1. Intern Seminar： Vitamin D deficiency
Presenter：Int. 許哲瑋
Supervisor：Dr. 林永傑
2016/10/03

2. Outline 02 Vitamin D insufficiency in Taiwan Biochemistry of Vitamin D
Definition of Vitamin D insufficiency
Disease associated with vitamin D deficiency / insufficiency
Vitamin D supplement 02

3. 03 Prevalence of Vitamin D deficiency in Taiwan
Nutrition And Health Survey in Taiwan
台灣營養健康狀況變遷調查 03

4. 60% population 3.5% population 04
Prevalence of Vitamin D deficiency in Taiwan
Nutrition And Health Survey in Taiwan
台灣營養健康狀況變遷調查
60% population
3.5% population 04

5. 05 Vitamin D insufficiency in Taiwan Biochemistry of Vitamin D
Definition of Vitamin D insufficiency
Disease associated with vitamin D deficiency / insufficiency
Vitamin D supplement 05

6. Structure of Vitamin D 06 1 nmol/L = 400 ng/L = 0.4 ng/ml
Cholecalciferol
Ergocalciferol
g/mol
g/mol
1 nmol/L = 400 ng/L = 0.4 ng/ml
50 nmol/L = 20 ng/ml 06

7. Synthesis of Vitamin D 07 Dietary UVB 7-dehydrocholesterol Vitamin D3
Liver
Calcidiol
25-OH Vitamin D
Skin
Gastrointestinal tract
Kidney
Vasculature
24,25-(OH)2 Vitamin D
Calcitriol
1,25-(OH)2 Vitamin D
Osteoblasts 07

8. Feedback system of Vitamin D
25-OH Vit D
Negative
Feedback
PTH↑
Ca ↓ P↓
1,25-(OH)2 Vit D 08

9. Functions of Vitamin D 09 Intestine
Absorption of calcium and phosphate
Kidney
PTH↓ → Phosphate reasorption ↑
Bone
Ca↑ P↑ → Bone mineralization↑
Vitamin D receptor element
3000 genes
VDRE 09

10. Distribution of Vitamin D receptors 10
Am J Physiol Cell Physiol Jun 1;304(11)C

11. 11 Long half-life Storage Deficiency ? Large amount Measured Disease ?
Dietary
UVB
7-dehydrocholesterol
Vitamin D3
Vitamin D2
Liver
Long half-life
Storage
Calcidiol
25-OH Vitamin D
Deficiency ?
Large amount
Measured
Kidney
24,25-(OH)2 Vitamin D
Calcitriol
1,25-(OH)2 Vitamin D
Disease ?
Bowel
Kidney
Bone
VDRE 11

12. 12 Vitamin D insufficiency in Taiwan Biochemistry of Vitamin D
Definition of Vitamin D insufficiency
Disease associated with vitamin D deficiency / insufficiency
Vitamin D supplement 12

13. Definition of Vitamin D deficiency
Serum 25-Hydroxyvitamin D [25(OH)D] Concentrations and Health
For Bone health！ 13
Beyond skeletal system

14. Definition of Vitamin D deficiency
Pediatrics
Endocrine
Kidney
Adult 14
J Pediatr Pharmacol Ther 2013;18(4):277–291

15. 15 Vitamin D insufficiency in Taiwan Biochemistry of Vitamin D
Definition of Vitamin D insufficiency
Disease associated with vitamin D deficiency / insufficiency
Vitamin D supplement 15

16. Vit D Deficiency 16 Rickets Wound Diabetes Muscle Infection Cancer
Osteomalacia
Rickets
Wound
Diabetes
Hypertension
Vit D Deficiency
Autoimmune
Muscle
Infection
Cancer
Obesity 16

17. 17
Public Health Reviews, Vol. 32, No 1,

18. Rickets
Deficient mineralization and architectural disruption at the growth plate
Initially manifests at the distal forearm and knee
Clinical presentation
Deformity, valgus, varus
Image: widening of the epiphyseal plate, disorganization
Lab data: Alk-P↑, Ca, P, PTH, 25(OH)D, 1,25(OH)2D
Classification
Calcipenic: with/ without vitamin D deficiency
Phosphopenic: renal phosphate wasting 18

19. 19 cupping splaying widening fraying 19
PEDIATRICS Volume 122, Number 2, August 2008

20. Neonatal sepsis 20 Maternal Calcidiol↑ Neonatal Calcidiol↑
Journal of Perinatology (2015) 35, 39–45
Chin J Contemp Pediatr Vol.18 No.9 Sep. 2016
Maternal Calcidiol↑ Neonatal Calcidiol↑
15 ng/mL , 20 ng/mL 20

21. Development delay 21 18 ng/ml 30 ng/ml
Pediatrics March 2012, VOLUME 129 / ISSUE 3

22. Diabetes 22 Diabetes Care. 2013 May;36(5):1422-8. 22
Diabetes Care May;36(5):

23. Hypertension 23 15 ng/ml 30 ng/ml 32 ng/ml 23
Eur J Epidemiol Mar;28(3):205-21

24. Breast Cancer 24 27.0 ng/mL vs 19.8 ng/mL 24
Tumour Biol Dec;34(6):

25. Leg ulcer 25 - 7 cm2 vs - 2.5 cm2 (p=0,0676)
17,05 ng/ml vs 22,75 ng/ml (p=0,0182) 25
Rev. Col. Bras. Cir. 2012; 39(5):

26. Groups at Risk of Vitamin D Inadequacy
Older adults
People with limited sun exposure
Fat malabsorption
Obese
Perinatal factors
Maternal vitamin D deficiency
Prematurity 
Exclusive breast feeding 26

27. 28 Vitamin D insufficiency in Taiwan Biochemistry of Vitamin D
Definition of Vitamin D insufficiency
Disease associated with vitamin D deficiency / insufficiency
Vitamin D supplement 28

28. 29 Recommendation of Vitamin D intake 1 micro gram = 40 IU
建議從新生兒開始每天給予400 IU口服維生素D
使用配方奶的兒童，如果每日進食少於1,000毫升加強維生素D的配方奶，需補充
維生素D 的其他來源，例如加強維生素D的食物，可計入400 IU的每日最低攝取量之中 29

29. 30 Recommendation of Vitamin D intake 300 IU
Nutrition And Health Survey in Taiwan
台灣營養健康狀況變遷調查
300 IU 30

30. Vitamin D in Food 31 100g D3 (μg) D3 (IU) 野生鮭魚 22 880 秋刀魚 19 760 吳郭魚11
440
植物性奶油 10
400 鴨肉
3.1
120 豬肝
1.3 52
1 顆雞蛋黃
0.5 20 豬肉
0.1 4 31

31. Vitamin D supplement
30 IU/pack
200 IU/ml 32

32. = 2 IU/100 ml
= 50 IU/100 ml 33

33. Sun Exposure 34 Season Cloud cover Time of day Skin melanin content
UVB (290–320 nm)
600 cm2 (5% ), 3 min → 435 IU
Season
Cloud cover
Time of day
Total body surface, erythema → IU
Skin melanin content
Sunscreen 34
Am J Clin Nutr 1999;69:842–56
Alternative Medicine Review ◆ Volume 10, Number 2 ◆ 2005

34. Take home message
Preterm IU 35

35. Thank you very much！