VITAMINA D EN LA PREVENCIÓN Y EVOLUCIÓN DE LA DIABETES MELLITUS / VITAMIN D IN THE PREVENTION AND EVOLUTION OF DIABETES MELLITUS

Introducción: El déficit de vitamina D y la diabetes son dos situaciones prevalentes en todas las edades, regiones geográficas y niveles socioeconómicos. La presencia de receptores para 1,25(OH)2D y la existencia de la enzima 1-α-hidroxilasa en la célula beta ­que permite la síntesis del metabolito activo­ sugieren que la vitamina D juega un papel importante en dichas células y que su deficiencia podría ser un factor capaz de acelerar el inicio y la evolución de la enfermedad. Objetivos: Se realizó una revisión del tema vitamina D y Diabetes. A su vez, se analizó el rol de la vitamina D en la insulinorresistencia y en la DM2, así como en la autoinmunidad y la DM1. También se indagó en el estado actual sobre los efectos de la suplementación con vitamina D en la prevención, el control glucémico y la evolución de las complicaciones asociadas a esta enfermedad. Materiales y Métodos: Se realizó una búsqueda bibliográfica utilizando los buscadores PubMed, MEDLINE, Cochrane, Research Gate. Los criterios de búsqueda fueron "vitamin D", "vitamin D and diabetes", "vitamin D and supplementation". Conclusiones: Existe suficiente evidencia acerca de que los niveles séricos de 25(OH)D deberían alcanzar valores entre 30 y 50 ng/ml para influir en las funciones metabólicas. Se enfatiza en la importancia de incluir el dosaje de 25(OH)D en el control clínico de rutina. Teniendo en cuenta la escasa distribución de la vitamina D en los alimentos naturales, el bajo consumo de los alimentos fuente en la población argentina y las recomendaciones actuales de limitar la exposición al sol por el cáncer de piel, emerge como necesario contar con alimentos fortificados de consumo masivo, además de la leche

Introduction: Vitamin D deficiency and diabetes are two prevalent situations in all ages, geographic regions and socioeconomic levels. The presence of receptors for 1,25(OH)2D and the existence of the enzyme 1-α-hydroxylase in the beta cell ­which allows the synthesis of the active metabolite­ suggest that vitamin D plays an important role in these cells and that vitamin deficiency could be a factor that can accelerate the onset and progression of the disease. Objectives: The subject vitamin D and Diabetes was review. The role of vitamin D in insulin resistance and DM2, as well as autoimmunity and DM1, were analyze. We also evaluated the effects of vitamin D supplementation on prevention, glycemic control and evolution of associated complications. Materials and methods: A bibliographic search was carried out using the search engines PubMed, MEDLINE, Cochrane, Research Gate. The search criteria were "vitamin D", "vitamin D and diabetes", "vitamin D and supplementation". Conclusions: There is sufficient evidence that blood levels of 25(OH)D should reach values between 30 and 50 ng/ml to influence metabolic functions. The importance of including 25(OH)D dosage in routine clinical control is emphasized. Taking into account the scarce distribution of vitamin D in natural foods, the low consumption of source foods in the Argentine population and the current recommendations to limit sun exposure due to skin cancer, it emerges as necessary to have fortified foods for mass consumption, in addition to milk

O que as revisões sistemáticas Cochrane mostram sobre a vitamina D? / What do Cochrane systematic reviews show about vitamin D?

Contextualização: A vitamina D tem sido utilizada na prática clínica e amplamente divulgada na mídia como opção preventiva ou terapêutica em muitas doenças esqueléticas e não esqueléticas, mas sua efetividade, em muitos casos, é ainda incerta. Objetivos: Sumarizar as evidências de revisões sistemáticas da Cochrane, referentes à efetividade da vitamina D para tratamento e prevenção de doenças. Métodos: Trata-se de overview de revisões sistemáticas Cochrane. Procedeu-se à busca na Cochrane Library (2023), sendo utilizado o descritor MeSH "VITAMIN D". Todas as revisões sistemáticas de ensaios clínicos foram incluídas. O desfecho primário de análise foi a melhora clínica, a redução dos sintomas ou a prevenção da doença. Resultados: 22 estudos foram incluídos, totalizando 284.404 participantes. Há evidência de baixa qualidade relativa a benefícios da suplementação da vitamina D na gestação para mãe e recém-nascido, não sendo encontrados, até o momento, benefícios para outras condições avaliadas. Discussão: Nenhuma intervenção mostrou efetividade com evidência de boa qualidade. Embora haja descrição de benefícios na redução do risco de pré-eclâmpsia, diabetes gestacional, baixo peso do bebê ao nascimento, redução no risco de hemorragia grave pós-parto e redução de fraturas em idosos (quando associada à suplementação de cálcio), esses achados têm evidência limitada e carecem de melhor análise no futuro próximo, a partir de novos ensaios clínicos. Conclusão: Atualmente, não há suporte com bom nível de evidência para a maioria das intervenções com suplementação de vitamina D, sendo recomendada a realização de novos ensaios clínicos para melhor robustez dos achados desses estudos.

25(OH)D levels during the COVID-19 pandemic: impact of lockdown and ultraviolet radiation.

BACKGROUND: Home confinement policies during the COVID-19 pandemic limited sun exposure and may have influenced on vitamin D levels. OBJECTIVE: To assess changes in 25(OH)D during the COVID-19 pandemic and the impact of Mandatory Preventive Social Isolation (MPSI) on UV radiation recommended dose modified by clouds for the synthesis of vitamin D (UVDVC). MATERIAL AND METHODS: A retrospective study was carried out on 15,908 patients in whom the level of 25(OH)D was determined between January 2019 and December 2021 in a centralized laboratory in Rosario, Argentina. RESULTS: Lower levels of 25(OH)D were documented in people younger than 40 years during 2020, as well as a variation during the pandemic period, with lower values in the first wave. Lower levels of 25(OH)D were recorded in the post-MPSI period in comparison with the MPSI period (p < 0.00001), in addition to a higher frequency of hypovitaminosis D (48.6% vs. 36.1%). These differences were not observed in the comparison of the same periods of 2019. UVDVC did not vary between 2019 and 2020. CONCLUSIONS: The restrictions due to the COVID-19 pandemic led to a higher frequency of hypovitaminosis D and lower frequency of optimal values.

ANTECEDENTES: Las políticas de confinamiento domiciliario durante la pandemia de COVID-19 limitaron la exposición solar y pudieron influir en los niveles de vitamina D. OBJETIVO: Evaluar los cambios en 25(OH)D durante la pandemia de COVID-19 y el impacto del aislamiento social, preventivo y obligatorio (ASPO) en la dosis recomendada de radiación UV modificada por las nubes para la síntesis de vitamina D (UVDVC). MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo de 15 908 pacientes en quienes se determinó el nivel de 25(OH)D entre enero de 2019 y diciembre de 2021 en un laboratorio centralizado en Rosario, Argentina. RESULTADOS: Se constataron niveles más bajos de 25(OH)D en menores de 40 años durante 2020, así como una variación durante el período pandémico, con menores valores en la primera ola. Se registraron menores niveles de 25(OH)D en el período posterior al ASPO en comparación con el período de ASPO (p < 0.00001), además de mayor frecuencia de hipovitaminosis D (48.6 % versus 36.1 %). No se observaron estas diferencias en la comparación de los mismos períodos de 2019. La UVDVC no varió entre 2019 y 2020. CONCLUSIONES: Las restricciones por la pandemia de COVID-19 llevaron a mayor frecuencia de hipovitaminosis D y menor frecuencia de valores óptimos.

Niveles de 25(OH)D durante la pandemia de COVID-19: impacto del confinamiento y la radiación ultravioleta / 25(OH)D levels during the COVID-19 pandemic: impact of lockdown and ultraviolet radiation

Resumen Antecedentes: Las políticas de confinamiento domiciliario durante la pandemia de COVID-19 limitaron la exposición solar y pudieron influir en los niveles de vitamina D. Objetivo: Evaluar los cambios en 25(OH)D durante la pandemia de COVID-19 y el impacto del aislamiento social, preventivo y obligatorio (ASPO) en la dosis recomendada de radiación UV modificada por las nubes para la síntesis de vitamina D (UVDVC). Material y métodos: Se realizó un estudio retrospectivo de 15 908 pacientes en quienes se determinó el nivel de 25(OH)D entre enero de 2019 y diciembre de 2021 en un laboratorio centralizado en Rosario, Argentina. Resultados: Se constataron niveles más bajos de 25(OH)D en menores de 40 años durante 2020, así como una variación durante el período pandémico, con menores valores en la primera ola. Se registraron menores niveles de 25(OH)D en el período posterior al ASPO en comparación con el período de ASPO (p < 0.00001), además de mayor frecuencia de hipovitaminosis D (48.6 % versus 36.1 %). No se observaron estas diferencias en la comparación de los mismos períodos de 2019. La UVDVC no varió entre 2019 y 2020. Conclusiones: Las restricciones por la pandemia de COVID-19 llevaron a mayor frecuencia de hipovitaminosis D y menor frecuencia de valores óptimos.

Abstract Background: Home confinement policies during the COVID-19 pandemic limited sun exposure and may have influenced on vitamin D levels. Objective: To assess changes in 25(OH)D during the COVID-19 pandemic and the impact of Mandatory Preventive Social Isolation (MPSI) on UV radiation recommended dose modified by clouds for the synthesis of vitamin D (UVDVC). Material and methods: A retrospective study was carried out on 15,908 patients in whom the level of 25(OH)D was determined between January 2019 and December 2021 in a centralized laboratory in Rosario, Argentina. Results: Lower levels of 25(OH)D were documented in people younger than 40 years during 2020, as well as a variation during the pandemic period, with lower values in the first wave. Lower levels of 25(OH)D were recorded in the post-MPSI period in comparison with the MPSI period (p < 0.00001), in addition to a higher frequency of hypovitaminosis D (48.6% vs. 36.1%). These differences were not observed in the comparison of the same periods of 2019. UVDVC did not vary between 2019 and 2020. Conclusions: The restrictions due to the COVID-19 pandemic led to a higher frequency of hypovitaminosis D and lower frequency of optimal values.

Risk of vitamin D deficit in asthmatic children hospitalized in the north area of Santiago / Riesgo de déficit de vitamina D en niños asmáticos hospitalizados en el área norte de Santiago

Introduction: in recent years asthma hospitalization rate in Chilean children has doubled. Numerous studies have shown an association between hypovitaminosis D and frequent, severe asthmatic exacerbations in children. Objective: to estimate the risk of vitamin D (vitD) deficiency and insufficiency in hospitalized asthmatic children compared with patients who are monitored on an outpatient basis and do not have records of hospitalization in one year. Material and methods: an observational, analytic, and case-control study carried out in one calendar year including asthmatic children between 5 and 15 years of age. This study registered: sociodemographic and clinical data, asthma control test, severity score of hospitalization and measurements of vitD blood levels. Associations between variables were analyzed using the t-test and chi-squared test. The risk for hypovitaminosis D and deficiency was calculated through logistic regression. The data was fed into the Stata 14 software. Results: a total of 117 patients, 9 ± 2.7 years old, were admitted, 64 % were male and 51 % presented with malnutrition by excess. Six out of ten children presented moderate asthma and 55 % had a poor control of their pathology; 73.5 % presented hypovitaminosis D (insufficiency and deficiency), hospitalized patients had 2.8 times more risk of presenting vitD deficiency, adjusted according to seasonality and age (95 %CI, 1.07-7.5, p < 0.05) without being associated with a higher severity score of hospitalization. Conclusion: Most of the asthmatic children in the sample presented with hypovitaminosis D, with a higher percentage of deficiency in hospitalized patients, which is not associated with greater severity of hospitalization. (AU)

Introducción: la tasa de hospitalización por asma se ha duplicado en los últimos años en Chile. Numerosos estudios demuestran una asociación entre la hipovitaminosis D y la presencia de exacerbaciones frecuentes y severas. Objetivo: comparar el riesgo de déficit e insuficiencia de vitamina D (vitD) en niños asmáticos que se hospitalizan en relación con los que se tratan ambulatoriamente. Material y métodos: estudio observacional, analítico, de casos y controles realizado durante 1 año calendario. Se incluyó a pacientes asmáticos de 5 a 15 años. Se registraron datos sociodemográficos, clínicos, nivel de control de asma, puntaje de severidad de hospitalización y se midió la concentración sanguínea de vitD. Se analizó la asociación entre las variables mediante la prueba de la t y la del chi cuadrado. Mediante regresión logística se calculó el riesgo de hipovitaminosis D y déficit de vitD en los sujetos. Los datos se analizaron con el software Stata 14. Resultados: se enrolaron 117 pacientes de 9 ± 2,7 años, 64 % de varones y 51 % con malnutrición por exceso. Seis de cada diez niños presentaban asma moderada y el 55 % tenían mal control de su enfermedad. El 73,5 % de los sujetos presentaban hipovitaminosis D (déficit o insuficiencia). Los hospitalizados tuvieron 2,8 veces más riesgo de presentar déficit de vitD (IC 95 %: 1,07-7,5), ajustado según estacionalidad y edad, sin asociarse a mayor puntaje de severidad de la hospitalización. Conclusión: la mayoría de los niños asmáticos de la muestra presentan hipovitaminosis D, siendo mayor el porcentaje de déficit en los hospitalizados, lo que no se asocia a mayor severidad de la hospitalización. (AU)

Variaciones y diferentes percepciones en la suplementación con vitamina D en la edad pediátrica en España / Variations and different perceptions in vitamin D supplementation in paediatric age in Spain

Introducción: el raquitismo es un problema de salud a nivel global. La deficiencia de vitamina D se ha convertido en una pandemia, su interés ha aumentado por la implicación de la misma en múltiples acciones extraesqueléticas. Material y métodos: se realizó una encuesta a través de correo electrónico entre pediatras españoles para estudiar su actitud en relación con la suplementación profiláctica de vitamina D. Resultados: un 83% de los pediatras tienen políticas de profilaxis de vitamina D en su área. Un 61,6% inicia la profilaxis en las dos primeras semanas y un 81,5% la mantiene el primer año. Un 57,2% realiza una búsqueda de deficiencia de vitamina D, sobre todo si trabajan en medio hospitalario. Conclusiones: las políticas de profilaxis con vitamina D son bastantes uniformes. Más de la mitad de los pediatras españoles realizan una búsqueda sistemática mediante analítica de deficiencia de vitamina D en sus pacientes con factores de riesgo durante la infancia y adolescencia (AU)

Introduction: rickets is a global health problem. Vitamin D deficiency has become a pandemic, its interest has increased due to its implication in multiple extraskeletal actions.Material and methods: a survey was conducted by e-mail among spanish paediatricians to study their attitude regarding prophylactic vitamin D supplementation.Results: 83% of pediatricians have vitamin D prophylaxis policies in their area. 61.6% start prophylaxis in the first two weeks, 81.5% maintain it the first year. 57.2% search for vitamin D deficiency, especially if they work in a hospital.Conclusions: vitamin D prophylaxis policies are uniform. More than a half of Spanish pediatricians conduct a systematic search for vitamin D deficiency in their patients with risk factors during childhood and adolescence (AU)

Programa de resistência muscular para membros inferiores melhora sarcopenia urêmica / Muscular resistance program for lower limbs improves uremic sarcopenia

Insuficiência renal crônica (IRC) é caracterizada pela deterioração irreversível dos néfrons, que causa uma condição crônica com prejuízo do desempenho físico dos indivíduos, principalmente de membros inferiores (MMII), devido a sarcopenia urêmica e déficit de vitamina D. Objetivo: Avaliar a eficiência de um programa de resistência muscular para MMII de pacientes com IRC. Métodos: Cinco pacientes com IRC participaram do programa de reabilitação que ocorreu 30 minutos antes do início da hemodiálise (HD), duas vezes por semana, cada sessão teve duração de 20 minutos, totalizando 14 sessões, sendo a primeira e última, destinadas a avaliação. A intervenção consistiu de circuito funcional e exercícios resistidos, isotônicos de cadeia cinética aberta e fechada. Foi avaliado o teste de sentar e levantar em 30 segundos e teste de uma repetição máxima (1RM). Resultados: Após a aplicação, foi verificado que a força muscular pós (2,92 ± 1,10) foi estatisticamente maior que a pré (1,90 ± 1,29, p= 0,02), além de evidenciar que as variáveis da progressão da carga e força muscular pós, estão diretamente correlacionadas (r² 0,976, p= 0,005). O desempenho no teste de sentar e levantar em 30 segundos obteve diferença significativa pré (6,8 ± 2,28) e pós intervenção (10,4 ± 1,67, p= 0,004). Conclusão: O programa de resistência muscular de MMII foi eficaz, visto que aumentou o desempenho físico funcional com ganho de força e resistência muscular em pacientes em HD

Chronic renal failure (CRF) is characterized by the irreversible deterioration of the nephrons, which causes a chronic condition with impaired physical performance of individuals, mainly of the lower limbs (LL), due to uremic sarcopenia and vitamin D deficit. Objective: To evaluate the efficiency of a muscular resistance program for the lower limbs of patients with CRF. Methods: Five patients with CRF participated in the rehabilitation program that took place thirty minutes before the beginning of hemodialysis (HD), twice a week, each session lasted 20 minutes, totaling 14 sessions, the first and last ones were destinated for evaluation. The intervention consisted of functional circuit and resistance exercises, isotonic with open and closed kinetic chain. The 30-second sit-and-stand test and the one maximum repetition test (1MR) were evaluated. Results: After application, it was found that post muscle strength (2.92 ± 1.10) was statistically higher than pre (1.90 ± 1.29, p= 0.02), in addition to showing that the variables of load progression and post muscle strength are directly correlated (r² 0.976, p= 0.005). The performance in the 30-second sit and stand test showed a significant difference pre (6.8 ± 2.28) and post intervention (10.4 ± 1.67, p= 0.004). Conclusion: The lower limbs muscular resistance program was effective, as it increased functional physical performance with gains in muscle strength and endurance in hemodialysis patients

Risk of vitamin D deficit in asthmatic children hospitalized in the north area of Santiago.

Introduction: Introduction: in recent years asthma hospitalization rate in Chilean children has doubled. Numerous studies have shown an association between hypovitaminosis D and frequent, severe asthmatic exacerbations in children. Objective: to estimate the risk of vitamin D (vitD) deficiency and insufficiency in hospitalized asthmatic children compared with patients who are monitored on an outpatient basis and do not have records of hospitalization in one year. Material and methods: an observational, analytic, and case-control study carried out in one calendar year including asthmatic children between 5 and 15 years of age. This study registered: sociodemographic and clinical data, asthma control test, severity score of hospitalization and measurements of vitD blood levels. Associations between variables were analyzed using the t-test and chi-squared test. The risk for hypovitaminosis D and deficiency was calculated through logistic regression. The data was fed into the Stata 14 software. Results: a total of 117 patients, 9 ± 2.7 years old, were admitted, 64 % were male and 51 % presented with malnutrition by excess. Six out of ten children presented moderate asthma and 55 % had a poor control of their pathology; 73.5 % presented hypovitaminosis D (insufficiency and deficiency), hospitalized patients had 2.8 times more risk of presenting vitD deficiency, adjusted according to seasonality and age (95 %CI, 1.07-7.5, p < 0.05) without being associated with a higher severity score of hospitalization. Conclusion: Most of the asthmatic children in the sample presented with hypovitaminosis D, with a higher percentage of deficiency in hospitalized patients, which is not associated with greater severity of hospitalization.

Introducción: Introducción: la tasa de hospitalización por asma se ha duplicado en los últimos años en Chile. Numerosos estudios demuestran una asociación entre la hipovitaminosis D y la presencia de exacerbaciones frecuentes y severas. Objetivo: comparar el riesgo de déficit e insuficiencia de vitamina D (vitD) en niños asmáticos que se hospitalizan en relación con los que se tratan ambulatoriamente. Material y métodos: estudio observacional, analítico, de casos y controles realizado durante 1 año calendario. Se incluyó a pacientes asmáticos de 5 a 15 años. Se registraron datos sociodemográficos, clínicos, nivel de control de asma, puntaje de severidad de hospitalización y se midió la concentración sanguínea de vitD. Se analizó la asociación entre las variables mediante la prueba de la t y la del chi cuadrado. Mediante regresión logística se calculó el riesgo de hipovitaminosis D y déficit de vitD en los sujetos. Los datos se analizaron con el software Stata 14. Resultados: se enrolaron 117 pacientes de 9 ± 2,7 años, 64 % de varones y 51 % con malnutrición por exceso. Seis de cada diez niños presentaban asma moderada y el 55 % tenían mal control de su enfermedad. El 73,5 % de los sujetos presentaban hipovitaminosis D (déficit o insuficiencia). Los hospitalizados tuvieron 2,8 veces más riesgo de presentar déficit de vitD (IC 95 %: 1,07-7,5), ajustado según estacionalidad y edad, sin asociarse a mayor puntaje de severidad de la hospitalización. Conclusión: la mayoría de los niños asmáticos de la muestra presentan hipovitaminosis D, siendo mayor el porcentaje de déficit en los hospitalizados, lo que no se asocia a mayor severidad de la hospitalización.

The impact of vitamin D deficiency on clinical, biochemical and metabolic parameters in primary hyperparathyroidism.

BACKGROUND: It has been suggested that vitamin D deficiency is associated with worse clinical outcomes in primary hyperparathyroidism (PHPT). We aimed to evaluate the relationship between vitamin D deficiency and clinical, biochemical and metabolic parameters in PHPT patients. METHODS: A total of 128 patients with biochemically confirmed PHPT were included. Patients were categorized as vitamin D deficient if 25-OH vitamin D was <50nmol/L, or normal if vitamin D was ≥50nmol/L. Biochemical parameters, bone mineral densitometry (BMD), and urinary tract and neck ultrasonography were assessed. RESULTS: In the study group, 66 (51.6%) patients had vitamin D deficiency and 60 (48.4%) had normal vitamin D levels. Nephrolithiasis and osteoporosis were found in 26.6% and 30.5% of subjects, respectively. The prevalence of metabolic syndrome (MetS), obesity (BMI≥30kg/m2) and hypertension (HTN) were higher in the vitamin D deficient group when compared to the normal group (p=0.04, p=0.01 and p=0.03, respectively). There was no difference regarding the presence of nephrolithiasis and osteoporosis between the groups. The mean adenoma size was similar in both groups. CONCLUSIONS: Vitamin D deficiency was not associated with osteoporosis, nephrolithiasis, adenoma size or biochemical parameters in PHPT. However, vitamin D deficiency may be a risk factor for developing HTN and MetS in PHPT.

Níveis séricos de vitamina D e urinários de KIM-1 e MCP-1 em pacientes com anemia falciforme / Serum levels of vitamin D, and urinary levels of KIM-1 and MCP-1 in patients with sickle cell anemia

Objetivo: realizar dosagens de biomarcadores de função renal não convencionais em pacientes com anemia falciforme e associar com os níveis séricos de vitamina D. Métodos: trata-se de um estudo observacional, analítico de corte transversal. Participaram do estudo 51 pacientes adultos com anemia falciforme, e o grupo controle foi composto por 17 adultos saudáveis doadores de sangue. Os níveis séricos de 25- hidroxi-vitamina D foram determinados por imunoensaio quimioluminecente de micropartículas (CMIA), e a função renal foi avaliada pelas dosagens de molécula-1 de lesão renal (KIM-1) e proteína-1 quimiotática de monócitos (MCP-1). Os resultados foram expressos como mediana (intervalo interquartil). Os testes t-Student de amostras independentes, análise de variância de Welch e teste não paramétrico de Kruskal-Wallis foram realizados para comparar as diferenças entre os grupos. Resultados: os pacientes apresentaram níveis séricos de vitamina D superiores ao grupo controle, além de uma maior prevalência de suficiência de vitamina D. Os níveis urinários de KIM-1 e MCP-1 estavam aumentados nos pacientes em relação ao grupo controle. Não houve relação entre baixos níveis séricos de vitamina D e a probabilidade de desenvolvimento de doença renal. Conclusões: este estudo fornece dados importantes sobre a prevalência da deficiência de vitamina D em pacientes com anemia falciforme e demonstra não haver relação entre baixos níveis de vitamina D e desenvolvimento de doença renal.

Objective: to measure non-conventional renal function biomarkers in patients with sickle cell anemia and associate them with serum levels of vitamin D. Method: this is an observational, analytical, cross-sectional study. Fifty-one adult patients with sickle cell anemia participated in the study, and the control group consisted of 17 healthy adult blood donors. Serum levels of 25-hydroxyvitamin D were determined by chemiluminescent microparticle immunoassay (CMIA), and renal function was assessed by measuring urinary Kidney Injury Molecule-1 (KIM-1) and Monocyte Chemoattractant Protein-1 (MCP-1). Results were expressed as median (interquartile range). Student's t-test, Welch analysis of variance, and non-parametric Kruskal-Wallis test were performed to compare differences between groups. Results: patients had higher serum levels of vitamin D than the control group, besides a higher prevalence of vitamin D sufficiency. Urinary levels of KIM-1 and MCP-1 were increased in patients compared to the control group. There was no relationship between low serum vitamin D levels and the likelihood of developing kidney disease. Conclusions: this study provides important data on the prevalence of vitamin D deficiency in patients with sickle cell anemia and demonstrates that there is no relationship between low levels of vitamin D and the development of kidney disease.

The effect of vitamin D deficiency on the retinal microvasculature: an observational case-control study / O efeito da deficiência de vitamina D nos microvasos da retina: um estudo caso-controle observacional

ABSTRACT Purpose: To determine the effects of vitamin D deficiency on retinal microvascularity using optical coherence tomography angiography. Methods: This study was designed as an observational case-control study. Ninety-eight eyes of patients with vitamin D deficiency and 96 eyes of healthy participants with serum vitamin D level >30 ng/mL were studied. Macula centered, 6.00 × 6.00 mm scan size images were taken. The vessel densities in the superficial and deep retinal capillary plexus, foveal avascular zone area, and choriocapillaris flow area were measured. Results: The groups were comparable in terms of best-corrected visual acuity, sex, axial length, refractive error, age, and adjusted intraocular pressure. The average vitamin D level was significantly lower in the study group (p=0.021). The whole, parafoveal, and perifoveal vessel densities in the deep capillary plexus were considerably higher in the study group than in the control group (p=0.012, p=0.014, and p=0.023, respectively). The foveal avascular zone area and the choriocapillaris flow area were similar in both groups (p=0.37 and p=0.27, respectively) there was a strong negative correlation between the serum vitamin D level and vessel density in the whole image, parafoveal, and perifoveal regions of the deep capillary plexus in the study group (Spearman's rho=-0.71, p=0.043; Spearman's rho= -0.79, p=0.011; and Spearman's rho = -0.74, p=0.032; respectively). Conclusion: An increase in vessel density might originate from vascular structural changes caused by vitamin D deficiency. The increased vessel density, especially in the deep capillary plexus, can enable early diagnosis of vitamin D-associated vasculopathy.

RESUMO Objetivo: Determinar os efeitos da deficiência de vitamina D nos microvasos da retina usando angiotomografia de coerência óptica. Métodos: Este estudo foi planejado para ser do tipo caso-controle observacional. Foram avaliados 98 olhos de pacientes com deficiência de vitamina D e 96 olhos de participantes saudáveis com nível sérico de vitamina D superior a 30 ng/mL. Foram adquiridas imagens de varredura centralizadas na mácula, com um tamanho de 6,00 × 6,00 mm. Mediram-se a densidade dos vasos nos plexos capilares superficial e profundo da retina, a área da zona avascular foveal e a área do fluxo coriocapilar. Resultados: Os grupos mostraram-se semelhantes em relação à melhor acuidade visual corrigida, ao gênero, ao comprimento axial, ao erro refrativo, à idade e à pressão intraocular ajustada. O nível médio de vitamina D foi significativamente menor no grupo de estudo (p=0,021). As densidades total, parafoveal e perifoveal do plexo capilar profundo foram significativamente maiores no grupo de estudo que no grupo controle (respectivamente, p=0,012, p=0,014 e p=0,023). As áreas da zona avascular foveal e do fluxo coriocapilar foram semelhantes nos dois grupos (respectivamente, p=0,37 e p=0,27). Além disso, houve uma forte correlação negativa do nível sérico de vitamina D com as densidades vasculares medidas em toda a imagem e nas regiões parafoveais e perifoveais do plexo capilar profundo no grupo de estudo (respectivamente, ρ de Spearman = −0,71, p=0,043; ρ de Spearman = −0,79, p=0,011; e ρ de Spearman = −0,74, p=0,032). Conclusão: Pode ocorrer um aumento na densidade vascular da retina devido a alterações estruturais dos vasos causadas pela deficiência de vitamina D. O aumento da densidade vascular, especialmente no plexo capilar profundo, pode ser usado para o diagnóstico precoce da vasculopatia associada à deficiência de vitamina D.

Suplementación efectiva de vitamina D en pacientes con fractura tibial / Effective vitamin D supplementation in patients with tibial fracture

OBJETIVOS Determinar la prevalencia de déficit de vitamina D, así como evaluar la seguridad y efectividad de un nuevo método de carga con colecalciferol en pacientes adultos con fractura de tibia. MATERIALES Y MÉTODOS Se reclutaron a 56 pacientes consecutivos con edades entre 18 y 65 años con fractura de tibia ingresados en nuestro hospital durante 1 año. Se determinó el nivel de 25-hidroxivitamina D ([25(OH)-D]) al ingreso y tras suplementación con 100.000 UI semanales de colecalciferol, durante 3 o 5 semanas, en casos de insuficiencia ([25(OH)-D] entre 20 ng/mL y 29,9 ng/mL) o deficiencia ([25(OH)-D] < 20 ng/mL), respectivamente. Se determinó la prevalencia de hipovitaminosis D, el porcentaje de normalización de [25(OH)-D], y los efectos adversos. RESULTADOS Se evaluaron 56 pacientes; 98,2% presentó hipovitaminosis D, y 28 (73,7%) y 10 (26,3%) presentaron déficit e insuficiencia, respectivamente. Tras la suplementación, 92,1% alcanzaron niveles [25(OH)-D] normales. Ningún paciente presentó efectos adversos. DISCUSIÓN La prevalencia de deficiencia de vitamina D en nuestra población fue mayor a la reportada en la literatura. Comprobamos que un esquema de suplementación en altas dosis de vitamina D es seguro, y más efectivo que los previamente recomendados. Este esquema de suplementación puede ser implementado en futuros estudios randomizados. CONCLUSIÓN La prevalencia de hipovitaminosis D en pacientes adultos chilenos con fractura de tibia fue alta (98,2%). El esquema de suplementación con vitamina D propuesto fue efectivo y seguro.

OBJETIVOS Determinar la prevalencia de déficit de vitamina D, así como evaluar la seguridad y efectividad de un nuevo método de carga con colecalciferol en pacientes adultos con fractura de tibia. MATERIALES Y MÉTODOS Se reclutaron a 56 pacientes consecutivos con edades entre 18 y 65 años con fractura de tibia ingresados en nuestro hospital durante 1 año. Se determinó el nivel de 25-hidroxivitamina D ([25(OH)-D]) al ingreso y tras suplementación con 100.000 UI semanales de colecalciferol, durante 3 o 5 semanas, en casos de insuficiencia ([25(OH)-D] entre 20 ng/mL y 29,9 ng/mL) o deficiencia ([25(OH)-D] < 20 ng/mL), respectivamente. Se determinó la prevalencia de hipovitaminosis D, el porcentaje de normalización de [25(OH)-D], y los efectos adversos. RESULTADOS Se evaluaron 56 pacientes; 98,2% presentó hipovitaminosis D, y 28 (73,7%) y 10 (26,3%) presentaron déficit e insuficiencia, respectivamente. Tras la suplementación, 92,1% alcanzaron niveles [25(OH)-D] normales. Ningún paciente presentó efectos adversos. DISCUSIÓN La prevalencia de deficiencia de vitamina D en nuestra población fue mayor a la reportada en la literatura. Comprobamos que un esquema de suplementación en altas dosis de vitamina D es seguro, y más efectivo que los previamente recomendados. Este esquema de suplementación puede ser implementado en futuros estudios randomizados. CONCLUSIÓN La prevalencia de hipovitaminosis D en pacientes adultos chilenos con fractura de tibia fue alta (98,2%). El esquema de suplementación con vitamina D propuesto fue efectivo y seguro.

Asociación entre niveles séricos de vitamina D y factores de riesgo cardiometabólicos en pacientes pediátricos del noroeste de México

RESUMEN Introducción: Actualmente se ha observado que la hipovitaminosis D y la obesidad pueden influir en el desarrollo de enfermedad cardiovascular en el futuro. Objetivo: Identificar la asociación entre deficiencia de vitamina D y factores de riesgo cardiometabólicos en los pacientes pediátricos del noroeste de México. Materiales y métodos : se incluyeron niños de 6 a 15 años, se les midieron variables somatométricas, niveles séricos de colesterol total, C-HDL, C-LDL, triglicéridos, glucosa, insulina, vitamina D e índice HOMA-IR. Se identificó la asociación de factores de riesgo cardiometabólicos y la deficiencia de vitamina D, mediante la prueba de Chi cuadrado. Resultados: De los 114 pacientes evaluados, se detectó eutrofia en 42.1%, sobrepeso en 12.3%, obesidad en 41.2% y desnutrición en 4.4%. La prevalencia de deficiencia en vitamina D, insuficiencia y suficiencia fueron 18.4%, 27.2% y 54.4% respectivamente. La deficiencia de vitamina D mostró mayor predominio en pacientes con obesidad (27 %). La hipertrigliceridemia se asoció estadísticamente con deficiencia de vitamina D (p 0.041). Se observaron correlaciones inversas entre niveles de vitamina D con HOMA (r=-0.191; p=0.41), score Z IMC (r=-0.210; p=0.025) e insulina (r=-0.227; p=0.015). Conclusiones: La deficiencia de vitamina D se asocia en niños con un IMC elevado y resistencia a la insulina, lo cual puede acelerar el desarrollo de síndrome metabólico, diabetes mellitus tipo 2 y enfermedad cardiovascular.

ABSTRACT Introduction: It has currently been observed that hypovitaminosis D and obesity can influence the future development of cardiovascular disease. Objective: To identify the association between vitamin D deficiency and cardiometabolic risk factors in pediatric patients from northwestern Mexico. Materials and methods: Children aged 6 to 15 years were included, somatometric variables, serum levels of total cholesterol, HDL-C, LDL-C, triglycerides, glucose, insulin, vitamin D and HOMA-IR index were measured. The association of cardiometabolic risk factors and vitamin D deficiency was identified using the Chi square test. Results: Of the 114 patients evaluated, normal body-mass index was detected in 42.1%, 12.3% were overweight, 41.2% were obese and 4.4% were malnourished. The prevalence of vitamin D deficiency, insufficiency and sufficiency were 18.4%, 27.2% and 54.4% respectively. Vitamin D deficiency was more prevalent in obese patients (27%). Hypertriglyceridemia was statistically associated with vitamin D deficiency (p = 0.041). Inverse correlations were observed between vitamin D levels with HOMA (r = -0.191; p = 0.41), BMI Z score (r = -0.210; p = 0.025) and insulin (r = -0.227; p = 0.015). Conclusions: Vitamin D deficiency is associated with a higher BMI and insulin resistance in children, which can accelerate the development of metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease.

Characterization of serum vitamin D levels in pediatric patients with chronic lymphocytic thyroiditis.

BACKGROUND: Chronic lymphocytic thyroiditis or Hashimoto's thyroiditis is the most frequent cause of acquired hypothyroidism in children. An association between low levels of 25-hydroxyvitamin D (25OH vitamin D) and the development of the disease have been detected. The aim of this study was to describe 25OH vitamin D levels in patients aged 5 to 18 years with a diagnosis of Hashimoto's thyroiditis in three pediatric endocrinology outpatient centers in Medellín, Colombia. METHODS: We conducted a cross-sectional observational study with retrospective data collection. We evaluated the sociodemographic characteristics, diagnoses, presence of comorbidities, and frequency of vitamin D deficiency. RESULTS: Sixty patients were included. The 25OH vitamin D levels were sufficient in 65% of the cases according to the Institute of Medicine (IOM) criteria and in 10% of the cases according to the Endocrine Society criteria. Serum calcium and phosphorus values were normal in 53% and 45% of the patients, respectively. All patients had normal magnesium and parathyroid hormone levels. No differences were found in the exploratory analysis when comparing 25OH vitamin D levels, thyroid antibody levels, and thyroid volume. CONCLUSIONS: In this chronic lymphocytic thyroiditis population, we did not find an increased prevalence of vitamin D deficiency according to IOM or the Endocrine Society criteria compared with previous data from the general population. No statistically significant differences were found in the exploratory analysis.

INTRODUCCIÓN: La tiroiditis linfocítica crónica o tiroiditis de Hashimoto es la causa más frecuente de hipotiroidismo adquirido en la edad pediátrica. Se ha detectado una asociación entre concentraciones bajas de 25-hidroxivitamina D (25OH vitamina D) y el desarrollo de la enfermedad. El objetivo de este trabajo fue describir las concentraciones de 25OH vitamina D en pacientes de 5 a 18 años con diagnóstico de tiroiditis linfocítica crónica en tres centros de consulta externa de endocrinología pediátrica enMedellín,Colombia. MÉTODOS: Se llevó a cabo un estudio observacional de corte transversal con recolección retrospectiva de la información. Se evaluaron características sociodemográficas, particularidades del diagnóstico, presencia de comorbilidad y frecuencia de deficiencia de vitamina D. RESULTADOS: Se incluyeron 60 pacientes. La concentración de 25OH vitamina D fue suficiente en el 65% de los casos según los criterios de Institute of Medicine (IOM) y en el 10% de los casos según los criterios de la Endocrine Society. Los valores de calcio y fósforo sérico fueron normales en el 53% y el 45% de los pacientes, respectivamente. Todos los pacientes presentaron concentraciones normales de magnesio y paratohormona. No se encontraron diferencias en el análisis exploratorio al comparar la concentración de 25OH vitamina D, de anticuerpos tiroideos y el volumen tiroideo. CONCLUSIONES: En esta población con tiroiditis linfocítica crónica no se encontró una mayor prevalencia de deficiencia de 25OH vitamina D según los criterios del IOM y de la Endocrine Society en comparación con datos previos de la población general. En el análisis exploratorio no se encontraron diferencias estadísticamente significativas.

Relación entre la deficiencia de vitamina D con el estado nutricional y otros factores en adultos de la región interandina del Ecuador / Relationship Between Vitamin D Deficiency with Nutritional Status and Other Factors in Adults from the Inter-Andean Region of Ecuador

Resumen Antecedentes: la deficiencia de vitamina D es un problema de salud pública asociado con diversas enfermedades en población adulta que podría estar relacionado con la actividad laboral. Objetivo: relacionar la deficiencia de vitamina D con el estado nutricional, la composición corporal y factores sociodemográficos en trabajadores de Quito, Ecuador. Materiales y métodos: estudio transversal en 245 trabajadores. Se evaluó vitamina D sérica por inmunofluorescencia, estado nutricional por Índice de Masa Corporal, composición corporal por bioimpedancia y otros factores sociodemo gráficos. Se usó regresión logística para identificar asociaciones entre deficiencia de vitamina D y variables de interés. Resultados: el 76 % de la población presentó deficiencia de vitamina D. El riesgo cardiovascular por circunferencia abdominal, edad y sexo estaban asociados con deficiencia de vitamina D. Por cada centímetro de incremento en la circunferencia abdominal, la prevalencia de deficiencia de vitamina D incrementaba 4,4 % (OR = 1,044 IC95 %:1,001-1,008; p = 0,043). Por cada año de edad de incremento, la prevalencia disminuía 4,1 % (OR = 0,96; IC95 %:0,93-0,99; p = 0,030). Las mujeres mostraron 2,33 veces más deficiencia de vitamina D en comparación con los hombres (OR = 2,33 IC95 %:1,28-6,94 p = 0,011). Conclusión: la deficiencia de vitamina D es alta en los traba jadores de la ciudad de Quito. Aparentemente, mujeres jóvenes con una circunferencia abdominal alta tienen mayor probabilidad de presentar esta deficiencia. El exceso de peso podría estar reduciendo la actividad física al aire libre, lo que disminuye a su vez la exposición a la luz solar y esto deriva en deficiencia de vitamina D.

Abstract: Background: Vitamin D Deficiency is a public health problem associated with various diseases in the adult population that could be related to work activity. Objective: To relate vitamin D deficiency with nutritional status, body composition, and sociodemographic factors in workers from Quito, Ecuador. Material and Methods: A cross-sectional study in 245 workers. Serum vitamin D was evaluated by immunofluorescence, nutritional status by Body Mass Index, body composition by bioimpedance, and other sociodemographic factors were also evaluated. The associations between vitamin D deficiency and variables of interest were examined by logistic regression. Results: Vitamin D deficiency was presented in 76% of the participants. Cardiovascular risk by abdominal circumference, age, and sex were associ ated with vitamin D deficiency. For each centimeter increase in abdominal circumference, the prevalence of vitamin D deficiency increased 4.4% (OR = 1.044 CI95%:1.001-1.008; p = 0.043). For each year of age increase, the prevalence decreased 4.1% (OR = 0.96; 95%CI:0.93-0.99; p = 0.030). Women showed 2.33 times more vitamin D deficiency than men (OR = 2.33 CI95%:1.28-6.94 p = 0.011). Conclusion: Vitamin D deficiency is high in workers in the city of Quito. Apparently, young female with a high abdominal circumference appear to be more likely to be this deficient. Excess weight likely influences outdoor physical activity, which in turn decreases exposure to sunlight and leads to vitamin D deficiency.

Caracterización de la concentración sérica de vitamina D en pacientes pediátricos con tiroiditis linfocítica crónica / Characterization of serum vitamin D levels in pediatric patients with chronic lymphocytic thyroiditis

Resumen Introducción: La tiroiditis linfocítica crónica o tiroiditis de Hashimoto es la causa más frecuente de hipotiroidismo adquirido en la edad pediátrica. Se ha detectado una asociación entre concentraciones bajas de 25-hidroxivitamina D (25OH vitamina D) y el desarrollo de la enfermedad. El objetivo de este trabajo fue describir las concentraciones de 25OH vitamina D en pacientes de 5 a 18 años con diagnóstico de tiroiditis linfocítica crónica en tres centros de consulta externa de endocrinología pediátrica enMedellín,Colombia. Métodos: Se llevó a cabo un estudio observacional de corte transversal con recolección retrospectiva de la información. Se evaluaron características sociodemográficas, particularidades del diagnóstico, presencia de comorbilidad y frecuencia de deficiencia de vitamina D. Resultados: Se incluyeron 60 pacientes. La concentración de 25OH vitamina D fue suficiente en el 65% de los casos según los criterios de Institute of Medicine (IOM) y en el 10% de los casos según los criterios de la Endocrine Society. Los valores de calcio y fósforo sérico fueron normales en el 53% y el 45% de los pacientes, respectivamente. Todos los pacientes presentaron concentraciones normales de magnesio y paratohormona. No se encontraron diferencias en el análisis exploratorio al comparar la concentración de 25OH vitamina D, de anticuerpos tiroideos y el volumen tiroideo. Conclusiones: En esta población con tiroiditis linfocítica crónica no se encontró una mayor prevalencia de deficiencia de 25OH vitamina D según los criterios del IOM y de la Endocrine Society en comparación con datos previos de la población general. En el análisis exploratorio no se encontraron diferencias estadísticamente significativas.

Abstract Background: Chronic lymphocytic thyroiditis or Hashimoto's thyroiditis is the most frequent cause of acquired hypothyroidism in children. An association between low levels of 25-hydroxyvitamin D (25OH vitamin D) and the development of the disease have been detected. The aim of this study was to describe 25OH vitamin D levels in patients aged 5 to 18 years with a diagnosis of Hashimoto's thyroiditis in three pediatric endocrinology outpatient centers in Medellín, Colombia. Methods: We conducted a cross-sectional observational study with retrospective data collection. We evaluated the sociodemographic characteristics, diagnoses, presence of comorbidities, and frequency of vitamin D deficiency. Results: Sixty patients were included. The 25OH vitamin D levels were sufficient in 65% of the cases according to the Institute of Medicine (IOM) criteria and in 10% of the cases according to the Endocrine Society criteria. Serum calcium and phosphorus values were normal in 53% and 45% of the patients, respectively. All patients had normal magnesium and parathyroid hormone levels. No differences were found in the exploratory analysis when comparing 25OH vitamin D levels, thyroid antibody levels, and thyroid volume. Conclusions: In this chronic lymphocytic thyroiditis population, we did not find an increased prevalence of vitamin D deficiency according to IOM or the Endocrine Society criteria compared with previous data from the general population. No statistically significant differences were found in the exploratory analysis.

Deficiency and Insufficiency of Vitamin D in Women of Childbearing Age: A Systematic Review and Meta-analysis / Deficiência e insuficiência de vitamina D em mulheres na idade reprodutiva: Uma revisão sistemática e meta-análise

Abstract Objective To estimate the prevalence of inadequate vitamin D level and its associated factors for women of childbearing age in Brazil. Methods A systematic reviewwas conducted (last updatedMay 2020).Meta-analyses were performed using the inverse-variance for fixed models with summary proportion calculation by Freeman-Tukey double arcsine. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies. Results Our review identified 31 studies, comprising 4,006 participants. All the studies had at least one weakness, mainly due to the use of convenience sampling and small sample size. The overall prevalence of vitamin D deficiency, insufficiency, and both deficiency and insufficiency were 35% (confidence interval, 95%CI: 34-37%), 42% (95%CI: 41-44%), and 72% (95%CI: 71-74%), respectively. Conclusion Although the magnitude of the prevalence of inadequate levels of vitamin D is uncertain, the evidence suggests that presence of vitamin D deficiency or insufficiency in women of reproductive age can cause moderate to severe problems.

Resumo Objetivo Estimar a prevalência de níveis inadequados de vitamina D e seus fatores associados para mulheres em idade fértil no Brasil. Métodos Uma revisão sistemática foi realizada (última atualização em maio de 2020). As meta-análises foram realizadas usando o inverso da variância para o modelo fixo com cálculo de proporção sumarizada por transformação arco-seno duplo de Freeman-Tukey. A qualidade metodológica e de reporte foi avaliada usando a ferramenta do Joanna Briggs Institute para estudos de prevalência. Resultados Nossa revisão identificou 31 estudos, compreendendo 4.006 participantes. Todos os estudos apresentaram pelo menos uma limitação, principalmente devido ao uso de amostra de conveniência e tamanho amostral pequeno. As prevalências gerais de deficiência, insuficiência e deficiência de vitamina D foram 35% (intervalo de confiança, IC 95%: 34-37%), 42% (IC 95%: 41-44%) e 72% (IC 95%: 71-74%), respectivamente. Conclusão Embora a magnitude da prevalência de níveis inadequados de vitamina D seja incerta, a evidência sugere que presença de deficiência ou insuficiência de vitamina D em mulheres em idade reprodutiva pode causar problemas moderados a graves.

Severe COVID-19 patients have severe vitamin D deficiency in Northeast Mexico / Los pacientes graves con COVID-19 tienen deficiencia grave de vitamina D en el noreste de México

Objective: the association between vitamin D and COVID-19 severity is not consistent. We compared prevalences and analyzed the association between vitamin D deficiency and COVID-19 severity in Northeast Mexico. Methods: this was a cross-sectional study with individuals consecutively included at a referral diagnostic center during March-September 2020 (n = 181). Concurrently, every patient admitted to intensive care was also consecutively included (n = 116). Serum 25(OH)D < 20 ng/mL was considered vitamin D deficiency. Descriptive, ANOVA, and multivariate ordinal regression analyses were performed. Results: vitamin D deficiency prevalence was 63.8 % (95 % CI, 54.7, 72.0) in severe COVID-19; 25.6 % (95 % CI, 17.4, 36.0) in mild COVID-19; and 42.4 % (95 % CI, 33.2, 52.3) in non-diseased individuals. Vitamin D deficiency increased 5 times the odds of severe COVID-19 (95 % CI, 1.1, 24.3), independently of sex, age, body mass index, and inflammatory markers. Conclusions: this study is the first report of vitamin D deficiency in Northeast Mexico. Vitamin D deficiency was associated with COVID-19 severity (AU)

Objetivo: la asociación entre la vitamina D y la gravedad de la COVID-19 no es consistente. Se comparó la prevalencia y se analizó la asociación de la deficiencia de vitamina D con la gravedad de los pacientes con COVID-19 en el noreste de México. Métodos: este fue un estudio transversal. Se incluyó consecutivamente a individuos de un centro de diagnóstico de referencia durante marzo-septiembre de 2020 (n = 181). Paralelamente, se reclutó a todos los pacientes que ingresaron a cuidados intensivos en ese mismo periodo (n = 116). Se consideró que había deficiencia de vitamina D ante cifras de 25(OH)D sérica < 20 ng/ml. Se realizaron un análisis descriptivo, un ANOVA y una regresión ordinal multivariante. Resultados: la prevalencia de la deficiencia de vitamina D fue del 63,8 % (IC del 95 %: 54,7; 72,0) en la COVID-19 grave, del 25,6 % (IC del 95 %: 17,4; 36,0) en la COVID-19 leve y del 42,4 % (IC del 95 %: 33,2; 52,3) sin COVID-19. La deficiencia aumentó 5 veces las probabilidades de una COVID-19 grave (IC del 95 %: 1,1; 23,9) independientemente del sexo, la edad, el índice de masa corporal y los marcadores inflamatorios. Conclusiones: este estudio es el primer informe de la deficiencia de vitamina D en el noreste de México. La deficiencia de vitamina D se asoció con la gravedad de la COVID-19 (AU)

Índice trabecular óseo y niveles de 25-hidroxivitamina D en las complicaciones microvasculares de la diabetes mellitus tipo 2 / Trabecular bone score and 25-hydroxyvitamin D levels in microvascular complications of type 2 diabetes mellitus

Antecedentes y objetivo:La enfermedad microvascular (EMV) diabética ha sido asociada con una fragilidad ósea incrementada. El objetivo fue analizar la relación entre la EMV y la microestructura trabecular -evaluada mediante el índice trabecular óseo (trabecular bone score, TBS)- en pacientes diabéticos tipo 2 (DM2). Adicionalmente, conocer la relación entre la vitamina D y la EMV.Pacientes y métodos:Diseño transversal analítico, que incluyó varones > 50 años y mujeres postmenopáusicas con DM2, participantes en una cohorte poblacional. Se clasificó como EMV+ la presencia de nefropatía, neuropatía y/o retinopatía. Fueron analizadas variables clínicas, de laboratorio, el TBS, la 25-hidroxivitamina D [25(OH)D] y la densidad mineral ósea (DMO). Se realizaron análisis bivariable y multivariable.Resultados:Fueron evaluados 361 pacientes (51,1% mujeres), de 63,8 (9) años. De ellos, 92 tenían EMV, con un peor control metabólico, mayor duración de la DM2, menor TBS (1,235 [0,1] vs. 1,287 [0,1]; p=0,003) y menores niveles de 25(OH)D (18,3 [7] vs. 21,6 [8] ng/mL; p=0,0001). No hubo diferencias entre EMV+ y EMV- en la DMO ni en los marcadores P1NP y β-CTX. Tras ajustar por confusores, incluyendo HbA1c y duración de la DM2, el TBS en EMV+ fue 1,252 (IC 95% 1,230-1,274) vs. 1,281 (IC 95% 1,267-1,295) en EMV- (p=0,034). La EMV se asoció a un nivel de 25(OH)D < 20 ng/mL con una OR ajustada=1,88 (IC 95% 1,06-3,31; p=0,028).Conclusiones:Los pacientes con EMV presentaron un TBS significativamente menor, tras ajustar por confusores. El análisis multivariable mostró asimismo una asociación significativa entre un nivel bajo de 25(OH)D y la EMV prevalente. (AU)

Background and objective:Diabetic microvascular disease (MVD) has been associated with increased bone fragility. The objective was to analyse the relationship between MVD and trabecular microstructure -assessed by the trabecular bone score (TBS)- in type 2 diabetic (T2D) patients. A second aim was to know the relationship between vitamin D and MVD.Patients and methods:Cross-sectional study, which included men >50 years and postmenopausal women participating in a population-based cohort, diagnosed with T2D. The presence of nephropathy, neuropathy and/or retinopathy was classified as MVD+. Clinical and laboratory variables, TBS, 25(OH)D and BMD by DXA, were evaluated. Bivariate and multivariate analysis were performed.Results:We evaluated 361 patients (51.1% women), 63.8 (9) years old. Of them, 92 were MVD+ and presented poorer metabolic control, longer duration of T2D, lower TBS [1.235 (.1) vs. 1.287 (.1); p=.007] and lower levels of 25(OH)D [18.3 (7) vs. 21.6 (8) ng/ml; p=.0001). There were no differences between MVD+ and MVD- with regard to BMD or P1NP and β-CTX markers. After adjusting for confounders, including HbA1c and duration of T2D, the TBS value in MVD+ was 1.252 (95% CI 1.230-1.274) vs. 1.281 (95% CI 1.267-1.295) in MVD- (p=.034). MVD was associated with a 25(OH)D level <20 ng ml with an adjusted OR of 1.88 (95% CI 1.06-3.31; p=.028).Conclusions:The MVD+ patients presented a significantly lower TBS, after adjusting for confounders. Furthermore, multivariable analysis showed a significant relationship between a low 25(OH)D level and a prevalent MVD. (AU)