Vitamin D project. Vitamin D three for winter blues project

Irina Nikolaevna, in recent decades there has been an unprecedented interest in various biological aspects of vitamin D. What is the reason for this?

Yes, indeed, interest in vitamin D is very high. Over the past 50 years, more than 62 thousand scientific papers devoted to vitamin D have been published in the scientific literature. And if at the early stages it was mainly studied its importance in calcium-phosphorus metabolism, now its role in the functioning of all organs and body systems is being studied. This is due to the fact that indisputable evidence has been obtained - vitamin D is a prehormone, receptors for which are found in almost every cell of the human body.

How can vitamin D promote or, conversely, prevent the development of certain diseases of various systems and organs?

The active metabolite of vitamin D, calcitriol, has a 100 times greater affinity for the vitamin D receptor than calcidiol (25(OH)D). By binding to the vitamin D receptor (VDR), it induces transcriptional changes at the genome-wide level. Expression of the VDR receptor gene has been established in all tissues of the human body. The wide representation of vitamin D receptors in various tissues of the body explains the versatility of the action of calcitriol on the development and prevention of various pathologies.

Does vitamin D affect a child's immune system?

Now it is clear that an adequate supply of vitamin D is necessary for the full functioning of various organs and body systems. But how common is vitamin D deficiency in the human population?

It has now been shown that 30-50% of the population living in Europe and the United States has vitamin D deficiency. Vitamin D deficiency has been shown to contribute to a range of diseases, including autoimmune, cardiovascular, cancer, endocrine, and even neurodegenerative ones. With a low vitamin D status in childhood, adolescence, as well as in adulthood, the earlier development and severe course of such pathological conditions and processes as vascular atherosclerosis, coronary heart disease, obesity, diabetes mellitus, memory and attention disorders (dementia) are associated, increased incidence of acute respiratory diseases, tumors and more.

How is vitamin D deficiency diagnosed?

The criterion for assessing the provision of the body with vitamin D is the indicator of 25 (OH) D in the blood serum. Most experts studying the effect of vitamin D on metabolic processes in the body agree on the following interpretation of its level for the population of the Russian Federation: 25(OH)D deficiency -<20 нг/мл; недостаточность - 21–29 нг/мл; норма - >30 ng/ml. It is recognized that the content of 25(OH)D at a level above 50 ng/ml is necessary to ensure all the extra-osseous effects of this vitamin on the human body. Based on scientific data, it has been established that the level of vitamin D in the blood above 100-120 ng / ml is considered excessive. Vitamin D intoxication is manifested by the development of hypercalcemia, hypercalciuria and hyperphosphatemia.

Does Moscow belong to the regions where the population has a vitamin D deficiency?

Yes, this is because skin synthesis of vitamin D is inversely related to the angle of incidence of sunlight. An increase in the angle of incidence due to the distance from the equator favors the predominance of radiation with a longer wavelength, thus, the rate and efficiency of vitamin D production decreases. That is why the area of ​​residence above 42 o north latitude can be attributed to the primary risk factors for low vitamin D supply. There are many other reasons for insufficient supply of this vitamin.

Are there currently specific recommendations for practicing clinicians on the diagnosis and correction of vitamin D deficiency?

A group of scientists under the auspices of the Union of Pediatricians of Russia (Chairman of the Executive Committee of the Union of Pediatricians of Russia, Academician of the Russian Academy of Sciences, Prof. A. A. Baranov) created a draft National Program "Vitamin D deficiency in children and adolescents of the Russian Federation: modern approaches to correction" for discussion. This program covers metabolic pathways, the prevalence of vitamin D deficiency, the skeletal and non-skeletal clinical manifestations of low vitamin D status, and many others.

Yes, in 2013–2014 we conducted a study on vitamin D availability for children in the first three years of life in Russia (“Rodnichok”). It was attended by employees of various scientific and educational institutions from Moscow (Prof. I. N. Zakharova, Prof. T. E. Borovik, Prof. G. V. Yatsyk, Associate Professor Yu. A. Dmitrieva, pediatricians E. V. Evseeva , M. V. Mozzhukhina), Kazan (Prof. S. V. Maltsev), Arkhangelsk (S. I. Malyavskaya), Yekaterinburg (Prof. I. V. Vakhlov), Vladivostok (Prof. T. A. Shumatova), Blagoveshchensk (prof. E. B. Romantsova), St. Petersburg (prof. F. P. Romanyuk), Stavropol (prof. L. Ya. Klimov, V. A. Kuryaninova), Novosibirsk (N. I. Pirozhkova), Khabarovsk (associate professor S. M. Kolesnikova).

We are very grateful to the Akrikhin company, which not only sponsored the Rodnichok study by organizing the examination of children in a single certified laboratory, but also ensured the delivery of the test samples in compliance with the cold chain rules.

What is the main purpose of creating national guidelines for the correction of vitamin D deficiency?

The main goal is to draw the attention of doctors to new scientific achievements on this topic and reflect modern approaches to the prevention and treatment of vitamin D deficiency in children. An important task of domestic pediatrics is to study the prevalence of vitamin D deficiency in children in order to develop modern recommendations for doctors on its prevention and treatment, taking into account the peculiarities in our country. The territory of the Russian Federation, from a geographical point of view, is a zone of reduced insolation and belongs to the regions of the world in which the risk of vitamin D deficiency and insufficiency is quite high. Between the southern and northern regions of our country there are significant differences in the length of daylight hours and the cold period of the year, when outdoor walks for young children are limited, and sometimes impossible.

What are the results of the Rodnichok study?

The results of this study showed an extremely low supply of vitamin D in children under 2-3 years of age. Children under 2 years of age, who regularly received vitamin D for the prevention of rickets, were provided with them much better.

The highest frequency of vitamin D deficiency (less than 20 ng / ml) was found in the following cities: Vladivostok - approximately 73% of children, Kazan - 67%, Novosibirsk - 65%, Stavropol - approximately 46%. The lowest frequency of vitamin D deficiency was registered in Moscow (27%), Yekaterinburg (29%) and Arkhangelsk (30%). Vitamin D deficiency has been registered in almost every third child living in Moscow, Stavropol, Khabarovsk and St. Petersburg. Somewhat less often (about one in five examined) vitamin D deficiency is noted in Yekaterinburg and Arkhangelsk. In general, only one in three children in the Russian Federation has sufficient levels of vitamin D (>30 ng/mL).

Is it possible to maintain optimal vitamin D levels in older children through a balanced diet?

The main dietary sources of vitamin D are fatty fish, which are usually deficient in a child's diet, and many children suffer from food allergies and do not eat fish. For example, in order to provide the required amount of vitamin D, you should consume about 400 g of canned salmon or 800 g of mackerel daily. Vitamin D is widely used in many countries for food fortification, including milk and bread. There is no such practice in our country yet.

In other words, is this question relevant for people of all age groups?

Yes, vitamin D should be taken by people of all ages, constantly, the dosage should be selected individually depending on age, weight, and the presence or absence of chronic diseases.

Are there any studies on the availability of vitamin D to adolescents in Russia, Moscow?

In DGP No. 133 of Moscow (chief physician, Candidate of Medical Sciences S. I. Lazareva), which is the clinical base of the Department of Pediatrics of the RMAPE (Associate Professor N. G. Sugyan, pediatrician E. V. Evseeva), a study was conducted during which studied vitamin D status in adolescents. Monthly during the year, venous blood was taken from them to determine 25(OH)D. A total of 360 people aged 11–18 were examined. All adolescents were surveyed with clarification of eating habits, lifestyle, as well as a physical examination. During the examination, it turned out that the average content of calcidiol in the winter months was 16 ± 0.40 ng / ml, in spring - 13 ± 0.35 ng / ml, in summer - 20.5 ± 0.80 ng / ml, in autumn - 18 ±0.30 ng/ml. The lowest vitamin D status was detected in May (8.13±0.80 ng/ml), which can be explained by the formation of a "debt" of the body for vitamin D in winter due to the depletion of its reserves in conditions of reduced insolation. In the summer-autumn period, the number of adolescents with vitamin D deficiency is significantly lower than in the winter-spring period, however, only 7–13% have a vitamin D concentration above 30 ng/ml. This indicates that even under conditions of sufficient insolation, children in Moscow have low levels of cholecalciferol supply, which requires adequate correction. Most children with severe vitamin D deficiency (<10 нг/мл), более 6 раз в год переносят острый назофарингит/тонзиллит, страдают проявлениями астеновегетативного синдрома, склонны к гиподинамии. Данные этих исследований согласуются с данными, полученными зарубежными исследователями: самые низкие концентрации витамина D обнаруживаются в конце зимы - начале весны, пиковые уровни 25(OH)D - в конце лета.

When selecting patients for the study, the presence of chronic/acute pathology was taken into account, or only healthy children were included in the study?

These data were taken into account when questioning patients. The study included both healthy and chronically ill children. The inclusion criteria for the study were: permanent residence in Moscow, age 11–18 years.

It turns out that the average content of calcidiol in the winter-spring period is the lowest. Were there any children who had a normal level of vitamin D in the blood during these periods?

Yes, the lowest level of calcidiol was registered in the spring. But even in the spring months, 3% of adolescents had vitamin D levels within normal limits. After analyzing the lifestyle of teenagers in this group, we found out that they spent the last 2 months on vacation in southern countries, took frequent walks (more than 2 hours a day), and had high physical activity.

Has the diet of adolescents been assessed?

One of the questions of the questionnaire concerned a detailed assessment of the child's diet and preferences. We aimed to find out the volume of consumed foods rich in vitamin D. The results showed that among the examined patients, not a single child consumes fatty fish, very few children eat egg yolk, and dairy products are present in the diet of children on average 3–4 times a week.

How safe is vitamin D? Is there a risk of developing hypervitaminosis D in older children?

European researchers have established the following safe average daily intake of vitamin D: newborns and infants - 400-1000 IU / day, children from 1 to 18 years old - 600-1000 IU / day. When using such doses for 6 months in children and adolescents, partial compensation of vitamin D deficiency is achieved (that is, an increase in the concentration of 25 (OH) D > 30 ng / ml) and hypercalcemia is not observed. Achieving 25(OH)D values ​​of 30 ng/ml and above is necessary for the implementation of the extraosseous effects of vitamin D. This helps prevent extraosseous manifestations of vitamin D deficiency in children (reduced resistance to infections, bronchopulmonary diseases, obesity, etc.).

Usually there are risk groups for the development of a particular pathology, a deficient state. Who is at risk for vitamin D deficiency?

Obese children with reduced skin synthesis of vitamin D (dark skinned; using sunscreen; staying indoors for a long time; wearing full-body clothing); using alternative diets or allowing changes in the structure of nutrition (for example, with the exclusion of animal products); premature babies; living in northern latitudes; taking certain drugs that interact with vitamin D (eg, anticonvulsants, glucocorticoids).

Taking into account changes in ideas about the role of vitamin D in the human body, its supply to the body, laboratory diagnostics data, it became possible to create new recommendations for correcting vitamin D deficiency, which will ensure not only optimal growth and development of children, but also the prevention of many diseases in them.

Irina Nikolaevna, we sincerely thank you for the interview and active cooperation with our publication! Health to you and new creative successes!

The year of publishing: 2018

Number of pages: 96

ISBN: 978-5-9500710-6-5

Publisher: Pediatrician

The program was created on the initiative of the Union of Pediatricians of Russia.

The purpose of this National Programme, prepared by a group of experts from various specialties, who represent leading clinical and research centers, and based on several large all-Russian studies, is to summarize the literature data on the importance of vitamin D in the body, form a unified concept and widely introduce into clinical practice agreed recommendations for the diagnosis, prevention and correction of vitamin D deficiency in children aged 0 to 18 years. This publication is the first step taken by the Russian pediatric community in solving the global problem of maintaining vitamin D supply in the country's child population. Clinical recommendations for the diagnosis, prevention and correction of vitamin D deficiency in children and adolescents. The program is intended for medical professionals (pediatricians, nutritionists, pediatric endocrinologists, orthopedists, pediatric nephrologists, phthisiatricians and doctors other specialties), as well as senior students of medical universities.

Reviews

Foreword

Introduction

Main provisions of the program

1. The history of vitamin D ideas

2. Metabolism and biological functions of vitamin D in the human body

4. Clinical manifestations of low vitamin D status

4.1. Bone (calcemic) manifestations of low vitamin D supply in the body

4.1.1. Rickets

4.1.2. Osteoporosis

4.2. Extraosseous (non-calcemic) manifestations of low vitamin D supply in the body

4.2.1. The role of vitamin D in the regulation of the body's immune function

4.2.2. The role of vitamin D in infection control

4.2.3. Effectiveness of dietary supplementation with vitamin D to prevent and/or reduce infectious diseases

4.2.4. The role of vitamin D in the genesis and course of allergic pathology in children and adolescents

4.2.5. The role of vitamin D in the pathogenesis of autoimmune diseases

4.2.6. Antitumor effects of vitamin D

4.2.7. Vitamin D deficiency and endocrine diseases

4.2.8. Vitamin D deficiency and cardiovascular disease

4.2.9. Vitamin D deficiency and kidney disease

4.2.10. Vitamin D and rickets-like diseases.

4.2.11. Vitamin D and urolithiasis 4.2.12. Cognitive and neuroplastic potential of vitamin D

5. Prevalence of low vitamin D sufficiency in the territory of the Russian Federation in different age groups

5.1. The prevalence of low vitamin D sufficiency among young children in the Russian Federation

5.2. Assessment of vitamin D sufficiency in children of the older age group

6. Prevention and correction of low vitamin D status

6.1. Food sources and dose grading of vitamin D

6.2. Vitamin fortified foods

6.3. Vitamin D use during pregnancy

6.4. Correction of low vitamin D status with its increased doses

6.5. Compensation of vitamin D in children and adolescents under various conditions

6.6. The use of vitamin D in various diseases in children

7. Vitamin D in newborns and premature babies

7.1. Hypovitaminosis D in newborns and premature babies: frequency and risk factors

7.2. Features of vitamin D metabolism in newborns and premature babies

7.3. Clinical manifestations of vitamin D deficiency in newborns and premature babies

7.4. Prevention and correction of vitamin D deficiency in newborns and premature babies

7.5. Monitoring 25(OH)D levels in neonates and premature infants

8. Correction of low vitamin D sufficiency in different age groups in the Russian Federation

8.1. Vitamin D supplementation in early childhood

8.1.1. Analysis of the effectiveness of the scheme for the prevention and correction of hypovitaminosis D in young children

8.1.2. Safety of the regimen for the prevention and drug correction of hypovitaminosis D in young children

8.2. Correction of vitamin D deficiency in older children

9. Safety of vitamin D supplementation in the case of hypercalcemia.

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What is it and how is it done?

The D vitamins include several biologically active substances at once. One of them is of the greatest importance for human health -cholecalciferol. By the name "vitamin D" usually mean it.

For the first time, a certain substance in cod oil that protects against rickets was reported back in 1913 by researchers Elmer McCallum and Margaret Davis from the United States.

At first, the found substance was considered to be already discovered vitamin A. Later it turned out that another compound had this effect, which was called vitamin D.

The human body cansynthesize vitamin D on your own. The substance 7-dihydrocholestorol contained in the skin is converted to cholecalciferol by the action of sunlight.

In countries close to the Arctic Circle, people often get too little sunlight to fully provide themselves with vitamin D. According to various sources, from 70 to 90 percent of the population of the northern latitudes suffer from a lack of this substance.

Why is it needed?

Cholecalciferol is not only a vitamin, but also a hormone. It supports the work of the thyroid gland, regulates the work of the cardiovascular, muscular and digestive systems.

But the most important function of vitamin D - stimulation of absorption in the intestinecalcium and phosphorusfrom food. The combination of these substances - calcium phosphate - forms in the bodynew bone tissue.

This process is calledremineralization. Its normal course is especially important during the fusion of fractures and with signsosteoporosis.

What if it's not enough?

Vitamin D is fat soluble and can be stored in the liver. But these reserves are not enough for the body: itquickly consumedduring calcium metabolism.

Therefore, a lack of vitamin D leads to gradualdecrease in bone density- osteoporosis. Especially in women, in whose body calcium metabolism occurs faster during pregnancy andfeeding.

The lack of calcium in the body negatively affects the function of nerve cells. In severe form, it provokes excessive activity of neurological reflexes - hypocalcemic tetany, which is expressed in cramps in the arms and legs, as well as in spasm of the larynx.

In addition, the work of the cardiovascular and muscular systems depends on the normal balance of calcium in the body.

Vitamin D is very important for infants - itdeficiency can lead to rickets. Its most serious symptoms are softening and deformation of the bones, which leads to abnormal development of the skeleton in the child. Deficiency can also be manifested by neurological symptoms: excessive excitability, sweating, impaired muscle tone.

It's important to know that hypervitaminosis of vitamin D is as dangerous as its deficiency. An excess leads to pain in the muscles and joints, digestive disorders and the work of the cardiovascular systems.

What hinders absorption?

Vitamin D is poorly absorbed in diseases of the liver, gallbladder and intestines. Its absorption is disturbed when using dietary supplements for weight loss containing laxatives, as well as whenfat-free diet.

How to get the?

Experts recommendbe in the sunat least three times a week - from 10 to 15 minutes in open clothes and withoutsunscreen.

This is quite enough for the synthesis of vitamin D. It is important to understand that"for the future" regular tanning in the summer sun, and even more so insolariumsvitamin D cannot be stored.

At the same time, in the summer you need to choose for a “prophylactic tan”morning and evening hourswhen ultraviolet radiation is not yet very active and does not damage the skin.

What to eat?

Most cholecalciferol is found in fat from the liver and meat of fish: salmon, tuna and mackerel.

According to scientists, two or threefish dishesa week can provide the need for this vitamin. You can get vitamin D from butter,dairy productsand egg yolk.

A less active form of this vitamin, D2, is found in plant foods such as parsley and nettles, as well as in mushrooms.

The most important

Vitamin D is essential for the absorption of calcium in the body. Its deficiency leads to fractures and convulsions, as well as in violation of the formation of the skeleton in children.

Optimal doses of this vitamin can be obtained by being in the sun enough, as well as eating foods rich in it:fish and milk products.

It is called vitamin D, but many biochemists consider it a hormone. In any case, vitamin D is different from all other vitamins.

We produce it ourselves. Not in the intestines, like all other vitamins, but in the skin. The fact is that the skin cells contain a cholesterol compound, which is looking forward to the first rays of the sun in the morning. As soon as ultraviolet rays touch it, without any participation of enzymes, a provitamin is created, which then, without any haste, turns into vitamin D 3 (cholecalciferol). As soon as it has matured, protein carriers appear and transport the vitamin molecules into the blood, to body cells and storage sites. This vitamin can be absorbed from food in the intestinal wall. Especially rich in vitamin D are fish oil, fatty fish - herring, salmon, mackerel, and eggs.

The molecules of this vitamin perform the main task in the body - the absorption of calcium and the use of its salts for the formation of bones and teeth. Thus, vitamin D maintains the strength and stability of the skeleton. Since women lose bone mass during menopause, they must pay special attention to supplying the body with sufficient amounts of vitamin D.

Although 99% of all calcium in the body is used for the needs of bones and teeth, the tasks of the remaining one percent are also extremely important. The fact is that calcium plays the first violin in the transmission of nerve impulses between nerve and brain cells. Calcium ions circulate through tiny channels between cell membranes and transmit signals from cell to cell. This is important not only for coordinated muscle activity, but also for hormone metabolism, for growth, for the already mentioned neurotransmitters that bring us calm or vice versa, joyful excitement and optimism. Therefore, modern neurophysiologists consider calcium the best own sedative. But he has been known to nature in this capacity since time immemorial. If animals, such as roe deer or hares, are under a lot of stress (say, after being rescued from a chase), they instinctively look for calcium-rich plants such as thyme, rosemary, dill, sage or marjoram, which are composed of almost 2.5% nerve calming calcium. But in order for calcium to begin to exert its effect, "sunshine" vitamin D is needed.

Discovered by ultra-modern analytical instruments, vitamin D gradually begins to reveal its secrets and demonstrate all the new amazing tasks that it solves in our body. Scientists are finding more and more receptors for the "solar" elixir, especially in the cells of the immune system. It is likely that this vitamin is of some importance for muscle strength. Of great interest is one of the latest discoveries: vitamin D in the nuclei of bone-forming cells uses the same receptors as estrogen. As you know, the deficiency of this sex hormone in menopause leads to bone atrophy. Thus, for the first time, biochemists groped for the hitherto unknown interaction between estrogen, calcium and vitamin D.

Vitamin D necessary for the absorption of calcium and the use of its salts in the formation of bones and teeth. Vitamin D gives strength to our skeleton. Since women experience bone loss during menopause, they should pay attention to ensure that the body receives enough vitamin D .

Myopia
Loss and decay of teeth
muscle weakness
Painful thickening of the joints
Hyperexcitability
Nervous disorders, irritability
Insomnia
depressive state

Fat-soluble vitamin D in the intestines is excreted from the food mass with the help of bile salts, just like fat or cholesterol molecules, surrounded by a protein shell and sent to the liver in the form of so-called lipoproteins. There, the vitamin is again released from its protein packaging (fat-like substances cannot otherwise be transported in the blood). Just like vitamin D from the skin, these molecules travel to the kidneys where they are again dynamically "charged". Now they are in full combat readiness to begin the formation of bones. Their relative vitamin A, also fat soluble, is actively involved in this work.

Vitamin D keeps a close eye on the fact that the concentration of calcium in the blood never falls below a certain level. A sufficient amount of calcium in the body guarantees a person healthy, strong bones. The strength of our bones and teeth is not always the same: their structure changes every hour depending on the intake of nutrients. The used bone mass is removed and a new one is created in its place. If our bones ache in the morning, we need to eat 200 grams of cottage cheese and drink the juice of two lemons, and by dinner you will feel “in shape” again, especially if you do a few more gymnastic exercises. In this simple way, each of us can avoid the danger of becoming a victim of frequent fractures.

If the calcium concentration in the blood drops (this may be due to smoked sausage and chips, a cake, or canned goulash from a can), a small amount of parathormone is released into the blood, which stimulates the production of vitamin D in the kidneys. The cells of the intestinal mucosa are tasked with delivering more calcium and phosphate to the blood. In addition, the kidneys now retain calcium heavily and do not excrete this important mineral in the urine. Finally, calcium can be taken from the bones and directed into the blood. The real reason for this complex process is that, first of all, the need for calcium in nerve cells must be satisfied. The 1% calcium level in the blood should not decrease under any circumstances. Otherwise, soon our muscles will stop contracting, which can lead to cardiac arrest. Therefore, calcium in the intestines has at its disposal special transport agents, the so-called calbindins, which quickly deliver this mineral to the blood and attach it to active enzymes and proteins. Thus, certain vitamins and minerals, such as vitamin C and calcium, "ride first class".

If a sufficient amount of calcium has accumulated in the intestinal walls, vitamin D ensures that the mineral borrowed from it is returned to the skeletal system. If there is not enough calcium in the food, then it is still washed out of the bones in order to maintain the necessary level of this substance in the blood. This often leads to osteoporosis, bone atrophy. If at the same time there is not enough vitamin D, then there is a danger of osteomalasia - softening of the bones. Without vitamin D, neither calcium nor phosphorus is absorbed in sufficient quantities, and the bones lose the necessary strength.

The latest discovery - vitamin D has the same receptor in the nucleus of bone-forming cells as the sex hormone estrogen.

Vitamin D deficiency can occur due to imbalanced absorption of fats. Without bile salts, vitamin D cannot pass from the intestines into the blood. During the winter months in our latitudes there is often not enough daylight to produce the vitamin in the skin. In addition, polluted air and window glass delay the ultraviolet rays necessary for the synthesis of the vitamin. Many people feel so good during a holiday in the sunny south because they accumulate a lot of vitamin D in their bodies, which significantly strengthens the skeletal system.

Vitamin D is fat soluble and therefore can be stored in the body. Therefore, you should not buy this vitamin in a pharmacy and take it uncontrollably in the hope that in a week you will have wonderful teeth and bones. Although raw food contains almost no vitamin D, and in general this vitamin is rarely found in food, you can easily meet the need for it through fish (herring, sardines, mackerel, trout), liver, butter, milk and eggs. The main thing is that the face and hands should be in the sun or daylight for at least ten minutes every day.

High doses of vitamin D (for example, in tablets) can lead to serious consequences. Not to mention that the vitamin itself can become toxic at high concentrations in the blood and tissues, leading to hypercalcemia, a high level of calcium in the blood. Excess calcium in this case enters the soft tissues such as the kidneys, heart, lungs or blood vessels, and is deposited there in the form of lime. This can result in atherosclerosis.

Since a large accumulation of vitamin D in the blood can be toxic, nature has invented protection against this danger. Otherwise, people living in the south near the equator would become victims of the vitamin produced in their own skin. Therefore, nature decided to protect people from the too hot sun by changing the color of their skin. The dark pigment melanin, which is made up of copper and the amino acid tyrosine, blocks UV rays and reduces vitamin D production.

However, in the process of getting a beautiful tan, we produce two-thirds more vitamin D than when we avoid the sun. In addition, with our constant exposure to the sun, cholesterol in the skin forms inactive substances such as lumisteria instead of vitamin D to reduce the harmful effects.

The more time we spend in the sun, the less vitamin D is synthesized in the skin. This is noticeable by the fact that the first days spent in the sun strengthen and give a boost of energy, but staying in the sun for several weeks often leads us to fatigue , lethargy and nervousness.

If calcium is deficient in food, it constantly taken from the bone substance. This is leads to osteomalasia, i.e. softening of the bones, and at an early age - to rickets. When we tan, we produce two-thirds more vitamin in our skin. D than when avoiding sunlight.

Children, adolescents, and adults need 5 to 10 micrograms daily, and in those who are growing, this dose may exceed 10 micrograms due to bone formation. These figures refer to people who are almost never exposed to the sun and must therefore make up for their vitamin D deficiency through food. Those who spend 20 minutes in the sun daily, or expose exposed skin to daylight for at least 30 minutes, can get by with half or even a third of that dose.

Food Micrograms
fish oil (two teaspoons) 242
Herring (100 gr) 25
Mackerel (100 gr) 24
Salmon (100 gr) 12
Sardines in oil (100 gr) 9
Tuna (100 gr) 6
Milk (1 cup) 3
Unshelled wheat grains (100 gr) 3
Egg (1 yolk) 1
Liver (100 grams) 1

These recommendations apply only to the intake of the vitamin with food, which at best is half the daily requirement for it. Over millions of years of development, human consumption of vitamin D has evolved much like that of animals. A significant part of the vitamin was synthesized in the body under the influence of ultraviolet rays. Our ancestors, as you know, spent the whole day outdoors and therefore did not experience any problems with vitamin D. As a sufficient amount of this substance was produced in the skin under the influence of solar radiation.

Therefore, people who are constantly indoors and only in a hurry run out into the street for shopping at lunchtime should additionally take the vitamin with food. Milk is perfect for this. One liter can completely cover the daily rate. People who do not miss the opportunity to be in the sun require a correspondingly smaller dose of vitamin D from food.

Those who do not miss the opportunity to be in the sun can accordingly take less vitamin D with food than those who constantly spend time indoors.

Bone formation
Healthy teeth
Calcium balance
Resilient nervous system
optimism, emancipation
active muscle activity
Healthy heart
Strong immune system
Synthesis of hormones
Normal circulation
Removal of lead from the body

People with low blood levels of vitamin D are more likely to be poisoned by lead and thus less protected. Dangerous lead molecules use the same transport routes in the intestines as vitamin D. Therefore, it is important to consume enough calcium (for example, with milk, cottage cheese) in order to win the competition with lead poison every day.

This year, a completely new national program of the Russian Federation for the correction of vitamin D deficiency in children and adolescents was adopted. Recommendations for the prevention and treatment of vitamin D-deficient conditions have been changed.

The program reveals the presentation of clinical bone and extra-osseous manifestations of a low supply of vitamin D to the body. Based on modern research, the program provides indicators of the relationship between vitamin D and anti-infective protection, allergic conditions, autoimmune diseases, diseases of the endocrine system (in particular, diabetes mellitus), cardiovascular vascular disease, kidney disease and obesity.

The section "Extra-osseous (non-calcemic) manifestations of low vitamin D supply" shows the importance of this program for physicians of all specialties. Not only pediatricians, but also endocrinologists, cardiologists, rheumatologists, infectious disease specialists, etc., should deal with the prevention and correction of low vitamin D supply in the Russian Federation. Doctors of narrow specialties should remember that the diseases with which a child comes to them may be interconnected with a low vitamin D status. And when a child is discharged from a hospital, the doctor must be able to correctly select the dosage of prophylactic doses of vitamin D.

Let's take a quick look at preventive doses of vitamin D for children of different age groups.

Children are advised to prescribe vitamin D, regardless of the time of year and type of feeding. At the same time, in children under 1 year old, the dosage was increased from 500 IU / day. up to 1000 IU / day. vitamin D. For the European North of Russia from 6 months to 18 years, the prophylactic dose of cholecalciferol should be 1500 IU / day.

Clinical signs of the period and severity of rickets can be used to prescribe therapeutic doses without determining 25(OH)D.

The maximum therapeutic dose of 4000 IU / day can only be prescribed after determining 25 (OH) D.