Vitamin D deficiency

A Personalized Approach to Vitamin D Supplementation in Cardiovascular Health Beyond the Bone: An Expert Consensus by the Italian National Institute for Cardiovascular Research

Vitamin D is increasingly recognized for its role in cardiovascular health beyond its well-established effects on bone metabolism. This review synthesizes findings from observational studies, interventional trials, and meta-analyses to clarify the mechanisms through which vitamin D impacts cardiovascular health, including its influence on vascular function, inflammation, and metabolic pathways. Additionally, this review emphasizes the importance of a personalized approach to vitamin D supplementation, integrating individual cardiovascular risk profiles, baseline vitamin D levels, and comorbid conditions, such as hypertension and diabetes. While current evidence supports the association between low vitamin D levels and increased cardiovascular mortality, this work contributes novel insights by proposing tailored strategies for supplementation, particularly for high-risk subgroups. Practical recommendations for implementing these strategies in clinical practice are also discussed, providing a framework for optimizing cardiovascular outcomes through individualized vitamin D management.

Biomarkers of Importance in Monitoring Heart Condition After Acute Myocardial Infarction

Despite notable advancements in cardiovascular medicine, morbidity and mortality rates associated with myocardial infarction (MI) remain high. The unfavourable prognosis and absence of robust post-MI protocols necessitate further intervention. In this comprehensive review, we will focus on well-established and novel biomarkers that can provide insight into the processes that occur after an ischemic event. More precisely, during the follow-up, it is of particular importance to monitor biomarkers that indicate an increase in myocardial stretch and stress, damage and death of cardiomyocytes, remodelling of the extracellular matrix, oxidative stress, and inflammation. This enables the identification of abnormalities in a timely manner, as well as the capacity to respond promptly to any changes. Therefore, we would like to highlight the importance of well-known markers, such as natriuretic peptides, high-sensitivity troponins, soluble suppression of tumorigenicity 2, galactin-3, C-reactive protein, and interleukins in post-MI settings, as well as biomarkers such as adrenomedullin, growth differentiation factor-15, insulin-like growth factor binding protein 7, amyloid beta, vitamin D, trimethylamine N-oxide, and advanced glycation end-products that recently emerged in the cardiovascular filed. The implementation of novel post-MI protocols, which encompass the monitoring of the aforementioned biomarkers deemed pertinent, in conjunction with adherence to established cardiac rehabilitation programmes, along with the already well-established therapeutic strategies and control of cardiovascular risk factors, has the potential to markedly enhance patient outcomes and reduce the elevated level of morbidity and mortality.

A new perspective on bone development in vitamin D deficiency-associated obese children

Vitamin D is crucial for maintaining bone health and development, and bone mineral accumulation during childhood and adolescence affects long-term bone health. Vitamin D deficiency has been widely recognized as one of the main causes of osteoporosis and fractures, especially during the growth and development stage of children. Recent studies have shown that vitamin D deficiency may affect the deviation of bone development in children by mediating lipid metabolism disorders, but its specific mechanism of action has not been fully elucidated. In this study, through clinical correlation analysis, it was found that vitamin D deficiency was negatively correlated with lipid metabolism levels. Subsequently, lipidomic analysis of vitamin D-deficient mice and children showed that triglycerides were the main lipid metabolites. It was found that the triglyceride synthesis pathway plays a key role in bone development in vitamin D-deficient obese children. Our study found that vitamin D deficiency mediates bone dysplasia by affecting triglyceride synthesis. These findings provide new insights into the mechanisms by which vitamin D deficiency affects bone development in children, which may guide more precise clinical interventions and support the development of new clinical treatments.

Predictive value of platelet parameters for bronchopulmonary dysplasia in preterm infants: A systematic review and meta-analysis

BACKGROUND

To systematically evaluate the predictive value of platelet (PLT) parameters for bronchopulmonary dysplasia (BPD) in preterm infants.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies on PLT parameters predicting BPD in preterm infants from inception to December 2023. The Newcastle-Ottawa Scale was adopted to judge the article's quality. RevMan 5.4 was utilized for Meta-analysis, and Stata/SE 15.1 was applied for sensitivity analysis and Egger regression test.

RESULTS

Ten studies were included, including 1637 preterm infants, of which 540 were diagnosed with BPD. Meta-analysis showed that PLTs (SMD = -0.98, 95% CI [-1.57, -0.38], P = .001), mean platelet volume (MPV) (SMD = 0.67, 95% CI [0.19, 1.15], P = .006), and PMI (SMD = -0.47, 95% CI [-0.65, -0.28], P < .00001) could assist in predicting BPD in preterm infants. Subgroup analyses showed that PLT parameters 3 days after birth had better predictive performance for BPD in preterm infants. Sensitivity analysis implied no significant change in the results after excluding the studies 1 by 1, suggesting robust results of meta-analysis. There was a significant publication bias in the enrolled studies (P < .001).

CONCLUSION

PLT, MPV, and PMI have a predictive value for BPD in preterm infants.

The Role of Nutrient Supplements in Female Infertility: An Umbrella Review and Hierarchical Evidence Synthesis

BACKGROUND AND OBJECTIVES

Nutrient supplements are commonly used to improve fertility outcomes by women with infertility trying to conceive spontaneously or utilising medically assisted reproduction (MAR). However, despite their widespread use and perceived safety, there is a lack of clear guidance on the efficacy and safety of these supplements for female infertility. The aim of this umbrella review was to identify the best available and most recent evidence on the efficacy and safety of nutrient supplements for female infertility to provide evidence-based guidance for clinicians and reproductive couples.

METHODS

Five electronic databases were searched for umbrella reviews, meta-analyses, and systematic reviews of randomised controlled trials on nutrient supplements for female infertility, published from August 2017 to January 2024. The primary outcomes were live birth, and clinical and biochemical pregnancy rates. Secondary outcomes were adverse effects including miscarriage and ectopic or multiple pregnancy. Quality assessment was performed using the A MeaSurement Tool to Assess systematic Reviews Version 2.0 (AMSTAR 2), and the certainty of evidence for outcomes were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, where possible.

RESULTS

Four meta-analyses were included. Multiple micronutrients and antioxidants increased live birth rates in women utilising MAR and/or trying to conceive spontaneously compared to placebo, standard or no treatment (odds ratio (OR) 2.59 and 1.81 respectively) with very low certainty evidence. L-carnitine, coQ10, melatonin, myo-inositol, NAC and vitamin D increased clinical pregnancy rates in women with PCOS and/or undergoing MAR compared to placebo, standard or no treatment (odds ratio (OR) 11.14, 2.49, 1.66, relative risk (RR) 1.52, OR 2.15, and 1.49 respectively) with very low certainty evidence. Vitamin D did not increase biochemical pregnancy rates in women utilising MAR with very low certainty evidence. NAC, vitamin D, and pooled antioxidants had no effect on miscarriage rates or multiple pregnancy rates in women trying to conceive spontaneously or utilising MAR, with low to very low certainty evidence. Pooled antioxidants had no effect on ectopic pregnancy rates in women trying to conceive spontaneously or utilising MAR, with low certainty evidence.

CONCLUSIONS

The available evidence is insufficient to recommend nutrient supplementation to improve female infertility in women trying to conceive naturally and those utilising MAR. However, there is currently no indication that these nutrients pose any risk of significant harm.

REGISTRATION

PROSPERO (CRD42022365966) 20 October 2022.

Fat Distribution as a Determinant of Vitamin D Status: A Cross-Sectional Study of Adults in the United States

BACKGROUND

This study aimed to elucidate correlations between obesity-related indicators and vitamin D (VD) status in a nationally representative sample of U.S. adults.

METHODS

We analysed data from 9168 adults aged 20-59 years obtained from the 2011-2018 National Health and Nutrition Examination Survey. Serum 25 hydroxyvitamin D [25(OH)D] levels were measured and categorised into quartiles. Anthropometric measurements, including weight, waist circumference, and fat mass in various body regions quantified through dual-energy X-ray absorptiometry, were collected. Multiple imputation was employed to replace missing data. The importance of obesity-related indicators and serum 25(OH)D concentration was explored using multiple linear regression adjusted for demographics, lifestyle factors, dietary intake, and clinical biomarkers, and stepwise regression.

RESULTS

Weight, waist circumference, and fat mass across all body regions were inversely associated with serum 25(OH)D levels (all p < 0.001). Notable differences were observed between men and women. Stepwise regression revealed a strong inverse correlation between visceral adipose tissue and serum 25(OH)D concentration in men [β 95% CI: -13.04 (-18.10, -7.99), p < 0.001], whereas in women, only weight was significantly correlated with serum 25(OH)D concentration [β 95% CI: -0.20 (-0.28, -0.12), p < 0.001]. Demographic attributes, seasonal sunlight exposure, dietary VD, calcium, phosphorus, and magnesium intake, and biomarkers including alkaline phosphatase and creatinine also emerged as significant predictors.

CONCLUSIONS

Besides conventional obesity measures, abdominal fat metrics exhibit robust associations with VD deficiency, especially in men. Public health initiatives and clinical management strategies for hypovitaminosis D in obese populations should consider nuanced aspects of adiposity distribution alongside other demographic, lifestyle, and dietary factors influencing VD.

Structural equation modeling of dietary patterns and association with vitamin D levels in children aged 9-16 years in Guangzhou, China

Background

Vitamin D deficiency and insufficiency represent critical public health concerns on a global scale. Due to the increase in indoor activities, the role of dietary intake of vitamin D has become increasingly prominent. However, previous studies have focused solely on a single food item.

Objectives

This study aimed to identify dietary patterns among school-aged children in rural areas of Guangzhou, China, and to explore their association with vitamin D levels.

Methods

A total of 2,346 children aged 6-17 years were included in this cross-sectional study. Demographic, lifestyle, and dietary data were collected through structured questionnaires. Dietary patterns were identified using factor analysis, while linear regression and structural equation modeling were employed to analyze the relationship between these patterns and vitamin D levels.

Results

Three distinct dietary patterns emerged: a fruits and vegetables pattern, high-protein pattern, and snack pattern. Analysis revealed that a higher adherence to the fruits and vegetables dietary pattern was associated with lower vitamin D levels. Conversely, among girls, a stronger preference for the high-protein dietary pattern was positively correlated with higher vitamin D levels.

Conclusion

The fruits and vegetables pattern emerged as a risk factor for inadequate internal vitamin D levels. In girls, the high-protein pattern functioned as a protective factor. These findings offer valuable insights and policy recommendations for enhancing the health status of children in rural communities.

Omega-3 Fatty Acid and Vitamin D Supplementations Partially Reversed Metabolic Disorders and Restored Gut Microbiota in Obese Wistar Rats

Obesity is a global public health issue linked to various comorbidities in both humans and animals. This study investigated the effects of vitamin D (VD) and omega-3 fatty acids (ω3FA) on obesity, gut dysbiosis, and metabolic alterations in Wistar rats. After 13 weeks on a standard (S) or High-Fat, High-Sugar (HFHS) diet, the rats received VD, ω3FA, a combination (VD/ω3), or a control (C) for another 13 weeks. The HFHS diet led to increased weight gain, abdominal circumference, glucose intolerance, insulin resistance, and gut dysbiosis. VD supplementation improved their fasting blood glucose and reduced liver damage, while ω3FA slowed BMI progression, reduced abdominal fat, liver damage, and intestinal permeability, and modulated the gut microbiota. The combination of VD/ω3 prevented weight gain, decreased abdominal circumference, improved glucose tolerance, and reduced triglycerides. This study demonstrates that VD and ω3FA, alone or combined, offer significant benefits in preventing obesity, gut dysbiosis, and metabolic alterations, with the VD/ω3 combination showing the most promise. Further research is needed to explore the mechanisms behind these effects and their long-term potential in both animal and human obesity management.

The Impact of Vitamin D Supplementation Duration on Early Childhood Developmental Milestones: A Retrospective Study

BACKGROUND

Vitamin D plays a pivotal role in early childhood development, influencing skeletal strength, neuromuscular coordination, and neurodevelopment. This study aimed to evaluate the impact of different durations of Vitamin D supplementation on achieving developmental milestones.

METHODS

A retrospective study was conducted on 209 children, divided into two cohorts based on Vitamin D supplementation duration: six months (n = 102) and twelve months (n = 107). Developmental milestones were assessed across motor (sitting, walking), fine motor (object tracking, grasping), and social (smiling, speech) domains. Statistical analyses, including t-tests and effect size calculations, were performed to compare the mean ages of milestone achievement.

RESULTS

The 12-month group achieved several milestones significantly earlier than the 6-month group. These included walking, object tracking, and combining words into phrases. Differences in other milestones, such as sitting and smiling, were not statistically significant. Effect sizes ranged from small to moderate.

CONCLUSION

Extended Vitamin D supplementation is associated with modest yet significant advancements in key developmental milestones. However, socio-environmental factors, including parental involvement, likely contributed to these differences. This study's retrospective design limits causal interpretation, emphasizing the need for prospective, randomized studies to validate findings. These results support the potential benefits of extending Vitamin D supplementation beyond six months to optimize developmental outcomes in infants.

Genetic prediction of serum micronutrient levels and the risk of frailty: Evidence from a Mendelian randomization study

Although observational studies have revealed a link between frailty and serum micronutrient levels, it remains unclear whether these 2 states are directly connected. Thus, Mendelian randomization (MR) was used to investigate the causal relationship between frailty and blood micronutrient levels. Summary-level data for 15 blood micronutrients (copper, selenium, zinc, calcium, iron, magnesium, potassium, folate, carotene, vitamin A, vitamin B6, vitamin B12, vitamin C, vitamin D, and vitamin E) were obtained from people of European ancestry from the Integrative Epidemiology Unit. Single nucleotide polymorphisms associated with the frailty index were extracted from a published meta-analysis study in the UK Biobank and Swedish TwinGene. We used the inverse variance weighted (IVW) method for the primary analysis. We employed pleiotropy residual sum and outlier (MR-PRESSO) tests, MR-Egger intercepts, Cochran Q tests, and leave-one-out analysis to assess causality validity and robustness. Reverse MR analysis was used to determine reverse causation. The IVW results revealed that vitamin D (odds ratio [OR] = 1.096; 95% confidence interval [CI]: 1.019-1.178; P = .014) increased the likelihood of a high risk of frailty, whereas the frailty index had a protective effect on selenium (OR = 0.622; 95% CI: 0.396-0.977; P = .039), carotene (OR = 0.916; 95% CI: 0.858-0.979; P = .009), vitamin C (OR = 0.895; 95% CI: 0.837-0.957; P = .001), iron (OR = 0.921; 95% CI: 0.859-0.988; P = .022), and vitamin E (OR = 0.907; 95% CI: 0.847-0.971; P = .005). The reverse IVW analysis revealed no significant correlation between micronutrient levels and frailty indices. The study revealed causal links between vitamin D and the risk of frailty. Notably, our findings highlight the necessity of adjuvant vitamin D in frailty management.

The Interplay Between Vitamin D Deficiency, Iron Status, and Anemia Risk in Moroccan Women of Reproductive Age: A Cross-Sectional Analysis

Background: Vitamin D and iron deficiencies are prevalent among Moroccan women of reproductive age (WRA). Research suggests that Vitamin D deficiency (VDD) may impair iron bioavailability, potentially leading to iron deficiency (ID) and anemia. Objectives: This study investigates associations between vitamin D status, iron levels, and anemia risk in WRA, aged 18-49, from Meknes, Morocco. Methods: A cross-sectional study was conducted among 463 participants, measuring serum 25(OH)D, blood count parameters, iron, ferritin, C-reactive protein, and creatinine. Lifestyle factors, including dietary intake, sun exposure, and physical activity, were assessed through validated questionnaires, and anthropometric data were collected. Linear and logistic regression models analyzed associations, while ROC analysis evaluated VDD's predictive accuracy for ID and anemia. Results: VDD (25(OH)D < 20 ng/mL) was significantly associated with reduced hemoglobin, hematocrit, red blood cells, and ferritin (all p < 0.01), indicating vitamin D's role in erythropoiesis and iron storage. Multivariate logistic regression showed that VDD increased the risk of anemia (OR: 7.17, 95% CI: 3.19-19.28, p < 0.001), ID (OR: 2.20, 95% CI: 1.32-3.77, p = 0.007), and IDA (OR: 4.10, 95% CI: 1.73-12.08, p = 0.004). Dietary iron intake was inadequate, showing minimal protective effects against anemia and ID (β(SE): -0.08(0.03), p = 0.030 and β(SE): -0.05(0.02), p = 0.037). Conclusions: VDD is a significant risk factor for impaired iron status and anemia in Moroccan WRA, highlighting the need for targeted nutritional interventions and further research.

The role of vitamin D in treated and refractory ulcerative colitis patients: a case-control study

BACKGROUND

Ulcerative colitis is a form of chronic inflammatory bowel disease (IBD) marked by ongoing inflammation of the mucosal lining that extends from the rectum to the upper part of the colon. Vitamin D regulates immune responses in several autoimmune and inflammatory diseases, including ulcerative colitis. Therefore, the study aims to investigate the role of vitamin D in the pathogenesis and treatment of ulcerative colitis.

METHODS

This case-control study included 94 participants who were divided into four groups. Group 1: people with ulcerative colitis who responded to treatment (n = 24). Group 2: family members of patients who responded to treatment and did not have the disease (n = 24). Group 3: People with ulcerative colitis who are resistant to treatment (n = 23). Group 4: family members of treatment-resistant patients who does not have the disease (n = 23). Groups 1 and 3 were considered as patient groups (n = 47) and groups 2 and 4 as control groups (n = 47). Blood samples were taken and analyzed for complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum vitamin D levels.

RESULTS

The mean age of treatment-responsive patients (group 1) was 45.88 ± 18.51 years, while treatment-resistant patients (group 3) averaged 41.30 ± 13.01 (P = 0.33) years. Serum Vitamin D levels were 24.96 ± 9.66 ng/mL in group 1 and 27.70 ± 12.28 ng/mL in group 3, showing no significant correlation with ulcerative colitis (P = 0.41). All groups had a BMI within the normal range, and mean CRP levels varied significantly across groups. Hemoglobin was significantly lower in group 3 compared to group 1 (P = 0.029), but ESR results showed no significant relationship with ulcerative colitis. Vitamin D levels were highest in patients with lower BMI, and no significant relationships were found between Vitamin D and other risk factors, although extensive colitis was associated with higher Vitamin D levels compared to distal colitis.

CONCLUSION

In this study, there was no significant association between ulcerative colitis and serum levels of vitamin D. However, the small number of patients may limit the conclusions that can be drawn regarding the role of vitamin D in the treatment of ulcerative colitis. Future studies should aim for larger cohorts to provide more definitive insights into this important issue.

Serum Vitamin D Profiles of Children with Asthma in Southwest Saudi: A Comparative Cross-Sectional Study

Background

Evidence suggests a strong association between vitamin D status and asthma, with individuals exhibiting vitamin D deficiency demonstrating increased prevalence and severity of asthma symptoms. This study aimed to determine the prevalence of vitamin D deficiency among asthmatic children, assess the association between vitamin D status and asthma severity/control, and identify potential predictors of vitamin D deficiency in this population.

Patients and Methods

This comparative cross-sectional, hospital-based study was conducted at Abha Maternity and Children's Hospital, a tertiary care and teaching institution in southwestern Saudi Arabia, between January 2023 and May 2024.

Results

A total of 331 asthmatic children and 101 non-asthmatic children were analyzed. Children with asthma had significantly lower serum vitamin D levels than those without asthma (21.5 ± 8.8 ng/mL vs 33.3 ± 13.2 ng/mL, p < 0.001). Significantly higher proportions of asthmatic children exhibited vitamin D deficiency (51.1%) and insufficiency (34.7%) compared to non-asthmatic children (19.8% and 29.7%, respectively). Serum vitamin D levels among asthmatic children showed significant negative correlations with age (r = -0.332, p < 0.001), weight (r = -0.292, p < 0.001), height (r = -0.298, p < 0.001), and BMI (r = -0.274, p < 0.001). These findings were further supported by univariate linear regression analysis. Multivariable analysis additionally confirmed age (β = -0.66, p < 0.001) and BMI (β = -0.25, p = 0.05) as independent predictors of vitamin D status, with older age and higher BMI associated with lower vitamin D levels. For each additional year of age, serum vitamin D decreased by an average of 0.66 ng/mL (p < 0.001) and a one-unit increase in BMI was associated with a decrease of 0.25 ng/mL in serum vitamin D (p = 0.05).

Conclusion

This study found a strikingly high prevalence of vitamin D deficiency among asthmatic children in southwestern Saudi Arabia, significantly exceeding rates in controls. These findings underscore the need for widespread vitamin D screening and supplementation in this population, particularly among older, overweight asthmatic children.

Association between magnesium and vitamin D status in adults with high prevalence of vitamin D deficiency and insufficiency

PURPOSE

It has been assumed that magnesium (Mg) status may interact with vitamin D status. We therefore aimed at investigating the association between Mg and vitamin D status in a large cohort of adult individuals with a high prevalence of deficient/insufficient vitamin D and Mg status.

METHODS

We used data from the Ludwigshafen Risk and Cardiovascular Health Study (n = 2,286) to analyze differences according to serum Mg status in circulating 25-hydroxyvitamin D [25(OH)D] (primary endpoint), 24,25-dihydroxyvitamin D3 [24,25(OH)2D3], vitamin D metabolite ratio and calcitriol, and odds ratios for deficient or insufficient 25(OH)D (secondary endpoints). We performed unadjusted and risk score (RS) adjusted and matched analyses.

RESULTS

Of the study cohort (average age > 60 years), one third was 25(OH)D deficient (< 12 ng/mL), one third 25(OH)D insufficient (12 to < 20 ng/mL), about 10% Mg deficient (< 0.75 mmol/L) and additional 40% potentially Mg deficient (0.75 to 0.85 mmol/L). In adjusted/matched analyses, 25(OH)D was only non-significantly lower in Mg deficient or insufficient groups versus their respective control group (P > 0.05). Only the RS-adjusted, but not the RS-matched odds ratio of 25(OH)D deficiency was significantly lower for the group with adequate versus deficient/potentially deficient Mg status (0.83; 95%CI: 0.69-0.99), and only the RS-matched, but not the RS-adjusted odds ratio of 25(OH)D insufficiency was significantly lower for non-deficient versus deficient Mg status (0.69; 95%CI: 0.48-0.99). Other adjusted or matched secondary endpoints did not differ significantly between subgroups of Mg status.

CONCLUSIONS

Our data indicate only little effect between Mg and vitamin D status in adults with high prevalence of vitamin D deficiency and insufficiency.

Parathyroid hormone mediates the adverse impact of air pollution exposure on serum 25-hydroxyvitamin D: A nationwide cross-sectional study in China

BACKGROUND

Maintaining normal levels of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) is crucial for preserving skeletal health. However, evidence regarding the associations of exposure to air pollution with serum 25(OH)D and PTH were limited and ambiguous. Hence, the objective of this cross-sectional study was to systematically evaluate the association between air pollution [particulate matter ≤ 2.5 μm (PM2.5) and ozone (O3)] exposure and serum 25(OH)D and PTH levels in males aged 50 and above and postmenopausal female.

MATERIALS AND METHODS

This study is multicenter, cross-sectional study within the framework of the ongoing China Community-based Cohort of Osteoporosis. The 1-year-average PM2.5 and O3 exposures prior to the baseline survey were estimated using random forest models with relatively high accuracy. Multiple linear regression models were employed to assess the associations between PM2.5 and O3 concentrations with the serum levels of 25(OH)D and PTH. Furthermore, mediation analysis was performed to scrutinize the potential mediating role of PTH in the interplay between PM2.5, O3, and serum 25(OH)D.

RESULTS

A total of 13194 participants were included. Our analysis showed that every 10 μg/m3 increase in the 1-year average PM2.5, were associated with -0.32 units (95% CI: 0.48, -0.17) of change in the 25(OH)D and 0.15 units (95% CI: 0.11, 0.19) of change in the PTH, respectively. Every 10 μg/m3 increase in the 1-year average O3, were associated with -0.78 units (95% CI: 1.05, -0.51) of change in the 25(OH)D and 0.50 units (95% CI: 0.43, 0.57) of change in the PTH, respectively. Estimates of the mediation ratio indicated that increased PTH mediated a 50.48% negative correlation between PM2.5 exposure and circulating 25(OH)D level. Increased PTH mediated 69.61% of the negative effects of O3 exposure on circulating 25(OH)D level.

CONCLUSIONS

Exposure to PM2.5 and O3 significantly diminished 25(OH)D while elevating PTH levels. Notably, the elevated PTH concentration partially mediates the associations between PM2.5 and O3 exposure and 25(OH)D level.

The causal association between body composition and 25-hydroxyvitamin D levels: A bidirectional Mendelian randomization analysis

Observational studies and meta-analyses have indicated a notable correlation between obesity and vitamin D deficiency, yet the causal relationship between the 2 remains contentious. This study employed a bidirectional Mendelian randomization (MR) analysis to explore the interrelation between obesity-associated body metrics: specifically body mass index (BMI), waist-to-hip ratio (WHR), body fat percentage (BFP), whole-body fat percentage (WHF), and 25-hydroxyvitamin D (25(OH)D) levels. Instrumental variables for BMI, WHR, BFP, whole body fat mass (WFM), and 25(OH)D were carefully selected based on predefined thresholds. The association between these metrics and 25(OH)D levels was assessed using the TwoSampleMR package in R 4.2.3. Analysis methods included inverse variance weighted (IVW), MR Egger regression, weighted median, weighted mode, and simple mode. Sensitivity analyses were conducted employing the TwoSampleMR and MR-PRESSO software packages in R 4.2.3 to evaluate heterogeneity and multiplicity of findings. All 4 body components exhibited statistically significant causal associations with decreased 25(OH)D levels: BMI (IVW: odds ratio [OR] = 0.912, 95% confidence interval [CI]: 0.888-0.937, P < .001), WHR (IVW: OR = 0.927, 95% CI: 0.882-0.975, P = .003), BFP (IVW: OR = 0.883, 95% CI: 0.867-0.899, P < .001), and WFM (IVW: OR = 0.850, 95% CI: 0.829-0.872, P < .001). However, no statistically significant inverse causative association was observed between these body components and 25(OH)D levels. Sensitivity analyses revealed no substantial heterogeneity or pleiotropy, ensuring robustness of the findings. This study substantiates a significant causal link between 4 obesity-related body components and decreased 25(OH)D levels, excluding reverse causality.

Ovarian reserve modulates the impact of vitamin D deficiency on assisted reproductive outcomes in patients undergoing controlled ovarian hyperstimulation

Objective

The association between vitamin D deficiency and ovarian reserve-specific outcomes of assisted reproductive technology (ART) remains uncertain. This study aimed to investigate the role of ovarian reserve in the association between basal serum vitamin D levels and ART outcomes in patients undergoing controlled ovarian hyperstimulation (COH).

Methods

A total of 1,333 infertile women undergoing COH cycles were retrospectively analyzed. Patients were divided into a vitamin D deficiency group (serum vitamin D < 20 ng/mL) and a normal vitamin D group. Univariate and multivariate logistic regression analyses were performed to estimate the relationship between vitamin D deficiency and pregnancy outcomes including biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, and live birth rate in the overall cohort and subgroups with diminished ovarian reserve (DOR) or polycystic ovary syndrome (PCOS).

Results

In the entire participants' cohort, no correlation between vitamin D deficiency and pregnancy results was observed (p > 0.05). However, in the DOR subgroup, vitamin D deficiency was associated with a lower biochemical pregnancy rate (adjusted OR 0.27; 95% CI 0.08-0.90; p < 0.01) and clinical pregnancy rate (adjusted OR 0.36; 95% CI 0.14-0.90; p < 0.01). No significant differences were observed in pregnancy outcomes among patients with PCOS (p > 0.05).

Conclusion

Vitamin D deficiency does not affect pregnancy outcomes in the overall patient population, but it may negatively impact women with DOR potentially leading to poorer pregnancy outcomes. Further studies are needed to clarify the mechanisms involved and the potential use of vitamin D screening and supplementation in specific populations.

Serum 25-Hydroxyvitamin D Levels and Disease Activity in Patients with Systemic Lupus Erythematosus: An Exploratory Study in Western Mexico

BACKGROUND AND OBJECTIVES

The correlation between diminished 25-hydroxyvitamin D (25-(OH)D) concentrations and heightened disease activity in systemic lupus erythematosus (SLE) patients remains contentious, as clinical studies have yielded conflicting outcomes-some propose a potential link, while others assert no relationship exists. Nonetheless, all studies report a significant prevalence of low 25-(OH)D levels among SLE patients. This study aimed to assess the frequency of low serum levels of 25-(OH)D in Mexican patients with SLE and to evaluate the correlation between 25-(OH)D deficiency or insufficiency and disease activity levels.

MATERIALS AND METHODS

This retrospective analysis comprised patients admitted to our hospital from November 2022 to October 2023, diagnosed with SLE, and had their serum 25-(OH)D levels tested upon admission. The frequency of low levels of 25-(OH)D was assessed, and clinical and demographic data were gathered to examine potential causes linked to 25-(OH)D deficiency or insufficiency.

RESULTS

A total of 61 patients were included, and 87% (n = 53) had low serum 25-(OH)D levels. Patients with 25-(OH)D deficiency (n = 21) were significantly younger (mean 23 vs. 39 years, p = 0.04) and had higher protein levels in 24 h urine protein (1.8 vs. 1.1 g/24 h, p = 0.006) than patients who presented only 25-(OH)D insufficiency, without significant differences in other indicators of disease activity.

CONCLUSIONS

In this investigation, patients with SLE exhibited a high frequency of low serum levels of 25-(OH)D, consistent with existing literature; however, no significant correlations were identified between 25-(OH)D levels and indicators of disease activity. These findings require validation in subsequent research.

Analysis of Usual Consumption of Vitamin D Among Adult Individuals in Italy

Background: The condition of vitamin D (25OHD) deficiency represents an important public health problem. In Europe, hypovitaminosis is common not only in the elderly population but also between 50 and 70 years, both in males and females. Data regarding vitamin D intake in the Italian population are very limited. In a recent paper, reporting data collected by a specific Frequency Food Questionnaire (FFQ), we observed in a small group of healthy subjects that the dietary consumption of vitamin D, both in females and males, was far below the average. Methods: With the aim of expanding our preliminary data, we conducted a survey on a large cohort of subjects from different areas of Northern, Central, and Southern Italy. The FFQ contained 11 different questions regarding the amount and type of intake of foods containing ergocalciferol and cholecalciferol. It was submitted to 870 subjects, 627 females and 243 males, with an age range from 40 to 80 years; 31.6% of the studied population was apparently in good health, while 68.4% were affected by different pathologies. Results: The present data confirm previous observations: the global quantity of vitamin D intake in 14 days was 70.8 μg (±1.8 SE, ±54.4 SD) in females and 87.5 μg (±1.9 SE, ±57.1 SD) in males; the mean daily intake of vitamin D in females and males was 5.05 μg (±0.5 SE, ±3.8 SD) and 6.25 μg (±0.21 SE, ±4.1 SD), respectively. In healthy subjects, a gradual decrease was observed in the overall intake of vitamin D in both females and males according to an increase in age bracket, ranging from 74.5 μg and 103.8 μg in the 40-50 age group to 54.5 μg and 87.8 μg in the 71-80 age group, respectively. Conclusions: In conclusion, the present data, collected in a large Italian cohort, underscore that the daily intake of vitamin D is far below the recommended daily average, thereby contributing to the development of potential hypovitaminosis.

Vitamin D supplementation may be beneficial in improving the prognosis of patients with sepsis-associated acute kidney injury in the intensive care unit: a retrospective study

Background

Vitamin D, an essential fat-soluble micronutrient, exerts diverse physiological effects including the regulation of calcium ion homeostasis, modulation of immune response, and enhancement of resistance against infectious pathogens. Empirical investigations have elucidated an association between inadequate levels of vitamin D and adverse clinical outcomes in critically ill cohorts, with a noteworthy prevalence of vitamin D deficiency observed among patients afflicted with acute kidney injury (AKI). In the context of this retrospective inquiry, our aim was to assess the potential correlation between vitamin D supplementation administered during admission to the intensive care unit (ICU) and the improvement of outcomes specifically in cases of severe AKI.

Methods

This study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV), a repository of ICU patient records from Beth Israel Deaconess Medical Center (BIDMC) in the United States. We focused on patients diagnosed with epsis-associated acute kidney injury (SA-AKI), dividing them into those who received vitamin D supplementation during their ICU admission and those who did not. Our primary analysis evaluated in-hospital mortality using various statistical methods, such as Kaplan-Meier survival curves, Cox proportional hazards regression models, and subgroup analyses. To enhance the robustness of our findings, we used propensity score matching (PSM) to reduce potential biases. Secondary outcomes included 28-day, 90-day mortality rates and norepinephrine-free days at 28 days.

Results

In this investigation, a cohort of 11,896 individuals diagnosed with SA-AKI was studied. Among them, 2,724 patients received vitamin D supplementation (the vitamin D group) while 9,172 did not (the no-vitamin D group). Kaplan-Meier survival analysis indicated a significant difference in survival probabilities between the two cohorts. Upon adjusting for potential confounders using Cox regression modeling, a notably decreased risk of hospitalization and ICU mortality was observed in the vitamin D group compared to the no-vitamin D group, with an adjusted risk ratio for in-hospital mortality of 0.56 (95% CI: 0.5-0.63). These findings were consistent following PSM and subsequent adjustments for propensity score, pairwise algorithm (PA), and overlapping weights (OW) analyses, yielding hazard ratios ranging from 0.53 to 0.59, all with p-values <0.001. Notably, E-value analyses underscored the robustness of these results against potential unmeasured confounders.

Conclusion

This study suggests that vitamin D supplementation may be associated with a reduced in-hospital mortality rate among SA-AKI patients in the ICU. Furthermore, the 28-day, 90-day mortality rates and norepinephrine days were significantly reduced in the group receiving vitamin D supplementation.

Vitamin D: A key player in COVID-19 immunity and lessons from the pandemic to combat immune-evasive variants

As of the 7th of July 2024, 775,754,322 confirmed cases of COVID-19, including 7,053,902 deaths worldwide, had been reported to the WHO (World Health Organization). Nevertheless, untill the 15th of July 2024, a total of 13,578,710,228 vaccine doses had been administered, with almost no country spared from COVID-19 attacks. The pathophysiology of this virus is complicated, and several symptoms require a deep understanding of the actual mechanisms. It is unclear why some patients develop severe symptoms while others do not, although literature suggests a role for vitamin D. Vitamin D plays a crucial role in the infection or in ameliorating the severity of symptoms. The mechanism of action of vitamin D and vitamin D deficiency (VDD) is well understood. VDD is associated with increased hospitalization of severely ill patients and increased levels of COVID-19-caused mortality. Recent studies suggest that vitamin D levels and genetic variations in the vitamin D receptor (VDR) gene significantly impact the severity and outcomes of COVID-19, especially in the infections caused by Delta and Omicron variants. Furthermore, VDD causes immune system dysregulation upon infection with SARS-CoV-2, indicating that vitamin D sufficiency is crucial in fighting against COVID-19 infection. The therapeutic effect of vitamin D raises interest in its potential role as a prophylactic and treatment adjunct. We evaluate the immunomodulatory effects of vitamin D and its ability to enhance the efficacy of new antiviral drugs like molnupiravir and paxlovid against SARS-CoV-2. This review discusses the role of vitamin D sufficiency and VDD in COVID-19 initiation and progression, emphasizing the molecular mechanisms by which vitamin D exerts its actions as a proactive step for the next pandemic. However, there is still no clear evidence of vitamin D's impact on prevention and treatment, leading to contradictory findings. Therefore, large-scale randomized trials are required to reach a definitive conclusion. A bibliometric analysis of publications related to vitamin D, immunity, and COVID-19 revealed a significant increase in research activity in this area, particularly in 2020-2024, underscoring the growing recognition of vitamin D's potential role in the context of the pandemic.

Smoking habits and osteoporosis in community-dwelling men subjected to dual-X-ray absorptiometry: a cross-sectional study

BACKGROUND

Active and Environmental Tobacco Smoke (ETS) are a global cause of death. Osteoporosis (Op) is the most common metabolic bone disorder worldwide, impacting on mortality and disability, with high health and welfare costs. Active smoking is a known risk factor for Op, but there is few information regarding Op and ETS in men.

PURPOSE

The study aim is to evaluate the association between smoking habits and Op in community-dwelling men that have been subjected to Dual-X-ray Absorptiometry and completed a questionnaire about their own and cohabiter's smoking habits.

METHODS

We performed a cross-sectional study based on administrative data. This study is part of the SIMON protocol. The binary logistic regression analysis was used to estimate the role of ETS on the risk of Op, adjusting for age, body mass index (BMI), type 2 diabetes mellitus (T2DM) and eGFR.

RESULTS

Four hundred sixteen men were selected and, based on questionnaire replies, 167 were classified as current smokers (CS), 93 as passive smokers (PS) and 156 as never smokers (NS). NS showed a lower prevalence of past fragility fracture, radiological features of osteoporosis and hypovitaminosis D compared to PS and CS (p < 0.05). NS showed a lower prevalence of Op compared to PS and CS, also after correction for age, BMI, T2DM and eGFR (p < 0.05).

CONCLUSION

The study results demonstrate that PS and CS have a higher risk of Op, fragility fractures and vitamin D deficiency compared to NS.

Longitudinal associations between vitamin D status and biomarkers of inflammation in a pan-European cohort of children and adolescents

PURPOSE

To investigate longitudinal associations between the vitamin D status and inflammatory markers in children and adolescents.

METHODS

Children from eight European countries from the IDEFICS/I.Family cohort with repeated measurements were included in this study. A linear mixed-effect model was used to model the association of serum 25(OH)D as independent variable and z-scores of inflammatory markers [CRP, cytokines, adipokines, combined inflammation score] as dependent variables, where one level accounts for differences between individuals and the other for changes over age within individuals.

RESULTS

A total of 1,582 children were included in the study. In the adjusted model, 25(OH)D levels were positively associated with adiponectin (β = 0.11 [95% CI 0.07; 0.16]) and negatively with the inflammation score (β = - 0.24 [95% CI - 0.40; - 0.08]) indicating that the adiponectin z-score increased by 0.11 units and the inflammation score decreased by 0.24 units per 12.5 nmol/l increase in 25(OH)D. In children with overweight or obesity, only a positive association between 25(OH)D and IP-10 was observed while in children with normal weight adiponectin was positively and the inflammation score was negatively associated. Associations of vitamin D with adiponectin and the inflammation score were stronger in girls than in boys and a positive association with TNF-α was observed only in girls.

CONCLUSION

Our results suggest that an increase in vitamin D concentrations may help to regulate inflammatory biomarkers. However, it seems to be no benefit of a better vitamin D status in children with overweight/obesity unless their weight is managed to achieve an improved inflammatory marker status.

A nationwide cohort study of inflammatory bowel disease, histological activity and fracture risk

BACKGROUND

Individuals with inflammatory bowel disease (IBD) are at increased risk of fracture. It is unclear if this risk varies by recent histological activity.

AIMS

To determine the fracture risk in IBD during periods with and without histological inflammation.

METHODS

We studied a nationwide cohort of 54,591 individuals diagnosed with IBD in 1990-2016 with longitudinal data on ileo-colorectal biopsies. Fractures were identified by inpatient and hospital-based outpatient diagnoses. We derived Cox regression estimated hazard ratios (HRs) for fracture during 12 months following a histological inflammation (vs. histological remission) record after adjusting for socio-demographics, comorbidities, IBD duration, IBD-related surgery and hospitalization. We adjusted sensitivity analyses for medical IBD treatment including corticosteroids.

RESULTS

Mean age of patients was 44.0 (SD = 18.3) and 45.5 (SD = 17.1) years at biopsy with histological inflammation and remission, respectively. For histological inflammation, there were 1.37 (95% CI 1.29-1.46) fractures per 100 years' follow-up versus 1.31 (95% CI 1.19-1.44) for remission (adjusted [a]HR 1.12; 95% CI 1.00-1.26; p = 0.04). HRs were similar with histological inflammation of Crohn's disease (1.11; 95% CI 0.91-1.36) and ulcerative colitis (1.18; 95% CI 1.02-1.36). Estimates were consistent across age groups. An overall small excess risk of any fracture remained after accounting for corticosteroids. A more prominently raised fracture risk was observed in corticosteroid-naïve IBD patients with histological inflammation versus histological remission (aHR 1.41; 95% CI 1.07-1.85). The aHR of hip fracture following histological inflammation was 1.29 (95% CI 0.87-1.92).

CONCLUSIONS

Histological inflammation in IBD predicted a small increase in short-term fracture risk. Measures to reduce disease activity may reduce fracture risk in IBD.

Simple prediction model for vitamin D deficiency in women with osteoporosis or risk factors for osteoporosis in Thailand

Introduction

In Thailand, the assessment of vitamin D status by measuring 25-hydroxyvitamin D[25(OH)D] levels in individuals at risk for osteoporosis is constrained by limited facilities and high costs. This study aimed to create a clinical model for predicting vitamin D deficiency in women with osteoporosis or risk factors for osteoporosis.

Materials and Methods

This was a cross-sectional study of 490 women. All participants had 25(OH)D levels measured. A questionnaire was used to assess factors related to vitamin D status. Vitamin D deficiency was defined as 25(OH)D levels < 30 ng/mL. Logistic regression analyses were conducted to investigate predictors of vitamin D deficiency. In the model, odds ratios (ORs) were converted into simple scores. The optimal cutoff for women at a high risk of vitamin D deficiency was established. Internal validation was assessed using a Bootstrap.

Results

Sixty percent had vitamin D deficiency. The final model for predicting vitamin D deficiency consisted of a body mass index ≥ 25 kg/m2 (OR:1.15), lack of exercise (OR:1.59), exercise 1-2 times/week (OR:1.40), sunlight exposure < 15 min/day (OR:1.70), no vitamin D supplementation (OR:8.76), and vitamin D supplementation of 1-20,000 IU/week (OR:2.31). The area under the curve was 0.747. At a cutoff of 6.6 in total risk score (range 4-13.6), the model predicted vitamin D deficiency with a sensitivity of 71.9 % and a specificity of 65.3 %. The internal validation by Bootstrap revealed a ROC of 0.737.

Conclusions

In women at risk of osteoporosis, a simple risk score can identify individuals with a high risk of vitamin D deficiency. These women could benefit from vitamin D supplementation without requiring 25(OH)D measurements.

The effect of vitamin D supplementation on markers of insulin resistance in women with polycystic ovarian syndrome: a systematic review

BACKGROUND

Insulin resistance (IR) is a common pathology in women with polycystic ovarian syndrome (PCOS) involved in increased rates of cardiometabolic disease such as diabetes and cardiovascular disease. Low serum vitamin D is often associated with insulin resistance but there is no consensus on whether vitamin D supplementation can ameliorate markers of IR in PCOS.

OBJECTIVES

We assessed evidence on the effects of vitamin D supplementation (≥ 1000 IU/day), without the use of additional supplements or other pharmacological treatments known to affect IR, on markers of IR and glycemic control in women with PCOS.

DESIGN

A systematic search was conducted using PubMed, Medline and Web of Science databases from January 2000 up to November 2023. Randomized controlled trials that assessed the effects of vitamin D supplementation in women with PCOS, on fasting glucose, fasting insulin, glycated haemoglobin (HbA1c) or homeostatic model assessment for insulin resistance (HOMA-IR) were included.

RESULTS

9 studies were identified. Study populations ranged from 28 to 180 participants, with mean ages ranging from 22 to 30 years. Daily vitamin D doses ranged from 1714-12,000 IU. Of the included studies, 3 reported statistically significant reductions in fasting glucose, 2 reported reductions in fasting insulin, 2 reported reductions in HOMA-IR, none reported reductions in HbA1c and 5 reported no differences in any of the relevant outcomes.

CONCLUSIONS

In conclusion, in RCTs of vitamin D supplementation in women with PCOS, the majority of studies do not report statistically significant improvements in fasting glucose, fasting insulin, HbA1c or HOMA-IR. However, as a minority of studies report some statistically significant results, further investigation may be warranted.

REGISTRY

PROSPERO ID: CRD42023486144.

Early Screening for Confusion and Vitamin D Deficiency in Elderly Hip Fracture Patients: A Quality Improvement Initiative to Mitigate the Risk of Postoperative Delirium

Background Postoperative delirium (POD) is a common and debilitating complication in elderly hip fracture patients, associated with significant clinical and functional consequences. Early identification of risk factors, such as cognitive impairment and vitamin D deficiency, is essential to mitigate its impact. However, preoperative screening practices are often inconsistent. This quality improvement initiative aimed to assess and improve compliance with early confusion and vitamin D screening in elderly hip fracture patients, with the goal of facilitating timely interventions to reduce the risk of POD. Methods A two-cycle audit was conducted in the Trauma and Orthopaedics Department at Royal Shrewsbury Hospital. The first cycle (April-June 2023) assessed baseline compliance with confusion (Abbreviated Mental Test Score (AMTS)) and vitamin D screening within 24 hours of admission. Identified barriers informed an intervention consisting of educational sessions, visual prompts, and checklist integration. The second cycle (August-October 2023) evaluated the impact of these measures. Compliance rates, timing of assessments, and prevalence of abnormal biochemical and cognitive screening results were analyzed using Fisher's exact test (p < 0.05). Results Baseline compliance with screening was 27 patients (27%) out of 100, with primary barriers including lack of awareness and logistical challenges. Post-intervention compliance improved significantly for 54 patients (52.4%) out of 103 (p = 0.0003). Screening timeliness also increased, with 45 patients (83.33%) out of 54 screenings completed within 24 hours in cycle 2 compared to 14 patients (51.85%) out of 27 in cycle 1 (p = 0.0039). Biochemical analysis revealed persistently high rates of vitamin D deficiency, underscoring the need for early detection. AMTS scores correlated with abnormal confusion screens but highlighted limitations in cognitive-only assessments. Conclusion This quality improvement (QI) initiative demonstrated the efficacy of targeted interventions in improving screening compliance for confusion and vitamin D deficiency in elderly hip fracture patients. The findings advocate for integrating proactive, dual-focused screening protocols into clinical workflows to address modifiable risk factors for POD. Future research should explore the long-term impact of such measures on POD incidence, recovery trajectories, and functional outcomes while emphasizing the need for sustained adherence to screening protocols.

Vitamin D Level Between Calcium-Phosphorus Homeostasis and Immune System: New Perspective in Osteoporosis

Vitamin D is a key molecule in calcium and phosphate homeostasis; however, increasing evidence has recently shown that it also plays a crucial role in the immune system, both innate and adaptive. A deregulation of vitamin D levels, due also to mutations and polymorphisms in the genes of the vitamin D pathway, determines severe alterations in the homeostasis of the organism, resulting in a higher risk of onset of some diseases, including osteoporosis. This review gives an overview of the influence of vitamin D levels on the pathogenesis of osteoporosis, between bone homeostasis and immune system.

Neuroplasticity-related effects of vitamin D relevant to its neuroprotective effects: A narrative review

The pathophysiology of a wide range of central nervous system (CNS) disorders, such as neurodegenerative and psychiatric diseases, has been associated with impairment of neurogenic and synaptogenic processes. Therefore, pharmacological and/or nutritional strategies based on the stimulation and/or restoration of these processes may have beneficial effects against diseases in which these processes are impaired. In this context, vitamin D has emerged as a promising neuroprotective compound. Due to its pleiotropic properties, it can interact with multiple molecular targets and thereby affect different cell types, including neurons and glial cells. This neurosteroid contributes to CNS homeostasis by non-genomic and genomic mechanisms through its interaction with vitamin D receptors (VDRs). Among several properties of this vitamin, its role in neuronal proliferation and differentiation as well as in synaptic plasticity has received attention. Considering this background, this narrative review aims to highlight the neuroplasticity-related mechanisms of vitamin D that may be associated with its neuroprotective effects.

Nonlinear correlation between serum vitamin D levels and the incidence of endometrial polyps in infertile women

STUDY QUESTION

Are serum vitamin D levels associated with the incidence of endometrial polyps (EPs) in infertile patients?

SUMMARY ANSWER

Serum 25(OH)D levels were nonlinearly correlated with the incidence of EPs in infertile women.

WHAT IS KNOWN ALREADY

EPs are a common condition that may affect the receptivity of the endometrium in women of reproductive age. Vitamin D regulates cell proliferation and differentiation, apoptosis, angiogenesis, anti-inflammation, and immunomodulation, in addition to its well-known functions in balancing calcium and phosphorus. Previous studies have shown that vitamin D concentrations are associated with reproductive outcomes, and that low vitamin D levels are associated with the incidence of colorectal polyps and nasal polyps. There is little evidence regarding the relationship between EPs and serum vitamin D levels.

STUDY DESIGN, SIZE, DURATION

We conducted a cross-sectional study using data from Guangdong Women and Children Hospital from January 2019 to October 2023, enrolling 3107 patients.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 3107 infertile patients who underwent hysteroscopy were included in this study; 642 patients had endometrial polyps and 2465 had a normal uterine cavity. Hysteroscopy findings included risk of EPs, polyp size, percentage of multiple polyps, and incidence of chronic endometritis (CE). Serum vitamin D were assessed by measuring total 25(OH)D using chemiluminescence. According to international guideline recommendations for vitamin D deficiency, patients were divided into two groups: the <50 nmol/l group and the ≥50 nmol/l group. Univariable and multivariable logistic regression models, stratified analyses, and smooth curve fitting were used to examine the relationship between serum 25(OH)D levels and risk of EPs.

MAIN RESULTS AND THE ROLE OF CHANCE

Of all patients, 23.8% (740/3107) were vitamin D deficient (<50 nmol/l). The incidence of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group (24.9% vs 19.3%; P = 0.001). However, there were no differences in polyp size, proportion of multiple polyps, and presence of CE between the two groups. After controlling for confounders, 25(OH)D ≥ 50 nmol/l (compared with <50 nmol/l) was negatively associated with risk of EPs (adjusted OR, 0.733; 95% CI, 0.598-0.898). Other variables that had an impact on polyp incidence included BMI, type of infertility, CA125, and CD138-positive plasma cells. In addition, a linear regression model between age and serum 25(OH)D levels showed a positive linear association. Subgroup analyses were performed for different age groups, and the risk of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group, both in the younger subgroup (23.8% vs 19.1%) and in the older subgroup (28.0% vs 19.9%). The smooth curve fitting model showed a nonlinear correlation between 25(OH)D levels and risk of EPs (nonlinear P-value = 0.020), with an optimal threshold of 51.8 nmol/l for 25(OH)D levels. Moreover, subgroup smooth curve fitting models showed a nonlinear correlation between 25(OH)D levels and polyp risk in patients aged <35 years (nonlinear P-value = 0.010), whereas a linear correlation between 25(OH)D levels and polyp risk was found in patients aged ≥35 years (nonlinear P-value = 0.682).

LIMITATIONS, REASONS FOR CAUTION

Caution should be exercised in interpreting our findings as this is a correlational study and causality cannot be inferred from our results. In addition, because of strict inclusion and exclusion criteria, our results may not be generalizable to unselected populations, including premenopausal women or women of other races.

WIDER IMPLICATIONS OF THE FINDINGS

This study demonstrated for the first time that vitamin D deficiency is an independent risk factor for the incidence of EPs in infertile patients. Identifying modifiable risk factors (e.g. vitamin D deficiency) can help in the development of new strategies for treating polyps or to protect against polyp development. Further clinical intervention trials and laboratory studies are needed to evaluate the effect of vitamin D on the development of EPs and to elucidate the mechanisms.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the National Natural Science Foundation of China (82101718) and Natural Science Foundation of Guangdong Province, China (2022A1515010776). No competing interest was involved in this study.

TRIAL REGISTRATION NUMBER

N/A.

Vitamin D deficiency in Ukraine: A multicentre cross-sectional study

Background

Available epidemiological data on vitamin D status in the Ukrainian population are limited.

Objective

The aim of this study is to investigate the prevalence of vitamin D deficiency in Ukraine.

Methods

This multicentre cross-sectional study included a total of 11,462 participants: 1530 children with a median age 10 years, (IQR 6-14) and 56.21 % of them were female; 9932 adults with a median age of 36 years (IQR 26-48) and 78.72 % of them were female. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured once by chemiluminescent immunoassay (UniCel DxI 800 Access Immunoassay System, Beckman Coulter Inc., USA) in the period of January-December 2021 in Kyiv and Kyiv Oblast. The cut-offs were: vitamin D deficiency, <50 nmol/L; moderate deficiency, 25-<50 nmol/L; severe deficiency, <25 nmol/L; vitamin D insufficiency, 50-<75 nmol/L; vitamin D sufficiency, 75-<250 nmol/L; optimal concentration, 75-<125 nmol/L; increased levels, 125-<250 nmol/L; and toxicity, ≥250 nmol/L.

Results

The median 25(OH)D level was 65.4 nmol/L (IQR 49.5-85.6) among all participants, severe vitamin D deficiency was recorded in 2.9 % of participants (95 % CI: 2.6-3.2), moderate deficiency in 23 % (95 % CI: 22-24), and vitamin D insufficiency in 37 % (95 % CI: 36-38).Prevalence of vitamin D deficiency in group 1-17 years was 23.5 % (95 % CI: 21-26). We did not find vitamin D deficiency in children aged 1-2 years; however toxic levels were recorded in 4.2 % of the children in this age group (95 % CI: 1.4-9.6). Among the adults (≥18 years old), prevalence of vitamin D deficiency was 26 % (95 % CI: 25-27).

Conclusion

Vitamin D deficiency and insufficiency are common in Ukraine.

Revisiting Vitamin D Guidelines: A Critical Appraisal of the Literature

BACKGROUND/OBJECTIVE

The goal of this review is to compare the 2024 and 2011 Endocrine Society's Clinical Practice Guidelines on vitamin D2 or vitamin D3 (vitamin D). The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines which provided clinicians with guidance on how to evaluate and treat patients with vitamin D deficiency and prevent recurrence.

DISCUSSION

The 2024 Guideline focused on randomized controlled trials and ignored association studies and other studies that have supported the skeletal and extra skeletal health benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy-related outcomes, prediabetic patients to reduce risk of diabetes, and to improve mortality in those over 75 years.

CONCLUSION

These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D, and bone metabolism which were provided in the 2011 Guidelines. For nonpregnant adults up to the age of 75, they recommend the Dietary Reference Intakes of 600 IUs (international units; 1 IU = 25 ng of vitamin D), and 800 IUs as recommended by The Institute of Medicine. Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, pre-eclampsia, low birth weight, neonatal dental caries, and deadly cancers circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.

Trends and hotspots in research on osteoporosis and nutrition from 2004 to 2024: a bibliometric analysis

BACKGROUND

The intricate association between nutrition and osteoporosis has garnered increasing attention, and approximately 3000 articles have been published in the past 20 years. However, there are currently very few comprehensive reviews on the development of this field. It is very necessary to retrospectively analyze the related articles and summarize the research hotspots, depth, and directions.

OBJECTIVES

This study aimed to quantitatively analyze, visually review and comment on the articles published in the field of osteoporosis and nutrition based on the bibliometric methods, providing new insights for future research.

METHODS

The related articles published from 2004 to 2024 were retrieved from the Web of Science Core Collection (WOSCC). CiteSpace 6.1R2 software was used to conduct collaborative network analysis of annual publication volume, author patterns, country/region contributions, institutional affiliations, journal publications, highly cited literature, and keyword clustering.

RESULTS

A total of 2138 articles were assessed, revealing a consistent upward trend in published works in this domain, with the majority originating from the United States (564 papers). Seoul National University was identified as the most prolific institution (56 papers). Geng Bin was the most prolific author. Research hotspots included bone density, postmenopausal women, vitamin D, hip fractures, etc. Research subjects included physical activity, sarcopenia, calcium intake, machine learning, etc. Recent research trends indicate that cross-sectional study was more and the quality of life, muscle, and zinc are receiving attention in studies.

CONCLUSIONS

Future research should continue to explore better methods for measuring bone density, investigating indicators for predicting fracture risk, exploring the relationship between various nutrients and substances with osteoporosis at a deeper level, and bolstering management strategies for male osteoporosis. Researchers should conduct longitudinal or interventional studies, and further improving the overall quality of life of patients with osteoporosis.

A new target for treating intervertebral disk degeneration: gut microbes

Intervertebral disk degeneration (IDD) is a common clinical spinal disease and one of the main causes of low back pain (LBP). Generally speaking, IDD is considered a natural degenerative process with age. However, with the deepening of research, people have discovered that IDD is not only related to age, but also has many factors that can induce and accelerate its progression. In addition, the pathogenesis of IDD remains unclear, resulting in limited traditional treatment methods that cannot effectively prevent and treat IDD. Conservative treatment may lead to patients' dependence on drugs, and the pain relief effect is not obvious. Similarly, surgical treatment is highly invasive, with a longer recovery time and a higher recurrence rate. With the deepening of exploration, people have discovered that intestinal microorganisms are an important symbiotic microbial community in the human body and are closely related to the occurrence and development of various diseases. Changes in intestinal microorganisms and their metabolites may affect the body's inflammatory response, immune regulation, and metabolic processes, thereby affecting the health of the intervertebral disk. In this context, the gut microbiota has received considerable attention as a potential target for delaying or treating IDD. This article first introduces the impact of gut microbes on common distal organs, and then focuses on three potential mechanisms by which gut microbes and their metabolites influence IDD. Finally, we also summarized the methods of delaying or treating IDD by interfering with intestinal microorganisms and their metabolites. Further understanding of the potential mechanisms between intestinal microorganisms and IDD will help to formulate reasonable IDD treatment strategies to achieve ideal therapeutic effects.

Mothers Practices and Factors Affecting Sunlight Exposure of Their Infants in Adami Tulu Jido Kombolcha District, East Shoa Zone, Oromia Region, Ethiopia, 2022: A Community Based Cross-Sectional Study

Background. Vitamin D deficiency (VDD) is a global health concern affecting people of all ages. The Ethiopian guidelines recommend sun exposure for neonates starting from 2 weeks old, with 15 to 20 minutes per day. However, evidence suggests that the implementation of this recommendation is inconsistent. Most studies conducted in Ethiopia regarding infant sunlight exposure have been limited to health facilities and towns. Objective. this study aimed to assess mothers' practice, and factors affecting the sunlight exposure of their infants in Adami Tulu Jido Kombolcha district, East Shoa Zone, Oromia Region, Ethiopia, 2022. Method. A community based cross-sectional study design was conducted among 575 mothers with their infant's from March 11 to 25, 2022. A lottery method sampling technique was employed to select local administrative units and systematic random sampling employed to select study participants. Practices and knowledge were assessed by categorizing mothers based on their responses to practice and knowledge questions, respectively. Mothers who scored above the mean value of 4.5 were classified as having good practice, while those who scored 6.9 or below on the knowledge questions were classified as having poor knowledge. Data were collected through face-to-face interviews using both semi-structured and structured questionnaires. The data were then entered into EPI Data version 3.1 and exported to SPSS version 25 for analysis. The association between variables was analyzed using bivariate and multivariable binary logistic regression and level of significant determined with adjusted odd ratio at 95% CI and P-value less than <.05. Result. All 575 mothers were interviewed and responded 100%. Out of 567 mothers, 55.2% had good practice of infant sunlight exposure. Lack of advice at health facility (AOR = 3.05, 95% CI: 1.08, 8.60), absence of postnatal care follow up (AOR = 2.38, 95% CI: 1.15, 4.94) and poor knowledge about sunlight exposure (AOR = 1.70, 95% CI: 1.15, 2.50) were factors associated with practice of infant sunlight exposure. Conclusions. In this study, more than half of the mothers had good practice of infants' sunlight exposure. This study highlights the importance of improving maternal knowledge and healthcare practices related to infant sunlight exposure. Key factors affecting these practices include lack of advice at health facilities, absence of postnatal care follow-up, and poor maternal knowledge. To address these issues, healthcare providers, local health offices, and mass media should focus on educational programs and strengthening advice during health visits. Future research should use validated tools and mixed-method approaches to better understand the social and cultural factors at play. Establishing national guidelines and studying infant serum vitamin D levels can further enhance community awareness and promote the benefits of sunlight exposure.

The Anti-Inflammatory Roles of Vitamin D for Improving Human Health

Vitamin D receptors (VDRs) are present in almost all cells of the immune system, including B cells, T cells, NK (Natural Killer) cells, dendritic cells, and monocytes, as well as the epithelial cells of many organs such as the intestine, pancreas, prostate, lungs, and cardiomyocytes. In addition, some immune cells, including dendritic cells, macrophages, and B and T cells, can synthesize calcitriol by expressing 1α-hydroxylase. Upon binding to VDRs, vitamin D (Vit D) regulates the expression of genes involved in immune responses, including those encoding for cytokines. It modulates the production of pro-inflammatory cytokines while promoting the synthesis of anti-inflammatory cytokines. Vit D also affects the differentiation and maturation of cells of the immune system. By inhibiting the nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) pathways, Vit D reduces the expression of pro-inflammatory genes. These effects highlight the potential of Vit D as a therapeutic agent in the management of inflammatory diseases, including autoimmune disorders, cardiovascular diseases, diabetes, metabolic syndrome, cancer, neurological diseases, depression, and inflammatory bowel disease.

Correlation between vitamin D metabolic pathway-related gene polymorphisms and cardiovascular disease

Vitamin D plays important roles in various physiological processes such as cardiovascular health, calcium balance regulation, bone health, immune system support, neurological function regulation, muscle function maintenance, and anti-inflammatory effects. Therefore, maintaining its adequate levels is essential for overall health. Genetic polymorphisms in vitamin D metabolic pathways have become a key factor affecting the susceptibility and progression of cardiovascular disease (CVD). This article reviews the relationship between gene polymorphisms in vitamin D metabolic pathways and vitamin D levels or CVD. It is emphasized that the polymorphisms of key genes such as GC, VDR, CYP2R1, CYP24A1 and CYP27B1 are related to the pathogenesis of CVD. These polymorphisms can regulate serum levels of vitamin D, thereby affecting the susceptibility, comorbidities and clinical manifestations of CVD. Despite the progress made, there are still inconsistencies and gaps in the literature. Thus, it is necessary to conduct large-scale, multicenter studies to verify these findings and deepen our understanding of the intricate interactions between gene polymorphisms in vitamin D metabolic pathways and CVD.

Comparison of two doses of vitamin D3 in critically ill patients undergoing continuous renal replacement therapy (NephroD): study protocol for a single-blinded, multicenter, parallel group randomized controlled trial

BACKGROUND

ICU patients are particularly susceptible to vitamin D3 deficiencies. This can be due to the severity of their underlying disease, the type of treatment they are on, and malnutrition before and inadequate nutrition during the hospitalization preceding ICU admission as well as advanced age. Literature provides no guidance on how to supplement vitamin D3 in severely deficient patients who are undergoing continuous renal replacement therapy (CRRT). Most serum 25(OH)D3 is bound with vitamin D binding protein in a complex whose molecular weight is 10 kDa. This means it can be removed during CRRT via convection mechanism. Critically ill patients undergoing CRRT can therefore be particularly prone to develop severe vitamin D3 deficiency.

METHODS

As the trial design, a randomized controlled, single blinded, multicenter, parallel group approach was chosen to compare a single administration of 750,000 IU of vitamin D3 via the enteral or oral route in ICU patients with severe vitamin D3 deficiency (measured serum 25(OH)D3 levels ≤ 12.5 ng/ml) undergoing CRRT with a single administration of 500,000 IU of vitamin D3. The trial will be performed in up to five university hospitals in Poland. The primary outcome is the percentage of patients that achieved serum 25(OH)D3 levels ≥ 30 ng/ml on days 3 and 7 following vitamin D3 administration. Assuming a drop-out rate of approximately 10%, the number of recruited patients should be 138.

DISCUSSION

Considering the potential pathophysiological mechanisms underlying hypovitaminosis D in critically ill patients under CRRT, it seems conceivable that these patients will require greater supplementation doses to correct severe deficiency. The study is meant to help answer the question whether increasing the supplementation dose by 50% will ensure a more effective replenishment of vitamin D3 in critically ill patients undergoing CRRT.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05657678, registered: December 12 2022, https://clinicaltrials.gov/study/NCT05657678?cond=NCT05657678&rank=1 .

1,25(OH)2D3 increase osteogenic potential of human periodontal ligament cells with low osteoblast potential

OBJECTIVE

Periodontal dental ligament mesenchymal stem cells (PDLMSCs) play a major role in periodontal tissue regeneration by the neoformation of root cementum and alveolar bone. These cells are highly heterogeneous, and many present low potential to renovate the hard tissue damaged by periodontal disease. A previous study found that the low osteoblast/cementoblast (O/C) differentiation potential of PDLMSCs is related to high asporin (ASPN) expression, which was identified as a negative regulator of PDL cells differentiation and mineralization, suppressing BMP-2-induced O/C differentiation. This study aimed to investigate whether 1,25(OH)2D3 treatment could stimulate the O/C differentiation of periodontal ligament mesenchymal progenitor cells characterized as low osteoblast potential (LOP), by asporin and bone morphogenetic protein-2 alteration.

METHODOLOGY

Three LOP cell populations were cultured in standard medium (CONTROL), osteogenic medium (OM), and osteogenic medium associated with 1 nM of 1,25(OH)2D3 (OM + VD). The following assays were performed: 1) MTT to evaluate metabolic activity; 2) gene expression for asporin (ASPN), bone morphogenetic protein-2 (BMP-2), runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteocalcin (OCN), and vitamin D receptor (VDR) using qRT-PCR; 3) BMP-2 extracellular expression; and 4) quantification of mineralized nodule deposition by Alizarin Red Staining. Data were subjected to two-way ANOVA and Tukey's test (P<0.05).

RESULTS

The results showed that the 1,25(OH)2D3 treatment did not affect the cell viability, as demonstrated by metabolic activity increase over the 10 days in culture. After 14 days of 1,25(OH)2D3 treatment, the mRNA levels for ASPN and VDR decreased (P<0.05), while BMP-2 transcripts and extracellular expression increased (P<0.05). In parallel, RUNX2, ALP, and OCN gene expression was upregulated by 1,25(OH)2D3 treatment, resulting in an increase of mineral nodule deposition in vitro (P<0.05).

CONCLUSIONS

These data show that 1,25(OH)2D3 improves osteoblast/cementoblast differentiation of low osteoblast potential accompanied by alterations in ASPN and BMP-2 expression.

Prevalence and Associated Risk Factors for Hypovitaminosis D in Patients Scheduled for Primary Total Knee Arthroplasty in Germany

OBJECTIVE

Several studies have reported a high prevalence of hypovitaminosis D in orthopedic patients. The purpose of this prospective observational study was to report on the prevalence of hypovitaminosis D in patients scheduled for elective primary total knee arthroplasty (TKA) and its associated risk factors.

METHODS

In this monocentric cohort study, 25(OH) vitamin D serum levels were measured in 687 consecutive patients undergoing primary total knee arthroplasty (TKA) over a period of twelve months. Vitamin D levels were classified into deficiency (<20 ng/mL), insufficiency (20-29 ng/mL), and sufficiency (≥30 ng/mL). The study assessed the association of vitamin D levels with demographic and clinical factors, including age, sex, BMI, smoking status, and season of measurement. Statistical analyses included chi-square tests, correlation analyses, and multiple linear regression to identify significant predictors of vitamin D levels.

RESULTS

The cohort had a mean age of 67.70 ± 8.95 years and a mean BMI of 31.00 ± 5.71 kg/m2. Collectively, 33.9% of patients were vitamin D deficient, a further 32.9% were insufficient, and only 33.2% were sufficient. Vitamin D levels varied significantly with the season and were associated with obesity and smoking. Specifically, there was a small significant inverse correlation between BMI and vitamin D levels (r = -0.17, p < 0.01). Furthermore, regular nicotine abuse was linked to lower vitamin D levels (r = 0.14, p < 0.01). Multiple linear regression analysis reveals that age, BMI, nicotine abuse, and season were small significant predictors of preoperative vitamin D levels (R2 = 0.15, adjusted R2 = 0.12). A total of 121 (17.61%) patients reported routine vitamin D intake prior to surgery. Supplementing patients had a significantly higher mean serum vitamin D level and a significant reduction in the mean length of in-hospital stay (p < 0.01).

CONCLUSIONS

The prevalence of vitamin D insufficiency and deficiency in patients undergoing elective primary TKA is alarmingly high. In ongoing efforts to optimize the efficacy and outcome of the TKA procedure, orthopedic surgeons should be advised to strongly implement the role of perioperative vitamin D levels in their routine practice.

The effect of vitamin D supplementation on depression: a systematic review and dose-response meta-analysis of randomized controlled trials

The impact of vitamin D supplementation on depressive symptoms remains uncertain. This study aimed to investigate the dose-dependent effects of vitamin D supplementation on depressive and anxiety symptoms in adults. We systematically searched PubMed, Scopus, and Web of Science up to December 2022 to identify randomized controlled trials evaluating the effects of vitamin D3 supplementation on depression and anxiety symptoms in adults. Using a random-effects model, we calculated the standardized mean difference (SMD) for each 1000 IU/day vitamin D3 supplementation. The GRADE tool assessed the certainty of evidence. Our analysis included 31 trials with 24189 participants. Each 1000 IU/day vitamin D3 supplementation slightly reduced depressive symptoms in individuals with and without depression (SMD: -0.32, 95% CI -0.43 to -0.22; GEADE = moderate). The effect was more pronounced in those with depressive symptoms (SMD: -0.57, 95% CI -0.69 to -0.44; n = 15). The greatest reduction occurred at 8000 IU/day (SMD: -2.04, 95% CI -3.77 to -0.31). Trials with follow-up ⩽8 weeks (SMD: -0.45, 95% CI -0.70 to -0.20; n = 8) and 8 to ⩽24 weeks (SMD: -0.47, 95% CI -0.70 to -0.24; n = 15) showed stronger effects compared to those lasting 24 to ⩽52 weeks (SMD: -0.13, 95% CI -0.28 to 0.02; n = 5) or longer than 52 weeks (SMD: 0.14, 95% CI -0.16 to 0.44; n = 3) (p group difference <0.001). Vitamin D3 supplementation had no significant effects on anxiety symptoms. In summary, this study suggests that vitamin D3 supplementation may effectively reduce depressive symptoms in short term. Further high-quality trials are warranted for a conclusive assessment of its impact on anxiety.

Sex-specific association of per- and polyfluoroalkyl substances (PFAS) exposure with vitamin D concentrations in older adults in the USA: an observational study

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are commonly utilized in consumer products. While earlier studies have suggested potential impacts of certain PFAS on serum concentrations of vitamin D, these investigations were constrained to a limited set of conventional PFAS. Moreover, they did not specifically focus on populations with longer duration of PFAS exposure and potentially higher blood PFAS levels, such as older adults, and lacked adequate evidence to examine sex-related disparities.

METHODS

This observational investigation utilized cross-sectional data obtained from the U.S. NHANES spanning the years 2003 to 2018. Survey-weighted multiple regression models were employed to evaluate the relationship between PFAS exposure and vitamin D concentrations. Multi-pollutant models were employed to evaluate the association between PFAS mixtures and vitamin D concentrations. Subsequently, environmental risk scores (ERS) were constructed to gauge associations with vitamin D concentrations. ERS was computed through a weighted linear combination of PFAS, utilizing calculations from ridge regression and adaptive elasticity network (adENET) methodologies. All analyses were stratified by sex.

RESULTS

The study encompassed 3,853 older adults. Our analysis revealed a negative association between PFOA, PFOS, PFNA, and MeFOSAA and serum vitamin D concentrations. In analyses examining mixed exposures, various models consistently indicated an inverse association between PFAS mixed exposure and vitamin D concentrations. Moreover, an increase in ERS of PFAS across the interquartile range was associated with a decrease in vitamin D concentrations (Q4 vs. Q1, adENET: β: -0.083, 95% CI: -0.117, -0.048; ridge regression: β: -0.077, 95% CI: -0.111, -0.042). Notably, these associations were exclusively observed within the female population.

CONCLUSIONS

Our study indicates that heightened exposure to PFAS correlates with diminished serum vitamin D concentrations in females aged 60 years and older, evident in both single and mixed exposures. These findings find support in in vitro mechanistic studies, suggesting that PFAS may impact the metabolism of 25(OH)D, consequently affecting vitamin D concentrations.

Correlation of serum vitamin D and IL-8 to stages of periodontitis: a case-control analysis

OBJECTIVES

The current literature lacks the correlation between serum levels of vitamin D and interleukin-8 (IL-8) to the stages of periodontitis. The present research objectives are to evaluate the serum levels of vitamin D and IL-8 in periodontitis participants and healthy controls and to measure their correlation with the stages of periodontitis.

METHODS

The current case-control study was conducted on patients with periodontitis and healthy controls. After obtaining a questionnaire from the participants, the following clinical parameters were measured; periodontal probing depth (PPD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and tooth count. The serum levels of vitamin D and IL-8 were measured using ELISA kits. Then, we measured the correlation of the stages of periodontitis with the serum levels of vitamin D and IL-8.

RESULTS

Ninety-eight participants; 52 with periodontitis and 46 healthy controls were included. The patients with periodontitis showed a significantly lower level of vitamin D, higher PPD, CAL, BOP, and lower number of teeth than the controls. In addition, serum vitamin D significantly correlated with the stages of periodontitis. Serum IL-8 showed no significant difference between the study and control groups while it does not significantly correlate with the stages of periodontitis.

CONCLUSION

The current study's findings suggest a potential association between serum level of vitamin D with severity of periodontitis which necessitates screening vitamin D status in patients with periodontitis and investigating the possibility of vitamin D supplementation in decreasing the progression of periodontitis.

Vitamin D concentration in maternal serum during pregnancy: Assessment in Hokkaido in adjunct study of the Japan Environment and Children's Study (JECS)

BACKGROUND

Vitamin D is an essential nutrient for maintaining blood calcium and phosphorus levels and controlling bone density. Deficiency in it leads to rickets, osteomalacia, osteoporosis, and various other diseases. Recently, it has gained attention for reportedly reducing the risk of COVID-19 severity. However, there are no reports evaluating pregnant women in the Hokkaido region of Japan. This study aims to elucidate the current status of vitamin D levels in pregnant women in the Hokkaido region.

METHODS

This study measured the serum concentrations of Vitamin D2 and D3 in 206 pregnant women participating in the Japan Environment and Children's Study-Hokkaido sub-cohort at the Hokkaido Regional Center. It analyzed the relationship between these concentrations and the months, seasons, and sunshine hours.

RESULTS

The mean maternal age was 31.7 ± 4.7 years, and the mean prepregnancy BMI was 21.0 ± 2.5 kg/m2. Only two women have given birth at least once. Regarding sunscreen use, 65 participants (31.6%) responded "often" or "sometimes." Five women used the supplement containing Vitamin D. The value of 25(OH)D2 was above 1 ng/ml in four of them. The average 25(OH)D3 level was 12.1 ng/ml, with a median of 11.0 ng/ml. Four participants (1.9%) had levels below 5 ng/ml. The highest median of 25(OH)D3 was in July, and the lowest was in April. The concentration of 25(OH)D3 was significantly higher in summer than in winter. A correlation was found between 25(OH)D3 and sunshine hours, with 25(OH)D3 concentrations gradually increasing as sunshine hours increase.

CONCLUSION

It was found that almost all pregnant women in Hokkaido were deficient in vitamin D. It is necessary to implement measures to enhance vitamin D levels in pregnant women to safeguard the health of women and fetuses in Hokkaido.

Association of CYP27B1 gene polymorphisms with pulmonary tuberculosis and vitamin D levels

BACKGROUND AND OBJECTIVES

Genetic factors are reported to be connected with tuberculosis (TB) infection. Studies have shown that genetic variations in genes involved in the vitamin D pathway influence the levels of vitamin D found in the bloodstream (serum). Cyp27b1 (1α-hydroxylase) is an enzyme that activates the synthesis of bioactive vitamin D3 by hydroxylation of 25(OH)D3.The in vitro studies reported rare gene variants of Cyp27b1 such as rs118204011 and rs118204012, associated with loss of Cyp27b1 function and lower serum vitamin D levels. Globally, a critical gap exists in understanding the link between these gene variants with TB and vitamin D levels. Hence, the study objective is to comprehend the association of Cyp27b1 rs118204009 (G/A), rs118204011 (C/T), and rs118204012 (A/G) with tuberculosis susceptibility/protection and to assess the influence of gene variants on vitamin D levels in both healthy controls (HCs) and those with pulmonary tuberculosis (PTB) in South India.

METHODS

Genomic DNA extraction was performed by salting-out procedure and subsequently genotyped through polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. Vitamin D level was measured by Enzyme-Linked Immunosorbent Assay (ELISA).

RESULTS

In rs118204012 (A/G), a substantial association was found with PTB susceptibility in allele 'A' [Odds Ratio (OR): 1.52 (1.02-2.26); p = 0.044] and 'AA' genotype [OR: 1.69 (1.02-2.81); p = 0.040] through the dominant model. Allele 'G' [OR: 0.66 (0.44-0.98); p = 0.044) was found to be associated with protection against TB. Males were associated with increased susceptibility towards TB compared to females in the rs118204011 "CC" [OR: 3.94 (1.94-7.98); p = 0.002] and rs118204012 'AA' [OR: 4.57 (2.13-9.79); p = 0.0001] genotypes. Vitamin D insufficiency (<30 ng/ml) was more prevalent in PTB patients (66.67 %) with the rs118201012 'AA' genotype compared with healthy controls (57.14 %). This genotype was associated with disease susceptible odds ratio of 1.5.

CONCLUSION

Cyp27b1 rs118204012 'AA' genotype was found to have association with vitamin D insufficiency and TB susceptibility. In terms of gender, our findings suggest that male individuals are correlated with a higher TB risk. This suggest that the gene variants may be involved in the downstream processing of serum Vitamin D levels and its association with the disease.

A Snapshot of Vitamin D Status, Performance, Blood Markers, and Dietary Habits in Runners and Non-Runners

BACKGROUND

Vitamin D can influence athletic performance and infection risk. This study aimed to investigate vitamin D status, hematochemical factors, anthropometric and performance parameters, and dietary habits in runners (n = 23) and sedentary healthy individuals (non-runners, n = 22) during the autumn season.

METHODS

Both groups had their serum 25-Hydroxyvitamin D (ng/mL) levels, blood and performance parameters, and dietary habits measured.

RESULTS

Serum 25-Hydroxyvitamin D levels were significantly lower in non-runners (runners: males 30.0 ± 5.6, females 31.2 ± 5.2 vs. non-runners: males, 22.8 ± 6.5, females 24.7 ± 6.5 ng/mL, p < 0.001). White blood cells, monocyte, and neutrophil levels were higher in non-runners for both males and females. Among the subjects, 23 had optimal vitamin D levels (>29 ng/mL), while 22 had insufficient/deficient levels (<29 ng/mL), with a higher prevalence of insufficiency in non-runners compared to runners (63.6% vs. 34.8%; p = 0.053). Maximal isometric force and jump height were equal in both groups, but VO2max was higher in runners. Linear regression analysis identified monocyte count as the only predictor of vitamin D levels for both males (y = -24.452 x + 40.520; R2 = 0.200; p = 0.015) and females (y = -33.409 x + 45.240; R2 = 0.368; p = 0.003).

CONCLUSIONS

This study highlights significant differences in vitamin D status between runners and non-runners, with runners exhibiting higher serum 25-Hydroxyvitamin D levels, although this finding is likely due to the increased sun exposure that runners receive. It also provides valuable insights into the vitamin D status of healthy young sedentary individuals and runners, enhancing the understanding of how physical activity influences vitamin D levels.

Population Pharmacokinetic Model of Vitamin D3 and Metabolites in Chronic Kidney Disease Patients with Vitamin D Insufficiency and Deficiency

Vitamin D insufficiency and deficiency are highly prevalent in patients with chronic kidney disease (CKD), and their pharmacokinetics are not well described. The primary study objective was to develop a population pharmacokinetic model of oral cholecalciferol (VitD3) and its three major metabolites, 25-hydroxyvitamin D3 (25D3), 1,25-dihydroxyvitamin D3 (1,25D3), and 24,25-dihydroxyvitamin D3 (24,25D3), in CKD patients with vitamin D insufficiency and deficiency. CKD subjects (n = 29) were administered one dose of oral VitD3 (5000 I.U.), and nonlinear mixed effects modeling was used to describe the pharmacokinetics of VitD3 and its metabolites. The simultaneous fit of a two-compartment model for VitD3 and a one-compartment model for each metabolite represented the observed data. A proportional error model explained the residual variability for each compound. No assessed covariate significantly affected the pharmacokinetics of VitD3 and metabolites. Visual predictive plots demonstrated the adequate fit of the pharmacokinetic data of VitD3 and metabolites. This is the first reported population pharmacokinetic modeling of VitD3 and metabolites and has the potential to inform targeted dose individualization strategies for therapy in the CKD population. Based on the simulation, doses of 600 International Unit (I.U.)/day to 1000 I.U./day for 6 months are recommended to obtain the target 25D3 concentration of between 30 and 60 ng/mL. These simulation findings could potentially contribute to the development of personalized dosage regimens for vitamin D treatment in patients with CKD.

Unveiling the Link Between Breast Cancer Treatment and Osteoporosis: Implications for Anticancer Therapy and Bone Health

Background: The interplay between breast cancer treatment and osteoporosis has important consequences for anticancer therapy and patient bone health. Many breast cancer therapies involve hormonal treatments that lower estrogen levels, which can lead to an increased risk of osteoporosis due to reduced bone mineral density. Aromatase inhibitors, chemotherapy, and surgeries such as oophorectomy can further aggravate bone loss, highlighting the necessity of prioritizing bone health during cancer treatment. Objective: This review is aimed at investigating the complex relationship between breast cancer therapies and bone health by examining the molecular and cellular mechanisms through which anticancer treatments lead to bone loss. It also seeks to assess the effects of various treatment options, such as selective estrogen receptor modulators (SERMs) and bisphosphonates, on reducing bone loss and maintaining bone health during cancer therapy. Method: The review explores the mechanisms underlying bone loss in breast cancer patients undergoing treatment, focusing on factors such as estrogen depletion, inflammatory cytokines, and changes in bone remodelling processes. Additionally, it evaluates the efficacy of different therapeutic interventions, including pharmacological treatments like bisphosphonates and third-generation SERMs, in mitigating bone-related side effects. Results: The findings indicate a critical need to balance the effectiveness of breast cancer treatments with the preservation of bone health. Pharmacological treatments like bisphosphonates and denosumab have been identified as essential for managing bone health in breast cancer patients. Furthermore, third-generation SERMs show potential in reducing bone loss associated with cancer therapy.

Prevalence and risk factors of vitamin D deficiency among Afghan primary school children

Vitamin D deficiency is common in many societies and causes rickets and non-skeletal disorders in children. There are no published data on vitamin D deficiency in Afghanistan. We, therefore, investigated the prevalence and associated factors of vitamin D deficiency in Afghan school children in Kandahar City, Afghanistan. This cross-sectional analytical study was conducted from September 2022 to April 2023 in 510 primary school students aged 6-15 years from six randomly selected schools. Data were analyzed by using descriptive statistics, Chi-square test, and multivariate logistic regression. Of the 510 enrolled children, 54.3% were boys and 91.8% were poor. The mean serum 25(OH)D concentration was 9.3 ng/mL. Vitamin D deficiency (< 20 ng/mL) was detected in 436/510 (85.5%) children that was severe in 267/510 (52.4%). By logistic regression analysis, independent factors for vitamin D deficiency were: (i) older age group 11-15 vs. 6 - 10 years, adjusted odds ratio (AOR) 2.8 (95% confidence interval 1.2-6.2), (ii) poverty AOR 2.0 (1.0-4.3), (iii) not doing outdoor physical activity AOR 4.8 (2.8-8.1), and (iv) daily sunlight exposure < 60 min AOR 2.2 (1.3-3.7). Although Kandahar is very sunny throughout the year, vitamin D deficiency is highly prevalent among school boys and girls, placing them at great risk of vitamin D-deficient rickets. More work is needed to define the country-wide prevalence of vitamin D deficiency to inform robust strategies of vitamin D supplementation, the provision of vitamin D-fortified food to the school children in Kandahar City and health education programs that can be conducted with the help of international organizations.

Sunlight exposure practice and its associated factors among infants in Ethiopia, systematic review and meta-analysis

BACKGROUND

Lack of sunlight exposure is the primary reason for the worldwide epidemic of vitamin D deficiency. There was a meta-analysis conducted under the title of Knowledge and Practice of Mothers towards sunshine exposure of their children in Ethiopia. However, studies conducted on factors associated with sunlight exposure practice among infants showed non-conclusive and inconsistent findings. Hence, this systematic review and meta-analysis were conducted to estimate the pooled prevalence of good sunlight exposure practice and its associated factors among infants in Ethiopia.

METHODS

All articles were systematically searched by PubMed, Hinari, Global Health and CINAHL, Epistemonikos, African Journal of Online (AJOL), Google Scholar and Google. All studies, until the end of May 30, 2023, were included in this review. Pure qualitative studies and studies in which the outcome was not reported were excluded from the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used. Meta-analysis was conducted by using STATA 17 software. Forest plots were used to present the pooled prevalence of good sunlight exposure practices. A random effect model was used to compute the pooled prevalence, while subgroup analysis was performed to identify the possible source of heterogeneity. Publication bias was assessed by begg's and Egger's tests. We use Trim and fill analysis was used to treat the publication bias.

RESULTS

This review involved 14 studies and 6,121 participants. The pooled prevalence of good sunlight exposure practice among infants in Ethiopia was 53.46% (95%CI: 45.98, 60.95). Mothers had PNC follow-up [OR = 2.22 (95% CI: 1.31, 3.47)], mothers with secondary and above educational status [OR = 4.17, (95% CI: 1.73, 10.06)], employed mothers [OR = 3.72, (95% CI: 2.71, 5.11)], urban residence [OR = 2.67, (95% CI: 1.17, 6.08)] and not fear of sunlight exposure [OR = 4.08, (95% CI: 1.44, 16.00)] were positively associated with good sunlight exposure practice.

CONCLUSIONS

The pooled prevalence of good sunlight exposure practices among infants in Ethiopia is low. Had postnatal care follow-up, being urban residents, mother's employment status, mother's educational status and not fear of sunlight exposure were independent factors of good sunlight exposure practice among infants. Therefore, health professionals create awareness for mothers to increase postnatal follow-up, and the importance of health education especially for rural residents.