Clinical nutrition and metabolismClinical nutrition and metabolismКлиническое питание и метаболизм2658-44332782-2974Eco-Vector11502810.17816/clinutr115028ReviewsНаучные обзорыReview ArticleIssues of diagnostics and treatment of vitamin D deficiency in older patientsПроблемные вопросы диагностики и лечения дефицита витамина D у пожилых больныхhttps://orcid.org/0000-0003-1699-08813595-1990NikitinIgor G.НикитинИгорь Геннадиевич
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

igor.nikitin.64@mail.ruhttps://orcid.org/0000-0002-5192-62121654-0859BrutskayaLudmila A.БруцкаяЛюдмила Алексеевна
Russian Federation

MD

ludmila3to@mail.ruhttps://orcid.org/0000-0002-5917-00774311-8989GultiaevaNadezhda A.ГультяеваНадежда Анатольевна
Russian Federation

MD

primlrc@mail.ruhttps://orcid.org/0000-0001-5050-63902818-8561PodkhvatilinaAnastasiya S.ПодхватилинаАнастасия Сергеевна
Russian Federation

MD

nansy.rezerpin@gmail.comPirogov Russian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаFederal Centre of Treatment and RehabilitationЛечебно-реабилитационный центр1901202302022023342302450112202209012023Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-Вектор2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journals.eco-vector.com/2658-4433/article/view/115028

Vitamin D is a fat-soluble compound that a person obtains from food or synthesizes independently when the skin is exposed to sunlight.

Vitamin D metabolism is modulated by various intrinsic and extrinsic factors, including genetic polymorphism, skin type (pigmentation), age, health, season, latitude, clothing, and diet. Some of them are modifiable, i.e., they can be controlled by humans.

To assess the vitamin D level in the body, the recommendation was to determine the concentration of total 25(OH)D in the blood serum, the main circulating form, which reflects both the intake of vitamin D from food and native preparations and the synthesized vitamin D in the skin under the influence of ultraviolet irradiation. This study focused on the diagnosis and treatment of vitamin D deficiency in older patients.

The age-related problem is associated with a more frequent history of surgery and chronic diseases requiring drug therapy, which in turn can affect the metabolism of this vitamin. Vitamin D deficiency in older people requires constant and long-term use of cholecalciferol; however, the risks of drug interactions and polypharmacy should not be overlooked.

The diagnosis and treatment of vitamin D deficiency in older people should consider all the characteristics of this group. Moreover, this study presents the features of vitamin D metabolism in older people, nosologies predisposing to the development of vitamin D deficiency, methods for diagnosing and correcting vitamin D deficiency, and relationship between severe COVID-19 and vitamin D levels.

Further study of possible drug interactions, additional effects of vitamin D, and its contribution to comorbidities is warranted.

Витамин D ― жирорастворимое соединение, которое человек получает с пищей или синтезирует самостоятельно при воздействии солнечного света с кожей.

Метаболизм витамина D модулируется многими внутренними и внешними факторами, включая генетический полиморфизм, тип кожи (пигментацию), возраст, состояние здоровья, время года, географическую широту, одежду и питание. Некоторые из них являются модифицируемыми, т.е. могут регулироваться человеком.

Для оценки уровня витамина D в организме рекомендуется использовать определение в сыворотке крови концентрации общего 25(ОН)D ― основной циркулирующей формы, которая отражает как поступление витамина D с пищей и нативными препаратами, так и синтезированный витамин D в коже под воздействием ультрафиолетового облучения.

Статья посвящена вопросам диагностики и лечения дефицита витамина D у пожилых пациентов. Проблема, обусловленная возрастом, связана с более частыми оперативными вмешательствами в анамнезе и хроническими заболеваниями, требующими приёма медикаментозной терапии, которая в свою очередь может влиять на метаболизм этого витамина. Дефицит витамина D у пожилых людей требует постоянного и длительного приёма колекальциферола, однако нельзя забывать о рисках лекарственного взаимодействия и полипрагмазии. Диагностика и терапия дефицита витамина D у пожилых людей должны проходить с учётом всех особенностей этой группы пациентов.

В статье обсуждаются особенности метаболизма витамина D в пожилом возрасте; представлены нозологии, предрасполагающие к развитию дефицита витамина D, способы диагностики и коррекции дефицита этого витамина, в том числе рассматривается взаимосвязь тяжёлого течения новой коронавирусной инфекции COVID-19 с уровнем витамина D.

Требуется дальнейшее изучение возможных лекарственных взаимодействий и возможных дополнительных эффектов витамина D, а также его вклад в течение сопутствующих заболеваний.

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