The Role of Vitamin D in Health and Disease: A Narrative Review on the Mechanisms Linking Vitamin D with Disease and the Effects of Supplementation

Autophagy is influenced by vitamin D3 level in people with HIV-1

BACKGROUND

Autophagy is the primary catabolic process responsible for degrading intracellular components and potentially harmful cytosolic entities by delivering them to lysosomes. Notably, this mechanism is crucial for controlling intracellular pathogens, with significant implications for both innate and adaptive immunity. In the context of HIV-1 infection, emerging evidence suggests that autophagy contributes to immune responses against the virus. Various compounds can modulate autophagy, among which vitamin D₃ is particularly effective due to its ability to prevent inflammation and slow HIV-1 disease progression. Indeed, vitamin D₃ contributes to regulating both innate and adaptive immunity, thereby modulating antiviral and antibacterial inflammatory responses. Importantly, vitamin D₃ deficiency is highly prevalent among people with HIV (PWH) and has been associated with an increased risk of severe disease progression.

RESULTS

In this study, we investigated the relationship between serum vitamin D₃ levels and the expression of autophagy markers in peripheral blood mononuclear cells from different categories of PWH: PWH under antiretroviral therapy (ART) with either normal vitamin D₃ levels or hypovitaminosis, and treatment-naïve PWH with either normal vitamin D₃ levels or hypovitaminosis. Our results show that low vitamin D₃ blood levels is associated with lower expression of the main factors involved in the autophagy mechanism, particularly in treatment-naïve PWH.

CONCLUSIONS

Our findings suggest that normal blood level of vitamin D₃ may play a crucial role in promoting autophagy in PWH. The observed differences in autophagy-related protein expression between ART-treated and untreated individuals underscore the intricate relationship between vitamin D₃ levels, ART exposure, and autophagic regulation. This is a preliminary exploration of the effects of vitamin D₃ on autophagy in PWH. Further studies are needed to deepen and explore the interplay between vitamin D₃ and autophagy in greater depth. A better understanding of these mechanisms could help to develop novel therapeutic strategies aimed at mitigating immune depletion and chronic inflammation, ultimately improving clinical outcomes for individuals living with HIV.

Mapping the landscape of vitamin D in cancer studies: a systematic global investigation

Purpose

This comprehensive study examines the multifaceted relationship between vitamin D and cancer, synthesizing key scientific advancements and global research trends to guide future investigations and address critical gaps in the field.

Methods

Publications on vitamin D and cancer were retrieved from Scopus up to November 2024. English-language original and review articles were analyzed using Excel, VOSviewer, and Scimago Graphica, focusing on publication trends, citation impacts, and research themes.

Results

A total of 11,442 publications (80.01% original articles, 19.98% reviews; 51.24% open access) were analyzed. The United States of America led in publications (38.3%) and citations (56.2%), followed by China (7.7%) and the United Kingdom (7.2%) in output, and the United Kingdom (10.6%) and Germany (6.4%) in citations. Countries with the highest citations per document were Belgium (103.4), Slovenia (87.9), and Puerto Rico (76.6). The most frequently studied cancers in relation to vitamin D were breast, colorectal, prostate, skin, lung, ovarian, pancreatic, gastric, hepatocellular, thyroid, leukemia, multiple myeloma, bladder, lymphoma, osteosarcoma, cervical, endometrial, and glioblastoma, respectively. Cluster analysis revealed key patterns related to vitamin D: Calcitriol's chemopreventive role in breast, prostate, and colorectal cancers, dietary vitamin D for its involvement in ovarian cancer, vitamin D for regulation of cancer-related hypercalcemia, vitamin D deficiency links to inflammation-obesity-cancer risk, VDR polymorphisms affecting outcomes in lung and colorectal cancers, and vitamin D's photoprotective effects on skin malignancies, and vitamin D in ulcerative colitis-related cancer. The most cited articles emphasized optimal vitamin D levels and cancer prevention.

Conclusion

This study highlights the extensive research on vitamin D and its complex links to cancer, emphasizing future prospects with a focus on precision medicine approaches, including targeted supplementation and genomic analyses, to better address individual variability in cancer prevention and treatment.

Vitamin D Levels in Patients Presenting to a Rheumatology Clinic in Germany: Associations with Patient Characteristics and Season

Background: High rates of vitamin D deficiency have been reported in population-based studies, including those conducted in Germany. The goal of this study was to evaluate vitamin D levels and associated factors in a clinical cohort of German patients presenting to a rheumatology clinic. Methods: We conducted a retrospective observational study of electronic health record data from patients presenting to a rheumatology clinic in southern Germany. Data included demographic characteristics and vitamin D levels as measured by the Elecsys® Vitamin D total III assay (Roche). Associations between vitamin D levels and patient characteristics were evaluated by Pearson correlation analyses, t-tests, and multiple regression analyses. We also explored seasonal changes. Results: A total of 4979 patients were included; 3230 (64.9%) were female and the mean (standard deviation [SD]) age was 53.6 (15.2) years. The mean (SD) vitamin D level was 27.4 (14.0) ng/mL (range, 3-240 ng/mL). Overall, 1540 (30.9%) had vitamin D levels in the deficient range (<20 ng/mL), 1774 (35.6%) had sufficient vitamin D (20 to 30 ng/mL), 1597 (32.1%) had optimal vitamin D levels (>30 to 70 ng/mL), and 68 (1.4%) had levels >70 ng/mL. Lower vitamin D levels were significantly associated with younger age, male sex, and higher body mass index. Mean levels were significantly lower during winter months and the percentages of patients with vitamin D deficiency were higher. Conclusions: Our data indicate that low levels of vitamin D are common in clinical cohorts, particularly in men, younger adults, overweight individuals, and during winter months. Patient education and/or supplementation may help to address this issue and potentially improve patient health.

Exploration of Pathogenesis and Cutting-Edge Treatment Strategies of Sarcopenia: A Narrative Review

Sarcopenia a progressive and multifactorial musculoskeletal syndrome characterized by loss of muscle mass and function, poses a significant global health challenge, particularly in aging populations. Epidemiological studies reveal that sarcopenia affects approximately 5-10% of the general population, with prevalence rates escalating dramatically after age 60 to reach 10-27% in older adults. This age-associated increase contributes significantly to healthcare burdens by elevating risks of disability, frailty, and mortality. Despite its profound impact, current clinical approaches to sarcopenia remain limited. While resistance exercise and protein supplementation form the cornerstone of management, their efficacy is often constrained by poor long-term adherence and variable individual responses, highlighting the urgent need for more comprehensive and personalized treatment strategies. The pathogenesis of sarcopenia is complex and influenced by various factors, including aging, inflammation, nutritional deficits, physical inactivity, and mitochondrial dysfunction. However, the precise molecular mechanisms underlying this condition are still not fully understood. Recent research has made significant strides in elucidating the intricate mechanisms contributing to sarcopenia, revealing novel insights into its molecular and cellular underpinnings. Notably, emerging evidence points to the pivotal role of mitochondrial dysfunction, altered myokine profiles, and neuromuscular junction degeneration in sarcopenia progression. Additionally, breakthroughs in stem cell therapy, exosome-based treatments, and precision nutrition offer promising avenues for clinical intervention. This review aims to synthesize the latest advancements in sarcopenia research, focusing on the novel contributions to its pathogenesis and treatment strategies. We explore emerging trends such as the role of cellular senescence, epigenetic regulation, and targeted therapeutic interventions that could reshape future approaches to managing sarcopenia. By highlighting recent breakthroughs and cutting-edge research, we hope to advance the understanding of sarcopenia and foster the translation of these findings into effective clinical therapies.

Vitamin D Imbalance and Hydro-Electrolyte Disturbances in Hospitalized Children: A Comparation Between Post-COVID-19 Status and SARS-CoV-2/EBV Coinfection

Background/Objectives: SARS-CoV-2 infection has the potential to cause multi-organ involvement and, when associated with Epstein-Barr virus (EBV) coinfection, may worsen the course of disease in pediatric patients by influencing the immune response. Methods: Our retrospective-observational study included 406 hospitalized children with post-COVID-19 status or SARS-CoV-2/EBV coinfection. Results: Hypovitaminosis D was more common in the coinfected sublot (59.18%) than in the COVID-19 one (50.74%), with a higher frequency of severe vitamin D deficiency (16.33% vs. 7.35%). Hypovitaminosis D was significantly associated with female sex (p = 0.033) only in the COVID-19 subgroup. Hypervitaminosis D, although rare, was only associated with severe forms of the disease (7.69%). Between clinical severity and vitamin D level, a statistically significant association of moderate intensity was identified only in the COVID-19 subgroup (χ2 = 11.708, φ = 0.293, p = 0.020). In the same subgroup, a significant correlation was found between vitamin D levels and serum potassium values (χ2 = 10.527, p = 0.032). Moreover, in the COVID-19 subgroup, an association between abnormal sodium levels and increased D-dimer levels was found (χ2 = 7.074, p = 0.029). Conclusions: These results underline the importance of monitoring immunologic, vitamin, and electrolyte imbalance in the management of these cases and highlight the need for personalized therapeutic strategies to prevent long-term complications.

Etiology of Adult Female Acne-Systematic Review

Background

Acne vulgaris is a common inflammatory disease of the skin. Acne occurring in > 25 years old is called "adult acne," and it occurs more commonly in women than in men.

Purpose

The aim of this study was to examine the recent findings of the connection between genetic factors, hormones and diet with adult female acne.

Methods

The study was conducted as a systematic literature review. For the review, data searches were made on the PubMed and Scopus databases. Finally, 20 articles met the inclusion criteria.

Results

According to this systematic literature review, several different hormones may be linked to the development of adult acne. Androgens play a particularly important role, as they can stimulate growth of the sebaceous glands and increase the secretion of sebum, thus promoting the formation of skin changes associated with acne. A high glycemic diet increases the secretion of insulin, which in turn causes an increase in the amount of insulin-like growth factor (IGF)-1. IGF-1 increases the growth of the sebaceous gland, sebum production, keratinocyte proliferation and it activates androgen synthesis, thus contributing to acne pathogenesis. Adults with acne have a positive familial history more often than healthy controls, which indicates the genetic nature of adult acne.

Conclusion

This literature review highlighted that especially hyperandrogenism, a positive familial history and a high-glycemic diet may be linked to the development of adult acne. Understanding the pathogenesis of adult acne is crucial for effective treatment.

Impact of vitamin D levels on mortality in older covid-19 vaccinated patients

BACKGROUND

Vitamin D plays a key role in regulating the immune system and vaccine response, and hypovitaminosis D is a known risk factor for mortality. However, its potential influence on mortality in SARS-CoV-2 vaccinated older adults remains underexplored. This study aims to examine survival differences between unvaccinated and vaccinated older adults with varying vitamin D levels, and to assess the impact of vitamin D on mortality.

METHODS

We recruited patients aged 65 and over from the Geriatrics Unit of Azienda Ospedale - Università Padova. Clinical, pharmacological data, including vaccination status and vitamin D levels, were collected at admission, alongside mortality data 12 months post-hospitalization. Participants were divided into three groups: unvaccinated, vaccinated with vitamin D levels of 25-50 nmol/L, and vaccinated with levels > 50 nmol/L.

RESULTS

A total of 126 participants were included (56% women, mean age 83 years). No significant differences were found in COVID-19 severity among the three groups. After 12 months, 24 deaths were recorded: 17% in unvaccinated, 19% in vaccinated with low vitamin D, and 20% in vaccinated with high vitamin D (p = 0.94). Kaplan-Meier curves showed that mortality risk for vaccinated individuals with low vitamin D was similar to unvaccinated patients but significantly higher than vaccinated individuals with high vitamin D (p = 0.04). Vitamin D levels of 25-50 nmol/L were associated with a threefold increased risk of 12-month mortality (HR: 3.79, p < 0.001).

CONCLUSIONS

Vitamin D levels can impact mortality in older vaccinated individuals. Early correction of vitamin D deficiency could potentially enhance outcomes.

Higher dietary vitamin D intake influences brain and mental function in elderly Americans: a cross-sectional analysis

Background

Vitamin D is known to have a potential impact on cognitive function and mental health. This study aims to assess the association between dietary vitamin D intake and cognitive performance, as well as depression, in an elderly U.S. population.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were analyzed. A total of 1,344 elderly participants were categorized into three tertiles based on their dietary vitamin D intake (D2 + D3). Cognitive function was measured using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, Digit Symbol Substitution Test (DSST), and Animal Fluency Test, while depression was assessed through the Patient Health Questionnaire-9 (PHQ-9). Adjustments were made for confounding variables, including age, sex, race, education, physical activity level, and other dietary factors.

Results

After adjustment for confounders, individuals in the 3rd tertile of vitamin D intake (≥4.9 mcg/day) had significantly reduced odds of low performance on the CERAD test (OR: 0.77, 95% CI: 0.57-0.98; p = 0.031) and Animal Fluency test (OR: 0.63, 95% CI: 0.49-0.85; p = 0.013) compared to the 1st tertile of intake (≤2.4 mcg/day). Similarly, participants in the 3rd tertile of vitamin D intake had lower odds of depression (PHQ-9 score > 4) after adjustment (OR: 0.68, 95% CI: 0.48-0.99; p = 0.046).

Conclusion

Our findings suggest that dietary vitamin D intake is associated with improved cognitive function and depressive symptoms in elderly individuals. However, further longitudinal studies are needed to establish causality and explore the underlying mechanisms.

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.

Two-phase linear relationship of Vitamin D and Vitamin A among children aged 0-14 years: a cross-sectional study

Background

Vitamin D and Vitamin A are crucial for children's immune function, bone health, and cellular growth, but their interrelationship and the impact of various factors remain poorly understood.

Objective

To explore the relationship between Vitamin D and Vitamin A levels in children and identify any critical thresholds.

Methods

A cross-sectional study was conducted from 2018 to 2021 in Ningbo, Zhejiang, China. Participants were children aged 0 to 14 years attending community health service centers for routine health check-ups. Multivariate linear regression analysis was conducted to ascertain the association between serum Vitamin D and Vitamin A levels. A smooth curve fitting approach was employed to analyze the dose-response relationship between Vitamin D and Vitamin A.

Results

A total of 4,752 participants were included. The study revealed significant variations in baseline Vitamin D and Vitamin A levels across different deficiency categories. Mean Vitamin D levels were lowest in the severe deficiency group (4.9 ng/mL) and highest in the normal group (34.8 ± 9.8 ng/mL), while mean Vitamin A levels were lowest in the deficiency group (226.6 ± 72.2 ng/mL) and highest in the normal group (263.3 ± 74.0 ng/mL). The study revealed a two-phase linear relationship with a significant threshold effect at a Vitamin D level of 28.289 ng/mL. Below this threshold, the association between Vitamin D and Vitamin A was strong (β = 2.935, 95% CI: 2.173, 3.696), while above the threshold, the association was significantly weaker (β = 0.737, 95% CI: 0.413, 1.061). The likelihood ratio test confirmed the significance of this threshold effect (p < 0.001).

Conclusion

The study concludes that a significant threshold at 28.289 ng/mL Vitamin D marks a point beyond which the association with Vitamin A levels plateaus, highlighting the importance of this threshold for optimizing vitamin status in children.

Supplementation Behavior and Expenditures in Healthy German Vegans, Lacto-Ovo-Vegetarians and Omnivores: A Cross-Sectional Study

Purpose: Dietary supplements may ensure an adequate intake of nutrients of concern in all diets. Supplementation behavior and expenditures in vegetarians and vegans, however, have been rarely discussed in the literature. Methods: We reviewed supplementation expenditures in a cohort of 115 healthy adult German vegans, lacto-ovo-vegetarians and omnivores, characterized by comparable sociodemographic data. Supplementation behavior (excluding protein supplements) was re-analyzed to estimate yearly supplementation expenditures by dietary group. Results: The number of total supplements and multivitamin supplements taken differed significantly between the 3 groups (P = .016 and .026, respectively). Median number (interquartile range) of reported supplements in vegans was n = 2.5 (3), n = 2 (1) in lacto-ovo-vegetarians and n = 1 (2) in omnivores. Yearly supplementation expenses in supplementing participants ranged from .66€ to 1566.50€. They were highest in vegans (53.81€), followed by omnivores (29.30€) and lacto-ovo-vegetarians (12.05€) (P = .013). Approximately 40% of participants spent more than 50 Euros per year on supplements. A strong association between supplement expenses and the number of reported supplements was found (Spearman's rho: .65, P < .001). The most frequent supplements were vitamin D (vegetarians/omnivores) and vitamin B12 (vegans). Conclusions: Supplements were widely used in our study population, with substantial differences in expenditures and risk for over-supplementation across the examined diet groups.

Impact of Dietary Supplements on Clinical Outcomes and Quality of Life in Patients with Breast Cancer: A Systematic Review

Background: This systematic review aimed to evaluate the efficacy and safety of dietary supplements in breast cancer patients, focusing on their impact on clinical outcomes, treatment-related side effects, and therapy adherence. Methods: Only RCTs investigating the effects of various orally administered supplements in adult breast cancer patients were included. Well-defined substances like vitamins, minerals, antioxidants, and specific herbal extracts were explored. The review excluded studies solely based on dietary interventions or non-supplemental approaches. The primary outcome assessed was quality of life. Secondary outcomes included disease-free survival, overall survival, tumor response, and biomarkers indicative of disease progression. Results: A total of 45 randomized controlled trials (RCTs) were included in this systematic review. Overall, supplementation was not associated with serious adverse events in the included trials. Vitamin D supplementation showed promise in some studies, with potential immunomodulatory and antioxidant effects, particularly when combined with other interventions. Omega-3 fatty acids and beta-glucan demonstrated potential in alleviating certain symptoms and improving quality of life. Studies on amino acids like acetyl-L-carnitine and L-arginine also yielded mixed results. Beta-glucan exhibited potential for immune-enhancing effects, while melatonin and creatine showed limited or no benefit for fatigue or muscle strength. Herbal extracts, including silymarin, curcumin, and EGCG, had varied effects. Curcumin studies presented mixed results. Silymarin showed potential for hepatoprotective effects. Conclusions: These findings highlight the potential of specific dietary supplements to improve various aspects of breast cancer care. However, the evidence is mixed across supplement types, and further research is needed to determine the most effective and safe approaches.

Vitamin D and LL-37 in Serum and Saliva: Insights into Oral Immunity

(1) Background: In recent years, there has been a growing interest in understanding the innate immunity of the mouth, particularly the mechanisms through which vitamin D influences oral health. Researchers have increasingly focused on the association between vitamin D and the antimicrobial peptide LL-37 since the CAMP gene, responsible for encoding the LL-37 peptide, is a direct target of both vitamin D and its receptor (vitamin D receptor, VDR). This study aimed to explore the correlation between the 25-hydroxyvitamin D (25(OH)D) levels and the concentration of the LL-37 peptide in both serum and saliva. The objective was to compare the serum concentrations of 25(OH)D and ll-37 with those in saliva and to access the correlations between the two compounds. (2) Methods: Serum and whole saliva samples were collected from 72 healthy adults (mean age 28.68 ± 8.35). The levels of 25(OH)D and LL-37 were assessed in both the saliva and serum samples using commercially available enzyme-linked immunosorbent assay (ELISA) kits. (3) Results: The 25(OH)D levels in the serum (median 5.92 ng/mL, min-max 2.7-10.4 ng/mL) correlated with the LL-37 serum levels (62 ng/mL, min-max 18-378 ng/mL; Pearson's r 0.328, p = 0.005). Additionally, the 25(OH)D levels in saliva (median 1.16 ng/mL, min-max 0.54-2.12 ng/mL) strongly correlated with the LL-37 salivary levels (median 44 ng/mL, min-max 6.5-205 ng/mL; Pearson's r 0.667, p < 0.001). The 25(OH)D salivary levels demonstrated a robust correlation with the LL-37 salivary levels. (4) Conclusions: This discovery emphasizes the complex interplay between vitamin D and LL-37 and lay the groundwork for the further exploration of vitamin D's role in oral immune function.

Can the use of vitamin D-fortified sunscreen cream be the solution to the vitamin D deficiency pandemic?

Current approaches to vitamin D supplementation are generally limited to its oral intake. In this experimental study, the effects of applying vitamin D-fortified sunscreen creams to the skin on the absorption, and therefore levels of serum vitamin D metabolites were investigated. Forty 8-week-old male Wistar Albino rats were used in the study. Eight rats (Group B) were sacrificed to determine the baseline values of biochemical parameters. The remaining 32 rats were randomly divided into 4 equal groups as follows: Group S, only the back skin of the rats were shaved; Group SD, only vitamin D3 diluted with sunflower oil was applied to the shaved area; Group SC, only sunscreen cream was applied to the shaved area; and Group SDC, sunscreen cream fortified with vitamin D3 was applied to the shaved area. Serum 25(OH)D3 and 24,25(OH)2D3 levels were determined at the end of 8 weeks. Mean (± SD) serum 25(OH)D3 levels of groups B, S, SD, SC, and SDC were determined as 17.7 ± 5.7, 13.5 ± 3.1, 54.1 ± 13.0, 19.6 ± 2.7, 67.2 ± 16.5 ng/mL, respectively. There were statistically significant differences in serum 25(OH)D3 values between groups S and SD (p < 0.001) and between groups SC and SDC (p = 0.002). A positive correlation was found between serum 25(OH)D3 and 24,25(OH)2D3 parameters (r = 0.772; p < 0.001). With this study, it was concluded that vitamin D-fortified sunscreen cream increases serum vitamin D levels by exerting transdermal activity. Further studies are required to confirm this observations.

A novel LC-MS/MS analysis of vitamin D metabolites in mice serum and hair: impact of diet and light exposure

Introduction

Numerous physiological systems, such as the functioning of the immune system, bone health, and the regulation of expression of genes, depend critically on vitamin D. Considering the significance of vitamin D for health, it is critical to understand how it is metabolized and the factors that affect its levels.

Methods

The objective of this study was to develop and validate an LC-MS/MS method to examine the effects of light exposure and dietary vitamin D consumption on the levels of vitamin D and its metabolites in a mouse model under consistent growth conditions throughout the year. Serum and hair samples from mice were analyzed under various experimental conditions for vitamin D and its metabolites using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The experimental conditions included a vitamin D-deficient diet, a vitamin D-standard diet, and changes in ambient light exposure ranging from complete darkness to a regular light-dark cycle.

Results

Mice fed a standard vitamin D diet and exposed to a regular light-dark cycle exhibited significantly higher levels of 25OHD3 in both serum and hair, indicating the synergistic effect of dietary vitamin D intake and light exposure. Mice fed a standard vitamin D diet but kept in continuous darkness showed moderately elevated 25OHD3 levels, demonstrating the efficacy of dietary vitamin D in maintaining adequate levels despite the absence of light. Conversely, mice fed a vitamin D-deficient diet and housed in darkness displayed 25OHD3 levels below the limit of quantification, highlighting the combined detrimental effects of dietary deficiency and lack of light exposure.

Discussion

This study provides valuable insights into the complex interplay between dietary vitamin D intake, light exposure, and the regulation of vitamin D metabolism in mice. Moreover, our results underscore the potential implications for human health, suggesting the importance of adequate vitamin D intake and sunlight exposure in maintaining optimal vitamin D levels. Further research in this area has the potential to unveil additional factors influencing vitamin D metabolism, offering valuable insights into strategies for optimizing vitamin D levels in both animal models and human subjects.

Roles of vitamins and nutrition in obstructive sleep apnea

INTRODUCTION

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder, with a prevalence that rises alongside with the increasing prevalence of obesity. OSA is characterized by a low-inflammatory state and is followed by cardiovascular and metabolic sequelae. Continuous positive airway pressure (CPAP) represents the cornerstone of treatment for severe OSA. However, poor compliance with CPAP treatment renders OSA treatment a challenging venture. Weight loss and exercise are recommended as adjunctive treatment options for OSA. Several diets have proven to facilitate weight loss, and to alleviate the inflammatory status in patients with OSA. Moreover, several vitamins exhibit antioxidant properties that beneficially affect OSA pathology and reduce the risk of cardiovascular complications.

AREA COVERED

This narrative review aims to summarize the current knowledge regarding the effect of nutrition and vitamin deficiencies on OSA. Included were publications, relevant to the topic, with different types of design (i.e. cross-sectional studies, cohort studies, clinical trials, systematic reviews, meta-analyses, etc.) and indexed in PubMed database until 31 March 2024.

EXPERT OPINION

In addition to weight loss, other food components, such as proteins, carbohydrates, anti-inflammatory agents, vitamins A, B, C, D, E, and sodium, may play a beneficial role in the incidence and severity of OSA.

A beneficial levels of 25-hydroxyvitamin D for a decrease in thyrotropin receptor antibody (TRAB) in patients with Graves' disease: a real-world study

OBJECTIVE

This study aimed to determine whether a relationship exist between pre-therapy 25-hydroxyvitamin D levels and the remission/negative conversion rates of thyrotropin receptor antibody (TRAB) during treatment in patients with newly diagnosed Graves' disease (GD).

METHODS

171 patients were included from the Endocrinology Department of the First Affiliated Hospital of Fujian Medical University in March 2013 to April 2016. Ninety-five patients of them were diagnosed at our hospital but transferred to local hospitals for treatment. Seventy-six patients were followed and treated at our hospital with a median follow-up time of 11.03 (range 6-27) months. Patients were divided into 3 groups according to baseline 25-hydroxyvitamin D levels; <20 ng/mL (31,43.05%), 20-29 ng /mL (20,27.78%), and ≥ 30 ng/mL (20,29.17%). The TRAB remission rate and negative conversion rate was assessed among each group.

RESULTS

There was a higher TSH and lower TRAB titer in the 20-29 ng/mL group at initial diagnosis. Cox regression analysis suggested that 20-29 ng/mL group had significantly higher remission rates [RR; 95% CI: 7.505 (1.401-40.201), 8.975 (2.759-29.196),6.853(2.206-21.285), respectively] and negative conversion rates [RR; 95% CI: 7.835 (1.468-41.804),7.189(1.393-37.092), 8.122(1.621-40.688)] at the 6-, 12-, and 24-month follow-up, respectively . The level of 25-hydroxyvitamin D at the time of initial diagnosis was not associated with the re-normal of free Triiodothyronine(FT3), free thyroxineIndex(FT4) or TSH levels during the follow-up.

CONCLUSION

Newly diagnosed GD patients with appropriate baseline 25-hydroxyvitamin D levels (20-29 ng/mL) are beneficial for the reduction of TRAB during antithyroid therapy.

Prevalence of Hypovitaminosis D in Pregnancy and Potential Benefits of Oral Supplementation

OBJECTIVE

 This study aimed to evaluate prevalence of hypovitaminosis D in a cohort of Italian pregnant women, and to evaluate potential benefits of oral supplementation STUDY DESIGN:  Observational cohort of women with singleton gestations who were referred to our institution for first trimester prenatal visit. Screening for hypovitaminosis D was performed at the time of first trimester routine scan between 11 and 13 weeks of gestations. Women were offered measurement of serum 25-hydroxyvitamin D (25[OH]D). Levels of 25(OH)D are interpreted as follows: 12 to <20 ng/mL: Vitamin D insufficiency; < 12 ng/mL: Vitamin D deficiency. Women with Vitamin D insufficiency or deficiency were offered daily oral supplementation at the dose of 2.000 UI, along with folic acid. The primary outcome was the prevalence of hypovitaminosis D in our cohort.

RESULTS

 During the study period, between January 2023 and January 2024, 250 pregnant women were included in the study and screened for 25(OH)D. More than half of the screened women had 25(OH)D < 20 ng/mL, with a prevalence of <12 ng/mL of 14%. Out of the 140 (140/250 = 56%) women with 25(OH)D < 20 ng/mL, 127/140 (90%) accepted supplementation with Vitamin D, whereas 13 refused the therapy for fear of teratogenic effects of the fetus. The overall rate of preterm delivery before 37 weeks was 8.4%, whereas the incidence of preeclampsia was 2.8%. Rate of preterm delivery was higher in women who did not received supplementation (9.5 vs. 30.8%), but the study was not powered for such comparison.

CONCLUSION

 Hypovitaminosis D has high prevalence in pregnant women. Universal screening in the first trimester with measurement of serum 25-hydroxyvitamin D (25[OH]D) can identify women at risk that may benefit of oral supplementation.

KEY POINTS

· Hypovitaminosis D has high prevalence in pregnant women.. · Universal screening with measurement of serum 25(OH)D can identify women at risk.. · Oral supplementation can be recommended in women with vitamin D insufficiency..

[Vitamin D role in oral cavity diseases]

The purpose of this scientific article is to analyze the scientific literature aimed at identifying the relationship between vitamin D levels in the body and diseases of the oral organs, in order to determine the potential impact of vitamin D deficiency on their development. Special attention is paid to the development of recommendations for maintaining optimal vitamin D levels for various population groups in order to strengthen both general health and prevent diseases of the oral cavity.

Vitamin D and Neurological Health: Unraveling Risk Factors, Disease Progression, and Treatment Potential

This study explores the complex link between vitamin D and neurological illnesses, focusing on how vitamin D affects possible risk factors, therapeutic applications, and the trajectory of the disease. An epidemiological study has linked vitamin D insufficiency to several neurological conditions, including Parkinson's disease, Alzheimer's disease, and multiple sclerosis. It is hypothesized that immunomodulatory and anti-inflammatory properties of vitamin D contribute to its neuroprotective effects. Two major mechanisms in dementia include neuroinflammation and oxidative stress. Adequate levels of vitamin D have been shown in both animal models and human studies to enhance both clinical outcomes and the duration of illness in those who have it. Other ways that vitamin D contributes to its therapeutic potential include the production of neurotrophic factors, control over neurotransmitter synthesis, and preservation of the blood-brain barrier. Despite the encouraging outcomes, research is still being conducted to determine the optimal dosage and long-term benefits of vitamin D supplementation on brain function. In order to furnish precise directives and clarify the processes behind the neuroprotective impacts of vitamin D, future research must focus on large-scale randomized controlled studies. . This study highlights the significance of maintaining adequate levels of vitamin D as a modifiable risk factor for neurological disorders. Further study is also required to comprehend the possible medical benefits of this vitamin fully.

Vitamin D3-VDR and vitamin A-RAR affect IL-13 and IFNγ secretion from human CD4+ T cells directly and indirectly via competition for their shared co-receptor RXR

The effects of vitamin D and vitamin A in immune cells are mediated through the vitamin D receptor (VDR) and retinoic acid receptor (RAR), respectively. These receptors share the retinoid X receptor (RXR) co-factor for transcriptional regulation. We investigated the effects of active vitamin D3 (1,25(OH)2D3) and 9-cis retinoic acid (9cRA) on T helper (TH)1 and TH2 cytokines and transcription factors in primary human blood-derived CD4+ T cells. We aimed to address the discrepancies in this field, particularly regarding the effects of 9cRA and the vitamins in combination. 1,25(OH)2D3 upregulated IL-13 and suppressed IFNγ, while 9cRA had the opposite effects. This was largely independent of a TH1/TH2 phenotype shift. Combined vitamin supplementation produced intermediate cytokine levels, not only through transcriptional regulation by VDR-RXR and RAR-RXR but also through 1,25(OH)2D3 counteracting the effects of 9cRA on solely 9cRA-responsive genes. Similar results were observed in hereditary vitamin D-resistant rickets (HVDRR) patient T cells, where VDR cannot bind to DNA, indicating that RXR binding to either receptor can limit the other's activity. Additionally, we observed downregulated RAR upon 9cRA supplementation and its re-localization out of the nucleus upon 1,25(OH)2D3 supplementation, suggesting a mechanism of indirect regulation by VDR. VDR protein levels were also upregulated upon 9cRA supplementation, suggesting a novel negative feedback mechanism of 9cRA transcriptional activity, whereby 9cRA promotes its own competitor. This study sets the stage for future research into the combined immunomodulatory mechanisms of 1,25(OH)2D3 and 9cRA, involving both direct transcriptional regulation and indirect regulation via RXR competitive binding.

Vitamin D Deficiency as a Risk Factor for Diabetic Retinopathy: A Systematic Review and Meta-Analysis

Diabetic retinopathy (DR), a significant microvascular complication of diabetes mellitus (DM), remains a major cause of vision loss worldwide. Vitamin D, recognized for its role in bone health, has also been implicated in various non-skeletal conditions, including DR. This systematic review analyzed data from 20 studies involving 22,408 participants to explore the relationship between vitamin D levels and DR. Studies were included based on strict eligibility criteria, ensuring they could distinctly classify participants into DR and non-DR groups and provide quantitative measurements of vitamin D levels. Of these, nine studies were included in the meta-analysis. The pooled analysis revealed a significant association between lower vitamin D levels and increased odds of DR, with a combined odds ratio (OR) of 1.15 (95% CI: 1.10-1.20) under the fixed-effects model and 1.17 (95% CI: 1.08-1.27) under the random-effects model. Mean serum vitamin D levels were lower in individuals with DR (18.11 ± 5.35 ng/mL) compared to those without DR (19.71 ± 7.44 ng/mL), with a progressive decline observed across DR severity stages. Subgroup analyses showed significantly lower levels of vitamin D in proliferative DR compared to non-proliferative stages. Heterogeneity (I2 = 89%) was noted, most probably due to geographic differences, varying methodologies for vitamin D measurement, and DR classification approaches. Secondary analyses indicated that vitamin D deficiency prevalence ranged from 27% to 95% in DR populations, highlighting its potential role in disease progression. This review highlights the need for longitudinal studies to better understand the causal relationship. The findings also call attention to a critical gap in the literature regarding the therapeutic role of vitamin D supplementation in preventing and managing DR. Addressing vitamin D deficiency as a modifiable risk factor in DM care may offer new avenues for reducing the burden of DR.

The role of vitamin D in treated and refractory ulcerative colitis patients: a case-control study

BACKGROUND

Ulcerative colitis is a form of chronic inflammatory bowel disease (IBD) marked by ongoing inflammation of the mucosal lining that extends from the rectum to the upper part of the colon. Vitamin D regulates immune responses in several autoimmune and inflammatory diseases, including ulcerative colitis. Therefore, the study aims to investigate the role of vitamin D in the pathogenesis and treatment of ulcerative colitis.

METHODS

This case-control study included 94 participants who were divided into four groups. Group 1: people with ulcerative colitis who responded to treatment (n = 24). Group 2: family members of patients who responded to treatment and did not have the disease (n = 24). Group 3: People with ulcerative colitis who are resistant to treatment (n = 23). Group 4: family members of treatment-resistant patients who does not have the disease (n = 23). Groups 1 and 3 were considered as patient groups (n = 47) and groups 2 and 4 as control groups (n = 47). Blood samples were taken and analyzed for complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum vitamin D levels.

RESULTS

The mean age of treatment-responsive patients (group 1) was 45.88 ± 18.51 years, while treatment-resistant patients (group 3) averaged 41.30 ± 13.01 (P = 0.33) years. Serum Vitamin D levels were 24.96 ± 9.66 ng/mL in group 1 and 27.70 ± 12.28 ng/mL in group 3, showing no significant correlation with ulcerative colitis (P = 0.41). All groups had a BMI within the normal range, and mean CRP levels varied significantly across groups. Hemoglobin was significantly lower in group 3 compared to group 1 (P = 0.029), but ESR results showed no significant relationship with ulcerative colitis. Vitamin D levels were highest in patients with lower BMI, and no significant relationships were found between Vitamin D and other risk factors, although extensive colitis was associated with higher Vitamin D levels compared to distal colitis.

CONCLUSION

In this study, there was no significant association between ulcerative colitis and serum levels of vitamin D. However, the small number of patients may limit the conclusions that can be drawn regarding the role of vitamin D in the treatment of ulcerative colitis. Future studies should aim for larger cohorts to provide more definitive insights into this important issue.

Prevalence of Vitamin D Deficiency Among Adults in Kazakhstan: A Systematic Review and Meta-Analysis

Background and Objectives: Despite frequent references to the high prevalence of vitamin D deficiency in Kazakhstan, a comprehensive synthesis of existing research on this issue among adults is lacking. This systematic review and meta-analysis aim to address this gap by determining the mean prevalence of vitamin D deficiency among adults in Kazakhstan. A secondary objective is to evaluate whether the prevalence differs between healthy adults and those with chronic conditions. Materials and Methods: A systematic search was conducted in PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar by two independent researchers using the keywords: "vitamin D" AND "Kazakhstan", following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported the prevalence of vitamin D in adults in Kazakhstan, defined as a blood level of 25-hydroxyvitamin D 25(OH)D below 20 ng/mL. Results: Seven studies were included in this review, encompassing 3616 individuals, of whom 2239 had vitamin D deficiency. Using a random-effects model, the pooled mean prevalence of vitamin D deficiency among adults with chronic conditions was 60% (95% CI, 38-79%), with high heterogeneity. Similarly, the analysis of five studies involving healthy adults revealed a pooled mean prevalence of 55% (95% CI, 38-70%), also with high heterogeneity. Overall, the pooled mean prevalence of vitamin D deficiency in the adult population was 57% (95% CI, 45-69%). Conclusions: This analysis indicates a high prevalence of vitamin D deficiency among adults in Kazakhstan, with 57% of the population affected. Addressing this issue requires a multifaceted approach, including policy reforms that consider the impact of time zone changes on sunlight exposure and the active involvement of nurse practitioners in preventive strategies.

Triclocarban disrupts the activation and differentiation of human CD8+ T cells by suppressing the vitamin D receptor signaling

Triclocarban (TCC) is a widely applied environmental endocrine-disrupting chemical (EDC). Similar to most of EDCs, TCC potentially damages the immunity of various species. However, whether and how TCC impacts the adaptive immunity in mammals has yet to be determined. Herein, we discovered that TCC disrupts the activation and differentiation of CD8+ T cells in primary human peripheral blood samples, purified CD8+ T cells, and in mice in vivo. Mechanistically, TCC might block the activation of the vitamin D receptor (VDR) and reduce the synthesis of cholesterol, a precursor of vitamin D, resulting in inhibition of VDR signaling due to the suppression of both its ligand and the receptor itself by TCC. Our findings elucidate the hazard and potential mechanisms of TCC in mammalian adaptive immunity and highlighted VDR as a potential therapeutic target for the immunodeficiency caused by TCC.

Vitamin D Supplementation as a Therapeutic Strategy in Autoimmune Diabetes: Insights and Implications for LADA Management

Latent autoimmune diabetes of adults (LADA) is the most prevalent form of autoimmune diabetes (AI-D) in adulthood; however, its accurate diagnosis and optimal treatment remain challenging. Vitamin D deficiency (VDD) is commonly observed in LADA patients, while increased vitamin D exposure through supplementation and dietary intake is associated with a reduced incidence of LADA. Although limited, case reports, case-control studies, and randomized clinical trials have examined the effects of vitamin D supplementation-alone or combined with dipeptidyl peptidase-4 inhibitors (DPP4-is)-on glucose regulation, residual β-cell function, and glutamic acid decarboxylase antibody (GADA65) levels. Findings, while preliminary, indicate that vitamin D supplementation may enhance glycemic control, preserve β-cell function, and reduce autoimmune activity. Given its accessibility, affordability, and relative safety, vitamin D supplementation presents an attractive adjunct treatment option for LADA patients. This narrative review discusses current evidence on the potential therapeutic benefits of vitamin D supplementation in patients with AI-D, including LADA, who are also vitamin D deficient. Beginning with an exploration of the epidemiological patterns, clinical presentation, and diagnostic framework essential for understanding and identifying LADA, this review then examines the proposed mechanisms through which vitamin D may influence autoimmune modulation of pancreatic β-cells, integrating recent data pertinent to LADA pathology. By distilling and consolidating existing research, we aim to provide a platform for advancing targeted investigations within this distinct patient population.

Vitamin D Deficiency: Insights and Perspectives from a Five-Year Retrospective Analysis of Children from Northeastern Romania

BACKGROUND

Vitamin D plays an important role in maintaining bone health with numerous benefits for extraskeletal health as well.

OBJECTIVES

We aimed to assess the prevalence of vitamin D deficiency in children (0-18 years old) in a tertiary hospital in Romania between August 2019 and January 2024 and to investigate the role of adequate supplementation in this vulnerable population.

METHODS

The serum 25(OH)D levels were measured using a chemiluminescence binding assay.

RESULTS

A total of 744 participants were included in this study: 396 female (53.23%) and 348 male (46.77%). The serum levels of 25(OH)D ranged between 2.2 and 125.4 ng/mL, with a mean value of 27.4 ng/mL and a median value of 23.5 ng/mL. According to the cutoff values for the definition of vitamin D status (severe deficiency: <10 ng/mL, deficiency: <20 ng/mL, insufficiency: 20-29 ng/mL, and sufficiency: ≥30 ng/mL), the sample consisted of 77 (10.34%) cases of severe deficiency, 221 (29.7%) cases of deficiency, 194 (26.07%) cases of insufficiency, and 245 (32.93%) cases of sufficiency. There were seven cases of hypervitaminosis D with values above 100 ng/mL. The mean values (and corresponding 95% confidence intervals, CIs) were as follows: 27.85 ng/mL [25.95-29.76] in the males, 22.45 ng/mL [25.12-28.82] in the females, 24.82 ng/mL [21.86-27.77] in the spring, 28.62 ng/mL [26.42-30.81] in the summer, 32.30 ng/mL [29.16-35.44] in the autumn, and 24.01 ng/mL [21.57-26.44] in the winter. We observed a notable decline in the serum 25(OH)D levels with age, with 82.08% of the children in the age group above 6 years old having serum 25(OH)D levels below 30 ng/mL. In obese subjects, a higher prevalence of hypovitaminosis D was observed compared to non-obese subjects, with a mean value of 19.54 [17.50-21.57] ng/mL in obese children versus 28.89 [27.39-30.40] ng/mL in normal weight children.

CONCLUSIONS

In our sample, the mean serum concentration of 25(OH)D was 27.4 ng/mL. Notably, 66.11% of the cases demonstrated varying degrees of hypovitaminosis D, with a significantly higher prevalence of 86.16% observed in the obese group. Healthcare providers should prioritize routine screening for vitamin D levels in pediatric patients with obesity to facilitate timely intervention and personalized supplementation strategies tailored to individual needs.

Association between dietary vitamin D intake and low muscle mass in US adults: results from NHANES 2011-2018

Purpose

To investigate the association between dietary vitamin D intake and low muscle mass (LMM) in a representative adult population, accounting for total energy intake and other potential confounders.

Materials and methods

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) involving 8,443 participants. Dietary vitamin D intake was assessed using 24-h dietary recalls, and LMM was defined based on appendicular lean mass (ALM) adjusted for body mass index (BMI). Multivariable logistic regression models were used to examine the association between quartiles of dietary vitamin D intake and the odds of LMM, adjusting for age, gender, race/ethnicity, BMI, total energy intake, and additional covariates.

Results

In Model 1, after adjusting for age, gender, race/ethnicity, BMI, and poverty-to-income ratio, participants in the highest quartile of vitamin D intake had an odds ratio (OR) of 0.54 (95% CI: 0.37-0.79) compared to the lowest quartile, with a p for trend <0.001. In Model 2, after further adjustment for total energy intake and several covariates, the association was attenuated but remained borderline significant (p for trend = 0.051). In Model 3, after adjusting for additional health-related factors, the OR for the highest quartile was 0.70 (95% CI: 0.47-1.05), with a significant p for trend of 0.029.

Conclusion

This study suggests that higher dietary vitamin D intake may be associated with a reduced risk of LMM. Further longitudinal research is needed to confirm these findings and explore potential interactions between vitamin D and other dietary factors in muscle mass preservation.

Effect of Consuming Salmon Products on Vitamin D Status of Young Caucasian Women in Autumn-A Randomized 8-Week Dietary VISA 2 (Vitamin D in Salmon Part 2) Intervention Study

BACKGROUND/OBJECTIVES

Young women are often at risk of vitamin D deficiency, while fatty fish can provide significant amounts of it, which is especially important when no vitamin D skin synthesis is possible due to limited sunshine exposure. This study aimed to analyze the impact of increasing the intake of salmon in various forms (smoked salmon, salmon sausages) on vitamin D status of young women in autumn.

METHODS

The 8-week intervention involved 120 non-obese women, aged 20-25 years. Participants were randomly assigned to one of three groups: smoked salmon (25 g/day), salmon sausage (100 g/day), or a control group. Both intervention products provided approximately 5 µg of vitamin D daily. Serum concentrations of 25(OH)D as well as vitamin D intakes were assessed pre-, mid-, and post-intervention.

RESULTS

The median vitamin D intake at baseline was 2.7-3.4 µg/day and did not differ between the groups (p > 0.05), while during the intervention, it was highest in the smoked salmon group (p < 0.001) and amounted to 7.3 µg/day. While all groups experienced a decrease in 25(OH)D serum concentrations, the decrease was significantly smaller in the salmon sausage group compared to the control group (-4.3 vs. -15.0 nmol/L, p < 0.05), and no significant difference was observed between the smoked salmon and control group after 8 weeks (p > 0.05). Moreover, in the salmon sausage group, the intervention was more effective among participants with an inadequate vitamin D status at baseline (25(OH)D change after the intervention: -3.0 vs. -5.4 nmol/L, p < 0.05; inadequate vs. adequate baseline vitamin D status).

CONCLUSIONS

Increasing the intake of salmon, and hence of vitamin D, was not enough to maintain the vitamin D status of young women in autumn. It seems that other, not-yet-fully-understood factors, may influence vitamin D absorption and/or metabolism, thereby affecting the outcomes of such interventions indicating that further research is needed. Nevertheless, it may be concluded that increasing salmon sausage intake might aid slow down the natural decline of 25(OH)D in young women in autumn.

Unveiling connections: bisphenol A and vitamin D dynamics in breast milk among healthy lactating mothers

Bisphenol A (BPA) has negative impact on human health. This study aims to explore the association between the levels of BPA and 25(OH) vitamin D in breastmilk. BPA exposure and vitamin D sources were recorded on the study form. Breastmilk 25(OH) vitamin D was measured by the competitive enzyme-linked immunosorbent assay method, and BPA was analyzed by fluorescence detector high pressure liquid chromatography technique. Multiple logistic regression analysis were performed for association. Among 70 lactating mothers, the median 25(OH) vitamin D level was 12.6 ng/mL. In 92.9% of breastmilk samples, detectable levels of BPA were found, with a median BPA concentration of 2.56 ng/mL. However, both univariate and multivariate analyses failed to reveal any association between breastmilk BPA and 25(OH) vitamin D levels. This lack of association in healthy lactating mothers, highlighting the need for further research to comprehensively understand the intricate dynamics of these factors.

Advances in pharmacotherapy for heart failure and reduced ejection fraction: what's new in 2024?

INTRODUCTION

Updated guidelines for heart failure with reduced ejection fraction (HFrEF) and acute decompensation have improved outcomes, but ongoing efforts are focused on uncovering new evidence and developing novel therapies. This review examines the limitations of current treatments and the potential impact of emerging therapies.

AREAS COVERED

A literature search focused on studies investigating drugs for HFrEF. We review recent clinical trials and emerging therapies to assess evidence strength, explore guideline updates, and identify strategies to optimize patient outcomes.

EXPERT OPINION

The HFrEF treatment landscape is rapidly evolving, with advances in therapies like sodium/glucose cotransporter inhibitors and sacubitril-valsartan. Though managing acute decompensated heart failure remains challenging, recent trials suggest improvements in diuretic strategies and anti-inflammatory treatments. Ongoing research is essential for validating these therapies and incorporating them into standard practice.

Update in exploring the connection and clinical implications between vitamin D and knee osteoarthritis

Knee osteoarthritis is a prevalent joint disorder characterized by cartilage degeneration, pain, and impaired physical function. Vitamin D might be implicated in the management of knee osteoarthritis through its effects on bone health, cartilage preservation, inflammation modulation, and muscle function. This literature review aims to synthesize the current state of literature to provide information about the correlation between vitamin D and knee osteoarthritis. Methods: We conducted a comprehensive literature search in databases such as PubMed, Web of Science, Scopus, and Google Scholar to identify studies published in the last ten years investigating the association between vitamin D and knee osteoarthritis. Vitamin D deficiency has been linked to cartilage degeneration and more severe symptomatology of knee osteoarthritis. The evidence supports an association between vitamin D levels and knee osteoarthritis, but with some studies showing mixed results, there is a need for further research.

The Association between Food Groups, Nutraceuticals, and Food Supplements Consumption on Vascular Health Outcomes: A Literature Review

Vascular aging, marked by alterations in the structure and function of blood vessels, including heightened arterial stiffness and impaired endothelial function, is linked to a higher likelihood of developing cardiovascular and age-associated pathological conditions. Oxidative stress and inflammation are key stimulation factors in vascular aging. Engaging in healthy dietary habits could enhance the functioning of blood vessels. The aim of this study was to conduct a literature review of the evidence regarding the relationship between food regimens, nutraceuticals, and dietary supplements and vascular health. A search of electronic databases, including PubMed, Scopus, and Web of Science Core Collection, was performed. Experimental and observational studies evaluating the association between food groups, nutraceuticals, supplements, and endothelial function and/or arterial stiffness were deemed eligible for this narrative review. Based on the current body of the included studies, food groups, nutraceuticals, and dietary supplements may not demonstrate superiority over placebos in enhancing markers of vascular health. To obtain more reliable evidence on the effectiveness of interventions in vascular health, additional RCTs with larger sample sizes, extended follow-up periods, and multi-center participation are necessary. Enhancing the credibility of these RCTs requires better control of dietary variables and more precise measurement of vascular health markers.

Recent Advances in the Use of Vitamin D Organic Nanocarriers for Drug Delivery

Nanotechnology, now established as a transformative technology, has revolutionized medicine by enabling highly targeted drug delivery. The use of organic nanocarriers in drug delivery systems significantly enhances the bioavailability of vitamins and their analogs, thereby improving cellular delivery and therapeutic effects. Vitamin D, known for its crucial role in bone health, also influences various metabolic functions, such as cellular proliferation, differentiation, and immunomodulation, and is increasingly explored for its anticancer potential. Given its versatile properties and biocompatibility, vitamin D is an attractive candidate for encapsulation within drug delivery systems. This review provides a comprehensive overview of vitamin D synthesis, metabolism, and signaling, as well as its applications in customized drug delivery. Moreover, it examines the design and engineering of organic nanocarriers that incorporate vitamin D and discusses advances in this field, including the synergistic effects achieved through the combination of vitamin D with other therapeutic agents. By highlighting these innovations, this review provides valuable insights into the development of advanced drug delivery systems and their potential to enhance therapeutic outcomes.

Confronting the global obesity epidemic: investigating the role and underlying mechanisms of vitamin D in metabolic syndrome management

The escalating prevalence of MetS, driven by global obesity trends, underscores the urgent need for innovative therapeutic strategies. To gain a deeper understanding of the therapeutic potential of vitamin D in addressing MetS, we embarked on a targeted literature review that thoroughly examines the scientific underpinnings and pivotal discoveries derived from pertinent studies, aiming to unravel the intricate mechanisms through which vitamin D exerts its effects on MetS and its components. This article explores the multifunctional role of vitamin D in the management of MetS, focusing on its regulatory effects on insulin sensitivity, lipid metabolism, inflammation, and immune response. Through an extensive review of current research, we unveil the complex mechanisms by which vitamin D influences MetS components, highlighting its potential as a therapeutic agent. Our analysis reveals that vitamin D's efficacy extends beyond bone health to include significant impacts on cellular and molecular pathways critical to MetS. We advocate for further research to optimize vitamin D supplementation as a component of precision medicine for MetS, considering the safety concerns related to dosage and long-term use.

Vitamin D status, vitamin D receptor, CYP2R1, and CYP24A1 profiles in children

Introduction

Vitamin D plays a major role in the musculoskeletal and immune system. Understanding the comprehensive mechanism of vitamin D receptors and the enzyme of vitamin D induction (CYP2R1) and inhibition (CYP24A1) in its metabolism is interesting. This study aims to understand vitamin D metabolism in Indonesian pediatrics, specifically in Jakarta, which has abundant sun exposure.

Methodology

A cross-sectional study with comparative, correlative, and multivariate analysis on vitamin D, vitamin D receptor, CYP2R1, and CYP24A1 levels was conducted on 46 children with no known morbidity.

Result

Subjects were mostly male (52.2%), age group of 2-6 years (34.8%), and had sufficient vitamin D status (43.5%, median 27.55 ng/mL). Age was found to have a negative correlation with vitamin D levels (p < 0.001; r = -0.625) and CYP2R1 (p = 0.035; r = -0.311). Significant positive associations were found between CYP24A1 and CYP2R1 (p = 0.046; r = 0.296). Participants aged 0-2 are more likely to have a higher level of vitamin D status compared to those aged >2 years (OR 42.092, 95% CI [4.532-390.914], p = 0.001). VDR levels were significantly lower in insufficient vitamin D levels than in the sufficient group (p = 0.018). VDR and vitamin D status had a positive relation (OR 7.023, 95% CI [1.864-26.453], p = 0.004).

Conclusion

Vitamin D levels decrease with the increase in age. Vitamin D receptor level has an inline-level progression with vitamin D level. CYP2R1 and CYP24A1 suggest a directly proportional relationship. Vitamin D screening and supplementation in children older than 2 years old are suggested.

Role of Nutrition in the Management of Patients with Multiple Endocrine Neoplasia Type 1

Multiple endocrine neoplasia type 1 (MEN1) is a rare syndrome caused by inactivating mutations in the MEN1 tumor suppressor gene. The three main clinical manifestations of MEN1 are primary hyperparathyroidism (PHPT), duodenal-pancreatic neuroendocrine tumors (DP-NETs) and anterior pituitary tumors. Endocrine tumors in patients with MEN1 differ from sporadic tumors because of their younger age at onset, common multiple presentations and the different clinical course. MEN1 is characterized by a complex clinical phenotype; thus, patients should be followed by a multidisciplinary team of experts that includes an endocrinologist, a surgeon, a oncologist, a radiotherapist, and not least, a nutritionist. It is important to remember the fundamental role that diet plays as a primary prevention tool, together with a healthy and active lifestyle in preventing osteoporosis/osteopenia and reducing the risk of developing kidney stones due to hypercalciuria, two frequent clinical complications in MEN1 patients. Is very important for MEN1 patients to have an adequate intake of calcium, vitamin D, magnesium and phosphate to maintain good bone health. The intake of foods containing oxalates must also be kept under control because in combination with calcium they concur to form calcium oxalate crystals, increasing the risk of nephrolithiasis. Another aspect to consider is the management of patients with pancreatic neuroendocrine tumors undergoing major surgical resections of the pancreas that can lead to alterations in digestion and absorption mechanisms due to partial or total reduction in pancreatic enzymes such as amylase, lipase, and protease, resulting in malabsorption and malnutrition. Therefore, the nutritionist's aim should be to devise a dietary plan that takes into consideration each single patient, educating them about a healthy and active lifestyle, and accompanying them through various life stages by implementing strategies that can enhance their quality of life.

Globally Estimated UVB Exposure Times Required to Maintain Sufficiency in Vitamin D Levels

A paucity of vitamin D is a common deficiency globally, with implications for many aspects of health besides the well-known impact on musculoskeletal health. The two sources of vitamin D are through oral intake, or through endogenous synthesis in the skin when exposed to ultraviolet radiation in sunlight. Assessing nutritional needs, whether by food, food fortification or supplementation, is aided by an understanding of local potential for cutaneous synthesis of the vitamin, dependent on latitude and climate, personal skin type and local culture. To aid these discussions we provide indicative exposure times for the maintenance of vitamin D status as a function of latitude, month and skin type, for the clear-sky case and all-sky conditions, for an ambulatory person wearing modest skirt/shorts and T-shirt. At latitudes greater than ±40 degrees, lack of available sunlight limits vitamin D synthesis in some months for all, while at the equator exposure times range from 3 to 15 min at noontime, for white and black skin, respectively. Rather than a sun exposure prescription, the data are intended to show where nutritional vitamin D intake is necessary, advisable, or can be mitigated by sun exposure, and allows for such advice to be personalized to account for different sub-groups in a multicultural population.

Gender Differences in the Interplay between Vitamin D and Microbiota in Allergic and Autoimmune Diseases

The synergic role of vitamin D and the intestinal microbiota in the regulation of the immune system has been thoroughly described in the literature. Vitamin D deficiency and intestinal dysbiosis have shown a pathogenetic role in the development of numerous immune-mediated and allergic diseases. The physiological processes underlying aging and sex have proven to be capable of having a negative influence both on vitamin D values and the biodiversity of the microbiome. This leads to a global increase in levels of systemic inflammatory markers, with potential implications for all immune-mediated diseases and allergic conditions. Our review aims to collect and analyze the relationship between vitamin D and the intestinal microbiome with the immune system and the diseases associated with it, emphasizing the effect mediated by sexual hormones and aging.

Correction of plasma fat-soluble vitamin levels by blood lipids in elderly patients with coronary heart disease

This study aims to investigate the correlation between plasma fat-soluble vitamin levels and blood lipid in elderly patients with coronary heart disease (CHD). A total of 120 participants were enrolled, including 60 CHD patients and 60 controls without CHD. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to quantify plasma levels of vitamins A, D3, E, and K. Data analysis was conducted using the statistical analysis system module of MetaboAnalyst 5.0. The CHD group showed significantly higher levels of plasma total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) but not high-density lipoprotein cholesterol (HDL-C) compared to controls. The CHD group exhibited significantly higher plasma levels of VA and VE, positively correlating with TC, TG, and LDL-C. After adjusted by TG levels, the CHD group had significantly lower plasma levels of VA and VE, negatively correlating with TC, TG, and LDL-C. The CHD group also had significantly lower concentrations of VD3, independent of TG modification, compared to controls. VD3 negatively correlated with TC, TG, and LDL-C. Elderly individuals with CHD display abnormal blood lipid metabolism, and fat-soluble vitamins adjusted by TG levels can more accurately and timely response to implicit fat-soluble vitamins deficiency in CHD patients.

Comparative Study of Vitamin D Levels in Newly Diagnosed Tuberculosis and a Normal Population

Background and Objectives: Tuberculosis (TB) is an ancient disease caused by Mycobacterium tuberculosis, a member of the Mycobacterium tuberculosis complex. It contributes to significant morbidity and mortality. Treatment of TB poses a considerable challenge because of emerging drug resistance and the longer duration of therapy. Various past studies, both in vitro and in vivo, have established the role of vitamin D in the pathogenesis and treatment of TB. Results of in vivo studies are inconsistent, and this study aims to determine vitamin D levels and their association with newly diagnosed TB (pulmonary and extrapulmonary) cases and normal populations. Material and Methods: A Prospective Case-Control study with 116 subjects (58 cases and 58 controls) was conducted over two years. 29 cases of pulmonary TB and 29 cases of extrapulmonary TB constituted 58 cases of TB. Vitamin D levels were measured and compared in both the cases and controls. Data analysis was carried out using SPSS software 22.0. Results: The prevalence of vitamin D deficiency was 68.96% in the cases, while it was 51.72% in the controls. The reported median and quartile of serum vitamin D levels were 14.35 ng/mL (8.65, 25.48) in the TB group and 19.08 ng/mL (13.92, 26.17) in the control group. There was a significant statistical difference between the TB and non-TB populations with a p-value of 0.029 on the Mann-Whitney test. Conclusion: Vitamin D deficiency was more prevalent in individuals with TB than those without TB.

Induction of autism-related behavior in male mice by early-life vitamin D deficiency: association with disruption of the gut microbial composition and homeostasis

Vitamin D deficiency (VDD) during early life emerges as a potential risk factor for autism spectrum disorder (ASD). Individuals with autism commonly exhibit lower vitamin D (VD) levels compared to the general population, and VD deficiency is prevalent during pregnancy and lactation. Moreover, gastrointestinal comorbidity, prevalent in ASD patients, correlates closely with disruptions in the gut microbiota and altered intestinal permeability. Therefore, it is fascinating and significant to explore the effects of maternal VD deficiency during pregnancy and lactation on the maturation of the gut microbiota of the offspring and its relevance to autism spectrum disorders. In this study, we established maternal pregnancy and lactation VD-deficient mouse models, employed shotgun macrogenomic sequencing to unveil alterations in the gut microbiome of offspring mice, and observed autism-related behaviours. Furthermore, fecal microbial transplantation (FMT) reversed repetitive and anxious behaviours and alleviated social deficits in offspring mice by modulating the gut microbiota and increasing short-chain fatty acid levels in the cecum, along with influencing the concentrations of claudin-1 and occludin in the colon. Our findings confirm that VDD during pregnancy and lactation is a risk factor for autism in the offspring, with disturbances in the structure and function of the offspring's gut microbiota contributing at least part of the effect. The study emphasises the importance of nutrition and gut health early in life. Simultaneously, this study further demonstrates the effect of VDD on ASD and provides potential ideas for early prevention and intervention of ASD.

What is New on Diabetic Neuropathy? Insights from the 2023 ADA and EASD Conferences

Diabetic neuropathy is a common complication of diabetes; yet its pathophysiology is still incompletely understood and until today, there is no specific treatment against it. In the two 2023 large congresses on diabetes (American Diabetes Association, ADA, European Association for the Study of Diabetes, EASD), several high-level studies have been presented. They have attempted to delineate the pathophysiology of DN, the characteristics of affected patients, and future potential treatments. We herein review the presented studies on diabetic neuropathy at these diabetes congresses and discuss the needs for future research on this topic.

Non-indicated vitamin B12- and D-testing among Dutch hospital clinicians: a cross-sectional analysis in data registries

OBJECTIVES

To assess the extent of non-indicated vitamin B12- and D-testing among Dutch clinicians and its variation among hospitals.

DESIGN

Cross-sectional study using registration data from 2015 to 2019.

PARTICIPANTS

Patients aged between 18 and 70 years who received a vitamin B12- or D-test.

PRIMARY AND SECONDARY OUTCOME MEASURES

The proportion of non-indicated vitamin B12- and D-testing among Dutch clinicians and its variation between hospitals (n=68) over 2015-2019.

RESULTS

Between 2015 and 2019, at least 79.0% of all vitamin B12-tests and 82.0% of vitamin D-tests lacked a clear indication. The number of vitamin B12-tests increased by 2.0% over the examined period, while the number of D-tests increased by 12.2%. The proportion of the unexplained variation in non-indicated vitamin B12- and D-tests that can be ascribed to differences between hospitals remained low. Intraclass correlation coefficients ranged between 0.072 and 0.085 and 0.081 and 0.096 for non-indicated vitamin B12- and D-tests, respectively. The included casemix variables patient age, gender, socioeconomic status and hospital size only accounted for a small part of the unexplained variation in non-indicated testing. Additionally, a significant correlation was observed in non-indicated vitamin B12- and D-testing among the included hospitals.

CONCLUSION

Hospital clinicians order vitamin B12- and D-tests without a clear indication on a large scale. Only a small proportion of the unexplained variation could be attributed to differences between hospitals.

Exploring demographical, clinical, and dietary determinants of vitamin D deficiency among adults in Douala, Cameroon during the COVID-19 era

Background and aim

Vitamin D deficiency (VDD) is a global public health problem in African populations. This study aimed at determining the prevalence, characteristics, and determinants of VDD in the era of SARS-CoV-2/COVID-19. This study was conducted from January to September 2022 in seven health facilities in Douala, Cameroon.

Methods

A structured, pre-tested questionnaire was administered to each participant to collect participants' information. Molecular detection of the SARS-CoV-2 genome was done. A serum level of 25-hydroxyvitamin D < 20 ng/mL was used to diagnose VDD.

Results

A total of 420 participants were included in the study. A Serum levels of 25(OH) vitamin D were reduced in SARS-CoV-2 (+) patients as compared to SARS-CoV-2 (-) patients (21.69 ± 5.64 ng/mL vs 42.09 ± 20.03 ng/mL, p < 0.0001). The overall prevalence of VDD was 10.2 %. SARS-CoV-2 (+) individuals had nearly two times more risk of being VDD compared to SARS-CoV-2 (-) individuals (aRR = 1.81, p < 0.0001). The risk of VDD was reduced by 46 % and 71 % in those consuming cocoa bean or powder regularly (aRR = 0.54, p = 0.03) and rarely (aRR = 0.29, p = 0.02) as compared to those never consuming it. Likewise, the risk of VDD was reduced by 59 % and 78 % in those consuming sardine fish regularly (aRR = 0.47, p = 0.002) and rarely (aRR = 0.22, p = 0.03). Overall, the association between VDD and SARS-CoV-2 infection was consistent, i.e., reduced risk of VDD in SARS-CoV-2 (-) individuals, after stratification for confounding variables.

Conclusion

This study outlined a high burden of VDD, a strong link between VDD and SARS-CoV-2, and suggests the possible utility of vitamin D supplementation for COVID-19 patients in Cameroon.

Vitamin D and cancer

The role of vitamin D in the prevention of chronic diseases including cancer, has received a great deal of attention during the past few decades. The term "Cancer" represents multiple disease states with varying biological complexities. The strongest link between vitamin D and cancer is provided by ecological and studies like observational, in preclinical models. It is apparent that vitamin D exerts diverse biological responses in a tissue specific manner. Moreover, several human factors could affect bioactivity of vitamin D. The mechanism(s) underlying vitamin D initiated anti-carcinogenic effects are diverse and includes changes at the muti-system levels. The oncogenic environment could easily corrupt the traditional role of vitamin D or could ensure resistance to vitamin D mediated responses. Several researchers have identified gaps in our knowledge pertaining to the role of vitamin D in cancer. Further areas are identified to solidify the role of vitamin D in cancer control strategies.

Highly selective whole-cell 25-hydroxyvitamin D3 synthesis using molybdenum-dependent C25-steroid dehydrogenase and cyclodextrin recycling

BACKGROUND

The global prevalence of vitamin D (VitD) deficiency associated with numerous acute and chronic diseases has led to strategies to improve the VitD status through dietary intake of VitD-fortified foods and VitD supplementation. In this context, the circulating form of VitD3 (cholecalciferol) in the human body, 25-hydroxy-VitD3 (calcifediol, 25OHVitD3), has a much higher efficacy in improving the VitD status, which has motivated researchers to develop methods for its effective and sustainable synthesis. Conventional monooxygenase-/peroxygenase-based biocatalytic platforms for the conversion of VitD3 to value-added 25OHVitD3 are generally limited by a low selectivity and yield, costly reliance on cyclodextrins and electron donor systems, or by the use of toxic co-substrates.

RESULTS

In this study, we used a whole-cell approach for biocatalytic 25OHVitD3 synthesis, in which a molybdenum-dependent steroid C25 dehydrogenase was produced in the denitrifying bacterium Thauera aromatica under semi-aerobic conditions, where the activity of the enzyme remained stable. This enzyme uses water as a highly selective VitD3 hydroxylating agent and is independent of an electron donor system. High density suspensions of resting cells producing steroid C25 dehydrogenase catalysed the conversion of VitD3 to 25OHVitD3 using either O2 via the endogenous respiratory chain or externally added ferricyanide as low cost electron acceptor. The maximum 25OHVitD3 titer achieved was 1.85 g L-1 within 50 h with a yield of 99%, which is 2.2 times higher than the highest reported value obtained with previous biocatalytic systems. In addition, we developed a simple method for the recycling of the costly VitD3 solubiliser cyclodextrin, which could be reused for 10 reaction cycles without a significant loss of quality or quantity.

CONCLUSIONS

The established steroid C25 dehydrogenase-based whole-cell system for the value-adding conversion of VitD3 to 25OHVitD3 offers a number of advantages in comparison to conventional oxygenase-/peroxygenase-based systems including its high selectivity, independence from an electron donor system, and the higher product titer and yield. Together with the established cyclodextrin recycling procedure, the established system provides an attractive platform for large-scale 25OHVitD3 synthesis.

Vitamin A, D, E, and K as Matrix Metalloproteinase-2/9 Regulators That Affect Expression and Enzymatic Activity

Fat-soluble vitamins (vitamin A, D, E, and K) assume a pivotal role in maintaining human homeostasis by virtue of their enzymatic functions. The daily inclusion of these vitamins is imperative to the upkeep of various physiological processes including vision, bone health, immunity, and protection against oxidative stress. Current research highlights fat-soluble vitamins as potential therapeutics for human diseases, especially cancer. Fat-soluble vitamins exert their therapeutic effects through multiple pathways, including regulation of matrix metalloproteinases' (MMPs) expression and enzymatic activity. As MMPs have been reported to be involved in the pathology of various diseases, such as cancers, cardiovascular diseases, and neurological disorders, regulating the expression and/or activity of MMPs could be considered as a potent therapeutic strategy. Here, we summarize the properties of fat-soluble vitamins and their potential as promising candidates capable of effectively modulating MMPs through multiple pathways to treat human diseases.

Correlation Between Fibrinogen/Albumin and Diabetic Peripheral Neuropathy

Purpose

This study aimed to examine the correlation between fibrinogen/albumin (FAR) and diabetic peripheral neuropathy (DPN).

Patients and Methods

A total of 342 patients were included and categorized into either the DPN group or the Non-DPN (NDPN) group based on their DPN status. The FAR index was determined by calculating the ratio of fibrinogen (FIB) to serum albumin (ALB), multiplied by 100. The participants were then divided into a High-FAR group and a Low-FAR group using the median FAR value as the threshold. Neurophysiological data were collected from the participants, which included motor conduction velocity (MCV) and sensory conduction velocity (SCV).

Results

The DPN group displayed higher FAR levels [(DPN vs NDPN:6.72 (5.89,7.74) vs 5.94±1.14], in addition to slower SCV and MCV data compared to the NDPN group. The high FAR group had a higher prevalence of DPN (78.9% vs 55.6%) (P<0.05). There was a negative correlation between FAR and NCV, including bilateral median nerve SCV, left ulnar nerve SCV, bilateral median nerve MCV, bilateral common peroneal nerve MCV, bilateral tibial nerve MCV, and left ulnar nerve MCV. FAR was revealed to be an independent risk factor for the development of DPN in patients and demonstrated a greater predictive value for DPN development in Type 2 diabetes mellitus (T2DM) compared with FIB, HbA1c.

Conclusion

The results suggest that monitoring FAR levels in patients with T2DM could identify those at higher risk for developing DPN, making the FAR index a valuable predictor of DPN development. Furthermore, since FAR has an inverse relationship with NCV, it stands to reason that high FAR levels may indicate nerve damage and slower conduction velocities. Thus, managing FAR could prove beneficial in both preventing and delaying the onset of DPN in T2DM patients.