Assessment the awareness of vitamin D deficiency among the general population in Syria: an online cross-sectional study.

BACKGROUND: Vitamin D deficiency is an importance preventable problem in the global and associates with lack levels of awareness about vitamin D. According to prior studies, in the Arab world, there is low of knowledge and awareness toward vitamin D deficiency. The target of our study is evaluating the knowledge level about vitamin D deficiency and determining the associated factors with levels of awareness of its. METHOD: This online cross-sectional study was performed in Syria between 25 February to 29 March 2023 to assess the levels of knowledge about vitamin D deficiency among general Syrian population. The study's survey was obtained from previously published research and we conducted a pilot study to assure the validity and clarity questionnaire. All Syrian individuals aged 18 or older who were able to read and write and willing to participate were included, while, non-Syrian nationality individuals and all medical staff (doctors, nurses, and medical students…), as well, those under 18 age were excluded. The questionnaire consisted of 23 questions separated into four categories. The first section was sociodemographic information of the study population. The second section measured the level awareness of the study population regarding the benefits of vitamin D. In addition, the third and fourth part evaluated knowing of the respondents about sources of and toxicity consequences of vitamin D. The data were analyzed by utilizing multivariate logistic regression in IBM, SPSS V.28 version. RESULTS: Overall, 3172 of the study population accepted to participate in this research and 57.9% the majority of them were aged in the range among 18 and 28. While, the average age of the respondents were 30.80 ± 11.957. Regarding with the awareness toward knowledge of advantages and source of vitamin D and outcomes of vitamin D toxicity. Most of the participants mentioned that vitamin D is used to treat bone disease and rickets and contributes in maintaining calcium and phosphates (91.4% and 84.6%, respectively). Whereas, more than half of them reported that sun exposure does not cause vitamin D poisoning and that vegetarians are more likelihood to have vitamin D than non-vegetarians, (54.1% and 54.9%, respectively). Only, age and occupation out of nine predictors variables were significantly correlated with adequate knowledge of Vitamin D (p-value < 0.05). The respondents aged more than 60 years were high probability to have good recognition of Vitamin D than participants aged between 18 and 28 years. (OR = 7.95). Retired participants have shown lower aware of Vitamin D 0.38 times than students. CONCLUSION: Our research revealed that most of the participated individuals have sufficient comprehension about vitamin D, despite, there were significant gap. Health education via programs by government health-care agencies, NGOs and social workers is necessary to increase the awareness and knowledge toward benefits, source, deficiency and toxicity of vitamin D to avoid injury several diseases such as rickets.

Ethnic-Based Assessment of Vitamin D and Magnesium Status in the Kingdom of Bahrain.

BACKGROUND: Vitamin D deficiency is a major global health problem. Most previous studies focused attention on the significant role of sunlight exposure in the homeostasis of vitamin D and calcium blood levels. Magnesium is pivotal in the proper functioning of vitamin D, and the physiologic functions of different organs require a balanced vitamin D and magnesium status. The relationship between sunlight exposure and blood levels of vitamin D and magnesium has often been overlooked. The aim of this study was to evaluate vitamin D and magnesium status based on sunlight exposure and ethnicity in Bahraini and expatriate workers. METHODS: A cross-sectional study was conducted between October 2018 and September 2019. One hundred and seventy-four subjects participated in this study were subdivided based on their ethnicity and work environment-dependent exposure to sunlight into four groups: (1) Bahraini exposed (n=94), (2) Bahraini non-exposed (n=25), (3) expatriate exposed (n=31), and (4) expatriate non-exposed (n=24). Blood levels of vitamin D and magnesium were evaluated for all the participants. RESULTS:  Independent of ethnicity, vitamin D levels were insignificantly different among the studied groups and were all below the normal reference range. Yet, there was still a sunlight-dependent increase in vitamin D level that could be seen only in Bahraini workers. Magnesium levels were significantly higher in expatriates when compared to Bahraini workers. Sunlight-exposed expatriates had significantly higher magnesium levels than their Bahraini counterparts, while there was no significant difference between both ethnicities in the non-exposed groups. CONCLUSION: Country- and ethnic-specific definitions for vitamin D status and sunlight exposure are recommended. The assessment of magnesium status is pivotal in the overall assessment of vitamin D status.

Assessment of vitamin D levels in patients with oral potentially malignant disorders and oral squamous cell carcinoma-A cross-sectional study.

Objectives: The aim of this study was to assess and compare the serum and salivary levels of Vitamin D in patients with oral potentially malignant disorders (OPMD) and Oral squamous cell carcinoma (OSCC) with healthy controls. Method: This cross-sectional study was carried out among 60 patients reporting to the department of Oral Medicine and Radiology, and included patients with OPMDs, OSCC and healthy controls. The Vitamin D levels were estimated using the chemiluminescence immunoassay. One-way ANOVA was used to compare mean and statistical difference between the groups. Tukey's post HOC test calculated for inter group difference. Serum and salivary Vitamin D levels were corelated with Pearson's coefficient. The values of p < 0.005 was considered as significant. Results: The levels of Vitamin D were decreased in study group as compared to controls both in serum and saliva. (p < 0.001). Between serum and salivary Vitamin D levels, a strong association was discovered using the Pearson's coefficient value of 0.737 (p < 0.001). Conclusion: In this study, patients with both OPMDs and OSCC had Vitamin D insufficiency & deficiency. Vitamin D level assessment should be included as a standard component of routine investigations for these individuals.

Assessment of the Relation Between Asthma Severity and Serum Vitamin D Levels: A Cross-Sectional Study.

Introduction Vitamin D3's importance for bone health in children and its potential role beyond musculocutaneous health is an ongoing area of research. This study assesses vitamin D3 deficiency prevalence in asthmatic children and its correlation with asthma cases and healthy controls.  Methods This cross-sectional study was conducted in a tertiary care hospital in Punjab, India among children between 5 and 15 years of age. Fifty children diagnosed with "bronchial asthma" who were under follow-up in the asthma clinic in outpatient and inpatient patients were enrolled as cases. Age-matched 50 healthy controls who presented for routine check-ups were enrolled in the control group. Demographic details were noted and clinical examination was done in all the cases. 25-(OH) vitamin D levels were estimated and compared in all cases and controls. The study also analyzed the relationship between 25-(OH) vitamin D levels with asthma control and severity. Results The study showed that serum vitamin D3 level was significantly decreased in asthmatic children (24.62 ± 14.95 ng/ml) as compared with the healthy control group (32.08 ± 12.22 ng/ml). Also, serum vitamin D3 level was significantly decreased in children with uncontrolled asthma (12.06 ± 4.68 ng/ml) as compared to children with well-controlled asthma (44.82 ± 10.48 ng/ml).  Conclusion The findings showed that low serum levels were observed more in asthmatic children as compared to healthy children. A correlation was also found between vitamin D3 levels and asthma severity, its control, and the number of acute exacerbations in the last year.

Novel Insights into Somatic Comorbidities in Children and Adolescents Across Psychiatric Diagnoses: An Explorative Study.

Many children with psychiatric disorders display somatic symptoms, although these are frequently overlooked. As somatic morbidity early in life negatively influences long-term outcomes, it is relevant to assess comorbidity. However, studies of simultaneous psychiatric and somatic assessment in children are lacking. The aim of this study was to assess the prevalence of somatic comorbidities in a clinical sample of children and adolescents with psychiatric disorders in a naturalistic design. Data were assessed from 276 children with various psychiatric disorders (neurodevelopmental disorders, affective disorders, eating disorders and psychosis) aged 6-18 years. These data were collected as part of routine clinical assessment, including physical examination and retrospectively analyzed. For a subsample (n = 97), blood testing on vitamin D3, lipid spectrum, glucose and prolactin was available. Results of this cross-sectional study revealed that food intake problems (43%) and insomnia (66%) were common. On physical examination, 20% of the children were overweight, 12% displayed obesity and 38% had minor physical anomalies. Blood testing (n = 97) highlighted vitamin D3 deficiency (< 50 nmol/L) in 73% of the children. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities. The main somatic comorbidities in this broad child- and adolescent psychiatric population consisted of (1) problems associated with food intake, including obesity and vitamin D3 deficiency and (2) sleeping problems, mainly insomnia. Child and adolescent psychiatrists need to be aware of potential somatic comorbidities and may promote a healthy lifestyle.

Preoperative vitamin D supplementation is a cost-effective intervention in arthroscopic rotator cuff repair.

BACKGROUND: This study investigates the potential role of preoperative 25(OH)D supplementation as a cost-effective strategy to decrease revision rotator cuff repair (RCR) rates and lower the total health care burden from patients undergoing primary arthroscopic RCR. Previous literature has emphasized the importance of vitamin D on bone health maintenance, soft tissue healing, and outcomes in RCR. Inadequate preoperative vitamin D levels may increase revision RCR rates following primary arthroscopic RCR. Although 25(OH)D deficiency is common in RCR patients, serum screening is not routinely performed. METHODS: A cost-estimation model was developed to determine the cost-effectiveness of both preoperative selective and nonselective 25(OH)D supplementation in RCR patients in order to reduce revision RCR rates. Prevalence and surgical cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean and lower and upper bounds of 1-year cost savings were calculated for both the selective and nonselective supplementation scenarios. RESULTS: Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost savings of $6,099,341 (range: -$2,993,000 to $15,191,683) per 250,000 primary arthroscopic RCR cases. Nonselective 25(OH)D supplementation of all arthroscopic RCR patients was calculated to result in a mean cost savings of $11,584,742 (range: $2,492,401-$20,677,085) per 250,000 primary arthroscopic RCR cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where the cost of revision RCR exceeds $14,824.69 and prevalence of 25(OH)D deficiency exceeds 6.67%. Additionally, nonselective supplementation is a cost-effective strategy in clinical scenarios where revision RCR cost is ≥$4216.06 and prevalence of 25(OH)D deficiency is ≥1.93%. CONCLUSIONS: This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce revision RCR rates and lower the overall health care burden from arthroscopic RCR. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the lower cost of 25(OH)D supplementation compared to serum assays.

Assessment of Vitamin D Levels and Other Bone Related Biochemical Markers in Healthy Adults in Rural Population of Uttarakhand, India.

Despite being close to equator and receiving sufficient sun rays, evidences revealed that Indians have severe deficiency of vitamin D (vit D) ranging from 41 to 100% in different geographical locations. Therefore, in this study levels of 25(OH)D (physiologically measurable form) along with other bone metabolism associated biochemical markers were determined in serum sample of 300 apparently healthy study subjects (rural) from Doiwala block of Dehradun district in the state of Uttarakhand. Demographic data was also obtained based on a structured questionnaire to establish an association between 25(OH)D levels and various dietary and socio-cultural factors. Results demonstrated that of all study subjects, 197 (65%) had 25(OH)D levels below < 12 ng/mL (deficient) and 65 (21%) had 25(OH)D levels between 12 and 20 ng/mL (insufficient) with all other markers falling within respectively established reference ranges. Further, in univariate analysis, gender, occupation (indoor and outdoor), education were independently associated with vitamin D status. Additionally, parathyroid hormone associated significantly with gender and occupation, while calcium associated significantly with gender, occupation and education. Lastly, regression analysis revealed that gender and occupation independently associated with vitamin D status of subjects. In conclusion, apparently healthy subjects showed considerable vitamin D deficiency thereby generating an urgent need for formulating and implementing better government policies for enrichment of vitamin D levels among rural adults of Uttarakhand in future. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01048-6.

Assessment of Serum 25-Hydroxyvitamin D and Its Association in Type 2 Diabetes Mellitus Elderly Patients with Kidney Disease: A Retrospective Cross Sectional Study.

The overall aim of this study is to determine the prevalence of vitamin D deficiency and its association with diabetic nephropathy in elderly patients with type 2 diabetes mellitus. This study is a single center retrospective cross-sectional design conducted at private medical center. The study group included all patients (18 years or older) suffering from type 2 diabetes mellitus that attended the diabetic clinic from September 2019 to January 2021. The main outcome variable is a trough level of (<20 ng/mL) for 25OHD. The patients were categorized as having diabetic nephropathy based on estimated glomerular filtration rate (eGFR). Total glycated hemoglobin (HbA1c), creatinine serum, Alb: Cr ratio, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were compared between vitamin D deficiency groups. Univariate and multivariate logistic regression was used to investigate the association between vitamin D deficiency and other significant anthropometric and biochemical factors. A p value < 0.05 was chosen as the criterion to make decisions regarding statistical significance. Among the 453 diabetic patients included in study, 48.6% (n = 220) were male and 51.4% (n = 233) were female. The mean age ± S.D of the patients was 54.5 ± 10.6 years old. Out of 453 diabetic patients, 71.1% (95% CI: 66.9%-75.3%) had vitamin D deficiency (25OHD < 20 ng/mL). There was a statistically significant association between 25OHD level and diabetic nephropathy in elderly patients with type 2 diabetes mellitus. Diabetic patients with e-GFR < 60 mL/min more likely to have vitamin D deficiency (p < 0.001). Similarly, individuals with Alb: Cr ratio > 30 mg/g were more likely to have vitamin D deficiency (p < 0.001). Moreover, diabetic patients with serum creatinine > 1.8 mg/dL were more likely to have vitamin D deficiency (p < 0.001). The study revealed a high prevalence of vitamin D deficiency in elderly patients with type 2 diabetes mellitus. A significant association was reported between 25-hydroxyvitamin D, e-GFR and Alb: Cr ratio.

Assessment of the vitamin D status and its determinants in young healthy students from Palestine.

The global prevalence of vitamin D deficiency is high. Poor vitamin D status, especially in women, has been reported in several countries in the Middle East despite adequate year-round sunlight for vitamin D synthesis. However, data on vitamin D status in Palestine are scarce. The aim of this cross-sectional study was to evaluate vitamin D status based on serum concentrations of 25-hydroxycholecalciferol [25-(OH)D] among young healthy Palestinian students (18-27 years) and to assess associations between 25-(OH)D concentrations and several predictors. The mean 25-(OH)D concentration of women (n 151) was 27⋅2 ± 14⋅5 nmol/l, with the majority having insufficient (31⋅1 %) or deficient (<60 %) 25-(OH)D status. Only 7 % of women achieved sufficient or optimal 25-(OH)D status. In contrast, men (n 52) had a mean 25-(OH)D concentration of 58⋅3 ± 14⋅5 nmol/l, with none classified as deficient, and most obtaining sufficient (55⋅8 %) or even optimal 25-(OH)D status (11⋅5 %). Among women, 98 % wore a hijab and 74 % regularly used sunscreen. Daily dietary vitamin D intake (3-d 24-h recalls) was 45⋅1 ± 36⋅1 IU in the total group (no sex differences). After adjustment, multiple linear regression models showed significant associations between 25-(OH)D concentrations and the use of supplements (B = 0⋅069; P = 0⋅020) and dietary vitamin D (B = 0⋅001; P = 0⋅028). In gender-stratified analysis, the association between supplement use and 25-(OH)D concentrations was significant in women (B = 0⋅076; P = 0⋅040). The vitamin D status of women in the present cohort is critical and appears to be mainly due to wearing a hijab, regular use of sunscreen and low dietary vitamin D intake. The vitamin D status of the women should be improved by taking vitamin D containing supplements or fortified foods.

Vitamin D deficiency in British South Asians, a persistent but avoidable problem associated with many health risks (including rickets, T2DM, CVD, COVID-19 and pregnancy complications): the case for correcting this deficiency.

High vitamin D deficiency rates, with rickets and osteomalacia, have been common in South Asians (SAs) arriving in Britain since the 1950s with preventable infant deaths from hypocalcaemic status-epilepticus and cardiomyopathy. Vitamin D deficiency increases common SA disorders (type 2 diabetes and cardiovascular disease), recent trials and non-linear Mendelian randomisation studies having shown deficiency to be causal for both disorders. Ethnic minority, obesity, diabetes and social deprivation are recognised COVID-19 risk factors, but vitamin D deficiency is not, despite convincing mechanistic evidence of it. Adjusting analyses for obesity/ethnicity abolishes vitamin D deficiency in COVID-19 risk prediction, but both factors lower serum 25(OH)D specifically. Social deprivation inadequately explains increased ethnic minority COVID-19 risks. SA vitamin D deficiency remains uncorrected after 70 years, official bodies using 'education', 'assimilation' and 'diet' as 'proxies' for ethnic differences and increasing pressures to assimilate. Meanwhile, English rickets was abolished from ~1940 by free 'welfare foods' (meat, milk, eggs, cod liver oil), for all pregnant/nursing mothers and young children (<5 years old). Cod liver oil was withdrawn from antenatal clinics in 1994 (for excessive vitamin A teratogenicity), without alternative provision. The take-up of the 2006 'Healthy-Start' scheme of food-vouchers for low-income families with young children (<3 years old) has been poor, being inaccessible and poorly publicised. COVID-19 pandemic advice for UK adults in 'lockdown' was '400 IU vitamin D/day', inadequate for correcting the deficiency seen winter/summer at 17.5%/5.9% in White, 38.5%/30% in Black and 57.2%/50.8% in SA people in representative UK Biobank subjects when recruited ~14 years ago and remaining similar in 2018. Vitamin D inadequacy worsens many non-skeletal health risks. Not providing vitamin D for preventing SA rickets and osteomalacia continues to be unacceptable, as deficiency-related health risks increase ethnic health disparities, while abolishing vitamin D deficiency would be easier and more cost-effective than correcting any other factor worsening ethnic minority health in Britain.

Interactive Effects of Maternal Vitamin D Status and Socio-Economic Status on the Risk of Spontaneous Abortion: Evidence from Henan Province, China.

BACKGROUND: Maternal vitamin D deficiency might generate adverse reproductive outcomes, and socio-economic inequalities in micronutrient-related diseases have often been found. This study aimed to explore the interactive effects of maternal vitamin D status and socio-economic status (SES) on risk of spontaneous abortion. METHODS: A population-based case-control study was conducted including 293 women with spontaneous abortion and 498 control women in December 2009 and January, 2010 in Henan Province, China. Information on pregnancy outcomes, maternal demographic, lifestyle and exposure factors and blood samples were collected at the same time. Vitamin D deficiency was defined as 25(OH)D < 20 ng/mL. SES index was constructed with principal component analysis by aggregating women's and their husbands' education level and occupation, and household income and expenditure. Interactive effects were assessed on a multiplicative scale with ratio of the odds ratio (ROR). RESULTS: Compared to those with high SES and vitamin D sufficiency, women with vitamin D deficiency and low SES index had an increased risk of spontaneous abortion (aOR: 1.99; 95% CI: 1.23-3.23). The ROR was 2.06 (95% CI: 1.04-4.10), indicating a significant positive multiplicative interaction. CONCLUSIONS: Maternal low SES may strengthen the effect of vitamin D deficiency exposure on spontaneous abortion risk in this Chinese population.

The association between tobacco smoke exposure and vitamin D levels among US general population, 2001-2014: temporal variation and inequalities in population susceptibility.

Tobacco smoking is endocrine-disrupting and may interfere with vitamin D endocrine systems (VDES), but supporting evidence is limited and inconsistent. Also, there is a lack of evidence on whether the association between tobacco smoke exposure and VD levels exhibit temporal variation. Data from the National Health and Nutrition Examination Survey was used to evaluate the association between tobacco smoke exposure and VD levels among US general participants from 2001 to 2014. We examined the linear association between serum cotinine and 25(OH)D concentrations, as well as relationship between tobacco smoke exposure categories (active, passive, non-smoking) with VD status (deficiency, inadequacy, sufficiency, intoxication), and assessed whether specific gender, age (3-11, 12-19, 20-59, ≥ 60 years), ethnicity/race, or body mass index (BMI) groups were disproportionately impacted. During 2001-2004, a decrease in both serum cotinine and passive smoking prevalence was observed, with a stabilized active smoking rate. The estimates for the association between tobacco smoke exposure and suboptimal VD levels increased over the study period. Overall results indicated that serum cotinine was negatively associated with 25(OH)D in all participants. Tobacco smoke exposure, including both active and passive smoking exposure, was associated with increased risk of VD deficiency. Moreover, active smoking was additionally related to enhanced risk of VD inadequacy. These associations showed some age and gender differences, with consistent and stronger associations observed in female adults. In contrast, effects of tobacco smoke exposure on VD levels were mostly negative or non-significant among children and adolescents aged 3-19 years. The percentage of US general population with active smoking exposure stabilized over the 14-year period and was still high. Tobacco smoke exposure may disrupt vitamin D levels with an increasing temporal trend in the risk. Our results also provided initial evidence of smoking exposure on VD intoxication, which needs to be further verified. Convincing studies have linked tobacco use exposure, to dysfunctional VDES accompanied with declined serum levels of VD metabolites. However, evidence on the association between tobacco smoke exposure and VD status was rather limited and inconsistent, and there were no researches to date that estimated the temporal variation of the association as well as the effects of smoke exposure on VD intoxication. This study analyzed national survey data, to evaluate the temporal trends in effects of tobacco smoke exposure on VD levels over a decade, and to comprehensively assess the impacts of tobacco smoke exposure on VD levels across specific subgroups. The evidence suggests that the prevalence of active smoking exposure stabilized over the 14-year period and was still high. Moreover, tobacco smoke exposure may disrupt vitamin D levels among general population, with an increasing temporal trend and age-, gender-differences in risk.

Burden of disease induced by public overexposure to solar ultraviolet radiation (SUVR) at the national and subnational levels in Iran, 2005-2019.

Estimating the burden of diseases induced by overexposure to solar ultraviolet radiation (SUVR) can help to prioritize environmental health interventions. The age-sex specific and cause-specific mortality and disability-adjusted life years (DALYs) attributable to overexposure to SUVR at the national and subnational levels in Iran, 2005-2019 were estimated. The burden of disease induced by overexposure to SUVR was quantified in four steps as follows: (1) estimating exposure to SUVR, (2) estimating total incidences and deaths of target causes, (3) assessing population attributable fractions of the target causes for the SUVR, and (4) calculating the attributable burden of disease. The attributable DALYs, deaths, age-standardized DALY rate, and age-standardized death rate at the national level were determined to be respectively 21896, 252, 42.59, and 0.56 in 2005 and were respectively changed to 28665, 377, 38.76, and 0.53 in 2019. The contributions of causes in the attributable DALYs at the national level were different by year and sex and for both sexes in 2019 were as follows: 46.15% for cataract, 20.36% for malignant skin melanoma, 16.07% for sunburn, 12.41% for squamous-cell carcinoma, and 5.01% for the other five causes. The contributions of population growth, population ageing, risk exposure, and risk-deleted DALY rate in the temporal variations of the attributable burden of disease in the country were +20.73%, +20.68%, +2.01%, and -12.51%. The highest and lowest provincial attributable age-standardized DALY rates in 2019 were observed in Fars (46.8) and Ardebil (32.7), respectively. The burden of disease induced by exposure to SUVR caused relatively low geographical inequality in health status in Iran. Due to increasing trends of the SUVR as well as the attributable burden of disease, the preventive interventions against the SUVR overexposure should be considered in the public health action plan all across the country.

Evaluation of vitamin D protocol in the neonatal intensive care unit at Rush University Medical Center.

BACKGROUND: In 2017, the neonatal intensive care unit (NICU) at Rush University Medical Center (RUMC) implemented a protocol to provide individualized vitamin D supplementation dosing for very low-birth-weight (VLBW) and very preterm infants. This study evaluated the association of demographic and socioeconomic factors, vitamin D dose, and health indicators, including bone mineral status, measured by alkaline phosphatase and phosphorus levels; linear growth velocity; and occurrence of fractures. METHOD: This retrospective cross-sectional study included 227 VLBW or very preterm infants (34 VLBW, 12 very preterm, and 181 VLBW and very preterm) born in and discharged from the RUMC NICU between February 1, 2017, and October 31, 2019. Vitamin D dose was classified as adjusted (supplemental dose of 800 IU/day, n = 169) or standard (recommended dose of 400 IU/day, n = 58), per the protocol. Binary logistic and linear regression models were constructed to test the associations between infant and maternal characteristics and vitamin D dose group and between vitamin D dose group and health indicators. RESULTS: The analysis found a statistically significant association between maternal age, gestational age, infant birth weight, and race/ethnicity and receipt of an adjusted vitamin D dose. No significant associations were found between health indicators and vitamin D dose. CONCLUSION: Sociodemographic factors may influence vitamin D deficiency in VLBW and very preterm infants in the NICU. At this time, there is insufficient evidence to support a tailored approach, but further research in this area is warranted.

Vitamin D Deficiency Is Inversely Associated with Homeostatic Model Assessment of Insulin Resistance.

The study was conducted to comprehensively assess the association of the concentration of vitamin D in the blood and insulin resistance in non-diabetic subjects. The objective was to pool the results from all observational studies from the beginning of 1980 to August 2021. PubMed, Medline and Embase were systematically searched for the observational studies. Filters were used for more focused results. A total of 2248 articles were found after raw search which were narrowed down to 32 articles by the systematic selection of related articles. Homeostatic Model Assessment of Insulin Resistance (HOMAIR) was used as the measure of insulin resistance and correlation coefficient was used as a measure of the relationship between vitamin D levels and the insulin resistance. Risk of bias tables and summary plots were built using Revman software version 5.3 while Comprehensive meta-analysis version 3 was used for the construction of forest plot. The results showed an inverse association between the status of vitamin D and insulin resistance (r = -0.217; 95% CI = -0.161 to -0.272; p = 0.000). A supplement of vitamin D can help reduce the risk of insulin resistance; however further studies, like randomized controlled trials are needed to confirm the results.

Prevalence and management of vitamin D deficiency in children with newly diagnosed coeliac disease: cohort study.

BACKGROUND: Coeliac disease (CD) causes deficiency of various micronutrients including vitamin D, and there are no specific guidelines for treatment. AIMS: To determine the prevalence of vitamin D deficiency in children newly diagnosed with CD and the role of oral high-dose vitamin D in its treatment. METHODS: Calcium intake, sun exposure and biochemical and radiological parameters related to vitamin D deficiency were compared between 60 children aged 0-18 years diagnosed with CD and 60 healthy age- and sex-matched controls. The cases with serum 25(OH)D (<20 ng/ml) were given oral vitamin D (60,000 IU/week) and calcium (500 mg/day) for 12 weeks, along with a gluten-free diet (GFD); they were re-evaluated within a week of completion. The primary outcome measure was the serum 25(OH)D level, and secondary measures included serum calcium, phosphorus, alkaline phosphatase, parathormone and clinical and/or radiological rickets. RESULTS: The prevalence of vitamin D deficiency (25(OH)D <20 ng/ml) was significantly greater in the cases (n=38, 63.3%) than in the controls (n=27, 45.0%). Upon treatment, all 38 cases with vitamin D deficiency showed a significant rise in 25(OH)D levels along with normalisation of other biochemical abnormalities. Two children had 25(OH)D levels >100 ng/ml with no other feature suggestive of vitamin D toxicity. CONCLUSIONS: Vitamin D deficiency is more prevalent in children with CD. Administration of oral high-dose vitamin D for 12 weeks along with a GFD leads to a robust response, indicating rapid mucosal recovery. The vitamin D dosage recommended for malabsorption states may be excessive in CD.Abbreviations: ALP: alkaline phosphatase; CaBP: calcium-binding proteins; CD: coeliac disease; GFD: gluten-free diet; PTH: parathormone; RU: reproducibility units; 25(OH)D: 25 hydroxy vitamin D.

Price Dispersion of Vitamin D Supplements Over Time: An Initiative for Prescriber Education.

OBJECTIVES: High prevalence of vitamin D deficiency mandates prescribing an appropriate form of vitamin D that allows attainment of sufficiency in a cost-effective manner. We aimed to compare vitamin D products in Indian market in terms of composition and cost in 2020 with 2013 to understand price dispersion over 7 years. METHODS: Constituents, formulations, and prices of 'branded' and generic vitamin D products were sourced from various drug information compendia and online sources. Price per defined daily dose (DDD), percentage cost variation, and change in prices over 7 years (2020 vs. 2013) was determined. RESULTS: There has been a disproportionate increase in the number of brands and cost variation of cholecalciferol and calcitriol in the last 7 years. The percentage cost variation increased almost 10 times for calcitriol and 4.4 times for alfacalcidiol tablets and cholecalciferol granules. An analysis of >1,100 products in 2020 showed that the predominant form was calcitriol which was combined with calcium in >90% of the products with huge cost variation (>3000%). Ergocalciferol and cholecalciferol were available in 22 and 15 different strengths respectively. Median price/unit of cholecalciferol (60,000IU) was lower for tablets/capsules compared to other formulations; but with >1000% cost variation. CONCLUSION: A wide cost variation exists with the use of different vitamin D brands and preparations with conventional cholecalciferol tablets and capsules being a low-priced alternative. Quality control measures and strict enforcements of existing regulations are essential to ensure that competitive prices of branded generics are translated into availability and affordability for the population.

[Assessment of relationship of lipid and carbon profile indicators with vitamin D supply in children depending on body mass index].

Overweight children represent a particularly vulnerable group for hypovitaminosis D. Clinical studies on the relationship between vitamin D (VD) deficiency and metabolic risk factors for cardiovascular disorders are controversial, and for children of primary school age who have overweight and obesity are insufficient. The aim of the research was to study the relationship between lipid and carbohydrate metabolism indicators and VD status in children, depending on the body mass index. Material and methods. A cross-sectional (one-step) study was carried out on a sample of 154 children with different weight of 8-10 years old (74 girls, 80 boys). Three groups of research participants were identified: group 1 - 44 obese, group 2 - 58 overweight, group 3 - 52 children with normal body weight. For all children, the serum level of 25(OH)D, parathyroid hormone (PTH), calcium (Ca), phosphorus (P), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglycerides (TG), ß-lipoproteins, glucose, insulin was determined, and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was also calculated. Results. VD deficiency in obese children was found almost 2.3 fold more often than in overweight (p=0.002) and 2.8 fold more often than in children with normal body weight (p=0.001). Indicators of lipid and carbohydrate metabolism were within physiological limits. However, in obese children they significantly exceeded the indicator of healthy children (p<0.05). When comparing the results of biochemical studies, it was revealed that children with VD deficiency [25(OH)D <20 ng/ml] had statistically significantly higher medians of PTH, TC, TG, ALT, AST, glucose, insulin, HOMA-IR and lower P and Ca level compared with children with normal micronutrient blood content (p<0.05). The medians of ALT, AST, TC, ß-lipoproteins, TG, glucose, insulin and HOMA-IR levels in obese children with VD deficiency were statistically significantly higher than in children with normal body weight and VD deficiency and in healthy children with an optimal concentration of 25(OH)D. At the same time, there was no statistically significant difference between the indicators of lipid and carbohydrate metabolism in the group of healthy children with normal VD status and its deficiency. Conclusion. VD deficiency is an important predictor of obesity complications and it exacerbates the risk of cardiometabolic disorders in children who are obese in the early school years.

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.

Can the palaeoepidemiology of rickets during the industrialisation period in France be studied through bioarchaeological grey literature and French medico-historical literature of the 18th-early 20th centuries? Preliminary examination of a complex topic.

OBJECTIVE: This study explores whether data relating to rickets from the French medico-historical literature (FMHL) and bioarchaeological grey literature are useful in evaluating its epidemiology during the industrialisation of France. Unlike other European countries such as England, industrialisation in France was a slow and continuous process with two phases: the first in 1830-1870 and the second in 1870-1914. MATERIALS AND METHODS: A bibliographical analysis of 2800 FMHL sources from the 18th to the early 20th centuries and 50 archaeological excavation reports from the last 21 years was undertaken. RESULTS: The FMHL data is very heterogeneous and predominantly dates to the second phase of industrialisation. The bioarchaeological data is very incomplete and predominantly relates to the period before industrialisation. At the same time, knowledge improvement and institutional changes to protect children could explain more systematic registration of cases of rickets. CONCLUSIONS: No solid conclusions can be made regarding the prevalence of rickets at present, however these data hold great potential. SIGNIFICANCE: In comparison to England, no systematic investigation of rickets prevalence during the period of industrialisation in France has been undertaken to date. LIMITATIONS: The lack of archaeological excavations from this period and the limited paleopathological analysis of the sites excavated have contributed to our current lack of understanding regarding the impact of industrialization on the prevalence of rickets on the French population. SUGGESTIONS FOR FURTHER WORK: The FMHL data needs to be homogenized and osteoarchaeological collections need to be restudied with a common protocol focusing on signs of vitamin D deficiency.