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Rodrigues CZ, Correia TC, Neves PAR, Malta MB, Cardoso MA, Lourenço BH. Predictors of 25-hydroxyvitamin D concentrations during pregnancy: A longitudinal analysis in the Brazilian Amazon. Eur J Clin Nutr 2022; 76:1281-1288. [PMID: 35190660 DOI: 10.1038/s41430-022-01102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine predictors of 25-hydroxyvitamin D3 (25(OH)D3) concentrations (25th, 50th, and 75th percentiles) in the third trimester of pregnancy. SUBJECTS/METHODS Data on sociodemographic, obstetric, lifestyle and pregnancy characteristics, including serum 25(OH)D3 and retinol, were collected among 448 pregnant women who participated in the Maternal and Child Health and Nutrition in Acre, Brazil (MINA-Brazil Study) in Cruzeiro do Sul, Brazilian Amazon (latitude 7°S). Simultaneous-quantile regression was fitted to prospectively assess predictors at the 25th, 50th and 75th percentiles of 25(OH)D3 concentrations. RESULTS In the third trimester, 25(OH)D3 <50 nmol/L was observed in 26% of pregnant women. Exposure to the Amazonian dry season during follow-up and vitamin D status ≥75 nmol/L in the second trimester of pregnancy were positively associated with 25(OH)D3 concentrations in the third trimester. Pregnant women who were the main providers of family income presented lower 25(OH)D3 concentrations (50th and 75th percentiles: -15 nmol/L, 95%CI -24; -3, p = 0.02, and -22 nmol/L, 95%CI -36; -7, p = 0.004, respectively), as well as those with sustained vitamin A insufficiency (25th and 50th percentiles: -27 nmol/L, 95%CI -40; -15, p < 0.001, and -17 nmol/L, 95%CI -33; -1, p = 0.04, respectively). Sun protection practices had a smaller negative impact on 25(OH)D3, restricted to participants whose concentrations were at the 25th percentile of the distribution. CONCLUSIONS Seasonality and vitamin A status were important predictors of 25(OH)D3 concentrations in the third trimester. Adequate exposure to sunlight and dietary sources of vitamin A within safe intake levels may help ensuring a good nutritional status of vitamin D during pregnancy.
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Affiliation(s)
- Caroline Zani Rodrigues
- Public Health Nutrition Program, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Thaís Carlos Correia
- Public Health Nutrition Program, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Paulo Augusto Ribeiro Neves
- Public Health Nutrition Program, School of Public Health, University of São Paulo, São Paulo, Brazil.,Postgraduate Program in Epidemiology, School of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Maíra Barreto Malta
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.,Postgraduate Program in Public Health, Catholic University of Santos, Santos, Brazil
| | - Marly Augusto Cardoso
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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Gannon BM, Jones C, Mehta S. Vitamin A Requirements in Pregnancy and Lactation. Curr Dev Nutr 2020; 4:nzaa142. [PMID: 32999954 PMCID: PMC7513584 DOI: 10.1093/cdn/nzaa142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/06/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
Pregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.
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Affiliation(s)
- Bryan M Gannon
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Camille Jones
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
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3
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Kolesnikova LI, Kolesnikov SI, Darenskaya MA, Grebenkina LA, Timofeeva EV, Leshchenko OY, Vanteeva OA, Rashidova MA. [Evaluation of the pro- and antioxidant status of women with HIV or coinfection]. TERAPEVT ARKH 2018; 88:17-21. [PMID: 28005027 DOI: 10.17116/terarkh2016881117-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM To reveal the specific features of changes in the parameters of lipid peroxidation - antioxidant defense and the status of the reproductive system in women of fertile age with monoinfection (HIV) or coinfection (HIV and hepatitis B and/or C). SUBJECTS AND METHODS 81 reproductive-aged women were examined and divided into 3 groups: 1) 28 apparently healthy women (controls); 2) 26 patients with HIV monoinfection; and 3) 27 patients with HIV coinfection (HIV + hepatitis B and/or C) who had not previously received antiretroviral therapy. RESULTS The HIV coinfection group showed the higher values of primary (conjugated dienes) and secondary (ketodienes and conjugated trienes) lipid peroxidation products in the presence of lower superoxide dismutase activity and obvious α-tocopherol deficiency than the control and HIV monoinfection groups. HIV coinfection in reproductive-aged women was accompanied by the high frequency of luteal phase deficiency. CONCLUSION HIV coinfection is characterized by a more pronounced oxidative stress, antioxidant factor deficiency, and the high frequency of luteal phase deficiency in the patients.
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Affiliation(s)
- L I Kolesnikova
- Research Centre for Problems of Family Health and Human Reproduction, Irkutsk, Russia
| | - S I Kolesnikov
- Research Centre for Problems of Family Health and Human Reproduction, Irkutsk, Russia
| | - M A Darenskaya
- Research Centre for Problems of Family Health and Human Reproduction, Irkutsk, Russia
| | - L A Grebenkina
- Research Centre for Problems of Family Health and Human Reproduction, Irkutsk, Russia
| | - E V Timofeeva
- Research Centre for Problems of Family Health and Human Reproduction, Irkutsk, Russia
| | - O Ya Leshchenko
- Research Centre for Problems of Family Health and Human Reproduction, Irkutsk, Russia
| | - O A Vanteeva
- Research Centre for Problems of Family Health and Human Reproduction, Irkutsk, Russia
| | - M A Rashidova
- Research Centre for Problems of Family Health and Human Reproduction, Irkutsk, Russia
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van der Pligt P, Willcox J, Szymlek-Gay EA, Murray E, Worsley A, Daly RM. Associations of Maternal Vitamin D Deficiency with Pregnancy and Neonatal Complications in Developing Countries: A Systematic Review. Nutrients 2018; 10:E640. [PMID: 29783717 PMCID: PMC5986519 DOI: 10.3390/nu10050640] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/16/2018] [Accepted: 05/12/2018] [Indexed: 01/01/2023] Open
Abstract
Pregnant women in Asia, the Middle East, Africa and Latin America are at risk of vitamin D deficiency (VDD) and prevalence throughout these regions are among the highest, globally. Maternal VDD has been associated with increased risk of a number of adverse maternal and neonatal health outcomes, yet research from developing countries is limited. We assessed the associations of maternal VDD during pregnancy with adverse health outcomes by synthesizing the literature from observational studies conducted in developing countries. Six electronic databases were searched for English-language studies published between 2000 and 2017. Thirteen studies from seven countries were included in the review. Prevalence of VDD ranged from 51.3% to 100%. Six studies assessed both maternal and neonatal outcomes, four studies assessed only maternal outcomes and three studies assessed only neonatal outcomes. Ten studies showed at least one significant association between VDD and adverse maternal and/or neonatal health outcomes including pre-eclampsia (n = 3), gestational diabetes mellitus (n = 1), postpartum depression (n = 1), emergency cesarean section delivery (n = 1), low birth weight babies (n = 4), small for gestational age (n = 2), stunting (n = 1). However most of these studies (n = 6) also showed no association with multiple health outcomes. Vitamin D assessment methods, criteria applied to define VDD, season and trimester in which studies were conducted varied considerably across studies. In conclusion, this study highlights the need to improve maternal vitamin D status in developing countries in an effort to support best maternal and child health outcomes across these regions. Future research should focus on more unified approaches to vitamin D assessment and preventative approaches that may be embedded into already existing antenatal care settings.
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Affiliation(s)
- Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Jane Willcox
- School of Exercise and Nutrition Sciences, Deakin University, Burwood 3125, Australia.
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora 3083, Australia.
| | - Ewa A Szymlek-Gay
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Emily Murray
- School of Exercise and Nutrition Sciences, Deakin University, Burwood 3125, Australia.
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
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5
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Naseh A, Ashrafzadeh S, Rassi S. Prevalence of vitamin D deficiency in pregnant mothers in Tehran and investigating its association with serum glucose and insulin. J Matern Fetal Neonatal Med 2017; 31:2312-2318. [DOI: 10.1080/14767058.2017.1342796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ali Naseh
- Department of Pediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Ashrafzadeh
- Department of Pediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA
| | - Sepehr Rassi
- Department of Pediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biology, Dalhousie University, Halifax, Nova Scotia, Canada
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6
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Toko EN, Sumba OP, Daud II, Ogolla S, Majiwa M, Krisher JT, Ouma C, Dent AE, Rochford R, Mehta S. Maternal Vitamin D Status and Adverse Birth Outcomes in Children from Rural Western Kenya. Nutrients 2016; 8:nu8120794. [PMID: 27941597 PMCID: PMC5188449 DOI: 10.3390/nu8120794] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 01/04/2023] Open
Abstract
Maternal plasma 25-hydroxyvitamin D (25(OH)D) status and its association with pregnancy outcomes in malaria holoendemic regions of sub-Saharan Africa is poorly defined. We examined this association and any potential interaction with malaria and helminth infections in an ongoing pregnancy cohort study in Kenya. The association of maternal plasma 25(OH)D status with pregnancy outcomes and infant anthropometric measurements at birth was determined in a subset of women (n = 63). Binomial and linear regression analyses were used to examine associations between maternal plasma 25(OH)D and adverse pregnancy outcomes. Fifty-one percent of the women had insufficient (<75 nmol/L) and 21% had deficient (<50 nmol/L) plasma 25(OH)D concentration at enrollment. At birth, 74.4% of the infants had insufficient and 30% had deficient plasma 25(OH)D concentrations, measured in cord blood. Multivariate analysis controlling for maternal age and body mass index (BMI) at enrollment and gestational age at delivery found that deficient plasma 25(OH)D levels were associated with a four-fold higher risk of stunting in neonates (p = 0.04). These findings add to the existing literature about vitamin D and its association with linear growth in resource-limited settings, though randomized clinical trials are needed to establish causation.
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Affiliation(s)
- Eunice N Toko
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Odada P Sumba
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Ibrahim I Daud
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | - Sidney Ogolla
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Maxwel Majiwa
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Jesse T Krisher
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853, USA.
| | - Collins Ouma
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- African Institute for Development Policy, Nairobi, Kenya.
| | - Arlene E Dent
- Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Rosemary Rochford
- SUNY Upstate Medical University, Syracuse, NY 13210, USA.
- Department of Immunology and Microbiology, University of Colorado, Denver, Aurora, CO 80045, USA.
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853, USA.
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7
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Shivakoti R, Christian P, Yang WT, Gupte N, Mwelase N, Kanyama C, Pillay S, Samaneka W, Santos B, Poongulali S, Tripathy S, Riviere C, Berendes S, Lama JR, Cardoso SW, Sugandhavesa P, Tang AM, Semba RD, Campbell TB, Gupta A. Prevalence and risk factors of micronutrient deficiencies pre- and post-antiretroviral therapy (ART) among a diverse multicountry cohort of HIV-infected adults. Clin Nutr 2016; 35:183-189. [PMID: 25703452 PMCID: PMC4531105 DOI: 10.1016/j.clnu.2015.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/30/2014] [Accepted: 02/03/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS HIV-infected adults have increased risk of several individual micronutrient deficiencies. However, the prevalence and risk factors of concurrent and multiple micronutrient deficiencies and whether micronutrient concentrations change after antiretroviral therapy (ART) initiation have not been well described. The objective of this study was to determine the prevalence and risk factors of individual, concurrent and multiple micronutrient deficiencies among ART-naïve HIV-infected adults from nine countries and assess change in micronutrient status 48 weeks post-ART initiation. METHODS A random sub-cohort (n = 270) stratified by country was selected from the multinational PEARLS clinical trial (n = 1571 ART-naïve, HIV-infected adults). We measured serum concentrations of vitamins A, D (25-hydroxyvitamin), E, carotenoids and selenium pre-ART and 48 weeks post-ART initiation, and measured vitamins B6, B12, ferritin and soluble transferrin receptor at baseline only. Prevalence of single micronutrient deficiencies, concurrent (2 coexisting) or conditional (a deficiency in one micronutrient given a deficiency in another) and multiple (≥3) were determined using defined serum concentration cutoffs. We assessed mean changes in micronutrient concentrations from pre-ART to week 48 post-ART initiation using multivariable random effects models. RESULTS Of 270 participants, 13.9%, 29.2%, 24.5% and 32.4% had 0, 1, 2 and multiple deficiencies, respectively. Pre-ART prevalence was the highest for single deficiencies of selenium (53.2%), vitamin D (42.4%), and B6 (37.3%) with 12.1% having concurrent deficiencies of all three micronutrients. Deficiency prevalence varied widely by country. 48 weeks post-ART initiation, mean vitamin A concentration increased (p < 0.001) corresponding to a 9% decrease in deficiency. Mean concentrations also increased for other micronutrients assessed 48 weeks post-ART (p < 0.001) but with minimal change in deficiency status. CONCLUSIONS Single and multiple micronutrient deficiencies are common among HIV-infected adults pre-ART initiation but vary between countries. Importantly, despite increases in micronutrient concentrations, prevalence of individual deficiencies remains largely unchanged after 48 weeks on ART. Our results suggest that ART alone is not sufficient to improve micronutrient deficiency.
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Affiliation(s)
- Rupak Shivakoti
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Wei-Teng Yang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Nikhil Gupte
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Noluthando Mwelase
- Department of Medicine, University of Witwatersrand, Johannesburg, 2050, South Africa.
| | | | - Sandy Pillay
- Durban International Clinical Research Site, Durban University of Technology, Durban, 4001, South Africa.
| | - Wadzanai Samaneka
- University of Zimbabwe Clinical Research Centre, Harare, 999, Zimbabwe.
| | - Breno Santos
- Hospital Nossa Senhora de Conceição, Porto Alegre, 91350-200, Brazil.
| | | | | | | | - Sima Berendes
- Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre, Malawi.
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, 4, Peru.
| | - Sandra W Cardoso
- STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clinica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, 21045-900, Brazil.
| | | | - Alice M Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, 02111, MA, USA.
| | - Richard D Semba
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, 21287, MD, USA.
| | - Thomas B Campbell
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Amita Gupta
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Monteiro JP, Cruz MLS, Mussi-Pinhata MM, Salomão RG, Jordão Junior A, Read JS, Pilotto JHDS, Cohen RA, Stoszek SK, Siberry GK. Vitamin A, vitamin E, iron and zinc status in a cohort of HIV-infected mothers and their uninfected infants. Rev Soc Bras Med Trop 2015; 47:692-700. [PMID: 25626647 DOI: 10.1590/0037-8682-0226-2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/18/2014] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Introduction: We hypothesized that nutritional deficiency would be common in a cohort of postpartum, human immunodeficiency virus (HIV)-infected women and their infants. METHODS Weight and height, as well as blood concentrations of retinol, α-tocopherol, ferritin, hemoglobin, and zinc, were measured in mothers after delivery and in their infants at birth and at 6-12 weeks and six months of age. Retinol and α-tocopherol levels were quantified by high performance liquid chromatography, and zinc levels were measured by atomic absorption spectrophotometry. The maternal body mass index during pregnancy was adjusted for gestational age (adjBMI). RESULTS Among the 97 women 19.6% were underweight. Laboratory abnormalities were most frequently observed for the hemoglobin (46.4%), zinc (41.1%), retinol (12.5%) and ferritin (6.5%) levels. Five percent of the women had mean corpuscular hemoglobin concentrations < 31g/dL. The most common deficiency in the infants was α-tocopherol (81%) at birth; however, only 18.5% of infants had deficient levels at six months of age. Large percentages of infants had zinc (36.8%) and retinol (29.5%) deficiencies at birth; however, these percentages decreased to 17.5% and 18.5%, respectively, by six months of age. No associations between infant micronutrient deficiencies and either the maternal adjBMI category or maternal micronutrient deficiencies were found. CONCLUSIONS Micronutrient deficiencies were common in HIV-infected women and their infants. Micronutrient deficiencies were less prevalent in the infants at six months of age. Neither underweight women nor their infants at birth were at increased risk for micronutrient deficiencies.
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Affiliation(s)
- Jacqueline Pontes Monteiro
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Maria Letícia Santos Cruz
- Departamento de Doenças Infecciosas, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brasil
| | - Marisa Márcia Mussi-Pinhata
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Roberta Garcia Salomão
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Alceu Jordão Junior
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Jennifer Suzanne Read
- Maternal and Pediatric Infectious Disease Branch, National Institute of Child Health and Human Development, National Institute of Health, Bethesda, Maryland, USA
| | | | | | | | - George Kelly Siberry
- Maternal and Pediatric Infectious Disease Branch, National Institute of Child Health and Human Development, National Institute of Health, Bethesda, Maryland, USA
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Jao J, Freimanis L, Mussi-Pinhata MM, Cohen RA, Monteiro JP, Cruz ML, Sperling RS, Branch A, Siberry GK. Low vitamin D status among pregnant Latin American and Caribbean women with HIV Infection. Int J Gynaecol Obstet 2015; 130:54-8. [PMID: 25912414 DOI: 10.1016/j.ijgo.2015.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/08/2015] [Accepted: 03/26/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the prevalence and predictors of low vitamin D status among pregnant women with HIV infection. METHODS The present cross-sectional study analyzed repository specimens collected at 12-34 weeks of pregnancy among women enrolled across 17 sites in Latin America and the Caribbean between 2002 and 2009. Logistic regression modeling was used to identify factors associated with low vitamin D status (25-hydroxyvitamin D <30 ng/mL). RESULTS Among 715 women, 218 (30.5%) were vitamin D deficient (<20 ng/mL) and 252 (35.2%) were insufficient (21- /mL). Factors associated with low vitamin D status included residence in subtropical latitudes (adjusted odds ratio [aOR] 1.97, 95% confidence interval [CI] 1.35-2.88), assessment during non-summer seasons (autumn: aOR 1.85, 95% CI 1.20-2.86; spring: 4.3, 2.65-6.95; winter: 10.82, 5.74-20.41), employment (aOR 1.56, 95% CI 1.06-2.38), and assessment before 20 weeks of pregnancy (aOR 1.89, 95% CI 1.18-3.06). Factors protective against low vitamin D status were CD4 count below 200 cells per mm(3) (aOR 0.45, 95% CI 0.26-0.77) and protease inhibitors (aOR 0.62, 95% CI 0.40-0.95). CONCLUSION Low vitamin D status was prevalent among pregnant women with HIV infection. Further studies are warranted to identify the impact of low maternal vitamin D status.
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Affiliation(s)
- Jennifer Jao
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | | | | | - Maria L Cruz
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Rhoda S Sperling
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Branch
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George K Siberry
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Pediatric Infectious Disease Branch, Bethesda, MD, USA
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Finkelstein JL, Pressman EK, Cooper EM, Kent TR, Bar HY, O'Brien KO. Vitamin D Status Affects Serum Metabolomic Profiles in Pregnant Adolescents. Reprod Sci 2014; 22:685-95. [PMID: 25367051 DOI: 10.1177/1933719114556477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vitamin D is linked to a number of adverse pregnancy outcomes through largely unknown mechanisms. This study was conducted to examine the role of vitamin D status in metabolomic profiles in a group of 30 pregnant, African American adolescents (17.1 ± 1.1 years) at midgestation (26.8 ± 2.8 weeks), in 15 adolescents with 25-hydroxy vitamin D (25(OH)D) ≥20 ng/mL, and in 15 teens with 25(OH)D <20 ng/mL. Serum metabolomic profiles were examined using gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry. A novel hierarchical mixture model was used to evaluate differences in metabolite profiles between low and high groups. A total of 326 compounds were identified and included in subsequent statistical analyses. Eleven metabolites had significantly different means between the 2 vitamin D groups, after correcting for multiple hypothesis testing: pyridoxate, bilirubin, xylose, and cholate were higher, and leukotrienes, 1,2-propanediol, azelate, undecanedioate, sebacate, inflammation associated complement component 3 peptide (HWESASXX), and piperine were lower in serum from adolescents with 25(OH)D ≥20 ng/mL. Lower maternal vitamin D status at midgestation impacted serum metabolic profiles in pregnant adolescents.
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Affiliation(s)
| | - Eva K Pressman
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Elizabeth M Cooper
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Tera R Kent
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Haim Y Bar
- Department of Statistics, University of Connecticut, Storrs, CT, USA
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Jaganath D, Walker AS, Ssali F, Musiime V, Kiweewa F, Kityo C, Salata R, Mugyenyi P. HIV-associated anemia after 96 weeks on therapy: determinants across age ranges in Uganda and Zimbabwe. AIDS Res Hum Retroviruses 2014; 30:523-30. [PMID: 24506102 DOI: 10.1089/aid.2013.0255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Given the detrimental effects of HIV-associated anemia on morbidity, we determined factors associated with anemia after 96 weeks of antiretroviral therapy (ART) across age groups. An HIV-positive cohort (n=3,580) of children age 5-14, reproductive age adults 18-49, and older adults ≥50 from two randomized trials in Uganda and Zimbabwe were evaluated from initiation of therapy through 96 weeks. We conducted logistic and multinomial regression to evaluate common and differential determinants for anemia at 96 weeks on therapy. Prior to initiation of ART, the prevalence of anemia (age 5-11 <10.5 g/dl, 12-14 <11 g/dl, adult females <11 g/dl, adult males <12 g/dl) was 43%, which decreased to 13% at week 96 (p<0.001). Older adults had a significantly higher likelihood of anemia compared to reproductive age adults (OR 2.60, 95% CI 1.44-4.70, p=0.002). Reproductive age females had a significantly higher odds of anemia compared to men at week 96 (OR 2.56, 95% CI 1.92-3.40, p<0.001), and particularly a greater odds for microcytic anemia compared to males in the same age group (p=0.001). Other common factors associated with anemia included low body mass index (BMI) and microcytosis; greater increases in CD4 count to week 96 were protective. Thus, while ART significantly reduced the prevalence of anemia at 96 weeks, 13% of the population continued to be anemic. Specific groups, such as reproductive age females and older adults, have a greater odds of anemia and may guide clinicians to pursue further evaluation and management.
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Affiliation(s)
- Devan Jaganath
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | | | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Robert Salata
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
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Mehta S, Mugusi FM, Bosch RJ, Aboud S, Urassa W, Villamor E, Fawzi WW. Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study. BMJ Open 2013; 3:e003703. [PMID: 24247327 PMCID: PMC3840339 DOI: 10.1136/bmjopen-2013-003703] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Vitamin D is an immunomodulator and can alter response to tuberculosis (TB) treatment, though randomised trials have been inconclusive to date. We present one of the first comprehensive analysis of the associations between vitamin D status and TB treatment, T-cell counts and nutritional outcomes by HIV status. DESIGN Cohort study. SETTING Outpatient clinics in Tanzania. PARTICIPANTS 25-hydroxyvitamin D levels were assessed in a cohort of 677 patients with TB (344 HIV infected) initiating anti-TB treatment at enrolment in a multivitamin supplementation (excluding vitamin D) trial (Clinicaltrials.gov identifier: NCT00197704). PRIMARY AND SECONDARY OUTCOME MEASURES Information on treatment outcomes such as failure and relapse, HIV disease progression, T-cell counts and anthropometry was collected routinely, with a median follow-up of 52 and 30 months for HIV-uninfected and HIV-infected patients, respectively. Cox and binomial regression, and generalised estimating equations were used to assess the association of vitamin D status with these outcomes. RESULTS Mean 25-hydroxyvitamin D concentrations at enrolment were 69.8 (±21.5) nmol/L (27.9 (±8.6) ng/mL). Vitamin D insufficiency (<75 nmol/L) was associated with a 66% higher risk of relapse (95% CI 4% to 164%; 133% higher risk in HIV-uninfected patients). Each unit higher 25-hydroxyvitamin D levels at baseline were associated with a decrease of 3 (p=0.004) CD8 and 3 (p=0.01) CD3 T-cells/µL during follow-up in patients with HIV infection. Vitamin D insufficiency was also associated with a greater decrease of body mass index (BMI; -0.21 kg/m(2); 95% CI -0.39 to -0.02), during the first 8 months of follow-up. No association was observed for vitamin D status with mortality or HIV disease progression. CONCLUSIONS Adequate vitamin D status is associated with a lower risk of relapse and with improved nutritional indicators such as BMI in patients with TB, with or without HIV infection. Further research is needed to determine the optimal dose of vitamin D and effectiveness of daily vitamin D supplementation among patients with TB.
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Affiliation(s)
- Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Ferdinand M Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Ronald J Bosch
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Willy Urassa
- Diagnostics and Laboratory Technology Team, World Health Organization, Geneva, Switzerland
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wafaie W Fawzi
- Departments of Global Health and Population, Nutrition, and Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
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Abstract
The positive effects of vitamin D in different acute and chronic diseases (e.g., bone and renal disorders, acute and chronic respiratory tract infections, and diabetes mellitus), and regulation of immune system function have been shown. In this review vitamin D status and the effects of its supplementation alone or in combination with other bone-modifying substances like calcium and bisphosphonates on the different aspects of human health have been investigated in HIV+ individuals. Three scientific electronic databases have been investigated for extracting related articles. Searching only PubMed yielded 59 results with ‘HIV OR AIDS’ and ‘Vitamin D’ keywords. Because many of the studies in this field are observational or cross-sectional, designing comprehensive and eligible randomized clinical trials has been recommended by several authors in order to develop evidence-based clinical practice guidelines to determine the best regimen of vitamin D supplementation in HIV-infected patients.
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Affiliation(s)
- Ali Tafazoli
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, 1417614411, PO Box 14155/6451, Iran
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Griffin AT, Arnold FW. Review of metabolic, immunologic, and virologic consequences of suboptimal vitamin D levels in HIV infection. AIDS Patient Care STDS 2012; 26:516-25. [PMID: 22861070 DOI: 10.1089/apc.2012.0145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low 25-hydroxyvitamin D levels are common in the general and HIV-infected populations alike. Defined as levels less than 30 ng/mL, suboptimal vitamin D is known to afflict over 70% of representative samples from each group in resource-rich countries with even greater prevalence in resource-poor regions of the world. In both those with and without HIV, dark skin, low vitamin D intake, exiguous exposure to sunlight, and season act as risk factors for suboptimal vitamin D levels. In those infected with HIV, antiretroviral therapy, particularly non-nucleoside reverse transcriptase inhibitors (NNRTIs), increase risk for low vitamin D as well. Furthermore, metabolic aberrations, including obesity and hyperlipidemia, and miscellaneous risk factors, such as advanced AIDS and substance abuse, have been linked to suboptimal vitamin D in those with HIV. While the skeletal and cardiovascular systems of HIV patients may be adversely impacted as a result of low levels, recent data have also linked low vitamin D to decreased CD4 counts, higher viral loads, and to critical end points including progression to AIDS events and death. More research is needed to confirm these potential consequences of low vitamin D in those with HIV and to discern the benefits of routine screening for and treatment of low vitamin D in this population.
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Affiliation(s)
- Allen T. Griffin
- School of Medicine, Department of Medicine, Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
| | - Forest W. Arnold
- School of Medicine, Department of Medicine, Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
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Kæstel P, Martinussen T, Aaby P, Michaelsen KF, Friis H. Serum retinol is associated with stage of pregnancy and the acute phase response in pregnant women in Guinea-Bissau. J Nutr 2012; 142:942-7. [PMID: 22437561 DOI: 10.3945/jn.111.155937] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Vitamin A deficiencies in pregnancy may impair the health of the mother and the growth, development, and later health of her offspring. However, the understanding of the variability of micronutrient status markers during pregnancy is limited. We measured serum retinol and β-carotene and the acute phase proteins C-reactive protein (CRP) and α(1)-antichymotrypsin (ACT) in 738 pregnant women in a cross-sectional study in Guinea-Bissau, West Africa. Gestational age ranged from 7 to 42 wk (mean ± SD = 23 ± 7 wk). The serum retinol concentration was 1.03 ± 0.33 μmol/L (mean ± SD) whereas serum β-carotene was 1.40 (0.85, 2.13) μmol/L [median (25, 75 percentile)]. Vitamin A deficiency (serum retinol <0.70 μmol/L) was observed in 13.8% of individuals. Serum CRP was elevated (>3 mg/L) in 51.6% of individuals and ACT (>0.3 g/L) in 66.3%. Gestational age >20 wk (β = -0.11; P < 0.001) as well as elevated serum CRP (β = -0.16; P < 0.001) and ACT (β = -0.80; P = 0.004) were associated with lower serum retinol. Based on this large cross-sectional study, we suggest that serum retinol and its conventional cutoff may be underestimating the vitamin A status in late pregnancy and in populations with high prevalence of infections. However, prospective cohort studies measuring the serum concentration of retinol during and after pregnancy and inflammation are needed to describe the physiological behavior of serum retinol and thereby to improve the assessment of vitamin A status.
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Affiliation(s)
- Pernille Kæstel
- Department of Human Nutrition, Faculty of Science, University of Copenhagen, Denmark.
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Current World Literature. Curr Opin Obstet Gynecol 2011; 23:481-5. [DOI: 10.1097/gco.0b013e32834dce59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bibliography. Parathyroids, bone and mineral metabolism. Current world literature. Curr Opin Endocrinol Diabetes Obes 2011; 18:418-22. [PMID: 22024994 DOI: 10.1097/med.0b013e32834decbe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Severe anaemia is common in Africa. It has a high mortality and particularly affects young children and pregnant women. Recent research provides new insights into the mechanisms and causes of severe acquired anaemia and overturns accepted dogma. Deficiencies of vitamin B12 and vitamin A, but not of iron or folic acid, are associated with severe anaemia. Bacterial infections and, in very young children, hookworm infections are also common in severe anaemia. Irrespective of the aetiology, the mechanism causing severe anaemia is often red cell production failure. Severe anaemia in Africa is therefore a complex multi-factorial syndrome, which, even in an individual patient, is unlikely to be amenable to a single intervention. Policies and practices concerning anaemia diagnosis, treatment and prevention need to be substantially revised if we are to make a significant impact on the huge burden of severe anaemia in Africa.
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Affiliation(s)
- Michael B van Hensbroek
- Emma Children's Hospital, Amsterdam Medical Centre, Amsterdam, NetherlandsLiverpool School of Tropical Medicine, Liverpool, UK
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Biesalski HK. Vitamin D Recommendations – Beyond Deficiency. ANNALS OF NUTRITION AND METABOLISM 2011; 59:10-6. [DOI: 10.1159/000332066] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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