Vitamin D: The "sunshine" vitamin

A review of vitamin D deficiency and vitamin D receptor polymorphisms in endocrine-related disorders

The endocrine system is a complex network of glands that produce and release hormones that regulate various physiological processes. In the past few decades, the human skin has been identified as an important peripheral endocrine organ that is the main site for the synthesis of vitamin D through exposure to sunlight. Mutations in downstream vitamin D-related gene pathways are associated with disease development. The vitamin D receptor (VDR) gene, which regulates the pleiotropic effects of vitamin D, has been extensively studied in adult populations. Several studies have reported the prevalence of vitamin D deficiency in children and adolescents. With changes in socioeconomic status and lifestyle, vitamin D-deficient individuals are prone to developing the disease at a young age. However, geographical and racial differences affect the association between VDR gene polymorphisms and vitamin D endocrine disorders, explaining the nonconsensus effects of polymorphisms and their association with disease development across populations. In this review, we discuss the connection between the vitamin D endocrine system and polymorphisms in the gene encoding VDR in children and adolescents, focusing on its effects on growth, puberty, insulin resistance, and the immune system.

Modelling the influence of vitamin D and probiotic supplementation on the microbiome and immune response

The intestinal microbiota play a critical role in human health and disease, maintaining metabolic and immune/inflammatory health, synthesizing essential vitamins and amino acids and maintaining intestinal barrier integrity. The aim of this paper is to develop a mathematical model to describe the complex interactions between the microbiota, vitamin D/vitamin D receptor (VDR) pathway, epithelial barrier and immune response in order to understand better the effects of supplementation with probiotics and vitamin D. This is motivated by emerging data indicating the beneficial effects of vitamin D and probiotics individually and when combined. We propose a system of ordinary differential equations determining the time evolution of intestinal bacterial populations, concentration of the VDR:1,25(OH)$_{2}$D complex in epithelial and immune cells, the epithelial barrier and the immune response. The model shows that administration of probiotics and/or vitamin D upregulates the VDR complex, which enhances barrier function and protects against intestinal inflammation. The model also suggests co-supplementation to be superior to individual supplements. We explore the effects of inflammation on the populations of commensal and pathogenic bacteria and the vitamin D/VDR pathway and discuss the value of gathering additional experimental data motivated by the modelling insights.

The Impact and Efficacy of Vitamin D Fortification

Vitamin D deficiency is a global health issue linked to various chronic diseases and overall mortality. It primarily arises from insufficient sunlight exposure, compounded by dietary limitations. Vitamin D fortification of commonly consumed foods has emerged as a viable public health intervention to address this deficiency. This review evaluates the impact of vitamin D food fortification on serum levels, intake, and health outcomes and explores the stability, bio-accessibility, bioavailability, and cost-effectiveness of such interventions. A comprehensive literature search was conducted in PubMed and Google Scholar, focusing on studies from 2015 to 2024. The criteria included primary research on healthy adults that addressed the effects of vitamin D fortification on health, intake, and serum levels, as well as the fortification's stability, bio-accessibility, bioavailability, and cost-effectiveness. Studies were extracted and analyzed according to PRISMA guidelines. The review included 31 studies from diverse geographic locations, revealing that fortifying dairy products, cereals, fats, oils, and other food items effectively increased serum 25-hydroxyvitamin D levels. The fortification methods varied, with vitamin D3 showing superior efficacy over vitamin D2. Encapsulation techniques improved stability and bioavailability. Fortifying staple foods like milk and eggs proved cost-effective compared with pharmaceutical interventions. Vitamin D food fortification significantly enhances serum levels and intake, with dairy and cereals being the most frequently fortified. Standardized fortification guidelines are essential to ensure safety and efficacy. Ongoing evaluation and region-specific policies are crucial for effectively optimizing fortification strategies and addressing vitamin D deficiency.

The interplay of immunity and growth: a case of combined variable immunodeficiency and growth hormone deficiency

Introduction

Common variable immunodeficiency (CVID) is one of the more common immunodeficiencies seen in clinical practice with a complex disease pathology; while growth hormone deficiency (GHD) is a disorder characterized by complete or relative absence of the human growth hormone.

Case presentation

This case report presents a 13-year-old female patient with a long history of recurrent respiratory tract and ear infections, along with a notable failure to hit her developmental milestones early in the second decade of her life. The diagnosis was based on a thorough investigation of serum immunoglobulins for CVID and a GH stimulation test for GHD. For these, the patient was placed on a tailored regimen of IVIGs, somatropin therapy, and antibiotics for the recurrent infections.

Case discussion

CVID patients characteristically present with recurrent respiratory and ear infections, showing a marked decrease in immunity. Often diagnosed in childhood, GHD typically presents as growth failure along with developmental delays in dentition. There has been a notable rise in the coexistence of immunodeficiency syndromes and endocrinopathies studied in the past few decades. The case highlights and discusses the complex underlying pathology at play that links the two conditions to each other, while also excluding the various differentials.

Conclusion

The report highlights the various challenges faced by both clinicians and patients when dealing with dual health conditions that may have a relatively nonspecific presentation. Some of which include the diagnostic difficulties, financial strains on the patient leading to poor follow-up, and in the long-term, the development of various complications. This emphasizes the importance of early disease diagnosis and strict management protocols for the said disease, for the overall betterment of the patient's quality of life.

Role of Bile Acid Receptors in the Development and Function of Diabetic Nephropathy

Diabetic nephropathy (DN) is a prevalent microvascular complication that occurs often in individuals with diabetes. It significantly raises the mortality rate of affected patients. Therefore, there is an urgent need to identify therapeutic targets for controlling and preventing the occurrence and development of DN. Bile acids (BAs) are now recognized as intricate metabolic integrators and signaling molecules. The activation of BAs has great promise as a therapeutic approach for preventing DN, renal damage caused by obesity, and nephrosclerosis. The nuclear receptors (NRs), farnesoid X receptor (FXR), pregnane X receptor (PXR), vitamin D receptor (VDR); and the G protein-coupled BA receptor, Takeda G-protein-coupled receptor 5 (TGR5) have important functions in controlling lipid, glucose, and energy metabolism, inflammation, as well as drug metabolism and detoxification. Over the past 10 years, there has been advancement in comprehending the biology and processes of BA receptors in the kidney, as well as in the creation of targeted BA receptor agonists. In this review, we discuss the role of BA receptors, FXR, PXR, VDR, and TGR5 in DN and their role in renal physiology, as well as the development and application of agonists that activate BA receptors for the treatment of kidney diseases.

Cord Blood 25-Hydroxyvitamin D Level is Correlated with a Risk for Atopic Dermatitis: Systematic Review and Meta-Analysis

Although Indonesia is located in an equatorial region with adequate year-round sun exposure, the prevalence of 25-hydroxyvitamin D (25[OH]D) deficiency is as high as 90%. Mothers are especially vulnerable to deficiencies due to changes in their gastrointestinal system. Previous studies have reported a correlation between the 25[OH]D status of mothers with atopic dermatitis (AD) and their offspring. However, studies investigating maternal cord blood 25[OH]D levels and the incidence of AD have yielded controversial results due to its variability. As such, this systematic review and meta-analysis aimed to evaluate the correlation between maternal cord blood 25[OH]D levels and the risk for AD. In accordance with Preferred Reporting System for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, Cochrane Library and ScienceDirect databases were searched for relevant observational studies and a meta-analysis was performed to obtain odds ratios (OR) and corresponding 95% confidence intervals (CI). Nine studies were included in the qualitative synthesis, five of which were included in the quantitative synthesis. Meta-analysis revealed that cord blood 25[OH]D levels < 50 nmol/L were associated with a 60% higher risk for the development of AD (OR = 1.60; 95% CI: 1.15, 2.22; I2 = 0%; P < 0.05). However, qualitative synthesis revealed a variety of cord blood 25[OH]D measurements and different methods of diagnosing AD in each study. Based on the current analysis, maternal cord blood 25[OH]D levels were significantly correlated with the risk for AD. Therefore, studies investigating 25[OH]D supplementation in pregnant women and its efficacy in decreasing the risk for AD are needed, especially in tropical and equatorial countries. This study also serves as a proof of concept that cord blood 25[OH]D levels can be used as a more affordable predictive parameter for AD.

Association between vitamin D deficiency and serum lipid levels in a group of Romanian patients

Background and aims

Vitamin D deficiency is widespread across the globe. Numerous reports have linked vitamin D deficiency to certain non-skeletal diseases such as cardiovascular diseases. According to recent studies, there is evidence indicating a possible link between 25-hydroxyvitamin D deficiency and dyslipidemia. The main aim of this study is to investigate the relationship between vitamin D levels and lipid profile and to identify people who may benefit from vitamin D supplementation.

Methods

In this observational study, a total of 154 patients were included, 98 women and 56 men, aged between 19 and 82 years, in which serum vitamin D levels, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) and blood sugar were analyzed.

Results

The serum levels of vitamin D showed some differences, being lower in patients with dyslipidemia, with a positive correlation between vitamin D levels and total cholesterol (F ratio = 7.3247, p=0.008), and also with LDL cholesterol (F ratio = 5.0023, p=0.027). The HDL-C fraction and triglycerides showed no significant correlation with the serum levels of vitamin D. Further on, we divided the patients according to the fraction that had pathological values and compared the levels of vitamin D between these categories. We observed that the lowest levels of vitamin D were present in patients with all lipid parameters modified (HIGH-TC/LOW-HDL/HIGH-LDL/HIGH-TG), and also the highest levels of low HDL-C and high LDL-C.

Conclusion

Our research provides additional evidence to the unfavorable lipid profile found in people with vitamin D deficiency.

Unraveling colorectal cancer prevention: The vitamin D - gut flora - immune system nexus

Colorectal cancer (CRC) is one of the most common cancers diagnosed in the world. Although environmental and genetic factors play a major role in the pathogenesis of CRC, extensive research has suggested that vitamin D may play a pivotal role in the development of CRC. Vitamin D, primarily obtained through sunlight exposure, dietary sources, and supplements, has long been recognized for its essential functions in maintaining health, including immune regulation. This article delves into the intricate relationship between vitamin D, the immune system, gut flora, and the prevention of CRC. It presents a synthesis of epidemiological data, experimental studies, and clinical trials, highlighting the mechanisms by which vitamin D influences immune cell function, cytokine production, and inflammation. By enhancing the immune system’s surveillance and anti-tumor activity, vitamin D may offer a promising avenue for CRC prevention. Furthermore, this comprehensive review delves into the prospective clinical applications of vitamin D supplementation and delineates the forthcoming avenues of research in this dynamic domain. Additionally, the paper tentatively outlines a spectrum of prophylactic impacts of vitamin D on CRC, emphasizing its significant potential in reducing CRC risk through shedding light on its mechanisms, encompassing antineoplastic mechanisms, influences on the immune system, and modulation of the gut microbiome.

Unraveling colorectal cancer prevention: The vitamin D - gut flora - immune system nexus

Colorectal cancer (CRC) is one of the most common cancers diagnosed in the world. Although environmental and genetic factors play a major role in the pathogenesis of CRC, extensive research has suggested that vitamin D may play a pivotal role in the development of CRC. Vitamin D, primarily obtained through sunlight exposure, dietary sources, and supplements, has long been recognized for its essential functions in maintaining health, including immune regulation. This article delves into the intricate relationship between vitamin D, the immune system, gut flora, and the prevention of CRC. It presents a synthesis of epidemiological data, experimental studies, and clinical trials, highlighting the mechanisms by which vitamin D influences immune cell function, cytokine production, and inflammation. By enhancing the immune system's surveillance and anti-tumor activity, vitamin D may offer a promising avenue for CRC prevention. Furthermore, this comprehensive review delves into the prospective clinical applications of vitamin D supplementation and delineates the forthcoming avenues of research in this dynamic domain. Additionally, the paper tentatively outlines a spectrum of prophylactic impacts of vitamin D on CRC, emphasizing its significant potential in reducing CRC risk through shedding light on its mechanisms, encompassing antineoplastic mechanisms, influences on the immune system, and modulation of the gut microbiome.

Exploring the Impact of Vitamin D Supplementation on Metabolic Syndrome Variables in Postmenopausal Women: A Comprehensive Review

Metabolic syndrome poses a significant health concern, particularly among postmenopausal women who are vulnerable to its adverse effects. Emerging evidence suggests a potential role of vitamin D in mitigating metabolic syndrome risk factors, prompting interest in its supplementation as a therapeutic intervention. This comprehensive review examines the impact of vitamin D supplementation on metabolic syndrome variables in postmenopausal women. Through a systematic synthesis of existing literature, we assess the evidence supporting the beneficial effects of vitamin D on insulin sensitivity, lipid profiles, and inflammation markers in this population. While findings suggest potential benefits, uncertainties remain regarding optimal dosage and duration of supplementation. Implications for clinical practice underscore the importance of assessing vitamin D status and considering supplementation as part of a comprehensive approach to metabolic health management. Furthermore, public health initiatives promoting adequate vitamin D intake may help mitigate the prevalence of metabolic syndrome and associated complications. However, further research is warranted to elucidate the underlying mechanisms, establish optimal supplementation protocols, and explore potential interactions with other nutrients or medications. Long-term randomized controlled trials are needed to evaluate the sustained effects of vitamin D supplementation on metabolic health outcomes in postmenopausal women.

Vitamin D Deficiency in Professional Football Players during Competitive Season of Italian First Division (Serie A)

BACKGROUND

Data in the literature have demonstrated the crucial role that vitamin D plays in the human organism, and recent studies also emphasize this essential role of vitamin D in athletes. Indeed, vitamin D acts on the skeletal muscles and plays a fundamental role in numerous physiological processes involved in immune function. Many factors such as sun exposure, skin tone, body mass index and chronic illness affect vitamin D levels. The aim of the study is to evaluate vitamin D levels in professional football players in Italy and investigate the variations in vitamin D values in footballers who train at different latitudes.

METHODS

The study performed is a retrospective observational study analyzing 25-OH vitamin D values in professional football players of the Italian First Division (Serie A). Two teams during the competitive season were selected: team A (latitude of 41° N in southern Italy) and team B (latitude of 45° N in northern Italy). Three time periods were identified and were classified as follows: the first quarter (May, June, July, and August), the second quarter (September, October, November, and December) and the third quarter (January, February, March, and April). The purpose of this was to study the average values of vitamin D during the year corresponding to different levels of sunlight exposure. Each athlete was subjected to at least one sampling during the three quarters of the competitive season.

RESULTS

Both vitamin D insufficiency (10.1%) and overt deficiency (1.93%) were found in Italian Serie A players. Insufficient vitamin D values are between 20 ng/mL and 29 ng/mL and overt deficiency values <20 ng/mL. At the same time, the data demonstrated a significant variation in vitamin D values depending on the period of the competitive season and the latitude of the cities of the two teams. In detail, there was no significant difference in the first quarter, while there was a significant increase in vitamin D values in team B in the second and third quarter, at p < 0.01 and p < 0.05, respectively.

CONCLUSIONS

Latitude and seasons have a significant impact on vitamin D levels. Therefore, it is essential to measure vitamin D in professional football players, especially during the spring and winter months, so as to monitor changes in levels in relation to the season and latitude and evaluate any supplements. Further studies should be performed to evaluate the relationship between vitamin D deficiency and football players' athletic performance.

The Non-conventional Effects of Hypovitaminosis D: A Pandemic Even in Sunlight-Rich Countries

The synthesis and absorption of Vitamin D play crucial roles in numerous bodily functions, yet deficiencies persist due to factors like insufficient sunlight exposure and dietary inadequacy. Research underscores the significance of lifestyle elements such as diet, sun exposure, and physical activity in maintaining optimal Vitamin D levels. Strategies aimed at tackling deficiencies emphasize supplementation alongside lifestyle adjustments, especially in regions with abundant sunlight like the Middle East and North Africa (MENA). Despite the abundance of sunshine in the Arab world, there remains a prevalent issue of Vitamin D deficiency. This problem arises from various factors, including cultural practices such as traditional clothing covering most skin areas, which limit sun exposure, and environmental factors like air pollution that reduce UV penetration. Dietary habits and lifestyle choices also contribute to this deficiency. Dealing with the ongoing pandemic requires a focused effort to enhance awareness. While some individuals may recognize common diseases caused by Vitamin D deficiency, such as rickets and osteomalacia, many remain unaware of the broader health risks associated with the condition, including non-skeletal manifestations. Additionally, there is a lack of understanding regarding the numerous hidden benefits of this hormone. Therefore, prioritizing educational initiatives that delve into these aspects is essential to effectively combat the current health crisis. This literature review aims to report both skeletal and extraskeletal consequences of hypovitaminosis and briefly discuss the cause of paradoxical vitamin D deficiency in sunny regions like the MENA. This was done by reviewing pertinent articles published between January 2000 and January 2024, sourced from databases such as PubMed, UpToDate, Scopus, and CINAHL, focusing exclusively on English language literature and using keywords such as "Vitamin D deficiency" and "Extraskeletal manifestations."

Vitamin D Deficiency in Patients With Low-Energy Hip Fractures in Accordance With the Mediterranean Paradox

Introduction Vitamin D deficiency (VDD) is considered one of the leading causes of poor bone quality. It may also be related to severe muscular weakness, especially in the elderly, which leads to frequent falls. Thus, VDD might be associated with fragility fractures of the hip, wrist, and spine in this age category. In this cross-sectional study, our goal was to present vitamin D levels in an elderly Mediterranean population with hip fractures and to assess whether its levels are related to the incidence or prevention of such injuries. Methods Between January and December 2021, 140 patients aged 65 years or older were hospitalized in our department with a fracture involving the hip joint. Serum calcium and vitamin D level control was performed upon admission, as well as recording whether anti-osteoporosis medication had been prescribed. Only patients with low-energy fractures were included, whereas oncologic patients and those with high-energy trauma were excluded. Results Thirty-eight men and 102 women, with a mean age of 83.12 and 84.88 years, respectively, participated in our study. Intertrochanteric fractures were the most common injuries (50.72%). Low vitamin D levels (<30 ng/mL) were observed in 132 patients (94.28%). A bone density scan during the last year had been conducted by only seven patients (5%), whereas in 136 patients (97.14%), no anti-osteoporotic medication was given. Conclusion There is an excessive percentage of aged patients with hip fractures in Greece, demonstrating a significant vitamin D insufficiency despite the high annual frequency of sunny days in this Mediterranean region. Presumably, most of these patients neither perform the routine bone density scan nor do they take any kind of preventive pharmaceutical treatment, which might reveal devaluation of osteoporosis from this age group due to contingent comorbidities.

COVID-19 and Comorbidities: What Has Been Unveiled by Metabolomics?

The COVID-19 pandemic has brought about diverse impacts on the global population. Individuals with comorbidities were more susceptible to the severe symptoms caused by the virus. Within the crisis scenario, metabolomics represents a potential area of science capable of providing relevant information for understanding the metabolic pathways associated with the intricate interaction between the viral disease and previous comorbidities. This work aims to provide a comprehensive description of the scientific production pertaining to metabolomics within the specific context of COVID-19 and comorbidities, while highlighting promising areas for exploration by those interested in the subject. In this review, we highlighted the studies of metabolomics that indicated a variety of metabolites associated with comorbidities and COVID-19. Furthermore, we observed that the understanding of the metabolic processes involved between comorbidities and COVID-19 is limited due to the urgent need to report disease outcomes in individuals with comorbidities. The overlap of two or more comorbidities associated with the severity of COVID-19 hinders the comprehension of the significance of each condition. Most identified studies are observational, with a restricted number of patients, due to challenges in sample collection amidst the emergent situation.

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.

The association between vitamin D deficiency and the clinical outcomes of hospitalized COVID-19 patients

Background

Vitamin D deficiency is an emerging public health problem that affects more than one billion people worldwide. Vitamin D has been shown to be effective in preventing and reducing the severity of viral respiratory diseases, including influenza. However, the role of vitamin D in COVID-19 infection remains controversial. This study aimed to analyze the association of vitamin D deficiency on the clinical outcome of hospitalized COVID-19 patients.

Methods

A prospective cohort study was conducted among hospitalized COVID-19 patients at two COVID-19 referral hospitals in Indonesia from October 2021 until February 2022.

Results

The median serum 25(OH)D level in 191 hospitalized COVID-19 patients was 13.6 [IQR=10.98] ng/mL. The serum 25(OH)D levels were significantly lower among COVID-19 patients with vitamin D deficiency who had cardiovascular disease (p-value=0.04), the use of a ventilator (p-value=0.004), more severe COVID-19 cases (p-value=0.047), and mortality (p-value=0.002). Furthermore, serum 25(OH)D levels were significantly different between patients with mild and severe COVID-19 cases (p-value=0.019). Serum 25(OH)D levels in moderate and severe COVID-19 cases were significantly different (p-value=0.031). Lower serum 25(OH)D levels were significantly associated with an increased number of comorbidities (p-value=0.03), the severity of COVID-19 (p-value=0.002), and the use of mechanical ventilation (p-value=0.032). Mortality was found in 7.3% of patients with deficient vitamin D levels. However, patients with either sufficient or insufficient vitamin D levels did not develop mortality.

Conclusions

COVID-19 patients with vitamin D deficiency were significantly associated with having cardiovascular disease, mortality, more severe COVID-19 cases, and the used of mechanical ventilation. Lower serum 25(OH)D levels were associated with an increased number of comorbidities, COVID-19 severity, and the use of mechanical-ventilation. Thus, we suggest hospitalized COVID-19 patients to reach a sufficient vitamin D status to improve the clinical outcome of the disease.

Study on Vitamin D Levels in 30 to 40-Year-Old Females With Low Back Pain

BACKGROUND

Vitamin D is associated with many skeletal-related processes in the body. A major health problem concerning decreased quality of life is chronic low back pain (LBP). Many studies have proved that chronic pain improves with Vitamin D supplementation. This study aimed to explore the correlation between vitamin D levels and the occurrence of LBP in women aged 30 to 40.

MATERIALS AND METHODS

A case-control study was taken up at PK Das Institute of Medical Sciences wherein 50 cases (women aged 30-34 years who had chronic LBP >3 months) and 50 age-matched controls were included. Frequencies of Vitamin D deficiency, inadequacy, and sufficiency were studied. The t-test for examining statistical significance was employed to compare means. Keeping a 95% confidence interval (p<0.05), the odds ratio was calculated.

RESULTS

Vitamin D deficiency diagnosed when Vitamin D level is <20ng/mL was found in 74% of cases and 48% of controls. Vitamin D levels were not found to be statistically different between cases and controls. The odds ratio was found to be 3.083 (p=0.009), showing that participants with LBP are more expected to be deficient in Vitamin D compared to those without LBP.

CONCLUSIONS

Although a higher frequency of Vitamin D deficiency was found in cases compared to controls, the mean value of Vitamin D levels was not found to be statistically different amongst cases and controls. A significant Odds ratio establishes a positive association between LBP and Vitamin D deficiency. The reason could be due to most people being restricted indoors due to COVID-19 restrictions. It is essential to standardize the biochemical analysis of Vitamin D and establish appropriate Vitamin D level ranges specifically tailored for the Indian population.

Correlation Between a Deficiency of D3 Levels and the Development of Allergic Rhinitis

<b>Background and Objective:</b> Allergic rhinitis (AR) is a common disorder characterized by sneezing, runny nose, nasal congestion and lacrimation, which negatively affects the quality of life to a large extent. The study aimed to find a link between the effect of vitamin D3 levels on Immunoglobulin (IgE) levels in patients with allergic AR. <b>Materials and Methods:</b> This study included 30 patients with AR, with ages ranging from 18 to 35, of both sexes. For vitamin D levels, <u>></u>30 ng/mL is considered sufficient and <u><</u>20 ng/mL is a deficiency. The second group includes 30 people with adequate levels of vitamin D3 as a control group. All results were analyzed statistically by ANOVA, in addition to using the regression coefficient test to test the extent of the effect of D3 on the development of allergic rhinitis at a significant level of p<u><</u>0.05 using the SPSS program 24. <b>Results:</b> The results showed a significant decrease in the levels of vitamin D3 in the serum of the AR patients compared with the control group and a substantial increase in the levels of IgE in the serum of the AR patients compared with the control group at a significant level of p<u><</u>0.05. Additionally, the results showed in the regression coefficient an inverse and significant effect of vitamin D3 concentration on serum IgE levels, which is significant in terms of the p-value, which appeared equal to 0.010. By observing the value of the R² coefficient of determination, it is clear that a change in the concentration of vitamin D3 causes 58% of the changes in IgE levels. <b>Conclusion:</b> Through linear regression correlation, an inverse linear relationship emerged linking low vitamin D3 levels to increased IgE levels with an effect rate of 58%.

Clinical Efficacy of Nutritional Supplements in Atopic Dermatitis: Systematic Review

BACKGROUND

Atopic dermatitis (AD), also known as eczema, is a chronic inflammatory skin condition that presents with symptoms of intense pruritus, dryness, and erythema. Dissatisfaction with first-line therapies for AD, the desire to avoid steroids, and the extreme cost of effective biologics have created a demand for alternative treatment options such as oral vitamins and nutritional supplements.

OBJECTIVE

The purpose of this review was to assess the effectiveness of oral nutritional supplements, pre- and probiotics, and vitamin deficiencies and supplements on AD symptomology and clinical course.

METHODS

We searched Scopus, PubMed, and MEDLINE (Ovid interface) for English-language articles published between 1993 and 2023. The final search was conducted on June 22, 2023. The search terms comprised the following: "(Atopic Dermatitis or Atopic Eczema) AND (supplement OR vitamin OR mineral OR micronutrients OR Fish Oil OR Omega Fatty Acid OR Probiotics OR Prebiotics OR apple cider vinegar OR collagen OR herbal OR fiber)."

RESULTS

A total of 18 studies-3 (17%) evaluating vitamins, 4 (22%) evaluating herbal medicine compounds, 2 (11%) evaluating single-ingredient nutritional supplements, and 9 (50%) evaluating pre- and probiotics-involving 881 patients were included in this review.

CONCLUSIONS

Overall, there is weak evidence to support any one nutritional supplement intervention for the alleviation of AD symptoms. Multiple trials (4/18, 22%) showed promise for supplements such as Zemaphyte, kefir, and freeze-dried whey with Cuscuta campestris Yuncker extract. The most evidence was found on the effectiveness of probiotics on the clinical course of AD. Lactiplantibacillus plantarum, Ligilactobacillus salivarius, and Lactobacillus acidophilus specifically showed evidence of efficacy and safety across multiple studies (6/18, 33%). However, larger, more extensive randomized controlled trials are needed to determine the true effectiveness of these supplements on the broader population.

TRIAL REGISTRATION

PROSPERO CRD42023470596; https://tinyurl.com/4a9477u7.

Promising role of Vitamin D and plant metabolites against COVID-19: Clinical trials review

Vitamin D possesses immunomodulatory qualities and is protective against respiratory infections. Additionally, it strengthens adaptive and cellular immunity and boosts the expression of genes involved in oxidation. Experts suggested taking vitamin D supplements to avoid and treat viral infection and also COVID-19, on the other hand, since the beginning of time, the use of plants as medicines have been vital to human wellbeing. The WHO estimates that 80 % of people worldwide use plants or herbs for therapeutic purposes. Secondary metabolites from medicinal plants are thought to be useful in lowering infections from pathogenic microorganisms due to their ability to inhibit viral protein and enzyme activity by binding with them. As a result, this manuscript seeks to describe the role of vitamin D and probable plant metabolites that have antiviral activities and may be complementary to the alternative strategy against COVID-19 in a single manuscript through reviewing various case studies.

Modulatory role of vitamins A, B3, C, D, and E on skin health, immunity, microbiome, and diseases

Disruption of the skin barrier and immunity has been associated with several skin diseases, namely atopic dermatitis (AD), psoriasis, and acne. Resident and non-resident immune cells and the barrier system of the skin are integral to innate immunity. Recent advances in understanding skin microbiota have opened the scope of further understanding the various communications between these microbiota and skin immune cells. Vitamins, being one of the important micronutrients, have been reported to exert antioxidant, anti-inflammatory, and anti-microbial effects. The immunomodulatory action of vitamins can halt the progression of skin diseases, and thus, understanding the immuno-pharmacology of these vitamins, especially for skin diseases can pave the way for their therapeutic potential. At the same time, molecular and cellular markers modulated with these vitamins and their derivatives need to be explored. The present review is focused on significant vitamins (vitamins A, B3, C, D, and E) consumed as nutritional supplements to discuss the outcomes and scope of studies related to skin immunity, health, and diseases.

Utilizing logistic regression to compare risk factors in disease modeling with imbalanced data: a case study in vitamin D and cancer incidence

Imbalanced data, a common challenge encountered in statistical analyses of clinical trial datasets and disease modeling, refers to the scenario where one class significantly outnumbers the other in a binary classification problem. This imbalance can lead to biased model performance, favoring the majority class, and affecting the understanding of the relative importance of predictive variables. Despite its prevalence, the existing literature lacks comprehensive studies that elucidate methodologies to handle imbalanced data effectively. In this study, we discuss the binary logistic model and its limitations when dealing with imbalanced data, as model performance tends to be biased towards the majority class. We propose a novel approach to addressing imbalanced data and apply it to publicly available data from the VITAL trial, a large-scale clinical trial that examines the effects of vitamin D and Omega-3 fatty acid to investigate the relationship between vitamin D and cancer incidence in sub-populations based on race/ethnicity and demographic factors such as body mass index (BMI), age, and sex. Our results demonstrate a significant improvement in model performance after our undersampling method is applied to the data set with respect to cancer incidence prediction. Both epidemiological and laboratory studies have suggested that vitamin D may lower the occurrence and death rate of cancer, but inconsistent and conflicting findings have been reported due to the difficulty of conducting large-scale clinical trials. We also utilize logistic regression within each ethnic sub-population to determine the impact of demographic factors on cancer incidence, with a particular focus on the role of vitamin D. This study provides a framework for using classification models to understand relative variable importance when dealing with imbalanced data.

A comparative absorption study of sucrosomial® orodispersible vitamin D3 supplementation vs. a reference chewable tablet and soft gel capsule vitamin D3 in improving circulatory 25(OH)D levels in healthy adults with vitamin D deficiency-Results from a prospective randomized clinical trial

Background

Vitamin D (Vit D) deficiency (VDD), associated with diverse health conditions, is commonly treated with Vit D3 supplements. However, the gastrointestinal (GI) absorption of Vit D3 in different formulations has not been well studied.

Objective

We aimed to compare the absorption of an innovative phospholipids-sucrester matrix biodelivery vehicle-based (sucrosomial®) orodispersible Vit D3 preparation against a reference chewable tablet and soft gel capsule (SGC) Vit D3 formulations in Vit D-deficient healthy adults.

Methods

In study 1, 25 subjects were randomized to receive a weekly single dose of 200,000 IU of sucrosomial® Vit D3 (n = 12) or chewable tablet Vit D3 (n = 13) for 3 weeks. In study 2, 20 subjects were randomized to receive a single dose of 200,000 IU every other week of sucrosomial® Vit D3 (n = 10) or SGC Vit D3 (n = 10) for 6 weeks. Circulatory 25-hydroxyvitamin D3 [25(OH)D] levels were reassessed after 2, 3, and 6 weeks in study 1 and after 4 and 6 weeks in study 2.

Results

In study 1, after 2 weeks, circulatory 25(OH)D levels increased significantly in both Vit D3 treatment groups (p < 0.0001) but improved markedly in the sucrosomial® Vit D3 group, with no further considerable change after 3 and 6 weeks in both groups. Overall, at all three follow-ups, sucrosomial® Vit D3 treatment achieved significantly higher and sustained 25(OH)D levels (p < 0.001). In study 2, after 4 weeks, both Vit D3 treatment groups showed significant improvement in circulatory 25(OH)D levels (p < 0.0001) but substantially higher in the sucrosomial® group with statistically significant differences between the two treatment groups (p = 0.02). At the 6-week follow-up, only subjects in the sucrosomial® Vit D3 group showed a further increase in circulatory 25(OH)D levels (p = 0.049), but no further significant changes in the levels of the SGC Vit D3 group (p = 0.062), showing a statistically significant difference between the two treatment groups (p = 0.002). The Vit D3 treatment was well tolerated by all participants, and no treatment-emergent effects or serious adverse events were reported.

Conclusion

Our results suggest that the sucrosomial® Vit D3 preparation absorbs efficiently in the GI system, achieving adequately higher and sustained circulatory Vit D levels in VDD, and thus can effectively contribute to the body protection against VDD-associated health conditions.

Clinical trial registration

clinicaltrials.gov, identifier: NCT05706259.

Vitamin D Levels in Children During Winter and the Relationship Between Sunscreen and Sun Protection Behaviors

INTRODUCTION

Sunlight is the major source of vitamin D, thus, the use of sunscreens could result in vitamin D insufficiency or deficiency.

OBJECTIVES

Our study aimed to assess serum vitamin D levels in healthy children aged 0-18 years in the winter season and determine the association between sunscreen use and sun protection behaviors on vitamin D status.

METHODS

The demographic data, clothing style, skin type, history of sunburn, history of visiting seaside towns in summer, sun protection behaviors including sunscreen use, wearing sunglasses and hats, and further detailed information about sunscreen use were recorded. Vitamin D status was assessed by measuring blood levels of total 25(OH)D during winter.

RESULTS

Three hundred seventy-six children (172 boys and 204 girls) with a mean age of 128.38±56.39 months were enrolled. The mean serum level of 25(OH)D was 15.32±8.64 ng/mL. The mean values of vitamin D were associated with age, sex, traditional clothing style, having a sunburn history, and sunscreen use (P < 0.05). Adolescents and girls had vitamin D deficiency and inadequacy more than younger children and boys (P < 0.05). Sunscreen use in the adequacy group was lower than in the inadequacy and deficiency groups (P = 0.001). There was no significant difference between vitamin D status according to the sunscreen details (sun protection factor, product source, season, and body areas) (P > 0.05).

CONCLUSIONS

Sunscreen use appears to reduce vitamin D levels measured in winter. Children, especially girls and adolescents, should be exposed to sufficient sunlight to maintain normal serum vitamin D levels. Vitamin D supplementation should be given to children, especially during winter.

Recent developments and emerging trends in dietary vitamin D sources and biological conversion

This review elaborates on biochemical characteristics, in vivo metabolism, biological conversion through UV irradiation, as well as dietary fortification of vitamin D. Recent innovations in vitamin D utilization, including nanoencapsulation, direct or indirect addition, emulsion, ultrasound, microwave processing, CRISPR-Cas9 genome editing, as well as UV photoconversion, were summarized. Mushrooms, eggs, yeasts, as well as seafood, such as Barramundi and Atlantic salmon, were typical representatives of original natural food materials for vitamin D bioconversion in relevant research. The critical session thereof referred to the 295 nm UV-B irradiation triggering biological fortification of vitamin D2 and vitamin D3, which occurred in ergosterol from mushrooms, and cholesterol from egg yolk, respectively. The schematic biosynthesis of vitamin D precursors in yeasts regulated miscellaneous enzymes were clearly demonstrated. These summarized pathways played a role as a theoretical primer for vitamin D bioconversion when the UV irradiation technique is concerned. Besides, tomatoes had become the latest potential vitamin D sources after genetic modification. The safety consideration for vitamin D fortified functional food was discussed either. Further research is required to fill the gap of investigating optimized factors like types of eggs, meat, and grain, boarder range of wavelength, and dosage in UV irradiation. Vitamin D has a great potential market in the field of functional food development.

Nutritional factors associated with aggression

Although the vast majority of patients in forensic psychiatry are treated using pharmacological agents, clinical and ethical concerns about their use have led to the consideration of alternative strategies to reduce aggression that is common in forensic psychiatric settings. One non-invasive and benign biologically-based treatment approach involves nutrition. This article provides a mini-review of the recent evidence on four salient nutritional factors associated with aggressive behavior, namely omega-3 fatty acids, vitamin D, magnesium, and zinc. The current evidence base indicates that lower omega-3 levels are associated with increased aggression. Although research on vitamin D and zinc in relation to aggressive behavior is more limited, there is initial evidence that they are negatively associated with aggression in healthy participants and in psychiatric samples. The relationship between magnesium and aggression varies depending on how magnesium is assessed. Findings from experimental trials reveal that nutritional intervention in the form of omega-3 supplementation has the potential to serve as an effective mode of treatment, with effects that can last beyond the intervention period. There is also support for the utility of nutrition to improve our understanding of how social processes are linked to aggression. In light of the nascent, but promising findings on the role of nutritional factors on aggressive behavior, directions for future research are discussed.

Within-limb variation in skin pigmentation does not influence cutaneous vasodilation

Ultraviolet radiation (UVR) exposure acutely reduces nitric oxide (NO)-dependent cutaneous vasodilation. In addition, increased constitutive skin melanin is associated with attenuated NO-dependent cutaneous vasodilation. However, the impact of within-limb variation in skin melanization, associated with seasonal UVR exposure, on NO-dependent cutaneous vasodilation is unknown. We investigated the effect of within-limb variation in skin melanin on NO-dependent cutaneous vasodilation. Intradermal microdialysis fibers were placed in the inner-upper arm, ventral forearm, and dorsal forearm of seven adults (33 ± 14 yr; 4 M/3 F) with constitutively light skin pigmentation. Melanin-index (M-index; an index of skin pigmentation), measured via reflectance spectrophotometry, confirmed differences in sun exposure among sites. A standardized local heating (42°C) protocol induced cutaneous vasodilation. After attaining a stable elevated blood flow plateau, 15 mM NG-nitro-l-arginine methyl ester (l-NAME; NO synthase inhibitor) was infused to quantify the NO contribution. Laser-Doppler flowmetry (LDF) measured red cell flux and cutaneous vascular conductance (CVC = LDF/mean arterial pressure) and was normalized to maximal (%CVCmax; 28 mM sodium nitroprusside + 43°C local heating). Dorsal forearm M-index was higher [50.5 ± 11.8 au (arbitrary units)] compared with the ventral forearm (37.5 ± 7.4 au; P ≤ 0.03) and upper arm (30.0 ± 4.0 au; P ≤ 0.001) M-index. Cutaneous vasodilation responses to local heating were not different among sites (P ≥ 0.12). Importantly, neither the magnitude of the local heating plateau (dorsal: 85 ± 21%; ventral: 70 ± 21%; upper: 87 ± 15%; P ≥ 0.16) nor the NO-mediated component of that response (dorsal: 59 ± 15%; ventral: 54 ± 13%; upper: 55 ± 11%; P ≥ 0.79) was different among sites. These data suggest that within-limb differences in skin pigmentation secondary to seasonal UVR exposure do not alter NO-dependent cutaneous vasodilation.NEW & NOTEWORTHY Locally derived endothelial nitric oxide (NO) contributes to the full expression of cutaneous vasodilation responses. Acute ultraviolet radiation (UVR) exposure attenuates NO-mediated vasodilation of the cutaneous microvasculature. Our findings suggest that in constitutively lightly pigmented skin, variation in skin melanin due to seasonal exposure to UVR does not alter the NO contribution to cutaneous vasodilation. Seasonal UVR exposure does not impact the NO-mediated cutaneous microvascular function.

Nutrient Adequacy in Endurance Athletes

Proper nutrition is critical for optimal performance in endurance athletes. However, it is unclear if endurance athletes are meeting all their energy and nutrient needs. We examined if endurance athletes are meeting their nutritional requirements and if this differed by sex. Ninety-five endurance athletes (n = 95; 50.5% men; 34.9 ± 12.9 y) participated in the study. Dietary intake was evaluated using the 24 h dietary recall method. Energy and nutrient intakes were calculated using the ESHA Food Processor Diet Analysis Software and compared against reference nutrient intakes. Endurance athletes did not consume the recommended amount of energy (76.8% of athletes), carbohydrates (95.8%), linoleic acid (75.8%), α-linolenic acid (ALA) (77.9%), eicosatetraenoic and docosahexaenoic acid (96.8%), dietary fiber (49.5%), vitamins D (93.7%), E (71.6%), and K (54.7%), folate (54.7%), pantothenic acid (70.5%), biotin (83.2%), manganese (58.9%), magnesium (56.8%), chromium (91.6%), molybdenum (93.7%), choline (85.3%), and potassium (56.8%), and consumed too much saturated fat (50.5%) and sodium (94.7%) than recommended. Fisher's Exact test showed that the requirements for dietary fiber (70.8% vs. 27.7%), ALA (87.5% vs. 68.1%), and total water (70.8% vs. 44.7%) were not met by more men versus women (p < 0.05). The needs for protein (70.2% vs. 25%) and vitamin B12 (46.8% vs. 22.9%) were not met by more women compared to men (p < 0.05). These findings need to be confirmed by a larger study.

Assessment of Serum Vitamin D Status and Its Associated Health Problem Among Children With Protein Energy Malnutrition: A Cross-Sectional Research Study in Central Rural India

Background Protein energy malnutrition (PEM) is a condition that results from inadequate intake of both macronutrients and micronutrients, leading to a lack of energy. The condition can manifest quickly or gradually, ranging from mild to severe. It predominantly affects children in low-income countries who do not receive enough calories and proteins. In developed nations, it is more prevalent among older individuals. PEM is more common in children as they consume less protein. In rare cases in developed countries, it may result from fad diets or a lack of knowledge about children's nutritional requirements, especially in cases of milk allergy. Vitamin D plays a critical role in bone growth and development by facilitating the absorption of calcium and phosphorus from food and supplements. Additionally, vitamin D has been linked to a reduced risk of infections, immune system disorders, diabetes, high blood pressure, and heart disease. Aims and objectives The primary objective of this study is to evaluate serum vitamin D levels and their relationship with health complications in children affected by PEM. The specific aim is to estimate the serum vitamin D levels in children with PEM who exhibit symptoms of being underweight, stunting (limited linear growth), wasting (abrupt weight loss), or edematous malnutrition (kwashiorkor). Additionally, this study seeks to analyze the correlation between serum vitamin D levels and the associated health problems in children with PEM. Materials and methods This cross-sectional study employed an analytical research approach. A total of 45 children with PEM participated in the study. Data were collected through a venipuncture method, and serum vitamin D level was assessed using an enhanced chemiluminescence method. The children's pain was assessed using a visual analogue scale, and developmental delay was evaluated using an assessment chart. Data were analyzed using SPSS Version 22 (IBM Corp., Armonk, NY). Results The study's results indicate that a considerable proportion of children, specifically 46.6%, were deficient in vitamin D, whereas 42.2% exhibited insufficiency and only 11.2% had sufficient levels of the vitamin. Pain assessment using the visual analogue scale classification revealed that 15.6% of children reported no pain, 60% reported mild pain, and 24.4% reported moderate pain. The mean and standard deviation of vitamin D levels correlated with developmental delay were 4.22±0.212 and 5.34±0.438, respectively. Similarly, the mean and standard deviation of vitamin D levels correlated with pain were 4.22±0.212 and 2.98±0.489, respectively. The Pearson correlation coefficient for vitamin D levels and pain was 0.010, with a significant level of 0.989, significantly lower than the tabulated value at a 5% significance level. Conclusion Based on the study's findings, it was concluded that children who suffer from PEM are at a risk of developing vitamin D deficiency, which can result in adverse health outcomes, including developmental delay and pain.

COVID-19 infection and metabolic comorbidities: Mitigating role of nutritional sufficiency and drug - nutraceutical combinations of vitamin D

The vulnerability of human health is amplified in recent times with global increase in non-communicable diseases (due to lifestyle changes and environmental insults) and infectious diseases (caused by newer pathogens and drug-resistance strains). Clinical management of diseases is further complicated by disease severity caused by other comorbid factors. Drug-based therapy may not be the sole approach, particularly in scenarios like the COVID-19 pandemic, where there is no specific drug against SARS-CoV-2. Nutritional interventions are significant in armouring human populations in disease prevention, and as adjunctive therapy for disease alleviation. Amidst ongoing clinical trials to determine the efficacy of Vit. D against infections and associated complications, this review examines the pleiotropic benefits of nutritional adequacy of vitamin D (Vit. D) in combating viral infections (COVID-19), its severity and complications due to co-morbidities (obesity, diabetes, stroke and Kawasaki disease), based on research findings and clinical studies. Supplements of Vit. D in combination with other nutrients, and drugs, are suggested as promising preventive-health and adjunct-treatment strategies in the clinical management of viral infections with metabolic comorbidities.

Vitamin D status in healthy Italian school-age children: a single-center cross-sectional study

BACKGROUND

Vitamin D is involved in calcium homeostasis and bone metabolism, although its extra-skeletal actions are also well-known. Low serum 25(OH)D levels are common both in adults and children worldwide.

METHODS

The purpose of this cross-sectional study was to determine the distribution of 25(OH)D levels in a cohort of healthy Italian school-age children, aged 5-10 years, in relationship to determinants of vitamin D deficiency such as season, BMI, gender, age and ethnicity.

RESULTS

The mean serum 25(OH) D level was 28.2 ng/mL; the prevalence of 25(OH)D sufficiency (> 30 ng/mL), insufficiency (20-30 ng/mL), deficiency (10-20 ng/mL) and severe deficiency (< 10 ng/mL) was 36%, 37%, 21% and 6% of the study-group population, respectively. The lower serum 25(OH)D values were observed during winter (21.6 ng/mL) and spring (22.9 ng/mL), as compared to summer (46.7 ng/mL) (p < 0.001). Higher BMI z-scores were associated with lower 25(OH)D level while no statistical difference was observed as related to gender and age groups.

CONCLUSIONS

Healthy Italian schoolchildren show low 25(OH)D levels, particularly during winter and spring time. Seasonality, ethnicity and overweight/obesity were confirmed to influence the vitamin D status, thus indicating the need for effective initiatives to support adequate vitamin D status in this population group.

Predictors of Maternal Knowledge, Attitude, and Practices Toward Vitamin D Supplements in Saudi Infants and Toddlers

OBJECTIVES

To assess maternal knowledge, attitude, and practices toward vitamin D supplements in Saudi infants and toddlers. In addition, we investigated predictors of maternal knowledge, attitude, and practices related to vitamin D supplements.

METHODS

Cross-sectional data of 156 Saudi infants and toddlers were collected from mothers via online survey. Data collected included sociodemographics, maternal knowledge, attitude, and practices toward vitamin D supplements.

RESULTS

Our data show a limited maternal knowledge toward vitamin D. Maternal knowledge and attitude as well as maternal knowledge and practices were not correlated. Spearman correlation between maternal attitude and practices was positively low (r_s= 0.47). Child's age and family monthly income predicted maternal knowledge towards vitamin D. Maternal age and maternal education level predicted maternal attitude toward vitamin D supplements. Order of the child, maternal age, and maternal employment status predicted maternal practices toward vitamin D supplements in infant and toddlers.

CONCLUSIONS FOR PRACTICE

Maternal knowledge, attitude, and practices toward vitamin D supplements can be predicted by certain sociodemographic characteristics. Interventions that focus on improving maternal knowledge, attitude, and practices toward vitamin D supplements are urgently needed.

Association of food allergy in children with vitamin D insufficiency: a systematic review and meta-analysis

Current literature regarding the association of vitamin D insufficiency and food allergy is contradicting. The purpose of our study was to investigate this association. This is a systematic review and meta-analysis according to the PRISMA statement. PubMeD and Scopus databases were systematically searched for case-control studies investigating the association between pediatric food allergy and vitamin D insufficiency. Our search yielded 806 studies. Ten final studies were considered eligible for qualitative and quantitative analysis. Children with vitamin D insufficiency were found to have 68% more probability to present a food allergy episode (adjusted pooled OR: 1.68, 95% CI [1.25-2.27], p-value: 0.001). In their second year of life they were 4 times more likely to present a food allergy episode (adjusted pooled OR: 4.06, 95% CI [1.93-8.56], p-value: < 0.001), and 56% more probable to develop food sensitization (OR: 1.56, 95% CI [1.15-2.11], p-value: < 0.004). Children in Australia with vitamin D insufficiency were almost 4 times more likely to develop egg sensitization (adjusted OR: 3.79, 95% CI [1.19-12.08], p-value: 0.024). Children with vitamin D insufficiency were almost twice as likely to have peanut sensitization (OR: 1.96, 95% CI [1.08-3.57], p-value: 0.028).  Conclusion: Decreased maternal vitamin D levels and infant vitamin D insufficiency appear to increase the incidence of food allergies, particularly in the second year of life. To confirm this association, multicenter longitudinal studies are required. What is Known: • In newborns and young children, vitamin D deficiency and insufficiency are prevalent. • The exact role of vitamin D in atopic diseases remains controversial. What is New: • Decreased maternal vitamin D levels and infant vitamin D insufficiency appear to increase the incidence of food allergies. This association is more evident in the second year of life.

Impact of Vitamin D Supplementation on the Clinical Outcomes and Epigenetic Markers in Patients with Acute Coronary Syndrome

Vitamin D has recently been found to influence the renin-angiotensin system (RAS); it can reduce the effects of renin-angiotensin system inhibitors (RASI) by decreasing plasma renin. This study examines the effect of vitamin D supplements on cardiac fibrosis markers, echocardiographic parameters, and epigenetic markers in patients with established acute coronary syndrome (ACS). It also looks at the incidence of vitamin D receptor (VDR) gene polymorphisms Apa I (rs7975232), Bsm I (rs1544410), Taq I (rs731236), and Fok I (rs2228570) and its association with the development of secondary major acute cardiovascular events (MACE) and heart failure (HF). A randomized controlled trial in which patients were divided into two groups was performed. Group 1 comprised of 125 ACS patients who received ACS standard therapy alone, while Group 2 consisted of 125 ACS patients who received ACS standard therapy plus vitamin D according to their vitamin D levels. Patients were monitored for 24 months to find subsequent MACE and HF. Vitamin D therapy for ACS patients resulted in a substantial decline in end systolic and end diastolic volumes (p = 0.0075 and 0.002, respectively), procollagen type III N-terminal peptide (PIIINP) and soluble ST2 levels (p = 0.007 and 0.001, respectively), as well as in ejection fraction and vitamin D level (p = 0.0001 and 0.008, respectively). In addition, vitamin D treatment was linked to a significant decline in the levels of noncoding RNA, such as mir361, lncRNA MEG3, and lncRNA Chaer (p = 2.9 × 10-4, 2.2 × 10-6, and 1.2 × 10-5, respectively). Furthermore, patients who suffered MACE had significantly higher levels of the Bsm I CC and Fok I GG genotypes (p = 4.8 × 10-4 and 0.003, respectively), while patients with HF had significantly higher levels of the Taq I AA genotype (p = 4.2 × 10-7). Supplementing ACS patients with vitamin D has been demonstrated to limit cardiac fibrosis and echocardiographic parameters, as well as epigenetic markers. Additionally, MACE and HF among ACS patients may be related to genetic variations among VDR gene polymorphisms.

Bone Health Status in Individuals with Amyotrophic Lateral Sclerosis: A Cross-Sectional Study on the Role of the Trabecular Bone Score and Its Implications in Neurorehabilitation

Background and Objectives: Osteoporosis is a metabolic skeletal disease resulting in low bone mass with increased bone fragility and susceptibility to fractures. May lead to rapid loss of bone mineral density (BMD) due to physical inactivity and reduced muscle contractions. Generally, the diagnosis of osteoporosis is made using dual X-ray absorptiometry (DXA), by measuring BMD and the trabecular bone score (TBS), which can be useful for detecting bone fragility and susceptibility to fractures. Therefore, the aim of this study was to investigate, using BMD and TBS, the bone health status in a sample of amyotrophic lateral sclerosis (ALS) inpatients attending neurorehabilitation. Materials and Methods: Thirty-nine patients were included in the study and underwent electrocardiogram and blood tests, including calcium and parathyroid hormone, as well as vitamin D dosage, and DXA. Results: We found that the TBS of patients with osteoporosis was lower than that of those ALS patients with osteopenia or normal bone status, both in the lumbar spine and femoral neck, although no statistical significance was reached. In addition, Spearman's correlation coefficient indicated a moderate correlation between TBS and lumbar spine BMD (r = -0.34) and a mild correlation between TBS and femoral neck BMD (r = -0.28). Conclusions: This study confirmed the hypothesis that ALS patients may exhibit deteriorated bone health with lower bone density and focused on the possible role of the TBS in the multidisciplinary approach to ALS.

Risk perception of sun exposure and knowledge of vitamin D among the healthcare providers in a high-risk country: a cross-sectional study

BACKGROUND

High levels of vitamin D deficiency are commonly reported even in regions with abundant sunshine. This necessitates a comprehensive understanding of the determinants that influence sun exposure practices. As the primary source of health-related knowledge for the general public, the attitude of the healthcare professionals towards sunlight and their awareness related to vitamin D deficiency can be critical in this regard.

METHODS

A cross-sectional survey was conducted among 2,242 physicians, intern doctors, and senior medical students in Bangladesh from October 2019 to February 2020. A pre-tested structured questionnaire (containing twelve close-ended questions) was used. The perceptions of health risks due to sun exposure, and basic knowledge of the physiological and epidemiological aspects of vitamin D deficiency were tested.

RESULTS

An overall negative attitude towards sunlight in the context of Bangladesh was highlighted - 68% participants thought regular sun exposure would be harmful or very harmful; 26% thought the level of UV radiation was very high; 44% recommended using sunscreen always; skin burns, heat stroke, and cancer were selected as potential consequences of regular sun exposure by 45%, 21%, and 30% respondents respectively. Overall knowledge regarding vitamin D deficiency appeared to be biased towards bone health; other symptoms and associated illnesses not having obvious link to Calcium-metabolism were identified much lesser frequently. Furthermore, 'sunrise to 10 am' was identified as the best time to get vitamin D by 69% participants; 60% believed < 30 min of weekly sun exposure would be sufficient for the Bangladeshi population; an only 33% identified that prevalence of vitamin D insufficiency in Bangladesh would be 50% or more. Taking vitamin D-rich food was suggested by more respondents over regular sun exposure (43% vs. 33%) as more effective remedial strategy to curb vitamin D deficiency in Bangladesh.

CONCLUSION

In addition to highlighting some crucial knowledge gaps, results from this study provides a comprehensive baseline dataset for knowledge and attitude regarding the public health aspects of vitamin D deficiency among the healthcare providers in Bangladesh, which would be generalizable to other countries with similar socio-demographic context, and will facilitate taking more effective policies worldwide.

Risk of major osteoporotic fractures among ultra-orthodox Jews

The Ultra-Orthodox Jewish population has behaviors that can influence the risk for osteoporotic fractures. We investigated whether this population is more prone to osteoporotic fractures than non-Orthodox Jewish. We did not find a significant difference in osteoporotic fracture rates between the two populations despite major differences in exposure to potential risk factors.

INTRODUCTION

The Ultra-Orthodox Jewish population is a conservative population with unique cultural behaviors such as modest clothing and specific dietary restrictions, which can influence bone density and risk for osteoporotic fractures. The aim of this study is to investigate whether the Ultra-Orthodox Jewish population is more prone to osteoporotic fractures than the non-Orthodox Jewish population.

METHODS

This retrospective cohort study utilized computerized records from Maccabi Health Service. Study population included patients 65 years and older without a history of osteoporotic fracture, who reside in regions of Ultra-Orthodox and non-Orthodox Jews. The primary outcome was the adjusted risk to osteoporotic fracture during 9 years of follow-up. Cox regression included patient characteristics and risk factors for osteoporosis.

RESULTS

A total of 115,134 patients were included in this study: 5397 patients residing in Ultra-Orthodox regions (51.0% female) and 109,737 patients residing in non-Orthodox regions (52.6% female). A total of 16,352 (14.2%) patients had an osteoporotic fracture during the study period. There was no significant difference in fracture rate between Ultra-Orthodox and non-Orthodox (14.3% vs. 14.2%, p = 0.827). Among Ultra-Orthodox and non-Orthodox females and males, there were no significant differences in fracture rates (19.1% vs. 19.1% p = 0.982 and 9.3% vs. 8.8% p = 0.311, respectively). The adjusted hazard risk for the Ultra-Orthodox Jews was 1.026, 95% CI: 0.95-1.11, p = 0.512.

CONCLUSION

We did not find a significant difference in the rate of osteoporotic fractures between Ultra-Orthodox and non-Orthodox populations despite major differences in exposure to potential risk factors. Results suggest that the perception of risk factors relevant for the religious communities should be re-evaluated.

Prevalence and risk factors for vitamin D insufficiency in 6-12-month-old infants: a cross-sectional study in Southern Thailand

BACKGROUND

Vitamin D is an essential micronutrient for bone mineralization and bone growth in children. There have been few studies to date of vitamin D status in infants aged 6-12 months in Southeast Asian countries.

AIM

To examine the prevalence of vitamin D insufficiency (VDI, including vitamin D deficiency) in healthy infants and the risk factors for VDI in southern Thailand.

METHODS

A cross-sectional study was carried out in 120 healthy infants aged 6-12 months and their mothers. Blood samples were obtained for measurement of serum calcium, phosphate, alkaline phosphatase, albumin, parathyroid hormone and 25-hydroxyvitamin D (25OHD) levels. The mothers were interviewed for their infants feeding intake, sunlight exposure, type of dress, and sunscreen use. Chi-square and t-test were used to compare between groups for categorical and continuous variables, respectively. Pearson correlation was used to identify the relationship between serum levels of 25OHD of the infants and other biochemical variables of the infants and serum levels of maternal 25OHD. Logistic regression analysis was used to identify the factors associated with vitamin D status.

RESULTS

The prevalence of VDI in our study infants was high at 28.3%, all of whom were mainly breastfed infants. Subgroup analysis of the mainly breastfed infants found that the risk factors for VDI were maternal VDI and a short duration of sunlight exposure. The serum 25OHD levels of the mainly breastfed infants were significantly positively correlated with the maternal serum 25OHD levels (r = 0.49, p-value < 0.01) and with sunlight exposure duration (r = 0.40, p-value < 0.01).

CONCLUSIONS

The prevalence of VDI was high in 6-12-month-old infants, particularly those who were mainly breastfed from VDI mothers, and who had short durations of sunlight exposure. As breast milk contains adequate amounts of most important vitamins and growth factors, breastfeeding is still encouraged for infants with 400 IU vitamin D daily supplementation to prevent VDI.

Association of Serum Vitamin D level and COVID-19 infection: A Case-control Study

BACKGROUND

Vitamin D is considered a potent modulator of the immune system, albeit its role in COVID-19 infection is a matter of debate. The present study aimed to estimate the association between serum vitamin D levels and COVID-19 among people in Qatar.

METHODS

This case-control study, approved by the Institutional Review Board of Primary Health Care Corporation (PHCC) Qatar, retrospectively evaluated the principal public healthcare sector population data repository retrieved from the cloud-based Electronic Health Record (EHR) software-Cerner, during April 2020-2021. The health records of all adult patients aged >18 years who had undergone the reverse transcription-polymerase chain reaction (RT-PCR) test and whose medical records had documented serum 25-hydroxyvitamin D [25 (OH)D] levels were analyzed.

RESULTS

A total of 924,173 EHRs were extracted, of which 62,451 EHR comprised of 16,446 (26.3%) COVID-19 patients and 46,005 (73.7%) negative-control group patients met the inclusion criteria. The odds ratio (OR) among different categories of vitamin D deficiency (VDD) revealed that people with mild/moderate VDD were 1.18 times (95% CI 1.126-1.258) and those with severe VDD were 1.90 times (95% CI 1.116-1.251) more likely to have COVID-19 infection when compared to the people with optimal serum vitamin D level. On applying multiple logistic regression, the odds of having COVID-19 infection were found to be 1.27 times (95% CI 1.184-1.371) higher among those with mild/moderate VDD and 1.32 times (95% CI 1.206-1.405) higher among those with severe VDD when compared to people with optimal vitamin D level (p < 0.001).

CONCLUSION

Our findings demonstrated a significant association between the suboptimal serum vitamin D level and COVID-19 infection. Further studies are required to determine the effects of VDD on the severity and outcomes of COVID-19 infections.

Characterization of various isomeric photoproducts of ergosterol and vitamin D2 generated by UV irradiation

Vitamin D2 is produced from its precursor ergosterol under the impact of ultraviolet (UV) light which is also commercially carried out to increase vitamin D2 contents in mushrooms (‘Novel Food’). However, this process is accompanied by the formation of various isomers that partly co-elute with the target compound and are currently difficult to analyze. For this reason, vitamin D2 and ergosterol were irradiated with the goal to generate and characterize various isomeric photoproducts with three analytical methods. High-performance liquid chromatography with ultraviolet detection (HPLC–UV) was accompanied by using a chiral detector (CD) which was serially linked with the UV detector. Applied for the first time in this research area, HPLC-CD chromatograms provided complementary information which was crucial for the identification of several co-elutions that would have been overlooked without this approach. Additional information was derived from gas chromatography with mass spectrometry analysis. Diagnostic fragment ions in the GC/MS spectra allowed to distinguish four classes of tri- (n = 2), tetra-, and pentacyclic isomer groups. Despite several drawbacks of each of the applied methods, the shared evaluation allowed to characterize more than ten isomeric photoproducts of vitamin D2 including previtamin D2, lumisterol2, tachysterol2,trans-vitamin D2 isomers, and two pentacyclic isomers (suprasterols2 I and II), which were isolated and characterized by proton magnetic resonance spectroscopy (1H NMR).

Vitamin D in the news: A call for clear public health messaging during Covid-19

Background: The public are increasingly reliant on the internet and media to access healthcare related information during the Covid-19 pandemic. Vitamin D is essential for musculoskeletal and immune health, with daily supplementation advised by public health bodies. Several studies assessing a possible link between vitamin D and Covid-19 severity have arrived at conflicting results and news articles have been rapidly disseminating such research to the public. There has been little focus on studying the quality of information available. Aim: To identify if online search interest in vitamin D increased with pandemic burden and analyse the accuracy of public health messaging relating to vitamin D in online news articles. Methods: Online search interest data for vitamin D was correlated with pandemic burden, defined as the number of Covid-19 deaths. Online news articles discussing vitamin D and Covid-19 were analysed using qualitative coding. Results: Online search interest for vitamin D increased as pandemic burden increased (p < 0.0001, Spearman's rank). Of the 72 articles identified, most (50%) offered a mixed opinion on the benefit of vitamin D in Covid-19. From articles making a recommendation for vitamin D supplementation, 23% of articles gave mixed messaging or advised against supplementation. 16% of articles recommended a dose which exceeded the safe limit of 4000 IU/day, risking toxicity. Conclusion: A significant number of articles provided mixed messaging or incorrectly advised supratherapeutic doses. This study highlights an opportunity for public health bodies to utilise the increased interest in vitamin D during the pandemic to raise awareness with accurate information.

The Frequency of Vitamin D and Calcium Deficiencies Among Women of Reproductive Age in Wadi Etba, Southern Region of Libya

Background

Vitamin D (VD) is the sunshine vitamin. Its deficiency is widely spread worldwide and is implicated in various health problems that have serious financial, mental, and physical health burdens. In Libya, it also has a high incidence as many studies have been conducted on this issue, but the exact situation of VD deficiency in the southern region of Libya remains unclear.

Aim 

The aim of this study is to investigate the frequency of VD deficiency and calcium status among females of reproductive age in Wadi Etba (located in the southern region of Libya).

Material and methods

This study included 622 females aged 20-40 years attending the Rural Hospital and Private Clinics in Wadi Etba for various health issues during the last five years. The study population was further subdivided into two age groups; 20-30 years and 31-40 years. VD and calcium were measured to determine the VD status among the study population.

Results

In general, 489 females had sub-optimal VD (<30 ng/mL), representing 78.6% of the total subjects. Normal VD levels were represented only by 133 subjects (21.4%). VD deficiency was represented by 354 subjects (57%) of the total subjects. A total of 232 (37%) subjects were VD-deficient females (18.3 ± 5.5 ng/ml), 122 subjects (20%) were considered poor (severe deficient, VD <10 ng/ml) represented with a mean serum VD of 8.2 ± 0.6. Furthermore, deficiency cases dominated the older age group. Regarding calcium (Ca⁺²) levels, 31% had lower than the normal range, 68% had normal range, and only 1% showed high Ca⁺² levels. On the other hand, there was no correlation between serum levels of VD and Ca⁺² levels.

Conclusion

VD deficiency has become a widespread condition in the southern region of Libya. Therefore, we recommended making lifestyle changes, including extending the exposure time to the sunlight radiation, fortifying foods and drinks with VD, and taking supplementary doses of VD to reduce the high incidence of VD deficiency.

Pleiotropic Effects of Vitamin D in Patients with Inflammatory Bowel Diseases

The multifaceted activity of vitamin D in patients with inflammatory bowel disease (IBD) presents a challenge for further research in this area. Vitamin D is involved in the regulation of bone mineral metabolism, it participates in the regulation of the immune system, and it is an underlying factor in the pathogenesis of IBD. Additionally, vitamin D affects Th1 and Th2 lymphocytes, influencing the release of cytokines and inhibiting tumor necrosis factor (TNF) expression and the wnt/β-catenin pathway. As far as IBDs are concerned, they are associated with microbiota dysbiosis, abnormal inflammatory response, and micronutrient deficiency, including vitamin D hypovitaminosis. In turn, the biological activity of active vitamin D is regulated by the vitamin D receptor (VDR) which is associated with several processes related to IBD. Therefore, in terms of research on vitamin D supplementation in IBD patients, it is essential to understand the metabolic pathways and genetic determinants of vitamin D, as well as to identify the environmental factors they are subject to, not only in view of osteoporosis prevention and therapy, but primarily concerning modulating the course and supplementation of IBD pharmacotherapy.

Photolyase Production and Current Applications: A Review

The photolyase family consists of flavoproteins with enzyme activity able to repair ultraviolet light radiation damage by photoreactivation. DNA damage by the formation of a cyclobutane pyrimidine dimer (CPD) and a pyrimidine-pyrimidone (6-4) photoproduct can lead to multiple affections such as cellular apoptosis and mutagenesis that can evolve into skin cancer. The development of integrated applications to prevent the negative effects of prolonged sunlight exposure, usually during outdoor activities, is imperative. This study presents the functions, characteristics, and types of photolyases, their therapeutic and cosmetic applications, and additionally explores some photolyase-producing microorganisms and drug delivery systems.

Evaluating Statin Tolerability in Historically Intolerant Patients After Correcting for Subclinical Hypothyroidism and Vitamin D Insufficiency

INTRODUCTION

Atherosclerotic cardiovascular disease (ASCVD) is the major cause of morbidity and mortality worldwide. Statins provide primary and secondary ASCVD prevention. Intolerance due to statin-associated myalgias reduces long-term adherence, thus muting potential benefits.

AIM

Our analysis sought to determine whether transition from a lipophilic statin to a water-soluble statin, or correction of subclinical hypothyroidism and/or vitamin D insufficiency/deficiency (metabolic abnormalities), improved statin tolerance.

METHODS

We performed a retrospective analysis of the data from patients referred to our lipid clinic because of statin intolerance. Patients intolerant to a lipophilic statin were switched to a water-soluble statin. Patients having vitamin D insufficiency/deficiency or subclinical hypothyroidism were re-challenged with a water-soluble statin (or lipophilic statin with minimal systemic exposure) after correction of the metabolic abnormality.

RESULTS

169 patients were statin intolerant. 86% (n = 145) were white and 48% (n = 81) were male. 82 of these patients had one or both metabolic abnormalities. The remaining patients (n = 87) had no metabolic abnormality, however, were unable to tolerate a lipophilic statin. 72% (n = 73) of eligible patients (n = 101), defined as those with a corrected metabolic abnormality or without a metabolic abnormality on a lipophilic statin, were able to tolerate a water-soluble statin or lipophilic statin with minimal systemic exposure. In addition, 75% (n = 127) of this total cohort met their LDL-C goal.

CONCLUSIONS

Our findings suggest that either correction of subclinical hypothyroidism and/or vitamin D insufficiency/deficiency or transition from a lipophilic statin to water-soluble statin (or lipophilic statin with minimal systemic exposure) improves statin tolerance.

Shelf-Life Prediction and Thermodynamic Properties of No Added Sugar Chocolate Spread Fortified with Multiple Micronutrients

The development of fortified healthy pleasant foods, in which saturated fats are replaced with unsaturated ones, poses a challenge for the food industry due to their susceptibility to oxidative rancidity, which decreases product shelf-life, causes the destruction of health-promoting molecules, and forms potentially toxic compounds. A comparative study applying the Arrhenius model was carried out to investigate the oxidative stability and predict the shelf-life of a newly developed no added sugar chocolate spread formulated with sunflower oil, and fortified with vitamin D, Mg, and Ca checked against two commercially available spreads: No Palm and a well-known commercially available product (RB). The results obtained from the accelerated shelf-life testing for peroxide value (PV) showed relatively higher activation energy (Ea, 14.48 kJ/mol K) for RB, whereas lower Ea (11.31–12.78 kJ/mol K) was obtained for No Palm and all the experimental spread chocolates. Q10 values were comparable (1.202–1.154), indicating a similar catalytic effect of the temperature upon the oxidation rate across all the investigated samples. The positive Gibbs free energies ranged from 75.014 to 83.550 kJ/mol and pointed out that the lipid oxidation reaction in the chocolate spread was an endergonic process. The predicted shelf-life at 293.15 K was 8.57 months (RB), 7 months (No Palm), and 6.8 months for all the experimental spreadable chocolate. However, the higher production of hydroperoxides was observed in chocolate fortified with magnesium-calcium carbonate nanoparticles and stored at 313.15 and 323.15 K, suggesting these particles may enhance lipid oxidation.

Characterization of methylation patterns associated with lifestyle factors and vitamin D supplementation in a healthy elderly cohort from Southwest Sweden

Numerous studies have shown that lifestyle factors, such as regular physical activity and vitamin D intake, may remarkably improve overall health and mental wellbeing. This is especially important in older adults whose vitamin D deficiency occurs with a high prevalence. This study aimed to examine the influence of lifestyle and vitamin D on global DNA methylation patterns in an elderly cohort in Southwest of Sweden. We also sought to examine the methylation levels of specific genes involved in vitamin D's molecular and metabolic activated pathways. We performed a genome wide methylation analysis, using Illumina Infinium DNA Methylation EPIC 850kBeadChip array, on 277 healthy individuals from Southwest Sweden at the age of 70–95. The study participants also answered queries on lifestyle, vitamin intake, heart medication, and estimated health. Vitamin D intake did not in general affect methylation patterns, which is in concert with other studies. However, when comparing the group of individuals taking vitamin supplements, including vitamin D, with those not taking supplements, a difference in methylation in the solute carrier family 25 (SCL25A24) gene was found. This confirms a previous finding, where changes in expression of SLC25A24 were associated with vitamin D treatment in human monocytes. The combination of vitamin D intake and high physical activity increased methylation of genes linked to regulation of vitamin D receptor pathway, the Wnt pathway and general cancer processes. To our knowledge, this is the first study detecting epigenetic markers associated with the combined effects of vitamin D supplementation and high physical activity. These results deserve to be further investigated in an extended, interventional study cohort, where also the levels of 25(OH)D₃ can be monitored.

The Role of Vitamin D in Stroke Prevention and the Effects of Its Supplementation for Post-Stroke Rehabilitation: A Narrative Review

Hypovitaminosis D is a serious public health problem, representing an independent factor in mortality among the general population. Vitamin D deficiency may affect up to one billion people worldwide. Recently, the potential association between vitamin D levels and stroke has gained increasing attention. Many studies suggest that maintaining normal serum vitamin D levels is associated with improvement of the cardiovascular system and a reduction in stroke risk. As a neurosteroid, vitamin D influences brain development and function and immunomodulation and affects brain neuroplasticity. It supports many processes that maintain homeostasis in the body. As stroke is the second most common cause of death worldwide, more studies are needed to confirm the positive effects of vitamin D supplementation, its dosage at different stages of the disease, method of determination, and effect on stroke onset and recovery. Many studies on stroke survivors indicate that serum vitamin D levels only offer insignificant benefits and are not beneficial to recovery. This review article aims to highlight recent publications that have examined the potential of vitamin D supplementation to improve rehabilitation outcomes in stroke survivors. Particular attention has been paid to stroke prevention.