Vitamin D and Human Health

The impact of demand management on vitamin D testing

Introduction

25-hydroxyvitamin D (25-OH-D) is essential for calcium homeostasis and bone health, with increasing evidence suggesting associations with non-skeletal diseases. However, the lack of consensus on optimal concentrations and laboratory variability has led to clinical uncertainty and excessive testing. This study evaluates the impact of demand management strategies and revised cut-off points on test volumes, unperformed determinations, and cost savings.

Material and methods

A retrospective study (January 2015-May 2024) analyzed all 25-OH-D requests. Concentrations of 25-OH-D were measured using electrochemiluminescence assays on a Cobas C8000. An annual trend analysis of 25-OH-D test requests was performed to evaluate changes in demand. In 2018, vitamin D deficiency prevalence was assessed according to three cut-off values (75, 50 and 30 nmol/L). We assessed the impact of demand management rules, implemented in May 2022, to reduce unnecessary testing. The follow-up testing rate was calculated as the proportion of repeat tests within 12 months after determination.

Results

There was 25-OH-D testing increased from 10,830 in 2015 to nearly 85,000 in 2023. Demand management strategies led to 12,406 rejections in 2022 (from May onwards), 16,809 in 2023, and 7566 in 2024 (until May), saving €85,600. Follow-up testing rates dropped from ~15% before 2022 to ~5% afterward. Lowering the deficiency threshold from 75 to 50 nmol/L reduced deficiency diagnoses from > 70% to < 50%; at 30 nmol/L, rates could drop to ~10-11%.

Conclusions

Demand management strategies effectively reduce unnecessary testing and healthcare costs. Establishing appropriate reference values prevents overestimation of vitamin D deficiency, optimizing clinical and economic outcomes.

Combating Methotrexate Resistance in Cancer Treatment: A Review on Navigating Pathways and Enhancing Its Efficacy With Fat-Soluble Vitamins

Methotrexate (MTX), a potent analogue and antagonist of folic acid, is a first-line treatment for rheumatoid arthritis, IBD and cancer. The development of MTX resistance contributes to the reduced efficacy and development of adverse reactions, forcing clinicians to withdraw treatment early. This drawback requires combinational approaches to combat the resistance and enhance the efficacy and safety of MTX. To provide a brief overview of MTX resistance and strategies to mitigate its aftereffects in cancer therapy, a literature-based search was conducted using keywords such as cancer pathology, MTX mechanism and resistance, S100A4, folate uptake, folate efflux, P-glycoprotein, beta-catenin and anticancer properties of Vitamins A, D, E and K. Investigations encompassing in vitro studies, in vivo studies and clinical trials were reviewed to identify the mechanisms of resistance induced by MTX and the potential benefits of coadministering fat-soluble vitamins with existing anticancer drugs. Derivates of Vitamin A could target cancer stem cells and increase chemotherapy sensitivity in non-small cell lung cancer. Similarly, calcitriol and cytotoxic medications exhibit additive or synergistic effects. Existing research revealed that fat-soluble vitamins can inhibit drug transporters, such as P-glycoprotein, which inhibit drug efflux, improving chemotherapy efficacy in cancer. As personalised medicine continues to evolve, incorporating combination approaches with MTX and fat-soluble vitamins holds promise for enhancing treatment efficacy, which can counteract MTX resistance via multiple pathways and improve the safety profile.

Association Between Shift Work and Vitamin D Levels in Brazilian Female Workers

Objectives: Vitamin D plays a crucial role in maintaining bone and muscle health and is associated with various health conditions. Risk factors for reduced vitamin D levels include occupation. The aim of this study was to explore the association between shift work and vitamin D levels among female workers. Methods: This cross-sectional study was conducted among 304 women from an industrial group located in southern Brazil. Vitamin D deficiency was defined as serum 25(OH)D levels < 20 ng/mL, and deficiency/insufficiency was defined as serum levels < 30 ng/mL. Work shift data were collected through interviews using the start and end times of work shifts, classified as "day shift" (6:00 AM ≤ hh:hh < 10:00 PM) and "night shift" (10:00 PM ≤ hh:hh < 6:00 AM), respectively. The association between vitamin D deficiency and shift work was expressed as prevalence ratio (PR), using Poisson regression adjusted for confounding variables. Results: The prevalence of vitamin D deficiency was 36.5% (95% CI: 31.1-41.9), while the prevalence of insufficiency was 75.7% (95% CI: 70.8-80.5). After adjustment, a significant association was found, with 65% and 17% higher probabilities of having vitamin D deficiency (PR = 1.65; 95% CI: 1.23-2.22; p = 0.001) and vitamin D deficiency/insufficiency (PR = 1.17; 95% CI: 1.02-1.35; p = 0.030) among nightshift workers compared with dayshift workers. Conclusions: The findings of this study indicate a high prevalence of hypovitaminosis D among Brazilian female fixed-shift workers as well as a higher probability of vitamin D deficiency and deficiency/insufficiency among nightshift workers compared with dayshift workers.

Calcium, magnesium, and vitamin D supplementations as complementary therapy for hypertensive patients: a systematic review and meta-analysis

BACKGROUND

Hypertension, the first global modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality, is a consequential and remediable threat to the health of individuals and society. Therefore, we conducted this study to explore the role of calcium (Ca++), magnesium (Mg++), and vitamin D (Vit-D) supplementation as complementary therapies for hypertension, focusing on their effects on systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate.

METHODS

This systematic review and meta-analysis examined relevant 6509 articles in PubMed, Scopus, Web of Science, and Cochrane CENTRAL up to October 2024. The primary outcome was the difference in blood pressure measurements (systolic and diastolic) and the pulse rate. The extracted data were analyzed using Open Meta Analyst software.

RESULTS

This systematic review and meta-analysis included 40 studies; of them, 24 studies were analyzed. Ca++ was associated with a significant drop in the DBP (MD: -2.04, 95% CI [-3.39, -0.69], P = 0.01), but not in the SBP (P = 0.34) or pulse rate (P = 0.84). Mg++ significantly reduced DBP (MD: -1.64, 95% CI [-3.19, -0.09], P = 0.04), but had no significant effect on the SBP (P = 0.16) or pulse rate (P = 0.81). The estimated effect of Vit-D showed a significant reduction in SBP (MD: -2.83, 95% CI [-5.47, -0.199], P = 0.04) and DBP (MD: -1.64, 95% CI [-2.97, -0.3], P = 0.01).

CONCLUSION

Ca++ and Mg++ significantly reduced DBP but had no significant effect on SBP or the pulse rate. Whereas, vitamin D significantly reduced SBP and DBP.

Correlation of renal biomarkers, electrolyte imbalances and vitamin D levels in hypertensive subjects

The mechanisms behind persistent high blood pressure and its effects on renal function and electrolyte balance are not yet fully understood. The present study aimed to identify electrolyte imbalances in hypertensive patients and to determine their association with renal function and vitamin D levels. For this purpose, 155 subjects were recruited for the study, including 83 hypertensive subjects and 72 healthy normotensive subjects matched for sex and age as controls. Demographic data were collected using a questionnaire, and anthropometric parameters were measured using standard procedures. Sodium and potassium levels were determined using an ion selective electrolyte analyzer, while calcium, magnesium and phosphorus levels were measured using spectrophotometry. Uric acid, creatinine and urea levels were analyzed using a semi-auto chemistry analyzer, and vitamin D levels were assessed using ELISA. The results obtained revealed that body mass index, systolic and diastolic blood pressure, and creatinine, urea, uric acid, magnesium and sodium levels were significantly higher in the hypertensive subjects compared with the healthy controls (P<0.05); however, the vitamin D, calcium, potassium and phosphate levels were significantly lower in the hypertensive subjects compared to the healthy controls (P<0.05). There was no statistically significant difference in all parameters studied as regards age and sex (P>0.05). On the whole, the present study demonstrates that an electrolyte imbalance, renal dysfunction and vitamin D deficiency are observed in hypertensive subjects. These findings emphasize the importance of assessing and monitoring these biochemical markers as they could improve prognosis, aid in early diagnosis, and assist in determining the optimal level of therapeutic interventions.

Low Serum Vitamin D Levels Are Associated with Reduced Muscle Strength in Women with Breast Cancer

Vitamin D insufficiency has been frequent in women with breast cancer (BC), as well as impaired muscle strength (MS), and a possible relationship between these conditions has been investigated in different populations, except in women with BC. This study aimed to analyze the association between serum vitamin D levels and MS in women with BC. Observational cross-sectional study carried out with adult women with BC, without metastasis/recurrence, with up to 12 months of diagnosis. Serum 25(OH)D concentration was categorized as insufficient (<30 ng/mL) or sufficient (≥30 ng/mL). MS was assessed by the Handgrip Strength test and divided into strength tertiles of the population itself: 1st tertile (6-21 kg), 2nd tertile (22-26 kg), and 3rd tertile (27-39 kg). Adjusted multinomial logistic regression models verified the association of serum vitamin D levels in MS tertiles, with a significance of 5%. A total of 151 women were evaluated. Most women had insufficient levels of vitamin D (70%). Insufficient serum vitamin D levels were associated with the 1st and 2nd tertile of MS (odds ratio [OR]: 5.74, 95% confidence interval [CI]: 1.77-18.64, P = 0.004; OR: 4.48, 95% CI: 1.34-14.97, P = 0.015, respectively). Serum vitamin D insufficiency incresed the probability to present lower tertiles of MS in women with BC.

Vitamin D Supplementation: Practical Advice in Different Clinical Settings

A global deficiency in vitamin D is now widely prevalent. Extensive scientific research has provided compelling evidence of the detrimental effects of vitamin D deficiency on the skeletal system. Furthermore, vitamin D supplementation not only helps prevent bone fractures but may also slow the progression of various conditions, such as diabetes, autoimmune disorders, and cardiovascular disease. Achieving optimal circulating vitamin D levels can be challenging, particularly in certain clinical scenarios. Moreover, the effect of vitamin D supplementation varies depending on factors such as body weight, pregnancy status, absorption capacity, metabolic rate, and renal function. This review aims to explore which vitamin D formulations are most effective in specific clinical contexts where reaching adequate vitamin D levels may not be straightforward.

Assessing the impact of 25-hydroxyvitamin concentrations on mortality in chronic diarrhea: a cross-sectional analysis

Background

The aim of this study was to assess the relationship between serum 25-hydroxyvitamin levels and all-cause mortality in patients with chronic diarrhea.

Methods

We carried out a cross-sectional study using information drawn from the National Health and Nutrition Examination Survey (NHANES). To assess mortality outcomes, we compared our data with records from the National Death Index as of December 31, 2011. The NHANES data were used to determine mortality outcome. We used a Cox regression model-based approach to analyze the relationship between serum 25-hydroxyvitamin concentrations and mortality in chronic diarrhea patients.

Results

A total of 2,972 participants with chronic diarrhea were included in our study, 488 cases of all-cause mortality were recorded. The study showed an L-shaped relationship between 25-hydroxyvitamin concentrations and all-cause mortality with a threshold of 73.40 nmol/L. On the left side of the threshold, each 1-unit increase in 25-hydroxyvitamin concentrations was associated with a 2.2% reduction in the risk of all-cause mortality (HR 0.978; 95% CI: 0.969, 0.987); however, on the right side of the threshold, there was no significant correlation between 25(OH)D concentrations and all-cause mortality.

Conclusion

Serum 25-hydroxyvitamin D levels showed an L-shaped association with all-cause mortality in patients with chronic diarrhea, with 73.40 nmol/L as the potential threshold. However, because this was a cross-sectional study, only an association, not a causal relationship, can be inferred. Further prospective studies are needed to confirm these findings and explore the potential impact of vitamin D supplementation on mortality outcomes.

Immune-endocrine crossroads: the impact of nuclear receptors in Tuberculosis and Chagas disease

Nuclear Receptors (NRs) comprise a superfamily of proteins with essential roles in cell signaling, survival, proliferation, and metabolism. They act as transcription factors and are subclassified into families based on their ligands, DNA-binding sequences, tissue specificity, and functions. Evidence indicates that in infectious diseases, cancer, and autoimmunity, NRs modulate immune and endocrine responses, altering the transcriptional profile of cells and organs and influencing disease progression. Chronic infectious diseases, characterized by pathogen persistence, are particularly notable for an exaggerated inflammatory process. Unlike acute inflammation, which helps the host respond to pathogens, chronic inflammation leads to metabolic disorders and a dysregulated neuro-immuno-endocrine response. Over time, disturbances in cytokine, hormone, and other compound production foster an unbalanced, detrimental defensive response. This complexity underscores the significant role of ligand-dependent NRs. Tuberculosis and Chagas Disease are two critical chronic infections. The causative agents, Mycobacterium tuberculosis and Trypanosoma cruzi, have developed evasion strategies to establish chronic infections. Their clinical manifestations are associated with disrupted immuno-endocrine responses, pointing to a potential involvement of NRs. This review explores the current understanding of NRs in regulating immune-endocrine interactions within the context Tuberculosis and Chagas Disease. These diseases remain significant global health concerns, particularly in developing countries, highlighting the importance of understanding the molecular mechanisms underlying host-pathogen interactions mediated by NRs.

Combating Methotrexate Resistance in Cancer Treatment: A Review on Navigating Pathways and Enhancing Its Efficacy With Fat‐Soluble Vitamins

Methotrexate (MTX), a potent analogue and antagonist of folic acid, is a first‐line treatment for rheumatoid arthritis, IBD and cancer. The development of MTX resistance contributes to the reduced efficacy and development of adverse reactions, forcing clinicians to withdraw treatment early. This drawback requires combinational approaches to combat the resistance and enhance the efficacy and safety of MTX. To provide a brief overview of MTX resistance and strategies to mitigate its aftereffects in cancer therapy, a literature‐based search was conducted using keywords such as cancer pathology, MTX mechanism and resistance, S100A4, folate uptake, folate efflux, P‐glycoprotein, beta‐catenin and anticancer properties of Vitamins A, D, E and K. Investigations encompassing in vitro studies, in vivo studies and clinical trials were reviewed to identify the mechanisms of resistance induced by MTX and the potential benefits of coadministering fat‐soluble vitamins with existing anticancer drugs. Derivates of Vitamin A could target cancer stem cells and increase chemotherapy sensitivity in non–small cell lung cancer. Similarly, calcitriol and cytotoxic medications exhibit additive or synergistic effects. Existing research revealed that fat‐soluble vitamins can inhibit drug transporters, such as P‐glycoprotein, which inhibit drug efflux, improving chemotherapy efficacy in cancer. As personalised medicine continues to evolve, incorporating combination approaches with MTX and fat‐soluble vitamins holds promise for enhancing treatment efficacy, which can counteract MTX resistance via multiple pathways and improve the safety profile.

Association between vitamin D level and cataract: A systematic review and meta-analysis

PURPOSE

The association between serum vitamin D level and cataract remains controversial. This study aims to evaluate the association between vitamin D level and cataract.

METHODS

In this study, articles in the PubMed, Web of Science, and EMBASE databases were searched up to 30 August 2023 and 626 articles were screened. Four studies involving a total of 10,928 subjects with cataract and 10,117 control subjects met the inclusion criteria.

RESULTS

Decreased serum vitamin D level was associated with higher incidence of cataract (P = 0.047; MD: -4.87; 95%CI: [-9.67, -0.07]). In the subgroup analysis by sex, a significant association was found between serum vitamin D level and cataract in both male (P = 0.01, MD: -2.15,95%CI: [-3.83, -0.46]) and female (P < 0.01; MD: -6.67,95%CI: [-8.20, -5.14]).In the subgroup analysis by the types of cataract, significant association was found between serum vitamin D level and nuclear (P < 0.01; MD: -10.48; 95%CI: [-12.72, -8.24]) and posterior subcapsular cataract (P = 0.02; MD: -6.05; 95%CI: [-11.30, -0.80]) but not in cortical cataract (P = 0.14; MD: -6.74; 95%CI: [-15.70, 2.22]).

CONCLUSION

This meta-analysis revealed potential association between serum vitamin D level and cataract, more significant in female, and the subtypes of nuclear and posterior subcapsular cataract.

The U-shaped correlation between serum VD concentration and systemic immune-inflammatory index: results from the NHANES database prospective cohort study

BACKGROUND

Vitamin D (VD) plays a critical role in regulating systemic inflammation, but its correlation with the systemic immune-inflammatory index (SII) remains unclear. This study aimed to explore the relationship between serum VD concentration, dietary VD intake, and SII using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

Data from NHANES 2007-2018 and NHANES 2007-2020 were analyzed for serum VD levels and dietary VD intake, respectively. Restricted cubic splines (RCS) and logistic regression were used to assess associations between VD and SII. Mediation analysis was conducted to evaluate the role of SII in VD-related disease outcomes and mortality.

RESULTS

Serum VD concentration exhibited a U-shaped correlation with SII (P-overall = 0.005; P-non-linear = 0.002). Severe VD deficiency significantly elevated SII levels compared to insufficiency or sufficiency groups. No association was observed between dietary VD intake and SII. Mediation analysis revealed that SII mediated the effects of VD on all-cause and cardiovascular disease-related mortality, but not on cancer, hypertension, or diabetes development.

CONCLUSION

A U-shaped relationship exists between serum VD and SII, with VD supplementation potentially reducing systemic inflammation and improving cardiovascular outcomes. Future studies should explore VD's role in systemic inflammation and its clinical implications.

Vitamin D supplementation may be beneficial in improving the prognosis of patients with sepsis-associated acute kidney injury in the intensive care unit: a retrospective study

Background

Vitamin D, an essential fat-soluble micronutrient, exerts diverse physiological effects including the regulation of calcium ion homeostasis, modulation of immune response, and enhancement of resistance against infectious pathogens. Empirical investigations have elucidated an association between inadequate levels of vitamin D and adverse clinical outcomes in critically ill cohorts, with a noteworthy prevalence of vitamin D deficiency observed among patients afflicted with acute kidney injury (AKI). In the context of this retrospective inquiry, our aim was to assess the potential correlation between vitamin D supplementation administered during admission to the intensive care unit (ICU) and the improvement of outcomes specifically in cases of severe AKI.

Methods

This study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV), a repository of ICU patient records from Beth Israel Deaconess Medical Center (BIDMC) in the United States. We focused on patients diagnosed with epsis-associated acute kidney injury (SA-AKI), dividing them into those who received vitamin D supplementation during their ICU admission and those who did not. Our primary analysis evaluated in-hospital mortality using various statistical methods, such as Kaplan-Meier survival curves, Cox proportional hazards regression models, and subgroup analyses. To enhance the robustness of our findings, we used propensity score matching (PSM) to reduce potential biases. Secondary outcomes included 28-day, 90-day mortality rates and norepinephrine-free days at 28 days.

Results

In this investigation, a cohort of 11,896 individuals diagnosed with SA-AKI was studied. Among them, 2,724 patients received vitamin D supplementation (the vitamin D group) while 9,172 did not (the no-vitamin D group). Kaplan-Meier survival analysis indicated a significant difference in survival probabilities between the two cohorts. Upon adjusting for potential confounders using Cox regression modeling, a notably decreased risk of hospitalization and ICU mortality was observed in the vitamin D group compared to the no-vitamin D group, with an adjusted risk ratio for in-hospital mortality of 0.56 (95% CI: 0.5-0.63). These findings were consistent following PSM and subsequent adjustments for propensity score, pairwise algorithm (PA), and overlapping weights (OW) analyses, yielding hazard ratios ranging from 0.53 to 0.59, all with p-values <0.001. Notably, E-value analyses underscored the robustness of these results against potential unmeasured confounders.

Conclusion

This study suggests that vitamin D supplementation may be associated with a reduced in-hospital mortality rate among SA-AKI patients in the ICU. Furthermore, the 28-day, 90-day mortality rates and norepinephrine days were significantly reduced in the group receiving vitamin D supplementation.

Melatonin and vitamin D as potential synergistic adjuvants for cancer therapy (Review)

Significant advancements have been made in cancer therapy; however, limitations remain with some conventional approaches. Adjuvants are agents used alongside primary treatments to enhance their efficacy and the treatment outcomes of patients. Modern lifestyles contribute to deficiencies in melatonin and vitamin D. Limited sun exposure affects vitamin D synthesis, and artificial light at night suppresses melatonin production. Both melatonin and vitamin D possess anti‑inflammatory, immune‑boosting and anticancer properties, rendering them potential adjuvants of interest. Studies suggest melatonin and vitamin D supplementation may address antioxidant imbalances in lip, oral and pharyngeal cancers. Moreover, promising results from breast, head and neck, brain, and osteosarcoma research indicate potential for tumor growth inhibition, improved survival, and a better quality of life of patients with cancer. The radioprotective properties of melatonin and vitamin D are another exciting area of exploration, potentially enhancing radiotherapy effectiveness while reducing side effects. For its part, the sleep‑promoting effects of melatonin may indirectly benefit patients with cancer by influencing the immune system. Thus, the prevalence of vitamin D and melatonin deficiencies highlights the importance of supplementation, as lower levels can worsen side‑effects from cancer treatments. The present review explores the potential of combining melatonin and vitamin D as synergistic adjuvants for cancer therapy. These agents have shown promise individually in cancer prevention and treatment, and their combined effects warrant investigation. Therefore, large‑scale controlled trials are crucial to definitively determine the optimal dosage, safety and efficacy of this combination in improving the lives of patients with cancer.

Vitamin D as a modulator of molecular pathways involved in CVDs: Evidence from preclinical studies

Vitamin D deficiency (VDD) is a widespread global health issue, affecting nearly a billion individuals worldwide, and mounting evidence links it to an increased risk of cardiovascular diseases like hypertension, atherosclerosis, and heart failure. The discovery of vitamin D receptors and metabolizing enzymes in cardiac and vascular cells, coupled with experimental studies, underscores the complex relationship between vitamin D and cardiovascular health. This review aims to synthesize and critically evaluate the preclinical evidence elucidating the role of vitamin D in cardiovascular health. We examined diverse preclinical in vitro (cardiomyocyte cell line) models and in vivo models, including knockout mice, diet-induced deficiency, and disease-specific animal models (hypertension, hypertrophy and myocardial infarction). These studies reveal that vitamin D modulates vascular tone, and prevents fibrosis and hypertrophy through effects on major signal transduction pathways (NF-kB, Nrf2, PI3K/AKT/mTOR, Calcineurin/NFAT, TGF-β/Smad, AMPK) and influences epigenetic mechanisms governing inflammation, oxidative stress, and pathological remodeling. In vitro studies elucidate vitamin D's capacity to promote cardiomyocyte differentiation and inhibit pathological remodeling. In vivo studies further uncovered detrimental cardiac effects of VDD, while supplementation with vitamin D in cardiovascular disease (CVD) models demonstrated its protective effects by decreasing inflammation, attenuating hypertrophy, reduction in plaque formation, and improving cardiac function. Hence, this comprehensive review emphasizes the critical role of vitamin D in cardiovascular health and its potential as a preventive/therapeutic strategy in CVDs. However, further research is needed to translate these findings into clinical applications as there are discrepancies between preclinical and clinical studies.

Efficacy of vitamin D supplementation on depressive symptoms in older patients: a meta-analysis of randomized controlled trials

Background

The relationship between vitamin D and depression has garnered significant attention in recent years. However, the efficacy of vitamin D in ameliorating depression among specific subgroups of older patients remains controversial. This study aimed to assess the impact of vitamin D supplementation on depressive symptoms and the prevalence of depression in older adults. Additionally, the study sought to examine potential moderating factors, including differences among population subgroups and various supplementation strategies.

Methods

A systematic literature search was conducted in the databases PubMed, EMBASE, Web of Science, and the Cochrane Library up to March 2024. The RevMan 5.3 software was utilized to calculate the standardized mean difference (SMD) and to evaluate the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The objective was to determine the efficacy of vitamin D supplementation in alleviating depressive symptoms or treating depression in older adults.

Results

This meta-analysis encompassed eleven studies, comprising a total of 21,561 participants. The findings did not indicate a statistically significant therapeutic benefit of vitamin D supplementation for depression in older patients [SMD: -0.10; 95% CI: (-1.19, 0.00); p = 0.05]. Subgroup analyses revealed that the efficacy of vitamin D intervention in geriatric depression correlated with several factors, including baseline serum 25(OH)D levels, the dosage of the intervention, gender, and the initial presence of depressive symptoms or a diagnosis of depression.

Conclusion

The current evidence is insufficient to conclusively establish the significant efficacy of vitamin D supplementation in alleviating depressive symptoms among older patients. Consequently, additional randomized controlled trials are warranted to further validate the relationship between vitamin D supplementation and depression in the older adults.

Intakes of energy, macronutrients, and micronutrients in adult Lithuanian population: a national study of 2019-2020

Dietary surveys are critical in evaluating dietary trends prevailing across the entire population. The aim of this study is to present the results of the latest research into the intakes of energy, macronutrients, and micronutrients amongst the adult population in Lithuania from 2019 through 2020. A cross-sectional study was conducted and dietary data was collected using a 24-h dietary recall method from a total of 2555 Lithuanian adults. Medians, 25th and 75th percentiles were calculated. The diet of Lithuanian adults was found insufficient as the energy intake from fats exceeded the recommended norms, while the energy intake from carbohydrates was below the lower range. The intakes of dietary fibre and most vitamins and minerals were insufficient. Men, compared to women, had a statistically higher total energy intake and energy intake from fats, and a higher intake of dietary fibre. Younger adults, compared to older ones, had statistically lower intakes of energy from fats, including saturated fats, and lower intakes of sodium chloride. Respondents with primary education, compared to those who had attained a higher degree of education, had a statistically lower intake of total energy and dietary fibre. Study showed that intakes of majority of nutrients in the diet of the adult Lithuanian population are not in compliance with the recommended daily intakes. Continuous nationally representative studies into food consumption and nutrient intake of the adult Lithuanian population must be carried out to assess the changes in the population's diet and the effectiveness of policies aimed at promoting healthy diets.

The impact of 25-hydroxyvitamin D and calcium on risk of age-related macular degeneration: a Mendelian randomization study

BACKGROUND

The relationships between 25-hydroxyvitamin D [25(OH)D] and calcium and age-related macular degeneration (AMD) are unclear.

OBJECTIVES

This study aimed to investigate the causal role of 25(OH)D concentrations, calcium concentrations, and dietary supplements use of vitamin D and calcium on risk of AMD and its subtypes.

METHODS

Independent genetic variants associated with 25(OH)D and calcium concentrations were used as instrumental variables in published genome-wide association studies (GWASs) of European ancestry. The bidirectional 2-sample Mendelian randomization (MR) analyses were performed using summary-level data from the UK Biobank and FinnGen datasets. Sensitivity analyses were conducted to ensure the robustness of the MR results. The meta-analyses were conducted using both fixed-effect and random-effect models to provide comprehensive and reliable estimates.

RESULTS

A standard deviation increase in calcium concentrations was linked to a 14%, 17%, and 13% reduction in the likelihood of developing AMD (95% confidence interval [CI]: 0.77, 0.97), wet AMD (95% CI: 0.73, 0.95), and dry AMD (95% CI: 0.75, 1.00), respectively. No significant causal relationships were detected between genetically predicted 25(OH)D concentrations and AMD and its subtypes (all P > 0.05). The combined analyses showed that higher calcium concentrations were associated with a reduced risk of overall AMD, with an odds ratio of 0.89 (95% CI: 0.81, 0.98).

CONCLUSIONS

This study provides evidence supporting the causal relationship between calcium concentrations and risk of AMD and its subtypes, which may have important implications for the prevention, monitoring, and treatment of AMD.

Tremendous Fidelity of Vitamin D3 in Age-related Neurological Disorders

Vitamin D3 (VD) is a secosteroid hormone and shows a pleiotropic effect in brain-related disorders where it regulates redox imbalance, inflammation, apoptosis, energy production, and growth factor synthesis. Vitamin D3's active metabolic form, 1,25-dihydroxy Vitamin D3 (1,25(OH)2D3 or calcitriol), is a known regulator of several genes involved in neuroplasticity, neuroprotection, neurotropism, and neuroinflammation. Multiple studies suggest that VD deficiency can be proposed as a risk factor for the development of several age-related neurological disorders. The evidence for low serum levels of 25-hydroxy Vitamin D3 (25(OH)D3 or calcidiol), the major circulating form of VD, is associated with an increased risk of Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), dementia, and cognitive impairment. Despite decades of evidence on low VD association with neurological disorders, the precise molecular mechanism behind its beneficial effect remains controversial. Here, we will be delving into the neurobiological importance of VD and discuss its benefits in different neuropsychiatric disorders. The focus will be on AD, PD, and HD as they share some common clinical, pathological, and epidemiological features. The central focus will be on the different attributes of VD in the aspect of its anti-oxidative, anti-inflammatory, anti-apoptotic, anti-cholinesterase activity, and psychotropic effect in different neurodegenerative diseases.

Effect of sunlight on vitamin D and hemoglobin levels among the residents of Ningbo, China

Introduction

Objective: this study investigated the effect of sunlight on vitamin D and hemoglobin levels among the residents of Ningbo, China. The impact of gender, age, and season on vitamin D and hemoglobin levels was also explored. Methods: a total of 8,481 research subjects, including 5,146 men and 3,335 women, who were permanent residents of Ningbo and received health checkups at Ningbo Second Hospital, were included in the study. Ningbo City climate bulletin data from 2019 to 2022 was also included. Results: the study subjects received an average of 132.20 ± 40.05 h of sunlight exposure per month and had average vitamin D levels of 19.63 ± 6.61 ng/ml. Hemoglobin levels were adequate in 85.4 % of the participants and deficient in 14.6 %. Sunlight exposure correlated positively with vitamin D and negatively with hemoglobin levels. Regression analysis indicated that gender, age, and season affected vitamin D and hemoglobin levels to different degrees. Conclusion: in Ningbo, vitamin D deficiency was common in adults while hemoglobin levels were mostly normal. The amount of sunlight exposure had a significant effect on vitamin D and hemoglobin levels and this relationship was impacted by gender, age, and season.

Vitamin D deficiency and the risk of diabetic retinopathy in patients with type 2 diabetes in Tibet: a cross-sectional analysis

BACKGROUND

Diabetic retinopathy (DR) is one of the most common complications of diabetes worldwide. The aim of this study was to assess the prevalence of DR in hospitalized patients with type 2 diabetes (T2DM) in Tibet and to identify risk factors that may influence the occurrence of DR.

METHODS

This was a cross-sectional study conducted in a third-class hospital in the Tibet Autonomous Region. The prevalence of DR in hospitalized patients with T2DM was measured. Univariate and multivariate logistic regression, restricted cubic spline (RCS) analysis and receiver-operating characteristic curve analysis were used to investigate the risk factors for DR.

RESULTS

The prevalence of DR was 29.3%. The duration of diabetes; concentrations of 25-OH-VitD3, hemoglobin, fasting insulin, alanine aminotransferase, total bilirubin, and creatinine; and HOMA-IR were significantly different between DR patients and non-DR patients (all P < 0.05). Univariate and multivariate logistic regression revealed that a longer duration of diabetes and lower 25-OH-VitD3 levels were associated with increased DR risk. RCS analysis suggested overall positive associations of the duration of diabetes and 25-OH-VitD3 concentrations with DR risk (P nonlinearity < 0.05). The turning points for the duration of diabetes and 25-OH-VitD3 concentrations were 5.1 years and 10.6 ng/mL, respectively. The sensitivity, specificity, and area under the receiver-operating characteristic curve for the combination of the duration of diabetes and 25-OH-VitD3 levels were 79.4%, 69.4% and 0.764, respectively.

CONCLUSIONS

Given the high prevalence of DR in hospitalized patients with T2DM in Tibet, vitamin D supplementation seems to be important in the prevention of DR to some degree.

Bibliometric analysis of vitamin D and obesity research over the period 2000 to 2023

Background

Globally, the incidence rates of obesity and its related diseases, such as cardiovascular diseases and type 2 diabetes, are continuously rising, posing a significant public health challenge. Studies have indicated a potential correlation between vitamin D deficiency and obesity. However, a quantitative analysis of the studies related vitamin D and obesity is lacking. This investigation aims to fill this gap by providing a comprehensive bibliometric analysis to uncover the collaborative networks, research hotspots, and evolutionary trends within the field of vitamin D and obesity research.

Methods

This study retrieved literature related to vitamin D and obesity from the Web of Science database spanning from 2000 to 2023. Bibliometric analysis was conducted using tools such as HistCite, VOSviewer, and CiteSpace to excavate multi-dimensional information including countries, institutions, authors, journals, citations, and keywords.

Results

A total of 6,144 records were retrieved, involving 123 countries, 6,726 institutions, and 28,156 authors, published in 1,551 journals. The number of published papers and citations showed a generally increasing trend. The United States led in terms of publication volume and influence, with journals such as Nutrients and Obesity Surgery having the highest publication counts. Nasser M. Al-Daghri was the most prolific and influential author. Keyword clustering revealed that research topics covered metabolic health, nutrition, immunity, and bariatric surgery. Citation burst analysis indicated a shift in research focus from the relationship between dietary calcium and obesity to the preventive effects of vitamin D supplementation on metabolic diseases.

Conclusion

The application of bibliometric methods to analyze the research literature in the fields of obesity and vitamin D has provided a comprehensive understanding of the collaborative networks, key research focus, and evolutionary trends in this field, offering insights for guiding future research directions.

Structural diversification of vitamin D using microbial biotransformations

Vitamin D deficiencies are linked to multiple human diseases. Optimizing its synthesis, physicochemical properties, and delivery systems while minimizing side effects is of clinical relevance and is of great medical and industrial interest. Biotechnological techniques may render new modified forms of vitamin D that may exhibit improved absorption, stability, or targeted physiological effects. Novel modified vitamin D derivatives hold promise for developing future therapeutic approaches and addressing specific health concerns related to vitamin D deficiency or impaired metabolism, such as avoiding hypercalcemic effects. Identifying and engineering key enzymes and biosynthetic pathways involved, as well as developing efficient cultures, are therefore of outmost importance and subject of intense research. Moreover, we elaborate on the critical role that microbial bioconversions might play in the a la carte design, synthesis, and production of novel, more efficient, and safer forms of vitamin D and its analogs. In summary, the novelty of this work resides in the detailed description of the physiological, medical, biochemical, and epidemiological aspects of vitamin D supplementation and the steps towards the enhanced and simplified industrial production of this family of bioactives relying on microbial enzymes. KEY POINTS: • Liver or kidney pathologies may hamper vitamin D biosynthesis • Actinomycetes are able to carry out 1α- or 25-hydroxylation on vitamin D precursors.

The Key Role of Vitamin D in Female Reproductive Health: A Narrative Review

Vitamin D, besides its crucial role in bone health and immune function, has received increased attention in recent years due to its possible impact on many processes related to female reproductive health. Recent research has tried to explain the role played by vitamin D in maintaining adequate hormonal status, fertility, and pregnancy outcomes. Our aim for this narrative literature review was to highlight and explain the mechanisms through which vitamin D status impacts female reproductive health. We believe this represents a very important subject of research, especially due to the increased incidence of infertility nowadays. Further studies are necessary on the association between vitamin D status and female reproductive health in order to fully understand its effects and to reach a consensus regarding vitamin D supplementation as a method to improve fertility status.

Association Between Serum Vitamin D Levels and Retinal Vascular Occlusion: A Systematic Review and Meta-Analysis

Previous studies found seasonal variations in the incidence of retinal vascular occlusion (RVO), with more occurrence in winter. There is increasing evidence linking vitamin D deficiency and RVO. Therefore, we conducted a meta-analysis to evaluate the association between vitamin D levels and RVO. From inception to February 2024, MEDLINE and EMBASE databases were comprehensively searched. Observational studies comparing 25-hydroxyvitamin D (25(OH)D) levels between adult patients with RVO and non-RVO controls were included. We calculated pooled mean difference (MD) and pooled odds ratio (OR) with 95% confidence intervals (CI) of our data using a random-effects model and generic inverse variance method. Five studies involving 528 patients (228 patients with RVO and 300 controls were included in the meta-analysis. 25(OH)D was significantly lower in patients with RVO (pooled MD of -9.65 (95%CI -13.72 to -5.59, I2 = 92.2%). Vitamin D deficiency (serum 25(OH)D < 20) was significantly associated with RVO with the pooled OR of 14.52 (95%CI 1.72 to 122.59, I2 = 90.5). There was no difference in 25(OH)D levels between patients with central RVO and branched RVO (pooled MD of -0.94 (95%CI -3.91 to 2.03, I2 = 59.1%). In conclusion, our meta-analysis demonstrates that serum vitamin D levels were lower in patients with RVO than non-RVO controls. Clinicians could consider screening for vitamin D deficiency in patients with RVO. Further studies are warranted to determine the correlation between vitamin D levels and disease severity and the role of vitamin D supplements in these populations.

Exploring the Role of Vitamin D, Vitamin D-Dependent Proteins, and Vitamin D Receptor Gene Variation in Lung Cancer Risk

Lung cancer has an unfavorable prognosis with a rate of low overall survival, caused by the difficulty of diagnosis in the early stages and resistance to therapy. In recent years, there have been new therapies that use specific molecular targets and are effective in increasing the survival chances of advanced cancer. Therefore, it is necessary to find more specific biomarkers that can identify early changes in carcinogenesis and allow the earliest possible treatment. Vitamin D (VD) plays an important role in immunity and carcinogenesis. Furthermore, the vitamin D receptor (VDR) regulates the expression of various genes involved in the physiological functions of the human organism. The genes encoding the VDR are extremely polymorphic and vary greatly between human populations. To date, there are significant associations between VDR polymorphism and several types of cancer, but the data on the involvement of VDR polymorphism in lung cancer are still conflicting. Therefore, in this review, our aim was to investigate the relationship between VDR single-nucleotide polymorphisms in humans and the degree of risk for developing lung cancer. The studies showcased different gene polymorphisms to be associated with an increased risk of lung cancer: TaqI, ApaI, BsmI, FokI, and Cdx2. In addition, there is a strong positive correlation between VD deficiency and lung cancer development. Still, due to a lack of awareness, the assessment of VD status and VDR polymorphism is rarely considered for the prediction of lung cancer evolution and their clinical applicability, despite the fact that studies have shown the highest risk for lung cancer given by TaqI gene polymorphisms and that VDR polymorphisms are associated with more aggressive cancer evolution.

Plasma 25-hydroxyvitamin D deficiency in the peri-operative period is associated with survival outcome in colorectal cancer patients: a meta-analysis

AIM

Surgery had a significant impact on 25-hydroxyvitamin D (25-(OH)D) levels. Uncertainty still existed regarding the effects of peri-operative 25(OH)D deficiency on colorectal cancer (CRC) patients' prognosis. The purpose of the present study was to explore the potential association between the peri-operative 25(OH)D deficiency and the survival outcome of CRC.

METHODS

Seven electronic databases [including PubMed, EMBASE, Web of Science, The Cochrane Library, OvidMEDLINE(R), China National Knowledge Infrastructure (CNKI) and Wangfang data] were searched without language limitations. The primary outcomes were overall survival and all-cause mortality. Secondary outcomes were the incidence of 25(OH)D deficiency and risk variables for low 25(OH)D level in the peri-operative period.

RESULTS

14 eligible studies were obtained with 9324 patients for meta-analysis. In the peri-operative period, the pooled incidence of blood 25(OH)D deficiency was 59.61% (95% CI: 45.74-73.48). The incidence of blood 25(OH)D deficiency post-operatively (66.60%) was higher than that pre-operatively (52.65%, 95% CI: 32.94-72.36). Male (RR = 1.09, 95% CI: 1.03-1.16), rectum tumor (RR = 1.23, 95% CI: 1.03-1.47), spring and winter sampling (RR = 1.24, 95% CI: 1.02-1.49) were the risk factors for the 25(OH)D deficiency. The association between the low 25(OH)D post-operatively and short-term overall survival (HR = 0.43, 95% CI: 0.24-0.77) was most prominent, while a low 25(OH)D pre-operatively (HR = 0.47, 95% CI: 0.31-0.70) was more significantly associated with long-term all-cause mortality than that after surgery.

CONCLUSION

Peri-operative 25(OH)D impacted the CRC patients' prognosis. Due to possible confounding effects of systemic inflammatory response (SIR), simultaneous measurement of vitamin D and SIR is essential for colorectal survival.

Magnesium status modulating the effect of serum vitamin D levels on retinopathy: National Health and Nutrition Examination Survey 2005 to 2008

Aim

Magnesium levels may influence the effect of vitamin D levels on the body. This study aimed to assess the combined effect of magnesium status as reflected by magnesium depletion score (MDS) and vitamin D status on the risk of retinopathy.

Methods

This cross-sectional study included participants aged 40 years and older with complete information on vitamin D, MDS, and retinopathy assessment from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Logistic regression analysis was utilized to analyze the relationship of MDS and vitamin D with retinopathy and expressed as odds ratio (OR) and 95% confidence interval (CI).

Results

Of these 4,953 participants included, 602 (9.53%) participants had retinopathy. Serum vitamin D levels ≤30 nmol/L (vs. >30 nmol/L) (OR = 1.38, 95%CI: 1.05-1.81) and MDS >2 points (vs. ≤2 points) (OR = 1.47, 95%CI: 1.01-2.16) were associated with higher odds of retinopathy. There was an interaction between MDS and vitamin D on the increased odds of retinopathy (OR = 2.29, 95%CI: 1.12-4.68, P interaction = 0.025). In different MDS groups, serum vitamin D levels ≤30 nmol/L increased the odds of retinopathy only in the MDS >2 group (OR = 2.90, 95%CI: 1.16-7.24), but not in the MDS ≤2 group (p = 0.293). Subgroups analyses demonstrated that the interaction between MDS and serum vitamin D on retinopathy was observed in males (OR = 6.88, 95%CI: 1.41-33.66, P interaction = 0.019), people with diabetes (OR = 3.43, 95%CI: 1.78-6.63, P interaction < 0.001), and people with body mass index (BMI) ≥25 kg/m2 (OR = 2.46, 95%CI: 1.11-5.44, P interaction = 0.028).

Conclusion

Magnesium plays a moderating role in the relationship between serum vitamin D and retinopathy. The protective effect of vitamin D against retinopathy was primarily present among those with inadequate magnesium levels.

High risk of malnutrition among hospitalised coronavirus disease 2019 (COVID-19) patients is associated with mortality and other clinical outcomes

INTRODUCTION

Increasing evidence indicates an association between nutritional status and Coronavirus disease 2019 (COVID-19) disease severity. The aim of the study was to describe the risk of malnutrition, body mass index (BMI) and vitamin D status of hospitalised COVID-19 patients and assess whether they are associated with duration of hospital stay, intensive care unit (ICU) admission, mechanical ventilation, and mortality.

METHODS

The study is a descriptive retrospective study of 273 patients with COVID-19 admitted to Hospital from February 2020 to March 2021. Patients were screened for risk of malnutrition using a validated screening tool. BMI was calculated from height and weight. Insufficient Vitamin D status was defined as 25(OH)vitD <50 nmol/L. Logistic regression analysis was used to assess the association between indicators of nutritional status of patients with COVID-19, and outcomes such as duration of stay >7 days, ICU admission, mechanical ventilation, and mortality. Interaction between risk of malnutrition and BMI of ≥30 kg/m2 was assessed using the likelihood ratio test with hospital stay, ICU admission, mechanical ventilation, and mortality as outcomes.

RESULTS

Screening for risk of malnutrition identified 201 (74%) patients at a medium to high risk of malnutrition. Patients defined as being at a medium or high risk of malnutrition were more likely to be hospitalised for >7 days compared to those defined as low risk (OR: 10.72; 95% CI: 3.9-29.46; p < 0.001 and OR: 61.57; 95% CI: 19.48-194.62; p < 0.001, respectively). All patients who were admitted to ICU (n = 41) and required mechanical ventilation (n = 27) were defined as having medium or high risk of malnutrition. High risk of malnutrition was also associated with increased odds of mortality (OR: 8.87; 955 CI 1.08-72,96; p = 0.042). BMI of ≥30 kg/m2 (43%) and 25(OH)vitD <50 nmol/L (20%) were not associated with duration of stay >7 days or mortality, although BMI ≥30 kg/m2 was associated with increased risk of ICU admission (OR: 7.12; 95% CI: 1.59-31.94; p = 0.010) and mechanical ventilation (OR: 8.86; 95% CI: 1.12-69.87; p = 0.038). Interactions between risk of malnutrition and BMI ≥30 kg/m2 were not significant to explain the outcomes of hospital stay >7 days, ICU admission, mechanical ventilation, or mortality.

CONCLUSION

High risk of malnutrition among hospitalised COVID-19 patients was associated with longer duration of hospital stay, ICU admission, mechanical ventilation and mortality, and BMI ≥30 kg/m2 was associated with ICU admission and mechanical ventilation. Insufficient Vitamin D status was not associated with duration of hospital stay, ICU admission, mechanical ventilation, or mortality.

Determinants of Vitamin D Status in Healthy Young Adults from Mexico City

BACKGROUND AND AIMS

Vitamin D deficiency is a global health problem. The determinants of this deficiency have not been evaluated in developing countries such as Mexico. Thus, this study aimed to determine vitamin D intake and sun exposure and its relationship with plasma concentrations of 25-hydroxyvitamin D -25(OH)D- in young adults from Mexico City.

METHODS

One hundred fifty five urban adult subjects were enrolled during 2017 and 2018. Sociodemographic, anthropometric, and clinical data, vitamin D intake, and sun exposure habits were collected. Plasma concentrations of 25(OH)D were also determined.

RESULTS

The proportion of vitamin D deficiency was significantly higher in women than in men (65.7 vs. 43.4%, p = 0.012). The overall median dietary vitamin D intake was 112 IU/d (less than 20% of the recommended daily intake; RDI). 25-hydroxyvitamin D correlated directly with vitamin D intake, sun exposure score, waist-to-hip ratio, and age; an inverse significant association was found with body fat percentage. A multiple regression analysis was performed; simultaneous and significant (p <0.01) effects of sun exposure score, dietary vitamin D, the season of the year (spring-summer vs. fall-winter), and age were observed on 25(OH)D levels.

CONCLUSION

High rates of vitamin D deficiency and insufficiency were observed in young adults from Mexico City. According to the RDI of this vitamin, its consumption, assessed by a 24 h multi-step nutritional questionnaire, was significantly low. A linear multiple regression model identified several predictors of plasma 25(OH)D concentrations. This multiple regression model was statistically validated.

Ethnic-Based Assessment of Vitamin D and Magnesium Status in the Kingdom of Bahrain

BACKGROUND

Vitamin D deficiency is a major global health problem. Most previous studies focused attention on the significant role of sunlight exposure in the homeostasis of vitamin D and calcium blood levels. Magnesium is pivotal in the proper functioning of vitamin D, and the physiologic functions of different organs require a balanced vitamin D and magnesium status. The relationship between sunlight exposure and blood levels of vitamin D and magnesium has often been overlooked. The aim of this study was to evaluate vitamin D and magnesium status based on sunlight exposure and ethnicity in Bahraini and expatriate workers.

METHODS

A cross-sectional study was conducted between October 2018 and September 2019. One hundred and seventy-four subjects participated in this study were subdivided based on their ethnicity and work environment-dependent exposure to sunlight into four groups: (1) Bahraini exposed (n=94), (2) Bahraini non-exposed (n=25), (3) expatriate exposed (n=31), and (4) expatriate non-exposed (n=24). Blood levels of vitamin D and magnesium were evaluated for all the participants.

RESULTS

 Independent of ethnicity, vitamin D levels were insignificantly different among the studied groups and were all below the normal reference range. Yet, there was still a sunlight-dependent increase in vitamin D level that could be seen only in Bahraini workers. Magnesium levels were significantly higher in expatriates when compared to Bahraini workers. Sunlight-exposed expatriates had significantly higher magnesium levels than their Bahraini counterparts, while there was no significant difference between both ethnicities in the non-exposed groups.

CONCLUSION

Country- and ethnic-specific definitions for vitamin D status and sunlight exposure are recommended. The assessment of magnesium status is pivotal in the overall assessment of vitamin D status.

Revisiting the significance of nano-vitamin D for food fortification and therapeutic application

OBJECTIVE

Vitamin D (a prohormone) is an important micronutrient required by the body for skeletal homeostasis and a range of non-skeletal actions. Calcitriol, the active form of vitamin D, regulates a variety of cellular and metabolic processes through both genomic and nongenomic pathways. Often prescribed for treating rickets and osteoporosis, vitamin D deficiency can exacerbate various other medical conditions.

SIGNIFICANCE, METHODS, AND RESULTS

Despite its multifunctional uses, the sensitivity of vitamin D makes formulating an efficient drug delivery system a challenging task, which is further complicated by its poor aqueous solubility. Enhancing the oral absorption of vitamin D is vital in utilizing its full efficacy. Recent developments in encapsulation and nanotechnology have shown promising results in overcoming these constraints.

CONCLUSION

This review thus offers an insight to adequately comprehend the mechanistic pharmacology of vitamin D, its pathophysiological role, and justification of its medical indications, along with the benefits of utilizing nanotechnology for vitamin D delivery.

Nodular type but not vitamin D levels increases the risk of second primary cancers in melanoma patients: An observational study of 663 patients

BACKGROUND

Vitamin D deficiency associates with the risk of developing many diseases, including cancer. At the molecular level, vitamin D appears to have an antineoplastic effect. However, the role of vitamin D deficiency in cancer pathogenesis remains unelucidated and numerous studies have resulted in discordant results. This study aimed to determine whether vitamin D deficiency during melanoma diagnosis increases the risk of developing non-cutaneous second primary cancers (SPC).

MATERIALS AND METHODS

A retrospective study on 663 patients diagnosed with melanoma between 1 January 2011 and 31 October 2022. The effect of each variable on the development of a subsequent non-cutaneous cancer was performed using Kaplan-Meier curves and differences were assessed by log-rank tests. Cox proportional hazard univariate and multivariate models were used to quantify the effect of each variable in the time to develop a non-cutaneous neoplasia.

RESULTS

Out of 663 patients, 34 developed a non-cutaneous SPC. There was no statistically significant association between vitamin D levels and non-cutaneous SPC development (log-rank, p=0.761). Age>60 years, stage III/IV, and nodular melanoma subtype were significantly associated with the development of a SPC. After multivariate analysis, only age>60 years (HR 3.4; HR CI 95%: 1.5-7.6) and nodular melanoma subtype (HR 2.2; HR CI 95%: 1.0-4.8) were included in the final model.

CONCLUSIONS

Our results suggest that vitamin D deficiency is not associated with an increased risk of developing non-cutaneous SPC in melanoma patients. However, age over 60 years and nodular melanoma subtype increase the risk for non-cutaneous SPC development.

25-Hydroxy vitamin D deficiency is an inferior predictor of peripheral T-cell lymphomas

The aim of the study was to explore the significance and prognostic value of 25-hydroxy vitamin D (25-(OH) D) deficiency in peripheral T-cell lymphomas (PTCLs). One hundred fifty-six patients of newly diagnosed PTCLs were enrolled in the study. Univariate and multivariate regression analyses were performed to determine independent risk factors for progression-free survival (PFS) and overall survival (OS). Receiver operating characteristic (ROC) curves were plotted, and corresponding areas under the curve (AUC) were calculated to estimate the accuracy of International Prognostic Index (IPI) plus 25-(OH) D deficiency and Prognostic Index for T-cell lymphoma (PIT) plus 25-(OH) D deficiency respectively in PTCL risk stratification. Our results showed that the 25-(OH) D deficiency was an independent inferior prognostic factor for both PFS (P = 0.0019) and OS (P = 0.005) for PTCLs, especially for AITL and PTCL-not otherwise specified (PTCL-NOS). Additionally, adding 25-(OH) D deficiency to PIT indeed has a superior prognostic significance than PIT alone for PFS (P = 0.043) and OS (P = 0.036). Multivariate COX regression analysis revealed that PIT 2‒4, albumin (ALB) ≤ 35 g/L, and 25-(OH) D deficiency were regarded as independent risk factors of PFS and OS. Our results showed that 25-(OH) D deficiency was associated with inferior survival outcome of PTCLs, especially for AITL and PTCL-NOS. PIT plus 25-(OH) D deficiency could better indicate the prognosis for PFS and OS of PTCLs than PIT.

Nodular Type but Not Vitamin D Levels Increases the Risk of Second Primary Cancers in Melanoma Patients: An Observational Study of 663 Patients

BACKGROUND

Vitamin D deficiency associates with the risk of developing many diseases, including cancer. At the molecular level, vitamin D appears to have an antineoplastic effect. However, the role of vitamin D deficiency in cancer pathogenesis remains unelucidated and numerous studies have resulted in discordant results. This study aimed to determine whether vitamin D deficiency during melanoma diagnosis increases the risk of developing non-cutaneous second primary cancers (SPC).

MATERIALS AND METHODS

A retrospective study on 663 patients diagnosed with melanoma between 1 January 2011 and 31 October 2022. The effect of each variable on the development of a subsequent non-cutaneous cancer was performed using Kaplan-Meier curves and differences were assessed by log-rank tests. Cox proportional hazard univariate and multivariate models were used to quantify the effect of each variable in the time to develop a non-cutaneous neoplasia.

RESULTS

Out of 663 patients, 34 developed a non-cutaneous SPC. There was no statistically significant association between vitamin D levels and non-cutaneous SPC development (log-rank, p=0.761). Age>60 years, stage III/IV, and nodular melanoma subtype were significantly associated with the development of a SPC. After multivariate analysis, only age>60 years (HR 3.4; HR CI 95%: 1.5-7.6) and nodular melanoma subtype (HR 2.2; HR CI 95%: 1.0-4.8) were included in the final model.

CONCLUSIONS

Our results suggest that vitamin D deficiency is not associated with an increased risk of developing non-cutaneous SPC in melanoma patients. However, age over 60 years and nodular melanoma subtype increase the risk for non-cutaneous SPC development.

Ukrainian Consensus on Diagnosis and Management of Vitamin D Deficiency in Adults

Vitamin D deficiency (VDD) is a global problem, however, there were no Ukrainian guidelines devoted to its screening, prevention, and treatment, which became the reason for the Consensus creation. This article aimed to present the Consensus of Ukrainian experts devoted to VDD management. Following the creation of the multidisciplinary Consensus group, consent on the formation process, drafting and fine-tuning of key recommendations, and two rounds of voting, 14 final recommendations were successfully voted upon. Despite a recent decrease in VDD prevalence in Ukraine, we recommend raising awareness regarding VDD's importance and improving the strategies for its decline. We recommend screening the serum 25-hydroxyvitamin D (25(OH)D) level in risk groups while maintaining a target concentration of 75-125 nmol/L (30-50 ng/mL). We recommend prophylactic cholecalciferol supplementation (800-2000 IU/d for youthful healthy subjects, and 3000-5000 IU/d for subjects from the risk groups). For a VDD treatment, we recommend a short-term administration of increased doses of cholecalciferol (4000-10,000 IU/d) with 25(OH)D levels monitored after 4-12 weeks of treatment, followed by the use of maintenance doses. Additionally, we recommend assessing serum 25(OH)D levels before antiosteoporotic treatment and providing vitamin D and calcium supplementation throughout the full course of the antiosteoporotic therapy.

The Association between Preoperative Vitamin D Levels and Postoperative Complications in Patients Undergoing Colorectal Liver Metastasis Surgery

(1) Background: Over the past several years, there has been a renewed interest with regard to the effect of pre-operative vitamin D levels on post-surgical outcomes. Pre-operative vitamin D deficiency has been associated with many negative post-operative outcomes. However, the role of vitamin D in postoperative outcomes in colorectal liver metastasis (CRLM) resection is relatively uninvestigated. Our study investigated the correlation between preoperative vitamin D levels and postoperative complications in patients undergoing resection for CRLM. (2) Methods: We retrospectively examined the post-operative course of 109 patients, who were evaluated based upon preoperative vitamin D levels: the first group had vitamin D levels less than 25 nmol/L (VIT D < 25 nmol/L) (n = 12) vs. the second group who had vitamin D levels equal to or greater than 25 nmol/L (VIT D ≥ 25 nmol/L) (n = 97). (3) Results: Patients with lower pre-operative vitamin D levels (VIT D < 25 nmol/L) had significantly higher rates of blood transfusions (33.3% vs. 10.3%, p = 0.01), post-operative surgical complications (50% vs. 17.5%, p = 0.009), and infectious complications (25% vs. 7.2%, p = 0.04). However, there was no difference in overall survival seen between the two groups. (4) Conclusions: The results of our study indicate that patients with preoperative vitamin D deficiency (defined as preoperative vitamin D levels less than 25 nmol/L) may have an increased risk of postoperative complications in patients undergoing liver surgery for metastatic colorectal cancer.

VDR and PDIA3 Are Essential for Activation of Calcium Signaling and Membrane Response to 1,25(OH)2D3 in Squamous Cell Carcinoma Cells

The genomic activity of 1,25(OH)2D3 is mediated by vitamin D receptor (VDR), whilst non-genomic is associated with protein disulfide isomerase family A member 3 (PDIA3). Interestingly, our recent studies documented that PDIA3 is also involved, directly or indirectly, in the modulation of genomic response to 1,25(OH)2D3. Moreover, PDIA3 was also shown to regulate cellular bioenergetics, possibly through the modulation of STAT signaling. Here, the role of VDR and PDIA3 proteins in membrane response to 1,25(OH)2D3 and calcium signaling was investigated in squamous cell carcinoma A431 cell line with or without the deletion of VDR and PDIA3 genes. Calcium influx was assayed by Fura-2AM or Fluo-4AM, while calcium-regulated element (NFAT) activation was measured using a dual luciferase assay. Further, the levels of proteins involved in membrane response to 1,25(OH)2D3 in A431 cell lines were analyzed via Western blot analysis. The deletion of either PDIA3 or VDR resulted in the decreased baseline levels of Ca2+ and its responsiveness to 1,25(OH)2D3; however, the effect was more pronounced in A431∆PDIA3. Furthermore, the knockout of either of these genes disrupted 1,25(OH)2D3-elicited membrane signaling. The data presented here indicated that the VDR is essential for the activation of calcium/calmodulin-dependent protein kinase II alpha (CAMK2A), while PDIA3 is required for 1,25(OH)2D3-induced calcium mobilization in A431 cells. Taken together, those results suggest that both VDR and PDIA3 are essential for non-genomic response to this powerful secosteroid.

Effects of Isoflavonoid and Vitamin D Synergism on Bone Mineral Density-A Systematic and Critical Review

Phytoestrogens are non-steroidal plant compounds, which bind to α and β estrogen receptors, thereby causing specific effects. The best-known group of phytoestrogens are flavonoids, including isoflavonoids-genistein and daidzein. They play a role in the metabolism of bone tissue, improving its density and preventing bone loss, which contributes to reducing the risk of fractures. Vitamin D is found in the form of cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2) and is traditionally recognized as a regulator of bone metabolism. The aim of this review was to evaluate the synergistic effect of isoflavonoids and vitamin D on bone mineral density (BMD). The MEDLINE (PubMed), Scopus and Cochrane databases were searched independently by two authors. The search strategy included controlled vocabulary and keywords. Reference publications did not provide consistent data regarding the synergistic effect of isoflavonoids on BMD. Some studies demonstrated a positive synergistic effect of these compounds, whereas in others, the authors did not observe any significant differences. Therefore, further research on the synergism of isoflavonoids and vitamin D may contribute to a significant progress in the prevention and treatment of osteoporosis.

Decreased choroidal vascularity index and subfoveal choroidal thickness in vitamin D insufficiency

BACKGROUND

To present the effects of vitamin D insufficiency on the choroidal vascularity index, central choroid and central macula.

METHODS

42 eyes of 42 patients with vitamin D insufficiency and 51 eyes of 51 age- and sex-matched healthy subjects were included in this retrospective, cross-sectional, and comparative study. The macular layer was examined using the retinal mapping mode of the spectral domain Optical coherence tomography (Optovue RTVue XR, Optovue Inc., Fremont, CA). Optical coherence tomography (OCT) images were taken in Enhanced Deep Imaging mode and transferred to Image J program. choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) measurements were evaluated.

RESULTS

The mean age of volunteers was 35.4 ± 7.2 years. There was a significant difference in CVI values 67.75±2.4 in the patients with vitamin D insufficiency and 69.22±1.75 in the control group. The SCFT of patients with vitamin D insufficiency and control group were 295.25±42.3 and 335.71±11.6 (p = 0.001, p<0.001 respectively).

CONCLUSION

OCT examination of patients with vitamin D insufficiency showed a decrease in CVI and SCFT values. These results are important in demonstrating the retinochoroidal effects of vitamin D insufficiency.

Determination of vitamin D metabolites in various biological samples through an improved chemical derivatization assisted liquid chromatography-tandem mass spectrometry approach

Vitamin D (VD) metabolites are involved in a variety of important metabolic processes and physiological effects in organisms. Profiling of VD metabolites favors a deep understanding of the physiological role of VD. However, VD metabolites are difficult to detect due to their high chemical structural rigidity, structural similarity, and low sensitivities under liquid chromatography-tandem mass spectrometry (LC-MS). Herein, we present a chemical derivatization assisted LC-MS/MS strategy for the detection of VDs, in which 4-phenyl-1,2,4-triazoline-3,5-dione (PTAD) is employed to derivatize the conjugated diene of VD metabolites and provides sensitizing reporters for MS detection. After PTAD derivatization, the sensitivities of seven VD metabolites increased by 24-276 folds, with the limits of detection ranging from 3 to 20 pg mL-1. Using this method, we achieved a sensitive and accurate quantification of 7 VD metabolites (vitamin D2, vitamin D3, 25-hydroxyvitamin D2, 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D2, 1,25-dihydroxyvitamin D3, and 1,24,25-trihydroxyvitamin D3) of the VD metabolic pathway in different trace biological samples, including human serum, mouse tissues (namely liver, kidney, lung, and spleen), and cells. We believe that the present method can provide a promising tool for an in-depth analysis of VD metabolism.

How does Canada's new vitamin D fortification policy affect the high prevalence of inadequate intake of the vitamin?

TAKE-HOME MESSAGE

The 2023 vitamin D fortification policy may significantly reduce inadequacies in non-supplement consumers; however, the policy is far from eliminating population-level vitamin D inadequacies and supplementation should still be encouraged.

Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians. Part I

The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlapping in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover pemphigus vulgaris and mucous membrane pemphigoid, recurrent aphthous stomatitis, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.

Causal associations of 25-hydroxyvitamin D with functional gastrointestinal disorders: a two-sample Mendelian randomization study

BACKGROUND

Previous observational studies have shown associations between vitamin Ds and FGIDS[Including irritable bowel syndrome(IBS) and functional dyspepsia(FD)]. However, the association is controversial and the causality remains unknown. In this study, two-sample MR was cited to explore the causal effect on FGIDS caused by vitamin D level and serum 25-hydroxyvitamin D.

METHOD

The GWASs of vitaminD and 25-hydroxyvitamin D, with 57-99 strongly related SNPs were all obtained from UK biobank. The GWASs of IBS and FD were obtained from FinnGen biobank with respectively 187,028 and 194,071 participants involved. Fixed-effect inverse variance weighted regression was used to evaluate causal estimates. Other statistical methods such as MR Egger, weighted median estimation, maximum likelihood estimation and penalty-weighted median estimation are also used to verify the accuracy of the main results.

RESULTS

Measuring by the IVW method, our research indicated that no causal relationship was detected between vitamin D intake and Functional gastrointestinal disorders [IVW, OR(vitamin D-IBS) = 0.909, 95% CI 0.789-1.053, p = 0.2017); OR(vitamin D-FD) = 1.0662, 95% CI 0.9182-1.2380, p = 0.4000]. As for serum 25-hydroxyvitamin D, no causal relationship was detected on FD(IVW, OR(25-hydroxyvitamin D-FD) = 0.9635, 95% CI 0.8039-1.1546, p = 0.6869). Nevertheless, a negative causal relationship was revealed between 25-hydroxyvitamin D and IBS(IVW, OR(25-hydroxyvitamin D-IBS) = 0.832, 95% CI 0.696-0.995, p = 0.0436). Sensitive analysis supported the main findings but did not suggest bias due to pleiotropy.

CONCLUSIONS

Our Mendelian randomization analyses suggest a negative causal relationship between 25-hydroxyvitamin D and IBS. For each additional SD increase of genetically determined 25-hydroxyvitamin D levels, the risk of IBS decreased by 16.8%.

Vitamin D Determinants, Status, and Antioxidant/Anti-inflammatory-Related Effects in Cardiovascular Risk and Disease: Not the Last Word in the Controversy

Beyond its key role in calcium homeostasis, vitamin D has been found to significantly affect the cardiovascular (CV) system. In fact, low vitamin D levels have been associated with increased CV risk, as well as increased CV morbidity and mortality. The majority of effects of this molecule are related directly or indirectly to its antioxidative and anti-inflammatory properties. Generally, vitamin D insufficiency is considered for 25-hydroxyvitamin D (25(OH)D) levels between 21-29 ng/mL (corresponding to 52.5-72.5 nmol/L), deficiency as 25(OH)D levels less than 20 ng/mL (<50 nmol/L), and extreme deficiency as 25(OH)D less than 10 ng/mL (<25 nmol/L). However, the definition of an optimal vitamin D status, as defined by 25(OH)D, remains controversial for many extra-bone conditions, including CV disease. In this review, confounding factors affecting the 25(OH)D measurement and status will be discussed. In particular, available evidence on the mechanism and role of vitamin D in relation to CV risk and disease through its antioxidant effect will be reported, also facing the aspect regarding the debate on the minimum blood 25(OH)D level required to ensure optimal CV health.

Vitamin D in pediatric age: Current evidence, recommendations, and misunderstandings

In recent years vitamin D has been in the spotlight of many researchers for its possible role in various disorders, including autoimmune and infectious diseases. Even if vitamin D deficiency remains a major public health problem, its symptomatic manifestations are less and less common in clinical practice, and pediatric age represents a “gray area” where vitamin D supplementation is often administered in the absence of an effective evaluation of its status. Moreover, a poor knowledge about different definitions of “deficiency,” “insufficiency,” and similar terms is spread among clinicians, while guidelines are not univocal, especially after the first year of life. The aim of this brief opinion paper is to sum up recent evidence about vitamin D status and its supplementation in pediatrics, in order to better clarify a common definition of its deficiency. The aim of this opinion article is to raise awareness on this topic among clinicians and encourage a discussion on the real need for routine 25-hydroxycholecalciferol serum evaluation and its supplementation.

Vitamin D deficiency in Ukraine: current evidence

BACKGROUND

Data from numerous studies demonstrate the high frequency of vitamin D deficiency (VDD) and insufficiency (VDI) in many countries worldwide that depend on age and sex, seasons, country, and concomitant pathology. This research aimed to study vitamin D status in the Ukrainian population during 2016-2022 years depending on age, sex, month, and year of the observation, and compare the results with the data of previous Ukrainian epidemiologic studies.

METHODS

In a single-center cohort study, we analyzed the serum total 25-hydroxyvitamin D (25(OH)D) level in 7,418 subjects aged 20-99 years. The analysis was performed depending on age, sex, month, season, and year of the observation. Also, we compared the results with the data of previous Ukrainian studies. 25(OH)D level was measured using the electrochemiluminescence method.

RESULTS

The mean serum 25(OH)D level in the total group was 31.0 [22.3-41.1] ng/mL, the lowest level was in the age group 90-99 years old. No gender differences were found in 25(OH)D levels, except the one for the women aged 60-69 years old who had higher vitamin D levels compared to male parameters. 41.6% of the subjects had an optimal (> 30-50 ng/mL) 25(OH)D level, 27.3% had VDI, and 19.5% had a VDD. The suboptimal and high serum concentration of 25(OH)D (> 50-100 ng/mL) was found in 11.4% of the subjects. Also, we established the increase of serum 25(OH)D level from 2016 to 2022 with the highest values in 2020-2022. Seasonal variations of 25(OH)D concentration confirmed the highest index in autumn (33.0 [24.0-42.4] ng/mL) and the lowest one in the spring (28.5 [19.7-38.7] ng/mL) with the highest 25(OH)D level in September and the lowest one in March.

CONCLUSION

Our results confirmed a decrease in VDD and VDI in 2020-2022 in the Ukrainian population compared to the previous years (2016-2019) and previous Ukrainian studies with similar age and seasonal particularities. It may be the consequence of an improvement in public awareness of global vitamin D deficiency, its positive skeletal and extra-skeletal effects, as well as more intensive vitamin D supplementation due to the COVID-19 pandemic in the recent years.

Cognitive Impairment in Celiac Disease Patients: Scoping Review Exploring Psychological Triggers in a Chronic Condition

Celiac disease (CD), also known as gluten-sensitive enteropathy, is an inflammatory autoimmune reaction triggered by ingestion of gluten in genetically predisposed subjects. Celiac disease is often associated with a wide range of disorders, caused by immune responses and by malabsorption with subsequent nutritional deficiencies. Prevalent neurologic manifestations are ataxia, epilepsy, cerebral calcification, cerebral white matter lesions, peripheral neuropathy and myopathy, but also cognitive impairment. The study aimed to identify emerging and urgent research domains in order to establish a CD-specific patient-tailored protocol that includes both psychological and neuropsychological evaluations. We performed a systematic search of MEDLINE, PubMed, SCOPUS, Web of Science and Cochrane library in November 2022. We conducted a descriptive analysis of the characteristics of the included literature. Based on the exclusion/inclusion criteria, a total of seven articles were included in the scoping review process. This review demonstrated the lack of research on CD-related cognitive impairment key features and tries to focus on both cognitive and psychological manifestations as well as their two-way interaction. We tried to establish the specific areas involved, in order to have a comprehensive view of this condition and trying to determine a correct way of assessing CD cognitive impairment and its correlations with psychological distress and personal coping skills to a chronic condition. Nevertheless, research on this topic is progressively increasing and future studies should address specific key points.

Serum 25-Hydroxyvitamin D Is Differentially Associated with Early and Late Age-Related Macular Degeneration in the United States Population

BACKGROUND

Age-related macular degeneration (AMD) has been the leading cause of irreversible blindness in industrialized countries. Emerging data suggest that serum vitamin D levels may be associated with AMD but show mixed results. National-level population data on the relationship between vitamin D and AMD severities are still lacking.

METHODS

We used data from the National Health and Nutrition Examination Survey (NHANES) 2005 to 2008. Retinal photographs were taken and graded for AMD stage. The odds ratio (OR) of AMD and its subtype was calculated after adjusting for confounding factors. Restricted cubic spline (RCS) analyses were used to explore potential non-linear relations.

RESULTS

A total of 5041 participants with a mean age of 59.6 years were included. After adjusting for covariates, participants with higher level of serum 25-hydroxyvitamin D [25(OH)D] had significantly greater odds of early AMD (OR, 1.65; 95% CI, 1.08-2.51) and decreased risk of late AMD (OR, 0.29; 95% CI, 0.09-0.88). When stratified by age, a positive association between the level of serum 25(OH)D and early AMD was present in the <60 years group (OR, 2.79; 95% CI, 1.08-7.29), whereas a negative relation between the level of serum 25(OH)D and late AMD was detected in the ≥60 years group (OR, 0.24; 95% CI, 0.08-0.76).

CONCLUSIONS

A higher level of serum 25(OH)D was related to increased risk of early AMD in those <60 years and decreased risk of late AMD in those ≥60 years.