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Heughebaert L, Stove CP. Is the stability of folates in dried blood microsamples sufficient to perform home-sampling studies? Analyst 2024; 149:895-908. [PMID: 38189100 DOI: 10.1039/d3an01004j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Dried blood microsampling is increasingly used for home-sampling and epidemiological studies because of its multiple advantages, including an often greatly improved analyte stability. However, a critical assessment of the stability under realistic conditions should always be performed as part of the validation, especially for unstable molecules like folates (vitamin B9). Here, the objective was to determine whether folate stability in dried blood microsamples is sufficient to allow the set-up of home-sampling studies for the monitoring of folate status in e.g., women of reproductive age. An extensive set of stability experiments was performed to evaluate the stability of the main folate vitamer 5-methyltetrahydrofolate (5MTHF), its oxidation product MeFOX and the minor non-methyl folate vitamers 10-formylfolic acid (10FoFA), 5,10-methenyltetrahydrofolate (5,10CH+THF) and tetrahydrofolate (THF) in dried blood microsamples using volumetric absorptive microsampling (VAMS) or regular dried blood spots (DBS). The evaluations included (EDTA-anticoagulated blood was collected from a single donor measured in four replicates per condition and time point): (i) the effect of temperature (-20 °C, 4 °C, ambient temperature and 37 °C), (ii) the effect of light (during drying and storage) and humidity, and (iii) the effect of storage under vacuum and pretreatment of the microsamples with stabilizing agents on folate stability. At -20 °C and 4 °C, all folate levels were within 85 to 115% of the baseline value up till two weeks of storage in both VAMS samples and DBS. However, at room temperature the stability of the analyzed folates was only consistently observed up till three days in VAMS samples, and for none of the folates at 37 °C. Humidity had a major impact on 5,10CH+THF stability, but this could be easily improved by using desiccant. Both vacuum treatment and pretreatment of microsamples with 0.1% DL-dithiothreitol and 5% butylated hydroxytoluene improved the stability at room temperature in VAMS samples, but these effects were limited at 37 °C and in DBS. Overall, the stability of the individual folate vitamers proved to be challenging and strongly temperature- and time-dependent. Nonetheless, if controlled transport (temperature and duration) can be assured, the set-up of home-sampling studies to evaluate the folate status using dried blood microsamples can still be beneficial.
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Affiliation(s)
- Liesl Heughebaert
- Laboratory of Toxicology, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Christophe Pol Stove
- Laboratory of Toxicology, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
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2
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Ma Y, Yu S, Mu D, Cheng J, Qiu L, Cheng X. Liquid chromatography-tandem mass spectrometry in fat-soluble vitamin deficiency. Clin Chim Acta 2023; 548:117469. [PMID: 37419302 DOI: 10.1016/j.cca.2023.117469] [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] [Received: 02/06/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023]
Abstract
Fat-soluble vitamins, including vitamins A, D, E, and K, are essential for maintaining normal body function and metabolism. Fat-soluble vitamin deficiency may lead to bone diseases, anemia, bleeding, xerophthalmia, etc. Early detection and timely interventions are significant for preventing vitamin deficiency-related diseases. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is developing into a potent instrument for the precise detection of fat-soluble vitamins due to its high sensitivity, high specificity, and high resolution.
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Affiliation(s)
- Yichen Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Songlin Yu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China.
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3
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Gürdeniz G, Kim M, Brustad N, Ernst M, Russo F, Stokholm J, Bønnelykke K, Hougaard D, Rasmussen M, Cohen A, Chawes B. Furan fatty acid metabolite in newborns predicts risk of asthma. Allergy 2023; 78:429-438. [PMID: 36254396 DOI: 10.1111/all.15554] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intake of fish-oil and fatty fish during pregnancy has been shown to reduce the risk of childhood asthma but biomarkers of such intake are lacking. OBJECTIVE To establish biomarkers of prenatal fish-oil exposure from newborn dry blood spot metabolomics profiles and assess their relevance for childhood asthma risk stratification. METHODS The Danish COPSAC2010 mother-child cohort was utilized to investigate the effect of a double-blinded randomized controlled trial of fish-oil supplementation during pregnancy on dry blood spot liquid-chromatography mass spectrometry-based metabolomics profiles of 677 newborns. We thereafter investigated the association between fish-oil associated biomarkers in the newborn and development of asthma-related outcomes. Replication was sought in the independent observational COPSAC2000 cohort with 387 newborn metabolomics profiles. RESULTS The newborn metabolomics profiles differed between children in the fish-oil vs. placebo group in COPSAC2010 (area under the receiver operator curve = 0.94 ± 0.03, p < .001). The fish-oil metabolomics profile and the top biomarker, 3-carboxy-4-methyl-5-propyl-2-furan propanoic acid (CMPF) were both associated with a decreased risk of asthma by age 6 years (HR = 0.89, p = .002 and HR = 0.67, p = .005, respectively). In COPSAC2000 , newborn CMPF level was also inversely associated with asthma risk by age 6 years (HR = 0.69, p = .01). Troublesome lung symptoms and common infections in the first 3 years were also inversely associated with newborn CMPF levels in both cohorts. CONCLUSIONS Newborn children's blood levels of the furan fatty acid metabolite CMPF reflect fish-oil and fatty fish intake during pregnancy and are associated with a lower risk of asthma across two cohorts, which could aid newborn screening for childhood asthma.
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Affiliation(s)
- Gözde Gürdeniz
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Section of Chemometrics and Analytical Technologies, Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Min Kim
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Nicklas Brustad
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Madeleine Ernst
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Francesco Russo
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - David Hougaard
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Morten Rasmussen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Section of Chemometrics and Analytical Technologies, Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Arieh Cohen
- Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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4
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Beauchesne AR, Cara KC, Krobath DM, Penkert LP, Shertukde SP, Cahoon DS, Prado B, Li R, Yao Q, Huang J, Reh T, Chung M. Vitamin D intakes and health outcomes in infants and preschool children: Summary of an evidence report. Ann Med 2022; 54:2278-2301. [PMID: 35975961 PMCID: PMC9387322 DOI: 10.1080/07853890.2022.2111602] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A systematic review was commissioned to support an international expert group charged to update the Food and Agriculture Organisation of the United Nations (FAO)/World Health Organisation (WHO)'s vitamin D intake recommendations for children aged 0-4 years. MATERIALS AND METHODS Multiple electronic databases were searched to capture studies published from database inception to the 2nd week of June 2020 according to key questions formulated by the FAO/WHO. Relevant studies were summarised and synthesised by key questions and by health outcomes using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. RESULTS The 146 included studies examined the effects of different vitamin D intake levels on a variety of health outcomes (e.g. infectious disease, growth, neurodevelopment, rickets, and bone mineral density), and on outcomes for setting vitamin D upper limits (e.g. hypercalcemia, hypercalciuria, and nephrocalcinosis). For most outcomes, the strength of evidence was low or very low. Evidence was rated moderate for the effect of daily vitamin D supplementation on raising serum 25(OH)D concentrations, and a random-effects meta-regression analysis of 28 randomised controlled trials (mostly in infants 0-12 months) showed that each 100 IU/d increase in vitamin D supplementation was associated with an average of 1.92 (95% CI 0.28, 3.56) nmol/L increase in achieved 25-hydroxy-vitaminn D (25[OH]D) concentration (n = 53 intervention arms; p = .022) with large residual heterogeneity (I2 = 99.39%). Evidence was very low on two of the upper limit outcomes - hypercalcemia and hypercalciuria. CONCLUSIONS The evidence report provided the expert group with a foundation and core set of data to begin their work to set vitamin D nutrient reference values. To move the field forward, future studies should use standardised 25(OH)D assay measurements and should examine the relationship between long-term vitamin D status and health outcomes.Key MessagesResults of a large complex systematic review suggest the current totality of evidence from trials and prospective observational studies do not reach sufficient certainty level to support a causal relationship between vitamin D intake and asthma, wheeze, eczema, infectious diseases, or rickets (most trials reported no rickets) in generally healthy infants and young children.In this systematic review, the only body of evidence that reached a moderate level of certainty was regarding the effect of daily vitamin D supplementation (vitamin D3 or D2 supplements to infants/children) on increasing serum 25(OH)D concentrations. However, currently there is no consensus on the definitions of vitamin D status, e.g. deficiency, insufficiency, sufficiency and toxicity, based on serum 25(OH)D concentrations.This systematic review provided an international expert group a foundation and core set of data through intake-response modelling to help set vitamin D nutrient reference values for infants and children up to 4 years of age.
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Affiliation(s)
| | - Kelly Copeland Cara
- School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Danielle M Krobath
- School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Laura Paige Penkert
- School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Shruti P Shertukde
- School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Danielle S Cahoon
- School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Belen Prado
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Ruogu Li
- School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Qisi Yao
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Jing Huang
- School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Tee Reh
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Mei Chung
- School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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5
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Albiñana C, Boelt SG, Cohen AS, Zhu Z, Musliner KL, Vilhjálmsson BJ, McGrath JJ. Developmental exposure to vitamin D deficiency and subsequent risk of schizophrenia. Schizophr Res 2022; 247:26-32. [PMID: 34247885 DOI: 10.1016/j.schres.2021.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 01/22/2023]
Abstract
Over the last half century, a body of convergent evidence has accumulated linking disruption of early brain development with an increased risk of mental disorders, including schizophrenia. The orderly cascade of brain development may be disrupted by exposure to suboptimal concentrations of a range of biological substrates and micronutrients. We hypothesized that those exposed to vitamin D deficiency during early life, have an increased risk of neurodevelopmental disorders, including schizophrenia. The hypothesis was based on the link between an increased risk of schizophrenia in (a) those born in winter and spring, when vitamin D deficiency is more prevalent, and (b) the offspring of dark-skinned migrants living in cold climates, who have a markedly increased risk of vitamin D deficiency. In this review, we summarize evidence from analytic epidemiology related to this hypothesis. Two case-control studies based on Danish neonatal dried blood spots have found that neonatal vitamin deficiency is associated with an increased risk of schizophrenia. However, recent genetic analyses have also suggested that common variants linked to schizophrenia may lead to lower vitamin D concentrations (possibly mediated via reduced outdoor activity). We summarize limitations of the current evidence and outline suggestions that can guide future research. Based on currently available data, there is insufficient evidence to support public health recommendations related to this topic. However, we cannot reject the hypothesis that the provision of vitamin D supplementation to pregnant women and/or offspring in groups vulnerable to vitamin D deficiency may subsequently reduce the incidence of schizophrenia in the offspring.
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Affiliation(s)
- Clara Albiñana
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; iPSYCH - the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | | | - Arieh S Cohen
- Department of Inherited Diseases, Statens Serum Institut, Copenhagen, Denmark
| | - Zhihong Zhu
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Katherine L Musliner
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; iPSYCH - the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Bjarni J Vilhjálmsson
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; iPSYCH - the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark; Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - John J McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia; Queensland Brain Institute, The University of Queensland, St Lucia, Australia.
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6
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Boelt SG, Plana-Ripoll O, Albiñana C, Vilhjálmsson B, McGrath JJ, Cohen AS. A method to correct for the influence of bovine serum albumin-associated vitamin D metabolites in protein extracts from neonatal dried blood spots. BMC Res Notes 2022; 15:194. [PMID: 35659347 PMCID: PMC9166528 DOI: 10.1186/s13104-022-06077-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/18/2022] [Indexed: 12/04/2022] Open
Abstract
Objective We developed an assay to measure the concentration of 25 hydroxyvitamin D2 and D3 in protein extracts derived from stored neonatal dried blood spots. During this study, we postulated that these samples had been contaminated with exogenous vitamin D metabolites because of the addition of bovine serum albumin (BSA) as part of an extraction step undertaken 7 years earlier. The aim of the current study was to develop methods in order to adjust for this contamination. Results We identified between-plate variations in 25 hydroxyvitamin D2 and D3 concentrations which suggested the presence of three different BSA batches. Based on repeat extraction (without the addition of BSA) and testing of 395 samples, we developed models to correct for the exogenous 25 hydroxyvitamin D2 and D3. The regression models were Diff25OHD3 = − 8.2 + 1.8* Diff25OHD2 for low contamination, Diff25OHD3 = 23.8 + 1.7* Diff25OHD2 for middle contamination, and Diff25OHD3 = 14.3 + 3.0* Diff25OHD2 for high contamination. After these corrections, the three subsamples had comparable distributions within the expected range for both 25 hydroxyvitamin D2 and D3. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06077-1.
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Affiliation(s)
- Sanne Grundvad Boelt
- Center for Neonatal Screening, Department of Congenital Disorders-Clinical Mass Spectrometry Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 26, Building 2640 Aarhus V, DK-8210, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45 Aarhus N, 8200, Aarhus, Denmark
| | - Clara Albiñana
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 26, Building 2640 Aarhus V, DK-8210, Aarhus, Denmark
| | - Bjarni Vilhjálmsson
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 26, Building 2640 Aarhus V, DK-8210, Aarhus, Denmark.,Bioinformatics Research Centre, Aarhus University, C.F. Møllers Allé 8, Building 1110 Aarhus C, DK-8000, Aarhus, Denmark
| | - John J McGrath
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 26, Building 2640 Aarhus V, DK-8210, Aarhus, Denmark. .,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, University of Queensland, St. Lucia, QLD-4072, Australia. .,Queensland Brain Institute, University of Queensland, St. Lucia, QLD-4072, Australia.
| | - Arieh S Cohen
- Center for Neonatal Screening, Department of Congenital Disorders-Clinical Mass Spectrometry Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
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7
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Evaluation of different biological matrices to assess the vitamin D status in newborns using LC-MS/MS. Microchem J 2021. [DOI: 10.1016/j.microc.2021.106368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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8
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Nybo M, Fruekilde PN, Andersen-Ranberg K. Measurement of vitamin D in dried blood spots stored under different temperature conditions. Ann Clin Biochem 2021; 58:461-467. [PMID: 33874736 DOI: 10.1177/00045632211013870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As part of the Survey of Health, Ageing and Retirement in Europe (SHARE) study, dried blood spot samples were obtained for measurement of potential biological biomarkers, among those vitamin D. Unfortunately, no studies describe the impact of high temperatures on dried blood spot samples and vitamin D measurements. MATERIALS AND METHODS Capillary samples were collected on dried blood spot cards from 40 outpatients (median age 78 years) along with venous blood samples. To mimic the different environmental and temporal challenges during collection and shipment until final storage in the SHARE study, dried blood spot cards were stored at different temperatures, at time span and with/without freeze-thaw. Vitamin D concentrations in venous plasma samples were measured by conventional immunoassay (on Architect i2000SR), while vitamin D concentrations in dried blood spot samples were measured using LC-MS/MS with a well-described extraction method and with relevant calibration and comparison with a reference method. RESULTS Vitamin D measured in dried blood spot samples did not differ significantly from venous plasma measurements under the different storage conditions tested. The optimal vitamin D correlation between the two matrices was by storage at either 21°C or 35°C for four days (r = 0.9060 and 0.9026, respectively). Freeze-thaw of the dried blood spot samples did not have any significant effect. CONCLUSION We find that vitamin D measured in dried blood spot samples do not differ significantly from venous plasma measurements despite storage at different temperatures and freeze-thaw, which enables the use of dried blood spot in multicentre studies taking place under alternating temperature conditions.
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Affiliation(s)
- Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Palle N Fruekilde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Danish Ageing Research Center (DARC), University of Southern Denmark (SDU), Odense, Denmark
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9
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Robinson DE, Ali MS, Strauss VY, Elhussein L, Abrahamsen B, Arden NK, Ben-Shlomo Y, Caskey F, Cooper C, Dedman D, Delmestri A, Judge A, Javaid MK, Prieto-Alhambra D. Bisphosphonates to reduce bone fractures in stage 3B+ chronic kidney disease: a propensity score-matched cohort study. Health Technol Assess 2021; 25:1-106. [PMID: 33739919 PMCID: PMC8020200 DOI: 10.3310/hta25170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bisphosphonates are contraindicated in patients with stage 4+ chronic kidney disease. However, they are widely used to prevent fragility fractures in stage 3 chronic kidney disease, despite a lack of good-quality data on their effects. OBJECTIVES The aims of each work package were as follows. Work package 1: to study the relationship between bisphosphonate use and chronic kidney disease progression. Work package 2: to study the association between using bisphosphonates and fracture risk. Work package 3: to determine the risks of hypocalcaemia, hypophosphataemia, acute kidney injury and upper gastrointestinal events associated with using bisphosphonates. Work package 4: to investigate the association between using bisphosphonates and changes in bone mineral density over time. DESIGN This was a new-user cohort study design with propensity score matching. SETTING AND DATA SOURCES Data were obtained from UK NHS primary care (Clinical Practice Research Datalink GOLD database) and linked hospital inpatient records (Hospital Episode Statistics) for work packages 1-3 and from the Danish Odense University Hospital Databases for work package 4. PARTICIPANTS Patients registered in the data sources who had at least one measurement of estimated glomerular filtration rate of < 45 ml/minute/1.73 m2 were eligible. A second estimated glomerular filtration rate value of < 45 ml/minute/1.73 m2 within 1 year after the first was requested for work packages 1 and 3. Patients with no Hospital Episode Statistics linkage were excluded from work packages 1-3. Patients with < 1 year of run-in data before index estimated glomerular filtration rate and previous users of anti-osteoporosis medications were excluded from work packages 1-4. INTERVENTIONS/EXPOSURE Bisphosphonate use, identified from primary care prescriptions (for work packages 1-3) or pharmacy dispensations (for work package 4), was the main exposure. MAIN OUTCOME MEASURES Work package 1: chronic kidney disease progression, defined as stage worsening or starting renal replacement. Work package 2: hip fracture. Work package 3: acute kidney injury, hypocalcaemia and hypophosphataemia identified from Hospital Episode Statistics, and gastrointestinal events identified from Clinical Practice Research Datalink or Hospital Episode Statistics. Work package 4: annualised femoral neck bone mineral density percentage change. RESULTS Bisphosphonate use was associated with an excess risk of chronic kidney disease progression (subdistribution hazard ratio 1.12, 95% confidence interval 1.02 to 1.24) in work package 1, but did not increase the probability of other safety outcomes in work package 3. The results from work package 2 suggested that bisphosphonate use increased fracture risk (hazard ratio 1.25, 95% confidence interval 1.13 to 1.39) for hip fractures, but sensitivity analyses suggested that this was related to unresolved confounding. Conversely, work package 4 suggested that bisphosphonates improved bone mineral density, with an average 2.65% (95% confidence interval 1.32% to 3.99%) greater gain in femoral neck bone mineral density per year in bisphosphonate users than in matched non-users. LIMITATIONS Confounding by indication was a concern for the clinical effectiveness (i.e. work package 2) data. Bias analyses suggested that these findings were due to inappropriate adjustment for pre-treatment risk. work packages 3 and 4 were based on small numbers of events and participants, respectively. CONCLUSIONS Bisphosphonates were associated with a 12% excess risk of chronic kidney disease progression in participants with stage 3B+ chronic kidney disease. No other safety concerns were identified. Bisphosphonate therapy increased bone mineral density, but the research team failed to demonstrate antifracture effectiveness. FUTURE WORK Randomised controlled trial data are needed to demonstrate antifracture efficacy in patients with stage 3B+ chronic kidney disease. More safety analyses are needed to characterise the renal toxicity of bisphosphonates in stage 3A chronic kidney disease, possibly using observational data. STUDY REGISTRATION This study is registered as EUPAS10029. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 17. See the NIHR Journals Library website for further project information. The project was also supported by the National Institute for Health Research Biomedical Research Centre, Oxford.
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Affiliation(s)
- Danielle E Robinson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - M Sanni Ali
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Y Strauss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Leena Elhussein
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Bo Abrahamsen
- Open Patient data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Nigel K Arden
- Arthritis Research UK Sports, Exercise and Osteoarthritis Centre, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Fergus Caskey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- UK Renal Registry, Bristol, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Daniel Dedman
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre (BRC), University Hospitals Bristol NHS Foundation Trust, University of Bristol, Southmead Hospital, Bristol, UK
| | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFes), University Institute for Primary Care Research (IDIAP) Jordi Gol, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
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10
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Nutrients, Diet, and Other Factors in Prenatal Life and Bone Health in Young Adults: A Systematic Review of Longitudinal Studies. Nutrients 2020; 12:nu12092866. [PMID: 32961712 PMCID: PMC7551661 DOI: 10.3390/nu12092866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
Optimizing skeletal health in early life has potential effects on bone health later in childhood and in adulthood. We aimed to evaluate the existing evidence that maternal exposures during pregnancy have an impact on the subsequent bone health among offspring in young adults aged between 16 and 30 years. The protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42019126890). The search was conducted up to 2 April 2019. We included seven observational prospective cohort studies that examined the association between maternal dietary factors, vitamin D concentration, age, preeclampsia, and smoking with any bone indices among offspring. The results indicated that high concentrations of maternal vitamin D; low fat intake; and high intakes of calcium, phosphorus, and magnesium may increase the bone mineral density in offspring at age 16. Evidence also suggests that the offspring of younger mothers may have a higher peak bone mass. It remains inconclusive whether there is an influence of preeclampsia or maternal smoking on bone health among young adults. Our assessment of internal validity warrants a cautious interpretation of these results, as all of the included studies were judged to have serious risks of bias. High-quality studies assessing whether prenatal prognostic factors are associated with bone health in young adults are needed.
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11
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Sauder KA, Stamatoiu AV, Leshchinskaya E, Ringham BM, Glueck DH, Dabelea D. Cord Blood Vitamin D Levels and Early Childhood Blood Pressure: The Healthy Start Study. J Am Heart Assoc 2020; 8:e011485. [PMID: 31020895 PMCID: PMC6512116 DOI: 10.1161/jaha.118.011485] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Vitamin D deficiency is associated with cardiovascular events among adults, but it is unclear whether early-life vitamin D deficiency influences cardiovascular risk factors in children. Methods and Results We measured total and bioavailable 25-dihydroxyvitamin D (25OHD) in cord blood and in blood from 4- to 6-year-old children, and we assessed cardiovascular risk factors (blood pressure, arterial stiffness, body size, and adiposity) at 4 to 6 years. We tested for racial/ethnic differences in total and bioavailable 25OHD (n=715) and modeled the adjusted association between cord blood 25OHD and childhood cardiovascular risk factors (n=171). We observed racial/ethnic differences in total and bioavailable 25OHD levels in both cord and child blood samples (all P<0.05). Each 25-nmol/L increase in cord blood total 25OHD was associated with a 2.5-mm Hg (SE 0.8) decrease in systolic blood pressure ( P=0.002) and a 1.7-mm Hg (SE 0.6) decrease in diastolic blood pressure ( P=0.01), independent of childhood 25OHD levels, race/ethnicity, and other covariates. There was no association between cord blood total 25OHD and any other cardiovascular risk factors. Cord blood levels of bioavailable and free 25OHD were not associated with any cardiovascular risk factor in childhood. Conclusions In this diverse prebirth cohort, we observed lower systolic and diastolic blood pressure among children with higher total 25OHD levels at birth. Our findings suggest that intrauterine exposure to vitamin D may contribute to early-life programming of offspring blood pressure. Intervention studies are needed to determine whether increasing fetal vitamin D exposure can reduce the risk of elevated blood pressure in childhood.
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Affiliation(s)
- Katherine A Sauder
- 1 Department of Pediatrics University of Colorado School of Medicine Aurora CO.,2 Department of Epidemiology Colorado School of Public Health Aurora CO.,3 Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Aurora CO
| | - Alexandra V Stamatoiu
- 3 Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Aurora CO
| | - Elina Leshchinskaya
- 3 Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Aurora CO
| | - Brandy M Ringham
- 2 Department of Epidemiology Colorado School of Public Health Aurora CO.,3 Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Aurora CO
| | - Deborah H Glueck
- 1 Department of Pediatrics University of Colorado School of Medicine Aurora CO.,3 Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Aurora CO
| | - Dana Dabelea
- 1 Department of Pediatrics University of Colorado School of Medicine Aurora CO.,2 Department of Epidemiology Colorado School of Public Health Aurora CO.,3 Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Aurora CO
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12
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Specht IO, Jacobsen N, Frederiksen P, Heitmann BL. Neonatal vitamin D status and myopia in young adult men. Acta Ophthalmol 2020; 98:500-505. [PMID: 31943811 DOI: 10.1111/aos.14349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/20/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The prevalence of myopia is increasing worldwide, and modifiable risk factors are thus important to identify. Season of birth has been associated with later myopia risk. Neonatal vitamin D status is highly dependent on season of birth due to maternal sun exposure late in gestation. We hypothesize that prenatal exposure to low levels of vitamin D can interfere with visual development in term-born infants and that this might contribute to adult visual dysfunction. The aim of this study was thus to compare neonatal vitamin D levels from stored dried blood spots taken shortly after birth among young term-born men with myopia (cases) and random controls with emmetropia. METHODS In this case-control study, we analysed neonatal 25(OH)D3 levels of 457 myopic male cases and 1280 emmetropic male controls assessed for myopia at the mandatory Danish conscript examination. Data were analysed using logistic regression analysis and results presented as crude and adjusted for potential confounders namely maternal age, maternal ethnicity, maternal and paternal education and season of birth. RESULTS We did not observe a seasonal variation in myopia risk, neither did we observe increased odds of myopia in relation to low neonatal 25(OH)D3 levels. CONCLUSION The rapid increase in myopia does not seem related to neonatal vitamin D status.
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Affiliation(s)
- Ina Olmer Specht
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Nina Jacobsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Peder Frederiksen
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Berit L Heitmann
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, Australia.,The Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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13
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Chung M, Ruan M, Cara KC, Yao Q, Penkert LP, Chen J. Vitamin D and Calcium in Children 0-36 Months: A Scoping Review of Health Outcomes. J Am Coll Nutr 2020; 40:367-396. [PMID: 32662755 DOI: 10.1080/07315724.2020.1774822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
METHODS Updated literature searches were conducted across 5 electronic databases to identify all randomized controlled trials, cohort studies, nested case-control or case-cohort studies, and systematic reviews published after the 2009 U.S. Agency for Healthcare Research and Quality's (AHRQ) evidence report, Vitamin D and Calcium: a Systematic Review of Health Outcomes. In total, 65 studies were summarized and analyzed in the present review. RESULTS There was a steady increasing trend in the number of publications reporting outcomes related to skeletal health, growth, and infectious disease from 2008 to 2019, although the number of published vitamin D studies was much larger than calcium studies. CONCLUSIONS The data presented in this review can facilitate assessment of the variety of outcomes and the amount of potentially useful literature available for each outcome. The results of this scoping review can be used to guide the undertaking of the subsequent systematic reviews.
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Affiliation(s)
- Mei Chung
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Mengyuan Ruan
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Kelly Copeland Cara
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Qisi Yao
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Laura Paige Penkert
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Jiawen Chen
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA.,School of Nursing, Peking University Health Science Center, Beijing, China
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14
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Rodrigues LA, Wellington MO, Sands JM, Weber LP, Olver TD, Ferguson DP, Columbus DA. Characterization of a Swine Model of Birth Weight and Neonatal Nutrient Restriction. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT
Background
Evidence indicates that birth weight and neonatal nutrition have lifelong effects. Animal models are required to improve our understanding of these factors.
Objectives
We aimed to develop and validate a swine model of birth weight and neonatal undernutrition.
Methods
At birth, a total of 112 piglets were identified as low (LBW; 1.22 ± 0.28 kg SEM) or normal birth weight (NBW; 1.70 ± 0.27 kg). From day 3 to weaning (day 28), piglets received normal nutrition (NN) or restricted nutrition (RN) via intermittent suckling, where piglets were isolated from the sow for 6 h/d. After weaning, pigs were fed a common diet for 28 d. Body weight (BW) was determined for the duration of the study. On days 28 and 56, empty carcass, viscera, and individual organ weights were determined in 8 pigs/treatment.
Results
LBW pigs remained smaller than NBW pigs, regardless of nutrient restriction (P < 0.05). Within birth weight category, RN reduced BW by day 7 after birth, which was maintained until weaning (P < 0.05); however, at 7 d postweaning there was no difference in BW due to RN (P > 0.05). At weaning, empty carcass, viscera, heart, liver, and lung weights were lower in LBW than in NBW pigs, whereas empty carcass, heart, small intestine, liver, kidneys, lung, and spleen weights were lower in RN than in NN pigs (P < 0.05). Brain weight was highest in NBW-NN and lowest in NBW-RN, with LBW intermediate, regardless of nutrient restriction (P < 0.05). Postweaning, LBW had lower empty carcass, viscera, heart, stomach, large intestine, liver, and kidney weights than NBW, whereas RN had a higher small intestine weight than NN (P < 0.05).
Conclusions
Intermittent suckling is an effective means of inducing nutrient restriction in a swine model.
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Affiliation(s)
- Lucas A Rodrigues
- Prairie Swine Centre, Inc., Saskatoon, SK, Canada
- Department of Animal and Poultry Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael O Wellington
- Prairie Swine Centre, Inc., Saskatoon, SK, Canada
- Department of Animal and Poultry Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jade M Sands
- Prairie Swine Centre, Inc., Saskatoon, SK, Canada
- Department of Animal and Poultry Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lynn P Weber
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - T Dylan Olver
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - David P Ferguson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Daniel A Columbus
- Prairie Swine Centre, Inc., Saskatoon, SK, Canada
- Department of Animal and Poultry Science, University of Saskatchewan, Saskatoon, SK, Canada
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15
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Specht IO, Thorsteinsdottir F, Walker KC, Olsen J, Heitmann BL. Neonatal vitamin D status and risk of childhood epilepsy. Epilepsia 2020; 61:1282-1290. [PMID: 32363640 DOI: 10.1111/epi.16520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Epilepsy is a nervous system abnormality that may be caused by unknown exposures during fetal development. Studies have shown neuroprotective effects of early exposure to vitamin D in other neurological disorders, and seasonal variation in birth of children with epilepsy. We aimed to investigate if neonatal 25(OH)D3 was associated with risk of childhood epilepsy. METHODS This case-cohort study compared neonatal 25(OH)D3 levels from children with epilepsy (n = 403) and a random selected cohort of controls (n = 1163), assessing the hazard of first epilepsy diagnosis between 1 and 4 years of age from a weighted Cox proportional hazard model. Analyses were adjusted for parental education, maternal age, maternal epilepsy, maternal ethnicity, and gestational age, and additionally for season of birth and smoking during pregnancy. RESULTS The mean (standard deviation [SD]) of neonatal 25(OH)D3 levels were 30.8(19.6) nmol/L among cases and 28.5(19.4) nmol/L among the cohort. The hazard ratio (HR) of epilepsy was in a dose-response pattern higher among children from the highest neonatal 25(OH)D3 quintiles (P-trend = .004). Results were unchanged after including season of birth in the analysis, where a significantly higher HR of epilepsy was observed among children in the two highest quintiles compared to children in the lowest quintile (Q4: HRadj 1.62, 95% CI 1.07-2.47 and Q5: HRadj 1.86, 95% CI 1.21-2.86). SIGNIFICANCE In this study, the risk of childhood epilepsy increased with neonatal 25(OH)D3 categories in a dose-response pattern, suggesting an association between a high neonatal 25(OH)D3 and the risk of childhood epilepsy. Considering that adjusting for season of birth strengthened the results, we conclude that maternal intake of vitamin D, and not vitamin D from sun exposure, was the vitamin D source associated with epilepsy. Although we cannot, in the present study, control for compounds in the diet like pollutants or heavy metals, which may correlate with dietary vitamin D, future studies investigating fetal origin of epilepsy should focus on compounds correlating with vitamin D.
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Affiliation(s)
- Ina O Specht
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Fanney Thorsteinsdottir
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Karen Christina Walker
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Jørn Olsen
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit L Heitmann
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, Australia.,The Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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16
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Ali MS, Ernst M, Robinson DE, Caskey F, Arden NK, Ben-Shlomo Y, Nybo M, Rubin KH, Judge A, Cooper C, Javaid MK, Hermann AP, Prieto-Alhambra D. Alendronate use and bone mineral density gains in women with moderate-severe (stages 3B-5) chronic kidney disease: an open cohort multivariable and propensity score analysis from Funen, Denmark. Arch Osteoporos 2020; 15:81. [PMID: 32483674 PMCID: PMC8448716 DOI: 10.1007/s11657-020-00746-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/30/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Bisphosphonates are contraindicated in moderate-to-severe chronic kidney disease patients. However, they are used to prevent fragility fractures in patients with impaired kidney function, despite a lack of evidence on their effects on bone density in these patients. We demonstrated that Alendronate had a positive effect on bone in these patients. PURPOSE This study aimed to assess the association between alendronate use and bone mineral density (BMD) change in subjects with moderate-severe chronic kidney disease (CKD). METHODS We created a cohort of CKD stage 3B-5 patients by linking all DXA-based measurements in the Funen area, Denmark, to biochemistry, national health registries and filled prescriptions. Exposure was dispensation of alendronate and the outcome was annualized percentage change in BMD at the femoral neck, total hip and lumbar spine. Individuals were followed from first BMD to the latest of subsequent DXA measurements. Alendronate non-users were identified using incidence density sampling and matched groups were created using propensity scores. Linear regression was used to estimate average differences in the annualized BMD. RESULTS Use of alendronate was rare in this group of patients: propensity score matching (PSM) resulted in 71 alendronate users and 142 non-users with stage 3B-5 CKD (as in the 1 year before DXA). Whilst alendronate users gained an average 1.07% femoral neck BMD per year, non-users lost an average of 1.59% per annum. The PSM mean differences in annualized BMD were + 2.65% (1.32%, 3.99%), + 3.01% (1.74%, 4.28%) and + 2.12% (0.98%, 3.25%) at the femoral neck, total hip and spine BMD, respectively, all in favour of alendronate users. CONCLUSION In a real-world cohort of women with stage 3B-5 CKD, use of alendronate appears associated with a significant improvement of 2-3% per year in the femoral neck, total hip and spine BMD. More data are needed on the anti-fracture effectiveness and safety of bisphosphonate therapy in moderate-severe CKD.
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Affiliation(s)
- M Sanni Ali
- Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Public Health, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Martin Ernst
- OPEN, Department of Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Danielle E Robinson
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Fergus Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Katrine H Rubin
- OPEN, Department of Health, University of Southern Denmark, Odense, Denmark
| | - Andrew Judge
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Anne P Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Daniel Prieto-Alhambra
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- MRC Lifecourse Epidemiology Unit, Southampton, UK.
- GREMPAL Research Group (Idiap Jordi Gol Primary Care Research Institute) and CIBERFes, Universitat Autonoma de Barcelona, Barcelona, Spain.
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17
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Li SR, Tan ZX, Chen YH, Hu B, Zhang C, Wang H, Zhao H, Xu DX. Vitamin D deficiency exacerbates bleomycin-induced pulmonary fibrosis partially through aggravating TGF-β/Smad2/3-mediated epithelial-mesenchymal transition. Respir Res 2019; 20:266. [PMID: 31775746 PMCID: PMC6882226 DOI: 10.1186/s12931-019-1232-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background Our earlier report indicated that active vitamin D3 inhibited epithelial-mesenchymal transition (EMT) in bleomycin (BLM)-induced pulmonary fibrosis. The objective of this study was to further investigate whether vitamin D deficiency exacerbates BLM-induced pulmonary fibrosis. Methods This study consists of two independent experiments. Experiment 1, male mice were fed with vitamin D deficient (VDD) fodder. Experiment 2, Cyp27b1+/+, Cyp27b1+/− and Cyp27b1−/− mice were fed with standard diet. For pulmonary fibrosis, mice were intratracheally instilled with a single dose of BLM (1.5 mg/kg). Serum 25(OH) D level was measured. Pulmonary collagen deposition was assessed by Sirius red staining. EMT was measured and transforming growth factor-beta (TGF-β)/Smad3 signaling was evaluated in the lungs of BLM-treated mice. Results The relative weight of lungs was elevated in BLM-treated mice. Col1α1 and Col1α2, two collagen protein genes, were upregulated, and collagen deposition, as determined by Sirius red staining, was observed in the lungs of BLM-treated mice. E-cadherin, an epithelial marker, was downregulated. By contrast, vimentin and α-SMA, two EMT markers, were upregulated in the lungs of BLM-treated mice. Pulmonary TGF-β/Smad3 signaling was activated in BLM-induced lung fibrosis. Further analysis showed that feeding VDD diet, leading to vitamin D deficiency, aggravated elevation of BLM-induced relative lung weight. Moreover, feeding VDD diet aggravated BLM-induced TGF-β/Smad3 activation and subsequent EMT in the lungs. In addition, feeding VDD diet exacerbated BLM-induced pulmonary fibrosis. Additional experiment showed that Cyp27b1 gene knockout, leading to active vitamin D3 deficiency, exacerbated BLM-induced pulmonary fibrosis. Moreover, Cyp27b1 gene knockout aggravated pulmonary TGF-β/Smad2/3 activation and subsequent EMT in BLM-induced lung fibrosis. Conclusion Vitamin D deficiency exacerbates BLM-induced pulmonary fibrosis partially through aggravating TGF-β/Smad2/3-mediated EMT in the lungs.
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Affiliation(s)
- Se-Ruo Li
- Second Affiliated Hospital, Anhui Medical University, Hefei, 230032, China
| | - Zhu-Xia Tan
- Second Affiliated Hospital, Anhui Medical University, Hefei, 230032, China
| | - Yuan-Hua Chen
- Department of Toxicology, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Biao Hu
- Second Affiliated Hospital, Anhui Medical University, Hefei, 230032, China
| | - Cheng Zhang
- Department of Toxicology, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Hua Wang
- Department of Toxicology, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Hui Zhao
- Second Affiliated Hospital, Anhui Medical University, Hefei, 230032, China.
| | - De-Xiang Xu
- Department of Toxicology, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
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18
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Neonatal vitamin D levels and cognitive ability in young adulthood. Eur J Nutr 2019; 59:1919-1928. [PMID: 31278417 DOI: 10.1007/s00394-019-02042-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/30/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Intelligence has a strong influence on life capability, and thus, identifying early modifiable risk factors related to cognitive ability is of major public health interest. During pregnancy, vitamin D is transported from the mother to the fetus through the placenta in the form of 25-hydroxyvitamin D (25(OH)D). Levels of 25(OH)D have in some studies been associated with childhood neurodevelopment; however, results from all studies are not in agreement. We investigated if neonatal 25(OH)D3 concentrations were associated with Børge Priens IQ test score (BPP) in young adulthood. METHODS In this nested cohort study, 25(OH)D3 concentrations were measured in dried blood spots from 818 newborns. We followed the children for their IQ BPP test scores in the Danish Conscription Register, which holds information on test results from the BPP test on individuals who have been recruited for Danish mandatory military draft board examination. Using general linear models, we investigated the crude and adjusted relationship between quintiles of 25(OH)D3 concentrations and BPP IQ test results. RESULTS The study population consisted of 95.8% men, with a mean age of 19.4 years. The median and range of the neonatal 25(OH)D3 levels were 26.2 nmol/L (0-104.7 nmol/L). The overall Wald test did not show an association between neonatal 25(OH)D3 levels and BPP IQ scores (p = 0.23); however, individuals within the 3rd (BPP IQ = 101.0, 98.0-103.9) and 4th (BPP IQ = 101.2, 99.1-104.3) quintiles had slightly higher BPP IQ scores than individuals from the first quintile (BPP IQ = 97.6, 94.6-100.6). CONCLUSIONS Our results support the hypothesis that individuals with the lowest levels of neonatal vitamin D might have slightly lower BPP. However, more studies are needed with larger study populations to confirm our results.
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19
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Zhou X, Yu R, Long Y, Zhao J, Yu S, Tang Q, Chen L. BMAL1 deficiency promotes skeletal mandibular hypoplasia via OPG downregulation. Cell Prolif 2018; 51:e12470. [PMID: 30117209 PMCID: PMC6528896 DOI: 10.1111/cpr.12470] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/13/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Skeletal mandibular hypoplasia (SMH), a common type of developmental deformities, results in impaired aesthetics of facial profile, occlusal dysfunction and poor life quality. In this study, BMAL1 deficiency leads to SMH formation, and we aim to investigate the mechanism by which BMAL1 deficiency induces SMH. MATERIALS AND METHODS Circadian rhythm-disordered mouse models were constructed by placing animals in a jet lag schedule of 6-h light advance every 7 days for 4 or 8 weeks. The OPG expression was evaluated by histomorphometry, immunohistochemistry and western blot analysis. The mechanism by which BMAL1 affects OPG expression was investigated by chromatin immunoprecipitation and luciferase reporter assays. The phenotypes caused by BMAL1 knockout can be rescued by exogenous supplementation with OPG. RESULTS We demonstrate that the expressions of BMAL1 and OPG decreased in SMH patients. Circadian rhythm-disordered mice and Bmal1-/- mice exhibited decreased expression of OPG, reduced bone mass and bone size of mandibles. Our results revealed that BMAL1 bound directly to the Opg promoter and upregulated its expression, thus inhibiting osteoclast differentiation. BMAL1 deficiency increased osteoclast differentiation by downregulating OPG expression. In vitro, the enhancement effect of osteoclast differentiation caused by BMAL1 knockdown was significantly reversed by exogenous supplementation with OPG. Importantly, bone loss caused by BMAL1 knockout can be partially reversed by injecting OPG Intraperitoneally. CONCLUSIONS These results indicate that the circadian clock plays a critical role in the growth and development of mandible by regulating OPG expression, and present a potential therapeutic strategy to prevent SMH.
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Affiliation(s)
- Xin Zhou
- Department of StomatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Ran Yu
- Department of StomatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Yanlin Long
- Department of StomatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Jiajia Zhao
- Department of StomatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Shaoling Yu
- Department of StomatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Qingming Tang
- Department of StomatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Lili Chen
- Department of StomatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
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20
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Sugiyama T. RE: "VITAMIN D AND FRACTURE RISK IN EARLY CHILDHOOD: A CASE-CONTROL STUDY". Am J Epidemiol 2018; 187:893. [PMID: 29420691 DOI: 10.1093/aje/kwy013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Sugiyama
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
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