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FAT-SOLUBLE VITAMINS: VITAMIN D
Nomenclature
There are about ten forms of vitamin D. The two most common forms are ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Precursors of vitamin D are ergosterol in plants and 7-dehydrocholesterol in the skin.
Utilization
Being fat-soluble, vitamin D is absorbed with fats. It is transported through the lymph circulation to the liver. Vitamin D in foods occurs in an inactive form. The liver accomplishes the first step and the kidney the second step in converting vitamin D to an active form. In its active form vitamin D behaves as a hormone; this is the only known example of a vitamin functioning as a hormone.
Functions
Active vitamin D aids in the absorption of calcium and phosphorus from the gastrointestinal tract; promotes the mineralization of bones and teeth; and regulates the normal level of calcium in the blood by releasing calcium from bone as it is needed. The regulation of calcium and phosphorus metabolism is also dependent upon the hormones parathormone and calcitonin.
Meeting daily needs
An allowance of 10 mcg (400 I.U.) vitamin D as cholecalciferol is recommended for infants, children, and adolescents; 5 mcg for men and women over age 22. Adults probably get enough vitamin D through exposure of the skin to sunlight. However, clothing, soot, fog, and window glass cut off the ultraviolet light and prevent the change of the precursor in the skin to the active vitamin. People, who work at night and sleep in the day, invalids, who do not get out in the sun, and people who wear religious habits may require a vitamin D supplement.
Sources
Foods are not good sources of vitamin D except when they are fortified. Almost all fresh milk or evaporated milk is fortified with 400 I.U. vitamin D to the quart or tall can, thus providing the daily needs during growth, Pregnancy, and lactation.
Toxicity
Large doses of vitamin D – 20,000 to 100,000 I.U. – have severe effects including loss of appetite, vomiting, diarrhea, fatigue, growth failure, and drowsiness. The blood calcium level is increased, and calcium salts are deposited in the soft tissues, including the blood vessels, heart, and kidney-tubules. Kidney stones may form.
As little as 1800 I.U. of vitamin D given daily may be mildly toxic, with some of the symptoms listed above being observed. Thus, if an infant is receiving vitamin D concentrate, it is important to measure the intake carefully and also to avoid the use of fortified milk or other foods that might contain vitamin D.
Clinical problems
Rickets is the deficiency disease seen in children who fail to get enough vitamin D. Calcium and phosphorus are inadequately deposited in the bones. The soft, pliable bones yield to pressure, the joints enlarge, and there is delayed closing of the skull bones. The child may have an enlarged skull, chest deformities, spinal curvature, and bowed legs.
Premature infants are more susceptible to rickets than full-term infants. The use of vitamin-D formulas, or the vitamin-D supplements if the infant is breast fed, account for the rarity of rickets in the United States.
Osteomalacia or adult rickets is sometimes seen in women of the Orient who have had a grossly inadequate intake of calcium, phosphorus, and vitamin D and who have had several pregnancies.
Osteodystrophy often occurs in severe renal disease because the kidney is unable to convert vitamin D to its active form. As a result the absorption of calcium is reduced. The level of calcium in the blood is lowered, which in turn leads to release of calcium from the bones. If allowed to continue the bones lose so much calcium that they become very fragile. The impairment of vitamin D function is accompanied by increased activity of the parathyroid hormone and also by the retention of phosphorus. The correction of the faulty vitamin D-calcium-phosphorus metabolism requires delicate dietary adjustment as well as appropriate medication.
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