Huri Seval Gönderen ÇAKMAK, Yunus Nadi YÜKSEK, Tanju TÜTÜNCÜ, Emine Özer KÜÇÜK, Turan TURHAN, Dilek BERKER, Rabia KAHVECİ

D vitamini testinin akılcı kullanımı: Test mi? Ya da tedavi mi?

Amaç: Dünya çapında D vitamini eksikliğinin ve D vitamini test oranlarının artması, D vitamininin yetersizliğini yönetmek ve gereksiz testleri azaltarak maliyeti düşürme gündeme gelmiştir. Bu çalışmada D vitamini testinin akılcı kullanımı konusunda literatür taraması yapılarak klinik uygulamaya ışık tutmak amaçlanmıştır. Gereç ve Yöntemler: D vitamini eksiklik prevalansı, tedavi şekilleri ve yaklaşımlar konusunda mevcut durumu ortaya koyabilmek için 2007 Nisan ile 2017 Nisan tarihleri arasında yayınlanmış 4372 çalışma incelenmiştir. Taramalar Cochrane Library, PubMed, Ulakbim, Science Direct elektronik veri tabanları kullanılarak yapılmıştır. Taramalar “Vitamin D status”, “Vitamin D screening”, “Vitamin D measurements”, “Vitamin D Testing”, “supplements” anahtar kelimeleri kullanılarak yapılmıştır. Çalışma sınırlarına uyan 74 çalışma değerlendirilmiştir. Bulgular: D vitamini eksikliği test sayısı ülkemizde ve dünyada giderek önemli bir artış göstermekte ve sağlık bakımına mali yük getirmektedir. D vitamini toksisitesinin az görüldüğü riskli gruplarda D vitamini takviyesine test yapmadan başlanmasının güvenli olduğu ortaya konulmaktadır. Dünyada yayınlanan rehberler D vitamini eksikliği için test yapmak yerine, farkındalığın artırılması, belli gruplarda testsiz D vitamini takviyesi yapıp, belli gruplarda D vitamini testi yapılmasını önermektedir. Depo D vitamini tedavisinden kaçınılması, D vitamini takviyesinin damla olarak kullanılması konusunda farkındalık yaratılması gerekmektedir. SonuçAmaç: Dünya çapında D vitamini eksikliğinin ve D vitamini test oranlarının artması, D vitamininin yetersizliğini yönetmek ve gereksiz testleri azaltarak maliyeti düşürme gündeme gelmiştir. Bu çalışmada D vitamini testinin akılcı kullanımı konusunda literatür taraması yapılarak klinik uygulamaya ışık tutmak amaçlanmıştır. Gereç ve Yöntemler: D vitamini eksiklik prevalansı, tedavi şekilleri ve yaklaşımlar konusunda mevcut durumu ortaya koyabilmek için 2007 Nisan ile 2017 Nisan tarihleri arasında yayınlanmış 4372 çalışma incelenmiştir. Taramalar Cochrane Library, PubMed, Ulakbim, Science Direct elektronik veri tabanları kullanılarak yapılmıştır. Taramalar “Vitamin D status”, “Vitamin D screening”, “Vitamin D measurements”, “Vitamin D Testing”, “supplements” anahtar kelimeleri kullanılarak yapılmıştır. Çalışma sınırlarına uyan 74 çalışma değerlendirilmiştir. Bulgular: D vitamini eksikliği test sayısı ülkemizde ve dünyada giderek önemli bir artış göstermekte ve sağlık bakımına mali yük getirmektedir. D vitamini toksisitesinin az görüldüğü riskli gruplarda D vitamini takviyesine test yapmadan başlanmasının güvenli olduğu ortaya konulmaktadır. Dünyada yayınlanan rehberler D vitamini eksikliği için test yapmak yerine, farkındalığın artırılması, belli gruplarda testsiz D vitamini takviyesi yapıp, belli gruplarda D vitamini testi yapılmasını önermektedir. Depo D vitamini tedavisinden kaçınılması, D vitamini takviyesinin damla olarak kullanılması konusunda farkındalık yaratılması gerekmektedir. Sonuç: D vitamini damla takviyesinin kanda D vitamini oranına bakılmaksızın, doktor değerlendirmesi ile başlanması çok daha kolay, güvenli ve ucuz bir yaklaşım olarak denenebilir.: D vitamini damla takviyesinin kanda D vitamini oranına bakılmaksızın, doktor değerlendirmesi ile başlanması çok daha kolay, güvenli ve ucuz bir yaklaşım olarak denenebilir.

Anahtar Kelimeler:

D Vitamin Eksikliği, D Vitamin Test

Rational use of vitamin D test: Is it a test? Or treatment?

Aim: The worldwide increase in vitamin D deficiency and vitamin D testing has led to lower vitamin D costs and lower unnecessary testing. In this study, we aimed to shed light on clinical practice by conducting a literature search on the rational use of vitamin D test. Material and Methods: 4372 studies published between April 2007 and April 2017 were examined to determine the prevalence, vitamin D deficiency prevalence, treatment modalities and approaches in the world. The scans were made using Cochrane Library, PubMed, Ulakbim, Science Direct electronic databases. The scans were made using the keywords "Vitamin D status", "Vitamin D screening", "Vitamin D measurements", "Vitamin D Testing", "supplements". Finally seventy-four studies that met the study limits were evaluated. Results: It is found that the number of vitamin D deficiency tests is increasing in our country and in the world, increasing the financial burden on health care. It is demonstrated that it is safe to start vitamin D supplementation without testing in risky groups in which D vitamin toxicity is low. Guidelines published in the world do not refer to test for lack of vitamin D, but rather raise awareness, make untested vitamin D supplementation in certain groups, and test for vitamin D in certain groups. Avoidance of high dose vitamin D therapy and awareness of the use of vitamin D supplementation as a drop should be performed. Conclusion: Regardless of the rate of vitamin D, it is much easier, safer and cheaper to start vitamin D supplementation with a doctor's assessment.

Keywords:

vitamin D vitamin D testing, vitamin D supplements,

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1. Metabolik Sendrom Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği. Ankara, Tuna Matbaacılık, 2009: 8-11.
2. Calvo MS, Whiting SJ, Barton CN, Vitamin D fortification in the United States and Canada: current status and data needs. The American Journal of Clinical Nutrition 2004; 80: 1710-16.
3. Yetley EA, Assessing the vitamin D status of the US population. The American Journal of Clinical Nutrition 2008; 88: 558-64.
4. Holick MF.Vitamin D deficiency. New England Journal of Medicine 2007; 357: 266-81.
5. Karami S, Colt JS, Stewart PA et al. A case–control study of occupational sunlight exposure and renal cancer risk.International Journal of Cancer 2016; 138: 1626-33.
6. Mokry LE, Ross S, Morris JA, Manousaki D, Forgetta V, Richards JB. Genetically decreased vitamin d and risk of alzheimer disease. Neurology 2016; 87: 2567-74.
7. Uçar F, Taşlıpınar MY, Soydaş AÖ, Özcan N. Ankara etlik ihtisas eğitim ve araştırma hastanesine başvuran hastalarda 25-oh vitamin d düzeyleri. Eur J Basic Med Sci 2012; 2: 12-15.
8. Pearce S, Cheetham TD. Diagnosis and management of vitamin d deficiency.Bmj, 2010; 340: 5664
9. Oren Y, Shapira Y, Agmon-Levin N et al. Vitamin d insufficiency in a sunny environment: a demographic and seasonal analysis.IMAJ-Israel Medical Association Journal 2010; 12: 751.
10. Lips P. Vitamin d status and nutrition in europe and asia.The Journal Of Steroid Biochemistry and Molecular Biology, 2007; 103: 620-25.
11. Bilinski K, BoyagesS.Evidence of overtesting for vitamin D in Australia: an analysis of 4.5 years of Medicare Benefits Schedule (MBS) data. BMJ open 2013; 3: 2955.
12. Bilinski KL, Boyages S C.The rising cost of vitamin D testing in Australia: time to establish guidelines for testing. Med J Aust 2012; 197: 90.
13. Sattar N, Welsh P, Panarelli M, Forouhi NG. Increasing requests for vitamin D measurement: costly, confusing, and without credibility. The Lancet 2012; 379: 95-96.
14. van Schoor NM, LipsP.Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 2011; 25: 671-80.
15. Ross AC, Manson JE, Abrams SA et al.The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. The Journal of Clinical Endocrinology & Metabolism 2011; 96:53-58.
16. Aspray TJ, Bowring C, Fraser W et al. National osteoporosis society vitamin D guideline summary. Age and ageing 2014; 43: 592-95.
17. Briot K, Audran M, Cortet B et al. Vitamin D: skeletal and extra skeletal effects; recommendations for good practice. Presse medicale (Paris, France: 1983), 2009; 38: 43-54.
18. Francis R. Vitamin D and bone health: a practical clinical guideline for patient management. National Osteoporosis Society, 2013.
19. ACOG Committee Opinion No. 495: Vitamin D: Screening and supplementation during pregnancy. Obstetrics and gynecology 2011; 118: 197.
20. Souberbielle JC, Body JJ, Lappe JM, Plebaniet M. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: recommendations for clinical practice. Autoimmunity reviews 2010; 9: 709-15.
21. Yener M. Kas iskelet sistem ağrısı ile vitamin D düzeyleri arasındaki ilişkinin araştırılması. SDÜ Tıp Fakültesi Dergisi 2007; 14.
22. Akpınar P, İçağasıoğluA, D vitamininin yaşam kalitesi ile ilişkisi. Türk Osteoporoz Dergisi 2012; 18: 13-18.
23. Koluaçık Yıldırım S. Malatya il merkezinde 20 yaş ve üzeri kadınlarda d vitamini düzeyi ile üst solunum yolu enfeksiyonları arasındaki ilişki. Doktora Tezi, İnönü Üniversitesi Sağlık Bilimleri Enstitüsü, Malatya; 2013.
24. Das G, Crocombe S, McGrath M, BerryJL.Hypovitaminosis D among healthy adolescent girls attending an inner city school. Arch Dis Child 2006; 91: 569-72.
25. Lippi G,MontagnanaM, TargherG, Vitamin D deficiency among Italian children. Cmaj 2007; 177: 1529-30.
26. Sahu M, Bhatia V, Aggarwal A et al. Vitamin D deficiency in rural girls and pregnant women despite abundant sunshine in northern India. Clin Endocrinol (Oxf) 2009; 70: 680-84.
27. Mansoor S, Habib A, Ghani F et al. Prevalence and significance of vitamin D deficiency and insufficiency among apparently healthy adults. Clinical biochemistry 2010; 43: 1431-35.
28. Østergård M, Arnberg K, Michaelsenet KF et al. Vitamin D status in infants: relation to nutrition and season. Eur J Clin Nutr 2011; 65: 657-60.
29. Daly RM, Gagnon C, Lu ZX, Magliano DJ. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clin Endocrinol (Oxf) 2012; 77: 26-35.
30. Mellati AA, Sharifi F, Faghihzade S et al. Vitamin D status and its associations with components of metabolic syndrome in healthy children. Journal of Pediatric Endocrinology and Metabolism 2015; 28: 641-48.
31. Voortman T, van den Hoovenet EH et al. Vitamin D deficiency in school-age children is associated with sociodemographic and lifestyle factors.The Journal of nutrition 2015; 145: 791-798.
32. Mithal A, Wahl DA, Bonjour JP, Burckhardt P. Global vitamin D status and determinants of hypovitaminosis D. Osteoporosis International 2009; 20: 1807-20.
33. Forrest KY, Stuhldreher WL.Prevalence and correlates of vitamin D deficiency in US adults. Nutrition Research 2011; 31: 48-54.
34. Ginde AA, Liu MC, Camargo CA, Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Archives of İnternal Medicine 2009; 169: 626-32.
35. Ginde AA, Sullivan AF, MansbachJM et al. Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the United States. American Journal of Obstetrics and Gynecology 2010; 202: 436-38.
36. Durvasula S, Kok C, Sambrook PN et al. Sunlight and health: attitudes of older people living in intermediate care facilities in southern Australia. Archives of Gerontology and Geriatrics 2010; 51: 94-99.
37. Sohl E, van Schoor NM, de JonghRT et al. The impact of medication on vitamin D status in older individuals. European Journal of Endocrinology 2012; 166: 477-85.
38. Jones G. Pharmacokinetics of vitamin D toxicity. The American Journal Of Clinical Nutrition 2008; 88: 582-86.
39. Stephenson DW, Peiris AN.The lack of vitamin D toxicity with megadose of daily ergocalciferol (D2) therapy: a case report and literature review. Southern Medical Journal 2009; 102: 765-68.
40. Hathcock JN, Shao A, ViethR and et al. Risk assessment for vitamin D. The American Journal of Clinical Nutrition 2007; 85: 6-18.
41. Lefevre M L. Screening for Vitamin D Deficiency in Adults: US Preventive Services Task Force Recommendation StatementScreening for Vitamin D Deficiency in Adults. Annals of İnternal Medicine 2015; 162: 133-40.
42. Cranney A, Horsley T, O'Donnell S et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007; 158: 23-25.
43. Welch AK. The rising cost of vitamin D testing in Australia: time to establish guidelines for testing. Med J Aust 2012; 197: 90.
44. Rosen CJ, Abrams SA, Aloia JF et al. IOM committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab 2012; 97: 1146-52.
45. Wood CL, Cheetham TD.Vitamin D: increasing supplement use among at-risk groups (NICE guideline PH56). Archives of disease in childhood-Education & practice edition 2015; 299-308.
46. CADTH Rapid Response Reports, in Vitamin D Testing in the General Population: A Review of the Clinical and Cost-Effectiveness and Guidelines. Canadian Agency for Drugs and Technologies in Health, Ottawa (ON).2015.
47. Mendy Moody R, Joyce Jackowski M. Are patients on oral chemotherapy in your practice setting safe? Clinical Journal of Oncology Nursing 2010; 14: 339.
48. Abrahamsem B, Masud T, Avenell A et al. Patient level pooled analysis of 68,500 patients from seven major vitamin D fracture trials in the US and Europe. British Medical Journal (BMJ) 2010; 340: 54-63.
49. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. Bmj 2009; 339: 3692.
50. Tang BMP, Eslick GD, Nowson C et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. The Lancet 2007; 370: 657-66.
51. Sözen T. TEMD Osteoporoz ve Diğer Metabolik Kemik Hastalıkları Çalışma Grubu. Osteoporoz. Sık Görülen Metabolik Kemik Hastalıkları Kullanım Klavuzu 2008: 9-25.
52. Ross AC, Taylor CL, Yaktine AL et al. Dietary reference intakes for adequacy: Calcium and Vitamin D.National Academies Press (US),2011.
53. Ross AC et al (Editors). Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, The National Academies Collection: Reports funded by National Institutes of Health, in Dietary Reference Intakes for Calcium and Vitamin D, National Academies Press (US), 2011.
54. Holick MF, BinkleyNC et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism 2011; 96: 1911-30.
55. Agostoni C, Bresson JL, Fairweather Tait S et al. Scientific opinion on the tolerable upper intake level of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA): EFSA panel on dietetic products, nutrition and allergies (NDA).The Efsa Journal 2012; 10: 1-48.
56. Vidailhet M, Mallet E, Bocquet A et al., Vitamin D: still a topical matter in children and adolescents. A position paper by the Committee on Nutrition of the French Society of Paediatrics. Archives de pédiatrie 2012; 19: 316-28.
57. Whiting SJ, Langlois KA, Vatanparast H et al. The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. The American Journal of Clinical Nutrition 2011; 94: 128-35.
58. Nowson CA, McGrath JJ, Ebeling PR et al. Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 2012; 196: 686-87.
59. Francis R, AsprayT, FraserW. Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management. National Osteoporosis Society, 2013.
60. LeFevre ML. Screening for vitamin D deficiency in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015; 162: 133-40.
61. de Koning L, Henne D, Woods P et al. Sociodemographic correlates of 25-hydroxyvitamin D test utilization in Calgary, Alberta. BMC Health Serv Res 2014; 14: 339.
62. Kotta S, Gadhvi D, Jakeways N et al., "Test me and treat me"--attitudes to vitamin D deficiency and supplementation: a qualitative study. BMJ Open 2015; 5: 007401.
63. Henry HL, Bouillon R, Norman AW et al. 14th Vitamin D Workshop consensus on vitamin D nutritional guidelines. The Journal of Steroid Biochemistry and Molecular Biology 2010; 121: 4-6.
64. Heaney RP, Davies KM, Chen TC et al., Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. The American Journal of Clinical Nutrition 2003; 77: 204-10.
65. Garland CF, French CB, Baggerly LL et al.Vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention. Anticancer Research 2011; 31: 607-11.
66. Mai S, Walker G, Vietti R et al. Acute Vitamin D(3) Supplementation in Severe Obesity: Evaluation of Multimeric Adiponectin. Nutrients 2017; 9
67. Mai S, Walker G, Vietti R, Cattaldo S, Mele C .The effect of vitamin D supplement on the score and quality of sleep in 20-50 year-old people with sleep disorders compared with control group. Nutr Neurosci 2017; 1-9.
68. Bilici ME. 10-18 yaş arası d vitamini eksikliği olan obez adolesanlarda 2000 IU/gün D vitamini tedavisinin insülin direnci ve kardiyovasküler risk parametreleri üzerine etkisi. Sağlık Bilimleri Üniversitesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Endokrinoloji Bilim Dalı. 2016.
69. Tambova AK. Kronik böbrek hastalığında d vitamininin trombosit fonksiyonları üzerine etkisi. Eskişehir Osmangazi Üniversitesi, İç Hastalıkları Anabilim Dalı. Eskişehir, 2015.
70. Moreira-Pfrimer LDF, Pedrosa MAC et al. Treatment of vitamin D deficiency increases lower limb muscle strength in institutionalized older people independently of regular physical activity: a randomized double-blind controlled trial. Ann Nutr Metab 2009; 54: 291-300.
71. Gallagher JC, Sai A, Templin T. Dose response to vitamin D supplementation in postmenopausal women: a randomized trial. Ann Intern Med 2012; 156: 425-37.
72. Dong Y, Stallmann-Jorgensen IS et al. A 16-week randomized clinical trial of 2000 international units daily vitamin D3 supplementation in black youth: 25-hydroxyvitamin D, adiposity, and arterial stiffness. J Clin Endocrinol Metab 2010; 95: 4584-91.
73. Ganmaa D, Stuart JJ, Sumberzul N et al. Vitamin D supplementation and growth in urban Mongol school children: Results from two randomized clinical trials. PLoS One, 2017; 12.