HYPERVITAMINOSIS-D ASSOCIATED WITH DRINKING MILK
HYPERVITAMINOSIS-D ASSOCIATED WITH DRINKING MILK
复制标题
DOI：
10.1056/nejm199204303261801
复制
发表时间：
1992-04-30
影响因子：
158.5
通讯作者：
SEELY, EW
中科院分区：
文献类型：
--
作者：
JACOBUS, CH;HOLICK, MF;SEELY, EW
背景自20世纪30年代以来，维生素D一直被添加到美国的牛奶中，以预防佝偻病。我们报告了8例维生素D中毒的不寻常的发生，这些中毒似乎是由过量的维生素D强化牛奶引起的。研究人员回顾了8名不明原因的维生素D过多症患者的医疗记录，并向他们发送了一份饮食调查问卷。采用高效液相色谱法对患者的血清、他们饮用的牛奶以及添加到牛奶中的维生素D浓缩物样品进行维生素D分析。所有8名患者每天都饮用当地乳品厂生产的牛奶，数量从1/2到3杯（118到710毫升）不等。所有患者血清25-羟基维生素D浓度均升高（平均值[+/- SD]，731 +/- 434 nmol/L [293 +/- 174 ng/ml]）。8名患者中有6名血清维生素D3浓度升高。在这8名患者中，7名有高钙血症，1名有高钙尿症但钙血症正常（平均血清钙，3.14 ± 0.51 mmol/L [12.6 ± 2.1 mg/dl]）。对乳制品的维生素D强化牛奶的分析显示，维生素D3（胆钙化醇）的浓度范围从检测不到到高达232，565 IU/升（245，840 IU/升）。对用于强化牛奶的浓缩物的分析表明，它含有维生素D2（麦角钙化醇）。维生素D过多症可能是由于饮用了不正确和过度强化维生素D的牛奶。添加维生素D的牛奶必须仔细监测。
Background. Vitamin D has been added to milk in the United States since the 1930s to prevent rickets. We report the unusual occurrence of eight cases of vitamin D intoxication that appear to have been caused by excessive vitamin D fortification of dairy milk.Methods. Medical records were reviewed and a dietary questionnaire was sent to eight patients who had unexplained hypervitaminosis D. Vitamin D analyses with high-performance liquid chromatography were performed on samples of the patients' serum, the dairy milk they drank, and the vitamin D concentrate added to the milk.Results. All eight patients drank milk produced by a local dairy in amounts ranging from 1/2 to 3 cups (118 to 710 ml) daily. All had elevated serum 25-hydroxyvitamin D concentrations (mean [+/- SD], 731 +/- 434 nmol per liter [293 +/- 174 ng per milliliter]). Six of the eight patients had elevated serum vitamin D3 concentrations. Of the eight patients, seven had hypercalcemia and one had hypercalciuria but normocalcemia (mean serum calcium, 3.14 +/- 0.51 mmol per liter [12.6 +/- 2.1 mg per deciliter]). Analysis of the dairy's vitamin D-fortified milk revealed concentrations of vitamin D3 (cholecalciferol) that ranged from undetectable to as high as 232,565 IU per quart (245,840 IU per liter). An analysis of the concentrate that was used to fortify the milk, labeled as containing vitamin D2 (ergocalciferol), revealed that it contained vitamin D3.Conclusions. Hypervitaminosis D may result from drinking milk that is incorrectly and excessively fortified with vitamin D. Milk that is fortified with vitamin D must be carefully monitored.