Download PDF
Aktuelle Ernährungsmedizin 2016; 41(05): 370-378
DOI: 10.1055/s-0042-116636
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Vitamin-D-Mangel bei hospitalisierten internistischen Patienten

Vitamin D Deficiency in Medical Inpatients
M. Merker   *
Medizinische Universitätsklinik, Kantonsspital Aarau, Aarau, und Medizinische Fakultät der Universität Basel, Basel, Schweiz
,
L. Grädel   *
Medizinische Universitätsklinik, Kantonsspital Aarau, Aarau, und Medizinische Fakultät der Universität Basel, Basel, Schweiz
,
B. Mueller
Medizinische Universitätsklinik, Kantonsspital Aarau, Aarau, und Medizinische Fakultät der Universität Basel, Basel, Schweiz
,
P. Schuetz
Medizinische Universitätsklinik, Kantonsspital Aarau, Aarau, und Medizinische Fakultät der Universität Basel, Basel, Schweiz
› Author Affiliations
Further Information

Publication History

Publication Date:
07 November 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Das Thema Vitamin D gewinnt weltweit an Bedeutung. Grund für dieses gesteigerte Interesse ist einerseits die zunehmende Häufigkeit des Vitamin-D-Mangels, andererseits auch das wachsende Wissen über dessen Auswirkungen. Es gibt keine einheitlichen und allgemein akzeptierten Empfehlungen, ob und wann das Screening für einen Vitamin-D-Mangel sinnvoll ist. Ebenso werden die vermeintlich positiven Auswirkungen einer Substitution kontrovers diskutiert. Dieser Artikel bezieht sich auf einen kürzlich veröffentlichten systematischen Review und fasst die aktuelle Datenlage zum Einfluss eines Vitamin-D-Mangels und einer Substitution auf verschiedene Endpunkte bei hospitalisierten internistischen Patienten zusammen. Beobachtungsstudien legen einen Zusammenhang zwischen einem tiefen Vitamin-D-Spiegel und erhöhter Mortalität, verlängerter Hospitalisationsdauer, erhöhter Infektionsrate und Krankheitsschwere sowie vermehrt funktionellen Einschränkungen nahe. Randomisierte kontrollierte Studien, welche den Benefit einer Vitamin-D-Therapie beweisen würden, existieren nur wenige, und diese liefern zudem widersprüchliche Daten. Zusammenfassend können zum jetzigen Zeitpunkt, in Anbetracht der aktuellen kontroversen Datenlage, keine Empfehlungen zu Vitamin-D-Screening und Substitution bei hospitalisierten Patienten gemacht werden. Größere interventionelle Studien sind notwendig, um diese Wissenslücke zu schließen.

Abstract

Vitamin D deficiency is an issue of growing global significance. The increasing prevalence and the more profound knowledge of negative consequences of a deficiency have led to an increased interest in the topic. There are no consistent recommendations about the benefit of vitamin D screening and substitution of a deficiency. This report refers to the results of a recently published systematic review and aims at summarizing current evidence regarding the impact of a vitamin D deficiency and supplementation on various adverse outcomes in the medical inpatient population. Several observational studies have implied that a connection between an inadequate vitamin D status and increased mortality, longer length of stay, higher risk of infections, increased disease severity and functional impairment. There are only few randomized controlled studies investigating this effect reporting contradicting results. In conclusion, screening and supplementation of vitamin D deficiency can currently not be recommended for the medical inpatient population. Larger randomized trials are needed to fill this gap.

Schlüsselwörter

Vitamin-D-Mangel - Hospitalisation - klinische Endpunkte

Keywords

vitamin D deficiency - medical inpatients - clinical outcomes

* gleichwertige Autorenschaft


 

  • Literatur

  • 1 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281
    CrossrefPubMedGoogle Scholar
  • 2 Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006; 81: 353-373
    CrossrefPubMedGoogle Scholar
  • 3 Lips P. Relative value of 25(OH)D and 1,25(OH)2D measurements. J Bone Miner Res 2007; 22: 1668-1671
    CrossrefPubMedGoogle Scholar
  • 4 LeFevre ML. and U.S.P.S.T. Force. Screening for vitamin d deficiency in adults: u.s. Preventive services task force recommendation statement. Ann Intern Med 2015; 162: 133-140
    CrossrefPubMedGoogle Scholar
  • 5 Holick MF et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911-1930
    CrossrefPubMedGoogle Scholar
  • 6 Hintzpeter B et al. Vitamin D status and health correlates among German adults. Eur J Clin Nutr 2008; 62: 1079-1089
    CrossrefPubMedGoogle Scholar
  • 7 LeBlanc ES et al. Screening for vitamin d deficiency: a systematic review for the u.s. Preventive services task force. Ann Intern Med 2015; 162: 109-122
    CrossrefPubMedGoogle Scholar
  • 8 Manson JE, Bassuk SS. Vitamin D research and clinical practice: at a crossroads. JAMA 2015; 313: 1311-1312
    CrossrefPubMedGoogle Scholar
  • 9 Ross AC et al., eds. Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin, D. and Calcium, The National Academies Collection. Reports funded by National Institutes of Health, in Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC).: National Academies Press (US) National Academy of Sciences; 2011
    Google Scholar
  • 10 Sanders KM et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010; 303: 1815-1822
    CrossrefPubMedGoogle Scholar
  • 11 Ness RA, Miller DD, Li W. The role of vitamin D in cancer prevention. Chin J Nat Med 2015; 13: 481-497
    PubMedGoogle Scholar
  • 12 Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol 2008; 37: 113-119
    CrossrefPubMedGoogle Scholar
  • 13 Klassen KM et al. Vitamin D Deficiency May Be Associated with a More Rapid Decline in CD4 Cell Count to <350 cells/muL in Untreated HIV-Infected Adults. Curr HIV Res 2015; 13: 517-523
    CrossrefPubMedGoogle Scholar
  • 14 Watkins RR, Lemonovich TL, Salata RA. An update on the association of vitamin D deficiency with common infectious diseases. Can J Physiol Pharmacol 2015; 93: 363-368
    CrossrefPubMedGoogle Scholar
  • 15 Zittermann A. Vitamin D and cardiovascular disease. Anticancer Res 2014; 34: 4641-4648
    PubMedGoogle Scholar
  • 16 Gradel L et al. Screening and Treatment of Vitamin D Deficiency in the Emergency Department – Is There a Benefit for Medical Inpatients?. Am J Med 2016; 129: 116.e1-116.e34
    CrossrefPubMedGoogle Scholar
  • 17 Amrein K et al. Evidence for a U-shaped relationship between prehospital vitamin D status and mortality: a cohort study. J Clin Endocrinol Metab 2014; 99: 1461-1469
    CrossrefPubMedGoogle Scholar
  • 18 Lange N et al. Pre-hospital vitamin D concentration, mortality, and bloodstream infection in a hospitalized patient population. Am J Med 2013; 126: 640 e19-27
    CrossrefPubMedGoogle Scholar
  • 19 Braun A et al. Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med 2011; 39: 671-677
    CrossrefPubMedGoogle Scholar
  • 20 Amrein K et al. Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA 2014; 312: 1520-1530
    CrossrefPubMedGoogle Scholar
  • 21 Leaf DE et al. Randomized controlled trial of calcitriol in severe sepsis. Am J Respir Crit Care Med 2014; 190: 533-541
    CrossrefPubMedGoogle Scholar
  • 22 Pletz MW et al. Vitamin D deficiency in community-acquired pneumonia: low levels of 1,25(OH)2 D are associated with disease severity. Respir Res 2014; 15: 53
    CrossrefPubMedGoogle Scholar
  • 23 Khalili H, Talasaz AH, Salarifar M. Serum vitamin D concentration status and its correlation with early biomarkers of remodeling following acute myocardial infarction. Clin Res Cardiol 2012; 101: 321-327
    CrossrefPubMedGoogle Scholar
  • 24 Abdelfatah M et al. Low vitamin D level and impact on severity and recurrence of Clostridium difficile infections. J Investig Med 2015; 63: 17-21
    CrossrefPubMedGoogle Scholar
  • 25 van der Wilden GM et al. Vitamin D Status and Severity of Clostridium difficile Infections: A Prospective Cohort Study in Hospitalized Adults. JPEN J Parenter Enteral Nutr 2015; 39: 465-470
    CrossrefPubMedGoogle Scholar
  • 26 Ginde AA, Camargo Jr CA, Shapiro NI. Vitamin D insufficiency and sepsis severity in emergency department patients with suspected infection. Acad Emerg Med 2011; 18: 551-554
    CrossrefPubMedGoogle Scholar
  • 27 Quraishi SA et al. Association between prehospital vitamin D status and hospital-acquired bloodstream infections. Am J Clin Nutr 2013; 98: 952-959
    CrossrefPubMedGoogle Scholar
  • 28 Hu J et al. Changes in the calcium-parathyroid hormone-vitamin d axis and prognosis for critically ill patients: a prospective observational study. PLoS One 2013; 8: e75441
    CrossrefPubMedGoogle Scholar
  • 29 Kiebzak GM et al. Vitamin D status of patients admitted to a hospital rehabilitation unit: relationship to function and progress. Am J Phys Med Rehabil 2007; 86: 435-445
    CrossrefPubMedGoogle Scholar
  • 30 Pellicane AJ et al. Prevalence of 25-hydroxyvitamin D deficiency in the acute inpatient rehabilitation population and its effect on function. Arch Phys Med Rehabil 2011; 92: 705-711
    CrossrefPubMedGoogle Scholar
  • 31 Graedel L, Merker M, Felder S et al. Vitamin D Deficiency Strongly Predicts Adverse Medical Outcome Across Different Medical Inpatient Populations: Results From a Prospective Study. Medicine (Baltimore) 2016; 95: e3533
    CrossrefPubMedGoogle Scholar
  • 32 Bikle DD et al. Assessment of the free fraction of 25-hydroxyvitamin D in serum and its regulation by albumin and the vitamin D-binding protein. J Clin Endocrinol Metab 1986; 63: 954-959
    CrossrefPubMedGoogle Scholar
  • 33 Bikle DD et al. Free 25-hydroxyvitamin D levels are normal in subjects with liver disease and reduced total 25-hydroxyvitamin D levels. J Clin Invest 1986; 78: 748-752
    CrossrefPubMedGoogle Scholar
  • 34 Premaor MO et al. Hyperparathyroidism secondary to hypovitaminosis D in hypoalbuminemic is less intense than in normoalbuminemic patients: a prevalence study in medical inpatients in southern Brazil. Endocrine 2004; 24: 47-53
    CrossrefPubMedGoogle Scholar
  • 35 Bouillon R, Bischoff-Ferrari H, Willett W. Vitamin D and health: perspectives from mice and man. J Bone Miner Res 2008; 23: 974-979
    CrossrefPubMedGoogle Scholar
  • 36 Liu PT et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006; 311: 1770-1703
    CrossrefPubMedGoogle Scholar
  • 37 Nagpal S, Na S, Rathnachalam R. Noncalcemic actions of vitamin D receptor ligands. Endocr Rev 2005; 26: 662-687
    CrossrefPubMedGoogle Scholar
  • 38 DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004; 80 (Suppl. 06) 1689S-1696S
    PubMedGoogle Scholar