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Verdoia M, De Luca G. Potential role of hypovitaminosis D and vitamin D supplementation during COVID-19 pandemic. QJM 2021; 114:3-10. [PMID: 32735326 PMCID: PMC7454841 DOI: 10.1093/qjmed/hcaa234] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
Vitamin D deficiency is a pandemic disorder affecting over 1 billion of subjects worldwide and displaying a broad spectrum of implications on cardiovascular and inflammatory disorders. Since the initial reports of the association between hypovitaminosis D and COVID-19, Vitamin D has been pointed as a potentially interesting treatment for SARS-CoV-2 infection. We provide an overview on the current status of vitamin D deficiency, the mechanisms of action of vitamin D and the current literature on the topic, with a special focus on the potential implications for COVID-19 pandemic.
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Affiliation(s)
- M Verdoia
- From the Department of Cardiology, Ospedale degli Infermi, ASL Biella, Biella, Italy
| | - G De Luca
- Department of Cardiology, AOU Maggiore della Carità, Università del Piemonte Orientale, Corso Mazzini, 18, 28100 Novara, Italy
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152
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Crescioli C. Vitamin D Restores Skeletal Muscle Cell Remodeling and Myogenic Program: Potential Impact on Human Health. Int J Mol Sci 2021; 22:1760. [PMID: 33578813 PMCID: PMC7916580 DOI: 10.3390/ijms22041760] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
Skeletal muscle cells, albeit classified as vitamin D receptor (VDR)-poor cells, are finely controlled by vitamin D through genomic and non-genomic mechanisms. Skeletal muscle constantly undergoes cell remodeling, a complex system under multilevel regulation, mainly orchestrated by the satellite niche in response to a variety of stimuli. Cell remodeling is not limited to satisfy reparative and hypertrophic needs, but, through myocyte transcriptome/proteome renewal, it warrants the adaptations necessary to maintain tissue integrity. While vitamin D insufficiency promotes cell maladaptation, restoring vitamin D levels can correct/enhance the myogenic program. Hence, vitamin D fortified foods or supplementation potentially represents the desired approach to limit or avoid muscle wasting and ameliorate health. Nevertheless, consensus on protocols for vitamin D measurement and supplementation is still lacking, due to the high variability of lab tests and of the levels required in different contexts (i.e., age, sex, heath status, lifestyle). This review aims to describe how vitamin D can orchestrate skeletal muscle cell remodeling and myogenic programming, after reviewing the main processes and cell populations involved in this important process, whose correct progress highly impacts on human health. Topics on vitamin D optimal levels, supplementation and blood determination, which are still under debate, will be addressed.
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Affiliation(s)
- Clara Crescioli
- Department of Movement, Human and Health Sciences, Section of Health Sciences, University of Rome "Foro Italico", Piazza L. de Bosis 6, 00135 Rome, Italy
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153
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Starek M, Mierzwa J, Gumułka P, Dąbrowska M. Vitamin D - current stage of knowledge about analysis and supplementation. Crit Rev Food Sci Nutr 2021; 62:4607-4621. [PMID: 33523712 DOI: 10.1080/10408398.2021.1877110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nowadays, topics related to the proper nutrition of the body, which requires a complex of compounds and supplementation of these ingredients have undoubtedly gained popularity, so it should come as no surprise that there is a widespread interest in vitamin D in science, medicine, analytics and nutrition. In the world of developing technologies, new directions of physiological action of this vitamin on the body are being discovered. Issues related to the demand for vitamin D in various populations and its sources in food, the appropriate form of supplementation, safety and toxicity are extremely important. The present manuscript focuses on the concise evaluation of key data in the field of vitamin D. Structure and physicochemical properties, demand and delivery trails, deficiency and its diagnosis, supplementation, interactions of vitamin D with supplements and drugs are discussed. Attention has also been paid to the methods of vitamin D analysis in various matrices, which allow for an accurate and precise quality assessment of dietary supplements, drugs and food products. The presented information allows deeper understanding of the mechanisms responsible for the development of many diseases in the context of vitamin D levels.
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Affiliation(s)
- Małgorzata Starek
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Justyna Mierzwa
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Gumułka
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Monika Dąbrowska
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
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154
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Lehner A, Johnson M, Zimmerman A, Zyskowski J, Buchweitz J. Vitamin D analyses in veterinary feeds by gas chromatography-tandem mass spectrometry. EUROPEAN JOURNAL OF MASS SPECTROMETRY (CHICHESTER, ENGLAND) 2021; 27:48-62. [PMID: 33722092 DOI: 10.1177/14690667211000244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This report examines the feasibility of determination of Vitamin D3, D2 and their 25-hydroxy metabolites utilizing Gas Chromatography Tandem Mass Spectrometry (GC/MS/MS) as a potential alternative to popular Liquid Chromatography Tandem Mass Spectrometric (LC/MS/MS) methodologies. The GC/MS/MS approach was found to operate reasonably well despite long-standing concerns that gas-liquid chromatography of vitamin D compounds invoke thermal rearrangements owing to the relatively high inlet and capillary column temperatures used. The workup procedure involved incubation of feed samples with concentrated potassium hydroxide for overnight fat saponification, extraction of D Vitamins in n-hexane and reaction with N,O-bis(trimethylsilyl)trifluoroacetamide at 70 °C for 30 mins. In addition to parent compounds, small amounts of pyro-, isopyro-, and iso-vitamin D and isotachysterol3 variants were obtained from each Vitamin D-related compound upon extraction and GC/MS/MS analysis. Mass spectral and chromatographic behavior of these compounds are herein described and interpreted. Multiple Reaction Monitoring settings on GC/MS/MS included m/z 456→351 for Vitamin D3 and m/z 486→363 for Vitamin D2. Trimethylsilylation enabled single predominant peaks for Vitamins D3 and D2, and sample workup in the presence of deuterated Vitamin D analogs enabled accurate and precise sensitivity to 1 ppb (ng/g) in feeds. The method could be extended with reasonable accuracy to 25-hydroxy (25OH) compounds, but accuracies would be significantly improved by inclusion of respective 25OH-specific deuterated internal standards. The method was applied to 27 submissions of suspect dog foods of which 22% were discovered elevated and 44% were discovered to contain toxic levels of Vitamin D3. The described method was thus discovered to provide a suitable mass spectrometric approach for Vitamin D, proving itself here specifically of value in detection of ergocalciferol and cholecalciferol in animal feeds. The specificity and sensitivity of the tandem quadrupole approach can enable suitable applicability to serum determination if desired.
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Affiliation(s)
- Andreas Lehner
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, East Lansing, MI, USA
| | - Margaret Johnson
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, East Lansing, MI, USA
| | - Alan Zimmerman
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, East Lansing, MI, USA
| | - Justin Zyskowski
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, East Lansing, MI, USA
| | - John Buchweitz
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, East Lansing, MI, USA
- Department of Pathobiology & Diagnostic Investigation, Michigan State University College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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155
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Hou J, Karin M, Sun B. Targeting cancer-promoting inflammation - have anti-inflammatory therapies come of age? Nat Rev Clin Oncol 2021; 18:261-279. [PMID: 33469195 DOI: 10.1038/s41571-020-00459-9] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
The immune system has crucial roles in cancer development and treatment. Whereas adaptive immunity can prevent or constrain cancer through immunosurveillance, innate immunity and inflammation often promote tumorigenesis and malignant progression of nascent cancer. The past decade has witnessed the translation of knowledge derived from preclinical studies of antitumour immunity into clinically effective, approved immunotherapies for cancer. By contrast, the successful implementation of treatments that target cancer-associated inflammation is still awaited. Anti-inflammatory agents have the potential to not only prevent or delay cancer onset but also to improve the efficacy of conventional therapeutics and next-generation immunotherapies. Herein, we review the current clinical advances and experimental findings supporting the utility of an anti-inflammatory approach to the treatment of solid malignancies. Gaining a better mechanistic understanding of the mode of action of anti-inflammatory agents and designing more effective treatment combinations would advance the clinical application of this therapeutic approach.
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Affiliation(s)
- Jiajie Hou
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Department of Liver Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Michael Karin
- Laboratory of Gene Regulation and Signal Transduction, Departments of Pharmacology and Pathology, University of California San Diego School of Medicine, La Jolla, CA, USA.
| | - Beicheng Sun
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
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156
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Schöttker B, Kuznia S, Brenner H. Efficacy of vitamin D 3 supplementation on cancer mortality in the general population and the prognosis of patients with cancer: protocol of a systematic review and individual patient data meta-analysis of randomised controlled trials. BMJ Open 2021; 11:e041607. [PMID: 33441357 PMCID: PMC7812083 DOI: 10.1136/bmjopen-2020-041607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Vitamin D insufficiency is much more common among patients with cancer than the general population. Previous meta-analyses of controlled trials showed an approximately 15% reduction of cancer mortality by vitamin D supplementation compared with placebo or no treatment in the general population.On top of updating the latest systematic review on vitamin D supplementation and cancer mortality in the general population, we aim to conduct the first meta-analyses of trials on vitamin D3 supplementation and cancer-specific and overall survival of patients with cancer. Besides, we will conduct for the first time subgroup analyses based on individual patient data collected from randomised controlled trials. METHODS AND ANALYSIS A systematic review and individual patient data meta-analysis will be performed on randomised placebo-controlled trials with a vitamin D3 intervention. All databases are searched from inception without time restriction. The addressed outcomes are cancer mortality in the general population as well as cancer-specific and overall survival of patients with cancer. The quality appraisal of the studies will be evaluated by the Cochrane risk-of-bias tool for randomised trials. Trial results will be reanalysed using adjusted and unadjusted Cox proportional hazard regression models and meta-analyses are planned. Cochran's Q-Test and the I2 index will be used to statistically assess the level of heterogeneity, while sensitivity and subgroup analyses serve to identify potential causes of heterogeneity. Subgroup analyses will be conducted for vitamin D3 dosing, follow-up time, age, sex, obesity, vitamin D deficiency/insufficiency, history of cancer and compliance. Publication bias will be assessed by funnel plots and Egger's test. ETHICS AND DISSEMINATION Ethical approval is not required since no human beings are involved in this systematic review. Results will be published in a peer-reviewed journal with open access. They will be presented at conferences and sent to patient advocacy groups and German oncological rehabilitation centres. PROSPERO REGISTRATION NUMBER CRD42020185566.
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Affiliation(s)
- Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Baden-Württemberg, Germany
- Network Aging Research (NAR), University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Sabine Kuznia
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Baden-Württemberg, Germany
- Medical Faculty Heidelberg - University of Heidelberg, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Baden-Württemberg, Germany
- Network Aging Research (NAR), University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Division of Preventive Oncology, German Cancer Research Centre (DKFZ) and National Centre for Tumor Diseases, Heidelberg, Baden-Württemberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
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157
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Song M, Lee IM, Manson JE, Buring JE, Dushkes R, Gordon D, Walter J, Wu K, Chan AT, Ogino S, Fuchs CS, Meyerhardt JA, Giovannucci EL. No Association Between Vitamin D Supplementation and Risk of Colorectal Adenomas or Serrated Polyps in a Randomized Trial. Clin Gastroenterol Hepatol 2021; 19:128-135.e6. [PMID: 32062040 PMCID: PMC7423703 DOI: 10.1016/j.cgh.2020.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The effects of vitamin D on risk of colorectal cancer precursors are not clear. We examined the influence of vitamin D supplementation on risk of colorectal adenomas and serrated polyps in a prespecified ancillary study of a large-scale prevention trial (the vitamin D and omegA-3 trial, VITAL) of individuals who were free of cancer and cardiovascular disease at enrollment. METHODS In VITAL trial, 25,871 adults with no history of cancer or cardiovascular disease (12,786 men 50 years or older and 13,085 women 55 years or older) were randomly assigned to groups given daily dietary supplements (2000 IU vitamin D3 and 1 g marine n-3 fatty acid) or placebo. Patients were assigned to groups from November 2011 through March 2014 and the study ended on December 31, 2017. We confirmed conventional adenomas and serrated polyps by reviewing histopathology reports from participants who had reported a diagnosis of polyps and were asked by their doctors to return for a repeat colonoscopy or sigmoidoscopy in 5 years or less. We calculated the odds ratios (ORs) and 95% CIs by logistic regression, after adjusting for age, sex, n-3 treatment assignment, and history of endoscopy at time of randomization. RESULTS During a median follow-up of 5.3 years, we documented 308 cases of conventional adenomas in 12,927 participants in the vitamin D group and 287 cases in 12,944 participants in the placebo group (OR for the association of vitamin D supplementation with adenoma, 1.08; 95% CI, 0.92-1.27). There were 172 cases of serrated polyps in the vitamin D group and 169 cases in the placebo group (OR for the association of vitamin D supplementation with serrated polyp, 1.02; 95% CI, 0.82-1.26). Supplementation was not associated with polyp size, location, multiplicity, or histologic features. We found evidence for an interaction between vitamin D supplementation and serum level of 25-hydroxyvitamin D, measured in 15,787 participants at randomization. Among individuals with serum levels of 25-hydroxyvitamin D below 30 ng/mL, the OR associated with supplementation for conventional adenoma was 0.82 (95% CI, 0.60-1.13), whereas among individuals with serum levels of 25-hydroxyvitamin D above 30 ng/mL, the OR for conventional adenoma was 1.20 (95% CI, 0.92-1.55) (P for interaction = .07). There was a significant interaction between vitamin D supplementation and serum level of 25-hydroxyvitamin D in their association with advanced adenoma (P for interaction = .04). CONCLUSIONS Based on an ancillary study of data from the VITAL trial, daily vitamin D supplementation (2000 IU) was not associated with risk of colorectal cancer precursors in average-risk adults not selected for vitamin D insufficiency. A potential benefit for individuals with low baseline level of vitamin D requires further investigation. ClinicalTrials.gov number: NCT01169259.
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Affiliation(s)
- Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - I-Min Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
| | - Julie E. Buring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Rimma Dushkes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - David Gordon
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Joseph Walter
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Kana Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA,Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
| | - Charles S. Fuchs
- Yale Cancer Center, New Haven, CT,Department of Medicine, Yale School of Medicine, New Haven, CT,Smilow Cancer Hospital, New Haven, CT
| | - Jeffrey A. Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
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158
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Verdoia M, Nardin M, Rolla R, Negro F, Gioscia R, Afifeh AMS, Viglione F, Suryapranata H, Marcolongo M, De Luca G. Prognostic impact of Vitamin D deficiency in patients with coronary artery disease undergoing percutaneous coronary intervention. Eur J Intern Med 2021; 83:62-67. [PMID: 32830035 DOI: 10.1016/j.ejim.2020.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Whether Vitamin D deficiency represents an independent predictor of mortality and major cardiovascular events or rather the mirror of a more advanced clinical condition with increased comorbidities is still debated. We aimed at assessing the impact of vitamin D levels on the long-term outcomes among patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention. METHODS Consecutive patients from a single centre were included. Vitamin D levels were measured at admission by chemiluminescence immunoassay kit LIAISON® Vitamin D assay (Diasorin Inc). Severe deficiency was defined for 25(OH)D < 10 ng/ml. The primary study endpoint was overall mortality. Secondary endpoints were cardiovascular mortality, recurrent acute coronary syndrome or major cardiovascular events (a composite of death, recurrent MI and target vessel revascularization) at the longest available follow-up. RESULTS We included a total of 705 patients, that were divided according to vitamin D tertiles (<12.7; 12.7-21.59; ≥21.6 ng/ml). Lower levels of Vitamin D were associated with renal failure (p=0.03), more severe coronary disease (p=0.001), diabetes mellitus and previous CABG (p<0.001), lower ejection fraction (p=0.02), acute presentation (p=0.04), use of statins (p=0.02), diuretics, nitrates and clopidogrel (p<0.001) and RASI (p=0.008). An inverse association was documented with BMI, glycemia, total cholesterol (p<0.001), creatinine and WBC (p=0.001). At a median follow-up of 996.5 [377-1552] days, 3.8% of the patients died. Vitamin D deficiency was significantly associated with overall mortality (7.6% vs 2.9% vs 0.4%, adjusted HR[95%CI]=3.6[1.43-8.9], p=0.006), MACE (adjusted HR[95%CI]=1.32[1.07-1.63], p=0.01) and the composite of death and MI (adjusted HR[95%CI]=1.3[1.03-1.65], p=0.03). A similarly increased risk was confirmed for all major higher-risk subsets of patients, with no significant interaction according to age, gender, diabetes mellitus or chronic kidney disease. CONCLUSION Among patients undergoing percutaneous coronary interventions, lower levels of vitamin D are associated with an over 3-fold increased risk of mortality and major cardiovascular events. Future larger studies are certainly warranted in order to define the prognostic implications of cholecalciferol supplementation among high-risk patients with established coronary artery disease.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL, Biella, Italy; Department of Translational Medicine, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy
| | - Matteo Nardin
- Department of Translational Medicine, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy
| | - Roberta Rolla
- Department of Translational Medicine, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy
| | - Federica Negro
- Department of Translational Medicine, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy
| | - Rocco Gioscia
- Department of Translational Medicine, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy
| | - Arraa Maddalena Saghir Afifeh
- Department of Translational Medicine, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy
| | - Filippo Viglione
- Department of Translational Medicine, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy
| | | | - Marco Marcolongo
- Division of Cardiology, Ospedale degli Infermi, ASL, Biella, Italy
| | - Giuseppe De Luca
- Department of Translational Medicine, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy.
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159
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Yang Y, Luo K, Jiang Y, Yu Q, Huang X, Wang J, Liu N, Huang P. The Impact of Frailty on COVID-19 Outcomes: A Systematic Review and Meta-analysis of 16 Cohort Studies. J Nutr Health Aging 2021; 25:702-709. [PMID: 33949641 PMCID: PMC7933604 DOI: 10.1007/s12603-021-1611-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Frail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. OBJECTIVE We aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. DESIGN A systematic review and Meta-analysis of 16 cohort studies. PARTICIPANTS Patients with COVID-19. METHODS A systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects. RESULTS According to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay. CONCLUSIONS In this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all- cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.
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Affiliation(s)
- Y Yang
- Nanhai Liu, Department of neurology, the first affiliated hospital of Gannan medical university,Ganzhou, Jiangxi province, China. ; Pan Huang, College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang province, China.
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160
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Fu H, Tang Z, Wang Y, Ding X, Rinaldi G, Rahmani J, Xing F. Relationship Between Vitamin D Level and Mortality in Adults With Psoriasis: A Retrospective Cohort Study of NHANES Data. Clin Ther 2020; 43:e33-e38. [PMID: 33358542 DOI: 10.1016/j.clinthera.2020.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Studies have shown an increased risk for mortality in patients with psoriasis. Furthermore, research has demonstrated an inverse relationship between 25-hydroxyvitamin D (25[OH]D) level and all-cause mortality. This study investigated the association between 25(OH)D level and all-cause mortality in US adults with psoriasis. METHODS Data from NHANES (1999-2014 and mortality data through December 31, 2015) were analyzed. Quartiles of 25(OH)D level were created based on 25(OH)D levels among patients. Cox proportional hazards models were used for estimating hazard ratios (95% CI) for all-cause mortality. FINDINGS A total of 82,091 participants were enrolled in the NHANES study from 1999 to 2014. Overall, 610 patients with psoriasis were identified in NHANES. The mean (SD) duration of follow-up was 5.61 (3.38) years (3427.92 person-years). The hazard ratio for mortality in the fully adjusted model was 0.12 (95% CI, 0.02-0.60; Ptrend = 0.01) in patients with a high 25(OH)D concentration compared to those with 25(OH)D deficiency. IMPLICATIONS The 25(OH)D concentration was significantly inversely associated with all-cause mortality among these patients with psoriasis. Studies have shown an increased risk for mortality in patients with psoriasis compared to the general population. Vitamin D is not regularly metabolized in patients with psoriasis due to their skin abnormality. Vitamin D supplementation has been associated with a reduced mortality in patients with psoriasis. In practice, attention to vitamin D level is crucial, as is the use of vitamin D supplementation, for improving the health of these patients.
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Affiliation(s)
- Hongyang Fu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiming Tang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yihan Wang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xueying Ding
- College of Basic Medical Science of Zhejiang Chinese Medical University, Hangzhou, China
| | - Giulia Rinaldi
- Guys and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Jamal Rahmani
- Department of Community Nutrition, Faculty of Nutrition and Food, Technology, National Nutrition, And Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fengling Xing
- Department of Dermatology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China.
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161
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Bao Y, Li Y, Gong Y, Huang Q, Cai S, Peng J. Vitamin D Status and Survival in Stage II-III Colorectal Cancer. Front Oncol 2020; 10:581597. [PMID: 33392078 PMCID: PMC7773833 DOI: 10.3389/fonc.2020.581597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/12/2020] [Indexed: 12/26/2022] Open
Abstract
Vitamin D status has been shown to be positively correlated with the morbidity and prognosis of colorectal cancer (CRC) patients. However, the prognostic effect of vitamin D status on patients with stage II and III CRC, especially Asian patients, remains unclear. A total of 728 patients (523 in the primary cohort and 205 in the validation cohort) who were diagnosed with stage II-III CRC between January 2011 and December 2015 were enrolled. Their serum 25-hydroxyvitamin D3 [25(OH)D] levels were tested. Kaplan-Meier curves and Cox regression analyses were carried out. Subgroup analyses were conducted according to tumor location. In the primary cohort, the serum 25(OH)D level was positively correlated with the overall survival (OS) of all CRC patients (p= 0.016) and stage III patients (p= 0.009), while no correlation was found between 25(OH)D level and the prognosis of patients with stage II CRC. Moreover, 25(OH)D level was an independent prognostic factor for the OS of all patients with CRC [HR 0.541, 95% CI 0.334-0.875, p=0.012] and those with stage III CRC (HR 0.563, 95% CI 0.319-0.993, p=0.047). Subgroup analysis indicated that only in the left-sided subgroup, stage III CRC patients with high 25(OH)D levels had better OS than those with low 25(OH)D levels (HR 0.474, 95% CI 0.230-0.978, p=0.043). In the validation cohort, serum 25(OH)D levels were verified to have prognostic value for patients with stage III CRC (HR 0.220, 95% CI 0.080-0.602, p=0.003), and low 25(OH)D levels indicated worse OS for left-sided stage III CRC patients (HR 0.233, 95% CI 0.075-0.727, p=.012). In conclusion, vitamin D status is positively correlated with the survival of CRC patients, especially those with left-sided stage III CRC.
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Affiliation(s)
- Yichao Bao
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaqi Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Gong
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qianxia Huang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junjie Peng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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162
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Story MJ. Zinc, ω-3 polyunsaturated fatty acids and vitamin D: An essential combination for prevention and treatment of cancers. Biochimie 2020; 181:100-122. [PMID: 33307154 DOI: 10.1016/j.biochi.2020.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 11/14/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
Zinc, ω-3 polyunsaturated fatty acids (PUFAs) and vitamin D are essential nutrients for health, maturation and general wellbeing. Extensive literature searches have revealed the widespread similarity in molecular biological properties of zinc, ω-3 PUFAs and vitamin D, and their similar anti-cancer properties, even though they have different modes of action. These three nutrients are separately essential for good health, especially in the aged. Zinc, ω-3 PUFAs and vitamin D are inexpensive and safe as they are fundamentally natural and have the properties of correcting and inhibiting undesirable actions without disturbing the normal functions of cells or their extracellular environment. This review of the anticancer properties of zinc, ω-3 PUFAs and vitamin D is made in the context of the hallmarks of cancer. The anticancer properties of zinc, ω-3 PUFAs and vitamin D can therefore be used beneficially through combined treatment or supplementation. It is proposed that sufficiency of zinc, ω-3 PUFAs and vitamin D is a necessary requirement during chemotherapy treatment and that clinical trials can have questionable integrity if this sufficiency is not checked and maintained during efficacy trials.
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Affiliation(s)
- Michael J Story
- Story Pharmaceutics Pty Ltd, PO Box 6086, Linden Park, South Australia, 5065, Australia.
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163
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Mäkitie A, Tuokkola I, Laurell G, Mäkitie O, Olsen K, Takes RP, Florek E, Szyfter K, Sier CFM, Ferlito A. Vitamin D in Head and Neck Cancer: a Systematic Review. Curr Oncol Rep 2020; 23:5. [PMID: 33216252 PMCID: PMC7679336 DOI: 10.1007/s11912-020-00996-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Observational studies have shown that serum 25-OH vitamin D [25(OH)D] is inversely associated with overall cancer risk in many malignancies. We performed a systematic literature review to determine whether vitamin D deficiency is related to head and neck cancer (HNC) etiology and outcome. RECENT FINDINGS The search yielded five prospective studies reporting 25(OH)D levels prior to cancer diagnosis and their effect on the risk of HNC. Eight studies were cross-sectional or case-control studies, in which 25(OH)D levels were only measured after cancer diagnosis. Two studies found an inverse association between 25(OH)D level and HNC risk, while two other prospective cohort studies demonstrated no connection between 25(OH)D and HNC risk. Several studies reported cancer patients to have significantly lower 25(OH)D levels than controls. Associations between 25(OH)D and prognosis and mortality were variable. The link between vitamin D and HNC has so far only been investigated in a few observational, prospective, and case-control studies. Vitamin D deficiency may be more common in HNC patients than in the healthy population. There is no evidence for a causal relationship. Further studies are needed to evaluate whether low 25(OH)D concentrations play a role in the development or outcome of HNCs.
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Affiliation(s)
- Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P. O. Box 263, FI-00029 HUS, Helsinki, Finland. .,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.
| | - Iida Tuokkola
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P. O. Box 263, FI-00029 HUS, Helsinki, Finland
| | - Göran Laurell
- Department of Surgical Sciences, ENT, Uppsala University, SE-75185, Uppsala, Sweden
| | - Outi Mäkitie
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kerry Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Szyfter
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Cornelis F M Sier
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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164
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Avenell A, Bolland MJ, Grey A. Population vitamin D supplementation in UK adults: too much of nothing? Drug Ther Bull 2020; 59:7-12. [PMID: 33208390 DOI: 10.1136/dtb.2020.000060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Topics for DTB review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mark J Bolland
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
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165
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Brown JC, Rosenthal MH, Ma C, Zhang S, Nimeiri HS, McCleary NJ, Abrams TA, Yurgelun MB, Cleary JM, Rubinson DA, Schrag D, Bullock AJ, Allen J, Zuckerman D, Chan E, Chan JA, Wolpin B, Constantine M, Weckstein DJ, Faggen MA, Thomas CA, Kournioti C, Yuan C, Zheng H, Hollis BW, Fuchs CS, Ng K, Meyerhardt JA. Effect of High-Dose vs Standard-Dose Vitamin D 3 Supplementation on Body Composition among Patients with Advanced or Metastatic Colorectal Cancer: A Randomized Trial. Cancers (Basel) 2020; 12:cancers12113451. [PMID: 33233566 PMCID: PMC7699725 DOI: 10.3390/cancers12113451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Skeletal muscle and adipose tissue express the vitamin D receptor and may be a mechanism through which vitamin D supplementation slows cancer progression and reduces cancer death. It is unknown if high-dose vitamin D3 impacts skeletal muscle and adipose tissue, as compared with standard-dose vitamin D3, in patients with advanced or metastatic colorectal cancer. In this exploratory analysis of a phase II randomized trial, high-dose vitamin D3 did not lead to changes of body weight, body mass index, muscle area, muscle attenuation, visceral adipose tissue area, or subcutaneous adipose tissue area, as compared with standard-dose vitamin D3. High-dose vitamin D3 did not change body composition in patients receiving chemotherapy for advanced or metastatic colorectal cancer. Abstract Skeletal muscle and adipose tissue express the vitamin D receptor and may be a mechanism through which vitamin D supplementation slows cancer progression and reduces cancer death. In this exploratory analysis of a double-blind, multicenter, randomized phase II clinical trial, 105 patients with advanced or metastatic colorectal cancer who were receiving chemotherapy were randomized to either high-dose vitamin D3 (4000 IU) or standard-dose (400 IU) vitamin D3. Body composition was measured with abdominal computed tomography at enrollment (baseline) and after cycle 8 of chemotherapy (16 weeks). As compared with standard-dose vitamin D3, high-dose vitamin D3 did not significantly change body weight [−0.7 kg; (95% CI: −3.5, 2.0)], body mass index [−0.2 kg/m2; (95% CI: −1.2, 0.7)], muscle area [−1.7 cm2; (95% CI: −9.6, 6.3)], muscle attenuation [−0.4 HU; (95% CI: −4.2, 3.2)], visceral adipose tissue area [−7.5 cm2; (95% CI: −24.5, 9.6)], or subcutaneous adipose tissue area [−8.3 cm2; (95% CI: −35.5, 18.9)] over the first 8 cycles of chemotherapy. Among patients with advanced or metastatic colorectal cancer, the addition of high-dose vitamin D3, vs standard-dose vitamin D3, to standard chemotherapy did not result in any changes in body composition.
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Affiliation(s)
- Justin C. Brown
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70012, USA
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA 70012, USA
- Correspondence: ; Tel.: +1-225-763-2715
| | - Michael H. Rosenthal
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Chao Ma
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Sui Zhang
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Halla S. Nimeiri
- Division of Hematology Oncology, Department of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Nadine J. McCleary
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Thomas A. Abrams
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Matthew B. Yurgelun
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - James M. Cleary
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Douglas A. Rubinson
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Deborah Schrag
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | | | - Jill Allen
- Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.); (H.Z.)
| | - Dan Zuckerman
- St Luke’s Mountain States Tumor Institute, Boise, ID 83712, USA;
| | - Emily Chan
- Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Jennifer A. Chan
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Brian Wolpin
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | | | | | | | | | | | - Chen Yuan
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Hui Zheng
- Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.); (H.Z.)
| | - Bruce W. Hollis
- Department of Pediatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA;
| | | | - Kimmie Ng
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
| | - Jeffrey A. Meyerhardt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA; (M.H.R.); (C.M.); (S.Z.); (N.J.M.); (T.A.A.); (M.B.Y.); (J.M.C.); (D.A.R.); (D.S.); (J.A.C.); (B.W.); (C.Y.); (K.N.); (J.A.M.)
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166
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Sluyter JD, Manson JE, Scragg R. Vitamin D and Clinical Cancer Outcomes: A Review of Meta-Analyses. JBMR Plus 2020; 5:e10420. [PMID: 33553987 PMCID: PMC7839823 DOI: 10.1002/jbm4.10420] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022] Open
Abstract
The relationship between vitamin D status or supplementation and cancer outcomes has been examined in several meta‐analyses. To address remaining knowledge gaps, we conducted a systematic overview and critical appraisal of pertinent meta‐analyses. For meta‐analyses of trials, we assessed their quality using AMSTAR‐2 (A Measurement Tool to Assess Systematic Reviews), strength of associations using umbrella review methodology and credibility of evidence using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. Meta‐analyses of observational studies reported inverse associations of 25OHD with risk of cancer incidence and cancer mortality and, particularly for colorectal cancer, fulfilled some of Bradford‐Hill's causation criteria. In meta‐analyses of trials, vitamin D supplementation did not affect cancer incidence. However, we found credible evidence that vitamin D supplementation reduced total cancer mortality risk, with five out of six meta‐analyses reporting a relative risk (RR) reduction of up to 16%: RR, 0.84 (95% CI, 0.74–0.95). The strength of the association, however, was classified as weak. This was true among meta‐analyses of high, moderate, and lower quality (AMSTAR‐2–rated). Trials did not include large numbers of vitamin D‐deficient participants; many tested relatively low doses and lacked sufficiently powered data on site‐specific cancers. In conclusion, meta‐analyses show that, although observational evidence indicates that low vitamin D status is associated with a higher risk of cancer outcomes, randomized trials show that vitamin D supplementation reduces total cancer mortality, but not cancer incidence. However, trials with larger proportions of vitamin D‐insufficient participants and longer durations of follow‐up, plus adequately powered data on site‐specific common cancers, would provide further insight into the evidence base. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- John D Sluyter
- School of Population Health, University of Auckland Auckland New Zealand
| | - JoAnn E Manson
- Department of Medicine Brigham and Women's Hospital, and Harvard Medical School Boston MA USA.,Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA USA
| | - Robert Scragg
- School of Population Health, University of Auckland Auckland New Zealand
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167
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Chandler PD, Chen WY, Ajala ON, Hazra A, Cook N, Bubes V, Lee IM, Giovannucci EL, Willett W, Buring JE, Manson JE. Effect of Vitamin D3 Supplements on Development of Advanced Cancer: A Secondary Analysis of the VITAL Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2025850. [PMID: 33206192 PMCID: PMC7675103 DOI: 10.1001/jamanetworkopen.2020.25850] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Epidemiologic and trial data suggest that vitamin D supplementation may reduce metastatic cancer and cancer mortality, reflecting shared biological pathways. OBJECTIVE To follow up on the possible reduction in cancer death in the Vitamin D and Omega-3 Trial (VITAL) with an evaluation of whether vitamin D reduces the incidence of advanced (metastatic or fatal) cancer and an examination possible effect modification by body mass index. DESIGN, SETTING, AND PARTICIPANTS VITAL is a randomized, double-blind, placebo-controlled, 2 × 2 factorial clinical trial of vitamin D3 (cholecalciferol, 2000 IU/d) and marine omega-3 fatty acids (1 g/d). This multicenter clinical trial was conducted in the United States; participants included men aged 50 years or older and women aged 55 years or older who were free of cancer and cardiovascular disease at baseline. Randomization took place from November 2011 through March 2014, and study medication ended on December 31, 2017. Data for this secondary analysis were analyzed from November 1, 2011, to December 31, 2017. INTERVENTIONS Vitamin D3 (cholecalciferol, 2000 IU/d) and marine omega-3 fatty acids (1 g/d) supplements. MAIN OUTCOMES AND MEASURES For the present analysis, the primary outcome was a composite incidence of metastatic and fatal invasive total cancer, because the main VITAL study showed a possible reduction in fatal cancer with vitamin D supplementation and effect modification by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) for total cancer incidence reduction for individuals with normal BMI, but not for individuals with overweight or obesity. Secondary analyses included examination of BMI (<25, 25 to < 30, and ≥30) as effect modifiers of the observed associations. RESULTS Among 25 871 randomized VITAL participants (51% female; mean [SD] age, 67.1 [7.1] years), 1617 were diagnosed with invasive cancer over a median intervention period of 5.3 years (range, 3.8-6.1 years). As previously reported, no significant differences for cancer incidence by treatment arm were observed. However, a significant reduction in advanced cancers (metastatic or fatal) was found for those randomized to vitamin D compared with placebo (226 of 12 927 assigned to vitamin D [1.7%] and 274 of 12 944 assigned to placebo [2.1%]; HR, 0.83 [95% CI, 0.69-0.99]; P = .04). When stratified by BMI, there was a significant reduction for the vitamin D arm in incident metastatic or fatal cancer among those with normal BMI (BMI<25: HR, 0.62 [95% CI, 0.45-0.86]) but not among those with overweight or obesity (BMI 25-<30: HR, 0.89 [95% CI, 0.68-1.17]; BMI≥30: HR, 1.05 [95% CI, 0.74-1.49]) (P = .03 for interaction by BMI). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, supplementation with vitamin D reduced the incidence of advanced (metastatic or fatal) cancer in the overall cohort, with the strongest risk reduction seen in individuals with normal weight. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01169259.
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Affiliation(s)
- Paulette D. Chandler
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wendy Y. Chen
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Oluremi N. Ajala
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aditi Hazra
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy Cook
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vadim Bubes
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward L. Giovannucci
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Walter Willett
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Julie E. Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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168
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Vaughan-Shaw PG, Buijs LF, Blackmur JP, Theodoratou E, Zgaga L, Din FVN, Farrington SM, Dunlop MG. The effect of vitamin D supplementation on survival in patients with colorectal cancer: systematic review and meta-analysis of randomised controlled trials. Br J Cancer 2020; 123:1705-1712. [PMID: 32929196 PMCID: PMC7686489 DOI: 10.1038/s41416-020-01060-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Low circulating vitamin D levels are associated with poor colorectal cancer (CRC) survival. We assess whether vitamin D supplementation improves CRC survival outcomes. METHODS PubMed and Web of Science were searched. Randomised controlled trial (RCTs) of vitamin D supplementation reporting CRC mortality were included. RCTs with high risk of bias were excluded from analysis. Random-effects meta-analysis models calculated estimates of survival benefit with supplementation. The review is registered on PROSPERO, registration number: CRD42020173397. RESULTS Seven RCTs (n = 957 CRC cases) were identified: three trials included patients with CRC at outset, and four population trials reported survival in incident cases. Two RCTs were excluded from meta-analysis (high risk of bias; no hazard ratio (HR)). While trials varied in inclusion criteria, intervention dose and outcomes, meta-analysis found a 30% reduction in adverse CRC outcomes with supplementation (n = 815, HR = 0.70; 95% confidence interval (CI): 0.48-0.93). A beneficial effect was seen in trials of CRC patients (progression-free survival, HR = 0.65; 95% CI: 0.36-0.94), with suggestive effect in incident CRC cases from population trials (CRC-specific survival, HR = 0.76; 95% CI: 0.39-1.13). No heterogeneity or publication bias was noted. CONCLUSIONS Meta-analysis demonstrates a clinically meaningful benefit of vitamin D supplementation on CRC survival outcomes. Further well-designed, adequately powered RCTs are needed to fully evaluate benefit of supplementation in augmenting 'real-life' follow-up and adjuvant chemotherapy regimens, as well as determining optimal dosing.
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Affiliation(s)
- Peter G Vaughan-Shaw
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Louis F Buijs
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - James P Blackmur
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Evi Theodoratou
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Lina Zgaga
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Farhat V N Din
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Susan M Farrington
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Malcolm G Dunlop
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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169
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Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, Martucci G, Pilz S, Malle O. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr 2020; 74:1498-1513. [PMID: 31959942 PMCID: PMC7091696 DOI: 10.1038/s41430-020-0558-y] [Citation(s) in RCA: 624] [Impact Index Per Article: 156.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/17/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023]
Abstract
Vitamin D testing and the use of vitamin D supplements have increased substantially in recent years. Currently, the role of vitamin D supplementation, and the optimal vitamin D dose and status, is a subject of debate, because large interventional studies have been unable to show a clear benefit (in mostly vitamin D replete populations). This may be attributed to limitations in trial design, as most studies did not meet the basic requirements of a nutrient intervention study, including vitamin D-replete populations, too small sample sizes, and inconsistent intervention methods regarding dose and metabolites. Vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] < 50 nmol/L or 20 ng/ml) is associated with unfavorable skeletal outcomes, including fractures and bone loss. A 25(OH)D level of >50 nmol/L or 20 ng/ml is, therefore, the primary treatment goal, although some data suggest a benefit for a higher threshold. Severe vitamin D deficiency with a 25(OH)D concentration below <30 nmol/L (or 12 ng/ml) dramatically increases the risk of excess mortality, infections, and many other diseases, and should be avoided whenever possible. The data on a benefit for mortality and prevention of infections, at least in severely deficient individuals, appear convincing. Vitamin D is clearly not a panacea, and is most likely efficient only in deficiency. Given its rare side effects and its relatively wide safety margin, it may be an important, inexpensive, and safe adjuvant therapy for many diseases, but future large and well-designed studies should evaluate this further. A worldwide public health intervention that includes vitamin D supplementation in certain risk groups, and systematic vitamin D food fortification to avoid severe vitamin D deficiency, would appear to be important. In this narrative review, the current international literature on vitamin D deficiency, its relevance, and therapeutic options is discussed.
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Affiliation(s)
- Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
- Thyroid Endocrinology Osteoporosis Institute Dobnig, Graz, Austria.
| | - Mario Scherkl
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Magdalena Hoffmann
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Stefan Neuwersch-Sommeregger
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
- Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Heinrichstrasse 31a, A-8010, Graz, Austria
| | - Markus Köstenberger
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
- Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Heinrichstrasse 31a, A-8010, Graz, Austria
| | - Adelina Tmava Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Oliver Malle
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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170
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He H, Zeng Y, Wang X, Yang L, Zhang M, An Z. Meteorological Condition and Air Pollution Exposure Associated with Vitamin D Deficiency: A Cross-Sectional Population-Based Study in China. Risk Manag Healthc Policy 2020; 13:2317-2324. [PMID: 33154683 PMCID: PMC7605970 DOI: 10.2147/rmhp.s273145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
Objective The aim of this study was to investigate the status of Vitamin D deficiency and the effect of environmental factors on Vitamin D levels so as to provide theoretical support for public health promotion in this region. Methods A total of 22,387 subjects who underwent a physical examination at the center in the West China Hospital, Sichuan University, between April, 2018 and May, 2020 were enrolled in this study. Their data on gender, age, inspection date, serum 25 hydroxyvitamin D (25-(OH) D), parathyroid hormone (PTH), and total calcium were retrospectively reviewed. Next, the percentage of Vitamin D status was compared in different sex and age groups, and the fluctuation of Vitamin D level was described in relation to the change of environment. Finally, the univariable and multivariable linear regression analyses were performed to explore the risk and protective factors of Vitamin D deficiency. Results The proportion of Vitamin D deficiency in this area was 42.17%, and it was significantly higher among women and young people. The fluctuation trend of 25-(OH) D levels are consistent with temperature and solar radiation, and opposite to air quality, in the whole year. There was a positive relationship between 25-(OH) D levels with temperature and solar radiation; however, parathyroid hormone, female and AQI were negatively correlated with Vitamin D levels. Conclusion Vitamin D deficiency is common in subtropic areas, such as Sichuan Basin, which is related to solar radiation and air pollution.
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Affiliation(s)
- He He
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuping Zeng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xia Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lidan Yang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Mei Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhenmei An
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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171
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Vitamin D Intake in a Population-Based Sample of Young Polish Women, Its Major Sources and the Possibility of Meeting the Recommendations. Foods 2020; 9:foods9101482. [PMID: 33080781 PMCID: PMC7602986 DOI: 10.3390/foods9101482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022] Open
Abstract
The recommendations of vitamin D intake are commonly not met, which results from the fact that fish, being its major sources, are commonly rarely consumed. Consequently, a reliable estimation of its habitual intake is also difficult, as its daily intake is highly variable. The aim of the study was to analyze vitamin D intake from food, its major sources and the possibility to meet its recommendations in a population-based sample of young Polish women. The study was conducted in a sample of Polish women aged 15–30 years, recruited in cooperation with local students’ and youth organizations from all regions of Poland (convenience sampling with the snowball effect), while the stratified sampling procedure was applied with a random quota sampling for voivodeships (an administrative subdivision), to obtain an adequate distribution regarding the general population of young Polish women (n = 1,032). The vitamin D intake was assessed while using the validated Vitamin D Estimation Only—Food Frequency Questionnaire (VIDEO-FFQ) and was compared with the recommended 10 µg. The median vitamin D intake in the study group was 3.09 µg (0.00–24.52 µg) and in 95% of participants was lower than recommended, while the highest vitamin D intake was observed for the following sources: eggs (0.50 µg), meat and meat products (0.49 µg), herring, sardine and tuna products (0.41 µg) and dairy products (0.40 µg). The correlation between total vitamin D intake and its intake from its sources was strongest for eggs (p < 0.0001; R = 0.5989) and for herring, sardine and tuna products (p < 0.0001; R = 0.5314), while the correlation between total vitamin D intake and the number of servings was strongest for herring, sardine and tuna products (p < 0.0001; R = 0.5314). At the same time, while compared with other fish species, consuming herring was the strongest predictor of meeting the recommended vitamin D level of 10 µg (p = 0.0292; odds ratio (OR) = 1.94; 95% confidence interval (CI) 1.07–3.52), but also of 5 µg (p < 0.0001; OR = 2.54; 95% CI 1.85–3.47). Therefore, taking into account the relatively low prices of herring, its high vitamin D content, as well as its influence on total vitamin D intake, it could be beneficial to recommend young women to increase herring intake in order to increase dietary vitamin D intake and to meet its recommendations.
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172
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Fan X, Wang J, Song M, Giovannucci EL, Ma H, Jin G, Hu Z, Shen H, Hang D. Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in a Large Cohort: Results From the UK Biobank. J Clin Endocrinol Metab 2020; 105:5867168. [PMID: 32620963 DOI: 10.1210/clinem/dgaa432] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Although an inverse association between vitamin D status and mortality has been reported in observational studies, the precise association shape and optimal vitamin D status remain undetermined. OBJECTIVE To investigate the association between vitamin D status and risk of all-cause and cause-specific mortality and estimate optimal serum 25-hydroxyvitamin D [25(OH)D] concentrations. DESIGN Prospective cohort study. SETTING UK Biobank. PARTICIPANTS 365 530 participants who had serum 25(OH)D measurements and no history of cardiovascular disease (CVD), cancer, or diabetes at baseline (2006-2010). MAIN OUTCOME MEASURES All-cause and cause-specific mortality. RESULTS During a median follow-up of 8.9 (interquartile range: 8.3-9.5) years, 10 175 deaths occurred, including 1841 (18.1%) due to CVD and 5737 (56.4%) due to cancer. The multivariate analyses revealed nonlinear inverse associations, with a decrease in mortality risk appearing to level off at 60 nmol/L of 25(OH)D for all-cause and CVD deaths and at 45 nmol/L for cancer deaths. Compared to participants with 25(OH)D concentrations below the cutoffs, those with higher concentrations had a 17% lower risk for all-cause mortality (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.79-0.86), 23% lower risk for CVD mortality (HR: 0.77, 95% CI: 0.68-0.86), and 11% lower risk for cancer mortality (HR: 0.89, 95% CI: 0.84-0.95). CONCLUSIONS Higher 25(OH)D concentrations are nonlinearly associated with lower risk of all-cause, CVD, and cancer mortality. The thresholds of 45 to 60 nmol/L might represent an intervention target to reduce the overall risk of premature death, which needs further confirmation in large clinical trials.
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Affiliation(s)
- Xikang Fan
- Department of Epidemiology and Biostatistics, International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jiayu Wang
- Department of Epidemiology and Biostatistics, International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mingyang Song
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, US
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, US
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, US
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, US
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, US
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, US
| | - Hongxia Ma
- Department of Epidemiology and Biostatistics, International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine, Center for Global Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Guangfu Jin
- Department of Epidemiology and Biostatistics, International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine, Center for Global Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Zhibin Hu
- Department of Epidemiology and Biostatistics, International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine, Center for Global Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Hongbing Shen
- Department of Epidemiology and Biostatistics, International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Dong Hang
- Department of Epidemiology and Biostatistics, International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China
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173
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Yalcin Bahat P, Aldikactioglu Talmac M, Bestel A, Topbas Selcuki NF, Aydın Z, Polat İ. Micronutrients in COVID-19 Positive Pregnancies. Cureus 2020; 12:e10609. [PMID: 32983745 PMCID: PMC7515144 DOI: 10.7759/cureus.10609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022] Open
Abstract
Pregnant women are considered among the high-risk population for COVID-19. Therefore, research for methods of treatment and prevention of COVID-19 positive pregnancies carries an importance. The aim of this study was to measure serum 25(OH)D, vitamin B12, and zinc levels in COVID-19 positive pregnant women to evaluate the role of these micronutrients in treatment and prevention. A total of 44 COVID-19 positive pregnant women who were hospitalized and treated at a tertiary clinic were included in this study. The mean serum 25(OH)D level was measured to be 9.70 ± 59.14. The mean serum zinc level was 62.58 ± 2.63, and the mean serum vitamin B12 level was 295.55 ± 302.48. All these variables were significantly lower than the accepted cut-off values (p < 0.001). These low values might have contributed to a deficiency in their immune response and thus made these patients susceptible to COVID-19 infection. Supplementation of micronutrients during the pandemic could be beneficial during pregnancy for prevention.
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Affiliation(s)
- Pinar Yalcin Bahat
- Obstetrics and Gynaecology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Merve Aldikactioglu Talmac
- Obstetrics and Gynaecology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Ayşegul Bestel
- Obstetrics and Gynaecology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Nura F Topbas Selcuki
- Obstetrics and Gynaecology, Health Sciences University, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, TUR
| | - Zelal Aydın
- Obstetrics and Gynaecology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - İbrahim Polat
- Obstetrics and Gynaecology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, TUR
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174
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Yuan C, Song M, Zhang Y, Wolpin BM, Meyerhardt JA, Ogino S, Hollis BW, Chan AT, Fuchs CS, Wu K, Wang M, Smith-Warner SA, Giovannucci EL, Ng K. Prediagnostic Circulating Concentrations of Vitamin D Binding Protein and Survival among Patients with Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:2323-2331. [PMID: 32917664 DOI: 10.1158/1055-9965.epi-20-0291] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/28/2020] [Accepted: 08/24/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Higher total 25-hydroxyvitamin D [25(OH)D] levels are associated with improved survival among patients with colorectal cancer, but the relationships between circulating vitamin D binding protein (VDBP), and bioavailable or free 25(OH)D, and colorectal cancer survival remain unknown. METHODS We examined the associations between prediagnostic plasma levels of vitamin D-related markers and survival among 603 White participants diagnosed with colorectal cancer from two prospective U.S. cohorts. Plasma VDBP and total 25(OH)D were directly measured, while bioavailable and free 25(OH)D was calculated using a validated formula on the basis of total 25(OH)D, VDBP, and albumin levels. Cox proportional hazards regression was used to estimate HRs for overall and colorectal cancer-specific mortality, with adjustment for other prognostic markers and potential confounders. RESULTS Higher VDBP levels were associated with improved overall (P trend = 0.001) and colorectal cancer-specific survival (P trend = 0.02). Compared with patients in the lowest quartile, those in the highest quartile of VDBP had a multivariate HR of 0.58 [95% confidence interval (CI), 0.41-0.80] for overall mortality and 0.58 (95% CI, 0.37-0.91) for colorectal cancer-specific mortality. The results remained similar after further adjustment for total 25(OH)D levels. In contrast, neither bioavailable nor free 25(OH)D levels were associated with overall or colorectal cancer-specific mortality (all P trend > 0.15). CONCLUSIONS Prediagnostic circulating concentrations of VDBP were positively associated with survival among patients with colorectal cancer. IMPACT The clinical utility of VDBP as a prognostic marker warrants further exploration, as well as research into underlying mechanisms of action.
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Affiliation(s)
- Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yin Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Bruce W Hollis
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Charles S Fuchs
- Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stephanie A Smith-Warner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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175
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Zittermann A, Ernst JB, Prokop S, Fuchs U, Berthold HK, Gouni-Berthold I, Gummert JF, Pilz S. A 3 year post-intervention follow-up on mortality in advanced heart failure (EVITA vitamin D supplementation trial). ESC Heart Fail 2020; 7:3754-3761. [PMID: 32915512 PMCID: PMC7755020 DOI: 10.1002/ehf2.12953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/02/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022] Open
Abstract
Aims Vitamin D supplementation is widely used in the clinical setting, but its effects on mortality and cardiovascular outcomes in patients with heart failure are unclear. This paper reports outcome data that were collected during follow‐up of 3 years after closure of the EVITA trial (a 3 year randomized, placebo‐controlled, intervention study with 4000 IU vitamin D daily in patients with advanced heart failure), to capture potential latency effects of vitamin D supplementation on clinical outcomes. Methods and results The prespecified primary endpoint was overall mortality. Secondary endpoints included hospitalization, mechanical circulatory support implantation, high urgent listing for heart transplantation, and heart transplantation. For group comparisons, we used Cox regression models with a time‐dependent categorical covariate. The calculated net difference in circulating 25‐hydroxyvitamin D between the vitamin D and placebo groups dropped from 60.9 nmol/L at the end of the active study period to 3.2 nmol/L at the end of the post‐intervention period. During the entire 6 year period, 73 patients (36.5%) died in the placebo group and 76 (38.8%) in the vitamin D group. Out of these 149 patients, 36 and 39 died during the first 3 years, and 37 and 37 during the second 3 years, respectively. The hazard ratio (HR) for mortality in the vitamin D versus the placebo group was 1.06 [95% confidence interval (CI): 0.68–1.66] for the first 3 years and 1.07 (95% CI: 0.68–1.70) for the 3 year post‐intervention follow‐up. Compared with the placebo group, the HRs for hospitalization and for mechanical circulatory support implant were significantly higher in the vitamin D group during vitamin D supplementation (HR = 1.31, 95% CI: 1.01–1.68 and HR = 2.01, 95% CI: 1.08–3.76, respectively) but not after vitamin D discontinuation (HR = 1.10, 95% CI: 0.62–1.94 and HR = 0.99, 95% CI: 0.38–2.56, respectively). There was no significant time‐dependent effect on the risk of high urgent listing for heart transplantation and heart transplantation. Conclusions No beneficial latency effects of vitamin D supplementation on overall mortality could be demonstrated. Instead, the disappearance of unfavourable findings in the vitamin D group (higher HRs for hospitalization and for mechanical circulatory support implant) after vitamin D discontinuation supports the assumption of adverse vitamin D effects on the cardiovascular system at doses of 4000 IU daily.
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Affiliation(s)
- Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Georgstraße 11, Bad Oeynhausen, D-32545, Germany
| | - Jana B Ernst
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Georgstraße 11, Bad Oeynhausen, D-32545, Germany
| | - Sylvana Prokop
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Georgstraße 11, Bad Oeynhausen, D-32545, Germany
| | - Uwe Fuchs
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Georgstraße 11, Bad Oeynhausen, D-32545, Germany
| | - Heiner K Berthold
- Department of Internal Medicine and Geriatrics, Bethel Clinic (EvKB), Bielefeld, Germany
| | - Ioanna Gouni-Berthold
- Polyclinic for Endocrinology, Diabetes and Preventive Medicine (PEDP), University of Cologne, Cologne, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Georgstraße 11, Bad Oeynhausen, D-32545, Germany
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Bischoff-Ferrari HA, de Godoi Rezende Costa Molino C, Rival S, Vellas B, Rizzoli R, Kressig RW, Kanis JA, Manson JE, Dawson-Hughes B, Orav EJ, da Silva JAP, Blauth M, Felsenberg D, Ferrari SM, Theiler R, Egli A. DO-HEALTH: Vitamin D3 - Omega-3 - Home exercise - Healthy aging and longevity trial - Design of a multinational clinical trial on healthy aging among European seniors. Contemp Clin Trials 2020; 100:106124. [PMID: 32858228 DOI: 10.1016/j.cct.2020.106124] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022]
Abstract
DO-HEALTH is a multi-center clinical trial among 2157 community-dwelling European men and women age 70 and older. The 2x2x2 randomized-control factorial design trial tested the individual and additive benefit, as well as the cost-effectiveness, of 3 interventions: vitamin D 2000 IU/day, omega-3 fatty acids 1000 mg/day (EPA + DHA, ratio 1:2), and a 30-minute 3 times/week home exercise (strength versus flexibility). Each treatment tested has shown considerable prior promise from mechanistic studies, small clinical trials, or large cohort studies, in the prevention of common age-related chronic diseases, but definitive data are missing. DO-HEALTH will test these interventions in relation to 6 primary endpoints (systolic and diastolic blood pressure, non-vertebral fractures, Short Physical Performance Battery score, the Montreal Cognitive Assessment, and risk of infections), plus several secondary endpoints explored in ancillary studies (i.e. rate of any falls and injurious falls, joint pain, oral health, quality of life, and incident frailty). As the 3 interventions have distinct mechanisms of action for each of the 6 primary endpoints, a maximum benefit is expected for their additive benefit as a "multi-modal" intervention. The trial duration is 3 years with in-person contacts with all participants at 4 clinical visits and by quarterly phone calls. Baseline and follow-up blood samples were collected in all participants to measure changes in 25-hydroxyvitamin D and poly-unsaturated fatty acid concentrations. Our objective was to test interventions that are expected to promote healthy aging and longer life expectancy and that can be easily and safely implemented by older community-dwelling adults.
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Affiliation(s)
- Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University Hospital Zurich, City HospitalWaid & Triemli and University of Zurich, Zurich, Switzerland; Department of Geriatric Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland; University Clinic for Acute Geriatric Care, City Hospital Waid&Triemli, Zurich, Switzerland.
| | | | - Sandrine Rival
- Center on Aging and Mobility, University Hospital Zurich, City HospitalWaid & Triemli and University of Zurich, Zurich, Switzerland
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Center Hospitalo-Universitaire de Toulouse, Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, United Kingdom; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Endel J Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Michael Blauth
- Department for Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dieter Felsenberg
- Center for Muscle and Bone Research, Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Robert Theiler
- Center on Aging and Mobility, University Hospital Zurich, City HospitalWaid & Triemli and University of Zurich, Zurich, Switzerland; Department of Geriatric Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andreas Egli
- Center on Aging and Mobility, University Hospital Zurich, City HospitalWaid & Triemli and University of Zurich, Zurich, Switzerland
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177
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Official recommendations for vitamin D through the life stages in developed countries. Eur J Clin Nutr 2020; 74:1514-1518. [PMID: 32820241 DOI: 10.1038/s41430-020-00706-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/01/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022]
Abstract
Inadequate vitamin D nutritional status is prevalent worldwide and has been associated with autoimmune disorders, heart disease, deadly cancers, insulin resistance, inflammation, neurological disorders, adverse outcomes in pregnancy, and increased risk for mortality. Expert recommendations for vitamin D intake differ between governmental agencies and practice guidelines from medical societies due to differences in the definition of vitamin D deficiency, insufficiency and sufficiency based on serum 25-hydroxyvitamin D [25(OH)D] concentrations. In addition, separate health promotion bodies also provide targeted recommendations for the prevention of specific disorders such as reducing risk for developing some cancers and autoimmune diseases. We review and provide perspectives regarding various recommendations from the Institute of Medicine (IOM, United States) and Health Canada, the European Food Safety Authority (EFSA), the Scientific Advisory Committee on Nutrition (SACN; United Kingdom), the World Health Organization, the Endocrine Society and other expert groups by life stage as a guide intended for clinician use.
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178
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Xu J, Chen K, Zhao F, Huang D, Zhang H, Fu Z, Xu J, Wu Y, Lin H, Zhou Y, Lu W, Wu Y, Xia D. Association between vitamin D/calcium intake and 25-hydroxyvitamin D and risk of ovarian cancer: a dose-response relationship meta-analysis. Eur J Clin Nutr 2020; 75:417-429. [PMID: 32814859 DOI: 10.1038/s41430-020-00724-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/20/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between vitamin D/calcium and risk of ovarian cancer is still a debatable point. The aim of our study was to systematically investigate the association between vitamin D/calcium, and the risk of ovarian cancer and estimate their dose-response association quantitatively. METHODS PubMed, EMBASE, and Web of Science databases were searched to identify relevant observational studies. Two investigators screened citations and extracted data independently. Data were extracted and the association between vitamin D/calcium and ovarian cancer risk was estimated by calculating pooled relative risks (RRs). Subgroup analyses, publication bias estimation, and dose-response analyses were carried out as well. RESULTS In total, 21 articles involving 980,008 participants were included in our present study. No significant association was observed between total vitamin D intake and ovarian cancer risk (RR: 1.02; 95% CI, 0.89-1.16, p = 0.81). Further subgroup analysis suggested that neither dietary vitamin D intake (RR: 0.80; 95% CI, 0.62-1.03, p = 0.09) nor supplementary vitamin D intake (RR: 0.98; 95% CI, 0.85-1.13, p = 0.80) was associated with the risk of ovarian cancer. As for calcium, total calcium intake was found to be statistically inversely associated with ovarian cancer risk in case-control studies (RR: 0.73; 95% CI, 0.63-0.86, p < 0.001) but not in cohort studies (RR: 1.05; 95% CI, 0.90-1.24, p = 0.52). Besides, supplementation with calcium plus vitamin D was not effective for the prevention of ovarian cancer (p = 0.98). Of note, dose-response analysis based on cohort studies suggested a potential inverse U-shape relationship between calcium intake (including total calcium and dietary calcium) and ovarian cancer risk, which indicated that low dose of calcium intake might reduce ovarian cancer risk while high dose of calcium intake might not. CONCLUSIONS Taken together, vitamin D could not decrease the risk of ovarian cancer. The role of calcium intake was not proven for reducing ovarian cancer risk. Besides, no evidence showed combinative use of calcium and vitamin D have additional benefits for ovarian cancer prevention.
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Affiliation(s)
- Jiawei Xu
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Kelie Chen
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Fan Zhao
- Department of Toxicology, Zhejiang University School of Public Health, Hangzhou, 310058, China
| | - Dongdong Huang
- Department of Pathology, Key Laboratory of Disease Proteomics of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Honghe Zhang
- Department of Pathology, Key Laboratory of Disease Proteomics of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Zhiqin Fu
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Jinming Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yongfeng Wu
- Department of Toxicology, Zhejiang University School of Public Health, Hangzhou, 310058, China.,Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Hui Lin
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Yexinyi Zhou
- Department of Toxicology, Zhejiang University School of Public Health, Hangzhou, 310058, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Yihua Wu
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Dajing Xia
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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179
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Yeh WZ, Gresle M, Jokubaitis V, Stankovich J, van der Walt A, Butzkueven H. Immunoregulatory effects and therapeutic potential of vitamin D in multiple sclerosis. Br J Pharmacol 2020; 177:4113-4133. [PMID: 32668009 DOI: 10.1111/bph.15201] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/04/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022] Open
Abstract
Initially recognised as an important factor for bone health, vitamin D is now known to have a range of effects on the immune system. Vitamin D deficiency is associated with an increased risk of multiple sclerosis (MS), a chronic immune-mediated demyelinating disease of the CNS. In this review, we explore the links between vitamin D deficiency, MS risk, and disease activity. We also discuss the known immune effects of vitamin D supplementation and the relevance of these observations to the immunopathology of MS. Finally, we review the existing evidence for vitamin D supplementation as an MS therapy, highlighting several recent clinical studies and trials.
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Affiliation(s)
- Wei Zhen Yeh
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Melissa Gresle
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
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180
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Heiskanen V, Pfiffner M, Partonen T. Sunlight and health: shifting the focus from vitamin D3 to photobiomodulation by red and near-infrared light. Ageing Res Rev 2020; 61:101089. [PMID: 32464190 DOI: 10.1016/j.arr.2020.101089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
Both sun exposure and serum vitamin D levels have been associated with lower risks of all-cause mortality and chronic age-related diseases, e.g., cancer, diabetes and cardiovascular disease, in epidemiological studies. These associations have mainly been ascribed to beneficial effects of vitamin D. However, a vast body of randomized controlled trials (RCTs) and Mendelian randomization studies have failed to confirm any major health benefits from vitamin D supplementation. In this review, we present tentative evidence showing that red and near-infrared light, both being present in sunlight, could explain the associations between sunlight exposure and better health status. Body irradiation with red and near-infrared light, usually termed as photobiomodulation (PBM), has demonstrated beneficial effects in animal models of chronic diseases. Beyond this, preliminary evidence from RCTs suggest potential clinical benefit from PBM for chronic diseases. PBM is currently being investigated in many pre-registered clinical trials, results of which will eventually clarify the role of red and near-infrared light in the prevention and treatment of common age-related chronic diseases.
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181
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Roumeliotis S, Mallamaci F, Zoccali C. Endothelial Dysfunction in Chronic Kidney Disease, from Biology to Clinical Outcomes: A 2020 Update. J Clin Med 2020; 9:jcm9082359. [PMID: 32718053 PMCID: PMC7465707 DOI: 10.3390/jcm9082359] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
The vascular endothelium is a dynamic, functionally complex organ, modulating multiple biological processes, including vascular tone and permeability, inflammatory responses, thrombosis, and angiogenesis. Endothelial dysfunction is a threat to the integrity of the vascular system, and it is pivotal in the pathogenesis of atherosclerosis and cardiovascular disease. Reduced nitric oxide (NO) bioavailability is a hallmark of chronic kidney disease (CKD), with this disturbance being almost universal in patients who reach the most advanced phase of CKD, end-stage kidney disease (ESKD). Low NO bioavailability in CKD depends on several mechanisms affecting the expression and the activity of endothelial NO synthase (eNOS). Accumulation of endogenous inhibitors of eNOS, inflammation and oxidative stress, advanced glycosylation products (AGEs), bone mineral balance disorders encompassing hyperphosphatemia, high levels of the phosphaturic hormone fibroblast growth factor 23 (FGF23), and low levels of the active form of vitamin D (1,25 vitamin D) and the anti-ageing vasculoprotective factor Klotho all impinge upon NO bioavailability and are critical to endothelial dysfunction in CKD. Wide-ranging multivariate interventions are needed to counter endothelial dysfunction in CKD, an alteration triggering arterial disease and cardiovascular complications in this high-risk population.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, School of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Francesca Mallamaci
- CNR-IFC (National Research Council of Italy, Centre of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension Unit, Reggio Cal., c/o Ospedali Riuniti, 89124 Reggio Cal, Italy;
| | - Carmine Zoccali
- CNR-IFC (National Research Council of Italy, Centre of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension Unit, Reggio Cal., c/o Ospedali Riuniti, 89124 Reggio Cal, Italy;
- Correspondence: ; Tel.: +39-340-73540-62
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182
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Zhang C, Fu S, Zhao M, Liu D, Zhao Y, Yao Y. Associations Between Complement Components and Vitamin D and the Physical Activities of Daily Living Among a Longevous Population in Hainan, China. Front Immunol 2020; 11:1543. [PMID: 32765534 PMCID: PMC7379858 DOI: 10.3389/fimmu.2020.01543] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/11/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Vitamin D and complement components shared some common pathophysiological pathways in the musculoskeletal system, circulation, and metabolism, which were linked to physical function. It is hypothesized that serum complement components may interact with vitamin D in respect of the physical activities of daily living (PADLs). Objective: To investigate if serum complement components 3 (C3), complement components 4 (C4), and 25-hydroxyvitamin D [25(OH)D] associate with PADLs, and to examine whether the association between 25(OH)D levels and PADLs varies at different complement component levels among Chinese centenarians. Methods: This study was conducted in a group of population-based centenarians. PADLs were evaluated using the Barthel Index. Multiple regressions were used to analyze the associations among 25(OH)D, complements C3 and C4, and PADLs. Results: Among 943 participants, 672 (71.3%) had physical dependence (PD). After adjusting for potential confounders, serum 25(OH)D and C3 levels were positively correlated with PADLs, while C4 levels were negatively correlated with PADLs (Ps < 0.05). Serum 25(OH)D levels significantly interacted with both C3 (P for interaction = 0.033) and C4 (P for interaction = 0.006) levels on PADLs. At lower complement component levels, the multivariate odds ratios (ORs) of the upper tertile of vitamin D for PD were 0.32 (95% CI: 0.18-0.55) in the C3 group and 0.29 (95% CI: 0.16-0.50) in the C4 group. At higher complement component levels, the ORs in the C3 and C4 groups were not statistically significant. Conclusions: In a group of population-based Chinese centenarians, we observed that serum complement C3 and 25(OH)D levels were positively associated with PADLs, while C4 was negatively associated with PADLs. The associations between 25(OH)D levels and PADLs were more pronounced in groups with lower serum complement component levels.
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Affiliation(s)
- Chi Zhang
- Department of Education, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Minghao Zhao
- School of Medicine, Peking University Health Science Center, Beijing, China
| | - Deping Liu
- Department of Education, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatrics Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yao Yao
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China.,Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, United States
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183
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Daimon M, Fujita T, Murabayashi M, Mizushiri S, Murakami H, Nishiya Y, Tanabe J, Matsuhashi Y, Yanagimachi M, Tokuda I, Sawada K, Ihara K. Exacerbation of Hyperparathyroidism, Secondary to a Reduction in Kidney Function, in Individuals With Vitamin D Deficiency. Front Med (Lausanne) 2020; 7:221. [PMID: 32582730 PMCID: PMC7289923 DOI: 10.3389/fmed.2020.00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/01/2020] [Indexed: 12/02/2022] Open
Abstract
Aims/Introduction: Chronic kidney disease (CKD)-mineral and bone disorders (CKD-MBD) are an adverse outcome derived from decreases in kidney function, where abnormality of serum concentrations of calcium (Ca), phosphorus, parathyroid hormone (PTH), and vitamin D can be seen simultaneously. To identify individuals at risk for CKD-MBD or secondary hyperparathyroidism, the relationships between estimated glomerular filtration rate (eGFR) and serum PTH concentration were evaluated, allowing for confounding factors, in particular vitamin D status, in a general Japanese population. Materials and Methods: Nine-hundred-and-thirty participants in the population-based Iwaki study conducted in 2016 who were not on drugs affecting mineral metabolism nor hemodialysis, were included in the study (326 men and 604 women; age: 55.4 ± 15.9 years). Results: Regression analysis showed a significant correlation between eGFR and serum intact PTH concentration, after adjustment for possible confounding factors (β = −0.122, p < 0.001). The smoothed spline curve applied for the correlation analysis revealed a biphasic correlation, with a division at an eGFR of ~60 mL/min/1.73 m2, below which the correlation coefficient was higher (β = −0.405, p < 0.001). Stratification on the basis of vitamin D status showed that the correlation was present only in participants with vitamin D deficiency (25-dihydroxyvitamin D3: <15 pg/mL) (β = −0.154, p < 0.001). Conclusions: These results indicate that a reduction in eGFR is a significant risk factor for an increase in serum PTH concentration when it is <60 mL/min/1.73 m2 and vitamin D is deficient, in the general Japanese population.
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Affiliation(s)
- Makoto Daimon
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoyuki Fujita
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaya Murabayashi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoru Mizushiri
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroshi Murakami
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Nishiya
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Jutaro Tanabe
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Matsuhashi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Miyuki Yanagimachi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itoyo Tokuda
- Department of Oral Healthcare Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kaori Sawada
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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184
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Tabbakh T, Wakefield M, Dobbinson SJ. Concerns about vitamin D and sun exposure behaviour among Australians. Health Promot J Austr 2020; 32:399-406. [PMID: 32557897 DOI: 10.1002/hpja.372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/15/2020] [Accepted: 06/11/2020] [Indexed: 11/08/2022] Open
Abstract
ISSUES ADDRESSED Australians' concerns about vitamin D and influence on sun protection were last quantified a decade ago in Queensland amidst media attention on emerging evidence of non-skeletal benefits of vitamin D. Meanwhile these circumstances persist and impact is worth assessing. METHODS Measures of concern about vitamin D were included in three recent population-based cross-sectional surveys of Australians' sun-related behaviours during summer months (2010-2011, 2013-2014 and 2016-2017). We analysed characteristics, beliefs and behaviours associated with vitamin D concerns regarding regular sunscreen use among adults in 2016-2017 (N = 3614). RESULTS Concerns about vitamin D continued to persist among adults surveyed between 2010-2011 and 2016-2017. Vitamin D concerns regarding the sunscreen use were more common among women, older respondents and adults with skin that tans or is not susceptible to sunburn. Respondents concerned about vitamin D were more likely to exhibit pro-tanning beliefs, scepticism about sunscreen safety and have attempted a suntan. They were also less likely to use sun protection in everyday activities outdoors and less likely to use sunscreen on summer weekends. CONCLUSIONS Vitamin D concerns related to sunscreen use remained common among Australian adults. Skin cancer control advocates may be reassured that those with the greatest skin cancer risk (burn only) were less likely to hold these concerns, while the related infrequent sun protection and tanning among concerned adults are problematic. SO WHAT?: Continued education and research is needed to ensure that the general public understand the risks and benefits of sun exposure in Australia.
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Affiliation(s)
- Tamara Tabbakh
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Suzanne J Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
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185
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Vitamin D and Cancer Survival: Does Vitamin D Supplementation Improve the Survival of Patients with Cancer? Curr Oncol Rep 2020; 22:62. [PMID: 32495112 DOI: 10.1007/s11912-020-00929-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Clinical evidence suggesting the beneficial effects of vitamin D on survival of patients with cancer has been accumulating. Recent articles were thoroughly reviewed to determine if there is enough evidence to conclude that vitamin D supplementation improves survival of patients with cancer. RECENT FINDINGS Meta-analyses of observational studies showed that higher blood 25-hydroxyvitamin D levels in patients with cancer at a variety of sites were associated with lower cancer-specific and overall mortalities. Moreover, meta-analyses of randomized clinical trials (RCTs) also suggested that vitamin D supplementation improved the survival of patients with cancer. However, each RCT used in these meta-analyses, as well as very recent RCTs, e.g., the SUNSHINE and the AMATERASU trial, did not show statistical significance in the primary results. For now, compelling evidence that vitamin D supplementation effectively improves survival of patients with cancer is lacking. Thus, confirmatory RCTs are still obligatory for the future.
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186
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Whiting SJ, Li W, Singh N, Quail J, Dust W, Hadjistavropoulos T, Thorpe LU. Predictors of hip fractures and mortality in long-term care homes in Saskatchewan: Does vitamin D supplementation play a role? J Steroid Biochem Mol Biol 2020; 200:105654. [PMID: 32169586 DOI: 10.1016/j.jsbmb.2020.105654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/11/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
High rates of hip fracture (HF) in long-term care (LTC) lead to increased hospitalization and greater risk of death. Supplementation of residents with vitamin D3 (vitD) has been recommended, but may be infrequently acted upon. Using a prospective cohort design, we explored use of vitD at doses ≥800 IU for hip fractures (HF) and for mortality among permanent LTC residents in Saskatchewan between 2008 and 2012, using provincial administrative health databases (N = 23178). We used stepwise backward regression with Cox proportional hazard multivariate analysis for time to first HF or to death upon entry into LTC (excluding the first three months), the association of daily vitD (determined during the first three months), age, sex, age*sex interaction, prior HF, osteoporosis diagnosis and Charlson Comormidity Score (CCS) was determined. Users of VitD were more likely older, women and those with previous HF. For HF, no significant impact of vitD or CCS was found. Models for mortality, stratified by sex, showed in women only, that vitD use resulted in a significant inverse association with time to death [HR (0.91(0.87-0.96)]; for men it was 0.94(0.88-1.01). The impact of VitD supplementation in LTC deserves further investigation, however, the mechanisms for its effect on mortality remain unclear.
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Affiliation(s)
- Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2T5 Canada.
| | - Wenbin Li
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada
| | - Nirmal Singh
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada
| | | | - William Dust
- Division of Orthopedic Surgery, Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Center on Aging and Health, University of Regina, Regina, SK, Canada
| | - Lilian U Thorpe
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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187
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Is vitamin D status reflected by testosterone concentration in elite athletes? Biol Sport 2020; 37:229-237. [PMID: 32879544 PMCID: PMC7433328 DOI: 10.5114/biolsport.2020.95633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Vitamin D is a nutrient whose active form affects tissues as a hormone and possibly enhances performance. One plausible mechanism is by increasing testosterone concentration, which is established as an important factor for athletic performance. Therefore the aim of the study was to examine the relationship between plasma concentration of 25(OH)D and testosterone in Polish elite track and field athletes depending on vitamin D status, season, training period, body composition, sex, type of training, sun exposure and vitamin D supplementation. Plasma concentrations of 25(OH)D and testosterone were measured in all seasons within two years in athletes (70 females, 79 males) who represent strength (n = 103) and endurance (n = 46) kinds of sports, in the preparatorycompetitive season and transition period. There were no differences in 25(OH)D concentration between male and female athletes, insufficiency [25(OH)D < 30 ng/ml] was observed in 32.9%, whereas deficiency [25(OH)D < 20 ng/ ml] in 3.2%. Circannual rhythm was noted for vitamin D but not for testosterone concentration; no correlations between them were found either in strength or endurance athletes or between 25(OH)D and body composition. Testosterone concentration was higher in the transition period than in the preparatory-competition period only in male athletes. Higher 25(OH)D was observed in athletes who trained during winter in Africa (higher sun exposure) or used oral supplementation, whereas the respective testosterone levels were unchanged. In athletes, testosterone concentration did not reflect vitamin D status. The widespread of inadequate vitamin D status among athletes, makes it vital to recommend them the regular monitoring of 25(OH)D concentration and use of reasonable supplementation.
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188
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Ben-Shabat N, Watad A, Shabat A, Bragazzi NL, Comaneshter D, Cohen AD, Amital H. Low Vitamin D Levels Predict Mortality in Ankylosing Spondylitis Patients: A Nationwide Population-Based Cohort Study. Nutrients 2020; 12:nu12051400. [PMID: 32414130 PMCID: PMC7285142 DOI: 10.3390/nu12051400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023] Open
Abstract
In this study, we aimed to examine the effect of vitamin D deficiency on all-cause mortality in ankylosing spondylitis (AS) patients and in the general population. This is a retrospective-cohort study based on the electronic database of the largest health-maintenance organization in Israel. AS patients who were first diagnosed between 2002–2007 were included. Controls were matched by age, gender and enrollment-time. Follow-up continued until death or end of study follow-up on 1 July 2019. Laboratory measures of serum 25-hydroxyvitamin-D levels during the entire follow-up period were obtained. A total of 919 AS patients and 4519 controls with a mean time of follow-up of 14.3 years were included. The mean age at the time of enrollment was 52 years, and 22% of them were females. AS was associated with a higher proportion of vitamin D deficiency (odds ratio 1.27 [95% confidence-interval (CI) 1.03–1.58]). In AS patients, insufficient levels of vitamin D (<30 ng/mL) were significantly associated with increased incidence of all-cause mortality (hazard ratio (HR) 1.59 [95% CI 1.02–2.50]). This association was more prominent with the decrease in vitamin D levels (< 20 ng/mL, HR 1.63 [95% CI 1.03–2.60]; <10 ng/mL, HR 1.79 [95% CI 1.01–3.20]) and among male patients (<30 ng/mL, HR 2.11 [95% CI 1.20–3.72]; <20 ng/mL, HR 2.12 [95% CI 1.19–3.80]; <10 ng/mL, HR 2.23 [95% CI 1.12–4.43]). However, inadequate levels of vitamin D among controls were not associated with an increased all-cause mortality. Our study has shown that vitamin D deficiency is more common in AS patients than controls and is linked to an increased risk for all-cause mortality. These results emphasize the need for randomized-controlled trials to evaluate the benefits of vitamin D supplementation as a secondary prevention of mortality in patients with chronic inflammatory rheumatic disease.
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Affiliation(s)
- Niv Ben-Shabat
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel; (N.B.-S.); (H.A.)
| | - Abdulla Watad
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel; (N.B.-S.); (H.A.)
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, Chapel Allerton Hospital, University of Leeds, Leeds LS7 4SA, UK
- Correspondence: ; Tel.: +972-3-530-2652
| | - Aviv Shabat
- Hadassah Faculty of Medicine, The Hebrew University, Jerusalem 9112001, Israel;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Doron Comaneshter
- Chief Physician’s Office, Clalit Health Services Tel Aviv, Tel-Aviv 6209813, Israel; (D.C.); (A.D.C.)
| | - Arnon D. Cohen
- Chief Physician’s Office, Clalit Health Services Tel Aviv, Tel-Aviv 6209813, Israel; (D.C.); (A.D.C.)
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Howard Amital
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel; (N.B.-S.); (H.A.)
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
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189
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Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors. Nutrients 2020; 12:nu12041021. [PMID: 32276412 PMCID: PMC7230756 DOI: 10.3390/nu12041021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
Patients affected by gastroenteropancreatic–neuroendocrine tumors (GEP–NETs) have an increased risk of developing osteopenia and osteoporosis, as several factors impact on bone metabolism in these patients. In fact, besides the direct effect of bone metastasis, bone health can be affected by hormone hypersecretion (including serotonin, cortisol, and parathyroid hormone-related protein), specific microRNAs, nutritional status (which in turn could be affected by medical and surgical treatments), and vitamin D deficiency. In patients with multiple endocrine neoplasia type 1 (MEN1), a hereditary syndrome associated with NET occurrence, bone damage may carry other consequences. Osteoporosis may negatively impact on the quality of life of these patients and can increment the cost of medical care since these patients usually live with their disease for a long time. However, recommendations suggesting screening to assess bone health in GEP–NET patients are missing. The aim of this review is to critically analyze evidence on the mechanisms that could have a potential impact on bone health in patients affected by GEP–NET, focusing on vitamin D and its role in GEP–NET, as well as on factors associated with MEN1 that could have an impact on bone homeostasis.
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190
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Neumeyer S, Butterbach K, Banbury BL, Berndt SI, Campbell PT, Chlebowski RT, Chan AT, Giovannucci EL, Joshi AD, Ogino S, Song M, McCullough ML, Maalmi H, Manson JE, Sakoda LC, Schoen RE, Slattery ML, White E, Win AK, Figueiredo JC, Hopper JL, Macrae FA, Peters U, Brenner H, Hoffmeister M, Newcomb PA, Chang-Claude J. Genetic Predictors of Circulating 25-Hydroxyvitamin D and Prognosis after Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:1128-1134. [PMID: 32188599 DOI: 10.1158/1055-9965.epi-19-1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/17/2020] [Accepted: 03/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Low serum 25-hydroxyvitamin D [25(OH)D] concentrations in patients with colorectal cancer have been consistently associated with higher mortality in observational studies. It is unclear whether low 25(OH)D levels directly influence colorectal cancer mortality. To minimize bias, we use genetic variants associated with vitamin D levels to evaluate the association with overall and colorectal cancer-specific survival. METHODS Six genetic variants have been robustly identified to be associated with 25(OH)D levels in genome-wide association studies. On the basis of data from the International Survival Analysis in Colorectal Cancer Consortium, the individual genetic variants and a weighted genetic risk score were tested for association with overall and colorectal cancer-specific survival using Cox proportional hazards models in 7,657 patients with stage I to IV colorectal cancer, of whom 2,438 died from any cause and 1,648 died from colorectal cancer. RESULTS The 25(OH)D decreasing allele of SNP rs2282679 (GC gene, encodes group-specific component/vitamin D-binding protein) was associated with poorer colorectal cancer-specific survival, although not significant after multiple-testing correction. None of the other five SNPs showed an association. The genetic risk score showed nonsignificant associations with increased overall [HR = 1.54; confidence interval (CI), 0.86-2.78] and colorectal cancer-specific mortality (HR = 1.76; 95% CI, 0.86-3.58). A significant increased risk of overall mortality was observed in women (HR = 3.26; 95% CI, 1.45-7.33; P heterogeneity = 0.01) and normal-weight individuals (HR = 4.14; 95% CI, 1.50-11.43, P heterogeneity = 0.02). CONCLUSIONS Our results provided little evidence for an association of genetic predisposition of lower vitamin D levels with increased overall or colorectal cancer-specific survival, although power might have been an issue. IMPACT Further studies are warranted to investigate the association in specific subgroups.
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Affiliation(s)
- Sonja Neumeyer
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Katja Butterbach
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Barbara L Banbury
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
| | - Peter T Campbell
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Rowan T Chlebowski
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edward L Giovannucci
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Amit D Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Mingyang Song
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Marjorie L McCullough
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Haifa Maalmi
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - JoAnn E Manson
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lori C Sakoda
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Robert E Schoen
- Department of Medicine and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Martha L Slattery
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Emily White
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Aung K Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Finlay A Macrae
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Victoria, Australia
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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191
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Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anaesth 2020; 67:655-663. [PMID: 32180175 PMCID: PMC7090434 DOI: 10.1007/s12630-020-01630-7] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose To assess the management and safety of epidural or general anesthesia for Cesarean delivery in parturients with coronavirus disease (COVID-19) and their newborns, and to evaluate the standardized procedures for protecting medical staff. Methods We retrospectively reviewed the cases of parturients diagnosed with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection disease (COVID-19). Their epidemiologic history, chest computed tomography scans, laboratory measurements, and SARS-CoV-2 nucleic acid positivity were evaluated. We also recorded the patients’ demographic and clinical characteristics, anesthesia and surgery-related data, maternal and neonatal complications, as well as the health status of the involved medical staff. Results The clinical characteristics of 17 pregnant women infected with SARS-CoV-2 were similar to those previously reported in non-pregnant adult patients. All of the 17 patients underwent Cesarean delivery with anesthesia performed according to standardized anesthesia/surgery procedures. Fourteen of the patients underwent continuous epidural anesthesia with 12 experiencing significant intraoperative hypotension. Three patients received general anesthesia with tracheal intubation because emergency surgery was needed. Three of the parturients are still recovering from their Cesarean delivery and are receiving in-hospital treatment for COVID-19. Three neonates were born prematurely. There were no deaths or serious neonatal asphyxia events. All neonatal SARS-CoV-2 nucleic acid tests were negative. No medical staff were infected throughout the patient care period. Conclusions Both epidural and general anesthesia were safely used for Cesarean delivery in the parturients with COVID-19. Nevertheless, the incidence of hypotension during epidural anesthesia appeared excessive. Proper patient transfer, medical staff access procedures, and effective biosafety precautions are important to protect medical staff from COVID-19.
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Affiliation(s)
- Rong Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuan Zhang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lei Huang
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bi-Heng Cheng
- Department of Obstetric, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhong-Yuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qing-Tao Meng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China. .,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China.
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Asakura K, Etoh N, Imamura H, Michikawa T, Nakamura T, Takeda Y, Mori S, Nishiwaki Y. Vitamin D Status in Japanese Adults: Relationship of Serum 25-Hydroxyvitamin D with Simultaneously Measured Dietary Vitamin D Intake and Ultraviolet Ray Exposure. Nutrients 2020; 12:nu12030743. [PMID: 32168939 PMCID: PMC7146414 DOI: 10.3390/nu12030743] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 02/08/2023] Open
Abstract
Vitamin D insufficiency/deficiency is prevalent worldwide. We investigated the effect of vitamin D intake and ultraviolet ray (UV) exposure on serum vitamin D concentration in Japan. A total of 107 healthy adult participants were recruited from Hokkaido (43° N) and Kumamoto (33° N) prefectures. All participants undertook surveys in both summer and winter. Serum 25-hydroxyvitamin D (25(OH)D3) was examined, and vitamin D intake was assessed with a diet history questionnaire. UV exposure was measured with a wearable UV dosimeter. Regression analysis was performed to investigate the relationship between these factors, with covariates such as sun avoidance behavior. The prevalence of vitamin D insufficiency (serum 25(OH)D3; 12 ng/mL (30 nmol/L) ≤ and <20 ng/mL (50 nmol/L))/deficiency (<12 ng/mL) was 47.7% in summer and 82.2% in winter. UV exposure time was short in Kumamoto (the urban area), at 11.6 min in summer and 14.9 min in winter. In Hokkaido (the rural area), UV exposure time was 58.3 min in summer and 22.5 min in winter. Vitamin D intake was significantly associated with serum 25(OH)D3, and a 1 μg/1000kcal increase in intake was necessary to increase 25(OH)D3 by 0.88 ng/mL in summer and by 1.7 ng/mL in winter. UV exposure time was significantly associated with serum 25(OH)D3 in summer, and a 10 min increase in UV exposure time was necessary to increase 25(OH)D3 by 0.47 ng/mL. Although consideration of personal occupation and lifestyle is necessary, most Japanese may need to increase both vitamin D intake and UV exposure.
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Affiliation(s)
- Keiko Asakura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16, Omori-Nishi, Ota-ku, Tokyo #143-8540, Japan; (H.I.); (T.M.); (T.N.); (Y.T.); (S.M.); (Y.N.)
- Correspondence: ; Tel.: +81-3-3762-4151
| | - Norihito Etoh
- Department of Biomedical Engineering, School of Engineering, Tokai University, 143 Shimokasuya, Isehara, Kanagawa #259-1193, Japan;
| | - Haruhiko Imamura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16, Omori-Nishi, Ota-ku, Tokyo #143-8540, Japan; (H.I.); (T.M.); (T.N.); (Y.T.); (S.M.); (Y.N.)
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16, Omori-Nishi, Ota-ku, Tokyo #143-8540, Japan; (H.I.); (T.M.); (T.N.); (Y.T.); (S.M.); (Y.N.)
| | - Takahiro Nakamura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16, Omori-Nishi, Ota-ku, Tokyo #143-8540, Japan; (H.I.); (T.M.); (T.N.); (Y.T.); (S.M.); (Y.N.)
| | - Yuki Takeda
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16, Omori-Nishi, Ota-ku, Tokyo #143-8540, Japan; (H.I.); (T.M.); (T.N.); (Y.T.); (S.M.); (Y.N.)
| | - Sachie Mori
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16, Omori-Nishi, Ota-ku, Tokyo #143-8540, Japan; (H.I.); (T.M.); (T.N.); (Y.T.); (S.M.); (Y.N.)
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16, Omori-Nishi, Ota-ku, Tokyo #143-8540, Japan; (H.I.); (T.M.); (T.N.); (Y.T.); (S.M.); (Y.N.)
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193
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Adekunle L, Chen R, Morrison L, Halley M, Eng V, Hendlin Y, Wehner MR, Chren MM, Linos E. Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review. BMJ 2020; 368:m7. [PMID: 32019742 PMCID: PMC7190068 DOI: 10.1136/bmj.m7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess whether an association exists between financial links to the indoor tanning industry and conclusions of indoor tanning literature. DESIGN Systematic review. DATA SOURCES PubMed, Embase, and Web of Science, up to 15 February 2019. STUDY SELECTION CRITERIA Articles discussing indoor tanning and health were eligible for inclusion, with no article type restrictions (original research, systematic reviews, review articles, case reports, editorials, commentaries, and letters were all eligible). Basic science studies, articles describing only indoor tanning prevalence, non-English articles, and articles without full text available were excluded. RESULTS 691 articles were included in analysis, including empiric articles (eg, original articles or systematic reviews) (357/691; 51.7%) and non-empiric articles letters (eg, commentaries, letters, or editorials) (334/691; 48.3%). Overall, 7.2% (50/691) of articles had financial links to the indoor tanning industry; 10.7% (74/691) articles favored indoor tanning, 3.9% (27/691) were neutral, and 85.4% (590/691) were critical of indoor tanning. Among the articles without industry funding, 4.4% (27/620) favored indoor tanning, 3.5% (22/620) were neutral, and 92.1% (571/620) were critical of indoor tanning. Among the articles with financial links to the indoor tanning industry, 78% (39/50) favored indoor tanning, 10% (5/50) were neutral, and 12% (6/50) were critical of indoor tanning. Support from the indoor tanning industry was significantly associated with favoring indoor tanning (risk ratio 14.3, 95% confidence interval 10.0 to 20.4). CONCLUSIONS Although most articles in the indoor tanning literature are independent of industry funding, articles with financial links to the indoor tanning industry are more likely to favor indoor tanning. Public health practitioners and researchers need to be aware of and account for industry funding when interpreting the evidence related to indoor tanning. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019123617.
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Affiliation(s)
- Lola Adekunle
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Rebecca Chen
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Lily Morrison
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Meghan Halley
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Victor Eng
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Yogi Hendlin
- School of Philosophy Erasmus University, Rotterdam, Netherlands
| | - Mackenzie R Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Departments of Health Services Research and of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
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Jungert A, Quack Lötscher K, Rohrmann S. Vitamin Substitution Beyond Childhood—Requirements and Risks. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:14-22. [PMID: 32008607 PMCID: PMC7008147 DOI: 10.3238/arztebl.2020.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/15/2019] [Accepted: 10/09/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamins are vitally important, but they are not always adequately supplied with the diet. In this review, we present the advantages and disadvantages of vitamin supplementation and the indications for it in various life situations. METHODS This review is based on pertinent publications retrieved by a selective search of the literature. RESULTS The German National Nutrition Survey II (Nationale Verzehrsstudie II) showed that most people in Germany consume adequate amounts of vitamins in their diet, with the exception of vitamin D and folate. Supplements are often taken by adults who already consume a balanced diet. Depending on the vitamin, 3-13% of survey respondents took vitamin supplements; the ones most often taken were vitamins C and E. No convincing evidence has yet demonstrated a health benefit from vitamin supplementation in addition to a balanced diet for the primary prevention of nutrition-associated diseases. Vitamin supplementation is indicated in certain specific life situations, e.g., pregnancy, but otherwise unnecessary, unless a deficiency has been diagnosed or the individual is at elevated risk. CONCLUSION Vitamin supplementation is recommended for certain population groups: folic acid for pregnant women, vitamin B12 for vegans and persons with resorption disorders, vitamin D for persons with insufficient endogenous synthesis. In all other cases, it should first be tested whether the individual might be substantially helped by dietary changes alone. In general, the potential adverse effects of vitamin supplementation need to be considered, and its benefits weighed against its risks.
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Affiliation(s)
| | | | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich
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195
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Prevalence of Vitamin D Deficiency and Its Associated Work-Related Factors among Indoor Workers in a Multi-Ethnic Southeast Asian Country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010164. [PMID: 31881679 PMCID: PMC6981433 DOI: 10.3390/ijerph17010164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 01/21/2023]
Abstract
Little is known about the effect of working conditions on vitamin D status in Southeast Asia, where vitamin D deficiency is common despite the presence of sunlight all year round in most places. We examined the prevalence of vitamin D deficiency and its associated work-related factors among indoor workers using the data of 213 participants (aged ≥21 years) from a workplace cohort study in Singapore. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/L. Data on work-related factors, socio-demographic characteristics, and lifestyle habits were collected using standardized questionnaires. Clinical and biochemical measurements were performed using standard tools and protocols. Multivariate Poisson regression was used to examine the independent association of work-related factors with vitamin D deficiency. Mean serum 25(OH)D concentration was 59.6 nmol/L. The prevalence of vitamin D deficiency was 32.9% (95% confidence interval (CI): 26.6-39.6%). In the multivariate analysis, office workers (prevalence ratio (PR): 2.16, 95% CI: 1.12-4.16 versus control room workers), workshop workers (PR: 2.25, 95% CI: 1.05-4.81 versus control room workers), and night shift workers (PR: 1.31, 95% CI: 1.03-1.67) were at a greater risk for vitamin D deficiency. Workplace policies and wellness programs should encourage workers to take regular breaks to go outdoors for sunlight exposure and to consume adequate amounts of vitamin D-rich foods to maintain optimal vitamin D levels.
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196
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Akutsu T, Okada S, Hirooka S, Ikegami M, Ohdaira H, Suzuki Y, Urashima M. Effect of Vitamin D on Relapse-Free Survival in a Subgroup of Patients with p53 Protein-Positive Digestive Tract Cancer: A Post Hoc Analysis of the AMATERASU Trial. Cancer Epidemiol Biomarkers Prev 2019; 29:406-413. [PMID: 31871108 DOI: 10.1158/1055-9965.epi-19-0986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/09/2019] [Accepted: 12/06/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The AMATERASU randomized trial of vitamin D3 supplementation (2,000 IU/day; UMIN000001977) showed the potential benefit of vitamin D in a subgroup of patients with digestive tract cancer. By conducting post hoc analyses of this trial, we further explored whether subgroups stratified by expression levels of p53, vitamin D receptor (VDR), and Ki-67 modify the effect of vitamin D supplementation. METHODS The primary outcome was relapse-free survival (RFS). On IHC using pathologic specimens, the degree of p53 protein expression parallel with TP53 missense mutations was classified as p53 positive (>10%) and p53 negative (≤10%). In addition, VDR and Ki-67 expression levels were divided into quartiles. RESULTS The p53 status of 372 patients' pathologic specimens was evaluated. In a subgroup of patients with p53-positive cancer (n = 226), 5-year RFS was 79% in the vitamin D group, which was significantly higher than the 57% in the placebo group (HR, 0.52; 95% confidence interval, 0.31-0.88; P = 0.02). In the subgroup of patients with p53-negative cancer, 5-year RFS in the vitamin D group versus placebo group was 72% versus 84% (not significantly different), respectively. Effect modification by p53 positivity was significant (P interaction = 0.02). However, no significant effect modification by either VDR or Ki-67 was observed. CONCLUSIONS These results generate a hypothesis that vitamin D supplementation may improve RFS in patients with p53-positive digestive tract cancer. IMPACT The results are still preliminary, but potentially important, because TP53 is the most frequently mutated gene across cancers at all sites.
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Affiliation(s)
- Taisuke Akutsu
- Division of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinya Okada
- Department of Pathology, International University of Health and Welfare Hospital, Otawara, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Otawara, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Otawara, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo, Japan.
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197
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Haidari F, Abiri B, Iravani M, Razavi SM, Sarbakhsh P, Ahmadi-Angali K, Vafa M. Effects of vitamin D and omega-3 fatty acids co-supplementation on inflammatory biomarkers, tumor marker CEA, and nutritional status in patients with colorectal cancer: a study protocol for a double blind randomized controlled trial. Trials 2019; 20:682. [PMID: 31815661 PMCID: PMC6900845 DOI: 10.1186/s13063-019-3719-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/13/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Much evidence is available demonstrating that both vitamin D and omega-3 fatty acids block the development and progression of colonic carcinogenesis. The results of animal studies have shown that the consumption of omega-3 fatty acids can decrease inflammatory biomarkers, enhance the efficacy of chemotherapy, and decrease the side effects of chemotherapy or cancer. Also, observational studies propose that higher levels of 25(OH)D are related to improved survival of colorectal cancer patients. This study will aim to evaluate the effects of vitamin D and omega-3 fatty acids co-supplementation on inflammatory biomarkers, tumor marker CEA, and nutritional status in colorectal cancer patients. METHODS/DESIGN We will carry out an 8-week double-blind randomized, placebo-controlled clinical trial to evaluate the effects of vitamin D and omega-3 fatty acids co-supplementation on inflammatory biomarkers, tumor marker CEA, and nutritional status in patients with stage ӀӀ or ӀӀӀ colorectal cancer undergoing chemotherapy. DISCUSSION Because of the important effects of vitamin D and omega-3 fatty acids on molecular pathways involved in cancer development and progression, it seems that both vitamin D and omega-3 fatty acids may provide a new adjuvant therapy by decreasing inflammatory biomarkers and resistance to cancer treatment in patients with colorectal cancer. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20180306038979N1. Registered on 16 March 2018.
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Affiliation(s)
- Fatemeh Haidari
- Department of Nutrition, Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behnaz Abiri
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masood Iravani
- Department of Oncology and Hematology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Mohsen Razavi
- Department of Oncology and Hematology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kambiz Ahmadi-Angali
- Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. .,Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
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Effect Modification of Vitamin D Supplementation by Histopathological Characteristics on Survival of Patients with Digestive Tract Cancer: Post Hoc Analysis of the AMATERASU Randomized Clinical Trial. Nutrients 2019; 11:nu11102547. [PMID: 31652554 PMCID: PMC6835362 DOI: 10.3390/nu11102547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/24/2022] Open
Abstract
Some coauthors of this study previously performed the AMATERASU randomized, double-blind, placebo-controlled trial of postoperative oral vitamin D supplementation (2,000 IU/day) in 417 patients with stage I to III digestive tract cancer from the esophagus to the rectum who underwent curative surgery (UMIN000001977). We conducted a post-hoc analysis of the AMATERASU trial to explore the effects of modification of vitamin D supplementation by histopathological characteristics on survival. Among patients with poorly differentiated adenocarcinoma, the 5-year relapse-free survival rate of patients supplemented with vitamin D was 91% compared with 63% in the placebo group (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; P = 0.017; P for interaction = 0.023). Similarly, the 5-year overall survival rate was 92% in the vitamin D group compared with 72% in the placebo group (HR, 0.25; 95%CI, 0.07 to 0.94; P = 0.040; P for interaction = 0.012). In contrast, there were no significant effects in other histopathological characteristics between vitamin D and placebo groups. These findings generated the hypothesis that oral vitamin D supplementation may improve both relapse-free survival and overall survival in a subgroup of patients with poorly differentiated adenocarcinoma.
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A Review of the Potential Benefits of Increasing Vitamin D Status in Mongolian Adults through Food Fortification and Vitamin D Supplementation. Nutrients 2019; 11:nu11102452. [PMID: 31615079 PMCID: PMC6835745 DOI: 10.3390/nu11102452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023] Open
Abstract
Serum 25-hydroxyvitamin D (25(OH)D) concentrations are low in Mongolia, averaging 22 ng/mL in summer and only 8 ng/mL in winter. Mongolians have high incidence and/or prevalence of several diseases linked to low 25(OH)D concentrations, including ischemic heart disease, malignant neoplasms, cirrhosis of the liver, ischemic stroke, lower respiratory tract infections, preterm birth complications, and diabetes mellitus. Fortifying regularly consumed foods such as flour, milk, and edible oils with vitamin D3 could raise 25(OH)D concentrations by about 10 ng/mL. However, to achieve 25(OH)D concentrations of 30–40 ng/mL in adults, vitamin D intakes of 1000 to 4000 IU/day would be required, making personal supplement use necessary. On the basis of prospective observational studies and clinical trials of disease incidence or known mortality rates and adverse pregnancy and birth outcomes, raising mean serum 25(OH)D concentrations to 40 ng/mL would likely reduce incidence and mortality rates for those and other diseases, reduce the rate of adverse pregnancy and birth outcomes, and increase mean life expectancy by one year or more.
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