The Association between Body Mass Index and Vitamin D Supplement Use among Adults in the United States

Supplementation of hyaluronic acid injections with vitamin D improve knee function by attenuating synovial fluid oxidative stress in osteoarthritis patients with vitamin D insufficiency

Objectives

There is still controversy about the effect of vitamin D supplementation on osteoarthritis (OA). The purpose of this study was to investigate the effects of vitamin D supplementation with Hyaluronic acid (HA) injection on OA.

Methods

We investigated serum vitamin D levels and oxidative stress (OS) in synovial fluid from patients with OA who underwent total knee arthroplasty (grade IV, n = 24) and HA injection (grade II and III, n = 40). The effects of HA injection with or without oral vitamin D supplementation on synovial fluid OS and knee pain and function were then further investigated. Finally, patients underwent HA injection were divided into two groups according to vitamin D levels (vitamin D < or > 30 ng/ml), and the efficacy of the two groups were compared.

Results

The results showed that the levels of glutathione peroxidase (GSH-PX) (P < 0.05) in the synovial fluid were lower in patients with stage IV OA than that in patients with stage II-III OA, while the levels of malondialdehyde (MDA) (P < 0.05) and lactate dehydrogenase (LDH) (P < 0.01) were significantly higher. Moreover, we found that age, BMI and vitamin D levels were significantly associated with the levels of oxidants and/or antioxidants in synovial fluid, and that vitamin D was significantly negatively correlated with BMI (R = −0.3527, p = 0.0043). Supplementation of HA injections with vitamin D significantly reduced the OS status in synovial fluid, attenuated knee pain and improved knee function in OA patients with vitamin D insufficiency.

Conclusion

We conclude that maintenance of vitamin D sufficiency may be beneficial for the treatment of OA by improving OS in synovial fluid.

Low serum levels of zinc and 25-hydroxyvitmain D as potential risk factors for COVID-19 susceptibility: a pilot case-control study

BACKGROUND AND AIMS

This study aimed to evaluate serum 25-hydroxyvitmain D and zinc levels in coronavirus disease 2019 (COVID-19) patients in comparison to healthy subjects.

METHODS

This was a single-center case-control study performed from March 20, 2020, to January 20, 2021, in Tehran, Iran. All patients diagnosed with COVID-19 based on a positive nasopharyngeal swab polymerase chain reaction (PCR) test were included in the case group. Controls were selected from patients referred for routine checkups who had a negative COVID-19 PCR test. Age, sex, marital and educational status, comorbidities, and serum 25-hydroxyvitmain D and zinc levels of patients were recorded.

RESULTS

Ninety patients in the case group and 95 subjects in the control group who were sex and age-matched were studied. 25-hydroxyvitmain D levels lower than 20 ng/ml were observed in 58 (64%) cases and 72 (76%) controls (P = 0.09). The median 25-hydroxyvitmain D level in the case group was significantly lower than controls (26 (interquartile range [IQR] = 24) ng/ml vs. 38 (IQR = 22) ng/ml, respectively, P < 0.01). The median zinc level in the case group was 56 (IQR = 23) ng/ml, while it was 110 (IQR = 27) ng/ml among the controls (P < 0.01). There was no significant difference in the level of 25-hydroxyvitmain D and zinc between cases with and without comorbidities (P > 0.05). Susceptibility to SARS-CoV-2 infection could be predicted by serum 25-hydroxyvitmain D levels below 25.2 ng/ml (81% sensitivity; 48% specificity) or zinc levels below 86.3 mmol/ml (93% sensitivity; 92% specificity).

CONCLUSIONS

Low serum zinc and 25-hydroxyvitmain D levels appear to be risk factors for COVID-19 affliction; thus, the treatment of individuals with such deficiencies is recommended.

Predictive Ability of Machine-Learning Methods for Vitamin D Deficiency Prediction by Anthropometric Parameters

Background: Vitamin D deficiency affects the general population and is very common among elderly Europeans. This study compared different supervised learning algorithms in a cohort of Spanish individuals aged 35–75 years to predict which anthropometric parameter was most strongly associated with vitamin D deficiency. Methods: A total of 501 participants were recruited by simple random sampling with replacement (reference population: 43,946). The analyzed anthropometric parameters were waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), body roundness index (BRI), visceral adiposity index (VAI), and the Clinical University of Navarra body adiposity estimator (CUN-BAE) for body fat percentage. Results: All the anthropometric indices were associated, in males, with vitamin D deficiency (p < 0.01 for the entire sample) after controlling for possible confounding factors, except for CUN-BAE, which was the only parameter that showed a correlation in females. Conclusions: The capacity of anthropometric parameters to predict vitamin D deficiency differed according to sex; thus, WC, BMI, WHtR, VAI, and BRI were most useful for prediction in males, while CUN-BAE was more useful in females. The naïve Bayes approach for machine learning showed the best area under the curve with WC, BMI, WHtR, and BRI, while the logistic regression model did so in VAI and CUN-BAE.

Association of Smoking with the Blood Concentration of 25-Hydroxy Vitamin D and Testosterone at High and Low Altitudes

Purpose

This research examined the association of cigarette smoking and altitude with the blood levels of 25-hydroxy vitamin D, testosterone and carotid artery thickness.

Patients and methods

This comparative cross-sectional study involved 37 non-smokers and 24 smokers from a high-altitude area (≥2245 m above sea level) and 40 smokers and 40 non-smokers from a low-altitude area (39–283 m above sea level). The blood testosterone level was determined spectrophotometrically, and the 25-hydroxy vitamin D concentration was measured by ELISA. The IMT of the right and left carotid arteries was determined using ultrasound imaging.

Results

Smoking notably elevated the thickness of the intima media of the right and left carotid arteries at both high and low altitudes (p ≤ 0.001). Smoking at high altitude was associated with a significant increase in the concentration of 25-hydroxy vitamin D and testosterone, while at low altitude it was associated with a significant decrease in both parameters (p ≤ 0.046).

Conclusion

These contrasting results suggest that future studies should focus on finding out if other biochemical parameters show any significant differences in smokers or/and non-smokers when they are tested at elevated height and sea-level. This indicates that dose modifications of medicines (related to alterations in vitamin D and testosterone levels) should be kept in mind while treating smokers and non-smokers at elevated height above sea level.

A Novel Biosensor and Algorithm to Predict Vitamin D Status by Measuring Skin Impedance

The deficiency and excess of vitamin D cause various diseases, necessitating continuous management; but it is not easy to accurately measure the serum vitamin D level in the body using a non-invasive method. The aim of this study is to investigate the correlation between vitamin D levels, body information obtained by an InBody scan, and blood parameters obtained during health checkups, to determine the optimum frequency of vitamin D quantification in the skin and to propose a vitamin D measurement method based on impedance. We assessed body composition, arm impedance, and blood vitamin D concentrations to determine the correlation between each element using multiple machine learning analyses and an algorithm which predicted the concentration of vitamin D in the body using the impedance value developed. Body fat percentage obtained from the InBody device and blood parameters albumin and lactate dehydrogenase correlated with vitamin D level. An impedance measurement frequency of 21.1 Hz was reflected in the blood vitamin D concentration at optimum levels, and a confidence level of about 75% for vitamin D in the body was confirmed. These data demonstrate that the concentration of vitamin D in the body can be predicted using impedance measurement values. This method can be used for predicting and monitoring vitamin D-related diseases and may be incorporated in wearable health measurement devices.

Protein, Calcium, Vitamin D Intake and 25(OH)D Status in Normal Weight, Overweight, and Obese Older Adults: A Systematic Review and Meta-Analysis

The aging process is often accompanied by increase in body weight. Older adults with overweight or obesity might have an overconsumption in energy that is accompanied by inadequate intake of protein, vitamin D, and calcium. It is unclear if intake of protein and vitamin D and calcium is sufficient in older adults with overweight/obesity, and whether it differs from older adults with normal weight, since a recent overview of the literature review is lacking. Therefore, we systematically analyzed the current evidence on differences in nutrient intake/status of protein, vitamin D and calcium between older adults with different body mass index (BMI) categories. Randomized controlled trials and prospective cohort studies were identified from PubMed and EMBASE. Studies reporting nutrient intake/status in older adults aged ≥50 years with overweight/obesity and studies comparing between overweight/obesity and normal weight were included. Nutrient intake/status baseline values were reviewed and when possible calculated for one BMI category (single-group meta-analysis), or compared between BMI categories (meta-analysis). Nutrient intake/status was compared with international recommendations. Mean protein (N = 8) and calcium intake (N = 5) was 0.98 gram/kilogram body weight/day (g/kg/d) [95% Confidence Interval (CI) 0.89-1.08] and 965 mg [95% CI: 704-1225] in overweight/obese. Vitamin D intake was insufficient in all BMI categories (N = 5). The pooled mean for vitamin D intake was 6 ug [95% CI 4-9]. For 25(OH)D, the pooled mean was 54 nmol/L [95% CI 45-62], 52 nmol/L [95% CI 46-58], and 48 nmol/l [95% CI 33-62] in normal (N = 7), combined overweight and obese (N = 12), and obese older adults (N = 4), respectively. In conclusion, older adults with overweight and obesity have a borderline sufficient protein and sufficient calcium intake, but insufficient vitamin D intake. The 25(OH)D concentration is deficient for the obese older adults.

Clinical significance of vitamin D in idiopathic normal pressure hydrocephalus

BACKGROUND

Although recent studies show vitamin D deficiency is associated with cognitive decline, urinary incontinence, and gait instability, there has been no study on the effect of vitamin D on idiopathic normal pressure hydrocephalus (iNPH) characterized by the classic symptom triad of cognitive decline, urinary incontinence, and gait instability. We investigated the clinical significance of vitamin D in patients with iNPH.

METHODS

Between 2017 and 2020, 44 patients who underwent ventriculoperitoneal shunt surgery were divided into low (< 15 ng/mL) and high (≥ 15 ng/mL) vitamin D groups according to the concentration of 25(OH)D, an effective indicator of vitamin D status. They were respectively evaluated according to clinical and radiological findings.

RESULTS

The low vitamin D group (n = 24) showed lower preoperative cognition compared to the high vitamin D group (n = 20) in terms of Korean-Mini Mental Status Examination (K-MMSE) and iNPH grading scale (iNPHGS) (K-MMSE: 20.5 ± 5.4 versus 24.0 ± 4.5, p = 0.041; iNPHGS cognitive score: 2 ± 0.9 versus 1 ± 0.6, p = 0.025). And the low vitamin D group showed pre- and postoperatively more severe urinary incontinence (preoperative iNPHGS urinary score: 1 ± 1.0 versus 0 ± 0.9, p = 0.012; postoperative iNPHGS urinary score:1 ± 1.0 versus 0 ± 0.9, p = 0.014). The score of narrow high-convexity sulci for the low vitamin D group was lower (low vitamin D group: 1 ± 0.7 versus high vitamin D group: 2 ± 0.4, p = 0.031).

CONCLUSION

Lower concentration of vitamin D in iNPH may be related to lower preoperative cognition, pre- and postoperative urinary incontinence, and brain morphological change.

The relationship between weight change history and 25(OH)D concentrations in adults

Introduction

Background: although obesity has been consistently associated with lower 25-OH hydroxyvitamin D-25(OH)D-levels, little is known about the effect of weight change on said 25(OH)D levels. Methods: the present analysis was based on data from the National Health and Nutrition Examination Survey. Percent weight changes were calculated from participant-reported maximum lifetime weight and weight in the past year and 10 years ago. Subsequently, general linear models adjusted for potential confounders were assembled to examine 25(OH)D concentrations across percent weight change categories. Results: a total of 6,237 participants with a mean age of 57.5 (SE, 0.2) years comprised the study sample. After adjustment for potential confounders, subjects who have gained weight ≥ 5 % in the past year and 10 years before had on average 4.5 and 5.1 nmol/L lower 25(OH)D levels than those with a stable weight, respectively. Moreover, this association persisted even among participants with adequate vitamin D intake. Notably, subjects who lost weight > 5 % from their maximum reported weight had significantly higher 25(OH)D levels than those who did not. Conclusion: subjects with a stable weight and those who lost weight ≥ 5% from their maximum reported lifetime weight had significantly higher 25(OH)D concentrations than those who did not. Thus, maintaining a healthy weight over time may be an effective strategy to reach optimal serum 25(OH)D levels.

The Effect of Statins on Serum Vitamin D Concentrations Among Older Adults

Background Randomized and observational studies have previously reported inconsistent results for the direct association between statin therapy and 25, hydroxyvitamin D [25(OH)D] levels. Thus, the present study aimed to examine the relationship between statin use and 25(OH)D and its metabolites concentrations in a large nationally representative sample of older adults. Methods This study was conducted using data from the National Health and Nutrition Examination Survey. Participants were asked to show the medication containers of all the products used in the previous 30 days, and the prescription of statins was defined on the three-level nested therapeutic classification scheme of Cerner Multum's Lexicon. General linear models adjusted for potential confounders were created to compare 25(OH)D concentrations between older adults taking statins and those who did not.  Results A total of 6,261 participants with a mean age of 69.5 years comprised the study sample. Of those, 40.2% were taking statins with a median length of therapy of 5 years. Adjusted mean 25(OH)D3 and 25(OH)D levels were 3.3 and 4.4 nmol/L higher among participants taking statins than those who did not, respectively. Moreover, this association was consistently seen regardless of the duration of therapy and particularly in subjects taking simvastatin, atorvastatin, or rosuvastatin. In subgroup analyses according to BMI categories and vitamin D intake, higher 25(OH)D levels were also seen among statin users. By contrast, this association was attenuated among those with a daily vitamin D between 400 and 800 and >800 IU. Conclusion Older adults on statin therapy had significantly higher serum 25(OH)D concentrations. Additional research should be conducted to define the mechanism of this association and determine if the pleiotropic effects attributed to statins may be mediated by vitamin D.

Food-based strategies for prevention of vitamin D deficiency as informed by vitamin D dietary guidelines, and consideration of minimal-risk UVB radiation exposure in future guidelines

There is widespread acknowledgement of the presence of vitamin D deficiency in the community and the pressing need to address this. From a public health perspective, emphasis has been placed on addressing vitamin D deficiency through dietary means. However, naturally rich food sources of vitamin D are few and infrequently consumed, and nutrition survey data from various countries have indicated that habitual vitamin D intakes in the community are much lower than the current vitamin D dietary guidelines. This review will briefly overview the extent of vitamin D deficiency within the community, its causes, and how our food chain, once its embraces the evidence-based practise of food fortification and potentially biofortification, can cater for meeting the dietary vitamin D needs of the community. Finally, international authorities, briefed with establishing vitamin D dietary guidelines over the past decade, have struggled with uncertainties and gaps in our understanding of the relative contribution of sunshine and diet to vitamin D status and vitamin D requirements for health maintenance. The review will also consider how emerging evidence of a possible minimal-risk UVB radiation exposure relative to skin cancer that also enables vitamin D production could greatly inform future vitamin D dietary guidelines.

The Sun's Vitamin in Adult Patients Affected by Prader-Willi Syndrome

Prader-Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia with progressive, severe obesity, and an increased risk of obesity-related comorbidities in adult life. Although low dietary vitamin D intake and low 25-hydroxy vitamin D (25OHD) levels are commonly reported in PWS in the context of bone metabolism, the association of low 25OHD levels with fat mass has not been extensively evaluated in PWS adults. The aims of this study were to investigate the following in PWS adults: (1) 25OHD levels and the dietary vitamin D intake; (2) associations among 25OHD levels with anthropometric measurements and fat mass; (3) specific cut-off values for body mass index (BMI) and fat mass predictive of the 25OHD levels. In this cross-sectional, single-center study we enrolled 30 participants, 15 PWS adults (age 19-41 years and 40% males) and 15 control subjects matched by age, sex, and BMI from the same geographical area (latitude 40° 49' N; elevation 17 m). Fat mass was assessed using a bioelectrical impedance analysis (BIA) phase-sensitive system. The 25OHD levels were determined by a direct competitive chemiluminescence immunoassay. Dietary vitamin D intake data was collected by three-day food records. The 25OHD levels in the PWS adults were constantly lower across all categories of BMI and fat mass compared with their obese counterpart. The 25OHD levels were negatively associated with BMI (p = 0.04), waist circumference (p = 0.03), fat mass (p = 0.04), and dietary vitamin D intake (p < 0.001). During multiple regression analysis, dietary vitamin D intake was entered at the first step (p < 0.001), thus explaining 84% of 25OHD level variability. The threshold values of BMI and fat mass predicting the lowest decrease in the 25OHD levels were found at BMI ≥ 42 kg/m2 (p = 0.01) and fat mass ≥ 42 Kg (p = 0.003). In conclusion, our data indicate that: (i) 25OHD levels and dietary vitamin D intake were lower in PWS adults than in the control, independent of body fat differences; (ii) 25OHD levels were inversely associated with BMI, waist circumference, and fat mass, but low dietary vitamin D intake was the major determinant of low vitamin D status in these patients; (iii) sample-specific cut-off values of BMI and fat mass might help to predict risks of the lowest 25OHD level decreases in PWS adults. The presence of trained nutritionists in the integrated care teams of PWS adults is strongly suggested in order to provide an accurate nutritional assessment and tailored vitamin D supplementations.

Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D

OBJECTIVES

To investigate whether sex, age, medical specialty and seasonal variations in serum concentration of 25-hydroxy vitamin D (25(OH)D) are evident among an Australian patient population.

DESIGN

Retrospective study analysing the results of serum 25(OH)D lab tests and vitamin D supplementation from Royal Melbourne Hospital (RMH) between 2014 and 2017.

SETTING

Tertiary healthcare centre in Victoria, Australia.

PARTICIPANTS

30 023 patients (inpatient and outpatient) who had their serum 25(OH)D levels measured at RMH between 2014 and 2017.

MAIN OUTCOME MEASURES

Serum 25(OH)D levels stratified according to patients' sex, age and medical specialty admitted to, as well as the season and year (2014 to 2017) 25(OH)D level was measured.

RESULTS

Mean serum 25(OH)D level of study population was 69.9 nmol/L (95% CI 69.5 to 70.2). Only 40.2% patients in this cohort were sufficient in vitamin D (>75 nmol/L). On average, 25(OH)D levels in male patients were 6.1 units (95% CI 5.4 to 6.9) lower than in females. Linear regression analysis found that 25(OH)D levels increased by 0.16 unit (95% CI 0.14 to 0.18) for every year increase in age. One-way analysis of variance showed patients from neurology had the highest average 25(OH)D level, 76.8 nmol/L (95% CI 74.2 to 79.3) compared with other medical specialties. Mean 25(OH)D level during winter, 64.9 nmol/L (95% CI 64.2 to 65.6) was significantly lower compared with other seasons despite supplementation. Average 25(OH)D level measured in 2014, 71.5 nmol/L (95 CI% 70.8 to 72.2) was significantly higher than levels measured in 2016-2017.

CONCLUSIONS

There is a sex, age, medical specialty, seasonal and yearly variation in vitamin D status in an Australian patient population. The association between low vitamin D status and winter despite supplementation suggests other interventions are required to boost serum 25(OH)D levels.