Vitamin-D deficiency predicts infections in young north Indian children: A secondary data analysis

Surveillance of Soil-Transmitted Helminth Infection in Preschool Child Population: Do Changes in Behavior and Immunological Responses Affect Prevalence?

Soil-transmitted helminths (STHs) persist as a significant global public health issue among neglected tropical diseases (NTDs), particularly in children. STH infection can induce immune responses that affect the course of the disease; if treatment fails, chronic infection can lead to stunting, especially among children aged 24-59 months, which is a vulnerable period for growth and development. We conducted a correlational, cross-sectional data collection study to evaluate the characteristics and association of 25(OH)D, interleukin-5 (IL-5), and interleukin-13 (IL-13) with the prevalence of STH infection in children aged 24-59 months in Bandung District, Indonesia, in October 2019-January 2023. We recruited 694 subjects (401 stunted and 293 normal-height children). The prevalence of STH infection among the stunted and normal-height groups was 5.7% (95% CI: 3.85-8.46%) and 3.4% (95% CI; 1.86-6.17%) (p = 0.156), respectively. The probability of the prevalence of STH infection in children with levels of 25(OH)D, IL-5, and IL-13 below the cut-off point was 6,93 to 16.71 times higher. We found a relationship between IL-5, IL-13, and environmental factors and the prevalence of STH infection in stunted children.

1,25(OH)2D3 alleviates LPS-induced preeclampsia-like rats impairment in the protective effect by TLR4/NF-kB pathway

INTRODUCTION

Accumulating epidemiological studies support that Vitamin D deficiency is associated with the pathogenesis of preeclampsia. However, it is unknown whether vitamin D can be used as a treatment for preeclampsia. This study aimed to explore whether vitamin D supplementation could improve the rat model of preeclampsia.

METHODS

LPS was used to establish a rat model of preeclampsia. Inflammatory cytokines were examined by QRT-PCR and ELISA assays, and the concentration of sfit-1 and NO was assessed by ELISA. Analyzing the pathological features of the placenta with hematoxylin-eosin. The spatial learning and memory abilities of offspring were evaluated by the Morris water maze. Immune histology and western blot were performed to evaluate the expression levels of inflammatory pathway-associated Factor and vascular endothelium-associated Factor in the placenta.

RESULTS

Vitamin D treatment reduced the blood pressure and urine protein of PE model rats, alleviated pathological damage to the placenta and pregnancy outcomes, and protected PE offspring from impaired memory and learning abilities. Moreover, TLR4 signaling pathway in the placenta was inhibited. Furthermore, vitamin D supplementation increased the expression of endothelial growth factor and vascular relaxing factor, and there was no significant difference compared with the control group.

DISCUSSION

We generated the result that Vitamin D supplementation significantly improved the phenotype of preeclampsia and adverse pregnancy outcome caused by an abnormal inflammatory reaction and endothelial dysfunction in the placenta, and improved the learning and cognitive ability of offspring.

Vitamins C and D and COVID-19 Susceptibility, Severity and Progression: An Evidence Based Systematic Review

Background and Objectives: Starting in early December 2019, the novel Coronavirus Disease (COVID-19) from infection with COVID-19 has caused a global pandemic. Many aspects of its pathogenesis and related clinical consequences are still unclear. Early diagnosis and dynamic monitoring of prognostic factors are essential to improve the ability to manage COVID-19 infection. This study aimed to provide an account of the role played by vitamins C and D on the onset, progression and severity of COVID-19. Clinical features and infection-related risk factors are also briefly discussed. Material and Methods: In March 2022, the main online databases were accessed. All the articles that investigate the possible role of vitamins C and D on COVID-19 susceptibility, severity and progression were considered. Results: The current evidence on vitamin C and D supplementation in patients with COVID-19 infection is inconsistent and controversial. In some studies, vitamins were used as coadjuvant of a formal experimental therapy, while in others as main treatment. Ethnicity and hospital setting (inpatient/outpatient) were also variable. Moreover, there was no consensus between studies in administration protocol: high heterogeneity in dosage, administration, and duration of the treatment were evident. Finally, some studies administered vitamins pre- and/or during COVID infection, in patients with different risk factors and infection severity. Conclusions: While waiting to develop a targeted, safe and effective therapy, it is important to investigate individual predisposition and proper disease management. Concluding, available data on the use of nutraceuticals in COVID-19 are inconsistent. However, there is a lack of evidence-based guidelines which recommend vitamin C and D supplementation in patients with COVID-19, and results from high quality randomised controlled trials (RCTs) are inconsistent. Current investigations so far are mostly observational, and include a relatively small sample size which can lead to biased results. Large-scale multicentre studies are therefore needed.

Effect of maternal vitamin D supplementation on nasal pneumococcal acquisition, carriage dynamics and carriage density in infants in Dhaka, Bangladesh

Background

Invasive pneumococcal disease is a major cause of infant morbidity and death worldwide. Vitamin D promotes anti-pneumococcal immune responses in vitro, but whether improvements in infant vitamin D status modify risks of nasal pneumococcal acquisition in early life is not known.

Methods

This is a secondary analysis of data collected in a trial cohort in Dhaka, Bangladesh. Acute respiratory infection (ARI) surveillance was conducted from 0 to 6 months of age among 1060 infants of women randomized to one of four pre/post-partum vitamin D dose combinations or placebo. Nasal swab samples were collected based on standardized ARI criteria, and pneumococcal DNA quantified by qPCR. Hazards ratios of pneumococcal acquisition and carriage dynamics were estimated using interval-censored survival and multi-state modelling.

Results

Pneumococcal carriage was detected at least once in 90% of infants by 6 months of age; overall, 69% of swabs were positive (2616/3792). There were no differences between any vitamin D group and placebo in the hazards of pneumococcal acquisition, carriage dynamics, or carriage density (p > 0.05 for all comparisons).

Conclusion

Despite in vitro data suggesting that vitamin D promoted immune responses against pneumococcus, improvements in postnatal vitamin D status did not reduce the rate, alter age of onset, or change dynamics of nasal pneumococcal colonization in early infancy.

Trial registration Registered in ClinicalTrials.gov with the registration number of NCT02388516 and first posted on March 17, 2015.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07032-y.

Efficacy of Vitamin D Supplementation in Allergic Rhinitis

Allergic Rhinitis is one of the most commonly recognised rhinitis globally. Though its not a life threatening entity but it is associated with severe impairment of quality of life along with substantial financial burden on patient. There has been a substantial rise in number of patients of allergic rhinitis over years and researchers worldwide have also found low levels of vitamin D in patients of allergic rhinitis. It is a randomised control trial with 87 subjects divided into two groups. Pre-treatment total nasal symptom score (TNSS) were recorded for these patients. The Group A was given intranasal steroidal spray while Group B was given vitamin D supplementation along with intranasal steroidal spray. Post treatment TNSS scores and rhinitis control assessment test scores were calculated and analysed. 38 patients had severe Vit D deficiency with average TNSS score as 11.3 while 49 patients had insufficient Vit D levels with average TNSS as 8.6. The pre-treatment TNSS score in Group A was 12.5 ± 2.68 while post-treatment score was 8.98 ± 1.009 with difference in both scores of Group A as 3.52. The pre-treatment TNSS score in Group B (fluticasone spay with Vit D) was 11.64 ± 3.09 while post-treatment score was 6.3 ± 1.45 with difference in both scores of Group A as 5.34. The post treatment RCAT in Group A and Group B was 19.72 ± 2.84 and 28.2 ± 1.53 respectively with difference between two groups as 8.48. Though Intranasal steroidal sprays are the first line of management of allergic rhinitis however vitamin D supplementation can have a role in better relief of symptoms when used in conjunction. More multi-institutional studies are encouraged to confirm the validity of results before it can be incorporated in standard treatment guidelines.

Vitamin D and Immunity in Infants and Children

The last couple of decades have seen an explosion in our interest and understanding of the role of vitamin D in the regulation of immunity. At the molecular level, the hormonal form of vitamin D signals through the nuclear vitamin D receptor (VDR), a ligand-regulated transcription factor. The VDR and vitamin D metabolic enzymes are expressed throughout the innate and adaptive arms of the immune system. The advent of genome-wide approaches to gene expression profiling have led to the identification of numerous VDR-regulated genes implicated in the regulation of innate and adaptive immunity. The molecular data infer that vitamin D signaling should boost innate immunity against pathogens of bacterial or viral origin. Vitamin D signaling also suppresses inflammatory immune responses that underlie autoimmunity and regulate allergic responses. These findings have been bolstered by clinical studies linking vitamin D deficiency to increased rates of infections, autoimmunity, and allergies. Our goals here are to provide an overview of the molecular basis for immune system regulation and to survey the clinical data from pediatric populations, using randomized placebo-controlled trials and meta-analyses where possible, linking vitamin D deficiency to increased rates of infections, autoimmune conditions, and allergies, and addressing the impact of supplementation on these conditions.

Vitamin-D deficiency and its association with breast feeding among children at 1 year of age in an urban community in South India

Context:

High prevalence of Vitamin D deficiency is reported among healthy infants, children and adolescents. Maternal Vitamin-D deficiency, poor vitamin-D content of breast milk even in Vitamin-D replete mothers, exclusive breastfeeding without Vitamin-D supplementation and inadequate sunlight exposure are important risk factors for Vitamin D deficiency in infants.

Aim:

To determine the prevalence of hypovitaminosis-D and its relation with breast feeding and childhood illness among healthy infants at 1 year of age.

Settings and Design:

A prospective cohort study was conducted among the infants in an urban community in south India.

Methods and Material:

A total of 495 children were followed up at 1 year of age. Clinical history, anthropometric measurements, and serum blood samples for vitamin-D were obtained. The effects of breastfeeding duration and infections on Vitamin-D status were assessed by univariate and multivariate analysis.

Results:

The prevalence of Vitamin D deficiency was 22% in these infants. Univariate analysis showed risk of hypovitaminosis-D in children breast fed for more than 6 months (p 0.02); however, multivariate analysis did not prove an association. Other risk factors analysed were not significantly associated with Hypovitaminosis D.

Conclusion:

The prevalence of hypovitaminosis-D in this study was low compared to previous studies from India. This study emphasizes the issue of hypovitaminosis-D in otherwise normal children. Routine Vitamin-D supplementation for antenatal women and infants may be needed to overcome this public health problem.

Vitamin D status in early childhood is not associated with cognitive development and linear growth at 6-9 years of age in North Indian children: a cohort study

BACKGROUND

Vitamin D is important for brain function and linear growth. Vitamin D deficiency during pregnancy has been linked with impaired neurodevelopment during early childhood. However, there is limited evidence from population-based studies on the long-term impact of vitamin D deficiency on cognitive development and linear growth. The objective of the current analysis is to examine whether vitamin D deficiency during infancy and early childhood is associated with cognitive development and linear growth measured in school age.

METHODS

This is a follow-up study of a placebo-controlled trial among 1000 North Indian children 6-30 months of age. We measured growth and neurodevelopment in 791 of these children when they were 6-9 years old. Neurodevelopment was measured using the Wechsler Intelligence Scale for Children, 4th edition ^INDIA, the Crichton Verbal Scale, NEPSY-II subtests, and the BRIEF 2. We categorized vitamin D concentrations during infancy and early childhood according to the US Institute of Medicine's recommendations; serum 25(OH)D < 12 ng/ml as deficient; 12-20 ng/ml as inadequate; > 20 ng/ml as sufficient. In multivariable regression models, adjusting for relevant confounders, we estimated the association between vitamin D status, growth and neurodevelopmental outcomes.

RESULTS

Among the 791 children, baseline vitamin D status was available for 716. Of these, 45.8% were vitamin D deficient, 32.7% were inadequate, and 21.5% were sufficient. Vitamin D status was not associated with any of the cognitive outcomes or linear growth [Adjusted β coefficient for height for age z-score between deficient and sufficient children was - 0.06 (95% CI - 0.24 to 0.11)] at follow up.

CONCLUSION

Our findings do not support the notion that poor vitamin D status in early childhood is an important limitation for cognitive development and linear growth.

TRIAL REGISTRATION

The trial was first registered at www.clinicaltrials.gov as NCT00717730 in July, 2008, and at CTRI/2010/091/001090 in August, 2010 and then as CTRI/2016/11/007494 in November 2016.

High burden of co-morbidity and mortality among severely malnourished children admitted to outpatient therapeutic programme facilities in the conflict setting of Borno, Nigeria: a retrospective review

OBJECTIVE

To present evidence on the burden and outcomes of co-morbidities among severely malnourished (SAM) children admitted to outpatient therapeutic programme (OTP) facilities in the conflict setting of Borno, Nigeria.

DESIGN

Retrospective medical chart review.

SETTING

Facility-based study.ParticipantsChildren aged 6-59 months with SAM enrolled in OTP between June and November 2016 whose medical records were analysed. Only pneumonia and diarrhoea were examined due to data limitations. Stata software was used for descriptive, multivariate and survival analyses.

RESULTS

Records of 396 children with median age of 15 months were identified and analysed from the date of enrolment to exit from OTP. Mean length of stay in OTP was 61d, with co-infected SAM children having shorter stay (P=0·006). Of the total, 148 (37·4 %) had at least one co-morbidity (pneumonia or diarrhoea), of which thirty-nine (26·4 %) had both. Cumulative rate of mortality during follow-up time was 9·5 (95 % CI 6·0, 15·1) per 10 000 child-days; SAM children with co-morbidities were ten times more likely to die than those without (hazard ratio=10·2; 95 % CI 3·4, 31·0). In multivariable analysis, co-morbidity (P=0·01), oedema (P=0·003), dehydration (P=0·02) and weight on admission (P=0·01) were associated with mortality. Both recovery and defaulter rates (57·8 and 36·1 %, respectively) did not meet SPHERE standards.

CONCLUSIONS

Children with SAM and co-morbidities are less likely to survive, presenting a significant barrier in improving child survival. The findings call for integrated OTP models that incorporate clinical algorithms and ensure prompt referral for SAM children with co-morbidity.

Serum 25 Hydroxy Vitamin D Levels in Very Low Birth Weight Infants Receiving Oral Vitamin D Supplementation

BACKGROUND AND OBJECTIVE

Vitamin D supplementation in preterm infants has been recommended by American Academy of Pediatrics (AAP); however, its efficacy and safety has not been well studied. To study 25-hydroxy vitamin D (25OHD) levels as a marker of vitamin D status of very low birth weight infants while on vitamin D supplementation during neonatal intensive care unit hospitalization.

METHODS

Retrospective study of preterm infants with birth weight <1500 g admitted to our unit from January 2013 to December 2015 who were on oral vitamin D3 400 IU supplementation. Serum 25OHD level were checked at 4, 8, and 12 weeks of age or before discharge and the levels were stratified as deficient <20 ng/mL, insufficient 20 to 29 ng/mL, normal 30 to 60 ng/mL, high 61 to 100 ng/mL and very high >100 ng/mL.

RESULTS

A total of 301 infants were enrolled, 186 very low birth weight (VLBW; 1000-1499 g) infants and 115 extremely low birth weight (ELBW; <1000 g) infants. Approximately 80% of both VLBWs and ELBWs had deficient or insufficient 25OHD levels at 4 weeks of age. On oral vitamin D supplementation, VLBW infants increased their 25OHD levels significantly by 8 and 12 weeks of age, whereas ELBW infants lagged behind at 8 weeks and increased their 25OHD levels by 12 weeks of age.

CONCLUSIONS

Eighty percent of ELBW and VLBW infants have either deficient or insufficient vitamin D status at 4 weeks of age. Vitamin D supplementation helps in improving the vitamin D levels, VLBW infants significantly more than ELBW infants. AAP recommendation appears to be safe; however, if using higher supplement dosing, 25OHD level should be monitored to avoid high and very high vitamin D levels.

Vitamin D Supplementation in Childhood - A Review of Guidelines

Vitamin D, a unique vitamin with endocrine function is required in the human body primarily for calcium homeostasis and possibly several other functions. Deficiency of the vitamin is extremely frequent world-wide. Studies on Indian population place the prevalence of deficiency at 70 to 100% in healthy individuals. There are several guidelines available on definition of vitamin D deficiency and supplementation in healthy children and adults. Sufficiency or deficiency of the vitamin depend upon the levels of 25OHD and various cut-offs are suggested by different groups formulating the guidelines. Although the vitamin is synthesized in the skin with the help of sunlight, it is mostly agreed by various groups that oral supplementation must be done in infants and in certain high risk groups. No such formal guidelines currently exist for Indian children though there is a need to develop one.

Vitamin D deficiency in India

Vitamin D is a fat-soluble vitamin playing a vital role in human physiology. Vitamin D deficiency is prevalent worldwide. This deficiency has many consequences which are still being explored, apart from the well-known skeletal complications. With this review, we aim to summarize the existing literature on Vitamin D status in India and understand the enormity of the problem. The prevalence of Vitamin D deficiency ranged from 40% to 99%, with most of the studies reporting a prevalence of 80%–90%. It was prevalent in all the age groups and high-risk groups alike. With the consequences of Vitamin D deficiency, namely, autoimmune diseases, cardiovascular diseases, cancer, and tuberculosis being explored, we can imagine the burden it would cause in our country. We need to create awareness among the public and healthcare providers about the importance of Vitamin D and the consequences of deficiency. Our Indian diet generally fails to satisfy the daily requirement of Vitamin D for a normal adult. This stresses on the need for fortifying various food with Vitamin D, through the national programs. This silent epidemic should be addressed appropriately with concrete public health action.

Vitamin C in Stem Cell Biology: Impact on Extracellular Matrix Homeostasis and Epigenetics

Transcription factors and signaling molecules are well-known regulators of stem cell identity and behavior; however, increasing evidence indicates that environmental cues contribute to this complex network of stimuli, acting as crucial determinants of stem cell fate. l-Ascorbic acid (vitamin C (VitC)) has gained growing interest for its multiple functions and mechanisms of action, contributing to the homeostasis of normal tissues and organs as well as to tissue regeneration. Here, we review the main functions of VitC and its effects on stem cells, focusing on its activity as cofactor of Fe⁺²/αKG dioxygenases, which regulate the epigenetic signatures, the redox status, and the extracellular matrix (ECM) composition, depending on the enzymes' subcellular localization. Acting as cofactor of collagen prolyl hydroxylases in the endoplasmic reticulum, VitC regulates ECM/collagen homeostasis and plays a key role in the differentiation of mesenchymal stem cells towards osteoblasts, chondrocytes, and tendons. In the nucleus, VitC enhances the activity of DNA and histone demethylases, improving somatic cell reprogramming and pushing embryonic stem cell towards the naive pluripotent state. The broad spectrum of actions of VitC highlights its relevance for stem cell biology in both physiology and disease.