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Dai C, Huang YH. Effectiveness of Vitamin D Supplementation on Disease Course in Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2023; 29:e14. [PMID: 36799906 DOI: 10.1093/ibd/izad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Cong Dai
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yu-Hong Huang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
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Stephenson AJ, Hunter B, Shaw PN, Kassim NSA, Trengove R, Takechi R, Lam V, Mamo J. A highly sensitive LC-MS/MS method for quantitative determination of 7 vitamin D metabolites in mouse brain tissue. Anal Bioanal Chem 2023; 415:1357-1369. [PMID: 36705732 PMCID: PMC9928823 DOI: 10.1007/s00216-023-04527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/13/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
Despite its critical role in neurodevelopment and brain function, vitamin D (vit-D) homeostasis, metabolism, and kinetics within the central nervous system remain largely undetermined. Thus, it is of critical importance to establish an accurate, highly sensitive, and reproducible method to quantitate vit-D in brain tissue. Here, we present a novel liquid chromatography tandem mass spectrometry (LC-MS/MS) method and for the first time, demonstrate detection of seven major vit-D metabolites in brain tissues of C57BL/6J wild-type mice, namely 1,25(OH)2D3, 3-epi-1,25(OH)2D3, 1,25(OH)2D2, 25(OH)D3, 25(OH)D2, 24,25(OH)2D3, and 24,25(OH)2D2. Chromatographic separation was achieved on a pentaflurophenyl column with 3 mM ammonium formate water/methanol [A] and 3 mM ammonium formate methanol/isopropanol [B] mobile phase components. Detection was by positive ion electrospray tandem mass spectrometry with the EVOQ elite triple quadrupole mass spectrometer with an Advance ultra-high-performance liquid chromatograph and online extraction system. Calibration standards of each metabolite prepared in brain matrices were used to validate the detection range, precision, accuracy, and recovery. Isotopically labelled analogues, 1,25(OH)2D3-d3, 25(OH)D3-c5, and 24,25(OH)2D3-d6, served as the internal standards for the closest molecular-related metabolite in all measurements. Standards between 1 fg/mL and 10 ng/mL were injected with a resulting linear range between 0.001 and 1 ng, with an LLOD and LLOQ of 1 pg/mL and 12.5 pg/mL, respectively. The intra-/inter-day precision and accuracy for measuring brain vit-D metabolites ranged between 0.12-11.53% and 0.28-9.11%, respectively. Recovery in acetonitrile ranged between 99.09 and 106.92% for all metabolites. Collectively, the sensitivity and efficiency of our method supersedes previously reported protocols used to measure vit-D and to our knowledge, the first protocol to reveal the abundance of 25(OH)D2, 1,25(OH)D2, and 24,25(OH)2D2, in brain tissue of any species. This technique may be important in supporting the future advancement of pre-clinical research into the function of vit-D in neurophysiological and neuropsychiatric disorders, and neurodegeneration.
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Affiliation(s)
- Andrea Joy Stephenson
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA Australia
| | - Benjamin Hunter
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- Separation Science & Metabolomics Laboratory at Murdoch University, Perth, Australia
| | - Paul Nicholas Shaw
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD Australia
| | - Nur Sofiah Abu Kassim
- School of Chemistry and Environment, Faculty of Applied Science, University Teknologi MARA, Negeri Sembilan, Cawangan Negeri Sembilan, Kampus Kuala Pilah, Kuala Pilah, Malaysia
| | - Robert Trengove
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- Separation Science & Metabolomics Laboratory at Murdoch University, Perth, Australia
| | - Ryu Takechi
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA Australia
| | - Virginie Lam
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA Australia
| | - John Mamo
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA Australia
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Ling Y, Xu F, Xia X, Dai D, Xiong A, Sun R, Qiu L, Xie Z. Vitamin D supplementation reduces the risk of fall in the vitamin D deficient elderly: An updated meta-analysis. Clin Nutr 2021; 40:5531-5537. [PMID: 34656949 DOI: 10.1016/j.clnu.2021.09.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Vitamin D supplementation has been widely recommended to prevent falls. However, considerable controversy exists regarding the association of such supplementation and fall risk. Previous meta-analyses yielded inconsistent results because of differences in the baseline of 25-hydroxyvitamin D [25(OH)D] and dose of vitamin D and use of vitamin D or in combination with calcium in different studies. Furthermore, some studies published recently were not included in the previous meta-analyses. Therefore, an updated and comprehensive meta-analysis is warranted. METHODS We systematically searched several literature databases including PubMed and the Embase from inception to September 2020. The protocol for this meta-analysis was registered with PROSPERO (CRD42021226380). Randomized clinical trials (RCTs) reporting the effect of vitamin D supplementation alone or with calcium on fall incidence were selected from studies. Qualitative and quantitative information was extracted; the random-effects model was conducted to pool the data for fall; statistical heterogeneity was assessed using the I2 test and potential for publication bias was assessed qualitatively by a visual estimate of the funnel plot and quantitatively by calculation of the Begg's test and the Egger's test. RESULTS Of the citations retrieved, 31 eligible studies involving 57 867 participants met inclusion criteria, reporting 17 623 falls. A total of 21 RCTs of vitamin D alone and 10 RCTs of vitamin D plus calcium were included in the meta-analysis. The meta-analysis of 21 RCTs (51 984 participants) of vitamin D supplementation alone (daily or intermittent doses of 400-60 000 IU) did not show a reduced risk of falls (The risk ratio [RR] 1.00, 95% confidence intervals [CI] 0.95 to 1.05) compared to placebo or no treatment. Subgroup analyses showed that the baseline of serum 25(OH)D concentration less than 50 nmol/L resulted in a reduction of fall risk (RR 0.77, 95% CI 0.61 to 0.98). In contrast, the meta-analysis of 10 RCTs (5883 participants) of combined supplementation of vitamin D (daily doses of 700-1000 IU) and calcium (daily doses of 1000-1200 mg) showed a 12% reduction in the risk of fall (RR 0.88, 95% CI 0.80 to 0.97). CONCLUSIONS The combination of vitamin D and calcium have beneficial effects on prevention falls in old adults. Although vitamin D supplementation alone has no effect on fall risk in old adults with 25(OH)D levels higher than 50 nmol/L, vitamin D supplementation alone does have a benefit on prevention of falls in old adults with 25(OH)D levels lower than 50 nmol/L.
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Affiliation(s)
- Yali Ling
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Feng Xu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Xuedi Xia
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Dexing Dai
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - An Xiong
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Ruoman Sun
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Lei Qiu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Zhongjian Xie
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
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Dai C, Jiang M. Influence of Severe Vitamin D Deficiency on the Clinical Course of Inflammatory Bowel Disease. Dig Dis Sci 2021; 66:919-920. [PMID: 32529518 DOI: 10.1007/s10620-020-06313-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/02/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Cong Dai
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, No. 92 of Beier Road, Heping District, Shenyang City, 110001, Liaoning Province, China.
| | - Min Jiang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, No. 92 of Beier Road, Heping District, Shenyang City, 110001, Liaoning Province, China
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A prediction tool for vitamin D deficiency in New Zealand adults. Arch Osteoporos 2020; 15:172. [PMID: 33128635 DOI: 10.1007/s11657-020-00844-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aims to develop a model for predicting vitamin D deficiency in New Zealand adults using easily accessible clinical characteristics. METHODS Data were derived from the Vitamin D Assessment (ViDA) study dataset. Included participants in the main analysis were aged 50-84 years and resided in Auckland, New Zealand. The dataset was split into a discovery dataset in which the prediction model was developed (n = 2036) and a validation dataset in which it was tested (n = 2037). The prediction model was developed using clinical characteristics in a logistic regression analysis with deseasonalised serum 25OHD (DS-25OHD) as the dependent variable. RESULTS DS-25OHD < 40 nmol/L was found in 8.2% of European participants, 18.8% of Māori participants, 23.1% of Pacific participants and 52.2% of South Asian participants. Predictors for DS-25OHD < 40 nmol/L in the European sub-cohort included increasing age, female sex, higher body mass index, current smoking, no alcohol intake, lower self-reported general health status, lower physical activity hours, lower outdoor hours and no use of vitamin D-containing supplementation. The area under the curve in the discovery dataset was 0.73, and in the validation dataset was 0.71. Of those with a prediction score ≥ 10 (total risk score range 0-21.5), the sensitivity and specificity for predicting vitamin D deficiency was 0.90 and 0.41, respectively. CONCLUSION Non-European ethnicity is an important risk factor for vitamin D deficiency. Our vitamin D deficiency prediction model performed well and demonstrates its potential as a tool that can be integrated into clinical practice for the prediction of vitamin D deficiency.
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Laviano E, Sanchez Rubio M, González-Nicolás MT, Palacian MP, López J, Gilaberte Y, Calmarza P, Rezusta A, Serrablo A. Association between preoperative levels of 25-hydroxyvitamin D and hospital-acquired infections after hepatobiliary surgery: A prospective study in a third-level hospital. PLoS One 2020; 15:e0230336. [PMID: 32214325 PMCID: PMC7098583 DOI: 10.1371/journal.pone.0230336] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Evidence implicates vitamin D deficiency in poorer outcomes and increased susceptibility to hospital-acquired infections (HAIs). This study examined the association between serum vitamin D levels and HAIs in a population of hepatobiliary surgery patients. Methods Participants in this prospective analytical observational study were patients who underwent hepatobiliary surgery in a tertiary hospital in Aragon, Spain, between February 2018 and March 2019. Vitamin D concentrations were measured at admission and all nosocomial infections during hospitalization and after discharge were recorded. Results The mean 25-hydroxyvitamin D concentration of the study population (n = 301) was 38.56 nmol/L, which corresponds to vitamin D deficiency. Higher vitamin D concentrations were associated with a decreased likelihood of developing a HAI in general (p = 0.014), and in particularly surgical site infection (p = 0.026). The risk of HAI decreased by 34% with each 26.2-nmol/L increase in serum vitamin D levels. Conclusions Vitamin D levels may constitute a modifiable risk factor for postoperative nosocomial infections in hepatobiliary surgery patients.
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Affiliation(s)
- Estefania Laviano
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, Spain
- * E-mail:
| | - Maria Sanchez Rubio
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, Spain
| | | | | | - Javier López
- Medicina Familiar y Comunitaria, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Pilar Calmarza
- Servicio de Bioquímica, Hospital Miguel Servet, Zaragoza, Spain
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Miguel Servet, Zaragoza, Spain
| | - Alejandro Serrablo
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, Spain
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Genetic, environmental and biomarker considerations delineating the regulatory effects of vitamin D on central nervous system function. Br J Nutr 2020; 123:41-58. [PMID: 31640823 DOI: 10.1017/s000711451900268x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Studies show that vitamin D (vit-D) (25(OH)D), the bioactive metabolite (1,25(OH)2D3) and vit-D receptors (vit-D receptor; protein disulphide isomerase, family A member 3) are expressed throughout the brain, particularly in regions pivotal to learning and memory. This has led to the paradigm that avoiding vit-D deficiency is important to preserve cognitive function. However, presently, it is not clear if the common clinical measure of serum 25(OH)D serves as a robust surrogate marker for central nervous system (CNS) homeostasis or function. Indeed, recent studies report CNS biosynthesis of endogenous 25(OH)D, the CNS expression of the CYP group of enzymes which catalyse conversion to 1,25(OH)2D3 and thereafter, deactivation. Moreover, in the periphery, there is significant ethnic/genetic heterogeneity in vit-D conversion to 1,25(OH)2D3 and there is a paucity of studies which have actually investigated vit-D kinetics across the cerebrovasculature. Compared with peripheral organs, the CNS also has differential expression of receptors that trigger cellular response to 1,25(OH)2D3 metabolites. To holistically consider the putative association of peripheral (blood) abundance of 25(OH)D on cognitive function, herein, we have reviewed population and genetic studies, pre-clinical and clinical intervention studies and moreover have considered potential confounders of vit-D analysis.
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8
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Oral Nano Vitamin D Supplementation and Disease Activity in Ulcerative Colitis. J Clin Gastroenterol 2019; 53:779-780. [PMID: 31524651 DOI: 10.1097/mcg.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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9
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Current Practice in Vitamin D Management in Allogeneic Hematopoietic Stem Cell Transplantation: A Survey by the Transplant Complications Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2019; 25:2079-2085. [PMID: 31229642 DOI: 10.1016/j.bbmt.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/05/2019] [Accepted: 06/15/2019] [Indexed: 11/23/2022]
Abstract
Beyond its impact on bone health, numerous studies have investigated the immune-regulatory properties of vitamin D and shown how its deficiency can affect outcomes in allogeneic hematopoietic stem cell transplantation (HSCT), particularly in acute or chronic graft-versus-host disease. This survey, carried out by the Transplant Complications Working Party of the European Society for Blood and Marrow Transplantation (EBMT), describes the current clinical practice discrepancies across the EBMT HSCT programs. We therefore recommend the development of evidence-based guidelines to standardize evaluation criteria and to harmonize the management of vitamin D deficiency in patients undergoing allogeneic HSCT.
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Veena SR, Krishnaveni GV, Srinivasan K, Thajna KP, Hegde BG, Gale CR, Fall CH. Association between maternal vitamin D status during pregnancy and offspring cognitive function during childhood and adolescence. Asia Pac J Clin Nutr 2017; 26:438-449. [PMID: 28429909 DOI: 10.6133/apjcn.032016.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Animal studies have demonstrated poor cognitive outcomes in offspring in relation to maternal vitamin D deficiency before and/or during pregnancy. Human studies linking maternal vitamin D status during pregnancy with offspring cognitive function are limited. We aimed to test the hypothesis that lower maternal vitamin D status during pregnancy is associated with poor offspring cognitive ability in an Indian population. METHODS AND STUDY DESIGN Cognitive function was assessed in children from the Mysore Parthenon birth cohort during childhood (age 9-10 years; n=468) and adolescence (age 13-14 years; n=472) using 3 core tests from the Kaufman Assessment Battery for children and additional tests measuring learning, long-term retrieval/ storage, short-term memory, reasoning, verbal fluency, visuo-spatial ability, and attention and concentration. Maternal serum 25-hydroxyvitamin D concentration was measured at 30±2 weeks of gestation. RESULTS During pregnancy 320 (68%) women had 'vitamin D deficiency' (serum 25-hydroxyvitamin D concentration <50 nmol/L). Girls scored better than boys in tests of short-term memory, reasoning, verbal fluency, and attention (p<0.05 for all). Maternal vitamin D status (low as well as across the entire range) was unrelated to offspring cognitive function at both ages, either unadjusted or after adjustment for the child's current age, sex, maternal age, parity, season at the time of blood sampling, gestational age, the child's birth and current size, socio-economic status, parents' education, maternal intelligence and home environment. CONCLUSIONS In this population, despite a high prevalence of vitamin D deficiency during pregnancy, there was no evidence of an association between maternal vitamin D status and offspring cognitive function.
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Affiliation(s)
- Sargoor R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India.
| | - Ghattu V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India
| | | | - Kotrangada P Thajna
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India
| | - Bhavya G Hegde
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, South India
| | - Catharine R Gale
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Caroline Hd Fall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
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Garg M. Serum Vitamin D and Risk of Clinical Relapse in Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol 2017; 15:1136. [PMID: 28238956 DOI: 10.1016/j.cgh.2017.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Mayur Garg
- Department of Gastroenterology and Hepatology, Eastern Health, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
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Abstract
Vitamin D deficiency has been linked with schizophrenia. We aimed to determine whether patients with a first episode of psychosis (FEP) had lower vitamin D levels compared with controls considering their final diagnosis. We conducted a cross-sectional study determining 25-hydroxyvitamin D blood levels. 25-Hydroxyvitamin D levels were considered optimum at 20 ng/mL or greater. A group of 45 adult patients with FEP and a group of 22 healthy controls matched for age were recruited. The patient group was subdivided in two final diagnosis groups (schizophrenia versus other psychoses) after a 6-month follow-up. Average vitamin D values were deficient for FEP patients, especially those 22 with a final diagnosis of schizophrenia. These results relating vitamin D and schizophrenia generate interest to further examine this association.
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Vignali E, Macchia E, Cetani F, Reggiardo G, Cianferotti L, Saponaro F, Marcocci C. Development of an algorithm to predict serum vitamin D levels using a simple questionnaire based on sunlight exposure. Endocrine 2017; 55:85-92. [PMID: 26965913 DOI: 10.1007/s12020-016-0901-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
Abstract
Sun exposure is the main determinant of vitamin D production. The aim of this study was to develop an algorithm to assess individual vitamin D status, independently of serum 25(OHD) measurement, using a simple questionnaire, mostly relying upon sunlight exposure, which might help select subjects requiring serum 25(OHD) measurement. Six hundred and twenty adult subjects living in a mountain village in Southern Italy, located at 954 m above the sea level and at a latitude of 40°50'11″76N, were asked to fill the questionnaire in two different periods of the year: August 2010 and March 2011. Seven predictors were considered: month of investigation, age, sex, BMI, average daily sunlight exposure, beach holidays in the past 12 months, and frequency of going outdoors. The statistical model assumes four classes of serum 25(OHD) concentrations: ≤10, 10-19.9, 20-29.9, and ≥30 ng/ml. The algorithm was developed using a two-step procedure. In Step 1, the linear regression equation was defined in 385 randomly selected subjects. In Step 2, the predictive ability of the regression model was tested in the remaining 235 subjects. Seasonality, daily sunlight exposure and beach holidays in the past 12 months accounted for 27.9, 13.5, and 6.4 % of the explained variance in predicting vitamin D status, respectively. The algorithm performed extremely well: 212 of 235 (90.2 %) subjects were assigned to the correct vitamin D status. In conclusion, our pilot study demonstrates that an algorithm to estimate the vitamin D status can be developed using a simple questionnaire based on sunlight exposure.
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Affiliation(s)
- Edda Vignali
- Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Enrico Macchia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Luisella Cianferotti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Federica Saponaro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Maternal-Cord Blood Vitamin D Correlations Vary by Maternal Levels. J Pregnancy 2016; 2016:7474192. [PMID: 27066272 PMCID: PMC4811107 DOI: 10.1155/2016/7474192] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/15/2016] [Indexed: 01/18/2023] Open
Abstract
Vitamin D levels of pregnant women and their neonates tend to be related; however, it is unknown whether there are any subgroups in which they are not related. 25-Hydroxyvitamin D [25(OH)D] was measured in prenatal maternal and child cord blood samples of participants (n = 241 pairs) in a birth cohort. Spearman correlations were examined within subgroups defined by prenatal and delivery factors. Cord blood as a percentage of prenatal 25(OH)D level was calculated and characteristics compared between those who did and did not have ≥25% and ≥50% of the maternal level and those who did and did not have a detectable 25(OH)D level. The correlation among Black children was lower than in White children. When the maternal 25(OH)D level was <15 ng/mL, the overall correlation was r = 0.16. Most children had a 25(OH)D cord blood level less than half of their mother's; 15.4% had a level that was <25% of their mother's. Winter birth and maternal level were associated with the level being less than 25%. Children with undetectable levels were more likely to be Black and less likely to be firstborn. These data suggest mothers may reduce their contribution to the fetus's 25(OH)D supply once their own level becomes low.
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Wegienka G, Havstad S, Zoratti EM, Kim H, Ownby DR, Johnson CC. Association between vitamin D levels and allergy-related outcomes vary by race and other factors. J Allergy Clin Immunol 2015; 136:1309-14.e1-4. [PMID: 26078105 PMCID: PMC4640935 DOI: 10.1016/j.jaci.2015.04.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Allergy-related studies that include biological measurements of vitamin D preceding well-measured outcomes are needed. OBJECTIVE We sought to examine the associations between early-life vitamin D levels and the development of allergy-related outcomes in the racially diverse Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study birth cohort. METHODS 25-Hydroxyvitamin D (25[OH]D) levels were measured in stored blood samples from pregnancy, cord blood, and age 2 years. Logistic regression models were used to calculate odds ratios (ORs) with 95% CIs for a 5 ng/mL increase in 25(OH)D levels for the following outcomes at age 2 years: eczema, skin prick tests (SPTs), increased allergen-specific IgE level (≥ 0.35 IU/mL), and doctor's diagnosis of asthma (3-6 years). RESULTS Prenatal 25(OH)D levels were inversely associated with eczema (OR, 0.85; 95% CI, 0.75-0.96). The association was stronger in white children (white children: OR, 0.79; 95% CI, 0.57-1.09; black children: OR, 0.96; 95% CI, 0.82-1.12), although this was not statistically significant. Cord blood 25(OH)D levels were inversely associated with having 1 or more positive SPT responses and aeroallergen sensitization. Both associations were statistically significant in white children (positive SPT response: OR, 0.50; 95% CI, 0.32-0.80; ≥ 1 aeroallergen sensitization: OR, 0.50; 95% CI, 0.28-0.92) in contrast with black children (positive SPT response: OR, 0.88; 95% CI, 0.68-1.14; ≥ 1 aeroallergen sensitization: OR, 0.85; 95% CI, 0.65-1.11). 25(OH)D levels measured concurrently with outcome assessment were inversely associated with aeroallergen sensitization (OR, 0.79; 95% CI, 0.66-0.96) only among black children (white children: OR, 1.21; 95% CI, 0.87-1.69). CONCLUSIONS Prenatal and cord blood 25(OH)D levels were associated with some allergy-related outcomes, with a general pattern indicating that children with higher 25(OH)D levels tend to have fewer allergy-related outcomes.
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Affiliation(s)
- Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich.
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich
| | - Edward M Zoratti
- Department of Internal Medicine, Division of Allergy, Henry Ford Hospital, Detroit, Mich
| | - Haejin Kim
- Department of Internal Medicine, Division of Allergy, Henry Ford Hospital, Detroit, Mich
| | - Dennis R Ownby
- Department of Pediatrics, Georgia Regents University, Augusta, Ga
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Clark P, Vivanco-Muñoz N, Piña JT, Rivas-Ruiz R, Huitrón G, Chico-Barba G, Reza-Albarrán AA. High prevalence of hypovitaminosis D in Mexicans aged 14 years and older and its correlation with parathyroid hormone. Arch Osteoporos 2015; 10:225. [PMID: 26168767 DOI: 10.1007/s11657-015-0225-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/29/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED A sample of 585 healthy subjects 14 years and older was studied to estimate the status of 25-hydroxyvitamin D (25(OH)D) and its correlation with parathyroid hormone in healthy Mexicans. In 43.6 % of the sample, levels of vitamin D were below 20 ng/mL and showed an inverse relationship with parathyroid hormone (PTH; p < 0.01). PURPOSE The purpose of the present study was to estimate the status of 25-hydroxyvitamin D (25(OH)D) and its correlation with parathyroid hormone in healthy Mexicans. METHODS A cross-sectional study of 585 healthy subjects 14 years and older was carried out. A questionnaire including all relevant demographics, medical history, and lifestyle factors was applied by trained interviewers. Morning fasting blood was collected in all subjects for estimation of 25(OH)D using liquid chromatography-tandem mass spectrometry and PTH hormone-intact molecule by RIA. RESULTS Of the group of 585 subjects, 54.1 % were women; the sample was divided in three age groups (14-29, 30-50, and >51). Only 9.6 % of the total sample had levels of 25(OH)D above 30 ng/mL; 46.8 % were between 20 and 29 ng/mL, and 43.6 % were below 20 ng/mL. Regarding PTH, a three-phase model was identified using regression smoothing scatterplot (LOESS), with two thresholds of 25(OH)D of 19 and 29 ng/mL. Phase 1 (25(OH)D <19 ng/mL) showed an inverse relationship with PTH (p < 0.01); phases 2 and 3 showed no significant relationship. CONCLUSION Our results show that 43.6 % of the Mexicans in this study have deficient concentration levels of vitamin D. The cutoff point of 20 ng/mL of 25(OH)D established by the Institute of Medicine has a biological and statistically significant relationship with PTH levels in the Mexican population, independently of principal confounding factors. Like many other countries, Mexico could be included in the global epidemic of hypovitaminosis D.
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Affiliation(s)
- Patricia Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez-Facultad de Medina UNAM, Calle Dr. Márquez 162, Cuahtemoc, Doctores, 06720, México, D.F., Mexico,
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Barassi A, Pezzilli R, Colpi GM, Corsi Romanelli MM, Melzi d'Eril GV. Vitamin D and Erectile Dysfunction. J Sex Med 2014; 11:2792-800. [DOI: 10.1111/jsm.12661] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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18
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SKARPHEDINSDOTTIR SJ, SIGURDSSON MI, COURSIN DB, HEAD DE, SPRINGMAN SR, WANG S, CHEN G, LI Q, KRUEGER DC, BINKLEY N, SIGURDSSON GH, HOGAN KJ. Vitamin D deficiency in anesthesia department caregivers at the end of winter. Acta Anaesthesiol Scand 2014; 58:802-6. [PMID: 25040952 DOI: 10.1111/aas.12316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND To test whether the vitamin D status of anesthesia department caregivers practicing at high Northern latitudes is compatible with current recommendations, the 25-hydroxyvitamin D (25(OH)D) levels of caregivers at hospitals in Iceland (64°08' N) and in Wisconsin (43°07' N) were compared at the end of winter. METHODS Anesthesia department faculty and resident physicians, non-physician anesthetists, and critical care nurses completed a questionnaire, and provided blood samples for analysis of 25(OH)D by reverse-phase high performance liquid chromatography. RESULTS One hundred and six participants in Iceland and 124 participants in Wisconsin were enrolled. No difference in mean serum 25(OH)D levels between Iceland [70.53 nmol/l, standard deviation (SD) 30.87 nmol/l] and Wisconsin (70.0 nmol/l, SD 30.0 nmol/l) was observed. In Iceland and Wisconsin, 25(OH)D levels below 25 nmol/l were observed in 4.7% and 4.0%, below 50 nmol/l in 34.9% and 25.0%, and below 75 nmol/l in 56.6% and 61.3% of caregivers, respectively. CONCLUSIONS 25(OH)D levels below the 50 nmol/l (20 ng/ml) threshold recommended by the Institute of Medicine and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and below the 75 nmol/l (30 ng/ml) threshold recommended by The Endocrine Society, are highly prevalent among anesthesia caregivers working at two Northern hospitals at the end of winter who may otherwise not meet criteria to be tested. Anesthesia and critical care providers may wish to determine their 25(OH)D levels and use effective, safe, and low cost supplementation to target a 25(OH)D level compatible with optimal health.
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Affiliation(s)
- S. J. SKARPHEDINSDOTTIR
- Department of Anaesthesia and Intensive Care Medicine; Landspitali University Hospital; Reykjavik Iceland
- Faculty of Medicine; University of Iceland; Reykjavik Iceland
| | - M. I. SIGURDSSON
- Department of Anaesthesia and Intensive Care Medicine; Landspitali University Hospital; Reykjavik Iceland
- Faculty of Medicine; University of Iceland; Reykjavik Iceland
| | - D. B. COURSIN
- Department of Anesthesiology; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - D. E. HEAD
- Department of Anesthesiology; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - S. R. SPRINGMAN
- Department of Anesthesiology; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - S. WANG
- Department of Biostatistics; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - G. CHEN
- Department of Biostatistics; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Q. LI
- Department of Biostatistics; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - D. C. KRUEGER
- Department of Medicine and Osteoporosis Clinical Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - N. BINKLEY
- Department of Medicine and Osteoporosis Clinical Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - G. H. SIGURDSSON
- Department of Anaesthesia and Intensive Care Medicine; Landspitali University Hospital; Reykjavik Iceland
- Faculty of Medicine; University of Iceland; Reykjavik Iceland
| | - K. J. HOGAN
- Department of Anesthesiology; University of Wisconsin School of Medicine and Public Health; Madison WI USA
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Karras SN, Anagnostis P, Bili E, Naughton D, Petroczi A, Papadopoulou F, Goulis DG. Maternal vitamin D status in pregnancy and offspring bone development: the unmet needs of vitamin D era. Osteoporos Int 2014; 25:795-805. [PMID: 23907574 DOI: 10.1007/s00198-013-2468-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/22/2013] [Indexed: 11/28/2022]
Abstract
Data from animal and human studies implicate maternal vitamin D deficiency during pregnancy as a significant risk factor for several adverse outcomes affecting maternal, fetal, and child health. The possible associations of maternal vitamin D status and offspring bone development comprise a significant public health issue. Evidence from randomized trials regarding maternal vitamin D supplementation for optimization of offspring bone mass is lacking. In the same field, data from observational studies suggest that vitamin D supplementation is not indicated. Conversely, supplementation studies provided evidence that vitamin D has beneficial effects on neonatal calcium homeostasis. Nevertheless, a series of issues, such as technical difficulties of current vitamin D assays and functional interplay among vitamin D analytes, prohibit arrival at safe conclusions. Future studies would benefit from adoption of a gold standard assay, which would unravel the functions of vitamin D analytes. This narrative review summarizes and discusses data from both observational and supplementation studies regarding maternal vitamin D status during pregnancy and offspring bone development.
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Affiliation(s)
- S N Karras
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece,
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20
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Influencia del inmunoensayo empleado en la determinación de vitamina D sérica. ACTA ACUST UNITED AC 2014; 61:123-9. [DOI: 10.1016/j.endonu.2013.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/25/2013] [Accepted: 04/29/2013] [Indexed: 11/24/2022]
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FGF23 concentrations measured using "intact" assays similar but not interchangeable. Int Urol Nephrol 2013; 45:1821-3. [PMID: 23649347 DOI: 10.1007/s11255-013-0451-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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22
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Shapses SA, Lee EJ, Sukumar D, Durazo-Arvizu R, Schneider SH. The effect of obesity on the relationship between serum parathyroid hormone and 25-hydroxyvitamin D in women. J Clin Endocrinol Metab 2013; 98:E886-90. [PMID: 23509103 PMCID: PMC3644609 DOI: 10.1210/jc.2012-3369] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Obesity is associated with lower serum concentrations of 25-hydroxyvitamin D (25OHD) and higher intact PTH. The threshold of 25OHD needed to maximally suppress intact PTH has been suggested as a marker of optimal vitamin D status. OBJECTIVE In this study, we hypothesized that whereas the obese have a higher serum PTH and lower 25OHD, suppression of serum PTH by 25OHD would be independent of body weight. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective analysis on 383 women (ages 24-75 y) with a wide range of body weights (43-185 kg) who were stabilized to 1-1.2 g calcium/d for 1 month before blood draw. Body composition, serum PTH, 25OHD, calcium, and creatinine were measured. Locally weighted regression and smoothing scatterplots were used to depict the association between serum PTH and 25OHD. A nonlinear exponential model determined the point for near maximal suppression of PTH by 25OHD. RESULTS The point for near maximal suppression of PTH by 25OHD for all women (body mass index, 31.4 ± 7.7 kg/m²) occurred at a 25OHD concentration of 21.7 ng/mL (95% confidence interval, 28-48 ng/mL). No point of maximal suppression was found for nonobese women, yet in the obese women (n = 207; body mass index, >30 kg/m²) suppression of PTH occurred at a 25OHD concentration of 11.1 ng/mL (95% confidence interval, 4.7-17.5 ng/mL). CONCLUSIONS These results suggest that if PTH is suppressed at a lower serum 25OHD in the obese compared to the entire population, the lower average 25OHD concentrations in the obese may not have the same physiological significance as in the general population.
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Affiliation(s)
- Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey 08901-8525, USA.
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23
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Major JM, Graubard BI, Dodd KW, Iwan A, Alexander BH, Linet MS, Freedman DM. Variability and reproducibility of circulating vitamin D in a nationwide U.S. population. J Clin Endocrinol Metab 2013; 98:97-104. [PMID: 23144464 PMCID: PMC3537087 DOI: 10.1210/jc.2012-2643] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Most studies examining associations between circulating vitamin D and disease are based on a single measure of vitamin D, which may not reflect levels over time, particularly because vitamin D concentrations vary by season. Few studies evaluated how well multiple 25-hydroxyvitamin D [25(OH)D] measures track within the same individual over time. OBJECTIVE This study examined variability and reproducibility of vitamin D by evaluating repeat measurements of plasma 25(OH)D concentrations while accounting for determinants of circulating concentrations including dietary supplement use and latitude of residence from a population of U.S. radiologic technologists. DESIGN AND PARTICIPANTS We analyzed circulating 25(OH)D in blood samples taken from 538 men and women from a prospective, nationwide study at two time points within a 1-yr period, most measured in different seasons. Inter- and intra-individual variability, reliability coefficients, and measurement error were examined. RESULTS The spearman rank correlation between two measurements of 25(OH)D concentrations was moderate (r = 0.75, P < 0.001) and did not vary significantly by participant characteristics including age, race, or latitude. The intraclass correlation coefficient was 0.72 (95% confidence interval = 0.68-0.76). The deattenuation factor of plasma 25(OH)D levels was 1.39, suggesting that a single measure of vitamin D on a continuous scale in regression analyses may result in attenuated relationships of about 40%. CONCLUSION Our results suggest that a single blood sample obtained in spring or fall provides a reasonable average for 25(OH)D over a 1-yr period, but additional studies are needed to estimate variability and agreement in plasma 25(OH)D measurements over longer intervals and younger populations.
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Affiliation(s)
- Jacqueline M Major
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Bethesda, Maryland 20852, USA.
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Gathungu RM, Flarakos CC, Reddy GS, Vouros P. The role of mass spectrometry in the analysis of vitamin D compounds. MASS SPECTROMETRY REVIEWS 2013; 32:72-86. [PMID: 22996283 DOI: 10.1002/mas.21353] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 06/01/2023]
Abstract
This review highlights the superseding role of mass spectrometry in the structural characterization and quantitation of vitamin D compounds in comparison to other analytical methods (e.g., UV, bioassays) that lack the sensitivity and specificity of mass spectrometry. After a short introduction to the biochemistry of vitamin D compounds, an overview of the current techniques to characterize and quantitate vitamin D compounds is given with emphasis on the contribution of mass spectrometry.
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Affiliation(s)
- Rose M Gathungu
- Barnett Institute of Chemical and Biological Analysis, Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts 02115, USA
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25
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Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, Josse R, Kanis JA, Mithal A, Pierroz DD, Stenmark J, Stöcklin E, Dawson-Hughes B. A global representation of vitamin D status in healthy populations. Arch Osteoporos 2012; 7:155-72. [PMID: 23225293 DOI: 10.1007/s11657-012-0093-0] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/06/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE This paper visualizes the available data on vitamin D status on a global map, examines the existing heterogeneities in vitamin D status and identifies research gaps. METHODS A graphical illustration of global vitamin D status was developed based on a systematic review of the worldwide literature published between 1990 and 2011. Studies were eligible if they included samples of randomly selected males and females from the general population and assessed circulating 25-hydroxyvitamin D [25(OH)D] levels. Two different age categories were selected: children and adolescents (1-18 years) and adults (>18 years). Studies were chosen to represent a country based on a hierarchical set of criteria. RESULTS In total, 200 studies from 46 countries met the inclusion criteria, most coming from Europe. Forty-two of these studies (21 %) were classified as representative. In children, gaps in data were identified in large parts of Africa, Central and South America, Europe, and most of the Asia/Pacific region. In adults, there was lack of information in Central America, much of South America and Africa. Large regions were identified for which the mean 25(OH)D levels were below 50 nmol/L. CONCLUSIONS This study provides an overview of 25(OH)D levels around the globe. It reveals large gaps in information in children and adolescents and smaller but important gaps in adults. In view of the importance of vitamin D to musculoskeletal growth, development, and preservation, and of its potential importance in other tissues, we strongly encourage new research to clearly define 25(OH)D status around the world.
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Affiliation(s)
- D A Wahl
- International Osteoporosis Foundation, Nyon, Switzerland
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Abstract
The optimal vitamin D status, as defined by serum 25-hydroxyvitamin D [25(OH)D], is still controversial. Some individuals are at risk for subclinical vitamin D deficiency, as defined by serum 25(OH)D levels between 25 and 75 nmol/L, and up to 80-100% of the entire population can display inadequate serum 25(OH)D values depending on latitude and seasonality. The clinical manifestation of extreme vitamin D deficiency, i.e. rickets and osteomalacia, are rare. Levels of 25(OH)D ≥ 50 nmol/L are required for optimal musculoskeletal health. However, levels of 25(OH)D above 75 nmol/L may be necessary to maximize musculoskeletal benefits and take advantage of the extraskeletal actions of vitamin D. This review will summarize the actual positions on the boundaries of subclinical vitamin D deficiency, the main available evidence on the effects of inadequate vitamin D status on skeletal and extraskeletal targets and supplementation strategies.
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Affiliation(s)
- Luisella Cianferotti
- Department of Endocrinology and Metabolism, Unit of Endocrinology and Bone Metabolism, University of Pisa, University Hospital of Pisa, Via Paradisa, 2 - 56124 Pisa, Italy
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Garg M, Lubel JS, Sparrow MP, Holt SG, Gibson PR. Review article: vitamin D and inflammatory bowel disease--established concepts and future directions. Aliment Pharmacol Ther 2012; 36:324-44. [PMID: 22686333 DOI: 10.1111/j.1365-2036.2012.05181.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 05/11/2012] [Accepted: 05/25/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Understanding of the role of vitamin D in health and disease has increased markedly in the past decade, with its involvement extending well beyond traditional roles in calcium and phosphate homeostasis and musculoskeletal health. This conceptual expansion has been underpinned by identification and exploration of components of this axis including vitamin D-binding protein, key enzymes and receptors in multiple cell types, and a greater recognition of nonclassical autocrine and paracrine effects. Its influence in IBD remains uncertain. AIM To review the role of vitamin D in bone health, immune regulation and cancer prevention in IBD, and to outline practical issues and limitations of its use. METHODS An extensive online literature review including PubMed and Medline. RESULTS In patients with IBD, the vitamin D axis provides an important and often underutilised pathway to preserving bone health. Furthermore, an exciting body of clinical and basic science research demonstrates that these pathways may have an integral part to play in regulation of the immune response in IBD, through effects on the intestinal barrier, antigen presenting cells and adaptive T cells. The possibility of chemoprevention requires further study. The optimal target level of 25-hydroxy vitamin D in patients with IBD is currently uncertain, as is the best therapeutic modality. CONCLUSIONS Study of vitamin D pathways may result in the development of relatively inexpensive therapeutic options to optimise patient outcomes. Further prospective clinical research is required to address efficacy and long-term safety.
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Affiliation(s)
- M Garg
- Department of Gastroenterology & Hepatology, Eastern Health, Box Hill, Vic., Australia.
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28
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Current 25-hydroxyvitamin D assays: Do they pass the test? Clin Chim Acta 2012; 413:1127-34. [DOI: 10.1016/j.cca.2012.03.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 02/06/2023]
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Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, Finkelstein JS. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:1802-22. [PMID: 22675062 DOI: 10.1210/jc.2011-3045] [Citation(s) in RCA: 381] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim was to formulate practice guidelines for management of osteoporosis in men. EVIDENCE We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and evidence quality. CONSENSUS PROCESS Consensus was guided by systematic evidence reviews, one in-person meeting, and multiple conference calls and e-mails. Task Force drafts were reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee and Clinical Affairs Core Committee; representatives of ASBMR, ECTS, ESE, ISCD; and members at large. At each stage, the Task Force received written comments and incorporated needed changes. The reviewed document was approved by The Endocrine Society Council before submission for peer review. CONCLUSIONS Osteoporosis in men causes significant morbidity and mortality. We recommend testing higher risk men [aged ≥70 and men aged 50-69 who have risk factors (e.g. low body weight, prior fracture as an adult, smoking, etc.)] using central dual-energy x-ray absorptiometry. Laboratory testing should be done to detect contributing causes. Adequate calcium and vitamin D and weight-bearing exercise should be encouraged; smoking and excessive alcohol should be avoided. Pharmacological treatment is recommended for men aged 50 or older who have had spine or hip fractures, those with T-scores of -2.5 or below, and men at high risk of fracture based on low bone mineral density and/or clinical risk factors. Treatment should be monitored with serial dual-energy x-ray absorptiometry testing.
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Affiliation(s)
- Nelson B Watts
- Mercy Health Osteoporosis & Bone Health Services, Cincinnati Ohio 45236, USA
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Fillée C, Keller T, Mourad M, Brinkmann T, Ketelslegers JM. Impact of vitamin D-related serum PTH reference values on the diagnosis of mild primary hyperparathyroidism, using bivariate calcium/PTH reference regions. Clin Endocrinol (Oxf) 2012; 76:785-9. [PMID: 22066864 DOI: 10.1111/j.1365-2265.2011.04285.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED BACKGROUND, OBJECTIVE: An international consensus conference underlined the importance of defining upper parathyroid hormone (PTH) reference values based on 25-OH-vitamin D [25(OH)D] to diagnose mild primary hyperparathyroidism. We determined the importance of this factor in a Belgian population. DESIGN, PATIENTS, METHODS Intact PTH and 25(OH)D were measured in 261 healthy controls (18-65 years, winter/summer). They were classified as 25(OH)D replete (50-153 nmol/l; n = 129) or deplete (8-50 nmol/l; n = 132). PTH was determined in 49 patients with surgically proven primary hyperparathyroidism. PTH thresholds for 95% specificities and corresponding sensitivities were computed from both 25(OH)D replete and deplete receiver operating characteristic (ROC) curves. The 95% bivariate reference ellipses, relating PTH to calcium for 25(OH)D replete and deplete controls, were compared to the PTH/calcium pairs of patients with primary hyperparathyroidism. RESULTS Parathyroid hormone correlated with 25(OH)D (r = -0.3232; P < 0.0001). PTH normative values were 20% lower in 25(OH)D replete than deplete controls (P < 0.0001). PTH thresholds, providing 95% specificities for primary hyperparathyroidism diagnosis, were 7.6 pmol/l and 5.8 pmol/l, using ROC curves derived from 25(OH)D deplete or replete controls, respectively. Corresponding sensitivities were of 56%vs 88%, respectively (P < 0.05). The 95% PTH/calcium bivariate reference ellipses for?deplete and replete 25(OH)D controls differed, but the PTH/calcium pairs of patients with primary hyperparathyroidism did not overlap these ellipses. CONCLUSION For a given specificity, primary hyperparathyroidism diagnostic parathyroid hormone thresholds were lower and sensitivities higher using ROC curves, derived from 25(OH)D replete vs deplete controls. The 25(OH)D status does not affect the efficiency of primary hyperparathyroidism diagnosis, using bivariate PTH/calcium reference density ellipses.
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Affiliation(s)
- Catherine Fillée
- Department of Clinical Biology and Pathology, Cliniques Universitaires St-Luc-Université Catholique de Louvain, Brussels, Belgium.
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Hypovitaminosis D and prevalent asymptomatic vertebral fractures in Moroccan postmenopausal women. BMC WOMENS HEALTH 2012; 12:11. [PMID: 22531050 PMCID: PMC3403946 DOI: 10.1186/1472-6874-12-11] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/24/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hypovitaminosis D is associated to accentuated bone loss. However, association between osteoporotic vertebral fractures (VFs) and vitamin D status has not been clearly established. OBJECTIVE To determine serum vitamin D status and to assess the association of vitamin D status with bone mineral density (BMD) and asymptomatic VFs prevalence using vertebral fracture assessment (VFA) in a cohort of Moroccan menopausal women. METHODS from June to September 2010, 178 menopausal women 50 years old and over were enrolled in this cross-sectional study. The mean ± SD (range) age, weight, height and BMI were 58.8 ± 8.2 (50 to 79) years, 73.2 ± 13.8 (35 to 119) Kgs, 1.56 ± 0.06 (1.43 - 1.79) m and 29.8 ± 5.9 (17.5 - 49.8) kg/m2, respectively. VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative approach and morphometry. Serum levels of 25-hydroxyvitamin D (25(OH)D) were measured. RESULTS Among the 178 women, 45 (25.2%) had densitometric osteoporosis, and on VFA, VFs (grade 2 or 3) were detected in 20.2% while grade 1 were identified in 33.1%. The mean values of serum levels of 25(OH)D were 15.8 ± 11.6 ng/ml (range: 3.0 - 49.1) with 152 patients (85.3%) having levels <30 ng/ml (insufficiency) and 92 (51.6%) <10 ng/ml (deficiency). Stepwise regression analysis showed that presence of VFs was independently related to age, 25(OH)D and densitometric osteoporosis. CONCLUSION our study shows that advanced age, hypovitaminosis D and osteoporosis are independent risk factors for asymptomatic VFs in Moroccan postmenopausal women.
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Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK. Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr 2012; 36:713-20. [PMID: 22523178 DOI: 10.1177/0148607112444449] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the numerous disease conditions associated with vitamin D deficiency in the general population, the relationship of this deficiency to outcome in critically ill patients remains unclear. The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes. METHODS The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28-day outcomes. RESULTS Of analyzable patients, 50 (26%) were deficient (≤30 nmol/L) and 109 (56%) were insufficient (>30 and ≤60 nmol/L). Baseline 25(OH)D levels decreased significantly in all patients after 3 days in the ICU and remained significantly lower through 10 days (P < .001). 25(OH)D status was not significantly associated with 28-day all-cause mortality (hazard ratio [HR], 0.89; 95% confidence interval, [CI] 0.37-2.24). Higher levels of 25(OH)D were associated with a shorter time-to-alive ICU discharge (HR, 2.11; 95% CI, 1.27-3.51). 25(OH)D-deficient patients showed a nonstatistically significant trend toward a higher infection rate (odds ratio [OR], 3.20; 95% CI, 0.784-13.07; P = .11) compared with patients with sufficient levels of 25(OH)D. CONCLUSIONS This study demonstrates significant decreases in vitamin D status over the duration of the patient's ICU stay. Low levels of vitamin D are associated with longer time to ICU discharge alive and a trend toward increased risk of ICU-acquired infection.
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Affiliation(s)
- David M Higgins
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
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Abstract
Vitamin D deficiency is increasing worldwide. Ultraviolet rays are supposed to provide humans over 80% of our vitamin D requirement; the rest is received through diet and supplements. In addition to enhancing calcium absorption from the intestine and mineralization of the osteoid tissue, vitamin D has many other physiological effects, including neuromodulation, improving muscle strength and coordination, insulin release, immunity and prevention of infections, and curtailing cancer. Whether the increased incidence of vitamin D deficiency is related to increased incidences of nonskeletal disorders remains to be determined. Serum levels of 25-hydroxyvitamin [25(OH)D] above 30 ng/mL indicate vitamin D sufficiency. An additional 1,000 IU of vitamin D/day is sufficient for most lighter-skinned individuals, whereas an extra 2,000 IU/day is needed by the elderly and dark-skinned individuals to maintain normal 25(OH)D levels. Additional research is needed to clarify the relationship between vitamin D and the nonskeletal systems, nonclassic functions, and targets of vitamin D.
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Affiliation(s)
- Sunil J Wimalawansa
- Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, and UMDNJ, Robert Wood Johnson Medical School, Physiology and Integrative Biology, Graduate School of Biomedical Sciences, New Brunswick, New Jersey 08903-0019, USA.
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Lai JKC, Lucas RM, Banks E, Ponsonby AL. Variability in vitamin D assays impairs clinical assessment of vitamin D status. Intern Med J 2012; 42:43-50. [DOI: 10.1111/j.1445-5994.2011.02471.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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van den Ouweland JMW, Kema IP. The role of liquid chromatography-tandem mass spectrometry in the clinical laboratory. J Chromatogr B Analyt Technol Biomed Life Sci 2011; 883-884:18-32. [PMID: 22197607 DOI: 10.1016/j.jchromb.2011.11.044] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 10/31/2011] [Accepted: 11/29/2011] [Indexed: 01/31/2023]
Abstract
Liquid chromatography coupled to mass spectrometry (LC-MS/MS) is increasingly used as a routine methodology in clinical laboratories for the analysis of low molecular weight molecules. The high specificity in combination with high sensitivity and multi-analyte potential makes it an attractive complementary method to traditional methodology used for routine applications. Its strength and weaknesses in this context will be discussed and examples of successful clinical applications will be given. For LC-MS/MS to truly fulfil its promise in clinical diagnosis, the prerequisite steps being sample pre-treatment, chromatographic separation and detection by selected reaction monitoring must become more integrated as they are in conventional clinical analysers. The availability of ready-to-use reagents kits, eliminating efforts needed for method development and extensive validation, are likely to contribute to a wider acceptance of LC-MS/MS in clinical laboratories. Growing applicability of LC-MS/MS in the clinical laboratory field is expected from quantitative protein analysis.
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Abstract
AbstractThe aim was to evaluate vitamin D levels in young healthy Lithuanian males in winter and to find possible associations of vitamin D concentration to body composition, cognitive functioning, emotional state.Subjects and Methods A total of 130 healthy males (age range, 18–26 years) were divided into the subgroups according to vitamin D concentration. The Profile of Mood States (POMS) questionnaire and Hospital Anxiety and Depression Scale were employed in the assessment of emotional state. Cognitive functioning was assessed by the Trail Making Test and the Digit Symbol Test of the Wechsler Adult Intelligence Scale.Results The mean concentration of vitamin D for the entire sample was 13.0±5.3 ng/ml. Only 2 persons (1.6%) had the recommended vitamin D level. Nearly half (45.4%) of study participants had vitamin D deficiency. Lower concentrations were associated with a significantly higher score on the POMS confusion-bewilderment scale. A tendency toward a lower mean depression-dejection score in the participants with a sufficient vitamin D level was observed. Vitamin D concentration correlated positively with body mass index (BMI) and inversely with the confusion-bewilderment score.In conclusion almost half of the young healthy males participating in the study were detected to have vitamin D deficiency in winter. Low vitamin D concentrations are associated with a worse emotional state.
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Pipili C, Dimitriadis C, Sekercioglu N, Bargman JM, Oreopoulos DD. Effect of nutritional vitamin D preparations on parathyroid hormone in patients with chronic kidney disease. Int Urol Nephrol 2011; 44:167-71. [PMID: 21870088 DOI: 10.1007/s11255-011-0048-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/11/2011] [Indexed: 12/15/2022]
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Abstract
Systemic lupus erythematosus (SLE) is a multi-system inflammatory disease where genetic susceptibility coupled with largely undefined environmental factors is reported to underlie the aetiology of the disease. One such factor is low vitamin D status. The primary source of vitamin D is endogenous synthesis following exposure of the skin to UVB light. Photosensitivity, sunlight avoidance and the use of sun protection factor in combination with medications prescribed to treat the symptoms of the disease, puts SLE patients at increased risk of vitamin D deficiency. Decreased conversion of 25-hydroxyvitamin D to the metabolically active form, 1,25-dihydroxyvitamin D3, is possible, due to renal impairment common in SLE putting additional stress on vitamin D metabolism. The majority of studies have identified low 25-hydroxyvitamin D in SLE patients, albeit using varying cut-offs (<25 to <80 nmol/l). Of these studies, fifteen have investigated a link between status and disease activity with conflicting results. Variation with disease activity index measures used alongside methodological limitations within the study design may partially explain these findings. This review discusses the importance of optimal vitamin D status in SLE, critically evaluates research carried out to date that has investigated vitamin D in SLE, and highlights the need for a well-designed observational study that controls for diet, medication use, dietary supplements, UV exposure and seasonality, that uses sensitive methods for measuring vitamin D status and disease activity in SLE to conclusively establish the role of vitamin D in SLE.
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Jafri L, Khan AH, Siddiqui AA, Mushtaq S, Iqbal R, Ghani F, Siddiqui I. Comparison of high performance liquid chromatography, radio immunoassay and electrochemiluminescence immunoassay for quantification of serum 25 hydroxy vitamin D. Clin Biochem 2011; 44:864-8. [DOI: 10.1016/j.clinbiochem.2011.04.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 04/13/2011] [Accepted: 04/23/2011] [Indexed: 10/18/2022]
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Shah I, James R, Barker J, Petroczi A, Naughton DP. Misleading measures in Vitamin D analysis: a novel LC-MS/MS assay to account for epimers and isobars. Nutr J 2011; 10:46. [PMID: 21569549 PMCID: PMC3114718 DOI: 10.1186/1475-2891-10-46] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 05/14/2011] [Indexed: 01/23/2023] Open
Abstract
Background Recently, the accuracies of many commercially available immunoassays for Vitamin D have been questioned. Liquid chromatography tandem mass spectrometry (LC- MS/MS) has been shown to facilitate accurate separation and quantification of the major circulating metabolite 25-hydroxyvitamin-D3 (25OHD3) and 25-hydroxyvitamin-D2 (25OHD2) collectively termed as 25OHD. However, among other interferents, this method may be compromised by overlapping peaks and identical masses of epimers and isobars, resulting in inaccuracies in circulating 25OHD measurements. The aim of this study was to develop a novel LC-MS/MS method that can accurately identify and quantitate 25OHD3 and 25OHD2 through chromatographic separation of 25OHD from its epimers and isobars. Methods A positive ion electrospray ionisation (ESI) LC-MS/MS method was used in the Multiple Reaction Monitoring (MRM) mode for quantification. It involved i) liquid-liquid extraction, ii) tandem columns (a high resolution ZORBAX C18 coupled to an ULTRON chiral, with guard column and inlet filter), iii) Stanozolol-D3 as internal standard, and iv) identification via ESI and monitoring of three fragmentation transitions. To demonstrate the practical usefulness of our method, blood samples were collected from 5 healthy male Caucasian volunteers; age range 22 to 37 years and 25OHD2, 25OHD3 along with co-eluting epimers and analogues were quantified. Results The new method allowed chromatographic separation and quantification of 25OHD2, 25OHD3, along with 25OHD3 epimer 3-epi-25OHD3 and isobars 1-α-hydroxyvitamin-D3 (1αOHD3), and 7-α-hydroxy-4-cholesten-3-one (7αC4). The new assay was capable of detecting 0.25 ng/mL of all analytes in serum. Conclusions To our knowledge, this is the first specific, reliable, reproducible and robust LC-MS/MS method developed for the accurate detection of 25OHD (Vitamin D). The method is capable of detecting low levels of 25OHD3 and 25OHD2 together with chromatographic separation from the co-eluting epimers and isobars and circumvents other instrumental/analytical interferences. This analytical method does not require time-consuming derivatisation and complex extraction techniques and could prove very useful in clinical studies.
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Affiliation(s)
- Iltaf Shah
- School of Life Sciences, Kingston University, Kingston-upon-Thames, Surrey, UK.
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Krishnaveni GV, Veena SR, Winder NR, Hill JC, Noonan K, Boucher BJ, Karat SC, Fall CHD. Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon Study. Am J Clin Nutr 2011; 93:628-35. [PMID: 21228264 PMCID: PMC3407368 DOI: 10.3945/ajcn.110.003921] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Metabolic consequences of vitamin D deficiency have become a recent research focus. Maternal vitamin D status is thought to influence musculoskeletal health in children, but its relation with offspring metabolic risk is not known. OBJECTIVE We aimed to examine the association between maternal vitamin D status and anthropometric variables, body composition, and cardiovascular risk markers in Indian children. DESIGN Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured at 28-32 wk gestation in 568 women who delivered at Holdsworth Memorial Hospital, Mysore, India. Anthropometric variables, glucose and insulin concentrations, blood pressure, and fasting lipid concentrations were measured in the offspring at 5 and 9.5 y of age. Muscle-grip strength was measured by using a hand-held dynamometer at age 9.5 y. Arm-muscle area was calculated as a measure of muscle mass. Fasting insulin resistance was calculated by using the homeostasis model assessment equation. RESULTS Sixty-seven percent of women had vitamin D deficiency [serum 25(OH)D concentration <50 nmol/L]. At ages 5 and 9.5 y, children born to vitamin D-deficient mothers had smaller arm-muscle area in comparison with children born to mothers without deficiency (P < 0.05). There was no difference in grip strength between offspring of women with and without vitamin D deficiency. At 9.5 y, children of vitamin D-deficient mothers had higher fasting insulin resistance than did children of nondeficient women (P = 0.04). There were no associations between maternal vitamin D status and other offspring risk factors at either age. CONCLUSION Intrauterine exposure to low 25(OH)D concentrations is associated with less muscle mass and higher insulin resistance in children.
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Agreement of blood spot card measurements of vitamin D levels with serum, whole blood specimen types and a dietary recall instrument. PLoS One 2011; 6:e16602. [PMID: 21304997 PMCID: PMC3031596 DOI: 10.1371/journal.pone.0016602] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 12/27/2010] [Indexed: 01/27/2023] Open
Abstract
Background The ability to measure 25-hydroxyvitamin D (25OHD) levels from blood spot cards can simplify sample collection versus samples obtained by venipuncture, particularly in populations in whom it is difficult to draw blood. We sought to validate the use of blood spot samples for the measurement of 25OHD compared to serum or whole blood samples and correlate the measured levels with intake estimated from dietary recall. Methods Utilizing 109 biological mothers of infants enrolled in the Tennessee Children's Respiratory Initiative cohort, we measured 25OHD levels through highly selective liquid chromatography–tandem mass spectrometry on samples from blood spot cards, serum, and whole blood collected at enrollment. Dietary questionnaires (n = 65) were used to assess 25OHD intake by dietary recall. Sample collection measures were assessed for agreement and 25OHD levels for association with dietary 25OHD intake. Results The mean absolute differences (95%CI) in 25OHD levels measured between whole blood and blood spot (n = 50 pairs) or serum and blood spot (n = 20) were 3.2 (95%CI:1.6, 4.8) ng/ml and 1.5 (95%CI:−0.5,3.4) ng/mL. Intake by dietary recall was marginally associated with 25OHD levels after adjustment for current smoking and race in linear regression. Discussion 25OHD levels determined by mass spectrometry from blood spot cards, serum and whole blood show relatively good agreement, although 25OHD levels are slightly lower when measured by blood spot cards. Blood spot samples are a less invasive means of obtaining 25OHD measurements, particularly in large population-based samples, or among children when venipuncture may decrease study participation.
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Beard JA, Bearden A, Striker R. Vitamin D and the anti-viral state. J Clin Virol 2011; 50:194-200. [PMID: 21242105 DOI: 10.1016/j.jcv.2010.12.006] [Citation(s) in RCA: 256] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/02/2010] [Accepted: 12/11/2010] [Indexed: 12/14/2022]
Abstract
Vitamin D has long been recognized as essential to the skeletal system. Newer evidence suggests that it also plays a major role regulating the immune system, perhaps including immune responses to viral infection. Interventional and observational epidemiological studies provide evidence that vitamin D deficiency may confer increased risk of influenza and respiratory tract infection. Vitamin D deficiency is also prevalent among patients with HIV infection. Cell culture experiments support the thesis that vitamin D has direct anti-viral effects particularly against enveloped viruses. Though vitamin D's anti-viral mechanism has not been fully established, it may be linked to vitamin D's ability to up-regulate the anti-microbial peptides LL-37 and human beta defensin 2. Additional studies are necessary to fully elucidate the efficacy and mechanism of vitamin D as an anti-viral agent.
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Affiliation(s)
- Jeremy A Beard
- University of Wisconsin-Madison, Department of Medicine, Wisconsin 53706, USA
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Cutolo M, Plebani M, Shoenfeld Y, Adorini L, Tincani A. Vitamin D endocrine system and the immune response in rheumatic diseases. VITAMINS AND HORMONES 2011; 86:327-51. [PMID: 21419278 DOI: 10.1016/b978-0-12-386960-9.00014-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Epidemiological evidence indicates a significant association between vitamin D deficiency and an increased incidence of autoimmune diseases. The presence of vitamin D receptors (VDRs) in the cells of the immune system and the fact that several of these cells produce the vitamin D hormone suggested that vitamin D could have immunoregulatory properties, and now potent immunomodulatory activities on dendritic cells, Th1 and Th17 cells, as well as B cells have been confirmed. Serum levels of vitamin D have been found to be significantly lower in patients with systemic lupus erythematosus, undifferentiated connective tissue disease, and type-1 diabetes mellitus than in the healthy population. In addition, it was also found that lower levels of vitamin D were associated with higher disease activity in rheumatoid arthritis. Promising clinical results together with evidence for the regulation of multiple immunomodulatory mechanisms by VDR agonists represent a sound basis for further exploration of their potential in the treatment of rheumatic autoimmune disorders.
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Affiliation(s)
- Maurizio Cutolo
- Research Laboratories and Academic Unit of Clinical Rheumatology, Postgraduate Academic School of Rheumatology, University of Genova, Genova, Italy
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Vitamin D Deficiency in Primary Hyperparathyroidism. South Med J 2011; 104:5-6. [DOI: 10.1097/smj.0b013e318200c3a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Vitamin D insufficiency is common globally and low levels are linked to higher cancer incidence. Although vitamin D insufficiency is related to inferior prognosis in some cancers, no data exist for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). We evaluated the relationship of 25(OH)D serum levels with time-to-treatment (TTT) and overall survival (OS) in newly diagnosed CLL patients participating in a prospective cohort study (discovery cohort) and a separate cohort of previously untreated patients participating in an observational study (confirmation cohort). Of 390 CLL patients in the discovery cohort, 119 (30.5%) were 25(OH)D insufficient. After a median follow-up of 3 years, TTT (hazard ratio[HR] = 1.66; P = .005) and OS (HR = 2.39; P = .01) were shorter for 25(OH)D-insufficient patients. In the validation cohort, 61 of 153 patients (39.9%) were 25(OH)D insufficient. After a median follow-up of 9.9 years, TTT (HR = 1.59; P = .05) and OS (HR 1.63; P = .06) were again shorter for 25(OH)D-insufficient patients. On pooled multivariable analysis of patients in both cohorts adjusting for age, sex, Rai stage, CD38 status, ZAP-70 status, immunoglobulin heavy chain variable (IGHV) gene mutation status, CD49d status, and cytogenetic abnormalities assessed by interphase fluorescent in situ hybridization testing, 25(OH)D insufficiency remained an independent predictor of TTT (HR = 1.47; P = .008), although the association with OS was not significant (HR = 1.47; P = .07). Vitamin D insufficiency is associated with inferior TTT and OS in CLL patients. Whether normalizing vitamin D levels in deficient CLL patients would improve outcome merits clinical testing.
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Ding S, Schoenmakers I, Jones K, Koulman A, Prentice A, Volmer DA. Quantitative determination of vitamin D metabolites in plasma using UHPLC-MS/MS. Anal Bioanal Chem 2010; 398:779-89. [PMID: 20628873 PMCID: PMC2939348 DOI: 10.1007/s00216-010-3993-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 11/27/2022]
Abstract
Vitamin D is an important determinant of bone health at all ages. The plasma concentrations of 25-hydroxy vitamin D (25-OH D) and other metabolites are used as biomarkers for vitamin sufficiency and function. To allow for the simultaneous determination of five vitamin D metabolites, 25-OH D(3), 25-OH D(2), 24,25-(OH)(2) D(3), 1,25-(OH)(2) D(3), and 1,25-(OH)(2) D(2), in low volumes of human plasma, an assay using ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was established. Plasma samples were spiked with isotope-labeled internal standards and pretreated using protein precipitation, solid-phase extraction (SPE) and a Diels-Alder derivatization step with 4-phenyl-1,2,4-triazoline-3,5-dione. The SPE recovery rates ranged from 55% to 85%, depending on the vitamin D metabolite; the total sample run time was <5 min. Mass spectrometry was conducted using positive ion electrospray ionization in the multiple reaction monitoring mode on a quadrupole-quadrupole-linear ion trap instrument after pre-column addition of methylamine to increase the ionization efficiency. The intra- and inter-day relative standard deviations were 1.6-4.1% and 3.7-6.8%, respectively. The limit of quantitation for these compounds was determined to be between 10 and 20 pg/mL. The 25-OH D results were compared with values obtained for reference materials (DEQAS). In addition, plasma samples were analyzed with two additional Diasorin antibody assays. All comparisons with conventional methods showed excellent correlations (r(2) = 0.9738) for DEQAS samples, demonstrating the high degree of comparability of the new UHPLC-MS/MS technique to existing methods.
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Affiliation(s)
- Shujing Ding
- Medical Research Council–Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL UK
| | - Inez Schoenmakers
- Medical Research Council–Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL UK
| | - Kerry Jones
- Medical Research Council–Keneba Field Site, P. O. Box 273, Banjul, Keneba The Gambia
| | - Albert Koulman
- Medical Research Council–Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL UK
| | - Ann Prentice
- Medical Research Council–Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL UK
| | - Dietrich A. Volmer
- Medical Research Council–Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL UK
- Institute of Bioanalytical Chemistry, Saarland University, Campus B2 2, Raum 2.27, 66123 Saarbrücken, Germany
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Drake MT, Maurer MJ, Link BK, Habermann TM, Ansell SM, Micallef IN, Kelly JL, Macon WR, Nowakowski GS, Inwards DJ, Johnston PB, Singh RJ, Allmer C, Slager SL, Weiner GJ, Witzig TE, Cerhan JR. Vitamin D insufficiency and prognosis in non-Hodgkin's lymphoma. J Clin Oncol 2010; 28:4191-8. [PMID: 20713849 DOI: 10.1200/jco.2010.28.6674] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Vitamin D insufficiency is common in the United States, with low levels linked in some studies to higher cancer incidence, including non-Hodgkin's lymphoma (NHL). Recent data also suggest that vitamin D insufficiency is related to inferior prognosis in some cancers, although there are no data for NHL. PATIENTS AND METHODS We tested the hypothesis that circulating 25-hydroxyvitamin D [25(OH)D] levels are predictive of event-free survival (EFS) and overall survival (OS) in a prospective cohort of 983 newly diagnosed patients with NHL. 25(OH)D and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] levels were measured by liquid chromatography-tandem mass spectrometry. RESULTS Mean age at diagnosis was 62 years (range, 19 to 94 years); 44% of patients had insufficient 25(OH)D levels (< 25 ng/mL) within 120 days of diagnosis. Median follow-up was 34.8 months; 404 events and 193 deaths (168 from lymphoma) occurred. After adjusting for known prognostic factors and treatment, 25(OH)D insufficient patients with diffuse large B-cell lymphoma (DLBCL) had inferior EFS (hazard ratio [HR], 1.41; 95% CI, 0.98 to 2.04) and OS (HR, 1.99; 95% CI, 1.27 to 3.13); 25(OH)D insufficient patients with T-cell lymphoma also had inferior EFS (HR, 1.94; 95% CI, 1.04 to 3.61) and OS (HR, 2.38; 95% CI, 1.04 to 5.41). There were no associations with EFS for the other NHL subtypes. Among patients with DLBCL and T-cell lymphoma, higher 1,25(OH)(2)D levels were associated with better EFS and OS, suggesting that any putative tumor 1-α-hydroxylase activity did not explain the 25(OH)D associations. CONCLUSION 25(OH)D insufficiency was associated with inferior EFS and OS in DLBCL and T-cell lymphoma. Whether normalizing vitamin D levels in these patients improves outcomes will require testing in future trials.
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Vogeser M. Quantification of circulating 25-hydroxyvitamin D by liquid chromatography-tandem mass spectrometry. J Steroid Biochem Mol Biol 2010; 121:565-73. [PMID: 20206693 DOI: 10.1016/j.jsbmb.2010.02.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 02/20/2010] [Accepted: 02/24/2010] [Indexed: 01/08/2023]
Abstract
Hypovitaminosis D is a highly prevalent condition and quantification of serum 25-hydroxyvitamin D3 is accepted to be the most useful marker for the assessment of the individual vitamin D status. Due to the increasing awareness of the prevalence and potential health consequences of hypovitaminosis D, the request numbers for 25-hydroxyvitamin D quantification are growing rapidly in many countries. Automated protein binding assays (based on the use of vitamin D-binding protein or antibodies) for the quantification of 25-hydroxyvitamin D3 are available which enable convenient high-throughput analyses in a routine setting; there is, however, substantial concern about accuracy and analytical reliability of these assays. Several LC-MS/MS methods for the quantification of 25-hydroxyvitamin D3 in serum have been described and in a growing number of clinical laboratories this technology is used routinely for vitamin D monitoring. It is justified to assume that LC-MS/MS enables more reliable analyses of 25-hydroxyvitamin D concentrations compared to protein binding assays. In particular the ability to co-quantify the naturally occurring 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 which is derived primarily from food fortification is a relevant advantage of LC-MS/MS over protein binding assays. This review describes the background of 25-hydroxyvitamin D measurement, compares published LC-MS/MS methods, discusses problems, strengths and limitations of these assays and compares the application characteristics of LC-MS/MS with those of protein binding assays and HPLC-UV.
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Affiliation(s)
- Michael Vogeser
- Institute of Clinical Chemistry, Hospital of the University of Munich, Marchioninistr. 15, D-81377 Munich, Germany.
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Snellman G, Melhus H, Gedeborg R, Byberg L, Berglund L, Wernroth L, Michaëlsson K. Determining vitamin D status: a comparison between commercially available assays. PLoS One 2010; 5:e11555. [PMID: 20644628 PMCID: PMC2903481 DOI: 10.1371/journal.pone.0011555] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 05/30/2010] [Indexed: 11/17/2022] Open
Abstract
Background Vitamin D is not only important for bone health but can also affect the development of several non-bone diseases. The definition of vitamin D insufficiency by serum levels of 25-hydroxyvitamin D depends on the clinical outcome but might also be a consequence of analytical methods used for the definition. Although numerous 25-hydroxyvitamin D assays are available, their comparability is uncertain. We therefore aim to investigate the precision, accuracy and clinical consequences of differences in performance between three common commercially available assays. Methodology/Principal Findings Serum 25-hydroxyvitamin D levels from 204 twins from the Swedish Twin Registry were determined with high-pressure liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry (HPLC-APCI-MS), a radioimmunoassay (RIA) and a chemiluminescent immunoassay (CLIA). High inter-assay disagreement was found. Mean 25-hydroxyvitamin D levels were highest for the HPLC-APCI-MS technique (85 nmol/L, 95% CI 81–89), intermediate for RIA (70 nmol/L, 95% CI 66–74) and lowest with CLIA (60 nmol/L, 95% CI 56–64). Using a 50-nmol/L cut-off, 8% of the subjects were insufficient using HPLC-APCI-MS, 22% with RIA and 43% by CLIA. Because of the heritable component of 25-hydroxyvitamin D status, the accuracy of each method could indirectly be assessed by comparison of within-twin pair correlations. The strongest correlation was found for HPLC-APCI-MS (r = 0.7), intermediate for RIA (r = 0.5) and lowest for CLIA (r = 0.4). Regression analyses between the methods revealed a non-uniform variance (p<0.0001) depending on level of 25-hydroxyvitamin D. Conclusions/Significance There are substantial inter-assay differences in performance. The most valid method was HPLC-APCI-MS. Calibration between 25-hydroxyvitamin D assays is intricate.
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Affiliation(s)
- Greta Snellman
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, [corrected] Uppsala, Sweden.
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