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Concerto C, Rodolico A, Ciancio A, Messina C, Natale A, Mineo L, Battaglia F, Aguglia E. Vitamin D and Depressive Symptoms in Adults with Multiple Sclerosis: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:199. [PMID: 35010459 PMCID: PMC8750302 DOI: 10.3390/ijerph19010199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Vitamin D deficiency has been correlated with Multiple Sclerosis (MS) risk and disease activity. There is some controversy as to whether vitamin D could have an impact on depressive symptoms in people with MS (pwMS). The aim of this scoping review was to evaluate the association between vitamin D status and depressive symptoms in pwMS. METHODS We searched databases to include studies published up to March 2021 to provide an overview of the available evidence on the correlation between vitamin D status and depressive symptoms in pwMS. The eligibility criteria were as follows: studies evaluating the use of vitamin D measurement on depressive symptoms in patients suffering from MS, including randomized and non-randomized studies; studies written in English; and studies exploring an adult population over the age of 18. RESULTS Eleven studies met our inclusion criteria: two of them were abstracts only; the majority were cross-sectional studies; two were prospective longitudinal studies; one was a retrospective cohort study; and one was a randomized placebo-controlled trial (RCT). Of the eleven studies selected, seven showed a potential correlation between low vitamin D levels and depressive symptoms. CONCLUSION Future RCT studies should include patients with greater severity of depressive symptoms and should consider confounding factors such as sun exposure and seasonal variation of vitamin D.
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Affiliation(s)
- Carmen Concerto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Alessandro Rodolico
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Alessia Ciancio
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Christian Messina
- MS Center, Department “G.F. Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy;
| | - Antimo Natale
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Ludovico Mineo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Fortunato Battaglia
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA;
| | - Eugenio Aguglia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
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El-Salem K, Khalil H, Al-Sharman A, Al-Mistarehi AH, Yassin A, Alhayk KA, Qawasmeh MA, Bashayreh SY, Kofahi RM, Obeidat AZ. Serum vitamin d inversely correlates with depression scores in people with multiple sclerosis. Mult Scler Relat Disord 2021; 48:102732. [PMID: 33422916 DOI: 10.1016/j.msard.2020.102732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vitamin D (Vit.D) deficiency is a risk factor for multiple sclerosis (MS) and correlates with its severity. Depression is also common in people with MS (PWMS). We aim to investigate Vit.D correlation with depression risk scores in PWMS. METHODS A cross-sectional cohort of PWMS were studied. Clinical and demographic data were collected. The Hospital Anxiety Depression Scale (HADS) and the Beck Depression Inventory-II (BDI-II) were used to evaluate the risk of depression. Expanded Disability Status Scale (EDSS) and Patient Determined Disease Steps (PDDS) were used to evaluate the disability. Serum concentrations of 25-hydroxyvitamin D were measured. Bivariate and partial correlations of Vit.D status and scores of depressive and disability scales were statistically analyzed. The IBM Statistical Package for Social Sciences software, version 25.0, was used for data processing. RESULTS A total of 88 PWMS were enrolled. More than half of them had potential depression, and 68% had below-normal serum Vit.D levels (normal ≥ 30 ng/ml, insufficient = 21-29 ng/ml, and deficient ≤ 20 ng/ml). Serum Vit.D levels significantly correlated with scores of depression scales in both males and females, which was more robust in males. This association was maintained with a partial correlation analysis controlling for age, sex, body mass index, disease duration, type of MS, and EDDS HADS: r=-0.513, p<0.001; BDI-II: r=-0.401, p<0.001). Serum Vit.D had significant inverse correlations with EDSS score (r=-0.353, p = 0.001) and PDDS score (r=-0.341, p = 0.001), with more robust correlations in females compared to the whole group. CONCLUSION Vit.D levels correlate with depression risk scores in PWMS with differential sex effects.
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Affiliation(s)
- Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Ahmed Yassin
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Kefah A Alhayk
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Majdi Al Qawasmeh
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Salma Y Bashayreh
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Raid M Kofahi
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, United States.
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TOLGAY EN, SEFEROGLU M, TAŞKAPILIOĞLU Ö, TURAN ÖF. Clinical Aspects of Vitamin D Deficiency in Multiple Sclerosis. TURKISH JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.46310/tjim.771364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Schaad KA, Bukhari AS, Brooks DI, Kocher JD, Barringer ND. The relationship between vitamin D status and depression in a tactical athlete population. J Int Soc Sports Nutr 2019; 16:40. [PMID: 31500652 PMCID: PMC6734287 DOI: 10.1186/s12970-019-0308-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/27/2019] [Indexed: 01/24/2023] Open
Abstract
Background Stressors inherent to the military, such as combat exposure, separation from family, and strenuous training, collectively contribute to compromised psychological resilience and greatly impact military performance. Methods This retrospective review of records was conducted to determine whether vitamin D status was associated with diagnoses of depression and if diagnoses differed by geographic location. Results Depression (defined using diagnostic codes) was more prevalent in individuals who were diagnosed with vitamin D deficiency (20.4%) than in individuals who were not (4.2%). After adjustment, vitamin D deficient diagnoses remained significantly associated with depression diagnoses (OR = 1.22; 95% CI, 1.11–1.33, p < 0.001). Furthermore, vitamin D deficient diagnoses were strongly associated with geographic latitude (r2 = 0.92, p = 0.002). Conclusion These results suggest that service members stationed at installations located at northerly latitudes may be at increased risk for vitamin D deficiency. Furthermore, vitamin D deficient service members may be at higher risk for diagnosis of depression. As a number of military service members avoid reporting symptoms or seeking treatment, vitamin D status may be a useful screening tool to identify service members at risk for depression.
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Affiliation(s)
- Kelly A Schaad
- U.S. Baylor Military Graduate Program in Nutrition, 3630 Stanley Road, San Antonio, TX, 78234, USA. .,Nutrition Services Department, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA.
| | - Asma S Bukhari
- U.S. Baylor Military Graduate Program in Nutrition, 3630 Stanley Road, San Antonio, TX, 78234, USA.,Nutrition Services Department, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA
| | - Justin D Kocher
- U.S. Baylor Military Graduate Program in Nutrition, 3630 Stanley Road, San Antonio, TX, 78234, USA.,Health Readiness Center of Excellence, Capability Development Integration Directorate, 3630 Stanley Road, San Antonio, TX, 78234, USA
| | - Nicholas D Barringer
- U.S. Baylor Military Graduate Program in Nutrition, 3630 Stanley Road, San Antonio, TX, 78234, USA.,Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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Vafa M, Azizi-Soleiman F, Kazemi SM, Salehi M, Zaeri F, Abiri B, Sadeghi H, Safavi M. Comparing the effectiveness of vitamin D plus iron vs vitamin D on depression scores in anemic females: Randomized triple-masked trial. Med J Islam Repub Iran 2019; 33:64. [PMID: 31456988 PMCID: PMC6708107 DOI: 10.34171/mjiri.33.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Indexed: 12/13/2022] Open
Abstract
Background: Low levels of 25-hydroxyvitamin D (25(OH)D) have been related to depression and anxiety. It seems that anemia is associated with vitamin D deficiency. We aimed to evaluate the effects of iron-vitamin D co-supplementation versus vitamin D alone on depression scores in anemic females with low levels of serum 25-hydroxyvitamin D.
Methods: This randomized controlled trial was conducted on eighty premenopausal females who were recruited between May 2015 and October 2015 from primary health care centers. Women with anemia and low concentrations of 25(OH)D were randomized to either 1000 IU/d vitamin D plus 27 mg/d iron (D-Fe) or vitamin D plus placebo supplements (D-P) for 12 weeks. Depressive and anxious symptoms were evaluated with the Beck Depression Inventory (BDI) with subscales 1–13 and 14–21 and Beck Anxiety Inventory (BAI). To compare the groups, Mann–Whitney or chi-squared tests were used and within groups comparison was performed using Wilcoxon signed ranks test. The study was registered on www.clinicaltrial.org as NC 01876563.
Results: The serum concentrations of 25(OH)D were increased significantly in both groups at the end of the study. In both groups, there was a significant improvement in total BDI, the BDI subscale, and the BAI scores (p<0.001). No differences were found between groups (p>0.05).
Conclusion: Although the potential positive effect of vitamin D on mental health was evident, iron plus vitamin D co-supplementation did not demonstrate any significant benefits over vitamin D alone, neither in depression score reduction nor anxiety symptoms.
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Affiliation(s)
- Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Azizi-Soleiman
- Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyyed Morteza Kazemi
- Bone, Joint, and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Salehi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Zaeri
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Abiri
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Homa Sadeghi
- School of Public Health, Department of Nutrition and Food Science, Texas Woman's University, TX 76204, Denton Campus
| | - Morteza Safavi
- Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
Vitamin D, a fat-soluble vitamin, plays a role not only in calcium and phosphate homeostasis but also in several other functions, including cell growth and neuromuscular and immune function. The deficiency of vitamin D is highly prevalent throughout the world and has been suggested to be associated with an enhanced risk of major depressive disorder (MDD) and anxiety disorders. Therefore, vitamin D supplementation has been investigated for the prevention and treatment of these disorders. This review presents preclinical and clinical evidence of the effects of vitamin D supplementation in these disorders. Although preclinical studies provide limited evidence on the possible mechanisms underlying the beneficial effects of vitamin D for the management of these disorders, most of the clinical studies have indicated that vitamin D supplementation is associated with the reduction of symptoms of depression and anxiety, particularly when the supplementation was carried out in individuals with an MDD diagnosis (of the 13 studies in which MDD diagnosis was established, 12 had positive results with vitamin supplementation). However, some heterogeneity in the outcomes was observed and might be associated with an absence of overt psychiatric symptoms in several studies, genetic polymorphisms that alter vitamin D metabolism and bioavailability, differences in the supplementation regimen (monotherapy, adjunctive therapy, or large bolus dosing), and levels of 25-hydroxyvitamin D3 (25(OH)D) at baseline (individuals with low vitamin D status may respond better) and attained after supplementation. Additionally, factors such as sex, age, and symptom severity also need to be further explored in relation to the effects of vitamin D. Therefore, although vitamin D may hold significant potential for mental health, further preclinical and clinical studies are clearly necessary to better understand its role on mood/affect modulation.
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A new way of rapidly screening for depression in multiple sclerosis using Emotional Thermometers. Acta Neuropsychiatr 2019; 31:151-158. [PMID: 30914071 DOI: 10.1017/neu.2019.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS. METHOD Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale - Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools. RESULTS In total, 190 patients were included. ET4 performed well as a 'rule-out' screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7. CONCLUSION ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.
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Taylor KL, Simpson S, Jelinek GA, Neate SL, De Livera AM, Brown CR, O'Kearney E, Marck CH, Weiland TJ. Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis. Front Psychiatry 2018; 9:526. [PMID: 30425659 PMCID: PMC6218592 DOI: 10.3389/fpsyt.2018.00526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Depression is common and has a significant impact on quality of life for many people with multiple sclerosis (MS). A preventive management approach via modification of lifestyle risk factors holds potential benefits. We examined the relationship between modifiable lifestyle factors and depression risk and the change in depression over 2.5 years. Methods: Sample recruited using online platforms. 2,224 (88.9%) at baseline and 1,309 (93.4%) at 2.5 years follow up completed the necessary survey data. Depression risk was measured by the Patient Health Questionnaire-2 (PHQ-2) at baseline and Patient Health Questionniare-9 (PHQ-9) at 2.5-years follow-up. Multivariable regression models assessed the relationships between lifestyle factors and depression risk, adjusted for sex, age, fatigue, disability, antidepressant medication use, and baseline depression score, as appropriate. Results: The prevalence of depression risk at 2.5-years follow-up in this cohort was 14.5% using the PHQ-2 and 21.7% using the PHQ-9. Moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline were associated with lower frequencies of positive depression-screen 2.5 years later. Moderate alcohol intake was associated with greater likelihood of becoming depression-free and a lower likelihood of becoming depressed at 2.5-years follow-up. Meditating at least once a week was associated with a decreased frequency of losing depression risk, against our expectation. After adjusting for potential confounders, smoking, diet, physical activity, and vitamin D and omega-3 supplementation were not associated with a change in risk for depression. Conclusion: In a large prospective cohort study of people with MS and depression, in line with the emerging treatment paradigm of early intervention, these results suggest a role for some lifestyle factors in depression risk. Further studies should endeavor to explore the impact of positive lifestyle change and improving depression in people living with MS.
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Affiliation(s)
- Keryn L. Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Department of Psychiatry and Psychosocial Cancer Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Steve Simpson
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Claudia H. Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Effect of Short-Term Interval Exercise Training on Fatigue, Depression, and Fitness in Normal Weight vs. Overweight Person With Multiple Sclerosis. Explore (NY) 2018; 15:134-141. [PMID: 30122328 DOI: 10.1016/j.explore.2018.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/25/2018] [Accepted: 07/14/2018] [Indexed: 11/20/2022]
Abstract
CONTEXT Excessive weight is a health problem that can exacerbate multiple sclerosis (MS) symptoms and its associated comorbidities such as depression and fatigue. In addition, weight may be a moderator of exercise effects on depression and fatigue symptoms. OBJECTIVE This study aimed to investigate the effects of exercise training on fatigue and depression in normal and overweight individuals with MS. METHODS Sixty-six persons with MS were randomly assigned into an exercise or control condition based on body weight status (overweight vs. normal weight). The exercise conditions involved 8-weeks of interval exercise at 60%-75% Wattpeak, while the control condition did not involve any exercise. Fatigue, depression, aerobic capacity, time up and go (TUG) and body mass index were measured before and following the 8-week period. RESULTS There were no significant relationship's revealed for weight status interactions for any of the variables examined. There were significant condition main effects for fatigue, depression, aerobic capacity and TUG, and significant improvements were noted for the exercise conditions, but not in the non-exercising control group. CONCLUSION The results from this study confirm that exercise is an effective therapeutic intervention for improving fatigue, depression and functional parameters, independent of initial weight status, in persons with MS.
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Association between Serum Vitamin Levels and Depression in U.S. Adults 20 Years or Older Based on National Health and Nutrition Examination Survey 2005⁻2006. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061215. [PMID: 29890739 PMCID: PMC6025280 DOI: 10.3390/ijerph15061215] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 12/14/2022]
Abstract
Depression is one of the leading causes of disability around the world. Although several studies have been conducted to analyze the association between vitamins and depression, the results have been inconsistent. Based on the database of National Health and Nutrition Examination Survey (NHANES) (2005–2006), a cross-sectional analysis was conducted to uncover the correlations between serum vitamin concentrations and depression in 2791 participants over 20 years of age. Vitamin concentrations in serum were measured by high performance liquid chromatography (HPLC), a standardized liquid chromatography-tandem mass spectrometry (LC-MS/MS) or radioassay kit method. A nine-item Patient Health Questionnaire (PHQ-9) was used to assess depression symptoms. The binary logistic regression model was applied to analyze the association between vitamins and depression. In the whole population, negative associations were discovered between folate concentrations (p for trend = 0.02), trans-β-carotene (p for trend = 0.01) and depression, while positive associations were found among vitamin B12 concentrations (p for trend = 0.008), vitamin A concentrations (p for trend = 0.01) and depression. In order to evaluate the influence of gender on the pathogenesis of depression of vitamins exposure, we performed gender-stratified analysis. In females, folate concentrations (p for trend = 0.03) and vitamin B12 concentrations (p for trend = 0.02) were correlated with depression. In males, no significant association was found between depression and serum vitamin concentrations. The correlation of vitamins with depression deserves further investigation in larger and diverse populations, especially in females.
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Rolf L, Damoiseaux J, Huitinga I, Kimenai D, van den Ouweland J, Hupperts R, Smolders J. Stress-Axis Regulation by Vitamin D 3 in Multiple Sclerosis. Front Neurol 2018; 9:263. [PMID: 29755397 PMCID: PMC5933207 DOI: 10.3389/fneur.2018.00263] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/04/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction Multiple sclerosis (MS) has been associated with both a poor vitamin D status and hyperactivity of the hypothalamus–pituitary–adrenal (HPA) axis. Since nuclear receptor ligands may regulate each other, we explored the association of vitamin D3 supplements with circadian cortisol levels in a double-blind and placebo-controlled supplementation study. Methods Female patients with relapsing-remitting MS received vitamin D3 supplements (4,000 IU/day; n = 22) or placebo (n = 19) during 16 weeks. Salivary cortisol levels, repeatedly measured during the day, and serum 25(OH)D levels were assessed before (T0) and after (T1) this treatment period. Results Median 25(OH)D levels at T1 were 139.9 (interquartile range 123.5–161.2) and 74.5 nmol/L (58.6–88.1) in the vitamin D3 and placebo group, respectively (p < 0.001). Comparisons within and between groups showed no differences in area under the curve (AUC) and slope of the cortisol day curve. Although the AUC of the cortisol awakening response (CAR, sampling each 15 min the first hour after awakening) showed a reduction over time in the vitamin D3 group [39.16 nmol/L (27.41–42.07) at T0 to 33.37 nmol/L (26.75–38.08) at T1] compared to the placebo group [33.90 nmol/L (25.92–44.61) at T0 to 35.00 nmol/L (25.46–49.23) at T1; p = 0.044], there was no significant difference in AUC of CAR at T1 corrected for baseline AUC of CAR (p = 0.066). Conclusion Suppression of HPA-axis activity by vitamin D3 supplements in non-depressed MS patients may be best reflected by CAR as primary outcome measure. Further studies should address this interaction and its potential implications for the disease course of MS. Registration This study was registered on ClinicalTrials.gov (NCT02096133) and EudraCT (2014-000728-97).
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Affiliation(s)
- Linda Rolf
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Zuyderland Medical Center, Academic MS Center Limburg, Sittard, Netherlands
| | - Jan Damoiseaux
- Maastricht University Medical Center, Central Diagnostic Laboratory, Maastricht, Netherlands
| | - Inge Huitinga
- Netherlands Institute for Neuroscience, Neuroimmunology Research Group, Amsterdam, Netherlands
| | - Dorien Kimenai
- Maastricht University Medical Center, Central Diagnostic Laboratory, Maastricht, Netherlands
| | - Jody van den Ouweland
- Canisius Wilhelmina Hospital, Department of Clinical Chemistry, Nijmegen, Netherlands
| | - Raymond Hupperts
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Zuyderland Medical Center, Academic MS Center Limburg, Sittard, Netherlands
| | - Joost Smolders
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Netherlands Institute for Neuroscience, Neuroimmunology Research Group, Amsterdam, Netherlands.,Canisius Wilhelmina Hospital, Department of Neurology, Nijmegen, Netherlands
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Mateen FJ, Manalo NC, Grundy SJ, Houghton MA, Hotan GC, Erickson H, Videnovic A. Light therapy for multiple sclerosis-associated fatigue: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2017; 96:e8037. [PMID: 28885372 PMCID: PMC6392596 DOI: 10.1097/md.0000000000008037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fatigue is the most commonly reported symptom among multiple sclerosis (MS) patients, more than a quarter of whom consider fatigue to be their most disabling symptom. However, there are few effective treatment options for fatigue. We aim to investigate whether supplemental exposure to bright white light will reduce MS-associated fatigue. METHODS Eligible participants will have clinically confirmed multiple sclerosis based on the revised McDonald criteria (2010) and a score ≥36 on the Fatigue Severity Scale (FSS). Participants will be randomized 1:1 to bright white light (10,000 lux; active condition) or dim red light (<300 lux; control condition) self-administered for 1 hour twice daily. The study will include a 2-week baseline period, a 4-week treatment period, and a 4-week washout period. Participants will record their sleep duration, exercise, caffeine, and medication intake daily. Participants will record their fatigue using the Visual Analogue Fatigue Scale (VAFS) 4 times every third day, providing snapshots of their fatigue level at different times of day. Participants will self-report their fatigue severity using FSS on 3 separate visits: at baseline (week 0), following completion of the treatment phase (week 6), and at study completion (week 10). The primary outcome will be the change in the average FSS score after light therapy. We will perform an intention-to-treat analysis, comparing the active and control groups to assess the postintervention difference in fatigue levels reported on FSS. Secondary outcome measures include change in global VAFS scores during the light therapy and self-reported quality of life in the Multiple Sclerosis Quality of Life-54. DISCUSSION We present a study design and rationale for randomizing a nonpharmacological intervention for MS-associated fatigue, using bright light therapy. The study limitations relate to the logistical issues of a self-administered intervention requiring frequent participant self-report in a relapsing condition. Ultimately, light therapy for the treatment of MS-associated fatigue may provide a low-cost, noninvasive, self-administered treatment for one of the most prevalent and burdensome symptoms experienced by people with MS.
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Affiliation(s)
- Farrah J. Mateen
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | - Natalie C. Manalo
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | - Sara J. Grundy
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital
| | - Melissa A. Houghton
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital
| | - Gladia C. Hotan
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA
| | - Hans Erickson
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital
| | - Aleksandar Videnovic
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
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Rolf L, Muris AH, Bol Y, Damoiseaux J, Smolders J, Hupperts R. Vitamin D 3 supplementation in multiple sclerosis: Symptoms and biomarkers of depression. J Neurol Sci 2017; 378:30-35. [DOI: 10.1016/j.jns.2017.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/10/2017] [Accepted: 04/04/2017] [Indexed: 02/06/2023]
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Simpson S, Tan H, Otahal P, Taylor B, Ponsonby A, Lucas RM, Blizzard L, Valery PC, Lechner‐Scott J, Shaw C, Williams D, Mei I. Anxiety, depression and fatigue at 5-year review following CNS demyelination. Acta Neurol Scand 2016; 134:403-413. [PMID: 26756925 DOI: 10.1111/ane.12554] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Anxiety and depression are common in multiple sclerosis (MS). We evaluated the prevalence and factors associated with anxiety, depression and fatigue at the 5-year review of a longitudinal cohort study following a first clinical diagnosis of CNS demyelination (FCD). METHODS Cases with a FCD were recruited soon after diagnosis and followed annually thereafter. A variety of environmental, behavioural and clinical covariates were measured at five-year review. Anxiety and depression were measured using the Hospital Anxiety & Depression Scale (HADS), and fatigue by the Fatigue Severity Scale (FSS). RESULTS Of the 236 cases, 40.2% had clinical anxiety (median HADS-A: 6.0), 16.0% had clinical depression (median HADS-D: 3.0), and 41.3% had clinical fatigue (median FSS: 4.56). The co-occurrence of all three symptoms was 3.76 times greater than expectation. Younger age, higher disability, concussion or other disease diagnosis were independently associated with a higher anxiety score; male sex, higher disability, being unemployed, less physical activity, and antidepressant and/or anxiolytic-sedative medication use were independently associated with a higher depression score. Higher disability, immunomodulatory medication use, other disease diagnosis and anxiolytic-sedative medication use were independently associated with having fatigue, while female sex, higher BMI, having had a concussion, being unemployed and higher disability were associated with a higher fatigue score. CONCLUSION These results support previous findings of the commonality of anxiety, depression and fatigue in established MS and extend this to post-FCD and early MS cases. The clustering of the three symptoms indicates that they may share common antecedents.
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Affiliation(s)
- S. Simpson
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - H. Tan
- School of Medicine University of Tasmania Hobart TAS Australia
| | - P. Otahal
- School of Medicine University of Tasmania Hobart TAS Australia
| | - B. Taylor
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - A.‐L. Ponsonby
- Murdoch Children's Research Institute University of Melbourne Parkville VIC Australia
| | - R. M. Lucas
- National Centre for Epidemiology and Population Health The Australian National University Canberra ACT Australia
| | - L. Blizzard
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - P. C. Valery
- QIMR Berghofer Medical Research Institute Brisbane QLD Australia
| | - J. Lechner‐Scott
- Dept. Neurology John Hunter Hospital New Lambton NSW Australia
- University of Newcastle Callaghan NSW Australia
| | - C. Shaw
- School of Medicine Faculty of Health Deakin University Geelong VIC Australia
| | - D. Williams
- Dept. Neurology John Hunter Hospital New Lambton NSW Australia
- University of Newcastle Callaghan NSW Australia
| | - I. Mei
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
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Rolf L, Damoiseaux J, Hupperts R, Huitinga I, Smolders J. Network of nuclear receptor ligands in multiple sclerosis: Common pathways and interactions of sex-steroids, corticosteroids and vitamin D3-derived molecules. Autoimmun Rev 2016; 15:900-10. [DOI: 10.1016/j.autrev.2016.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/08/2016] [Indexed: 01/12/2023]
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Masoudi Alavi N, Madani M, Sadat Z, Haddad Kashani H, Reza Sharif M. Fatigue and Vitamin D Status in Iranian Female Nurses. Glob J Health Sci 2015; 8:196-202. [PMID: 26755458 PMCID: PMC4954906 DOI: 10.5539/gjhs.v8n6p196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 12/18/2014] [Indexed: 12/20/2022] Open
Abstract
Introduction: Given that nurses are among professions with frequent problems of fatigue, and given the nature of their profession that provides little exposure to sunlight and the subsequent deficiency of vitamin D, the present study examined the relation between fatigue and circulating vitamin D levels in female nurses working in Shahid Beheshti Hospital, Kashan, Iran in 2013. Material and Methods: This cross-sectional study was conducted in 200 female nurses working in Shahid Beheshti Hospital. To measure fatigue, fatigue questionnaire containing 9 questions eliciting the subject’s feeling in scales of 1 to 7, getting a possible score of 9 to 63, and Visual Analogue Scale in which nurses specified their fatigue in a band of zero to 10 were used. The 25-hydroxyvitamin D, which is the most important vitamin D metabolite, also was determined. The data was analyzed by SPSS-16. The Pearson’s correlation of coefficients, t-test, and multiple regression analysis were used in this study. Results: The mean fatigue score of nurses was 38.76±12.66 in questionnaire and 5.73±2.12 in Visual Analog Scale. The 89 per cent of nurses suffered from vitamin D deficiency, 9.5 percent of them had normal level and 1.5 per cent had toxicity level of vitamin D. There was a significant relationship between vitamin D level and fatigue scores (P<0.0001), and visual fatigue scores (P<0.0001). According to multivariate regression analysis, vitamin D level accounted for 13 per cent of the fatigue based on data on questionnaire and 18.6 per cent of fatigue according to Visual Analog Scale. Conclusion: High prevalence of fatigue among nurses could be attributed to vitamin D deficiency.
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Affiliation(s)
- Negin Masoudi Alavi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, I. R. Iran.
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Moghimi E, Solomon JA, Gianforcaro A, Hamadeh MJ. Dietary Vitamin D3 Restriction Exacerbates Disease Pathophysiology in the Spinal Cord of the G93A Mouse Model of Amyotrophic Lateral Sclerosis. PLoS One 2015; 10:e0126355. [PMID: 26020962 PMCID: PMC4447353 DOI: 10.1371/journal.pone.0126355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/22/2015] [Indexed: 12/11/2022] Open
Abstract
Background Dietary vitamin D3 (D3) restriction reduces paw grip endurance and motor performance in G93A mice, and increases inflammation and apoptosis in the quadríceps of females. ALS, a neuromuscular disease, causes progressive degeneration of motor neurons in the brain and spinal cord. Objective We analyzed the spinal cords of G93A mice following dietary D3 restriction at 2.5% the adequate intake (AI) for oxidative damage (4-HNE, 3-NY), antioxidant enzymes (SOD2, catalase, GPx1), inflammation (TNF-α, IL-6, IL-10), apoptosis (bax/bcl-2 ratio, cleaved/pro-caspase 3 ratio), neurotrophic factor (GDNF) and neuron count (ChAT, SMI-36/SMI-32 ratio). Methods Beginning at age 25 d, 42 G93A mice were provided food ad libitum with either adequate (AI;1 IU D3/g feed; 12 M, 11 F) or deficient (DEF; 0.025 IU D3/g feed; 10 M, 9 F) D3. At age 113 d, the spinal cords were analyzed for protein content. Differences were considered significant at P ≤ 0.10, since this was a pilot study. Results DEF mice had 16% higher 4-HNE (P = 0.056), 12% higher GPx1 (P = 0.057) and 23% higher Bax/Bcl2 ratio (P = 0.076) vs. AI. DEF females had 29% higher GPx1 (P = 0.001) and 22% higher IL-6 (P = 0.077) vs. AI females. DEF males had 23% higher 4-HNE (P = 0.066) and 18% lower SOD2 (P = 0.034) vs. AI males. DEF males had 27% lower SOD2 (P = 0.004), 17% lower GPx1 (P = 0.070), 29% lower IL-6 (P = 0.023) and 22% lower ChAT (P = 0.082) vs. DEF females. Conclusion D3 deficiency exacerbates disease pathophysiology in the spinal cord of G93A mice, the exact mechanisms are sex-specific. This is in accord with our previous results in the quadriceps, as well as functional and disease outcomes.
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Affiliation(s)
- Elnaz Moghimi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Jesse A. Solomon
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Alexandro Gianforcaro
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Mazen J. Hamadeh
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
- * E-mail:
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20
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Fjeldstad C, Fjeldstad AS, Weir JP, Pardo G. Association of vitamin D deficiency with RNFL thickness in MS individuals without history of optic neuritis. Mult Scler Relat Disord 2015; 3:489-93. [PMID: 25877061 DOI: 10.1016/j.msard.2014.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/11/2014] [Accepted: 03/17/2014] [Indexed: 01/18/2023]
Abstract
UNLABELLED Vitamin D deficiency has been associated with both increased risk and severity of Multiple Sclerosis (MS) as it has a modulating effect on the immune process that causes inflammation/demyelination and axonal damage. Optical Coherence Tomography (OCT) offers a quick, reliable and non-invasive way to assess the Retinal Nerve Fiber Layer (RNFL) and identifies axonal loss generated by either direct inflammation or from neurodegeneration. OBJECTIVE To determine the association of vitamin D and RNFL in MS patients without a history of Optic Neuritis (ON) by comparing RNFL thickness in patients that are vitamin D deficient with those having normal serum levels. METHOD The cohort of 76 MS patients underwent OCT testing to assess the RNFL thickness and macular volume, and measurement of serum 25-OH Vitamin D level. Vitamin D deficiency was defined as <30ng/ml and sufficiency as ≥30ng/ml. RESULTS A total of 131 eyes were divided in two groups: vitamin D deficient (n=86 eyes, mean=17.7ng/ml) and vitamin D sufficient (n=45 eyes, mean=40.3ng/ml). Twenty one eyes had previous ON and were excluded from this analysis. Vitamin D deficiency was identified in 66% of the participants. RNFL thickness was similar for the vitamin D deficient and sufficient groups (85.5 vs 86μm respectively, p=0.89). Significant differences were present for age with the deficient group being younger (42 years vs 51 years, p=0.005) and having shorter disease duration (7.5 years vs 11.4 years, p=0.006). CONCLUSION Vitamin D deficiency is not associated with thinning of RNFL or macular volume in MS eyes unaffected by ON. This finding suggests the role of vitamin D in modulating the severity of MS is not exerted through an influence on neurodegeneration.
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Affiliation(s)
- Cecilie Fjeldstad
- OMRF Multiple Sclerosis Center of Excellence, 820 NE 15th Street, Oklahoma City, OK 73104, USA.
| | - Anette S Fjeldstad
- Department of Neurology, University of Utah, Imaging & Neurosciences Center at Research Park, 729 Arapeen Drive Rm 1172, Salt Lake City, UT 84108, USA.
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, 1301 Sunnyside Avenue, Robinson center 104D, University of Kansas, Lawrence, KS 66045, USA.
| | - Gabriel Pardo
- OMRF Multiple Sclerosis Center of Excellence, 820 NE 15th Street, Oklahoma City, OK 73104, USA
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Knippenberg S, Damoiseaux J, Bol Y, Hupperts R, Taylor BV, Ponsonby AL, Dwyer T, Simpson S, van der Mei IAF. Higher levels of reported sun exposure, and not vitamin D status, are associated with less depressive symptoms and fatigue in multiple sclerosis. Acta Neurol Scand 2014; 129:123-31. [PMID: 23763464 DOI: 10.1111/ane.12155] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Insufficient sun exposure and vitamin D deficiency have both been associated with increased risk of multiple sclerosis (MS). Depressi on, anxiety, fatigue and cognitive impairment are prevalent and disabling symptoms in MS. Our objective was to examine the associations between personal sun exposure and serum 25-hydroxyvitamin D (25(OH)D), and depression, anxiety, fatigue and cognition. METHODS A total of 198 participants with multiple sclerosis were followed prospectively for an average of 2.3 years. Assessments of serum 25(OH)D, sun exposure, depression, anxiety and fatigue were carried out biannually; cognition was assessed annually. RESULTS Personal reported sun exposure was inversely associated with depression scores (β -0.26 (95%CI -0.40, -0.12);P ≤ 0.001) and fatigue scores (β -0.65 (95%CI -1.23, -0.07); P = 0.028). Only high levels of 25(OH)D (>80 nm) were inversely associated depression scores (β -0.64 (95%CI -1.15, -0.13); P = 0.015), but this was not significant after adjustment for reported sun exposure. No associations were seen between reported sun exposure or serum 25(OH)D levels and anxiety or cognition scores. CONCLUSION We found that higher levels reported sun exposure, rather than 25(OH)D levels, were associated with less depressive symptoms and levels of fatigue. The role of UV or light therapy will need to be evaluated in randomized controlled trials to confirm an effect on these symptoms in MS.
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Affiliation(s)
- S. Knippenberg
- School for Mental Health and Neuroscience; Maastricht University Medical Center; Maastricht The Netherlands
- Academic MS Center Limburg; Orbis Medical Center; Sittard The Netherlands
- Department of Internal Medicine; Division of Clinical and Experimental Immunology; Maastricht University Medical Center; Maastricht The Netherlands
| | - J. Damoiseaux
- Central Diagnostic Laboratory; Maastricht University Medical Center; Maastricht The Netherlands
| | - Y. Bol
- Academic MS Center Limburg; Orbis Medical Center; Sittard The Netherlands
- Department of Medical Psychology and Psychiatry; Orbis Medical Center; Sittard The Netherlands
| | - R. Hupperts
- School for Mental Health and Neuroscience; Maastricht University Medical Center; Maastricht The Netherlands
- Academic MS Center Limburg; Orbis Medical Center; Sittard The Netherlands
| | - B. V. Taylor
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
| | - A.-L. Ponsonby
- Murdoch Childrens Research Institute; The University of Melbourne; Melbourne Victoria Australia
| | - T. Dwyer
- Murdoch Childrens Research Institute; The University of Melbourne; Melbourne Victoria Australia
| | - S. Simpson
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
| | - I. A. F. van der Mei
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
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Smolders J, Peelen E, Thewissen M, Menheere P, Damoiseaux J, Hupperts R. Circulating vitamin D binding protein levels are not associated with relapses or with vitamin D status in multiple sclerosis. Mult Scler 2013; 20:433-7. [DOI: 10.1177/1352458513500552] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: A low vitamin D status has been associated with multiple sclerosis (MS). Most circulating vitamin D metabolites are bound to vitamin D binding protein (DBP). Objectives: The purpose of this study was to explore whether there is an association between MS and DBP. Methods: We compared DBP concentrations in blood samples of controls ( n = 30) and subjects with relapsing–remitting MS (RRMS) during remission ( n = 29) and relapse ( n = 15). Furthermore, we explored correlations of DBP with 25- hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D levels (1,25(OH)2D), and the effect of high-dose vitamin D3 supplementation on DBP levels in RRMS patients ( n = 15). Results: DBP-concentration did not differ between the sub-groups measured, and there was no correlation between DBP and vitamin D metabolite concentration within the physiological range. Upon supplementation of high doses vitamin D3, DBP concentration remained unaltered. After supplementation, serum 1,25(OH)2D( R = 0.517, p = 0.049), but not 25(OH)D, correlated positively with DBP. Conclusions: We found no association between DBP, MS, and vitamin D status within the physiological range. After high - dose vitamin D supplementation, DBP concentrations may be relevant for vitamin D metabolism.
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Affiliation(s)
- Joost Smolders
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
| | - Evelyn Peelen
- School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
- Biomedical Research Institute and Transnationale Universiteit Limburg, Hasselt University, Belgium
| | - Mariëlle Thewissen
- Department of Internal Medicine, Maastricht University Medical Center, The Netherlands
| | - Paul Menheere
- Central Diagnostic Laboratory, Maastricht University Medical Center, The Netherlands
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, The Netherlands
| | - Raymond Hupperts
- School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
- Academic MS Center Limburg, Orbis Medical Center, The Netherlands
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Golan D, Halhal B, Glass-Marmor L, Staun-Ram E, Rozenberg O, Lavi I, Dishon S, Barak M, Ish-Shalom S, Miller A. Vitamin D supplementation for patients with multiple sclerosis treated with interferon-beta: a randomized controlled trial assessing the effect on flu-like symptoms and immunomodulatory properties. BMC Neurol 2013; 13:60. [PMID: 23767916 PMCID: PMC3691658 DOI: 10.1186/1471-2377-13-60] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 05/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flu-like symptoms (FLS) are common side effects of interferon beta (IFN-β) treatment in patients with Multiple Sclerosis (PwMS) and are associated with post-injection cytokine surge. We hypothesized that vitamin D3 supplementation would ameliorate FLS by decreasing related serum cytokines' levels. METHODS In a randomized, double blind study of 45 IFNβ-treated PwMS, 21 patients were assigned to 800 IU of vitamin D3 per day (low dose), while 24 patients received 4,370 IU per day (high dose) for one year. FLS were assessed monthly by telephonic interviews. Serum levels of 25-hydroxy-D (25-OH-D), calcium, PTH, IL-17, IL-10 and IFN-γ were measured periodically. EDSS, relapses, adverse events and quality of life (QoL) were documented. RESULTS 25-OH-D levels increased to a significantly higher levels and PTH levels decreased in the high dose group. There was no significant change in FLS. IL-17 levels were significantly increased in the low dose group, while patients receiving high dose vitamin D had a heterogeneous IL-17 response. No significant differences in relapse rate, EDSS, QoL, serum IL-10 and IFNγ were found. Hypercalcemia or other potential major adverse events were not observed. CONCLUSION Vitamin D supplementation to IFN-β treated PwMS, at the doses used, seems safe and associated with dose-dependent changes in IL-17 serum levels, while not affecting IFN-β related FLS. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT01005095.
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Affiliation(s)
- Daniel Golan
- Division of Neuroimmunology & Multiple Sclerosis Center, Carmel Medical Center, 7 Michal Street, Haifa, 34362, Israel
- Department of Neurology, Carmel Medical Center, Haifa, Israel
| | - Basheer Halhal
- Division of Neuroimmunology & Multiple Sclerosis Center, Carmel Medical Center, 7 Michal Street, Haifa, 34362, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lea Glass-Marmor
- Division of Neuroimmunology & Multiple Sclerosis Center, Carmel Medical Center, 7 Michal Street, Haifa, 34362, Israel
| | - Elsebeth Staun-Ram
- Division of Neuroimmunology & Multiple Sclerosis Center, Carmel Medical Center, 7 Michal Street, Haifa, 34362, Israel
| | - Orit Rozenberg
- Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine & Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Sara Dishon
- Division of Neuroimmunology & Multiple Sclerosis Center, Carmel Medical Center, 7 Michal Street, Haifa, 34362, Israel
| | - Mira Barak
- Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Haifa, Israel
| | - Sophia Ish-Shalom
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Miller
- Division of Neuroimmunology & Multiple Sclerosis Center, Carmel Medical Center, 7 Michal Street, Haifa, 34362, Israel
- Department of Neurology, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Pierrot-Deseilligny C, Souberbielle JC. Contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis. Ther Adv Neurol Disord 2013; 6:81-116. [PMID: 23483715 PMCID: PMC3582312 DOI: 10.1177/1756285612473513] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis (MS) is reviewed. Among the multiple recently discovered actions of vitamin D, an immunomodulatory role has been documented in experimental autoimmune encephalomyelitis and in humans. This action in the peripheral immune system is currently the main known mechanism through which vitamin D might influence MS, but other types of actions could be involved within the central nervous system. Furthermore, vitamin D insufficiency is widespread in temperate countries and in patients with MS at the earliest stages of the disease, suggesting that the deleterious effects related to vitamin D insufficiency may be exerted in these patients. In fact, many genetic and environmental risk factors appear to interact and contribute to MS. In genetics, several human leukocyte antigen (HLA) alleles (more particularly HLA-DRB1*1501) could favour the disease whereas some others could be protective. Some of the genes involved in vitamin D metabolism (e.g. CYP27B1) also play a significant role. Furthermore, three environmental risk factors have been identified: past Epstein-Barr virus infection, vitamin D insufficiency and cigarette smoking. Interactions between genetic and environmental risk or protective factors may occur during the mother's pregnancy and could continue during childhood and adolescence and until the disease is triggered in adulthood, therefore possibly modulating the MS risk throughout the first decades of life. Furthermore, some clinical findings already strongly suggest that vitamin D status influences the relapse rate and radiological lesions in patients with MS, although the results of adequately powered randomized clinical trials using vitamin D supplementation have not yet been reported. While awaiting these incontrovertible results, which might be long in coming, patients with MS who are currently in vitamin D insufficiency should be supplemented, at least for their general health status, using moderate doses of the vitamin.
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Affiliation(s)
- Charles Pierrot-Deseilligny
- Service de Neurologie 1, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (Paris VI), Paris, France
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Carlson NG, Rose JW. Vitamin D as a clinical biomarker in multiple sclerosis. ACTA ACUST UNITED AC 2013; 7:231-42. [DOI: 10.1517/17530059.2013.772978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bol Y, Smolders J, Duits A, Lange IMJ, Romberg-Camps M, Hupperts R. Fatigue and heat sensitivity in patients with multiple sclerosis. Acta Neurol Scand 2012; 126:384-9. [PMID: 22404677 DOI: 10.1111/j.1600-0404.2012.01660.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Fatigue is one of the most common and troubling symptoms of multiple sclerosis (MS), and heat is often reported as a trigger. Although it is assumed that this heat sensitivity is specific for MS, the evidence for disease specificity is limited. We studied the relationship between fatigue, heat sensitivity, and environmental temperature, and its specificity for MS. MATERIALS AND METHODS We compared 88 MS patients with 76 patients with ulcerative colitis (UC), another chronic auto-immune disease. As most important outcome measures, heat sensitivity, physical fatigue, mental fatigue, environmental temperature, and ambient UV-light levels were determined. RESULTS More patients with MS reported heat sensitivity for fatigue, compared to patients with UC (53.4% vs 35.5%, respectively, P = 0.016). However, heat-sensitive patients were equally fatigued as heat-insensitive patients. Climatological data, including day temperature and amount of ambient UV light, were not related to fatigue in both heat-sensitive and heat-insensitive patients with MS. CONCLUSIONS Our findings support the assumption that heat sensitivity regarding fatigue has an MS-specific component. Although patients with MS experience a relationship between environmental temperature and fatigue, objective assessment by climatological data could not confirm this.
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Affiliation(s)
- Y. Bol
- Orbis Medical Centre; Sittard-Geleen; the Netherlands
| | | | - A. Duits
- Maastricht University Medical Centre; Maastricht; the Netherlands
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What is needed to keep persons with multiple sclerosis vitamin D-sufficient throughout the year? J Neurol 2012; 260:182-8. [DOI: 10.1007/s00415-012-6611-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 06/27/2012] [Accepted: 07/05/2012] [Indexed: 12/16/2022]
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Abstract
OBJECTIVE To define the relationship between vitamin D status and employee presenteeism in a large sample of health care employees. METHODS Prospective observation study of 10,646 employees of a Midwestern-integrated health care system who completed an on-line health risk appraisal questionnaire and were measured for 25-hydroxyvitamin D. RESULTS Measured differences in productivity due to presenteeism were 0.66, 0.91, and 0.75 when comparing employees above and below vitamin D levels of 20 ng/mL, 30 ng/mL, and 40 ng/mL, respectively. These productivity differences translate into potential productivity savings of 0.191%, 0.553%, and 0.625%, respectively, of total payroll costs. CONCLUSIONS Low vitamin D status is associated with reduced employee work productivity. Employee vitamin D assessment and replenishment may represent a low-cost, high-return program to mitigate risk factors and health conditions that drive total employer health care costs.
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Kano O, Iwamoto K, Cridebring D, Ikeda K, Iwasaki Y. Relationship between vitamin D and depression in multiple sclerosis. Acta Neurol Scand 2012; 125:e25; author reply e26-7. [PMID: 22471766 DOI: 10.1111/j.1600-0404.2011.01641.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Osamu Kano
- Department of Neurology; Toho University Omori Medical Center; Tokyo; Japan
| | - Konosuke Iwamoto
- Department of Neurology; Toho University Omori Medical Center; Tokyo; Japan
| | - Derek Cridebring
- Department of Systems Medicine and Bioengineering; The Methodist Hospital Research Institute; Houston; TX; USA
| | - Ken Ikeda
- Department of Neurology; Toho University Omori Medical Center; Tokyo; Japan
| | - Yasuo Iwasaki
- Department of Neurology; Toho University Omori Medical Center; Tokyo; Japan
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30
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Knippenberg S, Bol Y, Smolders J, Hupperts R, Damoiseaux J. Response: relationship between vitamin D and depression in multiple sclerosis. Acta Neurol Scand 2012. [DOI: 10.1111/j.1600-0404.2011.01640.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - J. Smolders
- Netherlands Institute for Neuroscience; Amsterdam; The Netherlands
| | | | - J. Damoiseaux
- Laboratory for Clinical Immunology; Maastricht University Medical Center; Maastricht; The Netherlands
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Kampman MT, Steffensen LH, Mellgren SI, Jørgensen L. Effect of vitamin D3 supplementation on relapses, disease progression, and measures of function in persons with multiple sclerosis: exploratory outcomes from a double-blind randomised controlled trial. Mult Scler 2012; 18:1144-51. [PMID: 22354743 DOI: 10.1177/1352458511434607] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High vitamin D levels may reduce the risk of relapses and disease progression in multiple sclerosis. METHODS This 96-week randomised controlled trial was designed to assess the effect of vitamin D(3) supplementation on bone mineral density in persons with multiple sclerosis. Supplementation with 20,000 IU vitamin D(3) weekly raised median serum 25-hydroxy vitamin D (25[OH]D) to 121 nmol/L. The modified intention to treat analysis included 35 persons in the vitamin D(3) group and 33 in the placebo group. Participants were age 21 to 50 years and fully ambulatory (median Expanded Disability Status Scale (EDSS) 2.5). We studied the effect of supplementing vitamin D(3) on the exploratory outcomes annualised relapse rate (ARR), EDSS, multiple sclerosis functional composite (MSFC) components, grip strength, and fatigue. RESULTS After 96 weeks, there was no significant difference between groups in ARR (absolute difference 0.10, 95% CI -0.07 to 0.27; p = 0.25), EDSS (absolute difference -0.01, 95% CI -0.35 to 0.35; p = 0.97), MSFC components, grip strength, or fatigue. CONCLUSION Supplementation with 20,000 IU vitamin D(3) weekly did not result in beneficial effects on the measured multiple sclerosis-related outcomes. This study was not powered to address clinical outcomes, but none of the results were suggestive of an effect in this unselected population of fully ambulatory persons with multiple sclerosis.
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Affiliation(s)
- Margitta T Kampman
- Centre for Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway.
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van der Mei IAF, Simpson S, Knippenberg S, Winzenberg T, Taylor BV. Role of vitamin D in multiple sclerosis: implications for disease management. Neurodegener Dis Manag 2011. [DOI: 10.2217/nmt.11.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
SUMMARY This review discusses the evidence on the role of vitamin D in multiple sclerosis (MS) and whether vitamin D supplementation is effective for the management of MS. People with MS are at high risk of vitamin D deficiency, osteoporosis and fractures. Observational data suggest that higher vitamin D levels are associated with lower relapse risk and there is promising evidence on its effect on MRI measures, disability progression, mental health and fatigue. However, there is currently insufficient randomized controlled trial evidence to recommend vitamin D supplementation with the aim to improve those outcomes. There is sufficient evidence to justify assessing and correcting vitamin D and calcium levels to optimize bone health in people with MS at high absolute risk of fracture.
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Affiliation(s)
| | - Steve Simpson
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Stephanie Knippenberg
- School for Mental Health & Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tania Winzenberg
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
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Stockton KA, Kandiah DA, Paratz JD, Bennell KL. Fatigue, muscle strength and vitamin D status in women with systemic lupus erythematosus compared with healthy controls. Lupus 2011; 21:271-8. [DOI: 10.1177/0961203311425530] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent studies have demonstrated an inverse relationship between vitamin D levels and fatigue in systemic lupus erythematosus (SLE). The aims of this study were to evaluate proximal muscle strength, fatigue and vitamin D levels in women with SLE compared with healthy controls and to investigate relationships between these factors in a cohort of women with SLE. Forty-five women (24 SLE, 21 healthy controls) participated. Primary outcome measures were the fatigue severity scale (FSS), isometric muscle strength of dominant limbs using hand held dynamometry, two functional tests – the 30-second chair stand test and the 1-kg arm lift test, with vitamin D status measured using 25(OH)D. Overall 25(OH)D levels were 68.4 (22.4) nmol/L with no difference between SLE and control groups. There was a statistically and clinically significant difference in fatigue, 1-kg arm lift, 30-second sit to stand, knee extension, hip flexion, hip abduction, shoulder flexion and grip strength in the SLE group compared with the control group ( p < 0.05). In the SLE group FSS was moderately correlated with both functional measures (1-kg arm lift r = −0.42, 30-second chair stand r = −0.44, p < 0.05). However, no statistically significant correlation between dynamometry measures and fatigue was evident. There was no association between fatigue and 25(OH)D level ( r = −0.12). In summary, women with SLE were weaker and demonstrated reduced physical function and higher fatigue levels than healthy controls. Fatigue was related to physical function but not vitamin D status or maximal isometric strength in vitamin D replete individuals with SLE.
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Affiliation(s)
- KA Stockton
- University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - DA Kandiah
- University of Western Australia, Faculty of Medicine, Dentistry and Health Sciences, Perth, Australia
| | - JD Paratz
- University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - KL Bennell
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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Abstract
Vitamin D is an essential nutrient proven to be important for bone health. It has other physiological functions, and there are plausible reasons for investigating vitamin D in depressive disorders. Some cross-sectional clinical and epidemiologic studies, but not all studies, have found that low levels of vitamin D are significantly associated with higher levels of depressive symptoms or with a depression diagnosis. However, cross-sectional studies cannot establish causality, and the methodology of these studies has been criticized. Due to the poor quality of the treatment studies, the effectiveness of vitamin D for depression cannot be adequately assessed. Current evidence does not definitively demonstrate that vitamin D deficiency is a cause of or risk for developing depression or that vitamin D is an effective therapy for depression.
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Affiliation(s)
- Robert H Howland
- Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
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Smolders J. Vitamin d and multiple sclerosis: correlation, causality, and controversy. Autoimmune Dis 2010; 2011:629538. [PMID: 21188193 PMCID: PMC3003950 DOI: 10.4061/2011/629538] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 09/14/2010] [Indexed: 11/20/2022] Open
Abstract
The last years, many studies reported associations between correlates of vitamin D exposure and several correlates of multiple sclerosis (MS) disease activity. This review discusses studies on vitamin D status, Expanded Disability Status Scale (EDSS) score, and relapse activity of MS. Furthermore, several considerations for intervention studies on vitamin D supplementation in MS are provided.
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Affiliation(s)
- Joost Smolders
- Division of Clinical and Experimental Immunology, Department of Internal Medicine and School for Mental Health and Neuroscience, Maastricht University Medical Center, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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