Zasady suplementacji i leczenia witaminą D – nowelizacja 2018 r.

Vitamin D supplementation guidelines for Poland – a 2018 update

Agnieszka Rusińska1†, Paweł Płudowski2, M, Mieczysław Walczak3,A, G, Maria K. Borszewska-Kornacka4, I, Artur Bossowski5, Danuta Chlebna-Sokół1, K, Justyna Czech-Kowalska6, Anna Dobrzańska6, Edward Franek7, Ewa Helwich8, D, Teresa Jackowska9, C, Maria Kalina10, Jerzy Konstantynowicz11, Janusz Książyk12, L, Andrzej Lewiński13, B, Jacek Łukaszkiewicz14, Ewa Marcinowska-Suchowierska15, Artur Mazur16, Izabela Michałus1, Jarosław Peregud-Pogorzelski17, J,  Hanna Romanowska3, Marek Ruchała18, H, Piotr Socha19, Mieczysław Szalecki20, 21, Mirosław Wielgoś22, F, Ł, Danuta Zwolińska23, E, Arkadiusz Zygmunt13

1 Klinika Propedeutyki Pediatrii i Chorób Metabolicznych Kości, Uniwersytet Medyczny w Łodzi
2 Zakład Biochemii, Radioimmunologii i Medycyny Doświadczalnej, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
3 Klinika Pediatrii, Endokrynologii, Diabetologii, Chorób Metabolicznych i Kardiologii Wieku Rozwojowego, Pomorski Uniwersytet Medyczny w Szczecinie
4 Klinika Neonatologii i Intensywnej Terapii Noworodka, Warszawski Uniwersytet Medyczny
5 Klinika Pediatrii, Endokrynologii, Diabetologii z Pododdziałem Kardiologii, Uniwersytet Medyczny w Białymstoku
6 Klinika Neonatologii, Patologii i Intensywnej Terapii Noworodka, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
7 Instytut Medycyny Doświadczalnej i Klinicznej Polskiej Akademii Nauk, Klinika Chorób Wewnętrznych, Endokrynologii i Diabetologii, Centralny Szpital Kliniczny MSWiA w Warszawie
8 Klinika Neonatologii i Intensywnej Terapii Noworodka, Instytut Matki i Dziecka w Warszawie
9 Klinika Pediatrii, Centrum Medycznego Kształcenia Podyplomowego w Warszawie
10 Klinika Pediatrii i Endokrynologii Dziecięcej, Śląski Uniwersytet Medyczny w Katowicach
11 Klinika Pediatrii, Reumatologii, Immunologii i Chorób Metabolicznych Kości, Uniwersytet Medyczny w Białymstoku
12 Klinika Pediatrii, Żywienia i Chorób Metabolicznych, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
13 Klinika Endokrynologii i Chorób Metabolicznych, Uniwersytet Medyczny w Łodzi, Instytut Centrum Zdrowia Matki Polki w Łodzi
14 Katedra Biochemii i Chemii Klinicznej Wydziału Farmaceutycznego, Warszawski Uniwersytet Medyczny
15 Klinika Geriatrii, Centrum Medycznego Kształcenia Podyplomowego w Warszawie
16 II Klinika Pediatrii, Endokrynologii, Diabetologii, Uniwersytet Rzeszowski
17 Klinika Onkologii Dziecięcej, Pomorski Uniwersytet Medyczny w Szczecinie
18 Klinika Endokrynologii, Przemiany Materii i Chorób Wewnętrznych, Uniwersytet Medyczny w Poznaniu
19 Klinika Gastroenterologii, Hepatologii, Zaburzeń Odżywiania i Pediatrii, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
20 Klinika Endokrynologii i Diabetologii, Instytut „Pomnik – Centrum Zdrowia Dziecka” w Warszawie
21 Wydział Lekarski i Nauk o Zdrowiu, Uniwersytet Jana Kochanowskiego w Kielcach
22 I Katedra i Klinika Położnictwa i Ginekologii, Warszawski Uniwersytet Medyczny
23 Klinika Nefrologii Pediatrycznej, Uniwersytet Medyczny we Wrocławiu
A Konsultant Krajowy w Dziedzinie Endokrynologii i Diabetologii Dziecięcej
B Konsultant Krajowy w Dziedzinie Endokrynologii
C Konsultant Krajowy w Dziedzinie Pediatrii
D Konsultant Krajowy w Dziedzinie Neonatologii
E Konsultant Krajowy w Dziedzinie Nefrologii Dziecięcej
F Konsultant Krajowy w Dziedzinie Perinatologii
G Prezes Polskiego Towarzystwa Endokrynologii i Diabetologii Dziecięcej
H Prezes Polskiego Towarzystwa Endokrynologicznego
I Prezes Polskiego Towarzystwa Neonatologicznego
J Prezes Polskiego Towarzystwa Pediatrycznego
K Przewodnicząca Sekcji Chorób Metabolicznych Kości Dzieci i Młodzieży przy Polskim Towarzystwie Pediatrycznym
L Prezes Polskiego Towarzystwa Żywienia Klinicznego Dzieci
Ł Prezes Polskiego Towarzystwa Ginekologów i Położników
M Prezes Europejskiego Towarzystwa Witaminy D – EVIDAS

Paweł Płudowski
Zakład Biochemii, Radioimmunologii
i Medycyny Doświadczalnej,
Instytut „Pomnik Centrum Zdrowia Dziecka”,
Al. Dzieci Polskich 20,
04-730, Warszawa
Tel.: 22 8151789

Cytowanie

Tekst stanowi tłumaczenie wytycznych suplementacji i leczenia niedoboru witaminy D, które zostały opublikowane 31 maja 2018 roku w czasopiśmie Frontiers in Endocrinology (Rusińska A, Płudowski P, Walczak M, Borszewska-Kornacka MK, Bossowski A, Chlebna-Sokół D, Czech-Kowalska J, Dobrzańska A, Franek E, Helwich E, Jackowska T, Kalina MA, Konstantynowicz J, Książyk J, Lewiński A, Łukaszkiewicz J, Marcinowska-Suchowierska E, Mazur A, Michałus I, Peregud-Pogorzelski J, Romanowska H, Ruchała M, Socha P, Szalecki M, Wielgoś M, Zwolińska D, Zygmunt A. Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland – Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies – 2018 Update. Front Endocrinol 9:246, doi: 10.3389/fendo.2018.00246). Rozpowszechniany na podstawie licencji „Uznanie autorstwa 4.0 Międzynarodowe (CC BY 4.0)”

Copyright ©2018 Rusińska, Płudowski, Walczak, Borszewska-Kornacka, Bossowski, Chlebna-Sokół, Czech-Kowalska, Dobrzańska, Franek, Helwich, Jackowska, Kalina, Konstantynowicz, Książyk, Lewiński, Łukaszkiewicz, Marcinowska-Suchowierska, Mazur, Michałus, Peregud-Pogorzelski, Romanowska, Ruchała, Socha, Szalecki, Wielgoś, Zwolińska i Zygmunt

† Autor zmarł

WERSJA ELEKTRONICZNA

Streszczenie:
Wprowadzenie: Niedobór witaminy D jest ważnym i powszechnym problemem zdrowotnym w Polsce. Niezależnie od wieku, niedobór witaminy D jest wiązany ze znacznym wzrostem ryzyka rozwoju wielu chorób oraz wielu negatywnych skutków zdrowotnych. Celem niniejszego dokumentu zawierającego wytyczne oparte na dowodach jest dostarczenie pracownikom służby zdrowia w Polsce oraz populacji ogólnej aktualnych rekomendacji dotyczących zapobiegania, diagnozowania i leczenia niedoboru witaminy D. Metody: Przeprowadzono systematyczny przegląd piśmiennictwa dotyczącego zapobiegania i leczenia niedoboru witaminy D. Zaktualizowane zalecenia opracowano przy użyciu systemu klasyfikacji zaleceń (GRADE) opisującego siłę zalecenia i jakość dowodów potwierdzających. Zespół ekspertów oceniał dowody dotyczące zagadnienia niedoboru witaminy D, sformułował cele tego dokumentu i opracował wytyczne postępowania w populacji ogólnej i w grupach ryzyka. Wyniki: Zaktualizowane zalecenia określają kryteria diagnostyczne oceny stanu zaopatrzenia w witaminę D oraz opisują strategie zapobiegania i leczenia jej niedoboru w populacji ogólnej, a także w grupach o podwyższonym ryzyku wystąpienia niedoboru. Opracowano zalecenia dotyczące zapobiegania, suplementacji i leczenia niedoboru witaminy D oraz omówiono szczegółowe wytyczne dotyczące postępowania w podstawowej i specjalistycznej opiece zdrowotnej. Wniosek: Niedobór witaminy D jest bardzo rozpowszechniony w Polsce i dotyczy wszystkich grup wiekowych. Istnieje potrzeba wdrożenia regularnej suplementacji zalecanymi dawkami oraz opracowania skutecznej strategii łagodzenia skutków niedoboru witaminy D w populacji polskiej. Zaktualizowane zalecenia są skierowane do pracowników służby zdrowia i władz zajmujących się kompleksową polityką zdrowotną w Polsce. Opracowane wytyczne powinny być uwzględnione w programach zdrowia publicznego mających na celu zapobieganie szerokiemu spektrum chorób przewlekłych.

Słowa kluczowe: rekomendacje, witamina D, niedobór witaminy D

Abstract:
Introduction: Vitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland an updated recommendation for the prevention, diagnosis, and treatment of vitamin D deficiency. Methods: A systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated available published evidence related to vitamin D, formulated the goals of this document, and developed a common consolidated position. The consensus group, representing 6 national specialist consultants and 8 Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations. Results: The updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care. Conclusion: Vitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there is a great necessity to implement a regular supplementation with recommended doses, and to develop an effective strategy to alleviate vitamin D deficiency in the population. These updated recommendations are addressed to health professionals and the authorities pursuing comprehensive health policies, and should be also included in public health programs aimed at preventing a broad spectrum of chronic diseases.

Key words: vitamin D, supplementation, guidelines, vitamin D deficiency

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