This document discusses the relationship between vitamin D deficiency and iron deficiency anemia. It begins with background on vitamin D and iron, including dietary sources and recommended daily intake. It then examines the high rates of vitamin D deficiency and iron deficiency anemia in India. The document explores the plausible links between the two deficiencies from prevalence data, mechanistic evidence showing how one may contribute to the other, and clinical evidence from studies. One study in particular found that children with low vitamin D had lower hemoglobin and iron, supporting an association between the deficiencies. The document recommends a combined approach to prophylaxis against both deficiencies.
Role of Magnesium in Pregnancy Dr Dipti Nabh Dr Sharda Jain Dr Jyoti AgarwaLifecare Centre
Role of Magnesium in Pregnancy Dr Dipti Nabh Dr Sharda Jain Dr Jyoti Agarwal
Magnesium: Key Health Facts Are less Known to doctors
/public
IMPORTANT FACT
Magnesium is one of the most abundant minerals in the human body.
It plays several very significant roles in the health of our body and brain.
Though, we may not be getting enough of it, even if we eat a healthy diet.
We do not Indian data..but many developed countries have shown its rampant deficieny in public .
Role of Magnesium in Pregnancy Dr Dipti Nabh Dr Sharda Jain Dr Jyoti AgarwaLifecare Centre
Role of Magnesium in Pregnancy Dr Dipti Nabh Dr Sharda Jain Dr Jyoti Agarwal
Magnesium: Key Health Facts Are less Known to doctors
/public
IMPORTANT FACT
Magnesium is one of the most abundant minerals in the human body.
It plays several very significant roles in the health of our body and brain.
Though, we may not be getting enough of it, even if we eat a healthy diet.
We do not Indian data..but many developed countries have shown its rampant deficieny in public .
Need of Vitamin D3 supplement | Buy Vitamin D3 in EuropeRufus Greenbaum
Eat vitamin rich food; try as much as u can in contact with sun and start taking Vitamin D3 Supplement http://greenvits.eu/ . Many Researches proved that Vitamin D3 Supplement have numerous good effects on our health and it fight against various serious chronic illness like depression, cancer and many more.
Buying vitamin D in Europe is also important Decision as many over the counter supplements contains 180 % more vitamin d then stated in there level.
What is vitamin D and why do you need it? What it does. Symptoms & Signs of Deficiency; Optimum blood levels. Latest research findings relating to vitamin D and health. What is the best supplement dose? Tolerable upper intakes. Toxicity.
Role of Calcium in pregnancy DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Rashmi Jai...Lifecare Centre
ROLE OF CALCIUM IN PREGNANCY
FOCUS :
Daily requirement of calcium according to age
Calcium metabolism in pregnancy
Calcium requirement in pregnancy
Maternal benefits
Fetal benefits
Reduction in blood lead levels
Nutrition to improve calcium
Guidelines about dietary calcium intake / supplements in pregnancy
Need of Vitamin D3 supplement | Buy Vitamin D3 in EuropeRufus Greenbaum
Eat vitamin rich food; try as much as u can in contact with sun and start taking Vitamin D3 Supplement http://greenvits.eu/ . Many Researches proved that Vitamin D3 Supplement have numerous good effects on our health and it fight against various serious chronic illness like depression, cancer and many more.
Buying vitamin D in Europe is also important Decision as many over the counter supplements contains 180 % more vitamin d then stated in there level.
What is vitamin D and why do you need it? What it does. Symptoms & Signs of Deficiency; Optimum blood levels. Latest research findings relating to vitamin D and health. What is the best supplement dose? Tolerable upper intakes. Toxicity.
Role of Calcium in pregnancy DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Rashmi Jai...Lifecare Centre
ROLE OF CALCIUM IN PREGNANCY
FOCUS :
Daily requirement of calcium according to age
Calcium metabolism in pregnancy
Calcium requirement in pregnancy
Maternal benefits
Fetal benefits
Reduction in blood lead levels
Nutrition to improve calcium
Guidelines about dietary calcium intake / supplements in pregnancy
• Bio Tech's D3Natal contains 5000IU of Vitamin
D3 (cholecalciferol)
• The current RDA is grossly inadequate at
450mcg/day (UPMC study; Lisa Bodner, PhD,
M.P.H, M.D.)
• The ONLY prenatal with adequate and newly
recommended IU levels between 4000-6000IU
• Vitamin D3 is water-soluble and dissolves
instantly
Vitamin D3 regulates calcium absorption
from the intestines, maintains normal blood
levels of calcium and phosphorus, an
promotes bone formation
• More benefits of Vitamin D3 are coming to
light and affects nearly every disease state
from diabetes to cancer
• The main source of Vitamin D3 is sunlight
People with dark skin, limited exposure to
sunlight, and those who wear sunscreen
need to supplement Vitamin D in their
diets
• Adequate blood levels for Vitamin D
range between 50-125 nanomoles per
liter (nmpol/L)
• -60% of the population is "D deficient"
(Zellman,WebMD)
• Vitamin D3 vs.Vitamin D2 (Key Studies)
° "Vitamin D2 is Much Less Effective than Vitamin D3" (Arman, Hollis, Heaney 2004)
Conclusion: Vitamin D2 potency is less than 1/3 the potency of Vitamin D3 with a shorter duration of action
° "Vitamin D3 Is More Potent than Vitamin D2 in Humans" (Heaney, Recker, Grote, Horst, Armas 201 I)
Conclusion: Vitm in D3 is ~87% more potent in raising and maintaining serum 25(OH)D concentrations and produces 2-3 fold greater storage of Vitamin D3 over D2
Low levels of Vitamin D during pregnancy are associated with poor fetal/infant skeletal formation and growth as well as poor tooth mineralization
• Over 50 Universities, Hospitals and Clinics utilize Bio-Tech Vitamin D3 for their research
• Vitamin D3 is not a Rx. Vitamin D2 is available via Rx only
• Lactation and Vitamin D3
• A reassessment of current Vitamin D intake for mothers is critical as current recommendations result in a high degree of Vitamin D deficiency, especially in the African American population.
• Current recommendations of 200-400 ILJ/d for pregnant and lactating women are grossly inadequate, especially in minority populations. A growing body a research suggests that dosing with over 2000 ID/d is required to maintain robust normal levels.
• Studies that introduce high doses ofVitamin D (2000IU to 4000IU) improve the nutritional status of both mother and infant.
losses of both vitamin D binding protein and 25(OH)D in the urine
The urinary losses of vitamin D binding protein may be secondary to proteinuria.
Deficiency in 25(OH)D may lead to hypocalcemia, hyperparathyroidism, and diminished bone mineral density/content.
Vitamin D deficiency has also been associated with multiple systemic effects including elevated blood pressure ,metabolic syndrome, cardiovascular disease ,anemia and impaired immune system regulation .
Infertility Treatment in India | Best Fertility Specialist Ponni Babycentre
www.ponnitesttubebabycentre.com Ponni Hospitals is one of the best infertility hospital in india offers treatments like IVF , IUI , ICSI etc at affordable rate.
breech delivery is a vanishing art. Fast tracked TBT trial publication made majority to embrace lscs for breech presentation. Lack of confidence, skill deficit and lack of training during residency further complicated the issue.
treating anemia is a big challenge.oral iron therapy do not adequately treat IDA. IV ferric carboxy maltose (FCM)effectively treats IDA by circumventing the problem compliance of oral iron therapy.
female Genital tuberculosis,TB-PCR, female infertility, veerendrakumar cm
female genital TB poses stiffest challenge in the diagnosis, rapid molecular techniques have helped in arriving at a definitive diagnosis in suspicious clinical setting
prophylactic encerclage for multiple pregnancy is always debated.in this presentation cerclage for MFG is favored as there was a debate in recently held KSOGA conference at manipal on 3-11-11.
intravenous iron sucrose is a ray of hope for treating iron defeciency anemia which is still a major problem in india. It circumvents the problem of compliance and its large safety encourages its routine use in antenatal care and is highly suitable for treating postpartum anemia...
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
breast feeding problems can be easily tackled by obstetricians provided they make conscious efforts to look into the problem,they can create awareness among the paramedical people who are under their direct control
this presentation gives insight into the recent controversies of HPV vaccine, in a VAST country like India mass vaccination at minimal cost may be the only way to tackle killer cancer cervix
Hypertension in pregnancy is a major killer disease, this presentation explores the review of contemporary evidence in the management of acute severe hypertension,
accurate assessment of gestational age by certain mensrtual data and clinical examination may have dating discrepancy with the ultrasound. this ppt critically addresses such issues
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. Veerendrakumar C.M.
MD.,DNB
Associate Professor
Dept of OBG,VIMS,Bellary
Thursday, December 22, 2011 dr.veerendrakumar cm 1
2. Vitamin D & Iron Deficiency:
Deadly Duo
Alien + Predator
Thursday, December 22, 2011 dr.veerendrakumar cm 2
3. Vitamin D vitamin or Hormone ??
("sunshine" vitamin)
Vitamin D is a fat-soluble vitamin. Fat-soluble
vitamins are stored in the body's fatty tissue
Very few foods naturally contain vitamin D.
Thursday, December 22, 2011 dr.veerendrakumar cm 3
6. Contents
Vitamin D status & Deficiency Recap
Clinical Data
Health Implications
Iron Deficiency Anemia status in India
Vitamin D Deficiency & Iron Deficiency Anemia: is there a Link ?
Prevalence
Mechanistic Evidence
Clinical Evidence
Summary
Thursday, December 22, 2011 dr.veerendrakumar cm 6
7. Vitamin D
Vitamin D is found in the following foods:
Dairy products
Cheese
Butter
Cream
Fortified milk (all milk in the U.S. is fortified with vitamin D)
Fatty fish (such as tuna, salmon, and mackerel)
Oysters
Fortified breakfast cereals, margarine, and soy milk
Thursday, December 22, 2011 dr.veerendrakumar cm 7
8. 10 to 15 minutes of sunshine three times weekly is
enough to produce the body's requirement of vitamin D.
The sun needs to shine on the skin of your face, arms,
back, or legs (without sunscreen).
Skin that is exposed to sunshine indoors through a
window will not produce vitamin D. Cloudy days, shade,
and having dark-colored skin also cut down on the
amount of vitamin D the skin makes.
Thursday, December 22, 2011 dr.veerendrakumar cm 8
9. RDA
9 - 70 years: 600 IU (15 mcg/day)
Safe upper limit -
4,000 IU/day for children 9 years and older, adults, and
pregnant and breast-feeding teens and women
One microgram of cholecalciferol (D3) is the same as 40
IU of vitamin D.
Thursday, December 22, 2011 dr.veerendrakumar cm 9
10. The greater absorption of iron in vivo from
ferrous ascorbate [Fe(HL)2] as compared with
ferrous sulfate has been ascribed both to
retardation or prevention of Fe(II) oxidation by
ascorbate and to the existence of Fe(II) as a
chelate with ascorbate.
Pharm Weekbl Sci 1984 Dec 14;6(6):245-8.
Thursday, December 22, 2011 dr.veerendrakumar cm 10
11. Ascorbic acid (AA), is the most efficient enhancer of
non-heme iron absorption when its stability in the
food vehicle is ensured. The number of studies
investigating the effect of AA on ferrous sulfate
absorption far outweighs that of other iron
fortificants.
The promotion of iron absorption in the presence of
AA is more pronounced in meals containing inhibitors
of iron absorption. Meals containing low to medium
levels of inhibitors require the addition of AA at a
molar ratio of 2:1 (e.g., 20 mg AA: 3 mg iron).
Int J Vitam Nutr Res. 2004 Nov;74(6):403-19.
Thursday, December 22, 2011 dr.veerendrakumar cm 11
12. Pregnancy -The most dangerous journey of
mankind
Thursday, December 22, 2011 dr.veerendrakumar cm 12
13. ANEMIA
40-90% WOMEN AFFECTED
RESPONSIBLE FOR 65% MATERNAL DEATHS (FOGSI-
WHO 1996)
CHRONIC MORBIDITY
Thursday, December 22, 2011 dr.veerendrakumar cm 13
14. Eradicating anemia can save at least
200 mothers a day!
Thursday, December 22, 2011 dr.veerendrakumar cm 14
15. Public Health Significance
WHO 2008
Prevalence of anemia (%) Public health significance
< 04.9 No PH problem
05.0 – 19.9 Mild
20.0 – 39.9 Moderate
> 40.0 Severe
Thursday, December 22, 2011 dr.veerendrakumar cm 15
16. Silver shines Gold glitters
But… Iron strengthens!
Thursday, December 22, 2011 dr.veerendrakumar cm 16
17. Patients have a right to
Normal Hb and
Receive safe and efficient treatment;
It is the physician’s responsibility to ensure this and,
Where possible, avoid blood transfusion.
Thursday, December 22, 2011 dr.veerendrakumar cm 17
18. Anemia is on the increase!!
Economy is ‘better’
More women are educated, empowered
Tons of iron tablets distributed
Fancy iron preparations flood the market
Antenatal clinics are running full !
Iron is not reaching its destination!
Thursday, December 22, 2011 dr.veerendrakumar cm 18
19. Are we producing
a defective generation?
Thursday, December 22, 2011 dr.veerendrakumar cm 19
20. More doctors are finally testing patients for vitamin D
deficiencies…
“Upwards of 70 percent of American adults are vitamin D
deficient or insufficient," said cardiologist James O'Keefe of
St. Luke's Mid-America
Vitamin D prevents heart disease, too
Vitamin D is essential for activating immune system
function
Thursday, December 22, 2011 dr.veerendrakumar cm 20
21. Vitamin D: Optimum status
Ideal >30 ng/ml
Acceptable 20-30 ng/ml
Insufficient 10-20 ng/ml
Deficient <10 ng/ml
Thursday, December 22, 2011 dr.veerendrakumar cm 21
22. Vitamin D Deficiency:
Gender Analysis
Indian J Med Res. 2008;127:211-218
Thursday, December 22, 2011 dr.veerendrakumar cm 22
23. Vitamin D deficiency in Pregnant
women and their New born
≈84% Indian women have 25(OH)D values
< 22.5 ng/L.
Am J Clin Nutr 22, 2011
Thursday, December 2000;72:472-5.
dr.veerendrakumar cmAm J Clin Nutr 2005;81:1060-4. 23
24. Vitamin D deficiency in Lactating
Women and Breastfed infants
81.1%
66.7%
23.2% 27.1%
19.8%
11.6%
Deficiency: <15 ng/ml
Insufficiency: 15-20 ng/ml
Severe Deficiency: <5 ng/ml
Thursday, December 22, 2011 dr.veerendrakumar cm
Indian J Med Res. 2011;133:267-273 24
25. Vitamin D deficient Mother-
Deficient Infant
J Pediatr Endocrinol Metab. 2009;22(3):241-6.
Thursday, December 22, 2011 dr.veerendrakumar cm 25
26. Retards proliferation
and
increases differentiation of cells
Thursday, December 22, 2011 dr.veerendrakumar cm 26
27. Vitamin D Deficiency:
Health Implications
Osteomalacia & Rickets
Osteoporosis
Diabetes
Hypertension & CVD
&
Anemia
Thursday, December 22, 2011 dr.veerendrakumar cm Mayo Clin Proc. 2006;81(3):353-373 27
28. 60-90% Indians have Vitamin D Deficiency
Indians have Vitamin D Deficiency
~ 50% of those have anemia
INDIA
Latitude of 22° 00’N
Longitude of 77° 00’W
Thursday, December 22, 2011 dr.veerendrakumar cm 28
29. Vitamin D Deficiency and Iron
Deficiency Anemia: Is there a Link?
Thursday, December 22, 2011 dr.veerendrakumar cm 29
30. Prevalence in Pregnant Women &
Infants
Pregnant women with low serum 25(OH)D levels had 46%
higher risk of developing anemia.
Am J Clin Nutr. 1992;56:533-536
> 50% infants with Iron Deficiency Anemia had low
25(OH)D levels.
Plos One2010;5(1):e8770
Thursday, December 22, 2011 dr.veerendrakumar cm 30
31. Vitamin D & Iron Deficiency Link in
Toddlers
20% Asian children
had both Vit D
Deficiency & Anemia.
Children with
Vitamin D deficiency
had low Hb and
serum iron.
Thursday, December 22, 2011 dr.veerendrakumar cm Arch Dis Childhood. 1986;61:843-848
31
32. Vitamin D & Iron Deficiency Link in Children
Thursday, December 22, 2011 dr.veerendrakumar cm 32
BMJ. 1998;318:28
33. Vitamin D & Iron Deficiency Link:
The Hen or Egg?
Mechanistic Evidence
Thursday, December 22, 2011 dr.veerendrakumar cm 33
34. Vitamin D Deficiency causes
Anemia Plausible Mechanism # 1
Vitamin D receptors are present in bone marrow.
Hematons (buffy coat of bone marrow containing
erythroid precursors) shown to contain high
concentration of D25 & 1,25-hydroxyvitamin D.
Thus Vitamin D deficiency could result in reduced
activation of erythroid precursors, causing anemia.2
Endocrinology.2006;147(12):5542-5548
Thursday, December 22, 2011 2. Ann Hepatol. 2010;89:447-452
dr.veerendrakumar cm 34
35. High local concentrations of 1,25(OH)D in hematopoietic tissues
may directly activate erythroid precursors cells in a paracrine
fashion.
Vitamin D
Vitamin D supplementation will help the initial phase of erythropoesis.
Iron supplementation would be required for the latter phase.
Thursday, December 22, 2011 dr.veerendrakumar cm 35
37. Vitamin D Deficiency causes
Anemia Plausible Mechanism # 2
Myelofibrosis was observed in children with Vitamin D deficiency
induced rickets.1,2,3
Vitamin D Deficiency
Reduced activation of Vitamin D receptors in bone marrow
Myelofibrosis
Impaired Erythropoesis
Anemia
1. J Pediatr. 1989;114:213-217 2. Canad Med Assoc J. 1966;94:395 3. Indian Pediatr. 2005;42:482-484
Thursday, December 22, 2011 dr.veerendrakumar cm 37
38. Iron Deficiency Causes Vitamin D Deficiency
Background
Dietary/supplementary
Vitamin D absorbed from
the intestine, is converted to
25(OH)D in the liver.
Some of the 25(OH)D in liver
is secreted into bile (mainly (Enterohepatic
circulation)
as glucuronides) & is
reabsrobed by enterohepatic
circulation.1,2
Thursday, December 22, 2011 1. Am J Clin Nutr. 1992;56:533-536
dr.veerendrakumar cm 2. Proc Soc Exp Biol Med. 1975;149:570-572
38
39. IDA Causes Vitamin D Deficiency
Plausible Mechanism # 1
Iron Deficiency Anemia
Impaired Epithelial Regeneration & Function
Abnormal GI mucosa
Malabsorption of Fats
Pediatrics.1964;33:83-99
Thursday, December 22, 2011 dr.veerendrakumar cm 39
40. Malabsorption of Fats
Impairment in Bile secretion
Impaired Vitamin D absorption & 25(OH)D reabsorption in the
intestine
Vitamin D Deficiency
Thursday, December 22, 2011 dr.veerendrakumar cm 40
41. IDA Causes Vitamin D Deficiency
Plausible Mechanism # 2
Iron deficiency inhibits the metabolism of Vitamin D to 25(OH)D.
Clinical evidence
> 50% Infants with IDA had decreased concentration of 25(OH)D &
24,25(OH)2D despite receiving daily supplements of Vitamin D.
Treatment with iron increased the concentrations of both iron & vitamin D
metabolites.
Increase in serum vitamin D metabolites occurred even when no change
was made in the diet or vitamin D supplements.
Am J Clin Nutr. 1992;56:533-536
Thursday, December 22, 2011 dr.veerendrakumar cm 41
42. Vitamin D & Iron Deficiency Link:
The Hen or Egg?
Clinical Evidence
Thursday, December 22, 2011 dr.veerendrakumar cm 42
43. Clinical Evidence for the
relationship: 1
Thursday, December 22, 2011 dr.veerendrakumar cm 43
44. Clinical Evidence for the
relationship: 2
Thursday, December 22, 2011 dr.veerendrakumar cm 44
45. Study Answers the Crucial
Question
Why is Vitamin D deficiency disease (rickets) prevalent in
tropical countries (India) with abundant sunlight?
IDA contributes to the high prevalence because the
amount of Vitamin D synthesized in the skin is
insufficient. Does not satisfy the infants’ requirements.
Moreover, the absorption of vitamin D in the small
intestine is limited, due to IDA resulting in the
development of rickets.
Thursday, December 22, 2011 dr.veerendrakumar cm 45
47. Clinical Evidence for the
relationship: 3
Thursday, December 22, 2011 dr.veerendrakumar cm 47
48. Study Snapshot
Significant association, not a mere overlap of the two
deficiencies.
Children with low Vitamin D concentration had lower
hemoglobin and serum iron concentrations.
This was particularly noticeable in winter. 50% of children
with low Vitamin D concentration were anemic
compared to none with vitamin D sufficiency.
A combined approach to prophylaxis against iron and
vitamin D deficiency should be considered.
Thursday, December 22, 2011 dr.veerendrakumar cm 48
49. Vitamin D & Iron Deficiency Link:
The Hen or Egg?
OR BOTH?
Thursday, December 22, 2011 dr.veerendrakumar cm 49
50. Vitamin D Deficiency
Impaired Vitamin D
absorption & 25(OH)D
reabsorption
Ineffective Increased
erythropoesis inflammation or
marrow
Impaired myelofibrosis
Inhibition of
intestinal
Vitamin D
absorption of
Metabolism
fats.
Iron Deficiency Anemia
1.Thursday, December 22, 2011
Am J Clin Nutr. 1992;56(3):533-6 2. Plos One2010;5(1):e8770
dr.veerendrakumar cm 3. Ann Hematol. 2010;89:447-452 50
51. Thus....
Vitamin D & Iron Deficiency
The Never-ending Vicious Cycle leads to……
A Twin Epidemic
To Break the Cycle.......
Supplementation with IRON + VITAMIN D would provide optimum benefit
Thursday, December 22, 2011 dr.veerendrakumar cm 51
52. Recommended Dietary intakes of Vitamin D for patients at
risk for Vitamin D Deficiency
Age (Year) IOM(Institute of Medicine) Endocrine Society
RDA RDA
IU/ Day IU/ Day
ng/ml ng/ml
1-18 600 20 1000 30
19-50 600 20 1500-2000 30
50 & above 600-800 20 1500 -2000 30
Pregnancy &
400-600 20 1500-2000 30
Lactation
Endocrine society guidelines are suitable for Indian Patients to raise the blood
level of 25(OH)D consistently above 30 ng/ml
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53. Thus, at a minimum, lactating women may need to take
1400–1500 IU/d, and to satisfy their infant’s
requirement, they may need 4000–6000 IU/d
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54. Evidence of Vitamin D supplement in
adults Older than 51 yr
Participants receiving 800 IU/d
Had a 72% lower rate of falls than those taking
placebo or a lower dose of vitamin D.
Resulted in a 4–11% gain in lower extremity
strength or function and up to 28% improvement
in body sway.
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55. Summary
Vitamin D deficiency with Iron Deficiency Anemia is
prevalent in Indians of all age groups.
The mechanism of IDA leading to Vitamin D Deficiency or
vice versa is not fully established.
The available clinical data indicates a vicious cycle of the
twin deficiencies.
Supplementation with 1000 IU Vitamin D + 100 mg Iron
daily would synergistically improve the status in Indians.
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56. More news on…
Non calcemic benefits of
vitamin D
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57. Vitamin D triggers natural immune response against
tuberculosis, study finds
Increased vitamin D in blood adds years to life and helps
prevent colon cancer
8000 IUs of vitamin D daily necessary to raise blood
levels of "miracle" anti-cancer nutrient, declares
groundbreaking new research
Low vitamin D levels linked to Parkinson's disease
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58. Vitamin D grows hair, prevents the flu and reduces
arthritis pain
Scientists say higher vitamin D intake will slash
cancer, MS, and diabetes risk by half
Crucial vitamin D discovery: deficiency alters lung
growth, harms lung function
Low vitamin D levels linked to Parkinson's disease
Diabetics with low vitamin D have high risk of death
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