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Hassan-Smith ZK, Hewison M, Gittoes NJ. Effect of vitamin D deficiency in developed countries. Br Med Bull 2017; 122:79-89. [PMID: 28334220 DOI: 10.1093/bmb/ldx005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 02/10/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Vitamin D deficiency is common worldwide with adverse effects on skeletal health. In recent years, there has been great interest in non-classical actions of vitamin D. Basic research has uncovered actions in a range of non-skeletal tissues, and observational studies have identified inverse relationships with risk of a number of disease states including sarcopenia, obesity, the metabolic syndrome, cardiovascular disease, cancer and autoimmune diseases. SOURCES OF DATA PubMed, Medline and Cochrane Systematic Reviews. AREAS OF AGREEMENT Current evidence supports the use of vitamin D supplementation in deficiency to improve skeletal outcomes such as falls/fracture risk and bone mineral density. AREAS OF CONTROVERSY There is debate reflected in guidelines on optimal thresholds for circulating levels of vitamin D. Further studies are required to refine dosing regimens and treatment target levels of vitamin D. GROWING POINTS A number of studies have investigated the extra-skeletal effects of vitamin D deficiency but causality in humans has yet to be confirmed. AREAS TIMELY FOR DEVELOPING RESEARCH Large-scale randomized controlled trials incorporating data on vitamin D status at baseline and follow up, adverse events, and comparison of dosing regimens are required. It is imperative that studies are carried out with a diverse range of participants (age, gender and ethnicity), and settings to allow for a more individualized approach. In addition, we would advocate incorporating cutting-edge research tools into human studies to advance our understanding of the mechanisms of vitamin D action in extra-skeletal disease. This may involve multi-metabolite analysis of vitamin D metabolites, or unbiased approaches to assess regulation of gene/protein expression in tissues of interest.
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Affiliation(s)
- Zaki K Hassan-Smith
- Department of Endocrinology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Martin Hewison
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Neil J Gittoes
- Department of Endocrinology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
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202
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The future for long chain n-3 PUFA in the prevention of coronary heart disease: do we need to target non-fish-eaters? Proc Nutr Soc 2017; 76:408-418. [PMID: 28508737 DOI: 10.1017/s0029665117000428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dietary guidelines in many countries include a recommendation to consume oily fish, mainly on the basis of evidence from prospective cohort studies that fish consumption is cardioprotective. However, average intakes are very low in a large proportion of the UK population. Some groups, such as vegans and vegetarians, purposely omit fish (along with meat) from their diet resulting in zero or trace intakes of long chain (LC) n-3 PUFA. Although the efficacy of dietary fish oil supplementation in the prevention of CVD has been questioned in recent years, the balance of evidence indicates that LC n-3 PUFA exert systemic pleiotropic effects through their influence on gene expression, cell signalling, membrane fluidity and by conversion to specialised proresolving mediators; autacoid lipid mediators that resolve inflammatory events. The long-term impact of reduced tissue LC n-3 PUFA content on cardiovascular health is surprisingly poorly understood, particularly with regard to how low proportions of LC n-3 PUFA in cell membranes may affect cardiac electrophysiology and chronic inflammation. Randomised controlled trials investigating effects of supplementation on prevention of CHD in populations with low basal LC n-3 PUFA tissue status are lacking, and so the clinical benefits of supplementing non-fish-eating groups with vegetarian sources of LC n-3 PUFA remain to be determined. Refocusing dietary LC n-3 PUFA intervention studies towards those individuals with a low LC n-3 PUFA tissue status may go some way towards reconciling results from randomised controlled trials with the epidemiological evidence.
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203
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Umehara K, Mukai N, Hata J, Hirakawa Y, Ohara T, Yoshida D, Kishimoto H, Kitazono T, Hoka S, Kiyohara Y, Ninomiya T. Association Between Serum Vitamin D and All-Cause and Cause-Specific Death in a General Japanese Population - The Hisayama Study. Circ J 2017; 81:1315-1321. [PMID: 28428487 DOI: 10.1253/circj.cj-16-0954] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few studies have investigated the association between serum vitamin D levels and mortality in general Asian populations.Methods and Results:We examined the association of serum 1,25-dihydroxyvitamin D (1,25(OH)2D) levels with the risk of all-cause and cause-specific death in an average 9.5-year follow-up study of 3,292 community-dwelling Japanese subjects aged ≥40 years (2002-2012). The multivariable-adjusted hazard ratio (HR) for all-cause death increased significantly with lower serum 1,25(OH)2D levels (HR 1.54 [95% confidence interval, 1.18-2.01] for the lowest quartile, 1.31 [0.99-1.73] for the 2nd quartile, 0.94 [0.70-1.25] for the 3rd quartile, 1.00 [Ref.] for highest quartile; P for trend <0.001). A similar association was observed for cardiovascular and respiratory infection death (both P for trend <0.01), but not for cancer death or death from other causes. In the stratified analysis, the association between lower serum 1,25(OH)2D levels and the risk of respiratory infection death was stronger in subjects with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2than in those with eGFR ≥60 mL/min/1.73 m2; there was a significant heterogeneity in the association between eGFR levels (P for heterogeneity=0.04). CONCLUSIONS The findings suggested that a lower serum 1,25(OH)2D level is a potential risk factor for all-cause death, especially cardiovascular and respiratory infection death, in the general Japanese population, and that lower serum 1,25(OH)2D levels greatly increase the risk of respiratory infection death in subjects with kidney dysfunction.
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Affiliation(s)
- Kaoru Umehara
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Naoko Mukai
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Tomoyuki Ohara
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University
| | - Daigo Yoshida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Hiro Kishimoto
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Sumio Hoka
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
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204
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Herly M, Stengaard-Pedersen K, Hørslev-Petersen K, Hetland ML, Østergaard M, Christensen R, Løgstrup BB, Vestergaard P, Pødenphant J, Junker P, Ellingsen T. Association between baseline vitamin D metabolite levels and long-term cardiovascular events in patients with rheumatoid arthritis from the CIMESTRA trial: protocol for a cohort study with patient-record evaluated outcomes. BMJ Open 2017; 7:e014816. [PMID: 28391237 PMCID: PMC5541299 DOI: 10.1136/bmjopen-2016-014816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Cardiovascular morbidity and mortality is increased in patients with rheumatoid arthritis (RA), and among these patients, the prevalence of hypovitaminosis D is high. Moreover, low vitamin D levels have been associated with increased cardiovascular risk in healthy subjects. OBJECTIVE To evaluate the long-term risk of cardiovascular events in patients having low total 25-hydroxyvitamin D levels at baseline compared with patients with normal levels, in an efficiently treated, closed cohort of patients with an early diagnosis of RA. METHODS AND ANALYSIS This study is a prospective, closed, blinded endpoint cohort study, based on secondary analyses from a previous randomised trial (CIMESTRA study; NCT00209859, approved September 1999) including 160 patients with an early diagnosis of RA from Danish University clinics. Primary outcome will be the proportion of patients with any cardiovascular event in the follow-up period, evaluated using systematic journal audits. Logistic regression models will test the hypothesis that there are more cardiovascular events in enrolled patients with a low level of vitamin D (< 50 nmol/L). Secondarily, Cox regression models, based on survival analysis, will determine the extent to which independent variables (including different levels of vitamin D at baseline) predict whether a cardiovascular event will occur, and also when this will be. ETHICS AND DISSEMINATION All patients have received verbal and written information before enrolment, and have given written consent at baseline. To disseminate comprehension of factors of prognostic importance to cardiovascular outcome in RA, we will attempt to have a first draft ready no later than 1 year after the adjudication process has finished. If low vitamin D levels can predict cardiovascular events in RA, it is relevant to take into account in a prediction model, to be considered by patients, physicians and other decision-makers. TRIAL REGISTRATION NUMBER The parental controlled trial is registered as NCT00209859.
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Affiliation(s)
- M Herly
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - K Stengaard-Pedersen
- Department of Rheumatology, Centre of Cancer and Inflammation, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - K Hørslev-Petersen
- King Christian 10th Hospital for Rheumatic Diseases, Southern University of Denmark, Graasten, Denmark
| | - M L Hetland
- Department of Rheumatology, COPECARE, Copenhagen University Hospital, Glostrup, Denmark
| | - M Østergaard
- Department of Rheumatology, COPECARE, Copenhagen University Hospital, Glostrup, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - B B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - P Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University, Denmark
| | - J Pødenphant
- Department of Rheumatology, Copenhagen University Hospital, Gentofte, Denmark
| | - P Junker
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - T Ellingsen
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Onozuka D, Hagihara A. Out-of-hospital cardiac arrest attributable to sunshine: a nationwide, retrospective, observational study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:107-113. [PMID: 28927170 DOI: 10.1093/ehjqcco/qcw056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/02/2016] [Indexed: 11/15/2022]
Abstract
Aims To investigate the population attributable risk of out-of-hospital cardiac arrest (OHCA) from non-optimal sunshine duration and the relative contribution of daily sunshine hours. Methods and Results National registry data of all cases of OHCA occurred between 2005 and 2014 in the 47 Japanese prefectures were obtained. We examined the relationship between daily duration of sunshine and OHCA risk for each prefecture in Japan using a Poisson regression model combined with a distributed lag non-linear model, adjusting for confounding factors. The estimated associations for each prefecture were pooled at the nationwide level using a multivariate random-effects meta-analysis. A total of 658 742 cases of OHCA of presumed cardiac origin met our inclusion criteria. The minimum morbidity sunshine duration varied from the 21st percentile in Okayama to the 99th percentile in Hokkaido, Gifu, and Hyogo. Overall, 5.78% [95% empirical confidence interval (eCI): 3.57-7.16] of the OHCA cases were attributable to daily sunshine duration. The attributable fraction for short sunshine duration (below the minimum morbidity sunshine duration) was 4.18% (95% eCI: 2.64-5.38), whereas that for long sunshine duration (above the minimum morbidity sunshine duration) was 1.59% (95% eCI: 0.81-2.21). Conclusions Daily sunshine duration was responsible for OHCA burden, and a greater number of OHCA cases occurred in patients who were only exposed to sunshine for short periods of time each day. Our findings suggest that public health efforts to reduce OHCA burden should take sunshine level into account.
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206
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Putzu A, Belletti A, Cassina T, Clivio S, Monti G, Zangrillo A, Landoni G. Vitamin D and outcomes in adult critically ill patients. A systematic review and meta-analysis of randomized trials. J Crit Care 2017; 38:109-114. [DOI: 10.1016/j.jcrc.2016.10.029] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/23/2016] [Accepted: 10/30/2016] [Indexed: 12/31/2022]
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Prevalence and Determinants of Suboptimal Vitamin D Levels in a Multiethnic Asian Population. Nutrients 2017; 9:nu9030313. [PMID: 28327512 PMCID: PMC5372976 DOI: 10.3390/nu9030313] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/02/2022] Open
Abstract
This population-based cross-sectional study examined the prevalence and risk factors of suboptimal vitamin D levels (assessed using circulating 25-hydroxycholecalciferol (25(OH)D)) in a multi-ethnic sample of Asian adults. Plasma 25(OH)D concentration of 1139 Chinese, Malay and Indians (40–80 years) were stratified into normal (≥30 ng/mL), and suboptimal (including insufficiency and deficiency, <30 ng/mL) based on the 2011 Endocrine Society Clinical Practice Guidelines. Logistic regression models were used to assess the associations of demographic, lifestyle and clinical risk factors with the outcome. Of the 1139 participants, 25(OH)D concentration was suboptimal in 76.1%. In multivariable models, age ≤65 years (compared to age >65 years), Malay and Indian ethnicities (compared to Chinese ethnicity), and higher body mass index, HbA1c, education and income levels were associated with suboptimal 25(OH)D concentration (p < 0.05). In a population-based sample of Asian adults, approximately 75% had suboptimal 25(OH)D concentration. Targeted interventions and stricter reinforcements of existing guidelines for vitamin D supplementation are needed for groups at risk of vitamin D insufficiency/deficiency.
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208
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Aljefree NM, Lee P, Ahmed F. Knowledge and attitudes about vitamin D, and behaviors related to vitamin D in adults with and without coronary heart disease in Saudi Arabia. BMC Public Health 2017; 17:266. [PMID: 28302087 PMCID: PMC5356251 DOI: 10.1186/s12889-017-4183-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/09/2017] [Indexed: 12/14/2022] Open
Abstract
Background Vitamin D deficiency is prevailing in Saudi Arabia. Recent national data indicated an inverse association between vitamin D status and coronary heart disease (CHD), which increases concerns about vitamin D deficiency as a serious public health problem. Therefore, the current study aimed to investigate whether knowledge, attitudes and behaviors related to vitamin D contribute to the prevalence of vitamin D deficiency among adults with and without CHD in Saudi Arabia. Methods This case-control study consisted of 130 CHD cases and 195 matched controls. The study subjects were recruited from three hospitals in Saudi Arabia. Structured interviews were completed to collect data on participants’ socio-demographics, knowledge about vitamin D, attitudes toward sun exposure, and behaviors related to vitamin D. Also, serum vitamin D levels were measured. Results Severe vitamin D deficiency [serum 25(OH)D < 10 ng/mL] was more prevalent in the CHD cases than in the controls (46% and 3%, respectively). The total knowledge score was higher in the controls than in the cases [2.5 (±1.8) and 1.6 (±2.2), respectively]. The cases had better attitudes toward sun exposure compared to the controls (p = 0.001); however, the controls had better attitudes toward vitamin D compared to the cases (p = 0.001). The controls had a higher consumption of multivitamin supplements than the cases (6.7% and 0.8%, respectively; p = 0.010). Similarly, the controls had a higher consumption of butter (p = 0.001), oily fish (p = 0.004), and liver (p = 0.003) than the cases; however, the cases had a significantly higher intake of milk (p = 0.001). A multivariate logistic regression showed that vitamin D deficiency [25(OH)D < 20 ng/mL] was associated with low levels of knowledge about vitamin D, with an odds ratio of 1.82 (95% CI: 1.08–3.06, P = 0.024). Vitamin D deficiency was also associated with low intake of vitamin supplements, with an odds ratio of 4.35 (95% CI: 2.12–8.92, P < 0.001). Conclusion The present study revealed that low levels of knowledge about vitamin D and low consumption of vitamin supplementation, including vitamin D, calcium, multivitamin, and calcium supplements with vitamin D, may have contributed to the higher prevalence of vitamin D deficiency among the CHD cases than among the controls. Further studies using a qualitative approach are crucial to explore the underlying reasons for low knowledge about vitamin D and behaviors related to vitamin D including the intake of vitamin supplementation that may contribute to the high burden of vitamin D deficiency in the country. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4183-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Najlaa M Aljefree
- Public Health, School of Medicine and Menzies Health Institute Queensland, Griffith University, Building G01, Room 3.30, Gold Coast campus, Gold Coast, QLD, 4222, Australia.
| | - Patricia Lee
- Public Health, School of Medicine and Menzies Health Institute Queensland, Griffith University, Building G01, Room 3.30, Gold Coast campus, Gold Coast, QLD, 4222, Australia.,Department of Medical Research, China Medical University Hospital, China Medical University, Taiwan, Taiwan
| | - Faruk Ahmed
- Public Health, School of Medicine and Menzies Health Institute Queensland, Griffith University, Building G01, Room 3.30, Gold Coast campus, Gold Coast, QLD, 4222, Australia
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209
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Yao S, Kwan ML, Ergas IJ, Roh JM, Cheng TYD, Hong CC, McCann SE, Tang L, Davis W, Liu S, Quesenberry CP, Lee MM, Ambrosone CB, Kushi LH. Association of Serum Level of Vitamin D at Diagnosis With Breast Cancer Survival: A Case-Cohort Analysis in the Pathways Study. JAMA Oncol 2017; 3:351-357. [PMID: 27832250 DOI: 10.1001/jamaoncol.2016.4188] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance There are long-standing interests in the potential benefits of vitamin D for preventing breast cancer recurrence and mortality, yet data from prospective cohort studies are limited. Objective To investigate a serum biomarker of vitamin D status, 25-hydroxyvitamin D (25OHD) measured at the time of breast cancer diagnosis, to determine the association with prognosis. Design, Setting, and Participants The Pathways Study is a prospective cohort study of breast cancer survivors established in 2006. Enrollment was completed in 2013; follow-up is ongoing. The cohort was established in Kaiser Permanente Northern California, a large integrated health care delivery system in northern California. Women with a diagnosis of incident invasive breast cancer were typically consented and enrolled within 2 months of diagnosis. The overall enrollment rate was 46% (4505 of 9820). Participants are followed for health outcomes and comorbidities at 12, 24, 48, 72, and 96 months after baseline interview. A case-cohort design was used for efficiency assay of 25OHD, selecting 1666 cohort members with serum samples and ensuring representation in the subcohort of races and clinical subtypes. The data analysis was performed from January 5, 2014, to March 15, 2015. Main Outcomes and Measures Primary outcomes are breast cancer recurrence, second primary cancer, and death. Results Mean (SD) age was 58.7 (12.4) years. Serum 25OHD concentrations were lower in women with advanced-stage tumors, and the lowest in premenopausal women with triple-negative cancer. Levels were also inversely associated with hazards of disease progression and death. Compared with the lowest tertile, women with the highest tertile of 25OHD levels had superior overall survival (OS). This association remained after adjustment for clinical prognostic factors (hazard ratio [HR], 0.72; 95% CI, 0.54-0.98). Among premenopausal women, the association with OS was stronger, and there were also associations with breast cancer-specific survival and invasive disease-free survival (OS: HR, 0.45; 95% CI, 0.21-0.96; breast cancer-specific survival: HR, 0.37; 95% CI, 0.15-0.93; invasive disease-free survival: HR, 0.58; 95% CI, 0.34-1.01; all after full adjustment). Conclusions and Relevance Serum 25OHD levels were independently associated with breast cancer prognostic characteristics and patient prognosis, most prominently among premenopausal women. Our findings from a large, well-characterized prospective cohort provide compelling observational evidence on associations of vitamin D with lower risk of breast cancer morbidity and mortality.
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Affiliation(s)
- Song Yao
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Ting-Yuan David Cheng
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Susan E McCann
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Warren Davis
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Song Liu
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York
| | | | - Marion M Lee
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland
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210
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2016 European Guidelines on cardiovascular disease prevention in clinical practice. Int J Behav Med 2017; 24:321-419. [DOI: 10.1007/s12529-016-9583-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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211
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Onozuka D, Hagihara A. Within-summer variation in out-of-hospital cardiac arrest due to extremely long sunshine duration. Int J Cardiol 2017; 231:120-124. [DOI: 10.1016/j.ijcard.2016.12.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/18/2016] [Accepted: 12/21/2016] [Indexed: 12/30/2022]
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212
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Bandera Merchan B, Morcillo S, Martin-Nuñez G, Tinahones FJ, Macías-González M. The role of vitamin D and VDR in carcinogenesis: Through epidemiology and basic sciences. J Steroid Biochem Mol Biol 2017; 167:203-218. [PMID: 27913313 DOI: 10.1016/j.jsbmb.2016.11.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Abstract
In the last two decades vitamin D (VD) research has demonstrated new extraskeletal actions of this pre-hormone, suggesting a protective role of this secosteroid in the onset, progression and prognosis of several chronic noncommunicable diseases, such as cardiovascular disease, diabetes mellitus or cancer. Regarding carcinogenesis, both preclinical and epidemiological evidence available show oncoprotective actions of VD and its receptor, the VDR. However, in late neoplastic stages the VD system (VDS) seems to be less functional, which appears to be due to an epigenetic silencing of the system. In preclinical experimental studies, VD presents oncoprotective actions through modulation of inflammation, cell proliferation, cell differentiation, angiogenesis, invasive and metastatic potential, apoptosis, miRNA expression regulation and modulation of the Hedgehog signalling pathway. Moreover, epidemiological evidence points towards an oncoprotective role of vitamin D and VDR in colorectal cancer. This association is more controversial with breast, ovarian and prostate cancers, although with a few adverse effects. Nonetheless, we should consider other factors to determine the benefit of increased serum concentration of VD. Much of the epidemiological evidence is still inconclusive, and we will have to wait for new, better-designed ongoing RCTs and their results to discern the real effect of vitamin D in cancer risk reduction and therapy. The objective of this literature review is to offer an up-to-date analysis of the role of the VD and VDR, in the onset, progression and prognosis of all types of cancer. We further discuss the available literature and suggest new hypotheses and future challenges in the field of VD research.
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Affiliation(s)
- Borja Bandera Merchan
- Unidad de Gestiòn Clìnica y Endocrinologìa y Nutriciòn, Instituto de Investigaciòn Biomèdica de Màlaga (IBIMA),Complejo Hospitalario de Màlaga (Virgen de la Victoria), Universidad de Màlaga, 29010 Malaga, Spain
| | - Sonsoles Morcillo
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03),Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Gracia Martin-Nuñez
- Unidad de Gestiòn Clìnica y Endocrinologìa y Nutriciòn, Instituto de Investigaciòn Biomèdica de Màlaga (IBIMA),Complejo Hospitalario de Màlaga (Virgen de la Victoria), Universidad de Màlaga, 29010 Malaga, Spain
| | - Francisco José Tinahones
- Unidad de Gestiòn Clìnica y Endocrinologìa y Nutriciòn, Instituto de Investigaciòn Biomèdica de Màlaga (IBIMA),Complejo Hospitalario de Màlaga (Virgen de la Victoria), Universidad de Màlaga, 29010 Malaga, Spain; CIBER Pathophysiology of Obesity and Nutrition (CB06/03),Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Manuel Macías-González
- Unidad de Gestiòn Clìnica y Endocrinologìa y Nutriciòn, Instituto de Investigaciòn Biomèdica de Màlaga (IBIMA),Complejo Hospitalario de Màlaga (Virgen de la Victoria), Universidad de Màlaga, 29010 Malaga, Spain; CIBER Pathophysiology of Obesity and Nutrition (CB06/03),Instituto Salud Carlos III, 28029 Madrid, Spain.
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Cartier JL, Kukreja SC, Barengolts E. LOWER SERUM 25-HYDROXYVITAMIN D IS ASSOCIATED WITH OBESITY BUT NOT COMMON CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY OF AFRICAN AMERICAN AND CAUCASIAN MALE VETERANS. Endocr Pract 2017; 23:271-278. [PMID: 27849379 DOI: 10.4158/ep161456.or] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The study examined whether vitamin D insufficiency is a predictor of prevalent and/or incident common chronic conditions in African American men (AAM) and Caucasian American men (CAM). METHODS A total of 1,017 men were recruited at an urban VA medical center and followed prospectively for a mean of 5.4 years. Prevalent and incident chronic conditions evaluated were: obesity, type 2 diabetes, cancer, depression, dementia, and cardiovascular disease (CVD, including coronary artery disease [CAD], cerebrovascular accident [CVA], and congestive heart failure [CHF]). Univariate and multivariate regressions were performed to examine the association between 25-hydroxyvitamin D (25[OH]D) and these chronic illnesses. RESULTS This analysis was limited to 955 men (65.5% AAM, 27.2% CAM, 6.4% Hispanic) who had at least 1 year of follow-up (range, 1.0 to 7.1 years). Univariate analysis of the entire group showed that 25(OH)D correlated negatively with body mass index (BMI). There was no correlation between 25(OH)D and prevalent CVD (including separate analyses for CAD, CVA, and CHF), cancer, depression, dementia, all-cause mortality, or incident cancer, CAD, or CVA. Independent predictors of prevalent common conditions included increasing age, BMI, smoking, alcohol and polysubstance use, but not 25(OH)D levels. CONCLUSION The study does not support previously suggested associations of low vitamin D levels with prevalent common chronic conditions or increased risk for cancer, CAD, and CVA in a population of men with high burden of chronic disease. The finding that smoking and alcohol and polysubstance use are predictors of chronic conditions is an important reminder for addressing these risks during patient encounters. ABBREVIATIONS AAM = African American men BMI = body mass index CAD = coronary artery disease CAM = Caucasian American men CHF = congestive heart failure CI = confidence interval CVA = cerebrovascular accident CVD = cardiovascular disease HTN = hypertension OR = odds ratio T2DM = type 2 diabetes mellitus VAMC = Veteran Administration Medical Center 25(OH)D = 25-hydroxyvitamin D.
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Samefors M, Scragg R, Länne T, Nyström FH, Östgren CJ. Association between serum 25(OH)D 3 and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study. Diabet Med 2017; 34:372-379. [PMID: 27862247 DOI: 10.1111/dme.13290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 01/28/2023]
Abstract
AIM We aimed to explore the association between vitamin D and cardiovascular morbidity and mortality in people with Type 2 diabetes recruited from a community-based study because there is limited and inconsistent research of this group. METHODS A prospective community-based cohort study among people aged 55-66 years with Type 2 diabetes as part of The Cardiovascular Risk in Type 2 Diabetes - A Prospective Study in Primary Care (CARDIPP). We analysed serum 25-hydroxyvitamin D3 [25(OH)D3 ] at baseline. Cox regression analyses were used to calculate hazard ratios (HR) for the first myocardial infarction, stroke or cardiovascular mortality according to 25(OH)D3 . RESULTS We examined 698 people with a mean follow-up of 7.3 years. Serum 25(OH)D3 was inversely associated with the risk of cardiovascular morbidity and mortality: HR 0.98 [95% confidence interval (CI) 0.96 to 0.99, P = 0.001]. Compared with the fourth quartile (Q4) [25(OH)D3 > 61.8 nmol/l], HR (with 95% CI) was 3.46 (1.60 to 7.47) in Q1 [25(OH)D3 < 35.5 nmol/l] (P = 0.002); 2.26 (1.01 to 5.06) in Q2 [25(OH)D3 35.5-47.5 nmol/l] (P = 0.047); and 1.62 (0.70 to 3.76) in Q3 [25(OH)D3 47.5-61.8 nmol/l] (P = 0.26) when adjusting for age, sex and season. The results remained significant after adjusting also for cardiovascular risk factors, physiological variables including parathyroid hormone and previous cardiovascular disease (P = 0.027). CONCLUSIONS Low 25(OH)D3 is associated with an increased risk of cardiovascular morbidity and mortality in people with Type 2 diabetes independent of parathyroid hormone. Vitamin D could be considered as a prognostic factor. Future studies are needed to explore whether vitamin D deficiency is a modifiable risk factor in Type 2 diabetes.
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Affiliation(s)
- M Samefors
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - R Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - T Länne
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - F H Nyström
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - C J Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Vallet-Regí M, Manzano M, Rodriguez-Mañas L, Checa López M, Aapro M, Balducci L. Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions. Oncologist 2017; 22:335-342. [PMID: 28220025 DOI: 10.1634/theoncologist.2016-0276] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/12/2016] [Indexed: 01/21/2023] Open
Abstract
The management of cancer in older aged people is becoming a common problem due to the aging of the population. There are many variables determining the complex situation that are interconnected. Some of them can be assessed, such as risk of mortality and risk of treatment complications, but many others are still unknown, such as the course of disease, the host-related factors that influence cancer aggressiveness, and the phenotype heralding risk of permanent treatment-related damage.This article presents a dynamic and personalized approach to older people with cancer based on our experience on aging, cancer, and their biological interactions. Also, novel treatments and management approaches to older individuals, based on their functional age and their social and emotional needs, are thoughtfully explored here. The Oncologist 2017;22:335-342 IMPLICATIONS FOR PRACTICE: The goal of this article is to suggest a practical approach to complexity, a clinical situation becoming increasingly common with the aging of the population. Beginning with the analysis of two clinical cases, the authors offer an algorithm for approaching cancer in the older person that involves the assessment of life expectancy without cancer, the risk that cancer might compromise a patient's survival, function, or quality of life, and the potential benefits and risks of the treatments based on a clinical evaluation. The authors then review possible laboratory assessment of functional age and the importance of rapid-learning databases in the study of cancer and age.
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Affiliation(s)
- María Vallet-Regí
- Departamento de Química Inorgánica y Bioinorgánica, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital, 12 de Octubre i+12, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Miguel Manzano
- Departamento de Química Inorgánica y Bioinorgánica, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital, 12 de Octubre i+12, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | | | - Marta Checa López
- Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Madrid, Spain
| | - Matti Aapro
- Breast Center, IMO Clinique de Genolier, Genolier, Switzerland
| | - Lodovico Balducci
- University of South Florida, College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Senior Adult Oncology Program, Tampa, Florida, USA
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Gaksch M, Jorde R, Grimnes G, Joakimsen R, Schirmer H, Wilsgaard T, Mathiesen EB, Njølstad I, Løchen ML, März W, Kleber ME, Tomaschitz A, Grübler M, Eiriksdottir G, Gudmundsson EF, Harris TB, Cotch MF, Aspelund T, Gudnason V, Rutters F, Beulens JWJ, van ‘t Riet E, Nijpels G, Dekker JM, Grove-Laugesen D, Rejnmark L, Busch MA, Mensink GBM, Scheidt-Nave C, Thamm M, Swart KMA, Brouwer IA, Lips P, van Schoor NM, Sempos CT, Durazo-Arvizu RA, Škrabáková Z, Dowling KG, Cashman KD, Kiely M, Pilz S. Vitamin D and mortality: Individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS One 2017; 12:e0170791. [PMID: 28207791 PMCID: PMC5312926 DOI: 10.1371/journal.pone.0170791] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/16/2016] [Indexed: 01/15/2023] Open
Abstract
Background Vitamin D deficiency may be a risk factor for mortality but previous meta-analyses lacked standardization of laboratory methods for 25-hydroxyvitamin D (25[OH]D) concentrations and used aggregate data instead of individual participant data (IPD). We therefore performed an IPD meta-analysis on the association between standardized serum 25(OH)D and mortality. Methods In a European consortium of eight prospective studies, including seven general population cohorts, we used the Vitamin D Standardization Program (VDSP) protocols to standardize 25(OH)D data. Meta-analyses using a one step procedure on IPD were performed to study associations of 25(OH)D with all-cause mortality as the primary outcome, and with cardiovascular and cancer mortality as secondary outcomes. This meta-analysis is registered at ClinicalTrials.gov, number NCT02438488. Findings We analysed 26916 study participants (median age 61.6 years, 58% females) with a median 25(OH)D concentration of 53.8 nmol/L. During a median follow-up time of 10.5 years, 6802 persons died. Compared to participants with 25(OH)D concentrations of 75 to 99.99 nmol/L, the adjusted hazard ratios (with 95% confidence interval) for mortality in the 25(OH)D groups with 40 to 49.99, 30 to 39.99, and <30 nmol/L were 1.15 (1.00–1.29), 1.33 (1.16–1.51), and 1.67 (1.44–1.89), respectively. We observed similar results for cardiovascular mortality, but there was no significant linear association between 25(OH)D and cancer mortality. There was also no significantly increased mortality risk at high 25(OH)D levels up to 125 nmol/L. Interpretation In the first IPD meta-analysis using standardized measurements of 25(OH)D we observed an association between low 25(OH)D and increased risk of all-cause mortality. It is of public health interest to evaluate whether treatment of vitamin D deficiency prevents premature deaths.
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Affiliation(s)
- Martin Gaksch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Guri Grimnes
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Ragnar Joakimsen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Henrik Schirmer
- Tromsø Cardiovascular Research Group UNN, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B. Mathiesen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Winfried März
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
- Synlab Academy, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Marcus E. Kleber
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
- Department of Internal Medicine II - Cardiology, University of Ulm Medical Centre, Ulm, Germany
| | - Andreas Tomaschitz
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Specialist Clinic for Rehabilitation Bad Aussee, Bad Aussee, Austria
- Department of Internal Medicine - Cardiology, Charité University Hospital Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Martin Grübler
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | - Tamara B. Harris
- National Institute on Aging, Laboratory of Epidemiology, and Population Sciences, Bethesda, Maryland, United States of America
| | - Mary F. Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, United States of America
| | - Thor Aspelund
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Femke Rutters
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Joline W. J. Beulens
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esther van ‘t Riet
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Giel Nijpels
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Jacqueline M. Dekker
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Diana Grove-Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Markus A. Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Gert B. M. Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Karin M. A. Swart
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ingeborg A. Brouwer
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section, VU University medical center, Amsterdam, the Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Christopher T. Sempos
- National Institute of Health Office of Dietary Supplements, Bethesda, Maryland, United States of America
| | - Ramón A. Durazo-Arvizu
- Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Zuzana Škrabáková
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Kirsten G. Dowling
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Kevin D. Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Mairead Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research [INFANT], University College Cork, Cork, Ireland
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
- * E-mail:
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Ordóñez-Mena JM, Maalmi H, Schöttker B, Saum KU, Holleczek B, Wang TJ, Burwinkel B, Brenner H. Genetic Variants in the Vitamin D Pathway, 25(OH)D Levels, and Mortality in a Large Population-Based Cohort Study. J Clin Endocrinol Metab 2017; 102:470-477. [PMID: 27732326 DOI: 10.1210/jc.2016-2468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/10/2016] [Indexed: 12/12/2022]
Abstract
CONTEXT Low 25-hydroxyvitamin D [25(OH)D] concentrations have been consistently associated with excess mortality in epidemiological studies, but this association could be due to confounding by health impairments associated with low 25(OH)D levels. An association of vitamin D-related genetic variants with all-cause mortality could strengthen the claims of causality, because this association is assumed to be unaffected by confounding. OBJECTIVE To assess the associations of low 25(OH)D with mortality in the presence or absence of genetic variants in the vitamin D pathway. DESIGN, SETTING, AND PARTICIPANTS The study consisted of a population-based cohort of 8417 German older adults in whom genetic variants were genotyped. MAIN OUTCOME MEASURES The primary outcome measure was all-cause mortality. RESULTS Two single nucleotide polymorphisms (SNPs), rs3755967 (GC) and rs11603330 (DHCR7), were associated with higher risk of low vitamin D status [odds ratio (95% confidence interval) per minor allele, 1.27 (1.18 to 1.36) and 1.16 (1.08 to 1.25), respectively]. Low 25(OH)D (less than the season-specific 33rd percentile) was associated with increased mortality. However, none of the SNPs was associated with increased mortality. Furthermore, the increase in mortality for those with low 25(OH)D was generally smaller in the presence of the risk alleles for low 25(OH)D ["genetically low 25(OH)D"] than in the absence of those risk alleles ["otherwise low 25(OH)D"]. CONCLUSIONS Although we may have been limited by a low statistical power to detect small associations, our study showed that the strong relationship between low 25(OH)D and increased mortality may be at least partly due to other factors related to low 25(OH)D levels.
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Affiliation(s)
- José Manuel Ordóñez-Mena
- Division of Clinical Epidemiology and Aging Research, and
- Network Aging Research, Heidelberg University, 69115 Heidelberg, Germany
- Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, Oxford, Great Britain
| | - Haifa Maalmi
- Division of Clinical Epidemiology and Aging Research, and
- Network Aging Research, Heidelberg University, 69115 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, and
- Network Aging Research, Heidelberg University, 69115 Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, and
| | | | - Thomas J Wang
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; and
| | - Barbara Burwinkel
- Molecular Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
- Molecular Biology of Breast Cancer, Department of Gynecology and Obstetrics, University of Heidelberg, 69120 Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, and
- Network Aging Research, Heidelberg University, 69115 Heidelberg, Germany
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Dhondup T, Qian Q. Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure. Blood Purif 2017; 43:179-188. [PMID: 28114143 DOI: 10.1159/000452725] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The kidneys play a pivotal role in the regulation of electrolyte and acid-base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. As chronic kidney disease (CKD) has become a worldwide epidemic, medical providers are increasingly confronted with such problems. Adequate diagnosis and treatment will minimize complications and can potentially be lifesaving. In this review, we discuss the current understanding of the disease process, clinical presentation, diagnosis and treatment strategies, integrating up-to-date knowledge in the field. Although electrolyte and acid-base derangements are significant causes of morbidity and mortality in CKD and end-stage renal disease patients, they can be effectively managed through a timely institution of combined preventive measures and pharmacological therapy. Exciting advances and several upcoming outcome trials will provide further information to guide treatment and improve patient outcomes.
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Affiliation(s)
- Tsering Dhondup
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
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Abstract
UNLABELLED Internet search rates for "vitamin D" were explored using Google Trends. Search rates increased from 2004 until 2010 and thereafter displayed a seasonal pattern peaking in late winter. This knowledge could help guide the timing of public health interventions aimed at managing vitamin D deficiency. PURPOSE The Internet is an important source of health information. Analysis of Internet search activity rates can provide information on disease epidemiology, health related behaviors and public interest. We explored Internet search rates for vitamin D to determine whether this reflects the increasing scientific interest in this topic. METHODS Google Trends is a publically available tool that provides data on Internet searches using Google. Search activity for the term "vitamin D" from 1st January 2004 until 31st October 2016 was obtained. Comparison was made to other bone and nutrition related terms. RESULTS Worldwide, searches for "vitamin D" increased from 2004 until 2010 and thereafter a statistically significant (p < 0.001) seasonal pattern with a peak in February and nadir in August was observed. This seasonal pattern was evident for searches originating from both the USA (peak in February) and Australia (peak in August); p < 0.001 for both. Searches for the terms "osteoporosis", "rickets", "back pain" or "folic acid" did not display the increase observed for vitamin D or evidence of seasonal variation. CONCLUSION Public interest in vitamin D, as assessed by Internet search activity, did increase from 2004 to 2010, likely reflecting the growing scientific interest, but now displays a seasonal pattern with peak interest during late winter. This information could be used to guide public health approaches to managing vitamin D deficiency.
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Herrmann M, Farrell CJL, Pusceddu I, Fabregat-Cabello N, Cavalier E. Assessment of vitamin D status – a changing landscape. ACTA ACUST UNITED AC 2017; 55:3-26. [DOI: 10.1515/cclm-2016-0264] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/30/2016] [Indexed: 01/14/2023]
Abstract
Abstract
In recent years it has been shown that vitamin D deficiency is associated with an increased incidence as well as the progression of a broad range of diseases including osteoporosis, rickets, cardiovascular disease, autoimmune disease, multiple sclerosis and cancer. Consequently, requests for the assessment of vitamin D status have increased dramatically. Despite significant progress in the analysis of vitamin D metabolites and an expansion of our pathophysiological knowledge of vitamin D, the assessment of vitamin D status remains a challenging and partially unresolved issue. Current guidelines from scientific bodies recommend the measurement of 25-hydroxy vitamin D (25-OHD) in blood as the preferred test. However, growing evidence indicates significant limitations of this test, including analytical aspects and interpretation of results. In addition, the relationships between 25-OHD and various clinical indices, such as bone mineral density and fracture risk, are rather weak and not consistent across races. Recent studies have systematically investigated new markers of vitamin D status including the vitamin D metabolite ratio (VMR) (ratio between 25-OHD and 24,25-dihydroxy vitamin D), bioavailable 25-OHD [25-OHD not bound to vitamin D binding protein (DBP)], and free 25-OHD [circulating 25-OHD bound to neither DBP nor albumin (ALB)]. These parameters may potentially change how we will assess vitamin D status in the future. Although these new biomarkers have expanded our knowledge about vitamin D metabolism, a range of unresolved issues regarding their measurement and the interpretation of results prevent their use in daily practice. It can be expected that some of these issues will be overcome in the near future so that they may be considered for routine use (at least in specialized centers). In addition, genetic studies have revealed several polymorphisms in key proteins of vitamin D metabolism that affect the circulating concentrations of vitamin D metabolites. The affected proteins include DBP, 7-dehydrocholesterol synthase and the vitamin D receptor (VDR). Here we aim to review existing knowledge regarding the biochemistry, physiology and measurement of vitamin D. We will also provide an overview of current and emerging biomarkers for the assessment of vitamin D status, with particular attention methodological aspects and their usefulness in clinical practice.
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Skaaby T, Thuesen BH, Linneberg A. Vitamin D, Cardiovascular Disease and Risk Factors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:221-230. [DOI: 10.1007/978-3-319-56017-5_18] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Mellanby RJ. Beyond the skeleton: the role of vitamin D in companion animal health. J Small Anim Pract 2016; 57:175-80. [PMID: 27000647 DOI: 10.1111/jsap.12458] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/07/2015] [Accepted: 01/28/2016] [Indexed: 12/13/2022]
Abstract
While the role of vitamin D in the maintenance of skeletal health has been well-established for many years, the discovery that many non-skeletal tissues express the vitamin D receptor stimulated renewed interest in vitamin D and its wider physiological roles. Subsequently, a vast literature has emerged over the past three decades which has linked vitamin D deficiency to the development of many human diseases including cancer, autoimmune, infectious and cardiovascular disorders. In contrast, the role vitamin D plays in the physiology of non-skeletal tissues in cats and dogs has received little attention. The situation is now starting to change with the publication of several studies that have indicated that vitamin D metabolism is deranged in numerous companion animal disorders. This article reviews the biology of vitamin D in companion animals and highlights some of the recent studies which have advanced understanding of vitamin D homeostasis in cats and dogs. Finally, the essay discusses how a "One Health" approach could further the understanding of vitamin D metabolism in mammals. Investigating vitamin D homoeostasis in companion animals offers many advantages compared to human studies in which vitamin D status is influenced by many more variables.
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Affiliation(s)
- R J Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG
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Chai W, Fan JX, Wen M. Association of individual and community factors with C-reactive protein and 25-hydroxyvitamin D: Evidence from the National Health and Nutrition Examination Survey (NHANES). SSM Popul Health 2016; 2:889-896. [PMID: 27995178 PMCID: PMC5161036 DOI: 10.1016/j.ssmph.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/21/2016] [Accepted: 11/14/2016] [Indexed: 01/09/2023] Open
Abstract
Many individual and community/neighborhood factors may contribute to inflammation and vitamin D deficiency leading to the development of chronic diseases. This study examined the associations of serum C-reactive protein (CRP) and 25-hydroxyvitamin D [25(OH)D] levels with individual and community/neighborhood (tract-level or county-level) factors using a nationally representative sample from 2001-2006 National Health and Nutrition Examination Survey (NHANES). Data from the 2001-2006 waves of the continuous NHANES was merged with the 2000 census and other neighborhood data sources constructed using geographic information system. Associations between multilevel factors and biomarker levels were assessed using multilevel random-intercept regression models. 6643 participants aged 19-65 (3402 men and 3241 women) were included in the analysis. Family income-to-needs ratio was inversely associated with CRP (P=0.002) and positively associated with 25(OH)D levels (P=0.0003). County crime rates were positively associated with CRP (P=0.007) and inversely associated with 25(OH)D levels (P=0.0002). The associations with income-to-needs ratio were significant in men [CRP; P=0.005; 25(OH)D, P=0.005] but not in women. For county crime rates, the association was only significant in women for CRP (P=0.004) and was significant in both men (P=0.01) and women (P=0.001) for 25(OH)D. Additionally, overall CRP was positively associated with age (P<0.0001), female sex (P<0.0001), Hispanic race/ethnicity (P=0.0001), current smokers (P<0.0001), body mass index (BMI, P<0.0001), and participants who were US-born (P=0.02). Non-Hispanic black (P<0.0001) and Hispanic race/ethnicity (P<0.0001), current smoker (P=0.047), and higher BMI (P<0.0001) were associated with lower serum 25(OH)D levels. No significant associations were observed between other community/neighborhood variables and serum CRP and 25(OH)D levels. The current results suggest that family income-to-needs ratio and county crime rate may be important contributors to chronic inflammation and vitamin D status.
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Affiliation(s)
- Weiwen Chai
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Jessie X. Fan
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, USA
| | - Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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Stokes CS, Volmer DA. Assessment of 3-epi-25-hydroxyvitamin D levels during cholecalciferol supplementation in adults with chronic liver diseases. Appl Physiol Nutr Metab 2016; 41:1311-1317. [DOI: 10.1139/apnm-2016-0196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, hepatic immaturity was cited as a possible reason for high levels of the C-3 epimer of 25-hydroxyvitamin (25(OH)D) in premature infants: however what role, if any, the liver plays in controlling epimer concentrations is unknown. This study assesses 3-epi-25-hydroxyvitamin D (3-epi-25(OH)D) levels during the course of cholecalciferol supplementation in adults with chronic liver diseases (CLD). Vitamin D metabolites were analyzed in 65 CLD patients with 25(OH)D <30 ng/mL who received 20 000 IU cholecalciferol/week for 6 months. The primary outcome assessed serum 25(OH)D and 3-epi-25(OH)D in response to supplementation. Corresponding values from 16 CLD patients with sufficient vitamin D levels receiving no supplementation were compared. The epimer was detected in all samples and at lower relative concentrations with lower vitamin D baseline status, i.e., severe vitamin D deficiency (<10 ng/mL) as compared with deficient (10–19.9 ng/mL), insufficient (20–29.9 ng/mL), or sufficient (≥30 ng/mL) vitamin D levels (2.4% vs. 4.8%, 5.2%, 5.8%, respectively; P < 0.001). Similar relative concentrations for 3-epi-25(OH)D, ranging from 4.3%–7.1% (absolute concentrations: 1.1–4.0 ng/mL; all P < 0.001), were obtained in response to cholecalciferol in all supplemented patients, regardless of inadequacy threshold. Epimer levels significantly decreased (P = 0.007) in unsupplemented patients, coinciding with decreasing serum 25(OH)D concentrations over time. No epimer differences between patients with (n = 17) or without (n = 48) cirrhosis were demonstrated. The 3-epi-25(OH)D was present in serum of all patients at comparable levels to those reported by others. Epimer levels increased linearly with increasing 25(OH)D levels after supplementation. However, no effect of cirrhosis on epimer concentrations was observed.
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Affiliation(s)
- Caroline S. Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Dietrich A. Volmer
- Institute of Bioanalytical Chemistry, Saarland University, Saarbrücken, Germany
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225
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El Hilali J, de Koning EJ, van Ballegooijen AJ, Lips P, Sohl E, van Marwijk HWJ, Visser M, van Schoor NM. Vitamin D, PTH and the risk of overall and disease-specific mortality: Results of the Longitudinal Aging Study Amsterdam. J Steroid Biochem Mol Biol 2016; 164:386-394. [PMID: 26678328 DOI: 10.1016/j.jsbmb.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/20/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022]
Abstract
Observational studies suggest that low concentrations of serum 25-hydroxyvitamin D (25(OH)D) and high concentrations of parathyroid hormone (PTH) are associated with a higher risk of mortality. The aim of this study was to examine whether 25(OH)D and PTH concentrations are independently associated with overall and disease-specific (cardiovascular and cancer-related) mortality in a large, prospective population-based cohort of older adults. Data from 1317 men and women (65-85 years) of the Longitudinal Aging Study Amsterdam were used. Cox proportional hazard analyses were used to examine whether 25(OH)D and PTH at baseline were associated with overall mortality (with a follow-up of 18 years) and disease-specific mortality (with a follow-up of 13 years). Compared to persons in the reference category of ≥75nmol/L, persons with serum 25(OH)D <25nmol/L (HR 1.46; 95% CI: 1.12-1.91) and 25-49.9nmol/L (HR 1.24; 95% CI: 1.01-1.53) had a significantly higher risk of overall mortality, as well as men with baseline PTH concentrations ≥7pmol/L (HR 2.54 (95% CI: 1.58-4.08)), compared to the reference category of <2.33pmol/L. The relationship of 25(OH)D with overall mortality was partly mediated by PTH. Furthermore, men with PTH concentrations of ≥7pmol/L (HR 3.22; 95% CI: 1.40-7.42) had a higher risk of cardiovascular mortality, compared to the reference category. No significant associations of 25(OH)D or PTH with cancer-related mortality were observed. Both 25(OH)D and PTH should be considered as important health markers.
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Affiliation(s)
- Jamila El Hilali
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Elisa J de Koning
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Adriana J van Ballegooijen
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Health Sciences, VU University, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Paul Lips
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Evelien Sohl
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Harm W J van Marwijk
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of General Practice and Elderly Care Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Primary Care Research Center, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Marjolein Visser
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Health Sciences, VU University, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
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226
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Aljefree NM, Lee P, Alsaqqaf JM, Ahmed F. Association between Vitamin D Status and Coronary Heart Disease among Adults in Saudi Arabia: A Case-Control Study. Healthcare (Basel) 2016; 4:healthcare4040077. [PMID: 27763496 PMCID: PMC5198119 DOI: 10.3390/healthcare4040077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 12/20/2022] Open
Abstract
Recent evidence has pointed out an association between vitamin D deficiency and coronary heart disease (CHD). Due to the growing epidemic of CHD and vitamin D deficiency in Saudi Arabia, exploring the role of vitamin D in the prevention of CHD is crucial. The aim of this study was to examine the association between vitamin D status and CHD in Saudi Arabian adults. This case-control study included 130 CHD cases and 195 age-sex matched controls. Study subjects were recruited from three hospitals in the western region of Saudi Arabia. Study participants were interviewed face-to-face to collect data on their socio-demographic characteristics and family history of CHD. Fasting blood samples were collected, and serum levels of vitamin D, glucose, and total cholesterol were measured. Body weight, height, and blood pressure measurements were also recorded. Severe vitamin D deficiency (25(OH)D < 10 ng/mL) was much more prevalent in CHD cases than in controls (46% and 3%, respectively). The results of multivariate logistic regression showed that vitamin D deficiency (25(OH)D < 20 ng/mL) was associated with CHD, with an odds ratio of 6.5 (95% CI: 2.7-15, p < 0.001). The current study revealed that vitamin D deficiency is independently associated with CHD, suggesting an important predictor of CHD among Saudi adults.
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Affiliation(s)
- Najlaa M Aljefree
- Public Health, School of Medicine and Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Patricia Lee
- Public Health, School of Medicine and Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Jamal M Alsaqqaf
- Department of Cardiology, King Abdulla Medical City (KAMC), Makkah 21955, Saudi Arabia.
| | - Faruk Ahmed
- Public Health, School of Medicine and Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
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227
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Lindqvist PG, Epstein E, Nielsen K, Landin-Olsson M, Ingvar C, Olsson H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. J Intern Med 2016; 280:375-87. [PMID: 26992108 DOI: 10.1111/joim.12496] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Women with active sunlight exposure habits experience a lower mortality rate than women who avoid sun exposure; however, they are at an increased risk of skin cancer. We aimed to explore the differences in main causes of death according to sun exposure. METHODS We assessed the differences in sun exposure as a risk factor for all-cause mortality in a competing risk scenario for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 (aged 25-64 years at the start of the study). We obtained detailed information at baseline on sun exposure habits and potential confounders. The data were analysed using modern survival statistics. RESULTS Women with active sun exposure habits were mainly at a lower risk of cardiovascular disease (CVD) and noncancer/non-CVD death as compared to those who avoided sun exposure. As a result of their increased survival, the relative contribution of cancer death increased in these women. Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. Compared to the highest sun exposure group, life expectancy of avoiders of sun exposure was reduced by 0.6-2.1 years. CONCLUSION The longer life expectancy amongst women with active sun exposure habits was related to a decrease in CVD and noncancer/non-CVD mortality, causing the relative contribution of death due to cancer to increase.
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Affiliation(s)
- P G Lindqvist
- Clintec, Karolinska Institutet, Department of Obstetrics and Gynecology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
| | - E Epstein
- Department of Obstetrics and Gynecology, Mothers and Childrens Health, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - K Nielsen
- Department of Dermatology, Helsingborg Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - M Landin-Olsson
- Department of Endocrinology, Clinical Sciences, Lund University Hospital, Lund, Sweden
| | - C Ingvar
- Department of Surgery, Clinical Sciences, University Hospital, Lund, Sweden
| | - H Olsson
- Departments of Oncology and Cancer Epidemiology, Lund University Hospital, Lund, Sweden
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228
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Chailurkit LO, Aekplakorn W, Srijaruskul K, Ongphiphadhanakul B. Discrepant association of serum C-3 epimer of 25-hydroxyvitamin D versus non-epimeric 25-hydroxyvitamin D with serum lipid levels. Lipids Health Dis 2016; 15:157. [PMID: 27633775 PMCID: PMC5025584 DOI: 10.1186/s12944-016-0333-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Low vitamin D status has been associated with a number of chronic diseases. For dyslipidemia, vitamin D deficiency has been associated with higher low density lipoprotein-cholesterol (LDL-C) in a number of studies, but with inconsistent results in clinical trials. The purpose of the present study is to explore the relative importance of 3-epi-25-hydroxyvitamin D (25(OH)D) as compared with the non-epimeric form in relation to serum lipid. Method This study used data from 1068 randomly selected volunteers in the Thai 4th National Health Examination Survey (NHES IV). Serum 25(OH)D2, 25(OH)D3, 3-epi-25(OH)D2 and 3-epi-25(OH)D3 were analyzed by liquid chromatography–tandem mass spectrometry. Results There was no association between serum total 25(OH)D and serum LDL-C. However, circulating 3-epi-25(OH)D3 was negatively related to serum LDL-C (r = −0.077, P <0.05), while no such association was found for non-epimeric 25(OH)D3 (r =0.030, P = 0.33). On the other hand, both 3-epi-25(OH)D3 (r = 0.175, P <0.001) and non-epimeric 25(OH)D3 (r = 0.142, P <0.001) were positively related to serum triglyceride (TRIG) levels. In multiple linear regression models with age, gender, body mass index , urban residence, education, hypertension and education as covariates, it was found that 3-epi-25(OH)D3 was independently associated with serum LDL-C (beta = −0.12, P <0.01), while non-epimeric 25(OH)D3 was positively related to LDL-C (beta = 0.13, P = 0.002). For TRIG, there were positive association with 3-epi-25(OH)D3 (beta = 0.27, P <0.001) and negative association with non-epimeric 25(OH)D3 (beta = − 0.10, P = 0.011) independent of age, gender, urban resident and education. Conclusions There is a discrepant association of 25(OH)D levels with serum lipids according to 25(OH)D epimeric forms.
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Affiliation(s)
- La-Or Chailurkit
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand. .,Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6th Road, Bangkok, 10400, Thailand.
| | - Wichai Aekplakorn
- Department of Community Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Kriangsuk Srijaruskul
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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Glueck CJ, Jetty V, Rothschild M, Duhon G, Shah P, Prince M, Lee K, Goldenberg M, Kumar A, Goldenberg N, Wang P. Associations between Serum 25-hydroxyvitamin D and Lipids, Lipoprotein Cholesterols, and Homocysteine. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:284-90. [PMID: 27583236 PMCID: PMC4982357 DOI: 10.4103/1947-2714.187137] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Serum 25(OH) vitamin D levels are inversely associated with cardiovascular disease (CVD) mortality, mediated in part by independent positive relationships with high-density lipoprotein cholesterol (HDLC) and inverse relationships with low-density lipoprotein cholesterol (LDLC), triglyceride, and homocysteine. Aims: In this study, we assessed relationships between fasting serum vitamin D and lipids, lipoprotein cholesterols, and homocysteine. Materials and Methods: We studied 1534 patients sequentially referred to our center from 2007 to 2016. Fasting serum total 25(OH) vitamin D, plasma cholesterol, triglyceride, HDLC, LDLC, and homocysteine were measured. Stepwise regression models were used with total cholesterol, triglyceride, HDLC, LDLC, and homocysteine as dependent variables and explanatory variables age, race, gender, body mass index (BMI), and serum vitamin D levels. Relationships between quintiles of serum vitamin D and triglycerides, HDLC, LDLC, and homocysteine were assessed after covariance adjusting for age, race, gender, and BMI. Results: Fasting serum vitamin D was positively correlated with age, HDLC, and White race, and was inversely correlated with BMI, total and LDL cholesterol, triglyceride, and fasting serum homocysteine (P ≤ 0.0001 for all). Serum vitamin D was a significant independent inverse explanatory variable for total cholesterol, triglyceride, and LDL cholesterol, and accounted for the largest amount of variance in serum total cholesterol (partial R2 =3.6%), triglyceride (partial R2 =3.1%), and LDLC (partial R2 =2.9%) (P < 0.0001 for all). Serum vitamin D was a significant positive explanatory variable for HDLC (partial R2 = 1.4%, P < 0.0001), and a significant inverse explanatory variable for homocysteine (partial R2 = 6.0–12.6%). Conclusions: In hyperlipidemic patients, serum vitamin D was a significant independent inverse determinant of total cholesterol, LDLC, triglyceride, and homocysteine, and a significant independent positive determinant of HDLC. Thus, serum vitamin D might be protective against CVD.
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Affiliation(s)
- Charles J Glueck
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Vybhav Jetty
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Matan Rothschild
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Gregory Duhon
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Parth Shah
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Marloe Prince
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Kevin Lee
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Michael Goldenberg
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Ashwin Kumar
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Naila Goldenberg
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
| | - Ping Wang
- The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Ohio, USA
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Dadonienė J, Čypienė A, Rinkūnienė E, Badarienė J, Burca J, Sakaitė I, Kalinauskaitė G, Kumpauskaitė V, Laucevičius A. Vitamin D and functional arterial parameters in postmenopausal women with metabolic syndrome. Adv Med Sci 2016; 61:224-230. [PMID: 26946163 DOI: 10.1016/j.advms.2015.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 11/06/2015] [Accepted: 12/30/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE Our cross sectional study aimed to identify the relation between vitamin D level and functional arterial parameters in postmenopausal women with metabolic syndrome. MATERIAL AND METHODS 100 postmenopausal women at age 50-65 with diagnosed metabolic syndrome were included in this study. Laboratory tests were performed to determine lipid profile, serum glucose, creatinine, C-reactive protein, serum levels of 25(OH) D, ionized calcium and urine albumin/creatinine ratio. Also non-invasive assessment of arterial function (arterial stiffness, flow-mediated dilatation and carotid artery ultrasound examinations) was performed. RESULTS The mean vitamin D blood concentration was 47.4±16.9nmol/l. The prevalence of modest insufficiency and deficiency of vitamin D was 62%. Vitamin D concentration in samples assembled from January to March was significantly lower than concentration levels from September to November. No significant relationship was observed between vitamin D and endothelial function, arterial stiffness, carotid intima-media thickness. Week negative correlation was stated between mean arterial pressure and 25(OH) D concentration (p=0.04). A positive correlation was found between high density lipoprotein cholesterol and vitamin 25(OH) D (r=0.3, p<0.05). No significant difference between 25(OH) D and other lipoproteins, calcium ions, glucose, albumin/creatinine ratio and C-reactive protein blood concentrations were found. CONCLUSIONS The prevalence of vitamin D deficiency in postmenopausal women with metabolic syndrome is high. No relation was found between vitamin D levels and parameters that indicate atherosclerotic vascular lesions. Nevertheless our study revealed the relation between concentrations of vitamin D and mean blood pressure and high density lipoprotein cholesterol.
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231
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Li K, Yang X, Wang L, Chen M, Zhao W, Xu L, Yang X. Modification of the association between smoking status and severity of coronary stenosis by vitamin D in patients suspected of coronary heart disease. Medicine (Baltimore) 2016; 95:e4817. [PMID: 27603397 PMCID: PMC5023920 DOI: 10.1097/md.0000000000004817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Given both smoking and vitamin D are associated with coronary heart disease (CHD) via inflammation and smoking may interfere with the local antiinflammatory effects of vitamin D. We hypothesized that the relationship between smoking and severity of CHD may be modified by vitamin D.A cross-sectional study was conducted. 25-OH vitamin D values were determined in 348 consecutive patients (mean age 62.4 ± 10.5 years; 56.3% male) undergoing coronary angiography at the Heart Center of Chaoyang Hospital affiliated to Capital Medical University between the period of September 2014 and May 2015. We categorized the patients into 2 groups based on 25-OH vitamin D levels, that is, severe hypovitaminosis D (25-OH vitamin D < 10 ng/mL) and higher vitamin D (25-OH vitamin D > = 10 ng/mL). Multivariable logistic regression models were used to estimate odds ratios (ORs) of severe coronary stenosis or higher Gensini score across three smoking status, that is, never smokers, former smokers, and current smokers in severe hypovitaminosis D and higher vitamin D groups, respectively.Of these patients, we identified 212 (60.9%) cases of severe CHD and 161 (46.3%) cases of severe hypovitaminosis D. Multivariable logistic regression model showed the ORs of severe CHD were 1.94 (95% confidence interval [CI]: 0.47, 7.98) for former smokers and 2.62 (95% CI: 0.83, 8.24) for current smokers, compared with never smokers in group with severe hypovitaminosis D (P-trend = 0.005). In contrast, smoking was not found to be significantly associated with severe CHD in group with higher 25-OH vitamin D (P-trend = 0.115). We found a significant interaction between smoking status and vitamin D on presence of severe CHD (P-interaction = 0.015). In terms of Gensini score as a dependent variable, similar results were identified.Our finding indicated the association between smoking and severity of CHD appeared to be substantially stronger among patients with severe hypovitaminosis D as compared with those with higher vitamin D levels. This suggests vitamin D sufficiency may have a protective effect against the damaging effects of smoking on coronary artery. Future cohort studies are warranted to confirm this finding.
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Affiliation(s)
| | | | | | | | | | | | - Xinchun Yang
- Heart Center of Beijing Chaoyang Hospital Affiliated to Capital Medical University, Chaoyang District, Beijing, China
- Correspondence: Xinchun Yang, Heart Center of Chaoyang Hospital Affiliated to Capital Medical University, Beijing City, Beijing 100020, China (e-mail: )
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Abstract
Vitamin D is a secosteroid hormone with multiple functions that extend beyond the regulation of intestinal calcium absorption. In recent years, the publication of research articles investigating associations between vitamin D status and health has reached an all-time high, and an increase in supplementation studies has followed. Given the pleiotropic effects of vitamin D, the scientific focus has gone beyond its known classic benefits on skeletal health to include diabetes and cardiovascular, neurological, respiratory, renal, and liver diseases, yet numerous conflicting findings continue to emerge. This review presents some examples of recent work within the context of controversies surrounding vitamin D and highlights key factors that should be considered when designing vitamin D supplementation regimens.
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
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Mak JCS, Mason RS, Klein L, Cameron ID. An initial loading-dose vitamin D versus placebo after hip fracture surgery: randomized trial. BMC Musculoskelet Disord 2016; 17:336. [PMID: 27515154 PMCID: PMC4982117 DOI: 10.1186/s12891-016-1174-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 07/20/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Improving vitamin D (25-OHD) status may be an important modifiable factor that could reduce disability severity, fall-rates and mortality associated after hip fracture surgery. Providing a loading-dose post-surgery may overcome limitations in adherence to daily supplementation. METHOD In this randomized, double-blind, placebo-controlled trial, 218 adults, aged 65-years or older, requiring hip fracture surgery were assigned to receive a single loading-dose of cholecalciferol (250,000 IU vitamin-D3, the REVITAHIP - Replenishment of Vitamin D in Hip Fracture strategy) or placebo, both receiving daily vitamin-D(800 IU) and calcium (500 mg) for 26-weeks. Outcome measures were 2.4 m gait-velocity, falls, fractures, death (Week-4), 25-OHD levels, quality-of-life measure (EuroQoL) and mortality at weeks-2, 4 and 26. RESULTS Mean age of 218 participants was 83.9(7.2) years and 77.1 % were women. Baseline mean 25-OHD was 52.7(23.5)nmol/L, with higher levels at Week-2 (73 vs 66 nmol/L; p = .019) and Week-4 (83 vs 75 nmol/L; p = .030) in the Active-group, but not at Week-26. At week-4, there were no differences in 2.4 m gait-velocity (0.42 m/s vs 0.39 m/s, p = .490), fractures (2.7 % vs 2.8 %, p = .964) but Active participants reported less falls (6.3 % vs 21.1 %, χ(2) = 4.327; p = 0.024), with no significant reduction in deaths at week-4 (1 vs 3, p = 0.295), higher percentage reporting 'no pain or discomfort' (96.4 % vs 88.8 %, p = 0.037), and trended for higher EuroQoL-scores (p = 0.092) at week-26. One case of hypercalcemia at week-2 normalised by week-4. CONCLUSION Among older people after hip fracture surgery, the REVITAHIP strategy is a safe and low cost method of improving vitamin-D levels, reducing falls and pain levels. TRIAL REGISTRATION The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ANZCTRN ACTRN12610000392066 (Date of registration: 14/05/2010).
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Affiliation(s)
- Jenson CS Mak
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Sydney, New South Wales Australia
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW Australia
| | - Rebecca S. Mason
- Department of Physiology, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
| | - Linda Klein
- Office of Medical Education, Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Ian D. Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Sydney, New South Wales Australia
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Schtscherbyna A, Gouveia C, Pinheiro MFMC, Luiz RR, Farias MLF, Machado ES. Vitamin D status in a Brazilian cohort of adolescents and young adults with perinatally acquired human immunodeficiency virus infection. Mem Inst Oswaldo Cruz 2016; 111:128-33. [PMID: 26872341 PMCID: PMC4750453 DOI: 10.1590/0074-02760150403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/12/2016] [Indexed: 11/21/2022] Open
Abstract
The purpose was to determine the prevalence and related factors of vitamin D (VitD)
insufficiency in adolescents and young adults with perinatally acquired human
immunodeficiency virus. A cohort of 65 patients (17.6 ± 2 years) at the Federal
University of Rio de Janeiro, Brazil, were examined for pubertal development,
nutrition, serum parathormone and serum 25-hydroxyvitamin D [s25(OH)D]. s25(OH)D
levels < 30 ng/mL (< 75 nmol/L) were defined as VitD insufficiency.
CD4+ T-cell counts and viral load, history of worst clinical status,
immunologic status as nadir, current immunologic status, and antiretroviral (ART)
regimen were also evaluated as risk factors for VitD insufficiency. Mean s25(OH)D was
37.7 ± 13.9 ng/mL and 29.2% had VitD insufficiency. There was no difference between
VitD status and gender, age, nutritional status, clinical and immunological
classification, and type of ART. Only VitD consumption showed tendency of association
with s25(OH)D (p = 0.064). Individuals analysed in summer/autumn season had a higher
s25(OH)D compared to the ones analysed in winter/spring (42.6 ± 14.9 vs. 34.0 ± 11.9,
p = 0.011). Although, the frequency of VitD insufficiency did not differ
statistically between the groups (summer/autumn 17.9% vs. winter/spring 37.8%, p =
0.102), we suggest to monitor s25(OH)D in seropositive adolescents and young adults,
especially during winter/spring months, even in sunny regions.
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Affiliation(s)
- Annie Schtscherbyna
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Carla Gouveia
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Ronir Raggio Luiz
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Maria Lucia Fleiuss Farias
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Gussago C, Arosio B, Guerini FR, Ferri E, Costa AS, Casati M, Bollini EM, Ronchetti F, Colombo E, Bernardelli G, Clerici M, Mari D. Impact of vitamin D receptor polymorphisms in centenarians. Endocrine 2016; 53:558-64. [PMID: 26956844 DOI: 10.1007/s12020-016-0908-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/24/2016] [Indexed: 12/25/2022]
Abstract
Vitamin D is a seco-sterol produced endogenously in the skin or obtained from certain foods. It exerts its action through binding to intracellular vitamin D receptor (VDR). Lately, the role of vitamin D has been revised regarding its potential advantage on delaying the process of aging. The aim of this study was to assess the contribution of VDR gene polymorphisms in healthy aging and longevity. We evaluated the frequency of four polymorphisms of the VDR gene (FokI, BsmI, ApaI, and TaqI) in centenarians (102 subjects, mean age: 102.3 ± 0.3 years), compared to septuagenarians (163 subjects, mean age: 73.0 ± 0.6 years) and we analyzed a variety of pathophysiologically relevant functions in centenarians. BsmI and ApaI provided a significant association with longevity: there was a highly significant difference in the frequency of BsmI genotypes (p = 0.037), ApaI genotypes (p = 0.022), and ApaI alleles (p = 0.050) in centenarians versus septuagenarians. Furthermore, we found a significant correlation of all the VDR gene polymorphisms in centenarians with some measured variables such as hand grip strength, body mass index, blood pressure, HDL cholesterol, and mini-mental state examination. We also found a correlation with the prevalence of medical history of hypertension, acute myocardial infarction, angina, venous insufficiency, dementia, chronic obstructive pulmonary disease, and arthrosis. In conclusion, this study proposes a new scenario in which the variability of the VDR gene is relevant in the aging process and emphasizes the role of VDR genetic background in determining healthy aging.
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Affiliation(s)
- Cristina Gussago
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy.
| | - Beatrice Arosio
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy
- Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | | | - Evelyn Ferri
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy
- Nutritional Sciences, University of Milan, 20122, Milan, Italy
| | | | - Martina Casati
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy
- Nutritional Sciences, University of Milan, 20122, Milan, Italy
| | - Elisa Mariadele Bollini
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy
- Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Francesco Ronchetti
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy
- Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Elena Colombo
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy
| | - Giuseppina Bernardelli
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy
- Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Mario Clerici
- Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20133, Milan, Italy
| | - Daniela Mari
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Via Pace 9, 20122, Milan, Italy
- Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, 20122, Milan, Italy
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37:2315-2381. [PMID: 27222591 PMCID: PMC4986030 DOI: 10.1093/eurheartj/ehw106] [Citation(s) in RCA: 4516] [Impact Index Per Article: 564.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Massimo F. Piepoli
- Corresponding authors: Massimo F. Piepoli, Heart Failure Unit, Cardiology Department, Polichirurgico Hospital G. Da Saliceto, Cantone Del Cristo, 29121 Piacenza, Emilia Romagna, Italy, Tel: +39 0523 30 32 17, Fax: +39 0523 30 32 20, E-mail: ,
| | - Arno W. Hoes
- Arno W. Hoes, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500 (HP Str. 6.131), 3508 GA Utrecht, The Netherlands, Tel: +31 88 756 8193, Fax: +31 88 756 8099, E-mail:
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Affiliation(s)
| | - Arthur R H van Zanten
- a Department of Intensive Care Medicine , Gelderse Vallei Hospital , Ede , The Netherlands
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Donneyong MM, Taylor KC, Kerber RA, Hornung CA, Scragg R. Is outdoor recreational activity an independent predictor of cardiovascular disease mortality - NHANES III? Nutr Metab Cardiovasc Dis 2016; 26:735-742. [PMID: 27089974 DOI: 10.1016/j.numecd.2016.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS To investigate if frequency of outdoor recreational activity (ORA) predicts cardiovascular disease (CVD) mortality, independent of serum 25(OH)D concentration. METHODS AND RESULTS Baseline data on ORA and serum 25(OH)D, collected from 11,746 participants aged 30-90 years in the Third National Health and Nutrition Examination Survey during 1988-1994, were linked to the National Death Index for assessment of CVD deaths from baseline through December 2006. CVD mortality as a primary cause of death was assessed during a mean follow up of 12.9 (SD, 4.2) years. There were 1519 CVD deaths during follow up. A strong positive association was observed between frequency of ORA in the last month and serum 25(OH)D (p < 0.001). Compared to participants who did no ORA in the last month, the hazard ratio (HR) of CVD mortality was 0.72 (95% confidence interval 0.58-0.90) for those doing ORA 1-4 times, 0.64 (0.47-0.89) for 5-12 times, 0.70 (0.56-0.89) for 13-30 times and 0.63 (0.47-0.84) for ≥30 times (p-trend < 0.001), in a Cox proportional hazards regression model which included 25(OH)D and CVD risk factors. Serum 25(OH)D was inversely associated with CVD mortality (p-trend, 0.01) in this same model. CONCLUSIONS An inverse association between ORA and CVD mortality was observed independent of 25(OH)D. The underlying mechanism for this association may not involve 25(OH)D hence, further studies are warranted to confirm and investigate the underlying mechanism.
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Affiliation(s)
- M M Donneyong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02120, USA; Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, 40202, USA.
| | - K C Taylor
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, 40202, USA
| | - R A Kerber
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, 40202, USA
| | - C A Hornung
- Department of Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - R Scragg
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, Private Bag, 92019, New Zealand
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Holter JC, Ueland T, Norseth J, Brunborg C, Frøland SS, Husebye E, Aukrust P, Heggelund L. Vitamin D Status and Long-Term Mortality in Community-Acquired Pneumonia: Secondary Data Analysis from a Prospective Cohort. PLoS One 2016; 11:e0158536. [PMID: 27367810 PMCID: PMC4930204 DOI: 10.1371/journal.pone.0158536] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/17/2016] [Indexed: 12/11/2022] Open
Abstract
Background Low vitamin D status has been associated with short-term (30-day) mortality in hospitalized adults with community-acquired pneumonia (CAP). Data on its prevalence in these patients are scarce, and impact on long-term prognosis is unknown. We examined the prevalence of vitamin D deficiency and inadequacy and their effect on long-term mortality in hospitalized adults with CAP. Methods Secondary follow-up analysis of data from a prospectively recruited (January 2008–January 2011) well-defined cohort of 241 hospital survivors of CAP (Norway, latitude 60°N). Serum 25-hydroxyvitamin D levels, demographic, clinical, and laboratory data were measured within 48 hours of admission. The etiology of CAP was established in 63% of patients through extensive microbiological investigations. Mortality data were obtained from the national Cause of Death Registry. Explanatory strategy and Cox regression models were used to explore the association between vitamin D status and all-cause mortality. Results Median age was 66 years. Eighty-seven (36%) patients were vitamin D deficient (<30 nmol/L), 81 (34%) were inadequate (30–49 nmol/L), and 73 (30%) were sufficient (≥50 nmol/L). Seventy-two patients died over a median of 1839 days (range 1–2520 days), corresponding to cumulative 5-year survival rates of 66.2% (95% CI 56.2–76.2%), 77.0% (67.6–86.4%), and 77.8% (67.8–87.8%) for vitamin D deficient, inadequate, and sufficient patients, respectively. After adjusting for confounders (age, chronic obstructive pulmonary disease, immunocompromization and season), vitamin D deficiency, but not inadequacy, was significantly associated with higher mortality compared to patients with sufficiency (HR 1.91, 95% CI 1.06–3.45; P = .031). Conclusions There is a high prevalence of vitamin D deficiency and inadequacy among hospitalized adults with CAP. The results of this study also suggest that vitamin D deficiency is associated with an increased risk of mortality way beyond the short-term in these patients.
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Affiliation(s)
- Jan C. Holter
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail: (JCH)
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Jon Norseth
- Clinic for Medical Diagnostics, Bærum Hospital, Vestre Viken Hospital Trust, Rud, Norway
| | - Cathrine Brunborg
- Oslo Center of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Stig S. Frøland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Einar Husebye
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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241
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM, De Backer G, Roffi M, Aboyans V, Bachl N, Bueno H, Carerj S, Cho L, Cox J, De Sutter J, Egidi G, Fisher M, Fitzsimons D, Franco OH, Guenoun M, Jennings C, Jug B, Kirchhof P, Kotseva K, Lip GYH, Mach F, Mancia G, Bermudo FM, Mezzani A, Niessner A, Ponikowski P, Rauch B, Rydén L, Stauder A, Turc G, Wiklund O, Windecker S, Zamorano JL. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23:NP1-NP96. [PMID: 27353126 DOI: 10.1177/2047487316653709] [Citation(s) in RCA: 579] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societies: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societies: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Naveed Sattar
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leslie Cho
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Miles Fisher
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lars Rydén
- Societies: European Society of Cardiology (ESC)
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Sogomonian R, Alkhawam H, Jolly J, Vyas N, Ahmad S, Moradoghli Haftevani E, Al-Khazraji A, Finkielstein D, Vittorio TJ. Serum vitamin D levels correlate to coronary artery disease severity: a retrospective chart analysis. Expert Rev Cardiovasc Ther 2016; 14:977-82. [PMID: 27187061 DOI: 10.1080/14779072.2016.1190273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The pro-atherosclerotic nature of vitamin D deficiency has been shown to increase cardiovascular events. We further emphasized and evaluated the severity of coronary artery disease (CAD) with varying levels of vitamin D in relation to age, gender, ethnicity and baseline confounders. METHODS A retrospective, single-center study of 9,399 patients admitted between 2005 and 2014 for chest pain who underwent coronary angiography. Patients without a vitamin D level, measured as 25-dihydroxyvitamin D (25[OH]D) were excluded from our study. 25(OH)D deficiency and insufficiency were defined by having serum concentration levels of less than 20 ng/ml and 20 to 29.9 ng/ml, respectively, while normal levels were defined as greater than or equal to 30 ng/ml. We assessed levels of 25(OH)D and extent of coronary disease with coronary angiography as obstructive CAD (left main stenosis of ≥50% or any stenosis of ≥70%), non-obstructive CAD (≥1 stenosis ≥20% but no stenosis ≥70%) and normal coronaries (no stenosis >20%). RESULTS Among 9,399 patients, 1,311 qualified, of which 308 patients (23%) had normal 25(OH)D levels, 552 patients (42%) had 25(OH)D deficiency and 451 patients (35%) had 25(OH)D insufficiency. In an analysis of the extent of coronary disease, we identified 20% of patients having normal coronaries, 55% having obstructive CAD and 25% having non-obstructive CAD. Baseline clinical risk factors and co-morbidities did not differ between the groups. Patients with normal 25(OH)D levels were found to have normal coronaries compared to patients with 25(OH)D deficiency or insufficiency (OR: 7, 95% CI: 5.2 - 9.5, p < 0.0001). Comparing patients with normal 25(OH)D levels, patients with 25(OH)D deficiency or insufficiency (<29 ng/ml), 62% were found to have obstructive CAD (n = 624, OR: 2.9, 95% CI: 2.3-3.7, p < 0.0001) and 25% had non-obstructive CAD (n = 249, OR: 1.5, 95% CI: 1.1-2, p = 0.02). CONCLUSION Normal coronaries and CAD were shown to correlate with normal and low levels of 25(OH)D, respectively. There is an inverse relationship between the percentage of coronary artery occlusion and serum 25(OH)D concentrations. Vitamin D may provide benefits in risk stratification of patients with CAD and serve as a possible risk factor.
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Affiliation(s)
- Robert Sogomonian
- a Department of Medicine , Icahn School of Medicine at Mount Sinai , Elmhurst , NY , USA
| | - Hassan Alkhawam
- a Department of Medicine , Icahn School of Medicine at Mount Sinai , Elmhurst , NY , USA
| | - JoshPaul Jolly
- a Department of Medicine , Icahn School of Medicine at Mount Sinai , Elmhurst , NY , USA
| | - Neil Vyas
- a Department of Medicine , Icahn School of Medicine at Mount Sinai , Elmhurst , NY , USA
| | - Sumair Ahmad
- a Department of Medicine , Icahn School of Medicine at Mount Sinai , Elmhurst , NY , USA
| | | | - Ahmed Al-Khazraji
- a Department of Medicine , Icahn School of Medicine at Mount Sinai , Elmhurst , NY , USA
| | - Dennis Finkielstein
- c Department of Cardiology , Icahn School of Medicine at Mount Sinai Beth Israel Medical Center , New York , NY , USA
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Cheng Z, Lin J, Qian Q. Role of Vitamin D in Cognitive Function in Chronic Kidney Disease. Nutrients 2016; 8:nu8050291. [PMID: 27187460 PMCID: PMC4882704 DOI: 10.3390/nu8050291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 04/23/2016] [Accepted: 05/04/2016] [Indexed: 01/08/2023] Open
Abstract
Both vitamin D deficiency and cognitive impairment are common in patients with chronic kidney disease (CKD). Vitamin D exerts neuroprotective and regulatory roles in the central nervous system. Hypovitaminosis D has been associated with muscle weakness and bone loss, cardiovascular diseases (hypertension, diabetes and hyperlipidemia), inflammation, oxidative stress, immune suppression and neurocognitive impairment. The combination of hypovitaminosis D and CKD can be even more debilitating, as cognitive impairment can develop and progress through vitamin D-associated and CKD-dependent/independent processes, leading to significant morbidity and mortality. Although an increasingly recognized comorbidity in CKD, cognitive impairment remains underdiagnosed and often undermanaged. Given the association of cognitive decline and hypovitaminosis D and their deleterious effects in CKD patients, determination of vitamin D status and when appropriate, supplementation, in conjunction with neuropsychological screening, should be considered integral to the clinical care of the CKD population.
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Affiliation(s)
- Zhen Cheng
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210016, China.
- Division of Nephrology and Hypertension Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Jing Lin
- Division of Nephrology and Hypertension Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Qi Qian
- Division of Nephrology and Hypertension Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Tsilidis KK, Papadimitriou N, Capothanassi D, Bamia C, Benetou V, Jenab M, Freisling H, Kee F, Nelen A, O'Doherty MG, Scott A, Soerjomataram I, Tjønneland A, May AM, Ramón Quirós J, Pettersson-Kymmer U, Brenner H, Schöttker B, Ordóñez-Mena JM, Karina Dieffenbach A, Eriksson S, Bøgeberg Mathiesen E, Njølstad I, Siganos G, Wilsgaard T, Boffetta P, Trichopoulos D, Trichopoulou A. Burden of Cancer in a Large Consortium of Prospective Cohorts in Europe. J Natl Cancer Inst 2016; 108:djw127. [DOI: 10.1093/jnci/djw127] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/06/2016] [Indexed: 11/13/2022] Open
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Abstract
Vitamin D is a precursor of the steroid hormone calcitriol that is crucial for bone and mineral metabolism. Both the high prevalence of vitamin D deficiency in the general population and the identification of the vitamin D receptor in the heart and blood vessels raised interest in the potential cardiovascular effects of vitamin D. Experimental studies have demonstrated various cardiovascular protective actions of vitamin D, but vitamin D intoxication in animals is known to induce vascular calcification. In meta-analyses of epidemiological studies, vitamin D deficiency is associated with an increased cardiovascular risk. Findings from Mendelian randomization studies and randomized, controlled trials (RCTs) do not indicate significant effects of a general vitamin D supplementation on cardiovascular outcomes. Previous RCTs, however, were not adequately designed to address extraskeletal events, and did not focus on vitamin D-deficient individuals. Therefore, currently available evidence does not support cardiovascular benefits or harms of vitamin D supplementation with the commonly used doses, and whether vitamin D has cardiovascular effects in individuals with overt vitamin D deficiency remains to be evaluated. Here, we provide an update on clinical studies on vitamin D and cardiovascular risk, discuss ongoing vitamin D research, and consider the management of vitamin D deficiency from a cardiovascular health perspective.
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246
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Röckert Tjernberg A, Bonnedahl J, Ludvigsson JF. Does Celiac Disease Influence Survival in Sepsis? A Nationwide Longitudinal Study. PLoS One 2016; 11:e0154663. [PMID: 27124735 PMCID: PMC4849637 DOI: 10.1371/journal.pone.0154663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/15/2016] [Indexed: 01/08/2023] Open
Abstract
Background Individuals with celiac disease (CD) are at increased risk of sepsis. The aim of this study was to examine whether CD influences survival in sepsis of bacterial origin. Methods Nationwide longitudinal registry-based study. Through data on small intestinal biopsies from Sweden’s 28 pathology departments, we identified 29,096 individuals with CD (villous atrophy, Marsh stage III). Each individual with CD was matched with five population-based controls. Among these, 5,470 had a record of sepsis according to the Swedish Patient Register (1,432 celiac individuals and 4,038 controls). Finally we retrieved data on mortality in sepsis patients through the Swedish Cause of Death Registry. Results CD was associated with a 19% increase in overall mortality after sepsis (95% confidence interval (CI) = 1.09–1.29), with the highest relative risk occurring in children (adjusted hazard ratio (aHR) = 1.62; 95%CI = 0.67–3.91). However, aHR for death from sepsis was lower (aHR = 1.10) and failed to reach statistical significance (95%CI = 0.72–1.69). CD did not influence survival within 28 days after sepsis (aHR = 0.98; 95%CI = 0.80–1.19). Conclusions Although individuals with CD seem to be at an increased risk of overall death after sepsis, that excess risk does not differ from the general excess mortality previously seen in celiac patients in Sweden. CD as such does not seem to influence short-term or sepsis-specific survival in individuals with sepsis and therefore is not an independent risk factor for poor prognosis in sepsis.
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Affiliation(s)
- Anna Röckert Tjernberg
- Department of Pediatrics, Kalmar County Hospital, Kalmar, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- * E-mail:
| | - Jonas Bonnedahl
- Department of Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden
- Zoonotic Ecology and Epidemiology, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
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247
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van den Berg KS, Marijnissen RM, van den Brink RHS, Naarding P, Comijs HC, Oude Voshaar RC. Vitamin D deficiency, depression course and mortality: Longitudinal results from the Netherlands Study on Depression in Older persons (NESDO). J Psychosom Res 2016; 83:50-6. [PMID: 27020077 DOI: 10.1016/j.jpsychores.2016.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To study the effect of vitamin D levels on depression course and remission status after two years, as well as attrition and mortality, in an older cohort. METHODS This study was part of the Netherlands Study on Depression in Older persons (NESDO), a prospective cohort study. 367 depressed older persons (≥ 60 years) were included. Baseline vitamin D status, reasons for loss to follow up, clinical depression diagnosis at two-year follow up, and six-monthly symptom scores were obtained. Data were analyzed by logistic regression and random coefficient models and adjusted for confounders of vitamin D status. RESULTS Vitamin D had no effect on the course of depression or remission, except for a trend towards lower remission rates in the severely deficient subgroup (25-(OH) vitamin D<25 nmol/l). Patients who died during follow up had significantly lower 25-(OH) vitamin D and 1,25-(OH)2 vitamin D levels than patients with continued participation. CONCLUSIONS For the total sample we found no effect of vitamin D levels on the course of depression or remission rates. However, we did find an effect of lower vitamin D levels on mortality. This strengthens the interpretation of vitamin D deficiency being a marker for poor somatic health status. The trend towards lower remission rates in the severely deficient subgroup raises the question whether this group could benefit from supplementation. Randomized controlled trials are necessary to study this.
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Affiliation(s)
- Karen S van den Berg
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, The Netherlands; Department of Old Age Psychiatry, Pro Persona, Wolfheze, The Netherlands.
| | - Radboud M Marijnissen
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, The Netherlands; Department of Old Age Psychiatry, Pro Persona, Wolfheze, The Netherlands
| | - Rob H S van den Brink
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Paul Naarding
- GGNet, Center for Old Age Psychiatry, Apeldoorn, The Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Richard C Oude Voshaar
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, The Netherlands
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248
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25-Hydroxyvitamin D concentration and all-cause mortality: the Melbourne Collaborative Cohort Study. Public Health Nutr 2016; 20:1775-1784. [DOI: 10.1017/s1368980016000501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractObjectiveTo investigate relationships between mortality and circulating 25-hydroxyvitamin D (25(OH)D), 25-hydroxycholecalciferol (25(OH)D3) and 25-hydroxyergocalciferol (25(OH)D2).DesignCase–cohort study within the Melbourne Collaborative Cohort Study (MCCS). We measured 25(OH)D2and 25(OH)D3in archived dried blood spots by LC–MS/MS. Cox regression was used to estimate mortality hazard ratios (HR), with adjustment for confounders.SettingGeneral community.SubjectsThe MCCS included 29 206 participants, who at recruitment in 1990–1994 were aged 40–69 years, had dried blood spots collected and no history of cancer. For the present study we selected participants who died by 31 December 2007 (n2410) and a random sample (sub-cohort,n2996).ResultsThe HR per 25 nmol/l increment in concentration of 25(OH)D and 25(OH)D3were 0·86 (95 % CI 0·78, 0·96;P=0·007) and 0·85 (95 % CI 0·77, 0·95;P=0·003), respectively. Of 5108 participants, sixty-three (1·2 %) had detectable 25(OH)D2; their mean 25(OH)D concentration was 11·9 (95 % CI 7·3, 16·6) nmol/l higher (P<0·001). The HR for detectable 25(OH)D2was 1·80 (95 % CI 1·09, 2·97;P=0·023); for those with detectable 25(OH)D2, the HR per 25 nmol/l increment in 25(OH)D was 1·06 (95 % CI 0·87, 1·29;Pinteraction=0·02). HR were similar for participants who reported being in good, very good or excellent health four years after recruitment.ConclusionsTotal 25(OH)D and 25(OH)D3concentrations were inversely associated with mortality. The finding that the inverse association for 25(OH)D was restricted to those with no detectable 25(OH)D2requires confirmation in populations with higher exposure to ergocalciferol.
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249
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Chung GE, Kim D, Kwak MS, Yang JI, Yim JY, Lim SH, Itani M. The serum vitamin D level is inversely correlated with nonalcoholic fatty liver disease. Clin Mol Hepatol 2016; 22:146-51. [PMID: 27044765 PMCID: PMC4825160 DOI: 10.3350/cmh.2016.22.1.146] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 02/06/2023] Open
Abstract
Background/Aims: A low vitamin D level has been associated with metabolic syndrome and diabetes. However, an association between a low vitamin D level and nonalcoholic fatty liver disease (NAFLD) has not yet been definitively established. This study aimed to characterize the relationship between a vitamin D level and NAFLD in Korea. Methods: A cross-sectional study involving 6,055 health check-up subjects was conducted. NAFLD was diagnosed on the basis of typical ultrasonographic findings and a history of alcohol consumption. Results: The subjects were aged 51.7±10.3 years (mean±SD) and 54.7% were female. NAFLD showed a significant inverse correlation with the vitamin D level after adjusting for age and sex [odds ratio (OR)=0.85, 95% confidence interval (CI)=0.75–0.96]. The age- and sex-adjusted prevalence of NAFLD decreased steadily with increasing vitamin D level [OR=0.74, 95% CI=0.60–0.90, lowest quintile (≤14.4 ng/mL) vs highest quintile (≥28.9 ng/mL), p for trend <0.001]. Multivariate regression analysis after adjusting for other metabolic factors revealed that NAFLD showed a significant inverse correlation with both the vitamin D level (>20 ng/mL) [OR=0.86, 95% CI=0.75-0.99] and the quintiles of the vitamin D level in a dose-dependent manner (p for trend=0.001). Conclusions: The serum level of vitamin D, even when within the normal range, was found to be inversely correlated with NAFLD in a dose-dependent manner. Vitamin D was found to be inversely correlated with NAFLD independent of known metabolic risk factors. These findings suggest that vitamin D exerts protective effects against NAFLD.
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Affiliation(s)
- Goh Eun Chung
- Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Donghee Kim
- Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Min-Sun Kwak
- Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jong In Yang
- Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jeong Yoon Yim
- Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Seon Hee Lim
- Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Mustafa Itani
- Pulmonary and Critical Care Consultant, Sheikh Khalifa Specialty Hospital, Ras AlKhaimah, UAE
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Meyer HE, Støer NC, Samuelsen SO, Blomhoff R, Robsahm TE, Brustad M, Giovannucci EL, Bjørge T. Long Term Association between Serum 25-Hydroxyvitamin D and Mortality in a Cohort of 4379 Men. PLoS One 2016; 11:e0151441. [PMID: 26986958 PMCID: PMC4795600 DOI: 10.1371/journal.pone.0151441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/29/2016] [Indexed: 12/31/2022] Open
Abstract
Objective A number of observational studies have shown an inverse association between circulating 25-hydroxyvitamin D and total mortality, but a reverse J-shaped association has also been reported. In a large nested case-control study, serum-25-hydroxyvitamin D (s-25(OH)D) was positively associated with incident prostate cancer. Based on the same study population, the primary aim of the present study was to investigate the association between s-25(OH)D and total mortality. Methods Men participating in population based health screenings during 1981–1991 and enrolled in a nested case-control study were followed throughout 2007 with respect to all-cause and cause-specific mortality. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards regression. Results In men with prostate cancer (n = 2282), there was a significant inverse association between s-25(OH)D and total mortality after controlling for potential confounders (HR = 1.25 (95% CI 1.05–1.50), s-25(OH)D <50 nmol/l versus s-25(OH)D ≥50 nmol/l). The corresponding figure among controls (n = 2147) was HR = 1.15 (95% CI 0.88–1.50) and in the total study population HR = 1.19 (95% CI 1.03–1.38). For cause-specific deaths, we found no significant associations. Conclusions In this study population, s-25(OH)D was inversely associated with total mortality during more than two decades of follow-up, despite, as previous reported, high s-25(OH)D was associated with increased risk of prostate cancer.
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Affiliation(s)
- Haakon E. Meyer
- Department of Community Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Nathalie C. Støer
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sven O. Samuelsen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Trude E. Robsahm
- The Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Magritt Brustad
- Department of Community Medicine, UIT The Artic University of Norway, Tromsø, Norway
| | - Edward L. Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tone Bjørge
- The Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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