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Hsu S, Zelnick LR, Bansal N, Brown J, Denburg M, Feldman HI, Ginsberg C, Hoofnagle AN, Isakova T, Leonard MB, Lidgard B, Robinson‐Cohen C, Wolf M, Xie D, Kestenbaum BR, de Boer IH. Vitamin D Metabolites and Risk of Cardiovascular Disease in Chronic Kidney Disease: The CRIC Study. J Am Heart Assoc 2023; 12:e028561. [PMID: 37421259 PMCID: PMC10382125 DOI: 10.1161/jaha.122.028561] [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: 10/23/2022] [Accepted: 04/18/2023] [Indexed: 07/10/2023]
Abstract
Background The ratio of 24,25-dihydroxyvitamin D3/25-hydroxyvitamin D3 (vitamin D metabolite ratio [VDMR]) may reflect functional vitamin D activity. We examined associations of the VDMR, 25-hydroxyvitamin D (25[OH]D), and 1,25-dihydroxyvitamin D (1,25[OH]2D) with cardiovascular disease (CVD) in patients with chronic kidney disease. Methods and Results This study included longitudinal and cross-sectional analyses of 1786 participants from the CRIC (Chronic Renal Insufficiency Cohort) Study. Serum 24,25-dihydroxyvitamin D3, 25(OH)D, and 1,25(OH)2D were measured by liquid chromatography-tandem mass spectrometry 1 year after enrollment. The primary outcome was composite CVD (heart failure, myocardial infarction, stroke, and peripheral arterial disease). We used Cox regression with regression-calibrated weights to test associations of the VDMR, 25(OH)D, and 1,25(OH)2D with incident CVD. We examined cross-sectional associations of these metabolites with left ventricular mass index using linear regression. Analytic models adjusted for demographics, comorbidity, medications, estimated glomerular filtration rate, and proteinuria. The cohort was 42% non-Hispanic White race and ethnicity, 42% non-Hispanic Black race and ethnicity, and 12% Hispanic ethnicity. Mean age was 59 years, and 43% were women. Among 1066 participants without prevalent CVD, there were 298 composite first CVD events over a mean follow-up of 8.6 years. Lower VDMR and 1,25(OH)2D were associated with incident CVD before, but not after, adjustment for estimated glomerular filtration rate and proteinuria (hazard ratio, 1.11 per 1 SD lower VDMR [95% CI, 0.95-1.31]). Only 25(OH)D was associated with left ventricular mass index after full covariate adjustment (0.6 g/m2.7 per 10 ng/mL lower [95% CI, 0.0-1.3]). Conclusions Despite modest associations of 25(OH)D with left ventricular mass index, 25(OH)D, the VDMR, and 1,25(OH)2D were not associated with incident CVD in chronic kidney disease.
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Affiliation(s)
- Simon Hsu
- Division of Nephrology and Kidney Research Institute, Department of MedicineUniversity of WashingtonSeattleWA
| | - Leila R. Zelnick
- Division of Nephrology and Kidney Research Institute, Department of MedicineUniversity of WashingtonSeattleWA
| | - Nisha Bansal
- Division of Nephrology and Kidney Research Institute, Department of MedicineUniversity of WashingtonSeattleWA
| | - Julia Brown
- Division of Nephrology and Hypertension, Department of MedicineLoyola University of ChicagoMaywoodIL
| | - Michelle Denburg
- Division of Pediatric NephrologyDepartment of Pediatrics, The Children’s Hospital of PhiladelphiaPhiladelphiaPA
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Harold I. Feldman
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
- Center for Clinical Epidemiology and BiostatisticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Charles Ginsberg
- Division of Nephrology‐HypertensionUniversity of California, San DiegoSan DiegoCA
| | | | - Tamara Isakova
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Mary B. Leonard
- Division of Nephrology, Lucile Packard Children’s HospitalStanford University School of MedicinePalo AltoCA
| | - Benjamin Lidgard
- Division of Nephrology and Kidney Research Institute, Department of MedicineUniversity of WashingtonSeattleWA
| | | | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke Clinical Research InstituteDuke University School of MedicineDurhamNCUSA
| | - Dawei Xie
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
- Center for Clinical Epidemiology and BiostatisticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Bryan R. Kestenbaum
- Division of Nephrology and Kidney Research Institute, Department of MedicineUniversity of WashingtonSeattleWA
| | - Ian H. de Boer
- Division of Nephrology and Kidney Research Institute, Department of MedicineUniversity of WashingtonSeattleWA
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Fernández-Vicente M, Miján-de-la-Torre A, Vella-Ramírez J, Martí-Bonmatí E, Benito-Ibáñez V, Martínez-de-Arriba R. Variables influyentes en los niveles de 25(OH)D total y libre en población sana. REVISTA CLÍNICA ESPAÑOLA 2022. [DOI: 10.1016/j.rce.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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Lanham‐New SA, Buttriss JL, Gibson‐Moore H, Staines KA, Webb AR, Cashman KD, Hewison M, Martineau AR, Smith CP, Butler‐Laporte G, Bouillon R. UK
Nutrition Research Partnership ‘Hot Topic’ workshop: Vitamin D—A multi‐disciplinary approach to (1) elucidate its role in human health and (2) develop strategies to improve vitamin D status in the
UK
population. NUTR BULL 2022; 47:246-260. [DOI: 10.1111/nbu.12557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Susan A. Lanham‐New
- Department of Nutritional Sciences School of Biosciences and Medicine Faculty of Health and Medical Sciences University of Surrey Guildford UK
| | | | | | | | - Ann R. Webb
- Earth and Environmental Sciences University of Manchester Manchester UK
| | - Kevin D. Cashman
- School of Food and Nutritional Sciences University College Cork Cork Ireland
| | - Martin Hewison
- Institute of Metabolism and Systems Research University of Birmingham Birmingham UK
| | - Adrian R. Martineau
- Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Colin P. Smith
- Department of Nutritional Sciences School of Biosciences and Medicine Faculty of Health and Medical Sciences University of Surrey Guildford UK
- School of Pharmacy and Biomolecular Sciences University of Brighton Brighton UK
| | - Guillaume Butler‐Laporte
- Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal Quebec Canada
| | - Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing KU Leuven Leuven Belgium
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4
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Tiller C, Black LJ, Ponsonby AL, Taylor B, van der Mei I, Clarke MW, Lucas RM. Vitamin D metabolites and risk of first clinical diagnosis of central nervous system demyelination. J Steroid Biochem Mol Biol 2022; 218:106060. [PMID: 35031430 DOI: 10.1016/j.jsbmb.2022.106060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
Low 25-hydroxyvitamin D (25(OH)D) concentration is a recognised risk factor for multiple sclerosis (MS). Associations with vitamin D metabolites and vitamin D binding globulin (VDBG) have not been widely studied. We assessed the association between vitamin D metabolites (25(OH)D2, 25(OH)D3, c3-epimer 25(OH)D3, 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), and 24,25-dihydroxyvitamin D3 (24,25(OH)2D3)) measured by liquid chromatography-tandem mass spectrometry assays, VDBG measured using a polyclonal immunoassay, and calculated free and bioavailable 25(OH)D, free 1,25(OH)2D3, and the 24,25(OH)2D3: total 25(OH)D and total 1,25(OH)2D: total 25(OH)D ratios with risk of a first clinical diagnosis of CNS demyelination (FCD) in an Australian case-control study (n = 196 cases, n = 241 controls, matched on age, sex and study region). Higher 25(OH)D (adjusted odds ratio (AOR) = 0.94 (95 % confidence interval (CI) 0.85-1.03) per 10 nmol/L increment) and 24,25(OH)2D3 (AOR = 0.81 (95 %CI 0.65-1.00) per 1 nmol/L increment) concentrations were associated with reduced FCD risk. Our results were compatible with no association for the other vitamin D metabolites, ratios, or VDBG with FCD risk. Thus, using standardised assays, and a comprehensive range of vitamin D metabolites, we confirmed the association of higher 25(OH)D and reduced FCD risk, and describe a similar effect for 24,25(OH)2D3; free or bioavailable 25(OH)D were not associated with FCD risk.
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Affiliation(s)
- Courtney Tiller
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia; Graduate Medicine, University of Wollongong, New South Wales, Australia
| | - Lucinda J Black
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Anne-Louise Ponsonby
- Florey Institute for Neuroscience, University of Melbourne, Melbourne, Australia
| | - Bruce Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, WA, 6009, Australia; School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, 6009, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia.
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5
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Fernández-Vicente M, Miján-de-la-Torre A, Vella-Ramírez J, Martí-Bonmatí E, Benito-Ibáñez V, Martínez-de-Arriba R. Influencing variables on total and free 25(OH)D levels in healthy population. Rev Clin Esp 2022; 222:313-320. [DOI: 10.1016/j.rceng.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/16/2021] [Indexed: 10/19/2022]
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6
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Heo JC, Kim D, An H, Son CS, Cho S, Lee JH. A Novel Biosensor and Algorithm to Predict Vitamin D Status by Measuring Skin Impedance. SENSORS (BASEL, SWITZERLAND) 2021; 21:8118. [PMID: 34884121 PMCID: PMC8662433 DOI: 10.3390/s21238118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
The deficiency and excess of vitamin D cause various diseases, necessitating continuous management; but it is not easy to accurately measure the serum vitamin D level in the body using a non-invasive method. The aim of this study is to investigate the correlation between vitamin D levels, body information obtained by an InBody scan, and blood parameters obtained during health checkups, to determine the optimum frequency of vitamin D quantification in the skin and to propose a vitamin D measurement method based on impedance. We assessed body composition, arm impedance, and blood vitamin D concentrations to determine the correlation between each element using multiple machine learning analyses and an algorithm which predicted the concentration of vitamin D in the body using the impedance value developed. Body fat percentage obtained from the InBody device and blood parameters albumin and lactate dehydrogenase correlated with vitamin D level. An impedance measurement frequency of 21.1 Hz was reflected in the blood vitamin D concentration at optimum levels, and a confidence level of about 75% for vitamin D in the body was confirmed. These data demonstrate that the concentration of vitamin D in the body can be predicted using impedance measurement values. This method can be used for predicting and monitoring vitamin D-related diseases and may be incorporated in wearable health measurement devices.
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Affiliation(s)
- Jin-Chul Heo
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Doyoon Kim
- Samsung Research, Samsung Electronics, Suwon 16677, Korea; (D.K.); (H.A.)
| | - Hyunsoo An
- Samsung Research, Samsung Electronics, Suwon 16677, Korea; (D.K.); (H.A.)
| | - Chang-Sik Son
- Division of Intelligent Robot, Daegu Gyeongbuk Institute of Science and Technology, Daegu 42988, Korea;
| | - Sangwoo Cho
- The Center for Advanced Technology in Testing Human Factors, Keimyung University, Daegu 42601, Korea;
| | - Jong-Ha Lee
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu 42601, Korea;
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7
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Bilezikian JP, Formenti AM, Adler RA, Binkley N, Bouillon R, Lazaretti-Castro M, Marcocci C, Napoli N, Rizzoli R, Giustina A. Vitamin D: Dosing, levels, form, and route of administration: Does one approach fit all? Rev Endocr Metab Disord 2021; 22:1201-1218. [PMID: 34940947 PMCID: PMC8696970 DOI: 10.1007/s11154-021-09693-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 02/07/2023]
Abstract
The 4th International Conference on Controversies in Vitamin D was held as a virtual meeting in September, 2020, gathering together leading international scientific and medical experts in vitamin D. Since vitamin D has a crucial role in skeletal and extra-skeletal systems, the aim of the Conference was to discuss improved management of vitamin D dosing, therapeutic levels and form or route of administration in the general population and in different clinical conditions. A tailored approach, based on the specific mechanisms underlying vitamin D deficiency in different diseases that were discussed, was recommended. Specifically, in comparison to healthy populations, higher levels of vitamin D and greater amounts of vitamin D were deemed necessary in osteoporosis, diabetes mellitus, obesity (particularly after bariatric surgery), and in those treated with glucocorticoids. Emerging and still open issues were related to target vitamin D levels and the role of vitamin D supplementation in COVID-19 since low vitamin D may predispose to SARS-CoV-2 infection and to worse COVID-19 outcomes. Finally, whereas oral daily cholecalciferol appears to be the preferred choice for vitamin D supplementation in the general population, and in most clinical conditions, active vitamin D analogs may be indicated in patients with hypoparathyroidism and severe kidney and liver insufficiency. Parenteral vitamin D administration could be helpful in malabsorption syndromes or in states of vitamin D resistance.Specific guidelines for desired levels of vitamin D should be tailored to the different conditions affecting vitamin D metabolism with the goal to define disease-specific normative values.
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Affiliation(s)
- John P Bilezikian
- Department of Medicine, Endocrinology Division, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milano, Italy
| | - Robert A Adler
- McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of chronic diseases, metabolism and ageing, Leuven, KU, Belgium
| | - Marise Lazaretti-Castro
- Division of Endocrinology, Escola Paulista de Medicina - Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rene Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milano, Italy.
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8
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Travica N, Ried K, Hudson I, Scholey A, Pipingas A, Sali A. The effects of cardiovascular and orthopaedic surgery on vitamin concentrations: a narrative review of the literature and mechanisms of action. Crit Rev Food Sci Nutr 2021:1-31. [PMID: 34619992 DOI: 10.1080/10408398.2021.1983762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given the rise in worldwide chronic diseases, supplemented by an aging population, the volume of global major surgeries, encompassing cardiac and orthopedic procedures is anticipated to surge significantly. Surgical trauma can be accompanied by numerous postoperative complications and metabolic changes. The present review summarized the results from studies assessing the effects of orthopedic and cardiovascular surgery on vitamin concentrations, in addition to exploring the possible mechanisms associated with changes in concentrations. Studies have revealed a potentially severe depletion in plasma/serum concentrations of numerous vitamins following these surgeries acutely. Vitamins C, D and B1 appear particularly vulnerable to significant depletions, with vitamin C and D depletions consistently transpiring into inadequate and deficient concentrations, respectively. The possible multifactorial mechanisms impacting postoperative vitamin concentrations include changes in hemodilution and vitamin utilization, redistribution, circulatory transport and absorption. For a majority of vitamins, there has been a lack of investigation into the effects of both, cardiac and orthopedic surgery. Additionally, studies were predominantly restricted to short-term postoperative investigations, primarily performed within the first postoperative week of surgery. Overall, results indicated that further examination is necessary to determine the severity and clinical significance of the possible depletions in vitamin concentrations that ensue cardiovascular and orthopedic surgery.
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Affiliation(s)
- Nikolaj Travica
- Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia.,The National Institute of Integrative Medicine, Melbourne, Australia
| | - Karin Ried
- The National Institute of Integrative Medicine, Melbourne, Australia.,Honorary Associate Professor, Discipline of General Practice, University of Adelaide, South Australia, Australia.,Torrens University, Melbourne, Australia
| | - Irene Hudson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia.,Digital Health, CRC, College of STEM, Mathematical Sciences, Royal Melbourne Institute of Technology (RMIT), Melbourne, Australia.,School of Mathematical and Physical Science, University of Newcastle, Newcastle, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Avni Sali
- The National Institute of Integrative Medicine, Melbourne, Australia
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9
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Subber Z, Al-Shamma G, Hashim H. total and free vitamin D in type 2 diabetes mellitus patients in Baghdad city. BAGHDAD JOURNAL OF BIOCHEMISTRY AND APPLIED BIOLOGICAL SCIENCES 2021. [DOI: 10.47419/bjbabs.v2i02.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The free-form of vitamin D has been used by many researchers as an index of vitamin D status in health and disease. Several methods are there to estimate free, total, and even bioavailable vitamin D.
Objective: The present work was carried out to measure free vitamin D using a special formula suggested by Bikle and Schwartz in 2019, which includes the vitamin D binding protein (VDBP). The results will be used to evaluate the vitamin D status in patients with type 2 diabetes mellitus (T2DM), and its relation to the disease progression.
Methods: Sixty-four patients with T2DM and 73 healthy subjects, all from Baghdad city, were enrolled in the current study from March to October 2020. For each participant, fasting blood glucose, hemoglobin (HbA1c), insulin resistance HOMA-IR, and body mass index (BMI) were measured in addition to the total vitamin D and VDBP. Moreover, free vitamin D was calculated by the formula of Bikle & Schwartz.
Results: There were highly significant correlations between total vitamin D and absolute values of free vitamin D or its percentage. The difference in total vitamin D was significant between patients and healthy controls with no significant change in VDBP, free and bio-available vitamin D, while free vitamin D% was higher in the patient’s group. Correlations between vitamin D and each of BMI, fasting glucose, HbA1c, and HOMA-IR were not significant; however, there was a negative correlation with BMI and fasting glucose in the healthy control subjects only. The Receiver Operating Characteristic (ROC) curve analysis of vitamin D in the diagnosis of diabetes mellitus was poor.
Conclusion: Total vitamin D can represent vitamin D status, but it cannot be used as a factor for diagnosing T2DM. However, it could be of importance to change the glycemic status.
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10
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Dominguez LJ, Farruggia M, Veronese N, Barbagallo M. Vitamin D Sources, Metabolism, and Deficiency: Available Compounds and Guidelines for Its Treatment. Metabolites 2021; 11:metabo11040255. [PMID: 33924215 PMCID: PMC8074587 DOI: 10.3390/metabo11040255] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
Studies on vitamin/hormone D deficiency have received a vast amount of attention in recent years, particularly concerning recommendations, guidelines, and treatments. Moreover, vitamin D’s role as a hormone has been confirmed in various enzymatic, metabolic, physiological, and pathophysiological processes related to many organs and systems in the human body. This growing interest is mostly due to the evidence that modest-to-severe vitamin D deficiency is widely prevalent around the world. There is broad agreement that optimal vitamin D status is necessary for bones, muscles, and one’s general health, as well as for the efficacy of antiresorptive and anabolic bone-forming treatments. Food supplementation with vitamin D, or the use of vitamin D supplements, are current strategies to improve vitamin D levels and treat deficiency. This article reviews consolidated and emerging concepts about vitamin D/hormone D metabolism, food sources, deficiency, as well as the different vitamin D supplements available, and current recommendations on the proper use of these compounds.
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11
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Makris K, Bhattoa HP, Cavalier E, Phinney K, Sempos CT, Ulmer CZ, Vasikaran SD, Vesper H, Heijboer AC. Recommendations on the measurement and the clinical use of vitamin D metabolites and vitamin D binding protein - A position paper from the IFCC Committee on bone metabolism. Clin Chim Acta 2021; 517:171-197. [PMID: 33713690 DOI: 10.1016/j.cca.2021.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/10/2021] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Abstract
Vitamin D, an important hormone with a central role in calcium and phosphate homeostasis, is required for bone and muscle development as well as preservation of musculoskeletal function. The most abundant vitamin D metabolite is 25-hydroxyvitamin D [25(OH)D], which is currently considered the best marker to evaluate overall vitamin D status. 25(OH)D is therefore the most commonly measured metabolite in clinical practice. However, several other metabolites, although not broadly measured, are useful in certain clinical situations. Vitamin D and all its metabolites are circulating in blood bound to vitamin D binding protein, (VDBP). This highly polymorphic protein is not only the major transport protein which, along with albumin, binds over 99% of the circulating vitamin D metabolites, but also participates in the transport of the 25(OH)D into the cell via a megalin/cubilin complex. The accurate measurement of 25(OH)D has proved a difficult task. Although a reference method and standardization program are available for 25(OH)D, the other vitamin D metabolites still lack this. Interpretation of results, creation of clinical supplementation, and generation of therapeutic guidelines require not only accurate measurements of vitamin D metabolites, but also the accurate measurements of several other "molecules" related with bone metabolism. IFCC understood this priority and a committee has been established with the task to support and continue the standardization processes of vitamin D metabolites along with other bone-related biomarkers. In this review, we present the position of this IFCC Committee on Bone Metabolism on the latest developments concerning the measurement and standardization of vitamin D metabolites and its binding protein, as well as clinical indications for their measurement and interpretation of the results.
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Affiliation(s)
- Konstantinos Makris
- Clinical Biochemistry Department, KAT General Hospital, 14561 Athens, Greece; Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", Medical School, University of Athens, Athens, Greece.
| | - Harjit P Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU de Liège, Domaine du Sart-Tilman, B-4000 Liège, Belgium
| | - Karen Phinney
- Biomolecular Measurement Division, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Christopher T Sempos
- Coordinator, Vitamin D Standardization Program (VDSP), Havre de Grace, MD 21078, USA
| | - Candice Z Ulmer
- Clinical Chemistry Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samuel D Vasikaran
- PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Hubert Vesper
- Clinical Chemistry Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam Gastroenterology Endocrinology & Metabolism, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
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12
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Vitamin D Metabolites and Sex Steroid Indices in Postmenopausal Women with and without Low Bone Mass. Metabolites 2021; 11:metabo11020086. [PMID: 33535639 PMCID: PMC7912789 DOI: 10.3390/metabo11020086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
While the independent roles of vitamin D and sex hormones in skeletal health are well established, the associations of vitamin D and its metabolites to sex hormones and their indices are less investigated. In this observational study, clinical information of 189 Saudi postmenopausal women aged ≥50 years old [N = 80 with normal bone mineral density (BMD), aged 53.3 ± 7.7 years with body mass index (BMI)= 34.1kg/m2 ± 5.8, and N = 109 with low BMD (T-score −1.0 to −2.5), aged 57.0 ± 8.2 years, BMI = 32.4kg/m2 ± 6.2] was extracted from an existing capital-wide osteoporosis registry in Riyadh, Saudi Arabia. Data included were BMD scores, serum total 25(OH)D, sex hormones, and bone turnover markers which were measured using commercially available assays. Age- and BMI-adjusted comparisons revealed significantly higher parathyroid hormone (PTH) levels as well as significantly lower testosterone and bioavailable testosterone in the low BMD group than the normal BMD group (p-values 0.04, 0.02, and 0.03, respectively). Stepwise linear regression showed that circulating testosterone levels accounted for 9.7% and 8.9% of the variances perceived in bioavailable 25(OH)D and free 25(OH)D, respectively (p < 0.01), independent of other sex hormones, sex hormone indices, and bone turnover markers. Our study suggests that androgens are significantly associated with non-conventional vitamin D metabolites and these associations may have clinical relevance in assessing risk for low BMD and osteoporosis in Arab postmenopausal women.
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13
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Xu B, Feng Y, Gan L, Zhang Y, Jiang W, Feng J, Yu L. Vitamin D Status in Children With Short Stature: Accurate Determination of Serum Vitamin D Components Using High-Performance Liquid Chromatography-Tandem Mass Spectrometry. Front Endocrinol (Lausanne) 2021; 12:707283. [PMID: 34721288 PMCID: PMC8548707 DOI: 10.3389/fendo.2021.707283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/03/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Vitamin D is critical for calcium and bone metabolism. Vitamin D insufficiency impairs skeletal mineralization and bone growth rate during childhood, thus affecting height and health. Vitamin D status in children with short stature is sparsely reported. The purpose of the current study was to investigate various vitamin D components by high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) to better explore vitamin D storage of short-stature children in vivo. METHODS Serum circulating levels of 25-hydroxyvitamin D2 [25(OH)D2], 25-hydroxyvitamin D3 [25(OH)D3], and 3-epi-25-hydroxyvitamin D3 [3-epi-25(OH)D3, C3-epi] were accurately computed using the LC-MS/MS method. Total 25(OH)D [t-25(OH)D] and ratios of 25(OH)D2/25(OH)D3 and C3-epi/25(OH)D3 were then respectively calculated. Free 25(OH)D [f-25(OH)D] was also measured. RESULTS 25(OH)D3 and f-25(OH)D levels in short-stature subgroups 2 (school age: 7~12 years old) and 3 (adolescence: 13~18 years old) were significantly lower compared with those of healthy controls. By contrast, C3-epi levels and C3-epi/25(OH)D3 ratios in all the three short-stature subgroups were markedly higher than the corresponding healthy cases. Based on cutoff values developed by Endocrine Society Recommendation (but not suitable for methods 2 and 3), sufficient storage capacities of vitamin D in short-stature subgroups 1, 2, and 3 were 42.8%, 23.8%, and 9.0% as determined by Method 3 [25(OH)D2/3+25(OH)D3], which were lower than those of 57.1%, 28.6%, and 18.2% as determined by Method 1 [25(OH)D2+25(OH)D3+C3-epi] and 45.7%, 28.5%, and 13.6% as determined by Method 2 [25(OH)D2/3+25(OH)D3+C3-epi]. Levels of 25(OH)D2 were found to be weakly negatively correlated with those of 25(OH)D3, and higher 25(OH)D3 levels were positively correlated with higher levels of C3-epi in both short-stature and healthy control cohorts. Furthermore, f-25(OH)D levels were positively associated with 25(OH)D3 and C3-epi levels in children. CONCLUSIONS The current LC-MS/MS technique can not only separate 25(OH)D2 from 25(OH)D3 but also distinguish C3-epi from 25(OH)D3. Measurement of t-25(OH)D [25(OH)D2+25(OH)D3] alone may overestimate vitamin D storage in children, and short-stature children had lower vitamin D levels compared with healthy subjects. Ratios of C3-epi/25(OH)D3 and 25(OH)D2/25(OH)D3 might be alternative markers for vitamin D catabolism/storage in short-stature children. Further studies are needed to explore the relationships and physiological roles of various vitamin D metabolites.
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Affiliation(s)
| | | | | | | | | | | | - Lin Yu
- *Correspondence: Jiafu Feng, ; Lin Yu,
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14
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Hsu S, Hoofnagle AN, Gupta DK, Gutierrez OM, Peralta CA, Shea S, Allen NB, Burke G, Michos ED, Ix JH, Siscovick D, Psaty BM, Watson KE, Kestenbaum B, de Boer IH, Robinson-Cohen C. Race, Ancestry, and Vitamin D Metabolism: The Multi-Ethnic Study of Atherosclerosis. J Clin Endocrinol Metab 2020; 105:dgaa612. [PMID: 32869845 PMCID: PMC7526733 DOI: 10.1210/clinem/dgaa612] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT A comprehensive characterization of racial/ethnic variations in vitamin D metabolism markers may improve our understanding of differences in bone and mineral homeostasis and the risk of vitamin D-related diseases. OBJECTIVE Describe racial/ethnic differences in vitamin D metabolism markers and their associations with genetic ancestry. DESIGN, SETTING, PARTICIPANTS In a cross-sectional study within the Multi-Ethnic Study of Atherosclerosis (MESA), we compared a comprehensive panel of vitamin D metabolism markers across self-reported racial/ethnic groups of Black (N = 1759), White (N = 2507), Chinese (N = 788), and Hispanic (N = 1411). We evaluated associations of proportion African and European ancestry with this panel of markers in Black and Hispanic participants using ancestry informative markers. Latent class analysis evaluated associations between patterns of vitamin D measurements with race/ethnicity. RESULTS Compared with Black participants, White participants had significantly higher serum concentrations of 25-hydroxyvitamin D and fibroblast growth factor-23; lower concentrations of parathyroid hormone and 1,25-dihydroxyvitamin D; circulating vitamin D metabolite ratios suggesting lower CYP27B1 and higher CYP24A1 activity; higher urinary concentrations of calcium and phosphorus with higher urinary fractional excretion of phosphorus; and differences in vitamin D binding globulin haplotypes. Higher percent European ancestry was associated with higher 25-hydroxyvitamin D and lower parathyroid hormone concentrations among Black and Hispanic participants. Latent classes defined by vitamin D measurements reflected these patterns and differed significantly by race/ethnicity and ancestry. CONCLUSIONS Markers of vitamin D metabolism vary significantly by race/ethnicity, may serve to maintain bone and mineral homeostasis across ranges of 25-hydroxyvitamin D production, and be attributable, at least partly, to genetic ancestry.
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Affiliation(s)
- Simon Hsu
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Deepak K Gupta
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Orlando M Gutierrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carmen A Peralta
- Cricket Health, Inc., San Francisco, California
- The Kidney Health Research Collaborative, San Francisco, California
- University of California, San Francisco, San Francisco, California
| | - Steven Shea
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Norrina B Allen
- Department of Internal Medicine, Northwestern University, Chicago, Illinois
| | - Gregory Burke
- Division of Public Health Sciences Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
| | | | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karol E Watson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bryan Kestenbaum
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Ian H de Boer
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Cassianne Robinson-Cohen
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Giustina A, Bouillon R, Binkley N, Sempos C, Adler RA, Bollerslev J, Dawson-Hughes B, Ebeling PR, Feldman D, Heijboer A, Jones G, Kovacs CS, Lazaretti-Castro M, Lips P, Marcocci C, Minisola S, Napoli N, Rizzoli R, Scragg R, White JH, Formenti AM, Bilezikian JP. Controversies in Vitamin D: A Statement From the Third International Conference. JBMR Plus 2020; 4:e10417. [PMID: 33354643 PMCID: PMC7745884 DOI: 10.1002/jbm4.10417] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/18/2020] [Accepted: 09/20/2020] [Indexed: 12/19/2022] Open
Abstract
The Third International Conference on Controversies in Vitamin D was held in Gubbio, Italy, September 10–13, 2019. The conference was held as a follow‐up to previous meetings held in 2017 and 2018 to address topics of controversy in vitamin D research. The specific topics were selected by the steering committee of the conference and based upon areas that remain controversial from the preceding conferences. Other topics were selected anew that reflect specific topics that have surfaced since the last international conference. Consensus was achieved after formal presentations and open discussions among experts. As will be detailed in this article, consensus was achieved with regard to the following: the importance and prevalence of nutritional rickets, amounts of vitamin D that are typically generated by sun exposure, worldwide prevalence of vitamin D deficiency, the importance of circulating concentrations of 25OHD as the best index of vitamin D stores, definitions and thresholds of vitamin D deficiency, and efficacy of vitamin D analogues in the treatment of psoriasis. Areas of uncertainly and controversy include the following: daily doses of vitamin D needed to maintain a normal level of 25OHD in the general population, recommendations for supplementation in patients with metabolic bone diseases, cutaneous production of vitamin D by UVB exposure, hepatic regulation of 25OHD metabolites, definition of vitamin D excess, vitamin D deficiency in acute illness, vitamin D requirements during reproduction, potential for a broad spectrum of cellular and organ activities under the influence of the vitamin D receptor, and potential links between vitamin D and major human diseases. With specific regard to the latter area, the proceedings of the conference led to recommendations for areas in need of further investigation through appropriately designed intervention trials. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital Milan Italy
| | - Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases Metabolism and Ageing KU Leuven Leuven Belgium
| | - Neil Binkley
- Osteoporosis Clinical Research Program on Aging, University of Wisconsin Madison WI USA
| | | | - Robert A Adler
- McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine Richmond VA USA
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, and Faculty of Medicine University of Oslo Oslo Norway
| | - Bess Dawson-Hughes
- Jean Mayer USDA Nutrition Research Center on Aging Tufts University Boston MA USA
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences Monash University Calyton Victoria Australia
| | - David Feldman
- Department of Medicine Stanford University School of Medicine Stanford CA USA
| | - Annemieke Heijboer
- Endocrine Laboratory, Department of Clinical Chemistry Amsterdam UMC, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam Gastroenterology & Metabolism Amsterdam The Netherlands
| | - Glenville Jones
- Department of Biomedical and Molecular Sciences Queen's University Kingston Ontario Canada
| | - Christopher S Kovacs
- Faculty of Medicine Memorial University of Newfoundland St. John's Newfoundland and Labrador Canada
| | - Marise Lazaretti-Castro
- Division of Endocrinology Escola Paulista de Medicina-Universidade Federal de Sao Paulo (EPM-UNIFESP) São Paulo Brazil
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section Amsterdam University Medical Center Amsterdam The Netherlands
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines University of Rome "Sapienza" Rome Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes Campus Bio-Medico, University of Rome Rome Italy.,Division of Bone and Mineral Diseases Washington University in St. Louis St. Louis MO USA
| | - Rene Rizzoli
- Service of Bone Diseases Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Robert Scragg
- School of Population Health University of Auckland Auckland New Zealand
| | - John H White
- Department of Physiology McGill University Montreal Quebec Canada
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital Milan Italy
| | - John P Bilezikian
- Department of Medicine, Endocrinology Division, College of Physicians and Surgeons Columbia University New York NY USA
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16
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Sluyter JD, Manson JE, Scragg R. Vitamin D and Clinical Cancer Outcomes: A Review of Meta-Analyses. JBMR Plus 2020; 5:e10420. [PMID: 33553987 PMCID: PMC7839823 DOI: 10.1002/jbm4.10420] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022] Open
Abstract
The relationship between vitamin D status or supplementation and cancer outcomes has been examined in several meta‐analyses. To address remaining knowledge gaps, we conducted a systematic overview and critical appraisal of pertinent meta‐analyses. For meta‐analyses of trials, we assessed their quality using AMSTAR‐2 (A Measurement Tool to Assess Systematic Reviews), strength of associations using umbrella review methodology and credibility of evidence using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. Meta‐analyses of observational studies reported inverse associations of 25OHD with risk of cancer incidence and cancer mortality and, particularly for colorectal cancer, fulfilled some of Bradford‐Hill's causation criteria. In meta‐analyses of trials, vitamin D supplementation did not affect cancer incidence. However, we found credible evidence that vitamin D supplementation reduced total cancer mortality risk, with five out of six meta‐analyses reporting a relative risk (RR) reduction of up to 16%: RR, 0.84 (95% CI, 0.74–0.95). The strength of the association, however, was classified as weak. This was true among meta‐analyses of high, moderate, and lower quality (AMSTAR‐2–rated). Trials did not include large numbers of vitamin D‐deficient participants; many tested relatively low doses and lacked sufficiently powered data on site‐specific cancers. In conclusion, meta‐analyses show that, although observational evidence indicates that low vitamin D status is associated with a higher risk of cancer outcomes, randomized trials show that vitamin D supplementation reduces total cancer mortality, but not cancer incidence. However, trials with larger proportions of vitamin D‐insufficient participants and longer durations of follow‐up, plus adequately powered data on site‐specific common cancers, would provide further insight into the evidence base. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- John D Sluyter
- School of Population Health, University of Auckland Auckland New Zealand
| | - JoAnn E Manson
- Department of Medicine Brigham and Women's Hospital, and Harvard Medical School Boston MA USA.,Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA USA
| | - Robert Scragg
- School of Population Health, University of Auckland Auckland New Zealand
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17
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Hurst EA, Homer NZ, Mellanby RJ. Vitamin D Metabolism and Profiling in Veterinary Species. Metabolites 2020; 10:E371. [PMID: 32942601 PMCID: PMC7569877 DOI: 10.3390/metabo10090371] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 12/17/2022] Open
Abstract
The demand for vitamin D analysis in veterinary species is increasing with the growing knowledge of the extra-skeletal role vitamin D plays in health and disease. The circulating 25-hydroxyvitamin-D (25(OH)D) metabolite is used to assess vitamin D status, and the benefits of analysing other metabolites in the complex vitamin D pathway are being discovered in humans. Profiling of the vitamin D pathway by liquid chromatography tandem mass spectrometry (LC-MS/MS) facilitates simultaneous analysis of multiple metabolites in a single sample and over wide dynamic ranges, and this method is now considered the gold-standard for quantifying vitamin D metabolites. However, very few studies report using LC-MS/MS for the analysis of vitamin D metabolites in veterinary species. Given the complexity of the vitamin D pathway and the similarities in the roles of vitamin D in health and disease between humans and companion animals, there is a clear need to establish a comprehensive, reliable method for veterinary analysis that is comparable to that used in human clinical practice. In this review, we highlight the differences in vitamin D metabolism between veterinary species and the benefits of measuring vitamin D metabolites beyond 25(OH)D. Finally, we discuss the analytical challenges in profiling vitamin D in veterinary species with a focus on LC-MS/MS methods.
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Affiliation(s)
- Emma A. Hurst
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland EH25 9RG, UK;
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen’s Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh, Scotland EH16 4TJ, UK;
| | - Natalie Z. Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen’s Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh, Scotland EH16 4TJ, UK;
| | - Richard J. Mellanby
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland EH25 9RG, UK;
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18
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Stafne SN, Mørkved S, Gustafsson MK, Syversen U, Stunes AK, Salvesen KÅ, Johannessen HH. Vitamin D and stress urinary incontinence in pregnancy: a cross-sectional study. BJOG 2020; 127:1704-1711. [PMID: 32479701 DOI: 10.1111/1471-0528.16340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the association between levels of vitamin D and urinary incontinence (UI) in pregnancy. DESIGN A cross-sectional study. Secondary analysis of a randomised controlled trial. SETTING Two university hospitals in Norway. POPULATION A total of 851 healthy, pregnant women >18 years in gestational weeks 18-22 with a singleton live fetus. METHODS Data on UI were collected from a questionnaire at inclusion and serum analysis of 25-hydroxy vitamin D (25(OH)D) was performed. Univariable and multivariable logistic regression analyses were applied to study associations between exposure and outcomes. MAIN OUTCOME MEASURES Prevalence of self-reported UI, stress (SUI) and urge (UUI) or mixed UI. RESULTS In total, 230/851 (27%) of the participants were vitamin D insufficient (25(OH)D <50 nmol/l) and 42% reported to have any UI. Women with 25(OH)D <50 nmol/l were more likely to report any UI (P = 0.03) and SUI (P < 0.01) compared with women with 25(OH)D ≥50 nmol/l. In a univariable logistic regression analysis, serum levels of 25(OH)D <50 nmol/l was associated with increased risk of any UI (odds ratio [OR] 1.5 with 95% CI 1.0-2.1), SUI only (OR 1.7, 95% CI 1.2-2.4), but not mixed UI or UUI only (OR 0.8, 95% CI 0.5-1.5). In a multivariable logistic regression model, serum levels of 25(OH)D <50 nmol/l were associated with a higher risk of experiencing SUI only (OR 1.5, 95% CI 1.1-2.2). CONCLUSIONS Serum 25(OH)D <50 nmol/l was associated with increased risk of any UI, and SUI in particular. TWEETABLE ABSTRACT Low levels of vitamin D are associated with increased risk of urinary incontinence in pregnancy.
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Affiliation(s)
- S N Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinical Services, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - S Mørkved
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinical Services, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M K Gustafsson
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Division of Mental Health Care, Trondheim University Hospital (St Olav's Hospital), Trondheim, Norway
| | - U Syversen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Endocrinology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A K Stunes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Medical Clinic, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - K Å Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Obstetrics and Gynaecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - H H Johannessen
- Department for Physical Medicine and Rehabilitation, Østfold Hospital Trust, Sarpsborg, Norway.,Department of Health and Welfare, Østfold University College, Fredrikstad, Norway
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19
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Hurst EA, Homer NZ, Denham SG, MacFarlane E, Campbell S, Boswinkel M, Mellanby RJ. Development and application of a LC-MS/MS assay for simultaneous analysis of 25-hydroxyvitamin-D and 3-epi-25-hydroxyvitamin-D metabolites in canine serum. J Steroid Biochem Mol Biol 2020; 199:105598. [PMID: 31958632 DOI: 10.1016/j.jsbmb.2020.105598] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/25/2022]
Abstract
Hypovitaminosis D and hypervitaminosis D are well recognised disorders in dogs. Hypovitaminosis D can occur following consumption of a diet inadequately supplemented with vitamin D or as a sequelae of severe intestinal disease. Hypervitaminosis D may occur as a result of consuming proprietary dog foods over-supplemented with vitamin D or through ingestion of vitamin D containing medicinal products or rodenticides. Consequently, there is a clear need to establish a methodology that can accurately quantify vitamin D metabolites across a broad dynamic range in dogs. The existence of C3-epimers of vitamin D metabolites has yet to be elucidated in dogs, yet are known to interfere with the analysis of vitamin D and have unknown biological activity in other species. Here, we describe the development and validation of a sensitive, specific and robust analytical liquid chromatography tandem mass spectrometry (LC-MS/MS) assay capable of separating and accurately measuring 25-hydroxyvitamin-D2/3 (25(OH)D2/3) and 3-epi-25-hydroxyvitamin-D2/3 (3-epi-25(OH)D2/3). We describe a simplified workflow utilising supported liquid extraction (SLE) without derivatization that provides good linearity (mean r > 0.996) and accuracy across a broad dynamic range of 4-500 nmol/L for D3 metabolites and 7.8-500 nmol/L for D2 metabolites. Upon application of this assay to 117 canine serum samples, 25(OH)D3 was detectable in all samples with a median concentration of 82.1 nmol/L (inter-quartile range (IQR) 59.7-101.8 nmol/L). 3-epi-25(OH)D3 could be detected in 87.2 % of the study population, with a median concentration of 5.2 nmol/L (2.4-8.1 nmol/L). However, 3-epi-25(OH)D3 was quantified below the LLOQ in 40.2 % of these samples. 3-epi-25(OH)D3 contributed on average 6.3 % to 25(OH)D3 status (contribution ranges from 0 to 23.8%) and a positive correlation was detected between 25(OH)D3 and 3-epi-25(OH)D3 concentrations. Free 25(OH)D was also measured using an immunoassay with a median concentration of 15.2 pmol/L (12.5-23.2 pmol/L), and this metabolite was also positively correlated to both 3-epi-25(OH)D3 and 25(OH)D3 concentrations. D2 metabolites were not detected in canine serum as expected. Vitamin D metabolite concentrations were variable between individuals, and research into the causes of this variation should include factors such as breed, age, sex and neuter status to determine the impact of genetic and hormonal factors. Given the clinical importance of vitamin D in dogs, and the immense potential for utilising this species as a model for human disease, further elucidation of the vitamin D pathway in this species would provide immense clinical and research benefit.
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Affiliation(s)
- Emma A Hurst
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland, EH25 9RG, United Kingdom; Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh, Scotland, EH16 4TJ, United Kingdom.
| | - Natalie Z Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh, Scotland, EH16 4TJ, United Kingdom.
| | - Scott G Denham
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh, Scotland, EH16 4TJ, United Kingdom.
| | - Emma MacFarlane
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland, EH25 9RG, United Kingdom.
| | - Susan Campbell
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland, EH25 9RG, United Kingdom.
| | - Maaike Boswinkel
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland, EH25 9RG, United Kingdom.
| | - Richard J Mellanby
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland, EH25 9RG, United Kingdom.
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20
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Pelczyńska M, Grzelak T, Sperling M, Kręgielska-Narożna M, Bogdański P, Czyżewska K. Evaluation of Vitamin D Fractions in Obese Hypertensive Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051660. [PMID: 32143350 PMCID: PMC7084800 DOI: 10.3390/ijerph17051660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 12/16/2022]
Abstract
Vitamin D fractions can be involved in the pathogenesis of metabolic disorders, but their concentrations are rarely determined. The aim of this study was to evaluate the concentration of vitamin D fractions in obese hypertensive patients and to determine its associations with anthropometric parameters, glucose levels, and lipid profiles. A total of 85 obese hypertensive patients (OBHT) and 40 nonobese nonhypertensive subjects (NOBNHT) underwent biochemical measurements of lipid profiles, glycemia, 25-hydroxyvitamin D (25(OH)D), free vitamin D (free25(OH)D), vitamin D binding protein, albumin levels. Moreover, free25(OH)D and bioavailable25(OH)D (bio25(OH)D) concentrations were calculated. Blood pressure and anthropometric measurements were performed. Differences between groups (p < 0.001) were found for 25(OH)D (OBHT 40.25 ± 18.02 vs. NOBNHT 64.10 ± 22.29 nmol/L), free25(OH)D (9.77 (7.46; 11.49) vs. 13.80 (10.34; 16.82) pmol/L), bioavailable 25(OH)D (3.7 (2.8; 4.4) vs. 5.4 (4.2; 6.7) nmol/L), and calculated free25(OH)D (7.82 (5.54; 11.64) vs. 10.46(8.06;16.28) pmol/L, p = 0.002). The OBHT patients showed no relationship between vitamin D fractions concentration and glucose or lipids level, although it was associated with anthropometric parameters. In the NOBNHT group, vitamin D fractions correlated positively with HDL cholesterol and negatively with triglyceridemia and hip circumference. Vitamin D fractions were decreased in obese hypertensive subjects, and were associated with anthropometric parameters, but not with glucose level or lipid profiles; they thus cannot be considered as a predictive marker of metabolic disorders in this group of patients.
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Affiliation(s)
- Marta Pelczyńska
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, Szamarzewskiego 84 St., 60-569 Poznan, Poland
- Correspondence:
| | - Teresa Grzelak
- Department and Division of Physiology, Poznan University of Medical Sciences, Swiecickiego 6 St., 60-781 Poznan, Poland
| | - Marcelina Sperling
- Division of Biology of Civilization-Linked Diseases, Poznan University of Medical Sciences, Swiecickiego 6 St., 60-781 Poznan, Poland
| | - Matylda Kręgielska-Narożna
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, Szamarzewskiego 84 St., 60-569 Poznan, Poland
| | - Paweł Bogdański
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, Szamarzewskiego 84 St., 60-569 Poznan, Poland
| | - Krystyna Czyżewska
- Stanisław Staszic University of Applied Sciences in Pila, Podchorazych 10 St., 64-920 Pila, Poland
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21
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Mitchell DM, Ruppert K, Udupa N, Bassir F, Darakananda K, Solomon DH, Lian Y, Cauley JA, Karlamangla AS, Greendale GA, Finkelstein JS, Burnett-Bowie SAM. Temporal increases in 25-hydroxyvitamin D in midlife women: Longitudinal results from the Study of Women's Health Across the Nation. Clin Endocrinol (Oxf) 2019; 91:48-57. [PMID: 30972777 PMCID: PMC6565441 DOI: 10.1111/cen.13986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE 25-hydroxyvitamin D (25(OH)D) is critical for bone mineralization and may prevent fractures. Understanding vitamin D deficiency trends in midlife women is particularly important given their concurrent menopausal changes that increase risk for fracture. We aimed to evaluate changes in mean 25(OH)D over time and their determinants in a racially, ethnically and socioeconomically diverse cohort of midlife women. DESIGN A multi-centre prospective cohort study. PATIENTS 1585 women ages 42-52 years at baseline. MEASUREMENTS We measured serum 25(OH)D at 2 time points (1998-2000 and 2009-2011). Between-visit change was assessed in the whole cohort and in socioeconomic and demographic subgroups. Among those with vitamin D deficiency (25(OH)D <30 nmol/L) at baseline, we evaluated determinants of persistent deficiency at follow-up. RESULTS Mean 25(OH)D increased from 53.8 to 70.0 nmol/L (P < 0.001), and the prevalence of deficiency decreased from 20.4% to 9.7% (P < 0.001). While baseline 25(OH)D differed among subgroups, the changes in 25(OH)D were similar among groups. The proportion of women reporting dietary supplement use increased from 40.8% to 67.1% (P < 0.001), and the increase in 25(OH)D was significantly higher in supplement users. Among women with vitamin D deficiency at baseline, White women and supplement users were less likely to remain deficient at follow-up. CONCLUSIONS Among midlife women, temporal increases in 25(OH)D concentrations are driven largely by increases in supplement use. The proportion of women with 25(OH)D <30 nmol/L and thus at high risk for skeletal consequences remains substantial. Targeted screening for vitamin D deficiency in populations at risk for fragility fracture may be advisable.
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Affiliation(s)
- Deborah M Mitchell
- Endocrine Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Kristin Ruppert
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nisha Udupa
- Endocrine Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Fatima Bassir
- Endocrine Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Karin Darakananda
- Endocrine Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel H Solomon
- Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yinjuan Lian
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arun S Karlamangla
- Department of Medicine, Division of Geriatrics, University of California, Los Angeles, California
| | - Gail A Greendale
- Department of Medicine, Division of Geriatrics, University of California, Los Angeles, California
| | - Joel S Finkelstein
- Endocrine Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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22
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Prognostic Relevance of Circulating 25OHD Fractions for Early Recovery and Survival in Patients with Hip Fracture †. J Clin Med 2018; 7:jcm7080193. [PMID: 30071650 PMCID: PMC6111530 DOI: 10.3390/jcm7080193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/28/2018] [Accepted: 07/28/2018] [Indexed: 12/14/2022] Open
Abstract
The relation between vitamin-D (VD) status and healing after hip fracture had not been sufficiently addressed. Currently serum total 25-hydroxy-VD (t-25OHD) is the most widely used indicator of VD status. It is unclear whether free or bioavailable VD are better markers of 25OHD availability for tissues. Validity of overall cut-off values of t-25OHD is limited. OBJECTIVES (1) Assess serum levels of circulating forms of 25OHD in patients with hip fracture (PwHF: N = 199) compared to active controls without history of fracture (N = 102); (2) determine relationship between 25OHD fractions and functional performance after surgery (FPAS) and survival. The t-25OHD; VD binding protein and albumin levels were measured. Comorbidities; lifestyle; FPAS and survival were recorded at seven months. VD deficiency occurred more frequently in PwHF than in controls (72% vs. 38%). Patients with better FPAS showed higher 25OHD in all fractions than with poor FPAS. Controlled by lifestyle; 25OHD levels were independent predictive factors (p < 0.001). Good FPAS values forecasted longer survival (OR: 6.5CI:3.2⁻13.3; p < 0.0001). All 25OHD forms showed a tendency to predict survival. Mortality rate decreased to 8% in individuals with t-25OHD levels of >22.6⁻39.5 nmol/L and increased to 14% with >40 nmol/L. These observations highlight the importance of serum 25OHD assessment and moderate VD substitution for healing and survival.
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Alwan A, Rizkallah M, Maalouf G, Matta J, Frenn F, Berro AJ, Barakat A, Bachour F, Sebaaly A, Howayek M, Zouhal H, El Hage R. Positive Correlations Between Free Vitamin D and Bone Variables in a Group of Young Lebanese Men. J Clin Densitom 2018; 21:459-461. [PMID: 29673651 DOI: 10.1016/j.jocd.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Abir Alwan
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; Movement Sport and Health Sciences Laboratory, University of Rennes 2-ENS Cachan, Rennes, France
| | - Maroun Rizkallah
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Ghassan Maalouf
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Joseph Matta
- Industrial Research Institute, Baabda, Lebanon; Department of Nutrition, Faculty of Pharmacy, Saint Joseph University, Lebanon
| | - Fabienne Frenn
- Department of Nutrition, Faculty of Pharmacy, Saint Joseph University, Lebanon
| | - Abdel-Jalil Berro
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; EA-3300: APERE, Exercise Physiology and Rehabilitation Laboratory, Picardie Jules Verne University, Sport Sciences Department, Amiens Cedex, France
| | - Angélique Barakat
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Falah Bachour
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Amer Sebaaly
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Mirza Howayek
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Hassane Zouhal
- Movement Sport and Health Sciences Laboratory, University of Rennes 2-ENS Cachan, Rennes, France
| | - Rawad El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon
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24
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Alwan A, Rizkallah M, Maalouf G, Matta J, Frenn F, Barakat A, Bachour F, Sebaaly A, Berro AJ, Al Rassy N, Howayek M, Zouhal H, El Hage R. Positive Correlations Between Free Vitamin D and Bone Variables in a Group of Young Lebanese Women. J Clin Densitom 2018; 21:446-452. [PMID: 29678393 DOI: 10.1016/j.jocd.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/23/2018] [Indexed: 02/06/2023]
Abstract
Optimizing bone mass in adulthood is of great importance to prevent the occurrence of osteoporosis in later age. Vitamin D is an essential component of bone health. Low-serum vitamin D is associated with low bone mineral density (BMD), which is an important predictor of fracture risk. However, most cells, apart from renal tubular cells, are exposed to free rather than to total 25-hydroxyvitamin D. Whether free vitamin D would be a better marker than total vitamin D is still under debate. The aim of the present study was to explore the relationships between serum total vitamin D, vitamin D-binding protein (BP), free vitamin D, and bone parameters in a group of young Lebanese women. This study included 88 young female adults aged between 18 and 35 yr. Body composition and BMD were assessed by dual-energy X-ray absorptiometry, and the lumbar spine trabecular bone score was derived. Bone mineral content (BMC) and BMD were measured at the whole body (WB), the lumbar spine (L1-L4), the total hip (TH), and the femoral neck (FN). To evaluate hip bone geometry, dual-energy X-ray absorptiometry scans were analyzed at the FN, the intertrochanteric region, and the femoral shaft by the Hip Structure Analysis program. The cross-sectional area, the index of axial compression strength, and the section modulus (Z), as well as index of bending strength, were measured from bone mass profiles. Composite indices of FN strength (compressive strength index [CSI], bending strength index, and impact strength index [ISI]) were calculated as previously described. Direct measurement of free 25-hydroxyvitamin D concentrations was performed by immunoassay, which detects free vitamin D by ELISA on a microtiter plate. Serum vitamin D BP was measured using a Quantikine ELISA kit, which employed the quantitative sandwich enzyme immunoassay technique. Serum free vitamin D was positively correlated with WB BMC (r = 0.26, p < 0.05), WB BMD (r = 0.29, p < 0.05), L1-L4 BMD (r = 0.28, p < 0.05), TH BMD (r = 0.34, p < 0.01), FN BMD (r = 0.29, p < 0.05), CSI (r = 0.24, p < 0.05), and ISI (r = 0.28, p < 0.05). No positive correlations were detected between the total vitamin D level, the vitamin D BPs, and BMD. The positive associations between free vitamin D and several bone variables (WB BMC, WB BMD, L1-L4 BMD, TH BMD, FN BMD, CSI, bending strength index, and ISI) remained significant after adjustment for weight. In conclusion, the current study suggests that the free vitamin D serum level is a stronger positive determinant of bone parameters and hip bone strength indices in young female adults than total serum vitamin D.
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Affiliation(s)
- Abir Alwan
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; Movement Sport and Health Sciences Laboratory, University of Rennes 2-ENS Cachan, Rennes, France
| | - Maroun Rizkallah
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Ghassan Maalouf
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Joseph Matta
- Industrial Research Institute, Baabda, Lebanon; Department of Nutrition, Faculty of Pharmacy, Saint Joseph University, Lebanon
| | - Fabienne Frenn
- Department of Nutrition, Faculty of Pharmacy, Saint Joseph University, Lebanon
| | - Angélique Barakat
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Falah Bachour
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Amer Sebaaly
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Abdel-Jalil Berro
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; EA-3300: APERE, Exercise Physiology and Rehabilitation Laboratory, Sport Sciences Department, Picardie Jules Verne University, Amiens Cedex, France
| | - Nathalie Al Rassy
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; Laboratory of Pathophysiology of Inflammatory Bone Diseases PMOI EA4490, University of Littoral Opal Coast ULCO, Boulogne sur Mer and University of Lille, Lille, France
| | - Mirza Howayek
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Hassane Zouhal
- Movement Sport and Health Sciences Laboratory, University of Rennes 2-ENS Cachan, Rennes, France
| | - Rawad El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon.
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25
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Michaëlsson K, Rasmusson A, Wolk A, Byberg L, Mitchell A, Melhus H. The Free Hormone Hypothesis: Is Free Serum 25-Hydroxyvitamin D a Better Marker for Bone Mineral Density in Older Women? JBMR Plus 2018; 2:367-374. [PMID: 30460340 PMCID: PMC6237208 DOI: 10.1002/jbm4.10059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/07/2018] [Accepted: 05/13/2018] [Indexed: 11/09/2022] Open
Abstract
It is presently unclear whether free serum 25‐hydroxyvitamin D (S‐25(OH)D) better reflects bone health than total S‐25(OH)D. We have previously shown that summer total S‐25(OH)D values are more useful to predict bone mineral density (BMD) than winter values. Our objective was therefore to compare the relative importance of free and total S‐25(OH)D for BMD by season. BMD was measured by dual‐energy X‐ray absorptiometry (DXA) in 5002 Swedish women (mean age 68 years) randomly selected from a large population‐based longitudinal cohort study. Free S‐25(OH)D was analyzed by a commercial ELISA and total S‐25(OH)D by HPLC–tandem mass spectrometry (MS/MS). Free and total S‐25(OH)D co‐varied with season, with 26% and 29% higher values in August compared with those in January–March (nadir). There were no differences in mean BMD between categories of free or total S‐25(OH)D in samples collected during winter. Women with higher total S‐25(OH)D measured during summer had higher BMD at the total hip. Compared with women who had total S‐25(OH)D values above 80 nmol/L during summer, adjusted BMD at the total hip was 6% (95% CI, 1% to 11%) lower for S‐25(OH)D concentrations between 30 and 40 mmol/L, and 11% (95% CI, 3% to 19%) lower for those with total S‐25(OH)D <30 nmol/L. In contrast, free S‐25(OH)D measured during summer was not associated with BMD. Compared with women who had highest free S‐25(OH)D measured during summer (>8.8 pmol/L), those with intermediate (2.4–3.5 pmol/L) and lowest (<2.4 pmol/L) free S‐25(OH)D during summer did not have lower total hip BMD values (3% [95% CI, −2% to 7%] and −2% [95% CI, −8% to 4%]). In addition, we found no added value for the prediction of BMD with the combined measurement of total and free S‐25(OH)D during summer or winter. We conclude that vitamin D status assessed by direct measurements of free S‐25(OH)D does not reflect BMD better than total S‐25(OH)D. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Karl Michaëlsson
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Annica Rasmusson
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Liisa Byberg
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Adam Mitchell
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Håkan Melhus
- Department of Medical Sciences Uppsala University Uppsala Sweden
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26
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Pilz S, Obeid R, Schwetz V, Trummer C, Pandis M, Lerchbaum E, Pieber TR, Obermayer-Pietsch B, Wilhelm M, Hahn A, Schön C. Hormonal Contraceptive Use Is Associated With Higher Total but Unaltered Free 25-Hydroxyvitamin D Serum Concentrations. J Clin Endocrinol Metab 2018; 103:2385-2391. [PMID: 29672719 DOI: 10.1210/jc.2018-00336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/11/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Intake of hormonal contraceptives (HC) is associated with higher total 25-hydroxyvitamin D [25(OH)D] concentrations, but the effect of HC on free 25(OH)D is unclear. OBJECTIVE We investigated whether free 25(OH)D concentrations differ according to use of HC. DESIGN This is a post hoc analysis of a randomized open trial. SETTING This study was conducted from 13 January to 9 May, 2016, at a clinical research organization in Esslingen, Germany. PARTICIPANTS We included 201 apparently healthy women of childbearing age. INTERVENTION Participants were randomly assigned to receive a daily multimicronutrient supplement for 8 weeks; the supplement contained 200 IU (n =100) or 800 IU (n = 101) of vitamin D3. MAIN OUTCOME MEASURES Primary outcome was the difference in free 25(OH)D between users and nonusers of HC. RESULTS Overall, 176 participants [median (25th to 75th percentiles) age: 25 (22 to 29) years] with available free 25(OH)D were included in the present analysis. At baseline, total 25(OH)D was significantly higher in users (n = 110) than in nonusers (n = 66) of HC [49.2 (33.4 to 63.4) vs 39.1 (23.8 to 52.5) nmol/L; P < 0.001], whereas there was no difference in free 25(OH)D [7.87 (6.50 to 10.11) vs 7.88 (6.35 to 10.12) pmol/L; P = 0.923]. These results were confirmed after multimicronutrient supplementation and in subgroups according to treatment allocation. CONCLUSIONS Use of HC was associated with, on average, 26% higher total 25(OH)D, whereas free 25(OH)D values did not differ according to use of HC. These findings are relevant for epidemiological studies, but the physiological implications remain to be clarified.
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Affiliation(s)
- Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Rima Obeid
- Department of Clinical Chemistry, Saarland University Hospital, Homburg, Germany
| | - Verena Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Marlene Pandis
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Elisabeth Lerchbaum
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Thomas R Pieber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - Manfred Wilhelm
- Department of Mathematics, Natural and Economic Sciences, University of Applied Sciences Ulm, Ulm, Germany
| | - Andreas Hahn
- 5Institute of Food Science and Human Nutrition, Leibniz University of Hannover, Hannover, Germany
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27
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Alterations in the vitamin D endocrine system during pregnancy: A longitudinal study of 855 healthy Norwegian women. PLoS One 2018; 13:e0195041. [PMID: 29641551 PMCID: PMC5895009 DOI: 10.1371/journal.pone.0195041] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
To ensure optimal calcium accrual in the fetal skeleton, a substantial rise occurs in 1,25-dihydroxyvitamin D (1,25(OH)2D), but is dependent on sufficient 25-hydroxyvitamin (25(OH)D). Large longitudinal studies addressing free 25(OH)D and 1,25(OH)2D during pregnancy are scarce. We aimed to assess levels of and relationship between 25(OH)D, 1,25(OH)2D, vitamin D-binding protein (DBP), parathyroid hormone (PTH), and free 25(OH)D during pregnancy; determinants of vitamin D status; and association between vitamin D indices or PTH and pregnancy outcomes (gestational diabetes mellitus and birthweight). Altogether 855 pregnant Norwegian Caucasian women from Trondheim and Stavanger (latitude 63°N and 58°N) were recruited; 94 were lost to follow-up. The study was originally a randomized controlled trial (2007-2009) with gestational diabetes as primary outcome. Data were collected in second and third trimester. In third trimester, 246 (34%) had vitamin D insufficiency and 52 (7%) deficiency (25(OH)D <50 and <30nmol/L, respectively). During wintertime in third trimester, 61 (47%) from Trondheim and 23 (51%) from Stavanger exhibited vitamin D insufficiency. PTH was elevated in 27 (3.7%). Estimate of change between trimesters was (95% CI): 25(OH)D -1.8 (-2.8 to -0.7) nmol/L, DBP 0.62 (0.57 to 0.66) μmol/L, calculated free 25(OH)D -1.7 (-2.0 to -1.4) pmol/L, PTH 0.81 (0.72 to 0.90) pmol/L, 1,25(OH)2D (sub-analysis) 31.4 (CI 24.7 to 38.2) pmol/L. A decrease in 1,25(OH)2D occurred in 45% of those with vitamin D deficiency, and they also exhibited lower levels than women with adequate vitamin D status. No association of vitamin D indices and PTH with pregnancy outcomes was observed. Women in Trondheim displayed lower 25(OH)D levels, despite minor latitudinal differences. Less than one-fifth adhered to the authorities' vitamin D recommendations. These findings demonstrate that hypovitaminosis D is prevalent among pregnant women living in northern latitudes, especially during the dark season, and there is an unmet need to ensure adequate vitamin D intake.
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28
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Jukic AMZ, Hoofnagle AN, Lutsey PL. Measurement of Vitamin D for Epidemiologic and Clinical Research: Shining Light on a Complex Decision. Am J Epidemiol 2018; 187:879-890. [PMID: 29020155 DOI: 10.1093/aje/kwx297] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/03/2017] [Indexed: 01/08/2023] Open
Abstract
Vitamin D is a fat-soluble vitamin that is synthesized in the skin with exposure to sunlight or is ingested from dietary supplements or food. There has been a dramatic increase in research on vitamin D, linking it with health outcomes as varied as reproductive function, infection, cardiovascular disease, and cancer. The study of vitamin D has generated much excitement, partly because there is an ideal intervention: Low levels may be common and can be remedied with widely available supplements. Determination of vitamin D status is complex and has advanced dramatically in the past 5 years. In this paper, we begin by describing important considerations for measurement of total 25-hydroxyvitamin D (25(OH)D), the biomarker traditionally assessed in epidemiologic studies. While 25(OH)D remains the most commonly measured biomarker, emerging evidence suggests that other related analytes may contribute to the characterization of an individual's vitamin D status (e.g., vitamin D-binding protein, bioavailable and free 25(OH)D, the C-3 epimer of 25(OH)D, 1,25-dihydroxyvitamin D, and 24,25-dihydroxyvitamin D). The measurement of these analytes is also complex, and there are important considerations for deciding whether their measurement is warranted in new research studies. Herein we discuss these issues and provide the reader with an up-to-date synthesis of research on vitamin D measurement options and considerations.
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Affiliation(s)
- Anne Marie Z Jukic
- Department of Chronic Disease Epidemiology, Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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29
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Jakobsen J, Andersen EAW, Christensen T, Andersen R, Bügel S. Vitamin D Vitamers Affect Vitamin D Status Differently in Young Healthy Males. Nutrients 2017; 10:E12. [PMID: 29295513 PMCID: PMC5793240 DOI: 10.3390/nu10010012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 01/25/2023] Open
Abstract
Dietary intake of vitamin D includes vitamin D3 (vitD3), 25-hydroxyvitamin D3 (25OH-D3), and vitamin D2 (vitD2). However, the bioactivity of the different species has not been scientifically established. The hypothesis in this study was that vitD3, 25OH-D3, and vitD2 have an equal effect on 25-hydroxyvitamin D in serum (vitamin D status). To test our hypothesis, we performed a randomized, crossover study. Twelve young males consumed 10 µg/day vitD3 during a four-week run-in period, followed by 3 × 6 weeks of 10 µg/day vitD3, 10 µg/day 25OH-D3, and 10 µg/day vitD2. The content of vitD3, vitD2, 25OH-D3, and 25-hydroxyvitamin D2 (25OH-D2) in serum was quantified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The hypothesis that the three sources of vitamin D affect vitamin D status equally was rejected. Based on the assumption that 1 µg vitD3/day will show an increase in vitamin D status of 1.96 nmol/L, the results showed that 23 µg vitD2 and 6.8 µg 25OH-D3 was similar to 10 µg vitD3. These results demonstrate that further investigations are necessary to determine how to quantify the total vitamin D activity based on chemical quantification of the individual vitamin D metabolites to replace the total vitamin D activity assessed in biological rat models.
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Affiliation(s)
- Jette Jakobsen
- National Food Institute, Technical University of Denmark, 2800 Lyngby, Denmark.
| | | | - Tue Christensen
- National Food Institute, Technical University of Denmark, 2800 Lyngby, Denmark.
| | - Rikke Andersen
- National Food Institute, Technical University of Denmark, 2800 Lyngby, Denmark.
| | - Susanne Bügel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark.
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30
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Racial differences in calculated bioavailable vitamin D with vitamin D/calcium supplementation. AIDS 2017; 31:2337-2344. [PMID: 28832406 DOI: 10.1097/qad.0000000000001621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Some studies suggest that bioavailable 25-dihydroxyvitamin D [25-(OH)D] is more accurate than total 25-(OH)D as an assessment of vitamin D (VitD) status in black individuals. We hypothesized that increases in bioavailable 25-(OH)D would correlate better with improvement in bone outcomes among black HIV-infected adults. DESIGN This is a secondary analysis of AIDS Clinical Trials Group A5280, a randomized, double-blind study of VitD3 and calcium supplementation in HIV-infected participants initiating antiretroviral therapy. METHODS Effect of VitD/calcium on total and calculated bioavailable 25-(OH)D, parathyroid hormone, bone turnover markers, and bone mineral density in black and nonblack participants were evaluated at 48 weeks. Wilcoxon signed-rank tests and Wilcoxon rank sum tests assessed within and between-race differences. RESULTS Of 165 participants enrolled, 129 (40 black and 89 nonblack) had complete data. At baseline, black participants had lower total 25-(OH)D [median (Q1,Q3) 22.6 (15.8, 26.9) vs. 31.1 (23.1, 38.8) ng/ml, P < 0.001] but higher bioavailable 25-(OH)D [2.9 (1.5, 5.2) vs. 2.0 (1.5, 3.0) ng/ml, P = 0.022] than nonblack participants. After 48 weeks of VitD/calcium supplementation, bioavailable 25-(OH)D increased more in black than nonblack participants, but there were no between-race differences change in bone turnover markers or bone mineral density. The associations between increases in 25-(OH)D levels and change in bone outcomes appeared similar for both total and bioavailable 25-(OH)D. CONCLUSION Baseline and change in bioavailable 25-(OH)D were higher among black adults initiating antiretroviral therapy with VitD/calcium; however, associations between 25-(OH)D and bone outcomes appeared similar for total and bioavailable 25-(OH)D. The assessment of total 25-(OH)D may be sufficient for evaluation of VitD status in black HIV-infected individuals. TRIAL REGISTRATION NUMBER NCT01403051.
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Jones KS, Redmond J, Fulford AJ, Jarjou L, Zhou B, Prentice A, Schoenmakers I. Diurnal rhythms of vitamin D binding protein and total and free vitamin D metabolites. J Steroid Biochem Mol Biol 2017; 172:130-135. [PMID: 28732681 PMCID: PMC5571031 DOI: 10.1016/j.jsbmb.2017.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/02/2017] [Accepted: 07/15/2017] [Indexed: 11/19/2022]
Abstract
Vitamin D binding protein (DBP) concentration is known to influence the availability and bioactivity of vitamin D metabolites but its diurnal rhythm (DR), its inter-relationships with the DRs of vitamin D metabolites and its influence on free vitamin D metabolite concentrations are not well described. The DRs of plasma total 25(OH)D, total 1,25(OH)2D, DBP, albumin and calculated free 25(OH)D and free 1,25(OH)2D were measured in men and women aged 60-75 years and resident in the UK (n 30), Gambia (n 31) and China (n 30) with differences in lifestyle, dietary intake and vitamin D status. Blood samples were collected every 4h for 24h and DRs statistically analysed with Fourier regression. Gambians had significantly higher plasma concentrations of vitamin D metabolites and lower albumin concentration compared to the British and Chinese. Significant DRs were observed for all analytes and calculated free vitamin D metabolites (P<0.01). The pattern of DRs was similar between countries. The magnitude of the DRs of free 1,25(OH)2D was attenuated compared to that of total 1,25(OH)2D whereas it was not different between total and free 25(OH)D. Relationships between the DRs were generally weak. There was no phase shift between 1,25(OH)2D and DBP with the strongest cross correlation at 0h time lag (r=0.15, P=<0.001). In comparison, 25(OH)D correlated less well with DBP (1h time lag, r=0.07, P=0.12). These data demonstrate a relationship between the DRs of 1,25(OH)2D and DBP, possibly to maintain free 1,25(OH)2D concentrations. In contrast, the DRs of total and free 25(OH)D appeared to be less influenced by DBP, suggesting that DBP has comparatively less effect on 25(OH)D concentration and 25(OH)D availability. This work highlights the importance of standardisation in timing of sample collection particularly for the assessment of plasma protein concentrations.
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Affiliation(s)
- Kerry S Jones
- Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, United Kingdom.
| | - Jean Redmond
- Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, United Kingdom
| | - Anthony J Fulford
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | | | - Bo Zhou
- Department of Public Health, Shenyang Medical College, Shenyang 110034, PR China
| | - Ann Prentice
- Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, United Kingdom; MRC Keneba, MRC Unit, Gambia
| | - Inez Schoenmakers
- Medical Research Council Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, United Kingdom
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Eckard AR, Thierry-Palmer M, Silvestrov N, Rosebush JC, O'Riordan MA, Daniels JE, Uribe-Leitz M, Labbato D, Ruff JH, Singh RJ, Tangpricha V, McComsey GA. Effects of cholecalciferol supplementation on serum and urinary vitamin D metabolites and binding protein in HIV-infected youth. J Steroid Biochem Mol Biol 2017; 168:38-48. [PMID: 28161530 PMCID: PMC5385603 DOI: 10.1016/j.jsbmb.2017.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 01/23/2017] [Accepted: 01/29/2017] [Indexed: 12/15/2022]
Abstract
Vitamin D insufficiency is widespread in HIV-infected patients. HIV and/or antiretroviral therapy (ART), particularly efavirenz (EFV), may interfere with vitamin D metabolism. However, few data from randomized, controlled trials exist. Here, we investigate changes in vitamin D metabolites and binding protein (VDBP) after 6 months of supplementation in a randomized, active-control, double-blind trial investigating 2 different monthly cholecalciferol (vitamin D3) doses [60,000 (medium) or 120,000 (high) IU/month] vs. a control arm of 18,000 IU/month in 8-25year old HIV-infected youth on ART with HIV-1 RNA <1000 copies/mL and baseline 25-hydroxycholecalciferol (25(OH)D3) ≤30ng/mL. A matched healthy uninfected group was enrolled in a similar parallel study for comparison. Changes after 6 months were analyzed as intent-to-treat within/between groups [control group (low dose) vs. combined supplementation doses (medium+high)]. At 6 months, 55% vs. 82% of subjects in control and supplementation groups, respectively, reached 25(OH)D3 ≥30ng/mL (P=0.01) with no difference between medium and high doses (both 82% ≥30ng/mL). There were few differences for those on EFV vs. no-EFV, except serum VDBP decreased in EFV-treated subjects (both within- and between-groups P≤0.01). There were no significant differences between the HIV-infected vs. healthy uninfected groups. The major finding of the present study is that cholecalciferol supplementation (60,000 or 120,000 IU/month) effectively raises serum 25(OH)D3 in the majority of HIV-infected subjects, regardless of EFV use. Notably, response to supplementation was similar to that of uninfected subjects.
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Affiliation(s)
- Allison Ross Eckard
- Medical University of South Carolina, Charleston, SC, United States; Emory University School of Medicine, Atlanta, GA, United States.
| | | | | | | | | | - Julie E Daniels
- Emory University School of Medicine, Atlanta, GA, United States
| | | | | | - Joshua H Ruff
- Emory University School of Medicine, Atlanta, GA, United States
| | | | - Vin Tangpricha
- Emory University School of Medicine, Atlanta, GA, United States
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Han JE, Alvarez JA, Jones JL, Tangpricha V, Brown MA, Hao L, Brown LAS, Martin GS, Ziegler TR. Impact of high-dose vitamin D 3 on plasma free 25-hydroxyvitamin D concentrations and antimicrobial peptides in critically ill mechanically ventilated adults. Nutrition 2017; 38:102-108. [PMID: 28526374 DOI: 10.1016/j.nut.2017.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/09/2017] [Accepted: 02/09/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES High-dose vitamin D3 increases plasma total 25-hydroxyvitamin D [25(OH)D] in critically ill, ventilated patients; however, to our knowledge, the effect on plasma levels of free (nonprotein-bound) 25(OH)D has not been investigated in critical illness. Moreover, the relationship of free 25(OH)D and the regulation of endogenous antimicrobial peptides (AMPs) remains unknown. The aims of this study were to determine in critically ill adults with respiratory failure the effect of previous high-dose regimens of vitamin D3 on free 25(OH)D concentrations, the relationship of free 25(OH)D with circulating cathelicidin (LL-37) and human beta-defensin-2 (hBD-2), and the associations between plasma levels of free 25(OH)D and these AMPs to alveolar macrophage phagocytosis function. METHODS In a double blind, randomized controlled trial, critically ill ventilator-dependent adults (N = 30) received enteral vitamin D3 (250,000 or 500,000 IU total over 5 d) or placebo. Plasma was obtained serially for concentrations of free 25(OH)D, LL-37, hBD-2, and expression of peripheral blood mononuclear cell human cationic antimicrobial protein (hCAP18) mRNA. Total 25(OH)D and LL-37 concentrations and alveolar macrophage phagocytosis were determined in bronchoalveolar lavage fluid. RESULTS Plasma concentrations of free 25(OH)D over time were correlated with total 25(OH)D levels (r= 0.82; P < 0.001). The increase in free 25(OH)D was greater with the 500 000 IU vitamin D3 dose than with the lower dose. The percent change in mRNA expression of hCAP18 was positively associated with percent change in free 25(OH)D at days 7 and 14 (ρ = 0.48; P = 0.04 and ρ = 0.59; P = 0.03, respectively). Additionally, plasma LL-37 levels correlated with the percentage of alveolar macrophages exhibiting phagocytosis (ρ = 0.51; P = 0.04). CONCLUSIONS The present study found a dose-related increase in plasma free-25(OH)D levels, which was associated with increasing circulating mRNA expression of hCAP18 over time. There were no correlations between changes in total and free 25(OH)D against plasma LL-37 and hBD-2 concentrations. Larger studies appear warranted to determine the impact of high-dose vitamin D3 administration on endogenous AMPs.
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Affiliation(s)
- Jenny E Han
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Emory University, Atlanta, Georgia, USA; Emory Critical Care Center, Emory University, Atlanta, Georgia, USA.
| | - Jessica A Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jennifer L Jones
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, Georgia, USA; Atlanta VA Medical Center, Decatur, Georgia, USA
| | - Mona A Brown
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Li Hao
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Lou Ann S Brown
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Greg S Martin
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Emory University, Atlanta, Georgia, USA; Emory Critical Care Center, Emory University, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, Georgia, USA; Atlanta VA Medical Center, Decatur, Georgia, USA
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Oleröd G, Hultén LM, Hammarsten O, Klingberg E. The variation in free 25-hydroxy vitamin D and vitamin D-binding protein with season and vitamin D status. Endocr Connect 2017; 6:111-120. [PMID: 28179376 PMCID: PMC5428908 DOI: 10.1530/ec-16-0078] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/08/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Serum 25-hydroxy vitamin D [25(OH)D] varies greatly with season at northern latitudes. The purpose of this study was to determine if the seasonal variations in serum total 25(OH)D are followed by a concomitant variation in free 25(OH)D or if the variation is damped by alterations in the binding capacity of DBP. METHODS Serum was collected from 540 healthy blood donors (60% men; mean age 41 ± 13 years) during 12 months and analyzed for total 25(OH)D, directly measured free 25(OH)D, vitamin D-binding protein (DBP) and albumin. Calculated free 25(OH)D was estimated. RESULTS The UV-B radiation during the sampling month was positively correlated with the serum levels of total 25(OH)D (r = 0.355, P < 0.001), directly measured free (r = 0.336, P < 0.001) and calculated free 25(OH)D (r = 0.275, P < 0.001), but not with DBP and albumin. The percentage of free 25(OH)D was higher during the winter months than that during the summer months (0.020 ± 0.005% vs 0.019 ± 0.004%; P = 0.007) and higher in participants with a serum 25(OH)D below 25 nmol/L than that in participants with a serum 25(OH)D above 75 nmol/L (0.031 ± 0.007% vs 0.017 ± 0.003%; P < 0.001). iPTH was correlated with directly measured free 25(OH)D (r = -0.226; P < 0.001), but only weakly with calculated free 25(OH)D (r = -0.095; P = 0.027). CONCLUSIONS Directly measured free serum 25(OH)D was highly correlated with total serum 25(OH)D and followed the same seasonal variation, whereas the serum concentrations of DBP and albumin were stable. The fluctuation in free 25(OH)D was only marginally damped with an increase in the percentage of free 25(OH)D during the winter months and in participants with vitamin D deficiency.
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Affiliation(s)
- Göran Oleröd
- Department of Clinical Chemistry and Transfusion MedicineSahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Ola Hammarsten
- Department of Clinical Chemistry and Transfusion MedicineSahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation ResearchSahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Mirzakhani H, Litonjua AA, McElrath TF, O'Connor G, Lee-Parritz A, Iverson R, Macones G, Strunk RC, Bacharier LB, Zeiger R, Hollis BW, Handy DE, Sharma A, Laranjo N, Carey V, Qiu W, Santolini M, Liu S, Chhabra D, Enquobahrie DA, Williams MA, Loscalzo J, Weiss ST. Early pregnancy vitamin D status and risk of preeclampsia. J Clin Invest 2016; 126:4702-4715. [PMID: 27841759 DOI: 10.1172/jci89031] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/16/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Low vitamin D status in pregnancy was proposed as a risk factor of preeclampsia. METHODS We assessed the effect of vitamin D supplementation (4,400 vs. 400 IU/day), initiated early in pregnancy (10-18 weeks), on the development of preeclampsia. The effects of serum vitamin D (25-hydroxyvitamin D [25OHD]) levels on preeclampsia incidence at trial entry and in the third trimester (32-38 weeks) were studied. We also conducted a nested case-control study of 157 women to investigate peripheral blood vitamin D-associated gene expression profiles at 10 to 18 weeks in 47 participants who developed preeclampsia. RESULTS Of 881 women randomized, outcome data were available for 816, with 67 (8.2%) developing preeclampsia. There was no significant difference between treatment (N = 408) or control (N = 408) groups in the incidence of preeclampsia (8.08% vs. 8.33%, respectively; relative risk: 0.97; 95% CI, 0.61-1.53). However, in a cohort analysis and after adjustment for confounders, a significant effect of sufficient vitamin D status (25OHD ≥30 ng/ml) was observed in both early and late pregnancy compared with insufficient levels (25OHD <30 ng/ml) (adjusted odds ratio, 0.28; 95% CI, 0.10-0.96). Differential expression of 348 vitamin D-associated genes (158 upregulated) was found in peripheral blood of women who developed preeclampsia (FDR <0.05 in the Vitamin D Antenatal Asthma Reduction Trial [VDAART]; P < 0.05 in a replication cohort). Functional enrichment and network analyses of this vitamin D-associated gene set suggests several highly functional modules related to systematic inflammatory and immune responses, including some nodes with a high degree of connectivity. CONCLUSIONS Vitamin D supplementation initiated in weeks 10-18 of pregnancy did not reduce preeclampsia incidence in the intention-to-treat paradigm. However, vitamin D levels of 30 ng/ml or higher at trial entry and in late pregnancy were associated with a lower risk of preeclampsia. Differentially expressed vitamin D-associated transcriptomes implicated the emergence of an early pregnancy, distinctive immune response in women who went on to develop preeclampsia. TRIAL REGISTRATION ClinicalTrials.gov NCT00920621. FUNDING Quebec Breast Cancer Foundation and Genome Canada Innovation Network. This trial was funded by the National Heart, Lung, and Blood Institute. For details see Acknowledgments.
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