Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland.

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists' voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20-30 ng/mL (50-75 nmol/L)], and optimal concentration [30-50 ng/mL (75-125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland.

Specialist thyroid package 1 (PS1) in outpatient endocrine care [Pakiet specjalistyczny dotyczacy tarczycy (PS1) w ambulatoryjnej opiece endokrynologicznej].

The article presents the assumptions of a new specialist thyroid package (PS1) in outpatient specialist care in the field of endocrinology, which was introduced by the National Health Fund (NFZ - Narodowy Fundusz Zdrowia) from January 2020. It became an impulse to characterize the current problems affecting specialist care in the field of endocrinology, search for their potential causes and propose strategies that are intended to contribute to increasing the efficiency of the system.

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.

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 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 the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight 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 also be included in public health programs aimed at preventing a broad spectrum of chronic diseases.

An assessment of the effectiveness of iodine prophylaxis in pregnant women--analysis in one of reference gynaecological-obstetric centres in Poland.

INTRODUCTION: Iodine deficiency in pregnant women, even of a mild degree, may have adverse effects on both the mother and the foetus. Despite the obligatory model of functioning iodine prophylaxis in Poland, the iodine supply in women during pregnancy and physiological lactation is insufficient. Therefore, those groups should take additional iodine supplementation at a dose of 150-200 µg/day. The aim of this study was to examine the effectiveness of iodine prophylaxis in pregnant women in Poland. MATERIAL AND METHODS: The assessment of iodine supply, urine iodine concentration (UIC) in the spot urine sample, as well as levels of TSH, fT4, thyroid antibodies, and thyroid volume, was performed at one time point in 115 women (7 in the 1st trimester, 61 in the 2nd trimester, and 47 in the 3rd trimester). RESULTS: Only 45.2% of women were taking additional amounts of iodine at any time of pregnancy, and the median ioduria was 79.6 µg/L, which pointed to an insufficient supply of iodine. The percentage of women using iodine supplementation increased with the length of pregnancy, which indicates that the recommendations are implemented too late. In women who took iodine supplementation, ioduria was significantly higher than in those not applying iodine supplementation (median 129.4 µg/L vs. 73.0 µg/L; p < 0.001); however, this was still below recommended values. CONCLUSIONS: The effectiveness of iodine prophylaxis in pregnant women in Poland, evaluated on the basis of the analysis of randomly chosen sample, is not satisfactory in terms of compliance with the recommendations and, possibly, the quality of supplementation.

[Metabolic causes of bone mineralisation disorders in patients with anorexia nervosa]. / Uwarunkowania metaboliczne zaburzen mineralizacji koscca u pacjentek z jadlowstretem psychicznym.

AIM: To assess the influence of metabolic disorders on densitometric parameters in patients with anorexia nervosa. MATERIAL AND METHODS: Thirty patients with diagnosis of anorexia nervosa and twenty six healthy females from control group participated in the study. Serum calcium, phosphorus, estradiol, cortisol, osteocalcin and C-terminal telopeptide of collagen type I concentrations were estimated. Urine sample was analysed for 24 hrs excretion of calcium and phosphorus. Lumbar bone mineral density and Z-score were assessed by DEXA. RESULTS: Statistical analysis showed the presence of positive correlation between densitometric parameters and serum concentrations of estradiol and phosphorus and negative correlation with serum concentration of cortisol. The duration of anorexia nervosa and secondary amenorrhea correlated negatively with densitometric parameters. There was no correlation between bone turnover markers and densitometric parameters. CONCLUSIONS: Current data are in agreement with hypothesis of multifactorial ethiopathogenesis of osteoporosis in anorexia nervosa.