Vitamin-D-Mangel als Risikofaktor für Autoimmunerkrankungen, Diabetes mellitus und Herz-Kreislauf-Erkrankungen

Zusammenfassung

Vitamin D kann oral aufgenommen oder endogen in der Haut unter dem Einfluss von UV-Strahlung gebildet werden. In der Leber folgt eine Hydroxylierung zum 25-Hydroxy-Vitamin D₃ und in der Niere eine weitere Hydroxylierung zu 1,25-Dihydroxy-Vitamin D₃ (Calcitriol), einem wichtigen Steroidhormon. Calcitriol ist der aktivste Vitamin-D-Metabolit im Calciumstoffwechsel. Auch verschiedene andere Gewebe können Calcitriol bilden und einen Vitamin-D-Rezeptor exprimieren; dies weist auf eine physiologische Rolle von Vitamin D hin, die über den Calciumstoffwechsel und die Knochenbildung hinausgeht. Epidemiologische Daten zeigen einen niedrigen Vitamin-D-Status bzw. -Mangel bei Patienten mit Autoimmunerkrankungen wie Multipler Sklerose, rheumatoider Arthritis und entzündlichen Darmerkrankungen sowie bei Diabetikern und bei Patienten mit Herzinsuffizienz und Hypertonie. Die Gabe von Vitamin D kann günstige Wirkungen bei diesen Erkrankungen haben.

Die aktuellen Zufuhrempfehlungen der Deutschen Gesellschaft für Ernährung bezüglich Vitamin D betragen 5 μg für den erwachsenen Menschen (10 μg für Patienten über 65 Jahre). Diese Zufuhr ist in der Regel nicht ausreichend, um optimale Serumkonzentrationen von Vitamin D einzustellen. Eine ungenügende Vitamin-D-Versorgung kann mit verschiedenen chronischen Erkrankungen des älteren Menschen korrelieren wie Autoimmunerkrankungen, Diabetes, Hypertonie, Herzinsuffizienz und verschiedenen Tumoren.

Summary

Vitamin D formed in the skin after exposure to UV-light or orally ingested is metabolized in the liver to 25-hydroxy-vitamin D₃ and further more in the kidney to 1,25-dihydroxy-vitamin D₃, calcitriol, an important steroid hormone. Also different other tissues are capable of producing calcitriol or possess a vitamin-D-receptor and this indicates a physiological role of vitamin D exceeding the regulation of calcium metabolism and bone formation. Epidemiological data indicate an insufficient vitamin D status in patients with autoimmune disorders such as multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease, in diabetic patients and in patients with congestive heart failure and hypertension. Vitamin D supplementation may have beneficial effects in these disorders and can e.g. suppress the induction of autoimmune encephalomyelitis, an animal model of MS and has been shown to improve clinical symptoms in patients with rheumatoid arthritis. In type 1 diabetes it can influence the autoimmune process and in type 2 diabetes it can improve insulin resistance. Reduction of blood pressure was also shown under vitamin D supplementation in normotensive as well as hypertensive patients and patients with congestive heart failure often exhibit vitamin D deficiency.

The recommended dietary allowance for vitamin D for adults in Germany is 5 μg (10 μg for elderly people) but this dose may be insufficient to achieve optimal serum concentrations of vitamin D and vitamin D deficiency may be associated with different chronic disorders of elderly people such as autoimmune disorders, diabetes, hypertension, congestive heart failures, and some types of cancer.

Schlüsselwörter

Vitamin D - Steroidhormon - Autoimmunerkrankungen - Diabetes - Hypertonie - Herzinsuffizienz - Zufuhrempfehlungen

Key words

Vitamin D - steroid hormone - autoimmune disorders - diabetes - hypertension - congestive heart failure - recommended dietary allowances

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