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Wechsung K, Schnabel D, Wiegand S. Longitudinal analysis of vitamin D levels considering sunshine duration and suggestion for a standardised approach for vitamin D supplementation in children and adolescents with obesity. BMC Pediatr 2024; 24:337. [PMID: 38750418 PMCID: PMC11094954 DOI: 10.1186/s12887-024-04823-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Children with obesity have low 25 hydroxy-vitamin D (25-OH-D3) levels compared to lean children. Recommendations on when to start vitamin D supplementation differ largely between countries. Longitudinal data on 25-OH-D3 levels to guide treatment decisions are scarce since they are largely influenced by solar radiation and are difficult to compare. METHODS We carried out a retrospective analysis of multiple 25-OH-D3 and parathyroid hormone (PTH) measurements in a cohort of 543 patients without vitamin D supplementation. All measurements were taken at the local paediatric obesity clinic as documented in the German-Austrian-Swiss APV (Prospective Documentation of Overweight Children and Adolescents) registry from 2009 to 2019. Serial 25-OH-D3 and PTH levels were adjusted for sunshine duration over the last 30 days to account for seasonal variation, as well as for sex and body mass index (BMI). We further performed an exploratory analysis of the association of sunshine duration, sex, BMI SDS (standard deviation score), abnormal lipid levels or dysglycemia with the 25-OH-D3 trend. RESULTS 229 obese patients (mean BMI SDS: 2,58 (± 0,56), 53% females, mean age: 12 (± 3) years, range: 2-21 years) with two, 115 with three and 96 with four repeated 25-OH-D3 measurements were identified. Mean adjusted 25-OH-D3 (48.2 nmol/l) and PTH (34.9 ng/l) levels remained stable over 120 weeks. 5% of the patients had an elevated PTH > 65 ng/l. High total cholesterol ≥ 200 mg/dl and high triglycerides ≥ 130 mg/dl were associated with higher 25-OH-D3 levels. CONCLUSION We propose a simple method to include sunshine duration in the analysis of 25-OH-D3 levels to minimise the bias of seasonal variation. Based on our data we established the pragmatic strategy of limiting vitamin D supplementation to patients with biochemical signs of mineralisation disorders such as elevated PTH and alkaline phosphatase (AP). In children with normal PTH and AP we recommend adjustment of calcium intake and increase of outdoor activity instead.
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Affiliation(s)
- Katja Wechsung
- Department for Pediatric Endocrinology and Diabetology, Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Dirk Schnabel
- Department for Pediatric Endocrinology and Diabetology, Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Susanna Wiegand
- Department for Pediatric Endocrinology and Diabetology, Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Mehdad S, Belghiti H, Zahrou FE, Guerinech H, Mouzouni FZ, El Hajjab A, El Berri H, El Ammari L, Benaich S, Benkirane H, Barkat A, Aguenaou H. Vitamin D status and its relationship with obesity indicators in Moroccan adult women. Nutr Health 2023; 29:673-681. [PMID: 35435056 DOI: 10.1177/02601060221094376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Although vitamin D deficiency has been studied in various populations, there are few data on its prevalence and associated factors among Moroccan women. Aim: To determine the prevalence of vitamin D deficiency and investigate its association with body mass index (BMI), waist circumference, and serum concentrations of parathyroid hormone, calcium, and phosphorus in a sample of Moroccan adult women. Methods: This is a cross-sectional study conducted at Mohammed V Military Hospital of Instruction, Rabat. Anthropometric measurements and biochemical analyses were performed using standard procedures Results: A total of 714 women aged 18-65 years participated in this study. The overall prevalence of vitamin D deficiency was 74.4%. Approximately 24% and 51% of women had severe and moderate vitamin D deficiency, respectively. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were inversely correlated with BMI in vitamin D-deficient subjects (P = 0.036) and with parathyroid hormone 1-84 (PTH1-84) levels in the study sample (P = 0.010). PTH1-84 concentrations were greater among overweight/obese individuals compared to their non-overweight peers (P = 0.001) and tended to be higher among vitamin D-deficient women than vitamin D-sufficient women (P = 0.053). Conclusion: This study showed a very high prevalence of vitamin D deficiency in this sample of Moroccan women. Lower serum 25(OH)D levels were associated with increased BMI in vitamin D-deficient women and with elevated PTH1-84 levels among the study sample. Although these findings come from a convenience sample of women that attended a nutrition clinic, they underscore the urgent need to develop public health interventions to improve women's vitamin D status.
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Affiliation(s)
- Slimane Mehdad
- Physiology and Physiopathology Research Team, Research Centre of Human Pathologies Genomics, Faculty of Sciences, Mohammed V University in Rabat, Morocco
- Clinical Nutrition Unit, Mohammed V Military Hospital of Instruction, Rabat, Morocco
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Hakim Belghiti
- Clinical Nutrition Unit, Mohammed V Military Hospital of Instruction, Rabat, Morocco
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Fatima Ezzahra Zahrou
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Hassania Guerinech
- Clinical Nutrition Unit, Mohammed V Military Hospital of Instruction, Rabat, Morocco
| | | | - Amina El Hajjab
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | | | | | - Souad Benaich
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Hasnae Benkirane
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Amina Barkat
- Health and Nutrition Research Team of the Mother-Child Couple, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Hassan Aguenaou
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
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The Effect of Vitamin D3 on the Alignment of Mandibular Anterior Teeth: A Randomized Controlled Clinical Trial. Int J Dent 2022; 2022:6555883. [PMID: 35198025 PMCID: PMC8860536 DOI: 10.1155/2022/6555883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To investigate the effect of vitamin D3 level on the alignment of mandibular anterior teeth in adults and explore the associated root resorption and pain perception. Trial Design. Multicentre, double blinded randomized clinical trial. Subjects and Methods. Adult patients aged 18–30 years, with moderate mandibular incisor crowding [Little's Irregularity index (LII) 3–6 mm], needing nonextraction treatment with fixed orthodontic appliance, were randomly allocated into two groups with 1 : 1 allocation ratio. In the 1st group (normal vitamin D3 level group [ND3G]), vitamin D level was measured and corrected to normal before starting orthodontic treatment, while in the 2nd group [control group (CG)] the vitamin D level was kept unknown until completion of the alignment phase. Outcome measures included mandibular incisor crowding using LII, orthodontically induced root resorption (OIRR), and pain perception. Independent sample t-test was used to compare the duration of treatment, the effectiveness of alignment, and OIRR between groups, while differences in pain perception were analysed by Mann–Whitney U-test (P < 0.05). Results Out of 87 patients recruited from four centres, 33 patients were randomly allocated into two groups (17 patients to ND3G and 16 patients to CG). Time elapsed for the complete alignment of the mandibular incisor crowding was one month shorter in ND3G (23.532% faster), and the improvement percentage was significantly higher in all periods when compared to the CG. The amount of OIRR was not significantly different between groups; however, pain during the first three days of alignment was significantly less in ND3G. Conclusions Having optimal vitamin D3 level reduced the alignment time and pain associated with orthodontic treatment, but it had no role in reducing OIRR. Registration. The trial was registered with ClinicalTrials.gov on 12th April 2021 (registration number: NCT04837781).
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Karacan Küçükali G, Gülbahar Ö, Özalkak Ş, Dağlı H, Ceylaner S, Aycan Z, Savaş Erdeve Ş. Is Bioavailable Vitamin D Better Than Total Vitamin D to Evaluate Vitamin D Status in Obese Children? J Clin Res Pediatr Endocrinol 2021; 13:391-399. [PMID: 34013709 PMCID: PMC8638623 DOI: 10.4274/jcrpe.galenos.2020.2021.0230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Free hormones are biologically more active in target tissues. Thus, measurement of vitamin D taking into account bioavailability and free vitamin D may be preferable, especially when evidence is contradictory, as in obese children. In order to assess bioavailablity and free vitamin D, using a previously reported formula, vitamin D-binding protein (VDBP) level was measured and VDBP polymorphisms were also evaluated because of variations in binding affinity. METHODS Eighty-four obese and 78 healthy children were included. Anthropometry, calcium, phosphorus, alkaline-phosphatase, parathyroid hormone (PTH), 25 hydroxyvitamin D [25(OH)D], bioavailable-free vitamin D, and VDBP concentration and polymorphism were evaluated in the whole group. RESULTS Obese girls had significantly higher PTH than normal weight girls (p=0.001). Regardless of gender, obese children had significantly higher concentrations of VDBP (p=0.008) and PTH (p=0.002). When samples taken in winter were analyzed, PTH and VDBP were found to be higher and bioavailable and free vitamin D lower in the obese group. There was no difference in terms of total vitamin D between groups during the winter season. CONCLUSION While total, free, and bioavailable vitamin D in the obese group was similar to the control group in autumn, free and bioavailable vitamin D in the winter was lower in the obese than the control group. In addition, PTH was higher in the obese group in both autumn and winter. Therefore, more research is needed to evaluate the variability of free and bioavailable vitamin D according to body habitus, season and the effect any differences may have.
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Affiliation(s)
- Gülin Karacan Küçükali
- University of Health Science Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: University of Health Science Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey Phone: +90 533 764 84 26 E-mail:
| | - Özlem Gülbahar
- Gazi University Faculty of Medicine, Department of Clinical Biochemistry, Ankara, Turkey
| | - Şervan Özalkak
- University of Health Science Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Hasan Dağlı
- Gazi University Faculty of Medicine, Department of Clinical Biochemistry, Ankara, Turkey
| | | | - Zehra Aycan
- University of Health Science Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Şenay Savaş Erdeve
- University of Health Science Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
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