Vitamin D's role in health and disease: How does the present inform our understanding of the past?

Exploring the prognostic significance of vitamin D deficiency in pancreatic cancer: Disease progression and survival outcomes

BACKGROUND

Pancreatic cancer remains one of the most aggressive malignancies with limited treatment options and poor survival rates. Vitamin D deficiency has been suggested to influence cancer progression and survival outcomes in various malignancies.

AIM

This study aimed to investigate the association between Vitamin D deficiency and disease progression as well as survival in patients diagnosed with pancreatic cancer.

METHODS

A retrospective cohort study was conducted, including 151 patients diagnosed with pancreatic cancer between 2012 and 2022. Serum Vitamin D levels at the time of diagnosis were measured. Disease progression was evaluated through radiological assessments and clinical reports. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were analyzed using Kaplan-Meier survival curves and Cox proportional hazards regression models.

RESULTS

Of the 151 patients, 84 (56 %) were identified as Vitamin D deficient at the time of diagnosis. The deficient group exhibited a significantly higher frequency of advanced-stage disease (stages III and IV) compared to the non-deficient group (p < 0.05). During the follow-up period, 66 (78.6 %) of Vitamin d-deficient patients and 56 (84.8 %) of non-deficient patients experienced disease progression (p = 0.51). Moreover, Kaplan-Meier analysis showed a non-significant trend toward shorter median PFS (8.95 months vs. 9.27 months, p = 0.51) and OS (17.64 months vs. 19.05 months, p = 0.616) in the Vitamin d-deficient group.

CONCLUSION

Vitamin D deficiency is prevalent among patients with pancreatic cancer and appears to be associated with more advanced disease at diagnosis. Although a trend toward poorer survival outcomes was observed, the association between Vitamin D deficiency and OS/PFS did not reach statistical significance. Additional prospective studies are needed to confirm these findings and explore potential benefits of Vitamin D supplementation in pancreatic cancer management.

Rickets, resorption and revolution: An investigation into the relationship between vitamin D deficiency in childhood and osteoporosis in adulthood in an 18th-19th century population

OBJECTIVE

This study employs a Developmental Origins of Health and Disease (DOHaD) approach to assess the effect of vitamin D deficiency (VDD) in childhood on the risk of osteoporosis in adulthood in an archaeological sample of skeletons dating from the 18th to 19th centuries.

MATERIALS

Femora and lumbar vertebrae of 65 adults aged 18+ years (26 diagnosed with residual rickets and 39 without) from an 18th-19th century Quaker burial ground at Coach Lane, North Shields, England.

METHODS

Bone mineral density (BMD) was measured for the femoral neck and first four lumbar vertebrae of each individual using a dual energy X-ray absorptiometry (DXA) scanner as a proxy for assessing osteoporotic fracture risk.

RESULTS

3-way ANOVA revealed no statistically significant differences in BMD between individuals with and without residual rickets across age and sex.

CONCLUSIONS

A combination of lifestyle and environmental factors likely influenced the BMD of people buried at Coach Lane across the life course. The impact of childhood VDD on BMD later in life can be mitigated through other factors such as physical activity and diet.

SIGNIFICANCE

This is one of the first bioarchaeological studies to take a DOHaD approach to understand osteoporosis risk in 18th-19th century England. It highlights the complexity of aetiological factors for osteoporosis and that VDD in early life does not necessarily predispose a person to osteoporosis in adulthood.

LIMITATIONS

BMD is not the only indicator of osteoporosis. Microscopic methods for the assessment of childhood vitamin D deficiency, such as inter-globular dentine analysis, were not applied.

High-dose oral vitamin D supplementation for prevention of infections in children aged 0 to 59 months: a systematic review and meta-analysis

CONTEXT

Vitamin D plays an important role in immune function, and the deficiency thereof has been associated with several infections, most notably respiratory tract infections. However, data from intervention studies investigating the effect of high-dose vitamin D supplementation on infections have been inconclusive.

OBJECTIVE

The aim of this study was to evaluate the level of evidence regarding the efficacy of vitamin D supplementation above the standard dose (400 IU) in preventing infections in apparently healthy children < 5 years of age.

DATA SOURCES

PubMed, Scopus, Science Direct, Web of Science, Google Scholar, CINAHL, and MEDLINE electronic databases were searched between August 2022 and November 2022. Seven studies met the inclusion criteria.

DATA EXTRACTION

Meta-analyses of outcomes in more than one study were performed using Review Manager software. Heterogeneity was evaluated using the I2 statistic. Randomized controlled trials in which vitamin D was supplemented at > 400 IU compared with placebo, no treatment, or standard dose were included.

DATA ANALYSIS

Seven trials that enrolled a total of 5748 children were included. Odds ratios (ORs) with 95%CIs were calculated using random- and fixed-effects models. There was no significant effect of high-dose vitamin D supplementation on the incidence of upper respiratory tract infection (OR, 0.83; 95%CI, 0.62-1.10). There was a 57% (95%CI, 0.30-0.61), 56% (95%CI, 0.27-0.07), and 59% (95%CI, 0.26-0.65) reduction in the odds of influenza/cold, cough, and fever incidence, respectively, with daily supplementation of vitamin D > 1000 IU. No effect was found on bronchitis, otitis media, diarrhea/gastroenteritis, primary care visits for infections, hospitalizations, or mortality.

CONCLUSION

High-dose vitamin D supplementation provided no benefit in preventing upper respiratory tract infections (moderate certainty of evidence) but reduced the incidence influenza/cold (moderate certainty of evidence), cough, and fever (low certainty of evidence). These findings are based on a limited number of trials and should be interpreted with caution. Further research is needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42022355206.

[Vitamin D deficiency in patients with epilepsy: consideration to take into account]

Introduction

Effect of Medically Supervised Prolonged Fasting Therapy on Vitamin D, B12, Body Weight, Body Mass Index, Vitality and Quality of Life: A Randomized Control Trial

Background

Recent research indicates prolonged fasting for more than 7 days is beneficial in priming the vitamin D metabolism. However, methodological limitations in previous studies, such as insufficient sample size and a lack of control group, limits its generalizability. The present study evaluated the impact of prolonged fasting (10 days) on vitamin D, vitamin B12, body mass index (BMI), weight, hemoglobin, vitality and quality of life (QoL) compared to a normal diet.

Methods

This randomized control trial was conducted in an in-patient private yoga and naturopathy setting between February and April 2022. A total of 52 participants (mean age 51.57 ± 13.67 years) with varying medical conditions were randomized into a fasting group (FG) or a normal diet group (NDG) with 26 participants in each group. The FG was on a fasting diet (500 kCal/day) which included holy basil herbal tea, lemon honey water, and water (3 L). The NDG (1500 kCal/day) consumed a routine diet that included Indian bread, pulses, steamed rice, vegetable salads, and beverages.

Results

The FG has shown significant increase in the Vitamin D levels (P = .003, d = 0.475), vitality (P = .006, d = 0.425), physical QoL (P < .001, d = 0.549), psychological QoL (P = .002, d = 0.488), and environmental QoL (P = .004, d = 0.457) compared to NDG. No significant changes were observed in vitamin B12, weight, BMI, haemoglobin, and social QoL. A weak to moderate (ρ = 0.330-0.483) positive correlation was observed between vitality scores and QoL domains, whereas BMI scores showed an inverse correlation (ρ = -.280) with vitamin D levels.

Conclusion

The results suggest that prolonged fasting for 10 days can improve vitamin D levels, improve vitality, and promote quality of life compared to a normal diet. Unlike previous studies, the FG does not differ from the NDG concerning weight and BMI. Nevertheless, fasting may be utilized as an effective tool to tackle vitamin D deficiency and associated health insufficiencies.

Health effects of European colonization: An investigation of skeletal remains from 19th to early 20th century migrant settlers in South Australia

The British colony of South Australia, established in 1836, offered a fresh start to migrants hoping for a better life. A cohort of settlers buried in a section of St Mary’s Anglican Church Cemetery (1847–1927) allocated for government funded burials was investigated to determine their health, with a focus on skeletal manifestations associated with metabolic deficiencies. Findings of St Mary’s sample were compared with those published for contemporary skeletal samples from two British cemeteries, St Martin’s, Birmingham, and St Peter’s, Wolverhampton, to explore similarities and differences. To investigate the changing economic background of the St Mary’s cohort, which may have influenced the location of their burial within the cemetery, the number and demographic profile of government funded burials and those in privately funded leased plots were compared. The study sample consisted of the skeletal remains of 65 individuals (20 adults, 45 subadults) from St Mary’s Cemetery ‘free ground’ section. The bones and teeth of individuals in this cohort showed evidence of pathological manifestations, including areas of abnormal porosity in bone cortices in 9 adults and 12 subadults and flaring of metaphyses (one subadult) and costochondral junctions of the ribs (one subadult). Porous lesions of orbital roof bones (Types 3 to 4) were seen on three subadults. Macroscopic examination of teeth identified enamel hypoplastic defects and micro-CT scans showed areas of interglobular dentine. Comparison of St Mary’s findings with the British samples revealed that prevalences of manifestations associated with vitamin C deficiency were higher at St Mary’s and manifestations associated with vitamin D deficiency were lower respectively. The location of burial pattern at St Mary’s Cemetery, from the mid-1840s to1860s, showed differences in the economic status of migrants. This pattern changed from the 1870s, which reflected improvements in the local economy and the economic recovery of the colony.

Vitamin D Counteracts Lipid Accumulation, Augments Free Fatty Acid-Induced ABCA1 and CPT-1A Expression While Reducing CD36 and C/EBPβ Protein Levels in Monocyte-Derived Macrophages

The biologically active form of vitamin D, calcitriol (VD3), has received great attention for its extraskeletal effects, such as a protective role on the cardiovascular system. The aim of the present work is to test the capacity of VD3 to affect lipid metabolism and fatty acid accumulation in an in vitro model of monocyte (THP-1)-derived macrophages. Cells were treated for 24 h with oleic/palmitic acid (500 μM, 2:1 ratio) and different VD3 concentrations (0.1, 1, 10, 50 and 100 nM). Lipid accumulation was quantified spectrophotometrically (excitation: 544 nm, emission: 590 nm). C/EBPβ, PPAR-γ1, CD36, CPT-1A, and ABCA1 protein levels were assessed by ELISA kits at different time-points (1, 2, 4, 8, and 24 h). VD3 at 50 and 100 nM significantly reduced fatty acids accumulation in macrophages by 27% and 32%, respectively. In addition, tested at 50 nM, VD3 decreased CD36, PPAR-γ1, and C/EBPβ, while it increased ABCA1 and CPT-1A protein levels in free fatty acid-exposed cells. In conclusion, VD3 reduced fatty acid accumulation in THP-1-derived macrophages exposed to lipid excess. The anti-atherogenic effect of VD3 could be ascribable to the regulation of proteins involved in lipid transport and clearance.

Influence of Sunlight on Vitamin D and Health Status in Green (Chelonia mydas) Sea Turtles with Fibropapillomatosis

Simple Summary

Green sea turtles are an endangered species prone to a disease called fibropapillomatosis (FP). FP causes the growth of large debilitating tumors on the skin, eyes, and shell of sea turtles. Sea turtle rehabilitation facilities often treat turtles with this disease by removing the tumors, but many of these individuals do not survive or the tumors regrow. A way to improve the treatment of these turtles could help the population as a whole. The aim of this study was to compare plasma vitamin D levels in green sea turtles with and without evident FP tumors, as vitamin D influences immune function and overall health. We determined that exposure to more sunlight influences plasma vitamin D levels in sea turtles brought into a rehabilitation facility. We found that tumored individuals arriving at the facility had lower vitamin D and ionized calcium levels and higher parathyroid hormone levels compared to both wild-caught and rehabilitation turtles without evident tumors. Individuals housed in tanks exposed to greater ultraviolet (UV) (sun)light showed greater increases in plasma vitamin D levels and a more successful recovery. The results suggest that increasing sun exposure in rehabilitation facilities may enhance health and recovery in green turtles with FP.

Abstract

Green sea turtles (Chelonia mydas) are an endangered species, which as juveniles are prone to the debilitating disease green turtle fibropapillomatosis (FP). Previous work has shown an association between reduced immune function and FP. As vitamin D has been linked to immune function in numerous animals, the aim of this study was to compare vitamin D levels in green sea turtles with and without evident FP and determine if exposure to sunlight would influence vitamin D levels and other health parameters. Various health markers, including vitamin D, in turtles with and without evident tumors being treated at a rehabilitation facility in southeast Florida were compared to apparently healthy wild-caught juvenile green turtles. Turtles receiving treatment were housed in tanks exposed to higher or lower levels of sunlight for up to 6 months. Upon intake, tumored individuals had lower plasma vitamin D and ionized calcium levels and higher parathyroid hormone levels when compared to both wild-caught and rehabilitation turtles without evident tumors. Individuals exposed to greater sunlight showed greater increases in plasma vitamin D and a more successful recovery. The results suggest that increasing sun exposure in rehabilitation facilities may enhance health and recovery in green turtles with FP.

Generic SFC-MS methodology for the quality control of vitamin D3 oily formulations

Vitamin D₃ is a key micronutrient whose intakes are inadequate for most populations worldwide. Supplementation with medicines or food supplements is commonly prescribed to correct this imbalance and the quality of these products must be ensured. In this context, a generic methodology for the assay of vitamin D₃ in oily formulations is proposed using supercritical fluid chromatography coupled to mass spectrometry (SFC-MS). It is in line with green analytical chemistry principles and combines the use of i) a fast and robust analytical method (4.0 min analysis time) ii) an easy sample preparation compatible with high throughput analysis ("dilute-and-shoot" approach) and iii) a relevant control strategy. Seventeen products from multiple manufacturers and encompassing a large content range were evaluated in this study. They were classified in four groups to streamline their processing considering the use of a matrix-matched calibration procedure. Matrix effect was thoroughly studied and was found to be low (99-106%), stable intra/inter-series and comparable between the different groups and types of matrices. The implemented control strategy was based on a three-level system suitability tests (SST). Level 1 SST: resolution of the critical pair that was above 1.5 for all analysis series. Level 2 SST: evaluation of the adequacy of the calibration for a QC sample in terms of recovery that was between 97% and 104% with a variability between 1% and 2%. Level 3 SST: method trueness that was between 95% and 102%. Sample analysis highlighted differences in types of products and dosage forms. This is the first study to propose a complete strategy for the quality control of vitamin D₃ oily formulations and should prove useful in QC laboratories.

Does vitamin D status influence lumbar disc degeneration and low back pain in postmenopausal women? A retrospective single-center study

OBJECTIVE

To investigate the relationship between serum vitamin D concentration and lumbar disc degeneration (LDD) in postmenopausal women and the epidemiologic factors affecting low back pain (LBP).

METHODS

Between July 2017 and December 2018, 232 participants were retrospectively enrolled. Serum concentrations of bone turnover markers were measured using electrochemiluminescence assays. Disc degeneration was evaluated using the Pfirrmann grading system. Other variables were assessed using relevant questionnaires.

RESULTS

The mean age of the women was 65.6 ± 10.1 and their serum 25(OH)D concentrations were 19.38 ± 9.21 ng/mL. The prevalences of severe vitamin D deficiency (<10 ng/mL) and normal status (>30 ng/mL) were 12.9% and 12.5%, respectively. The severely deficient group had higher visual analog scale (VAS) scores for LBP (P = 0.002) and lower bone mineral density T scores (P = 0.004) than the other groups. Lower 25(OH)D concentration (<10 ng/mL) was significantly associated with more severe LDD in the lumbosacral region (L4-S1, L1-S1, P < 0.05), but less so in the upper lumbar region. There was an inverse relationship between vitamin D concentration and the severity of disc degeneration (L2-L3, L4-S1, L1-S1, P < 0.05). After adjustment for confounding factors, smoking, vitamin D deficiency, lack of vitamin D supplementation, high body mass index, and low bone mineral density T score were associated with higher incidence of moderate-to-severe pain in postmenopausal women (P < 0.05).

CONCLUSIONS

Vitamin D deficiency is associated with LDD and LBP in postmenopausal women. Specifically, a serum vitamin D concentration < 10 ng/mL is a marker of severe LDD and LBP. Smoking, severe vitamin D deficiency, lack of vitamin D supplementation, high body mass index, and osteoporosis are associated with a higher prevalence of moderate-to-severe pain.

Vitamin D improves pulmonary function in a rat model for congenital diaphragmatic hernia

A congenital diaphragmatic hernia (CDH) is an anomaly caused by defects in the diaphragm; the resulting limited thorax cavity in turn restricts lung growth (pulmonary hypoplasia). This condition is related to pulmonary hypertension. Despite advances in neonatal CDH therapy, the mortality for severe pulmonary hypoplasia remains high. Therefore, it is essential to establish prenatal therapeutic interventions. Vitamin D was reported to have beneficial effects on adult pulmonary hypertension. This study aims to evaluate the efficacy of prenatal vitamin D administration for CDH. First, serum 25-hydroxyvitamin D [25(OH)D] levels in umbilical cord blood were evaluated among CDH newborns. Second, Sprague Dawley rat CDH models were exposed to nitrofen on embryo day 9 (E9). Randomly selected rats in the nitrofen-treated group were infused with calcitriol from E9 to E21. Samples from CDH pups diagnosed after birth were used for lung weight measurements, blood gas analysis, and immunohistochemical analysis. Third, microarray analysis was performed to examine the effect of vitamin D on gene expression profiles in CDH pulmonary arterial tissues. Serum 25(OH)D levels in the umbilical cord blood of newborns who did not survive were significantly lower than those who were successfully discharged. Prenatal vitamin D showed no significant effect on CDH incidence or lung weight but attenuated alveolarization and pulmonary artery remodeling accompanied the improved blood gas parameters. Vitamin D inhibited several gene expression pathways in the pulmonary arteries of CDH rats. Our results suggest that prenatal vitamin D administration attenuates pulmonary vascular remodeling by influencing several gene pathways in CDH.

Intersectionality and trauma analysis in bioarchaeology

Intersectionality, the theory named by Kimberlé Crenshaw, outlines how multiple elements of an individual's social identity overlap to create and preserve societal inequalities and discrimination. Recently bioarchaeology's engagement with intersectionality has become increasingly explicit, as the field recognizes the lived experience of multiple axes of an individual's identity. Evidence of trauma can remain observable in an individual's skeleton for years, making it an ideal subject of study for intersectional analyses in bioarchaeology. Using contrasting case studies of two individuals who died in hospitals and were unclaimed after death, we explore the theoretical and methodological application of intersectionality to investigations of accidental and interpersonal trauma. Differences in identities and structural inequalities affect bone quality and health outcomes. As we demonstrate, a broken bone is the intersecting result of biological, histomorphological, sociocultural, and behavioral factors. This approach allows for a better acknowledgement of the inherent complexity of past lives, elevating and amplifying previously silenced voices. In this way, intersectionality in bioarchaeology demands social justice.

Role of vitamin D in the pathogenesis of atheromatosis

BACKGROUND AND AIMS

Cardiovascular disease is the main cause of death worldwide, but the collective efforts to prevent this pathological condition are directed exclusively to individuals at higher risk due to hypercholesterolemia, hypertension, obesity, diabetes. Recently, vitamin D deficiency was identified as a risk factor for cardiovascular disease in healthy people, as it predisposes to different vascular dysfunctions that can result in plaque development and fragility. In this scenario, the fundamental aim of the study was to reproduce a disease model inducing vitamin D deficiency and atheromatosis in ApoE-/- mice and then to evaluate the impact of this vitamin D status on the onset/progression of atheromatosis, focusing on plaque formation and instability.

METHODS AND RESULTS

In our murine disease model, vitamin D deficiency was achieved by 3 weeks of vitamin D deficient diet along with intraperitoneal paricalcitol injections, while atheromatosis by western-type diet administration. Under these experimental conditions, vitamin D deficient mice developed more unstable atheromatous plaques with reduced or absent fibrotic cap. Since calcium and phosphorus metabolism and also cholesterol and triglycerides systemic concentration were not affected by vitamin D level, our results highlighted the role of vitamin D deficiency in the formation/instability of atheromatous plaque and, although further studies are needed, suggested a possible intervention with vitamin D to prevent or delay the atheromatous disease.

CONCLUSIONS

The data obtained open the question about the potential role of the vitamins in the pharmacological treatments of cardiovascular disorders as coadjutant of the primary drugs used for these pathologies.

An Investigation of Micro-CT Analysis of Bone as a New Diagnostic Method for Paleopathological Cases of Osteomalacia

OBJECTIVE

This paper looks to broaden the methodological possibilities for diagnosing osteomalacia in archaeological bone using micro-CT analysis. Increasing the identification of osteomalacia in paleopathology will provide support for important interpretive frameworks.

MATERIALS

Nine embedded and two unembedded rib fragments were sourced from St. Martin's Birmingham and Ancaster, UK, and Lisieux Michelet, France. Of the 11 samples, nine were previously confirmed as osteomalacic, and presented with varying levels of diagenesis and two were non-osteomalacic controls, one of which exhibits diagenetic change.

METHODS

Micro-CT, backscattered scanning electron microscopy, and light microscopy were employed. Micro-CT images were evaluated for osteomalacic features using corresponding microscopic images.

RESULTS

Micro-CT images from osteomalacic samples demonstrated the presence of defective mineralization adjacent to cement lines, areas of incomplete mineralization, and resorptive bays/borders, three key diagnostic features of osteomalacia. Diagenetic change was also detectable in micro-CT images, but did not prevent the diagnosis of osteomalacia.

CONCLUSIONS

Micro-CT analysis is a non-destructive method capable of providing microstructural images of osteomalacic features in embedded and unembedded samples. When enough of these features are present, micro-CT images are capable of confirming a diagnosis of osteomalacia.

SIGNIFICANCE

Vitamin D deficiency has important health consequences which operate throughout the life course. Increasing the ability to detect cases of vitamin D deficiency provides researchers with a greater understanding of health and disease in past communities.

LIMITATIONS

Only adult rib samples were used.

SUGGESTIONS FOR FURTHER RESEARCH

Paleopathologists should look to test the utility of micro-CT analysis in diagnosing active rickets in subadult individuals.

IMMUNOMODULATORY ROLE OF VITAMIN D: CLINICAL IMPLICATIONS IN INFECTIONS AND AUTOIMMUNE DISORDERS

Vitamin D exerts its well-known effects on bone health and calcium-phosphate homeostasis primarily through the vitamin D receptor signaling pathway. Vitamin D also has several extra-skeletal actions and its deficiency is not only implicated in musculoskeletal disorders, but also cardiovascular disorders, diabetes, neurodegenerative conditions and cancers. There is a growing body of research highlighting the link of vitamin D deficiency and alterations in vitamin D signaling with certain infections and autoimmune disorders although the evidence is inconsistent and inconclusive. Vitamin D has been suggested to play a fundamental role in curbing infections and mitigating autoimmune disease processes. The present review was undertaken to explore the promise of vitamin D as a protective agent and a clinically useful therapeutic adjunct against infections and autoimmune diseases and identify knowledge gaps and limitations of the available data for informing future work. An exhaustive search was conducted in established databases including Google Scholar, PubMed, Science Direct and Springer for articles published on vitamin D, immunity, infection and autoimmune disorders. All relevant articles published in the English language between the year 200 and 2020 were retrieved for writing the review. Although a considerable body of evidence highlighting the potential clinical benefits of vitamin D against the development of various autoimmune conditions and for the prevention of infections has emerged over the last decade, the findings are limited by the lack of appropriately designed randomized controlled trials which are needed to formulate precise clinical recommendations.

Using teeth as tools: Investigating the mother-infant dyad and developmental origins of health and disease hypothesis using vitamin D deficiency

OBJECTIVES

With a growing interest in the mother-infant dyad and the Developmental Origins of Health and Disease hypothesis among biological and medical anthropologists, this study set out to provide all the information required to evaluate if mineralization defects in dentine might be caused by vitamin D deficiency in the critical first 1000 days of life.

MATERIALS AND METHODS

Information was compiled on dentine formation in utero to approximately 18 years, and a method for determining the location of the neonatal line in dentine was devised, allowing the assessment of the prenatal and early life period. Re-evaluation of previously analyzed teeth (n = 61) was undertaken with detailed examination of n = 5/22 first permanent molars forming in the prenatal and critical early life periods.

RESULTS

First permanent molars and all deciduous teeth give information on intrauterine development and on the first 1000 days postnatally providing a direct window on maternal and fetal health. Three archaeological individuals had interglobular dentine that formed prenatally suggesting that their mothers experienced vitamin D deficiency at the time dentine was forming and all other individuals had a deficiency during the first 1000 days of life. Conditions that could cause systemic mineralization defects were determined, and in each, case they were found to be consistent with vitamin D deficiency.

DISCUSSION

The neonatal line serves as a clear baseline for determining prenatal and postnatal events, particularly those related to vitamin D, calcium, and phosphate metabolism, and can be used to investigate the maternal-infant dyad for both past and present communities.

Serum 25-hydroxyvitamin-D and nonalcoholic fatty liver disease: Does race/ethnicity matter? Findings from the MESA cohort

BACKGROUND AND AIMS

Low serum 25-hydroxyvitamin D (25(OH)D) is associated with higher nonalcoholic fatty liver disease (NAFLD) risk in studies of mainly white participants. Significant racial/ethnic differences exist in serum 25(OH)D and NAFLD prevalence questioning extending this association to other racial/ethnic groups. We tested whether the association between serum 25(OH)D and NAFLD vary by race/ethnicity.

METHODS AND RESULTS

This was a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) that included 3484 participants (44% male; 38.4% Whites, 27.8% African-Americans, 23.5% Hispanics, and 10.3% Chinese-Americans) who had serum 25(OH)D and upper abdominal CT images available at baseline. Serum 25(OH)D was measured by high-performance liquid chromatography-tandem mass spectrometry. NAFLD was identified if liver-to-spleen Hounsfield-Unit ratio was <1. Whites had the highest 25(OH)D level and African-Americans had the lowest level (mean ± SD: 29.5 ± 10.4 vs.19.9 ± 9.1, respectively). Six hundred and eleven (17.5%) participants had NAFLD; Hispanics had the highest prevalence (26.2%) followed by Chinese-Americans (19.8%), Whites (15.8%) and African-Americans (11.7%), P < 0.0001. In adjusted model, the association of 25(OH)D with NAFLD differed by race/ethnicity (P < 0.0001). Negative association was only evident in Causations (OR (95% CI):1.23 (1.03, 1.47) per 1 SD lower serum 25(OH)D). For other racial/ethnic groups, BMI, triglycerides, diabetic status and/or smoking, but not serum 25(OH)D, were common independent risk factors for NAFLD.

CONCLUSIONS

The negative association between serum 25(OH)D and NAFLD in Whites may not be broadly generalizable to other racial/ethnic groups. Modifiable risk factors including BMI, triglycerides, diabetic status and/or smoking associate with NAFLD risk in non-white racial/ethnic groups beyond 25(OH)D.

Potential Beneficial Effects of Vitamin D in Coronary Artery Disease

Vitamin D plays a pivotal role in bone homeostasis and calcium metabolism. However, recent research has indicated additional beneficial effects of vitamin D on the cardiovascular system. This review aims to elucidate if vitamin D can be used as an add-on treatment in coronary artery disease (CAD). Large-scale epidemiological studies have found a significant inverse association between serum 25(OH)-vitamin D levels and the prevalence of essential hypertension. Likewise, epidemiological data have suggested plasma levels of vitamin D to be inversely correlated to cardiac injury after acute myocardial infarction (MI). Remarkably, in vitro trials have showed that vitamin D can actively suppress the intracellular NF-κB pathway to decrease CAD progression. This is suggested as a mechanistic link to explain how vitamin D may decrease vascular inflammation and atherosclerosis. A review of randomized controlled trials with vitamin D supplementation showed ambiguous results. This may partly be explained by heterogeneous study groups. It is suggested that subgroups of diabetic patients may benefit more from vitamin D supplementation. Moreover, some studies have indicated that calcitriol rather than cholecalciferol exerts more potent beneficial effects on atherosclerosis and CAD. Therefore, further studies are required to clarify these assumptions.

Nutritional vitamin D in CKD: Should we measure? Should we treat?

Vitamin Ddeficiency is frequently present in patients affected by chronic kidney disease (CKD). Experimental studies demonstrated that Vitamin D may play a role in the pathophysiology of diseases beyond mineral bone disorders in CKD (CKD-MBD). Unfortunately, the lack of large and interventional studies focused on the so called "non-classic" effects of 25(OH) Vitamin D supplementation in CKD patients, doesn't permit to conclude definitely about the beneficial effects of this supplementation in clinical practice. In conclusion, treatment of nutritional vitamin D deficiency in CKD may play a central role in both bone homeostasis and cardiovascular outcomes, but there is not clear evidence to support one formulation of nutritional vitamin D over another in CKD.

An update on the problem of osteoporosis in people with epilepsy taking antiepileptic drugs

INTRODUCTION

Antiepileptic drugs (AEDs) have been associated with a negative impact on bone health. Comorbid disorders in patients with epilepsy may require drugs exerting a pro-osteoporotic effect, so a possibility of untoward interactions with AEDs is probable.

AREAS COVERED

This review discusses evidence related to the deteriorating influence of AEDs on bone, demonstrating generally stronger negative effects of conventional AEDs. Lamotrigine seems to be a safer AED in this regard. Further, literature data indicate that generally AEDs can lower the serum concentration of vitamin D. Importantly, pediatric patients are of greater risk of bone problems during therapy with AEDs, which is probably due to their effects on bone-forming processes.

EXPERT OPINION

Supplementation with vitamin D and calcium is frequently recommended in patients taking AEDs chronically. Whether to add a bisphosphonate remains an open question due to the limited data on this issue. A possibility of negative interactions exists between AEDs and other pro-osteoporotic drugs: glucocorticoids, proton pump inhibitors and aromatase inhibitors. Depression is a frequent comorbidity in patients with epilepsy. Clinical data indicate that antidepressant drugs may also increase the risk of fractures. Again, patients with epilepsy and depression may be exposed to a greater risk of osteoporosis.