101
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Impaired Height Growth Associated with Vitamin D Deficiency in Young Children from the Japan Environment and Children's Study. Nutrients 2022; 14:nu14163325. [PMID: 36014831 PMCID: PMC9415323 DOI: 10.3390/nu14163325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Vitamin D is essential for calcium absorption and bone homeostasis. Although short-stature children were reported to have low vitamin D concentrations, there is no clear evidence of a link between vitamin D and height growth in young children not limited to those with short stature. We collected height and weight data at 2 and 4 years of age, serum vitamin D concentrations at 4 years, and questionnaire results on sun exposure from the Japan Environment and Children’s Study (JECS). We then analyzed the relationship between vitamin D deficiency and height growth. We also analyzed the correlation between serum vitamin D concentration and sun exposure. Overall, 3624 participants from JECS were analyzed. We identified cases of subclinical vitamin D deficiency and insufficiency. We further found that definitive vitamin D deficiency (<10 ng/mL) impaired height growth by 0.6 cm per year even in young children not limited to those with short stature. Furthermore, we clarified that children with vitamin D deficiency had reduced outdoor activity, especially during winter. In children with either short or normal stature, definitive vitamin D deficiency was associated with height growth decline, and reduction in outdoor activity, especially during winter, was a risk factor for vitamin D deficiency.
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102
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Weller RB, Macintyre IM, Melville V, Farrugia M, Feelisch M, Webb DJ. The effect of daily UVA phototherapy for 2 weeks on clinic and 24-h blood pressure in individuals with mild hypertension. J Hum Hypertens 2022:10.1038/s41371-022-00729-2. [PMID: 35931819 DOI: 10.1038/s41371-022-00729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/21/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
Abstract
Latitude and season determine exposure to ultraviolet radiation and correlate with population blood pressure. Evidence for Vitamin D causing this relationship is inconsistent, and temperature changes are only partly responsible for BP variation. In healthy individuals, a single irradiation with 20 J/cm2 UVA mobilises NO from cutaneous stores to the circulation, causes arterial vasodilatation, and elicits a transient fall in BP. We, therefore, tested whether low-dose daily UVA phototherapy might be an effective treatment for mild hypertension. 13 patients with untreated high-normal or stage 1 hypertension (BP 130-159/85-99 mm Hg), confirmed by 24-h ambulatory blood pressure (ABP), were recruited. Using home phototherapy lamps they were either exposed to 5 J/cm2 full body UVA (320-410 nm) radiation each day for 14 days, or sham-irradiated with lamps filtered to exclude wavelengths <500 nm. After a washout period of 3 ± 1 week, the alternate irradiation was delivered. 24-h ABP was measured on day 0 before either irradiation sequence and on day 14. Clinic BP was recorded on day 0, and within 90 min of irradiation on day 14. There was no effect on 24-h ABP following UVA irradiation. Clinic BP shortly after irradiation fell with UVA (-8.0 ± 2.9/-3.8 ± 1.1 mm Hg p = 0.034/0.029) but not sham irradiation (1.1 ± 3.0/0.9 ± 1.5 mm Hg). Once daily low-dose UVA does not control mildly elevated BP although it produces a transient fall shortly after irradiation. More frequent exposure to UVA might be effective. Alternatively, UVB, which photo-releases more NO from skin, could be tried.
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Affiliation(s)
- Richard B Weller
- Centre for Inflammation Research and Edinburgh Skin Network, University of Edinburgh, Edinburgh, UK.
| | - Iain M Macintyre
- Department of Nephrology, Royal Infirmary of Edinburgh, Edinburgh, UK.,University Clinical Research Centre, Western General Hospital, Edinburgh, UK
| | - Vanessa Melville
- University Clinical Research Centre, Western General Hospital, Edinburgh, UK
| | - Michael Farrugia
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David J Webb
- University Clinical Research Centre, Western General Hospital, Edinburgh, UK.,Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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103
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Liu H, Shen X, Yu T, Wang Y, Cai S, Jiang X, Cai X. A putative causality of vitamin D in common diseases: A mendelian randomization study. Front Nutr 2022; 9:938356. [PMID: 35983488 PMCID: PMC9378956 DOI: 10.3389/fnut.2022.938356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Backgrounds Vitamin D is considered as a nutrient protecting individuals against an array of diseases based on observational studies. Such a protective effect, however, has not been demonstrated by randomized controlled trials. This study aims to explore a putative causal role of vitamin D in common diseases through a two-sample Mendelian randomization (MR) framework. Methods Circulating vitamin D was predicted by 41 genetic variants discovered in European populations. Common diseases were verified through two ways, using information from Japanese patients of Biobank Japan and using information from European patients of FinnGen project. We additionally validated the results by replacing vitamin D-associated instrumental variables (IVs) of European population with that of an independent Japanese population and of an independent Indian population. Inverse-variance weighted method was used as the primary analytical approach while a series of MR methods including MR-Egger regression, weighted median, maximum likelihood, MR-PRESSO and multivariate MR were adopted to guarantee MR model assumptions and to detect horizontal pleiotropy. Results Genetically predicted vitamin D was significantly associated with an increased risk of Graves' disease (OR = 1.71, 95%CI: 1.25-2.33, P = 0.001) and cataract (OR = 1.14, 95%CI: 1.03-1.28, P = 0.016); while with a decreased risk of esophageal cancer (OR = 0.66, 95%CI: 0.46-0.93, P = 0.019). This significant causal link between vitamin D and cataract was validated replacing IVs identified in the European population with those from Japanese population. No notable associations of vitamin D with other diseases were observed. Conclusions Our findings indicate a potential causal role of vitamin D in common diseases, which needs further validation.
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Affiliation(s)
- Hui Liu
- Zhejiang Provincial Key Laboratory of Laparoscopic Technology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xudan Shen
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Drug Metabolism and Pharmaceutical Analysis, Zhejiang University, Hangzhou, China
| | - Tunan Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yifan Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sheng Cai
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Drug Metabolism and Pharmaceutical Analysis, Zhejiang University, Hangzhou, China
| | - Xia Jiang
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Xiujun Cai
- Zhejiang Provincial Key Laboratory of Laparoscopic Technology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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104
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Brenner H, Schöttker B, Niedermaier T. Vitamin D
3
for reducing mortality from cancer and other outcomes before, during and beyond the COVID‐19 pandemic: A plea for harvesting low‐hanging fruit. Cancer Commun (Lond) 2022; 42:679-682. [PMID: 35792358 PMCID: PMC9395316 DOI: 10.1002/cac2.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/19/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research German Cancer Research Center (DKFZ) Heidelberg Baden‐Württemberg 69120 Germany
- Division of Preventive Oncology German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg Baden‐Württemberg 69120 Germany
- German Cancer Consortium (DKTK) German Cancer Research Center (DKFZ) Heidelberg Baden‐Württemberg 69120 Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research German Cancer Research Center (DKFZ) Heidelberg Baden‐Württemberg 69120 Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research German Cancer Research Center (DKFZ) Heidelberg Baden‐Württemberg 69120 Germany
- German Cancer Consortium (DKTK) German Cancer Research Center (DKFZ) Heidelberg Baden‐Württemberg 69120 Germany
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105
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Teo CB, Tan PY, Tay RYK, Khoo J, Watts GF, Loh WJ. Association Between Vitamin D Supplementation and Statin-Associated Muscle Symptoms: A Systematic Review. High Blood Press Cardiovasc Prev 2022; 29:337-351. [PMID: 35768686 DOI: 10.1007/s40292-022-00526-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Although low vitamin D levels are associated with statin-associated muscle symptoms (SAMS), it remains unclear if vitamin D supplementation leads to symptom improvement. AIM We performed a systematic review to evaluate the association of vitamin D supplementation with resolution of SAMS. METHODS We searched Medline (PubMed), Embase and Cochrane Library till 12 December 2021. Full length articles that reported on the association between vitamin D supplementation in adult patients with SAMS were included. RESULTS We identified 8 interventional studies comprising 669 participants. Majority of the participants were of Caucasian ethnicity and the mean age of participants ranged from 59.5 to 64.8 years old. The studies recruited patients with initial mean pre-treatment vitamin D levels ranging from 17.8 to 22.0ng/mL. Follow up duration ranged from 2 to 24 months and mean post-treatment vitamin D levels ranged from 34.3 to 56.0ng/mL. We found that vitamin D supplementation was associated with improved statin tolerance in 509 out of 606 (83.9%) patients across the 7 studies which reported patient numbers after supplementation (95% CI = 0.81-0.87, I2 = 72% n = 7). None of the studies were randomized controlled trials (RCTs) and hence placebo effect of vitamin D could not be ruled out. Nocebo effect of statin was also not assessed by any of the studies. CONCLUSION Vitamin D supplementation in patients with mild-moderate vitamin D insufficiency was associated with improvement of SAMS. However, quantitative efficacy analysis was not possible and this observed association is likely confounded by nocebo and placebo effects. RCTs are required to conclusively assess the utility of vitamin D supplementation in improving SAMS.
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Affiliation(s)
- Chong Boon Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pek Yan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ryan Yong Kiat Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joan Khoo
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Perth, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Wann Jia Loh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore.
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106
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Wan Z, Geng T, Li R, Chen X, Lu Q, Lin X, Chen L, Guo Y, Liu L, Shan Z, Pan A, Manson JE, Liu G. Vitamin D status, genetic factors, and risk of cardiovascular disease among individuals with type 2 diabetes: a prospective study. Am J Clin Nutr 2022; 116:1389-1399. [PMID: 35771998 DOI: 10.1093/ajcn/nqac183] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The presence of a threshold effect has been proposed, suggesting that beneficial effects from vitamin D supplementation may only be present when vitamin D concentration was below a particular threshold. OBJECTIVES To investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] concentrations and genetic factors with risks of total and subtypes of CVD in individuals with type 2 diabetes (T2D), among whom vitamin D deficiency or insufficiency is particularly common. METHODS This prospective study included 15,103 individuals with T2D, initially free of CVD and with serum 25(OH)D measurements in UK Biobank. Incidence of total and subtypes of CVD, including ischemic heart disease (IHD) and stroke, were ascertained via electronic health records. Weighted genetic risk scores (GRSs) were constructed for IHD and stroke, respectively. RESULTS The mean (standard deviation) of serum 25(OH)D concentration was 43.4 (20.4) nmol/L, and 65.7% participants had vitamin D below 50 nmol/L. During a median of 11.2 years of follow-up, 3,534 incident CVD events were documented. Compared with individuals with 25(OH)D <25 nmol/L, participants with 25(OH)D ≥75 nmol/L had an HR of 0.75 (0.64, 0.88) for CVD, 0.69 (0.56, 0.84) for IHD, and 0.74 (0.52, 1.06) for stroke. Participants with 25(OH)D ≥50 nmol/L and low GRS, as compared with individuals with 25(OH)D <25 nmol/L and high GRS, had a 50% (39%, 65%) lower risk of IHD. No significant interactions between serum 25(OH)D and the GRSs and genetic variants in vitamin D receptor (VDR) were demonstrated. CONCLUSIONS Higher serum 25(OH)D concentrations were significantly associated with lower risks of total CVD and IHD among patients with T2D, regardless of genetic susceptibility and genetic variants in VDR. Risk reductions tended to plateau at serum 25(OH)D levels around 50 nmol/L. These findings suggest that maintaining adequate vitamin D status and avoiding deficiency may help to prevent CVD complications among patients with T2D.
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Affiliation(s)
- Zhenzhen Wan
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Geng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Lu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanjun Guo
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liegang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhilei Shan
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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107
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Grant WB, Boucher BJ. An Exploration of How Solar Radiation Affects the Seasonal Variation of Human Mortality Rates and the Seasonal Variation in Some Other Common Disorders. Nutrients 2022; 14:2519. [PMID: 35745248 PMCID: PMC9228654 DOI: 10.3390/nu14122519] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
Many diseases have large seasonal variations in which winter overall mortality rates are about 25% higher than in summer in mid-latitude countries, with cardiovascular diseases and respiratory infections and conditions accounting for most of the variation. Cancers, by contrast, do not usually have pronounced seasonal variations in incidence or mortality rates. This narrative review examines the epidemiological evidence for seasonal variations in blood pressure, cardiovascular disease rates and respiratory viral infections in relation to atmospheric temperature and humidity, and solar UV exposure through vitamin D production and increased blood concentrations of nitric oxide. However, additional mechanisms most likely exist by which solar radiation reduces the risk of seasonally varying diseases. Some studies have been reported with respect to temperature without considering solar UV doses, although studies regarding solar UV doses, such as for respiratory infections, often consider whether temperature can affect the findings. More research is indicated to evaluate the relative effects of temperature and sun exposure on the seasonality of mortality rates for several diseases. Since solar ultraviolet-B (UVB) doses decrease to vanishingly small values at higher latitudes in winter, the use of safe UVB lamps for indoor use in winter may warrant consideration.
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Affiliation(s)
- William B. Grant
- Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA
| | - Barbara J. Boucher
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK;
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108
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Zhang N, Wang Y, Chen Z, Liu D, Tse G, Korantzopoulos P, Letsas KP, Goudis CA, Lip GYH, Li G, Zhang Z, Liu T. Circulating Vitamin D Concentrations and Risk of Atrial Fibrillation: A Mendelian Randomization Study Using Non-deficient Range Summary Statistics. Front Nutr 2022; 9:842392. [PMID: 35782933 PMCID: PMC9248862 DOI: 10.3389/fnut.2022.842392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background and Aims Vitamin D deficiency is a common disorder and has been linked with atrial fibrillation (AF) in several observational studies, although the causal relationships remain unclear. We conducted a Mendelian randomization (MR) analysis to determine the causal association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and AF. Methods and Results The analyses were performed using summary statistics obtained for single-nucleotide polymorphisms (SNPs) identified from large genome-wide association meta-analyses conducted on serum 25(OH)D (N = 79,366) and AF (N = 1,030,836). Six SNPs related to serum 25(OH)D were used as instrumental variables. The association between 25(OH)D and AF was estimated using both the fixed-effect and random-effects inverse variance weighted (IVW) method. The MR analyses found no evidence to support a causal association between circulating 25(OH)D level and risk of AF using random-effects IVW (odds ratio per unit increase in log 25(OH)D = 1.003, 95% CI, 0.841–1.196; P = 0.976) or fixed-effect IVW method (OR = 1.003, 95% CI, 0.876–1.148; P = 0.968). Sensitivity analyses yielded similar results. No heterogeneity and directional pleiotropy were detected. Conclusion Using summary statistics, this MR study suggests that genetically predicted circulating vitamin D concentrations, especially for a non-deficient range, were not causally associated with AF in the general population. Future studies using non-linear design and focusing on the vitamin D deficiency population are needed to further evaluate the causal effect of vitamin D concentrations on AF.
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Affiliation(s)
- Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yueying Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ziliang Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Daiqi Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Kent and Medway Medical School, Canterbury, United Kingdom
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | | | - Konstantinos P. Letsas
- Arrhythmia Unit, Laboratory of Cardiac Pacing and Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhiwei Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- *Correspondence: Zhiwei Zhang
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Tong Liu
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109
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Wu Z, Sluyter J, Liew OW, Chong JPC, Waayer D, Camargo CA, Richards AM, Scragg R. Effect of monthly vitamin D supplementation on cardiac biomarkers: A post-hoc analysis of a randomized controlled trial. J Steroid Biochem Mol Biol 2022; 220:106093. [PMID: 35272017 DOI: 10.1016/j.jsbmb.2022.106093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
The effects of vitamin D supplementation on cardiovascular diseases are controversial. Data on effects of vitamin D upon cardiac biomarkers, as surrogate endpoints of cardiovascular diseases, are limited and inconclusive. Therefore, we carried out a post-hoc analysis of sub-samples of a randomized, double-blinded, placebo-controlled trial with community-based older adults who were randomized to receive monthly 100,000-IU vitamin D or placebo, to determine effect of monthly vitamin D supplementation on high-sensitivity cardiac troponin I (hs-cTnI), troponin T (hs-cTnT) and N-terminal-pro-B-type natriuretic peptide (NT-proBNP). Adjusted relative difference (aRD) of follow-up geometric mean of biomarkers and adjusted relative risk (aRR) of elevated biomarkers between two groups were calculated. A total of 779 participants aged 50-84 y, randomized to vitamin D (n = 395) or placebo (n = 384) groups underwent sampling for measurement of plasma biomarkers at baseline and after one or two years treatment. Over a mean follow-up of 1.6 years, we did not find significant relative difference of geometric mean levels of three biomarkers at follow-up between vitamin D and placebo groups: hs-cTnI (aRD=1.03, 95%CI=0.97-1.09), hs-cTnT (aRD=0.99, 95%CI=0.95-1.04), and NT-proBNP (aRD=1.01, 95%CI=0.92-1.10). No significant differences were found in likelihood of clinically elevated biomarkers between two groups: hs-cTnI (aRR=0.92, 95%CI=0.51-1.69), hs-cTnT (aRR=1.11, 95%CI=0.86-1.42), and NT-proBNP (aRR=1.03,95%CI=0.89-1.20). However, among participants with initial low vitamin D status (<50 nmol/L, n = 200), follow-up NT-proBNP were significantly lower in the vitamin D group compared to placebo (geometric mean 75.9 vs 94.5 pg/mL, respectively; aRD=0.84, 95%CI=0.71-<1.00). The same results were observed for the NT-proBNP levels change from baseline between two groups. Overall, in older adults, monthly vitamin D supplementation did not reduce concentrations of hs-cTnI, hs-cTnT, and NT-proBNP. In those with low vitamin D status, vitamin D treatment was associated, on follow up and change from baseline, with lower plasma NT-proBNP compared with placebo. This potentially signals reduced risk of subsequent heart failure within this sub-group. However, we acknowledge that these findings need to be considered exploratory. Further research is required to replicate them.
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Affiliation(s)
- Zhenqiang Wu
- School of Population Health, University of Auckland, Auckland, New Zealand; Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.
| | - John Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Oi Wah Liew
- Cardiovascular Research Institute, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Jenny Pek Ching Chong
- Cardiovascular Research Institute, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Debbie Waayer
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A Mark Richards
- Cardiovascular Research Institute, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
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110
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Jaiswal V, Ishak A, Peng Ang S, Babu Pokhrel N, Shama N, Lnu K, Susan Varghese J, Storozhenko T, Ee Chia J, Naz S, Sharma P, Jaiswal A. Hypovitaminosis D and cardiovascular outcomes: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2022; 40:101019. [PMID: 35463916 PMCID: PMC9019228 DOI: 10.1016/j.ijcha.2022.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 11/02/2022]
Abstract
Background The relation between blood vitamin D levels and the risk of cardiovascular outcomes is debatable. To our knowledge this is the first comparative meta-analysis of more than 100,000 patients' data with the aim to inspect the relevance of low vitamin D levels with adverse cardiovascular events. Methods Online databases including PubMed, Embase and Cochrane Central were queried to compare the cardiovascular outcomes among hypovitaminosis D (HVD) and control group. The outcomes assessed included differences in major adverse cardiovascular events (MACE), mortality, myocardial infarction, and heart failure. Unadjusted odds ratios (OR) were calculated using a random-effect model with a 95% confidence interval (CI) and P less than 0.05 as a statistical significance. Results A total of 8 studies including 426,039 patients were included in this analysis. HVD group was associated with a higher incidence of MACE (OR 1.92, 95% CI 1.24 to 2.98, p = 0.003), while there was no significant association of HVD and all-cause mortality (OR 1.77, 95% CI 0.75 to 4.17, p = 0.19), risk of myocardial infarction (OR 0.69, 95% CI 0.39 to 1.24, p = 0.22), and heart failure (OR 1.20, 95% CI 0.34 to 4.25, p = 0.78). Conclusions This meta-analysis suggested that low blood levels of vitamin D are associated with MACE, but no such difference in all-cause mortality, myocardial infarction or heart failure was observed. Appropriate supplementation of vitamin D in selected populations might be cardioprotective in nature and warrants extensive trials.
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Affiliation(s)
| | - Angela Ishak
- European University Cyprus, School of Medicine, Nicosia, Cyprus
| | - Song Peng Ang
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | | | - Nishat Shama
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh
| | - Kriti Lnu
- Department of Internal Medicine, UPMC Harrisburg, PA, USA
| | | | - Tatyana Storozhenko
- Government Institution “L.T. Malaya Therapy National Institute NAMSU”, Kharkiv, Ukraine
| | - Jia Ee Chia
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | | | - Prachi Sharma
- Department of Cardiology, King George’s Medical University, Lucknow, India
| | - Akash Jaiswal
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India
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Morelli C, Rofei M, Riondino S, Fraboni D, Torino F, Orlandi A, Tesauro M, Del Vecchio Blanco G, Federici M, Arkenau HT, Formica V, Roselli M. Immune Response in Vitamin D Deficient Metastatic Colorectal Cancer Patients: A Player That Should Be Considered for Targeted Vitamin D Supplementation. Cancers (Basel) 2022; 14:2594. [PMID: 35681576 PMCID: PMC9179512 DOI: 10.3390/cancers14112594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 01/05/2023] Open
Abstract
Background: Vitamin D deficiency is a poor prognostic factor in metastatic colorectal cancer (mCRC); however, targeted supplementation trials have so far yielded limited results. We investigated clinical-laboratory parameters influencing vitamin D deficiency, with a particular focus on immune response, and the effect on survival. These parameters could help optimize targeted supplementation therapy. Methods: Association of plasma 25-hydroxyvitamin D (25(OH])D) with overall survival (OS) was assessed with the Hazard Ratio Smoothed Curve with Restricted Cubic Splines (HRSC-RCS) and maximally selected rank statistics (MSRS) in mCRC patients who underwent first-line chemotherapy. Several hematobiochemical variables were evaluated as predictors of vitamin D deficiency by means of Least Absolute Shrinkage and Selection Operator (LASSO) analysis. In a patient subset, peripheral lymphocyte subpopulations were also analyzed. Results: One hundred thirty-three mCRC patients were included. The median(m) baseline 25(OH)D was 10.8 ng/mL (range 3−53.4). HRSC-RCS revealed a linear association between 25(OH)D and OS. MSRS found 10 ng/mL as the optimal 25(OH)D cut-off. The median OS for 25(OH)D < 10 (n = 60) vs. > 10 ng/mL (n = 73) was 12.3 and 24.5 months, respectively (p = 0.002). The LASSO analysis identified high neutrophil-to-lymphocyte ratio (NLR > 3.5) as the strongest predictor of vitamin D deficiency (Odds Ratio 3.35, p 0.0009). Moreover, patients with low 25(OH)D levels (< 10 ng/mL) and high NLR (>3.5) had the shortest survival and patients with 25(OH)D >10 ng/mL and NLR <3.5 had the longest: mOS 8.1 and 28.1 months, respectively, HR 3.40 (1.76−6.59), p 0.0004. Besides the significant difference in NLR between 25(OH)D < and > 10 ng/mL patients (mNLR 3.6 vs. 2.9, p 0.03), the lymphocyte subpopulation analysis revealed that vitamin D deficiency was associated with high T- CD4+ (p = 0.04) and low B (p = 0.03) lymphocyte frequency. Conclusions: NLR is a powerful predictor of Vitamin D deficiency and can further help in stratifying prognosis. Vitamin D deficiency was associated with significant variations in peripheral immune cells. We hypothesize that integrated targeted interventions to both vitamin D and immune system would improve the prognosis of mCRC patients.
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Affiliation(s)
- Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Michela Rofei
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Daniela Fraboni
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Francesco Torino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Manfredi Tesauro
- Department of Internal Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | | | - Massimo Federici
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute, Cancer Institute, University College London, London W1G 6AD, UK;
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.R.); (F.T.); (M.R.)
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Liu Y, Yang D, Shi F, Wang F, Liu X, Wen H, Mubarik S, Yu C. Association of Serum 25(OH)D, Cadmium, CRP With All-Cause, Cause-Specific Mortality: A Prospective Cohort Study. Front Nutr 2022; 9:803985. [PMID: 35571939 PMCID: PMC9094577 DOI: 10.3389/fnut.2022.803985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/24/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction To explore the relationship between serum 25(OH)D, cadmium, and CRP with all-cause mortality among people in diabetic and non-diabetic. Methods This study used data from the NHANES (2001–2010). Cox regression was used to analyze the relationship between Serum 25(OH)D, cadmium, CRP, and all-cause, cause-specific mortality. We used restricted cubic splines to explore the dose-response relationship between serum 25(OH)D, cadmium, CRP, and all-cause mortality. Results During a mean follow-up of 9.1 years, the study included 20,221 participants, 2,945 people with diabetes, and 17,276 people without diabetes. Compared with serum 25(OH)D deficiency group in diabetic patients, the sufficient serum 25(OH)D group was associated with lower all-cause mortality (HR = 0.41, 95%CI 0.28-0.60, P < 0.001) and cardiovascular mortality (HR = 0.46, 95%CI 0.22–0.95, P = 0.04). Compared with the low cadmium group, the high cadmium group was associated with higher all-cause mortality (HR = 1.49, 95%CI 1.06–2.09, P = 0.02). Compared with the low CRP group, the high CRP group was associated with higher all-cause mortality (HR = 1.65, 95%CI 1.24–2.19, P = 0.001) and cancer mortality (HR = 3.25, 95%CI 1.82–5.80, P < 0.001). Restricted cubic splines analysis showed a significant nonlinear association between serum 25(OH)D (P-nonlinearity P < 0.001), cadmium (P-nonlinearity = 0.002), CRP (P-nonlinearity = 0.003), and HR for all-cause mortality risk in diabetic patients. The results were similar among non-diabetic patients, but with different levels of risk. Sensitivity analysis and subgroup analysis presented the results of population studies with different follow-up times, different genders and ages. Conclusions In diabetic patients, serum 25(OH)D, cadmium, and CRP were related to all-cause mortality; serum 25(OH)D was related to cardiovascular mortality; CRP was related to cancer mortality. The results were similar among non-diabetic patients, but with different levels of risk.
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Affiliation(s)
- Yan Liu
- School of Public Health, Wuhan University, Wuhan, China
| | - Donghui Yang
- School of Public Health, Wuhan University, Wuhan, China
| | - Fang Shi
- School of Public Health, Wuhan University, Wuhan, China
| | - Fang Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xiaoxue Liu
- School of Public Health, Wuhan University, Wuhan, China
| | - Haoyu Wen
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Chuanhua Yu
- School of Public Health, Wuhan University, Wuhan, China
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113
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Burgess S, Gill D. Genetic evidence for vitamin D and cardiovascular disease: choice of variants is critical. Eur Heart J 2022; 43:1740-1742. [PMID: 34972215 PMCID: PMC7614342 DOI: 10.1093/eurheartj/ehab870] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Stephen Burgess
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
- Genetics Department, Novo Nordisk Research Centre Oxford, Old Road Campus, Oxford OX3 7FZ, UK
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Bouillon R, Manousaki D, Rosen C, Trajanoska K, Rivadeneira F, Richards JB. Reply to 'The emerging evidence for non-skeletal health benefits of vitamin D supplementation in adults'. Nat Rev Endocrinol 2022; 18:324. [PMID: 35194177 DOI: 10.1038/s41574-022-00647-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Roger Bouillon
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Leuven, Belgium.
| | - Despoina Manousaki
- Research Center of the Sainte-Justine University Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Cliff Rosen
- Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Katerina Trajanoska
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Fernando Rivadeneira
- Translational Skeletal Genomics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - J Brent Richards
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Departments of Medicine, Human Genetics, Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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115
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Boucher BJ. Discrepancies between current guidance from NICE on the treatment of vitamin D deficiency and the recommended daily amounts [RDAs] for its prevention in the UK. Expert Rev Endocrinol Metab 2022; 17:201-203. [PMID: 35450494 DOI: 10.1080/17446651.2022.2067143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
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Vandebergh M, Dubois B, Goris A. Effects of Vitamin D and Body Mass Index on Disease Risk and Relapse Hazard in Multiple Sclerosis: A Mendelian Randomization Study. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/3/e1165. [PMID: 35393342 PMCID: PMC8990978 DOI: 10.1212/nxi.0000000000001165] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/06/2022] [Indexed: 01/14/2023]
Abstract
Background and Objectives Decreased vitamin D levels and obesity are associated with an increased risk for multiple sclerosis (MS). However, whether they also affect the disease course after onset remains unclear. With larger data sets now available, we used Mendelian randomization (MR) to determine whether serum 25-hydroxyvitamin D (25OHD) and body mass index (BMI) are causally associated with MS risk and, moving beyond susceptibility toward heterogeneity, with relapse hazard. Methods We used genetic variants from 4 distinct genome-wide association studies (GWASs) for serum 25OHD in up to 416,247 individuals and for BMI from a GWAS in 681,275 individuals. Applying 2-sample MR, we examined associations of 25OHD and BMI with the risk of MS, with summary statistics from the International Multiple Sclerosis Genetics Consortium GWAS in 14,802 MS cases and 26,703 controls. In addition, we examined associations with relapse hazard, with data from our GWAS in 506 MS cases. Results A 1-SD increase in genetically predicted natural-log transformed 25OHD levels decreased odds of MS up to 28% (95% CI: 12%–40%, p = 0.001) and decreased hazard for a relapse occurring up to 43% (95% CI: 15%–61%, p = 0.006). A 1-SD increase in genetically predicted BMI, corresponding to roughly 5 kg/m2, increased risk for MS with 30% (95% CI: 15%–47%, p = 3.76 × 10−5). On the contrary, we did not find evidence for a causal role of higher BMI with an increased hazard for occurrence of a relapse. Discussion This study supports causal effects of genetically predicted serum 25OHD concentrations and BMI on risk of MS. In contrast, serum 25OHD but not BMI is significantly associated with relapse hazard after onset. These findings might offer clinical implications for both prevention and treatment.
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Affiliation(s)
- Marijne Vandebergh
- From the Laboratory for Neuroimmunology (M.V., B.D., A.G.), Department of Neurosciences, Leuven Brain Institute, KU Leuven; and Department of Neurology (B.D.), University Hospitals Leuven, Belgium
| | - Bénédicte Dubois
- From the Laboratory for Neuroimmunology (M.V., B.D., A.G.), Department of Neurosciences, Leuven Brain Institute, KU Leuven; and Department of Neurology (B.D.), University Hospitals Leuven, Belgium
| | - An Goris
- From the Laboratory for Neuroimmunology (M.V., B.D., A.G.), Department of Neurosciences, Leuven Brain Institute, KU Leuven; and Department of Neurology (B.D.), University Hospitals Leuven, Belgium
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Niedermaier T, Gredner T, Kuznia S, Schöttker B, Mons U, Lakerveld J, Ahrens W, Brenner H. Vitamin D food fortification in European countries: the underused potential to prevent cancer deaths. Eur J Epidemiol 2022; 37:309-320. [PMID: 35524028 PMCID: PMC9187526 DOI: 10.1007/s10654-022-00867-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Meta-analyses of randomized controlled trials have shown that vitamin D supplementation reduces cancer mortality by 13%. Vitamin D fortification of foods may increase vitamin D levels in a similar manner as vitamin D supplementation and could achieve similar reductions in cancer mortality. Whereas some European countries already implemented widespread fortification of foods with vitamin D, in other countries only few or no foods are fortified. In this study, we estimated the reduction in cancer mortality presumably already achieved by current fortification policies in 2017 and the potential for further reductions if all countries had effective fortification. METHODS We reviewed scientific literature, publicly available information, and contacted health authorities to obtain information on current vitamin D food fortification policies in 34 European countries. Together with country-specific cancer death statistics from Eurostat, information on life expectancy, and country-specific fortification policies, we used data from studies on supplementation and serum 25(OH)D increases and cancer mortality to estimate numbers of probably already prevented cancer deaths and numbers of potentially further preventable deaths and years of life lost. RESULTS Current vitamin D fortification is estimated to prevent approximately 11,000 in the European Union and 27,000 cancer deaths in all European countries considered per year. If all countries considered here would implement adequate vitamin D fortification of foods, an estimated additional 129,000 cancer deaths (113,000 in the European Union) could be prevented, corresponding to almost 1.2 million prevented years of life lost (1.0 million in the EU) or approximately 9% of cancer deaths (10% in the EU). INTERPRETATION Systematic fortification of foods might considerably reduce the burden of cancer deaths in Europe.
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Affiliation(s)
- Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Thomas Gredner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Kuznia
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research (NAR), University of Heidelberg, Heidelberg, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cancer Prevention Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | - Wolfgang Ahrens
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research (NAR), University of Heidelberg, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Effects of Vitamin D Supplementation on 24-Hour Blood Pressure in Patients with Low 25-Hydroxyvitamin D Levels: A Randomized Controlled Trial. Nutrients 2022; 14:nu14071360. [PMID: 35405973 PMCID: PMC9003372 DOI: 10.3390/nu14071360] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Accumulating evidence suggests that potential cardiovascular benefits of vitamin D supplementation may be restricted to individuals with very low 25-hydroxyvitamin D (25(OH)D) concentrations; the effect of vitamin D on blood pressure (BP) remains unclear. We addressed this issue in a post hoc analysis of the double-blind, randomized, placebo-controlled Styrian Vitamin D Hypertension Trial (2011−2014) with 200 hypertensive patients with 25(OH)D levels <30 ng/mL. We evaluated whether 2800 IU of vitamin D3/day or placebo (1:1) for 8 weeks affects 24-hour systolic ambulatory BP in patients with 25(OH)D concentrations <20 ng/mL, <16 ng/mL, and <12 ng/mL and whether achieved 25(OH)D concentrations were associated with BP measures. Taking into account correction for multiple testing, p values < 0.0026 were considered significant. No significant treatment effects on 24-hour BP were observed when different baseline 25(OH)D thresholds were used (all p-values > 0.30). However, there was a marginally significant trend towards an inverse association between the achieved 25(OH)D level with 24-hour systolic BP (−0.196 per ng/mL 25(OH)D, 95% CI (−0.325 to −0.067); p = 0.003). In conclusion, we could not document the antihypertensive effects of vitamin D in vitamin D-deficient individuals, but the association between achieved 25(OH)D concentrations and BP warrants further investigations on cardiovascular benefits of vitamin D in severe vitamin D deficiency.
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Barrea L, Grant WB, Frias-Toral E, Vetrani C, Verde L, de Alteriis G, Docimo A, Savastano S, Colao A, Muscogiuri G. Dietary Recommendations for Post-COVID-19 Syndrome. Nutrients 2022; 14:1305. [PMID: 35334962 PMCID: PMC8954128 DOI: 10.3390/nu14061305] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/19/2022] Open
Abstract
At the beginning of the coronavirus disease (COVID-19) pandemic, global efforts focused on containing the spread of the virus and avoiding contagion. Currently, it is evident that health professionals should deal with the overall health status of COVID-19 survivors. Indeed, novel findings have identified post-COVID-19 syndrome, which is characterized by malnutrition, loss of fat-free mass, and low-grade inflammation. In addition, the recovery might be complicated by persistent functional impairment (i.e., fatigue and muscle weakness, dysphagia, appetite loss, and taste/smell alterations) as well as psychological distress. Therefore, the appropriate evaluation of nutritional status (assessment of dietary intake, anthropometrics, and body composition) is one of the pillars in the management of these patients. On the other hand, personalized dietary recommendations represent the best strategy to ensure recovery. Therefore, this review aimed to collect available evidence on the role of nutrients and their supplementation in post-COVID-19 syndrome to provide a practical guideline to nutritionists to tailor dietary interventions for patients recovering from COVID-19 infections.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, 80143 Naples, Italy;
- Italian Centre for the Care and Well-Being of Patients with Obesity (C.I.B.O), Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (S.S.); (A.C.); (G.M.)
| | - William B. Grant
- Sunlight, Nutrition and Health Research Center, San Francisco, CA 94164-1603, USA;
| | - Evelyn Frias-Toral
- School of Medicine, Universidad Católica Santiago de Guayaquil, Guayaquil 090615, Ecuador;
| | - Claudia Vetrani
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (L.V.); (G.d.A.); (A.D.)
| | - Ludovica Verde
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (L.V.); (G.d.A.); (A.D.)
| | - Giulia de Alteriis
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (L.V.); (G.d.A.); (A.D.)
| | - Annamaria Docimo
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (L.V.); (G.d.A.); (A.D.)
| | - Silvia Savastano
- Italian Centre for the Care and Well-Being of Patients with Obesity (C.I.B.O), Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (S.S.); (A.C.); (G.M.)
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (L.V.); (G.d.A.); (A.D.)
| | - Annamaria Colao
- Italian Centre for the Care and Well-Being of Patients with Obesity (C.I.B.O), Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (S.S.); (A.C.); (G.M.)
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (L.V.); (G.d.A.); (A.D.)
- UNESCO Chair “Education for Health and Sustainable Development”, University of Naples “Federico II”, 80131 Naples, Italy
| | - Giovanna Muscogiuri
- Italian Centre for the Care and Well-Being of Patients with Obesity (C.I.B.O), Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (S.S.); (A.C.); (G.M.)
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (L.V.); (G.d.A.); (A.D.)
- UNESCO Chair “Education for Health and Sustainable Development”, University of Naples “Federico II”, 80131 Naples, Italy
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Bouillon R, Antonio L, Olarte OR. Calcifediol (25OH Vitamin D3) Deficiency: A Risk Factor from Early to Old Age. Nutrients 2022; 14:nu14061168. [PMID: 35334824 PMCID: PMC8949915 DOI: 10.3390/nu14061168] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
Vitamin D deficiency is the main cause of nutritional rickets in children and osteomalacia in adults. There is consensus that nutritional access to vitamin D can be estimated by measuring serum concentrations of 25OHD and vitamin D deficiency can thus be considered as calcifediol deficiency. However, the threshold for vitamin D/calcifediol sufficiency remains a matter of debate. Vitamin D/calcifediol deficiency has been associated with musculoskeletal effects but also multiple adverse extra-skeletal consequences. If these consequences improve or if they can be treated with vitamin D supplementation is still unclear. Observational studies suggest a higher infection risk in people with low calcifediol levels. There is also a consistent association between serum calcifediol and cardiovascular events and deaths, but large-scale, long-term intervention studies did not show any benefit on cardiovascular outcomes from supplementation, at least not in subjects without clear vitamin D deficiency. Cancer risk also did not change with vitamin D treatment, although there are some data that higher serum calcifediol is associated with longer survival in cancer patients. In pregnant women, vitamin D supplementation decreases the risk of pre-eclampsia, gestational diabetes mellitus, and low birth weight. Although preclinical studies showed that the vitamin D endocrine system plays a role in certain neural cells as well as brain structure and function, there is no evidence to support a beneficial effect of vitamin D in neurodegenerative diseases. Vitamin D supplementation may marginally affect overall mortality risk especially in elderly subjects with low serum calcifediol concentrations.
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Affiliation(s)
- Roger Bouillon
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, Catholic University of Leuven, 3000 Leuven, Belgium;
- Correspondence:
| | - Leen Antonio
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, Catholic University of Leuven, 3000 Leuven, Belgium;
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Oscar Rosero Olarte
- Clinical Endocrinology, Asociación Colombiana de Osteoporosis, Bogotá 500005, Colombia;
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Grübler MR, Bischoff-Ferrari HA, Pilz S. Dose-response relationships for vitamin D and all-cause mortality. Lancet Diabetes Endocrinol 2022; 10:158. [PMID: 35202589 DOI: 10.1016/s2213-8587(22)00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Martin R Grübler
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich 8006, Switzerland; Royal Brompton Hospital, London, UK; Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | | | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Burgess S, Butterworth AS. Dose-response relationships for vitamin D and all-cause mortality - Authors' reply. Lancet Diabetes Endocrinol 2022; 10:158-159. [PMID: 35202588 DOI: 10.1016/s2213-8587(22)00015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen Burgess
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, UK.
| | - Adam S Butterworth
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB2 0SR, UK; BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
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Janjusevic M, Fluca AL, Gagno G, Pierri A, Padoan L, Sorrentino A, Beltrami AP, Sinagra G, Aleksova A. Old and Novel Therapeutic Approaches in the Management of Hyperglycemia, an Important Risk Factor for Atherosclerosis. Int J Mol Sci 2022; 23:ijms23042336. [PMID: 35216451 PMCID: PMC8878509 DOI: 10.3390/ijms23042336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/13/2022] Open
Abstract
Hyperglycemia is considered one of the main risk factors for atherosclerosis, since high glucose levels trigger multiple pathological processes, such as oxidative stress and hyperproduction of pro-inflammatory mediators, leading to endothelial dysfunction. In this context, recently approved drugs, such as glucagon-like-peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), could be considered a powerful tool for to reduce glucose concentration and cardiovascular risk. Interestingly, many patients with type 2 diabetes mellitus (T2DM) and insulin resistance have been found to be deficient in vitamin D. Recent studies pointed out the unfavorable prognostic values of T2DM and vitamin D deficiency in patients with cardiac dysfunction, either when considered individually or together, which shed light on the role of vitamin D in general health status. New evidence suggests that SGLT2i could adversely affect the production of vitamin D, thereby increasing the risk of fractures, which are common in patients with T2DM. Therefore, given the biological effects of vitamin D as an anti-inflammatory mediator and a regulator of endothelial function and calcium equilibrium, these new findings should be taken into consideration as well. The aim of this review is to gather the latest advancements regarding the use of antidiabetic and antiplatelet drugs coupled with vitamin D supplementation to control glucose levels, therefore reducing the risk of coronary artery disease (CAD).
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Affiliation(s)
- Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Laura Padoan
- Cardiology and Cardiovascular Physiopathology, Azienda Ospedaliero-Universitaria S. Maria Della Misericordia, 06156 Perugia, Italy;
| | - Annamaria Sorrentino
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | | | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
| | - Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Deparment of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy; (M.J.); (A.L.F.); (G.G.); (A.P.); (A.S.); (G.S.)
- Correspondence: or ; Tel.: +39-3405507762; Fax: +39-040-3994878
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Grant WB, Al Anouti F, Boucher BJ, Dursun E, Gezen-Ak D, Jude EB, Karonova T, Pludowski P. A Narrative Review of the Evidence for Variations in Serum 25-Hydroxyvitamin D Concentration Thresholds for Optimal Health. Nutrients 2022; 14:639. [PMID: 35276999 PMCID: PMC8838864 DOI: 10.3390/nu14030639] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/18/2022] Open
Abstract
Vitamin D3 has many important health benefits. Unfortunately, these benefits are not widely known among health care personnel and the general public. As a result, most of the world's population has serum 25-hydroxyvitamin D (25(OH)D) concentrations far below optimal values. This narrative review examines the evidence for the major causes of death including cardiovascular disease, hypertension, cancer, type 2 diabetes mellitus, and COVID-19 with regard to sub-optimal 25(OH)D concentrations. Evidence for the beneficial effects comes from a variety of approaches including ecological and observational studies, studies of mechanisms, and Mendelian randomization studies. Although randomized controlled trials (RCTs) are generally considered the strongest form of evidence for pharmaceutical drugs, the study designs and the conduct of RCTs performed for vitamin D have mostly been flawed for the following reasons: they have been based on vitamin D dose rather than on baseline and achieved 25(OH)D concentrations; they have involved participants with 25(OH)D concentrations above the population mean; they have given low vitamin D doses; and they have permitted other sources of vitamin D. Thus, the strongest evidence generally comes from the other types of studies. The general finding is that optimal 25(OH)D concentrations to support health and wellbeing are above 30 ng/mL (75 nmol/L) for cardiovascular disease and all-cause mortality rate, whereas the thresholds for several other outcomes appear to range up to 40 or 50 ng/mL. The most efficient way to achieve these concentrations is through vitamin D supplementation. Although additional studies are warranted, raising serum 25(OH)D concentrations to optimal concentrations will result in a significant reduction in preventable illness and death.
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Affiliation(s)
- William B. Grant
- Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA
| | - Fatme Al Anouti
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi 144534, United Arab Emirates;
| | - Barbara J. Boucher
- The Blizard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London E12AT, UK;
| | - Erdinç Dursun
- Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey; (E.D.); (D.G.-A.)
| | - Duygu Gezen-Ak
- Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey; (E.D.); (D.G.-A.)
| | - Edward B. Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Fountain Street, Ashton-under-Lyne OL6 9RW, UK;
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Manchester Metropolitan University, All Saints Building, Manchester M15 6BH, UK
| | - Tatiana Karonova
- Clinical Endocrinology Laboratory, Department of Endocrinology, Almazov National Medical Research Centre, 194021 Saint-Petersburg, Russia;
| | - Pawel Pludowski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children’s Memorial Health Institute, 04730 Warsaw, Poland;
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Neale RE, Baxter C, Romero BD, McLeod DSA, English DR, Armstrong BK, Ebeling PR, Hartel G, Kimlin MG, O'Connell R, van der Pols JC, Venn AJ, Webb PM, Whiteman DC, Waterhouse M. The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality. Lancet Diabetes Endocrinol 2022; 10:120-128. [PMID: 35026158 DOI: 10.1016/s2213-8587(21)00345-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effect of supplementing unscreened adults with vitamin D3 on mortality is unclear. We aimed to determine whether monthly doses of vitamin D3 influenced mortality in older Australians. METHODS We did a randomised, double-blind, placebo-controlled trial of oral vitamin D3 supplementation (60 000 IU per month) in Australians 60 years or older who were recruited across the country via the Commonwealth electoral roll. Participants were randomly assigned (1:1), using automated computer-generated permuted block randomisation, to receive one oral gel capsule of either 60 000 IU vitamin D3 or placebo once a month for 5 years. Participants, staff, and investigators were blinded to study group allocation. The primary endpoint was all-cause mortality assessed in all participants who were randomly assigned. We also analysed mortality from cancer, cardiovascular disease, and other causes. Hazard ratios (HRs) and 95% CIs were generated using flexible parametric survival models. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000743763. FINDINGS Between Feb 14, 2014, and June 17, 2015, we randomly assigned 21 315 participants, including 10 662 to the vitamin D group and 10 653 to the placebo group. In 4441 blood samples collected from randomly sampled participants (N=3943) during follow-up, mean serum 25-hydroxy-vitamin D concentrations were 77 (SD 25) in the placebo group and 115 (SD 30) nmol/L in the vitamin D group. Following 5 years of intervention (median follow-up 5·7 years [IQR 5·4-6·7]), 1100 deaths were recorded (placebo 538 [5·1%]; vitamin D 562 [5·3%]). 10 661 participants in the vitamin D group and 10 649 participants in the placebo group were included in the primary analysis. Five participants (one in the vitamin D group and four in the placebo group) were not included as they requested to be withdrawn and their data to be destroyed. The HR of vitamin D3 effect on all-cause mortality was 1.04 [95% CI 0·93 to 1·18]; p=0·47)and the HR of vitamin D3 effect on cardiovascular disease mortality was 0·96 (95% CI 0·72 to 1·28; p=0·77). The HR for cancer mortality was 1·15 (95% CI 0·96 to 1·39; p=0·13) and for mortality from other causes it was 0·83 (95% CI 0·65 to 1·07; p=0·15). The odds ratio for the per-protocol analysis was OR 1·18 (95% CI 1·00 to 1·40; p=0·06). In exploratory analyses excluding the first 2 years of follow-up, those randomly assigned to receive vitamin D had a numerically higher hazard of cancer mortality than those in the placebo group (HR 1·24 [95% CI 1·01-1·54]; p=0·05). INTERPRETATION Administering vitamin D3 monthly to unscreened older people did not reduce all-cause mortality. Point estimates and exploratory analyses excluding the early follow-up period were consistent with an increased risk of death from cancer. Pending further evidence, the precautionary principle would suggest that this dosing regimen might not be appropriate in people who are vitamin D-replete. FUNDING The D-Health Trial is funded by National Health and Medical Research Council.
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Affiliation(s)
- Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Catherine Baxter
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Briony Duarte Romero
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Donald S A McLeod
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Dallas R English
- Melbourne School of Population Health, University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Bruce K Armstrong
- School of Public Health, University of Sydney, Sydney, Australia; School of Global and Population Health, University of Western Australia, Perth, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Gunter Hartel
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Michael G Kimlin
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Rachel O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mary Waterhouse
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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126
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Critical Appraisal of Large Vitamin D Randomized Controlled Trials. Nutrients 2022; 14:nu14020303. [PMID: 35057483 PMCID: PMC8778517 DOI: 10.3390/nu14020303] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
As a consequence of epidemiological studies showing significant associations of vitamin D deficiency with a variety of adverse extra-skeletal clinical outcomes including cardiovascular diseases, cancer, and mortality, large vitamin D randomized controlled trials (RCTs) have been designed and conducted over the last few years. The vast majority of these trials did not restrict their study populations to individuals with vitamin D deficiency, and some even allowed moderate vitamin D supplementation in the placebo groups. In these RCTs, there were no significant effects on the primary outcomes, including cancer, cardiovascular events, and mortality, but explorative outcome analyses and meta-analyses revealed indications for potential benefits such as reductions in cancer mortality or acute respiratory infections. Importantly, data from RCTs with relatively high doses of vitamin D supplementation did, by the vast majority, not show significant safety issues, except for trials in critically or severely ill patients or in those using very high intermittent vitamin D doses. The recent large vitamin D RCTs did not challenge the beneficial effects of vitamin D regarding rickets and osteomalacia, that therefore continue to provide the scientific basis for nutritional vitamin D guidelines and recommendations. There remains a great need to evaluate the effects of vitamin D treatment in populations with vitamin D deficiency or certain characteristics suggesting a high sensitivity to treatment. Outcomes and limitations of recently published large vitamin D RCTs must inform the design of future vitamin D or nutrition trials that should use more personalized approaches.
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Harse JD, Zhu K, Bucks RS, Hunter M, Lim EM, Cooke BR, Walsh JP, Murray K. Investigating Potential Dose-Response Relationships between Vitamin D Status and Cognitive Performance: A Cross-Sectional Analysis in Middle- to Older-Aged Adults in the Busselton Healthy Ageing Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010450. [PMID: 35010710 PMCID: PMC8744852 DOI: 10.3390/ijerph19010450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 01/20/2023]
Abstract
Low vitamin D status has been linked to adverse cognitive outcomes in older adults. However, relationships at higher levels remain uncertain. We aimed to clarify patterns of association between vitamin D status and cognitive performance, using flexible regression methods, in 4872 middle- to older-aged adults (2678 females) from the Busselton Healthy Ageing Study. Cross-sectional associations of serum levels of 25-hydroxyvitamin D (25OHD) and performance in cognitive domains were modelled using linear regression and restricted cubic splines, controlling for demographic, lifestyle, and health factors. Mean ± SD serum 25OHD levels were 78 ± 24 nM/L for women and 85 ± 25 nM/L for men. Increasing levels in women were associated with better global cognition (linear trend, p = 0.023) and attention accuracy (continuity of attention), with improvement in the latter plateauing around levels of 80 nM/L (nonlinear trend, p = 0.035). In men, increasing levels of serum 25OHD were associated with better attention accuracy (linear trend, p = 0.022), but poorer semantic verbal fluency (linear trend, p = 0.025) and global cognition (nonlinear trend, p = 0.015). We identified patterns of association between serum 25OHD levels and cognitive performance that may reflect early dose–response relationships, particularly in women. Longitudinal analyses extending through to older ages may help to clarify the nature, strength, and temporality of these relationships.
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Affiliation(s)
- Janis D. Harse
- School of Population and Global Health, University of Western Australia, Perth 6009, Australia; (M.H.); (K.M.)
- Correspondence:
| | - Kun Zhu
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth 6009, Australia; (K.Z.); (E.M.L.); (J.P.W.)
- Discipline of Internal Medicine, Medical School, University of Western Australia, Perth 6009, Australia
| | - Romola S. Bucks
- School of Psychological Science, University of Western Australia, Perth 6009, Australia;
| | - Michael Hunter
- School of Population and Global Health, University of Western Australia, Perth 6009, Australia; (M.H.); (K.M.)
- Busselton Population and Medical Research Institute, Busselton 6280, Australia
| | - Ee Mun Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth 6009, Australia; (K.Z.); (E.M.L.); (J.P.W.)
- PathWest Laboratory Medicine, Department of Clinical Biochemistry, Queen Elizabeth II Medical Centre, Perth 6009, Australia
| | - Brian R. Cooke
- PathWest Laboratory Medicine, Department of Clinical Biochemistry, Fiona Stanley Hospital, Perth 6150, Australia;
| | - John P. Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth 6009, Australia; (K.Z.); (E.M.L.); (J.P.W.)
- Discipline of Internal Medicine, Medical School, University of Western Australia, Perth 6009, Australia
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth 6009, Australia; (M.H.); (K.M.)
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Hujoel PP. How a Nutritional Deficiency Became Treated with Fluoride. Nutrients 2021; 13:4361. [PMID: 34959913 PMCID: PMC8706833 DOI: 10.3390/nu13124361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
Ignoring evidence on causes of disease such as smoking can harm public health. This report explores how public health experts started to ignore evidence that pediatric vitamin D deficiencies are associated with dental caries. Historical analyses show that an organization of clinical specialists, the American Dental Association (ADA), initiated this view. The ADA was a world-leading organization and its governing bodies worked through political channels to make fluoride a global standard of care for a disease which at the time was viewed as an indicator of vitamin D deficiencies. The ADA scientific council was enlisted in this endeavor and authorized the statement saying that "claims for vitamin D as a factor in tooth decay are not acceptable". This statement was ghost-written, the opposite of what the ADA scientific council had endorsed for 15 years, and the opposite of what the National Academy of Sciences concluded. Internal ADA documents are informative on the origin of this scientific conundrum; the ADA scientific council had ignored their scientific rules and was assisting ADA governing bodies in conflicts with the medical profession on advertising policies. The evidence presented here suggests that professional organizations of clinical specialists have the power to create standards of care which ignore key evidence and consequently can harm public health.
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Affiliation(s)
- Philippe P. Hujoel
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98105, USA;
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA 98105, USA
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