Vitamin deficiencies in children: Lessons from clinical and neuroimaging findings.

BACKGROUND AND AIMS: Water-soluble vitamins play an essential coenzyme role in the nervous system. Acquired vitamin deficiencies are easily treatable, however, without treatment, they can lead to irreversible complications. This study aimed to provide clinical, laboratory parameters and neuroimaging data on vitamin deficiencies in an attempt to facilitate early diagnosis and prompt supplementation. METHODS: From July 1998 to July 2023, patients at Necker-Enfants-Malades Hospital presenting with acute neurological symptoms attributed to acquired vitamin deficiency were included. Clinical data were extracted from Dr Warehouse database. Neuroimaging, biochemical and electrophysiological data were reviewed. RESULTS: Patients with vitamin B1 deficiency exhibited abnormal eye movements (n = 4/4), fluctuations in consciousness (n = 3/4), and ataxia (n = 3/4). Brain MRI showed alterations of fourth ventricle region (n = 4/4), periaqueductal region (n = 4/4), tectum (n = 3/4), and median thalami (n = 3/4). Patients with vitamin B2 deficiency presented with early onset hypotonia (n = 3/4), hyperlactatemia (n = 4/4), and hyperammonemia (n = 4/4). Plasma acylcarnitines revealed a multiple acyl-coA dehydrogenase deficiency-like profile (n = 4/4). In vitamin B12 deficiency, young children presented with developmental delay (n = 7/7) and older children with proprioceptive ataxia (n = 3/3). Brain MRI revealed atrophy (n = 7/7) and spinal MRI hyperintensity in posterior cervical columns (n = 3/3). Metabolic findings showed elevated methylmalonic acid (n = 6/7) and hyperhomocysteinemia (n = 6/7). Patients with vitamin C deficiency exhibited gait disturbances and muscle weakness (n = 2/2). CONCLUSIONS: Acquired vitamin deficiencies may display reversible clinical symptoms mimicking inherited metabolic disorders. Some situations raise suspicion for diagnosis: concordant clinical presentation, suggestive neuroimaging findings, and/or biochemical evidence. Any acute neurological condition should be treated without waiting for definitive biochemical confirmation.

Increased Left Atrial Volume and Its Relationship to Vitamin D in Primary Care

The study is based on the fact that left atrial (LA) volume measurement is a marker of the presence of diastolic dysfunction and that Vitamin D deficiency may be associated with ventricular remodeling, worsening of left ventricular (LV) diastolic and systolic function, and activation of the renin-angiotensin-aldosterone system. Objective: To evaluate whether LAV changes are related to vitamin D deficiency. Method: A cross-sectional, population-based, unicentric study in which 640 patients over 45 years of age enrolled in the Niterói's Médico de Família program, RJ, were evaluated. Patients were submitted to tissue Doppler echocardiography to evaluate the parameters of diastolic and systolic function and vitamin D dosage. The presence or absence of hypovitaminosis D associated with structural and functional cardiac changes was compared between each group. A p < 0.05 value was considered as an indicator of statistical significance. Results: Of the 640 individuals analyzed, hypovitaminosis D was confirmed in 39.2% of the patients, of whom 34.8% had diastolic dysfunction. The most relevant echocardiographic parameters that were statistically significant were non-indexed AEDs and LAV, E'/A' and E wave deceleration time, which were associated with the presence of hypovitaminosis D (P < 0.01). Conclusion: The study of the association of hypovitaminosis D and the appearance of structural and functional cardiac abnormalities may contribute to the discussion of the adoption of one more criterion to select individuals at risk of developing clinical cardiac insufficiency in primary care since, with the use of echocardiography, the subclinical condition of cardiac involvement, with prognostic and treatment implications for the referred patients with hypovitaminosis D, can be identified early

Severe malnutrition after bariatric surgery and clinic manifestations of infection

SUMMARY This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.

RESUMO Este relato descreve a evolução pós-cirurgia bariátrica de uma paciente obesa que apresentou baixa adesão à dieta e suplementação de micronutrientes. Quatro anos após duas cirurgias bariátricas, a paciente foi internada por perda transitória de consciência, raciocínio lento, anasarca, hipoalbuminemia grave, além de deficiências vitamínicas e minerais. Apresentava abscesso subcutâneo no pé, mas não apresentava febre. Recebeu antibióticos, vitaminas A, D, B12, tiamina, cálcio e nutrição parenteral. Após a internação (28 dias) houve redução significativa do peso corporal, provavelmente devido ao desaparecimento clínico da anasarca. A nutrição parenteral foi suspensa após 25 dias e a dieta oral foi mantida fracionada. Após a internação (atendimento ambulatorial semanal) houve uma melhora gradativa dos dados laboratoriais, que estavam próximos dos valores de referência. Tal desfecho mostra a necessidade de cuidados especializados na prevenção e tratamento de complicações nutricionais após cirurgias bariátricas, bem como manifestações clínicas de infecção em pacientes previamente desnutridos.

Deficiencias subclínicas asociadas al padecimiento de síndrome metabólico / Subclinical micronutrients deficiencies related to metabolic syndrome

El síndrome metabólico es el nombre que se da a un conjunto de factores de riesgo que aumenta el riesgo de enfermedad cardiovascular y otros problemas de salud, como diabetes y accidente cerebrovascular. Existen diferentes puntos de corte para establecer la definición de síndrome metabólico según diversos organismos internacionales, si bien en todas las definiciones se consideran cuatro pilares básicos: 1) obesidad; 2) alteración del metabolismo de la glucosa; 3) alteración del metabolismo de los lípidos; e 4) hipertensión arterial. Las estrategias para el tratamiento del síndrome metabólico incluyen cambios en el estilo de vida (dieta y actividad física) junto con tratamiento farmacológico en determinados casos. Se tiene poca evidencia sobre el efecto de diferentes micronutrientes en dicho síndrome, aunque existen múltiples investigaciones en esta línea

Metabolic syndrome is the name given to a set of risk factors that increases the risk of cardiovascular disease and other health problems, such as diabetes and stroke. There are different cut-off points to establish the definition of metabolic syndrome according to various international organizations, although in all definitions are considered four main data related to: 1) obesity; 2) alteration of glucose metabolism; 3) alteration of lipid metabolism; and 4) hypertension. Strategies for the treatment of the metabolic syndrome include changes in lifestyle (diet and physical activity), along with pharmacological treatment in certain cases. There is little evidence of the effect of different micronutrients in this syndrome, although there are many investigations in this line

La corrección del déficit de 25-OH-vitamina D mejora el control del hiperparatiroidismo secundario y el estado inflamatorio de pacientes estables en hemodiálisis / Correction of 25-OH-vitamin D deficiency improves control of secondary hyperparathyroidism and reduces the inflammation in stable haemodialysis patients

Introducción: El déficit de 25-OH-vitamina D (25-OH-D) es común en los pacientes en hemodiálisis (HD). Por otra parte, es bien conocida la elevada incidencia de hiperparatiroidismo secundario en este grupo de pacientes, y lo importante que es su adecuado control. La 25-OH-D está implicada en la regulación de la homeostasis del calcio, por lo que tener niveles adecuados puede contribuir en el control del metabolismo óseo-mineral. Objetivos: Evaluar el efecto de la repleción de 25-OH-D en pacientes en HD con déficit vitamínico (niveles<20ng/ml), en el control del hiperparatiroidismo secundario y en el estado de microinflamación. Pacientes y métodos: Estudio observacional, prospectivo en el que se trataron pacientes estables en HD con déficit de 25-OH-D (<20ng/ml), con calcifediol 0,266mcg/15 días vía oral durante 3 meses. Los datos de HD, parámetros bioquímicos y las dosis de fármacos administrados fueron analizados antes y después de la corrección del déficit. Resultados: Un total de 45 pacientes estables en HD con edad media 74,08±12,49 años completaron el tratamiento. Del total, 27 pacientes (60%) alcanzaron niveles de 25-OH-D>20ng/ml (en 23 fueron>30ng/ml, y 4 entre 20-30ng/ml). Las cifras de hormona paratiroidea descendieron en 32 de los 45 pacientes, alcanzando en 23 (51% de tratados) un descenso>30% respecto al valor basal. En cuanto al tratamiento concomitante, se objetivó un descenso significativo de la dosis de activador selectivo del receptor de vitamina D; sin evidenciarse cambios en la dosis de calcimimético ni de quelantes. Respecto al estado de malnutrición-inflamación, destaca un descenso de la proteína C reactiva, aunque no se modificaron otros parámetros de microinflamación como los monocitos activados (CD14+/CD16+ y CD 14++/CD16+). Tampoco se observaron cambios en los niveles de FGF-23. Conclusiones: La corrección del déficit de 25-OH-D en pacientes en HD se asocia a un mejor control del hiperparatiroidismo secundario con menores dosis de análogos de vitamina D y a una mejoría en el estado inflamatorio de estos pacientes. Nuestros resultados apoyan la recomendación de determinar niveles de 25-OH-D y corregir el déficit en pacientes en HD (AU)

Introduction: Patients on haemodialysis (HD) have a high prevalence of 25-OH-vitamin D (25-OH-D)deficiency. Secondary hyperparathyroidismis a common condition in these patients, which is very important to control. 25-OH-D is involved in regulating calcium homeostasis. As such, appropriate levels of this vitamin could help to control bone mineral metabolism. Objective: To evaluate the effect 25-OH-D repletion in HD patients with 25-OH-D deficiency (<20ng/ml) on the control of secondary hyperparathyroidism and microinflammation status. Patients and methods: Prospective observational study in which stable patients on HD with 25-OH-D deficiency (<20ng/ml) were treated with oral calcifediol 0.266mcg/every 2 weeks for three months. Dialysis characteristics, biochemical parameters and drug doses administered were analysed before and after the correction of the deficiency. Results: Forty-five stable HD patients with a mean age of 74.08±12.49 years completed treatment. Twenty-seven patients (60%) achieved 25-OH-D levels above 20ng/ml (23 with levels>30ng/ml and 4 between 20-30ng/ml). Parathyroid hormone levels decreased in 32 of the 45 patients, 23 of which (51%) achieved a>30% decrease from baseline. In terms of concomitant treatment, we observed a significant reduction in the selective vitamin D receptor activator dose, but no changes in calcimimetic or phosphate binders administration. In terms of malnutrition-inflammation status, a decrease in C-reactive protein was noted, although other microinflammation parameters, such as activated monocytes (CD14+/CD16+ and CD 14++/CD16+) were unchanged. No changes were observed in the levels of FGF-23. Conclusions: Correcting 25-OH-D deficiency in HD patients is associated with better secondary hyperparathyroidism control with lower doses of vitamin D analogues, as well as an improvement in inflammatory status. Our results support the recommendation to determine 25-OH-D levels and correct its deficiency in these patients (AU)

Relação entre consumo alimentar de vitaminas e minerais, índice de massa corporal e circunferência da cintura: um estudo de base populacional com adultos no Sul do Brasil / Relationship between dietary consumption of vitamins and minerals, body mass index, and waist circumference: a population-based study of adults in southern Brazil / Relación entre consumo alimentario de vitaminas y minerales, índice de masa corporal y circunferencia de la cintura: un estudio de base poblacional con adultos en el sur de Brasil

Resumo: O objetivo do estudo foi investigar a associação entre o consumo alimentar inadequado de micronutrientes e indicadores de obesidade geral e abdominal. Análise transversal, da segunda onda do estudo longitudinal EpiFloripa Adultos, incluindo 1.222 indivíduos de 22-63 anos, residentes em Florianópolis, Santa Catarina, Sul do Brasil. Os dados de consumo alimentar foram obtidos mediante aplicação de dois recordatórios de 24 horas, sendo o consumo habitual e as prevalências de inadequação no consumo de cálcio, ferro, zinco, e das vitaminas A, C, D e E estimadas conforme as recomendações do Instituto de Medicina e do Conselho Nacional de Pesquisa dos Estados Unidos. O estado nutricional de obesidade geral foi determinado considerando-se valores do índice de massa corporal (IMC), e a obesidade abdominal, considerando-se valores da circunferência da cintura (CC). Para a maioria dos micronutrientes investigados (cálcio, vitaminas A, C, D e E), as médias de consumo mostraram-se aquém dos valores recomendados, com prevalências elevadas de inadequação para toda a amostra. Somente a inadequação no consumo de vitamina C foi maior entre indivíduos obesos (geral ou abdominal). Além disso, associação inversa foi observada entre o menor consumo de cálcio e ferro com valores maiores do IMC e da CC, e entre o menor consumo das vitaminas A e D com valores maiores da CC (β = -0,92cm; IC95%: -1,76; -0,08 e β = -0,69cm; IC95%: -1,32; -0,06, respectivamente), principalmente entre adultos jovens. Foi possível identificar a existência de associação inversa entre o consumo alimentar inadequado de micronutrientes e o estado nutricional de obesidade geral e abdominal também em uma amostra de adultos residentes no Sul do Brasil.

Abstract: The study's objective was to investigate the association between inadequate dietary consumption of micronutrients and indicators of general and abdominal obesity. Cross-sectional analysis of the second wave of the EpiFloripa Adults longitudinal study, including 1,222 individuals, aged 22-63 years and residing in Florianópolis, Santa Catarina State, Southern Brazil. Food consumption data was obtained from two 24-hour food recalls, and habitual consumption and prevalence rates of inadequate consumption of calcium, iron, zinc, and vitamins A, C, D, and E were estimated according to the Institute of Medicine and National Research Council guidelines. General obesity was defined based on the body mass index (BMI) values and abdominal obesity was based on waist circumference (WC) values. For most of the micronutrients investigated (calcium and vitamins A, C, D, and E), consumption levels were below the recommendations, with high prevalence of inadequate consumption in the sample as a whole. Only inadequate vitamin C intake was higher among obese individuals (general or abdominal). In addition, there was an inverse association between lower consumption of calcium and iron and higher BMI and WC, and between lower consumption of vitamins A and D and higher WC levels (β = -0.92cm; 95%CI: -1.76; -0.08 and β = -0.69 cm; 95%CI: -1.32; -0.06, respectively), especially in young adults. The study showed an inverse association between inadequate dietary consumption of micronutrients and general and abdominal obesity in a sample of adults in Southern Brazil.

Resumen: El objetivo del estudio fue investigar la asociación entre el consumo alimentario inadecuado de micronutrientes e indicadores de obesidad general y abdominal. Métodos: análisis transversal, de la segunda fase del estudio longitudinal EpiFloripa Adultos, incluyendo 1.222 individuos de 22-63 años, residentes en Florianópolis, Santa Catarina, Sur de Brasil. Los datos de consumo alimentario fueron obtenidos mediante aplicación de dos recordatorios de 24 horas, siendo estimados, conforme las recomendaciones del Instituto de Medicina y del Consejo Nacional de Investigación, de los EEUU. El estado nutricional de obesidad general fue determinado considerándose valores del índice de masa corporal (IMC), y la obesidad abdominal, considerándose valores de la circunferencia de la cintura (CC). Para la mayoría de los micronutrientes investigados (calcio, vitaminas A, C, D y E), las medias de consumo fueron menores que las recomendaciones, con prevalencias elevadas de inadecuación para toda la muestra. Solamente la inadecuación en el consumo de vitamina C fue mayor entre individuos obesos (general o abdominal). Además, asociación inversa fue observada entre el menor consumo de calcio e hierro con valores mayores de IMC y de la CC, y entre el menor consumo de vitaminas A y D con valores mayores de la CC (β = -0,92cm; IC95%: -1,76; -0,08 y β = -0,69cm; IC95%: -1,32; -0,06), principalmente entre adultos jóvenes. Fue posible identificar la existencia de asociación inversa entre el consumo alimentario inadecuado de micronutrientes y el estado nutricional de obesidad general y abdominal en una muestra de adultos residentes en el Sur de Brasil.

Fibromialgia y niveles de vitamina D / Fibromyalgia and vitamin D levels

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Prevalencia de causas secundarias de baja masa ósea en una población de mujeres premenopáusicas / Prevalence of secondary causes in a population of premenopausal women with low bone mass

La osteoporosis es un trastorno común en las mujeres posmenopáusicas; sin embargo, también puede afectar a hombres y mujeres jóvenes premenopáusicas. El objetivo del presente trabajo fue evaluar la prevalencia de causas secundarias de baja masa ósea en un grupo de mujeres premenopáusicas que consultaron en una Institución especializada en Osteología. Material y métodos: se realizó un estudio retrospectivo, de corte transversal, descriptivo y observacional. Se analizaron las historias clínicas de 88 pacientes que consultaron por baja masa ósea durante un período de 19 meses, con la finalidad de encontrar posibles causas secundarias. A su vez, se definió como pacientes con diagnóstico de baja masa ósea idiopática aquellas en las cuales no se encontró ninguna causa secundaria de pérdida ósea. Resultados: de las 88 mujeres evaluadas, el 48,9% presentaba al menos una causa secundaria para baja masa ósea (amenorrea secundaria, hipercalciuria, tratamiento con glucorticoides, hipovitaminosis D y enfermedad celíaca) y el 51,1% fueron consideradas idiopáticas. Conclusiones: es esencial evaluar exhaustivamente a las mujeres premenopáusicas con baja masa ósea a fin de descartar posibles causas secundarias y tomar las medidas preventivas necesarias para mejorar esa condición. (AU)

Objective: osteoporosis is a common disorder in postmenopausal women, however it can also affect men and premenopausal young women. The purpose of this study was to evaluate the prevalence of secondary causes of low bone mass in premenopausal women that consulted physicians in an institution specialized in osteology for a period of 19 months. Material and methods: this is a retrospective, transversal, descriptive and observational study. The clinical history of 88 patients who consulted a physician due to low bone mass for a period of 19 months in an institution specialized in osteology. Were analyzed the patient's clinical history in order to find secondary causes. We define as suffering Low Bone Mass those patients who did not have secondary causes. Results: of the 88 women tested, 48,9% had one or more secondary causes or risks factors for low bone mass (secondary amenorrea, hypercalciuria, treatment with glucocorticoids, hypovitamiosis D and celiac disease) and 51,1% patients were considered idiopathic. Conclusions: we conclude that it is essential to exhaustively search for secondary causes of low bone mass in premenopausal women, due to the high prevalence of secondary osteoporosis in this population. (AU)

¿Existe déficit de vitamina D en los niños de una ciudad soleada del Mediterráneo? / Is there vitamin D deficiency in children in a sunny Mediterranean city?

INTRODUCCIÓN: A pesar del creciente interés por las funciones de la vitamina D, siguen documentándose casos deficitarios en regiones soleadas donde se presuponen niveles adecuados. El objetivo del estudio es determinar los niveles de 25-hidroxivitamina D en menores de 2 años ingresados en un hospital terciario de Valencia por enfermedades agudas leves y su relación con factores que puedan estar asociados con su deficiencia. MÉTODOS: Estudio prospectivo y descriptivo de un año de duración en niños, entre uno y 24 meses, ingresados por enfermedades agudas leves. Se han estudiado los niveles de 25-hidroxivitamina D, junto con una anamnesis y exploración clínica estructuradas. Se dividió la muestra en 2 grupos, dependiendo de los niveles de vitamina D (punto de corte 30ng/ml). RESULTADOS: Se estudiaron 169 niños, edad media de 9 meses, predominio etnia caucásica (75,7%) y menores de un año (79,3%). El 24,3% de los niños presentaba valores <30ng/ml, agrupándose en invierno/primavera y caracterizándose por fototipos cutáneos oscuros (p < 0,01). Los factores asociados con niveles >30ng/ml fueron: administración de profilaxis, ser hijo de madre caucásica y que no usara hiyab. No existieron diferencias en el tipo de lactancia recibida (p = 0,65). Solamente al 47% de los menores de un año amamantados se administró profilaxis. CONCLUSIONES: En Valencia, a pesar de la radiación solar suficiente, un cuarto de los niños <2 años tiene niveles de 25-hidroxivitamina D <30ng/ml. Nuestros resultados deberían sensibilizar sobre la importancia de la suplementación vitamínica durante el primer año de vida, incluso en las regiones soleadas del Mediterráneo

INTRODUCTION: Despite the increasing interest in vitamin D functions, new cases of deficiency have been reported in sunny regions where optimal levels are expected. The aim of this study was to analyze 25-hydroxivitamin D levels in children younger than 2 years admitted for acute mild diseases in a tertiary hospital in Valencia and its relationship with factors that can be associated with its deficiency. METHODS: This one year prospective and observational study was conducted on 169 children admitted for acute mild diseases. 25-hydroxivitamin D levels were analyzed. A standardized physical examination and structured interviews to the parents were performed. Children were classified into two groups, according to 25-hydroxivitamin D levels (cut-off 30ng/mL). RESULTS: A total of 169 children were included, with a median age of 9 months, being more prevalent Caucasians (75.7%) and youger than one year old (79.3%). Almost one quarter (24.3%) of the children had 25-hydroxivitamin D levels <30ng/mL, more frequently in winter/spring, and in children with higher skin phototypes (P<.01). Levels >30ng/mL were associated with vitamin D prophylaxis during the first year, in children of a Caucasian mother, and those who did not wear a hijab. No statistical differences were found in diet characteristics (P=.65). Prophylaxis was given to 47% of the breastfed children younger than one year. CONCLUSIONS: In Valencia, Spain, 25-hydroxivitamin D levels lower than 30ng/mL were found in a quarter of the children younger than two years. Our results emphasize the importance of vitamin D prophylaxis during the first year of life, even in sunny Mediterranean regions

Deficiencia de vitamina D: ¿la estamos identificando bien? / Vitamin D deficiency: are we identifying it properly?

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Diagnóstico de hiperparatiroidismo primario materno a propósito de una hipocalcemia neonatal sintomática / Maternal primary hyperparathyroidism unmasked by a symptomatic neonatal hypocalcemia

Los episodios paroxísticos neonatales pueden deberse a múltiples causas: patología estructural, infección del sistema nervioso central y alteraciones metabólicas. Entre estas últimas, la hipocalcemia es una causa tratable y bien conocida de convulsión en el periodo neonatal. El hiperparatiroidismo primario durante el embarazo puede suprimir la secreción fetal de PTH, produciendo como consecuencia una hipocalcemia por hipoparatiroidismo transitorio tras el nacimiento. Presentamos un caso de hipocalcemia neonatal sintomática, cuyo estudio etiológico permitió diagnosticar a la madre un hiperparatiroidismo primario, y discutimos la trascendencia de la sospecha y tratamiento precoces de ambas entidades (AU)

Seizures during the neonatal period have a broad differential diagnosis such as intracranial infections, structural pathology and metabolic disorders. Among them, hypocalcemia is a treatable and well-known cause of neonatal seizures. Maternal hyperparathyroidism during pregnancy suppresses parathyroid activity in the fetus resulting in transient hypoparathyroidism and hypocalcemia after birth. We report a case of neonatal symptomatic hypocalcemia leading to a diagnosis of maternal hyperparathyroidism. The relevance of early suspicion and treatment of both entities is also discussed (AU)

Déficit de vitamina D en una cohorte de pacientes mayores de 69 años con fractura de fémur atendidos en la Unidad Geriátrica de Agudos del Hospital de Igualada / Vitamin D deficiency in a cohort of patients over 69 years with femoral fracture admitted to an Acute Geriatric Unit of Hospital Igualada

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Skin changes after bariatric surgery

Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses.

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

Objective Bone loss has been established as a major extra-intestinal complication of short bowel syndrome (SBS). The purpose of this study was to correlate bone mineral density (BMD) with body mass index (BMI), serum vitamin and mineral levels in patients with SBS.Material and methods The study was conducted on 13 patients (8 male and 5 female, 54.7 ± 11.4 years) with SBS (residual small bowel length of 10 to 100 cm). We determined the food ingestion, anthropometry, serum levels of vitamins C, A, D, E and K, as well as serum and urinary levels of phosphorus and calcium. BMD was measured by dual-energy x-ray absorptiometry (DXA).Results Osteopenia and osteoporosis was diagnosed in all but one SBS patient. Serum levels of vitamin D were low in all volunteers. Sixty-one percent of patients had vitamin E deficiency; hypovitaminosis A and C occurred in one subject. BMI and C, E and K vitamin serum levels correlated with T-score of BMD.Conclusions Osteopenia and osteoporosis were common in SBS patients. There was a correlation between BMD and the serum levels of vitamins C, E and K, an indicative that such vitamins may influence bone health. Arch Endocrinol Metab. 2015;59(3):252-8.

Salud ósea, vitamina D y lupus / Bone health, vitamin D and lupus

Los pacientes con lupus eritematoso sistémico presentan una prevalencia elevada de deficiencia e insuficiencia de vitamina D. Esto se debe probablemente a las medidas de fotoprotección y a factores intrínsecos de la enfermedad. Los niveles bajos de vitamina D aumentan el riesgo de presentar una densidad mineral ósea reducida y de fractura. El déficit de vitamina D podría también tener efectos no deseados sobre la respuesta inmune de los pacientes, potenciando mecanismos de pérdida de tolerancia y autoinmunidad. Los niveles de vitamina D deberían ser monitorizados periódicamente y los pacientes deberían ser tratados con el objetivo de alcanzar unos niveles de vitamina D superiores a 30-40 ng/ml (AU)

The prevalence of vitamin D deficiency and insufficiency among patients with systemic lupus erythematosus is high. This is likely due to photoprotection measures in addition to intrinsic factors of the disease. Low levels of vitamin D increase the risk of low bone mineral density and fracture. Vitamin D deficiency could also have undesirable effects on patients’ immune response, enhancing mechanisms of loss of tolerance and autoimmunity. Vitamin D levels should be periodically monitored and patients should be treated with the objective of reaching vitamin D levels higher than 30-40 ng/ml (AU)

Association between vitamin D levels and adolescent idiopathic scoliosis / Associação entre os níveis de vitamina D e a escoliose idiopática do adolescente / Asociación entre los niveles de vitamina D y la escoliosis idiopática do adolescente

Objective: To compare the levels of 25-hydroxyvitamin D in patients with AIS and a control group. Methods: The patients were recruited from the outpatient clinic of our institution during the year of 2013. Children diagnosed with scoliosis before 10 or after 18 years of age, and those suffering from neurological or muscular disorders, congenital malformations or genetic syndromes were excluded. The 25-OHD levels were determined by a fully automated electrochemiluminescence test. The appropriate level of 25-OHD was defined as greater than 30 ng/mL. The results were compared to a group of healthy individuals. Results: In group 1 (control) 63,3% showed abnormal vitamin D levels, while 91% of patients with AIS presented a low level of vitamin D. The mean BMI was 19.6 kg/m2 for controls and 20.3 kg/m2 for group 2. Statistical analysis showed significant difference (p<0.0001) between the levels of vitamin D. The average and minimum levels of vitamin D were respectively 27 and 13.6 ng/mL for group 1 and 18.8 and 3.13 ng/mL for AIS group. Conclusions: Patients with AIS had statistically significant lower levels of 25-OHD than healthy patients. Further research should be conducted to investigate the actual impact of serum vitamin D levels on the pathophysiology of AIS. .

Objetivo: Comparar os níveis de 25-hidroxivitamina D em pacientes com EIA e um grupo controle. Métodos: Os pacientes foram recrutados no ambulatório de nossa instituição durante 2013. Crianças com escoliose diagnosticada antes de 10 ou após 18 anos de idade, portadoras de distúrbios neurológicos ou musculares, deformidades congênitas ou síndromes genéticas foram excluídas. Os níveis de 25-OHD foram determinados por teste de eletroquimioluminescência totalmente automatizado. O nível adequado de 25-OHD foi definido como acima de 30 ng/ml. Os resultados foram comparados a um grupo de indivíduos saudáveis. Resultados: No grupo 1 (controle), 63,3 % apresentaram níveis anormais de vitamina D, enquanto 91% dos pacientes portadores de EIA apresentaram baixo nível de vitamina D. A média do IMC foi de 19,6 kg/m2 para os controles e 20,3 kg/m2 no grupo 2. A análise estatística demonstrou diferença relevante (p < 0,0001) entre os níveis de vitamina D. A média e os valores mínimos de vitamina D foram respectivamente 27 e 13,6 ng/ml para o grupo 1 e 18,8 e 3,13 ng/ml para o grupo EIA. Conclusões: Pacientes portadores de EIA tinham níveis de 25-OHD mais baixos do que os pacientes saudáveis, com significância estatística. O presente ...

Objetivo: Comparar los niveles de 25-hidroxivitamina D en pacientes con EIA y un grupo control. Métodos: Los pacientes fueron reclutados en el ambulatorio de nuestra institución durante el año de 2013. Se excluyeron los niños diagnosticados con escoliosis antes de 10 años o después de 18 años, y quienes sufren de trastornos neurológicos o musculares, malformaciones congénitas o síndromes genéticos. Los niveles de 25-OHD se determinaron mediante un ensayo de electroquimiolumniscencia totalmente automatizado. El nivel apropiado de 25-OHD se define como mayor que 30 ng/ml. Los resultados se compararon con un grupo de individuos sanos. Resultados: En el grupo 1 (control), 63,3% tenían niveles anormales de vitamina D, mientras que el 91% de los pacientes con EIA mostraron bajo nivel de vitamina D. El IMC promedio fue 19,6 Kg./m2 para los controles y 20,3 Kg./m2 para el grupo 2. El análisis estadístico mostró diferencias significativas (p < 0,0001) entre los niveles de vitamina D. Los valores medios y mínimos de vitamina D fueron respectivamente 27 y 13,6 ng/ml para el grupo 1 y 18,8 y 3,13 ng/ml para el grupo EIA. Conclusiones: Los pacientes con EIA tenían niveles más bajos de 25-OHD que los pacientes sanos, con significación estadística. Este estudio sugiere que la deficiencia ...

Fat-soluble vitamin deficiencies after bariatric surgery could be misleading if they are not appropriately adjusted / Las deficiencias de vitaminas liposolubles tras la cirugía bariátrica pueden ser perjudiciales si no se ajustan adecudadamente

Objective: To evaluate the differences in frequency of fat-soluble vitamin deficiencies if we adjust their levels by its main carriers in plasma in patients undergoing Biliopancreatic diversion (BPD) and Roux-en-Y gastric bypass (RYGB). Research Methods & Procedures: We recruited 178 patients who underwent RYGB (n = 116 patients) and BPD (n = 62 patients) in a single centre. Basal data information and one-year after surgery included: anthropometric measurements, fat-soluble vitamins A, E and D, retinol binding protein (RBP) and total cholesterol as carriers of vitamin A and E respectively. Continuous data were compared using T-Student and proportions using chisquare test. Results: There was a vitamin D deficiency of 96% of all patients, 10% vitamin A deficiency and 1.2% vitamin E deficiency prior to surgery. One year after surgery, 33% of patients were vitamin A deficient but the frequency reduced to 19% when we adjusted by RBP. We found a vitamin E deficiency frequency of 0% in RYGB and 4.8% in DBP one year after surgery. However, when we adjusted the serum levels to total cholesterol, we found an increased frequency of 8.7% in RYGB group for vitamin E deficiency and 21.4% in DBP (p = 0.04). Conclusion: We have found a different frequency of deficit for fat-soluble vitamin both in BPD and RYGB once we have adjusted for its main carriers. This is clinically relevant to prevent from overexposure and toxicity. We suggest that carrier molecules should be routinely requested when we assess fat-soluble vitamin status in patients who undergo malabsorptive procedures (AU)

Objetivo: Evaluar las diferencias en la frecuencia de las deficiencias de vitaminas liposolubles si ajustamos sus concentraciones mediante sus principales transportadores plasmáticos en pacientes sometidos a derivación biliopancreática (DBP) y derivación gástrica en Y de Roux (DGYR). Métodos de investigación y procedimientos: Reclutamos a 178 pacientes sometidos a DGYR (n = 116 pacientes) y DBP (n = 62 pacientes) en un único centro. Los datos de información basal y al año de la cirugía incluyeron: mediciones antropométricas, vitaminas liposolubles A, E y D, proteína de unión al retinol (PUR) y el colesterol total como transportadores de las vitaminas A y E, respectivamente. Los datos continuos se compararon utilizando la t de Student y para las proporciones el test chi cuadrado. Resultados: Hubo una deficiencia de vitamina D en el 96% de todos los pacientes, de vitamina A en el 10% y de vitamina E en el 1,2% antes de la cirugía. Un año después de la cirugía, el 33% de los pacientes tenía deficiencia de vitamina A pero la frecuencia se redujo al 19% cuando ajustamos para la PUR. Encontramos una frecuencia de deficiencia de vitamina E en el 0% de los pacientes con DGYR y en el 4,8% de aquellos con DBP un año después de la cirugía. Sin embargo, cuando ajustamos las concentraciones séricas de colesterol total, encontramos un aumento de la frecuencia de hasta el 8,7% de deficiencia de vitamina E en el grupo con DGYR y del 21,4% en el grupo con DBP (p = 0,04). Conclusión: Encontramos una frecuencia diferente de déficit de vitaminas liposolubles tanto en DBP como en DGYR una vez que ajustamos para sus principales transportadores. Esto es clínicamente relevante para evitar la sobreexposición y la toxicidad. Sugerimos que se deberían solicitar de forma rutinaria las moléculas transportadoras a la hora de evaluar el estado de vitaminas liposolubles en pacientes sometidos a procedimientos que entrañan malabsorción (AU)

Déficit de vitamina D en una cohorte de mayores de 65 años: prevalencia y asociación con factores sociodemográficos y de salud / Vitamin D deficiency in a cohort over 65 years: Prevalence and association with sociodemographic and health factors

Introducción. La hipovitaminosis D es frecuente en los ancianos, especialmente entre los institucionalizados y/o con fractura de cadera. Sin embargo, existen pocos estudios sobre la prevalencia de este déficit en la población general mayor de 64 años de nuestro entorno. El objetivo del presente trabajo es conocer la prevalencia de hipovitaminosis D en una cohorte poblacional urbana de mayores de 64 años, y analizar su relación con factores sociodemográficos, climáticos y de salud. Material y métodos. Se realizó un estudio descriptivo transversal a partir de la «cohorte de Peñagrande», de base poblacional y formada por mayores de 64 años. Se determinó el valor de 25-hidroxivitamina D en sangre y se recogieron variables sociodemográficas (edad, sexo, estado civil, nivel educativo, nivel socioeconómico), estación del año en que se realizó la determinación, y de salud (comorbilidad, obesidad, desnutrición, insuficiencia renal, deterioro cognitivo, discapacidad e ingesta de suplementos de vitamina D). Resultados. Se obtuvo una muestra de 468 individuos siendo el 53,4% mujeres y la edad media de 76 años (DE 7,7). El valor medio de vitamina D fue de 20,3 ± 11,7 ng/mL. El 86,3% (IC95%: 83,0-89,5) presentó insuficiencia vitamínica (≤ 30 ng/mL) y el 35,2% (IC95%: 30,8-39,7) deficiencia grave (≤ 15 ng/mL). La insuficiencia vitamínica se incrementa linealmente con la edad (OR 1,06; IC95%: 1,01-1,11), y con nivel socioeconómico bajo (OR 3,29; IC95%: 1,55-6,95). La deficiencia severa de vitamina D aumenta con la edad (OR 1,06; IC95%: 1,02-1,09), el sexo femenino (OR 1,80; IC95%: 1,18-2,75) y con deterioro cognitivo (OR 1,71; IC95%: 1,04-2,83). Conclusión. La prevalencia de hipovitaminosis D en los mayores de 65 años de nuestra comunidad es elevada. Sería muy recomendable poder determinar los valores de vitamina D en mayores de riesgo en atención primaria con el objetivo de adoptar medidas de suplementación farmacológica en los pacientes con niveles no adecuados (AU)

ntroduction: Vitamin D deficiency is common in the elderly, especially among institutionalized and/or hip fracture patients. However, there are few population studies on the prevalence of this deficiency in the general population over 64 years in our environment. The aim of this study was to determine the prevalence of vitamin D deficiency in an urban population cohort of over 64 years, and analyze its relationship with sociodemographic, climatic, and health factors. Material and methods: Cross-sectional study from « Peñagrande cohort », a population-based cohort consisting of people over 64 years. We determined 25-hydroxyvitamin D levels, and recorded sociodemographic data (age, sex, marital status, education, socioeconomic status), season of measurement and health variables (comorbidity, obesity, malnutrition, renal failure, cognitive impairment, vitamin D supplements, and disability). Results: A total of 468 individuals with a mean age of 76.0 years (SD: 7.7) were included, of which 53.4% were women. The mean value of vitamin D was 20.3 ± 11.7 ng/mL. The large majority (86.3%, 95% CI: 83.0-89.5) had a vitamin insufficiency ( ≤ 30 ng/ml), and 35.2% (95% CI: 30.8-39.7) showed severe vitamin deficiency ( ≤ 15 ng/ml). Vitamin insufficiency increases linearly with age (OR 1.06; 95% CI: 1.01-1.11), and was associated with low socioeconomic status (OR 3.29; 95% CI: 1.55-6.95). Severe vitamin D deficiency increases with age (OR 1.06; 95% CI: 1.02-1.09), female gender (OR 1.80; 95% CI: 1.18-2.75) and with cognitive impairment (OR 1.71; 95% CI: 1.04-2.83). Conclusion: The prevalence of vitamin D deficiency in people over 65 years of age in our community is high. It would be advisable to determine the vitamin D values in the high risk elderly in order to introduce measures of pharmacological supplementation in those with inadequate levels (AU)