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Fitzpatrick D, Laird E, Ward M, Hoey L, Hughes CF, Strain JJ, Cunningham C, Healy M, Molloy AM, McNulty H, Lannon R, McCarroll K. Secondary hyperparathyroidism: Predictors and relationship with vitamin D status, bone turnover markers and bone mineral density. Bone 2024; 184:117108. [PMID: 38642819 DOI: 10.1016/j.bone.2024.117108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT) has adverse implications for bone health but is relatively understudied. In this study we examine the prevalence and determinants of SHPT and describe the relationship of SHPT with bone turnover markers and bone mineral density (BMD) in older Irish adults. METHOD Eligible participants (n = 4139) were identified from the Trinity-Ulster-Department of Agriculture (TUDA) study, a cohort of Irish adults aged ≥60 years. Exclusion criteria included an estimated glomerular filtration rate (eGFR) <30 ml/min and serum calcium >2.5 mmol/l to remove hyperparathyroidism due to advanced chronic kidney disease (CKD) and primary hyperparathyroidism respectively. The relationship between SHPT and bone turnover markers and BMD (measured by densitometry) was examined in a subsample (n = 1488). Vitamin D deficiency was defined as 25-hydroxyvitamin D [25 (OH)D] <30 nmol/l. RESULTS Participants had a mean age of 73.6 ± 7.9 years, 65.1 % were female and 19.4 % were found to be vitamin D deficient. The prevalence of SHPT decreased as vitamin D increased, from 30.6 % in those deficient to 9.8 % in those with 25(OH)D ≥ 50 nmol/l and increased with declining kidney function. In non‑calcium supplement users, principal determinants of SHPT were vitamin D deficiency (OR 4.18, CI 3.05-5.73, p < 0.001), eGFR 30-44 ml/min (OR 3.69, CI 2.44-5.57, p < 0.001), loop diuretic use (OR 3.52, CI 2.59-4.79, p < 0.001) and to a lesser extent body mass index (p = 0.001), eGFR 45-59 ml/min (p < 0.001) and 25(OH)D level 30-49 nmol/l (p = 0.002). Similar findings were observed in calcium supplement users, though proton pump inhibitors were also associated with SHPT (OR 1.55, CI 1.08-2.22, p = 0.018) while vitamin D 30-49 nmol/l was not. In participants with SHPT versus those without, bone turnover markers were higher: bone alkaline phosphatase (p = 0.017) and tartrate-resistant acid phosphatase (p = 0.033), whilst there was lower BMD at the neck of femur (0.880 vs. 0.903 g/cm2, p = 0.033) and total hip (0.968 vs. 0.995 g/cm2, P = 0.017). DISCUSSION The results show that up to one in six older Irish adults had SHPT and this was associated with lower BMD and higher concentrations of bone turnover markers. Both vitamin D deficiency and 25(OH)D level 30-49 nmol/l were important predictors of SHPT. Loop diuretics and PPIs may also increase the risk of SHPT, and their use may need to be carefully considered in this population. Further studies examining the potential impact of these factors on bone health in similar populations to our study sample are warranted.
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Affiliation(s)
- Donal Fitzpatrick
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland.
| | - Eamon Laird
- Department of Health & Nutritional Sciences, Atlantic Technological University Sligo, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Conal Cunningham
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Martin Healy
- Department of Biochemistry, St James's Hospital, Dublin, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Rosaleen Lannon
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - Kevin McCarroll
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
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Llombart R, Mariscal G, Barrios C, de la Rubia Ortí JE, Llombart-Ais R. Does vitamin D deficiency affect functional outcomes in hip fracture patients? A meta-analysis of cohort studies. J Endocrinol Invest 2024; 47:1323-1334. [PMID: 38112912 DOI: 10.1007/s40618-023-02266-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Vitamin D deficiency is common in patients with hip fractures and may negatively affect functional recovery and quality of life (QOL). OBJECTIVE This study aimed to conduct a meta-analysis to quantify the effects of vitamin D deficiency on physical function and quality of life after hip fractures. METHODS The PubMed, EMBASE, Scopus, and Cochrane Library databases were searched for relevant studies. The inclusion criteria were hip fracture, comparison between vitamin D deficiency and normal vitamin D levels in patients with hip fracture, and functional outcome as the primary outcome. The exclusion criteria were case reports, reviews, duplicates, studies with a high risk of bias, and non-comparable or missing data. Two independent reviewers selected studies, extracted data, assessed bias, and performed meta-analyses using the Review Manager. Heterogeneity and publication bias were also assessed. Two independent reviewers selected the studies, extracted data, and assessed the risk of bias. We performed a meta-analysis using Review Manager and assessed heterogeneity and publication bias. RESULTS Seven studies with 1,972 patients were included. Vitamin D deficiency was defined as a 25(OH)D level < 20 ng/mL. There were no significant differences in the ability to walk (OR 0.68, 95% CI 0.31-1.53, I2 = 69%) or length of hospital stay (MD 2.27 days, 95% CI - 2.47 to 7.01, I2 = 93%) between patients with and without vitamin D deficiency. However, patients with vitamin D deficiency had significantly worse functional ability and quality of life (SMD - 1.50, 95% CI - 2.88 to - 0.12, I2 = 96%). CONCLUSIONS Despite the limitations of this study, such as small sample size, heterogeneous outcome assessments, and variable vitamin D measurement techniques, the results demonstrated that screening for vitamin D status and optimizing levels through supplementation could facilitate rehabilitation, promote lifestyle changes, aid in the recovery of independence, and help reduce long-term burdens.
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Affiliation(s)
- R Llombart
- Orthopedic Surgery Department, University Clinic of Navarra, Pamplona, Spain
| | - G Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain.
| | - C Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain
| | - J E de la Rubia Ortí
- Department of Basic Medical Sciences, Catholic University of Valencia, 46001, Valencia, Spain
| | - R Llombart-Ais
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain
- Traumacenter, Casa de Salud Hospital, Valencia, Spain
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Donayeva A, Amanzholkyzy A, Abdelazim IA, Rakhyzhanova S, Mannapova A, Abilov T, Khamidullina Z, Bimagambetova K, Gubasheva G, Kulzhanova D, Turesheva A, Saparbayev S. The relationship between vitamin D and adolescents' parathyroid hormone and bone mineral density. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2024; 23:1-5. [PMID: 38690071 PMCID: PMC11056728 DOI: 10.5114/pm.2024.136327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 05/02/2024]
Abstract
Introduction To detect the relationship between 25-hydroxy vitamin D (25(OH)D) and adolescents' parathyroid hormone (PTH) and bone mineral density (BMD). Material and methods Two hundred adolescent girls were recruited for this cross-sectional comparative study. After detailed evaluation, a pelvic sonography was performed for the studied adolescents to rule out any pelvic pathology. Adolescents' blood samples were collected to measure the thyroid stimulating hormone, prolactin, glycosylated haemoglobin (HbA1C), PTH, and 25(OH)D. The studied adolescents' BMD and the T-score were evaluated at 2 anatomical sites. The studied adolescents were classified according to their serum 25(OH)D into 2 groups: a 25(OH)D-deficient group (study group; 25(OH)D < 20 ng/ml) and normal controls (25(OH)D > 30 ng/ml). Student's t-test was used for analysis of the studied adolescents' variables, and correlation analysis (Pearson`s correlation) was used to detect the relationship between 25(OH)D and adolescents' PTH and BMD. Results The parathyroid hormone was statistically higher in the 25(OH)D-deficient group than in the normal controls (41.3 ±3.4 pg/ml vs. 21.1 ±2.8) (p = 0.02), and the BMD was statistically lower in the 25(OH)D-deficient group than in the normal controls (-1.25 ±0.5 vs. 0.3 ±0.4) (p = 0.01). The 25(OH)D had a significant negative correlation with the adolescents' PTH (r = -0.9175; p < 0.00001) and a significant positive correlation with the adolescents' BMD (r = 0.756; p < 0.00001). The parathyroid hormone had a significant negative correlation with the adolescents' BMD (r = -0.7006; p < 0.00001). Conclusions The parathyroid hormone in this study had significant negative correlations with both 25(OH)D and BMD. The 25(OH)D had a significant positive correlation with the studied adolescents' BMD.
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Affiliation(s)
- Ainur Donayeva
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Ainur Amanzholkyzy
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Ibrahim A. Abdelazim
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ain Shams University, Cairo, Egypt
| | - Saule Rakhyzhanova
- Department of Physiological Disciplines, Named after T.A. Nazarova, NCJSC, Semey Medical University, Semey, Kazakhstan
| | - Akzhunus Mannapova
- Department of Neurology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Talgar Abilov
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Zaituna Khamidullina
- Department of Obstetrics and Gynaecology №1, Astana Medical University, Astana, Kazakhstan
| | - Karlygash Bimagambetova
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Gulnara Gubasheva
- Department of Obstetrics and Gynaecology №2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Dinara Kulzhanova
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Akbayan Turesheva
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Samat Saparbayev
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
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Xu Z, Yu K, Zhang M, Ju Y, He J, Jiang Y, Li Y, Jiang J. Accurate Clinical Detection of Vitamin D by Mass Spectrometry: A Review. Crit Rev Anal Chem 2024:1-25. [PMID: 38376891 DOI: 10.1080/10408347.2024.2316237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Vitamin D deficiency is thought to be associated with a wide range of diseases, including diabetes, cancer, depression, neurodegenerative diseases, and cardiovascular and cerebrovascular diseases. This vitamin D deficiency is a global epidemic affecting both developing and developed countries and therefore qualitative and quantitative analysis of vitamin D in a clinical context is essential. Mass spectrometry has played an increasingly important role in the clinical analysis of vitamin D because of its accuracy, sensitivity, specificity, and the ability to detect multiple substances at the same time. Despite their many advantages, mass spectrometry-based methods are not without analytical challenges. Front-end and back-end challenges such as protein precipitation, analyte extraction, derivatization, mass spectrometer functionality, must be carefully considered to provide accurate and robust analysis of vitamin D through a well-designed approach with continuous control by internal and external quality control. Therefore, the aim of this review is to provide a comprehensive overview of the development of mass spectrometry methods for vitamin D accurate analysis, including emphasis on status markers, deleterious effects of biological matrices, derivatization reactions, effects of ionization sources, contribution of epimers, standardization of assays between laboratories.
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Affiliation(s)
- Zhilong Xu
- School of Marine Science and Technology, Harbin Institute of Technology (Weihai), Weihai, China
- School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, China
| | - Kai Yu
- School of Marine Science and Technology, Harbin Institute of Technology (Weihai), Weihai, China
| | - Meng Zhang
- School of Marine Science and Technology, Harbin Institute of Technology (Weihai), Weihai, China
- School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, China
| | - Yun Ju
- School of Marine Science and Technology, Harbin Institute of Technology (Weihai), Weihai, China
- School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, China
| | - Jing He
- School of Marine Science and Technology, Harbin Institute of Technology (Weihai), Weihai, China
| | - Yanxiao Jiang
- School of Marine Science and Technology, Harbin Institute of Technology (Weihai), Weihai, China
| | - Yunuo Li
- College of Natural Resources and Environment, Northwest A&F University, Yangling, China
| | - Jie Jiang
- School of Marine Science and Technology, Harbin Institute of Technology (Weihai), Weihai, China
- School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, China
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, Harbin, China
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Kopiczko A, Czapla M, Juárez-Vela R, Ross C, Uchmanowicz B. Dairy product consumption, eating habits, sedentary behaviour and physical activity association with bone mineral density among adolescent boys: a cross-sectional observational study. BMC Pediatr 2024; 24:53. [PMID: 38233826 PMCID: PMC10792931 DOI: 10.1186/s12887-024-04539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND During childhood and adolescence, skeletal microarchitecture and bone mineral density (BMD) undergo significant changes. Peak bone mass is built and its level significantly affects the condition of bones in later years of life. Understanding the modifiable factors that improve bone parameters at an early age is necessary to early prevent osteoporosis. To identify these modifiable factors we analysed the relationship between dairy product consumption, eating habits, sedentary behaviour, and level of physical activity with BMD in 115 young boys (14-17 years). METHODS Bone parameters were measured by dual energy x-ray absorptiometry using paediatric specific software to compile the data. Dairy product consumption and eating habits were assessed by means of a dietary interview. Sedentary behaviour and physical activity was assessed in a face-to-face interview conducted using the International Physical Activity Questionnaire. Data collection on total physical activity level was performed by collecting information on the number of days and the duration of vigorous and moderate intensity (MVPA) and average daily time spent in sitting (SIT time). RESULTS The strongest relationships with BMD in distal part of forearm were found for moderate plus vigorous activity, sit time, and intake of dairy products, intake of calcium, protein, vitamin D, phosphorus from diet. Relationships between BMD, bone mineral content (BMC) in the distal and proximal part of the forearm and PA, sit time and eating parameters were evaluated using the multiple forward stepwise regression. The presented model explained 48-67% (adjusted R2 = 0.48-0.67; p < 0.001) of the variance in bone parameters. The predictor of interactions of three variables: protein intake (g/person/day), vitamin D intake (µg/day) and phosphorus intake (mg/day) was significant for BMD dis (adjusted R2 = 0.59; p < 0.001). The predictor of interactions of two variables: SIT time (h/day) and dairy products (n/day) was significant for BMD prox (adjusted R2 = 0.48; p < 0.001). Furthermore, the predictor of interactions dairy products (n/day), protein intake (g/person/day) and phosphorus intake (mg/day) was significant for BMC prox and dis (adjusted R2 = 0.63-0.67; p < 0.001). CONCLUSIONS High physical activity and optimal eating habits especially adequate intake of important dietary components for bone health such as calcium, protein, vitamin D and phosphorus affect the mineralization of forearm bones.
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Affiliation(s)
- Anna Kopiczko
- Department of Human Biology, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | - Michał Czapla
- Department of Emergency Medical Service, Wrocław Medical University, Wrocław, Poland.
- Institute of Heart Diseases, University Hospital, Wroclaw, 50-566, Poland.
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logrono, 26006, Spain.
| | - Raúl Juárez-Vela
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logrono, 26006, Spain
| | - Catherine Ross
- Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Bartosz Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Gupta N, Agarwal A, Jindal R, SR S. Estimating Vitamin D threshold for the Indian population: Delving into the actual disease burden. Med J Armed Forces India 2023; 79:S224-S229. [PMID: 38144653 PMCID: PMC10746810 DOI: 10.1016/j.mjafi.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/06/2022] [Indexed: 11/07/2022] Open
Abstract
Background Based on the current guidelines in practice, a vast majority of the healthy Indian population is vitamin D deficient. Since the serum 25 hydroxycholecalciferol (25HCC) levels are affected by race and skin pigmentation, the normal range of vitamin D may differ in the Indians compared to the Western population. This study attempted to determine a population-specific threshold for 25 HCC levels associated with adequate bone health and calcium and phosphate homeostasis in healthy Indians. Methods Subjects aged 20-50 years were included in the study. The exclusion criteria were obesity, chronic renal disease, liver failure, diabetes mellitus, thyroid disorders, a recent history of fracture, constant joint pain, and postmenopausal status. In addition, participants on prescribed medication such as glucocorticoids, anticonvulsants, or antifungals, as well as vitamin D and calcium supplementation, were also excluded.Blood samples were analyzed for serum calcium, phosphate, alkaline phosphatase, 25HCC, 1,25dihydroxycholecalciferol, parathyroid hormone (PTH), procollagen type-I N propeptide, and C-terminal telopeptide of type 1 collagen.Locally estimated smoothing scatter plot (LOESS) curves and Spearman correlation were utilized to study the correlation of all the biochemical parameters with 25 HCC to achieve thresholds. Results The study consisted of 270 healthy participants, out of which 97.8% were found to have vitamin D levels below 30 ng/ml. In addition, 8.8% had raised PTH, and 1.85% had hypocalcemia. Furthermore, 1.48% had raised serum alkaline phosphatase and hypophosphatemia, respectively. A weak inverse correlation was seen between 25 HCC and PTH (rs = -0.437, p < 0.001), as well as alkaline phosphatase (rs = -0.1475, p = 0.015), while a weak positive correlation was seen with serum phosphate (rs = 0.128, p = 0.047). Conclusion For a healthy Indian population, the reference range of 25 HCC is much lower, and the lower limit of normal is approximately 13.5 ng/ml. This study indicates that vitamin D insufficiency in this population starts at 25 HCC values of 13.5 ng/ml and deficiency at 7 ng/ml.
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Affiliation(s)
- Neha Gupta
- Classified Specialist (Pathology), Air Force Hospital, Hasimara, West Bengal, India
| | - Anupam Agarwal
- Professor (Aerospace Medicine), Rajiv Gandhi University of Health Sciences, Bengaluru, India
| | - Radhika Jindal
- Associate Professor (Endocrinology), Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Santhosh SR
- Professor (Aerospace Medicine), Institute of Aerospace Medicine, Vimanpura, Bengaluru, India
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Mehdad S, Belghiti H, Zahrou FE, Guerinech H, Mouzouni FZ, El Hajjab A, El Berri H, El Ammari L, Benaich S, Benkirane H, Barkat A, Aguenaou H. Vitamin D status and its relationship with obesity indicators in Moroccan adult women. Nutr Health 2023; 29:673-681. [PMID: 35435056 DOI: 10.1177/02601060221094376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Although vitamin D deficiency has been studied in various populations, there are few data on its prevalence and associated factors among Moroccan women. Aim: To determine the prevalence of vitamin D deficiency and investigate its association with body mass index (BMI), waist circumference, and serum concentrations of parathyroid hormone, calcium, and phosphorus in a sample of Moroccan adult women. Methods: This is a cross-sectional study conducted at Mohammed V Military Hospital of Instruction, Rabat. Anthropometric measurements and biochemical analyses were performed using standard procedures Results: A total of 714 women aged 18-65 years participated in this study. The overall prevalence of vitamin D deficiency was 74.4%. Approximately 24% and 51% of women had severe and moderate vitamin D deficiency, respectively. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were inversely correlated with BMI in vitamin D-deficient subjects (P = 0.036) and with parathyroid hormone 1-84 (PTH1-84) levels in the study sample (P = 0.010). PTH1-84 concentrations were greater among overweight/obese individuals compared to their non-overweight peers (P = 0.001) and tended to be higher among vitamin D-deficient women than vitamin D-sufficient women (P = 0.053). Conclusion: This study showed a very high prevalence of vitamin D deficiency in this sample of Moroccan women. Lower serum 25(OH)D levels were associated with increased BMI in vitamin D-deficient women and with elevated PTH1-84 levels among the study sample. Although these findings come from a convenience sample of women that attended a nutrition clinic, they underscore the urgent need to develop public health interventions to improve women's vitamin D status.
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Affiliation(s)
- Slimane Mehdad
- Physiology and Physiopathology Research Team, Research Centre of Human Pathologies Genomics, Faculty of Sciences, Mohammed V University in Rabat, Morocco
- Clinical Nutrition Unit, Mohammed V Military Hospital of Instruction, Rabat, Morocco
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Hakim Belghiti
- Clinical Nutrition Unit, Mohammed V Military Hospital of Instruction, Rabat, Morocco
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Fatima Ezzahra Zahrou
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Hassania Guerinech
- Clinical Nutrition Unit, Mohammed V Military Hospital of Instruction, Rabat, Morocco
| | | | - Amina El Hajjab
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | | | | | - Souad Benaich
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Hasnae Benkirane
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
| | - Amina Barkat
- Health and Nutrition Research Team of the Mother-Child Couple, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Hassan Aguenaou
- Ibn Tofail University- CNESTEN, Joint Unit of Nutrition, Health and Environment, Laboratory of Biology and Health, FSK, Regional Designated Center for Nutrition (AFRA/IAEA), Kenitra, 14000, Morocco
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Tsuruda T, Funamoto T, Suzuki C, Yamamura Y, Nakai M, Chosa E, Kaikita K. Increasing baseline aortic valve peak flow velocity is associated with progression of aortic valve stenosis in osteoporosis patients-a possible link to low vitamin D status. Arch Osteoporos 2023; 18:129. [PMID: 37874407 PMCID: PMC10598115 DOI: 10.1007/s11657-023-01339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The purpose of this study was to investigate the morphological characteristics of the aortic valve and identify factors associated with the progression of aortic valve stenosis (AS) in osteoporosis patients. METHODS In this single-center prospective cohort study, we recruited 10 patients (mean age: 75 ± 7 years, 90% female) who were taking anti-resorptive medicines at the outpatient clinic of University of Miyazaki Hospital, Japan. Baseline assessments, including transthoracic echocardiogram, blood sampling, and dual energy X-ray absorptiometry, were performed. Follow-up assessments were conducted at 6, 12, 18, and 24 months. RESULTS During the 2-year follow-up, three patients with aortic valve peak flow velocity (AV PFV) ≥2 m/s at baseline developed moderate AS, which is defined as AV PFV ≥3 m/s. However, seven patients with AV PFV <2 m/s did not exhibit any progression of AS. There were significant variations in terms of bone mineral density, T-score values, and biomarkers associated with bone turnover (i.e., bone alkaline phosphatase, tartrate-resistance acid phosphatase-5b) among the enrolled patients, but none of these factors were found to be associated with the progression of AS. All patients exhibited low vitamin D status, with a median level of 16.1 ng/mL (25th percentile, 9.7 ng/mL; 75th percentile, 23 ng/mL). The baseline levels of AV PFV values were negatively correlated with 25-hydroxyvitamin D levels, determined by univariate linear regression analysis (beta coefficient = -0.756, 95% confidence interval, -0.136 ̶ -0.023, p = 0.011). CONCLUSION Our data suggest that low vitamin D status might be a potential risk factor for the progression of AS in osteoporosis patients undergoing treatment with anti-resorptive medicines. Elderly patients with osteoporosis patients exhibited a subset of aortic valve stenosis. Our data suggest that the baseline aortic valve peak flow velocity predicts the progression of aortic valve stenosis, and there might be an association between the progression and the co-existing low vitamin D status in these patients.
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Affiliation(s)
- Toshihiro Tsuruda
- Cardiorenal Research Laboratory, Department of Vascular Advanced Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
- Division of Internal Medicine, Cardiovascular Medicine and Nephrology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Taro Funamoto
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Chiyoko Suzuki
- Clinical Laboratory, University of Miyazaki Hospital, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yoshimasa Yamamura
- Division of Internal Medicine, Cardiovascular Medicine and Nephrology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Michikazu Nakai
- Clinical Research Support Center, University of Miyazaki Hospital, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Koichi Kaikita
- Division of Internal Medicine, Cardiovascular Medicine and Nephrology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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9
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Gong M, Wang K, Sun H, Wang K, Zhou Y, Cong Y, Deng X, Mao Y. Threshold of 25(OH)D and consequently adjusted parathyroid hormone reference intervals: data mining for relationship between vitamin D and parathyroid hormone. J Endocrinol Invest 2023; 46:2067-2077. [PMID: 36920734 PMCID: PMC10514164 DOI: 10.1007/s40618-023-02057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE By recruiting reference population, we aimed to (1): estimate the 25(OH)D threshold that maximally inhibits the PTH, which can be defined as the cutoff value for vitamin D sufficiency; (2) establish the PTH reference interval (RI) in population with sufficient vitamin D. METHODS Study data were retrieved from LIS (Laboratory Information Management System) under literature suggested criteria, and outliers were excluded using Tukey fence method. Locally weighted regression (LOESS) and segmented regression (SR) were conducted to estimate the threshold of 25(OH)D. Multivariate linear regression was performed to evaluate the associations between PTH concentration and variables including 25(OH)D, gender, age, estimated glomerular filtration rate (EGFR), body mass index (BMI), albumin-adjusted serum calcium (aCa), serum phosphate(P), serum magnesium(Mg), and blood collection season. Z test was adopted to evaluate whether the reference interval should be stratified by determinants such as age and gender. RESULTS A total of 64,979 apparently healthy subjects were recruited in this study, with median (Q1, Q3) 25(OH)D of 45.33 (36.15, 57.50) nmol/L and median (Q1, Q3) PTH of 42.19 (34.24, 52.20) ng/L. The segmented regression determined the 25(OH)D threshold of 55 nmol/L above which PTH would somewhat plateau and of 22 nmol/L below which PTH would rise steeply. Multivariate linear regression suggested that gender, EGFR, and BMI were independently associated with PTH concentrations. The PTH RI was calculated as 22.17-72.72 ng/L for subjects with 25(OH)D ≥ 55 nmol/L with no necessity of stratification according to gender, age, menopausal status nor season. CONCLUSION This study reported 25(OH)D thresholds of vitamin D sufficiency at 55 nmol/L and vitamin D deficiency at 22 nmol/L, and consequently established PTH RIs in subjects with sufficient vitamin D for northern China population for the first time.
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Affiliation(s)
- M Gong
- Department of Laboratory Medicine, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - K Wang
- Department of Laboratory Medicine, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - H Sun
- Department of Laboratory Medicine, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - K Wang
- Department of Laboratory Medicine, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Y Zhou
- Department of Laboratory Medicine, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Y Cong
- Department of Laboratory Medicine, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - X Deng
- Department of Laboratory Medicine, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China.
| | - Y Mao
- Department of Laboratory Medicine, Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
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10
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Vervloet MG, Hsu S, de Boer IH. Vitamin D supplementation in people with chronic kidney disease. Kidney Int 2023; 104:698-706. [PMID: 37541585 DOI: 10.1016/j.kint.2023.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
Vitamin D supplements have long been advocated for people with chronic kidney disease based on data from observational studies among the general population and people with chronic kidney disease. These data consistently suggested that higher circulating concentrations of 25-hydroxyvitamin D are associated with improved fracture, cardiovascular, cancer, and mortality outcomes. In the past few years, large clinical trials have been conducted to assess the effects of vitamin D supplements on a range of clinically relevant outcomes. Most of these studies were performed in the general population, but they also enrolled people with chronic kidney disease. Virtually all of these trials were negative and contradicted the observational data. In this review, the key observational data and clinical trials are summarized, and potential explanations for the discrepancies between these studies are discussed.
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Affiliation(s)
- Marc G Vervloet
- Department of Nephrology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Division of Diabetes and Metabolism, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.
| | - Simon Hsu
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Ian H de Boer
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington, USA
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11
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Dugani P, Sharma PV, Krishna SM, Reddy KK. Serum Parathyroid Hormone and Vitamin D Levels as Predictors of Hypocalcemia after Total/ Near Total Thyroidectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:1502-1510. [PMID: 37636752 PMCID: PMC10447850 DOI: 10.1007/s12070-023-03599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Post-operative Hypocalcaemia is the most-common complication of total and near-total thyroidectomy which is a selective treatment for benign and malignant thyroid diseases. Incidence ranges from 0.5-50%. OBJECTIVES The role of vitamin-D and Parathyroid hormone(PTH) in incidence of Hypocalcemia after thyroidectomy has been taken into consideration. METHODS This is a prospective interventional study is conducted in Kasturba Medical College and hospital, Manipal after taking written informed consent from the participants. It aimed at surveying the serum level of preoperative Vitamin D, PTH and calcium before total-thyroidectomy surgery and its relationship with the incidence of postoperative hypocalcemia after the surgery. The study was done on 70 patients who were-planned for total/near total thyroidectomy. Preoperative Vitamin D, PTH, calcium and Postoperative 4 hours-PTH, Calcium were measured on POD-1, POD-2-4, the results obtained were then analysed. RESULTS Considering the cut-off of calcium as 8.6mg/dl, 42 patients developed hypocalcemia on POD-1, 28 patients on POD-2. Preoperative calcium and postoperative PTH levels in people having hypocalcaemia where significantly less compared to the patients having normal calcium. 4-hours post-operative PTH measurements showed 51% sensitivity, 100% specificity and strong co-relation between postoperative hypocalcemia and drop in PTH levels- (p=<0.001). Out of 42 patients who developed hypocalcemia 28- (65%) patients had vitamin-D deficiency(p=0.5) on POD-1 and out of 51 patients with hypocalcemia on POD 2-4, 33(78%) had-vitamin-D-deficiency(p=0.3852). Which was not statically significant. CONCLUSION 4 hours post-operative PTH level is a predictor of early postoperative hypocalcemia, by detecting this we can effectively manage postoperative hypocalcemia.
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Affiliation(s)
- Priya Dugani
- Department of General Surgery, Kasturba medical college and Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Poorvi V Sharma
- Department of ENT, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sunil M Krishna
- Department of General surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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12
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Shan X, Cao Y, Zhang H, Zhao X, Li S, Hu Y, Yang L. Free and bioavailable 25-hydroxyvitamin D thresholds for bone metabolism and their associations with metabolic syndrome in Chinese women of childbearing age. Front Nutr 2023; 10:1131140. [PMID: 37736136 PMCID: PMC10509557 DOI: 10.3389/fnut.2023.1131140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
Objective The free hormone hypothesis suggests that free and bioavailable 25-hydroxyvitamin D [25(OH)D] may better reflect vitamin D bioactivity. This study aimed to determine the free and bioavailable 25(OH)D characteristics, estimate their thresholds based on parathyroid hormone (PTH) and bone turnover markers (BTMs), assess their associations with the risk of metabolic syndrome (MetS), and evaluate their potential advantages. Methods A cross-sectional study was conducted using a nationally representative database (n = 1,505, female, 18-45 years). Serum total 25(OH)D, vitamin D-binding protein, albumin, PTH, and BTMs [osteocalcin, β-CrossLaps of type 1 collagen containing cross-linked C-telopeptide (β-CTX), and procollagen type 1 N-terminal propeptide (P1NP)] were measured. Free 25(OH)D and bioavailable 25(OH)D were calculated. The threshold associations of 25(OH)D with PTH and BTMs were analyzed. The relationship between 25(OH)D and MetS risk was examined. An intervention study was then performed in 39 women (18-47 years) to assess the associations of increasing 25(OH)D with PTH and BTMs after vitamin D supplementation. Results In the cross-sectional study, the three forms of 25(OH)D were found to have similar distribution characteristics. Free and bioavailable 25(OH)D correlated well with total 25(OH)D. Significant total 25(OH)D cutoffs were observed for PTH (14.19 ng/mL and 18.03 ng/mL), osteocalcin (15.14 ng/mL), β-CTX (14.79 ng/mL), and P1NP (15.08 ng/mL). Free and bioavailable 25(OH)D cutoffs were only found for P1NP (3.47 pg/mL and 1.66 ng/mL, respectively). A total 25(OH)D of <15.14 ng/mL was marginally associated with a higher risk of reduced high-density lipoprotein cholesterol (HDL-C) [odd ratios (OR) = 1.371 (0.991-1.899)]. The ORs of higher versus lower free and bioavailable 25(OH)D levels for reduced HDL-C were 0.770 (0.621-0.956) and 0.772 (0.622-0.958), respectively. The results of the intervention study indicated that PTH and BTMs responded more sensitively to total 25(OH)D than to free or bioavailable 25(OH)D. Conclusion Free and bioavailable 25(OH)D only had a threshold effect on P1NP. The active 25(OH)D thresholds could be used for risk assessment of reduced HDL-C. However, no superiority of free or bioavailable 25(OH)D was found based on the response of PTH and BTMs to changes in 25(OH)D in Chinese women of childbearing age following vitamin D supplementation. Clinical trial registration http://www.chictr.org.cn, ChiCTR2200058290.
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Affiliation(s)
- Xiaoyun Shan
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Hunan Key Laboratory of Typical Environmental Pollution and Health Hazards, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yang Cao
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huidi Zhang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiayu Zhao
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Siran Li
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yichun Hu
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lichen Yang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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13
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Childs-Sanford SE, Makowski AJ, Hilliard RL, Wakshlag JJ. EXPERIMENTAL CHOLECALCIFEROL SUPPLEMENTATION IN A HERD OF MANAGED ASIAN ELEPHANTS ( ELEPHAS MAXIMUS). J Zoo Wildl Med 2023; 54:219-230. [PMID: 37428684 DOI: 10.1638/2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 07/12/2023] Open
Abstract
Vitamin D supplementation may pose a significant health risk in species where levels of deficiency, sufficiency, and toxicity have not been clearly established, and species-specific research on vitamin D supplementation should be performed. This study documented the effect of vitamin D supplementation on serum vitamin D metabolites and other analytes of Ca homeostasis in Asian elephants (Elephas maximus). Six adult Asian elephants received PO supplementation with cholecalciferol at 300 IU/kg of body weight (BW) once a week for 24 wk. Serum was analyzed every 4 wk for 25-hydroxyvitamin D2/D3 [25(OH)D]; 24,25-dihydroxyvitamin D2/D3 [24,25(OH)2D]; 1,25-dihydroxyvitamin D [1,25(OH)2D]; parathyroid hormone (PTH); total Ca; ionized Ca (iCa); P; and Mg. After the supplement was discontinued, serum 25(OH)D2/D3 was measured every 4 wk until levels returned to baseline. At the start of the study, the average serum 25(OH)D3 was nondetectable (<1.5 ng/ml). With cholecalciferol supplementation, 25(OH)D3 increased at an average rate of 2.26 ng/ml per month and reached an average concentration of 12.9 ± 3.46 ng/ml at 24 wk. Both 24,25(OH)2D3 and 1,25(OH)2D increased over time with supplementation from an average of <1.5 to 12.9 ng/ml and from 9.67 to 36.4 pg/ml, respectively. PTH, iCa, Ca, P, and Mg remained within reported normal ranges throughout supplementation. After the supplement was discontinued, serum 25(OH)D3 demonstrated a slow decline to baseline, taking an average of 48 wk. Elephants demonstrated significant individual variation in response to supplementation and subsequent return to baseline. Supplementation of Asian elephants with a weekly dose of 300 IU/kg BW cholecalciferol for 24 wk appears to be effective and safe. Additional clinical studies would be necessary to investigate the safety of other routes of administration, dosages, and duration of vitamin D supplementation, as well as associated health benefits.
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Affiliation(s)
| | - Andrew J Makowski
- Heartland Assays, Iowa State University Research Park, Ames, Iowa 50010, USA
| | - Rachel L Hilliard
- College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA
| | - Joseph J Wakshlag
- Department of Clinical Sciences, Cornell University, Ithaca, New York 14853, USA
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14
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Haq T, Tomalika N, Mohsena M, Momtaz H, Banu A, Chowdhury MMH, Hashem KN, Tagar MM, Morshed MS, Sayeed MA. Vitamin D levels in seven non-identical occupational groups entail redefining of existing vitamin D deficiency diagnostic cut off level for native Bangladeshi population. IMC JOURNAL OF MEDICAL SCIENCE 2023. [DOI: 10.55010/imcjms.17.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background and objectives: Recent publications have reported alarming prevalence of hypovitaminosis D in South Asian countries including Bangladesh. But, data on vitamin D levels in different occupational groups are lacking. This study addressed the prevalence of hypovitaminosis D in different occupational groups of Bangladesh. Additionally, the study estimated parathyroid hormone, phosphate, calcium and metabolic syndrome in these groups to see the effect of hypovitaminosis D on these parameters.
Materials and method: Seven diverse occupational groups (agrarian workers, rickshaw-pullers, young cricketers and footballers, fishermen, dry fish industry workers, garment-workers and medical students) of Bangladesh were selected based on grade of physical activity and level of sun exposure. Blood was collected for the estimation of 25(OH) vitamin D, fasting glucose,lipid profiles, calcium, phosphate, magnesium and intact parathyroid (iPTH) hormone. Multiple comparisons of these variables among the 7 groups were estimated by ANOVA.
Results: A total of 785 (m / f = 359 / 426) participants volunteered. Of them, 54.2% had vitamin D deficiency. Metabolic syndrome was 5% and showed no significant association with hypovitaminosis D (x2 = 0.9, p=0.43). For biophysical characteristics, the mean (±SD) values of age, body mass index, waist to hip ratio and waist to height ratio were – 33.8±16.3y, 22.3±4.1 kg/m2, 0.87±0.06 and 0.39±0.16, respectively. The values for vitamin D (ng/ml), calcium (mg/dl), iPTH (pgm/ml) and phosphate (mg/dl) were 20.25±13.1, 9.57±1.85, 38.22±24.54 and 4.18±0.81, respectively. The comparisons of vitamin D and other related variables among the groups (ANOVA) showed vitamin D level in the garments worker was significantly (p<0.01) higher from other 6 groups. Likewise, compared with other six, rickshaw-pullers had significantly higher calcium level. Calcium, phosphate and parathyroid hormone did not show any change with decreasing vitamin D level (high to low quartile: Q4→Q1), though parathyroid hormone increased significantly at the lowest vitamin D level (Q1:<11.8ng/ml: p=0.002).
Conclusion: The prevalence of hypovitaminosis D was high irrespective of occupations, site (rural/urban), social class and sun-exposure. Overall, vitamin D level was low though varied among the groups. Despite minimum and maximum sun-exposure, the garments workers had the highest and the fishermen had the lowest vitamin D levels, respectively. Calcium level was normal in all groups. Calcium, phosphate and parathyroid hormone did not show any changes with decreasing vitamin D, though parathyroid hormone increased significantly when vitamin D decreased to the lowest quartile. The findings indicate that the specific cut off value for vitamin D deficiency needs to be determined for population of a given geographic area.
IMC J Med Sci. 2023; 17(2):001. DOI: https://doi.org/10.55010/imcjms.17.011
*Correspondence: M Abu Sayeed, Department of Community Medicine, Ibrahim Medical College, 1/A, Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh. Email: sayeed1950@gmail.com
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Affiliation(s)
- Tahniyah Haq
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Nehlin Tomalika
- Department of Community Medicine, Ibrahim Medical College, Segunbagicha, Dhaka, Bangladesh
| | - Masuda Mohsena
- Department of Community Medicine, Ibrahim Medical College, Segunbagicha, Dhaka, Bangladesh
| | - Hasina Momtaz
- Department of Community Medicine, Ibrahim Medical College, Segunbagicha, Dhaka, Bangladesh
| | - Akhter Banu
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | | | - Kazi Natasha Hashem
- Department of Gynaecology & Obstetrics, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Shahbag, Dhaka, Bangladesh
| | - Md Mohiuddin Tagar
- Department of Community Medicine, Ibrahim Medical College, Segunbagicha, Dhaka, Bangladesh
| | | | - MA Sayeed
- Department of Community Medicine, Ibrahim Medical College, Segunbagicha, Dhaka, Bangladesh
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15
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Andersen SL, Karmisholt J, Vestergaard P, Husted L, Venø SK, Christensen PA. Parathyroid hormone reference intervals in adults using second- and third-generation assays. Scand J Clin Lab Invest 2023; 83:38-44. [PMID: 36625213 DOI: 10.1080/00365513.2022.2164517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Parathyroid hormone (PTH) is a routine biochemical analysis, and it varies whether a second- or third-generation assay is used. Information on the levels obtained with different assays and evidence to substantiate local assay-specific reference ranges are important to inform clinical practice. Prior to a shift from the second- to the third-generation PTH assay (Cobas 8000, Roche Diagnostics) in the Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark, a total of 59 EDTA-plasma samples were collected for method comparison (Passing-Bablok). Furthermore, 120 EDTA-plasma samples were randomly obtained from adult blood donors and used for the establishment of reference intervals using the third-generation PTH assay (Cobas 8000, Roche Diagnostics) and two second-generation assays (Atellica, Siemens Healthineers; Alinity, Abbott Laboratories). Method comparison (Cobas 8000, Roche Diagnostics) showed lower levels with the third-generation (y) as compared to the second-generation assay (x) depending on the measurement range (PTH < 10 pmol/L: y = 0.8 (95% CI: 0.7; 0.9) x + 0.3 (95% CI: 0.2; 0.5), PTH ≥ 10 pmol/L: y = 0.6 (95% CI: 0.5; 0.6) x + 3.2 (95% CI: 1.1; 5.2)). Method-specific reference intervals (2.5 and 97.5 percentiles) after the exclusion of samples (n = 31) with 25-hydroxy-vitamin D below 50 nmol/L were: 1.8-8.5 pmol/L (second-generation, Atellica, Siemens Healthineers); 2.4-10.9 pmol/L (second-generation, Alinity, Abbott Laboratories), and 1.8-7.0 pmol/L (third-generation, Cobas 8000, Roche Diagnostics). PTH levels with second- and third-generation assays are not interchangeable. Clinicians should be informed when a laboratory assay is changed, and method-specific reference ranges are needed.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jesper Karmisholt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Lise Husted
- Department of Clinical Biochemistry, Viborg Regional Hospital, Viborg, Denmark
| | - Stine Krogh Venø
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Astrup Christensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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16
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Sochett EB, Dominicis M, Vali R, Shammas A, Elia Y, Moineddin R, Mahmud F, Assor E, Furman M, Boyd SK, Lenherr-Taube N. Relationship between risk factors for impaired bone health and HR-pQCT in young adults with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1144137. [PMID: 36936151 PMCID: PMC10020337 DOI: 10.3389/fendo.2023.1144137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVE In type 1 diabetes, risk factors associated with impaired bone health contribute to increased risk of fracture. The aim of this study was to (1): compare the high-resolution peripheral quantitative computed tomography (HR-pQCT) parameters of young adults with type 1 diabetes with those of healthy controls (2), identify sex differences, and (3) evaluate the association between diabetes and bone health risk factors, with HR-pQCT. METHODS This is a cross-sectional study in young Canadian adults with childhood onset type 1 diabetes. Z-scores were generated for HR-pQCT parameters using a large healthy control database. Diet, physical activity, BMI, hemoglobin A1C (A1C) and bone health measures were evaluated, and associations were analyzed using multivariate regression analysis. RESULTS Eighty-eight participants (age 21 ± 2.2 years; 40 males, 48 females, diabetes duration 13.9 ± 3.4 years) with type 1 diabetes were studied. Low trabecular thickness and elevated cortical geometry parameters were found suggesting impaired bone quality. There were no sex differences. Significant associations were found: Vitamin D (25(OH)D) with trabecular parameters with possible synergy with A1C, parathyroid hormone with cortical parameters, BMI with cortical bone and failure load, and diabetes duration with trabecular area. CONCLUSIONS Our data suggests impairment of bone health as assessed by HR-pQCT in young adults with type 1 diabetes. Modifiable risk factors were associated with trabecular and cortical parameters. These findings imply that correction of vitamin D deficiency, prevention and treatment of secondary hyperparathyroidism, and optimization of metabolic control may reduce incident fractures.
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Affiliation(s)
- Etienne B. Sochett
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- *Correspondence: Etienne B. Sochett,
| | - Mary Dominicis
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reza Vali
- Department of Diagnostic Imaging, Division of Nuclear Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Amer Shammas
- Department of Diagnostic Imaging, Division of Nuclear Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Yesmino Elia
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Farid Mahmud
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Esther Assor
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michelle Furman
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Steve K. Boyd
- Department of Radiology, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Nina Lenherr-Taube
- Division of Endocrinology, University Children’s Hospital Zürich, Zürich, Switzerland
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17
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Vitamin D Supplementation and Its Impact on Different Types of Bone Fractures. Nutrients 2022; 15:nu15010103. [PMID: 36615761 PMCID: PMC9824692 DOI: 10.3390/nu15010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Vitamin D helps to balance the levels of calcium and phosphorus to maintain proper bone structure. It is also involved in essential biological roles and displays a wide spectrum of potential benefits in the human body. Since there are many types of fractures that occur at specific ages and due to different circumstances, the influence of vitamin D on the frequency of a particular fracture may differ. Thus, the authors investigated the possible preventive effect of vitamin D on the risks of vertebral fractures, hip fractures, stress fractures and pediatric fractures. Additional aspects of vitamin D, especially on recuperation after injures and its impact on the severity of particular fractures, were also discussed. It was suggested that vitamin D supplementation may contribute to a reduction in hip fracture risk due to reduced bone turnover, decreased frequency of falls and improved muscle function. Furthermore, vitamin D appears to lower the risk of stress fractures in athletes and military recruits. Due to a nonunified protocol design, presented investigations show inconsistencies between vitamin D supplementation and a decreased risk of vertebral fractures. However, a vitamin D preventive effect on pediatric fractures seems to be implausible.
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18
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Barzin M, Ebadinejad A, Vahidi F, Khalaj A, Mahdavi M, Valizadeh M, Hosseinpanah F. The mediating role of bariatric surgery in the metabolic relationship between parathyroid hormone and 25-hydroxyvitamin D. Osteoporos Int 2022; 33:2585-2594. [PMID: 35982319 DOI: 10.1007/s00198-022-06533-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
UNLABELLED Vitamin D metabolism is altered in obese individuals. Our findings indicated that in patients with severe obesity, a relatively low 25(OH)D concentration was required to suppress PTH. The PTH inflection point increased following surgery-induced weight loss, highlighting 25(OH)D different regulation mechanisms in patients with obesity. INTRODUCTION An optimal and sufficient concentration of 25-hydroxyvitamin D (25(OH)D) has been suggested as the level required to maximally suppress intact parathyroid hormone (iPTH). We evaluated the role of surgery-induced weight loss in determining the threshold(s) of 25(OH)D required to suppress iPTH. METHODS This study was conducted in the framework of the Tehran Obesity Treatment Study (TOTS). We prospectively analyzed 687 patients with severe obesity who participated in the TOTS and underwent bariatric surgery from March 2013 to March 2019. The patients were followed for 1 year after surgery. Anthropometric parameters and serum levels of iPTH, 25OHD, phosphorous, and calcium were measured. Nonlinear and piecewise linear regression was used to evaluate the relationship between 25(OH)D and iPTH and to determine the 25(OH)D-suppression point at which iPTH was maximally suppressed. RESULTS Body mass index was 44.6 kg/m2 at the baseline and decreased to 29.7 kg/m2 1 year after surgery (P < 0.05). Before the surgery, iPTH and 25(OH)D showed an exponential relationship; iPTH began to decrease rapidly at 25(OH)D concentration of 12 ng/mL, reaching maximal suppression at 30 ng/mL. However, the relationship between 25(OH)D and iPTH was non-exponential 1 year after surgery. The piecewise linear regression model revealed the 25(OH)D concentration of 21 ng/mL as the inflection point following surgery-induced weight loss. CONCLUSION In patients with severe obesity, PTH was suppressed at a relatively lower concentration of 25(OH)D; this threshold increased following surgery-induced weight loss. These findings suggest a role for bariatric surgery in regulating 25(OH)D metabolism in patients with obesity.
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Affiliation(s)
- Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnaz Vahidi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Applying Machine Learning to Determine 25(OH)D Threshold Levels Using Data from the AMATERASU Vitamin D Supplementation Trial in Patients with Digestive Tract Cancer. Nutrients 2022; 14:nu14091689. [PMID: 35565657 PMCID: PMC9101674 DOI: 10.3390/nu14091689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/10/2022] Open
Abstract
Some controversy remains on thresholds for deficiency or sufficiency of serum 25-hydroxyvitamin D (25(OH)D) levels. Moreover, 25(OH)D levels sufficient for bone health might differ from those required for cancer survival. This study aimed to explore these 25(OH)D threshold levels by applying the machine learning method of multivariable adaptive regression splines (MARS) in post hoc analyses using data from the AMATERASU trial, which randomly assigned Japanese patients with digestive tract cancer to receive vitamin D or placebo supplementation. Using MARS, threshold 25(OH)D levels were estimated as 17 ng/mL for calcium and 29 ng/mL for parathyroid hormone (PTH). Vitamin D supplementation increased calcium levels in patients with baseline 25(OH)D levels ≤17 ng/mL, suggesting deficiency for bone health, but not in those >17 ng/mL. Vitamin D supplementation improved 5-year relapse-free survival (RFS) compared with placebo in patients with intermediate 25(OH)D levels (18−28 ng/mL): vitamin D, 84% vs. placebo, 71%; hazard ratio, 0.49; 95% confidence interval, 0.25−0.96; p = 0.04. In contrast, vitamin D supplementation did not improve 5-year RFS among patients with low (≤17 ng/mL) or with high (≥29 ng/mL) 25(OH)D levels. MARS might be a reliable method with the potential to eliminate guesswork in the estimation of threshold values of biomarkers.
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20
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Cheung MM, Dall RD, Shewokis PA, Altasan A, Volpe SL, Amori R, Singh H, Sukumar D. The Effect of Combined Magnesium and Vitamin D Supplementation on Vitamin D Status, Systemic Inflammation and Blood Pressure: A Randomized Double-Blinded Controlled Trial. Nutrition 2022; 99-100:111674. [DOI: 10.1016/j.nut.2022.111674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/11/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
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Karimian P, Ebrahimi HK, Jafarnejad S, Delavar MA. Effects of vitamin D on bone density in healthy children: A systematic review. J Family Med Prim Care 2022; 11:870-878. [PMID: 35495788 PMCID: PMC9051716 DOI: 10.4103/jfmpc.jfmpc_2411_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/16/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Skeletal growth and bone health are very important in children. The effective role of vitamin D in bone mineral density has been observed in children and adolescents. This systematic review study evaluated the effects of vitamin D on bone density in healthy children with the help of valid databases and the website of clinical trials. The results of experimental, clinical, retrospective, prospective, double-blind, and randomized studies were used. Articles that appropriately covered the topic and had the proper content structure were selected for this review. Out of a total of 132 articles, finally, 13 articles were selected based on inclusion and exclusion criteria for further study, the results of which show the association between serum levels of vitamin D and bone mineral density and health. However, in some articles, the relationship between other influential variables such as age and nutrition on bone density in children was identified. In general, the current systematic review demonstrates the role of vitamin D on bone density in healthy children, so that in children studied, vitamin D is at different levels and complications related to bone density are observed in many children. It is recommended that more clinical and longitudinal studies be performed to further understand the role of vitamin D levels in bone health in children.
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Affiliation(s)
- Pegah Karimian
- Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Aliasghar children Hospital, Tehran, Iran
| | - Hamidreza Khoshnezhad Ebrahimi
- Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Aliasghar children Hospital, Tehran, Iran
| | - Shabahang Jafarnejad
- Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Aliasghar children Hospital, Tehran, Iran
| | - Motahare Aghajani Delavar
- Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Aliasghar children Hospital, Tehran, Iran
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22
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Ravelo Marrero AJ, Guillén Astete CA, Román MM, Coronado MR, Del Rey Sánchez JM, Lozano AG, Terán Tinedo MA, Díaz MV, Gómez IA. Prevalence of vitamin D deficiency and association with parathyroid hormone. ADVANCES IN LABORATORY MEDICINE 2022; 3:51-66. [PMID: 37359435 PMCID: PMC10197301 DOI: 10.1515/almed-2021-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/11/2021] [Indexed: 06/28/2023]
Abstract
Objectives We evaluated the prevalence of 25-hydroxyvitamin D (25-(OH)D) deficiency in our setting according to season, sex, and age. We also studied the association with parathyroid hormone (PTH) levels. Methods The study population comprised all patients with requests for assessment of 25-(OH)D between January 1 and December 31, 2018, as registered in the database of the laboratory information system. Major exclusion criteria were pediatric samples (<18 years) and factors affecting 25-(OH)D and/or PTH levels (i.e., kidney injury, liver disease, PTH disorders). Results Among 33,601 patients (24,028 women, 9,573 men), the prevalence of 25-(OH)D deficiency was 48%. Prevalence was greater in males than in females (53% vs. 46%). By age group, deficiency was more prevalent in quartile 1 (Q1, 74-87 years) and less prevalent in quartile 2 (Q2, 60-73 years). By season, deficiency was greater in spring (nonsignificant differences with respect to winter) and lower in summer. The association between 25-(OH)D and PTH was assessed in 9,368 persons. Linear regression analysis showed a weak association (coefficient - 0.303). Multiple logistic regression analysis revealed a significant association between 25-(OH)D deficiency and increased PTH (Odds ratio (OR), 1.63). Other risk factors for increased PTH include female sex (OR, 1.27), season (winter, OR 1.63, spring OR 1.16), and age (quartile 1, OR, 3). Conclusions The prevalence of 25-(OH)D deficiency differed according to sex, age, and season of the year. Furthermore, elevation of PTH is mainly influenced by low 25-(OH)D, female sex, season, and age.
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Fernández-Araque A, Giaquinta-Aranda A, Moreno-Sainz C, Martínez-Martínez MC, Velasco-González V, Sainz-Gil M, Martín-Arias LH, Carretero-Molinero S, García-Hidalgo M, Verde Z. Haplotypes in the GC, CYP2R1 and CYP24A1 Genes and Biomarkers of Bone Mineral Metabolism in Older Adults. Nutrients 2022; 14:259. [PMID: 35057442 PMCID: PMC8778395 DOI: 10.3390/nu14020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/07/2022] Open
Abstract
Candidate gene studies have analyzed the effect of specific vitamin D pathway genes on vitamin D availability; however, it is not clear whether genetic variants also affect overall bone metabolism. This study evaluated the association between genetic polymorphisms in GC, CYP2R1 and CYP24A1 and serum levels of total 25(OH)D, iPTH and other mineral metabolism biomarkers (albumin, total calcium and phosphorus) in a sample of 273 older Spanish adults. We observed a significant difference between CYP2R1 rs10741657 codominant model and total 25(OH)D levels after adjusting them by gender (p = 0.024). In addition, the two SNPs in the GC gene (rs4588 and rs2282679) were identified significantly associated with iPTH and creatinine serum levels. In the case of phosphorus, we observed an association with GC SNPs in dominant model. We found a relationship between haplotype 2 and 25(OH)D levels, haplotype 4 and iPTH serum levels and haplotype 7 and phosphorus levels. In conclusion, genetic variants in CYP2R1 and GC could be predictive of 25(OH)D and iPTH serum levels, respectively, in older Caucasian adults. The current study confirmed the role of iPTH as one of the most sensitive biomarkers of vitamin D activity in vivo.
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Affiliation(s)
- Ana Fernández-Araque
- Department of Nursery, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain; (A.F.-A.); (A.G.-A.); (S.C.-M.)
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
| | - Andrea Giaquinta-Aranda
- Department of Nursery, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain; (A.F.-A.); (A.G.-A.); (S.C.-M.)
- Department of Hemodialysis, Hospital Santa Bárbara, 42005 Soria, Spain
| | - Carmelo Moreno-Sainz
- Department of Clinic Biochemistry, Hospital Santa Bárbara, 42005 Soria, Spain; (C.M.-S.); (M.C.M.-M.)
| | | | - Verónica Velasco-González
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
- Department of Nursery, University of Valladolid, 47005 Valladolid, Spain
- Centro de Farmacovigilancia de Castilla y León, University of Valladolid, 47005 Valladolid, Spain
| | - María Sainz-Gil
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
- Centro de Farmacovigilancia de Castilla y León, University of Valladolid, 47005 Valladolid, Spain
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), University of Valladolid, 47005 Valladolid, Spain
| | - Luis H. Martín-Arias
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
- Centro de Farmacovigilancia de Castilla y León, University of Valladolid, 47005 Valladolid, Spain
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), University of Valladolid, 47005 Valladolid, Spain
| | - Silvia Carretero-Molinero
- Department of Nursery, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain; (A.F.-A.); (A.G.-A.); (S.C.-M.)
| | | | - Zoraida Verde
- Grupo de Investigación Reconocido “Pharmacogenetics, Cancer Genetics, Genetic, Polymorphisms and Pharmacoepidemiology”, University of Valladolid, 47005 Valladolid, Spain; (V.V.-G.); (M.S.-G.); (L.H.M.-A.)
- Centro de Farmacovigilancia de Castilla y León, University of Valladolid, 47005 Valladolid, Spain
- Departamento de Bioquímica, Biología Molecular y Fisiología, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain
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Zhou T, Shen L, Li Z, Jia J, Xing H, Wang N, Jiao Q, Fan Y. Severe 25-Hydroxyvitamin D Deficiency May Predict Poor Renal Outcomes in Patients With Biopsy-Proven Diabetic Nephropathy. Front Endocrinol (Lausanne) 2022; 13:871571. [PMID: 35600603 PMCID: PMC9114460 DOI: 10.3389/fendo.2022.871571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
AIMS This study aims to investigate the role of 25-hydroxyvitamin D (25(OH)D) levels in predicting renal survival in biopsy-proven diabetic nephropathy (DN) with type 2 diabetes mellitus (DM). METHODS In this retrospective study, a total of 161 biopsy-proven DN patients were enrolled and divided into four groups (normal group: 25(OH)D>20ng/ml; mild group: 10<25(OH)D ≤ 20ng/ml; moderate group: 5<25(OH)D ≤ 10 ng/ml; severe group: 25(OH)D ≤ 5 ng/ml). The effect of the 25(OH)D level on renal survival was evaluated by multivariate Cox regression. RESULTS A total of 161 type 2 DM patients with biopsy-proven DN were enrolled in this study. Patients with lower 25(OH)D levels had higher serum creatinine, urinary albumin creatinine ratio (UACR), total cholesterol, and parathyroid hormone levels as well as lower estimated glomerular filtration rate (eGFR), hemoglobin, albumin, and calcium levels and were more prone to diabetic retinopathy (DR). Rather than proteinuria and renal function, glomerular class and interstitial fibrosis and tubular atrophy (IFTA) had a significant correlation with 25(OH)D levels. Multivariate Cox regression indicated that severe deficiency of 25(OH)D levels was associated with adverse renal outcomes. Compared to the level in the normal group, after adjusting for clinicopathological characteristics, a lower 25(OH)D level remained a risk factor for renal outcomes. The HRs were 3.446 (95% CI 0.366-32.406, p=0.279) for the mild group, 8.009 (95% CI 0.791-81.102, p=0.078) for the moderate group, and 14.957(95%CI 1.364-163.995, P=0.027) for the severe group. CONCLUSION Levels of 25(OH)D less than 5 ng/ml were correlated with worse renal function, more pathological injury and poorer renal prognosis in patients with biopsy-proven DN.
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Affiliation(s)
- Ting Zhou
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- General Practice Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Shen
- Clinical Research Unit, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ze Li
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Junjie Jia
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Haifan Xing
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Niansong Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Ying Fan, ; Qiong Jiao,
| | - Ying Fan
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Ying Fan, ; Qiong Jiao,
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Basińska-Lewandowska M, Lewiński A, Lewandowski KC, Skowrońska-Jóźwiak E. The effects of season (spring versus autumn) on diagnosis of normocalcemic primary hyperparathyroidism. Front Endocrinol (Lausanne) 2022; 13:1013362. [PMID: 36187131 PMCID: PMC9515376 DOI: 10.3389/fendo.2022.1013362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Raised parathormone (PTH) and normal calcium concentrations can be observed both in normocalcemic primary hyperparathyroidism (nPHPT) and in secondary hyperparathyroidism, e.g. due to vitamin D deficiency. We assessed the impact of season on the validity of diagnosis of nPHPT in terms of screening investigations to be performed in the primary care settings. MATERIAL AND METHODS On two occasions (March/April & September/October) we measured vitamin D (25OHD), PTH and total calcium in 125 healthy subjects, age range 6-50, not taking any vitamin D supplements. RESULTS In autumn there was an increase in 25OHD concentrations (from 18.1 ± 7.37ng/ml to 24.58 ± 7.72ng/ml, p<0.0001), a decline in PTH from 44.40 ± 17.76pg/ml to 36.63 ± 14.84pg/ml, p<0.001), without change in calcium levels. Only 45 subjects (36%) were vitamin D sufficient (25OHD>20/ml) in spring versus 83 (66.4%) in autumn, p<0.001. Elevated PTH concentrations were noted in 10 subjects in spring (8%) and in six subjects (4.8%) (p<0.05) in autumn. In spring, however, eight out of ten of these subjects (80%) had 25OHD<20 ng/ml, versus one in six (16.7%) in autumn (p<0.01). Normalization of PTH was observed in seven out ten subjects (70%), and all of them had 25-OHD<20 ng/ml in spring. CONCLUSIONS In spring elevated PTH concentrations in the setting of normocalcemia are more likely to be caused by 25OHD deficiency rather by nPHPT. In contrast, in autumn, increased PTH concentrations are more likely to reflect nPHPT. We postulate that screening for nPHPT should be done in 25OHD replete subjects, i.e. in autumn rather than in spring.
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Affiliation(s)
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital - Research Institute, Lodz, Poland
| | - Krzysztof C. Lewandowski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital - Research Institute, Lodz, Poland
| | - Elżbieta Skowrońska-Jóźwiak
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital - Research Institute, Lodz, Poland
- *Correspondence: Elżbieta Skowrońska-Jóźwiak,
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Hu Y, Li S, Wang J, Zheng D, Zhang H, Yu W, Zhu L, Liu Z, Yang X, Yang L. Threshold for Relationship between Vitamin D and Parathyroid Hormone in Chinese Women of Childbearing Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13060. [PMID: 34948669 PMCID: PMC8702147 DOI: 10.3390/ijerph182413060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022]
Abstract
Background: The aim of this study was to assess the relationship between serum 25-hydroxyvitamin D [25(OH)D] and serum intact parathyroid hormone (PTH) in Chinese childbearing women, and to estimate the optimum threshold of 25(OH)D that maximally inhibits the PTH, which is considered to be the optimal status for vitamin D sufficiency. Methods: Serum samples were selected from the biological samples' bank of the Chinese Chronic Diseases and Nutrition Survey (CCDNS) 2015. The serum 25(OH)D concentration was determined by liquid chromatography tandem mass spectrometry and the serum PTH was determined by electronic chemiluminescence. Simple linear and partial correlation analysis, locally weighted regression smooth scatterplot (LOESS), nonlinear least squares estimation (NLS), and segmented regression (SR) were utilized to estimate the relationship of 25(OH)D and PTH, and to determine the threshold of 25(OH)D. Results: A total of 1568 serum samples of 25(OH)D concentration and PTH concentration were analyzed. A significant inverse relationship between 25(OH)D and PTH concentration was observed below 15.25 (14.22-16.28) ng/mL, and PTH decreased slowly with the increase of 25(OH)D above 16.75 (15.43-18.06) ng/mL after adjusting by age, latitude, city type, season, corrected calcium, and phosphorus. A very short plateau of PTH was found at 15.25 ng/mL and 16.75 ng/mL in terms of 25(OH)D according to LOESS, NLS, and SR. Conclusions: The serum 25(OH)D was negatively correlated with the serum PTH. The threshold of VitD sufficiency was found in the range of 14.22-18.06 ng/mL in terms of serum 25(OH)D concentration for Chinese childbearing women aged 18-44 years old.
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Affiliation(s)
- Yichun Hu
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Siran Li
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Jun Wang
- Physical and Chemical Laboratory, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China; (J.W.); (W.Y.); (L.Z.)
| | - Deqiang Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China;
| | - Huidi Zhang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Wei Yu
- Physical and Chemical Laboratory, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China; (J.W.); (W.Y.); (L.Z.)
| | - Lijia Zhu
- Physical and Chemical Laboratory, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China; (J.W.); (W.Y.); (L.Z.)
| | - Zhen Liu
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Xiaoguang Yang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
| | - Lichen Yang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, China CDC, Beijing 100050, China; (Y.H.); (S.L.); (H.Z.); (Z.L.); (X.Y.)
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27
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Bilezikian JP, Formenti AM, Adler RA, Binkley N, Bouillon R, Lazaretti-Castro M, Marcocci C, Napoli N, Rizzoli R, Giustina A. Vitamin D: Dosing, levels, form, and route of administration: Does one approach fit all? Rev Endocr Metab Disord 2021; 22:1201-1218. [PMID: 34940947 PMCID: PMC8696970 DOI: 10.1007/s11154-021-09693-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 02/07/2023]
Abstract
The 4th International Conference on Controversies in Vitamin D was held as a virtual meeting in September, 2020, gathering together leading international scientific and medical experts in vitamin D. Since vitamin D has a crucial role in skeletal and extra-skeletal systems, the aim of the Conference was to discuss improved management of vitamin D dosing, therapeutic levels and form or route of administration in the general population and in different clinical conditions. A tailored approach, based on the specific mechanisms underlying vitamin D deficiency in different diseases that were discussed, was recommended. Specifically, in comparison to healthy populations, higher levels of vitamin D and greater amounts of vitamin D were deemed necessary in osteoporosis, diabetes mellitus, obesity (particularly after bariatric surgery), and in those treated with glucocorticoids. Emerging and still open issues were related to target vitamin D levels and the role of vitamin D supplementation in COVID-19 since low vitamin D may predispose to SARS-CoV-2 infection and to worse COVID-19 outcomes. Finally, whereas oral daily cholecalciferol appears to be the preferred choice for vitamin D supplementation in the general population, and in most clinical conditions, active vitamin D analogs may be indicated in patients with hypoparathyroidism and severe kidney and liver insufficiency. Parenteral vitamin D administration could be helpful in malabsorption syndromes or in states of vitamin D resistance.Specific guidelines for desired levels of vitamin D should be tailored to the different conditions affecting vitamin D metabolism with the goal to define disease-specific normative values.
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Affiliation(s)
- John P Bilezikian
- Department of Medicine, Endocrinology Division, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milano, Italy
| | - Robert A Adler
- McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of chronic diseases, metabolism and ageing, Leuven, KU, Belgium
| | - Marise Lazaretti-Castro
- Division of Endocrinology, Escola Paulista de Medicina - Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rene Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milano, Italy.
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Hurst EA, Mellanby RJ, Handel I, Griffith DM, Rossi AG, Walsh TS, Shankar-Hari M, Dunning J, Homer NZ, Denham SG, Devine K, Holloway PA, Moore SC, Thwaites RS, Samanta RJ, Summers C, Hardwick HE, Oosthuyzen W, Turtle L, Semple MG, Openshaw PJM, Baillie JK, Russell CD. Vitamin D insufficiency in COVID-19 and influenza A, and critical illness survivors: a cross-sectional study. BMJ Open 2021; 11:e055435. [PMID: 34686560 PMCID: PMC8728359 DOI: 10.1136/bmjopen-2021-055435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The steroid hormone vitamin D has roles in immunomodulation and bone health. Insufficiency is associated with susceptibility to respiratory infections. We report 25-hydroxy vitamin D (25(OH)D) measurements in hospitalised people with COVID-19 and influenza A and in survivors of critical illness to test the hypotheses that vitamin D insufficiency scales with illness severity and persists in survivors. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Plasma was obtained from 295 hospitalised people with COVID-19 (International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)/WHO Clinical Characterization Protocol for Severe Emerging Infections UK study), 93 with influenza A (Mechanisms of Severe Acute Influenza Consortium (MOSAIC) study, during the 2009-2010 H1N1 pandemic) and 139 survivors of non-selected critical illness (prior to the COVID-19 pandemic). Total 25(OH)D was measured by liquid chromatography-tandem mass spectrometry. Free 25(OH)D was measured by ELISA in COVID-19 samples. OUTCOME MEASURES Receipt of invasive mechanical ventilation (IMV) and in-hospital mortality. RESULTS Vitamin D insufficiency (total 25(OH)D 25-50 nmol/L) and deficiency (<25 nmol/L) were prevalent in COVID-19 (29.3% and 44.4%, respectively), influenza A (47.3% and 37.6%) and critical illness survivors (30.2% and 56.8%). In COVID-19 and influenza A, total 25(OH)D measured early in illness was lower in patients who received IMV (19.6 vs 31.9 nmol/L (p<0.0001) and 22.9 vs 31.1 nmol/L (p=0.0009), respectively). In COVID-19, biologically active free 25(OH)D correlated with total 25(OH)D and was lower in patients who received IMV, but was not associated with selected circulating inflammatory mediators. CONCLUSIONS Vitamin D deficiency/insufficiency was present in majority of hospitalised patients with COVID-19 or influenza A and correlated with severity and persisted in critical illness survivors at concentrations expected to disrupt bone metabolism. These findings support early supplementation trials to determine if insufficiency is causal in progression to severe disease, and investigation of longer-term bone health outcomes.
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Affiliation(s)
- Emma A Hurst
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, Edinburgh, UK
| | - Richard J Mellanby
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Ian Handel
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - David M Griffith
- Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Adriano G Rossi
- University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
| | - Timothy S Walsh
- University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Manu Shankar-Hari
- Intensive Care Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, Kings College London, London, UK
| | - Jake Dunning
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Natalie Z Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, Edinburgh, UK
| | - Scott G Denham
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, Edinburgh, UK
| | - Kerri Devine
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, Edinburgh, UK
| | - Paul A Holloway
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Shona C Moore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Romit J Samanta
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Hayley E Hardwick
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Wilna Oosthuyzen
- Division of Genetics and Genomics, Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | | | - J Kenneth Baillie
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
- Division of Genetics and Genomics, Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Clark D Russell
- University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
- Division of Genetics and Genomics, Roslin Institute, University of Edinburgh, Edinburgh, UK
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29
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Kaneshapillai A, Hettiaratchi U, Prathapan S, Liyanage G. Parathyroid hormone in Sri Lankan pregnant women: Vitamin D and other determinants. PLoS One 2021; 16:e0258381. [PMID: 34624060 PMCID: PMC8500411 DOI: 10.1371/journal.pone.0258381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Determinants of parathyroid hormone level during pregnancy have been less frequently studied. We aimed to describe the serum parathyroid hormone (PTH) and its determinants in Sri Lankan pregnant women in a community setting. Materials and methods In this cross-sectional analysis, 390 pregnant mothers in their third trimester were enrolled from primary care centers of 15 health divisions in the Colombo District in Sri Lanka. Venous blood was analyzed for a total 25-hydroxyvitamin-D [25(OH)D], serum parathyroid hormone (PTH), serum calcium, and alkaline phosphatase. The bone quality was assessed in terms of speed of sound (SOS) using the quantitative ultrasound scan (QUS). Univariate and multivariate regression analysis was used to examine the determinants of PTH concentration in blood. Results Median serum 25(OH)D was 17.5ng/mL. Most (61.6%) were vitamin D deficient (<20ng/mL). Median PTH was 23.7pg/mL. Only 0.8% had hyperparathyroidism (PTH >65pg/mL). The correlation between 25(OH)D and PTH was weak but significant (r = -0.197; p<0.001). SOS Z-score was below the cut-off (≤−2) in fifty-six women (14.7%), and SOS did not relate significantly to PTH. In regression analysis, serum 25(OH)D, serum calcium, body mass index, educational level, and weeks of pregnancy were significant independent variables when adjusted. The model explained 16% of the variation in the PTH level. Conclusions A high prevalence of vitamin D deficiency was observed among Sri Lankan pregnant women in the present study. Serum 25(OH)D, calcium, weeks of pregnancy, and educational level were determinants of serum PTH.
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Affiliation(s)
- Anusha Kaneshapillai
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Usha Hettiaratchi
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Shamini Prathapan
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Guwani Liyanage
- Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- * E-mail:
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Coley-Grant D, Jawad M, Ashby HL, Cornes MP, Kumar B, Hallin M, Nightingale PG, Ford C, Gama R. The Relationship Between Intact Parathyroid Hormone and 25-Hydroxyvitamin D in United Kingdom Resident South Asians and Whites: A Comparative, Cross-Sectional Observational Study. Horm Metab Res 2021; 53:672-675. [PMID: 34233374 DOI: 10.1055/a-1521-5026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ethnic differences in intact parathyroid hormone (iPTH) at similar total 25 hydroxyvitamin D [25(OH)D] concentrations have been reported between US resident Whites, Blacks, and Hispanics, but this has not been studied between South Asians and Whites. We, therefore, compared the iPTH relationship to 25(OH)D in UK resident South Asians and Whites. A comparative, cross-sectional observational study in which demographic and laboratory data on South Asian and White residents of Wolverhampton, UK were analyzed. Log-log models measured the association between 25(OH)D and the interaction term of ethnicity and iPTH. Seven hundred and seventy-two patients consisting of 315 white subjects (208 women) and 457 South Asian subjects (331 women) were studied. Compared to South Asians, White subjects were older, had higher serum concentrations of 25(OH)D, creatinine (lower eGFR), adjusted calcium and magnesium, but similar concentrations of iPTH and phosphate. In an adjusted model, variables significantly associated with 25(OH)D included age, creatinine, adjusted calcium and ethnicity; but not iPTH and the interaction term of ethnicity and iPTH (beta coefficient -0.071, 95% CI -0.209, 0.067, p=0.32). In our study cohort, iPTH was not, per se, influenced by 25 (OH)D. We found no ethnic differences in the association between iPTH and 25(OH)D between South Asians and White UK residents.
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Affiliation(s)
- Deon Coley-Grant
- Blood Sciences, Black Country Pathology Services, New Cross Hospital, Wolverhampton, United Kingdom
| | - Mohammed Jawad
- Blood Sciences, Black Country Pathology Services, New Cross Hospital, Wolverhampton, United Kingdom
| | - Helen L Ashby
- Blood Sciences, Black Country Pathology Services, New Cross Hospital, Wolverhampton, United Kingdom
| | - Michael P Cornes
- Blood Sciences, Black Country Pathology Services, New Cross Hospital, Wolverhampton, United Kingdom
| | - Bharan Kumar
- Blood Sciences, Black Country Pathology Services, New Cross Hospital, Wolverhampton, United Kingdom
| | - Magnus Hallin
- Blood Sciences, Black Country Pathology Services, New Cross Hospital, Wolverhampton, United Kingdom
| | - Peter G Nightingale
- Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Clare Ford
- Blood Sciences, Black Country Pathology Services, New Cross Hospital, Wolverhampton, United Kingdom
| | - Rousseau Gama
- Blood Sciences, Black Country Pathology Services, New Cross Hospital, Wolverhampton, United Kingdom
- School of Medicine and Clinical Practice, Wolverhampton University, Wolverhampton, United Kingdom
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Basińska-Lewandowska M, Lewiński A, Horzelski W, Skowrońska-Jóźwiak E. Effect of Summer Sunshine Exposure on Vitamin D Status in Young and Middle Age Poles: Is 30 ng/mL Vitamin D Cut-Off Really Suitable for the Polish Population? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158116. [PMID: 34360409 PMCID: PMC8345518 DOI: 10.3390/ijerph18158116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Background: There is no consensus regarding vitamin sufficiency status with either 20 ng/mL or 30 ng/mL sufficiency cut-off. We assessed the effects of summer sunshine exposure on vitamin D status. Participants: We measured vitamin D concentrations, PTH, creatinine, and total calcium in 132 healthy subjects, age 29.36 ± 13.57 years, in spring and autumn. Results: There was an overall increase in vitamin D concentrations from spring to autumn from 18.1 ± 7.39 ng/mL to 24.58 ± 7.72 ng/mL, (p < 0.001), accompanied by a decrease in PTH from 44.4 ± 17.76 pg/mL to 36.6 ± 14.84 pg/mL, (p < 0.001). In spring, only 5.3% of individuals were vitamin D sufficient for a 30 ng/mL cut-off, increasing to 23.2% in autumn (p < 0.001). In contrast, when a 20 ng/mL cut-off was employed, vitamin D sufficiency was found in 34.1% in spring and 66.4% individuals in autumn, respectively, (p < 0.001). In multiple regression analysis, holiday leave was the only significant determinant of vitamin D increase (p < 0.001). Conclusions: Holiday leave is the strongest determinant of an increase in vitamin D. The majority of healthy individuals fail to reach a 30 ng/mL vitamin D cut-off after summer sunshine exposure. This raises the question, whether such a cut-off is indeed suitable for the Polish population.
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Affiliation(s)
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland;
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 90-419 Lodz, Poland
| | - Wojciech Horzelski
- Department of Mathematics and Computer Science, University of Lodz, 90-238 Lodz, Poland;
| | - Elżbieta Skowrońska-Jóźwiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland;
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence: ; Tel.: +48-42-271-1141; Fax: +48-42-271-1140
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32
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Wang P, Xu Q, Cao RR, Deng FY, Lei SF. Global Public Interests and Dynamic Trends in Osteoporosis From 2004 to 2019: Infodemiology Study. J Med Internet Res 2021; 23:e25422. [PMID: 36260400 PMCID: PMC8406103 DOI: 10.2196/25422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/22/2020] [Accepted: 04/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background With the prolonging of human life expectancy and subsequent population aging, osteoporosis (OP) has become an important public health issue. Objective This study aimed to understand the global public search interests and dynamic trends in “osteoporosis” using the data derived from Google Trends. Methods An online search was performed using the term “osteoporosis” in Google Trends from January 1, 2004, to December 31, 2019, under the category “Health.” Cosinor analysis was used to test the seasonality of relative search volume (RSV) for “osteoporosis.” An analysis was conducted to investigate the public search topic rising in RSV for “osteoporosis.” Results There was a descending trend of global RSV for “osteoporosis” from January 2004 to December 2014, and a slowly increasing trend from January 2015 to December 2019. Cosinor analysis showed significant seasonal variations in global RSV for “osteoporosis” (P=.01), with a peak in March and a trough in September. In addition, similar decreasing trends of RSV for “osteoporosis” were found in Australia, New Zealand, Ireland, and Canada from January 2004 to December 2019. Cosinor test revealed significant seasonal variations in RSV for “osteoporosis” in Australia, New Zealand, Canada, Ireland, UK, and USA (all P<.001). Furthermore, public search rising topics related to “osteoporosis” included denosumab, fracture risk assessment tool, bone density, osteopenia, osteoarthritis, and risk factor. Conclusions Our study provided evidence about the public search interest and dynamic trends in OP using web-based data, which would be helpful for public health and policy making.
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Affiliation(s)
- Peng Wang
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Medical College, Soochow University, Suzhou, China
| | - Qing Xu
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Medical College, Soochow University, Suzhou, China
| | - Rong-Rong Cao
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Medical College, Soochow University, Suzhou, China
| | - Fei-Yan Deng
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Medical College, Soochow University, Suzhou, China
| | - Shu-Feng Lei
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Medical College, Soochow University, Suzhou, China
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Odhaib SA, Alibrahim NT, Zaboon IA, Mansour AA. Vitamin D Metabolic Profiles in Premenopausal Women Wearing Niqab and Hijab in Sunny Basrah. Cureus 2021; 13:e14909. [PMID: 34113519 PMCID: PMC8184100 DOI: 10.7759/cureus.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 11/05/2022] Open
Abstract
Background Conservative clothing like niqab and hijab may affect the wearer's vitamin D metabolic parameters even in predominantly sunny areas of the world (i.e., areas with adequate sunlight exposure throughout the year). Our objective was to evaluate the effect of wearing the niqab or hijab on different vitamin D3 metabolic parameters in a sample of premenopausal women from Basrah. Methodology This was a cross-sectional observational study on premenopausal women who wore a niqab (n = 64), with a comparable age-matched group of women who wore the hijab (n = 60). Biochemical evaluation of the vitamin D3 metabolic profile involved 25-hydroxycholecalciferol (25-OH)-vitamin D, corrected serum calcium, parathyroid hormone (PTH), phosphorus, and alkaline phosphatase estimation. Statistical comparison of these parameters was made using the independent sample t-test and Mann-Whitney-U test. Results The two groups of women were age- and weight-matched, with a median age of 39 and median body mass index (BMI) of 31.8 kg/m2. Overall, age, marital status, and BMI of women in both groups had no significant relationship with the vitamin D3 metabolic parameters (low 25-OH-vitamin D, low corrected calcium, and high PTH). The subgroup analysis for women wearing the niqab showed the same results. Conclusions Wearing niqab or hijab in premenopausal women was not associated with any significant statistical relationship or difference in vitamin D3 metabolic parameters. Conservative dress styles like niqab and hijab are practical barriers to sun exposure and contribute to suboptimal vitamin D levels, affecting subsequent metabolic pathways. Healthcare professionals should advise women who wear niqab or hijab to increase their vitamin D3 levels through culturally appropriate alternative mechanisms.
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Affiliation(s)
- Samih A Odhaib
- Adult Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) College of Medicine, University of Basrah, Basrah, IRQ
| | - Nassar T Alibrahim
- Adult Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) College of Medicine, University of Basrah, Basrah, IRQ
| | - Ibraheem A Zaboon
- Adult Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) College of Medicine, University of Basrah, Basrah, IRQ
| | - Abbas A Mansour
- Adult Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) College of Medicine, University of Basrah, Basrah, IRQ
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Smith LM, Gallagher JC. Reference range for 24-h urine calcium, calcium/creatinine ratio, and correlations with calcium absorption and serum vitamin D metabolites in normal women. Osteoporos Int 2021; 32:539-547. [PMID: 32886188 PMCID: PMC8451703 DOI: 10.1007/s00198-020-05615-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
UNLABELLED A study of 959 black and white women shows that the normal range for 24-h urine calcium excretion in white women is 30-300 mg and 10-285 mg in black women. Clinical laboratories use a normal range for 24-h urine calcium excretion of 100-300 mg; there is a need for them to update their age- and race-specific ranges. INTRODUCTION Recommendations for a normal range for 24-h urine calcium vary from a low of 50 mg to a high of 400 mg; most "laboratory normal ranges" based on older literature are incorrect. The objective of this analysis is to define a normal range for young women age 25-45 years and older women age 55-90 years, white and black, for 24-h urine calcium and calcium/creatinine ratio, and to examine the relationship between 24-h urine calcium, calcium absorption, and vitamin D metabolites. METHODS Data from 3 studies was collected on 959 normal black and white women, ages 25-87 years, for 24-h urine calcium, creatinine, calcium intake, serum 25-hydroxyvitamin D (25OHD),1,25 dihydroxyvitamin D (1,25(OH)2D), and calcium absorption. Urine calcium and creatinine were measured on an auto-analyzer. Calcium absorption was measured by a single isotope method. Serum 25OHD and 1,25(OH)2D were measured by competitive protein binding assay or radioimmunoassay. Because 24-h urine calcium did not fit a normal distribution, non-parametric methods were used to determine the 95% reference interval (RI) and 90% non-parametric confidence intervals (CI) calculated for groups. RESULTS The 95% reference intervals for 24-h urine calcium for women were as follows: black older 7-225 mg, black younger 8-285 mg; white older 37-275 mg, and white younger 23-287 mg. In older white women, 24-h urine calcium was significantly correlated with serum 1,25(OH)2 D, r = 0.23, p < 0.001, calcium intake r = 0.12, p = 0.001, and calcium absorption r = 0.18, p = 0.003, but not serum 25OHD r = 0.07, p = 0.06. CONCLUSIONS The normal reference interval for 24-h urine calcium for black women is lower than white women. Twenty-four-hour urine calcium was correlated with serum 1,25(OH)2 D calcium intake and calcium absorption, but not serum 25OHD. This range will be useful clinically for defining hypercalciuria and for following patients on vitamin D and calcium treatment.
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Affiliation(s)
- L M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA.
| | - J C Gallagher
- Bone Metabolism Unit, Creighton University School of Medicine, Omaha, NE, USA
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Dalamaga M, Muscogiuri G, Paganitsa G, Parvouleskou G, Syriou V, Karagkoynis P, Stratigou T, Vallianou N, Christodoulatos GS, Karampela I, Daskalopoulou K. Adherence to the Mediterranean diet is an independent predictor of circulating vitamin D levels in normal weight and non-smoker adults: an observational cross-sectional study. Int J Food Sci Nutr 2021; 72:848-860. [PMID: 33509003 DOI: 10.1080/09637486.2021.1878488] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We explored the association between circulating 25OHD and adherence to the Mediterranean Diet (MedDiet) in 402 Greek (21-65 years, 188 men and 214 women), normal weight, non-smoker, healthy volunteers in the Athens metropolitan area during summer and autumn, taking into account skin phototype, anthropometric, and lifestyle variables. Circulating 25OHD, parathormone, creatinine, calcium, and phosphate were determined. A vitamin D status of ≤25, ≤50, and ≤75 nmol/L was observed in 4.5, 37.3, and 74.1% of the subjects, respectively. The independent predictors of 25OHD deficiency were autumn, darker skin phototype, BMI, or waist circumference (WC), sunscreen use, less physical outdoor activity, and less adherence to the MedDiet. Higher intake of fish and olive oil was a positive independent predictor of elevated circulating 25OHD levels. In conclusion, higher adherence to the MedDiet, fish and olive oil consumption, were positively associated with circulating 25OHD independently from BMI or WC, skin phototype, season, and physical activity.
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Affiliation(s)
- Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Naples, Italy
| | - Georgia Paganitsa
- Laboratory of Biochemistry and Microbiology, 'ELPIS' General Hospital, Athens, Greece
| | - Georgeta Parvouleskou
- Laboratory of Biochemistry and Microbiology, 'ELPIS' General Hospital, Athens, Greece
| | - Vassiliki Syriou
- Laboratory of Biochemistry and Microbiology, 'ELPIS' General Hospital, Athens, Greece
| | | | - Theodora Stratigou
- Department of Endocrinology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Natalia Vallianou
- Department of Endocrinology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | | | - Irene Karampela
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Fan P, Wang Q, Li J, Lu C, Xu Y, Cao H, Xie X, Wu X, Guo Y, Liu T, Chen Y, Xu S, Huang Y, Zhang Q, Chen D. Poor Status of Vitamin D: A Survey of Area With Lowest Sunlight Radiation in Sichuan, China. Front Endocrinol (Lausanne) 2021; 12:626983. [PMID: 33732216 PMCID: PMC7959743 DOI: 10.3389/fendo.2021.626983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/12/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Vitamin D plays an important role in bone and mineral metabolism. Ultraviolet B (UVB) is the primary determinant for vitamin D synthesis. However, population-based data of vitamin D status was sparse in areas with sunlight deprivation in China. This study aimed to assess serum 25-hydroxyvitamin D [25(OH)D] levels among adult women in Sichuan basin with the lowest sunlight radiation in China, and the associations with sunlight exposure and age. METHODS In the context of the same ethnicity, similar latitude and lifestyle in sunlight-limited basin and sunlight-abundant plateau, 1,057 women in basin and 337 in plateau aged 29-95 years were included in this study, from November 2012 to February 2013. Daily sunlight exposure duration of previous month was obtained using questionnaires. Serum 25(OH)D was measured by enzyme-linked immunosorbent assay. RESULTS The prevalence of vitamin D severe deficiency [25(OH)D <30 nmol/L] and deficiency [30 ≤ 25(OH)D <50 nmol/L] was significantly higher in basin than plateau (21.85% vs. 10.09%, and 59.32% vs. 40.36%; P<0.0001). Women from basin exhibited lower serum 25(OH)D levels than those from plateau (40.66 ± 15.62 vs. 52.54 ± 19.94 nmol/L, P<0.0001). In basin, women more than 50 years old had higher 25(OH)D than younger counterparts, and 25(OH)D level of these groups was not associated with sunlight exposure duration. While in plateau, women younger than 60 years old had higher 25(OH)D than the older women. Furthermore, for those younger groups, women with long sunlight exposure (≥3 h daily) had higher 25(OH)D concentration than those with short sunlight exposure (<3 h daily). Serum PTH was negatively associated with 25(OH)D in basin, but not in plateau. CONCLUSIONS Alarmingly high prevalence of vitamin D deficiency was observed in women in sunlight-deprived basin in Sichuan. Only the vitamin D status of younger women from plateau with adequate solar radiation could benefit from sunlight exposure. Vitamin D supplementation and vitamin D-fortified food should be encouraged to improve vitamin D status for women living in sunlight-limited areas, or with old age.
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Affiliation(s)
- Pianpian Fan
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Qin Wang
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Li
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Chunyan Lu
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Yong Xu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongyi Cao
- Department of Endocrinology, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Xiaohua Xie
- Department of Endocrinology, First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang, China
| | - Xueyan Wu
- Department of Endocrinology, Guangyuan Central Hospital, Guangyuan, China
| | - Yanhong Guo
- Department of Endocrinology, Hospital of Chengdu Office of People’s Government of Tibetan autonomous Region, Chengdu, China
| | - Ting Liu
- Department of Endocrinology, Liangxiang Hospital, Beijing, China
| | - Yan Chen
- Department of Endocrinology, The First People’s Hospital of Neijiang, Neijiang, China
| | - Shen Xu
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuanyuan Huang
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Qi Zhang
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Decai Chen
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Decai Chen,
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Niculescu DA, Deacu LG, Caragheorgheopol A, Popescu N, Ghemigian A, Procopiuc C, Rosca R, Poiana C. Combined Effects of Vitamin D Status, Renal Function and Age on Serum Parathyroid Hormone Levels. Front Endocrinol (Lausanne) 2021; 12:657991. [PMID: 33995282 PMCID: PMC8120293 DOI: 10.3389/fendo.2021.657991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vitamin D status and renal function are well-known independent predictors of serum parathyroid hormone (PTH) levels. We aimed to describe the combined effects of 25-hydroxy vitamin D (25(OH)D), glomerular filtration rate (GFR) and age on serum PTH levels across the whole clinical spectrum. METHODS We retrieved from our endocrinology center database all PTH measurement between 2012 and 2020 for which a simultaneous measurement of serum 25(OH)D, calcium and creatinine was available. Age, sex and diagnosis were available for all subjects. Intact PTH was measured using the same electrochemiluminescence assay. RESULTS There were 6,444 adults and 701 children without a diagnosis of hyper- or hypoparathyroidism or abnormal serum calcium levels. In adults with 25(OH)D≥12 ng/mL multiple regression models showed that serum PTH was negatively correlated with both 25(OH)D and GFR. Regression (-0.68 and -1.59 vs. -0.45 and -0.22 respectively), partial correlation (-0.16 and -0.35 vs. -0.12 and -0.10 respectively) and determination coefficients (0.14 vs. 0.031) were higher in CKD than in normal renal function. In subjects with 25(OH)D<12 ng/mL, GFR was the only significant predictor in those with CKD (β-coefficient=-2.5, r=-0.55) and 25(OH)D was the only significant predictor in those with normal renal function (β-coefficient=-2.05, r=-0.11). Increasing age was associated with higher PTH levels only in those with normal renal function and 25(OH)D≥12 ng/mL. CONCLUSIONS We showed that declining vitamin D and renal function have additive effects on serum PTH in subjects without vitamin D deficiency. In vitamin D deficient subjects this dependency is stronger but is not additive anymore.
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Affiliation(s)
- Dan Alexandru Niculescu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Pituitary and Neuroendocrine Disorders, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania
- *Correspondence: Dan Alexandru Niculescu,
| | - Laura Georgiana Deacu
- Department of Pituitary and Neuroendocrine Disorders, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Andra Caragheorgheopol
- Research Laboratory, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Nicoleta Popescu
- Biochemistry Department, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Adina Ghemigian
- Department of Gonadal Disorders, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Camelia Procopiuc
- Department of Pediatric Endocrinology, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Roxana Rosca
- Department of Adrenal and Bone Disorders, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Catalina Poiana
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Pituitary and Neuroendocrine Disorders, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania
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Total vs. Bioavailable: Determining a Better 25(OH)D Index in Association with Bone Density and Muscle Mass in Postmenopausal Women. Metabolites 2020; 11:metabo11010023. [PMID: 33396337 PMCID: PMC7824471 DOI: 10.3390/metabo11010023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022] Open
Abstract
The concurrent presence of low bone density (osteopenia/osteoporosis) and low muscle mass (sarcopenia) in older adults has led to the recognition of “osteosarcopenia” (OS) as a singular entity. Vitamin D may play important role in the manifestation of OS, in terms of intake, absorption, and bioavailability. Evidence suggests that bioavailable 25(OH)D may be a better indicator of Vitamin D compared to total 25(OH)D due to its weak bind to albumin, increasing its ‘availability’. The aim of this study was to assess total and bioavailable 25(OH)D levels in postmenopausal women and to determine their associations to bone density and muscle mass. We assessed body composition, bone density, and 25(OH)D indices of multiethnic, postmenopausal Malaysian women. A significant and negative correlation was found between body fat % and each index of 25(OH)D. Both bioavailable and total 25(OH)D were positively correlated with serum calcium and negatively correlated with iPTH(intact parathyroid hormone). VDBP(Vitamin D binding protein) level was significantly correlated with bioavailable 25(OH)D level, but not with the total 25(OH)D level. Stepwise regression analysis revealed that bioavailable, but not total, 25(OH)D was significantly correlated to bone density and muscle mass, (where stronger correlation was found with bone density), suggesting its superiority. Nevertheless, the low effect size warrants further studies.
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Abstract
Vitamin D is essential for bone health and is known to be involved in immunomodulation and cell proliferation. Vitamin D status remains a significant health issue worldwide. However, there has been no clear consensus on vitamin D deficiency and its measurement in serum, and clinical practice of vitamin D deficiency treatment remains inconsistent. The major circulating metabolite of vitamin D, 25-hydroxyvitamin D (25(OH)D), is widely used as a biomarker of vitamin D status. Other metabolic pathways are recognised as important to vitamin D function and measurement of other metabolites may become important in the future. The utility of free 25(OH)D rather than total 25(OH)D needs further assessment. Data used to estimate the vitamin D intake required to achieve a serum 25(OH)D concentration were drawn from individual studies which reported dose-response data. The studies differ in their choice of subjects, dose of vitamin D, frequency of dosing regimen and methods used for the measurement of 25(OH)D concentration. Baseline 25(OH)D, body mass index, ethnicity, type of vitamin D (D2 or D3) and genetics affect the response of serum 25(OH)D to vitamin D supplementation. The diversity of opinions that exist on this topic are reflected in the guidelines. Government and scientific societies have published their recommendations for vitamin D intake which vary from 400-1000 IU/d (10-25 μg/d) for an average adult. It was not possible to establish a range of serum 25(OH)D concentrations associated with selected non-musculoskeletal health outcomes. To recommend treatment targets, future studies need to be on infants, children, pregnant and lactating women.
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Ribbans WJ, Aujla R, Dalton S, Nunley JA. Vitamin D and the athlete-patient: state of the art. J ISAKOS 2020; 6:46-60. [PMID: 33833045 DOI: 10.1136/jisakos-2020-000435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022]
Abstract
Vitamin D deficiency is common in athletes. The conventional measurement of vitamin D levels provides a general indicator of body stores. However, there are nuances in its interpretation as values of 25(OH)D do not correlate absolutely with the amount of 'bioavailable' vitamin to the cells. Vitamin D should be regarded as a hormone and influences between 5% and 10% of our total genome. Determining the precise effect of the vitamin, isolated from the actions of other cofactors, is not straightforward and restricts our complete understanding of all of its actions. Deficiency has harmful effects on not only bone and muscle but also wider areas, including immunity and respiratory and neurological activities. More caution should be applied regarding the ability of supranormal vitamin D levels to elevate athletic performance. Hopefully, future research will shed more light on optimal levels of vitamin D and supplementation regimes, and improved understanding of its intracellular control of our genetic mechanisms and how extrinsic influences modify its activity.
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Affiliation(s)
- William J Ribbans
- Faculty of Health, Education and Society, University of Northampton, Northampton, Northamptonshire, UK
| | - Randeep Aujla
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Seamus Dalton
- North Sydney Sports Medicine, Sydney, New South Wales, Australia
| | - James A Nunley
- Duke Orthopedics, Duke University, Durham, North Carolina, USA
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Mäkitaipale J, Sankari S, Sievänen H, Laitinen-Vapaavuori O. The relationship between serum 25-hydroxyvitamin D and parathyroid hormone concentration in assessing vitamin D deficiency in pet rabbits. BMC Vet Res 2020; 16:403. [PMID: 33109180 DOI: 10.1186/s12917-020-02599-7] [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] [Received: 04/28/2020] [Accepted: 09/30/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vitamin D deficiency and related metabolic bone diseases in pet rabbits have been intermittently debated. In human research, the parathyroid hormone concentration in relation to the 25-hydroxyvitamin D concentration is used to determine vitamin D deficiency. Thus, this study aimed to identify the breakpoint in the 25-hydroxyvitamin D concentration indicating a significant change in the parathyroid hormone concentration in 139 pet rabbits. An enzyme immunoassay kit was used for 25-hydroxyvitamin D analysis and the intact parathyroid hormone (PTH 1-84) immunoradiometric assay kit for parathyroid hormone analysis. The mid-tibial cortical bone density was measured using peripheral quantitative computed tomography. A segmented linear regression analysis was performed, with the 25-hydroxyvitamin D concentration as the independent variable, and parathyroid hormone, ionised calcium, total calcium, inorganic phosphorus concentrations and the mid-tibial cortical density as the dependent variables. RESULTS The breakpoint for the parathyroid hormone concentration occurred at a 25(OH)D concentration of 17 ng/mL, whereas the cortical bone density breakpoint occurred at a 25-hydroxyvitamin D concentration of 19 ng/mL. No breakpoints were found for ionised calcium, total calcium or phosphorus. CONCLUSIONS These results suggest that a serum 25-hydroxyvitamin D concentration of 17 ng/mL serves as the threshold for vitamin D deficiency in rabbits. Nearly one-third of the rabbits had a serum 25-hydroxyvitamin D concentration below this threshold. Concerns persist regarding the high prevalence of vitamin D deficiency in pet rabbits and the possible health consequences caused by a chronic vitamin D deficiency, including the risk for metabolic bone diseases.
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Affiliation(s)
- J Mäkitaipale
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland.
| | - S Sankari
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland
| | - H Sievänen
- The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - O Laitinen-Vapaavuori
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland
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Luiz MM, Máximo R, Oliveira DC, Ramírez PC, de Souza AF, Delinocente MLB, Steptoe A, de Oliveira C, Alexandre T. Association of Serum 25-Hydroxyvitamin D Deficiency with Risk of Incidence of Disability in Basic Activities of Daily Living in Adults >50 Years of Age. J Nutr 2020; 150:2977-2984. [PMID: 32937653 PMCID: PMC7675030 DOI: 10.1093/jn/nxaa258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Vitamin D deficiency compromises muscle function and is related to the etiology of several clinical conditions that can contribute to the development of disability. However, there are few epidemiological studies investigating the association between vitamin D deficiency and the incidence of disability. OBJECTIVES We aimed to assess whether vitamin D deficiency is associated with the incidence of disability in basic activities of daily living (BADL) and to verify whether there are sex differences in this association. METHODS A 4-y follow-up study was conducted involving individuals aged 50 y or older who participated in ELSA (English Longitudinal Study of Ageing). The sample consisted of 4814 participants free of disability at baseline according to the modified Katz Index. Vitamin D was assessed by serum 25-hydroxyvitamin D [25(OH)D] concentrations and the participants were classified as sufficient (>50 nmol/L), insufficient (>30 to ≤50 nmol/L), or deficient (≤30 nmol/L). Sociodemographic, behavioral, and clinical characteristics were also investigated. BADL were re-evaluated after 2 and 4 y of follow-up. The report of any difficulty to perform ≥1 BADL was considered as an incident case of disability. Poisson models stratified by sex and controlled for sociodemographic, behavioral, and clinical characteristics were carried out. RESULTS After 4-y follow-up, deficient serum 25(OH)D was a risk factor for the incidence of BADL disability in both women (IRR: 1.53; 95% CI: 1.16, 2.03) and men (IRR: 1.44; 95% CI: 1.02, 2.02). However, insufficient serum 25(OH)D was not a risk factor for the incidence of BADL disability in either men or women. CONCLUSIONS Independently of sex, deficient serum 25(OH)D concentrations were associated with increased risk of incidence of BADL disability in adults >50 y old and should be an additional target of clinical strategies to prevent disability in these populations.
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Affiliation(s)
- Mariane M Luiz
- Postgraduate Program in Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Roberta Máximo
- Postgraduate Program in Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Dayane C Oliveira
- Postgraduate Program in Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Paula C Ramírez
- Postgraduate Program in Physical Therapy, Federal University of São Carlos, São Carlos, Brazil,School of Physical Therapy, Santander Industrial University, Bucaramanga, Colombia
| | - Aline F de Souza
- Postgraduate Program in Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Maicon L B Delinocente
- Postgraduate Program in Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Hao L, Carson JL, Schlussel Y, Noveck H, Shapses SA. Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: a prospective study. Am J Clin Nutr 2020; 112:613-618. [PMID: 32073599 PMCID: PMC7458775 DOI: 10.1093/ajcn/nqaa029] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. OBJECTIVE This study aims to determine whether 25-hydroxyvitamin D [25(OH)D] concentration or the Geriatric Nutritional Risk Index (GNRI) is associated with mortality or rates of walking in a patient cohort after hip fracture surgery. METHODS Patients undergoing hip fracture repair from a multisite study in North America were included. Mortality and mobility were assessed at 30 and 60 d after surgery. Serum albumin, 25(OH)D, and intact parathyroid hormone were measured. Patients were characterized according to 25(OH)D <12 ng/mL, 12 to <20 ng/mL, 20 to <30 ng/mL, or ≥30 ng/mL. GNRI was categorized into major/moderate nutritional risk (<92), some risk (92 to <98), or in good nutritional status (≥98). RESULTS Of the 290 patients [aged 82 ± 7 y, BMI (kg/m2): 25 ± 5], 73% were women. Compared with patients with <12 ng/mL, those with higher 25(OH)D concentrations had higher rates of walking at 30 d (P = 0.031): 12 to <20 ng/mL (adjusted OR: 2.61; 95% CI: 1.13, 5.99); 20 to <30 ng/mL (3.48; 1.53, 7.95); ≥30 ng/mL (2.84; 1.12, 7.20). In addition, there was also greater mobility at 60 d (P = 0.028) in patients with higher 25(OH)D compared with the reference group (<12 ng/mL). Poor nutritional status (GNRI <92) showed an overall trend to reduce mobility (unadjusted P = 0.044 and adjusted P = 0.056) at 30 but not at 60 d. There was no association of vitamin D or GNRI with mortality at either time. CONCLUSIONS Vitamin D deficiency (<12 ng/mL) is associated with reduced ambulation after hip fracture surgery, whereas GNRI also contributes to immobility but is a less reliable predictor. Mechanisms that can explain why vitamin D deficiency is associated with mobility should be addressed in future studies.
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Affiliation(s)
- Lihong Hao
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ USA
- Rutgers Center for Lipid Research and the Center for NEx-Metabolism at the Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ, USA
| | - Jeffrey L Carson
- Department of Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Yvette Schlussel
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ USA
| | - Helaine Noveck
- Department of Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ USA
- Rutgers Center for Lipid Research and the Center for NEx-Metabolism at the Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ, USA
- Department of Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Aul AJ, Dudenkov DV, Mara KC, Juhn YJ, Wi CI, Maxson JA, Thacher TD. The relationship of 25-hydroxyvitamin D values and risk of fracture: a population-based retrospective cohort study. Osteoporos Int 2020; 31:1787-1799. [PMID: 32377805 PMCID: PMC7725389 DOI: 10.1007/s00198-020-05436-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
UNLABELLED Our study investigates 25-hydroxyvitamin D levels and fracture risk using population-level data. 25-Hydroxyvitamin D values < 12, 12-19, and > 50 ng/mL were not associated with increased risk of fractures overall compared with values 20-50 ng/mL. Severely low levels may be associated with increased risk of osteoporotic fracture, particularly of the wrist. INTRODUCTION Studies of the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and fracture risk have been inconsistent. We hypothesized that high 25(OH)D concentrations (> 50 ng/mL) would be associated with increased risk of fracture. METHODS We identified all adult patients living in Olmsted County, Minnesota, between January 1, 2005 and December 31, 2011, who had at least one 25(OH)D measurement. Fracture outcomes were retrieved starting 30 days after 25(OH)D measurement and until patients' final clinical visit as an Olmsted County resident, December 31, 2014, or death. Data were analyzed using Cox proportional hazard regression. RESULTS Of 11,002 individuals with a 25(OH)D measurement, 5.8% had a 25(OH)D value ˂ 12 ng/mL, and 5.1% had a value > 50 ng/mL. Compared with subjects with 25(OH)D values 20-50 ng/mL (reference group), values < 12, 12-19, and > 50 ng/mL displayed no association with overall fracture risk. After adjusting for a prior diagnosis of osteoporosis/osteopenia, only individuals with values ˂ 12 ng/mL had increased risk of any osteoporotic fracture (aHR = 1.41; 95% CI 1.05-1.89) and wrist fracture (aHR = 2.11; 95% CI 1.27-3.48) compared with the reference group. Compared with the reference group, values ˂ 12 ng/mL were associated with increased risk of any fracture (aHR = 1.35; 95% CI 1.01-1.80), osteoporotic fracture (aHR = 2.18; 95% CI 1.44-3.31), and wrist fracture (aHR = 2.39; 95% CI 1.19-4.81) in subjects without a prior diagnosis of osteoporosis/osteopenia, but not in those with a prior diagnosis of osteoporosis/osteopenia. CONCLUSION Severely low 25(OH)D levels may be associated with increased risk of osteoporotic fracture, particularly of the wrist, but 25(OH)D values > 50 ng/mL were not associated with increased fracture risk.
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Affiliation(s)
- A J Aul
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D V Dudenkov
- Department of Internal Medicine, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - K C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Y J Juhn
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - C I Wi
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - J A Maxson
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - T D Thacher
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Malik MZ, Latiwesh OB, Nouh F, Hussain A, Kumar S, Kaler J. Response of Parathyroid Hormone to Vitamin D Deficiency in Otherwise Healthy Individuals. Cureus 2020; 12:e9764. [PMID: 32821633 PMCID: PMC7430694 DOI: 10.7759/cureus.9764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objectives Vitamin D deficiency is a global public health issue, which affects people of all ages and ethnicities. However, severe deficiency seems to be more prevalent in the Middle East and South Asia. Evidence suggests that low serum 25-hydroxycholicalciferol [25(OH)D] levels are associated with an increase in parathyroid hormone (PTH). Yet, the 25-OHD levels leading to serum PTH increase are still a matter of debate. The objective of this study is to assess deficiency of vitamin D in otherwise healthy individuals, and to determine the response of the PTH to vitamin D deficiency. Methods This observational study was conducted from January 2018 to May 2018. A total of 43 individuals were selected from three separate clinics in Libya (Alrazy clinic, Alhaya clinic, and Alnukbah clinic). Blood drawn from these individuals was assessed for serum calcium, phosphorus, 25(OH)D, and PTH. These data were collected and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for Windows (SPSS Inc., Chicago, IL). Results The mean age and standard (SD) of the study participants was 47.4 ± 12.4. The age range was 19-67 years. The ratio of male to female was 1:2. The percentage of individuals with vitamin D deficiency in the study group was 95.3%, whereas the percentage of vitamin D insufficiency was 4.7%. These data suggest that individuals with severe deficiency show higher PTH values (75.66 ng/ml), whereas those with insufficiency showed lower PTH values (37.5 ng/ml). Conclusion The population in the present study was overall deficient in 25-OH vitamin D, which indicates a greater need for supplementation with vitamin D. However, not all the individuals with vitamin D deficiency have high levels of PTH, a finding that agrees with the need for new criteria in the management of vitamin D deficiency and the importance of PTH testing.
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Affiliation(s)
- Mayra Z Malik
- Internal Medicine, Combined Military Hospital Lahore Medical College and Institute of Dentistry, New York, USA
| | - Omar B Latiwesh
- Pathology, Higher Institute of Medical Professions, Benghazi, LBY.,Biochemistry, Higher Institute of Medical Professions, Benghazi, LBY
| | - Fatimah Nouh
- Biochemistry, Faculty of Medicine, University of Benghazi, Benghazi, LBY
| | - Azhar Hussain
- Healthcare Administration, Franklin University, Columbus, USA.,Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Sohail Kumar
- Internal Medicine, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Jasndeep Kaler
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
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Moreira CA, Ferreira CEDS, Madeira M, Silva BCC, Maeda SS, Batista MC, Bandeira F, Borba VZC, Lazaretti-Castro M. Reference values of 25-hydroxyvitamin D revisited: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:462-478. [PMID: 32813765 PMCID: PMC10522078 DOI: 10.20945/2359-3997000000258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 03/01/2020] [Indexed: 11/23/2022]
Abstract
Hypovitaminosis D is a common condition with a negative impact on health. This statement, prepared by experts from the Brazilian Society of Endocrinology and Metabolism and the Brazilian Society of Clinical Pathology/Laboratory Medicine, includes methodological aspects and limitations of the measurement of 25-hydroxyvitamin D [25(OH)D] for identification of vitamin D status, and identifies individuals at increased risk for deficiency of this vitamin in whom 25(OH)D measurement is recommended. For the general population, 25(OH)D levels between 20 and 60 ng/mL are considered normal, while individuals with levels below 20 ng/mL are considered to be vitamin D deficient. This statement identifies potential benefits of maintaining 25(OH)D levels > 30 ng/mL in specific conditions, including patients aged > 65 years or pregnant, those with recurrent falls, fragility fractures, osteoporosis, secondary hyperparathyroidism, chronic kidney disease, or cancer, and individuals using drugs with the potential to affect the vitamin D metabolism. This statement also calls attention to the risk of vitamin D intoxication, a life-threatening condition that occurs at 25(OH)D levels above 100 ng/mL.
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Affiliation(s)
- Carolina Aguiar Moreira
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
| | | | - Miguel Madeira
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
| | | | - Sergio Setsuo Maeda
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
| | | | - Francisco Bandeira
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
| | | | - Marise Lazaretti-Castro
- Departamento de Metabolismo Ósseo, Sociedade Brasileira de Endocrinologia e Metabologia, Brasil
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Ismail NA, Kamaruddin NA, Azhar Shah S, Sukor N. The effect of vitamin D treatment on clinical and biochemical outcomes of primary aldosteronism. Clin Endocrinol (Oxf) 2020; 92:509-517. [PMID: 32073675 DOI: 10.1111/cen.14177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Primary aldosteronism (PA) contributed to the cardiovascular disease and metabolic alterations independent of the blood pressure level. Evidence exists that aldosterone excess also affects calcium and mineral homeostasis. PA subjects have been shown to have greater prevalence of vitamin D deficiency. However, the impact of vitamin D treatment in this population has never been assessed. OBJECTIVE This study aimed to evaluate the effect of vitamin D treatment on clinical and biochemical outcomes of PA patients. METHODS Two hundred forty hypertensive subjects were screened, 31 had positive ARR, and 17 patients with newly confirmed PA following positive confirmatory test that has not been subjected for definitive treatment were enrolled. Clinical parameter (blood pressure) and biochemical parameters (renal profile, plasma aldosterone concentration, plasma renin activity, serum calcium, vitamin D, intact parathyroid hormone, 24-hour urinary calcium) were measured at baseline and 3 months of treatment with Bio-D3 capsule. Primary outcomes were the changes in the blood pressure and biochemical parameters. RESULTS About 70% of our PA subjects have low vitamin D levels at baseline. Three months following treatment, there were significant: (a) improvement in 25(OH)D levels; (b) reduction in systolic blood pressure and plasma aldosterone concentration; and (c) improvement in the eGFR. The vitamin D deficient subgroup has the greatest magnitude of the systolic blood pressure reduction following treatment. CONCLUSIONS This study demonstrated significant proportion of PA patients has vitamin D insufficiency. Vitamin D treatment improves these interrelated parameters possibly suggesting interplay between vitamin D, aldosterone, renal function and the blood pressure.
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Affiliation(s)
- Noor Ashikin Ismail
- Endocrine Unit, Department of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nor Azmi Kamaruddin
- Endocrine Unit, Department of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shamsul Azhar Shah
- Department of Community Health, UKM Medical Molecular Biology Institute, Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Endocrine Unit, Department of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Niculescu DA, Deacu LG, Caragheorgheopol A, Dusceac R, Procopiuc C, Petris R, Poiana C. Seasonal periodicity of serum parathyroid hormone and its relation with vitamin D in Romania. Arch Osteoporos 2020; 15:66. [PMID: 32367244 DOI: 10.1007/s11657-020-00744-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/27/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED We measured serum parathyroid hormone in 8409 Romanian subjects and found a mild seasonal variation with highest levels in March and lowest levels in September. PTH was dependent on serum vitamin D, particularly below 12.82 ng/mL. Together, these suggest that vitamin D supplementation is warranted only in at-risk groups. PURPOSE Seasonal variation of parathyroid hormone (PTH) and its dependency on serum 25-hydroxy vitamin D (25(OH)D) levels are well-described. However, there are few studies from Europe, and genetic, nutritional, and cultural differences are important. We describe the seasonal variation of serum PTH and its relation with serum 25(OH)D levels in Romania. METHODS We retrieved from our endocrinology center database all PTH measurements between 2011 and 2019 together with age, sex, diagnosis, and date of blood sampling. Simultaneous serum 25(OH)D levels were partially available. Intact PTH was measured using the same electrochemiluminescence assay. RESULTS There were 8409 subjects (median age 49 (36, 60) years; 20.5% men) without a diagnosis of hyperparathyroidism (primary or secondary to chronic kidney disease), hypoparathyroidism, or low bone mass. Serum PTH showed a mild seasonal variation with highest levels at the end of March (47.61 pg/mL) and lowest levels at the end of September (43.15 pg/mL). All sex and age subgroups showed highest levels in the spring and lowest levels in the fall. Males had significantly lower PTH levels than females irrespective of season. PTH correlated inversely with serum 25(OH)D with a breakpoint of 12.82 ng/mL in 2800 subjects who had a simultaneous measurement of 25(OH)D. Increasing age was associated with increasing PTH levels independently of serum 25(OH)D. CONCLUSIONS We showed a mild seasonal variation of serum PTH in Romania, at an inverse sinusoidal pattern than serum 25(OH)D. The breakpoint on the PTH-25(OH)D correlation suggests that vitamin D supplementation is warranted only in at-risk groups.
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Affiliation(s)
- Dan Alexandru Niculescu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor Blvd., 011863, Bucharest, Romania.
| | - Laura Georgiana Deacu
- Department of Pituitary and Neuroendocrine Disorders, C. I. Parhon National Institute of Endocrinology, 34-38 Aviatorilor Blvd., 011863, Bucharest, Romania
| | - Andra Caragheorgheopol
- Research Laboratory, C. I. Parhon National Institute of Endocrinology, 34-38 Aviatorilor Blvd., 011863, Bucharest, Romania
| | - Roxana Dusceac
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor Blvd., 011863, Bucharest, Romania
| | - Camelia Procopiuc
- Department of Pediatric Endocrinology, C. I. Parhon National Institute of Endocrinology, 34-38 Aviatorilor Blvd., Bucharest, Romania
| | - Rodica Petris
- Department of Adrenal and Bone Diseases, C. I. Parhon National Institute of Endocrinology, 34-38 Aviatorilor Blvd., Bucharest, Romania
| | - Catalina Poiana
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor Blvd., 011863, Bucharest, Romania
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Mandal UK, Gutch M, Kumar S. Vitamin D Status in Infants during the First 9 Months of Age and its Effect on Growth and Other Biochemical Markers: A Prospective Cohort Study. Adv Biomed Res 2020; 9:8. [PMID: 32318358 PMCID: PMC7147515 DOI: 10.4103/abr.abr_242_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/25/2019] [Accepted: 01/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Despite food fortification policies in many countries and recommendations for Vitamin D supplementation of at-risk groups, Vitamin D deficiency (VDD) and infantile rickets remain major public health challenges in many developed and developing countries. Materials and Methods: Ninety-six participants at birth were enrolled and followed up until 9 months of age. Serum 25OHD was estimated in cord blood at birth and at 14 ± 1 weeks of life. Seventy-seven participants were followed up at 9 months for estimation of serum 25OHD, parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, and phosphorus. VDD was defined as serum 25OHD <15 ng/mL as per USIOM guidelines. Results: Serum 25OHD levels at 9 months of age (15.78 ± 8.97 ng/mL) were significantly increased in comparison to the level of 3 months of age (14.04 ± 7.10 ng/mL) and at birth (8.94 ± 2.24 ng/mL). At birth, all the participants (77) were deficient in 25OHD levels. It was found that 16/94 (17%) and 19/77 (24.7%) participants at 3 and 9 months of age, respectively, became Vitamin D sufficient without any Vitamin D supplementation. There was a significant inverse correlation between serum 25OHD and PTH concentration (r = −0.522, P < 0.001), serum 25OHD and ALP (r = −0.501, P < 0.001). It was found that reduction in serum Vitamin D level to <10.25 ng/mL results in a surge of serum PTH. Conclusion: VDD is common from birth to 9 months of age but incidence decreases spontaneously even without supplementation. Furthermore, a large number of babies may be falsely labeled as Vitamin D deficient with currently followed cutoffs. Hence a new cutoff for VDD needs to be established for neonates and infants.
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Affiliation(s)
- Uday Kumar Mandal
- Department of Pediatrics, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Manish Gutch
- Department of Endocrinology, Dr. RMLIMS, Lucknow, Uttar Pradesh, India
| | - Sukriti Kumar
- Department of Radiodiagnosis, King George's Medical College, Lucknow, Uttar Pradesh, India
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Hernando VU, Andry MM, María Virginia PF, Valentina A. Vitamin D nutritional status in the adult population in Colombia - An analytical cross-sectional study. Heliyon 2020; 6:e03479. [PMID: 32140595 PMCID: PMC7044797 DOI: 10.1016/j.heliyon.2020.e03479] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/08/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background The key role of Vitamin D is to maintain an adequate calcium and phosphorus metabolism. Vitamin D plays an antagonistic role with the parathyroid hormone. 25 OH Vitamin D is the major circulating form and the best indicator to monitor Vitamin D levels. Methods A cross-sectional study was conducted in 1339 individuals ≥18 years old. The main objective was to establish the nutritional status of Vitamin D and its association with PTH and ionized calcium levels. Other objectives were to compare the levels of 25 OH Vitamin D based on sun exposure habits, and to identify the minimum cut-off point for the levels of 25 OH Vitamin D that could give rise to a concomitant increase in PTH and ionized calcium levels. Results 14.2% of participants presented Vitamin D deficiency, and 28.8% presented insufficiency; ≥89% of the participants with deficiency or insufficiency were exposed to sunlight <30 minutes per week. A value of 25 OH Vitamin D >30 ng/mL was associated with a more stable and "flat" PTH value. The median of 25 OH Vit-D associated with hypercalcemia was <10 ng/mL. Conclusion In Colombia, low 25 OH Vitamin D values are highly prevalent; this may be accounted for by poor sun-exposure habits and frequent use of sunscreen. Just as in other similar trials, the lower the levels of 25 OH Vit-D, the higher the effect on PTH and ionized calcium elevation.
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Affiliation(s)
- Vargas-Uricoechea Hernando
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayán-Cauca, Colombia
| | - Mera-Mamián Andry
- Epidemiology and Statistics Research Group, Universidad CES, Medellín, Colombia
| | | | - Agredo Valentina
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayán-Cauca, Colombia
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