Hypovitaminosis D in Patients Admitted to an Internal Medicine Ward

Tânia Santiago, Marta Rebelo, João Porto, Nuno Silva, José Vieira, J M Nascimento Costa


Introduction: Hypovitaminosis D (hypoD) is a vitamin deficiency that has been rising in the developed countries, due not only to inappropriate eating habits, but also because of lower sun exposure and lack of exercise.

Objective: To determine the prevalence of vitamin D deficiency and to analyze associated factors, in patients admitted to an Internal medicine Ward.

Methods: Cross-sectional study which included 123 hospitalized patients admitted to an Internal Medicine Ward between April and May. Serum levels of vitamin D [25-hydroxyvitamin D, 25(OH)D] were determined and the sample divided into three groups based on 25(OH)D levels: severe hypoD (<10ng/mL), moderate deficiency of 25(OH)D (>10ng/mL and <20ng/mL) and third group with normal levels of 25(OH)D (>20ng/mL). Demographic variables were recorded as were factors potentially related to vitamin D deficiency.

Results: In this sample (52.0% women) the average age was 71 ± 17 years, 67.5% of patients had severe hypoD, 25.2% moderate deficiency and 7.3% normal levels of vitamin D. The patients in the group with severe hypoD were older (p=0.027). In the same group there was a higher percentage of patients in the bedridden state (p=0.022), with higher impaired functional capacity (p=0.009) and with chronic renal insufficiency (p=0.011). In multivariate logistic regression analysis, factors associated with an increased likelihood of severe hypoD were: furosemide treatment [OR=3.673 (1.232-10.956) p=0.020] and albumin ≤3.25 [OR=5.617 (2.257-13.981) p<0.001].

Conclusion: The high prevalence of hypoD (67.5%) in this sample expresses the need for systematic evaluation of serum levels of 25(OH)D, in order to initiate early treatment in patients with inadequate levels. Furosemide treatment and hypoalbuminaemia present an increased likelihood of being associated with severe hypoD. Treatment of this hypovitaminosis is warranted not only because of the clinical consequences related to bone loss, but also because of its relationship with hypoalbuminemia which is associated with a poorer prognosis in hospitalized patients.

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