Hypovitaminosis D in a healthy female population, aged from 40 to 85 years, in the west of Ireland

Vitamin D Status of Adults in the Community, in Outpatient Clinics, in Hospital, and in Nursing Homes in the West of Ireland

BACKGROUND

Approximately 1 billion people worldwide have Vitamin D deficiency. The aim of this study was to compare Vitamin D status and serum 25-hydroxyvitamin D (25(OH)D) concentrations among adults sampled in the community, in outpatient clinics, as hospital inpatients and in nursing homes in the West of Ireland. The secondary aim was to determine the associations between length of hospital stay (inpatients) at the time of serum 25(OH)D sampling and Vitamin D status.

METHODS

A cross-sectional study was carried out. Patients who had serum 25(OH)D analysis carried out in Galway University Hospitals (January 2011-December 2015) were identified following interrogation of the electronic laboratory data system. Baseline demographics, location, and date of sample collection were recorded. Vitamin D deficiency was defined as a serum 25(OH)D concentration <25 nmol/L.

RESULTS

In total, 24,302 patient samples were eligible for inclusion: community 15,319; outpatient clinics 6,371; inpatients 2,339; and nursing home residents 273. Vitamin D deficiency was more common in nursing home residents than inpatients, or those sampled in outpatient clinics or in the community (42% vs 37% vs 17% vs 13%; p < .001). Inpatients sampled further into their hospital stay (≥3 days) had greater Vitamin D deficiency than inpatients sampled on 0-2 days (p = .007). Season (p < .001), sex (p < .001), and age (p < .001) were associated with 25(OH)D concentrations. Vitamin D deficiency was more common in Winter/Spring, in males, and in those aged ≥80 years.

CONCLUSIONS

Nursing home residents and inpatients are at the highest risk for Vitamin D deficiency. Season, sex, age, and day of hospital stay on which serum 25(OH)D concentrations were sampled were associated with Vitamin D status.

Higher risk of vitamin D insufficiency/deficiency for rural than urban dwellers

There are many risk factors for Vitamin D deficiency. This study aimed to compare the Vitamin D status and serum 25(OH)D concentrations of adults living in an urban area to adults living in a rural area in the West of Ireland (latitude 53.27° North). A cross-sectional retrospective analysis of clinical records was performed. Following interrogation of the electronic laboratory information system, individuals who had serum 25(OH)D concentrations measured at Galway University Hospitals between January 2011 and December 2015 were identified. Clinical demographics, setting and date of sampling were recorded. In total, 17,590 patients (urban n = 4,824; rural n = 12,766) were eligible for inclusion. Serum 25(OH)D concentrations were lower among rural compared to urban dwellers irrespective of season (spring p < 0.001, summer p = 0.009, autumn p = 0.002, winter p < 0.001). There was a significant difference in Vitamin D status between urban and rural dwellers in three of the four seasons: spring- deficiency: 16%-v-23%, insufficiency: 39%-v-43%, sufficiency: 45%-v-35% (p < 0.001); autumn- deficiency: 11%-v-10%, insufficiency: 30%-v-35%, sufficiency: 59%-v-56% (p = 0.01); winter- deficiency: 23%-v-25%, insufficiency: 35%-v-42%, sufficiency: 41%-v-33% (p < 0.001). Serum 25(OH)D concentrations were higher and the prevalence of deficiency lower in urban/rural females compared to urban/rural males (p < 0.001). Serum 25(OH)D concentrations increased sequentially from the 18-39 year age group to the 60-69 year age group in both urban (p < 0.001) and rural (p < 0.001) dwellers and then decreased progressively as age increased to ≥90 years. The odds of Vitamin D deficiency increased with age, lower daily sunshine hours, male gender, rural address and season.

COVID-19: the older adult and the importance of vitamin D sufficiency

In December 2019, in Wuhan, China, the novel coronavirus ‘severe acute respiratory syndrome 2’ (SARS-CoV-2) was discovered as the cause of a pneumonia-like illness and subsequently named coronavirus disease 2019 (COVID-19). COVID-19 spread and is now a global pandemic. With few exceptions, countries in the Northern hemisphere have higher mortality rates from COVID-19. This may be due to an increased prevalence of older people in Northern Europe at higher risk of having cardio-pulmonary and metabolic comorbidities as well as hypovitaminosis D. With increasing age, immunosenescence and ‘inflammaging’ lead to impaired and maladaptive immune responses to SARS-CoV-2 infections, contributing to the enhanced prevalence of severe COVID-19 in older patients. The association of ageing with increased vitamin D deficiency, which is associated with cardiovascular risk factors and disease and worse prognosis in COVID-19 infection, is discussed. Considerable experimental evidence demonstrates the immuno-modulatory properties of vitamin D, in particular, its role in regulating and suppressing the inflammatory cytokine response to viral respiratory infections links the importance of vitamin D sufficiency as a potential protective factor in COVID-19. There is an urgent need for prospective randomised studies to examine whether hypovitaminosis D correlates with severity of COVID-19 disease and the actual benefit of repletion. Moreover, given what has been described as a ‘pandemic of vitamin D deficiency’, especially in Europe, and in the context of the SARS-CoV-2 contagion, the authors support the call for public health doctors and physicians, with support from Governments, to prioritise and strengthen recommendations on vitamin D intake and supplementation.

High Vitamin D Levels May Downregulate Inflammation in Patients with Behçet's Disease

Vitamin D plays a significant role in the immune system modulation and may confer a protective role in autoimmune diseases. We conducted a case-control study to compare 25(OH)D levels in patients with BD who were managed at a regional rheumatology programme in the midwest region of Ireland compared to matched controls. Healthy controls were selected from the Irish health system and matched in 1 : 5 ratio for age, sex, and the month of the year. 25(OH)D levels <20 nmol/L were classified as deficient while levels between 20 and 40 nmol/L were classified as insufficient. Differences between groups were assessed using Mann-Whitney test and associations between cases and controls were expressed as odds ratios and 95% confidence intervals. Nineteen patients with BD were compared with 95 controls matched by age, sex, and month of blood draw. 25(OH)D levels were significantly higher in patients in BD than in matched controls (median values: 45 nmol/L versus 22 nmol/L, p < 0.005) and tended to be lower in patients with active disease than in those without (median values: 35 nmol/L (IQR: 22.75-47.25 nm/L) versus 50 nmol/L (IQR: 35-67 nmol/L), p = 0.11). Compared to controls, patients with BD were significantly less likely to have 25(OH)D deficiency or insufficiency (OR: 0.09, 95% CI: 0.03-0.28, p < 0.001). Our findings suggest a possible role for 25(OH)D in modifying the inflammatory response in BD and uncover a potential opportunity to assess whether correction of Vit D deficiency confers protective benefits.

Vitamin D Deficiency and Insufficiency Prevalence in the West of Ireland - A Retrospective Study

OBJECTIVES

Vitamin D plays an important role in calcium homeostasis and is essential for normal bone growth and remodeling. Previous studies of acutely ill and institutionalized older women in Galway revealed that vitamin D insufficiency is extremely common. We aimed to evaluate age and gender-related rates of vitamin D insufficiency and deficiency in adult patients attending their General Practitioners in the same region.

DESIGN

A retrospective cohort study.

SETTING

General practices in Galway, a city located on the west coast of Ireland, latitude 53.17 North.

PARTICIPANTS

A total of 15,708 consecutive blood samples from adults attending their General Practitioners between January 2013 and December 2014 were sent to the Clinical Biochemistry Laboratory in the University Hospital Galway for vitamin D level testing. 73% were from women.

INTERVENTION

Data were collected and grouped according to age, sex and season. Vitamin D levels (25OHD) were categorised into deficiency (<25nmol/L), insufficiency (25-50nmol/L) and sufficiency ( >50nmol/L).

MEASUREMENTS

Median and interquartile range were reported as vitamin D levels were not normally distributed. Descriptive statistics were performed using STATA/MP 13.1 for Mac.

RESULTS

While vitamin D levels were sufficient in 56.4% (n=8,496), they were insufficient in 32.4% (n=4,891) and deficient in 11.2% (n=1,691). Of the deficient group, 19%( 325) had levels <15nmol/L consistent with profound deficiency. Men were more likely than women to be deficient (12% (n=489) vs. 10.9% (n=1,202)) and insufficient (38.0% (n=1,550) vs. 30.4% (n=3,341)) (p<0.01). Highest rates of deficiency were seen in those 81-97 years (19.4% (n=136)) and 18-40 years (13.8% (n=543)), the former group showing less seasonal variation.

CONCLUSION

Overall prevalence of insufficiency is similar to those in national and European studies published recently. However, there is a high possibility that those most vulnerable to vitamin D deficiency were underrepresented in this cohort, when results from previous studies in the same region are considered. Further prospective studies are needed to guide treatment with supplementation of vitamin D for appropriate subgroups.

Assessment of prevalence of hypovitaminosis D in multiethnic population of the United Arab Emirates

United Arab Emirates (UAE) has a high prevalence of hypovitaminosis D. Not much data are available regarding the prevalence of Vitamin D deficiency among multiethnic UAE adult population. (1) To determine the prevalence of hypovitaminosis D in multiethnic UAE population (2) To compare the Vitamin D status in Arab and non-Arab population (3) To identify the demographic variables associated with hypovitaminosis D. It was a retrospective study conducted at a secondary care hospital. Electronic case records of all the subjects who had checked their Vitamin D levels during the time period of May 2010–October 2012 were considered for the study. Vitamin D severe deficiency, deficiency, insufficiency, and sufficiency were defined as serum 25-hydroxy Vitamin D (25(OH)D) levels < 10 ng/mL, 10–20 ng/mL, 21–30 ng/mL, and > 30 ng/mL, respectively. A total 425 subjects were included for the data analysis. Vitamin D deficiency was diagnosed in 208 (48.9%) subjects followed by severe Vitamin D deficiency and insufficiency in 141 (33.2%) and 63 (14.8%) subjects, respectively. The overall prevalence of hypovitaminosis D was 96.9%. Negative association (r = −0.196, P < 0.01) was observed between body mass index (BMI) and 25(OH)D levels. Ethnicity was not (P = 0.103) a predictor of 25(OH)D levels. Majority of our study subjects had Vitamin D deficiency. There was no substantial difference in 25(OH)D levels of different ethnic groups. Female gender, age, and BMI were the predictors 25(OH)D levels.

High prevalence of vitamin D insufficiency in community-dwelling postmenopausal Polish women

Introduction

Inadequate vitamin D level is associated with altered bone turnover and bone loss, which increases the fracture risk.

Aim

To assess the seasonal prevalence of inadequate (insufficient or deficient) serum vitamin D levels in community-dwelling postmenopausal Polish women screened for osteoporosis.

Material and methods

A cross-sectional observational study based on the regional urban non-institutionalized sample (n = 107) of postmenopausal Caucasian women in the age range of 51-83 years, not taking any medication and free from any condition likely to affect vitamin D status or calcium/bone metabolism. The outcome measures were the mean 25-OH vitamin D level across all the seasons and the percentage of vitamin D deficiency and insufficiency and defined as < 20 ng/dl (50 nmol/l) and 20-30 ng/dl (50-75 nmol/l), respectively.

Results

No statistically significant difference has been found in the mean vitamin D level, regardless of the season (p = 0.4). The prevalence of vitamin D deficiency and insufficiency were in spring 54% and 32%, in summer 46% and 46%, in autumn 67% and 27%, and in winter 61% and 22%, respectively.

Conclusions

Vitamin D inadequacy is common in a sample of Polish community-dwelling postmenopausal women regardless of the season.

Vitamin D status of Irish adults: findings from the National Adult Nutrition Survey

Previous national nutrition surveys in Irish adults did not include blood samples; thus, representative serum 25-hydroxyvitamin D (25(OH)D) data are lacking. In the present study, we characterised serum 25(OH)D concentrations in Irish adults from the recent National Adult Nutrition Survey, and determined the impact of vitamin D supplement use and season on serum 25(OH)D concentrations. Of the total representative sample (n 1500, aged 18+ years), blood samples were available for 1132 adults. Serum 25(OH)D was measured via immunoassay. Vitamin D-containing supplement use was assessed by questionnaire and food diary. Concentrations of serum 25(OH)D were compared by season and in supplement users and non-users. Year-round prevalence rates for serum 25(OH)D concentration < 30, < 40, < 50 and < 75 nmol/l were 6.7, 21.9, 40.1 and 75.6 %, respectively (11.1, 31.1, 55.0 and 84.0 % in winter, respectively). Supplement users had significantly higher serum 25(OH)D concentrations compared to non-users. However, 7.5 % of users had winter serum 25(OH)D < 30 nmol/l. Only 1.3 % had serum 25(OH)D concentrations >125 nmol/l. These first nationally representative serum 25(OH)D data for Irish adults show that while only 6.7 % had serum 25(OH)D < 30 nmol/l (vitamin D deficiency) throughout the year, 40.1 % had levels considered by the Institute of Medicine as being inadequate for bone health. These prevalence estimates were much higher during winter time. While vitamin D supplement use has benefits in terms of vitamin D status, at present rates of usage (17.5 % of Irish adults), it will have only very limited impact at a population level. Food-based strategies, including fortified foods, need to be explored.

The nutrition transition in the Republic of Ireland: trends in energy and nutrient supply from 1961 to 2007 using Food and Agriculture Organization food balance sheets

Over the course of the last 50 years the Republic of Ireland has gone from being one of the poorest countries in Europe to one of the richest; however, it is now experiencing increasing rates of obesity and non-communicable chronic disease. Although several national nutrition surveys have been carried out in Ireland since 1990, there is little information on the Irish diet before then. We analysed the FAO food balance sheets for Ireland from 1961 to 2007 in order to characterise the changes in energy and nutrient supply that took place during that period. Food balance sheets were downloaded from the FAOSTAT database and per capita supply of commodities was analysed using dietary analysis software. Energy from carbohydrate as a percentage of total energy fell from 55 % in 1961 to 46 % in 2007, whereas energy from fat increased from 29 % to 34 %; these values are well outside WHO recommendations for the prevention of chronic disease. Energy from alcohol as a percentage of total energy has doubled within the last 20 years. On a nutrient-density basis, vitamins and minerals met or exceeded WHO recommendations, apart from vitamin D, folate, Ca and Fe. Although there are methodological limitations associated with the use of food balance sheets, the present results demonstrate that the current imbalances in the Irish diet were already evident several decades ago. Because they are so long established, they will be difficult to reverse unless major public health nutrition interventions are implemented.