Vitamin D: Non-skeletal actions and effects on growth

Influence of vitamin D metabolites on vitamin D status, immunity and gut health of piglets

Immediately post-weaning, piglets are prone to gastrointestinal infectious diseases. The active metabolite of vitamin D 1,25-dihydroxyvitamin D has direct impact on immune cell function and responses. Thus, a low vitamin D status may compromise the immune responses during infectious diseases. The aim of this study was to examine the effect of supplementation of different forms of vitamin D (25-OH-D₃ and vitamin D₃) to suckling piglets' vitamin D status at weaning. In addition, to determine whether the vitamin D status could affect the immune development in piglets and their robustness against E. coli challenge. Genetically E. coli F4 susceptible litters of piglets were divided into two treatment groups: group 1 (n = 16) provided milk formula supplemented with vitamin D₃ (CON), and group 2 (n = 16) provided milk formula supplemented with 25-OH-D₃ (TREAT). Piglets were offered the experimental milk formulas from day 3 after farrowing until weaning (at day 28 of age). A commercial weaner diet with high protein content were provided to induce weaning stress. Milk formulas, sow and weaner diets as well as plasma and milk samples obtained from sows (n = 8) were analysed for vitamin D metabolites. Vitamin D status in piglets was investigated by collection of plasma samples on day 3, 15, 28 and 35 of age. Eight piglets randomly selected from each dietary group (in total 16 pigs) were inoculated with E. coli F4 O149 on day 2 and 3 post-weaning. Blood samples collected on day 2 and 9 post-weaning (pre- and post E. coli inoculation, respectively) were analysed for haematological and immunological parameters including immunoglobulins, antibodies specific to E. coli O149 K88, cytokines and C-reactive protein. In addition, intestinal samples were obtained one week after E. coli inoculation to study the influence of infection and vitamin D status on immune responses at different sites of the intestine. This was accomplished by gene expression of various cytokines and tight junction proteins. In general, vitamin D status of the piglets were low. However, piglets provided TREAT during the suckling period had increased vitamin D status at weaning compared to piglets provided CON. Vitamin D was used during activation of the immune system as pigs inoculated with E. coli had lower plasma concentrations of 25-OH-D₃ than non-inoculated pigs possibly due to mobilising of vitamin D in the liver. Hence, increased vitamin D status at weaning might improve piglets' resistance to E. coli infection.

Vitamin D and Ageing

One hundred years has passed since the discovery of vitamin D as the active component of cod-liver oil which cured the bone disease rickets. Since then our knowledge of vitamin D has expanded tremendously and has included recognition of the importance of UV radiation as a source of the vitamin as well as the discovery of the vitamin as a nutrient, a pro-hormone and a potent steroid hormone with a major role in calcium and bone metabolism. In the last 25 years or so, the discovery of the vitamin D receptor in over 30 different body tissues together with the existence of the alpha-1-hydroxylase enzyme in these tissues provided evidence of a pleiotropic role of vitamin D outside its classical role in the skeleton. These important discoveries have provided the basis for the increasing interest in vitamin D in the context of nutritional requirements for health including the prevention of chronic diseases of ageing. The recent publication of the Dietary Reference Intake report on vitamin D and calcium by the North American Institute of Medicine (IOM) is the most comprehensive report to date on the basis for setting nutritional requirements for vitamin D. This chapter will summarize the nutritional aspects of vitamin D and discuss the changes in vitamin D metabolism and requirements with ageing. It will summarize key evidence on the relationship between vitamin D status and some of the main ageing related health outcomes including bone, muscle and cognitive health as well as survival focusing on the published literature in very-old adults (those >= 85 years of age).

Vitamin D deficiency in children and adolescents submitted to hematopoietic stem cell transplantation

BACKGROUND

Sub-optimal levels of vitamin D have been found to be highly prevalent in all age groups, with epidemiologic studies demonstrating a link between vitamin D deficiency and disease susceptibility, such as infection and cancer, and mortality rates. In adult transplant patients, it has been suggested that the immunomodulatory properties of vitamin D may have an important role in the prevention and treatment of graft-versus-host disease.

OBJECTIVE

The objective of this study was to assess serum 25-hydroxyvitamin D levels of children and adolescents submitted to allogeneic hematopoietic stem cell transplantation.

METHODS

Serum 25-hydroxyvitamin D levels of 66 patients, aged 4-20 years, were assessed at three stages: before hospitalization for hematopoietic stem cell transplantation and at 30 and 180 days after hematopoietic stem cell transplantation. The control group consisted of 25 healthy children.

RESULTS

At the pre-hematopoietic stem cell transplantation stage, patients had lower levels of 25-hydroxyvitamin D compared to controls (25.7 ± 12.3 ng/mL vs. 31.9 ± 9.9 ng/mL; p-value = 0.01), and a higher prevalence of 25-hydroxyvitamin D deficiency (32% vs. 8%; p-value = 0.01). Prevalence increased significantly after hematopoietic stem cell transplantation (p-value = 0.01) with half of the patients having vitamin D deficiency at 180 days after transplantation. At this stage, mean serum 25-hydroxyvitamin D levels were 20.9 ± 10.9 ng/mL, a significant decline in relation to baseline (p-value = 0.01). No correlation was found between 25-hydroxyvitamin D levels and vitamin D intake, graft-versus-host disease, corticoid use or survival rates.

CONCLUSION

Low levels of 25-hydroxyvitamin D were detected even before hematopoietic stem cell transplantation and were significantly lower at 180 days after hematopoietic stem cell transplantation, thus recommending vitamin D supplementation for children and adolescents submitted to hematopoietic stem cell transplantation.

Vitamin D and bone health outcomes in older age

The aim of this review is to summarise the evidence linking vitamin D to bone health outcomes in older adults. A plethora of scientific evidence globally suggests that large proportions of people have vitamin D deficiency and are not meeting recommended intakes. Older adults are at particular risk of the consequences of vitamin D deficiency owing to a combination of physiological and behavioural factors. Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism. There seems to be inconsistent evidence for a protective role of vitamin D supplementation alone on bone mass. However, it is generally accepted that vitamin D (17·5 μg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. Evidence for a benefit of vitamin D supplementation alone on reducing fracture risk is varied. According to a recent Agency for Healthcare Research and Quality review in the USA the evidence base shows mixed results for a beneficial effect of vitamin D on decreasing overall fracture risk. Limitations such as poor compliance with treatment, incomplete assessment of vitamin D status and large drop-out rates however, have been highlighted within some studies. In conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care. The lack of data on vitamin D and bone health outcomes in certain population groups such as diverse racial groups warrants attention.

Reproductive performance and bone status markers of gilts and lactating sows supplemented with two different forms of vitamin D

In swine nutrition, little is known about the vitamin D requirements for reproductive processes and bone health. Consequently, the vitamin D recommendation for sows during gestation and lactation is not based on scientific reports. The current study was undertaken to obtain information on the dose-response pattern of 2 vitamin D sources, the commonly used cholecalciferol, called vitamin D(3), and a newly developed Hy.D product (25-hydroxycholecalciferol). In Exp. 1, a total of 160 gilts were randomly assigned from the first estrus until d 28 of gestation to dietary treatments containing 4 concentrations of 1 of the 2 different vitamin D sources [200, 800, 1,400, and 2,000 IU/kg of vitamin D from cholecalciferol or corresponding doses of 5, 20, 35, and 50 microg/kg of feed from 25(OH)D(3) (Hy.D)]. In a concurrent experiment, the same 8 dietary treatments were provided to 160 multiparous sows from the first day of mating until weaning. Plasma concentrations of 25(OH)D(3) were influenced by a dose x form interaction (P < 0.001); furthermore, plasma 25(OH)D(3) concentrations were influenced by the lactation state of the sows. Irrespective of the dietary dose and form of vitamin D provided to the sows, very little vitamin D was transferred to the progeny. Reproductive performance was not influenced by dietary vitamin D treatments, except for a decreased number of stillborn piglets (P = 0.03, SE = 0.40) with the larger doses of vitamin D (1,400 and 2,000 IU of vitamin D, resulting in 1.17 and 1.13 stillborn piglets per litter, respectively) compared with the smaller doses of vitamin D (200 and 800 IU of vitamin D, resulting in 1.98 and 1.99 stillborn piglets per litter, respectively). In the gilt trial, the ultimate strength of the bones (P = 0.01) and their content of ash (P = 0.02) were greater when vitamin D(3) was supplemented in doses larger than 800 IU, compared with the same amount of Hy.D supplementation. In the sow experiment, lactation day (P < 0.001), rather than dietary vitamin D, influenced the concentrations of osteocalcin and Ca as well as the activities of total alkaline phosphatase and bone alkaline phosphatase in plasma. Age of the suckling piglets affected their plasma bone health markers. In conclusion, at doses greater than 200 IU, Hy.D was more bioavailable than vitamin D(3) and, as such, could be considered an equivalent or even more advantageous source of vitamin D. In addition, a dietary dose of approximately 1,400 IU of vitamin D is recommended for reproducing swine. Irrespective of the dietary dose and form of vitamin D provided to the sows, very little vitamin D was transferred to the progeny.

Colon cancer: prognosis for different latitudes, age groups and seasons in Norway

The survival of colon cancer patients in Norway, as determined three years after diagnosis, is dependent on the season of diagnosis. This has been attributed to seasonal variations of the vitamin D status. Since solar radiation and food are the human sources of vitamin D, we divided Norway in three regions: The southeast region with a high annual dose of ultraviolet (UV) to the population, as evidenced by a high incidence rate of squamous cell carcinoma of the skin (SCC), the midwest region and the north region with low annual UV doses. The latter region is characterized by a high consumption of vitamin D, mainly through fish intake. Vacations to southern latitudes were equally frequent for all the three geographical regions. Two age groups were analyzed separately (< or =65 years and >65 years), since the photosynthesis of vitamin D(3) in skin decreases with age. In all three regions, and in both age groups, the survival was highest for summer and autumn diagnosis. The seasonal effect was slightly, but not significantly, better for the younger than for the older age group. The effect was similar for all three geographical regions, irrespective of SCC incidence.

Prostate cancer survival is dependent on season of diagnosis

BACKGROUND

We have earlier found that the prognosis for several cancers is dependent on season of diagnosis. More recently, both prostate cancer incidence and mortality have been shown to increase with increasing latitude, which probably relates to photosynthesis of vitamin D.

METHODS

The 3 year survival of prostate cancer patients has been analyzed with the Cox regression method for two age groups at different latitudes in Norway.

RESULTS

Patients diagnosed during the summer and autumn had the best prognosis (Ralative risk (RR) death 0.8; 95% CI 0.75-0.85). Similar results were observed in three regions of the country that differ with respect to annual fluences of solar UV radiation, incidence rates of squamous cell carcinoma (SCC) and intake of fish. Furthermore, similar relationship between the season and survival was seen among patients </=65 years and >65 years old, although the younger group had a slightly larger advantage of summer and autumn diagnosis.

CONCLUSIONS

The seasonal effect on prognosis may be related to the seasonal variations of calcidiol (the marker of vitamin D status). The lack of latitude effect and the similarity of prognosis for different age groups may be related to higher consumption of vitamin D in food in the north region and to increase of such consumption with age.

Solar radiation, vitamin D and survival rate of colon cancer in Norway

Solar radiation contributes significantly to the status of serum calcidiol (25-hydroxyvitamin D3, 25-(OH)D3) in humans, even at the high latitudes of northern Norway. Thus, in late summer the serum concentration of calcidiol is roughly 50% larger than that in late winter, when the solar radiation in Norway contains too little ultraviolet radiation to induce any synthesis of vitamin D3 in human skin. This seems to influence the prognosis of colon cancer. We here report that the survival rate of colon cancer in men and women, assessed 18 months after diagnosis, is dependent on the season of diagnosis. A high serum concentration of calcidiol at the time of diagnosis, i.e. at the start of conventional therapy, seems to give an increased survival rate. This agrees with cell and animal experiments reported in the literature, as well as with epidemiological data from some countries relating colon cancer survival with latitude and vitamin D3 synthesis in skin. One possible interpretation of the present data is that, the level of calcidiol, or its derivative calcitriol (1alpha,25-dihydroxyvitamin D3, 1alpha,25-(OH)2D3), may act positively in concert with conventional therapies of colon cancer.