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Abbaszadeh F, Javadpour P, Mousavi Nasab MM, Jorjani M. The Role of Vitamins in Spinal Cord Injury: Mechanisms and Benefits. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2024; 2024:4293391. [PMID: 38938696 PMCID: PMC11211004 DOI: 10.1155/2024/4293391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/18/2024] [Accepted: 06/06/2024] [Indexed: 06/29/2024]
Abstract
Spinal cord injury (SCI) is a common neurological disease worldwide, often resulting in a substantial decrease in quality of life, disability, and in severe cases, even death. Unfortunately, there is currently no effective treatment for this disease. Nevertheless, current basic and clinical evidence suggests that vitamins, with their antioxidant properties and biological functions, may play a valuable role in improving the quality of life for individuals with SCI. They can promote overall health and facilitate the healing process. In this review, we discuss the mechanisms and therapeutic potential of vitamins in the treatment of SCI.
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Affiliation(s)
- Fatemeh Abbaszadeh
- Neurobiology Research CenterShahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Javadpour
- Neuroscience Research CenterShahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Masoumeh Jorjani
- Neurobiology Research CenterShahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of PharmacologySchool of MedicineShahid Beheshti University of Medical Sciences, Tehran, Iran
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Serag I, Abouzid M, Elmoghazy A, Sarhan K, Alsaad SA, Mohamed RG. An updated systematic review of neuroprotective agents in the treatment of spinal cord injury. Neurosurg Rev 2024; 47:132. [PMID: 38546884 DOI: 10.1007/s10143-024-02372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/03/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
This systematic review aims to summarize the findings from all clinical randomized trials assessing the efficacy of potential neuroprotective agents in influencing the outcomes of acute spinal cord injuries (SCI). Following the PRISMA guidelines, we conducted comprehensive searches in four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) up to September 5th, 2023. Our analysis included a total of 30 studies. We examined the effects of 15 substances/drugs: methylprednisolone, tirilazad mesylate, erythropoietin, nimodipine, naloxone, Sygen, Rho protein antagonist, granulocyte colony-stimulating factor, autologous macrophages, autologous bone marrow cells, vitamin D, progesterone, riluzole, minocycline, and blood alcohol concentration. Notable improvements in neurological outcomes were observed with progesterone plus vitamin D and granulocyte colony-stimulating factor. In contrast, results for methylprednisolone, erythropoietin, Sygen, Rho Protein, and Riluzole were inconclusive, primarily due to insufficient sample size or outdated evidence. No significant differences were found in the remaining evaluated drugs. Progesterone plus vitamin D, granulocyte colony-stimulating factor, methylprednisolone, Sygen, Rho Protein, and Riluzole may enhance neurological outcomes in acute SCI cases. It is worth noting that different endpoints or additional subgroup analyses may potentially alter the conclusions of individual trials. Therefore, certain SCI grades may benefit more from these treatments than others, while the overall results may remain inconclusive.
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Affiliation(s)
- Ibrahim Serag
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St, 60-806, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, 60-812, Poznan, Poland.
| | | | - Khalid Sarhan
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Rashad G Mohamed
- Mansoura Manchester Program for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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3
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Pedroza-García KA, Careaga-Cárdenas G, Díaz-Galindo C, Quintanar JL, Hernández-Jasso I, Ramírez-Orozco RE. Bioactive role of vitamins as a key modulator of oxidative stress, cellular damage and comorbidities associated with spinal cord injury (SCI). Nutr Neurosci 2023; 26:1120-1137. [PMID: 36537581 DOI: 10.1080/1028415x.2022.2133842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Spinal cord injury (SCI) cause significant disability and impact the quality of life of those affected by it. The nutritional status and diet are fundamental to diminish the progression of complications; vitamins modulate the inflammatory response and oxidative stress, promote blood-spinal cord barrier preservation and the prompt recovery of homeostasis. A deep knowledge of the benefits achieved from vitamins in patients with SCI are summarized. Information of dosage, time, and effects of vitamins in these patients are also displayed. Vitamins have been extensively investigated; however, more clinical trials are needed to clarify the scope of vitamin supplementation.Objective: The objective of this review was to offer relevant therapeutic information based on vitamins supplementation for SCI patients.Methods: Basic and clinical studies that have implemented the use of vitamins in SCI were considered. They were selected from the year 2000-2022 from three databases: PubMed, Science Direct and Google Scholar.Results: Consistent benefits in clinical trials were shown in those who were supplemented with vitamin D (prevents osteoporosis and improves physical performance variables), B3 (improves lipid profile) and B12 (neurological prophylaxis of chronic SCI damage) mainly. On the other hand, improvement related to neuroprotection, damage modulation (vitamin A) and its prophylaxis were associated to B complex vitamins supplementation; the studies who reported positive results are displayed in this review.Discussion: Physicians should become familiar with relevant information that can support conventional treatment in patients with SCI, such as the use of vitamins, a viable option that can improve outcomes in patients with this condition.
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Affiliation(s)
- Karina A Pedroza-García
- Departamento de Nutrición, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Gabriela Careaga-Cárdenas
- Biomedical Research, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Carmen Díaz-Galindo
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - J Luis Quintanar
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Irma Hernández-Jasso
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Ricardo E Ramírez-Orozco
- Departamento de Nutrición, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, México
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Guha L, Kumar H. Drug Repurposing for Spinal Cord Injury: Progress Towards Therapeutic Intervention for Primary Factors and Secondary Complications. Pharmaceut Med 2023; 37:463-490. [PMID: 37698762 DOI: 10.1007/s40290-023-00499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/13/2023]
Abstract
Spinal cord injury (SCI) encompasses a plethora of complex mechanisms like the involvement of major cell death pathways, neurodegeneration of spinal cord neurons, overexpression of glutaminergic transmission and inflammation cascade, along with different co-morbidities like neuropathic pain, urinary and sexual dysfunction, respiratory and cardiac failures, making it one of the leading causes of morbidity and mortality globally. Corticosteroids such as methylprednisolone and dexamethasone, and non-steroidal anti-inflammatory drugs such as naproxen, aspirin and ibuprofen are the first-line treatment options for SCI, inhibiting primary and secondary progression by preventing inflammation and action of reactive oxygen species. However, they are constrained by a short effective drug administration window and their pharmacological action being limited to symptomatic relief of the secondary effects related to spinal cord injury only. Although post-injury rehabilitation treatments may enable functional recovery, they take a long time to show results. Drug repurposing might be an innovative method for expanding therapy alternatives, utilising drugs that are already approved by various esteemed federal agencies throughout the world. Reutilising a drug molecule to treat SCI can eliminate the need for expensive and lengthy drug discovery processes and pave the way for new therapeutic approaches in SCI. This review summarises marketed drugs that could be repurposed based on their safety and efficacy data. We also discuss their mechanisms of action and provide a list of repurposed drugs under clinical trials for SCI therapy.
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Affiliation(s)
- Lahanya Guha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Opposite Air Force Station, Palaj, P.O-382355, Gandhinagar, Gujarat, India
| | - Hemant Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Opposite Air Force Station, Palaj, P.O-382355, Gandhinagar, Gujarat, India.
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Garcia E, Buzoianu-Anguiano V, Silva-Garcia R, Esparza-Salazar F, Arriero-Cabañero A, Escandon A, Doncel-Pérez E, Ibarra A. Use of Cells, Supplements, and Peptides as Therapeutic Strategies for Modulating Inflammation after Spinal Cord Injury: An Update. Int J Mol Sci 2023; 24:13946. [PMID: 37762251 PMCID: PMC10531377 DOI: 10.3390/ijms241813946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Spinal cord injury is a traumatic lesion that causes a catastrophic condition in patients, resulting in neuronal deficit and loss of motor and sensory function. That loss is caused by secondary injury events following mechanical damage, which results in cell death. One of the most important events is inflammation, which activates molecules like proinflammatory cytokines (IL-1β, IFN-γ, and TNF-α) that provoke a toxic environment, inhibiting axonal growth and exacerbating CNS damage. As there is no effective treatment, one of the developed therapies is neuroprotection of the tissue to preserve healthy tissue. Among the strategies that have been developed are the use of cell therapy, the use of peptides, and molecules or supplements that have been shown to favor an anti-inflammatory environment that helps to preserve tissue and cells at the site of injury, thus favoring axonal growth and improved locomotor function. In this review, we will explain some of these strategies used in different animal models of spinal cord injury, their activity as modulators of the immune system, and the benefits they have shown.
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Affiliation(s)
- Elisa Garcia
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan 52786, Mexico; (E.G.); (F.E.-S.); (A.E.)
| | - Vinnitsa Buzoianu-Anguiano
- Grupo Regeneración Neural, Hospital Nacional de Parapléjicos, SESCAM, 45071 Toledo, Spain; (V.B.-A.); (A.A.-C.)
| | - Raúl Silva-Garcia
- Unidad de Investigación Médica en Inmunología Hospital de Pediatría, CMN-SXXI, IMSS, Mexico City 06720, Mexico;
| | - Felipe Esparza-Salazar
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan 52786, Mexico; (E.G.); (F.E.-S.); (A.E.)
| | - Alejandro Arriero-Cabañero
- Grupo Regeneración Neural, Hospital Nacional de Parapléjicos, SESCAM, 45071 Toledo, Spain; (V.B.-A.); (A.A.-C.)
| | - Adela Escandon
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan 52786, Mexico; (E.G.); (F.E.-S.); (A.E.)
| | - Ernesto Doncel-Pérez
- Grupo Regeneración Neural, Hospital Nacional de Parapléjicos, SESCAM, 45071 Toledo, Spain; (V.B.-A.); (A.A.-C.)
| | - Antonio Ibarra
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan 52786, Mexico; (E.G.); (F.E.-S.); (A.E.)
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Ortega MA, Fraile-Martinez O, García-Montero C, Haro S, Álvarez-Mon MÁ, De Leon-Oliva D, Gomez-Lahoz AM, Monserrat J, Atienza-Pérez M, Díaz D, Lopez-Dolado E, Álvarez-Mon M. A comprehensive look at the psychoneuroimmunoendocrinology of spinal cord injury and its progression: mechanisms and clinical opportunities. Mil Med Res 2023; 10:26. [PMID: 37291666 PMCID: PMC10251601 DOI: 10.1186/s40779-023-00461-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
Spinal cord injury (SCI) is a devastating and disabling medical condition generally caused by a traumatic event (primary injury). This initial trauma is accompanied by a set of biological mechanisms directed to ameliorate neural damage but also exacerbate initial damage (secondary injury). The alterations that occur in the spinal cord have not only local but also systemic consequences and virtually all organs and tissues of the body incur important changes after SCI, explaining the progression and detrimental consequences related to this condition. Psychoneuroimmunoendocrinology (PNIE) is a growing area of research aiming to integrate and explore the interactions among the different systems that compose the human organism, considering the mind and the body as a whole. The initial traumatic event and the consequent neurological disruption trigger immune, endocrine, and multisystem dysfunction, which in turn affect the patient's psyche and well-being. In the present review, we will explore the most important local and systemic consequences of SCI from a PNIE perspective, defining the changes occurring in each system and how all these mechanisms are interconnected. Finally, potential clinical approaches derived from this knowledge will also be collectively presented with the aim to develop integrative therapies to maximize the clinical management of these patients.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Sergio Haro
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Miguel Ángel Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Diego De Leon-Oliva
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Ana M. Gomez-Lahoz
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Mar Atienza-Pérez
- Service of Rehabilitation, National Hospital for Paraplegic Patients, Carr. de la Peraleda, S/N, 45004 Toledo, Spain
| | - David Díaz
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Elisa Lopez-Dolado
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology Service and Internal Medicine, University Hospital Príncipe de Asturias (CIBEREHD), 28806 Alcala de Henares, Spain
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Hertig-Godeschalk A, Ruettimann B, Valido E, Glisic M, Stoyanov J, Flueck JL. Energy Availability and Nutritional Intake during Different Training Phases of Wheelchair Athletes. Nutrients 2023; 15:nu15112578. [PMID: 37299541 DOI: 10.3390/nu15112578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Optimizing nutritional intake and timing helps athletes to improve performance and long-term health. Different training phases can require varying nutritional needs. In this study, we conducted a descriptive assessment of dietary intake, energy availability (EA), and blood biochemical parameters in elite wheelchair athletes during distinct training phases. Data analyzed in this study were collected as part of a randomized controlled crossover trial exploring the feasibility of probiotics and prebiotic supplementation. Data were obtained from consecutive three-day diaries and blood samples, both collected at four different time points across four consecutive months. We included 14 athletes (mean (standard deviation) age 34 (9) years, eight females, and six males) active in different wheelchair sports. The mean daily nutritional intake (g/kg body mass) for females and males was 2.7 (0.9) and 4.0 (0.7) for carbohydrates, 1.1 (0.3) and 1.5 (0.3) for protein, and 0.8 (0.3) and 1.4 (0.2) for fat. EA did not change across the four time points in either female (p = 0.30) or male (p = 0.05) athletes. The mean EA was lower in female athletes compared to male athletes (p = 0.03). Low EA (≤30 kcal/ kg fat-free mass/day) was observed in female (58 (29) % of days) and male (34 (23) % of days) athletes. Iron deficiency with anemia was observed in two female athletes. Mean vitamin D levels were insufficient (<75 nmol/L). Macronutrient intake, EA, and blood biochemical parameters were suboptimal in this cohort of elite wheelchair athletes, especially in female athletes.
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Affiliation(s)
- Anneke Hertig-Godeschalk
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207 Nottwil, Switzerland
| | - Belinda Ruettimann
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207 Nottwil, Switzerland
| | - Ezra Valido
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences, University of Lucerne, 6002 Lucerne, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Joelle L Flueck
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207 Nottwil, Switzerland
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Hertig-Godeschalk A, Scheel-Sailer A, Wey Y, Perret C, Lehnick D, Krebs J, Jenny A, Flueck JL. Prevalence of an insufficient vitamin D status at the onset of a spinal cord injury - a cross-sectional study. Spinal Cord 2023; 61:211-217. [PMID: 36581746 DOI: 10.1038/s41393-022-00873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE This study aimed to investigate the vitamin D status after acute spinal cord injury (SCI) onset. SETTING Specialized SCI rehabilitation center in Switzerland. METHODS Patients admitted to the center after an acute SCI onset were included. The prevalence of a deficient (25(OH)D ≤ 50 nmol/l), insufficient (50 < 25(OH)D ≤ 75 nmol/l) and sufficient (25(OH)D > 75 nmol/l) vitamin D status were determined after admission. Vitamin D status was compared between different patient groups based on demographic and SCI characteristics. The occurrence of bed rest, falls and pressure injuries were also assessed. RESULTS In total, 87 patients (median (interquartile range); 53 (39-67) years, 25 females, 66 traumatic SCI, 54 paraplegia) were included. Assessed a median of 15 (9-22) days after SCI onset, median vitamin D status was 41 (26-57) (range 8-155) nmol/l. The majority of patients had a deficient (67%, 95% confidence interval (95% CI) 0.56-0.76) or insufficient (25%, 95% CI 0.17-0.36) vitamin D status. A moderate negative correlation was found between vitamin D status and body mass index (p = 0.003). A moderate positive correlation was found between vitamin D and calcium status (p = 0.01). CONCLUSION A deficient or insufficient vitamin D status directly after SCI onset is highly prevalent. Vitamin D status should be carefully observed during acute SCI rehabilitation. We recommend that all patients with recent SCI onset should receive vitamin D supplementation with a dosage depending on their actual vitamin D status.
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Affiliation(s)
| | - Anke Scheel-Sailer
- Department of Rehabilitation, Swiss Paraplegic Centre Nottwil, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Yannick Wey
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, Nottwil, Switzerland
| | - Claudio Perret
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, Nottwil, Switzerland
| | - Dirk Lehnick
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Clinical Trial Unit Central Switzerland, University of Lucerne, Lucerne, Switzerland
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Andreas Jenny
- Department of Rehabilitation, Swiss Paraplegic Centre Nottwil, Nottwil, Switzerland
| | - Joelle L Flueck
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, Nottwil, Switzerland
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Wang L, Gan J, Wu J, Zhou Y, Lei D. Impact of vitamin D on the prognosis after spinal cord injury: A systematic review. Front Nutr 2023; 10:920998. [PMID: 36866055 PMCID: PMC9973556 DOI: 10.3389/fnut.2023.920998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
Vitamin D (VitD) insufficiency is a worldwide health problem and affects billions of people. Spinal cord injury (SCI) patients seem more susceptible to developing suboptimal levels of VitD. However, the literature regarding its impact on the prognosis of SCI is limited. Thus, in this review, we systematically investigated the published studies via a combination of keywords associated with SCI and VitD in four medical databases (Medline, Embase, Scopus, and Web of Science). All included studies were analyzed, and selected clinical data on the prevalence of VitD insufficiency (serum 25-hydroxyvitamin D < 30 ng/ml) and deficiency (serum 25-hydroxyvitamin D < 20 ng/ml) were collected for further meta-analysis via random effects. Through literature review, a total of 35 studies were eligible and included. The meta-analysis of VitD status (13 studies, 1,962 patients) indicated high prevalence of insufficiency (81.6% [75.7, 87.5]) and deficiency (52.5% [38.1, 66.9]) after SCI. Besides, low levels of VitD were reported to be associated with a higher risk of skeletal diseases, venous thromboembolism, psychoneurological syndromes, and chest illness after injury. Existing literature suggested that supplemental therapy might act as an adjuvant treatment to facilitate post-injury rehabilitation. Non-human experimental studies highlighted the neuroprotective effect of VitD, which was associated with enhancing axonal and neuronal survival, suppressing neuroinflammation, and modulating autophagy. Therefore, the current evidence suggests that the prevalence of VitD insufficiency is high in the SCI population, and low-level VitD may impair functional restoration after SCI. VitD supplemental treatment may have potential benefits to accelerate rehabilitation in mechanistically related processes after SCI. However, due to the limitation of the available evidence, more well-designed randomized controlled trials and mechanism experimental research are still needed to validate its therapeutic effect, elucidate its neuroprotective mechanism, and develop novel treatments.
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Affiliation(s)
- Lei Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | | | | | - Deqiang Lei
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Prevalence of vitamin D deficiency in patients with spinal cord injury at admission: a single-centred study in the UK. J Nutr Sci 2023; 12:e24. [PMID: 36843972 PMCID: PMC9947757 DOI: 10.1017/jns.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 02/22/2023] Open
Abstract
Vitamin D deficiency is prevalent in patients with chronic spinal cord injury (SCI) and has been implicated as an aetiologic factor of osteoporosis and various skeletal and extra-skeletal issues in SCI patients. Few data were available regarding vitamin D status in patients with acute SCI or immediately assessed at hospital admission. This retrospective cross-sectional study evaluated vitamin D status in SCI patients at admission to a UK SCI centre in January-December 2017. A total of 196 eligible patients with serum 25(OH)D concentration records at admission were recruited. The results found that 24 % were vitamin D deficient (serum 25(OH)D < 25 nmol/l), 57 % of the patients had serum 25(OH)D < 50 nmol/l. The male patients, patients admitted in the winter-spring time (December-May), and patients with serum sodium < 135 mmol/l or with non-traumatic causes had a significant higher prevalence of vitamin D deficiency than their counterparts (28 % males v. 11⋅8 % females, P = 0⋅02; 30⋅2 % in winter-spring v. 12⋅9 % in summer-autumn, P = 0⋅007; 32⋅1 % non-traumatic v. 17⋅6 % traumatic SCI, P = 0⋅03; 38⋅9 % low serum sodium v. 18⋅8 % normal serum sodium, P = 0⋅010). There was a significant inverse association of serum 25(OH)D concentration with body mass index (BMI) (r = -0⋅311, P = 0⋅002), serum total cholesterol (r = -0⋅168, P = 0⋅04) and creatinine concentrations (r = -0⋅162, P = 0⋅02) that were also significant predictors of serum 25(OH)D concentration. Strategies for systematic screening and efficacy of vitamin D supplementation in SCI patients need to be implemented and further investigated to prevent the vitamin D deficiency-related chronic complications.
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Hertig-Godeschalk A, Brinkhof MWG, Scheel-Sailer A, Perret C, Jenny A, Landmann G, Wyss PO, Flueck JL. Vitamin D supplementation in chronic spinal cord injury (VitD-SCI): study protocol for a randomised controlled trial. BMJ Open 2021; 11:e053951. [PMID: 34921084 PMCID: PMC8685947 DOI: 10.1136/bmjopen-2021-053951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Vitamin D insufficiency, a vitamin D status or serum 25(OH)D concentration of ≤75 nmol/L, is highly prevalent in individuals with a spinal cord injury (SCI). Vitamin D is important for the functioning of the musculoskeletal, immune and respiratory systems, which are relevant determinants of secondary health conditions in SCI. An insufficiency should be treated with vitamin D supplementation. However, there is a lack of evidence regarding the optimal dosage and duration of vitamin D supplementation for individualised and long-term management of the vitamin D status in the context of SCI. This paper presents the protocol for the vitamin D supplementation in chronic spinal cord injury (VitD-SCI) trial that aims to investigate the effect of a 12-month intake of vitamin D supplementation on vitamin D status as well as on several secondary parameters among individuals with a chronic SCI. METHODS AND ANALYSES The VitD-SCI trial is a randomised, placebo-controlled, double-blinded, parallel-group, superiority trial, conducted at the Swiss Paraplegic Centre. A total of 45 participants living with an SCI for at least 3 years (chronic SCI) and a vitamin D insufficiency at the first study visit, will be randomly assigned to one of three intervention groups. Participants receive either a monthly dosage of 24 000 IU or 48 000 IU vitamin D or a placebo for 12 months. Measurements taking place every 3 months include the assessment of vitamin D status (primary outcome) as well as bone mineral density, handgrip strength, fatigue, mood, pain and pressure injuries (secondary outcomes). Safety and tolerance of vitamin D supplementation will also be evaluated. ETHICS AND DISSEMINATION The Swiss Ethics Committee for Northwest/Central Switzerland (EKNZ, 2020-01493) and the Swiss Agency for Therapeutic Products (Swissmedic, 2020DR3150) approved this study. Findings will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBERS NCT04652544 and SNCTP000004032.
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Affiliation(s)
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzerne, Switzerland
| | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Luzerne, Switzerland
- Department of Rehabilitation, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Claudio Perret
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Andreas Jenny
- Department of Rehabilitation, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Gunter Landmann
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Patrik O Wyss
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
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Köhli P, Otto E, Jahn D, Reisener MJ, Appelt J, Rahmani A, Taheri N, Keller J, Pumberger M, Tsitsilonis S. Future Perspectives in Spinal Cord Repair: Brain as Saviour? TSCI with Concurrent TBI: Pathophysiological Interaction and Impact on MSC Treatment. Cells 2021; 10:2955. [PMID: 34831179 PMCID: PMC8616497 DOI: 10.3390/cells10112955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022] Open
Abstract
Traumatic spinal cord injury (TSCI), commonly caused by high energy trauma in young active patients, is frequently accompanied by traumatic brain injury (TBI). Although combined trauma results in inferior clinical outcomes and a higher mortality rate, the understanding of the pathophysiological interaction of co-occurring TSCI and TBI remains limited. This review provides a detailed overview of the local and systemic alterations due to TSCI and TBI, which severely affect the autonomic and sensory nervous system, immune response, the blood-brain and spinal cord barrier, local perfusion, endocrine homeostasis, posttraumatic metabolism, and circadian rhythm. Because currently developed mesenchymal stem cell (MSC)-based therapeutic strategies for TSCI provide only mild benefit, this review raises awareness of the impact of TSCI-TBI interaction on TSCI pathophysiology and MSC treatment. Therefore, we propose that unravelling the underlying pathophysiology of TSCI with concomitant TBI will reveal promising pharmacological targets and therapeutic strategies for regenerative therapies, further improving MSC therapy.
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Affiliation(s)
- Paul Köhli
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ellen Otto
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Denise Jahn
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marie-Jacqueline Reisener
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
| | - Jessika Appelt
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Adibeh Rahmani
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nima Taheri
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
| | - Johannes Keller
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
- University Hospital Hamburg-Eppendorf, Department of Trauma Surgery and Orthopaedics, Martinistraße 52, 20246 Hamburg, Germany
| | - Matthias Pumberger
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
| | - Serafeim Tsitsilonis
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
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Waliullah S, Kumar D, Kumar D, Tewari PG, Kumar V, Srivastava RN. Prevalence of Vitamin D Deficiency in a Young Adult With Acute Spinal Cord Injury. Cureus 2021; 13:e13791. [PMID: 33842165 PMCID: PMC8027954 DOI: 10.7759/cureus.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Vitamin D deficiency has been implicated as an etiologic factor responsible for osteoporosis and various skeletal and extra-skeletal issues in spinal cord injury patients. There is a dearth of publications regarding the prevalence of vitamin D deficiency in acute spinal cord injury (ASCI) patients, thus it becomes imperative to study the status of vitamin D in ASCI cases to make an early diagnosis and start treatment for osteoporosis. Apart from this, we also planned to evaluate other factors associated with vitamin D deficiency in our subset of patients. Material and methods: This cross-sectional cohort study included patients with acute thoracolumbar spinal cord injury patients admitted to a tertiary trauma centre between July 2019 and July 2020. Patients were assessed clinically and classified as per the American Spinal Cord Injury Association (ASIA) scale. Demographic details along with the mode of trauma and duration of injury were noted. Serum 25(OH) vitamin D3 levels were measured by chemiluminescence immunoassay. Depending upon serum 25(OH) vitamin D3 level, patients were classified into vitamin D deficient with serum level less than 20 ng/ml, vitamin D insufficient with serum level between 21-29 ng/ml and vitamin D sufficient with serum level greater than 30 ng/ml. Results: Mean vitamin D level in 85 ASCI subjects (mean age 30.82 ± 6.77 years, 60 males) was 20.56 ± 11.22 ng/ml. Fifty subjects (58.82%) were vitamin D deficient, 15 subjects (17.64%) were vitamin D insufficient and the rest (n=20, 23.52%) were vitamin D sufficient. There was no significant difference in vitamin D levels as per gender, age, mode of trauma, type of injury and injury location. Patients admitted on the fifth day of injury had maximum vitamin D levels (mean 25.7143 ± 8.32 ng/ml), but it was also insignificant. The mean vitamin D level of subjects with samples taken during the summer season was significantly higher as compared to the winter season (p value <.05). Conclusion: Vitamin D deficiency is widely prevalent in ASCI patients at admission to the trauma centre. Seventy-six percent of patients had vitamin D levels below 30 ng/ml in our study. Routine measurement of 25(OH) vitamin D3 levels at the time of admission is recommended for early diagnosis of vitamin D deficiency. Early treatment will be helpful in the prevention of osteoporosis and its long-term related consequences.
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Affiliation(s)
- Shah Waliullah
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Deepak Kumar
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Dharmendra Kumar
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Prakash G Tewari
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Vineet Kumar
- Department of Orthopaedic Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
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Weaver FM, Etingen B, Guihan M, Ray C, Priebe M, Burns S, Carbone L. Spinal cord injury providers' perspectives on managing sublesional osteoporosis. J Spinal Cord Med 2020; 43:428-434. [PMID: 31859610 PMCID: PMC7480594 DOI: 10.1080/10790268.2019.1704552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: Persons with spinal cord injuries (SCI) experience rapid sublesional bone loss following injury (1, 3). Evidence on preventing/managing osteoporosis in SCI is lacking. This project examined how providers manage bone loss in SCI. Design: Telephone interviews with SCI providers. Setting: VA SCI centers and clinics. Participants: Veterans Administration SCI centers and clinics were categorized on their average number of dual-energy X-ray absorptiometry (DXA) scans (FY2014-2016). Twelve SCI providers from high and low DXA-ordering sites were interviewed. Questions included osteoporosis screening/diagnosis, prevention/treatment strategies, secondary causes of osteoporosis, and osteoporotic fracture complications. Interviews were audio-recorded, transcribed, and analyzed. Results: Providers described a lack of standardized guidelines for managing osteoporosis in SCI. They most often screened for osteoporosis using DXA when: (1) considering use of a new device or activity, (2) for patients with a history of fracture. Some providers assumed that non-ambulatory SCI patients already have osteoporosis so infrequently ordered DXAs. Assessment of secondary causes of osteoporosis was uncommon. Fracture prevention strategies identified included weight-bearing and engaging in activities like adaptive sports. Vitamin D and calcium were frequently prescribed as a result of deficiencies identified during lab testing. Providers seldom prescribed FDA-approved medications for osteoporosis. Post-fracture complications encountered included nonunion/malunion and compartment syndrome. Providers indicated that patients often experienced psychological stress, anxiety and depression following fractures. Conclusion: Providers described a lack of evidence for screening and management of patients with SCI and osteoporosis. Future efforts should include developing evidence-informed guidelines to aid providers in osteoporosis management.
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Affiliation(s)
- Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines VA Hospital, Hines, Illinois, USA,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA,Correspondence to: Frances M. Weaver, Edward Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL60304, USA.
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines VA Hospital, Hines, Illinois, USA
| | - Marylou Guihan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines VA Hospital, Hines, Illinois, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines VA Hospital, Hines, Illinois, USA
| | - Michael Priebe
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Stephen Burns
- Department of Veterans Affairs-Puget Sound Health Care System, Seattle, Washington, USA,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Laura Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA,Department of Medicine, Division of Rheumatology, J. Harold Harrison, MD, Distinguished Chair in Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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15
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Impact of vitamin D on mobilization, pulmonary function tests, grip strength and functionality in patients with spinal cord injury: A cross-sectional study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.689130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mailhot G, Lamarche J, Gagnon DH. Effectiveness of two vitamin D 3 repletion protocols on the vitamin D status of adults with a recent spinal cord injury undergoing inpatient rehabilitation: a prospective case series. Spinal Cord Ser Cases 2018; 4:96. [PMID: 30393567 DOI: 10.1038/s41394-018-0129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 01/24/2023] Open
Abstract
Study design Prospective case series. Objectives To assess the effectiveness and safety of two vitamin D3 repletion protocols given to individuals with spinal cord injury (SCI). Setting Publicly-funded intensive inpatient rehabilitation center, Montreal, Canada. Methods Thirty adults with recent SCI complete or incomplete sensorimotor impairments were recruited upon admission from designated regional SCI trauma centers. Participants with serum 25OHD ≤ 30 nmol/L were given 10,000 IU of weekly and 1000 IU of daily vitamin D3 for 36.8 ± 11.9 days (higher dose: HD). Subjects with serum 25OHD > 30 nmol/L received 1000 IU of daily vitamin D3 for 38.2 ± 11.6 days (lower dose: LD). Outcomes were changes in 25OHD levels from baseline to the end of the study period and safety outcomes. Thresholds for vitamin D deficiency, insufficiency and sufficiency were: 25OHD levels ≤30 nmol/L, 30-74 nmol/L, and ≥75 nmol/L. Results At baseline, 34 and 66% of participants had serum 25OHD < 30 and >30 nmol/L. Both protocols induced a rise in serum 25OHD with a greater increase in the HD vs. LD regimen (31.4 [95% CI: 16.7, 46.0] vs. 11.7 nmol/L [95% CI: 2.2, 21.2]). None of the participants given the HD remained vitamin D deficient, but only one achieved vitamin D sufficiency. Nearly all individuals on the LD regimen remained vitamin D insufficient with only two reaching vitamin D sufficiency. No adverse effects were observed over the course of the supplementation. Conclusions Although 1000 IU of daily vitamin D3 alone or in combination with weekly 10,000 IU for an average of 37.6 days increased serum 25OHD, they were unsuccessful in improving the impaired vitamin D status during inpatient rehabilitation of individuals with a recent SCI.
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Affiliation(s)
- Geneviève Mailhot
- 1Research Centre, CHU Sainte-Justine, Montreal, Quebec Canada.,2Department of Nutrition, Université de Montréal, Montreal, Quebec Canada
| | - Josée Lamarche
- 2Department of Nutrition, Université de Montréal, Montreal, Quebec Canada.,3Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec Canada.,4Institut universitaire sur la réadaptation en déficience physique de Montréal of the Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec Canada
| | - Dany H Gagnon
- 3Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec Canada.,4Institut universitaire sur la réadaptation en déficience physique de Montréal of the Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec Canada.,5School of Rehabilitation, Université de Montréal, Montreal, Quebec Canada
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Koutrakis NE, Goldstein RL, Walia P, Polak MM, Lazzari AA, Tun CG, Hart JE, Garshick E. Vitamin D, diet, and lifestyle in a chronic SCI population. Spinal Cord 2018; 57:117-127. [PMID: 30089890 PMCID: PMC6359957 DOI: 10.1038/s41393-018-0148-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/24/2018] [Accepted: 03/29/2018] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES Determine dietary, lifestyle, and clinical factors associated with plasma 25-hydroxyvitamin D [25(OH)D] levels in persons with chronic spinal cord injury (SCI). SETTING Veterans Affairs Medical Center in Boston, MA. METHODS 174 participants completed food frequency and health questionnaires, provided a blood sample, and underwent dual x-ray absorptiometry (DXA) to assess %total body fat. Linear regression models were used to assess cross-sectional associations of personal, lifestyle, and nutritional factors with plasma 25(OH)D. RESULTS Independent factors positively associated with higher plasma 25(OH)D included vitamin D intake, age, hours of planned exercise, female sex, white race, wine consumption, and if a never or former smoker. The most important predictor of 25(OH)D was supplement intake. The majority of subjects (98.9% for vitamin D and 74.1% for calcium) did not meet the recommended daily allowance for adults from their diet alone. Level and completeness of SCI, injury duration, mobility, %total body fat, time outside, and comorbid diseases were not associated with plasma 25(OH)D. CONCLUSIONS Plasma 25(OH)D level in chronic SCI is not associated with clinical factors specific to SCI such as injury level and completeness, injury duration, and mobility mode, but related to supplement intake and other lifestyle factors.
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Affiliation(s)
| | - Rebekah L Goldstein
- Research and Development Service, VA Boston Healthcare System, Boston, MA, USA
| | - Palak Walia
- Research and Development Service, VA Boston Healthcare System, Boston, MA, USA
| | - Madeline M Polak
- Research and Development Service, VA Boston Healthcare System, Boston, MA, USA
| | - Antonio A Lazzari
- Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - Carlos G Tun
- Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA, USA
| | - Jaime E Hart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Eric Garshick
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA, USA.
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