Hipovitaminosis D: una visión desde la clínica y la biología molecular

Abstract

ResumenLa vitamina D es una hormona que participa en gran cantidad de procesos fisiológicos y bioquímicos dentro del organismo humano, tales como la absorción de calcio y fosfato a nivel intestinal, regulación de la calcemia y mineralización ósea; además, tiene efectos sobre el ciclo celular, proliferación, diferenciación, señalización, apoptosis y producción de varias moléculas en diferentes células y tejidos, lo que explica la relación de sus bajos niveles con el desarrollo de múltiples patologías. En los últimos años, se ha reportado una elevada prevalencia de hipovitaminosis D a nivel mundial, que oscila entre el 50 y 92% según la población estudiada, producto de la deficiente exposición a la luz solar, escasa ingesta dietética, poco uso de suplementos vitamínicos, entre otros factores asociados. A su vez, se ha encontrado que la deficiencia de vitamina D es causada por algunos polimorfismos genéticos que afectan su metabolismo y conllevan al desarrollo de varias enfermedades. Debido a la importancia clínica de la vitamina D, se realizó esta revisión de la literatura por medio de la búsqueda de artículos originales, revisiones sistemáticas y narrativas en las bases de datos Pubmed y ScienceDirect y en el buscador Google Scholar. Se seleccionaron en total 71 artículos, a partir de los cuales se busca describir en el presente texto algunos de los aspectos relacionados con la fisiología, epidemiología, clínica y etiología de la hipovitaminosis D. Vitamin D deficiency: a view from clinical features and molecular biology AbstRActVitamin D is a hormone involved in many physiological and biochemical processes within the human, such as the absorption of calcium and phosphate in the intestine, regulation of blood calcium and bone mineralization; it also has effects on the cell cycle, proliferation, differentiation, signaling, apoptosis and production of various molecules in different cells and tissues, which explains the relationship between low levels of vitamin D and the development of many diseases. In recent years, there has been reported a high prevalence of vitamin D deficiency worldwide, ranging between 50 and 92% depending on the population studied, the result of poor exposure to sunlight, poor dietary intake, little use of vitamin supplements, among other associated factors. Hence, it has been found that vitamin D deficiency is caused by some genetic polymorphisms that affect their metabolism and lead to the development of various diseases. Because of the clinical importance of vitamin D, this review of the literature was conducted by the search for original articles, systematic reviews and narrative articles in PubMed, ScienceDirect and Google Scholar reviews. They were selected in total 71 articles, from which we seek to describe here some of the aspects of physiology, epidemiology, clinical and etiology of vitamin D deficiency. mÉD.uIs. 2017;30(1):45-56.

Vitamin D Deficiency in Brazil: Questions about Potential Causes and Clinical Characteristics*

“…19 Soy milk, margarine, breads, breakfast cereals, orange juice, and egg yolks are also good vitamin D sources. 1,10,[26][27][28] Brazil has a difficult ethnic classification due to its high degree of miscegenation. 29 As revealed by the 2016 National Continuous Household Sample Survey (PNAD), the Brazilian population is comprised of 8.2% black and 46.2% brown subjects.…”

“…There is a worldwide consensus that serum calcidiol levels below 25 to 30 nmol/L can damage bone metabolism. 1,55 Within this context, it is worth highlighting a discussion regarding these values, which change according to location and source, as shown in ►Table 1.…”

“…Vitamin D is a fat-soluble steroid hormone, and it is considered a micronutrient essential to a complex endocrinological system. [1][2][3][4][5][6] Its action has been studied since the beginning of the 20 th century and it is increasingly clear that vitamin D functions are not restricted to the classical bone mineralization regulation. [1][2][3]7 Vitamin D has several roles, encompassing both endocrine reactions and functions from other systems, such as the immune system.…”

“…conditions such as systemic arterial hypertension, cancer, osteoarthritis, multiple sclerosis, and diabetes mellitus is described. 1,2,8 Although the main site of vitamin D metabolism (►Figure 1) is the skin, it also occurs in other properly functioning organs, such as the bowel, liver and kidney. 9,10 Cutaneous 7-dehydrocholesterol (pro-vitamin D3) is converted by ultraviolet B (UVB) radiation in cholecalciferol (vitamin D3), which can be also obtained from food sources.…”

Niveles de vitamina D según el estado nutricional de un grupo de niños y adolescentes entre 2015-2019 en Bogotá.

“…La vitamina D (VitD) es una prohormona esencial, que cumple un rol determinante en el metabolismo óseo, interactuando con la absorción intestinal y reabsorción renal de calcio; su deficiencia, produce efectos en la mineralización ósea, siendo su presentación clínica más grave, el raquitismo en los niños (2). En pediatría, la deficiencia se ha relacionado con otros condiciones clínicas como desnutrición, obesidad(3), síndrome metabólico, diabetes, cáncer, infecciones de vías respiratorias y problemas del sistema inmune (4,5).…”