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Grace AF, Olubunmi AA, Adetutu OT, Kweku RJ, Olubisi AO, Daniel OF. Prevalence and Risk Factors of Vitamin D, Calcium and Phosphate Deficiency among Apparently Healthy Children Aged 6-24 Months in a Semi-urban Community in Southwest, Nigeria. Niger Postgrad Med J 2024; 31:213-219. [PMID: 39219343 DOI: 10.4103/npmj.npmj_101_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Adequate levels of calcium, phosphate and Vitamin D are essential for bone physiology and growth, as well as preventing some common childhood illnesses. This study aimed to determine the prevalence of the deficiencies of these nutrients and factors affecting their serum levels in Nigerian children. METHODS This was a cross-sectional study that involved 220 apparently healthy children aged 6-24 months in Ikenne Local Government Area of Ogun State, Nigeria. Serum calcium and phosphate were assayed using the calorimetric method, while Vitamin D (25-OH Vitamin D) was assayed with ELISA. RESULTS The mean (±standard deviation [SD]) serum Vitamin D level was 55.07 ± 16.53 ng/ml, while the mean (±SD) serum calcium and phosphate were 2.27 ± 0.13 mmol/l and 1.28 ± 0.18 mmol/l, respectively. Eleven (5%) of the children had hypovitaminosis D, 23 (10.5%) had hypocalcaemia and 12 (5.5%) had hypophosphataemia. Factors found to be significantly associated with hypovitaminosis D included low consumption of milk and the use of a hijab veil, while malnutrition (both undernutrition and overnutrition) was significantly associated with hypocalcaemia. CONCLUSION The prevalence levels of hypovitaminosis D and hypophosphataemia were low, while hypocalcaemia was more common. Low milk consumption and use of a hijab veil were risk factors for hypovitaminosis D, while malnutrition was a risk factor for hypocalcaemia. Malnourished children, especially overnourished ones, should be routinely screened for hypocalcaemia because of its high prevalence among them.
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Affiliation(s)
- Ajayi Fisayo Grace
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | | | - Ogunlesi Tinuade Adetutu
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Renner James Kweku
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | | | - Obaya Fisayo Daniel
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
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Bhattacharjee R, Chakraborty PP, Agrawal N, Roy A, Maiti A, Chowdhury S. Etiology and Biochemical Profile of Rickets in Tertiary Care Centres in Eastern India: A Retrospective Cross-sectional Study. Indian J Endocrinol Metab 2024; 28:184-191. [PMID: 38911108 PMCID: PMC11189282 DOI: 10.4103/ijem.ijem_221_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/19/2023] [Accepted: 10/25/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction We aimed to describe the clinical, biochemical and etiological profile of patients referred with a provisional diagnosis of rickets in tertiary care centres. In addition, we tried to propose a diagnostic algorithm for the evaluation of such patients. Methods This was a retrospective cross-sectional study conducted in two tertiary care centres of West Bengal. Data of patients were retrieved between 2014 and 2021. Results Out of 101 children, 22 had conditions simulating rickets. Renal tubular acidosis (RTA) was the most common (53.2%) etiology of rickets, followed by phosphopenic rickets (PR) (22.8%) and calcipenic rickets (CR) (17.7%). The prevalence of true nutritional rickets (NR) was only 8.9%. Children with RTA had a significantly higher prevalence of chronic ill health (69%) and polyuria (95.2%). Weight standard deviation score (SDS) and body mass index (BMI) SDS scores were significantly lower in the RTA group compared to others. Around 90.5% of children with RTA, and none in the other groups, had hypokalemia. Biochemically, hypophosphatemia and elevated alkaline phosphatase (ALP) were present in all patients with PR and CR. Compared to CR, median serum phosphate was significantly lower in the PR group. A significant difference in ALP values was noticed in patients with hypophosphatemia (815 ± 627 IU/L) compared to those without (279 ± 204 IU/L). Plasma parathyroid hormone (PTH) of 100 pg/ml seemed useful to differentiate CR from other forms. Conclusion NR is uncommon in tertiary care centres. Children with rickets should be approached systematically with the estimation of ALP, phosphorus, creatinine, calcium, PTH and 25-hydroxy vitamin D to reach an etiological diagnosis.
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Affiliation(s)
- Rana Bhattacharjee
- Department of Endocrinology and Metabolism, Medical College, Kolkata, West Bengal, India
| | - Partha P. Chakraborty
- Department of Endocrinology and Metabolism, Medical College, Kolkata, West Bengal, India
| | - Neeti Agrawal
- Department of Endocrinology and Metabolism, Medical College, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Department of Endocrinology, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Animesh Maiti
- Department of Endocrinology and Metabolism, Medical College, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, IPGME and R/SSKM Hospital, Kolkata, West Bengal, India
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3
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Albai O, Braha A, Timar B, Golu I, Timar R. Vitamin D-A New Therapeutic Target in the Management of Type 2 Diabetes Patients. J Clin Med 2024; 13:1390. [PMID: 38592202 PMCID: PMC10931811 DOI: 10.3390/jcm13051390] [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: 02/13/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Vitamin D is a fat-soluble vitamin that prevents cardiovascular diseases and diabetes mellitus (DM). The present research aimed to study the impact of 25-hydroxyvitamin D (25(OH)D) level on the health status of patients with type 2 DM (T2DM) hospitalized in the "Pius Brînzeu" Emergency Clinical County University Hospital in Timisoara, Romania. Methods: The study retrospectively included 160 patients with T2DM who were clinically and biologically evaluated during hospitalization. Results: 13.1% of patients had optimal, 23.1% insufficient, and 63.8% deficient 25(OH)D values. Patients with 25(OH)D deficiency presented poorer glycemic control and were older, with higher weight, but had altered renal function, anemia, and lower iron values. Also, patients with associated neoplasia, diabetic neuropathy, cardiovascular disease (CVD), dementia, and grade 3 arterial hypertension (HTN) had lower values of 25(OH)D. An age > 55 years (sensitivity 69.9, specificity 82.5, AUROC 0.786, p < 0.001) and an HbA1c > 7.7% (sensitivity 89.3, specificity 92.9, AUROC 0.938, p < 0.001) predict 25(OH)D deficiency in T2DM patients. Conclusions: Vitamin D influences almost every system and organ in the body, so it should be a routine test for all patients with DM to correct the deficiency and prevent other diseases and complications.
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Affiliation(s)
- Oana Albai
- Department of Second Internal Medicine—Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.A.); (B.T.); (R.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases Clinic, “Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease/MOL-NEPHRO-VASC, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adina Braha
- Department of Second Internal Medicine—Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.A.); (B.T.); (R.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases Clinic, “Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
| | - Bogdan Timar
- Department of Second Internal Medicine—Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.A.); (B.T.); (R.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases Clinic, “Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease/MOL-NEPHRO-VASC, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Golu
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Romulus Timar
- Department of Second Internal Medicine—Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.A.); (B.T.); (R.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases Clinic, “Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease/MOL-NEPHRO-VASC, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Anetakis C, Mitka S, Chatzidimitriou M, Anagnostopoulos K, Eleftheriou P, Lialiaris T. Vitamin D Status in Osteoporotic and Diabetic Patients and Athletic Healthy Individuals from Northern Greece. Rep Biochem Mol Biol 2023; 11:565-576. [PMID: 37131899 PMCID: PMC10149132 DOI: 10.52547/rbmb.11.4.565] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/12/2022] [Indexed: 05/04/2023]
Abstract
Background Vitamin D deficiency is recognised as a pandemic in the developed world. However, the importance of prudent sun exposure tends to be overlooked, which is responsible for this pandemic. Methods We investigated the vitamin D status in 326 adults, 165 females and 161 males: 99 Osteoporosis patients, 53 Type 1 Diabetes patients, 51 Type 2 Diabetes patients, and 123 Athletic Healthy individuals, from Northern Greece, through the measurement of total calcidiol in winter and summer by immunoenzymatic assay. Results In the Whole Sample 23.31% had severe deficiency, 13.50% mild deficiency, 17.48% insufficiency, and 45.71% adequacy at the end of winter. Mean concentrations differed significantly (p <0.001) between males and females. The prevalence of deficiency in the young was significantly lower than in the middle-aged (p = 0.004) and in the elderly (p <0.001), while it was significantly lower (p = 0.014) in the middle-aged than in the elderly. The best vitamin D status was found in the Athletic Healthy individuals, followed by the Type 1 and Type 2 Diabetic patients, while Osteoporotic patients had the poorest status. The difference in mean concentrations between winter and summer was significant (p <0.001). Conclusions Vitamin D status deteriorated with increasing age and it was better in males than in females. Our findings suggest that outdoor physical activity in a Mediterranean country can cover the vitamin D needs of the young and the middle-aged, but not of the elderly, without the need for dietary supplements.
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Affiliation(s)
- Constantine Anetakis
- Laboratory of Clinical Chemistry, Faculty of Biomedical Sciences, School of Health Sciences, Alexandrian Campus of International Hellenic University, 57400 Sindos, Thessaloniki, Greece.
- Corresponding author: Constantine Anetakis; Tel: +30 6944158868; E-mail:
| | - Stella Mitka
- Laboratory of Clinical Chemistry, Faculty of Biomedical Sciences, School of Health Sciences, Alexandrian Campus of International Hellenic University, 57400 Sindos, Thessaloniki, Greece.
| | - Maria Chatzidimitriou
- Laboratory of Clinical Chemistry, Faculty of Biomedical Sciences, School of Health Sciences, Alexandrian Campus of International Hellenic University, 57400 Sindos, Thessaloniki, Greece.
- Bioanalysis Diagnostic Laboratory, D. Gounari 33, 54622 Thessaloniki, Greece.
| | | | - Phaedra Eleftheriou
- Laboratory of Clinical Chemistry, Faculty of Biomedical Sciences, School of Health Sciences, Alexandrian Campus of International Hellenic University, 57400 Sindos, Thessaloniki, Greece.
| | - Theodoros Lialiaris
- Faculty of Medicine, School of Health Sciences, Democritus University of Thrace, Greece.
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Mengistu GT, Terefe AB, Gudeta TG, Mengistu BK. Factors associated with infants' sunlight exposure among mothers attending the EPI unit of Wolkite University Specialized Hospital. PLoS One 2022; 17:e0277349. [PMID: 36395250 PMCID: PMC9671437 DOI: 10.1371/journal.pone.0277349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Infant sunlight exposure in their early infancy is essential for the cutaneous synthesis of vitamin D. Vitamin D deficiency is highly prevalent due to inadequate exposure to sunlight. In Ethiopia, one in thirteen children had rickets, which could be prevented by sunlight exposure or supplementation. This study aimed to identify the practice of infants' sunlight exposure and associated factors among mothers attending the Expanded program immunization unit of Wolkite University Specialized Hospital. METHOD This study employed an institutional-based cross-sectional study design to collect data. Data were collected from 220 mothers using an interviewer-administered questionnaire. The study employed a systematic random sampling technique to reach the study participants. The collected data were entered into a computer using the software Epidata 3.1 version and exported to SPSS version 23 for statistical analysis. Descriptive and inferential analysis was conducted. Logistic regression analysis was done, and a statistical association was declared at a p-value < 5% and a 95% confidence interval(CI). Then the results were presented using a frequency table, figures, and description. RESULT A total of 220 infant-coupled mothers who visited the Expanded program immunization unit were included in the study. According to the current study, 67.3% of mothers had good practice with infants' sunlight exposure. Mothers' practice of infant sunlight exposure was affected by age of mothers 30-34 years, [AOR = 3.10, 95%CI (1.13, 8.51)], and age ≥35 years, [AOR = 4.49, 95%CI (1.20, 16.86)], and living in urban, [AOR = 1.94, 95%CI (1.053, 3.57)]. CONCLUSION The current study showed that two-thirds (67.3%) of mothers had good practice of sunlight exposure to their infants. Factors that affect mothers' practice of infants' sunlight exposure are age and place of residence. Health professionals should provide health education for mothers on the benefits of infants' sunlight exposure.
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Affiliation(s)
- Girma Teferi Mengistu
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
- * E-mail: ,
| | - Ayana Benti Terefe
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tolesa Gemeda Gudeta
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Bizunesh Kefale Mengistu
- Department of Statistics, College of Natural and Computational Science, Ambo University, Ambo, Ethiopia
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Vitamin D May Be Connected with Health-Related Quality of Life in Psoriasis Patients Treated with Biologics. J Pers Med 2022; 12:jpm12111857. [PMID: 36579586 PMCID: PMC9695623 DOI: 10.3390/jpm12111857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Suboptimal states of vitamin D may play a role in psoriasis evolution, but the interconnections have been studied over the past years with controversial results. Although a peerless therapy among moderate to severe types of psoriasis, the therapeutic effectiveness of biological therapy may vary unforeseeably between patients and leads to biologics switch. We conducted a pilot study in patients diagnosed with psoriasis and treated with biologics, the purpose of which was to explore the prevalence of suboptimal states of vitamin D, especially in the group of patients characterized by the failure of previous biologics, and to investigate the associations between vitamin D levels and psoriasis, regarding aspects such the severity of the disease and quality of life. Their current result of latent tuberculosis infection (LTBI) was also considered concerning a feasible relationship with vitamin D levels. From July to December 2021, 45 patients corresponding to our inclusion criteria were assessed. Variables such as Psoriasis Area and Severity Index (PASI) score and the Dermatology Life Quality Index (DLQI) score, as well as vitamin D serum concentrations and their LTBI result, were recorded for them. Lower serum concentrations of vitamin D were not more common in patients characterized by failure to previous biologics (p = 0.443), but we concluded a weak correlation between the DLQI score and vitamin D (rho = -0.345, p-value = 0.020), although a statistically insignificant result was obtained between vitamin D and the PASI score (rho = -0.280, p-value = 0.062), and with the LTBI result (rho = -0.053, p-value = 0.728). These results establish a connection between higher levels of vitamin D and a better outcome of psoriasis from the perspective of the patient's quality of life, with no significant association with psoriasis severity and no significant prevalence of suboptimal states among patients that failed previous biologics compared to those with a continuously good response.
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Hart MD, Girma M, Strong MD, Tadesse BT, Taddesse BM, Alemayehu FR, Stoecker BJ, Chowanadisai W. Vitamin D binding protein gene polymorphisms are associated with lower plasma 25-hydroxy-cholecalciferol concentrations in Ethiopian lactating women. Nutr Res 2022; 107:86-95. [PMID: 36206636 DOI: 10.1016/j.nutres.2022.09.003] [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: 05/09/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 12/27/2022]
Abstract
Ethiopian women have been reported to have low plasma 25-hydroxy-cholecalciferol (25(OH)D) concentrations despite an abundance of sunshine. Low dietary vitamin D intake, limited skin exposure to sun, and genetics are among factors suggested to affect vitamin D status in this population. In this study (Clinical Trial NCT02210884), we hypothesized that polymorphisms in the vitamin D binding protein (VDBP) gene (rs7041, rs4588) are associated with reduced plasma 25(OH)D concentrations in Ethiopian women. Lactating Ethiopian women (n = 110) were randomly assigned to weekly administration of vitamin D3 (15,000 IU) or a placebo. Plasma 25(OH)D was measured at baseline (within 2 weeks of delivery, before supplementation) and at 3, 6, and 12 months after delivery. Associations between VDBP polymorphism status for rs7041 and rs4588 and plasma 25(OH)D were determined by analysis of variance and multiple linear and logistic regressions. Multiple linear regression with maternal age as a covariate revealed that rs7041 is associated with reduced plasma 25(OH)D (P = .021) and more risk alleles at rs7041 and rs4588 are associated with reduced plasma 25(OH)D (P = .017). Logistic regression models for vitamin D insufficiency showed that additional risk alleles for rs7041 and rs4588 are associated with increased odds ratios (OR = 1.66; 95% CI, 1.10-2.62; P = .019) for plasma 25(OH)D below 40 nmol/L. Supplementation increased plasma 25(OH)D at 3 months in women with fewer risk alleles and across all genotypes at 6 and 12 months. VDBP polymorphisms may contribute to vitamin D insufficiency in Ethiopian lactating women. Furthermore, VDBP polymorphisms may blunt short-term responses to vitamin D supplementation and require longer periods of intervention.
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Affiliation(s)
- Matthew D Hart
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Meron Girma
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, 74078, USA; School of Nutrition, Food Science, and Technology, Hawassa University, Hawassa, Ethiopia
| | - Morgan D Strong
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | | | | | - Fikadu Reta Alemayehu
- School of Nutrition, Food Science, and Technology, Hawassa University, Hawassa, Ethiopia
| | - Barbara J Stoecker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, 74078, USA.
| | - Winyoo Chowanadisai
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, 74078, USA.
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Khadilkar A, Kajale N, Oza C, Oke R, Gondhalekar K, Patwardhan V, Khadilkar V, Mughal Z, Padidela R. Vitamin D status and determinants in Indian children and adolescents: a multicentre study. Sci Rep 2022; 12:16790. [PMID: 36202910 PMCID: PMC9537341 DOI: 10.1038/s41598-022-21279-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
Studies performed on Indian children to assess vitamin-D status have been on small sample sizes, limited to specific geographical locations and used non-standard methods to measure 25(OH)D3. This multicentre study assessed 25(OH)D3 concentrations from dried blood spots (DBS) in 5–18-year-old Indian children and adolescents using a standardized protocol and identified factors contributing towards vitamin D deficiency. Cross-sectional, observational school-based study was conducted by multi-stage stratified random sampling. A city and nearby village were selected from 6 Indian states covering wide geographical areas. Demography, anthropometry, body-composition, dietary-intakes and DBS samples were collected. 25(OH)D3 was assessed from DBS using Liquid chromatography with tandem-mass spectrometry. Vitamin-D status was assessed in 2500 children; with additional data collected on a subset (n = 669) to assess predictors. Mean vitamin-D concentration was 45.8 ± 23.9 nmol/L, 36.8% of subjects had sufficient vitamin-D (> 50 nmol/L); rural subjects and boys had higher concentrations (p < 0.05). On regression analysis, younger age, female-gender, overweight and urban residence significantly contributed to deficiency. More than half the Indian children/adolescents were vitamin-D deficient or insufficient. Our study reinforces vitamin-D deficiency as a major public health problem and the need for supplementation, food fortification and educating the population as initiatives required to improve sufficiency status.
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Affiliation(s)
- Anuradha Khadilkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India. .,Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India.
| | - Neha Kajale
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India.,Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | - Chirantap Oza
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India
| | - Rashmi Oke
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India
| | - Ketan Gondhalekar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India
| | - Vivek Patwardhan
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India
| | - Vaman Khadilkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, Pune, 411 001, India.,Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, NHS Foundation Trust, Manchester, UK
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, NHS Foundation Trust, Manchester, UK
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Li HA, Zou SQ, Li BT, Wang T, Ma ZC, Luo Q, Huang XY, Fan LC, Xiang W. Serum vitamin D status among healthy children in Hainan, South China: a multi-center analysis of 10,262 children. Transl Pediatr 2022; 11:1010-1017. [PMID: 35800264 PMCID: PMC9253947 DOI: 10.21037/tp-22-235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There are limited data regarding the prevalence and risk factors relating to vitamin D deficiency (VDD) in children of Hainan, a tropical city with abundant sunlight in China. To gather and analyze the serum VD levels of healthy children in Hainan, so as to understand their VD nutritional status and improve the representative data of VD nutritional status in south China. METHODS Children who presented to the outpatient clinic for physical examination at 4 hospitals in the Hainan Province from 2012 to 2020 were enrolled in this study. The serum 25-hydroxyvitamin D (25-OHD) levels was analyzed. 25-OHD levels <50 nmol/L is considered VDD, 50-75 nmol/L is vitamin D insufficiency (VDI), and ≥75 nmol/L is VD sufficient (VDS). RESULTS The average serum 25-OHD level was 94.63±49.99 nmol/L [95% confidence interval (CI): 93.67-95.60]. VDD was detected in 13.98% of participants (1,435 cases), VDI was detected in 30.60% of participants (3,140 cases), and 55.42% presented with VDS (5,687 cases). The average 25-OHD level of boys was significantly higher than that of girls (t=3.67, P<0.001). The average serum 25-OHD levels in the following age groups 0-1, 1-3, 3-7, 7-14, and 14-18 years were 105.92±57.39, 100.55±53.22, 86.35±39.19, 73.61±34.21, and 54.97±19.19 nmol/L, respectively. These results suggested that with an increase in age, the 25-OHD levels decreased. The average 25-OHD levels of children with a body mass index (BMI) <85th percentile were significantly higher than that of children in the overweight and obese group (F=7.393, P=0.001). CONCLUSIONS A certain proportion of all age groups showed vitamin D deficiency and insufficiency in Hainan. A formal recommendation for vitamin D supplementation should be considered, especially in autumn and winter seasons for children over 7 years old, and in those with BMI ≥85th percentile or BMI ≥95th percentile.
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Affiliation(s)
- Hong-Ai Li
- Department of Child Health Care, Hainan Women and Children's Medical Center (Children's Hospital Affiliated to Hainan Medical University), Haikou, China
| | - Shao-Qiu Zou
- Department of Pediatrics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Bang-Tao Li
- Department of Pediatrics, Hainan Women and Children's Medical Center (Children's Hospital Affiliated to Hainan Medical University), Haikou, China
| | - Teng Wang
- Department of Pediatrics, Hainan General Hospital, Haikou, China
| | - Zhi-Chao Ma
- Department of Pediatrics, Hainan General Hospital, Haikou, China
| | - Qing Luo
- Department of Child Health Care, Hainan Women and Children's Medical Center (Children's Hospital Affiliated to Hainan Medical University), Haikou, China
| | - Xiao-Yan Huang
- Department of Endocrinology, Hainan Women and Children's Medical Center (Children's Hospital Affiliated to Hainan Medical University), Haikou, China
| | - Li-Chun Fan
- Department of Child Health Care, Hainan Women and Children's Medical Center (Children's Hospital Affiliated to Hainan Medical University), Haikou, China
| | - Wei Xiang
- National Health Commission (NHC) Key Laboratory of Control of Tropical Diseases, Hainan Medical University, Haikou, China
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Lake EA, Demissie BW, Gebeyehu NA, Azeze GA, Gelaw KA, Fite RO, Gebrekirstos LG, Chichiabellu TY, Guta MT. Knowledge and practice of mothers towards sunshine exposure of their children in Ethiopia: a systematic review and meta-analysis. BMC Pediatr 2022; 22:213. [PMID: 35436897 PMCID: PMC9014620 DOI: 10.1186/s12887-022-03281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early morning sunlight exposure for infants is a good practice to prevent rickets and alleviate the problem of vitamin D deficiency. Rickets is a major public health problem in many countries especially in developing country including Ethiopia. As mothers are frontline person for their children who should know and practice about sunlight exposure, this systematic review and meta-analysis aimed to assess the pooled level of knowledge and practice towards sunlight exposure of their children among mothers in Ethiopia. METHODS PubMed, Google Scholar, Excerpta Medica database (EMBASE), Cochrane Library, Web of Science, and African Journal of Online (AJOL) were searched. The data were extracted using Microsoft Excel and analyzed using STATA version 14. Publication bias was checked by funnel plot and more objectively through Egger's regression test, with P < 0.05 considered to indicate potential publication bias. The heterogeneity of studies was checked using I2 statistics. Pooled analysis was conducted using a weighted inverse variance random-effects model. Subgroup analysis was done related to geographic region and time. A leave-one-out sensitivity analysis was also employed. RESULT A total of 8 studies with 2974 study participants for knowledge, nine studies with 3475 study participants for practice were used to estimate the pooled level of good knowledge and good practice of sunshine exposure among Ethiopian mothers. The overall estimated good level of knowledge and good practice towards sunshine exposure of their children among mothers was found to be 56.08% ((95% CI: 46.26 - 65.89%; I2 = 96.8%) and 55.632% (95%CI: 44.091 - 67.174%; I2 = 98.2%). Regional subgroup analysis showed that the pooled level of good practice in Amhara and Sidama regions found to be 54.41 and 58.32% respectively. CONCLUSION Study findings showed mothers knowledge and practice towards sunshine exposure of children was quite low in Ethiopia. This study therefore recommends that interventions are needed to increase knowledge and practice of sunlight exposure. This study provides much needed significant evidence for making health-policy recommendations for this vulnerable population group.
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Affiliation(s)
- Eyasu Alem Lake
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | | | - Natneal Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gedion Asnake Azeze
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kelemu Abebe Gelaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Robera Olana Fite
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | | | - Tesfaye Yitna Chichiabellu
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mistire Teshome Guta
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Middelkoop K, Walker N, Stewart J, Delport C, Jolliffe DA, Nuttall J, Coussens AK, Naude CE, Tang JCY, Fraser WD, Wilkinson RJ, Bekker LG, Martineau AR. Prevalence and Determinants of Vitamin D Deficiency in 1825 Cape Town Primary Schoolchildren: A Cross-Sectional Study. Nutrients 2022; 14:nu14061263. [PMID: 35334921 PMCID: PMC8952729 DOI: 10.3390/nu14061263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Vitamin D deficiency (25-hydroxyvitamin D[25(OH)D] <50 nmol/L) is common among adults in Cape Town, South Africa, but studies investigating vitamin D status of children in this setting are lacking. We conducted a cross-sectional study to determine the prevalence and determinants of vitamin D deficiency in 1825 Cape Town schoolchildren aged 6−11 years. Prevalence of vitamin D deficiency was 7.6% (95% Confidence Interval [CI] 6.5% to 8.9%). Determinants of vitamin D deficiency included month of sampling (adjusted odds ratio [aOR] for July−September vs. January−March 10.69, 95% CI 5.02 to 22.77; aOR for October−December vs. January−March 6.73, 95% CI 2.82 to 16.08), older age (aOR 1.25 per increasing year, 95% CI: 1.01−1.53) and higher body mass index (BMI; aOR 1.24 per unit increase in BMI-for-age Z-score, 95% CI: 1.03−1.49). In a subset of 370 participants in whom parathyroid hormone (PTH) concentrations were measured; these were inversely related to serum 25(OH)D concentrations (p < 0.001). However, no association between participants with hyperparathyroidism (PTH >6.9 pmol/L) and vitamin D deficiency was seen (p = 0.42). In conclusion, we report that season is the major determinant of vitamin D status among Cape Town primary schoolchildren, with prevalence of vitamin D deficiency ranging from 1.4% in January−March to 22.8% in July−September.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
- Correspondence: (K.M.); (A.R.M.)
| | - Neil Walker
- Wolfson Institute of Population Health, Queen Mary University of London, London E1 2AB, UK; (N.W.); (D.A.J.)
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - David A. Jolliffe
- Wolfson Institute of Population Health, Queen Mary University of London, London E1 2AB, UK; (N.W.); (D.A.J.)
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town 7700, South Africa;
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7700, South Africa
| | - Anna K. Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (A.K.C.); (R.J.W.)
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute, Parkville, VIC 3052, Australia
| | - Celeste E. Naude
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Jonathan C. Y. Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (J.C.Y.T.); (W.D.F.)
| | - William D. Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (J.C.Y.T.); (W.D.F.)
- Departments of Clinical Biochemistry and Endocrinology, Norfolk and Norwich University Hospitals Trust, Norwich NR4 7UY, UK
| | - Robert J. Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (A.K.C.); (R.J.W.)
- The Francis Crick Institute, Midland Road, London NW1 1AT, UK
- Department of Infectious Diseases, Imperial College London, London W12 0NN, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Adrian R. Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- Correspondence: (K.M.); (A.R.M.)
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12
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Marzban M, Kalantarhormozi M, Mahmudpour M, Ostovar A, Keshmiri S, Darabi AH, Khajeian A, Bolkheir A, Amini A, Nabipour I. Prevalence of vitamin D deficiency and its associated risk factors among rural population of the northern part of the Persian Gulf. BMC Endocr Disord 2021; 21:219. [PMID: 34732181 PMCID: PMC8565643 DOI: 10.1186/s12902-021-00877-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accumulating evidence indicates that vitamin D deficiency has been increased globally over the last two decades. However, the majority of these studies are concerned with cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among the rural population in Bushehr province which shares the longest border with the Persian Gulf. METHODS The rural inhabitants of more than 25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants' demographic and anthropometric data and their past medical history, serum 25-hydroxyvitamin D [25(OH)D] was measured using ELISA. RESULTS A total of 1806 (means ±SD, 46± 14years old) rural subjects (35 % males and 65 % females) participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 28 %, 50 %, and 22 %, respectively. The deficiency of vitamin D in women was higher than in men (OR=1.27, 95 % CI: 1.05 to 1.54, P=0.04). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.7). There was no significant difference between the food item's consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively. CONCLUSIONS Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their lifestyle patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf.
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Affiliation(s)
- Maryam Marzban
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mohammadreza Kalantarhormozi
- Department of Endocrine and Metabolic Disease, the Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mehdi Mahmudpour
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Keshmiri
- Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Amir Hossein Darabi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Amirreza Bolkheir
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Azam Amini
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Iraj Nabipour
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
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13
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Mogire RM, Morovat A, Muriuki JM, Mentzer AJ, Webb EL, Kimita W, Ndungu FM, Macharia AW, Cutland CL, Sirima SB, Diarra A, Tiono AB, Lule SA, Madhi SA, Sandhu MS, Prentice AM, Bejon P, Pettifor JM, Elliott AM, Adeyemo A, Williams TN, Atkinson SH. Prevalence and predictors of vitamin D deficiency in young African children. BMC Med 2021; 19:115. [PMID: 34011341 PMCID: PMC8136043 DOI: 10.1186/s12916-021-01985-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Children living in sub-Saharan Africa have a high burden of rickets and infectious diseases, conditions that are linked to vitamin D deficiency. However, data on the vitamin D status of young African children and its environmental and genetic predictors are limited. We aimed to examine the prevalence and predictors of vitamin D deficiency in young African children. METHODS We measured 25-hydroxyvitamin D (25(OH)D) and typed the single nucleotide polymorphisms, rs4588 and rs7041, in the GC gene encoding the vitamin D binding protein (DBP) in 4509 children aged 0-8 years living in Kenya, Uganda, Burkina Faso, The Gambia and South Africa. We evaluated associations between vitamin D status and country, age, sex, season, anthropometric indices, inflammation, malaria and DBP haplotypes in regression analyses. RESULTS Median age was 23.9 months (interquartile range [IQR] 12.3, 35.9). Prevalence of vitamin D deficiency using 25(OH)D cut-offs of < 30 nmol/L and < 50 nmol/L was 0.6% (95% CI 0.4, 0.9) and 7.8% (95% CI 7.0, 8.5), respectively. Overall median 25(OH)D level was 77.6 nmol/L (IQR 63.6, 94.2). 25(OH)D levels were lower in South Africa, in older children, during winter or the long rains, and in those with afebrile malaria, and higher in children with inflammation. 25(OH)D levels did not vary by stunting, wasting or underweight in adjusted regression models. The distribution of Gc variants was Gc1f 83.3%, Gc1s 8.5% and Gc2 8.2% overall and varied by country. Individuals carrying the Gc2 variant had lower median 25(OH)D levels (72.4 nmol/L (IQR 59.4, 86.5) than those carrying the Gc1f (77.3 nmol/L (IQR 63.5, 92.8)) or Gc1s (78.9 nmol/L (IQR 63.8, 95.5)) variants. CONCLUSIONS Approximately 0.6% and 7.8% of young African children were vitamin D deficient as defined by 25(OH)D levels < 30 nmol/L and < 50 nmol/L, respectively. Latitude, age, season, and prevalence of inflammation and malaria should be considered in strategies to assess and manage vitamin D deficiency in young children living in Africa.
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Affiliation(s)
- Reagan M Mogire
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- KEMRI-Wellcome Trust Research Programme - Accredited Research Centre, Open University, Kilifi, Kenya.
| | - Alireza Morovat
- Department of Clinical Biochemistry, Oxford University Hospitals, Oxford, UK
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alexander J Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Li Ka Shing Centre for Health Information and Discovery, Big Data Institute, University of Oxford, Oxford, UK
| | - Emily L Webb
- Medical Research Council (MRC) Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Wandia Kimita
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Francis M Ndungu
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alex W Macharia
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Clare L Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sodiomon B Sirima
- Groupe de Recherche Action en Sante (GRAS), 06, 06 BP 10248, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Groupe de Recherche Action en Sante (GRAS), 06, 06 BP 10248, Ouagadougou, Burkina Faso
| | - Alfred B Tiono
- Groupe de Recherche Action en Sante (GRAS), 06, 06 BP 10248, Ouagadougou, Burkina Faso
| | - Swaib A Lule
- Medical Research Council (MRC) Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John M Pettifor
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Adebowale Adeyemo
- Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, South Drive, MSC 5635, Bethesda, Maryland, 20891-5635, USA
| | - Thomas N Williams
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Institute of Global Health Innovation, Imperial College, London, UK
| | - Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Department of Paediatrics, University of Oxford, Oxford, UK.
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14
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Augustine LF, Nair KM, Kulkarni B. Sun exposure as a strategy for acquiring vitamin D in developing countries of tropical region: Challenges & way forward. Indian J Med Res 2021; 154:423-432. [PMID: 34854426 PMCID: PMC9131791 DOI: 10.4103/ijmr.ijmr_1244_18] [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] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 11/21/2022] Open
Abstract
Adopting sun exposure as a low-cost sustainable strategy in tropical countries needs critical analysis for its feasibility and inclusion in national policy. This review explores the opportunities and challenges associated with sun exposure in tropical countries and discusses potential strategies that may be adopted for promoting sun exposure. For this, two strands of evidence were reviewed; trials on sun exposure, analysed for risk of bias and, the environmental factors that influence acquisition of vitamin D from sun exposure in the context of on-going ecological and nutritional transition. Compilation of data from available databases in terms of deficiency, per cent rural population, status of fortification, air pollution, ultraviolet index, skin reflectance and skin cancer prevalence were done. In the context of environmental and lifestyle-related challenges, opportunities go hand-in-hand in terms of built environment, variability in air pollution and personal factors such as skin pigmentation, precursor availability and general nutritional status. Contextual policy decisions should consider urban and rural development planning, control of air pollution, targeted guidelines for indigenous and immigrant population and use of space technology in educating general population for balanced sun exposure as essential components for a sustainable strategy. Important opportunities exist for tropical countries to develop sun exposure as a strategy for acquiring vitamin D and these need to be explored.
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Affiliation(s)
- Little Flower Augustine
- Division of Clinical Studies, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
| | - K. Madhavan Nair
- Micronutrient Research, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
| | - Bharati Kulkarni
- Division of Clinical Studies, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
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15
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Al Khalifah R, Alsheikh R, Alnasser Y, Alsheikh R, Alhelali N, Naji A, Al Backer N. The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression. Syst Rev 2020; 9:144. [PMID: 32546259 PMCID: PMC7298752 DOI: 10.1186/s13643-020-01360-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Vitamin D (vitD) deficiency is a global childhood health problem. Food fortification is a promising strategy to curb vitD deficiency. We aimed to assess the effectiveness of utilizing vitD fortification in staple foods to improve 25hydroxyvitamin D (25(OH)D) concentration and to reduce the prevalence of vitD deficiency among healthy children. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of vitD fortified food products compared to no fortification among healthy children aged 1-18 years old. We searched Medline, Embase, Global Health, and Cochrane (CENTRAL) databases from database inception until May 2019. Independently, six reviewers in pairs screened titles and abstracts, assessed the full text for eligibility, and performed data extraction and quality assessment. The primary outcome is the impact of fortification on 25(OH)D concentration. The secondary outcomes included the impact of fortification on the prevalence of vitD deficiency, school performance, cognitive function, school absences, infection rate, hospital admission length, and compliance with fortified food product consumption. RESULTS We identified 2229 articles. After assessing eligibility, 20 RCTs met the inclusion criteria. The eligible RCTs assessed the fortification of milk, cereal, juice, bread, yogurt, and cheese compared with no fortification. All RCTs, except for three, had a low risk of bias. Food fortification improved 25(OH)D concentration by a mean difference (MD) of 15.51 nmol/L (95% confidence interval (CI) 6.28, 24.74; I2 = 99%), which resulted in a mean increase of 3 nmol/l for every 100 IU of vitD, when adjusted for baseline 25(OH)D concentration and country latitude. Additionally, the prevalence of vitD deficiency decreased by a risk ratio of 0.53 (95% CI 0.41, 0.69; I2 = 95%), and cognitive function improved by a MD of 1.22 intelligence quotient (IQ) points (95% CI 0.65, 1.79; I2 = 0%). The overall evidence quality was high. CONCLUSION VitD food fortification is an effective way to improve 25(OH)D concentration, prevent vitD deficiency, and improve IQ levels. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017057631.
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Affiliation(s)
- Reem Al Khalifah
- Division of Pediatric Endocrinology, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Rawan Alsheikh
- Pediatric Department, King Saud University, Riyadh, Saudi Arabia
| | - Yossef Alnasser
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Department, King Saud University, Riyadh, Saudi Arabia.,Pediatric Department, BC Children's Hospital, Vancouver, BC, Canada
| | - Rana Alsheikh
- Pediatric Department, King Saud University, Riyadh, Saudi Arabia
| | - Nora Alhelali
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ammar Naji
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Al Backer
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Division of Developmental-Behavioral Pediatric, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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16
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Ilmiawati C, Oviana A, Friadi A, Reza M. Sunlight exposed body surface area is associated with serum 25-hydroxyvitamin D (25(OH)D) level in pregnant Minangkabau women, Indonesia. BMC Nutr 2020; 6:18. [PMID: 32467767 PMCID: PMC7232832 DOI: 10.1186/s40795-020-00342-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/10/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is highly prevalent in women, and living in a tropical country with a year-round abundance of sunlight as the primary source of vitamin D does not seem to guarantee adequate serum 25(OH)D. While living in the tropics, Minangkabau women are known to dress specifically according to their culture. This study was aimed to elucidate the association of sunlight exposed body surface area with serum 25(OH)D in pregnant Minangkabau women of Indonesia. METHODS We performed a cross-sectional study on 88 Minangkabau women in late pregnancy. Lifestyle data were collected using a questionnaire, and dietary intake of vitamin D was calculated from 24-h food recall. The skin pigmentation type was determined by the Fitzpatrick scale, and the body surface area exposed to sunlight was estimated. Serum 25(OH)D was quantified by ELISA method. Serum 25(OH)D differences according to the duration of sunlight exposure, skin pigmentation type, and sunscreen use were statistically analyzed by ANOVA. The correlation of sunlight exposed body surface area and serum 25(OH)D was analyzed by Spearman's correlation. RESULTS Nearly half of the subjects (n = 40; 45.5%) were deficient in vitamin D (< 20 ng/ml) with serum 25(OH)D level 23.0 ± 10.0 ng/ml (mean ± SD) and the estimated daily intake of vitamin D was 5.6 ± 3.9 μg/1000 kcal/day (mean ± SD). The median percentage of body area exposed to sunlight was 15.8%. There were no differences in serum 25(OH)D levels according to sunlight exposure time, skin pigmentation type, and sunscreen use. The percentage of body area exposed to sunlight was positively correlated with serum 25(OH)D level (Spearman's ρ = 0.403; p < 0.001). CONCLUSIONS Vitamin D deficiency is prevalent in pregnant Minangkabau women. Since increasing body surface area exposed to sunlight may not be culturally acceptable, vitamin D supplementation needs to be considered in this population.
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Affiliation(s)
- Cimi Ilmiawati
- Department of Pharmacology, Faculty of Medicine, Andalas University, Gedung A, Lantai 1, Main Campus Limau Manis, Pauh, PO. BOX 49, Padang, West Sumatra 25166 Indonesia
| | - Athica Oviana
- Graduate Program of Midwifery, Faculty of Medicine, Andalas University, Padang, West Sumatra Indonesia
- School of Midwifery, STIKes Perintis, Padang, West Sumatra Indonesia
| | - Andi Friadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Andalas University, Padang, West Sumatra Indonesia
| | - Mohamad Reza
- Department of Biology, Faculty of Medicine, Andalas University, Padang, West Sumatra Indonesia
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Griffin TP, Wall D, Blake L, G Griffin D, Robinson S, Bell M, Mulkerrin EC, O'Shea PM. Higher risk of vitamin D insufficiency/deficiency for rural than urban dwellers. J Steroid Biochem Mol Biol 2020; 197:105547. [PMID: 31756419 DOI: 10.1016/j.jsbmb.2019.105547] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 12/11/2022]
Abstract
There are many risk factors for Vitamin D deficiency. This study aimed to compare the Vitamin D status and serum 25(OH)D concentrations of adults living in an urban area to adults living in a rural area in the West of Ireland (latitude 53.27° North). A cross-sectional retrospective analysis of clinical records was performed. Following interrogation of the electronic laboratory information system, individuals who had serum 25(OH)D concentrations measured at Galway University Hospitals between January 2011 and December 2015 were identified. Clinical demographics, setting and date of sampling were recorded. In total, 17,590 patients (urban n = 4,824; rural n = 12,766) were eligible for inclusion. Serum 25(OH)D concentrations were lower among rural compared to urban dwellers irrespective of season (spring p < 0.001, summer p = 0.009, autumn p = 0.002, winter p < 0.001). There was a significant difference in Vitamin D status between urban and rural dwellers in three of the four seasons: spring- deficiency: 16%-v-23%, insufficiency: 39%-v-43%, sufficiency: 45%-v-35% (p < 0.001); autumn- deficiency: 11%-v-10%, insufficiency: 30%-v-35%, sufficiency: 59%-v-56% (p = 0.01); winter- deficiency: 23%-v-25%, insufficiency: 35%-v-42%, sufficiency: 41%-v-33% (p < 0.001). Serum 25(OH)D concentrations were higher and the prevalence of deficiency lower in urban/rural females compared to urban/rural males (p < 0.001). Serum 25(OH)D concentrations increased sequentially from the 18-39 year age group to the 60-69 year age group in both urban (p < 0.001) and rural (p < 0.001) dwellers and then decreased progressively as age increased to ≥90 years. The odds of Vitamin D deficiency increased with age, lower daily sunshine hours, male gender, rural address and season.
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Affiliation(s)
- Tomás P Griffin
- Regenerative Medicine Institute at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland; Centre for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Deirdre Wall
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Liam Blake
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
| | - Damian G Griffin
- Regenerative Medicine Institute at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland; Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
| | - Stephanie Robinson
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland
| | - Marcia Bell
- Regenerative Medicine Institute at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Eamon C Mulkerrin
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland
| | - Paula M O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland.
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Bosha T, Lambert C, Riedel S, Gola U, Melesse A, Biesalski HK. Validation of the CIMI-Ethiopia Program and Seasonal Variation in Maternal Nutrient Intake in Enset (False Banana) Growing Areas of Southern Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2852. [PMID: 31405023 PMCID: PMC6719118 DOI: 10.3390/ijerph16162852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tools for the rapid and accurate analysis of nutrient intakes from diets of individuals in Southern Ethiopia are lacking. The Calculator of Inadequate Micronutrient Intake program for Ethiopia (CIMI-Ethiopia) has been developed to overcome this problem. CIMI-Ethiopia also computes protein and energy intakes from the diet. The objectives of the current study were to validate CIMI-Ethiopia for the dietary pattern of Southern Ethiopia, and assess the nutrient intakes in postharvest dry and lean wet seasons. METHODS 24-h dietary recall (24HR) data was collected from 578 women of a reproductive age in postharvest dry and lean wet seasons in 2017. For analysis, 24HR data was entered into NutriSurvey (NS), which was the reference nutrition software, and then into CIMI-Ethiopia. For validation, the mean and standard deviation (SD) of the difference between CIMI-Ethiopia and NS were computed. The percentage of participants with an inadequate intake was calculated. The correlation between CIMI-Ethiopia and NS results was determined. The nutrient intakes in postharvest dry and lean seasons were compared. RESULTS Among the nutrients, pantothenic acid, vitamin B1, and protein showed a very high accuracy in CIMI-Ethiopia calculation (|difference (D)| < 5.0% of the NS result). Nutrients with a good accuracy (|D| = 5%-15%) were iron, zinc, magnesium, vitamin B12, vitamin B6, and energy. The accuracy for calcium, niacin, and vitamin A was moderate (|D| = 15%-30%). The intakes calculated by CIMI-Ethiopia and NS of iron, zinc, magnesium, calcium, B-complex vitamins, vitamin A, protein, and energy were highly correlated (r = 0.85-0.97, p < 0.001). NS analysis identified a significant reduction in the mean intake of iron; zinc; magnesium; pantothenic acid; vitamin B1, B12, and D; protein; and energy in the lean wet season; however, calcium and vitamin A intake increased. CONCLUSIONS It has been found that CIMI-Ethiopia is a valid tool for estimating nutrient intakes at an individual level in Southern Ethiopia. The study demonstrated a decline in intakes of iron; zinc; magnesium; pantothenic acid; vitamin B1, B12, and D; protein; and energy in the lean wet season. This result provides some hint for fortification and supplementation programs that aim to combat maternal malnutrition in rural Southern Ethiopia.
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Affiliation(s)
- Tafese Bosha
- Institute of Nutritional Sciences, University of Hohenheim, Garbenstr. 30, 70593 Stuttgart, Germany.
- College of Agriculture, Hawassa University, P.O. Box 5, Hawassa, Ethiopia.
| | - Christine Lambert
- Institute of Nutritional Sciences, University of Hohenheim, Garbenstr. 30, 70593 Stuttgart, Germany
| | - Simon Riedel
- Institute of Nutritional Sciences, University of Hohenheim, Garbenstr. 30, 70593 Stuttgart, Germany
| | - Ute Gola
- Day Med Concept GmbH, Garbatyplatz 2, 13187 Berlin, Germany
| | - Aberra Melesse
- College of Agriculture, Hawassa University, P.O. Box 5, Hawassa, Ethiopia
| | - Hans K Biesalski
- Institute of Nutritional Sciences, University of Hohenheim, Garbenstr. 30, 70593 Stuttgart, Germany
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Bodin J, Mihret A, Holm-Hansen C, Dembinski JL, Trieu MC, Tessema B, Tarekegne A, Yimer SA, Cox R, Aseffa A, Haneberg B, Mjaaland S. Vitamin D Deficiency is Associated with Increased Use of Antimicrobials among Preschool Girls in Ethiopia. Nutrients 2019; 11:nu11030575. [PMID: 30866564 PMCID: PMC6471093 DOI: 10.3390/nu11030575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 12/12/2022] Open
Abstract
Preschool children in Addis Ababa, Ethiopia, are highly exposed to influenza viruses. Factors related to infections, nutrition, and environmental conditions that might explain the burden of influenza among these children were investigated. Ninety-five preschool children, 48 girls and 47 boys, were followed clinically for 12 months. Illness and immune responses to influenza; three other respiratory viruses; five airway pathogenic bacteria; and levels of vitamins D, A, and B12 were assessed. Most of the children had antibodies to numerous respiratory viral and bacterial agents at study start, and many were infected during follow-up. Twenty-five girls and 25 boys fell ill during the study, and were treated with one or more courses of systemic antimicrobials. Ninety percent of both girls and boys had 25-hydroxyvitamin D [25(OH)D] levels below the recommended levels. While there was no overall difference in the levels of vitamins D, A, and B12 between girls and boys, treated girls had significantly lower 25(OH)D levels than non-treated girls and treated boys. There was a considerable number of short for age children, but only the short treated girls had significantly lower 25(OH)D levels than the non-treated children. Preschool girls with low 25(OH)D levels were more vulnerable to pathogenic microbes than boys.
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Affiliation(s)
- Johanna Bodin
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0316 Oslo, Norway.
| | - Adane Mihret
- Armauer Hansen Research Institute, 1005 Addis Ababa, Ethiopia.
| | - Carol Holm-Hansen
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Jennifer L Dembinski
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- Department of Virology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Mai-Chi Trieu
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0316 Oslo, Norway.
- The Influenza Centre and Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Bamlak Tessema
- Armauer Hansen Research Institute, 1005 Addis Ababa, Ethiopia.
| | - Azeb Tarekegne
- Armauer Hansen Research Institute, 1005 Addis Ababa, Ethiopia.
| | - Solomon A Yimer
- Coalition for Epidemic Preparedness Innovations (CEPI), 0306 Oslo, Norway.
- Department of Microbiology, University of Oslo, 0316 Oslo, Norway.
| | - Rebecca Cox
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0316 Oslo, Norway.
- The Influenza Centre and Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Abraham Aseffa
- Armauer Hansen Research Institute, 1005 Addis Ababa, Ethiopia.
| | - Bjørn Haneberg
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Siri Mjaaland
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0316 Oslo, Norway.
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Ahmed JH, Makonnen E, Fotoohi A, Yimer G, Seifu D, Assefa M, Tigeneh W, Aseffa A, Howe R, Aklillu E. Vitamin D Status and Association of VDR Genetic Polymorphism to Risk of Breast Cancer in Ethiopia. Nutrients 2019; 11:nu11020289. [PMID: 30699973 PMCID: PMC6412905 DOI: 10.3390/nu11020289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Emerging evidence associates vitamin D deficiency and vitamin D receptor (VDR) genetic variations with risk for breast cancer. This study investigated the prevalence of vitamin D deficiency and its association with tumor characteristics and the implications of VDR genetic variations for risk of breast cancer in Ethiopia. This unmatched case–control study involved 392 female breast cancer patients and 193 controls. The plasma 25-hydroxyvitamin D (25(OH)D3) level was quantified in chemotherapy-naïve (N = 112) and tamoxifen-treated patients (N = 89). Genotyping for the VDR common variant alleles rs7975232 (ApaI), rs2228570 (FokI), and rs731236 (TaqI) was done. Eighty-six percent of the patients were vitamin D deficient (<50 nmol/L). Chemotherapy-naïve breast cancer patients had a higher prevalence of vitamin D deficiency (91.9% vs. 78.3%) compared to the tamoxifen-treated group (p < 0.001). The prevalence of severe vitamin D deficiency (<25 nmol/L) was significantly higher in chemotherapy-naïve (41.1%) than tamoxifen-treated (11.2%) patients. Vitamin D deficiency was not significantly associated with tumor characteristics or VDR genotype. The rs2228570 GG genotype was associated with increased risk of breast cancer (OR = 1.44, 95% confidence interval = 1.01−2.06). Our result indicates that rs2228570 might be a moderate risk factor for breast cancer development in the Ethiopian population. The high prevalence of severe vitamin D deficiency in treatment-naïve breast cancer patients indicates the need for nutritional supplementation of vitamin D at the time of chemotherapy initiation.
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Affiliation(s)
- Jemal Hussien Ahmed
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia.
- Department of Pharmacy, Jimma University, P.O. Box 378 Jimma, Ethiopia.
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
| | - Eyasu Makonnen
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia.
- Center for Innovative Drug Development and Therapeutic Trials, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia.
| | - Alan Fotoohi
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
- Division of Clinical Pharmacology, Department of Medicine, Karolinska Institutet, 171 76 Solna, Stockholm, Sweden.
| | - Getnet Yimer
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia.
- Ohio State Global One Health initiative, Office of international affairs, Ohio State University, Pobox 9842 Addis Ababa, Ethiopia.
| | - Daniel Seifu
- Department of Biochemistry, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia.
| | - Mathewos Assefa
- Radiotherapy center, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia.
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, P.O. Box 1005 Addis Ababa, Ethiopia.
| | - Rawleigh Howe
- Armauer Hansen Research Institute, P.O. Box 1005 Addis Ababa, Ethiopia.
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
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Vitamin D Deficiency among Patients with Tuberculosis: a Cross-Sectional Study in Iranian-Azari Population. TANAFFOS 2019; 18:11-17. [PMID: 31423135 PMCID: PMC6690331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vitamin D deficiency or insufficiency has been conducted with increased risk for tuberculosis (TB). Despite this association, discrepancies exist among different studies in different regions. The aim of this study was to evaluate the prevalence of vitamin D deficiency and its predictors in tuberculosis among the Iranian-Azari population. MATERIALS AND METHODS A total of 60 participants were enrolled in this study, 30 of which were newly diagnosed TB patients and 30 were healthy volunteers. At least two serum samples were collected, the first sample before the start of anti-TB treatment and the second sample 3 months after the effective treatment. RESULTS The prevalence of vitamin D deficiency (25 patients vs. 2 healthy individuals; P<0.001) and serum levels of the vitamin D (22.66±15.17 vs. 73.03±25.6 ng/mL; P<0.001) were significantly higher in patients with TB than healthy subjects. Likewise, the prevalence of vitamin D deficiency in the extrapulmonary TB group was higher than that of the pulmonary TB, but this difference was not statistically significant (P=0 .397). Moreover, there was no significant difference between mean levels of vitamin D in patients with tuberculosis before and after treatment (P = 0.787). Linear regression analysis showed there was no significant relationship between vitamin D levels after treatment and age, gender, body site of tuberculosis, and vitamin D levels before treatment, P≥0.68. CONCLUSION Vitamin D deficiency is higher in patients with tuberculosis than healthy individuals.
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AlQuaiz AM, Kazi A, Fouda M, Alyousefi N. Age and gender differences in the prevalence and correlates of vitamin D deficiency. Arch Osteoporos 2018; 13:49. [PMID: 29705881 DOI: 10.1007/s11657-018-0461-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/08/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Younger adults and males had a higher prevalence of vitamin D deficiency compared to older participants and females. Low intake of milk, central obesity, and lack of use of vitamin D supplements were associated with vitamin D deficiency, highlighting potentially important avenues for preventive intervention. BACKGROUND Vitamin D deficiency is a public health concern. This study's objective was to measure the prevalence of vitamin D deficiency and determine its correlates among Saudi adults in Riyadh, Saudi Arabia. METHODS A cross-sectional study was conducted with 2835 Saudi males and females aged 30-75 years in 18 different primary health care centers (PHCC) in Riyadh. Detailed interviews on sociodemographic and lifestyle factors and anthropometric measurements were conducted. Serum calcium, phosphorus, parathyroid, alkaline phosphatase, and 25(OH) vitamin D were measured. Multiple logistic regression analyses were conducted. RESULTS The mean age (SD) of male and female participants was 43.0 (± 11.7) and 42.8 (± 10.3) years, respectively. Serum 25(OH) vitamin D assays for participants revealed that 72.0% (n = 695) of males and 64.0% (n = 1191) of females had levels < 50 nmol/L (deficiency), whereas 17.3% (n = 166) and 19.4% (n = 362), respectively, had levels of 50-75 nmol/L (insufficiency). Multivariate analyses for males revealed that lack of use of vitamin D supplements [adjusted odds ratio (aOR) = 4.0, 95% CI 1.7, 9.4], younger age [30-40 years aOR = 3.6, 95% CI 1.7, 7.3 and 41-50 years aOR = 4.2, 95% CI 2.0, 8.8], low milk intake [aOR = 1.7, 95% CI 1.0, 2.8], consumption of cola drinks [aOR = 2.0, 95% CI 1.1, 3.9], and central obesity [aOR = 1.8, 95% CI 1.0, 3.4] were associated with low vitamin D. In females, lack of use of vitamin D supplements [aOR = 3.7, 95% CI 2.8, 4.9], younger age [30-40 years aOR = 3.4, 95% CI 2.0, 5.8 and 41-50 years aOR = 2.8, 95% CI 1.6, 4.7], central obesity [aOR = 1.4, 95% CI 1.0, 2.2], and seasonal variation [aOR = 1.6, 95% CI 1.3, 2.1] had higher odds for vitamin D deficiency. Significantly lower levels were observed for men than women for mean serum 25(OH) vitamin D [42.6 (± 24.1) vs. 46.8 (± 30.5)], parathyroid hormone [5.3 (± 2.9) vs. 5.9 (± 2.7)], and phosphorus [1.1 (± 0.2) vs. 1.2 (± 0.2)], respectively; alkaline phosphatase levels [106 (± 32.8) vs. 99 (± 27.8)] [p < 0.01] were significantly higher in males than females. CONCLUSION Vitamin D deficiency was highly prevalent, particularly among young adults and those with central obesity. Proper fortification policy, health education, and regular screening PHCCs may help prevent and treat vitamin D deficiency.
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Affiliation(s)
- AlJohara M AlQuaiz
- Princess Nora Bent Abdallah Chair for Women's Health Research, Research Chairs program, College of Medicine, King Saud University, PO Box 231831, Riyadh, 11321, Kingdom of Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ambreen Kazi
- Princess Nora Bent Abdallah Chair for Women's Health Research, Research Chairs program, College of Medicine, King Saud University, PO Box 231831, Riyadh, 11321, Kingdom of Saudi Arabia. .,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Mona Fouda
- Princess Nora Bent Abdallah Chair for Women's Health Research, Research Chairs program, College of Medicine, King Saud University, PO Box 231831, Riyadh, 11321, Kingdom of Saudi Arabia.,Department of Endocrinology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nada Alyousefi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Mandlik R, Kajale N, Ekbote V, Patwardhan V, Khadilkar V, Chiplonkar S, Khadilkar A. Determinants of Vitamin D Status in Indian School-children. Indian J Endocrinol Metab 2018; 22:244-248. [PMID: 29911039 PMCID: PMC5972482 DOI: 10.4103/ijem.ijem_622_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Due to the high prevalence of Vitamin D deficiency in spite of abundant sunshine and scarcity of studies investigating Vitamin D status in Indian children from rural and semirural areas, the objectives of this cross-sectional study were to: (1) assess the Vitamin D status of school-children in a semi-rural setting and (2) identify the determinants of Vitamin D status in these children. MATERIALS AND METHODS Data collected included anthropometric measurements (height and weight), body composition, three-one-day dietary recall method, demographic data, and sunlight exposure. Serum 25-hydroxyVitamin D (25(OH)D) was estimated by enzyme-linked immunosorbent assay (ELISA) technique. SPSS software was used for statistical analysis. RESULTS Anthropometric characteristics of the children were similar and mean serum 25(OH)D concentration was 58.5 ± 10.3 nmol/L with no significant differences between genders. Around 80% children reported sunlight exposure of 2 h or more. A majority (71%) of children were Vitamin D insufficient with serum 25(OH)D concentrations between 50 and 74.9 nmol/L. Determinants of Vitamin D identified were duration of sunlight exposure and body fat percent. Significant (P < 0.05) positive association of duration of sunlight exposure was observed with serum 25(OH)D concentrations, while BF% showed a negative association with serum 25(OH)D (β = -0.307; standard error = 0.1388; P < 0.05). DISCUSSION We have reported a high prevalence of Vitamin D insufficiency in school-children aged 6-12 years, from a semirural setting, in spite of a majority (80%) reporting >2 h of sunlight exposure. We have also demonstrated that duration of sunlight exposure and body fat percentage are the two important determinants of serum 25(OH)D concentrations in these children.
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Affiliation(s)
- Rubina Mandlik
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vivek Patwardhan
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
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Current Evidence on Vitamin D Deficiency and Metabolic Syndrome in Obese Children: What Does the Evidence from Saudi Arabia Tell Us? CHILDREN-BASEL 2018; 5:children5010011. [PMID: 29342981 PMCID: PMC5789293 DOI: 10.3390/children5010011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/23/2017] [Accepted: 01/11/2018] [Indexed: 01/12/2023]
Abstract
Obesity and vitamin D deficiency represent major health problems among Saudi children, and have been linked to chronic diseases. Obese children are at risk of developing vitamin D deficiency, which appears to have negative influences on energy homeostasis, impeded bone mineralisation, insulin resistance and inflammation. Evidence supporting the association between vitamin D deficiency of obese children and metabolic syndrome has not specifically been studied in early childhood. The mechanisms through which vitamin D deficiency is associated with metabolic syndrome in obese children needs further elucidation. This commentary aims to (i) summarise current knowledge of the association between vitamin D deficiency and metabolic syndrome in obese children; and (ii) discuss current evidence for the association among Saudi Arabian children.
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CRP Genotypes Predict Increased Risk to Co-Present with Low Vitamin D and Elevated CRP in a Group of Healthy Black South African Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010111. [PMID: 29320465 PMCID: PMC5800210 DOI: 10.3390/ijerph15010111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/15/2017] [Accepted: 12/30/2017] [Indexed: 01/07/2023]
Abstract
Low 25-hydroxyvitamin D (25(OH)D) and elevated C-reactive protein (CRP) concentrations are independently associated with adverse health outcomes, including cardiovascular disease (CVD). Although an inverse association between these factors has been described, the underlying mechanisms remain unknown. We postulate that environment-gene interactions, through which 25(OH)D interacts with single nucleotide polymorphisms (SNPs) within the CRP gene, modulate CRP; that certain CRP genotypes predispose individuals to a co-phenotype of low 25(OH)D and elevated CRP concentrations; and that this co-phenotype is associated with higher CVD risk. Twelve CRP SNPs were genotyped, and both 25(OH)D and CRP were quantified, in 505 black South African women. Alarmingly, 66% and 60% of the women presented with deficient/insufficient 25(OH)D and elevated CRP concentrations, respectively. CRP concentrations were higher in individuals with lower 25(OH)D concentrations. However, no 25(OH)D-CRP genotype interactions were evident. Several genotypes were associated with an altered risk of presenting with the co-phenotype, indicating a genetic predisposition. Women presenting with this co-phenotype had higher blood pressure and increased anthropometric measures, which may predispose them to develop CVD. We recommend increasing vitamin D fortification and supplementation efforts to reduce inflammation among black women with vitamin D deficiency, thereby possibly curbing diseases contingent on the co-phenotype described here.
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Abstract
Rickets is a bone disease associated with abnormal serum calcium and phosphate levels. The clinical presentation is heterogeneous and depends on the age of onset and pathogenesis but includes bowing deformities of the legs, short stature and widening of joints. The disorder can be caused by nutritional deficiencies or genetic defects. Mutations in genes encoding proteins involved in vitamin D metabolism or action, fibroblast growth factor 23 (FGF23) production or degradation, renal phosphate handling or bone mineralization have been identified. The prevalence of nutritional rickets has substantially declined compared with the prevalence 200 years ago, but the condition has been re-emerging even in some well-resourced countries; prematurely born infants or breastfed infants who have dark skin types are particularly at risk. Diagnosis is usually established by medical history, physical examination, biochemical tests and radiography. Prevention is possible only for nutritional rickets and includes supplementation or food fortification with calcium and vitamin D either alone or in combination with sunlight exposure. Treatment of typical nutritional rickets includes calcium and/or vitamin D supplementation, although instances infrequently occur in which phosphate repletion may be necessary. Management of heritable types of rickets associated with defects in vitamin D metabolism or activation involves the administration of vitamin D metabolites. Oral phosphate supplementation is usually indicated for FGF23-independent phosphopenic rickets, whereas the conventional treatment of FGF23-dependent types of rickets includes a combination of phosphate and activated vitamin D; an anti-FGF23 antibody has shown promising results and is under further study.
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Wakayo T, Belachew T, Whiting SJ. Serum Vitamin D Level Associates With Handgrip Muscle Strength Among Ethiopian Schoolchildren: A Cross-Sectional Study. Food Nutr Bull 2017; 39:54-64. [PMID: 28823213 DOI: 10.1177/0379572117724545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite varying serum levels of 25(OH)D among schoolchildren in Ethiopia, data are lacking whether this affects their muscle function as measured by handgrip strength of these children. Handgrip strength may be used as a proxy indicator of muscle strength and function. This study evaluated the association between serum levels of 25(OH)D and handgrip strength among schoolchildren in Ethiopia. METHODS The study used a data set from a school-based cross-sectional study conducted on a total of 174 randomly selected schoolchildren from urban (N = 89) and rural (N = 85) settings of Adama Town and Adama Woreda, respectively. Handgrip strength, serum 25(OH)D levels, and anthropometry were measured for each child following standard procedures, while data on demographic characteristics of children and their parents were collected using a structured interviewer-administered questionnaire. A multivariable linear regression model was used to determine the association between serum vitamin D level and handgrip strength after adjusting for other predictors. RESULTS The mean handgrip muscle strength of the students was 17.6 ± 6.9 kg. The average serum 25(OH)D for the group was 54.5 ± 15.8 nmol/L. On multivariable linear regression model, serum 25(OH)D level was significantly associated with handgrip strength (β = 0.06, P = .008) of the children after controlling for potential confounders. Other variables, female gender (β = -2.20, P = .004), age (β = 1.97, P < .001), height (β = .22, P < .001), weight (β = 0.33, P < .001), and triceps skinfold thickness (β = -0.19, P = .023), were identified to have significant association with handgrip strength of schoolchildren. CONCLUSION Serum 25(OH)D levels had significant positive association with handgrip strength of Ethiopian schoolchildren. The results imply the need for incorporating school nutrition education on consumption of foods rich in important nutrients including vitamin D-rich foods in the school curricula and also enhancing behavioral change communication toward exposure to sunlight in the school to produce adequate vitamin D. Further longitudinal study involving a larger sample is recommended to confirm the findings.
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Affiliation(s)
- Tolassa Wakayo
- 1 College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- 1 College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Susan J Whiting
- 2 College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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Tessema B, Moges F, Habte D, Hiruy N, Yismaw S, Melkieneh K, Kassie Y, Girma B, Melese M, Suarez PG. Vitamin D deficiency among smear positive pulmonary tuberculosis patients and their tuberculosis negative household contacts in Northwest Ethiopia: a case-control study. Ann Clin Microbiol Antimicrob 2017; 16:36. [PMID: 28490367 PMCID: PMC5426057 DOI: 10.1186/s12941-017-0211-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 05/04/2017] [Indexed: 01/13/2023] Open
Abstract
Background Vitamin D is a fat-soluble vitamin that increases the immunity against tuberculosis (TB), decreases the re-activation of latent TB and reduces the severity of active TB disease. Epidemiological studies on the prevalence of vitamin D deficiency, and its association with TB showed inconsistent results in different countries. This study was aimed to determine the prevalence of vitamin D deficiency and its association with TB in Northwest Ethiopia. Methods A case–control study was conducted among smear positive pulmonary tuberculosis patients and their household contacts without symptoms suggestive of TB. Study participants were recruited at 11 TB diagnostic health facilities in North and South Gondar zones of Amhara region between May 2013 and April 2015. The spot-morning-spot sputum samples and 5 ml blood sample were collected prior to commencing TB treatment for the diagnosis of TB and serum vitamin D assay, respectively. The diagnosis of TB was performed using smear microscopy and GeneXpert. Serum vitamin D level was analyzed using VIDAS 25 OH Vitamin D Total testing kits (Biomerieux, Marcy I’Etoile, France) on mini VIDAS automated immunoassay platform. Vitamin D status was interpreted as deficient (<20 ng/ml), insufficient (20–29 ng/ml), sufficient (30–100 ng/ml) and potential toxicity (>100 ng/ml). Results Of the total study participants, 134 (46.2%) were vitamin D deficient, and only 56 (19.3%) had sufficient vitamin D level. A total of 59 (61.5%) TB patients and 75 (38.7%) non TB controls were vitamin D deficient. Results of multivariate logistic regression analyses showed a significantly higher vitamin D deficiency among tuberculosis cases (p < 0.001), females (p = 0.002), and urban residents (p < 0.001) than their respective comparison groups. Moreover, age groups of 35–44 (p = 0.001), 45–54 (p = 0.003) and ≥55 (p = 0.001) years had significantly higher vitamin D deficiency compared with age group <15 years. Conclusions Vitamin D deficiency is highly prevalent among TB patients and non TB controls in Ethiopia where there is year round abundant sunshine. Study participants with tuberculosis, females, older age groups, and urban residents had significantly higher prevalence of vitamin D deficiency. These findings warrant further studies to investigate the role of vitamin D supplementation in the prevention and treatment of tuberculosis in high TB burden countries like Ethiopia.
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Affiliation(s)
- Belay Tessema
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Feleke Moges
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Habte
- Management Sciences for Health, Help Ethiopia Address the Low Performance of Tuberculosis (HEAL TB) Project, Addis Ababa, Ethiopia
| | - Nebiyu Hiruy
- Management Sciences for Health, Help Ethiopia Address the Low Performance of Tuberculosis (HEAL TB) Project, Addis Ababa, Ethiopia
| | - Shewaye Yismaw
- Department of Chemistry, College of Natural and Computational Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Melkieneh
- Management Sciences for Health, Help Ethiopia Address the Low Performance of Tuberculosis (HEAL TB) Project, Addis Ababa, Ethiopia
| | | | - Belaineh Girma
- Monitoring and Evaluation TA, National Tuberculosis Program, Lilongwe, Malawi
| | - Muluken Melese
- Management Sciences for Health, Help Ethiopia Address the Low Performance of Tuberculosis (HEAL TB) Project, Addis Ababa, Ethiopia
| | - Pedro G Suarez
- Management Sciences for Health, Health Programs Group, Arlington, VA, USA
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Creo AL, Thacher TD, Pettifor JM, Strand MA, Fischer PR. Nutritional rickets around the world: an update. Paediatr Int Child Health 2017; 37:84-98. [PMID: 27922335 DOI: 10.1080/20469047.2016.1248170] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Worldwide, nutritional rickets continues to be an evolving problem with several causes. This paper provides an updated literature review characterising the prevalence, aetiology, pathophysiology and treatment of nutritional rickets worldwide. A systematic review of articles on nutritional rickets from various geographical regions was undertaken. For each region, key information was extracted, including prevalence, cause of rickets specific to the region, methods of confirming the diagnosis and current treatment and preventive measures. Calcium deficiency continues to be a major cause of rickets in Africa and Asia. Vitamin D deficiency rickets is perhaps increasing in the Americas, Europe and parts of the Middle East. There continues to be a distinct presentation of calcium-predominant versus vitamin D predominant rickets, although there are overlapping features. More careful diagnosis of rickets and reporting of 25-OHD concentrations has improved accurate knowledge of rickets prevalence and better delineated the cause. Nutritional rickets continues to be an evolving and multi-factorial problem worldwide. It is on a spectrum, ranging from isolated vitamin D deficiency to isolated calcium deficiency. Specific areas which require emphasis include a consistent community approach to screening and diagnosis, vitamin D supplementation of infants and at-risk children, prevention of maternal vitamin D deficiency and the provision of calcium in areas with low calcium diets.
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Affiliation(s)
- Ana L Creo
- a Department of Pediatric and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA
| | - Tom D Thacher
- b Department of Family Medicine , Mayo Clinic , Rochester , MN , USA
| | - John M Pettifor
- c Wits/SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics , University of the Witwatersrand , Johannesburg , South Africa
| | - Mark A Strand
- d Pharmacy Practice, Department of Public Health , North Dakota State University , Fargo , ND , USA
| | - Philip R Fischer
- a Department of Pediatric and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA
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Giudici KV, Fisberg RM, Marchioni DM, Martini LA. Comparisons of physical activity, adipokines, vitamin D status and dietary vitamin D intake among adolescents. J Hum Nutr Diet 2016; 30:369-377. [PMID: 27779331 DOI: 10.1111/jhn.12434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Considering that lifestyle and diet are key factors responsible for the increases in adiposity in youth, it is important to understand how vitamin D, adipokines and markers of glucose metabolism are related to physical activity level (PAL) during growth. The present study aimed to investigate associations between physical activity level, adiponectin/leptin ratio, vitamin D status and dietary vitamin D intake among adolescents. METHODS A cross-sectional study was conducted with adolescents aged 14-18 years old who were living in São Paulo, Brazil. Serum 25 hydroxyvitamin D [25(OH)D], adiponectin (A), leptin (L), glucose and insulin were obtained after 12 h of fasting. Dietary calcium and vitamin D intake were measured by 24-h food record, as repeated in 62.6% of the sample. PAL was measured by the International Physical Activity Questionnaire (IPAQ). Pearson's chi-square test, Pearson correlation and linear regression analysis were performed. RESULTS A total of 198 subjects, mean (SD) age 16.3 (1.4) years, 51% male, were enrolled in the study. Some 9% of participants were sedentary, 22% were insufficiently active (IA), 51% were active and 18% were very active (VA). The A/L ratio was lower among sedentary/IA subjects [2.2 (4.0) versus 5.6 (12.3); P = 0.01] compared to active/VA subjects. PAL was not associated with vitamin D status or markers of glucose metabolism. Serum 25(OH)D positively associated with vitamin D intake, after adjusting for sex, sun exposure and season of the year in regression analysis (partial r2 =0.026, P = 0.02). CONCLUSIONS Low PAL was associated with a lower A/L ratio. Vitamin D status was not associated with sun exposure habits, although it was positively correlated with vitamin D intake.
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Affiliation(s)
- K V Giudici
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - R M Fisberg
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - D M Marchioni
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - L A Martini
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
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Association between serum levels of bioavailable vitamin D and negative symptoms in first-episode psychosis. Psychiatry Res 2016; 243:390-4. [PMID: 27449008 DOI: 10.1016/j.psychres.2016.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/20/2016] [Accepted: 07/03/2016] [Indexed: 01/01/2023]
Abstract
Total vitamin D levels had been commonly reported to be lowered in patients with chronic psychotic illnesses in countries from the higher latitudes. However, studies on patients with first episode psychosis (FEP) are limited. In this study we investigated serum concentrations of total and bioavailable vitamin D levels in FEP patients compared to healthy controls and the association between symptom severity and vitamin D components. A total of 31 FEP patients and 31 healthy controls were recruited from Institute of Mental Health, Singapore. FEP patients were identified using Structured Clinical Interview for DSM-IV Axis I disorders (SCID-1) and severity symptoms were assessed using the positive and negative syndrome scale (PANSS). Sera from participants were analyzed for total vitamin D, vitamin D-binding protein (DBP) and bioavailable vitamin D. Linear regressions were performed to examine the associations between serum total and bioavailable vitamin D and the PANSS subscales. Current study noted a significantly lower bioavailable vitamin D was in the FEP group and an association between bioavailable vitamin D and negative symptoms in FEP patients in a population with a consistent supply of sun exposure throughout the year.
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Nylén H, Habtewold A, Makonnen E, Yimer G, Bertilsson L, Burhenne J, Diczfalusy U, Aklillu E. Prevalence and risk factors for efavirenz-based antiretroviral treatment-associated severe vitamin D deficiency: A prospective cohort study. Medicine (Baltimore) 2016; 95:e4631. [PMID: 27559961 PMCID: PMC5400328 DOI: 10.1097/md.0000000000004631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Initiation of efavirenz-based combination antiretroviral therapy (cART) is associated with Vitamin D deficiency, but the risk factors including efavirenz pharmacokinetics for cART-induced severe vitamin D deficiency (SVDD) and the impact of anti-tuberculosis (TB) cotreatment are not explored. We investigated the prevalence of SVDD in HIV and TB-HIV coinfected patients and associated risk factors for treatment-induced SVDD.Treatment-naïve Ethiopian HIV patients with (n = 102) or without (n = 89) TB co-infection were enrolled prospectively and received efavirenz-based cART. In TB-HIV coinfected patients, rifampicin-based anti-TB treatment was initiated 4 or 8 weeks before starting cART. Plasma 25-hydroxyvitamin D (25 [OH]D), cholesterol and 4-beta hydroxycholesterol concentrations were measured at baseline, 4, 16, and 48 week of cART. Plasma efavirenz concentrations were determined at 4 and 16 weeks of cART.TB-HIV patients had significantly lower plasma 25 (OH)D3 levels than HIV-only patients at baseline. TB co-infection, low Karnofsky score, high viral load, and high CYP3A activity as measured by plasma 4β-hydroxycholesterol/cholesterol ratios were significant predictors of low 25 (OH)D3 levels at baseline. In HIV-only patients, initiation of efavirenz-based cART increased the prevalence of SVVD from 27% at baseline to 76%, 79%, and 43% at 4, 16, and 48 weeks of cART, respectively. The median 25 (OH)D3 levels declined from baseline by -40%, -50%, and -14% at 4, 16, and 48 weeks of cART, respectively.In TB-HIV patients, previous anti-TB therapy had no influence on 25 (OH)D3 levels, but the initiation of efavirenz-based cART increased the prevalence of SVDD from 57% at baseline to 70% and 72% at the 4 and 16 weeks of cART, respectively. Median plasma 25 (OH)D3 declined from baseline by -17% and -21% at week 4 and 16 of cART, respectively.Our results indicate low plasma cholesterol, high CYP3A activity, and high plasma efavirenz concentrations as significant predictors of early efavirenz-based cART-induced vitamin D deficiency. Low plasma 25 (OH)D3 level at baseline is associated with TB co-infection and HIV diseases progression. Initiation of efavirenz-based cART is associated with high incidence of SVDD, whereas rifampicin based anti-TB therapy co-treatment has no significant effect. Supplementary vitamin D during cART initiation may be beneficial for HIV patients regardless of TB coinfection.
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Affiliation(s)
- Hanna Nylén
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Abiy Habtewold
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leif Bertilsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jürgen Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Ulf Diczfalusy
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Eleni Aklillu
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Correspondence: Professor Eleni Aklillu, Division of Clinical Pharmacology, Department of Laboratory of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge C-168, SE-141 86 Stockholm, Sweden (e-mail: )
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Vitamin D and Autism Spectrum Disorder: A Literature Review. Nutrients 2016; 8:236. [PMID: 27110819 PMCID: PMC4848704 DOI: 10.3390/nu8040236] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/08/2016] [Accepted: 04/14/2016] [Indexed: 12/16/2022] Open
Abstract
Low vitamin D status in early development has been hypothesised as an environmental risk factor for Autism Spectrum Disorder (ASD), given the concurrent increase in the prevalence of these two conditions, and the association of vitamin D with many ASD-associated medical conditions. Identification of vitamin D-ASD factors may provide indications for primary and secondary prevention interventions. We systematically reviewed the literature for studies on vitamin D-ASD relationship, including potential mechanistic pathways. We identified seven specific areas, including: latitude, season of conception/birth, maternal migration/ethnicity, vitamin D status of mothers and ASD patients, and vitamin D intervention to prevent and treat ASD. Due to differences in the methodological procedures and inconsistent results, drawing conclusions from the first three areas is difficult. Using a more direct measure of vitamin D status—that is, serum 25(OH)D level during pregnancy or childhood—we found growing evidence for a relationship between vitamin D and ASD. These findings are supported by convincing evidence from experimental studies investigating the mechanistic pathways. However, with few primary and secondary prevention intervention trials, this relationship cannot be determined, unless randomised placebo-controlled trials of vitamin D as a preventive or disease-modifying measure in ASD patients are available.
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Wakayo T, Whiting SJ, Belachew T. Vitamin D Deficiency is Associated with Overweight and/or Obesity among Schoolchildren in Central Ethiopia: A Cross-Sectional Study. Nutrients 2016; 8:190. [PMID: 27043619 PMCID: PMC4848659 DOI: 10.3390/nu8040190] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/19/2016] [Accepted: 03/22/2016] [Indexed: 12/11/2022] Open
Abstract
Childhood and adolescent obesity is an international public health problem leading to an increased risk of adulthood obesity, mortality and morbidity. Its prevalence is increasing in low-income populations, and we hypothesized it may be associated with vitamin D deficiency. Low vitamin D status is a worldwide public health issue including in Ethiopia; however, no one has examined overweight/obesity in Ethiopian schoolchildren with regard to vitamin D status. The Analyses of a data set from a school-based cross-sectional study conducted in Adama Town (n = 89) and in rural Adama Woreda (n = 85) was carried out to determine vitamin D deficiency and its association with overweight and/or obesity. Data on a total of 174 schoolchildren aged 11-18 years was used for these analyses. The overall prevalence of overweight and/or obesity was 10.3%, with 8.5% overweight and 2.3% obese; the prevalence of underweight was 19%. In the multivariable logistic regression model, vitamin D deficiency, being in the higher age group, female sex and urban residence of students, their mothers' occupation of being employed and their households' high and middle socioeconomic status were significantly associated with overweight and/or obesity. We concluded that vitamin D deficiency is an independent predictor significantly associated with overweight and/or obesity among schoolchildren from rural and urban settings in Ethiopia. The results imply the need for behavior change communications on the importance of exposure to sunlight to produce adequate vitamin D to curb this emerging health problem of overweight/obesity following economic growth and globalization in Ethiopia. As this study only highlighted the association, prospective studies and randomized controlled trials are required to establish causality.
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Affiliation(s)
- Tolassa Wakayo
- College of Health Sciences, Jimma University, Jimma, Ethiopia.
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada.
| | - Tefera Belachew
- College of Health Sciences, Jimma University, Jimma, Ethiopia.
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Predictors of Serum 25-Hydroxyvitamin D Concentrations among a Sample of Egyptian Schoolchildren. ScientificWorldJournal 2016; 2016:8175768. [PMID: 26942211 PMCID: PMC4749821 DOI: 10.1155/2016/8175768] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/21/2015] [Accepted: 12/30/2015] [Indexed: 12/31/2022] Open
Abstract
Objective. To assess the level of 25-hydroxyvitamin D status among a sample of Egyptian schoolchildren and to evaluate predictors of deficiency and insufficiency. Subjects and Methods. A cross-sectional study comprising 200 prepubescent schoolchildren aged from 9 to 11 years was performed. A questionnaire including frequency of midday sun exposure, milk intake, physical activity, and level of maternal education was taken. Body mass index (BMI) was calculated; serum 25-hydroxyvitamin D [25(OH)D], serum calcium, phosphorus, and parathyroid hormone were measured. Results. Vitamin D deficiency [serum 25(OH)D < 20 ng/mL] was detected in 11.5% of subjects while its insufficiency (serum 25(OH)D is between 20 and 29.9 ng/mL) was detected in 15%. Results revealed that obesity, low physical activity, low sun exposure, and low maternal education level are significant predictors of insufficiency, though female gender, low maternal education level, and low milk intake are significant predictors of deficiency. Lower serum phosphorus and higher serum parathyroid hormone were significantly associated with both deficiency and insufficiency (p < 0.05). Conclusion. Vitamin D deficiency and insufficiency are common among schoolchildren in Egypt. Food fortification, vitamin D supplementation, and increasing maternal awareness about the importance of physical activity and exposure of their children to ultraviolet light may help to overcome this problem.
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Kiggundu DS, Mutebi E, Kibirige D, Boxer R, Kakande B, Kigozi BK, Katabira E. Vitamin D deficiency and its characteristics among patients with acute stroke at a national referral hospital in Kampala Uganda. BMC Endocr Disord 2015; 15:53. [PMID: 26437924 PMCID: PMC4594645 DOI: 10.1186/s12902-015-0053-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/01/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Vitamin D deficiency has been associated with acute stroke and other cardiovascular diseases in the developed world. Low 25-hydroxyvitamin D (25OHD) has been described in some populations in Sub-Saharan Africa (SSA) in spite of adequate sunshine all year round. There is no information on the magnitude of vitamin D deficiency among patients with stroke and other cardiovascular diseases in Uganda or SSA. The aim of this study was to determine the burden and characteristics of vitamin D deficiency among patients with acute stroke, the most common form of cardiovascular events in SSA. METHODS We conducted a cross-sectional study between October 2012 and March 2013. We consecutively recruited 142 subjects with acute stroke admitted to the medical wards of Mulago hospital. We administered a pre-tested questionnaire to the study participants, and did a detailed physical examination and laboratory evaluation. Serum levels of 25OHD were determined using an electrochemiluminescence assay. Data were analyzed using STATA version 12 software. RESULTS The prevalence of vitamin D deficiency (25OHD < 20 ng/ml) was 15 %. Longer hours of sunshine exposure decreased the likelihood vitamin D deficiency significantly (adjusted OR 0.85, p = 0.03). Higher HDL cholesterol had a significant inverse association with vitamin D deficiency (adjusted OR 0.15, p = 0.02). In addition, the likelihood of vitamin D deficiency increased with rising age (adjusted OR 1.03, p = 0.05). CONCLUSIONS There was a relatively low burden of vitamin D deficiency among patients with acute stroke in Uganda. With increasing longevity and indoor lifestyles vitamin D deficiency may assume a greater role in stroke and other cardiovascular diseases in tropical sub Saharan Africa. Future studies on the mechanisms of vitamin D deficiency and its relationship to outcomes among patients with stroke may be necessary.
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Affiliation(s)
- Daniel S Kiggundu
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Edrisa Mutebi
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital, Lubaga, Kampala, Uganda.
| | - Rebecca Boxer
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | | | | | - Elly Katabira
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
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