Есть ли рекомендации по скринингу взрослых на дефицит витамина D?

[o_udovichenko]

Коллеги, добрый вечер!
Пишу по следам публикации в "Клинических обзорах в эндокринологии" по поводу витамина D (№1 / 2014, стр.50
[Ссылки доступны только зарегистрированным пользователям ])
Видел ли кто-нибудь рекомедации (guidelines) о том, чтобы проводить скрининг взрослых на дефицит витамина D?
Возможно, это актуально... Но вошло ли это в рекомендации?

[Samitin]

На Медскейпе статья [Ссылки доступны только зарегистрированным пользователям ] с последним обновлением от 21 апреля 2014 года содержит следующую информацию:

Screening for vitamin D deficiency is recommended only in those individuals who are at high risk for vitamin D deficiency, including the following:
•Patients with osteoporosis

•Patients with a malabsorption syndrome

•Black and Hispanic individuals

•Obese persons (body mass index >30 kg/m2)

•Patients with disorders that affect the metabolism of vitamin D and phosphate (eg, chronic kidney disease)

[Samitin]

Опубликованный 23.06.14 проект (доступный для комментария) Screening for Vitamin D Deficiency: U.S. Preventive Services Task Force Recommendation Statement ([Ссылки доступны только зарегистрированным пользователям ]):

Assessment of Risk

Although there is not enough evidence to support screening for vitamin D deficiency, there is some evidence on what factors may increase an individual's risk for vitamin D deficiency. Persons with low vitamin D intake, decreased vitamin D absorption, and little or no sun exposure (such as due to the winter season, high latitude, and physical sun avoidance) may be at increased risk for vitamin D deficiency (1). Obesity and darker skin pigmentation may also be associated with low levels of total serum 25-hydroxy vitamin D, but it is unclear whether these factors reflect vitamin D deficiency and increase risk for adverse clinical outcomes. Obesity may allow for greater sequestration of vitamin D into adipose tissue, however, this vitamin D may still be bioavailable (1). Increased skin pigmentation reduces the skin's ability to produce vitamin D in response to UVB exposure. Prevalence rates of low total serum 25-hydroxy vitamin D are 2 to 9 times higher in African Americans and 2 to 3 times higher in Hispanics compared with whites (1), yet risk for fracture in African Americans is half of that in whites (7). Although other factors such as body composition and calcium economy have been proposed to explain this paradox (8), a recent study suggests that although total serum 25-hydroxy vitamin D levels in African Americans may be low, the concentration of bioavailable 25-hydroxy vitamin D levels may not be low (1, 9). Some evidence suggests that older age and female sex may also be associated with increased risk for vitamin D deficiency, however, these findings are inconsistent (1).

[lci699]

У детей с клиническим рахитом, или у взрослых с высоким ПТГ - я понимаю, нужно мерять.
Но скрининг у взрослых? Зачем?
Советую почитать метаанализ: повышенная смертность и морбидность у людей с дефицитом Д не вызваны дефицитом Д: они больны независимыми болезнями, которые вторично снижают Д.

Autier P, Boniol M et al
Vitamin D status and ill health: a systematic review.
The Lancet Diabetes & Endocrinology 2: 76-89, 2014



После сего можно сделать выводы:-)

[lci699]

Samitin:

"Опубликованный 23.06.14 проект (доступный для комментария) Screening for Vitamin D Deficiency: U.S. Preventive Services Task Force Recommendation Statement (ссылка)"


Др. Самитин,
Вы пропустили самое главное:



Benefits of Detection and Early Treatment

No studies were identified that evaluated the direct benefit of screening for vitamin D deficiency in adults. Adequate evidence was found that showed treatment of asymptomatic vitamin D deficiency has no benefit on cancer, type 2 diabetes, mortality in community-dwelling adults, and risk for fractures in persons not selected based on having a high risk for fracture. The USPSTF found inadequate evidence on the benefit of treating asymptomatic vitamin D deficiency on other outcomes, including psychosocial or physical functioning. The USPSTF concluded that the overall evidence on the early treatment of asymptomatic, screen-detected vitamin D deficiency to improve overall health outcomes in adults is inadequate.
......................

Based on the current, available science, the USPSTF concludes that the evidence on screening for vitamin D deficiency to improve health outcomes is insufficient and the balance of benefits and harms of screening and early intervention cannot be determined.



Короче, никаких выгод скрининг дефицитa витаминa Д не даёт.