- Management of vitamin D deficiency in patients with dyshormonal combined proliferative diseases of the reproductive organs
Management of vitamin D deficiency in patients with dyshormonal combined proliferative diseases of the reproductive organs
HEALTH OF WOMAN. 2018.4(130):14–18; doi 10.15574/HW.2018.130.14
Lviv national medical University named Danylo Galitsky
The lack of vitamin D, according to WHO, is a pandemic. Studies conducted in different countries show the problem of vitamin D deficiency regardless of geographical latitudes in people of different age, nationality, vitamin D intake with food, even in those countries where there is no shortage of sunny days. Low level of vitamin D is considered as an independent predictor of the formation and progression of obesity, insulin resistance, PCOS, increased risk of endometriosis, uterine leiomyoma.
Along with the influence on many vital processes in the human body, vitamin D plays a very important role in regulating the reproductive function of women. D-hormone affects the reproductive organs both directly, by binding to receptors (VDR), and mediated, through stimulation of the synthesis of steroid hormones and other effects.
The objective: to study the effectiveness of clinical management of vitamin D deficiency in women with combined dyshormonal proliferative diseases of the reproductive organs.
Materials and methods. The study involved 350 women of active and late reproductive age, residents of the Lviv region, who applied for preventive examination or with complaints of menstrual irregularity, infertility, miscarriage, chronic pelvic pain. The complex examination included ultrasonographic screening of the pelvic organs, mammary glands, thyroid gland, for hysteroscopy, endometrial needle biopsy, diagnostic / operative laparoscopy. Level 25(OH)D in the serum was determined by the enzyme immunoassay. I group consisted of 50 women without gynecological and concomitant pathology at the time of enrollment, group II – 300 patients with dyshormonal proliferative pathology of the reproductive organs.
Results. Level 25(OH)D in the blood serum averaged 33.8±2.5 ng/ml occurred in 62.0% of women without gynecological pathology and only in 21.6% of women with dyshormonal pathology of the reproductive organs, lack of vitamin D(25(OH)D 22.3±1.5 ng/ml) was detected in 24.0% and 37.7%, respectively. Deficiency of vitamin D(25(OH)D 13.8±4.6 ng/ml) in women without gynecological and somatic pathology was diagnosed in 5.0% of cases and in 36.3% of women with benign proliferative pathology of reproductive organs (p<0.0001), with a severe deficit of vitamin D(25(OH)D in the serum from 4 to 9 ng/ml occurred in 73.7% of the latter.) A differential correction of vitamin D deficiency and deficiency with the use of preventive and curative doses of cholecalciferol
Сonclusion. The dose of cholecalciferol (vitamin D3) 2000 IU/day is a sufficient preventive dose with an initial adequate level of vitamin D, but insufficient to eliminate its deficiency. Admission cholecalciferol in a daily dose of 100 mcg (4000 IU) with vitamin D deficiency allows after 3 months to reach 25–28 ng/ml 25(OH)D in the blood serum, but does not result in the level of 25(OH)D 40–50 ng/ml. Admission of 6000 IU/day cholecalciferol with severe vitamin D deficiency allows to reach 25(OH)D 40–50 ng/ml on average after 2.8±1.2 months in the absence of undesirable effects.
Key words: vitamin D, vitamin D deficiency, combined dyshormonal proliferative diseases of the reproductive organs, cholecalciferol.
1. Akman AO, Tumer L, Hasanoglu A et al. 2011. Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey. Pediatr Int 53:968–77. https://doi.org/10.1111/j.1442-200X.2011.03486.x; PMid:21988338
2. Buggio L, Roncella E, Somigliana E, Vercellini P. 2015. Vitamin D and benign gynaecological diseases: A critical analysis of the current evidence. Gynecol Endocrinol. 16:1-5.
3. Dietary Reference Intakes for Calcium and Vitamin D Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. In: A.C. Ross, C.L. Taylor, A.L. Yaktine, H.B. Del Valle (eds). Washington, DC: National Academies Press. 2011. URL: https://www.ncbi.nlm.nih.gov/books/NBK56070/
4. EFSA Panel on Dietetic Products NaAN. Scientific opinion on the tolerable upper intake level of vitamin D. EFSA J. 2012; 10 (7): 2813. URL: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2012.2813/full]
5. Food and Drug Administration, HHS et al. 2016. Food Labeling: Revision of the Nutrition and Supplement Facts Labels. Final rule. Federal Register. 81(103):33-741. URL: https://www.federalregister. gov/documents/2016/05/27/2016-11867/food-labeling-revisionof-the-nutrition-and-supplement-facts-labels#h-127
6. Holick MF. 2007. Vitamin D deficiency. N Engl J Med. 357:266–281. https://doi.org/10.1056/NEJMra070553; PMid:17634462
7. Holick MF, Chen TC. 2008. Vitamin D deficiency: a worldwide problem with health consequences. The American journal of clinical nutrition 87(4):1080S–1086S.
8. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM et al. 2011. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96(7):1911–30. https://doi.org/10.1210/jc.2011-0385
9. Holick MF. 2015. Vitamin D is not as toxic as was once thought: a historical and an up to-date perspective. Mayo Clin. Proc. 90:561–4. https://doi.org/10.1016/j.mayocp.2015.03.015; PMid:25939933
10. Hossein-Nezhad A, Holick MF. 2013. Vitamin D for health: a global perspective. Mayo Clin Proc. 88(7):720–55. https://doi.org/10.1016/j.mayocp.2013.05.011; PMid:23790560 PMCid:PMC3761874
11. Mithal A, Wahl DA, Bonjour JP et al. 2009. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–20. https://doi.org/10.1007/s00198-009-0954-6; https://doi.org/10.1007/s00198-009-1030-y; PMid:19543765
12. Palacios С, Gonzalez L. 2014. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 144Pt A:138-145.
13. Rodriguez-Rodriguez E, Aparicio A, Lopez-Sobaler AM et al. 2011. Vitamin D status in a group of Spanish schoolchildren. Minerva Pediatr 63:11–8.
14. Scientific Opinion on Dietary Reference Values for vitamin D. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). EFSA J. 2016. URL: https://www.efsa.europa.eu/sites/default/files/consultation/160321.pdf.
15. Shoelson SE, Herrero L, Naaz A. 2007. Obesity, inflammation, and insulin resistance. Gastroenterol. 132:2169-2180. https://doi.org/10.1053/j.gastro.2007.03.059; PMid:17498510
16. Scientific Opinion on the Tolerable Upper Intake Level of vitamin. EFSA J. 2012. 10 (7): 2813. https://doi.org/10.2903/j.efsa.2012.2813.
17. Veugelers PJ, Pham T.-M, Ekwaru JP. 2015. Optimal vitamin D supplementation doses that minimize the risk for both low and high serum 25 hydroxyvitamin D concentrations in the general population. Nutrients. 7:10 189–208.