Calcified Tissue International

, Volume 80, Issue 2, pp 76–80 | Cite as

Hypovitaminosis D in Internal Medicine Inpatients

  • A. Corino
  • P. D’Amelio
  • R. Gancia
  • P. Del Rizzo
  • S. Gabasio
  • P. Limone
  • G. Isaia


Some studies have suggested that hypovitaminosis D may be a consequence of protein-calorie malnutrition. This study assessed both the relationship between vitamin D status, malnutrition, calcium and phosphorus metabolism indices and the importance attached by internists to these alterations. There were 239 patients admitted to an internal medicine division who underwent examinations to assess nutritional state, liver and renal function, and bone metabolism. At the end of the study, the clinical data included in the discharge letter, the treatment prescribed, and the diagnosis assigned to patients on their hospital discharge form were collected. Hypovitaminosis D was found in 72% and hypoalbuminemia in 34.3% of patients. Subjects with hypovitaminosis were generally older and had lower albumin levels than those with mild or no hypovitaminosis. 25-Hydroxyvitamin D was inversely related with parathyroid hormone and directly related with albumin. Alterations of calcium and phosphorus metabolism were present in 55.6% and recorded by the division’s physicians for only 13.53% of patients, of whom 72.37% were not specifically treated. There is a direct correlation between 25-hydroxyvitamin D and albumin levels. The high incidence and the metabolic consequence of hypovitaminosis D and of protein-calorie malnutrition is significantly underestimated and undertreated by physicians.


Albumin Inpatient Malnutrition Parathyroid hormone Vitamin D 


  1. 1.
    Ryan P, Dixon T (2006) Prevalence of vitamin D inadequacy in patients attending a metabolic bone clinic in Medway. Curr Med Res Opin 22:211–216PubMedCrossRefGoogle Scholar
  2. 2.
    Venning G (2005) Recent developments in vitamin D deficiency and muscle weakness among elderly people. BMJ 330:524–526PubMedCrossRefGoogle Scholar
  3. 3.
    Holick MF (2005) The vitamin D epidemic and its health consequences. J Nutr 135:2739S–2748SPubMedGoogle Scholar
  4. 4.
    Guyton KZ, Kensler TW, Posner GH (2003) Vitamin D and vitamin D analogs as cancer chemopreventive agents. Nutr Rev 61:227–238PubMedCrossRefGoogle Scholar
  5. 5.
    Guyton KZ, Kensler TW, Posner GH (2001) Cancer chemoprevention using natural vitamin D and synthetic analogs. Annu Rev Pharmacol Toxicol 41:421–442PubMedCrossRefGoogle Scholar
  6. 6.
    Giovannucci E (2005) The epidemiology of vitamin D and cancer incidence and mortality: a review (United States). Cancer Causes Control 16:83–95PubMedCrossRefGoogle Scholar
  7. 7.
    Ahonen MH, Tenkanen L, Teppo L, Hakama M, Tuohimaa P (2000) Prostate cancer risk and prediagnostic serum 25-hydroxyvitamin D levels (Finland). Cancer Causes Control 11:847–852PubMedCrossRefGoogle Scholar
  8. 8.
    Feskanich D, Ma J, Fuchs CS, Kirkner GJ, Hankinson SE, Hollis BW, Giovannucci EL (2004) Plasma vitamin D metabolites and risk of colorectal cancer in women. Cancer Epidemiol Biomarkers Prev 13:1502–1508PubMedGoogle Scholar
  9. 9.
    Cantorna MT, Munsick C, Bemiss C, Mahon BD (2000) 1,25-Dihydroxycholecalciferol prevents and ameliorates symptoms of experimental murine inflammatory bowel disease. J Nutr 130:2648–2652PubMedGoogle Scholar
  10. 10.
    Andreassen H, Rix M, Brot C, Eskildsen P (1998) Regulators of calcium homeostasis and bone mineral density in patients with Crohn’s disease. Scand J Gastroenterol 33:1087–1093PubMedCrossRefGoogle Scholar
  11. 11.
    Norman AW, Frankel JB, Heldt AM, Grodsky GM (1980) Vitamin D deficiency inhibits pancreatic secretion of insulin. Science 209:823–825PubMedCrossRefGoogle Scholar
  12. 12.
    Boucher BJ, Mannan N, Noonan K, Hales CN, Evans SJ (1995) Glucose intolerance and impairment of insulin secretion in relation to vitamin D deficiency in east London Asians. Diabetologia 38:1239–1245PubMedCrossRefGoogle Scholar
  13. 13.
    Prufer K, Veenstra TD, Jirikowski GF, Kumar R (1999) Distribution of 1,25-dihydroxyvitamin D3 receptor immunoreactivity in the rat brain and spinal cord. J Chem Neuroanat 16:135–145PubMedCrossRefGoogle Scholar
  14. 14.
    Brewer LD, Thibault V, Chen KC, Langub MC, Landfield PW, Porter NM (2001) Vitamin D hormone confers neuroprotection in parallel with downregulation of L-type calcium channel expression in hippocampal neurons. J Neurosci 21:98–108PubMedGoogle Scholar
  15. 15.
    Landfield PW, Cadwallader-Neal L (1998) Long-term treatment with calcitriol (1,25(OH)2 vit D3) retards a biomarker of hippocampal aging in rats. Neurobiol Aging 19:469–477PubMedCrossRefGoogle Scholar
  16. 16.
    Wang Y, Chiang YH, Su TP, Hayashi T, Morales M, Hoffer BJ, Lin SZ (2000) Vitamin D3 attenuates cortical infarction induced by middle cerebral arterial ligation in rats. Neuropharmacology 39:873–880PubMedCrossRefGoogle Scholar
  17. 17.
    Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S (2003) Prevalence of hypovitaminosis D in elderly women in Italy: clinical consequences and risk factors. Osteoporos Int 14:577–582PubMedCrossRefGoogle Scholar
  18. 18.
    Gloth FM 3rd, Gundberg CM, Hollis BW, Haddad JG Jr, Tobin JD (1995) Vitamin D deficiency in homebound elderly persons. JAMA 274:1683–1686PubMedCrossRefGoogle Scholar
  19. 19.
    Hochwald O, Harman-Boehm I, Castel H (2004) Hypovitaminosis D among inpatients in a sunny country. Isr Med Assoc J 6:82–87PubMedGoogle Scholar
  20. 20.
    Romagnoli E, Caravella P, Scarnecchia L, Martinez P, Minisola S (1999) Hypovitaminosis D in an Italian population of healthy subjects and hospitalized patients. Br J Nutr 81:133–137PubMedGoogle Scholar
  21. 21.
    Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS (1998) Hypovitaminosis D in medical inpatients. N Engl J Med 338:777–783PubMedCrossRefGoogle Scholar
  22. 22.
    Delappe E, McGreevy C, Ni Chadhain N, Grimes H, O’Brien T, Mulkerrin E (2006) Vitamin D insufficiency in older female community-dwelling acute hospital admissions and the response to supplementation. Eur J Clin Nutr 60:1009–1015PubMedCrossRefGoogle Scholar
  23. 23.
    Shinchuk LM, Morse L, Huancahuari N, Arum S, Chen TC, Holick MF (2006) Vitamin D deficiency and osteoporosis in rehabilitation inpatients. Arch Phys Med Rehabil 87:904–908PubMedCrossRefGoogle Scholar
  24. 24.
    Muscarella S, Filabozzi P, D’Amico G, Mascia ML, Annese MA, Scillitani A, Carnevale V (2006) Vitamin D status in inpatients admitted to an internal medicine department. Horm Res 66:216–220PubMedCrossRefGoogle Scholar
  25. 25.
    Elia M, Stratton RJ (2005) Geographical inequalities in nutrient status and risk of malnutrition among English people aged 65 y and older. Nutrition 21:1100–1106PubMedCrossRefGoogle Scholar
  26. 26.
    Dunnigan MG, Henderson JB, Hole DJ, Barbara Mawer E, Berry JL (2005) Meat consumption reduces the risk of nutritional rickets and osteomalacia. Br J Nutr 94:983–991PubMedCrossRefGoogle Scholar
  27. 27.
    Furman EF (2006) Undernutrition in older adults across the continuum of care: nutritional assessment, barriers, and interventions. J Gerontol Nurs 32:22–27PubMedGoogle Scholar
  28. 28.
    Lucas JA, Bolland MJ, Grey AB, Ames RW, Mason BH, Horne AM, Gamble GD, Reid IR (2005) Determinants of vitamin D status in older women living in a subtropical climate. Osteoporos Int 16:1641–1648PubMedCrossRefGoogle Scholar
  29. 29.
    Bolland MJ, Grey AB, Ames RW, Horne AM, Gamble GD, Reid IR (2006) Fat mass is an important predictor of parathyroid hormone levels in postmenopausal women. Bone 38:317–321PubMedCrossRefGoogle Scholar
  30. 30.
    Premaor MO, Alves GV, Crossetti LB, Furlanetto TW (2004) Hyperparathyroidism secondary to hypovitaminosis D in hypoalbuminemic is less intense than in normoalbuminemic patients: a prevalence study in medical inpatients in southern Brazil. Endocrine 24:47–53PubMedCrossRefGoogle Scholar
  31. 31.
    Holick MF (2006) High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 81:353–373PubMedCrossRefGoogle Scholar
  32. 32.
    Rahman SA, Reid IR, Chee WS, Yassin Z, Chan SP (2004) International perspectives on vitamin D and implications for bone health. Asia Pac J Clin Nutr 13:S45PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  • A. Corino
    • 1
  • P. D’Amelio
    • 2
  • R. Gancia
    • 1
  • P. Del Rizzo
    • 2
  • S. Gabasio
    • 1
  • P. Limone
    • 2
  • G. Isaia
    • 2
  1. 1.Division of Internal MedicineGradenigo HospitalTorinoItaly
  2. 2.Department of Internal MedicineUniversity of TorinoTorinoItaly

Personalised recommendations