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Tan Y, Wang Z, Xu M, Li B, Huang Z, Qin S, Nice EC, Tang J, Huang C. Oral squamous cell carcinomas: state of the field and emerging directions. Int J Oral Sci 2023; 15:44. [PMID: 37736748 PMCID: PMC10517027 DOI: 10.1038/s41368-023-00249-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
Oral squamous cell carcinoma (OSCC) develops on the mucosal epithelium of the oral cavity. It accounts for approximately 90% of oral malignancies and impairs appearance, pronunciation, swallowing, and flavor perception. In 2020, 377,713 OSCC cases were reported globally. According to the Global Cancer Observatory (GCO), the incidence of OSCC will rise by approximately 40% by 2040, accompanied by a growth in mortality. Persistent exposure to various risk factors, including tobacco, alcohol, betel quid (BQ), and human papillomavirus (HPV), will lead to the development of oral potentially malignant disorders (OPMDs), which are oral mucosal lesions with an increased risk of developing into OSCC. Complex and multifactorial, the oncogenesis process involves genetic alteration, epigenetic modification, and a dysregulated tumor microenvironment. Although various therapeutic interventions, such as chemotherapy, radiation, immunotherapy, and nanomedicine, have been proposed to prevent or treat OSCC and OPMDs, understanding the mechanism of malignancies will facilitate the identification of therapeutic and prognostic factors, thereby improving the efficacy of treatment for OSCC patients. This review summarizes the mechanisms involved in OSCC. Moreover, the current therapeutic interventions and prognostic methods for OSCC and OPMDs are discussed to facilitate comprehension and provide several prospective outlooks for the fields.
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Affiliation(s)
- Yunhan Tan
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhihan Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Mengtong Xu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Bowen Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Zhao Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Siyuan Qin
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Edouard C Nice
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia
| | - Jing Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Canhua Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China.
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Significant improvement of facial actinic keratoses after blue light photodynamic therapy with oral vitamin D pretreatment: An interventional cohort-controlled trial. J Am Acad Dermatol 2022; 87:80-86. [PMID: 35314199 PMCID: PMC9233022 DOI: 10.1016/j.jaad.2022.02.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In mouse models of skin cancer, high-dose oral vitamin D3 (VD3; cholecalciferol) combined with photodynamic therapy (PDT) can improve the clearance of squamous precancers (actinic keratoses [AKs]). OBJECTIVE To determine whether oral VD3 can improve the clinical efficacy of a painless PDT regimen in humans with AK. METHODS The baseline lesion counts and serum 25-hydroxyvitamin D3 levels were determined. In group 1, 29 patients underwent gentle debridement and 15-minute aminolevulinic acid preincubation with blue light (30 minutes; 20 J/cm2). In group 2, 29 patients took oral VD3 (10,000 IU daily for 5 or 14 days) prior to debridement and PDT. Lesion clearance was assessed at 3 to 6 months. RESULTS In group 1, the mean clearance rates of facial AK were lower in patients with VD3 deficiency (25-hydroxyvitamin D3 level < 31 ng/dL; clearance rate, 40.9% ± 42%) than in patients with normal 25-hydroxyvitamin D3 levels (62.6% ± 14.2%). High-dose VD3 supplementation (group 2) significantly improved the overall AK lesion response (72.5% ± 13.6%) compared with that in group 1 (54.4% ± 22.8%). No differences in side effects were noted. LIMITATIONS Nonrandomized trial design (interventional cohort matched to registry-based controls). CONCLUSIONS Oral VD3 pretreatment significantly improves AK clinical responses to PDT. The regimen appears promising and well tolerated.
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Prasad M, Rajarajeswari D, Aruna P, Ramalingam K, Viswakumar R, Fathima N, Vishwakarma SK, Khan AA. Status of Vitamin D Receptor Gene Polymorphism and 25-Hydroxy Vitamin D Deficiency with Essential Hypertension. Indian J Clin Biochem 2021; 37:335-341. [PMID: 34149207 PMCID: PMC8203720 DOI: 10.1007/s12291-021-00984-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022]
Abstract
Essential hypertension (EH) is a multifactorial and complex disease with high rate of incidence and associated co-morbidities. Previous studies do not provide unanimous results for the risk of hypertension and association with Fok I genotype frequency and serum vitamin D levels. Hence, this study was undertaken to determine the status of Fok I vitamin D receptor (VDR) gene polymorphism along with vitamin D levels and blood pressure in patients with EH. Four hundred (200 controls and 200 cases of essential hypertension) participants from general Indian population were enrolled in this study. Peripheral blood samples were collected for genotyping Fok I-VDR gene polymorphism using PCR–RFLP method whereas 25-OH vitamin D levels in serum were quantified using high performance liquid chromatography (HPLC). Significantly reduced 25-OH vitamin D levels were observed in patients with EH (24.04 ± 8.62 vs 50.46 ± 15.46) compared to control subjects (p = 0.0001). Homozygous recessive genotype ‘ff’ frequency was increased by 8.06 fold (CI: 3.71–17.47, p = 0.0001) in patients with EH compared to dominant ‘FF’ genotype frequency. In conclusion, recessive ‘ff’ genotype frequency correlates with reduced serum vitamin D levels and results in significantly increased systolic and diastolic blood pressures leading to predisposition of EH.
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Affiliation(s)
- M Prasad
- Department of Biochemistry, Narayana Medical College and Hospital, Chinthareddypalem, Nellore, Andhra Pradesh 524003 India
| | - D Rajarajeswari
- Department of Biochemistry, Narayana Medical College and Hospital, Chinthareddypalem, Nellore, Andhra Pradesh 524003 India
| | - P Aruna
- Department of Biochemistry, ACSR Government Medical College, Dargamitta, Nellore, Andhra Pradesh 524004 India
| | - K Ramalingam
- Department of Biochemistry, Narayana Medical College and Hospital, Chinthareddypalem, Nellore, Andhra Pradesh 524003 India
| | - R Viswakumar
- Department of Biochemistry, Narayana Medical College and Hospital, Chinthareddypalem, Nellore, Andhra Pradesh 524003 India
| | - Nusrath Fathima
- Department of Genetics, Osmania University, Hyderabad, Telangana 500007 India
| | - Sandeep Kumar Vishwakarma
- Central Laboratory for Stem Cell Research and Translational Medicine, Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad, Telangana 500058 India
| | - Aleem Ahmed Khan
- Central Laboratory for Stem Cell Research and Translational Medicine, Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad, Telangana 500058 India
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Karacan M, Usta A, Biçer S, Baktir G, İpek Gündogan G, Sancakli Usta C, Akinci G. Serum vitamin D levels in healthy urban population at reproductive age: effects of age, gender and season. Cent Eur J Public Health 2020; 28:306-312. [PMID: 33338368 DOI: 10.21101/cejph.a5947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/13/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the study was to determine the effects of age, gender and season on vitamin D status in healthy urban population at reproductive age. Also, we investigated the distribution of population into different groups regarding 25(OH)D levels. METHODS Serum 25(OH)D levels of 21,317 participants: 5,364 men (25.1%) and 15,953 women (74.8%), aged between 18-45 years, applying to two medical centres for check-up located in the same city were retrospectively analyzed. Group I consisted of 14,720 participants (11,257 women and 3,463 men) in the first centre and Group II consisted of 6,597 participants (4,696 women and 1,901 men) in the second centre. RESULTS The mean 25(OH)D levels did not differ between women and men in both groups: 23.4 (SD = 14.4) and 23.1 (SD = 12.6) in Group I, and 22.6 (SD = 15.9) and 23.1 (SD = 14.3) in Group II, respectively, (p > 0.05). Similar trends exhibiting lower mean 25(OH)D levels at younger ages and higher levels at later ages were observed in both groups; a seasonal variation of 25(OH)D levels was observed in both genders with the highest levels in August and September and the lowest levels from February through April; percentages of women with 25(OH)D level of < 5 ng/ml were significantly higher than of men in Group I (1.4% vs. 0.2%, respectively, p < 0.001) and in Group II (4.1% vs. 1.1%, respectively, p < 0.001). CONCLUSION There is a slight increase in serum 25(OH)D levels from 18 through 45 years of age in healthy population. The seasonal variation of 25(OH)D levels is prominent in both genders with men having slightly lower levels in some months of winter and higher levels in summer as compared to women. The prevalence of women having 25(OH)D levels less than 5 ng/ml is higher than that of men.
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Affiliation(s)
- Meriç Karacan
- Department of Obstetrics and Gynaecology, School of Medicine, Yeni Yuzyil University, Istanbul, Turkey
| | - Akin Usta
- Department of Obstetrics and Gynaecology, School of Medicine, Balikesir University, Balikesir, Turkey
| | - Sermin Biçer
- Department of Obstetrics and Gynaecology, School of Medicine, Yeni Yuzyil University, Istanbul, Turkey
| | - Gül Baktir
- Department of Obstetrics and Gynaecology, School of Medicine, Yeni Yuzyil University, Istanbul, Turkey
| | - Gül İpek Gündogan
- Department of Obstetrics and Gynaecology, School of Medicine, Yeni Yuzyil University, Istanbul, Turkey
| | - Ceyda Sancakli Usta
- Department of Obstetrics and Gynaecology, School of Medicine, Balikesir University, Balikesir, Turkey
| | - Gulsema Akinci
- Department of Internal Medicine, Balikesir Havran State Hospital, Balikesir, Turkey
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Elsafi SSMS, Nour BM, Abakar AD, Omer IH, Almugadam BS. Vitamin D level and it is association with the severity of pulmonary tuberculosis in patients attended to Kosti Teaching Hospital, Sudan. AIMS Microbiol 2020; 6:65-74. [PMID: 32226915 PMCID: PMC7099198 DOI: 10.3934/microbiol.2020004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/09/2020] [Indexed: 01/08/2023] Open
Abstract
Globally, tuberculosis is one of the major causes of morbidity and mortality in many countries. Previous studies suggest that the incidence and severity of tuberculosis are associated with low levels of vitamin D (Vit D). Therefore, this study aimed to determine the occurrence and associated factors of vitamin D3 deficiency in pulmonary tuberculosis patients at White Nile State, Sudan. 101 individuals of diagnosed pulmonary tuberculosis patients (71 males and 30 females) and 100 non-TB controls (58 males and 42 females) were included in this study. Sputum samples were obtained from TB patients and subjected to examination for acid-fast bacilli (AFB) using Ziehl-Neelsen (ZN) stain and Gene Xpert analysis. Blood samples were collected from both groups and Serum 25(OH)-vitamin D3 was determined by an Enzyme-Linked Immunosorbent Assay. HIV infection in Tuberculosis (TB) group was also investigated using the immunochromatographic test. In our study, the majority of TB patients were suffered from TB relapse (36.6%); non-HIV infected individuals (99.1%) or showed a positive result for AFB (61.4%) in Gene Xpert analysis. Moreover, there is a significant difference in microscopy findings and bacillary levels of AFB, and Rifampicin (RIF) susceptibility pattern of M. tuberculosis strain among sputum samples of TB patients, P-values less 0.0001. Furthermore, we found that TB patients were suffered from vitamin D deficiency. In particular, the mean of vitamin D level was significantly much lower in TB patients (26.7 ± 1.6) compared to non-TB controls (117.3 ± 3.2), P-value equal 0.0001. Likewise, it's much lower in females, individuals of 21-40 years old, and patients with high bacillary levels or those infected by Rifampicin resistance strain. Accordingly, our study was highlighted the TB and Vit D deficiency relationship and showed the need for further studies to a better understanding of the impact of TB on Vit D level and investigate whether vitamin D supplementation can have a role in the prevention and treatment of tuberculosis.
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Affiliation(s)
| | - Bakri Mohammed Nour
- Department of Medical Parasitology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan
| | - Adam Dawoud Abakar
- Department of Medical Parasitology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan.,Department of Parasitology, Blue Nile National Institute for Communicable Diseases, University of Gezira, Sudan
| | - Izzedeen Haroun Omer
- Department of Medicine, Faculty of Medicine, University of El Imam El Mahdi, Kosti, Sudan
| | - Babiker Saad Almugadam
- Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
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Importance of Studying the Levels of Hepcidin and Vitamin D in Egyptian Children with Chronic Hepatitis C. J Transl Int Med 2019; 7:15-21. [PMID: 30997352 PMCID: PMC6463826 DOI: 10.2478/jtim-2019-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objective Hepcidin is the key regulator of iron metabolism and is a significant biomarker for systemic inflammatory states. Vitamin D is a powerful immunomodulator and plays a significant role in the inflammatory responses and fibrosis occurring due to hepatitis C virus (HCV) infection. This study assessed the level of vitamin D and serum hepcidin and its expression in peripheral blood of children with chronic hepatitis C (CHC) and correlated them with other serum markers to reflect iron metabolism and liver disease severity. Methods A total of 100 children were included in this study: 50 with HCV infection and 50 healthy controls. Biochemical parameters together with vitamin D, hepcidin, and its expression were all measured. Results The level of hepcidin and its expression together with vitamin D and hepcidin-to-ferritin (H/F) ratios were significantly reduced in patients, but the iron and ferritin levels were higher (P<0.001). Serum hepcidin level showed significant positive correlation with hepcidin expression, HCV titer, iron, ferritin, and H/F ratio (r = 0.43, 0.31, 0.34, 0.28, and 0.91, respectively) but significant negative correlation with vitamin D (r = -0.37). Both hepcidin and ferritin were higher in patients with Child Pugh scores B and C than those with score A (P<0.001). Conclusion Measuring serum hepcidin and its expression together with vitamin D levels in patients may have a prognostic value and is promising in the follow-up of the severity of liver disease.
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Yang K, Fung TT, Nan H. An Epidemiological Review of Diet and Cutaneous Malignant Melanoma. Cancer Epidemiol Biomarkers Prev 2018; 27:1115-1122. [PMID: 30018150 DOI: 10.1158/1055-9965.epi-18-0243] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/01/2018] [Accepted: 07/09/2018] [Indexed: 11/16/2022] Open
Abstract
Incidence of cutaneous malignant melanoma has continued to rise despite public efforts to promote sun protection behaviors among populations at risk. However, dietary factors may also affect the development of melanoma. In the past few decades, findings from epidemiologic and experimental research have linked consumption of several foods and other nutrients to the risk of melanoma. Caffeine has been associated with a lower risk of melanoma, and citrus fruits and alcohol with increased risk. Associations between polyunsaturated fatty acid, niacin/nicotinamide, folate, and vitamin D with melanoma remain controversial. Diet likely influences melanoma development through several potential mechanisms, such as enhancing UV-induced apoptosis and increasing photosensitivity. We conducted a narrative review to summarize recent epidemiologic studies of diet and melanoma based on published literature. Given the high prevalence of the food items and nutrients covered in this review and the decades-long rising melanoma incidence worldwide, the associations we discuss may have important public health implications in terms of reducing melanoma incidence through dietary modification. Cancer Epidemiol Biomarkers Prev; 27(10); 1115-22. ©2018 AACR.
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Affiliation(s)
- Keming Yang
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Teresa T Fung
- Department of Nutrition, Simmons College, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hongmei Nan
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana.
- IU Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, Indiana
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Lee CWS, Muo CH, Liang JA, Sung FC, Hsu CY, Kao CH. Increased osteoporosis risk in dermatomyositis or polymyositis independent of the treatments: a population-based cohort study with propensity score. Endocrine 2016; 52:86-92. [PMID: 26429781 DOI: 10.1007/s12020-015-0756-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/22/2015] [Indexed: 01/29/2023]
Abstract
We investigated the relationship between dermatomyositis/polymyositis (DM/PM) and the risk of subsequent osteoporosis development. A population-based retrospective cohort analysis was conducted using the National Health Insurance Research Database and the Catastrophic Illness Patients Database of Taiwan. We included 1179 patients and 4716 patients from 1999 to 2008 as the DM/PM cohort and the comparison cohort, respectively, and calculated the incidence rates of newly diagnosed osteoporosis. We used Cox proportional hazards models stratified on matched pair to assess the effect of DM/PM. The Kaplan-Meier method was applied to estimate the cumulative osteoporosis incidence curves. Patients with DM/PM were 2.99 times more likely to experience osteoporosis than those without DM/PM. The risk for osteoporosis in DM/PM patients was higher than comparisons in different propensity score quartiles. DM/PM cohort, no matter treated with or without corticosteroids and immunosuppressant, had a higher risk than the comparison cohort. The incidence of osteoporosis in Taiwan is associated with a priori DM/PM history. This risk was independent of the corticosteroids and immunosuppressant treatment.
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Affiliation(s)
- Cynthia Wei-Sheng Lee
- Center for Drug Abuse and Addiction, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Department of Public Health, China Medical University and Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Ji-An Liang
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan.
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Spiller HA, Good TF, Spiller NE, Aleguas A. Vitamin D exposures reported to US poison centers 2000-2014: Temporal trends and outcomes. Hum Exp Toxicol 2015; 35:457-61. [PMID: 26519481 DOI: 10.1177/0960327115595685] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED There has been an increased use of vitamin D both by prescription and by the public as a widely available supplement. We evaluated 15 years of single-substance vitamin D exposures to US poison centers. METHODS Retrospective analysis of data from the National Poison Data System (NPDS) to evaluate clinical effects, trends, and outcomes of exposures to vitamin D over the period January 1, 2000 through June 30, 2014. Cases were limited to exposures involving vitamin D as a single substance. Multiple vitamin products that may have included vitamin D were not included in this study. RESULTS From 2000 through June 30, 2014, there were 25,397 human exposures to vitamin D reported to NPDS. There was a mean of 196 cases per year from 2000 to 2005, followed by a 1600% increase in exposures between 2005 and 2011 to a new annual mean of 4535 exposures per year. The mean and median ages were 23.4 years and 10 years, respectively. There were no fatalities, but five (0.02%) major effect outcomes. Serious medical outcomes (major or moderate outcome) were infrequent, ranging from 2 patients/year to 22 patients/year. Clinical effects were primarily gastrointestinal (0.7-1.5%) and mild neurological effects (0.2-0.4%). There was a decline in the percentage of patients treated in a health care facility and of patients with serious medical outcome. CONCLUSION Despite the enormous increase in number of exposures, there was not a significant increase in patients with a serious medical outcome. Rare severe outcomes may occur.
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Affiliation(s)
- H A Spiller
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA Department of Pediatrics, College of Medicine, Ohio State University, Columbus, OH, USA
| | - T F Good
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - N E Spiller
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - A Aleguas
- Florida Poison Information Center - Tampa, Tampa, FL, USA
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Lee A, Chan SKC, Samy W, Chiu CH, Gin T. Effect of Hypovitaminosis D on Postoperative Pain Outcomes and Short-Term Health-Related Quality of Life After Knee Arthroplasty: A Cohort Study. Medicine (Baltimore) 2015; 94:e1812. [PMID: 26496317 PMCID: PMC4620783 DOI: 10.1097/md.0000000000001812] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Vitamin D may have an important role in pain perception. Inadequate vitamin D levels are associated with suboptimal recovery after surgery. However, the effects of hypovitaminosis D on postoperative pain-related outcomes and its impact on health-related quality of life after surgery are not well understood. The objective of this study was to determine the effects of hypovitaminosis D on postoperative pain-related outcomes and health-related quality of life at 3 months after knee arthroplasty.This was a longitudinal cohort study of 191 consecutive Hong Kong Chinese patients who were given patient-controlled morphine analgesia for up to 72 hours after 214 knee arthroplasties. Serum total 25-hydroxyvitamin D (25-OHD) concentration was assessed by liquid chromatography-tandem mass spectrometry. The primary outcomes were postoperative pain intensity at rest scores (0-72 h), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index (pain, stiffness and function), and moderate-to-severe persistent pain (transformed WOMAC pain score of 0-75 at 3 months after knee arthroplasty; 0, extreme pain; 100, no pain). Group differences were analyzed using generalized estimating equation models and a logistic regression model.The prevalence of preoperative hypovitaminosis D (25-OHD <50 nmol/L) was 44% (95% confidence interval [CI]: 37%-51%). There were transient higher pain intensity scores in the moderate-to-severe hypovitaminosis D (25-OHD <30 nmol/L) group compared with the sufficient vitamin D group. Vitamin D status had no effect on total WOMAC index (P = 0.22). The incidence of moderate-to-severe persistent pain was 9% (95% CI: 6%-14%). Hypovitaminosis D increased the risk of moderate-to-severe persistent pain (adjusted odds ratio 2.64, 95% CI: 1.03-6.77).Preoperative hypovitaminosis D had subtle effects on pain intensity scores in the early postoperative period and is a risk factor for moderate-to-severe persistent pain after knee arthroplasty. Hypovitaminosis D was not associated with worse health-related quality of life at 3 months after knee arthroplasty.
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Affiliation(s)
- Anna Lee
- From the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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Stechschulte SA, Kirsner RS, Federman DG. Sunscreens for Non-Dermatologists: What you Should Know when Counseling Patients. Postgrad Med 2015; 123:160-7. [DOI: 10.3810/pgm.2011.07.2315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Raimundo FV, Lang MAB, Scopel L, Marcondes NA, Araújo MGA, Faulhaber GAM, Furlanetto TW. Effect of fat on serum 25-hydroxyvitamin D levels after a single oral dose of vitamin D in young healthy adults: a double-blind randomized placebo-controlled study. Eur J Nutr 2014; 54:391-6. [PMID: 24853643 DOI: 10.1007/s00394-014-0718-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/12/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE This double-blind placebo-controlled trial evaluated serum 25-hydroxyvitamin D [25(OH)D] levels after the oral intake of a single dose of cholecalciferol during one of the three meals, containing different amounts of fat or placebo. METHODS AND RESULTS Sixty-four healthy medical residents or students of a university hospital in Porto Alegre, latitude 30° S, Brazil, were divided into four groups. Three groups received a single 50,000 IU oral dose of cholecalciferol during a meal containing 0 g (Group 1), 15 g (Group 2) or 30 g (Group 3) of fat, and one group received placebo (Group 4), according to randomization. Serum 25(OH)D, parathyroid hormone, total calcium, albumin, magnesium, and creatinine levels, and urinary calcium, magnesium, and creatinine levels were measured at baseline and after 14 days. Baseline mean serum 25(OH)D levels were low in all groups. Vitamin D given during breakfast increased the mean change of serum 25(OH)D levels, when compared to placebo. Furthermore, the intake of fat with vitamin D increased the mean change of serum 25(OH)D levels. CONCLUSION A single oral dose of vitamin D given with food increased mean serum 25(OH)D levels, after 2 weeks, and the mean increase was larger, when the meal had at least 15 g of fat. These findings can have important implications to oral vitamin D supplementation.
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Affiliation(s)
- Fabiana Viegas Raimundo
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Ohta H, Uemura Y, Nakamura T, Fukunaga M, Ohashi Y, Hosoi T, Mori S, Sugimoto T, Itoi E, Orimo H, Shiraki M. Serum 25-hydroxyvitamin D level as an independent determinant of quality of life in osteoporosis with a high risk for fracture. Clin Ther 2014; 36:225-35. [PMID: 24462224 DOI: 10.1016/j.clinthera.2013.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/18/2013] [Accepted: 12/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Deteriorated quality of life (QOL) is a major problem in osteoporotic women. However, little is known regarding the determinants of QOL in patients with osteoporosis. OBJECTIVE Our aim was to explore the role of vitamin D status on QOL score in osteoporosis with high fracture risk. METHODS Patients were osteoporotic women aged ≥70 years and with ≥1 risk factor for incident fracture, namely prevalent osteoporotic fracture, bone mineral density (BMD) >-3.0 SD of young adult mean, or high bone turnover marker. Health-related QOL was assessed using the Japanese Osteoporosis Quality of Life Questionnaire (JOQOL). When patients were classified into quartiles by total QOL score). Serum 25-hydroxyvitamin D (25[OH]D) level was measured by immunoassay. RESULTS A total of 1585 osteoporotic women were included in the study (age range, 70-95 years). Age, body mass index, serum 25(OH)D status (low, normal, or high), bone mineral density, number of prevalent vertebral fractures, presence of hypertension, presence of osteoarthritis, and history of falls were significantly correlated with QOL quartile. Multivariate liner regression analysis indicated that low serum 25(OH)D level (<20 ng/mL) was an independent determinant of total QOL score quartile (P = 0.0055). The conventional determinants of QOL-age (P < 0.0001), body mass index (P = 0.0060), number of prevalent vertebral fractures (P < 0.0001), presence of osteoarthritis (P = 0.0074), and history of fall (P = 0.0098)-were also independent determinants of total QOL score. CONCLUSIONS These results strongly suggest that low serum 25(OH)D level was a significant determinant of QOL in these osteoporotic women, independently of the conventional factors that reduce QOL. Maintenance of serum 25(OH)D levels >20 ng/mL may be required to maintain patients' QOL in osteoporosis.
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Affiliation(s)
- Hiroaki Ohta
- Department of Clinical Medical Research Center, International University of Health and Welfare, Women's Medical Center of Sanno Medical Center, Tokyo, Japan
| | - Yukari Uemura
- Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan
| | | | | | - Yasuo Ohashi
- Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Takayuki Hosoi
- Department of Clinical Research and Development, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Satoshi Mori
- Bone and Joint Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | | | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | | | - Masataka Shiraki
- Department of Internal Medicine, Research Institute and Practice for Involutional Diseases, Nagano, Japan.
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Oral postdialysis cholecalciferol supplementation in patients on maintenance hemodialysis: a dose-response approach. Int J Nephrol 2014; 2014:597429. [PMID: 24579049 PMCID: PMC3918706 DOI: 10.1155/2014/597429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 11/02/2013] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to evaluate the dose of postdialysis cholecalciferol needed to maintain the 25-hydroxyvitamin D [25(OH)D] levels in the optimal range of 75–150 nmol/L. Twenty-six patients who had low baseline 25(OH)D levels (mean 27.5 ± 14.9 nmol/L) were studied. The 25(OH)D levels were measured every 2 months for one year. During the first two months, all the patients received 2000 IU of cholecalciferol after each hemodialysis (=6000 IU/wk). Thereafter, the dose was individualized and adapted every 2 months by administering 1 to 6 cholecalciferol tablets (2000 IU each) per week (total weekly dose = 2000–12000 IU/wk). During cholecalciferol supplementation, the 25(OH)D concentrations rapidly increased from baseline to 140.1 ± 28.3 nmol/L at month 6 and 95.6 ± 20.9 nmol/L at month 12. At month twelve, 86% of the patients had 25(OH)D levels within the target range with a mean dose of 5917 ± 4106 IU/wk of cholecalciferol; however, the amount needed to maintain these levels varied widely from 0 (n = 2) to 12000 IU/wk (n = 5). In conclusion, postdialysis cholecalciferol prescription is quite effective in correcting vitamin D deficiency/insufficiency, but the amount of cholecalciferol needed to maintain the 25(OH)D levels within the optimal range over the long-term varies widely among patients and must be individualized.
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Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2014; 2014:CD007470. [PMID: 24414552 PMCID: PMC11285307 DOI: 10.1002/14651858.cd007470.pub3] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Available evidence on the effects of vitamin D on mortality has been inconclusive. In a recent systematic review, we found evidence that vitamin D3 may decrease mortality in mostly elderly women. The present systematic review updates and reassesses the benefits and harms of vitamin D supplementation used in primary and secondary prophylaxis of mortality. OBJECTIVES To assess the beneficial and harmful effects of vitamin D supplementation for prevention of mortality in healthy adults and adults in a stable phase of disease. SEARCH METHODS We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index-Expanded and Conference Proceedings Citation Index-Science (all up to February 2012). We checked references of included trials and pharmaceutical companies for unidentified relevant trials. SELECTION CRITERIA Randomised trials that compared any type of vitamin D in any dose with any duration and route of administration versus placebo or no intervention in adult participants. Participants could have been recruited from the general population or from patients diagnosed with a disease in a stable phase. Vitamin D could have been administered as supplemental vitamin D (vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol)) or as an active form of vitamin D (1α-hydroxyvitamin D (alfacalcidol) or 1,25-dihydroxyvitamin D (calcitriol)). DATA COLLECTION AND ANALYSIS Six review authors extracted data independently. Random-effects and fixed-effect meta-analyses were conducted. For dichotomous outcomes, we calculated the risk ratios (RRs). To account for trials with zero events, we performed meta-analyses of dichotomous data using risk differences (RDs) and empirical continuity corrections. We used published data and data obtained by contacting trial authors.To minimise the risk of systematic error, we assessed the risk of bias of the included trials. Trial sequential analyses controlled the risk of random errors possibly caused by cumulative meta-analyses. MAIN RESULTS We identified 159 randomised clinical trials. Ninety-four trials reported no mortality, and nine trials reported mortality but did not report in which intervention group the mortality occurred. Accordingly, 56 randomised trials with 95,286 participants provided usable data on mortality. The age of participants ranged from 18 to 107 years. Most trials included women older than 70 years. The mean proportion of women was 77%. Forty-eight of the trials randomly assigned 94,491 healthy participants. Of these, four trials included healthy volunteers, nine trials included postmenopausal women and 35 trials included older people living on their own or in institutional care. The remaining eight trials randomly assigned 795 participants with neurological, cardiovascular, respiratory or rheumatoid diseases. Vitamin D was administered for a weighted mean of 4.4 years. More than half of the trials had a low risk of bias. All trials were conducted in high-income countries. Forty-five trials (80%) reported the baseline vitamin D status of participants based on serum 25-hydroxyvitamin D levels. Participants in 19 trials had vitamin D adequacy (at or above 20 ng/mL). Participants in the remaining 26 trials had vitamin D insufficiency (less than 20 ng/mL).Vitamin D decreased mortality in all 56 trials analysed together (5,920/47,472 (12.5%) vs 6,077/47,814 (12.7%); RR 0.97 (95% confidence interval (CI) 0.94 to 0.99); P = 0.02; I(2) = 0%). More than 8% of participants dropped out. 'Worst-best case' and 'best-worst case' scenario analyses demonstrated that vitamin D could be associated with a dramatic increase or decrease in mortality. When different forms of vitamin D were assessed in separate analyses, only vitamin D3 decreased mortality (4,153/37,817 (11.0%) vs 4,340/38,110 (11.4%); RR 0.94 (95% CI 0.91 to 0.98); P = 0.002; I(2) = 0%; 75,927 participants; 38 trials). Vitamin D2, alfacalcidol and calcitriol did not significantly affect mortality. A subgroup analysis of trials at high risk of bias suggested that vitamin D2 may even increase mortality, but this finding could be due to random errors. Trial sequential analysis supported our finding regarding vitamin D3, with the cumulative Z-score breaking the trial sequential monitoring boundary for benefit, corresponding to 150 people treated over five years to prevent one additional death. We did not observe any statistically significant differences in the effect of vitamin D on mortality in subgroup analyses of trials at low risk of bias compared with trials at high risk of bias; of trials using placebo compared with trials using no intervention in the control group; of trials with no risk of industry bias compared with trials with risk of industry bias; of trials assessing primary prevention compared with trials assessing secondary prevention; of trials including participants with vitamin D level below 20 ng/mL at entry compared with trials including participants with vitamin D levels equal to or greater than 20 ng/mL at entry; of trials including ambulatory participants compared with trials including institutionalised participants; of trials using concomitant calcium supplementation compared with trials without calcium; of trials using a dose below 800 IU per day compared with trials using doses above 800 IU per day; and of trials including only women compared with trials including both sexes or only men. Vitamin D3 statistically significantly decreased cancer mortality (RR 0.88 (95% CI 0.78 to 0.98); P = 0.02; I(2) = 0%; 44,492 participants; 4 trials). Vitamin D3 combined with calcium increased the risk of nephrolithiasis (RR 1.17 (95% CI 1.02 to 1.34); P = 0.02; I(2) = 0%; 42,876 participants; 4 trials). Alfacalcidol and calcitriol increased the risk of hypercalcaemia (RR 3.18 (95% CI 1.17 to 8.68); P = 0.02; I(2) = 17%; 710 participants; 3 trials). AUTHORS' CONCLUSIONS Vitamin D3 seemed to decrease mortality in elderly people living independently or in institutional care. Vitamin D2, alfacalcidol and calcitriol had no statistically significant beneficial effects on mortality. Vitamin D3 combined with calcium increased nephrolithiasis. Both alfacalcidol and calcitriol increased hypercalcaemia. Because of risks of attrition bias originating from substantial dropout of participants and of outcome reporting bias due to a number of trials not reporting on mortality, as well as a number of other weaknesses in our evidence, further placebo-controlled randomised trials seem warranted.
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Affiliation(s)
- Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Lise Lotte Gluud
- Copenhagen University Hospital HvidovreGastrounit, Medical DivisionKettegaards AlleHvidovreDenmark
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Kate Whitfield
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812CopenhagenDenmark
| | - Jørn Wetterslev
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812CopenhagenDenmark
| | - Rosa G Simonetti
- Ospedali Riuniti Villa Sofia‐CervelloU.O. di Medicina 2Via Trabucco 180PalermoItalyI‐90146
| | - Marija Bjelakovic
- Medical Faculty, University of NisInstitute of AnatomyBoulevard Dr Zorana Djindjica 81NisSerbia18000
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Lee CJ, Subeq YM, Lee RP, Liou HH, Hsu BG. Calcitriol decreases TGF-β1 and angiotensin II production and protects against chlorhexide digluconate-induced liver peritoneal fibrosis in rats. Cytokine 2013; 65:105-18. [PMID: 24210651 DOI: 10.1016/j.cyto.2013.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/20/2013] [Accepted: 10/04/2013] [Indexed: 11/30/2022]
Abstract
Peritoneal fibrosis is a major complication of peritoneal dialysis that can lead to ultrafiltration failure. This study investigates the protective effects of calcitriol on chlorhexidine digluconate-induced peritoneal fibrosis in rats. Peritoneal fibrosis was induced in Sprague-Dawley rats by daily administration of 0.5mL 0.1% chlorhexidine digluconate in normal saline via peritoneal dialysis for 1week. Rats received daily intravenous injections of calcitriol (low-dose, 10ng/kg; or high-dose, 100ng/kg) for 1week. After 7days, conventional 4.25% Dianeal (30mL) was administered via peritoneal dialysis over 4h. Peritoneal solute transport was calculated from the dialysate concentration relative to its concentration in the initial infused dialysis solution (D4/D0 glucose) for glucose, and the dialysate-to-plasma concentration ratio (D4/P4 urea) at 4h for urea. Rats were then sacrificed and the liver peritoneum was harvested for immunohistochemical analysis via microscopy. After dialysis, the D4/P4 Urea level was reduced; increases were observed in the D4/D0 glucose level and the levels of active transforming growth factor-β1 and angiotensin II in serum and dialysate; the liver peritoneum and muscle peritoneum was markedly thickened, and the expression of α-SMA, fibronectin, collagen, vascular endothelial growth factor, angiotensin II, transforming growth factor-β1, and phosphorylated Smad2/3 (P-Smad2/3)-positive cells in the liver peritoneum was elevated in the peritoneal fibrosis group compared with the vehicle group. Calcitriol decreased the serum and dialysate active transforming growth factor-β1 and angiotensin II level, decreased the thickness of the liver peritoneum and muscle peritoneum, and decreased the expression of α-SMA, fibronectin, collagen, vascular endothelial growth factor, angiotensin II, transforming growth factor-β1, and P-Smad2/3-positive cells in liver peritoneum cells. High-dose calcitriol exhibited better protective effects against peritoneal fibrosis than did the lower dose. Calcitriol protected against chlorhexidine digluconate-induced peritoneal fibrosis in rats by decreasing transforming growth factor-β1 and angiotensin II production.
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Affiliation(s)
- Chung-Jen Lee
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
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Wang Y, Liu XJ, Robitaille L, Eintracht S, MacNamara E, Hoffer LJ. Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients. Am J Clin Nutr 2013; 98:705-11. [PMID: 23885048 DOI: 10.3945/ajcn.112.056366] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypovitaminosis C and D are highly prevalent in acute-care hospitals. Malnutrition with regard to these vitamins has been linked to mood disturbance and cognitive dysfunction. OBJECTIVE The objective was to determine whether vitamin C or D supplementation improves mood state or reduces psychological distress in acutely hospitalized patients with a high prevalence of hypovitaminosis C and D. DESIGN A randomized, double-blind, active-control clinical trial compared the effects of vitamin C (500 mg twice daily) with those of high-dose vitamin D (5000 IU/d) on mood (Profile of Mood States) and psychological distress (Distress Thermometer). RESULTS Vitamin C provided for a mean of 8.2 d increased plasma vitamin C concentrations to normal (P < 0.0001) and was associated with a 71% reduction in mood disturbance (P = 0.0002) and a 51% reduction in psychological distress (P = 0.0002). High-dose vitamin D provided for a mean of 8.1 d increased plasma 25-hydroxyvitamin D [25(OH)D] concentrations (P < 0.0001), but not into the normal range, and had insignificant effects on mood (P = 0.067) and distress (P = 0.45). The changes in mood and distress in the vitamin C group were greater than those in the vitamin D group (P = 0.045 for mood; P = 0.009 for distress). CONCLUSIONS Short-term therapy with vitamin C improves mood and reduces psychological distress in acutely hospitalized patients with a high prevalence of hypovitaminosis C and D. No conclusion is possible regarding the effects of vitamin D because the dose and duration of therapy were insufficient to raise 25(OH)D concentrations into the normal range. This trial was registered at clinicaltrials.gov as NCT01630720.
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Affiliation(s)
- Yifan Wang
- Lady Davis Institute for Medical Research and Diagnostic Medicine, Jewish General Hospital, McGill University, Montreal, Canada
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Abstract
BACKGROUND AND AIM Sometimes, a temporary increase in alkaline phosphatase level is found in healthy infants and toddlers without evidence of liver or bone disease. The condition is customarily termed transient benign hyperphosphatasemia of infancy and early childhood. Most textbooks do not refer to the condition. The aim of the study was to promote broader awareness of transient benign hyperphosphatasemia. METHODS We completed a systematic review of the literature using the principles underlying the UK Economic and Social Research Council guidance on the conduct of narrative synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. RESULTS The 142 reports retained for analysis included 813 cases (male:female ratio 1.1:1.0): 80 in subjects older than 18 years and 733 in subjects 18 years or younger. The alkaline phosphatase ratio, calculated by dividing the measured level by the upper limit of normal, was ≥5.0 in ≈70% and the duration of the elevation was ≤4 months in 80% of the cases. Transient benign hyperphosphatasemia often followed a benign infection, but available data fail to demonstrate a causal link. The prevalence of transient benign hyperphosphatasemia ranged from 1.1% to 3.5% in infants 2 to 24 months of age. CONCLUSIONS Transient benign hyperphosphatasemia is likely the most common cause of hyperphosphatasemia among healthy infants and toddlers. Sometimes it also occurs in older children and adults, indicating that the traditional term transient benign hyperphosphatasemia of infancy and early childhood may not be correct. The elevation in alkaline phosphatase persists for >4 months in ≈20% of the cases. Recognition of this benign condition is crucial to avoid unnecessary investigations.
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Vitamin D and bone disease. BIOMED RESEARCH INTERNATIONAL 2012; 2013:396541. [PMID: 23509720 PMCID: PMC3591184 DOI: 10.1155/2013/396541] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022]
Abstract
Vitamin D is important for normal development and maintenance of the skeleton. Hypovitaminosis D adversely affects calcium metabolism, osteoblastic activity, matrix ossification, bone remodeling and bone density. It is well known that Vit. D deficiency in the developing skeleton is related to rickets, while in adults is related to osteomalacia. The causes of rickets include conditions that lead to hypocalcemia and/or hypophosphatemia, either isolated or secondary to vitamin D deficiency. In osteomalacia, Vit. D deficiency leads to impairment of the mineralisation phase of bone remodeling and thus an increasing amount of the skeleton being replaced by unmineralized osteoid. The relationship between Vit. D and bone mineral density and osteoporosis are still controversial while new evidence suggests that Vit. D may play a role in other bone conditions such as osteoarthritis and stress fractures. In order to maintain a “good bone health” guidelines concerning the recommended dietary intakes should be followed and screening for Vit. D deficiency in individuals at risk for deficiency is required, followed by the appropriate action.
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Lee SH, Park SJ, Kim KM, Lee DJ, Kim WJ, Park RW, Joo NS. Effect of sunlight exposure on serum 25-hydroxyvitamin d concentration in women with vitamin d deficiency: using ambulatory lux meter and sunlight exposure questionnaire. Korean J Fam Med 2012; 33:381-9. [PMID: 23267424 PMCID: PMC3526721 DOI: 10.4082/kjfm.2012.33.6.381] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 10/08/2012] [Indexed: 11/18/2022] Open
Abstract
Background Vitamin D is an important factor in human health. Yet, vitamin D deficiency is very common. We aimed to confirm serum 25-hydroxyvitamin D (25OHD) concentration change after sunlight exposure and to elucidate the relationship between the amount of sunlight exposure and serum 25OHD level change by ambulatory lux meter and sunlight exposure questionnaire. Methods Twenty healthy young women were enrolled. They were educated to obtain 20 minutes of sunlight exposure during weekdays from October to November, 2010, during which they were to wear an ambulatory lux meter on an arm. All subjects completed a one-week recall sunlight exposure questionnaire at the end of the study. Before and after sunlight exposure, serum 25OHD level was measured. Results Mean pre-exposure serum 25OHD concentration was 11.01 ng/mL. The mean change of pre- and post-exposure 25OHD level was -0.62 ng/mL, but it was not statistically significant. The mean personal sunlight exposure recorded by ambulatory lux meter, 292.6 lux/s, showed no significant relationship with average change of 25OHD and average weekly sunlight exposure score, 11.9, calculated by the sunlight exposure questionnaire. However, the mean change of serum 25OHD level and weekly sunlight exposure score showed significant negative correlation (r = -0.469, P = 0.037). Conclusion Change of serum 25OHD concentration after four weeks of sunlight exposure was not statistically significant in women with vitamin D deficiency. However, serum 25OHD concentration change was significantly negatively correlated with the sunlight exposure score by the questionnaire.
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Affiliation(s)
- Sang-Hoon Lee
- Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, Korea
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Kwan CK, Eckhardt B, Baghdadi J, Aberg JA. Hyperparathyroidism and complications associated with vitamin D deficiency in HIV-infected adults in New York City, New York. AIDS Res Hum Retroviruses 2012; 28:1025-32. [PMID: 22220755 DOI: 10.1089/aid.2011.0325] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although recent studies report a high prevalence of vitamin D deficiency in HIV-infected adults similar to that in the general population, metabolic complications of vitamin D deficiency may be worsened with HIV infection and remain insufficiently characterized. We conducted a retrospective cross-sectional cohort study to determine prevalence and correlates of vitamin D deficiency and hyperparathyroidism among HIV-infected patients attending an urban clinic. Vitamin D deficiency was defined as 25(OH)-vitamin D <20 ng/ml and insufficiency as 20 to <30 ng/ml, and hyperparathyroidism as parathyroid-hormone >65 pg/ml. We used the X(2) test to compare proportions and logistic regression to assess for associations. Among 463 HIV-infected patients, the prevalence of vitamin D deficiency was 59%. The prevalence of hyperparathyroidism was 30% among patients with vitamin D deficiency, 23% among those with insufficiency, and 12% among those with sufficient vitamin D levels. Vitamin D deficiency was associated with increased odds of hyperparathyroidism. Severe vitamin D deficiency was associated with elevated alkaline phosphatase, a marker for increased bone turnover. Although efavirenz use was associated with vitamin D deficiency, and protease inhibitor use with decreased odds of vitamin D deficiency, there was no statistical difference in rates of hyperparathyroidism stratified by combination antiretroviral therapy (cART) use. Given the increased risk of osteopenia with HIV infection and cART use, vitamin D supplementation for all HIV-infected patients on cART should be prescribed in accordance with the 2011 Endocrine Society guidelines. In HIV-infected patients with severe vitamin D deficiency or hyperparathyroidism, screening for osteomalacia and osteopenia may be warranted.
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Affiliation(s)
- Candice K. Kwan
- Bellevue Hospital Center, New York City Health and Hospital Corporation, New York, New York
- New York University School of Medicine, New York, New York
| | - Benjamin Eckhardt
- Bellevue Hospital Center, New York City Health and Hospital Corporation, New York, New York
- New York University School of Medicine, New York, New York
| | | | - Judith A. Aberg
- Bellevue Hospital Center, New York City Health and Hospital Corporation, New York, New York
- New York University School of Medicine, New York, New York
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Maytin EV, Honari G, Khachemoune A, Taylor CR, Ortel B, Pogue BW, Sznycer-Taub N, Hasan T. Vitamin D Combined with Aminolevulinate (ALA)-Mediated Photodynamic Therapy (PDT) for Human Psoriasis: A Proof-of-Principle Study. Isr J Chem 2012; 52:767-775. [PMID: 23264699 DOI: 10.1002/ijch.201200005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We previously showed that select agents (methotrexate or Vitamin D), when administered as a preconditioning regimen, are capable of promoting cellular differentiation of epithelial cancer cells while simultaneously enhancing the efficacy of 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT). In solid tumors, pretreatment with Vitamin D simultaneously promotes cellular differentiation and leads to selective accumulation of target porphyrins (mainly protoporphyrin IX, PpIX) within diseased tissue. However, questions of whether or not the effects upon cellular differentiation are inexorably linked to PpIX accumulation, and whether these effects might occur in hyperproliferative noncancerous tissues, have remained unanswered. In this paper, we reasoned that psoriasis, a human skin disease in which abnormal cellular proliferation and differentiation plays a major role, could serve as a useful model to test the effects of pro-differentiating agents upon PpIX levels in a non-neoplastic setting. In particular, Vitamin D, a treatment for psoriasis that restores (increases) differentiation, might increase PpIX levels in psoriatic lesions and facilitate their responsiveness to ALA-PDT. This concept was tested in a pilot study of 7 patients with bilaterally-matched psoriatic plaques. A regimen in which calcipotriol 0.005% ointment was applied for 3 days prior to ALA-PDT with blue light, led to preferential increases in PpIX (~130%), and reductions in thickness, redness, scaling, and itching in the pretreated plaques. The results suggest that a larger clinical trial is warranted to confirm a role for combination treatments with Vitamin D and ALA-PDT for psoriasis.
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Affiliation(s)
- Edward V Maytin
- Department of Dermatology, Cleveland Clinic, Cleveland, OH ; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH ; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA
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Resolution of chronic urticaria coincident with vitamin D supplementation. Ann Allergy Asthma Immunol 2012; 109:359-60. [PMID: 23062393 DOI: 10.1016/j.anai.2012.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/22/2012] [Accepted: 07/26/2012] [Indexed: 11/23/2022]
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Peris P, Martínez-Ferrer A, Monegal A, Martínez de Osaba MJ, Muxi A, Guañabens N. 25 hydroxyvitamin D serum levels influence adequate response to bisphosphonate treatment in postmenopausal osteoporosis. Bone 2012; 51:54-8. [PMID: 22487299 DOI: 10.1016/j.bone.2012.03.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 01/26/2012] [Accepted: 03/22/2012] [Indexed: 01/09/2023]
Abstract
UNLABELLED It remains unclear whether vitamin D sufficiency optimizes response to bisphosphonate (BP) treatment in postmenopausal osteoporosis. We evaluated the role and possible mechanisms of vitamin D in adequate response to standard BP treatment for postmenopausal osteoporosis. METHODS We included 120 postmenopausal osteoporotic women (aged 68 ± 8 years) receiving BP (alendronate or risedronate) at their annual follow-up, performing complete anamnesis, including treatment adherence, use of vitamin D supplements, and previous falls and fractures during the last year. We analyzed the evolution of bone mineral density (BMD) during this period and serum PTH and 25 hydroxyvitamin D (25(OH)D) and urinary NTx levels. Patients were classified as inadequate responders to antiosteoporotic treatment based on BMD loss>2% and/or the presence of fragility fractures during the last year. RESULTS Thirty percent of patients showed inadequate response to BP treatment, with significantly lower levels of 25(OH)D (22.4 ± 1.3 vs. 26.6 ± 0.3 ng/ml, p=0.01), a higher frequency of 25(OH)D levels<30 ng/ml (91% vs. 69%, p=0.019) and higher urinary NTx values (42.2 ± 3.9 vs. 30.9 ± 2.3 nM/mM, p=0.01). Patients with 25(OH)D>30 ng/ml had a greater significant increase in lumbar BMD than women with values <30 ng/ml (3.6% vs. 0.8%, p<0.05). The probability of inadequate response was 4-fold higher in patients with 25(OH)D<30 (OR, 4.42; 95% CI, 1.22-15.97, p=0.02). CONCLUSIONS Inadequate response to BP treatment is frequent in postmenopausal women with osteoporosis as is vitamin D insufficiency, despite vitamin D supplementation. Maintenance of 25(OH)D levels >30 ng/ml is especially indicated for adequate response to BP treatment.
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Abstract
Osteoporosis is a major public health issue in the general population, particularly in postmenopausal women. Patients with cancer may not only be at risk for primary osteoporosis, but for secondary osteoporosis related to cancer therapies-particularly therapies that impair gonadal function, lead to loss of serum estrogen, and negatively affect bone turnover. Normal bone remodeling is influenced by the receptor activator for nuclear kappa-B ligand pathway, calcium, vitamin D, and other nutrition factors, as well as modifiable and nonmodifiable factors. Identifying which patients with cancer are at risk for bone mineral density loss is important and may include patients with breast or prostate cancer, some survivors of pediatric malignancies, and adults with other tumors. Nurses play a major role in identifying those patients and their risk for low-impact fractures, which can have a significant effect on patient morbidity and mortality. Counseling and teaching are central nursing functions, as well as safely administering therapies, particularly bisphosphonates and denosumab.
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Affiliation(s)
- Rita Wickham
- School of Nursing, Northern Michigan University, Marquette, MI, USA.
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Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol 2012; 109:359-63. [PMID: 22071212 DOI: 10.1016/j.amjcard.2011.09.020] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/13/2011] [Accepted: 09/13/2011] [Indexed: 02/06/2023]
Abstract
Recent evidence supports an association between vitamin D deficiency and hypertension, peripheral vascular disease, diabetes mellitus, metabolic syndrome, coronary artery disease, and heart failure. The effect of vitamin D supplementation, however, has not been well studied. We examined the associations between vitamin D deficiency, vitamin D supplementation, and patient outcomes in a large cohort. Serum vitamin D measurements for 5 years and 8 months from a large academic institution were matched to patient demographic, physiologic, and disease variables. The vitamin D levels were analyzed as a continuous variable and as normal (≥30 ng/ml) or deficient (<30 ng/ml). Descriptive statistics, univariate analysis, multivariate analysis, survival analysis, and Cox proportional hazard modeling were performed. Of 10,899 patients, the mean age was 58 ± 15 years, 71% were women (n = 7,758), and the average body mass index was 30 ± 8 kg/m(2). The mean serum vitamin D level was 24.1 ± 13.6 ng/ml. Of the 10,899 patients, 3,294 (29.7%) were in the normal vitamin D range and 7,665 (70.3%) were deficient. Vitamin D deficiency was associated with several cardiovascular-related diseases, including hypertension, coronary artery disease, cardiomyopathy, and diabetes (all p <0.05). Vitamin D deficiency was a strong independent predictor of all-cause death (odds ratios 2.64, 95% confidence interval 1.901 to 3.662, p <0.0001) after adjusting for multiple clinical variables. Vitamin D supplementation conferred substantial survival benefit (odds ratio for death 0.39, 95% confidence interval 0.277 to 0.534, p <0.0001). In conclusion, vitamin D deficiency was associated with a significant risk of cardiovascular disease and reduced survival. Vitamin D supplementation was significantly associated with better survival, specifically in patients with documented deficiency.
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Wang C, Hu YM, He JW, Gu JM, Zhang H, Hu WW, Yue H, Gao G, Xiao WJ, Yu JB, Ke YH, Hu YQ, Li M, Liu YJ, Fu WZ, Ren Y, Zhang ZL. Association between low density lipoprotein receptor-related protein 2 gene polymorphisms and bone mineral density variation in Chinese population. PLoS One 2011; 6:e28874. [PMID: 22174918 PMCID: PMC3235174 DOI: 10.1371/journal.pone.0028874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 11/16/2011] [Indexed: 01/16/2023] Open
Abstract
Low density lipoprotein receptor-related protein 2 gene (LRP2) is located next to the genomic region showing suggestive linkage with both hip and wrist bone mineral density (BMD) phenotypes. LRP2 knockout mice showed severe vitamin D deficiency and bone disease, indicating the involvement of LRP2 in the preservation of vitamin D metabolites and delivery of the precursor to the kidney for the generation of 1α,25(OH)2D3. In order to investigate the contribution of LRP2 gene polymorphisms to the variation of BMD in Chinese population, a total of 330 Chinese female-offspring nuclear families with 1088 individuals and 400 Chinese male-offspring nuclear families with 1215 individuals were genotyped at six tagSNPs of the LRP2 gene (rs2389557, rs2544381, rs7600336, rs10210408, rs2075252 and rs4667591). BMD values at the lumbar spine 1–4 (L1-4) and hip sites were measured by DXA. The association between LRP2 polymorphisms and BMD phenotypes was assessed by quantitative transmission disequilibrium tests (QTDTs) in female- and male-offspring nuclear families separately. In the female-offspring nuclear families, rs2075252 and haplotype GA of rs4667591 and rs2075252 were identified in the nominally significant total association with peak BMD at L1-4; however, no significant within-family association was found between peak BMD at the L1-4 and hip sites and six tagSNPs or haplotypes. In male-offspring nuclear families, neither the six tagSNPs nor the haplotypes was in total association or within-family association with the peak BMD variation at the L1-4 and hip sites by QTDT analysis. Our findings suggested that the polymorphisms of LRP2 gene is not a major factor that contributes to the peak BMD variation in Chinese population.
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Affiliation(s)
- Chun Wang
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Yi-Ming Hu
- Department of Special Medical Services, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Jin-Wei He
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Jie-Mei Gu
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Hao Zhang
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Wei-Wei Hu
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Hua Yue
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Gao Gao
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Wen-Jin Xiao
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Jin-Bo Yu
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Yao-Hua Ke
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Yun-Qiu Hu
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Miao Li
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Yu-Juan Liu
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Wen-Zhen Fu
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Ying Ren
- Department of Special Medical Services, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Zhen-Lin Zhang
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetics Research Unit, Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
- * E-mail:
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Bogazzi F, Rossi G, Lombardi M, Tomisti L, Sardella C, Manetti L, Curzio O, Marcocci C, Grasso L, Gasperi M, Martino E. Vitamin D status may contribute to serum insulin-like growth factor I concentrations in healthy subjects. J Endocrinol Invest 2011; 34:e200-3. [PMID: 20671418 DOI: 10.3275/7228] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate whether vitamin D [25-(OH) D3] status affects serum IGFI concentrations in healthy subjects. DESIGN AND PATIENTS Two hundred and forty-one consecutive healthy subjects were included in the present study. MEASUREMENTS Serum IGF-I and 25-(OH) D3 concentrations. RESULTS As expected, serum IGF-I concentrations progressively decreased with age (r=-0.55, p<0.0001); on the contrary, gender was not related to serum IGF-I levels. A positive relationship was identified between serum 25-(OH) D3 and IGF-I concentrations (r=0.33, p<0.0001); the 25-(OH) D3-dependent changes of serum IGF-I concentrations were observed also when subjects were divided on the basis of vitamin D deficiency; in fact, those with severe 25-(OH) D3 deficiency (<20 ng/ml) had lower (185 ± 83 μg/l) IGF-I values than those with mild-to absent 25-(OH) D3 deficit (225 ± 83 μg/l, p=0.0004). CONCLUSIONS 25-(OH) D3 status may contribute to determine serum IGF-I levels in healthy population.
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Affiliation(s)
- F Bogazzi
- Department of Endocrinology and Metabolism, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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How to diagnose and manage difficult problems of calcium metabolism in sarcoidosis. Curr Opin Pulm Med 2011; 17:297-302. [DOI: 10.1097/mcp.0b013e328348b3cb] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Paula FJA, Dick-de-Paula I, Bornstein S, Rostama B, Le P, Lotinun S, Baron R, Rosen CJ. VDR haploinsufficiency impacts body composition and skeletal acquisition in a gender-specific manner. Calcif Tissue Int 2011; 89:179-91. [PMID: 21637996 PMCID: PMC3157554 DOI: 10.1007/s00223-011-9505-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 05/07/2011] [Indexed: 10/18/2022]
Abstract
The vitamin D receptor (VDR) is crucial for virtually all of vitamin D's actions and is thought to be ubiquitously expressed. We hypothesized that disruption of one allele of the VDR gene would impact bone development and would have metabolic consequences. Body composition and bone mass (BMD) in VDR heterozygous (VDR HET) mice were compared to those obtained in male and female VDR KO and WT mice at 8 weeks of age. Male mice were also evaluated at 16 weeks, and bone marrow mesenchymal stem cell (MSC) differentiation was evaluated in VDR female mice. Additionally, female VDR HET and WT mice received intermittent PTH treatment or vehicle (VH) for 4 weeks. BMD was determined at baseline and after treatment. MRI was done in vivo at the end of treatment; μCT and bone histomorphometry were performed after killing the animals. VDR HET male mice had normal skeletal development until 16 weeks of age but showed significantly less gain in fat mass than WT mice. In contrast, female VDR HET mice showed decreased total-body BMD at age 8 weeks but had a normal skeletal response to PTH. MSC differentiation was also impaired in VDR HET female mice. Thus, female VDR HET mice show early impairment in bone acquisition, while male VDR HET mice exhibit a lean phenotype. Our results indicate that the VDR HET mouse is a useful model for studying the metabolic and skeletal impact of decreased vitamin D sensitivity.
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Affiliation(s)
- Francisco J. A. de Paula
- Maine Medical Center Research Institute, Research Drive 81, Scarborough, ME 04074-7205, USA; Department of Internal Medicine, School of Medicine of Ribeirão Preto, USP, Av. Bandeirantes 3900, Ribeirão Preto, SP 14049-900, Brazil
| | - Ingrid Dick-de-Paula
- Maine Medical Center Research Institute, Research Drive 81, Scarborough, ME 04074-7205, USA; Department of Internal Medicine, School of Medicine of Ribeirão Preto, USP, Av. Bandeirantes 3900, Ribeirão Preto, SP 14049-900, Brazil
| | - Sheila Bornstein
- Maine Medical Center Research Institute, Research Drive 81, Scarborough, ME 04074-7205, USA
| | - Bahman Rostama
- Maine Medical Center Research Institute, Research Drive 81, Scarborough, ME 04074-7205, USA
| | - Phuong Le
- Maine Medical Center Research Institute, Research Drive 81, Scarborough, ME 04074-7205, USA
| | - Sutada Lotinun
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Roland Baron
- Harvard Medical School and School of Dental Medicine, and Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Clifford J. Rosen
- Maine Medical Center Research Institute, Research Drive 81, Scarborough, ME 04074-7205, USA
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Sweiss NJ, Lower EE, Korsten P, Niewold TB, Favus MJ, Baughman RP. Bone health issues in sarcoidosis. Curr Rheumatol Rep 2011; 13:265-72. [PMID: 21327743 DOI: 10.1007/s11926-011-0170-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sarcoidosis affects the bone directly in only a minority of patients. Nonetheless, bone health should be considered in the management of all patients with sarcoidosis. Deficiency in vitamin D, an important contributor to bone health, has been linked to autoimmune disease incidence. Studies have shown that patients with sarcoidosis frequently have low levels of vitamin D-25 but may have normal or increased levels of vitamin D-1,25. In addition, granuloma formation has been linked to a failure of the innate immune system, which could be related to a deficiency in vitamin D, although this relationship has not been fully characterized. Furthermore, many patients with sarcoidosis are treated with corticosteroids, which are known to induce osteoporosis. Therefore, bone health may be impacted in several ways in sarcoidosis--by direct involvement with granulomas, vitamin D deficiency, or corticosteroid therapy.
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Affiliation(s)
- Nadera J Sweiss
- Sections of Rheumatology and Pulmonary Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC0930, Room N005B, Chicago, IL 60637, USA.
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Clipp SL, Burke A, Hoffman-Bolton J, Alani R, Liégeois NJ, Alberg AJ. Sun-seeking behavior to increase cutaneous vitamin D synthesis: when prevention messages conflict. Public Health Rep 2011; 126:533-9. [PMID: 21800747 DOI: 10.1177/003335491112600409] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The public has long been encouraged to engage in sun-safe practices to minimize exposure to sunlight, the major cause of nonmelanoma skin cancer. More recently, some have advocated unprotected sun exposure to increase cutaneous synthesis of vitamin D as a way to promote health. We assessed the net result of these conflicting messages. METHODS In a cross-sectional survey in 2007, questionnaires were mailed to participants of an ongoing cohort study in Washington County, Maryland. The study population consisted of 8,027 adults (55% response rate). RESULTS Thirty percent of respondents were aware that unprotected sun exposure increased endogenous vitamin D levels. Among those who were aware of this benefit, 42% reported going out into the sun to increase vitamin D levels. Sun-seeking to increase vitamin D production did not significantly differ according to self-reported personal history of skin cancer, but was significantly higher among women, older age groups, those with less education, and vitamin D supplement users. CONCLUSION A substantial proportion of respondents reported sun-seeking behavior expressly to increase endogenous vitamin D levels. The message about sun exposure and vitamin D is reaching the general public; however, this finding poses challenges to skin cancer prevention efforts.
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Affiliation(s)
- Sandra L Clipp
- Comstock Center for Public Health Research and Prevention, Washington County, MD, USA
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Makariou S, Liberopoulos EN, Elisaf M, Challa A. Novel roles of vitamin D in disease: what is new in 2011? Eur J Intern Med 2011; 22:355-62. [PMID: 21767752 DOI: 10.1016/j.ejim.2011.04.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 04/21/2011] [Accepted: 04/28/2011] [Indexed: 12/31/2022]
Abstract
Vitamin D is a steroid molecule, mainly produced in the skin that regulates the expression of a large number of genes. Until recently its main known role was to control bone metabolism and calcium and phosphorus homeostasis. During the last 2 decades it has been realized that vitamin D deficiency, which is really common worldwide, could be a new risk factor for many chronic diseases, such as the metabolic syndrome and its components, the whole spectrum of cardiovascular diseases, several auto-immune conditions, and many types of cancer as well as all-cause mortality. Except for the great number of epidemiological studies that support the above presumptions, vitamin D receptors (VDRs) have been identified in many tissues and cells. The effect of vitamin D supplementation remains controversial and the need for more persuasive study outcomes is intense.
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Affiliation(s)
- Stefania Makariou
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
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Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2011:CD007470. [PMID: 21735411 DOI: 10.1002/14651858.cd007470.pub2] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The available evidence on vitamin D and mortality is inconclusive. OBJECTIVES To assess the beneficial and harmful effects of vitamin D for prevention of mortality in adults. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science (to January 2011). We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials. SELECTION CRITERIA We included randomised trials that compared vitamin D at any dose, duration, and route of administration versus placebo or no intervention. Vitamin D could have been administered as supplemental vitamin D (vitamin D(3) (cholecalciferol) or vitamin D(2) (ergocalciferol)) or an active form of vitamin D (1α-hydroxyvitamin D (alfacalcidol) or 1,25-dihydroxyvitamin D (calcitriol)). DATA COLLECTION AND ANALYSIS Six authors extracted data independently. Random-effects and fixed-effect model meta-analyses were conducted. For dichotomous outcomes, we calculated the risk ratios (RR). To account for trials with zero events, meta-analyses of dichotomous data were repeated using risk differences (RD) and empirical continuity corrections. Risk of bias was considered in order to minimise risk of systematic errors. Trial sequential analyses were conducted to minimise the risk of random errors. MAIN RESULTS Fifty randomised trials with 94,148 participants provided data for the mortality analyses. Most trials included elderly women (older than 70 years). Vitamin D was administered for a median of two years. More than one half of the trials had a low risk of bias. Overall, vitamin D decreased mortality (RR 0.97, 95% confidence interval (CI) 0.94 to 1.00, I(2) = 0%). When the different forms of vitamin D were assessed separately, only vitamin D(3) decreased mortality significantly (RR 0.94, 95% CI 0.91 to 0.98, I(2) = 0%; 74,789 participants, 32 trials) whereas vitamin D(2), alfacalcidol, or calcitriol did not. Trial sequential analysis supported our finding regarding vitamin D(3), corresponding to 161 individuals treated to prevent one additional death. Vitamin D(3) combined with calcium increased the risk of nephrolithiasis (RR 1.17, 95% CI 1.02 to 1.34, I(2) = 0%). Alfacalcidol and calcitriol increased the risk of hypercalcaemia (RR 3.18, 95% CI 1.17 to 8.68, I(2) = 17%). Data on health-related quality of life and health economics were inconclusive. AUTHORS' CONCLUSIONS Vitamin D in the form of vitamin D(3) seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent care. Vitamin D(2), alfacalcidol, and calcitriol had no statistically significant effect on mortality. Vitamin D(3) combined with calcium significantly increased nephrolithiasis. Both alfacalcidol and calcitriol significantly increased hypercalcaemia.
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Affiliation(s)
- Goran Bjelakovic
- Department of Internal Medicine - Gastroenterology and Hepatology, Medical Faculty, University of Nis, Zorana Djindjica 81, Nis, Serbia, 18000
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Robinson-Cohen C, Katz R, Hoofnagle AN, Cauley JA, Furberg CD, Robbins JA, Chen Z, Siscovick DS, de Boer IH, Kestenbaum B. Mineral metabolism markers and the long-term risk of hip fracture: the cardiovascular health study. J Clin Endocrinol Metab 2011; 96:2186-93. [PMID: 21508146 PMCID: PMC3135189 DOI: 10.1210/jc.2010-2878] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 03/29/2011] [Indexed: 11/19/2022]
Abstract
CONTEXT Disturbances in mineral metabolism are associated with lower bone mineral density and fracture; however, previous human studies have assessed individual mineral metabolism markers in isolation. OBJECTIVE We assessed serum concentrations of 25-hydroxyvitamin D (25-OHD), PTH, and bone-specific alkaline phosphatase (BAP) concentrations individually, and in combination, in association with the long-term risk of hip fracture among a general population of older adults. DESIGN AND SETTING We studied 2294 participants from the Cardiovascular Health Study (mean age 74 yr) who were ambulatory and free of hip fracture and known cardiovascular disease at baseline. We used proportional hazards models to evaluate associations of baseline serum 25-OHD, PTH, and BAP concentrations with the time to first hospitalized hip fracture. RESULTS During a median of 13 yr of follow-up, 242 participants (10.6%) developed an incident hip fracture. Serum 25-OHD concentrations less than 15 ng/ml were associated with a 61% greater adjusted risk of fracture (95% confidence interval 12-132% greater). In contrast, neither serum PTH nor BAP concentrations were significantly associated with fracture risk. The association of 25-OHD deficiency with hip fracture was not significantly altered by either PTH or BAP concentrations. CONCLUSIONS Serum concentrations of 25-OHD, but not PTH or BAP, are associated with long-term hip fracture risk among ambulatory older adults. These data suggest that 25-OHD is the most relevant mineral metabolism marker of fracture risk among older people.
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Affiliation(s)
- Cassianne Robinson-Cohen
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington 98104, USA.
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Di Monaco M, Vallero F, Castiglioni C, Di Monaco R, Tappero R. Low levels of 25-hydroxyvitamin D are associated with the occurrence of concomitant upper limb fractures in older women who sustain a fall-related fracture of the hip. Maturitas 2011; 68:79-82. [PMID: 20888157 DOI: 10.1016/j.maturitas.2010.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 08/02/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the association between serum levels of 25-hydroxyvitamin D and the occurrence of simultaneous fractures of the upper limb in older women who sustain a fall-related fracture of the hip. STUDY DESIGN Cross-sectional study. MAIN OUTCOME MEASURES We investigated 472 of 480 white women consecutively admitted to a rehabilitation hospital because of a fall-related hip fracture. Twenty-seven (5.7%) of the 472 women sustained a concomitant upper-limb fracture of either distal radius (20 women) or proximal humerus (seven women). We assessed serum levels of 25-hydroxyvitamin D 14.2 ± 4.1 (mean ± SD) days after surgical repair of the hip fracture in the 472 women by an immunoenzymatic assay. RESULTS Twenty-five-hydroxyvitamin D levels were significantly lower in the 27 women with concomitant fractures of both hip and upper limb than in the remaining 445 hip-fracture women: mean ± SD values were 6.5 ± 5.0 ng/ml and 11.7 ± 10.4 ng/ml respectively in the two groups (mean difference between groups 5.2 ng/ml: 95% CI 1.2-9.2; p=0.011). Low levels of 25-hydroxyvitamin D were significantly associated with concomitant fractures of the upper limb (p=0.017), after adjustment for eight potential confounders including age, height, weight, hip-fracture type, cognitive impairment, neurologic impairment, previous hip fracture, and previous upper-limb fracture. CONCLUSIONS Low levels of 25-hydroxyvitamin D were significantly associated with concomitant upper-limb fractures in our sample of older women with a fall-related fracture of the hip. Preventing vitamin D deficiency may lower the incidence of simultaneous fractures due to a singe fall in elderly women.
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Affiliation(s)
- Marco Di Monaco
- Osteoporosis Research Center, Presidio Sanitario San Camillo, Strada Santa Margherita 136, 10131 Torino, Italy.
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Cruz-Jentoft AJ, Triana FC, Gómez-Cabrera MC, López-Soto A, Masanés F, Martín PM, Rexach JAS, Hidalgo DR, Salvà A, Viña J, Formiga F. [The emergent role of sarcopenia: Preliminary Report of the Observatory of Sarcopenia of the Spanish Society of Geriatrics and Gerontology]. Rev Esp Geriatr Gerontol 2011; 46:100-110. [PMID: 21216498 DOI: 10.1016/j.regg.2010.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 11/25/2010] [Indexed: 05/30/2023]
Abstract
Sarcopenia is a common and prominent geriatric syndrome, of major interest for daily clinical practice of professionals working with older people. The number of affected individuals and its relation with disability, frailty, many chronic diseases, lifestyle and adverse outcomes are extremely relevant for geriatric care. Moreover, biological changes that lead to the loss of muscle mass and strength are intrinsically related to the mechanisms of aging. It is not therefore surprising that research in this field is growing exponentially in recent years, and sarcopenia has been placed in recent years in the forefront of research in geriatric medicine and gerontology. The Spanish Society of Geriatrics and Gerontology has recently created an Observatory of Sarcopenia, which aims to promote educational and research activities in this field. The first activity of the Observatory has been to offer the Spanish speaking scientific community a review of the current status of sarcopenia, that may allow unifying concepts and fostering interest in this promising field of geriatrics.
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Vitamin D depletion: of clinical significance in advanced cancer? Support Care Cancer 2011; 19:865-7. [PMID: 21331483 DOI: 10.1007/s00520-011-1117-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/07/2011] [Indexed: 01/08/2023]
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Pierrot-Deseilligny C, Souberbielle JC. Widespread vitamin D insufficiency: A new challenge for primary prevention, with particular reference to multiple sclerosis. Presse Med 2011; 40:349-56. [PMID: 21333483 DOI: 10.1016/j.lpm.2011.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 01/04/2011] [Indexed: 12/11/2022] Open
Abstract
In the past 10 years, our knowledge of vitamin D has been revolutionized on two main points. Firstly, this vitamin is not only crucial for bone and calcium metabolism but also exerts major hormonal actions via its active metabolite (calcitriol) and specific receptors in almost all organs. The diverse non-classical actions of vitamin D-i.e. anti-inflammatory, immunomodulatory, antiproliferative and as a neurotransmitter-could have protective and preventive effects for a wide variety of pathologies, such as autoimmune diseases, cancer, infections and cardiovascular affections. Secondly, daily vitamin D requirements have been redefined thanks to many recent metabolic and pathological studies and are about 10 times higher than the amount considered sufficient until a few years ago. The fact that sunshine is the essential natural source of vitamin D and is limited in temperate and Nordic countries, coupled with the fact that modern lifestyle increasingly removes people from exposure to the sun, could explain why a great majority of the general population in these countries are in a state of vitamin D insufficiency. A lack of vitamin D can therefore also be observed in all pathologies but it may play a pathogenic role only in some of them. The incrimination of hypovitaminosis D as a risk factor is a reasonable assumption when several different research approaches used in a given pathology have consistently concluded that vitamin D is likely involved in that pathology. In multiple sclerosis, taken here as a prime example, there is a substantial rationale for vitamin D involvement, based on the findings of different experimental, epidemiological, genetic and immunological studies. Possible curative effects of vitamin D, in addition to a preventive action, are currently being tested but have not yet been demonstrated in most pathologies. However, these two questions appear to be clearly distinct and may involve notably different mechanisms. Lastly, since vitamin D insufficiency exists in most people living in mid- or high-latitude countries, vitamin D could exert multiple major preventive actions, simple supplementation is both safe and inexpensive and, for a vitamin-hormone, supplementation seems obligatory from a general preventive medical point of view alone, it follows that vitamin D supplementation should be organized in these countries to treat all those currently in a state of insufficiency, patients and 'normal' subjects alike, without further delay.
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Affiliation(s)
- Charles Pierrot-Deseilligny
- Université Pierre-et-Marie-Curie (Paris VI), Assistance publique-Hôpitaux de Paris, hôpital de la Salpêtrière, service de neurologie 1, 75643 Paris cedex 13, France.
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Shin M, Minden C. Evaluation of the effectiveness of cholecalciferol in long-term care elderly patients with hypovitaminosis D. ACTA ACUST UNITED AC 2011; 26:101-7. [PMID: 21310707 DOI: 10.4140/tcp.n.2011.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the efficacy and safety of cholecalciferol (vitamin D3) 2,000 units daily for 12 weeks in elderly patients with hypovitaminosis D. Secondarily, to postulate causes for those patients who did not return to normal 25-hydroxy vitamin D (25-OHD) levels. DESIGN One-group, pretest post-test. Retrospective chart review. Data collected from Computerized Patient Record System. SETTING Long-term care facility at Central Arkansas Veterans Healthcare System. PATIENTS, PARTICIPANTS Potential study subjects were elderly patients (≥ 65 years of age) treated with total daily dose of cholecalciferol 2,000 units daily by mouth, for at least 12 weeks' duration period between July 1, 2007, and July 31, 2009, with documented 25-OHD levels before and after treatment. INTERVENTIONS None. MAIN OUTCOME MEASURES Efficacy of cholecalciferol was assessed by categorizing patients as responders (25-OHD levels ≥ 30 ng/mL) and nonresponders (25-OHD levels < 30 ng/mL). Safety of vitamin D3 was determined by measuring prevalence of hypercalcemia. Patient demographics, disease states, and medications that can affect 25-OHD levels between responders and nonresponders of vitamin D treatment were assessed. RESULTS 24 patients were included in analysis. 58.3% (14) of patients responded to cholecalciferol treatment and 41.7% (10) of patients did not. The mean 25-OHD level after treatment was 38.7 ng/mL in responders and 26.4 ng/mL in non responders. Twelve patients (50%) developed hypercalcemia. CONCLUSION The present study has shown that some long-term care elderly patients respond to three months of vitamin D supplementation. The reason why some patients did not respond cannot be determined from this study.
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Affiliation(s)
- Maria Shin
- Sullivan University College of Pharmacy, Louisville, Kentucky
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Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R. Appendicular Lean Mass Does Not Mediate the Significant Association Between Vitamin D Status and Functional Outcome in Hip-Fracture Women. Arch Phys Med Rehabil 2011; 92:271-6. [DOI: 10.1016/j.apmr.2010.09.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/30/2010] [Accepted: 09/24/2010] [Indexed: 12/18/2022]
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Ho-Pham LT, Nguyen ND, Lai TQ, Eisman JA, Nguyen TV. Vitamin D status and parathyroid hormone in a urban population in Vietnam. Osteoporos Int 2011; 22:241-8. [PMID: 20414642 DOI: 10.1007/s00198-010-1207-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/03/2010] [Indexed: 12/31/2022]
Abstract
UNLABELLED In this cross-sectional study in Vietnam, the prevalence of vitamin D insufficiency was 46% in adult women and 20% in adult men. There was a linear inverse relationship between serum 25(OH)D and PTH concentrations, but there was no threshold of 25(OH)D at which PTH levels plateaued. INTRODUCTION Vitamin D insufficiency is adversely associated with health outcomes. Vitamin D status in Asian populations is not well documented. This study sought to assess vitamin D status and its relationship to parathyroid hormone in a Vietnamese population. METHODS This cross-sectional study involved 205 men and 432 women aged 18-87 years, who were randomly sampled from various districts in Ho Chi Minh City (Vietnam) according to a proportional sampling scheme. Serum concentration of 25(OH)D and PTH were measured by the Electrochemiluminescence immunoassay on the Roche Elecsys 10100/201 system (Roche Diagnosis Elecsys). Vitamin D insufficiency was quantified as serum 25(OH)D levels below 30 ng/ml (75 nmol/L). RESULTS The average age for men and women was 43.8 ± 18.4 years (mean ± SD) and 47.7 ± 17.1 years, respectively. The mean 25(OH)D concentration in men (36.8 ± 10.2 ng/mL) was significantly higher than in women (30.1 ± 5.9; P < 0.0001). The prevalence of vitamin D insufficiency in men was 20% (41/205) which was significantly lower than in women (46%, 199/432). Age, height and weight were independent predictors of 25(OH)D concentrations, and the three factors explained 15% and 5% of variance in 25(OH)D in men and women, respectively. There was a linear inverse relationship between serum 25(OH)D and PTH concentrations, but there was no threshold of 25(OH)D at which PTH levels plateaued. CONCLUSIONS These data show that vitamin D insufficiency is common even in tropical region, and that women had a greater risk of vitamin D insufficiency than men. These data suggest that an elevation in PTH cannot be used as a marker for vitamin D deficiency.
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Affiliation(s)
- L T Ho-Pham
- Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Thanh Thai Street, District 10, Ho Chi Minh City, Vietnam.
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Cutolo M, Plebani M, Shoenfeld Y, Adorini L, Tincani A. Vitamin D endocrine system and the immune response in rheumatic diseases. VITAMINS AND HORMONES 2011; 86:327-51. [PMID: 21419278 DOI: 10.1016/b978-0-12-386960-9.00014-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Epidemiological evidence indicates a significant association between vitamin D deficiency and an increased incidence of autoimmune diseases. The presence of vitamin D receptors (VDRs) in the cells of the immune system and the fact that several of these cells produce the vitamin D hormone suggested that vitamin D could have immunoregulatory properties, and now potent immunomodulatory activities on dendritic cells, Th1 and Th17 cells, as well as B cells have been confirmed. Serum levels of vitamin D have been found to be significantly lower in patients with systemic lupus erythematosus, undifferentiated connective tissue disease, and type-1 diabetes mellitus than in the healthy population. In addition, it was also found that lower levels of vitamin D were associated with higher disease activity in rheumatoid arthritis. Promising clinical results together with evidence for the regulation of multiple immunomodulatory mechanisms by VDR agonists represent a sound basis for further exploration of their potential in the treatment of rheumatic autoimmune disorders.
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Affiliation(s)
- Maurizio Cutolo
- Research Laboratories and Academic Unit of Clinical Rheumatology, Postgraduate Academic School of Rheumatology, University of Genova, Genova, Italy
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To T. Vitamin D deficiency in an Australian inpatient hospice population. J Pain Symptom Manage 2011; 41:e1-2. [PMID: 21050710 DOI: 10.1016/j.jpainsymman.2010.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/21/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Timothy To
- Palliative and Supportive Services, Flinders University, Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia
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Affiliation(s)
- Hee-Jeong Choi
- Department of Family Medicine, Eulji University School of Medicine, Daejeon, Korea
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Raimundo FV, Faulhaber GAM, Menegatti PK, Marques LDS, Furlanetto TW. Effect of High- versus Low-Fat Meal on Serum 25-Hydroxyvitamin D Levels after a Single Oral Dose of Vitamin D: A Single-Blind, Parallel, Randomized Trial. Int J Endocrinol 2011; 2011:809069. [PMID: 22190928 PMCID: PMC3235461 DOI: 10.1155/2011/809069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 09/15/2011] [Accepted: 09/16/2011] [Indexed: 01/25/2023] Open
Abstract
Background/Aims. Vitamin D(3) is liposoluble, so dietary fat could increase its oral absorption. Our aim was to compare serum 25-hydroxyvitamin D [25(OH)D] after the oral intake of cholecalciferol with a high- or low-fat meal. Methods. In a single-blind, parallel clinical trial, 32 healthy physicians were divided into two groups. In the same day, they ingested 50,000 IU (1.25 mg) of vitamin D(3) with food: group 1 (G1): lipids: 25.6 g and group 2 (G2) lipids: 1.7 g. Serum 25(OH)D (0, 7, and 14 days), and parathyroid hormone (PTH), and calcium (0 and 14 days) were measured. Results. Baseline mean serum 25(OH)D levels were 42.7 ± 19.0 nmol/L in G1 and 36.4 ± 19.0 nmol/L in G2 (P = 0.38). After cholecalciferol, mean serum 25(OH)D was higher in G1 (P < 0.001): 7 days: G1 = 46.2 (38.4-53.9) nmol/L and G2 = 33.7 (25.4-40.1) nmol/L; 14 days: G1 = 53.7 (45.2-62.1) nmol/L and G2 = 33.7 (25.2-42.2) nmol/L. Serum PTH and 25(OH)D were negatively correlated before and after the intake of vitamin D(3), respectively, r = -0.42 (P = 0.02) and r = -0.52 (P = 0.003). Conclusions. A high-fat meal increased the absorption of vitamin D(3), as measured by serum 25(OH)D.
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Affiliation(s)
- Fabiana Viegas Raimundo
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 90035-003 Porto Alegre, RS, Brazil
| | | | - Paula Kalinka Menegatti
- Serviço de Medicina Interna, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350/700, 90035-903 Porto Alegre, RS, Brazil
| | - Leonardo da Silva Marques
- Serviço de Medicina Interna, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350/700, 90035-903 Porto Alegre, RS, Brazil
| | - Tania Weber Furlanetto
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 90035-003 Porto Alegre, RS, Brazil
- Serviço de Medicina Interna, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350/700, 90035-903 Porto Alegre, RS, Brazil
- *Tania Weber Furlanetto:
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Herrmann M, Harwood T, Gaston-Parry O, Kouzios D, Wong T, Lih A, Jimenez M, Janu M, Seibel MJ. A new quantitative LC tandem mass spectrometry assay for serum 25-hydroxy vitamin D. Steroids 2010; 75:1106-12. [PMID: 20654641 DOI: 10.1016/j.steroids.2010.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 07/09/2010] [Accepted: 07/13/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND The accurate measurement of 25-hydoxy vitamin D (25OH-D) in serum has been a challenge for many years. We developed a liquid chromatography tandem mass spectrometry (LC Tandem MS) assay for the quantitative determination of 25OH-D(2) and 25OH-D(3) in serum. The new method was compared with two widely used commercially available immunoassays. METHODS Sample preparation involved protein precipitation with acetonitrile containing deuterated forms of the target species as internal standards. An API 5000 mass spectrometer coupled with a photoionization source was used for quantitation. The performance of the new LC Tandem MS assay was compared with a radioimmunoassay (RIA, Diasorin) and a chemiluminescence immunoassay (ECLIA, Roche Diagnostics), analysing serum obtained from 152 individuals. RESULTS Using 100 μl of serum, the LC Tandem MS assay had a limit of quantitation of 1.3 nmol/L for both 25OH-D(2) and 25OH-D(3) with a linear response between 1.3 and 625 nmol/L and accuracy of between 95 and 124%. Intra- and inter-assay precision were ≤7% and ≤4%, respectively. Measurement of 25OH-D levels in 152 serum samples gave run averages of 71, 56 and 62 nmol/L for LC Tandem MS, ECLIA and RIA, respectively. Correlations between the various methods were: LC Tandem MS vs. RIA: r=0.931; LC Tandem MS vs. ECLIA: r=0.784; RIA vs. ECLIA: r=0.787. The LC Tandem MS method had a positive proportional bias of 26% over the RIA, whereas the ECLIA showed variable differences. CONCLUSION The new LC Tandem MS assay is accurate and precise at physiologically relevant 25OH-D concentrations, and compares favourably with the RIA. In contrast, the ECLIA shows variable bias with the other assays tested.
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Affiliation(s)
- Markus Herrmann
- Bone Research Program, ANZAC Research Institute, The University of Sydney, Sydney, Australia.
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2010; 17:568-80. [PMID: 21030841 DOI: 10.1097/med.0b013e328341311d] [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: 11/25/2022]
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