1
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Mao S, Wu L, Shi W. Calcium, phosphorus, magnesium levels in frequent respiratory tract infections. Ann Med 2024; 55:2304661. [PMID: 38233369 PMCID: PMC10798295 DOI: 10.1080/07853890.2024.2304661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/16/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND It was well documented that calcium (Ca), phosphorus (P), and magnesium (Mg) participate in many physiological processes. We aimed to study the changing trend of serum levels of Ca, P, and Mg in frequent respiratory tract infections (FRTI) in children. METHODS A retrospective study was performed in our centre. A total of 213 FRTI cases and 33 controls were enrolled in our study. We analyzed the correlation between serum Ca/P/Mg levels and inflammatory indexes by using Spearman correlation analysis. Standard mean difference (SMD) was applied to test the differences of serum Ca/P/Mg levels between FRTI subgroups and controls. In terms of the findings of SMD between Ca/P/Mg status between FRTI subgroups and controls, receiver operating characteristics (ROC) curve analysis was further applied to test the association between serum Ca level and bronchitis, parainfluenza virus infection, influenza B virus infection and cytomegalovirus infection. RESULTS Serum Ca level was significantly associated with white blood cell (WBC), platelet (PLT) and procalcitonin (PCT) (p = 0.006; p < 10-4; p = 0.004). Serum P level was markedly associated with eryhtrocyte sedimentation rate (ESR) and PCT (p = 0.018; p < 10-4). Controls showed significantly lower serum Ca level than that among bronchitis (p = 0.001), parainfluenza virus infection (p = 0.027), influenza B virus infection (p = 0.017), cytomegalovirus infection (p = 0.029), and two pathogens infected (p = 0.020). ROC curve analysis showed that serum Ca level was significantly associated with bronchitis (p = 0.047) and influenza B virus infection (p = 0.049). CONCLUSIONS Serum levels of Ca and P may reflect the inflammatory status in children with FRTI. Alteration of serum Ca level may predict the risk of bronchitis and influenza B virus infection. Keeping the homeostasis of Ca, P, and Mg may be important for the prevention and treatment of FRTI.
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Affiliation(s)
- Song Mao
- Department of Pediatrics, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangxia Wu
- Department of Pediatrics, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Shi
- Department of Pediatrics, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wimalawansa SJ. Controlling Chronic Diseases and Acute Infections with Vitamin D Sufficiency. Nutrients 2023; 15:3623. [PMID: 37630813 PMCID: PMC10459179 DOI: 10.3390/nu15163623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Apart from developmental disabilities, the prevalence of chronic diseases increases with age especially in those with co-morbidities: vitamin D deficiency plays a major role in it. Whether vitamin D deficiency initiates and/or aggravates chronic diseases or vice versa is unclear. It adversely affects all body systems but can be eliminated using proper doses of vitamin D supplementation and/or safe daily sun exposure. Maintaining the population serum 25(OH)D concentration above 40 ng/mL (i.e., sufficiency) ensures a sound immune system, minimizing symptomatic diseases and reducing infections and the prevalence of chronic diseases. This is the most cost-effective way to keep a population healthy and reduce healthcare costs. Vitamin D facilitates physiological functions, overcoming pathologies such as chronic inflammation and oxidative stress and maintaining broader immune functions. These are vital to overcoming chronic diseases and infections. Therefore, in addition to following essential public health and nutritional guidance, maintaining vitamin D sufficiency should be an integral part of better health, preventing acute and chronic diseases and minimize their complications. Those with severe vitamin D deficiency have the highest burdens of co-morbidities and are more vulnerable to developing complications and untimely deaths. Vitamin D adequacy improves innate and adaptive immune systems. It controls excessive inflammation and oxidative stress, generates antimicrobial peptides, and neutralizes antibodies via immune cells. Consequently, vitamin D sufficiency reduces infections and associated complications and deaths. Maintaining vitamin D sufficiency reduces chronic disease burden, illnesses, hospitalizations, and all-cause mortality. Vulnerable communities, such as ethnic minorities living in temperate countries, older people, those with co-morbidities, routine night workers, and institutionalized persons, have the highest prevalence of vitamin D deficiency-they would significantly benefit from vitamin D and targeted micronutrient supplementation. At least now, health departments, authorities, and health insurance companies should start assessing, prioritizing, and encouraging this economical, non-prescription, safe micronutrient to prevent and treat acute and chronic diseases. This approach will significantly reduce morbidity, mortality, and healthcare costs and ensure healthy aging.
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Affiliation(s)
- Sunil J Wimalawansa
- Department of Medicine, CardioMetabolic & Endocrine Institute, North Brunswick, NJ 08902, USA
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3
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Reid C, Flores-Villalva S, Remot A, Kennedy E, O'Farrelly C, Meade KG. Long-term in vivo vitamin D 3 supplementation modulates bovine IL-1 and chemokine responses. Sci Rep 2023; 13:10846. [PMID: 37407588 DOI: 10.1038/s41598-023-37427-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
Vitamin D deficiency at birth, followed by prolonged insufficiency in early life may predispose bovine calves to infection and disease. However, the effects of vitamin D levels on innate immunity are unclear due to the lack of long-term supplementation trials in vivo and reliable approaches for reproducibly assessing immune function. Here, a standardized whole blood immunophenotyping assay was used to compare innate immune responses to infection relevant ligands (LPS, Pam3CSK4 and R848) between Holstein-Friesian calves supplemented with vitamin D (n = 12) from birth until 7 months of age and control calves (n = 10) raised on an industry standard diet. Transcriptomic analysis in unstimulated whole blood cells revealed increased expression of type I interferons and chemokines in vitamin D supplemented calves, while IL-1 and inflammasome gene expression was decreased. In response to stimulation with the bacterial ligand LPS, supplemented calves had significantly increased expression of CASP1, CX3CR1, CAT, whereas STAT1 was decreased. Stimulation with the bacterial ligand Pam3CSK4 revealed increased expression of IL1A, IL1B and CAT genes; and decreased C5AR1 expression. In response to the viral ligand R848, STAT1 and S100A8 expression was significantly decreased. An increased IL-1 and inflammasome gene expression signature in vitamin D supplemented calves in response to LPS and Pam3CSK4 was also found, with ELISA confirming increased IL-1β protein production. In contrast, a decreased chemokine gene expression signature was found in response to R848 in supplemented animals, with decreased IL-8 protein expression exhibited in response to all PAMPs also found. These results demonstrated expression of several cytokine, chemokine and inflammasome genes were impacted by vitamin D supplementation in the first 7 months of life, with IL-8 expression particularly responsive to vitamin D. Overall, vitamin D supplementation induced differential innate immune responses of blood immune cells that could have important implications for disease susceptibility in cattle.
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Affiliation(s)
- Cian Reid
- Animal & Bioscience Research Department, Animal & Grassland Research and Innovation Centre, Teagasc, Grange, Co Meath, Ireland
- School of Biochemistry and Immunology, Trinity College Dublin, Dublin 2, Ireland
| | - Susana Flores-Villalva
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
- CENID Salud Animal e Inocuidad, INIFAP, Mexico, Mexico
| | - Aude Remot
- INRAE, Université de Tours, ISP, Nouzilly, France
| | - Emer Kennedy
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - Cliona O'Farrelly
- School of Biochemistry and Immunology, Trinity College Dublin, Dublin 2, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Kieran G Meade
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland.
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
- Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland.
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4
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Umarje SC, Banerjee SK. Non-traditional approaches for control of antibiotic resistance. Expert Opin Biol Ther 2023; 23:1113-1135. [PMID: 38007617 DOI: 10.1080/14712598.2023.2279644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION The drying up of antibiotic pipeline has necessitated the development of alternative therapeutic strategies to control the problem of antimicrobial resistance (AMR) that is expected to kill 10-million people annually by 2050. Newer therapeutic approaches address the shortcomings of traditional small-molecule antibiotics - the lack of specificity, evolvability, and susceptibility to mutation-based resistance. These 'non-traditional' molecules are biologicals having a complex structure and mode(s) of action that makes them resilient to resistance. AREAS COVERED This review aims to provide information about the non-traditional drug development approaches to tackle the problem of antimicrobial resistance, from the pre-antibiotic era to the latest developments. We have covered the molecules under development in the clinic with literature sourced from reviewed scholarly articles, official company websites involved in innovation of concerned therapeutics, press releases from the regulatory bodies, and clinical trial databases. EXPERT OPINION Formal introduction of non-traditional therapies in general practice can be quick and feasible only if supported with companion diagnostics and used in conjunction with established therapies. Owing to relatively higher development costs, non-traditional therapeutics require more funding as well as well as clarity in regulatory and clinical path. We are hopeful these issues are adequately addressed before AMR develops into a pandemic.
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Affiliation(s)
- Siddharth C Umarje
- Department of Proteomics, AbGenics Life Sciences Pvt. Ltd., Pune, India
- AbGenics Life Sciences Pvt. Ltd., Pune, India
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5
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Laird E, O'Halloran AM, Molloy AM, Healy M, Bourke N, Kenny RA. Vitamin D status & associations with inflammation in older adults. PLoS One 2023; 18:e0287169. [PMID: 37379302 DOI: 10.1371/journal.pone.0287169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Research studies have observed associations of vitamin D with inflammation but data in representative older adult studies is lacking. We aimed to investigate the association of C-reactive protein (CRP) with vitamin D status in a representative sample of the older Irish population. The concentrations of 25-hydroxyvitamin D (25(OH)D) and CRP was measured in 5,381 community dwelling Irish adults aged ≥50 years from the Irish Longitudinal Study on Ageing (TILDA). Demographic, health and lifestyle variables were assessed by questionnaire and categorical proportions of CRP were generated by vitamin D status and age. Multi-nominal logistic regression was used to investigate the association of 25(OH)D and CRP status. The prevalence (mean; 95% confidence interval (95% CI)) of normal CRP status (0-5 mg/dL) was 83.9% (82.6-85.0%), elevated status (5-10 mg/dL) 11.0% (9.9-12.0%) and high status (>10 mg/dL) was 5.1% (4.5-5.8%). Mean (95% CI) CRP concentrations were lower in those with normal vs. deficient 25(OH)D status (2.02 mg/dL (1.95-2.08) vs. 2.60 mg/dL (2.41-2.82); p<0.0001). In a logistic regression analysis, those with insufficient or sufficient 25(OH)D status were less likely to have a high CRP status compared to those with deficient 25(OH)D status (insufficient: coefficient (CE) -0.732, 95% CI -1.12-0.33, p<0.0001; sufficient: CE -0.599, 95% CI -0.95-0.24, p = 0.001). In conclusion older adults with deficient vitamin D status had higher levels of inflammation as measured by CRP. Given that inflammation is an important pathological driver of chronic diseases of ageing, and that emerging evidence suggests that vitamin D therapy can reduce inflammation in some disease settings, optimising vitamin D status could represent an effective low risk/low-cost pathway to modulate inflammation in community dwelling older adults.
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Affiliation(s)
- Eamon Laird
- School of Physical Education and Sports Science, University of Limerick, Limerick, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Martin Healy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig Bourke
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- The TILDA Study, School of Medicine, Trinity College Dublin, Dublin, Ireland
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6
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Lindqvist PG, Gissler M, Essén B. Is there a relation between stillbirth and low levels of vitamin D in the population? A bi-national follow-up study of vitamin D fortification. BMC Pregnancy Childbirth 2023; 23:359. [PMID: 37198534 DOI: 10.1186/s12884-023-05673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Stillbirth has been associated with low plasma vitamin D. Both Sweden and Finland have a high proportion of low plasma vitamin D levels (< 50 nmol/L). We aimed to assess the odds of stillbirth in relation to changes in national vitamin D fortification. METHODS We surveyed all pregnancies in Finland between 1994 and 2021 (n = 1,569,739) and Sweden (n = 2,800,730) with live or stillbirth registered in the Medical Birth Registries. The mean incidences before and after changes in the vitamin D food fortification programs in Finland (2003 and 2009) and Sweden (2018) were compared with cross-tabulation with 95% confidence intervals (CI). RESULTS In Finland, the stillbirth rate declined from ~ 4.1/1000 prior to 2003, to 3.4/1000 between 2004 and 2009 (odds ratio [OR] 0.87, 95% CI 0.81-0.93), and to 2.8/1000 after 2010 (OR 0.84, 95% CI 0.78-0.91). In Sweden, the stillbirth rate decreased from 3.9/1000 between 2008 and 2017 to 3.2/1000 after 2018 (OR 0.83, 95% CI 0.78-0.89). When the level of the dose-dependent difference in Finland in a large sample with correct temporal associations decreased, it remained steady in Sweden, and vice versa, indicating that the effect may be due to vitamin D. These are observational findings that may not be causal. CONCLUSION Each increment of vitamin D fortification was associated with a 15% drop in stillbirths on a national level. If true, and if fortification reaches the entire population, it may represent a milestone in preventing stillbirths and reducing health inequalities.
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Affiliation(s)
- Pelle G Lindqvist
- Clinical Sciences and Education, Obstetrics and Gynecology, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, Stockholm, 11883, Sweden.
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry and Invest Research Flagship, University of Turku, Turku, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health/IMHm, Uppsala University, Uppsala, Sweden
- WHO Collaborating Centre On Migration and Health, Uppsala University, Uppsala, Sweden
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7
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Zittermann A, Trummer C, Theiler-Schwetz V, Pilz S. Long-term supplementation with 3200 to 4000 IU of vitamin D daily and adverse events: a systematic review and meta-analysis of randomized controlled trials. Eur J Nutr 2023; 62:1833-1844. [PMID: 36853379 DOI: 10.1007/s00394-023-03124-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE The upper tolerable intake level for vitamin D in the general population has been set at 4000 international units (IU) daily, but considerable uncertainty remains. We summarized reported harmful effects of a daily vitamin D supplement of 3200-4000 IU in trials lasting ≥ 6 months. METHODS We performed a systematic review and meta-analysis of randomized controlled trials in several databases and identified 22 trials reporting safety data. Parameters of calcium metabolism, falls, hospitalization, and mortality were assessed. RESULTS The selected trials comprised a total number of 12,952 participants. All trials used supplemental vitamin D3. The relative risk (RR) of hypercalcemia in the vitamin D vs. control arm was 2.21 (95%CI: 1.26-3.87; 10 studies), with a vitamin D-induced frequency of hypercalcemia of 4 cases per 1000 individuals. Subgroup analysis in trials with > 100 and ≤ 100 study participants revealed an RR of 2.63 (95%CI: 1.30-5.30; 7 studies) and 0.80 (95%CI: 0.24-2.62; 3 studies), respectively (Pinteraction = 0.06). Risks of falls and hospitalization were also significantly increased in the vitamin D arm with an RR of 1.25 (95%CI: 1.01-1.55; 4 studies) and 1.16 (95%CI: 1.01-1.33; 7 studies), respectively. Risks of hypercalciuria, kidney stones, and mortality did not differ significantly between study arms. Quality assessment revealed high risk of incomplete reporting of safety-related outcome data. CONCLUSION Supplemental vitamin D doses of 3200-4000 IU/d appear to increase the risk of hypercalcemia and some other adverse events in a small proportion of individuals, indicating that this dose is not completely safe. In future studies, rigorous reporting of safety-related outcomes is needed when using moderately high doses of vitamin D.
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Affiliation(s)
- Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Verena Theiler-Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Abstract
Vitamin-D receptors are found in a variety of cells with the potential to regulate many cellular functions. Higher COVID-19 severity has been reported in individuals, which are known to have lower vitamin-D levels. The relation between vitamin-D and COVID-19 has been analysed with a number of studies but only few met high standards. Studies revealed discordant findings. There is no data from interventional trials clearly indicating that vitamin-D supplementation may prevent against COVID-19. An increasing number of observational studies put forward the preventive feature of adequate vitamin-D status for COVID-19 mortality. Yet, there are again conflicting findings. This narrative review summarizes the current evidence and provides a practical advice to lessen the impact of COVID-19 by ensuring recommended vitamin-D intakes. This approach would not be harmful, but potentially useful. Vitamin-D is safe especially if it does not exceed the upper-tolerable-limit. Daily doses are recommended over the weekly or monthly higher doses. Mega-doses are not recommended because of its potential to lead adverse events. The target level of vitamin-D is proposed above 30 ng/mL in majority of the studies. Nonetheless, one should consider that the benefit is foreseen to be small, and some time (months) may be needed for such effect.
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Affiliation(s)
- Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey,CONTACT Gülistan Bahat Istanbul University, Istanbul Medical School, Turgut Ozal Mıllet Street, Capa, Istanbul34390, Turkey
| | - Duygu Erbas Sacar
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
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Benson R, Unnikrishnan MK, Kurian SJ, Velladath SU, Rodrigues GS, Chandrashekar Hariharapura R, Muraleedharan A, Bangalore Venkateshiah D, Banerjee B, Mukhopadhyay C, Johnson AS, Munisamy M, Rao M, Kochikuzhyil BM, Sekhar Miraj S. Vitamin D attenuates biofilm-associated infections via immunomodulation and cathelicidin expression: a narrative review. Expert Rev Anti Infect Ther 2023; 21:15-27. [PMID: 36440493 DOI: 10.1080/14787210.2023.2151439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Infections are becoming more difficult to treat, at least partly on account of microbes that produce biofilms. Reports suggest that decreased levels of antimicrobial peptides like cathelicidin, elevated levels of inflammatory cytokines, and biofilm formation are all associated with vitamin D deficiency, making vitamin D - deficient individuals more susceptible to infection. Infections attributable to biofilm-producing microbes can be managed by adjuvant therapy with vitamin D because of its immunomodulatory role, particularly because of the ability of vitamin D-pathway to induce the antimicrobial peptides like cathelicidin and decrease proinflammatory cytokines. AREAS COVERED This narrative review covers biofilm formation, infections associated with biofilm due to vitamin D deficiency, putative role of vitamin D in host protection and the effect of vitamin D supplementation in biofilm-associated infections. A comprehensive literature search in PubMed and Google Scholar utilizing suitable keywords at multiple time points extracted relevant articles. EXPERT OPINION Although vitamin D deficiency has been associated with infections by biofilm producing microbes, comprehensive clinical trials in various ethnicities are required to understand the likely relationships between vitamin D receptor gene expression, cathelicidin levels, and infection outcome. Current evidence hypothesizes that maintaining normal vitamin D level can help prevent and treat these infections.
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Affiliation(s)
- Ruby Benson
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | | | - Shilia Jacob Kurian
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Saleena Ummer Velladath
- Department of Medical Laboratory Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
| | | | - Raghu Chandrashekar Hariharapura
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Anju Muraleedharan
- Department of Medical Laboratory Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Dinesh Bangalore Venkateshiah
- Department of General Surgery, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Barnini Banerjee
- Department of Microbiology, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Aieshel Serafin Johnson
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Murali Munisamy
- Department of Translational Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Benson Mathai Kochikuzhyil
- Department of Pharmacology, Dr. Joseph Mar Thoma Institute of Pharmaceutical Sciences and Research, Kattanam, India
| | - Sonal Sekhar Miraj
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
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10
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Nicoll R, Henein MY. COVID-19 Prevention: Vitamin D Is Still a Valid Remedy. J Clin Med 2022; 11:jcm11226818. [PMID: 36431297 PMCID: PMC9699290 DOI: 10.3390/jcm11226818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Seven meta-analyses and systematic reviews and three later clinical trials argued that low vitamin D status increased susceptibility to COVID-19 and the risk of greater disease severity and mortality [...].
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11
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Jolliffe DA, Holt H, Greenig M, Talaei M, Perdek N, Pfeffer P, Vivaldi G, Maltby S, Symons J, Barlow NL, Normandale A, Garcha R, Richter AG, Faustini SE, Orton C, Ford D, Lyons RA, Davies GA, Kee F, Griffiths CJ, Norrie J, Sheikh A, Shaheen SO, Relton C, Martineau AR. Effect of a test-and-treat approach to vitamin D supplementation on risk of all cause acute respiratory tract infection and covid-19: phase 3 randomised controlled trial (CORONAVIT). BMJ 2022; 378:e071230. [PMID: 36215226 PMCID: PMC9449358 DOI: 10.1136/bmj-2022-071230] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effect of population level implementation of a test-and-treat approach to correction of suboptimal vitamin D status (25-hydroxyvitamin D (25(OH)D) <75 nmol/L) on risk of all cause acute respiratory tract infection and covid 19. DESIGN Phase 3 open label randomised controlled trial. SETTING United Kingdom. PARTICIPANTS 6200 people aged ≥16 years who were not taking vitamin D supplements at baseline. INTERVENTIONS Offer of a postal finger prick test of blood 25(OH)D concentration with provision of a six month supply of lower dose vitamin D (800 IU/day, n=1550) or higher dose vitamin D (3200 IU/day, n=1550) to those with blood 25(OH)D concentration <75 nmol/L, compared with no offer of testing or supplementation (n=3100). Follow-up was for six months. MAIN OUTCOME MEASURES The primary outcome was the proportion of participants with at least one swab test or doctor confirmed acute respiratory tract infection of any cause. A secondary outcome was the proportion of participants with swab test confirmed covid-19. Logistic regression was used to calculate odds ratios and associated 95% confidence intervals. The primary analysis was conducted by intention to treat. RESULTS Of 3100 participants offered a vitamin D test, 2958 (95.4%) accepted and 2674 (86.3%) had 25(OH)D concentrations <75 nmol/L and received vitamin D supplements (n=1328 lower dose, n=1346 higher dose). Compared with 136/2949 (4.6%) participants in the no offer group, at least one acute respiratory tract infection of any cause occurred in 87/1515 (5.7%) in the lower dose group (odds ratio 1.26, 95% confidence interval 0.96 to 1.66) and 76/1515 (5.0%) in the higher dose group (1.09, 0.82 to 1.46). Compared with 78/2949 (2.6%) participants in the no offer group, 55/1515 (3.6%) developed covid-19 in the lower dose group (1.39, 0.98 to 1.97) and 45/1515 (3.0%) in the higher dose group (1.13, 0.78 to 1.63). CONCLUSIONS Among people aged 16 years and older with a high baseline prevalence of suboptimal vitamin D status, implementation of a population level test-and-treat approach to vitamin D supplementation was not associated with a reduction in risk of all cause acute respiratory tract infection or covid-19. TRIAL REGISTRATION ClinicalTrials.gov NCT04579640.
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Affiliation(s)
- David A Jolliffe
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Hayley Holt
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Matthew Greenig
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Mohammad Talaei
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Natalia Perdek
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Paul Pfeffer
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Giulia Vivaldi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Sheena Maltby
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | | | - Nicola L Barlow
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Alexa Normandale
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Rajvinder Garcha
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christopher Orton
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - David Ford
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - Gwyneth A Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Frank Kee
- Centre for Public Health (NI), Queen's University Belfast, Belfast, UK
| | - Christopher J Griffiths
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
- Health Data Research UK BREATHE Hub, Queen Mary University of London, London, UK
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Data Research UK BREATHE Hub, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Data Research UK BREATHE Hub, University of Edinburgh, Edinburgh, UK
| | - Seif O Shaheen
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Clare Relton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
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12
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Weng J, Shao Z, Chan HW, Li SPY, Lam JKW, Tsang CK, Chow SF. Mediating bio-fate of polymeric cholecalciferol nanoparticles through rational size control. BIOMATERIALS ADVANCES 2022; 140:213074. [PMID: 35970111 DOI: 10.1016/j.bioadv.2022.213074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Whilst 10-200 nm polymeric nanoparticles hold enormous medical potential, successful clinical translation remains scarce. There is an inadequate understanding of how these nanoparticles could be fabricated with consistent particle architecture in this size range, as well as their corresponding biological performance. We seek to fill this important knowledge gap by employing Design of Experiment (DoE) to examine critical formulation and processing parameters of cholecalciferol (VitD3)-loaded nanoparticles by flash nanoprecipitation (FNP). Based on the regression analysis of the critical processing parameters, six VitD3 nanoparticle formulations with z-average particle sizes between 40 and 150 nm were successfully developed, possessing essentially the same particle shape and zeta potential. To evaluate the effect of particle size on the in vivo performance, not only VitD3 but also its active metabolites (25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3) were assayed in the biodistribution study. Results indicated that VitD3 nanoparticles with sizes ≤110 nm would achieve higher plasma retention. VitD3 nanoparticles with sizes of 40 nm and 150 nm were superior for lung deposition, while particle size had no major role in the brain uptake of VitD3 nanoparticles. The present study demonstrates the value of DoE for generating size-tunable nanoparticles with controlled particle properties in FNP and offers important insights into the particle size effect of nanoparticles <200 nm on their therapeutic potential.
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Affiliation(s)
- Jingwen Weng
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Zitong Shao
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Ho Wan Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Steve Po Yam Li
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Jenny Ka Wing Lam
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong, China
| | - Chi Kwan Tsang
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shing Fung Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong, China.
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13
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Fontalvo-Rivera D, Mazenett E, Àlvarez-Zambrano C, Gómez-Camargo D. Vitamin D3 in acute respiratory infections in patients under five years old (Cartagena de Indias, Colombia). JOURNAL OF MEDICAL SCIENCE 2022. [DOI: 10.20883/medical.e679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background and Aim. Low serum levels of 25-hydroxyvitamin D3 are associated with an increased risk of Acute Respiratory Infection (ARI) that is among the most important causes of morbidity and mortality in children under 5 years old. We describe the clinical behavior of acute respiratory infections in patients under five years ago in one sanitary institution in Colombia after VD3 supplementation.
Material and Methods. A case series was conducted on 38 patients of both genders aged less to 5 years ago was included. Participants were supplied 50,000 units of VD3 orally each month for three months. The number of events, consultations for emergency services, and hospitalization due to acute respiratory infections (ARIs) before and after VD3 administration were described.
Results. The average age of the participants was 25.81 ± 17.50 months. The average clinical ARIs per month was 4.02 (95% CI 3.64-4.40) before VD3 administration. Fewer episodes at the end of the three cycles was found at 2.23/month (95% CI 1.81-2.65; p=0.0230). The average consultations for emergency services during the three months before VD3 administration was 2.15 (95% CI 1.77-2.53). After three months of treatment, the average use of emergency services decreased to 0.52 (95% CI 0.37-0.72; p=0.0180). After the administration of the three doses of VD3, only one patient required hospitalization (2.63%; : 0.026 (IC95% 0.02-0.03; p=0.0368)).
Conclusions. The administration of vitamin D3 could have a benefit in decreasing the number of episodes, emergencies, and hospitalization for ARI in children under five years old. Trial studies are required to determine this potential benefit.
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14
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Shah MW, Ahmad T, Khan M, Muhammad S, Sun G. Global research on vitamin D and coronavirus disease 2019: A bibliometric and visualized study. Medicine (Baltimore) 2022; 101:e29768. [PMID: 35801745 PMCID: PMC9258968 DOI: 10.1097/md.0000000000029768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIM Vitamin D play a substantial role in immune function, but little is known about its prevention in coronavirus disease 2019 (COVID-19). A detail bibliometric analysis of the published scientific literature indexed in Web of Science on vitamin D as a therapeutic option for the COVID-19 patients' treatment is lacking. Thus, the current study was conducted to determine the key bibliometric indices and plot the global research on vitamin D and COVID-19. METHODS The Web of Science Core Collection database was utilized to retrieve publications on vitamin D and COVID-19. A Boolean search strategy was applied and the obtained data were exported to Microsoft Excel to generate relevant graphs. Furthermore, VOSviewer software version 1.6.17 for Windows was used to generate co-authorship countries, bibliographic coupling sources and co-occurrence keyword network visualization mapping. In addition, RStudio and Bibliometric online tool were used to generate WordCloud and thematic map, and intercountries relation map, respectively. RESULTS A total of 818 publications on vitamin D and COVID-19 were included in the final analysis. These publications were cited 10,713 times, with an H-index of 50. The number of publications and citations score from 2020 to November 2021 increased from 317 (2423 citations) to 501 (8290 citations). Delanghe JR and Speeckaert MM were the most prolific authors with 13 publications each. The most productive journal was Nutrients (n = 63). The most studied research area is nutrition dietetics. The most widely used author keywords were COVID-19 (n = 444), Vitamin D (n = 312), and SARS-CoV-2 (n = 190). The National Institute of Health and US Department of Health and Human Services were the leading funding agencies. Harvard University was the most active institution with 25 publications. The United States of America was the highly contributing and influential country in terms of publications (n = 203) and total link strength (n = 185). CONCLUSION It was concluded that an increasing trend in the number of publications on vitamin D and COVID-19 has been observed. Significantly, the majority of the research has been conducted in developed countries. Most importantly, over the time, the direction of research has been changed and the recent trend topics are vitamin D deficiency, risk and infection, and vitamin D supplementation based on KeyWords Plus. The use of vitamin D supplement is one of the promising therapeutic options for COVID-19 treatment. Therefore, the current study not only highlight the global research trends but also provide standard bibliographic information for future studies.
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Affiliation(s)
- Muhammad Waseem Shah
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Tauseef Ahmad
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Muhammad Khan
- Department of Biotechnology and Genetic Engineering, Centre for Human Genetics, Hazara University, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - Shafi Muhammad
- Department of Biosciences, COMSATS University Islamabad, Tarlai Kalan, Islamabad, Pakistan
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
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15
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Pham H, Waterhouse M, Baxter C, Romero BD, McLeod DSA, Armstrong BK, Ebeling PR, English DR, Hartel G, Kimlin MG, O'Connell RL, van der Pols JC, Venn AJ, Webb PM, Whiteman DC, Neale RE. Vitamin D supplementation and antibiotic use in older Australian adults - an analysis of data from the D-Health Trial. J Infect Dis 2022; 226:949-957. [PMID: 35780325 DOI: 10.1093/infdis/jiac279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vitamin D supplementation may reduce the risk or severity of infection, but this has been investigated in few large population-based trials. We analyzed data from the D-Health Trial, using prescription of antibiotics as a surrogate for infection. METHODS The D-Health Trial is a randomized, double-blind, placebo-controlled trial in which 21,315 Australians aged 60-84 years were randomized to 60,000 IU of supplementary vitamin D3 or placebo monthly for 5 years. For this analysis, the primary outcome was the number of antibiotic prescription episodes; secondary outcomes were total number of prescriptions; repeat prescription episodes; and antibiotics for urinary tract infection. We estimated incidence rate ratios (IRRs) using negative binomial regression, and odds ratios using logistic regression. RESULTS Vitamin D supplementation slightly reduced the number of prescription episodes (IRR 0.98, 95% CI 0.95-1.01), total prescriptions (IRR 0.97, 95% CI 0.93-1.00), and repeat prescription episodes (IRR 0.96, 95% CI 0.93-1.00). There was stronger evidence of benefit in people predicted to have insufficient vitamin D at baseline (prescription episodes IRR 0.93, 95% CI 0.87-0.99). CONCLUSIONS Vitamin D may reduce the number of antibiotic prescriptions, particularly in people with low vitamin D status. This supports the hypothesis that vitamin D has a clinically relevant effect on the immune system.
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Affiliation(s)
- Hai Pham
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, the University of Queensland, Brisbane, Australia
| | - Mary Waterhouse
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Catherine Baxter
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Briony Duarte Romero
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Donald S A McLeod
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Bruce K Armstrong
- School of Public Health, University of Sydney, Sydney, Australia and School of Population and Global Health, University of Western Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Dallas R English
- Melbourne School of Population Health, University of Melbourne.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne Australia
| | - Gunter Hartel
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Michael G Kimlin
- School of Biomedical Sciences, Queensland University of Technology, Australia
| | | | - Jolieke C van der Pols
- Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Brisbane, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, the University of Queensland, Brisbane, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, the University of Queensland, Brisbane, Australia
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16
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Pham H. Analyzing the relationship between the vitamin D deficiency and COVID-19 mortality rate and modeling the time-delay interactions between body's immune healthy cells, infected cells, and virus particles with the effect of vitamin D levels. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:8975-9004. [PMID: 35942745 DOI: 10.3934/mbe.2022417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper presents some recent views on the aspects of vitamin D levels in relation to the COVID-19 infections and analyzes the relationship between the prevalence rates of vitamin D deficiency and COVID-19 death rates per million of various countries in Europe and Asia using the data from the PubMed database. The paper also discusses a new mathematical model of time-delay interactions between the body's immune healthy cells, infected cells, and virus particles with the effect of vitamin D levels. The model can be used to monitor the timely progression of healthy immune cells with the effects of the levels of vitamin D and probiotics supplement. It also can help to predict when the infected cells and virus particles free state can ever be reached as time progresses. The consideration of the time delay in the modeling due to effects of the infected cells or virus particles and the growth of healthy cells is also an important factor that can significantly change the outcomes of the body's immune cells as well as the infections.
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Affiliation(s)
- Hoang Pham
- Department of Industrial and Systems Engineering, Rutgers University, Piscataway, New Jersey 08854, USA
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17
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Briceno Noriega D, Savelkoul HFJ. Vitamin D: A Potential Mitigation Tool for the Endemic Stage of the COVID-19 Pandemic? Front Public Health 2022; 10:888168. [PMID: 35757617 PMCID: PMC9226430 DOI: 10.3389/fpubh.2022.888168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/06/2022] [Indexed: 12/12/2022] Open
Abstract
The impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and associated development of clinical symptoms of COVID-19 have presented an enormous global impact on our health care systems, public health and economy. To date several observational epidemiological studies consistently found that vitamin D deficiency, measured as low levels of circulating 25-hydroxyvitamin D, is associated with cardiovascular diseases, diabetes, certain cancers, autoimmune diseases and many infectious diseases, including acute respiratory infections. Since vitamin D is not merely immunosuppressive but also acts as an immunomodulator in tolerance and homeostasis, many experts have considered a role of vitamin D in the prevalence and severity of immune mediated inflammatory diseases, such as SARS-CoV-2, adding to the evidence of the importance of vitamin D in the immune response against viral respiratory infections and reinforcing the need for targeted vitamin D supplementation, with a focus on high-risk populations and a high-dose supplementation treatment for COVID-19 hospitalized patients. The expected transition to endemicity of SARS-CoV-2 even further corroborates as a potential of vitamin D as an potential mitigation tool for the prevention of COVID-19. The aim of this paper is to analyse the current evidence regarding vitamin D and present a hypothesis of its potential role in the current COVID-19 pandemic and in the future as a potential preventive measurement in public health.
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Affiliation(s)
- Daniela Briceno Noriega
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, Netherlands
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18
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Mahwish, Saeed F, Afzaal M, Hussain M, Imran M, Nawaz T, Siddeeg A. Dietary guidelines to boost immunity during pre and post covid-19 conditions. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2022. [DOI: 10.1080/10942912.2022.2071287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mahwish
- Institute of Home Sciences, University of Agriculture, Faisalabad, Pakistan
| | - Farhan Saeed
- Department of Food Sciences, Government College University Faisalabad, Pakistan
| | - Muhammad Afzaal
- Department of Food Sciences, Government College University Faisalabad, Pakistan
| | - Muzzamal Hussain
- Department of Food Sciences, Government College University Faisalabad, Pakistan
| | - Muhammad Imran
- Food, nutrition and lifestyle Unit, King Fahed Medical Research Center, Clinical Biochemistry Department, Faculty of Medicine, King Abdulaziz University
- Department of food science and technology, University of Narowal, Pakistan
| | - Taufiq Nawaz
- Department of Food Science and Technology, The University of Agriculture, Peshawar, Pakistan
| | - Azhari Siddeeg
- Department of Food Engineering and Technology, Faculty of Engineering and Technology, University of Gezira, Wad Medani, Sudan
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19
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Wågström P, Nilsdotter-Augustinsson Å, Nilsson M, Björkander J, Dahle C, Nyström S. Fatigue Is Common in Immunoglobulin G Subclass Deficiency and Correlates With Inflammatory Response and Need for Immunoglobulin Replacement Therapy. Front Immunol 2022; 12:797336. [PMID: 35082787 PMCID: PMC8785394 DOI: 10.3389/fimmu.2021.797336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose Individuals with immunoglobulin G deficiency (IgGsd) often complain of fatigue. The correlation between systemic inflammation and fatigue is unknown. In this study perceived quality of life (QoL) and fatigue in individuals with IgGsd, on and off immunoglobulin replacement therapy (IgRT) were correlated to inflammatory markers in plasma to identify the subgroup that benefits from IgRT. Method Thirty-five IgGsd-patients were sampled on three occasions: at baseline, after being on IgRT for at least 18 months, and 18 months after discontinuation of IgRT. Short form 36, EQ-5D-5L visual analogue scale and fatigue impact scale questionnaires were used for evaluation of QoL and fatigue. Furthermore, a panel of 92 inflammatory markers were analysed in plasma. Thirty-two gender- and age-matched healthy individuals were included as controls and sampled on one occasion. Results QoL was lower and perceived fatigue higher in IgGsd compared to the controls. Severe fatigue and low QoL were associated with the need to restart IgRT (which is considered in IgGsd-individuals with a high burden of infections in Sweden). Twenty-five inflammatory factors were dysregulated in IgGsd and the plasma protein patterns were similar regardless of whether IgRT was ongoing or not. Enrichment analysis indicated IL-10 signalling as the most affected pathway. Severe fatigue was associated with decreased levels of the neurotrophic factors VEGFA and CSF-1. Conclusion Fatigue is a major contributory factor to impaired health-related QoL in IgGsd and is related to the need for IgRT. Low-grade systemic inflammation is a potential driver of fatigue. In addition to the burden of infections, we suggest the degree of fatigue should be considered when the decision to introduce IgRT is made.
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Affiliation(s)
- Per Wågström
- Department of Infectious Diseases, Ryhov County Hospital, Jönköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Infectious Diseases, The Vrinnevi Hospital, Norrköping, Sweden
| | - Mats Nilsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Futurum, Academy of Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Janne Björkander
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Wetterhälsan, Health Care Centre, Jönköping, Sweden
| | - Charlotte Dahle
- Division of Clinical Immunology and Transfusion Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sofia Nyström
- Division of Clinical Immunology and Transfusion Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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20
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Ganmaa D, Enkhmaa D, Nasantogtokh E, Sukhbaatar S, Tumur-Ochir KE, Manson JE. Vitamin D, respiratory infections, and chronic disease: Review of meta-analyses and randomized clinical trials. J Intern Med 2022; 291:141-164. [PMID: 34537990 DOI: 10.1111/joim.13399] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Observational studies have suggested associations of vitamin D deficiency (VDD) with respiratory tract infections, impaired bone health, and myriad chronic diseases. OBJECTIVE To assess potential causal relationships between vitamin D supplementation and a reduced risk of these conditions, a review of the evidence across available meta-analyses of randomized control trials (RCTs) and RCTs was performed. METHOD PubMed, Embase, Cochrane Library, and Web of Science were searched from their inception to March 2021. We included only RCTs and meta-analyses of RCTs focusing on the association between vitamin D and respiratory disease, bone health, cardiovascular disease (CVD), diabetes mellitus, and cancer. RESULTS A total of 107 RCTs and 62 meta-analysis of RCTs were included. Although most RCTs did not support benefits of vitamin D supplementation, suggestive evidence for benefit was found in populations at greater risk of VDD and for acute respiratory infections, fractures in institutionalized older adults, type 2 diabetes among patients with prediabetes, and cancer mortality. In contrast, no compelling evidence for benefit was found for other respiratory conditions, fractures in community-dwelling adults, falls, cancer incidence, or CVD. CONCLUSIONS Current evidence from RCTs and meta-analyses of RCTs is inconsistent regarding the effects of vitamin D supplementation on respiratory infections and chronic diseases. Individuals most likely to benefit are those with baseline VDD or with selected high-risk conditions. Public health initiatives are needed to eliminate VDD globally, and future research will be enhanced by a 'precision prevention' approach to identify those most likely to benefit from vitamin D supplementation.
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Affiliation(s)
- Davaasambuu Ganmaa
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | | | | | - J E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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21
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Current opinion on the role of vitamin D supplementation in respiratory infections and asthma/COPD exacerbations: A need to establish publication guidelines for overcoming the unpublished data. Clin Nutr 2022; 41:755-777. [DOI: 10.1016/j.clnu.2022.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/29/2021] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
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22
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Baloyi NN, Tugizimana F, Sitole LJJ. Metabolomics assessment of vitamin D impact in Pam3CSK4 stimulation. Mol Omics 2022; 18:397-407. [DOI: 10.1039/d1mo00377a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mycobacterium tuberculosis, a causative agent of tuberculosis, is amongst the leading causes of mycobacterial mortality worldwide. Although several studies have proposed the possible therapeutic role of vitamin D in antimycobacterial...
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23
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Abstract
Asthma is chronic eosinophilic bronchitis with the dominancy of T helper 2 (Th2) inflammation. However, patients with asthma and metabolic dysfunction have pathogenic and pathological differences from those with Th2 inflammation. Metabolic dysfunction, typically presented as metabolic syndrome, has several important clinical components including central obesity, insulin resistance or glucose intolerance, dyslipidemia, and vitamin D deficiency. Data from large epidemiological studies support the significance of these components in the control of asthma and their contribution to airway remodeling, suggesting the presence of an asthma phenotype with metabolic dysfunction. These components are quite interactive with each other, so it is difficult to reveal the individual role of each. It is well known that asthma is difficult to treat in patients with obesity, due in part to inadequate response to inhaled corticosteroids. Additionally, vitamin D deficiency and insulin resistance have been regarded as aggravating factors of asthma control and airway remodeling. Recent clinical and in vivo studies have revealed the specific mechanisms of these components, which may aggravate asthma control and airway remodeling. In this review article, I summarize the recent studies and unmet needs for patients with asthma and metabolic dysfunction.
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Affiliation(s)
- Jung-Won Park
- Institute for Allergy & Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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24
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Demers-Mathieu V, Lavangnananda S, Medo E. Influence of Vitamin D3 Levels and T Cell-Related Cytokines in Human Milk on Coronavirus Disease 2019 Infection in Lactating Women. Breastfeed Med 2021; 16:995-1003. [PMID: 34388035 DOI: 10.1089/bfm.2021.0170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Vitamin D deficiency was associated with an increased risk of coronavirus disease 2019 (COVID-19) infection. Vitamin D deficient mothers are more likely to have infants with vitamin D deficiency, affecting their immunity and protection against infection. This study aimed at comparing the concentrations of vitamin D3 and T cell-related cytokines in milk between mothers with confirmed COVID-19 polymerase chain reaction (PCR) test, mothers with viral infections suggestive of COVID-19, and mothers without infection. Materials and Methods: Concentrations of vitamin D3 and T cell-related cytokines in milk samples were determined by ELISA from 10 mothers who had a positive COVID-19 PCR test, 10 mothers with viral symptoms suggestive of COVID-19, and 20 mothers without infection. Results: Vitamin D3 concentration in human milk was higher in women without infection than in women with viral symptoms or COVID-19 PCR. Interleukin-2 level in milk was higher in the no-infection group than the COVID-19 PCR group but it did not differ with the viral symptoms group. Vitamin D3 did not correlate with any cytokines in human milk. Prenatal vitamin intake did not affect the vitamin D3 in human milk. The percentage of milk from mothers with <20 ng/mL of vitamin D3 was 50% in the COVID-19 PCR group, 60% in the viral symptoms group, and 5% in the no-infection group. Conclusions: Vitamin D3 level in breast milk may influence maternal immunity against COVID-19 infection. A larger study is needed to evaluate the relationship between vitamin D3 concentration in breast milk, maternal immune response, and the incidence of COVID-19 infection in lactating mothers.
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Affiliation(s)
- Veronique Demers-Mathieu
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories, A Public Benefit Corporation, Boulder City, Nevada, USA
| | - Sirima Lavangnananda
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories, A Public Benefit Corporation, Boulder City, Nevada, USA
| | - Elena Medo
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories, A Public Benefit Corporation, Boulder City, Nevada, USA
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Helde Frankling M, Klasson C, Björkhem-Bergman L. Successful Strategies and Areas of Improvement-Lessons Learned from Design and Conduction of a Randomized Placebo-Controlled Trial in Palliative Care, 'Palliative-D'. Life (Basel) 2021; 11:life11111233. [PMID: 34833109 PMCID: PMC8619948 DOI: 10.3390/life11111233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022] Open
Abstract
Clinical trials in palliative care are challenging to design and conduct. Burden on patients should be minimized, while gatekeeping by professionals and next-of kin needs to be avoided. Clinical deterioration due to disease progression affects attrition unrelated to intervention, and different care settings complicate comparisons and reduce the generalizability of the results. The aim of this review is to provide advice for colleagues planning to perform clinical trials in palliative care based on our own experiences from performing the Palliative-D study and by a thorough literature review on this topic. The Palliative-D study was a double-blind trial with 244 randomized patients comparing the effect of vitamin D3 to placebo in patients with advanced or metastatic cancer in the palliative phase of their disease trajectory who were enrolled in specialized palliative home care teams. Endpoints were opioid and antibiotic use, fatigue, and QoL. Recruitment was successful, but attrition rates were higher than expected, and we did not reach targeted power. For the 150 patients who completed the study, the completeness of the data was exceptionally high. Rather than patient reported pain, we choose the difference in the mean change in opioid dose between groups after twelve weeks compared to baseline as the primary endpoint. In this paper we discuss challenges in palliative care research based on lessons learned from the "Palliative-D" trial regarding successful strategies as well as areas for improvement.
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Affiliation(s)
- Maria Helde Frankling
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Solna, SE-171 64 Stockholm, Sweden
- Correspondence:
| | - Caritha Klasson
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-112 19 Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-112 19 Stockholm, Sweden
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The Effects of Vitamin D on Immune System and Inflammatory Diseases. Biomolecules 2021; 11:biom11111624. [PMID: 34827621 PMCID: PMC8615708 DOI: 10.3390/biom11111624] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/22/2022] Open
Abstract
Immune cells, including dendritic cells, macrophages, and T and B cells, express the vitamin D receptor and 1α-hydroxylase. In vitro studies have shown that 1,25-dihydroxyvitamin D, the active form of vitamin D, has an anti-inflammatory effect. Recent epidemiological evidence has indicated a significant association between vitamin D deficiency and an increased incidence, or aggravation, of infectious diseases and inflammatory autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis. However, the impact of vitamin D on treatment and prevention, particularly in infectious diseases such as the 2019 coronavirus disease (COVID-19), remains controversial. Here, we review recent evidence associated with the relationship between vitamin D and inflammatory diseases and describe the underlying immunomodulatory effect of vitamin D.
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The Combined Beneficial Effects of Postbiotic Butyrate on Active Vitamin D3-Orchestrated Innate Immunity to Salmonella Colitis. Biomedicines 2021; 9:biomedicines9101296. [PMID: 34680413 PMCID: PMC8533643 DOI: 10.3390/biomedicines9101296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
Salmonella spp. Remains a major public health problem globally. Biomedicine is the cornerstone of modern health care and could be a solution for antibiotic-resistant Salmonellosis. Although postbiotics seem to be an effective treatment in various clinical conditions, their clinical effects on Salmonella colitis have not been reported. Our previous report revealed that active vitamin D attenuates the severity of Salmonella colitis and invasiveness by reducing inflammation and enhancing the production of antimicrobial peptides. Therefore, we investigated the synergistic effects of butyrate, the most studied postbiotic, and active vitamin D on the severity of Salmonella colitis, invasiveness of Salmonella, and host immune responses, as well as its novel mechanisms, using in vitro and in vivo studies. We demonstrated that a combination of butyrate and active vitamin D (1 alpha, 25-dihydroxyvitamin D3) synergically reduced the severity of Salmonella colitis in C57BL/6 mice and reduced cecal inflammatory mIL-6, mIL-8, mTNF-α, and mIL-1β mRNA expression, but enhanced the antimicrobial peptide mhBD-3 mRNA, compared to a single treatment. Additionally, upregulated vitamin D receptor (VDR) plays a critical role in the synergistic effects. This suggests combined benefits of butyrate and active vitamin D on Salmonella colitis through VDR-mediated antibacterial and anti-inflammatory responses. The combined use of both supplements could be a potential biomedicine for infectious and autoimmune colitis.
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The Cooperation of Bifidobacterium longum and Active Vitamin D3 on Innate Immunity in Salmonella Colitis Mice via Vitamin D Receptor. Microorganisms 2021; 9:microorganisms9091804. [PMID: 34576700 PMCID: PMC8465383 DOI: 10.3390/microorganisms9091804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
Salmonella spp. remains a major public health problem for the whole world. Intestinal epithelial cells serve as an essential component of the mucosal innate immune system to defend against Salmonella infection. Our in vitro studies showed probiotics and active vitamin D have similar effects on innate immunity in Salmonella-infected intestinal epithelial cells, including antimicrobial peptide and inflammatory responses, to protect the host against infection while downregulating detrimental overwhelming inflammation. Hence, we investigated the synergistic effects of probiotics and active vitamin D on Salmonella colitis and translocation to liver and spleen by in vitro and in vivo studies. The Salmonella colitis model is conducted with 6–8 w/o male C57BL/6 mice: Streptomycin (20 mg/mouse p.o.)-pretreated C57BL/6 mice are mock infected with sterile PBS or infected orally with 1 × 108 CFU of a S. Typhimurium wild-type strain SL1344 for 48 h. The mice in the treated groups received 1, 25D daily (0.2 ug/25 g/d) and/or 1 × 108 CFU of probiotics, Lactobacillus rhamnosus GG (LGG) and Bifidobacterium longum (BL) by intragastric administration for 14 days. The in vivo study demonstrated the combination of probiotic Bifidobacterium longum and active vitamin D3 had the synergistic effects on reducing the severity of Salmonella colitis and body weight loss in C57BL/6 mice by reducing cecal inflammatory mIL-6, mIL-8, mTNF-α and mIL-1β mRNA responses, blocking the translocation of bacteria while enhancing the antimicrobial peptide mhBD-3 mRNA in comparison to the infection only group. However, LGG did not have the same synergistic effects. It suggests the synergistic effects of Bifidobacterium longum and active vitamin D on the antibacterial and anti-inflammatory responses in Salmonella colitis. Therefore, our in vivo studies demonstrated that the combination of probiotic Bifidobacterium longum and active vitamin D3 has the synergistic effects on reducing the severity of Salmonella colitis via the suppression of inflammatory responses, and blocking the translocation of bacteria through the enhancement of antimicrobial peptides.
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Helde Frankling M, Klasson C, Sandberg C, Nordström M, Warnqvist A, Bergqvist J, Bergman P, Björkhem-Bergman L. 'Palliative-D'-Vitamin D Supplementation to Palliative Cancer Patients: A Double Blind, Randomized Placebo-Controlled Multicenter Trial. Cancers (Basel) 2021; 13:cancers13153707. [PMID: 34359609 PMCID: PMC8345220 DOI: 10.3390/cancers13153707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary In this study, the effect of vitamin D supplementation on pain, infections, fatigue and quality of life in patients with advanced cancer with verified vitamin D deficiency was studied. To this end, a randomized controlled trial, ‘Palliative-D’, was conducted, comparing the effect of 4000 IU vitamin D3/day for 12 weeks to placebo in cancer patients admitted to palliative care. Pain was assessed as change in opioid dose and infections measured as days on antibiotics. Vitamin D-supplemented patients increased their opioid doses at a significantly slower rate than patients receiving placebo, i.e., 0.56 µg less fentanyl/h per week with vitamin D treatment. Vitamin D reduced self-assessed fatigue but did not affect antibiotic use or self-assessed Quality of life. The treatment was safe and well-tolerated. In conclusion, correction of vitamin D deficiency may have positive effects on pain and fatigue in palliative cancer patients. Abstract The aim of the ‘Palliative-D’ study was to test the hypothesis that correction of vitamin D deficiency reduces opioid use in cancer patients admitted to palliative care. A multicenter randomized, placebo-controlled, double-blind trial in three home-based palliative care facilities in Sweden was performed. Patients with advanced cancer and 25-hydroxyvitamin D < 50 nmol/L were randomized to vitamin D3 4000 IU/day or placebo for 12 weeks. The primary endpoint was the difference of long-acting opioid use (fentanyl ug/h) between the groups during 12 weeks, based on four time points. Secondary outcomes included changes in antibiotic use, fatigue and Quality of Life (QoL). A total of 244 patients were randomized, and 150 patients completed the 12 weeks. The major reason for drop-out was death due to cancer. The vitamin D-group had a significantly smaller increase of opioid doses compared to the placebo-group; beta coefficient −0.56 (p = 0.03), i.e., 0.56 µg less fentanyl/h per week with vitamin D treatment. Vitamin D-reduced fatigue assessed with ESAS was −1.1 points after 12 weeks (p < 0.01). Antibiotic use or QoL did not differ significantly between the groups. The treatment was safe and well-tolerated. In conclusion, correction of vitamin D deficiency may have positive effects on opioid use and fatigue in palliative cancer patients, but only in those with a survival time more than 12 weeks.
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Affiliation(s)
- Maria Helde Frankling
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, SE-141 83 Huddinge, Sweden; (M.H.F.); (C.K.)
- ASIH Stockholm Södra, Palliative Home Care and Hospice Ward, SE-125 59 Älvsjö, Sweden
| | - Caritha Klasson
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, SE-141 83 Huddinge, Sweden; (M.H.F.); (C.K.)
- ASIH Stockholm Södra, Palliative Home Care and Hospice Ward, SE-125 59 Älvsjö, Sweden
- Stockholms Sjukhem, Palliative Medicine, SE-112 19 Stockholm, Sweden; (C.S.); (M.N.)
| | - Carina Sandberg
- Stockholms Sjukhem, Palliative Medicine, SE-112 19 Stockholm, Sweden; (C.S.); (M.N.)
| | - Marie Nordström
- Stockholms Sjukhem, Palliative Medicine, SE-112 19 Stockholm, Sweden; (C.S.); (M.N.)
| | - Anna Warnqvist
- Department of Environmental Medicine, Division of Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden;
| | - Jenny Bergqvist
- Department of Surgery, Breast Centre, Capio St Gorans Hospital, SE-112 19 Stockholm, Sweden;
- Department of Oncology-Pathology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Peter Bergman
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, SE-141 86 Stockholm, Sweden;
- Department of Infectious Diseases, Immunodeficiency Unit, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, SE-141 83 Huddinge, Sweden; (M.H.F.); (C.K.)
- ASIH Stockholm Södra, Palliative Home Care and Hospice Ward, SE-125 59 Älvsjö, Sweden
- Stockholms Sjukhem, Palliative Medicine, SE-112 19 Stockholm, Sweden; (C.S.); (M.N.)
- Correspondence:
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Wu Z, Camargo CA, Sluyter J, Waayer D, Toop L, Scragg R. Effect of monthly vitamin D supplementation on antibiotic prescribing in older adults: a post hoc analysis of a randomized controlled trial. Am J Clin Nutr 2021; 114:314-321. [PMID: 33742207 DOI: 10.1093/ajcn/nqab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Observational studies have reported that low vitamin D status is associated with increased risk of antibiotic use. However, trials on the effect of vitamin D supplementation on antibiotics are limited and inconclusive. OBJECTIVES The main objective of this study was to determine the effect of monthly vitamin D supplementation on the proportion of adults with ≥1 prescriptions of antibiotics. The secondary outcomes were to determine the effect of monthly vitamin D supplementation on the number of antibiotic prescriptions and the number of days on antibiotics. METHODS This was a post hoc analysis of a randomized, double-blinded, placebo-controlled trial with community-based older adults who were randomly assigned to receive monthly 100,000 IU of vitamin D or identical placebo. All analyses were based on the principle of "intention to treat." RR from log-binomial models and the incidence rate ratio (IRR) from negative binomial models were estimated for primary and secondary outcomes after adjusting for age, sex, and ethnicity. RESULTS A total of 5108 participants aged 50-84 y were randomly assigned to vitamin D supplementation (n = 2558) or placebo (n = 2550) groups. During a median follow-up of 3.3 y, 4211 (82%) participants were prescribed antibiotics. There was no difference in the proportion of participants prescribed antibiotics between vitamin D (82%) and placebo (83%) groups (adjusted RR: 0.99; 95% CI: 0.97, 1.01; P = 0.42). Similarly, the number of antibiotic prescriptions per person-year did not differ between the 2 treatment groups (adjusted IRR: 0.98; 95% CI: 0.93, 1.04; P = 0.58). However, the number of days on antibiotics per person-year was significantly lower in the vitamin D group (mean ± SEM: 15 ± 0.7) compared with the placebo group (mean ± SEM: 17 ± 0.8) (adjusted IRR: 0.90; 95% CI: 0.82, 0.98; P = 0.01), especially for the tetracyclines (IRR: 0.65; 95% CI: 0.50, 0.85; P = 0.002). CONCLUSIONS Long-term, monthly, high-dose vitamin D3 supplementation did not prevent antibiotic prescribing in older adults, but the vitamin D group had fewer days per person-year on antibiotics. Further research is required to replicate these findings. This trial was registered at www.anzctr.org.au as ACTRN12611000402943.
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Affiliation(s)
- Zhenqiang Wu
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Debbie Waayer
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Les Toop
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
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Marazziti D, Parra E, Palermo S, Barberi FM, Buccianelli B, Ricciardulli S, Cappelli A, Mucci F, Dell'Osso L. Vitamin D: A Pleiotropic Hormone with Possible Psychotropic Activities. Curr Med Chem 2021; 28:3843-3864. [PMID: 33302828 DOI: 10.2174/0929867328666201210104701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND After the recognition of the efficacy of cod-liver oil in rickets at the end of the eighteenth century, and the isolation and synthesis of the liposoluble vitamin D in 1931, its mode of actions and functions were deeply explored. Biochemical studies permitted to identify five forms of vitamin D, called D1, D2, D3, D4 and D5, differing in ultrastructural conformation and origin, with vitamin D2 (ergocalciferol) and D3 (cholecalciferol) representing the active forms. In the last decades especially, a constantly increasing bulk of data highlighted how vitamin D could regulate several activities and processes. AIMS The aim of the present paper was to review and comment on the literature on vitamin D, with a focus on its possible role in the pathophysiology of neuropsychiatric disorders. DISCUSSION Available literature indicates that vitamin D regulates a variety of processes in humans and in the central nervous system. Vitamin D deficiency is associated with an enhanced pro-inflammatory state, and formation of Aβ oligomers that might contribute to the cognitive decline typical of the elderly age and, perhaps, dementia. More in general, vitamin D is supposed to play a crucial role in neuroinflammation processes that are currently hypothesized to be involved in the pathophysiology of different psychiatric disorders, such as major depression, bipolar disorders, obsessive-compulsive disorders and psychosis. CONCLUSION It is conceivable that vitamin D supplementation might pave the way towards "natural" treatments of a broad range of neuropsychiatric disorders, or at least be useful to boost response to psychotropic drugs in resistant cases.
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Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Elisabetta Parra
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Stefania Palermo
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Filippo Maria Barberi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Beatrice Buccianelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Sara Ricciardulli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Andrea Cappelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Federico Mucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
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Abstract
The nasopharyngeal microbiome is a dynamic microbial interface of the aerodigestive tract, and a diagnostic window in the fight against respiratory infections and antimicrobial resistance. As its constituent bacteria, viruses and mycobacteria become better understood and sampling accuracy improves, diagnostics of the nasopharynx could guide more personalized care of infections of surrounding areas including the lungs, ears and sinuses. This review will summarize the current literature from a clinical perspective and highlight its growing importance in diagnostics and infectious disease management.
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Affiliation(s)
- Matthew Flynn
- School of Biomedical Sciences, Ulster University, Coleraine BT52 1SA, UK
- Otolaryngology Department, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - James Dooley
- School of Biomedical Sciences, Ulster University, Coleraine BT52 1SA, UK
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Tourkochristou E, Triantos C, Mouzaki A. The Influence of Nutritional Factors on Immunological Outcomes. Front Immunol 2021; 12:665968. [PMID: 34135894 PMCID: PMC8201077 DOI: 10.3389/fimmu.2021.665968] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/05/2021] [Indexed: 12/19/2022] Open
Abstract
Through food intake, humans obtain a variety of nutrients that are essential for growth, cellular function, tissue development, energy, and immune defense. A special interaction between nutrients and gut-associated lymphoid tissue occurs in the intestinal tract. Enterocytes of the intestinal barrier act as sensors for antigens from nutrients and the intestinal microbiota, which they deliver to the underlying immune system of the lamina propria, triggering an immune response. Studies investigating the mechanism of influence of nutrition on immunological outcomes have highlighted an important role of macronutrients (proteins, carbohydrates, fatty acids) and micronutrients (vitamins, minerals, phytochemicals, antioxidants, probiotics) in modulating immune homeostasis. Nutrients exert their role in innate immunity and inflammation by regulating the expression of TLRs, pro- and anti-inflammatory cytokines, thus interfering with immune cell crosstalk and signaling. Chemical substrates derived from nutrient metabolism may act as cofactors or blockers of enzymatic activity, influencing molecular pathways and chemical reactions associated with microbial killing, inflammation, and oxidative stress. Immune cell function appears to be influenced by certain nutrients that form parts of the cell membrane structure and are involved in energy production and prevention of cytotoxicity. Nutrients also contribute to the initiation and regulation of adaptive immune responses by modulating B and T lymphocyte differentiation, proliferation and activation, and antibody production. The purpose of this review is to present the available data from the field of nutritional immunology to elucidate the complex and dynamic relationship between nutrients and the immune system, the delineation of which will lead to optimized nutritional regimens for disease prevention and patient care.
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Affiliation(s)
- Evanthia Tourkochristou
- Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Christos Triantos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Athanasia Mouzaki
- Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
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Power determination in vitamin D randomised control trials and characterising factors affecting it through a novel simulation-based tool. Sci Rep 2021; 11:10804. [PMID: 34031451 PMCID: PMC8144427 DOI: 10.1038/s41598-021-90019-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/12/2021] [Indexed: 11/21/2022] Open
Abstract
Thousands of observational studies have linked vitamin D deficiency with numerous diseases, but randomised controlled trials (RCTs) often fail to show benefit of supplementation. Population characteristics and trial design have long been suspected to undermine power but were not systematically investigated. We propose a flexible generative model to characterise benefit of vitamin D supplementation at the individual level, and use this to quantify power in RCTs. The model can account for seasonality and population heterogeneity. In a simulated 1-year trial with 1000 participants per arm and assuming a 25-hydroxyvitamin D (25OHD) increase of 20 nmol/L due to the intervention, with baseline 25OHD in the population of 15, 35, 50, 60 and 75 nmol/L, the power to detect intervention effect was 77%, 99%, 95%, 68% and 19%, respectively. The number of participants required per arm to achieve 80% power according to baseline 25OHD of 15–60 nmol/L was 1200, 400, 600 and 1400, respectively. As expected, larger increases in 25OHD due to supplementation improved power in certain scenarios. For a population baseline of 50 nmol/L, with 1500 participants in each arm, there was 100% power to detect a 20 nmol/L 25OHD increase while it was 76% for a 10 nmol/L increase. Population characteristics and trial design, including temporal considerations, have a dramatic impact on power and required sample size in vitamin D RCTs.
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Jolliffe DA, Camargo CA, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, Bergman P, Bischoff-Ferrari HA, Borzutzky A, Damsgaard CT, Dubnov-Raz G, Esposito S, Gilham C, Ginde AA, Golan-Tripto I, Goodall EC, Grant CC, Griffiths CJ, Hibbs AM, Janssens W, Khadilkar AV, Laaksi I, Lee MT, Loeb M, Maguire JL, Majak P, Mauger DT, Manaseki-Holland S, Murdoch DR, Nakashima A, Neale RE, Pham H, Rake C, Rees JR, Rosendahl J, Scragg R, Shah D, Shimizu Y, Simpson-Yap S, Trilok-Kumar G, Urashima M, Martineau AR. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol 2021; 9:276-292. [PMID: 33798465 DOI: 10.1016/s2213-8587(21)00051-6] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A 2017 meta-analysis of data from 25 randomised controlled trials (RCTs) of vitamin D supplementation for the prevention of acute respiratory infections (ARIs) revealed a protective effect of this intervention. We aimed to examine the link between vitamin D supplementation and prevention of ARIs in an updated meta-analysis. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and the ClinicalTrials.gov registry for studies listed from database inception to May 1, 2020. Double-blind RCTs of vitamin D3, vitamin D2, or 25-hydroxyvitamin D (25[OH]D) supplementation for any duration, with a placebo or low-dose vitamin D control, were eligible if they had been approved by a research ethics committee, and if ARI incidence was collected prospectively and prespecified as an efficacy outcome. Studies reporting results of long-term follow-up of primary RCTs were excluded. Aggregated study-level data, stratified by baseline 25(OH)D concentration and age, were obtained from study authors. Using the proportion of participants in each trial who had one or more ARIs, we did a random-effects meta-analysis to obtain pooled odds ratios (ORs) and 95% CIs to estimate the effect of vitamin D supplementation on the risk of having one or more ARIs (primary outcome) compared with placebo. Subgroup analyses were done to estimate whether the effects of vitamin D supplementation on the risk of ARI varied according to baseline 25(OH)D concentration (<25 nmol/L vs 25·0-49·9 nmol/L vs 50·0-74·9 nmol/L vs >75·0 nmol/L), vitamin D dose (daily equivalent of <400 international units [IU] vs 400-1000 IU vs 1001-2000 IU vs >2000 IU), dosing frequency (daily vs weekly vs once per month to once every 3 months), trial duration (≤12 months vs >12 months), age at enrolment (<1·00 years vs 1·00-15·99 years vs 16·00-64·99 years vs ≥65·00 years), and presence versus absence of airway disease (ie, asthma only, COPD only, or unrestricted). Risk of bias was assessed with the Cochrane Collaboration Risk of Bias Tool. The study was registered with PROSPERO, CRD42020190633. FINDINGS We identified 1528 articles, of which 46 RCTs (75 541 participants) were eligible. Data for the primary outcome were obtained for 48 488 (98·1%) of 49 419 participants (aged 0-95 years) in 43 studies. A significantly lower proportion of participants in the vitamin D supplementation group had one or more ARIs (14 332 [61·3%] of 23 364 participants) than in the placebo group (14 217 [62·3%] of 22 802 participants), with an OR of 0·92 (95% CI 0·86-0·99; 37 studies; I2=35·6%, pheterogeneity=0·018). No significant effect of vitamin D supplementation on the risk of having one or more ARIs was observed for any of the subgroups defined by baseline 25(OH)D concentration. However, protective effects of supplementation were observed in trials in which vitamin D was given in a daily dosing regimen (OR 0·78 [95% CI 0·65-0·94]; 19 studies; I2=53·5%, pheterogeneity=0·003), at daily dose equivalents of 400-1000 IU (0·70 [0·55-0·89]; ten studies; I2=31·2%, pheterogeneity=0·16), for a duration of 12 months or less (0·82 [0·72-0·93]; 29 studies; I2=38·1%, pheterogeneity=0·021), and to participants aged 1·00-15·99 years at enrolment (0·71 [0·57-0·90]; 15 studies; I2=46·0%, pheterogeneity=0·027). No significant interaction between allocation to the vitamin D supplementation group versus the placebo group and dose, dose frequency, study duration, or age was observed. In addition, no significant difference in the proportion of participants who had at least one serious adverse event in the vitamin supplementation group compared with the placebo group was observed (0·97 [0·86-1·07]; 36 studies; I2=0·0%, pheterogeneity=0·99). Risk of bias within individual studies was assessed as being low for all but three trials. INTERPRETATION Despite evidence of significant heterogeneity across trials, vitamin D supplementation was safe and overall reduced the risk of ARI compared with placebo, although the risk reduction was small. Protection was associated with administration of daily doses of 400-1000 IU for up to 12 months, and age at enrolment of 1·00-15·99 years. The relevance of these findings to COVID-19 is not known and requires further investigation. FUNDING None.
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Affiliation(s)
- David A Jolliffe
- Barts and The London School of Medicine and Dentistry, and Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Mary Aglipay
- Department of Pediatrics, St Michael's Hospital, Toronto, ON, Canada
| | - John F Aloia
- Bone Mineral Research Center, Winthrop University Hospital, Mineola, NY, USA
| | - Davaasambuu Ganmaa
- Department of Nutrition, Harvard TH Chan Shool of Public Health, Boston, MA, USA
| | - Peter Bergman
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heike A Bischoff-Ferrari
- Department of Geriatric Medicine and Aging Research, University Hospital Zurich, Zurich, Switzerland
| | - Arturo Borzutzky
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camilla T Damsgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Gal Dubnov-Raz
- Exercise, Lifestyle and Nutrition Clinic, Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
| | - Susanna Esposito
- Paediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Clare Gilham
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Inbal Golan-Tripto
- Saban Pediatric Medical Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Emma C Goodall
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Christopher J Griffiths
- Barts and The London School of Medicine and Dentistry, and Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | | | | | - Ilkka Laaksi
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland; Centre for Military Medicine, Helsinki, Finland
| | - Margaret T Lee
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, NY USA
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Paweł Majak
- Department of Pediatric Pulmonology, Medical University of Lodz, Lodz, Poland
| | - David T Mauger
- Department of Statistics, The Pennsylvania State University, Hershey, PA, USA
| | - Semira Manaseki-Holland
- Department of Public Health, Epidemiology and Biostatistics, Institute of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - David R Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | | | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, QLD, Australia
| | - Hai Pham
- Population Health Department, QIMR Berghofer Medical Research Institute, QLD, Australia
| | - Christine Rake
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Judy R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jenni Rosendahl
- Children's Hospital, Pediatric Research Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dheeraj Shah
- Department of Paediatrics, University College of Medical Sciences, Delhi, India
| | - Yoshiki Shimizu
- FANCL Research Institute, FANCL Corporation, Yokohama, Japan
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | | | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, and Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
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Shokri-Mashhadi N, Kazemi M, Saadat S, Moradi S. Effects of select dietary supplements on the prevention and treatment of viral respiratory tract infections: a systematic review of randomized controlled trials. Expert Rev Respir Med 2021; 15:805-821. [PMID: 33858268 DOI: 10.1080/17476348.2021.1918546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Viral respiratory tract infections (RTIs) have been recognized as a global public health burden. Despite current theories about their effectiveness, the true benefits of dietary supplements on the prevention and treatment of viral RTIs remain elusive, due to contradictory reports. Hence, we aimed to evaluate the effectiveness of dietary supplements on the prevention and treatment of viral RTIs.Areas covered: We systematically searched databases of PubMed, Web of Science, Scopus, and Google Scholar through 4 March 2020, to identify randomized controlled trials that evaluated the effects of consuming selected dietary supplements on the prevention or treatment of viral RTIs.Expert opinion: Thirty-nine randomized controlled trials (n = 16,797 participants) were eligible and included. Namely, vitamin D supplementation appeared to improve viral RTIs across cohorts particulate in those with vitamin D deficiency. Among the evaluated dietary supplements, specific lactobacillus strains were used most commonly with selected prebiotics that showed potentially positive effects on the prevention and treatment of viral RTIs. Further, ginseng extract supplementation may effectively prevent viral RTIs as adjuvant therapy. However, longitudinal research is required to confirm these observations and address the optimal dose, duration, and safety of dietary supplements being publicly recommended.
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Affiliation(s)
- Nafiseh Shokri-Mashhadi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Kazemi
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NewYork, USA
| | - Saeed Saadat
- Department of Computer Sciences, Faculty of Mathematics and Natural Sciences, Heinrich Heine Universität, Düsseldorf, Germany
| | - Sajjad Moradi
- Halal Research Center of IRI, FDA, Tehran, Iran.,Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zhamankulov A, Rozenson R, Morenko M, Shnayder K, Akhmetova U, Tyo A. COVID-19 and recurrent respiratory infections in children of Kazakhstan. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The study goal was to investigate the COVID-19 clinical course in children with recurrent respiratory infections (RRI) in Nur-Sultan, Kazakhstan.
Material and Methods — we conducted the retrospective analysis of 94 children with RRI, diagnosed with COVID-19, in Nur-Sultan, Kazakhstan. The study involved 53 males and 41 females. The inclusion criterion for the study was the frequency of RRI at least six times per year. In the course of our study, we split the patients among three groups and identified two phenotypes. These groups included children with RRI and atopic phenotype (Group 1), with D-deficiency phenotype (Group 2), and control group (Group 3) encompassing children with RRI lacking these phenotypes.
Results — The most common symptoms of 94 pediatric patients were dry cough (94.7%), fever (81.9%), along with a loss of appetite and fatigue (76.6%). Malaise was observed in 74.5% cases, rhinorrhea was noted in 71.2% of patients, sore throat was detected in 64.9 % of children, and dyspnea was established in 45.7% of cases. We observed no statistical differences in clinical manifestations of COVID-19 among three groups of children. However, duration of hospitalization period, of fever, and of the catarrhal period differed significantly among the groups (р<0.001).
Conclusion — In children with RRI and vitamin D deficiency, who were diagnosed with COVID-19, the course of the infection was unfavorable (which was confirmed by a longer hospital stay and catarrhal period), and a more severe intoxication syndrome was observed. In the group of children with atopic phenotype, a prolonged residual cough was detected.
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Camargo CA, Sluyter J, Stewart AW, Khaw KT, Lawes CMM, Toop L, Waayer D, Scragg R. Effect of Monthly High-Dose Vitamin D Supplementation on Acute Respiratory Infections in Older Adults: A Randomized Controlled Trial. Clin Infect Dis 2021; 71:311-317. [PMID: 31420647 DOI: 10.1093/cid/ciz801] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although adults with low vitamin D status are at increased risk of acute respiratory infection (ARI), randomized controlled trials of vitamin D supplementation have provided inconsistent results. METHODS We performed a randomized, double-blinded, placebo-controlled trial of 5110 adults aged 50-84 years. In 2011-2012, participants were randomized to an initial oral dose of 200 000 IU vitamin D3 followed by 100 000 IU monthly (n = 2558) or placebo (n = 2552) until late 2013 (median follow-up, 1.6 years). Participants reported upper and lower ARIs on monthly questionnaires. Cox models analyzed time to first ARI (upper or lower) by treatment group. RESULTS Participants' mean age was 66 years and 58% were male; 83% were of European/other ethnicity, with the rest Maori, Polynesian, or South Asian. Mean (SD) baseline blood 25-hydroxyvitamin D [25(OH)D] level was 63 (24) nmol/L; 25% were <50 nmol/L. In a random sample (n = 441), vitamin D supplementation increased mean 25(OH)D to 135 nmol/L at 3 years, while those on placebo remained at 63 nmol/L. During follow-up, 3737 participants reported ≥1 ARI: 74.1% in the vitamin D group versus 73.7% in the placebo group. The hazard ratio for vitamin D compared with placebo was 1.01 (95% CI, 0.94, 1.07). Similar results were seen in most subgroups, including those with baseline 25(OH)D <50 nmol/L and in analyses of the upper/lower components of the ARI outcome. CONCLUSIONS Monthly high-dose vitamin D supplementation does not prevent ARI in older adults with a low prevalence of profound vitamin D deficiency at baseline. Whether effects of daily or weekly dosing differ requires further study. CLINICAL TRIALS REGISTRATION Australian New Zealand Clinical Trials Registry, identifier ACTRN12611000402943.
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Affiliation(s)
- Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Alistair W Stewart
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Carlene M M Lawes
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Les Toop
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Debbie Waayer
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
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Han H, Chung SI, Park HJ, Oh EY, Kim SR, Park KH, Lee JH, Park JW. Obesity-induced Vitamin D Deficiency Contributes to Lung Fibrosis and Airway Hyperresponsiveness. Am J Respir Cell Mol Biol 2021; 64:357-367. [PMID: 33296297 DOI: 10.1165/rcmb.2020-0086oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] Open
Abstract
Vitamin D (VitD) has pleiotropic effects. VitD deficiency is closely involved with obesity and may contribute to the development of lung fibrosis and aggravation of airway hyperresponsiveness (AHR). We evaluated the causal relationship between VitD deficiency and the lung pathologies associated with obesity. In vivo effects of VitD supplementation were analyzed using high-fat diet (HFD)-induced obese mice and TGF-β1 (transforming growth factor-β1) triple transgenic mice. Effects of VitD supplementation were also evaluated in both BEAS-2B and primary lung cells from the transgenic mice. Obese mice had decreased 25-OH VitD and VitD receptor expressions with increases of insulin resistance, renin and angiotensin-2 system (RAS) activity, and leptin. In addition, lung pathologies such as a modest increase in macrophages, enhanced TGF-β1, IL-1β, and IL-6 expression, lung fibrosis, and AHR were found. VitD supplementation to HFD-induced obese mice recovered these findings. TGF-β1-overexpressing transgenic mice enhanced macrophages in BAL fluid, lung expression of RAS, epithelial-mesenchymal transition markers, AHR, and lung fibrosis. VitD supplementation also attenuated these findings in addition to the attenuation of the expressions of TGF-β1, and phosphorylated Smad-2/3 in lung. Supplementing in vitro-stimulated BEAS-2B and primary lung cells with VitD inhibited TGF-β1 expression, supporting the suppressive effect of VitD for TGF-β1 expression. These results suggest that obesity leads to VitD deficiency and worsens insulin resistance while enhancing the expression of leptin, RAS, TGF-β1, and proinflammatory cytokines. These changes may contribute to the development of lung fibrosis and AHR. VitD supplementation rescues these changes and may have therapeutic potential for asthma with obesity.
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Affiliation(s)
| | | | - Hye Jung Park
- Department of Internal Medicine and Gangnam Severance Hospital, and
| | | | - Sung-Ryeol Kim
- Institute for Allergy
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Institute for Allergy
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hyun Lee
- Institute for Allergy
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Institute for Allergy
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Lordan R. Notable Developments for Vitamin D Amid the COVID-19 Pandemic, but Caution Warranted Overall: A Narrative Review. Nutrients 2021; 13:740. [PMID: 33652653 PMCID: PMC7996924 DOI: 10.3390/nu13030740] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel contagion that has infected over 113 million people worldwide. It is responsible for the coronavirus disease (COVID-19), which has cost the lives of 2.5 million people. Ergo, the global scientific community has been scrambling to repurpose or develop therapeutics to treat COVID-19. Dietary supplements and nutraceuticals are among those under consideration due to the link between nutritional status and patient outcomes. Overall, poor vitamin D status seems to be associated with an increased risk of COVID-19. Severely ill COVID-19 patients appear to be deficient or have suboptimal levels of serum 25-hydroxyvitamin D, a measure of vitamin D status. Consequently, vitamin D is now the subject of several prophylactic and therapeutic clinical trials. In this review, the general status of nutraceuticals and dietary supplements amid the pandemic is appraised, with a particular focus on vitamin D. Consumers should be aware of misinformation and unsubstantiated promises for products marketed for COVID-19 protection. However, maintaining a healthy diet and lifestyle will likely maintain health including optimum immune function that may affect patient outcomes. Those who are deficient in key nutrients such as vitamin D should consider lifestyle changes and potentially supplementation in consultation with their physician and/or registered dieticians.
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Affiliation(s)
- Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-5158, USA
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Mishra P, Parveen R, Agarwal NB. Role of Vitamin D in Risk Reduction of COVID-19: A Narrative Review. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2021. [DOI: 10.1055/s-0041-1724460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AbstractThe world is in the midst of the COVID-19 pandemic. In addition to quarantine, public health interventions which can reduce the risk of infection and death are urgently required. This article discusses the roles of vitamin D in reducing the risk of COVID-19, and how vitamin D supplementation may be a useful risk reduction measure. Vitamin D can reduce the risk of infections through a variety of mechanisms: induction of cathelicidins and defensins that can lower the rate of viral replication and decrease the concentrations of pro-inflammatory cytokines, which are responsible for induction of inflammation, injuring lining of lungs and contributing to developing pneumonia. Evidence supporting the role of vitamin D in reducing the incidence of COVID-19 includes a) winter outbreak; b) a timeframe when concentrations of 25-hydroxyvitamin D (25(OH)D) are lowest; c) a small number of cases in the southern hemisphere toward the end of summer; d) a vitamin D deficiency found to lead to acute respiratory distress syndrome (ARDS); e) and a rise in case-fatality rates with increasing age and comorbid chronic diseases, both of which are associated with lower concentrations of 25(OH)D. It is recommended that people at risk of COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly increase 25(OH)D concentrations, followed by 5,000 IU/d to reduce the risk of infection. Higher doses of vitamin D3 may be useful for treating people who are infected with COVID-19. To test these guidelines, randomized controlled trials and comprehensive population studies should be performed.
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Affiliation(s)
- Pinki Mishra
- Centre for Translational and Clinical Research, School of Chemical & Life Sciences, New Delhi, India
| | - Rizwana Parveen
- Centre for Translational and Clinical Research, School of Chemical & Life Sciences, New Delhi, India
| | - Nidhi Bharal Agarwal
- Centre for Translational and Clinical Research, School of Chemical & Life Sciences, New Delhi, India
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Tanner A, Tiwari D, Allen S. Covid-19 Susceptibility and Severity Might be Modified by Vitamin D Status: Theoretical and Practical Considerations. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1568009620999200924155221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background:
The recently identified SARS-CoV-2 coronavirus has resulted in the
Covid-19 pandemic with severe morbidity and high mortality, particularly in certain sections of the
population. The co-morbidity patterns associated with adverse outcomes are multiple and complex
and there is emerging epidemiological, nutritional and molecular biological evidence that an inadequate
vitamin D status is a contributing factor.
Objective:
The aim was to review the role of vitamin D in immune function with particular reference
to the mechanisms whereby it supports immune efficiency, host protection and immune modulation.
The evidence for the possible benefit of vitamin D supplementation to ameliorate the severity
of respiratory infection by SARS-CoV-2 and other pathogens was also reviewed with a view to
making a recommendation.
Methods:
PubMed, MEDLINE and Google Scholar were searched using the terms: Covid-19, coronavirus,
SARS-CoV-2, vitamin D, calcitriol, deficiency, adaptive immunity, innate immunity, ventilation,
critical care, intensive care, acute respiratory distress syndrome, cytokine storm, respiratory
viruses, respiratory tract infection, respiratory syncytial virus, influenza, supplementation. Papers
for inclusion were selected on the basis of relevance and quality.
Findings:
Vitamin D insufficiency is widespread in many parts of the world. Vitamin D is needed
for normal protective and surveillance immune function and there is evidence that deficiency increases
the risk of some respiratory infections, probably including Covid-19. By binding with dedicated
receptors on immune cells vitamin D influences several strands of immune function, including
the production of anti-microbial peptides and several cytokines that promote an appropriate immune
response. Vitamin D supplementation probably reduces the risk of respiratory infection, with
persuasive biological, epidemiological and observational evidence for possible benefit against
Covid-19.
Conclusion:
Despite the lack of direct evidence specific to Covid-19 a cogent theoretical case can
be made for giving adults from selected groups, and arguably all adults, routine supplementation
with vitamin D to improve immune efficiency and reduce the incidence and severity of respiratory
infections. This could be particularly important in sections of the population with a high prevalence
of vitamin D insufficiency. Targeted research is required to provide firm evidence to guide practice.
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Affiliation(s)
- Alex Tanner
- The Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Divya Tiwari
- The Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Stephen Allen
- The Royal Bournemouth Hospital, Dorset, United Kingdom
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Bergman P. The link between vitamin D and COVID-19: distinguishing facts from fiction. J Intern Med 2021; 289:131-133. [PMID: 32652766 PMCID: PMC7405052 DOI: 10.1111/joim.13158] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/23/2022]
Abstract
Click here to view the Perspective by Rhodes et al.
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Affiliation(s)
- P Bergman
- From the Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden
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Wang R, DeGruttola V, Lei Q, Mayer KH, Redline S, Hazra A, Mora S, Willett WC, Ganmaa D, Manson JE. The vitamin D for COVID-19 (VIVID) trial: A pragmatic cluster-randomized design. Contemp Clin Trials 2021; 100:106176. [PMID: 33045402 PMCID: PMC7547023 DOI: 10.1016/j.cct.2020.106176] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine the effect of vitamin D supplementation on disease progression and post-exposure prophylaxis for COVID-19 infection. We hypothesize that high-dose vitamin D3 supplementation will reduce risk of hospitalization/death among those with recently diagnosed COVID-19 infection and will reduce risk of COVID-19 infection among their close household contacts. METHODS We report the rationale and design of a planned pragmatic, cluster randomized, double-blinded trial (N = 2700 in total nationwide), with 1500 newly diagnosed individuals with COVID-19 infection, together with up to one close household contact each (~1200 contacts), randomized to either vitamin D3 (loading dose, then 3200 IU/day) or placebo in a 1:1 ratio and a household cluster design. The study duration is 4 weeks. The primary outcome for newly diagnosed individuals is the occurrence of hospitalization and/or mortality. Key secondary outcomes include symptom severity scores among cases and changes in the infection (seroconversion) status for their close household contacts. Changes in vitamin D 25(OH)D levels will be assessed and their relation to study outcomes will be explored. CONCLUSIONS The proposed pragmatic trial will allow parallel testing of vitamin D3 supplementation for early treatment and post-exposure prophylaxis of COVID-19. The household cluster design provides a cost-efficient approach to testing an intervention for reducing rates of hospitalization and/or mortality in newly diagnosed cases and preventing infection among their close household contacts.
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Affiliation(s)
- Rui Wang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Victor DeGruttola
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Kenneth H Mayer
- Fenway Health, and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Aditi Hazra
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Davaasambuu Ganmaa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Boulkrane MS, Ilina V, Melchakov R, Fedotova J, Drago F, Gozzo L, Das UN, Abd El-Aty AM, Baranenko D. COVID-19 Disease and Vitamin D: A Mini-Review. Front Pharmacol 2020; 11:604579. [PMID: 33390994 PMCID: PMC7773655 DOI: 10.3389/fphar.2020.604579] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022] Open
Abstract
Novel coronavirus disease (COVID-19) pandemic caused by SARS-CoV-2, for which there is no effective treatment except employing prevention strategies, has already instituted significant number of deaths. In this review, we provide a scientific view on the potential role of vitamin D in SARS-CoV-2 virus/COVID-19 disease. Vitamin D is well-known to play a significant role in maintaining the immune health of an individual. Moreover, it induces antimicrobial peptide expression that can decrease viral replication and regulate the levels of pro-inflammatory/anti-inflammatory cytokines. Therefore, supplementation of vitamin D has the potential to reduce the incidence, severity and the risk of death from pneumonia resulting from the cytokine storm of many viral infections including COVID-19. We suggest that supplementation of subjects at high risk of COVID-19 with vitamin D (1.000 to 3.000 IU) to maintain its optimum serum concentrations may be of significant benefit for both in the prevention and treatment of the COVID-19.
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Affiliation(s)
- Mohamed Said Boulkrane
- International Research Centre “Biotechnologies of the Third Millennium”, ITMO University, Saint-Petersburg, Russia
| | - Victoria Ilina
- International Research Centre “Biotechnologies of the Third Millennium”, ITMO University, Saint-Petersburg, Russia
| | - Roman Melchakov
- International Research Centre “Biotechnologies of the Third Millennium”, ITMO University, Saint-Petersburg, Russia
| | - Julia Fedotova
- Laboratory of Neuroendocrinology, I.P. Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia
- Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, Biological Tower, School of Medicine, University of Catania, Catania, Italy
| | - Lucia Gozzo
- Department of Biomedical and Biotechnological Sciences, Biological Tower, School of Medicine, University of Catania, Catania, Italy
| | | | - A. M. Abd El-Aty
- Department of Pharmacology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
- Department of Medical Pharmacology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Denis Baranenko
- International Research Centre “Biotechnologies of the Third Millennium”, ITMO University, Saint-Petersburg, Russia
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Jolliffe DA, Camargo CA, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, Bergman P, Borzutzky A, Damsgaard CT, Dubnov-Raz G, Esposito S, Gilham C, Ginde AA, Golan-Tripto I, Goodall EC, Grant CC, Griffiths CJ, Hibbs AM, Janssens W, Khadilkar AV, Laaksi I, Lee MT, Loeb M, Maguire JL, Majak P, Mauger DT, Manaseki-Holland S, Murdoch DR, Nakashima A, Neale RE, Pham H, Rake C, Rees JR, Rosendahl J, Scragg R, Shah D, Shimizu Y, Simpson-Yap S, Kumar GT, Urashima M, Martineau AR. Vitamin D supplementation to prevent acute respiratory infections: systematic review and meta-analysis of aggregate data from randomised controlled trials. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.07.14.20152728. [PMID: 33269357 PMCID: PMC7709175 DOI: 10.1101/2020.07.14.20152728] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A 2017 meta-analysis of data from 25 randomised controlled trials of vitamin D supplementation for the prevention of acute respiratory infections revealed a protective effect of the intervention. Since then, 20 new RCTs have been completed. METHODS Systematic review and meta-analysis of data from randomised controlled trials (RCTs) of vitamin D for ARI prevention using a random effects model. Pre-specified sub-group analyses were done to determine whether effects of vitamin D on risk of ARI varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration or dosing regimen. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and the ClinicalTrials.gov registry from inception to 1st May 2020. Double-blind RCTs of supplementation with vitamin D or calcidiol, of any duration, were eligible if they were approved by a Research Ethics Committee and if ARI incidence was collected prospectively and pre-specified as an efficacy outcome. Aggregate data, stratified by baseline 25(OH)D concentration, were obtained from study authors. The study was registered with PROSPERO (no. CRD42020190633). FINDINGS We identified 45 eligible RCTs (total 73,384 participants). Data were obtained for 46,331 (98.0%) of 47,262 participants in 42 studies, aged 0 to 95 years. For the primary comparison of vitamin D supplementation vs. placebo, the intervention reduced risk of ARI overall (Odds Ratio [OR] 0.91, 95% CI 0.84 to 0.99; P for heterogeneity 0.01). No statistically significant effect of vitamin D was seen for any of the sub-groups defined by baseline 25(OH)D concentration. However, protective effects were seen for trials in which vitamin D was given using a daily dosing regimen (OR 0.75, 95% CI 0.61 to 0.93); at daily dose equivalents of 400-1000 IU (OR 0.70, 95% CI 0.55 to 0.89); and for a duration of ≤12 months (OR 0.82, 95% CI 0.72 to 0.93). No significant interaction was seen between allocation to vitamin D vs. placebo and dose frequency, dose size, or study duration. Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (OR 0.97, 95% CI 0.86 to 1.09). Risk of bias within individual studies was assessed as being low for all but three trials. A funnel plot showed left-sided asymmetry (P=0.008, Egger's test). INTERPRETATION Vitamin D supplementation was safe and reduced risk of ARI, despite evidence of significant heterogeneity across trials. Protection was associated with administration of daily doses of 400-1000 IU vitamin D for up to 12 months. The relevance of these findings to COVID-19 is not known and requires investigation. FUNDING None.
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Affiliation(s)
- David A Jolliffe
- Institute for Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Mary Aglipay
- Department of Pediatrics, St Michael’s Hospital, Toronto, Ontario, Canada
| | - John F Aloia
- Bone Mineral Research Center, Winthrop University Hospital, Mineola, NY, USA
| | - Davaasambuu Ganmaa
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Peter Bergman
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Arturo Borzutzky
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camilla T Damsgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Gal Dubnov-Raz
- Exercise, Lifestyle and Nutrition Clinic, Edmond and Lily Safra Children’s Hospital, Tel Hashomer, Israel
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Clare Gilham
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Inbal Golan-Tripto
- Saban Pediatric Medical Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Emma C Goodall
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Cameron C Grant
- Department of Paediatrics: Child & Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Christopher J Griffiths
- Institute for Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
| | | | | | - Ilkka Laaksi
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Margaret T Lee
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York, NY USA
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonathon L Maguire
- Department of Pediatrics, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Paweł Majak
- Department of Pediatric Pulmonology, Medical University of Lodz, Lodz, Poland
| | - David T Mauger
- Department of Statistics, The Pennsylvania State University, Hershey, PA, USA
| | - Semira Manaseki-Holland
- Department of Public Health, Epidemiology and Biostatistics, Institute of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - David R Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | | | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Hai Pham
- Population Health Department, QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Christine Rake
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Judy R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jenni Rosendahl
- Children’s Hospital, Pediatric Research Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dheeraj Shah
- Department of Paediatrics, University College of Medical Sciences, Delhi, India
| | - Yoshiki Shimizu
- FANCL Research Institute, FANCL Corporation, Yokohama, Japan
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | | | - Adrian R Martineau
- Institute for Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
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Hoong CWS, Huilin K, Cho S, Aravamudan VM, Lin JHX. Are Adequate Vitamin D Levels Helpful in Fighting COVID-19? A Look at the Evidence. Horm Metab Res 2020; 52:775-783. [PMID: 32942311 DOI: 10.1055/a-1243-5462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
COVID-19 is a global pandemic with high mortality in vulnerable groups. Given the current lack of definitive treatment or vaccine that significantly reduces mortality rate, governments, researchers and healthcare providers are racing to find possible solutions to the crisis. Vitamin D and its analogues have been previously studied for their non-skeletal benefits. In particular, questions regarding their role in the modulation of immunity have re-surfaced, in view of possible epidemiological links observed between COVID-19 and vitamin D levels in selected populations. In this review, we highlight potential mechanisms and summarise the evidence for and against the potential role of vitamin D supplementation in our fight against COVID-19.
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Affiliation(s)
| | - Koh Huilin
- Woodlands Health Campus, National Healthcare Group, Singapore
| | - Sanda Cho
- Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
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Balla M, Merugu GP, Konala VM, Sangani V, Kondakindi H, Pokal M, Gayam V, Adapa S, Naramala S, Malayala SV. Back to basics: review on vitamin D and respiratory viral infections including COVID-19. J Community Hosp Intern Med Perspect 2020; 10:529-536. [PMID: 33194123 PMCID: PMC7599018 DOI: 10.1080/20009666.2020.1811074] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Importance As the scientific community is in a marathon in finding out the cure for COVID-19, in this crisis, it is essential for the physicians not to forget about the basics. Due to the pandemic crisis, in many nursing homes and hospitals, there established new policies on decreasing unnecessary medications to minimize cross-contamination. Sometimes these policies are making providers avoid essential drugs such as Vitamins, including Vitamin D. In this paper, we try to emphasize the importance of Vitamin D in COVID-19 and respiratory viral patients. Relevance Vitamin D helps in decreasing the ‘pro-inflammatory cytokines’ in the lungs and acts in immunomodulatory function, and ‘also it will increase the anti-inflammatory, antiviral responses of the respiratory epithelial cells during infection.’ Conclusion Due to the highly contagious nature of COVID-19 and the increased morbidity and mortality with no appropriate therapy and vaccine, one must be cautious and do everything to help COVID-19 patients. In hospitals and other health care settings to decrease cross-contamination, holding other non-essential medications is taking place. Discontinuing Vitamins could increase the mortality and morbidity of those affected, especially in deficient/insufficient individuals. Obtaining serum 25 (OH) D levels in all patients with viral respiratory infections, especially COVID-19, could help in the detection and treatment of Vitamin D deficiency and potentially decrease recovery time and improve outcome. Even though evidence suggests that vitamin D has the anti-inflammatory, antiviral properties, randomized double-blinded controlled trials are needed to verify this further, and to understand Vitamin D and COVID-19 better. Abbreviations Vitamin D receptor-VDR; 25(OH)D- 25 hydroxyvitamin D; 1,25 (OH)D-1,25 dihydroxy Vitamin D; 1α,25-dihydroxy Vitamin D-1,25[OH]2 D or calcitriol; IU- International Units; Interferons stimulated genes- ISG; ARI- acute respiratory infection; RSV- respiratory syncytial virus; RTI- Respiratory tract infections; COPD-Chronic obstructive pulmonary disease; BMI-Basal metabolic index; USA-USA.
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Affiliation(s)
- Mamtha Balla
- Department of Internal Medicine, University of Toledo and Promedica Toledo Hospital, Toledo, OH, USA
| | - Ganesh Prasad Merugu
- Division of Geriatric Medicine, Department of Family Medicine, University of Toledo- Health Sciences, Toledo, OH, USA
| | - Venu Madhav Konala
- Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, KY, USA
| | - Vikram Sangani
- Department of Internal Medicine, Medical Center of Central Georgia, Macon, GA, USA
| | - Hema Kondakindi
- Gynecologist, Depart of Obgyn, Durgabhai Deshmukh Hospital and Research Center, India
| | - Mytri Pokal
- Department of Internal Medicine, University of Toledo and Promedica Toledo Hospital, Toledo, OH, USA.,Division of Geriatric Medicine, Department of Family Medicine, University of Toledo- Health Sciences, Toledo, OH, USA.,Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, KY, USA.,Department of Internal Medicine, Medical Center of Central Georgia, Macon, GA, USA.,Gynecologist, Depart of Obgyn, Durgabhai Deshmukh Hospital and Research Center, India.,Department of Internal Medicine, Medical Center of Central Georgia, GA, USA.,Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA.,Department of Internal Medicine, Division of Nephrology, Adventist Medical Center, Hanford, CA, USA.,Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, CA, USA.,Department of Internal Medicine, Jeanes Campus, Temple University, Philadelphia, PA, USA
| | - Vijay Gayam
- Department of Internal Medicine, Medical Center of Central Georgia, GA, USA.,Department of Internal Medicine, Jeanes Campus, Temple University, Philadelphia, PA, USA
| | - Sreedhar Adapa
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Srikanth Naramala
- Department of Internal Medicine, Division of Nephrology, Adventist Medical Center, Hanford, CA, USA
| | - Srikrishna V Malayala
- Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, CA, USA
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Klasson C, Helde-Frankling M, Sandberg C, Nordström M, Lundh-Hagelin C, Björkhem-Bergman L. Vitamin D and Fatigue in Palliative Cancer: A Cross-Sectional Study of Sex Difference in Baseline Data from the Palliative D Cohort. J Palliat Med 2020; 24:433-437. [PMID: 32936046 DOI: 10.1089/jpm.2020.0283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Fatigue is one of the most distressing symptoms in patients with advanced cancer. Previous studies have shown an association between low vitamin D levels and fatigue. Objectives: The aim of this study was to investigate the association between vitamin D levels and self-assessed fatigue in cancer patients admitted to palliative care, with focus on possible sex differences. Design: This is a cross-sectional study. Subjects: Baseline data from 530 screened patients, 265 women and 265 men, from the randomized placebo-controlled trial "Palliative-D" were analyzed. Measurements: Vitamin D status was measured as 25-hydroxyvitamin D (25-OHD) and fatigue was assessed with EORTC-QLQ-PAL15 and with Edmonton Symptom Assessment System (ESAS). Results: In men, there was a significant correlation between 25-OHD and fatigue measured with the "Tiredness question" (Q11) in EORTC-QLQ-PAL15 (p < 0.05), where higher 25-OHD levels were associated with less fatigue. No correlation between 25-OHD and fatigue was seen for women. Fatigue measured with ESAS did not show any significant association with 25-OHD levels neither in men nor in women. Conclusion: Low vitamin D levels were associated with more fatigue in men but not in women. The study underscores the importance of subgroup analysis of men and women when evaluating the effect of vitamin D in clinical trials since the effect may differ between the sexes. The ongoing "Palliative-D study" will reveal whether vitamin D supplementation may counteract fatigue in both men and women. ClinicalTrial.gov: NCT03038516.
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Affiliation(s)
- Caritha Klasson
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden.,Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Älvsjö, Sweden
| | - Maria Helde-Frankling
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden.,Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Älvsjö, Sweden
| | - Carina Sandberg
- Palliative Home Care and Hospice Ward, Stockholms Sjukhem, Stockholm, Sweden
| | - Marie Nordström
- Palliative Home Care and Hospice Ward, Stockholms Sjukhem, Stockholm, Sweden
| | - Carina Lundh-Hagelin
- Department of Health Care Sciences, Ersta-Sköndal-Bräcke University College, Stockholm, Sweden.,Division of Care Science, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
| | - Linda Björkhem-Bergman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden.,Palliative Home Care and Hospice Ward, Stockholms Sjukhem, Stockholm, Sweden
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50
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Lindqvist PG. On the Relationship Between Sun Exposure and All-Cause Mortality. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1268:115-122. [PMID: 32918215 DOI: 10.1007/978-3-030-46227-7_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Increasing sun exposure is related to lower prevalence of death in cardiovascular disease (CVD), type 2 diabetes, and other noncancer non-CVD. In this chapter we aim to make a short update on the knowledge regarding sun exposure and all-cause mortality. Data support the hypothesis that low sun exposure habits are a major risk factor for all-cause mortality. Low sun exposure is related to an increased risk of death due to CVD and noncancer/non-CVD, and a minor reduction in risk of cancer. Active sun exposure habits have a dual effect; it increases the incidence of skin cancer, but also improves the prognosis in terms of all-cause mortality. In a low solar intensity region, we should carefully assess both risk and benefits of sun exposure in order to obtain balanced recommendations.
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Affiliation(s)
- Pelle G Lindqvist
- Clinical Sciences and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden. .,Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
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