The New England Journal of Medicine published two different studies today on Vitamin D -- but first, let me please present some introductory information regarding The New England Journal of Medicine:
This following info on NEJM I believe is accurate as of July 19, 2007:
New England Journal of Medicine
The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. It is one of the most popular and widely-read peer-reviewed general medical journals in the world. It is also the oldest continuously published medical journal in the world.
It was founded by Dr. John Collins Warren in 1812 as a quarterly called The New England Journal of Medicine and Surgery. In 1828, it became a weekly, and was renamed The Boston Medical and Surgical Journal; one hundred years later, it took on its present name.
It publishes editorials, papers on original research, widely-cited review articles, correspondences, case reports, and has a special section called "Images in Clinical Medicine".
Authors have included Oliver Wendell Holmes, Sr., Hans Zinsser, and Lewis Thomas. One of its early editors, Jerome V. C. Smith, resigned in 1857 to assume his duties as mayor of the City of Boston.
The website for the George Polk Awards noted that its 1977 award to the New England Journal of Medicine "provided the first significant mainstream visibility for a publication that would achieve enormous attention and prestige in the ensuing decades"[1]
The journal usually has the highest impact factor of the journals of clinical medicine (including the Journal of the American Medical Association, and The Lancet); in 2006, the impact factor was 51, according to Journal Citation Reports, the first research journal to break 50.
1. ^ http://www.brooklyn....lk/history.html
The two reports were:
1. Dietary Supplement–Induced Vitamin D Intoxication:
Here is the abstract:
Volume 357:308-309 July 19, 2007 Number 3
Dietary Supplement–Induced Vitamin D Intoxication
To the Editor: Vitamin D intoxication that is associated with the consumption of dietary supplements is reported rarely.1 In 2004, the Food and Drug Administration (FDA) learned of the following case.
A 58-year-old woman with diabetes mellitus and rheumatoid arthritis began taking a dietary supplement called Solutions IE Ageless Formula II on January 12, 2004. Fatigue, constipation, back pain, forgetfulness, nausea, and vomiting soon developed. On March 15, 2004, she was hospitalized because her speech was slurred, and a blood glucose reading taken at home was 30 mg per deciliter. On admission, her serum levels were as follows: calcium, more than 3.75 mmol per liter; 25-hydroxyvitamin D, 1171 nmol per liter (normal range, 22 to 135); 1,25-dihydroxyvitamin D, 305 pmol per liter (normal range, 36 to 144); parathyroid hormone, 12 ng per liter (normal range, 10 to 65); calcitonin, 4.5 ng per liter (normal range, 0 to 4.6); albumin, 31 g per liter; phosphorus, 0.81 mmol per liter; blood urea nitrogen, 18.6 mmol per liter; and creatinine, 265 µmol per liter.
The patient was treated with intravenous normal saline, furosemide, and pamidronate disodium. On March 19, 2004, while still hospitalized, she was informed by the product distributor of an error in product formulation such that 188,640 IU of vitamin D3 had been added to the daily serving size of six capsules instead of the intended 400 IU. At discharge on March 24, the patient's serum levels were as follows: calcium, 2.60 mmol per liter; blood urea nitrogen, 10.0 mmol per liter; and creatinine, 221 µmol per liter. The patient died from a cause unknown to us on January 8, 2005.
Laboratory analysis of the product by the FDA, obtained from one of two lots reportedly overfortified with vitamin D3, revealed 186,906 IU of vitamin D3 in each serving size of six capsules, indicating that the patient had consumed roughly 90 times the recommended safe upper limit of 2000 IU per day. Long-term daily vitamin D consumption of more than 40,000 IU (1000 µg) is needed to cause hypercalcemia in healthy persons.2 In March 2004, the product distributor announced that during the previous month it had received three complaints from customers who had been hospitalized for hypercalcemia and vitamin D toxicity. The same month, the product manufacturer recalled 1600 bottles of the product. The case described here underscores the need for the manufacturers of dietary supplements to rigorously monitor levels of ingredients in products and for physicians to be aware of supplements their patients may be taking.
The second study published today in NEJM only has an extract publicly available:
2. Vitamin D Deficiency (extract):
Volume 357:266-281 July 19, 2007 Number 3
Vitamin D Deficiency
Michael F. Holick, M.D., Ph.D.
Once foods were fortified with vitamin D and rickets appeared to have been conquered, many health care professionals thought the major health problems resulting from vitamin D deficiency had been resolved. However, rickets can be considered the tip of the vitamin D–deficiency iceberg. In fact, vitamin D deficiency remains common in children and adults. In utero and during childhood, vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life. Vitamin D deficiency in adults can precipitate or exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the . .
Sources and Metabolism of Vitamin D
Definition and Prevalence of Vitamin D Deficiency
Calcium, Phosphorus, and Bone Metabolism
Osteoporosis and Fracture
Muscle Strength and Falls
Nonskeletal Actions of Vitamin D
Latitude, Vitamin D Deficiency, and Chronic Diseases
Cancer
Autoimmune Diseases, Osteoarthritis, and Diabetes
Cardiovascular Disease
Vitamin D Deficiency and Other Disorders
Schizophrenia and Depression
Lung Function and Wheezing Illnesses
Causes of Vitamin D Deficiency
Vitamin D Requirements and Treatment Strategies
Children and Adults
Breast-Fed Infants and Children
Patients with Chronic Kidney Disease
Malabsorption and Medication
Sunlight and Artificial Ultraviolet B Radiation
Vitamin D Intoxication
Conclusions
Source Information
From the Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, the Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston.
Address reprint requests to Dr. Holick at Boston University School of Medicine, 715 Albany St., M-1013, Boston, MA 02118, or at mfholick@bu.edu.
I have access to the full text, so I guess I will try to provide some insider information:
Sources and Metabolism of Vitamin D
Humans get vitamin D from exposure to sunlight, from their diet, and from dietary supplements
....
Conclusions
...
Much evidence suggests that the recommended adequate intakes are actually inadequate and need to be increased to at least 800 IU of vitamin D3 per day. Unless a person eats oily fish frequently, it is very difficult to obtain that much vitamin D3 on a daily basis from dietary sources. Excessive exposure to sunlight, especially sunlight that causes sunburn, will increase the risk of skin cancer.125,126 Thus, sensible sun exposure (or ultraviolet B irradiation) and the use of supplements are needed to fulfill the body's vitamin D requirement.
....
Supported in part by grants from the National Institutes of Health (M01RR00533 and AR36963) and the UV Foundation.
Dr. Holick reports receiving honoraria from Merck, Eli Lilly, and Procter & Gamble and consulting fees from Quest Diagnostics, Amgen, Novartis, and Procter & Gamble. No other potential conflict of interest relevant to this article was reported.
I thank Dr. Farhad Chimeh for his helpful review of an earlier version of this manuscript and Donna Gendron and Lorrie MacKay for their secretarial assistance.
It appears Health Day News reported on the second story in a piece called: "One Billion People Don't Get Enough Vitamin D: Expert suggests recommended daily intake be boosted to help prevent disease ."
Thoughts or comments?
My comment? Since some individuals seem to be highly concerned about conflict of interest concerns, I'd like to state that I do not think conflict of interest could possibly play a role in this report. Why? First, the study was funded by grants from the National Institutes of Health (M01RR00533 and AR36963) and the UV Foundation.
Second, here you have a VERY well respected researcher who has been financially compensated by several pharmaceutical firms for his expertise, time, and efforts (in other research) that might possibly seem to be more pleased (the pharmaceutical firms, that is) to see a vitamin be shown to be ineffective and something more profitable (like a patentable drug) be shown effective in its place. In addition, this study is published in a peer-reviewed Medical Journal -- among the most highly respected and most cited (#1 highest impact factor) in the world. So whatever Michael F. Holick, M.D., Ph.D. wrote is also corroborated by other HIGHLY respected researchers.
Take care.
Edited by adam_kamil, 19 July 2007 - 08:59 PM.
