Nurtrient factsheet- vitamin D Assignment Sample

Part A: Fact Sheet

Introduction to Vitamin D

Vitamin D is a fat-soluble vitamin that has an important role in physiological functions and specifically in maintaining the health of bones. It exists in two forms. With D2 or ergocalciferol and with D3 cholecalciferol. It has particular importance in the processes of the absorption of calcium and maintaining its balance. This is important in the development of bones, maintaining the immune system, along the functioning of cells.

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Functions of Vitamin D

Calcium and Phosphorus metabolism also depends on vitamin D which helps to minimize bone and teeth hardness. This aspect helps in the absorption of calcium in the intestines and maintenance of it in the blood stream hence preventing rickets in children and osteomalacia in adults.

Apart from bone health, Vitamin D works through the immune system and therefore increases the pathogen-killing ability of the monocytes and macrophages, decreases inflammation, and increases immunity against infections[1]. It is also involved in the ability of cell differentiation and division, keeping tissues healthy and controlling for the formation of tumors.

Vitamin D works to affect the mechanical process of muscles by playing a role in the absorption of calcium. This mineral is needed when a muscle contraction is to occur. Moreover, it is associated with the well-being of the brain[2].Although there are some indications that it take part in the prevention of mood disorders, including depression. Due to the hormone-like properties of Vitamin D, it affects adipose tissue, central nervous system in the body.

Deficiency/Insufficiency Signs and Symptoms

List of the main Deficiency signs and symptoms

Osteoporosis: weakened bones leading to increased risk of fractures

Bone Pain: discomfort in bones due to poor mineralization

Muscle Weakness: reduced muscle strength affecting mobility and balance

Fatigue: continuing tiredness or lack of energy

Increased Fracture Risk: higher susceptibility to fractures from minor falls or injuries

Rickets (in children): soft and deformed bones, often leading to bowing of the legs

Osteomalacia (in adults): softening of bones, causing pain and deformities

Impaired Wound Healing: slower healing of wounds or fractures

Depression or Mood Changes: potential link to mood disorders due to Vitamin D's role in brain function

The deficiency of this vitamin cause to rickets in children and osteomalacia in adults causing adverse effects that decrease the absorption of calcium and make bones turn soft. The main signs are bone pain, muscle weak point and osteoporosis, and increased fracture risk [3].Another deficiency that is known to cause osteoporosis is that of Vitamin D due to poor bone mineral density amongst the elderly. Some of the other symptoms include, tiredness, demoralization, and weakened immunity. These symptoms are because Vitamin D has an important role in the body [4].As it helps regulate the level of calcium and phosphate in the body, supports bone health, and has an important role in muscle and immune functions in case of deficiency.

Therapeutic Uses and Supplemental Doses

It is the most commonly used vitamin therapeutically to treat and prevent osteoporosis and osteomalacia due to the role of the vitamin in the bioavailability and utilization of calcium. For osteoporosis, the dosage of 800–2000 IU/day has been found useful in increasing bone density and lowering the odds of fracture[5]. This range is relatively similar in most studies while the specific doses depend on the system and health status of the user.

In deficiency-related disorders, one might require higher doses for some time to normalize the depressed levels these conditions cause. This is mostly under the doctor’s recommendation. Other conditions for which Vitamin D has promise as therapy include autoimmune disease[6], cardiovascular disease, and seasonal affective disorder, although the evidence is less strong. The recommended dosage for general health maintenance and prevention of various ailments ranges between 400 and 800 IU per day[7]. The dosage should come according to the individual need and one should keep on monitoring the level of toxicity, more so when used in therapeutic dosage form.

Dietary Sources of Vitamin D

List of key dietary sources of Vitamin D

Vitamin D can be received from various dietary sources, including.

Fatty Fish (e.g., salmon, mackerel): 570 IU per 100g

Cod Liver Oil: 1,360 IU per tablespoon

Fortified Milk: 100 IU per cup

Fortified Orange Juice: 137 IU per cup

Egg Yolks: 37 IU per yolk

Beef Liver: 49 IU per 100g

Fortified Cereals: 40-60 IU per serving

Cheese: 6 IU per 30g

Mushrooms (exposed to UV light): 450 IU per 100g

Fortified Plant-Based Milk: 100 IU per cup

Examples of factors that influence the bioavailability of nutrients include fat content, food preparation and other nutrient presence for example Vitamin D is a fat-soluble vitamin, methods of cooking can reduce vitamin D and the existence of other nutrients such as calcium and phosphorous will enhance absorption of nutrients [8]. The sources of this vitamin obtained from processed foods are comparatively healthier than natural products, particularly for people who live in areas characterized by little sunlight.

Recommended Nutrient Intakes (RNIs)

In Ireland, the Recommended Nutrient Intakes (RNIs) for Vitamin D are

Table 1: RNIs for Vitamin D

(Source: Self-created)

Toxicity Levels and Symptoms

The toxicity of Vitamin D can be taken if one takes so many supplements in a given period of time. The UL of Vitamin D is usually at 4000 IU/day for those adults according to many health bodies the EFSA (European Food Safety Authority) and IOM (Institute of Medicine) included [9].

Going beyond this amount the body can experience hypercalcemia, a condition arising from high levels of calcium in the blood. Its symptoms include nausea, vomiting, muscle weakness, bone pain, and kidney problems[10]. Long-term toxicity has symptoms manifested by calcification of organs such as the heart and kidneys.

The clients with high-dose supplement intake without a doctor’s prescription, patients with kidney illness, and clients with hyperparathyroidism[11]. It may therefore be necessary for those on high-dose supplements for a long period to have their Vitamin D level checked to avoid toxicity associated with Vitamin D supplements.

Nutrient and Drug Interactions

Calcium is better absorbed with the help of Vitamin D, so the use of the calcium supplements must be accompanied with Vitamin D. However, thiazide diuretics when used in combination with Vitamin D increase hypercalcemia[12]. Considering the fact that Vitamin D is activated in the liver, Kidney and small intesting corticosteroids interfere with its activation hence lowering its levels. Another widely used drug Orlistat which is used in weight reduction might inhibit the absorption of Vitamin D because Orlistat decreases fat assimilation [13].The interactions of magnesium and vitamin K with Vitamin D may be termed as symbiotic in a sense that magnesium and vitamin K help in management of bones and calcium in the body respectively.

Part B: Critical Discussion

Introduction

Vitamin D is very essential in maintaining the health of human bones and managing osteoporosis in particular. This discussion summarizes a number of recent Vitamin D interventions in osteoporosis for effectiveness; issues of strength/weaknesses of the studies are discussed. It will evaluate how it will impact an area of concern and inform therapeutic application of Vitamin D in osteoporosis treatment.

Research Studies Overview

Based on the authors research (Polzonetti et al.(2020) the purpose of the study was to an form of the idea and the impact that consumes Vitamin D from dairy products on chances of having osteoporosis. With the help of a cross-sectional approach, it analyzed participant’s dietary records and bone mineral density. This study also present that increased consumption of Vitamin D from the dairy products could actually help decrease the risks of osteoporosis[14]. With enhanced nutrient intake a positive change in bone mineralization was observed and so senior citizen dietary Vitamin D was found to have a protective effect against osteoporosis.

These research based on although a number of systematic reviews have been carried on the subject (Voulgaridou et al.(2023).The purpose of this particular narrative review was to evaluate the systematic impact of Vitamin D and calcium in osteoporosis, with the use to bone turnover markers [15]. The review was based on data affirmed by twenty-eight recent RCTs. A recent review also pointed that co-supplementation of Vitamin D and calcium also enhanced BMD and decreased bone turnover which reflects proper management of osteoporosis. The findings also considering that Vitamin D and calcium help bones health and prevent osteoporosis.

This paper (Skalny et al.(2023) examined the different vitamins involved in bone health and osteoporosis with emphasis being placed on Vitamin D3. They were done meta-analysis evaluating the impact of multiple vitamins on bone remodeling, osteoporosis based on different studies.The review concluded that though Vitamin D3 is important for bone health there exist other vitamins which play vital roles[16]. Specifically, the study also emphasized that Vitamin D3 similar to other vitamins is essential in retention of bone density or the prevention of osteoporosis, and thus the need for a nutrient-based approach towards bone health.

Strengths and Limitations of Evidence

In this study, the author give useful information on the change of dietary vitamin D from dairy on osteoporosis risk while using a specific population group and reliable dietary assessment. One of the great advantages is the fact that Vitamin D is positively connected with the density of the bones, which affirms that it might effectively be used in the treatment of osteoporosis (Polzonetti et al.(2020). But, the cross-sectional nature of the study restricts the possibility to establish cause-effect relationships and regulate all the confounding factors.

This work provide a systematic evaluation of randomized controlled trials with focus on the interaction of Vitamin D and calcium on bone health. The strength is that it compiles high quality evidences, besides emphasizing on the bone turnover markers (Voulgaridou et al.(2023). Such issues include; integrating the different methodologies used in conducting various studies may cause the review to have bias especially in the results’ interpretation part.

It broadens them by adding other vitamins except D, to show the diversity of the bones issue. Although it provides a broader perspective most often (Skalny et al.(2023).The review may fail to identify on the individualistic view of things like the isolated effect of Vitamin D on osteoporosis hence reducing its putative influence in handling of osteoporosis.

Critical Evaluation of Evidence

In subsequent work, Polzonetti et al. (2020) do a good job of associating dietary Vitamin D with lowered osteoporosis risk,based on cross-sectional data that preclude causative inferences. In a comprehensive meta-analysis of RCTs, Voulgaridou et al. (2023) also explain that combined Vitamin D and calcium may enhance the quality of bones but large variations in study quality may influence the results. Skalny et al. (2023) provide wider perspective that addresses multiple vitamins and stresses the position of Vitamin D in the context of the spectrum of nutritive elements. Although useful,this approach may wee destabilising and might diffuse understanding of vitamins’ particular impacts, especially Vitamin D. In total, all the studies are informative but the variance and study design constraints should be taken into account when drawing general conclusions on the Vitamin D’s potential use in osteoporosis treatment.

Relevance and Application to Clinical Practice

In clinical practice, Vitamin D can be used to treat osteoporosis by suggesting the intake of vitamin supplements that would help increase bone mass and effectively lower the threat of fractures. According to Polzonetti et al. (2020) and Voulgaridou et al. (2023), it is evident that Vitamin D is used together with calcium hence the importance of using them together in enhancing their benefits on bone health. To the client it would check their Vitamin D status and their dietary pattern and then recommend what kind of Vitamin D supplementation they should take bearing in mind the upper limit. To incorporate Vitamin D as one of the modalities of managing osteoporosis [17].Then it would be crucial to closely and frequently assess the response by the body and then, modify the dosages by keeping patient’s age and other aspects of their bone health in mind.

Conclusion

Calcium must always be supplemented together with vitamin D due to its importance in relation to osteoporosis since it boosts bone health. Although there is variation in the studies Vitamin D supplementation is therefore practical and beneficial in clinical practice for increasing bone mineral density and decreasing fracture risk.

Reference List

• Saloxiddinovna, Xalimova Yulduz. "CLINICAL FEATURES OF VITAMIN D EFFECTS ON BONE METABOLISM." ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 36, no. 5 (2024): 90-99.
• Zhao, Rui, Wei Zhang, Chenghong Ma, Yaping Zhao, Rong Xiong, Hanmin Wang, Weiwen Chen, and Song Guo Zheng. "Immunomodulatory function of vitamin D and its role in autoimmune thyroid disease." Frontiers in immunology 12 (2021): 574967.
• Cashman, Kevin D. "Vitamin D deficiency: defining, prevalence, causes, and strategies of addressing." Calcified tissue international 106, no. 1 (2020): 14-29.
• Amrein, Karin, Mario Scherkl, Magdalena Hoffmann, Stefan Neuwersch-Sommeregger, Markus Köstenberger, Adelina Tmava Berisha, Gennaro Martucci, Stefan Pilz, and Oliver Malle. "Vitamin D deficiency 2.0: an update on the current status worldwide." European journal of clinical nutrition 74, no. 11 (2020): 1498-1513.
• foundation.com, 2024, Vitamin D - International Osteoporosis Foundation. Accessing From:https://www.osteoporosis.foundation/patients/prevention/vitamin-d. [Accessing on: 10.09.2024]
• com, 2023 Global Consensus Recommendations on Prevention and Management of NutritionalRickets.AccessingFrom:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880117/] [Accessing on: 10.09.2024]
• com, 2024, The nutrition source and recommendations. Accessing From: https://nutritionsource.hsph.harvard.edu/vitamin-d/.] [Accessing on: 10.09.2024]
• com, 2023, Scientific opinion on the tolerable upper intake level for vitamin D, including the derivation of a conversion factor for calcidiol monohydrate. Accessing From: https://www.efsa.europa.eu/en/efsajournal/pub/8145. [Accessing on: 10.09.2024]
• com, 2024, Scientific opinion on the tolerable upper intake level for vitamin D, including the derivation of a conversion factor for calcidiol monohydrate. Accessing From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158375/. [Accessing on: 10.09.2024]
• National institute of health.com, 2024, Vitamin D - Health Professional Fact Sheet. Accessing From: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. [Accessing on: 10.09.2024]
• Kupisz-Urbańska, Małgorzata, Paweł Płudowski, and Ewa Marcinowska-Suchowierska. "Vitamin D deficiency in older patients—problems of sarcopenia, drug interactions, management in deficiency." Nutrients 13, no. 4 (2021): 1247.
• Gröber, Uwe, Joachim Schmidt, and Klaus Kisters. "Important drug-micronutrient interactions: A selection for clinical practice." Critical reviews in food science and nutrition 60, no. 2 (2020): 257-275.
• Polzonetti, Valeria, Stefania Pucciarelli, Silvia Vincenzetti, and Paolo Polidori. "Dietary intake of vitamin D from dairy products reduces the risk of osteoporosis." Nutrients 12, no. 6 (2020): 1743.
• Voulgaridou, Gavriela, Sousana K. Papadopoulou, Paraskevi Detopoulou, Despoina Tsoumana, Constantinos Giaginis, Foivi S. Kondyli, Evgenia Lymperaki, and Agathi Pritsa. "Vitamin D and calcium in osteoporosis, and the role of bone turnover markers: A narrative review of recent data from RCTs." Diseases 11, no. 1 (2023): 29.
• Skalny, Anatoly V., Michael Aschner, Aristidis Tsatsakis, Joao BT Rocha, Abel Santamaria, Demetrios A. Spandidos, Airton C. Martins et al. "Role of vitamins beyond vitamin D3 in bone health and osteoporosis." International journal of molecular medicine 53, no. 1 (2023): 9.
• Dominguez, Ligia J., Mario Farruggia, Nicola Veronese, and Mario Barbagallo. "Vitamin D sources, metabolism, and deficiency: available compounds and guidelines for its treatment." Metabolites 11, no. 4 (2021): 255.
• Health Service Executive (HSE).com, 2024, Ireland: HSE Nutrition Guidelines.Accessing From:https://www.hse.ie/eng/about/who/healthwellbeing/our-priority programmes/heal/healthy-eating-guidelines/ [Accessing on: 10.09.2024]
• Irish Nutrition and Dietetic Institute (INDI).com, 2024, INDI Dietary Guidelines.Accessing From: https://www.indi.ie/?view=article&id=437&catid=11 [Accessing on: 10.09.2024]
• [1] Saloxiddinovna, Xalimova Yulduz. "CLINICAL FEATURES OF VITAMIN D EFFECTS ON BONE METABOLISM." ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 36, no. 5 (2024): 90-99.
• [2] Zhao, Rui, Wei Zhang, Chenghong Ma, Yaping Zhao, Rong Xiong, Hanmin Wang, Weiwen Chen, and Song Guo Zheng. "Immunomodulatory function of vitamin D and its role in autoimmune thyroid disease." Frontiers in immunology 12 (2021): 574967.
• [3] Cashman, Kevin D. "Vitamin D deficiency: defining, prevalence, causes, and strategies of addressing." Calcified tissue international 106, no. 1 (2020): 14-29.
• [4] Amrein, Karin, Mario Scherkl, Magdalena Hoffmann, Stefan Neuwersch-Sommeregger, Markus Köstenberger, Adelina Tmava Berisha, Gennaro Martucci, Stefan Pilz, and Oliver Malle. "Vitamin D deficiency 2.0: an update on the current status worldwide." European journal of clinical nutrition 74, no. 11 (2020): 1498-1513.
• [5]Osteoporosis.foundation.com, 2024, Vitamin D - International Osteoporosis Foundation. Accessing From:https://www.osteoporosis.foundation/patients/prevention/vitamin-d. [Accessing on: 10.09.2024]
• [6]Ncbi.com, 2023 Global Consensus Recommendations on Prevention and Management of NutritionalRickets.AccessingFrom:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880117/] [Accessing on: 10.09.2024]
• [7]Osteoporosis.foundation.com, 2024, Vitamin D - International Osteoporosis Foundation. Accessing From:https://www.osteoporosis.foundation/patients/prevention/vitamin-d. [Accessing on: 10.09.2024]
• [8]Nutritionsource.com, 2024, The nutrition source and recommendations. Accessing From: https://nutritionsource.hsph.harvard.edu/vitamin-d/.] [Accessing on: 10.09.2024]
• [9] Efsa.com, 2023, Scientific opinion on the tolerable upper intake level for vitamin D, including the derivation of a conversion factor for calcidiol monohydrate. Accessing From: https://www.efsa.europa.eu/en/efsajournal/pub/8145. [Accessing on: 10.09.2024]
• [10] Ncbi.com, 2024, Scientific opinion on the tolerable upper intake level for vitamin D, including the derivation of a conversion factor for calcidiol monohydrate. Accessing From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158375/. [Accessing on: 10.09.2024]
• [11]National institute of health.com, 2024, Vitamin D - Health Professional Fact Sheet. Accessing From: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. [Accessing on: 10.09.2024]
• [12] Kupisz-Urbańska, Małgorzata, Paweł Płudowski, and Ewa Marcinowska-Suchowierska. "Vitamin D deficiency in older patients—problems of sarcopenia, drug interactions, management in deficiency." Nutrients 13, no. 4 (2021): 1247.
• [13] Gröber, Uwe, Joachim Schmidt, and Klaus Kisters. "Important drug-micronutrient interactions: A selection for clinical practice." Critical reviews in food science and nutrition 60, no. 2 (2020): 257-275.
• [14] Polzonetti, Valeria, Stefania Pucciarelli, Silvia Vincenzetti, and Paolo Polidori. "Dietary intake of vitamin D from dairy products reduces the risk of osteoporosis." Nutrients 12, no. 6 (2020): 1743.
• [15] Voulgaridou, Gavriela, Sousana K. Papadopoulou, Paraskevi Detopoulou, Despoina Tsoumana, Constantinos Giaginis, Foivi S. Kondyli, Evgenia Lymperaki, and Agathi Pritsa. "Vitamin D and calcium in osteoporosis, and the role of bone turnover markers: A narrative review of recent data from RCTs." Diseases 11, no. 1 (2023): 29.
• [16] Skalny, Anatoly V., Michael Aschner, Aristidis Tsatsakis, Joao BT Rocha, Abel Santamaria, Demetrios A. Spandidos, Airton C. Martins et al. "Role of vitamins beyond vitamin D3 in bone health and osteoporosis." International journal of molecular medicine 53, no. 1 (2023): 9.
• [17] Dominguez, Ligia J., Mario Farruggia, Nicola Veronese, and Mario Barbagallo. "Vitamin D sources, metabolism, and deficiency: available compounds and guidelines for its treatment." Metabolites 11, no. 4 (2021): 255.

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