fibroblast growth factor, FGF D 25-OH Vit D D 25-OH Vit D [2] D 200 IU D D 25- OH Vit D D [3] 維生素 D 缺乏 D vitamin D deficiency 25-OH Vit D 10 ng/ml 25

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D 家庭醫業 1 2 3 4 前言維生素 D 的來源及合成 D vitamin D deficiency D D vitamin D insufficiency D D D 1 台北榮民總醫院家庭醫學部住院醫師 2 台北榮民總醫院家庭醫學部住院醫師 3 台北榮民總醫院家庭醫學部主治醫師 4 台北榮民總醫院家庭醫學部主任國立陽明大學醫學系教授兼家庭醫學科主任 vitamin D

1 D 家庭醫業前言維生素 D 的來源及合成 D vitamin D deficiency D D vitamin D insufficiency D D D 1 台北榮民總醫院家庭醫學部住院醫師 2 台北榮民總醫院家庭醫學部住院醫師 3 台北榮民總醫院家庭醫學部主治醫師 4 台北榮民總醫院家庭醫學部主任國立陽明大學醫學系教授兼家庭醫學科主任 vitamin D deficiency, vitamin D insufficiency, bone health, vitamin D supplementation, vitamin D daily requirement D IU( ) D1 7- (7-dehydrocholesterol) B 290 ~ 315 nm 7-dehydrocholesterol D3 D(1,25- dihydroxyvitamin D, 1,25-(OH)2 Vit D [1] ergosterol D2 lanolin 7-dehydrocholesterol D3 D 25-OH Vit D 25-hydroxyvitamin D-1 hydroxylase CYP27B1 D 1,25-(OH)2 Vit D 14 家庭醫學與基層醫療第一期

2 fibroblast growth factor, FGF D 25-OH Vit D D 25-OH Vit D [2] D 200 IU D D 25- OH Vit D D [3] 維生素 D 缺乏 D vitamin D deficiency 25-OH Vit D 10 ng/ml 25 nmol/l [2] [4] 25-OH Vit D 10 ng/ml phenobarbital, phenytoin [5] 界定維生素 D 不足 D 25-OH Vit D 10 ~ 30 ng/ml 25- OH Vit D 30 ng/ml 25-OH Vit D [6] 25- (OH) Vit D 25-OH Vit D 20% 30 D 25-OH Vit D 25-OH Vit D 25-OH Vit D BMI 25-OH Vit D 25-OH Vit D 10~20 ng/ml [5] 家庭醫學與基層醫療第ㄧ期 15

3 D 25-OH Vit D OH Vit D 10 ng/ml D 20 ng/ml [7] 25-OH Vit D 30~76 ng/ml 50-80% [8] OH Vit D 24 ng/ml WHO D [9] 25-OH Vit D 30 ng/ml 1 PTH 25-OH Vit D 30 ng/ml [10] 2 25-OH Vit D 30 ng/ml [11] PTH 25-OH Vit D [10] PTH 25-OH Vit D ng/ml 25-OH Vit D PTH 25-OH Vit D 25-OH Vit D ng/ml 維生素 D 與骨質健康 D bone health outcomes D 25-OH Vit D PTH 2004 (NHANES- III) 13, OH Vit D 2009 (Agency for Healthcare Research and Quality, AHRQ 25- OH Vit D D D 2007 Tang Eslick meta analysis mg 800 IU 2009 (Cochrane meta-analysis) 10 D 8 D D 16 家庭醫學與基層醫療第一期

4 [12] 25-OH Vit D 16~20 ng/ml 25-OH Vit D 24~26 ng/ml Institute of Medicine 25-OH Vit D 20 ng/ml 50 nmol/l [13] (Endocrine Society) (International Osteoporosis Foundations, IOF) 30 ng/ml [14,15] 維生素 D 與其他健康議題 D systemic review/ meta-analysis D 25-OH Vit D 維生素 D 的參考建議攝取量 D D3 cholecalciferol 1 g=40 IU Institute of Medicine 2011 D Recommended Dietary Allowances, RDA IU IU [13] 2012 Dietary Reference Intakes, DRIs D adequate intake, AI 400 IU IU 200 IU Tolerable Upper Intake Levels, UL IU IU [16] 結語家庭醫學與基層醫療第ㄧ期 17

5 OH Vit D 20 ng/ml D 25-OH Vit D 20 ng/ml 10:00-15: D 參考資料 1. Szulc P, Duboeuf F, Marchand F, Delmas PD: Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr 2004; 80: Sharkey JR, Giuliani C, Haines PS, Branch LG, Busby-Whitehead J, Zohoori N: Summary measure of dietary musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes is associated with lower-extremity physical performance in homebound elderly men and women. Am J Clin Nutr 2003; 77: IOM report on calcium and vitamin D. Washington, DC: Institute of Medicine, edu/vitamind. Accessed March 29, Mithal A, Wahl DA, Bonjour JP et al: Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009; 20: Holick MF: Vitamin D deficiency. N Engl J Med 2007; 357: Binkley N, Krueger D, Lensmeyer G: 25-hydroxyvitamin D measurement, 2009: a review for clinicians. J Clin Densitom 2009; 12: WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of a WHO scientific group. Geneva: World Health Organization, Holick MF, Siris ES, Binkley N et al: Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005; 90: National Health and Nutrition Examination Survey. What we eat in America, usda.gov/ba/bhnrc/fsrg. Accessed March 29, Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G: Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 2005; 294: Chapuy MC, Preziosi P, Maamer M et al.: Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997; 7: Rosen CJ: Clinical practice. Vitamin D insufficiency. N Engl J Med 2011; 364: Ross AC, Taylor CL, Yaktine AL, Del Valle HB: 5. Dietary Reference Intakes for Adequacy: Calcium and Vitamin D. In: Dietary Reference Intakes for Calcium and Vitamin D Insititute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Washington (DC): National Academies Press (US); books/nbk56056/. Accessed March 29, Dawson-Hughes B, Mithal A, Bonjour JP et al.: IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 2010; 21: Holick MF, Binkley NC, Bischoff-Ferrari HA et al.: Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: (DRIs) 家庭醫學與基層醫療第一期

, %, 3.01%, BMI BMI 24 BMI 28 85cm 80cm ii

, %, 3.01%, BMI BMI 24 BMI 28 85cm 80cm ii 2003 4 , 2 22.4%, 3.01%, 2002 4 21 BMI BMI 24 BMI 28 85cm 80cm 2003 3 10 ii *, iii 1 1 2 1 2.1 2 2.2 3 2.3 3 3 4 3.1 5 3.2 5 4 6 4.1 6 4.2 7 4.2.1 7 4.2.2 8 4.2.3 8 5 9 5.1 9 5.1.1 10 5.1.2 2 11 5.1.3