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DOI: 10.1055/s-0033-1360073
Epidemiologische Untersuchung zur Häufigkeit eines Vitamin-D-Mangels in Norddeutschland
Epidemiological study on the dimension of vitamin D deficiency in North GermanyPublication History
24 March 2013
21 November 2013
Publication Date:
25 February 2014 (online)
Zusammenfassung
Hintergrund und Fragestellung: Die für eine ausreichende Vitamin-D-Produktion empfohlene Sonnenlichtexposition von 30 Minuten pro Tag wird kaum erreicht. Begründet ist dies vor allem in den Witterungsbedingungen sowie heutigen Lebens- und Arbeitsgewohnheiten. Das Ziel unserer Studie war, das Ausmaß eines Vitamin-D-Mangels in Norddeutschland zu untersuchen.
Methodik: Hierzu wurden retrospektiv die 25-Hydroxy-Vitamin-D-Spiegel von über 99 000 Menschen aus Norddeutschland der Jahre 2008–2011 nach Alter, Geschlecht und Jahreszeit ausgewertet. Eine Einteilung des 25-Vitamin-D-Status erfolgte in suffiziente (> 75 nmol/l) und insuffiziente (50 – 75 nmol/l) Versorgung sowie Vitamin-D-Mangel (< 50 – 27,5 nmol/l) und schweren Vitamin-D-Mangel (< 27,5 nmol/l).
Ergebnisse: Eine Vitamin-D-Unterversorgung konnte in allen Altersgruppen sowohl bei Frauen als auch Männern in Norddeutschland nachgewiesen werden. In den sonnenarmen Monaten war der Vitamin-D-Mangel besonders ausgeprägt. So zeigten in den Monaten Januar bis April mehr als 30 % der untersuchten Personen einen schweren Vitamin-D-Mangel. Die Untersuchung ergab zudem, dass nahezu gleichverteilt über die einzelnen Monate des gesamten Jahres 25-Vitamin-D-Bestimmungen durchgeführt wurden. Insgesamt wurde häufiger bei Älteren als bei Jüngeren diese Untersuchung angefordert. Allerdings konnte gerade auch für das Jugend- und junge Erwachsenenalter ein schwerer Vitamin-D-Mangel bei ca. 25 % der untersuchten Personen detektiert werden.
Folgerungen: Aus den dargestellten Ergebnissen kann die Empfehlung abgeleitet werden, einmal pro Jahr 25-Vitamin-D-Spiegel in den Monaten Januar bis April zu bestimmen, um rechtzeitig einen schweren Mangel zu erkennen und präventiv-therapeutisch eingreifen zu können.
Abstract
Background and purpose: In North Germany, the recommended exposure to sunlight of 30 minutes per day to produce sufficient vitamin D is hardly achieved, in particular due to weather conditions. Moreover, lifestyle and working habits also contribute to this problem. The aim of our study was therefore to investigate the prevalence of the vitamin D deficiency in North Germany.
Methods: For this purpose, 25-hydroxy vitamin D levels of over 98,000 people from North Germany during the time period 2008–2011 were retrospectively analysed based on age, gender and season. 25-vitamin D status was divided into sufficient (> 75 nmol/l) and insufficient (50 to 75 nmol/l) supply as well as vitamin D deficiency (< 50 to 25 nmol/l) and severe vitamin D deficiency (< 25 nmol/l).
Results: An undersupply of vitamin D was evident in all age groups analysed both in women and men in North Germany. Overall, vitamin D deficiency was particularly present during the months with less sunlight: more than 30 % of the people analysed showed a severe vitamin D deficiency in the months January to April. The study also showed that 25-vitamin D tests were almost evenly distributed over the individual months of the whole year and that this analysis was requested more frequently in elderly than in younger people. However, a severe vitamin D deficiency could also be detected in 25 % of the people analysed in the adolescent and young adult age group.
Conclusion: Based on these results, it can be recommended to test 25-vitamin D levels once a year during the months January to April to detect a severe deficiency and to early initiate preventive supplementation.
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Literatur
- 1 Absoud M, Cummins C, Lim MJ et al. Prevalence and predictors of vitamin D insufficiency in children: a Great Britain population based study. PLoS One 2011; 6: e22179
- 2 Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab 2010; 95: 471-478
- 3 Aloia JF. Clinical Review: The 2011 report on dietary reference intake for vitamin D: where do we go from here?. J Clin Endocrinol Metab 2011; 96: 2987-2996
- 4 Andersen R, Brot C, Jakobsen J et al. Seasonal changes in vitamin D status among Danish adolescent girls and elderly women: the influence of sun exposure and vitamin D intake. Eur J Clin Nutr 2013; 67: 270-274
- 5 Bouillon R, Carmeliet G, Verlinden L et al. Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev 2008; 29: 726-776
- 6 Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009; 339: b3692
- 7 Bischoff-Ferrari HA, Willett WC, Wong JB et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 2009; 169: 551-561
- 8 Bolland MJ, Grey A, Avenell A et al. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ 2012; 342: d2040
- 9 Brown J, Ignatius A, Amling M et al. New perspectives on vitamin D sources in Germany based on a novel mathematical bottom-up model of 25(OH)D serum concentrations. Eur J Nutr 2012; [epub ahead of print]
- 10 Cavalier E, Fache W, Souberbielle JC. A Randomised, Double-Blinded, Placebo-Controlled, Parallel Study of Vitamin D3 Supplementation with Different Schemes Based on Multiples of 25,000 IU Doses. Int J Endocrinol 2013; 2013: 327265
- 11 Current controlled trials Ltd, London UK. http://www.controlled-trials.com/ISRCTN46328341 Letzter Besuch der Seite am 25.09.2013
- 12 Deutscher Dachverband Osteologie e.V., Bad Kreuznach, Germany. DVO-Leitlinie zur Prophylaxe, Diagnostik und Therapie bei Erwachsenen. Osteologie 2009; 4: 304-324
- 13 Deutsche Gesellschaft für Ernährung e.V., Bonn, Germany. Stellungnahme 2011: Vitamin D und Prävention ausgewählter chronischer Krankheiten. http://www.dge.de/pdf/ws/DGE-Stellungnahme-Vitamin D-111220.pdf Letzter Besuch der Seite am 25.09.2013
- 14 Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V., Berlin, Germany. Stellungnahme 2011: Vitamin D-Versorgung im Säuglings-, Kindes- und Jugendalter. http://www.dgkj.de/wissenschaft/stellungnahmen/meldung/meldungsdetail/vitamin_d_versorgung_im_saeuglings_kindes_und_jugendalter/ Letzter Besuch der Seite am 25.09.2013
- 15 Dror Y, Giveon SM, Hoshen M et al. Vitamin D levels for preventing acute coronary syndrome and mortality: evidence of a nonlinear association. J Clin Endocrinol Metab 2013; 98: 2160-2167
- 16 Durup D, Jorgensen HL, Christensen J et al. A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study. J Clin Endocrinol Metab 2012; 97: 2644-2652
- 17 Gonzalez-Gross M, Valtuena J, Breidenassel C et al. Vitamin D status among adolescents in Europe: the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Br J Nutr 2012; 107: 755-764
- 18 Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004; 80: 1678S-1688S
- 19 Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006; 116: 2062-2072
- 20 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281
- 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: 1911-1930
- 22 Hintzpeter B, Mensink GB, Thierfelder W et al. Vitamin D status and health correlates among German adults. Eur J Clin Nutr 2008; 62: 1079-1089
- 23 Hintzpeter B, Scheidt-Nave C, Muller MJ et al. Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr 2008; 138: 1482-1490
- 24 Jones G, Strugnell SA, DeLuca HF. Current understanding of the molecular actions of vitamin D. Physiol Rev 1998; 78: 1193-1231
- 25 Larsson SC. Are calcium supplements harmful to cardiovascular disease? Comment on: "Dietary and supplemental calcium intake and cardiovascular diseases mortality: The National Institutes of Health-AARP Diet and Health Study". JAMA Intern Med 2013; 173: 647-648
- 26 Llewellyn DJ, Lang IA, Langa KM et al. Vitamin D and risk of cognitive decline in elderly persons. Arch Intern Med 2010; 170: 1135-1141
- 27 Maxwell JD. Seasonal variation in vitamin D. Proc Nutr Soc 1994; 53: 533-543
- 28 Mithal A, Wahl DA, Bonjour JP et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009; 20: 1807-1820
- 29 National Institute of Health, Bethesda, Maryland, USA. http://clinicaltrials.gov/show/NCT01169259 Letzter Besuch der Seite am 25.09.2013
- 30 Priemel M, von Domarus C, Klatte TO et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res 2010; 25: 305-312
- 31 Reusch J, Ackermann H, Badenhoop K. Cyclic changes of vitamin D and PTH are primarily regulated by solar radiation: 5-year analysis of a German (50 degrees N) population. Horm Metab Res 2009; 41: 402-407
- 32 Souberbielle JC, Body JJ, Lappe JM et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Autoimmun Rev 2010; 9: 709-715
- 33 Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 1999; 69: 842-856
- 34 Visser M, Deeg DJ, Puts MT et al. Low serum concentrations of 25-hydroxyvitamin D in older persons and the risk of nursing home admission. Am J Clin Nutr 2006; 84: 616-622
- 35 Wacker M, Holick MF. Vitamin D – effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 2013; 5: 111-148
- 36 Wahl DA, Cooper C, Ebeling PR et al. A global representation of vitamin D status in healthy populations. Arch Osteoporos 2012; 7: 155-172
- 37 Thuesen B, Husemoen L, Fenger M et al. Determinants of vitamin D status in a general population of Danish adults. Bone 2012; 50: 605-610
- 38 Tolppanen AM, Fraser A, Fraser WD et al. Risk factors for variation in 25-hydroxyvitamin D(3) and D(2) concentrations and vitamin D deficiency in children. J Clin Endocrinol Metab 2012; 97: 1202-1210
- 39 Zittermann A. The estimated benefits of vitamin D for Germany. Mol Nutr Food Res 2010; 54: 1164-1171
- 40 Zittermann A, Prokop S, Gummert JF et al. Safety issues of vitamin D supplementation. Anticancer Agents Med Chem 2013; 13: 4-10