Reposição de vitamina D nativa: indicação à luz das evidências científicas atuais
DOI:
https://doi.org/10.5327/z1984-4840201626833Palavras-chave:
vitamina D, deficiência de vitamina D, estudo clínicoResumo
O papel da vitamina D nativa na fisiologia do tecido ósseo é evidente não só como um nutriente essencial capaz de prevenir e tratar o raquitismo mas também como regulador da homeostase do cálcio, fosfato e do metabolismo ósseo. Um amplo espectro de ações biológicas tem sido descrito, incluindo efeitos sobre os sistemas cardiovascular, nervoso central e imune, na diferenciação e crescimento celular, bem como no controle de outros sistemas hormonais. Evidências epidemiológicas associaram estados de déficit de vitamina D com doenças como câncer, diabetes mellitus, hipertensão arterial, doenças autoimunes, infecções e aumento da mortalidade. O conjunto dessas informações levou à medicalização da vitamina D, acarretando seu uso em diversas doenças, e até mesmo em situações clínicas questionáveis. No entanto, os resultados de estudos clínicos apontam para resultados divergentes, colocando em questão o uso indiscriminado da vitamina D. Este artigo apresenta uma revisão sobre a vitamina D e relaciona algumas das principais evidências científicas sobre os reais benefícios de sua suplementação em seres humanos em diversas condições.Downloads
Metrics
Referências
Gröber U, Spitz J, Reichrath J, Kisters K, Holick MF. Vitamin D: update 2013: from rickets prophylaxis to general preventive healthcare. Dermatoendocrinol. 2013;5(3):331-47.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-81.
Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young adults. Am J Med. 2002;112(8):659-62.
LaClair RE, Hellman RN, Karp SL, Kraus M, Ofner S, Li Q, et al. Prevalence of calcidiol deficiency in CKD: a cross-sectional study across latitudes in the United States. Am J Kidney Dis. 2005;45(6):1026-33.
Powe CE, Evans MK, Wenger J, Zonderman AB, Berg AH, Nalls M, et al. Vitamin D-binding protein and vitamin D status of black Americans and white Americans. N Engl J Med. 2013;369(21):1991-2000.
Scott MG, Gronowski AM, Reid IR, Holick MF, Thadhani R, Phinney K. Vitamin D: the more we know, the less we know. Clin Chem. 2015;61(3):462-5.
Holick MF, Garabedian M. Vitamin D: photobiology, metabolism, mechanism of action, and clinical application. In: Favus MJ, editor. Primer on the metabolic bone diseases and disorders of mineral metabolism. 6th ed. Pennsylvania: Rittenhouse Book Distribution; 2006. p. 106-14.
Kramer H, Berns JS, Choi MJ, Martin K, Rocco MV. 25-Hydroxyvitamin D testing and supplementation in CKD: an NKF-KDOQI controversies report. Am J Kidney Dis. 2014;64(4):499-509.
Dusso AS. Kidney disease and vitamin D levels: 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and VDR activation. Kidney Int Suppl. 2011;1(4):136-41.
Andress DL. Vitamin D in chronic kidney disease: a systemic role for selective vitamin D receptor activation. Kidney Int. 2006;69(1):33-43.
Heijboer AC, Blankenstein MA, Kema IP, Buijs MM. Accuracy of 6 routine 25-hydroxyvitamin D assays: influence of vitamin D binding protein concentration. Clin Chem. 2012;58(3):543-8.
Bhan I, Powe CE, Berg AH, Ankers E, Wenger JB, Karumanchi SA, et al. Bioavailable vitamin D is more tightly linked to mineral metabolism than total vitamin D in incident hemodialysis patients. Kidney Int. 2012;82(1):84-9.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-30.
Priemel M, von Domarus C, Klatte TO, Kessler S, Schlie J, Meier S, et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res. 2010;25(2):305-12.
Moyses RMA, Reis LM, Jorgetti V. Distúrbios de cálcio de fósforo. In: Zatz R, editor. Bases fisiológicas da nefrologia. São Paulo: Editora Atheneu; 2011. p. 273.
Kidney disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2009;(113):S1-130.
Aspray TJ, Bowring C, Fraser W, Gittoes N, Javaid MK, Macdonald H, et al. National Osteoporosis Society vitamin D guideline summary. Age Ageing. 2014;43(5):592-5.
Morris HA. Vitamin D: a hormone for all seasons. How much is enough? Clin Biochem Rev. 2004;26(1):21-32.
Morgan SL, Weinsier RL. Fundamentals of clinical nutrition. St. Louis: Mosby; 1998. p. 3.
Vogiatzi MG, Jacobson-Dickman E, DeBoer MD. Vitamin D supplementation and risk of toxicity in pediatrics: a review of current literature. J Clin Endocrinol Metab. 2014;99(4):1132-41.
Ramos MFP, Santana LG, Rasvickas CV, Teixeira VP, Schor N. Effect of vitamin D3 overdose and calcium supplementation in experimental nephrolithiasis model. J Bras Nefrol. 2014;36(2):132-8.
Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354(7):669-83.
Kooienga L, Fried L, Scragg R, Kendrick J, Smits G, Chonchol M, et al. The effect of combined calcium and vitamin D3 supplementation on serum intact parathyroid hormone in moderate CKD. Am J Kidney Dis. 2009;53(3):408-16.
Zisman AL, Hristova M, Ho LT, Sprague SM. Impact of ergocalciferol treatment of vitamin D deficiency on serum parathyroid hormone concentrations in chronic kidney disease. Am J Nephrol. 2007;27(1):36-43.
Miskulin DC, Majchrzak K, Tighiouart H, Muther RS, Kapoian T, Johnson DS, et al. Ergocalciferol supplementation in hemodialysis patients with vitamin D deficiency: a randomized clinical trial. J Am Soc Nephrol. 2015. pii: ASN.2015040468. [Epub ahead of print]
Drechsler C, Pilz S, Obermayer-Pietsch B, Verduijn M, Tomaschitz A, Krane V, et al. Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients. Eur Heart J. 2010;31(18):2253-61.
Marckmann P, Agerskov H, Thineshkumar S, Bladbjerg EM, Sidelmann JJ, Jespersen J, et al. Randomized controlled trial of cholecalciferol supplementation in chronic kidney disease patients with hypovitaminosis D. Nephrol Dial Transplant. 2012;27(9):3523-31.
Okša A, Spustová V, Krivosíková Z, Gazdíková K, Fedelesová V, Lajdová I, et al. Effects of long-term cholecalciferol supplementation on mineral metabolism and calciotropic hormones in chronic kidney disease. Kidney Blood Press Res. 2008;31(5):322-9.
Kogawa M, Findlay DM, Anderson PH, Ormsby R, Vincent C, Morris HA, et al. Osteoclastic metabolism of 25(OH)- vitamin D3: a potential mechanism for optimization of bone resorption. Endocrinology. 2010;151(10):4613-25.
Shroff R, Aitkenhead H, Costa N, Trivelli A, Litwin M, Picca S, et al. Normal 25-hydroxyvitamin D levels are associated with less proteinuria and attenuate renal failure progression in children with CKD. J Am Soc Nephrol. 2016;27(1):314-22.
Molina P, Górriz JL, Molina MD, Peris A, Beltrán S, Kanter J, et al. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant. 2014;29(1):97-109.
Custodio MR, Canziani ME, Moyses RM, Barreto FC, Neves CL, Oliveira RB, et al. Clinical protocol and therapeutic guidelines for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease. J Bras Nefrol. 2013;35(4):308-22.
Barreto FC, Oliveira RA, Oliveira RB, Jorgetti V. Pharmacotherapy of chronic kidney disease and mineral bone disorder. Expert Opin Pharmacother. 2011;12(17):2627-40.
DeLuca HF. Vitamin D: historical overview. Vitam Horm. 2016;100:1-20.
Eijkman C. Ein beri-beri anliche der huhner. Virchow Arch. 1897;148:523-7.
Grijns G. Over polyneuritis gallinarum. Geneeskd Tijdschr Ned-Indie. 1901;41:3-41.
McCollum EV, Davis M. The necessity of certain lipids in the diet during growth. J Biol Chem. 1913;15:167-75.
McCollum EV, Simmonds N, Pitz W. The relation of the unidentified dietary factors, the fat-soluble A and water-soluble B of the diet to the growth promoting properties of milk. J Biol Chem. 1916;27:33-8.
Mellanby E. An experimental investigation on rickets. Lancet. 1919;1:407-12.
McCollum EV, Simmonds N, Becker JE, Shipley PG. An experimental demonstration of the existence of a vitamin which promotes calcium deposition. J Biol Chem. 1922;53:293-8.
Hulshinsky K. Heilung von rachitis durch kunstlich hohen-sonne. Dtsch Med Wochenschr. 1919;45:712-3.
Askew FA, Bourdillon RB, Bruce HM, Jenkins RGC, Webster TA. The distillation of vitamin D. Proc Royal Soc B. 1931;107:76-90.
Windaus A, Linsert O. Vitamin D1. Ann Chemie. 1928;465:148.
Windaus A, Bock F. Uber das provitamin aus dem sterin der schweineschwarte. Hoppe-Seyler’s Zeitschrift Physiol Chemie. 1937;245(3-4):168-70.
Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, Staehelin HB, Meyer OW, Theiler R, et al. Monthly high-dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern Med. 2016;176(2):175-83.
Uusi-Rasi K, Patil R, Karinkanta S, Kannus P, Tokola K, Lamberg-Allardt C, et al. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern Med. 2015;175(5):703-11.
Patil R, Kolu P, Raitanen J, Valvanne J, Kannus P, Karinkanta S, et al. Cost-effectiveness of vitamin D supplementation and exercise in preventing injurious falls among older home-dwelling women: findings from an RCT. Osteoporos Int. 2016;27(1):193-201.
Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res. 2004;19(3):370-8.
Hansen KE, Johnson RE, Chambers KR, Johnson MG, Lemon CC, Vo TN, et al. Treatment of vitamin D insufficiency in postmenopausal women: a randomized clinical trial. JAMA Intern Med. 2015;175(10):1612-21.
Padi SK, Zhang Q, Rustum YM, Morrison C, Guo B. MicroRNA-627 mediates the epigenetic mechanisms of vitamin D to suppress proliferation of human colorectal cancer cells and growth of xenograft tumors in mice. Gastroenterology. 2013;145(2):437-46.
Ting HJ, Messing J, Yasmin-Karim S, Lee YF. Identification of microRNA-98 as a therapeutic target inhibiting prostate cancer growth and a biomarker induced by vitamin D. J Biol Chem. 2013;288(1):1-9.
Komagata S, Nakajima M, Takagi S, Mohri T, Taniya T, Yokoi T. Human CYP24 catalyzing the inactivation of calcitriol is post-transcriptionally regulated by miR- 125b. Mol Pharmacol. 2009;76(4):702-9.
Leyssens C, Verlinden L, Verstuyf A. Antineoplastic effects of 1,25(OH)2D3 and its analogs in breast, prostate and colorectal cancer. Endocr Relat Cancer. 2013;20(2):R31-47.
Feldman D, Krishnan AV, Swami S, Giovannucci E, Feldman BJ. The role of vitamin D in reducing cancer risk and progression. Nat Rev Cancer. 2014;14(5):342-57.
Hendrickson WK, Flavin R, Kasperzyk JL, Fiorentino M, Fang F, Lis R, et al. Vitamin D receptor protein expression in tumor tissue and prostate cancer progression. J Clin Oncol. 2011;29(17):2378-85.
Ditsch N, Toth B, Mayr D, Lenhard M, Gallwas J, Weissenbacher T, et al. The association between vitamin D receptor expression and prolonged overall survival in breast cancer. J Histochem Cytochem. 2012;60(2):121-9.
Lee JE. Circulating levels of vitamin D, vitamin D receptor polymorphisms, and colorectal adenoma: a meta-analysis. Nutr Res Pract. 2011;5(5):464-70.
Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta- analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(12):827-38.
Yin L, Grandi N, Raum E, Haug U, Arndt V, Brenner H. Meta-analysis: serum vitamin D and colorectal adenoma risk. Prev Med. 2011;53(1-2):10-6.
Baron JA, Barry EL, Mott LA, Rees JR, Sandler RS, Snover DC, et al. A trial of calcium and vitamin D for the prevention of colorectal adenomas. N Engl J Med. 2015;373(16):1519-30.
United Stated of America. Institute of Medicine. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary reference intakes for calcium and vitamin D. Washington: National Academies Press (US); 2011.
Feldman D, Krishnan AV, Swami S, Giovannucci E, Feldman BJ. The role of vitamin D in reducing cancer risk and progression. Nat Rev Cancer. 2014;14(5):342-57.
Pilz S, Gaksch M, Kienreich K, Grübler M, Verheyen N, Fahrleitner-Pammer A, et al. Effects of vitamin D on blood pressure and cardiovascular risk factors: a randomized controlled trial. Hypertension. 2015;65(6):1195-201.
Arora P, Song Y, Dusek J, Plotnikoff G, Sabatine MS, Cheng S, et al. Vitamin D therapy in individuals with prehypertension or hypertension: the DAYLIGHT trial. Circulation. 2015;131(3):254-62.
Scragg R, Slow S, Stewart AW, Jennings LC, Chambers ST, Priest PC, et al. Long-term high- dose vitamin D3 supplementation and blood pressure in healthy adults: a randomized controlled trial. Hypertension. 2014;64(4):725-30.
Boxer RS, Kenny AM, Schmotzer BJ, Vest M, Fiutem JJ, Piña IL. A randomized controlled trial of high dose vitamin D3 in patients with heart failure. JACC Heart Fail. 2013;1(1):84-90.
Donneyong MM, Hornung CA, Taylor KC, Baumgartner RN, Myers JA, Eaton CB, et al. Risk of heart failure among postmenopausal women: a secondary analysis of the randomized trial of vitamin D plus calcium of the women’s health initiative. Circ Heart Fail. 2015;8(1):49-56.
Shedeed SA. Vitamin D supplementation in infants with chronic congestive heart failure. Pediatr Cardiol. 2012;33(5):713-9.
Luo J, Liu D, Liu CT. Can vitamin D supplementation in addition to asthma controllers improve clinical outcomes in patients with asthma?: a meta-analysis. Medicine (Baltimore). 2015;94(50):e2185.
Tukvadze N, Sanikidze E, Kipiani M, Hebbar G, Easley KA, Shenvi N, et al. High-dose vitamin D3 in adults with pulmonary tuberculosis: a double-blind randomized controlled trial. Am J Clin Nutr. 2015;102(5):1059-69.
Elder GJ. Mushroom clouds for vitamin D? J Am Soc Nephrol. 2016. pii: ASN.2015111279. [Epub ahead of print].
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Os autores no momento da submissão transferem os direitos autorais, assim, os manuscritos publicados passam a ser propriedade da revista.
O conteúdo do periódico está licenciado sob uma Licença Creative Commons 4.0, esta licença permite o livre acesso imediato ao trabalho e que qualquer usuário leia, baixe, copie, distribua, imprima, pesquise ou vincule aos textos completos dos artigos, rastreando-os para indexação, passá-los como dados para o software, ou usá-los para qualquer outra finalidade legal.
Este obra está licenciada com uma Licença 