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© Borgis - Postępy Nauk Medycznych 6/2013, s. 393-395
*Andrzej Boszczyk, Stanisław Pomianowski
Powszechny niedobór witaminy D u pracowników oddziału ortopedycznego
Vitamin D deficiency is common in orthopaedic ward staff
Department of Traumatology and Orthopaedics, The Medical Centre of Postgraduate Education, prof. Adam Gruca Clinical Hospital, Otwock
Head of Department: prof. Stanisław Pomianowski, MD, PhD
Streszczenie
Wstęp. Niedobór witaminy D jest powszechny w wielu populacjach, a konsekwencje tego niedoboru wykraczają poza układ kostny.
Cel pracy. Ocena stężenia witaminy D u pracowników oddziału ortopedycznego w okresie jego fizjologicznego minimum.
Materiał i metody. Wczesną wiosną przebadano asymptomatycznych 18 osób (10 kobiet, 8 mężczyzn) w wieku od 30 do 55 lat (średnio 39,8 lat) będących pracownikami szpitala (pielęgniarki i lekarze). U wszystkich osób wykonano oznaczenie stężenia 25(OH)D we krwi.
Wyniki. W badanej grupie stwierdzono średnie stężenie 25(OH)D równe 14,25 ng/ml (odchylenie standardowe = 5,55, mediana = 12,85). U żadnego z badanych nie stwierdzono zalecanego stężenia witaminy D, co oznacza 100% rozpowszechnienie niedoboru.
Wnioski:
1. W badanej wczesną wiosną grupie lekarzy i pielęgniarek stwierdzono 100% rozpowszechnienie niedoboru witaminy D.
2. Niedobór witaminy D jest powszechnym i łatwo korygowalnym zaburzeniem. Suplementacja witaminy D jest konieczna także u osób profesjonalnie zajmujących się medycyną.
Summary
Introduction. Vitamin D deficiency is common in many populations and its health are not limited to bone.
Aim. To determine vitamin D concentrations at its minimum in orthopaedic ward staff.
Material and methods. In early spring we measured 25(OH)D concentrations in 18 asymptomatic health professionals (nurses and physicians, 10 women, 8 men) 30-55 years of age (average 39.8).
Results. We observed mean vitamin D concentration of 14.25 ng/ml (SD = 5.55, median = 12.85). None of the subjects reached a normal concentration, which means 100% deficiency in this population.
Conclusions:
1. In a group of physicians and nurses investigated in early spring we observed 100% of subjects with vitamin D deficiency.
2. Vitamin D deficiency is common and easily correctable. Vitamin D supplementation is indicated also in medical professionals.
Słowa kluczowe: witamina D, niedobór, konsekwencje.
Introduction
Reduced concentrations of vitamin D were observed in numerous populations around the world (1-5). High prevalence of deficiency was noted in elderly, in patients with reduced sun exposure due to cultural reasons, in overweight patients, in black-sinned individuals and also in physicians in training (6, 7) (American data). Vitamin D is synthesized after exposition to sun (wavelength 290-315 nm – UVB). At the geographical latitude that Poland is situated synthesis is not observed between October and March and even in summer may be ineffective (8) for obtaining desired concentrations. Additionally, individuals working indoors (physicians, nurses) are not exposed to sun in the midday period.
In vitamin D deficiency intestinal resorption of calcium is reduced. Reduced serum calcium concentration leads to increase in parathyroid hormone excretion, which in turn mobilizes calcium from bone leading to abnormal bone mineralization. Vitamin D is also a hormone active in muscle tissue and it’s deficiency leads to proximal myopathy (9).
Active form of vitamin D – 1.25(OH)2D3 – is a hormone directly influencing gene expression (10). Epidemiological data shows, that adequate concentration of vitamin D is related to reduced risk of death due to colon cancer, prostate cancer, breast cancer and pancreatic cancer (11-13). Reduced concentration of vitamin D has been linked to autoimmune diseases: type I diabetes mellitus, sclerosis multiplex, Crohn disease and rheumatoid arthritis. Patients with vitamin D deficiency are at greater risk of cardiovascular diseases, including hypertension. Correction of deficiency leads to reduction in blond pressure of 6 mmHg (14). Vitamin D has been linked to type II diabetes, resistance to insulin and metabolic syndrome (15).
Aim
This study was performed to asses vitamin D concentrations – as 25(OH)D – among healthy employees of orthopedic hospital. The sampling was performed in the early spring, when yearly minimum of concentration is located. This study aimed to show that among healthy medical professionals vitamin D deficiency can be observed and to prompt the subjects to introduce supplementation.
Material and methods
Eighteen asymptomatic subjects were enrolled, among them 10 women and 8 men, 6 nurses and 12 physicians, aged 30 to 55 years (mean 39.8 years) employed at prof. Adam Gruca Clinical Hospital in Otwock. Samples were collented in 13th and 14th week of the year. One subject (marked with square in figure 1) used oral supplementation of vitamin D (cholecalciferol 1500 units daily). Two subjects declared high sun exposure and another two spent at least one week in the sun reach-country in the 3 months preceding the investigation.
Fig. 1. Results in the investigated group. Vertical axis – 25(OH)D concentration (ng/ml). Grey area corresponds to normal values. Subject marked with square used supplementation.
After informed consent was obtained 5 mL of venous blood was drawn. After centrifugation serum was freezed in -38°C and then transferred for testing with LIAISON test (DiaDorin). LIAISON is a indirect competitive test employing technology of chemiluminescent immunologic testing. It measures combined concentration of 25(OH)D2 and 25(OH)D3 form of vitamin D (16-18).
Results
Mean concentration of 25(OH)D was 14.25 ng/mL (standard deviation = 5.55, median = 12.85).
In this group sampled in early spring no subject achieved normal concentration of 25(OH)D (fig. 1). In the subject that used supplementation, the concentration was relatively high, but didn’t reach normal values (fig. 1, square).
In this group of symptom-free subjects severe deficiency of vitamin D was observed in 28%. Literature search revealed that such deep deficiency leads to: elevated PTH secretion, reduced calcium absorption, osteomalacia and myopathy (tab. 1) (19). In 56% of subjects moderate deficiency was observed, which leads to elevation of PTH concentration, reduced intestinal calcium absorption and subclinical myopathy. Another 17% of subjects mild deficiency leading to mild elevation of PTH concentration was observed.
Table 1. Terminology describing status of vitamin D nutrition (25(OH)D concentration) (19).
 25(OH)D (ng/ml)Percentage
Severe deficiency0-1028%
Moderate deficiency10-2056%
Light deficiency20-3017%
Normal concentration30-800%
Discussion
The direct conclusion of the investigation is revealing, that all subjects require treatment of vitamin D deficiency with subsequent supplementation at least in the winter-spring period. Lately the issue of ineffective skin synthesis in the summer months has been studied (20). This is caused by high geographical lattitude and the life style leading to reduced sun exposure. Probably supplementation should be encouraged also in summer months.
Physicians and nurses o of the orthopaedic ward have easy access to musculoskeletal information. It has been shown thant this access does not lead to behavior leading to proper vitamin D concentration. Even the subject using supplementation didn’t achieve a target concentration of vitamin D.
An important limitation of this study was a limited number of subjects, which was caused by the availability of staff in the short period of time.
A studied population may not be representative to whole population of hospital employees as only consenting individuals were studied. There are, however, no clues to the non-representativeness of the studied population (standard diet, two subjects declared high sun exposure, two subjects travelled to sun-reach regions).
In authors opinion results can be generalized do all employees of our and other hospitals. If no active form of supplementation of vitamin D is undertaken, than at the end of the winter more or less pronounced deficiency exists with all its health consequences (15).
Vitamin D deficiency is an easily correctable abnormality with important health consequences (19). Spreading this knowledge among health professionals is the first step to popularizing it in the whole society.
Conclusions
1. In a group of physicians and nurses studied in the early spring 100% prevalence of vitamin D deficiency was observed.
2. Vitamin D deficiency is common and easily correctable abnormality. Health professionals are in need of vitamin D supplementation.
Piśmiennictwo
1. Thomas MK, Lloyd-Jones DM, Thadhani RI et al.: Hypovitaminosis D in medical inpatients. N Engl J Med 1998; 338: 777-783.
2. van Schoor NM, Lips P: Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 2011; 25: 671-680.
3. Lips P: Worldwide status of vitamin D nutrition. J Steroid Biochem Mol Biol 2010; 121: 297-300.
4. Singhellakis PN, Malandrinou FCh, Psarrou CJ et al.: Vitamin D deficiency in white, apparently healthy, free-living adults in a temperate region. Hormones 2011; 10: 131-143.
5. Merewood A, Mehta SD, Grossman X et al.: Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers. Pediatrics 2010; 125: 640-647.
6. Growdon AS, Camargo CA Jr, Clark S et al.: Serum 25-hydroxyvitamin D levels among Boston trainee doctors in winter. Nutrients 2012; 4: 197-207.
7. Haney EM, Stadler D, Bliziotes MM: Vitamin D insufficiency in internal medicine residents. Calcif Tissue Int 2005; 76: 11-16.
8. Krzyścin JW, Jarosławski J, Sobolewski PS: A mathematical model for seasonal variability of vitamin D due to solar radiation. J Photochem Photobiol B 2011; 105: 106-112.
9. Vieth R: Why the minimum desirable serum 25-hydroxyvitamin D level should be 75 nmol/L (30 ng/ml). Best Pract Res Clin Endocrinol Metab 2011; 25: 681-691.
10. Holick MF: Vitamin D: a d-lightful solution for health. J Investig Med 2011; 59: 872-880.
11. Garland CF, Gorham ED, Mohr SB et al.: Vitamin D and prevention of breast cancer: pooled analysis. J Steroid Biochem Mol Biol 2007; 103: 708-711.
12. Lappe JM, Travers-Gustafson D, Davies KM et al.: Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007; 85: 1586-1591.
13. Gorham ED, Garland CF, Garland FC et al.: Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol 2005; 97: 179-194.
14. Pilz S, Tomaschitz A, März W et al.: Vitamin D, cardiovascular disease and mortality. Clin Endocrinol (Oxf) 2011; 75: 575-584.
15. Holick MF: Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004; 80: 1678-1688.
16. Horst RL: Exogenous versus endogenous recovery of 25-hydroxyvitamins D2 and D3 in human samples using high-performance liquid chromatography and the DiaSorin LIAISON Total-D Assay. Journal of Steroid Biochemistry & Molecular Biology 2010; 121: 180-182.
17. Wallace AM, Gibson S, de la Hunty A et al.: Measurement of 25-hydroxyvitamin D in the clinical laboratory: current procedures, performance characteristics and limitations. Steroids 2010; 75: 477-488.
18. Hollis BW: Editorial: The Determination of Circulating 25-Hydroxyvitamin D: No Easy Task. The Journal of Clinical Endocrinology & Metabolism 2004; 89: 3149-3151.
19. Płudowski P, Kryśkiewicz E, Karczmarewicz E: Zasady suplementacji i standard oceny zaopatrzenia organizmu w witaminę D w świetle jej działania plejotropowego. Post N Med 2012; 25: 265-273.
20. Hall LM, Kimlin MG, Aronov PA et al.: Vitamin D intake needed to maintain target serum 25-hydroxyvitamin D concentrations in participants with low sun exposure and dark skin pigmentation is substantially higher than current recommendations. J Nutr 2010; 140: 542-550.
otrzymano: 2013-03-25
zaakceptowano do druku: 2013-05-08

Adres do korespondencji:
*Andrzej Boszczyk
Department of Traumatology and Orthopaedics Medical Centre of Postgraduate Education
ul. Konarskiego 13, 05-400 Otwock
tel.: +48 (22) 779-40-31
e-mail: boszczyk@gazeta.pl

Postępy Nauk Medycznych 6/2013
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