Estacionalidad de la vitamina D plasmática
Su importancia en la clínica y en la salud
Palabras clave:
VITAMINA D, DEFICIENCIA DE VITAMINA D, OSTEOPOROSIS
Resumen
Un nivel adecuado de vitamina D (VD) es importante no solo para el hueso y el metabolismo fosfocálcico, sino también para la inmunomodulación, la regulación genética, la producción hormonal y la salud a lo largo del ciclo vital. Numerosos estudios observacionales han demostrado una variación estacional en los niveles plasmáticos de la VD, habitualmente con un máximo en torno al verano y un mínimo en torno al invierno. La latitud geográfica juega un papel considerable en la influencia de los rayos ultravioleta del espectro solar. Estudios hechos en Uruguay en la década del 2000 confirmaron la estacionalidad de la VD plasmática y se enfocaron en los vínculos con el metabolismo fosfocálcico y la osteoporosis, generando un marco terapéutico e inclusive preventivo para esta patología. Además de los efectos sobre la calcemia y fosfatemia, el déficit de esta vitamina está involucrado en el origen o desarrollo de patologías crónicas de actual relevancia, tales como algunos tipos de cáncer, enfermedades autoinmunes, cardiovasculares y degenerativas, así como también en la mortalidad global. Desde una perspectiva clínica y de salud pública, es importante comprender la influencia de la estacionalidad en el nivel plasmático de VD a fin de evaluar e interpretar adecuadamente las mediciones individuales y la suplementación destinada a combatir la deficiencia de la vitamina, todo lo cual hace necesaria una actualización del conocimiento.
Citas
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(2) Garrison LM, Murray LE, Green AE. Ultraviolet limit of solar radiation at the earth’s surface with a photon counting monochromator. Appl Opt 1978; 17(5):683-4.
(3) Kudish AI, Abels D, Harari M. Ultraviolet radiation properties as applied to photoclimatherapy at the Dead Sea. Int J Dermatol 2003; 42(5):359-65.
(4) Holick MF, ed. Vitamin D: physiology, molecular biology, and clinical applications. 2 ed. New York: Springer, 2010.
(5) McKenna MJ. Differences in vitamin D status between countries in young adults and the elderly. Am J Med 1992; 93(1):69-77.
(6) Bunker JWM, Harris RS, Mosher LM. Relative efficiency of active wave lengths of ultraviolet in activation of 7-dehydrocholesterol. J Am Chem Soc 1940; 62(3):508-11.
(7) Holick MF. Sunlight, UV-radiation, vitamin D and skin cancer: how much sunlight do we need? Adv Exp Med Biol 2008; 624:1-15
(8) Niggli HJ. Biophotons: ultraweak light impulses regulate life processes in aging. J Gerontol Geriat Res 2014; 3(2):143.
(9) Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1982; 1(8263):74-6.
(10) Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 1987; 64(6):1165-8.
(11) Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 1988; 67(2):373-8.
(12) Lu Z, Chen TC, Holick MF. In?uence of season and time of day on the synthesis of vitamin D3. En: Holick MF, Kligman AM, eds. Biological effects of light. Berlin: Walter de Gruyter, 1992:57–61.
(13) Ladizesky M, Lu Z, Oliveri B, San Roman N, Diaz S, Holick MF, et al. Solar ultraviolet B radiation and photoproduction of vitamin D3 in central and southern areas of Argentina. J Bone Miner Res 1995; 10(4):545-9.
(14) Ala-Houhala M, Parviainen MT, Pyykkö K, Visakorpi JK. Serum 25-hydroxyvitamin D levels in Finnish children aged 2 to 17 years. Acta Paediatr Scand 1984; 73(2):232-6.
(15) Sherman SS, Hollis BW, Tobin JD. Vitamin D status and related parameters in a healthy population: the effects of age, sex, and season. J Clin Endocrinol Metab 1990;71(2):405-13.
(16) Klenk J, Rapp K, Denkinger MD, Nagel G, Nikolaus T, Peter R, et al. Seasonality of vitamin D status in older people in Southern Germany: implications for assessment. Age Ageing 2013; 42(3):404-8.
(17) Genuis SJ, Schwalfenberg GK, Hiltz MN, Vaselenak SA. Vitamin D status of clinical practice populations at higher latitudes: analysis and applications. Int J Environ Res Public Health 2009; 6(1):151-73.
(18) Papadakis G, Keramidas I, Kakava K, Pappa T, Villiotou V, Triantafillou E, et al. Seasonal variation of serum vitamin D among Greek female patients with osteoporosis. In Vivo 2015; 29(3):409-13.
(19) Hirani V, Cumming RG, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, et al. Associations between serum 25-hydroxyvitamin D concentrations and multiple health conditions, physical performance measures, disability, and all-cause mortality: the Concord Health and Ageing in Men Project. J Am Geriatr Soc 2014; 62(3):417-25.
(20) Andersen R, Brot C, Jakobsen J, Mejborn H, Mølgaard C, Skovgaard LT, et al. Seasonal changes in vitamin D status among Danish adolescent girls and elderly women: the influence of sun exposure and vitamin D intake. Eur J Clin Nutr 2013; 67(3):270-4.
(21) Cinar N, Harmanci A, Yildiz BO, Bayraktar M. Vitamin D status and seasonal changes in plasma concentrations of 25-hydroxyvitamin D in office workers in Ankara, Turkey. Eur J Intern Med 2014; 25(2):197-201.
(22) Mendoza B, Ronco A. Importancia de los niveles séricos de vitamina D3. Tend Med 2001; 18:97-100.
(23) Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. N Engl J Med 1998; 338(12):777-83
(24) Watson RR, ed. Handbook of vitamin D in human health: prevention, treatment and toxicity. Wageningen: Wageningen Academic Publishers, 2013.
(25) Mendoza B, Ronco A, Mintegui G, Belzarena MC. Serum vitamin D status among postmenopausal Uruguayan women. International Osteoporosis Foundation World Congress, June 2-6, 2006, Toronto, Canada. Osteoporos Int 17(Suppl 2): S332. Abstract.
(26) Mendoza B, Ronco AL, Hernández J, Uboldi C, Ramagli A, Gómez E. Factores de riesgo para osteoporosis en Uruguay: resultados preliminares de un estudio caso-control. En: II Congreso Internacional de Metabolismo Óseo y Mineral, Rio de Janeiro, Oct. 25-27, 2001.
(27) Darling AL, Hart KH, Gibbs MA, Gossiel F, Kantermann T, Horton K, et al. Greater seasonal cycling of 25-hydroxyvitamin D is associated with increased parathyroid hormone and bone resorption. Osteoporos Int 2014; 25(3):933-41.
(28) Mendoza B. Osteoporosis: nuevo enfoque terapéutico. ¿A quién debemos tratar? Tend Med 2010; 5:59-64.
(29) International Society for Clinical Densitometry. 2013 ISCD Official Positions: adult. Middletown: ISCD, 2015. Disponible en: http://www.iscd.org/official-positions/2013- iscd-official-positions-adult/. Consulta: 25 junio 2015.
(30) Mendoza B. Abordaje de la Osteoporosis en la atención primaria. Tend Med 2004; 24:112-20.
(31) Mendoza B. Deficiencia de vitamina D. Guías clínicas para su diagnóstico y tratamiento. Tend Med 2013; 42:149-58.
(32) Littlejohns TJ, Henley WE, Lang IA, Annweiler C, Beauchet O, Chaves PH, et al. Vitamin D and the risk of dementia and Alzheimer disease. Neurology 2014; 83(10):920-8.
(33) Maxwell CS, Wood RJ. Update on vitamin D and type 2 diabetes. Nutr Rev 2011; 69(5):291-5.
(34) Wingfield T, Schumacher SG, Sandhu G, Tovar MA, Zevallos K, Baldwin MR, et al. The seasonality of tuberculosis, sunlight, vitamin D, and household crowding. J Infect Dis 2014; 210(5):774-83.
(35) Fares A. Factors influencing the seasonal patterns of infectious diseases. Int J Prev Med 2013; 4(2):128-32.
(36) Brum D Guimarães, Comini-Frota ER, Vasconcelos CC, Dias-Tosta E. Suplementação e uso terapêutico de vitamina D nos pacientes com esclerose múltipla: consenso do Departamento Científico de Neuroimunologia da Academia Brasileira de Neurologia. Arq Neuro-Psiquiatr 2014; 72(2):152-6.
(37) Grant WB. Ecological studies of the UVB-vitamin D-cancer hypothesis. Anticancer Res 2012; 32(1):223-36.
(38) Ronco A, Cornelissen G, Halberg F, Revilla M, De Stefani E. About half yearly pattern in the incidence of hormone-related cancers in Uruguay. Anticancer Res 1995; 15(5A):1753. Abstract
(39) Mendoza B, Ronco A. Vitamin D and breast cancer: a short review. Biomedicina 2007; (3)2:139-48.
(40) Ronco A, De Stefani E. Nutritional Epidemiology of Breast Cancer. Dordrecht: Springer, 2012.
(41) Edvardsen K, Veierød MB, Brustad M, Braaten T, Engelsen O, Lund E. Vitamin D-effective solar UV radiation, dietary vitamin D and breast cancer risk. Int J Cancer 2011; 128(6):1425-33.
(42) Ronco A. Nutrición en el paciente oncológico: fundamentos para una optimización terapéutica. Montevideo: De la Plaza, 2014.
(43) Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al.; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96(7):1911-30.
(44) Bouillon R, Van Schoor NM, Gielen E, Boonen S, Mathieu C, Vanderschueren D, et al. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab 2013; 98(8):E1283-304.
(2) Garrison LM, Murray LE, Green AE. Ultraviolet limit of solar radiation at the earth’s surface with a photon counting monochromator. Appl Opt 1978; 17(5):683-4.
(3) Kudish AI, Abels D, Harari M. Ultraviolet radiation properties as applied to photoclimatherapy at the Dead Sea. Int J Dermatol 2003; 42(5):359-65.
(4) Holick MF, ed. Vitamin D: physiology, molecular biology, and clinical applications. 2 ed. New York: Springer, 2010.
(5) McKenna MJ. Differences in vitamin D status between countries in young adults and the elderly. Am J Med 1992; 93(1):69-77.
(6) Bunker JWM, Harris RS, Mosher LM. Relative efficiency of active wave lengths of ultraviolet in activation of 7-dehydrocholesterol. J Am Chem Soc 1940; 62(3):508-11.
(7) Holick MF. Sunlight, UV-radiation, vitamin D and skin cancer: how much sunlight do we need? Adv Exp Med Biol 2008; 624:1-15
(8) Niggli HJ. Biophotons: ultraweak light impulses regulate life processes in aging. J Gerontol Geriat Res 2014; 3(2):143.
(9) Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1982; 1(8263):74-6.
(10) Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 1987; 64(6):1165-8.
(11) Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 1988; 67(2):373-8.
(12) Lu Z, Chen TC, Holick MF. In?uence of season and time of day on the synthesis of vitamin D3. En: Holick MF, Kligman AM, eds. Biological effects of light. Berlin: Walter de Gruyter, 1992:57–61.
(13) Ladizesky M, Lu Z, Oliveri B, San Roman N, Diaz S, Holick MF, et al. Solar ultraviolet B radiation and photoproduction of vitamin D3 in central and southern areas of Argentina. J Bone Miner Res 1995; 10(4):545-9.
(14) Ala-Houhala M, Parviainen MT, Pyykkö K, Visakorpi JK. Serum 25-hydroxyvitamin D levels in Finnish children aged 2 to 17 years. Acta Paediatr Scand 1984; 73(2):232-6.
(15) Sherman SS, Hollis BW, Tobin JD. Vitamin D status and related parameters in a healthy population: the effects of age, sex, and season. J Clin Endocrinol Metab 1990;71(2):405-13.
(16) Klenk J, Rapp K, Denkinger MD, Nagel G, Nikolaus T, Peter R, et al. Seasonality of vitamin D status in older people in Southern Germany: implications for assessment. Age Ageing 2013; 42(3):404-8.
(17) Genuis SJ, Schwalfenberg GK, Hiltz MN, Vaselenak SA. Vitamin D status of clinical practice populations at higher latitudes: analysis and applications. Int J Environ Res Public Health 2009; 6(1):151-73.
(18) Papadakis G, Keramidas I, Kakava K, Pappa T, Villiotou V, Triantafillou E, et al. Seasonal variation of serum vitamin D among Greek female patients with osteoporosis. In Vivo 2015; 29(3):409-13.
(19) Hirani V, Cumming RG, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, et al. Associations between serum 25-hydroxyvitamin D concentrations and multiple health conditions, physical performance measures, disability, and all-cause mortality: the Concord Health and Ageing in Men Project. J Am Geriatr Soc 2014; 62(3):417-25.
(20) Andersen R, Brot C, Jakobsen J, Mejborn H, Mølgaard C, Skovgaard LT, et al. Seasonal changes in vitamin D status among Danish adolescent girls and elderly women: the influence of sun exposure and vitamin D intake. Eur J Clin Nutr 2013; 67(3):270-4.
(21) Cinar N, Harmanci A, Yildiz BO, Bayraktar M. Vitamin D status and seasonal changes in plasma concentrations of 25-hydroxyvitamin D in office workers in Ankara, Turkey. Eur J Intern Med 2014; 25(2):197-201.
(22) Mendoza B, Ronco A. Importancia de los niveles séricos de vitamina D3. Tend Med 2001; 18:97-100.
(23) Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. N Engl J Med 1998; 338(12):777-83
(24) Watson RR, ed. Handbook of vitamin D in human health: prevention, treatment and toxicity. Wageningen: Wageningen Academic Publishers, 2013.
(25) Mendoza B, Ronco A, Mintegui G, Belzarena MC. Serum vitamin D status among postmenopausal Uruguayan women. International Osteoporosis Foundation World Congress, June 2-6, 2006, Toronto, Canada. Osteoporos Int 17(Suppl 2): S332. Abstract.
(26) Mendoza B, Ronco AL, Hernández J, Uboldi C, Ramagli A, Gómez E. Factores de riesgo para osteoporosis en Uruguay: resultados preliminares de un estudio caso-control. En: II Congreso Internacional de Metabolismo Óseo y Mineral, Rio de Janeiro, Oct. 25-27, 2001.
(27) Darling AL, Hart KH, Gibbs MA, Gossiel F, Kantermann T, Horton K, et al. Greater seasonal cycling of 25-hydroxyvitamin D is associated with increased parathyroid hormone and bone resorption. Osteoporos Int 2014; 25(3):933-41.
(28) Mendoza B. Osteoporosis: nuevo enfoque terapéutico. ¿A quién debemos tratar? Tend Med 2010; 5:59-64.
(29) International Society for Clinical Densitometry. 2013 ISCD Official Positions: adult. Middletown: ISCD, 2015. Disponible en: http://www.iscd.org/official-positions/2013- iscd-official-positions-adult/. Consulta: 25 junio 2015.
(30) Mendoza B. Abordaje de la Osteoporosis en la atención primaria. Tend Med 2004; 24:112-20.
(31) Mendoza B. Deficiencia de vitamina D. Guías clínicas para su diagnóstico y tratamiento. Tend Med 2013; 42:149-58.
(32) Littlejohns TJ, Henley WE, Lang IA, Annweiler C, Beauchet O, Chaves PH, et al. Vitamin D and the risk of dementia and Alzheimer disease. Neurology 2014; 83(10):920-8.
(33) Maxwell CS, Wood RJ. Update on vitamin D and type 2 diabetes. Nutr Rev 2011; 69(5):291-5.
(34) Wingfield T, Schumacher SG, Sandhu G, Tovar MA, Zevallos K, Baldwin MR, et al. The seasonality of tuberculosis, sunlight, vitamin D, and household crowding. J Infect Dis 2014; 210(5):774-83.
(35) Fares A. Factors influencing the seasonal patterns of infectious diseases. Int J Prev Med 2013; 4(2):128-32.
(36) Brum D Guimarães, Comini-Frota ER, Vasconcelos CC, Dias-Tosta E. Suplementação e uso terapêutico de vitamina D nos pacientes com esclerose múltipla: consenso do Departamento Científico de Neuroimunologia da Academia Brasileira de Neurologia. Arq Neuro-Psiquiatr 2014; 72(2):152-6.
(37) Grant WB. Ecological studies of the UVB-vitamin D-cancer hypothesis. Anticancer Res 2012; 32(1):223-36.
(38) Ronco A, Cornelissen G, Halberg F, Revilla M, De Stefani E. About half yearly pattern in the incidence of hormone-related cancers in Uruguay. Anticancer Res 1995; 15(5A):1753. Abstract
(39) Mendoza B, Ronco A. Vitamin D and breast cancer: a short review. Biomedicina 2007; (3)2:139-48.
(40) Ronco A, De Stefani E. Nutritional Epidemiology of Breast Cancer. Dordrecht: Springer, 2012.
(41) Edvardsen K, Veierød MB, Brustad M, Braaten T, Engelsen O, Lund E. Vitamin D-effective solar UV radiation, dietary vitamin D and breast cancer risk. Int J Cancer 2011; 128(6):1425-33.
(42) Ronco A. Nutrición en el paciente oncológico: fundamentos para una optimización terapéutica. Montevideo: De la Plaza, 2014.
(43) Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al.; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96(7):1911-30.
(44) Bouillon R, Van Schoor NM, Gielen E, Boonen S, Mathieu C, Vanderschueren D, et al. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab 2013; 98(8):E1283-304.
Publicado
2016-06-30
Cómo citar
1.
Mendoza B, Ronco Álvaro L. Estacionalidad de la vitamina D plasmática. Rev. Méd. Urug. [Internet]. 30 de junio de 2016 [citado 29 de abril de 2024];32(2):80-6. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/172
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