Prevalence and predictors of vitamin D deficiency in healthy adults

Association of vitamin D with risk of warts: A retrospective and Mendelian randomization study

BACKGROUND

The clinical strategy of oral supplementation of Vitamin D (VD) as a preventive and therapeutic measure for warts needs further exploration.

METHODS

The clinical data of patients with skin diseases who visited the Children's Hospital affiliated with Chongqing Medical University from February 2018 to June 2024 were collected. The serum VD levels in patients with warts (common warts, flat warts, and plantar warts) and patients with other common skin diseases (atopic dermatitis, psoriasis, alopecia areata, vitiligo, and chronic urticaria) were compared. Two-sample bidirectional Mendelian randomization (MR) analysis was performed to investigate potential causal associations between VD and warts.

RESULTS

The average serum VD level of children with warts was 23.27 ± 7.07 ng/mL, which showed no statistically significant difference compared to children with other common skin diseases. The inverse variance weighted (IVW) method analysis indicated a positive causal relationship between VD and warts (Odds Ratio [OR] = 1.86, [95% CI: 1.19-2.92], p = 0.007). Sensitivity analysis did not show any indication of horizontal pleiotropy or heterogeneity. The MR-PRESSO method did not identify any outliers.

CONCLUSION

The levels of serum VD in children with warts do not significantly decrease compared to children with other common skin conditions. The evidence from the MR analysis indicates a positive causal relationship between VD and warts, suggesting caution in supplementing VD for children with warts who have normal or elevated serum VD levels. Further clinical studies are needed for validation in the future.

Considerations Regarding Vitamin D in Foot and Ankle Treatment and Surgery

Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with calcium (1 g/day) to promote bone healing. Although orthopedic F&A surgeons are frequently the first provider to detect the harbingers of osteoporosis by the occurrence of fragility fractures, this should trigger referral to the appropriate specialist for assessment and treatment. There is circumstantial evidence suggesting a role of hypovitaminosis D in bone marrow edema syndrome and possibly osteochondritis dissecans. There should be a low threshold for assessing vitamin D levels in such patients.

Incidence of Vitamin D Deficiency in Foot and Ankle Arthrodesis Nonunions

Background Vitamin D has been found to be crucial in musculoskeletal health. The role of vitamin D levels in orthopedic patients has become a growing area of interest given its negative impact on fracture healing which can contribute to the development of nonunion following surgery. We sought to investigate the incidence of hypovitaminosis D in a cohort of patients who experienced a nonunion following a foot and ankle arthrodesis procedure. Methodology Patients who underwent a major elective foot and ankle arthrodesis procedure and developed a nonunion were given the opportunity to obtain serum vitamin D levels. All vitamin D levels were reported from percutaneous venous blood samples and compared to our institution's range of accepted normal values (25-80 ng/mL). Results A total of 13 patients who developed a nonunion agreed to have a vitamin D level obtained, and 11 of 13 patients had a low vitamin D level (average = 14.6 ng/mL, range = 9-24 ng/mL). Five patients underwent revision arthrodesis after normalization of vitamin D levels, and four out of five patients went on to successful union. Conclusions Hypovitaminosis D may be a modifiable risk factor for nonunion following a major foot and ankle arthrodesis procedure. Orthopedic surgeons should consider vitamin D screening and supplementation in patients undergoing elective arthrodesis procedures.

No benefit of vitamin D supplementation on muscle function and health-related quality of life in primary cardiovascular prevention patients with statin-associated muscle symptoms: A randomized controlled trial

BACKGROUND

Statins are the leading lipid-lowering drugs, reducing blood cholesterol by controlling its synthesis. Side effects are linked to the use of statins, in particular statin-associated muscle symptoms (SAMS). Some data suggest that vitamin D supplementation could reduce SAMS.

OBJECTIVE

The purpose of this study was to evaluate the potential benefits of vitamin D supplementation in a randomized controlled trial.

METHODS

Men (n = 23) and women (n = 15) (50.5 ± 7.7 years [mean ± SD]) in primary cardiovascular prevention, self-reporting or not SAMS, were recruited. Following 2 months of statin withdrawal, patients were randomized to supplementation (vitamin D or placebo). After 1 month of supplementation, statins were reintroduced. Before and 2 months after drug reintroduction, muscle damage (creatine kinase and myoglobin) was measured. Force (F), endurance (E) and power (P) of the leg extensors (ext) and flexors (fle) and handgrip strength (FHG) were also measured with isokinetic and handheld dynamometers, respectively. The Short Form 36 Health Survey (SF-36) questionnaire and a visual analog scale (VAS) were administrated to assess participants' self-reported health-related quality of life and SAMS intensity, respectively. Repeated-measures analysis was used to investigate the effects of time, supplementation, and their interaction, according to the presence of SAMS.

RESULTS

Despite no change for objective measures, subjective measures worsened after reintroduction of statins, independent of supplementation (VAS, SF-36 mental component score, all p < 0.05). However, no interaction between time and supplementation according to the presence of SAMS was observed for any variables.

CONCLUSIONS

Vitamin D supplementation does not appear to mitigate SAMS.

Vitamin D-A New Therapeutic Target in the Management of Type 2 Diabetes Patients

Background: Vitamin D is a fat-soluble vitamin that prevents cardiovascular diseases and diabetes mellitus (DM). The present research aimed to study the impact of 25-hydroxyvitamin D (25(OH)D) level on the health status of patients with type 2 DM (T2DM) hospitalized in the "Pius Brînzeu" Emergency Clinical County University Hospital in Timisoara, Romania. Methods: The study retrospectively included 160 patients with T2DM who were clinically and biologically evaluated during hospitalization. Results: 13.1% of patients had optimal, 23.1% insufficient, and 63.8% deficient 25(OH)D values. Patients with 25(OH)D deficiency presented poorer glycemic control and were older, with higher weight, but had altered renal function, anemia, and lower iron values. Also, patients with associated neoplasia, diabetic neuropathy, cardiovascular disease (CVD), dementia, and grade 3 arterial hypertension (HTN) had lower values of 25(OH)D. An age > 55 years (sensitivity 69.9, specificity 82.5, AUROC 0.786, p < 0.001) and an HbA1c > 7.7% (sensitivity 89.3, specificity 92.9, AUROC 0.938, p < 0.001) predict 25(OH)D deficiency in T2DM patients. Conclusions: Vitamin D influences almost every system and organ in the body, so it should be a routine test for all patients with DM to correct the deficiency and prevent other diseases and complications.

Unveiling the potent effect of vitamin D: harnessing Nrf2/HO-1 signaling pathways as molecular targets to alleviate urban particulate matter-induced asthma inflammation

BACKGROUND

Asthma is the most common allergic disease characterized by an inflammatory response in the airways. Mechanismly, urban particulate matter (PM) is the most widely air pollutant associated with increased asthma morbidity and airway inflammation. Current research found that vitamin D is an essential vitamin with anti-inflammatory, antioxidant and other medical efficacy. Inadequate or deficient vitamin D often leads to the pathogenesis and stability of asthma. NGF exacerbates airway inflammation in asthma by promoting smooth muscle cell proliferation and inducing the Th2 immune response. Activation of the Nrf2/HO-1 signaling pathway can exert a protective effect on the inflammatory response in bronchial asthma. However, the specific mechanism of this pathway in PM-involved asthmatic airway smooth muscle cells remains unclear.

METHODS

Mice were sensitized and challenged with Ovalbumin (OVA) to establish an asthma model. They were then exposed to either PM, vitamin D or a combination of both, and inflammatory responses were observed. Including, acetylcholine stimulation at different concentrations measured airway hyperresponsiveness in mice. Bronchoalveolar lavage fluid (BALF) and serum were collected for TNF-α, IL-1β, IL-6, and Nerve growth factor (NGF) analysis. Additionally, lung tissues underwent histopathological examination to observe alveolar structure and inflammatory cell infiltration. Specific ELISA kits were utilized to determine the levels of the inflammatory factors TNF-α, IL-1β, IL-6, and Nerve growth factor (NGF). Nrf2/HO-1 signaling pathways were examined by western blot analysis. Meanwhile, we constructed a cell system with low HO-1 expression by lentiviral transfection of airway smooth muscle cells. The changes of Nrf2, HO-1, and NGF were observed after the treatment of OVA, PM, and Vit D were given.

RESULTS

The in vivo results showed that vitamin D significantly alleviated pathological changes in lung tissue of PM-exposed mice models. Mechanismly, vitamin D decreased substantial inflammatory cell infiltration in lung tissue, as well as the number of inflammatory cells in BALF. Furthermore, vitamin D reduced the heightened inflammatory factors including of TNF-α, IL-1β, IL-6, and NGF caused by PM exposure, and triggered the activity of nucleus Nrf2 and HO-1 in PM-exposed asthmatic mice. Notably, knockdown HO-1 weakens the Vitamin D- mediated inhibition to pollution toxicity in asthma. Importantly, in vitro experiments on OVA-stimulated mice airway smooth muscle cells, the results showed that OVA and PM, respectively, reduced Nrf2/HO-1 and increased NGF's expression, while vitamin D reversed the process. And in the HO-1 knockdown cell line of Lenti-si-HO-1 ASMCs, OVA and PM reduced Nrf2's expression, while HO-1 and NGF's expression were unchanged.

CONCLUSIONS

The above results demastrate that vitamin D downregulated the inflammatory response and the expression of NGF by regulating the Nrf2/HO-1 signaling pathways in airway smooth muscle cells, thereby showing potent anti-inflammatory activity in asthma.

Vitamin D/Bone Mineral Density and Triglyceride Paradoxes Seen in African Americans: A Cross-Sectional Study and Review of the Literature

Vitamin D is known to have a positive effect on bone health. Despite the greater frequency of vitamin D deficiency in African Americans (AA), they have a higher bone mineral density (BMD) compared to whites, demonstrating a disconnect between BMD and vitamin D levels in AA. Another intriguing relationship seen in AA is the triglyceride (TG) paradox, an unusual phenomenon in which a normal TG status is observed even when patients house conditions known to be characterized by high TG levels, such as Type II diabetes. To the best of our knowledge, no study has examined whether these two paradoxical relationships exist simultaneously in AA subjects with Type II diabetes. In this study, we compared levels of blood markers, including HbA1c, TG, and vitamin D, measured as serum 25-hydroxyvitamin D [25(OH)VD] µM/mL, [25(OH)VD]/TG, calcium, and BMD in AA (n = 56) and white (n = 26) subjects with Type II diabetes to see whether these relationships exist concurrently. We found that AA subjects had significantly lower TG and [25(OH)VD] levels and a significantly higher BMD status compared to white subjects, even when the ages, BMI, duration of diabetes, HbA1c, and calcium levels were similar between the two groups. This demonstrates that these two paradoxical relationships exist simultaneously in Type II diabetic AA subjects. In addition to these findings, we discuss the current hypotheses in the literature that attempt to explain why these two intriguing relationships exist. This review also discusses four novel hypotheses, such as altered circulating levels and the potential role of estrogen and hydrogen sulfide on BMD and HMG-CoA reductase as a possible contributor to the TG paradox in AA subjects. This manuscript demonstrates that there are still many unanswered questions regarding these two paradoxical relationships and further research is needed to determine why they exist and how they can be implemented to improve healthcare.

Medical nutrition therapy in patients receiving ECMO: Evidence-based guidance for clinical practice

Patients receiving extracorporeal membrane oxygenation (ECMO) inherit substantial disease-associated metabolic, endocrinologic, and immunologic modifications. Along with the technical components of ECMO, the aforementioned alterations may affect patients' needs and feasibility of adequate macronutrient and micronutrient supply and intake. Thus, patients receiving ECMO are at increased risk for iatrogenic malnutrition and require targeted individual medical nutrition therapy (MNT). However, specific recommendations for MNT in patients receiving ECMO are limited and, with some exceptions, based on an evidence base encompassing general patients who are critically ill. Consequently, clinician decision-making for MNT in patients receiving ECMO is unguided, which may further increase nutrition risk, culminating in iatrogenic malnutrition and ultimately affecting patient outcomes. The purpose of this article is to provide educational background and highlight specific points for MNT in adult patients receiving ECMO, which might serve as evidence-based guidance to develop institutional standard operating procedures and nutrition protocols for daily clinical practice.

Vitamin D Levels in Newly Diagnosed Breast Cancer Patients according to Tumor Sub-Types

Vitamin D is an important regulator of bone health. In addition, as a ligand for a nuclear receptor expressed in breast cancer cells, vitamin D exerts neoplasia modulating effects in breast cancer. However, despite extensive investigations, associations of vitamin D levels with breast cancer patient characteristics and disease sub-types are conflicting. A retrospective review of medical records of consecutive breast cancer patients treated and followed in a single cancer center was undertaken. All patients with 25-hydroxyvitamin D (25-OHD, the circulating form of vitamin D) measurements available within 3 months of their diagnosis and before the start of any systemic treatment were included. Characteristics of patients and tumors with sufficient levels of 25-OHD were compared with those of patients with 25-OHD insufficiency. Two hundred ninety-two patients were included in the study. Almost two-thirds of the patients were 25-OHD insufficient, defined as having 25-OHD levels below 75 nmol/L. Compared with the group of patients who were 25-OHD sufficient, patients with 25-OHD insufficiency were younger and more often obese. Tumors of patients with 25-OHD insufficiency were more often ductal, of higher grade, and ER negative. 25-OHD insufficiency is prevalent in breast cancer patients and even more prevalent in younger and obese patients. 25-OHD insufficiency is associated with cancers that have aggressive characteristics, including higher grade and ER negativity.

Serum 25-Hydroxyvitamin D is Associated With Bone Microarchitecture and Strength in a Multiracial Cohort of Young Adults

PURPOSE

To determine whether 25-hydroxyvitamin D (25-OH D) levels are associated with bone outcomes in a multiracial cohort of young adults.

METHODS

This cross-sectional study included 165 participants (83 men, 82 women, 18-30 years of age) who self-identified as Asian, Black, or White. We measured bone microarchitecture and strength of the distal radius and tibia using high-resolution peripheral quantitative computed tomography. We used linear regression to estimate the association between 25-OH D (ng/mL) and bone measurements, adjusting for race, sex, age, weight, height, calcium intake, physical activity, and season.

RESULTS

A total of 43.6% of participants were 25-OH D deficient (<20 ng/mL) with greater prevalence in Asian (38.9%) and Black (43.1%) compared with White (18.0%) participants (P < 0.001). At the distal radius, 25-OH D was positively associated with cortical area, trabecular density, cortical thickness, cortical porosity, and failure load (P < 0.05 for all). At the distal tibia, higher 25-OH D was associated with higher cortical area, trabecular density, trabecular number, failure load, and lower trabecular separation and cortical density (P < 0.05 for all). After multivariable adjustment, those with 25-OH D deficiency had generally worse bone microarchitecture than those with 25-OH D sufficiency. Black individuals had largely more favorable bone outcomes than Asian and White individuals, despite higher prevalence of 25-OH D deficiency.

CONCLUSIONS

We found a high prevalence of 25-OH D deficiency in a multiracial cohort of young adults. Lower 25-OH D was associated with worse bone outcomes at the distal radius and tibia at the time of peak bone mass, warranting further attention to vitamin D status in young adults.

Vitamin D Metabolite Ratio in Pregnant Women with Low Blood Vitamin D Concentrations Is Associated with Neonatal Anthropometric Data

Existing evidence on the correlation between maternal vitamin D concentrations and birth outcomes is conflicting. Investigation of these associations requires accurate assessment of vitamin D status, especially in individuals with low 25-hydroxyvitamin D (25(OH)D) concentrations. This study examined the correlations between birth outcomes and the maternal vitamin D metabolite ratio (VMR) 1 (defined as the ratio of 24,25(OH)2D3 to 25(OH)D) and VMR2 (defined as the ratio of 3-epi-25(OH)D3 to 25(OH)D) using data from the Japan Environment and Children's Study at Chiba Regional Center. A total of 297 mother-neonate pairs were analyzed. Using liquid chromatography-tandem mass spectrometry, we measured 25(OH)D2, 25(OH)D3, 24,25(OH)2D3, and 3-epi-25(OH)D3 concentrations in maternal serum samples. These data were analyzed in relation to birth anthropometric data using multivariable linear regression. Of the study participants, 85.2% showed insufficient vitamin D concentrations. VMR1 was strongly correlated with 25(OH)D concentrations, whereas VMR2 showed a weak correlation. Only VMR2 was associated with all anthropometric data. VMR2 in pregnant women with low vitamin D blood concentrations is a useful marker for neonatal anthropometric data and is independent of 25(OH)D. Accurate measurement of vitamin D metabolites could help better understand the effects of vitamin D on birth outcomes.

Simultaneous determination of vitamin D metabolites 25(OH)D3 and 1α,25(OH)2D3 in human plasma using liquid chromatography tandem mass spectrometry

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LC-MS/MS method development and optimization for simultaneous determination of 25(OH)D₃ and 1α,25(OH)₂D₃ in human plasma.

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Lowest concentration of 25(OH)D₃ and 1α,25(OH)₂D₃ was 1000 and 20 pg/mL, respectively.

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The validated method was applied to a pharmacokinetic study in humans.

Background

Although measurement of 25(OH)D₃ is a routine analytical method to determine plasma vitamin D status, 1α,25(OH)₂D₃ is the biologically active form. Hence, simultaneous measurement of 25(OH)D₃ and 1α,25(OH)₂D₃ could provide better insight into vitamin D status and pharmacokinetics. However, 1α,25(OH)₂D₃ has a low plasma concentration, making its quantification challenging for most analytical techniques. Here, we demonstrate use of liquid chromatography tandem mass spectrometry (LC-MSMS) for the development of a simple and rapid method for the simultaneous quantification of 25(OH)D₃ and 1α,25(OH)₂D₃.

Methods

Samples were purified from 250 µL human plasma. Chromatography was performed on an analytical column, under gradient conditions using a mobile phase consisting of methanol-lithium acetate. The mass detector was operated in positive multiple reaction monitoring mode. The established method was validated according to the guidance issued by ICH and FDA. Furthermore, a clinical study was performed using this method to detect the plasma concentrations of 1α,25(OH)₂D₃ after oral administration of calcitriol.

Results and conclusion

The method was acceptably linear over the concentration ranges of 20–1200 pg/mL for 1α,25(OH)₂D₃ and 1–60 ng/mL for 25(OH)D₃, respectively, with correlation coefficients of r² > 0.993. Both the inter-assay and intra-assay precision was < 15%, and the analytical recoveries were within 100% ± 10%, with no significant matrix effect or carryover. Thereby, we, provide a facile method for the simultaneous detection of vitamin D metabolites in plasma.

Tipping the Balance: Vitamin D Inadequacy in Children Impacts the Major Gut Bacterial Phyla

Vitamin D inadequacy appears to be on the rise globally, and it has been linked to an increased risk of osteoporosis, as well as metabolic, cardiovascular, and autoimmune diseases. Vitamin D concentrations are partially determined by genetic factors. Specific single nucleotide polymorphisms (SNPs) in genes involved in vitamin D transport, metabolism, or binding have been found to be associated with its serum concentration, and these SNPs differ among ethnicities. Vitamin D has also been suggested to be a regulator of the gut microbiota and vitamin D deficiency as the possible cause of gut microbial dysbiosis and inflammation. This pilot study aims to fill the gap in our understanding of the prevalence, cause, and implications of vitamin D inadequacy in a pediatric population residing in Qatar. Blood and fecal samples were collected from healthy subjects aged 4–14 years. Blood was used to measure serum metabolite of vitamin D, 25-hydroxycholecalciferol 25(OH)D. To evaluate the composition of the gut microbiota, fecal samples were subjected to 16S rRNA gene sequencing. High levels of vitamin D deficiency/insufficiency were observed in our cohort with 97% of the subjects falling into the inadequate category (with serum 25(OH)D < 75 nmol/L). The CT genotype in rs12512631, an SNP in the GC gene, was associated with low serum levels of vitamin D (ANOVA, p = 0.0356) and was abundant in deficient compared to non-deficient subjects. Overall gut microbial community structure was significantly different between the deficient (D) and non-deficient (ND) groups (Bray Curtis dissimilarity p = 0.049), with deficient subjects also displaying reduced gut microbial diversity. Significant differences were observed among the two major gut phyla, Firmicutes (F) and Bacteroidetes (B), where deficient subjects displayed a higher B/F ratio (p = 0.0097) compared to ND. Vitamin D deficient children also demonstrated gut enterotypes dominated by the genus Prevotella as opposed to Bacteroides. Our findings suggest that pediatric vitamin D inadequacy significantly impacts the gut microbiota. We also highlight the importance of considering host genetics and baseline gut microbiome composition in interpreting the clinical outcomes related to vitamin D deficiency as well as designing better personalized strategies for therapeutic interventions.

The impact of vitamin D level on serum lipids in type 2 diabetes mellitus

Background: Vitamin D is considered an important regulator of many metabolic processes in the body. Its deficiency was reported to associate with many pathological conditions, with contradicting reports on its role in dyslipidemia. Objectives: To evaluate the role of vitamin D (total and/or free) in improving dyslipidemia of type 2 diabetes mellitus (T2DM). Methods: Sixty-four patients with T2DM, and 73 apparently healthy normal subjects were enrolled in the study from March to October 2020. Their fasting blood glucose, glycated hemoglobin, HbA1c, and serum lipids (cholesterol, its fractions and triglycerides) were measured in addition to total and free vitamin D. Results: There was a significant negative correlation between total vitamin D and each of cholesterol and LDL-C in the diabetic group. The correlations between serum vitamin D and all other lipid parameters (HDL-C, VLDL-C and triglycerides) were non-significant in the diabetic group, while in the control groups none of serum lipids showed significant correlations with vitamin D. Conclusions: The significant negative association of vitamin D with total cholesterol and LDLC in the diabetics reveals the important action of vitamin D in reducing the atherogenic indices, and consequent reduction in the rate of atherosclerosis and cardiovascular disease or stroke.

Vitamin D Deficiency in Patients with Diabetes in French Guiana: Epidemiology and Relation with Microvascular and Macrovascular Complications

Vitamin D (VD) insufficiency is common among patients with diabetes in French Guiana. The study aimed to evaluate the prevalence of VD deficiency in the different type of diabetes encountered and to analyze the relationship between VD deficiency and diabetes complications. Methods: An observational study was conducted between May 2019 and May 2020 in French Guiana, based on data from the CODIAM study (Diabetes Cohort in French Amazonia), describing the characteristics of patients with diabetes mellitus. Among 600 patients enrolled with diabetes, 361 had an available VD assay. Results: The mean 25(OH)VD (hydroxycalciferol) level was 27.9 ng/mL. The level of VD was inversely proportional to the HbA1c (glycated hemoglobin) level. Patients with angina pectoris had a greater proportion of deficiencies VD < 20 ng/mL than those without angina. By contrast, patients with retinopathy had higher vitamin D concentrations than those without retinopathy. There was no association between vitamin D and arteriopathy, stroke, nephropathy and polyneuropathy. VD deficiency was more frequent in women, and in patients with a high school education. Conclusion: The prevalence of VD deficiency was high in patients with diabetes in French Guiana, emphasizing the importance of VD supplementation.

Prevalence of vitamin D deficiency and its associated risk factors among rural population of the northern part of the Persian Gulf

BACKGROUND

Accumulating evidence indicates that vitamin D deficiency has been increased globally over the last two decades. However, the majority of these studies are concerned with cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among the rural population in Bushehr province which shares the longest border with the Persian Gulf.

METHODS

The rural inhabitants of more than 25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants' demographic and anthropometric data and their past medical history, serum 25-hydroxyvitamin D [25(OH)D] was measured using ELISA.

RESULTS

A total of 1806 (means ±SD, 46± 14years old) rural subjects (35 % males and 65 % females) participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 28 %, 50 %, and 22 %, respectively. The deficiency of vitamin D in women was higher than in men (OR=1.27, 95 % CI: 1.05 to 1.54, P=0.04). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.7). There was no significant difference between the food item's consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively.

CONCLUSIONS

Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their lifestyle patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf.

Burden of illness in patients with chronic hypoparathyroidism not adequately controlled with conventional therapy: a Belgium and the Netherlands survey

PURPOSE

To determine the burden of illness in patients with not adequately controlled chronic hypoparathyroidism receiving conventional therapy in Belgium and the Netherlands.

METHODS

Data were generated from a cross-sectional, two-part online survey where endocrinologists from both countries and nephrologists from Belgium were invited by phone to participate. Part 1 included collecting data on general management of patients with hypoparathyroidism. In Part 2, physicians were requested to provide data on one or two current cases of patients with chronic hypoparathyroidism not adequately controlled on conventional therapy. Data collected included aetiology of hypoparathyroidism, clinical manifestations, comorbidities, results of laboratory and other investigations used for diagnosis and screening for complications, therapy received, and physician's perception of impaired quality of life (QoL).

RESULTS

Thirty-six endocrinologists and 29 nephrologists from Belgium and 28 endocrinologists from the Netherlands participated in the survey. Data included clinical symptoms, biochemical parameters, and QoL for 97 current patients with not adequately controlled chronic hypoparathyroidism on conventional therapy. Median duration of not adequately controlled hypoparathyroidism was 2.2 years, range 0.17-20.0. Most patients had neuromuscular (85%) and/or neurological (67%) symptoms, 71% had abnormal biochemical parameters, 10% were overweight, and physicians perceived that 71% had impaired QoL. Most frequently reported comorbidities included hypertension (25%), renal comorbidity (20%), diabetes mellitus (12%), and dyslipidaemia (11%).

CONCLUSION

Patients with chronic hypoparathyroidism not adequately controlled on conventional therapy experience a substantial burden of illness, mainly due to persistence of symptoms and presence of multiple comorbidities.

Frequency and determinants of vitamin D deficiency among premenopausal and postmenopausal women in Karachi Pakistan

Background

Vitamin D deficiency is becoming a serious public health problem, even in sun-drenched cities like Karachi, Pakistan. We investigated the prevalence of vitamin D deficiency and its association with sociodemographic characteristics, anthropometric measures, and lifestyle factors among premenopausal and postmenopausal women (n = 784).

Methods

Face-to-face interviews were conducted to collect information and serum concentrations of 25-hydroxyvitamin D were measured after the interviews.

Results

A total of 57% of women were vitamin D deficient with higher vitamin D deficiency found among premenopausal women (64.7%) compared to postmenopausal women (49%). The median serum concentrations of 25-hydroxyvitamin D (IQR) were 16.7 ng/ml (IQR 9.8–30.0). Factors associated with vitamin D deficiency were lower socioeconomic status (OR 2.00; 95% CI 1.15–3.48), younger age with highest vitamin D deficiency found in < 35 years of age group (OR 3.11; 95% CI 1.76–5.51), and winter season (OR 1.51, 95% CI 1.07–2.15) after adjusting for multiple confounders. The use of vitamin D supplement (OR 0.59, 95% CI 0.38–0.92) and vigorous exercise (OR 0.20, 95% CI 0.05–0.80) were protective against vitamin D deficiency.

Conclusions

The study shows a high prevalence of vitamin D deficiency, with detrimental health effects, among younger women belonging to lower socioeconomic status and during the winter season. The use of vitamin D supplements and vigorous exercise were protective measures. Public health campaigns are needed for education and awareness about vitamin D deficiency to improve vitamin D status for younger women living in poor environments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01339-9.

Developing a Model for Prediction of Serum 25-Hydroxyvitamin D Level: The Use of Linear Regression and Machine Learning Methods

OBJECTIVE

Because vitamin D status affects many organs and tissues of the body, it is important to determine the factors affecting it. The purpose of this study was to develop a model for predicting the serum 25-hydroxyvitamin D [25(OH)D] level in healthy young adults.

METHOD

This cross-sectional study was conducted on 201 healthy individuals aged 20 to 40 years old in Shiraz, Iran. Data regarding demographic characteristics, vitamin D intake through supplements, and sun exposure habits were gathered. Serum 25(OH)D concentration was also measured. Data were analyzed with R software using linear regression and different machine learning methods such as conditional tree, conditional forest and random forest.

RESULTS

Based on the linear regression, male sex (p < 0.001), taking 50,000 IU vitamin D₃ supplement monthly (p < 0.001), and lower waist circumference (p = 0.018) were identified as effective factors in increasing serum 25(OH)D levels. According to the conditional tree, taking 50,000 IU vitamin D₃ supplement monthly (p < 0.001) and sex (p < 0.001) were two main factors in the classification of individuals in terms of serum 25(OH)D levels. Besides, conditional forest and random forest results showed that the most important variable was taking 50,000 IU vitamin D₃ supplement monthly.

CONCLUSIONS

Supplement use is the first and most important predictor of 25(OH)D levels and other factors, including sex and waist circumference, are ranked thereafter, and the importance of these factors is greater in those who do not take vitamin D₃ supplements.

Low Prenatal Vitamin D Metabolite Ratio and Subsequent Postpartum Depression Risk

Background: Depression is a common complication of pregnancy and vitamin D deficiency is one biological risk factor for postpartum depression (PPD). Materials and Methods: We evaluated the ratio of 24,25(OH)2D and 25(OH)D serum concentrations referred to as the Vitamin D Metabolite Ratio (VMR), a new candidate biomarker during pregnancyand its relationship with PPD. Women were enrolled in the first trimester of pregnancy and followed through four timepoints. Results: A total of 89 women had complete depression, biomarker and demographic data and 34% were at risk for PPD (CES-D≥16). Stepwise multiple logistic regression models for PPD risk were carried out with eight predictors. Results showed that only lower VMR, OR = 1.43, 95% CI 1.10-1.86, p = 0.007, and Hispanic/Latina identification, OR = 3.83, 95% CI 1.44-10.92, p = 0.007 were significantly associated with higher PPD risk. Conclusion: Routine prenatal screening for vitamin D metabolites, particularly in Hispanic/Latina women, may identify women at risk for PPD.

A prediction tool for vitamin D deficiency in New Zealand adults

PURPOSE

This study aims to develop a model for predicting vitamin D deficiency in New Zealand adults using easily accessible clinical characteristics.

METHODS

Data were derived from the Vitamin D Assessment (ViDA) study dataset. Included participants in the main analysis were aged 50-84 years and resided in Auckland, New Zealand. The dataset was split into a discovery dataset in which the prediction model was developed (n = 2036) and a validation dataset in which it was tested (n = 2037). The prediction model was developed using clinical characteristics in a logistic regression analysis with deseasonalised serum 25OHD (DS-25OHD) as the dependent variable.

RESULTS

DS-25OHD < 40 nmol/L was found in 8.2% of European participants, 18.8% of Māori participants, 23.1% of Pacific participants and 52.2% of South Asian participants. Predictors for DS-25OHD < 40 nmol/L in the European sub-cohort included increasing age, female sex, higher body mass index, current smoking, no alcohol intake, lower self-reported general health status, lower physical activity hours, lower outdoor hours and no use of vitamin D-containing supplementation. The area under the curve in the discovery dataset was 0.73, and in the validation dataset was 0.71. Of those with a prediction score ≥ 10 (total risk score range 0-21.5), the sensitivity and specificity for predicting vitamin D deficiency was 0.90 and 0.41, respectively.

CONCLUSION

Non-European ethnicity is an important risk factor for vitamin D deficiency. Our vitamin D deficiency prediction model performed well and demonstrates its potential as a tool that can be integrated into clinical practice for the prediction of vitamin D deficiency.

Vitamin D3 metabolite ratio as an indicator of vitamin D status and its association with diabetes complications

BACKGROUND

Vitamin D deficiency is diagnosed by total serum 25-hydroxyvitamin D (25(OH)D) concentration and is associated with poor health and increased mortality; however, some populations have low 25(OH) D concentrations without manifestations of vitamin D deficiency. The Vitamin D Metabolite Ratio (VMR) has been suggested as a superior indicator of vitamin D status. Therefore, VMR was determined in a population with type 2 diabetes at high risk for vitamin D deficiency and correlated with diabetic complications.

RESEARCH DESIGN AND METHODS

Four hundred sisty patients with type 2 diabetes (T2D) were recruited, all were vitamin D₃ supplement naive. Plasma concentration of 25-hydroxyvitamin D₃ (25(OH)D₃) and its metabolites 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) and 24,25-dihydroxyvitamin D₃ (24,25(OH)₂D₃) and its epimer, 3-epi-25-hydroxyvitamin D₃ (3-epi-25(OH)D₃), were measured by LC-MS/MS analysis. VMR-1 was calculated as a ratio of 24,25(OH)₂D₃:25(OH)D₃; VMR-2 as a ratio of 1,25(OH)₂D₃:25(OH)D₃; VMR-3 was calculated as a ratio of 3-epi-25(OH)D₃: 25(OH)D_3. RESULTS: An association means that there were significant differences between the ratios found for those with versus those without the various diabetic complications studied. VMR-1 was associated with diabetic retinopathy (p = 0.001) and peripheral artery disease (p = 0.012); VMR-2 associated with hypertension (p < 0.001), dyslipidemia (p < 0.001), diabetic retinopathy (p < 0.001), diabetic neuropathy (p < 0.001), coronary artery disease (p = 0.001) and stroke (p < 0.05). VMR-3 associated with hypertension (p < 0.05), dyslipidemia (p < 0.001) and coronary artery disease (p < 0.05).

CONCLUSIONS

In this cross sectional study, whilst not causal, VMR-2 was shown to be the superior predictor of diabetic and cardiovascular complications though not demonstrative of causality in this cross-sectional study population over VMR-1, VMR-3 and the individual vitamin D concentration measurements; VMR-2 associated with both microvascular and cardiovascular indices and therefore may have utility in predicting the development of diabetic complications.

Serum 25 hydroxyvitamin D levels and affecting factors among preconception fertile women

Background

Recent study found that vitamin D before conception was considered as a potential additional determinant for achieving pregnancy and live births. The study aimed to evaluate the serum 25 hydroxyvitamin D (25(OH)D) levels and its affecting factors among preconception fertile women.

Methods

This cross-sectional study enrolled 410 women aged 22–44 years who attended a preconception genetic counseling clinic from January 2018 to May 2019. Sociodemographic characteristics and reproductive history of women were collected, and height and weight were measured. Serum 25(OH)D concentration was assayed with chemiluminescence immunoassay. Descriptive statistics were used to examine serum 25(OH)D concentration, and socio-demographic characteristics and reproductive history among preconception women. Determinants of vitamin D deficiency and its affecting factors were assessed using χ2 test and logistic regression.

Results

Findings showed 84.4% of women had serum 25(OH)D concentration below 20 ng/mL. Women working indoors as well as without a history of childbirth had significantly lower 25(OH)D levels compared with those non-working individuals and having delivered a previous child (both P < 0.05). The 25(OH)D levels were the lowest in winter among that in spring, summer, and autumn (all P < 0.001). Women in winter have significantly elevated OR of 5.00 (95%CI 1.75–14.25) to develop vitamin D deficiency. Seasonal variation in serum 25(OH)D levels was not present in non-working individuals and women aged 31–44 years.

Conclusions

Vitamin D deficiency is common among preconception women especially nulliparous women and working women, which propose to screen serum 25(OH)D on preconception evaluation and emphasize need vitamin D supplements and get sunshine exposure.

To D or not to D: vitamin D in hematopoietic cell transplantation

Vitamin D plays an essential role in bone health, immune tolerance, and immune modulation. Autologous and allogeneic hematopoietic cell transplantation (HCT) recipients are at increased risk of vitamin D deficiency, which may increase risks of bone loss and fracture, graft-versus-host disease (GVHD), and relapse, and can delay hematologic and immune recovery following HCT. Growing evidence indicates that vitamin D may have a role as an immunomodulator, and supplementation during HCT may decrease the risk of GVHD, infection, relapse, and mortality. In this paper, we review the role of vitamin D and its association with HCT outcomes and discuss prevention and treatment of vitamin D deficiency after HCT in adult recipients. We review the role of monitoring of vitamin D levels pre- and post-HCT and its supplementation in appropriate patients. We also review the use of bone densitometry prior to HCT and in long-term follow-up and the treatment of osteoporosis in this high-risk population.

Prevalence of vitamin D deficiency in urban south Indians with different grades of glucose tolerance

The present study assessed the prevalence of vitamin D deficiency in an urban south Indian population in individuals with different grades of glucose tolerance. A total of 1500 individuals (900 normal glucose tolerance (NGT), 300 prediabetes and 300 with type 2 diabetes mellitus (T2DM)) who were not on vitamin D supplementation were randomly selected from the Chennai Urban Rural Epidemiological Study follow-up study. Anthropometric, clinical examination and biochemical investigations (25-hydroxyvitamin D (25(OH)D), insulin, glycated Hb (HbA1c) and serum lipids) were measured. Vitamin D deficiency was defined as serum 25(OH)D < 20·0 ng/ml, insufficiency as 20-29·9 ng/ml and sufficiency as ≥30 ng/ml. Of the 1500 individuals studied, 45 % were males and the mean age was 46 (sd 12) years. Vitamin D levels lowered with increasing degrees of glucose tolerance (NGT: 21 (sd 11); prediabetes: 19 (sd 10); T2DM: 18 (sd 11) ng/ml, P < 0·001). The overall prevalence of vitamin D deficiency was 55 % and was significantly higher among individuals with T2DM (63 %) followed by prediabetes (58 %) and NGT (51 %) (Pfor trend < 0·001). Women had 1·6 times the risk of vitamin D deficiency compared with men (unadjusted OR 1·6 (95 % CI 1·3, 2·0) and adjusted OR 1·6 (95 % CI 1·2, 1·9)). However, there was no increasing trend observed with increasing age. The prevalence of abdominal obesity (66 v. 49 %), generalised obesity (80 v. 64 %), the metabolic syndrome (45 v. 37 %) and insulin resistance (38 v. 27 %) was significantly higher in those with vitamin D deficiency compared with those without. This study shows that vitamin D deficiency is highly prevalent in this urban south Indian population and was higher among individuals with T2DM and prediabetes compared with those with NGT.

Effect of vitamin D supplementation on serum lipid profiles: a systematic review and meta-analysis

CONTEXT

Vitamin D deficiency is highly prevalent across the world. The existing evidence suggests vitamin D may have beneficial effects on serum lipid profiles and thus cardiovascular health.

OBJECTIVE

The objective of this systematic review and meta-analysis was to examine the effect of vitamin D supplementation on serum lipid profiles.

DATA SOURCE

Original randomized controlled trials (RCTs) examining the effect of vitamin D supplementation on serum lipid profiles and published before July 2018 were identified by searching online databases, including PubMed, Google Scholar, and ScienceDirect, using a combination of relevant keywords.

DATA EXTRACTION

Data on study characteristics, effect size, measure of variation, type of vitamin D supplementation, and duration of follow-up were extracted by the author.

DATA ANALYSIS

PRISMA guidelines for systematic reviews were followed. Random effects (DerSimonian and Laird [D-V)] models were used to pool standardized mean differences in total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides between the active and the placebo arms of RCT studies. Between-study heterogeneities were assessed using Cochrane Q and I2, and publication bias was assessed using Begg's test, Egger's test, and funnel plot.

RESULTS

A total of 41 RCTs comprising 3434 participants (n = 1699 in the vitamin D supplementation arm and n = 1735 in the placebo arm) were identified and included in the meta-analysis. Approximately 63.4% of study participants were women, with 14 studies conducted entirely among women. Approximately 24% of the trials had follow-up duration >6 months, whereas the remaining 76% had follow-up duration of <6 months. The standardized mean differences (SMDs) and 95% confidence intervals (CIs) for comparing the change from baseline to follow-up between the vitamin D supplementation arm and the placebo (control) arm were as follows: total cholesterol = -0.17 (-0.28 to -0.06); LDL cholesterol = -0.12 (-0.23 to -0.01); triglycerides = -0.12 (-0.25 to 0.01); and HDL cholesterol = -0.19 (-0.44 to 0.06). After removing a trial that was an outlier based on the magnitude of the effect size, the SMD for triglycerides was -0.15 (-0.24 to -0.06) and that for HDL cholesterol was -0.10 (-0.28 to 0.09). The improvements in total cholesterol and triglycerides were more pronounced in participants with baseline vitamin D deficiency.

CONCLUSIONS

Vitamin D supplementation appeared to have a beneficial effect on reducing serum total cholesterol, LDL cholesterol, and triglyceride levels but not HDL cholesterol levels. Vitamin D supplementation may be useful in hypercholesterolemia patients with vitamin D insufficiency who are at high risk of cardiovascular diseases.

Vitamin D supplementation after the menopause

The purpose of this review was to assess recent evidence regarding the effects of low vitamin D levels on some highly prevalent clinical conditions of postmenopausal women. We reviewed and selected recent literature regarding menopause-related conditions associated with vitamin D deficiency and interventions to manage them. Low circulating 25-hydroxyvitamin D (25(OH)D) levels related to menopause are linked to diet, lifestyle, changes in body composition, insulin sensitivity, and reduced physical activity. Vitamin D supplementation increases serum 25(OH)D levels while normalizing parathyroid hormone and bone markers, and in women with serum 25(OH)D levels below 10 ng/ml supplementation may improve bone mineral density. Low vitamin D status has been associated with the metabolic syndrome, high triglyceride levels, and low high-density lipoprotein cholesterol levels. When compared with placebo, vitamin D supplementation may lower the risk of the metabolic syndrome, hypertriglyceridemia, and hyperglycemia. There is an inverse relationship between fat mass and serum 25(OH)D levels and, therefore, the dosage of supplementation should be adjusted according to the body mass index. Although vitamin D supplementation may improve glucose metabolism in prediabetic subjects, data regarding muscle strength are conflictive. There is evidence that vitamin D over-treatment, to reach extremely high circulating 25(OH)D levels, does not result in better clinical outcomes. The identification and treatment of vitamin D deficiency in postmenopausal women may improve their general health and health outcomes. Vitamin D supplementation should preferably be based on the use of either cholecalciferol or calcifediol.

Defining the Characteristics of Chronic Hypoparathyroidism Not Adequately Controlled on Conventional Therapy: Consensus Findings of Three European Delphi Panels

Introduction

European Society of Endocrinology (ESE) guidelines provide goals for hypoparathyroidism management but do not define characteristics of chronic hypoparathyroidism that is not adequately controlled. Three European country-specific Delphi panels were conducted to gain consensus on these characteristics.

Methods

Delphi panels were conducted in the UK, Sweden, and Portugal using similar methodology. At each round, panellists considered patients with chronic hypoparathyroidism whose disease is not adequately controlled on conventional therapy according to a matrix of four presentations of patients with chronic hypoparathyroidism: normal biochemical levels/well (group 1), abnormal biochemical levels/well (group 2), normal biochemical levels/unwell (group 3), and abnormal biochemical levels/unwell (group 4), with wellness defined by the patient’s persistent symptoms, comorbidities, and complications. For groups 2–4, panellists rated characteristics in five categories (patient characteristics, family history, comorbidities, biochemistry, and symptoms/impact on quality of life [QoL]) with respect to defining a patient as having chronic hypoparathyroidism that was not adequately controlled on conventional therapy. Consensus was achieved when more than 80% of respondents agreed.

Results

Among the three countries, panellists agreed that characteristics within four of the five categories (patient characteristics, comorbidities, biochemistry, and symptoms/impact on QoL) were important for defining inadequate control. Characteristics deemed important in groups 2–4 included a history of compliance problems and chronic kidney disease stages 4 and 5. In groups 2 and 4, the biochemical parameters deemed important were serum calcium, urinary calcium, and serum creatinine. In groups 3 and 4, tingling or numbness in the hands/feet and face was the only symptom deemed important in all three countries.

Conclusion

Delphi panels conducted in three European countries provided national consensus on key parameters of patient characteristics, biochemistry, comorbidities, and symptoms/impact on QoL that define not adequately controlled chronic hypoparathyroidism. These characteristics should be tested more widely for their applicability in clinical practice.

Funding

Shire International GmbH, Zug, Switzerland, a member of the Takeda group of companies.

Electronic supplementary material

The online version of this article (10.1007/s12325-019-01102-5) contains supplementary material, which is available to authorized users.

Temporal increases in 25-hydroxyvitamin D in midlife women: Longitudinal results from the Study of Women's Health Across the Nation

OBJECTIVE

25-hydroxyvitamin D (25(OH)D) is critical for bone mineralization and may prevent fractures. Understanding vitamin D deficiency trends in midlife women is particularly important given their concurrent menopausal changes that increase risk for fracture. We aimed to evaluate changes in mean 25(OH)D over time and their determinants in a racially, ethnically and socioeconomically diverse cohort of midlife women.

DESIGN

A multi-centre prospective cohort study.

PATIENTS

1585 women ages 42-52 years at baseline.

MEASUREMENTS

We measured serum 25(OH)D at 2 time points (1998-2000 and 2009-2011). Between-visit change was assessed in the whole cohort and in socioeconomic and demographic subgroups. Among those with vitamin D deficiency (25(OH)D <30 nmol/L) at baseline, we evaluated determinants of persistent deficiency at follow-up.

RESULTS

Mean 25(OH)D increased from 53.8 to 70.0 nmol/L (P < 0.001), and the prevalence of deficiency decreased from 20.4% to 9.7% (P < 0.001). While baseline 25(OH)D differed among subgroups, the changes in 25(OH)D were similar among groups. The proportion of women reporting dietary supplement use increased from 40.8% to 67.1% (P < 0.001), and the increase in 25(OH)D was significantly higher in supplement users. Among women with vitamin D deficiency at baseline, White women and supplement users were less likely to remain deficient at follow-up.

CONCLUSIONS

Among midlife women, temporal increases in 25(OH)D concentrations are driven largely by increases in supplement use. The proportion of women with 25(OH)D <30 nmol/L and thus at high risk for skeletal consequences remains substantial. Targeted screening for vitamin D deficiency in populations at risk for fragility fracture may be advisable.

Serum 25(OH)D and Cognition: A Narrative Review of Current Evidence

The effect of low serum 25(OH)D on cognitive function is difficult to determine owing to the many factors that can influence these relationships (e.g., measurements, study design, and obesity). The primary purpose of this review was to synthesize the current evidence on the association between serum 25(OH)D and cognition giving special consideration to specific influential factors. A search was conducted in PubMed for studies published between 2010 and 2018 using terms related to serum 25(OH)D and cognition. Only studies that used liquid chromatography tandem-mass spectrometry (LC-MS) were included, since this is considered the 'gold standard method', to measure serum 25(OH)D. Of the 70 articles evaluated, 13 met all inclusion criteria for this review. The majority of the observational and longitudinal studies demonstrate a significant association between low serum 25(OH)D and compromised cognition. However, two randomized controlled trials showed inconsistent results on the impact of vitamin D supplementation on cognitive function. The varied methodologies for ascertaining cognition and the inclusion or exclusion of confounding variables (e.g., obesity, sunlight exposure) in the statistical analyses make drawing conclusions on the association between serum 25(OH)D and cognitive functioning inherently difficult. Despite the known higher occurrence of serum 25(OH) deficiency among minority populations, the majority of studies were conducted in with White participants. In order to more clearly discern the relationship between serum 25(OH)D and cognitive functioning, future studies should target more diverse study populations and utilize comprehensive measures to reliably capture cognition, as well as important known determinants of serum 25(OH)D.

The Role of Vitamin D in the Pathogenesis of Inflammatory Bowel Disease

Vitamin D has a complex role in the pathogenesis of inflammatory bowel disease (IBD), which is still under investigation. We conducted a literature search using PubMed through December 2018 through the use of relevant search terms. We found an abundance of evidence to support the role of vitamin D in regulating the innate and adaptive arms of the immune system. The pathogenesis of IBD implicates the immune dysregulation of these immune system components. Proof of concept of the vitamin’s role in the pathogenesis of IBD is the mapping of the vitamin D receptor in a region of chromosome 12, where IBD is also mapped, and specific VDR polymorphisms’ link to IBD phenotypes. Further research is needed to better delineate vitamin D’s role in preventing IBD and its potential as a therapeutic target for this disease.

Vitamin D level and its determinants among Sudanese Women: Does it matter in a sunshine African Country?

Background:

Vitamin D deficiency is a worldwide concern. The aim of the current study was to determine the vitamin D level and its contributing factors in Sudanese women.

Methods:

In this cross-sectional study, 251 Sudanese women attending Family Health Centers in Khartoum, Sudan were interviewed. Following the exclusion of confounding factors, samples from 190 women were analzsed. Serum 25 hydroxyvitamin D “25(OH) D” was quantified using competitive electrochemiluminescence immunoassay.

Results:

Participants’ age ranged from 18 to 85 years with a mean age (±SD) of 40.2 (±14.06) years. The mean (±SD) vitamin D level was 13.4 (±6.72) ng/ml, ranged 3.00–36.5 ng/ml and the median was 12.7 ng/mL. In total, 157 out of 190 (82.6%) had vitamin D serum levels below 20 ng/ml (deficient); of whom, 52 (27.4%) were in the age group 21–30 years (P value = 0.228). The correlation between vitamin D level and residence outside Khartoum, sun-exposed face and hands, and face and limbs in comparison with being completely covered were found to be statistically significant (p values 0.008, 0.023, and 0.036).

Conclusion:

This study displayed a high percentage (82.6%.) of vitamin D deficiency among women in Sudan, and this in part may indicate that sunshine alone cannot guarantee vitamin D sufficiency in the tropics. Family physicians in tropical countries should screen those with clinical presentations related to vitamin D deficiency.

The role of vitamin D testing and replacement in fibromyalgia: a systematic literature review

BACKGROUND

Fibromyalgia is a debilitating condition, characterized by extensive muscular pain and fatigue. Vitamin D is essential for overall health, with ubiquitous involvement in various inflammatory and pain pathways. Little is known about its role in fibromyalgia. We performed a systematic literature review to determine if vitamin D contributes to the pathology and disability of patients with fibromyalgia, and to assess the role of vitamin D supplementation in disease management.

METHODS

We searched Medline, EMBASE and the Cochrane Library for clinical studies and randomized controlled trials published in English during January 2000 to June 2017, using the terms vitamin D or hypovitaminosis D combined with fibromyalgia or FMS. References were reviewed manually and articles were only included if they were specific in their diagnosis of fibromyalgia and used appropriate control groups.

RESULTS

Four hundred and sixty-six studies were retrieved, of which fourteen fulfilled the inclusion criteria. Six studies, of which two had the best quality evidence, found that patients with fibromyalgia have low levels of vitamin D compared to healthy controls. Conflicting results were obtained on the effect of vitamin D on pain or symptom control, with no clear consensus as to the role of supplementation in the management of fibromyalgia.

CONCLUSIONS

Our results highlight an association between vitamin D deficiency and fibromyalgia. However, its role in the pathophysiology of fibromyalgia and the clinical relevance of identifying and treating this requires further elucidation with appropriately controlled studies.

Shortening day length: a potential risk factor for perinatal depression

The aim of this secondary analysis was to determine whether seasonal light exposure, categorized by type of day length, is associated with or predictive of depressive symptoms in late pregnancy and the first 3 months postpartum. Women (n = 279) expecting their first child were recruited from prenatal clinics and childbirth education classes. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. Day lengths were categorized into short, lengthening, long and shortening. Data analysis included linear mixed models and multiple linear regression. When days were shortening (August to first 4 days of November) in late third trimester, depressive symptom scores were highest (35%) and continued to be higher at each postpartum assessment compared to other day length categories. Implications for clinical practice include increased vigilance for depressive symptoms, particularly if late pregnancy and birth occurs during the 3 months around the Autumn equinox when day length is shortening. Strategies that increase light exposure in late pregnancy and postpartum should also be considered.

Predictive Factors for Vitamin D Concentrations in Swiss Athletes: A Cross-sectional Study

Vitamin D concentrations corresponding to 75 nmol/L 25(OH)D have been associated with maintained muscle function, growth and regeneration, optimal bone health and immunology in athletes. The objective of this study was to investigate the prevalence and predictors of insufficient 25(OH)D concentrations in athletes. Six hundred three Swiss athletes were assessed. 25(OH)D was analysed by high-performance liquid chromatography (HPLC). A standardized questionnaire was used to gather information about potential predictors for 25(OH)D concentrations; 50.5% showed insufficient 25(OH)D concentrations. Differences in predicted probability of insufficient 25(OH)D were found for those vitamin D supplemented (42%) versus not supplemented (52%), in those performing indoor (58%) versus outdoor sports (43%), and during the sun-deprived seasons of fall (49%), winter (70%) and spring (57%) compared with summer (17%). Higher BMI z-scores and age were associated with higher 25(OH)D concentrations. In conclusion, insufficient 25(OH)D concentrations were common among athletes especially at a younger age, among those not supplemented, in athletes who trained indoors, and during the sun-deprived seasons. Because the prevalence of insufficient 25(OH)D concentrations in this study was high, regular supplementation in athletes may be indicated, except perhaps during the summer season. Further research is needed to determine which 25(OH)D concentrations lead to optimal health and performance in athletes.

Vitamin D supplementation attenuates asthma development following traffic-related particulate matter exposure

BACKGROUND

Recent literature suggests that children who are vitamin D deficient are uniquely susceptible to the effects of traffic-related air pollution (TRAP) exposure. This is highly significant because large segments of the population reside in zones of high TRAP exposure.

OBJECTIVE

We sought to determine whether vitamin D supplementation mitigates the effect of TRAP exposure on asthma development, asthma exacerbation, and/or airway inflammation and to determine the timing of vitamin D supplementation that confers maximal health benefit.

METHODS

Using established mouse models of asthma, we examined the effect of prenatal and postnatal vitamin D supplementation on asthma development, as well as the utility of vitamin D as a treatment for established asthma in the context of diesel exhaust particle (DEP) exposure.

RESULTS

DEP and allergen coexposure resulted in increased airway hyperresponsiveness (AHR) and accumulation of pathogenic T_H2/T_H17 cells in the lungs of vitamin D-deficient mice compared with control mice. Prenatal and postnatal vitamin D supplementation significantly attenuated the development of AHR and decreased pulmonary accumulation of T_H2/T_H17 cells after coexposure to TRAP and allergen but not to allergen alone. Restoration of normal vitamin D status had no effect on AHR once asthma was already established.

CONCLUSIONS

Our data establish that vitamin D confers protection against asthma development specifically in the context of TRAP exposure. Although vitamin D replacement did not reverse established asthma, restoration of normal vitamin D status in early life significantly attenuated the development of AHR in the setting of DEP-exacerbated allergic asthma and reduced numbers of lung T_H2/T_H17 cells, which portend the development of severe asthma.

Vitamin D Status among Young Children Aged 6 to 23 Months from 4 Different Ethnic Groups in Yunnan, China

OBJECTIVES

To determine the prevalence of vitamin D deficiency in 6- to 23-month-old children from 4 different ethnic groups, Han, Lisu, Hani, and Bai, in Yunnan Province of China.

METHODS

A large cohort of 938 young children aged 6 to 23 months who were living in Yunnan, China (23°28'-27°52' N), were selected and recruited in this study. Venous-blood sampling was conducted in all the participants, and serum 25-hydroxyvitamin D [25(OH)D] levels were measured. The children's physical status was measured.

RESULTS

General mean serum 25(OH)D level was 21.46 ± 7.95 ng/mL, which was obtained from a total of 938 cases. No significant difference was found in age, gender, height, and weight of participants from different ethnic groups. The mean 25(OH)D level was significantly lower in children of Lisu ethnic groups compared with that of Han and Hani participants, respectively ( P < .05). In addition, Bai children had lower 25(OH)D content than Hani children ( P < .001). Among the children with 25(OH)D sufficiency, the number of Lisu participants was significantly lower than Han children ( P < .001).

CONCLUSION

The prevalence of vitamin D deficiency varied among the ethnically different children in Yunnan, China, and significantly fewer Lisu children maintained vitamin D sufficiency compared with other ethnic children. Recognizing these ethnic differences in treating children with vitamin D deficiency may improve the therapeutic outcome.

Factors Associated with Vitamin D Testing, Deficiency, Intake, and Supplementation in Patients with Chronic Pain

Vitamin D deficiency is a public health issue, with reports of six- to twenty-five-fold rise in vitamin D testing. Vitamin D deficiency has been linked to many chronic diseases such as diabetes mellitus, cardiovascular disease, depression, and chronic pain. Identifying factors associated with risk of deficiency in individuals with chronic pain will help minimize time and cost. This study aims to examine the factors associated with vitamin D testing, intake, and physician-advised supplementation in individuals with chronic pain. Using a cross-sectional design, data were collected from 465 individuals with chronic pain. These data were analyzed using penalized logistic regression with the LASSO technique. Fifty-seven percent reported being tested for vitamin D, about 40% reported being diagnosed with vitamin D deficiency, and of those who had been tested, 60% reported taking vitamin D supplementation. The findings suggest older age (OR 3.12, CI [1.02, 9.50]) and higher mean pain intensity score (OR 2.02, CI [1.13, 3.59]) increased an individual's chance of being vitamin D deficient. Unemployment or on leave due to pain (OR 1.79, [CI 1.03, 3.11]), part-time employment (OR 1.86, CI [1.02, 3.39]), and being a resident of Australia (OR 2.32, CI [1.13, 4.72]) increased chances of being tested for vitamin D. Being diagnosed with vitamin D deficiency (OR 6.67, CI [2.75, 16.19]), unemployed or on leave due to pain (OR 3.71, CI [1.25, 11.00]), and in part-time employment (OR 2.69, CI [0.86, 8.38]) were associated with physician-advised vitamin D supplementation. Our results may have practical implications, as identifying pretest risk factors may assist in identifying who is at risk of vitamin D deficiency, whom to test, and when to treat.

Ambient ultraviolet radiation exposure and hepatocellular carcinoma incidence in the United States

BACKGROUND

Hepatocellular carcinoma (HCC), the most commonly occurring type of primary liver cancer, has been increasing in incidence worldwide. Vitamin D, acquired from sunlight exposure, diet, and dietary supplements, has been hypothesized to impact hepatocarcinogenesis. However, previous epidemiologic studies examining the associations between dietary and serum vitamin D reported mixed results. The purpose of this study was to examine the association between ambient ultraviolet (UV) radiation exposure and HCC risk in the U.S.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) database provided information on HCC cases diagnosed between 2000 and 2014 from 16 population-based cancer registries across the U.S. Ambient UV exposure was estimated by linking the SEER county with a spatiotemporal UV exposure model using a geographic information system. Poisson regression with robust variance estimation was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between ambient UV exposure per interquartile range (IQR) increase (32.4 mW/m2) and HCC risk adjusting for age at diagnosis, sex, race, year of diagnosis, SEER registry, and county-level information on prevalence of health conditions, lifestyle, socioeconomic, and environmental factors.

RESULTS

Higher levels of ambient UV exposure were associated with statistically significant lower HCC risk (n = 56,245 cases; adjusted IRR per IQR increase: 0.83, 95% CI 0.77, 0.90; p < 0.01). A statistically significant inverse association between ambient UV and HCC risk was observed among males (p for interaction = 0.01) and whites (p for interaction = 0.01).

CONCLUSIONS

Higher ambient UV exposure was associated with a decreased risk of HCC in the U.S. UV exposure may be a potential modifiable risk factor for HCC that should be explored in future research.

Prevalence and predictors of hypovitaminosis D among the elderly in subtropical region

The prevalence of low vitamin D status in the elderly population of subtropical area and the potential risk/protective factors have not been addressed. This cross-sectional questionnaire-based study, which collected demographic/anthropometric data and information on diet habit and sun exposure, recruited 170 subjects with mean age 70.9±5.6 in rural areas of southern Taiwan. Serum 25-OH vitamin D, calcium, and intact parathyroid hormone were also measured. Using cut-off level of 30 ng/mL, subjects were divided into low (n = 95) and normal (n = 75) serum vitamin D groups. The results demonstrated a low vitamin D status in 30.6% of men and 57.7% of women. Dietary vitamin D intake was another factor associated with vitamin D status (p = 0.02). Logistic regression identified inadequate intake of vitamin D-rich food as the only risk factor for low vitamin D status in men (OR = 4.55, p = 0.01), whereas inadequate sun exposure was the only predictable risk with dose-response relationship in women (low vs. high sun exposure, OR = 6.84, p = 0.018; moderate vs. high sun exposure, OR = 6.67, p = 0.005). In conclusion, low vitamin D status was common in the elderly of subtropical rural areas. Low sun exposure and inadequate dietary vitamin D consumption were associated with a low vitamin D status in females and males, respectively.

Risk of Stress Fracture Varies by Race/Ethnic Origin in a Cohort Study of 1.3 Million US Army Soldiers

Stress fractures (SF) are common and costly injuries in military personnel. Risk for SF has been shown to vary with race/ethnicity. Previous studies report increased SF risk in white and Hispanic Soldiers compared with black Soldiers. However, these studies did not account for the large ethnic diversity in the US military. We aimed to identify differences in SF risk among racial/ethnic groups within the US Army. A retrospective cohort study was conducted using data from the Total Army Injury and Health Outcomes Database from 2001 until 2011. SF diagnoses were identified from ICD-9 codes. We used Cox-proportional hazard models to calculate time to SF by racial/ethnic group after adjusting for age, education, and body mass index. We performed a sex-stratified analysis to determine whether the ethnic variation in SF risk depends on sex. We identified 21,549 SF cases in 1,299,332 Soldiers (more than 5,228,525 person-years of risk), revealing an overall incidence rate of 4.12 per 1000 person-years (7.47 and 2.05 per 1000 person-years in women and men, respectively). Using non-Hispanic blacks as the referent group, non-Hispanic white women had the highest risk of SF, with a 92% higher risk of SF than non-Hispanic black women (1.92 [1.81-2.03]), followed by American Indian/Native Alaskan women (1.72 [1.44-1.79]), Hispanic women (1.65 [1.53-1.79]), and Asian women (1.32 [1.16-1.49]). Similarly, non-Hispanic white men had the highest risk of SF, with a 59% higher risk of SF than non-Hispanic black men (1.59 [1.50-1.68]), followed by Hispanic men (1.19 [1.10-1.29]). When examining the total US Army population, we found substantial differences in the risk of stress fracture among racial/ethnic groups, with non-Hispanic white Soldiers at greatest risk and Hispanic, American Indian/Native Alaskan, and Asian Soldiers at an intermediate risk. Additional studies are needed to determine the factors underlying these race- and ethnic-related differences in stress fracture risk. © 2017 American Society for Bone and Mineral Research.

Sub-Saharan African migrants have slower initial CD4+ cell recovery after combined antiretroviral treatment initiation than French natives

OBJECTIVE

Poorer immunologic responses to combined antiretroviral treatment (cART) have been reported among sub-Saharan African (SSA) migrants than among native Europeans. We studied whether differences in CD4 cell recovery between French natives and SSA migrants starting first-line cART could be explained by differences in socioeconomic conditions, inflammatory marker levels, and other established determinants.

METHODS

We compared 319 French natives and 175 SSA migrants (ANRS-COPANA cohort). Clinical, biological, and socioeconomic data (education, employment, income, and cohabiting partnership) were recorded at regular visits. A piecewise linear mixed-effects model was used to analyze CD4 cell count kinetics on cART.

RESULTS

Compared with French natives, SSA migrants were more frequently women, younger, less educated, living in more adverse conditions, and had more frequent symptoms of depression. The rate of CD4 cell recovery during the first 4 months on cART was significantly slower in SSA migrants, despite a similar virologic response, but did not differ significantly thereafter. The mean CD4 cell count rose from 251 cells/μl at baseline to 508 cells/μl at 36 months in migrants, and from 308 to 623 cells/μl in natives (additional mean gain of 58 cells/μl in natives). The difference persisted after adjustment for clinical, updated socioeconomic, and living conditions (-0.40√CD4 cells/month, P = 0.04); 25-hydroxyvitamin D, monocyte chemoattractant protein-1 and soluble tumor necrosis factor receptor 1 (sTNFR1) levels were lower in SSA migrants, but only sTNFR1 contributed to the difference in CD4 slope.

CONCLUSION

Initial CD4 cell recovery on cART was slower among SSA migrants than among French natives. This difference was not explained by established clinical and biological determinants or by socioeconomic status.

Vitamin D (FokI) Receptor Gene Polymorphism is associated with Vitamin D Deficiency and Chronic Musculoskeletal Pain. A meta-analysis

Background: Musculoskeletal pain is the most common chronic pain experienced by older adults. The aim of this study is to explore the associations between vitamin D (FOKI) receptor gene polymorphism (VDR) and vitamin D deficiency (VDD) and chronic musculoskeletal pain. Methods: Cross-sectional studies published in English from January 2000 to January 2015which reported prevalence of chronic pain (CP) and chronic musculoskeletal pain (CMP) were included in this systematic review and meta-analysis. A heat map was used to visualize and observe the correlation between VDR and CMP, CP and VDD. Results: 20 studies (N = 216,365) were included in the analysis, which showed an overall pooled prevalence estimate of CMP and CP as 30.6 per 100 (95 % CI: 30.59, 30.69) and 27.9 per 100 (95 % CI: 27.68, 28.24) respectively. The heat map clustering analysis visualizes the similarity between CP and CMP. Moreover, a direct correlation was observed between the three disease conditions (namely CMP, CP, and VDD) and FokI VDR polymorphism (FF). Spearman's correlation analyses with adjusted r² revealed that there is a statistically significant interaction effect of the FF genotype and VDD on CMP (r² = 0.19, p = 0.03), a marginally significant interaction effect of the ff genotype and VDD on CMP (r² = 0.11, p = 0.08). VDD was also associated with increased CMP (r² = 0.19, p = 0.028). The pooled estimates of the prevalence of CMP in this review were found to be high. Conclusion: FokI VDR gene polymorphism (FF) plays an important role in the relationship between VDD and CMP.

Optimal vitamin D status and its relationship with bone and mineral metabolism in Hong Kong Chinese

BACKGROUND

Although 25-hydroxyvitamin D (25[OH]D) is commonly used to define vitamin D status, there is no consensus on the cutoff levels for vitamin D deficiency and insufficiency. In this study, we aimed to identify the 25(OH)D threshold that maximally suppressed parathyroid hormone (PTH) in Hong Kong Chinese population.

METHODS

The study included 5276 participants (70% female) of the Hong Kong Osteoporosis Study aged 20 or above who had total 25(OH)D measured. Three-phase segmented regression was used to identify the optimal break-point between 25(OH)D and PTH.

RESULTS

The prevalence of vitamin D deficiency observed was 43.8% and the prevalence of insufficient (<75nmol/L) or deficient (<50nmol/L) vitamin D levels was 90.1% in our study population. Using unadjusted three-phase segmented regression, the estimated first and second break-point of 25(OH)D on PTH suppression were 32nmol/L (95% CI: 29-35) and 89nmol/L (95% CI: 77-101) with an r² of 0.048, whereas the estimated first and second break-point of 25(OH)D were 27nmol/L (95% CI: 24-30) and 47nmol/L (95% CI: 37-56) after adjusting for factors affecting bone and mineral metabolism. In addition, the relationship between 25(OH)D and PTH significantly differed by sex and age.

CONCLUSION

The threshold for 25OHD at the point of maximal suppression of PTH estimated in this study was lower than the suggested threshold of vitamin D deficiency in the literature, perhaps due to race or assay differences, and the relationship between vitamin D and PTH changed with sex and age. Standardization in the methodology of searching for the optimal break-point is desirable so that a consensus on cutoff points can be obtained.