Vitamin D insufficiency and disease risk in the elderly.

Vitamin D insufficiency, milder than deficiency, is common, and a risk of various diseases. Since vitamin D exert diverse actions, both skeletal and non-skeletal, its insufficiency is a risk of various diseases including osteoporosis, sarcopenia, cardiovascular disease, cancer, and even mortality. Regarding the association of vitamin D status and disease risk, a marked discrepancy exists between the results from the observational studies and intervention studies, mostly yielding the positive and negative results in the former and latter, respectively. Such inconsistency probably arises from methodological problems, of which the baseline vitamin D status would be the most important. Vitamin D intervention would be effective in the deficient/insufficient subjects, but not in sufficient subjects. Since the elderly subjects, especially the institutionalized people, are mostly vitamin D deficient/insufficient, they are likely to benefit from improvement of vitamin D status. Vitamin insufficiency is a risk of various diseases, and correcting the vitamin status alone would reduce the risk of many diseases, and favorable to avoid the undesirable consequences of polypharmacy in the elderly. Additionally, disease prevention by nutritional improvement is cheap and free from side effects, and suited for the primary prevention of diseases.

Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis.

Bariatric surgery is associated with a postoperative reduction of 25(OH) vitamin D levels (25(OH)D) and with skeletal complications. Currently, guidelines for 25(OH)D assessment and vitamin D supplementation in bariatric patients, pre- and post-surgery, are still lacking. The aim of this work is to analyse systematically the published experience on 25(OH)D status and vitamin D supplementation, pre- and post-surgery, and to propose, on this basis, recommendations for management. Preoperatively, 18 studies including 2,869 patients were evaluated. Prevalence of vitamin D insufficiency as defined by 25(OH)D < 30 ng/mL (75 nmol/L) was 85%, whereas when defined by 25(OH)D < 20 ng/mL (50 nmol/L) was 57%. The median preoperative 25(OH)D level was 19.75 ng/mL. After surgery, 39 studies including 5,296 patients were analysed and among those undergoing either malabsorptive or restrictive procedures, a lower rate of vitamin D insufficiency and higher 25(OH)D levels postoperatively were observed in patients treated with high-dose oral vitamin D supplementation, defined as ≥ 2,000 IU/daily (mostly D3-formulation), compared with low-doses (< 2,000 IU/daily). Our recommendations based on this systematic review and meta-analysis should help clinical practice in the assessment and management of vitamin D status before and after bariatric surgery. Assessment of vitamin D should be performed pre- and postoperatively in all patients undergoing bariatric surgery. Regardless of the type of procedure, high-dose supplementation is recommended in patients after bariatric surgery.

Association between anaemia and vitamin D insufficiency among 6- to 12-month-old infants: implications for clinical practice.

BACKGROUND: Anaemia and vitamin D insufficiency (VDI) are among the most common nutritional problems. Anaemia screening is routinely performed; however, screening for VDI is not usually recommended. OBJECTIVES: To study the association between anaemia and VDI and identify the risk factors for VDI. METHODS: We conducted a cross-sectional study of 120 infants aged 6-12 months attending a well-child clinic at Songklanagarind Hospital between December 2020 and November 2021. Sociodemographic data and 24-h food records were also collected. Blood samples were obtained for complete blood count and 25-hydroxyvitamin D [25(OH)D] levels. Logistic regression analysis was used to determine risk factors for VDI. RESULTS: The mean 25(OH)D level was 22.2 ± 8.9 ng/mL in anaemic infants and 27.2 ± 9.6 ng/mL in non-anaemic infants (P value 0.01). The median (IQR) Hb level was 11.1 g/dL (10.3, 11.4) in the VDI group and 11.4 g/dL (11, 12.1) in the non-VDI group (P value 0.002). The proportion of breastfed infants was higher in infants with anaemia (80%) (P < 0.001) and VDI (85.3%) (P < 0.001). Sunlight exposure <15 min/day (odds ratio [OR] 3.84; 95% confidence interval [CI]: 1.23-12.00; P = 0.020) was a risk factor, and vitamin D intake (OR 0.37; 95% CI: 0.20-0.74; P = 0.004) was a protective factor for VDI. CONCLUSION: Infants with anaemia, short duration of sunlight exposure, breastfeeding, low vitamin D intake, and low iron intake were more likely to be vitamin D insufficient. However, after adjustment in the multivariate analyses, only sunlight exposure and vitamin D intake were significantly associated with vitamin D insufficiency.

Anaemia and vitamin D insufficiency (VDI) are the 2 most common global nutrition-related problems. Recently, data have been reported on the association between anaemia and VDI; however, no data exist for infants in Thailand. We assessed the vitamin D levels in infants attending a well-child clinic and investigated possible correlations with anaemia. We found that infants with anaemia, short duration of sunlight exposure, breastfeeding, low vitamin D intake, and low iron intake were more likely to be vitamin D insufficient. However, anaemia was not shown to be an independent risk factor for VDI. Risk factor and protective factor for VDI were short duration of sunlight exposure and adequate vitamin D intake, respectively. Vitamin D supplementation to infants has been recommended in many countries, yet, it has not been implemented in Thailand or other tropical countries. We suggest that VDI should be of concern in infants with anaemia or breastfeeding, particularly among those with inadequate sunlight exposure and low vitamin D intake. Implementing vitamin D supplementation should be considered for future practice.

High prevalence of missed information related on bone health in orthogeriatric patients with fragility fractures of the pelvis-an institutional register-based analysis.

This is the first study that highlighted the amount of missed information related on bone health in orthogeriatric patients suffering fragility fractures of the pelvis and also evaluated its prevalence and differing etiology in the assessed patients, regarding osteoporosis and/or osteomalacia, based on laboratory and instrumental measurements. This evaluation should become a standardized procedure in the treatment of orthogeriatric patients presenting with a FFP. INTRODUCTION: Fragility fractures of the pelvis (FFP) are common in orthogeriatric patients. Secondary fracture prevention regarding evaluation and treatment of an underlying osteoporosis or osteomalacia is still often neglected. The purpose of this study was to evaluate the amount of missed information related on bone health in older adult FFP patients, the prevalence of vitamin D deficiency in assessed patients, and if fracture type-dependent distribution patterns could be observed. METHODS: A retrospective analysis of prospectively collected data of an institutional register was performed. Patients aged 80 years and older (n = 456) admitted with a FFP from 01/2003 until 12/2019 to a level I trauma center were included. RESULTS: In 456 patients, FFP type II were leading (66.7%). Diagnostics were conducted in 37.1% of the patients regarding measurement of vitamin D levels and 21.7% regarding DXA measurements; vitamin D deficiency was observed in 62.7%, indicators for an underlying osteomalacia in 45.8%, and an osteoporosis in 46.5% of the assessed patients. CONCLUSION: Although FFP are common and will increase, there is still a lack of secondary fracture prevention, starting with information related on bone health. In the assessed patients, a high prevalence of vitamin D deficiency was present, but no significant correlation between vitamin D level and type of fracture was observed. Ongoing education for varying etiology and specific treatment of these fractures is necessary, as surgical treatment was unified, but drug therapy remains different.

High prevalence of vitamin D insufficiency among South Asian pregnant women: a systematic review and meta-analysis.

Insufficiency of vitamin D, during pregnancy, is a common cause of various pregnancy-related complications. Despite such insufficiency being frequently reported among South Asian pregnant women, the absence of systematic review and meta-analysis renders the true extent of this problem being poorly characterised. In this systematic review, three main databases (PubMed, Scopus and Google Scholar) were searched for original studies. We included original studies published between 1January 2001 to 31 December 2019, conducted on pregnant women who lived in South Asian countries and reported the prevalence of vitamin D insufficiency among the study participants. Twenty studies with a total of 7804 participants from four South Asian countries finally met our selection criteria. Overall pooled prevalence of insufficiency was 65 % (95 % CI: 51 %, 78 %) with a significant heterogeneity (I2 = 99·37 %; P = 0·00). The average level of vitamin D ranged from 9 ng/ml to 24·86 ng/ml with a weighted mean of 16·37 ng/ml (weighted standard deviation 7·13 ng/ml). The highest prevalence of insufficiency was found in Pakistan (76 %) followed by India (67 %), Bangladesh (64 %) and Nepal (14 %). Results obtained in this study suggest that vitamin D insufficiency is highly prevalent among South Asian pregnant women. Being the first systematic review in this region, findings from this study will help the future studies and strengthen the evidence for policymakers to develop effective mitigation strategies.

Clinical, metabolic, and immunological characterisation of adult Ugandan patients with new-onset diabetes and low vitamin D status.

BACKGROUND: Low vitamin D concentrations are associated with metabolic derangements, notably insulin resistance and pancreatic beta-cell dysfunction in Caucasian populations. Studies on its association with the clinical, metabolic, and immunologic characteristics in black African adult populations with new-onset diabetes are limited. This study aimed to describe the clinical, metabolic, and immunologic characteristics of a black Ugandan adult population with recently diagnosed diabetes and hypovitaminosis D. METHODS: Serum vitamin D concentrations were measured in 327 participants with recently diagnosed diabetes. Vitamin D deficiency, vitamin D insufficiency, and normal vitamin D status were defined as serum 25 hydroxyvitamin D levels of < 20 ng/ml, 21-29 ng/ml, and ≥ 30 ng/ml, respectively. RESULTS: The median (IQR) age, glycated haemoglobin, and serum vitamin D concentration of the participants were 48 years (39-58), 11% (8-13) or 96 mmol/mol (67-115), and 24 ng/ml (18-30), respectively. Vitamin D deficiency, vitamin D insufficiency, and normal vitamin D status were noted in 105 participants (32.1%), 140 participants (42.8%), and 82 participants (25.1%), respectively. Compared with those having normal serum vitamin D levels, participants with vitamin D deficiency and insufficiency had higher circulating concentrations of interleukin (IL) 6 (29 [16-45] pg/ml, 23 [14-40] pg/ml vs 18 [14-32] pg/ml, p = 0.01), and IL-8 (24 [86-655] pg/ml, 207 [81-853] pg/ml vs 98 [67-224], p = 0.03). No statistically significant differences were noted in the markers of body adiposity, insulin resistance, and pancreatic beta-cell function between both groups. CONCLUSION: Vitamin D deficiency and insufficiency were highly prevalent in our study population and were associated with increased circulating concentrations of pro-inflammatory cytokines. The absence of an association between pancreatic beta-cell function, insulin resistance, and low vitamin D status may indicate that the latter does not play a significant role in the pathogenesis of type 2 diabetes in our adult Ugandan population.

Real-world assessment: effectiveness and safety of extended-release calcifediol and other vitamin D therapies for secondary hyperparathyroidism in CKD patients.

INTRODUCTION: Extended-release calcifediol (ERC), active vitamin D hormones and analogs (AVD) and nutritional vitamin D (NVD) are commonly used therapies for treating secondary hyperparathyroidism (SHPT) in adults with stage 3-4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI). Their effectiveness for increasing serum total 25-hydroxyvitamin D (25D) and reducing elevated plasma parathyroid hormone (PTH), the latter of which is associated with increased morbidity and mortality, has varied across controlled clinical trials. This study aimed to assess real-world experience of ERC and other vitamin D therapies in reducing PTH and increasing 25D. METHODS: Medical records of 376 adult patients with stage 3-4 CKD and a history of SHPT and VDI from 15 United States (US) nephrology clinics were reviewed for up to 1 year pre- and post-ERC, NVD or AVD initiation. Key study variables included patient demographics, concomitant usage of medications and laboratory data. The mean age of the study population was 69.5 years, with gender and racial distributions representative of the US CKD population. Enrolled patients were grouped by treatment into three cohorts: ERC (n = 174), AVD (n = 55) and NVD (n = 147), and mean baseline levels were similar for serum 25D (18.8-23.5 ng/mL), calcium (Ca: 9.1-9.3 mg/dL), phosphorus (P: 3.7-3.8 mg/dL) and estimated glomerular filtration rate (eGFR: 30.3-35.7 mL/min/1.73m2). Mean baseline PTH was 181.4 pg/mL for the ERC cohort versus 156.9 for the AVD cohort and 134.8 pg/mL (p < 0.001) for the NVD cohort. Mean follow-up during treatment ranged from 20.0 to 28.8 weeks. RESULTS: Serum 25D rose in all cohorts (p < 0.001) during treatment. ERC yielded the highest increase (p < 0.001) of 23.7 ± 1.6 ng/mL versus 9.7 ± 1.5 and 5.5 ± 1.3 ng/mL for NVD and AVD, respectively. PTH declined with ERC treatment by 34.1 ± 6.6 pg/mL (p < 0.001) but remained unchanged in the other two cohorts. Serum Ca increased 0.2 ± 0.1 pg/mL (p < 0.001) with AVD but remained otherwise stable. Serum alkaline phosphatase remained unchanged. CONCLUSIONS: Real-world clinical effectiveness and safety varied across the therapies under investigation, but only ERC effectively raised mean 25D (to well above 30 ng/mL) and reduced mean PTH levels without causing hypercalcemia.

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

BACKGROUND: Vitamin D is an essential micronutrient for bone mineralization and bone growth in children. There have been few studies to date of vitamin D status in infants aged 6-12 months in Southeast Asian countries. AIM: To examine the prevalence of vitamin D insufficiency (VDI, including vitamin D deficiency) in healthy infants and the risk factors for VDI in southern Thailand. METHODS: A cross-sectional study was carried out in 120 healthy infants aged 6-12 months and their mothers. Blood samples were obtained for measurement of serum calcium, phosphate, alkaline phosphatase, albumin, parathyroid hormone and 25-hydroxyvitamin D (25OHD) levels. The mothers were interviewed for their infants feeding intake, sunlight exposure, type of dress, and sunscreen use. Chi-square and t-test were used to compare between groups for categorical and continuous variables, respectively. Pearson correlation was used to identify the relationship between serum levels of 25OHD of the infants and other biochemical variables of the infants and serum levels of maternal 25OHD. Logistic regression analysis was used to identify the factors associated with vitamin D status. RESULTS: The prevalence of VDI in our study infants was high at 28.3%, all of whom were mainly breastfed infants. Subgroup analysis of the mainly breastfed infants found that the risk factors for VDI were maternal VDI and a short duration of sunlight exposure. The serum 25OHD levels of the mainly breastfed infants were significantly positively correlated with the maternal serum 25OHD levels (r = 0.49, p-value < 0.01) and with sunlight exposure duration (r = 0.40, p-value < 0.01). CONCLUSIONS: The prevalence of VDI was high in 6-12-month-old infants, particularly those who were mainly breastfed from VDI mothers, and who had short durations of sunlight exposure. As breast milk contains adequate amounts of most important vitamins and growth factors, breastfeeding is still encouraged for infants with 400 IU vitamin D daily supplementation to prevent VDI.

Vitamin D, oral health, and disease characteristics in juvenile idiopathic arthritis: a multicenter cross-sectional study.

BACKGROUND: Vitamin D deficiency has been associated with autoimmune diseases and oral health. Knowledge about the association between vitamin D status and oral conditions in JIA is limited. We aimed to investigate vitamin D status in a cohort of Norwegian children and adolescents with JIA and possible associations between serum vitamin D levels, clinical indicators of oral health, and JIA disease characteristics. METHODS: This multi-center, cross-sectional study, included individuals with JIA aged 4-16 years from three geographically spread regions in Norway. Demographic data, age at disease onset, disease duration, JIA category, disease status, medication, and vitamin D intake were registered. One blood sample per individual was analyzed for 25(OH) vitamin D, and the level of insufficiency was defined as < 50 nmol/L. A clinical oral examination was performed applying commonly used indices in epidemiological studies of dental caries, dental erosion, enamel defects, gingival bleeding, and oral hygiene. Serum vitamin D was used as exposure variable in multivariable regression analyses to estimate the associations between insufficient vitamin D level, JIA disease status, and oral conditions, with adjustments for age, sex, geographical region, BMI, seasonal blood sampling, and parental education. RESULTS: Among the 223 participants with JIA, 97.3% were Caucasians, 59.2% were girls, and median age was 12.6 years. Median disease duration was 4.6 years, and 44.4% had oligoarticular JIA. Mean serum vitamin D level was 61.4 nmol/L and 29.6% had insufficient levels. Vitamin D levels did not differ between sexes, but between regions, iso-BMI categories, age groups, and seasons for blood sampling. Insufficient vitamin D levels were associated with dentin caries (adjusted OR 2.89, 95% CI 1.43-5.86) and gingival bleeding (adjusted OR 2.36, 95% CI 1.10-5.01). No associations were found with active JIA disease or more severe disease characteristics. CONCLUSION: In our study, nearly 30% had vitamin D insufficiency, with a particularly high prevalence among adolescents. Vitamin D insufficiency was associated with dentin caries and gingival bleeding, but not with JIA disease activity. These results point to the need for a multidisciplinary approach in the follow-up of children with JIA, including an increased focus on vitamin D status and oral health.

Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol.

INTRODUCTION: The safety and efficacy of extended-release calcifediol (ERC) as a treatment for secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI) has been demonstrated in prospective randomized clinical trials (RCTs). ERC (Rayaldee®) was approved by the Food and Drug Administration in 2016 on the basis of these prospective RCTs. The current retrospective study assessed the postlaunch data available with respect to ERC's efficacy and safety in increasing serum 25-hydroxyvitamin D (25D) and reducing parathyroid hormone (PTH) in the indicated population. MATERIALS AND METHODS: Medical records of 174 patients who met study criteria from 15 geographically representative United States nephrology clinics were reviewed for 1 year before and after initiation of ERC treatment. Enrolled subjects had ages ≥18 years, stage 3 or 4 CKD, and a history of SHPT and VDI. Key study variables included patient demographics, medication usage, and laboratory results, including serial 25D and PTH determinations. RESULTS: The enrolled subjects had a mean age of 69.0 years, gender and racial distributions representative of the indicated population, and were balanced for CKD stage. Most (98%) received 30 mcg of ERC/day during the course of treatment (mean follow-up: 24 weeks). Baseline 25D and PTH levels averaged 20.3 ± 0.7 (standard error) ng/mL and 181 ± 7.4 pg/mL, respectively. ERC treatment raised 25D by 23.7 ± 1.6 ng/mL (p < 0.001) and decreased PTH by 34.1 ± 6.6 pg/mL (p < 0.001) with nominal changes of 0.1 mg/dL (p > 0.05) in serum calcium (Ca) and phosphorus (P) levels. DISCUSSION/CONCLUSION: Analysis of postlaunch data confirmed ERC's effectiveness in increasing serum 25D and reducing PTH levels without statistically significant or notable impact on serum Ca and P levels. A significant percentage of these subjects achieved 25D levels ≥30 mg/mL and PTH levels which decreased by at least 30% from baseline. Dose titration to 60 mcgs was rarely prescribed. Closer patient monitoring and appropriate dose titration may have led to a higher percentage of subjects achieving an increase in 25D levels to at least 50 ng/mL and a reduction in PTH levels of at least 30%.

The psychotropic effect of vitamin D supplementation on schizophrenia symptoms.

BACKGROUND: Schizophrenia is a multifactorial disease involving interactions between genetic and environmental factors. Vitamin D has recently been linked to many metabolic diseases and schizophrenia. Vitamin D plays essential roles in the brain in the context of neuroplasticity, neurotransmitter biosynthesis, neuroprotection, and neurotransmission. Vitamin D receptors are demonstrated in most brain regions that are related to schizophrenia. However, very few studies in the literature examine the effects of 25-hydroxyvitamin D (25OHD) on schizophrenia symptoms. METHODS: This study aimed to examine the effects of vitamin D replacement on positive, negative, and cognitive symptoms of schizophrenia. Serum 25OHD levels of 52 schizophrenia patients were measured. SANS and SAPS were used to evaluate the severity of schizophrenia symptoms, and the Wisconsin Card Sorting Test: CV4 was used for cognitive assessment. The study was completed with 40 patients for various reasons. The patients whose serum 25OHD reached optimal levels after vitamin D replacement were reevaluated with the same scales in terms of symptom severity. The SPSS 25 package program was used for statistical analysis. The Independent-Samples t-test was used to examine the relationship between the variables that may affect vitamin D levels and the vitamin D level and to examine whether vitamin D levels had an initial effect on the scale scores. RESULTS: The mean plasma 25OHD levels of the patients was 17.87 ± 5.54. A statistically significant relationship was found only between the duration of sunlight exposure and 25 OHD level (p < 0.05). The mean SANS and SAPS scores of the participants after 25OHD replacement (23.60 ± 15.51 and 7.78 ± 8.84, respectively) were statistically significantly lower than mean SANS and SAPS scores before replacement (51.45 ± 17.96 and 18.58 ± 15.59, respectively) (p < 0.001 for all). Only the total attention score was significantly improved after replacement (p < 0.05). CONCLUSION: The data obtained from our study suggest that eliminating the 25OHD deficiency together with antipsychotic treatment can improve the total attention span and positive and negative symptoms in schizophrenia. The 25OHD levels should be regularly measured, replacement should be started when necessary, and the patients should be encouraged to get sunlight exposure to keep optimal 25OHD levels.

The effect of PCOS status on atherosclerosis markers and cardiovascular disease risk factors in young women with vitamin D deficiency.

OBJECTIVE: To investigate whether polycystic ovary syndrome (PCOS) had further deteriorating influence on endothelial function or cardiometabolic parameters in women with vitamin D deficiency during reproductive age. STUDY DESIGN: The study group was composed of women with PCOS and vitamin D deficiency and insufficiency between the ages of 18 and 35 years. Age and body mass index (BMI)-matched women were chosen as controls. Serum 25(OH) Vit D levels below 20 ng/mL were considered as vitamin D deficiency. The cutoff level of vitamin D insufficiency was suggested at 30 ng/mL. Serum FSH, LH, estradiol, testosterone, DHEA-S, fasting glucose, total cholesterol, HDL, LDL, triglyceride levels were analyzed. Carotid artery intima-media thickness (CIMT) was measured, and the flow-mediated vasodilation (FMD) was calculated. RESULTS: CIMT and FMD values in both vitamin D deficiency and insufficiency subgroups showed no significant difference between PCOS and non-PCOS groups. There was a weak negative correlation between BMI, waist/hip ratio, CRP, and 25(OH) Vitamin D. CONCLUSION: PCOS is a heterogeneous disease with different combinations of the diagnostic components. Vitamin D is an important variable for a healthy cardiovascular system. We did not find any difference in early atherosclerotic markers and cardiometabolic features between PCOS and non-PCOS group with Vitamin D deficiency.

Assessment of Serum Vitamin D Levels in the serum of Patients with Postherpetic neuralgia and its correlation to pain severity: A cross-sectional comparative study.

INTRODUCTION: Vitamin D is an essential micronutrient for the maintenance of many functions in the human body. Postherpetic neuralgia (PHN) is caused by the reactivation of the latent varicella-zoster virus (VZV) in the neurons. This study aims to assess the serum vitamin D level in patients with PHN and to correlate the level of vitamin D with pain severity. METHODS AND MATERIALS: A hospital-based cross-sectional comparative study was conducted in the period from April 2019 to January 2021. One hundred and sixty-two individuals, matched for age and gender, divided into cases and controls (81 for each). Serum levels of 25(OH)D were measured for cases and controls. Demographic data were taken, and then the diagnosis of neuropathic pain in cases was established using the Douleur Neuropathique 4 (DN4) questionnaire. RESULTS: We included 39 (52%) males in the PHN group and 36 (48%) in the control group. There was no significant difference between groups regarding age, marital status, smoking and BMI. The duration of pain in our study had a mean of 7.6 ± 3.6 months. We found the DN4 score for the pain to be negatively associated with vitamin D levels (Pearson's correlation coefficient: -0.511, P = .000). The levels of vitamin D were moderately associated with pain duration (Pearson's correlation: -0.466, P = .000). CONCLUSION: PHN patients had a high prevalence of vitamin D deficiency and those who had vitamin D deficiency were older and had higher degrees of pain for a longer duration. In PHN patients, vitamin D deficiency was moderately associated with increased severity and duration of pain.

Vitamin D status in full-term exclusively breastfed infants versus full-term breastfed infants receiving vitamin D supplementation in Thailand: a randomized controlled trial.

BACKGROUND: Many international medical organizations recommend vitamin D supplementation for infants, especially exclusively breastfed infants. In Thailand, however, data regarding the vitamin D status in Thai infants are lacking. Such data would help to support physician decisions and guide medical practice. METHODS: Full-term, exclusively breastfed infants were randomized into two groups at 2 months of age to continue exclusive breastfeeding either without vitamin D supplementation (control group, n = 44) or with vitamin D3 supplementation at 400 IU/day (intervention group, n = 43) until 6 months of age. At 6 months, the serum vitamin D (25OHD) of the infants and their mothers, serum bone marker, and infants' growth parameters were compared between the two groups. RESULTS: The infants' serum 25OHD concentration was lower in the control group than intervention group (20.57 ± 12.66 vs. 46.01 ± 16.42 ng/mL, p < 0.01). More infants had vitamin D sufficiency (25OHD of > 20 ng/mL) in the intervention group than control group (93.0% vs. 43.2%, p < 0.01). There were no significant differences in the maternal 25OHD concentrations between the control and intervention groups (25.08 ± 7.75 vs. 23.75 ± 7.64 ng/mL, p = 0.42). Serum calcium, phosphorus, intact parathyroid hormone, alkaline phosphatase, and infants' growth parameters were comparable between the two groups. After adjustment for the confounding factors, 25OHD concentration in the intervention group was 25.66 ng/mL higher than the control group (95% confidence interval, 19.07-32.25; p < 0.001). Vitamin D supplement contributed to an 88.7% decrease in the prevalence of vitamin D insufficiency/deficiency (relative risk, 0.11; 95% confidence interval, 0.04-0.35; p < 0.01). CONCLUSIONS: Most full-term, exclusively breastfed Thai infants have serum vitamin D concentration below sufficiency level at 6 months of age. However, vitamin D supplementation (400 IU/day) improves their vitamin D status and prevents vitamin D deficiency. TRIAL REGISTRATION: The study was pre-registered in the Thai Clinical Trials Registry ( TCTR20190622001 ) on 22/06/2019.

Ineffectiveness of antenatal guidance intervention for vitamin D insufficiency and deficiency in pregnant women in Kyoto, Japan.

AIM: The aim of this study was to investigate the vitamin D status among healthy pregnant women in Japan, and to evaluate the effectiveness of the antenatal health guidance intervention for the pregnant women who were informed about their low vitamin D levels. METHODS: We measured the level of 25-hydroxyvitamin D (25[OH]D) using chemiluminescent immunoassay among the singleton pregnant women who received at antenatal routine check-up (8-24 weeks of gestation) with written consent during September 2017-September 2018. The measurement values were informed by the concerned physician and health guidance intervention was given to the pregnant women with inadequate Vitamin D status (25[OH]D < 30 ng/mL). At around 36 weeks of gestation, the measurement of 25(OH)D and a questionnaire regarding behavioral changes after the guidance was conducted. RESULTS: The average value of 25(OH)D of 1192 pregnant women before the guidance was 14.89 ± 4.85 ng/mL, and the prevalence of sufficient vitamin D status (25(OH)D ≥ 30 ng/mL) was 0.67% (8/1192). Nine hundred eighty-two pregnant women who had inadequate vitamin D status were followed, thereafter-guidance prevalence of sufficiency was 1.02% (10/982); insufficiency, 14.66% (144/982); and deficiency, 84.32% (828/982), respectively. Although the prevalence of deficiency was decreased after guidance intervention significantly, the prevalence was still high and the effect on behavioral changes was a little. CONCLUSION: The prevalence of vitamin D sufficient status among pregnant women in Japan was extremely low, which is a serious condition. It was also revealed the effectiveness of the antenatal health guidance intervention for pregnant women was not enough.

Efficacy of denosumab co-administered with vitamin D and Ca by baseline vitamin D status.

INTRODUCTION: In anti-osteoporosis drug trials, vitamin D and calcium (Ca) are common supplements; however, the optimal dose of each is unclear. Using data from the randomized, double-blind, placebo-controlled DIRECT trial, we assessed whether baseline serum 25-hydroxy vitamin D (25[OH]D) level influences the efficacy of denosumab co-administered with vitamin D and Ca. MATERIALS AND METHODS: In this prespecified sub-analysis, subjects with primary osteoporosis who received denosumab or placebo, plus vitamin D (≥ 400 IU/day) and Ca (≥ 600 mg/day), were classified as 25(OH)D deficient (< 20 ng/mL), insufficient (≥ 20 to < 30 ng/mL), and sufficient (≥ 30 ng/mL). Study endpoints included absolute serum 25(OH)D level at baseline, 12 months, and 24 months; change in serum 25(OH)D and bone mineral density (BMD) status from baseline; and incidence of new vertebral fractures at 24 months. RESULTS: In 475 denosumab-treated and 481 placebo-treated subjects, proportions with deficient/insufficient/sufficient 25(OH)D at baseline were 53.1%/37.1%/9.9% and 50.9%/42.0%/7.1%, respectively. Supplementation significantly increased mean serum 25(OH)D levels; at 24 months, mean levels were > 30 ng/mL (sufficient) in both treatment groups. Increase in BMD over time was higher in the denosumab group vs. placebo group in all three vitamin D status groups. At month 24, denosumab-treated subjects with deficient/insufficient baseline 25(OH)D had a significantly lower risk of new vertebral fracture vs. placebo-treated subjects. CONCLUSION: Among DIRECT trial subjects supplemented with ≥ 400 IU/day of vitamin D and ≥ 600 mg/day of Ca, baseline 25(OH)D sufficiency may not influence the efficacy of denosumab in increasing BMD or preventing vertebral fractures.

Vitamin D and stress urinary incontinence in pregnancy: a cross-sectional study.

OBJECTIVE: To assess the association between levels of vitamin D and urinary incontinence (UI) in pregnancy. DESIGN: A cross-sectional study. Secondary analysis of a randomised controlled trial. SETTING: Two university hospitals in Norway. POPULATION: A total of 851 healthy, pregnant women >18 years in gestational weeks 18-22 with a singleton live fetus. METHODS: Data on UI were collected from a questionnaire at inclusion and serum analysis of 25-hydroxy vitamin D (25(OH)D) was performed. Univariable and multivariable logistic regression analyses were applied to study associations between exposure and outcomes. MAIN OUTCOME MEASURES: Prevalence of self-reported UI, stress (SUI) and urge (UUI) or mixed UI. RESULTS: In total, 230/851 (27%) of the participants were vitamin D insufficient (25(OH)D <50 nmol/l) and 42% reported to have any UI. Women with 25(OH)D <50 nmol/l were more likely to report any UI (P = 0.03) and SUI (P < 0.01) compared with women with 25(OH)D ≥50 nmol/l. In a univariable logistic regression analysis, serum levels of 25(OH)D <50 nmol/l was associated with increased risk of any UI (odds ratio [OR] 1.5 with 95% CI 1.0-2.1), SUI only (OR 1.7, 95% CI 1.2-2.4), but not mixed UI or UUI only (OR 0.8, 95% CI 0.5-1.5). In a multivariable logistic regression model, serum levels of 25(OH)D <50 nmol/l were associated with a higher risk of experiencing SUI only (OR 1.5, 95% CI 1.1-2.2). CONCLUSIONS: Serum 25(OH)D <50 nmol/l was associated with increased risk of any UI, and SUI in particular. TWEETABLE ABSTRACT: Low levels of vitamin D are associated with increased risk of urinary incontinence in pregnancy.

Vitamin D insufficiency and deficiency are associated with a higher level of serum uric acid: A systematic review and meta-analysis.

Introduction/objectives: Several epidemiological studies have suggested that patients with vitamin D insufficiency and deficiency tend to have a higher level of serum uric acid compared with those with adequate vitamin D level although the results were inconsistent across the studies. The current systematic review and meta-analysis was conducted with the aim to summarize all the available data.Methods: A systematic review was conducted using MEDLINE and EMBASE database from inception to May 2018 to identify all studies that compared the level of serum uric acid between individuals with normal vitamin D level and patients with vitamin D insufficiency/deficiency. Eligible studies must be cohort or cross-sectional studies that consisted of two groups of adult participants, one with normal level of vitamin D (vitamin D level >30 ng/ml) and one with vitamin D insufficiency (vitamin D level 20-30 ng/ml) or vitamin D deficiency (vitamin D level of <20 ng/ml). Mean serum uric acid level and standard deviation of participants were extracted from each study to calculate mean difference (MD). Pooled MD was then calculated by combining MDs of each study using random-effects model.Results: A total of seven cross-sectional studies were eligible for the meta-analyses. Individuals with normal vitamin D level had a significantly lower serum uric acid level than patients with vitamin D insufficiency with the pooled MD of -0.33 mg/dl (95%CI, -0.61, -0.04), and also had a significantly lower serum uric acid level than patients with vitamin D deficiency with the pooled MD of -0.45 mg/dl (95%CI, -0.82, -0.08). The statistical heterogeneity of these meta-analyses was high with the I2 of 78% and 89%, respectively. Funnel plots of both meta-analyses were fairly symmetric and did not provide a suggestive evidence for the presence of publication bias.Conclusion: Both patients with vitamin D insufficiency and patients with vitamin D deficiency had a significantly higher level of serum uric acid compared with individuals with normal vitamin D level.

Implementing Evidence-Based Vitamin D Protocol in the Dialysis Clinic: An Educational Approach.

Vitamin D deficiency is prevalent among patients with chronic kidney disease (CKD) and even more pronounced in patients with kidney failure who are undergoing peritoneal dialysis and hemodialysis. This project was a nurse practitioner-led quality improvement project conducted in an outpatient hemodialysis unit that focused on determining if educating providers and hemodialysis unit clinical staff on vitamin D guidelines increased the awareness and monitoring of patients on hemodialysis. The number of patients screened for vitamin D levels increased from 29% to 100%, and 70% of patients tested were deficient in vitamin D. While the follow-up monitoring yielded a result of only 32%, we recommend processes and structures for long-term sustainability, such as periodic re-education, reminders and prompts for conducting needed follow-up, continued outcome monitoring, and champions to support the ongoing processes and structures.

Bone health and its association with vitamin D and other covariates: A community-based study among women in a rural area of West Bengal.

BACKGROUND: Low bone mineral density (BMD) is implicated in the pathogenesis of osteoporosis and osteopenia, and primarily manifest as fragile bones. This is a rapidly emerging global health problem with increasing prevalence in India. OBJECTIVES: The objective of this was to assess the status of bone health and find its determinants among women aged 40 years and above in a rural population of West Bengal. METHODS: A community-based cross-sectional study was conducted from May 2017 to April 2018 among 260 women aged 40 years and above residing in the selected villages of Singur through multistage random sampling. Each respondent was interviewed using a structured schedule. Serum Vitamin D and calcium levels were investigated. BMD was assessed through calcaneal quantitative ultrasound. Osteoporosis was diagnosed among those with T-score ≤-2.5, while those with 25(OH) Vitamin D <30 ng/ml were classified to have Vitamin D insufficiency (VDI). Individuals with BMD T-score <-1 were considered to have low BMD. Inferential statistics were employed to find the associates of poor bone health. RESULTS: Out of 260 participants, 34 (13.1%) were screened positive for osteoporosis and 77.7% had low BMD. Approximately 75% had VDI. On multivariable analysis, VDI (adjusted odds ratio [95% confidence interval] = 4.13 [2.12, 8.37]) was a significant predictor of low BMD after adjustment for poor education, decreasing diet score, menopause, presence of comorbidity, underweight, and overweight explaining 43.6% of the variance. CONCLUSION: Serum Vitamin D levels are implicated to play a crucial role in bone metabolism; however, its effect on the body in accordance with other important hormones should be explored.