence of radiation and transforms into pre-vitamin D3, which then undergoes two-stage activation in the liver and kidneys, which ultimately leads to the formation of calcitriol.
The second, less important source of vitamin D in the body is food. Ergocalciferol (D2) from food is absorbed in the small intestine, but its natural resources are quite limited and in most cases rather poor in this vitamin. The largest food source is oily sea fish, such as eel or salmon, as well as eggs, cheese, liver and some mushrooms. However, to meet the daily requirement of vitamin D, you would need to eat about 20 eggs, over half a kilo of salmon, a few kilograms of cheese, or drink over 80 liters of milk.

Vitamin D biological activity

Effects on the skeletal system
The most important and best-known function of vitamin D is the regulation of calcium-phosphate metabolism, which creates optimal conditions in the body for proper bone mineralization. Vitamin D determines the development and maturation of the skeleton from fetal life to the end of growth, and its deficiency leads to bone mineralization disorders and is the cause of abnormal skeletal development and commonly known rickets in children. Later in life, vitamin D deficiency leads to disturbances in bone metabolism, i.e. osteomalacia and osteoporosis. Additionally, the anti-fracture effect of this vitamin has been demonstrated, especially in the elderly.

Immunomodulating effect of vitamin D.
The presence of the vitamin D receptor (VDR) was found on many immunologically competent cells. The high concentration of active metabolites of vitamin D in the blood increases the production of human cathelicidin, which is a natural broad-spectrum antibiotic.
The main effect of vitamin D is to reduce the inflammatory reaction, which is to protect the body against chronic inflammatory processes and autoimmune diseases, such as inflammatory bowel disease, rheumatoid arthritis, fibromyalgia, and diabetes. Vitamin D, by modulating the immune system, may also influence the course of cancer and infectious diseases. Scientific studies have described the beneficial effects of vitamin D in the treatment of psoriasis and in obstructive diseases such as asthma and COPD, where chronic progressive inflammation leads to disease progression
The nervous system
Vitamin D is one of the neurosteroids influencing the maturation and functioning of the brain, actively participating in its metabolism, regulating its local concentration. Vitamin D deficiency likely contributes to the higher incidence of mood disorders, including depression. Many scientific studies show a correlation between low vitamin D levels in the blood and the incidence of cognitive impairment and Alzheimer's disease. In addition, the incidence of multiple sclerosis (MS) is greater in areas of the globe with less exposure to sunlight, and among people who eat large amounts of vitamin D-rich fish, the incidence of MS is decreasing.

The effects of vitamin D deficiency in pregnancy

The supply of vitamin D in the mother's body during pregnancy and lactation affects the health of the baby immediately after birth and later in life. Severe vitamin D deficiency during pregnancy can cause neonatal hypocalcaemia and seizures, and maternal and neonatal secondary hyperparathyroidism.
Low birth weight is more common in newborns whose mothers did not have an adequate intake of calcium and vitamin D during pregnancy.
In addition, vitamin D deficiency during pregnancy causes reduced bone mineralization and lower bone mass in children, and in pregnant women it may be a risk factor for pre-eclampsia and gestational diabetes.
Metabolic diseases
Vitamin D receptors (VDR) have been found on pancreatic beta cells, adipocytes and skeletal muscle cells. Vitamin D, through VDR receptors, may reduce insulin resistance and increase glucose uptake in muscle tissue, therefore in people with vitamin D deficiency there is a greater risk of metabolic syndrome, insulin resistance and later development of type 2 diabetes.
Tumors
Vitamin D has antiproliferative properties and influences cell differentiation and apoptotic mechanisms. In vivo studies showed the effectiveness of cholecalciferol in inhibiting the progression of cancer and autoimmune diseases. Vitamin D derivatives are used in the treatment of prostate cancer and psoriasis.
The cardiovascular system
Hypovitaminosis D may cause more frequent occurrence of atherosclerosis, arterial hypertension or heart failure and additionally promotes left ventricular hypertrophy. Supplementation with vitamin D regulates the function of the vascular endothelium and improves its functioning.

Causes of Vitamin D Deficiency

According to the research of many European centers, vitamin D deficiency in adults and children is a common phenomenon. According to epidemiological data, the causes are both insufficient or no exposure to sunlight, and low vitamin D content in everyday food.
Providing the body with vitamin D through sun exposure is in many cases very difficult. In Poland, it is provided in summer, but it is disturbing that currently commonly used sunscreens inhibit as much as 90-95% of the natural production of vitamin D in the skin. In the autumn-winter period, that is from September to March, the synthesis of this vitamin ceases almost completely. Moreover, our daily diet satisfies the daily need for vitamin D only in 3-5%, therefore the majority of the population suffer from deficiencies, which seriously affects the physiological economy and increases the risk of many chronic diseases..

In addition to the above very important factors, there are groups of people more exposed to vitamin deficiencies. First of all, these are newborns whose skin is still immature and extremely sensitive to sun exposure. Additionally, milk - the only food in this period of life - is very poor in vitamin D.
The ability to naturally produce calcitriol also decreases with age, which is why the next group of people exposed to deficiencies are the elderly. With age, the synthesis of provitamin D3 (7-dehydrocholesterol) in the skin decreases, and thus, in a further stage, they have a reduced ability to synthesize cholecalciferol. Additionally, older people are more likely to have mobility problems and are less likely to stay in the sun.
The group of obese children and adults is particularly at risk, who, due to the excessive accumulation of adipose tissue in the body and the associated phenomenon of vitamin D storage (sequestration) in this tissue, have a lower concentration of vitamin D in the blood serum compared to people with a normal BMI.
Another group are people with darker complexions (especially African Americans) who have significant amounts of melanin in their skin, which reduces the synthesis of vitamin D by up to 99%.
Additionally, the medications that the patient is taking should be taken into account. Antiepileptic drugs, antiretrovirals, drugs used to prevent transplant rejection and glucocorticoids accelerate the conversion of active metabolites of vitamin D to inactive calcitric acid which is excreted from the body in the bile.

Symptoms and effects of vitamin D deficiency

The high percentage of vitamin D deficiency found in various age groups in the Polish population is worrying. It contributes not only to the development of rickets in children and osteomalacia and osteoporosis in adults, but also may significantly increase the risk of developing many other diseases, including type I diabetes, cancer (breast, prostate, colon), autoimmune diseases (sclerosis). disseminated, rheumatoid arthritis, systemic lupus erythematosus), cardiovascular and metabolic syndromes. Therefore, it is important to properly supply the entire human system with vitamin D, which takes into account its multidirectional action and impact on the body.
Indicator of the body's supply of vitamin D, which helps to determine whether its synthesis
and dietary intake is sufficient serum 25-hydroxyvitamin D (25 (OH) D) concentration is present. The optimal level in children is 20-60 ng / ml (50-150 nmol / l), and in adults 30-80 ng / ml (75-200 nmol / l).

In people suffering from vitamin D deficiency, we observe the following symptoms:
• muscle weakness - a reduction in the amount of muscle tissue is a very common consequence of vitamin D deficiency;
• bad mood, depression, apathy, and in extreme cases even depression;
• greater sensitivity to pain, frequent chronic musculoskeletal and even skin pain;
• increased risk of fractures, greater susceptibility to fatigue fractures;
• high blood pressure, dangerous pressure spikes;
• sleepiness, lack of energy and motivation to act;
• lower resistance to stress - vitamin D influences the level of serotonin in the brain;
• worse condition and loss of endurance;
• additionally, with low vitamin D levels in the body, symptoms such as loss of appetite, visual disturbances or even disgust and burning sensation in the mouth or throat may also appear.

Symptoms and effects of vitamin D deficiency - children

Vitamin D deficiency is dangerous for a child in the womb. This condition can lead to disorders of the child's brain development and be the cause of permanent damage to certain brain functions, and thus the development of various diseases, e.g. schizophrenia or autism.
In infants, the deficiency is manifested by an excessively flat head on the back as a result of softening of the cranial bones, as well as convex frontal tumors. Due to the lack of vitamin D, the fontanel overgrowth is delayed. In addition, vitamin D deficiency can lead to rickets of the ribs and weakness of the abdominal muscles, which may cause the infant to deal with the so-called "Frog's belly" (curving belly).

Treatment of vitamin D deficiency and its supplementation

Currently, due to the universally low concentration of vitamin D in the European population, prophylactic supplementation of this compound is recommended. Prophylactic dosage of vitamin D should be individualized depending on age, body weight, sun exposure (season), diet and lifestyle. It should also be remembered about groups particularly exposed to deficiencies, in which standard supplementation is sometimes insufficient and it is recommended to use maximum doses for a given age group of the population.
In both children and adults, in the case of laboratory-confirmed deficiency, it is advisable to use pharmacological treatment after prior consultation and under constant medical supervision, because treatment requires the use of doses depending on the concentration of 25 (OH) D and the patient's age, taking into account body weight and comorbidities and medications used. During the therapy, it is recommended to control the concentration of 25-hydroxyvitamin D every 1-3 months and to test the concentration of alkaline phosphatase, as well as the concentration of Ca and P in the serum.

Source

1) Agata Krasińska, Bogda Skowrońska, Znaczenie witaminy D u pacjentów z nadmierną masą ciała — nowe zasady suplementacji, Forum Zaburzeń Metabolicznych 2014, tom 5, nr 2, 63–70
2) Zasady suplementacji i leczenia witamina D – nowelizacja 2018 r., Postępy neonatologii 2018;24(1)
3) Zygmunt Zdrojewicz, Ewa Chruszczewska, Michał Miner, Wpływ witaminy D na organizm człowieka, Med Rodz 2015; 2(18): 61-66
4) Artur Gadomski, Skutki niedoboru witaminy D w organizmie człowieka, Nowa Pediatria 2017; 21(1): 34-37
5) Bogna Grygiel-Górniak, Mariusz Puszczewicz, Witamina D – nowe spojrzenie w medycynie i reumatologii, Postepy Hig Med Dosw (online), 2014; 68: 359-368 e-ISSN 1732-2693
6) Kurt A. Kennel, Matthew T. Drake, Daniel L. Hurley, Niedobór witaminy D u dorosłych:
kiedy badać i jak leczyć?, Vol 20/NR 5/MAJ 2011
7) Paweł Płudowski, Waldemar Misiorowski, Jerzy Konstantynowicz, Jacek Łukaszkiewicz,
Ewa Marcinowska-Suchowierska, Profilaktyka i leczenie niedoboru witaminy D – wybór właściwych rekomendacji, Post N Med 2016; XXIX(10): 738-746

FAQ

1. What might the effects of long-term vitamin D deficiency in adults be?
Long-term vitamin D deficiency in adults may be the primary cause of osteoporosis or osteomalacia. In addition, there may be problems with walking and balance, and painful contractions as a result of weakening muscle strength. Vitamin D deficiencies increase the risk of developing civilization diseases, e.g. obesity, diabetes, arterial hypertension, inflammatory and autoimmune diseases and cancer. In addition, long-term vitamin D deficiencies may accelerate the aging processes of the skin and the entire body, and additionally adversely affect the more frequent occurrence of mood disorders, including depression.

2. How to deal with insufficient vitamin D levels?

Insufficient vitamin D levels can adversely affect the human body. Exposure to UV radiation can cover the body's total daily requirements for this vitamin, but for most of the year we are unable to reap these benefits. Therefore, vitamin D deficiencies should be supplemented by consuming products that are its rich source, e.g. eggs, cheese, fish or mushrooms, and additionally supplemented with dietary supplements with the addition of vitamin D.
Taking higher doses of vitamin D is especially recommended for elderly people and women during menopause - this is due to the fact that with age they lose bone mass and weaken bones. However, as in cases of suspected vitamin D deficiency in children, adults are also advised to determine the necessary dose of this vitamin with their doctor to avoid the risk of overdosing.