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Singh Ospina N, Diaz-Thomas A, McDonnell ME, Demay MB, Pittas AG, York E, Corrigan MD, Lash RW, Brito JP, Murad MH, McCartney CR. Navigating Complexities: Vitamin D, Skin Pigmentation, and Race. J Clin Endocrinol Metab 2024; 109:1955-1960. [PMID: 38828960 PMCID: PMC11244154 DOI: 10.1210/clinem/dgae314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Indexed: 06/05/2024]
Abstract
Vitamin D plays a critical role in many physiological functions, including calcium metabolism and musculoskeletal health. This commentary aims to explore the intricate relationships among skin complexion, race, and 25-hydroxyvitamin D (25[OH]D) levels, focusing on challenges the Endocrine Society encountered during clinical practice guideline development. Given that increased melanin content reduces 25(OH)D production in the skin in response to UV light, the guideline development panel addressed the potential role for 25(OH)D screening in individuals with dark skin complexion. The panel discovered that no randomized clinical trials have directly assessed vitamin D related patient-important outcomes based on participants' skin pigmentation, although race and ethnicity often served as presumed proxies for skin pigmentation in the literature. In their deliberations, guideline panel members and selected Endocrine Society leaders underscored the critical need to distinguish between skin pigmentation as a biological variable and race and ethnicity as socially determined constructs. This differentiation is vital to maximize scientific rigor and, thus, the validity of resulting recommendations. Lessons learned from the guideline development process emphasize the necessity of clarity when incorporating race and ethnicity into clinical guidelines. Such clarity is an essential step toward improving health outcomes and ensuring equitable healthcare practices.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, University of Florida, Gainesville, FL 32610, USA
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Marie E McDonnell
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Marie B Demay
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | | | | | | | - Juan P Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M Hassan Murad
- Mayo Clinic, Evidence-Based Practice Center, Rochester, MN 55905, USA
| | - Christopher R McCartney
- Division of Endocrinology and Metabolism, Department of Medicine, West Virginia University, Morgantown, WV 26506, USA
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Gómez O, Campusano C, Cerdas-P S, Mendoza B, Páez-Talero A, de la Peña-Rodríguez MP, Reza-Albarrán AA, Rueda-Plata PN. Clinical Practice Guidelines of the Latin American Federation of Endocrinology for the use of vitamin D in the maintenance of bone health: recommendations for the Latin American context. Arch Osteoporos 2024; 19:46. [PMID: 38850469 PMCID: PMC11162390 DOI: 10.1007/s11657-024-01398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/01/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION These guidelines aim to provide evidence-based recommendations for the supplementation of Vitamin D in maintaining bone health. An unmet need persists in Latin American regarding the availability of clinical and real-world data for rationalizing the use of vitamin D supplementation. The objective of these guidelines is to establish clear and practical recommendations for healthcare practitioners from Latin American countries to address Vitamin D insufficiency in clinical practice. METHODS The guidelines were developed according to the GRADE-ADOLOPMENT methodology for the adaptation or adoption of CPGs or evidence-based recommendations. A search for high quality CPGs was complemented through a comprehensive review of recent literature, including randomized controlled trials, observational studies, and systematic reviews evaluating the effects of Vitamin D supplementation on bone health. The evidence to decision framework proposed by the GRADE Working Group was implemented by a panel of experts in endocrinology, bone health, and clinical research. RESULTS The guidelines recommend Vitamin D supplementation for individuals aged 18 and above, considering various populations, including healthy adults, individuals with osteopenia, osteoporosis patients, and institutionalized older adults. These recommendations offer dosing regimens depending on an individualized treatment plan, and monitoring intervals of serum 25-hydroxyvitamin D levels and adjustments based on individual results. DISCUSSION The guidelines highlight the role of Vitamin D in bone health and propose a standardized approach for healthcare practitioners to address Vitamin D insufficiency across Latin America. The panel underscored the necessity for generating local data and stressed the importance of considering regional geography, social dynamics, and cultural specificities when implementing these guidelines.
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Affiliation(s)
- Oscar Gómez
- Department of Psychiatry and Mental Health, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Claudia Campusano
- Facultad de Medicina de La Universidad de los Andes, Unidad de Endocrinología de La Clínica Universidad de los Andes, Sociedad Chilena de Endocrinología y Diabetes (SOCHED), Santiago, Chile
| | - Sonia Cerdas-P
- Facultad de Medicina de la Universidad de Costa Rica, Servicio de Endocrinología del Hospital Cima San José, Asociación Costarricense de Endocrinología (ASCEND), San José, Costa Rica
| | - Beatriz Mendoza
- Clínica de Endocrinología y Metabolismo de La Facultad de Medicina de La República Oriental del Uruguay, Clínica de Endocrinología y Metabolismo del Hospital Manuel Quintela, Sociedad Uruguaya de Endocrinología y Metabolismo (SUEM), Montevideo, Uruguay
| | - Amanda Páez-Talero
- Asociación Colombiana de Endocrinología, Diabetes y Metabolismo (ACE), Bogotá, Colombia
| | - María Pilar de la Peña-Rodríguez
- Departamento de Endocrinología de La Facultad de Medicina de la Universidad Autónoma de Guadalajara (UAG), Presidenta Electa Para La Federación Latinoamericana de Endocrinología (FELAEN), Sociedad Mexicana de Nutrición y Endocrinología, Colegio Jalisciense de Endocrinología y Nutrición, Servicios Médicos De La Peña, SC, Guadalajara, México
| | - Alfredo Adolfo Reza-Albarrán
- Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Sede Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Sociedad Mexicana de Nutrición y Endocrinología y Consejo Mexicano de Endocrinología, Ciudad de Mexico, México
| | - Pedro Nel Rueda-Plata
- Federación Latinoamericana de Endocrinología (FELAEN), Universidad Nacional de Colombia, Asociación Colombiana de Endocrinología, Diabetes y Metabolismo (ACE), Bogotá, Colombia
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Harvey NC, Ward KA, Agnusdei D, Binkley N, Biver E, Campusano C, Cavalier E, Clark P, Diaz-Curiel M, Fuleihan GEH, Khashayar P, Lane NE, Messina OD, Mithal A, Rizzoli R, Sempos C, Dawson-Hughes B. Optimisation of vitamin D status in global populations. Osteoporos Int 2024:10.1007/s00198-024-07127-z. [PMID: 38836946 DOI: 10.1007/s00198-024-07127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
Vitamin D is important for musculoskeletal health. Concentrations of 25-hydroxyvitamin D, the most commonly measured metabolite, vary markedly around the world and are influenced by many factors including sun exposure, skin pigmentation, covering, season and supplement use. Whilst overt vitamin D deficiency with biochemical consequences presents an increased risk of severe sequelae such as rickets, osteomalacia or cardiomyopathy and usually warrants prompt replacement treatment, the role of vitamin D supplementation in the population presents a different set of considerations. Here the issue is to keep, on average, the population at a level whereby the risk of adverse health outcomes in the population is minimised. This position paper, which complements recently published work from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, addresses key considerations regarding vitamin D assessment and intervention from the population perspective. This position paper, on behalf of the International Osteoporosis Foundation Vitamin D Working Group, summarises the burden and possible amelioration of vitamin D deficiency in global populations. It addresses key issues including screening, supplementation and food fortification.
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Affiliation(s)
- N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - K A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - N Binkley
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C Campusano
- Internal Medicine Department, Clínica Universidad de los Andes and Universidad de los Andes, Santiago, Chile
| | - E Cavalier
- Department of Clinical Chemistry, University of Liege, CIRM, CHU de Liège, Liège, Belgium
| | - P Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez-Facultad de Medicina UNAM, Mexico, Mexico
| | - M Diaz-Curiel
- Fundacion Jimenez Diaz, Autonoma University, Madrid, Spain
| | - G E-H Fuleihan
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, Lebanon
| | - P Khashayar
- International Institute for Biosensing, University of Minnesota, Minneapolis, USA
| | - N E Lane
- Division of Rheumatology, Department of Medicine, U.C. Davis Health, Sacramento, CA, USA
| | - O D Messina
- IRO Medical Research Centre, Collaborating Centre WHO, Buenos Aires, Argentina
| | - A Mithal
- Institute of Endocrinology and Diabetes, Max Healthcare, Delhi, India
| | - R Rizzoli
- Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C Sempos
- Vitamin D Standardization Program (VDSP), Havre de Grace, MD, USA
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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Grant WB. Cancer Incidence Rates in the US in 2016-2020 with Respect to Solar UVB Doses, Diabetes and Obesity Prevalence, Lung Cancer Incidence Rates, and Alcohol Consumption: An Ecological Study. Nutrients 2024; 16:1450. [PMID: 38794688 PMCID: PMC11123752 DOI: 10.3390/nu16101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
This article reports the results of an ecological study of cancer incidence rates by state in the US for the period 2016-2020. The goals of this study were to determine the extent to which solar UVB doses reduced cancer risk compared to findings reported in 2006 for cancer mortality rates for the periods 1950-1969 and 1970-1794 as well as cancer incidence rates for the period 1998-2002 and to determine which factors were recently associated with cancer risk. The cancer data for non-Hispanic white (European American) men and women were obtained from the Centers for Disease Control and Prevention. Indices were obtained for solar UVB at the surface for July 1992, and alcohol consumption, diabetes, and obesity prevalence near the 2016-2020 period. Lung cancer incidence rates were also used in the analyses as a surrogate for smoking, diet, and air pollution. The cancers for which solar UVB is significantly associated with reduced incidence are bladder, brain (males), breast, corpus uteri, esophageal, gastric, non-Hodgkin's lymphoma, pancreatic, and renal cancer. Lung cancer was significantly associated with colorectal, laryngeal, and renal cancer. Diabetes was also significantly associated with breast, liver, and lung cancer. Obesity prevalence was significantly associated with breast, colorectal, and renal cancer. Alcohol consumption was associated with bladder and esophageal cancer. Thus, diet has become a very important driver of cancer incidence rates. The role of solar UVB in reducing the risk of cancer has been reduced due to people spending less time outdoors, wearing sunscreen that blocks UVB but not UVA radiation, and population increases in terms of overweight and obese individuals, which are associated with lower 25-hydroxyvitamin D concentrations and the generation of systemic inflammation, which is a risk factor for cancer. A dietary approach that would reduce the risk of diabetes, obesity, lung cancer, and, therefore, cancer, would be one based mostly on whole plants and restrictions on red and processed meats and ultraprocessed foods. Solar UVB exposure for a few minutes before applying sunscreen and taking vitamin D supplements would also help reduce the risk of cancer.
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Affiliation(s)
- William B Grant
- Sunlight, Nutrition, and Health Research Center, 1745 Pacific Ave., Suite 504, San Francisco, CA 94109, USA
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Cavalier E, Makris K, Heijboer AC, Herrmann M, Souberbielle JC. Vitamin D: Analytical Advances, Clinical Impact, and Ongoing Debates on Health Perspectives. Clin Chem 2024:hvae056. [PMID: 38712647 DOI: 10.1093/clinchem/hvae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Vitamin D, acknowledged since the 1930s for its role in preventing rickets, gained additional prominence in relation to fragility fracture prevention in the late 1980s. From the early 2000s, connections between vitamin D deficiency and extra-skeletal pathologies emerged, alongside increased awareness of widespread deficits. This prompted crucial debates on optimal serum concentrations, expected to conclude when the outcomes of high-dose supplementation randomized controlled trials were available. Skepticism arose with inconclusive results from these trials. CONTENT This review begins with an exploration of vitamin D metabolism, followed by a detailed description of the measurement of vitamin D metabolites and the crucial role of standardization. Subsequent sections focus on the association of vitamin D with bone health and explore the extra-skeletal effects. The review concludes with a comprehensive discussion on the definition of vitamin D status and its implications for supplementation. SUMMARY Despite standardization efforts, assay variations and challenges still exist, especially in specific patient groups. Vitamin D supplementation has a significant impact on bone metabolism and optimal vitamin D status improves the efficacy of antiresorptive drugs such as bisphosphonates. The extra-skeletal effects of vitamin D remain debated, but may include potential benefits in conditions such as respiratory infections and cancer mortality, particularly in deficient individuals. The definition of vitamin D sufficiency is nuanced, especially when variations in population groups and analytical methods are taken into account. Despite ongoing debates and recent mega-trials tempering enthusiasm, vitamin D remains a complex and essential element in human health. Further research is needed to clarify its role in various health outcomes and guide supplementation strategies.
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Affiliation(s)
- Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CIRM, CHU de Liège, Liège, Belgium
| | | | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam Gastroenterology & Metabolism, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Markus Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
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Mao Y, Li X, Li Y, Zhu S, Han X, Zhao R, Geng Y. Association of serum 25-hydroxyvitamin d concentrations with all-cause and cause-specific mortality among individuals with depression: A cohort study. J Affect Disord 2024; 352:10-18. [PMID: 38341158 DOI: 10.1016/j.jad.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Limited evidence exists on the relationship between vitamin D status and mortality in depressed patients. METHODS This study investigates serum 25-hydroxyvitamin D [25(OH)D] concentrations in 8417 adults with depression among the National Health and Nutrition Examination Survey (NHANES, 2005-2018). Mortality outcomes were assessed through National Death Index records up to December 31, 2019. Cox proportional risk models estimated risk ratios (HR) and 95 % confidence intervals (CI) for all-cause, cardiovascular disease (CVD), and cancer mortality. Restricted cubic spline analyses explored the nonlinear association of serum 25(OH)D levels with mortality, using the likelihood ratio test for nonlinearity. RESULTS The weighted mean serum 25(OH)D level was 66.40 nmol/L (95 % CI: 65.8, 67.0), with 36.3 % having deficient vitamin D (<50 nmol/L [20 ng/mL]). Over an average 7.16-year follow-up, 935 deaths were documented, including 296 CVD deaths and 191 cancer deaths. Higher serum 25(OH)D levels were associated with reduced all-cause mortality (HRs 0.55-1.00, p trend = 0.006) and cancer-specific mortality (HRs 0.36-1.00, p trend = 0.015) after multivariate adjustment. The relationship between serum 25(OH)D and all-cause mortality exhibited a nonlinear pattern (P for nonlinearity <0.001), with a 34 % lower risk for each unit increase in natural log-transformed 25(OH)D levels. Significant interactions were observed with age, antidepressant use, and diabetes status. CONCLUSIONS Higher serum 25(OH)D levels were associated with decreased all-cause and cancer-specific mortality in depressed adults, particularly among younger individuals and those using antidepressants or without diabetes. Further research is essential to understand mechanisms and interventions related to vitamin D in depression.
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Affiliation(s)
- Yafei Mao
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Laboratory Medicine, Fengfeng General Hospital of North China Medical & Health Group, Han Dan, Hebei, China
| | - Xinyuan Li
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yanming Li
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shumin Zhu
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xu Han
- Department of Laboratory Medicine, Fengfeng General Hospital of North China Medical & Health Group, Han Dan, Hebei, China
| | - Rui Zhao
- Department of Laboratory Medicine, Fengfeng General Hospital of North China Medical & Health Group, Han Dan, Hebei, China
| | - Yulan Geng
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Fang A, Zhao Y, Yang P, Zhang X, Giovannucci EL. Vitamin D and human health: evidence from Mendelian randomization studies. Eur J Epidemiol 2024; 39:467-490. [PMID: 38214845 DOI: 10.1007/s10654-023-01075-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 10/30/2023] [Indexed: 01/13/2024]
Abstract
We summarized the current evidence on vitamin D and major health outcomes from Mendelian randomization (MR) studies. PubMed and Embase were searched for original MR studies on vitamin D in relation to any health outcome from inception to September 1, 2022. Nonlinear MR findings were excluded due to concerns about the validity of the statistical methods used. A meta-analysis was preformed to synthesize study-specific estimates after excluding overlapping samples, where applicable. The methodological quality of the included studies was evaluated according to the STROBE-MR checklist. A total of 133 MR publications were eligible for inclusion in the analyses. The causal association between vitamin D status and 275 individual outcomes was examined. Linear MR analyses showed genetically high 25-hydroxyvitamin D (25(OH)D) concentrations were associated with reduced risk of multiple sclerosis incidence and relapse, non-infectious uveitis and scleritis, psoriasis, femur fracture, leg fracture, amyotrophic lateral sclerosis, anorexia nervosa, delirium, heart failure, ovarian cancer, non-alcoholic fatty liver disease, dyslipidemia, and bacterial pneumonia, but increased risk of Behçet's disease, Graves' disease, kidney stone disease, fracture of radium/ulna, basal cell carcinoma, and overall cataracts. Stratified analyses showed that the inverse association between genetically predisposed 25(OH)D concentrations and multiple sclerosis risk was significant and consistent regardless of the genetic instruments GIs selected. However, the associations with most of the other outcomes were only pronounced when using genetic variants not limited to those in the vitamin D pathway as GIs. The methodological quality of the included MR studies was substantially heterogeneous. Current evidence from linear MR studies strongly supports a causal role of vitamin D in the development of multiple sclerosis. Suggestive support for a number of other health conditions could help prioritize conditions where vitamin D may be beneficial or harmful.
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Affiliation(s)
- Aiping Fang
- Department of Nutrition, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Yue Zhao
- Department of Nutrition, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Ping Yang
- School of Nursing, Peking University, Beijing, China
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Xuehong Zhang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Ensrud KE, Crandall CJ. Osteoporosis. Ann Intern Med 2024; 177:ITC1-ITC16. [PMID: 38190715 DOI: 10.7326/aitc202401160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Osteoporosis is a common systemic skeletal disorder resulting in bone fragility and increased fracture risk. Evidence-based screening strategies improve identification of patients who are most likely to benefit from drug treatment to prevent fracture. In addition, careful consideration of when pharmacotherapy should be started, choice of medication, and duration of treatment maximizes the benefits of fracture prevention while minimizing potential harms of long-term drug exposure.
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Affiliation(s)
| | - Carolyn J Crandall
- David Geffen School of Medicine at UCLA, Los Angeles, California (C.J.C.)
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Zhong P, Zhu Z, Wang Y, Huang W, He M, Wang W. Cardiovascular and microvascular outcomes according to vitamin D level and genetic variants among individuals with prediabetes: a prospective study. J Transl Med 2023; 21:724. [PMID: 37845735 PMCID: PMC10577927 DOI: 10.1186/s12967-023-04557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Whether serum vitamin D mediate vascular diseases in prediabetic populations remains unclear. This study aimed to determine the associations between circulating 25-hydroxyvitamin D [25(OH)D] levels and vitamin D receptor (VDR) polymorphisms with the risk of macrovascular complications, including myocardial infarction and stroke, and microvascular complications such as diabetic nephropathy and retinopathy, among adults with prediabetes. METHODS Participants with prediabetes in UK Biobank were included (N = 56,387). Multivariable dose-response and Cox proportion models were used to explore the relationship of serum 25(OH)D status and the risks of vascular complications. The interaction of VDR polymorphisms with serum 25(OH)D level on risks of vascular events was also assessed. RESULTS During a median follow-up of 12 years, higher levels of 25(OH)D were significantly and nonlinearly associated with a lower risk of macrovascular diseases among prediabetic individuals. The adjusted hazard ratios (95% confidential interval) of serum 25(OH)D levels of ≥ 75.0 nmol/L versus < 25 nmol/L were 0.75 (0.63-0.88) for myocardial infarction, 0.74 (0.55-1.00) for stroke, 1.02 (0.60-1.74) for diabetic nephropathy, and 1.30 (0.92-1.84) for diabetic retinopathy, respectively. The rs2228570 (FokI) polymorphisms significantly interacted with 25(OH)D on incident myocardial infarction (P-interaction = 0.042) and stroke (P-interaction = 0.033). The individuals with serum 25(OH)D level of 50.0-74.9 nmol/L and rs2228570 (FokI) homozygotes had the lowest risks of vascular complications. CONCLUSIONS Lower serum 25(OH)D levels are significantly and nonlinearly associated with an increased risk of cardiocerebrovascular diseases in prediabetic individuals, with VDR polymorphisms of rs2228570 (FokI) modify such associations. Monitoring a safe 25(OH)D concentration is suggested to prevent the vascular complications for prediabetes.
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Affiliation(s)
- Pingting Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China
| | - Zhuoting Zhu
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Yunlong Wang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China.
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China.
- Experimental Ophthalmology, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China.
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China.
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Bouillon R, LeBoff MS, Neale RE. Health Effects of Vitamin D Supplementation: Lessons Learned From Randomized Controlled Trials and Mendelian Randomization Studies. J Bone Miner Res 2023; 38:1391-1403. [PMID: 37483080 PMCID: PMC10592274 DOI: 10.1002/jbmr.4888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
Vitamin D plays an important role in calcium homeostasis and many cellular processes. Although vitamin D supplements are widely recommended for community-dwelling adults, definitive data on whether these supplements benefit clinically important skeletal and extraskeletal outcomes have been conflicting. Although observational studies on effects of vitamin D on musculoskeletal and extraskeletal outcomes may be confounded by reverse causation, randomized controlled studies (RCTs) and Mendelian randomization (MR) studies can help to elucidate causation. In this review, we summarize the recent findings from large RCTs and/or MR studies of vitamin D on bone health and risk of fractures, falls, cancer, and cardiovascular disease, disorders of the immune system, multiple sclerosis, and mortality in community-dwelling adults. The primary analyses indicate that vitamin D supplementation does not decrease bone loss, fractures, falls, cancer incidence, hypertension, or cardiovascular risk in generally healthy populations. Large RCTs and meta-analyses suggest an effect of supplemental vitamin D on cancer mortality. The existence of extraskeletal benefits of vitamin D supplementations are best documented for the immune system especially in people with poor vitamin D status, autoimmune diseases, and multiple sclerosis. Accumulating evidence indicates that vitamin D may reduce all-cause mortality. These findings, in mostly vitamin D-replete populations, do not apply to older adults in residential communities or adults with vitamin D deficiency or osteoporosis. The focus of vitamin D supplementation should shift from widespread use in generally healthy populations to targeted vitamin D supplementation in select individuals, good nutritional approaches, and elimination of vitamin D deficiency globally. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Mebabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Meryl S LeBoff
- Calcium and Bone Section, Endocrine, Diabetes and Hypertension Division, Department of Medicine Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel E Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Zhou Y, Jiang M, Sun JY, Cheng C, Shen H, Sun W, Kong XQ. The Association Between Vitamin D Levels and the 10-Year Risk of Atherosclerotic Cardiovascular Disease: A Population-Based Study. J Cardiovasc Nurs 2023; 38:E178-E186. [PMID: 36178328 DOI: 10.1097/jcn.0000000000000943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The association between vitamin D levels and atherosclerotic cardiovascular disease (ASCVD) risk remains unclear. In this study, the association between serum 25(OH)D and 10-year ASCVD risk was examined in a national sample of middle-aged and older adults. METHODS Cross-sectional data from the 2009-2014 National Health and Nutrition Examination Survey were analyzed. The Pooled Cohort Equations were used to estimate the risk of a first ASCVD event in 10 years. An adjusted multiple linear regression model was used to investigate the association between serum 25(OH)D and ASCVD risk. In addition, we performed sensitivity analysis and interactive analysis to assess the robustness of associations across different subgroups. RESULTS A total of 3354 participants were included in this study. The linear regression model indicated that the risk of ASCVD decreased with the increase in serum 25(OH)D. When analyzed as a continuous variable, serum 25(OH)D was significantly associated with the estimated 10-year risk of ASCVD. In the fully adjusted model, each 10-nmol/L increase in serum 25(OH)D reduced the estimated 10-year ASCVD risk by 0.172% ( P < .001). Individuals in the moderate, insufficient, and sufficient vitamin D deficiency groups had a 0.449% ( P = .362), 0.957% ( P = .046), 1.475% ( P = .003) decrease in ASCVD risk, respectively, when a severe vitamin D deficiency group was set as a reference in the fully adjusted model. CONCLUSION Our data suggest a negative association between vitamin D levels and the predicted 10-year risk of ASCVD. Further studies are required to investigate whether vitamin D supplements could reduce the risk of ASCVD.
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Zhuang Y, Zhu Z, Chi P, Zhou H, Peng Z, Cheng H, Xin X, Luo W, Si S, Mo M, Chen D, Liu H, Yu Y. Efficacy of intermittent versus daily vitamin D supplementation on improving circulating 25(OH)D concentration: a Bayesian network meta-analysis of randomized controlled trials. Front Nutr 2023; 10:1168115. [PMID: 37693250 PMCID: PMC10488712 DOI: 10.3389/fnut.2023.1168115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Background Vitamin D deficiency is a widespread issue globally, resulting in increased use of vitamin D supplements. However, it is unclear whether intermittent (weekly or monthly) vitamin D supplementation is as effective as daily supplementation in improving circulating 25-hydroxyvitamin D [25(OH)D] levels. Methods Three databases including Medline, EMBASE, and the Cochrane Library were systematically searched up to 10 November 2020. The risk of bias was evaluated according to Cochrane Collaboration's tool for rating methodological quality assessment. Direct and indirect comparisons between interventions and controls were performed by a Bayesian network meta-analysis (NMA), where the mean difference (MD) and its 95% confidence interval (CI) were used to indicate the efficacy. Results This NMA analysis included 116 RCTs with a total of 11,376 participants. Generally, we observed that 25(OH)D concentrations were significantly elevated regardless of vitamin D supplementation frequency. Although the findings of SUCRA indicated that daily vitamin D supplementation had a higher rank value than intermittent supplementation when the supplement dosage was similar, no statistically significant pooled mean differences of 25(OH)D concentration were noted between the daily supplementation group and intermittent supplementation group. Additionally, weekly supplementation with a total of 600,000 IU vitamin D supplementation during 3 months had the best efficacy in elevating 25(OH)D concentration (pooled MD = 63 nmol/L, 95%CI: 49-77). To achieve optimal 25(OH)D concentration (>75 nmol/L), we recommend 60,000 IU vitamin D supplementation monthly (~2,000 IU/day). Conclusion The efficacy of intermittent vitamin D supplementation was similar to daily supplementation. Coupled with its convenience, the frequency and dosage of intermittent vitamin D supplements were recommended to reach the optimal 25(OH)D level.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257257, PROSPERO CRD42021257257.
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Affiliation(s)
- Yan Zhuang
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Peihan Chi
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Haibo Zhou
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhicheng Peng
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Haoyue Cheng
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xing Xin
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wenliang Luo
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shuting Si
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Minjia Mo
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Danqing Chen
- Department of Obstetrics and Gynecology, Woman's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Liu
- Central Lab, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunxian Yu
- Department of Public Health, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Schrack JA, Cai Y, Urbanek JK, Wanigatunga AA, Mitchell CM, Miller ER, Guralnik JM, Juraschek SP, Michos ED, Roth DL, Appel LJ. The association of vitamin D supplementation and serum vitamin D levels with physical activity in older adults: Results from a randomized trial. J Am Geriatr Soc 2023; 71:2208-2218. [PMID: 36821761 PMCID: PMC10363216 DOI: 10.1111/jgs.18290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND To assess whether vitamin D3 supplementation attenuates the decline in daily physical activity in low-functioning adults at risk for falls. METHODS Secondary data analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You), a response-adaptive randomized clinical trial. Participants included 571 adults aged 70 years and older with baseline serum 25(OH)D levels of 10-29 ng/mL and elevated fall risk, who wore a wrist accelerometer at baseline and at least one follow-up visit and were randomized to receive: 200 IU/day (control), 1000, 2000, or 4000 IU/day of vitamin D3 . Objective physical activity quantities and patterns (total daily activity counts, active minutes/day, and activity fragmentation) were measured for 7-days, 24-h/day, in the free-living environment using the Actigraph GT9x over up to 24-months of follow-up. RESULTS In adjusted models, physical activity quantities declined (p < 0.001) and became more fragmented, or "broken up", (p = 0.017) over time. Supplementation with vitamin D3 did not attenuate this decline. Changes in physical activity were more rapid among those with baseline serum 25(OH)D <20 ng/mL compared to those with baseline 25(OH)D levels of 20-29 ng/mL (time*baseline 25(OH)D, p < 0.05). CONCLUSION In low-functioning older adults with serum 25(OH)D levels 10-29 ng/mL, vitamin D3 supplementation of 1000 IU/day or higher did not attenuate declines in physical activity compared with 200 IU/day. Those with baseline 25(OH)D <20 ng/mL showed accelerated declines in physical activity. Alternative interventions to supplementation are needed to curb declines in physical activity in older adults with low serum 25(OH)D.
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Affiliation(s)
- Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
| | - Yurun Cai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Jacek K. Urbanek
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of Geriatric Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amal A. Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
| | - Christine M. Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
| | - Edgar R. Miller
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jack M. Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen P. Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, Massachusetts, USA
| | - Erin D. Michos
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - David L. Roth
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of Geriatric Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Ruiz-García A, Pallarés-Carratalá V, Turégano-Yedro M, Torres F, Sapena V, Martin-Gorgojo A, Martin-Moreno JM. Vitamin D Supplementation and Its Impact on Mortality and Cardiovascular Outcomes: Systematic Review and Meta-Analysis of 80 Randomized Clinical Trials. Nutrients 2023; 15:nu15081810. [PMID: 37111028 PMCID: PMC10146299 DOI: 10.3390/nu15081810] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The impact of vitamin D supplementation on cardiovascular outcomes and mortality risk reduction remains unclear due to conflicting study findings. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between 1983 and 2022, that reported the effect of vitamin D supplementation in adults versus placebo or no treatment on all-cause mortality (ACM), cardiovascular mortality (CVM), non-cardiovascular mortality (non-CVM), and cardiovascular morbidities. Only studies with a follow-up period longer than one year were included. The primary outcomes were ACM and CVM. Secondary outcomes were non-CVM, myocardial infarction, stroke, heart failure, and major or extended adverse cardiovascular events. Subgroup analyses were performed according to low-, fair- and good-quality RCTs. RESULTS Eighty RCTs were assessed, including 82,210 participants receiving vitamin D supplementation and 80,921 receiving placebo or no treatment. The participants' mean (SD) age was 66.1 (11.2) years, and 68.6% were female. Vitamin D supplementation was associated with a lower risk of ACM (OR: 0.95 [95%CI 0.91-0.99] p = 0.013), was close to statistical significance for a lower risk of non-CVM (OR: 0.94 [95%CI 0.87-1.00] p = 0.055), and was not statistically associated with a lower risk of any cardiovascular morbi-mortality outcome. Meta-analysis of low-quality RCTs showed no association with cardiovascular or non-cardiovascular morbi-mortality outcomes. CONCLUSIONS The emerging results of our meta-analysis present evidence that vitamin D supplementation appears to decrease the risk of ACM (especially convincing in the fair- and good-quality RCTs), while not showing a decrease in the specific cardiovascular morbidity and mortality risk. Thus, we conclude that further research is warranted in this area, with well-planned and executed studies as the basis for more robust recommendations.
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Affiliation(s)
- Antonio Ruiz-García
- Lipids and Cardiovascular Prevention Unit, Pinto University Health Center, 28320 Madrid, Spain
- Department of Medicine, European University of Madrid, 28670 Madrid, Spain
| | - Vicente Pallarés-Carratalá
- Health Surveillance Unit, Castellón Mutual Insurance Union, 12003 Castellón, Spain
- Department of Medicine, Universitat Jaume I, 12006 Castellón, Spain
| | | | - Ferran Torres
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona Bellaterra, 08193 Barcelona, Spain
| | - Víctor Sapena
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona Bellaterra, 08193 Barcelona, Spain
| | | | - Jose M Martin-Moreno
- Department of Preventive Medicine and Public Health, University of Valencia, 46010 Valencia, Spain
- Biomedical Research Institute INCLIVA, Clinic University Hospital, 46010 Valencia, Spain
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Xu JJ, Zhang XB, Tong WT, Ying T, Liu KQ. Phenome-wide Mendelian randomization study evaluating the association of circulating vitamin D with complex diseases. Front Nutr 2023; 10:1108477. [PMID: 37063319 PMCID: PMC10095159 DOI: 10.3389/fnut.2023.1108477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundCirculating vitamin D has been associated with multiple clinical diseases in observational studies, but the association was inconsistent due to the presence of confounders. We conducted a bidirectional Mendelian randomization (MR) study to explore the healthy atlas of vitamin D in many clinical traits and evaluate their causal association.MethodsBased on a large-scale genome-wide association study (GWAS), the single nucleotide polymorphism (SNPs) instruments of circulating 25-hydroxyvitamin D (25OHD) from 443,734 Europeans and the corresponding effects of 10 clinical diseases and 42 clinical traits in the European population were recruited to conduct a bidirectional two-sample Mendelian randomization study. Under the network of Mendelian randomization analysis, inverse-variance weighting (IVW), weighted median, weighted mode, and Mendelian randomization (MR)–Egger regression were performed to explore the causal effects and pleiotropy. Mendelian randomization pleiotropy RESidual Sum and Outlier (MR-PRESSO) was conducted to uncover and exclude pleiotropic SNPs.ResultsThe results revealed that genetically decreased vitamin D was inversely related to the estimated BMD (β = −0.029 g/cm2, p = 0.027), TC (β = −0.269 mmol/L, p = 0.006), TG (β = −0.208 mmol/L, p = 0.002), and pulse pressure (β = −0.241 mmHg, p = 0.043), while positively associated with lymphocyte count (β = 0.037%, p = 0.015). The results did not reveal any causal association of vitamin D with clinical diseases. On the contrary, genetically protected CKD was significantly associated with increased vitamin D (β = 0.056, p = 2.361 × 10−26).ConclusionThe putative causal effects of circulating vitamin D on estimated bone mass, plasma triglyceride, and total cholesterol were uncovered, but not on clinical diseases. Vitamin D may be linked to clinical disease by affecting health-related metabolic markers.
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Affiliation(s)
- Jin-jian Xu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University (North Campus), Guangzhou, Guangdong, China
- Department of Epidemiology, School of Public Health, Sun Yat-sen University (North Campus), Guangzhou, Guangdong, China
| | - Xiao-bin Zhang
- Department of Hepatobiliary Surgery, Jingdezhen No.1 People's Hospital, Jingdezhen, Jiangxi, China
| | - Wen-tao Tong
- Department of Hepatobiliary Surgery, Jingdezhen No.1 People's Hospital, Jingdezhen, Jiangxi, China
| | - Teng Ying
- Department of Cardiology, The First Affiliated Hospital of Jiangxi Medical College, Shangrao, Jiangxi, China
| | - Ke-qi Liu
- Department of Clinical Medicine, Jiangxi Medical College, Shangrao, Jiangxi, China
- *Correspondence: Ke-qi Liu
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Burkhardt R. Vitamin D: review of physiology and clinical uses. Minerva Endocrinol (Torino) 2023; 48:88-105. [PMID: 36920117 DOI: 10.23736/s2724-6507.22.03652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Interest in vitamin D has increased within the scientific community due to the impact of osteoporosis in the aging population. Vitamin D receptors are present in many tissues and low vitamin D status has been associated with many diseases in observational studies. There was hope that enhanced vitamin D provision might help prevent and treat some widespread disorders. Some of these hopes have been refuted by the results of recent large and well-conducted randomized trials. This review provides an overview of the basic physiology of vitamin D and an update on the evidence base for its clinical applications.
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Cai B, Zhou M, Xiao Q, Zou H, Zhu X. L-shaped association between serum 25-hydroxyvitamin D and all-cause mortality of individuals with rheumatoid arthritis. Rheumatology (Oxford) 2023; 62:575-582. [PMID: 35689616 DOI: 10.1093/rheumatology/keac341] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE We aimed to examine the relationship between serum 25-hydroxyvitamin D and all-cause, cause-specific mortality of patients with RA. METHODS This cohort study included 1466 patients with RA from The National Health and Nutrition Examination Survey (NHANES) 2001-14. Mortality status was obtained according to death certificate records from the National Death Index. Cox proportional risk models were used to estimate hazard ratios (HR) and 95% CI for mortality. A generalized additive model, smooth curve fitting and 2-piecewise Cox proportional hazards models were established to address the nonlinearity between serum 25-hydroxyvitamin D and mortality. RESULTS A total of 1466 patients [mean (s.d.) 59.89 (14.14) years old; 58.94% female] were enrolled. The weighted mean level of 25-hydroxyvitamin D was 59.26 (24.99) nmol/l and 38.95% were found with deficient (or severe deficient) vitamin D (<50.00 nmol/l). During 10453 person-years of follow-up, 268 patients were documented for all-cause death, including 52 cardiovascular disease (CVD)deaths and 48 cancer deaths. Compared with patients with serum 25-hydroxyvitamin D <25.00 nmol/l, patients with higher serum 25-hydroxyvitamin D were more likely to have lower rate of all-cause mortality. Nonlinear and L-shaped association between serum 25-hydroxyvitamin D and all-cause mortality was found, and decreased serum 25-hydroxyvitamin D was significantly associated with increased risk of all-cause mortality in patients with serum 25-hydroxyvitamin D <37.30 nmol/l [HR 0.95 (0.92, 0.98); P < 0.01]. CONCLUSION An L-shaped association between serum 25-hydroxyvitamin D and all-cause mortality was found among patients with RA, indicating that serum 25-hydroxyvitamin D should be improved to a certain level for the prevention of premature death.
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Affiliation(s)
- Bin Cai
- Department of Rheumatology, Huashan Hospital, Fudan University.,Department of Rheumatology and Immunology, Renji Hospital, Shanghai Jiaotong University School of Medicine
| | - Mengmeng Zhou
- Department of Rheumatology, Huashan Hospital, Fudan University
| | - Qingqing Xiao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hejian Zou
- Department of Rheumatology, Huashan Hospital, Fudan University
| | - Xiaoxia Zhu
- Department of Rheumatology, Huashan Hospital, Fudan University
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Lavigne JE, Gibbons JB. The association between vitamin D serum levels, supplementation, and suicide attempts and intentional self-harm. PLoS One 2023; 18:e0279166. [PMID: 36724169 PMCID: PMC9891532 DOI: 10.1371/journal.pone.0279166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/29/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES The purpose of this study is to determine the associations between Vitamin D supplementation, 25(OH) blood serum levels, suicide attempts, and intentional self-harm in a population of veterans in the Department of Veterans Affairs (VA). METHODS A retrospective cohort study of US Veterans supplemented with Vitamin D. Veterans with any Vitamin D3 (cholecalciferol) or Vitamin D2 (ergocalciferol) fill between 2010 and 2018 were matched 1:1 to untreated control veterans having similar demographics and medical histories. Cox proportional hazards regression was used to estimate the time from the first Vitamin D3 (cholecalciferol) or Vitamin D2 (ergocalciferol) prescription fill to the first suicide attempt or intentional self-harm. Analyses were repeated in stratified samples to measure associations by race (Black or White), gender (male or female), blood levels (0-19 ng/ml, 20-39 ng/ml, and 40+ ng/ml), and average daily dosage. RESULTS Vitamin D3 and D2 supplementation were associated with a 45% and 48% lower risk of suicide attempt and self-harm ((D2 Hazard Ratio (HR) = 0.512, [95% CI, 0.457, 0.574]; D3 HR = 0.552, [95% CI, 0.511, 0.597])). Supplemented black veterans and veterans with 0-19 ng/ml vitamin D serum levels were at ~64% lower risk relative to controls (Black Veteran HR: 0.362 [95% CI: 0.298,0.440]; 0-19 ng/ml HR: 0.359 [95% CI: 0.215,0.598]). Supplementation with higher vitamin D dosages was associated with greater risk reductions than lower dosages (Log Average Dosage HR: 0.837 [95% CI: 0.779,0.900]). CONCLUSIONS Vitamin D supplementation was associated with a reduced risk of suicide attempt and self-harm in Veterans, especially in veterans with low blood serum levels and Black veterans.
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Affiliation(s)
- Jill E. Lavigne
- Department of Veterans Affairs, Center of Excellence for Suicide Prevention, Canandaigua, New York, United States of America
- Wegmans School of Pharmacy, St John Fisher College, Rochester, New York, United States of America
| | - Jason B. Gibbons
- Department of Veterans Affairs, Center of Excellence for Suicide Prevention, Canandaigua, New York, United States of America
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
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Guan L, Reijnierse EM, Maier AB. Associations of 25-Hydroxyvitamin D Status and Supplementation with Adverse Outcomes in Geriatric Rehabilitation Inpatients: RESORT. J Nutr Health Aging 2023; 27:1206-1211. [PMID: 38151871 DOI: 10.1007/s12603-023-2021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/25/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Geriatric rehabilitation inpatients are at a higher risk of 25-hydroxyvitamin D (25(OH)D) deficiency due to poor nutrition and low sunlight exposure. This study aimed to evaluate the prevalence of 25-hydroxyvitamin (25(OH)D) deficiency and supplementation and to investigate their association with adverse health outcomes in geriatric rehabilitation inpatients. DESIGN Prospective, observational and longitudinal study. SETTING AND PARTICIPANTS Geriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital (Melbourne, Australia) from 16th, October 2017 and discharged until 18th, March 2020 in the REStORing health of acutely unwell adulTs (RESORT) study were included. METHODS 25(OH)D levels measured close to rehabilitation admission were classified as sufficiency (>54 nmol/L), insufficiency (26-54 nmol/L), or deficiency (<26 nmol/L). The usage of vitamin D supplementation was extracted from medication records. Outcomes included incidence of institutionalization at three-month post-discharge, in-hospital mortality and post-discharge mortality. RESULTS The median age of 1328 geriatric rehabilitation inpatients was 83.9 years (IQR: 78.1-88.7, 58.6% female). 25(OH)D deficiency and insufficiency were present in 8.1% and 26.4% of inpatients, respectively; 74.2% used vitamin D supplementation. 25(OH)D deficiency was associated with higher odds of institutionalization (odds ratio (OR): 1.88, 95% confidence interval (CI): 1.14-3.11), in-hospital mortality (OR: 3.30, 95% CI: 1.54-7.07) and higher risks of one-year mortality (hazard ratio (HR): 1.77, 95% CI: 1.17-2.69) compared to 25(OH)D sufficiency but not with three-month mortality. 25(OH)D insufficiency was not associated with outcomes. Patients who did not use supplementation and had 25(OH)D insufficiency or deficiency had significantly higher in-hospital mortality compared to those who used supplementation. CONCLUSIONS Among geriatric rehabilitation inpatients, 25(OH)D deficiency was associated with institutionalization, in-hospital mortality and one-year mortality. Attention to monitor the vitamin D status is of upmost importance during hospitalization.
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Affiliation(s)
- L Guan
- Prof. Andrea B. Maier, Department of Medicine and Aged Care, @Age, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam Movement Sciences, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. E: ; T: +31 20 5982000; Twitter: @AndreaBMaier
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LeBoff MS, Chou SH, Manson JE. Vitamin D and Incident Fractures. Reply. N Engl J Med 2022; 387:1626-1627. [PMID: 36300986 DOI: 10.1056/nejmc2211434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Should vitamin D supplements be prescribed routinely for midlife women? Menopause 2022; 29:1329-1330. [PMID: 36256920 DOI: 10.1097/gme.0000000000002066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recommendations for vitamin D in midlife women include daily intakes of at least 600 IU to 800 IU daily to promote bone health. Although vitamin D supplements do not appear to benefit healthy women with normal vitamin D reserves, daily doses of 1,000 IU to 2,000 IU are safe and ensure adequate vitamin D levels in most women. This Practice Pearl will review updated knowledge and recommendations regarding the role of vitamin D in midlife and older women.
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22
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Definition, Assessment, and Management of Vitamin D Inadequacy: Suggestions, Recommendations, and Warnings from the Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS). Nutrients 2022; 14:nu14194148. [PMID: 36235800 PMCID: PMC9573415 DOI: 10.3390/nu14194148] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
In the recent years, both the prescriptions of serum 25(OH)D levels assay, and vitamin D supplementation are constantly increasing, as well as the costs to be incurred relating to these specific aspects. As in many other countries, the risk of vitamin D deficiency is particularly high in Italy, as recently confirmed by cohort studies in the general population as well as in patients with metabolic bone disorder. Results confirmed the North-South gradient of vitamin D levels described among European countries, despite the wide use of supplements. Although vitamin D supplementation is also recommended by the Italian Medicine Agency for patients at risk for fragility fracture or for initiating osteoporotic medication, the therapeutic gap for osteoporosis in Italy is very high. There is a consistent proportion of osteoporotic patients not receiving specific therapy for osteoporosis following a fragility fracture, with a poor adherence to the recommendations provided by national guidelines and position paper documents. The failure or inadequate supplementation with vitamin D in patients on antiresorptive or anabolic treatment for osteoporosis is thought to further amplify the problem and exposes patients to a high risk of re-fracture and mortality. Therefore, it is important that attention to its possible clinical consequences must be given. Thus, in light of new evidence from the literature, the SIOMMMS board felt the need to revise and update, by a GRADE/PICO system approach, its previous original recommendations about the definition, prevention, and treatment of vitamin D deficiency in adults, released in 2011. Several key points have been here addressed, such as the definition of the vitamin D status: normality values and optimal values; who are the subjects considered at risk of hypovitaminosis D; opportunity or not of performing the biochemical assessment of serum 25(OH)D levels in general population and in subjects at risk of hypovitaminosis D; the need or not to evaluate baseline serum 25(OH)D in candidate subjects for pharmacological treatment for osteoporosis; how and whether to supplement vitamin D subjects with hypovitaminosis D or candidates for pharmacological treatment with bone active agents, and the general population; how and whether to supplement vitamin D in chronic kidney disease and/or chronic liver diseases or under treatment with drugs interfering with hepatic metabolism; and finally, if vitamin D may have toxic effects in the subject in need of supplementation.
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LeBoff MS, Chou SH, Ratliff KA, Cook NR, Khurana B, Kim E, Cawthon PM, Bauer DC, Black D, Gallagher JC, Lee IM, Buring JE, Manson JE. Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults. N Engl J Med 2022; 387:299-309. [PMID: 35939577 PMCID: PMC9716639 DOI: 10.1056/nejmoa2202106] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Vitamin D supplements are widely recommended for bone health in the general population, but data on whether they prevent fractures have been inconsistent. METHODS In an ancillary study of the Vitamin D and Omega-3 Trial (VITAL), we tested whether supplemental vitamin D3 would result in a lower risk of fractures than placebo. VITAL was a two-by-two factorial, randomized, controlled trial that investigated whether supplemental vitamin D3 (2000 IU per day), n-3 fatty acids (1 g per day), or both would prevent cancer and cardiovascular disease in men 50 years of age or older and women 55 years of age or older in the United States. Participants were not recruited on the basis of vitamin D deficiency, low bone mass, or osteoporosis. Incident fractures were reported by participants on annual questionnaires and adjudicated by centralized medical-record review. The primary end points were incident total, nonvertebral, and hip fractures. Proportional-hazards models were used to estimate the treatment effect in intention-to-treat analyses. RESULTS Among 25,871 participants (50.6% women [13,085 of 25,871] and 20.2% Black [5106 of 25,304]), we confirmed 1991 incident fractures in 1551 participants over a median follow-up of 5.3 years. Supplemental vitamin D3, as compared with placebo, did not have a significant effect on total fractures (which occurred in 769 of 12,927 participants in the vitamin D group and in 782 of 12,944 participants in the placebo group; hazard ratio, 0.98; 95% confidence interval [CI], 0.89 to 1.08; P = 0.70), nonvertebral fractures (hazard ratio, 0.97; 95% CI, 0.87 to 1.07; P = 0.50), or hip fractures (hazard ratio, 1.01; 95% CI, 0.70 to 1.47; P = 0.96). There was no modification of the treatment effect according to baseline characteristics, including age, sex, race or ethnic group, body-mass index, or serum 25-hydroxyvitamin D levels. There were no substantial between-group differences in adverse events as assessed in the parent trial. CONCLUSIONS Vitamin D3 supplementation did not result in a significantly lower risk of fractures than placebo among generally healthy midlife and older adults who were not selected for vitamin D deficiency, low bone mass, or osteoporosis. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; VITAL ClinicalTrials.gov number, NCT01704859.).
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Affiliation(s)
- Meryl S LeBoff
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Sharon H Chou
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Kristin A Ratliff
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Nancy R Cook
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Bharti Khurana
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Eunjung Kim
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Peggy M Cawthon
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Douglas C Bauer
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Dennis Black
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - J Chris Gallagher
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - I-Min Lee
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - Julie E Buring
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
| | - JoAnn E Manson
- From the Division of Endocrinology, Diabetes, and Hypertension (M.S.L., S.H.C., K.A.R.), the Division of Preventive Medicine (N.R.C., E.K., I.-M.L., J.E.B., J.E.M.), and the Department of Radiology (B.K.), Brigham and Women's Hospital, Harvard Medical School (M.S.L., S.H.C., N.R.C., B.K., I.-M.L., J.E.B., J.E.M.), and the Department of Epidemiology, Harvard T.H. Chan School of Public Health (N.R.C., I.-M.L., J.E.B., J.E.M.) - all in Boston; California Pacific Medical Center Research Institute (P.M.C.), and the Departments of Epidemiology and Biostatistics (P.M.C., D.C.B., D.B.) and Medicine (D.C.B.), University of California, San Francisco - both in San Francisco; and the Department of Endocrinology, Creighton University School of Medicine, Omaha, NE (J.C.G.)
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Bouloukaki I, Markakis M, Pateli R, Lyronis I, Schiza S, Tsiligianni I. Vitamin D levels in primary care patients: correlations with clinical, seasonal, and quality-of-life parameters. Fam Pract 2022; 39:678-684. [PMID: 35325110 DOI: 10.1093/fampra/cmac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of vitamin D deficiency varies across countries and few data exist in the adult population in Greece. OBJECTIVES To assess vitamin D levels in unselected patients from primary care and to investigate possible correlations with clinical, seasonal, and quality-of-life parameters. METHODS In this cross-sectional study, 389 consecutive patients were included. They were grouped according to vitamin D status as vitamin D deficient (<20 ng/mL) and vitamin D sufficient groups (≥20 ng/mL). Demographic, Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Beck Depression Inventory (BDI), and Fatigue Severity Scale (FSS) scores were measured and compared between groups. RESULTS Vitamin D deficiency (<20 ng/mL) was observed in 50.4% of the cohort. Female gender (76% vs 66%, P = 0.026), obesity (42% vs 26%, P = 0.005), and hypertension (55% vs 43%, P = 0.023) were higher in the vitamin D deficiency group compared with the group without deficiency. After multiparametric adjustments (for age, gender, obesity, comorbidities, and seasonality), hypertension (odds ratio [OR] = 2.338, 95% confidence interval [CI] = 1.257-4.349, P = 0.007), excessive daytime sleepiness (ESS >10; OR = 3.345, 95% CI = 1.124-9.948, P = 0.029), depressive symptoms (BDI >10; OR = 3.769, 95% CI = 0.984-14.443, P = 0.04), and fatigue (FSS >36; OR = 7.157, 95% CI = 0.855-59.877, P = 0.04) showed significant independent associations with vitamin D deficiency in specific subgroups of patients. CONCLUSION A large proportion of patients in primary care had vitamin D deficiency, independently associated with hypertension, sleepiness, depressive symptoms, and fatigue. Further research is needed in order to determine the role of vitamin D in these patients.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece.,Primary Care Health Center of Kastelli, Heraklion, Crete, Greece.,Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Markakis
- Primary Care Health Center of Kastelli, Heraklion, Crete, Greece
| | - Rodanthi Pateli
- Primary Care Health Center of Kastelli, Heraklion, Crete, Greece
| | - Ioannis Lyronis
- Primary Care Health Center of Kastelli, Heraklion, Crete, Greece
| | - Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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Affiliation(s)
| | - Alexander Singer
- Max Rady College of Medicine, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Wendy Levinson
- Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Briceno Noriega D, Savelkoul HFJ. Vitamin D: A Potential Mitigation Tool for the Endemic Stage of the COVID-19 Pandemic? Front Public Health 2022; 10:888168. [PMID: 35757617 PMCID: PMC9226430 DOI: 10.3389/fpubh.2022.888168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/06/2022] [Indexed: 12/12/2022] Open
Abstract
The impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and associated development of clinical symptoms of COVID-19 have presented an enormous global impact on our health care systems, public health and economy. To date several observational epidemiological studies consistently found that vitamin D deficiency, measured as low levels of circulating 25-hydroxyvitamin D, is associated with cardiovascular diseases, diabetes, certain cancers, autoimmune diseases and many infectious diseases, including acute respiratory infections. Since vitamin D is not merely immunosuppressive but also acts as an immunomodulator in tolerance and homeostasis, many experts have considered a role of vitamin D in the prevalence and severity of immune mediated inflammatory diseases, such as SARS-CoV-2, adding to the evidence of the importance of vitamin D in the immune response against viral respiratory infections and reinforcing the need for targeted vitamin D supplementation, with a focus on high-risk populations and a high-dose supplementation treatment for COVID-19 hospitalized patients. The expected transition to endemicity of SARS-CoV-2 even further corroborates as a potential of vitamin D as an potential mitigation tool for the prevention of COVID-19. The aim of this paper is to analyse the current evidence regarding vitamin D and present a hypothesis of its potential role in the current COVID-19 pandemic and in the future as a potential preventive measurement in public health.
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Affiliation(s)
- Daniela Briceno Noriega
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, Netherlands
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Bae JH, Choe HJ, Holick MF, Lim S. Association of vitamin D status with COVID-19 and its severity : Vitamin D and COVID-19: a narrative review. Rev Endocr Metab Disord 2022; 23:579-599. [PMID: 34982377 PMCID: PMC8724612 DOI: 10.1007/s11154-021-09705-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 01/08/2023]
Abstract
Vitamin D is associated with biological activities of the innate and adaptive immune systems, as well as inflammation. In observational studies, an inverse relationship has been found between serum 25-hydroxyvitamin D (25(OH)D) concentrations and the risk or severity of coronavirus disease 2019 (COVID-19). Several mechanisms have been proposed for the role of vitamin D in COVID-19, including modulation of immune and inflammatory responses, regulation of the renin-angiotensin-aldosterone system, and involvement in glucose metabolism and cardiovascular system. Low 25(OH)D concentrations might predispose patients with COVID-19 to severe outcomes not only via the associated hyperinflammatory syndrome but also by worsening preexisting impaired glucose metabolism and cardiovascular diseases. Some randomized controlled trials have shown that vitamin D supplementation is beneficial for reducing severe acute respiratory syndrome coronavirus 2 RNA positivity but not for reducing intensive care unit admission or all-cause mortality in patients with moderate-to-severe COVID-19. Current evidence suggests that taking a vitamin D supplement to maintain a serum concentration of 25(OH)D of at least 30 ng/mL (preferred range 40-60 ng/mL), can help reduce the risk of COVID-19 and its severe outcomes, including mortality. Although further well designed studies are warranted, it is prudent to recommend vitamin D supplements to people with vitamin D deficiency/insufficiency during the COVID-19 pandemic according to international guidelines.
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Affiliation(s)
- Jae Hyun Bae
- grid.411134.20000 0004 0474 0479Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hun Jee Choe
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Michael F. Holick
- grid.189504.10000 0004 1936 7558Section of Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University Medical Campus, 715 Albany St #437, Boston, MA 02118 USA
| | - Soo Lim
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620 South Korea
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Chen L, Arai H, Assantachai P, Akishita M, Chew ST, Dumlao LC, Duque G, Woo J. Roles of nutrition in muscle health of community-dwelling older adults: evidence-based expert consensus from Asian Working Group for Sarcopenia. J Cachexia Sarcopenia Muscle 2022; 13:1653-1672. [PMID: 35307982 PMCID: PMC9178363 DOI: 10.1002/jcsm.12981] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 12/29/2022] Open
Abstract
General muscle health declines with age, and in particular, sarcopenia-defined as progressive loss of muscle mass and strength/physical performance-is a growing issue in Asia with a rising population of community-dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is central to treatment of sarcopenia, there are currently few guidelines that have examined this specifically in the Asian population. Therefore, the Asian Working Group for Sarcopenia established a special interest group (SIG) comprising seven experts across Asia and one from Australia, to develop an evidence-based expert consensus. A systematic literature search was conducted using MEDLINE on the topic of muscle health, from 2016 (inclusive) to July 2021, in Asia or with relevance to healthy, Asian community-dwelling older adults (≥60 years old). Several key topics were identified: (1) nutritional status: malnutrition and screening; (2) diet and dietary factors; (3) nutritional supplementation; (4) lifestyle interventions plus nutrition; and (5) outcomes and assessment. Clinical questions were developed around these topics, leading to 14 consensus statements. Consensus was achieved using the modified Delphi method with two rounds of voting. Moreover, the consensus addressed the impacts of COVID-19 on nutrition, muscle health, and sarcopenia in Asia. These statements encompass clinical expertise and knowledge across Asia and are aligned with findings in the current literature, to provide a practical framework for addressing muscle health in the community, with the overall aim to encourage and facilitate broader access to equitable care for this target population.
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Affiliation(s)
- Liang‐Kung Chen
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General HospitalTaipeiTaiwan
- Taipei Municipal Gan‐Dau HospitalTaipeiTaiwan
| | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | | | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Samuel T.H. Chew
- Department of Geriatric MedicineChangi General Hospital, SingHealthSingapore
| | | | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthMelbourneVictoriaAustralia
| | - Jean Woo
- Chinese University of Hong KongHong Kong
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Pratt CA, Brown AGM, Dixit S, Farmer N, Natarajan A, Boyington J, Shi S, Lu Q, Cotton P. Perspectives: on Precision Nutrition Research in Heart, Lung, and Blood Diseases and Sleep Disorders. Adv Nutr 2022; 13:1402-1414. [PMID: 35561742 PMCID: PMC9526828 DOI: 10.1093/advances/nmac053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 01/28/2023] Open
Abstract
The release of the 2020-2030 Strategic Plan for NIH Nutrition Research (SPNR) and its emphasis on precision nutrition has provided an opportunity to identify future nutrition research that addresses individual variability in response to diet and nutrition across the life span-including those relevant to the Strategic Vision of the National Heart, Lung, and Blood Institute (NHLBI). The SPNR and the NHLBI's Strategic Vision were developed with extensive input from the extramural research community, and both have 4 overarching strategic goals within which are embedded several objectives for research. For the SPNR, these include 1) spur discovery science and normal biological functions (e.g., role of the microbiome in health and disease), 2) population science to understand individual differences (e.g., biomarkers including 'omics that predict disease status), 3) emerging scientific areas of investigation and their application (e.g., data science, artificial intelligence), and 4) cross-cutting themes (e.g., training the scientific workforce and minority health and health disparities). These strategic goals and objectives serve as blueprints for research and training. Nutrition remains important in the prevention and treatment of heart, lung, blood, and sleep (HLBS) disorders and diseases, and the NHLBI has played a pivotal role in supporting nutrition research. In this paper, we report important gaps in the scientific literature related to precision nutrition in HLBS diseases. Research opportunities that could stimulate precision nutrition and their alignment with the SPNR and the NHLBI Strategic Vision Objectives are provided. These opportunities include 1) exploring individual differences in response to varying dietary patterns and nutrients; 2) investigating genetic/epigenetic, biological (e.g., microbiome, biomarkers), social, psychosocial, and environmental underpinnings of individual variability in diet; 3) elucidating the role of circadian rhythm and chrononutrition; and 4) applying implementation science research methods in precision nutrition interventions relevant to HLBS diseases.
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Affiliation(s)
| | - Alison G M Brown
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Shilpy Dixit
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Nicole Farmer
- National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Aruna Natarajan
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Josephine Boyington
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Scarlet Shi
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Qing Lu
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Paul Cotton
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
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Prevalence of vitamin D deficiency and its association with metabolic syndrome among the elderly population of Birjand, Iran. J Diabetes Metab Disord 2022; 21:475-481. [PMID: 35673492 PMCID: PMC9167312 DOI: 10.1007/s40200-022-00998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
Background With increasing life expectancy and the aging population of most countries, attention to the diseases of old age has also increased. Due to the high prevalence of vitamin D deficiency in the elderly, the present study was designed and performed to investigate the relationship between serum vitamin D levels in Iranian elderly with the risk of metabolic syndrome (MetS). Methods This study was conducted on an elderly population of Birjand (60 and older) in the urban and rural areas of the city. In 1325 elderly men and women, with age range of 60 and older, serum 25-hydroxyvitamin D, anthropometric measurements and laboratory variables were measured. Results Twenty-eight percent of the elderly participants in the study had vitamin D deficiency. We found that participants with higher 25(OH)D had lower odds for elevated waist circumference (WC) (OR = 0.91, 95% CI 0.83-0.98), reduced HDL (OR = 0.96, 95% CI 0.86-0.97) and elevated fasting blood sugar (FBS) (OR = 0.96, 95% CI 0.89-0.98). We not found any significant association between 25(OH)D levels and other MetS components. Conclusion Higher 25(OH)D levels in the elderly are linked to a reduced prevalence of MetS and, specifically, higher levels of favorable HDL-C, WC and FBS. Further intervention studies are needed to substantiate the results of this study.
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Epling JW, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement. JAMA 2022; 327:360-367. [PMID: 35076659 DOI: 10.1001/jama.2021.23732] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence of AF increases with age, from less than 0.2% in adults younger than 55 years to about 10% in those 85 years or older, with a higher prevalence in men than in women. It is uncertain whether the prevalence of AF differs by race and ethnicity. Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter. OBJECTIVE To update its 2018 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults. POPULATION Adults 50 years or older without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke. EVIDENCE ASSESSMENT The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined. RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Hu X, Han X, Chen Y, Xiang P, Wei X, Gong T, He Z, Su Y, Chen G, Liu C. Factors Defining the Association Between Vitamin D and Testosterone in Males With Type 2 Diabetes and Hypogonadism. Front Endocrinol (Lausanne) 2022; 13:842722. [PMID: 35498428 PMCID: PMC9039328 DOI: 10.3389/fendo.2022.842722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate Serum 25-hydroxyvitamin D (25[OH]D) levels in diabetic men with and without hypogonadism and figured out the potential factors influencing the connection between vitamin D and testosterone. METHODS A total of 367 men with type 2 diabetes mellitus (T2DM) were investigated, including 254 men with normal gonadal function (Group 1) and 113 men with hypogonadism (Group 2). Men with hypogonadism were classified as either hypogonadotropic hypogonadism (Group 2a) or hypergonadotropic hypogonadism (Group 2b). Serum 25(OH)D levels were detected by liquid chromatography-tandem mass spectrometry in all cases. Morning total testosterone (TT), estradiol (E), dehydroepiandrosterone (DHEA), prolactin (PRL), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid function, parathyroid and adrenal hormones, fasting blood glucose (FBG), fasting insulin (Fins) and hemoglobin A1c (HbA1c) were also assessed. RESULTS The prevalence of hypovitaminosis D in men with T2DM was up to 96.46%. Serum 25(OH)D levels were significantly lower in men with hypogonadism than those with eugonadism (16.65 ± 6.44 ng/mL vs. 18.17 ± 6.17 ng/mL, P=0.033). The lowest 25(OH)D level was observed in Group 2a (16.22 ± 6.52 ng/mL). After adjustment for the selected factors, serum 25(OH)D concentrations were shown to be positively correlated with TT concentrations (r=0.137, P=0.032). The relationship between 25(OH)D and testosterone was altered by age, duration of T2DM, body mass index, and HbA1c. Serum 25(OH)D level was positively associated with serum TT level in men with age <60 years (r=0.180, P=0.003), or with duration≥5 years (r=0.186, P=0.013), or with body mass index (BMI)≥28kg/m2 (r=0.431, P=0.000), or with HbA1c≥9% (r=0.145, P=0.031). CONCLUSIONS These findings indicate that type 2 diabetes patients with hypogonadism have lower 25(OH)D levels than those without hypogonadism. There seems to be a positive association between the serum 25(OH)D and TT levels, which affected by age, duration, BMI, and HbA1c.
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Affiliation(s)
- Xin Hu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xue Han
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Chen
- Key Laboratory of Tradicional Chinese Medicine Syndrome and Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Pingping Xiang
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiao Wei
- Key Laboratory of Tradicional Chinese Medicine Syndrome and Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Tong Gong
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiwei He
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yafeng Su
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Chao Liu,
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Penckofer S, Ridosh M, Adams W, Grzesiak M, Woo J, Byrn M, Kouba J, Sheean P, Kordish C, Durazo-Arvizu R, Wallis D, Emanuele MA, Halaris A. Vitamin D Supplementation for the Treatment of Depressive Symptoms in Women with Type 2 Diabetes: A Randomized Clinical Trial. J Diabetes Res 2022; 2022:4090807. [PMID: 35280228 PMCID: PMC8913152 DOI: 10.1155/2022/4090807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/04/2022] [Indexed: 12/23/2022] Open
Abstract
AIM To determine the efficacy and safety of vitamin D3 supplementation in reducing depressive symptoms in women with type 2 diabetes (T2D), depression, and low vitamin D. METHODS In this double-blind randomized active comparator-controlled trial, women with significant depressive symptoms as assessed by the Center for Epidemiologic Studies Depression (CES-D) scale received weekly oral vitamin D3 supplementation (50,000 IU) or an active comparator (5,000 IU) for 6 months. Assessments of vitamin D, 25-hydroxyvitamin D [25 (OH) D], and depression were measured at baseline, 3 months, and 6 months. RESULTS A total of 129 women were randomized, from which 119 completed the study (57 in lower dose and 62 in higher dose). Participants had an average 25 (OH) D and HbA1c of 20.8 ng/mL and 7.8%, respectively, at baseline. They were diverse (48% Black) and had a mean age of 50 and T2D for about 8 years. Upon completion of vitamin D3 supplementation, serum 25 (OH) D levels increased with 50,000 IU (+34 ng/mL) and 5,000 IU (+10 ng/mL). There was no difference in CES-D scores by treatment dose. Overall, depressive symptoms significantly improved over time with an average CES-D decline of 12.98 points (95% CI: -15.04 to -10.93; p < 0.001). Among women with moderate baseline depressive symptoms, those receiving the lower dose had nominally lower depression scores at follow-up than those in the higher dose cohort. Among women with severe baseline depressive symptoms, the improvement in follow-up depression scores was the same regardless of dose. CONCLUSIONS There was no difference in the dosing effect of vitamin D3 supplementation for the treatment of depressive symptoms in women with T2D who present with significant symptoms and low vitamin D. Regardless of the dose, participants' mood improved over time. Further study of vitamin D to target depressive symptoms in comorbid populations is needed.
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Affiliation(s)
- Sue Penckofer
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | - Monique Ridosh
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | - William Adams
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | - Meghan Grzesiak
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | | | - Mary Byrn
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | - Joanne Kouba
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | - Patricia Sheean
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | - Colleen Kordish
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | | | - Diane Wallis
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | - Mary Ann Emanuele
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
| | - Angelos Halaris
- Loyola University Chicago, Health Sciences Campus, Maywood, IL 60153, USA
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Abril Rubio A, Arjona González P, Castillo Fernández N, Salmerón Portela P, Hidalgo Martín F, Mancera Romero J. [Adequacy of the prescription of vitamin D in Primary Care]. Semergen 2021; 48:38-44. [PMID: 34465546 DOI: 10.1016/j.semerg.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the adequacy of vitamin D treatment based on clinic evidence in a Primary Care Center as well as to analyze some characteristics of the prescriptions made. MATERIALS AND METHODS Descriptive cross-sectional study. Primary Care. Patients above 14 years old with vitamin D prescription. Main variable was the therapeutic adequacy with vitamin D compounds (adequacy was considered when there was a clinical indication for treatment and blood vitamin D levels below 20ng/ml). Other clinical variables were collected. Frequency and association measures were used for statistical analysis. Level of statistical significance was considered <0.05. RESULTS 430 patients, 346 women (80.5%, 95% CI=77-84). Record of vitamin D values in 216 (50.2%, 95% CI=45-55). Screening/treatment indications in 219 patients (50.9%, 95% CI=46-56), of those in 150 patients vitamin D values were recorded (68.5%, 95% CI=62-75), average (±SD) was 21.22±12ng/ml, deficiency criteria in 86 (57.3%, 95% CI=51-64), insufficiency in 37 (24.7%, 95% CI=19-30) and sufficiency in 27 (18%, 95% CI=13-23). 86 patients (20%, 95% CI=16-24) had treatment indications plus vitamin D deficiency with no differences between genders. CONCLUSIONS Only 20% of the patients had treatment indications plus vitamin D deficiency. Female predominance. Just over half had indications for screening of serological vitamin D values and/or indications for treatment with vitamin D compounds.
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Affiliation(s)
- A Abril Rubio
- Medicina Familiar y Comunitaria, CS Ciudad Jardín, DS Málaga-Guadalhorce, Málaga, España.
| | - P Arjona González
- Medicina Familiar y Comunitaria, CS Ciudad Jardín, DS Málaga-Guadalhorce, Málaga, España
| | - N Castillo Fernández
- Medicina Familiar y Comunitaria, CS Ciudad Jardín, DS Málaga-Guadalhorce, Málaga, España
| | - P Salmerón Portela
- Medicina Familiar y Comunitaria, CS Ciudad Jardín, DS Málaga-Guadalhorce, Málaga, España
| | - F Hidalgo Martín
- Medicina Familiar y Comunitaria, CS Colmenar, AGS Este de Málaga-Axarquía, Málaga, España
| | - J Mancera Romero
- Medicina Familiar y Comunitaria, CS Ciudad Jardín, DS Málaga-Guadalhorce, Málaga, España
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Burnett-Bowie SAM, Cappola AR. The USPSTF 2021 Recommendations on Screening for Asymptomatic Vitamin D Deficiency in Adults: The Challenge for Clinicians Continues. JAMA 2021; 325:1401-1402. [PMID: 33847724 DOI: 10.1001/jama.2021.2227] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Associate Editor, JAMA
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Krist AH, Davidson KW, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Epling JW, Kubik M, Li L, Ogedegbe G, Owens DK, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Vitamin D Deficiency in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325:1436-1442. [PMID: 33847711 DOI: 10.1001/jama.2021.3069] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Vitamin D is a fat-soluble vitamin that performs an important role in calcium homeostasis and bone metabolism and also affects many other cellular regulatory functions outside the skeletal system. Vitamin D requirements may vary by individual; thus, no one serum vitamin D level cutpoint defines deficiency, and no consensus exists regarding the precise serum levels of vitamin D that represent optimal health or sufficiency. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on screening for vitamin D deficiency, including the benefits and harms of screening and early treatment. POPULATION Community-dwelling, nonpregnant adults who have no signs or symptoms of vitamin D deficiency or conditions for which vitamin D treatment is recommended. EVIDENCE ASSESSMENT The USPSTF concludes that the overall evidence on the benefits of screening for vitamin D deficiency is lacking. Therefore, the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults cannot be determined. RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. (I statement).
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Affiliation(s)
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, New York, New York
| | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Michos ED, Kalyani RR, Segal JB. Why USPSTF Still Finds Insufficient Evidence to Support Screening for Vitamin D Deficiency. JAMA Netw Open 2021; 4:e213627. [PMID: 33847756 DOI: 10.1001/jamanetworkopen.2021.3627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rita R Kalyani
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jodi B Segal
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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