Role of diet quality in bone health in children and adolescents: a systematic review

CONTEXT

Poor diet quality and unhealthy dietary patterns have been linked to poor bone health, yet few studies have investigated the role of diet quality in bone health in pediatric populations.

OBJECTIVE

This systematic review aims to assess the available evidence on the association between diet quality and bone health markers in children and adolescents.

DATA SOURCES

The PubMed, Scopus, and Virtual Health Library databases were searched electronically from October to November 2022, without any restrictions on date or language. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist was used to assess the quality of the studies.

DATA EXTRACTION

Published observational studies in children and adolescents (ages 2 to 19 years) that investigated the association between diet quality and bone health were eligible for inclusion. Two researchers independently analyzed and selected all articles using the Rayyan app. Initially, 965 papers were identified. A total of 12 observational studies qualified, including 8 cross-sectional and 4 longitudinal studies. The sample comprised 7130 individuals aged 3 to 17.9 years, representing both sexes. Bone health was evaluated by measures of bone mineral density and bone mineral content.

DATA ANALYSIS

Seven studies (58.3%) showed significant associations between diet quality and bone health markers, all of which evaluated diet quality by identifying dietary patterns. Diet quality as evaluated by all dietary indexes was not associated with bone health markers.

CONCLUSIONS

Adherence to a healthy diet may benefit bone health in children and adolescents. These findings emphasize the importance of developing effective public health policies that encourage healthy eating habits from childhood to preserve bone health. Longitudinal research using a specific tool to assess diet quality in relation to bone health is warranted. Future studies should also measure bone-regulating hormones and markers of bone turnover.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022368610.

Combined vitamin D and magnesium supplementation does not influence markers of bone turnover or glycemic control: A randomized controlled clinical trial

High-dose vitamin D supplementation can increase total osteocalcin concentrations that may reduce insulin resistance in individuals at risk for prediabetes or diabetes mellitus. Magnesium is a cofactor in vitamin D metabolism and activation. The purpose of this study was to determine the combined effect of vitamin D and magnesium supplementation on total osteocalcin concentrations, glycemic indices, and other bone turnover markers after a 12-week intervention in individuals who were overweight and obese, but otherwise healthy. We hypothesized that combined supplementation would improve serum total osteocalcin concentrations and glycemic indices more than vitamin D supplementation alone or a placebo. A total of 78 women and men completed this intervention in 3 groups: a vitamin D and magnesium group (1000 IU vitamin D₃ and 360 mg magnesium glycinate), a vitamin D group (1000 IU vitamin D₃), and a placebo group. Despite a significant increase in serum 25-hydroxyvitamin D concentrations in the vitamin D and magnesium group compared with the placebo group (difference = 5.63; CI, -10.0 to -1.21; P = .001) post-intervention, there were no differences in serum concentrations of total osteocalcin, glucose, insulin, and adiponectin or the homeostatic model assessment of insulin resistance (HOMA-IR) among groups (P > .05 for all). Additionally, total osteocalcin (β = -0.310, P = .081), bone-specific alkaline phosphatase (β = 0.004, P = .986), and C-terminal cross-linked telopeptide (β = 0.426, P = .057), were not significant predictors of HOMA-IR after the intervention. Combined supplementation was not associated with short-term improvements in glycemic indices or bone turnover markers in participants who were overweight and obese in our study. This trial was registered at clinicaltrials.gov (NCT03134417).

Vitamin d deficiency and metabolic syndrome: The joint effect on cardiovascular and all-cause mortality in the United States adults

BACKGROUND

The long-term impact of vitamin D deficiency and metabolic syndrome (MetS) on cardiovascular disease (CVD) and all-cause mortality are still a matter of debate.

AIM

To test the hypotheses that lower serum 25 hydroxyvitamin D [25(OH)D] concentrations (a marker of vitamin D level) and MetS have a long-term impact on the risk of CVD and all-cause mortality, and individuals with vitamin D deficiency can be identified by multiple factors.

METHODS

A sample of 9094 adults, 20 to 90 years of age, who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994) were followed through December 2015 was analyzed. The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models. Classification and regression tree (CART) for machine learning was applied to classify individuals with vitamin D deficiency.

RESULTS

Of 9094 participants, 30% had serum 25(OH)D concentrations < 20 ng/mL (defined as vitamin D deficiency), 39% had serum 25(OH)D concentrations between 20 to 29 ng/mL (insufficiency), and 31% had serum 25(OH)D concentrations ≥30 ng/mL (sufficiency). Prevalence of MetS was 28.4%. During a mean of 18 years follow-up, vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality. Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality (HR = 1.77, 95%CI: 1.22-2.58) and all-cause mortality (HR = 1.62, 95%CI: 1.26-2.09), followed by those with both vitamin D insufficiency and MetS for CVD mortality (HR = 1.59, 95%CI: 1.12-2.24), and all-cause mortality (HR = 1.41, 95%CI: 1.08-1.85). Meanwhile, vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS. Among the total study sample, CART analysis suggests that being non-Hispanic Black, having lower serum folate level, and being female were the first three predictors for those with serum 25(OH)D deficiency.

CONCLUSION

Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality. There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality. Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.

Higher protein intake during caloric restriction improves diet quality and attenuates loss of lean body mass

OBJECTIVE

Higher protein intake during weight loss is associated with better health outcomes, but whether this is because of improved diet quality is not known. The purpose of this study was to examine how the change in self-selected protein intake during caloric restriction (CR) alters diet quality and lean body mass (LBM).

METHODS

In this analysis of pooled data from multiple weight loss trials, 207 adults with overweight or obesity were examined before and during 6 months of CR (approximately 10 food records/person). Body composition was measured by dual-energy x-ray absorptiometry. Diet quality was assessed using the Healthy Eating Index in 2 groups: lower (LP) and higher (HP) protein intake.

RESULTS

Participants (mean [SD], 54 [11] years; 29 [4] kg/m² ) lost 5.0% (5.4%) of weight. Protein intake was 79 (9) g/d (1.0 [0.2] g/kg/d) and 58 (6) g/d (0.8 [0.1] g/kg/d) in the HP and LP groups, respectively (p < 0.05), and there was an attenuated LBM (kilograms) loss in the HP (-0.6% [1.5%]) compared with the LP (-1.2% [1.4%]) group (p < 0.01). The increased Healthy Eating Index score in the HP compared with the LP group was attributed to greater total protein and green vegetable intake and reduced refined grain and added-sugar intake (p < 0.05).

CONCLUSIONS

Increasing dietary protein during CR improves diet quality and may be another reason for reduced LBM, but it requires further study.

Serum Osteocalcin Is an Important Predictor of Central and Total Adiposity and Insulin Resistance

Objectives

Osteocalcin (OC) is a non-collagenous protein expressed by osteoblasts and has gained immense attention due to its endocrine role in modulating glucose homeostasis and fat mass. However, the relationship of this bone turnover marker with adipose tissue distribution and alternative methods of insulin resistance (IR) risk evaluation have not been fully explored. Considering that a better understanding of OC hormone role may be a possible pathway to improve cardiometabolic health, the objective of this study was to investigate the association of OC with central and total adiposity and IR risk.

Methods

This is a cross-sectional study with 154 non-osteoporotic men (57.1%) and women (42.9%), mean age and BMI were 37.3 ± 13.1 years and 29.1 ± 5.5 kg/m², respectively. Weight, height and waist circumference (WC) were measured to calculate BMI and waist-height ratio (WhR). Body composition was assessed by dual energy x-ray absorptiometry (DXA). Blood samples were obtained to analyze serum OC, fasting glucose, insulin, adiponectin, and triglycerides. IR was evaluated using traditional (Homeostatic Model Assessment for Insulin Resistance, HOMA-IR) and alternatives methods (HOMA-adiponectin, HOMA-AD; triglyceride-glucose (TyG) index; quantitative insulin-sensitivity check index, QUICKI). Multivariable linear regression models were performed to determine the association between OC and outcomes.

Results

The sample mean OC concentration was 20.7 ± 17.1 ng/mL. After adjustments of potential covariates, OC was positively associated with free fat mass (β = 5.54, p = 0.013) and lean mass (β = 5.41, p = 0.012), and inversely associated with WC (β = −11.39, p = 0.004), WhR (β = −0.06, p = 0.004), visceral abdominal tissue (−1.16, p = 0.015), android fat (β = −3.01, p = 0.001), trunk fat (β = −0.08, p = 0.001), total region fat (β = −53.57, p = 0.015), and total fat mass (β = −5.32, p = 0.016). Moreover, OC was inversely associated to HOMA-AD (β = −0.43, p = 0.026) and QUICKI (β = −0.38, p = 0.020).

Conclusions

These results suggests that OC is an important predictor of central and total adiposity, as well as IR. Whether or not improvements in OC will be associated with improvements in body composition and glucose metabolism should be examined in future interventional studies.

Funding Sources

American Heart Association, Drexel University College of Nursing and Health Professions

Changes in Dietary Magnesium Intake and Risk of Type 2 Diabetes Mellitus in Middle School Students: Using Data from the HEALTHY Study

BACKGROUND

The HEALTHY Study was a multicomponent school-based intervention, designed to prevent type 2 diabetes mellitus (T2DM) in middle-school students.

OBJECTIVES

We examined whether the difference in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grade were related in the intervention schools and in the control schools that participated in the HEALTHY Study.

METHODS

A total of 2181 ethnically diverse students, from 11.3 to 13.7 y of age, with completed dietary records, BMI percentile, and plasma glucose and insulin concentrations at 6th and 8th grades were included. Dietary magnesium intake was self-reported using the Block Kids FFQ. A hierarchical multiple regression model was used to determine whether the differences in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grades were related, while adjusting for dietary calcium intake and total energy intake.

RESULTS

The difference in dietary magnesium intake was significantly related to changes in BMI percentile from 6th to 8th grade in intervention and in control schools [intervention: β: -0.07; 95% CI: -0.58, -0.02; P = 0.03; R2 (regression coefficient effect size): 0.14; 95% CI for R2: 0.10, 0.17; control: β: -0.08; 95% CI: -0.63, -0.09; P = 0.01; R2: 0.12; 95% CI for R2: 0.08, 0.15]. The difference in dietary magnesium intake was not related to plasma glucose and insulin concentrations in intervention and in control schools.

CONCLUSIONS

We conclude that a multicomponent intervention was associated with reduced risk of T2DM, and that this association may be modulated, in part, by magnesium. The differences in dietary magnesium intake from 6th to 8th grade were negatively related to changes in BMI percentile among middle-school students.

Decreased fasting serum glucogenic amino acids with a higher compared to normal protein diet during energy restriction in women: a randomized controlled trial

Dietary protein alters circulating amino acid (AAs) levels and higher protein intake (HP) is one means of losing weight. We examined 34 overweight and obese women (57 ± 4 years) during 6 months of energy restriction (7.3 ± 3.8% weight loss) divided into groups consuming either normal protein (NP; 18.6 energy% protein) or HP (24.3 energy% protein). There was a reduction in fasting serum glucogenic AAs (p = 0.015) that also associated with greater weight loss (p < 0.05) in the HP group, but not in the NP group. These findings have implications for nutrient prioritization during energy restriction.

Association Between Serum Vitamin D Concentrations and Markers of Adiposity in Ethnically Diverse Population

Objectives

Background: South Asian Indians (SAI) have a higher prevalence of both chronic diseases and vitamin D deficiency compared to Caucasians. Previous research shows that vitamin D status is a determinant of metabolic health. SAIs have higher total fat, lower lean mass, and higher visceral or truncal fat compared to Caucasians. These factors are all associated with chronic health conditions at a younger age than their Caucasian counterparts.

Objective

The study aimed to determine the association between body composition parameters and the biomarkers of vitamin D status and whether these relationships differed between Caucasian and SAI cohorts.

Methods

Healthy SAIs and Caucasian men, who were 22 to 60 years of age, were enrolled. Anthropometric and body composition measurements, serum levels of 25 Hydroxy-vitamin D (25OHD), Parathyroid Hormone, and Vitamin D Binding-Protein were obtained. Independent t-test and Mann-Whitney u test were used to report the differences between groups. Spearman correlation was used to identify the possible association. A P value of less than 0.05 was considered significant.

Results

30 SAIs and 30 Caucasians completed the study. Both groups did not significantly differ in their age and BMI. The 25OHD levels were statistically different between Caucasians (31.24 ± 9.14 ng/mL) and SAIs (22.94 ± 7.19 ng/mL), (P &lt; 0.01). The correlation analysis found that among Caucasians, percent of Fat Free Mass (FFM), android fat, gynoid fat, visceral adipose tissue (VAT) correlated negatively with 25OHD levels (P &lt; 0.05). Among SAIs, % of FFM, Fat Mass, Lean mass correlated negatively with 25OHD levels (P &lt; 0.05).

Conclusions

VAT showed a negative association with vitamin D status in Caucasians only. These findings may have important implications for development of metabolic diseases in young Caucasian vs a SAI population.

Funding Sources

Drexel CNHP Seed Grant to Dr. Sukumar

Dietary magnesium intake in relation to body mass index and glycemic indices in middle school students from the HEALTHY Study

BACKGROUND

Data on dietary magnesium intake on the risk of type 2 diabetes mellitus (T2DM) among children and adolescents is limited.

AIM

We examined whether dietary magnesium intake was related to body mass index (BMI) percentile, and glycemic indices at baseline and at end of the HEALTHY Study for both intervention and control schools. The HEALTHY Study was a multi-component, school-based intervention, to prevent T2DM in children and adolescents from 6th to 8th grades.

METHODS

A secondary data analyses of 2181 ethnically diverse students with completed dietary records, BMI percentile, and plasma insulin and glucose concentrations at baseline (6th grade) and end of study (8th grade) were included from the HEALTHY Study. Dietary magnesium intake was self-reported using the Block Kids Food Frequency Questionnaire. A hierarchical multiple regression model was used to determine the relationships between dietary magnesium intake, BMI percentile, and glycemic indices at baseline and end of the HEALTHY Study, adjusting for magnesium intake from supplements, total energy intake, and fitness level.

RESULTS

Dietary magnesium intake was related to BMI percentile at baseline and at end of the HEATHY Study (β = -0.05, 95% CI = -0.02 to 0, p = 0.04; β = -0.06, 95% CI = -0.02 to -0.003, p = 0.004); R ² [regression coefficient effect size] = 0.03; R ² = 0.06). Dietary magnesium intake was not related to plasma insulin and glucose concentrations at baseline and end of the HEALTHY Study.

CONCLUSION

Dietary magnesium intake was inversely related to BMI percentile among middle school students from the HEALTHY Study. Research is required to evaluate the dose-response relationship between fruit and vegetable consumption (good sources of magnesium) and risk of T2DM in children and adolescents. This relationship also needs to be explored among different BMI categories.

The implications of vitamin D deficiency on COVID-19 for at-risk populations

Novel coronavirus disease 2019 (COVID-19) has spread to > 10 000 000 individuals in a short time. With no pharmacological agents successfully implemented to control the outbreak, the use of less invasive nonpharmacological agents, such as vitamin D, are increasingly being studied. This purpose of this article is to determine the current knowledge about the risk of COVID-19 development for populations at risk for vitamin D deficiency, including individuals living with overweight and obesity, those of older age, and racial or ethnic minorities. Despite the documented impact of vitamin D on viral disease prevention, many subgroups at risk for contracting COVID-19 are also known to have increased rates of vitamin D deficiency. Because vitamin D is most commonly obtained from sunlight, when interpreted alongside the stay-at-home orders, the importance of identifying safe approaches to obtain sufficient vitamin D is apparent. Furthermore, elucidating the cause-and-effect relationship between vitamin D and COVID-19, including optimal dosing for COVID-19 outcomes, is also warranted for immediate investigation.

The Relationship Between Inflammatory Cytokines and Calciotropic Hormones in South Asian and Caucasian Men

Objectives

The study objective was to identify the differences in inflammatory profile, and possible predictors of vitamin D and parathyroid hormone (PTH) concentrations between South Asian Indians (SAIs) and Caucasians.

Methods

Healthy SAIs and Caucasian men, who were 22 to 50 years of age, were recruited. Anthropometric measurements including body composition using Dual X-Ray Energy Absorptiometry and serum 25 hydroxy-vitamin D (25(OH)D), PTH, Matrix metallopeptidase 9 (MMP-9), C-terminal peptide (CTX), osteocalcin, insulin, adiponectin, and serum glucose concentrations were obtained. Independent t-test was used to report the mean differences between groups. Spearman correlation, and linear regression were used to identify possible predictors of 25(OH)D, and PTH levels. A P-value of less than 0.05 was considered significant.

Results

28 SAIs and 28 Caucasians completed the study. Both groups did not significantly differ in their age and BMI. The mean 25(OH)D levels were 22.3 ± 6.6 ng/mL and 31.96 ± 9 ng/mL for SAIs and Caucasians, (P &lt; 0.01). The mean PTH levels were 65.0 ± 26.7pg/mL, and 53.5 ± 30.1pg/mL for SAIs and Caucasians, (P &gt; 0.05). The mean adiponectin levels were significantly lower among SAIs (2.26 ± 1.8 ng/mL) compared to the Caucasians (71 ± 2.4 ng/mL), (P &lt; 0.001). The MMP-9 levels were significantly higher in the Caucasians (P = 0.050). The regression analysis found both serum 25(OH)D and insulin concentrations as best predictors of PTH levels in SAIs, while MMP-9 level was the best predictor of PTH levels in Caucasians. Serum glucose and PTH levels were best predictors of 25(OH)D levels in SAIs, while adiponectin level was the best predictor of the 25(OH)D in Caucasians.

Conclusions

The differences in serum levels of 25(OH)D, MMP-9, and adiponectin between the two ethnic groups could explain why SAIs have a higher risk for chronic diseases. Future studies should consider improving vitamin D and adiponectin levels among SAIs via vitamin or minerals supplements that could improve their cardiometabolic health.

Funding Sources

Drexel University.

Parathyroid Hormone and Glycemic Profile in Healthy Overweight and Obese Adults

Objectives

Elevated serum parathyroid hormone concentration (sPTH) is associated with higher prevalence of cardiometabolic diseases. The objective of this study was to examine the differences in cardiometabolic parameters in overweight or obese (Owt/Ob) individuals categorized into a low and high PTH group.

Methods

A total of 116 Owt/Ob men and women with a body mass index (BMI) between 24.7 to 43.2 kg/m2 and ages 20 to 70 years participated in this study. Blood samples were obtained for analyses of sPTH, serum 25-hydroxyvitamin D (s25OHD), serum ionized magnesium (iMg), inflammatory cytokines, insulin, fasting glucose, and triglyceride. Body composition information was measured using dual energy x-ray absorptiometry (DXA). Participants were categorized into either a Low PTH Group (sPTH &lt; 55pg/mL) and High PTH Group (sPTH ≥55pg/mL).

Results

The mean sPTH in the Low PTH Group was 39.8pg/mL ± 10.0 (age = 33.5years ± 11.3, BMI = 28.9 kg/m2 ± 3.4), and in the High PTH Group was 79.5pg/mL ± 19.9 (age = 40.7years ± 12.5, BMI = 29.5/m2 ± 4.6). The High PTH Group had a higher fat mass % (36.7% ± 8.4, P = 0.029) and lower lean mass % (59.8% ± 7.9, P = 0.015) compared to the Low PTH Group (33.0% ± 9.7; 63.7% ± 9.1 respectively). After controlling for age, fasting blood glucose was significantly higher (P = 0.024) in the High PTH Group (97.6 mg/dL ± 3.1SEM) compared to the low PTH group (97.6 mg/dL ± 2.9SEM). There were no differences between BMI, body composition, s25OHD, iMg, inflammation cytokines, insulin, and triglyceride between PTH groups after controlling for age.

Conclusions

Higher sPTH was associated with a higher fasting glucose in Owt/Ob, but otherwise healthy adults. Attempts to lower sPTH in this population may delay the onset of metabolic conditions and should be explored in prospective studies.

Funding Sources

American Heart Association, Drexel University College of Nursing and Health Professions.

Osteocalcin as a Predictor of Body Composition in Healthy Adults

Objectives

The objectives of this study were to determine if body composition and nutrient status are dependent on serumosteocalcin concentrations in healthy adults.

Methods

Adults 20 to 70 years of age completed fasting blood sampling to measure serum ionized calcium concentrations, serum ionized magnesium concentrations, and serum total osteocalcin concentrations. Dual Energy X-Ray Absorptiometry was also completed to measure body composition variables including body mass index (BMI), total fat mass, total fat freemass, total lean mass, android fat, gynoid fat, trunk fat, and visceral adipose tissue.

Results

A sample of 60 women and 78 men with a median age of 33.0 (21.0) years were categorized into two groups accordingto the median osteocalcin concentration measured: low osteocalcin (12.11 ± 2.72 ng/mL), and high osteocalcin (26.80 ± 9.72 ng/mL). Means, standard deviations, medians and interquartile ranges were calculated and independent t-tests, and Mann Whitney U tests were conducted to determine differences between groups in body composition variables. Total fat mass, total fat percentage, android fat, trunk fat, and trunk fat percentage were all significantly higher, and totalfat free mass, fat free mass percentage, total lean mass, lean mass percentage, serum ionized calcium concentrations, and serum ionized magnesium concentrations were all significantly lower (P &lt; 0.05) in the low osteocalcin groupcompared to the high osteocalcin group. There were no differences (P &gt;0.05) between groups in weight, gynoid fat, visceral adiposity tissue, or visceral adiposity tissue percentage.

Conclusions

The results of this study provide preliminary evidence that serum osteocalcin concentrations can predict bodycomposition. Interventional studies should consider methods to alter osteocalcin concentrations through vitamin ormineral supplementation as a means to improve body composition in adults.

Funding Sources

American Heart Association; Drexel University.

Dietary Magnesium Intake and Risk of Type 2 Diabetes Mellitus Using Data from the HEALTHY Study

Objectives

Type 2 diabetes mellitus (T2DM) in children and adolescents has increased dramatically worldwide. Diet plays a key role in the development of T2DM, but little is known about the contribution of dietary magnesium intake in the risk of T2DM among children and adolescents. We conducted secondary analyses using the HEALTHY Study data. The HEALTHY Study was a multi-component, school-based intervention designed to reduce modifiable risk factors for T2DM in middle school students from 6th through 8th grades. The purpose of our study was to examine whether the difference in dietary magnesium intake, body mass index (BMI) percentile, and plasma glucose and insulin concentrations from 6th to 8th grade were related in the intervention schools and in the control schools that participated in the HEALTHY Study.

Methods

A total of 2181 students from intervention and control schools with completed dietary records, BMI percentile, plasma glucose and insulin concentrations, at 6th and 8th grades were included in these analyses. Dietary magnesium intake was self-reported using the Block Kids Food Frequency Questionnaire. A hierarchical multiple regression model was used to determine whether the difference in dietary magnesium intake, BMI percentile, and plasma glucose and plasma insulin concentrations from 6th to 8th grades were related, while adjusting for dietary calcium intake.

Results

The difference in dietary magnesium intake was a significant predictor for changes in BMI percentile in control schools from 6th to 8th grade (β = −0.07, 95% confidence interval [CI] = −0.03 to −0.01, P = 0.007; R2 [regression coefficient effect size] = 0.24, 95% CI for R2 = 0.19 to 0.28) indicating a small-to-medium effect size.

Conclusions

We concluded that changes in dietary magnesium intake from 6th to 8th grades were negatively related to changes in BMI percentile among middle school students.

Funding Sources

The original research related to this abstract was funded by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) of the National Institutes of Health (NIH), with additional support from the American Diabetes Association.

Three Doses of Vitamin D and Cognitive Outcomes in Older Women: A Double-Blind Randomized Controlled Trial

Vitamin D may affect cognitive performance, but previous studies are either short term or observational. We conducted a randomized controlled trial of vitamin D supplementation on domain-specific cognitive measures in postmenopausal women. Overweight/obese women with serum 25-hydroxyvitamin D (25OHD) levels less than 30 ng/mL were recruited. Vitamin D3 supplementation (600, 2,000, or 4,000 IU/d) was randomly assigned in a double-blinded manner for 1 year. Serum 25-hydroxyvitamin D, osteocalcin (total and undercarboxylated), amyloid beta, parathyroid hormone, and estradiol were analyzed before and after supplementation. Cognitive tests were administered after treatment. The women (58 ± 6 years; body mass index, 30.0 ± 3.5 kg/m2) had a baseline serum 25-hydroxyvitamin D level of 22.6 ± 5.8 ng/mL that increased to 30.2 ± 5.6, 36.0 ± 4.9, and 40.8 ± 7.0 ng/mL in the 600, 2,000, and 4,000 IU/d groups, respectively (p < .001). Participants taking 2,000 IU/d compared to other doses performed better in learning and memory tests (p < .05), yet the 4,000 IU/d group had a slower reaction time compared to the 600 IU/d group. Multiple regression indicated that serum undercarboxylated osteocalcin predicted tasks associated with reaction time and executive function, whereas body mass index and parathyroid hormone negatively predicted reaction time and executive function (p ≤ .01). These data suggest that vitamin D has differential effects on domain-specific cognitive measures and that a higher dose may negatively affect reaction time.

Sedentary behavior time as a predictor of hemoglobin A1c among adults, 40 to 59 years of age, living in the United States: National Health and Nutrition Examination Survey 2003 to 2004 and 2013 to 2014

BACKGROUND

Sedentary behavior activities have been associated with an increased risk of type 2 diabetes. Aim: Our aim was to determine whether sedentary behavior time (SBT) is predictive of hemoglobin A1c (HbA1c) ≥ 6.5% (48 mmol/mol).

METHODS

We used cross-sectional data, adults 40 to 59 years of age, from the National Health and Nutrition Examination Survey (NHANES) for 2003 to 2004 and 2013 to 2014. Responses to questions on the Physical Activity Questionnaire regarding time watching television/videos, and time spent sitting in front of a computer per day were compiled into tertiles. Binary logistic regression analysis was used to determine whether SBT was a predictor of a HbA1c ≥ 6.5% adjusting for age, sex, race and ethnicity, and body mass index.

RESULTS

In a univariate model, adults reporting ≥ 8 hours of SBT in NHANES 2003-2004 had 2.02 increased odds of a HbA1c ≥ 6.5% (OR = 2.02, 95% CI: 1.31, 3.13, p < 0.0001) compared to adults reporting ≤ 3 hours. After adjusting the regression model for age, sex, race and ethnicity, and body mass index, adults reporting ≥ 8 hours of SBT in NHANES 2003 to 2004 had 1.72 increased odds of HbA1c ≥ 6.5% (OR = 2.02, 95% CI: 1.10, 2.68, p < 0.0001) compared to adults reporting ≤ 3 hours of SBT. Reported SBT was not a predictor of HbA1c ≥ 6.5% for NHANES 2013 to 2014.

CONCLUSION

Reported SBT was a predictor of HbA1c ≥ 6.5% among adults, 40 to 59 years of age, in NHANES 2003 to 2004, but was not a predictor in 2013 to 2014.

Low dietary magnesium intake alters vitamin D-parathyroid hormone relationship in adults who are overweight or obese

Vitamin D metabolism is dependent on magnesium (Mg) as a cofactor; therefore, poor Mg status may alter the relationship between vitamin D metabolite serum 25-hydroxyvitamin D (s25OHD) and serum parathyroid hormone (sPTH). We hypothesized that low dietary Mg intake may alter sPTH response to s25OHD in a population with excess body weight, thereby leading to a worsening of cardiometabolic health. To explore this hypothesis, we conducted a cross-sectional study on adults who were either overweight or obese (owt/ob). Dietary Mg intake was measured using a Mg food frequency questionnaire (MgFFQ). Body composition information was measured using Dual Energy X-ray Absorptiometry (DXA). Blood samples were obtained for all biochemical analyses. A total of 57 participants, 22 to 65 years of age, with a body mass index between 25 to 45 kg/m² were divided into 3 groups, according to dietary Mg intake percentiles (Low Mg Group = <33 percentile, Medium Mg Group = 33 to 66 percentile, High Mg Group = >66 percentile). Higher s25OHD was negatively associated with lower sPTH in the High Mg Intake group (r = -0.472, P = .041), but not in other groups. A positive relationship between s25OHD and serum high-molecular weight adiponectin concentrations was observed in the High Mg Group (r = 0.532, r = 0.022), but not in other groups. Serum Interleukin-6 concentrations were negatively associated with s25OHD (r = -0.316, P = .017) for the entire study group. Based on these results, our study demonstrated that a low dietary Mg intake may alter PTH response to 25OHD.

The Relationship Between Serum Ionized Magnesium Concentrations and Diastolic Blood Pressure in Overweight and Obese Adults (P24-040-19)

Objectives

Adequate magnesium (Mg) status has been shown to be associated with improved cardiometabolic health. Magnesium status is commonly assessed by measuring serum concentrations of Mg in clinical settings; however, serum concentrations of ionized Mg (iMg) is a better indicator of bioavailable Mg status. Few researchers have assessed iMg as a measure of Mg status due to difficulties in sample preparation and storage. Furthermore, the influence of iMg concentrations on cardiometabolic health is scarce. The objective of this study was to investigate whether changes in iMg induced by supplementation may affect cardiometabolic health parameters in an overweight and obese (owt/ob) population.

Methods

Participants were randomly assigned to receive a daily dose of magnesium (360 mg Mg glycinate) and/or vitamin D (1000 IU D3) supplements or placebo in a 12-week double-blinded, randomized ongoing clinical trial. Because this is an ongoing study, the analyses are still not unblinded. Blood samples were obtained for analyses of serum 25-hydroxyvitamin D (s25OHD), parathyroid hormone, total triglyceride, insulin, fasting glucose and inflammatory cytokine concentrations to determine cardiometabolic risk factors. Serum concentration of iMg were assessed by a NOVA-8 analyzer with an ion sensitive electrode method, using serum samples within 5 hours of initial venipuncture for each participant. Seated blood pressure was assessed with an automated oscillometric device on the right arm, according to the American Heart Association Guidelines for In-Clinic Blood Pressure Measurement.

Results

A total of 66 Owt/Ob adults, 29 to 65 years of age, with a body mass index (BMI) between 24 to 41 kg/m2, completed all study measurements. Mean iMg concentrations at baseline were 0.543 ± 0.055 mmol/L. There was a significant negative correlation between change in iMg and change in diastolic blood pressure (r = −0.299, P = 0.039).

Conclusions

Improvement in Mg status may be associated with lowering of diastolic blood pressure. Whether changes in iMg status may affect overall cardiometabolic health is inconclusive at this point.

Funding Sources

American Heart Association.

Calcitropic Hormones and Metabolic Markers Differ in Young South Asian Indian Men and Caucasians (P04-119-19)

Objectives

The incidence rate of metabolic syndrome is higher in South Asian Indians (SAI) and is generally accompanied by changes in calcitropic hormones. Typically, these findings are reported in middle age or older adults and data in a younger population is scarce. The purpose of the study was to analyze the differences in calcitropic hormones and metabolic markers in younger South Asian Indian and Caucasian men

Methods

Caucasian or South Asian Indian men between 21–41 years of age were recruited for this study. Anthropometric measurements such as weight (kg), height (cm) and waist circumference (cm) were obtained. An 8-hour fasting blood sample was collected for analysis of serum concentrations of 25 hydroxyvitamin D (25OHD), parathyroid hormone (PTH), C-reactive protein (CRP), osteocalcin (OC), high molecular weight (HMW) adiponectin, glycemic indices, and lipid profile. Independent sample t-tests were used to report the mean differences between groups. The significance level was set for P < 0.05.

Results

A total of 26 men (13 SAIs and 13 Caucasians) completed the study. The mean age for SAI men was 27.82 ± 5.64 y and 27.39 ± 5.29 y for Caucasian men. Body mass index (BMI) averaged at 25.93 ± 3.97 kg/m2 for SAIs and 26.44 ± 2.49 kg/m2 for Caucasians. Serum 25(OH)D concentrations were lower in the SAI men (21.58 ± 8.11 ng/mL) compared to Caucasian men (29.14 ± 7.17 ng/mL) (P = 0.019). Serum concentrations of PTH were higher (P = 0.007) in the SAI men (72.39 ± 24.32 pg/mL) compared to Caucasian Men (45.30 ± 21.95 pg/mL). Furthermore, HMW adiponectin was significantly lower (P = 0.008) in SAIs (2.00 ±1.29 mg/L) compared to Caucasians (3.95 ± 2.01 mg/L). Glycemic indices, inflammatory markers, serum osteocalcin, and lipid profiles were not different between groups.

Conclusions

These results show that differences in calcitropic hormones are observed in young South Asian Indian men compared to Caucasians although differences in metabolic parameters do not exist at this point. Changes in calcitropic hormones may provide early insight into the development of metabolic syndrome in this population. Intervention studies should address whether correction of vitamin D status will delay the development of metabolic syndrome in this population.

Funding Sources

CNHP Seed Funding.

Calcium to Magnesium Ratio Higher Than Optimal Across Age Groups (P10-100-19)

Objectives

The ratio of calcium to magnesium (Ca: Mg) intake has gained immense attention in recent years, since a ratio above 2:1 has been associated with increased risk of metabolic, inflammatory and cardiovascular disorders. The objective of this study was to assess Ca: Mg ratios across age groups and to determine the relationship between Ca: Mg ratios and markers of inflammation.

Methods

Adult men and women, 18 to 60 years of age, completed a demographic form, a magnesium food frequency questionnaire and a calcium food frequency questionnaire. In a subset of individuals, biochemical assays were completed for inflammation markers such as interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), C-reactive protein (CRP) and matrix metallopeptidase 9 (MMP-9). Means, standard deviations, medians and interquartile ranges were calculated, and Pearson's correlations were conducted to determine the relationship between Ca: Mg ratio and markers of inflammation.

Results

Fifty-six adults were included in this analysis, and were categorized into four age categories: 18 to 29 years, 30 to 39 years, 40 to 49 years and 50 to 59 years. On average, participants were 28.87 ± 10.16 years of age, with a body mass index of 24.54 ± 3.72 kg/m2. Mean magnesium intake, calcium intake and Ca: Mg ratio for each age group were: 249.08 mg, 763.89 mg and 3.37 for the 18–29 years group, 226.59 mg, 730.50 mg and 3.58 for the 30 to 39 years group, 252.63 mg, 731.29 mg and 3.19 for the 40 to 49 years group and 286.03 mg, 595.03 mg and 2.79 mg for the 50 to 59 years group. All study groups had lower magnesium and calcium intakes compared to the Recommended Daily Allowances for these nutrients; however, the Ca: Mg ratio was higher than the optimal ratio of 2:1 in all age groups. In a subset, Ca: Mg ratio was significantly associated with IL-6 (r = 0.626, P = 0.017).

Conclusions

All age groups had a high Ca: Mg ratio above the optimal 2:1 ratio and in a subset of participants, a higher Ca: Mg ratio was associated with greater inflammation. Interventional studies should target lowering the Ca: Mg ratio in the diet and assess the effect of lowering Ca: Mg ratio on changes in metabolic markers.

Funding Sources

None.

Can bone-regulating hormones and nutrients help characterize the metabolically healthy obese phenotype

BACKGROUND:

Bone-regulating hormones and nutrients play an important role in influencing metabolic health.

AIM:

The aim of this study was to determine whether bone-regulating hormones and nutrients, such as parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and magnesium (Mg) could be used to characterize the metabolically healthy obese (MHO) phenotype.

METHODS:

This study included 27 overweight or obese participants (14 men/13 women) classified as MHO ( n = 14) or metabolically unhealthy obese (MUO) ( n = 13) based on the presence or absence of metabolic abnormalities, determined by percentage body fat, percentage trunk fat, and waist circumference. Biochemical (serum concentrations of hormones and cytokines such as PTH, 25OHD, ionized Mg (iMg), cytokines, lipids, glycemic indices), physiological (percentage body fat, percentage trunk fat, blood pressure (BP)), and dietary intake (Mg intake, calcium intake) measurements were obtained.

RESULTS:

Serum PTH concentrations were significantly lower ( p = 0.005) in the MHO group (39.68 ± 11.06 pg/mL) compared with the MUO group (63.78 ± 25.82 pg/mL). Serum iMg concentrations were higher ( p = 0.052) in the MHO group (0.565 ± 0.41 mmol/L) than in the MUO group (0.528 ± 0.050 mmol/L). Serum concentrations of osteocalcin were also higher (10.37 ± 3.70 ng/mL) in the MHO compared with the MUO (6.51 ± 4.14 ng/mL) group ( p = 0.017). The MHO group had significantly lower serum insulin concentrations ( p = 0.006) and diastolic BP ( p = 0.035). Concentrations of serum 25OHD, total triglycerides, C-reactive protein and systolic BP did not differ between groups.

CONCLUSIONS:

These findings suggest that bone-regulating hormones and nutrients, especially serum PTH, osteocalcin concentrations, and dietary Mg intakes, can help to characterize the MHO phenotype.

Occurrence of Listeria monocytogenes on the seafood contact surfaces of Tuticorin Coast of India

Listeria monocytogenes was screened from different seafood contact surfaces in five sampling sites of fishing harbour, fish landing centers, seafood processing plants, fish market, and fish curing yards of Tuticorin Coast of India. 115 swab samples were collected and tested for the occurrence of L. monocytogenes by conventional and molecular methods. Overall, 5.22% of swab samples collected were positive for L. monocytogenes. The fishing harbour had high incidence (10.3%) of L. monocytogenes followed by fish landing centers (5.9%), and seafood processing plants (4.1%). Boat deck, fish transport tricycle were the two seafood contact surfaces in fishing harbour, which had the occurrence of L. monocytogenes. The swab samples from fish market and fish curing yards were negative for L. monocytogenes. All the isolated colonies of L. monocytogenes were confirmed by PCR assay targeting virulent hlyA gene. The DNA of all the isolates yielded a product of 174 bp on PCR amplification in comparison with L. monocytogenes Type culture (MTCC 1143). The results clearly indicated the occurrence of L. monocytogenes in seafood contact surfaces along the Tuticorin Coast of India.

A clinical, dermoscopic, and histopathological study of Dermatosis Papulosa Nigra (DPN) - An Indian perspective

BACKGROUND

Dermatosis papulosa nigra (DPN) is a benign cutaneous condition which commonly occurs in dark-skinned people, especially Asians and African Americans. Owing to its benign nature and rarity, very few studies have been conducted to date, and dermoscopic studies are practically nonexistent.

OBJECTIVES

To study the clinical and epidemiological characteristics of patients with dermatosis papulosa nigra (DPN) and to correlate the clinical findings with dermoscopic and histopathological findings in DPN.

METHODS

A total of 100 patients attending the Dermatology outpatient department at Father Muller Medical College, Mangalore, India, with clinically diagnosed dermatosis papulosa nigra were included in the study. Histopathology and dermoscopic evaluation of the lesions were done, and the characteristics seen were noted.

RESULTS

Earlier onset of lesions was noted in our study, i.e. onset in the 4th decade as compared to the 6th decade in most other studies. A female preponderance, positive family history, history of sun exposure, and involvement of the head and neck were other significant associations. Histopathology revealed an acanthotic variant in all the lesions that were biopsied. The predominant dermoscopic finding was fissures and ridges of the cerebriform pattern followed by comedo-like openings.

CONCLUSION

Dermatosis papulosa nigra is a benign unaesthetic condition seen in Fitzpatrick skin types IV-VI. The diagnosis is mainly clinical; however, in a few cases histopathology and dermoscopy aid in differentiating it from other benign and malignant tumors. Dermoscopy, in particular, being a noninvasive investigative moiety is a rapid and accurate diagnostic tool.

Serum Parathyroid Hormone Responses to Vitamin D Supplementation in Overweight/Obese Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Obesity is often associated with vitamin D deficiency and secondary hyperparathyroidism. Vitamin D supplementation typically leads to the reductions in serum parathyroid hormone (PTH) levels, as shown in normal weight individuals. Meanwhile, the dose of vitamin D supplementation for the suppression of PTH may differ in overweight and obese adults. We conducted a systematic review and meta-analysis of randomized controlled trials to determine the dose of vitamin D supplementation required to suppress PTH levels in overweight/obese individuals. We identified 18 studies that examined overweight or obese healthy adults who were supplemented with varying doses of vitamin D3. The primary outcomes examined were changes in PTH and serum 25-hydroxyvitamin D (25OHD) levels from baseline to post-treatment. The results of the meta-analysis showed that there was a significant treatment effect of vitamin D supplementation on PTH, total standardized mean difference (SMD) (random effects) = -0.38 (95% CI = -0.56 to -0.20), t = -4.08, p < 0.001. A significant treatment effect of vitamin D supplementation was also found on 25OHD, total SMD (random effects) = 2.27 (95% CI = 1.48 to 3.06) t = 5.62, p < 0.001. Data from available clinical trials that supplemented adults with D3 ranging from 400 IU to 5714 IU, showed that 1000 IU of vitamin D supplementation best suppressed serum PTH levels, total SMD = -0.58, while vitamin D supplementation with 4000 IU showed the greatest increase in serum 25OH levels. Vitamin D and calcium supplementation of 700 IU and 500 mg, respectively, also showed a significant treatment effect on the suppression of PTH with a total SMD = -5.30 (95% CI = -9.72 to -0.88). In conclusion, the meta analysis of available clinical trials indicates that 1000 IU vitamin D supplementation can suppress serum PTH levels, while 4000 IU of vitamin D was associated with the largest increase in serum 25OHD levels in the overweight and obese population.

Three doses of vitamin D, bone mineral density, and geometry in older women during modest weight control in a 1-year randomized controlled trial

The effects of higher than recommended vitamin D doses on bone mineral density (BMD) and quality are not known. In this study, higher intakes, in postmenopausal women undergoing weight control over 1 year, had no effect on areal or volumetric BMD but prevented the deterioration in cortical bone geometry.

INTRODUCTION

Studies examining how bone responds to a standard dose of vitamin D supplementation have been inconsistent. In addition, the effects of higher doses on BMD and quality are not known. Postmenopausal women undergoing weight control to improve health outcomes are particularly at risk for bone loss and might benefit from supplemental vitamin D intake above the recommended allowance.

METHODS

This 1-year-long, randomized, double-blind controlled study addresses whether vitamin D supplementation, in healthy overweight/obese older women, affects BMD and bone structural parameters. In addition, bone turnover and serum total, free, and bioavailable 25-hydroxyvitamin D (25OHD) responses to one of three daily levels of vitamin D₃ (600, 2000, 4000 IU) with 1.2 Ca g/day during weight control were examined.

RESULTS

Fifty-eight women (age, 58 ± 6 years; body mass index, 30.2 ± 3.8 kg/m², serum 25OHD, 27.3 ± 4.4 ng/mL) were randomized to treatment. After 1 year, serum 25OHD concentrations increased to 26.5 ± 4.4, 35.9 ± 4.5, and 41.5 ± 6.9 ng/mL, in groups 600, 2000, and 4000 IU, respectively, and differed between groups (p < 0.01). Weight change was similar between groups (-3.0 ± 4.1 %). Cortical (Ct) thickness of the tibia changed by -1.5 ± 5.1 %, +0.6 ± 3.2 %, and +2.0 ± 4.5 % in groups 600, 2000, and 4000 IU, respectively, and each group was significantly different from each other (p < 0.05).

CONCLUSION

The decline in Ct thickness was prevented with higher vitamin D₃ supplementation, but there were no other significant changes due to treatment over 1 year. Whether these findings translate to changes in biomechanical properties leading to reduced fracture risk should be addressed in future studies.

A Clinicopathological and Dermoscopic Correlation of Seborrheic Keratosis

BACKGROUND

Seborrheic keratosis (SK) is the most common benign epidermal tumor of the skin. Even though SK has been well characterized clinically, dermoscopically, and histopathologically, data regarding clinical dermoscopic and histopathological correlation of different types of SK are inadequate.

AIM

We carried out this study to establish any correlation between the clinical, dermoscopic, and histopathological appearance of SK and its variants.

METHODS

This was a descriptive study. Patients with SK were evaluated with respect to age, sex, family history of similar lesions, site of lesions, and symptoms associated with the lesions. Dermoscopy was performed in all cases. Biopsies were taken from the lesions and assessed for histopathology.

RESULTS

The most common age group affected by SK was 31-50 years (42%). A female preponderance of 76% was seen. Majority of our patients had a positive family history (62%), though Sun exposure was not seen to be a major factor. The most common clinical variant was common SK (CSK) (46%). The most common dermoscopic findings seen in CSK were comedo-like (CL) openings, fissures and ridges (FR), and milia-like (ML) cysts. Dermatosis papulosa nigra and pedunculated SK had characteristic FR and CL openings on dermoscopy. Stucco keratoses showed network-like (NL) structures and sharp demarcation. CL opening on dermoscopy corresponded to papillomatosis and pigmentation, ML cysts corresponded to horn cysts, FR corresponded to papillomatosis, and NL structures corresponded to an increase in basal layer pigmentation.

CONCLUSIONS

This study emphasizes the use of dermoscopy in improving the diagnostic accuracy of SK. The correlation between the various histological and dermoscopic features is described.

Obesity Prevention in Older Adults

The number of older adults living in the USA, 65 years of age and older, has been steadily increasing. Data from the National Health and Nutrition Examination Survey (NHANES), 2007-2010, indicate that more than one-third of older adults, 65 years of age and older, were obese. With the increased rate of obesity in older adults, the purpose of this paper is to present research on different methods to prevent or manage obesity in older adults, namely dietary interventions, physical activity interventions, and a combination of dietary and physical activity interventions. In addition, research on community assistance programs in the prevention of obesity with aging will be discussed. Finally, data on federal programs for older adults will also be presented.

Cerebriform Cutaneous Lesions in Pemphigus Vegetans

Pemphigus vegetans is an autoimmune bullous disorder characterized by vegetating lesions commonly over the flexures. A 42-year-old female patient came with pemphigus vegetans presenting with interesting cerebriform morphology of the cutaneous lesions over the flexures. Cerebriform tongue, a morphology with typical pattern of sulci and gyri over dorsum of the tongue is a well-known sign seen in pemphigus vegetans. Interestingly, we noticed the typical sulci and gyri pattern in the skin lesions of pemphigus vegetans over the flexures of the body. This clinical sign can be used as a clue in the diagnosis of pemphigus vegetans. Morphology and physical characteristics are important for the diagnosis of the disease. Clinical signs always give a clue to the probable or possible diagnosis in most of the dermatological conditions.

Influence of vitamin D and estrogen receptor gene polymorphisms on calcium absorption: BsmI predicts a greater decrease during energy restriction

Low calcium absorption is associated with low bone mass and fracture. In this study, we use gold standard methods of fractional calcium absorption (FCA) to determine whether polymorphisms of intestinal receptors, vitamin D receptor (VDR) and estrogen receptor α (ESR1), influence the response to energy restriction. Fractional calcium absorption was measured using dual stable isotopes ((42)Ca and (43)Ca) in women given adequate calcium and vitamin D and examined at baseline and after 6 weeks of energy restriction or no intervention. After genotyping, the relationship between VDR and ESR1 genotypes/haplotypes and FCA response was assessed using several genetic models. One-hundred and sixty-eight women (53 ± 11 years of age) were included in this analysis. The ESR1 polymorphisms, PvuII and XbaI and VDR polymorphisms (TaqI, ApaI) did not significantly influence FCA. The BB genotype of the VDR polymorphism, BsmI, was associated with a greater decrease in FCA than the Bb/bb genotype. Multiple linear regression showed that the BsmI polymorphism or the VDR haplotype, BAt, in addition to changes in weight and vitamin D intake explained ~16% of the variation in changes in FCA. In conclusion, the reduction in calcium absorption due to energy restriction is greatest for those with the BB genotype. Previous candidate gene studies show that VDR polymorphisms are associated with higher risk for osteoporosis, and the current study supports the notion that the BsmI polymorphism in intestinal VDR may be contributing to alterations in bone health.

Vitamin D supplementation during short-term caloric restriction in healthy overweight/obese older women: Effect on glycemic indices and serum osteocalcin levels

The effect of vitamin D supplementation and caloric restriction (CR) on glycemic indices and osteocalcin (OC) is not clear. In this randomized controlled double blind trial, we examined whether vitamin D3 supplementation at 2500 IU/d (D) or placebo has differential effects on markers of insulin sensitivity and bone turnover in overweight/obese postmenopausal women during 6 weeks of caloric restriction (weight loss; WL, n = 39) compared to weight maintenance (WM, n = 37). Seventy-six women (57 ± 6 years) completed this study and the WL groups lost 4 ± 1% of body weight. Baseline serum 25-hydroxyvitamin D (25OHD) was 24.8 ± 5.6 ng/mL at baseline; the rise was greatest in WL-D group (p < 0.05). There was an interaction between vitamin D intake and weight on serum OC, insulin, glucose and markers of insulin sensitivity (p < 0.05). The change in OC was explained by changes in serum 25OHD and insulin (model R(2) = 25.6%). Overall, vitamin D supplementation and CR influence serum osteocalcin levels and modestly favor improvements in insulin sensitivity.

A comparative study of 10% KOH solution and 5% imiquimod cream for the treatment of Molluscum contagiosum in the pediatric age group

Background:

Although Molluscum contagiosum (MC) is a self-limiting condition, active therapy could prevent further spread and improve cosmesis. Most of the available treatment modalities traumatize the lesions and have to be undertaken in the hospital, therefore evoking panic in children. In the quest for an alternative therapy, this study comparing 10% potassium hydroxide (KOH) solution and 5% imiquimod cream was taken up.

Aims and Objectives:

To compare the efficacy and tolerability of 10% KOH and 5% imiquimod in the treatment of MC.

Materials and Methods:

This comparative study was conducted over a period of 18 months from October 2011 to March 2013, 40 patients between the age group of 1-18 years with clinically diagnosed MC were divided into two groups (lottery method), 20 patients were treated with 5% imiquimod cream (Group A) and the other 20 were treated with 10% KOH solution (Group B). Patients were followed up on the 4^th, 8^th and 12^th week of treatment.

Results:

At the end of 12 weeks, out of 20 patients who received 10% KOH, 17 patients showed complete disappearance, whereas out of 20 patients who received 5% imiquimod, only 10 patients showed total clearance of the lesions. Adverse events were more frequent with 10% KOH, pigmentary disturbances being the most common.

Conclusion:

With only minor adverse effects, 10% KOH is an inexpensive and efficient modality for the treatment of MC in the pediatric age group. Although 5% imiquimod was effective in clearing the lesions with minimal adverse effects, the longer duration required for its efficacy may deter its wider use.

Moderate weight loss in obese and overweight men preserves bone quality

BACKGROUND

Weight loss (WL) negatively affects bone mineral density (BMD) in older populations and has specifically been shown in women.

OBJECTIVE

In this prospective controlled trial, we examined variables of bone quality and endocrine changes after intentional WL in men.

DESIGN

Thirty-eight overweight and obese [mean ± SD body mass index (in kg/m²): 31.9 ± 4.4; age: 58 ± 6 y] men were recruited to either WL through caloric restriction or weight maintenance (WM) for 6 mo.

RESULTS

There was a -7.9 ± 4.4% and +0.2 ± 1.6% change in body weight in the WL and WM groups, respectively. There was a greater increase in femoral neck and total body BMD and bone mineral content (BMC) in the WM group than in the WL group (P-interaction effect < 0.05). In contrast, there was a trend for the tibia cortical thickness and area to decrease more in the WM group than in the WL group (P ≤ 0.08). There was a decrease in the periosteal circumference in both groups over time (P < 0.01) and no statistically significant changes in trabecular bone. Circulating total, free, and bioavailable estradiol decreased in the WL group compared with the WM group, and changes were different between groups (P < 0.05). Serum total and bioavailable testosterone increased in both groups (P < 0.01). Serum 25-hydroxyvitamin D increased to a similar extent in both groups (P < 0.05).

CONCLUSIONS

Moderate WL in overweight and obese men did not decrease BMD at any anatomical site or alter cortical and trabecular bone and geometry. Also, despite increased BMD at some sites when maintaining excess body weight, cortical bone showed a trend in the opposite direction.

A clinical and mycological study of dermatophytic infections

BACKGROUND

Dermatophytoses refer to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. According to observations worldwide, dermatophytoses are the most common of the superficial fungal infections. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity. Although common, the precise size of the problem defies measurement.

AIMS

The present study was undertaken to assess the clinical profile of dermatophytic infection and to identify the species of fungi that are prevalent in this region.

MATERIALS AND METHODS

A total of 100 patients clinically suspected for dermatophytoses were selected for the study. Direct microscopy in 10% potassium hydroxide (KOH) and culture was done in each case.

RESULTS

Out of 100 patients, the maximum were seen in the age groups of 16-30 years. Tinea corporis was the most common clinical type (44.3%) followed by tinea cruris (38.2%). Overall positivity by culture was 39% and by direct microscopy 96%.

CONCLUSION

Trichophyton rubrum was the predominant species isolated (67.5%) in all clinical types followed by Trichophyton mentagrophytes. Culturing the fungus may identify the species, but it is not essential for the diagnosis as it is not a sensitive test.

Vitamin D-binding protein levels in female patients with primary hyperparathyroidism

OBJECTIVE

To determine whether low levels of vitamin D-binding protein (DBP) are related to 25-hydroxyvitamin D (25[OH]D) deficiency in female patients with primary hyperparathyroidism (PHPT).

METHODS

Twenty-five female patients with PHPT (serum calcium level >10.2 mg/dL and intact parathyroid hormone (iPTH) level >66 pg/mL) and 25 healthy age- and body mass index-matched female control subjects were xaminod. Serum calcium and iPTH levels were determined by commercial laboratories. Levels of 25(OH)D and 1,25-dihydroxyvitamin D (1,25[OH]₂D) were determined by radioimmunoassay, and DBP level was determined by enzyme-linked immunosorbent assay.

RESULTS

Serum iPTH and calcium levels were higher in PHPT patients than control subjects (P<.001). Levels of 25(OH)D, albumin, and DBP were lower in the serum of PHPT patients than control subjects (P<.01). There were no significant differences in 1,25(OH)₂D and free 25(OH)D levels between PHPT patients and control subjects. DBP level was inversely correlated with calcium (r = -0.47; P<.01) and iPTH (r = -0.31; P<.05) levels. The 25(OH)D level correlated positively with both DBP (r = 0.28; P<.05) and albumin (r = 0.44; P<.05) levels.

CONCLUSION

Both serum 25(OH)D and DBP levels were lower in female patients with PHPT compared with control subjects. We suggest that a low DBP level contributes to the low 25(OH)D level observed in female PHPT patients. The etiology of the decrease in DBP and its relationship to calcium, 25(OH)D, and PTH levels require further investigation.

Clinico-etiological study of 30 erythroderma cases from tertiary center in South India

Background:

Erythroderma is a morphological reaction pattern of skin having many underlying causes and finding the etiology helps in the proper management of erythroderma cases.

Aim:

To evaluate the clinical profile, etiology of erythroderma and to correlate clinical diagnosis with histopathology.

Materials and Methods:

This study was performed at the department of dermatology, Father Muller Medical College and Hospital, Mangalore, South India. We studied 30 consecutive cases of erythroderma with respect to the epidemiological, clinical and histological data. Clinico-histological correlation was analyzed for etiology of erythroderma.

Results:

The mean age of onset was 52.3 years with a male to female ratio of 14:1. In addition to erythroderma, other co-existent features included pruritus, fever, lymphadenopathy, and edema. Of the pre-existing dermatoses, psoriasis was the most common (33.3%) disease followed by eczema (20%), atopic dermatitis (6.6%), pityriasis rubra pilaris (3.3%) and drug-induced erythroderma (16.6%). In 16.6% of cases, etiology could not be ascertained. Clinico-histopathological correlation could be established in 73.3% of cases.

Conclusion:

Clinical features were identical irrespective of etiology. Detailed clinico-histopathological examination helps to establish the etiology of erythroderma.

The clinical spectrum and antibiotic sensitivity patterns of staphylococcal pyodermas in the community and hospital

Context:

The uncontrolled use of antibiotics has resulted in a relentless spread of multiresistant strains of Staphylococcus aureus. There are studies conducted in medical colleges in Chandigarh, Chennai, Mumbai and Vellore comparing pyodermas in the community and hospital setting based on clinical and bacteriological parameters.

Aims:

This study, conducted over 1½ years from March 2009 to August 2010, aimed at analyzing the clinical spectrum and antibiotic sensitivity pattern of community and hospital-associated (HA) staphylococcal pyoderma. It also assessed the prevalence of methicillin-resistant S. aureus (MRSA) in the community and hospital cohort settings.

Subjects and Methods:

The study comprised of 200 cases of staphylococcal pyodermas, derived from the community (150 cases) and hospital (50 cases). Patients were evaluated based on their clinical presentation; antibiotic susceptibility was tested using the Kirby-Bauer disk diffusion method.

Statistical Analysis Used:

Statistical significance between individual attributes between the community and HA staphylococcal pyoderma groups was analyzed using Chi-square test and mean differences using student's t-test.

Results:

Factors associated with community-associated (CA) pyodermas were young age (P = 0.0021), primary pyodermas, and involvement of extremities, while those with HA pyodermas were middle age, secondary pyodermas, and significantly increased body surface involvement (P = 0.041). Incidence of CA-MRSA was 11.3%, while that of HA-MRSA was 18%.

Conclusions:

A high level of resistance to first-line drugs such as penicillin, ciprofloxacin and cotrimoxazole was observed, more so in the hospital strain than in the community strain. S. aureus demonstrated good susceptibility to cephalosporins. Though the two strains of MRSA differed clinically, they showed 100% sensitivity to vancomycin and linezolid.

Physico-functional and mechanical properties of chitosan and calcium salts incorporated fish gelatin scaffolds

Four types of fish gelatin scaffolds viz. gelatin (G), gelatin-chitosan (GC), gelatin-calcium acetate (GCA) and gelatin-chitosan-calcium acetate (GCCA) prepared were investigated for their functional properties, biomechanical strength, microstructural changes in relation to biodegradation. GC scaffold was superior with pH 3.15 and viscosity 9.40 cP. Chitosan and calcium acetate improved tensile strength (TS) and Young's modulus (YM), but lowered elongation at break (EAB). GCCA scaffold possessed moderate TS of 19.6 MPa, EAB of 4.76% and YM of 185 MPa. Foaming ability ratio of GC scaffold was high (3.41). GCA and GCCA scaffolds remained for 4 days before complete in vitro biodegradation. GC scaffold had larger cavities (180-300 μm) that were responsible for low swelling ratios and shrinkage factor. GCCA scaffold with moderate swelling rates, mechanical, functional properties and lowered biodegradation rate were found more suitable for biomedical applications.

A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma

Background:

Melasma is a common acquired cause of facial hyperpigmentation seen predominantly among females with significant psychological and social impact. It is often recalcitrant to treatment. Several topical hypopigmenting agents have been used to combat melasma. Hydroquinone and Kojic Acid are well established monotherapeutic agents for treating melasma.

Objectives:

This study focuses mainly on the efficacy of once daily application of 4% Hydroquinone and 0.75% Kojic Acid cream (containing 0.75% Kojic acid and 2.5% vitamin C) so as to determine an effective modality of treatment for facial melasma.

Materials and Methods:

A total number of 60 patients with facial melasma attending the Out-patient department of Dermatology, Venerology and Leprosy, Fr. Muller Medical College Hospital, Mangalore from Oct 2008-April 2010 were studied. Patients were allocated alternately to group A and group B. Group A patients received 4% Hydroquinone cream and group B patient received a Kojic Acid cream (which contained 0.75% Kojic acid and 2.5% vitamin C) and were advised to apply topically once daily at night. Patients were followed up on 4^th, 8^th and 12^th week. At each visit side effects were noted and clinical response to treatment was calculated using the MASI score.

Statistical Methods:

Chi square test, student ‘t’ test.

Results:

At the 4^th week post treatment evaluation, facial hyperpigmentation responded early to 4% Hydroquinone cream than to 0.75% Kojic Acid cream. At the end of 12 week treatment period, 4% Hydroquinone cream had an overall superiority to 0.75% Kojic Acid cream as a topical hypopigmenting agent.

Conclusion:

The results of the study show that 4% Hydroquinone cream is a better topical hypopigmenting agent with rapid rate of clinical improvement when compared to 0.75% Kojic Acid cream.

The effect of obesity on the relationship between serum parathyroid hormone and 25-hydroxyvitamin D in women

CONTEXT

Obesity is associated with lower serum concentrations of 25-hydroxyvitamin D (25OHD) and higher intact PTH. The threshold of 25OHD needed to maximally suppress intact PTH has been suggested as a marker of optimal vitamin D status.

OBJECTIVE

In this study, we hypothesized that whereas the obese have a higher serum PTH and lower 25OHD, suppression of serum PTH by 25OHD would be independent of body weight.

DESIGN, SETTING, AND PARTICIPANTS

We performed a retrospective analysis on 383 women (ages 24-75 y) with a wide range of body weights (43-185 kg) who were stabilized to 1-1.2 g calcium/d for 1 month before blood draw. Body composition, serum PTH, 25OHD, calcium, and creatinine were measured. Locally weighted regression and smoothing scatterplots were used to depict the association between serum PTH and 25OHD. A nonlinear exponential model determined the point for near maximal suppression of PTH by 25OHD.

RESULTS

The point for near maximal suppression of PTH by 25OHD for all women (body mass index, 31.4 ± 7.7 kg/m²) occurred at a 25OHD concentration of 21.7 ng/mL (95% confidence interval, 28-48 ng/mL). No point of maximal suppression was found for nonobese women, yet in the obese women (n = 207; body mass index, >30 kg/m²) suppression of PTH occurred at a 25OHD concentration of 11.1 ng/mL (95% confidence interval, 4.7-17.5 ng/mL).

CONCLUSIONS

These results suggest that if PTH is suppressed at a lower serum 25OHD in the obese compared to the entire population, the lower average 25OHD concentrations in the obese may not have the same physiological significance as in the general population.

Vitamin D supplementation and calcium absorption during caloric restriction: a randomized double-blind trial

BACKGROUND

Weight loss (WL) is associated with a decrease in calcium absorption and may be one mechanism that induces bone loss with weight reduction.

OBJECTIVE

Because vitamin D supplementation has been shown to increase true fractional calcium absorption (TFCA), the goal of this study was to examine the effect of vitamin D during WL or weight maintenance (WM).

DESIGN

A randomized, placebo-controlled, double-blind 6-wk study was conducted in 82 postmenopausal women [BMI (in kg/m(2); ±SD): 30.2 ± 3.7] with 25-hydroxyvitamin D [25(OH)D] concentrations <70 nmol/L during either WL or WM. All women were given 10 μg vitamin D(3)/d and 1.2 g Ca/d and either weekly vitamin D(3) (375 μg) or a placebo equivalent to 63 μg (2500 IU)/d and 10 μg (400 IU)/d, respectively. We measured TFCA with the use of dual-stable isotopes, 25(OH)D, parathyroid hormone, estradiol, calcitriol, and urinary calcium at baseline and 6 wk in weight loss and vitamin D(3)-supplementation (WL-D; n = 19), weight maintenance and vitamin D(3)-supplementation (WM-D; n = 20), weight loss and placebo (n = 22), and weight maintenance and placebo (n = 21) groups.

RESULTS

WL groups lost 3.8 ± 1.1% of weight with no difference between vitamin D(3) supplementation and the placebo. The rise in serum 25(OH)D was greatest in the WL-D group (19.8 ± 14.5 nmol/L) compared with in WM-D (9.1 ± 10.3 nmol/L) and placebo groups (1.5 ± 10.9 nmol/L). TFCA increased with vitamin D(3) supplementation compared with placebo treatment (P < 0.01) and decreased during WL compared with WM. Serum 25(OH)D or 1,25-dihyroxyvitamin D did not correlate with TFCA.

CONCLUSION

These data show that vitamin D supplementation increases TFCA and that WL decreases TFCA and suggest that, when calcium intake is 1.2 g/d, either 10 or 63 μg vitamin D/d is sufficient to maintain the calcium balance. This trial was registered at clinicaltrials.gov as NCT00473031.

Bone metabolism in obesity and weight loss

Excess body weight due to obesity has traditionally been considered to have a positive effect on bone; however, more recent findings suggest that bone quality is compromised. Both obesity and caloric restriction increase fracture risk and are regulated by endocrine factors and cytokines that have direct and indirect effects on bone and calcium absorption. Weight reduction will decrease bone mass and mineral density, but this varies by the individual's age, gender, and adiposity. Dietary modifications, exercise, and medications have been shown to attenuate the bone loss associated with weight reduction. Future obesity and weight loss trials would benefit from assessment of key hormones, adipokine and gut peptides that regulate calcium absorption, and bone mineral density and quality by using sensitive techniques in high-risk populations.

Darier-White disease in siblings responding to isotretinoin

Darier-White disease (keratosis follicularis) is a rare disorder of keratinization involving the epidermis, mucous membranes, and nails. It is said to occur as a result of mutation in the ATP2A2 gene located on chromosome 12q23-24.1. In this article we present the case of two brothers with exacerbations of Darier-White disease who responded very well to systemic retinoids without any side effects within 2 weeks of commencing treatment.

Hormonal and dietary influences on true fractional calcium absorption in women: role of obesity

The goal in this study was to examine the hormonal and dietary predictors of true fractional Ca absorption (TFCA) in adult women and to determine whether TFCA differs due to body weight. Results showed that TFCA is higher in obese individuals and dietary fat, estradiol, and 1,25-dihydroxy vitamin D are the most significant positive predictors of TFCA in adult women.

INTRODUCTION

Calcium absorption is an important determinant of calcium balance and is influenced by several factors. Previous studies have identified that age, intake of protein, fat and fiber, and hormones such as 1, 25-dihyroxyvitamin D (1,25(OH)(2)D(3)) influence absorption. The determinants of TFCA using the double isotope method, the gold standard estimate of absorption, have not been examined previously in adult women nor has the role of obesity been addressed.

METHODS

In this study, we examined the hormonal and dietary predictors of TFCA in adult women with a wide range of age, body weights, and nutrient intake. TFCA was measured using dual stable isotope ((42)Ca and (43)Ca) technique. Serum was analyzed for bone-regulating hormones, and dietary information was obtained through food records. The independent dietary factors and hormonal predictors (25-hydroxyvitamin D, 1,25(OH)(2)D(3), parathyroid hormone, and estradiol) of TFCA were analyzed using multiple regression analysis.

RESULTS

Two hundred twenty-nine women aged 54 ± 11 years old (24-75 years) and with BMI of 31 ± 7.0 kg/m(2) were eligible and were categorized into tertiles of body mass index (BMI) into leaner, overweight, and obese. In the entire group of women, total fat intake, estradiol, and 1,25(OH)(2)D(3) are significant positive predictors (p < 0.05). As expected, age is a significant negative predictor of TFCA (R (2) = 26%). TFCA is higher in obese women compared to non-obese women (p < 0.05).

CONCLUSION

Together, these data show that dietary fat is the most significant positive predictor of TFCA which may have implications for dietary intake for non-obese individuals who are more likely to have lower and potentially compromised Ca absorption.