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1.
Medicine (Baltimore) ; 98(48): e18113, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770235

RESUMO

The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03-1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01-2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48-1.13, P = .15).Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/mortalidade , Desnutrição/mortalidade , Deficiência de Vitamina D/mortalidade , Deficiência de Vitamina D/terapia , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Feminino , Fragilidade/sangue , Fragilidade/complicações , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Desnutrição/sangue , Desnutrição/complicações , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Vitaminas/uso terapêutico
2.
Pediatr Ann ; 48(8): e298-e303, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31426097

RESUMO

The importance of vitamin D and its role in several biological processes has been a topic of interest in recent years. Vitamin D is an essential nutrient that is needed for metabolic bone health and for maintaining bone calcium homeostasis. It is primarily synthesized in the skin on exposure to sunlight. Of late, vitamin D deficiency has been associated with conditions such as obesity, poor control of asthma and other autoimmune diseases, which has led to questions about its potential role in causation and management of these conditions. Given the increase in data about this topic, providers may often have questions about whom to screen and what to tell patients. In this article, we address screening guidelines for vitamin D in children and adolescents, management of vitamin D deficiency, and current literature on the role of vitamin D in conditions such as obesity, asthma, and type 1 diabetes mellitus. [Pediatr Ann. 2019;48(8):e298-e303.].


Assuntos
Deficiência de Vitamina D/terapia , Adolescente , Asma/etiologia , Criança , Diabetes Mellitus Tipo 1/etiologia , Suplementos Nutricionais , Humanos , Obesidade Pediátrica/etiologia , Luz Solar , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Vitaminas/uso terapêutico
3.
Reprod Health ; 16(1): 106, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307482

RESUMO

BACKGROUND: Vitamin D deficiency has been associated with an increased risk of abnormal pregnancy implantation leading to obstetric complications such as pre-eclampsia and fetal growth restriction. However, the effect of vitamin D on reproductive treatment outcomes in couples undergoing assisted reproductive treatment is poorly understood. This study investigates the association between vitamin D and reproductive treatment outcomes in women undergoing assisted reproductive treatments? METHODS: A prospective cohort study conducted at a large tertiary teaching hospital, United Kingdom. Five hundred women undergoing assisted reproductive treatment were recruited between September 2013 and September 2015. All participants had their serum vitamin D measured and their reproductive treatment outcomes collated. Women were categorised in to three groups: vitamin D replete (> 75 nmol/L), insufficient (50-75 nmol/L) and deficient (< 50 nmol/L) according to Endocrine Society guidance. The primary outcome was live birth. Secondary outcomes included biochemical pregnancy, clinical pregnancy and pregnancy loss rates. RESULTS: Vitamin D deficiency was found in 53.2% (266/500) of participants and vitamin D insufficiency was found in 30.8% (154/500) of participants. Only 16% (80/500) of women were vitamin D replete. The live birth rates for vitamin D deficient, insufficient and replete women were 23.2% (57/246), 27.0% (38/141) and 37.7% (29/77) respectively (p = 0.04). The respective live birth rates for vitamin D deficient, insufficient and replete women were 24.3, 27.1, 34.4% after adjustment for key prognostic factors (p = 0.25). CONCLUSIONS: Vitamin D deficiency and insufficiency are common in women undergoing assisted reproductive treatments. The crude live birth rate achieved in women undergoing assisted reproductive treatments are associated with serum vitamin D, although statistical significance is lost when adjusting for important prognostic variables. Vitamin D deficiency could be an important condition to treat in women considering fertility treatment. A research trial to investigate the benefits of vitamin D deficiency treatment would test this hypothesis. TRIAL REGISTRATION: Clinicaltrials.gov - NCT02187146 .


Assuntos
Infertilidade Feminina/terapia , Nascimento Vivo , Técnicas de Reprodução Assistida , Deficiência de Vitamina D/terapia , Vitamina D/administração & dosagem , Vitamina D/sangue , Adulto , Implantação do Embrião , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/complicações , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Estudos Prospectivos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Vitaminas/administração & dosagem , Vitaminas/sangue
4.
Metabolism ; 98: 112-120, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31226354

RESUMO

Although vitamin D has been reported to have pleiotropic effects including effects on the immune system and on cancer progression, the principal action of vitamin D is the maintenance of calcium and phosphate homeostasis. The importance of vitamin D in this process is emphasized by the consequences of vitamin D deficiency which includes rickets in children and osteomalacia in adults. Vitamin D deficiency has also been reported to increase the risk of falls and osteoporotic fractures. Although vitamin D fortification of foods (including dairy products) has contributed to a marked decrease in rickets in the Western world, vitamin D deficiency in children and adults is still prevalent world-wide. This review summarizes new developments in our understanding of vitamin D endocrine system and addresses clinical syndromes related to abnormalities in vitamin D metabolism and action. In addition, the current understanding of the evaluation of vitamin D deficiency and sufficiency and recommendations for achieving vitamin D sufficiency are discussed.


Assuntos
Vitamina D/metabolismo , Animais , Densidade Óssea , Osso e Ossos/metabolismo , Humanos , Vitamina D/fisiologia , Deficiência de Vitamina D/metabolismo , Deficiência de Vitamina D/terapia
5.
Nutrients ; 11(6)2019 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-31181771

RESUMO

Sarcopenic obesity (SO) is referred to as the combination of obesity with low skeletal muscle mass and function. However, its definition and diagnosis is debated. SO represents a sizable risk factor for the development of disability, possibly with a worse prognosis in women. The present narrative review summarizes the current evidence on pharmacological, nutrition and exercise strategies on the prevention and/or treatment of SO in middle-aged and older-aged women. A literature search was carried out in Medline and Google Scholar between 29th January and 14th March 2019. Only controlled intervention studies on mid-age and older women whose focus was on the prevention and/or treatment of sarcopenia associated with obesity were included. Resistance training (RT) appears effective in the prevention of all components of SO in women, resulting in significant improvements in muscular mass, strength, and functional capacity plus loss of fat mass, especially when coupled with hypocaloric diets containing at least 0.8 g/kg body weight protein. Correction of vitamin D deficit has a favorable effect on muscle mass. Treatment of SO already established is yet unsatisfactory, although intense and prolonged RT, diets with higher (1.2 g/kg body weight) protein content, and soy isoflavones all look promising. However, further confirmatory research and trials combining different approaches are required.


Assuntos
Dieta , Força Muscular , Músculo Esquelético , Obesidade/terapia , Desempenho Físico Funcional , Treinamento de Resistência , Sarcopenia/terapia , Tecido Adiposo/metabolismo , Envelhecimento , Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/uso terapêutico , Feminino , Humanos , Isoflavonas/uso terapêutico , Músculo Esquelético/metabolismo , Obesidade/complicações , Obesidade/metabolismo , Obesidade/prevenção & controle , Sarcopenia/complicações , Sarcopenia/prevenção & controle , Soja/química , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/terapia
7.
Crit Care Resusc ; 21(1): 39-44, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30857511

RESUMO

OBJECTIVE: The purpose of this study was to evaluate if vitamin D deficiency is associated with increased rates of persistent critical illness, and whether repletion of vitamin D among patients with this deficiency leads to decreased persistent critical illness. DESIGN: Retrospective cohort analysis. SETTING: Seven intensive care units (ICUs) at the University Medical Center of Graz, Austria, with participants recruited between July 2008 and April 2010. The VITdAL-ICU trial cohort included five ICUs at the University Medical Center of Graz, Austria, with patients recruited between May 2010 through September 2012. PARTICIPANTS: There were 628 patients aged ≥ 18 years admitted to the ICU and who had their 25-hydroxyvitamin D (25(OH)D) level measured at least once. The VITdAL-ICU cohort included 475 patients aged ≥ 18 years who were expected to stay in the ICU for greater than 48 hours and found to have a 25(OH)D level of ≤ 20 ng/mL. MAIN OUTCOME MEASURES: Development of persistent critical illness. RESULTS: In the retrospective cohort, vitamin D level on admission was not significantly associated with the development of persistent critical illness compared with patients who were discharged alive earlier (relative risk ratio [RRR], 1.02; 95% CI, 1.00-1.04) or who died (RRR, 1.02; 95% CI, 0.99-1.05). In the VITdAL-ICU trial, supplementation with vitamin D3 did not lead to less persistent illness relative to patients who were discharged alive earlier (RRR, 1.19; 95% CI, 0.79-1.80) or who died (RRR, 1.34; 95% CI, 0.72-2.52). CONCLUSION: Vitamin D deficiency was not associated with persistent critical illness, nor did supplementation with vitamin D3 mitigate the development of persistent critical illness.


Assuntos
Estado Terminal/terapia , Deficiência de Vitamina D/terapia , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Vitaminas/administração & dosagem , Adolescente , Adulto , Estudos de Coortes , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico
8.
Artigo em Inglês | MEDLINE | ID: mdl-30857517

RESUMO

OBJECTIVE: Maternal vitamin D deficiency is an important risk factor that causes infantile rickets in the neonatal and infantile period. The aim of this study was to review the prevalence, clinical characteristics, and treatment of vitamin D deficiency and the follow-ups with infants and their mothers by the neonatal intensive care unit of Afiyet Hospital in Turkey. METHODS: Calcium (Ca), phosphorus (P) and 25 (OH) vitamin D were studied and prospectively recorded in infants and their mothers detected to have hypocalcemia during routine biochemistry tests performed on the third postnatal day of the patients follow up and treated with different diagnoses. RESULTS: A total of 2,460 infants were admitted into the neonatal intensive care unit between August 2014 and January 2018. Of the infants included in the study, 324 (66.1%) were male and 166 (33.8%) were female, and 366 (74.6%) of them had been delivered by cesarean section (C/S), 124 (25.3%) of them had been delivered by Normal Spontaneous Delivery (NSD). Hypocalcemia was detected in 490 (19.9%) of the infants. In a total of 190 (38.7%) infants and 86 mothers (17.5%), the levels of 25 (OH) vitamin D were found to be below the laboratory detection limit of <3 ng/ml. When vitamin D deficiency + insufficiency is assessed by season, 151 of them were found to be in summer (30.99%), 118 in spring (24.18%), 117 in the winter season(23.87%), and 93 in autumn(18.97%), respectively. There was a statistically significant positive correlation of 78.7% between the vitamins D values of the mothers and the infants (p: 0.000, p<0.05). CONCLUSION: This study conducted that a positive correlation of between the vitamin D values of the mothers and the infants. In order to prevent maternal vitamin D deficiency, the appropriate dose of prophylaxis providing optimal levels of vitamin D and should be given by according to the levels of 25 (OH) D vitamin during pregnancy.


Assuntos
Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/terapia , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/terapia , Adolescente , Adulto , Estudos de Casos e Controles , Quimioprevenção , Suplementos Nutricionais , Feminino , Seguimentos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Raquitismo/epidemiologia , Raquitismo/prevenção & controle , Turquia/epidemiologia , Deficiência de Vitamina D/congênito , Adulto Jovem
9.
Br J Nutr ; 121(5): 538-548, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30843501

RESUMO

In India, there is a lack of information about the adequate daily dose of vitamin D3 supplementation in school children. Hence, we undertook this study to evaluate the adequacy and efficacy of different doses of vitamin D3 in schoolchildren. A total of 1008 vitamin D-deficient (VDD) children, aged 6-16 years with serum 25-hydroxyvitamin D (25(OH)D) levels <50nmol/l, were cluster randomised into three groups (A-344, B-341 and C-232) for supplementation (600, 1000 and 2000 IU daily) of vitamin D3 under supervision for 6 months. Of the 1008 subjects who completed the study, 938 (93 %) were compliant. Baseline and post-supplementation fasting blood and urine samples were evaluated for Ca, phosphates, alkaline phosphatase, 25(OH)D and parathormone and urine Ca:creatinine ratio. The mean age of the subjects was 11·7 (sd 2·4) years, and the overall mean baseline serum 25(OH)D level was 24·3 (SD 9·5)nmol/l. Post-supplementation rise in serum 25(OH)D in compliant group was maximum with 2000 IU (70·0 (SD 30·0)nmol/l), followed by 1000 IU (46·8 (SD 22·5)nmol/l) and 600 IU (36·5 (SD 18·5)nmol/l), and serum 25(OH)D levels of ≥50nmol/l were achieved in 71·5, 81·8 and 92·9 % by groups A, B and C, respectively. Secondary hyperparathyroidism decreased from 31·7 to 8·4 % post-supplementation. Two participants developed hypercalciuria, but none developed hypercalcaemia. Children with VDD benefit maximum with the daily supplementation of 2000 IU of vitamin D3. Whether recommendations of 400 IU/d by Indian Council of Medical Research or 600 IU by Indian Academy of Pediatrics or Institute of Medicine would suffice to achieve vitamin D sufficiency in children with VDD remains debatable.


Assuntos
Colecalciferol/administração & dosagem , Suplementos Nutricionais , Deficiência de Vitamina D/terapia , Vitaminas/administração & dosagem , Adolescente , Fosfatase Alcalina/sangue , Cálcio/sangue , Cálcio/urina , Criança , Creatinina/urina , Feminino , Humanos , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/urina , Índia , Masculino , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Estudos Prospectivos , Método Simples-Cego , Estudantes , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/urina
10.
Indian J Tuberc ; 66(1): 26-29, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30797277

RESUMO

Many western societies have eliminated tuberculosis years before the advent of potent anti-tuberculous drugs, as a result of the improved standards of living and good nutrition. But even with the availability of powerful anti-tuberculous drugs, India still has a long road ahead to reach the "End TB by 2025" goal. One of the major reason is that tuberculosis control program in India till now have focused primarily on case detection and medical treatment of active tuberculosis. Drug treatment alone does not completely prevent the occurrence of new infections in the community and also contributes to development of drug resistant strains if used improperly or incompletely. Although the treatment of active cases can reduce the period of transmission of disease, a significant amount of transmission to contacts occurs even before they have been diagnosed and treated. Additionally, this approach cannot prevent re-activation to active TB in the vast pool of persons with latent TB infection. Tuberculosis occurs in those with suppressed cell mediated immunity mainly due to poor nutritional status. Improving the nutritional status of the society by several social interventions hand-in-hand with utilizing the available anti-tuberculous drugs is possibly the only effective strategy. Promising programmatic guidance for nutritional support in TB patients have been formulated by the Central TB division of India but it needs a refocusing of TB control strategies towards nutrition at all levels and strong public health actions for effective implementation.


Assuntos
Imunidade Celular/imunologia , Hospedeiro Imunocomprometido/imunologia , Desnutrição/imunologia , Estado Nutricional/imunologia , Tuberculose/prevenção & controle , Antituberculosos/uso terapêutico , Controle de Doenças Transmissíveis , Humanos , Índia , Tuberculose Latente/terapia , Desnutrição/dietoterapia , Tuberculose/imunologia , Tuberculose/terapia , Deficiência de Vitamina D/imunologia , Deficiência de Vitamina D/terapia
11.
Eur J Endocrinol ; 180(4): P23-P54, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30721133

RESUMO

Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) <50 nmol/L or 20 ng/mL) is common in Europe and the Middle East. It occurs in <20% of the population in Northern Europe, in 30-60% in Western, Southern and Eastern Europe and up to 80% in Middle East countries. Severe deficiency (serum 25(OH)D <30 nmol/L or 12 ng/mL) is found in >10% of Europeans. The European Calcified Tissue Society (ECTS) advises that the measurement of serum 25(OH)D be standardized, for example, by the Vitamin D Standardization Program. Risk groups include young children, adolescents, pregnant women, older people (especially the institutionalized) and non-Western immigrants. Consequences of vitamin D deficiency include mineralization defects and lower bone mineral density causing fractures. Extra-skeletal consequences may be muscle weakness, falls and acute respiratory infection, and are the subject of large ongoing clinical trials. The ECTS advises to improve vitamin D status by food fortification and the use of vitamin D supplements in risk groups. Fortification of foods by adding vitamin D to dairy products, bread and cereals can improve the vitamin D status of the whole population, but quality assurance monitoring is needed to prevent intoxication. Specific risk groups such as infants and children up to 3 years, pregnant women, older persons and non-Western immigrants should routinely receive vitamin D supplements. Future research should include genetic studies to better define individual vulnerability for vitamin D deficiency, and Mendelian randomization studies to address the effect of vitamin D deficiency on long-term non-skeletal outcomes such as cancer.


Assuntos
Suplementos Nutricionais , Sociedades Médicas/normas , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Calcinose/sangue , Calcinose/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Oriente Médio/epidemiologia , Vitamina D/administração & dosagem , Vitamina D/sangue , Deficiência de Vitamina D/terapia
12.
Nutrients ; 11(2)2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30791641

RESUMO

During pregnancy, vitamin D supplementation may be a feasible strategy to help prevent low birthweight (LBW) and small for gestational age (SGA) births. However, evidence from randomized controlled trials (RCTs) is inconclusive, probably due to heterogeneity in study design and type of intervention. A systematic literature search in the PubMed-Medline, EMBASE, and Cochrane Central Register of Controlled Trials databases was carried out to evaluate the effects of oral vitamin D supplementation during pregnancy on birthweight, birth length, head circumference, LBW, and SGA. The fixed-effects or random-effects models were used to calculate mean difference (MD), risk ratio (RR), and 95% Confidence Interval (CI). On a total of 13 RCTs, maternal vitamin D supplementation had a positive effect on birthweight (12 RCTs; MD = 103.17 g, 95% CI 62.29⁻144.04 g), length (6 RCTs; MD = 0.22 cm, 95% CI 0.11⁻0.33 cm), and head circumference (6 RCTs; MD:0.19 cm, 95% CI 0.13⁻0.24 cm). In line with these findings, we also demonstrated that maternal vitamin D supplementation reduced the risk of LBW (3 RCTs; RR = 0.40, 95% CI 0.22⁻0.74) and SGA (5 RCTS; RR = 0.69, 95% CI 0.51⁻0.92). The present systematic review and meta-analysis confirmed the well-established effect of maternal vitamin D supplementation on birth size. However, further research is required to better define risks and benefits associated with such interventions and the potential implications for public health.


Assuntos
Suplementos Nutricionais , Fenômenos Fisiológicos da Nutrição Materna , Resultado da Gravidez , Cuidado Pré-Natal/métodos , Vitamina D/administração & dosagem , Peso ao Nascer , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Estado Nutricional , Gravidez , Complicações na Gravidez/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Deficiência de Vitamina D/terapia
13.
J Eur Acad Dermatol Venereol ; 33 Suppl 2: 28-33, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30811696

RESUMO

Vitamin D seems to be associated with a protective effect in a vast range of diseases, including cardiovascular, autoimmune and oncologic conditions. Since ultraviolet (UV) B light is the most important prerequisite for the cutaneous synthesis of vitamin D, sunbeds are able to increase serum vitamin D levels, although only transiently in most cases. In this scenario, the artificial tanning industry relentlessly tries to promote the use of sunbeds as a 'safe' therapeutic measure to achieve an adequate serum vitamin D status. The World Health Organization classified UV-emitting tanning devices, as well as the whole UV spectrum, as group-1 carcinogens, as they significantly increase the risk of melanoma and non-melanoma skin cancer. In case of vitamin D deficiency or insufficiency, the current risk-benefit ratio is therefore in favour of vitamin D supplementation instead of sunbed use. Artificial tanning devices should never be considered as an option to achieve an appropriate vitamin D status. Their supposedly beneficial effects, vastly publicised by the artificial tanning industry, are not worth the carcinogenic risk associated with sunbed use.


Assuntos
Neoplasias Cutâneas/etiologia , Banho de Sol , Raios Ultravioleta/efeitos adversos , Terapia Ultravioleta/efeitos adversos , Deficiência de Vitamina D/terapia , Vitamina D/uso terapêutico , Suplementos Nutricionais , Humanos , Vitamina D/sangue , Vitamina D/efeitos da radiação
14.
Int Orthop ; 43(3): 735-749, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30627846

RESUMO

PURPOSE: After Glisson's description of rickets, it took two centuries to realize that rickets was due to the absence of antirachitic nutrients in the diet or lack exposure of the skin to ultraviolet rays. This bone disease caused by vitamin D deficiency was one of the most common diseases of children 100 years ago. This paper explores how the definition, diagnosis, and treatment of rickets shifted in the first decades of the twentieth century. MATERIAL AND METHODS: Although benefits of cod liver oil as food were known as early as the seventh century, cod liver oil was only proposed as medicinal for rickets in Northern Europe at the end of the eighteenth century. The relationship between rickets and nutritional deficiency was suspected and demonstrated between 1880 and 1915, at the same time of the discovery of other vital substances (vitamins) needed to prevent beriberi, scurvy, and pellagra. Understanding that the lack of photosynthesized vitamin D or the lack of dietary vitamin D was a similar risk of rickets was an important turn in the comprehension of the disease. We look at the sequence and turn of events related to the discovery of vitamin D. RESULTS: Rickets has been recognized first as a disease of urban living people. Cod liver oil had been used since 1700 as a nonspecific treatment for a range of diseases. Generations of children in cities of the north of Europe had learned to hate the taste and smell of the black oily liquid and then grown up to be parents who, in turn, hated to force it down their children's throats. Occasional papers before 1900 pointed to its efficacy for rickets, and most textbooks of the early 1900s mentioned it only as a treatment option. The discovery in the early 1900s that artificial and natural ultraviolet rays had both antirachitic activity allowed to produce antirachitic foods just by food irradiation with artificial ultraviolet irradiation. Clinical guidelines were adopted to propose exposure to sunlight or to artificial ultraviolet radiation to prevent rickets in children. By the mid-1920s, rickets was promoted as universal, at times invisible to non-experts, but present to some degree in nearly every young child regardless of race or class. It was thus used to promote the young disciplines of preventive medicine, pediatrics, and public health. Innovative advances were made in the understanding of vitamin D synthesis from 1915 to 1935. A public health campaign of the 1930s was a success to eradicate rickets, using irradiated ergosterol from yeast to enrich milk and other foods with vitamin D, ensuring that the general population was consuming sufficient vitamin D. CONCLUSION: Rickets therefore provides an excellent window into the early politics of preventive health and the promotion of targeted interventions in the world. It is also a relevant historical counterpoint for current debates over the role of risk factors (absence of light or sun) for disease (today's so-called "lifestyle" diseases).


Assuntos
Óleo de Fígado de Bacalhau/história , Raquitismo/história , Terapia Ultravioleta/história , Deficiência de Vitamina D/história , Animais , Óleo de Fígado de Bacalhau/uso terapêutico , Europa (Continente) , História do Século XVII , História do Século XIX , História do Século XX , História Antiga , Humanos , Raquitismo/diagnóstico , Raquitismo/etiologia , Raquitismo/terapia , Raios Ultravioleta/história , Vitamina D/história , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/terapia
15.
Allergol Int ; 68(2): 172-177, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30670337

RESUMO

The season of birth and ultraviolet B exposure have been related to the occurrence of food allergy. The levels of vitamin D produced from skin by ultraviolet B exposure might reflect this relationship. Vitamin D is known to induce antimicrobial peptides, protect intestinal flora, enhance the gut epithelial barrier, suppress mast cell activation and IgE synthesis from B cells, and increase the number of tolerogenic dendritic cells and IL-10-producing regulatory T cells. Vitamin D deficiency has been shown to exacerbate sensitization and allergic symptoms in a murine model of food allergy. However, in clinical situations, contradictory observations have been reported regarding the relationship between food allergy and vitamin D deficiency/supplementation. In this review, we have explored the links between food allergy and vitamin D levels. One explanation for the discrepant findings is confounding factors such as race, age, residency, skin color, and epigenetic changes that contribute to vitamin D levels. In addition, the season of birth influences the development of atopic dermatitis, which could lead to food sensitization. Finally, ultraviolet radiation could lead to regulatory T cell expansion and immunosuppression, irrespective of vitamin D status. Based on our current understanding, we believe that correction of vitamin D deficiency by supplementation, appropriate skin care, and sufficient ultraviolet radiation exposure could alter the prognosis of food allergy. To identify potential treatment strategies for food allergy, it is essential to gain a better understanding of the appropriate levels of vitamin D and ultraviolet radiation exposure.


Assuntos
Hipersensibilidade Alimentar/epidemiologia , Exposição à Radiação , Estações do Ano , Deficiência de Vitamina D/epidemiologia , Animais , Suplementos Nutricionais , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/terapia , Humanos , Imunidade nas Mucosas , Mucosa Intestinal/imunologia , Luz Solar , Vitamina D/uso terapêutico , Deficiência de Vitamina D/etiologia , Deficiência de Vitamina D/imunologia , Deficiência de Vitamina D/terapia
16.
Int J Sport Nutr Exerc Metab ; 29(1): 18-23, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29757043

RESUMO

Recent studies suggest that a substantial proportion of athletes with spinal cord injury have insufficient 25(OH) vitamin D (25(OH)D) status, which may be associated with decreased muscle strength. This study consisted of two parts: (a) to examine the effects of a 12- to 16-week vitamin D3 supplementation protocol on 25(OH)D concentration and (b) to determine whether subsequent 25(OH)D status impacts muscle performance in elite athletes with spinal cord injury. Thirty-four members (age: 33 ± 15 years, weight: 69.6 ± 28.2 kg, and height: 170.2 ± 25.4 cm) of the U.S. and Canadian Paralympic program participated in the study. 25(OH)D concentrations and performance measures (handgrip strength and 20-m wheelchair sprint) were assessed pre- and postsupplementation. Participants were assigned a vitamin D3 supplementation protocol based on initial 25(OH)D concentrations. Participants with deficient 25(OH)D status (<50 nmol/L) received 50,000 IU/week for 8 weeks, and participants with insufficient status (50-75 nmol/L) received 35,000 IU/week for 4 weeks, after which both received a maintenance dose of 15,000 IU/week. Participants with sufficient status (>75 nmol/L) received the maintenance dose of 15,000 IU/week. 25(OH)D concentrations increased significantly (p < .001; 66.3 ± 24.3 nmol/L and 111.3 ± 30.8 nmol/L pre- and postsupplementation, respectively). About 26% of athletes had sufficient 25(OH)D concentrations presupplementation, and 91% had sufficient concentrations postsupplementation. About 62% of participants improved handgrip strength postsupplementation with no change in 20-m wheelchair sprint performance. The supplementation protocol was effective for achieving sufficient vitamin D concentrations in elite athletes with spinal cord injury.


Assuntos
Desempenho Atlético , Colecalciferol/administração & dosagem , Suplementos Nutricionais , Força da Mão , Traumatismos da Medula Espinal/sangue , Vitamina D/sangue , Adolescente , Adulto , Atletas , Canadá , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/fisiopatologia , Esportes para Pessoas com Deficiência , Estados Unidos , Deficiência de Vitamina D/terapia , Cadeiras de Rodas , Adulto Jovem
17.
Nefrologia ; 39(1): 18-28, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30274806

RESUMO

Chronic kidney disease patients have a high prevalence of vitamin D insufficiency/deficiency. Vitamin D deficiency has been associated with a variety of bone, metabolic and cardiovascular disorders. However, the role of native vitamin D supplementation (ergocalciferol, cholecalciferol or calcifediol) remains unclear in chronic kidney disease (CKD), particularly in the pre-dialytic phase. Several international guidelines have been developed on CKD-Mineral and Bone Disorder, but the optimal strategy for native vitamin D supplementation and its clinical benefit remains a subject of debate in the scientific community. This paper aims to review the available literature, including randomized clinical trials that evaluated the effects of native vitamin D supplementation on pre-dialysis CKD on biochemical and clinically relevant outcomes.


Assuntos
Insuficiência Renal Crônica/complicações , Deficiência de Vitamina D/etiologia , Deficiência de Vitamina D/terapia , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Calcifediol/uso terapêutico , Calcitriol/sangue , Calcitriol/fisiologia , Hormônios e Agentes Reguladores de Cálcio/uso terapêutico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Colecalciferol/uso terapêutico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Ergocalciferóis/uso terapêutico , Humanos , Hormônio Paratireóideo/sangue , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal , Insuficiência Renal Crônica/metabolismo , Vitamina D/fisiologia , Deficiência de Vitamina D/sangue
18.
J Steroid Biochem Mol Biol ; 186: 110-116, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30296587

RESUMO

A proportion of circulating 25-hydroxy vitamin D3 (25(OH)D3)) undergoes epimerization to form C3-epi 25(OH)D3 and C3-epi 1,25(OH)2D3. These epimers have less calcaemic activity than non-epimerized metabolites and are not differentiated by many immunoassays when reporting total 25(OH)D3 levels. This study aimed to compare the effect of exposure to ultraviolet radiation (UVR) and oral vitamin D3 supplementation on vitamin D C3-epimer levels. C57Bl/6 female mice were fed either vitamin D-sufficient (vitamin D3 2000 IU/kg) or -deficient diets (no vitamin D3) for 4 weeks. Among the vitamin D-deficient group, the shaved backs of half were irradiated daily for 4 days with 1 kJ/m2 UVR, followed by twice weekly irradiation for 4 weeks. Despite similar 25(OH)D3 levels, the UV-irradiated group had a lower proportion of C3-epi 25(OH)D3 at week 7 (p < 0.05) and week 9 (p < 0.01). C3-epimer concentrations and %C3-epi 25(OH)D3 were also analysed in serum samples from two human clinical trials. These trials investigated the effect of high dose oral vitamin D3 supplementation and narrowband UVB phototherapy, respectively. Serum 25(OH)D3 and the %C3-epi 25(OH)D3 levels measured at 12 months after oral vitamin D3 supplementation were not significantly different to those measured at the time of maximal effect of phototherapy (2 months). Thus, the proportion of 25(OH)D3 that undergoes epimerization is greater with oral vitamin D3 supplementation than exposure to UVR in mice, but not in humans. This important difference between human and murine vitamin D metabolism warrants consideration when interpreting animal studies.


Assuntos
Calcifediol/sangue , Deficiência de Vitamina D/sangue , Vitamina D/sangue , Vitaminas/sangue , Administração Oral , Animais , Calcifediol/administração & dosagem , Calcifediol/uso terapêutico , Colestanotriol 26-Mono-Oxigenase/genética , Dieta , Suplementos Nutricionais/análise , Feminino , Regulação da Expressão Gênica/efeitos da radiação , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Raios Ultravioleta , Terapia Ultravioleta , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/genética , Deficiência de Vitamina D/terapia , Vitamina D3 24-Hidroxilase/genética , Vitaminas/administração & dosagem , Vitaminas/uso terapêutico
20.
J Sports Med Phys Fitness ; 59(4): 693-699, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30411595

RESUMO

BACKGROUND: High prevalence of vitamin D deficiency is well known around the world in risk populations. Although less is known about the athletic population, some studies report vitamin D deficiency amongst athletic population and adequate vitamin D levels are crucial for athletic population as they can prevent injuries such as stress fractures and might even have ergogenic effects for example on muscle function. The main objectives were to evaluate the basal serum levels of 25(OH)D and calcium in professional soccer athletes on the latitude 40°N, to evaluate the effects in 25(OH)D and calcium serum levels following supplementation of 1667 IU/day of cholecalciferol during a period of 8 weeks and evaluate eventual toxicity arising from it. METHODS: Twenty-eight professional athletes were evaluated according to the skin type. Basal serum levels of 25(OH)D and calcium were evaluated during winter months. Athletes were then supplemented with cholecalciferol 25.000 IU every two weeks. Serum levels of 25(OH)D and calcium were evaluated after supplementation. RESULTS: 25(OH)D initially ranged between 9.9 ng/mL and 32.9 ng/mL with a median of 19.2 IQR 7.24 ng/mL. A statistically significant inverse correlation exists between vitamin D deficiency and the Fitzpatrick Scale (ρ=-0.555 P=0.003). After 8 weeks, 25(OH)D ranged between 10.6 ng/mL and 43.4 ng/mL with a median of 33.2 ng/mL IQR 6.1 ng/mL. We verified a statistically significant increase of serum 25(OH) D levels (11.74±5.988; CI 95% [9,02; 14,47]; P<0.001. In addition, there was a statistically significant reduction of calcium: -0.36±0.457; CI 95% [- 0.57; -0.15]; P=0.002. CONCLUSIONS: Professional athletes have a high prevalence of vitamin D deficiency. Supplementation with cholecalciferol in winter months during 8 weeks is safe and effective in raising 25(OH)D serum levels. However, it may not be sufficient for athletes to reach adequate vitamin D levels.


Assuntos
Colecalciferol/administração & dosagem , Suplementos Nutricionais , Futebol , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/terapia , Adolescente , Adulto , Atletas , Cálcio/sangue , Colecalciferol/sangue , Feminino , Humanos , Masculino , Prevalência , Estações do Ano , Esportes , Vitaminas , Adulto Jovem
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