Vitamin D deficiency is significantly associated with depression in patients with chronic kidney disease

Association between Chronic Kidney Disease-Mineral and Bone Disorder Biomarkers and Symptom Burden in Older Patients with Advanced Chronic Kidney Disease: Results from the EQUAL Study

Key Points

In nondialysis patients with advanced CKD, mild-to-moderately increased parathyroid hormone is associated with lower levels of reported symptoms. Phosphate and calcium are not independently associated with overall symptom burden. Patients with both severe hyperphosphatemia and severe hyperparathyroidism had the highest symptom burden.

Background

Patients with advanced CKD develop numerous symptoms, with a multifactorial origin. Evidence linking mineral disorders (CKD-Mineral and Bone Disorder) and uremic symptoms is scant and mostly limited to dialysis patients. Here, we aim to assess the association between CKD-Mineral and Bone Disorder and symptom burden in nondialysis patients with CKD.

Methods

We used data from the European Quality study, which includes patients aged ≥65 years with eGFR ≤20 ml/min per 1.73 m2 from six European countries, followed up to 5 years. We used generalized linear mixed-effect models to determine the association between repeated measurements of parathyroid hormone (PTH), phosphate, and calcium with the overall symptom number (0–33), the overall symptom severity (0–165), and the presence of 33 CKD-related symptoms. We also analyzed subgroups by sex, age, and diabetes mellitus and assessed effect mediation and joint effects between mineral biomarkers.

Results

The 1396 patients included in the study had a mean of 13±6 symptoms at baseline, with a median overall severity score of 32 (interquartile range, 19–50). The association between PTH levels and symptom burden appeared U-shaped with a lower symptom burden found for mild-to-moderately increased PTH levels. Phosphate and calcium were not independently associated with overall symptom burden. The highest symptom burden was found in patients with a combination of both severe hyperparathyroidism and severe hyperphosphatemia (+2.44 symptoms [0.50–4.38], P = 0.01). The association of both hypocalcemia and hyperphosphatemia with symptom burden seemed to differ by sex and age.

Conclusions

In older patients with advanced CKD not on dialysis, mild-to-moderately increased PTH was associated with a lower symptom burden, although the effect size was relatively small (less than one symptom). Neither phosphate nor calcium were associated with the overall symptom burden, except for the combination of severe hyperphosphatemia and severe hyperparathyroidism which was associated with an increased number of symptoms.

Impact of Vitamin D Deficiency on Mental Health in University Students: A Cross-Sectional Study

Students pursuing a university education are vulnerable to psychological burdens such as depression, anxiety, and stress. The frequency of vitamin D deficiency, on the other hand, is extensively recognized worldwide, and vitamin D regulates various neurological pathways in the brain that control psychological function. Therefore, the goal of this cross-sectional study was to determine the relationship between vitamin D deficiency and psychological burden among university students in Riyadh, Saudi Arabia. During March-May 2021 in Riyadh, a cross-sectional comparative study survey was delivered to university students. The DASS-21 scale was used to determine the severity of the psychological burden. Both univariate and binomial regression analyses were conducted to analyze the level of significance and influence of several factors on the development of psychological burden. The data were analyzed with SPSS-IBM, and a p value of <0.05 was considered significant. Of the 480 students recruited for the study, 287 (59.79%) had a vitamin D deficiency. Significantly (p = 0.048), a high proportion of the vitamin D-deficient students attained a low or moderate GPA compared to the control cohort. The prevalence of depression, anxiety, and stress among the vitamin D-deficient students was 60.35%, 6.31%, and 75.08%, respectively, which was significantly (p < 0.05) different from the control group. The odds of developing depression (OR = 4.96; CI 2.22-6.78; p < 0.001), anxiety (OR = 3.87; CI 2.55-6.59; p < 0.001), and stress (OR = 4.77; CI 3.21-9.33; p < 0.001) were significantly higher in the vitamin D-deficient group. The research shows a strong association between psychological stress and vitamin D deficiency. To promote the mental health and psychological wellbeing of university students, it is critical to create awareness about the adequate consumption of vitamin D. Additionally, university students should be made aware of the likelihood of a loss in academic achievement owing to vitamin D deficiency, as well as the cascade effect of psychological burden.

Nutrient Inadequacy in Korean Young Adults with Depression: A Case Control Study

The role of diet is gaining attention among the modifiable factors associated with depression; thus, this case-control study examined the association between nutrition and depression in young Korean adults. Dietary surveys in individuals with depression (n = 39) and age- and gender-matched controls (n = 76) were conducted using food records and food frequency questionnaires. Men with depression consumed less mushrooms and meat, while women consumed significantly less grains (p < 0.05). Overall, the depression group consumed less energy and nutrients, and the difference was more pronounced in men. The male depression group had lower nutrient adequacy ratio (NAR) for energy, protein, vitamin A, thiamine, niacin, folate, and phosphorus, whereas the female depression group had lower NARs for energy, protein, niacin, and vitamin B₁₂. The depression group had a significantly lower mean adequacy ratio in both genders. Furthermore, the proportion of inappropriate nutrient intake was higher in both genders of the depression group, exhibiting significant differences in energy, protein, niacin, folate, and zinc in men and energy, riboflavin, folate, and vitamin C in women. Hence, both men and women in the depression group had poor nutrient intake and high rates of nutrient inadequacy and improper consumption. This suggests that the quantity and quality of meals should be improved for individuals with depressive symptoms.

A Retrospective Study on Vitamin D Status and Its Association With Cardiometabolic Risk Factors Among Children With Chronic Kidney Disease at King Abdulaziz University Hospital

BACKGROUND

Vitamin D deficiency is a significant global health issue. It is prevalent in chronic kidney disease (CKD) patients, which is an important cause of death among children. Many studies have found a link between low vitamin D status in CKD patients and cardiovascular disease (CVD) risk factors. However, there are no data on this relationship in children with CKD in Saudi Arabia.

AIMS

We aimed to demonstrate this association among children with CKD admitted to the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia.

MATERIALS AND METHODS

Data were collected between June and August 2020 from a convenience sample of pediatric patients.

RESULTS

In total, 153 pediatric patients with CKD stages 2-5 were admitted to the KAUH between 2010 and 2019, and 67.3% had CKD stage 5. Approximately 4.6% and 10.5% of the participants were overweight or obese, respectively. Patients who fell into the lower 25-hydroxyvitamin D (25[OH]D) tertile were older, had higher body mass index (BMI) values, and had higher blood pressure than those in the upper two tertiles; however, these differences were not statistically significant. There was a significant inverse association of 25(OH)D levels with BMI, blood pressure, and serum creatinine levels.

CONCLUSIONS

The results of this retrospective study suggest that patients with CKD and lower vitamin D levels have a higher BMI and blood pressure and are therefore at higher risk of developing CVD. Future prospective studies with a larger sample size are needed to confirm these findings. Randomized clinical trials are also needed to investigate the effect of sufficient vitamin D status on reducing CVD in patients with CKD.

A pathway phenotype linking metabolic, immune, oxidative, and opioid pathways with comorbid depression, atherosclerosis, and unstable angina

BACKGROUND

There is strong comorbidity between atherosclerosis (ATS) and depression which is attributed to increased atherogenicity, insulin resistance (IR), and immune and oxidative stress.

AIM OF THE STUDY

To examine the role of the above pathways and mu-opioid receptor (MOR), β-endorphin levels, zinc, copper, vitamin D3, calcium, and magnesium in depression due to ATS/unstable angina (UA).

METHODS

Biomarkers were assayed in 58 controls and 120 ATS patients divided into those with moderate and severe depression according to the Beck Depression Inventory-II (BDI-II) scores >19 and >29, respectively.

RESULTS

Neural network and logistic regression models showed that severe depression due to ATS/UA was best predicted by interleukin-6 (IL-6), UA, MOR, zinc, β-endorphin, calcium and magnesium, and that moderate depression was associated with IL-6, zinc, MOR, β-endorphin, UA, atherogenicity, IR, and calcium. Neural networks yielded a significant discrimination of severe and moderate depression with an area under the receiver operating curves of 0.831 and 0.931, respectively. Using Partial Least Squares path analysis, we found that 66.2% of the variance in a latent vector extracted from ATS/UA clinical features, and the BDI-II scores, atherogenicity, and IR could be explained by the regression on IL-6, IL-10, zinc, copper, calcium, MOR, and age. The BDI-II scores increased from controls to ATS to UA class III to UA class IV.

CONCLUSIONS

Immune activation, the endogenous opioid system, antioxidants, trace elements, and macrominerals modulate a common core shared by increased depressive symptoms, ATS, UA, atherogenicity, and IR.

Vitamin D Intake and Factors Associated With Self-Reported Vitamin D Deficiency Among US Adults: A 2021 Cross-Sectional Study

Vitamin D deficiency is a global issue that may be attributed to various factors such as dietary habits, sun exposure, age, race and chronic conditions. The purpose of this study was to determine the relationship between vitamin D intake from food/supplements and factors that may be associated with self-reported vitamin D deficiency among US adults. A cross-sectional online study was conducted among 1,637 adults using a 38-item questionnaire. Frequency counts and percentages were tabulated and a multiple linear regression was performed. Statistical significance was determined at p &lt; 0.05. Participants (n = 554, 33.8%) were considered vitamin D deficient and consumed an average of 347.05 ± 307.8 IUs of vitamin D through foods/beverages. The multivariate linear regression showed no statistically significant difference with vitamin D intake from foods/beverages on vitamin D deficiency status. Significant positive correlations were seen with vitamin D deficiency status and certain chronic conditions such as chronic kidney disease (p = 0.04), depression (p &lt; 0.001), diabetes (p = 0.02), and vitamin D supplement use (p &lt; 0.001). Significant negative correlations were observed with vitamin D deficiency status and age (p = 0.01) and sun exposure (p &lt; 0.001). Future focus should be on educating individuals about factors associated with vitamin D to reduce the prevalence of vitamin D deficiency.

Dietary Supplementations and Depression

Depression is a mood disturbance condition that occurs for more than two weeks in a row, leading to suicide. Due to adverse effects of depression, antidepressants and adjunctive therapies, such as dietary supplementation, are used for treatment. Therefore, this review explored and summarized dietary supplements’ types, dosages, and effectiveness in preventing and treating depression. A literature search of the PubMed database was conducted in August 2021 to identify studies assessing depression, after which scale measurements based on dietary supplements were identified. From the obtained 221 studies, we selected 63 papers. Results showed PUFA (EPA and DHA combination), vitamin D, and probiotics as the most common supplementation used in clinical studies to reduce depressive symptoms. We also observed that although the total daily PUFA dosage that exhibited beneficial effects was in the range of 0.7–2 g EPA and 0.4–0.8 g DHA daily, with an administration period of three weeks to four months, positive vitamin D-based supplementation effects were observed after administering doses of 2000 IU/day or 50,000 IU/week between 8 weeks and 24 months. Alternatively, microbes from the genus Lactobacillus and Bifidobacterium in the probiotic group with a minimum dose of 10⁸ CFU in various dose forms effectively treated depression. Besides, a depression scale was helpful to assess the effect of an intervention on depression. Hence, PUFA, vitamin D, and probiotics were proposed as adjunctive therapies for depression treatment based on the results from this study.

Independent Associations of Serum 25-hydroxyvitamin D3 and D2 with Depressive Symptoms in Females

BACKGROUND

The role of vitamin D in depression has been gaining increased research interest. However, little is known about the independent associations of serum 25-hydroxyvitamin D₃ (25(OH)D₃) and D₂ (25(OH)D₂) with depressive symptoms. The goal of this study was to examine the metabolites of vitamin D and their associations with depression.

METHODS

This study was conducted in US females using data from the National Health and Nutrition Examination Survey 2011-2014. Depressive symptoms were assessed using a nine-item Patient Health Questionnaire, and serum 25(OH)D₃ and 25(OH)D₂ levels were measured using liquid chromatography-tandem mass spectrometry. Linear regression and generalized additive models were applied to evaluate the associations between 25(OH)D₃, 25(OH)D₂ and depression.

RESULTS

A negative association between serum 25(OH)D₃ and depressive symptoms was observed in the fully adjusted model. This association was also found among widowed, divorced, separated, and never-married individuals. The association between 25(OH)D₂ and depressive symptoms was not statistically significant, but the dose-response analysis revealed an inverted U-shaped relationship between them with an inflection point at 56.2 nmol/L. To the left of the inflection point, we detected a positive association between 25(OH)D₂ and depressive symptoms, whereas a negative association was observed to the right of the inflection point.

LIMITATIONS

The study used a cross-sectional approach, so causation cannot be determined.

CONCLUSIONS

Our study shows an inverse linear association between serum 25(OH)D₃ and depressive symptoms in US females. The association between 25(OH)D₂ and depression follows an inverted U-shaped curve with the inflection point at 56.2 nmol/L.

Calcitriol Treatment Attenuates Uric Acid-Induced Kidney Injury via Super Oxide Dismutase-1 (SOD-1) Upregulation and Fibrosis Reduction

Background

Hyperuricemia induces nephropathy through the mediation of oxidative stress, tubular injury, inflammation, and fibrosis. The high uric acid level is associated with the reduction of vitamin D levels. However, the reno-protective effects of this vitamin in hyperuricemia condition remain unknown. This study aimed to elucidate calcitriol treatment in a uric acid-induced hyperuricemia mice model.

Methods

: Uric acid (125 mg/kg body weight [BW]) was administered intraperitoneally for 7 (UA7) and 14 (UA14) days. Calcitriol (0.5 g/kg BW) was intraperitoneally injected for the following seven days, after 14 days of uric acid induction (UA14VD7 group). The control group received NaCl 0.9%, by the same route. Serum creatinine was measured using calorimetric method, and uric acid levels were assessed using enzymatic calorimetric assay. Tubular injury and fibrosis were assessed using PAS and Sirius red staining. RT-PCR and real-time reverse transcription PCR were carried out for the analyses of SOD-1, Collagen-1, and TGF-1 mRNA expression in the kidney. Immunostaining of super oxide dismutase type 1 (SOD-1) was performed to detect its expression in the kidney.

Results

Uric acid and creatinine levels markedly increased in UA14 groups, followed by an exacerbation of tubular injury. RT-PCR revealed the upregulation of Collagen-1 and TGF-1, along with the downregulation of SOD-1. Calcitriol treatment attenuated the injury with reducing uric acid and creatinine levels, as well as tubular injury. This was associated with lower Collagen-1 and TGF-1 mRNA expression compared to the UA7 and UA14 groups. SOD-1 was upregulated in epithelial cells in the UA14VD7 group.

Conclusion

Calcitriol treatment after uric acid induction may attenuate kidney injury through upregulation of SOD-1 and downregulation of Collagen-1 and TGF-1 gene expression.

Dietary Intake and Mental Health among Saudi Adults during COVID-19 Lockdown

The study aimed to explore the influence of the COVID-19 lockdown on the mental status and dietary intake of residents in Saudi Arabia. In this cross-sectional study, an online survey was conducted from 11 May to 6 June 2020 corresponding to almost two weeks during and after Ramadan (23 April–23 May 2020). The Patient Health Questionnaire was used to assess anxiety, depression, and insomnia. Logistic regression analysis was used to identify predictors of anxiety, depression, and insomnia. The prevalence of anxiety, depression, and insomnia among the participants was 25.4%, 27.7%, and 19.6%, respectively. Participants aged ≥50 years with high income (≥8000 SAR) were at a lower risk of developing depression, whereas participants of the same age group with income 5000–7000 SAR were at high risk of developing anxiety. Students and master-educated participants suffer from median elevated depression and are required to take more multivitamins and vitamin D than others. Anxiety and depression were more common among married participants with low income. There is a wide range of Saudi residents who are at a higher risk of mental illness during the COVID-19 pandemic. Policymakers and mental healthcare providers are advised to provide continuous monitoring of the psychological consequences during this pandemic and provide mental support.

Clinical Significance of Analysis of Vitamin D Status in Various Diseases

Vitamin D plays a role not only in the proper functioning of the skeletal system and the calcium-phosphate equilibrium, but also in the immune system, the cardiovascular system and the growth and division of cells. Although numerous studies have reported on the analysis of vitamin D status in various groups of patients, the clinical significance of measurements of vitamin D forms and metabolites remains ambiguous. This article reviews the reports analyzing the status of vitamin D in various chronic states. Particular attention is given to factors affecting measurement of vitamin D forms and metabolites. Relevant papers published during recent years were identified by an extensive PubMed search using appropriate keywords. Measurement of vitamin D status proved to be a useful tool in diagnosis and progression of metabolic syndrome, neurological disorders and cancer. High performance liquid chromatography coupled with tandem mass spectrometry has become the preferred method for analyzing the various forms and metabolites of vitamin D in biological fluids. Factors influencing vitamin D concentration, including socio-demographic and biochemical factors as well as the genetic polymorphism of the vitamin D receptor, along with vitamin D transporters and enzymes participating in vitamin D metabolism should be considered as potential confounders of the interpretation of plasma total 25(OH)D concentrations.

Vitamin D deficiency and suicidal ideation: A cross-sectional study of 157,211 healthy adults

OBJECTIVES

Vitamin D deficiency has been reported to be associated with various neuropsychiatric disorders. However, there are few studies addressing deficient vitamin D levels and suicidal ideation.

METHODS

Serum vitamin D of 157,211 Korean adult participants were measured using electrochemiluminescence immunoassay. A self-reported questionnaire was used to assess whether participants experienced suicidal ideation. Logistic regression model was used to estimate the odds ratio (OR) of suicidal ideation according to vitamin D levels. The regression was adjusted for a range of covariates.

RESULTS

Compared with sufficient vitamin D levels (≥20 ng/mL), deficient vitamin D levels (<10 ng/mL) were significantly associated with the risk of suicidal ideation (OR = 1.138, 95% Cl = 1.027-1.262). However, the OR of suicidal ideation was not significantly different between the vitamin D insufficient group (10-19.99 ng/mL) and sufficient group (≥20 ng/mL) (OR = 0.988, 95% Cl = 0.932-1.047).

CONCLUSION

Deficient vitamin D levels were significantly associated with the risk of suicidal ideation. However, the risk of suicidal ideation was not significantly different between the vitamin D insufficient group and sufficient group.

Role of vitamin D in oxidative stress modulation in end-stage renal disease patients: A double-blind randomized clinical trial

INTRODUCTION

Oxidative stress is considered as important actor in uremia-associated morbidity and mortality in hemodialysis (HD) patients. We aimed to evaluate the role of vitamin D supplementation on oxidative stress parameters in this group.

METHODS

This double-blind randomized clinical trial was conducted on HD patients who were randomly allocated into intervention (n = 40) or control groups (n = 38) for 10 weeks. Blood samples were taken before and at the end of the trial to measure serum 25-hydroxyvitamin D (25(OH)D), malondialdehyde (MDA), glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase (SOD). Data were analyzed using SPSS, and P value <0.05 was considered to be statistically significant.

FINDINGS

Out of the 78 patients with a mean age of 44.7 ± 13.0 years, 55.1% were men. At the commencement of the study, there was no difference with respect to serum 25(OH)D levels in our groups (P = 0.575), but during the study it was significantly elevated in the intervention group (18.1 ± 9.1 vs. 31.7 ± 12.9, P < 0.0001). Serum antioxidative enzymes activity (GPx, CAT, and SOD) had significantly increased after vitamin D supplementation in the intervention group (P < 0.05). Furthermore, MDA levels was significantly reduced only in the intervention group (31.7 ± 18.0 vs. 24.7 ± 7.7, P = 0.018).

DISCUSSION

Regular consumption of vitamin D can increase the GPx, CAT, SOD, and reduce the MDA plasma levels in HD patients. Since no adverse effects of vitamin D supplementation was reported by the patients; hence, it can be prescribed for HD patients.

Calcitriol Ameliorates Kidney Injury Through Reducing Podocytopathy, Tubular Injury, Inflammation and Fibrosis in 5/6 Subtotal Nephrectomy Model in Rats

Chronic kidney diseases (CKDs) lead to end-stage renal diseases (ESRD) which are characterized by glomerulosclerosis, tubular injury, anemia, inflammation, and interstitial fibrosis. Vitamin D is known to have renal protective effects. However, its effects relate to low and high doses of Vitamin D in CKD model is still unknown. CKD was performed using 5/6 subtotal nephrectomy procedure in male Sprague Dawley rats (3 months old, 200-300 grams, SN group; n=6), then rats were sacrificed on day 14 after operation. Sham operation was used for control (SO group; n=6). Calcitriol was administered in two doses : 0.01 µg/mL/100 gramsBW/day (SND1 group; n=6) and 0.05 µg/mL/100 gramsBW/day (SND2 group; n=6) intraperitoneally for 14 days. Glomerulosclerosis and tubular injury score were examined using PAS staining, meanwhile, interstitial fibrosis area fraction was assessed with Sirius Red staining. RT-PCR was performed for assessing nephrin, podocin, IL-6, CD68, Collagen-1, and TGF-β1 mRNA expressions. Immunostaining (IHC) was carried out to observe macrophage (CD68) and myofibroblast (α-SMA). SN demonstrated CKD condition with higher tubular injury, glomerulosclerosis, interstitial fibrosis, and inflammation compared to SO. Calcitriol-treated group (especially SND2) demonstrated significant lower tubular injury, glomerulosclerosis, and interstitial fibrosis compared to SN. SND2 group showed not only significantly lower CD68, IL-6, Collagen-1, and TGF-β1 mRNA expressions, but also higher mRNA expressions of nephrin and podocin. SND2 group also demonstrated reduction of macrophages infiltration and myofibroblasts expansion based on its histopathological appearance. Vitamin D may have a renoprotective effect on 5/6 subtotal nephrectomy model by attenuating podocytopathy, tubular injury, inflammation and interstitial fibrosis.

Vitamin D and Depression in Women: A Mini-review

Affective-related disorders, including depression, are constantly rising, complicating people's personal lifestyle increasing disqualification and hospital care. Because of the high intensity of urbanization, our lifestyle and food have altered dramatically in the last twenty years. These food modifications have been associated with scores of depression and other affective-related disorders in urbanized countries with high economic levels. Nutrients imbalance is considered as one of the critical causes enabling the pathophysiological mechanisms for the development of psychiatric disorders. The application of additional nutritional interventions for treatment of mood deteriorations can be beneficial for both the prophylaxis and therapy of affective-related disorders. This paper will review recent research on the relation of Vitamin D levels and the epidemiology of depression in women. In this paper, we will provide an overview of the results of a variety of different studies taking into account research which both suggests and refutes an association. Based on these findings we will propose important directions for future research in relation to this topic.

Contribuições da vitamina D no tratamento de sintomas depressivos e fatores de risco cardiovascular: protocolo de estudo para um ensaio clínico randomizado, duplo-cego e controlado por placebo

ABSTRATO

FUNDO: A depressão é uma das principais causas de incapacidade crônica em todo o mundo e um importante fator de risco cardiovascular, aumentando o risco relativo de doença arterial coronariana, bem como as taxas de morbimortalidade cardiovascular. Concomitantemente à alta prevalência de depressão, houve uma redução na exposição à luz solar com o aumento da urbanização e do uso de protetores solares, o que levou a uma redução nos níveis séricos de 25-hidroxivitamina D. Portanto, este artigo descreve uma protocolo para um ensaio clínico com o objetivo de avaliar os efeitos da suplementação de vitamina D na depressão e fatores de risco cardiovascular para contribuir com evidências sobre a influência potencial da suplementação na regulação do humor. MéTODOS: Este estudo de protocolo foi orientado pelos itens de protocolo padrão: recomendações para ensaios intervencionistas. Um ensaio clínico randomizado, controlado por placebo, duplo-cego será realizado envolvendo 224 adultos (faixa etária de 18 a 60 anos) com depressão que estão tomando antidepressivos e não têm histórico de suplementação de vitamina D, comorbidades psiquiátricas, doença renal crônica, hipercalcemia, ou neoplasia. Os participantes serão recrutados nos ambulatórios psiquiátricos de duas universidades do nordeste do Brasil. Os participantes elegíveis que fornecerem consentimento por escrito serão designados aleatoriamente para o grupo de intervenção (n = 112; suplementação de vitamina D 50.000 UI por semana durante 6 meses) ou para o grupo controle (n = 112; placebo tomado semanalmente por 6 meses). Medidas para monitorar sintomas depressivos, exames clínicos e exames laboratoriais para avaliar fatores de risco cardiovascular e níveis séricos de vitamina D serão realizadas antes e após o período de intervenção. DISCUSSãO: Até onde sabemos, este será o primeiro ensaio clínico com o objetivo de testar a eficácia da suplementação de vitamina D na redução do risco cardiovascular e como um adjuvante à terapia da depressão por um período prolongado (6 meses). Os resultados contribuirão para a compreensão dos efeitos terapêuticos da suplementação de vitamina D no tratamento da depressão e podem ajudar a orientar políticas públicas direcionadas à suplementação de vitamina para a redução do risco cardiovascular.

REGISTRO DE TESTE

Registro Brasileiro de Ensaios Clínicos, RBR-6yj8sj/ Número Universal de Ensaios (UTN) U1111-1217-9237 . Registrado em 23 de julho de 2018.

Association of depressive symptoms with 25(OH) vitamin D in hemodialysis patients and effect of gender

BACKGROUND

Depression is common in chronic kidney disease (CKD) patients and associated with significant increase in morbidity and mortality. In recent years, a relationship between vitamin D deficiency and depression has been shown. The aim of this study is to investigate the relationship between 25-hydroxy (OH) vitamin D and depression in hemodialysis patients.

METHODS

A total of 140 patients were included in the study. Hamilton depression scale (HAM-D) was completed by all patients. 25(OH) vitamin D levels were compared between patients with and without depressive symptoms.

RESULTS

Patients who had depressive symptoms had significantly lower 25(OH) vitamin D levels (13.70 [24.3-8.25] vs. 18.20 [29.2-11.7] ng/mL, p = 0.016). HAM-D score showed significant association with gender (p = 0.011) and 25(OH) vitamin D level (p = 0.011). Univariate logistic regression analysis showed that males had lower risk of depression by a ratio of 61.1% (OR 0.389, p = 0.012) and vitamin D-deficient patients had 2.88 times greater risk of depression compared to non-deficient patients (OR 2.885, p = 0.013). Multivariate logistic regression analysis showed that males had 53.7% less risk of depression (OR 0.463, p = 0.046) and vitamin D-deficient patients had 2.39 times greater risk of depression (OR 2.397, p = 0.047). When evaluated by gender, univariate logistic regression analysis showed that 25(OH) vitamin D and other variables were not associated with depression in females (p > 0.05), while only vitamin D level had a significant effect on depression in males (OR 8.207, p = 0.008).

CONCLUSIONS

We found a significant association between vitamin D level and depressive symptoms in hemodialysis patients. When analyzed according to gender, this association was found to stand independent of other variables only in males.

Malnutrition and inflammation are associated with severity of depressive and cognitive symptoms of old patients affected by chronic kidney disease

OBJECTIVE

Chronic kidney disease (CKD) is a disabling condition associated with different medical comorbidities including depression and cognitive impairment. We investigated the association between malnutrition, inflammation and depressive/cognitive symptoms in elderly subjects with advanced CKD.

METHODS

We evaluated cross-sectionally 132 elderly subjects (age ≥65 years) with advanced CKD (stage 4-5, non-dialytic-ND) in regular follow up at the outpatient clinic of nephrology. Blood and urinary samples were collected after an overnight fast. All patients were evaluated by Geriatric Depression Scale (GDS)-30 items for severity of depressive symptoms, Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) for cognition. Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Different linear regression models were performed to study the association between clinical variables, diet and inflammatory parameters with the above mentioned rating scale scores. A final linear regression model with only previous statistically significant variables was performed for GDS scores.

RESULTS

Our cohort consisted of 95 males and 37 females with a mean age of 78 ± 7. Female gender (B = 3.20, p < .01), higher MIS (B = 0.29, p = .02) and higher IL-12p70 serum levels (pg/mL) (B = 0.37, p = .03) were associated with severity of depressive symptoms. MIS was associated with the severity of cognitive impairment as assessed by MMSE (B = -0.19, p < .01) and CDT (B = 0.10, p = .03).

CONCLUSION

In elderly subjects affected by CKD the severity of depressive symptoms and cognitive impairment is associated with specific inflammatory and nutritional parameters. These results have to be considered as preliminary and need replication by further studies.

Native Hypovitaminosis D in CKD Patients: From Experimental Evidence to Clinical Practice

Native hypovitaminosis D (n-hVITD) is frequently found from the early stages of chronic kidney disease (CKD) and its prevalence increases with CKD progression. Even if the implications of n-hVITD in chronic kidney disease-mineral bone disorder (CKD-MBD) have been extensively characterized in the literature, there is a lot of debate nowadays about the so called "unconventional effects" of native vitamin D (25(OH)VitD) supplementation in CKD patients. In this review, highlights of the dimension of the problem of n-hVITD in CKD stages 2-5 ND patients will be presented. In addition, it will focus on the "unconventional effects" of 25(OH)VitD supplementation, the clinical impact of n-hVITD and the most significant interventional studies regarding 25(OH)VitD supplementation in CKD stages 2-5 ND.

Depression: Prevalence and Associated Risk Factors in the United Arab Emirates

A Depression is a prevalent mental healthcare problem and a common cause of disability worldwide. The purpose of this study was to determine the prevalence and risk factors of depression in individuals living in the UAE. We used a systematic review approach, searching PubMed and Scopus electronic databases to collect studies conducted between 2007 and 2017 on the UAE population (both citizens and expatriates) relating to depression. After evaluating and screening relevant articles, a review of 14 articles was conducted. The prevalence of depression and study populations varied widely across studies with some including students and workers and others limited to those with diabetes. The most common contributing factors were female sex, financial difficulties/low socioeconomic status, stressful life events, lack of social support, serious or chronic illness (e.g., diabetes, obesity, epilepsy, multiple sclerosis), and a history of eating disorders. Vitamin D deficiency was also highlighted as a risk factor for seasonal depression. Even though previous evidence has promulgated the role of numerous causative factors, the epidemiological studies including risk factors such as personal or family history of depression, low academic performance, and the use of alcohol remain lacking. Further research is needed to identify effective strategies for treating and preventing depression in the future.

Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state

PURPOSE

This review provides a current perspective on the mechanism of vitamin D on skeletal muscle function with the emphasis on oxidative stress, muscle anabolic state and muscle energy metabolism. It focuses on several aspects related to cellular and molecular physiology such as VDR as the trigger point of vitamin D action, oxidative stress as a consequence of vitamin D deficiency.

METHOD

The interaction between vitamin D deficiency and mitochondrial function as well as skeletal muscle atrophy signalling pathways have been studied and clarified in the last years. To the best of our knowledge, we summarize key knowledge and knowledge gaps regarding the mechanism(s) of action of vitamin D in skeletal muscle.

RESULT

Vitamin D deficiency is associated with oxidative stress in skeletal muscle that influences the mitochondrial function and affects the development of skeletal muscle atrophy. Namely, vitamin D deficiency decreases oxygen consumption rate and induces disruption of mitochondrial function. These deleterious consequences on muscle may be associated through the vitamin D receptor (VDR) action. Moreover, vitamin D deficiency may contribute to the development of muscle atrophy. The possible signalling pathway triggering the expression of Atrogin-1 involves Src-ERK1/2-Akt- FOXO causing protein degradation.

CONCLUSION

Based on the current knowledge we propose that vitamin D deficiency results from the loss of VDR function and it could be partly responsible for the development of neurodegenerative diseases in human beings.

Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials

Background

There is a need to develop and periodically evaluate new treatment strategies in major depression due to the high burden of nonresponse and inadequate response to antidepressants.

Aim

We aimed to assess the effect of vitamin D supplementation on depression symptom scores among individuals with clinically diagnosed major depression.

Materials and Methods

Electronic search of databases was carried out for published randomized controlled trials in English language, peer-reviewed journals from inception till August 2017. Outcome measure used for effect size calculation was depression symptom scores. Effect sizes for the trials were computed using standardized mean difference (Cohen's d), and I2 test was used to assess sample heterogeneity. Pooled mean effect sizes were derived using both fixed and random-effects model. Critical appraisal of studies was done using the Cochrane risk of bias assessment tool.

Results

A total of four trials involving 948 participants were included in the study. In three trials, the intervention group received oral vitamin D supplementation whereas in one parenteral vitamin D was given. Pooled mean effect size for vitamin D supplementation on depressive symptom ratings in major depression was 0.58 (95% confidence interval, 0.45-0.72). The I2 value for heterogeneity was 0 suggesting low heterogeneity among studies. Egger plot intercept indicated minimal publication bias.

Conclusion

Vitamin D supplementation favorably impacted depression ratings in major depression with a moderate effect size. These findings must be considered tentative owing to the limited number of trials available and inherent methodological bias noted in few of them.

Irritable bowel syndrome: a review of the general aspects and the potential role of vitamin D

Irritable Bowel Syndrome (IBS) is a bowel disorder leading to symptoms such as abdominal pain, modifications in the motility and bowel habits, distention, bloating, and gas. Vitamin D (VD) may interfere in a plethora of cellular mechanisms, and act directly or indirectly in the regulation of the microbiome, the release of anti-microbial peptides, modulation of the immune system and inflammation processes; which in turn, may positively interfere with the altered gut function. The main purpose of this review was to survey studies involving the impacts of VD on IBS. Area covered: Eligible studies including the term VD and IBS were searched in the MEDLINE-PubMed and EMBASE (2009-2018). VD may act direct or indirectly in the regulation of the gut microbiome, immune response, and psychosocial factors that may be included in the list of IBS triggering factors. Expert opinion: Once VD plays an essential role in many processes associated with IBS, its deficiency may be associated with IBS, and the supplementation could help in the therapeutic approach for this condition. For these reasons, the understanding of the association of VD in IBS is indispensable for the development of new strategies that could improve the quality of life of the patient.

Neurological sequel of chronic kidney disease: From diminished Acetylcholinesterase activity to mitochondrial dysfunctions, oxidative stress and inflammation in mice brain

With increasing prevalence, chronic kidney disease (CKD) has become a global health problem. Due to the retention of uremic toxins, electrolytes and water, and the resultant metabolic disturbances, CKD affects several organs, including the nervous system. Thus, CKD patients suffer from several neurological complications, including dementia, cognitive impairment, motor abnormalities, depression, and mood and sleep disturbances. However, the mechanisms underlying the neurological complications are least elucidated. We have recently reported a highly reproducible mice model of CKD induced by high adenine diet, which exhibited psychomotor behavioral abnormalities and blood-brain barrier disruption. In the present study, using the mice model, we have investigated psycho-motor and cognitive behaviour, and the neurochemical and histopathological alterations in brain relevant to the observed behavioural abnormalities. The results demonstrate global loss of Acetylcholinesterase activity, and decrease in neuronal arborisation and dendritic spine density in discrete brain regions, of the CKD mice. Oxidative stress, inflammation, and mitochondrial dysfunctions were found in specific brain regions of the mice, which have been regarded as the underlying causes of the observed neurochemical and histopathological alterations. Thus, the present study is of immense importance, and has therapeutic implications in the management of CKD-associated neurological complications.

Effect of Vitamin D Supplement on Mood Status and Inflammation in Vitamin D Deficient Type 2 Diabetic Women with Anxiety: A Randomized Clinical Trial

Background:

Vitamin D plays an important role in nervous health and depression. Vitamin D deficiency and anxiety affect diabetic status. The purpose of this study was to determine the effect of vitamin D supplementation on anxiety, depression, and inflammation in diabetic women with anxiety.

Methods:

In this randomized controlled trial, totally 51 women with type 2 diabetes (T2DM) and vitamin D deficiency were randomly allocated to receive one oral pearl of 50,000 IU vitamin D3 (26 women) or a placebo (25 women) fortnightly for 16 weeks. Anthropometric indices, sun exposure, dietary intake, depression, anxiety, and stress scores and biochemical biomarkers including high sensitivity C-reactive protein (hs-CRP) and interleukin-10 (IL-10) were measured at the baseline and after 16-week supplementation.

Results:

Mean ± SD age of participant was 47.43 ± 9.57 years old. Baseline values were not different between the groups. Anxiety score changes were significantly lower in vitamin D group than the controls (P = 0.001). Within group comparison indicated that depression in supplement group with lower vitamin D levels was significantly reduced. Serum hs-CRP reduced (P = 0.01), while IL-10 concentrations increased (P = 0.04) in the intervention group.

Conclusions:

Vitamin D supplementation can improve mood status and anti-inflammatory biomarkers in female diabetics with anxiety and vitamin D deficiency.

Correlation Analysis between Serum Vitamin D Levels and Lower Extremity Macrovascular Complications in Individuals with Type 2 Diabetes Mellitus

The correlation between serum 25-hydroxy vitamin D (25(OH)D) levels and lower extremity atherosclerotic disease and the predictive value of 25(OH)D for early-stage lower extremity atherosclerotic disease in patients with type 2 diabetes mellitus (T2DM) were explored. In total, 620 subjects (590 T2DM patients and 30 healthy subjects) completed a questionnaire. All subjects were divided into four groups according to serum 25(OH)D concentration quartile: Q1 (<12.18 ng/ml), Q2 (12.18~20.65 ng/ml), Q3 (20.65~31.97 ng/ml), and Q4 (>31.97 ng/ml). Participants were also divided into four groups based on the degree of lower extremity arteriostenosis: A1 (T2DM), A2 (T2DM with mild lower extremity vascular lesions (LEVL)), A3 (T2DM with moderate LEVL), and A4 (T2DM with severe LEVL). The incidence of lower extremity artery plaque was significantly higher in groups Q1 and Q2 than in group Q4 (both P < 0.05). The concentration of 25(OH)D was significantly lower in group A4 than in groups A1 and A2. Pearson correlation analysis revealed that the degree of lower extremity vascular stenosis was positively correlated with age, smoking, and HbA1c, CRP, and LDL-C levels and negatively correlated with 25(OH)D concentrations. Logistic regression analysis demonstrated that 25(OH)D concentrations exerted a protective effect against LEVL in T2DM patients. Serum 25(OH)D concentrations may be correlated with the incidence of macrovascular disease in T2DM patients. A low serum 25(OH)D concentration is an independent risk factor for lower extremity vascular pathological changes and acts as a prognostic index for lower extremity atherosclerotic disease.

Association between vitamin D deficiency and depression in Nepalese population

Recent studies link vitamin D deficiency with depression; however evidences from the Nepalese population are scarce. The current study explored the association between vitamin D deficiency and depression among 300 adults of 18 years and above age residing in eastern Nepal. Validated Nepali version of the Beck Depression Inventory scale (BDI-Ia) was used to determine depressive symptoms and a BDI cutoff score of ≥20 was considered as clinically significant depression. Sociodemographic data were collected using semi-structured questionnaire. Blood samples were collected to measure serum 25‑hydroxy vitamin D (25(OH)D) and classify vitamin D status (deficient, insufficient and sufficient). We used Chi-square test to identify the association of sociodemographic variables and vitamin D status with clinically significant depression. We found a significant association of gender, geographical location of residence, marital status, religion and vitamin D status with clinically significant depression. Binary logistic regression model was used to examine the likelihood of clinically significant depression among vitamin D deficient individuals. Vitamin D deficiency was significantly associated with increased odds of clinically significant depression even after adjusting for confounding variables. This finding suggests Vitamin D deficient people have increased odds of having clinically significant depression.

Agomelatine versus paroxetine in treating depressive and anxiety symptoms in patients with chronic kidney disease

OBJECTIVE

Depressive and anxiety symptoms could affect the quality of life and prognostic outcomes in chronic kidney disease (CKD) patients, but only a few studies focus on the interventions to manage or prevent these symptoms in CKD patients. Therefore, this study was conducted to compare the efficacy and acceptability of agomelatine versus paroxetine in treating depressive and anxiety symptoms in CKD patients.

METHODS

CKD stage 2-4 patients with depressive and anxiety symptoms were included. The first patient was randomized in April 2013 and the last clinic visit occurred in March 2017. The included patients were randomly assigned to receive paroxetine 20-40 mg/day or agomelatine 25-50 mg/day. The treatment was continued for 12 weeks. The Hamilton Depression Rating Scale (HDRS) (17-item) and Hamilton Anxiety Rating Scale (HARS) were the primary outcome measures, and the response rate, remission rate, and Activities of Daily Living (ADL) scale were the secondary outcome measures. Meanwhile, the adverse events were recorded during the whole treatment period.

RESULTS

At baseline and week 4, both groups had similar average HDRS and HARS scores. But at week 8 and 12, compared to the patients receiving paroxetine, the patients receiving agomelatine had significantly lower average HDRS scores (p=0.002, p=0.001, respectively) and HARS scores (p<0.00001, p<0.00001, respectively). At week 12, the patients receiving agomelatine had a non-significantly lower average ADL score, and non-significantly higher response and remission rates. The adverse events in both groups were mild and transient.

CONCLUSION

These results demonstrated that the agomelatine had some advantages over par-oxetine in treating CKD stage 2-4 patients with depressive and anxiety symptoms, and future studies are needed to further explore its efficacy and acceptability.

Reduced estimated glomerular filtration rate is associated with depressive symptoms in elder Chinese: A population-based cross-sectional study

Depression has been associated with chronic kidney disease (CKD). However, few studies have examined whether such association exist in average older individuals with mild to moderate reduced kidney function. This study investigated the association between reduced estimated glomerular filtration rate (eGFR) and depressive symptoms in Chinese older population. Data was obtained from the Rugao Longevity and Ageing Study conducted in Jiangsu, China. Cockcroft-Gault (CG) equation was used to calculate eGFR. Depressive symptoms were defined by using Chinese version of 15-item Geriatric Depression Scale (GDS-15). The prevalence of depressive symptoms was 9.9% among 1749 elderly participants aged 70-84 years. Many elderly had a mild to moderate reduced renal function (84.3%, 57.1% in stage2 CKD and 27.2% in stage3 CKD, respectively). The overall GDS-15 score showed an upward trend with decreasing of eGFR (p < 0.05). Furthermore, a moderate decline of eGFR (in stage3 CKD) was significantly associated with increased risk of depressive symptoms even after adjusting for confounders (OR = 1.71, 95%CI 1.05-2.77, P = 0.03). Elder had no depressive symptoms if their eGFR was normal or mildly reduced. Our results suggest that a moderate decrease of eGFR (stage3 CKD) was independently associated with depressive symptoms in general Chinese elderly.