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Gorini F, Tonacci A. Vitamin D: An Essential Nutrient in the Dual Relationship between Autoimmune Thyroid Diseases and Celiac Disease-A Comprehensive Review. Nutrients 2024; 16:1762. [PMID: 38892695 PMCID: PMC11174782 DOI: 10.3390/nu16111762] [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: 05/11/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Autoimmune thyroid diseases (AITD) are among the most frequent autoimmune disorders, with a multifactorial etiology in which both genetic and environmental determinants are probably involved. Celiac disease (CeD) also represents a public concern, given its increasing prevalence due to the recent improvement of screening programs, leading to the detection of silent subtypes. The two conditions may be closely associated due to common risk factors, including genetic setting, changes in the composition and diversity of the gut microbiota, and deficiency of nutrients like vitamin D. This comprehensive review discussed the current evidence on the pivotal role of vitamin D in modulating both gut microbiota dysbiosis and immune system dysfunction, shedding light on the possible relevance of an adequate intake of this nutrient in the primary prevention of AITD and CeD. While future technology-based strategies for proper vitamin D supplementation could be attractive in the context of personalized medicine, several issues remain to be defined, including standardized assays for vitamin D determination, timely recommendations on vitamin D intake for immune system functioning, and longitudinal studies and randomized controlled trials to definitely establish a causal relationship between serum vitamin D levels and the onset of AITD and CeD.
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Affiliation(s)
- Francesca Gorini
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy;
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Muthusami S, Hatchman L, Carson VJ. Hypotonia and Failure to Thrive in an 8-month-old Infant. Pediatr Rev 2023; 44:644-649. [PMID: 37907420 DOI: 10.1542/pir.2021-005040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Sunil Muthusami
- Department of Pediatrics, Children's Hospital of Philadelphia, CHOP Care Network, Lancaster, PA
| | - Laura Hatchman
- Department of Family Medicine, Penn Medicine, Lancaster General Health, Lancaster, PA
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Moreira MLM, de Araújo IM, Fukada SY, Venturini LGR, Guidorizzi NR, Garrido CE, Rosen CJ, de Paula FJA. Refining Evaluation of Bone Mass and Adipose Distribution in Dunnigan Syndrome. Int J Mol Sci 2023; 24:13118. [PMID: 37685926 PMCID: PMC10488191 DOI: 10.3390/ijms241713118] [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] [Received: 07/16/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Familial partial lipodystrophies (FPLD) are rare diseases characterized by selective loss of subcutaneous adipose tissue at different sites. This cross-sectional observational study aimed to estimate adipose tissue in the bone marrow (BMAT), intra (IMCL) and extra-myocyte lipids (EMCL), and define the bone phenotype in the context of FPLD2/Dunnigan syndrome (DS). The subjects comprised 23 controls (C) and 18 DS patients, matched by age, weight and height. Blood samples, dual-energy X-ray absorptiometry for bone mineral density (BMD) and trabecular bone score (TBS) and 1H-spectroscopy using magnetic resonance to estimate BMAT in the lumbar spine, IMCL, EMCL and osteoclastogenesis were assessed. The prevalence of diabetes mellitus was 78% in DS patients. Glucose, HbA1c, triglycerides, insulin and HOMA-IR levels were elevated in DS, whereas HDLc, 25(OH)D, PTH and osteocalcin levels were reduced. BMD was similar between groups at all sites, except 1/3 radius, which was lower in DS group. TBS was reduced in DS. DS presented increased osteoclastogenesis and elevated BMAT, with greater saturation levels and higher IMCL than the C group. HOMA-IR and EMCL were negatively associated with TBS; osteocalcin and EMCL were correlated negatively with BMD. This study contributes to refining the estimation of adipose tissue in DS by showing increased adiposity in the lumbar spine and muscle tissue. DXA detected lower TBS and BMD in the 1/3 radius, suggesting impairment in bone quality and that bone mass is mainly affected in the cortical bone.
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Affiliation(s)
- Mariana Lima Mascarenhas Moreira
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (M.L.M.M.); (I.M.d.A.); (N.R.G.)
| | - Iana Mizumukai de Araújo
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (M.L.M.M.); (I.M.d.A.); (N.R.G.)
| | - Sandra Yasuyo Fukada
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14040-900, SP, Brazil; (S.Y.F.); (L.G.R.V.)
| | - Lucas Gabriel R. Venturini
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14040-900, SP, Brazil; (S.Y.F.); (L.G.R.V.)
| | - Natalia Rossin Guidorizzi
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (M.L.M.M.); (I.M.d.A.); (N.R.G.)
| | - Carlos Ernesto Garrido
- Department of Physics, Faculty of Philosophy, Sciences and Letters of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil;
| | | | - Francisco José Albuquerque de Paula
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (M.L.M.M.); (I.M.d.A.); (N.R.G.)
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Twanabasu S, Ghimire J, Homagain S, Duwadee P, Devkota S, Bhandari A, Sunar P. Vitamin D supplementation leading to hypervitaminosis D in a breastfed infant: A case report. Clin Case Rep 2023; 11:e7635. [PMID: 37415587 PMCID: PMC10320360 DOI: 10.1002/ccr3.7635] [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: 05/23/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/08/2023] Open
Abstract
Breast milk alone is a poor and inadequate source of vitamin D. Many guidelines suggest supplementation of vitamin D to the newborns to prevent vitamin D deficiency. However, due to practices of outdoor breastfeeding and sunbathing, vitamin D supplementation may not be routinely required in our settings. Overzealous use of vitamin D supplementation and over-the-counter prescription may result in hypervitaminosis D.
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Asdie RH, Mulya DP, Nainggolan M. Assessment of 28-day survival of patients with sepsis based on vitamin D status: a hospital-based prospective cohort study in Indonesia. Pan Afr Med J 2023; 45:76. [PMID: 37663638 PMCID: PMC10474818 DOI: 10.11604/pamj.2023.45.76.36336] [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: 07/13/2022] [Accepted: 05/06/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction sepsis is a potentially life-threatening condition caused by the body´s response to an infection. Recent studies have demonstrated a correlation between low vitamin D status and high mortality in septic patients. This study aims to evaluate the vitamin D status of septic patients at Dr. Sardjito Hospital and describe 28-day survival with very low vitamin D levels (< 8.1 ng/mL). Methods this prospective cohort study was conducted in the intensive care unit and internal medicine ward at Dr. Sardjito Hospital in septic patients admitted between December 2018 and October 2019. Vitamin D [25(OH)D] was prospectively measured within 24 hours of admission. Data collection used SPSS software for statistical analysis. In addition, the sample size was calculated using the sample size formula used in a comparative survival study intended to find the incidence rate in septic patients. The minimum sample for each group is 23 samples. Results sepsis-related mortality was higher in patients with low vitamin D. The analysis included 88 septic patients during the study period. The mean age was 56.09 ± 16.82 years and the proportion of males was 46.6%. 26 of 28 patients with vitamin D levels < 8.1 ng/mL died (92.6%), whereas 39 of 60 patients with vitamin D levels ≥ 8.1 ng/mL (65%) died. Multivariate Cox regression analysis showed that vitamin D concentrations < 8.1 ng/mL at admission (p=0.01) and sepsis shock (p=0.02) were associated with increased sepsis mortality. The hazard ratio of 28-day mortality was 1.95 (95% CI 1.15-3.29, p=0.01) for vitamin D levels < 8.1 ng/mL. The average survival was 9 days for patients with vitamin D levels < 8.1 ng/mL (median: 6 days) compared with 14 days for those with vitamin D levels ≥ 8.1 ng/mL (median: 10 days). Conclusion low serum vitamin D levels (< 8.1ng/mL) at admission were associated with increased 28-day mortality in septic patients.
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Affiliation(s)
- Rizka Humardewayanti Asdie
- Division of Tropical Medicine, Department of Internal Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Deshinta Putri Mulya
- Division of Allergy Immunology, Department of Internal Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Maria Nainggolan
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
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Association between serum Vitamin D levels and asthma severity and control in children and adolescents. Lung 2023; 201:181-187. [PMID: 36809416 DOI: 10.1007/s00408-023-00605-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To assess the association of serum Vitamin D (vitD) levels with asthma control and severity in children and adolescents in different seasons of the year. METHOD Longitudinal, prospective study with 7- to 17-year-old children and adolescents diagnosed with asthma. All participants underwent two assessments conducted in opposite seasons of the year which included a clinical assessment, a questionnaire for classification of asthma control (Asthma Control Test), spirometry, and blood collection to measure serum vitD levels. RESULTS In total, 141 individuals with asthma were evaluated. The mean vitD was lower in females (p = 0.006) and sunlight exposure appears not to be an influencing factor for vitD levels. We found no differences in mean vitD of patients with controlled and uncontrolled asthma (p = 0.703; p = 0.956). However, the severe asthma group had lower mean Vitamin D than the mild/moderate asthma group for both assessments (p = 0.013; p = 0.032). In the first assessment, the group with vitD insufficiency had a higher prevalence of severe asthma (p = 0.015). Vitamin D was positively correlated with FEV1 in both assessments (p = 0.008; p = 0.006) and with FEF25-75% in the first assessment (p = 0.038). CONCLUSION In a tropical climate zone, there is no evidence of association between seasonality and serum vitD levels or between serum vitD levels and asthma control in children and adolescents. However, vitD and lung function were positively correlated and the group with vitD insufficiency had a higher prevalence of severe asthma.
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Araújo IMD, Moreira MLM, Paula FJAD. Diabetes and bone. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:633-641. [PMID: 36382752 PMCID: PMC10118819 DOI: 10.20945/2359-3997000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Globally, one in 11 adults has diabetes mellitus of which 90% have type 2 diabetes. The numbers for osteoporosis are no less staggering: 1 in 3 women has a fracture after menopause, and the same is true for 1 in 5 men after the age of 50 years. Aging is associated with several physiological changes that cause insulin resistance and impaired insulin secretion, which in turn lead to hyperglycemia. The negative balance between bone resorption and formation is a natural process that appears after the fourth decade of life and lasts for the following decades, eroding the bone structure and increasing the risk of fractures. Not incidentally, it has been acknowledged that diabetes mellitus, regardless of whether type 1 or 2, is associated with an increased risk of fracture. The nuances that differentiate bone damage in the two main forms of diabetes are part of the intrinsic heterogeneity of diabetes, which is enhanced when associated with a condition as complex as osteoporosis. This narrative review addresses the main parameters related to the increased risk of fractures in individuals with diabetes, and the mutual factors affecting the treatment of diabetes mellitus and osteoporosis.
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Gomes MM, da Silva MMR, de Araújo IM, de Paula FJA. Bone, fat, and muscle interactions in health and disease. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:611-620. [PMID: 36382750 PMCID: PMC10118823 DOI: 10.20945/2359-3997000000550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022]
Abstract
Energy metabolism is a point of integration among the various organs and tissues of the human body, not only in terms of consumption of energy substrates but also because it concentrates a wide interconnected network controlled by endocrine factors. Thus, not only do tissues consume substrates, but they also participate in modulating energy metabolism. Soft mesenchymal tissues, in particular, play a key role in this process. The recognition that high energy consumption is involved in bone remodeling has been accompanied by evidence showing that osteoblasts and osteocytes produce factors that influence, for example, insulin sensitivity and appetite. Additionally, there are significant interactions between muscle, adipose, and bone tissues to control mutual tissue trophism. Not by chance, trophic and functional changes in these tissues go hand in hand from the beginning of an individual's development until aging. Likewise, metabolic and nutritional diseases deeply affect the musculoskeletal system and adipose tissue. The present narrative review highlights the importance of the interaction of the mesenchymal tissues for bone development and maintenance and the impact on bone from diseases marked by functional and trophic disorders of adipose and muscle tissues.
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Affiliation(s)
- Mayra Macena Gomes
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Iana Mizumukai de Araújo
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brasil
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Alencar MAVSD, Araújo IMD, Parreiras-E-Silva LT, Nogueira-Barbosa MH, Salgado W, Elias J, Salmon CEG, Paula FJAD. Hashtag bone: detrimental effects on bone contrast with metabolic benefits one and five years after Roux-en-Y gastric bypass. Braz J Med Biol Res 2021; 54:e11499. [PMID: 34878062 PMCID: PMC8647898 DOI: 10.1590/1414-431x2021e11499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/30/2021] [Indexed: 12/15/2022] Open
Abstract
Bone loss is a potential adverse consequence of rapid and sustained weight loss after bariatric surgery. The aim of the present study was to evaluate the bone mass, body fat distribution, and metabolic parameters in women submitted to Roux-en-Y gastric bypass (RYGB). The study included the following three groups: one group of lean women (control [C] group) and two groups of obese women, one evaluated one year (B1) and the other five years (B5) after RYGB. Dual-energy X-ray absorptiometry and magnetic resonance imaging were used to determine bone mineral density (BMD; lumbar spine, total hip, and femoral neck) and abdominal fat content (subcutaneous [SAT] and visceral [VAT] adipose tissues, and intrahepatic lipids [IHL]). The BMD/body mass index ratio was lower in the B5 compared with the C group at all sites. Serum C-terminal telopeptide of type I collagen (CTX) levels were higher in the B1 and B5 groups compared with the C group. Individuals submitted to RYGB showed greater SAT but similar VAT and IHL values compared with those in the C group. However, the B5 group had higher mean parathyroid hormone levels compared with the other two groups. Individuals submitted to RYGB presented increased levels of CTX and low BMD for body weight than those in the C group, suggesting that bone catabolism is a persistent alteration associated with RYGB. In conclusion, the long-lasting metabolic benefits obtained with RYGB in obesity are counterbalanced by a persistent catabolic effect of the procedure on bone and mineral metabolism.
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Affiliation(s)
- M A V S D Alencar
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - I M de Araújo
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L T Parreiras-E-Silva
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M H Nogueira-Barbosa
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - W Salgado
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J Elias
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C E G Salmon
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F J A de Paula
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Segheto KJ, Juvanhol LL, da Silva DCG, de Carvalho CJ, Hansen F, Gabiatti MP, Kakehasi AM, Longo GZ. Does the relationship between 25-hydroxyvitamin D status and bone mass vary according to skin color in adults? Results of a Brazilian population-based study. Arch Osteoporos 2021; 16:31. [PMID: 33591401 DOI: 10.1007/s11657-021-00876-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/23/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Skin color has been indicated as an important factor in determining serum concentrations of 25-hydroxyvitamin D [25(OH)D], and consequently bone health. However, studies are controversial and scarce for mixed populations. PURPOSE/INTRODUCTION To analyze the association of 25(OH)D with bone mineral content (BMC) and bone mineral density (BMD); and to investigate the presence of interaction with skin color in Brazilian adults. METHODS This is a cross-sectional, population-based study conducted with adult individuals (20-59 years) of both genders. Bone health was assessed by dual energy radiological absortometry. Vitamin D status was measured using serum 25(OH)D. Skin color and other variables in the adjusted model were collected using a questionnaire and anthropometric assessment. Associations and interactions were evaluated using linear regression models stratified according to gender. RESULTS Non-white men with vitamin D deficiency (< 20.0 ng/mL) have less bone mass than those with insufficiency and sufficiency for the femoral neck and hip sites. According to the adjusted regression analysis, the deficient status of 25(OH)D in men was associated with worse bone health for the lumbar spine sites (β = - 0.1; p = 0.006), femoral neck (β = - 0.08; p = 0.006), and hip (β = - 0.08; p = 0.009). No statistically significant associations were observed between 25(OH)D and bone health in women. In addition, no statistical interaction was identified between skin color and vitamin D status in relation to bone health (p > 0.05 for all tests) in either gender and for all bone sites evaluated. CONCLUSION Deficient vitamin D status is associated with lower bone mass in adults with differences observed according to gender, but not according to skin color.
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Affiliation(s)
- Kátia Josiany Segheto
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Avenida PH Rolfs, s/n, Viçosa, Minas Gerais, 36571-000, Brasil.
| | - Leidjaira Lopes Juvanhol
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Avenida PH Rolfs, s/n, Viçosa, Minas Gerais, 36571-000, Brasil
| | | | - Cristiane Junqueira de Carvalho
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Avenida PH Rolfs, s/n, Viçosa, Minas Gerais, 36571-000, Brasil
| | - Fernanda Hansen
- Departamento de Nutrição, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, 88040-900, Florianópolis, Santa Catarina, Brasil
| | - Mariana Papini Gabiatti
- Departamento de Nutrição, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, 88040-900, Florianópolis, Santa Catarina, Brasil
| | - Adriana Maria Kakehasi
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, n. 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brasil
| | - Giana Zarbato Longo
- Departamento de Nutrição, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, 88040-900, Florianópolis, Santa Catarina, Brasil
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Jiang Y, Zhang J, Liu Y, Huang T, Cao Z, Shi X. Differences of Serum 25- (OH) D3 Level and Adverse Pregnancy Outcomes between Women with Gestational Diabetes and Healthy Pregnant Women. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:139-145. [PMID: 34178772 PMCID: PMC8213623 DOI: 10.18502/ijph.v50i1.5080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: The difference in serum 25-hydroxyvitamin D3 (25-(OH) D3
) level between the gestational diabetes mellitus (GDM) and healthy pregnant women was analyzed, to provide the experimental evidence for the vitamin supplement in pregnant women, especially those with GDM. Methods: Pregnant women (n=50) who received prenatal care in the Obstetrical Clinic of Xuzhou Maternity and Child Health Care Hospital in summer and winter of 2016 were enrolled. They were assigned to the summer GDM group, winter GDM group, summer control group and winter control group. The level of serum 25-(OH)D3 was determined using immunochromatography. Results: The mean level of serum 25-(OH)D3 in pregnant women of four groups was lower than normal level. Compared with control group in corresponding season, the winter and summer GDM groups had significantly lower level of 25-(OH)D3 than the winter and summer control groups (P<0.05). The winter GDM group had significantly lower level of 25-(OH)D3 than the summer GDM group (P<0.05). The winter control group had significantly lower level of 25-(OH)D3 than the summer control group (P<0.05). The percentage of deficient 25-(OH)D3 level was the highest in winter GDM group. Vitamin D deficiency was severer in pregnant women with GDM than healthy pregnant women. In winter, vitamin D deficiency was severer than that in summer. Conclusion: Pregnant women, especially those with GDM, should pay more attention to vitamin D supplementation.
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Affiliation(s)
- Yingfeng Jiang
- Department of Pharmacy, Xuzhou Maternity and Child Health Care Hospital, Xuzhou 221009, P.R. China
| | - Jing Zhang
- Department of Pharmacy, Xuzhou Maternity and Child Health Care Hospital, Xuzhou 221009, P.R. China
| | - Yuan Liu
- Department of Pharmacy, Xuzhou Maternity and Child Health Care Hospital, Xuzhou 221009, P.R. China
| | - Ting Huang
- Department of Pharmacy, Xuzhou Maternity and Child Health Care Hospital, Xuzhou 221009, P.R. China
| | - Zheng Cao
- Department of Pharmacy, Xuzhou Maternity and Child Health Care Hospital, Xuzhou 221009, P.R. China
| | - Xiangkui Shi
- Department of Pharmacy, Xuzhou Maternity and Child Health Care Hospital, Xuzhou 221009, P.R. China
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de Paula FJA. Vitamin D: more does not mean better. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:493-494. [PMID: 33047904 PMCID: PMC10118955 DOI: 10.20945/2359-3997000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
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Won DJ, Seong KS, Jang CH, Lee JS, Ko JA, Bae H, Park HJ. Effects of vitamin D 2-fortified shiitake mushroom on bioavailability and bone structure. Biosci Biotechnol Biochem 2019; 83:942-951. [PMID: 30732553 DOI: 10.1080/09168451.2019.1576497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/13/2019] [Indexed: 02/08/2023]
Abstract
Bioavailability and bone loss inhibitory effects of vitamin D2 derived from UV-irradiated shiitake mushroom were determined in vivo. The effect of the absence of ovaries on the bioavailability of vitamin D2 and bone structure was also investigated. Sham operated (sham) and ovariectomized (OVX) rats were divided in 3 groups according to their diets, i.e. control: only vitamin D-deficient diets; UV(X): vitamin D-deficient diets with non-irradiated mushroom powder; UV(O): vitamin D-deficient diets with irradiated mushroom powder. The obtained results showed that vitamin D2 from shiitake mushroom was able to increase bone mineral density and trabecular bone structure of femur bone as well as its bioavailability. The absence of estrogen induced adverse effects not only on bioavailability of vitamin D2 but also on trabecular bone. In conclusion, vitamin D2-fortified shiitake mushroom might help postmenopausal women increase vitamin D2 bioavailability and retard trabecular bone loss. Abbreviations: OVX: ovariectomized; 25(OH)D: 25-hydroxyvitamin D; 1,25(OH)2D: 1,25-dihydroxyvitamin D; BMD: bone mineral density; micro-CT: micro computed tomography; RSM: response surface methodology; RP-HPLC: Reverse phase-high performance liquid chromatography; MS/MS: tandem mass spectrometry; E2: estradiol; NTx: N-terminal telopeptide of type I collagen; BV/TV: bone volume/total volume; BS/BV: bone surface/bone volume; Tb.Th: trabecular thickness; Tb.Sp: trabecular separation.
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Affiliation(s)
- Dong Jae Won
- a Department of Biotechnology , College of Life Science and Biotechnology, Korea University , Seongbuk-gu, Seoul , Republic of Korea
| | - Ki Seung Seong
- b Korea Food Research Institute , Wanju-gun, Jeollabuk-do , Republic of Korea
| | | | - Jin Sil Lee
- d Department of Food Service Management and Nutrition , Sangmyung University, Seoul, Korea
| | - Jung A Ko
- a Department of Biotechnology , College of Life Science and Biotechnology, Korea University , Seongbuk-gu, Seoul , Republic of Korea
| | - Hojae Bae
- e KU Convergence Science and Technology Institute, Department of Stem Cell and Regenerative Biology , Konkuk University , Hwayang-dong , Republic of Korea
| | - Hyun Jin Park
- a Department of Biotechnology , College of Life Science and Biotechnology, Korea University , Seongbuk-gu, Seoul , Republic of Korea
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Sankar J, Ismail J, Das R, Dev N, Chitkara A, Sankar MJ. Effect of Severe Vitamin D Deficiency at Admission on Shock Reversal in Children With Septic Shock: A Prospective Observational Study. J Intensive Care Med 2019; 34:397-403. [PMID: 28335672 DOI: 10.1177/0885066617699802] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
OBJECTIVES: To evaluate the association of severe vitamin D deficiency with clinically important outcomes in children with septic shock. METHODS: We enrolled children ≤17 years with septic shock prospectively over a period of 6 months. We estimated 25-hydroxyvitamin D [25 (OH) D] levels at admission and 72 hours. Severe deficiency was defined as serum 25 (OH) <10 ng/mL. We performed univariate and multivariate analysis to evaluate association with clinically important outcomes. RESULTS: Forty-three children were enrolled in the study. The prevalence of severe vitamin D deficiency was 72% and 69% at admission and 72 hours, respectively. On univariate analysis, severe vitamin D deficiency at admission was associated with lower rates of shock reversal, 74% (23) versus 25% (3); relative risk (95% confidence interval [CI]): 2.9 (1.09-8.08), at 24 hours and greater need for fluid boluses (75 vs 59 mL/kg). On multivariate analysis, nonresolution of shock at 24 hours was significantly associated with severe vitamin D deficiency after adjusting for other key baseline and clinical variables, adjusted odds ratio (95% CI): 12 (2.01-87.01); 0.01. CONCLUSION: The prevalence of severe vitamin D deficiency is high in children with septic shock admitted to pediatric intensive care unit. Severe vitamin D deficiency at admission seems to be associated with lower rates of shock reversal at 24 hours of ICU stay. Our study provides preliminary data for planning interventional studies in children with septic shock and severe vitamin D deficiency.
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Affiliation(s)
- Jhuma Sankar
- 1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Javed Ismail
- 1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Das
- 1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishanth Dev
- 2 Department of Medicine, PGIMER, Dr RML Hospital, New Delhi, India
| | - Anubhuti Chitkara
- 3 Department of Biochemistry PGIMER, Dr RML Hospital, New Delhi, India
| | - M Jeeva Sankar
- 1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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15
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Non-hormonal Chemoprevention. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Razzaque MS. Can adverse effects of excessive vitamin D supplementation occur without developing hypervitaminosis D? J Steroid Biochem Mol Biol 2018; 180:81-86. [PMID: 28734988 DOI: 10.1016/j.jsbmb.2017.07.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/03/2017] [Accepted: 07/08/2017] [Indexed: 12/25/2022]
Abstract
Vitamin D is a fat-soluble hormone that has endocrine, paracrine and autocrine functions. Consumption of vitamin D-supplemented food & drugs have increased significantly in the last couple of decades due to campaign and awareness programs. Despite such wide use of artificial vitamin D supplements, serum level of 25 hydroxyvitamin D does not always reflect the amount of uptake. In contrast to the safe sunlight exposure, prolonged and disproportionate consumption of vitamin D supplements may lead to vitamin D intoxication, even without developing hypervitaminosis D. One of the reasons why vitamin D supplementation is believed to be safe is, it rarely raises serum vitamin D levels to the toxic range even after repeated intravenous ingestion of extremely high doses of synthetic vitamin D analogs. However, prolonged consumption of vitamin D supplementation may induce hypercalcemia, hypercalciuria and hyperphosphatemia, which are considered to be the initial signs of vitamin D intoxication. It is likely that calcium and phosphorus dysregulation, induced by exogenous vitamin D supplementation, may lead to tissue and organ damages, even without developing hypervitaminosis D. It is needed to be emphasized that, because of tight homeostatic control of calcium and phosphorus, when hypercalcemia and/or hyperphosphatemia is apparent following vitamin D supplementation, the process of tissue and/or organ damage might already have been started.
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Affiliation(s)
- Mohammed S Razzaque
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA; Department of Preventive & Community Dentistry, School of Dentistry, University of Rwanda College of Medicine & Health Sciences, Kigali, Rwanda; Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA; Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
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Mark KA, Dumas KJ, Bhaumik D, Schilling B, Davis S, Oron TR, Sorensen DJ, Lucanic M, Brem RB, Melov S, Ramanathan A, Gibson BW, Lithgow GJ. Vitamin D Promotes Protein Homeostasis and Longevity via the Stress Response Pathway Genes skn-1, ire-1, and xbp-1. Cell Rep 2017; 17:1227-1237. [PMID: 27783938 DOI: 10.1016/j.celrep.2016.09.086] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 06/09/2016] [Accepted: 09/26/2016] [Indexed: 12/17/2022] Open
Abstract
Vitamin D has multiple roles, including the regulation of bone and calcium homeostasis. Deficiency of 25-hydroxyvitamin D, the major circulating form of vitamin D, is associated with an increased risk of age-related chronic diseases, including Alzheimer's disease, Parkinson's disease, cognitive impairment, and cancer. In this study, we utilized Caenorhabditis elegans to examine the mechanism by which vitamin D influences aging. We found that vitamin-D3-induced lifespan extension requires the stress response pathway genes skn-1, ire-1, and xbp-1. Vitamin D3 (D3) induced expression of SKN-1 target genes but not canonical targets of XBP-1. D3 suppressed an important molecular pathology of aging, that of widespread protein insolubility, and prevented toxicity caused by human β-amyloid. Our observation that D3 improves protein homeostasis and slows aging highlights the importance of maintaining appropriate vitamin D serum levels and may explain why such a wide variety of human age-related diseases are associated with vitamin D deficiency.
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Affiliation(s)
- Karla A Mark
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Kathleen J Dumas
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA.
| | - Dipa Bhaumik
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Birgit Schilling
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Sonnet Davis
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Tal Ronnen Oron
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Dylan J Sorensen
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Mark Lucanic
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Rachel B Brem
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Simon Melov
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Arvind Ramanathan
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Bradford W Gibson
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Gordon J Lithgow
- The Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA.
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18
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Ferrari D, Lombardi G, Banfi G. Concerning the vitamin D reference range: pre-analytical and analytical variability of vitamin D measurement. Biochem Med (Zagreb) 2017; 27:030501. [PMID: 28900363 PMCID: PMC5575654 DOI: 10.11613/bm.2017.030501] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/22/2017] [Indexed: 12/17/2022] Open
Abstract
Unlike other vitamins, the vitamin D concentration in blood varies cyclically over the course of the year in relation to genetic (gender, ethnicity, polymorphisms) and environmental factors (sunlight exposure, diet, food-related or direct vitamin D supplementation, skin pigmentation). Although the major diagnostics manufacturers have recently developed improved automated 25-hydroxy vitamin D immunoassays, the intra- and inter-laboratory variability is still high (especially at low vitamin D concentrations) which might lead to incorrect vitamin D deficiency/insufficiency diagnosis. Moreover, despite recent efforts to standardize the assay and minimize its variability, the current bias for measured vitamin D concentrations is often still above the desirable ± 10% criterion. Because the implications of low vitamin D concentrations in non-skeletal diseases are still partially unknown, international guideline recommendations for establishing meaningful ranges, at any time over the course of the year, irrespective not only of environmental and personal factors but also of instrumental variability, are needed. In this review, we discuss the main factors that influence the variability of vitamin D concentrations and whether a centile curve, individually calculated by a theoretical equation considering such factors, might be better suited than a fixed limit to assess abnormal vitamin D concentrations in otherwise healthy subjects. Vitamin D reference ranges during pregnancy, childhood, or diagnosed illnesses, which merit separate discussion, are beyond the scope of this review.
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Affiliation(s)
- Davide Ferrari
- Department of Biosciences, University of Parma, Parma, Italy
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Giuseppe Banfi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
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19
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Bilbao NA. Vitamin D Toxicity in Young Breastfed Infants: Report of 2 Cases. Glob Pediatr Health 2017; 4:2333794X17731695. [PMID: 28955720 PMCID: PMC5607921 DOI: 10.1177/2333794x17731695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022] Open
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20
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Putzu A, Belletti A, Cassina T, Clivio S, Monti G, Zangrillo A, Landoni G. Vitamin D and outcomes in adult critically ill patients. A systematic review and meta-analysis of randomized trials. J Crit Care 2017; 38:109-114. [DOI: 10.1016/j.jcrc.2016.10.029] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/23/2016] [Accepted: 10/30/2016] [Indexed: 12/31/2022]
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21
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De Pascale G, Vallecoccia MS, Schiattarella A, Di Gravio V, Cutuli SL, Bello G, Montini L, Pennisi MA, Spanu T, Zuppi C, Quraishi SA, Antonelli M. Clinical and microbiological outcome in septic patients with extremely low 25-hydroxyvitamin D levels at initiation of critical care. Clin Microbiol Infect 2015; 22:456.e7-456.e13. [PMID: 26721785 DOI: 10.1016/j.cmi.2015.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/04/2015] [Accepted: 12/12/2015] [Indexed: 01/28/2023]
Abstract
A relationship between vitamin D status and mortality in patients in intensive care units (ICU) has been documented. The present study aims to describe the clinical profile and sepsis-related outcome of critically ill septic patients with extremely low (<7 ng/mL) vitamin D levels at ICU admission. We conducted an observational study in the ICU of a teaching hospital including all patients admitted with severe sepsis/septic shock and undergoing 25-hydroxyvitamin D (25(OH)D) testing within the first 24 hours from admission. We studied 107 patients over 12 months. At ICU admission vitamin D deficiency (≤20 ng/mL) was observed in 93.5% of the patients: 57 (53.3%) showed levels <7 ng/mL. As primary outcome, sepsis-related mortality rate was higher in patients with vitamin D levels <7 ng/mL (50.9% versus 26%). Multivariate regression analysis showed that vitamin D concentration <7 ng/mL on ICU admission (p 0.01) and higher mean SAPS II (p <0.01) score were independent predictors of sepsis-related mortality. Patients with very low vitamin D levels suffered higher rate of microbiologically confirmed infections but a lower percentage of microbiological eradication with respect to patients whose values were >7 ng/mL (80.7% versus 58%, p 0.02; 35.3% versus 68%; p 0.03, respectively). Post hoc analysis showed that, in the extremely low vitamin D group, the 52 patients with pneumonia showed a longer duration of mechanical ventilation (9 days (3.75-12.5 days) versus 4 days (2-9 days), p 0.04) and the 66 with septic shock needed vasopressor support for a longer period of time (7 days (4-10 days) versus 4 days (2-7.25 days), p 0.02). Our results suggest that in critical septic patients extremely low vitamin D levels on admission may be a major determinant of clinical outcome. Benefits of vitamin D replacement therapy in this population should be elucidated.
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Affiliation(s)
- G De Pascale
- Department of Intensive Care and Anaesthesiology, Rome, Italy.
| | - M S Vallecoccia
- Department of Intensive Care and Anaesthesiology, Rome, Italy
| | - A Schiattarella
- Institute of Biochemistry and Clinical Biochemistry, Rome, Italy
| | - V Di Gravio
- Department of Intensive Care and Anaesthesiology, Rome, Italy
| | - S L Cutuli
- Department of Intensive Care and Anaesthesiology, Rome, Italy
| | - G Bello
- Department of Intensive Care and Anaesthesiology, Rome, Italy
| | - L Montini
- Department of Intensive Care and Anaesthesiology, Rome, Italy
| | - M A Pennisi
- Department of Intensive Care and Anaesthesiology, Rome, Italy
| | - T Spanu
- Institute of Microbiology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - C Zuppi
- Institute of Biochemistry and Clinical Biochemistry, Rome, Italy
| | - S A Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - M Antonelli
- Department of Intensive Care and Anaesthesiology, Rome, Italy
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22
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Fuleihan GEH, Bouillon R, Clarke B, Chakhtoura M, Cooper C, McClung M, Singh RJ. Serum 25-Hydroxyvitamin D Levels: Variability, Knowledge Gaps, and the Concept of a Desirable Range. J Bone Miner Res 2015; 30:1119-33. [PMID: 25952470 DOI: 10.1002/jbmr.2536] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/09/2015] [Accepted: 04/16/2015] [Indexed: 12/21/2022]
Abstract
Hypovitaminosis D is prevalent worldwide but proportions vary widely between regions, depending on genetic and lifestyle factors, the threshold to define deficiency, and accuracy of 25-hydroxyvitamin D (25OHD) assays used. Latitude, pollution, concealing clothing, sun exposure, gender, dietary habits, and lack of government regulation account for up to 50% in variations in serum 25OHD levels, whereas genetic polymorphisms in the vitamin D pathway account for less than 5%. Organizations/societies have developed guidelines for recommended desirable 25OHD levels and vitamin D doses to reach them, but their applicability across age groups and populations are still debated. This article and the accompanying online Supporting Information highlight sources of variations in circulating 25OHD levels, uncertainties and knowledge gaps, and analytical problems facing 25OHD assays, while keeping efficacy and safety data as the dominant factors when defining a desirable range for 25OHD levels. We propose a desirable range of 20 to 40 ng/mL (50 to 100 nmol/L), provided precise and accurate assays are used. Although slightly lower levels, 15 to 20 ng/mL, may be sufficient for some infants and adults, higher levels, 40 to 60 ng/mL, may still be safe. This desirable range allows physicians to tailor treatment while taking season, lifestyle, vitamin D intake, and other sources of variation into account. We reserve 25OHD measurements for at-risk patients, defined by disease or lifestyle, and the use of 25OHD assays calibrated against the recommended international standards. Most target groups reach desirable target levels by a daily intake of 400 to 600 IU for children and 800 IU for adults. A total daily allowance of vitamin D of up to 1000 IU in the pediatric age groups, and up to 2000 IU in adults, tailored to an individual patient risk profile, is probably safe over long durations. Additional data are needed to validate the proposed range and vitamin D doses, especially in children, pregnant women, and non-white populations.
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Affiliation(s)
- Ghada El-Hajj Fuleihan
- Department of Internal Medicine, Calcium Metabolism and Osteoporosis Program, American University of Beirut, Beirut, Lebanon
| | - Roger Bouillon
- Department of Endocrinology and Laboratory Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bart Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Foundation, Rochester, MN, USA
| | - Marlene Chakhtoura
- Department of Internal Medicine, Calcium Metabolism and Osteoporosis Program, American University of Beirut, Beirut, Lebanon
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Ravinder J Singh
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Foundation, Rochester, MN, USA
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23
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Maeda SS, Borba VZC, Camargo MBR, Silva DMW, Borges JLC, Bandeira F, Lazaretti-Castro M. Recommendations of the Brazilian Society of Endocrinology and Metabology (SBEM) for the diagnosis and treatment of hypovitaminosis D. ACTA ACUST UNITED AC 2015; 58:411-33. [PMID: 25166032 DOI: 10.1590/0004-2730000003388] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/18/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence. MATERIALS AND METHODS The Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Brazilian Medical Association (AMB) Guidelines Program. Data search was performed using PubMed, Lilacs and SciELO and the evidence was classified in recommendation levels, according to the scientific strength and study type. CONCLUSION A scientific update regarding hypovitaminosis D was presented to serve as the basis for the diagnosis and treatment of this condition in Brazil.
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Affiliation(s)
- Sergio Setsuo Maeda
- Disciplina de Endocrinologia, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Victoria Z C Borba
- Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | | | | | | - Francisco Bandeira
- Disciplina de Endocrinologia, Hospital Agamenon Magalhães, Escola de Medicina, Universidade de Pernambuco, Recife, PE, Brasil
| | - Marise Lazaretti-Castro
- Disciplina de Endocrinologia, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil
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Vogiatzi MG, Jacobson-Dickman E, DeBoer MD. Vitamin D supplementation and risk of toxicity in pediatrics: a review of current literature. J Clin Endocrinol Metab 2014; 99:1132-41. [PMID: 24456284 DOI: 10.1210/jc.2013-3655] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Although vitamin D toxicity is rare in children, increased use of vitamin D formulations, re-examination of optimal vitamin D levels, and use of higher doses lend potential for an increased incidence of vitamin D toxicity. EVIDENCE ACQUISITION A PubMed search was conducted through May 2013 for cases of vitamin D intoxication and vitamin D trials in pediatrics. Safety data were collected and reviewed. EVIDENCE SYNTHESIS A small number of pediatric studies tested vitamin D doses at or above the currently recommended upper tolerable intake. In children and adolescents, vitamin D excess was rare and usually asymptomatic. Recent cases of intoxication relate to errors in manufacturing, formulation, or prescription; involve high total intake in the range of 240,000 to 4,500,000 IU; and present with severe hypercalcemia, hypercalciuria, or nephrocalcinosis. However, mild hypercalcemia and hypervitaminosis using currently recommended doses have been reported in infants with rickets. CONCLUSIONS Although rare, cases of vitamin D intoxication that present with dramatic life-threatening symptoms still occur in children. Moreover, recent studies in infants raise a potential need for monitoring vitamin D levels when doses at or above the currently recommended upper range are used. Further studies are needed to clarify these findings. The Drugs and Therapeutics Committee of the Pediatric Endocrine Society suggests obtaining serum 25-hydroxyvitamin D levels in infants and children who receive long-term vitamin D supplementation at or above the upper level intake that is currently recommended.
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Affiliation(s)
- Maria G Vogiatzi
- Weill Cornell Medical College (M.G.V.), New York, New York 10065; SUNY Downstate Medical Center (E.J.-D.), Brooklyn, New York 11203; and University of Virginia Health System (M.D.D.), Charlottesville, Virginia 22908
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Holmøy T, Kampman MT, Smolders J. Vitamin D in multiple sclerosis: implications for assessment and treatment. Expert Rev Neurother 2014; 12:1101-12. [DOI: 10.1586/ern.12.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Romagnoli E, Pepe J, Piemonte S, Cipriani C, Minisola S. Management of endocrine disease: value and limitations of assessing vitamin D nutritional status and advised levels of vitamin D supplementation. Eur J Endocrinol 2013; 169:R59-69. [PMID: 23847326 DOI: 10.1530/eje-13-0435] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The growing attention to the role of vitamin D in skeletal and extra-skeletal diseases over the last decade induced an increased demand for vitamin D determination as well as a dramatic rise of sales of vitamin D supplement. However, several critical points in this field remain to be clarified. We lack a clear consensus about the definition of vitamin D deficiency, insufficiency, and sufficiency. The identification of different thresholds defining vitamin D status has relevant implications in clinical practice. In fact, the worldwide prevalence of low vitamin D status is highly varying according to the level of 25(OH)D utilized to define sufficiency. Therefore, the assessment of 25-hydroxyvitamin D levels may have a critical role, but a number of different technical problems associated with its determination may interfere in interpreting the results. The hydrophobic nature of vitamin D and the tight binding to its carrier (vitamin D binding protein), the different forms circulating in blood, and the issue of standardization are among the most important factors influencing the measurement of this metabolite. Another controversial point relies on the conflicting guidance on prevention and treatment of vitamin D deficiency endorsed by different medical and scientific communities. In particular, uncertainty exists about how to replete vitamin D stores, how to maintain normal 25(OH)D levels after repletion, which form of vitamin D is preferable for supplementation, and which route of administration and dosing regimens are advisable. Finally, concerns have been raised regarding vitamin D toxicity and its adverse effects.
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Affiliation(s)
- Elisabetta Romagnoli
- Department of Internal Medicine and Medical Disciplines, University of Rome 'Sapienza', Viale del Policlinico 155, 00161 Rome, Italy
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Rolland Y, de Souto Barreto P, Abellan Van Kan G, Annweiler C, Beauchet O, Bischoff-Ferrari H, Berrut G, Blain H, Bonnefoy M, Cesari M, Duque G, Ferry M, Guerin O, Hanon O, Lesourd B, Morley J, Raynaud-Simon A, Ruault G, Souberbielle JC, Vellas B. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging 2013; 17:402-12. [PMID: 23538667 DOI: 10.1007/s12603-013-0007-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of vitamin D insufficiency is very high in the nursing home (NH) population. Paradoxically, vitamin D insufficiency is rarely treated despite of strong clinical evidence and recommendations for supplementation. This review aims at reporting the current knowledge of vitamin D supplementation in NH and proposing recommendations adapted to the specificities of this institutional setting. DESIGN Current literature on vitamin D supplementation for NH residents was narratively presented and discussed by the French Group of Geriatrics and Nutrition. RESULT Vitamin D supplementation is a safe and well-tolerated treatment. Most residents in NH have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. Current specific and personalized protocols for vitamin D supplementation may not be practical for use in NH settings (e.g., assessment of serum vitamin D concentrations before and after supplementation). Therefore, our group proposes a model of intervention based on the systematic supplementation of vitamin D (1,000 IU/day) since the patient's admission to the NH and throughout his/her stay without the need of a preliminary evaluation of the baseline levels. Calcium should be prescribed only in case of poor dietary calcium intake. CONCLUSION A population-based rather than individual-based approach may probably improve the management of vitamin D insufficiency in the older population living in NH, without increasing the risks of adverse health problems. The clinical relevance and cost effectiveness of this proposal should be assessed under NH real-world conditions to establish its feasibility.
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Affiliation(s)
- Y Rolland
- Department of Geriatric Medicine, CHU Toulouse, Institute of aging, F-31059 Toulouse, France.
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Leccia MT. [Skin, sun exposure and vitamin D: facts and controversies]. Ann Dermatol Venereol 2013; 140:176-82. [PMID: 23466150 DOI: 10.1016/j.annder.2012.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/16/2012] [Accepted: 12/05/2012] [Indexed: 12/31/2022]
Abstract
Vitamin D plays a clearly defined role in phosphorus, calcium and bone metabolism. In addition to its effects on cellular proliferation and differentiation, and on immunity, it appears to exert other action, poorly understood to date, on human physiology and disease. A number of epidemiological studies have demonstrated a protective role of sun exposure with regard to the incidence of certain immune diseases and cancer, and upon the related mortality rates. Furthermore, over the last 10 years, studies have purported to find levels judged "inadequate" in numerous populations, and, in the absence of any strict scientific arguments, a correlation was established by certain authors between supposedly "inadequate" levels, sun exposure and risk of cancer. However, analysis of the literature shows that there is in fact no precise and consensual definition of normal ranges and that the notion of inadequacy was created artificially using assay techniques lacking in sensitivity and reproducibility. Photosynthesis of vitamin D can in fact be considered perfectly adequate in the majority of populations. However, greater care is needed with elderly subjects and with subjects exposed very little to sunlight. Current studies show that the means of photoprotection used in everyday life do not adversely affect such photosynthesis. In the event of documented vitamin D deficiency, oral supplements should be given, and exposure to natural or artificial UV radiation should not be prescribed. Ultraviolet radiation has been shown to be carcinogenic and responsible for the onset of most skin cancers, and the population must be warned against misleading advertising from the tanning industry. Care should also be taken with regard to the potential harmful effects of inappropriate vitamin D supplementation.
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Affiliation(s)
- M-T Leccia
- Clinique de dermatologie et photobiologie, pôle pluridisciplinaire de médecine, CHU A.-Michallon, 38043 Grenoble cedex, France.
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Mendonça ML, Pereira FA, Nogueira-Barbosa MH, Monsignore LM, Teixeira SR, Watanabe PCA, Maciel LMZ, de Paula FJA. Increased vertebral morphometric fracture in patients with postsurgical hypoparathyroidism despite normal bone mineral density. BMC Endocr Disord 2013; 13:1. [PMID: 23286605 PMCID: PMC3546901 DOI: 10.1186/1472-6823-13-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/27/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The mechanism behind parathyroid hormone (PTH) activation of bone remodeling is intimately dependent on the time of exposure of bone cells to hormone levels. Sustained high PTH levels trigger catabolism, while transitory elevations induce anabolism. The effects of hypoparathyroidism (PhPT) on bone are unknown. The objective was to study the impact of PhPT on bone mineral density (BMD), on the frequency of subclinical vertebral fracture and on mandible morphometry. METHODS The study comprised thirty-three postmenopausal women, 17 controls (CG) and 16 with PhPT (PhPTG) matched for age, weight and height. Bone mineral density (BMD) of lumbar spine, total hip and 1/3 radius, radiographic evaluation of vertebral morphometry, panoramic radiography of the mandible, and biochemical evaluation of mineral metabolism and bone remodeling were evaluated in both groups. RESULTS There were no significant differences in lumbar spine or total hip BMD between groups. There was marked heterogeneity of lumbar spine BMD in PhPTG (high = 4, normal = 9, osteopenia = 1, and osteoporosis = 2 patients). BMD was decreased in the 1/3 radius in PhPTG P < 0.005). The PhPTG group exhibited an increased frequency of morphometric vertebral fractures and decreased mandible cortical thickness. CONCLUSION The study suggests that vertebral fragility occurs in PhPT despite normal or even high BMD. The current results encourage further studies to evaluate the use of panoramic radiography in the identification of osteometabolic disorders, such as PhPT and the development of a more physiological treatment for PhPT.
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Affiliation(s)
- Maira L Mendonça
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Francisco A Pereira
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lucas M Monsignore
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Sara R Teixeira
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Plauto CA Watanabe
- Department of Radiology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lea MZ Maciel
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Francisco JA de Paula
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
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Abstract
PURPOSE OF REVIEW The pleotropic effects of vitamin D on chronic diseases have received significant attention; however, its role in acute illness is less understood. The purpose of this review is to summarize the current evidence regarding the role of vitamin D in acute stress and critical illness. RECENT FINDINGS 25-Hydroxyvitamin D levels may affect risk of developing acute illnesses (e.g. respiratory infections), and low concentrations are associated with unfavorable outcomes during critical care. Inflammatory changes alone do not explain the observed deterioration in vitamin D status following acute stress. Hemodilution, interstitial extravasation, decreased synthesis of binding proteins, and renal wasting of 25-hydroxyvitamin D, all appear to play a more significant role in the regulation of vitamin D status during critical illness. SUMMARY Single-point assessments of 25-hydroxyvitamin D following acute stress may provide an inaccurate assessment of vitamin D status. In such cases, measurement of binding proteins and free vitamin D metabolites may be essential to create a more realistic approximation of vitamin D status. Variations in patient responses to acute stress and critical illness may depend not only on the degree of systemic vitamin D insufficiency, but also on the individual tissue requirements.
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Affiliation(s)
- Sadeq A Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Abstract
OBJECTIVE To review the current literature regarding vitamin D insufficiency and supplementation in major illnesses. DESIGN AND METHODS We reviewed Pubmed-indexed, English language manuscripts from January, 2003 to June, 2012 using search terms related to vitamin D, all-cause mortality, cardiovascular disease, pulmonary disease, diabetes mellitus, and cancer. OUTCOME MEASURES Incidence of disease, risk ratios associated with 25-hydroxyvitamin D [25(OH)D] levels, and/or vitamin D supplementation schedules were documented. RESULTS Although 25(OH)D levels ≥20 ng/mL were often associated with improved health outcomes, evidence suggests that 25(OH)D levels ≥30 ng/mL may confer additional health benefits. CONCLUSIONS Based on the available evidence, vitamin D supplementation to restore 25(OH)D levels within a range of 30-50 ng/mL is reasonable in order to optimize potential benefits and minimize potential risks. This, of course, should be considered in the context of individual patient needs and co-morbidities.
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Affiliation(s)
- Sadeq A Quraishi
- Vitamin D In Stress (ViDIS) Laboratory, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 5 Fruit Street, GRJ 402, Boston, MA 02114, USA,
| | - Carlos A Camargo
- Emergency Medicine Network (EMNet) Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge St, Suite 410, Boston, MA 02114,
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