우연히 발견된 무증상 구루병 8례

서지영,김규리,이희우,안영민 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.8

Purpose:Vitamin D plays a key role in bone mineralization of the skeleton and vitamin D deficiency can lead to rickets. It is well known that vitamin D deficiency is common in breast fed infants. Of these patients, clinically, some have no signs of rickets, but laboratory and radiographic findings are diagnostic for vitamin D deficiency rickets (subclinical vitamin D deficiency rickets). The purpose of this study is to clarify current causes and ways to prevent this disease. Methods:We reviewed the clinical and laboratory characteristics of children who were incidentally diagnosed as subclinical rickets during treatment of other disease such as pneumonia, gastroenteritis, urinary tract infection at Eulji Hospital, Seoul, Korea from March, 2003 to July 2007. Results:Eight patients (six boys and two girls) were diagnosed with subclinical vitamin D deficiency rickets. The mean age of the patients was 12.6±5.8 months, and they were diagnosed from January to July. The associated diseases were pneumonia, urinary tract infection, acute gastroenteritis, and iron deficiency anemia. All patients were breast-fed. Two showed growth failure. The mean serum alkaline phosphatase was 1995.8±739.5 IU/L, the mean calcium count was 9.5±0.6 mg/ dL, and the mean phosphorus content was 3.6±1.5 mg/dL mg/dL. The mean intact parathyroid hormone was 214.8±155.9 pg/mL (reference range, 9-65), the mean 1,25-dihydroxyvitamin D was 82.4±49.3 pg/mL (reference range, 2070), and the mean 25-hydroxyvitamin D was 29.6±10.6 ng/mL (reference range, 1030). A radiographic examination showed cupping, fraying, and flaring of metaphyses in all patients. Six patients were administered calcitriol (400 IU/day) for three months. A consequent radiographic and laboratory examination showed improvement. The first two patients were initially diagnosed with metaphyseal dysplasia, without the detection of vitamin D deficiency and they spontaneously improved without vitamin D supplements. However, two years later, they showed mild scoliosis and metaphyseal dysplasia, respectively. Conclusion:Breast-feeding without supplementation involves high risk of vitamin D deficiency. Some infants may also develop rickets; therefore, such groups should be considered for vitamin D supplementation. (Korean J Pediatr 2008;51: 812-819) Purpose:Vitamin D plays a key role in bone mineralization of the skeleton and vitamin D deficiency can lead to rickets. It is well known that vitamin D deficiency is common in breast fed infants. Of these patients, clinically, some have no signs of rickets, but laboratory and radiographic findings are diagnostic for vitamin D deficiency rickets (subclinical vitamin D deficiency rickets). The purpose of this study is to clarify current causes and ways to prevent this disease. Methods:We reviewed the clinical and laboratory characteristics of children who were incidentally diagnosed as subclinical rickets during treatment of other disease such as pneumonia, gastroenteritis, urinary tract infection at Eulji Hospital, Seoul, Korea from March, 2003 to July 2007. Results:Eight patients (six boys and two girls) were diagnosed with subclinical vitamin D deficiency rickets. The mean age of the patients was 12.6±5.8 months, and they were diagnosed from January to July. The associated diseases were pneumonia, urinary tract infection, acute gastroenteritis, and iron deficiency anemia. All patients were breast-fed. Two showed growth failure. The mean serum alkaline phosphatase was 1995.8±739.5 IU/L, the mean calcium count was 9.5±0.6 mg/ dL, and the mean phosphorus content was 3.6±1.5 mg/dL mg/dL. The mean intact parathyroid hormone was 214.8±155.9 pg/mL (reference range, 9-65), the mean 1,25-dihydroxyvitamin D was 82.4±49.3 pg/mL (reference range, 2070), and the mean 25-hydroxyvitamin D was 29.6±10.6 ng/mL (reference range, 1030). A radiographic examination showed cupping, fraying, and flaring of metaphyses in all patients. Six patients were administered calcitriol (400 IU/day) for three months. A consequent radiographic and laboratory examination showed improvement. The first two patients were initially diagnosed with metaphyseal dysplasia, without the detection of vitamin D deficiency and they spontaneously improved without vitamin D supplements. However, two years later, they showed mild scoliosis and metaphyseal dysplasia, respectively. Conclusion:Breast-feeding without supplementation involves high risk of vitamin D deficiency. Some infants may also develop rickets; therefore, such groups should be considered for vitamin D supplementation. (Korean J Pediatr 2008;51: 812-819)

위암으로 전위절제술을 시행한 환자에서의 비타민 B12 결핍성 빈혈

고윤웅(Yun Woong Ko),민진식(Jin Sik Min),서형찬(Hyung Chan Suh),조준식(Joon Sik Cho),이석(Seok Lee),정소영(So Young Chong),유내춘(Nae Choon Yoo),민유홍(Yoo Hong Min),한지숙(Jee Sook Hahn) 대한내과학회 1998 대한내과학회지 Vol.54 No.3

Objectives: We attempt to find out the decremental character of serum vitamin B12 level and features of patients with vitamin B12 deficiency anemia occurring earlier than 4 years after total gastrectomy. Methods: We studied 91 patients who underwent total gastrectomy and select 59 patients who evaluate serum vitamin B12 level within 4 years after total gastrectomy to characterize the features of vitamin B12 deficiency anemia group occurring earlier than 4 years after the operation. Results: 1) In 91 patients, the mean postoperative duration is 31.9(range: 0-135) months and mean serum vitamin B12 level 158.9(total 159 times, range: 20.0-806.2) pg/mL. Correlation equation is y=403.30×e-0.09x +175.93×e-0.02x (r2=0.804). The postoperation duration that serum vitamin B12 level falls below 200pg/mL is 20 months. 2) Among 59 patient, there were 20 cases of vitamin B12 deficiency anemia group(Group I), 21 cases of vitamin B12 deficiency(Group II) and 39 cases of non-vitamin B12 deficiency group(Group III). Preoperation symptom duration in Group I was longer than that in Group II(18.2 vs 9.6 weeks, p<0.01). Group 1 and Group II showed lower serum vitamin B12 level than Group III(126.7 & 96.0pg/mL vs 330.4pg/mL, p<0.01). 3) Eleven cases had associated diseases(9 alcoholics and 2 liver cirrhosis) with vitamin B12 deficiency anemia and these disease had significant influence on the incidence of vitamin B12 deficiency anemia(p<0.01) within 4 years. Among the 30 cases who could measure iron profile, 10 patients had an iron deficiency anemia, There was a higher incidence of vitamin B12 deficiency anemia in iron deficiency anemia group(7/10, 70%) than that in non iron deficiency anemia group(7/20, 35%) but no statistical significance(p=0.12). 4) Although anti-cancer chemotherapy did not have a significant influence on the incidence of vitamin B12 deficiency anemia, vitamin B12 level in anti-cancer chemotherapy group was higher than that in non-chemotherapy group(201.83 vs 127.66pg/mL, p=0.01) at similar mean postoperation duration(27.8 vs 27.7 months, p=0.97). 5) The independent predictor of vitamin B12 deficiency anemia within 4 years were associated disease(p=0.002) and preoperation symptom duration(p=0.004), Conclusion: Red cell indices such as Hb or MCV did not have any clinical significances in predicting the development of vitamin Biz deficiency. To prevent vitamin B12 deficiency anemia and promote better quality of life in total gastrectomized patients with stomach cancer, careful monitoring of serum Vitamin B12 level and replacement therapy should be necessary at least 20 months after operation, especially in patients with associated disease and longer preoperation symptom duration.

Maternal Anemia and Vitamin D deficiency: associations with neonatal hemoglobin levels and the vitamin D status

( Sook-hyun Park ) 대한주산의학회 2017 大韓周産醫學會雜誌 Vol.28 No.1

Objective: To evaluate maternal anemia and vitamin D deficiency and their associations with the neonatal hemoglobin (Hb) levels and the vitamin D status. Methods: This retrospective study enrolled a total of 120 newborns delivered at Kyungpook National University Children`s Hospital between June 2015 and June 2016. Maternal anemia was defined as an Hb level<11 g/dL and vitamin D deficiency was defined as a serum 25- hydroxyvitamin D (25-OHD) concentration<20 ng/mL. Results: The mean neonatal and maternal serum 25-OHD concentrations were 20.1±12.5 ng/ mL, and 16.9±7.3 ng/mL, respectively. Sixty-eight (56.7%) of the infants and 85 (70.8%) of the mothers were vitamin D deficient. The mean maternal hemoglobin levels were 11.7±1.6 g/dL, and 38 (31.7%) of the mothers had anemia. Thirty-four (89.5%) of mothers with anemia were vitamin D deficient. After adjusting for the confounding factors, maternal vitamin D deficiency increased the risk of maternal anemia by 4.061 times (95% confidence interval [CI], 1.238-13.320; P=0.021), and neonatal vitamin D deficiency by 8.283 times (95% CI, 2.861-23.980; P<0.001) compared with maternal vitamin D non-deficiency group. One-year older maternal age decreased the risk of neonatal vitamin D deficiency (odds ratio, 0.913; 95% CI, 0.841-0.991; P=0.029). Conclusion: Maternal vitamin D deficiency increased the risk of maternal anemia and neonatal vitamin D deficiency regardless of maternal ferritin concentrations under non-inflammatory condition. A younger maternal age may be a risk factor for neonatal vitamin D deficiency associated with maternal anemia, and maternal vitamin D deficiency.

Vitamin D deficiency is associated with increased risk of bacterial infections after kidney transplantation

( Young-jae Park ),( Sang-un Kim ),( Kyung-hee Lee ),( Jong-hak Lee ),( Eugene Kwon ),( Hee-yeon Jung ),( Ji-young Choi ),( Jang-hee Cho ),( Sun-hee Park ),( Yong-lim Kim ),( Hyung-kee Kim ),( Seung H 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.3

Background/Aims: There may be an association between vitamin D levels and allograft outcomes in kidney transplant recipients (KTRs). However, few studies have been conducted to determine the association between vitamin D levels and post-transplant infections. This study investigated the impact of vitamin D deficiency on the risk of infection after kidney transplantation. Methods: We measured 25-hydroxyvitamin D (25(OH)D) levels prior to kidney transplantation. Vitamin D deficiency was defined as a serum 25(OH)D level < 20 ng/mL. We examined the incidence of various post-transplant infections during follow-up period. We used Cox proportional hazards regression analysis to determine factors associated with increased risk of post-transplant infections during the follow-up period. Results: A total of 164 KTRs were followed up for a mean of 24.8 ± 10.7 months. Among them, 135 patients (82.3%) had vitamin D deficiency. Patients with vitamin D deficiency had a significantly higher incidence of urinary tract infection (p = 0.027) and any bacterial infection (p = 0.010) compared to those without vitamin D deficiency. Vitamin D deficiency was not significantly associated with incidence of viral or fungal infections. Cox proportional hazards regression analysis revealed that vitamin D deficiency (hazard ratio, 11.07; 95% confidence interval, 1.46 to 84.03; p = 0.020) was independent risk factor for post-transplant bacterial infections. Conclusions: Pre-transplant vitamin D deficiency was a significant risk factor for bacterial infections after kidney transplantation. Further studies are needed on possible benefits of vitamin D supplementation for preventing post-transplant bacterial infection.

비타민 D 작용에 대한 새로운 조명

최희정 대한가정의학회 2011 Korean Journal of Family Medicine Vol.32 No.2

Vitamin D deficiency is now recognized as a pandemic with more than half of the world’s population currently at risk. Traditionally, vitamin D has been associated primarily with bone and calcium metabolism. However, it is now known that adequate vitamin D status is important for optimal function of many organs and tissues throughout the body. This discovery has provided new insights into the action of vitamin D. Many epidemiologic studies have demonstrated an association between vitamin D deficiency and the risk of various chronic diseases, including cardiovascular disease,diabetes, cancers, autoimmune diseases, and infectious diseases. However, it is not enough to limit definitive conclusions. Large randomized controlled trials are needed to establish the relevance of vitamin D status to such as chronic diseases. Vitamin D deficiency and insufficiency can be both treated and prevented safely through supplementation. Recommendation of adequate vitamin D intake should be considered in appropriate patients to optimize general health. In this article, I review its role in skeletal and extraskeletal health and the adverse impact of vitamin D deficiency on musculoskeletal system, cardiometabolic health, immune system, and oncogenesis, and suggest strategies for prevention and treatment of vitamin D deficiency. 비타민 D는 칼슘과 뼈의 대사 외에, 골격근이나 당 대사,혈관과 심장, 면역기능, 세포증식과 연관된 다양한 작용이 밝혀지면서 새롭게 주목을 받고 있으나, 우리나라를 비롯한 전세계인구의 반 이상이 비타민 D 결핍 위험에 놓여있어 비타민D 부족은 이제 세계적인 유행질환이 되었다. 지금까지의 실험실 연구나 역학연구 결과는 적정 비타민 D 농도를 유지하는것이 최적의 건강상태를 유지하는데 필요한 또 하나의 필수요건임을 시사하고 있다. 그러나 비타민 D 부족과 연관이 있는 것으로 알려진 임상질환들은 대부분 역학연구를 통해 밝혀진 것으로 식이나 기저 비타민 D 상태, 체질량지수, 나이, 질환, 계절, 순응도, 신체활동량과 같은 혼란변수를 보정하지 못한 경우가 대부분이다. 또한 칼슘이나 다른 영양소에 의한 영향을 배제하고 비타민 D의 효과를 단독으로 실험하였던 연구나 비타민 D 보충제를 이용한 중재연구가 거의 없고, 결과 또한 일관성을 보이지 않고 있어 비타민 D 부족과 이들 질환 간에 인과관계를 증명하기 위한 무작위 대조군 중재연구가 필요한 실정이다. 현재로는 골연화증을 제외한 나머지 임상질환에서 중재연구를 통한 비타민 D의 효과에 대한 근거가 부족한 상황이지만 비타민 D는 보충제를 통해 쉽고 안전하게 투여가 가능하므로 비타민 D 부족이 있는 환자에게는 적당량의 비타민 D 투여를 고려해야 할 것이다.

Vitamin D: A D-Lightful Vitamin for Health

Michael F. Holick 대한내분비학회 2012 Endocrinology and metabolism Vol.27 No.4

Vitamin D is a sunshine vitamin that has been produced on this earth for more than 500 million years. Because foods contain so little vitamin D most humans have always depended on sun exposure for their vitamin D requirement. Vitamin D deficiency has been defined as a serum 25-hydroxyvitamin D concentration < 20 ng/mL (50 nmol/L); vitamin D insufficiency as a serum 25-hydroxyvitamin D of 21-29 ng/mL and vitamin D sufficiency as a serum 25-hydroxyvitamin D of 30-100 ng/mL whereas toxicity is usually not seen until blood levels are above 150 ng/mL. Vitamin D deficiency is a global health problem that increases risk for metabolic bone diseases in children and adults as well as many chronic illnesses including autoimmune diseases, type 2 diabetes, cardiovascular disease, infectious disease, and cancer. The major causes of vitamin D deficiency are lack of adequate sensible exposure to sunlight,inadequate dietary intake and obesity. The United States Endocrine Society recommended that to prevent vitamin D deficiency in those at risk, children 1 year and older require 600-1,000 international unit (IU) of vitamin D daily and adults require 1,500-2,000 IU of vitamin D daily. Obese patients require 2-3 times more vitamin D to both treat and prevent vitamin D deficiency.

국내 운동선수에서 비타민 D 수치의 현 상태 및 결핍과 관련된 인자: 실내외 종목에 따른 차이, 나이, 성별, 체질량지수, 계절 변동과의 관련성

양성석,이상훈 대한스포츠의학회 2018 대한스포츠의학회지 Vol.36 No.2

Purpose: Several studies have suggested that vitamin D deficiency has significant effects on muscle weakness, injury and illness, and ultimately, exercise performance. However, studies on vitamin D status and deficiency related factors for young athletes are still lacking. Methods: Four hundred athletes who have undergone serum vitamin D (D2 and D3) test were studied. Vitamins were classified into three groups (deficiency, insufficiency, and adequacy). Blood sampling time was classified into four groups (spring, summer, fall, and winter). Results: Of the 400 athletes, 31.5% were deficient, 48.25% were insufficient, and 20.25% were adequate in vitamin D. The group with lower vitamin D levels was older, had a higher body weight, and had higher body mass index. Comparisons by sex were significantly lower in female athletes than male athletes for indoor sports. Seasonal comparisons were significantly lower in winter than in spring, summer, and autumn. When the correlation analysis between the characteristics of the athletes and vitamin D was analyzed, there was a weak negative correlation between age and body mass index and height and weight were not related. Athletes' vitamin D levels are higher than the general population, but about 80% of them have vitamin D deficiency. Conclusion: Vitamin D deficiency causes exercise performance and performance deterioration; therefore, it is necessary to monitor and manage more closely when there are related factors.

Clinical Phenotypes, Comorbidities, and Exacerbations according to Serum 25-OH Vitamin D and Plasma Fibrinogen Levels in Chronic Obstructive Pulmonary Disease

현동곤,오연목,이세원,이상도,이재승 대한의학회 2019 Journal of Korean medical science Vol.34 No.29

Background: Although vitamin D deficiency is prevalent in patients with chronic obstructive pulmonary disease (COPD), the influence of vitamin D deficiency on COPD has not been fully established. Moreover, the inflammation process is associated with vitamin D deficiency in the general population. Therefore, this study aimed to determine whether clinical phenotypes, comorbidities, and exacerbation rates are affected by the level of plasma fibrinogen, well studied by an inflammatory marker in COPD patients, and 25-hydroxy (25- OH) vitamin D. Methods: This retrospective study analyzed patients with COPD whose inflammatory marker levels, especially plasma fibrinogen and 25-OH vitamin D levels, had been examined. A correlation analysis was conducted for inflammatory markers and 25-OH vitamin D. Clinical characteristics, comorbidities and exacerbation rates were compared among four groups based on plasma fibrinogen concentrations (threshold, 350 mg/dL) and 25-OH vitamin D levels (threshold, 20 ng/mL). Results: Among 611 patients with COPD, 236 were included in the study. The levels of inflammatory markers had no statistical correlation with the serum 25-OH vitamin D levels. The four groups showed no statistically significant differences in age, sex, smoking history, inhaler use, and severity of comorbidities. Patients with high plasma fibrinogen concentrations and low 25-OH vitamin D levels had lower lung function, higher severity index, and higher annual rate of severe exacerbations 12 months before (0.23/year) and after (0.41/year) the measurement of 25-OH vitamin D levels than did the other patients. Conclusion: Our findings suggested an interaction between vitamin D deficiency and COPD. The measurement of plasma fibrinogen concentrations could help identify a severe phenotypic group among patients with vitamin D deficiency.

고등학생의 혈중 비타민 D 결핍에 영향을 미치는 요인: 5∼6기 국민건강영양조사 자료 활용(2010-2015)

정미라,하영미,양승경,조정의,채여주,한상미 인문사회 21 2022 인문사회 21 Vol.13 No.6

Factors Associated with Vitamin D Deficiency Among High School Students: Data from the Korean National Health andNutrition Examination Survey V-Ⅵ (2010-2015)Mira Jung, Yeongmi Ha, Seungkyoung Yang,Jeongeui Cho, Yeojoo Chae, & Sangmi Han Abstract: In this study was to identify factors affecting vitamin D deficiency among high school students aged 16-18 through the 5th and 6th National Health and Nutrition Examination Survey. As for the research method, 16,418 people who measured vitamin D were selected from a total of 53,829 subjects who participated in the National Health and Nutrition Survey from 2010 to 2015, and a total of 326 people excluding missing values ​​were finally analyzed using the SPSS 23.0 program. The content of this study was to investigate the factors affecting vitamin D deficiency by examining the relationship between demographic and socioeconomic characteristics by age and vitamin D deficiency among high school students aged 16-18 through the 5th and 6th National Health and Nutrition Survey. Confirmed. According to the results of this study, only high school students' vigorous physical activity was found to be a factor influencing vitamin D deficiency. High school students who engaged in vigorous physical activity were found to have a 0.51 times lower risk of developing vitamin D deficiency than those who did not. In order to solve the vitamin D deficiency in high school students, it is necessary to increase the physical activity practice rate at school and develop a program to strengthen moderate or more vigorous physical activity and engage in regular physical activity. Key Words: Vitamin D Deficiency, High School Student, National Health and Nutrition Survey, Exercise, Rate 고등학생의 혈중 비타민 D 결핍에 영향을 미치는 요인:5∼6기 국민건강영양조사 자료 활용(2010-2015)정 미 라*ㆍ하 영 미**ㆍ양 승 경***ㆍ조 정 의****ㆍ채 여 주*****ㆍ한 상 미****** 연구 목적: 본 연구는 제5차 및 6차 국민건강영양조사를 통해 16-18세 고등학생을 대상으로 비타민 D 결핍에 영향을 미치는 요인을 확인하는 데 목적을 두었다. 연구 방법: 2010년부터 2015년까지 국민건강영양조사에 참여한 총 53,829명의 피험자 중 비타민 D를 측정한 16,418명을 선정하여 결측치를 제외한 총 326명을 최종 분석하여 SPSS 23.0 프로그램을 이용하여 분석하였다. 연구 내용: 제5차 및 6차 국민건강영양조사를 통해 16-18세 고등학생을 대상으로 연령별 인구통계학적, 사회경제적 특성과 비타민 D 결핍과의 관계를 조사하여 비타민 D 결핍에 영향을 미치는 요인을 확인한다. 결론 및 제언: 고등학생은 격렬한 신체활동 실천율이 비타민 D 결핍에 영향을 주는 요인으로 나타났다. 고등학생이 격렬한 신체활동을 실천하면 실천하지 않는 것보다 비타민 D 결핍이 발생할 위험도가 0.51배 감소하는 것으로 나타났다. 본 연구 결과를 바탕으로 고등학생의 신체활동 실천율을 높이고 중등도 이상의 신체활동을 강화하기 위한 규칙적인 신체활동을 할 수 있는 프로그램을 개발할 필요가 있다. 핵심어: 비타민 D 결핍, 고등학생, 국민건강영양조사, 신체활동, 실천율 □ 접수일: 2022년 10월 11일, 수정일: 2022년 11월 12일, 게재확정일: 2022년 12월 20일* 주저자, 한영대학교 간호학과 부교수(First Author, Professor, Hanyeong Univ.)** 공동저자 1, 경상국립대학교 간호대학 교수 & 건강과학연구원(Co-author, Professor, Gyeongsang National Univ.)*** 공동저자 2, 경남대학교 간호학과 조교수(Co-author, Professor, Kyungnam Univ.)**** 공동저자 3, 거붕백병원 간호이사(Co-author, Chief Nursing Officer, Geoboong Baik Medical Center)***** 공동저자 4, 광주대학교 간호학과 조교수(Co-author, Professor, Gwangju Univ.)****** 교신저자, 경남도립거창대학 간호학과 조교수(Corresponding Author, Professor, Gyeongnam Geochang Univ., Email: y2k2509@nate.com)

Prevalence and Related Factors of Vitamin D Deficiency in Critically Ill Patients

김현정,Min Su Sohn,최은영 대한중환자의학회 2016 Acute and Critical Care Vol.31 No.4

Background: To identify the prevalence and related factors for vitamin D deficiency in the patients who admitted to the medical intensive care unit (ICU) of a Korean tertiary care hospital. Methods: We retrospectively analyzed the data from ICU patients requiring mechanical ventilation (MV) for a period of > 48 h to identify the prevalence and associated factors for vitamin D deficiency. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] level < 20 ng/mL. Results: Among 570 patients admitted to the ICU, 221 were enrolled in the study, 194 in the vitamin D deficient group and 27 in the non-deficient group. Prevalence of vitamin D deficiency in critically ill patients was 87.8%. The patient age was lower in the vitamin D deficient group compared with the non-deficient group (64.4 ± 15.4 vs. 71.0 ± 9.6 years, p = 0.049). A higher acute physiology and chronic health evaluation II (APACHE II) score (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.10-1.37) and chronic illness (OR 3.12, 95% CI 1.08-9.01) were associated with vitamin D deficiency after adjusting for age and body mass index. Clinical outcomes of duration of MV, ICU stay, and 28- and 90-day mortality rates were not significantly different between the vitamin D deficient and nondeficient groups. Conclusions: Vitamin D deficiency was common in critically ill patients, particularly among younger patients. Higher APACHE II score and chronic illness were associated with vitamin D deficiency.