Global vitamin D status and determinants of hypovitaminosis D

Unraveling the Relationship Between Vitamin D and Noncommunicable Diseases: A Systemic Review and Meta-Analysis

BACKGROUND

Subclinical vitamin D insufficiency is frequent in both developing and developed countries. Even after rickets was eliminated in the 1930s by fortifying milk, up to 1 billion people worldwide suffer from subclinical vitamin D deficiency (VDD). Numerous noncommunicable diseases (NCDs), including depression, autoimmune illnesses, diabetes, osteoporosis, and cardiovascular disease, are linked to this deficiency.

METHODOLOGY

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was applied when conducting a systematic review. Relevant studies published between 2010 and 2023 were found by searching databases such as Web of Science, Scopus, and PubMed. To find correlations between deficiency of vitamin D and NCDs, data was extracted from the studies and analyzed using the Mixed Method Appraisal Tools (MMAT). In meta-analysis data combined from multiple observational Unraveling the Relationship Between Vitamin D and Noncommunicable Diseases-A Systemic Review and Meta-Analysis studies to evaluate the relationship between vitamin D insufficiency and health outcomes. Statistical techniques, such as calculating effect sizes and constructing confidence ranges, are employed to determine combined outcomes and investigate possible causal connections.

RESULTS

Fourteen studies-including cross-sectional studies, prospective cohorts, randomized controlled trials, and longitudinal studies-met the inclusion criteria. Significant correlations among deficiency of vitamin D and a number of NCDs, including anemia, diabetes, hypertension, rheumatoid arthritis (RA), mental health issues, and autoimmune hypothyroidism, were found in the review. The results highlight the prevalence of deficiency of vitamin D worldwide and its detrimental impact on health. In order to lower the risk of numerous NCDs, this review emphasizes the need for greater awareness and possible interventions to maintain appropriate vitamin D levels. A meta-analysis was conducted to investigate the potential causal connections between vitamin D insufficiency and different health disorders. It elucidates the connections between deficient levels of vitamin D and conditions such as mental health disorders, anemia, diabetes, hypertension, and autoimmune diseases. The study prioritizes the examination of temporal correlations, biological plausibility, and the removal of confounding factors to provide support for these associations. While the text acknowledges that experimental data, such as randomized controlled trials, would enhance the argument for causation, it mostly depends on observational studies.

Major risk factors underlying the development of metabolic syndrome in vitamin D-deficient rats

Background

Vitamin D is essential for calcium-phosphorus homeostasis, skeletal mineralization, and cardiovascular health. Its deficiency is associated with increased risk of metabolic syndrome and cardiovascular diseases. In this study, we aimed to investigate the relationship between vitamin D deficiency and cardiovascular metabolic syndrome while identifying underlying mechanisms.

Methodology

Forty-eight Wistar albino rats were divided into four groups: control, vitamin D deficient (VD-), metabolic syndrome (MetS), and combined vitamin D deficient with metabolic syndrome (VD- + MetS). VD- and VD- + MetS rats were fed a vitamin D-deficient diet with increased calcium and phosphate to prevent secondary hyperparathyroidism and to determine the direct effects of vitamin D. Metabolic syndrome was induced via 10% fructose in drinking water for 8 weeks. Evaluations included metabolic syndrome markers (hypertension, diabetes, dyslipidemia, and obesity), myocardial injury indicators (lactate dehydrogenase [LDH] and creatine kinase-MB [CK-MB]), and oxidative stress/inflammation markers (malondialdehyde [MDA] and nitric oxide [NO]). Vascular reactivity in thoracic aorta tissues, heart weight, and histopathological changes were also assessed.

Result

The results revealed that vitamin D deficiency was strongly related to each component of metabolic syndrome. Combined vitamin D deficiency and metabolic syndrome induced a highly significant increase in CK-MB, LDH, NO, and MDA levels (p < 0.05). However, there was no significant difference in CK-MB and NO levels for the (VD-) group compared to the control (p > 0.05). Heart weight was significantly increased, and a histological examination of the heart showed increased left ventricular and aortic wall thickness in the combined group (p < 0.05). Vascular response to phenylephrine was significantly increased, whereas the vascular response to acetylcholine was significantly decreased in all experimental groups (VD-, MetS, and VD- + MetS) compared to control (p < 0.05).

Conclusion

The present study demonstrates that vitamin D deficiency is considered one of the major risky and predisposing factors for cardiovascular metabolic syndrome, which could affect the outcome of the disease, partly by affecting endothelial function, vascular oxidative stress, and inflammation.

Macronutrients, Micronutrients, and Malnutrition: Effects of Nutrition on Immune Function in Infants and Young Children

The function of the immune system is not only dependent on factors like genetics, age, the environment, and exposure to infectious agents and allergens but also on our microbiota and our diet. It has been known for centuries that food can influence health and vulnerability to infection. This is especially true for infants, young children, and the elderly. This review focuses on how nutrition can support immune function from gestation to school-aged children. Immune support begins during pregnancy by the mother's diet and transfer of nutritional components as well as antibodies to her fetus. After birth, breastfeeding is of crucial importance for immune development as well as for the development of the intestinal microbiota of an infant. If breastfeeding is not possible, early-life formulas are an alternative. These can provide several of the functionalities of breastmilk, as well as the key nutrients a child needs. New foods are introduced during and after weaning, and after this period, children switch to consuming a normal diet. However, due to circumstances, children can be malnourished. This can range from severe protein/energy malnutrition to micronutrient deficiencies and obesity, all of which can affect the function of the immune system. This narrative review describes the immune challenges in early life, explores breastfeeding and early life nutrition, and provides mechanistic insight into the relative contribution of macronutrients, micronutrients and other immunomodulatory food components that can support immune function in early life.

From cultural dispositions to biological dimensions: a narrative review on the synergy between oral health and vitamin D through the lens of Indian habitus

Oral health is intricately related to systemic health, with new worldwide research demonstrating vitamin D's critical role in sustaining dental and periodontal health. Vitamin D regulates calcium and phosphate metabolism, which is required for the formation and maintenance of healthy teeth and bones. According to research, vitamin D deficiency may contribute to the etiology of periodontal disease by decreasing the host immune response, making it more susceptible to infections like gingivitis and periodontitis. Oral health in India is a tapestry of traditional practices, socioeconomic factors, lifestyle factors, and access to modern healthcare, all of which are intricately linked with the concept of habitus, which refers to deeply embedded habits, dispositions, and practices shaped by an individual's social space. Deep-rooted social and cultural influences have a substantial impact on oral hygiene practices, food patterns, and health-seeking behaviours. Oral diseases are considered as a worldwide health issue. Though standard Western medicine has had effectiveness in preventing and treating periodontal diseases and other oral disorders, the hunt for alternative solutions continues, and natural phytochemicals extracted from plants used in traditional medicine are regarded as viable alternatives to synthetic chemicals. India's traditional medical knowledge and practice, take a comprehensive approach to oral health, emphasizing the balance of physiological components and the use of natural treatments to maintain oral hygiene and treat oral disorders. However, the structural integrity of teeth and optimal oral health can be accomplished by combining Indian traditional medical practices with vitamin D supplementation, which has synergistic attributes for gum health, anti-inflammatory effects, and dental caries prevention. Nevertheless, the unique association of oral health, vitamin D deficiency and the habitus from Indian perspective is extremely underrepresented in academia. To the best of our knowledge, in the aforementioned context, the present narrative review is probably the maiden attempt to discern the crosstalk of oral health and Vitamin D from the perspectives of Indian habitus.

The Lebanese GRADE-based vitamin D guidelines: a paradigm for the MENA region

BACKGROUND

The Middle East and North Africa region are traditionally known as regions with a high prevalence of vitamin D deficiency. However, serum 25-hydroxyvitamin D (25OHD) levels seem to be increasing lately. We developed guidelines on the screening and supplementation of adult Lebanese patients with vitamin D. These guidelines address community-dwelling and institutionalized individuals.

METHODS

Our guideline panel consisted of clinical and methodology experts that formulated the guidelines questions. We conducted a systematic review to gather global data on fracture (CRD42019129540), regional data on vitamin D trials (CRD42014010488), and on patients' values and preferences (CRD42022320022). We also complemented the latter with results from a cross-sectional local study. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to assess the quality and certainty of evidence, and to develop recommendations.

RESULTS

For community-dwelling and institutionalized Lebanese adult population, the panel suggests no screening for vitamin D deficiency, over screening for vitamin D deficiency (conditional recommendation, based on very low certainty evidence). For community-dwelling Lebanese adult population, the panel suggests no supplementation with calcium and vitamin D, over supplementation (conditional recommendation, based on moderate certainty evidence). For institutionalized Lebanese adult population, the panel suggests supplementation with calcium and vitamin D, over no supplementation (conditional recommendation, based on moderate certainty evidence). The guidelines also identify high-risk subgroups, more likely to benefit from screening and supplementation. In community dwelling and institutionalized Lebanese adult individuals, for whom there is a decision to supplement with calcium and vitamin D, the panel suggests supplementation with a daily vitamin D equivalent of 600-2000 IU, as compared to doses higher than 2000 IU (conditional recommendation, very low certainty evidence).

CONCLUSION

The Lebanese GRADE-based vitamin D guidelines recommend against population screening and vitamin D supplementation. Subgroups at high risk are identified. The guidelines take into account contextual factors, and allow their adoption or adaptation in countries in the region.

Strategies for preventing bone loss in populations with insufficient calcium and vitamin D intake

Calcium and vitamin D are essential nutrients for maintaining skeletal health, yet deficiencies in these nutrients are particularly widespread in regions such as Asia and Africa. Inadequate intake of these nutrients in these areas has been associated with diminished bone integrity and a rising incidence of osteoporosis. This review examines the underlying mechanisms of bone loss driven by calcium and vitamin D deficiencies, emphasizing their crucial roles in bone metabolism. It also presents strategies to improve nutrient intake, such as fortification of staple foods and supplementation, along with lifestyle modifications including increased physical activity, sun exposure, and dietary education, to prevent bone loss effectively. Special consideration is given to vulnerable populations, including older adults, individuals with limited sun exposure, and those with dietary restrictions, who are at higher risk of deficiency. The review further evaluates public health strategies, including government-initiated fortification and educational programs, as essential measures for tackling widespread nutrient deficiencies. Lastly, it explores future avenues for addressing calcium and vitamin D deficiencies, including the potential role of digital health tools, personalized nutrition, and innovative public health policies to alleviate the global burden of bone-related diseases.

Impact of Education and Gender on Knowledge, Attitudes, and Practices Toward Vitamin D Among the Lebanese Population With Emphasis on Young Adults

Background Vitamin D deficiency is a growing global health concern that affects populations, even in sun-rich regions such as Lebanon. Despite abundant sunlight, limited research has explored the knowledge, attitudes, and practices (KAP) related to vitamin D among young Lebanese adults. Study design This study employed an online quantitative cross-sectional design. Methods A self-administered online questionnaire distributed over six months (from August 2023 to January 2024) collected data on the participants' demographic characteristics, as well as their knowledge, attitudes, and practices related to vitamin D. Results Most participants (75.7%) had sufficient knowledge about vitamin D sources. The internet and physicians emerged as the dominant sources, cited by 175 participants, which represented 17.6% of the total responses related to vitamin D knowledge sources. Sunlight was perceived by the participants as the most crucial source. Additionally, 244 (33.7%) of the participants acknowledged the role of vitamin D in preventing osteoporosis, whereas 144 (20.4%) believed that it was aiding in calcium absorption. Significant levels of knowledge (defined as scores of ≥21 out of 40) and positive attitudes (defined as ≥4 correct answers out of six) were evident among more than 255 (75%) of the participants. However, over half expressed concerns about their vitamin D levels. Most were willing to take supplements (330, 92.7%) and undergo testing (326, 92.1%). Conclusion Although young Lebanese adults demonstrated good overall knowledge and positive attitudes toward vitamin D deficiency, implementing comprehensive awareness campaigns and health programs that emphasize behavior change is crucial for combating deficiency. These initiatives should focus on promoting tangible changes in practices, such as safe sun exposure, the consumption of vitamin D-rich foods, and adherence to testing and supplementation when necessary.

The role of nutritional vitamin D in chronic kidney disease-mineral and bone disorder in children and adults with chronic kidney disease, on dialysis, and after kidney transplantation-a European consensus statement

Vitamin D deficiency is common in patients with chronic kidney disease (CKD) and associates with poor outcomes. Current clinical practice guidelines recommend supplementation with nutritional vitamin D as for the general population. However, recent large-scale clinical trials in the general population failed to demonstrate a benefit of vitamin D supplementation on skeletal or non-skeletal outcomes, fueling a debate on the rationale for screening for and correcting vitamin D deficiency, both in non-CKD and CKD populations. In a collaboration between the European Renal Osteodystrophy initiative of the European Renal Association (ERA) and the European Society for Paediatric Nephrology (ESPN), an expert panel performed an extensive literature review and formulated clinical practice points on vitamin D supplementation in children and adults with CKD and after kidney transplantation. These were reviewed by a Delphi panel of members from relevant working groups of the ERA and ESPN. Key clinical practice points include recommendations to monitor for, and correct, vitamin D deficiency in children and adults with CKD and after kidney transplantation, targeting 25-hydroxyvitamin D levels >75 nmol/l (>30 ng/ml). Although vitamin D supplementation appears well-tolerated and safe, it is recommended to avoid mega-doses (≥100 000 IU) and very high levels of 25 hydroxyvitamin D (>150-200 nmol/l, or 60-80 ng/ml) to reduce the risk of toxicity. Future clinical trials should investigate the benefit of vitamin D supplementation on patient-relevant outcomes in the setting of vitamin D deficiency across different stages of CKD.

Utility of the Fragility Score (FS) Determined Through Radiofrequency Ecographic Multi-Spectrometry (REMS) in the Follow-Up of Patients with Axial Spondyloarthritis (AxSpA)

Objectives: Bone mineral density (BMD) variation under vitamin D supplementation, determined using dual-energy X-ray absorptiometry (DXA), is the gold standard and the main tool used in most studies in this domain. However, the scientific literature is lacking with regard to the usefulness of REMS in BMD follow-up, especially the importance of the fragility score (FS). The main objective of this study was to determine whether FS follow-up is relevant in a group of patients with axial spondyloarthritis and whether REMS could have clinical applicability. Methods: Patients with a certain diagnosis of axial spondyloarthritis (AxSpA) were recruited from two medical healthcare centers and were scanned using Radiofrequency Echographic Multi-Spectrometry in order to obtain their fragility score (FS), an objective measurement of bone quality. The main group was randomized into a vitamin D supplementation branch and a non-supplementation branch and followed up every 6 months for 18 months in total. Comparisons between the branches were made using MiniTab v.20 statistical software. Results: Lower FS values were obtained in patients who initially had high scores, suggesting a positive impact of vitamin D on bone quality (p = 0.008). Muscle strength was evaluated through a visual analogue scale (VAS), with improvements being seen in the supplementation branch (p < 0.005). Furthermore, although some patients had experienced falls in previous years, during the study period, no new events were recorded in either group. Conclusions: The FS is a reliable tool for evaluating bone architecture and is useful in everyday practice for the management of patients taking vitamin D supplements.

Nutrient Intakes in Vegans, Lacto-Ovo-Vegetarians, Orthodox Fasters, and Omnivores in Russia: A Cross-Sectional Study

In Eastern Europe, the number of vegetarians is growing, and the number of people adhering to Christian Lents is traditionally high. However, data on the nutritional value of plant-based diets in this part of the world are limited. The aim of this study was to compare the nutritional intakes of three groups with different plant-based patterns with that of omnivores in Russia, Moscow region. The nutrient intakes of 46 vegans, 49 lacto-ovo-vegetarians, 42 people who adhered to Orthodox Great Lent, and 48 omnivores were assessed. The food frequency questionnaire method was used for data collection and analysis. The differences in absolute and calorie adjusted nutrient intakes between the groups were analysed. Additionally, a pairwise comparison of the general plant-based group (combined of the vegan, lacto-ovo-vegetarian, and Great Lent samples) and the omnivorous groups was conducted. Vegan diet was the most favourable in micronutrient composition. The intake of many micronutrients increased when switching to a more plant-based diet from a more animal-based one. The opposite association was observed only for selenium and vitamins D and B12. Fasting people consumed more iodine and n-3 polyunsaturated fatty acids; however, after the calorie content was standardized, the omnivores caught up with them. The omnivores had the largest list of dietary inadequacies: they significantly more often than all other groups had inadequate intake of cholesterol (excessive), fibre, potassium, magnesium, iron, and vitamins B1, B6, B9, and E (insufficient). Inadequate intake of polyunsaturated fatty acids, calcium, iodine, chromium, molybdenum, and zinc; or vitamins B2, PP, H, B12, and D was observed rather often in all the studied groups. Although, the vegan diet was richer in most micronutrients, plant products often contain substances that reduce the bioavailability of various nutrients, which can partially affect their status in the body, and, thus, may increase the need in them in vegetarians and fasters.

Association between serum 25-hydroxyvitamin D concentrations and urinary vitamin D metabolite concentrations measured by the NLucVDR assay

It is well known that vitamin D is essential for human health; however, many people suffer from vitamin D deficiency or insufficiency worldwide, including in Japan. Serum 25-hydroxyvitamin D (25(OH)D) concentrations are typically measured to evaluate vitamin D status. In a previous study, we demonstrated that the concentrations of vitamin D metabolites in urine, measured using the NLucVDR assay system composed of a split-type nanoluciferase and the ligand-binding domain (LBD) of the human vitamin D receptor, correlated with serum 25(OH)D concentrations measured using liquid chromatography-mass spectrometry (LC-MS) or electrochemiluminescence immunoassays (ECLIAs). However, the number of participants was limited to 23. In the present study, we investigated the relationship between urinary vitamin D metabolite concentrations measured using the NLucVDR assay and serum 25(OH)D concentrations measured using ECLIA in 292 healthy individuals aged 20-69 years. We observed a significant positive correlation between 25(OH)D concentrations and urinary vitamin D metabolite concentrations (r = 0.400, p < 0.001). Furthermore, in a multiple regression model with serum 25(OH)D concentrations as the dependent variable and urinary vitamin D metabolite concentrations, sex, age, body mass index (BMI), and vitamin D intake as independent variables, urinary vitamin D metabolite concentrations showed a significant positive association with serum 25(OH)D concentrations regardless of sex, age, BMI, and vitamin D intake. Additionally, receiver operating characteristic (ROC) curve analysis was performed to evaluate whether this multiple regression model could predict vitamin D deficiency. The area under the curve (AUC) was 0.743 and 0.708 for women and men with vitamin D deficiency (serum 25(OH)D < 20 ng/mL), respectively. Our results suggest that urinary vitamin D metabolite concentrations, measured by the NLucVDR assay, may be useful for the noninvasive predictive tool of vitamin D deficiency.

Accelerated bone loss in late reproductive-aged and perimenopausal women with vitamin D insufficiency

INTRODUCTION

The association between serum vitamin D levels and bone mineral density (BMD) varies by race and gender. This study aimed to evaluate this relationship between serum vitamin D levels and BMD, and changes of BMD over time in Korean women.

MATERIALS AND METHODS

We analyzed data from 586 generally healthy Korean women aged 29-79 who underwent health check-ups at Seoul National University Gangnam Center between 2010 and 2011 (baseline measurement) and 2015-2016 (follow-up). Dual energy X-ray absorptiometry (DEXA) and serum 25-hydroxyvitamin D (25OH-D) level measurements were conducted. We assessed the association between serum 25OH-D levels and BMD, as well as changes in BMD over time.

RESULTS

The mean age of participants was 51.3 ± 7.9 years, with a mean follow-up interval of 4.6 ± 0.7 years, and mean serum 25OH-D level of 20.6 ± 8.5 ng/ml. Baseline serum 25OH-D levels did not correlate with BMD values at the lumbar spine, femoral neck, or total femur, nor with changes in BMD over time. A significant negative association was found between perimenopausal status and BMD changes at all sites, and between premenopausal status and lumbar bone mass, compared to postmenopausal status in the 25OH-D < 20 ng/ml group. This association was not observed in women with higher serum 25OH-D levels.

CONCLUSIONS

Serum 25OH-D levels did not correlate with BMD levels or changes in BMD overall. However, in late reproductive-aged and perimenopausal women with serum 25OH-D insufficiency, there was a significant association with accelerated bone loss.

Knowledge and Predictors of Vitamin D Awareness Among Greek Women: A Cross-Sectional Study

BACKGROUND

Vitamin D plays a crucial role in bone health, calcium absorption, and immune function, yet significant misconceptions and knowledge gaps persist. This study aimed to assess knowledge regarding vitamin D among Greek women and identify factors associated with vitamin D knowledge.

METHODS

A cross-sectional study was conducted among 761 Greek women (mean age: 41.2 ± 7.7 years) using an online self-administered questionnaire designed in Google Forms. Participants were recruited via social media platforms to ensure a geographically diverse sample.

RESULTS

Overall, 57.4% of participants demonstrated knowledge of vitamin D's functions, primarily linking it to bone health (34.4%) and immune function (26.8%). The multiple regression model identified significant predictors of knowledge of vitamin D's functions, including age (OR = 1.041, 95% CI: 1.019-1.062, p < 0.001), weight (OR = 0.964, 95% CI: 0.938-0.992, p = 0.010), and frequent vitamin D testing (>2 times: OR = 2.280, 95% CI: 1.392-3.736, p = 0.001; once-twice: OR = 1.776, 95% CI: 1.111-2.829, p = 0.016). Furthermore, age (OR = 1.054, 95% CI: 1.027-1.081, p < 0.001), weight (OR = 0.987, 95% CI: 0.975-0.999, p = 0.028), higher city population (>50,000 citizens: OR = 1.598, 95% CI: 1.021-2.502, p = 0.040), frequent vitamin D testing (>2 times: OR = 2.616, 95% CI: 1.529-4.447, p < 0.003; one-two times: OR = 1.773, 95% CI: 1.052-2.989, p = 0.032), and children's supplementation (OR = 1.414, 95% CI: 1.007-1.987, p = 0.046) were significant predictors of knowledge regarding diseases preventable by vitamin D.

CONCLUSIONS

Greek women demonstrated moderate awareness of vitamin D's functions, but significant knowledge gaps persist, particularly regarding its role in calcium absorption and dietary sources. Age, frequent vitamin D testing, and urban residence were significant predictors of knowledge. Targeted public health campaigns are essential to address misconceptions and improve vitamin D awareness and practices.

Sodium Glycerophosphate vs. Inorganic Phosphate Use in Parenteral Nutrition for Preterm Infants: A Retrospective Study

BACKGROUND/OBJECTIVES

Sodium glycerophosphate improves the adverse side effects of parenteral nutrition. Therefore, this study aimed to evaluate different outcomes, including metabolic bone disease and electrolyte imbalance, associated with the use of sodium glycerophosphate or inorganic phosphate in parenteral nutrition for preterm neonates.

METHODS

This retrospective cohort study enrolled 402 newborns admitted to the neonatal intensive care unit of one medical center between January 2019 and September 2021. Of them, 205 received sodium glycerophosphate as parenteral nutrition, while the other 197 received inorganic phosphate. Baseline characteristics and growth parameters, including body weight, body length, and head circumference in the first year of life; calcium and phosphate content of parenteral nutrition in the first 4 weeks; calcium, phosphorus, alkaline phosphatase (ALP), and creatinine levels; and morbidities were compared.

RESULTS

During the first 4 weeks, the calcium and phosphate contents of parenteral nutrition were significantly higher in the sodium glycerophosphate vs. inorganic phosphate group. Growth parameters did not differ significantly between groups. The sodium glycerophosphate group showed a higher mean serum phosphate level (4.0 ± 1.2 mg/dL vs. 3.5 ± 1.3 mg/dL, p = 0.001), lower serum ALP level (402.8 ± 202.8 U/L vs. 466.4 ± 228.6 U/L, p = 0.004), lower seizure incidence (4.9% vs. 13.2%, p = 0.003), and higher hypocalcemia incidence (41.5% vs. 31.5%, p = 0.038). However, there were no significant intergroup differences in other common morbidities such as metabolic bone diseases of prematurity, bronchopulmonary dysplasia, electrolyte imbalance, hypoglycemia, retinopathy of prematurity, or intraventricular hemorrhage.

CONCLUSIONS

Compared to inorganic phosphate, sodium glycerophosphate is associated with higher serum phosphate levels, lower ALP levels, and reduced seizure incidence in premature infants. However, as the study was retrospective and single-center, further randomized controlled trials are needed to confirm these findings.

Enhancing the Design of Nutrient Clinical Trials for Disease Prevention-A Focus on Vitamin D: A Systematic Review

OBJECTIVES

This systematic review (SR) highlights principles for nutrient clinical trials and explore the diverse physiological functions of vitamin D beyond its traditional role in the musculoskeletal system related to clinical study designs.

BACKGROUND

Thousands of published research articles have investigated the benefits of vitamin D (a nutrient example taken in this SR) beyond the musculoskeletal system, including the immune, pulmonary, and cardiovascular systems; pregnancy; autoimmune disorders; and cancer. They illustrated vitamin D's molecular mechanisms, interactions, and genomic and nongenomic actions.

METHODS

This SR was designed to identify shortcomings in clinical study designs, statistical methods, and data interpretation that led to inconsistent findings in vitamin D-related publications. SR also highlights examples and insights into avoiding study design errors in future clinical studies, including randomized controlled clinical trials (RCTs). The SR adheres to the latest PRISMA statement, guidelines, and the PICOS process.

RESULTS

Inappropriate or flawed study designs were frequent in clinical trials. Major failures discussed here include too short clinical study duration, inadequate or infrequent doses, insufficient statistical power, failure to measure baseline and achieved levels, and recruiting vitamin D-sufficient participants. These design errors have led to misleading interpretations. Thus, conclusions from such studies should not be generalized or used in guidelines, recommendations, or policymaking.

CONCLUSION

Adequately powered epidemiological studies and RCTs with sufficient vitamin D and duration in individuals with vitamin D deficiency reported favorable clinical outcomes, enriching the literature, enabling to understand its physiology and mechanisms. Proper study designs with rigorous methodologies and cautious interpretation of outcomes are crucial in advancing the nutrient field. The principles discussed apply not only to vitamin D, but also other micro-nutrients and nutraceutical research. Adhering to them enhances the credibility and reliability of clinical trials, SRs, and meta-analysis outcomes. The study emphasizes the importance of focused, hypothesis-driven, well-designed, statistically powered RCTs to explore the diverse benefits of nutrients, conducted in index nutrient deficient participants, and avoidance of study design errors. Findings from such studies should be incorporated into clinical practice, policymaking, and public health guidelines, improving the health of the nation and reducing healthcare costs.

Knowledge, attitude and practices regarding vitamin D among adults in Ghana: a cross-sectional study

BACKGROUND

Vitamin D deficiency is a major public health concern, affecting approximately half of the world's population, partly due to limited public knowledge about vitamin D sources. However, there is lack of data on awareness, knowledge, attitudes, and practices regarding vitamin D in high-risk countries like Ghana. We investigated vitamin D awareness, knowledge and its associated factors in the Ghanaian population.

METHODS

This cross-sectional study involved 515 adults from Jaman South Municipal between January and June 2024. Questionnaires were used to obtain data on demographics, clinical characteristics, awareness and knowledge, attitude and practices towards vitamin D. Binary logistic regression analysis was used to determine the independent predictors of knowledge and practices regarding vitamin D. SPSS (version 26.0) was used for all statistical analysis. P < 0.05 was considered statistically significant.

RESULTS

Awareness, knowledge, attitude and practice level towards vitamin D was 61%, 56.9%, 63.7% and 73.2% respectively. Aged between 18-24 yrs [(aOR = 4.106, 95% CI: (1.523-11.072); p = 0.005)], being single [(aOR = 0.243, 95% CI: (0.065-0.904); p = 0.035)], having basic [(aOR = 0.216, 95% CI: (0.068-0.685); p = 0.009)] or secondary education [(aOR = 0.151, 95% CI: (0.073-0.313); p < 0.001)] and speaking English [(aOR = 3.553, 95% CI: (1.519-8.313); p = 0.003)] were the independent predictors of adequate knowledge on vitamin D. Having basic [(aOR = 9.058, 95% CI: (2.449-33.509); p = 0.001)] or secondary education [(aOR = 5.252, 95% CI: (2.508-10.996); p < 0.001)] increased the likelihood of good practices.

CONCLUSION

There is high awareness but reduced knowledge on Vitamin D among the general public in Jaman South. Age, education, employment status, language were the factors associated with knowledge and practice regarding vitamin D. There is need for extensive health educational campaigns to the public to boost the knowledge levels on the importance of Vitamin D.

Vitamin D Deficiency and Associated Factors in Children: A Multicenter Study of 21,811 Samples in Southern China

Objective

To investigate the prevalence of vitamin D deficiency (VDD) in children/adolescents in extreme southern China.

Methods

This multicenter, cross-sectional study included 21,811 children aged 0-18 years from 18 districts in Hainan Province, using a multistage stratified random sampling method from January 2021 to March 2022.

Results

Serum 25(OH)D levels decreased with age (p trend <0.001). VDD prevalence increased significantly from 3.7% (95% CI: 3.2, 4.3) in children aged 0-3 years to 43.5% (95% CI: 42.1, 45.0) in those aged 13-18 years. Girls and urban residents showed higher deficiency rates. Adolescents (13-18 years) had the highest prevalence of VDD (43.5%), while toddlers (0-3 years) had the lowest (3.7%). Factors influencing vitamin D status included gender, urban residency, and breastfeeding duration. Seasonal variations showed higher deficiency rates in autumn, particularly among preschoolers. Regional differences were noted, with the highest deficiency in semiarid and subhumid zones for various age groups.

Conclusion

A significant increase in VDD with age, particularly among adolescents, urban girls, and during autumn, emphasizing the need for targeted strategies.

The Relationship Between Novel Inflammatory Markers and Serum 25-Hydroxyvitamin D Among US Adults

BACKGROUND

Vitamin D is the focus of extensive medical research globally. Recent studies have investigated the correlation between serum 25-hydroxyvitamin D (25(OH)D) and common inflammatory markers. However, few studies have incorporated novel inflammatory markers such as the platelet-to-lymphocyte ratio (PLR), platelet-to-high density lipoprotein cholesterol ratio (PHR), systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory response (SIRI), and neutrophil-to-high-density lipoprotein cholesterol ratio (NHR). This study investigated these correlations among adults in the USA.

METHODS

We ultimately included a total of 5308 participants from the National Health and Nutrition Examination Survey (NHANES) database spanning 2007 to 2018. A multivariable linear regression model assessed the links between serum 25(OH)D and these novel inflammatory markers, with subgroup analyses for hypertension and diabetes. To further explore the relationship between the two, we applied smooth curve fittings and generalized additive models. Upon detecting nonlinear relationships, we used a recursive algorithm to pinpoint the inflection point.

RESULTS

In our multivariate linear regression model, serum 25(OH)D concentrations were negatively correlated with NHR (β = -0.003, 95% CI: -0.005 to -0.001), NLR (β = -0.002, 95% CI: -0.003 to 0.000), SII (β = -0.579, 95% CI: -0.954 to -0.205), PHR (β = -0.171, 95% CI: -0.249 to -0.093), and PLR (β = -0.096, 95% CI: -0.051 to -0.040) among adults in the USA. Nevertheless, no significant association was found with SIRI (β = -0.001, 95% CI: -0.002 to 0.000). Subgroup analysis by hypertension and diabetes showed that in the hypertensive group, serum 25(OH)D was significantly and negatively associated with NHR, NLR, SII, SIRI, PHR, and PLR. However, no correlation was found in the diabetic group between serum 25(OH)D levels and these inflammatory markers.

CONCLUSIONS

Our research confirms that serum 25(OH)D levels are negatively correlated with several novel inflammatory markers among adults in the USA, suggesting potential directions for further research into vitamin D's role in inflammation.

Cross Sectional Study of Vitamin D Levels in Western Rajasthan and Meta-Analysis for Estimation of Vitamin D Levels

Many studies showed Vitamin D deficiency is highly prevalent in healthy individuals. We planned to study the normal levels of Vitamin D in healthy individuals and make recommendation for defining deficiency of 25(OH)D in Indian population. Normal healthy subjects 18 to 60 years of age were included. Estimation of serum calcium, serum phosphorus, iPTH and bone alkaline phosphatase levels with vitamin D (25(OH)D) levels were done to study the normal 25(OH)D levels and make recommendation for defining deficiency of 25(OH)D in Indian population. Meta-analysis was performed of studies which estimated the mean vitamin D levels in healthy individuals. There was significant positive correlation of serum 25(OH)D levels with calcium levels (r = 0.148; p-value = 0.003). The normal mean values of 25(OH)D levels in total population was 13.5 ± 7.83 ng/ml, iPTH was 59.8 ± 28.84 pg/ml, bone ALP was 14.6 ± 6.66 microg/ml. The normal upper bound of 25(OH)D in 97.5% of total population in our study is less than 33.19 ng/ml. The normal upper bound of iPTH and bone ALP in 97.5% of total population in our study was less than 123.97 pg/ml and 32.19 microg/ml, respectively. Pooled analysis of 33 studies revealed overall mean 25(OH)D levels in total population to be 13.95 ng/ml (95%CI - 12.37-15.54). The concept of initializing treatment based on serum Vitamin D levels using the RDA (20ng/ml) and EAR (16ng/ml) values as "cutoff-points" is not recommended as per Institute of Medicine Committee on Dietary Reference Intakes, Washington DC. Vitamin D levels less than 12.5ng/ml in a symptomatic individual should be the sole criteria for treatment rather than Vitamin D levels alone. Trial Registration: CTRI/2018/02/011820; CTRI/2018/02/011913.

Comparative Effects of Vitamin D Supplementation on Oxidative Stress in Relapsing-Remitting Multiple Sclerosis

Studies suggest that vitamin D (VitD) may reduce oxidative stress (OS) in multiple sclerosis (MS) patients. This study aimed to compare the effects of various VitD doses on OS in relapsing-remitting MS (RRMS). A 6-month supplementation was introduced using two doses of VitD: 2000 IU/day in the high-dose group (HD, n = 23) and 15,960 IU/month in the low-dose group (LD, n = 29). Significant differences in body weight, height, and age were found between groups. A significant increase in the level of VitD (25(OH)D) was noted in both groups (p < 0.01). A significant increase was observed in the levels of LF and MDA (p < 0.01) and a significant decrease in the concentrations of PSH (p < 0.01), CuZnSOD (p = 0.02), and TOS (p < 0.01). A significant positive correlation was observed between serum VitD and SOD (R = 0.38, p < 0.01) and MnSOD (R = 0.31, p < 0.05), as well as a significant negative correlation between serum VitD and MDA (R = -0.31, p = 0.05) at the beginning of the study. At the end of the study, a significant positive correlation was observed between serum VitD and SOD (R = 0.34, p < 0.05) and CuZnSOD (R = 0.51, p < 0.01). In RRMS patients, the VitD doses are probably insufficient to induce a beneficial effect on the pro- and antioxidant balance.

Analysis of Usual Consumption of Vitamin D Among Adult Individuals in Italy

Background: The condition of vitamin D (25OHD) deficiency represents an important public health problem. In Europe, hypovitaminosis is common not only in the elderly population but also between 50 and 70 years, both in males and females. Data regarding vitamin D intake in the Italian population are very limited. In a recent paper, reporting data collected by a specific Frequency Food Questionnaire (FFQ), we observed in a small group of healthy subjects that the dietary consumption of vitamin D, both in females and males, was far below the average. Methods: With the aim of expanding our preliminary data, we conducted a survey on a large cohort of subjects from different areas of Northern, Central, and Southern Italy. The FFQ contained 11 different questions regarding the amount and type of intake of foods containing ergocalciferol and cholecalciferol. It was submitted to 870 subjects, 627 females and 243 males, with an age range from 40 to 80 years; 31.6% of the studied population was apparently in good health, while 68.4% were affected by different pathologies. Results: The present data confirm previous observations: the global quantity of vitamin D intake in 14 days was 70.8 μg (±1.8 SE, ±54.4 SD) in females and 87.5 μg (±1.9 SE, ±57.1 SD) in males; the mean daily intake of vitamin D in females and males was 5.05 μg (±0.5 SE, ±3.8 SD) and 6.25 μg (±0.21 SE, ±4.1 SD), respectively. In healthy subjects, a gradual decrease was observed in the overall intake of vitamin D in both females and males according to an increase in age bracket, ranging from 74.5 μg and 103.8 μg in the 40-50 age group to 54.5 μg and 87.8 μg in the 71-80 age group, respectively. Conclusions: In conclusion, the present data, collected in a large Italian cohort, underscore that the daily intake of vitamin D is far below the recommended daily average, thereby contributing to the development of potential hypovitaminosis.

Association of vitamin D and bisphenol A levels with cardiovascular risk in an elderly Italian population: results from the InCHIANTI study

Few studies have evaluated the association between circulating levels of 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), and the endocrine disruptor bisphenol A (BPA), with risk of cardiovascular (CV) disease in elderly individuals. This was a cross-sectional study in a subgroup of elderly people from the InCHIANTI Biobank in Italy. We examined the association between circulating serum vitamin D metabolites, 1,25(OH)2D, 25(OH)D, and the endocrine disrupting agent BPA, with an arbitrary CV risk score and the European Society of Cardiology-based 10-year CV risk (SCORE2/SCORE2-OP) using univariate and multiple regression. In 299 individuals, blood samples were tested for serum values of 25(OH)D, 1,25(OH)2D and urinary BPA levels. One hundred eighty individuals (60.2%) were deficient (< 20 ng/ml) in 25(OH)D. Levels of 25(OH)D and 1,25(OH)2D were negatively correlated with CV risk score (p < 0.0001 for both) as well as SCORE2/SCORE2-OP (p < 0.0001 for both) while BPA levels were positively correlated with both CV risk scores (p < 0.0001 for both). In a logistic regression model, male gender (odds ratio; OR: 2.1, 95% CI:1.1-3.8, p = 0.022), obesity (OR:2.8, 95% CI:1.2-6.5, p = 0.016) and BPA levels ≥ 110 ng/dl (OR:20.9, 95% CI:9.4-46.8, p < 0.0001) were associated with deficient levels of 25(OH)D. 1,25(OH)2D levels < 41 ng/dl and 25(OH)D levels < 20 ng/ml were associated with CV risk score ≥ 3 (OR: 4.16, 95% CI: 2.32-7.4, p < 0.0001 and OR: 1.86, 95% CI: 1.02-3.39, p = 0.044) respectively and 1,25(OH)2D levels < 41 ng/dl were associated with SCORE2/SCORE2-OP of ≥ 20% (OR:2.98, 95% CI: 1.7-5.2, p = 0.0001). In this cross-sectional analysis, BPA exposure was associated with significantly reduced levels of vitamin D that in turn were significantly associated with increased CV risk.

Prevalence and Associated Risk Factors for Hypovitaminosis D in Patients Scheduled for Primary Total Knee Arthroplasty in Germany

OBJECTIVE

Several studies have reported a high prevalence of hypovitaminosis D in orthopedic patients. The purpose of this prospective observational study was to report on the prevalence of hypovitaminosis D in patients scheduled for elective primary total knee arthroplasty (TKA) and its associated risk factors.

METHODS

In this monocentric cohort study, 25(OH) vitamin D serum levels were measured in 687 consecutive patients undergoing primary total knee arthroplasty (TKA) over a period of twelve months. Vitamin D levels were classified into deficiency (<20 ng/mL), insufficiency (20-29 ng/mL), and sufficiency (≥30 ng/mL). The study assessed the association of vitamin D levels with demographic and clinical factors, including age, sex, BMI, smoking status, and season of measurement. Statistical analyses included chi-square tests, correlation analyses, and multiple linear regression to identify significant predictors of vitamin D levels.

RESULTS

The cohort had a mean age of 67.70 ± 8.95 years and a mean BMI of 31.00 ± 5.71 kg/m2. Collectively, 33.9% of patients were vitamin D deficient, a further 32.9% were insufficient, and only 33.2% were sufficient. Vitamin D levels varied significantly with the season and were associated with obesity and smoking. Specifically, there was a small significant inverse correlation between BMI and vitamin D levels (r = -0.17, p < 0.01). Furthermore, regular nicotine abuse was linked to lower vitamin D levels (r = 0.14, p < 0.01). Multiple linear regression analysis reveals that age, BMI, nicotine abuse, and season were small significant predictors of preoperative vitamin D levels (R2 = 0.15, adjusted R2 = 0.12). A total of 121 (17.61%) patients reported routine vitamin D intake prior to surgery. Supplementing patients had a significantly higher mean serum vitamin D level and a significant reduction in the mean length of in-hospital stay (p < 0.01).

CONCLUSIONS

The prevalence of vitamin D insufficiency and deficiency in patients undergoing elective primary TKA is alarmingly high. In ongoing efforts to optimize the efficacy and outcome of the TKA procedure, orthopedic surgeons should be advised to strongly implement the role of perioperative vitamin D levels in their routine practice.

The Co-Existence of Hypovitaminosis D and Diabetes Mellitus Triples the Incidence of Severe Coronary Artery Disease in Women

Background and Aims: Hypovitaminosis D is involved in the development and progression of atherosclerosis, and it is more prevalent in women. The differential impact of hypovitaminosis D on the severity of coronary artery disease (CAD) between genders remains poorly understood. This study aims to address this literature gap. Methods: A total of 1484 consecutive patients with acute myocardial infarction (AMI) were enrolled in the study. Hypovitaminosis D was defined as vitamin D ≤ 20 ng/mL. CAD was defined as the presence of at least one coronary vessel stenosis > 50%, while severe CAD was defined as left main disease and/or three-vessel disease > 50%. Results: The mean age of the cohort was 66.3 (11.5) years, with a predominance of the male gender (71.8%). Vitamin D values were significantly lower in women than in men (15.7 [8.4-25.4] ng/mL vs. 17.9 [11-24.3] ng/mL, p = 0.01). A higher prevalence of severe CAD was observed in female patients with hypovitaminosis D compared to those without (33% vs. 19%, p < 0.01). This finding was not observed in men. Among women, hypovitaminosis D significantly increased the risk of severe CAD (OR: 1.85, p = 0.01), together with diabetes mellitus (DM) and older age, adjusted for GFR < 60 mL/min/1.73 m2, cholesterol and body mass index. Furthermore, women with both hypovitaminosis D and DM had more than three times the risk of severe CAD compared with women who lacked both (OR: 3.56, p = 0.02). Conclusions: In women, hypovitaminosis D increases the risk of severe CAD, and the co-existence of hypovitaminosis D and DM triples the incidence of severe CAD.

Sex-related differences in vitamin D testing in the Veneto Region, Italy: a retrospective analysis from 2005 to 2016

A retrospective analysis was performed to evaluate the frequency of vitamin D blood testing in individuals from the Padua province, Veneto, Italy from 2005 to 2016. A significant increase in the frequency of vitamin D blood tests, particularly in females was observed and in individuals with severe vitamin D deficiency (Class I).

PURPOSE

Vitamin D deficiency has been linked to negative health outcomes that extend beyond bone-related conditions. The frequency of vitamin D blood testing in residents from the Padua province, (Veneto, Italy) from 2005 to 2016 was evaluated.

METHODS

Data were retrospectively retrieved from blood test databases (Laboratory Medicine Unit, Padua University Hospital) and information on number of vitamin D blood tests performed on residents from 2005 to 2016 was collected. Data were stratified by sex and ten birth cohorts from 1901 to 2016. Blood tests were classified into five vitamin D classes: I < 50 nmol/L, II 50-74.9 nmol/L, III 75-149 nmol/L, IV 150-250 nmol/L, and V > 250-1000 nmol/L. Blood test trends were analyzed as blood test rate and vitamin D class rate/resident population. Population analysis was analyzed by incidence rates and stratified by vitamin D class.

RESULTS

293,013 vitamin D blood tests were conducted between 2005 and 2016 across 10 birth cohorts. Females accounted for 75% of tests and fewer were conducted in the youngest and oldest birth cohorts. Sex differences in vitamin D blood test frequency were observed; adjusted rates ranging from 1.7 to 35.6% for males and 8 to 81% for females from 2005 to 2016. Crude incidence rates (per 1000 from 2005 to 2016) varied from 1.5 to 10.8‰ for males and 7 to 19.4‰ for females. Crude blood test rates for vitamin D deficiency (Class I) increased from 1.1 to 9.9‰ in 2016 for males and 5 to 17.3‰ for females. Crude incidence rates (from 2005 to 2016) for Class I were 9.7-57.1‰ in males and 43.6-92.4‰ in females.

CONCLUSIONS

These findings highlight sex-related differences in vitamin D testing, providing valuable insight for healthcare planning.

Vitamin D Levels and Temporomandibular Disorders: A Bidirectional Two-Sample Mendelian Randomization Analysis

OBJECTIVE

Growing researches explore vitamin D's role in temporomandibular disorders (TMDs), but the link between vitamin D and TMDs remains debated. To clarify the causal relationship, we conducted a Mendelian randomization (MR) analysis using data from genome-wide association studies (GWAS).

SUBJECTS AND METHODS

The GWAS dataset of vitamin D (GWAS ID: ukb-d-30890_irnt; sample size: 329247) was obtained from the IEU Open GWAS project. And that of TMDs (GWAS ID: finn-b-TEMPORO; sample size: 134280), initiated on August 25th, 2017 and publicly released on December 18th, 2023, was extracted from the FinnGen dataset, whose cases were diagnosed based on the revised International Classification of Diseases, 10th Edition (ICD-10) code K07.6. Both datasets were obtained from the European population. According to three assumptions of MR analysis, a bi-directional MR analysis was performed to measure the causal relationship, with Inverse variance weighted (IVW) as the primary method and MR Egger and Weighted median as supplement. Moreover, diverse sensitivity analyses, including Cochran's Q test, MR Egger intercept, Mendelian randomized polymorphism RESidual Sum and Outlier (MR-PRESSO), and leave-one-out analysis, were used to verify the stability of the findings.

RESULTS

The MR analysis supported causal effects of vitamin D levels on TMDs risks within the European population using IVW method [odds ratio = 1.316; 95% confidence interval = 1.086 to 1.595; P = 0.005], supported by MR Egger and Weighted median. While there was no indication that TMDs have a direct impact on vitamin D levels [β: -0.00738, standard error = 0.00665; P = 0.568].

CONCLUSION

The study revealed that within the European population higher levels of vitamin D led to higher risks of developing temporomandibular disorders, but found no obvious evidence that TMDs are causally associated with vitamin D. The conclusion should be cautiously interpreted, given the selection bias of TMDs patients sample.

Assessment of the quality and content of clinical practice guidelines for vitamin D and for immigrants using the AGREE II instrument: global systematic review

BACKGROUND

Worldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants. Recommendations in current clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants, and there are concerns regarding the quality of guidance in these CPGs.

OBJECTIVES

This study aimed to identify and evaluate the quality of published CPGs addressing vitD and immigrants' health using the Appraisal of Guidelines for Research and Evaluation-II (AGREE II) tool and clarify the recommendations pertaining to vitD and immigrant populations in these CPGs.

METHODS

We performed a systematic search to identify the most recent CPGs across various databases (Ovid MEDLINE ALL, Embase and Turning Research Into Practice), guideline repositories and grey literature. Two reviewers independently conducted study selection and data abstraction and evaluated the quality of the included guidelines using the AGREE II tool.

RESULTS

We identified 25 relevant CPGs; 21 focused on vitD and 4 covered immigrants' health. Around one-quarter of the included CPGs were high quality (≥60% in at least four of the six domains, including 'rigour of development'). The highest mean scores among the six AGREE II domains were for 'clarity of presentation' and 'scope and purpose'. About 4.8% (1/21) of the CPGs on vitD had immigrant-related recommendations. VitD recommendations were emphasised in one out of the four immigrant health CPGs (25%). CPGs covering immigrants' health and vitD were inadequately systematically appraised. Moreover, recommendations regarding vitD were insufficient to address the growing epidemic of vitD deficiency among immigrant populations.

CONCLUSION

The insufficient recommendations for vitD fail to address the rising vitD deficiency among immigrants, highlighting a critical gap in healthcare provisions. Urgent national and international efforts are needed to develop comprehensive CPGs, bridging research, policy and practice disparities. Future guidelines must prioritise routine vitD screening, supplementation protocols for vulnerable immigrant groups, and culturally appropriate interventions to improve health outcomes for immigrants globally.

PROSPERO REGISTRATION NUMBER

CRD42021240562.

Efficacy of vitamin D supplementation on depressive symptoms in older patients: a meta-analysis of randomized controlled trials

Background

The relationship between vitamin D and depression has garnered significant attention in recent years. However, the efficacy of vitamin D in ameliorating depression among specific subgroups of older patients remains controversial. This study aimed to assess the impact of vitamin D supplementation on depressive symptoms and the prevalence of depression in older adults. Additionally, the study sought to examine potential moderating factors, including differences among population subgroups and various supplementation strategies.

Methods

A systematic literature search was conducted in the databases PubMed, EMBASE, Web of Science, and the Cochrane Library up to March 2024. The RevMan 5.3 software was utilized to calculate the standardized mean difference (SMD) and to evaluate the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The objective was to determine the efficacy of vitamin D supplementation in alleviating depressive symptoms or treating depression in older adults.

Results

This meta-analysis encompassed eleven studies, comprising a total of 21,561 participants. The findings did not indicate a statistically significant therapeutic benefit of vitamin D supplementation for depression in older patients [SMD: -0.10; 95% CI: (-1.19, 0.00); p = 0.05]. Subgroup analyses revealed that the efficacy of vitamin D intervention in geriatric depression correlated with several factors, including baseline serum 25(OH)D levels, the dosage of the intervention, gender, and the initial presence of depressive symptoms or a diagnosis of depression.

Conclusion

The current evidence is insufficient to conclusively establish the significant efficacy of vitamin D supplementation in alleviating depressive symptoms among older patients. Consequently, additional randomized controlled trials are warranted to further validate the relationship between vitamin D supplementation and depression in the older adults.

Seasonal variation and Vitamin-D status in ostensibly healthy Indian population: An experience from a tertiary care institute

Background

25-hydroxy vitamin-D (25(OH)D) deficiency is prevalent worldwide including India. Earlier some cross-sectional studies have discussed 25(OH)D deficiency and its prevalence. The correlation of 25(OH)D with seasonal variation has been reported rarely in India. To determine the 25(OH)D levels and seasonal changes of 25(OH)D status at a tertiary care hospital in North-western India.

Materials and methods

25(OH)D assessments performed in laboratories between 2018 and 2020 was acquired using hospital records. A total of 11,428 assays of serum 25(OH)D were analyzed in the study. Subjects were divided into three groups based on the International Endocrine Society's recommendation for serum 25(OH)D level. The 25(OH)D deficiency <20 ng/ml, insufficiency 20-29 ng/mL and sufficiency ≥30 ng/mL was defined. The months have been separated into the following seasons to analyze seasonal trends: Summer/monsoon (April-September), and winter/spring (October-March).

Results

The median 25(OH)D was 17.2 ng/mL. We observed the prevalence of 60 %, 24.1 % & 15.9 % of 25(OH)D deficiency, 25(OH)D insufficiency, and sufficiency respectively in the total number of individuals tested. 56 % male and 63 % females were 25(OH)D deficient. Notably, the lowest median 25(OH)D value was found in the 21-30 age group (14.8 ng/mL). A significant difference in 25(OH)D levels between the summer (18.7 ng/mL) and winter (15.8 ng/mL) seasons has been noticed.

Discussion

Current study revealing that 25(OH)D deficiency is common in all age groups and genders, according to our findings. Surprisingly, the lowest levels were reported in young adults. Seasonal variation has an impact on 25(OH)D status, however in all seasons 25(OH)D levels are lower than reference intervals. These findings suggest that the criteria for determining the state of 25(OH)D insufficiency and deficiency in the Indian population should be reconsidered.

Prevalence of Vitamin D Deficiency in Orthopedic Trauma Patients: A Cross-Sectional Survey From a Tertiary Care Trauma Center

Background Vitamin D deficiency is prevalent globally, with potential consequences for bone health and trauma outcomes. This study aimed to assess the prevalence of vitamin D deficiency in orthopedic trauma patients and investigate its correlation with various demographic and injury-related factors. Methodology A cross-sectional investigation was undertaken at a tertiary care center. An evaluation of serum 25-hydroxyvitamin D3 levels was conducted on 124 individuals, aged 20 to 70 years, who were hospitalized with orthopedic injuries. Demographic information, the injury method, the bone involvement pattern, and socioeconomic status were documented. Statistical analysis was employed to evaluate the correlations between vitamin levels D and these variables. Results The overall prevalence of vitamin D deficiency was 54 (43.6%) cases, with nine (7.3%) cases exhibiting severe deficiency and 45 (36.3%) cases exhibiting moderate deficiency. Higher rates of deficiency were associated with lower socioeconomic status (p = 0.044) and low-velocity trauma (p = 0.037). No significant association was found with age, sex, or residence. Interestingly, patients with multiple fractures were more prone to deficiency compared to those with single fractures. Conclusions This survey revealed a significant vitamin D deficiency among orthopedic trauma patients. Factors such as socioeconomic status and the nature of the injury emerged as significant risk factors. While conducting routine vitamin D assessments might pose challenges in developing nations, consistent supplementation could prove advantageous in enhancing fracture healing and overall health outcomes among this demographic. There is a call for future research to delve deeper into the role of vitamin D in trauma management and refine supplementation strategies.

Serum 25(OH)D and vitamin K1 levels in patients with severe motor and intellectual disability: A Japanese single-center experience

PURPOSE

To investigate whether patients with severe motor and intellectual disability (SMID) have nutritional vitamin D and K insufficiencies and clarify the required vitamin supplementation.

METHODS

This prospective observational study enrolled Japanese adults with SMID receiving institutionalized care who underwent blood sampling between February 2020 and February 2022 during annual medical checkups. Serum vitamin K1 and 25-hydroxy vitamin D (25(OH)D) levels were measured to determine their relationship with serum uncarboxylated osteocalcin (ucOC) levels. Vitamin D and K intake was compared among tube-fed and oral-intake patients with SMID and control participants using corresponding serum levels.

RESULTS

The study included 124 patients with SMID (56 men and 68 women; mean age: 53.0 years) and 20 control participants. Serum 25(OH)D levels were significantly higher in the SMID group than in the control group and the oral intake SMID group than in the tube-fed SMID group. In the tube-fed SMID group, vitamin D intake was lower than the daily recommended intake and correlated with serum 25(OH)D levels. Daily vitamin K intake in the tube-fed group was lower than recommended but not correlated with serum vitamin K levels. Serum ucOC levels were significantly higher in the SMID group than in the control group. Tube feeding was significantly and positively correlated with serum 25(OH)D levels. Serum 25(OH)D levels were not correlated with serum vitamin K1 levels.

CONCLUSIONS

The SMID group had higher ucOC levels than the control group, possibly owing to daily vitamin K and D deficiencies. Vitamin D supplementation is recommended to decrease ucOC levels.

Vitamin D Deficiency-A Public Health Issue in Children

BACKGROUND

25-hydroxyvitamin D [25(OH)D] deficiency is a global health concern, particularly in pediatric populations, with implications for musculoskeletal health and overall well-being. This study aimed to evaluate serum 25(OH)D levels in a pediatric population and assess the prevalence of deficiency and insufficiency.

METHODS

A retrospective analysis was conducted on data from 741 pediatric patients (2-17 years old) who visited an urban hospital for children for acute respiratory and gastrointestinal conditions in the span of 2 years. Serum 25(OH)D levels were measured using chemiluminescent microparticle immunoassay. Statistical analyses were performed to assess the prevalence of deficiency and insufficiency, seasonal variations, and correlations with age and daylight exposure.

RESULTS

Of the 739 pediatric patients analyzed, a substantial proportion exhibited insufficient (31.80%) or deficient (36.54%) serum 25(OH)D levels. While younger age groups generally had higher mean 25(OH)D levels, a negative correlation was observed between 25(OH)D levels and age. Sunlight exposure variations did not significantly impact serum 25(OH)D levels. Despite diverse daylight exposure patterns, there were no significant differences between longer and shorter daylight periods.

CONCLUSIONS

This study highlights the high prevalence of 25(OH)D deficiency and insufficiency in the pediatric population, emphasizing the need for public health monitoring and targeted supplementation strategies. Findings underscore the importance of regular consultations with healthcare providers to ensure optimal 25(OH)D levels in children, with potential implications for revising current sufficiency thresholds. Addressing 25(OH)D deficiency is crucial for promoting musculoskeletal health and overall well-being in children.

Vitamin D content and prevalence of vitamin D deficiency in patients with epilepsy: a systematic review and meta-analysis

Introduction

The prevalence of vitamin D deficiency and vitamin D levels in patients with epilepsy (PWE) were systematically evaluated, and the differences between subgroups were analyzed.

Method

We identified all articles investigating the prevalence of vitamin D deficiency in patients with epilepsy from the database established in March 2024 from PubMed, Web of Science, and Embase. We divided them into anti-seizure medication (ASM) interventions and non-ASM interventions according to whether or not someone used ASM.

Results

A total of 68 articles were included. The prevalence of newly diagnosed epilepsy was 50.2% (95% CI: 38.7-61.7%), and the prevalence after ASM intervention was 47.9% (95% CI: 40-55.9%), including 7,070 patients with epilepsy. Subgroup and meta-regression analyses were performed according to the diagnostic criteria, economic development level, region, age, ASM treatment, and other factors. The results showed that the differences were not significant. In addition, the vitamin D content of epilepsy patients (18.719 ng/mL) was lower than that of healthy people (20.295 ng/mL).

Conclusion

The prevalence of vitamin D deficiency in patients with epilepsy is very high. Still, the related factors have little effect on the high prevalence of vitamin D in epilepsy, and ASM intervention can reduce the vitamin D content in patients with epilepsy. Therefore, it is emphasized that monitoring vitamin D levels is part of the routine management of patients with epilepsy.

Systematic review registration

The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). (registration number CRD42023493896). https://www.crd.york.ac.uk/PROSPERO/ # myprospero.

Biochemical study of the effect of lead exposure in nonobese gasoline station workers and risk of hyperglycemia: A retrospective case-control study

Evaluate the relationship between blood lead (Pb) levels and other biomedical markers and the risk of diabetes in gasoline station workers. The participants were separated into 2 groups: group A consisted of 26 workers from gasoline filling stations, while group B comprised 26 healthy individuals. Serum levels of malondialdehyde, IL-1β, visfatin, insulin, fasting blood sugar, and vitamin D were assessed. Mean Pb level was significantly higher in group A compared to group B (almost 2.9 times higher levels) (14.43 ± 1.01 vs 5.01 ± 1.41, µg/dL). The levels of visfatin (23.19 ± 0.96 vs 3.88 ± 0.58, ng/mL), insulin (22.14 ± 1.31 vs 11.26 ± 0.75, mU/L), fasting blood sugar (118.4 ± 26.1 vs 82.7 ± 9.2, gm/dL), malondialdehyde (6.40 ± 0.27 vs 1.62 ± 0.21, nmol/mL), and IL-1β (330.25 ± 10.34 vs 12.35 ± 1.43, pg/mL) were significantly higher in group A, meanwhile; vitamin D (11.99 ± 1.55 vs 35.41 ± 3.16, ng/mL) were significantly lower in group A. A positive association exists between blood Pb levels and increased inflammatory markers. Lead exposure increases serum insulin and fasting blood sugar, which suggests that it is diabetogenic and that increased inflammation is a possible cause.

Can Vitamin D Reduce Inflammation? The Influence of Supplementation on Selected Immunological Markers

There is increasing evidence that vitamin D (VitD) supplementation may reduce inflammation in individuals with multiple sclerosis (MS). The aim of this study was to evaluate the effect of different doses of VitD on selected markers of inflammation in patients with relapsing-remitting MS (RRMS). Participants were divided depending on the supplemented dose of VitD into a high-dose (2000 IU/d; HD) group and a low-dose (15,960 IU/month; LD) group (n = 23 and n = 29, respectively). The concentration of 25(OH)D and the levels of CXCL16, PTX3, ALCAM, IL-1RA, and OPG were measured initially and after six months of VitD supplementation in blood serum. A significant increase in the concentrations of CXCL16, PTX3, and OPG was observed during the study (p = 0.02, p = 0.01, and p < 0.01, respectively). Furthermore, a higher increase in PTX3 and OPG in the LD group was observed (p = 0.04 and p = 0.03, respectively). A significant positive correlation was observed between the 25(OH)D serum concentration and PTX3 (R = 0.28, p < 0.05) and OPG (R = 0.28, p < 0.05) only at the beginning of the study. In patients with RRMS, such doses of VitD might be too low to induce obvious beneficial effects on the pro-inflammatory and inflammatory balance.

Increased loss-of-function filaggrin gene mutation prevalence in atopic dermatitis patients across northern latitudes indicates genetic fitness: A systematic review and meta-analysis

Loss-of-function (LoF) mutations in the filaggrin gene (FLG) constitute the strongest genetic risk for atopic dermatitis (AD). A latitude-dependent difference in the prevalence of LoF FLG mutations was systematically evaluated. A systematic review and meta-analysis were performed to estimate the prevalence of LoF FLG mutations in AD patients and the general population by geography and ethnicity. Risk of bias was assessed by Newcastle-Ottawa Scale and Jadad score. StatsDirect, version 3 software was used to calculate all outcomes. PubMed and EMBASE were searched until 9th December 2021. Studies were included if they contained data on the prevalence of LoF FLG mutations in AD patients or from the general population or associations between AD and LoF FLG mutations and were authored in English. Overall, 248 studies and 229 310 AD patients and individuals of the general population were included in the quantitative analysis. The prevalence of LoF FLG mutations was 19.1% (95% CI, 17.3-21.0) in AD patients and 5.8% (95% CI, 5.3-6.2) in the general population. There was a significant positive association between AD and LoF FLG mutations in all latitudes in the Northern hemisphere, but not in all ethnicities. The prevalence of LoF FLG mutations became gradually more prevalent in populations residing farther north of the Equator but was negligible in Middle Easterners and absent in most African populations. FLG LoF mutations are common and tend to increase with northern latitude, suggesting potential clinical implications for future AD management. The existence of possible genetic fitness from FLG LoF mutations remains unknown.

Nutritional interventions as modulators of the disease activity for idiopathic inflammatory myopathies: a scoping review

Idiopathic inflammatory myopathies (IIMs) are chronic, autoimmune connective tissue diseases associated with significant morbidity and disability. Nutrients can activate the immune system and contribute to chronic low-grade inflammation (LGI). Chronic muscle inflammation leads to imbalanced pro-inflammatory and anti-inflammatory cytokines, causing inadequate nutrition, weight loss and muscle weakness during a negative cycle. Owing to its potential to modulate LGI in various diseases, the Mediterranean diet (Med Diet) has been extensively studied. This scoping review explores the nutritional implications and recommendations of the Med Diet as a treatment for immune-mediated diseases, focusing on the gaps in IIM nutritional interventions. A comprehensive literature search of the MEDLINE and EBSCO databases between September 2018 and December 2022 was performed. We identified that the Med Diet and its specific components, such as omega-3 (nω3) fatty acids, vitamin D and antioxidants, play a role in the dietary treatment of connective tissue-related autoimmune diseases. Nutritional interventions have demonstrated potential for modulating disease activity and warrant further exploration of IIMs through experimental studies. This review introduces a dietary therapeutic approach using the Med Diet and related compounds to regulate chronic inflammatory processes in IIMs. However, further clinical studies are required to evaluate the efficacy of the Med Diet in patients with IIMs. Emphasising a clinical-nutritional approach, this study encourages future research on the anti-inflammatory effects of the Med Diet on IIMs. This review highlights potential insights for managing and treating these conditions using a holistic approach.

Consequences of Maternal Vitamin D Deficiency on Newborn Health

BACKGROUND AND OBJECTIVES

Maternal-fetal gestational pathology is one of the biggest challenges in the field of health at this moment. The current study is designed to determine the effects of vitamin D on pregnancy, starting with the idea that impairment of vitamin D status is thought to be correlated with impairment of the newborn's health.

MATERIALS AND METHODS

In this retrospective study, we tried to establish the link between vitamin D deficiency and maternal characteristics and also how it impacted the clinical status of the newborn. We analyzed a group of 260 patients: 130 pregnant women and 130 newborns, in whom vitamin D status was detected using the serum levels of 25-hydroxyvitamin D (25-(OH)D).

RESULTS

The results showed that vitamin D deficiency has a high incidence among pregnant women, as was presented in many important international studies. Our study also showed a positive, direct correlation between the mother's and newborn's vitamin D status.

CONCLUSIONS

Taking into consideration that vitamin D deficiency has been correlated with many complications, both in maternal and newborn health, a serum level determination of 25-(OH)D is necessary in the first trimester of pregnancy, and after that, adequate supplementation is necessary in order to prevent any negative effects.

Physiology of Vitamin D-Focusing on Disease Prevention

Vitamin D is a crucial micronutrient, critical to human health, and influences many physiological processes. Oral and skin-derived vitamin D is hydroxylated to form calcifediol (25(OH)D) in the liver, then to 1,25(OH)2D (calcitriol) in the kidney. Alongside the parathyroid hormone, calcitriol regulates neuro-musculoskeletal activities by tightly controlling blood-ionized calcium concentrations through intestinal calcium absorption, renal tubular reabsorption, and skeletal mineralization. Beyond its classical roles, evidence underscores the impact of vitamin D on the prevention and reduction of the severity of diverse conditions such as cardiovascular and metabolic diseases, autoimmune disorders, infection, and cancer. Peripheral target cells, like immune cells, obtain vitamin D and 25(OH)D through concentration-dependent diffusion from the circulation. Calcitriol is synthesized intracellularly in these cells from these precursors, which is crucial for their protective physiological actions. Its deficiency exacerbates inflammation, oxidative stress, and increased susceptibility to metabolic disorders and infections; deficiency also causes premature deaths. Thus, maintaining optimal serum levels above 40 ng/mL is vital for health and disease prevention. However, achieving it requires several times more than the government's recommended vitamin D doses. Despite extensive published research, recommended daily intake and therapeutic serum 25(OH)D concentrations have lagged and are outdated, preventing people from benefiting. Evidence suggests that maintaining the 25(OH)D concentrations above 40 ng/mL with a range of 40-80 ng/mL in the population is optimal for disease prevention and reducing morbidities and mortality without adverse effects. The recommendation for individuals is to maintain serum 25(OH)D concentrations above 50 ng/mL (125 nmol/L) for optimal clinical outcomes. Insights from metabolomics, transcriptomics, and epigenetics offer promise for better clinical outcomes from vitamin D sufficiency. Given its broader positive impact on human health with minimal cost and little adverse effects, proactively integrating vitamin D assessment and supplementation into clinical practice promises significant benefits, including reduced healthcare costs. This review synthesized recent novel findings related to the physiology of vitamin D that have significant implications for disease prevention.

Persistence of vitamin D deficiency among Italian patients with acute myocardial infarction

BACKGROUND AND AIMS

Vitamin D deficiency is a common cardiovascular risk factor associated with the development of atherosclerosis. We evaluated changes in 25(OH)D concentrations in 1510 patients with acute myocardial infarction (AMI) over a long observation period, including the COVID-19 pandemic.

METHODS AND RESULTS

Patients were separated into four groups according to the year of enrolment, group 1 (2009-2010), group 2 (2014-2016), group 3 (2017-2019), and group 4 (2020-2022). The median 25(OH)D concentration in the overall cohort was 17.15 (10.3-24.7) ng/mL. The median plasma concentrations of 25(OH)D for groups 1, 2, 3, and 4 were 14.45 (7.73-22.58) ng/mL, 17.3 ng/mL (10.33-24.2), 18.95 (11.6-26.73) ng/mL and 19.05 (12.5-27.3) ng/mL, respectively. Although 25(OH)D levels increased over the years, the prevalence of vitamin D deficiency remained high in each group (68.4%, 61.4%, 53.8%, and 52% respectively). Hypovitaminosis D was predicted by the season influence (OR:2.03, p < 0.0001), higher body mass index (OR:1.25; p = 0.001), diabetes mellitus (OR:1.54; p = 0.001), smoking (OR:1.47; p = 0.001), older age (OR:1.07; p = 0.008), higher triglycerides levels (OR:1.02; p = 0.01), and female gender (OR:1.3; p = 0.038). After multivariable adjustment, vitamin D ≤ 20 ng/mL was an independent predictor of mortality.

CONCLUSION

Vitamin D deficiency is highly prevalent and persistent in patients with AMI despite a trend towards increasing 25(OH)D concentrations over the years. The frequent lockdowns did not reduce the levels of 25(OH)D in the fourth group. Low levels of 25(OH)D are an independent predictor of mortality.

Causal effect of serum 25 hydroxyvitamin D concentration on cardioembolic stroke: Evidence from two-sample Mendelian randomization

BACKGROUND AND AIMS

The putative association between serum 25-hydroxyvitamin D concentration [25(OH)D] and the risk of cardioembolic stroke (CES) has been examined in observational studies, which indicate controversial findings. We performed Mendelian randomization (MR) analysis to determine the causal relationship of serum 25(OH)D with the risk of CES.

METHODS AND RESULTS

The summary statistics dataset on the genetic variants related to 25(OH)D was used from the published GWAS of European descent participants in the UK Biobank, including 417,580 subjects, yielding 143 independent loci in 112 1-Mb regions. GWAS summary data of CES was obtained from GIGASTROKE Consortium, which included European individuals (10,804 cases, 1,234,808 controls). Our results unveiled a causal relationship between 25(OH)D and CES using IVW [OR = 0.82, 95% CI: 0.67-0.98, p = 0.037]. Horizontal pleiotropy was not seen [MR-Egger intercept = 0.001; p = 0.792], suggesting an absence of horizontal pleiotropy. Cochrane's Q [Q = 78.71, p-value = 0.924], Rucker's Q [Q = 78.64, p-value = 0.913], and I2 = 0.0% (95% CI: 0.0%, 24.6%) statistic suggested no heterogeneity. This result remained consistent using different MR methods and sensitivity analyses, including Maximum likelihood [OR = 0.82, 95%CI: 0.67-0.98, p-value = 0.036], Constrained maximum likelihood [OR = 0.76, 95%CI: 0.64-0.90, p-value = 0.002], Debiased inverse-variance weighted [OR = 0.82, 95%CI: 0.68-0.99, p-value = 0.002], MR-PRESSO [OR = 0.82, 95%CI 0.77-0.87, p-value = 0.022], RAPS [OR = 0.82, 95%CI 0.67-0.98, p-value = 0.038], MR-Lasso [OR = 0.82, 95%CI 0.68-0.99, p-value = 0.037].

CONCLUSION

Our MR analysis provides suggestive evidence that increased 25(OH)D levels may play a protective role in the development of cardioembolic stroke. Determining the role of 25(OH)D in stroke subtypes has important clinical and public health implications.

Interaction between MARK3 (rs11623869), PLCB4 (rs6086746) and GEMIN2 (rs2277458) variants with bone mineral density and serum 25-hidroxivitamin D levels in Mexican Mestizo women

Introduction

Understanding the genetic factors contributing to variations in bone mineral density (BMD) and vitamin D could provide valuable insights into the pathogenesis of osteoporosis. This study aimed to evaluate the association of single nucleotide variants in MARK3 (rs11623869), PLCB4 (rs6086746), and GEMIN2 (rs2277458) with BMD in Mexican women.

Methods

The gene-gene interaction was evaluated in these variants in serum 25(OH)D levels and BMD. A genetic risk score (GRS) was created on the basis of the three genetic variants. Genotyping was performed using predesigned TaqMan assays.

Results

A significant association was found between the rs6086746-A variant and BMD at the total hip, femoral neck, and lumbar spine, in women aged 45 years or older. However, no association was observed between the variants rs11623869 and rs2277458. The rs11623869 × rs2277458 interaction was associated with total hip (p=0.002) and femoral neck BMD (p=0.013). Similarly, for vitamin D levels, we observed an interaction between the variants rs6086746 × rs2277458 (p=0.021). GRS revealed a significant association with total hip BMD (p trend=0.003) and femoral neck BMD (p trend=0.006), as well as increased vitamin D levels (p trend=0.0003). These findings provide evidence of the individual and joint effect of the MARK3, PLCB4, and GEMIN2 variants on BMD and serum vitamin D levels in Mexican women.

Discussion

This knowledge could help to elucidate the interaction mechanism between BMD-related genetic variants and 25OHD, contributing to the determination of the pathogenesis of osteoporosis and its potential implications during early interventions.

Low plasma 25-hydroxyvitamin D levels are not associated with a high risk of recurrent falls in community-dwelling Japanese adults: the Murakami cohort study

Reports on the association between vitamin D levels and fall risk have been mixed, and long-term follow-up studies are lacking. This 5-year cohort study of 5,343 community-dwelling Japanese people aged 40-74 years found that low vitamin D levels are not associated with a high risk of recurrent falls.

PURPOSE

Findings of cohort studies on the association between plasma 25-hydoxyvitamin D (25[OH]D) levels and fall risk have been mixed, and long-term follow-up studies are lacking. The present study investigated whether low plasma 25(OH)D levels are longitudinally associated with a high risk of recurrent falls in adults.

METHODS

This 5-year cohort study included 5,343 community-dwelling Japanese people aged 40-74 years. Baseline blood collection and a questionnaire survey were conducted in 2011-2013. Plasma 25(OH)D levels were determined and divided into quintiles after stratification by season, sex, and age group. Information on recurrent falls occurring in the year before the survey 5 years later was obtained, and participants with two or more falls were considered to have experienced recurrent falls. Covariates were sex, age, marital status, education, occupation, BMI, total physical activity levels, calcium intake, vitamin K intake, smoking, drinking, and disease history.

RESULTS

Mean age and 25(OH)D levels were 60.9 years and 50.9 nmol/L, respectively. In the follow-up survey, 209 recurrent falls were reported. Plasma 25(OH)D levels were not significantly associated with the occurrence of recurrent falls in men, women, or men/women-combined (adjusted P for trend = 0.1198, 0.8383, and 0.2355, respectively). In men and men/women-combined, adjusted ORs for recurrent falls in the lowest quintile were significantly lower (adjusted OR = 0.42 and 0.59, respectively) than the middle quintile (reference).

CONCLUSION

Low plasma 25(OH)D levels are not associated with a high risk of recurrent falls in middle-aged and older people. Further longitudinal studies will be needed to confirm our findings in other populations.

Vitamin D and cardiovascular diseases: A narrative review

Cardiovascular diseases (CVD) and vitamin D deficiency are becoming highly prevalent among general populations. Despite plausible biological mechanisms for the role of vitamin D in cardio-protection, a cause-and-effect relationship has not yet been established. The interest in vitamin D as a potential therapeutic target to attenuate cardiovascular risk has been raised. The question about the benefit of vitamin D supplementation for cardiovascular outcomes cannot be answered certainly for the moment. The association between hypovitaminosis D and CVD has been proven by some studies while other studies deny any such link. The present narrative review gives a comprehensive overview of studies on the potential impact of hypovitaminosis D on CVD. The potential role of vitamin D supplementation in the management of CVD is also evaluated. Particular emphasis is paid to those studies that achieve a high level of scientific evidence.

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.

Assessment the awareness of vitamin D deficiency among the general population in Syria: an online cross-sectional study

BACKGROUND

Vitamin D deficiency is an importance preventable problem in the global and associates with lack levels of awareness about vitamin D. According to prior studies, in the Arab world, there is low of knowledge and awareness toward vitamin D deficiency. The target of our study is evaluating the knowledge level about vitamin D deficiency and determining the associated factors with levels of awareness of its.

METHOD

This online cross-sectional study was performed in Syria between 25 February to 29 March 2023 to assess the levels of knowledge about vitamin D deficiency among general Syrian population. The study's survey was obtained from previously published research and we conducted a pilot study to assure the validity and clarity questionnaire. All Syrian individuals aged 18 or older who were able to read and write and willing to participate were included, while, non-Syrian nationality individuals and all medical staff (doctors, nurses, and medical students…), as well, those under 18 age were excluded. The questionnaire consisted of 23 questions separated into four categories. The first section was sociodemographic information of the study population. The second section measured the level awareness of the study population regarding the benefits of vitamin D. In addition, the third and fourth part evaluated knowing of the respondents about sources of and toxicity consequences of vitamin D. The data were analyzed by utilizing multivariate logistic regression in IBM, SPSS V.28 version.

RESULTS

Overall, 3172 of the study population accepted to participate in this research and 57.9% the majority of them were aged in the range among 18 and 28. While, the average age of the respondents were 30.80 ± 11.957. Regarding with the awareness toward knowledge of advantages and source of vitamin D and outcomes of vitamin D toxicity. Most of the participants mentioned that vitamin D is used to treat bone disease and rickets and contributes in maintaining calcium and phosphates (91.4% and 84.6%, respectively). Whereas, more than half of them reported that sun exposure does not cause vitamin D poisoning and that vegetarians are more likelihood to have vitamin D than non-vegetarians, (54.1% and 54.9%, respectively). Only, age and occupation out of nine predictors variables were significantly correlated with adequate knowledge of Vitamin D (p-value < 0.05). The respondents aged more than 60 years were high probability to have good recognition of Vitamin D than participants aged between 18 and 28 years. (OR = 7.95). Retired participants have shown lower aware of Vitamin D 0.38 times than students.

CONCLUSION

Our research revealed that most of the participated individuals have sufficient comprehension about vitamin D, despite, there were significant gap. Health education via programs by government health-care agencies, NGOs and social workers is necessary to increase the awareness and knowledge toward benefits, source, deficiency and toxicity of vitamin D to avoid injury several diseases such as rickets.

Vitamin D Deficiency in Patients With Low-Energy Hip Fractures in Accordance With the Mediterranean Paradox

Introduction Vitamin D deficiency (VDD) is considered one of the leading causes of poor bone quality. It may also be related to severe muscular weakness, especially in the elderly, which leads to frequent falls. Thus, VDD might be associated with fragility fractures of the hip, wrist, and spine in this age category. In this cross-sectional study, our goal was to present vitamin D levels in an elderly Mediterranean population with hip fractures and to assess whether its levels are related to the incidence or prevention of such injuries. Methods Between January and December 2021, 140 patients aged 65 years or older were hospitalized in our department with a fracture involving the hip joint. Serum calcium and vitamin D level control was performed upon admission, as well as recording whether anti-osteoporosis medication had been prescribed. Only patients with low-energy fractures were included, whereas oncologic patients and those with high-energy trauma were excluded. Results Thirty-eight men and 102 women, with a mean age of 83.12 and 84.88 years, respectively, participated in our study. Intertrochanteric fractures were the most common injuries (50.72%). Low vitamin D levels (<30 ng/mL) were observed in 132 patients (94.28%). A bone density scan during the last year had been conducted by only seven patients (5%), whereas in 136 patients (97.14%), no anti-osteoporotic medication was given. Conclusion There is an excessive percentage of aged patients with hip fractures in Greece, demonstrating a significant vitamin D insufficiency despite the high annual frequency of sunny days in this Mediterranean region. Presumably, most of these patients neither perform the routine bone density scan nor do they take any kind of preventive pharmaceutical treatment, which might reveal devaluation of osteoporosis from this age group due to contingent comorbidities.

Proportion of vitamin D deficiency in children/adolescents with type 1 diabetes: a systematic review and meta-analysis

BACKGROUND

The impact of vitamin D on type 1 diabetes has been a controversial topic in public health. Furthermore, significant differences in the proportion of vitamin D have been noted. The purpose of this systematic review was to determine the overall proportion of vitamin D deficiency in children/adolescents with type 1 diabetes (T1D).

METHODS

Based on six electronic databases (PubMed, Web of Science, Embase, Ovid Medline, ProQuest, and Cochrane Library), eligible studies since the databases' inception up to April 2022 were searched. Reference lists were also manually searched to identify additional studies. Overall, studies with statistical information on vitamin D deficiency in children and adolescents with T1D were included, and a random effects model was applied for the meta-analysis. In addition, subgroup and sensitivity analyses were carried out to evaluate heterogeneity, and publication bias was evaluated by using Egger's test.

RESULTS

A total of 45 studies involving 6,995 participants met the inclusion criteria; these included 25 countries covering Africa, Oceania, Europe, North America and Asia. The proportion of vitamin D deficiency in children/adolescents with T1D was 45% (95% confidence interval [CI] 37-54%, I2 = 97.94%). Subgroup analysis further revealed that the publication year, study design, vitamin D classification, season and geographical region significantly contributed to the variation in the reported incidence of vitamin D deficiency.

CONCLUSIONS

The results of the meta-analysis showed that the proportion of vitamin D deficiency among T1D children/adolescents was 45%. In addition, the proportion remains higher, which has important implications for adapting health and social care systems.

Serum 25-Hydroxyvitamin D and Risk of Disability in Activities of Daily Living among the Oldest-Old: An Observational and Mendelian Randomization Study

BACKGROUND

Vitamin D deficiency and disability are both prevalent among older adults. However, the association between them has rarely been investigated in the oldest-old subjects (aged ≥80 y), and the causality remains unclear.

OBJECTIVE

This study aimed to elucidate the causal effect of vitamin D on the incident risk of disability in activities of daily living (ADL) among Chinese oldest-old based on the 2012-2018 Chinese Healthy Ageing and Biomarkers Cohort Study.

METHODS

Serum 25-hydroxyvitamin D [25(OH)D] concentrations and ADL status at baseline and follow-up interviews were documented. Cox regression models were applied among 1427 oldest-old (mean age, 91.2 y) with normal baseline ADL status. One sample Mendelian randomization (MR) analyses were performed on a subset of 941 participants with qualified genetic data, using a 25(OH)D-associated genetic risk score as the genetic instrument.

RESULTS

During a median follow-up of 3.4 y, 231 participants developed disability in ADL. Serum 25(OH)D concentration was inversely associated with the risk of disability in ADL [per 10 nmol/L increase hazard ratio (HR) 0.85; 95% CI: 0.75, 0.96]. Consistent results from MR analyses showed that a 10 nmol/L increment in genetically predicted 25(OH)D concentration corresponded to a 20% reduced risk of ADL disability (HR 0.80; 95% CI: 0.68, 0.94). Nonlinear MR demonstrated a monotonic declining curve, with the HRs exhibiting a more pronounced reduction among individuals with 25(OH)D concentrations below 50 nmol/L. Subgroup analyses showed that the associations were more distinct among females and those with poorer health conditions.

CONCLUSIONS

Our study supports an inverse causal relationship between serum 25(OH)D concentration and the risk of disability in ADL among Chinese oldest-old. This protective effect was more distinct, especially for participants with vitamin D deficiency. Appropriate measures for improving vitamin D might help reduce the incidence of physical disability in this specific age group.