Vitamin D deficiency

Strategies for preventing bone loss in populations with insufficient calcium and vitamin D intake

Calcium and vitamin D are essential nutrients for maintaining skeletal health, yet deficiencies in these nutrients are particularly widespread in regions such as Asia and Africa. Inadequate intake of these nutrients in these areas has been associated with diminished bone integrity and a rising incidence of osteoporosis. This review examines the underlying mechanisms of bone loss driven by calcium and vitamin D deficiencies, emphasizing their crucial roles in bone metabolism. It also presents strategies to improve nutrient intake, such as fortification of staple foods and supplementation, along with lifestyle modifications including increased physical activity, sun exposure, and dietary education, to prevent bone loss effectively. Special consideration is given to vulnerable populations, including older adults, individuals with limited sun exposure, and those with dietary restrictions, who are at higher risk of deficiency. The review further evaluates public health strategies, including government-initiated fortification and educational programs, as essential measures for tackling widespread nutrient deficiencies. Lastly, it explores future avenues for addressing calcium and vitamin D deficiencies, including the potential role of digital health tools, personalized nutrition, and innovative public health policies to alleviate the global burden of bone-related diseases.

Impact of Education and Gender on Knowledge, Attitudes, and Practices Toward Vitamin D Among the Lebanese Population With Emphasis on Young Adults

Background Vitamin D deficiency is a growing global health concern that affects populations, even in sun-rich regions such as Lebanon. Despite abundant sunlight, limited research has explored the knowledge, attitudes, and practices (KAP) related to vitamin D among young Lebanese adults. Study design This study employed an online quantitative cross-sectional design. Methods A self-administered online questionnaire distributed over six months (from August 2023 to January 2024) collected data on the participants' demographic characteristics, as well as their knowledge, attitudes, and practices related to vitamin D. Results Most participants (75.7%) had sufficient knowledge about vitamin D sources. The internet and physicians emerged as the dominant sources, cited by 175 participants, which represented 17.6% of the total responses related to vitamin D knowledge sources. Sunlight was perceived by the participants as the most crucial source. Additionally, 244 (33.7%) of the participants acknowledged the role of vitamin D in preventing osteoporosis, whereas 144 (20.4%) believed that it was aiding in calcium absorption. Significant levels of knowledge (defined as scores of ≥21 out of 40) and positive attitudes (defined as ≥4 correct answers out of six) were evident among more than 255 (75%) of the participants. However, over half expressed concerns about their vitamin D levels. Most were willing to take supplements (330, 92.7%) and undergo testing (326, 92.1%). Conclusion Although young Lebanese adults demonstrated good overall knowledge and positive attitudes toward vitamin D deficiency, implementing comprehensive awareness campaigns and health programs that emphasize behavior change is crucial for combating deficiency. These initiatives should focus on promoting tangible changes in practices, such as safe sun exposure, the consumption of vitamin D-rich foods, and adherence to testing and supplementation when necessary.

Vitamin D deficiency and oral health: a systematic review of literature

BACKGROUND

Vitamin D (VD) levels are gaining increasing interest in dentistry due to their association with several oral diseases.

OBJECTIVE

This study aimed to evaluate the relationship between vitamin D deficiency and various oral disorders.

MATERIALS AND METHODS

A broad search on the MEDLINE database via the PubMed interface and on the Spring Link platform was carried out using keywords related to the subject. An additional electronic search of gray literature was conducted via Google Scholar. Inclusion criteria were listed for the selection of articles and a reading grid was designed for the extraction of data relating to the research question. The quality of included studies was assessed using JBI's critical appraisal tools.

RESULTS

A total of 57 studies were identified. After reading the full text, 16 studies were included and selected for qualitative analysis. There is an association between vitamin D deficiency and different oral disorders. Indeed, ten publications assessed the association between vitamin deficiency and periodontal disease, three examined the relationship between vitamin D deficit and dental caries, and one examined the intriguing relationship between vitamin D deficiency and tooth mineralization and two articles interested in vitamin D deficiency and stomatitis.

CONCLUSION

The analysis of these selected articles shows that Vitamin D deficiency can lead to various oral health disorders during growth and adulthood. Indeed, it can be linked to tooth mineralization defects and increasing the risk of dental caries. Severe Vitamin D deficiency also increases the prevalence of periodontitis and gingival inflammation. It may also be linked to certain oral pathology entities, such as oral cancers and jaw osteonecrosis.

Associations of the serum 25-hydroxyvitamin D with mortality among patients in osteopenia or osteoporosis

PURPOSE

The correlation between serum 25-hydroxy vitamin D [(25(OH)D] and mortality in patients with osteopenia or osteoporosis remains unclear. Therefore, this study examined the relationship between serum 25(OH)D and mortality in patients with osteopenia or osteoporosis.

METHODS AND RESULTS

This prospective cohort study included patients with osteopenia or osteoporosis from the National Health and Nutrition Examination Survey from 2001 to 2018. Multivariate Cox regression models examined the correlation between serum 25(OH)D and all-cause mortality, cardiovascular mortality (CVD), and cancer mortality. The cohort included 9282 adult participants with a median follow-up period of 97.01 months, including 1394 all-cause deaths, 413 CVD-related deaths, and 322 cancer deaths. In fully adjusted models, higher serum 25(OH)D levels (≥75.0 nmol/L) were associated with a lower risk of all-cause mortality (hazard ratio 0.54, 95 % confidence interval 0.41 to 0.73) and cardiovascular death (0.47, 0.29 to 0.76), using participants with low 25(OH)D levels (<25 nmol/L) as the reference. In addition, we found an L-shaped non-linear dose-response relationship between serum 25(OH)D and all-cause and cardiovascular mortality, with inflection points of 38.8 nmol/L and 53.6 nmol/L, respectively.

CONCLUSION

Higher serum 25(OH)D concentrations are strongly associated with a diminished risk of all-cause and CVD mortality in patients with osteopenia or osteoporosis. This association has a threshold effect. More in-depth intervention studies are needed to clarify underlying mechanisms.

Achieving clinical remission in asthma with mepolizumab: a subanalysis on vitamin D as a predictor of response

OBJECTIVE

Mepolizumab, an anti-IL-5 monoclonal antibody, has shown promise in reducing exacerbations and steroid dependency in severe eosinophilic asthma. This study aims to evaluate the effectiveness of mepolizumab in achieving clinical remission in asthma over 12 months and explore Vitamin D levels as a predictor of response.

METHOD

We assessed Asthma Control Questionnaire (ACQ) scores, spirometry, number of exacerbations, oral corticosteroid (OCS) use, and inhaled corticosteroid (ICS) use in 32 patients, observing significant clinical improvements. Data were collected 1 year prior to starting mepolizumab and one year after starting mepolizumab. Nasal polyps were not seen in all the patients, and computed tomography of para-nasal sinuses are not available for all the patients, so nasal polyps status are not evaluated to avoid any bias.

RESULT

Our results indicate that 12 patients achieved clinical remission after starting mepolizumab, with a strong correlation between higher Vitamin D levels and positive treatment outcomes. This suggests that optimizing Vitamin D levels could enhance the response to mepolizumab in asthma patients, and help in achieving better asthma control.

CONCLUSION

Mepolizumab is an effective treatment for severe eosinophilic asthma, significantly improving clinical outcomes and reducing corticosteroid use. This study highlights the importance of Vitamin D as a predictor of response to mepolizumab, suggesting that higher Vitamin D levels may enhance treatment efficacy.

Efficacy and safety of enteral supplementation with high-dose vitamin D in critically ill patients with vitamin D deficiency

BACKGROUND

Vitamin D deficiency is associated with mortality and morbidity in critically ill patients. This study investigated the safety and effectiveness of enteral high-dose vitamin D supplementation in intensive care unit (ICU) patients in Asia.

METHODS

This was a multicenter, prospective, randomized-controlled study. Eligible participants with vitamin D deficiency were randomly assigned to the control or vitamin D supplementation group. In the vitamin D supplementation group, the patients received 569,600 IU vitamin D. The primary outcome was the serum 25(OH)D level on day 7.

RESULTS

41 and 20 patients were included in the vitamin D supplementation and control groups, respectively. On day 7, the serum 25(OH)D level was significantly higher in the vitamin D supplementation group compared to the control group (28.5 [IQR: 20.2-52.6] ng/mL and 13.9 [IQR: 11.6-18.8] ng/mL, p < 0.001). Only 41.5% of the patients achieved serum 25(OH)D levels higher than 30 ng/mL in the supplementation group. This increased level was sustained in the supplementation group on both day 14 and day 28. There were no significant adverse effects noted in the supplementation group. Patients who reached a serum 25(OH)D level of >30 ng/mL on day 7 had a significantly lower 30-day mortality rate than did those who did not (5.9% vs 37.5%, p < 0.05).

CONCLUSIONS

In our study, less than half of the patients reached adequate vitamin D levels after the enteral administration of high-dose vitamin D. A reduction in 30-day mortality was noted in the patients who achieved adequate vitamin D levels. TRIAL REGISTRATION CLINICALTRIALS.

GOV ID

NCT04292873, Registered, March 1, 2020.

Effect of vitamin D on anterior cruciate ligament injury rates and post-reconstruction function-A systematic review

Purpose

This systematic review aimed to investigate the association between serum vitamin D levels and key outcomes following anterior cruciate ligament reconstruction (ACLR), including ACL injury risk, postoperative muscle recovery and post-reconstruction functional outcomes.

Methods

We conducted a comprehensive search across five databases (Cochrane Library, EMBASE, MEDLINE, Scopus and Web of Science) until July 2024. Studies were selected based on specific inclusion criteria, such as studies evaluating the relationship between vitamin D and injury risk, ACLR outcomes and muscle strength. Risk of bias was assessed using the MINORS tool, and results were synthesized narratively due to study heterogeneity.

Results

Five studies with 656,243 participants met the inclusion criteria. Most studies reported that low vitamin D levels were associated with a significantly increased risk of ACL injuries and poorer postoperative muscle strength recovery. However, evidence regarding bone health and functional outcomes was inconsistent. No meta-analysis was conducted due to the variability of study designs and outcomes, but qualitative synthesis indicated a potential protective role of vitamin D in ACL recovery.

Conclusions

Vitamin D deficiency appears to increase the risk of ACL injury and impede muscle recovery post-surgery. However, limitations include a high risk of bias and inconsistent evidence on functional outcomes, underscoring the need for further research. The review was registered in PROSPERO (ID: CRD42024584483).

Level of Evidence

Level III, systematic review.

Evaluation of vitamin D and serum lipid profile levels in obstructive meibomian gland dysfunction

PURPOSE

To compare the serum lipid profile and 25-hydroxyvitamin D3 (25-OH D3) levels of patients diagnosed with obstructive meibomian gland dysfunction (OMGD) and healthy controls.

METHODS

This prospective study included OMGD patients who were seen at our clinic between April 2023 and October 2023 and age- and gender-matched controls. All participants underwent a detailed ophthalmological examination, including Ocular Surface Disease Index (OSDI) testing, tear-film breakup time (TBUT), and shrinkage testing. Ocular surface staining (corneal and conjunctival staining) was evaluated according to the Oxford scale. The quality of the main meibomian secretions, morphological differences at the lid margin, and the degree of contamination of the meibomian secretions, which directly indicates meiboimian gland dysfunction, were evaluated. Serum 25-OH D3, triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels were compared.

RESULTS

Of our participants, 35 OMGD patients and 35 healthy controls, 35 (50%) were female and 35 (50%) were male. No statistically significant difference was observed in vitamin D levels between the healthy and OMGD groups (P=0.112). There was no significant difference in the distribution of serum vitamin D levels (deficient, inadequate, and optimal) between the two groups (P>0.05). Serum lipid levels (TG, TC, HDL, and LDL) were higher in the OMGD group than in the control group, but only TG was statistically significant (P=0.001).

CONCLUSION

Serum vitamin D levels did not significantly differ between the OMGD and control groups. However, there may be a relationship between the serum lipid profile and OMGD.

Effect of calcium supplementation on bone deformity and histopathological findings of skin papules in a pediatric patient with vitamin D-dependent rickets type 2A: A case report

Vitamin D-dependent rickets type 2A (VDDR2A) is an autosomal recessive disease caused by pathogenic variants of the vitamin D receptor (VDR) gene. VDDR2A rickets are usually resistant to native or active vitamin D treatment because of impaired active calcium absorption against the calcium concentration gradient, which is a ligand-dependent VDR action in the small intestine. Alopecia due to an impaired skin follicular cycle is occasionally observed in patients with VDDR2A. Among the pathogenic VDR variants, most in the DNA-binding domain and some in the ligand-binding domain, which affect the dimerization of VDR with the retinoic X receptor, are associated with alopecia. Herein, we report a case of VDDR2A caused by compound heterozygous pathogenic variants of the DNA-binding domain of VDR. Active vitamin D treatment did not ameliorate genu varum, rachitic changes in the roentgenogram, or abnormal laboratory findings. However, oral administration of calcium lactate dramatically improved these findings. The patient also experienced hair loss at two months of age and multiple papules on the skin at two yr of age, which did not improve with vitamin D or calcium supplementation. We also report the histopathological findings of skin papules in this patient.

Retrospective real world study on vitamin D supplementation: Looking for the most effective molecule and its frequency of use

BACKGROUND & AIMS

There is still uncertainty regarding the optimal serum levels 25-Hydroxy-vitamin D [25(OH)D] and the most effective supplementation strategies, including the choice of molecule and its dosing frequency. The aim of the study is to compare the effects of calcifediol versus two different frequencies of cholecalciferol administration on vitamin D supplementation, and to identity the key parameters that predict response to treatment.

METHODS

This retrospective, real-world cohort study included 105 patients, who were divided into three groups. Group 1 (n = 21) received cholecalciferol 50,000 international units (UI) once a month, Group 2 (n = 27) received cholecalciferol 25,000 UI every two weeks, and Group 3 (n = 57) received calcifediol 0.266 mg (mg) once a month. The primary outcome measured was the delta increase in 25(OH)D levels after 6 months of treatment, compared to pre-treatment levels.

RESULTS

The study revealed a significant greater delta increase in 25(OH)D levels in Group 1, which received cholecalciferol 50,000 IU once a month, compared to the other two groups. However, multiple regression analysis indicated that neither the type of molecule nor the frequency of administration independently influenced the treatment outcome. Only pre-treatment serum 25(OH)D levels were found to significantly affect the outcome. Based on the receiver operating characteristic curve, serum 25(OH)D levels below 19.5 ng/dL were predictive of a doubling of pre-treatment values, with high sensitivity and specificity.

CONCLUSION

Pre-treatment serum 25(OH)D levels are valuable for selecting patients who should undergo supplementation. This finding suggests the importance of tailoring therapy according to the degree of vitamin D deficiency.

Two-phase linear relationship of Vitamin D and Vitamin A among children aged 0-14 years: a cross-sectional study

Background

Vitamin D and Vitamin A are crucial for children's immune function, bone health, and cellular growth, but their interrelationship and the impact of various factors remain poorly understood.

Objective

To explore the relationship between Vitamin D and Vitamin A levels in children and identify any critical thresholds.

Methods

A cross-sectional study was conducted from 2018 to 2021 in Ningbo, Zhejiang, China. Participants were children aged 0 to 14 years attending community health service centers for routine health check-ups. Multivariate linear regression analysis was conducted to ascertain the association between serum Vitamin D and Vitamin A levels. A smooth curve fitting approach was employed to analyze the dose-response relationship between Vitamin D and Vitamin A.

Results

A total of 4,752 participants were included. The study revealed significant variations in baseline Vitamin D and Vitamin A levels across different deficiency categories. Mean Vitamin D levels were lowest in the severe deficiency group (4.9 ng/mL) and highest in the normal group (34.8 ± 9.8 ng/mL), while mean Vitamin A levels were lowest in the deficiency group (226.6 ± 72.2 ng/mL) and highest in the normal group (263.3 ± 74.0 ng/mL). The study revealed a two-phase linear relationship with a significant threshold effect at a Vitamin D level of 28.289 ng/mL. Below this threshold, the association between Vitamin D and Vitamin A was strong (β = 2.935, 95% CI: 2.173, 3.696), while above the threshold, the association was significantly weaker (β = 0.737, 95% CI: 0.413, 1.061). The likelihood ratio test confirmed the significance of this threshold effect (p < 0.001).

Conclusion

The study concludes that a significant threshold at 28.289 ng/mL Vitamin D marks a point beyond which the association with Vitamin A levels plateaus, highlighting the importance of this threshold for optimizing vitamin status in children.

Preoperative Calcium or Vitamin D Supplement in Thyroidectomy: A Systematic Review and Meta-Analysis

OBJECTIVES

The objective of this systematic review and meta-analysis was to assess the role of preoperative calcium and vitamin D supplementation in patients who underwent total thyroidectomy.

DATA SOURCES

The search for randomized controlled trials was performed in the OVID Medline and Embase databases.

REVIEW METHODS

The last search was made on September 16, 2024. Three independent reviewers evaluated full-text articles from relevant reports based on eligibility criteria. The quality of the included studies was assessed by two reviewers according to the ROB 2 tool.

RESULTS

This systematic review and meta-analysis considered 13 studies with 1504 participants. There were positive results in treatment outcomes including the mean postoperative calcium level (MD, 0.30 mg/dL: 95% CI, 0.15 to 0.44); the 48 h of postoperative hypocalcemia (OR, 0.41; 95% CI, 0.27 to 0.62); the postoperative symptomatic hypocalcemia (OR, 0.38; 95% CI, 0.24 to 0.62); the IV calcium supplementation (OR, 0.32; 95% CI, 0.18 to 0.58); and length of hospital stays (MD, -0.29; 95% CI, -0.51 to -0.07) as compared to the control group. Readmission rates showed no significant differences between the groups (OR, 0.15; 95% CI, 0.01 to 3.08).

CONCLUSIONS

Preoperative calcium and vitamin D supplementation in patients who underwent total thyroidectomy results in reduction of postoperative symptomatic hypocalcemia. The finding is critical because it offers a feasible and effective solution that could improve patient care while potentially reducing the burden of numerous blood tests during the postoperative period.

REGISTRATION

This systematic review protocol was registered with PROSPERO (registration number CRD42021278859).

LEVEL OF EVIDENCE

1 Laryngoscope, 135:1267-1277, 2025.

Utility of the Fragility Score (FS) Determined Through Radiofrequency Ecographic Multi-Spectrometry (REMS) in the Follow-Up of Patients with Axial Spondyloarthritis (AxSpA)

Objectives: Bone mineral density (BMD) variation under vitamin D supplementation, determined using dual-energy X-ray absorptiometry (DXA), is the gold standard and the main tool used in most studies in this domain. However, the scientific literature is lacking with regard to the usefulness of REMS in BMD follow-up, especially the importance of the fragility score (FS). The main objective of this study was to determine whether FS follow-up is relevant in a group of patients with axial spondyloarthritis and whether REMS could have clinical applicability. Methods: Patients with a certain diagnosis of axial spondyloarthritis (AxSpA) were recruited from two medical healthcare centers and were scanned using Radiofrequency Echographic Multi-Spectrometry in order to obtain their fragility score (FS), an objective measurement of bone quality. The main group was randomized into a vitamin D supplementation branch and a non-supplementation branch and followed up every 6 months for 18 months in total. Comparisons between the branches were made using MiniTab v.20 statistical software. Results: Lower FS values were obtained in patients who initially had high scores, suggesting a positive impact of vitamin D on bone quality (p = 0.008). Muscle strength was evaluated through a visual analogue scale (VAS), with improvements being seen in the supplementation branch (p < 0.005). Furthermore, although some patients had experienced falls in previous years, during the study period, no new events were recorded in either group. Conclusions: The FS is a reliable tool for evaluating bone architecture and is useful in everyday practice for the management of patients taking vitamin D supplements.

Association of vitamin D and platelet-to-lymphocyte ratio in treatment escalation risk for newly diagnosed Crohn's disease adults

BACKGROUND

Accumulating research has implicated that vitamin D (VD) may be important in the pathogenesis of Crohn's disease (CD), while the platelet-to-lymphocyte ratio (PLR) is emerging as a biomarker in immune disorders. However, the synergistic effect of VD and PLR on treatment escalation in newly diagnosed CD patients remains unclear. Therefore, this study aims to assess the interaction between PLR and VD on the subsequent use of infliximab and/or immunosuppressants in patients with CD.

METHODS

Newly diagnosed CD patients were selected from the Sir Run Run Shaw Hospital Inflammatory Bowel Disease Biobank (SRRSH-IBC). COX proportional hazards models were employed to assess the association between VD, PLR, and treatment escalation among CD patients.

RESULTS

Among 108 newly diagnosed CD adult patients, vitamin D deficiency (VDD) was prevalent (78.7%). Compared to CD patients without VDD, those with VDD exhibited a higher risk of treatment escalation, i.e., using infliximab and/or immunosuppressants (HR = 3.22, 95% CI = 1.24-8.35, P = 0.016). There is a clear trend of decreasing risk of treatment escalation as VD levels elevating (HR = 0.26, 95% CI = 0.09-0.76, P for trend = 0.014). The stratified analysis revealed a noteworthy interaction between PLR and VD levels concerning treatment escalation. Baseline VDD amplified the risk of treatment escalation among patients with elevated PLR (HR = 4.17, 95% CI = 1.51-11.53, Pinteraction = 0.031). Similar trends were observed when VD levels were stratified into quartiles (highest quartile vs. lowest quartile: HR = 0.18, 95% CI = 0.05-0.62, P for trend = 0.014).

CONCLUSION

This study underscores a significant interplay between VD levels and PLR in influencing treatment outcomes in CD. VDD exacerbates the risk of treatment escalation primarily in individuals with heightened PLR levels, highlighting the combined impact of vitamin D status and inflammation on disease progression of CD.

Vitamin D status in children undergoing allogeneic hematopoietic stem cell transplantation: A prospective exploratory study

OBJECTIVES

Allogeneic hematopoietic stem cell transplantation (HSCT) is associated with nutritional risks. This study describes vitamin D status and intake in children undergoing HSCT and compares results to healthy children.

METHODS

In a prospective observational study, vitamin 25(OH)D and 1,25(OH)2D were assessed at hospital admission before HSCT (baseline), at 3-month and 1-year post-transplant. Vitamin D deficiency was defined as 25(OH)D < 50 nmol/L. A 4-day diet record assessed vitamin D intake at 3-months and 1-year. Healthy children were assessed once.

RESULTS

Twenty-eight HSCT patients (mean age: 10.3-years, standard deviation [SD]: 4.0) and 50 healthy children (mean age: 10.0-years, SD: 3.6) were included. Vitamin D deficiency was more prevalent in patients at baseline (36%, p < 0.001) and 3-months (24%, p = 0.007) but not at 1-year (14%, p = 0.084) than in healthy children (2%). Median 1,25(OH)2D was significantly lower than in healthy children at the two first visits (p < 0.001) but not at 1-year (p = 0.198). Median vitamin D provision was higher at 3-months (18.1 µg/day) and 1-year (25 µg/day) compared to healthy children (5.3 µg/day, p < 0.001).

CONCLUSIONS

Children undergoing HSCT were at a high risk of vitamin D deficiency at baseline and 3-month post-transplant, but not at 1-year compared to healthy children. Vitamin D intake was higher after transplantation than in healthy children. These findings indicate that vitamin D requirements are elevated in HSCT patients, emphasizing the need for monitoring and adequate supplementation.

TRIAL REGISTRATION

Clinical Trials AEV2017/1. 2016/391/REK sør-øst B.

Genomic regions occupied by both RARα and VDR are involved in the convergence and cooperation of retinoid and vitamin D signaling pathways

Retinoic acid receptors (RARs) and the vitamin D receptor (VDR) regulate distinct but overlapping gene sets in multiple cell types. The abundance and characteristics of regulatory regions, occupied by both RARs and VDR are largely unexplored. We used global approaches (ChIP-seq, RNA-seq, and ATAC-seq) and bioinformatics tools to map and characterize common binding regions of RARα and VDR in differentiated human THP-1 cells. We found that the cistromes of ligand-activated RARα and VDR largely overlapped, and their agonists (AM580 and calcitriol) co-regulated several genes, often cooperatively. Common binding regions were frequently (but not exclusively) annotated with co-regulated genes and exhibited increased MED1 occupancy upon ligand stimulation, suggesting their involvement in gene regulation. Chromatin accessibility was typically higher in the common regions than in regions occupied exclusively by RARα or VDR. DNA response elements for RARα (DR1/2/5) and VDR (DR3) were enriched in the common regions, albeit the co-occurrence of the two types of canonical motifs was low (8.4%), suggesting that "degenerate" DR1/2/5 and DR3 motifs or other sequences could mediate the binding. In summary, common binding regions of RARα and VDR are at the crossroads of the retinoid and vitamin D pathways, playing important roles in their convergence and cooperation.

Correlation between longitudinal serum vitamin D levels and myopia in children: a prospective birth cohort analysis

BACKGROUND

Myopia is an increasingly prevalent visual impairment associated with severe ocular complications. Risk factors for childhood myopia include genetics, East Asian ethnicity, age, parental myopia, and various environmental factors. The relationship between vitamin D levels, outdoor activity, and myopia remains inconclusive. This study aims to investigate the correlation between longitudinal serum vitamin D levels and myopia in Taiwanese children.

METHODS

The study measured serum 25-hydroxyvitamin D (25(OH)D) concentrations in children from the Prediction of Allergies in Taiwanese Children (PATCH) study at multiple time points, including umbilical cord blood and ages 1, 3, and 5 years. Refractive error under cycloplegic conditions and axial length were assessed from January 2021 to April 2022. Myopia was defined as a mean spherical equivalent in both eyes ≤ -0.5 diopter. Independent sample t-tests, partial correlation analyses, and generalized estimating equation (GEE) analyses were conducted to examine the relationship between serum vitamin D concentrations and myopia.

RESULTS

A total of 126 eyes from 63 children (mean age: 8.90 ± 2.24 years) were analyzed. The lowest serum vitamin D level (19.11 ± 9.10 ng/mL) was observed in umbilical cord blood, while the highest level (37.01 ± 12.61 ng/mL) occurred at 1 year of age. No significant differences in serum vitamin D concentrations were found between children with and without myopia during gestation, at birth, or at ages 1, 3, and 5 years (all P > 0.05). Additionally, GEE analysis revealed that serum vitamin D levels were not significantly associated with cycloplegic spherical equivalent or axial length after adjusting for age and sex.

CONCLUSIONS

This prospective birth cohort study found no association between serum vitamin D concentrations at birth, 1, 3, or 5 years of age and the development of myopia in Taiwanese children. These findings suggest that other factors, such as ethnicity, near work activities, or lighting conditions, may play more significant roles in myopia development, particularly among East Asian populations.

Surya Namaskar as a Gender-sensitive Intervention: Addressing Social Physique Anxiety (SPA) Issues in Women with PCOS

Background

Polycystic ovary syndrome (PCOS) is a common, lifelong condition affecting about 20% of women, characterised by symptoms such as infertility, obesity, acne and excess facial hair, which can negatively impact both physical and mental health.

Purpose

This study aimed to assess the effect of Surya Namaskar on reducing social physique anxiety (SPA) in women diagnosed with PCOS.

Methods

The study applied a pre- and post-test design with 60 women diagnosed with PCOS; there were 100 participants in the study. Out of these 100, only 70 participants had high levels of SPA. Out of these 70 participants, only 60 responded and agreed to participate in the study. The participants were selected from colleges in Dehradun, India, and were between the ages of 18 and 30 years. Split into intervention and control groups. The intervention group practiced Surya Namaskar for 12 weeks, while the control group did not participate in any structured physical activity. SPA and body dissatisfaction were measured using established scales at the beginning and end of the study. Statistical analyses, including paired and independent samples t-tests, were conducted to assess changes within and between the groups.

Results

The results indicated that Surya Namaskar significantly improved overall health and well-being, with the intervention group showing notable reductions in SPA and body dissatisfaction compared to the control group. Statistical analyses confirmed significant differences in psychological outcomes, supporting the effectiveness of Surya Namaskar in this context.

Conclusion

Surya Namaskar significantly alleviates SPA and body dissatisfaction, enhancing the psychological health of women with PCOS. Given its accessibility and low cost, Surya Namaskar shows potential as an effective complementary treatment to improve the quality of life for women with PCOS. Further research is needed to explore its long-term effects and the mechanisms behind these improvements.

State-of-the-Art and Future Challenges for Nutritional Interventions in Facioscapulohumeral Dystrophy: A Narrative Review

Facioscapulohumeral dystrophy (FSHD), the second most common inherited muscular dystrophy in adulthood, is characterized by progressive muscle loss, accompanied by an increase in fat mass. Beyond these alterations in body composition, which contribute to the risk of sarcopenic obesity, FSHD is associated with systemic inflammation and oxidative stress. These interconnected mechanisms may worsen muscle atrophy, leading to a decline in physical efficiency and quality of life. While the therapeutic benefits of physical therapy and exercise have been investigated, the impact of dietary interventions remains underexplored. Given the established role of nutrition in managing various chronic diseases, there is growing interest in understanding how it might influence the clinical management of FSHD. By addressing current gaps in the literature, this review aims to investigate the potential role of dietary patterns and specific nutrients in modulating muscle metabolism within the context of FSHD. Some studies have indicated various compounds (flavonoids, curcumin, L-carnitine, coenzyme Q10, and omega-3), vitamins (C and E), and minerals (zinc and selenium) with antioxidant and anti-inflammatory properties as promising treatment strategies for FSHD. Instead, few data regarding the effects of proteins and creatine supplementation are available. Furthermore, the potential benefits of essentials amino acids, β-hydroxy-β-methylbutyrate, and vitamin D in contrasting muscle atrophy and enhancing muscle function remain unexplored. Despite these preliminary findings, the existing body of evidence is limited. Identifying novel therapeutic strategies to complement existing treatments could provide a more comprehensive management framework, aimed at improving the long-term health outcomes and quality of life of FSHD patients.

Vitamin D in Irritable Bowel Syndrome: Exploring Its Role in Symptom Relief and Pathophysiology

Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder. Despite its common occurrence, the pathophysiology of IBS remains not fully understood. Emerging evidence suggests that IBS is a multifactorial condition characterized by low-grade inflammation, immune system activation, impaired gut permeability, intestinal hypersensitivity, and alterations in intestinal microbiota. Recent data have highlighted the potential role of vitamin D in modulating these underlying mechanisms. Vitamin D is known to influence various cellular processes, including the regulation of the gut microbiome, immune response modulation, and anti-inflammatory effects, which may alleviate the altered gut function observed in IBS. Research indicates that individuals with IBS often have lower levels of vitamin D compared to healthy controls, suggesting a possible link between vitamin D deficiency and IBS. Vitamin D supplementation has been associated with improvements in IBS symptoms, such as bloating, flatulence, abdominal pain, constipation, and overall quality of life. The mechanisms by which vitamin D exerts these effects may involve direct or indirect modulation of immune responses, the production of antimicrobial peptides, and the regulation of gene expression related to serotonergic metabolism. Despite these promising findings, the exact pathways through which vitamin D affects IBS pathophysiology remain unclear. The aim of this review is to outline the current knowledge and evidence regarding these mechanisms, as well as the therapeutic potential of vitamin D supplementation in IBS patients. Exploring the connection between vitamin D and IBS may pave the way for innovative interventions, enhancing both management strategies and the quality of life for those affected by the disorder.

Application of Mendelian randomized analysis method in Vitamin D research: A 10-year bibliometric analysis

Vitamin D is an open-cyclic steroidal trace organic compound that plays a crucial role in human metabolism and nutritional health. In recent years, Mendelian randomization (MR) has emerged as a widely adopted method for analyzing causal relationships, particularly in studying the association between Vitamin D and related diseases. However, no bibliometric analyses have been conducted to explore the research hotspots and trends regarding Vitamin D status in MR studies. This study utilized the Web of Science Core Collection as a source database and retrieved articles on Vitamin D status in MR published from 2014 to 2024. Bibliometric and visualization analyses utilized VOSviewer, Microsoft Excel 2021, and Scimago Graphica. An in-depth analysis of country or region, authors, journals, keywords, and references were performed to provide insights into the content related to the field. A total of 186 documents authored by 1122 contributors across 30 countries were identified. China and the University of Bristol had the highest publication counts, with 94 and 19 articles, respectively. The nutrients published the largest number of articles, and J Brent Richards was the largest contributors. The most frequently used keywords included "Mendelian randomization," "Vitamin D," "25-hydroxyVitamin D," "obesity," and "Type 2 Diabetes." The current research focuses on using MR methods to explore the associations between Vitamin D status and metabolic, cardiovascular, immune skin, psychiatric and neurological diseases. The related research in this field will continue to increase in the next few years, which is a promising research prospect in this field. This study systematically reviews the literature from the past decade, revealing research hotspots and trends in the field of Vitamin D status within MR studies. This information will provide a strong reference for readers and researchers.

Relationship Between Vitamin D Receptor Gene BsmI Polymorphism and 25-Hydroxyvitamin D Total Levels in Slovak Postmenopausal Women with Reduced Bone Mineral Density

Objectives: The BsmI polymorphism of the VDR gene (vitamin D receptor) is one of the important genetic variants influencing the development of osteoporosis. Measurement and evaluation of the 25-hydroxyvitamin D (25(OH)D) concentration in individuals with reduced bone mineral density are essential because deficiency of this hormone causes impaired bone mineralization, leads to low BMD (bone mineral density), and influences fracture formation. The aim of the study was to investigate the relationship between the VDR gene BsmI polymorphism and 25(OH)D levels in Slovak postmenopausal women. Materials and Methods: The study population consisted of 287 untreated postmenopausal women, who were divided into three groups based on T-scores: normal (CG = 65), osteopenia (OPE = 126), and osteoporosis (OPO = 96). DNA isolation was performed using a standard protocol. Genetic analyses of the BsmI (rs1544410) polymorphism of the VDR gene were performed using the TaqMan SNP genotyping assays. Biochemical analysis of total 25(OH)D was performed in blood serum using the electrochemiluminescence method. Results: The chi-square test confirmed that the mutant T allele was not associated with the development of osteoporosis (p = 0.419). Through Kruskal-Wallis analysis, we found significant differences (p < 0.05, p < 0.01) in total 25(OH)D concentrations in individual genotypes of the BsmI variant of the VDR gene between the groups of women studied. Conclusions: It can be concluded that the VDR gene and its variant BsmI as well as 25(OH)D total may be relevant markers in the etiology of the search for individuals at risk of osteoporosis.

Evaluation of the role of thyroid hormones, vitamin B12, vitamin D3, folic acid and ferritin serum levels in pterygium development

To evaluate the relationship between pterygium and serum thyroid hormone, vitamin B12, vitamin D3, folic acid, and ferritin levels between pterygium patients and control and to assess its correlation with clinical findings. 18-65-year-old 100 pterygium patients and age and sex matched 60 healthy control subjects were included. The peripheric blood sampling results were investigated. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), vitamin B12, vitamin D3, folic acid, and ferritin levels of pterygium and control groups were compared. FT3 level was higher in the patient group compared to the control group, while vitamin B12, vitamin D3, folic acid and ferritin levels were significantly lower in the patient group compared to the control group (p < 0.05) No significant difference was found between the patient and control groups in terms of age, gender and body mass index (BMI) (p = 0.295, p = 0.625, p = 0.547, respectively). This study reports that pterygium patients have lower serum vitamin B12, folic acid, ferritin and vitamin D3 levels than healthy individuals.

Association Between Laboratory Values and Covert Hepatic Encephalopathy in Patients with Liver Cirrhosis: A Multicenter, Retrospective Study

Background/Objective: Recently, there has been an increasing need to implement the diagnosis of the presence of covert hepatic encephalopathy (CHE) in patients with cirrhosis. The aim of this study was to identify novel factors associated with CHE in clinical practice. Methods: This retrospective study enrolled a total of 402 patients with cirrhosis at 17 institutions. The Stroop test was performed to diagnose CHE at each center. Results: The patients comprised 233 males and 169 females, with a median age of 69 (IQR, 61-75) years. The median albumin and 25(OH)D3 levels were 3.9 (3.5-4.3) g/dL and 15.4 (11.0-21.0) ng/mL, respectively. This cohort included 181 patients with esophageal varices (EV). Multivariate analysis revealed that low 25(OH)D3 (p < 0.05) and EV (p < 0.05) were independent risk factors for CHE. When limited to only laboratory factors, low albumin (p < 0.01) and low 25(OH)D3 (p < 0.05) were independent factors for CHE. The optimal cut-off values of albumin and 25(OH)D3 for predicting CHE were 3.7 g/dL and 16.5 ng/mL, respectively. The prevalence of CHE was 59.2% for 25(OH)D3 < 16.5 ng/mL and EV, 53.8% for albumin < 3.7 g/dL and 25(OH)D3 < 16.5 ng/mL, and 66.7% for albumin < 3.7 g/dL, EV, and 25(OH)D3 < 16.5 ng/mL. Conclusions: Low 25(OH)D3 and albumin levels, and the EV were positively associated with CHE in patients with cirrhosis. Specifically, the prevalence of CHE increased with a decrease in 25(OH)D3 levels. Patients with such risk factors should be actively and carefully examined for the presence of CHE.

A comparative study on the antioxidant and antiglycation properties of different vitamin D forms

Vitamin D plays multiple roles in the body. Recently, there has been an increase in its popularity and growing interest in vitamin D supplementation. However, the mechanisms of vitamin D action have not yet been sufficiently explored. Our study focused on the antioxidant and antiglycation properties of the four primary forms of vitamin D such as cholecalciferol, calcifediol, alfacalcidol, and calcitriol. For this purpose, we used an in vitro bovine serum albumin model. Glucose, fructose, ribose, galactose, glyoxal, and methylglyoxal were glycation factors. The antiglycative mechanism of vitamin D was evaluated through in silico docking. We showed that all forms of vitamin D exhibit antioxidant and antiglycation activity, although calcitriol demonstrated the most potent effect. We observed decreased levels of advanced glycation end products and advanced oxidation protein products in samples with the addition of different vitamin D forms compared to positive control. Notably, the antioxidant and antiglycation activity is similar to routinely used antioxidants (reduced glutathione) and protein glycation inhibitors (aminoguanidine). Molecular docking analyses revealed that calcitriol demonstrated strong binding affinities with human and bovine serum albumin forming polar contacts with lysine residues highly susceptible to glycation. Calcitriol also exhibited significant interactions with the receptor for advanced glycation endproducts (RAGE). The pleiotropic action of vitamin D, especially calcitriol, may indicate a high therapeutic potential of vitamin D supplementation in various diseases with carbonyl stress etiology. Further research is needed to fully understand the underlying mechanisms of vitamin D pleiotropic effects and determine the optimal dosages for clinical use.

Investigating the expression of anti/pro-inflammatory cytokines in the pathogenesis and treatment of ulcerative colitis and its association with serum level of vitamin D

Ulcerative colitis is an idiopathic gastrointestinal disease described by chronic inflammation of the digestive system. Cytokines may be responsible for immunopathogenesis, mucosal and tissue damage, and even treatment response. In addition to its role in calcium and phosphorus homeostasis and bone health, vitamin D is an immunomodulatory and anti-inflammatory agent. Understanding the role of cytokines may lead to improving the pathogenesis and treatment of this disease, therefore we aimed to investigate the relative gene expression of pro- and anti-inflammatory cytokines in biopsy samples taken from the affected area in the colon of ulcerative colitis patients and its association with serum vitamin D levels. A total of 47 ulcerative colitis patients were enrolled in this case-control study. The case group consisted of 23 patients with treatment-resistant ulcerative colitis, and the control group consisted of 24 ulcerative colitis patients responding to routine treatment. Serum vitamin D levels were measured by ELISA method. Real-time PCR was employed to quantify the relative expression of pro- and anti-inflammatory cytokines in colon biopsy samples from case and control groups. The pro-inflammatory cytokines included tumor necrosis factor-α (TNF-α), interferon-gamma (IFN-γ), interleukin-1β (IL-1β), IL-6, IL-8, IL-17 A, and IL-33, while the anti-inflammatory cytokines were IL-10, IL-35, and TGF-β. Data are showed as mean ± standard deviation (SD), and p values < 0.05 were considered statistically significant. The mean age of the control group was 45.88 ± 18.51 years, while that of the case group was 41.30 ± 13.01 years. The relative gene expression of TNF-α, IFN-γ, IL-1β, IL-6, IL-8, IL-17 A, IL-33, TGF-β, IL-10, and IL-35, in the case and control groups did not exhibit statistically significant differences (p > 0.05). However, the gene expression levels of the principal pro-inflammatory cytokines, including IL-6, IL-1β, and TNF-α, were elevated in treatment-resistant patients compared to patients who responded to treatments. No correlation was observed between serum vitamin D levels and the gene expression of pro- and anti-inflammatory cytokines (p > 0.05). The present study did not identify a statistically significant correlation between the expression of pro- or anti-inflammatory cytokines and treatment response. Therefore, routine treatments had no effect on the expression of these cytokines in treatment-resistant patients. Additionally, serum vitamin D levels were not related to the relative expression of pro- and anti-inflammatory cytokines in the affected area of the colon of these patients. Despite the need for further research on the protective and pathological roles of cytokines and vitamin D, regular screening and early and complementary treatment may be beneficial in reducing inflammatory symptoms in these patients.

Effects of vitamin D on brain function in preschool children with autism spectrum disorder: a resting-state functional MRI study

BACKGROUND

Previous studies indicate vitamin D impacts autism spectrum disorder (ASD), but its relationship with brain function is unclear. This study investigated the association between serum 25-hydroxyvitamin D [25(OH)D] levels and brain function in preschool children with ASD using resting-state functional magnetic resonance imaging (rs-fMRI), and explored correlations with clinical symptoms.

METHODS

A total of 226 ASD patients underwent rs-fMRI scanning and serum 25(OH)D testing. Clinical symptoms were assessed using Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC). Patients were categorized into mild and severe groups based on the CARS, and further divided into normal (NVD), insufficient (VDI), and deficient (VDD) serum 25(OH)D levels. Changes in brain function among these groups were analyzed using regional homogeneity (ReHo), with ABC scores used for correlation analysis.

RESULTS

In mild ASD, ReHo increased in the right postcentral gyrus and left precuneus in the VDI and VDD groups compared to NVD, and decreased in the bilateral middle cingulate gyrus and left superior frontal gyrus in the VDD group compared to VDI. In severe ASD, ReHo decreased in the right middle occipital gyrus and increased in the right insula in the VDI group compared to NVD, and increased in the right superior frontal gyrus in the VDD group compared to VDI. Correlation analysis revealed that in mild ASD, ReHo in the right postcentral gyrus was positively correlated with body and object use scores in the NVD and VDI groups, while ReHo in the right middle cingulate gyrus was negatively correlated with relating scores in the VDD and VDI groups. In severe ASD, ReHo in the right insula was positively correlated with language scores in the NVD and VDI groups.

CONCLUSIONS

ASD patients with lower serum 25(OH)D levels show multiple brain functional abnormalities, with specific brain region alterations linked to symptom severity. These findings enhance our understanding of vitamin D's impact on ASD and suggest that future research may explore its therapeutic potential.

Vitamin D in Reproductive Health Disorders: A Narrative Review Focusing on Infertility, Endometriosis, and Polycystic Ovarian Syndrome

Vitamin D (VD) is a fat-soluble steroid hormone with essential physiological functions beyond calcium and bone metabolism. In recent years, its role in women's reproductive health has gained attention, influencing ovarian function, follicular development, endometrial receptivity, and steroid hormone regulation. VD deficiency has been linked to reproductive disorders such as polycystic ovarian syndrome (PCOS), endometriosis, and infertility. Studies indicate that up to 40-50% of healthy pregnant women have insufficient VD levels, which may contribute to adverse pregnancy outcomes and reduced fertility. With growing evidence connecting VD to reproductive health, this review examines its molecular and endocrine mechanisms in fertility, endometriosis, and PCOS. It explores VD's therapeutic potential and its implications for improving clinical approaches and future research in reproductive medicine. Maintaining adequate VD levels is crucial for ovarian function, immune modulation in reproductive tissues, and overall fertility. Its deficiency is associated with insulin resistance, hormonal imbalances, and inflammatory processes, which contribute to reproductive pathophysiology. Establishing reference values for VD in reproductive medicine is essential for optimizing fertility treatments and improving clinical outcomes. This review synthesizes current research on VD's role in reproductive health and highlights the need for further investigation into its therapeutic applications.

Causal association between serum 25-hydroxyvitamin D levels and gestational diabetes mellitus: a bidirectional two-sample Mendelian randomization study

PURPOSE

Previous investigations have assessed the connection between vitamin D deficiency and an increased risk of gestational diabetes mellitus (GDM); however, the findings remain inconsistent. The purpose of this study was to investigate the causal relationship between 25-hydroxyvitamin D (25OHD) levels and GDM.

METHODS

Summary statistics data from genome-wide association studies (GWASs) were used to perform a bidirectional two-sample Mendelian randomization (MR) study. A total of 417,580 Europeans from the UK Biobank provided summary statistics data for 25OHD. The tenth data release of the FinnGen study provided the data for GDM, comprising 14,718 cases and 215,592 controls. For the univariate MR (uvMR) investigations, we employed the inverse variance weighted (IVW) method as our major analytical approach. Multiple sensitivity analyses were performed to evaluate the robustness of the results. Moreover, multivariate MR (mvMR) studies were conducted to account for potential confounding variables, including obesity, insulin resistance, and lipid traits.

RESULTS

In the forward MR study, uvMR analysis did not provide evidence supporting a causal effect of 25OHD levels on the risk of GDM [IVW odds ratio (OR): 1.07, 95% confidence interval (CI): 0.95 to 1.19, p = 0.273]. After adjusting for obesity, fasting insulin levels, and lipid traits, the findings from the mvMR analysis aligned with those of the uvMR analysis. In the reverse MR study, uvMR analysis indicated that GDM had no causal effect on serum 25OHD levels (IVW β = -0.003, p = 0.804), and the robustness of this finding was confirmed in the mvMR study.

CONCLUSION

Our MR research revealed no causal effect of serum 25OHD levels on GDM, suggesting that 25OHD deficiency does not correlate with an increased risk of GDM. Furthermore, our reverse analysis revealed no causal effect of GDM on 25OHD levels.

Association between serum 25-hydroxyvitamin D concentrations and urinary vitamin D metabolite concentrations measured by the NLucVDR assay

It is well known that vitamin D is essential for human health; however, many people suffer from vitamin D deficiency or insufficiency worldwide, including in Japan. Serum 25-hydroxyvitamin D (25(OH)D) concentrations are typically measured to evaluate vitamin D status. In a previous study, we demonstrated that the concentrations of vitamin D metabolites in urine, measured using the NLucVDR assay system composed of a split-type nanoluciferase and the ligand-binding domain (LBD) of the human vitamin D receptor, correlated with serum 25(OH)D concentrations measured using liquid chromatography-mass spectrometry (LC-MS) or electrochemiluminescence immunoassays (ECLIAs). However, the number of participants was limited to 23. In the present study, we investigated the relationship between urinary vitamin D metabolite concentrations measured using the NLucVDR assay and serum 25(OH)D concentrations measured using ECLIA in 292 healthy individuals aged 20-69 years. We observed a significant positive correlation between 25(OH)D concentrations and urinary vitamin D metabolite concentrations (r = 0.400, p < 0.001). Furthermore, in a multiple regression model with serum 25(OH)D concentrations as the dependent variable and urinary vitamin D metabolite concentrations, sex, age, body mass index (BMI), and vitamin D intake as independent variables, urinary vitamin D metabolite concentrations showed a significant positive association with serum 25(OH)D concentrations regardless of sex, age, BMI, and vitamin D intake. Additionally, receiver operating characteristic (ROC) curve analysis was performed to evaluate whether this multiple regression model could predict vitamin D deficiency. The area under the curve (AUC) was 0.743 and 0.708 for women and men with vitamin D deficiency (serum 25(OH)D < 20 ng/mL), respectively. Our results suggest that urinary vitamin D metabolite concentrations, measured by the NLucVDR assay, may be useful for the noninvasive predictive tool of vitamin D deficiency.

Link Between Ferritin, Vitamin D, Performance, and Eating Attitudes in Female Athletes

Iron and vitamin D deficiencies can affect athletes' health and performance. However, the epidemiology and associated risk factors remain unclear. Forty-three elite female athletics athletes (20.2±1.9 years) were included. A survey regarding the training schedule and Eating Attitudes Test-26, body composition, bone mineral density, and serum 25-hydroxyvitamin D (25(OH)D) and ferritin levels were assessed. Mean serum 25(OH)D and ferritin levels were 25.2±5.5 ng/mL and 29.0±13.2 ng/mL, respectively, and 83.7% and 41.9% of athletes had vitamin D and ferritin insufficiency, respectively. Serum 25(OH)D level was negatively correlated with the number of rest days per week (Coefficient,-6.19; 95% confidence interval [CI],-9.82--2.57; p=0.002), and serum ferritin level was negatively correlated with body mass index (Coefficient,-3.87; 95% CI,-7.57--0.16; p=0.041). Performance levels were positively correlated with serum vitamin D levels (Coefficients, 7.25; 95% CI, 0.25-14.25; p=0.043) and negatively correlated with EAT-26 scores (Coefficient,-7.30; 95% CI,-12.61--1.98; p=0.009) and body fat percentage (Coefficient,-13.26; 95% CI,-24.66--1.86; p=0.025). Vitamin D and ferritin insufficiencies are prevalent among Japanese female athletics athletes. Serum vitamin D level was related to performance level.

Accelerated bone loss in late reproductive-aged and perimenopausal women with vitamin D insufficiency

INTRODUCTION

The association between serum vitamin D levels and bone mineral density (BMD) varies by race and gender. This study aimed to evaluate this relationship between serum vitamin D levels and BMD, and changes of BMD over time in Korean women.

MATERIALS AND METHODS

We analyzed data from 586 generally healthy Korean women aged 29-79 who underwent health check-ups at Seoul National University Gangnam Center between 2010 and 2011 (baseline measurement) and 2015-2016 (follow-up). Dual energy X-ray absorptiometry (DEXA) and serum 25-hydroxyvitamin D (25OH-D) level measurements were conducted. We assessed the association between serum 25OH-D levels and BMD, as well as changes in BMD over time.

RESULTS

The mean age of participants was 51.3 ± 7.9 years, with a mean follow-up interval of 4.6 ± 0.7 years, and mean serum 25OH-D level of 20.6 ± 8.5 ng/ml. Baseline serum 25OH-D levels did not correlate with BMD values at the lumbar spine, femoral neck, or total femur, nor with changes in BMD over time. A significant negative association was found between perimenopausal status and BMD changes at all sites, and between premenopausal status and lumbar bone mass, compared to postmenopausal status in the 25OH-D < 20 ng/ml group. This association was not observed in women with higher serum 25OH-D levels.

CONCLUSIONS

Serum 25OH-D levels did not correlate with BMD levels or changes in BMD overall. However, in late reproductive-aged and perimenopausal women with serum 25OH-D insufficiency, there was a significant association with accelerated bone loss.

Association of Posttransplant Circulating 25-Hydroxyvitamin D and Late-Onset Infections Among Kidney Transplant Recipients: The Wisconsin Allograft Recipient Database (WisARD)

INTRODUCTION

Late-onset infection occurring more than 6 months after transplantation is a major threat to the long-term survival of kidney transplant recipients (KTRs). Accumulating evidence indicates a potential role for vitamin D in host resistance to infections. While vitamin D inadequacy is common among KTRs, the association of posttransplant circulating 25-hydroxyvitamin D [25(OH)D] and late-onset infection remains uncertain.

METHODS

We analyzed data from adult kidney-only transplant recipients at our center from 2005 to 2020 who had at least one valid posttransplant circulating 25(OH)D measurement from 5 to 13 months posttransplant. Survival analyses were conducted using marginal proportional rates models with late-onset infection within 1 year following the 25(OH)D measurement as the event of interest. Additional analyses used time-varying 25(OH)D measurements.

RESULTS

Of 2207 KTRs included, 642 recipients had a total of 1448 late-onset infection episodes. Each 5 ng/mL lower serum 25(OH)D was associated with a 5% higher risk of late-onset infection (adjusted rate ratio [aRR] = 1.05; 95% confidence interval [CI]: 1.03, 1.07; p < 0.01). Vitamin D deficiency (≤ 20 ng/mL) was associated with a 1.22-fold higher incidence of late-onset infection (aRR = 1.22; 95% CI: 1.03-1.43; p = 0.02) compared with vitamin D sufficiency (≥30 ng/mL). The association was strongest for urinary tract infection among male recipients (aRR = 2.20; 95% CI: 1.57-3.08; p < 0.01).

CONCLUSION

Vitamin D deficiency is significantly associated with a higher incidence of late-onset infection among KTRs, especially urinary tract infections in male recipients. Further research, including clinical trials, is needed to determine the causal relationship.

Comparison of vitamin D status in healthy Bangladeshi urban and rural individuals and their association with serum calcium and alkaline phosphatase: A pilot study

Vitamin D insufficiency is a worldwide problem that is likely underestimated since physical symptoms may only be apparent in individuals with severe deficiencies. Previously, people in South Asian countries were thought to be vitamin D sufficient because of plentiful sunshine, but vitamin D insufficiency has also been reported in these countries. In a South Asian country like Bangladesh, people living in the rural and urban parts of the country can have considerable differences in their sun exposure, types of clothing worn, and levels of air pollution. This pilot study aimed to explore the vitamin D status (measured by serum 25[OH]D) of healthy urban and rural Bangladeshi people and to examine the association of serum 25(OH)D concentration with calcium and alkaline phosphatase concentrations. A total of 101 apparently healthy adult individuals, aged 20-58 years, were enrolled from both urban and rural areas. The participants were selected from students, staff and patient attendants from the outpatient department (OPD) of Bangabandhu Sheikh Mujib Medical University and Mirsarai Upazila Health Complex, Chittagong. The overall rate of vitamin D insufficiency was 39.6% and of vitamin D deficiency was 51.5%. However, it was observed that the proportion of vitamin D-deficient participants in urban areas (70.6%) was more than double that of participants living in rural areas (32%) and that serum 25(OH)D concentrations were higher in rural compared to urban participants with similar sunlight exposure times. However, participants aged 50 years or more showed similar concentrations of serum vitamin D levels irrespective of their habitat. This pilot study highlights the need for further larger-scale studies in Bangladesh to determine the reasons for the high rates of vitamin D inadequacy overall and the differences between rural and urban populations.

A Comparison Between Severity-Dependent Protocol and Fixed-Dose Regimen of Oral Vitamin D Supplementation on Correction of Hypovitaminosis D Among Dialysis Patients

OBJECTIVE

Low vitamin D status is associated with either low muscle mass or impaired muscle function in dialysis patients. However, there is no consensus on how best to correct hypovitaminosis D, defined as serum 25-hydroxyvitamin D level <30 ng/mL, in patients with end-stage kidney disease (ESKD). This study investigated the effect of different vitamin D supplementation regimens on sarcopenia outcomes in dialysis patients.

METHODS

This was a prospective randomized controlled trial. ESKD patients treated with maintenance hemodialysis (HD) or peritoneal dialysis with low vitamin D status on a ratio of 1:1, were randomized to either receive oral ergocalciferol utilizing a severity-dependent treatment protocol for low vitamin D status suggested by the Kidney Disease Outcomes Quality Initiative as a control group or a fixed-dose regimen of 20,000 international units/week. The changes in muscle mass were measured by bioimpedance spectroscopy, muscle strength was assessed by a hand grip dynamometer, physical performance was determined by gait speed, and muscle-related biomarkers were examined.

RESULTS

A total of 76 dialysis patients were randomized (HD = 43.4%). Baseline characteristics, including age, dialysis vintage, and muscle parameters were similar. After supplementation, the average serum 25-hydroxyvitamin D levels in the severity-dependent and fixed-dose groups were significantly elevated from 14.5 ± 7.3 to 27.2 ± 13.2 ng/mL, P < .001 and from 15.1 ± 6.4 to 28.8 ± 11.5 ng/mL, P < .001, respectively, and did not differ between groups at 6 months (P = .60). Despite comparable energy and protein intake, the mean bioimpedance spectroscopy-derived total body muscle mass normalized to height squared was significantly increased at 6 months in the fixed-dose group (14.5 ± 3.3 to 15.3 ± 3.0 kg/m2, P = .03) compared with the severity-dependent protocol (13.5 ± 2.7 to 13.7 ± 2.9 kg/m2, P = .58). In the subgroup analysis, muscle mass improvement was statistically elevated in peritoneal dialysis patients (P = .01) while unaltered among HD patients (P = .88) in the fixed-dose group. Muscle strength, gait speed, and serum insulin-like growth factor-1 level, as the mediators of muscle cell growth, were not different between the two groups at 6 months (P > .05). Neither hypercalcemia nor hyperphosphatemia was found throughout the study.

CONCLUSION

A fixed-dose ergocalciferol supplementation demonstrates similar performance in the correction of low vitamin D status but better muscle mass improvement than a severity-dependent protocol among ESKD patients. Regular dosing intervals of weekly vitamin D supplementation appear to be a promising treatment for sarcopenia among patients undergoing dialysis.

The role of greenspace in vitamin D status: cross-sectional, observational evidence from the UK Biobank

BACKGROUND

Exposure to greenspace is associated with positive health outcomes. This relationship is poorly understood, with limited knowledge on the mechanisms through which greenspace affects health, including biomarkers of greenspace effects.

METHODS

We used data from the UK Biobank to examine the cross-sectional association between greenspace exposure and serum 25-hydroxyvitamin D [25(OH)D]. Greenspace was assessed in a 300- and 1000-m buffer of land cover around each participant's home location, while 25(OH)D was measured by chemiluminescent immunoassay. We used multinomial regression models accounting for individual and area-level covariates. Additionally, we conducted mediation analysis by physical activity and time spent outdoors and performed various stratifications and sensitivity analyses.

RESULTS

A total of 443 810 participants (mean age: 56.51 [SD: 8.1] years, 53.6% females) were included in the study. Compared to the first quartile (within 1000 m buffer of participants' home locations), we found positive associations between the highest quartile of greenspace and insufficient (OR: 1.16, 95% CI: 1.11, 1.21) and sufficient 25(OH)D (OR: 1.36, 95% CI: 1.30, 1.42) categories after adjusting for individual- and areal-level covariates. Other quartiles showed similar but smaller effect estimates. The observed association exhibited similar directionality when a 300 m buffer was used, and was more pronounced among males, and most deprived individuals. Physical activity and time spent outdoors partially explained the relationship between greenspace quartiles and sufficient serum 25(OH)D.

CONCLUSION

We found positive associations between greenspace quartiles and serum 25(OH)D categories. This has implications for greening policies aimed at reducing vitamin D deficiency through controlled sun exposure.

Vitamin D intake and status in children and adolescents: Comparing vegetarian, vegan, and omnivorous diets

AIM

This study aimed to evaluate papers analysing dietary intake, 25-hydroxyvitamin D (25(OH)D) concentrations and anthropometry in children on vegetarian, vegan and omnivorous diets, as research indicates all diets generally fall below recommended vitamin D intake.

METHODS

This mini review examined the vitamin D status of children aged 1-18 years by systematically searching PubMed, Google Scholar and Scopus databases from January 1, 2000, to December 31, 2023.

RESULTS

The review included nine studies published between 2000 and 2023. Four studies reported lower vitamin D intake in children on vegetarian and vegan diets compared to omnivores. Three studies reported lower 25(OH)D concentrations in children on vegetarian and vegan diets. Specifically, one study found lower concentrations in vegans compared to omnivores, another found lower concentrations in vegetarians and vegans not taking supplements and a third reported lower 25(OH)D concentrations in Asian children aged 3-4.5 years compared to Caucasian children. Three studies found no significant differences in 25(OH)D between diet groups. Three studies assessing anthropometry showed that vegetarians have similar body weight and height as omnivores.

CONCLUSION

Children across all dietary groups may have low vitamin D intakes; supplementation should be considered for those with inadequate sun exposure, especially those avoiding animal products.

Vitamin D deficiency in Mongolian men aged 15-49 years

We aimed to estimate the prevalence of vitamin D deficiency in Mongolian men aged from 15 to 49 years at the National level as part of the Fifth National Nutrition Survey in 2016. This was a cross-sectional survey, conducted between September and November in 21 aimags of 4 economic regions of the country, and also in Ulaanbaatar. Given the regional differences in lifestyle and nutritional status, the target populations were stratified into 5 strata based on their economic region and in Ulaanbaatar, with equal samples drawn from each stratum using a cluster-randomized sampling design. A representative sample of 30 clusters [villages] was randomly selected using Probability Proportional to Size [PPS] methodology in each of the 4 regions and in Ulaanbaatar for a total of 150 cluster units. The selection of survey participants differed for the three sampling regions. Household eligibility was based on having a child 0-59 months of age, living in the household which was randomly selected from each cluster for a total of 450 households in each region. Households with a child 0-59 months of age were selected from household lists available at the kheseg or bagh level. All men 15-49 years of age who resided in the selected households were also eligible to participate in the survey. Serum concentration of 25-hydroxyvitamin D [25(OH)D] were measured using an enzyme-linked fluorescence assay in 377 men aged 15-49 years. The overall mean serum level of 25(OH)D concentration was 22.26 ± 0.48 ng/mL (95 % CI 21.31-23.21). The mean serum 25(OH)D concentrations were 19.65 ± 0.32 ng/mL (95 % CI19.01-19.82), and 33.68 ± 0.49 ng/mL (95 % CI 32.72-34.64) in vitamin D deficient, and in vitamin D sufficient subjects, respectively. The prevalence of vitamin D deficiency was 83.5 % with no significant difference in the prevalence of vitamin D deficiency by age group, economic region, area, location, education, and wealth index quintile. The prevalence of men in this study who were overweight or obese was 48.8 % and 14.6 % respectively. Although no significant difference was found between vitamin D deficiency and obesity, vitamin D deficiency was higher among men aged 30-39 and 40-49 years old by age specific analyses. The men did not take vitamin D supplements, and there is currently no vitamin D food fortification in Mongolia. The findings of this survey showed that vitamin D deficiency in men is a public health problem in Mongolia. In conclusion, vitamin D deficiency are common in Mongolian men, which indicates the need for vitamin D screening and treatment, as well as for an increased use of vitamin D supplements and for implementing vitamin D food fortification programs.

The bone-heart axis in the pathogenesis of cardiovascular diseases: A narrative review

Cardiovascular diseases (CVDs) cause about 30% of deaths worldwide, increasing social and economic burden in our societies. Although the treatment of the canonical cardiovascular risk factors has reduced the impact of CVDs on morbidity and mortality in the past few years, they continue to represent a major health problem. The definition of the biological properties of the bone-heart axis has led to new insights in the pathogenesis of CVDs; hence, the aim of this review is to try to elucidate the role of this axis on the susceptibility to CVDs. There is evidence that the bone interacts with extra-skeletal organs, including the cardiovascular system, through its endocrine functions. Clinical and experimental data strongly indicate that the interplay between the bone and the cardiovascular system represents a future tool for the prevention, diagnosis and treatment of CVDs. The identification of these non-canonical cardiovascular risk factors could prompt pharmacological research towards new target therapy aimed at precision medicine.

The Impacts of Seasonal Factors on Psoriasis

Psoriasis is a chronic inflammatory skin condition driven by immune system dysfunction, genetic predisposition and environmental factors. Patients with psoriasis experience a well-known clinical phenomenon of 'winter severity and summer relief', in which seasonal environmental factors play critical roles in the onset and progression of psoriasis. These factors include temperature, humidity, infection, light exposure and psychological stress. Seasonal changes in temperature and humidity can compromise skin barrier function and exacerbate inflammatory responses, thereby worsening psoriasis symptoms. Notably, during the winter, decreased light exposure leads to reduced vitamin D (VD) levels, reaching their lowest levels from late winter to early spring. This decline in VD levels is associated with increased disease activity, greater disease severity and more frequent flare-ups in patients with psoriasis. During the winter, influenza and Streptococcus pneumoniae infections are more prevalent, which can further exacerbate psoriasis symptoms. Moreover, the environmental conditions in winter can trigger or intensify feelings of depression, which may adversely affect psoriasis through the brain-skin axis. In this comprehensive review, we thoroughly examined the influence of seasonal environmental factors on the incidence, recurrence and severity of psoriasis. By clarifying these complex relationships, we aimed to support the future development of more personalised and effective treatment and management strategies for patients with psoriasis.

Association between depression and vitamin D3 among the people attending private clinic in Ernakulam, Kerala, India

Background

Depression is a serious global public health issue due to its significant impact on well-being and quality of life. Since vitamin D3 is involved in more than simply bone health, there has been discussion over its potential link to depression. Despite growing evidence that there is a connection between vitamin D3 deficiency and depression, there is a lack of evidence from India. So this study aims to evaluate vitamin D deficiency and depression among patients attending private clinics in Ernakulam, Kerala, India.

Methods

The cross-sectional study investigated the association between vitamin D3 levels and depression. This study was approved by the institutional ethical committee of SRM School of Public Health, SRMIST, Kattankulathur, and Tamil Nadu. After getting informed consent from the patients the data regarding socio-demographic profile, Vitamin D and depression was acquired from the patients during their next consecutive follow-up. Participants without significant psychiatric problems or chronic illnesses between the ages of 18 and 49 were enrolled. Serum 25 (OH) D levels were tested, and depression was evaluated using the modified Beck Depression Inventory (BDI-II). Descriptive, Chi-square, and logistic regression analyses were done.

Results

The study was among the 126 participants. Depression was more common in those with low vitamin D3 levels than in those without it (67.2% vs. 32.8%). There is a significant association between depression and demographic variables such as age, gender, and occupation. Under logistic regression, age was found to be a significant predictor, the odds ratios showed that older adults had 12 times the odds of developing depression than younger adults. Males have 2.9 times the odds of developing depression than females.

Conclusion

This study shows that there is an association between vitamin D insufficiency and increased depression in Ernakulam, Kerala, India. The identification and treatment of depression should take into account vitamin D3 status since treating vitamin D3 insufficiency may have an impact on mental health outcomes. Prospective investigations ought to delve into longitudinal associations and encompass a range of demographics to reinforce causal deductions and overall applicability.

Redefining vitamin D status: Establishing population-based indirect reference intervals through big data analysis

OBJECTIVES

To establish accurate population-based reference intervals (RIs) for serum 25-hydroxyvitamin D [25(OH)D] using the refineR indirect method and real-world data (RWD), accounting for demographic, methodological, and seasonal factors.

METHODS

A retrospective analysis of 130,030 serum 25(OH)D samples collected from 2018 to 2022 at a tertiary hospital in Barcelona was performed. Samples were measured using VDSP-certified Liaison and Atellica immunoassays. The refineR algorithm was employed to establish RIs, utilizing Box-Cox transformations to adjust for data distribution. Demographic variables (sex and age), assay differences, medical department and seasonal variations were analysed. RIs were verified using a subset of healthy individuals.

RESULTS

The median serum 25(OH)D level was 25 ng/mL (62.5 nmol/L). Vitamin D deficiency (≤20 ng/mL, ≤50 nmol/L) was observed in 34.2% of samples, and severe deficiency (≤12 ng/mL, ≤30 nmol/L) in 12.6%. The default Box-Cox transformation estimated RIs of 11.5-64.5 ng/mL (28.7-161.2 nmol/L), while the modified Box-Cox transformation yielded RIs of 14.2-65.9 ng/mL (35.5-164.7 nmol/L). Women exhibited wider RIs (14.5-68.6 ng/mL, 36.2-171.5 nmol/L) compared to men (11.6-57.3 ng/mL, 29-143.2 nmol/L). Method-specific RIs were 10.2-58.6 ng/mL (25.5-146.5 nmol/L) for the Liaison assay and 9.9-59.3 ng/mL (24.7-133.2 nmol/L) for the Atellica assay. The lowest RIs were observed in outpatients (4.3-46.4 ng/mL, 10.7-116 nmol/L) and endocrinology patients (5.5-43.9 ng/mL, 13.7-109.7 nmol/L). Seasonal variation significantly impacted RIs, with higher levels during summer months.

CONCLUSIONS

The refineR algorithm effectively established population-based RIs for serum 25(OH)D in Barcelona, revealing significant demographic and seasonal variations. Redefining 25-hydroxyvitamin D thresholds based on population-specific data may reduce unnecessary screening and supplementation, minimizing associated risks. This study highlights the need for population-, seasonal-, and method-specific RIs to improve vitamin D assessment and management.

A randomized multi-arm open labelled comparative clinical trial report of Pankajakasthuri DiabetEaze powder, a novel polyherbal formulation on the nutritional management and glycemic control in type 2 diabetic and prediabetic patients

Background and aims

Recently Diabetes Mellitus (DM) has been associated with heightened susceptibility to malnutrition, suggesting that augmenting nutritional intake stands out as a potent therapeutic strategy for addressing malnutrition in individuals with DM. The aim of this clinical investigation was to evaluate the effect of DiabetEaze powder, a polyherbal nutritional formulation developed by us for nutritional management and glycaemic control, on patients with diabetic and prediabetic conditions.

Methods

A total of 143 type II diabetic (T2D) patients who were managing their diabetic condition through modern medicine, AYUSH medicine, lifestyle modification and 68 pre-diabetic patients, aged between 40 and 65 years, were randomly assigned into six groups: control, modern, AYUSH, lifestyle, prediabetic control and prediabetic trial. The treatment groups were administered 5 g of DiabetEaze powder two times a day after food for 6 months. Microminerals, vitamins, glycaemic parameters, Quality of Life (QoL), hematology, lipid profiles, Renal Function Test (RFT) and Liver Function Test (LFL) parameters, and electrolytes were evaluated at Day 0, Day 90, and Day 180.

Results

Out of 211 enrolled patients, 189 individuals successfully completed the entire 180-day duration of the study, indicating a retention rate of approximately 89.6 %. In our study, we observed a statistically significant elevation in the levels of vitamin D, B2, and B6 across all treatment groups. Besides, the treatment groups displayed a notable increase in zinc and manganese levels compared to the other minerals tested. Notably, the treatment groups demonstrated distinct mineral and vitamin profiles. In terms of metabolic markers, significant reductions in Fasting Blood Sugar (FBS)/Post Prandial Blood Sugar (PPBS) were observed across the modern, AYUSH, and lifestyle groups, while the modern group also showed a marked decrease in glycated haemoglobin (HbA1c) levels. Furthermore, overall QoL among the tested groups was also statistically significant. The consistent maintenance of normal LFT and RFT parameters and electrolyte levels across trial groups throughout the study duration indicates that the supplement does not induce liver toxicity or negatively impact hepatic function.

Conclusion

In conclusion, the nutrients present in the DiabetEaze powder contribute to the effective management of nutritional status in diabetic people and thus effectively reduce sugar spikes by regulating PPBS and HbA1c levels, which is a critical aspect of its role in diabetes management. These properties benefit in managing diabetes-related outcomes and overall quality of life.

Clinical trial registry of India under registration no

CTRI/2021/04/032956 on 20/04/2021.

The Role of Vitamin D in Rare Diseases-A Clinical Review

Background/Objectives: Patients suffering from rare diseases are particularly vulnerable to vitamin D deficiency. The role of vitamin D status in rare disease management remains insufficiently investigated and employed in routine clinical practice. Methods: This review analyses current data on vitamin D status in selected rare diseases of organs involved in vitamin D metabolism: skin (epidermolysis bullosa, morphea), liver (autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis), kidney (Alport syndrome, Fabry disease), and cystic fibrosis as a model of a systemic rare disease. Additionally, this review critically examines potential drug-vitamin D interactions in the context of rare disease patient polypharmacy. Results: Evidence suggests that vitamin D deficiency is prevalent in rare disease patient populations, often at once exacerbating and being simultaneously exacerbated by the underlying condition. Vitamin D deficiency correlates with worse clinical outcomes and lower quality of life across the examined diseases. Immunoregulatory properties of vitamin D appear relevant for rare diseases with autoimmune components. Conclusions: An urgent need for developing disease-specific clinical practice guidelines, implementing routine vitamin D monitoring in rare disease patient care, and introducing tailored supplementation under the principles of precision medicine is emphasized.

A multistage double-blind placebo-controlled study to assess the safety and efficacy of transdermal vitamin D phosphate supplementation (TransVitD)

BACKGROUND

Lifestyle changes have meant that it is problematic for many people across the globe to maintain adequate vitamin D concentrations. As UV-catalysed production in the skin, which uses vitamin D-binding protein to facilitate systemic absorption, is the primary source of vitamin D, it is questionable if oral supplementation of this vitamin is the optimal means to replace it. However, supplementing an oil-soluble vitamin via the skin is problematic as it gets stuck in the stratum corneum after topical application. This clinical study will test if a new vitamin D ester, vitamin D phosphate, which is more water-soluble compared to vitamin D, administered via a transdermal patch, can be used to improve vitamin D status.

METHOD

This is a two-part study comprising a dose-escalation with the vitamin D phosphate transdermal patch followed by a randomised, double-blind, placebo-controlled, multiarmed, multistage clinical trial. It is a single-centred, 12-week study that will enrol a maximum of 100 participants. The dose escalation study will monitor safety and tolerability using serum calcium and 25(OH)D3 levels. The blinded, randomised trial will test different dose frequencies for 4 weeks compared to a placebo. Then, after an interim analysis, the best dosing frequency will be assessed against a placebo. The primary outcome for the multistage clinical study will be the percentage change in 25(OH)D3 concentration in the serum (ng/mL) at weeks 4 and 8 compared to baseline. The secondary outcome measures include percentage change in serum vitamin D-binding protein levels, skin interstitial fluid biomarker concentrations, and nail appearance after 4 and 8 weeks compared to baseline.

DISCUSSION

This study will determine if a vitamin D phosphate transdermal patch can improve vitamin D status. In addition, it could provide a better understanding of how vitamin D is absorbed directly into the skin after application by measuring the serum vitamin D-binding protein and skin biomarker responses to transdermal supplementation.

TRIAL REGISTRATION

Clinical Trials.gov NCT06098846, registered on 23rd October 2023.

Age Difference in the Association Between Nutritional Status and Dynapenia in Older Adults

BACKGROUND

Although nutritional status plays a critical role in maintaining muscle strength, limited evidence exists regarding its association with dynapenia.

OBJECTIVES

We aimed to investigate the association between different nutritional statuses and dynapenia among Taiwanese older adults, and assessed whether age modifies this relationship.

METHODS

In this study, we enrolled individuals aged 65 years and older living in community settings through convenience sampling from 2020 to 2021, following a cross-sectional design. The Mini-Nutritional Assessment Short Form (MNA-SF) was used to assess whether the participants were at nutritional risk. Standardized assessments measured muscle strength (handgrip measurement), physical performance (6 m walking test), and muscle mass (bioelectrical impedance analysis) to confirm dynapenia classifications. The interaction terms were tested using likelihood ratio tests to examine for dynapenia between nutritional status and age. For overall sample and subgroup analyses, binary logistic regression was employed.

RESULTS

Among 211 participants (mean age: 80.7 ± 7.1 years), after adjusting for potential confounders, those at nutritional risk (OR: 3.11; 95% CI: 1.31-7.36) were positively associated with dynapenia, whereas higher MNA-SF scores (OR: 0.73; 95% CI: 0.57-0.93) were negatively associated. Interactions regarding dynapenia were observed between nutritional status and age group (p = 0.014), with nutritional risk significantly associated with dynapenia only in the old-old group (≥75 years) (OR = 4.11, 95% CI: 1.39-12.15).

CONCLUSIONS

Age is a potential moderator of nutritional status and dynapenia among older populations. Nutritional status appeared to be more profound in the old-old group in terms of the risk of dynapenia. These findings offer insights for monitoring nutritional status and implementing targeted interventions to prevent dynapenia in those aged over 75 years. Future studies using prospective designs should explore the underlying mechanisms linking nutritional status to dynapenia and assess the effectiveness of nutritional interventions in preventing muscle strength decline.

Vitamin D Supplementation and Allergic Rhinitis: A Systematic Review and Meta-Analysis

Background and Objectives: Vitamin D supplementation is effective for allergic rhinitis; however, its usefulness is unclear. We conducted a systematic review and meta-analysis to examine the conditions in which vitamin D supplementation was effective in allergic rhinitis management. Materials and Methods: Randomized controlled trials of vitamin D supplementation used for patients with allergic rhinitis were searched for across different databases. We extracted scores on patients' symptoms and the medication types used as the baseline treatments and performed a meta-analysis to evaluate the effect of vitamin D supplementation on allergic rhinitis symptoms. Meta-regression and subgroup analyses were performed for the average age, proportion of female participants, concomitant medications, vitamin D administration durations, and baseline serum 25-hydroxyvitamin D levels. Results: In total, 2389 articles were screened, and 5 randomized controlled trials (RCTs) were included in the meta-analysis. Compared with placebos, vitamin D supplementation alleviated allergic rhinitis symptoms, although the difference was not significant; there was significant heterogeneity among studies (standardized mean difference [SMD] = -2.69, 95% confidence interval [CI]: -6.20 to 0.82, I2 = 98%, p < 0.01). The proportion of female participants in the RCTs (slope: 0.21, p = 0.026) and concomitant corticosteroid use (slope: -9.16, p = 0.005) influenced the vitamin D response. Compared with the placebos, vitamin D supplementation without corticosteroids alleviated the allergic rhinitis symptoms (SMD = -0.56, 95% CI: -0.90 to -0.23). Combination treatment with corticosteroids also non-significantly alleviated symptoms. Additionally, the heterogeneity between studies was significant (SMD = -5.97, 95% CI: -13.55 to 1.16, I2 = 99%, p < 0.01). Conclusions: The study results suggest that vitamin D supplementation alleviates allergic rhinitis symptoms, although the effects differ according to the patient's sex and concomitant medications.

Exploring the link between fat-soluble vitamins and aging-associated immune system status: a literature review

The importance of vitamin D for a well-functioning immune system is becoming increasingly evident. Nevertheless, the other fat-soluble vitamins A, E and K also seem to play a central role regarding the adequate function of immune cells and to counteract excessive immune reactions and inflammatory processes. However, recognizing hidden hunger, particularly micronutrient deficiencies in vulnerable groups like the elderly, is crucial because older adults often lack sufficient micronutrients for various reasons. This review summarizes the latest findings on the immune modulating functions of fat-soluble vitamins in a physiological and pathophysiological context, provides a graphical comparison of the Recommended Daily Allowances between Deutschland, Austria, Confoederatio Helvetica (D-A-CH; eng. GSA, Germany, Switzerland, Austria), Deutsche Gesellschaft für Ernährung (DGE; eng. German Nutrition Society) and National Institutes of Health (NIH) across all age groups and, in particular, addresses the question regarding the benefits of supplementation of the respective micronutrients for the aging population of industrialized nations to strengthen the immune system. The following review highlights the importance of fat-soluble vitamins A, D, E and K which play critical roles in maintaining immune system function and, in some cases, in preventing excessive immune activation. Therefore, a better understanding of the relevance of adequate blood levels and consequently potential supplementation strategies may contribute to the prevention and management of infectious diseases as well as better overall health of the elderly.

Effect of Repeated Low-Dose UVR Exposure on Skin Inflammation Threshold, Skin Biomarkers, and Vitamin D in Healthy Adults

UVR can cause photoaging, skin burns, and skin cancer. The skin counters these effects through photoadaptation, which involves melanin production, skin thickening, and immune responses. This study investigated the effects of repeated, suberythemal low-dose UVR on the skin's inflammation threshold, assessed as minimal erythema dose, across different skin phototypes. In addition, epidermal and stratum corneum thickness, melanin index, erythema index, skin and blood levels of immunological biomarkers, and blood vitamin D3 25(OH) were measured. Over 9 weeks, 31 subjects were exposed to UVR (0.8 standard erythema dose) on the lower back 3 times per week. Results showed a 50% increase in minimal erythema dose, with a stronger effect in lighter phototypes. Increase in minimal erythema dose was paralleled by an increase in erythema index. Melanin index and stratum corneum thickness increased significantly by 12 and 34%, respectively, with melanin having a stronger effect on the minimal erythema dose increase. Vitamin D levels rose by 21%, adjusting for seasonal decline. Immunological markers of T helper 1/T helper 2 response and vascular markers declined, indicating local immunosuppression, although no systemic changes in immunological markers were observed. These findings suggest that even low UVR doses are sufficient to induce photoadaptation. Further research is needed to evaluate the long-term benefits and risks of this exposure.