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Oliver SL, Santana KV, Ribeiro H. The Effect of Sunlight Exposure on Vitamin D Status in Countries of Low and High Latitudes: A Systematic Literature Review. Curr Nutr Rep 2023; 12:1-13. [PMID: 36522570 DOI: 10.1007/s13668-022-00443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF THE REVIEW To conduct a systematic review of studies to investigate the association between climate and vitamin D in humans. RECENT FINDINGS There is growing interest in the association between the environment and vitamin D, but robust methods to understand this relationship are lacking. Studies focus mainly on seasonality and latitude. Research quantifying sunlight exposure necessary for adequate vitamin D synthesis in people with darker skin color and those people living at low latitudes are scarce, as are studies in urban populations that may have limited opportunity for sunlight exposure. There are gaps regarding values and timing of exposure to UV radiation required for adequate vitamin D synthesis considering skin color, geography, climate, and local irradiation. Nature-based solutions (NbS) that can mitigate climate change will become increasingly important for preventing hypovitaminosis D. For example, tree-shaded spaces might encourage more participation in outside activities and thereby favor vitamin D synthesis by the skin.
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Affiliation(s)
- Sofia Lizarralde Oliver
- Department of Environmental Health, PhD Global Health and Sustainability Program, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, SP, 01246-904, Brasil
| | - Keila Valente Santana
- Department of Environmental Health, PhD Global Health and Sustainability Program, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, SP, 01246-904, Brasil
| | - Helena Ribeiro
- Department of Environmental Health, PhD Global Health and Sustainability Program, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715-Cerqueira César, São Paulo, SP, 01246-904, Brasil.
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Foroni MZ, Cendoroglo MS, Sakane EN, Marin-Mio RV, Moreira PFDP, Maeda SS, Lazaretti-Castro M. Serum 25 hydroxyvitamin D concentrations in individuals over 80 years old and their correlations with musculoskeletal and health parameters. Endocrine 2023; 79:559-570. [PMID: 36305996 DOI: 10.1007/s12020-022-03231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/09/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The present study aims to evaluate the serum concentrations of 25 hydroxyvitamin D[25(OH)D] in individuals aged ≥80 years, independent, free-living in Sao Paulo, Brazil (Lat 23.5 oS), and to investigate their associations with musculoskeletal system, physical performance and health markers. METHOD This cross-sectional study included 212 community dwellers aged ≥80 years and evaluated serum 25(OH)D, PTH, calcium, albumin, phosphorus, creatinine, bone markers, and bone mineral density. Physical performance was evaluated with stationary march, Flamingo, and functional reach tests, questionnaires to assess falls and fractures in the previous year, energy expenditure (MET), and Charlson index. Physical activity was evaluated with the International Physical Activity Questionnaire. RESULTS Vitamin D deficiency (<20 ng/mL) was observed in 56% and severe vitamin D deficiency (<10 ng/mL) in 13% of those individuals. Serum concentrations of 25(OH)D were significantly and positively associated with BMD total hip (p = 0.001), femoral neck (p = 0.011) and 33% radius (p = 0.046) BMDs, MET (p = 0.03) and functional reach test (p = 0.037) and negatively with age (p = 0.021), PTH (p = 0.004) and osteoporosis diagnosis (p = 0.012). Long-lived individuals with 25(OH)D ≥ 20 ng/mL had higher total hip and femoral neck BMDs (p = 0.012 and p = 0.014, respectively) and lower PTH (p = 0.030). In multiple linear regression analysis, age and osteoporosis diagnosis remained negatively associated with 25(OH)D levels (p = 0.021 and p = 0.001, respectively), while corrected calcium and cholecalciferol use remained positively associated (p = 0.001 and p = 0.024, respectively). CONCLUSION We observed high vitamin D inadequacy prevalence in those Brazilian community dwellers' oldest old. Serum concentrations of 25(OH)D were positively associated with bone mass and dynamic balance, and negatively with PTH and osteoporosis diagnosis. Additionally, 25(OH)D ≥ 20 ng/mL was associated with better bone mass and lower PTH levels.
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Affiliation(s)
- Mariana Zuccolotto Foroni
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Maysa Seabra Cendoroglo
- Division of Geriatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Eliane Naomi Sakane
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rosangela Villa Marin-Mio
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Sergio Setsuo Maeda
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marise Lazaretti-Castro
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Okai GG, Cardozo KHM, Ferrer CM, Goldman MM, Clarke NJ, Vieira JGH. LC-MS/MS reduces interference by high levels of 25(OH)D and its metabolites on measured 1,25(OH) 2D. Steroids 2022; 187:109095. [PMID: 35908594 DOI: 10.1016/j.steroids.2022.109095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND High-dose vitamin D supplementation has been recommended as treatment to several conditions; however, potential side effects such as hypercalcemia should be considered, plus the fact that high levels of 25(OH)D may interfere with potential 1,25(OH)2D measurements. Our study compared two methods of measuring 1,25-dihydroxyvitamin D [1,25(OH)2D] in samples with 25-hydroxyvitamin D [25(OH)D] levels above 150 ng/mL (375 nmol/L). METHODS We studied serum samples referred to 25(OH)D and 1,25(OH)2D quantification. The concentrations of 25(OH)D and 1,25(OH)2D were measured using DiaSorin chemiluminescent assays (CLIA) in 213 samples (CLIA group), whereas in 357 samples 25(OH)D and 1,25(OH)2D were measured by DiaSorin CLIA and liquid chromatography-tandem mass spectrometry (LC-MS/MS), respectively (CLIA + MS group). RESULTS Median concentrations of 25(OH)D and 1,25(OH)2D in the CLIA group were 371 ng/mL (928 nmol/L, range 154-856 ng/mL) and 350 pg/mL (875 pmol/L, range 41-1280 pg/mL), respectively, and correlated significantly (Spearman correlation coefficient rs = 0.8469, P < 0.001). In the CLIA + MS group, the median concentrations of 25(OH)D and 1,25(OH)2D were, respectively, 344 ng/mL (860 nmol/L, range 152-756 ng/mL) and 56 pg/mL (140 pmol/L, range 17-151 pg/mL), and were not correlated (rs = 0.0218, P = 0.6811). No significant difference was found in calcium, creatinine, and PTH serum values between the groups. CONCLUSION Methods for measuring 1,25(OH)2D in patients with high levels of 25(OH)D may be susceptible to interference by 25(OH)D and its metabolites and should be validated carefully. In such cases, measurement of 1,25(OH)2D using LC-MS/MS is preferred.
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Vinueza Veloz AF, Carpio Arias TV, Vargas Mejía JS, Tapia Veloz EC, Piedra Andrade JS, Nicolalde Cifuentes TM, Heredia Aguirre SI, Vinueza Veloz MF. Cognitive function and vitamin B12 and D among elders: A cross-sectional study. Clin Nutr ESPEN 2022; 50:270-276. [DOI: 10.1016/j.clnesp.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
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Rolizola PMD, Freiria CN, Silva GMD, Brito TRPD, Borim FSA, Corona LP. Insuficiência de vitamina D e fatores associados: um estudo com idosos assistidos por serviços de atenção básica à saúde. CIENCIA & SAUDE COLETIVA 2022; 27:653-663. [DOI: 10.1590/1413-81232022272.37532020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste artigo é analisar a insuficiência de vitamina D e fatores associados em idosos assistidos na atenção primária à saúde. Trata-se de um estudo transversal que avaliou 533 idosos (≥ 60 anos) em três cidades do estado de São Paulo, Brasil. Foi avaliada a 25-hidroxivitamina D (25 OH D) sérica por quimioluminescência. Os fatores avaliados foram condições sociodemográficas (sexo, faixa etária, etnia, escolaridade, renda, estado civil), de saúde (doenças referidas), composição corporal (IMC, circunferência da cintura), estilo de vida (atividade física e tabagismo) e exposição solar (finalidade, duração, frequência e horário de exposição, partes expostas, uso de protetor solar, tipo de pele). A prevalência de insuficiência foi de 64,5%, com associação para sexo feminino, etnia não brancos/não declarados, baixo peso, circunferência da cintura elevada (risco para DCV) e inatividade física. Houve associação negativa para exposição solar habitual de mãos, braços e pernas, durante atividade de lazer, deslocamentos diários e atividade física e entre as 9h e 15h. Os achados mostram a relevância de fatores como sexo, etnia, composição corporal, atividade física e hábitos de exposição solar na alta prevalência de níveis inadequados de vitamina D em idosos.
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Santos ATD, Zardo ADLG, Kalva DC, Maciel MAS. Evaluation of vitamin D and inflammatory markers in elderly. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Valle CARD, Pedri LAF, Pires GB, Blanco MS, Paula BS, Araújo CDM. Influence of Hypovitaminosis D on the Ocurrence of Fractures. Rev Bras Ortop 2021; 56:784-789. [PMID: 34900108 PMCID: PMC8651456 DOI: 10.1055/s-0041-1729585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
Objective
To measure the levels of vitamin D in patients hospitalized for fractures and to evaluate its relationship with fractures.
Methods
A primary, analytical, cross-sectional, non-interventional, observational, controlled study was conducted in humans. The serum measurement of: vitamin D, parathyroid hormone (PTH), calcium, phosphorus, magnesium and albumin was performed in 49 patients who were consecutively hospitalized for surgery due to fracture(s) (study group), and in 50 patients without fractures, from the various outpatient clinics, and who underwent routine tests (control group).
Results
The mean level of 25-hydroxyvitamin D (25[OH]D) in patients with fractures was of 23.78 ± 8.01 ng/mL (61.22% of patients with fractures had hypovitaminosis D). The mean 25(OH)D of the control group was of 37.52 ± 9.21 ng/mL (10% of the patients had hypovitaminosis D). Most cases of hypovitaminosis (96%) did not course with secondary hyperparathyroidism (mean PTH = 41.80 ± 22.75 pg/mL).
Conclusion
Hypovitaminosis D was found in a significant percentage (61.22%) of the patients who suffered fractures. Further studies on the subject are needed to better understand the influence of hypovitaminosis D on the occurrence of fractures, as well as the benefits of vitamin D supplementation in these patients.
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Affiliation(s)
- Cleandro Augusto Ribeiro do Valle
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas Samuel Libânio, Universidade do Vale do Sapucaí (Univás), Pouso Alegre, Minas Gerais, MG, Brasil
| | - Luiz Alfredo Furtado Pedri
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas Samuel Libânio, Universidade do Vale do Sapucaí (Univás), Pouso Alegre, Minas Gerais, MG, Brasil
| | - Guilherme Bigonha Pires
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas Samuel Libânio, Universidade do Vale do Sapucaí (Univás), Pouso Alegre, Minas Gerais, MG, Brasil
| | - Mariella Soares Blanco
- Faculdade de Ciências Médicas Dr. José Garcia Coutinho, Universidade do Vale do Sapucaí (Univás), Pouso Alegre, Minas Gerais, MG, Brasil
| | - Bruna Soares Paula
- Faculdade de Ciências Médicas Dr. José Garcia Coutinho, Universidade do Vale do Sapucaí (Univás), Pouso Alegre, Minas Gerais, MG, Brasil
| | - Carlos Delano Mundim Araújo
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas Samuel Libânio, Universidade do Vale do Sapucaí (Univás), Pouso Alegre, Minas Gerais, MG, Brasil.,Centro Universitário Atenas (UniAtenas), Paracatu, Minas Gerais, MG, Brasil
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Abstract
Vitamin D is a fundamentally critical nutrient that the human body requires to function properly. It plays an important role in musculoskeletal health due to its involvement in the regulation of calcium and phosphorus. Having a low level of vitamin D in the body may be detrimental for a wide range of health outcomes, including risk of osteoporotic and stress fractures, risk of CVD and some cancers, and lowering of the capability of the immune system. Vitamin D is an unusual nutrient; it is not a vitamin, in the true sense of the word but a pro-hormone. The main source of vitamin D is UV exposure, not dietary intake. Interestingly, there are two forms of vitamin D, vitamin D2 and vitamin D3, both of which are metabolised into 25-hydroxyvitamin D (25(OH)D) in the liver, the biomarker of vitamin D status. Vitamin D deficiency is a global public health problem, especially amongst older people and ethnic minority groups. The newest publication from the UK Government's Public Health England Department recommends that vitamin D intake should be 10 μg daily and this recommendation compares well (albeit lower) with other guidelines such as the Institute of Medicine recommendation of 15 μg for those aged 1-70 years and 20 μg for those 70 years or over. Few countries, however, have a specific vitamin D policy to prevent deficiency in populations. Finland leads the way, demonstrating impressive results in reducing population-level vitamin D deficiency through mandatory food fortification programmes. Collaboration between academia, government and industry, including countries from varying latitudes, is essential to identify long-term solutions to the global issue of vitamin D deficiency. This paper provides a narrative review of the evidence related to the role of vitamin D deficiency in health outcomes, outlines controversies regarding setting levels of adequacy, identifies the prevalence of vitamin D deficiency across the globe, and identifies population-level strategies adopted by countries to prevent vitamin D deficiency.
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Leão LMCS, Rodrigues BC, Dias PTP, Gehrke B, de Souza TDSP, Hirose CK, Freire MDC. Vitamin D status and prevalence of hypovitaminosis D in different genders throughout life stages: A Brazilian cross-sectional study. Clinics (Sao Paulo) 2021; 76:e2571. [PMID: 33852654 PMCID: PMC8009065 DOI: 10.6061/clinics/2021/e2571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/17/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the mean concentration of 25-hydroxivitamin D [25(OH) D] and prevalence of hypovitaminosis D in individuals residing in Rio de Janeiro, Brazil. METHODS The data of 80,000 consecutive individuals who had 25(OH) D measurements performed by electrochemiluminescence between 1/2/2018 and 2/5/2018 were selected. Patients who reported the use of therapies/supplements were excluded. Levels of 25(OH) D ≥20 ng/mL (ages <60 years) and ≥30 ng/mL (ages ≥60 years) were considered adequate. RESULTS We analyzed the data of 24,074 individuals (1-95 years old, 64.7% female). Descriptive curves showed that, in both sexes, the mean values of 25(OH) D decreased from the first years of life until adolescence, then slightly increased, and then tended to stabilize during adulthood. Levels of 25(OH) D <20 ng/mL were observed in 6% of girls versus 3.6% of boys and in 13.6% of adolescent girls versus 12.6% of adolescent boys and 11% of adults. The percentage of seniors with serum levels of 25(OH) D <20 ng/mL was 13.6% in women and 12.7% in men; 53.2% of women and 50.6% of men had levels <30 ng/mL. CONCLUSIONS Mean 25(OH) D values were higher in children and lower in adolescents and women. Approximately 90% of non-seniors and presumably healthy residents of the urban metropolitan region of Rio de Janeiro presented satisfactory levels of 25(OH) D during the summer months; however, in over half of the elderly, the serum concentrations of 25(OH) D were inadequate. Therefore, strategies for the prevention of hypovitaminosis D should be considered in the senior population.
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Affiliation(s)
- Lenora M. Camarate S.M. Leão
- Servico de Endocrinologia, Hospital Universitario Pedro Ernesto, Faculdade de Ciencias Medicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | | | - Paulo Telles Pires Dias
- Nucleo de Estudos e Pesquisas em Atencao ao Uso de Drogas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
- Departamento de Epidemiologia e Bioestatistica (MEB-ISC), Universidade Federal Fluminense, Niteroi, RJ, BR
| | - Bárbara Gehrke
- Programa de Pos-Graduacao em Fisiopatologia Clinica e Experimental (FISCLINEX), Faculdade de Ciencias Medicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
- *Corresponding author. E-mail:
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Association of Vitamin D with the TaqI Polymorphism of the VDR Gene in Older Women Attending the Basic Health Unit of the Federal District, DF (Brazil). J Aging Res 2020; 2020:7145193. [PMID: 33029399 PMCID: PMC7532410 DOI: 10.1155/2020/7145193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022] Open
Abstract
Aging is accompanied by various functional modifications determined by their environment, lifestyle, nutrition, and genetics. Based on these factors, it is essential to verify the vitamin deficiency in the elderly population. Hypovitaminosis D is commonly present in human aging, increasing the chances of developing noncommunicable chronic diseases. The VDR gene TaqI polymorphism may modify the vitamin D metabolic pathway by altering the interaction between the vitamin D receptor and the active circulating vitamin D. Therefore, this study aimed to investigate the association between serum vitamin D and biochemical and genetic factors, considering the TaqI polymorphism of the VDR gene, in an elderly population of the Federal District. The study was a descriptive, case-control, quantitative, and cross-sectional type and was conducted in two basic health units in the administrative region of Ceilândia, Federal District, DF, Brazil, with women aged 60 years or older. Anthropometric, biochemical, and genetic parameters (VDR TaqI polymorphism) were evaluated. The adopted significance level was 5%, and statistical analyses were performed using the SPSS version 20.0 program. The study consisted of 128 participants. The most prevalent age was from 60 to 65 years (N = 53; 41.4%). 66 elderly (51.6%) were part of the case group (hypovitaminosis D), while 62 were in the control group. In the case group, 30.2% had grade I obesity, 77.3% were hypertensive, and 51.5% were diabetic. The TT genotype was present in 47% of the case group and 54.8% in the control group (p=0.667). There was no association between serum vitamin D levels and the VDR gene variant TaqI polymorphism in an elderly Brazilian population.
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de Paula ALT, Gonzaga WPF, Oliveira LM, Feibelmann TCM, Markus J. Exogenous intoxication by non-prescribed use of vitamin D, a case report. BMC Geriatr 2020; 20:221. [PMID: 32580697 PMCID: PMC7315533 DOI: 10.1186/s12877-020-01614-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This case report, unlike the current literature related to vitamin D intoxication, aims to highlight the risk of self-medication, and how publicity boosts the acquisition of vitamins for different purposes, increasing consumption with no professional indication or supervision. This practice can pose a serious health risk to the population. CASE PRESENTATION Our patient, a brazilian retired 64-year-old female, presented to the emergency service with post-prandial food vomiting of undigested content and stabbing abdominal pain with worsening during palpation. Concomitantly, onset of sporadic frontal headache, fatigue, hyporexia, weight loss of 18 kg in the same period, severe pruritus, musculoskeletal pain in the limbs and nocturia. The physical examination showed hypertension (160/80 mmHg) and itchy macules in the lower limb. Initially, the main diagnostic hypotheses were multiple myeloma, hyperparathyroidism and pancreatitis secondary to hypercalcemia, osteolytic neoplasms and other neoplasms that present with hypercalcemia. However, blood count, parathyroid hormone, chest X-ray, immunoglobulins, myelogram and bone marrow biopsy were not compatible with these diagnoses. Meanwhile, 25 OH vitamin D dosage and diluted vitamin D test confirmed the diagnosis of hypervitaminosis D. Hypercalcemic crisis was managed with vigorous hydration (50 ml/kg in 2 h), furosemide, bisphosphonates and blood pressure control with amlodipine and atenolol. Subsequently, the patient was discharged from the outpatient clinic with complete remission of symptoms, weight gain, serum calcium values of 10.76 mg/dL and ionizable calcium values of 6.52 mg/dL. CONCLUSION Our report summarizes the possible consequences of using a vitamin compound without supervision of a competent professional, as these substances are mistakenly considered non-toxic. To add, little information is available about the supplements' metabolism and their biological effects. Therefore, It is difficult to diagnose intoxication. This case report shows that even the self-administration of a product designed to bring health benefits can become a risky behavior. These vitamin and mineral supplements are supposed to bring patient empowerment and reduce government spending in health-care, but indeed represent a significant public health concern due to possible overdose and drug interactions.
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Affiliation(s)
- Ana Laura Teodoro de Paula
- Medical Doctorate Degree, Faculty of Medicine, Federal University of Uberlândia, Av Pará, 1720, Uberlândia, Minas Gerais, 38405-320, Brazil
| | - Wemerson Philipe Ferreira Gonzaga
- Medical Doctorate Degree, Faculty of Medicine, Federal University of Uberlândia, Av Pará, 1720, Uberlândia, Minas Gerais, 38405-320, Brazil
| | - Lucas Martins Oliveira
- Medical Doctorate Degree, Faculty of Medicine, Federal University of Uberlândia, Av Pará, 1720, Uberlândia, Minas Gerais, 38405-320, Brazil.
| | | | - Juliana Markus
- Internal Medicine Department, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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Ribeiro H, Santana KVDSD, Oliver SL, Rondó PHDC, Mendes MM, Charlton K, Lanham-New S. Does Vitamin D play a role in the management of Covid-19 in Brazil? Rev Saude Publica 2020; 54:53. [PMID: 32491112 PMCID: PMC7244235 DOI: 10.11606/s1518-8787.2020054002545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 02/03/2023] Open
Abstract
The study discusses the possible role of adequate vitamin D status in plasma or serum for preventing acute respiratory infections during the Covid-19 pandemic. Our arguments respond to an article, published in Italy, that describes the high prevalence of hypovitaminosis D in older Italian women and raises the possible preventive and therapeutic role of optimal vitamin D levels. Based on literature review, we highlight the findings regarding the protective role of vitamin D for infectious diseases of the respiratory system. However, randomized controlled trials are currently lacking. Adequate vitamin D status is obtained from sun exposure and foods rich in vitamin D. Studies in Brazil have shown that hypovitaminosis D is quite common in spite of high insolation. Authors recommend ecological, epidemiological and randomized controlled trials studies to verify this hypothesis.
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Affiliation(s)
- Helena Ribeiro
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Keila Valente de Souza de Santana
- Programa de Pós-Graduação em Saúde Global e Sustentabilidade, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Sofia Lizarralde Oliver
- Programa de Pós-Graduação em Saúde Global e Sustentabilidade, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Marcela Moraes Mendes
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, United Kingdom
| | - Karen Charlton
- Faculty of Science, School of Medicine, University of Wollongong, Wollongong, Australia
| | - Susan Lanham-New
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, United Kingdom
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Gandolfi NRS, Corrente JE, De Vitta A, Gollino L, Mazeto GMFDS. The influence of the Pilates method on quality of life and bone remodelling in older women: a controlled study. Qual Life Res 2019; 29:381-389. [PMID: 31512157 DOI: 10.1007/s11136-019-02293-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to evaluate the effects of the Pilates method on quality of life and bone remodeling markers in a group of older women. METHODS A longitudinal prospective study with intervention was performed on 40 women aged over 60 years; they were divided into two groups: one submitted to a 50-min Pilates exercise session once a week for 20 weeks (Pilates), and the other was not (Control). Both groups were compared for quality of life using the Medical Outcomes Study 36, and for bone-specific alkaline phosphatase (BSAP) and Type 1 collagen C-telopeptide (CTx) bone remodeling markers. RESULTS The Pilates group presented improvement in the quality of life evaluation scores: physical functioning (67.50 ± 18.88 × 86.25 ± 9.58; p = 0.0232), and physical component summary (65.00 ± 14.39 × 79.70 ± 3.83; p = 0.0220). The Pilates group also presented higher scores than that of Controls after the exercise program: physical functioning (86.25 ± 9.58 × 55.50 ± 20.83, p = 0.0003), physical role (100.00 ± 0.00 × 41.25 ± 46.79, p = 0.0009), emotional role (100.00 ± 0.00 × 48.33 ± 50.12, p = 0.0046), vitality (82.50 ± 14.28 × 60.25 ± 21.43, p = 0.011), physical component summary (79.70 ± 3.83 × 54.90 ± 15.05, p < 0.0001), and emotional component summary (74.10 ± 8.37 × 54.18 ± 22.55, p = 0.0111). No changes were noted in bone remodeling markers [CTx (0.39 ± 0.26 × 0.38 ± 0.22 ng/mL) and BSAP (10.73 ± 2.40 × 11.01 ± 3.56 μg/L)] and did not differ from the Control group both before (CTx: 0.39 ± 0.26 × 0.37 ± 0.17 ng/mL; BSAP: 10.73 ± 2.40 × 10.58 ± 3.49 μg/L; p > 0.05) and after exercise (CTx: 0.38 ± 0.22 × 0.38 ± 0.22 ng/mL; BSAP: 11.01 ± 3.56 × 9.85 ± 3.12 μg/L; p > 0.05). CONCLUSION The group of women submitted to Pilates presented improved quality of life but without changes in bone remodeling.
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Affiliation(s)
| | - Jose Eduardo Corrente
- Biostatistics Department, Institute of Biosciences, Sao Paulo State University - Unesp, Botucatu, Sao Paulo, 18618-687, Brazil
| | - Alberto De Vitta
- Universidade Anhanguera - UNIDERP, Campo Grande, Mato Grosso do Sul, 79037-280, Brazil
| | - Loraine Gollino
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, Sao Paulo, 18618-687, Brazil
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Coutinho RCS, dos Santos AF, da Costa JG, Vanderlei AD. Sun exposure, skin lesions and vitamin D production: evaluation in a population of fishermen. An Bras Dermatol 2019; 94:279-286. [PMID: 31365655 PMCID: PMC6668935 DOI: 10.1590/abd1806-4841.20197201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/07/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Exposure to UVR provides benefits related to vitamin D synthesis, but also causes harms, since UVB is considered a complete carcinogen. There is no definition of the level of sun exposure and the proportion of exposed body required for proper synthesis of vitamin D in the skin without causing it damage. OBJECTIVES This study aims to analyze the sun exposure index, vitamin D levels and clinical changes in the skin caused by constant sun exposure in the fishermen population. METHODS It is a cross-sectional, observational and analytical study. The sample consisted of fishermen and was calculated in 174 individuals. The questionnaire was applied, the dermatological examination was carried out and the examinations of calcidiol, parathyroid hormone, calcium and phosphorus were requested. Data were expressed as percentages. The comparative analysis was done through the Chi-square test, and the correlations were established through the Pearson's linear coefficient. Results: We observed that there was vitamin D deficiency in a small part of the cases (11.46%), and the frequency of diagnosis of skin cancer was 2.7% of the cases surveyed. STUDY LIMITATIONS The difficulty in categorizing the sun exposure index. CONCLUSION The fact that fishermen expose themselves to the sun chronically and have been exposed to the sun for more than 15 years, between 21 and 28 hours a week, and without photoprotection, were indicative factors for protection against vitamin D deficiency. Chronic exposure to sun and high vitamin levels D may be indicative of protection of this population against skin cancer.
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Affiliation(s)
- Roberta Cavalcanti Soriano Coutinho
- Discipline of Dermatology, Centro Universitário CESMAC,
Maceió (AL), Brazil
- Program of Post-Graduation, Professional Master’s Degree in Health
Research, Centro Universitário CESMAC, Maceió (AL), Brazil
| | - Aldenir Feitosa dos Santos
- Program of Post-Graduation, Professional Master’s Degree in Health
Research, Centro Universitário CESMAC, Maceió (AL), Brazil
- Program of Post-Graduation, Professional Master’s Degree in
Analysis of Environmental Systems, Centro Universitário CESMAC, Maceió
(AL), Brazil
- Discipline de Biochemistry, Universidade Estadual de Alagoas,
Arapiraca (AL), Brazil
| | - João Gomes da Costa
- Program of Post-Graduation, Professional Master’s Degree in
Analysis of Environmental Systems, Centro Universitário CESMAC, Maceió
(AL), Brazil
- Program of Post-Graduation in Agriculture and Environment,
Universidade Federal de Alagoas, Maceió (AL), Brazil
| | - Aleska Dias Vanderlei
- Program of Post-Graduation, Professional Master’s Degree in Health
Research, Centro Universitário CESMAC, Maceió (AL), Brazil
- Discipline of Dentistry, Centro Universitário CESMAC,
Maceió (AL), Brazil
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Sousa SES, Sales MC, Araújo JRT, Sena-Evangelista KCM, Lima KC, Pedrosa LFC. High Prevalence of Hypovitaminosis D in Institutionalized Elderly Individuals is Associated with Summer in a Region with High Ultraviolet Radiation Levels. Nutrients 2019; 11:nu11071516. [PMID: 31277405 PMCID: PMC6682871 DOI: 10.3390/nu11071516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023] Open
Abstract
Vitamin D may play a significant role in regulating the rate of aging. The objective of the study was to assess vitamin D status and its associated factors in institutionalized elderly individuals. A total of 153 elderly individuals living in Nursing Homes (NH) were recruited into the study. Serum 25-hydroxyvitamin D [25(OH)D] concentration was used as the biomarker of vitamin D status, and it was considered as the dependent variable in the model. The independent variables were the type of NH, age-adjusted time of institutionalization, age, sex, skin color, body mass index, waist and calf circumference, physical activity practice, mobility, dietary intake of vitamin D and calcium, vitamin D supplementation, use of antiepileptics, and season of the year. Serum 25(OH)D concentrations less than or equal to 29 ng/mL were classified as insufficient vitamin D status. The prevalences of inadequate dietary intake of vitamin D and calcium were 95.4% and 79.7%, respectively. The prevalence of hypovitaminosis D was 71.2%, and the mean serum concentration of 25(OH)D was 23.9 ng/mL (95% confidence interval [CI]: 22.8-26.1). Serum 25(OH)D concentration was associated with the season of summer (p = 0.046). There were no associations with other independent variables (all p > 0.05). The present results showed that a high prevalence of hypovitaminosis D was significantly associated with summer in institutionalized elderly individuals.
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Affiliation(s)
- Sara Estéfani S Sousa
- Postgraduate Program in Nutrition, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, 59078970 Natal, RN, Brazil
| | - Márcia Cristina Sales
- School of Medicine, State University of Roraima, Rua Sete de Setembro, 231, Canarinho, 69306530 Boa Vista, RR, Brazil
| | - José Rodolfo T Araújo
- Postgraduate Program of Health Sciences, Federal University of Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias, Petrópolis, 59010180 Natal, RN, Brazil
| | - Karine C M Sena-Evangelista
- Postgraduate Program in Nutrition, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, 59078970 Natal, RN, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, 59078970 Natal, Brazil
| | - Kenio C Lima
- Postgraduate Program of Health Sciences, Federal University of Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias, Petrópolis, 59010180 Natal, RN, Brazil
- Department of Dentistry, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, 59056000 Natal, RN, Brazil
| | - Lucia F C Pedrosa
- Postgraduate Program in Nutrition, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, 59078970 Natal, RN, Brazil.
- Postgraduate Program of Health Sciences, Federal University of Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias, Petrópolis, 59010180 Natal, RN, Brazil.
- Department of Nutrition, Federal University of Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Lagoa Nova, 59078970 Natal, Brazil.
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16
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Association between 25-Hydroxyvitamin D, Parathyroid Hormone, Vitamin D and Calcium Intake, and Bone Density in Healthy Adult Women: A Cross-Sectional Analysis from the D-SOL Study. Nutrients 2019; 11:nu11061267. [PMID: 31167443 PMCID: PMC6628165 DOI: 10.3390/nu11061267] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022] Open
Abstract
There is still limited data on the association between 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), and bone health in healthy younger adults, particularly in Latin America. This cross-sectional analysis aimed to investigate the associations of 25(OH)D and plasma PTH concentrations with bone parameters, and potential confounders, in women living in a high (England) or low (Brazil) latitude country. Bone was assessed by either peripheral quantitative computed tomography (pQCT) (England) or dual-energy x-ray absorptiometry (DXA) scan (Brazil), serum 25(OH)D concentrations by high performance liquid chromatography tandem mass spectrometry (HPLC-MS) and PTH by the chemiluminescent method. In participants living in England, total volumetric bone mineral density (vBMD) was significantly higher in women <29 years compared to ≥30 years, and total and cortical vBMD values at the 66% site were negatively correlated with weight and body mass index (BMI). In participants living in Brazil, age was positively correlated with bone mineral density (BMD) at the femur and bone mineral content (BMC), and weight, BMI, and body fat were correlated with BMD (lumbar spine and femur) and BMC. PTH concentrations were negatively correlated with 25(OH)D concentrations, and the prevalence of secondary hyperparathyroidism was 28.6% (n = 14) in participants with concentrations <25 nmol/L and 12.2% (n = 41) with concentrations between 25 and 49.9 nmol/L, compared to 6.3% (n = 79) in those with concentrations ≥50 nmol/L. In conclusion, weight and BMI were significantly correlated with bone parameters in both groups and age was significantly correlated with BMD at the femoral neck for women living in Brazil only. Although 25(OH)D concentrations were not correlated to bone parameters at any sites, in either country, PTH concentrations showed a significant correlation with total vBMD at the 66% site for women living in England. Secondary hyperparathyroidism was more common amongst those with deficient and insufficient vitamin D status.
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17
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Mendes MM, Hart KH, Botelho PB, Lanham-New SA. Vitamin D status in the tropics: Is sunlight exposure the main determinant? NUTR BULL 2018. [DOI: 10.1111/nbu.12349] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M. M. Mendes
- Department of Nutritional Sciences; University of Surrey; Guildford UK
| | - K. H. Hart
- Department of Nutritional Sciences; University of Surrey; Guildford UK
| | - P. B. Botelho
- Faculty of Health Science; University of Brasília; Brasília Brazil
| | - S. A. Lanham-New
- Department of Nutritional Sciences; University of Surrey; Guildford UK
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18
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Carvalho VA, Ferreira do Prado Moreira P, Périgo Nascimento NA, Bertolini AA, Aragão L, Cendoroglo MS. The influence of 25-hydroxyvitamin D and High-Density Lipoprotein Cholesterol on BIA Resistance results and aging on BIA Reactance results in elderly people. Clin Nutr ESPEN 2018; 27:92-95. [PMID: 30144899 DOI: 10.1016/j.clnesp.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/15/2018] [Accepted: 06/13/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS The use of Bioimpedance (BIA) as a bedside method of evaluation of body composition increased in the last years. However there are still some questions about correct interpretation of the raw data, reactance and resistance, as measures of body composition. This study investigated the relationship of age, physical activity practice, Body Mass Index (BMI), 25-hydroxyvitamin D and serum lipoproteins in BIA data of resistance and reactance. METHODS A transversal study was performed with elderly women who practiced regular physical activity (Group 1) and community dwelling elderly women (Group 2). Blood test, antrophometric measures and BIA exam were performed. As some studies had suggested, the ones with a BMI superior to 34 Kg/m2 were excluded. Students T-test was applied to assess differences between both groups, and due to its results, it was performed a stepwise multiple regression analysis. RESULTS The results of 320 elderly women with a BMI ≤34 Kg/m2 (Group 1 = 225; Group 2 = 95) were analyzed. At the blood test, there was a statistically significant difference for total-cholesterol, LDL-cholesterol, High-Density Lipoprotein Cholesterol and 25-hydroxyvitamin D. We observed an increase of 0.42 OHMS in BIA Resistance for each increment of 1 nmol/dL of 25-hydroxyvitamin D (p < 0.005), and an increase of 1 mg/dL of High-Density Lipoprotein Cholesterol led to an increase of 0.655 OHMS in BIA Resistance (p < 0.005). Also, it was observed that an increment of 1 year old have showed a reduction of 0.038 OHMS in BIA Reactance (p < 0.1). CONCLUSIONS BIA Reactance was influenced by aging and BIA Resistance was influenced by High-Density Lipoprotein Cholesterol and 25-hydroxyvitamin D.
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19
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Loures MAR, Zerbini CAF, Danowski JS, Pereira RMR, Moreira C, Paula APD, Castro CHM, Szejnfeld VL, Mendonça LMC, Radominiski SC, Bezerra MC, Simões R, Bernardo WM. Guidelines of the Brazilian Society of Rheumatology for the diagnosis and treatment of osteoporosis in men. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57 Suppl 2:497-514. [PMID: 28800970 DOI: 10.1016/j.rbre.2017.07.003] [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] [Received: 12/05/2016] [Accepted: 05/24/2017] [Indexed: 02/07/2023] Open
Abstract
Osteoporosis, a metabolic disease characterized by low bone mass, deterioration of the bone tissue microarchitecture and increased susceptibility to fractures, is commonly regarded as a women's health problem. This point of view is based on the fact that compared with men, women have lower bone mineral density and longer lifespans and lose bone mass faster, especially after menopause, due to a marked decrease in serum estrogen levels. However, in the last 20 years, osteoporosis in men has become recognized as a public health problem due to the occurrence of an increasingly higher number of fragility fractures. Approximately 30% of all hip fractures occur in men. Recent studies show that the probability of fracture due to hip, vertebral or wrist fragility in Caucasian men older than fifty years, for the rest of their lives, is approximately 13% versus a 40% probability of fragility fractures in women. Men show bone mass loss and fractures later than women. Although older men have a higher risk of fracture, approximately half of all hip fractures occur before the age of 80. Life expectancy is increasing for both sexes in Brazil and worldwide, albeit at a higher rate for men than for women. This Guideline was based on a systematic review of the literature on the prevalence, etiology, diagnosis and treatment of osteoporosis in men.
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Affiliation(s)
- Marco Antônio R Loures
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Estadual de Maringá (UEM), Hospital Universitário, Maringá, PR, Brazil.
| | - Cristiano Augusto F Zerbini
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Centro Paulista de Investigação Clínica (CEPIC), São Paulo, SP, Brazil
| | - Jaime S Danowski
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Hospital Israelita Albert Sabin, Unidade de Reumatologia, Rio de Janeiro, RJ, Brazil
| | - Rosa Maria R Pereira
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil
| | - Caio Moreira
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Ana Patrícia de Paula
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Secretaria de Saúde do Distrito Federal (SES-DF), Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS), Brasília, DF, Brazil; Universidade de Brasília (UnB), Faculdade de Ciências da Saúde (FS), Brasília, DF, Brazil
| | - Charlles Heldan M Castro
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Vera Lúcia Szejnfeld
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Setor de Doenças Osteometabólicas, São Paulo, SP, Brazil
| | - Laura Maria C Mendonça
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Programa de Residência Médica de Reumatologia, Rio de Janeiro, RJ, Brazil
| | - Sebastião C Radominiski
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Mailze C Bezerra
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Hospital Geral de Fortaleza (HGF), Ambulatório de Osteoporose e Doenças Osteometabólicas, Fortaleza, CE, Brazil
| | - Ricardo Simões
- Associação Médica Brasileira (AMB), Projeto Diretrizes, São Paulo, SP, Brazil
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Correia-Sá I, Serrão P, Marques M, Vieira-Coelho MA. Hypertrophic Scars: Are Vitamins and Inflammatory Biomarkers Related with the Pathophysiology of Wound Healing? Obes Surg 2017; 27:3170-3178. [PMID: 28569361 DOI: 10.1007/s11695-017-2740-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hypertrophic scars are a consequence of wound healing. OBJECTIVE The objective of the present study is to evaluate vitamin D and inflammatory biomarker plasma levels during wound healing. METHODS A prospective study was performed in patients (n = 63) submitted to body contouring surgery. Blood samples were collected before (t 0) and 5 days after surgery (t 5). Blood cell count, protein inflammatory biomarkers, and circulating plasma levels of 25(OH)D, vitamin A and vitamin E were quantified. Six months after surgery, scars were evaluated and classified as normal or hypertrophic. RESULTS At the end of the study, 73% of the patients developed a normal scar (control group, n = 46) and 27% of the patients presented hypertrophic scars (HT group, n = 17). The patients in the HT group presented higher eosinophil (0.145 × 109 /L vs. 0.104 × 109 /L, p = 0.028) and basophil count (0.031 × 109 /L vs. 0.22 × 109 /L, p = 0.049) and C-reactive protein levels (6.12 mg/L vs. 2.30 mg/L, p = 0.015) in t 0 than the patients in the control group. At t 5, the patients in the HT group showed a decrease in neutrophil (3.144 × 109/L vs. 4.03 × 109/L, p = 0.031) and an increase in basophil (0.024 × 109/L vs. 0.015 × 109/L, p = 0.005) and lymphocyte count (1.836 × 109 /L vs. 1.557 × 109/L; p = 0.028). Before surgery, vitamin D plasma levels were found to be decreased by almost 50% (23.52 ng/mL vs. 15.46 ng/mL, p = 0.031) in the patients who developed hypertrophic scars. Thirty-one percent of the patients submitted to bariatric surgery had more hypertrophic scars, versus 24% of the patients with no previous bariatric surgery. CONCLUSION There is a different systemic inflammatory profile response in the patients during the formation of hypertrophic scars. Vitamin D plasma levels are marked reduced in these patients. Considering the powerful anti-inflammatory effect of vitamin D, these findings could be related.
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Affiliation(s)
- Inês Correia-Sá
- Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery and Burn Unit, Centro Hospitalar de São João, EPE, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Oporto, Porto, Portugal. .,Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Oporto, Porto, Portugal.
| | - Paula Serrão
- Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Oporto, Porto, Portugal
| | - Marisa Marques
- Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery and Burn Unit, Centro Hospitalar de São João, EPE, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Oporto, Porto, Portugal
| | - Maria A Vieira-Coelho
- Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Oporto, Porto, Portugal
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Eloi M, Horvath DV, Ortega JC, Prado MS, Andrade LEC, Szejnfeld VL, de Moura Castro CH. 25-Hydroxivitamin D Serum Concentration, Not Free and Bioavailable Vitamin D, Is Associated with Disease Activity in Systemic Lupus Erythematosus Patients. PLoS One 2017; 12:e0170323. [PMID: 28085957 PMCID: PMC5234837 DOI: 10.1371/journal.pone.0170323] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/03/2017] [Indexed: 12/18/2022] Open
Abstract
We aim to evaluate the prevalence of vitamin D deficiency in patients with systemic lupus erythematosus (SLE) and investigate the association between total, free and bioavailable vitamin D serum concentrations and disease activity. Patients with SLE (ACR 1997) consecutively seen at UNIFESP's outpatient's clinics had disease activity measured after clinical and laboratory evaluation using SLEDAI (Systemic Lupus Erythematosus Disease Activity Index). 25-hydroxyvitamin D (25(OH)D) serum concentrations measured by chemiluminescence and vitamin D binding protein (DBP) measured by ELISA were used to calculate free and bioavailable vitamin D. Healthy blood donors were used as controls. A total of 142 patients (71.4%) had 25(OH)D serum concentrations below 30 ng/mL. Total 25(OH)D serum concentration was associated with disease activity categorized in 5 continuous groups of SLEDAI. 25(OH)D serum concentrations were higher among patients with SLEDAI 1-5 and lower in those with severe activity (SLEDAI≥20) (p <0.05). On the other hand, no statistically significant difference was observed for DBP, free and bioavailable vitamin D measurements in the disease activity subgroups evaluated. Vitamin D deficiency is highly prevalent among patients with SLE and was associated with higher disease activity. DBP serum level and calculation of free and bioavailable vitamin D were not associated with SLE disease activity.
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Affiliation(s)
- Marina Eloi
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/ EPM), São Paulo—Brazil
| | - Daniela Vargas Horvath
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/ EPM), São Paulo—Brazil
| | - João Carlos Ortega
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/ EPM), São Paulo—Brazil
| | - Mônica Simon Prado
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/ EPM), São Paulo—Brazil
| | - Luis Eduardo Coelho Andrade
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/ EPM), São Paulo—Brazil
| | - Vera Lúcia Szejnfeld
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/ EPM), São Paulo—Brazil
| | - Charlles Heldan de Moura Castro
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/ EPM), São Paulo—Brazil
- * E-mail:
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Loures MAR, Zerbini CAF, Danowski JS, Pereira RMR, Moreira C, Paula APD, Castro CHM, Szejnfeld VL, Mendonça LMC, Radominiski SC, Bezerra MC, Simões R, Bernardo WM. Diretrizes da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da osteoporose em homens. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Eloi M, Horvath DV, Szejnfeld VL, Ortega JC, Rocha DAC, Szejnfeld J, Castro CHM. Vitamin D deficiency and seasonal variation over the years in São Paulo, Brazil. Osteoporos Int 2016; 27:3449-3456. [PMID: 27339172 DOI: 10.1007/s00198-016-3670-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/13/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED Brazil is a tropical/subtropical geographic area with elevated ultraviolet (UV) radiation. We report very high prevalence of vitamin D deficiency in a large database of Brazilian subjects and show seasonal and reciprocal relationship between vitamin D and parathyroid hormone (PTH) over the years in this tropical area. INTRODUCTION We aim to examine the prevalence of vitamin D deficiency, characterize the temporal relationship between 25-hydroxyvitamin D levels (25(OH)D) and intact PTH (iPTH) according to seasons, and investigate potential associations between 25(OH)D levels and extra-skeletal outcomes in a Brazilian population. METHODS We retrospectively determined population weekly mean concentrations of unpaired 25(OH)D and iPTH using 39,004 laboratory results of Brazilian individuals of both genders aged 2 to 95 years. The 25(OH)D and iPTH distributions were normalized, and the means fit with a sinusoidal function. Potential associations between 25(OH)D serum levels and inflammatory markers, fasting glucose, HbA1c and Homeostasis Model Assessment index (HOMA) were examined. RESULTS Of the samples, 33.9 % had 25(OH)D serum concentrations lower than 20 ng/mL, while the vast majority (70.7 %) were found to be vitamin D deficient or insufficient (<30 ng/mL). Vitamin D deficiency was significantly higher during the winter as compared to the summer (38.4 % <20 ng/mL and 75.5 % <30 ng/mL versus 23.3 % <20 ng/mL and 62.5 % <30 ng/mL, respectively; p < 0.001). Seasonal variation was observed for both 25(OH)D and iPTH. 25(OH)D peaks occurred in March and troughs in September. iPTH levels showed an inverted pattern of peaks and troughs with a delay of 1 ± 5 week. 25(OH)D was significantly associated with inflammatory markers but not with glucose homeostasis. CONCLUSIONS A sinusoidal interrelationship has been detected between vitamin D and PTH in this tropical population. A large percentage of the individuals showed vitamin D deficiency. Public health strategies are needed to better understand and manage this very high and apparently contradictory prevalence of vitamin D deficiency.
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Affiliation(s)
- M Eloi
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
- CURA Imagem and Diagnóstico, São Paulo, Brazil
| | - D V Horvath
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
- CURA Imagem and Diagnóstico, São Paulo, Brazil
| | - V L Szejnfeld
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
| | - J C Ortega
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
- CURA Imagem and Diagnóstico, São Paulo, Brazil
| | - D A C Rocha
- CURA Imagem and Diagnóstico, São Paulo, Brazil
| | - J Szejnfeld
- CURA Imagem and Diagnóstico, São Paulo, Brazil
- Imaging and Diagnosis Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
| | - C H M Castro
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil.
- CURA Imagem and Diagnóstico, São Paulo, Brazil.
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Guerra MTE, Feron ET, Viana RD, Maboni J, Pastore SI, Castro CCD. Idosos com fratura da extremidade proximal do fêmur apresentam níveis significativamente menores de 25‐hidroxivitamina D. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Guerra MTE, Feron ET, Viana RD, Maboni J, Pastore SI, Castro CCD. Elderly with proximal hip fracture present significantly lower levels of 25-hydroxyvitamin D. Rev Bras Ortop 2016; 51:583-588. [PMID: 27818981 PMCID: PMC5091024 DOI: 10.1016/j.rboe.2016.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/15/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare serum 25-hydroxyvitamin D (25[OH]D) levels, a serum marker of vitamin D3, between patients with and without proximal hip fracture. METHODS This was a case-control study in which serum samples of 25(OH)D were obtained from 110 proximal hip fracture inpatients and 231 control patients without fractures, all over 60 years of age. Levels of 25(OH)D lower than or equal to 20 ng/mL were considered deficient; from 21 ng/mL to 29 ng/mL, insufficient; and above 30 ng/mL, sufficient. Sex, age, and ethnicity were considered for association with the study groups and 25(OH)D levels. RESULTS Patients with proximal hip fracture had significantly lower serum 25(OH)D levels (21.07 ng/mL) than controls (28.59 ng/mL; p = 0.000). Among patients with proximal hip fracture, 54.5% had deficient 25(OH)D levels, 27.2% had insufficient levels, and only 18.2% had sufficient levels. In the control group, 30.3% of patients had deficient 25(OH)D levels, 30.7% had insufficient levels, and 38.9% had sufficient levels. Female patients had decreased serum 25(OH)D levels both in the fracture group and in the control group (19.50 ng/mL vs. 26.94 ng/mL; p = 0.000) when compared with male patients with and without fracture (25.67 ng/mL vs. 33.74 ng/mL; p = 0.017). Regarding age, there was a significant association between 25(OH)D levels and risk of fracture only for the age groups 71-75 years and above 80 years. CONCLUSION Patients with proximal hip fracture had significantly decreased serum 25(OH)D levels when compared with the control group. Female patients had significantly lower serum 25(OH)D levels in both groups.
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Affiliation(s)
- Marcelo Teodoro Ezequiel Guerra
- Universidade Luterana do Brasil (Ulbra), Departamento de Ortopedia e Traumatologia, Canoas, RS, Brazil
- Universidade Luterana do Brasil (Ulbra), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Eduardo Terra Feron
- Universidade Luterana do Brasil (Ulbra), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Roberto Deves Viana
- Universidade Luterana do Brasil (Ulbra), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Jonathan Maboni
- Universidade Luterana do Brasil (Ulbra), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Stéfany Ignêz Pastore
- Universidade Luterana do Brasil (Ulbra), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Cyntia Cordeiro de Castro
- Universidade Luterana do Brasil (Ulbra), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
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Nascimento NAP, Moreira PFP, Marin RV, Moreira LDF, Castro ML, Santos CAF, Filho CMA, Cendoroglo MS. Relation among 25(OH)D, Aquatic Exercises, and Multifunctional Fitness on Functional Performance of Elderly Women from the Community. J Nutr Health Aging 2016; 20:376-82. [PMID: 26999236 DOI: 10.1007/s12603-015-0569-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this study was to investigate if there is a relation among 25(OH)D, aquatic training, and multifunctional fitness on functional performance of elderly woman from the community. DESIGN Cross-sectional study. SETTING Community. PARTICIPANTS We evaluated elderly women aged ≥ 60 years (67±5 years old). One-hundred eighty were engaged in aquatic training (AT), 119 in multifunctional fitness (MF) for at least one year, and sedentary group (SED) with 162 independent elderly women from the community centers who had not practicing any regular physical exercise at least one year before. MEASUREMENTS Timed up-and-go (TUG), 2-minute step test (2MST), 30-second chair stand (CS), arm curl (AC), functional reach test (FRT), unipedal balance test (UB) with visual control, handgrip right (HR) and handgrip left (HL) portable dynamometer for strength hip flexors (Hip strength) and knee extensors (Knee strength), serum 25(OH)D, intact parathyroid hormone (PTH), and creatinine clearance. RESULTS Physical and functional tests showed differences among the three groups (ST; TUG, CS, AC, FR and USB = p <0.001). The PTH and the TUG test correlated inversely with 25(OH)D (r = -0.29 - p <0.001/ r = - 0.16 - p <0.001), also between 25(OH)D and BMI for AT and MF groups respectively (r= -0,15; p=0,04/ r= - 0,19; p=0,036). The AC test showed positive correlation (r = 0, 1 - p <0.001). The age and 25(OH)D were controlled and assumed to be a covariates in the statistical analysis that employed ANCOVA. There was difference on the performance of TUG test (p= 0.049). CONCLUSION TUG performance was associated with age, exercise type and serum levels of 25(OH)D. The 25(OH)D insufficiency was common in elderly women from subtropical areas.
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Affiliation(s)
- N A Perigo Nascimento
- Neide Alessandra Perigo Nascimento, Federal University of São Paulo, São Paulo, SP-São Paulo Brazil,
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Garbaccio JL, Ferreira AD, Pereira ALGG. Self-skincare knowledge and practice described by elderly persons in the mid-west of Minas Gerais. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-9823.2016.14237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The present study aimed to assess the knowledge and practices reported by the elderly in relation to basic care of one's skin. A cross sectional study was performed from November 2011 to August 2012 in Arcos, Minas Gerais, based on a structured questionnaire administered to 250 elderly persons, with answers statistically analyzed. Knowledge and practices of self-skincare were evaluated from the median number of ten questions answered by the elderly. Most of the sample population were women (54.8%), aged between 60 and 69 years (52.4%), with a primary education (71.6%) and working in a job where they were exposed to direct sunlight (58.0%). The majority (76.4%) said they did not use protective sun filter despite considering it important (77.6%). The use of body moisturizing creams was reported by 55.6%. An association (p<0.05) was identified between the variables practice/knowledge and gender and practice outdoor activity. Further studies can be conducted as a result of the present research to clarify factors related to non-adherence to self-skincare, and educational measures should be put in place for the entire population, regardless of age, to prevent pathological skin aging.
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Canuto JMP, Canuto VMP, de Lima MHA, de Omena ALCS, Morais TMDL, Paiva AM, Diniz ET, de Almeida DJFT, Ferreira SMS. Risk factors associated with hypovitaminosis D in HIV/aids-infected adults. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:34-41. [PMID: 25926112 DOI: 10.1590/2359-3997000000007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/17/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate risk factors associated with hypovitaminosis D in adult patients infected with HIV/aids, at a referral hospital in Maceió, Brazil. SUBJECTS AND METHODS This cross-sectional study involved 125 patients evaluated from April to September 2013 by means of interviews, review of medical records, physical examination, and laboratory tests. The data were analyzed using the SPSS® software, version 17.0; the prevalence of hypovitaminosis D and mean levels of vitamin D were determined. The association between hypovitaminosis D and the independent variables was assessed using the Chi-square or the Fisher's exact tests; mean vitamin D concentrations were analyzed using Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests. The level of significance was set at 5% across tests. RESULTS The prevalence of hypovitaminosis D was 24%, with a significant association with higher household income (p < 0.05). Higher vitamin D levels were associated with female gender (p < 0.001), no use of sunscreen (p < 0.05), and previous opportunistic infections (p < 0.01). Lower values were associated with the use of antiretroviral medication (p < 0.05), overweight and obesity (p < 0.01). CONCLUSION Lower vitamin D concentrations were significantly associated with well-known risk factors for hypovitaminosis D: use of sunscreen, antiretroviral medication, overweight, and obesity. The prevalence of hypovitaminosis D in this study, considering values > 20 ng/mL or > 30 ng/mL as vitamin D sufficiency, was lower to that of previous studies with HIV-infected patients, a fact that might be related to the low latitude and high intensity of solar radiation of the location of the present study.
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dos Santos PP, Rafacho BPM, Gonçalves ADF, Jaldin RG, do Nascimento TB, Silva MAB, Cau SBA, Roscani MG, Azevedo PS, Minicucci MF, Tostes RDC, Zornoff LAM, de Paiva SAR. Vitamin D induces increased systolic arterial pressure via vascular reactivity and mechanical properties. PLoS One 2014; 9:e98895. [PMID: 24921930 PMCID: PMC4055656 DOI: 10.1371/journal.pone.0098895] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/08/2014] [Indexed: 11/18/2022] Open
Abstract
Background/Aims The aim of this study was to evaluate whether supplementation of high doses of cholecalciferol for two months in normotensive rats results in increased systolic arterial pressure and which are the mechanisms involved. Specifically, this study assesses the potential effect on cardiac output as well as the changes in aortic structure and functional properties. Methods Male Wistar rats were divided into three groups: 1) Control group (C, n = 20), with no supplementation of vitamin D, 2) VD3 (n = 19), supplemented with 3,000 IU vitamin D/kg of chow; 3) VD10 (n = 21), supplemented with 10,000 IU vitamin D/kg of chow. After two months, echocardiographic analyses, measurements of systolic arterial pressure (SAP), vascular reactivity, reactive oxygen species (ROS) generation, mechanical properties, histological analysis and metalloproteinase-2 and -9 activity were performed. Results SAP was higher in VD3 and VD10 than in C rats (p = 0.001). Echocardiographic variables were not different among groups. Responses to phenylephrine in endothelium-denuded aortas was higher in VD3 compared to the C group (p = 0.041). Vascular relaxation induced by acetylcholine (p = 0.023) and sodium nitroprusside (p = 0.005) was impaired in both supplemented groups compared to the C group and apocynin treatment reversed impaired vasodilation. Collagen volume fraction (<0.001) and MMP-2 activity (p = 0.025) was higher in VD10 group compared to the VD3 group. Elastin volume fraction was lower in VD10 than in C and yield point was lower in VD3 than in C. Conclusion Our findings support the view that vitamin D supplementation increases arterial pressure in normotensive rats and this is associated with structural and functional vascular changes, modulated by NADPH oxidase, nitric oxide, and extracellular matrix components.
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Affiliation(s)
- Priscila Portugal dos Santos
- Department of Internal Medicine, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Bruna Paola Murino Rafacho
- Department of Internal Medicine, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Andréa de Freitas Gonçalves
- Department of Internal Medicine, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Rodrigo Gibin Jaldin
- Department of Surgery and Orthopaedics, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Thiago Bruder do Nascimento
- Department of Pharmacology, School of Medicine at Ribeirao Preto - USP, University of São Paulo, São Paulo, Brazil
| | | | - Stêfany Bruno Assis Cau
- Department of Pharmacology, School of Medicine at Ribeirao Preto - USP, University of São Paulo, São Paulo, Brazil
| | - Meliza Goi Roscani
- Department of Internal Medicine, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Paula Schimdt Azevedo
- Department of Internal Medicine, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Marcos Ferreira Minicucci
- Department of Internal Medicine, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Rita de Cássia Tostes
- Department of Pharmacology, School of Medicine at Ribeirao Preto - USP, University of São Paulo, São Paulo, Brazil
| | - Leonardo Antonio Memede Zornoff
- Department of Internal Medicine, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Sergio Alberto Rupp de Paiva
- Department of Internal Medicine, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
- * E-mail:
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Lopes JB, Fernandes GH, Takayama L, Figueiredo CP, Pereira RMR. A predictive model of vitamin D insufficiency in older community people: from the São Paulo Aging & Health Study (SPAH). Maturitas 2014; 78:335-40. [PMID: 24985066 DOI: 10.1016/j.maturitas.2014.05.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/21/2014] [Accepted: 05/24/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the prevalence of 25-hydroxyvitamin D insufficiency (25OHD<20 ng/mL) and to develop a predictive model for this status. METHODS This is a cross-sectional study including 908 community-dwelling older subjects, 18% (158) of which were randomly selected to be a "test" sample, with the remaining (750) composing a "development" sample. A radioimmunoassay technique was used to measure 25OHD levels. Anthropometrical data, information about lifestyle habits and co-morbidities were obtained. Multiple logistic regression models were created. An Index Risk of Vitamin D Insufficiency (IRVDI) was designed and subsequently validated. The performance of this tool was assessed through ROC analysis. RESULTS The prevalence of 25OHD<20 ng/mL was of 58.0% (CI 95% 51.6-64.6). The clinical independent factors for 25OHD<20 ng/mL were female gender (OR=2.16; 95%CI 1.13-4.13; p=0.020), diabetes (OR=1.84; 95%CI 1.23-2.74; p=0.003) and season (winter/spring) (OR=3.63, 95%CI 2.62-4.88; p<0.001). After statistical adjustments, the IRVDI was able to identify older people at risk for vitamin D insufficiency with a sensitivity of 55.9%, specificity 72.3% and ROC area of 0.685 (p<0.001). CONCLUSIONS Our results suggest that vitamin D insufficiency is common among Brazilian community-dwelling elderly. Female gender, diabetes and the season (winter/spring) were the important parameters that predicted this status. The clinical use of these parameters can be help to design and target appropriate public health interventions. The IRVDI is a convenient tool for the selection of older people at risk for vitamin D insufficiency.
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Affiliation(s)
- Jaqueline B Lopes
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Georgea H Fernandes
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Camille P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rosa M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Salmaso FV, Vigário PDS, Mendonça LMCD, Madeira M, Netto LV, Guimarães MRM, Farias MLFD. Análise de idosos ambulatoriais quanto ao estado nutricional, sarcopenia, função renal e densidade óssea. ACTA ACUST UNITED AC 2014; 58:226-31. [DOI: 10.1590/0004-2730000002580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/25/2014] [Indexed: 11/21/2022]
Abstract
Objetivo : Avaliar relações entre estado nutricional, sarcopenia e osteoporose em idosas.Sujeitos e métodos : Estudamos 44 mulheres, 67-94 anos, mediante miniavaliação nutricional (MAN), filtração glomerular (FG) corr. 1,73 m2, índice de massa corporal (IMC), circunferência da panturrilha e braquial (CP e CB), densidade mineral óssea e composição corporal, DXA (massa gorda – MG; massa magra – MM). Aferimos sarcopenia: IMM = MM MSS + MIS/altura2. Utilizamos o coeficiente de correlação de Pearson, e p < 0,05 como significativo.Resultados : MNA e IMM se correlacionaram positivamente com IMC, CP, CB e MG. A idade influenciou negativamente FG corr., IMC, MG, IMM e CP. Quatorze tinham história de fraturas osteoporóticas. O mais baixo T-score foi diretamente relacionado a MAN e MG.Conclusões : O envelhecimento acarretou o declínio da FG, MG e massa muscular; a circunferência da panturrilha e braquial refletiu estado nutricional e composição corporal; e as grandes influências na DMO foram estado nutricional e MG. Arq Bras Endocrinol Metab. 2014;58(3):226-31
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Maeda SS, Saraiva GL, Hayashi LF, Cendoroglo MS, Ramos LR, Corrêa MDP, Henrique de Mesquita C, Lazaretti-Castro M. Seasonal variation in the serum 25-hydroxyvitamin D levels of young and elderly active and inactive adults in São Paulo, Brazil: The São PAulo Vitamin D Evaluation Study (SPADES). DERMATO-ENDOCRINOLOGY 2014; 5:211-7. [PMID: 24494057 PMCID: PMC3897593 DOI: 10.4161/derm.24476] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 03/17/2013] [Accepted: 03/27/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the 25-hydroxyvitamin D [25(OH)D] concentrations in individuals in the city of São Paulo belonging to different age groups and exhibiting specific behavioral characteristics and to correlate the 25(OH)D concentration with the level of UV radiation (UVR). PATIENTS AND METHODS A total of 591 individuals were included, distributed as follows: 177 were living in institutions (NURSING, 76.2 ± 9.0 y old), 243 were part of the community elderly (COMMUNITY, 79.6 ± 5.3 y old), 99 were enrolled in a physical activity program targeting the elderly (ACTIVE, 67.6 ± 5.4 y old) and 72 were young (YOUNG, 23.9 ± 2.8 y old). Blood samples from all individuals were collected throughout the year. UVR measurements were taken by an official meteorology institution. RESULTS The UVR values varied throughout the year, following a sinusoidal-like pattern. Because of the Earth's orbit, we hypothesized that there would be cyclic patterns for the 25(OH)D and UVR values that repeat every 12 mo. The general formula is represented by the equation P1+P2⋅sin(-2⋅π12⋅(t-P3)) The mean 25(OH)D concentration and the amplitude of the variation were significantly higher for the YOUNG and ACTIVE groups than for the COMMUNITY and NURSING groups. The nadir for UVR was in June, whereas the nadir for the 25(OH)D concentration was in the spring, corresponding to a delay of one season. CONCLUSIONS There was seasonal variation in the 25(OH)D concentration for all the groups studied; however, the amplitude of the variation was higher for the groups of young and physically active people, possibly due to the higher level of sunlight exposure for these groups. The lowest 25(OH)D concentration was detected in the spring.
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Affiliation(s)
- Sergio Setsuo Maeda
- Department of Medicine; Endocrinology; UNIFESP (Universidade Federal de São Paulo); São Paulo, Brazil
| | - Gabriela Luporini Saraiva
- Department of Medicine; Endocrinology; UNIFESP (Universidade Federal de São Paulo); São Paulo, Brazil
| | - Lilian Fukusima Hayashi
- Department of Medicine; Endocrinology; UNIFESP (Universidade Federal de São Paulo); São Paulo, Brazil
| | - Maysa Seabra Cendoroglo
- Department of Medicine; Geriatrics; UNIFESP (Universidade Federal de São Paulo); São Paulo, Brazil
| | - Luiz Roberto Ramos
- Department of Preventive Medicine; UNIFESP (Universidade Federal de São Paulo); São Paulo, Brazil
| | | | | | - Marise Lazaretti-Castro
- Department of Medicine; Endocrinology; UNIFESP (Universidade Federal de São Paulo); São Paulo, Brazil
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Burkiewicz CJCC, Guadagnin FA, Skare TL, do Nascimento MM, Servin SCN, de Souza GD. Vitamin D and skin repair: a prospective, double-blind and placebo controlled study in the healing of leg ulcers. Rev Col Bras Cir 2013; 39:401-7. [PMID: 23174792 DOI: 10.1590/s0100-69912012000500011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 05/30/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the relation between vitamin D insufficiency and wound healing in patients with venous ulcers; to correlate vitamin D insufficiency with characteristics of the ulcer (size and pain) and to evaluate if reposition of vitamin D in these subjects expedites ulcer healing. METHODS We selected 26 patients with leg ulcers, and 26 control patients without ulcers, matched for gender, age, systemic arterial hypertension and tobacco use. The venous ulcer group was divided in two subgroups: one that received placebo (nine patients) and other receiving vitamin D, 50.000 IU per week over two months (13 patients). Blood was collected for 25 OH vitamin D dosage before and after the medication. In the ulcer group, we obtained data concerning demographics, leg ulcer size, as well as pain severity, measured by an analogical visual scale. Data was grouped in contingency and frequency tables, the tests of Fisher and chi-squared being used for nominal variables and Mann-Whitney for numerical variables. The adopted significance was of 5%. RESULTS We found vitamin D insufficiency in the great majority of the patients. The median level in the ulcer group was 17.05 ng/dl and 22.75 ng/dl in the group without ulcer (p=0,0182) No relation was found between the ulcer size without treatment and the level of vitamin D. After treatment, the average size of the ulcer changed from 25 cm² to 18 cm² in the patients that took vitamin D and from 27 cm² to 24,5 cm² in the placebo group (p=0,7051 and p=0,7877, respectively). Considering the variability of the size of the ulcer in the treatment group versus placebo group, the average size was equal to -0,75 cm² in the first group and +4cm² in the second (p=0,0676) CONCLUSION Patients with leg ulcers have more vitamin D deficiency. No difference in the ulcer characteristics was noted between those with and without vitamin D deficiency. There was a trend toward a better healing in those with vitamin D reposition.
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Clark P, Chico G, Carlos F, Zamudio F, Pereira RMR, Zanchetta J, Castillo J. Osteoporosis in Latin America: panel expert review. Medwave 2013. [DOI: 10.5867/medwave.2013.08.5791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Labronici PJ, Blunck SS, Lana FR, Esteves BB, Franco JS, Fukuyama JM, Pires RES. Vitamin D and its Relation to Bone Mineral Density in Postmenopause Women. Rev Bras Ortop 2013; 48:228-235. [PMID: 31214537 PMCID: PMC6565868 DOI: 10.1016/j.rboe.2012.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 07/23/2012] [Indexed: 11/30/2022] Open
Abstract
Objective Compare the level of vitamin D with the bone mineral density (BMD) in postmenopausal women, with or without fractures. Methods 250 women with mean age of 71.1 were evaluated. The serum levels of vitamin D considered sufficient were ≥ 30 ng/mL, insufficient between 20 and 30 ng/mL and deficient < 20 ng/mL. The bone mineral density was measured and considered osteopenia when T value total of lumbar spine or hip was between -1 and -2.5 and osteoporosis < 2.5. The patients with fractures accounted for 25.2%. Results There was no significant difference in the vitamin D (ng/mL) levels among the age groups (p = 0.25), the levels of fractures (p = 0.79) and the levels of BMD (p = 0.76). Conclusion 82% of the patients presented deficient and insufficient blood levels of vitamin D. Ours results showed any significant correlation between vitamin D levels and bone mineral density after adjusting for age.
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Affiliation(s)
- Pedro José Labronici
- PhD in Medicine at Escola Paulista de Medicina, at Universidade Federal de São Paulo; Clinical Head of the Orthopedics and Traumatology Service of Prof. Dr. Donato D'Ângelo, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Saulo Santos Blunck
- Resident Physician of the Orthopedics and Traumatology Service of Prof. Dr. Donato D'Ângelo, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Flavius Ribeiro Lana
- Resident Physician of the Orthopedics and Traumatology Service of Prof. Dr. Donato D'Ângelo, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Bruno Bandeira Esteves
- Resident Physician of the Orthopedics and Traumatology Service of Prof. Dr. Donato D'Ângelo, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - José Sergio Franco
- Head of Department, Associate Professor and Doctor of the Orthopedics and Traumatology Service of the Department of the Medical School at UFRJ, Rio de Janeiro, RJ, Brazil
| | | | - Robinson Esteves Santos Pires
- Assistant Professor of the Department of the Locomotor System of the Universidade Federal de Minas Gerais and Coordinator of the Specialization Course in Orthopedics and Traumatology of the Hospital Felício Rocho, Belo Horizonte, MG, Brazil
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Brito A, Cori H, Olivares M, Fernanda Mujica M, Cediel G, López de Romaña D. Less than adequate vitamin D status and intake in Latin America and the Caribbean:a problem of unknown magnitude. Food Nutr Bull 2013; 34:52-64. [PMID: 23767281 DOI: 10.1177/156482651303400107] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of vitamin D deficiency in Latin America and the Caribbean is unknown. OBJECTIVE To examine the prevalence data available on vitamin D deficiency in Latin America and the Caribbean. METHODS A systematic review was conducted in 2011. Studies using biochemical biomarkers and dietary intake estimation were included. Studies conducted in apparently healthy individuals, independently of age, latitude, skin pigmentation, and season of the year at the time of blood collection, were included. RESULTS A total of 243 studies were identified. The final number of selected studies was 28, including two National Health Surveys (Mexico and Argentina). There are studies that report the vitamin D status of specific subgroups conducted in Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, and Mexico. However, the small sample sizes in these studies and thus the low national representativeness of the reported data do not allow for an accurate assessment of vitamin D status at the regional level. In the majority of the countries with available data, we observed that vitamin D insufficiency was classified as a mild, moderate, or severe public health problem. The only country with a nationally representative sample was Mexico, which found 24%, 10%, 8%, and 10% prevalence rates of vitamin D insufficiency (25-hydroxyvitamin D < 50 nmol/L) in preschoolers, schoolchildren, adolescents, and adults, respectively. The prevalence of vitamin D deficiency (25-hydroxyvitamin D < 20 nmol/L) was less than 1% for all groups. CONCLUSIONS There is some indication that vitamin D insufficiency may be a public health problem in Latin America and the Caribbean, but the exact magnitude is currently unknown.
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Affiliation(s)
- Alex Brito
- Micronutrients Laboratory, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.
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Vitamina D e sua relação com a densidade mineral óssea em mulheres na pós-menopausa. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Maeda SS, Saraiva GL, Kunii IS, Hayashi LF, Cendoroglo MS, Ramos LR, Lazaretti-Castro M. Factors affecting vitamin D status in different populations in the city of São Paulo, Brazil: the São PAulo vitamin D Evaluation Study (SPADES). BMC Endocr Disord 2013; 13:14. [PMID: 23627369 PMCID: PMC3645955 DOI: 10.1186/1472-6823-13-14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 02/21/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hypovitaminosis D is a common condition among elderly individuals in temperate-climate countries, with a clear seasonal variation on 25 hydroxyvitamin D [(25(OH)D] levels, increasing after summer and decreasing after winter, but there are few data from sunny countries such as Brazil. We aimed to evaluate 25-hydroxyvitamin D concentrations and its determining factors, in individuals in the city of São Paulo belonging to different age groups and presenting different sun exposure habits. METHODS 591 people were included as follows: 177 were living in institutions (NURSING HOMES, NH, 76.2 ± 9.0 years), 243 were individuals from the community (COMMUNITY DWELLINGS, CD, 79.6 ± 5.3 years), 99 were enrolled in physical activity program designed for the elderly (PHYSICAL ACTIVITY, PA, 67.6 ± 5.4 years) and 72 were young (YOUNG, 23.9 ± 2.8 years). Ionized calcium, PTH, 25(OH)D, creatinine and albumin were evaluated. ANOVA, Mann-Whitney and Kruskal Wallis tests, Pearson Linear Correlation and Multiple Regression were used in the statistical analysis. RESULTS 25(OH)D mean values during winter for the different groups were 36.1 ± 21.2 nmol/L (NH), 44.1 ± 24.0 nmol/L (CD), 78.9 ± 30.9 nmol/L (PA) and 69.6 ± 26.2 nmol/L (YOUNG) (p < 0.001) while during summer they were 42.1 ± 25.9 nmol/L, 59.1 ± 29.6 nmol/L, 91.6 ± 31.7 nmol/L and 103.6 ± 29.3 nmol/L, respectively (p < 0.001). The equation which predicts PTH values based on 25(OH)D concentration is PTH = 10 + 104.24.e-(vitD-12.5)/62.36 and the 25(OH)D value above which correlation with PTH is lost is 75.0 nmol/L. In a multiple regression analysis having 25(OH)D concentration as the depending variable, the determining factors were PTH, ionized calcium and month of the year (p < 0.05). CONCLUSIONS Much lower 25(OH)D values were found for the older individuals when compared to younger individuals. This finding is possibly due to age and habit-related differences in sunlight exposure. The existence of seasonal effects on 25(OH)D concentration throughout the year was evident for all the groups studied, except for the nursing home group. According to our data, PTH values tend to plateau above 75 nmol/L.
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Affiliation(s)
- Sergio Setsuo Maeda
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) – Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Gabriela Luporini Saraiva
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) – Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Ilda Sizue Kunii
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) – Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Lilian Fukusima Hayashi
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) – Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | | | - Luiz Roberto Ramos
- Department of Preventive Medicine, UNIFESP, São Paulo, São Paulo, Brazil
| | - Marise Lazaretti-Castro
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) – Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
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Souto M, Coelho A, Guo C, Mendonça L, Argolo S, Papi J, Farias M. Vitamin D insufficiency in Brazilian patients with SLE: prevalence, associated factors, and relationship with activity. Lupus 2011; 20:1019-26. [PMID: 21646315 DOI: 10.1177/0961203311401457] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The influence of vitamin D on the severity of systemic lupus erythematosus (SLE) has been studied. Our objectives were to determine the prevalence of vitamin D insufficiency in Brazilian lupus patients and its relationship with demographic, clinical, and laboratory variables and to study the relationship between vitamin D insufficiency and disease activity. This is a cross-sectional study of 159 SLE patients. Levels of serum 25-hydroxyvitamin D (25(OH)D) <30 ng/ml were defined as vitamin D insufficiency and <20 ng/ml as deficiency. Data collected included sex, age, ethnicity, postmenopausal status, disease duration, cumulative amount of oral glucocorticoids (GC) in the last six months, duration of GC usage, calcium and vitamin D supplements, photosensitivity, sunscreen usage, sun exposure, diabetes mellitus, creatinine clearance, lifestyle habits, and smoking. Disease activity was measured by the SLE Disease Activity Index 2000 (SLEDAI-2K). Bivariate statistical analysis was performed using the Mann-Whitney test, Spearman's correlation coefficient, Chi-square test, and Fisher's exact test. Multivariate analysis was performed with multiple linear regression. The prevalence of vitamin D insufficiency and deficiency were 37.7% and 8.2%, respectively. Levels of 25(OH) D were not associated with lupus activity score, disease duration, sun exposure, vitamin D supplementation, or use of corticosteroids.
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Affiliation(s)
- Mid Souto
- Division of Internal Medicine, Federal University of Rio de Janeiro, Brazil.
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Nutritional aspects of the prevention and treatment of osteoporosis. ACTA ACUST UNITED AC 2011; 54:179-85. [PMID: 20485907 DOI: 10.1590/s0004-27302010000200014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 01/28/2010] [Indexed: 11/22/2022]
Abstract
Osteoporosis is a global health problem characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. Nutrition plays a critical role in reducing the risk of osteoporosis through its effect on all of these fragility factors, especially on the development and maintenance of bone mass. An adequate calcium, vitamin D and protein intake resulted in reduced bone remodeling, better calcium retention, reduced age-related bone loss, and reduced fracture risk. Recent evidence indicates that a healthy dietary pattern including dairy products (mainly fat free), fruit and vegetables and adequate amounts of meat, fish and poultry is positively related to bone health. Furthermore, mineral and vitamin supplementation should be closely monitored by health professionals since it could have adverse effects and be insufficient to ensure optimal protection of bone health.
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Vitamin D deficiency and its relationship with bone mineral density among postmenopausal women living in the tropics. ACTA ACUST UNITED AC 2011; 54:227-32. [PMID: 20485913 DOI: 10.1590/s0004-27302010000200020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 10/08/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine vitamin D (25OHD) status and its relationship with bone mineral density (BMD) in 93 postmenopausal women. SUBJECTS AND METHODS Patients were distributed in two groups: Group 1 - 51 to 65 years (n = 45) and Group 2 - 66 to 84 years (n = 48); 25OHD and PTH serum were analyzed and a DXA scan of the lumbar spine (LS) and femoral neck (FN) were taken. RESULTS Mean +/- SD of serum 25OHD levels were 80.6 +/- 43.3 nmol/L (Group 1) and 63.7 +/- 27.6 nmol/L (Group 2); 24% had 25OHD levels < 25 nmol/L and 43.7% < 50 nmol/L. The prevalence of vitamin D deficiency at the 62.5 nmol/L cutoff increased significantly with age. Patients with hypovitaminosis D had a lower BMD at the FN (0.738 +/- 0.102 vs. 0.793 +/- 0.115 g/cm, p = 0.03) and had been postmenopausal for longer (21.0 +/- 8.4 vs. 16.2 +/- 8.4 years, p = 0.01). CONCLUSION We found a high prevalence of hypovitaminosis D in postmenopausal women. Age, years elapsed since menopause and low BMD in the FN were associated with deficiency.
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Russo LAT, Gregório LHD, Lacativa PGS, Marinheiro LPF. [Concentration of 25-hydroxyvitamin D in postmenopausal women with low bone mineral density]. ACTA ACUST UNITED AC 2010; 53:1079-87. [PMID: 20126865 DOI: 10.1590/s0004-27302009000900004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 09/21/2009] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study was designed to determine mean serum concentrations of 25-hydroxyvitamin D (25OHD) in postmenopausal women with low bone mineral density (BMD), to find the cutoff of parathormone (PTH) elevation, and to evaluate the correlation 25OHD with BMD, biochemical parameters and vertebral fracture presence. METHODS Transversal study, with collection of 25OHD and PTH, and determination of DMO and column radiograph. RESULTS A high incidence of inadequate serum concentrations of 25OHD (68.3%) was found and 8% of secondary hyperparathyreoidism. No significant differences were found between 25OHD serum concentrations and the evaluated parameters, except for PTH, which showed a negative association. The established cutoff was 61.5 nmol/L. CONCLUSIONS The elevated incidence of hipovitaminosis D in elderly women with low BMD suggests that a systematic evaluation of 25OHD serum concentrations must be done for this population.The use of 61.5 nmol/L as a cutoff is recommended until the realization of an epidemiologic study that represents all Rio de Janeiro city (RJ, Brazil).
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Maeda SS, Kunii IS, Hayashi LF, Lazaretti-Castro M. Increases in summer serum 25-hydroxyvitamin D (25OHD) concentrations in elderly subjects in São Paulo, Brazil vary with age, gender and ethnicity. BMC Endocr Disord 2010; 10:12. [PMID: 20546572 PMCID: PMC2902474 DOI: 10.1186/1472-6823-10-12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 06/14/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hypovitaminosis D is a common condition among elderly individuals in temperate-climate countries, with a clear seasonal variation on 25 hydroxyvitamin D levels, increasing after summer and decreasing after winter, but there are few data from sunny countries such as Brazil. Many factors can interfere on vitamin D cutaneous synthesis. We aimed at studying the 25OHD variations during winter and summer in an outdoor physically active elderly population living in São Paulo city, and analysed their determining factors. METHODS Ninety-nine individuals (52 women and 47 men, from 55 to 83 years old) from different ethnic groups were selected from an outdoor physical activity group. Data are reported as Mean +/- SD, and we used Pearson Linear Correlation, Student's t-test for non-related samples, Chi-square (chi(2)) test and One-way ANOVA for analysis. RESULTS Mean 25OHD value for the whole group was 78.9 +/- 30.9 nmol/L in the winter and 91.6 +/- 31.7 nmol/L in the summer (p = 0.005). Mean winter serum 25OHD concentrations were not different between men and women (81.2 +/- 30.1 nmol/L vs. 76.7 +/- 31.8 nmol/L, respectively), and 19.2% of the individuals showed values < 50 nmol/L. In the summer, we noticed an increase only for men (107.6 +/- 31.4 nmol/L) compared to women (76.7 +/- 24.0 nmol/L), and 6.5% showed values < 50 nmol/L. A decrease in the mean PTH in the summer compared to the winter was noticed, with PTH levels showing a relationship with 25OHD concentrations only in the winter (r = -0.208, p = 0.041). White individuals showed an increase in mean serum 25OHD in the summer (p = 0.016) which was not noticed for other ethnic groups (Asians, native Brazilians and blacks). An increase in 25OHD values in the summer was observed in the age groups ranging from 51-60 and 61-70 years old (p < 0.05), but not in the age group from 71 years old on. CONCLUSIONS 25OHD values increased during the summer in elderly residents of São Paulo, but to different extents depending on ethnicity, gender and age. This season-dependent increase was noticed only among men, white and who were in the youngest group of individuals.
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Affiliation(s)
- Sergio S Maeda
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | - Ilda S Kunii
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | - Lilian F Hayashi
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | - Marise Lazaretti-Castro
- Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
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Fleiuss de Farias ML. [Primary hyperparathyroidism: important confirm first, find later. ]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2010; 54:343-344. [PMID: 20625644 DOI: 10.1590/s0004-27302010000400001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Sarkis KS, Salvador MB, Pinheiro MM, Silva RG, Zerbini CA, Martini LA. Association between osteoporosis and rheumatoid arthritis in women: a cross-sectional study. SAO PAULO MED J 2009; 127:216-22. [PMID: 20011927 DOI: 10.1590/s1516-31802009000400007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 08/25/2009] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES Osteoporosis has frequently been observed in patients with rheumatoid arthritis. The present study was undertaken in order to evaluate factors associated with osteoporosis among women with rheumatoid arthritis. DESIGN AND SETTING Cross-sectional study, carried out in a public hospital in São Paulo. METHODS The participants were 83 women with rheumatoid arthritis (53.7 +/- 10.0 years old). Bone mineral density (BMD) and body composition were measured by dual energy X-ray absorptiometry. The patients were divided into three groups according to BMD: group 1, normal BMD (n = 24); group 2, osteopenia (n = 38); and group 3, osteoporosis (n = 21). Tests were performed to compare differences in means and correlations, with adjustments for age, duration of disease and cumulative corticosteroid. The relationships between clinical factors, physical activity score, dietary intake, body composition and biochemical parameters were analyzed using linear regression models. RESULTS Mean calcium, vitamin D and omega-6 intakes were lower than the recommendations. Associations were found between BMD and age, disease duration, parathyroid hormone concentration and fat intake. The linear regression model showed that being older, with more years of disease and lower weight were negatively correlated with BMD [Total femur = 0.552 + 0.06 (weight) + 0.019 (total physical activity) - 0.05 (age) - 0.003 (disease duration); R(2) = 48.1; P < 0.001]. CONCLUSION The present study indicates that nutritional factors and body composition are associated with bone mass in women with rheumatoid arthritis.
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Affiliation(s)
- Karin Sedó Sarkis
- Nutrition Department, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
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Silva BCC, Camargos BM, Fujii JB, Dias EP, Soares MMS. [Prevalence of vitamin D deficiency and its correlation with PTH, biochemical bone turnover markers and bone mineral density, among patients from ambulatories]. ACTA ACUST UNITED AC 2009; 52:482-8. [PMID: 18506273 DOI: 10.1590/s0004-27302008000300008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 12/03/2007] [Indexed: 12/14/2022]
Abstract
Consequences of VD deficiency include rickets and osteomalacia. However, marginal concentrations of 25-hydroxyvitamin D (25(OH)VD) are associated with secondary hyperparathyroidism and osteoporosis. In this context, levels of 25(OH)VD capable to elevate parathyroid hormone (PTH) could be considered as insufficient. The VD insufficiency, although widely prevalent, is still under-recognized and under-treated. The authors have studied 180 patients followed in a endocrinology clinic in Belo Horizonte, who had 25(OH)VD measured, correlating it with PTH, biochemical bone turnover markers and bone mineral density. To determine the sufficiency of VD, 25(OH)VD was correlated with PTH and the cutoff found was of 32ng/ml. CTX-1 and PTH were significantly negative correlated to 25(OH)VD and the prevalence of VD insufficiency was 42%. One concludes that the VD insufficiency is widely prevalent among patients who frequently come to our offices, alerting us for the importance to assess VD status more often and to practice politics for prevention of VD insufficiency.
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Affiliation(s)
- Bárbara C Carvalho Silva
- Ambulatório de Doenças Osteometabólicas, Serviço de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil.
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Pinheiro MM, Schuch NJ, Genaro PS, Ciconelli RM, Ferraz MB, Martini LA. Nutrient intakes related to osteoporotic fractures in men and women--the Brazilian Osteoporosis Study (BRAZOS). Nutr J 2009; 8:6. [PMID: 19178745 PMCID: PMC2646749 DOI: 10.1186/1475-2891-8-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 01/29/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Adequate nutrition plays an important role in bone mass accrual and maintenance and has been demonstrated as a significant tool for the prevention of fractures in individuals with osteoporosis. OBJECTIVE The aim of the present study was to evaluate bone health-related nutrients intake and its association with osteoporotic fractures in a representative sample of 2344 individuals aged 40 years or older in Brazil. METHODS In a transversal population-based study, a total of 2420 individuals over 40 years old were evaluated from March to April 2006. Participants were men and women from all socio-economic classes and education levels living around the Brazilian territory Individuals responded a questionnaire including self reported fractures as well a 24-hour food recall. Nutrient intakes were evaluated by Nutrition Data System for Research software (NDSR, University of Minnesota, 2007). Low trauma fracture was defined as that resulting of a fall from standing height or less. Nutrient intakes adequacies were performed by using the DRI's proposed values. Statistical analysis comprises Oneway ANCOVA adjusted by age and use of nutritional supplements and multiple logistic regression. SAS software was used for statistical analysis. RESULTS Fractures was reported by 13% of men and 15% of women. Women with fractures presented significantly higher calcium, phosphorus and magnesium intakes. However, in all regions and socio-economical levels mean intakes of bone related nutrients were below the recommended levels. It was demonstrated that for every 100 mg/phosphorus increase the risk of fractures by 9% (OR 1.09; IC95% 1.05-1.13, p < 0.001). CONCLUSION The results demonstrated inadequacies in bone related nutrients in our population as well that an increase in phosphorus intake is related to bone fractures.
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Affiliation(s)
- Marcelo M Pinheiro
- Rheumatology Division, Universidade Federal de São Paulo/EPM, São Paulo, Brazil
- Av. Dr. Altino Arantes, 669, apto 105, Vila Clementino, São Paulo, SP, Brazil
| | - Natielen J Schuch
- Department of Nutrition, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Patrícia S Genaro
- Department of Nutrition, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Rozana M Ciconelli
- Rheumatology Division, Universidade Federal de São Paulo/EPM, São Paulo, Brazil
- São Paulo Health Care Economics Center, Universidade Federal de São Paulo/EPM, São Paulo, Brazil
| | - Marcos B Ferraz
- São Paulo Health Care Economics Center, Universidade Federal de São Paulo/EPM, São Paulo, Brazil
| | - Lígia A Martini
- Department of Nutrition, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
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Martini LA, Wood RJ. Vitamin D and blood pressure connection: update on epidemiologic, clinical, and mechanistic evidence. Nutr Rev 2008; 66:291-7. [DOI: 10.1111/j.1753-4887.2008.00035.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Scalco R, Premaor MO, Fröehlich PE, Furlanetto TW. High prevalence of hypovitaminosis D and secondary hyperparathyroidism in elders living in nonprofit homes in South Brazil. Endocrine 2008; 33:95-100. [PMID: 18401764 DOI: 10.1007/s12020-008-9061-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 03/22/2008] [Accepted: 03/26/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Hypovitaminosis D (HD) and secondary hyperparathyroidism (SHP) are common in elders, and many factors could contribute to them. The objectives of this study were to estimate the prevalence of HD, SHP, and its associated factors, in individuals living in nonprofit homes for elders in south Brazil. Design Cross-sectional study. METHODS Serum 25-hydroxyvitamin D 25(OH)D, intact parathyroid hormone (PTH), total calcium, phosphorus, alkaline phosphatase, magnesium, creatinine, and albumin levels were measured in late spring, November, 2005. The presence of factors potentially related with HD and SHP-age, sex, weight, height, skin phototype, sun exposure, exercise, smoking, use of < or = 5 medications or diuretics or alcohol, and daily calcium ingestion. RESULTS 102 subjects age 77.8 +/- 9.0 were included in the study. HD was found in 85.7% and SHP in 53% of the subjects. The estimated daily calcium ingestion was 720 mg. There was no association between serum 25(OH)D levels and any of the risk factors evaluated. Serum 25(OH)D levels were correlated with serum PTH (r = -0.358, P = 0.000), calcium (r = 0.306, P = 0.002), and albumin (r = 0.253, P = 0.011) levels. In univariate analysis, SHP was positively associated with age (P = 0.006), and female sex (0.007); and negatively associated with sunlight exposure (P = 0.020), GFR (P = 0.000), Ln25(OH)D (P = 0.002), and total serum calcium (P = 0.024). After multivariate model adjustment, age [OR 1.09 (CI 1.01-1.18); P = 0.024], Ln25(OH)D [OR 0.92 (CI 0.08-0.74); P = 0.013], GFR [OR 0.96 (CI 0.92-0.99); P = 0.013], and hydrochlorothiazide treatment [OR 7.63 (CI 1.67-34.9); P = 0.008] were independently associated with SHP. CONCLUSIONS HD and SHP are highly prevalent in elders living in old-age homes. No associations were established between common risk factors and low serum levels of 25(OH)D levels; however, SHP was independently related with age, 25(OH)D, GFR, and hydrochlorothiazide use.
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Affiliation(s)
- Rosana Scalco
- Post-graduation Program in Medicine: Medical Sciences, Federal University of Rio Grande do Sul and Serviço de Patologia Clínica do Hospital de Clínicas de Porto Alegre , Rua Ramiro Barcellos 2400, Porto Alegre, RS, 90035-003, Brazil.
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