Vitamin D and progression of carotid intima-media thickness in HIV-positive Canadians.

OBJECTIVES: Based on a growing body of evidence implicating low vitamin D status in the development of cardiovascular disease (CVD), we hypothesized that in Canadian HIV-positive adults, low 25-hydroxyvitamin D (25(OH)D) concentration would be associated with increased subclinical vascular disease progression. METHODS: We prospectively studied the relationship between baseline 25(OH)D and subsequent progression of carotid intima-media thickness (CIMT) between 2002 and 2011, in the Canadian HIV Vascular Study using stored blood specimens. RESULTS: Of the 128 participants, 89.1% were men, the mean age (standard deviation [SD]) was 46.5 (8.2) years, 93.8% were white, and 36.7% were current smokers. Mean (SD) annual CIMT follow-up was 5.9 (1.8) years (maximum 8.5 years), providing approximately 750 patient-years of follow-up. Mean (SD) CIMT progression was 0.027 (0.030) mm/year. Mean (SD) 25(OH)D was 95.0 (46.9) nmol/L. Only 13.3% of participants were vitamin D deficient (25(OH)D < 50 nmol/L), whereas 61.7% had a 25(OH)D exceeding the sufficiency threshold (75 nmol/L). Vitamin D quartiles were inversely associated with body mass index (BMI) (P = 0.034), total cholesterol to high-density lipoprotein (HDL) cholesterol ratio (P = 0.001) and parathyroid hormone concentration (P = 0.003), but not efavirenz exposure (P = 0.141). In linear regression analyses, baseline 25(OH)D as a continuous variable was inversely associated with CIMT progression in univariable (P < 0.001) and multivariable (P < 0.001) models. CONCLUSIONS: Baseline 25(OH)D was associated with CIMT progression in this relatively vitamin D replete, predominately white and male, Canadian HIV-positive population. Future research needs to establish causality as this may warrant more targeted screening or supplementation.

Water and sanitation associated with improved child growth.

OBJECTIVE: To examine the relation between household water and sanitation, and the risk of stunting and reversal of stunting in Khartoum and Crezira regions, Sudan. DESIGN: Prospective cohort study. SETTING: A total of 25 483 children aged 6-72 months from rural Sudan enrolled in an 18-month field trial in 1988 to study the effect of vitamin A supplementation on child health and survival. RESULTS: The mean height-for-age z-scores at baseline and the end of study were -1.66 and -1.55, respectively, for the group with water and sanitation facilities, and -2.03 and -1.94 for the group without water and sanitation, after adjustment for age, region, gender, mother's literacy, intervention group (vitamin A vs placebo), family wealth, breastfeeding and cleanliness. Among children of normal height-for-age at baseline, the risk of stunting (<-2 height-for-age z-score) was lowest in the group that came from homes that had both water and sanitation compared to children from homes without these facilities (multivariate RR=0.79, 95% CI 0.69-0.90). Among children stunted at baseline, those coming from homes with water and sanitation had a 17% greater chance of reversing stunting than those coming from homes without either facility (adjusted RR=1.17, 95% CI 0.99-1.38). We did not detect a synergistic association between access to water and sanitation. CONCLUSIONS: Water and sanitation are independently associated with improved growth of children. SPONSORSHIP: None.

Clinical and functional staging of oral submucous fibrosis.

OBJECTIVE: To investigate the association of location of bands in oral submucous fibrosis and extent of mouth-opening. DESIGN: Cross-sectional study. SETTING: University hospital, Pakistan. SUBJECTS: 325 patients who presented with oral submucous fibrosis in Karachi between January 1992 and October 1994, of whom 288 had data sufficient for analysis. MAIN MEASURES: Location of fibrous bands in the mouth and interincisal distance (mm). RESULTS: All subjects with labial bands had bands in the fauces, and all but one who had labial bands also had buccal bands. All those with buccal bands also had bands in the fauces. Of those with buccal bands, 42% did not have labial bands. The proportion of patients with bands in all three sites increased from functional stage A (interincisal opening < or = 10 mm) to stage C (interincisal opening > or = 20 mm) with a simultaneous reduction in the proportion of people with bands in one or two sites (X2 = 105, df = 4, P < 0.0001). CONCLUSIONS: Bands are common at the back of the mouth in mild cases of oral submucous fibrosis and, as the disease increases in severity, are more likely to be found anteriorly as well.

Increased severity of oral submucous fibrosis in young Pakistani men.

OBJECTIVE: To investigate the influence of age and sex on the incidence of severe oral submucous fibrosis (mouth opening 15 mm or less). DESIGN: Case (severe disease) control (mild disease) study. SETTING: University hospital, Pakistan. SUBJECTS: 147 patients with severe (mouth opening 15 mm or less) and 83 with mild disease (mouth opening 20 mm or more). MAIN MEASURES: Influence of sex and age on severity of oral submucous fibrosis. RESULTS: Men were twice as likely as women to have severe disease (odds ratio (OR) 2.0, 95% confidence interval (CI) of OR 1.15 to 3.47, P=0.02). Men in the 20-39 year age group were 4.8 times as likely as women to have severe disease (OR 5.8, 95% CI 2.15 to 15.5, P=0.00004). Men aged 40 years or more were 40% less likely to have severe disease than women (OR 0.6, 95% CI 0.19 to 1.88, P=0.39). CONCLUSIONS: Smoking increases the carcinogenic potential of submucous fibrosis. As men in this population smoke more than women, men with severe oral submucous fibrosis may develop oral cancer and die younger. Alternatively, young men may consume more areca nut than women.