V špecifických klinických situáciách sa jasne preukázala dôležitosť včasného rozpoznania deficitov mikronutrientov a účinnosť ich liečby. Približne tretina populácie vo svete má dokázateľný deficit niektorého z druhov mikronutientov. Na druhej strane sa predpokladá, že asi 20 mikronutrientov má dôležitý vplyv na metabolóm, proteóm a genóm u človeka. V súčasnosti už máme dostatok vedomostí z veľkých randomizovaných kontrolovaných štúdií, ktoré dokázali dôležitosť nedostatočného statusu mikronutrientov, ako aj účinok a účinnosť intervencií zameraných na efektívnu liečbu ich deficitných stavov. V kontexte deficitu vitamínu D sa v súčasnosti preukázala výhoda zavedenia novej suplementačnej farmakologickej liečby.
In specific clinical situations clearly have been seen an importance of the early identification of micronutrient deficiencies and an effectivity of their therapies. About one third of all population in the world suffers from an certain micronutrient deficiency. On the other site it is supposed, that about 20 micronutrients have an important effects on metabolome, proteome and genome of the humans. At present we have growing number of large, randomized, controlled trials concerning the evidences of the micronutrient deficiency, as well as of the effects and effectivity of interventions in the therapy of deficient states. In context of vitamin D deficiency quite new therapeutic possibility in the supplementation pharmacotherapy is present.
- MeSH
- Calcifediol pharmacology therapeutic use MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Micronutrients deficiency therapeutic use MeSH
- Vitamin D Deficiency * drug therapy MeSH
- Vitamin D * therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Vápník a fosfor jsou důležitými minerály, na jejichž metabolismu a homeostáze se v organismu podílí celá řada hormonů a orgánů, zejména skelet, příštítná tělíska, gastrointestinální trakt a ledviny. Poruchy fosfokalciového metabolismu mohou být spojeny s nefyziologickými koncentracemi těchto minerálů v séru, patologickými ději v kostní tkáni a poruchami hlavních regulačních systémů, hlavně příštítných tělísek, ledvin a gastrointestinálního traktu.
Calcium and phosphorus are important minerals whose metabolism and homeostasis in the body involve many hormones and organs, especially the skeleton, parathyroid glands, digestive tract and kidneys. Disturbances in phospho-calcium metabolism may be associated with non-physiological serum concentrations of these minerals, pathological processes in bone tissue, and disturbances in major regulatory systems, particularly the parathyroid glands, kidneys, and gastrointestinal tract.
- MeSH
- Phosphorus * blood MeSH
- Hyperphosphatemia diagnosis complications MeSH
- Hypercalcemia diagnosis drug therapy complications MeSH
- Hypophosphatemia diagnosis complications MeSH
- Hypocalcemia diagnosis drug therapy complications MeSH
- Calcitriol blood metabolism MeSH
- Humans MeSH
- Metabolic Diseases diagnosis drug therapy complications metabolism MeSH
- Vitamin D Deficiency diagnosis drug therapy blood MeSH
- Calcium * blood MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
V článku je uveden přehled současných poznatků o vitaminu D z klinického hlediska. Jsou shrnuta základní fakta o jeho formách, fyziologických účincích a metabolismu. Z klinického hlediska se článek věnuje stavu zásobení vitaminem D, deficitu vitaminu D a jeho klinickým projevům a léčbě. V části věnované léčbě jsou shrnuty současné poznatky o používaných formách vitaminu D, jejich indikacích, strategiích léčby a doporučeném dávkování.
The article reviews current knowledge about vitamin D from the clinical point of view. The basic facts about its forms, physiological effects and metabolism are summarized. From clinical point of view the article deals with the state of supply of vitamin D, vitamin D deficiency and its clinical signs, symptoms and therapy. In paragraphs devoted to the treatment the current knowledge about forms of vitamin D, their indication, doses and dosage regimens are summarized.
- MeSH
- Humans MeSH
- Vitamin D Deficiency complications pathology prevention & control therapy MeSH
- Risk Factors MeSH
- Vitamin D * administration & dosage pharmacology classification metabolism MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
V článku je uveden přehled současných poznatků o vitaminu D z klinického hlediska. Jsou shrnuta základní fakta o jeho formách, fyziologických účincích a metabolismu. Z klinického hlediska se článek věnuje stavu zásobení vitaminem D, deficitu vitaminu D a jeho klinickým projevům a léčbě. V části věnované léčbě jsou shrnuty současné poznatky o používaných formách vitaminu D, jejich indikacích, strategiích léčby a doporučeném dávkování.
The article reviews current knowledge about vitamin D from the clinical point of view. The basic facts about its forms, physiological effects and metabolism are summarized. From clinical point of view the article deals with the state of supply of vitamin D, vitamin D deficiency and its clinical signs, symptoms and therapy. In paragraphs devoted to the treatment the current knowledge about forms of vitamin D, their indication, doses and dosage regimens are summarized.
- MeSH
- Diabetes Mellitus etiology MeSH
- Clinical Laboratory Techniques methods MeSH
- Humans MeSH
- Vitamin D Deficiency etiology pathology prevention & control MeSH
- Osteomalacia drug therapy prevention & control MeSH
- Drug Overdose MeSH
- Rickets diagnosis etiology drug therapy MeSH
- Vitamin D * administration & dosage physiology metabolism MeSH
- Recommended Dietary Allowances MeSH
- Check Tag
- Humans MeSH
BACKGROUND/AIM: Low levels of vitamin D are a widespread global issue. This study aimed to determine the optimal vitamin D3 supplementation dose for healthy young adults by comparing the effectiveness of gradually increasing cholecalciferol doses over two years. PATIENTS AND METHODS: Thirty-five volunteers participated in a two-season pilot study conducted from October to April to avoid sunlight-induced vitamin D3 synthesis. The participants used oil-based drops of cholecalciferol, increasing their dose from 1,000 to 2,000, 4,000, and then 8,000 IU daily for 60 days with a 30-day break. RESULTS: Supplementing with 1,000 IU/day raised vitamin D levels to the recommended range (above 75 nmol/l), but levels dropped below this range after a 30-day break. A dose of 2,000 IU/day maintained vitamin D levels within the recommended range, even after the break. Increasing the dose to 4,000 IU/day produced a rapid rise, though levels dropped more significantly after stopping supplementation. With 8,000 IU/day, both the rise and subsequent decline in vitamin D levels were more pronounced. CONCLUSION: Effective vitamin D supplementation in healthy young adults can be achieved with a daily dose of 2,000 IU during winter. However, 4,000 IU/day was more effective for maintaining levels above 100 nmol/l, supporting broader health benefits. Regular monitoring of [25(OH)D], calcium, and phosphorus levels is essential.
- MeSH
- Cholecalciferol * administration & dosage MeSH
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Vitamin D Deficiency drug therapy blood MeSH
- Pilot Projects MeSH
- Dietary Supplements * MeSH
- Seasons MeSH
- Vitamin D * administration & dosage blood MeSH
- Dose-Response Relationship, Drug MeSH
- Healthy Volunteers * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
Vitamin D je skupina steroidních hormonů. Většina v těle vzniká za pomoci UV záření ze slunce, ale je obsažen v různých potravinách, jako jsou oleje z mořských ryb apod. V těle je postupně hydroxylován na účinný metabolit v játrech a ledvinách. V krvi je transportován bílkovinou VDBP (vitamin D binding protein). Váže se v jádře buňky na receptor VDR (vitamin D Rreceptor). Na koncentraci vitaminu D má vliv mnoho faktorů jako zeměpisná poloha, sezóna (délka slunečního svitu), pigmentace kůže i množství tukové a svalové tkáně. Jeho nejznámější funkcí je regulace kalcio-fosfátového metabolizmu, avšak podílí se rovněž na regulaci buněčného cyklu, indukci apoptózy a také hraje roli v regulaci imunitního systému. Obecně lze říci, že jeho působení vede spíše k imunotoleranci. Nedostatek vitaminu D se v populaci projevuje stále častěji, dnes jím trpí až téměř 50 % evropské populace. Deficience se spojuje s vyšší agresivitou nádorů vč. Nehodgkinových lymfomů a je prokázáno, že pacienti s vyššími hladinami vitaminu D vykazují lepší celkové přežití i dobu do progrese. Nabízí se tedy otázka, zda by suplementace vitaminem D mohla příznivě ovlivnit prognózu pacienta s lymfomy. Výsledky publikovaných studií jsou v tomto ohledu dosud rozporuplné. Navzdory ne zcela jednoznačným výsledkům se uvádí, že suplementace by měla být zvážena u pacientů s insuficientními hladinami vitaminu D.
Vitamin D is a group of steroid hormones, produced with the help of UV radiation of the sun in the skin. It is also contained in various foods such as marine fish oils etc. In the body, it is subsequently transformed into its active form in the liver and kidneys. In the blood, it is transported by the VDBP (vitamin D binding protein). In the cell nucleus, it is bound to the VDR receptor (vitamin D receptor). The concentration of vitamin D in plasma is influenced by many factors: geographical latitude, season (length of sunshine), skin pigmentation, amount of fat, and muscle tissue. The best-known function of vitamin D is the regulation of calcium-phosphate metabolism, but it is involved in many processes such as the regulation of the cell cycle and the induction of apoptosis. It plays a role in the regulation of the immune system as well. Its immunomodulatory action is required for adequate anti-infectious and anti-tumoral immune response. It prevents an exaggerated inflammatory reaction and leads to immunotolerance. Deficiency has become more common in our population, affecting up to 50% of Europeans. Deficiency is also associated with a higher aggressiveness of tumours, including non-Hodgkin lymphomas. It has been shown that higher levels of vitamin D are associated with better overall survival and time to progression. The question is, whether vitamin D supplementation could impact and improve prognosis. Despite the ambiguous results of published studies, vitamin D supplementation should be considered in patients with diagnosed deficiency.
- MeSH
- Humans MeSH
- Lymphoma * etiology therapy MeSH
- Vitamin D Deficiency complications MeSH
- Prognosis MeSH
- Retrospective Studies MeSH
- Vitamin D * immunology metabolism therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Cíle: Deficit vitaminu D je spojen u řady chorob s horší prognózou. V naší práci jsme analyzovali hladiny vitaminu D u pacientů s Nehodgkinovými lymfomy (NHL) v České republice. Metody: Retrospektivní analýza nově diagnostikovaných pacientů, kteří měli před zahájením léčby stanoveny plazmatické hladiny vitaminu D, vybraných mikronutrientů (selen, zinek), albuminu a IgG. Analýza zahrnovala asociaci vitaminu D s demografickými, klinickými a vybranými laboratorními parametry a dopad hypovitaminózy D na přežití. Výsledky: Celkem bylo analyzováno 1 196 pacientů (medián věku 65 let, 49,5 % mužů), medián koncentrace vitaminu D byl 43,5 nmol/l. Pacientů s deficitem (≤ 50 nmol/l) bylo 717/1196 (59,9 %), hladinu v normě (≥ 75 nmol/l) mělo pouze 14,1 % nemocných. Medián sledování byl 3,9 roku. Ženské pohlaví (p < 0,000001), špatný celkový stav PS ≥ 2 (p < 0,0001), LDH > normu (p = 0,0063) a hypoalbuminémie (p < 0,000001) byly asociovány s deficitem vitaminu D. U agresivních lymfomů byly pozorovány signifikantně nižší hladiny vitaminu D (p = 0,000002). Deficit vitaminu D koreloval u difuzního velkobuněčného B-lymfomu s kratší dobou do progrese a celkovým přežitím (5,16 roku vs. nedosažen a 8,9 roku vs. nedosažen; p < 0,01), u folikulárního lymfomu nebyl rozdíl v PFS; nicméně 5leté celkové přežití bylo 80 vs. 95 %; p = 0,0007). Závěr: Deficit vitaminu D před zahájením léčby je problém většiny pacientů s NHL. Deficit je sdružen s dalšími negativními prognostickými faktory (hypoalbuminémie, vyšší LDH, horší klinický stav) a je rovněž asociován s kratším přežitím.
Objectives: Vitamin D deficiency is associated with worse prognosis in several diseases. In our study, we analysed vitamin D levels in patients with non-Hodgkin lymphomas (NHL) in the Czech Republic. Methods: A retrospective analysis of newly diagnosed patients who had their plasma levels of vitamin D, selected micronutrients (selenium, zinc), albumin, and IgG measured before initiating treatment. The analysis included the association of vitamin D with demographic, clinical, and selected laboratory parameters, as well as the impact of vitamin D deficiency on survival. Results: A total of 1,196 patients were analysed (median age 65 years, 49.5% male). The median vitamin D concentration was 43.5 nmol/L. Vitamin D deficiency (≤ 50 nmol/L) was observed in 717/1,196 patients (59.9%), while only 14.1% had normal levels (≥ 75 nmol/L). The median follow-up period was 3.9 years. Female gender (P < 0.000001), poor performance status (PS ≥ 2; P < 0.0001), elevated LDH levels (P = 0.0063), and hypoalbuminemia (P < 0.000001) were associated with vitamin D deficiency. Significantly lower vitamin D levels were observed in aggressive lymphomas (P = 0.000002). In diffuse large B-cell lymphoma, vitamin D deficiency correlated with shorter progression-free survival and overall survival (5.16 years vs. not reached and 8.9 years vs. not reached; P < 0.01). For follicular lymphoma, there was no difference in progression-free survival; however, 5-year overall survival was 80% vs. 95% (P = 0.0007). Conclusion: Vitamin D deficiency prior to treatment is a concern for the majority of patients with NHL. It is associated with other negative prognostic factors (hypoalbuminemia, elevated LDH, poorer clinical status) and with shorter survival.
V článku je uveden přehled současných poznatků o vitaminu D z klinického hlediska. Jsou shrnuta základní fakta o jeho formách, fyziologických účincích a metabolismu. Z klinického hlediska se článek věnuje stavu zásobení vitaminem D, defi- citu vitaminu D a jeho klinickým projevům a léčbě. V části věnované léčbě jsou shrnuty současné poznatky o používaných formách vitaminu D, jejich indikacích, strategiích léčby a doporučeném dávkování.
The article reviews current knowledge about vitamin D from the clinical point of view. The basic facts about its forms, physiological effects and metabolism are summarized. From clinical point of view the article deals with the state of supply of vitamin D, vitamin D deficiency and its clinical signs, symptoms and therapy. In paragraphs devoted to the treatment the current knowledge about forms of vitamin D, their indication, doses and dosage regimens are summarized.
Background/Objectives: Given the crucial health benefits of vitamin D, addressing severe deficiencies is a pressing medical concern. This study aimed to evaluate the effectiveness and safety of two new weekly doses of calcifediol (100 μg and 125 μg) for long-term management in patients with severe vitamin D deficiency, defined as plasma 25(OH)D levels ≤10 ng/mL. Methods: This study was a randomized, two-cohort, controlled, double-blind, multicentre phase II-III trial. Subjects were randomized 2:2:1 to weekly calcifediol 100 μg, 125 μg or a placebo. The primary endpoint was the proportion of patients achieving plasma 25(OH)D levels of ≥20 ng/mL and/or ≥30 ng/mL by week 16. Results: A total of 276 patients (mean age: 55.2 years, SD 15.42) were randomized. By week 16, 92.3% and 91.8% of patients in the calcifediol 100 μg and 125 μg groups, respectively, reached ≥20 ng/mL, compared to 7.3% in the placebo group. Levels of ≥30 ng/mL were achieved by 49% (100 μg) and 76.4% (125 μg) of participants, with none in the placebo group. Calcifediol demonstrated superior efficacy at all response levels and time points (p < 0.0001). Plasma 25(OH)D concentrations increased by week 24 and remained stable. The incidence of adverse events was comparable across groups. Conclusions: A weekly calcifediol dose of 100 μg demonstrates the best profile of efficacy and tolerability, providing a reliable solution for achieving and maintaining adequate vitamin D levels in patients with severe deficiency.
- MeSH
- Adult MeSH
- Double-Blind Method MeSH
- Calcifediol * blood administration & dosage MeSH
- Middle Aged MeSH
- Humans MeSH
- Vitamin D Deficiency * drug therapy blood MeSH
- Dietary Supplements MeSH
- Drug Administration Schedule MeSH
- Aged MeSH
- Vitamin D blood analogs & derivatives administration & dosage MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase II MeSH
- Clinical Trial, Phase III MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
To evaluate vitamin D levels in children treated with fractures during the healing period. A four-year prospective study, including healthy children treated with diaphyseal fracture of femur or forearm bones. Vitamin D levels were examined four times: at the time of the injury and then one, three, and five months after the injury, together with P1NP, ALP, GGT, and parathormone. In the beginning, patients were blindly divided into two groups, one supplemented with vitamin D3 for the entire follow-up period, the other non-supplemented. Altogether, 107 children underwent examination at the time of their injuries. Of these, 63 were included in the study and examined for the entire follow-up period - 36 supplemented, 27 non-supplemented. At the time of injury, 42 % had a deficit of vitamin D, 36.5 % had insufficiency, only 21.5 % had normal levels. In the children supplemented with cholecalciferol, vitamin D levels increased statistically significantly during the follow-up period (already after 1 month), in contrast with non-supplemented patients, where they did not. When we divided patients according to the initial vitamin D levels (deficit/insufficiency/normal levels) or fracture type (femur/forearm), we also observed significantly better results in supplemented groups. We observed a high prevalence of vitamin D deficit or insufficiency in healthy children at the time of their injuries. Patients supplemented with vitamin D3 had normal levels already after one month and this persisted throughout the follow-up period, in contrast with non-supplemented patients. Therefore, we recommend vitamin D testing and administration for children treated for fractures. Keywords: Vitamin D, Pediatric fracture, Children, Vitamin D supplementation.
- MeSH
- Cholecalciferol blood therapeutic use MeSH
- Child MeSH
- Femoral Fractures blood epidemiology MeSH
- Fracture Healing * drug effects MeSH
- Humans MeSH
- Adolescent MeSH
- Follow-Up Studies MeSH
- Vitamin D Deficiency * blood epidemiology drug therapy MeSH
- Dietary Supplements MeSH
- Child, Preschool MeSH
- Prospective Studies MeSH
- Vitamin D * blood therapeutic use MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
