Vitamin D deficiency

Enhancing the Design of Nutrient Clinical Trials for Disease Prevention-A Focus on Vitamin D: A Systematic Review

OBJECTIVES

This systematic review (SR) highlights principles for nutrient clinical trials and explore the diverse physiological functions of vitamin D beyond its traditional role in the musculoskeletal system related to clinical study designs.

BACKGROUND

Thousands of published research articles have investigated the benefits of vitamin D (a nutrient example taken in this SR) beyond the musculoskeletal system, including the immune, pulmonary, and cardiovascular systems; pregnancy; autoimmune disorders; and cancer. They illustrated vitamin D's molecular mechanisms, interactions, and genomic and nongenomic actions.

METHODS

This SR was designed to identify shortcomings in clinical study designs, statistical methods, and data interpretation that led to inconsistent findings in vitamin D-related publications. SR also highlights examples and insights into avoiding study design errors in future clinical studies, including randomized controlled clinical trials (RCTs). The SR adheres to the latest PRISMA statement, guidelines, and the PICOS process.

RESULTS

Inappropriate or flawed study designs were frequent in clinical trials. Major failures discussed here include too short clinical study duration, inadequate or infrequent doses, insufficient statistical power, failure to measure baseline and achieved levels, and recruiting vitamin D-sufficient participants. These design errors have led to misleading interpretations. Thus, conclusions from such studies should not be generalized or used in guidelines, recommendations, or policymaking.

CONCLUSION

Adequately powered epidemiological studies and RCTs with sufficient vitamin D and duration in individuals with vitamin D deficiency reported favorable clinical outcomes, enriching the literature, enabling to understand its physiology and mechanisms. Proper study designs with rigorous methodologies and cautious interpretation of outcomes are crucial in advancing the nutrient field. The principles discussed apply not only to vitamin D, but also other micro-nutrients and nutraceutical research. Adhering to them enhances the credibility and reliability of clinical trials, SRs, and meta-analysis outcomes. The study emphasizes the importance of focused, hypothesis-driven, well-designed, statistically powered RCTs to explore the diverse benefits of nutrients, conducted in index nutrient deficient participants, and avoidance of study design errors. Findings from such studies should be incorporated into clinical practice, policymaking, and public health guidelines, improving the health of the nation and reducing healthcare costs.

Effects of vitamin D3 supplementation on the recovery of hospitalized burn patients: a randomized double-blind controlled trial

BACKGROUND

Burn patients, due to their damaged skin, may not be able to synthesize vitamin D. In this study, we aimed to evaluate the effects of vitamin D supplementation on the recovery of hospitalized burn patients.

METHODS

Fifty-four patients participated in a randomized controlled trial. Eighteen patients were randomly assigned to group C (control, received gelatin soft gel as placebo), 18 patients to group D1 (received 1000 IU/day vitamin D), and 18 patients to group D2 (received 3000 IU/day vitamin D). After supplementation, wound biopsy and blood samples were obtained from the patients. Weight, height, 25(OH)D level, wound healing, scar formation, quality of pain, and blood parameters were evaluated.

RESULTS

There were no significant differences in the serum vitamin D levels between the groups at admission (P = 0.52), and 81.5% of the participants were deficient, with a noteworthy increase during study in supplemented groups (P < 0.001). The Bates-Jensen Wound Assessment Tool demonstrated significant differences in wound healing between the C group and the D1 and D2 groups (P = 0.003), and the supplemented groups experienced greater improvement. The D2 group showed significant differences in thickness and total score on the Vancouver scar scale up to three months after discharge (P = 0.03). Moreover, there was a notable decrease in insulin requirements and the number of injected insulin units in the supplemented groups compared with those in group C (P = 0.006 and P = 0.01, respectively). In addition, shorter hospitalization was observed in group D2 (P = 0.04).

CONCLUSION

Supplementation with vitamin D at doses of 1000 and 3000 IU/day improved wound healing and decreased scar thickness as well as exogenous insulin requirements. Overall, at 3000 IU/day, better results were achieved than at 1000 IU/day.

TRIAL REGISTRATION

This article is registered in 24/04/2020 on the Iranian Randomized Clinical Trials Registry (trial registration number (IRCT, code: IRCT20200420047141N1.

Problems in Commercial Kits of 25-Hydroxy Vitamin D and the Development of Simple, Robust and Faster HPLC Method

Vitamin D is a lipid-soluble compound that plays a key role in bone mineral metabolism. The commercial current kits and several published assay methods (High-performance liquid chromatography (HPLC) and Immunoassay) are complicated due to the use of multiple reagents, larger sample volume, high backpressure, longer extraction time, evaporation under nitrogen after extraction, significant interference and antibody cross-reactivity. Here we report a new HPLC method for the determination of 25-hydroxyvitamin D2 (25-OHD2) and 25-hydroxyvitamin D3 (25-OHD3) that is simple (no evaporation), rapid (10-minute run time) and robust. Serum sample (300 μl) is mixed with 300 μl acetonitrile containing lauraphenone as internal standard. After vortexing and centrifugation, the supernatant was loaded into C18 extraction cartridges, washed with 70% methanol and then eluted with 200 μl of a mixture of 70% ethanol and 30% isopropyl alcohol (IPA). The eluent was mixed with 50 μl of water and injected into the HPLC-UV system for analysis. The method proved to be linear in the range of 10-750 nmol/L of 25-OHD2 and 25-OHD3. The intra- and inter-assay precision was less than 10 for both compounds at four different concentrations. The method was compared with (LC-MS/MS) and the correlation coefficients (R2) were 0.9454 and 0.9673 for 25-OHD2 and 25-OHD3 respectively. The proposed HPLC method is simple, rapid, robust and free from the most common problems encountered with commercial kits. It can be used in a high-volume laboratory that uses the HPLC method for the simultaneous determination of 25-OHD2 and 25-OHD3 in serum samples.

Harnessing the fundamental roles of vitamins: the potent anti-oxidants in longevity

Aging is a complex and heterogeneous biological process characterized by telomere attrition, genomic instability, mitochondrial dysfunction, and disruption in nutrient sensing. Besides contributing to the progression of cancer, metabolic disorders, and neurodegenerative diseases, these manifestations of aging also adversely affect organ function. It is crucial to understand these mechanisms and identify interventions to modulate them to promote healthy aging and prevent age-related diseases. Vitamins have emerged as potential modulators of aging beyond their traditional roles in health maintenance. There is an increasing body of evidence that hormetic effects of vitamins are responsible for activating cellular stress responses, repair mechanisms, and homeostatic processes when mild stress is induced by certain vitamins. It is evident from this dual role that vitamins play a significant role in preventing frailty, promoting resilience, and mitigating age-related cellular damage. Moreover, addressing vitamin deficiencies in the elderly could have a significant impact on slowing aging and extending life expectancy. A review of recent advances in the role of vitamins in delaying aging processes and promoting multiorgan health is presented in this article. The purpose of this paper is to provide a comprehensive framework for using vitamins as strategic tools for fostering longevity and vitality. It offers a fresh perspective on vitamins' role in aging research by bridging biological mechanisms and clinical opportunities.

Hypovitaminosis D in patients with oral leukoplakia: insights from a cross-sectional study

Introduction

Oral leukoplakia is one of the most frequent oral potentially malignant disorders. The present study aims to compare serum vitamin D levels between patients with and without oral leukoplakia, by smoking habit.

Methods

This cross-sectional study involved a group of 45 cases with oral leukoplakia and a control group with 45 individuals. In both groups a pathology report was done, and for leukoplakia a binary classification of low- and high-grade epithelial dysplasia was employed. Serum 25(OH)D3 vitamin D levels, and data on smoking status, age, gender, comorbidities, and clinical and pathological characteristics were collected for both groups.

Results

vitamin D levels were lower in the oral leukoplakia group with a median of 19.1 ng/ml, while the control group had a median of 24.8 ng/ml. When subdividing each group by smoking habit, the smoking case group had a median of 19.4 ng/ml (IQR: 15.7-21.5 ng/ml), the non-smoking case group had 18.8 ng/ml (IQR: 13.6-29.2 ng/ml), the smoking control group had 21.8 ng/ml (IQR: 17.5-27.3 ng/ml), and the non-smoking control group had 25.4 ng/ml (IQR: 20.4-32.9 ng/ml) (p<0.05). When comparing serum vitamin D levels, statistically significant differences were found between the smoking case group versus the non-smoking control group and between the non-smoking case group versus the non-smoking control group (p<0.05). Serum vitamin D levels by histopathological diagnosis showed no differences between leukoplakia groups.

Discussion

This study shows that serum vitamin D levels were lower in patients with OL compared to those without OL, which was more evident in the smoking group. Patients with OL were previously observed to have hypovitaminosis D, without assessing smoking habits. This finding suggests a possible role of vitamin D deficiency in the development of OL, which could be more marked in smokers. This opens the possibility of future research on vitamin D as a chemopreventive agent in the malignant transformation of OL, and to evaluate the relationship between smoking and hypovitaminosis D.

Specific airway resistance according to early maternal vitamin D status during pregnancy in children aged 5 to 6 years old from the FEPED cohort (RESPIFEPED)

There are conflicting results on the association between maternal vitamin D concentrations during pregnancy and respiratory outcomes for their offspring. However, published studies have mainly focused on the second and third trimesters of pregnancy or on high-risk population. The main objective of this study was to evaluate the association between vitamin D plasma concentrations in the first trimester (T1) of pregnancy and effective specific airway resistance (sReff) for children aged 5 to 6. Secondary objectives were to evaluate this association in the third trimester (T3) and in cord blood as well as the association between vitamin D plasma concentration and interrupter resistance (Rint), bronchiolitis, asthma, and allergen sensitization at the same time points. This multicenter study included 140 children born from women enrolled in the FEPED cohort. Associations between sReff and maternal vitamin D plasma concentration at T1, T3 of pregnancy, and in cord blood were assessed. sReff was analyzed according to in-utero and postnatal exposure to tobacco smoke and the occurrence of an episode of bronchiolitis before 6 months of age. The impact of maternal vitamin D status on the secondary outcomes was similarly assessed. sReff values were not associated with the maternal vitamin D status at T1 and T3, nor asthma status or allergen sensitization.

CONCLUSION

In a cohort of young children, airway resistance and asthma were not associated with early vitamin D deficiency during pregnancy.

TRIAL REGISTRATION

This study is registered with the ClinicalTrials.gov identifier NCT03229317.

WHAT IS KNOWN

• There are conflicting results on the association between maternal vitamin D concentrations during pregnancy and respiratory outcomes for their offspring. However, published studies have mainly focused on the second and third trimesters of pregnancy or on high-risk population.

WHAT IS NEW

• In a cohort of 5- to 6-year-old children assessed prospectively, there was no significant difference in sReff or any other lung function measurements depending on maternal vitamin D status during the first trimester of pregnancy.

Chapter 12: Preparation for parathyroid surgery

Preoperative treatment of PHPT aims to (1) manage severe and/or symptomatic hypercalcemia and (2) prevent postoperative hypocalcemia. Severe hypercalcemia, defined as a blood calcium level≥3.5mmol/L, requires admission to hospital in a conventional or critical care unit, depending on clinical symptoms and comorbidities. Decision to admit a patient in a critical care unit relies on the existence of one or more clinical manifestations (impaired alertness, dehydration with acute renal failure, severe acute pancreatitis) or threatening electrocardiographic signs, or one or more significant comorbidities, notably cardiovascular. Oral rehydration and/or intravenous volume expansion, adapted to cardiac and renal function, form the basis of treatment to lower blood calcium level. If insufficient, intravenous bisphosphonates (zoledronate or pamidronate) are recommended to achieve a reduction in blood calcium levels sufficiently long to allow surgery to be organized. All bisphosphonate injections must be preceded by a minimum etiological work-up of hypercalcemia, including PTH, phosphate and 25-hydroxy vitamin D levels, as well as calciuria and creatininuria. Since bisphosphonates take 24-36hours to take effect, calcitonin can initially be combined with them, as it has a rapid onset of action of a few hours. Denosumab is recommended in second line where bisphosphonates cannot be used, notably because of impaired renal function. Hemodialysis is proposed for patients with an identified vital risk, especially if volume expansion is not possible due to cardiac or renal insufficiency. Correction of vitamin D deficiency is recommended before parathyroid surgery if blood calcium levels are<3.5mmol/L, to prevent or attenuate severe postoperative hypocalcemia due to massive calcium transfer to the bone.

Unveiling the Link: The Potential Roles of Vitamin D in Keloid Pathophysiology

Keloid disease, a fibroproliferative skin disorder, is characterised by scar tissue growth that extends beyond the original wound boundaries. Despite advancements, current treatments, particularly surgical excision, often result in high recurrence rates, ranging from 45% to 100%. Recent investigations into the role of vitamin D (vit D) in keloids present a promising avenue for novel therapeutic strategies. Studies have highlighted the multifaceted involvement of vit D, including its immunomodulatory effects and influence on key processes such as fibroblast activity, collagen production and extracellular matrix dynamics. Additionally, emerging research has explored the potential impact of vit D on epithelial-to-mesenchymal transition and endothelial dysfunction, both of which are implicated in keloid formation and progression. This review consolidates the current evidence linking vitamin D deficiency to keloid pathogenesis, shedding light on potential mechanisms and therapeutic targets. By elucidating the intricate interplay between vit D signalling and keloid development, this study paves the way for innovative treatment approaches that may enhance patient outcomes and mitigate the burden of this challenging dermatological condition.

Decreased levels of vitamin D in Post-Corona Virus-19 Disease syndrome (PCS) patients compared to a control group

BACKGROUND & AIMS

Vitamin D deficiency is defined by most experts as a level of less than 20 ng/ml. Studies have shown a relationship between musculoskeletal pain, muscle weakness, headache, and fatigue with low vitamin D level. The term Post-Corona Virus-19 Disease syndrome (PCS) describes new, returning or ongoing symptoms more than 12 weeks after Corona Virus Disease -19 (COVID-19) infection which cannot be explained by any other disorders or illnesses. The most prominent symptoms in PCS are fatigue, headache, and attention disorders. These similarities in PCS and vitamin D deficiency leads to the hypothesis of an association. The aim of this study was to find possible differences in vitamin D levels between PCS patients and a control group without PCS.

METHODS

We measured vitamin D levels from April 2021 to December 2022 in 75 (2021) and 73 (2022) subjects (PCS) and compared these values with data from 2019 to 2022 in a non-PCS control group (non-PCS).

RESULTS

We found significantly lower (p < 0,05) vitamin D levels in the PCS cohort (2021: 17,04 ± 8,0 ng/ml; 2022: 17,6 ± 6,6 ng/ml) compared to all years of the non-PCS group (2019: 23,7 ± 14,7 ng/ml; 2020:22,3 ± 13,7 ng/ml; 2021: 22,4 ± 12,3 ng/ml; 2022: 22,6 ± 11,0 ng/ml). There were no significant differences in vitamin D levels within the different years of the non-PCS group and when comparing the two PCS groups.

CONCLUSION

The results of the study recorded for the first-time decreased vitamin D values in a PCS cohort compared to a control group. This raises the question of whether vitamin D deficiency influences PCS symptoms or whether they are merely the consequences of the limitations of PCS.

Neurological Mystery Post Travel: An Atypical Presentation and Partial Recovery With Immunotherapy

This case highlights the diagnostic challenges in atypical neurological presentations and the role of empirical immunotherapy despite the absence of a definitive diagnosis. We present a South Indian woman in her 40s who developed progressive lower limb weakness and respiratory compromise after recent international travel. Initially suspected to have Guillain-Barré syndrome (GBS), extensive investigations, including electromyography (EMG), nerve conduction studies (NCS), and cerebrospinal fluid (CSF) analysis, failed to confirm a clear diagnosis. Despite this uncertainty, empirical intravenous immunoglobulin (IVIG) therapy resulted in clinical improvement, supporting the likelihood of an immune-mediated process. Notably, the patient had been experiencing an ongoing flare-up of vitiligo, an autoimmune disease characterized by immune-mediated destruction of melanocytes, for approximately six months leading up to and during the onset of neurological symptoms, suggesting heightened autoimmune activity around the period of symptom onset. Additionally, the patient's South Indian ethnicity is relevant, as autoimmune disorders, including neurological conditions, may have distinct presentations and prevalence among South Asian populations due to genetic and environmental factors. The patient's prolonged ICU stay, need for mechanical ventilation, and complications such as stridor and vocal cord dysfunction underscore the complexity of managing undifferentiated neurological cases. This case serves as an important educational tool, demonstrating the limitations of standard diagnostic criteria in rare or evolving neurological syndromes, the importance of empirical immunotherapy in suspected immune-mediated conditions, and the need for a multidisciplinary approach with careful follow-up. By highlighting the intersection between neurology, immunology, and critical care, this case reinforces the importance of clinical judgment and individualized treatment strategies when conventional diagnostics fall short.

Nutrition and Dietary Pattern Associated With Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is one of the world's most significant causes of illness and mortality. It is vital to identify modifiable risk factors for COPD prevention and therapy, and the scientific community has started to focus closely on nutrition as a crucial component of COPD management, from prevention to treatment. For the progression, and management of obstructive lung illnesses like asthma and COPD, diet and nutrition may be modifiable risk factors of COPD. This review examined the connection between dietary habits, nutrient consumption, and obstructive lung disorders. Additionally, this review highlights and summarizes the evidence from observational and clinical studies regarding the influence of nutrients and dietary habits on lung function and the onset, progression, and outcomes of COPD and lung disease. Regarding the advancement or prevention of COPD, supplemental nutrition has an impact on the onset, progression, and treatment of COPD. Better pulmonary function, less deterioration in lung function, and a lower risk of COPD linked to nutraceuticals, particularly those with antioxidant and anti‐inflammatory effects, when combined with balancepatterns. Health providers may use an evidence‐based lifestyle approach to help counsel patients toward improved lung health if they are aware of the dietary implications of COPD.

Cathelicidin, but not vitamin D, is associated independently with sepsis in pediatric patients with cancer and febrile neutropenia

Sepsis and septic shock are major complications of febrile neutropenia (FN) in pediatric patients with cancer (PPCs). The aim of the present study was to determine the association of vitamin D (VD) and cathelicidin levels with sepsis and septic shock in PPCs with FN. A prospective cohort of PPCs with FN who had previously received cytotoxic chemotherapy was analyzed. At baseline, the plasma levels of VD and cathelicidin were quantified. Patients with sepsis and septic shock were compared with patients with FN without complications. Relative risks (RRs) were calculated with 95% confidence intervals (95% CIs) to determine associations. Multiple logistic regression analysis was performed to adjust the results for the identified confounders. A total of 78 episodes of FN were included; 35 (44.8%) completed their FN treatment without complications, 19 (24.4%) presented with sepsis and 24 (30.8%) progressed to septic shock. The median plasma VD level was 15.2 ng/ml, while the median plasma cathelicidin level was 27.9 ng/ml. Patients with severe VD deficiency (RR, 2.34; 95% CI, 1.17-4.70) and patients with cathelicidin levels >41.5 ng/ml (RR, 2.44; 95% CI, 1.07-5.56) exhibited a higher risk of developing sepsis compared with the control group. Patients with severe VD deficiency had a higher risk of septic shock (RR, 1.96; 95% CI, 1.02-3.79) compared with patients without complications, while cathelicidin levels were not associated with septic shock. After adjusting for confounders, cathelicidin levels >41.5 ng/ml (odds ratio, 5.52; 95% CI, 1.17-26.06) remained as an independent risk factor for progressing to sepsis. In patients who developed septic shock, the multivariate model revealed <700 leukocytes/mm3 and glucose levels >100 mg/dl as independent risk factors. In conclusion, higher plasma cathelicidin levels were independently associated with progression to sepsis in PPCs with FN.

The Effects of Vitamin D on Muscle Strength Are Influenced by Testosterone Levels

BACKGROUND

Although the role of vitamin D receptor (VDR) in muscle mass and strength is well established, the effects of vitamin D (VD) on muscle remain controversial due to various factors. Herein, the influence of sex on the effects of VD on muscle function and the underlying reasons was explored.

METHODS

Male and female Sod1 gene knockout (SKO) mice, serving as a model for skeletal muscle atrophy, were treated with the VD active analogue calcipotriol, and RNA sequencing was employed to investigate this potential signalling pathway. The National Health and Nutrition Examination Survey (NHANES) database was utilized to explore whether testosterone affects the correlation between VD and grip strength in human participants. Experiments involving C2C12 cells and castrated male mice subjected to immobilization were conducted to demonstrate the enhancing effects of testosterone on VD function.

RESULTS

In male SKO mice, Vdr expression in the gastrocnemius muscle was positively correlated with grip strength (R2 = 0.4689, p < 0.001), whereas no such correlation was identified in female mice. At 28 weeks of age, both male and female SKO mice exhibited significantly reduced grip strength compared to Sod1 wild-type (SWT) mice, and calcipotriol restored grip strength in male SKO mice (SWT-veh: 0.0716 ± 0.0006, SWT-cal: 0.0686 ± 0.0010, SKO-veh: 0.0601 ± 0.0010, SKO-cal: 0.0703 ± 0.0007; p < 0.05). Calcipotriol increased muscle protein synthesis and mitochondrial biogenesis while decreasing inflammation and atrogenes in gastrocnemius muscle of male SKO mice. However, the effect of calcipotriol on muscle was not significant in female SKO mice. Compared to wild-type mice, both male and female SKO mice exhibited reduced levels of 1,25(OH)2D3 due to ROS-induced hepatic CYP3A4 overexpression, thereby excluding the influence of baseline VD levels. The serum 25(OH)D3 and testosterone interactively affect grip strength in adults (p < 0.05). Using C2C12 cells differentiated into myotubes, testosterone significantly enhanced the inducing effects of VD on VDR, androgen receptor (AR), P-AKT, PGC1α, Beclin1 and LC3B. Calcipotriol improved grip strength in sham-operated mice but had a negligible effect on grip strength in castrated mice. However, a significant improvement in grip strength was observed in castrated mice following testosterone restoration (p < 0.05).

CONCLUSIONS

This study demonstrates the existence of sex heterogeneity in the effects of VD on muscle and that testosterone enhances the strength and molecular responses to VD. These findings underscore the importance of considering testosterone levels when utilizing VD to enhance muscle strength.

Nicotinamide: A Multifaceted Molecule in Skin Health and Beyond

Nicotinamide (NAM), the amide form of vitamin B3, is a precursor to essential cofactors nicotinamide adenine dinucleotide (NAD⁺) and NADPH. NAD⁺ is integral to numerous cellular processes, including metabolism regulation, ATP production, mitochondrial respiration, reactive oxygen species (ROS) management, DNA repair, cellular senescence, and aging. NAM supplementation has demonstrated efficacy in restoring cellular energy, repairing DNA damage, and inhibiting inflammation by suppressing pro-inflammatory cytokines release. Due to its natural presence in a variety of foods and its excellent safety profile-even at high doses of up to 3 g/day-NAM is extensively used in the chemoprevention of non-melanoma skin cancers and the treatment of dermatological conditions such as blistering diseases, atopic dermatitis, rosacea, and acne vulgaris. Recently, its anti-aging properties have elevated NAM's prominence in skincare formulations. Beyond DNA repair and energy replenishment, NAM significantly impacts oxidative stress reduction, cell cycle regulation, and apoptosis modulation. Despite these multifaceted benefits, the comprehensive molecular mechanisms underlying NAM's actions remain not fully elucidated. This review consolidates recent research to shed light on these mechanisms, emphasizing the critical role of NAM in cellular health and its therapeutic potential. By enhancing our understanding, this work underscores the importance of continued exploration into NAM's applications, aiming to inform future clinical practices and skincare innovations.

Association of Vitamin D Status with Immune Markers in a Cohort of Healthy Adults

BACKGROUND

Immune function is affected by vitamin D status, but the optimal serum 25-hydroxy vitamin D [25(OH)D] concentration for immune function is not known.

OBJECTIVES

We hypothesized that 25(OH)D would be associated with markers of inflammation and immune activation.

METHODS

We identified associations between 25(OH)D and immune markers from 361 healthy adults using polynomial regression. Linear regression was used to define the slope (β) of significant linear associations, and piecewise regression identified inflection points (IPs) for curvilinear associations with P < 0.05. IPs with a slope difference (SD) P < 0.05 before and after were significant.

RESULTS

25(OH)D had linear, negative associations with interleukin (IL)-6 (β: -0.126; P = 0.009) and macrophage-derived chemokine (MDC) (β: -0.108; P = 0.04) and a linear, positive association with matrix metalloproteinase (MMP)-1 (β: 0.108; P = 0.04). Among the significant curvilinear associations, 2 showed negative associations below but positive associations above an IP with nearly significant SD P values, including percentage of effector-memory CD8 T cells (IP: 56.2 nmol/L; SD P = 0.067) and platelet concentration (IP: 38.9 nmol/L; SD P = 0.058). The opposite associations, positive below and negative above an IP, were seen for eotaxin (IP: 49.5 nmol/L; SD P = 0.049); interferon (IFN)-γ-induced protein-10 (IP-10) (IP: 71.8 nmol/L; SD P = 0.02); percentage of CD4 T cells expressing programmed cell death protein (PD)-1 (IP: 71.2 nmol/L; SD P = 0.01); percentage of Tregs expressing human leukocyte antigen, DR isotype (HLA-DR) (IP: 67.5 nmol/L; SD P < 0.0001); percentage of memory Tregs (IP: 68.8 nmol/L; SD P = 0.002); and percentage of memory Tregs expressing HLA-DR (IP: 68.8 nmol/L; SD P = 0.0008).

CONCLUSIONS

These findings are consistent with low vitamin D status allowing and higher vitamin D status dampening inflammation and immune activation. IP analysis identified possible thresholds for vitamin D effects on immune function. Two of 3 IPs at ∼50 nmol/L show higher inflammation below this concentration, suggesting 50 nmol/L as a minimum target for dampening inflammation. IPs at ∼70 nmol/L identify a threshold for CD4 T-cell activity, including Treg activation and IFN-γ-driven production of the T-cell chemokine IP-10, suggesting an optimal concentration for regulating adaptive immunity. This study was registered at clinicaltrials.gov as NCT02367287.

Serum 25-Hydroxyvitamin D Is Associated With Prediabetes, Type 2 Diabetes Mellitus, and Insulin Resistance in Children: A Systematic Review and Dose-Response Meta-analysis of Epidemiologic Studies

CONTEXT

Although several investigations have been conducted on the association between serum vitamin D levels and prediabetes and type 2 diabetes mellitus (T2DM) in children and adolescents, their findings are inconsistent.

OBJECTIVE

We conducted a systematic review and dose-response meta-analysis to summarize this subject.

DATA SOURCES

The electronic databases of ISI Web of Science, Scopus, PubMed, and motor engineering of Google Scholar were comprehensively searched up to May 2023.

DATA EXTRACTION

Epidemiologic studies that investigated the risk of hyperglycemia and insulin resistance in relation to serum 25-hydroxy vitamin D levels in children and adolescents were included.

DATA ANALYSIS

Twenty-two investigations, with a total of 38 622 participants, were systematically reviewed. Meta-analysis of 15 studies (n = 32 720 participants) showed that participants with the highest serum vitamin D levels had 42% lower risk of hyperglycemia, compared with those in the lowest category of serum vitamin D levels (relative risk [RR] = 0.58; 95%CI, 0.48, 0.71). Moreover, pooling 8 studies (n = 10 465 participants) illustrated that highest serum vitamin D level was associated with a 44% lower risk of insulin resistance compared with the lowest serum vitamin D level (RR = 0.56; 95%CI, 0.37, 0.83). Based on linear dose-response analysis, each 10 nmol/L increment in serum 25-hydroxy vitamin D was associated with a 6% decreased risk of hyperglycemia and insulin resistance in children. Furthermore, nonlinear dose-response analysis revealed that increasing serum vitamin D concentration from 40 nmol/L to sufficient values (>50 nmol/L) was associated with a decreasing trend in risk of hyperglycemia and insulin resistance.

CONCLUSION

This meta-analysis revealed inverse associations between serum vitamin D levels and hyperglycemia and insulin resistance in children and adolescents, in a dose-response manner. Increasing serum vitamin D concentration from 40 nmol/L to sufficient values (>50 nmol/L) was associated with a decreasing trend in hyperglycemia and insulin resistance risk. Systematic Review Registration: PROSPERO registration no. CRD42023458155.

Vitamin-D Insufficiency Leads to Interleukin-10 Reduction in Peri-Implant Tissues: A Case-Control Study

OBJECTIVES

Vitamin D has been reported to be crucial for bone mineralization and to play a significant role in immune and inflammatory responses. Its deficiency has been stated to be highly prevalent and might alter osseointegration of dental implants. Successful osseointegration has been claimed to be a critical aspect of implant survival and the effects of vitamin D on implant osseointegration have not been well documented. This study aimed to evaluate bone markers and cytokine levels of patients with or without vitamin D insufficiency.

MATERIAL AND METHODS

A total of 42 patients were included and divided into two groups: vitamin D insufficient (Group IN-S; n = 21) and vitamin D sufficient (Group S; n = 21). Besides clinical periodontal parameters and implant stability measurements, the levels of RANKL, OPG, osteocalcin (OC), calcium (Ca), tumor necrosis factor alpha (TNF-α), IL-1β, caspase-1 (CASP1), and IL-10 in bone biopsy from implant preparation sockets and peri-implant crevicular fluid (PICF) were determined by enzyme-linked immunosorbent assay (ELISA). The results were represented as concentration and total amount.

RESULTS

PICF RANKL levels (both concentration and total amount) were higher in patients with Vitamin D insufficiency compared to sufficient controls (p < 0.05). Concentration and total amount of IL-10 were significantly lower in vitamin D insufficient participants than those of vitamin D sufficient group (p < 0.05). No differences were detected between the groups in terms of other parameters. Bone levels of all evaluated parameters also did not differ between the groups (p > 0.05).

CONCLUSION

It may be concluded that a low serum level of vitamin D may affect peri-implant health through altering IL-10 and RANKL.

Bone health in newly diagnosed female breast cancer patients in China: a cross-sectional study

Bone health problem is one of the important concomitant diseases of breast cancer (BC). This study aimed to investigate the bone health status of newly diagnosed female BC patients in China. A total of 636 newly diagnosed female BC patients and 268 women undergoing routine physical examinations (control group) were included. Bone mineral density and bone metabolism parameters were assessed. The association between BC and abnormal bone mass (ABM) was analyzed by logistic regression. We found that approximately 15.3% of BC patients presented with hypocalcemia after albumin adjustment. 25-OHVitD deficiency or insufficiency was observed in 92.3% of BC patients. ABM was identified in 63.2% of BC patients, comprising 36.4% with osteopenia and 26.8% with osteoporosis. ABM prevalence was significantly higher in BC patients under 40 years old (40.8%) compared to 8% in the age-matched control group. The severity of bone loss correlated with elevated bone turnover markers. Logistic regression analysis showed that a 5.5-fold and 3.4-fold increased risk of ABM and osteoporosis, respectively, in newly diagnosed BC patients versus the control group. All BC subtypes were associated with a markedly higher risk of ABM. Young BC patients (< 45 years) exhibited a nearly 9-fold higher risk of ABM compared to their age-matched counterparts. Vitamin D deficiency/insufficiency, osteopenia, and osteoporosis were highly prevalent among newly diagnosed female BC patients. Regardless of age and BC subtype, BC patients face a higher risk of ABM compared to those physical examination women, especially among the young.

Vitamin D deficiency may accelerate cognitive decline in female apolipoprotein E ε4 non-carriers

BACKGROUND & AIMS

The impact of vitamin D deficiency (VDD) on cognition remains controversial. Evidences suggest that variability based on apolipoprotein E (APOE) ε4 status and gender, given APOE ε4's influence on vitamin D metabolism and women's heightened vitamin D sensitivity. We investigated the interplay between APOE ε4, gender, and VDD in cognitive decline among older adults.

METHODS

In a population-based cohort of 1547 cognitively normal Koreans aged ≥60 years, Mini Mental State Examination (MMSE) changes were tracked biennially (2010-2020). VDD was defined as serum 25-hydroxyvitamin D < 10 ng/mL. Linear mixed models analyzed VDD effects, with subgroup analyses for APOE ε4 status and gender.

RESULTS

VDD was present in 21.3 % at baseline and was linked to faster MMSE decline (estimate = -0.054, 95 % CI [-0.091, -0.017], p = 0.004), particularly in APOE ε4 non-carriers (estimate = -0.070, 95 % CI [-0.112, -0.029], p = 0.001). A gender-based analysis revealed that this effect was significant only in female non-carriers (estimate = -0.097, 95 % CI [-0.156, -0.038], p = 0.001). Conversely, male non-carriers demonstrated an absence of a statistically significant association (estimate = -0.017, 95 % CI [-0.076, 0.041], p = 0.562).

CONCLUSIONS

VDD accelerates cognitive decline in cognitively normal APOE ε4 non-carriers, particularly women, underscoring the importance of tailored prevention strategies.

Autoimmune Hepatitis and Vitamin D Deficiency: A Nationwide Perspective

BACKGROUND

Vitamin D deficiency is linked to worse outcomes in patients with chronic liver diseases (CLD). However, data in patients with autoimmune hepatitis (AIH) remain limited.

AIMS

We aimed to assess the impact of vitamin D deficiency on the outcomes of individuals with AIH.

METHODS

This retrospective cohort study used the TriNetX research network to identify patients with AIH. Patients were matched using propensity score matching and stratified to sufficient vitamin D levels (e.g., 25 (OH) D3 ≥ 30 ng/mL), vitamin D insufficiency (25 (OH) D3: 20-29.9 ng/mL) and vitamin D deficiency (e.g., 25 (OH) D3 < 20 ng/mL). The primary outcome was the all-cause mortality among adult patients with AIH. Secondary outcomes included decompensated liver cirrhosis, acute hepatic failure, liver transplantation (LT), all-cause hospitalizations and all-cause critical care admissions.

RESULTS

A total of 1288 AIH patients with vitamin D deficiency were identified and propensity matched with 1288 patients with normal vitamin D levels. Patients with vitamin D deficiency had significantly increased odds for all-cause mortality compared to those with normal levels (adjusted odds ratio (aOR) = 3.2, 95%CI: 2.3-4.48). Patients with vitamin D deficiency were at increased odds of all-cause hospitalizations (aOR = 2.37, 95%CI: 1.97-2.84), critical care unit admissions (aOR = 2.8, 95%CI: 2.21-3.71), decompensated liver cirrhosis (aOR = 2.74, 95%CI: 2.13-3.54), acute hepatic failure (aOR = 3.11, 95%CI: 2.09-4.62) and LT (aOR = 3.47, 95%CI: 1.71-7.04), as compared to those with normal vitamin D levels.

CONCLUSION

This cohort study showed significantly increased odds for all-cause mortality in AIH patients with vitamin D deficiency. Vitamin D deficiency in patients with AIH was associated with increased likelihood of hospitalisation, decompensated liver cirrhosis, acute liver failure and LT.

The necessity of gestational vitamin D supplementation depends on ambient temperature: concern for infant vitamin D status

Background

Given the ease of access to ambient temperature, it may be a more practical guide than the UVB index. However, the association between gestational temperature and vitamin D level in newborns remains unclear. Our study aims to explore this association and the necessity of maternal vitamin D supplementation when ambient temperature is less than a specific value.

Methods

Based on a birth cohort study, we measured cord blood concentrations of 25(OH)D in 1419 neonates from January to September 2008 in Hefei, a new first-tier city in China. The daily mean temperature of Hefei was obtained from the China Meteorological Data Sharing Service System. Individual information on sociodemographic characteristics, perinatal health status, lifestyle, and birth outcomes was collected prospectively.

Results

The best-fit relationship was observed in the regression model using a quadratic function to describe the association between the ambient temperature of the eighth gestational month (29-32 gestational weeks) and cord blood 25(OH)D concentrations (R 2 = 0.358, p < 0.001). Ambient temperatures of 10 and 24.5°C were linked to the cutoff of vitamin D inadequacy (<50 nmol/L) and deficiency (<30 nmol/L) in cord blood, respectively. For maternal exposure to an ambient temperature of ≥24.5°C in the eighth gestational month, vitamin D supplementation during pregnancy failed to significantly enhance neonatal vitamin D concentrations. In contrast, for maternal exposure to ambient temperature of <10°C, maternal vitamin D supplementation was significantly associated with elevated 25(OH)D concentrations in cord blood.

Conclusion

Gestational ambient temperature may be an ideal predictor for infant vitamin D status screening. Maternal exposure to an ambient temperature of less than 10°C is a critical index in the eighth gestational month, which may determine the onset of vitamin D supplementation.

Cholecalciferol and Ergocalciferol Replacement in Critically Injured Burn Patients: An Observational Cohort Study

Vitamin D deficiency appears to be more prevalent than previously considered in the adult critically ill population, specifically burn-injured patients. No definitive regimen has been shown to restore vitamin D (25(OH)D) levels more effectively to therapeutic levels in the burn-injured population. The purpose of this study was to investigate the effects of either ergocalciferol (D2, 50 000 IU weekly) or cholecalciferol (D3, 6000 IU daily) in adults with burns ≥10% TBSA. This retrospective, observational study (2020-2022) included patients with vitamin D insufficiency (<30 ng/mL) who received replacement and monitoring with weekly vitamin D levels. Patients on dialysis or those with a hospital length of stay less than 2 weeks were excluded. Forty-five patients treated with ergocalciferol and 99 patients with cholecalciferol were included in the study. Patients treated with cholecalciferol were more likely to achieve 25(OH)D levels greater than 30 ng/mL compared to ergocalciferol over a 42-day period (HR 23.56, [95% CI, 12.57-44.16], P < .0001). A higher proportion of patients in the cholecalciferol group achieved vitamin D greater than 20 ng/mL (HR 6.37, [95% CI, 4.20-9.66], P < .0001). The adjusted hazard ratios (D3 vs D2) for achieving 25(OH)D levels > 30 ng/mL and > 20 ng/mL were and 23.94 (95% CI 5.09-427.6, P = .0019) and 7.32 (95% CI, 3.83-15.52, P < .0001) respectively, after controlling for TBSA and initial 25(OH)D. Cholecalciferol appears to be a more effective agent than ergocalciferol for correcting vitamin D deficiency and insufficiency in patients with burn injuries.

Vegetarian Diets During Complementary Feeding: An Overview of Nutritional and Health Features

Nowadays, vegetarian diets are present in a solid way in Western countries' lifestyles. Some families opt for this dietetic pattern for their infants too, during the period of introduction of complementary foods. Many releases have been issued about this subject, with different and often contradictory advice and conclusions. The aim of this work is to provide a comprehensive overview through the analysis of recently published opinions of the implementation of a vegetarian or vegan diet over the course of complementary feeding. The literature agrees about some key points to consider, that is the necessity for the diet to be well-planned, in order to meet energy, macro- and micronutrients requirements, as well as the need to follow the child longitudinally. Also, there is a substantial agreement on the need for fortified foods and/or supplements to be included in the diet. Following these suggestions, most (but not all) of the papers agree that normal growth and development may be achieved. Final considerations, however, are not straightforward to make and more research with better definition of the features of the diet adopted and of supplementation used and long-term follow-up studies are highly warranted.

The potential impact of the extended vitamin D fortification policy during pregnancy varies by continent of origin - a population-representative Swedish cohort

PURPOSE

We aimed to explore the potential impact of Sweden's extended fortification policy, launched in 2018, on vitamin D intake during pregnancy, depending on continent of origin.

METHODS

The population-representative GraviD cohort was conducted within the antenatal care in 2013-2014 in Southwestern Sweden. Background data including country of origin were collected through questionnaires. In the third trimester, participants (N = 1761) answered a vitamin D questionnaire which included intakes of margarine, milk, and fermented milk. Reported vitamin D intake in 2013-2014 was compared to simulated vitamin D intake following the 2018 vitamin D fortification policy expansion.

RESULTS

Pre-expansion reported median intake of vitamin D from fortified foods differed by continent of origin (p < 0.001). Pre-expansion intake was highest among participants from Northern Europe (2.4 µg/day) compared to those from Continental Europe (2.0 µg/day, p = 0.002), Asia (1.6 µg/day, p < 0.001), and Africa (2.0 µg/day, p = 0.001). Post-expansion simulated median vitamin D intake from fortified foods was higher among participants from Northern Europe (6.3 µg/day) compared to Asia (5.0 µg/day, p < 0.001) and Africa (5.0 µg/day, p = 0.013). Participants from Continental Europe had the largest change (3.6 µg/day) between pre- and post-expansion, while those born in Asia had the smallest change (2.9 µg/day).

CONCLUSION

The Swedish fortification policy expansion had a positive potential impact on vitamin D intake during pregnancy, but the effect depended on the continent of origin. The potential impact was smallest for participants from Asia and Africa, indicating that the current Swedish fortification policy is most beneficial for individuals of European origin.

Single-Cell Analysis Dissects the Effects of Vitamin D on Genetic Senescence Signatures Across Murine Tissues

Background/Objectives: Vitamin D (VD) plays a crucial role in age-related diseases, and its influence on cellular senescence (CS) could help clarify its function in aging. Considering VD's pleiotropic effects and the heterogeneity of CS. Methods: we utilized single-cell RNA sequencing (scRNA-seq) to explore these dynamics across multiple tissues. We analyzed three murine tissue datasets (bone, prostate, and skin) obtained from public repositories, enriching for senescence gene signatures. We then inferred gene regulatory networks (GRNs) at the tissue and cell-type levels and performed two cell communication analyses: one for senescent cells and another for interactions between senescent and non-senescent cells. Results: VD supplementation significantly decreased senescence scores in the skin (p = 3.96×10-134) and prostate (p=1.56×10-34). GRN analysis of the prostate revealed an altered macrophage-fibroblast regulatory relationship. In bone, distinct aging-related modules emerged for different bone lineages. In skin, contrary differentiation patterns between suprabasal and basal cells were observed. The main VD-modulated pathways were involved in inflammation, extracellular matrix remodeling, protein metabolism, and translation. VD reduced fibroblast-macrophage interactions in the prostate and skin but increased overall cellular crosstalk in bone. Conclusions: Our findings demonstrate that VD alleviates CS burden across tissues by modulating inflammation and metabolic processes and promoting differentiation. Key aging-related genes modulated by VD were linked to anabolism and cellular differentiation, suggesting VD's potential for therapeutic interventions targeting age-related diseases.

Effects of a Novel Dispersible Supplement Containing 2500 IU of Vitamin D and 1000 µg of B12 in Restoring Vitamin D and B12 Insufficiency: A Multicenter, Randomized Controlled Trial

BACKGROUND/OBJECTIVES

Vitamins D and B12 play a crucial role in maintaining bone health, immune function, and neurological integrity. Combined deficiencies in these vitamins can lead to severe health consequences. Current treatment approaches, such as dietary changes and single-vitamin supplementation, often fail to address these deficiencies comprehensively. This study evaluates the effectiveness of concurrent vitamin D and B12 supplementation to correct these insufficiencies.

METHODS

A prospective, multicenter, randomized controlled trial was conducted in Greece from October 2024 to December 2024. Participants aged 20 to 80 years, with insufficient levels of 25-hydroxyvitamin D (serum < 20 ng/mL) and B12 (serum < 250 ng/L), were eligible for inclusion.

RESULTS

A total of 124 patients were randomized into three groups: one receiving vitamins B12 and D in a single supplement (2500 IU + 1000 mcg), one receiving separate doses of each vitamin (2000 IU + 1000 mcg), and a control group receiving no supplementation. The results demonstrated a significant increase in B12 and 25-hydroxyvitamin D levels among the supplemented groups. Particularly, participants in the combined supplementation group showed higher average serum levels of both vitamins. By the end of this study, 37.1% of those in the combined supplement group achieved adequate vitamin levels, compared to 29.4% in the separate supplementation group.

CONCLUSIONS

In conclusion, combined supplementation may improve patient adherence and compliance, leading to better health outcomes for individuals with combined vitamins D and B12 deficiencies.

Effects of vitamin D supplementation on diabetic foot ulcer healing: a meta-analysis

PURPOSE

To systematically review the effect of vitamin D supplementation on diabetic foot ulcer (DFU) healing.

METHODS

The PubMed, Web of Science, Science direct, Ebsco host, CNKI, WanFang, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the impact of vitamin D supplementation on DFUs from inception to 19 November 2022. Two researchers independently screened the literature, extracted the data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software.

RESULTS

A total of seven studies involving 580 patients were included. The results of meta-analysis showed that compared with control group, the wound healing efficiency rate (RR = 1.42, 95%CI 1.03 to 1.95, P = 0.03) and wound reduction rate (MD = 13.11, 95%CI 4.65 to 21.56, P < 0.01) of the experimental group were higher; the change values of the wound area (MD = -3.29, 95%CI -4.89 to 1.70, P < 0.01) and 25 (OH) D (MD = 9.63, 95%CI 6.96 to 12.31, P < 0.01) were larger. Supplementation of vitamin D on DFU patients can improve glucose metabolism and insulin indexes: hemoglobin A1c (MD = -0.44, 95%CI -0.62 to -0.26, P < 0.01), fasting insulin (MD = -3.75, 95%CI -5.83 to -1.67, P < 0.01), HOMA - β (MD = -5.14, 95%CI -8.74 to -1.54, P < 0.01), and quantitative insulin sensitivity check index (MD = 0.02, 95%CI 0.01 to 0.02, P < 0.01). It can also improve inflammation and oxidative stress markers: high sensitivity C-reactive protein (MD = -0.83, 95%CI -1.06 to -0.59, P < 0.01), erythrocyte sedimentation rate (MD = -15.74, 95%CI -21.78 to -9.71, P<0.01), nitric oxide (MD = 1.81, 95%CI 0.07 to 3.55, P = 0.04), and malondialdehyde (MD = -0.43, 95%CI -0.61 to -0.24, P<0.01). There was no statistically significant difference in changes of fasting plasma glucose, homeostasis model of assessment-insulin resistance, total antioxidant capacity, glutathione, very low density lipoprotein cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol (P>0.05).

CONCLUSION

The current evidence suggests that vitamin D supplementation can significantly promote DFU healing by lowering blood sugar and alleviating inflammation and oxidative stress. Key messages What is already known on this topic  Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus, with high morbidity, mortality and resource utilization. Vitamin D has the effect of lowering blood sugar, improving insulin sensitivity, and increasing anti-inflammatory response. Clinical research on vitamin D supplementation for the treatment of DFU is increasing, but due to the lack of combing and integration, the actual efficacy of vitamin D in patients is unclear. What this study adds  This meta-analysis has shown that vitamin D supplementation can significantly promote DFU healing by lowering blood glucose and alleviating inflammation and oxidative stress. How this study might affect research, practice or policy  This study preliminarily found the effectiveness of vitamin D supplementation on the healing of DFU, which can provide a reference for the treatment of DFU by medical staff.

Outdoor activity time and depression risk among adults aged 40 years and older: a cross-sectional analysis of NHANES 2011-2018 data

Background

Depression is a significant global public health issue, affecting millions worldwide. Outdoor activities have shown potential mental health benefits, but the specific mechanisms and influencing factors remain unclear.

Objectives

This study aimed to investigate the association between time spent outdoors and depression risk among U.S. adults, with a focus on variations across age and ethnic groups.

Methods

Using data from the NHANES 2011-2018 survey, we analyzed 9,036 adults aged 20 years and older. Participants self-reported their outdoor activity time and depressive symptoms. Statistical analysis, accounting for various demographic and lifestyle factors, was employed to assess the relationship between outdoor activity and depression risk.

Results

Spending more time outdoors was associated with a 51% lower risk of depression (odds ratio: 0.51, 95% CI: 0.40-0.64). Subgroup analysis revealed that this association was particularly pronounced among adults aged 40 and older, as well as non-Hispanic whites and non-Hispanic blacks.

Conclusion

Encouraging outdoor activities may represent an effective public health strategy to reduce depression risk, particularly among middle-aged and older adults and specific ethnic populations. Public health policies should prioritize initiatives that encourage outdoor engagement, and future research is needed to explore the underlying mechanisms and population-specific responses to outdoor activity.

Prevalence of vitamin D deficiency and its association with adverse obstetric outcomes among pregnant women in Uganda: a cross-sectional study

OBJECTIVE

There is a dearth of published data on the vitamin D status of the Ugandan population; the objective of the study was to determine the prevalence of vitamin D deficiency among pregnant women in Uganda and its associations with maternal characteristics and adverse foetal-maternal outcomes.

STUDY DESIGN AND SETTING

We conducted a cross-sectional study on pregnant women admitted to a tertiary referral hospital in Kampala, Uganda for delivery during the study period from July to December 2023.

PARTICIPANTS

The study was conducted on 351 pregnant women aged ≥18 years who consented to participate in the study, who had a single intrauterine pregnancy and a gestational age greater than 26 weeks, and who delivered at St. Francis Hospital, Nsambya. We excluded pregnant women admitted to the hospital longer than 1 week before delivery; pregnant women with self-reported pre-existing kidney diseases, liver diseases, or gut or malabsorption disorders and pregnant women with severe pregnancy-unrelated comorbidities requiring intensive care unit admission before delivery.

INTERVENTIONS

Maternal venous blood was collected at admission, and serum 25-hydroxy-vitamin D (25(OH)D) was measured by an electrochemiluminescence binding assay.

PRIMARY AND SECONDARY OUTCOME MEASURES

Maternal sociodemographic characteristics and obstetric-medical factors, and adverse maternal and foetal outcomes were captured by using a data collection form. The data were analysed by logistic regression analysis at the univariate, bivariate and multivariate levels.

RESULTS

The prevalence of vitamin D deficiency, defined as a serum 25(OH)D concentration less than 20 ng/mL, was 40.2%. This was seen more among the Muslims (OR 2.4, 95% CI 1.33 to 4.43, p value 0.004), members of the Banyankore tribe (OR 2.1, 95% CI 1.02 to 4.36, p value 0.043) and primigravidae (OR 0.6 for women with parity of 1-4 compared with primigravidity, 95% CI 0.36 to 0.94, p value 0.028). Among adverse maternal outcomes, vitamin D deficiency was associated with hypertensive disorders in pregnancy (OR 2.4, 95% CI 1.16 to 4.10, p value <0.001), in particular gestational hypertension (OR 2.2, 95% CI 1.21 to 4.94, p value 0.014), and pre-eclampsia/eclampsia/haemolysis, elevated liver enzymes and low platelets syndrome (OR 2.9, 95% CI 1.45 to 6.08, p value 0.003), with increased preterm birth (OR of 4.0, 95% CI 1.78 to 10.84, p value<0.001) and with delivery of babies with low birth weight (OR 4.2, 95% CI 2.63 to 13.62, p value 0.001).

CONCLUSIONS

The study found a high prevalence (40.2%) of vitamin D deficiency among pregnant women delivering at St. Francis Hospital, Nsambya. Additionally, vitamin D deficiency was linked with adverse maternal and foetal outcomes such as hypertensive disorders in pregnancy, preterm birth and low birth weight.

Illuminating the Connection: Cutaneous Vitamin D3 Synthesis and Its Role in Skin Cancer Prevention

Sunlight exposure plays an important role in human health, impacting processes such as mood, blood pressure regulation, and vitamin D3 production. Solar ultraviolet B radiation initiates vitamin D3 synthesis in the skin, which is subsequently metabolized into its biologically active form. UVB exposure plays a key role in enabling vitamin D3 synthesis, but it can also contribute to skin carcinogenesis, creating a complex interplay between its beneficial and harmful effects. Vitamin D deficiency, affecting over half the global population, is linked to a range of chronic diseases, including cancers, cardiovascular conditions, and autoimmune disorders. Simultaneously, excessive solar UVB exposure increases the risk of non-melanoma and melanoma skin cancers through mechanisms involving DNA damage and oxidative stress. This review examines the dual role of UVB radiation in health and disease, focusing on the mechanisms of cutaneous vitamin D3 synthesis, the epidemiology of skin cancer, and the protective roles of vitamin D3's photoproducts and its active metabolite, 1,25-dihydroxyvitamin D3. Understanding these interconnections is critical for developing strategies that balance adequate sun-induced vitamin D3 production with skin cancer prevention.

Prevalence of metabolic syndrome with different serum vitamin D levels in middle-aged and older adults

BACKGROUND

The relationship between serum vitamin D levels and metabolic syndrome (MetS) has been controversial. This study focused on the relationship between the prevalence of MetS and serum vitamin D levels in middle-aged and elderly people.

METHODS

This study included middle-aged and older adults who participated in the 2023 Zhejiang Provincial Nutrition and Health Survey, which was conducted in 90 districts and counties in Zhejiang Province, China.

RESULTS

A total of 11,305 participants were included in this study. MetS was prevalent in 31.7% of participants. Vitamin D and vitamin D3 concentrations were inversely associated with MetS prevalence (Ptrend<0.05), but not with vitamin D2, regardless of whether logistic regression models were adjusted for confounding factors. After adjusting for age, sex, physical activity level, smoking status, education level, annual per capita household income, and body mass index residuals, the highest tertile (Q3) of vitamin D (odds ratio [OR], 0.779; 95% confidence interval [CI], 0.702-0.865) and vitamin D3 (OR, 0.787; 95% CI, 0.709-0.875) concentrations had a lower risk of MetS than the lowest tertile (Q1). We found that vitamin D and D3 levels were correlated with age (Pinteraction<0.05). When age-stratified analyses were performed, vitamin D and vitamin D3 levels were significantly negatively associated with MetS in older adults but not in middle-aged adults.

CONCLUSIONS

Low total serum vitamin D and vitamin D3 levels were associated with a higher risk of MetS in adults aged 60 years and older.

Practice and factors associated with sunlight exposure of infants among mothers in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Exposure to sunlight aids in the body's production of vitamin D, guards against rickets, and treats newborn jaundice. In Ethiopia, the magnitude of sunlight exposure practice varies across studies. Thus, this study aimed to estimate the pooled practices and factors associated with sunlight exposure of infants among mothers in Ethiopia.

METHODS

Electronic search was carried out using databases (PubMed, HINARI, Science Direct, electronic databases, and Google Scholar) for relevant articles published from January 1, 2010, to March 27, 2024. The screening process was carried out in accordance with PRISMA guidelines. Articles conducted in English and quantitatively expressed were considered in this review. The quality assessment of included articles was evaluated using the Newcastle-Ottawa Scale. Data analysis was carried out using STATA-14 version software. I2 statistics and Egger's test were used to evaluate heterogeneity and publication bias, respectively. The pooled prevalence with a 95% confidence interval (CI) of the meta-analysis utilizing the random effect model was displayed using forest plots, and adjusted odds ratio (AOR) was utilized to quantify the association.

RESULTS

1171 records, 13 studies were included in the meta-analysis with 5190 study participants that fulfill the inclusion criteria, and all the included studies were cross-sectional in design. The pooled prevalence of sunlight exposure practice among mothers in Ethiopia was 45.38% CI (38.36, 52.4). Good sunlight-related knowledge (AOR; 1.61, 95% CI 1.3, 1.98), maternal formal education (AOR; 1.35, 95% CI 1.08, 1.69), housewife (AOR; 0.7, 95% CI 0.51, 0.95), and husband formal education (AOR; 1.29, 95% CI 1.07, 1.56) were significantly associated with good sunlight exposure practice.

CONCLUSION

The pooled prevalence of good sunlight exposure practice among mothers in Ethiopia was low. Good sunlight-related knowledge, being a housewife, and maternal and husband formal education were the factors that were associated with good sunlight exposure practice. Thus, the government needs to cater further assistance and initiate greater information circulation and follow-up to improve the situation.

Unraveling the dual threat: sarcopenia and insufficient physical activity in diabetes risk

Purpose

This study aimed to investigate the alterations in diabetes risk associated with sarcopenia and insufficient physical activity, as well as the demographic shifts within the diabetic population.

Method

Utilizing pertinent data from the National Health and Nutrition Examination Survey (NHANES) database spanning 2011 to 2018, the criteria for sarcopenia were established by the Foundation for the National Institutes of Health. These criteria were calculated using lean body mass data in conjunction with body mass index data. Physical activity levels were assessed using the PAQ questionnaire from the NHANES database. The presence of diabetes was determined through the DIQ questionnaire and the laboratory examination within the NHANES database. The analysis was performed using multivariable logistic regression.

Result

The prevalence of both sarcopenia and insufficient physical activity in the diabetic population was 188% greater than in the non-diabetic population. Sarcopenia and insufficient physical activity were positively correlated with an increased risk of diabetes onset, demonstrating a 1.45-fold heightened risk when both conditions were present (OR=2.45,95%CI,1.35-4.44,P<0.05). This combined effect was significantly greater than the risk associated with sarcopenia alone (OR=1.84,95%CI,1.09-3.11,P<0.05) or insufficient physical activity alone (OR=1.55,95%CI,1.11-2.15,P<0.05).

Conclusion

A synergistic relationship exists between sarcopenia and insufficient physical activity, resulting in a markedly elevated risk of diabetes when both conditions are present concurrently. Therefore, comprehensive diabetes management strategies should prioritize populations exhibiting both sarcopenia and insufficient physical activity.

Vitamin D Deficiency and Associated Factors in Children: A Multicenter Study of 21,811 Samples in Southern China

Objective

To investigate the prevalence of vitamin D deficiency (VDD) in children/adolescents in extreme southern China.

Methods

This multicenter, cross-sectional study included 21,811 children aged 0-18 years from 18 districts in Hainan Province, using a multistage stratified random sampling method from January 2021 to March 2022.

Results

Serum 25(OH)D levels decreased with age (p trend <0.001). VDD prevalence increased significantly from 3.7% (95% CI: 3.2, 4.3) in children aged 0-3 years to 43.5% (95% CI: 42.1, 45.0) in those aged 13-18 years. Girls and urban residents showed higher deficiency rates. Adolescents (13-18 years) had the highest prevalence of VDD (43.5%), while toddlers (0-3 years) had the lowest (3.7%). Factors influencing vitamin D status included gender, urban residency, and breastfeeding duration. Seasonal variations showed higher deficiency rates in autumn, particularly among preschoolers. Regional differences were noted, with the highest deficiency in semiarid and subhumid zones for various age groups.

Conclusion

A significant increase in VDD with age, particularly among adolescents, urban girls, and during autumn, emphasizing the need for targeted strategies.

Vitamin D status and its determinants in German elite athletes

PURPOSE

This study investigated elite German athletes to (1) assess their serum 25(OH)D levels and the prevalence of insufficiency, (2) identify key factors influencing serum 25(OH)D levels, and (3) analyze the association between serum 25(OH)D levels and handgrip strength.

METHODS

In this cross-sectional study, a total of 474 athletes (231 female), aged 13-39 years (mean 19.3 years), from ten Olympic disciplines were included. Serum 25(OH)D levels were analyzed via liquid chromatography-mass spectrometry, and 17 single nucleotide polymorphisms (SNPs) related to vitamin D metabolism were determined using leukocyte DNA. Grip strength was measured unimanually using a hand-held dynamometer. Multiple linear regressions were used to analyze the influence of SNPs, age, sex, season (summer vs. winter), and discipline (indoor vs. outdoor) on 25(OH)D status. Linear regression analyzed the relationship between handgrip strength and serum 25(OH)D levels.

RESULTS

In total, 55.5% (n = 263) of athletes demonstrated insufficient serum 25(OH)D levels (< 30 ng/mL, < 75 nmol/L), with 16% (n = 76) showing levels below 20 ng/mL (50 nmol/L). After correction for multiple testing, significant influences on 25(OH)D levels were observed for the C allele of VDBP rs7041 (AC Genotype: β ^  = 7.46, p < .001; CC Genotype: β ^  = 6.23, p = .001). Age (all p < .01) and discipline (indoor vs. outdoor; all p < .05) also influenced serum 25(OH)D levels. Furthermore, serum 25(OH)D was positively associated with handgrip strength ( β ^ = 0.01, p < .001).

CONCLUSION

A high prevalence of insufficient 25(OH)D levels (< 30 ng/mL, < 75 nmol/L) was observed. We identified certain genetic variants as well as age and discipline as predictors of serum 25(OH)D levels. This knowledge may guide individualized diagnostic, nutritional, and supplementation strategies.

[Vitamin D role in oral cavity diseases]

The purpose of this scientific article is to analyze the scientific literature aimed at identifying the relationship between vitamin D levels in the body and diseases of the oral organs, in order to determine the potential impact of vitamin D deficiency on their development. Special attention is paid to the development of recommendations for maintaining optimal vitamin D levels for various population groups in order to strengthen both general health and prevent diseases of the oral cavity.

Vitamin D and Endometriosis: Is There a Mechanistic Link?

Endometriosis is a prevalent chronic gynaecological disorder, but its cause is still unclear, and both genetic and environmental factors may contribute disease aetiology. Prominent amongst the latter is vitamin D which can be obtained either by the action of sunlight on skin or from dietary sources. Serum levels of the main circulating form of vitamin D, 25-hydroxvitamin D (25(OH)D), have been reported to be inversely correlated with endometriosis, suggesting that vitamin D-deficiency may be a risk factor for the disease. Crucially, the active form of vitamin D, 1,25-dihydroxyvitamin D (1,25(OH)2D) is known to exert many functions beyond its established role in the endocrinology of mineral homoeostasis and prevention of rickets. Several of these extra-skeletal effects of 1,25(OH)2D may impact the risk and progression of endometriosis. The following review details the studies that have assessed associations between vitamin D status/supplementation and endometriosis severity and disease progression, but also describes the mechanistic targets for 1,25(OH)2D in endometriosis with specific reference to immunomodulatory responses and effects on angiogenesis. Endometriosis is an under-reported health issue with poor non-invasive options for diagnosis. Given that vitamin D-deficiency may trigger or exacerbate key pathophysiological responses linked to endometriosis, analysis of vitamin D status in women may provide an alternative risk marker for endometriosis. Treatment options for endometriosis are also limited and the review will also consider whether vitamin D supplementation has a role in the management of endometriosis, either in prevention or treatment.

Bioactive metabolites: A clue to the link between MASLD and CKD?

Metabolites produced as intermediaries or end-products of microbial metabolism provide crucial signals for health and diseases, such as metabolic dysfunction-associated steatotic liver disease (MASLD). These metabolites include products of the bacterial metabolism of dietary substrates, modification of host molecules (such as bile acids [BAs], trimethylamine-N-oxide, and short-chain fatty acids), or products directly derived from bacteria. Recent studies have provided new insights into the association between MASLD and the risk of developing chronic kidney disease (CKD). Furthermore, alterations in microbiota composition and metabolite profiles, notably altered BAs, have been described in studies investigating the association between MASLD and the risk of CKD. This narrative review discusses alterations of specific classes of metabolites, BAs, fructose, vitamin D, and microbiota composition that may be implicated in the link between MASLD and CKD.

The Vitamin D-Sirt1/PGC1α Axis Regulates Bone Metabolism and Counteracts Osteoporosis

Background

Objective: Vitamin D insufficiency is a major contributor to osteoporosis. This study aimed to elucidate the mechanisms by which the vitamin D-Sirt1/PGC1α axis regulates bone metabolism and counteracts osteoporosis induced by active vitamin D insufficiency.

Methods

Mouse models including Sirt1 transgenic (Sirt1Tg), Cyp27b1+/- (active vitamin D deficient), and compound Sirt1TgCyp27b1+/- mice were utilized. Bone parameters were assessed by radiography, micro-CT, histology, and immunohistochemistry. In vitro studies used bone marrow-derived mesenchymal stem cells (BM-MSCs). Gene and protein expression were analyzed by RT-PCR and Western blotting. Chromatin immunoprecipitation and luciferase assays investigated transcriptional regulation. Effects of resveratrol supplementation were examined.

Results

1,25-dihydroxyvitamin D (1,25(OH)2D) insufficiency caused downregulation of Sirt1 expression, leading to accelerated bone loss. Overexpression of Sirt1 in mesenchymal stem cells corrected bone loss by inhibiting oxidative stress, DNA damage, osteocyte senescence and senescence-associated secretory phenotype, promoting osteoblastic bone formation, and reducing osteoclastic bone resorption. 1,25(OH)2D3 transcriptionally upregulated Sirt1 expression in BM-MSCs through vitamin D receptor binding to the Sirt1 gene promoter. Resveratrol, a Sirt1 agonist, attenuated osteoporosis induced by 1,25(OH)2D insufficiency by modulating the Sirt1/PGC1α axis. Sirt1 interacted with and deacetylated PGC1α, a transcriptional coactivator involved in mitochondrial biogenesis and energy metabolism. Deacetylated PGC1α mediated the effects of Sirt1 on osteogenesis, oxidative stress, and cellular senescence in BM-MSCs.

Conclusion

This study elucidated the critical role of the vitamin D-Sirt1/PGC1α axis in regulating bone metabolism and counteracting osteoporosis induced by active vitamin D insufficiency. The findings highlight the potential of this axis as a therapeutic target for the prevention and treatment of osteoporosis.

The Impact of Diet and Nutrition on the Oral Microbiome

At present, it is well known that oral health is essential for the well-being of the body as a whole, thanks to the increasing awareness of how various oral diseases, including periodontal disease, oral carcinomas, and other conditions, have a close connection with various systemic disorders. In recent decades, studies on the oral microbiome have increasingly emphasized how the balance between the host and the microbial species that coexist there is essential for oral health at all stages of life. However, there are many factors capable of interfering with that balance, and diet is precisely one of them. The real influence of diet on the oral microbiota, and consequently on oral health, has been much debated. In this context, the observation of two key periods in human history, the Neolithic and the Industrial Revolution, has proved to be diriment. The foods and processing techniques that emerged in these two historical periods, in association with changes in customs and habits, significantly altered the central constituents of the human diet, including macronutrient proportions, glycemic load, fatty acid composition, sodium and potassium levels, micronutrient levels, dietary pH, and fiber content taken in by human beings. The introduction of these foods into the daily human routine has been linked to a decline in oral health and an increase of several other diseases, including cardiovascular diseases, inflammatory bowel disease, rheumatic diseases, many cancers, and obesity. The aim of this chapter is to update the current knowledge and further discuss the role of diet and nutrition on oral health.

Association between childhood obesity and vitamin D: A Mendelian randomization study

BACKGROUND

This study evaluated the causal relationship between childhood obesity and vitamin D levels by performing a Mendelian randomization (MR) analysis using publicly available genome-wide association study (GWAS) summary statistics. To mitigate bias stemming from confounding and reverse causation, we conducted an MR analysis to assess the causal impact of childhood obesity on the major circulating form of vitamin D, 25-hydroxyvitamin D (25(OH)D).

METHODS

Vitamin D is present in the blood in the form of 25(OH)D; childhood obesity and 25(OH)D levels data were obtained from the IEU open GWAS project, which were subjected to MR analyses. The IVW method was used as the predominant analysis method and was complemented by MR-Egger, simple mode, weighted median, and weighted mode methods. The MR-PRESSO method was utilized to identify horizontal pleiotropy and potential outliers.

RESULTS

This study indicated that childhood obesity affects the serum of 25(OH)D, which was significant in the IVW (OR [95%CI], 0.977 [0.966-0.989], p = 0.0001), and weighted-median (OR [95%CI], 0.983 [0.969-0.997], p = 0.015) analyses, but nonsignificant in the MR-Egger (OR [95%CI], 0.985 [0.897-1.082], p = 0.784), simple mode (OR [95%CI], 0.985 [0.965-1.005], p = 0.233), and weighted mode (OR [95%CI], 0.985 [0.967-1.004], p = 0.214) analyses.

CONCLUSIONS

In summary, we found a potential inverse association between elevated childhood obesity and 25(OH)D levels, which suggested that obese children need to pay attention to their 25(OH)D levels, and vitamin D supplementation may be necessary when needed.

Income effect of prenatal sunlight exposure: Empirical evidence from China

Despite a growing interest in the impacts of prenatal factors on adulthood quality of life, economists have not estimated the income effects of sunlight exposures by mothers during pregnancy. This paper estimates such effects using data from China General Social Survey and China National Meteorological Data Service Center. The results show that the income effects of prenatal sunlight exposure in the second trimester are significantly positive. The effects differ for individuals born in different months and the effects are larger for female employees, older employees, those born in rural areas, in the pre-reform period, or whose mothers are less-educated. Finally, we investigate the possible mechanisms via the human capital pathway, discovering that fetuses with longer sunlight exposure in the second trimester are healthier and do more exercises in adulthood. It is suggested that families, communities, policymakers should pay attention to prenatal sunlight exposure, especially for pregnant women in the developing world who are less educated or live in rural areas.

Vitamin D-Parathyroid Hormone-Fibroblast Growth Factor 23 Axis and Cardiac Remodeling

Cardiac remodeling is a compensatory adaptive response to chronic heart failure (HF) altering the structure, function, and metabolism of the heart. Many nutritional and metabolic diseases can aggravate the pathophysiological development of cardiac remodeling. Vitamin D deficiency leads to cardiac remodeling by activating the renin-angiotensin-aldosterone system (RAAS), resulting in enhanced inflammation and directly promoting cardiac fibrosis and extracellular matrix deposition. Hyperparathyroidism upregulates protein kinase A or protein kinase C, enhances intracellular calcium influx, promotes oxidative stress, activates RAAS, and increases aldosterone levels, thereby aggravating cardiac remodeling. Besides, fibroblast growth factor 23 (FGF23) plays a direct role in the heart, resulting in ventricular hypertrophy and myocardial fibrosis. Vitamin D deficiency leads to hyperparathyroidism, which in turn increases the level of FGF23. Elevated levels of FGF23 further inhibit vitamin D synthesis. Evidence exists that vitamin D deficiency, hyperparathyroidism, and marked elevations in FGF23 concentration form a vicious cycle and are believed to contribute directly to cardiac remodeling. Therefore, the purpose of this article is to introduce the specific effects of the above substances on the heart and to explain the significance of understanding the vitamin D-parathyroid hormone-FGF23 axis in improving or even reversing cardiac remodeling, thus contributing to the treatment of patients with HF.

The Relationship Between Novel Inflammatory Markers and Serum 25-Hydroxyvitamin D Among US Adults

BACKGROUND

Vitamin D is the focus of extensive medical research globally. Recent studies have investigated the correlation between serum 25-hydroxyvitamin D (25(OH)D) and common inflammatory markers. However, few studies have incorporated novel inflammatory markers such as the platelet-to-lymphocyte ratio (PLR), platelet-to-high density lipoprotein cholesterol ratio (PHR), systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory response (SIRI), and neutrophil-to-high-density lipoprotein cholesterol ratio (NHR). This study investigated these correlations among adults in the USA.

METHODS

We ultimately included a total of 5308 participants from the National Health and Nutrition Examination Survey (NHANES) database spanning 2007 to 2018. A multivariable linear regression model assessed the links between serum 25(OH)D and these novel inflammatory markers, with subgroup analyses for hypertension and diabetes. To further explore the relationship between the two, we applied smooth curve fittings and generalized additive models. Upon detecting nonlinear relationships, we used a recursive algorithm to pinpoint the inflection point.

RESULTS

In our multivariate linear regression model, serum 25(OH)D concentrations were negatively correlated with NHR (β = -0.003, 95% CI: -0.005 to -0.001), NLR (β = -0.002, 95% CI: -0.003 to 0.000), SII (β = -0.579, 95% CI: -0.954 to -0.205), PHR (β = -0.171, 95% CI: -0.249 to -0.093), and PLR (β = -0.096, 95% CI: -0.051 to -0.040) among adults in the USA. Nevertheless, no significant association was found with SIRI (β = -0.001, 95% CI: -0.002 to 0.000). Subgroup analysis by hypertension and diabetes showed that in the hypertensive group, serum 25(OH)D was significantly and negatively associated with NHR, NLR, SII, SIRI, PHR, and PLR. However, no correlation was found in the diabetic group between serum 25(OH)D levels and these inflammatory markers.

CONCLUSIONS

Our research confirms that serum 25(OH)D levels are negatively correlated with several novel inflammatory markers among adults in the USA, suggesting potential directions for further research into vitamin D's role in inflammation.

Risk factors and outcomes of vitamin D deficiency in very preterm infants

BACKGROUND

Vitamin D is essential for bone health and immune system. Vitamin D deficiency (VDD) poses a high-risk to very preterm (VP) infants. This study aimed to evaluate the risk factors associated with VDD in VP infants and its potential clinical outcomes.

METHODS

A retrospective cohort study was conducted on VP infants admitted to the neonatal intensive care unit of a specialized tertiary hospital in Seoul, Republic of Korea, between January 2018 and June 2022. Serum 25-hydroxyvitamin D (25(OH)D) levels and other biochemical parameters were measured between 4 and 6 weeks of age. VDD was defined as a serum 25(OH)D level <20 ng/mL. Prenatal and postnatal risk factors and clinical outcomes were compared between the VDD and non-VDD groups.

RESULTS

Of the 82 VP infants analyzed, 27 (32.9%) were diagnosed with VDD. The VDD group exhibited a significantly longer duration of parenteral nutrition (PN) compared to the non-VDD group (adjusted odds ratio [OR] = 1.12; 95% confidence interval [CI]: 1.008-1.245). Breast milk intake was lower in the VDD group than in the non-VDD group (adjusted OR = 0.976, 95% CI, 0.955-0.999). Notably, calcium levels were significantly lower in the VDD group, while parathyroid hormone levels were significantly higher, compared with the non-VDD group. Additionally, the rickets severity score was higher in the VDD group than in the non-VDD, although the difference was not statistically significant.

CONCLUSIONS

Prolonged PN duration and low breast milk intake significantly increased the risk of VDD in VP infants.

Survey on vitamin D supplementation in children in France: Evaluation of real-life practices following the new 2022 French recommendations

BACKGROUND AND OBJECTIVE

In 2022, recommendations for vitamin D supplementation in children were updated in France. The objective of this study was to assess real-life practices of vitamin D supplementation in children following these recommendations.

METHODS

A thirty-three-question questionnaire was distributed to members of the scientific societies of paediatrics and general medicine via an online platform.

RESULTS

There were 966 respondents, of whom 87 % were paediatricians and 13 % were general practitioners. About half of the physicians (47 %) were in private practice, 49 % worked in a hospital centre and 6 % worked in a maternal and child health centre. As recommended and regardless of the professional practice, vitamin D supplementation was almost systematically prescribed in all age groups (over 90 % of respondents), in daily doses up to 2 years of age (97 % of all respondents) and then every 3 months in older children (year-round in 38 % and winter/spring only in 40 %). Contrary to the new recommendations, loading doses of 200,000 units of vitamin D were prescribed by 5 % of respondents and non-pharmaceutical forms of vitamin D (e.g. unlicensed food supplements) were prescribed by 10 % of respondents. Although risk factors such as low sun exposure and dark skin were well known by respondents (75 % and 74 % respectively), obesity and veganism were only reported by half the respondents (40 % and 53 % respectively). Two-thirds (61 %) of respondents reported assessing calcium intakes when following children; however, only 10 % of them use specific questionnaires or calcium equivalence tables. Finally, the calcium content of foods and its bioavailability appeared to be poorly understood by health professionals.

CONCLUSION

This survey shows that the practice of paediatricians and general practitioners are in accordance with the new recommendations for vitamin D supplementation in very young children. The identification by this survey of knowledge gaps will allow targeted information campaigns.

Vitamin D3-VDR and vitamin A-RAR affect IL-13 and IFNγ secretion from human CD4+ T cells directly and indirectly via competition for their shared co-receptor RXR

The effects of vitamin D and vitamin A in immune cells are mediated through the vitamin D receptor (VDR) and retinoic acid receptor (RAR), respectively. These receptors share the retinoid X receptor (RXR) co-factor for transcriptional regulation. We investigated the effects of active vitamin D3 (1,25(OH)2D3) and 9-cis retinoic acid (9cRA) on T helper (TH)1 and TH2 cytokines and transcription factors in primary human blood-derived CD4+ T cells. We aimed to address the discrepancies in this field, particularly regarding the effects of 9cRA and the vitamins in combination. 1,25(OH)2D3 upregulated IL-13 and suppressed IFNγ, while 9cRA had the opposite effects. This was largely independent of a TH1/TH2 phenotype shift. Combined vitamin supplementation produced intermediate cytokine levels, not only through transcriptional regulation by VDR-RXR and RAR-RXR but also through 1,25(OH)2D3 counteracting the effects of 9cRA on solely 9cRA-responsive genes. Similar results were observed in hereditary vitamin D-resistant rickets (HVDRR) patient T cells, where VDR cannot bind to DNA, indicating that RXR binding to either receptor can limit the other's activity. Additionally, we observed downregulated RAR upon 9cRA supplementation and its re-localization out of the nucleus upon 1,25(OH)2D3 supplementation, suggesting a mechanism of indirect regulation by VDR. VDR protein levels were also upregulated upon 9cRA supplementation, suggesting a novel negative feedback mechanism of 9cRA transcriptional activity, whereby 9cRA promotes its own competitor. This study sets the stage for future research into the combined immunomodulatory mechanisms of 1,25(OH)2D3 and 9cRA, involving both direct transcriptional regulation and indirect regulation via RXR competitive binding.

Naïve Bayes is an interpretable and predictive machine learning algorithm in predicting osteoporotic hip fracture in-hospital mortality compared to other machine learning algorithms

Osteoporotic hip fractures (HFs) in the elderly are a pertinent issue in healthcare, particularly in developed countries such as Australia. Estimating prognosis following admission remains a key challenge. Current predictive tools require numerous patient input features including those unavailable early in admission. Moreover, attempts to explain machine learning [ML]-based predictions are lacking. Seven ML prognostication models were developed to predict in-hospital mortality following minimal trauma HF in those aged ≥ 65 years of age, requiring only sociodemographic and comorbidity data as input. Hyperparameter tuning was performed via fractional factorial design of experiments combined with grid search; models were evaluated with 5-fold cross-validation and area under the receiver operating characteristic curve (AUROC). For explainability, ML models were directly interpreted as well as analysed with SHAP values. Top performing models were random forests, naïve Bayes [NB], extreme gradient boosting, and logistic regression (AUROCs ranging 0.682-0.696, p>0.05). Interpretation of models found the most important features were chronic kidney disease, cardiovascular comorbidities and markers of bone metabolism; NB also offers direct intuitive interpretation. Overall, NB has much potential as an algorithm, due to its simplicity and interpretability whilst maintaining competitive predictive performance.

Vitamin D Supplementation in Critically Ill-Narrative Review

BACKGROUND

Studies have shown a high prevalence of vitamin D deficiency in critically ill patients, and these patients are at higher risk for pneumonia and have increased incidence of sepsis and mortality. In this study, we reviewed available literature from randomized controlled trials (RCTs) on vitamin D supplementation in critically ill patients and summarized the evidence in this narrative review.

METHODS

Randomized controlled trials that included vitamin D supplementation as an intervention were eligible for inclusion. No limits were set regarding vitamin D dosage or route of administration, as well as for primary and secondary outcomes. A search was conducted in MEDLINE via PubMed for eligible RCTs. References from systematic reviews (SRs) and meta-analyses (MAs) were screened, and Clinicaltrials.gov was searched for ongoing studies.

RESULTS

A total of 21 RCTs involving 3166 patients were analyzed. There was a large heterogeneity in terms of patients' characteristics and inclusion criteria. Only six studies included patients with vitamin D levels < 50 nmol/L. Regarding clinically important outcomes, most of the studies did not show differences between the intervention and control group in terms of mortality, intensive care unit (ICU) or hospital length of stay (LoS).

CONCLUSIONS

There is great variability in trial designs regarding the selection of patients, dosage, dosing intervals and routes of administration of vitamin D supplements. Better study designs are mandatory for future clinical research, with measuring and reporting basal vitamin D levels before randomization. Since variability in supplementation regimes limits the possibility of data synthesis, standardized protocols for vitamin D supplementation should be used in clinical trial settings.