Talk:Vitamin D deficiency
|WikiProject Women's Health||(Rated C-class, Low-importance)|
|Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Vitamin D deficiency.
|WikiProject Medicine||(Rated C-class, High-importance)|
|This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Assigned student editor(s): Vway2209. Assigned peer reviews: ACBurnette.|
- 1 Depression?
- 2 Remove material on osteomalacia and phenytoin use?
- 3 Merge with the brain fog article?
- 4 External Review Comments
- 5 USPSTF
- 6 Requested move 14 June 2016
- 7 WP:MEDRS compliance
- 8 WP:MEDMOS
- 9 Peer review response
"Vitamin D malnutrition may also be linked to an increased susceptibility to several chronic diseases such as high blood pressure, tuberculosis, cancer, periodontal disease, multiple sclerosis, chronic pain, depression..."
The cite given for 'depression' is http://www.springerlink.com/content/h5q5rb2lpetmf8gn/ - the summary given there acknowledges that D3 levels were significantly lower for patients with major depression than for healthy controls, but goes on to say: "These findings do not support the idea that vitamin D is specifically involved in the pathophysiology of depression. The difference in patients as compared to the healthy controls might be related to a different social background resulting in differing habits e.g. of nutrition."
- I tend to disagree. The article states that these things are linked to a deficiency of vitamin D. It makes claims of correlation, not causation. 18.104.22.168 (talk) 20:45, 23 March 2009 (UTC)
- I can attest to depression being brought on by a vitamin D deficiency, but as a "secondary symptom", not something that's actually caused by the deficiency itself.
I agree that this should be revised. A more recent review article published in August of 2009 concludes that due to conflicting results from multiple studies, "it is premature to conclude that vitamin D status is related to the occurrence of depression". () I did not find any more recent studies that support or rule-out an association between vitamin D and depression. BioScience Writers (talk) 05:00, 6 May 2010 (UTC)BioScience Writers
- There is a more recent paper (2010) that reports "Our findings suggest that hypovitaminosis D is a risk factor for the development of depressive symptoms in older persons,"  So I will add 'depressive symptoms in older person' to the list;
Remove material on osteomalacia and phenytoin use?
I don't think the (well-referenced!) material describing a competing mechanism for osteomalacia that is unrelated to vitamin D belongs in a vitamin D article. I'm planning to remove it from the article's lead. It certainly does belong in the osteomalacia article! Please comment if you disagree. Easchiff (talk) 16:08, 11 September 2009 (UTC)
Merge with the brain fog article?
The brain fog article sound suspiciously much like symptoms of lack of vitamin D. http://rheumatology.oxfordjournals.org/cgi/reprint/ken121v1 maybe it can be merged.
- I recommend against merging. I can find no clear link between these two articles. The reference given is unrelated and discusses correlation between vitamin D deficiency and SLE (Lupus). BSW-RMH (talk) 21:46, 19 May 2010 (UTC)
- As someone recovering from vitamin D deficiency I can attest to brain fog being a symptom of it, but it's just one of many and brain fog can probably be caused by numerous other conditions. — Preceding unsigned comment added by 22.214.171.124 (talk) 09:51, 14 June 2011 (UTC)
External Review Comments
The following comments are from an external reviewer BSW-RMH as part of the new joint Wikipedia talk:WikiProject Medicine/Google Project.
Hello Hypovitaminosis D article writers and editors, This article currently has 'C' status and is a high priority article for the Wikipedia talk:WikiProject Medicine/Google Project. With the recent publishing of studies showing a worldwide increase in the percent of the human population with vitamin D insufficiency and deficiency (hypovitaminosis D), this article will draw increased public attention and should be criticially reviewed and expanded. The three main overall issues that should be addressed are: article organization, need to reduce technical/research terminology, and expansion of information on hypovitaminosis-associated disorders. Useful general references that I will refer to in this review are:
- Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. (2009);20(11):1807-20. PMID: 19543765
- U.S. Centers for Disease Control and Prevention. National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population 1999-2002: Fat-Soluble Vitamins & Micronutrients: Vitamin D. Atlanta (GA): National Center for Environmental Health; July 2008. p61-69 (http://www.cdc.gov/nutritionreport/part_2b.html)
- Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab. (2010);95(2):471-8. PMID: 20133466
- Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ. (2010);340:b5664. PMID: 20064851
- Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D: an evidence-based review. J Am Board Fam Med. (2009);(6):698-706. PMID: 19897699
- Wang S. Epidemiology of vitamin D in health and disease. Nutr Res Rev. (2009) Dec;22(2):188-203. PMID: 19860998
- Binkley N, Krueger D, Lensmeyer G.25-hydroxyvitamin D measurement, 2009: a review for clinicians. J Clin Densitom. (2009);12(4):417-27.PMID: 19734080
- Bordelon P, Ghetu MV, Langan RC. Recognition and management of vitamin D deficiency. Am Fam Physician. (2009);80(8):841-6. PMID: 19835345
Specific suggestions by section are as follows:
Language was smoothed in the introductory paragraph. I would suggest expanding the introduction, perhaps mentioning that people get 10-20% of vitamin D from nutritional sources (especially oily fish and fortified foods) and 80-90% from sunlight exposure before mentioning the causes of deficiency.(see Mithal 2009 page 1808 and refs therein)
After the info on the most common clinical manifestations of hypovitaminosis D (bone-related), it might also be good to mention that it has also been linked to a wide spectrum of disorders including cancer, metabolic syndrome, cardiovascular disease, susceptibility to infections, and autoimnume disease-with a note that it is still not clear if hypovitaminosis D actually cause these disorders or is just more common in patients with them. This can be discussed in more detail in later sections.
I would also add a paragraph addressing the recently reported increases in hypervitaminosis and vitamin D insufficiency worldwide with mention of a few statistics such as that will be expanded upon later:
- 75-90% of the US population is has a insufficiency and deficiency of vitamin D (Adams 2010, CDC report 2008)
- this statistic has nearly doubled in ten years (Adams 2010, CDC report 2008)
- 50% of the adult population in the UK has insufficient vitamin D, and 16% are deficient in winter/spring (Pearce 2010)
- vitamin D insufficiency and deficiency also reported for: Australia, India, China, and other parts of Europe, Asia, Africa, and the Americas (reviewed in Mithal 2009)
The calcidiol mapping image is a bit misleading in that it suggests that people with the exact 25OHD ranges given will develop those particular disorders. The numbers are not absolute, standard, or comparable for 25OHD tests. You can see this easily when trying to track the cut off serum level of 25OHD that defines hypovitaminosis D, which is different for most studies. The disorder are actually correlated with the category, that is insufficient or deficient, within a population for a given test being used and within a particular study group of population. (ex. see Wang 2009, Binkley 2009, and Analytical Note for NHANES 2000-2006 and NHANES III (1988-1994), http://www.cdc.gov/nchs/data/nhanes/nhanes3/VitaminD_analyticnote.pdf, and compare cutoffs for UK in Simon 2010 to US in Adams 2010)
Related images are hard to find! a few suggestions are (please check to be sure they are Wiki compliant):
- http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18111.jpg (requires ADAM license)
- http://www.worldofmolecules.com/supplements/VitaminD.jpg (vitamin D molecule)
- http://www.who.int/entity/uv/health/en/uvexposure.jpg (sun exposure vs. burden of disease, WHO)
The arithmetic at the start of this section is misleading:
Insufficient 25–74 nmol/L (20–40 ng/mL)
is incorrect, as revealed by the following text shortly thereafter:
Note that 1.0 nmol/L = 0.4 ng/mL for this compound.
A corrected statement might read:
Insufficient 25–75 nmol/L (10–30 ng/mL)
I recommend revising this section (perhaps by adding a 'diagnostic' or 'testing' subsection) to talk about the current standard for vitamin D levels (ELISA) and other newer tests being developed (LC-tandem mass spec and HPLC). (see 'Measuring 25OHD) in Adams 2010)
In the classification section I'd start with a statement about the variations between test types, studies, and populations that lead to a wide range of serum levels being classified as normal, insufficient, or deficient. (Wang 2009, Binkley 2009)
Also the 25OHD ranges should be updated and based on multiple and more current references rather than the one review reference. The most common classfications I are normal (above 75 nmol/L (30 ng/ml)), vitamin D insufficiency (50-75 nmol/L (30-50 ng/ml)), vitamin D deficiency (below 50 nmol/L (20 ng/ml)). (Adams 2010, Wang 2009, Bordelon 2009, CDC Report 2008). However there are deviations from this. (Pearce 2010)
This sentence seemed a little odd to me: "Other authors have suggested that a 25-hydroxyvitamin D level of 75-80 nmol/L (30-32 ng/mL) may be sufficient although a majority of healthy young people with comparatively extreme sun exposure did not reach this level in a study done in Hawaii.". First of all, levels in that range are commonly considered normal in the vast majority of articles I've read. Second it cites the one study in Hawaii for the purpose of making (I think) the point that sun exposure does not necessarily correlate with serum 25OHD levels. I think this belongs in a discussion under Risk factors: sun exposure, later in the article.
The entire section on vitamin D status and uptake should be moved and rewritten. Although there is controversy on the standards for vitamin D supplementation therapy for patients with hypovitaminosis D, those with clinical symptoms related to bone disease have well-established clinical benefits from supplementation. The use of vitamin supplementation for other purposes (such as cancer prevention) is highly controversial and there are reports of both beneficial effects and negative consequences for this practice. I think this paragraph should be moved to a new section entitled Treatment of hypovitaminosis D, as a subsection addressing the controversies associated with treating deficient individuals without clinical signs of bone disease or for other purposes (ex. cancer prevention). This section should rely primarily on reviews dedicated to this area and present a balanced view of the controvery rather than relying heavily on a non-peer-reviewed scientific news article (http://www.medconnect.com.au/tabid/84/ct1/c335474/Skepticism-Grows-Regarding-Widespread-Vitamin-D-Supplementation/Default.aspx) which presents the opinion of a clinical rheumatologist working outside the field of hypovitaminosis D or vitamin D supplementation (LM Buckley's last published any research article was in 2003) on one recent reported study.
Signs & Symptoms
I've removed the discussion of non-bone disorders linked to vitamin D deficiency because it is inaccurate and poorly referenced with single articles rather than references representing the consensus view of the medical and scientific community. The cited links between vitamin D deficiency and disorders like autism do not have enough primary research support and I consider them misleading and possibly harmful to readers. Please note that the vitamin D council is not recognized as a reliable reference by the scientific and medical communities.
- Garite TJ, Kim M. The "Vitamin D Council" advertisement. Am J Obstet Gynecol. (2009);201(1):2.
I recommed rewriting and breaking this section into subsection dedicated to the diseases and disorders definitively shown to be caused by hypovitaminosis D (bone diseases, psoriasis, hypo and hyperphosphatemia, see http://www.mayoclinic.com/health/vitamin-d/NS_patient-vitamind/DSECTION=evidence). The there should be one subsection dedicated to the new research linking hypovitaminosis D to other diseases/conditions that have not yet had enough study to show a cause/effect relationship (ie. cancer, susceptibility to infectious disease, and autoimmune disease). This last section should not include anecdotal evidence or non-peer reviewed evidence (ex. the vitamin D council). It should only include linkages with sufficient primary research support to be fully reviewed and found to be linked to vitaminosis D (see references in the beginning of this review, esp. Kulie 2009).
This section needs to be added. It should cover treating clinical complications caused by vitamin D deficiency, methods, and safety issues like overdosing and effects related to pregnancy. In addition it should discuss (methods and controversy over, see above) vitamin D supplementation as treatment for individuals with 'insufficient' or deficient vitamin D levels that do not have clinical symptoms of disease. The Institute of Medicine of the US National Academies will publish updated baseline guidelines for vitamin D dietary reference intakes in September of 2010 (http://www.iom.edu/Activities/Nutrition/DRIVitDCalcium.aspx). Until then they can be found here:
- IOM 1997 guidelines (http://www.iom.edu/Reports/1997/Dietary-Reference-Intakes-for-Calcium-Phosphorus-Magnesium-Vitamin-D-and-Fluoride.aspx)
References for the treatment for vitaminosis D include:
- Mayo Clinic page of dosing (http://www.mayoclinic.com/health/vitamin-d/NS_patient-vitamind/DSECTION=dosing)
- Mayo Clinic page on safety (http://www.mayoclinic.com/health/vitamin-d/NS_patient-vitamind/DSECTION=safety)
- the references presented at the beginning of this review
Removed unreferenced and unclear section on 'sick people' as a risk factor. I think it was meant to be as section covering diseases that predispose individuals to developing vitamin D deficiency (ex. Cystic fibrosis, celiac disease, Crohn's disease, and cancer). This is an important section to have and can also include other medical situations (like gastric bypass surgery) and medication (antiretroviral therapy) that can predispose individuals to D deficiency. (see Kulie 2009 and other refs above).
I combined the discussion on deficiency in the elderly and children into one section of 'age'
This section is very odd. It begins with a discussion of Rickets and then a bit on nutrition, but then has a section on 'clothing' that has only one sentence related to clothing, and one section on 'cancer'. I am going to move the nutrition info into risk factors under a new section entitled Malnutrition, and move the 'clothing' sentence under sun protection in risk factors (rename to sun exposure).
The cancer section has been left as a separate section, slightly edited-though I am not convinced it should stay so. The research on whether there is a correlation between vitamin D levels and cancer has dramatically increased in the last two years but is far from reaching a consensus on this issue due to conflicting results and no clearly established causual relationship between the two. Whether this section remains independent, or is severly shortened and incorporated into signs & symptoms (which I think is more appropriate), it needs to be rewritten from a balanced and non-technical perspective. I think citing each primary research article in the area is both misleading and confusing for readers. Instead discussing the consensus views from review articles would be more appropriate. The consensus seems ot be that the links to breast and prostate cancer are unconvincing, while there is more support for a correlation with colorectal cancer.(see Kulie 2009, Adams 2010, Pearce 2010 and the Mayo Clinic page on vitamin D evidence, http://www.mayoclinic.com/health/vitamin-d/NS_patient-vitamind/DSECTION=evidence)
The article says: "Most specialists, however, agree that vitamin D supplementation is an effective way of curing gout." There is a reference supplied, but it says nothing about gout that I can locate. (The source site requires payment, so I looked at what I think is the same article on another site.) I can find no other source supporting this assertion, and even the Vitamin D Council mentions nothing about gout on its web site. The statement should be properly referenced or removed. Nicmart (talk) 12:51, 2 April 2012 (UTC)
The USPSTF has pronounced on the screening for vitamin D deficiency.
Requested move 14 June 2016
Hello. I am trying in good faith to improve the encyclopedia, and in particular, this article.
I am restoring a small amount of text that was a component of one large chunk of text added during a single revision that was deleted for being off-topic using old references.
The specific passage I am restoring right now on-topic: it speaks exactly to Vitamin D deficiency.
Also, to address the issue about the age of the references: I understand that the WP:MEDRS guideline states, "In many topics, a review that was conducted more than five or so years ago will have been superseded by more up-to-date ones, and editors should try to find those newer sources, to determine whether the expert opinion has changed since the older sources were written." The first reference is over 5 years old; I TRIED to find a newer reference, per WP:MEDRS guidelines. The second reference is 4 years old which falls within WP:MEDRS guidelines.
- Hello again. In addition to what I just wrote above, I restored another small amount of text that was a component of one large chunk of text added during a single revision that was deleted for being off-topic using old references. The specific passage I am restoring right now on-topic: it speaks exactly to Vitamin D deficiency. Also, to address the issue about the age of the references: I understand that the WP:MEDRS guideline states, "In many topics, a review that was conducted more than five or so years ago will have been superseded by more up-to-date ones, and editors should try to find those newer sources, to determine whether the expert opinion has changed since the older sources were written." The reference is 6 years old, which is slightly over the suggested 5 year limit; however I did try to find a newer reference, per WP:MEDRS guidelines. As I said earlier, feedback and discussion is welcome! Thanks! --Sarahcunningham87 (talk) 03:20, 24 October 2016 (UTC)
- First-first, thanks for attempting to meet the criteria of MEDRS with your sourcing! Two things - First it would be great if you used the pubmed ID (PMID) in your citation. Please see your talk page about formatting refs and how we use the PMID. Secondly, the first ref is PMID 19709382, and it is not a MEDRS source - it is not secondary, but primary. The same is true of the second ref, PMID 22356633, is also not a MEDRS source; it is a "letter to the editor" - a primary source, not a secondary source. Jytdog (talk) 03:28, 24 October 2016 (UTC)
- (ec) I have reverted the new additions. (Note: I wasn't the editor who reverted your original edit.)
- The first article () was used to support the statement "Vitamin D deficiency has been linked to cancer as well as diabetes and multiple sclerosis." Unfortunately, the cited article is a primary source – not a secondary one – and moreover it's not really on the topic of Vitamin D deficiency and disease; rather, it's about measurement of variations in vitamin D levels in summer versus winter. I haven't pulled the article's full text yet, but I'm going to guess that the content cited is from the padding in the paper's intro or discussion sections, where authors tend to be granted extra leeway to ramble about how groundbreaking and essential their research is.
- The second article () is a brief commentary (less than dozen paragraphs); it's not clear if it's peer-reviewed material or just editorial remarks. It's particularly troubling that the statement in the commentary supporting the proposed Wikipedia edit is drawn from a passage in the commentary unsupported by citations. It's worth noting the article's particularly tepid choice of wording: "Vitamin D deficiency has been related to a high number of health disorders..." and "It is thus clear that much more evidence is needed to understand the relations between vitamin D and skin disorders." Saying has been related is one small step better than I once heard. TenOfAllTrades(talk) 03:38, 24 October 2016 (UTC)
Work Plan—Victoria Way I plan to prioritize the lead/introduction paragraph. There is room for improvement here as the lead is currently brief and could be more information rich. I also plan to re-format the classification section to make it more reader-friendly and informative for the audience likely reading the article. I plan to add more details and more content to the risk factor and signs/symptoms portions of the article. I would also like to add more about the ongoing research of vitamin D deficiency to the closing paragraph with sources/links to more in depth content for those who may be interested. I plan to include more images to help the reader better visualize different concepts/information. Finally, I would like to change the order of the information presented so that it flows in a way that is easy for the reader to follow.
I will use ClinicalKey, PubMed, and UpToDate to find sources of information about current known, well established risk factors and treatments for vitamin D deficiency, as well as studies for ongoing research to make the final paragraph more useful to the reader. I plan to begin information gathering during week 1 of the course, with synthesis and condensing of the information into paragraph form during week 2.
I plan to be as comprehensive as possible when deciding what information to include, as it may be important for the reader to have access to as much information as possible. For information that may be less useful to the majority of the readers, I plan to reference the information available and provide resources to dig deeper into the topic if desired. I will exclude any information that is still within research stages and has not been well established by the scientific community—however this information could be present in the “ongoing research” portion of the article at the end if appropriate.
I do plan to embed links to other Wiki pages when appropriate. I believe this will be useful when referencing topics within the article that cannot be fully addressed. Links to other pages can be provided for readers that want easy and convenient access to more information about a given topic.
I will ensure that I avoid medical jargon by carefully proofreading the parts of the article that I edit. I also plan to have several people read the article that are not part of the medical community to attempt to minimize “doctor-talk”.Vway2209 (talk) 20:10, 20 November 2017 (UTC)
@Vway2209: Hello, great work so far improving the article. When making decisions about headings and how the article is organized, please read through WP:MEDMOS. This is the manual of style for medical-related articles. There is a list of headings that are appropriate (signs and symptoms is one of them) Wikipedia:Manual_of_Style/Medicine-related_articles#Diseases_or_disorders_or_syndromes. Thanks again, is great to see people helping improve these articles by adding high quality WP:MEDRS content. Kind regards, JenOttawa (talk) 15:08, 4 December 2017 (UTC)
Peer review response
Hi Amanda! Thank you so much for reviewing the article. I found your suggestions very helpful. In the pathophysiology section, I chose not to give examples of medications that could speed up vitamin D metabolism because there was no way that I could provide an exhaustive list in this section and did not want to target certain medications. My hope is that the sentence prompts readers to review side effects of any medications they are on. Also, I decided to leave the term "osteoclast" since that is the technical name. I did embed a link for further clarification if needed. I did change "renal absorption" to make it easier to read. I also used your suggestion for the final sentence of the classification section.
The statement about pre-eclampsia was added by another user so I further clarified the statement and found a reputable source to cite. I also fixed all of the typos that you found in the article--thank you for picking those up! I added citations where they were needed and cleaned up the sources section. I did not previously realize some of the links to articles did not work so thank you for catching that error. They should all work now! However I do realize that we in the scientific community may have access to some resources that the general public does not. Thank you again for your review! Vway2209 (talk) 20:54, 14 December 2017 (UTC)