Smoking behavior and circulating vitamin D levels in adults: A meta-analysis

Vitamin D deficiency and its potential associations on the health status of older patients with chronic obstructive pulmonary disease in rural Crete, Greece: A cross-sectional study

BACKGROUND & AIMS

While low vitamin D levels are common in Chronic Obstructive Pulmonary Disease (COPD) and have been associated with various adverse COPD-related outcomes, data on vitamin D status in rural COPD cohorts is limited. Therefore, the present study aimed to assess the prevalence of Vitamin D deficiency among patients with COPD living in rural areas and explore its potential association on the overall health status.

METHODS

This cross-sectional study included 138 participants >40 years with COPD from the prospective "COlaborative care vs usual CARE in primary care patients with COPD" (COCARE) study. Sociodemographic characteristics, medical history, patient's health-related quality of life (HRQoL) with the COPD Assessment Test (CAT), fatigue with the Fatigue Severity Scale (FSS), phycological parameters with Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7), sleep disorders with the COPD and Asthma Sleep Impact Scale (CASIS), Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS) were collected. Vitamin D deficiency was defined as levels of 25-hydroxy (OH)-Vitamin D below 20 ng/mL. Multiple logistic regression analysis was conducted to test for associations of Vitamin D deficiency with CAT, FSS, PHQ-9, GAD-7, CASIS, AIS, and ESS, adjusting for age, gender, smoking status, comorbidities, and seasonality.

RESULTS

Most of the participants were male (70 %) with a mean age of 68 ± 9 years and a mean Body Mass Index (BMI) of 30 ± 6 kg/m2. Moreover, 33 % of the participants had Vitamin D deficiency. Vitamin D deficiency increased the odds for worse HRQoL (CAT≥10 OR: 2.3, CI: 0.9-6.4, p = 0.008), greater fatigue severity (FSS, OR: 1.2, CI: 0.4-3.1, p = 0.756), more depressive (PHQ-9≥5, OR: 2.9, CI: 1.1-7.4, p = 0.024), anxiety (GAD-7, OR: 0.8, CI: 0.3-2.1, p = 0.592) and insomnia symptoms (AIS score OR: 1.1, CI: 0.7-5, p = 0.29), excessive daytime sleepiness (ESS, OR: 1.1, CI: 0.7-5, p = 0.29), and lower sleep quality (CASIS OR: 2.5, CI: 0.9-6.5, p = 0.006).

CONCLUSION

In conclusion, our findings indicate that Vitamin D deficiency is positively associated with numerous negative health outcomes of patients with COPD, including worse HRQoL, fatigue, depression, anxiety and sleep disorders. However, further research is needed to determine the role of Vitamin D in the health status of these patients.

A Phenome-Wide Association Study of Marijuana Use and Circulating Biomarkers in the United States: National Health and Nutrition Examination Survey 2009-2018

This study aimed to assess the associations between recent cannabis use and 49 biochemical biomarkers in a representative sample of American adults, using data from the 2009-2018 National Health and Nutrition Examination Survey. A phenotype-wide association study (PheWAS) was conducted to uncover new biomarkers linked to cannabis use. The analysis included 19,926 adults aged 18-59, with a mean age of 38.93 years (50.8% women), and 36.7% reporting recent cannabis use. Metabolic associations included higher high-density lipoprotein (HDL) cholesterol (3.51 mg/dL, 95% CI [2.50, 4.62]) and lower glycohemoglobin (-0.09%, 95% CI [-0.15, -0.04]) and glucose (-2.39 mg/dL, 95% CI [-4.07, -0.70]). Hematological findings included higher hemoglobin (0.09 g/dL, 95% CI [0.02, 0.16]), mean erythrocyte volume (1.46 fL, 95% CI [1.12, 1.80]), mean erythrocyte hemoglobin (0.46 pg, 95% CI [0.32, 0.60]), erythrocyte volume fraction (0.31%, 95% CI [0.11%, 0.50%]), and lower erythrocyte counts (-0.04 million cells/µL, 95% CI [-0.07, -0.02]). Serum chemistry associations included higher bicarbonate (0.20 mmol/L, 95% CI [0.06, 0.35]) and lower chloride (-0.47 mmol/L, 95% CI [-0.69, -0.24]). Associations were also observed with 25 hydroxyvitamin-3 (OHD3) (2.38 nmol/L, 95% CI [0.55, 4.22]) and epi-25OHD3 (0.40 nmol/L, 95% CI [0.15, 0.65]), and an inverse association with globulin (-0.03 g/dL, 95% CI [-0.06, -0.01]). Sensitivity analyses confirmed the robustness of these associations. Recent marijuana use is associated with diverse and complex phenotypes, several of which have not been previously evaluated. Further validation studies are warranted, this approach offers an opportunity to understand a comprehensive range of potential effects of marijuana use.

Nutritional Support of Chronic Obstructive Pulmonary Disease

Background: COPD is a heterogenous disease of the respiratory tract caused by diverse genetic factors along with environmental and lifestyle-related effects such as industrial dust inhalation and, most frequently, cigarette smoking. These factors lead to airflow obstruction and chronic respiratory symptoms. Additionally, the increased risk of infections exacerbates airway inflammation in COPD patients. As a consequence of the complex pathomechanisms and difficulty in treatment, COPD is among the leading causes of mortality both in the western countries and in the developing world. Results: The management of COPD is still a challenge for the clinicians; however, alternative interventions such as smoking cessation and lifestyle changes from a sedentary life to moderate physical activity with special attention to the diet may ameliorate patients' health. Here, we reviewed the effects of different dietary components and supplements on the conditions of COPD. Conclusions: COPD patients are continuously exposed to heavy metals, which are commonly present in cigarette smoke and polluted air. Meanwhile, they often experience significant nutrient deficiencies, which affect the detoxification of these toxic metals. This in turn can further disrupt nutritional balance by interfering with the absorption, metabolism, and utilization of essential micronutrients. Therefore, awareness and deliberate efforts should be made to check levels of micronutrients, with special attention to ensuring adequate levels of antioxidants, vitamin D, vitamin K2, magnesium, and iron, as these may be particularly important in reducing the risk of COPD development and limiting disease severity.

Potential roles for vitamin D in preventing and treating impulse control disorders, behavioral addictions, and substance use disorders: A scoping review

Vitamin D deficiency is a problem of endemic proportions. Vitamin D is a major regulator of dopaminergic and serotonergic circuits, pathways implicated in addictive disorders. This scoping review (OSF registered as 67yhb) examines preclinical and clinical studies exploring relationships between vitamin D in impulse control disorders, behavioral addictions, and substance use disorders. We searched Ovid MEDLINE, Embase, APA PsycInfo, Cochrane Library, Web of Science, and Scopus databases. We extracted and summarized quantitative and qualitative data through a narrative synthesis and assessed the quality of studies using the Joanna Briggs Institute (JBI) and SYRCLE (Systematic Review Centre for Laboratory Animal Experimentation) criteria. Of 5,442 initial records identified, 28 preclinical and clinical studies were included. For most conditions, we found a negative relationship between vitamin D levels and symptom presence and/or severity. While data suggest a potential beneficial effect of vitamin D on preventing or treating these conditions, there were significant limitations identified by the JBI and SYRCLE assessments. Future studies should include impulse control disorders and other under-explored conditions, address heterogeneity regarding forms, doses, and duration of exposures to vitamin D, and explore vitamin D's potential therapeutic mechanisms.

Hypovitaminosis D in patients with oral squamous cell carcinoma: Is a risk factor of developing this neoplasia?

BACKGROUND

Hypovitaminosis D raised a significant public health concern due to its potential association with various diseases, including Oral Squamous Cell Carcinoma (OSCC). The objective of this study was to compare serum 25(OH)D3 levels between individuals with and without OSCC, and by subgroups based on their smoking habits.

MATERIAL AND METHODS

A case-control study was conducted utilizing progressive multicenter recruitment, involving 46 patients with Oral Squamous Cell Carcinoma (OSCC) and 65 controls. Serum levels of 25(OH)D3 were evaluated via electrochemiluminescence. Patients were categorized according to their vitamin D levels into sufficiency, mild deficiency, moderate deficiency, and severe deficiency. Comparative analyses of serum 25(OH)D3 levels were performed between OSCC patients and controls, as well as among subgroups based on their smoking habits. Group comparisons were made with the Mann-Whitney test, and subgroup analyses used the Kruskal-Wallis test. Significance was set at p < 0.05 Results: 91% of participants, including both OSCC patients and controls, exhibited some degree of 25(OH)D3 deficiency. Among them, 71.7% of OSCC patients and 50.7% of controls had serum levels characterized by moderate to severe deficiencies. Patients with OSCC showed lower levels of 25(OH)D3, with medians of 20.2 ng/ml (IQR 9.48), compared to controls, with medians of 24.8 ng/ml (IQR 9.13) (p=0.002). Furthermore, when comparing the medians among the four study groups (smoking and non-smoking controls and smoking and non-smoking patients with OSCC), a significant difference was observed between non-smoking control patients with 25.04 ng/ml (IQR = 9.71) and smoking OSCC patients with 19.65 ng/ml (IQR = 12.14) (p < 0.05).

CONCLUSIONS

Individuals with oral squamous cell carcinoma (OSCC) exhibited lower serum levels of vitamin D (25(OH)D3) compared to controls, suggesting a potential link between vitamin deficiency and the development of this type of cancer. Vitamin D supplementation could serve as a preventive and therapeutic strategy.

Hypovitaminosis D in university workers in Southern Ecuador: interactions between gender and lifestyle

Background

Hypovitaminosis D may be common in tropical countries and is linked to disorders of phospho-calcium metabolism, rickets, muscle pain, immune system deficiencies, and increased susceptibility to microbial infections.

Objective

To assess the prevalence of hypovitaminosis D in apparently healthy university workers in Loja, Ecuador.

Methods

A cross-sectional study was completed in a private Ecuadorian university from May 2023 to September 2023, involving 440 participants. Data were gathered using a structured questionnaire created to assess risk factors influencing vitamin D levels. Serum 25-hydroxyvitamin D (25-OH)D concentrations were measured utilizing immunoenzymatic methods. Altered states (insufficiency or deficiency) of vitamin D were defined with serum values <30 ng/mL. Associations between vitamin D status and selected determinants were analyzed with independence tests, with significance set at p < 0.05. Where possible, odds ratios (OR) were calculated using logistic regression.

Results

The sample consisted of 60.9% faculty members and 39.1% administrative staff; 42.7% were men and 57.3% were women, with an average age of 41.9 ± 7.6 years. Only 2.7% of participants were aged 60 years or older. The mean serum 25-(OH)D concentration was 19.5 ± 6.8 ng/mL. Altered 25-(OH)D levels were found in 93.4% of participants, with 94.0% showing decreased serum 25-(OH)D concentrations and 1.6% displaying deficiency states. Hypovitaminosis D was associated with sex (OR = 2.40; 95% CI: 1.3-5.57; p < 0.05) and sunscreen use (OR = 0.36; 95% IC: 0.13-0.99; p < 0.05).

Conclusion

Hypovitaminosis D was almost universal among the apparently healthy university workers studied. The findings suggest that both sex and sunscreen use may independently or jointly contribute to hypovitaminosis D in these individuals. Further studies will be required to clarify this interplay.

Prevalence and Risk Factors of Vitamin D Deficiency in Patients Scheduled to Undergo Revision Arthroplasty of the Hip, Knee and Shoulder-Data from a Single-Centre Analysis

Vitamin D is crucial for ideal bone health and good muscle function, both essential requirements for successful joint arthroplasty. Hence, vitamin D deficiency has recently been identified as a predictor of poorer outcomes in patients scheduled to undergo total joint arthroplasty (TJA). Moreover, there is ample evidence today that vitamin D deficiency is associated with periprosthetic joint infection. Yet, vitamin D deficiency seems to be frequent in patients who are scheduled to undergo TJA. However, the prevalence of hypovitaminosis D in patients who require revision arthroplasty (rTJA) is largely unknown. Further, risk factors of vitamin D deficiency in these patients remain to be elucidated. For this reason, the primary objective of this study was to assess the vitamin D status of patients scheduled to undergo rTJA of the hip, knee and shoulder. The secondary objective was to identify potential risk factors for hypovitaminosis D in these patients. Serum vitamin D [25(OH)D] levels of 249 patients who were scheduled for rTJA were assessed over a period of twelve months at a high-volume TJA centre. Collectively, 23% of patients reported a routine intake of vitamin D supplements (58/249). Notably, 81% of patients (155/191) who did not report a routine vitamin D intake presented with insufficient vitamin D levels (below 30 ng/mL), while only 19% of patients (36/191) had sufficient vitamin D levels. Of those who reported a routine vitamin D intake, 75% (43/58) had sufficient vitamin D levels, while 25% (15/58) showed insufficient vitamin D status. Patients who did not routinely take any vitamin D supplements had significantly lower vitamin D levels compared to patients who reported regular vitamin D intake (19.91 ng/mL vs. 40.66 ng/mL). Further, BMI and nicotine abuse were identified as potential risk factors for hypovitaminosis D in patients without vitamin D supplementation. Moreover, the season of spring seems to be a risk factor in patients with vitamin D supplementation, while age itself did not appear to be a significant risk factor for low vitamin D levels. In conclusion, we found an alarmingly high rate of vitamin D deficiency in patients scheduled to undergo rTJA. Notably, reported routine vitamin D supplementation showed significantly increased serum vitamin D levels compared to patients with no reported supplementation. Due to the high prevalence of vitamin D deficiency, we believe that vitamin D status should routinely be assessed in patients who are scheduled to undergo rTJA.

Structural diversification of vitamin D using microbial biotransformations

Vitamin D deficiencies are linked to multiple human diseases. Optimizing its synthesis, physicochemical properties, and delivery systems while minimizing side effects is of clinical relevance and is of great medical and industrial interest. Biotechnological techniques may render new modified forms of vitamin D that may exhibit improved absorption, stability, or targeted physiological effects. Novel modified vitamin D derivatives hold promise for developing future therapeutic approaches and addressing specific health concerns related to vitamin D deficiency or impaired metabolism, such as avoiding hypercalcemic effects. Identifying and engineering key enzymes and biosynthetic pathways involved, as well as developing efficient cultures, are therefore of outmost importance and subject of intense research. Moreover, we elaborate on the critical role that microbial bioconversions might play in the a la carte design, synthesis, and production of novel, more efficient, and safer forms of vitamin D and its analogs. In summary, the novelty of this work resides in the detailed description of the physiological, medical, biochemical, and epidemiological aspects of vitamin D supplementation and the steps towards the enhanced and simplified industrial production of this family of bioactives relying on microbial enzymes. KEY POINTS: • Liver or kidney pathologies may hamper vitamin D biosynthesis • Actinomycetes are able to carry out 1α- or 25-hydroxylation on vitamin D precursors.

The Association of Serum Vitamin D With Anthropometric Indices, Lipid Profile, ICAM-1, and IL-17 in Patients Undergoing Coronary Artery Bypass Graft Surgery

This study aimed to assess the relationship between serum levels of vitamin D with anthropometric indices, lipid profile and vascular inflammatory factors, in patients who candidate for coronary artery bypass grafting (CABG). This analytical cross-sectional study was conducted in patients who were candidate for CABG. Demographic information, medical records, anthropometric indicators, blood samples, and physical activity of 150 patients were collected. 146 participants with mean ± standard deviation of age: 61.8 ± 10.0 years and body mass index: 26.9 ± 3.7 kg/m2 completed the study. Based on serum levels of vitamin D, patients were divided into 2 groups; groups with sufficient (≥ 30 ng/mL) and insufficient amount of vitamin D (< 30 ng/mL). The 30.14% of the patients had serum vitamin D deficiency. Ejection fraction (EF) % between the 2 groups had significant difference. Unexpectedly the EF% increased 7% in patients with insufficient level of vitamin D (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.11; p = 0.001). Vitamin D status had a significant inverse association with body weight. The odds of vitamin D deficiency significantly increased by 4% with increasing one kg in weight (OR, 1.04; 95% CI, 1-1.08; p = 0.044). There were no significant association between serum vitamin D level and intra cellular adhesion molecule-1, interleukin-17, fasting blood glucose, and lipid profile (p > 0.05). Considering the inverse association observed between serum vitamin D with EF% and body weight, vitamin D may play a role in modulating of these indices.

Impact of body mass index elevation, Vitamin D receptor polymorphisms and antipsychotics on the risk of Vitamin D deficiency in schizophrenia patients

Antipsychotics with weight gain as side effect and vitamin D receptor dysfunction associated with single nucleotide polymorphisms (VDR SNPs) may have different effects on vitamin D status. Hence, present study aimed to investigate the relationship between vitamin D with body mass index (BMI), antipsychotics and VDR SNPs (rs2228570, rs1544410, rs7975232 and rs731236) in Malaysian patients with schizophrenia. Serum vitamin D level was measured using competitive enzyme-linked immunosorbent assay kit. VDR SNPs were analyzed using polymerase chain reaction-restriction fragment length polymorphism. We found significantly lower serum vitamin D level in patients with schizophrenia (p < 0.01), especially those taking atypical antipsychotics (p = 0.02) and combined antipsychotics (p = 0.02) and obese (BMI ≥27.5 kg/m2) patients (p = 0.04) after adjustment for covariates. For VDR SNPs, the CT genotype of rs1544410, CA genotype of rs7975232, and AA and AG genotypes of rs731236 may contribute to the significant decreased serum vitamin D level in patients (p < 0.05). Nevertheless, these relationships may differ by populations or medical conditions. The hypotheses of volumetric dilution and sequestration of vitamin D may explain the lower vitamin D level in obese patients. In addition, lifestyle factors such as poor diet and lack of physical activity with less sunlight exposure may cause reduced vitamin D level among patients. As patients in present study were prescribed with various antipsychotics, the effect of each antipsychotic on vitamin D level could not be determined. Thus, future studies should investigate the effect of different types of antipsychotics and obesity on vitamin D level in schizophrenia.

Exploiting meta-analysis of genome-wide interaction with serum 25-hydroxyvitamin D to identify novel genetic loci associated with pulmonary function

BACKGROUND

Higher 25-hydroxyvitamin D (25(OH)D) concentrations in serum has a positive association with pulmonary function. Investigating genome-wide interactions with 25(OH)D may reveal new biological insights into pulmonary function.

OBJECTIVES

We aimed to identify novel genetic variants associated with pulmonary function by accounting for 25(OH)D interactions.

METHODS

We included 211,264 participants from the observational United Kingdom Biobank study with pulmonary function tests (PFTs), genome-wide genotypes, and 25(OH)D concentrations from 4 ancestral backgrounds-European, African, East Asian, and South Asian. Among PFTs, we focused on forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) because both were previously associated with 25(OH)D. We performed genome-wide association study (GWAS) analyses that accounted for variant×25(OH)D interaction using the joint 2 degree-of-freedom (2df) method, stratified by participants' smoking history and ancestry, and meta-analyzed results. We evaluated interaction effects to determine how variant-PFT associations were modified by 25(OH)D concentrations and conducted pathway enrichment analysis to examine the biological relevance of our findings.

RESULTS

Our GWAS meta-analyses, accounting for interaction with 25(OH)D, revealed 30 genetic variants significantly associated with FEV1 or FVC (P2df <5.00×10-8) that were not previously reported for PFT-related traits. These novel variant signals were enriched in lung function-relevant pathways, including the p38 MAPK pathway. Among variants with genome-wide-significant 2df results, smoking-stratified meta-analyses identified 5 variants with 25(OH)D interactions that influenced FEV1 in both smoking groups (never smokers P1df interaction<2.65×10-4; ever smokers P1df interaction<1.71×10-5); rs3130553, rs2894186, rs79277477, and rs3130929 associations were only evident in never smokers, and the rs4678408 association was only found in ever smokers.

CONCLUSION

Genetic variant associations with lung function can be modified by 25(OH)D, and smoking history can further modify variant×25(OH)D interactions. These results expand the known genetic architecture of pulmonary function and add evidence that gene-environment interactions, including with 25(OH)D and smoking, influence lung function.

Vitamin D deficiency during the coronavirus disease 2019 (COVID-19) pandemic among healthcare workers

BACKGROUND & AIMS

Vitamin D deficiency is a common nutritional problem worldwide that may have worsened during the coronavirus disease 2019 (COVID-19) pandemic. The present study sought to examine the prevalence and correlates of vitamin D deficiency among healthcare workers three years after the start of the COVID-19 pandemic.

METHODS

Participants comprised 2543 staff members from a medical research institute, who completed a questionnaire and donated blood samples in June 2023. 25-hydroxyvitamin D (25[OH]D) levels were measured using an electrochemiluminescence immunoassay. Logistic regression was used to calculate the odds ratio and its 95% confidence interval while adjusting for covariates.

RESULTS

The proportions of participants with vitamin D insufficiency (25[OH]D 20-29 ng/mL) and deficiency (25[OH]D < 20 ng/mL) were 44.9% and 45.9%, respectively. In a multivariable-adjusted model, factors associated with a higher prevalence of vitamin D deficiency included younger age, female sex, fewer hours of daytime outdoor physical activity during leisure time (without regular use of sunscreen), lower intake of fatty fish, no use of vitamin D supplements, smoking, and no alcohol consumption. Occupational factors, including shift work, were not independently associated with vitamin D deficiency.

CONCLUSIONS

Our results suggest that vitamin D insufficiency and deficiency are highly prevalent among healthcare workers. Health education regarding lifestyle modifications for this occupational group are warranted to improve their vitamin D status in the COVID-19 era.

Associations of Serum Vitamin D Concentration with Cardiovascular Risk Factors and the Healthy Lifestyle Score

Vitamin D status is reportedly associated with risk factors for cardiovascular disease (CVD), although conflicting data have been generated. The healthy lifestyle score (HLS) was formulated as a primary approach toward preventing CVD; however, data on the association between the HLS and vitamin D status remain insufficient. This study aimed to investigate the associations of CVD risk factors and the HLS with serum 25-hydroxyvitamin D concentration in adults who participated in a national survey. HLS components, including body mass index, smoking status, alcohol consumption, physical activity, and dietary pattern, as well as other risk factors, including diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DL), were fitted in multiple linear regression models to determine their association with vitamin D status. DM, HTN, and DL were inversely associated whereas a balanced dietary pattern, alcohol consumption, and physical activity were positively associated with serum vitamin D concentration (p < 0.01). Furthermore, a strong association was observed between the total HLS and serum vitamin D concentration (p for trend <0.01); the regression coefficient estimate (95% confidence interval) for the highest score was 1.41 (0.65, 2.17) (p < 0.01) compared with that for the lowest. These findings suggest that CVD risk factors and the HLS may reflect vitamin D status.

The roles of serum vitamin D and tobacco smoke exposure in insomnia: a cross-sectional study of adults in the United States

Aim

Tobacco smoke exposure and vitamin D (VD) status were both associated with insomnia. However, the combined effect of smoking and VD on insomnia has not been discussed. This study aimed to explore the role of VD in the association between tobacco smoke exposure and insomnia.

Methods

Data on adults were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2005-2008 for this cross-sectional study. Weighted univariate and multivariate logistic regression analyses were used to explore the associations between serum cotinine, serum VD, and insomnia. A surface diagram was drawn to reflect the effect of VD on the association between serum cotinine and insomnia. In addition, the potential regulating effect of VD in subgroups of smoking status was also performed. The evaluation index was odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Among the eligible participants, 1,766 had insomnia. After adjusting for covariates, we found that elevated serum cotinine levels were associated with higher odds of insomnia [OR = 1.55, 95% CI: (1.22, 1.97)]. However, the relationship between serum VD level and insomnia was not significant (P = 0.553). Higher serum cotinine levels were also associated with higher odds of insomnia [OR = 1.52, 95% CI: (1.17, 1.98)] when serum VD level was <75 nmol/L; however, this relationship became non-significant when serum VD concentration was elevated (P = 0.088). Additionally, the potential regulating effect of VD was also found in adults who were not smoking.

Conclusion

VD may play a potential regulative role in the association between tobacco smoke exposure and insomnia. Further studies are needed to clarify the causal relationships between VD, tobacco smoke exposure, and insomnia.

Serum 25-hydroxyvitamin D response to vitamin D supplementation using different lipid delivery systems in middle-aged and older adults: a randomised controlled trial

Food fortification improves vitamin D intakes but is not yet mandated in many countries. Combining vitamin D with different dietary lipids altered vitamin D absorption in in vitro and postprandial studies. This randomised, placebo-controlled trial examined the effect of the lipid composition of a vitamin D-fortified dairy drink on change in 25-hydroxyvitamin D (25(OH)D) concentrations. Sixty-three healthy adults aged 50+ years were randomised to one of the following for 4 weeks: vitamin D-fortified olive oil dairy drink, vitamin D-fortified coconut oil dairy drink, vitamin D supplement or placebo control dairy drink. All vitamin D groups received 20 µg of vitamin D3 daily. Serum was collected at baseline and post-intervention to measure 25(OH)D concentrations and biomarkers of metabolic health. Repeated-measures general linear model ANCOVA (RM GLM ANCOVA) compared changes over time. There was a significant time × treatment interaction effect on 25(OH)D concentrations for those classified as vitamin D-insufficient (P < 0·001) and -sufficient at baseline (P = 0·004). 25(OH)D concentrations increased significantly for all insufficient participants receiving vitamin D3 in any form. However, for vitamin D-sufficient participants at baseline, 25(OH)D concentrations only increased significantly with the coconut oil dairy drink and supplement. There was no effect of vitamin D on biomarkers of metabolic health. Vitamin D fortification of lipid-containing foods may be used in lieu of supplementation when supplement adherence is low or for individuals with dysphagia. These results are important given the recent recommendation to increase vitamin D intakes to 15-20 µg for older adults in Ireland.

Associations of serum 25-hydroxyvitamin D with serum folate, cobalanin, and homocysteine concentrations and methylene tetrahydrofolate reductase (MTHFR) gene polymorphisms in healthy adults

AIM

The aim of this study was to investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] with various demographic, anthropometric, and genetic characteristics and biochemical parameters in healthy Greek adults.

METHODS

Demographic (age and sex), anthropometric (body mass index/BMI), and genetic (MTHFR gene polymorphisms) characteristics and biochemical parameters (serum folate, cobalamin/Cbl, and total homocysteine/tHcy concentrations), which had been recorded and measured, among others, in the framework of periodic medical examination (military personnel) or check-up (non-military personnel) of 383 healthy Greek adults (199 men and 184 women) were analyzed. Serum 25(OH)D, tHcy, folate, and Cbl levels were determined using immunoassay methods. The MTHFR C677T and A1298C gene polymorphisms were genotyped using polymerase chain reaction and reverse hybridization.

RESULTS

Serum 25(OH)D concentrations were correlated with Cbl levels and MTHFR C677T gene polymorphism, while they had a reverse correlation with serum tHcy levels, age, and BMI. There was no significant correlation between serum 25(OH)D concentrations and sex, serum folate levels, and smoking status. Individuals with the 677TT genotype had statistically significantly lower serum 25(OH)D levels than those with the 677CC or 677CT genotype, while individuals with the 1298CC genotype had statistically significantly higher serum 25(OH)D levels than those with 1298AA or 1298AC genotype. Moreover, the reverse correlation between the serum 25(OH)D and tHcy levels was statistically significant in all six MTHFR genotypes.

CONCLUSIONS

Serum 25(OH)D levels are associated with age, BMI, serum tHcy, and Cbl levels and MTHFR C677T gene polymorphism. The most significant finding of our study is the observed reverse correlation of serum 25(OH)D levels with serum tHcy levels. Considering that vitamin D deficiency and hyperhomocysteinemia (HHcy) are associated with an increased risk for cardiovascular diseases (CVDs), we suggest that individuals with high serum tHcy levels should be further investigated for, inter alia, their serum 25(OH)D levels.

Prevalence and Correlates of Vitamin D Deficiency among Adult Population in Urban and Rural Areas of the National Capital Region of Delhi, India

ABSTRACT

High prevalence of Vitamin D deficiency has been reported among selective population, but its population prevalence from representative adult population is lacking in India. The aim of this study was to estimate the prevalence and identify the correlates of Vitamin D deficiency among urban and rural areas of the National Capital Region (NCR) of Delhi, India. Serum Vitamin D levels of 1403 adults (aged 30 years above), 702 from urban and 701 from rural NCR of Delhi, who participated in a representative cross-sectional survey were measured using the quantitative chemiluminescent immunoassay method. The prevalence of Vitamin D deficiency was classified as severe deficient, and insufficient at three serum levels of 25-hydroxyvitamin D-<10, 10-<20, and 20-<30 ng/mL, respectively. The median (interquartile range) 25-hydroxyvitamin D levels in urban and rural areas were 7.7 (5.2, 10.8) ng/mL and 16.2 (10.9, 22.3) ng/mL, respectively. The prevalence of Vitamin D severe deficiency, deficiency, and insufficiency in urban areas were 71%, 27%, and 2%, respectively. The corresponding prevalence in rural areas was 20%, 47%, and 25%. Urban location (odds ratio [OR] [95% confidence interval [CI]: 11.7 [8.6, 15.9]), female gender (OR [95% CI]: 1.5 [1.1, 2.2]), and abdominal obesity (OR [95% CI]:1.5 [1.1, 2.0]) were independently associated with severe deficiency. This study revealed a high prevalence of severe vitamin deficiency among the adult living in NCR, more so among urban areas, women, and obese.

Vitamin D status and chronic obstructive pulmonary disease risk: a prospective UK Biobank study

BACKGROUND

Low vitamin D status has been linked to an increased risk for various inflammatory diseases. Conflicting results have been reported regarding chronic obstructive pulmonary disease (COPD). This study aims to investigate the associations of serum 25-hydroxyvitamin D (25(OH)D) concentrations with COPD risk and survival.

METHODS

We included 403 648 participants with serum 25(OH)D measurements and free of COPD at baseline from UK Biobank. Follow-up was until 30 September 2021. Multivariable-adjusted cox regression models were applied to estimate HRs and 95% CIs for the associations of season-standardised 25(OH)D concentrations with COPD risk and survival. The restricted cubic splines were used to assess dose-response relationship. Kaplan-Meier estimation was used to create graphs of the survival curves.

RESULTS

During a median follow-up of 12.3 (IQR: 11.4-13.2) years, 11 008 cases of COPD were recorded. We observed a non-linear inverse association between 25(OH)D concentrations and COPD risk. Compared with participants in the fourth quintile of 25(OH)D, those in the lowest quintile were associated with a 23% higher risk (HR, 1.23; 95% CI, 1.16 to 1.31). Stronger associations were observed for the risk in men and current smokers (Both p for interaction <0.05). In survival analyses, compared with the fourth quintile, cases in the lowest quintile had a 38% higher risk for overall death (HR, 1.38; 95% CI, 1.22 to 1.56).

CONCLUSION

Our findings indicate that serum 25(OH)D concentrations are non-linearly negatively associated with incidence and mortality of COPD, suggesting a potential protective role of vitamin D in the pathogenesis of COPD.

The mediating role of Vitamin D in the association between personality and memory: Evidence from two samples

Five-Factor Model (FFM) personality traits are consistently related to cognition in old age. However, little is known about the biological mediators of this association. The present study examined whether levels of Vitamin D mediated the association between personality and memory. Participants were adults aged 50-96 years from the Health and Retirement Study (HRS, N = 5229) and the English Longitudinal Study of Ageing (ELSA, N = 4249). In HRS, personality and demographic factors were assessed in 2012/2014, Vitamin D was assessed in 2016, and memory was assessed in 2018. In ELSA, personality and demographic factors were obtained in 2010/2011, Vitamin D was measured in 2012/2013, and memory was assessed in 2014/2015. In both samples, higher extraversion and conscientiousness were related to higher levels of Vitamin D, whereas higher neuroticism was related to lower Vitamin D. In both samples, higher Vitamin D partly mediated the association between both higher extraversion and conscientiousness and better memory. The association between higher neuroticism and worse memory at follow-up was partially mediated by lower Vitamin D in the HRS and ELSA. Vitamin D did not mediate the association between higher openness and better memory. The present study extends the personality-cognition literature by providing new replicable evidence that Vitamin D is a biological mediator.

Vitamin D intakes among women living with and without HIV in Canada

BACKGROUND

Patterns of vitamin D intake are relatively unexplored among women living with HIV, despite its importance for women's health. We compared vitamin D dietary and supplement intakes in women with HIV and population-based national controls and investigated barriers to intake.

METHODS

In this case-control study, women with HIV in the Children and Women: AntiRetrovirals and Markers of Aging (CARMA) cohort were matched with Canadian Multicentre Osteoporosis Study (CaMos) controls. Participants were queried for vitamin D in dairy consumption, supplementation/dosage, and sociodemographic variables. We assessed barriers to supplementation and factors associated with dietary intake by regression modelling.

RESULTS

Ninety-five women living with HIV were age-matched to 284 controls. Women with HIV had lower income and bone mineral density and were more likely to smoke, take multiple medications and be non-white. Vitamin D dietary intake was lower in women living with HIV versus controls [0.76 vs. 1.79 μg/day; adjusted odds ratio (aOR) for greater than or equal to median intake 0.29 (0.12-0.61), p = 0.002], but any supplementation was higher [62.2% vs. 44.7%; aOR = 3.44 (95% CI: 1.16-11.00), p = 0.03]. Total vitamin D intake was similar between groups. Smoking was associated with no supplementation; non-white ethnicity and low income were related to lower dietary intake.

CONCLUSIONS

Women living with HIV showed lower dietary vitamin D intake but higher supplementation rates, suggesting that care providers are promoting supplementation. Women living with HIV who smoke, have low incomes and are non-white may particularly benefit from targeted efforts to improve vitamin D intake.

Dietary Antioxidants and Lung Cancer Risk in Smokers and Non-Smokers

Smoking is considered a major risk factor in the development of lung diseases worldwide. Active smoking and secondhand (passive) smoke (SHS) are related to lung cancer (LC) risk. Oxidative stress (OS) and/or lipid peroxidation (LP) induced by cigarette smoke (CS) are found to be involved in the pathogenesis of LC. Meta-analyses and other case-control/prospective cohort studies are inconclusive and have yielded inconsistent results concerning the protective role of dietary vitamins C and E, retinol, and iron intake against LC risk in smokers and/or non-smokers. Furthermore, the role of vitamins and minerals as antioxidants with the potential in protecting LC cells against CS-induced OS in smokers and non-smokers has not been fully elucidated. Thus, this review aims to summarize the available evidence reporting the relationships between dietary antioxidant intake and LC risk in smokers and non-smokers that may be used to provide suggestions for future research.

The association of 25 (OH) D3 serum level with ischemic cerebrovascular accident risk, severity and outcome in Iranian population

OBJECTIVES

The role of combined presence of vitamin D deficiency and other risk factors of stroke in ischemic cerebrovascular accident (CVA) development in Iranian adults has been unclear, so far. The association of vitamin D status at admission with ischemic CVA severity and outcome in this community is not yet well elucidated. This study aimed to clarify these ambiguities.

METHODS

In a cross-sectional study 104 hospitalized ischemic CVA patients and 104 healthy controls participated. The serum level of 25 (OH) D3 and baseline biochemical parameters were measured in ischemic patients within the first 24 h of admission, as well as healthy controls. The severity of CVA and clinical outcome were assessed using National Institutes Health Stroke Scale and Modified Rankin Scale, respectively. Data were analyzed using the Chi-square test, independent t-test, and multiple logistic regression.

RESULTS

There was a significant difference between patients and controls regarding the presence of vitamin D3 deficiency, hypertension, smoking, and baseline level of LDL and FBS. Vitamin D3 deficiency boosted the risk of ischemic in males and those having family history of CVA. A low serum level of 25 (OH) D3 was associated with more severity and poor outcome of CVA. The CVA severity, vitamin D3 deficiency, and hypertension were predictors of poor outcome.

CONCLUSIONS

The study highlights the increased risk of ischemia in Iranians by cooccurrence of vitamin D3 deficiency and other risk factors of CVA. Clinical significance of vitamin D3 deficiency control may be suggested in those at risk of CVA and functional poor outcomes.

Associations among vitamin D, tobacco smoke, and hypertension: A cross-sectional study of the NHANES 2001-2016

The interrelationships among vitamin D, tobacco smoking, and hypertension are currently unknown. This study was conducted to determine the relationship between vitamin D levels and hypertension and the effect of tobacco smoke exposure levels on this relationship among US adults. We performed a cross-sectional analysis of adult participants from the 2001-2016 National Health and Nutrition Examination Survey (NHANES). Serum 25-hydroxyvitamin D concentration was used as a biomarker of vitamin D status, and tobacco smoke exposure levels were objectively evaluated by serum cotinine levels. Among 22,875 eligible adults who were not receiving antihypertensive medications, the prevalence of hypertension, vitamin D deficiency (<50 mmol/L), and cotinine ≥3 ng/mL was 13.9%, 34.9%, and 29.4%, respectively. Serum cotinine and vitamin D levels were independently associated with hypertension risk after controlling for confounders (P < 0.05). When stratified by the cotinine group (<0.05, 0.05-3 and ≥3 ng/mL), we found that the risk of hypertension associated with vitamin D deficiency was higher among subjects with cotinine levels ≥3 ng/mL compared with the other strata [OR (95% CI) 1.30 (1.09, 1.54) vs. 1.53 (1.19, 1.96) vs. 1.64 (1.30, 2.06); P for heterogeneity test <0.05]. Furthermore, serum cotinine levels were negatively correlated with vitamin D levels. These findings suggested that the increased risk of hypertension could be partly attributed to low vitamin D levels induced by tobacco smoke exposure, in addition to the effects of tobacco smoke exposure and vitamin D deficiency themselves.

Vitamin D Deficiency and Risk Factors Related to Acute Psychiatric Relapses in Patients with Severe Mental Disorders: A Preliminary Study

Previous studies have indicated that vitamin (Vit) D deficiency is frequent in psychiatric patients, regardless of diagnostic category. We aimed to assess whether acute psychiatric relapses in inpatients was associated with Vit D deficiency compared to stabilized outpatients. The cohort (152 total patients, 75 males and 77 females) had a mean age of 47.3 ± 14.4 years at admission and was grouped according to psychiatric diagnosis. Psychopathological symptom severity was assessed by the Brief Psychiatric Rating Scale (BPRS), a multidimensional symptom inventory. Total calcium serum levels were measured using standard laboratory methods, while plasma levels of 25-OH-Vit D and parathyroid hormone (PTH) were measured by automated chemiluminescence immunoassays. The psychiatric inpatient subgroup showed a significant difference in serum levels of 25-OH-Vit D and PTH (p < 0.001). Correlation analysis between serum levels of 25-OH-Vit D and BPRS total and subitem scores indicated a significantly negative relationship. In addition, linear regression analysis evidenced that the inpatient condition might predict low PTH and 25-OH-Vit D serum levels. Hospitalized psychiatric patients are at increased risk for Vit D deficiency regardless of their diagnostic categories. The mechanism underlying the association between acute psychiatric relapses and Vit D deficiency remains unclear. Therefore, screening for Vit D deficiency should pertain to the health assessment of patients with major psychiatric disorders.

The effect of vitamin D supplementation on tobacco-related disorders in individuals with a tobacco use disorder: a randomized clinical trial

Vitamin D deficiency in cigarette smokers (CS) might associate with several complications, including metabolic deficits, depression and anxiety. This study evaluated the effects of vitamin D on mental health symptoms, nicotine misuse, and biomarkers of metabolic diseases in individuals with a tobacco use disorder. A randomized, double-blind, placebo-controlled trial was conducted with 60 CS subjects receiving either 50,000 IU vitamin D supplements (n = 30) or placebo (n = 30) every 2 weeks for 24-weeks. Nicotine misuse, mental health scale, and metabolic parameters were measured before and after the intervention in the CS subjects. Compared with the placebo-group, after the 24-weeks intervention, serum 25 (OH) vitamin D levels increased in the intervention group (β 2.96; 95% CI, 0.91, 5.01; P = 0.006). In addition, vitamin D supplementation significantly improved Beck Depression Inventory (BDI) (β -2.06; 95% CI, -3.84, -0.28; P = 0.02). In addition, vitamin D administration significantly decreased fasting plasma glucose (FPG) (β -4.56; 95% CI, -8.94, -0.19; P = 0.04), insulin (β -0.50; 95% CI, -0.88, -0.13; P = 0.009), and homeostasis model of assessment-estimated insulin resistance (HOMA-IR) levels (β -0.21; 95% CI, -0.33, -0.08; P = 0.001). Furthermore, vitamin D resulted in a significant elevation in total antioxidant capacity (TAC) (β 81.20; 95% CI, 18.30, 144.11; P = 0.01), and plasma glutathione (GSH) levels (β 73.05; 95% CI, 18.56, 127.54; P = 0.01), compared with the placebo-group. Administration of vitamin D for 24-weeks to CS subjects had beneficial effects on symptoms of depression and several metabolic biomarkers. While this preliminary study suggests that vitamin D might have beneficial effects, its clinical efficacy in individuals with a tobacco use disorder should be further validated in future clinical trials.

Moderate Sun Exposure Is the Complementor in Insufficient Vitamin D Consumers

Background and Aims

Vitamin (Vit) D plays a vital role in human health, and the prevalence of Vit D deficiency worldwide has been a rising concern. This study investigates the serum 25-hydroxy-Vit D [25(OH)D] status in healthy US civilians and identifies how the two main sources, sun exposure and dietary Vit D intake, determine the final 25(OH)D levels in individuals.

Methods

A total of 2,360 of participants from The National Health and Nutrition Examination Survey (NHANES) 2009–2014 were analyzed. We divided the levels of sun exposure and dietary Vit D intake of all subjects into 10 strata and gave a score ranging from 1 to 10 points, respectively. Scores 1–5 in sun exposure and dietary intake were considered as relatively low exposure groups, whereas scores 6–10 were considered as relatively high exposure groups. Serum Vit D inadequacy was defined as <50 nmol/L. Linear and logistic regression analyses were used to examine the associations between sources of Vit D and serum 25(OH)D levels.

Results

In relatively low Vit D intake groups (Vit D intake score 1–5), relatively high sun exposure (sun exposure score >5) resulted in higher serum 25(OH)D levels (average 57 nmol/L) compared with relatively low sun exposure (sun exposure score <5) (average 50 nmol/L), whereas this difference became negligible in high intake groups (Vit D intake score 6–10). Moreover, the greatest slope occurred in the low Vit D intake curve (decile 3 of Vit D intake), which shows increased sun exposure time causing the greatest degree of change in serum 25(OH)D level in this group.

Conclusion

Sun exposure can significantly make up for deficiencies in subjects who consume insufficient dietary Vit D. Compared with the extra cost and time for building habits of Vit D supplementation, moderate sun exposure appears to be a simple and costless means for the public to start in daily practice.