High prevalence of asymptomatic vitamin D and iron deficiency in East African immigrant children and adolescents living in a temperate climate

Synthesis, physicochemical characteristics, cytocompatibility, and antibacterial properties of iron-doped biphasic calcium phosphate nanoparticles with incorporation of silver

The application of biphasic calcium phosphate (BCP) in tissue engineering and regenerative medicine has been widely explored due to its extensively documented multi-functionality. The present study attempts to synthesize a new type of BCP nanoparticles, characterised with favourable cytocompatibility and antibacterial properties via modifications in their structure, functionality and assemblage, using dopants. In this regard, this study initially synthesized iron-doped BCP (FB) nanoparticles with silver subsequently incorporated into FB nanoparticles to create a nanostructured composite (FBAg). The FB and FBAgnanoparticles were then characterized using Fourier transform infrared spectroscopy, x-ray diffraction, ultraviolet-visible spectroscopy, and x-ray photoelectron spectroscopy. The results showed that silver was present in the FBAgnanoparticles, with a positive correlation observed between increasing AgNO3concentrations and increasing shape irregularity and reduced particle size distribution. Additionally, cell culture tests revealed that both FB and FBAgnanoparticles were compatible with bone marrow-derived mesenchymal stem cells (hBMSCs). The antibacterial activity of the FBAgnanoparticles was also tested using Gram-negativeE. coliand Gram-positiveS. aureus, and was found to be effective against both bacteria. The inhibition rates of FBAgnanoparticles againstE. coliandS. aureuswere 33.78 ± 1.69-59.03 ± 2.95%, and 68.48 ± 4.11-89.09 ± 5.35%, respectively. These findings suggest that the FBAgnanoparticles have potential use in future biomedical applications.

The Problem of Vitamin D Scarcity: Cultural and Genetic Solutions by Indigenous Arctic and Tropical Peoples

Vitamin D metabolism differs among human populations because our species has adapted to different natural and cultural environments. Two environments are particularly difficult for the production of vitamin D by the skin: the Arctic, where the skin receives little solar UVB over the year; and the Tropics, where the skin is highly melanized and blocks UVB. In both cases, natural selection has favored the survival of those individuals who use vitamin D more efficiently or have some kind of workaround that ensures sufficient uptake of calcium and other essential minerals from food passing through the intestines. Vitamin D scarcity has either cultural or genetic solutions. Cultural solutions include consumption of meat in a raw or boiled state and extended breastfeeding of children. Genetic solutions include higher uptake of calcium from the intestines, higher rate of conversion of vitamin D to its most active form, stronger binding of vitamin D to carrier proteins in the bloodstream, and greater use of alternative metabolic pathways for calcium uptake. Because their bodies use vitamin D more sparingly, indigenous Arctic and Tropical peoples can be misdiagnosed with vitamin D deficiency and wrongly prescribed dietary supplements that may push their vitamin D level over the threshold of toxicity.

Association between serum vitamin D status and the anti-seizure treatment in Chinese children with epilepsy

Objective

To compare the serum 25-OH-VitD levels, the major marker of vitamin D (VitD) status, between healthy children and children with epilepsy before initiation of and during anti-seizure medications (ASMs) treatment and to evaluate the potential influence factors on 25-OH-VitD levels. Another major aim was to assess the potential role of VitD supplementation.

Methods

For comparison, we finally enrolled and collected data from 6,338 healthy children presenting to Health Care Department and 648 children visiting primary care pediatricians with symptoms of epilepsy in Children’s Hospital of Nanjing Medical University from January 2019 to June 2021. The demographic and biochemical characteristics of each child were extracted from the hospital information system.

Results

Serum 25-OH-VitD levels in 648 children with epilepsy were significantly lower than those of 6,338 healthy children (P < 0.0001), and the percentage of VitD insufficiency and deficiency status in pediatric patients was 49.19%. Of note, the serum 25-OH-VitD levels in children with newly diagnosed epilepsy before receiving any ASMs treatment were also significantly lower than those in healthy controls. Interestingly, ASMs therapy, alone or in combination, did not consistently reduce baseline serum VitD levels in children with epilepsy. The lower serum VitD levels in pediatric patients than those in healthy children might be related to the disease itself, rather than the ASMs treatment. As expected, VitD supplementation substantially increased the serum 25-OH-VitD levels (P < 0.0001). More critically, children with epilepsy receiving VitD supplementation achieved good seizure control in our study.

Significance

In this retrospective study, the childhood epilepsy before initiation of and during ASMs treatment decreased the serum 25-OH-VitD concentrations, suggesting a clear association between epileptic disease and the risk of VitD deficiency. ASMs coadministration and long-term valproic acid treatment did not worse VitD-deficiency status, but in the small group receiving VitD supplementation, there was a significant improvement in reduction of seizure frequency. Therefore, pediatric clinicians are urged to raise public awareness of epilepsy-associated VitD deficiency.

Iron and 25-hydroxyvitamin D in postmenopausal women with osteoporosis

Iron and vitamin D deficiencies are some of the most common health problems in the world. Iron is essential in oxygen transport and participates in many enzymatic systems in the body, with important roles in vitamin D metabolism. Osteoporosis is one of the most prevalent chronic disease of the elderly in the world as well as in the Saudi population. The relationship between iron, vitamin D deficiency and bone health comes from clinical observations in iron overload patients who suffered bone loss. The opposite scenario, whether iron and vitamin D deficiencies affect bone metabolism, has not been fully addressed. This is of great interest, as this nutrient deficiency is a worldwide public health problem and at the same time osteoporosis and bone alterations are highly prevalent. The relationship between 25(OH)D and iron deficiencies with osteoporosis is unknown up to date. This review presents the current knowledge on nutritional iron and vitamin D deficiencies in bone remodeling, and discuss the link between iron and bone metabolism among postmenopausal women. Finally, it is hypothesized that chronic iron and vitamin D deficiencies induces bone resorption and risk of osteoporosis, thus complete recovery from anemia and its prevention should be promoted in order to improve quality of life including bone health. Several mechanisms are implicated; hence, further investigation on the possible impact of iron and vitamin D deficiencies on the development of osteoporosis is needed.

Favorable osteogenic activity of iron doped in silicocarnotite bioceramic: In vitro and in vivo Studies

Background

Methods

Results

Conclusion

The translational potential of this article

A Scoping Review of the Health of African Immigrant and Refugee Children

Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.

The association of serum levels of zinc and vitamin D with wasting among Iranian pre-school children

PURPOSE

Wasting is a main indicator of Child's undernutrition that is associated with several non-communicable diseases and child mortality. This is the first population-based study which evaluated the association of serum zinc and vitamin D levels with wasting in a Middle East region. We also reported the prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years.

METHODS

This was a multicenter cross-sectional study that included 425 children aged between 5 and 7 years (on average 6 years) with BMI-for-age Z-scores of < - 1 SD resident in urban and rural areas of Iran in the spring of 2012 as part of the National Integrated Micronutrient Survey 2 (NIMS-2). Anthropometric measurements and blood sampling were obtained. The prevalence of vitamin D and zinc deficiencies together with the correlations of these variables with the increase of BMI-for-age Z-scores were evaluated.

RESULTS

The prevalence of vitamin D and zinc deficiencies was 18.8% and 12.7%, respectively. In addition, 31.1% of children were wasted. Children in the second tertile of 25(OH)D levels were less likely to have wasting compared with those in the first tertile in both crude and adjusted models (OR 0.47, 95% CI 0.27-0.83). A significant inverse association was found between serum levels of zinc and wasting (OR 0.57, 95% CI 0.34-0.96); such that after adjusting for confounders, children in the highest tertile of serum zinc had 47% less odds of wasting compared with those in the first tertile (OR 0.53, 95% CI 0.31-0.91).

CONCLUSION

The prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years was 18.8 and 12.7%, respectively. Serum levels of vitamin D and zinc were inversely associated with wasting either before or after controlling for confounders.

LEVEL OF EVIDENCE

Level III, case-control analytic studies.

Vitamin D status in preschool children: should vitamin D supplementation, preventing vitamin D deficiency be continued in children over 2 years?

BACKGROUND

The aim of this study was to determine the prevalence of vitamin D deficiency among preschool children in rural and urban areas of Northern Iran and need for continuing vitamin D supplementation after 2 years of age.

METHOD

A sample of 406 children aged 30-72 months was selected from health centres. Serum levels of 25-hydroxyvitamin D (25OHD), demographic data, anthropometric characteristics and total body surface area, were evaluated.

RESULTS

Subnormal vitamin D levels were found in 68.94% (269) of children. In multiple logistic regression models, season (P = 0.001) and residency (P = 0.006) were significantly correlated with vitamin D deficiency. Multiple linear regression analysis revealed that age (β = -0.18, P < 0.001), body mass index (β = -1.1, P < 0.001) and sun exposure (β = 0.4, P < 0.001) were significantly associated with 25OHD level.

CONCLUSION

Owing to the high prevalence of subnormal vitamin D levels in preschool children, it is recommended that vitamin D deficiency prevention programs are continued in this age group.

Differences in RAAS/vitamin D linked to genetics and socioeconomic factors could explain the higher mortality rate in African Americans with COVID-19

COVID-19 is said to be a pandemic that does not distinguish between skin color or ethnic origin. However, data in many parts of the world, especially in the United States, begin to show that there is a sector of society suffering a more significant impact from this pandemic. The Black population is more vulnerable than the White population to infection and death by COVID-19, with hypertension and diabetes mellitus as probable predisposing factors. Over time, multiple disparities have been observed between the health of Black and White populations, associated mainly with socioeconomic inequalities. However, some mechanisms and pathophysiological susceptibilities begin to be elucidated that are related directly to the higher prevalence of multiple diseases in the Black population, including infection and death by COVID-19. Plasma vitamin D levels and evolutionary adaptations of the renin-angiotensin-aldosterone system (RAAS) in Black people differ considerably from those of other races. The role of these factors in the development and progression of hypertension and multiple lung diseases, among them SARS-CoV-2 infection, is well established. In this sense, the present review attempts to elucidate the link between vitamin D and RAAS ethnic disparities and susceptibility to infection and death by COVID-19 in Black people, and suggests possible mechanisms for this susceptibility.

Prevalence and Predictors of Vitamin D Deficiency among African Immigrants Living in Australia

Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentrations <50 nmol/L) is a public health issue in Australia and internationally. Those with darker skin require a greater dose of ultraviolet B radiation from sunlight than those with paler skin to synthesise adequate amounts of vitamin D. Using data from the 2011-2013 Australian Health Survey, we investigated the prevalence and predictors of vitamin D deficiency in African immigrants aged ≥18 years living in Australia (n = 236). Serum 25(OH)D was measured using a liquid chromatography-tandem mass spectrometry method that is certified to international reference measurement procedures. Poisson regression was used to investigate independent predictors of vitamin D deficiency. A total of 36% of adults were vitamin D deficient (35% of men, 37% of women). The prevalence ratio (PR) of vitamin D deficiency decreased by 2% per year of age (PR 0.98; 95% CI (0.97, 0.99); p = 0.004) and was 1.6 times higher in those with low/sedentary, compared to moderate/high, physical activity levels (PR 1.64; 95% CI (1.12, 2.39); p = 0.011). The greatest risk was for those assessed during winter/spring compared with summer/autumn (PR 1.89; 95% CI (1.33, 2.64); p < 0.001). Culturally appropriate messaging on safe sun exposure and dietary vitamin D is warranted in order to promote vitamin D sufficiency in African immigrants living in Australia.

Prevalence of iron deficiency in a South African adolescent inpatient psychiatric population: Rates, risk factors and recommendations

BACKGROUND

Severe iron deficiency is associated with anaemia, but iron deficiency with normal haemoglobin (Hb) may also affect morbidity and quality of life and contribute to psychiatric illness onset and severity. Psychiatric presentations in adolescence are often indicative of serious long-term morbidity, and addressing contributing health risk factors, such as iron deficiency, is important.

OBJECTIVES

To determine rates of iron deficiency in a South African inpatient adolescent psychiatric population and possible associations between psychiatric diagnosis and iron deficiency risk factors.

METHODS

We conducted a retrospective chart review of all adolescent patients (13-18 years old) who were admitted to the Adolescent Psychiatric Inpatient Unit at Tygerburg Hospital (Cape Town, South Africa) during 2016. Patient records were limited to those with haemoglobin and ferritin levels available, as well as a psychiatric disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The final sample consisted of 93 patients.

RESULTS

Of all participants, 7.6% were anaemic, while 22.6% were iron deficient. We found 29% of our population to have anaemia in the absence of iron deficiency. Gender was the only statistically significant correlate, with adolescent females at particular risk of compromised iron status as indicated by a low ferritin level (45% of female sample).

CONCLUSION

Iron deficiency rates remain a relevant health concern, and testing Hb alone is inadequate to assess iron status in this population. Ferritin is a necessary additional parameter and should be included in the usual medical workup.

Nutritional assessment of resettled paediatric refugees in Western Australia

AIM

Nutritional deprivation, inadequate diet and food insecurity are common refugee experiences. The growth and nutritional status of paediatric refugees following resettlement in developed countries and the related interplay with socio-economic factors remain less defined; this study aims to describe these features.

METHODS

Standardised dietary, medical and socio-demographic health assessments of new refugee patients attending a multidisciplinary paediatric Refugee Health Service (RHS) in Western Australia between 2010 and 2015 were analysed.

RESULTS

Demographic data from 1131 paediatric refugees are described (age 2 months to 17.8 years). The majority experienced socio-economic disadvantage, had limited parental education and required interpreters. Nutritional deficiencies were common but varied across ethnicities: iron deficiency (ID) (12.3%), anaemia (7.3%) and inadequate dairy intake (41.0%). A third of children (32.6%) did not consume meat. Infant breastfeeding was sustained (77.8%) in infants <12 months. Prolonged breastfeeding (44.9% aged 12-24 months) was associated with an increased risk of ID (odds ratio 4.0, 95% confidence interval 1.4-11.6). Median body mass index increased significantly for those >24 months between referral and RHS assessment (median period 1.8 months). Overall, 27.1% required additional formal dietetic follow-up, with higher nutritional concerns in refugee children <24 months compared to older patients.

CONCLUSIONS

Identification of frequent post-settlement nutritional concerns has been captured through structured multidisciplinary paediatric health screening. Specific screening for socio-economic influencing factors, including education, poverty and food insecurity, during refugee clinical assessments is recommended. Development of targeted, culturally appropriate parental education resources and interventions may improve management following resettlement. Longitudinal research assessing resettlement growth trajectories is required.

The association of serum 25-hydroxyvitamin D concentrations with elevated serum ferritin levels in normal weight, overweight and obese Canadians

In light of the growing body of literature suggesting a beneficial effect of vitamin D on inflammatory response, we hypothesized that vitamin D affects serum ferritin (SF), a biomarker of inflammation. The objective of the present study is to examine the association of serum 25-hydroxyvitamin D [25(OH)D] with elevated SF concentrations indicative of inflammation as no earlier study has done so. Data from 5550 Canadian adults who participated in the 2012/2013 and the 2014/2015 Canadian Health Measures Surveys were analysed. We observed that 9.4% of Canadian adults have elevated SF concentrations and that 35.6% were vitamin D insufficient. Among Canadians with under/normal body weights, those with serum 25(OH)D ≥ 75 nmol/L relative to those with serum 25(OH)D < 50 nmol/L, were substantially less at risk for elevated SF concentrations (OR = 0.24; 95% CI = 0.06, 0.89; p = 0.034). We did not observe this association for overweight and obese Canadians. Canadians of older age, non-white ethnicity, males, those with income above $100,000, those who consumed alcohol, and those with high total cholesterol concentrations and elevated blood pressures were more likely to have elevated SF concentrations. Serum 25(OH)D ≥ 75 nmol/L is likely to provoke anti-inflammatory benefits, but intervention studies that achieve high 25(OH)D concentrations and with long follow up are needed to establish the role of vitamin D on SF.

Enhanced In Vivo Bone and Blood Vessel Formation by Iron Oxide and Silica Doped 3D Printed Tricalcium Phosphate Scaffolds

Calcium phosphate (CaP) ceramics show significant promise towards bone graft applications because of the compositional similarity to inorganic materials of bone. With 3D printing, it is possible to create ceramic implants that closely mimic the geometry of human bone and can be custom-designed for unusual injuries or anatomical sites. The objective of the study was to optimize the 3D-printing parameters for the fabrication of scaffolds, with complex geometry, made from synthesized tricalcium phosphate (TCP) powder. This study was also intended to elucidate the mechanical and biological effects of the addition of Fe+3 and Si+4 in TCP implants in a rat distal femur model for 4, 8, and 12 weeks. Doped with Fe+3 and Si+4 TCP scaffolds with 3D interconnected channels were fabricated to provide channels for micronutrients delivery and improved cell-material interactions through bioactive fixation. Addition of Fe+3 into TCP enhanced early-stage new bone formation by increasing type I collagen production. Neovascularization was observed in the Si+4 doped samples after 12 weeks. These findings emphasize that the additive manufacturing of scaffolds with complex geometry from synthesized ceramic powder with modified chemistry is feasible and may serve as a potential candidate to introduce angiogenic and osteogenic properties to CaPs, leading to accelerated bone defect healing.

Evidence of a significant vitamin D deficiency among 9-13-year-old Polish children: results of a multicentre study

PURPOSE

To evaluate the extent to which the population of Polish preadolescents is vitamin D deficient and to assess seasonal variations in vitamin D status.

PARTICIPANTS AND METHODS

A total of 720 healthy children aged 9-13 years (409 girls, 311 boys) residing in 6 representative geographical locations in Poland were studied. A parental-assisted questionnaire provided data on nutritional habits, vitamin D supplements and sun exposure. Serum concentration of 25-hydroxyvitamin was determined twice, after the winter in March and after the summer in October.

RESULTS

In March, vitamin D deficiency (25-50 nmol/L) was found in 64%, and severe deficiency (< 25 nmol/L) in 20.2% of children. In October, the deficiency and severe deficiency were still noticed in 25.9 and 0.1% of children, respectively. The mean serum concentration of 25-OHD was 52% higher in October (55.4 ± 14.0 nmol/L) than in March (36.4 ± 13.5 nmol/L), (p < 0.01). In children with 25-OHD < 50 nmol/L in March, their 25-OHD concentration increased by 64% through March to October (32.5 ± 8.2 vs. 53.2 ± 7.9 nmol/L, p < 0.01). An association was found between 25-OHD concentration and regular consumption of vitamin D supplements, cod-liver oil and fish.

CONCLUSIONS

The majority of preadolescent Polish boys and girls show vitamin D deficiency after the winter period, although a distinct amelioration over summertime is found in this age group. There is a need to implement effective prevention and intervention strategies in the management of vitamin D deficiency among schoolchildren in Poland, with the supplementation throughout the entire year.

Clinical and laboratory evaluation of new immigrant and refugee children arriving in Greece

Background

Migrant children are a population at risk for various health problems. Despite the increased inflow of migrants in Greece, data regarding their health assessment are lacking. This study aims to describe the clinical and certain laboratory characteristics and identify possible associations in a group of new immigrant (I) and refugee (R) children, arriving in Athens, Greece.

Methods

A prospective, cross- sectional study was performed in a migrant outpatient clinic of a tertiary Children’s hospital. All immigrant and refugee children, examined to obtain a health certificate, within 3 months of their arrival in the country, were enrolled. Clinical and laboratory information was collected in a pre- designed form. We applied multiple logistic regression models to investigate the association between the child’s status (immigrant vs refugee) and health indicators controlling for possible confounding effects, mainly of age and area of origin.

Results

From 2010 to 2013, a total of 300 children (I/R:138/162) with a mean age of 7.08 (range 1–14) years were included. Overall, 79.3% presented unknown vaccination status, 21.3% dental and 7.3% additional clinical problems. Latent tuberculosis was identified in 2.7%, while anemia, low serum ferritin and eosinophilia were found in 13.7%, 17.3%, and 22.7% of subjects, respectively. 57.7% had protective antibodies to hepatitis B surface antigen (anti-HBs ≥ 10 IU/L) and 30.6% elevated blood lead levels (EBLLs). Immigrants had less likely unknown immunization (OR = 0.25, p < 0.001), but had increased odds of low ferritin (OR = 1.97, p = 0.043), EBLLs (OR = 2.97, p = 0.001) and protective anti-HBs (OR = 1.79, p = 0.03). Age was inversely associated with anemia (OR = 0.0.89, p = 0.017), low ferritin (OR = 0.91, p = 0.027), EBLLs (OR = 0.86, p = 0.001) or positive anti-HBs (OR = 0.92, p = 0.025). Children from Europe or Africa presented decreased probability of EBLLs (OR = 0.31, p = 0.001, and OR = 0.15, p = 0.005, respectively) compared to those from Asia.

Conclusions

New immigrant and refugee children presented distinct clinical problems and certain laboratory abnormalities. Some of these health issues differed according to their migration status, age and geographic area of origin. These findings provide evidence that may assist the optimal approach of this vulnerable population.

Screening and Primary Care Access for Newly Arrived Paediatric Refugees in Regional Australia: A 5 year Cross-sectional Analysis (2007-12)

This study aimed to determine the prevalence of health conditions in newly arrived refugee children and access to timely heath screening. Methods: Cross-sectional data from screening of refugee children in regional Australia (2007-12) were analysed for health conditions and timeliness of primary care access. The health of 376 newly arrived refugee children (0-15 years) was assessed. Refugee children came from African (45%), Southeast Asian (29%) and Eastern Mediterranean (10%) regions. Access to primary care screening was present in 367 children (97% of arrivals). Completion of all recommended screening tests was 72%. Of 188 children with arrival and screening dates recorded, 88% were screened within 1 month and 96% within 6 months of arrival. Timely access of remaining children could not be assessed. Conclusion: Primary care was highly accessible to almost all newly arrived refugee children. Health screening was timely in those children with complete medical records.

Effects of Iron on Physical and Mechanical Properties, and Osteoblast Cell Interaction in β-Tricalcium Phosphate

Iron (Fe) is a vital element and its deficiency causes abnormal bone metabolism. We investigated the effects of Fe and its concentration in β-tricalcium phosphate (β-TCP) on physicomechanical properties and in vitro proliferation and differentiation of osteoblasts. Our results showed that Fe addition at concentrations of 0.5 wt.% (0.5 Fe-TCP) and 1.0 wt.% (1.0 Fe-TCP) inhibits the β-TCP to α-TCP phase transformation at sintering temperature of 1250 °C. Addition of 0.25 wt.% Fe (0.25 Fe-TCP) increased the compressive strength of β-TCP from 167.27 ± 16.2 to 227.10 ± 19.3 MPa. After 3 days of culture, surfaces of 0.5 Fe-TCP and 1.0 Fe-TCP samples were covered by osteoblast cells, compared to that of pure and 0.25 Fe-TCP. Cells grew to confluency on all Fe-doped samples after 7 days of culture and monolayer sheet-like cellular structure was found at 11 days. Optical cell density and alkaline phosphatase activity were significantly higher on Fe-doped samples and the highest values were found in 0.5 Fe-TCP samples. Our results show that Fe concentration had significant effect on physical and mechanical properties of TCP ceramics, and also on the in vitro osteoblast cellular interactions in TCP ceramics.

Efficacy of high dose Vitamin D supplementation in improving serum 25(OH)D among migrant and non migrant population: a retrospective study

BACKGROUND

Higher dose of vitamin D supplementation 50000 IU is required for those whose serum 25(OH)D levels are 50 nmol/L and below. The increment in serum 25(OH)D though not significantly affected by race, sex or age it is negatively correlated to the baseline 25(OH)D concentration. This study investigated whether the mean increase in serum 25(OH)D will be higher among participants with lower baseline 25(OH)D levels and whether the duration of supplementation has an influence on the serum 25(OH)D achieved.

METHODS

A clinical audit of patients' medical records from a community health centre in Melbourne for the period 01.01.2010 to 31-12.2012 was undertaken. Paired sample t test was used to determine difference in pre and post dose serum 25(OH)D. Simple and multiple linear regressions were used to examine the association between the difference in pre and post dose serum 25(OH)D and duration of supplementation and baseline serum 25(OH)D, adjusting for socio-demographic factors.

RESULTS

A total of 205 patients were included in the study. Mean difference in serum 25(OH)D was highest 52.8 nmol/L (95 % CI: 46.63-58.92) among those whose serum 25(OH)D was below 25 nmol/L at baseline. Baseline 25(OH)D alone accounted for 13.7 % of variance in the effect size (F(2, 202) = 16.0. p < 0.001), with the effect size significantly higher among participants with a baseline 25(OH)D level of 25-49 nmol/L (β = 11.93, 95 % CI: 0.48, 23.40, p < 0.05). Mean serum 25(OH)D difference was highest, 47.53 nmol/L (95 % CI: 40.95-54.11) when measured within 3 months of supplementation. Duration of supplementation explained 2.9 % of the variance in the effect size (F (1, 203) = 6.11, p < 0.05) and there was an inverse relationship between the length of supplementation and mean pre and post supplementation serum 25(OH)D difference (β = -1.45, 95 % CI: -2.62, -0.29, p = 0.014).

CONCLUSION

Following 50000 IU vitamin D3 for 12 months mean serum 25(OH)D increase was highest among those whose baseline serum 25(OH)D was lower. Migrants especially dark-skinned are at a high risk for vitamin D deficiency in Australia. High dose vitamin D3 50000 IU (cholecalciferol) is effective in achieving sufficient serum 25(OH)D among these populations who tend to have lower baseline serum 25(OH)D.

Effect of vitamin D3 supplementation on iron status: a randomized, double-blind, placebo-controlled trial among ethnic minorities living in Norway

BACKGROUND

Both vitamin D and iron deficiencies are widespread globally, and a relationship between these deficiencies has been suggested. However, there is a paucity of randomised controlled trials assessing the effect of vitamin D supplementation on iron status.

PURPOSE

We aimed to investigate whether 16 weeks of daily vitamin D3 supplementation had an effect on serum ferritin, haemoglobin, serum iron and transferrin saturation.

METHODS

Overall, 251 participants from South Asia, Middle East and Africa aged 18-50 years who were living in Norway were randomised to receive daily oral supplementation of 10 μg vitamin D3, 25 μg vitamin D3, or placebo for 16 weeks during the late winter. Blood samples from baseline and after 16 weeks were analysed for serum 25-hydroxyvitamin D (s-25(OH) D), serum ferritin, haemoglobin and serum iron. In total, 214 eligible participants completed the intervention (86 % of those randomised). Linear regression analysis were used to test the effect of vitamin D3 supplementation combined (10 or 25 μg) and separate doses 10 or 25 μg compared to placebo on change (T2-T1) in each outcome variable adjusted for baseline s-25(OH)D values.

RESULTS

There was no difference in change in the levels of s-ferritin (1.9 μg/L, 95 % CI: -3.2, 7.0), haemoglobin (-0.02 g/dL, 95 % CI: -0.12, 0.09), s-iron (0.4 μg/L, 95 % CI: -0.5, 1.3) or transferrin saturation (0.7 %, 95 % CI: -0.6.1, 2.0) between those receiving vitamin D3 or those receiving placebo. Serum 25-hydroxyvitamin D increased from 29 nmol/L at baseline to 49 nmol/L after the intervention, with little change in the placebo group.

CONCLUSIONS

In this population of healthy ethnic minorities from South Asia, the Middle East and Africa who had low vitamin D status, 16 weeks of daily supplementation with 10 or 25 μg of vitamin D3 did not significantly affect the haemoglobin levels or other markers of iron status.

Birth season and vitamin D concentration in adulthood

BACKGROUND

Recent evidences suggest that the season of birth may influence human development and vulnerability to develop certain diseases.

METHODS

A retrospective analysis was hence carried out in the laboratory information system of the University Hospital of Parma (North-West Italy), to retrieve values of total serum vitamin D (25-hydroxyvitamin D) measured in a the whole cohort of unselected outpatients age 18 years and older referred for routine health check-up during January to December 2014. Vitamin D was then stratified according to birth season.

RESULTS

The study population consisted in 11,150 unselected Italian residents (median age 62 years; 8,592 women and 2,558 men). Serum vitamin D values were found to be significantly lower in subjects born in winter than in those born in spring and summer. More specifically, winter season birth was associated with 11% increased risk of developing vitamin D deficiency later in life compared to spring birth. Daily sunlight hours at birth independently predicted vitamin D concentration in adulthood.

CONCLUSIONS

The results of this large, cross-sectional retrospective investigation attest that subjects born in winter have a total vitamin D concentration in adulthood that is significantly lower than those born in seasons with longer daylight periods.

Hypovitaminosis D in adolescent females--an analytical cohort study in the United Arab Emirates

BACKGROUND

Despite living in a sunny country, hypovitaminosis D is common in women of reproductive age in Al Ain, United Arab Emirates (UAE).

AIMS AND OBJECTIVES

To establish the prevalence of hypovitaminosis D in adolescent female Emirati nationals and its risk factors.

METHODS

This was an analytical prospective cohort study of 350 female Emirati nationals aged 11-18 years attending public schools in Al Ain. Socio-economic status, diet and amount of sun exposure were evaluated by face-to-face interviews. Serum total 25 (OH) vitamin D (D2 + D3) levels were measured by electrochemiluminescence assay. The prevalence of hypovitaminosis D was calculated and the association with risk factors analysed.

RESULTS

Data were complete for 293 girls. Only one girl [prevalence 0.3%, 95% confidence interval (CI) 0.01-1.9] had vitamin D sufficiency (serum vitamin D levels >75 nmol/L). Three girls (1.0%, 95% CI 0.2-2.9) had vitamin D insufficiency (50-75 nmol/L), 58 (19.8%, 95% CI 15.0-25.5) were deficient (27.5-50 nmol/L) and 231 (78.8%, 95% CI 68.9-89.6) had severe deficiency (<27.5 nmol/L). Serum vitamin D levels declined between the ages of 11 and 13 years before progressively rising until the age of 18 years but without regaining the levels they were at the age of 11. There was no statistically significant difference between the vitamin D status groups in age, body mass index, accommodation type, family income, percentage of surface area unexposed to the sun when outdoors, consumption of oily fish or total vitamin D intake.

CONCLUSION

The finding of a high prevalence of hypovitaminosis D in adolescent females in UAE is of serious concern for their health and that of their infants during their reproductive lives. Adolescent girls with a similar social and cultural background currently living in less sunny, industrialised countries might also be at risk.

Plasma fibroblast growth factor 23 concentration and iron status. Does the relationship exist in the elderly population?

OBJECTIVE

Fibroblast growth factor 23 (FGF23) is a phosphaturic agent involved in calcium-phosphate homeostasis. Recent findings show that iron deficiency and inflammation regulate FGF23 release and/or biodegradation. Iron deficiency is frequently observed in the elderly, therefore the aim of this study was to find out if iron deficiency is independent from low grade inflammatory factors affecting both forms of FGF23 that are detectable in circulation in a large population-based study of elderly subjects.

DESIGN AND METHODS

The analysis included 3780 elderly (1798 females) PolSenior study participants and assessed levels of phosphorus, calcium, iron, ferritin, interleukin 6, C-reactive protein (hs-CRP), intact (iFGF23), and c-terminal FGF (cFGF23). The analysis was performed for all subjects and terciles of serum iron levels in relation to hs-CRP were calculated.

RESULTS

The highest plasma cFGF23 and iFGF23 concentrations were found in subjects with the lowest serum iron levels (p<0.001). The effect of low grade inflammation was markedly weaker and affected only iFGF23 levels. The adjusted serum levels of hs-CRP, iPTH, phosphorus, and 25-(OH)-D3 analysis revealed that plasma iFGF23 and cFGF23 levels were almost unchanged up to a serum iron level of 59.3 ng/mL and 57.3 ng/mL respectively and then were nearly linearly increasing by 0.285 pg/mL and 3.742 RU/mL for each unit of serum iron increase.

CONCLUSIONS

Low iron levels are associated with increased levels of both cFGF23 and iFGF23, independent of low grade inflammation. A similar analysis of cFGF23 and iFGF23 does not suggest enhanced biodegradation of iFGF23 induced by iron deficiency.

Assessment of vitamin D and its association with cardiovascular disease risk factors in an adult migrant population: an audit of patient records at a Community Health Centre in Kensington, Melbourne, Australia

Background

Vitamin D deficiency is a global public health problem associated with increased risk of cardio-metabolic diseases and osteoarthritis. Migrants with dark skin settled in temperate climates are at greater risk of both vitamin D deficiency and cardiovascular diseases. This study aims to identify the risk of vitamin D deficiency and associations with cardiovascular disease in a migrant population in Australia.

Methods

An audit was carried out at a Community Health Service in Kensington, Melbourne which, services a large migrant population. Data from the clinical records of all adults who visited the medical centre at least once during the period from 1^st January 2010 to 31^st December 2012 was extracted. The future (10 year) coronary heart disease risk was estimated using Framingham Risk Score.

Results

The centre has given higher priority to vitamin D testing in migrants, those middle-aged, females and those with diabetes and osteoarthritis. Migrants from countries located in lower latitude regions (Latitude N23⁰ to S23⁰) were 1.48 (95% C.I. 1.32-1.65) times more likely to develop vitamin D deficiency post migration and 0.44 (95% C.I. 0.31-0.62) times less likely to have a >15% 10-year risk of coronary heart disease when compared to their Australian-born counterparts.

Conclusions

Adherence to a high risk strategy for vitamin D testing was observed in the centre. Pre-migration latitude is an important factor for vitamin D deficiency (lower the latitude higher the risk) and in predicting future risk of cardiovascular disease in migrants. These findings suggest that a targeted approach for vitamin D testing, including zone of origin might better identify individuals at higher risk of both vitamin D deficiency and cardiovascular disease.

The Role of 25-Hydroxy Vitamin D Deficiency in Iron Deficient Children of North India

Extensive data from animal and human studies indicate a role of vitamin D in erythropoiesis. Iron and vitamin D deficiencies are implicated with adverse health effects in children even if they are asymptomatic. The potential relationship between the two remains poorly understood. A cross-sectional study was performed in the period from 1st May 2012 through 30th April 2013 and subjects were classified into vitamin D deficiency (VDD), vitamin D insufficiency (VDI) and vitamin D sufficiency (VDS) groups according to their 25(OH) D levels. A total of 263 children were included in the analysis. Anaemia was present in 66 % of 25(OH) D deficient subjects compared with 35 % in vitamin D sufficient individuals (p < 0.0001). The association of breast feeding and development of VDD was also significant (p < 0.05). Serum levels of 25(OH) D were found lower in female sex and if the analysis was performed in the winter/spring season. Physicians should therefore assess vitamin D levels in all anaemic children and ensure adequate supplementation to prevent deficiencies.

Non-Western immigrant children have lower 25-hydroxyvitamin D than children from Western families

OBJECTIVE

To determine if children aged 1-6 years from non-Western immigrant families have lower serum 25-hydroxyvitamin D (25(OH)D) levels than children from Western-born families and examine which factors influence this relationship.

DESIGN

Cross-sectional study.

SETTING

Toronto, Canada.

SUBJECTS

Healthy children (n 1540) recruited through the TARGet Kids! practice-based research network. Serum 25(OH)D concentrations of non-Western immigrants were compared with those of children from Western-born families. Children from non-Western immigrant families were defined as those born, or their parents were born, outside a Western country. Univariate and multiple linear regression analyses were used to identify factors which might influence this relationship.

RESULTS

Median age was 36 months, 51 % were male, 86 % had 'light' skin pigmentation, 55 % took vitamin D supplements, mean cow's milk intake was 1·8 cups/d and 27 % were non-Western immigrants. Median serum 25(OH)D concentration was 83 nmol/l, with 5 % having 25(OH)D < 50 nmol/l. Univariable analysis revealed that non-Western immigrant children had serum 25(OH)D lower by 4 (95 % CI 1·3, 8·0) nmol/l (P = 0·006) and increased odds of 25(OH)D < 50 nmol/l (OR = 1·9; 95 % CI 1·3, 2·9). After adjustment for known vitamin D determinants the observed difference attenuated to 0·04 (95 % CI -4·8, 4·8) nmol/l (P = 0·99), with higher cow's milk intake (P < 0·0001), vitamin D supplementation (P < 0·0001), summer season (P = 0·008) and increased age (P = 0·04) being statistically significant covariates. Vitamin D supplementation was the strongest explanatory factor of the observed difference.

CONCLUSIONS

There is an association between non-Western immigration and lower 25(OH)D in early childhood. This difference appears related to known vitamin D determinants, primarily vitamin D supplementation, representing opportunities for intervention.

Clinical and seasonal variations of nutritional risk screening in patients scheduled for rehabilitation after heart surgery

BACKGROUND

Current knowledge on the pervasiveness of increased nutritional risk in cardiovascular diseases is limited. Our aim was to analyze the characteristics of nutritional risk screening in patients scheduled for rehabilitation after heart surgery. Prevalence and extent of nutritional risk were studied in connection with patients' characteristics and seasonal climate effects on weight loss dynamics.

METHODS

The cohort included 65 consecutive patients with an age range of 25-84 years, 2-6 months after surgical treatment for ischemic or valvular heart disease. Nutritional risk screening was appraised using a standardized NRS-2002 questionnaire. Groups were analyzed according to a timeline of rehabilitation according to the "cold" and "warm" seasons of the moderate Mediterranean climate in Opatija, Croatia.

RESULTS

Increased nutritional risk scores (NRS-2002) of >3 were found in 96% of studied patients. Mean NRS-2002 of patients was 5.0 ± 1.0, with a percentage weight loss history of 11.7% ± 2.2% (4.6-19.0). Risk was found to be more pronounced during the warmer season, with NRS-2002 scores of 5.3 ± 0.7 versus 4.8 ± 1.1 (P = 0.136) and greater loss of weight of 13.0% ± 3.2% versus 10.6% ± 3% (P = 0.005), respectively. Increased nutritional risk correlated significantly with creatinine concentrations (rho = 0.359; P = 0.034 versus 0.584; P = 0.001, respectively). Significant discordance in correlations was found between NRS-2002 and the decrease in left ventricle systolic function (rho correlation coefficient [rho-cc] = -0.428; P = 0.009), the increase in glucose concentrations (cc = 0.600; P < 0.001), and the decrease in erythrocyte counts (cc = -0.520; P = 0.001) during the colder season.

CONCLUSION

Increased nutritional risk was found to be frequently expressed in the course of rehabilitation after heart surgery. Although seasonal climate effects influenced the weight loss dynamics, the impact on reproducibility of NRS-2002 was clinically less important. Further studies on the connection of nutritional risk with composited end points might offer improvements in overall quality of treatment.

Deficiency of 25-hydroxyvitamin d and dyslipidemia in Indian subjects

Background. Vitamin D deficiency is widespread throughout the world. Several reports have incriminated vitamin D deficiency as the cause of rickets, osteomalacia, and other chronic diseases. Recent studies have suggested a possible link between deficiency of 25-hydroxyvitamin D and dyslipidemia. Aim. To investigate the association between 25-hydroxyvitamin D deficiency and dyslipidemia in Indian subjects. Methodology. We recruited 150 asymptomatic consecutive subjects from patients' attendees at the Departments of Neurology and Medicine in Yashoda Hospital, Hyderabad, India. Study period was from October 2011 to March 2012. All subjects underwent 25-hydroxyvitamin D assay by chemiluminescent microparticle immunoassay, fasting blood sugar and lipid profile, calcium, phosphorus, alkaline phosphatase, and C-reactive protein (CRP). Results. Out of 150 subjects, men were 82 (54.6%), and mean age was 49.4 (±15.6) years. Among risk factors, hypertension was noted in 63/150 (42%), 25-hydroxyvitamin D deficiency in 59/150 (39.3%), diabetes in 45/150 (30%), dyslipidemia in 60 (40%), smoking in 35/150 (23.3%), and alcoholism in 27/150 (18%). Deficiency of 25-hydroxyvitamin D was significantly associated with dyslipidemia (P = 0.0001), mean serum glucose (P = 0.0002) mean CRP (P = 0.04), and mean alkaline phosphatase (P = 0.01). Multivariate analysis showed that 25-hydroxyvitamin D deficiency was independently associated with dyslipidemia (odds ratio: 1.9; 95% CI : 1.1–3.5). Conclusions. We found that deficiency of 25-hydroxyvitamin D was independently associated with dyslipidemia in Indian subjects.

Decreased circulating 25-(OH) Vitamin D concentrations in obese female children and adolescents: positive associations with Retinol Binding Protein-4 and Neutrophil Gelatinase-associated Lipocalin

OBJECTIVE

Hypovitaminosis D has been associated with adult as well as childhood obesity. Retinol-binding-protein-4 (RBP-4) and Neutrophil Gelatinase-associated Lipocalin (NGAL) are altered in obese individuals. The aim of this study was to examine circulating 25-(OH) Vitamin D (25-(OH) D) concentrations according to BMI and its associations with RBP-4 and NGAL in female children and adolescents.

DESIGN

Seventy-nine (79) children, aged 8-16 years, were studied and divided into four groups: 19 control (BMI z-score range -2.15 - 1.24), 20 overweight (1.34 - 2.49), 20 obese (2.50 - 2.87) and 20 ultra-obese (3 - 4.37). Patients were derived from a Pediatric Obesity Clinic. Plasma 25-(OH) D, RBP-4 and NGAL concentrations were measured with specific assays.

RESULTS

Plasma 25-(OH) D concentrations were decreased significantly in the ultra-obese (p=0.005) and marginally in the obese group (p=0.05) compared to the control group. In the entire BMI range, Spearman correlations revealed strong positive associations between 25-(OH) D and RBP-4 (r=0.349, p=0.002) and between 25-(OH) D and NGAL (r=0.338, p=0.003).

CONCLUSIONS

25-(OH) D is deficient in a clinical population of obese female children and adolescents, whereas in the entire BMI range 25-(OH) D is associated with RBP4 and NGAL concentrations. Longitudinal studies are needed to reveal the role of these associations in metabolic alterations related to childhood and adolescent obesity and associated metabolic morbidities.

Low iron status as a factor of increased bone resorption and effects of an iron and vitamin D-fortified skimmed milk on bone remodelling in young Spanish women

PURPOSE

This study aimed to determine whether there is a relationship between iron status and bone metabolism, and to compare the effects of the consumption, as part of the usual diet, of an iron or iron and vitamin D-fortified skimmed milk on bone remodelling in iron-deficient women.

METHODS

Young healthy iron-deficient or iron-sufficient women (serum ferritin ≤30 ng/mL or >30 ng/mL, respectively) were recruited. Iron-deficient women were assigned to a nutritional intervention consisting of a randomised, controlled, double-blind, parallel design trial of 16 weeks during winter. They consumed, as part of their usual diet, an iron (Fe group, n = 54) or iron and vitamin D-fortified (Fe+D group, n = 55) flavoured skimmed milk (iron, 15 mg/day; vitamin D3, 5 μg/day, 200 IU). The iron-sufficient women followed their usual diet without supplementation (R group, n = 56). Dietary intake, body weight, iron biomarkers, 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), procollagen-type 1 N-terminal propeptide (P1NP), and aminoterminal telopeptide of collagen I (NTx) were determined.

RESULTS

Negative correlations were found between baseline log-ferritin and log-NTx (p < 0.001), and between transferrin and P1NP (p = 0.002). Serum 25OHD increased (from 62 ± 21 to 71 ± 21 nmol/L, mean ± SD, p < 0.001) while P1NP and NTx decreased in Fe+D during the assay (p = 0.004 and p < 0.001, respectively). NTx was lower in Fe+D compared to Fe at week 8 (p < 0.05) and was higher in Fe and Fe+D compared to R throughout the assay (p < 0.01). PTH did not show changes.

CONCLUSIONS

Iron deficiency is related with higher bone resorption in young women. Consumption of a dairy product that supplies 5 μg/day of vitamin D3 reduces bone turnover and increases circulating 25OHD to nearly reach an optimal vitamin D status, defined as 25OHD over 75 nmol/L.

Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement

• The recommended level for serum 25-hydroxyvitamin D (25(OH)D) in infants, children, adolescents and during pregnancy and lactation is ≥ 50 nmol/L. This level may need to be 10-20 nmol/L higher at the end of summer to maintain levels ≥ 50 nmol/L over winter and spring. • Sunlight is the most important source of vitamin D. The US recommended dietary allowance for vitamin D is 600 IU daily in children aged over 12 months and during pregnancy and lactation, assuming minimal sun exposure. • Risk factors for low vitamin D are: lack of skin exposure to sunlight, dark skin, southerly latitude, conditions affecting vitamin D metabolism and storage (including obesity) and, for infants, being born to a mother with low vitamin D and exclusive breastfeeding combined with at least one other risk factor. • Targeted measurement of 25(OH)D levels is recommended for infants, children and adolescents with at least one risk factor for low vitamin D and for pregnant women with at least one risk factor for low vitamin D at the first antenatal visit. • Vitamin D deficiency can be treated with daily low-dose vitamin D supplements, although barriers to adherence have been identified. High-dose intermittent vitamin D can be used in children and adolescents. Treatment should be paired with health education and advice about sensible sun exposure. Infants at risk of low vitamin D should be supplemented with 400 IU vitamin D₃ daily for at least the first year of life. • There is increasing evidence of an association between low vitamin D and a range of non-bone health outcomes, however there is a lack of data from robust randomised controlled trials of vitamin D supplementation.

Vitamin D status of refugees arriving in Canada: findings from the Calgary Refugee Health Program

OBJECTIVE

To determine the 25-hydroxyvitamin D (25[OH]D) serum levels in refugee women of childbearing age and in refugee children; to compare their 25(OH)D levels with the recommended levels in order to determine the prevalence of deficiency; to compare their 25(OH)D levels with those in the general Canadian population in the appropriate age and sex groups; and to investigate the association of vitamin D deficiency with potential risk factors.

DESIGN

Cross-sectional chart review.

SETTING

The Calgary Refugee Health Program, an urban family practice that serves newly arrived refugees in Calgary, Alta.

PARTICIPANTS

A total of 1217 refugee women and children screened between June 2005 and January 2010.

MAIN OUTCOME MEASURES

Serum 25(OH)D values that were measured during initial screening visits.

RESULTS

Overall, 1217 of the 1768 eligible participants (69%) had 25(OH)D laboratory values recorded. The mean concentration of 25(OH)D was 52.0 nmol/L (95% CI 50.6 to 53.3 nmol/L). Using the Institute of Medicine guideline for adequate serum vitamin D levels (>50 nmol/L), 61% of women and 42% of children had lower-than-desirable 25(OH)D levels. Considering the Osteoporosis Canada guidelines, 88% of women and 81% of children had lower-than-desirable 25(OH)D levels (<75 nmol/L), and 21% of women and 10% of children were vitamin D deficient (<25 nmol/L). Mean levels of 25(OH)D were significantly lower across all age and sex groupings compared with the general Canadian population (P<.001). Women from the Middle East had lower mean 25(OH)D values (24.6 nmol/L, 95% CI 21.7 to 27.5 nmol/L) compared with women from Asia, Africa, or South America (P<.001). Mean values of 25(OH)D were lower during the winter in children (P=.01) but not in women. Female refugees between the ages of 12 and 19 years old had lower mean values of 25(OH)D than male refugees in the same age group did (P=.01).

CONCLUSION

Most refugees had lower-than-desirable vitamin D levels. All age groups studied had lower mean 25(OH)D levels compared with the general Canadian population. Health care providers should be aware of this concern and consider vitamin D supplementation among refugees.

The prevalence of vitamin D deficiency in iron-deficient and normal children under the age of 24 months

BACKGROUND

Iron and vitamin D deficiencies cause a variety of health issues in children, which might have long-lasting effects even in asymptomatic cases. The present study sought to elucidate the potential association between iron status and serum vitamin D levels in infants.

METHODS

We evaluated 102 infants aged 3-24 months who visited the CHA Bundang Medical Center from August 2010 to July 2011. Questionnaire and laboratory data were collected. The infants were classified into iron deficiency anemia (IDA), iron deficiency (ID), and normal groups according to hemoglobin (Hb) and ferritin levels. They were then classified into vitamin D deficiency (VDD), vitamin D insufficiency (VDI), and vitamin D sufficiency (VDS) groups according to 25-hydroxyvitamin D [25(OH)D] levels.

RESULTS

VDD was present in 67% of IDA, 53% of ID, and 29% of normal subjects. The proportion of breastfed infants was the highest in the IDA (97%) and VDD (96%) groups. The odds ratio for the likelihood of iron-deficient infants to have subnormal vitamin D levels was 4.115. There was a significant correlation between Hb and 25(OH)D levels. Plasma 25(OH)D levels were lower in the winter/spring. Body mass index values were higher in the IDA/ID groups. Iron, age, and season were predictors of 25(OH)D levels.

CONCLUSION

The prevalence of iron and vitamin D deficiency was high in breastfed infants. There was also a significant association between Hb and 25(OH)D levels in infants. Since all breastfed infants should receive vitamin D supplementation, there should also be concern about concurrent deficiencies in infants with IDA.

Low vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study

BACKGROUND

Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories.

METHODS

In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees (n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011.

RESULTS

16.5% of participants had Vitamin B12 deficiency (<150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%.

CONCLUSION

Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes, treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.

Prevalence and risk factors for vitamin D deficiency in children with iron deficiency anemia

PURPOSE

The increasing prevalence of breast feeding has led to concerns about vitamin D deficiency (VDD) and iron deficiency anemia (IDA) in children. We evaluated the prevalence of VDD in a population of Korean children with IDA and assessed the risk factors for VDD in these children.

METHODS

A total of 79 children who were diagnosed with IDA were prospectively surveyed from April 2010 to March 2011. Data were collected by questionnaire, medical assessment, and laboratory tests, including measurement of 25-hydroxyvitamin D (25OHD), hemoglobin, and wrist radiography.

RESULTS

The median age was 22 months and 30% of the subjects were female. Over a half of subjects (58%) had subnormal vitamin D level (25OHD<30 ng/mL), and VDD (25OHD<20 ng/mL) was present in 39% of children. There was no difference in serum hemoglobin level between IDA patients with VDD and those without VDD. Most subjects (89%) were currently or had recently been breastfed and almost all subjects (97%) who had VDD received breastfeeding. Children with VDD were more likely to be younger than 2 years, to have been breastfed, and to have been tested in winter or spring. Multivariable analysis indicated seasonal variation was a significant independent risk factor for VDD in our IDA patients.

CONCLUSION

Our results demonstrated that VDD has a high prevalence in Korean children with IDA. Primary care physicians should be aware of the possibility of VDD in children with IDA and should supplement the vitamin D as well as iron.

Post-arrival health screening in Karen refugees in Australia

Objective

To document the prevalence of nutritional deficiencies, infectious diseases and susceptibility to vaccine preventable diseases in Karen refugees in Australia.

Design

Retrospective audit of pathology results.

Setting

Community based cohort in Melbourne over the period July 2006–October 2009.

Participants

1136 Karen refugee children and adults, representing almost complete local area settlement and 48% of total Victorian Karen humanitarian intake for the time period.

Main Outcome Measures

Prevalence of positive test results for refugee health screening, with breakdown by age group (<6 years, 6–11 years, 12–17 years, 18 years and older).

Results

Overall prevalence figures were: anaemia 9.2%, microcytosis 19.1%, iron deficiency 13.1%, low vitamin B₁₂ 1.5%, low folate 1.5%, abnormal thyroid function tests 4.4%, vitamin D<50 nmol/L 33.3%, hypocalcaemia 7.4%, raised alkaline phosphatase 5.2%, abnormal liver transaminases 16.1%, hepatitis B surface antigen positive 9.7%, hepatitis B surface antibody positive 49.5%, isolated hepatitis B core antibody positive 9.0%, hepatitis C positive 1.9%, eosinophilia 14.4%, Schistosoma infection 7%, Strongyloides infection 20.8%, malaria 0.2%, faecal parasites 43.4%. Quantiferon-gold screening was positive in 20.9%. No cases of syphilis or HIV were identified. Serological immunity to vaccine preventable diseases was 87.1% for measles, 95% for mumps and 66.4% for rubella; 56.9% of those tested had seroimmunity to all three.

Conclusions

Karen refugees have high rates of nutritional deficiencies and infectious diseases and may be susceptible to vaccine preventable diseases. These data support the need for post-arrival health screening and accessible, funded catch-up immunisation.

Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food

BACKGROUND

Iron and vitamin D deficiencies are two of the most widespread nutritional disorders in the world. Our aim was to know whether the consumption of an iron-fortified fruit juice modifies bone remodelling and the possible influence of baseline vitamin D status on the recovery of iron status in a group of iron-deficient women.

METHODS

Iron biomarkers, 25-hydroxyvitamin D levels and dietary intake were measured in 123 iron-deficient menstruating women. A subgroup (n = 41) participated in a randomised double-blind placebo-controlled study of 16-weeks during winter. They consumed a placebo fruit juice (P) or iron-fortified fruit juice (F). Dietary intake, 25-hydroxyvitamin D, parathormone (PTH), bone alkaline phosphatase (ALP), aminoterminal telopeptide of collagen I (NTX) and iron biomarkers were determined.

RESULTS

Ninety-two per cent of the iron-deficient women were vitamin D deficient or insufficient. Transferrin saturation and 25-hydroxyvitamin D were positively correlated. Iron status improved in F, 25-hydroxyvitamin D decreased in F and P, and PTH, ALP and NTX levels were within the normal range and did not vary. Women with 25-hydroxyvitamin D ≥ 50 nmol/L compared with 25-hydroxyvitamin D < 50 nmol/L showed a higher increase in transferrin saturation (a marker of iron supply to tissues) during iron recovery.

CONCLUSION

The prevalence of vitamin D deficiency or insufficiency is very high in iron-deficient women. The recovery of iron status by consuming an iron-fortified food does not affect 25-hydroxyvitamin D levels; however, the increase in iron supply to tissues is lower if the women also present vitamin D deficiency. Although bone health does not seem to be affected in this group of women, correction of iron and vitamin D deficiencies should be promoted in young women to improve present and future health.

Vitamin D deficiency among northern Native Peoples: a real or apparent problem?

Vitamin D deficiency seems to be common among northern Native peoples, notably Inuit and Amerindians. It has usually been attributed to: (1) higher latitudes that prevent vitamin D synthesis most of the year; (2) darker skin that blocks solar UVB; and (3) fewer dietary sources of vitamin D. Although vitamin D levels are clearly lower among northern Natives, it is less clear that these lower levels indicate a deficiency. The above factors predate European contact, yet pre-Columbian skeletons show few signs of rickets-the most visible sign of vitamin D deficiency. Furthermore, because northern Natives have long inhabited high latitudes, natural selection should have progressively reduced their vitamin D requirements. There is in fact evidence that the Inuit have compensated for decreased production of vitamin D through increased conversion to its most active form and through receptors that bind more effectively. Thus, when diagnosing vitamin D deficiency in these populations, we should not use norms that were originally developed for European-descended populations who produce this vitamin more easily and have adapted accordingly.

Vitamin D deficiency in children living in Jeddah, Saudi Arabia

OBJECTIVE

Vitamin D deficiency is an unrecognized epidemic and a common health problem worldwide. This study was conducted to evaluate the vitamin D status in children living in Jeddah, Saudi Arabia and to study its relation to various variables.

MATERIALS AND METHODS

A cross-sectional study was conducted in the pediatric clinic in Jeddah Clinic Hospital-Kandarah, Jeddah, KSA, from October through December 2010, in which 510 healthy children aged 4-15 years were enrolled. Serum calcium, phosphorus, alkaline phosphatase and 25-hydroxyvitamin D [25(OH)D] were measured. Dietary vitamin D intake and duration of daily sunlight exposure were determined. 25(OH)D levels <20 ng/mL and <7 ng/mL were defined as relative and severe vitamin D deficiency, respectively.

RESULTS

The mean concentration of 25(OH)D was 13.07 ± 7.81 ng/mL. Seventy subjects (13.72%) had normal 25(OH)D level ranging 20-70 ng/mL. Three hundred (58.82%) had relative 25(OH)D deficiency and 140 (27.45%) had severe deficiency (P=0.000). 220 (43.14%) subjects were males and 290 (56.86%) were females having a statistically significant higher incidence of 25(OH)D deficiency (P=0.019). 54.9% were Saudis, 27.45% were Yemenis and 11.76% were Egyptians. Saudis and Yemenis were more subjected to 25(OH)D deficiency in comparison to Egyptians and other nationalities (P=0.01). There were significant inverse correlations between 25(OH)D levels and bony aches (P=0.000). 56.25% of asymptomatic children had vitamin D deficiency (P=0.000). Duration of sunlight exposure and daily intake of vitamin D had significant effects on serum level of vitamin D (P=0.000).

CONCLUSIONS

A high prevalence of vitamin D deficiency in children living in Jeddah was observed in this study. Vitamin D supplementation of food products can prevent vitamin D deficiency in these children.

Rickets

Rickets is disorder of a growing child arising from disorders that result in impaired apoptosis of hypertrophic cells and mineralization of the growth plate. Rickets due to nutritional causes remains an important global problem. The factors responsible for resurgence of rickets among dark-skinned infants living in developed countries include the following: residence in northern or southern latitudes, voluntary avoidance of exposure to solar ultraviolet B radiation, maternal vitamin D deficiency during pregnancy, and prolonged breastfeeding without provision of vitamin D supplements. Fibroblast growth factor 23 (FGF23), secreted by osteocytes, is an important regulator of serum phosphate and 1,25(OH)(2)D(3) levels. Hypophosphatemic rickets resulting from increased synthesis or under-catabolism of FGF23 is reviewed.

Worldwide vitamin D status

The aim of the present study is to summarize existing literature on vitamin D levels in adults in different continents and different countries worldwide. The best determinant of vitamin D status is the serum concentration of 25-hydroxyvitamin D (25(OH)D). Most investigators agree that serum 25(OH)D should be higher than 50 nmol/l, but some recommend higher serum levels. Traditional risk groups for vitamin D deficiency include pregnant women, children, older persons, the institutionalized, and non-western immigrants. This chapter shows that serum 25(OH)D levels are not only suboptimal in specific risk groups, but also in adults in many countries. Especially, in the Middle-East and Asia, vitamin D deficiency in adults is highly prevalent.

Vitamin D, obesity, and obesity-related chronic disease among ethnic minorities: a systematic review

OBJECTIVE

To assess the association between 25-hydroxyvitamin D (25[OH]D) status and obesity, cardiovascular diseases (CVDs), the metabolic syndrome, and type 2 diabetes mellitus (T2DM) in ethnic minorities.

METHODS

Databases searched were CINHAL with full text, Global Health, MEDLINE with full text, and PsycINFO from 1980 through 2010 (February). Studies were included if they 1) targeted immigrants from low- to high-income countries or ethnic minorities, 2) focused primarily on 25(OH)D and its relation to obesity, T2DM, and/or CVDs, and 3) were published in peer-reviewed journals. The influences of key confounders such as age, gender, and ethnicity on any observed relations were also assessed. Due to the heterogeneity of study characteristics, only a narrative synthesis was undertaken.

RESULTS

Ethnic minorities had significantly higher rates of vitamin D insufficiency (25[OH]D <50 nmol/L; children 43.6-48.7% versus 10%; adults 30.3-53% versus 13.7-26%) than their white counterparts. None of the studies reported a prevalence of obesity stratified by ethnicity. There was evidence supporting links between vitamin D deficiency and obesity-related chronic diseases, with 14 of 14 studies reporting a statistically significant result with a measurement of obesity, four of five for T2DM, four of five for CVDs, and one of one for the metabolic syndrome. However, the strength of the association varied across ethnic groups depending on the index used to measure adiposity, T2DM, and CVDs. Because most of the included studies were cross-sectional and there were variations in outcome measurements, it was not possible to determine the relative contributions of obesity or vitamin D insufficiency to CVD risk and risk of T2DM or which is the initial driver It is possible both have a role to play.

CONCLUSION

Further research specific to migrant populations using randomized controlled trials are required to establish whether causal links between 25(OH)D and obesity-related chronic disease exist, and whether vitamin D supplementation could be valuable in the prevention or treatment of obesity-related diseases.