Обоснование. Витамин D является важным компонентом, регулирующим кальциевый гомеостаз и многие другие клеточные функции. Гиповитаминоз D ассоциирован с риском развития остеопении, ожирения, сахарного диабета 1 и 2-го типа, злокачественных новообразований и иммунных нарушений. Недостаточное потребление витамина во время беременности повышает риск развития преэклампсии, преждевременных родов, рождения маловесных новорожденных, а также оказывает негативное влияние на здоровье детей и подростков. Клиницисту важно ориентироваться в профилактических и терапевтических схемах назначения препаратов витамина D в зависимости от сывороточного уровня 25(ОН)D. Цель. Установить причины и последствия развития дефицита витамина D и определить способы их коррекции. Материалы и методы. Для написания обзора был осуществлен поиск отечественных и зарубежных публикаций в российских и международных системах поиска (PubMed, eLibrary и пр.) за последние 2–15 лет. В обзор были включены статьи из рецензируемой литературы. Результаты. В работе показано, что витамин D оказывает значительное влияние на функционирование органов сердечно-сосудистой, эндокринной, пищеварительной, дыхательной и других систем, а также на перинатальные исходы, что обусловливает необходимость коррекции дефицита витамина. Представлены схемы расчета эффективной лечебной и профилактической доз лекарственных средств в зависимости от концентрации витамина D3 в сыворотке крови. Заключение. Предпочтение должно отдаваться холекальциферолу (витамин D3) в связи с его лучшими абсорбционными свойствами и более эффективным преобразованием в активные метаболиты витамина (класс IIC).
Background. Vitamin D is an essential component that regulates calcium homeostasis and many other cellular functions. Hypovitaminosis D is associated with a risk of osteopenia, obesity, type 1 and type 2 diabetes, malignant neoplasms and immune disorders. Inadequate vitamin D intake during pregnancy increases a risk of pre-eclampsia, preterm birth, low birth weight as well as it has a negative impact on both children’s and adolescents’ health. It is important for the clinician to be known administrating of vitamin D prophylactic and therapeutic regimens according to serum 25(OH)D levels. Aim. To determine causes and effects of vitamin D deficiency and to elaborate ways of their correction. Materials and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2–15 years was conducted. The review includes articles from peer-reviewed literature. Results. The article shows that vitamin D has a significant impact on both the cardiovascular, endocrine, digestive, respiratory and other systems functioning and perinatal outcomes that necessitates vitamin D deficiency correction. It provides schemes for effective therapeutic and prophylactic drug doses calculating depending on vitamin D3 blood serum concentration. Conclusion. Preference should be given to cholecalciferol (vitamin D3) due to its better absorption properties and more efficient conversion to active vitamin metabolites (class IIC).
Key words: hypovitaminosis D, cholecalciferol, correction of vitamin deficiency.
1. Prentice A. Vitamin D deficiency: a global perspective. Nutr Rev 2008; 66: S153.
2. Bouillon R. Vitamin D: from photosynthesis, metabolism and action to clinical applications. In: Endocrinology, Jameson JL, De Groot LJ (Eds.), Philadelphia: Saunders Elsevier, 2010; 1: 1089.
3. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266.
4. Bouillon R, Marcocci C, Carmeliet G et al. Skeletal and extra-skeletal actions of vitamin D: Current evidence and outstanding questions. Endocr Rev 2018.
5. Rosen CJ, Adams JS, Bikle DD et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr Rev 2012; 33: 456.
6. Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ et al. Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial. JAMA Intern Med 2016; 176: 175.
7. Vaughan-Shaw PG, O'Sullivan F, Farrington SM et al. The impact of vitamin D pathway genetic variation and circulating 25-hydroxyvitamin D on cancer outcome: systematic review and meta-analysis. Br J Cancer 2017; 116: 1092.
8. Ong JS, Cuellar-Partida G, Lu Y et al. Association of vitamin D levels and risk of ovarian cancer: a Mendelian randomization study. Int J Epidemiol 2016; 45: 1619.
9. Stolzenberg-Solomon RZ, Jacobs EJ, Arslan AA et al. Circulating 25-hydroxyvitamin D and risk of pancreatic cancer: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol 2010; 172: 81.
10. McCullough ML, Zoltick ES, Weinstein SJ et al. Circulating Vitamin D and Colorectal Cancer Risk: An International Pooling Project of 17 Cohorts. J Natl Cancer Inst 2018.
11. Gilbert R, Martin RM, Beynon R et al. Associations of circulating and dietary vitamin D with prostate cancer risk: a systematic review and dose-response meta-analysis. Cancer Causes Control 2011; 22: 319.
12. Manson JE, Cook NR, Lee IM et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med 2019; 380: 33.
13. Thorsen SU, Mortensen HB, Carstensen B et al. No difference in vitamin D levels between children newly diagnosed with type 1 diabetes and their healthy siblings: a 13-year nationwide Danish study. Diabetes Care 2013; 36: e157.
14. Dong JY, Zhang WG, Chen JJ et al. Vitamin D intake and risk of type 1 diabetes: a meta-analysis of observational studies. Nutrients 2013; 5: 3551.
15. Vimaleswaran KS, Berry DJ, Lu C et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med 2013; 10: e1001383.
16. Del Pinto R, Pietropaoli D, Chandar AK et al. Association Between Inflammatory Bowel Disease and Vitamin D Deficiency: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 2015; 21: 2708.
17. Cooper JD, Smyth DJ, Walker NM et al. Inherited variation in vitamin D genes is associated with predisposition to autoimmune disease type 1 diabetes. Diabetes 2011; 60: 1624.
18. Castro M, King TS, Kunselman SJ et al. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: the VIDA randomized clinical trial. JAMA 2014; 311: 2083.
19. Scragg R, Khaw KT, Toop L et al. Monthly High-Dose Vitamin D Supplementation and Cancer Risk: A Post Hoc Analysis of the Vitamin D Assessment Randomized Clinical Trial. JAMA Oncol 2018; 4: e182178.
20. Kositsawat J, Freeman VL, Gerber BS, Geraci S. Association of A1C levels with vitamin D status in U.S. adults: data from the National Health and Nutrition Examination Survey. Diabetes Care 2010; 33: 1236.
21. Holmøy T, Moen SM. Assessing vitamin D in the central nervous system. Acta Neurol Scand 2010; 122 (Suppl. 190): 88–92.
22. Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry 2013; 202: 100.
23. Bauer SR, Hankinson SE, Bertone-Johnson ER, Ding EL. Plasma vitamin D levels, menopause, and risk of breast cancer: dose-response meta-analysis of prospective studies. Medicine (Baltimore) 2013; 92: 123.
24. Lappe J, Watson P, Travers-Gustafson D et al. Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women: A Randomized Clinical Trial. JAMA 2017; 317: 1234.
25. Chowdhury R, Kunutsor S, Vitezova A et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 2014; 348: g1903.
26. Gaksch M, Jorde R, Grimnes G et al. Vitamin D and mortality: Individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS One 2017; 12: e0170791.
27. Amer M, Qayyum R. Relationship between 25-hydroxyvitamin D and all-cause and cardiovascular disease mortality. Am J Med 2013; 126: 509.
28. Freedman DM, Looker AC, Abnet CC et al. Serum 25-hydroxyvitamin D and cancer mortality in the NHANES III study (1988-2006). Cancer Res 2010; 70: 8587.
29. Mokry LE, Ross S, Ahmad OS et al. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study. PLoS Med 2015; 12: e1001866.
30. Arshi S, Fallahpour M, Nabavi M et al. The effects of vitamin D supplementation on airway functions in mild to moderate persistent asthma. Ann Allergy Asthma Immunol 2014; 113: 404.
31. Gale CR, Robinson SM, Harvey NC et al. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr 2008; 62: 68.
32. Chawes BL, Bønnelykke K, Stokholm J et al. Effect of Vitamin D3 Supplementation During Pregnancy on Risk of Persistent Wheeze in the Offspring: A Randomized Clinical Trial. JAMA 2016; 315: 353.
33. Aghajafari F, Nagulesapillai T, Ronksley PE et al. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013; 346: f1169.
34. Lawlor DA, Wills AK, Fraser A et al. Association of maternal vitamin D status during pregnancy with bone-mineral content in offspring: a prospective cohort study. Lancet 2013; 381: 2176.
35. Zhu K, Whitehouse AJ, Hart PH et al. Maternal vitamin D status during pregnancy and bone mass in offspring at 20 years of age: a prospective cohort study. J Bone Miner Res 2014; 29: 1088.
36. Bi WG, Nuyt AM, Weiler H et al. Association Between Vitamin D Supplementation During Pregnancy and Offspring Growth, Morbidity, and Mortality: A Systematic Review and Meta-analysis. JAMA Pediatr 2018; 172: 635.
37. Gernand AD, Bodnar LM, Klebanoff MA et al. Maternal serum 25- hydroxyvitamin D and placental vascular pathology in a multicenter US cohort. Am J Clin Nutr 2013; 98: 383–8.
38. Ma R, Gu Y, Zhao S et al. Expressions of vitamin D metabolic components VDBP, CYP2R1, CYP27B1, CYP24A1, and VDR in placentas from normal and preeclamptic pregnancies. Am J Physiol Endocrinol Metab 2012; 303: E928–935.
39. Zhong W, Gu B, Gu Y et al. Activation of vitamin D receptor promotes VEGF and CuZn-SOD expression in endothelial cells. J Steroid Biochem Mol Biol 2014; 140: 56–62.
40. Munns CF, Shaw N, Kiely M et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab 2016; 101: 394.
________________________________________________
1. Prentice A. Vitamin D deficiency: a global perspective. Nutr Rev 2008; 66: S153.
2. Bouillon R. Vitamin D: from photosynthesis, metabolism and action to clinical applications. In: Endocrinology, Jameson JL, De Groot LJ (Eds.), Philadelphia: Saunders Elsevier, 2010; 1: 1089.
3. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266.
4. Bouillon R, Marcocci C, Carmeliet G et al. Skeletal and extra-skeletal actions of vitamin D: Current evidence and outstanding questions. Endocr Rev 2018.
5. Rosen CJ, Adams JS, Bikle DD et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr Rev 2012; 33: 456.
6. Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ et al. Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial. JAMA Intern Med 2016; 176: 175.
7. Vaughan-Shaw PG, O'Sullivan F, Farrington SM et al. The impact of vitamin D pathway genetic variation and circulating 25-hydroxyvitamin D on cancer outcome: systematic review and meta-analysis. Br J Cancer 2017; 116: 1092.
8. Ong JS, Cuellar-Partida G, Lu Y et al. Association of vitamin D levels and risk of ovarian cancer: a Mendelian randomization study. Int J Epidemiol 2016; 45: 1619.
9. Stolzenberg-Solomon RZ, Jacobs EJ, Arslan AA et al. Circulating 25-hydroxyvitamin D and risk of pancreatic cancer: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol 2010; 172: 81.
10. McCullough ML, Zoltick ES, Weinstein SJ et al. Circulating Vitamin D and Colorectal Cancer Risk: An International Pooling Project of 17 Cohorts. J Natl Cancer Inst 2018.
11. Gilbert R, Martin RM, Beynon R et al. Associations of circulating and dietary vitamin D with prostate cancer risk: a systematic review and dose-response meta-analysis. Cancer Causes Control 2011; 22: 319.
12. Manson JE, Cook NR, Lee IM et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med 2019; 380: 33.
13. Thorsen SU, Mortensen HB, Carstensen B et al. No difference in vitamin D levels between children newly diagnosed with type 1 diabetes and their healthy siblings: a 13-year nationwide Danish study. Diabetes Care 2013; 36: e157.
14. Dong JY, Zhang WG, Chen JJ et al. Vitamin D intake and risk of type 1 diabetes: a meta-analysis of observational studies. Nutrients 2013; 5: 3551.
15. Vimaleswaran KS, Berry DJ, Lu C et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med 2013; 10: e1001383.
16. Del Pinto R, Pietropaoli D, Chandar AK et al. Association Between Inflammatory Bowel Disease and Vitamin D Deficiency: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 2015; 21: 2708.
17. Cooper JD, Smyth DJ, Walker NM et al. Inherited variation in vitamin D genes is associated with predisposition to autoimmune disease type 1 diabetes. Diabetes 2011; 60: 1624.
18. Castro M, King TS, Kunselman SJ et al. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: the VIDA randomized clinical trial. JAMA 2014; 311: 2083.
19. Scragg R, Khaw KT, Toop L et al. Monthly High-Dose Vitamin D Supplementation and Cancer Risk: A Post Hoc Analysis of the Vitamin D Assessment Randomized Clinical Trial. JAMA Oncol 2018; 4: e182178.
20. Kositsawat J, Freeman VL, Gerber BS, Geraci S. Association of A1C levels with vitamin D status in U.S. adults: data from the National Health and Nutrition Examination Survey. Diabetes Care 2010; 33: 1236.
21. Holmøy T, Moen SM. Assessing vitamin D in the central nervous system. Acta Neurol Scand 2010; 122 (Suppl. 190): 88–92.
22. Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry 2013; 202: 100.
23. Bauer SR, Hankinson SE, Bertone-Johnson ER, Ding EL. Plasma vitamin D levels, menopause, and risk of breast cancer: dose-response meta-analysis of prospective studies. Medicine (Baltimore) 2013; 92: 123.
24. Lappe J, Watson P, Travers-Gustafson D et al. Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women: A Randomized Clinical Trial. JAMA 2017; 317: 1234.
25. Chowdhury R, Kunutsor S, Vitezova A et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 2014; 348: g1903.
26. Gaksch M, Jorde R, Grimnes G et al. Vitamin D and mortality: Individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS One 2017; 12: e0170791.
27. Amer M, Qayyum R. Relationship between 25-hydroxyvitamin D and all-cause and cardiovascular disease mortality. Am J Med 2013; 126: 509.
28. Freedman DM, Looker AC, Abnet CC et al. Serum 25-hydroxyvitamin D and cancer mortality in the NHANES III study (1988-2006). Cancer Res 2010; 70: 8587.
29. Mokry LE, Ross S, Ahmad OS et al. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study. PLoS Med 2015; 12: e1001866.
30. Arshi S, Fallahpour M, Nabavi M et al. The effects of vitamin D supplementation on airway functions in mild to moderate persistent asthma. Ann Allergy Asthma Immunol 2014; 113: 404.
31. Gale CR, Robinson SM, Harvey NC et al. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr 2008; 62: 68.
32. Chawes BL, Bønnelykke K, Stokholm J et al. Effect of Vitamin D3 Supplementation During Pregnancy on Risk of Persistent Wheeze in the Offspring: A Randomized Clinical Trial. JAMA 2016; 315: 353.
33. Aghajafari F, Nagulesapillai T, Ronksley PE et al. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013; 346: f1169.
34. Lawlor DA, Wills AK, Fraser A et al. Association of maternal vitamin D status during pregnancy with bone-mineral content in offspring: a prospective cohort study. Lancet 2013; 381: 2176.
35. Zhu K, Whitehouse AJ, Hart PH et al. Maternal vitamin D status during pregnancy and bone mass in offspring at 20 years of age: a prospective cohort study. J Bone Miner Res 2014; 29: 1088.
36. Bi WG, Nuyt AM, Weiler H et al. Association Between Vitamin D Supplementation During Pregnancy and Offspring Growth, Morbidity, and Mortality: A Systematic Review and Meta-analysis. JAMA Pediatr 2018; 172: 635.
37. Gernand AD, Bodnar LM, Klebanoff MA et al. Maternal serum 25- hydroxyvitamin D and placental vascular pathology in a multicenter US cohort. Am J Clin Nutr 2013; 98: 383–8.
38. Ma R, Gu Y, Zhao S et al. Expressions of vitamin D metabolic components VDBP, CYP2R1, CYP27B1, CYP24A1, and VDR in placentas from normal and preeclamptic pregnancies. Am J Physiol Endocrinol Metab 2012; 303: E928–935.
39. Zhong W, Gu B, Gu Y et al. Activation of vitamin D receptor promotes VEGF and CuZn-SOD expression in endothelial cells. J Steroid Biochem Mol Biol 2014; 140: 56–62.
40. Munns CF, Shaw N, Kiely M et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab 2016; 101: 394.
1. ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2. ГБУЗ «Городская клиническая больница №40» Департамента здравоохранения г. Москвы. 129301, Россия, Москва, ул. Касаткина, д. 7;
3. ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*katyanikitina@mail.ru
________________________________________________
Iuliia E. Dobrokhotova1, Ekaterina I. Borovkova*1, Sofya A. Zalesskaya1, Victoria S. Skalnaya2, Ivan M. Borovkov3, Zulya S. Zaydieva2
1. N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 1, Ostrovitianova st., Moscow, 117997, Russian Federation;
2. City Clinical Hospital №40 of the Department of Health of Moscow. 7, Kasatkina st., Moscow, 129301, Russian Federation;
3. I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 2, 8, Trubetskaia st., Moscow, 119991, Russian Federation
*katyanikitina@mail.ru