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1、糖尿病：在型糖尿病中，免疫系统会杀灭人体自身的细胞。科学家认为，维生素D可起到免疫抑制剂的作用,补充维生素D可使肥胖者的胰岛素敏感性改善60%，其作用甚至强于二甲双胍和曲格列酮 ,因此，有学者提出，尤其对初诊者，冬季补充维生素D可能是T2DM的综合治疗方法之一，联合短期胰岛素泵强化治疗效果更佳 高血压：维生素D为颈部甲状腺上的副甲状腺所利用。这些腺体分泌出一种调节体内钙水平的激素，钙则帮助调节血压，但科学家尚未完全理解这一过程动物实验发现，维生素D信号转导系统受损可导致肾素-血管紧张素-醛固酮系统（RAS）激活，引起高血压和心肌肥厚。2项前瞻研究均提示，维生素缺乏的男性（500 IU/d可降低
2、心血管死亡和全因死亡 癌症（包括乳腺癌、结肠癌、卵巢癌和前列腺癌等）：据认为，维生素D对调节细胞繁殖起到关键作用癌症患者体内则缺乏这种调控机制。因此，通过防止细胞过度繁殖，维生素D就能预防某些癌症。 自身免疫性疾病 维生素D可多方位调控机体的免疫功能，包括调节树突细胞分化、淋巴细胞增殖和细胞因子排泌。动物实验证实，补充维生素D对于多种自身免疫性疾病有治疗作用，如自身免疫性脑脊髓炎、抗原诱导性关节炎、T1DM、炎症性肠病、自身免疫性甲状腺炎和系统性红斑狼疮等。最近研究证实，高维生素D状态与远期多发性硬化症发生率低有关 需要人群： 1.住在都市的人，特别是浓烟污染的地域的人应该摄取更多的维生素D。
3、 2.夜间工作者、修女，或者是因为服装、生活方式而不能充分得到阳光的人要特别注意在饮食中增加维生素D的摄取。 3.如果您正服用抗痉挛的药物，则必须增加对维生素D的摄取。 4.饮用未添加维生素D牛奶的小孩必须增加维生素D的摄取量。 5.皮肤颜色较黑且住在北方气候地域的人需要更多的维生素D。 Who is at higher risk of Vitamin D deficiency?Breastfed Infants normally human milk has only 25 IU/L and often the mother is Vitamin D deficient herself. T
4、herefore, most infants are prescribed 400 IU of Vitamin D daily. Unfortunately, often our poor can not afford medical care for their infants, so these babies are at a very high risk.Older Adults - have a reduce level of 7-dehydr-cholesterol, so they cant synthesize Vitamin as well. Also their kidney
5、s are less able to produce the active hormone, 1,25 dihydro Vitamin D. 50岁以下的人每天应该提供200国际单位的维生素D，51岁至70岁的人需要400国际单位，70岁以上需要600国际单位。随着年龄的增长而增加需求量是因为皮肤随着年龄的老化，制造维生素D的能力越来越低。Dark skinned people melanin in the darker skin reduces the ability to produce Vitamin D from sunlight exposure, because it absorb
6、s the sunlight.Limited Sun Exposure this eliminates one of the two sources of Vitamin D. This often happens to the institutionalized people.Obese people because Vitamin D is fat soluble, it is sequestered in the fat; not allowing it to circulate. Also those who have had a gastric bypass dont have a
7、portion of their small intestine and can not absorb Vitamin D as readily. Typical Milk Volume:From birth to 24 hours, colostrum averages about 37 ml From 24 to 96 hours, there is a slow rise in volume Day 5: approximately 500 ml/day 3 to 5 months: 750 ml/day 6 months: 800 ml/dSource: F. R. Bringhurs
8、t, et.al., “Bone and Mineral Metabolism in Health and Disease” ; Chapter 23 of “Harrisons Endocrinology”, J. Larry Jameson, editor, McGraw-Hill Medical Publishing Division, copyright 2006.Reduced skin synthesisSunscreens, pigmentation, aging, season / latitude, skin grafts for burnsDecreased bioavai
9、labilityFat malabsorption due to cystic fibrosis, celiac disease, Crohns disease, medications etcIncreased catabolismAnticonvulsants, glucocortoids, AIDS treatments, antirejection medicationsBreast-feedingPoor vitamin D content in human milkDecreased synthesis of 25 (OH) Vit. DLiver failureIncreased
10、 urinary loss of 25 (OH) Vit. D or decreased synthesis of 25 (OH) Vit. DNephrotic syndrome or chronic kidney disease Various heritable or acquired disordersVit D-dependent rickets type 1, 2, 3, hypophosphatemic rickets, tumor secretion of FGF23, hyperthyroidism and hyperparathyroidism, granulomatous disorders, sarcoidosis, tuberculosis
VD临床相关知识
