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Cai Z, Zhang Q, Xia Z, Zheng S, Zeng L, Han L, Yan J, Ke P, Zhuang J, Wu X, Huang X. Determination of serum 25-hydroxyvitamin D status among population in southern China by a high accuracy LC-MS/MS method traced to reference measurement procedure. Nutr Metab (Lond) 2020; 17:8. [PMID: 31988650 PMCID: PMC6969429 DOI: 10.1186/s12986-020-0427-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
Objective We aimed to describe the 25-hydroxyvitamin D (25(OH)D) status of southern Chinese individuals by a high-accuracy liquid chromatography tandem mass spectrometry (LC-MS/MS) method which can trace to reference measurement procedure. Materials and methods From January 2018 to June 2019, a total of 4775 southern Chinese individuals were evaluated in our study. The serum levels of parathyroid hormone (PTH) were detected simultaneously in 162 cases. 25(OH)D was determined by LC-MS/MS, and PTH was detected using routine automated analysers. The distribution of the concentration, prevalence and seasonal variability of 25(OH)D in males and females of different age groups were studied. Results The mean 25(OH)D concentration in our study was 32.57 ng/mL (4.20-101.40 ng/mL). The global 25(OH)D concentration in males was higher than that in females of different age group. The prevalence of vitamin D deficiency (< 20 ng/mL) in females (16.65%) was higher than that in males (6.83%). The prevalence of vitamin D deficiency (< 20 ng/mL) was most common in winter (22.98% of all women and 15.49% of all men). 25(OH)D concentrations were higher in those from whom blood samples were collected in summer and autumn than in winter and spring. 25(OH)D2 was detected in 672 serum samples (14.07%). In addition, there was a negative correlation between the concentrations of 25(OH)D and serum PTH (r = - 0.149, P < 0.05). Conclusion Our study demonstrated that the average serum 25(OH)D concentration in southern Chinese individuals was higher than that in other Chinese cohorts by a high-accuracy LC-MS/MS method. The global 25(OH)D concentration in males was higher than that in females of different ages, and the prevalence of vitamin D deficiency in females was higher than that in males. Seasonal change was an important aspect of 25(OH)D concentration in young and middle-aged people but became less relevant for that in older subjects. 25(OH)D2 detection was of minor practical significance in our study. In addition, we also found that there was a negative correlation between the serum levels of 25(OH)D and PTH in southern Chinese individuals.
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Affiliation(s)
- Zhiliang Cai
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,2Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
| | - Qiaoxuan Zhang
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,2Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
| | - Ziqiang Xia
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,2Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
| | - Songbai Zheng
- Guangzhou Huayin Medical Laboratory Center, Guangzhou, China
| | - Lilan Zeng
- Guangzhou Huayin Medical Laboratory Center, Guangzhou, China
| | - Liqiao Han
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Yan
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peifeng Ke
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junhua Zhuang
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinzhong Wu
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xianzhang Huang
- 1Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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French D. The (Sun)Light and Dark of 25-Hydroxyvitamin D Testing. J Appl Lab Med 2019; 3:460-473. [DOI: 10.1373/jalm.2017.023051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
Abstract
Abstract
Background
Vitamin D is obtained by the body via sunlight on the skin, from the diet, or from supplementation. The primary function of vitamin D is to maintain calcium homeostasis and bone health, but in the past decade, numerous other health benefits have been proposed.
Content
With the increased awareness of the potential benefits of maintaining sufficient concentrations of 25-hydroxyvitamin D, clinicians began ordering this test for their patients much more frequently. The number of available methods increased, but with that came a larger focus on the challenges of measuring 25-hydroxyvitamin D accurately due to binding to vitamin D-binding protein and the presence of other vitamin D metabolites. Further, standardization of these assays became a focus for several organizations so that clinical guidelines can be applicable to every patient regardless of what methodology is used in 25-hydroxyvitamin D measurement.
Summary
Improvements are being made in the specificity, accuracy, and standardization of the measurement of 25-hydroxyvitamin D, and the future of this testing is looking brighter.
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Affiliation(s)
- Deborah French
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
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Saha S, Walia S, Sharma K, Banerjee K. Suitability of stationary phase for LC analysis of biomolecules. Crit Rev Food Sci Nutr 2019; 60:2856-2873. [PMID: 31621391 DOI: 10.1080/10408398.2019.1665494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Biologically active compounds such as carotenoids/isoprenoids, vitamins, steroids, saponins, sugars, long chain fatty acids, and amino acids play a very important role in coordinating functions in living organisms. Determination of those substances is indispensable in advanced biological sciences. Engineered stationary phase in LC for the analysis of biomolecules has become easier with the development of chromatographic science. In general, C18 column is being used for routine analysis but specific columns are being used for specific molecule. Monolithic columns are found to have higher efficiency than normal column. Among recent introduction, triacontyl stationary phases, designed for the separation of carotenoid isomers, are widely used for the estimation of carotenoids. In comparison to conventional C18 phases, C30 phases exhibited superior shape selectivity for the separation of isomers of carotenoids. It is also found useful for better elution and analysis of tocopherols, vitamin K, sterols, and fatty acids. Vitamin K, E, and their isomers are also successfully resoluted and analyzed by using C30 column. Amino bonded phase column is specifically used for better elution of sugars, whereas phenyl columns are suitable for the separation and analysis of curcuminoids and taxol. Like triacontyl stationary phase, pentafluorophenyl columns are also used for the separation and analysis of carotenoids. Similarly, HILIC column are best suited for sugar analysis. All the stationary phases are made possible to resolute and analyze the target biomolecules better, which are the future of liquid chromatography. The present article focuses on the differential interaction between stationary phase and target biomolecules. The applicability of these stationary phases are reported in different matrices.
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Affiliation(s)
- Supradip Saha
- Division of Agricultural Chemicals, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Suresh Walia
- Division of Agricultural Chemicals, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Khushbu Sharma
- Division of Agricultural Chemicals, ICAR-Indian Agricultural Research Institute, New Delhi, India
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Li XX, Liu Y, Luo J, Huang ZD, Zhang C, Fu Y. Vitamin D deficiency associated with Crohn's disease and ulcerative colitis: a meta-analysis of 55 observational studies. J Transl Med 2019; 17:323. [PMID: 31547829 PMCID: PMC6757415 DOI: 10.1186/s12967-019-2070-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate the association of serum levels of 25(OH)D and 1,25(OH)2D3 in healthy and non-healthy controls with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Three electronic databases: PubMed, EMbase and EBSCOhost CINAHL, were searched for observational studies to measure the relationship between serum levels of vitamin D (VitD) and CD (or UC). RESULTS Fifty-five studies were included in the meta-analysis. We found that mean serum 25(OH)D levels in patients with CD were significantly lower than those in healthy controls (MD: - 3.17 ng/mL; 95% CI - 4.42 to - 1.93). Results from the meta-analysis examining 1,25(OH)2D3 levels in Crohn's patients revealed higher levels in the CD group than in healthy (MD: 3.47 pg/mL; 95% CI - 7.72 to 14.66) and UC group (MD: 5.05 pg/mL; 95% CI - 2.42 to 12.52). Serum 25(OH)D levels were lower in the UC group than in the healthy control group (MD: - 2.52 ng/mL; 95% CI - 4.02 to - 1.02). In studies investigating the level of 1,25(OH)2D3 in UC and healthy control groups, the level of 1,25(OH)2D3 in the UC groups were found to be higher than that in the control groups (MD: 3.76 pg/mL; 95% CI - 8.36 to 15.57). However, the 1,25(OH)2D3 level in patients with UC was lower than that in CD groups (MD: - 6.71 pg/mL; 95% CI - 15.30 to 1.88). No significant difference was noted between CD patients and UC patients in terms of average serum 25(OH)D levels. CONCLUSIONS This study found that VitD levels were inversely related to CD and UC. Serum levels of 25(OH)D were lower in patients with CD and UC than in healthy people, and more than half of the patients had insufficient vitamin D levels. The serum level of 1,25(OH)2D3 in both the CD and UC groups was higher than that in healthy people.
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Affiliation(s)
- Xi-Xi Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.,Zhejiang Chinese Medical University, No. 548, Binwen Road, Zhengjiang, 310053, China
| | - Yang Liu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Jie Luo
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Zhen-Dong Huang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.
| | - Yan Fu
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.
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Rate of change of circulating 25-hydroxyvitamin D following sublingual and capsular vitamin D preparations. Eur J Clin Nutr 2019; 73:1630-1635. [PMID: 31548595 DOI: 10.1038/s41430-019-0503-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vitamin D is critical for skeletal health, and is increasingly associated with other pathologies encompassing gastrointestinal, immunological and psychological effects. A significant proportion of the population exhibits suboptimal levels of vitamin D, particularly in Northern latitudes in winter. Supplementation is advocated, but few data are available on achievable or typical rates of change. There has been considerable interest in the potential use of sublingual sprays for delivery of nutrient supplements, but data on efficacy remain sparse. METHODS A randomised, placebo-controlled, three-arm parallel design study was conducted in healthy volunteers (n = 75) to compare the rate of change of vitamin D status in response to vitamin D3 (3000 IU/day) supplementation in capsule and sublingual spray preparations over a 6-week period between January and April 2017. Blood 25(OH)D concentrations were measured after day 0, 3, 7, 14, 21 and 42 days of supplementation with 3000 IU per diem. RESULTS Baseline measurements show 25(OH)D deficiency (<30 nmol/l), insufficiency (31-46 nmol/l) and sufficiency (> 50 mmol/l) in 14.9, 44.6 and 40.5% of the participants, respectively. There was a significant elevation in blood concentrations of 25(OH)D in both of the treatment arms (capsule p = 0.003, spray p = 0.001) compared with control. The capsule and spray were equally efficacious. The rate of change ranged from 0.69 to 3.93 (capsule) and 0.64 to 3.34 (spray) nmol/L day with average change in blood 25(OH)D levels of 2 nmol/l/day. Rates followed a simple normal distribution in the study population (ks = 0.94 and 0.82 for capsule and spray, respectively). The data suggest that rates of change are higher in individuals with lower levels of 25(OH)D. CONCLUSIONS A sublingual vitamin D spray is an effective mode of delivery for supplementation in a healthy population. The data provide reference values and ranges for the rate of change of 25(OH)D for nutrikinetic analyses.
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Abbatemarco JR, Fox RJ, Li H, Ontaneda D. Vitamin D and MRI measures in progressive multiple sclerosis. Mult Scler Relat Disord 2019; 35:276-282. [PMID: 31445221 DOI: 10.1016/j.msard.2019.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/05/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D deficiency is a proposed risk factor for multiple sclerosis (MS), but its role in progressive MS is not well understood. OBJECTIVE To examine the association between vitamin D levels and MRI features in primary progressive (PPMS) and secondary progressive MS (SPMS). METHODS Serum 25-hydroxyvitamin D (25[OH]D) and 25-hydroxyvitamin D3 (25[OH]D3) levels were obtained from 267 subjects enrolled into the Secondary and Primary Progressive Ibudilast NeuroNEXT Trial in Multiple Sclerosis (SPRINT-MS). Associations between imaging data and vitamin D levels was determined using Pearson or Spearman correlation and multivariate regression analyses. RESULTS 267 patients (age 55.6 ± 7.4, 47.2% male, and 51.3% PPMS) were evaluated with quantitative MRI and vitamin D levels. 25(OH)D and 25(OH)D3 were similar between PPMS and SPMS. There was no significant association between vitamin D and T1/2 lesion volume and brain parenchymal fraction. Modest associations were found between 25(OH)D3 and whole brain-magnetization transfer ratio (WB-MTR, r = 0.17, p = 0.007) and normal appearing grey matter MTR (NAGM-MTR, r = 0.15, p = 0.02). CONCLUSIONS 25(OH)D3 levels were not associated with brain volume or lesional measures in progressive MS contrary to what has been described in relapsing remitting MS. An association between WB-MTR and NAGM-MTR suggest higher vitamin D levels may exert a protective role on myelin content in progressive MS.
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Affiliation(s)
- Justin R Abbatemarco
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hong Li
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Jenkinson C. The vitamin D metabolome: An update on analysis and function. Cell Biochem Funct 2019; 37:408-423. [PMID: 31328813 DOI: 10.1002/cbf.3421] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/03/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023]
Abstract
Current understanding of vitamin D tends to be focussed on the measurement of the major circulating form 25-hydroxyvitamin D3 (25OHD3) and its conversion to the active hormonal form, 1α,25-dihydroxyvitamin D3 (1α,25(OH)2 D3) via the enzyme 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1). However, whilst these metabolites form the endocrine backbone of vitamin D physiology, it is important to recognise that there are other metabolic and catabolic pathways that are now recognised as being crucially important to vitamin D function. These pathways include C3-epimerization, CYP24A1 hydroxylase, CYP11A1 alternative metabolism of vitamin D3, and phase II metabolism. Endogenous metabolites beyond 25OHD3 are usually present at low endogenous levels and may only be functional in specific target tissues rather than in the general circulation. However, the technologies available to measure these metabolites have also improved, so that measurement of alternative vitamin D metabolic pathways may become more routine in the near future. The aim of this review is to provide a comprehensive overview of the various pathways of vitamin D metabolism, as well as describe the analytical techniques currently available to measure these vitamin D metabolites.
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Affiliation(s)
- Carl Jenkinson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Herrick KA, Storandt RJ, Afful J, Pfeiffer CM, Schleicher RL, Gahche JJ, Potischman N. Vitamin D status in the United States, 2011-2014. Am J Clin Nutr 2019; 110:150-157. [PMID: 31076739 PMCID: PMC7263437 DOI: 10.1093/ajcn/nqz037] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/21/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Vitamin D is important for bone health; in 2014 it was the fifth most commonly ordered laboratory test among Medicare Part B payments. OBJECTIVES The aim of this study was to describe vitamin D status in the US population in 2011-2014 and trends from 2003 to 2014. METHODS We used serum 25-hydroxyvitamin D data from NHANES 2011-2014 (n = 16,180), and estimated the prevalence at risk of deficiency (<30 nmol/L) or prevalence at risk of inadequacy (30-49 nmol/L) by age, sex, race and Hispanic origin, and dietary intake of vitamin D. We also present trends between 2003 and 2014. RESULTS In 2011-2014, the percentage aged ≥1 y at risk of vitamin D deficiency or inadequacy was 5.0% (95% CI: 4.1%, 6.2%) and 18.3% (95% CI: 16.2%, 20.6%). The prevalence of at risk of deficiency was lowest among children aged 1-5 y (0.5%; 95% CI: 0.3%, 1.1%), peaked among adults aged 20-39 y (7.6%; 95% CI: 6.0%, 9.6%), and fell to 2.9% (95% CI: 2.0%, 4.0%) among adults aged ≥60 y; the prevalence of at risk of inadequacy was similar. The prevalence of at risk of deficiency was higher among non-Hispanic black (17.5%; 95% CI: 15.2%, 20.0%) than among non-Hispanic Asian (7.6%; 95% CI: 5.9%, 9.9%), non-Hispanic white (2.1%; 95% CI: 1.5%, 2.7%), and Hispanic (5.9%; 95% CI: 4.4%, 7.8%) persons; the prevalence of at risk of inadequacy was similar. Persons with higher vitamin D dietary intake or who used supplements had lower prevalences of at risk of deficiency or inadequacy. From 2003 to 2014 there was no change in the risk of vitamin D deficiency; the risk of inadequacy declined from 21.0% (95% CI: 17.9%, 24.5%) to 17.7% (95% CI: 16.0%, 19.7%). CONCLUSION The prevalence of at risk of vitamin D deficiency in the United States remained stable from 2003 to 2014; at risk of inadequacy declined. Differences in vitamin D status by race and Hispanic origin warrant additional investigation.
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Affiliation(s)
- Kirsten A Herrick
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
- Address correspondence to KAH (e-mail: )
| | - Renee J Storandt
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | | | - Christine M Pfeiffer
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rosemary L Schleicher
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD
| | - Nancy Potischman
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD
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Chikwati RP, Musarurwa C, Duri K, Mhandire K, Snyman T, George JA. Maternal plasma vitamin D levels and associated determinants in late pregnancy in Harare, Zimbabwe: a cross-sectional study. BMC Pregnancy Childbirth 2019; 19:218. [PMID: 31253114 PMCID: PMC6599374 DOI: 10.1186/s12884-019-2362-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The importance of vitamin D in bone health and calcium homeostasis has been well documented. However, emerging evidence supports the role of vitamin D beyond its recognised traditional roles. In pregnancy, vitamin D levels are crucial in sustaining both the maternal stores and optimal growth of the foetus. In Southern Africa, there is paucity of data on vitamin D in pregnancy and related outcomes. To expand this body of knowledge, we assessed vitamin D levels in late pregnancy and (if any) associated maternal determinants in Harare, Zimbabwe. METHODS Study participants comprised of 138 pregnant Zimbabwean women in their third trimester. These were stratified by HIV status; sampling median (IQR) gestation for HIV negative study participants was 34 weeks (26-41) and 31 weeks (20-40) in the HIV positive participants. Maternal plasma 25 hydroxyvitamin (OH) Dlevels were measured using the ClinPrepHigh Pressure Liquid Chromatography (HPLC) kit. Statistical analysis was carried out using the STATA statistical package version 13. A p-value of < 0.05was considered to be statistically significant. RESULTS HIV infected participants had significantly higher mean 25 (OH) D concentration (112 ± 33.4 nmol/L) compared to the HIV uninfected (100 ± 27.1 nmol/L), p = 0.032.Participants whose samples were collected during summer had higher maternal 25 (OH) D levels than those cART duration and maternal 25 (OH) D levels (p = 0.031, Spearman correlation =0.28). CONCLUSIONS Our findings show high mean levels of maternal 25 (OH) D in late pregnancy in our setting and in the absence of vitamin D supplementation. Both HIV infection and season are significant determinants of maternal vitamin D levels. Summer season is associated with higher maternal plasma 25 (OH) D levels. HIV infection is associated with increased maternal vitamin D levels. Prolonged use of cART, Tenolam E is associated with improved maternal 25(OH) D levels.
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Affiliation(s)
- Raylton P Chikwati
- Department of Chemical Pathology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe.
| | - Cuthbert Musarurwa
- Department of Chemical Pathology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Kerina Duri
- Department of Immunology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Kudakwashe Mhandire
- Department of Chemical Pathology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Tracy Snyman
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Erdman P, Palmer-Toy DE, Horowitz G, Hoofnagle A. Accuracy-Based Vitamin D Survey: Six Years of Quality Improvement Guided by Proficiency Testing. Arch Pathol Lab Med 2019; 143:1531-1538. [PMID: 31116045 DOI: 10.5858/arpa.2018-0625-cp] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The goal of the College of American Pathologists Accuracy-Based Proficiency Testing Program is to promote the quality, standardization, and harmonization of clinical laboratory results through proficiency testing specimens that are free from matrix effects, have target values that are traceable to reference methods, and that probe the limitations of current methods. OBJECTIVE.— To summarize the first 6 years of the Accuracy-Based Vitamin D Survey and highlight key insights from the data generated as it relates to assay performance. DESIGN.— Accuracy-based challenges were created by using pooled human serum samples. Certain samples were derived from participants in an institutional review board-approved protocol in which vitamin D-deficient participants were treated with ergocalciferol (vitamin D2). Reference targets for the survey were set by the Centers for Disease Control and Prevention using isotope-dilution liquid chromatography-tandem mass spectrometry. Each method was compared with the reference method procedure over the course of the program (n = 43 proficiency testing samples). RESULTS.— Linear regression versus the reference method procedure revealed proportional biases across the methods, ranging from 0.0% to 16.7%. Pearson correlation coefficients (r2) ranged from 0.902 to 0.996. Results were influenced by the concentration of 25-hydroxyvitamin D2 as well as the C-3 epimer of 25-hydroxyvitamin D3. During the 6 years, 2 manufacturers altered their assays to match the reference method procedure more closely. CONCLUSIONS.— There is considerable bias, both proportional bias and sample-specific matrix effects, affecting many assays. This ongoing accuracy-based proficiency testing program for vitamin D will provide the data needed for laboratories and manufacturers to improve their assays and thereby patient care.
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Affiliation(s)
- Patrick Erdman
- From the Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Erdman); Regional Reference Labs, Southern California Permanente Medical Group, North Hollywood (Dr Palmer-Toy); the Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts (Dr Horowitz); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Hoofnagle)
| | - Darryl E Palmer-Toy
- From the Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Erdman); Regional Reference Labs, Southern California Permanente Medical Group, North Hollywood (Dr Palmer-Toy); the Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts (Dr Horowitz); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Hoofnagle)
| | - Gary Horowitz
- From the Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Erdman); Regional Reference Labs, Southern California Permanente Medical Group, North Hollywood (Dr Palmer-Toy); the Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts (Dr Horowitz); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Hoofnagle)
| | - Andrew Hoofnagle
- From the Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Erdman); Regional Reference Labs, Southern California Permanente Medical Group, North Hollywood (Dr Palmer-Toy); the Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts (Dr Horowitz); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Hoofnagle)
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Park HY, Hong YC, Lee K, Koh J. Vitamin D status and risk of non-Hodgkin lymphoma: An updated meta-analysis. PLoS One 2019; 14:e0216284. [PMID: 31034511 PMCID: PMC6488072 DOI: 10.1371/journal.pone.0216284] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/17/2019] [Indexed: 01/11/2023] Open
Abstract
Purpose This meta-analysis aimed to extensively investigate the association between various measures of vitamin D status and non-Hodgkin lymphoma (NHL) and its subtypes. Methods We searched MEDLINE (PubMed), Embase, and the Cochrane Library in February 2018. Two authors independently reviewed and selected articles based on predetermined criteria. Results A total of 30 studies with 56,458 NHL cases were finally selected, with 24, 9, and 3 studies on sunlight/ultraviolet radiation (UVR) exposure, dietary intake, and serum/plasma 25-hydroxyvitamin D levels, respectively. Significant protective effects of overall sunlight/UVR exposure on NHL and subtypes were observed, with summary relative risks (RRs) ranging from 0.67–0.80 (RR for NHL = 0.80; 95% confidence interval [CI]: 0.71–0.90) among subjects with high exposure compared to those with low exposure. The results were consistent with various classifications of sunlight/UVR exposure. In contrast, when exposure measures of dietary vitamin D intake (RR for NHL = 1.03; 95% CI: 0.90–1.19) and serum/plasma 25-hydroxyvitamin D levels (RR for NHL = 0.97; 95% CI: 0.82–1.15) were used, risk estimates were inconsistent or non-significant for NHL and the subtypes. Conclusion While risk estimates varied by different measures of vitamin D status, a protective effect of sunlight/UVR exposure on NHL incidence was verified, across most of the tested subtypes as well as exposure categories.
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Affiliation(s)
- Hye Yin Park
- Samsung Health Research Institute, Samsung Electronics Co. Ltd., Hwaseong-si, Gyeonggi-do, Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
- * E-mail:
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Environment Health Center, Seoul National University, Seoul, Korea
| | - Kyoungho Lee
- Samsung Health Research Institute, Samsung Electronics Co. Ltd., Hwaseong-si, Gyeonggi-do, Korea
| | - Jaewoo Koh
- Samsung Health Research Institute, Samsung Electronics Co. Ltd., Hwaseong-si, Gyeonggi-do, Korea
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Lin YC, Lee HH, Tseng SC, Lin KD, Tseng LP, Lee JF, Lee YH, Chen BH. Quantitation of serum 25(OH)D2 and 25(OH)D3 concentrations by liquid chromatography tandem mass spectrometry in patients with diabetes mellitus. J Food Drug Anal 2019; 27:510-517. [PMID: 30987722 PMCID: PMC9296195 DOI: 10.1016/j.jfda.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/22/2022] Open
Abstract
Vitamin D has been considered to regulate calcium and phosphorus homeostasis and to preserve skeletal integrity. Serum 25-hydroxyvitamin D (25(OH)D) is the best indicator of vitamin D levels. The association of serum 25(OH)D deficiency with increased risk of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) is controversial. We investigated serum 25(OH) D2 and 25(OH)D3 levels in diabetes patients by using liquid chromatography tandem mass spectrometry (LC-MS/MS). Serum 25(OH)D2 and 25(OH)D3 levels were measured with liquid chromatography tandem mass spectrometry in electrospray ionization positive mode. Chromatograms were separated using an ACE5 C18 column on a gradient of methanol. The total 25(OH)D levels were calculated as the sum of 25(OH)D3 and 25(OH)D2 levels. A total of 56 patients with T1DM and 41 patients with T2DM were enrolled in this study. There were 42 and 28 non-diabetic, age-matched volunteers who participated as the T1DM controls and the T2DM controls, respectively. The total 25(OH)D levels were lowest in the 21–40 age group. The levels of both 25(OH)D3 and the total 25(OH)D were significantly higher in the T1DM and T2DM groups than in the controls (p < 0.01 in T1DM and p < 0.05 in T2DM group, respectively). The 25(OH)D2 levels were only significantly higher in T1DM patients than in the controls. The percentages of vitamin D deficiency (total 25(OH)D less than 20 ng/mL) in the T1DM, T2DM, the T1DM controls and the T2DM controls were 7.1%, 0%, 14.3% and 3.6%, respectively. The percentages of vitamin D insufficiency (total 25(OH)D less than 30 ng/mL) in the T1DM, T2DM, the T1DM controls and the T2DM controls were 26.8%, 7.3%, 54.8% and 17.9%, respectively. The percentages of vitamin D deficiency and insufficiency were significantly lower in the T1DM patients than in the T1DM controls (p < 0.01). In the present study, both type 1 and type 2 diabetes patients had higher serum 25(OH)D levels and lower percentages of vitamin D deficiency/insufficiency.
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Affiliation(s)
- Yi-Ching Lin
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hei-Hwa Lee
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shing-Cheng Tseng
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kun-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Ping Tseng
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jong-Feng Lee
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Hung Lee
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bai-Hsiun Chen
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Carter GD, Ahmed F, Berry J, Cavalier E, Durazo-Arvizu R, Gunter E, Jones G, Jones J, Phinney K, Sempos CT, Twomey PJ, Williams EL, Wise SA. External Quality Assessment of 24,25-dihydroxyvitamin D 3 (24,25(OH) 2D 3) assays. J Steroid Biochem Mol Biol 2019; 187:130-133. [PMID: 30476591 DOI: 10.1016/j.jsbmb.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/18/2018] [Accepted: 11/23/2018] [Indexed: 01/31/2023]
Abstract
The discovery that mutations of the CYP24A1 gene are a cause of idiopathic infantile hypercalcemia (IIH) has revived interest in measuring serum 24,25(OH)2D3. Several studies have also suggested that a high 25-hydroxyvitamin D3(25-OHD3):24,25(OH)2D3 ratio might provide additional diagnostic information in the investigation of vitamin D deficiency. Measurement of 24,25(OH)2D3 is necessarily restricted to laboratories with mass spectrometry methods although cross reactivity of the metabolite in immunoassays for 25-OHD is a potential cause of misleading results. The international External Quality Assessment (EQA) scheme for vitamin D metabolites (DEQAS) was set up in 1989. In 2013 DEQAS became an accuracy based EQA for 25-OHD with 'target values' assigned by the National Institute of Standards and Technology (NIST) Reference Measurement Procedure (RMP). A pilot scheme for serum 24,25(OH)2D3 was started in 2015 and participants were asked to measure the metabolite on each of the 5 samples sent out for 25-OHD. Inter-laboratory agreement was poor but this may reflect methodological differences, in particular different approaches to assay standardization. An important potential contribution to reducing variability among assays was the development by NIST of a 24,25(OH)2D3 RMP and its use in assigning values to SRMs 972a, 2973 and 2971, supported by the NIH Office of Dietary Supplements (ODS) as part of the Vitamin D Standardization Program (VDSP) effort.
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Affiliation(s)
- G D Carter
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom.
| | - F Ahmed
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - J Berry
- DEQAS Advisory Panel, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - E Cavalier
- DEQAS Advisory Panel, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - R Durazo-Arvizu
- DEQAS Advisory Panel, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - E Gunter
- DEQAS Advisory Panel, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - G Jones
- DEQAS Advisory Panel, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - J Jones
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - K Phinney
- DEQAS Advisory Panel, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - C T Sempos
- DEQAS Advisory Panel, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - P J Twomey
- DEQAS Advisory Panel, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - E L Williams
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - S A Wise
- National Institutes of Health (NIH) Office of Dietary Supplements (ODS), Bethesda, MD, 20892-7517, USA
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Zugic Soares J, Pettersen R, Saltyte Benth J, Knapskog AB, Selbæk G, Bogdanovic N. Higher Vitamin D Levels Are Associated with Better Attentional Functions: Data from the NorCog Register. J Nutr Health Aging 2019; 23:725-731. [PMID: 31560030 DOI: 10.1007/s12603-019-1220-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this cross-sectional study was to evaluate which cognitive domains are mostly affected in persons with vitamin D insufficiency or deficiency, defined as 25(OH)D < 50 nmol/l and < 25 nmol/l, respectively. METHODS Data were collected from the Norwegian register for persons assessed for cognitive symptoms (NorCog). 580 persons aged ≥ 65 years were included. The following cognitive and neuropsychiatric tests were used: Mini Mental State Examination, Norwegian Revised Version (MMSE-NR), the Clock Drawing test, the Trail Making Test A and B, the 10-word memory test and the figure copying test from CERAD - immediate and delayed recall, The Controlled Oral Word Association Test -FAS and Boston Naming test. Neuropsychiatric symptoms were assessed by Neuropsychiatric Inventory-Questionnaire and Cornell Scale for Depression in Dementia. RESULTS Vitamin D-insufficiency was found in approx. 30 % of the study cohort. After adjustment for relevant covariates, higher serum 25(OH)D levels were associated with higher score on MMSE-NR (p=0.032) and 10-word Memory Test, immediate recall (p=0.038), as well as faster execution of Trail Making Test A and B (p=0.038 and p=0.021, respectively). Other tests were not significantly associated with 25(OH)D levels. CONCLUSION Higher vitamin D levels appear to be associated with better cognition, especially in areas of executive function and mental flexibility.
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Affiliation(s)
- J Zugic Soares
- J. Zugic Soares, Medical Department, Section of Geriatrics, Lovisenberg Diaconal Hospital, PB 4970 Nydalen 0440 Oslo, Norway,
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Grigoriou EV, Trovas G, Papaioannou N, Makras P, Kokkoris P, Dontas I, Makris K, Tournis S, Dedoussis GV. Serum 25-hydroxyvitamin D status, quantitative ultrasound parameters, and their determinants in Greek population. Arch Osteoporos 2018; 13:111. [PMID: 30324335 DOI: 10.1007/s11657-018-0526-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/27/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Vitamin D deficiency and quantitative ultrasound measurements are associated with bone fragility. We assessed these parameters and their correlates. 87.7% of the population has vitamin D inadequacy and this correlated with lifestyle factors. These results contribute to epidemiological data needed for population guidelines for bone health. PURPOSE Vitamin D deficiency and quantitative ultrasound (QUS) parameters are among the most important clinical risk factors of bone fragility. Few data are available for Greek population. The aim of the study was to evaluate the serum 25-hydroxyvitamin D [25(OH)D] level and their determinants, as well as QUS parameters in Greek population. METHODS OSTEOS is an observational cross-sectional study conducted from June 2010 to July 2012. Nine hundred seventy adults were recruited from rural and urban areas throughout Greece and completed the appropriate questionnaire. Serum 25(OH)D measured by enzyme immunoassay, QUS parameters, broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI), was assessed with an Achilles device. Univariate Analysis of Variance was used for the assessment of serum 25(OH)D determinants. RESULTS Mean serum 25(OH)D of the total population was 20,00 ± 8,00 ng/mL. Females had lower levels than males. The negative determinants of serum 25(OH)D in the total population were the female sex and the winter-spring season of sampling while age proved negative association solely in obese subjects. Positive determinants of vitamin D status were summer sun exposure and organized physical activity as expected. Urban had lower SOS and SI than rural residents. Individuals with 25(OH)D ≥ 20 ng/mL had higher SOS than those with 25(OH)D < 20 ng/mL. BUA, SOS, and SI are positively correlated with organized physical activity and negatively with PTH. CONCLUSIONS This study reports that vitamin D deficiency is highly prevalent among healthy Greek men and women, demonstrates the multifactorial causation of 25(OH)D levels, and points out that further research is required to determine more factors related to vitamin D status and bone health.
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Affiliation(s)
- Effimia V Grigoriou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, El. Venizelou 70, 17671, Athens, Greece
| | - George Trovas
- Th. Garofalidis Laboratory for Research of the Musculoskeletal System, Medical School, National and Kapodistrian University of Athens, 10 Athinas Street, 14561, Athens, Greece
| | - Nikolaos Papaioannou
- Th. Garofalidis Laboratory for Research of the Musculoskeletal System, Medical School, National and Kapodistrian University of Athens, 10 Athinas Street, 14561, Athens, Greece
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, 3 Kanellopoulou st, 11525, Athens, Greece
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Panagiotis Kokkoris
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, 3 Kanellopoulou st, 11525, Athens, Greece
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Ismene Dontas
- Th. Garofalidis Laboratory for Research of the Musculoskeletal System, Medical School, National and Kapodistrian University of Athens, 10 Athinas Street, 14561, Athens, Greece
| | | | - Symeon Tournis
- Th. Garofalidis Laboratory for Research of the Musculoskeletal System, Medical School, National and Kapodistrian University of Athens, 10 Athinas Street, 14561, Athens, Greece
| | - George V Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, El. Venizelou 70, 17671, Athens, Greece.
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Mineva EM, Sternberg MR, Pfeiffer CM, Momin SS, Maw KL, Schleicher RL. Quality specifications and their daily application to evaluate the accuracy of reference measurements for serum concentrations of 25-hydroxyvitamin D 3 and 25-hydroxyvitamin D 2. Clin Chim Acta 2018; 487:241-249. [PMID: 30292631 DOI: 10.1016/j.cca.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reference measurement procedures (RMP) have rigorous accuracy specifications. For total 25-hydroxyvitamin D, 25(OH)D, bias ≤1.7% and CV ≤5% are recommended. These quality specifications are impractical for minor analytes, such as 25(OH)D2. Furthermore, documentation on RMP quality performance specifications for the individual 25(OH)D metabolites and their daily application are missing. METHODS To assess accuracy, we used zeta-scores. Daily, 5-10 specimens (duplicate) and 3 reference materials (singleton or duplicate) were measured for 25(OH)D3 and 25(OH)D2 using JCTLM-accepted LC-MS/MS RMPs. Protocols were repeated on 3-4 occasions to generate campaign results. We used separate zeta-score acceptability criteria for daily (≤|2|) and campaign (≤|1|) evaluations. Allowable imprecision was determined experimentally. RESULTS Across 7 campaigns, unacceptable daily zeta-scores required repeating 2 runs for 25(OH)D3 and 5 runs for 25(OH)D2. Hence, the zeta-scores of acceptable reference material results indicated high accuracy. The allowable imprecision for the RMPs was ≤5% (daily) and ≤ 3% (campaign) for 25(OH)D3 and ≤ 7% (daily) and ≤ 4% (campaign) for 25(OH)D2, respectively. CONCLUSIONS Using zeta-scores and experimentally derived imprecision, we developed a straightforward approach to assess the acceptability of individual 25(OH)D reference measurements, providing also much-needed practical accuracy specifications for 25(OH)D2.
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Affiliation(s)
- Ekaterina M Mineva
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Maya R Sternberg
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Christine M Pfeiffer
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Shahzad S Momin
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Khin L Maw
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Rosemary L Schleicher
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States.
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Sempos CT, Heijboer AC, Bikle DD, Bollerslev J, Bouillon R, Brannon PM, DeLuca HF, Jones G, Munns CF, Bilezikian JP, Giustina A, Binkley N. Vitamin D assays and the definition of hypovitaminosis D: results from the First International Conference on Controversies in Vitamin D. Br J Clin Pharmacol 2018; 84:2194-2207. [PMID: 29851137 PMCID: PMC6138489 DOI: 10.1111/bcp.13652] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 01/02/2023] Open
Abstract
The First International Conference on Controversies in Vitamin D was held in Pisa, Italy, 14-16 June 2017. The meeting's purpose was to address controversies in vitamin D research, review the data available, to help resolve them, and suggest a research agenda to clarify areas of uncertainty. The serum 25-hydroxyvitamin D [25(OH)D] concentration [i.e. the sum of 25(OH)D3 and 25(OH)D2 ] remains the critical measurement for defining vitamin D status. Assay variation for 25(OH)D has contributed to the current chaos surrounding efforts to define hypovitaminosis D. An essential requirement to develop a consensus on vitamin D status is that measurement of 25(OH)D and, in the future, other potential vitamin D biomarkers [e.g. 1α,25(OH)2 D3 , 3-epi-25(OH)D, 24,25(OH)2 D3, vitamin D-binding protein, free/bioavailable 25(OH)D and parathyroid hormone] be standardized/harmonized, to allow pooling of research data. Vitamin D Standardization Program tools are described and recommended for standardizing 25(OH)D measurement in research. In the future, similar methodology, based on National Institute for Standards and Technology standard reference materials, must be developed for other candidate markers of vitamin D status. Failure to standardize/harmonize vitamin D metabolite measurements is destined to promulgate continued chaos. At this time, 25(OH)D values below 12 ng ml-1 (30 nmol l-1 ) should be considered to be associated with an increased risk of rickets/osteomalacia, whereas 25(OH)D concentrations between 20 ng ml-1 and 50 ng ml-1 (50-125 nmol l-1 ) appear to be safe and sufficient in the general population for skeletal health. In an effort to bridge knowledge gaps in defining hypovitaminosis D, an international study on rickets as a multifactorial disease is proposed.
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Affiliation(s)
| | - Annemieke C. Heijboer
- Endocrine Laboratory, Department of Clinical ChemistryVU University Medical CenterAmsterdamThe Netherlands
- Laboratory of EndocrinologyAcademic Medical CenterAmsterdamThe Netherlands
| | - Daniel D. Bikle
- San Francisco, San Francisco Department of Veterans Affairs Medical Center, Endocrine Research UnitUniversity of CaliforniaSan FranciscoCAUSA
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Department of EndocrinologyOslo University Hospital, RikshospitaletOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | - Roger Bouillon
- Department of Chronic Diseases, Metabolism and AgeingLaboratory of Clinical and Experimental EndocrinologyKULeuvenBelgium
| | | | - Hector F. DeLuca
- Department of BiochemistryUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Glenville Jones
- Department of Biomedical and Molecular SciencesQueen's UniversityKingstonONCanada
| | - Craig F. Munns
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadSydneyNSWAustralia
| | - John P. Bilezikian
- Department of Medicine, Endocrinology Division, College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | - Andrea Giustina
- Division of EndocrinologySan Raffaele University HospitalMilanItaly
| | - Neil Binkley
- Osteoporosis Clinical Research Program and Institute on AgingUniversity of Wisconsin‐MadisonMadisonWIUSA
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Saponaro F, Saba A, Frascarelli S, Prontera C, Clerico A, Scalese M, Sessa MR, Cetani F, Borsari S, Pardi E, Marvelli A, Marcocci C, Passino C, Zucchi R. Vitamin D measurement and effect on outcome in a cohort of patients with heart failure. Endocr Connect 2018; 7:957-964. [PMID: 30300540 PMCID: PMC6176284 DOI: 10.1530/ec-18-0207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aims of this paper were to evaluate the levels of Vitamin D (VitD) in patients with heart failure (HF), compared to a control group, to assess the effects of VitD on HF outcome and to compare VitD measurement between LIAISON immunoassay and HPLC-MS-MS methods in this population. DESIGN AND METHODS We collected clinical, biochemical and outcome data from 247 patients with HF and in a subgroup of 151 patients, we measured VitD both with LIAISON and HPLC-MS-MS. RESULTS HF patients had statistically lower 25OHD levels (45.2 ± 23.7 nmol/L vs 58.2 ± 24.0 nmol/L, P < 0.001) and a statistically higher prevalence of VitD insufficiency (61.1% vs 39.5%, P < 0.001) and deficiency (24.7% vs 6.6%, P < 0.001), compared to healthy controls. There was a significant inverse relationship between baseline 25OHD and risk of HF-related death, with a HR of 0.59 (95% CI 0.37–0.92, P = 0.02), confirmed in a multivariate adjusted analysis. Kaplan–Meier survival analyses showed that VitD insufficiency was associated with reduced survival in HF patients (log rank P = 0.017). There was a good agreement between LIAISON and HPLC-MS-MS (Cohen’s kappa coefficient 0.70), but the prevalence of VitD insufficiency was significantly higher with the former compared to the latter method (58.3%, n = 88 vs 55.6%, n = 84, P < 0.001). LIAISON underestimated the 25OHD levels and showed a mean relative bias of −0.739% with 95% of limits of agreement (−9.00 to +7.52%), when compared to HPLC-MS-MS. CONCLUSIONS 25OHD levels adequately measured by HPLC-MS-MS showed to be low in HF population and to be correlated with HF-related risk of death.
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Affiliation(s)
- Federica Saponaro
- Department of SurgicalMedical, Molecular and Critical Area Pathology, Laboratory of Biochemistry, University of Pisa, Pisa, Italy
- Endocrinology Unit 2University of Pisa, Pisa, Italy
- Correspondence should be addressed to F Saponaro:
| | - Alessandro Saba
- Department of SurgicalMedical, Molecular and Critical Area Pathology, Laboratory of Biochemistry, University of Pisa, Pisa, Italy
- Laboratory of Clinical PathologyUniversity Hospital of Pisa, Pisa, Italy
| | - Sabina Frascarelli
- Department of SurgicalMedical, Molecular and Critical Area Pathology, Laboratory of Biochemistry, University of Pisa, Pisa, Italy
| | | | - Aldo Clerico
- Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Marco Scalese
- Institute of Clinical PhysiologyNational Council of Research, Pisa, Italy
| | - Maria Rita Sessa
- Laboratory of EndocrinologyUniversity Hospital of Pisa, Pisa, Italy
| | | | | | - Elena Pardi
- Endocrinology Unit 2University of Pisa, Pisa, Italy
| | - Antonella Marvelli
- Department of Translational Research and of New Surgical and Medical TechnologiesUniversity of Pisa, Pisa, Italy
| | | | | | - Riccardo Zucchi
- Department of SurgicalMedical, Molecular and Critical Area Pathology, Laboratory of Biochemistry, University of Pisa, Pisa, Italy
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LC-MS/MS based 25(OH)D status in a large Southern European outpatient cohort: gender- and age-specific differences. Eur J Nutr 2018; 58:2511-2520. [PMID: 30088075 PMCID: PMC6689275 DOI: 10.1007/s00394-018-1803-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 08/01/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Developed countries have a high prevalence of vitamin D deficiency. In previous studies, 25(OH)D was predominantly measured by immunoassays. The present study assessed serum 25(OH)D in a very large Southern European outpatient cohort by liquid chromatography tandem mass spectrometry (LC-MS/MS). MATERIALS AND METHODS 74,235 serum 25(OH)D results generated under routine conditions between 2015 and 2016 were extracted from the laboratory information system of the Department of Clinical Pathology at Bolzano Hospital (Italy). In 3801 cases, parathyroid hormone (PTH) was requested in parallel. Serum 25(OH)D was measured by a NIST-972 aligned commercial LC-MS/MS method. The distribution of serum 25(OH)D concentrations in males and females of different age groups, the prevalence of 25(OH)D2 and seasonal variability were studied. RESULTS The average 25(OH)D concentration in the entire cohort was 68.6 nmol/L (7.5-1880 nmol/L). Females had a 7 nmol/L higher average 25(OH)D concentration than males, which increased significantly with age. 37.9 and 28.3% of males and females, respectively, had a deficient 25(OH)D concentration of < 50 nmol/L. 620 samples (0.84%) had measureable amounts of 25(OH)D2. In samples with a normal PTH, 25(OH)D was 11 nmol/L higher than in the entire cohort. Seasonal variation ranged between 20 and 30% and was most pronounced in young individuals. 25(OH)D2 remained constant throughout the year. CONCLUSION Average serum 25(OH)D in South Tyrol is higher than in other parts of Europe. 25(OH)D and PTH show a continuous inverse relationship. Seasonal variation of serum 25(OH)D is an important aspect in young and middle-aged adults, but becomes less relevant in elderly subjects. 25(OH)D2 is of minor practical importance in South Tyrol.
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Turck D, Bresson JL, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst KI, Mangelsdorf I, McArdle HJ, Naska A, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Loveren HV, Vinceti M, Willatts P, Fewtrell M, Lamberg-Allardt C, Przyrembel H, Arcella D, Dumas C, Fabiani L, Martino L, Tomcikova D, Neuhäuser-Berthold M. Update of the tolerable upper intake level for vitamin D for infants. EFSA J 2018; 16:e05365. [PMID: 32626014 PMCID: PMC7009676 DOI: 10.2903/j.efsa.2018.5365] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to revise the tolerable upper intake level (UL) for vitamin D for infants (≤ 1 year) set in 2012. From its literature review, the Panel concluded that the available evidence on daily vitamin D intake and the risk of adverse health outcomes (hypercalciuria, hypercalcaemia, nephrocalcinosis and abnormal growth patterns) cannot be used alone for deriving the UL for infants. The Panel conducted a meta-regression analysis of collected data, to derive a dose-response relationship between daily supplemental intake of vitamin D and mean achieved serum 25(OH)D concentrations. Considering that a serum 25(OH)D concentration of 200 nmol/L or below is unlikely to pose a risk of adverse health outcomes in infants, the Panel estimated the percentage of infants reaching a concentration above this value at different intakes of vitamin D. Based on the overall evidence, the Panel kept the UL of 25 μg/day for infants aged up to 6 months and set a UL of 35 μg/day for infants 6-12 months. The Panel was also asked to advise on the safety of the consumption of infant formulae with an increased maximum vitamin D content of 3 μg/100 kcal (Commission Delegated Regulation (EU) 2016/127 repealing Directive 2006/141/EC in 2020). For infants aged up to 4 months, the intake assessment showed that the use of infant formulae containing vitamin D at 3 μg/100 kcal may lead some infants to receive an intake above the UL of 25 μg/day from formulae alone without considering vitamin D supplemental intake. For infants aged 4-12 months, the 95th percentile of vitamin D intake (high consumers) estimated from formulae and foods fortified or not with vitamin D does not exceed the ULs, without considering vitamin D supplemental intake.
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71
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Cavalier E, Souberbielle JC. Vitamin D and its metabolites: from now and beyond. EJIFCC 2018; 29:105-110. [PMID: 30050393 PMCID: PMC6053816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Total 25-hydroxyvitamin D is currently considered as the most representative metabolite of vitamin D status. There are a multitude of challenges that still deserve to be addressed and despite recent technological advances its determination remains complicated. This current review gives an abbreviated overview of the phases of development that vitamin D metabolite determination has gone through and discusses the difficulties that still require resolving. Furthermore, given the different platforms and methodologies available, the critical issue of standardization and all efforts made as far towards its realization have been discussed. And last but not least, the concepts of 'free' and 'bioavailable' vitamin D along with the 'Vitamin D Metabolism Ratio' have been discussed.
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Affiliation(s)
- Etienne Cavalier
- Department of Clinical Chemistry, University of Liege, CHU de Liège, Belgium,Corresponding author: Etienne Cavalier Department of Clinical Chemistry University of Liège 4000 Liège Belgium E-mail:
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72
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Rabenberg M, Scheidt-Nave C, Busch MA, Thamm M, Rieckmann N, Durazo-Arvizu RA, Dowling KG, Škrabáková Z, Cashman KD, Sempos CT, Mensink GBM. Implications of standardization of serum 25-hydroxyvitamin D data for the evaluation of vitamin D status in Germany, including a temporal analysis. BMC Public Health 2018; 18:845. [PMID: 29980236 PMCID: PMC6035438 DOI: 10.1186/s12889-018-5769-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Comparability of 25-hydroxyvitamin D (25(OH)D) measurements is hampered by method-related differences in measurement values. International standardization of laboratory assays has been suggested to solve this problem. METHODS As part of the European Commission-funded project 'Food-based solutions for optimal vitamin D nutrition and health through the life cycle' (ODIN), original measurements of serum 25(OH)D of three German national health surveys conducted between 1998 and 2011 have been standardized retrospectively. In these representative population-based samples including persons aged between 1 and 79 years, the original 25(OH)D values were compared with those after standardization. Mean values and prevalences of vitamin D deficiency, insufficiency, and sufficiency (25(OH)D levels < 30, 30- < 50, and > =50 nmol/l, respectively) were calculated by sex and age groups based on original and standardized 25(OH)D data. RESULTS In comparison to the original 25(OH)D levels, the standardized levels showed higher means overall and in age- and sex-specific analyses. After standardization, the prevalence of vitamin D deficiency was lower in all surveys while the prevalence of vitamin D sufficiency was higher. Nevertheless, even after standardization ~ 15% of adults and 12.5% of children had serum 25(OH)D levels < 30 nmol/l. Thus, the proportion of deficient vitamin D levels in the German population is still considerable. CONCLUSIONS The use of standardization of 25(OH)D levels has a substantial impact on estimates of the vitamin D status in Germany. Since clinical diagnostic, therapeutic and public health decision-making require valid and comparable data, standardization and calibration of commercial, clinical and research laboratory assays for 25(OH)D measurement should become common practice. Until then, researchers, health practitioners and policy makers should be aware of the peculiarities of the measurement methods when comparing and interpreting 25(OH)D levels.
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Affiliation(s)
- Martina Rabenberg
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany.
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Markus A Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité-Universitätsmedizin, Seestraße 73, 13347, Berlin, Germany
| | - Ramón A Durazo-Arvizu
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA
| | - Kirsten G Dowling
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - Zuzana Škrabáková
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - Christopher T Sempos
- Vitamin D Standardization Program (VDSP), 520 Ferdinand Dr, Havre de Grace, MD, 21078, USA
| | - Gert B M Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
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73
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A Review of the Extraction and Determination Methods of Thirteen Essential Vitamins to the Human Body: An Update from 2010. Molecules 2018; 23:molecules23061484. [PMID: 29921801 PMCID: PMC6099991 DOI: 10.3390/molecules23061484] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/12/2018] [Accepted: 06/17/2018] [Indexed: 11/17/2022] Open
Abstract
Vitamins are a class of essential nutrients in the body; thus, they play important roles in human health. The chemicals are involved in many physiological functions and both their lack and excess can put health at risk. Therefore, the establishment of methods for monitoring vitamin concentrations in different matrices is necessary. In this review, an updated overview of the main pretreatments and determination methods that have been used since 2010 is given. Ultrasonic assisted extraction, liquid–liquid extraction, solid phase extraction and dispersive liquid–liquid microextraction are the most common pretreatment methods, while the determination methods involve chromatography methods, electrophoretic methods, microbiological assays, immunoassays, biosensors and several other methods. Different pretreatments and determination methods are discussed.
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74
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Carter GD, Berry J, Durazo-Arvizu R, Gunter E, Jones G, Jones J, Makin HLJ, Pattni P, Sempos CT, Twomey P, Williams EL, Wise SA. Hydroxyvitamin D assays: An historical perspective from DEQAS. J Steroid Biochem Mol Biol 2018; 177:30-35. [PMID: 28734989 DOI: 10.1016/j.jsbmb.2017.07.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
Abstract
Recent years have seen a substantial increase in demand for 25-hydroxyvitamin D (25-OHD) assays. DEQAS (the Vitamin D External Quality Assessment Scheme) has been monitoring the performance of these assays since 1989. The first DEQAS distribution was in June 1989 and results were submitted by 13 laboratories in the UK, two of which used HPLC/UV; the rest used ligand binding assays with a tritium tracer. Inter-laboratory CVs (ALTM) ranged from 29.3% (42.7nmol/L) to 53.7% (20.0nmol/L). Currently the scheme has participants in 56 countries using 30 methods or variants of methods. In January 2017, 918 participants returned results and inter-laboratory CVs (ALTM) ranged from 10.3% (73.1nmol/L) to 15.3% (29.4nmol/L). Over the last 27 years, there have been a number of significant milestones in assay development. The first major advance was the development of an iodinated 25-OHD tracer by Hollis and Napoli in 1992, subsequently used in an RIA kit marketed by DiaSorin. This and other commercial radioimmunoassays that followed brought 25-OHD assays within reach of many more non-specialist routine laboratories. With the introduction of fully automated non-isotopic assays without solvent extraction, measurement of 25-OHD became available to any clinical chemistry laboratory with an appropriate analytical platform. However, as the limitations of these non-extraction assays became apparent more laboratories started using LC-MS/MS methodology. Meanwhile the variable accuracy of 25-OHD methods has been addressed by the Vitamin D Standardization Program (VDSP) which encourages manufacturers to produce methods traceable to the reference measurement procedures (RMPs) of NIST, University of Ghent and the Centers for Disease Control and Prevention (CDC). DEQAS changed to an accuracy-based scheme in 2013 and now assesses assay accuracy against the NIST RMP. This review will use DEQAS results and statistics to chart the historical development in 25-OHD assay technology and highlight some of the problems encountered in obtaining reliable results for this most challenging of analytes.
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Affiliation(s)
- G D Carter
- Imperial College Healthcare NHS Trust, Clinical Biochemistry Department, Charing Cross Hospital, London W6 8RF, UK.
| | - J Berry
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - R Durazo-Arvizu
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - E Gunter
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - G Jones
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - J Jones
- Imperial College Healthcare NHS Trust, Clinical Biochemistry Department, Charing Cross Hospital, London W6 8RF, UK
| | - H L J Makin
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - P Pattni
- Imperial College Healthcare NHS Trust, Clinical Biochemistry Department, Charing Cross Hospital, London W6 8RF, UK
| | - C T Sempos
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK; National Institutes of Health (NIH) Office of Dietary Supplements (ODS), Bethesda, MD 20892-7517, USA
| | - P Twomey
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - E L Williams
- Imperial College Healthcare NHS Trust, Clinical Biochemistry Department, Charing Cross Hospital, London W6 8RF, UK
| | - S A Wise
- National Institutes of Health (NIH) Office of Dietary Supplements (ODS), Bethesda, MD 20892-7517, USA
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75
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Binkley N, Carter GD. Toward Clarity in Clinical Vitamin D Status Assessment: 25(OH)D Assay Standardization. Endocrinol Metab Clin North Am 2017; 46:885-899. [PMID: 29080641 DOI: 10.1016/j.ecl.2017.07.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Widespread variation in 25-hydroxyvitamin D (25(OH)D) assays continues to compromise efforts to develop clinical and public health guidelines regarding vitamin D status. The Vitamin D Standardization Program helps alleviate this problem. Reference measurement procedures and standard reference materials have been developed to allow current, prospective, and retrospective standardization of 25(OH)D results. Despite advances in 25(OH)D measurement, substantial variability in clinical laboratory 25(OH)D measurement persists. Existing guidelines have not used standardized data and, as a result, it seems unlikely that consensus regarding definitions of vitamin D deficiency, inadequacy, sufficiency, and excess will soon be reached. Until evidence-based consensus is reached, a reasonable clinical approach is advocated.
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Affiliation(s)
- Neil Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, University of Wisconsin-Madison, 2870 University Avenue, Madison, WI 53705, USA.
| | - Graham D Carter
- Vitamin D External Quality Assessment Scheme (DEQAS), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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76
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Taylor CL, Sempos CT, Davis CD, Brannon PM. Vitamin D: Moving Forward to Address Emerging Science. Nutrients 2017; 9:E1308. [PMID: 29194368 PMCID: PMC5748758 DOI: 10.3390/nu9121308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 12/19/2022] Open
Abstract
The science surrounding vitamin D presents both challenges and opportunities. Although many uncertainties are associated with the understandings concerning vitamin D, including its physiological function, the effects of excessive intake, and its role in health, it is at the same time a major interest in the research and health communities. The approach to evaluating and interpreting the available evidence about vitamin D should be founded on the quality of the data and on the conclusions that take into account the totality of the evidence. In addition, these activities can be used to identify critical data gaps and to help structure future research. The Office of Dietary Supplements (ODS) at the National Institutes of Health has as part of its mission the goal of supporting research and dialogues for topics with uncertain data, including vitamin D. This review considers vitamin D in the context of systematically addressing the uncertainty and in identifying research needs through the filter of the work of ODS. The focus includes the role of systematic reviews, activities that encompass considerations of the totality of the evidence, and collaborative activities to clarify unknowns or to fix methodological problems, as well as a case study using the relationship between cancer and vitamin D.
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Affiliation(s)
- Christine L Taylor
- Office of Dietary Supplements, National Institutes of Health, Room 3B01, 6100 Executive Boulevard, Bethesda, MD 20892, USA.
| | - Christopher T Sempos
- Office of Dietary Supplements, National Institutes of Health, Room 3B01, 6100 Executive Boulevard, Bethesda, MD 20892, USA.
| | - Cindy D Davis
- Office of Dietary Supplements, National Institutes of Health, Room 3B01, 6100 Executive Boulevard, Bethesda, MD 20892, USA.
| | - Patsy M Brannon
- Division of Nutritional Sciences, 225 Savage Hall, Cornell University, Ithaca, NY 14853, USA.
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77
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Ferrari D, Lombardi G, Banfi G. Concerning the vitamin D reference range: pre-analytical and analytical variability of vitamin D measurement. Biochem Med (Zagreb) 2017; 27:030501. [PMID: 28900363 PMCID: PMC5575654 DOI: 10.11613/bm.2017.030501] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/22/2017] [Indexed: 12/17/2022] Open
Abstract
Unlike other vitamins, the vitamin D concentration in blood varies cyclically over the course of the year in relation to genetic (gender, ethnicity, polymorphisms) and environmental factors (sunlight exposure, diet, food-related or direct vitamin D supplementation, skin pigmentation). Although the major diagnostics manufacturers have recently developed improved automated 25-hydroxy vitamin D immunoassays, the intra- and inter-laboratory variability is still high (especially at low vitamin D concentrations) which might lead to incorrect vitamin D deficiency/insufficiency diagnosis. Moreover, despite recent efforts to standardize the assay and minimize its variability, the current bias for measured vitamin D concentrations is often still above the desirable ± 10% criterion. Because the implications of low vitamin D concentrations in non-skeletal diseases are still partially unknown, international guideline recommendations for establishing meaningful ranges, at any time over the course of the year, irrespective not only of environmental and personal factors but also of instrumental variability, are needed. In this review, we discuss the main factors that influence the variability of vitamin D concentrations and whether a centile curve, individually calculated by a theoretical equation considering such factors, might be better suited than a fixed limit to assess abnormal vitamin D concentrations in otherwise healthy subjects. Vitamin D reference ranges during pregnancy, childhood, or diagnosed illnesses, which merit separate discussion, are beyond the scope of this review.
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Affiliation(s)
- Davide Ferrari
- Department of Biosciences, University of Parma, Parma, Italy
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Giuseppe Banfi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
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78
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Carter GD, Berry J, Durazo-Arvizu R, Gunter E, Jones G, Jones J, Makin HLJ, Pattni P, Phinney KW, Sempos CT, Williams EL. Quality assessment of vitamin D metabolite assays used by clinical and research laboratories. J Steroid Biochem Mol Biol 2017; 173:100-104. [PMID: 28315391 DOI: 10.1016/j.jsbmb.2017.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/17/2017] [Accepted: 03/09/2017] [Indexed: 10/20/2022]
Abstract
The Vitamin D External Quality Assessment Scheme (DEQAS) was launched in 1989 and monitors the performance of 25-hydroxyvitamin D (25-OHD) and 1,25- dihydroxyvitamin D (1,25(OH)2D) assays. In April 2015 a pilot scheme for 24,25-dihydroxyvitamin D (24,25(OH)2D) was introduced. The 25-OHD scheme is accuracy - based with target values assigned by the NIST Reference Measurement Procedure (RMP) for 25-OHD2 and 25-OHD3. A similar method is used to assign values for 3-epi-25-OHD. Five samples of human serum are distributed quarterly to over 1000 participants in 58 countries (April 2016) and clinical laboratories are expected to submit results within approximately 5 weeks. Research laboratories with assays run less frequently are not given a deadline. Archived samples with NIST- assigned values are also available. Performance is assessed on the first four samples with the fifth reserved for investigations e.g. recovery experiments or to assess the influence of other serum constituents such as lipids. DEQAS provides rapid feedback, with an on-line preliminary report available immediately after a participant submits results and a comprehensive report soon after the results deadline. In 2015, DEQAS investigations revealed that several 25-OHD immunoassays under-recovered 25-OHD2 and 25-OHD results were falsely low on a sample with a modestly raised triglyceride concentration. An RMP for 1,25 (OH)2D is not yet available and results are judged against the Method Mean. Free advice is available from the DEQAS Advisory Panel which includes experts on methodology and biostatistics. DEQAS collaborates closely with the Vitamin D Standardization Program (VDSP) and both organizations have successfully worked with participants and manufacturers to improve the accuracy of vitamin D assays.
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Affiliation(s)
- G D Carter
- Imperial College Healthcare NHS Trust, Clinical Biochemistry Department, Charing Cross Hospital, London W6 8RF, UK.
| | - J Berry
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - R Durazo-Arvizu
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - E Gunter
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - G Jones
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - J Jones
- Imperial College Healthcare NHS Trust, Clinical Biochemistry Department, Charing Cross Hospital, London W6 8RF, UK
| | - H L J Makin
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - P Pattni
- Imperial College Healthcare NHS Trust, Clinical Biochemistry Department, Charing Cross Hospital, London W6 8RF, UK
| | - K W Phinney
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - C T Sempos
- DEQAS Advisory Panel, Charing Cross Hospital, London W6 8RF, UK
| | - E L Williams
- Imperial College Healthcare NHS Trust, Clinical Biochemistry Department, Charing Cross Hospital, London W6 8RF, UK
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79
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Binkley N, Dawson-Hughes B, Durazo-Arvizu R, Thamm M, Tian L, Merkel JM, Jones JC, Carter GD, Sempos CT. Vitamin D measurement standardization: The way out of the chaos. J Steroid Biochem Mol Biol 2017; 173:117-121. [PMID: 27979577 DOI: 10.1016/j.jsbmb.2016.12.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
Abstract
Substantial variability is associated with laboratory measurement of serum total 25-hydroxyvitamin D [25(OH)D]. The resulting chaos impedes development of consensus 25(OH)D values to define stages of vitamin D status. As resolving this situation requires standardized measurement of 25(OH)D, the Vitamin D Standardization Program (VDSP) developed methodology to standardize 25(OH)D measurement to the gold standard reference measurement procedures of NIST, Ghent University and CDC. Importantly, VDSP developed protocols for standardizing 25(OH)D values from prior research based on availability of stored serum samples. The effect of such retrospective standardization on prevalence of "low" vitamin D status in national studies reported here for The Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and the German Health Interview and Examination Survey for Children and Adolescents (KIGGS, 2003-2006) was such that in NHANES III 25(OH)D values were lower than original values while higher in KIGGS. In NHANES III the percentage with values below 30, 50 and 75 nmol/L increased from 4% to 6%, 22% to 31% and 55% to 71%, respectively. Whereas in KIGGS after standardization the percentage below 30, 50, and 70 nmol/L decreased from 28% to 13%, 64% to 47% and 87% to 85% respectively. Moreover, in a hypothetical example, depending on whether the 25(OH)D assay was positively or negatively biased by 12%, the 25(OH)D concentration which maximally suppressed PTH could vary from 20 to 35ng/mL. These examples underscore the challenges (perhaps impossibility) of developing vitamin D guidelines using unstandardized 25(OH)D data. Retrospective 25(OH)D standardization can be applied to old studies where stored serum samples exist. As a way forward, we suggest an international effort to identify key prior studies with stored samples for re-analysis and standardization initially to define the 25(OH)D level associated with vitamin D deficiency (rickets/osteomalacia). Subsequent work could focus on defining inadequacy. Finally, examples reported here highlight the importance of suspending publication of meta-analyses based on unstandardized 25(OH)D results.
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Affiliation(s)
- N Binkley
- Osteoporosis Clinical Research Program and Institute on Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MI, 02111, USA
| | - R Durazo-Arvizu
- Department of Public Health Sciences, Loyola University Stritch School of Medicine, Maywood, IL, 60153, USA
| | - M Thamm
- Robert Koch Institute, 12101 Berlin, Germany
| | - L Tian
- Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - J M Merkel
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA
| | - J C Jones
- Vitamin D External Quality Assurance Scheme (DEQAS) Coordination Centre, Imperial College, London, UK
| | - G D Carter
- Vitamin D External Quality Assurance Scheme (DEQAS) Coordination Centre, Imperial College, London, UK
| | - C T Sempos
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA; Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, 53726, USA.
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Phinney KW, Camara JE, Tai SSC, Sander LC, Wise SA, De Grande LAC, Thienpont LM, Possolo AM, Toman B, Sempos CT, Betz JM, Coates PM. Value Assignment of Vitamin D Metabolites in Vitamin D Standardization Program Serum Samples. J AOAC Int 2017; 100:1253-1259. [PMID: 28623654 PMCID: PMC5601309 DOI: 10.5740/jaoacint.17-0204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assay variability has been cited as an obstacle to establishing optimal vitamin D exposure. As part of the Vitamin D Standardization Program (VDSP) effort to standardize the measurement of total 25-hydroxyvitamin D [25(OH)D], the value assignment of total 25(OH)D in 50 single-donor serum samples was performed using two isotope-dilution LC with tandem MS methods. Both methods are recognized as reference measurement procedures (RMPs) by the Joint Committee for Traceability in Laboratory Medicine. These samples and their assigned values serve as the foundation for several aspects of the VDSP. To our knowledge, this is the first time that two RMPs have been used to assign 25(OH)D values to such a large number of serum samples.
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Affiliation(s)
- Karen W Phinney
- National Institute of Standards and Technology, Biomolecular Measurement Division and Chemical Sciences Division, Gaithersburg, MD 20899
| | - Johanna E Camara
- National Institute of Standards and Technology, Biomolecular Measurement Division and Chemical Sciences Division, Gaithersburg, MD 20899
| | - Susan S-C Tai
- National Institute of Standards and Technology, Biomolecular Measurement Division and Chemical Sciences Division, Gaithersburg, MD 20899
| | - Lane C Sander
- National Institute of Standards and Technology, Biomolecular Measurement Division and Chemical Sciences Division, Gaithersburg, MD 20899
| | - Stephen A Wise
- National Institute of Standards and Technology, Biomolecular Measurement Division and Chemical Sciences Division, Gaithersburg, MD 20899
| | - Linde A C De Grande
- Ghent University, Faculty of Pharmaceutical Sciences, Laboratory for Analytical Chemistry, Ghent, Belgium
| | - Linda M Thienpont
- Ghent University, Faculty of Pharmaceutical Sciences, Laboratory for Analytical Chemistry, Ghent, Belgium
| | - Antonio M Possolo
- National Institute of Standards and Technology, Statistical Engineering Division, Gaithersburg, MD 20899
| | - Blaza Toman
- National Institute of Standards and Technology, Statistical Engineering Division, Gaithersburg, MD 20899
| | - Christopher T Sempos
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD 20892
| | - Joseph M Betz
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD 20892
| | - Paul M Coates
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD 20892
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Cho SE, Kim S, Kim YD, Lee H, Seo DH, Song J, Um TH, Cho CR, Kim NH, Hwang JH. Measurement of serum 3-epi-25-hydroxyvitamin D 3, 25-hydroxyvitamin D 3 and 25-hydroxyvitamin D 2 in infant, paediatric and adolescent populations of Korea using ultra-performance liquid chromatography-tandem mass spectrometry. Ann Clin Biochem 2017; 54:530-538. [PMID: 27614352 DOI: 10.1177/0004563216671009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We evaluated the performance of ultra-performance liquid chromatography-tandem mass spectrometry to measure serum 3-epi-25-hydroxyvitamin D3, 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 concentrations in 519 infant, paediatric and adolescent serum samples in Korea. Methods We used a Kinetex XB-C18 column and isocratic methanol/water (77.5/22.5, v/v) with 0.025% (v/v) high-performance liquid chromatography solvent additive flowing at 0.25 mL/min, yielding an 11 min/sample run time. A TQD triple quadrupole mass spectrometer in electrospray ionization positive ion mode with multiple reaction monitoring transition via an MSMS vitamin D kit was used to evaluate precision, carryover, ion suppression and linearity. Samples were prepared using the 4-phenyl-1,2,4-triazoline-3,5-dione derivatization method. Results Intra- and inter-run precisions were 1.23-13.28% and 1.02-10.08%, respectively. Group carryovers were -0.27% and 0.10%, respectively. There was no ion suppression. The calibration curve showed good linearity from calibrator Level 1 (11.75 nmol/L) to 6 (375 nmol/L) with R2 > 0.9999. The 3-epi-25-hydroxyvitamin D3 and 25-hydroxyvitamin D3 peaks were clearly separated in the extracted ion chromatogram. Infant serum samples 3-epi-25-hydroxyvitamin D3 concentrations were significantly higher than paediatric and adolescent concentrations. Conclusions The ultra-performance liquid chromatography-tandem mass spectrometry assay performed acceptably, clearly separating 3-epi-25-hydroxyvitamin D3 from 25-hydroxyvitamin D3. High 3-epi-25-hydroxyvitamin D3 concentrations were observed in infant but not in paediatric and adolescent serum samples.
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Affiliation(s)
- Sung E Cho
- 1 LabGenomics Clinical Laboratories, Seongnam, Korea
| | - Sollip Kim
- 2 Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Young D Kim
- 3 Department of Pediatrics, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hyojung Lee
- 1 LabGenomics Clinical Laboratories, Seongnam, Korea
| | - Dong H Seo
- 1 LabGenomics Clinical Laboratories, Seongnam, Korea
| | - Junghan Song
- 4 Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.,5 Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae H Um
- 2 Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Chong R Cho
- 2 Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Nam H Kim
- 3 Department of Pediatrics, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong H Hwang
- 3 Department of Pediatrics, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Spanaus K, von Eckardstein A. Evaluation of two fully automated immunoassay based tests for the measurement of 1α,25-dihydroxyvitamin D in human serum and comparison with LC-MS/MS. Clin Chem Lab Med 2017; 55:1305-1314. [PMID: 28245186 DOI: 10.1515/cclm-2016-1074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/10/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND 1α,25-Dihydroxyvitamin D [1,25(OH)2 vitD] is the bioactive form of vitamin D. Due to the very low concentrations of 1,25(OH)2 vitD in the blood and its lipophilic character, measurement of this parameter is analytically challenging. Requiring preceding manual extraction steps before analysis, previous assays have been laborious. METHODS In the presented study, we evaluated the performance of two immunoassays from DiaSorin and from Immunodiagnostic Systems (IDS) which combine fully automated extraction and measurement of 1,25(OH)2 vitD. Imprecision and linearity were verified according to Clinical and Laboratory Standards Institute EP15-A3 and EP6-A guidelines, respectively. Ninety-three patient serum samples sent to our institute for determination of 1,25(OH)2 vitD, as well as 20 Vitamin D External Quality Assessment Scheme (DEQAS) samples, were used to evaluate correlation and agreement of 1,25(OH)2 vitD measurements between the two immunoassays and with liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). RESULTS Total imprecision was 5.2% or less for the DiaSorin test but reached 20.1% for the IDS iSYS test. 1,25(OH)2 vitD concentrations measured with the DiaSorin assay showed a strong correlation with 1,25(OH)2 vitD levels measured by LC-MS/MS and a good agreement with method specific means of DEQAS samples. By contrast, the IDS iSYS test overestimated 1,25(OH)2 vitD concentrations in human serum, particularly at higher concentrations. CONCLUSIONS Due to its high sensitivity, low imprecision, broad measurement range, and good agreement with 1,25(OH)2 vitD concentrations measured by LC-MS/MS, the DiaSorin test is a valuable analytical option for the determination of 1,25(OH)2 vitD.
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83
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Shroff R, Wan M, Nagler EV, Bakkaloğlu S, Fischer DC, Bishop N, Cozzolino M, Bacchetta J, Edefonti A, Stefanidis CJ, Vande Walle J, Haffner D, Klaus G, Schmitt CP. Clinical practice recommendations for native vitamin D therapy in children with chronic kidney disease Stages 2-5 and on dialysis. Nephrol Dial Transplant 2017; 32:1098-1113. [PMID: 28873969 PMCID: PMC5837199 DOI: 10.1093/ndt/gfx065] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/15/2017] [Indexed: 01/10/2023] Open
Abstract
Vitamin D deficiency is widely prevalent and often severe in children and adults with chronic kidney disease (CKD). Although native vitamin D {25-hydroxyvitamin D [25(OH)D]} is thought to have pleiotropic effects on many organ systems, its skeletal effects have been most widely studied. The 25(OH)D deficiency is causally linked with rickets and fractures in healthy children and those with CKD, contributing to the CKD-mineral and bone disorder (MBD) complex. There are few studies to provide evidence for vitamin D therapy or guidelines for its use in CKD. A core working group (WG) of the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis WGs have developed recommendations for the evaluation, treatment and prevention of vitamin D deficiency in children with CKD. We present clinical practice recommendations for the use of ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3) in children with CKD Stages 2-5 and on dialysis. A parallel document addresses treatment recommendations for active vitamin D analogue therapy. The WG has performed an extensive literature review to include meta-analyses and randomized controlled trials in healthy children as well as children and adults with CKD, and prospective observational studies in children with CKD. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system has been used to develop and grade the recommendations. In the absence of applicable study data, the opinion of experts from the ESPN CKD-MBD and Dialysis WGs is provided, but clearly GRADE-ed as such and must be carefully considered by the treating physician, and adapted to individual patient needs as appropriate.
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Affiliation(s)
- Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mandy Wan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | | | | | - Mario Cozzolino
- Department of Health Sciences, Ospedale San Paolo, University of Milan, Milan, Italy
| | | | - Alberto Edefonti
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Phinney KW, Tai SSC, Bedner M, Camara JE, Chia RR, Sander LC, Sharpless KE, Wise SA, Yen JH, Schleicher RL, Chaudhary-Webb M, Maw KL, Rahmani Y, Betz JM, Merkel J, Sempos CT, Coates PM, Durazo-Arvizu RA, Sarafin K, Brooks SP. Development of an Improved Standard Reference Material for Vitamin D Metabolites in Human Serum. Anal Chem 2017; 89:4907-4913. [PMID: 28375002 PMCID: PMC5575745 DOI: 10.1021/acs.analchem.6b05168] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The National Institute of Standards and Technology (NIST) has developed Standard Reference Material (SRM) 972a Vitamin D Metabolites in Frozen Human Serum as a replacement for SRM 972, which is no longer available. SRM 972a was developed in collaboration with the National Institutes of Health's Office of Dietary Supplements. In contrast to the previous reference material, three of the four levels of SRM 972a are composed of unmodified human serum. This SRM has certified and reference values for the following 25-hydroxyvitamin D [25(OH)D] species: 25(OH)D2, 25(OH)D3, and 3-epi-25(OH)D3. The value assignment and certification process included three isotope-dilution mass spectrometry approaches, with measurements performed at NIST and at the Centers for Disease Control and Prevention (CDC). The value assignment methods employed have been modified from those utilized for the previous SRM, and all three approaches now incorporate chromatographic resolution of the stereoisomers, 25(OH)D3 and 3-epi-25(OH)D3.
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Affiliation(s)
- Karen W. Phinney
- Biomolecular Measurement Division and Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - Susan S.-C. Tai
- Biomolecular Measurement Division and Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - Mary Bedner
- Biomolecular Measurement Division and Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - Johanna E. Camara
- Biomolecular Measurement Division and Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - Rosalind R.C. Chia
- Biomolecular Measurement Division and Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - Lane C. Sander
- Biomolecular Measurement Division and Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - Katherine E. Sharpless
- Biomolecular Measurement Division and Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - Stephen A. Wise
- Biomolecular Measurement Division and Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - James H. Yen
- Statistical Engineering Division, National Institute of Standards and Technology Gaithersburg, MD 20899
| | - Rosemary L. Schleicher
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Madhulika Chaudhary-Webb
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Khin L. Maw
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Yasamin Rahmani
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Joseph M. Betz
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892
| | - Joyce Merkel
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892
| | | | - Paul M. Coates
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892
| | - Ramón A. Durazo-Arvizu
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153
| | - Kurtis Sarafin
- Bureau of Nutritional Sciences, Health Canada, Ottawa, Ontario, Canada K1A 0K9
| | - Stephen P.J. Brooks
- Bureau of Nutritional Sciences, Health Canada, Ottawa, Ontario, Canada K1A 0K9
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85
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Jakab E, Kalina E, Petho Z, Pap Z, Balogh A, Grant WB, Bhattoa HP. Standardizing 25-hydroxyvitamin D data from the HunMen cohort. Osteoporos Int 2017; 28:1653-1657. [PMID: 28321506 DOI: 10.1007/s00198-017-3924-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/11/2017] [Indexed: 12/31/2022]
Abstract
UNLABELLED Standardization of 25-hydroxyvitamin D (25OHD) values is still a challenge. We propose standardization by correction of the measured 25OHD values using the linear regression bias from the National Institute of Standards and Technology (NIST) 'total' target values reported by Vitamin D External Quality Assessment Scheme (DEQAS). Our approach could perhaps be a practical solution to the anomaly surrounding non-standardized 25OHD values. INTRODUCTION Standardization of 25OHD values is still a challenge. We propose standardization by correction of the measured 25OHD values using the linear regression equation derived from the analysis of relationship between total 25OHD values measured by the methodology used by the laboratory and the NIST total target values (TV) reported by the DEQAS for all 5 of the DEQAS samples in a given survey. METHODS We applied our approach to standardize total 25OHD values of the HunMen cohort. RESULTS All 206 samples for the HunMen cohort were evaluated using the automated Liaison DiaSorin total 25OHD chemiluminescence immunoassay (CLIA). The timing of these measurements coincided with that of the October 2015 DEQAS survey using samples 481 to 485. Following standardization, the mean total 25OHD changed from 53 to 62 nmol/L and the prevalence of hypovitaminosis D (<75 nmol/L) decreased significantly from 84 to 72%. CONCLUSION A simple approach readily applicable at the routine diagnostic laboratory could perhaps be a practical solution to the anomaly surrounding non-standardized 25OHD values.
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Affiliation(s)
- E Jakab
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei Blvd 98, Debrecen, H-4032, Hungary
| | - E Kalina
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei Blvd 98, Debrecen, H-4032, Hungary
| | - Z Petho
- Department of Rheumatology, University of Debrecen, Debrecen, H-4032, Hungary
| | - Z Pap
- Department of Traumatology, University of Debrecen, Debrecen, H-4032, Hungary
| | - A Balogh
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, H-4032, Hungary
| | - W B Grant
- Sunlight, Nutrition and Health Research Center, San Francisco, CA, 94164-1603, USA
| | - H P Bhattoa
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei Blvd 98, Debrecen, H-4032, Hungary.
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Improved accuracy of an tandem liquid chromatography–mass spectrometry method measuring 24R,25-dihydroxyvitamin D3 and 25-hydroxyvitamin D metabolites in serum using unspiked controls and its application to determining cross-reactivity of a chemiluminescent microparticle immunoassay. J Chromatogr A 2017; 1497:102-109. [DOI: 10.1016/j.chroma.2017.03.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/11/2017] [Accepted: 03/19/2017] [Indexed: 11/21/2022]
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87
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Durazo-Arvizu RA, Dawson-Hughes B, Kramer H, Cao G, Merkel J, Coates PM, Sempos CT. The Reverse J-Shaped Association Between Serum Total 25-Hydroxyvitamin D Concentration and All-Cause Mortality: The Impact of Assay Standardization. Am J Epidemiol 2017; 185:720-726. [PMID: 28338905 DOI: 10.1093/aje/kww244] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/24/2016] [Indexed: 12/15/2022] Open
Abstract
We evaluated the impact of standardizing the originally measured serum total 25-hydroxyvitamin D (25(OH)D) values from Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) on the association between 25(OH)D and rate of all-cause mortality. Values were standardized to the gold-standard laboratory method. Follow-up from 1990-2006 consisted of 15,099 participants aged at least 20 years at baseline, among whom there were 3,784 deaths. Relative risk of death was adjusted for age, sex, race/ethnicity, and season using Poisson regression. Results were obtained for eight 25(OH)D (nmol/L) categories: <20 nmol/L, 20-29 nmol/L, 30-39 nmol/L, 40-49 nmol/L, 50-59 nmol/L, 60-74 nmol/L, 75-99 nmol/L (reference), and ≥100 nmol/L. Assay standardization dramatically shifted original 25(OH)D values toward zero. Accordingly, risk ≥120 nmol/L could not be evaluated (i.e., n = 7 and ndeaths = 2). Relative risk (95% confidence interval (CI)) <40 nmol/L remained significant (30-39 nmol/L: relative risk (RR) = 1.4 (95% CI: 1.1, 1.6); 20-29 nmol/L: RR = 1.6 (95% CI: 1.3, 1.9), and <20 nmol/L: RR = 2.1 (95% CI: 1.6, 2.7). However, adjusted relative risk estimates for 25(OH)D levels ≥40 nmol/L were no longer significant (40-49 nmol/L: RR = 1.2 (95% CI: 0.99, 1.4); 50-59 nmol/L: RR = 1.2 (95% CI: 1.04, 1.4); 60-74 nmol/L: RR = 1.1 (95% CI: 0.94, 1.2); 75-99 nmol/L: RR = 1.0 (referent), and ≥100 nmol/L: RR = 1.1 (95% CI: 0.6, 2.1). In summary, after standardization, risk of death from all causes increased with decreasing 25(OH)D <40 nmol/L, while there was no association with values in categories between 40 nmol/L and 120 nmol/L.
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88
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Ong MWS, Salota R, Reeman T, Lapsley M, Jones L. Artefactual 25-OH vitamin D concentration in multiple myeloma. Ann Clin Biochem 2017; 54:716-720. [DOI: 10.1177/0004563217690175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The most commonly used techniques to measure vitamin D are automated immunoassays which are known to be affected by interferences, especially from immunoglobulins present in the patient’s serum. We present a case of a patient with myeloma in whom interference with the vitamin D assay was identified. An 83-year-old female, known to have IgG myeloma, was found to have a high concentration of 25-OH vitamin D on a routine test without any signs of vitamin D toxicity. She was not taking vitamin D supplements or any other multivitamin preparation and had minimal sun exposure. The initial and subsequent samples run by the ARCHITECT 25-OH vitamin D assay (chemiluminescent microparticle immunoassay technology, Abbott Laboratories, Abbott Park, IL) showed a high concentration of 25-OH vitamin D of 281 nmol/L and 327 nmol/L, respectively. Further fresh samples taken for 25-OH vitamin D and analysed by liquid chromatography-mass spectrometry (LC-MS/MS) and ARCHITECT analysis showed results of 49 nmol/L and 289 nmol/L, respectively. Our patient had high concentrations of circulating IgG paraproteins and had a long history of rheumatoid arthritis; paraproteins and rheumatoid factor may interfere in the assay. In conclusion, we report a case of a patient with IgG myeloma and rheumatoid arthritis with high concentrations of 25-OH vitamin D detected by the Abbott ARCHITECT, but not by a reference method (LC-MS/MS). The most likely cause of the discordant results is interference in the immunoassay by the paraprotein but interference from rheumatoid factor remains a possibility.
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Affiliation(s)
- Michal WS Ong
- Department of Haematology, Epsom and St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK
| | - Rashim Salota
- Department of Chemical Pathology, Epsom and St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK
| | - Tracy Reeman
- Department of Haematology, Epsom and St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK
| | - Marta Lapsley
- Department of Chemical Pathology, Epsom and St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK
| | - Lydia Jones
- Department of Haematology, Epsom and St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK
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89
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Couchman L, Moniz CF. Analytical considerations for the biochemical assessment of vitamin D status. Ther Adv Musculoskelet Dis 2017; 9:97-104. [PMID: 28382113 DOI: 10.1177/1759720x17692500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/08/2016] [Indexed: 01/21/2023] Open
Abstract
The most widely used and clinically accepted biochemical marker for assessing vitamin D status is the total serum 25-hydroxyvitamin D [25(OH)D] concentration. Despite the analysis of 25(OH)D dating back to the early 1970s, modern analytical techniques still exhibit significant interassay variability due to varying concentrations of other related vitamin D metabolites and sample-to-sample matrix differences. It is important for clinicians requesting 25(OH)D analyses to understand these issues and limitations, and where necessary to confront laboratories for details of analytical methods used. The availability of reference measurement procedures for 25(OH)D based on liquid chromatography and tandem mass spectrometry, whilst not intended for routine clinical sample analysis, should be utilized to improve assay harmonization and reduce interlaboratory variability. Laboratories should also be forthcoming with details of subscriptions to external quality assessment schemes and assay traceability. As well as discussing the reasons for ongoing assay variability for 25(OH)D, this short review will also briefly discuss other assays related to the assessment of vitamin D status, including parathyroid hormone, 24,25-dihydroxyvitamin D, 1,25-dihydroxyvitamin D and vitamin D binding proteins.
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Affiliation(s)
- Lewis Couchman
- Viapath Analytics, Department of Clinical Biochemistry, King's College Hospital, London SE5 9RS, UK
| | - Cajetan F Moniz
- Department of Clinical Biochemistry, Kings College Hospital, London, UK
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Herrmann M, Farrell CJL, Pusceddu I, Fabregat-Cabello N, Cavalier E. Assessment of vitamin D status – a changing landscape. ACTA ACUST UNITED AC 2017; 55:3-26. [DOI: 10.1515/cclm-2016-0264] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/30/2016] [Indexed: 01/14/2023]
Abstract
Abstract
In recent years it has been shown that vitamin D deficiency is associated with an increased incidence as well as the progression of a broad range of diseases including osteoporosis, rickets, cardiovascular disease, autoimmune disease, multiple sclerosis and cancer. Consequently, requests for the assessment of vitamin D status have increased dramatically. Despite significant progress in the analysis of vitamin D metabolites and an expansion of our pathophysiological knowledge of vitamin D, the assessment of vitamin D status remains a challenging and partially unresolved issue. Current guidelines from scientific bodies recommend the measurement of 25-hydroxy vitamin D (25-OHD) in blood as the preferred test. However, growing evidence indicates significant limitations of this test, including analytical aspects and interpretation of results. In addition, the relationships between 25-OHD and various clinical indices, such as bone mineral density and fracture risk, are rather weak and not consistent across races. Recent studies have systematically investigated new markers of vitamin D status including the vitamin D metabolite ratio (VMR) (ratio between 25-OHD and 24,25-dihydroxy vitamin D), bioavailable 25-OHD [25-OHD not bound to vitamin D binding protein (DBP)], and free 25-OHD [circulating 25-OHD bound to neither DBP nor albumin (ALB)]. These parameters may potentially change how we will assess vitamin D status in the future. Although these new biomarkers have expanded our knowledge about vitamin D metabolism, a range of unresolved issues regarding their measurement and the interpretation of results prevent their use in daily practice. It can be expected that some of these issues will be overcome in the near future so that they may be considered for routine use (at least in specialized centers). In addition, genetic studies have revealed several polymorphisms in key proteins of vitamin D metabolism that affect the circulating concentrations of vitamin D metabolites. The affected proteins include DBP, 7-dehydrocholesterol synthase and the vitamin D receptor (VDR). Here we aim to review existing knowledge regarding the biochemistry, physiology and measurement of vitamin D. We will also provide an overview of current and emerging biomarkers for the assessment of vitamin D status, with particular attention methodological aspects and their usefulness in clinical practice.
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91
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Davey RX. Vitamin D-binding protein as it is understood in 2016: is it a critical key with which to help to solve the calcitriol conundrum? Ann Clin Biochem 2016; 54:199-208. [PMID: 27742848 DOI: 10.1177/0004563216677100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The misnamed 'vitamin' D is actually the hormone calcitriol (1,25 dihydroxyhydroxyvitamin D). It has a central regulatory role in calcium metabolism, and more widely in the immune system. The prohormone calcifediol (25 hydroxyvitamin D) is more easily measured in the laboratory and is the analyte used in reference interval formulation. Being highly lipid soluble, both calcifediol and calcitriol travel in the bloodstream on carriage proteins, principally on vitamin D-binding protein. Summary This review reports our current understanding of vitamin D-binding protein. Its genetic determinants and their effect on it and secondarily on calcifediol concentrations and assays are described. Its complex interplay with parathyroid hormone is considered. The analytical state of the art is translated into the challenge it imposes clinically, in the formulation of reference intervals and in their use in advising and managing patients. Several recent challenges thrown up to laboratories by percipient clinicians highlight the dilemma vitamin D-binding protein poses. A way forward is suggested.
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Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal MZ, Mäkitie O, Ramos-Abad L, Ward L, DiMeglio LA, Atapattu N, Cassinelli H, Braegger C, Pettifor JM, Seth A, Idris HW, Bhatia V, Fu J, Goldberg G, Sävendahl L, Khadgawat R, Pludowski P, Maddock J, Hyppönen E, Oduwole A, Frew E, Aguiar M, Tulchinsky T, Butler G, Högler W. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr 2016; 85:83-106. [PMID: 26741135 DOI: 10.1159/000443136] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. PROCESS Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.
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Sempos CT, Durazo-Arvizu RA, Binkley N, Jones J, Merkel JM, Carter GD. Developing vitamin D dietary guidelines and the lack of 25-hydroxyvitamin D assay standardization: The ever-present past. J Steroid Biochem Mol Biol 2016; 164:115-119. [PMID: 26321386 DOI: 10.1016/j.jsbmb.2015.08.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/20/2015] [Accepted: 08/24/2015] [Indexed: 01/13/2023]
Abstract
Unstandardized laboratory measurement of 25-hydroxyvitamin D (25(OH)D) confounds efforts to develop clinical and public health vitamin D guidelines. The Vitamin D Standardization Program (VDSP), an international collaborative effort, was founded in 2010 to correct this problem. Nearly all published vitamin D research is based on unstandardized laboratory 25(OH)D measurements. While it is impossible to standardize all old data, it may be possible to identify a small subset of prior studies critical to guidelines development. Once identified it may be possible to calibrate their 25(OH)D values to the NIST and Ghent University reference measurement procedures using VDSP methods thereby permitting future guidelines to be based on standardized results. We simulated the calibration of a small set of ten clinical trials of vitamin D supplementation on achieved 25(OH)D under minimal sun exposure. These studies were selected because they played a prominent role in setting the 2010 vitamin D dietary reference intakes (DRI). Using random-effects meta-regression analysis, Vitamin D External Quality Assessment (DEQAS) data on assay bias was used to simulate the potential bias due to the lack of assay standardization by calibrating the achieved 25(OH)D levels from those 10 studies to: (1) the largest negative, and (2) the largest positive bias from the DEQAS all laboratory trimmed mean (ALTM) for the appropriate assay and year of analysis. For a usual vitamin D intake of 600IU/day the difference in mean achieved 25(OH)D values for those two options was 20nmol/L. However, without re-calibration of 25(OH)D values it is impossible to know the degree to which any of the current guidelines may have been biased. This approach may help stimulate the search for and standardization of that small subset of key studies and, in the cases where standardization is impossible, to identify areas of urgently needed vitamin D research.
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Affiliation(s)
- C T Sempos
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517, USA.
| | - R A Durazo-Arvizu
- Department of Public Health Sciences, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA
| | - N Binkley
- Osteoporosis Clinical Research Program and Institute on Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - J Jones
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - J M Merkel
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517, USA
| | - G D Carter
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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Carter GD, Jones JC, Shannon J, Williams EL, Jones G, Kaufmann M, Sempos C. 25-Hydroxyvitamin D assays: Potential interference from other circulating vitamin D metabolites. J Steroid Biochem Mol Biol 2016; 164:134-138. [PMID: 26718874 DOI: 10.1016/j.jsbmb.2015.12.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/30/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
The vitamin D External Quality Assessment Scheme (DEQAS) for 25-hydroxyvitamin D (25-OHD) has approximately 1100 participants in 53 countries using 26 different methods or variants of methods (October 2014). In April 2015, the scheme was extended to cover 24,25-dihydroxyvitamin D (24,25(OH)2D). Since 2013, the 25-OHD scheme has been accuracy-based with values assigned by the NIST reference measurement procedure (RMP). DEQAS is uniquely placed to assess the accuracy (bias) and specificity of 25-OHD methods in a routine laboratory setting. Other vitamin D metabolites are known to interfere in 25-OHD assays and DEQAS has distributed samples spiked with 3-epi-25-OHD3 (52.4nmol/L), 24R,25(OH)2D3 (14.4nmol/L) and 24S,25(OH)2D3 (57.9nmol/L). The 3-epimer showed a cross reactivity of 56% in a competitive protein binding assay but was not detected in any antibody-based methods. Not all HPLC/UV or LC-MS/MS methods were able to resolve 3-epi-25-OHD3 from 25-OHD3 and thus overestimated total 25-OHD. The cross reactivity of 24R,25(OH)2D3 (24S,25(OH)2D3) ranged from <5% (<5%) to 548% (643%) in ligand binding assays. Both 24-hydroxylated metabolites were resolved by HPLC/UV and LC-MS/MS methods and thus caused no complications in the measurement of 25-OHD. Most antibodies to 25-OHD are known to cross-react with dihydroxylated metabolites but interference in some assays was far greater than expected. This may be related to the anomalous behaviour of exogenously added metabolites in these 25-OHD methods.
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Affiliation(s)
- G D Carter
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - J C Jones
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - J Shannon
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - E L Williams
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - G Jones
- Department of Biomedical and Molecular Sciences, Queen's University, ON K7L 3N6, Canada
| | - M Kaufmann
- Department of Biomedical and Molecular Sciences, Queen's University, ON K7L 3N6, Canada
| | - C Sempos
- National Institutes of Health, Bethesda, MD 20892-7, USA
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Dirks NF, Vesper HW, van Herwaarden AE, van den Ouweland JMW, Kema IP, Krabbe JG, Heijboer AC. Various calibration procedures result in optimal standardization of routinely used 25(OH)D ID-LC-MS/MS methods. Clin Chim Acta 2016; 462:49-54. [PMID: 27570062 DOI: 10.1016/j.cca.2016.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND The variety of LC-MS/MS methods measuring total 25(OH)D used today is vast and the comparability among these methods is still not well assessed. METHODS Here, we performed a comparison in samples of healthy donors between the currently routinely used 25(OH)D LC-MS/MS methods in the Netherlands and the Ghent University reference measurement procedure to address this issue (n=40). Additionally, an interlaboratory comparison in patient serum samples assessed agreement between the Dutch diagnostic methods (n=37). RESULTS The overall correlation of the routine methods for 25(OH)D3 with the reference measurement procedures and with the mean of all diagnostic methods was excellent (r>0.993 and r>0.989, respectively). Three out of five methods aligned perfectly with both the reference measurement procedure and the median of all methods. One of the routine methods showed a small positive bias, while another showed a small negative bias consistently in both comparisons. CONCLUSION The biases most probably originated from differences in calibration procedure and may be obviated by reassessing calibration of stock standards and/or calibrator matrices. In conclusion, five diagnostic centers have performed a comparison with the 25(OH)D Ghent University reference measurement procedure in healthy donor serum samples and a comparison among themselves in patient serum samples. Both analyses showed a high correlation and specificity of the routine LC-MS/MS methods, yet did reveal some small standardization issues that could not be traced back to the technical details of the different methods. Hence, this study indicates various calibration procedures can result in perfect alignment.
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Affiliation(s)
- Niek F Dirks
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, The Netherlands
| | - Hubert W Vesper
- Centers for Disease Control and Prevention (CDC), Division of Laboratory Sciences, Atlanta, GA, United States
| | | | | | - Ido P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Johannes G Krabbe
- Department of Clinical Chemistry and Laboratory Medicine, Medical Spectrum Twente, Medlon BV, The Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, The Netherlands.
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Schleicher RL, Sternberg MR, Lacher DA, Sempos CT, Looker AC, Durazo-Arvizu RA, Yetley EA, Chaudhary-Webb M, Maw KL, Pfeiffer CM, Johnson CL. The vitamin D status of the US population from 1988 to 2010 using standardized serum concentrations of 25-hydroxyvitamin D shows recent modest increases. Am J Clin Nutr 2016; 104:454-61. [PMID: 27385610 PMCID: PMC4962157 DOI: 10.3945/ajcn.115.127985] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/01/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Temporal trends in the US population's vitamin D status have been uncertain because of nonstandardized serum 25-hydroxyvitamin D [25(OH)D] measurements. OBJECTIVE To accurately assess vitamin D status trends among those aged ≥12 y, we used data from the cross-sectional NHANESs. DESIGN A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for measuring 25(OH)D (sum of 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3), calibrated to standard reference materials, was used to predict LC-MS/MS-equivalent concentrations from radioimmunoassay data (1988-2006 surveys; n = 38,700) and to measure LC-MS/MS concentrations (2007-2010 surveys; n = 12,446). Weighted arithmetic means and the prevalence of 25(OH)D above or below cutoff concentrations were calculated to evaluate long-term trends. RESULTS Overall, mean predicted 25(OH)D showed no time trend from 1988 to 2006, but during 2007-2010 the mean measured 25(OH)D was 5-6 nmol/L higher. Those groups who showed the largest 25(OH)D increases (7-11 nmol/L) were older, female, non-Hispanic white, and vitamin D supplement users. During 1988-2010, the proportions of persons with 25(OH)D <40 nmol/L were 14-18% (overall), 46-60% (non-Hispanic blacks), 21-28% (Mexican Americans), and 6-10% (non-Hispanic whites). CONCLUSIONS An accurate method for measuring 25(OH)D showed stable mean concentrations in the US population (1988-2006) and recent modest increases (2007-2010). Although it is unclear to what extent supplement usage compared with different laboratory methods explain the increases in 25(OH)D, the use of higher vitamin D supplement dosages coincided with the increase. Marked race-ethnic differences in 25(OH)D concentrations were apparent. These data provide the first standardized information about temporal trends in the vitamin D status of the US population.
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Affiliation(s)
| | | | - David A Lacher
- National Center for Health Statistics, CDC, Atlanta, GA; and the
| | | | - Anne C Looker
- National Center for Health Statistics, CDC, Atlanta, GA; and the
| | | | | | | | - Khin L Maw
- National Center for Environmental Health and the
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Romanenko I, Norsic S, Veyre L, Sayah R, D'Agosto F, Raynaud J, Boisson C, Lacôte E, Thieuleux C. Active and Recyclable Polyethylene-Supported Iridium-(N- Heterocyclic Carbene) Catalyst for Hydrogen/Deuterium Exchange Reactions. Adv Synth Catal 2016. [DOI: 10.1002/adsc.201600045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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