Investigating the comparative effect of vitamin D level with the type of complications in Henoch Schönlein purpura and Kawasaki disease.

INTRODUCTION AND OBJECTIVES: Henoch Schönlein purpura (HSP) and Kawasaki disease (KD) are two main inflammatory diseases among childhood vasculitis. Considering the anti-inflammatory effects of 25-hydroxyvitamin D3, we decided to investigate the association of serum 25-hydroxy vitamin D3 level with the type and severity of these conditions. MATERIALS AND METHODS: The present study was performed as a historical cohort of 254 affected children with KD and HSP vasculitis. The required data were extracted, using a researcher-made questionnaire from patients' electronic file, and then they were analyzed after collecting information of the patients. RESULTS: In HSP group, 54% of participants were boys. Similarly, in KD group, boys were more affected than girls. The comparative 25-hydroxyvitamin vitamin D3 level in HSP patients with and without renal involvement (P=0.02), hematuria (P=0.14), and in two groups with and without heart disease, and also with and without coronary artery dilatation in KD patients (P<0.001) were significant. DISCUSSION AND CONCLUSIONS: The findings showed that insufficient level of vitamin D3 were significantly associated with the exacerbation of complications of both diseases, and therefore it seems that vitamin D deficiency can be an effective predictive factor of severity in HSP and KD patients.

Investigating the comparative effect of vitamin D level with the type of complications in Henoch Schönlein purpura and Kawasaki disease / Investigación del efecto comparativo del nivel de vitamina D con el tipo de complicaciones en la púrpura de Henoch-Schönlein y la enfermedad de Kawasaki

Introduction and objectives: Henoch Schönlein purpura (HSP) and Kawasaki disease (KD) are two main inflammatory diseases among childhood vasculitis. Considering the anti-inflammatory effects of 25-hydroxyvitamin D3, we decided to investigate the association of serum 25-hydroxy vitamin D3 level with the type and severity of these conditions. Materials and methods: The present study was performed as a historical cohort of 254 affected children with KD and HSP vasculitis. The required data were extracted, using a researcher-made questionnaire from patients’ electronic file, and then they were analyzed after collecting information of the patients. Results: In HSP group, 54% of participants were boys. Similarly, in KD group, boys were more affected than girls. The comparative 25-hydroxyvitamin vitamin D3 level in HSP patients with and without renal involvement (P=0.02), hematuria (P=0.14), and in two groups with and without heart disease, and also with and without coronary artery dilatation in KD patients (P<0.001) were significant. Discussion and conclusions: The findings showed that insufficient level of vitamin D3 were significantly associated with the exacerbation of complications of both diseases, and therefore it seems that vitamin D deficiency can be an effective predictive factor of severity in HSP and KD patients.(AU)

Introducción y objetivos: La púrpura de Henoch-Schönlein (HSP) y la enfermedad de Kawasaki (EK) son dos patologías inflamatorias principales entre las vasculitis infantiles. Teniendo en cuenta los efectos antiinflamatorios de la 25-hidroxivitamina D3, decidimos investigar la asociación del nivel sérico de esta con el tipo y la gravedad de dichas afecciones. Materiales y métodos: El presente estudio se realizó como una cohorte histórica de 254 niños afectados con vasculitis por EK y HSP. Los datos requeridos se extrajeron mediante un cuestionario elaborado por un investigador del expediente electrónico de los pacientes y se analizaron después de recopilar la información de los usuarios. Resultados: En el grupo HSP, 54 y 46% de los participantes eran niños y niñas, respectivamente. De manera similar, en el grupo KD, los varones se vieron más afectados. El nivel comparativo de 25-hidroxivitamina D3 en pacientes con HSP con y sin afectación renal (p = 0,02), hematuria (p = 0,14), y en dos grupos con y sin enfermedad cardiaca, y en dos con y sin dilatación de la arteria coronaria en usuarios con EK (p < 0,001) fueron significativos. Discusión y conclusiones: Los hallazgos mostraron que los niveles insuficientes de vitamina D se asociaron significativamente con la exacerbación de las complicaciones de ambas enfermedades, por lo que parece que la deficiencia de vitamina D puede ser un factor predictivo eficaz de la gravedad en pacientes con HSP y EK.(AU

Association between the genetic variant in the vitamin D pathway (rs2282679), circulating 25-hydroxyvitamin D levels, insulin resistance and metabolic syndrome criteria / Asociación entre la variante genética en la vía de la vitamina D (rs2282679), niveles circulantes de 25-hidroxivitamina D, resistencia a la insulina y criterios de síndrome metabólico

Background and aims: some studies have reported links between 25-hydroxyvitamin D levels and the presence of metabolic syndrome. The aim of the present study was to evaluate whether an association exists among 25-hydroxyvitamin D, rs2282679 of the GC gene and metabolic syndrome (MS). Methods: the study involved a population of 134 postmenopausal obese females. Measurements of anthropometric parameters, blood pressure, bone turnover markers, fasting blood glucose, insulin resistance (HOMA-IR), lipid profile, C-reactive protein and prevalence of MS were recorded. Genotype of CG gene polymorphism (rs2282679) was evaluated. Results: insulin (delta: 4.6 ± 0.9 mUI/l; p = 0.02), triglycerides (delta: 21.6 ± 2.9 mg/dl; p = 0.04) and HOMA-IR (delta: 1.1 ± 0.9 unit; p = 0.02) were lower in TT subjects than TG + GG patients. The percentages of individuals who had MS (OR = 2.80, 95 % CI = 1.39-5.65; p = 0.02), hypertriglyceridemia (OR = 2.39, 95 % CI = 1.44-5.96; p = 0.01), and hyperglycemia (OR = 2.72, 95 % CI = 1.23-6.00; p = 0.43) were higher in G allele carriers. Logistic regression analysis showed an increased risk of MS in G allele carriers (OR = 2.36, 95 % CI = 1.11-5.91, p = 0.02) and an increased risk of 25-hydroxyvitamin D deficiency (< 20 ng/ml) (OR = 2.43, 95 % CI = 1.13-6.69, p = 0.02), too. Conclusions: a negative association among G allele and insulin resistance, hypertriglyceridemia, deficiency of 25 hydroxyvitamin D levels and MS was reported in this population. (AU)

Antecedentes y objetivos: algunos estudios han demostrado una relación entre los niveles de 25-hidroxivitamina D y la presencia del síndrome metabólico. El objetivo de este estudio fue evaluar si existe una asociación entre la 25-hidroxivitamina D, la variante rs2282679 del gen GC y el síndrome metabólico (SM). Métodos: el estudio involucró a una población de 134 mujeres obesas posmenopáusicas. Se registraron parámetros antropométricos, presión arterial, marcadores de recambio óseo, glucemia en ayunas, resistencia a la insulina (HOMA-IR), perfil lipídico, proteína C reactiva y prevalencia de SM. Se evaluó el genotipo del polimorfismo del gen CG (rs2282679). Resultados: los niveles de insulina (delta: 4,6 ± 0,9 mUI/l; p = 0.02), triglicéridos (delta: 21,6 ± 2,9 mg/dl; p = 0,04) y HOMA-IR (delta: 1,1 ± 0,9 unidades; p = 0,02) fueron menores en los sujetos TT que en los pacientes TG + GG. Los porcentajes de individuos que tenían SM (OR = 2,80, IC 95 % = 1,39-5,65; p = 0,02), hipertrigliceridemia (OR = 2,39, IC 95 % = 1,44-5,96; p = 0,01) e hiperglucemia (OR = 2,72, IC 95 % = 1,23-6,00; p = 0,43) fueron mayores en los portadores del alelo G. El análisis de regresión logística mostró un mayor riesgo de SM en los portadores del alelo G (OR = 2,36, IC 95 % = 1,11-5,91; p = 0,02) y un mayor riesgo de deficiencia de 25-hidroxivitamina D (< 20 ng/ml) (OR = 2,43, IC 95 % = 1,13-6,69; p = 0,02). Conclusiones: en esta población hemos detectado una asociación negativa entre el alelo G y la resistencia a la insulina, hipertrigliceridemia, deficiencia niveles de 25-hidroxivitamina D y SM. (AU)

Association between the genetic variant in the vitamin D pathway (rs2282679), circulating 25-hydroxyvitamin D levels, insulin resistance and metabolic syndrome criteria.

Introduction: Background and aims: some studies have reported links between 25-hydroxyvitamin D levels and the presence of metabolic syndrome. The aim of the present study was to evaluate whether an association exists among 25-hydroxyvitamin D, rs2282679 of the GC gene and metabolic syndrome (MS). Methods: the study involved a population of 134 postmenopausal obese females. Measurements of anthropometric parameters, blood pressure, bone turnover markers, fasting blood glucose, insulin resistance (HOMA-IR), lipid profile, C-reactive protein and prevalence of MS were recorded. Genotype of CG gene polymorphism (rs2282679) was evaluated. Results: insulin (delta: 4.6 ± 0.9 mUI/l; p = 0.02), triglycerides (delta: 21.6 ± 2.9 mg/dl; p = 0.04) and HOMA-IR (delta: 1.1 ± 0.9 unit; p = 0.02) were lower in TT subjects than TG + GG patients. The percentages of individuals who had MS (OR = 2.80, 95 % CI = 1.39-5.65; p = 0.02), hypertriglyceridemia (OR = 2.39, 95 % CI = 1.44-5.96; p = 0.01), and hyperglycemia (OR = 2.72, 95 % CI = 1.23-6.00; p = 0.43) were higher in G allele carriers. Logistic regression analysis showed an increased risk of MS in G allele carriers (OR = 2.36, 95 % CI = 1.11-5.91, p = 0.02) and an increased risk of 25-hydroxyvitamin D deficiency (< 20 ng/ml) (OR = 2.43, 95 % CI = 1.13-6.69, p = 0.02), too. Conclusions: a negative association among G allele and insulin resistance, hypertriglyceridemia, deficiency of 25 hydroxyvitamin D levels and MS was reported in this population.

Introducción: Antecedentes y objetivos: algunos estudios han demostrado una relación entre los niveles de 25-hidroxivitamina D y la presencia del síndrome metabólico. El objetivo de este estudio fue evaluar si existe una asociación entre la 25-hidroxivitamina D, la variante rs2282679 del gen GC y el síndrome metabólico (SM). Métodos: el estudio involucró a una población de 134 mujeres obesas posmenopáusicas. Se registraron parámetros antropométricos, presión arterial, marcadores de recambio óseo, glucemia en ayunas, resistencia a la insulina (HOMA-IR), perfil lipídico, proteína C reactiva y prevalencia de SM. Se evaluó el genotipo del polimorfismo del gen CG (rs2282679). Resultados: los niveles de insulina (delta: 4,6 ± 0,9 mUI/l; p = 0.02), triglicéridos (delta: 21,6 ± 2,9 mg/dl; p = 0,04) y HOMA-IR (delta: 1,1 ± 0,9 unidades; p = 0,02) fueron menores en los sujetos TT que en los pacientes TG + GG. Los porcentajes de individuos que tenían SM (OR = 2,80, IC 95 % = 1,39-5,65; p = 0,02), hipertrigliceridemia (OR = 2,39, IC 95 % = 1,44-5,96; p = 0,01) e hiperglucemia (OR = 2,72, IC 95 % = 1,23-6,00; p = 0,43) fueron mayores en los portadores del alelo G. El análisis de regresión logística mostró un mayor riesgo de SM en los portadores del alelo G (OR = 2,36, IC 95 % = 1,11-5,91; p = 0,02) y un mayor riesgo de deficiencia de 25-hidroxivitamina D (< 20 ng/ml) (OR = 2,43, IC 95 % = 1,13-6,69; p = 0,02). Conclusiones: en esta población hemos detectado una asociación negativa entre el alelo G y la resistencia a la insulina, hipertrigliceridemia, deficiencia niveles de 25-hidroxivitamina D y SM.

Vitamin D status and biomarkers of renal graft function after kidney transplantation: a longitudinal study / Estado de la vitamina D y biomarcadores de función del injerto renal después del trasplante de riñón: un estudio longitudinal

Introduction: Low 25-hydroxyvitamin D [25(OH)D] levels occur after kidney transplantation (KTx), and can be associated with increase the risk of graft loss. This longitudinal study aimed to evaluate the vitamin D status and association with biomarkers of the renal graft function after KTx. Methods: this longitudinal study included 42 patients evaluated at baseline, 3 and 6 months after KTx. Biodemographic, clinical, and biochemical parameters such as 25(OH)D and parathyroid hormone (PTH), and biomarkers of renal graft function, such as creatinine, estimated glomerular filtration rate (eGFR), and albumin/creatinine ratio (ACR), were assessed. Sun exposure was also evaluated. Patients were categorized according to their 25(OH)D levels. Results: at baseline, 25(OH)D levels < 30 ng/mL were found in 43 % patients, and 38 % of these patients failed to improve their 25(OH)D levels by 6 months after KTx. Low 25(OH)D levels occurred regardless of sun exposure. Further, 44 % patients developed albuminuria at 6 months. An increased ACR was observed in patients with 25(OH)D levels < 30 ng/mL (p = 0.002) compared to that in patients with 25(OH)D > 30 ng/mL. Additionally, 25(OH)D levels were negatively correlated with ACR at 6 months post-KTx (r = -0.444; p = 0.003). Twelve (28.6 %) patients with 25(OH)D levels < 30 ng/mL showed no eGFR recovery until 6 months after KTx. Conclusion: low vitamin D levels and increased albuminuria were observed at 6 months after KTx, even in a region with high sun exposure. The association between vitamin D status and biomarkers of renal graft function after KTx should be explored in further studies. (AU)

Introducción: los bajos niveles de 25-hidroxivitamina D [25(OH)D] ocurren después del procedimiento de trasplante de riñón (KTx) y pueden estar asociados con un aumento del riesgo de pérdida del injerto. Este estudio longitudinal tuvo como objetivo evaluar el estado de la vitamina D y la asociación con los biomarcadores de función del injerto renal después del KTx. Métodos: este estudio longitudinal incluyó a 42 pacientes que fueron evaluados al inicio del estudio, y 3 y 6 meses después del KTx. Se evaluaron los parámetros biodemográficos, clínicos y bioquímicos, como 25(OH)D y hormona paratiroidea (PTH), y los biomarcadores de función del injerto renal, como creatinina, tasa de filtración glomerular estimada (eGFR) y relación albúmina/creatinina (ACR). También se evaluó la exposición al sol. Los pacientes se clasificaron según sus niveles de 25(OH)D. Resultados: al inicio del estudio se encontraron niveles de 25(OH)D < 30 ng/ml en el 43 % de los pacientes, mientras que el 38 % de estos pacientes no lograron mejorar sus niveles de 25(OH)D a los 6 meses después del KTx. También se produjeron niveles bajos de 25(OH)D independientemente de la exposición al sol. Asimismo, el 44 % de los pacientes desarrollaron albuminuria a los 6 meses. Se observó un aumento de la ACR en los pacientes con niveles de 25(OH)D < 30 ng/mL (p = 0,002) en comparación con los pacientes con 25(OH)D > 30 ng/mL. Además,los niveles de 25(OH)D se correlacionaron negativamente con la ACR a los 6 meses después del KTx (r = -0,444; p = 0,003). Doce (28,6 %) pacientes con niveles de 25(OH)D < 30 ng/ml no mostraron recuperación de la TFGe hasta 6 meses después del KTx. Conclusión: se observaron niveles bajos de vitamina D y un aumento de la albuminuria a los 6 meses después del KTx, incluso en una región con alta exposición solar. La asociación entre el estado de la vitamina D y los biomarcadores de función del injerto renal después del KTx debeexplorarse en estudios adicionales. (AU)

Vitamin D status and biomarkers of renal graft function after kidney transplantation: a longitudinal study.

Introduction: Introduction: Low 25-hydroxyvitamin D [25(OH)D] levels occur after kidney transplantation (KTx), and can be associated with increase the risk of graft loss. This longitudinal study aimed to evaluate the vitamin D status and association with biomarkers of the renal graft function after KTx. Methods: this longitudinal study included 42 patients evaluated at baseline, 3 and 6 months after KTx. Biodemographic, clinical, and biochemical parameters such as 25(OH)D and parathyroid hormone (PTH), and biomarkers of renal graft function, such as creatinine, estimated glomerular filtration rate (eGFR), and albumin/creatinine ratio (ACR), were assessed. Sun exposure was also evaluated. Patients were categorized according to their 25(OH)D levels. Results: at baseline, 25(OH)D levels < 30 ng/mL were found in 43 % patients, and 38 % of these patients failed to improve their 25(OH)D levels by 6 months after KTx. Low 25(OH)D levels occurred regardless of sun exposure. Further, 44 % patients developed albuminuria at 6 months. An increased ACR was observed in patients with 25(OH)D levels < 30 ng/mL (p = 0.002) compared to that in patients with 25(OH)D > 30 ng/mL. Additionally, 25(OH)D levels were negatively correlated with ACR at 6 months post-KTx (r = -0.444; p = 0.003). Twelve (28.6 %) patients with 25(OH)D levels < 30 ng/mL showed no eGFR recovery until 6 months after KTx. Conclusion: low vitamin D levels and increased albuminuria were observed at 6 months after KTx, even in a region with high sun exposure. The association between vitamin D status and biomarkers of renal graft function after KTx should be explored in further studies.

Introducción: Introducción: los bajos niveles de 25-hidroxivitamina D [25(OH)D] ocurren después del procedimiento de trasplante de riñón (KTx) y pueden estar asociados con un aumento del riesgo de pérdida del injerto. Este estudio longitudinal tuvo como objetivo evaluar el estado de la vitamina D y la asociación con los biomarcadores de función del injerto renal después del KTx. Métodos: este estudio longitudinal incluyó a 42 pacientes que fueron evaluados al inicio del estudio y, 3 y 6 meses después del KTx. Se evaluaron los parámetros biodemográficos, clínicos y bioquímicos, como 25(OH)D y hormona paratiroidea (PTH), y los biomarcadores de función del injerto renal, como creatinina, tasa de filtración glomerular estimada (eGFR) y relación albúmina/creatinina (ACR). También se evaluó la exposición al sol. Los pacientes se clasificaron según sus niveles de 25(OH)D. Resultados: al inicio del estudio se encontraron niveles de 25(OH)D < 30 ng/ml en el 43 % de los pacientes, mientras que el 38 % de estos pacientes no lograron mejorar sus niveles de 25(OH)D a los 6 meses después del KTx. También se produjeron niveles bajos de 25(OH)D independientemente de la exposición al sol. Asimismo, el 44 % de los pacientes desarrollaron albuminuria a los 6 meses. Se observó un aumento de la ACR en los pacientes con niveles de 25(OH)D < 30 ng/mL (p = 0,002) en comparación con los pacientes con 25(OH)D > 30 ng/mL. Además, los niveles de 25(OH)D se correlacionaron negativamente con la ACR a los 6 meses después del KTx (r = -0,444; p = 0,003). Doce (28,6 %) pacientes con niveles de 25(OH)D < 30 ng/ml no mostraron recuperación de la TFGe hasta 6 meses después del KTx. Conclusión: se observaron niveles bajos de vitamina D y un aumento de la albuminuria a los 6 meses después del KTx, incluso en una región con alta exposición solar. La asociación entre el estado de la vitamina D y los biomarcadores de función del injerto renal después del KTx debe explorarse en estudios adicionales.

Variables influyentes en los niveles de 25(OH)D total y libre en población sana / Influencing variables on total and free 25(OH)D levels in healthy population

Introducción La vitamina D ejerce un papel fundamental en la homeostasis del calcio y el metabolismo óseo. Procede, mayoritariamente, de la síntesis cutánea, por acción de la luz solar. Así, variaciones en la exposición a esta radiación modifican sus niveles séricos. Estudiamos dos analitos diferentes de vitamina D en población sana española, y la influencia de la estacionalidad, el clima y la latitud en sus estatus. Métodos Estudio descriptivo, transversal. Se incluyeron 206 donantes de sangre de Burgos y Valencia de 18-60 años durante marzo-abril y octubre-noviembre de 2018. Se analizaron las concentraciones séricas de 25-hidroxicolecalciferol (25(OH)D) total y libre. Resultados Las concentraciones medias de 25(OH)D total y libre tras el verano en Burgos fueron: 24,31 ± 5,25 ng/mL y 5,01 ± 1,25 pg/mL; y en Valencia: 25,99 ± 6,87 ng/mL y 8,97 ± 2,82 pg/mL. Tras el invierno, los resultados en Burgos fueron: 17,66 ± 5,04 ng/mL y 4,08 ± 0,66 pg/mL, y en Valencia: 21,38 ± 3,77 ng/mL y 7,23 ± 2,44 pg/mL. Los cambios estacionales resultaron estadísticamente significativos para los dos componentes estudiados, tanto de manera global como en ambas poblaciones por separado. Las diferencias poblacionales en los niveles de 25(OH)D total y libre resultaron estadísticamente significativas, excepto en 25(OH)D total tras el verano (24,07 ng/mL vs. 26,03 ng/mL; p = 0,408). La latitud también demostró ser un factor influyente en las concentraciones de ambos analitos, en verano e invierno. Conclusiones Nuestro estudio refleja niveles de vitamina D más bajos de lo esperable tratándose de población sana española. Se demuestra la influencia de la estacionalidad, el clima y la latitud en los niveles de 25(OH)D total y 25(OH)D libre (AU)

Introduction Vitamin D plays a fundamental role in calcium homeostasis and bone metabolism. It mainly comes from cutaneous synthesis through the action of sunlight. Therefore, variations in exposure to this radiation modify serum levels. We studied two different analytes of vitamin D in the healthy Spanish population and the influence of seasonality, climate, and latitude on its levels. Methods This work is a cross-sectional, descriptive study. A total of 206 blood donors from Burgos and Valencia between 18-60 years of age were recruited during March-April and October-November 2018. Total and free serum 25-hydroxycholecalciferol (25(OH)D) were analyzed. Results After summer, total and free serum 25(OH)D medium levels were 24.31 ± 5.25 ng/mL and 5.01 ± 1.25 pg/mL in Burgos and 25.99 ± 6.87 ng/mL and 8.97 ± 2.82 pg/mL in Valencia. After winter, they were 17.66 ± 5.04 ng/mL and 4.08 ± 0.66 ng/mL in Burgos and 21.38 ± 3.77 ng/mL and 7.23 ± 2.44 ng/mL in Valencia. The seasonal changes were statistically significant for both components studied both in the sample as a whole and in the separate populations. The differences found between the two populations in total and free 25(OH)D levels were statistically significant except for total 25(OH)D after summer (24.07 ng/mL vs. 26.03 ng/mL; p = 0.408). Latitude was also shown to be a factor that influences concentrations of both analytes in summer and winter. Conclusions Our study shows lower vitamin D levels than expected for a healthy Spanish population. Seasonality, climate, and latitude were demonstrated to influence total and free 25(OH)D levels (AU)

Serum 25-hydroxyvitamin D correlates with systolic blood pressure in obese male schoolchildren / La 25-hidroxivitamina D sérica se correlaciona con la presión arterial sistólica en niños escolares con obesidad

Introduction: childhood obesity is associated with an increased risk of chronic diseases. We aimed to examine the relation between serum levels of 25-hydroxyvitamin D (25[OH]D) and blood pressure in obese schoolchildren. Material and methods: a cross-sectional study in school-age children with obesity. The serum levels of 25(OH)D were measured and classified as sufficient or insufficient/deficient. Blood pressure was measured. Normal values were considered < 90th percentile, elevated blood pressure ≥ 90th to < 95th percentiles, and hypertension ≥ 95th percentile, according to blood pressure reference tables specific for age, sex, and height. A Pearson correlation was performed. Results: a total of 256 obese schoolchildren (123 [48.0 %] females and 133 [51.9 %] males) were evaluated. The prevalence rates of vitamin D deficiency, insufficiency, and sufficiency were 23.4 %, 52.3 %, and 24.2 %, respectively. Normal blood pressure was observed in 101 (39.4 %) children; the frequencies of elevated blood pressure and hypertension were 10.9 % and 49.6 %, respectively. A moderate inverse correlation of 25(OH)D levels with systolic blood pressure levels (r = -0.54, p = 0.03) was observed. When analyzed by sex, a significantly high inverse correlation between 25(OH)D levels and systolic blood pressure was observed in males (r = -0.85 and p ≤ 0.001). No significant correlation was found in females (systolic r = -0.16 and p = 0.67; diastolic r = -0.15 and p = 0.812). When performing the multiple regression analysis, the 25(OH)D levels and BMI were the significant predictors for systolic blood pressure. Conclusions: we identified an inverse correlation between 25[OH]D levels and systolic blood pressure in male schoolchildren with obesity (AU)

Introducción: la obesidad infantil se asocia con un mayor riesgo de desarrollar enfermedades crónicas. El objetivo fue analizar la relación entre los niveles séricos de 25-hidroxivitamina D (25[OH]D) y la presión arterial (PA) en escolares obesos. Material y métodos: estudio transversal en niños en edad escolar con obesidad. Los niveles séricos de 25(OH)D se clasificaron como suficientes e insuficientes/deficientes. Los valores de PA se clasificaron como normales si < percentil 90, presión elevada entre los percentiles ≥ 90 y < 95, e hipertensión si ≥ percentil 95, de acuerdo con las tablas de referencia de la PA, específicas para cada edad, sexo y altura. Se realizaron una correlación de Pearson y una regresión múltiple. Resultados: se evaluaron 256 escolares obesos (123 [48,0 %] mujeres y 133 [51,9 %] hombres). La frecuencia de la deficiencia, insuficiencia y suficiencia de vitamina D fue del 23,4 %, 52,3 % y 24,2 %, respectivamente. Se observó una PA normal en 101 (39,4 %) niños; las frecuencias de la PA elevada y la hipertensión fueron del 10,9 % y 49,6 %, respectivamente. Se observó una correlación inversa moderada de los niveles de 25(OH)D con los niveles de presión arterial sistólica (PAS) (r = -0,54; p = 0,03). Cuando se analizó por sexos, se observó una correlación inversa entre los niveles de 25(OH)D y la PAS en los niños (r = -0,85; p ≤ 0,001). No se encontró ninguna correlación significativa en las niñas (sistólica, r = -0,16; p = 0,67; diastólica, r = -0,15; p = 0,812). Al realizar el análisis de regresión múltiple, los niveles de 25(OH)D y el IMC fueron predictores significativos de la PAS. Conclusiones: identificamos una correlación inversa entre los niveles de 25[OH]D y la PAS en niños escolares con obesidad (AU)

Relationship of vitamin D intake and sun exposure with serum 25-hydroxyvitamin-D in schoolchildren with obesity

The obesity worldwide has produced an increase in obesity-related diseases and can be associated with low concentrations of 25-hydroxyvitamin-D. Also obesity and low physical activity can decrease sun exposure, so the aim was to correlate vitamin D intake with serum 25-hydroxyvitamin-D levels and to assess sun exposure habits in schoolchildren with obesity. Materials and methods. A correlational study was performed from January 2017 to January 2018 on 103 children between 6-12 years of age, with a body mass index ≥+2SD for age and sex, according to the World Health Organization. Blood samples were taken to determine the serum concentrations of 25-hydroxyvitamin-D, a nutritional survey to determine the vitamin D intake and a sun exposure questionnaire were applied. A Spearman correlation coefficient analysis was performed. Results. Forty-seven percent of the children were girls. The median years of age was 10. The median serum 25-hydroxyvitamin-D levels were 35.5 ng/mL, 74.8% had sufficient levels, 25.2% had insufficient levels. The median vitamin D intake was 214.7IU in boys and 231.9IU in girls. Regarding sun exposure, most of the children had excessive levels of sun exposure and inadequate sun protection practices. A positive correlation between vitamin D intake and serum 25-hydroxyvitamin-D was identified only in boys (rho=0.276, p=0.041). Conclusion. A positive correlation between vitamin D intake and serum 25-hydroxyvitamin-D levels was found in obese boys and excessive levels of sun exposure with inadequate sun protection practices in boys and girls(AU)

La obesidad se le ha asociado con distintas comorbilidades, bajas concentraciones séricas de 25-hidroxivitamina-D, sedentarismo que a su vez podría comprometer la exposición solar; por tanto, el objetivo fue relacionar la ingesta de vitamina D con los niveles séricos de 25-hidroxivitamina-D y determinar los hábitos de exposición solar en escolares con obesidad. Materiales y métodos. Estudio correlacional realizado de enero 2017 a enero 2018, en 103 niños entre 6 y 12 años, con un índice de masa corporal ≥+2DE para edad y sexo, según la Organización Mundial de la Salud. Se extrajo muestras sanguíneas para determinar las concentraciones séricas de 25-hidroxivitamina-D, se aplicó una encuesta nutricional para determinar la ingesta de vitamina D y un cuestionario de exposición solar. Se realizó un análisis del coeficiente de correlación de Spearman. Resultados. El 47% de los sujetos eran niñas. La mediana de edad fue de 10. La mediana de los niveles séricos de 25-hidroxivitamina-D fue de 35,5 ng/mL, el 74,8% tenía niveles suficientes, el 25,2% tenía niveles insuficientes. La mediana de la ingesta de vitamina D fue de 214,7UI en niños y de 231,9UI en niñas. Con respecto a la exposición solar, la mayoría de los niños presentaban una exposición excesiva y prácticas inadecuadas de protección solar. Se identificó una correlación positiva entre la ingesta de vitamina D y la 25-hidroxivitamina-D sérica en los niños (rho=0,276, p=0,041). Conclusión. Se identificó una correlación positiva entre la ingesta de vitamina D y los niveles séricos de 25-hidroxivitamina-D en niños obesos y exposición excesiva con prácticas inadecuadas de protección solar en niños y niñas(AU)

Serum 25-Hydroxyvitamin D correlates with systolic blood pressure in obese male schoolchildren.

Introduction: Introduction: childhood obesity is associated with an increased risk of chronic diseases. We aimed to examine the relation between serum levels of 25-hydroxyvitamin D (25[OH]D) and blood pressure in obese schoolchildren. Material and methods: a cross-sectional study in school-age children with obesity. The serum levels of 25(OH)D were measured and classified as sufficient or insufficient/deficient. Blood pressure was measured. Normal values were considered < 90th percentile, elevated blood pressure ≥ 90th to < 95th percentiles, and hypertension ≥ 95th percentile, according to blood pressure reference tables specific for age, sex, and height. A Pearson correlation was performed. Results: a total of 256 obese schoolchildren (123 [48.0 %] females and 133 [51.9 %] males) were evaluated. The prevalence rates of vitamin D deficiency, insufficiency, and sufficiency were 23.4 %, 52.3 %, and 24.2 %, respectively. Normal blood pressure was observed in 101 (39.4 %) children; the frequencies of elevated blood pressure and hypertension were 10.9 % and 49.6 %, respectively. A moderate inverse correlation of 25(OH)D levels with systolic blood pressure levels (r = -0.54, p = 0.03) was observed. When analyzed by sex, a significantly high inverse correlation between 25(OH)D levels and systolic blood pressure was observed in males (r = -0.85 and p ≤ 0.001). No significant correlation was found in females (systolic r = -0.16 and p = 0.67; diastolic r = -0.15 and p = 0.812). When performing the multiple regression analysis, the 25(OH)D levels and BMI were the significant predictors for systolic blood pressure. Conclusions: we identified an inverse correlation between 25[OH]D levels and systolic blood pressure in male schoolchildren with obesity.

Introducción: Introducción: la obesidad infantil se asocia con un mayor riesgo de desarrollar enfermedades crónicas. El objetivo fue analizar la relación entre los niveles séricos de 25-hidroxivitamina D (25[OH]D) y la presión arterial (PA) en escolares obesos. Material y métodos: estudio transversal en niños en edad escolar con obesidad. Los niveles séricos de 25(OH)D se clasificaron como suficientes e insuficientes/deficientes. Los valores de PA se clasificaron como normales si < percentil 90, presión elevada entre los percentiles ≥ 90 y < 95, e hipertensión si ≥ percentil 95, de acuerdo con las tablas de referencia de la PA, específicas para cada edad, sexo y altura. Se realizaron una correlación de Pearson y una regresión múltiple. Resultados: se evaluaron 256 escolares obesos (123 [48,0 %] mujeres y 133 [51,9 %] hombres). La frecuencia de la deficiencia, insuficiencia y suficiencia de vitamina D fue del 23,4 %, 52,3 % y 24,2 %, respectivamente. Se observó una PA normal en 101 (39,4 %) niños; las frecuencias de la PA elevada y la hipertensión fueron del 10,9 % y 49,6 %, respectivamente. Se observó una correlación inversa moderada de los niveles de 25(OH)D con los niveles de presión arterial sistólica (PAS) (r = -0,54; p = 0,03). Cuando se analizó por sexos, se observó una correlación inversa entre los niveles de 25(OH)D y la PAS en los niños (r = -0,85; p ≤ 0,001). No se encontró ninguna correlación significativa en las niñas (sistólica, r = -0,16; p = 0,67; diastólica, r = -0,15; p = 0,812). Al realizar el análisis de regresión múltiple, los niveles de 25(OH)D y el IMC fueron predictores significativos de la PAS. Conclusiones: identificamos una correlación inversa entre los niveles de 25[OH]D y la PAS en niños escolares con obesidad.

The importance of optimal 25-hydroxyvitamin D levels in the glycemic control of older adults with type 2 Diabetes Mellitus: Data from the study on aging and longevity EELO

INTRODUCTION: Optimal serum levels of vitamin D are of great importance, especially in populations with comorbidities such as Diabetes Mellitus (DM). OBJECTIVE: The study evaluated the relationship between hypovitaminosis D and glycemic control in older adults with type 2 DM. METHODS: Cross-sectional and prospective study, part of the EELO project (Study on Aging and Longevity), conducted in Southern Brazil. Glycated hemoglobin (diabetes ≥6.5%) and serum levels of vitamin D (25(OH)D) were evaluated. Hypovitaminosis D was determined using cutoff points <20 and <30 ng/mL). Multivariate logistic regression was used to assess the risk of having uncontrolled DM. RESULTS: Of the 120 older adults included in the study, aged between 60 and 87 years, 74.2% were women, 66.7% used hypoglycemic medications and 75.8% exhibited uncontrolled diabetes. An inverse correlation was observed between the levels of 25(OH) D and glycated hemoglobin (rS=-0.19, p=0.037), suggesting that low levels of vitamin D are associated with poor glycemic control in diabetic individuals. The prevalence of hypovitaminosis D when using the cutoff points of <20 and <30 ng/mL were 34.2% and 75.0%, respectively. The odds ratio (OR) analysis showed that individuals with 25(OH)D<20ng/mL have almost 4 times more risk of having uncontrolled DM (OR:3.94; CI95%:1.25-12.46, p=0.02) when compared to the older adults with sufficient levels of vitamin D. CONCLUSION: The results indicate that the optimal serum levels currently recommended for 25(OH)D should preferably be 30 ng/mL or higher to contribute to better glycemic control in older adults with type 2 DM.

INTRODUÇÃO: Os níveis séricos ideais de vitamina D são de grande importância, especialmente na população com comorbidades como o Diabetes Mellitus (DM). OBJETIVO: O estudo avaliou a relação entre hipovitaminose D e controle glicêmico em idosos com DM tipo 2. MÉTODOS: Estudo transversal e prospectivo, parte do projeto EELO (Estudo sobre Envelhecimento e Longevidade), no Sul do Brasil. A hemoglobina glicada (diabetes ≥6,5%) e os níveis séricos de vitamina D (25(OH)D) foram avaliados. Hipovitaminose D foi determinada usando ponto de corte <20 e <30 ng/mL. Regressão logística multivariada foi utilizada para avaliar o risco de ter DM descompensado. RESULTADOS: Dos 120 idosos incluídos no estudo, idade entre 60 a 87 anos, 74,2% eram mulheres, 66,7% faziam uso de medicamentos hipoglicemiantes e 75,8% apresentavam diabetes descompensada. Uma correlação inversa foi observada entre os níveis de 25(OH)D e hemoglobina glicada (rS=-0,19; p=0.037), sugerindo que baixos níveis de vitamina D está associado a um pior controle glicêmico em diabéticos. A prevalência de hipovitaminose D quando se utiliza ponto de corte <20 e <30 ng/mL foi de 34,2% e 75,0%, respectivamente. A análise Odds ratio (OR) mostrou que indivíduos com 25(OH)D<20 ng/mL tem quase 4 vezes mais risco de ter DM descompensado (OR:3,94; IC95%:1,25­12,46; p=0,02) quando comparado aos idosos com níveis suficientes de vitamina D. CONCLUSÃO: Os resultados indicam que os níveis sérios ideais atualmente recomendados para 25(OH)D maior ou igual a 30 ng/ml contribuem para o melhor controle glicêmico na população idosa com DM tipo 2.

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)

Influencing variables on total and free 25(OH)D levels in healthy population.

INTRODUCTION: Vitamin D plays a fundamental role in calcium homeostasis and bone metabolism. It mainly comes from cutaneous synthesis through the action of sunlight. Therefore, variations in exposure to this radiation modify serum levels. We studied two different analytes of vitamin D in the healthy Spanish population and the influence of seasonality, climate, and latitude on its levels. METHODS: This work is a cross-sectional, descriptive study. A total of 206 blood donors from Burgos and Valencia between 18-60 years of age were recruited during March-April and October-November 2018. Total and free serum 25-hydroxycholecalciferol (25(OH)D) were analyzed. RESULTS: After summer, total and free serum 25(OH)D medium levels were 24.31 ±â€¯5.25 ng/mL and 5.01 ±â€¯1.25 pg/mL in Burgos and 25.99 ±â€¯6.87 ng/mL and 8.97 ±â€¯2.82 pg/mL in Valencia. After winter, they were 17.66 ±â€¯5.04 ng/mL and 4.08 ±â€¯0.66 ng/mL in Burgos and 21.38 ±â€¯3.77 ng/mL and 7.23 ±â€¯2.44 ng/mL in Valencia. The seasonal changes were statistically significant for both components studied both in the sample as a whole and in the separate populations. The differences found between the two populations in total and free 25(OH)D levels were statistically significant except for total 25(OH)D after summer (24.07 ng/mL vs. 26.03 ng/mL; p = .408). Latitude was also shown to be a factor that influences concentrations of both analytes in summer and winter. CONCLUSIONS: Our study shows lower vitamin D levels than expected for a healthy Spanish population. Seasonality, climate, and latitude were demonstrated to influence total and free 25(OH)D levels.

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

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 ß-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.

Associação entre vitamina D sérica e rinossinusite crônica: uma metanálise / Association between serum vitamin D and chronic rhinosinusitis: a meta-analysis

Resumo Introdução: A rinossinusite crônica é uma inflamação crônica altamente heterogênea do trato respiratório superior causada por uma disfunção imune nos seres humanos. Entretanto, a etiologia subjacente dessa doença ainda não foi bem estabelecida. Diversos estudos revelaram que anormalidades nos níveis séricos de vitamina D podem desempenhar um papel na fisiopatologia da doença. Objetivo: Fazer uma metanálise de estudos para comparar os níveis séricos de vitamina D entre pacientes com rinossinusite crônica e controles saudáveis e avaliar as potenciais associações do nível sérico de vitamina D com a ocorrência da doença. Método: Seguindo as diretrizes Prisma, bancos de dados relevantes, inclusive Pubmed, Web of Science, Embase e Cochrane Library, foram pesquisados desde a sua data de início até 1° de dezembro de 2018. A simetria do gráfico de funil (funnel plot symmetry) e o teste de Egger foram usados para detectar o viés da publicação. Os desfechos foram apresentados como diferença média ponderada e combinamos a diferença média ponderada e intervalos de confiança de 95% para estimar a diferença dos níveis séricos de vitamina D entre pacientes com rinossinusite crônica e os controles. O valor de I2 de Higgins foi usado para testar a heterogeneidade entre os estudos incluídos. Resultados: Dos 176 estudos que identificamos, apenas oito, que envolveram 337 pacientes com rinossinusite crônica e 179 controles saudáveis, preencheram os critérios e foram incluídos na metanálise. Em uma análise combinada de todos os estudos, a diminuição do nível sérico de vitamina D foi demonstrada na rinossinusite crônica (DMP = −7,80, IC95% −13,28 ± −2,31, p = 0,000). Análises de subgrupos com base no local do estudo (EUA vs. Não EUA), tipos de biomarcadores (25[OH]D3 vs. 25[OH]D) e desenho do estudo (retrospectivo vs. prospectivo) não explicaram a heterogeneidade. No entanto, o fenótipo da rinossinusite crônica (rinossinusite crônica com pólipos nasais vs. rinossinusite crônica sem pólipos nasais) pode explicar algum grau de heterogeneidade. Contudo, um nível sérico mais baixo de vitamina D foi observado em pacientes com rinossinusite crônica com pólipos nasais. Conclusão: Nossos achados indicam que o nível sérico de vitamina D pode estar associado à rinossinusite crônica, pois detectamos uma associação significante entre níveis séricos mais baixos de vitamina D em pacientes com rinossinusite crônica, especialmente na rinossinusite crônica com pólipos nasais. No entanto, mais estudos abrangentes são necessários para se chegar a conclusões abalizadas.

Vitamin D-dependent rickets (VDDR) type 1: case series of two siblings with a CYP27B1 mutation and review of the literature / Raquitismo dependente de vitamina D: tipo 1: série de casos de dois irmãos com mutação CYP27B1 e revisão da literatura

Abstract Two siblings presented with clinical and biochemical features of rickets, initially suspected as hypophosphatemic rickets. There was no improvement initially, hence the siblings were reinvestigated and later diagnosed as having vitamin D-dependent rickets (VDDR) type 1 due to a rare mutation in the CYP27B1 gene encoding the 1α-hydroxylase enzyme. Both siblings improved with calcitriol supplementation. The initial presentation of VDDR is often confusing and algorithmic evaluation helps in diagnosis. We also present a brief review of the literature, including genetics.

Resumo Dois irmãos apresentaram características clínicas e bioquímicas do raquitismo, com suspeita clínica inicial de raquitismo hipofosfatêmico. Não houve melhora no início, portanto os irmãos foram reavaliados e, posteriormente, diagnosticados com raquitismo dependente de vitamina D (VDDR) tipo 1 devido a uma rara mutação no gene CYP27B1, que codifica a enzima 1a-hidroxilase. Ambos os irmãos melhoraram com a suplementação de calcitriol. A apresentação inicial do VDDR geralmente é confusa e a avaliação algorítmica ajuda no diagnóstico. Também apresentamos uma breve revisão da literatura, incluindo genética.

Serum 25-hydroxyvitamin D level is negatively associated with serum phosphorus level among stage 3a-5 chronic kidney disease patients.

BACKGROUND: Serum 25-hydroxyvitamin D (25(OH)D) negatively correlates with serum phosphorus level of stage 3a-5 chronic kidney disease (CKD) patients. So far, no explanation has been provided for this negative association. OBJECTIVE: To confirm this negative association and determine if this relationship is mediated through other known co-morbid factors. CASES AND METHODS: One hundred (57 male and 43 female) pre-dialysis stage 3a-5 CKD patients were selected. Estimated glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), 25(OH)D, parathyroid hormone (PTH), and intact fibroblast growth factor-23 (FGF23) were assessed. A correlation analysis between serum 25(OH)D and the different parameters studied was performed. Multivariate linear regression analysis was carried out to determine predictors of 25(OH)D. RESULTS: The negative association between serum 25(OH)D and serum P was confirmed in univariate and multivariate correlation analysis. On the other hand, we failed to detect a significant association between 25(OH)D and serum FGF23. Serum P is the most important independent predictor of 25(OH)D in these patients (partial R2=0.15, p<0.0001). CONCLUSION: Serum P is likely to have a direct negative impact on serum 25(OH)D. Further studies are needed to determine the underlying mechanism.

Concentraciones de 25-hidroxivitamina D en embarazadas con y sin diabetes gestacional / Levels of 25-hydroxyvitamin D in pregnant womens with and without gestational diabetes mellitus

Resumen Objetivo: Comparar las concentraciones de 25-hidroxivitamina D (25[OH]D) en pacientes con y sin diabetes gestacional. Materiales y métodos: Estudio observacional, transversal y analítico consistente en la toma de muestras sanguíneas para determinar y comparar las concentraciones de 25-hidroxivitamina D. El tamaño de la muestra se determinó previamente con base en una prevalencia de 35% para la deficiencia de vitamina D, un error alfa de 0.05 y un error beta de 0.80. Resultados: Se reclutaron 784 embarazadas, 394 con diabetes gestacional y 390 sin este padecimiento. En este último grupo 51% (n = 199) tuvieron concentraciones suficientes, 33% (n = 129) concentraciones insuficientes y 16% (n = 62) concentraciones deficientes. En el grupo de mujeres con diabetes gestacional, 12% (n = 47) tuvieron concentraciones suficientes, 67% (n = 264) concentraciones insuficientes y 21% (n = 83) concentraciones deficientes. Los resultados obtenidos muestran que 88.9% (n = 350) de las mujeres con diabetes gestacional tenían concentraciones inferiores a 30 ng/mL vs 48.5% (n = 189) del grupo sin diabetes gestacional (p < 0.00001; RM: 7.69; IC95%: 5.3-11). Conclusiones: Las concentraciones inferiores a 30 ng/mL de vitamina D total son más frecuentes en pacientes con diabetes gestacional.

Abstract Objective: To compare the levels of vitamin (25[OH]D) between patients with or without gestational diabetes. Materials and methods: Analytical cross-sectional study that consisted in taking blood samples to determine and compare the concentrations of (25[OH]D) vitamin D. The sample size was previously determined considering a prevalence of 35% for vitamin D deficiency, an alpha error of 0.05 and a beta error of 0.80 for which 784 pregnant women were recruited, 394 patients with gestational diabetes and 390 without gestational diabetes. Results: In the group of patients without gestational diabetes, 51% (n = 199) had sufficient levels, 33% (n = 129) insufficient levels and 16% (n = 62) deficient levels. In the group of patients with gestational diabetes, 12% (n = 47) had sufficient levels, 67% (n = 264) insufficient levels and 21% (n = 83) deficient levels. The results obtained show that 88.9% (n = 350) of women with gestational diabetes present with levels lower than 30 ng/mL vs 48.5% (n = 189) of the group without gestational diabetes [p <0.00001 OR 7.69 (IC95%: 5.3 - 11)]. Conclusions: Levels below 30 ng/mL of total vitamin D are more frequent in patients with gestational diabetes.

Niveles de 25(oh)-vitamina D en pacientes con diabetes mellitus tipo 2 con y sin síndrome metabólico / 25(OH)-Vitamin D levels in type 2 diabetes with and without metabolic syndrome

Los bajos niveles de 25-hidroxivitamina D (25OHD) se han vinculado con el desarrollo de enfermedad cardiovascular, diabetes mellitus tipo 2, obesidad, dislipidemia e hipertensión arterial, todos componentes del síndrome metabólico (SM). Además, se ha reportado una asociación inversa entre 25OHD y el SM, resistencia a la insulina, deterioro de la función celular ß e intolerancia a la glucosa. El objetivo de este trabajo fue evaluar los niveles de 25OHD en pacientes diabéticos tipo 2 con y sin SM. Se llevó a cabo un estudio observacional de corte transversal. Se evaluaron 108 pacientes diabéticos tipo 2 (grupo DM2) y 89 pacientes sin DM2 (GC) con y sin SM, en los cuales se determinó la concentración de 25OHD total. Se calculó el cociente de probabilidad (OR) e intervalo de confianza del 95% (IC95) para la deficiencia de 25OHD (<20 ng/ml). Resultados: el grupo DM2 presentó niveles menores de 25OHD (19,8 ng/ml vs. 25,0 ng/ml) y mayor proporción de pacientes con deficiencia de 25OHD respecto del GC (50,9% vs. 28,1%, OR 2,7, IC95%: 1,5-4,8). No se halló una correlación entre 25OHD y HbA1c. Se halló asociación significativa entre deficiencia de 25OHD y presencia de diabetes, obesidad y SM. Sin embargo, en el análisis multivariado solo la presencia del SM presentó asociación negativa significativa con la deficiencia de 25OHD (OR=4,04, IC95% 1,48-11,68). En conclusión, nuestros datos demuestran una elevada prevalencia de hipovitaminosis D en pacientes con diabetes mellitus tipo 2 a expensas, principalmente, del elevado porcentaje de pacientes que padecen SM. El SM incrementa cuatro veces el riesgo de deficiencia de vitamina D independientemente de la presencia de diabetes mellitus tipo 2. (AU)

Low levels of 25-hydroxyvitamin D (25OHD) have been linked to cardiovascular disease, type 2 diabetes mellitus, obesity, dyslipidemia and hypertension, all components of the metabolic syndrome. An inverse association has been observed between 25OHD and metabolic syndrome, insulin resistance, impaired ß-cell function and glucose intolerance. The aim of this study was to evaluate the 25OHD levels in type 2 diabetic patients with and without metabolic syndrome. An observational cross-sectional study was carried out. We included 108 type 2 diabetic patients (DM2 group) and 89 patients without DM2 (CG) with and without metabolic syndrome, in which the total 25OHD levels were measured. The odds ratio (OR) and 95% confidence interval (95%CI) for 25OHD deficiency (<20 ng/ml) were estimated. Results: The DM2 group had lower 25OHD levels (19.8 ng/ml vs 25.0 ng/ml) and higher proportion of patients with a 25OHD deficiency compared to the CG (50.9% vs 28.1%, OR 2.7, 95%CI: 1.5-4.8). No correlation was found between 25OHD and HbA1c. A significant association was found between 25OHD deficiency and the presence of diabetes, obesity, and the presence of metabolic syndrome. However, in the multivariate analysis only the presence of metabolic syndrome had a significant negative association with the 25OHD deficiency (OR=4.04, 95%CI 1.48-11.68). In conclusion, we found a high prevalence of hypovitaminosis D in DM2 and the metabolic syndrome increases the risk of 25OHD deficiency by four times. (AU)

Consensus - reference ranges of vitamin D [25(OH)D] from the Brazilian medical societies. Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC/ML) and Brazilian Society of Endocrinology and Metabolism (SBEM) / Posicionamento oficial da Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML) e da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) sobre intervalos de referência da vitamina D [25(OH)D]

ABSTRACT Introduction: Vitamin D is considered a pre-hormone and plays a crucial role in calcium homeostasis and, consequently, in bone health. The best source of vitamin D is the skin in response to sunlight. Only small amounts of this vitamin are found in some foods (especially fatty fish), which makes availability of vitamin D in the diet limited. Brazilian population studies show that the prevalence of hypovitaminosis D in our country is high. Objective: To define the reference intervals for vitamin D [25(OH)D]. Discussion: Consensus of specialists - literature review. Conclusion: The standardization of reference intervals is fundamental for the correct diagnosis and treatment of hypovitaminosis D.

RESUMO Introdução: A vitamina D é considerada um pré-hormônio e apresenta papel crucial na homeostase do cálcio e, consequentemente, na saúde óssea. A maior fonte de vitamina D é a pele, em resposta à luz solar. Apenas pequenas quantidades dessa vitamina são encontradas em alguns alimentos (especialmente peixes gordurosos), o que faz com que a disponibilidade da vitamina D na dieta seja limitada. Estudos populacionais brasileiros demonstram que a prevalência da hipovitaminose D no nosso país é elevada. Objetivo: Definição dos intervalos de referência para vitamina D [25(OH)D]. Discussão: Consenso de especialistas - revisão da literatura. Conclusão: A padronização dos intervalos de referência é fundamental para o correto diagnóstico e tratamento da hipovitaminose D.