Vitamin D in Health: A Brief Narrative Review
Keywords:
Vitamin D, Calcium, Osteoporosis, Sunlight, Vitamin D deficiency, India.
Abstract
Vitamin D is a sunshine vitamin as sunlight exposure is necessary for biosynthesis of this fat-soluble vitamin. Vitamin D plays an essential role in bone and skeletal health as well as it is implicated in multiple non-skeletal functions such as immunity. Deficiency of vitamin D, defined as serum levels <20 ng/mL of 25-hydroxyvitamin D, is widely prevalent and is a global health concern. In India, Vitamin D deficiency (VDD) is much ubiquitous and affects all ages irrespective of diet, lifestyle and regional differences. VDD is found to be associated with various disorders such as infections, diabetes, and cancers. For VDD, prevention is a best strategy achieved easily with adequate skin exposure to sunlight in routine life. Treatment of VDD demands treatment for 6-8 weeks with active vitamin D followed by maintenance therapy to maintain adequate levels. Inappropriate and overzealous treatment can lead to toxicity and therefore, a cautious approach is necessary while managing VDD with vitamin D supplements. Supplementation with vitamin D has shown to reduce the risk of mortality. In conclusion, vitamin D is a delight that sun can help us synthesize it and its deficiency can be prevented. As modernization is increasing with indoor lifestyles, VDD may further increase globally demanding early diagnosis and appropriate treatment to reduce the VDD consequences and improve overall health.
References
1. DeLuca HF. Overview of general physiologic features and functions of vitamin D. The American journal of clinical nutrition. 2004 Dec 1;80(6):1689S-96S.
2. Schmid A, Walther B. Natural vitamin D content in animal products. Adv Nutr. 2013 Jul 1;4(4):453-62. doi: 10.3945/an.113.003780. PMID: 23858093; PMCID: PMC3941824.
3. Holick MF. Vitamin D: a D-lightful vitamin for health. Endocrinology and Metabolism. 2012 Dec 1;27(4):255-67.
4. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. The American journal of clinical nutrition. 2008 Apr 1;87(4):1080S-6S.
5. Holick MF. The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Molecular aspects of medicine. 2008 Dec 1;29(6):361-8.
6. Cannell JJ, Hollis BW, Zasloff M, Heaney RP. Diagnosis and treatment of vitamin D deficiency. Expert opinion on pharmacotherapy. 2008 Jan 1;9(1):107-18.
7. Janoušek J, Pilařová V, Macáková K, Nomura A, Veiga-Matos J, Silva DD, Remiao F, Saso L, Malá-Ládová K, Malý J, Novakova L. Vitamin D: Sources, physiological role, biokinetics, deficiency, therapeutic use, toxicity, and overview of analytical methods for detection of vitamin D
and its metabolites. Critical reviews in clinical laboratory sciences. 2022 Nov 17;59(8):517-54.
8. Aranow C. Vitamin D and the immune system. J Investig Med. 2011 Aug;59(6):881-6. doi: 10.2310/JIM.0b013e31821b8755.
9. Zbytek B, Janjetovic Z, Tuckey RC, et al. 20-Hydroxyvitamin D3, a product of vitamin D3 hydroxylation by cytochrome P450scc, stimulates keratinocyte differentiation. J Invest Dermatol. 2008;128(9):2271–2280.
10. Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J. 2005 Oct;98(10):1024-7.
11. Sizar O, Khare S, Goyal A, et al. Vitamin D Deficiency. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532266/
12. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010 Jul;21(7):1151-4.
13. Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2013. eds. Institute of Medicine of the National Academies
14. Gani LU, How CH. PILL Series. Vitamin D deficiency. Singapore Med J. 2015 Aug;56(8):433-6; quiz 437.
15. Khadilkar A, Khadilkar V, Chinnappa J, Rathi N, Khadgawat R, Balasubramanian S, Parekh B, Jog P. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) guidelines. Indian Pediatrics. 2017; 54:567-73.
16. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society: Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911-1930,
2011
17. Nair R, Maseeh A. Vitamin D: The "sunshine" vitamin. J PharmacolPharmacother. 2012 Apr;3(2):118-26.
18. Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015 Apr;16(4):341-9.
19. Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council. 2019. Comprehensive National Nutrition Survey (CNNS) National Report. New Delhi.
20. Gupta A. Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients. 2014 Feb 21;6(2):729-75.
21. Bischoff-Ferrari H.A., Dawson-Hughes B., Willett W.C., Staehelin H.B., Bazemore M.G., Zee R.Y., Wong J.B. Effect of Vitamin D on falls: A meta-analysis. JAMA. 2004;291:1999–2006.
22. Bischoff-Ferrari H.A., Dietrich T., Orav E.J., Dawson-Hughes B. Positive association between 25-hydroxy vitamin D levels and bone mineral density: A population-based study of younger and older adults. Am. J. Med. 2004;116:634–639.
23. Lips P., van Schoor N.M. The effect of vitamin D on bone and osteoporosis. Best Pract. Res. Clin. Endocrinol. Metab. 2011;25:585–591.
24. Haines S.T., Park S.K. Vitamin D supplementation: What’s known, what to do, and what’s needed. Pharmacotherapy. 2012;32:354–382.
25. Martins D., Wolf M., Pan D., Zadshir A., Tareen N., Thadhani R., Felsenfeld A., Levine B., Mehrotra R., Norris K. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: Data from the Third National Health and Nutrition
Examination Survey. Arch. Intern. Med. 2007;167:1159–1165.
26. Brewer L.C., Michos E.D., Reis J.P. Vitamin D in atherosclerosis, vascular disease, and endothelial function. Curr. Drug Targets. 2011;12:54–60.
27. Zipitis C.S., Akobeng A.K. Vitamin D supplementation in early childhood and risk of type 1 diabetes: A systematic review and meta-analysis. Arch. Dis. Child. 2008;93:512–517.
28. Pittas A.G., Lau J., Hu F.B., Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 2007;92:2017–2029.
29. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007 Sep 10;167(16):1730-7.
30. Bolland MJ, Grey A, Gamble GD, Reid IR. Calcium and vitamin D supplements and health outcomes: a reanalysis of the Women's Health Initiative (WHI) limited-access data set. Am J Clin Nutr. 2011 Oct;94(4):1144-9.
31. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.
32. Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of vitamin D deficiency. Clinical endocrinology. 2015 Sep;83(3):327-31.
33. Jetty V, Glueck CJ, Wang P, Shah P, Prince M, Lee K, Goldenberg M, Kumar A. Safety of 50,000-100,000 units of vitamin D3/week in vitamin D-deficient, hypercholesterolemic patients with reversible statin intolerance. North American Journal of Medical Sciences. 2016
Mar;8(3):156-162.
2. Schmid A, Walther B. Natural vitamin D content in animal products. Adv Nutr. 2013 Jul 1;4(4):453-62. doi: 10.3945/an.113.003780. PMID: 23858093; PMCID: PMC3941824.
3. Holick MF. Vitamin D: a D-lightful vitamin for health. Endocrinology and Metabolism. 2012 Dec 1;27(4):255-67.
4. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. The American journal of clinical nutrition. 2008 Apr 1;87(4):1080S-6S.
5. Holick MF. The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Molecular aspects of medicine. 2008 Dec 1;29(6):361-8.
6. Cannell JJ, Hollis BW, Zasloff M, Heaney RP. Diagnosis and treatment of vitamin D deficiency. Expert opinion on pharmacotherapy. 2008 Jan 1;9(1):107-18.
7. Janoušek J, Pilařová V, Macáková K, Nomura A, Veiga-Matos J, Silva DD, Remiao F, Saso L, Malá-Ládová K, Malý J, Novakova L. Vitamin D: Sources, physiological role, biokinetics, deficiency, therapeutic use, toxicity, and overview of analytical methods for detection of vitamin D
and its metabolites. Critical reviews in clinical laboratory sciences. 2022 Nov 17;59(8):517-54.
8. Aranow C. Vitamin D and the immune system. J Investig Med. 2011 Aug;59(6):881-6. doi: 10.2310/JIM.0b013e31821b8755.
9. Zbytek B, Janjetovic Z, Tuckey RC, et al. 20-Hydroxyvitamin D3, a product of vitamin D3 hydroxylation by cytochrome P450scc, stimulates keratinocyte differentiation. J Invest Dermatol. 2008;128(9):2271–2280.
10. Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J. 2005 Oct;98(10):1024-7.
11. Sizar O, Khare S, Goyal A, et al. Vitamin D Deficiency. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532266/
12. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010 Jul;21(7):1151-4.
13. Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2013. eds. Institute of Medicine of the National Academies
14. Gani LU, How CH. PILL Series. Vitamin D deficiency. Singapore Med J. 2015 Aug;56(8):433-6; quiz 437.
15. Khadilkar A, Khadilkar V, Chinnappa J, Rathi N, Khadgawat R, Balasubramanian S, Parekh B, Jog P. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) guidelines. Indian Pediatrics. 2017; 54:567-73.
16. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society: Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911-1930,
2011
17. Nair R, Maseeh A. Vitamin D: The "sunshine" vitamin. J PharmacolPharmacother. 2012 Apr;3(2):118-26.
18. Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015 Apr;16(4):341-9.
19. Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council. 2019. Comprehensive National Nutrition Survey (CNNS) National Report. New Delhi.
20. Gupta A. Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients. 2014 Feb 21;6(2):729-75.
21. Bischoff-Ferrari H.A., Dawson-Hughes B., Willett W.C., Staehelin H.B., Bazemore M.G., Zee R.Y., Wong J.B. Effect of Vitamin D on falls: A meta-analysis. JAMA. 2004;291:1999–2006.
22. Bischoff-Ferrari H.A., Dietrich T., Orav E.J., Dawson-Hughes B. Positive association between 25-hydroxy vitamin D levels and bone mineral density: A population-based study of younger and older adults. Am. J. Med. 2004;116:634–639.
23. Lips P., van Schoor N.M. The effect of vitamin D on bone and osteoporosis. Best Pract. Res. Clin. Endocrinol. Metab. 2011;25:585–591.
24. Haines S.T., Park S.K. Vitamin D supplementation: What’s known, what to do, and what’s needed. Pharmacotherapy. 2012;32:354–382.
25. Martins D., Wolf M., Pan D., Zadshir A., Tareen N., Thadhani R., Felsenfeld A., Levine B., Mehrotra R., Norris K. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: Data from the Third National Health and Nutrition
Examination Survey. Arch. Intern. Med. 2007;167:1159–1165.
26. Brewer L.C., Michos E.D., Reis J.P. Vitamin D in atherosclerosis, vascular disease, and endothelial function. Curr. Drug Targets. 2011;12:54–60.
27. Zipitis C.S., Akobeng A.K. Vitamin D supplementation in early childhood and risk of type 1 diabetes: A systematic review and meta-analysis. Arch. Dis. Child. 2008;93:512–517.
28. Pittas A.G., Lau J., Hu F.B., Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 2007;92:2017–2029.
29. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007 Sep 10;167(16):1730-7.
30. Bolland MJ, Grey A, Gamble GD, Reid IR. Calcium and vitamin D supplements and health outcomes: a reanalysis of the Women's Health Initiative (WHI) limited-access data set. Am J Clin Nutr. 2011 Oct;94(4):1144-9.
31. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.
32. Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of vitamin D deficiency. Clinical endocrinology. 2015 Sep;83(3):327-31.
33. Jetty V, Glueck CJ, Wang P, Shah P, Prince M, Lee K, Goldenberg M, Kumar A. Safety of 50,000-100,000 units of vitamin D3/week in vitamin D-deficient, hypercholesterolemic patients with reversible statin intolerance. North American Journal of Medical Sciences. 2016
Mar;8(3):156-162.
Published
2024-11-16
How to Cite
Dr. Kiran Acharya, Dr. Parag Biniwale, Dr. NK Soni, Dr. Aaditi Phdake, Ashwin Kotamkar, Dr. Neel Patel, Shailesh Pallewar, Sampat Chaudhary, & Dr. Amit Qamra. (2024). Vitamin D in Health: A Brief Narrative Review. The Indian Practitioner, 77(10), 13-17. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/1798
Section
Review article
