Vitamin D: An overview of vitamin D status and intake in Europe

Vitamin D testing in pharmacies: Results of a federal screening campaign

Introduction

The convenient accessibility of pharmacies positions them as optimal venues for screening initiatives. There is growing public concern regarding vitamin D levels, particularly during the winter months in middle-and northern latitudes. This study aimed to assess vitamin D levels in early spring and to evaluate the feasibility of implementing a large-scale screening campaign within pharmacies.

Methods

This investigation was structured as a cross-sectional multicenter survey conducted in a routine care setting. Data collection was performed in a fully anonymized manner. An automatic fluorescent immunoassay system was utilized for point-of-care-testing, and both patient and provider questionnaires were developed. Quantitative data were analyzed descriptively. Both parametric- and nonparametric statistical tests were performed to analyze the data, ensuring robust results across different assumptions. A resulting maturity matrix for implementation was conceptualized.

Results

Over a two-week campaign, 62 community pharmacies conducted a total of 2770 vitamin D tests. All participants completed the questionnaire, and 45 pharmacists participated in a retrospective survey. Vitamin D deficiency was identified in 56.2 % of participants, while 25.2 % exhibited levels of insufficiency. A higher BMI was associated with lower vitamin D levels, whereas daily supplementation correlated with higher levels compared to intermittent or weekly dosing regimens. The vast majority of patients expressed high satisfaction with the services provided. Pharmacists valued the positive feedback from patients and expressed enthusiasm for further testing and the advancement of clinical pharmacy services. The resulting maturity matrix facilitates corporate implementation.

Conclusion

The implementation of a large-scale federal vitamin D screening campaign proved to be feasible and resulted in high levels of satisfaction among both patients and providers. The findings indicated significantly low vitamin D levels among participants. Pharmacists expressed a desire for an expansion of clinical pharmacy services in the future.Vitamin D testing in pharmacies: results of a federal screening campaign.

Contribution of different vitamin D forms and fortified foods to vitamin D intake in Europe: a narrative review

In the current narrative review, the bioavailability of the main vitamin D forms is evaluated. The mean intakes and main contributing forms of vitamin D in the European diet are estimated, as well as the major contributing dietary sources. The literature is reviewed for studies reporting on the proportion of users and non-users of fortified food with vitamin D intakes below reference intakes. In addition, the availability of vitamin D-fortified prepackaged retail products and fortification levels in the European market is assessed. Previously, vitamins D2 and D3 forms were considered the primary forms in the diet. Recent analytical methods suggest that dietary 25(OH)D3, when adjusted for higher bioequivalence, significantly contributes to total vitamin D intakes. When also considering 25(OH)D3 from foods, the estimated vitamin D intake from an average European diet was 3.8µg/d of total Vitamin D Equivalents: vitamin D3, vitamin D2 and 25(OH)D3, contributing about 71%, 2%, and 27%, respectively. Animal foods, fortified fats and spreads contributed most to total intakes. Literature suggests that 94-100% of Europeans aged ≥13y fail to meet the vitamin D reference intake of 10µg/d. About 98-100% of vitamin D-fortified food users and 99-100% of non-users in the UK and Netherlands consumed less than 10µg/d of vitamin D. About 1.2% of prepackaged foods and drinks were voluntary fortified with vitamin D, margarine and plant-based drinks providing most of the daily vitamin D. Encouraging fortification and other strategies may support closing the gap between current and recommended vitamin D intakes.

Dietary and lifestyle determinants of vitamin D status in the UK Biobank Cohort study for predictive modeling

BACKGROUND

Vitamin D (VD) is involved in a wide variety of physiological processes. The high prevalence of VD deficiency in the population requires stronger preventive measures.

OBJECTIVE

Characterize the dietary and lifestyle determinants of VD levels in blood and of VD deficiency to further develop predictive models of these two outcomes.

METHODS

63,759 participants from the UK Biobank study with available data on dietary intake of VD, assessed via 24-hour recalls, and with measurements of serum 25(OH)D levels. Linear and logistic regression models were applied to identify factors associated with VD levels and VD deficiency outcomes, and to evaluate the influence of covariates on the association between VD in serum and VD in the diet. Predictive models were constructed using classical regression models and machine learning methods based on penalized likelihood methods.

RESULTS

Approximately 10% of the participants had VD deficiency (VD < 25 nmol/L), and 38.9% were at risk of VD inadequacy (VD 25-49 nmol/L). The dietary intake of VD was significantly lower in the VD deficient group. This latter group showed lower engagement in physical activity (22.1%) compared to the non-deficient group (13.4%; p < 0.001). Also, overweight and obesity (vs normal weight) were related to a greater likelihood of VD deficiency (OR = 1.18 and 1.96, respectively). A similar odds of VD deficiency was observed for abdominal obesity (OR = 1.83). A weaker association was observed between dietary VD intake, based on participant reports, and VD levels. With regard to sunlight exposure, darker skin tones (OR dark vs fair skin = 3.11), season (OR winter vs autumn = 3.76) and less outdoor time activities (OR per 1 hour increase = 0.96) were also related to VD deficiency. Predictive models for both classical regression and machine learning, showed good accuracy (AUC = 0.8-0.9 for VD deficiency).

CONCLUSIONS

While a rich diet in VD boosts its levels, sun exposure plays a more significant role particularly in populations from the UK or Northern Europe. A predictive model including key determinants could effectively assess VD deficiency.

Calcitriol Treated Mesenchymal Stem Cells Modulated Immune Response in Collagen-Induced Rheumatoid Arthritis in BALB/c Mice

BACKGROUND AND AIM

Rheumatoid arthritis (RA) is a chronic inflammatory disease that primarily involves synovial joints. During the past decade, disease-modifying antirheumatic drugs and biologic agents have been introduced for the treatment of RA. However, they have limitations, including incomplete treatment response, adverse effects requiring drug withdrawal, fall off in efficacy over time, high cost of biologic agents, and refractory cases. Consequently, there is a need to establish safe and effective advanced therapeutic modalities for RA to overcome the shortcomings of current treatments.

METHODS

MSCs after isolation were exposed to 200 nM calcitriol. Rheumatoid arthritis was induced in BALB/c mice using collagen and Freund's complete adjuvant. One week after immunization, the mice were divided into 3 groups including without treatment, groups treated with untreated and treated MSCs. One week after the last injection, mice sacrificed and samples were taken and the desired evaluations were done.

RESULTS

Our results revealed that the respiratory burst capacity, neutrophil phagocytosis, and nitric oxide production in the population of splenocytes were higher in the positive control group compared to the treatment groups. Also, the level of production of IL-4, IL-10 and TGF-β cytokines and INF-γ and IL-17 cytokines showed a significant increase and decrease, respectively, compared to the positive control group.

CONCLUSION

Treatment of MSCs with calcitriol leads to an improvement in regulatory function and inhibitory effects on inflammatory mediators of innate immune cells, particularly splenocytes, in a rheumatoid arthritis model compared to untreated mesenchymal stem cells.

Harnessing the fundamental roles of vitamins: the potent anti-oxidants in longevity

Aging is a complex and heterogeneous biological process characterized by telomere attrition, genomic instability, mitochondrial dysfunction, and disruption in nutrient sensing. Besides contributing to the progression of cancer, metabolic disorders, and neurodegenerative diseases, these manifestations of aging also adversely affect organ function. It is crucial to understand these mechanisms and identify interventions to modulate them to promote healthy aging and prevent age-related diseases. Vitamins have emerged as potential modulators of aging beyond their traditional roles in health maintenance. There is an increasing body of evidence that hormetic effects of vitamins are responsible for activating cellular stress responses, repair mechanisms, and homeostatic processes when mild stress is induced by certain vitamins. It is evident from this dual role that vitamins play a significant role in preventing frailty, promoting resilience, and mitigating age-related cellular damage. Moreover, addressing vitamin deficiencies in the elderly could have a significant impact on slowing aging and extending life expectancy. A review of recent advances in the role of vitamins in delaying aging processes and promoting multiorgan health is presented in this article. The purpose of this paper is to provide a comprehensive framework for using vitamins as strategic tools for fostering longevity and vitality. It offers a fresh perspective on vitamins' role in aging research by bridging biological mechanisms and clinical opportunities.

Vitamin D and its relationship to performance and health during a competitive period in elite women's basketball and volleyball players

Vitamin D [25(OH)D] is a key nutrient, although its level is often low in the general population. To investigate the relationship between vitamin D levels and muscle performance, and to analyze how vitamin D changes during a 16-week competitive season and its relationship to the performance tests performed. Participant characteristics: age 25.1 ± 4.7 years; height 1.8 ± 0.1 m, and body mass 73.9 ± 15.4 kg. Vitamin D levels (ng/mL) were at T1 (September): 33.7 ± 14.7 (n = 23), and at T2 (January): 26.1 ± 7.3 (n = 23). Over 16 weeks of competition, participants' blood was analyzed to determine their vitamin D levels. Their athletic abilities were evaluated through various tests: vertical jumps (standing jump and countermovement jump); 20-m sprint without direction changes; and intermittent endurance test; the vitamin D level decreased from T1 to T2 by -22. 40% [p < 0.05] but performance improved in all tests performed (SJ: 4.57%; CMJ: 6.94%; VO2max: 4.99% [p < 0.05]; 20 m: -1.83%). There is a relationship between vitamin D levels and physical performance in female indoor athletes. The results suggest that increased training load may also negatively affect vitamin D levels in elite female indoor athletes.

Expert consensus on vitamin D in osteoporosis

Background

Adequate vitamin D is essential for maintaining optimal bone health, preventing and treating of osteoporosis. However, in recent years, large clinical trials and meta-analyses on the efficacy of vitamin D supplementation to prevent fractures in populations at different risks have been equivocal. The optimal level of 25-hydroxyvitamin D (25[OH]D) remains controversial. Recommendations vary between societies. The lack of standardized assays also poses a challenge in interpreting available research data.

Methods

We systematically searched for articles in MEDLINE database through PubMed, which included meta-analysis, systematic reviews of randomized controlled trials (RCTs) and observational studies that assessed measurement, diagnosis and treatment about vitamin D deficiency. The experts evaluated the available literature, graded references according to the type of study and described the strength recommendations.

Results

This expert consensus is based on the review of relevant clinical evidence and provides nine key recommendations on vitamin D deficiency in populations at different risks, especially in patients with osteoporosis. Supporting information is provided in the subsequent appendix box.

Conclusions

This expert consensus is a practical tool for endocrinologists, general physicians for the diagnosis, assessment, and treatment of populations at different risks of vitamin D deficiency, especially in patients with osteoporosis. Clinicians should be aware of the evidence but make individualized decisions based on specific patients or situation.

International expert consensus on micronutrient supplement use during the early life course

BACKGROUND

Growing evidence demonstrates that maternal nutrition is crucial for the health of the mother-to-be, and early life course of the offspring. However, for most micronutrients, guidelines are inconsistent. This Delphi study aimed to investigate the level of expert consensus on maternal nutrition and micronutrient needs during preconception, pregnancy and lactation.

METHODS

We conducted a two-round web-based Delphi survey on various topics including general approaches to diet and supplement use, and existing guidelines. For the periods of preconception, pregnancy and lactation, questions focused on the importance and strength of evidence for supplement use with the following micronutrients for low- and high-risk populations: folic acid, choline, iodine, magnesium, calcium, iron, selenium, docosahexaenoic acid (DHA), and vitamins B1, B2, B6, B12, D and K.

RESULTS

Thirty-five experts participated in the panel, who were healthcare professionals (HCPs), researchers and joint HCP-researchers with expertise in nutrition, gynaecology and/or obstetrics. Panellists reached consensus on the importance of diet and dietary supplement use during pregnancy and agreed on the lack of clarity and consistency in current guidelines, and the need for education in these areas for HCPs, pregnant people and the general population. For general low-risk populations, there was consensus on the importance of supplement use with iron and vitamin D from preconception through lactation, with folic acid and iodine from preconception through the second and third trimesters, respectively, with DHA from the first trimester through lactation and with calcium during lactation. Panellists agreed that the evidence for supplement use with each of these micronutrients during these phases to improve outcomes and/or foetal development is strong, except for vitamin D (preconception), DHA (first trimester), and iron (both periods). There was also consensus that supplement use advice should be tailored for people following vegan/vegetarian diets, restricted diets due to food intolerances, obesity, polycystic ovary syndrome, diabetes mellitus, and previous nutrition-related pregnancy complications.

CONCLUSION

The findings revealed robust consensus on various aspects of maternal nutrition, including the need for education, the lack of consistency in current guidelines on supplement use, the importance of supplement use across specific phases of pregnancy and the at-risk groups requiring tailored approaches.

The Interplay Between Vitamin D Deficiency, Iron Status, and Anemia Risk in Moroccan Women of Reproductive Age: A Cross-Sectional Analysis

Background: Vitamin D and iron deficiencies are prevalent among Moroccan women of reproductive age (WRA). Research suggests that Vitamin D deficiency (VDD) may impair iron bioavailability, potentially leading to iron deficiency (ID) and anemia. Objectives: This study investigates associations between vitamin D status, iron levels, and anemia risk in WRA, aged 18-49, from Meknes, Morocco. Methods: A cross-sectional study was conducted among 463 participants, measuring serum 25(OH)D, blood count parameters, iron, ferritin, C-reactive protein, and creatinine. Lifestyle factors, including dietary intake, sun exposure, and physical activity, were assessed through validated questionnaires, and anthropometric data were collected. Linear and logistic regression models analyzed associations, while ROC analysis evaluated VDD's predictive accuracy for ID and anemia. Results: VDD (25(OH)D < 20 ng/mL) was significantly associated with reduced hemoglobin, hematocrit, red blood cells, and ferritin (all p < 0.01), indicating vitamin D's role in erythropoiesis and iron storage. Multivariate logistic regression showed that VDD increased the risk of anemia (OR: 7.17, 95% CI: 3.19-19.28, p < 0.001), ID (OR: 2.20, 95% CI: 1.32-3.77, p = 0.007), and IDA (OR: 4.10, 95% CI: 1.73-12.08, p = 0.004). Dietary iron intake was inadequate, showing minimal protective effects against anemia and ID (β(SE): -0.08(0.03), p = 0.030 and β(SE): -0.05(0.02), p = 0.037). Conclusions: VDD is a significant risk factor for impaired iron status and anemia in Moroccan WRA, highlighting the need for targeted nutritional interventions and further research.

Impact of 24-week supervised concurrent exercise on S-Klotho and vitamin D levels: A randomized controlled trial

This study aimed to investigate the effects 24 weeks of supervised exercise training at different intensities on S-Klotho and 25-hydroxyvitamin D plasma levels in young adults. This report was based on a secondary analysis from the ACTIBATE single-center unblinded randomized controlled trial (ClinicalTrials.gov ID: NCT02365129). A total of 144 young adults (~34% men and ~66% women) aged between 18 and 25 years took part in the study. The participants were randomly assigned to 3 different groups: (i) concurrent exercise training program based on the international physical activity recommendations at vigorous intensity (Ex-Vigorous group), (ii) at moderate intensity (Ex-Moderate group), and (iii) control group (no exercise). S-Klotho and 25-hydroxyvitamin D plasma levels were determined before and after the 24-week intervention programme. A significant decrease of 25-hydroxyvitamin D plasma levels were identified across time in all groups (p < 0.001), whereas no significant differences across time were observed in S-Klotho plasma levels (p = 0.497). There was no time x group interaction neither in S-Klotho nor in 25-hydroxyvitamin D plasma levels (all p > 0.7). In summary, our results showed that 24 weeks of supervised concurrent exercise training does not induce significant changes on S-Klotho and 25-hydroxyvitamin D independently of the exercise intensity in young adults.

Integrating Endocrine, Genomic, and Extra-Skeletal Benefits of Vitamin D into National and Regional Clinical Guidelines

BACKGROUND/OBJECTIVES

Vitamin D is essential for bone health, immune function, and overall well-being. Numerous ecological, observational, and prospective studies, including randomized controlled clinical trials (RCTs), report an inverse association between higher serum 25-hydroxyvitamin D [25(OH)D; calcifediol] levels in various conditions, including cardiovascular disease, metabolic disorders such as diabetes and obesity, susceptibility to infection-related complications, autoimmune diseases, and all-cause mortality.

RESULTS

Vitamin D operates through two distinct systems. The endocrine system comprises the renal tubular cell-derived circulatory calcitriol, which primarily regulates calcium homeostasis and muscular functions. In contrast, intracellularly generated calcitriol in peripheral target cells is responsible for intracrine/paracrine system signaling and calcitriol-vitamin D receptor-mediated genomic effects. Government-appointed committees and health organizations have developed various clinical practice guidelines for vitamin D supplementation and management. However, these guidelines heavily relied on the 2011 Institute of Medicine (IoM) report, which focused solely on the skeletal effects of vitamin D, ignoring other body systems. Thus, they do not represent maintaining good overall health and aspects of disease prevention. Additionally, the IoM report was intended as a public health recommendation for the government and is not a clinical guideline.

DISCUSSION

New country- and regional-specific guidelines must focus on healthy nations through disease prevention and reducing healthcare costs. They should not be restricted to bone effect and must encompass all extra-skeletal benefits. Nevertheless, due to misunderstandings, medical societies and other governments have used faulty IoM report as a foundation for creating vitamin D guidelines. Consequently, they placed disproportionate emphasis on bone health while largely overlooking its benefits for other bodily systems, making current guidelines, including 2024, the Endocrine Society less applicable to the public. As a result, the utility of published guidelines has been significantly reduced for clinical practice and RCTs that designed on bone-centric are generate misleading information and remain suboptimal for public health and disease prevention.

CONCLUSIONS

This review and its recommendations address the gaps in current vitamin D clinical practice guidelines and propose a framework for developing more effective, country and region-specific recommendations that capture the extra-skeletal benefits of vitamin D to prevent multiple diseases and enhance public health.

Prevalence and risk factors of vitamin D deficiency among Afghan primary school children

Vitamin D deficiency is common in many societies and causes rickets and non-skeletal disorders in children. There are no published data on vitamin D deficiency in Afghanistan. We, therefore, investigated the prevalence and associated factors of vitamin D deficiency in Afghan school children in Kandahar City, Afghanistan. This cross-sectional analytical study was conducted from September 2022 to April 2023 in 510 primary school students aged 6-15 years from six randomly selected schools. Data were analyzed by using descriptive statistics, Chi-square test, and multivariate logistic regression. Of the 510 enrolled children, 54.3% were boys and 91.8% were poor. The mean serum 25(OH)D concentration was 9.3 ng/mL. Vitamin D deficiency (< 20 ng/mL) was detected in 436/510 (85.5%) children that was severe in 267/510 (52.4%). By logistic regression analysis, independent factors for vitamin D deficiency were: (i) older age group 11-15 vs. 6 - 10 years, adjusted odds ratio (AOR) 2.8 (95% confidence interval 1.2-6.2), (ii) poverty AOR 2.0 (1.0-4.3), (iii) not doing outdoor physical activity AOR 4.8 (2.8-8.1), and (iv) daily sunlight exposure < 60 min AOR 2.2 (1.3-3.7). Although Kandahar is very sunny throughout the year, vitamin D deficiency is highly prevalent among school boys and girls, placing them at great risk of vitamin D-deficient rickets. More work is needed to define the country-wide prevalence of vitamin D deficiency to inform robust strategies of vitamin D supplementation, the provision of vitamin D-fortified food to the school children in Kandahar City and health education programs that can be conducted with the help of international organizations.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

PROSPERO REGISTRATION NUMBER

CRD42021240562.

Can Vitamin D Levels Influence Bone Metabolism and Osseointegration of Dental Implants? An Umbrella Review

INTRODUCTION

Due to the large amount of scientific evidence on the subject and the limitations and incongruities in previous reviews, the primary aim of this umbrella review is to gather all the information regarding the importance of vitamin D levels in the osseointegration of dental implants.

METHODS

The literature search was performed in PubMed, Web of Science, CINAHL Plus, Cochrane Library, and Academic Search Complete throughout the search expression ["vitamin D" AND ("dental implant" OR "dental implants")].

RESULTS

The initial search yielded 351 results, but at the end of the process, only five systematic reviews were selected.

CONCLUSIONS

Vitamin D seems to have a positive effect on the osseointegration of dental implants and on the reduction of dental implant failures; however, it is recommended that future studies take into account the limitations mentioned in this study in order to increase the validity and quality of scientific evidence on the subject.

Seasonal variation of total and bioavailable 25-hydroxyvitamin D [25(OH)D] in the healthy adult Slovenian population

Objective: The aim of our study was to compare the total 25(OH)D fraction, the bioavailable vitamin fraction, and the free vitamin D fraction in spring and fall in a group of healthy individuals. Methods: In our study, we collected blood samples from healthy participants at the end of both summer and winter, and measured serum levels of albumin, DBP, and 25(OH)D. Utilizing these data, we calculated the percentage of free and bioavailable vitamin D. Our cohort comprised 87 participants, with a male-to-female ratio of 14:73, aged 35.95 ± 12.55 years, ranging from 19 to 70 years. We employed the chemiluminescence method to determine the vitamin 25(OH)D levels, the ELISA method was utilized to determine DBP levels, the albumin BCP Assay was performed using the ADVIA biochemical analyzer (Siemens) and an online calculator was used to determine the free and bioavailable 25(OH)D levels. Results: Our findings indicate significantly lower 25(OH)D levels in winter (44.13 ± 17.82 nmol/L) compared to summer (74.97 ± 22.75 nmol/L; p < 0.001). For vitamin D binding protein there was no significant difference from summer (236.2 ± 164.39 mg/L) to winter (239.86 ± 141.9 mg/L; p = 0.77), albumin levels were significantly higher in summer (49.37 ± 4.15 g/L vs. 47.97 ± 3.91 g/L, p = 0.01), but the magnitude of the change may not be large enough to be solely responsible for the stability of vitamin D levels throughout the year. In the winter season a significantly lower calculated bioavailable 25(OH)D vitamin (7.45 ± 5.66 nmol/L against 13.11 ± 8.27 nmol/L; p < 0.001) was observed, and the free fraction also showed a significant decrease (17.3 ± 12.9 pmol/L versus 29.7 ± 19.1 pmol/L; p < 0.0001). We observed a moderately positive correlation between 25(OH)D and bioavailable percentage in winter (r = 0.680; p < 0.001), in contrast with a lower positive association in summer (r = 0.343; p < 0.001). Conclusion: Our data suggest a positive correlation between total and bioavailable 25(OH)D levels. In addition to the statistically significant variation in 25(OH)D between the two observation periods, there was an additional variation in the free vitamin D percentage. The summertime synthesis of vitamin D in the skin could contribute directly to the free fraction of vitamin D. Standardizing the measurement of free 25(OH)D and clinical studies is necessary to establish reference values before these methods can be implemented in clinical practice.

The Prevalence of Low Vitamin D in Elite Para-Athletes: A Systematic Review

BACKGROUND

Vitamin D insufficiency (25OHD, 50-75 nmolˑl- 1) is a common issue within healthy adults and elite athletes and is associated with decreased musculoskeletal health and performance. However, few studies have identified the prevalence and risk factors associated with vitamin D insufficiency within elite Para-Athletes.

METHODS

An electronic search was completed on the 5th January 2023 and updated on the 21st June 2024, searching Web of Science, PubMed, Scopus, Cochrane Library and EASY (originally OpenGrey). To meet the eligibility criteria, retrieved studies were required to include at least one baseline measure of a vitamin D biomarker from elite Para-Athletes performing at national or international levels and therefore all quantitative study designs could be included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist (8-item) for analytical cross-sectional studies. Data from the eligible studies was extracted and charted, with a supporting narrative synthesis.

RESULTS

The search strategy retrieved 3083 articles, of which ten studies met the inclusion criteria. In total there were n = 355 Para-Athletes, 69.6% of which comprised of males in the included studies. Across the ten included studies, n = 546 samples were taken from n = 355 Para-Athletes across different seasons and based upon the 25(OH)D insufficiency and deficiency thresholds set by each individual study 43.2% of the samples were considered insufficient and 28.1% deficient. During the winter months vitamin D insufficiency was at its most prevalent at 74.1%, compared to 57.1% in summer of the 25(OH)D samples measured in Para-Athletes. Wheelchair athletes who competed in indoor sports were also more susceptible to low vitamin D.

CONCLUSION

This review has highlighted that vitamin D insufficiency and deficiency is highly prevalent in elite level Para-Athletes, all year, across both summer and winter months. Therefore, this review highlights the need for education, treatment, and preventative measures in elite Para-Athletes throughout the year.

REGISTRATION

The following systematic review was prospectively registered through PROSPERO International prospective register of systematic reviews (PROSPERO registration ID number: CRD42022362149).

Prenatal Vitamin D Deficiency and Maternal and Fetal Health Outcomes

Vitamin D deficiency (VDD) is a significant health issue that could have serious implications for the well-being of women and their offspring. Prenatal vitamins are widely used, but deficiency still occurs frequently in the preconception period, during pregnancy, and in breastfed infants. We analyzed the association between prenatal VDD and maternal and fetal health outcomes by reviewing studies conducted in Europe. The literature was searched for articles published in the last 10 years focusing on preeclampsia, gestational diabetes mellitus, preterm birth, low birth weight, asthma, and autism spectrum disorder. We identified a total of 43 review articles, 31 original articles, and two guidelines. During pregnancy, VDD is associated with a higher likelihood of developing gestational diabetes mellitus and preeclampsia. It may also lead to an increase in the risk of preterm birth, low birth weight, as well as asthma, and autism spectrum disorder in the offspring. While the official guidelines for vitamin D dosage differ in various countries, health authorities usually recommend a total daily supplement intake of 400-2,000 IU. In conclusion, this review emphasizes the importance of establishing guidelines for vitamin D supplementation as well as the requirement of official standards for the consumption of vitamin D in the prenatal period. Future research should concentrate on developing more unified approaches to vitamin D assessment and establishing preventative measures that can be incorporated into prenatal care programs.

Vitamin D Deficiency-A Public Health Issue in Children

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relative Energy Deficiency in Sport (REDs) and knee injuries: current concepts for female athletes

In athletes, a mismatch between caloric intake and energy expended in exercise can eventually lead to Relative Energy Deficiency in Sport (REDs), where the athlete suffers from physiological derangements and decreased sport performance. The prevalence of REDs is higher in females than males. Females are already at a higher risk of knee injuries, which has been attributed to a multitude of factors such as hormonal influences, differences in musculoskeletal anatomy and neuromuscular control compared to males. The literature demonstrates an even higher risk of knee injuries in female athletes with symptoms of REDs. We propose the various factors that influence this risk. A reduction in anabolic hormones can affect muscle development and tendon repair. A relationship between poor neuromuscular control and knee injury has been established, and this can be further worsened in patients with menstrual dysfunction. Chronic deficiency in nutrients such as collagen and vitamin D can result in poorer recovery from microtrauma in tendons and ligaments. All these factors may contribute to increasing the risk of knee injuries, which may include anterior cruciate ligament tears, patella tendinopathy and patellofemoral pain syndrome. This review aims to educate sports clinicians to have a high index of suspicion when treating knee injuries in females; to screen and then manage for REDs if present, for holistic patient care.

Evaluation of the vitamin D response index in a Saudi cohort

The concept of the vitamin D response index was developed based on vitamin D intervention studies conducted with Finnish cohorts. In this study, we challenged the concept by performing a single vitamin D3 bolus (80,000 IU) intervention with a cohort of 100 native Saudis. The change of serum levels of the proinflammatory cytokines interleukin 6, interleukin 8 and tumor necrosis factor measured directly before intervention in comparison to samples taken one and thirty days after vitamin D3 supplementation were used as biomarkers for distinguishing low, mid and high responders. Interestingly, we identified 39 % of the study participants as low responders. In contrast, when we used in a subset of 37 study participants whole blood expression changes of seven well-known vitamin D target genes one and thirty days after supplementation as alternative biomarkers, only 9 persons (24 %) were identified as low responders. In conclusion, in Saudi Arabia the rate of low vitamin D responders is equal or even higher than that in Finland. Therefore, similar to Nordic countries also in Saudi Arabia appropriate vitamin D3 supplementation is essential, in order to fulfill the needs of low responders.

Cord Blood 25-Hydroxyvitamin D Level is Correlated with a Risk for Atopic Dermatitis: Systematic Review and Meta-Analysis

Although Indonesia is located in an equatorial region with adequate year-round sun exposure, the prevalence of 25-hydroxyvitamin D (25[OH]D) deficiency is as high as 90%. Mothers are especially vulnerable to deficiencies due to changes in their gastrointestinal system. Previous studies have reported a correlation between the 25[OH]D status of mothers with atopic dermatitis (AD) and their offspring. However, studies investigating maternal cord blood 25[OH]D levels and the incidence of AD have yielded controversial results due to its variability. As such, this systematic review and meta-analysis aimed to evaluate the correlation between maternal cord blood 25[OH]D levels and the risk for AD. In accordance with Preferred Reporting System for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, Cochrane Library and ScienceDirect databases were searched for relevant observational studies and a meta-analysis was performed to obtain odds ratios (OR) and corresponding 95% confidence intervals (CI). Nine studies were included in the qualitative synthesis, five of which were included in the quantitative synthesis. Meta-analysis revealed that cord blood 25[OH]D levels < 50 nmol/L were associated with a 60% higher risk for the development of AD (OR = 1.60; 95% CI: 1.15, 2.22; I2 = 0%; P < 0.05). However, qualitative synthesis revealed a variety of cord blood 25[OH]D measurements and different methods of diagnosing AD in each study. Based on the current analysis, maternal cord blood 25[OH]D levels were significantly correlated with the risk for AD. Therefore, studies investigating 25[OH]D supplementation in pregnant women and its efficacy in decreasing the risk for AD are needed, especially in tropical and equatorial countries. This study also serves as a proof of concept that cord blood 25[OH]D levels can be used as a more affordable predictive parameter for AD.

[Translated article] Vitamin D and Skin Cancer: A Controversial Society. Literature Update and Review

Vitamin D (VD) deficiency has been associated with various tumors. However, the association between VD and skin cancer is controversial. Although in non-melanoma skin cancer, adequate or even high levels of VD can be associated with a higher risk of developing tumors, this could be biased by the direct association between sun exposure and VD levels. Regarding melanoma, results are contradictory. Most studies analyzed state that higher levels of VD could reduce the risk of melanoma, be associated with melanomas with better prognosis and with an enhanced antitumor response, and also with fewer adverse events associated with melanoma immunotherapy. However, prospective studies of adequate methodological quality are still needed to assess the association between VD levels and its supplementation and development/prognosis in skin cancer.

Vitamin D and Skin Cancer: A Controversial Society. Literature Update and Review

Vitamin D (VD) deficiency has been associated with various tumors. However, the association between VD and skin cancer is controversial. Although in non-melanoma skin cancer, adequate or even high levels of VD can be associated with a higher risk of developing tumors, this could be biased by the direct association between sun exposure and VD levels. Regarding melanoma, results are contradictory. Most studies analyzed state that higher levels of VD could reduce the risk of melanoma, be associated with melanomas with better prognosis and with an enhanced antitumor response, and also with fewer adverse events associated with melanoma immunotherapy. However, prospective studies of adequate methodological quality are still needed to assess the association between VD levels and its supplementation and development/prognosis in skin cancer.

Vitamin D Supplementation Improves Physical Performance in Athletes and Healthy Aging in Physically Active Adults

Vitamin D deficiency is a significant global public health issue, even in regions with all year sun exposure. Currently, the scientific community has not yet reached a unanimous agreement regarding the optimum levels of vitamin D and the precise threshold values. Additional efforts are required to standardize the evaluation of vitamin D insufficiency and deficiency and to provide uniform treatment guidelines. Epidemiological studies have identified a broad spectrum of estimated prevalences in athletes. Their performance when participating in sports. depend on their muscles, heart and lung function. It seems that athletes have significantly lower levels of vitamin D compared to the general population. However, there is a lack of comprehensive studies and systematic reviews on this subject, making it challenging to reach conclusions due to variations in laboratory techniques and cut-off values. While there is an abundant of research on the supplementation of vitamin D and its benefits, it is challenging to provide general recommendations for athletes due to the limitations of extrapolation. However, there is a rather high occurrence of Vitamin D deficiency among individuals who engage in regular physical activity. Supplementing with Vitamin D helps prevents osteoporosis, bone fractures, enhances muscle strength, avoids lung infections, heart failure, and arrhythmias. It is generally safe when used in appropriate quantities, given its wide therapeutic range. Athletes can decrease the occurrence of training dropouts caused by infection, arrhythmias, muscular weakness and potentially prevent the inability to participate in competitions through correct nutrition and vitamin D supplementation. Keywords: vitamin D; sports; muscle; heart, athletes rehabilitation, vitamin D, ventricular premature contractions, physical activity

Nutritional Challenges in Nursing Homes: Pilot Study on Macronutrient Intake and Status of Vitamins D and B12

Older adults living in nursing homes (NH) are considered a population group that could be at risk in terms of nutrition, even more so than their community-dwelling peers. Evidence on the nutritional status of NH residents is scarce, as they are commonly excluded from population-based dietary studies. This is also the case in Slovenia. In the presented pilot study, we assessed the intake of macronutrients as well as the intake and status of vitamin D and vitamin B12 on a sample of NH and NH daycare center users to explore the need for a larger representative study. The pilot study included 37 participants from three Slovenian NH (20 participants) and their daycare centers (17 participants). Daycare centers offer daytime care services for older adults, where users are also provided with major meals during their stay. Intakes of energy and nutrients were estimated by three 24 h dietary records. Fasting blood samples were collected for the assessment of vitamin D and vitamin B12 status. Over 90% of the participants had daily energy and protein intakes below recommendations (reference values: energy intake: males 2100 kcal and females 1700 kcal; protein intake > 1 g/kg body mass). The males' median daily intakes of vitamin D were 1.7 µg (1.5 µg females), and 2.3 µg for vitamin B12 (2.0 µg females). None of the participants had adequate vitamin D intake (>20 µg), and 92.3% males and 87.5% females had inadequate vitamin B12 intake (<4 µg). The prevalence of vitamin D deficiency (serum 25-OH-D conc. < 30 nmol/L) was 100% among NH residents and 53% among NH daycare center users. The prevalence of vitamin B12 deficiency was found in 20% of NH residents. The study results highlighted that certain nutrients might be critical in this population, especially among NH residents; however, a more thorough investigation with the inclusion of other important markers of nutritional status should be performed on a larger, representative sample to support the development and implementation of appropriate public health interventions.

A Study of Vitamin D Status and Its Influencing Factors among Pregnant Women in Szeged, Hungary: A Secondary Outcome of a Case-Control Study

Adequate vitamin D (VD) intake during pregnancy is needed for fetal development and maternal health maintenance. However, while there is no doubt regarding its importance, there is not a unified recommendation regarding adequate intake. The main aim of our study was to measure the VD serum level of studied women, together with its potential influencing factors: demographic (i.e., age, level of education, relationship status and type of residence), conception and pregnancy related factors. Results are based on secondary data analyses of a retrospective case-control study of 100 preterm and 200 term pregnancies, where case and control groups were analyzed together. Data collection was based on a self-administered questionnaire, health documentation, and maternal serum VD laboratory tests. VD intake was evaluated by diet and dietary supplement consumption. According to our results, 68.1% of women took some kind of prenatal vitamin, and only 25.9% of them knew about its VD content. Only 12.1% of included women reached the optimal, 75 nmol/L serum VD level. Higher maternal serum levels were associated with early pregnancy care visits (p = 0.001), assisted reproductive therapy (p = 0.028) and advice from gynecologists (p = 0.049). A correlation was found between VD intake and serum levels (p < 0.001). Despite the compulsory pregnancy counselling in Hungary, health consciousness, VD intake and serum levels remain below the recommendations. The role of healthcare professionals is crucial during pregnancy regarding micronutrients intake and the appropriate supplementation dose.

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

BACKGROUND AND AIMS

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

METHODS AND RESULTS

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

CONCLUSION

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

Autophagy in Its (Proper) Context: Molecular Basis, Biological Relevance, Pharmacological Modulation, and Lifestyle Medicine

Autophagy plays a critical role in maintaining cellular homeostasis and responding to various stress conditions by the degradation of intracellular components. In this narrative review, we provide a comprehensive overview of autophagy's cellular and molecular basis, biological significance, pharmacological modulation, and its relevance in lifestyle medicine. We delve into the intricate molecular mechanisms that govern autophagy, including macroautophagy, microautophagy and chaperone-mediated autophagy. Moreover, we highlight the biological significance of autophagy in aging, immunity, metabolism, apoptosis, tissue differentiation and systemic diseases, such as neurodegenerative or cardiovascular diseases and cancer. We also discuss the latest advancements in pharmacological modulation of autophagy and their potential implications in clinical settings. Finally, we explore the intimate connection between lifestyle factors and autophagy, emphasizing how nutrition, exercise, sleep patterns and environmental factors can significantly impact the autophagic process. The integration of lifestyle medicine into autophagy research opens new avenues for promoting health and longevity through personalized interventions.

Factors to take into account when interpreting 25-hydroxy-vitamin D serum levels

BACKGROUND

Assessing vitamin D status, typically evaluated using serum or plasma 25-hydroxy vitamin D [25(OH)D] concentration, is complex because of various influencing factors.

METHODS

Seasonality significantly affects intra-individual variability in 25(OH)D levels. This variation can be addressed by employing cosinor functions that are tailored to the geographical location of the patient to correct for seasonal effects. In addition to seasonality, genetic factors, such as DBP polymorphism and body composition, particularly adiposity, play crucial roles. Dialysis patients with DBP 2-2 phenotype exhibit higher vitamin D requirements. Genotyping/phenotyping of DBP allows for better tailored vitamin D supplementation. The lipid-soluble nature of vitamin D also interacts with plasma components such as serum triglycerides, which can influence vitamin D measurements. Adiposity, which is negatively correlated with vitamin D concentration, necessitates body mass-based mathematical adjustments for accurate vitamin D assessment in subjects with extreme BMI values.

CONCLUSIONS

Accordingly, vitamin D replacement therapy must be personalized, taking into account factors such as body size and seasonal variations, to effectively reach the target serum 25(OH)D concentrations.

Alzheimer's Disease: A Review of Pathology, Current Treatments, and the Potential Therapeutic Effect of Decreasing Oxidative Stress by Combined Vitamin D and l-Cysteine Supplementation

Significance: Excess oxidative stress and neuroinflammation are risk factors in the onset and progression of Alzheimer's disease (AD) and its association with amyloid-β plaque accumulation. Oxidative stress impairs acetylcholine (ACH) and N-methyl-d-aspartate receptor signaling in brain areas that function in memory and learning. Glutathione (GSH) antioxidant depletion positively correlates with the cognitive decline in AD subjects. Treatments that upregulate GSH and ACH levels, which simultaneously decrease oxidative stress and inflammation, may be beneficial for AD. Recent Advances: Some clinical trials have shown a benefit of monotherapy with vitamin D (VD), whose deficiency is linked to AD or with l-cysteine (LC), a precursor of GSH biosynthesis, in reducing mild cognitive impairment. Animal studies have shown a simultaneous decrease in ACH esterase (AChE) and increase in GSH; combined supplementation with VD and LC results in a greater decrease in oxidative stress and inflammation, and increase in GSH levels compared with monotherapy with VD or LC. Therefore, cosupplementation with VD and LC has the potential of increasing GSH, downregulation of oxidative stress, and decreased inflammation and AChE levels. Future Directions: Clinical trials are needed to determine whether safe low-cost dietary supplements, using combined VD+LC, have the potential to alleviate elevated AChE, oxidative stress, and inflammation levels, thereby halting the onset of AD. Goal of Review: The goal of this review is to highlight the pathological hallmarks and current Food and Drug Administration-approved treatments for AD, and discuss the potential therapeutic effect that cosupplementation with VD+LC could manifest by increasing GSH levels in patients. Antioxid. Redox Signal. 40, 663-678.

Serum Calcium Normal Range in 1,000 Term Newborns

INTRODUCTION

Serum calcium rapidly declines at birth because of the sudden interruption of the maternal-fetal calcium influx. Several factors are known to influence serum calcium in the first days of life, including circulating concentrations of maternal vitamin D. Objective was to establish the normal range variations of neonatal serum calcium according to the current French vitamin D supplementation during pregnancy, i.e., 100,000 IU of cholecalciferol during the third trimester.

METHODS

We included in our prospective cohort study 1,002 mother-newborn dyads recruited from April 2012 to July 2014 in two centers located in the neighborhoods of Paris, France.

RESULTS

Total serum calcium at 3 days of life in neonates varied from 2.06 mmol/L to 2.73 mmol/L [2.5 and 97.5 percentiles], with a mean of 2.45 mmol/L. Serum calcium was similar between babies born from vitamin D-supplemented mothers and those born from non-supplemented ones. In univariate and multivariable analyses, we demonstrated the importance of maternal and cord blood 25(OH)D concentrations for newborn serum calcium maintenance.

CONCLUSION

We established that the expected serum calcium in neonates ranges between 2.06 mmol/L and 2.73 mmol/L which is significantly wider than the adult range. This finding should help physicians in the diagnosis of hypo- or hypercalcemia. In addition, our study supports the importance of vitamin D supplementation and 25(OH)D status for neonatal serum calcium maintenance.

Ethnic-Based Assessment of Vitamin D and Magnesium Status in the Kingdom of Bahrain

BACKGROUND

Vitamin D deficiency is a major global health problem. Most previous studies focused attention on the significant role of sunlight exposure in the homeostasis of vitamin D and calcium blood levels. Magnesium is pivotal in the proper functioning of vitamin D, and the physiologic functions of different organs require a balanced vitamin D and magnesium status. The relationship between sunlight exposure and blood levels of vitamin D and magnesium has often been overlooked. The aim of this study was to evaluate vitamin D and magnesium status based on sunlight exposure and ethnicity in Bahraini and expatriate workers.

METHODS

A cross-sectional study was conducted between October 2018 and September 2019. One hundred and seventy-four subjects participated in this study were subdivided based on their ethnicity and work environment-dependent exposure to sunlight into four groups: (1) Bahraini exposed (n=94), (2) Bahraini non-exposed (n=25), (3) expatriate exposed (n=31), and (4) expatriate non-exposed (n=24). Blood levels of vitamin D and magnesium were evaluated for all the participants.

RESULTS

 Independent of ethnicity, vitamin D levels were insignificantly different among the studied groups and were all below the normal reference range. Yet, there was still a sunlight-dependent increase in vitamin D level that could be seen only in Bahraini workers. Magnesium levels were significantly higher in expatriates when compared to Bahraini workers. Sunlight-exposed expatriates had significantly higher magnesium levels than their Bahraini counterparts, while there was no significant difference between both ethnicities in the non-exposed groups.

CONCLUSION

Country- and ethnic-specific definitions for vitamin D status and sunlight exposure are recommended. The assessment of magnesium status is pivotal in the overall assessment of vitamin D status.

Vitamin D-A New Therapeutic Target in the Management of Type 2 Diabetes Patients

Background: Vitamin D is a fat-soluble vitamin that prevents cardiovascular diseases and diabetes mellitus (DM). The present research aimed to study the impact of 25-hydroxyvitamin D (25(OH)D) level on the health status of patients with type 2 DM (T2DM) hospitalized in the "Pius Brînzeu" Emergency Clinical County University Hospital in Timisoara, Romania. Methods: The study retrospectively included 160 patients with T2DM who were clinically and biologically evaluated during hospitalization. Results: 13.1% of patients had optimal, 23.1% insufficient, and 63.8% deficient 25(OH)D values. Patients with 25(OH)D deficiency presented poorer glycemic control and were older, with higher weight, but had altered renal function, anemia, and lower iron values. Also, patients with associated neoplasia, diabetic neuropathy, cardiovascular disease (CVD), dementia, and grade 3 arterial hypertension (HTN) had lower values of 25(OH)D. An age > 55 years (sensitivity 69.9, specificity 82.5, AUROC 0.786, p < 0.001) and an HbA1c > 7.7% (sensitivity 89.3, specificity 92.9, AUROC 0.938, p < 0.001) predict 25(OH)D deficiency in T2DM patients. Conclusions: Vitamin D influences almost every system and organ in the body, so it should be a routine test for all patients with DM to correct the deficiency and prevent other diseases and complications.

Causal relationship between diet and knee osteoarthritis: A Mendelian randomization analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common disabling joint disease that affects millions of people worldwide. Diet may play a role in the etiology and progression of KOA, but evidence for a causal relationship is limited. We aimed to investigate the causal impact of dietary intake on KOA risk using Mendelian randomization (MR).

METHODS

We used summary-level data from genome-wide association studies (GWAS) including dietary intake (n = 335, 394-462, 342), and KOA (n = 403, 124). We selected 6-77 genetic variants as instrumental variables for 18 dietary factors, including processed meat, poultry, beef, oily fish, non-oily fish, pork, lamb, frequency of alcohol intake, alcoholic beverages, tea, coffee, dried fruit, cereals, cheese, bread, cooked vegetables, salad/raw vegetables, and fresh fruit. We performed univariate and multivariate MR analyses to estimate the causal effect of each dietary factor on KOA risk. We also performed some sensitivity analyses to assess the validity of the MR hypothesis.

RESULTS

We found that higher coffee intake was associated with increased KOA risk, whereas higher intake of dried fruits, grains, cheese, and oily fish was associated with reduced KOA risk. After multivariate adjustment, we found that coffee and oily fish intake may affect KOA through obesity, body mass index (BMI), diabetes, hypertension, and prolonged standing. Sensitivity analyses did not reveal any evidence of pleiotropy.

CONCLUSIONS

Our study provides new causal evidence that dietary intake may influence KOA risk. Specifically, we suggest that increased intake of dried fruits, grains, cheese, and oily fish and decreased coffee intake may be beneficial in preventing and mitigating KOA. further studies are needed to elucidate the underlying mechanisms and to confirm our findings in different populations.

Possible benefits of food supplementation or diet in scar management: A scoping review

Aim

The evidence regarding a potential role of food supplementation as an adjunct therapy in scar aftercare is limited. In this scoping review we aim to provide an overview of the possible beneficial role of supplementations in aftercare settings.

Method

After formulating the research question and accompanying key words, a comprehensive search for relevant publications was performed using PubMed and Web of Science. Two authors independently identified and checked each study against the inclusion criteria. All data was collected and summarized for further discussion.

Results

After screening, 11 studies were included in the qualitative synthesis. Four studies including human subjects showed a promising connection between scar improvement and supplementation of vitamin D, omega-3 fatty-acids or a Solanaceae-free diet and lower omega-6 fatty-acid intake. Most of the studies were performed on in-vitro models. Preliminary evidence confirmed the beneficial role of vitamin D. Curcumin- and quercetin-supplementation were linked to decreased fibroblast proliferation. Vitamin C enhanced collagen production in healthy as well as keloidal dermal fibroblasts. Chitin stimulated cell-proliferation in human fibroblasts and keratinocytes.

Conclusion

The findings suggest early potential benefits of additional food supplementation in scar management for scars but provide no clear evidence. To establish guidelines or gather more evidence on food supplementation, studies involving human subjects (in vivo) are essential. The intricacies associated with nutritional studies in vivo present multifaceted challenges. It should be emphasized that substantial additional evidence is required before aspects such as timing and dosage of supplementation could be addressed for clinical application.

Lay Summary

Aim: This scoping review looks at whether taking food supplements might help with scar care alongside standard scar management following burn injury. Little information is thought to be available on this subject. An up-to-date review of the literature was undertaken to assimilate the body of evidence and determine if a consensus could be drawn.Method: A specific research question was designed and search conducted in scientific databases like PubMed and Web of Science. Two of our team members carefully selected and reviewed each study to determine which studies met the inclusion or exclusion criteria. All studies that met the inclusion criteria were then reviewed and the information collated to enable conclusions to be drawn.Results: Eleven studies met the inclusion criteria and were used to formulate the conclusions drawn. Four studies showed that taking vitamin D, omega-3 fatty acids, a diet without certain vegetables (Solanaceae), and eating less omega-6 fatty acids might help improve scars. It is important to note that most studies (seven out of 11) were carried out in a laboratory and not with real people. These lab studies showed that vitamin D might be helpful. Supplements like curcumin and quercetin seemed to slow down the growth of skin cells like fibroblasts and keratinocytes. Vitamin C aided collagen synthesis, which is important for healthy skin, in both normal and keloid scar cells. Another substance, chitin, was also found to help skin cells and keratinocytes grow better.Conclusion: Our findings point to some early possible benefits of taking extra nutrient supplements for managing scars but do not provide clear evidence. More research is required to enable the development of supplement recommendation and guidelines to be produced. Future research should focus on human trials but do keep in mind that carrying out supplement studies with people is more complicated. The evidence provided by this scoping review is insufficient to recommend the intake of any supplements or the imposition of dietary restrictions for the purpose of managing scars.

The ultra-processed foods hypothesis: a product processed well beyond the basic ingredients in the package

The NOVA classification of food items has become increasingly popular and is being used in several observational studies as well as in nutritional guidelines and recommendations. We propose that there is a need for this classification and its use in the formulation of public health policies to be critically discussed and re-appraised. The terms 'processing' and 'ultra-processing', which are crucial to the NOVA classification, are ill-defined, as no scientific, measurable or precise reference parameters exist for them. Likewise, the theoretical grounds of the NOVA classification are unclear and inaccurate. Overall, the NOVA classification conflicts with the classic, evidence-based evaluation of foods based on composition and portion size because NOVA postulates that the food itself (or how much of it is eaten) is unimportant, but rather that dietary effects are due to how the food is produced. We contend that the NOVA system suffers from a lack of biological plausibility so the assertion that ultra-processed foods are intrinsically unhealthful is largely unproven, and needs further examination and elaboration.

Association between Average Vitamin D Levels and COVID-19 Mortality in 19 European Countries-A Population-Based Study

Early epidemic reports have linked low average 25(OH) vitamin D levels with increased COVID-19 mortality. However, there has been limited updated research on 25(OH) vitamin D and its impact on COVID-19 mortality. This study aimed to update the initial report studying the link between vitamin D deficiency and COVID-19 mortality by using multi-country data in 19 European countries up to the middle of June 2023. COVID-19 data for 19 European countries included in this study were downloaded from Our World in Data from 1 March 2020, to 14 June 2023, and were included in the statistical analysis. The 25(OH) vitamin D average data were collected by conducting a literature review. A generalized estimation equation model was used to model the data. Compared to European countries with 25(OH) vitamin D levels of ≤50 nmol/L, European countries with 25(OH) vitamin D average levels greater than 50 nmol/L had lower COVID-19 mortality rates (RR = 0.794, 95% CI: 0.662-0.953). A statistically significant negative Spearman rank correlation was observed between 25(OH) vitamin D average levels and COVID-19 mortality. We also found significantly lower COVID-19 mortality rates in countries with high average 25(OH) vitamin D levels. Randomized trials on vitamin D supplementation are needed. In the meantime, the issue of vitamin D use should be debated in relation to the ongoing discussions of national post-COVID-19 resilience against future pandemics.

Results of longitudinal Nutri-D study: factors influencing winter and summer vitamin D status in a Caucasian population

Introduction

Inadequate vitamin D status is a worldwide public health issue. In humans, vitamin D status is affected by diet, and even more by exposure to ultraviolet B (UVB) light and consequential endogenous synthesis. Various personal and environmental factors influence endogenous synthesis. Factors affecting vitamin D status were investigated in a prospective longitudinal cohort study with a summer and winter observation period.

Methods

The final sample included 292 adults, of those 111 (38%) males and 181 (62%) females, with a mean age of 38.2 (±11.8) years from Slovenia who were not supplementing vitamin D. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured in both periods; vitamin D intake, self-reported body mass index (BMI), and protective behaviors against sun were also recorded. Other measured parameters included measurements of constitutive skin color using the objective individual typology angle (ITA), and difference in the melanin index (ΔMI) for assessment of objective sun exposure.

Results

In winter a high prevalence (63.4%) of insufficient vitamin D status (< 50 nmoL/L) was observed with higher odds ratios (OR) for insufficiency in those with a higher BMI and light ITA. During summer, insufficiency prevalence was low (5.5%), but half of the participants (50.0%) had suboptimal 25(OH)D concentration (< 75 nmol/L). In summer OR for suboptimal status were higher in those with obesity, lower ΔMI, light ITA, low vitamin D intake, and protective clothing behaviors.

Conclusion

Using a series of measures, we showed that vitamin D status is hugely affected by several personal factors such as BMI, ITA, vitamin D intake, ΔMI, and protective behavior against the sun. This conclusion questions the usefulness of generalized population-level recommendations since personal factors are a major predictor of vitamin D status.

Effects of an Individualized vs. Standardized Vitamin D Supplementation on the 25(OH)D Level in Athletes

Vitamin D is crucial to the health and performance of athletes. Although the exact vitamin D requirements for athletes have not been established, maintaining a 25(OH)D level of at least 40 ng/mL is considered beneficial. This randomized controlled intervention study aimed to determine whether an individual loading dose formula for vitamin D supplementation is more effective than standardized supplementation and suitable enough for athletes to meet a target value of 40 ng/mL. In a 10-week supplementation study conducted during the winter months in Germany, 90 athletes with insufficient vitamin D levels (25(OH)D < 30 ng/mL) were randomly assigned to receive either a universal dose of 2000 IU/day of vitamin D or a loading dose of 4000 IU/day, followed by a maintenance dose of 1000 IU/day. The total 25(OH)D concentration was measured from dried blood spots at three time points: at baseline, at the computed date of 40 ng/mL, and after the 10-week period. Additionally, a vitamin-D-specific questionnaire was issued. On the day when 25(OH)D blood concentrations of 40 ng/mL were calculated to prevail, the individualized group had a significantly higher 25(OH)D level than the standardized group (41.1 ± 10.9 ng/mL vs. 32.5 ± 6.4 ng/mL, p < 0.001). This study demonstrated that the examined formula is suitable enough for athletes to achieve a 25(OH)D concentration of 40 ng/mL. This indicates that a personalized approach is more effective than a one-size-fits-all approach in restoring adequate vitamin D levels in athletes.

The Impact of Vitamin D Deficiency on Infants' Health

Vitamin D is an essential nutrient that plays a vital role in bone health and musculoskeletal development. The aim of this narrative review is to present up-to-date information about the impact of vitamin D deficiency (VDD) on the health status of infants in their first year of life. Vitamin D is indispensable for skeletal growth and bone health, and emerging research suggests that it may also have significant roles in maternal and fetal health. VDD affects a large proportion of infants according to current guidelines. However, its prevalence varies depending on geographic location, skin pigmentation, and the time of year. Based on current guidelines for normal vitamin D levels and recommended daily intake, studies suggest that VDD is a global health issue with potentially significant implications for those at risk, especially infants. Our understanding of the role of vitamin D has improved significantly in the last few decades. Systematic reviews and meta-analyses investigating the effect of vitamin D on preterm birth, low birth weight, anthropometric parameters, and health outcomes such as infectious diseases in infants, have found conflicting or inconsistent results. It is important to encourage further research to fill in these knowledge gaps and develop national or global strategies that ease the burden of VDD, especially in groups at risk.

Senior citizens' vitamin D supplements intake: evidence from Denmark

BACKGROUND

Several public interventions have been designed in recent years to urge the intake of vitamin D supplements among the senior population to avoid the direct and indirect consequences associated with vitamin D deficiency. However, the effectiveness of these public campaigns remains quite limited. In an online survey, the current study investigates attitudes towards vitamin D supplements intake and associated behaviours in a representative sample of Danish senior citizens (N = 554) - that is, individuals aged 55 years and above.

RESULTS

Approximately half of the sample reported taking vitamin D supplements in the preceding year. Furthermore, being male and having a positive perception of individuals' own health status increased the probability of being a non-user. Increasing confidence in the information provided by health authorities (such as medical doctors and pharmacies) is particularly critical for enhancing the likelihood of non-users to purchase vitamin D supplements. However, also encouraging the uptake of vitamin D supplements in specialized supermarkets with stands and promotions seems an appealing and practical solution to increase seniors' uptake of vitamin D supplements.

CONCLUSIONS

The present study outlines the characteristics of senior Danish non-users of vitamin D supplements. Additionally, the research provides information on the strategies that could be applied by public organizations to foster vitamin D supplements intake among this target segment of the population. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Pre-diagnostic intake of vitamin D and incidence of colorectal cancer by anatomical subsites: the Norwegian Women and Cancer Cohort Study (NOWAC)

According to the World Cancer Research Fund International, vitamin D might decrease the risk of colorectal cancer (CRC). However, less is known about the association with cancers in different subsites of the colon and in the rectum. The aim of this study was to examine associations between pre-diagnostic intake of vitamin D and risk of CRC by anatomical subsites. Data from 95 416 participants in the Norwegian Women and Cancer Cohort Study was included, and vitamin D intake was estimated from two repeated FFQ. Associations between vitamin D intake and incidence of CRC were assessed using multivariable Cox regression. During follow-up, there were 1774 incident cases of CRC. A small but borderline significant inverse association was found for a 5-µg increase in vitamin D intake and risk of CRC (hazard ratio (HR) = 0·97; 95 % CI 0·93, 1·01) and colon cancer (HR = 0·96; 95 % CI 0·91, 1·01). High (≥ 20 µg) compared with low (< 10 µg) vitamin D intake was associated with 17 % borderline significant reduced risk of CRC (HR = 0·83; 95 % CI 0·68, 1·02). Medium (10-19 µg) v. low intake (< 10 µg) was associated with 27 % reduced risk of proximal colon cancer (HR = 0·73; 95 % CI 0·57, 0·94). No significant associations were observed between vitamin D intake and risk of distal colon or rectal cancer. Our study indicates that vitamin D may be differently associated with subsites of the colon. The association between vitamin D intake and proximal colon cancer is novel.

Meta-Analysis of European Clinical Trials Characterizing the Healthy-Adult Serum 25-hydroxyvitamin D Response to Vitamin D Supplementation

To obtain reliable data that allow health authorities to re-evaluate recommendations for oral vitamin D uptake, we conducted a meta-analysis to investigate the impact of supplementation on serum 25-hydroxyvitamin D (25(OH)D) levels in healthy adults in Europe. Of the publications identified (n = 4005) in our literature search (PUBMED, through 2 January 2022), 49 primary studies (7320 subjects, 73 study arms) were eligible for inclusion in our meta-analysis. The risk of bias was assessed using the Cochrane RoB tool based on seven categories, according to which each study is rated using three grades, and overall was rated as rather low. The median duration of intervention was 136.78 days (range, 1088 days); the mean weighted baseline 25(OH)D concentration and mean age were 33.01 vs. 33.84 nmol/L and 46.8 vs. 44.8 years in the vitamin D and placebo groups, respectively. Using random-effects models, 25(OH)D levels were increased by 36.28 nmol/L (95% CI 31.97-40.59) in the vitamin D group compared to the placebo, with a relative serum increment of 1.77 nmol/L per 2.5 μg of vitamin D daily. Notably, the relative serum 25(OH)D increment was affected by various factors, including the dosage and baseline serum 25(OH)D concentration, decreasing with increasing vitamin D doses and with increasing baseline serum levels. We estimate that supplementation in all healthy adults in Europe with appr. 25 μg of vitamin D (1000 IU) daily would raise serum 25(OH)D levels in 95% of the population to ≥50 nmol/L. Our work provides health authorities with reliable data that can help to re-evaluate recommendations for oral vitamin D supplementation.

Dairy intake and risk of hip fracture in prospective cohort studies: non-linear algorithmic dose-response analysis in 486 950 adults

Previous studies on the relationship between dairy consumption and hip fracture risk have reported inconsistent findings. Therefore, we aimed to conduct an algorithmically driven non-linear dose-response meta-analysis of studies assessing dairy intake and risk of developing incident hip fracture. Meta-analysis from PubMed and Google Scholar searches for articles of prospective studies of dairy intake and risk of hip fracture, supplemented by additional detailed data provided by authors. Meta-regression derived dose-response relative risks, with comprehensive algorithm-driven dose assessment across the entire dairy consumption spectrum for non-linear associations. Review of studies published in English from 1946 through December 2021. A search yielded 13 studies, with 486 950 adults and 15 320 fractures. Non-linear dose models were found to be empirically superior to a linear explanation for the effects of milk. Milk consumption was associated with incrementally higher risk of hip fractures up to an intake of 400 g/d, with a 7 % higher risk of hip fracture per 200 g/d of milk (RR 1⋅07, 95 % CI 1⋅05, 1⋅10; P < 0⋅0001), peaking with 15 % higher risk (RR 1⋅15, 95 % CI 1⋅09, 1⋅21, P < 0⋅0001) at 400 g/d versus 0 g/d. Although there is a dose-risk attenuation above 400 g/d, milk consumption nevertheless continued to exhibit elevated risk of hip fracture, compared to zero intake, up to 750 g/d. Meanwhile, the analysis of five cohort studies of yoghurt intake per 250 g/d found a linear inverse association with fracture risk (RR 0⋅85, 95 % CI 0⋅82, 0⋅89), as did the five studies of cheese intake per 43 g/d (~1 serving/day) (RR 0⋅81, 95 % CI 0⋅72, 0⋅92); these studies did not control for socioeconomic status. However, no apparent association between total dairy intake and hip fracture (RR per 250 g/d of total dairy = 0⋅97, 95 % CI 0⋅93, 1⋅004; P = 0⋅079). There were both non-linear effects and overall elevated risk of hip fracture associated with greater milk intake, while lower risks of hip fracture were reported for higher yoghurt and cheese intakes.

Relationship of vitamin D with the anthropometric indicators and lifestyle of adults. Medellín, Colombia

Introduction

Serum vitamin D levels depend on sunlight, diet, and other factors.

Objective

We aimed to determine serum vitamin D levels and evaluate their relationship with anthropometric indicators and lifestyle habits in apparently healthy volunteers.

Materials and Methods

In this cross-sectional study (n=75), socio-demographic, anthropometric, and lifestyle habit-related data were collected. Serum vitamin D levels were determined with high performance liquid chromatography, food intake was measured by semiquantitative frequency and nutritional status was assessed by anthropometry. Chi-square test and also principal component analysis were used to analyze the relationship between some variables and vitamin D status. Spearman's test was used to determine correlations between quantitative variables.

Results

73% were women and 61% belonged to medium socio-economic level. Median vitamin D intake was 137 (83.1-227.3) IU/day. Based on body mass index (BMI), 44% individuals had overweight/obesity. The 68% exhibited deficient/insufficient vitamin D levels (Hypovitaminosis D). BMI classification and waist circumference (CW) were not related with vitamin D status; however, activities with higher sun exposure were highly related (p = 0.013). Sun exposure time explained variation in component 2 (16.60%), where most of the individuals with normal level were grouped. Sun exposure time was positively correlated with vitamin D status (r = 0.263; p = 0.023).

Discussion

Excess weight and abdominal obesity are not always associated with hypovitaminosis D.

Conclusions

The majority of individuals showed hypovitaminosis D but their status was not related with anthropometric indicators. A Sun exposure time was the only factor positively correlated with vitamin D status.

Vitamin D level and bone profile among 1- to 5-year-old children in Galle municipality and Bope-Poddala areas in Sri Lanka

Objective

Identify the incidence and risk factors of vitamin D deficiency/vitamin D insufficiency in children aged 1-5 years.

Methods

A cross-sectional survey was conducted among children between the ages of 1 and 5 in the Bope-Poddala and Galle municipality areas. The sample was obtained by cluster sampling method. Data on socio-demography, pregnancy, sun exposure, and diet were obtained. Serum 25(OH)D concentrations were measured and the cutoff value was determined as per the global consensus in 2016.

Results

Among 100 children, the mean serum 25(OH)D level was 86.4 nmol/L (24.06 ng/mL). The prevalence of vitamin D deficiency and vitamin D insufficiency was 7% and 28%, respectively. Birth weight and sunlight exposure were significantly different among vitamin D deficiency/vitamin D insufficiency and sufficient groups. Both were found to be risk factors for vitamin D deficiency/vitamin D insufficiency in logistic regression.

Conclusion

Vitamin D deficiency/vitamin D insufficiency is significant among children aged 1-5 years and decreased sun exposure and low birth weight are the main risk factors.

25(OH)D Concentration in Neonates, Infants, Toddlers, Older Children and Teenagers from Poland-Evaluation of Trends during Years 2014-2019

INTRODUCTION

Local and international guidelines have provided schedules for the vitamin D supplementation of general populations of different ages, including children. Our study aimed to assess 25(OH)D concentration and its potential change during a growth and maturation period, adding parameters that reflect the risk of hypercalcemia.

MATERIALS AND METHODS

The available 25(OH)D concentration values (n = 17,636; 7.8 ± 6.0 years), calcium (n = 2673; 16.3 ± 6.1 years) and phosphate (n = 2830; 3.8 ± 5.2 years) metabolism markers were analyzed in a studied group of patients (0-18 years).

RESULTS

In the studied group the mean 25(OH)D concentration was 29.4 ± 11.7 ng/mL. Concentrations of 25(OH)D < 10 ng/mL were observed in 1.7% of patients (n = 292), 10-20 ng/mL in 17.2% (n = 3039), 20-30 ng/mL in 39.5% (n = 6960) and 30-50 ng/mL in 37.2% (n = 6567). In patients with a 25(OH)D concentration <10 ng/mL, normal calcemia (2.25-2.65 mmol/L) was observed in 29.5% of cases (n = 86). Three patients had 25(OH)D concentrations above 100 ng/mL with co-existing hypercalcemia; the mean was Ca = 3.40 mmol/L. Hypocalcemia (Ca < 2.25 mmol/L) was observed in 10,4% of patients (n = 2797). Furthermore, 5.0% of patients showed an increased calcium concentration >2.65 mmol/L (n = 1327). The highest mean 25(OH)D concentration of 32.1 ng/mL ± 12.9 was noted in the years 2018-2019 (n = 3931) and the lowest in the year 2015 (27.2 ng/mL ± 11.0; n = 2822).

CONCLUSIONS

Vitamin D deficiency (<20 ng/mL) was noted in 18,9% of subjects in the years 2014-2019. An effective prevention of vitamin D deficiency was observed in children aged 3 years and younger. A relationship between the concentrations of calcium and 25(OH)D was not observed.

Diet, physical activity, and UV protection comprehensively influenced vitamin D status in college students: a cross-section study from China

BACKGROUND

Vitamin D deficiency is one of the most prevalent health problems worldwide in all age groups, whereas vitamin D status of Chinese college students was seldom studied in China. The purpose of this study was to explore the vitamin D status in Chinese college freshmen and its influencing factors, providing evidence for nutrition strategy application.

METHODS

Information including demographic status, diet habit, physical activity, and ultraviolet ray (UV) protection was collected by online questionnaire. Serum 25(OH)D₃ concentrations were measured using a liquid chromatograph mass spectrometer. Multivariate linear regression analyses were used to explore the comprehensive influence of diet, physical activity and UV protection on serum 25(OH)D₃ levels.

RESULTS

Totally 1667 freshmen from 26 provinces, autonomous districts or municipalities, were recruited, with a mean age of 18.6 ± 0.9 years. The mean serum 25(OH)D₃ levels were 18.1 ± 6.3 ng/mL and the proportion of vitamin D deficiency and insufficiency was 67.5% and 27.8%, respectively. Multivariate linear regression indicated that higher intake of milk and yogurt, calcium or vitamin D supplementation, and longer time of outdoor activity were positively linked to higher serum 25(OH)D₃, while higher intake of candy and higher UV protection index were negatively associated with serum 25(OH)D₃, after adjusted for age, gender, region of original residence, latitudes, longitude and BMI.

CONCLUSIONS

Vitamin D deficiency is very common in Chinese college students. Milk and yogurt intake and outdoor activity should be encouraged while candy intake should be limited for preventing vitamin D deficiency. Public health policies should focus on these changeable lifestyles and consider well-balanced guidelines on UV protection and vitamin D supplementation.

Prevention and Treatment of Retinal Vein Occlusion: The Role of Diet-A Review

Retinal vein occlusion (RVO) is the second most common retinal disorder. In comparison to diabetic retinopathy or age-related macular degeneration, RVO is usually an unexpected event that carries a greater psychological impact. There is strong evidence to suggest that cardiovascular diseases are the most common risk factors in this pathology and it has long been known that a higher consumption of fish, nuts, fruits, and vegetables has a protective effect against these types of conditions. In the last several years, interest in plant-based diets has grown in both the general population and in the scientific community, to the point to which it has become one of the main dietary patterns adopted in Western countries. The aim of this review is to investigate the potential impact of macro- and micronutrients on retinal vein occlusion.