دانلود مقاله شیوع کمبود ویتامین D در بزرگسالان
خلاصه
1. معرفی
2. مواد و روشها
3. نتایج
4. بحث
5. نتیجه گیری ها
تایید اخلاق و رضایت برای شرکت
رضایت برای انتشار
در دسترس بودن داده ها و مواد
منابع مالی
محدودیت ها
مشارکت های نویسنده
اعلامیه منافع رقابتی
اختصارات
منابع
Summary
1. Introduction
2. Materials and methods
3. Results
4. Discussion
5. Conclusions
Ethics approval and consent to participate
Consent for publication
Availability of data and materials
Funding
Limitations
Author contributions
Declaration of competing interest
Abbreviations
References
چکیده
زمینه و هدف: کمبود ویتامین D یک بیماری با علل مختلف است. این بیماری با بیماری‌های همراه متعددی مانند بیماری‌های خود ایمنی، بیماری‌های استخوان، سرطان، بیماری‌های قلبی عروقی، بیماری‌های عصبی، بیماری‌های روانپزشکی و عفونت‌های تنفسی مانند COVID-19 مرتبط است. با توجه به شیوع بالای آن در سراسر جهان، وظیفه اصلی سیستم های مراقبت بهداشتی در سراسر جهان است. از طریق ترکیبی از قرار گرفتن در معرض نور خورشید کم، تغذیه ناکافی، و تغییرات مرتبط با افزایش سن در عملکرد پوست، کبد و کلیه، به ویژه سالمندان و ساکنان خانه سالمندان، به طور قابل توجهی خطر ابتلا به کمبود ویتامین D را افزایش می دهند.
روشها: این مطالعه گذشته‌نگر شیوع کمبود ویتامین D (سرم 25- هیدروکسی ویتامین D [25(OH)D] < 12ng/ml) را در میان سالمندان منتخب خانه سالمندان اتریشی مورد تجزیه و تحلیل قرار داد. همچنین با استفاده از ضریب همبستگی پیرسون بررسی کرد که آیا داده‌های دموگرافیک و سایر مقادیر آزمایشگاهی مانند کلسیم با سطوح ویتامین D مرتبط هستند یا خیر. این همبستگی به صورت گرافیکی با نمودار پراکندگی و خط رگرسیون نشان داده شد. در مجموع 478 بیمار بستری شده در آسایشگاه سالمندان در وین بین 3 ژانویه 2017 تا 31 اوت 2020، شامل شدند.
یافته‌ها: در مجموع 106 سالمند (2/22%) از کمبود آشکار ویتامین D رنج می‌بردند. سطح ویتامین D مردان به طور قابل توجهی کمتر از سطح زنان بود (22.9 ± 12.6 نانوگرم در میلی لیتر در مقابل 26.2 ± 14.8 نانوگرم در میلی لیتر، 0.027 ¼ p). سطح سرمی ویتامین D به طور معنی داری با سطح کلسیم سرم شرکت کنندگان همبستگی داشت (19/0 ¼ r، 001/0 > p). 39.5% (189 از 478) از ساکنان خانه سالمندان سطح سرمی ویتامین D ناکافی داشتند.
نتیجه گیری: به طور خلاصه می توان گفت که شیوع کمبود ویتامین D در بین ساکنین خانه سالمندان به طور قابل توجهی بالا است. سطوح ناکافی ویتامین D اغلب با کاهش سطح کلسیم همراه بود. با توجه به شیوع بالا، پیامدهای منفی متعدد سلامتی سطوح ناکافی، و شاخص درمانی بزرگ، این گروه پرخطر باید مکمل کلی با دوز 25 میلی گرم (1000 IU) ویتامین D3 در روز دریافت کنند. علاوه بر این، آزمایش خون باید سه ماه پس از شروع مکمل درمانی انجام شود. اگر برخی از ساکنان به غلظت کافی ویتامین D نرسند، جایگزینی باید با نیازهای فرد تطبیق داده شود تا آنها را تا حد امکان دقیق درمان کند.
Summary
Background & aims
Vitamin D deficiency is a condition with different causes. It is associated with numerous comorbidities such as autoimmune diseases, bone diseases, cancer, cardiovascular diseases, neurodegenerative diseases, psychiatric diseases, and respiratory infections like COVID-19. Due to its high prevalence all over the world, it is a major task for health care systems worldwide. Through a combination of low sunlight exposure, insufficient nutrition, and age-related changes in skin, liver, and kidney function, especially seniors and nursing home residents, in particular, have a significantly increased risk of developing a vitamin D deficiency.
Methods
This retrospective study analyzed the prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] < 12 ng/ml) amongst selected Austrian nursing home seniors. It also examined whether demographic data and other laboratory values like calcium correlate with vitamin D levels by using the Pearson correlation coefficient. This correlation was graphically illustrated with a scatter plot and regression line. A total of 478 patients admitted to a nursing home in Vienna between January 3, 2017, and August 31, 2020, were included.
Results
A total of 106 seniors (22,2%) suffered from a manifest vitamin D deficiency. The vitamin D level of the men was significantly lower than the level of the women (22.9 ± 12.6 ng/ml vs. 26.2 ± 14.8 ng/ml, p = 0.027). The vitamin D serum levels significantly correlated with the serum calcium levels of the participants (r = 0.19, p < 0.001). 39.5% (189 out of 478) of the nursing home residents had inadequate serum vitamin D levels.
Conclusions
In summary, it can be said that the prevalence of vitamin D deficiency among nursing home residents is considerably high. Inadequate vitamin D levels were often associated with reduced calcium levels. Given the high prevalence, the numerous negative health consequences of inadequate levels, and the large therapeutic index, this risk group should get a general supplementation with a dose of 25 μg (1000 IU) vitamin D3 per day. In addition, a blood examination should be performed as early as three months after the start of the supplementation therapy. If some residents do not achieve an adequate vitamin D concentration, the substitution has to be adapted to the individual needs to treat them as precisely as possible.
Introduction
More than 100 years ago, it became apparent that an adequate vitamin D supply is essential for bone health and physical development [1]. In addition to the well-known effects on calcium and phosphate metabolism, numerous immunomodulatory properties have also been detected [2]. Therefore, the consequences of a vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] < 12 ng/ml) are extensive, from mineralization disorders with accelerated bone turnover and reduced bone density (osteopenia and osteoporosis) to extraskeletal consequences such as reduced muscle strength, acute respiratory infections, and even cancer [[3], [4], [5]]. In addition, vitamin D deficiency could also be linked with neurodegenerative diseases, psychiatric disorders, and autoimmune diseases such as diabetes mellitus, multiple sclerosis, psoriasis, and rheumatoid arthritis [[6], [7], [8], [9], [10]]. Furthermore, an association between vitamin D levels and the risk of developing cardiovascular disease could also be found [11].
Despite the numerous diseases associated with vitamin D inadequate levels, more than 40% of the European population show insufficient vitamin levels (below 20 ng/ml). Also, more than 13% have an acute deficiency (less than 12 ng/ml) [12]. Especially the elderly often suffer from low vitamin D levels in their blood serum, and several studies have already demonstrated that nursing home residents, particularly, have a significantly increased risk [13]. On the one hand, the concentration of the vitamin D3 precursor 7-dehydrocholesterol in the blood decreases with advancing age; on the other hand, the ability of the skin to synthesize vitamin D3 under UV radiation declines. A little sunlight exposure, a poor diet, and age-related changes in the skin, liver, and kidney function predispose this population group to develop a vitamin D deficiency [14]. In addition, medication such as antiepileptics and glucocorticoids can affect the vitamin D status [12].
Conclusions
In conclusion, it can be summarized that there was a high prevalence of vitamin D deficiency in the examined nursing home residents. The vitamin D serum level significantly correlated with the calcium level of the participants, and females had slightly lower vitamin D concentrations than men.
Given the numerous adverse health consequences and because a vitamin D deficiency can be easily treated, all nursing home residents should get a general supplementation of a dose of 25 μg (1000 IU) vitamin D3 per day. This dosage is considered safe, and therefore neither the kidney function nor the calcium needs to be monitored regularly. A blood test should be used no earlier than three months after starting the vitamin D supplementation therapy to check whether a sufficient serum concentration has been reached. If this is not the case, the vitamin D substitution must be adapted to individual needs and treated precisely.
In addition, further action is needed to make health workers aware of the high incidence and risks associated with vitamin D deficiency. Further research is required to establish clear, evidence-based guidelines for the prophylaxis, detection, and treatment of vitamin D deficiency in nursing homes.