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Benefits of Vitamin D: A Nursing Home Perspective
Vitamin D has many health benefits. Musculoskeletal problems are more common in those with vitamin D deficiency/insufficiency. This includes osteoporosis, increased risk of fractures, increased risk of falls and reduced muscle function.
Osteoporosis affects a large percentage of nursing home residents. Osteoporosis is a bone disease associated with low bone mass and increased risk of fractures. Ten million Americans are affected by osteoporosis while 34 million are affected by osteopenia. It is estimated that 70 to 85 percent of individuals living in a nursing home have osteoporosis.
Osteoporosis is related to insufficient calcium intake, but vitamin D helps calcium absorption. Long-term vitamin D deficiency increases the risk of osteoporosis2. Vitamin D may prevent osteoporosis in the elderly who are not ambulatory, those taking chronic steroids, and postmenopausal women.
Vitamin D supplementation has the potential to increase bone density. In one study there was an increase in lumbar spine and femoral neck bone density with vitamin D supplementation of 50,000 international units twice weekly for five weeks in those who were vitamin D deficient.
Vitamin D and calcium together reduce fractures in institutionalized older adults, but vitamin D alone is not effective in reducing the risk of falls or fractures. Those over age 65 with low vitamin D levels are at increased risk for hip fractures and decreased muscle mass and strength.
Vitamin D has the potential to reduce the risk of falls. It potentially does this by improving muscle function. Low levels of vitamin D in the blood are associated with poorer muscle function, and higher levels are associated with better muscle function. Those with a low baseline serum 25-hydroxyvitamin D concentration (between 10-20 ng/ml) are likely to benefit more in terms of muscle strength when supplemented with vitamin D.
When vitamin D supplements are consumed in doses of 700 to 1000 international units per day, the risk of falls is reduced. When 500,000 units of cholecalciferol were given once a year, the risk of falling actually increased.
A link has been established between vitamin D and cancer. Vitamin D may help prevent colon, breast and prostate cancer. Precancerous lesions of the intestine and breast are associated with vitamin D receptor deficiency in animals.
Many types of cancer have been linked to poor vitamin D status. Colorectal cancer risk is increased in those with poor vitamin D status. One analysis showed that those who consume 1,000 international units of vitamin D per day have a reduced risk of colorectal cancer. Another analysis showed that vitamin D intake was inversely associated with colorectal cancer risk. Despite the positive data on vitamin D, the research is inconsistent, and the National Cancer Institute does not advise for or against the use of vitamin D supplements to reduce the risk of colorectal cancer or any other type of cancer.
Some studies show that serum 25-hydroxyvitamin D concentration is associated with a reduced risk of breast cancer, but the findings do not reach statistical significance. More research is needed to determine the role of vitamin D in breast cancer risk.
There is some evidence that vitamin D may be harmful. A large prospective study suggested that vitamin D does not reduce the risk of prostate cancer, and higher circulating levels of vitamin D may be associated with a higher risk of aggressive disease. Other studies suggest that those with the highest levels of vitamin D may be at an increased risk for pancreatic cancer.
Despite some research suggesting that vitamin D reduces the risk of some types of cancer, current evidence does not recommend high doses of vitamin D in cancer prevention. A large analysis of over 16,000 people suggested that total cancer mortality is not related to baseline vitamin D status. Overall research does not support a role for vitamin D in cancer prevention. More research is needed to determine the exact link between cancer and vitamin D.
The immune system
Vitamin D has effects on the immune system. Vitamin D may reduce the risk of autoimmune diseases in animals. Diseases that may be affected by vitamin D status include: type 1 diabetes mellitus, multiple sclerosis, and inflammatory bowel disease.
Vitamin D supplementation in early infancy reduces the risk of type 1 diabetes. One study suggested that those with a serum concentration of 25-hydroxyvitamin D below 20 ng/mL had about a twofold increased rate of later developing multiple sclerosis. . Currently, only animal, in vitro, and epidemiological studies suggest a link between diabetes/multiple sclerosis and vitamin D. Randomized controlled trials need to occur before a firm conclusion can be drawn.
Higher levels of vitamin D are associated with a lower risk of Crohn’s disease. Impaired regulation of vitamin D is associated with the development of autoimmune processes (including inflammatory bowel disease) in animals. Administration of vitamin D may improve these symptoms.
Vitamin D can help fight bacterial and viral infections. Vitamin D levels are associated with tuberculosis. Vitamin D deficiency may be more common in those with tuberculosis. Vitamin D may have a role in the treatment of tuberculosis, but more research is needed before this link can be definitively established.
Vitamin D levels may have a beneficial effect on viral respiratory tract infections, but this relationship has not been firmly established. Multiple studies have not found an association between vitamin D status and the prevention of viral respiratory infections. A more recent analysis suggested that vitamin D supplementation may reduce the risk of viral upper respiratory tract infections and tuberculosis.
Vitamin D and the heart
Many genes in the cardiovascular system are regulated by vitamin D. Vitamin D deficiency has been linked to heart attack, stroke, high blood pressure, diabetes, peripheral vascular disease and heart failure. There are few studies examining vitamin D and cardiovascular disease. Observational studies suggest that there is an association between cardiovascular disease and vitamin D status. More research is needed to determine the role of vitamin D supplementation in cardiovascular disease.
The renin-angiotensin system is partially regulated by vitamin D. There is an inverse relationship between spontaneous hypertension and serum 25-hydroxyvitamin D concentration. More research is needed to confirm a causal relationship between vitamin D levels and blood pressure.
In a review, five of seven studies showed an inverse association between serum 25-hydroxyvitamin D levels and cardiovascular disease. The prevalence of coronary heart disease is higher in those with a low serum 25-hydroxyvitamin D concentration than in those with higher levels. Vitamin D supplementation did not result in any beneficial effect on cardiovascular disease risk factors, and no benefit was assessed after serum 25-hydroxyvitamin D concentration increased from 23 ng/mL to above 40 ng/mL.
Vitamin D and other diseases
Diabetes is linked to vitamin D. The link between vitamin D and type 1 diabetes mellitus was discussed above. Low levels of vitamin D are associated with type 2 diabetes. Higher levels of vitamin D intake are associated with a lower risk of type 2 diabetes. Despite these correlations, interventional studies with vitamin D have not shown that supplementation vitamin D reduces the risk of diabetes.
Vitamin D is important for brain development, so it may be linked to psychopathology. Low serum levels of 25-hydroxyvitamin D have been shown to be present in those with Alzheimer’s disease and depression. These studies do not show that low levels of vitamin D are the cause of these conditions.
Low levels of vitamin D may increase the risk of death. Although there is an association between vitamin D and all-cause mortality, it is unclear whether this increased risk of death is strictly related to vitamin D deficiency or simply to general poor health. Some studies suggest that cancer patients have a reduced risk of mortality with a higher vitamin D level, but other studies showed no association between cancer death rates and serum 25-hydroxyvitamin D concentrations.
A recent analysis showed that higher levels of vitamin D are associated with reduced all-cause mortality, but found no association between vitamin D levels and stroke or coronary heart disease. Those with severe chronic renal failure are at increased risk of death with low serum 25-hydroxyvitamin D concentrations, and vitamin D treatment improves survival.
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