520 |
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|b We read with interest the review by Amin on the role of vitamin D in mental health. There are many epidemiological studies showing increased risks of not only psychological and psychiatric disorders but also cancer and autoimmune, cardiovascular, infectious, and metabolic diseases when serum 25-hydroxyvitamin D[25(OH)D] levels are <20 ng/mL (50 nmol/L) and that risks decrease with higher serum 25(OH)D concentrations. However, there is no convincing evidence from randomized controlled trials that supplements of vitamin D can influence outcomes in those extra-skeletal conditions. A decisive verdict on the value of vitamin D supplementation has come from the findings from the Vitamin D and Omega-3 Trial (VITAL). Results of analyses from VITAL, published in several learned journals, had clearly shown that vitamin D supplementation, 2000 IU per day, did not prevent cancer or cardiovascular disease, prevent falls, improve cognitive function, reduce atrial fibrillation, change body composition, reduce migraine frequency, improve stroke outcomes, decrease agerelated macular degeneration, reduce knee pain, or have any important health benefits in older adults, even in those with low serum 25(OH)D. Though serum 25(OH)D is considered the best marker of vitamin D status, it is largely inert, compared to the activated form, 1,25-dihydrdihydroxy vitamin citriol). The latter has a short half-life and its serum levels do not adequately reflect vitamin D stores. In contrast, serum 25(OH)D has a longer half-life of 2-3 weeks. Hence in practice, it provides a better reflection of vitamin D status. Low serum 25(OH)D might reflect poor health status in general, possibly due to reverse causation or confounding by other health behaviors, such as limited outdoor mobility and exposure to sunlight. In addition, serum 25(OH)D is a negative acute phase reactant in patients with acute or chronic inflammatory diseases, such as acute systemic infections or autoimmune diseases. If the C-reactive protein (CRP) level increases, serum 25(OH)D level decreases and when the condition of the patient improves, serum 25(OH)D goes back to normal. There is no data to define the optimal level of serum 25(OH)D level in extra-skeletal conditions or diseases. We need to emphasize the recommendation by the 2011 Institute of Medicine report that established recommended dietary allowances for vitamin D of 600 to 800 IU per day to meet the bone health needs of 97.5% of the general population.
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