Vitamin D in Critically Ill Patients - From Molecular Damage Interactions to Clinical Outcomes Benefits. When, Why, How?

Open access

Abstract

Vitamin D - „the sunshine vitamin” is essential for the good functioning of the human body. The most important forms of the vitamin D are the vitamin D2 and the vitamin D3, both biologically inactived. Vitamin D can come from: diet or nutritiv suplimentts and skin. The activation of vitamin D is effect in two steps to the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D]. The biological actions of Vitamin D involve regulation of gene expression at the transcriptional level and are mediated through binding to a Vitamin D Receptor (VDR). Vitamin D has multiple roles: hormonale/ nonhormonale, skeletale/nonscheletale, genomice/nongenomice. Interesting is inversely corelation between Vitamin D and total body fat (BMI) and correlation between Vitamin D and cognitive impairment, especially Alzheimer Disease or delirium during hospitalisation. The curent recomandations regarding the supplying with Vitamin D are different for regions of the globe, also differ depending on the baseline serum Vitamin D and on the desired effect. So, potential nonskeletal effects occur at levels >30ng/ml, above 50-75ng/ml, serum level who should become the target of the supplementation. The loading dose should be considered perioperatively for rapid effects. In conclusion, Vitamin D is more than just a vitamin. It is a substance with multiple roles in body’s economy, and in recent years there has been an interest in the relation be tween vitamin D deficiency and obesity or cognitive impairment. The majority of the data supports association, not causation, of low vitamin D levels. In other words, much of data does not clearly support the idea that vitamin D supplementation in a patient with low vitamin D levels reduces the risk of these diseases. But, the supplimentation is very easy and no harm might be done.

1. Wolf G. The Discovery of Vitamin D: The Contribution of Adolf Windaus. J Nutr 2004;134(6):1299-302

2. Bover J, Egido J, Fernández-Giráldez E, Praga M, Solozábal-Campos C, Torregrosa JV, et al. Vitamin D, vitamin D receptor and the importance of its activation in patients with chronic kidney disease. Nefrologia 2015;35(1):28-41

3. Thacher TD, Fischer PR, Pettifor JM. Vitamin D treatment in calcium-deficiency rickets: a randomised controlled trial. Arch Dis Child 2014;99(9):807-11

4. Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007;(158):1-235

5. Laughlin JM, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Investigation 1985;76(4):1536 -1538

6. Strushkevich N, Usanov SA, Plotnikov AN, Jones G, Park HW. Structural analysis of CYP2R1 in complex with vitamin D3. Jour- nal of Molecular Biology 2008;380(1):95- 106

7. Al Mutair AN, Nasrat GH, Russell DW. Mutation of the CYP2R1 vitamin D 25-hydroxylase in a Saudi Arabian family with severe vitamin D deficiency. J Clin Endocrinol 2012;97(10):E2022-5.

8. Urbschat A, Paulus P, von Quernheim QF, Brück P, Badenhoop K, Zeuzem S, et al. Vitamin D hydroxylases CYP2R1, CYP27B1 and CYP24A1 in renal cell carcinoma. Eur J Clin Invest 2013;43(12):1282-90

9. Penna-Martinez M, Ramos-Lopez E, Stern J, Kahles H, Hinsch N, Hansmann ML, et al. Impaired vitamin D activation and association with CYP24A1 haplotypes in differentiated thyroid carcinoma. Thyroid 2012;22(7):709-16

10 Sakaki T, Kagawa N, Yamamoto K, Inouye K. Metabolism of vitamin D3 by cytochromes P450. Front Biosci 2005;10:119-34

11. Quarles LD. Endocrine functions of bone in mineral metabolism regulation. Journal of Clinical Investigation 2008;118(12):3820-8

12. Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab 2010;95:471-478

13. Hewison M. Vitamin D and innate immunity. Curr Opin Investig Drugs 2008;9:485-490

14. Chun RF, Adams JS, Hewison M. Back to the future: a new look at ‘old’ vitamin D. J Endocrinol 2008;198:261-26

15. Wacker M, Holick MF. Vitamin D - effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 2013;5:111-148

16. Zhou Y, Zhao LJ, Xu X, Ye A, Travers-Gustafson D, Zhou B, et al. DNA methylation levels of CYP2R1 and CYP24A1 predict vitamin D response variation. J Steroid Biochem Mol Biol 2014;144:207-14

17. Wagner D, Hanwell HE, Schnabl K, Yazdanpanah M, Kimball S, Fu L, et al. The ratio of serum 24,25-dihydroxyvitamin D(3) to 25-hydroxyvitamin D(3) is predictive of 25-hydroxyvitamin D(3) response to vitamin D(3) supplementation. J Steroid Biochem Mol Biol 2011;126(3-5):72-7

18. Fu L, Yun F, Oczak M, Wong BY, Vieth R, Cole DE. Common genetic variants of the vitamin D binding protein (DBP) predict differences in response of serum 25-hydroxyvitamin D [25(OH)D] to vitamin D supplementation. Clin Biochem 2009;42(10- 11):1174-7

19. Blum M, Dallal GE, Dawson-Hughes B. Body size and serum 25 hydroxy vitamin D response to oral supplements in healthy older adults. J Am Coll Nutr 2008;27(2):274-9

20. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-1930

21. Trochoutsou AI, Kloukina V, Samitas K, Xanthou G. Vitamin-D in the Immune System: Genomic and Non-Genomic Actions. Mini Rev Med Chem 2015;15(11):953-63

22. Hewison M. An update on vitamin D and human immunity. Clin Endocrinol (Oxf) 2012;76(3):315-25

23. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2014;(1):CD007470

24. Seo JA, Eun CR, Cho H, Lee SK, Yoo HJ, Kim SG, et al. Low vitamin D status is associated with nonalcoholic Fatty liver disease independent of visceral obesity in Korean adults. PLoS One 2013;8(10):e75197

25. Bhatt SP, Nigam P, Misra A, Guleria R, Qadar Pasha MA. Independent associations of low 25 hydroxy vitamin D and high parathyroid hormonal levels with nonalcoholic fatty liver disease in Asian Indians residing in north India. Atherosclerosis 2013;230(1):157-63

26. Saliba W, Barnett-Griness O, Rennert G. The relationship between obesity and the increase in serum 25(OH)D levels in response to vitamin D supplementation. Osteoporos Int 2013;24(4):1447-54

27. Shab-Bidar S, Bours S, Geusens PP, Kessels AG, van den Bergh JP. Serum 25(OH) D response to vitamin D3 supplementation: a meta-regression analysis. Nutrition 2014;30(9):975-85

28. Gallagher JC, Yalamanchili V, Smith LM. The effect of vitamin D supplementation on serum 25(OH)D in thin and obese women. J Steroid Biochem Mol Biol 2013;136:195- 200

29. Annweiler C, Dursun E, Féron F, Gezen-Ak D, Kalueff AV, Littlejohns T, et al. Vitamin D and cognition in older adults: international consensus guidelines. Geriatr Psychol Neuropsychiatr Vieil 2016;14(3):265-73

30. Lu’o’ng KV, Nguyen LT. The Role of Vitamin D in Alzheimer’s disease: Possible Genetic and Cell Signaling Mechanisms. AM J Alzheimer’s Disease and Other Dementias 2013;28(2):126-36

31. Shen L, Ji HF. Vitamin D deficiency is associated with increased risk of Alzheimer’s disease and dementia: evidence from me- ta-analysis. Nutr J 2015;14:76-81

32. Chaves M, Toral A, Bisonni A, Rojas JI, Fernández C, Basallo MJ, et al. Treatment with vitamin D and slowing of progression of severe stage of Alzheimer s disease. Vertex 2014;25(114):85-91

33. Soni M, Kos K, Lang IA, Jones K, Melzer D, Llewellyn DJ. Vitamin D and cognitive function. Scand J Clin Lab Invest Suppl 2012;243:79-82

34. Annweiler C, Llewellyn DJ, Beauchet O. Low serum vitamin D concentrations in Alzheimer’s disease: a systematic review and meta-analysis. J. Alzheimer’s Disease 2013;33(3):659-674

35. Kalueff AV, Tuohimaa P. Neurosteroid hormone vitamin D and its utility in clinical nutrition. Curr Opin Clin Nutr Metab Care 2007;10(1):12-19

36. Amraei M, Mohamadpour R, Moayeri A, Abbasi N, Shirzadpour E, Mohamadpour M. Vitamin D and its association with memory and learning: A systematic review and meta-analysis. Biomedical Research 2017;28(17):7427-7433

37. Al-Tarrah K, Hewison M, Moiemen N, Lord JM. Vitamin D status and its influence on outcomes following major burn injury and critical illness. Burns Trauma 2018;6:11

38. Hshieh TT, Fong TG, Marcantonio ER, Inouye SK. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 2008;63(7):764-72

39. Ford J, Hategan A, Bourgeois JA, Tisi DK, Xiong GL. Hypovitaminosis D in Delirium: a Retrospective Cross-sectional Study. Can Geriatr J 2013;16(4):186-191

40. Quraishi SA, Litonjua AA, Elias KM, Gibbons FK, Giovannucci E, Camargo CA, et al. Association between pre-hospital vitamin D status and hospital-acquired new-onset delirium. Br J Nutr 2015;113(11):1753-1760

41. Findlay M, Anderson J, Roberts S, Almond A and Isles C. Treatment of vitamin D deficiency: divergence between clinical practice and expert advice. Postgraduate Medical Journal 2012;88(1039):255-260.

42. Shab-Bidar S, Bours SP, Geusens PP, van der Velde RY, Janssen MJ, van den Bergh JP. Suboptimal effect of different vitamin D3 supplementations and doses adapted to baseline serum 25(OH)D on achieved 25(OH)D levels in patients with a recent fracture: a prospective observational study. Eur J Endocrinol 2013;169(5):597-604

43. Zhang Y, Shan GJ, Zhang YX, Cao SJ, Zhu SN, Li HJ, et al. First Study of Perioperative Organ Protection (SPOP1) Investigators. Preoperative vitamin D deficiency increases the risk of postoperative cognitive dysfunction: a predefined exploratory sub-analysis. Acta Anaesthesiol Scand 2018;62(7):924-935

44. Torbergsne AC, Watne LO, Frihagen F, Wylle TB, Brugaard A, Mowe M. Vitamin deficiency as a risk factor for delirium. European Geriatric Medicine 2015;6(4):314-318

45. Henrikson NB, Morrison CC, Blasi PR, Nguyen M, Shibuya KC, Patnode CD. Behavioral Counseling for Skin Cancer Prevention: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018;319(11):1143-1157

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 163 163 26
PDF Downloads 111 111 13