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Peng B, Chen MW, Peng CR, Liu YY, Liu D. Association between serum 25-hydroxyvitamin D and asthma: Evidence from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. J Asthma 2024:1-9. [PMID: 39225308 DOI: 10.1080/02770903.2024.2400604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/15/2024] [Accepted: 08/30/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Asthma is a heterogeneous respiratory disease characterized by airway hyper-responsiveness and reversible airflow blockage. There is ongoing debate about the impact of vitamin D on asthma. This research is focused on investigating the correlation between serum levels of 25-hydroxyvitamin D and asthma. METHODS This cross-sectional study comprised 22,708 eligible participants. Data on asthma and serum 25-hydroxyvitamin D levels from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 were analyzed. Serum 25-hydroxyvitamin D levels were the main factor, with the presence of asthma as the outcome variable. Weighted logistic regression was utilized to investigate the relationship between serum levels of 25-hydroxyvitamin D and asthma, while accounting for factors such as age, gender, race, length of time in US, annual family income, education level, high-density lipoprotein, low-density lipoprotein, triglycerides, and cholesterol. RESULTS Upon adjusting all variables in model III, epi-25-hydroxyvitamin D3 displayed a negative correlation with current asthma at the lower quartile Q1 (0.784, [0.697 to 0.922]), Q2 (0.841, [0.729 to 0.946]), Q3 (0.396, [0.240 to 0.653]) when compared to the highest quartile Q4 level. However, no significant difference was observed between asthma and 25-hydroxyvitamin D2, as well as 25-hydroxyvitamin D3. CONCLUSIONS In the U.S. population, elevated levels of epi-25-hydroxyvitamin D3 are correlated with an increased risk of developing existing asthma. However, it is important to interpret this finding carefully given the constraints of cross-sectional studies.
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Affiliation(s)
- Biao Peng
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Min-Wei Chen
- Department of Critical Care Medicine, Anhua People's Hospital, Yiyang, Hunan, China
| | - Cheng-Rong Peng
- Department of Tuberculosis Intensive Care Unit, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Yu-Yan Liu
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Da Liu
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
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Luo L, Chen G, Zhou Y, Xiang Y, Peng J. Dietary intake, antioxidants, minerals and vitamins in relation to childhood asthma: a Mendelian randomization study. Front Nutr 2024; 11:1401881. [PMID: 38846540 PMCID: PMC11153797 DOI: 10.3389/fnut.2024.1401881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024] Open
Abstract
Background Currently, there is limited and inconsistent evidence regarding the risk association between daily dietary intake, antioxidants, minerals, and vitamins with Childhood Asthma (CA). Therefore, this study employs Mendelian Randomization (MR) methodology to systematically investigate the causal relationships between daily dietary intake, serum antioxidants, serum minerals, and the circulating levels of serum vitamins with CA. Methods This study selected factors related to daily dietary intake, including carbohydrates, proteins, fats, and sugars, as well as serum antioxidant levels (lycopene, uric acid, and β-carotene), minerals (calcium, copper, selenium, zinc, iron, phosphorus, and magnesium), and vitamins (vitamin A, vitamin B6, folate, vitamin B12, vitamin C, vitamin D, and vitamin E), using them as Instrumental Variables (IVs). Genetic data related to CA were obtained from the FinnGen and GWAS Catalog databases, with the primary analytical methods being Inverse Variance Weighting (IVW) and sensitivity analysis. Results Following MR analysis, it is observed that sugar intake (OR: 0.71, 95% CI: 0.55-0.91, P: 0.01) is inversely correlated with the risk of CA, while the intake of serum circulating magnesium levels (OR: 1.63, 95% CI: 1.06-2.53, P: 0.03), fats (OR: 1.44, 95% CI: 1.06-1.95, P: 0.02), and serum vitamin D levels (OR: 1.14, 95% CI: 1.04-1.25, P: 0.02) are positively associated with an increased risk of CA. Conclusion This study identified a causal relationship between the daily dietary intake of sugars and fats, as well as the magnesium and vitamin D levels in serum, and the occurrence of CA. However, further in-depth research is warranted to elucidate the specific mechanisms underlying these associations.
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Affiliation(s)
- Liang Luo
- School of TCM Health Care, Leshan Vocational of Technical College, Leshan, Sicuan Province, China
| | - Guanglei Chen
- School of Basic Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou Province, China
| | - Yan Zhou
- School of TCM Health Care, Leshan Vocational of Technical College, Leshan, Sicuan Province, China
| | - YaJun Xiang
- School of TCM Health Care, Leshan Vocational of Technical College, Leshan, Sicuan Province, China
| | - Jing Peng
- School of TCM Health Care, Leshan Vocational of Technical College, Leshan, Sicuan Province, China
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Dadon Y, Hecht Sagie L, Mimouni FB, Arad I, Mendlovic J. Vitamin D and Insulin-Dependent Diabetes: A Systematic Review of Clinical Trials. Nutrients 2024; 16:1042. [PMID: 38613075 PMCID: PMC11013464 DOI: 10.3390/nu16071042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Vitamin D supplementation after type 1 diabetes mellitus (T1DM) onset has led to conflicting results on beta-cell preservation. Aim: This paper presents a systematic review to verify whether randomized prospective controlled trials (RCTs) demonstrate that improved vitamin D status confers protection on T1DM. (2) Methods: A systematic review was conducted up until 18 January 2024 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching MEDLINE, MEDLINE In-Process, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, using keywords "vitamin D", "type 1 diabetes", and "children". (3) Results: Following the above-mentioned search process, 408 articles in PubMed and 791 in Embase met inclusion criteria. After removing duplicates, 471 articles remained. After exclusion criteria, 11 RCTs remained. Because of major heterogeneity in design and outcomes, no meta-analyses were conducted, allowing only for qualitative analyses. There was no strong evidence that vitamin D supplementation has lasting effects on beta-cell preservation or glycemic control in new-onset T1DM. (4) Conclusions: More rigorous, larger studies are needed to demonstrate whether vitamin D improves beta-cell preservation or glycemic control in new-onset T1DM. Because T1DM may cause osteopenia, it is advisable that patients with new onset T1DM have adequate vitamin D stores.
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Affiliation(s)
- Yuval Dadon
- Ministry of Health, Jerusalem 9101002, Israel (J.M.)
| | | | - Francis B. Mimouni
- Leumit Health Services Research Center, Tel Aviv 6473817, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Iris Arad
- School of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Joseph Mendlovic
- Ministry of Health, Jerusalem 9101002, Israel (J.M.)
- Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem 9103102, Israel
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Indolfi C, Klain A, Dinardo G, Decimo F, Marrapodi MM, Licari A, Giudice MMD. Mini-Review on Vitamin D in Pediatric Population and its Role in Respiratory and Atopic Disorders. Mini Rev Med Chem 2024; 24:1386-1394. [PMID: 38415448 DOI: 10.2174/0113895575284873240212045431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/28/2023] [Accepted: 01/26/2024] [Indexed: 02/29/2024]
Abstract
In recent years, our comprehension of the function of vitamin D has significantly evolved. The ubiquitous presence of the vitamin D receptor (Vitamin D Receptor- VDR) in the body has led to its redefinition from a steroidal hormone primarily involved in skeletal functions to a hormone with pleiotropic effects, exerting its influence on the circulatory, nervous, and immune systems. This has prompted investigations into its potential use in preventing and treating chronic metabolic disorders, cardiovascular diseases, infections, and allergic and autoimmune diseases. This comprehensive review explores the various aspects of vitamin D, including its sources, synthesis, functions, and its impact on different physiological systems. It delves into the epidemiology of vitamin D deficiency, highlighting its occurrence among various age demographics and geographic regions. The impact of vitamin D on the immune system is also explored, elucidating its immunomodulatory and anti-inflammatory properties, particularly in the context of respiratory infections. The review discusses emerging evidence concerning the potential advantages of vitamin D in respiratory diseases, pediatric asthma and atopic dermatitis. It also addresses vitamin D supplementation recommendations for various pediatric populations, including term and preterm infants. The growing concern regarding the global health impacts of insufficient vitamin D levels necessitates further research to bridge gaps in knowledge, particularly in enhancing screening, prevention, and approaches to address vitamin D deficiency from birth onwards. In summary, this comprehensive overview underscores the vital role of vitamin D, highlighting the significance of understanding its multifaceted functions and the need for tailored supplementation strategies, especially in vulnerable populations.
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Affiliation(s)
- Cristiana Indolfi
- Department of woman, child and general and specialized surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Angela Klain
- Department of woman, child and general and specialized surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giulio Dinardo
- Department of woman, child and general and specialized surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Fabio Decimo
- Department of woman, child and general and specialized surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Maria Maddalena Marrapodi
- Department of woman, child and general and specialized surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Amelia Licari
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Michele Miraglia Del Giudice
- Department of woman, child and general and specialized surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Wang CK, Chang CY, Chu TW, Liang YJ. Using Machine Learning to Identify the Relationships between Demographic, Biochemical, and Lifestyle Parameters and Plasma Vitamin D Concentration in Healthy Premenopausal Chinese Women. Life (Basel) 2023; 13:2257. [PMID: 38137858 PMCID: PMC10744461 DOI: 10.3390/life13122257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Vitamin D plays a vital role in maintaining homeostasis and enhancing the absorption of calcium, an essential component for strengthening bones and preventing osteoporosis. There are many factors known to relate to plasma vitamin D concentration (PVDC). However, most of these studies were performed with traditional statistical methods. Nowadays, machine learning methods (Mach-L) have become new tools in medical research. In the present study, we used four Mach-L methods to explore the relationships between PVDC and demographic, biochemical, and lifestyle factors in a group of healthy premenopausal Chinese women. Our goals were as follows: (1) to evaluate and compare the predictive accuracy of Mach-L and MLR, and (2) to establish a hierarchy of the significance of the aforementioned factors related to PVDC. METHODS Five hundred ninety-three healthy Chinese women were enrolled. In total, there were 35 variables recorded, including demographic, biochemical, and lifestyle information. The dependent variable was 25-OH vitamin D (PVDC), and all other variables were the independent variables. Multiple linear regression (MLR) was regarded as the benchmark for comparison. Four Mach-L methods were applied (random forest (RF), stochastic gradient boosting (SGB), extreme gradient boosting (XGBoost), and elastic net). Each method would produce several estimation errors. The smaller these errors were, the better the model was. RESULTS Pearson's correlation, age, glycated hemoglobin, HDL-cholesterol, LDL-cholesterol, and hemoglobin were positively correlated to PVDC, whereas eGFR was negatively correlated to PVDC. The Mach-L methods yielded smaller estimation errors for all five parameters, which indicated that they were better methods than the MLR model. After averaging the importance percentage from the four Mach-L methods, a rank of importance could be obtained. Age was the most important factor, followed by plasma insulin level, TSH, spouse status, LDH, and ALP. CONCLUSIONS In a healthy Chinese premenopausal cohort using four different Mach-L methods, age was found to be the most important factor related to PVDC, followed by plasma insulin level, TSH, spouse status, LDH, and ALP.
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Affiliation(s)
- Chun-Kai Wang
- Department of Obstetrics and Gynecology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung 813, Taiwan;
| | - Ching-Yao Chang
- Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan;
| | - Ta-Wei Chu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Chief Executive Officer’s Office, MJ Health Research Foundation, Taipei 114, Taiwan;
| | - Yao-Jen Liang
- Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan;
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Fainardi V, Caffarelli C, Deolmi M, Zambelli G, Palazzolo E, Scavone S, Bergamini BM, Bertelli L, Biserna L, Bottau P, Corinaldesi E, De Paulis N, Di Palmo E, Dondi A, Gallucci M, Guidi B, Lombardi F, Magistrali MS, Marastoni E, Pastorelli S, Piccorossi A, Poloni M, Tagliati S, Vaienti F, Gregori G, Sacchetti R, Antodaro F, Bergomi A, Reggiani L, De Fanti A, Marchetti F, Grandinetti R, Mussi N, Ricci G, Esposito S. Maintenance Therapy for Children and Adolescents with Asthma: Guidelines and Recommendations from the Emilia-Romagna Asthma (ERA) Study Group. J Clin Med 2023; 12:5467. [PMID: 37685533 PMCID: PMC10487522 DOI: 10.3390/jcm12175467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Asthma is the most frequent chronic disease of childhood, affecting up to 20% of children worldwide. The main guidelines on asthma maintenance therapy in pediatrics suggest different approaches and describe different stages of asthma to determine the most appropriate treatment. This project aims to summarize the most recent evidence regarding maintenance therapy for asthma in children and adolescents. A multidisciplinary panel of experts was asked clinical questions regarding the treatment of children and adolescents with asthma. Overall, 10 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results showed that the choice of medication depends on the severity of the child's asthma, phenotype, age, preference, and individual factors. In addition to medications, the identification of comorbidities and modifiable factors is crucial to obtaining good control. Asthma in children is heterogeneous, and its evolution varies over time. Since most recommendations for asthma management in childhood are extrapolated from clinical studies performed in adults, more clinical trials specifically designed for young children should be conducted.
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Affiliation(s)
- Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Michela Deolmi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Giulia Zambelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Elisabetta Palazzolo
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Sara Scavone
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Barbara Maria Bergamini
- Paediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Luca Bertelli
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Loretta Biserna
- Paediatrics and Neonatology Unit, Ravenna Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 48121 Ravenna, Italy; (L.B.); (F.M.)
| | - Paolo Bottau
- Paediatrics Unit, Imola Hospital, 40026 Imola, Italy;
| | | | - Nicoletta De Paulis
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.)
| | - Emanuela Di Palmo
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Arianna Dondi
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Marcella Gallucci
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Battista Guidi
- Hospital and Territorial Paediatrics Unit, 41026 Pavullo, Italy;
| | | | - Maria Sole Magistrali
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.)
| | - Elisabetta Marastoni
- Paediatrics Unit, Santa Maria Nuova Hospital, Azienda Unità Sanitaria Locale (AUSL)-Scientific Institute for Research and Healthcare (IRCCS) of Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.F.)
| | | | - Alessandra Piccorossi
- Paediatrics and Paediatric Intensive Care Unit, Cesena Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47521 Cesena, Italy
| | - Maurizio Poloni
- Paediatrics Unit, Rimini Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47921 Rimini, Italy;
| | | | - Francesca Vaienti
- Paediatrics Unit, G.B. Morgagni Pierantoni Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47121 Forlì, Italy;
| | - Giuseppe Gregori
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Piacenza, 29121 Piacenza, Italy; (G.G.); (R.S.)
| | - Roberto Sacchetti
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Piacenza, 29121 Piacenza, Italy; (G.G.); (R.S.)
| | - Francesco Antodaro
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Modena, 41125 Modena, Italy; (F.A.)
| | - Andrea Bergomi
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Modena, 41125 Modena, Italy; (F.A.)
| | - Lamberto Reggiani
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Imola, 40026 Imola, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, Azienda Unità Sanitaria Locale (AUSL)-Scientific Institute for Research and Healthcare (IRCCS) of Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.F.)
| | - Federico Marchetti
- Paediatrics and Neonatology Unit, Ravenna Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 48121 Ravenna, Italy; (L.B.); (F.M.)
| | - Roberto Grandinetti
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Nicole Mussi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Giampaolo Ricci
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
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Illidi CR, Romer LM, Johnson MA, Williams NC, Rossiter HB, Casaburi R, Tiller NB. Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals. Eur J Appl Physiol 2023; 123:1599-1625. [PMID: 36917254 PMCID: PMC10013266 DOI: 10.1007/s00421-023-05166-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
Respiratory function has become a global health priority. Not only is chronic respiratory disease a leading cause of worldwide morbidity and mortality, but the COVID-19 pandemic has heightened attention on respiratory health and the means of enhancing it. Subsequently, and inevitably, the respiratory system has become a target of the multi-trillion-dollar health and wellness industry. Numerous commercial, respiratory-related interventions are now coupled to therapeutic and/or ergogenic claims that vary in their plausibility: from the reasonable to the absurd. Moreover, legitimate and illegitimate claims are often conflated in a wellness space that lacks regulation. The abundance of interventions, the range of potential therapeutic targets in the respiratory system, and the wealth of research that varies in quality, all confound the ability for health and exercise professionals to make informed risk-to-benefit assessments with their patients and clients. This review focuses on numerous commercial interventions that purport to improve respiratory health, including nasal dilators, nasal breathing, and systematized breathing interventions (such as pursed-lips breathing), respiratory muscle training, canned oxygen, nutritional supplements, and inhaled L-menthol. For each intervention we describe the premise, examine the plausibility, and systematically contrast commercial claims against the published literature. The overarching aim is to assist health and exercise professionals to distinguish science from pseudoscience and make pragmatic and safe risk-to-benefit decisions.
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Affiliation(s)
- Camilla R Illidi
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Lee M Romer
- Division of Sport, Health and Exercise Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Michael A Johnson
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, UK
| | - Neil C Williams
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, UK
| | - Harry B Rossiter
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA
| | - Richard Casaburi
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA
| | - Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA.
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Abstract
BACKGROUND Since the previous Cochrane Review on this topic in 2016, debate has continued surrounding a potential role for vitamin D in reducing risk of asthma exacerbation and improving asthma control. We therefore conducted an updated meta-analysis to include data from new trials completed since this date. OBJECTIVES To evaluate the effectiveness and safety of administration of vitamin D or its hydroxylated metabolites in reducing the risk of severe asthma exacerbations (defined as those requiring treatment with systemic corticosteroids) and improving asthma symptom control. SEARCH METHODS We searched the Cochrane Airways Group Trial Register and reference lists of articles. We contacted the authors of studies in order to identify additional trials. Date of last search: 8 September 2022. SELECTION CRITERIA We included double-blind, randomised, placebo-controlled trials of vitamin D in children and adults with asthma evaluating exacerbation risk or asthma symptom control, or both. DATA COLLECTION AND ANALYSIS Four review authors independently applied study inclusion criteria, extracted the data, and assessed risk of bias. We obtained missing data from the authors where possible. We reported results with 95% confidence intervals (CIs). The primary outcome was the incidence of severe asthma exacerbations requiring treatment with systemic corticosteroids. Secondary outcomes included the incidence of asthma exacerbations precipitating an emergency department visit or requiring hospital admission, or both, end-study childhood Asthma Control Test (cACT) or Asthma Control Test (ACT) scores, and end-study % predicted forced expiratory volume in one second (FEV1). We performed subgroup analyses to determine whether the effect of vitamin D on risk of asthma exacerbation was modified by baseline vitamin D status, vitamin D dose, frequency of dosing regimen, form of vitamin D given, and age of participants. MAIN RESULTS We included 20 studies in this review; 15 trials involving a total of 1155 children and five trials involving a total of 1070 adults contributed data to analyses. Participant ages ranged from 1 to 84 years, with two trials providing data specific to participants under five years (n = 69) and eight trials providing data specific to participants aged 5 to 16 (n = 766). Across the trials, 1245 participants were male and 1229 were female, with two studies not reporting sex distribution. Fifteen trials contributed to the primary outcome analysis of exacerbations requiring systemic corticosteroids. The duration of trials ranged from three to 40 months; all but two investigated effects of administering cholecalciferol (vitamin D3). As in the previous Cochrane Review, the majority of participants had mild to moderate asthma, and profound vitamin D deficiency (25-hydroxyvitamin D (25(OH)D) < 25 nmol/L) at baseline was rare. Administration of vitamin D or its hydroxylated metabolites did not reduce or increase the proportion of participants experiencing one or more asthma exacerbations treated with systemic corticosteroids (odds ratio (OR) 1.04, 95% CI 0.81 to 1.34; I2 = 0%; 14 studies, 1778 participants; high-quality evidence). This equates to an absolute risk of 226 per 1000 (95% CI 185 to 273) in the pooled vitamin D group, compared to a baseline risk of 219 participants per 1000 in the pooled placebo group. We also found no effect of vitamin D supplementation on the rate of exacerbations requiring systemic corticosteroids (rate ratio 0.86, 95% CI 0.62 to 1.19; I2 = 60%; 10 studies, 1599 participants; high-quality evidence), or the time to first exacerbation (hazard ratio 0.82, 95% CI 0.59 to 1.15; I2 = 22%; 3 studies, 850 participants; high-quality evidence). Subgroup analysis did not reveal any evidence of effect modification by baseline vitamin D status, vitamin D dose, frequency of dosing regimen, or age. A single trial investigating administration of calcidiol reported a benefit of the intervention for the primary outcome of asthma control. Vitamin D supplementation did not influence any secondary efficacy outcome meta-analysed, which were all based on moderate- or high-quality evidence. We observed no effect on the incidence of serious adverse events (OR 0.89, 95% CI 0.56 to 1.41; I2 = 0%; 12 studies, 1556 participants; high-quality evidence). The effect of vitamin D on fatal asthma exacerbations was not estimable, as no such events occurred in any trial. Six studies reported adverse reactions potentially attributable to vitamin D. These occurred across treatment and control arms and included hypercalciuria, hypervitaminosis D, kidney stones, gastrointestinal symptoms and mild itch. In one trial, we could not ascertain the total number of participants with hypercalciuria from the trial report. We assessed three trials as being at high risk of bias in at least one domain; none of these contributed data to the analysis of the outcomes reported above. Sensitivity analyses that excluded these trials from each outcome to which they contributed did not change the null findings. AUTHORS' CONCLUSIONS In contrast to findings of our previous Cochrane Review on this topic, this updated review does not find evidence to support a role for vitamin D supplementation or its hydroxylated metabolites to reduce risk of asthma exacerbations or improve asthma control. Participants with severe asthma and those with baseline 25(OH)D concentrations < 25 nmol/L were poorly represented, so further research is warranted here. A single study investigating effects of calcidiol yielded positive results, so further studies investigating effects of this metabolite are needed.
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Affiliation(s)
- Anne Williamson
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R Martineau
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - David Jolliffe
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Gaudet M, Plesa M, Mogas A, Jalaleddine N, Hamid Q, Al Heialy S. Recent advances in vitamin D implications in chronic respiratory diseases. Respir Res 2022; 23:252. [PMID: 36117182 PMCID: PMC9483459 DOI: 10.1186/s12931-022-02147-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/14/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic airway inflammatory and infectious respiratory diseases are the most common medical respiratory conditions, associated with significant morbidity and mortality. Vitamin D (1,25(OH)2D3) deficiency has been shown to be highly prevalent in patients with chronic airway inflammatory and infectious diseases, correlated with increased disease severity. It has been established that vitamin D modulates ongoing abnormal immune responses in chronic respiratory diseases and is shown to restrict bacterial and viral colonization into the lungs. On the contrary, other studies revealed controversy findings regarding vitamin D efficacy in respiratory diseases. This review aims to update the current evidence regarding the role of vitamin D in airway inflammation and in various respiratory diseases. A comprehensive search of the last five years of literature was conducted using MEDLINE and non-MEDLINE PubMed databases, Ovid MEDLINE, SCOPUS-Elsevier, and data from in vitro and in vivo experiments, including clinical studies. This review highlights the importance of understanding the full range of implications that vitamin D may have on lung inflammation, infection, and disease severity in the context of chronic respiratory diseases.
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Affiliation(s)
- Mellissa Gaudet
- Translational Research in Respiratory Diseases, Meakins-Christie Laboratories, Research Institute of the McGill University Health Center, Montréal, QC, Canada
| | - Maria Plesa
- Translational Research in Respiratory Diseases, Meakins-Christie Laboratories, Research Institute of the McGill University Health Center, Montréal, QC, Canada
| | - Andrea Mogas
- Translational Research in Respiratory Diseases, Meakins-Christie Laboratories, Research Institute of the McGill University Health Center, Montréal, QC, Canada
| | - Nour Jalaleddine
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Qutayba Hamid
- Translational Research in Respiratory Diseases, Meakins-Christie Laboratories, Research Institute of the McGill University Health Center, Montréal, QC, Canada. .,College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
| | - Saba Al Heialy
- Translational Research in Respiratory Diseases, Meakins-Christie Laboratories, Research Institute of the McGill University Health Center, Montréal, QC, Canada. .,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
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