Vitamin D and Chronic Diseases

Development of functional whey cheese enriched in vitamin D3: nutritional composition, fortification, analysis, and stability study during cheese processing and storage

"Ricotta" cheese is a traditional and popular Italian fresh whey cheese commonly produced from cow's milk. Food fortification is an efficient strategy to reduce the high global prevalence of vitamin D deficiency. This study aims to study the chemical-nutritional analysis of ricotta cheese and to assess its suitability as a dairy matrix for vitamin D fortification. The chemical-nutritional analyses revealed that ricotta cheese is a good source of proteins (7.8 g/100 g) with high levels of branched-chain amino acids (1.8 g/100 g). Moreover, ricotta contains high levels of calcium (0.4 g/100 g) and phosphorus (0.2 g/100 g). 50 mg of vitamin D₃ were added to 95 kg of cheese reaching a mean fortification level of 41.4 ± 4.0 µg/100 g of ricotta cheese. The fortification study showed that vitamin D homogenously distributes in ricotta cheese after the homogenisation process. Moreover, vitamin D₃ has high heat stability (93.8 ± 1.8%) and remains stable throughout the shelf-life of the fortified food. This study demonstrates that ricotta cheese represents an ideal alternative dairy matrix for vitamin D₃ fortification.

Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss

The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.

Inflammation, HIV, and Immune Quiescence: Leveraging on Immunomodulatory Products to Reduce HIV Susceptibility

The relationship between inflammation and HIV has been a focus of research over the last decade. In HIV-infected individuals, increased HIV-associated immune activation significantly correlated to disease progression. While genital inflammation (GI) has been shown to significantly increase the risk of HIV acquisition and transmission, immune correlates for reduced risk remain limited. In certain HIV-exposed seronegative individuals, an immune quiescent phenotype characterized reduced risk. Immune quiescence is defined by specific, targeted, highly regulated immune responses that hinder overt inflammation or immune activation. Targeted management of inflammation, therefore, is a plausible strategy to mitigate HIV risk and slow disease progression. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as hydroxychloroquine and aspirin have shown encouraging preliminary results in low-risk women by reducing systemic and genital immune activation. A topical NSAID, containing ibuprofen, is effective in treating vulvovaginal inflammation. Additionally, the glucocorticoids (GCs), prednisolone, and dexamethasone are used to treat HIV-associated immune activation. Collectively, these data inform on immune-modulating drugs to reduce HIV risk. However, the prolonged use of these pharmaceutical drugs is associated with adverse effects, both systemically and to a lesser extent topically. Natural products with their reduced side effects coupled with anti-inflammatory properties render them viable options. Lactic acid (LA) has immunomodulatory properties. LA regulates the genital microbiome by facilitating the growth of Lactobacillus species, while simultaneously limiting bacterial species that cause microbial dysbiosis and GI. Glycerol monolaurate, besides being anti-inflammatory, also inhibited SIV infections in rhesus macaques. The proposed pharmaceutical and natural products could be used in combination with either antiretrovirals for treatment or preexposure prophylaxis for HIV prevention. This review provides a summary on the associations between inflammation, HIV risk, and disease progression. Furthermore, we use the knowledge from immune quiescence to exploit the use of pharmaceutical and natural products as strategic interventions to manage inflammation, toward mitigating HIV infections.

Vitamin D Deficiency Is Associated with COVID-19 Incidence and Disease Severity in Chinese People [corrected]

BACKGROUND

Vitamin D might have beneficial potential in influencing the natural history of the coronavirus disease 2019 (COVID-19) due to its immunomodulatory and anti-inflammatory properties.

OBJECTIVE

The aim was to investigate whether vitamin D deficiency is associated with COVID-19 incidence and disease severity in Chinese people.

METHODS

In a cross-sectional study we retrospectively analyzed 335 COVID-19 patients (median: 56.0; IQR: 43.0-64.0 y) who were admitted to the Wuhan Tongji Hospital between 27 February and 21 March 2020. We also included an age- and sex-matched population of 560 individuals (median: 55; IQR: 49.0-60.0 y) who underwent the physical examination program. Their serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured during the same period from 2018-2019. Serum 25(OH)D concentrations were measured for all COVID-19 patients on admission. Severity of COVID-19 was determined based on the level of respiratory involvement. A general linear model with adjustment for covariates was used to compare 25(OH)D concentrations between the COVID-19 and 2018-2019 control groups. Adjusted ORs with 95% CIs for associations between vitamin D status and COVID-19 severity were estimated via multivariable logistic regression.

RESULTS

In the general linear model adjusted for age, sex, comorbidities, and BMI, serum 25(OH)D concentrations were significantly lower among COVID-19 patients than the 2018-2019 controls [ln transformed values of 3.32 ± 0.04 vs. 3.46 ± 0.022 ln (nmol/L), P = 0.014]. Multivariable logistic regression showed that male sex (OR: 2.26; 95% CI: 1.06, 4.82), advanced age (≥65 y) (OR: 4.93; 95% CI: 1.44, 16.9), and vitamin D deficiency (<30 nmol/L) (OR: 2.72; 95% CI: 1.23, 6.01) were significantly associated with COVID-19 severity (all P < 0.05).

CONCLUSIONS

These findings suggested that vitamin D deficiency impacts COVID-19 hospitalization and severity in the Chinese population.

Body composition in nonobese individuals according to vitamin D level

Obesity is associated with lower 25-hydroxyvitamin D (25OHD) levels, but the association between 25OHD deficiency and specific body composition (BC) patterns remains unclear. The aim of this study was to analyze the correlation between 25OHD levels and BC in a population of healthy, nonobese individuals. Cross-sectional, observational study including a convenience sample of community-dwelling healthy individuals aged ≥18 years who responded to a study advertisement and were randomly selected. The participants filled out a questionnaire and had fasting blood drawn and anthropometric indices taken. Dual-energy x-ray absorptiometry was performed for BC analysis (fat and lean body mass). The subjects were divided according to 25OHD levels into three groups: I (≤20 ng/mL, vitamin D deficient), II (>20 and <30 ng/mL, vitamin D insufficient), and III (≥30 ng/mL, vitamin D sufficient). Of 299 individuals selected, 51 were excluded, yielding a final sample of 248 (128 women) who had serum 25OHD levels measured. Women presented higher 25OHD levels than men (27.8±12.0 ng/mL and 24.8±11.3 ng/mL, respectively; p = 0.03). Including both sexes, Group I had greater body mass index (BMI; 26.6±2.5 kg/m2) and waist circumference (WC; 91.8.8±9.1 cm) compared with the other groups. Group I also had 75.7% and 65.3% of abnormal BMI and WC values, respectively, (p<0.05 for both) and a higher percentage of trunk and android fat confirmed by multivariate analysis. No differences in BC were observed in individuals with insufficient versus sufficient 25OHD levels. Individuals with lower 25OHD levels had increased fat in the android region and trunk. This study confirms the association of lower 25OHD levels with greater BMI and WC and increased deposition of fat in body compartments, which, even in nonobese individuals, are commonly associated with increased metabolic risk.

History of tobacco, vitamin D and women

Tobacco usage kills more than 8 million people a year. Approximately 7 million of those deaths are the result of direct tobacco use, while approximately 1.2 million are the result of non-smokers being exposed to second-hand smoke. About 200 million of the world's one billion smokers are women and usage among women is increasing in some countries. Nicotine from smoking tobacco, specifically its metabolite cotinine, has negative effects on human health causing lung cancer, COPD and non-respiratory problems. Over a billion people worldwide are Vitamin D deficient or insufficient, which is prevalent across all age-groups, geographic regions, and sunlight. With the discovery of Vitamin D in 1919, a new chapter in the prevention of rickets was introduced opening the door to its therapeutic properties for other diseases. Since 1919, there have been many clinical and epidemiolocal studies performed globally on the effect of the vitamin on prevention of other diseases, including but not limited to, cancer, autoimmune disorders, cardiovascular diseases, and osteoporosis. Exposure to environmental tobacco smoke has been associated with reduced levels of Vitamin D in the blood stream and sinus tissues. Manavi et al. (2015) demonstrated that among three smoking categories (heavy, light, non-smokers), black female heavy smokers have lower vitamin D (13.374 ng/ml), than Hispanic (19.213 ng/ml) or white (24.929 ng/ml) females correlating to higher levels of cotinine. Therefore, blood serum concentrations of cotinine contribute to decreased Vitamin D concentrations in addition to other factors such as gender and ethnicity. Further information is provided in the text.

Role of Dietary Intake and Serum 25(OH)D on the Effects of a Multicomponent Exercise Program on Bone Mass and Structure of Frail and Pre-Frail Older Adults

The multicomponent training (MCT) effect on bone health in frail and pre-frail elders, which is influenced by dietary intake, is still unknown. The objective of this non-randomized intervention trial was to assess the effects of a 6-month MCT on bone structure in frail and pre-frail elders, and to analyse the influence of dietary intake and serum vitamin D (25(OH)D) in these changes. Thirty MCT (TRAIN) and sixteen controls (CON), frail and pre-frail completed the information required for this study. Peripheral quantitative computed tomography measurements were taken at 4% and 38% of the tibia length and dietary intake was registered. The 25(OH)D values were obtained from blood samples. Analyses of covariance (ANCOVA) for repeated measures showed significant decreases for CON in total bone mineral content at 38% of tibia length. One factor ANOVAs showed smaller decreases in bone mineral density and cortical thickness percentage of change in TRAIN compared to CON. Linear regression analyses were performed to study the influence of nutrients and 25(OH)D on bone changes. Alcohol showed a negative influence on fracture index changes, while polyunsaturated fatty acid and vitamin A showed a positive association with some bone variables. The 25(OH)D only affected positively the cortical bone mineral density. In conclusion, our MCT seems to slow down some of the bone detriments associated with ageing in frail and pre-frail older adults, with alcohol showing a negative effect on the bone and apparent limited effect of nutrients and serum 25(OH)D on training related changes.

Pharmaconutrition in the Clinical Management of COVID-19: A Lack of Evidence-Based Research But Clues to Personalized Prescription

A scientific interest has emerged to identify pharmaceutical and nutritional strategies in the clinical management of coronavirus disease 2019 (COVID-19). The purpose of this narrative review is to critically assess and discuss pharmaconutrition strategies that, secondary to accepted treatment methods, could be candidates in the current context of COVID-19. Oral medicinal doses of vitamin C (1-3 g/d) and zinc (80 mg/d elemental zinc) could be promising at the first signs and symptoms of COVID-19 as well as for general colds. In critical care situations requiring parenteral nutrition, vitamin C (3-10 g/d) and glutamine (0.3-0.5 g/kg/d) administration could be considered, whereas vitamin D3 administration (100,000 IU administered intramuscularly as a one-time dose) could possess benefits for patients with severe deficiency. Considering the presence of n-3 polyunsaturated fatty acids and arginine in immune-enhancing diets, their co-administration may also occur in clinical conditions where these formulations are recommended. However, despite the use of the aforementioned strategies in prior contexts, there is currently no evidence of the utility of any nutritional strategies in the management of SARS-CoV-2 infection and COVID-19. Nevertheless, ongoing and future clinical research is imperative to determine if any pharmaconutrition strategies can halt the progression of COVID-19.

The Molecular Mechanisms by Which Vitamin D Prevents Insulin Resistance and Associated Disorders

Numerous studies have shown that vitamin D deficiency is very common in modern societies and is perceived as an important risk factor in the development of insulin resistance and related diseases such as obesity and type 2 diabetes (T2DM). While it is generally accepted that vitamin D is a regulator of bone homeostasis, its ability to counteract insulin resistance is subject to debate. The goal of this communication is to review the molecular mechanism by which vitamin D reduces insulin resistance and related complications. The university library, PUBMED, and Google Scholar were searched to find relevant studies to be summarized in this review article. Insulin resistance is accompanied by chronic hyperglycaemia and inflammation. Recent studies have shown that vitamin D exhibits indirect antioxidative properties and participates in the maintenance of normal resting ROS level. Appealingly, vitamin D reduces inflammation and regulates Ca²⁺ level in many cell types. Therefore, the beneficial actions of vitamin D include diminished insulin resistance which is observed as an improvement of glucose and lipid metabolism in insulin-sensitive tissues.

Protective Effect of Calcitriol on Organ Damage Induced by 5-Fluorouracil Treatment

Chemotherapy is a major therapeutic strategy for patients with cancer. Owing to the severe inflammatory response of chemotherapy, patients experience extreme discomfort during treatment, and this may interrupt treatment completion. The vitamin D3 has a role in anti-inflammation, but no study has explored whether vitamin D3 has beneficial effects on patients undergoing chemotherapy. In this study, we investigated the effect of calcitriol (Vit-D) on inflammatory responses during 5-fluorouracil (5-FU) treatment. Rats were divided into five groups and treated with 1:1 dilution of 5-FU with equal amount of 0.9% saline, 1:3 dilution of 5-FU with 0.9% saline threefold dilution, 5-FU, Vit-D, or 5-FU + Vit-D. A single dose of 15 mg/kg of 5-FU was intravenously administered for 4 h, and the blood biochemical substances and inflammatory cytokines were assessed after the intervention. The 5-FU group had higher AST, ALT, LDH, and CPK levels than those in the 5-FU + Vit-D group. The 5-FU + Vit-D group had a lower TNF-α value than the 5-FU. The IL-6 levels in the 5-FU + Vit-D group were also significantly lower than those in 5-FU. Calcitriol administration during 5-FU therapy can alleviate the production of inflammatory cytokines and liver damage.

Non-classical presentation of vitamin D deficiency: a case report

Background

Vitamin D is a fat-soluble vitamin; vitamin D is essential to sustain health and it protects against osteoporosis. It is crucial to the human body’s physiology in terms of muscular movement and neurological signal transmission, and to the immune system in defense against invading pathogens.

Case presentation

This was a case of a 26-year-old Sudanese woman who presented with a 2-year history of anosmia, recurrent nasal polyps, back pain, and chronic fatigue. She was diagnosed as having a case of vitamin D deficiency and responded well to treatment.

Conclusion

There is an association between vitamin D deficiency and recurrent allergic nasal conditions.

25-Hydroxyvitamin D status, vitamin D intake, and skin cancer risk: a systematic review and dose-response meta-analysis of prospective studies

Sun exposure is a major environmental risk factor for skin cancers and is also an important source of vitamin D. However, while experimental evidence suggests that vitamin D may have a protective effect on skin cancer risk, epidemiologic studies investigating the influence of 25-hydroxyvitamin D (25(OH)D) level and/or vitamin D intake on skin cancer risk are conflicting. A systematic review and dose–response meta-analyses of prospective studies was conducted to clarify these associations. Relevant studies were identified by searching the PubMed database up to 30th August 2019. Random effects dose–response meta-analyses were used to estimate summary relative risks (SRRs) and 95% confidence intervals (CIs). Overall, thirteen prospective studies were included. Circulating level of 25(OH)D was associated with higher risks of melanoma (SRR (95% CI) per 30 nmol = 1.42 (1.17–1.72)) and keratinocyte cancer (KC) (SRR (95% CI) per 30 nmol/L = 1.30 (1.13–1.49)). The SRR (95% CI) per 30 nmol/L increase in 25(OH) D level was 1.41 (1.19–1.67), and 1.57 (0.64–3.86), for basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), respectively. However, while we found that vitamin D intake (from diet, supplemental and total) was not associated with risks of melanoma and SCC, vitamin D intake was associated with slightly increased BCC risk, albeit with no heterogeneity across skin cancer type. This meta-analysis suggests positive associations between circulating 25(OH)D level and risk of melanoma and KC, however, this finding is most likely confounded by sun exposure. We found no associations between vitamin D intake skin cancers, except positive associations with BCC risk.

Low systemic vitamin D as a potential risk factor in primary open-angle glaucoma: a review of current evidence

Currently, intraocular pressure is the only modifiable risk factor for glaucoma; thus, identifying other modifiable determinants may have far-reaching outcomes. There has been increasing interest in vitamin D status and glaucoma pathogenesis as low vitamin D has been identified by some studies as an independent risk factor for glaucoma. Although the exact mechanism of vitamin D in glaucoma remains uncertain, there is sufficient evidence to continue research in this area. There is a potential physiological role for vitamin D as an anti-inflammatory agent in the oxidative stress-driven pathogenesis of primary open-angle glaucoma, and further studies are required to evaluate the temporal and causal relationship. Ocular vitamin D status in the tear, aqueous and vitreous fluid is a prospective gap in research.

Letter: does vitamin D have a potential role against COVID-19?

LINKED CONTENT This article is linked to Tian et al and Tian and Rong papers. To view these articles, visit https://doi.org/10.1111/apt.15731 and https://doi.org/10.1111/apt.15817.

Vitamin D and the Host-Gut Microbiome: A Brief Overview

There is a growing body of evidence for the effects of vitamin D on intestinal host-microbiome interactions related to gut dysbiosis and bowel inflammation. This brief review highlights the potential links between vitamin D and gut health, emphasizing the role of vitamin D in microbiological and immunological mechanisms of inflammatory bowel diseases. A comprehensive literature search was carried out in PubMed and Google Scholar using combinations of keywords "vitamin D," "intestines," "gut microflora," "bowel inflammation". Only articles published in English and related to the study topic are included in the review. We discuss how vitamin D (a) modulates intestinal microbiome function, (b) controls antimicrobial peptide expression, and (c) has a protective effect on epithelial barriers in the gut mucosa. Vitamin D and its nuclear receptor (VDR) regulate intestinal barrier integrity, and control innate and adaptive immunity in the gut. Metabolites from the gut microbiota may also regulate expression of VDR, while vitamin D may influence the gut microbiota and exert anti-inflammatory and immune-modulating effects. The underlying mechanism of vitamin D in the pathogenesis of bowel diseases is not fully understood, but maintaining an optimal vitamin D status appears to be beneficial for gut health. Future studies will shed light on the molecular mechanisms through which vitamin D and VDR interactions affect intestinal mucosal immunity, pathogen invasion, symbiont colonization, and antimicrobial peptide expression.

Vitamin D deficiency as a potential risk factor for accelerated aging, impaired hippocampal neurogenesis and cognitive decline: a role for Wnt/β-catenin signaling

Vitamin D is an essential fat-soluble vitamin that participates in several homeostatic functions in mammalian organisms. Lower levels of vitamin D are produced in the older population, vitamin D deficiency being an accelerating factor for the progression of the aging process. In this review, we focus on the effect that vitamin D exerts in the aged brain paying special attention to the neurogenic process. Neurogenesis occurs in the adult brain in neurogenic regions, such as the dentate gyrus of the hippocampus (DG). This region generates new neurons that participate in cognitive tasks. The neurogenic rate in the DG is reduced in the aged brain because of a reduction in the number of neural stem cells (NSC). Homeostatic mechanisms controlled by the Wnt signaling pathway protect this pool of NSC from being depleted. We discuss in here the crosstalk between Wnt signaling and vitamin D, and hypothesize that hypovitaminosis might cause failure in the control of the neurogenic homeostatic mechanisms in the old brain leading to cognitive impairment. Understanding the relationship between vitamin D, neurogenesis and cognitive performance in the aged brain may facilitate prevention of cognitive decline and it can open a door into new therapeutic fields by perspectives in the elderly.

Genetic Variation in Cytochrome P450 2R1 and Vitamin D Binding Protein Genes are associated with Vitamin D Deficiency in Adolescents

Background: Genome Wide Association Studies (GWAS) have evaluated several genes related to vitamin D synthesis, metabolism and transport. They have proposed a genetic basis for low levels of vitamin D in the blood. The current study aims to investigate the relationship between certain vitamin D-associated gene variants and vitamin D deficiency in Iranian adolescents. Methods: In this case-control study, the genomic DNA was extracted by Real Time PCR High Resolution Melt (HRM). All measurements were carried out with triple repetition. The following factors were assessed: single nucleotide polymorphisms (SNPs) in Vitamin D binding protein (DBP, rs2282679), 7-Dehydrocholesterol reductase (DHCR7, rs12785878) and Cytochrome P450 2R1 (CYP2R1, rs10741657). Results: the genomic DNA of blood samples obtained from 481 adolescents. Participants with hypovitaminosis D were compared with a control group. The average vitamin D level of sufficient subjects (controls) was 44.88±14.01 ng/mL, while subjects who were insufficient (cases) had an average vitamin D level of 7.03±1.24 ng/mL. No statistically significant differences were found in the allelic and genotypic distributions between genders. The SNP frequency in CYP2R1 (rs10741657) and DBP (rs2282679) in the vitamin D deficient group was significantly higher than in the control group (p-values < 0.001 and 0.01 respectively). There were no statistically significant differences in the DHCR7 SNP (rs12785878) distributions between the Vitamin D deficient group and control group. Conclusion: The present study demonstrated evidence of the ability of the SNPs under investigation to predict circulating vitamin D concentration. Further study is needed to better understand if and how genetic factors contribute to vitamin D levels, and certain skeletal-associated disorders in adolescents.

Association between the rs1544410 polymorphism in the vitamin D receptor (VDR) gene and insulin secretion after gestational diabetes mellitus

Background and aims

Genetic variants involved in vitamin D metabolism have been associated with diabetes and related syndromes/diseases. We wanted to investigate possible associations of polymorphisms in genes involved in vitamin D metabolism with indices of insulin resistance and insulin secretion, and also with development of diabetes after gestational diabetes mellitus (GDM).

Materials and methods

We have studied 376 women with previous GDM. Eight single nucleotide polymorphisms (SNPs) in the genes for vitamin D receptor (VDR) [rs731236, rs7975232, rs10735810, and rs1544410], vitamin D binding protein (DBP) [rs7041 and rs4588], and cytochrome P450 family 27 subfamily B member 1 (CYP27B1) [rs10877012 and rs4646536] were genotyped by TaqMan Allelic Discrimination Assay using the Quantstudio 7 Flex system. A 75-g oral glucose tolerance test (OGTT) was performed 1–2 years postpartum. The homeostasis model assessment of insulin resistance (HOMA-IR) and the disposition index [(insulinogenic index: I30/G30)/HOMA-IR] were used to calculate insulin resistance and insulin secretion, respectively. Serum samples for determination of 25(OH)D3 were collected at the time of the OGTT. Manifestation of diabetes was followed up to five years postpartum.

Results

After adjustment for BMI, age, and ethnicity, the A-allele of the VDR rs1544410 polymorphism was found to be associated with increased disposition index (difference per allele = 3.56, 95% CI: 0.4567–6.674; p = 0.03). The A-allele of the DBP rs7041 polymorphism was found to be associated with 25(OH)D3 levels (difference [in nmol/L] per allele = −5.478, 95% CI: -8.315 to −2.641; p = 0.0002), as was the T-allele of the DBP rs4588 polymorphism (OR = −6.319, 95% CI: −9.466 to −3.171; p = 0.0001). None of the SNPs were significantly associated with HOMA-IR or postpartum diabetes.

Conclusions

This study provides evidence that the rs1544410 polymorphism of the VDR gene may be associated with increased insulin secretion in women after pregnancy complicated by GDM. Further studies in other populations are needed to confirm the results.

Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity after Noncardiac Surgery

BACKGROUND

Low 25-hydroxyvitamin D is associated with cardiovascular, renal, and infectious risks. Postsurgical patients are susceptible to similar complications, but whether vitamin D deficiency contributes to postoperative complications remains unclear. We tested whether low preoperative vitamin D is associated with cardiovascular events within 30 days after noncardiac surgery.

METHODS

We evaluated a subset of patients enrolled in the biobank substudy of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) study, who were at least 45 yr with at least an overnight hospitalization. Blood was collected preoperatively, and 25-hydroxyvitamin D was measured in stored samples. The primary outcome was the composite of cardiovascular events (death, myocardial injury, nonfatal cardiac arrest, stroke, congestive heart failure) within 30 postoperative days. Secondary outcomes were kidney injury and infectious complications.

RESULTS

A total of 3,851 participants were eligible for analysis. Preoperative 25-hydroxyvitamin D concentration was 70 ± 30 nmol/l, and 62% of patients were vitamin D deficient. Overall, 26 (0.7%) patients died, 41 (1.1%) had congestive heart failure or nonfatal cardiac arrest, 540 (14%) had myocardial injury, and 15 (0.4%) had strokes. Preoperative vitamin D concentration was not associated with the primary outcome (average relative effect odds ratio [95% CI]: 0.93 [0.85, 1.01] per 10 nmol/l increase in preoperative vitamin D, P = 0.095). However, it was associated with postoperative infection (average relative effect odds ratio [95% CI]: 0.94 [0.90, 0.98] per 10 nmol/l increase in preoperative vitamin D, P adjusted value = 0.005) and kidney function (estimated mean change in postoperative estimated glomerular filtration rate [95% CI]: 0.29 [0.11, 0.48] ml min 1.73 m per 10 nmol/l increase in preoperative vitamin D, P adjusted value = 0.004).

CONCLUSIONS

Preoperative vitamin D was not associated with a composite of postoperative 30-day cardiac outcomes. However, there was a significant association between vitamin D deficiency and a composite of infectious complications and decreased kidney function. While renal effects were not clinically meaningful, the effect of vitamin D supplementation on infectious complications requires further study.

Prospects of the Use of Cell Therapy to Induce Immune Tolerance

Conditions in which abnormal or excessive immune responses exist, such as autoimmune diseases (ADs), graft-versus-host disease, transplant rejection, and hypersensitivity reactions, are serious hazards to human health and well-being. The traditional immunosuppressive drugs used to treat these conditions can lead to decreased immune function, a higher risk of infection, and increased tumor susceptibility. As an alternative therapeutic approach, cell therapy, in which generally intact and living cells are injected, grafted, or implanted into a patient, has the potential to overcome the limitations of traditional drug treatment and to alleviate the symptoms of many refractory diseases. Cell therapy could be a powerful approach to induce immune tolerance and restore immune homeostasis with a deeper understanding of immune tolerance mechanisms and the development of new techniques. The purpose of this review is to describe the current panoramic scope of cell therapy for immune-mediated disorders, discuss the advantages and disadvantages of different types of cell therapy, and explore novel directions and future prospects for these tolerogenic therapies.

Gender differences in the prevalence of vitamin D deficiency in a southern Latin American country: a pilot study

Aim: This study aimed to study the prevalence of vitamin D deficiency, assessing the influence of sex, age, and season of the year.Methods: A cross-sectional study was conducted with 1329 healthy subjects (668 women and 661 men) aged 18-89 years in Santiago, Chile. Age (years), body mass index, medical history, working status, sex, and date of blood sample were collected.Results: Men were slightly older than women (53.1 ± 18.2 vs. 50.0 ± 15.6 years; p < 0.01) and a higher percentage worked outside the home (73.1% vs. 51.9%, p < 0.001). The mean serum concentration of 25-hydroxyvitamin D (25(OH)-D) was 23.3 ± 9.3 ng/ml in women and 20.9 ± 9.5 ng/ml in men (p < 0.001). The levels of 25(OH)-D by season were 26.7 ± 9.0, 23.6 ± 9.7, 19.4 ± 8.5, and 19.1 ± 9.5 ng/ml (for summer, fall, winter, and spring, respectively; p < 0.05). The prevalence of vitamin D deficiency increases with age, rising from 36.5% under 40 years to 48.0% over 60 years (p < 0.004). Male sex, winter and spring, and age showed negative correlation with levels of 25(OH)-D (p < 0.05). Multivariate linear regression showed a final model that incorporates: age (coefficient: -0.06; 95% confidence interval [CI]: -0.09 to -0.03; p < 0.001), male sex (coefficient: -2.00; 95% CI: -2.96 to -1.05; p < 0.001), summer (coefficient: 7.30; 95% CI: 6.17 to 8.43; p < 0.001), and fall (coefficient: 4.27; 95% CI: 3.04 to 5.50; p < 0.001).Conclusions: Vitamin D deficiency is more prevalent in men than in women, in the elderly, and during the winter and spring seasons.

Association between pre-chemotherapy serum levels of vitamin D and clinicopathologic findings in gastric cancer

BACKGROUND

To examine the serum levels of vitamin D in newly diagnosed gastric cancer (GC) patients compared with normal subjects and any possible association with prognostic variables.

METHODS

One-hundred subjects (50 GC and 50 controls) were enrolled and serum vitamin D levels were assessed using ELISA. Based on two definitions, vitamin D was classified as a sufficient level (≥30 ng/dL) and optimal level (25-80 ng/dL). The χ²and unpaired t-test was used for data analysis with a significance level of 0.05.

RESULTS

The mean serum levels of vitamin D in patients and controls were 26.86 (±14.6) and 31.72 (±13.4), respectively (P=0.09). The prevalence of vitamin D insufficiency and deficiency was higher in GC cases than controls (P=0.045 if sufficient level ≥30 and P=0.065 if sufficient level ≥25). According to histological grade analysis, grade 3 patients (poorly differentiated) were found with significantly lower vitamin D concentrations in serum than grade 1 and 2 subjects (22.25 vs 33.29 ng/dL, P=0.021). No significant differences were observed between the two groups in pathological tumor-node-metastasis (pTNM) stages, distant metastasis, and location of the tumor.

CONCLUSION

Higher prevalence of vitamin D insufficiency and deficiency in GC patients may reflect its role in malignancy; however, further studies are needed to confirm this relationship and any possible benefits to the patients.

Daily and seasonal mitochondrial protection: Unraveling common possible mechanisms involving vitamin D and melatonin

From an evolutionary point of view, vitamin D and melatonin appeared very early and share functions related to defense mechanisms. In the current clinical setting, vitamin D is exclusively associated with phosphocalcic metabolism. Meanwhile, melatonin has chronobiological effects and influences the sleep-wake cycle. Scientific evidence, however, has identified new actions of both molecules in different physiological and pathological settings. The biosynthetic pathways of vitamin D and melatonin are inversely related relative to sun exposure. A deficiency of these molecules has been associated with the pathogenesis of cardiovascular diseases, including arterial hypertension, neurodegenerative diseases, sleep disorders, kidney diseases, cancer, psychiatric disorders, bone diseases, metabolic syndrome, and diabetes, among others. During aging, the intake and cutaneous synthesis of vitamin D, as well as the endogenous synthesis of melatonin are remarkably depleted, therefore, producing a state characterized by an increase of oxidative stress, inflammation, and mitochondrial dysfunction. Both molecules are involved in the homeostatic functioning of the mitochondria. Given the presence of specific receptors in the organelle, the antagonism of the renin-angiotensin-aldosterone system (RAAS), the decrease of reactive species of oxygen (ROS), in conjunction with modifications in autophagy and apoptosis, anti-inflammatory properties inter alia, mitochondria emerge as the final common target for melatonin and vitamin D. The primary purpose of this review is to elucidate the common molecular mechanisms by which vitamin D and melatonin might share a synergistic effect in the protection of proper mitochondrial functioning.

CYP2R1 and CYP27A1 genes: An in silico approach to identify the deleterious mutations, impact on structure and their differential expression in disease conditions

Mutations in CYP2R1 and CYP27A1 involved in the conversion of Cholecalciferol into Calcidiol were associated with the impaired 25-hydroxylase activity therefore affecting the Vitamin D metabolism. Hence, this study attempted to understand the influence of genetic variations at the sequence and structural level via computational approach. The non-synonymous mutations retrieved from dbSNP database were assessed for their pathogenicity, stability as well as conservancy using various computational tools. The above analysis predicted 11/260 and 35/489 non-synonymous mutations to be deleterious in CYP2R1 and CYP27A1 genes respectively. Native and mutant forms of the corresponding proteins were modeled. Further, interacting native and mutant proteins with cholecalciferol showed difference in hydrogen bonds, hydrophobic bonds and their binding affinities suggesting the possible influence of these mutations in their function. Also, expression of these genes in various disease conditions was investigated using GEO datasets which predicted that there is a differential expression in cancer and arthritis.

Effects of Drugs, Phytoestrogens, Nutrients and Probiotics on Endothelial Dysfunction in the Estrogen-Deficient State

BACKGROUND

Endothelial dysfunction is commonly present in estrogen-deficient states, e.g., after menopause. In the search for alternatives to hormone replacement therapy (HRT), treatments based on phytoestrogens or in non-hormonal mechanisms have been under evaluation.

OBJECTIVE

Here we aim to present an overview of innovative potential treatments for endothelial dysfunction in estrogen-deficient states, introducing our own preliminary data about the probiotic kefir.

METHODS

We conducted a review based on a PubMed database search for keywords of interest (Menopause, Ovariectomy, Vascular dysfunction, Hot flashes, Metformin, Statins, Phytoestrogens, Omega-3, Vitamin D, Probiotics).

RESULTS

Vascular parameters were found to be improved by both metformin and statins through pleiotropic effects, being related to a decrease in oxidative stress and restoration of the nitric oxide pathway. Phytoestrogens such as genistein and resveratrol have also been shown to improve vascular dysfunction, which seems to involve their estrogenic-like actions. Omega-3, vitamin D and its analogues, as well as probiotics, have shown similar vascular beneficial effects in both postmenopausal women and an animal model of ovariectomy (OVX), which could be related to antioxidant and/or anti-inflammatory effects. Moreover, our preliminary data on the probiotic kefir treatment in OVX rats suggested a vascular antioxidant effect. In particular, some evidence points to statins and vitamin D having anti-atherogenic effects.

CONCLUSION

Pleiotropic effects of common medications and natural compounds could have therapeutic potential for endothelial dysfunction in estrogen-deficient states. They could, therefore, work as future complementary or alternative treatments to HRT.

Evaluation of Vitamin D Fractions in Obese Hypertensive Patients

Vitamin D fractions can be involved in the pathogenesis of metabolic disorders, but their concentrations are rarely determined. The aim of this study was to evaluate the concentration of vitamin D fractions in obese hypertensive patients and to determine its associations with anthropometric parameters, glucose levels, and lipid profiles. A total of 85 obese hypertensive patients (OBHT) and 40 nonobese nonhypertensive subjects (NOBNHT) underwent biochemical measurements of lipid profiles, glycemia, 25-hydroxyvitamin D (25(OH)D), free vitamin D (free25(OH)D), vitamin D binding protein, albumin levels. Moreover, free25(OH)D and bioavailable25(OH)D (bio25(OH)D) concentrations were calculated. Blood pressure and anthropometric measurements were performed. Differences between groups (p < 0.001) were found for 25(OH)D (OBHT 40.25 ± 18.02 vs. NOBNHT 64.10 ± 22.29 nmol/L), free25(OH)D (9.77 (7.46; 11.49) vs. 13.80 (10.34; 16.82) pmol/L), bioavailable 25(OH)D (3.7 (2.8; 4.4) vs. 5.4 (4.2; 6.7) nmol/L), and calculated free25(OH)D (7.82 (5.54; 11.64) vs. 10.46(8.06;16.28) pmol/L, p = 0.002). The OBHT patients showed no relationship between vitamin D fractions concentration and glucose or lipids level, although it was associated with anthropometric parameters. In the NOBNHT group, vitamin D fractions correlated positively with HDL cholesterol and negatively with triglyceridemia and hip circumference. Vitamin D fractions were decreased in obese hypertensive subjects, and were associated with anthropometric parameters, but not with glucose level or lipid profiles; they thus cannot be considered as a predictive marker of metabolic disorders in this group of patients.

The effect of vitamin D status on ovarian reserve markers in infertile women: A prospective cross-sectional study

Background

Vitamin D deficiency and infertility are two important health problems in Iran. Some studies suggest that vitamin D may influence Anti-Müllerian hormone (AMH) and antral follicle count (AFC) as an ovarian reserve.

Objective

The present study aimed to investigate the impact of vitamin D on AMH serum concentrations/AFC.

Materials and Methods

Three hundred and five infertile women referred to the IVF Unit of Yas hospital, between July and December 2017, were enrolled in this cross-sectional study. The demographic characteristics of the participants, as well as the serum levels of vitamin D, AMH, and ultrasonic examination of AFC were recorded.

Results

Finally, 287 infertile women were included in the analysis with a mean age of 29.95 ± 4.73 yr (18-45 yr) and a mean Body mass indexof 25.11 ± 4.41 kg/m 2 . The median AMH and vitamin D levels were 3.20 and 22.82 ng/ml, respectively. Considering the cut-off level of 20 ng/ml, 58.7% were vitamin D deficient. Regression analysis showed no association between AMH and vitamin D levels (p = 0.161), even after adjusting for baseline variables (p = 0.182). A total of 120 patients had an AFC < 6 and 164 ≥ 6, which was not statistically different between the groups with normal level or deficient vitamin D (p = 0.133).

Conclusion

The present cross-sectional study showed no significant association between serum levels of vitamin D and AMH or AFC in infertile women, even after adjusting for baseline variables.

The Association of Vitamin D Status with Lipid Profile and Inflammation Biomarkers in Healthy Adolescents

Background: The association between vitamin D status and inflammatory biomarkers and lipid profile is not well known, especially in adolescents. Therefore, the aim of the current study is to investigate the association of vitamin D status with serum lipids and inflammatory biomarkers, including IL-10, IL-6, hsCRP, and TNFR-2, in male adolescents. Methods and materials: A sample of seventy-one high school male students, aged 17 years old, from a high school in Tehran were enrolled in the study. They were divided into four groups including group with serum vitamin D below 25 (ng/mL) (SVD < 25; n = 36), 25 and above (ng/mL) (SVD ≥ 25; n = 35), negative-hsCRP (n = 48), and positive-hsCRP (n = 23). Weight, height, body mass index, dietary intake, serum lipids, and inflammatory biomarkers, including IL-10, IL-6, hsCRP, and TNFR-2, were measured. Results: In the (SVD < 25) group, the serum level of TNFR-2 was significantly higher compared to that in the (SVD ≥ 25) group. There was a significant negative association between serum TNFR-2 and vitamin D levels in the whole sample. We found significant lower levels of IL-10 in positive-hsCRP group compared to the negative-hsCRP group. In addition, there was a significant negative correlation between the serum vitamin D level and hsCRP in both hsCRP groups. The HDL level was lower in the (SVD < 25) group compared to that in the (SVD ≥ 25) group. Finally, there was a negative correlation between the serum HDL and hsCRP levels in the positive-hsCRP subjects. Conclusion: Based on the findings it can be concluded that serum vitamin D affects HDL and inflammation status. Although serum levels of HDL and inflammation status are both predictors of metabolic syndrome and cardiovascular disease, further studies are needed to prove it, especially in adolescents.

The Epidemiology of Skin Cancer and Public Health Strategies for Its Prevention in Southern Africa

Skin cancer is a non-communicable disease that has been underexplored in Africa, including Southern Africa. Exposure to solar ultraviolet radiation (UVR) is an important, potentially modifiable risk factor for skin cancer. The countries which comprise Southern Africa are Botswana, Lesotho, Namibia, South Africa, and Swaziland. They differ in population size and composition and experience different levels of solar UVR. Here, the epidemiology and prevalence of skin cancer in Southern African countries are outlined. Information is provided on skin cancer prevention campaigns in these countries, and evidence sought to support recommendations for skin cancer prevention, especially for people with fair skin, or oculocutaneous albinism or HIV-AIDS who are at the greatest risk. Consideration is given to the possible impacts of climate change on skin cancer in Southern Africa and the need for adaptation and human behavioural change is emphasized.

The association between serum vitamin D level and risk and prognosis of melanoma: a systematic review and meta-analysis

BACKGROUND

Vitamin D has antineoplastic effects, but the synthesis of vitamin D requires ultraviolet radiation, a known risk factor for melanoma.

OBJECTIVE

To investigate the correlations between serum vitamin D levels and risk and prognosis of melanoma.

METHODS

A systematic review and meta-analysis were conducted. Online databases were searched on 31 Oct 2018.

RESULTS

Twenty-five studies with a total of 11166 patients with melanoma were included. There was no significant difference in serum vitamin D levels between patients with melanoma and controls [standardized mean difference (SMD), -0.185; 95% confidence interval (CI), -0.533 to 0.162]. However, the prevalence of vitamin D deficiency was significantly higher in patients with melanoma than that in controls (odds ratio, 2.115; 95% CI, 1.151-3.885). In terms of prognosis, serum vitamin D levels were significantly higher in melanoma patients with lower Breslow thickness (≦1 vs. >1 mm: SMD, 0.243; 95% CI, 0.160-0.327). Moreover, melanoma patients with lower vitamin D levels had a significantly higher mortality rate (hazard ratio, 1.558; 95% CI, 1.258-1.931).

CONCLUSIONS

Vitamin D deficiency is associated with higher Breslow thickness and mortality in melanoma patients.

Association of serum vitamin D level and nonalcoholic fatty liver disease: a meta-analysis

We aimed to explore the potential link of serum vitamin D level with nonalcoholic fatty liver disease (NAFLD). PubMed, Embase and the Cochrane Library database were searched until the end of February 2018. Clinical studies with sufficient data investigating the relationship between serum vitamin D and NAFLD were included. The outcome data were processed to make an overall estimate of combined standardized mean differences (SMD) and pooled odds ratio (OR)/hazard ratios with 95% confidence intervals (CIs). Of the 309 initially retrieved studies, 15 studies of high quality involving a total of 20 096 participants (including 7803 NAFLD patients) were included in this meta-analysis. Meta-analysis of continuous data indicated that NAFLD patients had averagely 0.90 ng/ml lower levels of 25-hydroxyvitamin D compared with the non-NAFLD subjects (SMD -0.90; 95% CI: -1.29 to -0.52). Parallelly, pooled dichotomous data revealed that serum vitamin D level is negatively associated with NAFLD (OR = 0.64, 95% CI = 0.54-0.77), albeit with substantial heterogeneity. Next, subgroup analysis showed that Western NAFLD patients were more likely to be vitamin D deficient (OR = 0.60, 95% CI = 0.46-0.78). Finally, meta-regression showed that sample size, ethnic background, and diagnosis of NAFLD were possible sources of heterogeneity in the meta-analysis. Our results revealed that serum vitamin D level was inversely associated with an increased risk of NAFLD. Patients with hypovitaminosis D might benefit from extra supplement of vitamin D against the risk of NAFLD.

Association between vitamin D deficiency and cognitive function in the elderly Korean population: A Korean frailty and aging cohort study

It is well known that vitamin D (VitD) plays an important role in bone and calcium metabolism in the human body. VitD has additional roles in the body including modulation of cell growth, neurogenesis, neuroprotection, detoxification, immune function, and reduction of inflammation. Recent studies reveal insufficiency of VitD as a risk factor for cognitive decline or dementia. VitD has a role in normal brain function; insufficiency of VitD may lead to decreased memory and cognitive function.Using 2 years of baseline data from Korean frailty and aging cohort study, 2990 subjects (1415 men and 1575 women) were recruited. A short form of Korean version of the consortium to establish a registry for Alzheimer disease (CERAD-K), an assessment of cognitive status in patients with dementia was used. Among CERAD-K tests, we included word list memory/recall/recognition, digit span (forward, backward), trail making test (TMT) A, and mini-mental state examination in the Korean version of the CERAD assessment packet (MMSE-KC). Serum samples were collected and 25-hydroxyvitamin D (25(OH)D) was measured. Serum 25(OH)D concentrations were classified into clinically relevant categories as: deficient (<10 nmol/L), insufficient (10-30 nmol/L), and sufficient (≥30 nmol/L).The mean age of participants was 76.5 ± 3.9 years, and 52.7% were women. Among 2990 participants, 119 (4.0%) were classified as 25(OH)D deficient and 2253 (75.3%) as insufficient. Only 618 (20.7%) participants were sufficient for 25(OH)D. Among them performance in MMSE-KC, TMT A, and digit span tests was better in sufficient, insufficient, and deficient groups, which was statistically significant (P < .05). However, in multivariable regression analysis after adjusting for age, sex, body mass index, education, center, seasonality, physical activity, and alcohol use, association between 25(OH)D and cognitive function was not statistically significant.Although, when comparing VitD levels, there were differences in cognitive tests among the groups, fully adjusted analysis did not show any association. This result suggests that cognition was not affected by VitD levels alone but also population and sociological variables. In a fully adjusted model, there was no statistically significant association between VitD and cognitive function in the elderly Koreans in logistic regression analysis.

Role of Dietary Nutrients in the Modulation of Gut Microbiota: A Narrative Review

Understanding how dietary nutrients modulate the gut microbiome is of great interest for the development of food products and eating patterns for combatting the global burden of non-communicable diseases. In this narrative review we assess scientific studies published from 2005 to 2019 that evaluated the effect of micro- and macro-nutrients on the composition of the gut microbiome using in vitro and in vivo models, and human clinical trials. The clinical evidence for micronutrients is less clear and generally lacking. However, preclinical evidence suggests that red wine- and tea-derived polyphenols and vitamin D can modulate potentially beneficial bacteria. Current research shows consistent clinical evidence that dietary fibers, including arabinoxylans, galacto-oligosaccharides, inulin, and oligofructose, promote a range of beneficial bacteria and suppress potentially detrimental species. The preclinical evidence suggests that both the quantity and type of fat modulate both beneficial and potentially detrimental microbes, as well as the Firmicutes/Bacteroides ratio in the gut. Clinical and preclinical studies suggest that the type and amount of proteins in the diet has substantial and differential effects on the gut microbiota. Further clinical investigation of the effect of micronutrients and macronutrients on the microbiome and metabolome is warranted, along with understanding how this influences host health.

Vitamin D and Demyelinating Diseases: Neuromyelitis Optica (NMO) and Multiple Sclerosis (MS)

Vitamin D deficiency is prevalent in all ages regardless of climate or geographical location and evidence is emerging that the incidence of autoimmune diseases is increasing worldwide. Women make up a large proportion of autoimmune disease diagnoses, underscoring the importance of fully elucidating the complex synergistic relationships between estrogens and vitamin D. Vitamin D receptor-activating drugs appear to enhance remyelination in patients diagnosed with multiple sclerosis (MS) and other demyelinating diseases such as neuromyelitis optica (NMO). This review is intended to update health practitioners about the potential role of vitamin D deficiency demyelination and to motivate future research on dietary recommendations for vitamin D in preventing and treating demyel1nating diseases.

The Relationship of Serum 25-Hydroxyvitamin-D Level with Severity of Obstructive Sleep Apnea in Patients with Type 2 Diabetes Mellitus

OBJECTIVE

To explore the association of serum vitamin-D levels with the severity of obstructive sleep apnea (OSA) in patients with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study of 136 patients with T2DM who underwent overnight polysomnography (PSG) tests and serum 25-hydroxyvitamin-D3 (25(OH)D3) level detections was conducted. Multivariable linear regression and logistic regression analyses were performed to determine the associations of serum 25(OH)D3 levels with apnea-hypopnea index (AHI) and obstructive sleep apnea (OSA).

RESULTS

The prevalence rates of OSA were 84.4% for male and 65.2% for female patients, respectively (p = 0.011). With increasing severities of OSA categories (none, mild, moderate and severe), patients were more likely to be male and obese, but there was no significant difference in serum 25(OH)D3 level ((mean ± standard deviation) 21.8 ± 8.8, 27.7 ± 14.6, 24.2 ± 9.8 and 26.8 ± 6.2 ng/mL, respectively, p=0.086). Serum 25(OH)D3 level was not significantly correlated with AHI (log-transformed), with the correlation coefficient of 0.133 (p=0.124). With adjustment for potential confounding factors, multivariable linear regression and logistic regression analyses showed that serum 25(OH)D3 level was not significantly associated with either AHI (log-transformed) or the risk of OSA, with the standardized regression coefficient (95% confidence interval (CI)) of 0.098 (-0.004-0.014, p=0.252) and the adjusted odds ratio (95% CI) of 1.055 (0.991-1.124, p=0.095), respectively.

CONCLUSION

Serum 25(OH)D3 level was not significantly associated with either AHI or the risk of OSA in patients with T2DM.

Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?

Metformin is the first-choice drug in uncomplicated type 2 diabetes (T2DM) and is effective in improving glycaemic control. It is the most widely prescribed oral antidiabetic medicine and has a good safety profile. However, there is an abundance of evidence that metformin use is associated with decreased Vitamin B12 status, though the clinical implications of this in terms of increased risk of diabetic peripheral neuropathy are debated. There is growing evidence that other B vitamins, vitamin D and magnesium may also be impacted by metformin use in addition to alterations to the composition of the microbiome, depending on the dose and duration of therapy. Patients using metformin for prolonged periods may, therefore, need initial screening with intermittent follow-up, particularly since vitamin B₁₂ deficiency has similar symptoms to diabetic neuropathy which itself affects 40-50% of patients with T2DM at some stage. Among patients with T2DM, 40% are reported to experience symptomatic gastroesophageal reflux disease (GORD), of whom 70% use oral antidiabetic medications. The most common medications used to treat GORD are proton pump inhibitors (PPIs) and antagonists of histamine selective H₂ receptors (H₂RAs), both of which independently affect vitamin B₁₂ and magnesium status. Research indicates that co-prescribing metformin with either PPIs or H₂RAs can have further deleterious effects on vitamin B₁₂ status. Vitamin B12 deficiency related to metformin and polypharmacy is likely to contribute to the symptoms of diabetic neuropathy which may frequently be under-recognised. This review explores current knowledge surrounding these issues and suggests treatment strategies such as supplementation.

Effects of vitamin D supplementation in women with polycystic ovary syndrome: a review

Increasing evidence supports the contribution of vitamin D deficiency (VDD) in metabolic disturbances among women with polycystic ovary syndrome (PCOS). This review aims to assess the associations between vitamin D levels and metabolic/endocrine dysregulations and to determine the effects of vitamin D supplementation on glucose metabolism, insulin sensitivity, lipid profile, and hormones functionality in PCOS patients. We searched in PubMed human randomized controlled trials (RCTs) published in English between 2016 and 2019 on the effects of vitamin D supplementation on PCOS. Nine studies were included and analyzed. Vitamin D supplementation restored physiological serum 25(OH)D levels in PCOS women in all the studies included. In six studies, it significantly decreased fasting plasma glucose and brought to improvements in insulin resistance (IR) and serum fasting insulin. In addition, four studies reported decreases of serum triglycerides, while discordant data are reported as far as LDL, HDL, and total cholesterol levels. High-doses of vitamin D (4000 IU), compared with low-dose (1000 IU), and placebo, showed beneficial effects on total testosterone, sex hormone-binding globulin (SHBG) and free androgen index (FAI). Vitamin D supplementation at high doses for a period of at least 12 weeks, may lead to improvement in terms of glucose level, insulin sensitivity, hyperlipidemia, and hormonal functionality in PCOS women.

Association between vitamin D plasma concentrations and VDR gene variants and the risk of premature birth

Background

Premature birth is the main cause of mortality in children under 1 year, and vitamin D deficiency during gestation is associated with prematurity. The effects of vitamin D are mediated by its receptor, which is encoded by the VDR gene. VDR variants—such as single nucleotide variation (SNV)—are associated with increased risk of prematurity, but there are conflicting results. We evaluated serum vitamin D concentrations and the frequency of TaqI/A > G, BsmI/C > T, ApaI/C > A, and FokI/A > T VDR variants in mothers and preterm (PTN) and full-term (FTN) newborns.

Methods

We conducted a case-control study comprising 40 pairs of mothers and their PTNs (gestational age < 32 weeks and/or weight < 1500 g), and 92 pairs of mothers and FTNs as controls. Genotyping was performed by real-time PCR, and plasma vitamin D concentrations were measured by electrochemiluminescence.

Results

Vitamin D levels were significantly lower in PTN mothers. Genotypes TaqI/GG and BsmI/TT, and haplotypes AAG (TaqI/A-ApaI/A-FokI/G) and GCA (TaqI/G-ApaI/C-FokI/A) were significantly more frequent in PTN mothers, and genotypes TaqI/AG, ApaI/AA, and FokI/AG resulted in significantly lower vitamin D levels. Genotypes BsmI/TT and ApaI/AA were associated with vitamin D deficiency and 2.36 and 7.99 times greater likelihood of PTB, respectively. Vitamin D levels were also lower in PTNs, although it was not statistically significant. Genotypes BsmI/TT, ApaI/AA, and FokI/GG, and haplotype GAG (TaqI/G-ApaI/A-FokI/G) were significantly more frequent in PTNs. Those with FokI/GG genotypes had significantly lower vitamin D levels.

Conclusions

VDR variants contribute to variations in vitamin D concentrations and the increased risk of prematurity.

FokI vitamin D receptor gene polymorphism and serum 25-hydroxyvitamin D in patients with cardiovascular risk

INTRODUCTION

The biological actions of vitamin D are mediated through vitamin D receptor (VDR). Numerous single-nucleotide polymorphisms (SNPs) in the VDR gene have been identified, and some have been associated with cardiovascular disease (CVD) risk factors. This study aims to evaluate the association of five SNPs in the VDR gene with 25-hydroxyvitamin D (25[OH]D) levels in patients with at least one CVD risk factor.

MATERIAL AND METHODS

Genomic DNA was sequenced using standard Sanger methods for five VDR SNPs (BsmI rs1544410; ApaI rs7975232; Cdx2 rs11568820; TaqI rs731236; FokI rs2228570) in 50 Mediterranean subjects having hypovitaminosis D with at least one documented CVD risk factor, aged 18 years or more. The collected variables were serum levels of (25[OH]D), HbA1c, fasting plasma glucose, triglycerides, LDL cholesterol, and total cholesterol.

RESULTS

BsmI, ApaI, and TaqI were moderately to highly intercorrelated. Cdx2 was less frequent than expected. With respect to the number of mutations in FokI, levels of (25 [OH]D) were 11.2 ±5.5 ng/ml in the absence of mutations, 12.6 ±4.7 ng/ml in the presence of one mutation, and 16.5 ± 5.5 ng/ml in the presence of two mutations.

CONCLUSIONS

FokI polymorphism is more frequent in subjects with cardiovascular risk factors than in the general Caucasian population.

The effect of daily consumption of different doses of fortified Lavash bread versus plain bread on serum vitamin-D status, body composition, metabolic and inflammatory biomarkers, and gut microbiota in apparently healthy adult: study protocol of a randomized clinical trial

BACKGROUND

Due to the high prevalence of vitamin-D deficiency worldwide and its health consequences, intervention studies at the community level are warranted. The present study has been conducted to evaluate the effectiveness of vitamin-D-fortified bread on serum vitamin-D levels, inflammatory and metabolic biomarkers, and gut microbiota composition in vitamin-D-deficient individuals.

METHODS/DESIGN

A double-blind, randomized controlled clinical trial is conducted on apparently healthy individuals with vitamin-D deficiency. The random allocation is done to divide participants into intervention groups including daily intake of vitamin-D-3-fortified bread (FB) with 500 IU/100 g bread (n = 30), FB with 1000 IU/100 g bread (n = 30), and 100 g plain bread (PD) (n = 30). At baseline and after 3 months of the intervention period, blood, stool, and urine samples are taken. Anthropometric measures, body composition, blood pressure, and dietary assessment are made. The gut microbiome composition is measured by the 16S rRNA approach. Data is analyzed by SPSS software version 21.

DISCUSSION

This study may partly explain for the first time the conflicting results from recent critical and systematic reviews regarding the role of vitamin D in microbiota composition.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT), ID: IRCT20170812035642N3. Registered on 11 March 2018; http://www.irct.ir/user/trial/28134/view.

Association of VDR Gene Variant (rs1544410) with Type 2 Diabetes in a Pakistani Cohort

The present study was designed to measure the mean values of body mass index (BMI), random blood sugar/ fast ing blood sugar (RBS/FBS) tests, and Hb A_1c and to investigate the role of a genetic variant rs1544410 in the VDR gene in a Pakistani cohort. For this purpose, a total of 917 samples including 469 diabetes mellitus type 2 (T2DM), 145 DM type 1 (T1DM), and 303 healthy control were collected. Out of the total sample set, 500 individuals (250 T2DM cases and 250 controls) were genotyped for rs1544410. It was found that 65 (26.0%) cases and 32 (12.8%) controls had homozygous AA, while 69 (27.6%) cases and 139 (55.6%) controls had heterozygous AG, and 116 (46.4%) cases and 79 (31.6%) controls had homozygous GG (χ² = 41.81, p = 0.0001). In addition, a similar distribution of allele frequency was determined in cases and controls [p value = 0.866; odds ratio (OR) = 0.967; relative risk (RR) = 1.034]. A significant difference was observed in homozygous dominant [OR = 2.394 (1.501-3.816); RR = 1.46 (1.225-1.740); p = 0.003] and homozygous recessive models [OR = 2.970 (2.086-4.227); RR = 1.798 (1.501-2.154); p = <0.0001] analysis of rs1544410 in the VDR gene. These findings suggest that the VDR gene is associated with T2DM and genotype GG of genetic variant rs1544410 is the susceptible genotype in our Pakistani cohort.

Study of low vitamin D among children with anorexia in Sulaymaniyah, Kurdistan region, Iraq during summer months

Objectives:

To determine the impact of vitamin D deficiency and insufficiency on the development of anorexia in children with mild malnutrition without an obvious cause.

Methods:

This cross-sectional study was conducted in Faruk Medical City, Sulaymaniyah, Kurdistan Region, Iraq, between May and September 2018. It included 39 mildly malnourished children with a poor appetite for over 3 months and 156 children who were healthy except for minor illnesses as the control group. All the children were regular attendees at the outpatient clinic and were tested for serum levels of 25-hydroxy vitamin D. We used binary logistic regression statistical analysis to measure the significance of the association between vitamin D deficiency/insufficiency and anorexia with mild malnutrition in young children.

Results:

Of the 39 children in the anorexia group, 20 had vitamin D deficiency, and the remaining 6 had vitamin D insufficiency. On the other hand, 16 of the remaining children with normal appetites, showed a vitamin D deficiency, and 38 of them displayed insufficiency. Statistically significant association between vitamin D deficiency and anorexia with malnutrition was noted (odd ratio: 9.808; 95% confidence interval: 4.089 - 23.523; p=0.0001), while it was insignificant with vitamin D insufficiency.

Conclusion:

This study displayed a noteworthy relationship between vitamin D deficiency and anorexia with mild malnutrition in young children.

Evaluation and comparison of serum vitamin D and calcium levels in periodontally healthy, chronic gingivitis and chronic periodontitis in patients with and without diabetes mellitus - a cross-sectional study

Objective: Limited data are available with respect to the relation of vitamin D and calcium with periodontal infections and type-2 diabetes mellitus (T2DM). The aim of this cross-sectional study was to evaluate the levels of vitamin D and calcium in serum of periodontally healthy, chronic gingivitis and chronic periodontitis patients with and without T2DM. Material and methods: The study evaluated 100 patients equally divided into five groups (Group I to Group V) according to the inclusion criteria. Clinical parameters and serum 25-hydroxyvitamin D level were assessed. Other laboratory investigations comprised of random blood sugar, glycated haemoglobin and serum calcium. Results: The probing pocket depth and clinical attachment loss were found to be greater in chronic periodontitis and chronic periodontitis with diabetes mellitus, while the vitamin D and calcium levels were found to be least in these groups. When vitamin D and calcium levels were compared between periodontal disease with diabetes to that of non-diabetics, statistically significant difference were found between the two with p-value of .001 indicating decrease in levels of vitamin D and calcium with increase in RBS and HbA1c values. Conclusion: Vitamin D and calcium levels are inversely correlated with random blood sugar and glycated haemoglobin and also probing pocket depth and clinical attachment loss, thus contributing towards increase in periodontal disease severity.

Correlation of 25-hydroxy vitamin D level with neonatal hyperbilirubinemia in term healthy newborn: A prospective hospital-based observation study

Background

Neonatal hyperbilirubinemia is one of the common entities that lead to frequent hospital admission of newborn. There are many risk factors that, when present, can lead to increased chances of neonatal hyperbilirubinemia. It is essential to identify these risk factors that are involved in the increased incidence of neonatal hyperbilirubinemia because its incidence can be decreased by modifying them.

Objective

To compare and determine any correlation of 25-hydroxy vitamin D levels of newborn and their mothers with the serum bilirubin level of newborn.

Methodology

This was a case–control study conducted in a tertiary care hospital on 100 newborn who were divided into two groups (50 in each group) on the basis of their serum bilirubin level on the 5th day of life. Newborns having serum bilirubin levels in the physiological range were included in the control group, and newborns having serum bilirubin levels out of the physiological range and who needed treatment were included in the case group. The blood samples of both newborns and their mothers were collected on the 5th day and sent to the laboratory for serum bilirubin and 25-hydroxy vitamin D estimation.

Results

The mean serum vitamin D level of cases was found to be lower than that of controls in both newborn and their mothers. A statistically significant difference was noted only between the vitamin D level of newborn but not in mothers when cases and controls were compared. Negative, statistically insignificant correlation was seen between vitamin D level and serum bilirubin in cases and controls. However, correlation of the vitamin D level of cases and their serum bilirubin was statistically significant, with a correlation coefficient of −0.335 and a p value of 0.0172.

Conclusion

Term healthy newborn having hyperbilirubinemia, with serum bilirubin levels out of the physiological range, have significantly low vitamin D levels and show a statistically negatively correlation with neonatal hyperbilirubinemia (which is out of the physiological range). Thus, decreased vitamin D can be included in the list of risk factors for neonatal jaundice.

Involvement of Vitamin D in Chronic Infections of the Waldeyer`s Ring in the School Aged Child

Chronic infections of the Waldeyer`s lymphatic ring constitute a frequent pathology in school age, one of the pathogenic mechanisms involving low levels of vitamin D. In this study, we analyzed integrated the clinico-epidemiological aspects, the risk factors and the serum level of vitamin D for 51 school aged children who presented chronic inflammation in various levels of the Waldeyer`s ring. Most inflammations were present in females patients (80.4%), from the urban areas (66.6%), being localized in palatine tonsils (64.7%), in patients with deficient prophylaxis of hypovitaminosis D (68.6%) and low serum levels of vitamin D (72.5%). The results highlight the importance of maintaining a normal status of vitamin D, especially in recurrent infectious context.

Vitamin D and alopecia areata: possible roles in pathogenesis and potential implications for therapy

Alopecia areata is characterized by the loss of hair on the scalp and elsewhere on the body. It affects approximately 2% of the general population. It is believed to be an autoimmune disease. However, its pathogenesis remains incompletely understood. Recent studies have revealed a substantial link between vitamin D and alopecia areata. But the underlying mechanism still yet to be deciphered. This article reviews the current literature and discusses the possible roles of vitamin D in the pathogenesis of alopecia areata in the context of (1) loss of immune privilege in hair follicle, (2) autoreactive effector T cells and mast cells, (3) nature killer group 2 member d-positive cytotoxic T cells, (4) Janus kinase/signal transducers and activators of transcriptional signaling pathway, (5) regulatory T cells, (6) immune checkpoints, and (7) oxidative stress, which are believed to play important roles in autoimmunity in AA. This paper provides new insights into research directions to elucidate the exact mechanisms of vitamin D in the pathogenesis. Calcipotriol, a vitamin D analog, has been reported to be topically used in treating alopecia areata with promising results. Combination therapy of vitamin D analogs with corticosteroids might also be used in treating alopecia areata.

Micronutrient Adequacy in Preschool Children Attending Family Child Care Homes

Limited data is available on the micronutrient intake and adequacy in preschool children enrolled in family child care homes (FCCH). The goal of this paper is to describe the micronutrient adequacy relative to age-specific recommendations of preschool-aged children (aged 2-5 years) attending FCCH in Rhode Island (RI). Dietary data among younger preschoolers (aged 2-3 years), n = 245) and older preschoolers (aged 4-5 years), n = 121) in 118 RI FCCH (N = 366 children) were analyzed. Nutrient adequacy was assessed as the amount of nutrient per 1000 kcal of the diet that would meet the Institute of Medicine nutrient requirements (critical nutrient density), and it was compared to the observed nutrient densities of the children. The sodium:potassium ratio was also calculated. For most micronutrients, the observed density met or exceeded the recommendation, meaning the children's intake was adequate. However, a high proportion of children had nutrient densities under the recommendation for vitamins D, E, K, and potassium (86.1%, 89.1%, 70.8%, and 99.2% of children, respectively). The mean vitamin B12, potassium, and zinc densities were statistically higher in younger vs. older preschoolers (p < 0.05 for all). Low densities in calcium and vitamins K and B5 were more frequent in older children vs. younger children (p < 0.05). In addition, older preschoolers had a higher sodium:potassium ratio than younger children (p < 0.05). The micronutrient intake density was adequate for most nutrients. However, intake of some nutrients was of concern. Further attention to training and compliance in FCCH may improve the diet quality of those cared for in these settings.

Rickets treatment improves more than bone health in toddler with autism spectrum disorder: A brief report

Children with autism spectrum disorder have been found to have lower levels of vitamin D than their peers. Our case report supports the hypothesis that vitamin D may be an effective treatment for developmental delay in autism. In addition, we review the literature surrounding vitamin D deficiency as a potential cause of autism spectrum disorder and the role that vitamin D may play in treatment.