Vitamin D: the tricky hormone

Abstract

Vitamin D, a pre-hormone produced in the skin under sunlight exposure, undergoes various metabolic steps until its active form, 1,25-dihydroxyvitamin D3, is formed. The intermediary form, 25-hydroxyvitamin D (25OHD), is the recommended form for monitoring vitamin D status. The presence of 1α-hydroxylase (CYP27B1) and the vitamin D receptor (VDR) in many cells indicates a possible local ability to synthesize 1,25-dihydroxyvitamin D3, the active metabolite of vitamin D, which has turned the attention of the medical community to the noncalcemic effects of vitamin D (1). In recent decades, several studies have demonstrated the association of circulating 25OHD levels with different diseases, their activity, and health conditions. A positive association was found in several disorders such as systemic lupus erythematosus (SLE) and its activity (2); chronic obstructive pulmonary disease (COPD) (3); inflammatory bowel disease (IBD) (4); systemic sclerosis; endocrine disorders; cancer; immune; cardiovascular and other chronic diseases (1,5); despite the presence of numerous positive observational studies, causation studies are lacking. A few good-quality randomized controlled studies on vitamin D supplementation in diverse disease endpoints show a modest effect on blood pressure, glycemic control, cancer, and immune response (5,6).Hypovitaminosis D is highly frequent worldwide and in Brazil, the prevalence ranges from 16% to 80% depending on the latitude and the population studied (1,7). Although low levels of vitamin D are present in different diseases, infertile women studied in the article by Lopes and cols. (8) and also by others (9) did not show lower levels compared to controls. The literature in the field is ambiguous, showing both the importance of its adequate level and the lack of effect in infertility issues, such as polycystic ovary syndrome, endometriosis, myoma-induced infertility, male infertility, premature ovary failure and in vitro fertilization techniques (10,11). Interestingly, however, Lopes and cols. (8) pointed out the high prevalence of hypovitaminosis D in a young premenopausal population, which is in agreement with the low vitamin D levels described for postmenopausal and older women in Brazil. Vitamin D and its level of impact on fertility is a matter to be defined. This controversy points out the wide effect of vitamin D and the need for a better understanding of its metabolism.Nolasco and cols. (12) showed a positive effect of vitamin D on pulmonary function in healthy postmenopausal women participating in an aquatic exercise program. Low vitamin D levels were previously described in pulmonary diseases as well as their