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Vitamin D. Molecular Biology, Physiology and Clinical Applications. Edited by Holick MF. (Pp 458; illustrated; $145.00.) US: Humana Press, 1999. ISBN 0 896 03467 4.
A comprehensive study of vitamin D, this book starts with a brief consideration of the evolutionary aspects of vitamin D and the essential role of photosynthesis of the vitamin in the conservation of calcium in aquatic and land animals. Cutaneous synthesis is the principal source of vitamin D for most healthy people but dietary intake becomes increasingly important in the very young and the elderly. Adequate intakes (formerly called recommended daily allowances) for all age groups, and for pregnant or lactating women, are provided and the central question of how to define vitamin D deficiency is revisited; based on serum parathyroid hormone responses to vitamin D supplementation, a threshold level of intake of 20 ng/ml (50 nmol/l) is suggested.
Vitamin D deficiency is a common side effect of hepatic and gastrointestinal diseases and often results in bone disease; gastroenterologists should, therefore, have some knowledge of the causes, consequences, and treatment of vitamin D related bone disorders. It also has a wide range of actions which are unrelated to its effects on calcium metabolism; receptors for its active metabolite, 1,25-dihydroxyvitamin D, are found in many places including the stomach, thymus, immune system, gonads, and some cancer cells. The antiproliferative and prodifferentiation effects of vitamin D have already been exploited in the development of treatment for psoriasis and other skin disorders and the exciting potential applications of vitamin D in some malignant diseases are discussed towards the end of the book.
Since the pivotal research in the 1960s on the metabolism of vitamin D there has been intense research activity in a number of related areas, including the synthesis and metabolism of vitamin D metabolites and analogues, the molecular biology of the vitamin D receptor, and the mechanisms by which 1,25-dihydroxyvitamin D affects the renal, intestinal, and skeletal transport of calcium. These aspects are covered in considerable detail and occupy about one half of the book; there is also a detailed chapter on the methodology for assays of vitamin D, although the authors do not discuss the usefulness of these assays in clinical practice. The latter part of the book is devoted to clinical issues—for example, rickets and osteomalacia, osteoporosis, inherited defects of vitamin D metabolism, and the pathophysiology of hypercalcaemia associated with the extrarenal production of 1,25-dihydroxyvitamin D, which occurs in conditions such as sarcoidosis and lymphoproliferative disorders. There is also an interesting chapter on the epidemiology of cancer risk and vitamin D. Disappointingly, at least for the gastroenterologist, there is very little coverage of vitamin D deficiency associated with hepatic and gastrointestinal disorders.
The book is well produced and has many illustrations and diagrams; it provides an excellent and comprehensive account of the substantial advances occurring in this area. Furthermore, the chapters are well referenced, many containing over 100 references. This book is not for the gastroenterologist who wishes to extract information about the diagnosis and management of vitamin D deficiency in clinical practice, but will be highly valued by those with a close interest in following the fascinating progress of this hormone.