1
|
Vinod A, Karthiga V, Venkatesh Chakraborty S, Palanisamy S, Rathod S. Association between maternal vitamin D status during late pregnancy and acute lower respiratory tract infections and acute diarrheal disease during infancy - A cohort study. Clin Nutr ESPEN 2024; 64:411-417. [PMID: 39486477 DOI: 10.1016/j.clnesp.2024.10.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 09/30/2024] [Accepted: 10/22/2024] [Indexed: 11/04/2024]
Abstract
BACKGROUND Acute lower respiratory tract infection (ALRI) and acute diarrheal disease (ADD) are the leading causes of mortality in children globally. There is emerging evidence of an association between maternal hypovitaminosis D and ALRI/ADD during infancy. OBJECTIVE To determine whether maternal hypovitaminosis D (25(OH)D [<20 ng/ml] during late pregnancy is associated with increased risk of ALRI/ADD in their offspring during infancy. METHODS This South Indian hospital-based, ambispective cohort study included 140 mother-baby dyads with known maternal vitamin D status before delivery in late third trimester (72 mothers with hypovitaminosis D and 68 mothers with adequate vitamin D level). Babies with cord blood vitamin D deficiency were treated as per consensus guidelines and those with adequate levels were supplemented with 400 IU vitamin D daily for 1 year. All infants were followed up at 6,10,14 weeks and 6, 9, 12 months for the occurrence, frequency, and severity of ALRI (pneumonia, bronchiolitis, viral induced wheezing) and ADD. RESULTS Overall incidence of ALRI was 0.23 per child year during infancy. Incidence of ALRI was 0.12 per child year in adequate maternal vitamin D group versus 0.32 per child year in maternal hypovitaminosis D group (p value = 0.024) and that of bronchiolitis/viral wheeze was 0.07 per child year in adequate maternal vitamin D group versus 0.21 per child year in maternal hypovitaminosis D group (p value = 0.047). Cox regression analysis with maternal hypovitaminosis D level as predictor variable, adjusted for gestational age at birth and other covariates, revealed a hazard ratio of 3.18 (95 % CI: 1.17-8.65, p = 0.023) and 3.63 (95 % CI 1.36-9.65, p = 0.010) for ALRI and ADD respectively. No increased risk for occurrence of pneumonia was observed and none had severe pneumonia. CONCLUSION Maternal hypovitaminosis D is associated with increased risk of ALRI and ADD in their babies during infancy. Routine screening of pregnant women at risk for hypovitaminosis D and supplementation based on 25(OH)D level may decrease the burden of ALRI, for which further studies are needed.
Collapse
Affiliation(s)
- Amritha Vinod
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry-607402, India
| | - Vikneswari Karthiga
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry-607402, India
| | - Soma Venkatesh Chakraborty
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry-607402, India.
| | - Soundararajan Palanisamy
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry-607402, India
| | - Setu Rathod
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry-607402, India
| |
Collapse
|
2
|
Zeng R, Li Y, Shen S, Qiu X, Chang CL, Koplin JJ, Perrett KP, Dharmage SC, Lodge CJ, Lowe AJ. Is antenatal or early-life vitamin D associated with eczema or food allergy in childhood? A systematic review. Clin Exp Allergy 2023; 53:511-525. [PMID: 36648071 DOI: 10.1111/cea.14281] [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: 08/30/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To summarise the associations between antenatal or early-life blood vitamin D and the development of eczema/food allergy in childhood. DESIGN A systematic review and meta-analyses were conducted to synthesize the published literature. Two reviewers independently performed the study selection and data extraction on Covidence. We assessed the risk of bias for observational studies by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool for clinical trials. The certainty of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). DATA SOURCES We systematically searched PubMed and Embase from inception and April 2022. ELIGIBILITY CRITERIA Human studies that investigated prospective associations between antenatal or early-life blood vitamin D levels, dietary intake or supplementation and childhood eczema/food allergy. RESULTS Forty-three articles including six randomised controlled trials (RCTs) were included. Four RCTs of vitamin D supplementation during pregnancy showed no evidence of an effect on the incidence of eczema (pooled odds ratio [OR] = 0.85; 0.67-1.08, I2 = 6.7%, n = 2074). Three RCTs reported null associations between supplementation in pregnancy/infancy and food allergy. From six cohort studies, increasing cord blood vitamin D levels were associated with reduced prevalence of eczema at/close to age one (OR per 10 nmol/L increase = 0.89; 0.84-0.94, I2 = 0%, 2025 participants). We found no evidence of an association between maternal antenatal or infant vitamin D level or dietary intake and the development of food allergy or eczema in offspring. CONCLUSIONS We found an association between higher vitamin D levels in cord blood and reduced risk of eczema in cohort studies. Further trials with maternal and infant supplementation are needed to confirm if vitamin D supplementation can effectively prevent eczema or food allergy in childhood. SYSTEMATIC REVIEW REGISTRATION PROSPERO, No. CRD42013005559.
Collapse
Affiliation(s)
- Rong Zeng
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Yusi Li
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Songying Shen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chia-Lun Chang
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jennifer J Koplin
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Allergy & Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| |
Collapse
|
3
|
Association of food allergy in children with vitamin D insufficiency: a systematic review and meta-analysis. Eur J Pediatr 2023; 182:1533-1554. [PMID: 36790484 DOI: 10.1007/s00431-023-04843-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
Current literature regarding the association of vitamin D insufficiency and food allergy is contradicting. The purpose of our study was to investigate this association. This is a systematic review and meta-analysis according to the PRISMA statement. PubMeD and Scopus databases were systematically searched for case-control studies investigating the association between pediatric food allergy and vitamin D insufficiency. Our search yielded 806 studies. Ten final studies were considered eligible for qualitative and quantitative analysis. Children with vitamin D insufficiency were found to have 68% more probability to present a food allergy episode (adjusted pooled OR: 1.68, 95% CI [1.25-2.27], p-value: 0.001). In their second year of life they were 4 times more likely to present a food allergy episode (adjusted pooled OR: 4.06, 95% CI [1.93-8.56], p-value: < 0.001), and 56% more probable to develop food sensitization (OR: 1.56, 95% CI [1.15-2.11], p-value: < 0.004). Children in Australia with vitamin D insufficiency were almost 4 times more likely to develop egg sensitization (adjusted OR: 3.79, 95% CI [1.19-12.08], p-value: 0.024). Children with vitamin D insufficiency were almost twice as likely to have peanut sensitization (OR: 1.96, 95% CI [1.08-3.57], p-value: 0.028). Conclusion: Decreased maternal vitamin D levels and infant vitamin D insufficiency appear to increase the incidence of food allergies, particularly in the second year of life. To confirm this association, multicenter longitudinal studies are required. What is Known: • In newborns and young children, vitamin D deficiency and insufficiency are prevalent. • The exact role of vitamin D in atopic diseases remains controversial. What is New: • Decreased maternal vitamin D levels and infant vitamin D insufficiency appear to increase the incidence of food allergies. This association is more evident in the second year of life.
Collapse
|
4
|
Thorsteinsdottir F, Walker KC, Runstedt SE, Jacobsen R, Maslova E, Backer V, Heitmann BL, Händel MN. The role of prenatal vitamin D on the development of childhood asthma and wheeze: An umbrella review of systematic reviews and meta-analyses. Clin Nutr 2022; 41:1808-1817. [PMID: 35834913 DOI: 10.1016/j.clnu.2022.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND & OBJECTIVE It has been suggested that prenatal vitamin D plays a role in the development of childhood asthma and wheeze. Several systematic reviews have been conducted, but the results are inconsistent, and the methodological quality has not been studied. Therefore, the objective of this umbrella review was to assess the internal validity of the evidence base and the evidence for an association between prenatal vitamin D and asthma or wheezing in the offspring. METHODS We searched the electronic databases Embase, PubMed, and Cochrane Library for studies on prenatal vitamin D using search words such as vitamin D, 25-hydroxyvitamin D, calcidiol, fetal, and neonatal. The search was conducted in June 2020, and the databases were searched from their date of establishment. We included systematic reviews and/or meta-analyses of experimental and observational studies assessing the association between prenatal vitamin D or asthma and wheeze. We excluded narrative reviews, commentaries, and other umbrella reviews. The methodological quality of systematic reviews was assessed using AMSTAR 2 tool. PROSPERO reg. no. CRD42020151329. RESULTS We identified 22 eligible systematic reviews (17 on asthma and 20 on wheeze). Using the AMSTAR 2 quality assessment tool, the methodological quality was rated as critically low in 21 out of 22 systematic reviews, suggesting that previous reviews and meta-analyses did not provide accurate and comprehensive summaries of the included studies and that conclusions reached were potentially flawed. The majority of the included reviews reported that prenatal vitamin D reduces the risk of wheeze in the offspring. CONCLUSION Prior to informing public guidelines, high-quality systematic reviews of the current evidence are greatly warranted.
Collapse
Affiliation(s)
- Fanney Thorsteinsdottir
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.
| | - Karen Christina Walker
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Suzanne Elizabeth Runstedt
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Ramune Jacobsen
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | | | - Vibeke Backer
- Department of ENT and Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark; The Boden Group, Faculty of Medicine and Health, Sydney University, Australia; The Department of Public Health, Section of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Mina Nicole Händel
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| |
Collapse
|
5
|
Mustapa Kamal Basha MA, Majid HA, Razali N, Yahya A. Risk of eczema, wheezing and respiratory tract infections in the first year of life: A systematic review of vitamin D concentrations during pregnancy and at birth. PLoS One 2020; 15:e0233890. [PMID: 32542014 PMCID: PMC7295196 DOI: 10.1371/journal.pone.0233890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Allergic conditions and respiratory tract infections (RTIs) are common causes of morbidity and mortality in childhood. The relationship between vitamin D status in pregnancy (mothers), early life (infants) and health outcomes such as allergies and RTIs in infancy is unclear. To date, studies have shown conflicting results. OBJECTIVE This systematic review aims to gather and appraise existing evidence on the associations between serum vitamin D concentrations during pregnancy and at birth and the development of eczema, wheezing, and RTIs in infants. DATA SOURCES PubMed, MEDLINE, ProQuest, Scopus, CINAHL, Cochrane Library and Academic Search Premier databases were searched systematically using specified search terms and keywords. STUDY SELECTION Articles on the associations between serum vitamin D concentrations during pregnancy and at birth and eczema, wheezing, and RTIs among infants (1-year-old and younger) published up to 31 March 2019 were identified, screened and retrieved. RESULTS From the initial 2678 articles screened, ten met the inclusion criteria and were included in the final analysis. There were mixed and conflicting results with regards to the relationship between maternal and cord blood vitamin D concentrations and the three health outcomes-eczema, wheezing and RTIs-in infants. CONCLUSION Current findings revealed no robust and consistent associations between vitamin D status in early life and the risk of developing eczema, wheezing and RTIs in infants. PROSPERO registration no. CRD42018093039.
Collapse
Affiliation(s)
- Muzaitul Akma Mustapa Kamal Basha
- Department of Social Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Special Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia (IIUM), Kuantan Campus, Pahang, Malaysia
| | - Hazreen Abdul Majid
- Department of Social Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Nutrition, Harvard Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | - Nuguelis Razali
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abqariyah Yahya
- Department of Social Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
6
|
Maretzke F, Bechthold A, Egert S, Ernst JB, Melo van Lent D, Pilz S, Reichrath J, Stangl GI, Stehle P, Volkert D, Wagner M, Waizenegger J, Zittermann A, Linseisen J. Role of Vitamin D in Preventing and Treating Selected Extraskeletal Diseases-An Umbrella Review. Nutrients 2020; 12:E969. [PMID: 32244496 PMCID: PMC7231149 DOI: 10.3390/nu12040969] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022] Open
Abstract
Evidence is accumulating that vitamin D may have beneficial effects on respiratory tract, autoimmune, neuro-degenerative, and mental diseases. The present umbrella review of systematic reviews (SRs) of cohort studies and randomised controlled trials (RCTs), plus single Mendelian randomisation studies aims to update current knowledge on the potential role of vitamin D in preventing and treating these extraskeletal diseases. Altogether, 73 SRs were identified. Observational data on primary prevention suggest an inverse association between vitamin D status and the risk of acute respiratory tract infections (ARI), dementia and cognitive decline, and depression, whereas studies regarding asthma, multiple sclerosis (MS), and type 1 diabetes mellitus (T1DM) are scarce. SRs of RCTs support observational data only for the risk of ARI. No respective RCTs are available for the prevention of chronic obstructive pulmonary disease (COPD), MS, and T1DM. SRs of RCTs indicate beneficial therapeutic effects in vitamin D-deficient patients with asthma and COPD, while effects on major depression and T1DM need to be further elucidated. Mendelian randomisation studies do not consistently support the results of SRs. Since several limitations of the included SRs and existing RCTs do not permit definitive conclusions regarding vitamin D and the selected diseases, further high-quality RCTs are warranted.
Collapse
Affiliation(s)
- Friederike Maretzke
- German Nutrition Society, 53175 Bonn, Germany; (F.M.); (A.B.); (J.B.E.); (J.L.)
| | - Angela Bechthold
- German Nutrition Society, 53175 Bonn, Germany; (F.M.); (A.B.); (J.B.E.); (J.L.)
| | - Sarah Egert
- Institute of Nutritional Medicine, University of Hohenheim, 70599 Stuttgart, Germany;
| | - Jana B. Ernst
- German Nutrition Society, 53175 Bonn, Germany; (F.M.); (A.B.); (J.B.E.); (J.L.)
| | - Debora Melo van Lent
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX 78229, USA;
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Jörg Reichrath
- Department of Adult and Pediatric Dermatology, Venereology, Allergology, University Hospital Saarland, 66424 Homburg, Germany;
| | - Gabriele I. Stangl
- Institute for Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany;
| | - Peter Stehle
- Department of Nutrition and Food Sciences, University of Bonn, 53115 Bonn, Germany;
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany;
| | - Michael Wagner
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, 53127 Bonn, Germany;
| | - Julia Waizenegger
- German Nutrition Society, 53175 Bonn, Germany; (F.M.); (A.B.); (J.B.E.); (J.L.)
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, 32545 Bad Oeynhausen, Germany;
| | - Jakob Linseisen
- German Nutrition Society, 53175 Bonn, Germany; (F.M.); (A.B.); (J.B.E.); (J.L.)
- University Center of Health Sciences at Klinikum Augsburg (UNIKA-T), Ludwig Maximilian University of Munich, 86156 Augsburg, Germany
| |
Collapse
|
7
|
The Role of Vitamin D in Fertility and during Pregnancy and Lactation: A Review of Clinical Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102241. [PMID: 30322097 PMCID: PMC6210343 DOI: 10.3390/ijerph15102241] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/29/2018] [Accepted: 09/29/2018] [Indexed: 12/19/2022]
Abstract
Vitamin D deficiency is common and there exists a huge gap between recommended dietary vitamin D intakes and the poor vitamin D supply in the general population. While vitamin D is important for musculoskeletal health, there are accumulating data suggesting that vitamin D may also be important for fertility, pregnancy outcomes and lactation. Significant changes in vitamin D metabolism during pregnancy such as increased production of the “active vitamin D hormone” calcitriol support the important role of vitamin D in this setting. Observational studies show that vitamin D deficiency is a risk marker for reduced fertility and various adverse pregnancy outcomes and is associated with a low vitamin D content of breast milk. Meta-analyses of randomized controlled trials (RCTs) document that physiological vitamin D supplementation during pregnancy is safe and improves vitamin D and calcium status, thereby protecting skeletal health. Although certain RCTs and/or meta-analyses reported some other beneficial effects, it is still not clear whether vitamin D supplementation improves fertility or decreases the risk of adverse pregnancy outcomes such as low birth weight, pre-eclampsia and neonatal mortality, or reduces wheeze/asthma in the infants. Nevertheless, vitamin D supplementation in pregnant women is frequently required to achieve a sufficient vitamin D status as recommended by nutritional vitamin D guidelines. In this review, we provide an overview of systematic reviews, meta-analyses and large trials reporting clinical data on the role of vitamin D for fertility, pregnancy and lactation.
Collapse
|
8
|
Vitamin D status during pregnancy and in cord blood in a large prospective French cohort. Clin Nutr 2018; 38:2136-2144. [PMID: 30224306 DOI: 10.1016/j.clnu.2018.08.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Vitamin D status during pregnancy and in newborns has never been studied in France. This study aims at determining the vitamin D status during the first and third trimesters of pregnancy (T1, T3) and in cord blood (CB) in the middle-north of France. METHODS We conducted a prospective cohort study in five French centers (latitude 47.22 to 48.86°N). Serum 25(OH)-vitamin D (25(OH)D) concentrations were measured using a radioimmunoassay during T1, T3 and in CB. According to the French guidelines, pregnant women received cholecalciferol, 100,000 IU, in the seventh month. RESULTS Between April 2012 and July 2014, 2832 women were included, of whom 2803 were analyzed (mean ± SD age: 31.5 ± 5.0 years; phototypes 5-6: 21.8%). Three and 88.6% of participants received supplementation during the month before inclusion and in the seventh month, respectively. At T1, T3, and CB, mean 25(OH)D concentrations were 21.9 ± 10.4, 31.8 ± 11.5, and 17.0 ± 7.2 ng/mL, respectively, and 25(OH)D was <20 ng/mL in 46.5%, 14.0%, and 68.5%, respectively. At T1, body mass index ≥25 kg/m2, dark phototypes, sampling outside summer, and no supplementation before inclusion were independently associated with vitamin D insufficiency (25(OH)D < 20 ng/mL). Women who received cholecalciferol supplementation in month 7 had higher 25(OH)D at T3 than non-supplemented women (32.5 ± 11.4 versus 25.8 ± 11.4 ng/mL, p = <0.001) and marginally higher 25(OH)D in CB (17.2 ± 7.2 versus 15.5 ± 7.1 ng/mL, p = 0.004). CONCLUSIONS Despite the recommended supplementation, vitamin D insufficiency is frequent during pregnancy and in newborns in France.
Collapse
|
9
|
von Websky K, Hasan AA, Reichetzeder C, Tsuprykov O, Hocher B. Impact of vitamin D on pregnancy-related disorders and on offspring outcome. J Steroid Biochem Mol Biol 2018; 180:51-64. [PMID: 29169993 DOI: 10.1016/j.jsbmb.2017.11.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 12/16/2022]
Abstract
Observational studies from all over the world continue to find high prevalence rates of vitamin D insufficiency and deficiency in many populations, including pregnant women. Beyond its classical function as a regulator of calcium and phosphate metabolism, vitamin D elicits numerous effects in the human body. Current evidence highlights a vital role of vitamin D in mammalian gestation. During pregnancy, adaptations in maternal vitamin D metabolism lead to a physiologic increase of vitamin D levels, mainly because of an increased renal production, although other potential sources like the placenta are being discussed. A sufficient supply of mother and child with calcium and vitamin D during pregnancy ensures a healthy bone development of the fetus, whereas lack of either of these nutrients can lead to the development of rickets in the child. Moreover, vitamin D insufficiency during pregnancy has consistently been associated with adverse maternal and neonatal pregnancy outcomes. In multitudinous studies, low maternal vitamin D status was associated with a higher risk for preeclampsia, gestational diabetes mellitus and other gestational diseases. Likewise, several negative consequences for the fetus have been reported, including fetal growth restriction, increased risk of preterm birth and a changed susceptibility for later-life diseases. However, study results are diverging and causality has not been proven so far. Meta-analyses on the relationship between maternal vitamin D status and pregnancy outcomes revealed a wide heterogeneity of studied populations and the applied methodology in vitamin D assessment. Until today, clinical guidelines for supplementation cannot be based on high-quality evidence and it is not clear if the required intake for pregnant women differs from non-pregnant women. Long-term safety data of vitamin D supplementation in pregnant women has not been established and overdosing of vitamin D might have unfavorable effects, especially in mothers and newborns with mutations of genes involved in vitamin D metabolism. Reliable data from large observational and interventional randomized control trials are urgently needed as a basis for any detailed and safe recommendations for supplementation in the general population and, most importantly, in pregnant women. This is of utmost importance, as ensuring a sufficient vitamin D-supply of mother and child implies a great potential for the prevention of birth complications and development of diseases.
Collapse
Affiliation(s)
- Karoline von Websky
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Center for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ahmed Abdallah Hasan
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Egypt
| | - Christoph Reichetzeder
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Center for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oleg Tsuprykov
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Institute for Laboratory Medicine, IFLB, Berlin, Germany
| | - Berthold Hocher
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Institute for Laboratory Medicine, IFLB, Berlin, Germany; Department of Basic Medicine, Medical College of Hunan Normal University, Changsha, China.
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW In the past decade, food allergy has been increasingly recognized as an important public health issue. The role of maternal and infant diet in the development of food allergy has been a major focus of research throughout this period. Recently, research in this area has moved from observational studies to intervention trials, and the findings from these trials have started to influence infant feeding guidelines. In this article, we review recent studies of dietary interventions for preventing food allergy, summarize current knowledge and discuss future research directions. RECENT FINDINGS The latest result from an intervention trial shows that introduction of peanut in the first year of life reduces the risk of peanut allergy in high-risk infants. A systematic review and meta-analysis of intervention trials also suggests a protective effect of egg introduction from around 4 to 6 months of age for reducing the risk of egg allergy, with most studies conducted in high-risk infants. Despite several intervention trials involving modifications to the maternal diet, the effect of maternal diet during pregnancy and lactation in preventing food allergy remains unclear. SUMMARY Earlier introduction of allergenic foods is a promising intervention to reduce the risk of some food allergies in high-risk infants. Further work is needed to improve knowledge of how to prevent food allergy in the general population.
Collapse
|
11
|
Colotta F, Jansson B, Bonelli F. Modulation of inflammatory and immune responses by vitamin D. J Autoimmun 2017; 85:78-97. [PMID: 28733125 DOI: 10.1016/j.jaut.2017.07.007] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
Vitamin D (VitD) is a prohormone most noted for the regulation of calcium and phosphate levels in circulation, and thus of bone metabolism. Inflammatory and immune cells not only convert inactive VitD metabolites into calcitriol, the active form of VitD, but also express the nuclear receptor of VitD that modulates differentiation, activation and proliferation of these cells. In vitro, calcitriol upregulates different anti-inflammatory pathways and downregulates molecules that activate immune and inflammatory cells. Administration of VitD has beneficial effects in a number of experimental models of autoimmune disease. Epidemiologic studies have indicated that VitD insufficiency is frequently associated with immune disorders and infectious diseases, exacerbated by increasing evidence of suboptimal VitD status in populations worldwide. To date, however, most interventional studies in human inflammatory and immune diseases with VitD supplementation have proven to be inconclusive. One of the reasons could be that the main VitD metabolite measured in these studies was the 25-hydroxyVitD (25OHD) rather than its active form calcitriol. Although our knowledge of calcitriol as modulator of immune and inflammatory reactions has dramatically increased in the past decades, further in vivo and clinical studies are needed to confirm the potential benefits of VitD in the control of immune and inflammatory conditions.
Collapse
|
12
|
Venter C, Brown KR, Maslin K, Palmer DJ. Maternal dietary intake in pregnancy and lactation and allergic disease outcomes in offspring. Pediatr Allergy Immunol 2017; 28:135-143. [PMID: 27864894 DOI: 10.1111/pai.12682] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 12/28/2022]
Abstract
As the prevalence of allergic disease dramatically rises worldwide, prevention strategies are increasingly being considered. Given the potential modulatory effect of nutritional factors on disease, altering maternal diet during pregnancy and/or lactation has been considered in preventing allergic disease in offspring. Although there are a number of observational studies that have examined possible associations between maternal diet and allergic outcomes in offspring, interventional trials are limited. Furthermore, there is a paucity of studies that have prospectively studied maternal dietary intake as well as measuring maternal and infant biologic samples (blood, urine, breast milk) and their relation to allergic outcomes in infants. There is also a particular need to define terminology such as 'fruit and vegetables intake', 'healthy diet', and 'diet diversity' in order to make studies comparable. In this review, we discuss current evidence of maternal dietary factors during pregnancy and/or lactation that may play a role in the offspring developing allergic disease, including factors such as overall dietary intake patterns, specific whole food consumption (fish, fruit and vegetables, and common allergic foods), and individual immunomodulatory nutrient intakes. Additionally, we discuss the limitations of previous studies and propose improvements to study design for future investigation.
Collapse
Affiliation(s)
- Carina Venter
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kari R Brown
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kate Maslin
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Debra J Palmer
- School of Paediatrics and Child Health, Princess Margaret Hospital, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
13
|
Zdrenghea MT, Makrinioti H, Bagacean C, Bush A, Johnston SL, Stanciu LA. Vitamin D modulation of innate immune responses to respiratory viral infections. Rev Med Virol 2016; 27. [PMID: 27714929 DOI: 10.1002/rmv.1909] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/28/2016] [Accepted: 08/30/2016] [Indexed: 12/23/2022]
Abstract
Vitamin D, in addition to its classical functions in bone homeostasis, has a modulatory and regulatory role in multiple processes, including host defense, inflammation, immunity, and epithelial repair. Patients with respiratory disease are frequently deficient in vitamin D, implying that supplementation might provide significant benefit to these patients. Respiratory viral infections are common and are the main trigger of acute exacerbations and hospitalization in children and adults with asthma and other airways diseases. Respiratory monocytes/macrophages and epithelial cells constitutively express the vitamin D receptor. Vitamin D, acting through this receptor, may be important in protection against respiratory infections. Whether the in vitro findings can be translated into a substantial in vivo benefit still remains uncertain. Here we review the in vitro data on the role of vitamin D in antiviral innate immunity, the data concerning the deficient levels of vitamin D in lung diseases, and the in vivo role of supplementation as protection against respiratory viral infections in healthy individuals and in patients with chronic respiratory diseases. Finally, we suggest ways of improving the effectiveness of vitamin D as an adjuvant in the prevention and treatment of acute respiratory infections.
Collapse
Affiliation(s)
- Mihnea T Zdrenghea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj and Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Heidi Makrinioti
- Airways Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Cristina Bagacean
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj and Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania.,Laboratory of Immunology and Immunotherapy, University Hospital Brest, France
| | - Andy Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and Imperial College London, London, UK
| | - Sebastian L Johnston
- Airways Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Luminita A Stanciu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj and Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania.,Airways Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
14
|
Domaracki P, Sadlecki P, Odrowaz-Sypniewska G, Dzikowska E, Walentowicz P, Siodmiak J, Grabiec M, Walentowicz-Sadlecka M. Serum 25(OH) Vitamin D Levels in Polish Women during Pregnancies Complicated by Hypertensive Disorders and Gestational Diabetes. Int J Mol Sci 2016; 17:E1574. [PMID: 27690002 PMCID: PMC5085625 DOI: 10.3390/ijms17101574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND An association between the level of vitamin D and the risk of pregnancy-related complications remains unclear. The aim of this study was to examine concentrations of 25(OH) vitamin D in Polish women with normal pregnancies and pregnancies complicated by gestational hypertension, preeclampsia or gestational diabetes mellitus (GDM). Moreover, we analyzed an association between maternal serum 25(OH)D and the risk of gestational hypertension, preeclampsia and GDM. MATERIAL AND METHODS The study included 207 pregnant women, among them 171 with pregnancy-related complications: gestational hypertension (n = 45), preeclampsia (n = 23) or GDM (n = 103). The control group consisted of 36 women with normal pregnancies. Concentrations of serum 25(OH)D were measured at admission to the hospital prior to delivery Results: Patients with hypertension did not differ significantly from the controls in terms of their serum 25(OH)D concentrations (18.20 vs. 22.10 ng/mL, p = 0.15). Highly significant differences were found in 25(OH)D concentrations of women with preeclampsia and the controls (14.75 vs. 22.10 ng/mL, p = 0.0021). GDM was not associated with significant differences in 25(OH)D concentration. A low level of 25(OH)D turned out to be associated with an increased risk of preeclampsia during pregnancy on both univariate and multivariate regression analysis, and was a significant predictor of this condition on ROC (receiver operating characteristic) analysis (AUC = 0.70, p < 0.01). CONCLUSIONS 25(OH)D deficiency is common among pregnant Polish women. Low concentrations of 25(OH)D may play a role in the etiopathogenesis of preeclampsia. Routine assessment of the 25(OH)D level during pregnancy may be crucial for the identification of women at increased risk of preeclampsia.
Collapse
Affiliation(s)
- Piotr Domaracki
- Department of Obstetrics and Gynecology, L. Rydygier Collegium in Bydgoszcz, Nicolaus Copernicus University, ul. Ujejskiego 75, Bydgoszcz 85-168, Poland.
| | - Pawel Sadlecki
- Department of Obstetrics and Gynecology, L. Rydygier Collegium in Bydgoszcz, Nicolaus Copernicus University, ul. Ujejskiego 75, Bydgoszcz 85-168, Poland.
| | - Grazyna Odrowaz-Sypniewska
- Department of Laboratory Medicine, L. Rydygier Collegium in Bydgoszcz, Nicolaus Copernicus University, M. Curie Skłodowskiej 9, Bydgoszcz 85-094, Poland.
| | - Ewa Dzikowska
- Department of Obstetrics and Gynecology, L. Rydygier Collegium in Bydgoszcz, Nicolaus Copernicus University, ul. Ujejskiego 75, Bydgoszcz 85-168, Poland.
| | - Pawel Walentowicz
- Department of Obstetrics and Gynecology, L. Rydygier Collegium in Bydgoszcz, Nicolaus Copernicus University, ul. Ujejskiego 75, Bydgoszcz 85-168, Poland.
| | - Joanna Siodmiak
- Department of Laboratory Medicine, L. Rydygier Collegium in Bydgoszcz, Nicolaus Copernicus University, M. Curie Skłodowskiej 9, Bydgoszcz 85-094, Poland.
| | - Marek Grabiec
- Department of Obstetrics and Gynecology, L. Rydygier Collegium in Bydgoszcz, Nicolaus Copernicus University, ul. Ujejskiego 75, Bydgoszcz 85-168, Poland.
| | - Malgorzata Walentowicz-Sadlecka
- Department of Obstetrics and Gynecology, L. Rydygier Collegium in Bydgoszcz, Nicolaus Copernicus University, ul. Ujejskiego 75, Bydgoszcz 85-168, Poland.
| |
Collapse
|