The association between Vitamin D and health outcomes in women: A review on the related evidence

Micro- and Macronutrients in Endometrial Cancer-From Metallomic Analysis to Improvements in Treatment Strategies

Endometrial cancer is reported to be one of the most prevalent cancers of the female reproductive organs worldwide, with increasing incidence and mortality rates over the past decade. Early diagnosis is critical for effective treatment. Recently, there has been a growing focus on the role of nutrition and micronutrient and macronutrient status in patients with gynecologic cancers, including endometrial cancer. In the following paper, we have conducted an in-depth narrative literature review with the aim of evaluating the results of metallomic studies specifically concerning the micro- and macronutrient status of patients with endometrial cancer. The main objective of the paper was to analyze the results regarding the nutritional status of endometrial cancer patients and describe the role of chosen elements in the onset and progression of endometrial carcinogenesis. Further, we have focused on the evaluation of the usage of the described elements in the potential treatment of the abovementioned cancer, as well as the possible prevention of cancer considering proper supplementation of chosen elements in healthy individuals. Calcium supplementation has been proposed to reduce the risk of endometrial cancer, although some studies offer conflicting evidence. Deficiencies in phosphorus, selenium, and zinc have been inversely associated with endometrial cancer risk, suggesting they may play a protective role, whereas excessive levels of iron, copper, and cadmium have been positively correlated with increased risk. However, the molecular mechanisms by which these elements affect endometrial carcinogenesis are not fully understood, and current findings are often contradictory. Further research is needed to clarify these relationships and to evaluate the potential of nutritional interventions for the prevention and treatment of endometrial cancer.

The effect of vitamin D and magnesium supplementation on clinical symptoms and serum inflammatory and oxidative stress markers in patients with COVID-19: a structured summary of a study protocol for a randomized controlled trial

OBJECTIVES

This study aims to evaluate the effect of vitamin D and magnesium supplementation on clinical symptoms and serum inflammatory and oxidative stress markers in patients with COVID-19.

TRIAL DESIGN

This study is a 4-arm randomized, double-blind, placebo-controlled clinical trial with a factorial design and the intervention period is 3 weeks.

PARTICIPANTS

This study is conducted on COVID-19 patients admitted to the Shahid Mohammadi hospital in Bandar Abbas, Iran, who are eligible for inclusion in the study. Patients are included only if they meet all of the following criteria: (1) aged from 18 to 65 years old; (2) confirmation of COVID-19 by RT-PCR test; (3) completing informed consent; (4) passing less than 48 h since the patient's hospitalization; (5) no skin or gastrointestinal allergies due to taking multivitamin supplements, vitamin D, and magnesium; and (6) having more than 30 breaths per minute and less than 93% oxygen saturation in room air and sea level. Patients are excluded if they have any of the following conditions: (1) pregnancy or lactation; (2) taking a daily multivitamin or take a vitamin D or magnesium supplement in the last month; (3) participating in other clinical trials; (4) renal failure or dialysis, severe liver disease or cirrhosis; (5) known diagnosis of hypercalcemia; (6) discharging from the hospital less than 24 h after the start of the intervention; (7) history of kidney stones in the last year; (8) transfer the patient to the ICU; (9) baseline vitamin D levels above 80 ng/ml; (10) baseline magnesium levels above 2.6 mg/dl; and (11) unwillingness of the patient to continue the study.

INTERVENTION AND COMPARATOR

Participants will be randomly allocated to one of the four following groups: (A) vitamin D (two 50,000 IU capsules at the beginning of the study, two 50,000 IU capsules on the 4th day, one 50,000 IU capsule on the 11th day, and one 50,000 IU capsule on the 17th day) and magnesium supplement (300 mg/day); (B) vitamin D capsule and magnesium placebo; (C) magnesium supplement and vitamin D placebo; and (D) vitamin D placebo and magnesium placebo.

MAIN OUTCOMES

The resolution of clinical symptoms (fever, dry cough, shortness of breath, headache, myalgia, oxygen saturation, and mortality rate) and interpretation of laboratory assays (CRP, MDA, TAC, WBC, neutrophils count, lymphocytes count, ratio of neutrophils to lymphocytes, levels of 25 hydroxyvitamin D and magnesium) will be assessed in the study groups.

RANDOMIZATION

A computer-generated block randomization list is used for randomization.

BLINDING (MASKING)

Investigators and patients are blinded to group allocation and treatment. A double-blind design is achieved using matched placebos.

NUMBERS TO BE RANDOMIZED (SAMPLE SIZE)

A total of 104 eligible patients are randomized into four groups of 26 subjects (1:1:1:1 allocation ratio).

DISCUSSION

With the rapid prevalence of COVID-19 in recent years, more attention has been paid to effective dietary supplementation to improve clinical symptoms and biochemical parameters in these patients. To our knowledge, this is the first study to evaluate the effects of vitamin D supplementation in combination with magnesium or alone with respect to this infectious disease. The findings of the current RCT will provide evidence regarding the effectiveness of dietary supplementation strategies to improve COVID-19 outcomes.

TRIAL STATUS

Ethical approval of the first version of the study protocol was obtained from the medical ethics committee of Hormozgan University of Medical Sciences, Bandar Abbas, Iran on May 30, 2021 (IR.HUMS.REC.1400.085). Currently, the recruitment phase is ongoing since August 23, 2021, and is anticipated to be complete by the end of August 2022.

TRIAL REGISTRATION

The study protocol was registered in the Iranian Registry of Clinical Trials ( https://www.irct.ir ; IRCT20210702051763N1) on August 14, 2021. https://www.irct.ir/trial/57413 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.

Racial Differences in 25-Hydroxy Vitamin D and Self-Reported Pain Severity in a Sample of Individuals Living with Non-Specific Chronic Low Back Pain

Introduction

Considerable evidence suggests that there are significant ethnic/racial differences in the experience of pain among individuals suffering from chronic musculoskeletal conditions. Additionally, low levels of vitamin D have been associated with pain severity. Further, vitamin D deficiency is more prevalent in Non-Hispanic Black (NHB) individuals compared to Non-Hispanic Whites (NHW).

Objective

The aim of this study was to investigate the associations among race, pain severity, and serum levels of vitamin D in a sample of patients with chronic low back pain (cLBP).

Methods

All study participants (n = 155) self-identified their race/ethnicity as either NHB or NHW. Blood samples were collected to assess circulating levels of serum 25- hydroxy vitamin D. Vitamin D levels were categorized as optimal (≥20 ng/mL), insufficient (12-19 ng/mL) or deficient (<12 ng/mL). Participants then self-reported their pain severity using the Brief Pain Inventory - Short Form.

Results

Results showed that a greater proportion of NHB versus NHW participants were categorized as Vitamin D deficient (χ 2 (2, N = 155) = 16.79, p < 0.001). An analysis of covariance (ANCOVA) revealed that NHBs reported significantly greater pain severity relative to NHWs (F(1150) = 6.45) p = 0.012. Further, self-reported pain severity significantly differed according to Vitamin D clinical categories (F(2150) = 4.19, p = 0.013). Participants with deficient vitamin D reported significantly greater pain severity in comparison to participants with optimal vitamin D (F(1101) = 7.28, p = 0.008).

Conclusion

The findings suggest that Vitamin D deficiency may be linked to greater pain severity in a sample of individuals with cLBP, especially for those who identify as NHB.

Oxidative stress in the pathophysiology of type 2 diabetes and related complications: Current therapeutics strategies and future perspectives

Type 2 diabetes (T2DM) is a persistent metabolic disorder rising rapidly worldwide. It is characterized by pancreatic insulin resistance and β-cell dysfunction. Hyperglycemia induced reactive oxygen species (ROS) production and oxidative stress are correlated with the pathogenesis and progression of this metabolic disease. To counteract the harmful effects of ROS, endogenous antioxidants of the body or exogenous antioxidants neutralise it and maintain bodily homeostasis. Under hyperglycemic conditions, the imbalance between the cellular antioxidant system and ROS production results in oxidative stress, which subsequently results in the development of diabetes. These ROS are produced in the endoplasmic reticulum, phagocytic cells and peroxisomes, with the mitochondrial electron transport chain (ETC) playing a pivotal role. The exacerbated ROS production can directly cause structural and functional modifications in proteins, lipids and nucleic acids. It also modulates several intracellular signaling pathways that lead to insulin resistance and impairment of β-cell function. In addition, the hyperglycemia-induced ROS production contributes to micro- and macro-vascular diabetic complications. Various in-vivo and in-vitro studies have demonstrated the anti-oxidative effects of natural products and their derived bioactive compounds. However, there is conflicting clinical evidence on the beneficial effects of these antioxidant therapies in diabetes prevention. This review article focused on the multifaceted role of oxidative stress caused by ROS overproduction in diabetes and related complications and possible antioxidative therapeutic strategies targeting ROS in this disease.

Response of Vitamin D after Magnesium Intervention in a Postmenopausal Population from the Province of Granada, Spain

Menopause is a stage of hormonal imbalance in women which, in addition to other physiopathological consequences, poses a risk of deficiency of key micronutrients such as magnesium and vitamin D. A study was made of the influence of a magnesium intervention upon vitamin D status in a postmenopausal population from the province of Granada (Spain). Fifty-two healthy postmenopausal women between 44–76 years of age were included. Two randomized groups—placebo and magnesium (500 mg/day)—were treated during eight weeks. Nutrient intake was assessed using questionnaires based on 72-h recall. Vitamin D was analyzed by liquid chromatography—tandem mass spectrometry. Baseline vitamin D proved deficient in over 80% of the subjects. The administration of magnesium resulted in significantly increased vitamin D levels in the intervention group versus the controls (p < 0.05). Magnesium supplementation improved vitamin D status in the studied postmenopausal women.

Is There a Difference in Serum Vitamin D Levels and Bone Mineral Density According to Body Mass Index in Young Adult Women?

Background

In the life cycle, bone mineral density (BMD) is the most optimal condition in the 20s. In Korea, vitamin D deficiency status is very serious in Korean women due to recent lack of activity, weight polarization, and inadequate nutritional intake. The purpose of this study was to compare serum vitamin D and BMD according to obesity status in Korean young adult women.

Methods

A total of 143 female college students participated in the research. Body fat and lean body status were analyzed using a body composition analyzer. Nutrient intakes of the subjects were assessed by 3-days food record method. The BMDs was measured by dual energy X-ray absorptiometry. The subjects were divided into normal weight group and obesity group on their body mass index.

Results

Obesity group showed significantly higher weight, body fat (%), and body fat (kg) than normal weight group and T-scores of lumbar-2 spines were significantly lower. Obesity group showed high triglyceride and low-density lipoprotein cholesterol levels and vitamin D levels were significantly lower. Physical fitness and activity status showed that sit and reach and sit up were significantly lower in obesity group. The intake of carbohydrates was higher in the obesity group than in the normal weight group, and the intake of vitamin C and vitamin D was significantly lower. Factors affecting serum vitamin D were analyzed as body fat (%), lumbar-2 T-score, triglyceride, and carbohydrate intake.

Conclusions

Obese women need more effort to manage their serum vitamin D status and balanced nutrition to prevent bone loss.

The Correlation Between Serum Vitamin D Level and Total Antioxidant Capacity in Diabetic and Non-diabetic Subjects in Iran

BACKGROUND & OBJECTIVE

Increase in intraand extracellular glucose levels can cause oxidative stress, and theprolonged imbalance between prooxidants and antioxidantscan lead to cell damage and the associated complications in patients with diabetes. Vitamin D acts as a strong antioxidant in the body and several studies emphasized on its important role to preventoxidative stress in prediabeticand diabetic subjects. The current study aimed at determining and comparingthe total antioxidant capacity (TAC) in individuals with hemoglobin A1c(HbA1c) below and above 6.5%, and its correlation with vitamin D levels.

METHODS

The current cross sectional study was conducted on a total of 107patients with diabetes (HbA1c >6.5%) and 107 non-diabetic subjects (HbA1c<6.5%)referred toRassoolAkram Hospital, Tehran, Iranfrom2015 to 2016, as the sample population. The two groups were compared regarding their TAC and vitamin D serum levels and the association between vitamin D concentration and TAC was evaluated.

RESULTS

Age and body mass index (BMI)were significantly higher in patients with diabetes,comparedwiththe serum levels of vitamin D and TAC (P<0.001 for both). Both TAC and vitamin D levels were significantly lower in the group with diabetesand a weak significant correlation was observedbetween the two factors (r=0.2, P=0.003). In multivariate regression model, the duration of diabetes was also significantly associated with TAC level (beta coefficient=-0.82, P <0.001).

CONCLUSION

The low serum levels of TAC and vitamin D in patients with diabetescould be indicative of oxidative stress in the presence of high blood glucose levels. Supplementation of vitamin D in patients with diabetes might be effective to control thenegative impacts of the disease and decreasecells' exposure to oxidative environment in prediabetes.

Prevalence and Predictors of Hypovitaminosis D Among Female University Students in Tabuk, Saudi Arabia

BACKGROUND

A high hypovitaminosis D prevalence has repeatedly been reported in Middle Eastern countries. Previous data regarding the vitamin D status of young women in Saudi Arabia and the related hypovitaminosis D risk factors are scarce, so this research assessed hypovitaminosis D prevalence and its risk factors among apparently healthy female university students in Tabuk, Saudi Arabia.

METHODS

This cross-sectional research used a convenience sample of healthy female students (n = 180) aged between 19 and 25 years in May 2016. Information was gathered on the participants' sociodemographics, health, lifestyle, dietary intakes, anthropometry, and serum 25-hydroxyvitamin D (25(OH)D), and a logistic regression analysis was performed to assess hypovitaminosis D risk factors.

RESULTS

The sample's hypovitaminosis D prevalence (25(OH)D <30 ng/mL) was 80.6%. The main determinants of hypovitaminosis D were as follows: urban residence (odds ratio [OR] = 6.54; 95% confidence interval [CI], 2.74-5.63), rare sun exposure (OR = 6.14; 95% CI, 2.15-17.55), and insufficient vitamin D intake (OR = 2.50; 95% CI, 1.07-5.81).

CONCLUSIONS

The findings emphasize that despite plentiful sunshine, Saudi Arabia and the Middle East face a vitamin D deficiency epidemic. Vitamin D status must therefore be assessed at the national level so that strategies aimed at boosting vitamin D levels can be instigated.

Role of Vitamin D on glycemic control and oxidative stress in type 2 diabetes mellitus

Background:

Vitamin D deficiency may play a key role in the development of impaired glucose tolerance, type 2 diabetes mellitus (T2DM), and metabolic syndrome. Several studies have shown that Vitamin D has an antioxidant property. We aimed to investigate 25-hydroxy Vitamin D (25[OH]D) levels in patients with T2DM and in nondiabetic healthy controls and to ascertain the impact of 25(OH)D levels on glycemic control and oxidative stress in T2DM patients.

Materials and Methods:

Thirty male patients with T2DM and twenty age- and socioeconomic status-matched male healthy controls were included in the study. Fasting and postprandial blood sugar and glycated hemoglobin (HbA1c) were measured. Enzyme activity of superoxide dismutase (SOD) and glutathione peroxidase (GPx) was determined by spectrophotometric assay, and serum levels of 25(OH)D were measured using radioimmunoassay.

Results:

Serum Vitamin D levels were significantly lower in patients with T2DM than healthy controls (P = 0.015). There was a significantly lower GPx activity in patients with T2DM than controls (P = 0.048), but the difference in SOD activity did not reach statistical significance. There was a significant negative correlation between serum Vitamin D levels and HbA1c (P = 0.016), but no statistical correlation was shown between serum Vitamin D levels and GPx and SOD.

Conclusion:

We conclude that low level of Vitamin D might play a significant role in T2DM pathogenesis. Hence, Vitamin D supplementation may improve glycemic control and oxidative stress in T2DM.