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Yu Y, Qiu J, Chuan F, Feng Z, Long J, Zhou B. The Ca∗Cl/P Ratio: A Novel and More Appropriate Screening Tool for Normocalcaemic or Overt Primary Hyperparathyroidism. Endocr Pract 2024; 30:231-238. [PMID: 38086525 DOI: 10.1016/j.eprac.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE The main purpose of this study was to explore the diagnostic performance of the Ca∗Cl/P ratio for primary hyperparathyroidism (PHPT), especially normocalcaemic PHPT (NPHPT), to assist health care providers in making reliable and rapid clinical identifications. METHODS From January 1, 2013, to March 31, 2023, 230 PHPT patients, including 65 with NPHPT and 230 sex- and age-matched controls, were enrolled in this retrospective study. Differences between hypercalcaemic PHPT (HPHPT) and NPHPT and between them and their respective controls were analyzed. The diagnostic accuracy of the Ca∗Cl/P ratio, Ca/P ratio, Cl/P ratio and albumin-corrected calcium was assessed by the area under the receiver operating characteristic curve. RESULTS Compared with corresponding controls, NPHPT and HPHPT patients both had significantly higher Ca ∗ Cl/P ratios (271.64 ± 51.74 vs 192.71 ± 26; 419.91 ± 139.11 vs 199.14 ± 36.75, P < .001). In the overall cohort, the ROC-AUC of the Ca∗Cl/P ratio (0.964, 95% CI = 0.943-0.979) for diagnosis of PHPT patients was superior to albumin-corrected calcium (0.959, 95% CI = 0.934-0.973), the Ca/P ratio (0.956, 95% CI = 0.934-0.973), and the Cl/P ratio (0.923, 95% CI = 0.895-0.946). A Ca ∗ Cl/P ratio above 239.17 mmol/L, with sensitivity (0.952), specificity (0.922), PPV (0.924), NPV (0.951) and accuracy (0.937), can distinguish PHPT patients from healthy individuals. Furthermore, the Ca ∗ Cl/P ratio yielded a sensitivity of 0.831, specificity of 0.938, PPV of 0.931, NPV of 0.847 and accuracy of 0.885 for NPHPT. CONCLUSION The Ca∗Cl/P ratio provides excellent diagnostic power for diagnosis of PHPT, especially NPHPT.
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Affiliation(s)
- Yanling Yu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingwen Qiu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fengning Chuan
- Department of Endocrinology, Chongqing University Fuling Hospital, Chongqing, China
| | - Zhengping Feng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Long
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Cavalcante LBCP, Brandão CMÁ, Chiamolera MI, Biscolla RPM, Junior JVL, de Sá Tavares Russo P, Morgado JPM, de Francischi Ferrer CMA, Vieira JGH. Big data-based parathyroid hormone (PTH) values emphasize need for age correction. J Endocrinol Invest 2023; 46:2525-2533. [PMID: 37286864 PMCID: PMC10632255 DOI: 10.1007/s40618-023-02107-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/30/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE We aimed to study the relationship between aging and increased parathyroid hormone (PTH) values. METHODS We performed a retrospective cross-sectional study with data from patients who underwent outpatient PTH measurements performed by a second-generation electrochemiluminescence immunoassay. We included patients over 18 years of age with simultaneous PTH, calcium, and creatinine measurements and 25-OHD measured within 30 days. Patients with glomerular filtration rate < 60 mL/min/1.73 m2, altered calcemia, 25-OHD level < 20 ng/mL, PTH values > 100 pg/mL or using lithium, furosemide or antiresorptive therapy were excluded. Statistical analyses were performed using the RefineR method. RESULTS Our sample comprised 263,242 patients for the group with 25-OHD ≥ 20 ng/mL, that included 160,660 with 25-OHD ≥ 30 ng/mL. The difference in PTH values among age groups divided by decades was statistically significant (p < 0.0001), regardless of 25-OHD values, ≥ 20 or ≥ 30 ng/mL. In the group with 25-OHD ≥ 20 ng/mL and more than 60 years, the PTH values were 22.1-84.0 pg/mL, a different upper reference limit from the reference value recommended by the kit manufacturer. CONCLUSION We observed a correlation between aging and PTH increase, when measured by a second-generation immunoassay, regardless of vitamin D levels, if greater than 20 ng/mL, in normocalcemic individuals without renal dysfunction.
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Affiliation(s)
- L B C P Cavalcante
- Fleury Group, Rua Mato Grosso, 306, cj 408, Higienópolis, São Paulo, SP, 01239-040, Brazil.
| | - C M Á Brandão
- Fleury Group, Rua Mato Grosso, 306, cj 408, Higienópolis, São Paulo, SP, 01239-040, Brazil
| | - M I Chiamolera
- Fleury Group, Rua Mato Grosso, 306, cj 408, Higienópolis, São Paulo, SP, 01239-040, Brazil
| | - R P M Biscolla
- Fleury Group, Rua Mato Grosso, 306, cj 408, Higienópolis, São Paulo, SP, 01239-040, Brazil
| | - J V L Junior
- Fleury Group, Rua Mato Grosso, 306, cj 408, Higienópolis, São Paulo, SP, 01239-040, Brazil
| | - P de Sá Tavares Russo
- Fleury Group, Rua Mato Grosso, 306, cj 408, Higienópolis, São Paulo, SP, 01239-040, Brazil
| | - J P M Morgado
- Fleury Group, Rua Mato Grosso, 306, cj 408, Higienópolis, São Paulo, SP, 01239-040, Brazil
| | | | - J G H Vieira
- Fleury Group, Rua Mato Grosso, 306, cj 408, Higienópolis, São Paulo, SP, 01239-040, Brazil
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Saha M, Deb A, Sultan I, Paul S, Ahmed J, Saha G. Leveraging machine learning to evaluate factors influencing vitamin D insufficiency in SLE patients: A case study from southern Bangladesh. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002475. [PMID: 37906537 PMCID: PMC10617712 DOI: 10.1371/journal.pgph.0002475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/07/2023] [Indexed: 11/02/2023]
Abstract
Vitamin D insufficiency appears to be prevalent in SLE patients. Multiple factors potentially contribute to lower vitamin D levels, including limited sun exposure, the use of sunscreen, darker skin complexion, aging, obesity, specific medical conditions, and certain medications. The study aims to assess the risk factors associated with low vitamin D levels in SLE patients in the southern part of Bangladesh, a region noted for a high prevalence of SLE. The research additionally investigates the possible correlation between vitamin D and the SLEDAI score, seeking to understand the potential benefits of vitamin D in enhancing disease outcomes for SLE patients. The study incorporates a dataset consisting of 50 patients from the southern part of Bangladesh and evaluates their clinical and demographic data. An initial exploratory data analysis is conducted to gain insights into the data, which includes calculating means and standard deviations, performing correlation analysis, and generating heat maps. Relevant inferential statistical tests, such as the Student's t-test, are also employed. In the machine learning part of the analysis, this study utilizes supervised learning algorithms, specifically Linear Regression (LR) and Random Forest (RF). To optimize the hyperparameters of the RF model and mitigate the risk of overfitting given the small dataset, a 3-Fold cross-validation strategy is implemented. The study also calculates bootstrapped confidence intervals to provide robust uncertainty estimates and further validate the approach. A comprehensive feature importance analysis is carried out using RF feature importance, permutation-based feature importance, and SHAP values. The LR model yields an RMSE of 4.83 (CI: 2.70, 6.76) and MAE of 3.86 (CI: 2.06, 5.86), whereas the RF model achieves better results, with an RMSE of 2.98 (CI: 2.16, 3.76) and MAE of 2.68 (CI: 1.83,3.52). Both models identify Hb, CRP, ESR, and age as significant contributors to vitamin D level predictions. Despite the lack of a significant association between SLEDAI and vitamin D in the statistical analysis, the machine learning models suggest a potential nonlinear dependency of vitamin D on SLEDAI. These findings highlight the importance of these factors in managing vitamin D levels in SLE patients. The study concludes that there is a high prevalence of vitamin D insufficiency in SLE patients. Although a direct linear correlation between the SLEDAI score and vitamin D levels is not observed, machine learning models suggest the possibility of a nonlinear relationship. Furthermore, factors such as Hb, CRP, ESR, and age are identified as more significant in predicting vitamin D levels. Thus, the study suggests that monitoring these factors may be advantageous in managing vitamin D levels in SLE patients. Given the immunological nature of SLE, the potential role of vitamin D in SLE disease activity could be substantial. Therefore, it underscores the need for further large-scale studies to corroborate this hypothesis.
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Affiliation(s)
- Mrinal Saha
- Department of Medicine, Chattogram Medical College, Chattogram, Bangladesh
| | - Aparna Deb
- Department of Medicine, Chattogram Medical College, Chattogram, Bangladesh
| | - Imtiaz Sultan
- Department of Medicine, Chattogram Medical College, Chattogram, Bangladesh
| | - Sujat Paul
- Department of Medicine, Chattogram Medical College, Chattogram, Bangladesh
| | - Jishan Ahmed
- Department of Mathematics, University of Barisal, Barisal, Bangladesh
| | - Goutam Saha
- Department of Mathematics, University of Dhaka, Dhaka, Bangladesh
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Hu Y, Li S, Wang J, Zheng D, Zhang H, Yu W, Zhu L, Liu Z, Yang X, Yang L. Threshold for Relationship between Vitamin D and Parathyroid Hormone in Chinese Women of Childbearing Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13060. [PMID: 34948669 PMCID: PMC8702147 DOI: 10.3390/ijerph182413060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022]
Abstract
Background: The aim of this study was to assess the relationship between serum 25-hydroxyvitamin D [25(OH)D] and serum intact parathyroid hormone (PTH) in Chinese childbearing women, and to estimate the optimum threshold of 25(OH)D that maximally inhibits the PTH, which is considered to be the optimal status for vitamin D sufficiency. Methods: Serum samples were selected from the biological samples' bank of the Chinese Chronic Diseases and Nutrition Survey (CCDNS) 2015. The serum 25(OH)D concentration was determined by liquid chromatography tandem mass spectrometry and the serum PTH was determined by electronic chemiluminescence. Simple linear and partial correlation analysis, locally weighted regression smooth scatterplot (LOESS), nonlinear least squares estimation (NLS), and segmented regression (SR) were utilized to estimate the relationship of 25(OH)D and PTH, and to determine the threshold of 25(OH)D. Results: A total of 1568 serum samples of 25(OH)D concentration and PTH concentration were analyzed. A significant inverse relationship between 25(OH)D and PTH concentration was observed below 15.25 (14.22-16.28) ng/mL, and PTH decreased slowly with the increase of 25(OH)D above 16.75 (15.43-18.06) ng/mL after adjusting by age, latitude, city type, season, corrected calcium, and phosphorus. A very short plateau of PTH was found at 15.25 ng/mL and 16.75 ng/mL in terms of 25(OH)D according to LOESS, NLS, and SR. Conclusions: The serum 25(OH)D was negatively correlated with the serum PTH. The threshold of VitD sufficiency was found in the range of 14.22-18.06 ng/mL in terms of serum 25(OH)D concentration for Chinese childbearing women aged 18-44 years old.
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Affiliation(s)
- Yichun Hu
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Siran Li
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Jun Wang
- Physical and Chemical Laboratory, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China; (J.W.); (W.Y.); (L.Z.)
| | - Deqiang Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China;
| | - Huidi Zhang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Wei Yu
- Physical and Chemical Laboratory, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China; (J.W.); (W.Y.); (L.Z.)
| | - Lijia Zhu
- Physical and Chemical Laboratory, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China; (J.W.); (W.Y.); (L.Z.)
| | - Zhen Liu
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Xiaoguang Yang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Lichen Yang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
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Association of serum 25-hydroxyvitamin D concentration with anthropometric measures in children and adolescents: the CASPIAN-V study. Eat Weight Disord 2021; 26:2219-2226. [PMID: 33247367 DOI: 10.1007/s40519-020-01067-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Serum 25-hydroxyvitamin D (25(OH)D) concentrations reflect vitamin D status, with deficiency implicated as an underlying factor for many adverse health effects. This study aims to analyze the association between vitamin D status and different anthropometric measures in a large pediatric population. METHODS This nationwide cross-sectional study was conducted in 2019 in blood samples obtained from school students of 30 provinces in Iran. Participants were 2596 children and adolescents aged 7-18 years. Weight, height, waist circumference (WC), hip circumference (HC), neck circumference (NC), and wrist circumference (WrC) were measured. Body mass index (BMI) and waist-to-height ratio (W/HtR) were calculated. Serum 25(OH)D concentrations were measured using chemiluminescent immunoassay. RESULTS Participants consisted of 55% boys, 71.3% urban inhabitants, with a mean (SD) age of 12.1 (3.0) years. Overall, vitamin D deficiency was documented in 10.6% of participants, insufficiency in 60.4%, and sufficiency in 29% of the population studied. The mean of BMI and WC was higher in the vitamin D deficient than in the vitamin D sufficient group (19.31 kg/m2 and 69.24 cm vs. 18.34 kg/m2 and 65.73 cm, respectively, P < 0.01). Multivariate linear regression models revealed a significant association of vitamin D insufficiency with WC and W/HtR (P < 0.05). Likewise, in the multivariate regression models, vitamin D deficiency was associated with BMI, WC, and W/HtR (P < 0.05). CONCLUSION Our findings on the inverse association between vitamin D status and some anthropometric measures underscore the importance of providing vitamin D by fortification and supplementation programs of vitamin D for the pediatric population. LEVEL OF EVIDENCE V.
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Živanović J, Jarić I, Ajdžanović V, Miler M, Stanković S, Milošević V, Filipović B. Genistein regulates calcium and phosphate homeostasis without activation of MEK 1/2 signalling pathway in an animal model of the andropause. Ann Anat 2021; 239:151836. [PMID: 34563672 DOI: 10.1016/j.aanat.2021.151836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023]
Abstract
Soy isoflavone genistein interplays with numerous physiological or pathophysiological processes during ageing. However, its protective role and underlying mechanisms of action in the regulation of calcium (Ca2+) and phosphate (Pi) homeostasis in an animal model of the andropause are yet to be fully clarified. Wistar male rats (16-month-old) were divided into sham-operated, orchidectomized, orchidectomized estradiol-treated (0.625 mg/kg b.m./day) and orchidectomized genistein-treated (30 mg/kg b.m./day) groups. Treatments were administered subcutaneously for 3 weeks, while the controls received vehicle alone. Estradiol treatment increased the expression level of fibroblast growth factor receptor (FGFR) and parathyroid hormone 1 receptor (PTH1R), and activated mitogen - activated protein kinase kinase 1/2 (MEK 1/2) signaling pathway in the kidneys. Genistein application induced a prominent gene and protein expression of Klotho and downregulated the expression of FGFR and PTH1R in the kidney of andropausal rats. Activation of protein kinase B (Akt) signalling pathway was observed, while MEK 1/2 signaling pathway wasn't altered after genistein treatment. The increase of 25 (OH) vitamin D in the serum and decrease in Ca2+ urine content was observed after genistein application. Our findings strongly suggest genistein as a potent biocompound with beneficial effects on the regulation of Ca2+ and Pi homeostasis, especially during aging process when the balance of mineral metabolism is impaired. These novel data provide closer insights into the physiological roles of genistein in the regulation of mineral homeostasis.
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Affiliation(s)
- Jasmina Živanović
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia.
| | - Ivana Jarić
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia; Animal Welfare Division, Vetsuisse, University of Bern, Bern, Switzerland
| | - Vladimir Ajdžanović
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Marko Miler
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Sanja Stanković
- Center for Medical Biochemistry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Verica Milošević
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Branko Filipović
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
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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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Chakhtoura M, Chamoun N, Rahme M, Fuleihan GEH. Impact of vitamin D supplementation on falls and fractures-A critical appraisal of the quality of the evidence and an overview of the available guidelines. Bone 2020; 131:115112. [PMID: 31676406 DOI: 10.1016/j.bone.2019.115112] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The beneficial effect of vitamin D supplementation on musculo-skeletal outcomes have been recently questioned and recommendations regarding supplementation vary widely. The aim of this paper is to systematically assess the quality of the evidence evaluating the effect of vitamin D supplementation on falls and fractures. METHODS We conducted a systematic search in Medline, PubMed, and Embase and selected systematic reviews (SRs) / meta-analyses (MAs) of randomized controlled trials (RCTs) on vitamin D supplementation and falls or fracture, published between 2012 - 2018. We identified 5 MAs of RCTs on falls, 4 on fractures and 4 on both outcomes. We applied the critical appraisal tool "A MeaSurement Tool to Assess systematic Reviews 2" - AMSTAR 2 - to assess the quality of the identified MAs. RESULTS Vitamin D and calcium supplementation (CaD), compared to calcium only or placebo, may reduce the risk of falls, in institutionalized individuals and/or those from the community, but the data is inconsistent. The largest and most consistent evidence for a protective effect of CaD, compared to placebo or control, is in reducing the risk of hip fracture, by 16-33%, and any fracture, by 5-19%. This effect was demonstrated when combining trials in community-dwelling and institutionalized individuals, potentially driven by data from institutionalized individuals as shown in 3 SRs/MAs. Major limitations to the quality of the evidence include variability in the methodology of MAs, but more importantly, differences between trials in terms of subjects' characteristics, vitamin D regimens, outcome definition and ascertainment, risk of bias, trial duration and/or low power. The quality of the included MAs was moderate to critically low. CONCLUSIONS While the effect on falls is inconsistent, CaD reduces the risk of fracture (hip and any fracture), as shown in meta-analyses pooling data of studies combining institutionalized and community individuals. The evidence is however limited by major shortcomings and heterogeneity.
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Affiliation(s)
- Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box: 113, 6044/C8, Beirut, Lebanon.
| | - Nariman Chamoun
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box: 113, 6044/C8, Beirut, Lebanon
| | - Maya Rahme
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box: 113, 6044/C8, Beirut, Lebanon
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, P.O. Box: 113, 6044/C8, Beirut, Lebanon
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Jiang Y, Liao L, Li J, Wang L, Xie Z. Older Age Is Associated with Decreased Levels of VDR, CYP27B1, and CYP24A1 and Increased Levels of PTH in Human Parathyroid Glands. Int J Endocrinol 2020; 2020:7257913. [PMID: 32351560 PMCID: PMC7171617 DOI: 10.1155/2020/7257913] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/25/2019] [Accepted: 01/04/2020] [Indexed: 01/09/2023] Open
Abstract
Parathyroid glands contain the vitamin D receptor (VDR) and 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1) and 24-hydroxylase (CYP24A1), which catalyze the production and degradation of 1,25-dihydroxyvitamin D [1,25(OH)2D], respectively. Previous studies have shown that the serum level of intact parathyroid hormone (iPTH) increases with age. We hypothesized that the expression of CYP27B1 or VDR in parathyroid glands decreases with age, which might account for the increased serum levels of iPTH due to decreased suppression of parathyroid hormone (PTH) secretion by 1,25(OH)2D in older people. To test this hypothesis, we examined relative expression levels of VDR, CYP27B1, CYP24A1, and PTH in specimens from parathyroid glands unintentionally removed during thyroidectomy for 70 patients varying in age from 10 to 70 years. The results showed that there was an inverse correlation between age and VDR, CYP27B1, and CYP24A1 expression (p < 0.05). A significant positive correlation between PTH expression levels and age was also observed (p < 0.05). These data indicate that older age is associated with decreased levels of VDR, CYP27B1, and CYP24A1 and increased levels of PTH in human parathyroid glands.
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Affiliation(s)
- Yi Jiang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liyan Liao
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jina Li
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Larry Wang
- Department of Pathology, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA 90027, USA
| | - Zhongjian Xie
- Department of Metabolism and Endocrinology, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha 410011, Hunan, China
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Gannagé-Yared MH, Kallas-Chémaly MN, Sleilaty G. Parathormone Levels in a Middle-Eastern Healthy Population Using 2 nd and 3 rd Generation PTH Assays. Int J Endocrinol 2020; 2020:6302861. [PMID: 32148490 PMCID: PMC7054794 DOI: 10.1155/2020/6302861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/15/2019] [Accepted: 01/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The purpose of the current study is to determine PTH reference values in vitamin-D-replete Lebanese adults using 2nd and 3rd generation PTH assays and to look at the factors that affect PTH variations. METHODS Fasting PTH was measured using 2nd and 3rd generation Diasorin PTH assays in 339 vitamin-D-replete healthy subjects aged 18 to 63 years (230 men and 109 women) who have normal calcium levels and an eGFR ≥60 ml/mn. 25-OH vitamin D (25(OH)D) was measured using the Diasorin assay. RESULTS For the 2nd PTH generation, median (IQR) levels were 48.9 (34.9-66.0) pg/ml, and its 2.5th-97.5th percentile values were 19.7-110.5 pg/ml for 25(OH)D values between 20 and 30 ng/ml, and 19.7-110.7 pg/ml for 25(OH)D values ≥30 ng/ml. For the 3rd PTH generation, the median (IQR) values were 23.9 (17.7-30.5) pg/ml, and its 2.5th-97.5th percentile values were, respectively, 9.2 and 50.2 pg/ml for 25(OH)D values between 20 and 30 ng/ml, and 8.4 and 45.4 pg/ml for 25(OH)D values ≥30 ng/ml. The median (IQR) serum 25(OH)D levels were 27.5 (23.8-32.7) ng/ml. 2nd and 3rd generation PTH values are strongly correlated (r = 0.96, p < 0.0001), but poorly concordant (Lin's concordance coefficient 0.365, 95% CI: 0.328-0.401) with observations beyond the 95% Bland-Altman limits of agreement. 2nd and 3rd generation PTH levels did not differ according to gender and were significantly correlated with age but not with 25(OH)D and serum calcium levels. CONCLUSION Lebanese adult healthy subjects have higher 2nd and 3rd generation PTH levels compared with the reference range provided by the manufacturer. The reference range was not influenced by changing the 25(OH)D cutoff. The clinical significance of the higher PTH levels in our population should be investigated.
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Affiliation(s)
| | | | - Ghassan Sleilaty
- Department of Biostatistics, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Clinical Research Center, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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11
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Abstract
Although first discovered in 1931, vitamin D has seen an increased interest in the scientific community over the past decades, including the dermatology field. Vitamin D promotes calcium and phosphorus absorption; however, the actions of vitamin D are not confined to bone. Indeed, there is now overwhelming and compelling scientific data that vitamin D plays a crucial role in a plethora of cellular function and in extra-skeletal health. Except for fatty fish livers, very few foods naturally contain vitamin D; and the major source of vitamin D comes from skin exposure to sunlight via ultraviolet B. Keratinocytes are unique in the body as not only do they provide the primary source of vitamin D for the body, but they also possess both the enzymatic machinery to metabolize the vitamin D produced to active metabolites. This has been referred to as the photoendocrine vitamin D system. Vitamin D regulates keratinocytes proliferation and differentiation; and plays a role in the defense against opportunistic infections. Multiple factors are linked to vitamin D status; and a growing number of dermatologic diseases has been linked to vitamin D status such as atopic dermatitis, psoriasis, vitiligo, and cutaneous cancers. In this article, we reviewed the potential determinants of vitamin D status, as its implications in dermatologic diseases.
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Affiliation(s)
- Christina Bergqvist
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Université Paris-Est Créteil, Créteil, France
| | - Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Université Paris-Est Créteil, Créteil, France - .,EA 7379 EpidermE, Université Paris-Est Créteil, Créteil, France
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12
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Lips P, Cashman KD, Lamberg-Allardt C, Bischoff-Ferrari HA, Obermayer-Pietsch B, Bianchi ML, Stepan J, El-Hajj Fuleihan G, Bouillon R. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol 2019; 180:P23-P54. [PMID: 30721133 DOI: 10.1530/eje-18-0736] [Citation(s) in RCA: 368] [Impact Index Per Article: 73.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) <50 nmol/L or 20 ng/mL) is common in Europe and the Middle East. It occurs in <20% of the population in Northern Europe, in 30-60% in Western, Southern and Eastern Europe and up to 80% in Middle East countries. Severe deficiency (serum 25(OH)D <30 nmol/L or 12 ng/mL) is found in >10% of Europeans. The European Calcified Tissue Society (ECTS) advises that the measurement of serum 25(OH)D be standardized, for example, by the Vitamin D Standardization Program. Risk groups include young children, adolescents, pregnant women, older people (especially the institutionalized) and non-Western immigrants. Consequences of vitamin D deficiency include mineralization defects and lower bone mineral density causing fractures. Extra-skeletal consequences may be muscle weakness, falls and acute respiratory infection, and are the subject of large ongoing clinical trials. The ECTS advises to improve vitamin D status by food fortification and the use of vitamin D supplements in risk groups. Fortification of foods by adding vitamin D to dairy products, bread and cereals can improve the vitamin D status of the whole population, but quality assurance monitoring is needed to prevent intoxication. Specific risk groups such as infants and children up to 3 years, pregnant women, older persons and non-Western immigrants should routinely receive vitamin D supplements. Future research should include genetic studies to better define individual vulnerability for vitamin D deficiency, and Mendelian randomization studies to address the effect of vitamin D deficiency on long-term non-skeletal outcomes such as cancer.
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Affiliation(s)
- Paul Lips
- Endocrine Section, Department of Internal Medicine, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, Department of Medicine, University College Cork, Cork, Ireland
| | - Christel Lamberg-Allardt
- Calcium Research Unit, Department of Food and Nutritional Sciences, University of Helsinki, Helsinki, Finland
| | | | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Jan Stepan
- Institute of Rheumatology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roger Bouillon
- Clinic and Laboratory of Endocrinology, Gasthuisberg, KU Leuven, Leuven, Belgium
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Havens PL, Long D, Schuster GU, Gordon CM, Price G, Wilson CM, Kapogiannis BG, Mulligan K, Stephensen CB. Tenofovir disoproxil fumarate appears to disrupt the relationship of vitamin D and parathyroid hormone. Antivir Ther 2018; 23:623-628. [PMID: 30260797 DOI: 10.3851/imp3269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) increases serum parathyroid hormone (PTH) and 1,25 dihydroxy vitamin D (1,25-(OH)2D), and decreases bone mineral density (BMD). Optimal treatment of TDF-associated BMD loss requires an understanding of the primary cause of these abnormalities. METHODS Secondary review of data from two studies of TDF use in youth, comparing the relationship of PTH, 25-hydroxy vitamin D (25-OHD) and 1,25-(OH)2D in three groups with varying exposures to TDF: youth without HIV enrolled in a trial of TDF/emtricitabine (FTC) for HIV pre-exposure prophylaxis (PrEP) at baseline (no TDF exposure) and after 12 weeks of TDF (short-term TDF exposure); and youth with HIV treated with TDF-containing combination antiretroviral therapy (cART) for at least 6 months at study entry (long-term TDF exposure). Relationships were evaluated by correlation analyses. RESULTS Participants ranged in age from 17 to 24 years and >50% were Black/African American. In persons not treated with TDF, PTH had the physiologically appropriate negative correlation with 25-OHD (r=-0.3504, P=0.004). Correlations between PTH and 25-OHD in groups treated with TDF were weaker or absent. With longer term TDF treatment in persons with HIV, 25-OHD and 1,25-(OH)2D had the positive correlation similar to that found in vitamin D deficiency. CONCLUSIONS TDF changes the relationship of 25-OHD to PTH, suggesting that in persons using TDF for PrEP or cART, a higher than usual target for serum 25-OHD concentration might be needed to reduce PTH and optimize bone health. CLINICAL TRIALS REGISTRATION NCT01751646 (ATN 109) and NCT01769469 (ATN 117).
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Affiliation(s)
- Peter L Havens
- Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Dustin Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Catherine M Gordon
- Department of Pediatrics, University of Cincinnati College of Medicine/Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Craig M Wilson
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bill G Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Kathleen Mulligan
- Department of Medicine, Division of Endocrinology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Charles B Stephensen
- USDA, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, USA
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Dixit V, Tripathi RL, Dhanwal DK. All 25-hydroxyvitamin D-deficient Indian postmenopausal women do not have secondary hyperparathyroidism. Arch Osteoporos 2018; 13:62. [PMID: 29806069 DOI: 10.1007/s11657-018-0465-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/27/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study shows a high 25-hydroxyvitamin D deficiency among postmenopausal women accompanying secondary hyperparathyroidism. However, a sizable number of subjects did not have secondary hyperparathyroidism despite having low 25-hydroxyvitamin D levels. This condition arises a research question in clinical practice needed to be addressed in the future. PURPOSE The present study was attempted to determine the prevalence of secondary hyperparathyroidism and also to analyze the mean value (cutoff) of 25-hydroxyvitamin D from where the PTH begins to rise in Indian postmenopausal women. METHODS A cross-sectional study including 334 postmenopausal women attending the outpatient department (MOPD) of Lok Nayak Hospital, New Delhi, between July 2008 and June 2010. Institutional ethical approval was obtained for this study. The apparently healthy postmenopausal women and attendees of the patients were included in the study. Post-thyroidectomy, thyroid illness, pregnant women, subjects taking drugs that can affect bone mineral metabolism, such as glucocorticoids, antitubercular therapy, antiepileptic, and 25-hydroxyvitamin D supplement were excluded from the study. BMD parameters such as PTH and 25(OH)D were measured by using commercial kits from DiaSorin, USA, and blood chemistry was evaluated by standard methods from the central facility of the center. Dietary calcium was analyzed by applying a food frequency questionnaire by a trained dietician. RESULTS Mean (SD) age of the subjects was 56.4 ± 7.7 years. The mean BMI was 24.7 ± 5.5 kg/m2. The baseline biochemical investigations such as total bilirubin, liver function test (LFT), kidney function test (KFT), calcium, phosphorous, total protein, and serum albumin were in reference range except alkaline phosphatase (ALP). The mean values of 25(OH)D and PTH were 12.95 ± 8.08 ng/ml and 91.60 ± 75.56 pg/ml respectively. The 24-h dietary calcium intake was 487.06 ± 239.36 mg/24 h. 25-hydroxyvitamin D deficiency was found in 277 subjects (82.93%) and was inversely related to PTH. Forty-three subjects had 25-hydroxyvitamin D levels between 20 and 29 ng/ml (12.87%), and only 14 subjects (4.19%) had optimum 25-hydroxyvitamin D levels. Secondary hyperparathyroidism was found in 235 (70.35%) subjects; however, it was not found in 30%. CONCLUSIONS Majority of postmenopausal women of India had 25-hydroxyvitamin D deficiency with raised PTH levels. The cutoff point of 25-hydroxyvitamin D at which PTH began to rise was found at 25 ng/ml which seems similar to that of the Caucasians.
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Affiliation(s)
- Vivek Dixit
- Department of Medicine, Division of Endocrinology and Metabolism, Maulana Azad Medical College, New Delhi, India
| | - R L Tripathi
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
| | - Dinesh Kumar Dhanwal
- Department of Medicine, Division of Endocrinology and Metabolism, Maulana Azad Medical College, New Delhi, India.
- NMC Specialty Hospital, Abu Dhabi, United Arab Emirates.
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Ismail TST, Muda BC, Rosdi RAM, Zainuddin A, Isa S, Mustapaha Z. Determining the Required Vitamin D Level for Bone Health Based on Bone Turnover Markers. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2017. [DOI: 10.15324/kjcls.2017.49.4.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tuan Salwani Tuan Ismail
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Bayani Che Muda
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Roznie Aida Mohd Rosdi
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Azalina Zainuddin
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Salbiah Isa
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Zulkarnain Mustapaha
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Soares LM, Pedrosa W, Elói-Santos SM, Vasconcellos LS. 25-Hydroxyvitamin D threshold values should be age-specific. Clin Chem Lab Med 2017; 55:e140-e142. [PMID: 27831917 DOI: 10.1515/cclm-2016-0798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/07/2016] [Indexed: 11/15/2022]
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17
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Sheriba NA, Elewa AAA, Mahdy MM, Bahaa El Din AM, Ibrahim NA, Marawan DA, Abd El Moneim TM. Effect of vitamin D3 in treating hyperthyroidism in patients with graves’ disease. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/ejim.ejim_10_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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18
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Buchebner D, Malmgren L, Christensson A, McGuigan F, Gerdhem P, Ridderstråle M, Åkesson K. Longitudinal Assessment of PTH in Community-Dwelling Older Women-Elevations Are Not Associated With Mortality. J Endocr Soc 2017; 1:615-624. [PMID: 29264515 PMCID: PMC5686779 DOI: 10.1210/js.2017-00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/14/2017] [Indexed: 12/23/2022] Open
Abstract
Context: In older women, the magnitude of elevated parathyroid hormone (PTH) and its consequence is unclear. Objective: To describe normal PTH profiles over time and the association with mortality. Design and Participants: There were 1044 community-dwelling women in the Malmö Osteoporosis Prospective Risk Assessment cohort (OPRA) who attended baseline (age 75 years). Follow-ups were attended by 715 (age 80 years) and 382 (age 85 years). Main Outcome Measures: PTH, estimated glomerular filtration rate (eGFR), 25-hydroxyvitamin D (25OHD) and mortality. Results: At age 75 years, PTH levels for most (n = 877, 88%) were within the normal reference range (NRR) (i.e., <6.9 pmol/L). Longitudinally, between ages 75 and 80 years, PTH increased in 60% of all women (n = 390) but increases of up to 50% above baseline values (64%; n=250) still resulted in PTH levels within the NRR. These women had lower 25OHD levels (74 vs 83 nmol/L, P = 0.001). Only when increases were >50% was PTH elevated beyond the NRR (mean 7.1 ± 3.3). Here, a pronounced decline in eGFR (56 vs 61 mL/min/1.73 m2, P = 0.002) was found, despite no further changes in 25OHD. Extending the observational period until age 85 years gave similar results. Baseline PTH levels above NRR were associated with mortality (hazard ratio, 1.4; 95% confidence interval (CI), 1.1-1.8; P = 0.007), although not after adjustment for covariates (P = 0.082). Conclusions: Most women remained within normal PTH ranges despite large increases of up to 50%. PTH elevated above normal is not independently associated with mortality; impaired kidney function and low 25OHD status may be more prognostic in the very old.
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Affiliation(s)
- David Buchebner
- Department of Clinical Science Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Department of Orthopaedics, Skåne University Hospital, 221 00 Malmö, Sweden.,Department of Internal Medicine, Hallands Hospital Halmstad, 301 85 Halmstad, Sweden
| | - Linnea Malmgren
- Department of Clinical Science Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Department of Orthopaedics, Skåne University Hospital, 221 00 Malmö, Sweden
| | | | - Fiona McGuigan
- Department of Clinical Science Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Department of Orthopaedics, Skåne University Hospital, 221 00 Malmö, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Department of Orthopaedics, Karolinska University Hospital, 171 77 Stockholm, Sweden
| | - Martin Ridderstråle
- Department of Endocrinology, Clinical Obesity Research, Skåne University Hospital 214 28, Malmö, Sweden
| | - Kristina Åkesson
- Department of Clinical Science Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Department of Orthopaedics, Skåne University Hospital, 221 00 Malmö, Sweden
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Nikooyeh B, Abdollahi Z, Hajifaraji M, Alavi-Majd H, Salehi F, Yarparvar AH, Neyestani TR. Vitamin D Status, Latitude and their Associations with Some Health Parameters in Children: National Food and Nutrition Surveillance. J Trop Pediatr 2017; 63:57-64. [PMID: 27594396 DOI: 10.1093/tropej/fmw057] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent data indicate a role for vitamin D in many health aspects including anthropometric measures and blood lipid profiles. Dermal vitamin D synthesis may be influenced by latitude. However, the contribution of latitude in vitamin D status and its association with anthropometric and blood lipid measures in Iranian children have not been studied to date. METHODS We used data from the National Food and Nutritional Surveillance Program. In total, 667 apparently healthy children aged 5-18 years were randomly selected from six provinces of Iran with different latitudes, from 29 to 37°. Weight, height, circulating 25-hydroxycalciferol; calcidiol [25(OH)D] and blood lipids were measured. RESULTS In total, 16.7 and 4.1% of children were overweight or obese, respectively. The mean 25(OH)D concentration was 27.3 ± 17.6 nmol/l (95% confidence interval: 26.0-28.7 nmol/l). Over 93% of all children had suboptimal circulating calcidiol concentrations. Undesirable status of vitamin D, serum triglyceride and low-density lipoprotein were all more prevalent in children living in regions >33° latitude than those in <33°, significantly. There was no significant difference in duration of sun exposure between children living in latitudes below and above 33° (p = 0.093). In multivariate regression model, sex, latitude, body mass index for age z-score and sun exposure duration were independently related to 25(OH)D concentrations, but age was not. CONCLUSION Despite significant association of latitude and vitamin D status, hypovitaminosis D is prevalent across latitude gradient in Iranian children. Our findings warrant immediate sustainable nutritional intervention, including supplementation, to protect children from hypovitaminosis D irrespective of the latitude of their residence.
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Affiliation(s)
- Bahareh Nikooyeh
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 1981619573, Iran
| | - Zahra Abdollahi
- Nutrition Office, Iran Ministry of Health, Treatment and Medical Education, Tehran 1467664961, Iran
| | - Majid Hajifaraji
- Department of Nutritional Policy-Making Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 1981619573, Iran
| | - Hamid Alavi-Majd
- Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran 1971653313, Iran
| | - Forouzan Salehi
- Nutrition Office, Iran Ministry of Health, Treatment and Medical Education, Tehran 1467664961, Iran
| | | | - Tirang R Neyestani
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 1981619573, Iran
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Li M, Lv F, Zhang Z, Deng W, Li Y, Deng Z, Jiang Y, Wang O, Xing X, Xu L, Xia W. Establishment of a normal reference value of parathyroid hormone in a large healthy Chinese population and evaluation of its relation to bone turnover and bone mineral density. Osteoporos Int 2016; 27:1907-16. [PMID: 26733373 DOI: 10.1007/s00198-015-3475-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/21/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED A normal reference value of parathyroid hormone (PTH) was established for the first time in a large sample of healthy Chinese subjects by completely excluding interference of vitamin D deficiency. A high PTH level correlated significantly with an elevated bone turnover and a reduced bone mineral density (BMD). INTRODUCTION The aims of this study are to establish a normal reference value for serum PTH and to evaluate the effect of parathyroid gland status on bone turnover and BMD. METHODS Our cross-sectional study included 1436 healthy individuals from 5 different Chinese cities. Concentrations of serum PTH, 25-hydroxyvitamin D (25OHD), procollagen I N-terminal peptide (P1NP, a bone formation marker), and carboxyl-terminal telopeptide of type I collagen (β-CTX, a bone resorption marker) were measured by electrochemiluminescence immunoassay. BMD was measured by dual-energy X-ray absorptiometry. The relation of PTH concentration to age, gender, height, and weight was examined. Reference values of PTH were established for all subjects and for subjects categorized by serum 25OHD concentrations. Correlations of PTH levels with bone turnover biomarkers and BMD were statistically analyzed. RESULTS Reference values of PTH were 8.84-69.95 pg/mL in all the subjects and 7.48-60.73 and 5.83-56.78 pg/mL in the subjects with serum 25OHD concentrations of ≥20 and ≥30 ng/mL, respectively. Serum PTH showed a negative linear correlation with 25OHD, and the breakpoint was 18.21 ng/mL, below which the PTH level rapidly increased. The increase in PTH levels with age showed a positive linear correlation with P1NP and β-CTX concentrations and a negative linear correlation with BMD at the lumbar spines and the femoral neck. CONCLUSIONS A reference value of PTH was established in a large sample of healthy Chinese subjects according to 25OHD status, gender, and age. A high PTH level correlated significantly with an elevated bone turnover and a reduced BMD.
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Affiliation(s)
- M Li
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - F Lv
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Z Zhang
- Department of Osteoporosis, Sixth People's Hospital, Shanghai Jiaotong University, No. 600 Yishan Road, Shanghai, 200233, China
| | - W Deng
- Department of Geriatrics, General Hospital of Guangzhou Military Command, No. 111 Liuhua Road, Guangzhou, 510010, China
| | - Y Li
- Department of Laboratory, Hubei General Hospital, No. 238 Jiefang Road, Wuhan, 430060, China
| | - Z Deng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang road, Chongqing, 400010, China
| | - Y Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - O Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - X Xing
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - L Xu
- Department of Obstetrics and Gynecology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - W Xia
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
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Predictors of Serum 25-Hydroxyvitamin D Concentrations among a Sample of Egyptian Schoolchildren. ScientificWorldJournal 2016; 2016:8175768. [PMID: 26942211 PMCID: PMC4749821 DOI: 10.1155/2016/8175768] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/21/2015] [Accepted: 12/30/2015] [Indexed: 12/31/2022] Open
Abstract
Objective. To assess the level of 25-hydroxyvitamin D status among a sample of Egyptian schoolchildren and to evaluate predictors of deficiency and insufficiency. Subjects and Methods. A cross-sectional study comprising 200 prepubescent schoolchildren aged from 9 to 11 years was performed. A questionnaire including frequency of midday sun exposure, milk intake, physical activity, and level of maternal education was taken. Body mass index (BMI) was calculated; serum 25-hydroxyvitamin D [25(OH)D], serum calcium, phosphorus, and parathyroid hormone were measured. Results. Vitamin D deficiency [serum 25(OH)D < 20 ng/mL] was detected in 11.5% of subjects while its insufficiency (serum 25(OH)D is between 20 and 29.9 ng/mL) was detected in 15%. Results revealed that obesity, low physical activity, low sun exposure, and low maternal education level are significant predictors of insufficiency, though female gender, low maternal education level, and low milk intake are significant predictors of deficiency. Lower serum phosphorus and higher serum parathyroid hormone were significantly associated with both deficiency and insufficiency (p < 0.05). Conclusion. Vitamin D deficiency and insufficiency are common among schoolchildren in Egypt. Food fortification, vitamin D supplementation, and increasing maternal awareness about the importance of physical activity and exposure of their children to ultraviolet light may help to overcome this problem.
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Vitamin D status predicts reproductive fitness in a wild sheep population. Sci Rep 2016; 6:18986. [PMID: 26757805 PMCID: PMC4725927 DOI: 10.1038/srep18986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/02/2015] [Indexed: 01/01/2023] Open
Abstract
Vitamin D deficiency has been associated with the development of many human diseases, and with poor reproductive performance in laboratory rodents. We currently have no idea how natural selection directly acts on variation in vitamin D metabolism due to a total lack of studies in wild animals. Here, we measured serum 25 hydroxyvitamin D (25(OH)D) concentrations in female Soay sheep that were part of a long-term field study on St Kilda. We found that total 25(OH)D was strongly influenced by age, and that light coloured sheep had higher 25(OH)D3 (but not 25(OH)D2) concentrations than dark sheep. The coat colour polymorphism in Soay sheep is controlled by a single locus, suggesting vitamin D status is heritable in this population. We also observed a very strong relationship between total 25(OH)D concentrations in summer and a ewe’s fecundity the following spring. This resulted in a positive association between total 25(OH)D and the number of lambs produced that survived their first year of life, an important component of female reproductive fitness. Our study provides the first insight into naturally-occurring variation in vitamin D metabolites, and offers the first evidence that vitamin D status is both heritable and under natural selection in the wild.
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Steinach M, Kohlberg E, Maggioni MA, Mendt S, Opatz O, Stahn A, Tiedemann J, Gunga HC. Changes of 25-OH-Vitamin D during Overwintering at the German Antarctic Stations Neumayer II and III. PLoS One 2015; 10:e0144130. [PMID: 26641669 PMCID: PMC4671590 DOI: 10.1371/journal.pone.0144130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/14/2015] [Indexed: 12/31/2022] Open
Abstract
Purpose Humans in Antarctica face different environmental challenges, such as low ultra-violet radiation, which is crucial for vitamin D production in humans. Therefore we assessed changes in 25-OH-vitamin D serum concentration during 13 months of overwintering at the German Stations Neumayer II and III (2007–2012). We hypothesized that (i) 25-OH-vitamin D serum concentration would significantly decrease, (ii) changes would be affected by age, gender, baseline (i.e. pre-overwintering) fat mass, baseline 25-OH-vitamin D serum concentration, and station residence, and (iii) our results would not differ from similar previous studies in comparable high latitudes. Materials & Methods 25-OH-vitamin D serum concentrations were determined before, after, and monthly during the campaigns from venous blood samples of n = 43 participants (28 men, 15 women). Baseline fat mass was determined via bio impedance analysis and body plethysmography. Data were analyzed for change over time, dependency on independent parameters, and after categorization for sufficiency (>50nmol/l), insufficiency (25-50nmol/l), and deficiency (<25nmol/l). Results were compared with data from similar previous studies. Results We found a significant decrease of 25-OH-vitamin D with dependency on month. Age, gender, fat mass, and station residence had no influence. Only baseline 25-OH-vitamin D serum concentrations significantly affected subsequent 25-OH-vitamin D values. Conclusions Overwinterings at the Antarctic German research stations Neumayer II and III are associated with a decrease in 25-OH-vitamin D serum concentrations, unaffected by age, gender, baseline fat mass, and station residence. Higher baseline vitamin D serum concentrations might protect from subsequent deficiencies. Residence at the Neumayer Stations may lead to lower vitamin D serum concentrations than found in other comparable high latitudes.
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Affiliation(s)
- Mathias Steinach
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Eberhard Kohlberg
- Alfred Wegener Institute for Polar and Marine Research, Bremerhaven, Germany
| | - Martina Anna Maggioni
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Stefan Mendt
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Opatz
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Stahn
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Josefine Tiedemann
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hanns-Christian Gunga
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Hoteit M, Al-Shaar L, Yazbeck C, Bou Sleiman M, Ghalayini T, Fuleihan GEH. Hypovitaminosis D in a sunny country: time trends, predictors, and implications for practice guidelines. Metabolism 2014; 63:968-78. [PMID: 24874590 DOI: 10.1016/j.metabol.2014.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/14/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
The aim of the current study is to investigate the prevalence of hypovitaminosis D in Lebanese subjects, its robust predictors, evaluate the relationship between 25 hydroxy vitamin D [25(OH)D] and parathyroid hormone levels, and derive desirable vitamin D levels, based on a large hospital laboratory database spanning all age groups. Data from a large representative digitized database of 9147 subjects, mostly outpatients, evaluated between 2000-2004 and 2007-2008, in whom information on age, gender, service, and time of the year, was analyzed. The PTH-25(OH)D relationship was studied in a subset of 657 adult subjects, in whom such data were available. At a 25(OH)D cut-off of<20 ng/ml, the prevalence of hypovitaminosis D ranged between 58% and 62% in pediatric subjects, 44% and 60% in adults, and 41% and 62% in elderly, in the 2 study periods. At a cut-off <30 ng/ml, the prevalence was above 78%, in most sub-groups. Regardless of cut-off used, the only significant predictors of high mean 25(OH)D levels were the male gender in the pediatric group, and female gender in adults and elderly, summer/fall seasons, out-patient status, as well as study period. Curve fitting of the PTH-25(OH)D relationship, in adults and elderly, revealed a plateau at 25(OH)D levels of 17-21 ng/ml, depending on sub-study group. Hypovitaminosis D is prevalent in our sunny country, even using a conservative population-derived cut-off of 20 ng/ml, and thus the need for a public health strategy for supplementation.
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Affiliation(s)
- Maha Hoteit
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorder, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laila Al-Shaar
- Vascular Medicine Program, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cynthia Yazbeck
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorder, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maria Bou Sleiman
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorder, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tala Ghalayini
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorder, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorder, American University of Beirut Medical Center, Beirut, Lebanon.
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Risk factors of low vitamin D status in adolescent females in Kuwait: implications for high peak bone mass attainment. Arch Osteoporos 2014; 9:178. [PMID: 24858401 DOI: 10.1007/s11657-014-0178-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 04/07/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Risks of low vitamin D status in Kuwaiti adolescent girls are high parathyroid hormone (PTH), high waist/hip ratio, veiling and not having a private room. Low vitamin D status is likely to have a negative impact on their bone mass and accrual. INTRODUCTION Low serum 25-hydroxyvitamin D (25OHD) levels are repeatedly found in females in the Middle East, which is a cause for concern particularly for adolescent females. This is because vitamin D has been shown to promote bone mineral accrual in adolescence. PURPOSE The aim of this study was to assess the risk factors of low vitamin D status in adolescent females and to assess its impact on their bone mass. METHODS Serum 25OHD and PTH were measured in 232 females. Anthropometric measurements and skin colour were obtained. Bone measurements at the lumbar spine were performed using dual-energy x-ray absorptiometry (DXA). Data on food intake, physical activity (PA) and sun exposure were taken. Binary logistic regression was used to assess the risk factors of serum 25OHD levels <25 nmol/L and multiple linear regression was used to assess the predictors of bone mineral variables. RESULTS Median 25OHD was 19.4 nmol/L (IQR 16.4-23.68), among which 98.7 % obtained <50 nmol/L. PTH >7 pmol/L (odds ratio (OR) 4.3; 95 % CI 1.8, 10.2), not having a private room (OR 3.7; 95 % CI 1.4, 9.8), veiling (OR 2.4; 95 % CI 1.1, 5.5) and waist/hip ratio >0.75 (OR 2.1; 95 % CI 1.0, 4.3) were risk factors of low vitamin D status, whereas, height, weight, month since menarche, PTH, animal protein intake and PA were independent predictors of bone mineral content (p < 0.05). CONCLUSION Low vitamin D status is prevalent in Kuwaiti adolescent females, which may have a negative impact on their bone mineralization and accrual. Further investigation is needed to reveal the underlying causes.
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del Pozo E, Janner M, Mackenzie AR, Arampatzis S, Dixon AK, Perrelet R, Ruch W, Lippuner K, Zapf J, Lamberts SW, Mullis PE. Radiometrical, hormonal and biological correlates of skeletal growth in the female rat from birth to senescence. Growth Horm IGF Res 2014; 24:83-88. [PMID: 24735836 DOI: 10.1016/j.ghir.2014.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/22/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We investigated the skeletal growth profile of female rats from birth to senescence (100weeks) on the basis of sequential radiometrical, hormonal and biochemical parameters. DESIGN Weaning rats entered the study which was divided into two sections: a) sequential measurements of vertebral and tibial growths and bone mineral density (BMD), estimation of mineral content of the entire skeleton (BMC) and chemical analysis of vertebral Ca; and b) determination of basal and pulsatile growth hormone (rGH), insulin-like growth hormone (IGF-I), estradiol (E2), parathyroid hormone (PTH), osteocalcin (OC) and urinary d-pyridinoline (dp) throughout the experimental period. RESULTS Vertebral and tibial growths ceased at week 25 whereas BMD and BMC as well as total vertebral Ca exhibited a peak bone mass at week 40. rGH pulsatile profiles were significantly higher in younger animals coinciding with the period of active growth and IGF-I peaked at 7weeks, slowly declining thereafter and stabilizing after week 60. OC and dp closely paralleled IGF-I coinciding with the period of enhanced skeletal growth, remaining thereafter in the low range indicative of reduced bone turnover. E2 increased during reproductive life but the lower values subsequently recorded were still in the physiological range, strongly suggesting a protective role of this steroid on bone remodeling. PTH followed a similar profile to E2, but the significance of this after completion of growth remains unclear. CONCLUSIONS Mechanisms governing skeletal growth in the female rat appear similar to those in humans. Bone progression and attainment of peak bone mass are under simultaneous control of rGH, IGF-I and calciotropic hormones and are modulated by E2. This steroid seems to protect the skeleton from resorption before senescence whereas the role of PTH in this context remains uncertain.
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Affiliation(s)
- Emilio del Pozo
- Department of Osteoporosis, University Hospital, Bern, Switzerland.
| | - Marco Janner
- Division of Pediatric Endocrinology, Diabetes and Metabolism; University Children's Hospital, Bern, Switzerland
| | | | | | - Arnold K Dixon
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Romain Perrelet
- Department of Osteoporosis, University Hospital, Bern, Switzerland
| | - Walter Ruch
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Kurt Lippuner
- Department of Osteoporosis, University Hospital, Bern, Switzerland
| | - Juergen Zapf
- Department of Internal Medicine, University Hospital, Zürich, Switzerland
| | | | - Primus E Mullis
- Division of Pediatric Endocrinology, Diabetes and Metabolism; University Children's Hospital, Bern, Switzerland
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Abstract
PURPOSE OF REVIEW We propose to review several recent key clinically oriented topics related to vitamin D and health in children. RECENT FINDINGS We found a very large number of recent clinical studies related to vitamin D. However, most are association studies with few physiological or clinical trials that are adequately powered for clinical outcomes. Key results are available related to pulmonary disease and allergic disorders. Recent studies have also evaluated the relationship of vitamin D to bone health as well as new insights into genetic conditions related to vitamin D metabolism. SUMMARY Recent studies generally support the recommendations of the Institute of Medicine related to vitamin D intake but there is new and increasing evidence that some health conditions, such as pulmonary diseases in children, might benefit from close monitoring of vitamin D status. However, controlled trials are mostly lacking and there is an inadequate basis from recent studies to recommend high dose vitamin D pending the results of controlled trials.
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Affiliation(s)
- Steven A Abrams
- aUnited States Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA bPediatric Endocrinology, Rambam Healthcare Campus, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Bassil D, Rahme M, Hoteit M, Fuleihan GEH. Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes. DERMATO-ENDOCRINOLOGY 2013; 5:274-98. [PMID: 24194968 PMCID: PMC3772916 DOI: 10.4161/derm.25111] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/10/2013] [Accepted: 05/21/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Middle East and North Africa (MENA) region registers some of the highest rates of hypovitaminosis D worldwide. AIM We systematically reviewed the prevalence of hypovitaminosis D, rickets and osteomalacia, their predictors and impact on major outcomes, in the region. METHODS Medline, Pubmed and Embase search engines, entering keywords and concepts, combined with individual countries of interest, were used. Search was limited years 2000-2012; and review articles were used for the period preceding year 2000. RESULTS Rickets and osteomalacia still occur in this sunny region. Hypovitaminosis D prevails, with rates varying 30-90%, considering a desirable serum 25 hydroxy-vitamin D [25(OH)D] of 20 ng/ml. Advancing age, female gender, multi-parity, clothing style, season, socio-economic status and urban living are recognized predictors of hypovitaminosis D in adults. Prolonged breastfeeding without vitamin D supplementation and low dietary calcium intake are the recognized risk factors for rickets and hypovitaminosis D in children.. Associations with pain score and disease activity in rheumatologic disorders, viral load and interleukins in hepatitis C, BMI, lipids and insulin sensitivity, blood pressure, heart failure and mortality are described. Sun exposure in adults decreased prevalence of metabolic syndrome in one study. Few randomized vitamin D trials revealed that the majority of mothers or children failed to achieve a desirable 25(OH)D level, even with doses by far exceeding current recommendations. A trial in adolescent girls reveals substantial bone and lean mass increments. CONCLUSION Hypovitaminosis D is prevalent in MENA. The lack of populations based studies, gaps in studies in infants, pre-pubertal children and pregnant women, hinder the development of region specific guidelines and constitute a major obstacle to impact this chronic and most often subclinical disease.
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Affiliation(s)
- Darina Bassil
- Calcium Metabolism and Osteoporosis Program; WHO Collaborating Center for Metabolic Bone Disorder; Faculty of Medicine; American University of Beirut Medical Center; Beirut, Lebanon
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Abstract
Vitamin D deficiency is associated with osteoporosis and is thought to increase the risk of cancer and CVD. Despite these numerous potential health effects, data on vitamin D status at the population level and within key subgroups are limited. The aims of the present study were to examine patterns of 25-hydroxyvitamin D (25(OH)D) levels worldwide and to assess differences by age, sex and region. In a systematic literature review using the Medline and EMBASE databases, we identified 195 studies conducted in forty-four countries involving more than 168 000 participants. Mean population-level 25(OH)D values varied considerably across the studies (range 4·9-136·2 nmol/l), with 37·3 % of the studies reporting mean values below 50 nmol/l. The highest 25(OH)D values were observed in North America. Although age-related differences were observed in the Asia/Pacific and Middle East/Africa regions, they were not observed elsewhere and sex-related differences were not observed in any region. Substantial heterogeneity between the studies precluded drawing conclusions on overall vitamin D status at the population level. Exploratory analyses, however, suggested that newborns and institutionalised elderly from several regions worldwide appeared to be at a generally higher risk of exhibiting lower 25(OH)D values. Substantial details on worldwide patterns of vitamin D status at the population level and within key subgroups are needed to inform public health policy development to reduce risk for potential health consequences of an inadequate vitamin D status.
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Sharara AI, El-Halabi MM, Ghaith OA, Habib RH, Mansour NM, Malli A, El Hajj-Fuleihan G. Proton pump inhibitors have no measurable effect on calcium and bone metabolism in healthy young males: a prospective matched controlled study. Metabolism 2013; 62:518-26. [PMID: 23102518 DOI: 10.1016/j.metabol.2012.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/17/2012] [Accepted: 09/19/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Proton pump inhibitors (PPIs) are associated with an increased risk of bone fractures. This study sought to evaluate the effect of PPIs on biochemical markers of calcium and bone metabolism. METHODS Prospective matched controlled study involving healthy adult males (age 18-50years) suffering from frequent heartburn. Patients received standard-dose PPI for 12weeks and were matched by age with healthy controls. Blood studies were taken at 0, 1 and 3months for biochemical markers of mineral and bone metabolism. Two-way (time and PPI treatment) repeated measures analysis of variance (RM-ANOVA) and multiple linear regression were used for analysis. RESULTS A total of 58 participants (29 per group) completed the study. Mean age of participants was 33.2±7.5years. Baseline characteristics and biomarkers were similar for both groups except for higher BMI (28.6 vs. 25.6kg/m(2), p=0.008) and serum C-terminal cross linked telopeptides of type I collagen [CrossLaps, (300 vs. 228pg/ml, p=0.028)] in the PPI group. There was no difference in parathormone (PTH), ionized calcium, vitamin D, osteocalcin and CrossLaps between the PPI and control subjects (all non-significant; 2-way RM-ANOVA). Multiple linear regression modeling showed no effect of PPIs on any of the studied calcium or bone metabolism biomarkers. CONCLUSION PPI intake for 12weeks has no measurable effect on calcium or bone metabolism in healthy young males.
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Affiliation(s)
- Ala I Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon.
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Valcour A, Blocki F, Hawkins DM, Rao SD. Effects of age and serum 25-OH-vitamin D on serum parathyroid hormone levels. J Clin Endocrinol Metab 2012; 97:3989-95. [PMID: 22933544 DOI: 10.1210/jc.2012-2276] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Several studies define optimal serum 25-hydroxyvitamin D (25-OHD) levels based on serum PTH level reaching an asymptote. However, results differ widely, ranging from 25-OHD levels of 12-44 ng/ml: many studies are constrained by small sample size. OBJECTIVE The objective of the study was to determine the relationship between serum PTH and 25-OHD levels and age in a very large reference laboratory database. DESIGN This was a detailed cross-sectional analysis of 312,962 paired serum PTH and 25-OHD levels measured from July 2010 to June 2011. RESULTS Median PTH levels and the proportion of patients (PTH > 65 pg/ml), from 63 successive 25-OHD frequency classes of 5000 patients, provide smooth, exceptionally well-fitted curves (R(2) = 0.994 and R(2) = 0.995, respectively) without discernible inflection points or asymptotes but with striking age dependencies. Serum 25-OHD was below the recent Institute of Medicine sufficiency guidance of 20 ng/ml in 27% (85,000) of the subjects. More importantly, 40 and 51% of subjects (serum 25-OHD <20 and 10 ng/ml, respectively) had biochemical hyperparathyroidism (PTH > 65 pg/ml). CONCLUSIONS This analysis, despite inevitable inherent limitations, introduces several clinical implications. First, median 25-OHD-dependent PTH levels revealed no threshold above which increasing 25-OHD fails to further suppress PTH. Second, the large number of subjects with 25-OHD deficiency and hyperparathyroidism reinforces the Third International Workshop on Asymptomatic Primary Hyper parathyroidism's recommendations to test for, and replete, vitamin D depletion before considering parathyroidectomy. Third, strong age dependency of the PTH-25-OHD relationship likely reflects the composite effects of age-related decline in calcium absorption and renal function. Finally, this unselected large population database study could guide clinical management of patients based on an age-dependent, PTH-25-OHD continuum.
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Affiliation(s)
- A Valcour
- Diasorin, 1951 Northwestern Avenue, Stillwater, Minnesota 55082, USA
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Wright NC, Chen L, Niu J, Neogi T, Javiad K, Nevitt MA, Lewis CE, Curtis JR. Defining physiologically "normal" vitamin D in African Americans. Osteoporos Int 2012; 23:2283-91. [PMID: 22189572 PMCID: PMC3677509 DOI: 10.1007/s00198-011-1877-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 09/26/2011] [Indexed: 11/28/2022]
Abstract
UNLABELLED The relationship between serum 25(OH)D and intact parathyroid hormone (iPTH) was evaluated in the Multicenter Osteoarthritis Study (MOST). No further change in iPTH was observed for African Americans with 25(OH)D levels above 20 ng/ml, suggesting that compared to Caucasians, lower vitamin D targets for sufficiency may be appropriate for African Americans. INTRODUCTION Vitamin D levels ≥30 ng/ml are commonly considered "normal" based upon maximal suppression of iPTH; however, this has recently been challenged and the optimal 25(OH)D level among non-Caucasians is unclear. We evaluated the cross-sectional relationship between serum 25(OH)D and iPTH in a sample of Caucasian and African American adults. METHODS We used baseline serum samples of participants from the Multicenter Osteoarthritis Study (MOST) for this analysis and used three methods to model the relationship between 25(OH)D and iPTH: ordinary least squares regression (OLS), segmented regression and Helmert contrasts. RESULTS Among Caucasians (n = 1,258), 25(OH)D and iPTH ranged from 4 to 51 ng/ml and 2 to 120 pg/ml and from 3 to 32 ng/ml and 3 to 119 pg/ml in African Americans (n = 423). We observed different thresholds between African Americans and Caucasians using each analytic technique. Using 25(OH)D as a categorical variable in OLS, iPTH was statistically higher at lower 25(OH)D categories than the 24-32 ng/ml referent group among Caucasians. However, in African Americans, the mean iPTH was only significantly higher at 25(OH)D levels below 15 ng/ml. Using segmented regression, iPTH appeared to stabilize at a lower 25(OH)D level in African Americans (19-23 ng/ml) compared to in Caucasians (>32 ng/ml). Helmert contrasts also revealed a lower threshold in African Americans than Caucasians. CONCLUSION Among MOST participants, the 25(OH)D thresholds at which no further change in iPTH was observed was approximately 20 ng/ml in African Americans versus approximately 30 ng/ml in Caucasians, suggesting optimal vitamin D levels in Caucasians may not be applicable to African Americans.
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Affiliation(s)
- N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, University Blvd, Birmingham, AL 35294, USA
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Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, Josse R, Kanis JA, Mithal A, Pierroz DD, Stenmark J, Stöcklin E, Dawson-Hughes B. A global representation of vitamin D status in healthy populations. Arch Osteoporos 2012; 7:155-72. [PMID: 23225293 DOI: 10.1007/s11657-012-0093-0] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/06/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE This paper visualizes the available data on vitamin D status on a global map, examines the existing heterogeneities in vitamin D status and identifies research gaps. METHODS A graphical illustration of global vitamin D status was developed based on a systematic review of the worldwide literature published between 1990 and 2011. Studies were eligible if they included samples of randomly selected males and females from the general population and assessed circulating 25-hydroxyvitamin D [25(OH)D] levels. Two different age categories were selected: children and adolescents (1-18 years) and adults (>18 years). Studies were chosen to represent a country based on a hierarchical set of criteria. RESULTS In total, 200 studies from 46 countries met the inclusion criteria, most coming from Europe. Forty-two of these studies (21 %) were classified as representative. In children, gaps in data were identified in large parts of Africa, Central and South America, Europe, and most of the Asia/Pacific region. In adults, there was lack of information in Central America, much of South America and Africa. Large regions were identified for which the mean 25(OH)D levels were below 50 nmol/L. CONCLUSIONS This study provides an overview of 25(OH)D levels around the globe. It reveals large gaps in information in children and adolescents and smaller but important gaps in adults. In view of the importance of vitamin D to musculoskeletal growth, development, and preservation, and of its potential importance in other tissues, we strongly encourage new research to clearly define 25(OH)D status around the world.
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Affiliation(s)
- D A Wahl
- International Osteoporosis Foundation, Nyon, Switzerland
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Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey. Public Health Nutr 2012; 16:1306-13. [PMID: 22877974 DOI: 10.1017/s1368980012003588] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the frequency of vitamin D deficiency in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters in adult out-patients. DESIGN Descriptive, retrospective study concerning evaluation of the initial 25-hydroxyvitamin D (25(OH)D) levels determined at admission in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters. 25(OH)D levels ,20 ng/ml were classified as deficiency, 20–30 ng/ml as insufficiency and .30 ng/ml as sufficiency. SETTING Out-patient clinics at a tertiary care centre. SUBJECTS A total of 2488 adult patients (mean age: 53?3 (SD 15?2) years; 85?2% were females) admitted to out-patient clinics at Baskent University Istanbul Hospital were included. RESULTS Mean level of 25(OH)D in the overall population was 17?4 (SD 11?5) ng/ml while insufficiency and deficiency were evident in 24% and 66% of patients, respectively. Mean 25(OH)D levels in males .45 years old were higher than in their female counterparts (19?4 (SD 11?3) ng/ml v. 17?8 (SD 12?2) ng/ml; P,0?05). Mean 25(OH)D levels obtained in summer (18?6 (SD 11?1) ng/ml) and autumn (23?3 (SD 13?6) ng/ml) were significantly higher than levels in spring (16?1 (SD 10?3) ng/ml) and winter (14?6 (SD 10?2) ng/ml; P,0?01). Mean 25(OH)D levels were determined to be significantly lower in obese patients compared with non-obese patients (15?6 (SD 10?4) ng/ml v. 17?6 (SD 11?6) ng/ml; P,0?05). Levels of 25(OH)D were significantly negatively correlated with serum parathyroid hormone levels (r520?194; P,0?001) while significantly positively correlated with phosphorus (r50?059; P,0?01) and HDL cholesterol (r50?070; P,0?01) levels. CONCLUSIONS Our findings indicate that vitamin D deficiency is very common among out-patients in Turkey, regardless of gender and age, especially among obese people and during winter and spring.
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Agmon-Levin N, Kivity S, Tzioufas AG, López Hoyos M, Rozman B, Efes I, Shapira Y, Shamis A, Amital H, Youinou P, Shoenfeld Y. Low levels of vitamin-D are associated with neuropathy and lymphoma among patients with Sjögren's syndrome. J Autoimmun 2012; 39:234-9. [PMID: 22835660 DOI: 10.1016/j.jaut.2012.05.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND/PURPOSE Primary Sjögren's syndrome (SS) is a chronic autoimmune disease primarily involving the exocrine glands. The clinical picture of SS ranges from exocrinopathy to systemic disease affecting the lung, kidney, liver, skin, musculockeletal and nervous systems. The morbidity of SS is mainly determined by extraglandular disease and increased prevalence of lymphoma. Environmental and hormonal factors, such as vitamin-D may play a role in the pathogenic process and disease expression. Thus, we aimed to evaluate levels of vitamin-D and their association with manifestations of SS. METHODS Vitamin-D levels were determined in 176 primary SS patients and 163 matched healthy volunteers utilizing the LIAISON chemiluminescent immunoassays (DiaSorin-Italy). A correlation between vitamin-D levels and clinical and serological manifestations of SS was performed. RESULTS Mean vitamin-D levels were comparable between SS patients and control 21.2 ± 9.4 ng/ml and 22.4 ± 10 ng/ml, respectively. Peripheral neuropathy was diagnosed in 23% of SS patients and associated with lower vitamin-D levels (18.6 ± 5.5 ng/ml vs. 22.6±8 ng/ml (p = 0.04)). Lymphoma was diagnosed in 4.3% of SS patients, who had lower levels of vitamin-D (13.2 ± 6.25 ng/ml), compared to SS patients without lymphoma (22 ± 8 ng/ml), (p = 0.03). Other clinical and serological manifestations did not correlate with vitamin-D status. CONCLUSIONS In this study, low levels of vitamin-D correlated with the presence of peripheral neuropathy and lymphoma among SS patients. The link between vitamin-D and neuropathy or lymphoma was reported in other conditions, and may support a role for vitamin-D in the pathogenesis of these processes. Plausible beneficial effect for vitamin-D supplementation may thus be suggested.
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Affiliation(s)
- Nancy Agmon-Levin
- The Zabludowicz Center for Autoimmune Diseases, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
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Changes in healthy elderly women's physical performance: a 3-year follow-up. Exp Gerontol 2011; 46:929-33. [PMID: 21884781 DOI: 10.1016/j.exger.2011.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/27/2011] [Accepted: 08/15/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inflammatory states, hypovitaminosis D and secondary hyperparathyroidism may have a role in the age-related loss of muscle mass, and physical performance in healthy old people. The aim of this study is to investigate changes in muscle mass, strength and physical performance in healthy, active elderly females over a 3-year follow-up, correlating them with any inflammatory states and PTH and 25-hydroxyvitamin D (25-OHD) levels. METHODS One hundred healthy females over 65 years of age routinely attending a twice-weekly mild fitness program were eligible for the study. Clinical history, serum parameters, body composition by DEXA, handgrip strength, knee extensor isometric/isotonic strength and functional performance measured using the Short Physical Performance Battery (SPPB) were evaluated at the baseline and after 3 years. RESULTS After 3 years, the women had a significant decrease in weight (∆:-0.8±3.1 kg; p<0.05) and height (∆:-0.4±0,6 cm; p<0.001), while their BMI and body composition parameters did not change. Only IL-6 (∆: 0.6±2.0; p<0.01) and PTH (∆: 30.7±29.2 ng/L; p<0.001) increased significantly, while there were no changes in 25-OHD levels. There was a significant decrease in all the SPPB results and in muscle strength. ∆ PTH only correlated with the variation in 4-meter walking speed (r: 0.41; p<0.01). CONCLUSIONS With advancing age, physical performance declines even in healthy, active females despite a spare of muscle mass. The increase in PTH seems to have a role in this decline, that could be clarified by further investigations.
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Schierbeck LL, Jensen TS, Bang U, Jensen G, Køber L, Jensen JEB. Parathyroid hormone and vitamin D-markers for cardiovascular and all cause mortality in heart failure. Eur J Heart Fail 2011; 13:626-632. [DOI: 10.1093/eurjhf/hfr016] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Louise Lind Schierbeck
- Department of Endocrinology, afsn.541; Hvidovre Hospital; Kettegård alle 30, 2650 Hvidovre Denmark
| | | | - Ulrich Bang
- Department of Endocrinology, afsn.541; Hvidovre Hospital; Kettegård alle 30, 2650 Hvidovre Denmark
| | - Gorm Jensen
- Department of Cardiology; Hvidovre University Hospital; Hvidovre Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Jens-Erik Beck Jensen
- Department of Endocrinology, afsn.541; Hvidovre Hospital; Kettegård alle 30, 2650 Hvidovre Denmark
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Cerdà D, Peris P, Monegal A, Albaladejo C, Martínez de Osaba MJ, Surís X, Guañabens N. [Increase of PTH in post-menopausal osteoporosis]. Rev Clin Esp 2011; 211:338-43. [PMID: 21596374 DOI: 10.1016/j.rce.2011.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/21/2011] [Accepted: 03/27/2011] [Indexed: 11/30/2022]
Abstract
AIMS Increased parathyroid values (PTH) serum values can be observed in postmenopausal women. However, the clinical repercussion and causes of this finding are poorly understood. This study has aimed to analyze the prevalence and conditions associated to the increased serum PTH levels in postmenopausal women with osteoporosis as well as their clinical characteristics. METHODS Post-menopausal women with osteoporosis were included in the study. PTH, 25-hydroxyvitamin D (25OHD), 24-h urinary calcium, glomerular filtration rate (GFR) and calcium intake were evaluated. The prevalence of increased PTH serum values and its relationship with vitamin D deficiency and insufficiency, kidney failure, hypercalciuria and calcium intake deficiency were evaluated, these being conditions that may increase PTH secretion. RESULTS A total of 204 postmenopausal women with osteoporosis with a mean age of 64 years were included. Increase PTH levels (>65 pg/ml) were observed in 35% and 5 women had primary hyperparathyroidism. Women with increased serum PTH levels were older (67 ± 9 years) were old than those with normal PTH levels (63 ± 11 years) (P=0.03). PTH elevation was associated to calcium intake deficiency (<800 mg/d) in 81% of the women, to a vitamin D deficiency and insufficiency in 55% and 86%, respectively, renal insufficiency in 35% and hypercalciuria in 17% of the patients. These values, however, did not differ when compared with patients with normal PTH serum levels. Serum PTH levels were related to age (r=0.19, P=0.01) but not to 25OHD or GFR values. CONCLUSIONS One third of the post-menopausal women with osteoporosis had elevated PTH levels. This was due to primary hyperparathyroidism in 10%. The prevalence of conditions associated to the increase in PTH (reduced calcium intake, 25-hydroxyvitamin D, renal failure and hypercalciuria) is similar to that observed in women with normal PTH values.
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Affiliation(s)
- D Cerdà
- Unidad de Reumatología, Servicio de Medicina Interna, Hospital General de Granollers, Barcelona, España.
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Abstract
Inadequate serum 25-hydroxyvitamin D (25[OH]D) concentrations are associated with muscle weakness, decreased physical performance, and increased propensity in falls and fractures. This paper discusses several aspects with regard to vitamin D status and supplementation when treating patients with osteoporosis in relation to risks and prevention of falls and fractures. Based on evidence from literature, adequate supplementation with at least 700 IU of vitamin D, preferably cholecalciferol, is required for improving physical function and prevention of falls and fractures. Additional calcium supplementation may be considered when dietary calcium intake is below 700 mg/day. For optimal bone mineral density response in patients treated with antiresorptive or anabolic therapy, adequate vitamin D and calcium supplementation is also necessary. Monitoring of 25(OH)D levels during follow-up and adjustment of vitamin D supplementation should be considered to reach and maintain adequate serum 25(OH)D levels of at least 50 nmol/L, preferably greater than 75 nmol/L in all patients.
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Affiliation(s)
- Joop P. W. van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre Noord-Limburg, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Faculty of Health Medicine and Life Science, Department of Internal Medicine, Maastricht University Medical Centre/Nutrim, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Sandrine P. G. Bours
- Department of Internal Medicine, Subdivision Endocrinology, Maastricht University Medical Centre, Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Tineke A. C. M. van Geel
- Faculty of Health Medicine and Life Science, Department of General Practice, Maastricht University Medical Centre/Caphri, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Piet P. Geusens
- Faculty of Health Medicine and Life Science, Department of Internal Medicine, Maastricht University/Caphri, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Biomedical Research Center, University Hasselt, Hasselt, Belgium
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Sai AJ, Walters RW, Fang X, Gallagher JC. Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab 2011; 96:E436-46. [PMID: 21159838 PMCID: PMC3047227 DOI: 10.1210/jc.2010-1886] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT There is a controversy regarding the definition of vitamin D insufficiency as it relates to bone health. OBJECTIVE The objective of the study was to examine the evidence for a threshold value of serum 25-hydroxyvitamin D (25OHD) that defines vitamin D insufficiency as it relates to bone health. DESIGN AND PARTICIPANTS This was a cross-sectional analysis of baseline data in 488 elderly Caucasian women, mean age 71 yr, combined with a literature review of 70 studies on the relationship of serum PTH to serum 25OHD. SETTING The study was conducted in independent-living women in the midwest United States. MAIN OUTCOME MEASURE The relationship between serum 25OHD, serum PTH, and serum osteocalcin and 24-h urine N-telopeptides was evaluated. RESULTS Serum PTH was inversely correlated with serum 25OHD (r = -0.256, P < 0.0005), but no threshold as defined by suppression of serum PTH was found within the serum 25OHD range 6-60 ng/ml (15-150 nmol/liter). However, in contrast, there was a threshold for bone markers, serum osteocalcin and urine N-telopeptides, that increased only below a serum 25OHD of approximately 18 ng/ml (45 nmol/liter). Calcium absorption was not correlated with serum PTH and serum 25OHD, and no threshold was found. A literature review of 70 studies generally showed a threshold for serum PTH with increasing serum 25OHD, but there was no consistency in the threshold level of serum 25OHD that varied from 10 to 50 ng/ml (25-125 nmol/liter). CONCLUSIONS Vitamin D insufficiency should be defined as serum 25OHD less than 20 ng/ml (50 nmol/liter) as it relates to bone.
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Affiliation(s)
- A J Sai
- Bone Metabolism Unit, Department of Medicine, Creighton University Medical Center, 601 North 30 Street, Suite 6718, Omaha, Nebraska 68131, USA.
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González-Molero I, Morcillo S, Valdés S, Pérez-Valero V, Botas P, Delgado E, Hernández D, Olveira G, Rojo G, Gutierrez-Repiso C, Rubio-Martín E, Menéndez E, Soriguer F. Vitamin D deficiency in Spain: a population-based cohort study. Eur J Clin Nutr 2010; 65:321-8. [DOI: 10.1038/ejcn.2010.265] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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