Journal
CURRENT OPINION IN CLINICAL NUTRITION AND METABOLIC CARE
Volume 15, Issue 6, Pages 625-634Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MCO.0b013e328358fc2b
Keywords
25(OH)D; acute illness; critical care; vitamin D
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Funding
- National Institutes of Health (NIH) [5T32GM007592-33, UL1 RR025758]
- NIH [R01 AI093723, U01 AI087881]
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Purpose of review The pleotropic effects of vitamin D on chronic diseases have received significant attention; however, its role in acute illness is less understood. The purpose of this review is to summarize the current evidence regarding the role of vitamin D in acute stress and critical illness. Recent findings 25-Hydroxyvitamin D levels may affect risk of developing acute illnesses (e.g. respiratory infections), and low concentrations are associated with unfavorable outcomes during critical care. Inflammatory changes alone do not explain the observed deterioration in vitamin D status following acute stress. Hemodilution, interstitial extravasation, decreased synthesis of binding proteins, and renal wasting of 25-hydroxyvitamin D, all appear to play a more significant role in the regulation of vitamin D status during critical illness. Summary Single-point assessments of 25-hydroxyvitamin D following acute stress may provide an inaccurate assessment of vitamin D status. In such cases, measurement of binding proteins and free vitamin D metabolites may be essential to create a more realistic approximation of vitamin D status. Variations in patient responses to acute stress and critical illness may depend not only on the degree of systemic vitamin D insufficiency, but also on the individual tissue requirements.
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