ed production of 1,25(OH)2D by activated macrophages and lymphoma cells is responsible for the hypercalciuria associated with chronic granulomatous disorders and the hypercalcemia seen with lymphoma (Adams, 1989; Davies et al., 1994).
Elderly. Aging significantly decreases the capacity of human skin to produce vitamin D3 (MacLaughlin and Holick, 1985). In adults over age 65 years, there is a fourfold decrease in the capacity to produce vitamin D3 when compared with younger adults aged 20 to 30 years (Holick et al., 1989; Need et al., 1993). Although one study suggested that there may be a defect in intestinal calcium absorption of tracer quantities of vitamin D3 in the elderly (Barragry et al., 1978), two other studies demonstrated that aging does not significantly affect absorption of pharmacologic doses of vitamin D (Clemens et al., 1986; Holick, 1986). It is not known whether the absorption of physiologic amounts of vitamin D is altered in the elderly.
Malabsorption Disorders. Patients suffering from various intestinal malabsorption syndromes such as severe liver failure, Crohn's disease, Whipple's disease, and sprue often suffer from vitamin D deficiency because of their inability to absorb dietary vitamin D (Lo et al., 1985). Thus, patients who are unable to secrete adequate amounts of bile or who have a disease of the small intestine are more prone to develop vitamin D deficiency owing to their inability to absorb this fat-soluble vitamin.
Vitamin D intake from food and nutrient supplements is expressed in either international units (IU) or micrograms (µg). One IU of vitamin D is defined as the activity of 0.025 µg of cholecalciferol in bioassays with rats and chicks. Thus, the biological activity of 1 µg of vitamin D is 40 IU. The activity of 25(OH)D is 5 times more potent than cholecalciferol; thus, 1 IU = 0.005 µg 25(OH)D.
Throughout the world, the major source of vitamin D for humans is the exposure of the skin to sunlight (Holick, 1994). During sun