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 deficiency, vitamin D insufficiency, bone health, vitamin D supplementation, vitamin D daily requirement D 5 10 3000 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
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
D 25-OH Vit D 2003 25-OH Vit D 10 ng/ml D 20 ng/ml [7] 25-OH Vit D 30~76 ng/ml 50-80% [8] 2005 2006 25-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 20 30 ng/ml 25-OH Vit D PTH 25-OH Vit D 25-OH Vit D 20 30 ng/ml 維生素 D 與骨質健康 D bone health outcomes D 25-OH Vit D PTH 2004 (NHANES- III) 13,432 25- OH Vit D 2009 (Agency for Healthcare Research and Quality, AHRQ 25- OH Vit D D D 2007 Tang Eslick meta analysis 29 1200mg 800 IU 2009 (Cochrane meta-analysis) 10 D 8 D D 16 家庭醫學與基層醫療 第一期
[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 1 70 600 IU 70 800 IU [13] 2012 Dietary Reference Intakes, DRIs -- 1 51 D adequate intake, AI 400 IU 1 50 200 IU 200 IU Tolerable Upper Intake Levels, UL 1 1000 IU 1 2000 IU [16] 結語 家庭醫學與基層醫療 第ㄧ期 17
2003 25-OH Vit D 20 ng/ml D 25-OH Vit D 20 ng/ml 10:00-15:00 10-15 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; 80:496-503. 2. 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; 77:847-56. 3. IOM report on calcium and vitamin D. Washington, DC: Institute of Medicine, 2010. http://www.iom. edu/vitamind. Accessed March 29, 2013. 4. Mithal A, Wahl DA, Bonjour JP et al: Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009; 20:1807-20. 5. Holick MF: Vitamin D deficiency. N Engl J Med 2007; 357:266-81. 6. Binkley N, Krueger D, Lensmeyer G: 25-hydroxyvitamin D measurement, 2009: a review for clinicians. J Clin Densitom 2009; 12:417-27. 7. 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, 2003. 8. 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; 90:3215-24. 9. National Health and Nutrition Examination Survey. What we eat in America, 2005-2006. http://www.ars. usda.gov/ba/bhnrc/fsrg. Accessed March 29, 2013. 10. Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G: Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 2005; 294:2336-41. 11. Chapuy MC, Preziosi P, Maamer M et al.: Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997; 7:439-43. 12. Rosen CJ: Clinical practice. Vitamin D insufficiency. N Engl J Med 2011; 364:248-54. 13. 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); 2011. http://www.ncbi.nlm.nih.gov/ books/nbk56056/. Accessed March 29, 2013. 14. Dawson-Hughes B, Mithal A, Bonjour JP et al.: IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 2010; 21:1151-54. 15. 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; 96:1911-30. 16. (DRIs) 2013 3 29 http://consumer.fda.gov.tw/files/doc/.pdf. 18 家庭醫學與基層醫療 第一期