Vitamin D Implications and Effect of Supplementation in Endocrine Disorders: Autoimmune Thyroid Disorders (Hashimoto’s Disease and Grave’s Disease), Diabetes Mellitus and Obesity

Vitamin D Deficiency and the Clinical Outcomes of Calcimimetic Therapy in Dialysis Patients: A Population-Based Study

BACKGROUND

Vitamin D deficiency (VDD) is prevalent in patients with secondary hyperparathyroidism (SHPT) undergoing dialysis and may attenuate the efficacy of calcimimetic therapy, which is designed to reduce parathyroid hormone (PTH) levels and improve clinical outcomes. This study aimed to investigate the impact of vitamin D status on all-cause mortality, major adverse cardiovascular events (MACEs), fractures, and hypocalcemia in dialysis patients receiving calcimimetics.

METHODS

This retrospective cohort study utilized the TriNetX database to identify dialysis patients treated with calcimimetics between 2010 and 2024. Patients were classified into VDD (<20 ng/mL) and vitamin D-adequate (VDA, ≥30 ng/mL) groups. Propensity score matching (1:1) was performed on 95 covariates to minimize confounding. Outcomes, including all-cause mortality, MACEs, fractures, hypocalcemia, and PTH suppression (≤300 pg/mL), were compared between groups over a 3-year follow-up. Multiple comparisons were adjusted using the Bonferroni-Holm correction.

RESULTS

All-cause mortality was significantly higher in the VDD group (25.4%) compared to the VDA group (20.9%), with an adjusted odds ratio (OR) of 1.29 (95% CI: 1.10-1.51, p = 0.002, corrected α = 0.007). While initial analyses suggested associations between VDD and the increased risks of MACEs, fractures, and hypocalcemia, these results did not remain significant after correction. Subgroup analysis indicated that comorbidities, such as obesity, dyslipidemia, and depression, amplified these risks in the VDD group. No significant differences were observed for PTH suppression (≤300 pg/mL) between groups.

CONCLUSIONS

VDD is independently associated with increased all-cause mortality in dialysis patients with SHPT, even after multiple comparison adjustments. While risks for MACEs, fractures, and hypocalcemia showed non-significant trends, their observed patterns suggest potential clinical relevance. Optimizing vitamin D status may enhance clinical outcomes in this high-risk population, warranting further investigation through randomized controlled trials.

A Scoping Review on the Prevalence of Hashimoto's Thyroiditis and the Possible Associated Factors

BACKGROUND

Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease (AITD) and is characterized by the presence of thyroid autoantibodies against thyroid peroxidase and/or thyroglobulin. Several studies have found that the global prevalence of HT has increased in recent decades, while others show the opposite.

METHODS AND RESULTS

The objective of this scoping review was to synthesize and analyze the different studies that have evaluated the prevalence of HT (in adults) and the possible associated factors. The following databases were consulted, as follows: MEDLINE, Web of Science, PubMed, and Scopus. The search terms "epidemiology", "prevalence", and "Hashimoto disease" and "Hashimoto thyroiditis" were used. The search was limited to articles published between January 1965 and October 2024, and only articles in English were considered. In order to reduce selection bias, each article was scrutinized using the JBI Critical Appraisal Checklist independently by two authors. Studies were included if the number of participants (study population and/or cases and controls, depending on the study design) was clearly described and duplicate studies were excluded. A total of 59 studies were identified, the vast majority of them used a cross-sectional design, using different methods of disease assessment.

CONCLUSIONS

Globally, the prevalence of HT is estimated to be between 5-10%; some areas with prevalences > 20% and others < 0.5% were identified. Prevalence is also higher in women than in men. Multiple underlying factors (genetic, epigenetic, environmental, and lifestyle), together with socioeconomic, nutritional, overdiagnosis, inter alia, may explain (at least in part) the wide variability in the prevalence of HT.

A retrospective analysis on maternal and neonatal outcomes in pSS/AITD pregnancies

The combined impact of concurrent primary Sjögren's syndrome (pSS) and autoimmune thyroid disease (AITD) on pregnancy outcomes remains underreported. A retrospective analysis was conducted on 115 pregnant patients diagnosed with pSS and delivering at the Third Affiliated Hospital of Guangzhou Medical University from January 2009 to July 2023. The effects of AITD on maternal and neonatal outcomes were examined and compared to a control group without AITD. In the group with pSS and AITD, the pregnancy loss rate was significantly higher than in the non-AITD group (P = 0.015), primarily reflected in the increased rate of neonatal death (P = 0.029). The proportion of term births and vaginal deliveries in the AITD group was notably reduced compared to the non-AITD group (54% vs. 81.5%; 16.0% vs. 41.5%; P = 0.001 and P = 0.003, respectively). No significant differences were observed in other maternal pregnancy outcomes, including induced abortion, spontaneous abortion, therapeutic abortion, and premature delivery (P > 0.05). The average birth weight of newborns in the pSS with AITD group was significantly lower than in the pSS without AITD group (2587.70 ± 720.50 g vs. 2812.54 ± 495.30 g, P < 0.001). Additionally, the rate of low-birth-weight infants in the pSS with AITD group was higher than in the pSS without AITD group (39.0% vs. 19.7%, P = 0.032). However, no significant differences were found between the two groups in the rates of fetal death, neonatal live birth, and fetal distress (P > 0.05). These results emphasize the importance of monitoring and managing thyroid health during pregnancy to optimize maternal and neonatal outcomes. Further exploration is essential to unravel the precise mechanisms through which AITD impacts fetal growth and to identify potential interventions to mitigate these effects.

[Vitamin D deficiency in overweight patients: current strategies and practical aspects]

On September 27, 2024, a discussion-based working meeting on the issue of vitamin D deficiency in patients with overweight and obesity was held in Vladikavkaz.The meeting aimed to evaluate the relationship between vitamin D deficiency, overweight, and associated comorbidities, as well as to explore modern strategies and practical approaches for managing such patients in endocrinology practice. The resolution of the meeting was developed by its participants, comprising leading endocrinologists.

Prevention and Treatment of Vitamin D Deficiency in India: An Expert Group Consensus

Vitamin D deficiency is highly prevalent in India, yet no standardized guidelines exist for classifying vitamin D status or its prevention and treatment. Even more, there is no consensus specific to vitamin D supplementation for the Indian population, and there are inconsistencies in the cut-off values for deficiency, severe deficiency, and insufficiency across various guidelines, which this evidence-based consensus seeks to resolve, thus guiding healthcare professionals in identifying, preventing, and managing vitamin D deficiency. An expert group of 41 endocrinologists from across India developed the consensus using the DELPHI method, achieving over 90% agreement on all recommendations. The consensus defines vitamin D deficiency, severe deficiency, and insufficiency, recommending supplementation strategies to maintain physiological 25(OH) D levels of 40-60 ng/mL (100-150 nmol/L). Tailored treatment regimens for neonates, infants, children, adolescents, adults, the elderly, pregnant and lactating women, and individuals with co-morbid conditions are provided to ensure optimal health for all age groups in India.

Assessment of Vitamin Concentrations in Patients with Hashimoto's Thyroiditis and Their Relationships with Thyroid Function, Biochemical Status, and Anthropometric Parameters-A Preliminary Study

Hashimoto's thyroiditis (HT) is the leading cause of hypothyroidism, affecting mainly the female population. Many patients with HT have metabolic disorders and nutritional deficiencies. The aim of this study was to evaluate vitamin D, A, E, B2, and B6 concentrations, thyroid function, metabolic profile, and anthropometric parameters of patients with Hashimoto's thyroiditis. In 81 female patients with HT (study group), vitamin A and B2 concentrations were significantly lower than in 34 healthy women (control group). No differences were noted in vitamin D, E, and B6 concentrations between groups. Moreover, HT patients had similar anthropometric parameters, lipid profiles, and glucose and insulin concentrations compared to controls. This study showed some relationships between vitamin concentrations and anthropometric or biochemical profiles in HT patients. Among others, in the HT group, the concentration of vitamin D was positively correlated with the level of HDL and negatively correlated with BMI, total fat mass, and insulin level, which influence cardiovascular risk. The results indicate that patients with HT should be routinely tested for vitamin concentrations to prevent nutritional deficiencies. Further studies are also needed on the role of vitamins in the development and progression of HT and the presence of metabolic complications in this population.

Differences in Plasma 25-Hydroxyvitamin D Levels at Diagnosis of Celiac Disease and Type 1 Diabetes

AIM

The aim of this work is to assess the vitamin D levels, evaluated as plasma 25-hydroxyvitamin D of children with a new diagnosis of celiac disease (CD), of children with a new onset of type 1 diabetes (T1D) and in children with CD at diagnosis of T1D (T1D&CD).

METHODS

In this single-center observational study, we collected data for four groups of children and adolescents: T1D, CD, T1D&CD, and a control group (CG). The CG included schoolchildren who had negative results during a mass screening campaign for CD and were not diagnosed for T1D, according to RIDI Marche registry data, were considered for the purposes of this study. Plasma 25-hydroxyvitamin D, 25(OH)D2, and 25(OH)D3 were considered as the parameters for evaluating vitamin D nutritional status, and the date of measurement was recorded to analyze vitamin D level seasonality. Vitamin D nutritional status was categorized as follows: severe deficiency (<10 ng/mL), deficiency (<20 ng/mL), insufficiency (20-29 ng/mL), or sufficiency/adequacy (≥30 ng/mL). The Kruskal-Wallis test was used to compare the groups. The association of 25(OH)D levels with health conditions and seasonal differences of 25(OH)D levels was analyzed using a multiple linear regression model.

RESULTS

The number of children enrolled for the present study was 393: 131 in the CG, 131 CD, 109 T1D, and 22 T1D&CD. Significantly lower levels of vitamin D were displayed for children with CD, T1D, or both the diseases. Interestingly, severe vitamin D deficiency was detected in no children with CD, 1.5% of children in the CG, in 24.4% with T1D, and 31.8% with T1D&CD (p < 0.001). As expected, the CG children vitamin D levels were significantly influenced by seasonality. Contrarily, no seasonal differences were reported in children with CD, T1D, and T1D&CD. Multiple regression analysis showed that children with T1D and T1D&CD had lower 25(OH)D levels of 9.9 ng/mL (95% CI: 5.4; 14.5) and 14.4 ng/mL (95% CI: 6.2-22.7) compared to CG children (p < 0.001).

CONCLUSIONS

Our results showed low levels of vitamin D diagnosis of T1D, CD, and T1D&CD; however, severe deficiency was only reported in children with T1D and T1D&CD. More studies are needed to better understand the role of this deficiency in children newly diagnosed with CD and T1D.

Elucidating the role of phytocompounds from Brassica oleracea var. italic (Broccoli) on hyperthyroidism: an in-silico approach

Thyroid hormone (TH) plays a crucial role in regulating the metabolism in every cell and all organs in of the human body. TH also control the rate of calorie burning, body weight, and function of the heartbeat. Therefore, the aim of the present study is to investigate the role of phytocompounds from Brassica oleracea var. italic (Broccoli) against irregularities of TH biosynthesis (hyperthyroidism) through in silico molecular modelling. Initially, the genetic network was built with graph theoretical network analysis to find the right target to control excessive TH production. Based on the network analysis, the three-dimensional crystal structure of the mammalian enzyme lactoperoxidase (PDB id: 5ff1) was retrieved from the protein data bank (PDB), and the active site was predicted using BIOVIA Discovery studio. Sixty-three phytocompounds were selected from the IMPPAT database and other literature. Selected sixty-six phytocompounds were docked against lactoperoxidase enzyme and compared with the standard drug methimazole. Based on the docking scores and binding energies, the top three compounds, namely brassicoside (- 10.00 kcal × mol-1), 24-methylene-25-methylcholesterol (- 9.50 kcal × mol-1), 5-dehydroavenasterol (- 9.40 kcal × mol-1) along with standard drug methimazole (- 4.10 kcal × mol-1) were selected for further ADMET and molecular dynamics simulation analysis. The top-scored compounds were for their properties such as ADMET, physicochemical and drug-likeness. The molecular dynamics simulation analyses proved the stability of lactoperoxidase-ligand complexes. The intermolecular interaction assessed by the dynamic conditions paved the way to discover the bioactive compounds brassicoside, 24-methylene-25-methylcholesterol, and 5-dehydroavenasterol prevent the excessive production of thyroid hormones.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40203-023-00180-2.

Supplementing Vitamin D in Different Patient Groups to Reduce Deficiency

INTRODUCTION

Studies indicate a high prevalence of vitamin D deficiency in both the general population and at-risk groups. Given the association between vitamin D deficiency and various diseases, addressing this concern becomes crucial, especially in situations where routine monitoring is challenging.

MATERIALS AND METHODS

A systematic literature review of the current knowledge on vitamin D dosing in diverse at-risk populations and the application of the findings to a broader clinical perspective.

RESULTS

The reviewed studies revealed a high prevalence of vitamin D deficiency among patients with musculoskeletal disorders, systemic connective tissue diseases, corticosteroid use, endocrine and metabolic conditions, malabsorption syndromes, obesity, chronic kidney disease, cancer, and central nervous system diseases. Vitamin D deficiency was often more severe compared to the general population. Higher dosages of vitamin D beyond the recommended levels for the general population were shown to be effective in improving vitamin D status in these at-risk individuals. Additionally, some studies suggested a potential link between intermittent vitamin D administration and improved adherence.

CONCLUSION

Simplified dosing could empower clinicians to address vitamin D deficiency, particularly in high-risk populations, even without routine monitoring. Further research is needed to establish the optimal dosing regimens for specific at-risk populations.

The comparisons of vitamin D3 levels in IgA vasculitis across different subgroups and healthy children: a comparative study

Background

IgA vasculitis is the most common form of vasculitis in children. Vitamin D deficiency has been observed to contribute to immune function and the pathogenesis of various immune diseases. However, at present, only a few studies with small sample sizes have shown that IgA vasculitis patients have lower vitamin D levels than healthy children. Thus, we conduct a large study to investigate the significance of serum 25-hydroxyvitamin D3 (25(OH)D) levels of children with IgA vasculitis across different subgroups and healthy children.

Methods

In this retrospective study, 1,063 children were recruited from the Ningbo Women and Children's Hospital between February 2017 and October 2019, including 663 patients hospitalized with IgA vasculitis and 400 healthy examination children who served as the control group at the same time. There wasn't any bias in the season. The healthy group came from children who underwent normal physical examination. The 663 IgA vasculitis patients were then divided into the IgA vasculitis-nephritis and non-IgA vasculitis-nephritis groups, streptococcal-infection and no-streptococcal-infection groups, gastrointestinal-involvement and no-gastrointestinal-involvement groups, and joint-involvement and no-joint-involvement groups. The serum 25(OH)D levels at disease onset were analyzed. All the participants were followed up for 6 months from the date of onset.

Results

The serum 25(OH)D levels of the IgA vasculitis group (15.47±6.58 ng/mL) were significantly lower than those of the healthy control group (22.48±6.24 ng/mL) (P<0.01). There were no significant differences in terms of age and sex between the IgA vasculitis and healthy control group. Further, among the IgA vasculitis patients serum 25(OH)D levels were reduced in the IgA vasculitis-nephritis (12.99±4.92 ng/mL), streptococcal-infection (14.2±6.06 ng/mL), and gastrointestinal-involvement (14.43±6.33 ng/mL) groups (P=0.00, 0.004, 0.002, respectively). The vitamin D levels with IgA vasculitis were significantly lower in winter and spring than summer and autumn. Conversely, the joint-involvement group did not show a significant reduction in vitamin D levels compared to no joints involved group.

Conclusions

IgA vasculitis patients have reduced vitamin D levels, which suggests that vitamin D deficiency may be involved in the development of IgA vasculitis. Vitamin D supplementation may reduce the incidence of IgA vasculitis, and maintaining high vitamin D levels in IgA vasculitis patients may prevent renal damage.

The Effect of Vitamin D Adequacy on Thyroid Hormones and Inflammatory Markers after Bariatric Surgery

Vitamin D status affects the clinical and corporal outcomes of postoperative patients who undergo a Roux-en-Y gastric bypass (RYGB). The aim of this study was to evaluate the effect of adequate vitamin D serum concentrations on thyroid hormones, body weight, blood cell count, and inflammation after an RYGB. A prospective observational study was conducted with eighty-eight patients from whom we collected blood samples before and 6 months after surgery to evaluate their levels of 25-hydroxyvitamin D 25(OH)D, thyroid hormones, and their blood cell count. Their body weight, body mass index (BMI), total weight loss, and excess weight loss were also evaluated 6 and 12 months after surgery. After 6 months, 58% of the patients achieved an adequate vitamin D nutritional status. Patients in the adequate group showed a decrease in the concentration of thyroid-stimulating hormone (TSH) (3.01 vs. 2.22 µUI/mL, p = 0.017) with lower concentrations than the inadequate group at 6 months (2.22 vs. 2.84 µUI/mL, p = 0.020). Six months after surgery, the group with vitamin D adequacy showed a significantly lower BMI compared with the inadequate group at 12 months (31.51 vs. 35.04 kg/m², p = 0.018). An adequate vitamin D nutritional status seems to favor a significant improvement in one's thyroid hormone levels, immune inflammatory profile, and weight loss performance after an RYGB.

25 Hydroxyvitamin D Serum Concentration and COVID-19 Severity and Outcome-A Retrospective Survey in a Romanian Hospital

Interest in the immunomodulatory function of vitamin D has grown since the COVID-19 pandemic started. Our study investigated the possible association between vitamin D deficiency and COVID-19 severity, intensive care needs, and mortality in patients hospitalized with COVID-19. A prospective cohort study was performed on 2342 COVID-19 hospitalized patients between April 2020 and May 2022 in a Romanian tertiary hospital for infectious diseases. A multivariate generalized linear model for binary data was fit with dependent variables: severe/critical form of COVID-19, intensive care need, and fatal outcome as a function of vitamin D deficiency, controlling for age, comorbidities, and vaccination status. More than half of the patients (50.9%) were classified with vitamin D deficiency based on a serum concentration of less than 20 ng/mL. There was a negative association between vitamin D and age. Vitamin D-deficient patients presented with more cardiovascular, neurological, and pulmonary diseases, as well as diabetes, and cancer. In multivariate logistic regression models, vitamin D-deficient patients had higher odds of severe/critical forms of COVID-19 [OR = 1.23 (95% CI 1.03-1.47), p = 0.023] and higher odds of death [OR = 1.49 (95% CI 1.06-2.08), p = 0.02]. Vitamin D deficiency was associated with disease severity and death outcome in hospitalized COVID-19 patients.

Vitamin D as a Nutri-Epigenetic Factor in Autoimmunity-A Review of Current Research and Reports on Vitamin D Deficiency in Autoimmune Diseases

Epigenetics is a series of alterations regulating gene expression without disrupting the DNA sequence of bases. These regulatory mechanisms can result in embryogenesis, cellular differentiation, X-chromosome inactivation, and DNA-protein interactions. The main epigenetic mechanisms considered to play a major role in both health and disease are DNA methylation, histone modifications, and profiling of non-coding RNA. When the fragile balance between these simultaneously occurring phenomena is disrupted, the risk of pathology increases. Thus, the factors that determine proper epigenetic modeling are defined and those with disruptive influence are sought. Several such factors with proven negative effects have already been described. Diet and nutritional substances have recently been one of the most interesting targets of exploration for epigenetic modeling in disease states, including autoimmunity. The preventive role of proper nutrition and maintaining sufficient vitamin D concentration in maternal blood during pregnancy, as well as in the early years of life, is emphasized. Opportunities are also being investigated for affecting the course of the disease by exploring nutriepigenetics. The authors aim to review the literature presenting vitamin D as one of the important nutrients potentially modeling the course of disease in selected autoimmune disorders.

Cardiovascular Risk Among Saudi Adults with Prediabetes: A Sub-Cohort Analysis from the Heart Health Promotion (HHP) Study

Background

This study aimed to estimate the prevalence of prediabetes among Saudi adults and to evaluate their risk of developing cardiovascular diseases.

Methods

This is a cohort of 2470 Saudi adults attending employee clinics in the university hospital. WHO-STEPs approach was used to collect sociodemographic (age, gender, and education), clinical (body mass index and blood pressure) and laboratory data (HbA1c, lipid profile and vitamin D concentration). Prediabetes was defined according to HbA1c level of 5.7–6.4%. Cardiovascular risk (CVR) scores were evaluated using the Framingham Risk Score. SPSS was used for data analysis to investigate the relation between different CVR and prediabetes.

Results

Prediabetes affected 25.1% of the study population. Males had higher rates of prediabetes than females (27.5% versus 23.5%). The prevalence of prediabetes increased from 11.6% among young individuals (18–29 years) to 56.0% among participants 60 years and older. Prediabetes patients exhibited considerably higher levels of all cardiovascular risk factors and nearly half of them (49.3%) had at least two risk factors. The prevalence of intermediate CVR among prediabetics was 13.2% compared to just 2.9% among the normal group, and high CVR was defined in 3.7% among prediabetics compared to only 1.7% in the normal group. Having prediabetes increased the odds to develop higher CVR of 2.64 times compared to those without prediabetes (OR = 2.64, 95% CI = 1.51–4.64) and the level of vitamin D did not affect the odds of CVR.

Conclusion

Prediabetes is quite prevalent among Saudi adults, and they are at a higher risk of cardiovascular diseases. Patients with prediabetes have higher cardiac risk scores when compared to normal participants across the whole spectrum of (25(OH)D) concentrations. Additionally, no significant correlation was observed between HbA1c and (25(OH)D) levels in prediabetics or normoglycemic subjects.

Inflammasome activation as a link between obesity and thyroid disorders: Implications for an integrated clinical management

Obesity is strongly associated with chronic low-grade inflammation. Obese patients have an increased risk to develop thyroid autoimmunity and to became hypothyroid, suggesting a pathogenetic link between obesity, inflammation and autoimmunity. Moreover, type 2 diabetes and dyslipidemia, also characterized by low-grade inflammation, were recently associated with more aggressive forms of Graves' ophthalmopathy. The association between obesity and autoimmune thyroid disorders may also go in the opposite direction, as treating autoimmune hyper and hypothyroidism can lead to weight gain. In addition, restoration of euthyroidism by L-T4 replacement therapy is more challenging in obese athyreotic patients, as it is difficult to maintain thyrotropin stimulation hormone (TSH) values within the normal range. Intriguingly, pro-inflammatory cytokines decrease in obese patients after bariatric surgery along with TSH levels. Moreover, the risk of thyroid cancer is increased in patients with thyroid autoimmune disorders, and is also related to the degree of obesity and inflammation. Molecular studies have shown a relationship between the low-grade inflammation of obesity and the activity of intracellular multiprotein complexes typical of immune cells (inflammasomes). We will now highlight some clinical implications of inflammasome activation in the relationship between obesity and thyroid disease.