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Grygorieva N, Tronko M, Kovalenko V, Komisarenko S, Tatarchuk T, Dedukh N, Veliky M, Strafun S, Komisarenko Y, Kalashnikov A, Orlenko V, Pankiv V, Shvets O, Gogunska I, Regeda S. Ukrainian Consensus on Diagnosis and Management of Vitamin D Deficiency in Adults. Nutrients 2024; 16:270. [PMID: 38257163 PMCID: PMC10820145 DOI: 10.3390/nu16020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Vitamin D deficiency (VDD) is a global problem, however, there were no Ukrainian guidelines devoted to its screening, prevention, and treatment, which became the reason for the Consensus creation. This article aimed to present the Consensus of Ukrainian experts devoted to VDD management. Following the creation of the multidisciplinary Consensus group, consent on the formation process, drafting and fine-tuning of key recommendations, and two rounds of voting, 14 final recommendations were successfully voted upon. Despite a recent decrease in VDD prevalence in Ukraine, we recommend raising awareness regarding VDD's importance and improving the strategies for its decline. We recommend screening the serum 25-hydroxyvitamin D (25(OH)D) level in risk groups while maintaining a target concentration of 75-125 nmol/L (30-50 ng/mL). We recommend prophylactic cholecalciferol supplementation (800-2000 IU/d for youthful healthy subjects, and 3000-5000 IU/d for subjects from the risk groups). For a VDD treatment, we recommend a short-term administration of increased doses of cholecalciferol (4000-10,000 IU/d) with 25(OH)D levels monitored after 4-12 weeks of treatment, followed by the use of maintenance doses. Additionally, we recommend assessing serum 25(OH)D levels before antiosteoporotic treatment and providing vitamin D and calcium supplementation throughout the full course of the antiosteoporotic therapy.
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Affiliation(s)
- Nataliia Grygorieva
- D.F. Chebotarev Institute of Gerontology, The National Academy of Medical Sciences of Ukraine, 04114 Kyiv, Ukraine
| | - Mykola Tronko
- V.P. Komisarenko Institute of Endocrinology and Metabolism, The National Academy of Medical Sciences of Ukraine, 04114 Kyiv, Ukraine
| | - Volodymir Kovalenko
- National Scientific Center «The M.D. Strazhesko Institute of Cardiology», Clinical and Regenerative Medicine, The National Academy of Medical Sciences of Ukraine, 03151 Kyiv, Ukraine
| | - Serhiy Komisarenko
- Palladin Institute of Biochemistry, The National Academy of Sciences of Ukraine, 02000 Kyiv, Ukraine
| | - Tetiana Tatarchuk
- Institute of Pediatrics, Obstetrics and Gynecology Named after Academician O.M. Lukyanova, The National Academy of Medical Sciences of Ukraine, 04050 Kyiv, Ukraine
| | - Ninel Dedukh
- D.F. Chebotarev Institute of Gerontology, The National Academy of Medical Sciences of Ukraine, 04114 Kyiv, Ukraine
| | - Mykola Veliky
- Palladin Institute of Biochemistry, The National Academy of Sciences of Ukraine, 02000 Kyiv, Ukraine
| | - Serhiy Strafun
- Institute of Traumatology and Orthopedics, The National Academy of Medical Sciences of Ukraine, 01601 Kyiv, Ukraine
| | - Yulia Komisarenko
- Department of Endocrinology, O.O. Bogomolets National Medical University, 01601 Kyiv, Ukraine
| | - Andrii Kalashnikov
- Institute of Traumatology and Orthopedics, The National Academy of Medical Sciences of Ukraine, 01601 Kyiv, Ukraine
| | - Valeria Orlenko
- V.P. Komisarenko Institute of Endocrinology and Metabolism, The National Academy of Medical Sciences of Ukraine, 04114 Kyiv, Ukraine
| | - Volodymyr Pankiv
- Ukrainian Scientific and Practical Centre for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues, Health Ministry of Ukraine, 01021 Kyiv, Ukraine
| | - Oleg Shvets
- Department of Public Health and Nutrition, National University of Life and Environmental Sciences of Ukraine, 03041 Kyiv, Ukraine
| | - Inna Gogunska
- O.S. Kolomiychenko Institute of Otolaryngology, The National Academy of Medical Sciences of Ukraine, 03057 Kyiv, Ukraine
| | - Svitlana Regeda
- Center of Innovative Medical Technologies, The National Academy of Sciences of Ukraine, 04053 Kyiv, Ukraine
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Sallinen RJ, Dethlefsen O, Ruotsalainen S, Mills RD, Miettinen TA, Jääskeläinen TE, Lundqvist A, Kyllönen E, Kröger H, Karppinen JI, Lamberg-Allardt C, Viljakainen H, Kaunisto MA, Kallioniemi O. Genetic Risk Score for Serum 25-Hydroxyvitamin D Concentration Helps to Guide Personalized Vitamin D Supplementation in Healthy Finnish Adults. J Nutr 2021; 151:281-292. [PMID: 33382404 DOI: 10.1093/jn/nxaa391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/26/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Genetic factors modify serum 25-hydroxyvitamin D [25(OH)D] concentration and can affect the optimal intake of vitamin D. OBJECTIVES We aimed to personalize vitamin D supplementation by applying knowledge of genetic factors affecting serum 25(OH)D concentration. METHODS We performed a genome-wide association study of serum 25(OH)D concentration in the Finnish Health 2011 cohort (n = 3339) using linear regression and applied the results to develop a population-matched genetic risk score (GRS) for serum 25(OH)D. This GRS was used to tailor vitamin D supplementation for 96 participants of a longitudinal Digital Health Revolution (DHR) Study. The GRS, serum 25(OH)D concentrations, and personalized supplementation and dietary advice were electronically returned to participants. Serum 25(OH)D concentrations were assessed using immunoassays and vitamin D intake using FFQs. In data analyses, cross-sectional and repeated-measures statistical tests and models were applied as described in detail elsewhere. RESULTS GC vitamin D-binding protein and cytochrome P450 family 2 subfamily R polypeptide 1 genes showed genome-wide significant associations with serum 25(OH)D concentration. One single nucleotide polymorphism from each locus (rs4588 and rs10741657) was used to develop the GRS. After returning data to the DHR Study participants, daily vitamin D supplement users increased from 32.6% to 60.2% (P = 6.5 × 10-6) and serum 25(OH)D concentration from 64.4 ± 20.9 nmol/L to 68.5 ± 19.2 nmol/L (P = 0.006) between August and November. Notably, the difference in serum 25(OH)D concentrations between participants with no risk alleles and those with 3 or 4 risk alleles decreased from 20.7 nmol/L to 8.0 nmol/L (P = 0.0063). CONCLUSIONS We developed and applied a population-matched GRS to identify individuals genetically predisposed to low serum 25(OH)D concentration. We show how the electronic return of individual genetic risk, serum 25(OH)D concentrations, and factors affecting vitamin D status can be used to tailor vitamin D supplementation. This model could be applied to other populations and countries.
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Affiliation(s)
- Riitta J Sallinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Science for Life Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Olga Dethlefsen
- National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Stockholm University, Stockholm, Sweden
| | - Sanni Ruotsalainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Robert D Mills
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Timo A Miettinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Tuija E Jääskeläinen
- Finnish Institute for Health and Welfare, Department of Public Health Solutions, Helsinki, Finland
| | - Annamari Lundqvist
- Finnish Institute for Health and Welfare, Department of Public Health Solutions, Helsinki, Finland
| | - Eero Kyllönen
- Physical and Rehabilitation Medicine Division, Oulu University Hospital, Oulu, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jaro I Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | | | - Heli Viljakainen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Mari A Kaunisto
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Olli Kallioniemi
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Science for Life Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Hoevenaar-Blom MP, Wielders JP, Groeneveld H, de Leeuw E, Schmits RJ, Pepermans C, Pasker-de Jong PC, Hogeman PH. Prevalence and determinants of vitamin D deficiency in infants and toddlers in the Netherlands: a pilot study. Ann Clin Biochem 2019; 56:613-618. [PMID: 31154805 DOI: 10.1177/0004563219857772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Little is known of the vitamin D status of young infants and toddlers and its determinants in West Europe. The prevalence and determinants of vitamin D deficiency of children aged 6–48 months in the centre of the Netherlands (52°N) is investigated. Methods In a cross-sectional population study, randomly recruited infants and toddlers ( n = 150) were studied using an online questionnaire and a physical examination either in late summer ( n = 52) or in late winter ( n = 98). Vitamin D analysis was performed by capillary blood sampling using dried bloodspots plus LC-MS/MS. Results In late winter, 32% of the children were vitamin D deficient (<50 nmol/L 25OH vitamin D3) with 5% severely deficient (<25 nmol/L). In late summer, 2% were deficient. The odds of vitamin D deficiency were higher in children aged 24–48 months, for those not using formula milk and those not adhering to the supplementation guidelines. Conclusion One-third of Dutch infants and toddlers were found to be vitamin D deficient in late winter. Suggested strategies for raising the vitamin D status may include improving the adherence to supplementation, a sensible sun exposure or the use of fortified foods. Special attention is needed for the children aged 24–48 months.
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Affiliation(s)
| | - Jos Pm Wielders
- 2 Department of Clinical Chemistry, Meander Medical Center, Amersfoort, the Netherlands
| | - Henk Groeneveld
- 3 Department of Youth Health Care, Public Health Services Region, Utrecht, the Netherlands
| | - Elly de Leeuw
- 4 Department of Public Health, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ruben Jh Schmits
- 3 Department of Youth Health Care, Public Health Services Region, Utrecht, the Netherlands.,4 Department of Public Health, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carolien Pepermans
- 3 Department of Youth Health Care, Public Health Services Region, Utrecht, the Netherlands
| | | | - Paul Hg Hogeman
- 1 Department of Pediatrics, Meander Medical Center, Amersfoort, the Netherlands
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Pilz S, Zittermann A, Trummer C, Theiler-Schwetz V, Lerchbaum E, Keppel MH, Grübler MR, März W, Pandis M. Vitamin D testing and treatment: a narrative review of current evidence. Endocr Connect 2019; 8:R27-R43. [PMID: 30650061 PMCID: PMC6365669 DOI: 10.1530/ec-18-0432] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
Vitamin D testing and treatment is a subject of controversial scientific discussions, and it is challenging to navigate through the expanding vitamin D literature with heterogeneous and partially opposed opinions and recommendations. In this narrative review, we aim to provide an update on vitamin D guidelines and the current evidence on the role of vitamin D for human health with its subsequent implications for patient care and public health issues. Vitamin D is critical for bone and mineral metabolism, and it is established that vitamin D deficiency can cause rickets and osteomalacia. While many guidelines recommend target serum 25-hydroxyvitamin D (25[OH]D) concentrations of ≥50 nmol/L (20 ng/mL), the minimum consensus in the scientific community is that serum 25(OH)D concentrations below 25-30 nmol/L (10-12 ng/mL) must be prevented and treated. Using this latter threshold of serum 25(OH)D concentrations, it has been documented that there is a high worldwide prevalence of vitamin D deficiency that may require public health actions such as vitamin D food fortification. On the other hand, there is also reason for concern that an exploding rate of vitamin D testing and supplementation increases costs and might potentially be harmful. In the scientific debate on vitamin D, we should consider that nutrient trials differ from drug trials and that apart from the opposed positions regarding indications for vitamin D treatment we still have to better characterize the precise role of vitamin D for human health.
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Affiliation(s)
- Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christian Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Verena Theiler-Schwetz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Lerchbaum
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin H Keppel
- University Institute for Medical and Chemical Laboratory Diagnostics, Paracelsus Medical University, Salzburg, Austria
| | - Martin R Grübler
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Medical Clinic V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, Ruperto-Carola University of Heidelberg, Heidelberg, Germany
- Synlab Medical Center of Human Genetics Mannheim, Mannheim, Germany
| | - Marlene Pandis
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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