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Prevalence of vitamin D insufficiency and evidence for disease prevention in the older population

Prävalenz für Vitamin-D-Insuffizienz und Evidenz für Krankheitsprävention bei der älteren Population

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Abstract

The prevalence of vitamin D insufficiency, usually assessed by the analysis of circulating 25-hydroxyvitamin D (25[OH])D), is very high in the aging German population. An important factor that reduces endogenous vitamin D synthesis in older persons is physical inactivity or care-dependency that limits the time spent outside. Additionally, it has been suggested that the age-dependent decline in the glomerular filtration rate is associated with a reduced production of bioactive calcitriol. As this phenomenon is not detectable by the assessment of 25(OH)D, it is necessary to analyze the level of parathyroid hormone as a marker of calcitriol function. Because 25(OH)D levels are highly correlated with an active and healthy life style, data from epidemiological studies are not necessarily suitable to elucidate the role of vitamin D in disease prevention. Recently published meta-analyses of randomized controlled trials (RCTs) showed moderate effects of vitamin D supplementation on fracture risk and found that vitamin D was more effective when administered in combination with calcium. The role of vitamin D in the prevention of falls and frailty remains unclear. Much evidence has demonstrated the beneficial effects of vitamin D on respiratory tract infections and asthma, which are very relevant health issues in the older population. To conclude, vitamin D, particularly combined with calcium, has moderately beneficial effects on the skeletal system and is useful for the prevention of respiratory tract infections.

Zusammenfassung

Die Prävalenz für Vitamin-D-Insuffizienz, welche üblicherweise anhand des zirkulierenden 25-Hydroxyvitamin D (25[OH]D) ermittelt wird, ist in der alternden deutschen Bevölkerung sehr hoch. Ein wichtiger Faktor, der die endogene Vitamin-D-Synthese bei älteren Menschen reduziert, ist der verminderte Aufenthalt im Freien, bedingt durch körperliche Inaktivität oder Pflegebedürftigkeit. Darüber hinaus wird vermutet, dass die altersabhängige Abnahme der glomerulären Filtrationsrate mit einer verminderten Produktion des bioaktiven Calcitriols einhergeht. Da dieses Phänomen nicht durch die Analyse von 25(OH)D nachweisbar ist, ist es empfehlenswert, Parathormon als Marker für die Calcitriol-Funktion zu messen. Bedingt durch den Umstand, dass die 25(OH)D-Spiegel in hohem Maße mit einem aktiven und gesunden Lebensstil korrelieren, sind Daten aus epidemiologischen Studien nicht unbedingt geeignet, die Bedeutung von Vitamin D für die Krankheitsprävention aufzuzeigen. Aktuell publizierte Metaanalysen von randomisierten kontrollierten Studien zeigen moderat positive Effekte von Vitamin D auf das Frakturrisiko, insbesondere, wenn gleichzeitig Kalzium verabreicht wird. Die Rolle von Vitamin D bei der Prävention von Stürzen und Gebrechlichkeit bleibt unklar. Die größte Evidenz für vorteilhafte Vitamin D-Wirkungen wurde für Infektionen der Atemwege und Asthma gezeigt. Bei beiden Erkrankungen handelt sich um äußerst relevante Gesundheitsprobleme bei älteren Menschen. Zusammenfassend ist festzuhalten, dass Vitamin D, besonders in Kombination mit Kalzium, wahrscheinlich moderat positive Effekte auf die Knochengesundheit hat und auch vor Atemwegsinfektionen schützt.

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  1. Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Von-Danckelmann-Platz 2, 06120, Halle (Saale), Germany

    Julia Kühn, Paula Trotz &  Gabriele I. Stangl

  2. Competence Cluster of Cardiovascular Health and Nutrition (nutriCARD), Halle-Jena-Leipzig, Germany

    Julia Kühn &  Gabriele I. Stangl

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J. Kühn, P. Trotz and G.I. Stangl declare that they have no competing interests.

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Kühn, J., Trotz, P. & Stangl, G.I. Prevalence of vitamin D insufficiency and evidence for disease prevention in the older population. Z Gerontol Geriat 51, 567–572 (2018). https://doi.org/10.1007/s00391-018-1390-z

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