vitamina d: effetti...
TRANSCRIPT
![Page 1: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/1.jpg)
Vitamina D: effetti extrascheletrici
F. Vescini
![Page 2: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/2.jpg)
![Page 3: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/3.jpg)
Patologie e condizioni cliniche
associate all’ipovitaminosi D
• Rachitismo/Osteomalacia/Osteoporosi
• Fratture
• Mialgia/Sarcopenia/Astenia/Aumentato rischio di cadute
• Ridotta salute dentaria
• Neoplasie (colon, mammella, prostata)
• Malattie cardiovascolari/Ipertensione Arteriosa
• Diabete mellito
• Malattie infettive
• Osteoartrite e fibromialgia
• Malattie respiratorie
• Aumentata mortalità
![Page 4: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/4.jpg)
Patologie e condizioni cliniche
associate all’ipovitaminosi D
CADUTE
MALATTIE CV CANCRO
HIV
MORTALITA’ GLOBALE
![Page 5: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/5.jpg)
CADUTE
![Page 6: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/6.jpg)
Bischoff-Ferrari HA et al. JAMA 2004
Vitamina D e rischio di cadute
![Page 7: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/7.jpg)
Murad MH et al.
![Page 8: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/8.jpg)
2012, Issue 12.
Art. No.:
CD005465
![Page 9: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/9.jpg)
INFEZIONE DA HIV
![Page 10: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/10.jpg)
2010 May 15;24(8):1127-34
![Page 11: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/11.jpg)
J Acquir Immune Defic Syndr. 2011 oct 1;58(2):163-172
![Page 12: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/12.jpg)
Véronique Fabre-Mersseman, et al.
![Page 13: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/13.jpg)
![Page 14: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/14.jpg)
![Page 15: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/15.jpg)
MORTALITA’ PER
CANCRO
![Page 16: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/16.jpg)
VITAMIN D AND CANCER RISK
Garland CF Am J Pub Health 2006 Giovannuci E Cancer Causes Control 2005
Level vit D Incidence Severity
Breast <40 ng/ml +30-40% +5 fold
Prostate <16ng/ml +70% +6.3 fold
Colon <30 ng/ml +50% +4 fold
![Page 17: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/17.jpg)
Chowdhury R, et al. BMJ 2014;348:g1903
Relative risks of cancer mortality for baseline 25(OH)
vitamin D levels in observational cohort studies
![Page 18: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/18.jpg)
![Page 19: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/19.jpg)
MORTALITA’ PER
MALATTIE CV
![Page 20: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/20.jpg)
Ipotesi patogenetiche dell’associazione tra carenza di
vitamina D ed eventi cardiovascolari
Lee et al, J Am Coll Cardiol, 2008
![Page 21: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/21.jpg)
Chowdhury R, et al. BMJ 2014;348:g1903
Relative risks of cardiovascular mortality for baseline
25(OH) vitamin D levels in observational cohort studies
![Page 22: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/22.jpg)
The RECORD trial: Estimated effects of vitamin D on outcomes
![Page 23: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/23.jpg)
CARDIAC FAILURE
![Page 24: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/24.jpg)
STROKE
![Page 25: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/25.jpg)
MYOCARDIAL INFARCTION
![Page 26: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/26.jpg)
MORTALITA’ GLOBALE
![Page 27: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/27.jpg)
Overall effect size for all-cause mortality for the lowest category of
25OHD compared to the highest category (reference)
![Page 28: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/28.jpg)
Chowdhury R, et al. BMJ 2014;348:g1903
Relative risks of nonvascular, noncancer mortality for baseline
25(OH) vitamin D levels in observational cohort studies
![Page 29: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/29.jpg)
Schöttker B, et al. BMJ 2014;348:g3656
Dose-response trend of pooled effect estimates for the
comparison of 25-hydroxyvitamin D quintiles (top
quintile as reference) with respect to mortality outcomes
![Page 30: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/30.jpg)
Chowdhury R, et al. BMJ 2014;348:g1903
Relative risks of all cause mortality in vitamin D3
supplementation trials
![Page 31: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/31.jpg)
Chowdhury R, et al. BMJ 2014;348:g1903
Relative risks of all cause mortality in vitamin D2
supplementation trials
![Page 32: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/32.jpg)
Vitamin D decreased mortality in all 56 trials analysed.
RR 0.97 (95% CI 0.94 to 0.99; P = 0.02; I2 = 0%)
When different forms of vitamin D were assessed in separate analyses, only vitamin
D3 decreased mortality.
RR 0.94 (95% CI 0.91 to 0.98; P = 0.002; I2 = 0%)
Vitamin D2, alfacalcidol and calcitriol did not significantly affect mortality.
Trial sequential analysis supported our finding regarding vitamin D3, corresponding
to 150 people treated over five years to prevent one additional death.
Vitamin D3 statistically significantly decreased cancer mortality.
RR 0.88 (95% CI 0.78 to 0.98; P = 0.02; I2 = 0%)
Vitamin D3 combined with calcium increased the risk of nephrolithiasis.
RR 1.17 (95% CI 1.02 to 1.34; P = 0.02; I2 = 0%)
Alfacalcidol and calcitriol increased the risk of hypercalcaemia.
RR 3.18 (95% CI 1.17 to 8.68; P = 0.02; I2 = 17%)
![Page 33: Vitamina D: effetti extrascheletricinetwork.dynamicomeducation.it/.../training/13/slide/14/vescini.pdf · • Malattie infettive • Osteoartrite e fibromialgia • Malattie respiratorie](https://reader035.vdocuments.mx/reader035/viewer/2022070615/5c6a503409d3f2b2078c7446/html5/thumbnails/33.jpg)
“Meta-analyses of RCTs report that vitamin D reduces mortality risk by
3-4%, suggesting that if vitamin D supplements have an effect on
mortality, it is small and of doubtful clinical relevance.”