Associations of C-reactive Protein with 25-hydroxyvitamin D in 24 Specific Diseases: A Cross-sectional Study from NHANES

Vitamin D Deficiency, Inflammation, and Diminished Endogenous Regenerative Capacity in Coronary Heart Disease

Background

Vitamin D deficiency (VDD) is associated with coronary heart disease (CHD) and poor outcomes, but supplementation does not improve prognosis. VDD has been implicated in and may promote greater risk through inflammation and impaired progenitor cell function.

Objectives

The authors examined VDD, high-sensitivity C-reactive protein (hsCRP), circulating progenitor cell (CPC) counts, and outcomes in patients with CHD. They hypothesized that the higher risk with VDD is mediated by inflammation and impaired regenerative capacity.

Methods

A total of 5,452 individuals with CHD in the Emory Cardiovascular Biobank had measurement of 25-hydroxyvitamin D, subsets of whom had hsCRP measurements and CPCs estimated as CD34-expressing mononuclear cell counts. Findings were validated in an independent cohort. 25-hydroxyvitamin D <20 ng/mL was considered VDD. Cox and Fine-Gray models determined associations between marker levels and: 1) all-cause mortality; 2) cardiovascular mortality; and 3) major adverse cardiovascular events, a composite of adverse CHD outcomes.

Results

VDD (43.6% of individuals) was associated with higher adjusted cardiovascular mortality (HR: 1.57, 95% CI: 1.09-2.28). There were significant interactions between VDD and hsCRP and CPC counts in predicting cardiovascular mortality. Individuals with both VDD and elevated hsCRP had the greatest risk (HR: 2.82, 95% CI: 2.16-3.67). Only individuals with both VDD and low CPC counts were at high risk (HR: 2.25, 95% CI: 1.46-3.46). These findings were reproduced in the validation cohort.

Conclusions

VDD predicts adverse outcomes in CHD. Those with VDD, inflammation and/or diminished regenerative capacity are at a significantly greater risk of cardiovascular mortality. Whether targeted supplementation in these high-risk groups improves risk warrants further study.

Vitamin D Status of People 3 to 79 Years of Age from the Canadian Health Measures Survey 2012-2019

BACKGROUND

Vitamin D is recognized in bone health and the prevention of rickets and osteomalacia.

OBJECTIVE

This study aimed to assess vitamin D status of people in Canada and to identify factors associated with vitamin D inadequacy and deficiency.

METHODS

Serum 25-hydroxyvitamin D (25(OH)D) from the Canadian Health Measures Survey (cycles 3-6, n = 21,770, 3-79 y) were evaluated for geometric means and proportions <40 (inadequate) and <30 (risk of deficiency) nmol/L. Factors associated with inadequacy or deficiency were tested using logistic regression.

RESULTS

Mean serum 25(OH)D was 57.9 (95% CI: 55.4, 60.5) nmol/L; the prevalence of inadequacy was 19.0% (95% CI: 15.7, 22.3) and risk of deficiency was 8.4% (95% CI: 6.5, 10.3). Prominent dietary factors associated with inadequacy in adults included: not consuming fish compared with ≥1/wk (adjusted OR_adj: 1.60; 95% CI: 1.21, 2.11), none compared with ≥1/d for cow's milk (OR_adj: 1.41; 95% CI: 1.02, 1.94) or margarine (OR_adj: 1.42; 95% CI: 1.08, 1.88); or nonuser compared with user of vitamin D supplements (OR_adj: 5.21; 95% CI: 3.88, 7.01). Notable demographic factors included: younger adults compared with 71 to 79 y (19-30 y OR_adj: 2.33; 95% CI: 1.66, 3.29); BMI ≥30 compared with <25 kg/m² (OR_adj: 2.30; 95% CI: 1.79, 2.95); lower household income quartile 1 compared with 4 (OR_adj: 1.46; 95% CI: 1.00, 2.15); and self-reported Black (OR_adj: 8.06; 95% CI: 4.71, 13.81), East/Southeast Asian (OR_adj: 3.83; 95% CI: 2.14, 6.85), Middle Eastern (OR_adj: 4.57; 95% CI: 3.02, 6.92), and South Asian (OR_adj: 4.63; 95% CI: 2.62, 8.19) race compared with White. Similar factors were observed in children and for deficiency.

CONCLUSIONS

Most people in Canada have adequate vitamin D status; nonetheless, racialized groups have an elevated prevalence of inadequacy. Further research is required to evaluate if current strategies to improve vitamin D status, including increasing vitamin D in fortified foods and supplements, and dietary guidance to include a source of vitamin D every day help to reduce health inequality in Canada.

Assessment of Vitamin D status and association with inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

BACKGROUND

It is unclear whether 25(OH)D concentrations in children and female adults may be influenced by inflammation and thus require adjustment when estimating the population prevalence of vitamin D deficiency.

OBJECTIVES

We examined correlations between inflammation biomarkers, CRP or alpha-1-acid glycoprotein (AGP), and serum 25(OH)D concentrations among preschool children (PSC; 6-59 mo) and nonpregnant females of reproductive age (FRA; 15-49 y).

METHODS

We analyzed cross-sectional data from 6 nationally representative nutrition surveys (Afghanistan, Cambodia, Pakistan, UK, USA, and Vietnam) conducted among PSC (n = 9880) and FRA (n = 14,749) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project. Rank correlations between CRP or AGP and 25(OH)D concentrations were examined while taking into account complex survey design effects.

RESULTS

Among both PSC and FRA, correlations between inflammation and vitamin D biomarkers were weak and inconsistent across surveys. For PSC, correlation coefficients between CRP and 25(OH)D concentrations ranged from -0.04 to 0.08, and correlations between AGP and 25(OH)D ranged from 0.01 to 0.05. Correlation coefficients between CRP and 25(OH)D for FRA ranged from -0.11 to 0.14, and correlations between AGP and 25(OH)D concentrations ranged from -0.05 to 0.01.

CONCLUSIONS

Based on the weak and inconsistent correlations between CRP or AGP and 25(OH)D, there is no rationale to adjust for these inflammation biomarkers when estimating population prevalence of vitamin D deficiency in PSC or FRA.

Association of High-Sensitivity C-Reactive Protein and Vitamin D with Bronchial Asthma

Background: Bronchial asthma (BA) is a common lung illness and a significant health concern affecting over 315 million individuals globally. Asthma involves three main pathologies: airways hyperresponsiveness (AHR), inflammation, and remodeling. VitD has a forceful immunomodulatory effect able of reducing inflammatory responses in many cells intricate in BA. Deficiency of vitD has been linked with much inflammation and global worsening of asthmatic patients. C-reactive protein (CRP) is elevated in primary stages of inflammation of BA and high serum CRP values are observed with impaired pulmonary function and AHR. For that reason, it is sensible to explore the role of vitD in BA via its associations with CRP. This comparative study was aimed to evaluate the relationship between serum levels of HSCRP and vitD in patients with asthma. Patients and Methods: This is a case-control study conducted on 127 asthmatic patients with 113 (sex/aged matching) healthy control. The FeNo results had obtained in private centers, according to the ''guidelines of the American Thoracic Society (ATS)''. All participants had blood analysis of HSCRP and correlated with FeNo measures. VitD Values were classified as sufficient (>30ng/ml), insufficient (20 to 30ng/ml), and deficient (<20ng/mL) based on the preceding reference. Statistical Package for Social Sciences (SPSS/23-IBM) had used. The chi-squared test had used for univariate investigation, and a t-test had completed detecting variations between the studied groups, treatment groups, and genders. The outcomes had calculated at a 95% CI and had assigned as significant for all variables. The categorization accuracy of HSCRP, vitD, and FeNo measures had been investigated under the ''ROC curves'' for their diagnostic fitness to decide asthma prediction. Results Compared to the control group, the mean FeNo levels were significantly higher in asthmatics (p-0.001). Vitamin D mean levels were parallel between the study groups (p>0.05). The mean HSCRP levels were significantly (p-0.03) higher among asthmatics. Around 40% of all participants had lower than normal levels of serum VitD and <10% only revealed deficient levels. There was no effect of history of the treatment of BA on the blood levels of vitD and HSCRP. There was a positive non-significant correlation of vitD with FeNo results (r-0.067, p-0.54) and negative non-significant (r-0.082, p-0.086) correlation of vitD with HSCRP. ROC-curve analysis showed a significant ability (p-0.001) of FeNo to distinguish asthma, with high accuracy, sensitivity and specificity: 0.967, 93.5%, 93.2%, at 95% CI [0.946-1.000], respectively. Likewise, ROC analysis of HSCRP revealed significant ability (p-0.001), but with lower accuracy (0.881), sensitivity (87.1%), and specificity (76.3%) at 95% CI [0.812-0.950] to distinguish asthma patients from healthy subjects. Unlikely, VitD had a non-significant (p-0.085) and lower ability to predict asthma from healthy participants showing AUC (0.612), sensitivity (54.8%), and specificity (68.3%) at 95% CI [0.488 -0.736]. Conclusion No relation or minor conflicting correlations between serum levels of vitD with asthma severity, treatment history, and inflammation (as indicated by HSCRP). Highly sensitive CRP is correlated with asthma.

Associations between Vitamin D, Omega 6:Omega 3 Ratio, and Biomarkers of Aging in Individuals Living with and without Chronic Pain

Elevated inflammatory cytokines and chronic pain are associated with shorter leukocyte telomere length (LTL), a measure of cellular aging. Micronutrients, such as 25-hydroxyvitamin D (vitamin D) and omega 3, have anti-inflammatory properties. Little is known regarding the relationships between vitamin D, omega 6:3 ratio, LTL, inflammation, and chronic pain. We investigate associations between vitamin D, omega 6:3 ratio, LTL, and C-reactive protein (CRP) in people living with/without chronic pain overall and stratified by chronic pain status. A cross-sectional analysis of 402 individuals (63% women, 79.5% with chronic pain) was completed. Demographic and health information was collected. Chronic pain was assessed as pain experienced for at least three months. LTL was measured in genomic DNA isolated from blood leukocytes, and micronutrients and CRP were measured in serum samples. Data were analyzed with general linear regression. Although an association between the continuous micronutrients and LTL was not observed, a positive association between omega 6:3 ratio and CRP was detected. In individuals with chronic pain, based on clinical categories, significant associations between vitamin D, omega 6:3 ratio, and CRP were observed. Findings highlight the complex relationships between anti-inflammatory micronutrients, inflammation, cellular aging, and chronic pain.