Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status

The Impact of LDL Cholesterol, HDL Cholesterol, Triglycerides, and Vitamin D on Short-Term Implant Survival Rate: A Prospective Observational Study

Background/Objectives: Dental implant success is influenced by a range of systemic and local factors. Emerging evidence suggests that metabolic markers such as lipid profiles and vitamin D levels may play a role in osseointegration and implant survival. The aim of this study was to evaluate the influence of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and vitamin D levels on the short-term survival rate of dental implants. Materials and Methods: A prospective observational study was conducted on patients receiving dental implants. Preoperative serum levels of LDL, HDL, triglycerides, and vitamin D were recorded. A total of 556 conical, platform-switching implants were placed in 166 patients, smokers and no smokers with mean age 48 years ± 4.7. Implant survival was evaluated from 14 to 21 days after placement, at 6- and at a 12-month follow-up. Spearman's rank correlation was performed to assess potential correlations between the abovementioned systemic factors and implant loss. Results: Out of 556 implants, 13 (2.34%) were lost from 14 to 21 days after placement, a further two (0.35%) were lost after 6 months after surgery and a further eight (1.44%) were lost 12 months after placement. No significant correlation was found between HDL levels, cholesterol levels, triglyceride levels and implant loss. Spearman's correlation analysis revealed a strong negative correlation between vitamin D levels and implant loss with no statistical significance. Conclusions: Within the limitations of this study, no statistically significant associations were found between lipid profile markers or vitamin D levels and early dental implant loss. Further large-scale and long-term studies are warranted to validate these findings and better understand the interplay between systemic biochemical markers and implant survival rate.

Risk of Benign Paroxysmal Positional Vertigo Modified by Diuretics-A Population-Level Case-Control Study

OBJECTIVE

This study aims to characterize diuretic use among patients with and without benign paroxysmal positional vertigo (BPPV) using a population-level database.

STUDY DESIGN

A case-control study.

SETTING

TriNetX US Collaborative Network.

METHODS

Subjects with ≥1 hospital visit between 2019 and 2024 were queried and stratified by age (18-44, 45-64, and 65+ years) and sex. Each cohort was then divided into those with/without BPPV. Patients with head trauma, middle/inner ear surgery, central vertigo, or migraine were excluded. The prevalence of diuretic use and vitamin D deficiency of each case cohort was compared against the control cohort of the same age/sex using Chi-square analysis. This stratification and analysis were repeated for patients with a vestibular disorder, as well as those with/without Ménière's disease (MD).

RESULTS

Diuretic use was significantly more common in case cohorts than in control cohorts in the general population. In vestibular patients, thiazide and carbonic anhydrase inhibitor (CAI) use were more common in control cohorts, and loop use was less common. In MD patients, thiazide and loop use were more common in control cohorts, and CAI use did not differ significantly. In patients without MD, CAI use also did not differ, while thiazide and loop use were less common in control cohorts.

CONCLUSION

All diuretics may alter the risk of BPPV. Their influences can be favorable or unfavorable, depending on the individual patient's medical history. Their effects might relate more directly to the efficacy of each diuretic class rather than their specific mechanisms of action.

Brazilian older adults' vitamin D insufficiency and deficiency: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to identify the prevalence of vitamin D insufficiency and deficiency in older Brazilian adults. Design: Systematic review and meta-analysis. The search explored the MEDLINE, EMBASE, and LILACS platforms. Clinical and observational studies published before November 9, 2022, were included. The review was registered in PROSPERO No. 74,732 and evaluated using the adapted Loney scale. The search strategy identified 1,169 articles, of which 26 met the inclusion criteria, totaling 9,606 older adults. The vitamin D deficiency prevalence was 34.2% (95%CI: 25.0-44.6), and the insufficiency prevalence was 35.2% (95%CI: 31.0-39.5). The highest prevalence found was in the southern region (86.3% deficiency) and the southeast (51.4% insufficiency). Cross-sectional studies have shown a similar prevalence of vitamin D deficiency and insufficiency to the overall prevalence (34.2% and 33.7%). A statistically significant difference was found in the studies' risk of bias assessment (insufficiency subgroup). The results show a high prevalence of vitamin D insufficiency and deficiency in older Brazilian adults, pronounced even in places with higher incidences of sunlight.

Correlation Between Vitamin D Deficiency (25(OH)D3) and the Severity of Purulent Oropharyngeal Infections

Background: Vitamin D plays a crucial role in immune system function, and its deficiency has been associated with an increased risk of infections. This study investigates the relationship between vitamin D deficiency and the severity of purulent oropharyngeal infections, considering the need for surgical interventions and the duration of hospitalization. Materials and Methods: This retrospective study included patients diagnosed with peritonsillar phlegmons, laterocervical abscesses, and peritonsillar abscesses. Patients were categorized based on their vitamin D levels: deficiency (<30 ng/mL) and optimal levels (≥30 ng/mL). The clinical parameters, length of hospitalization, and type of treatment were analyzed. Statistical analyses included Student's t-test, the chi-square test, and ANOVA to assess differences between groups. Results: Patients with vitamin D (25(OH)D3) deficiency had a significantly longer hospital stay (8.50 days vs. 3.24 days, p = 0.001) and required more frequent surgical interventions (55.6% vs. 27.8%, p = 0.002) compared to those with optimal vitamin D levels. A trend toward more complex treatment regimens was also observed, although this relationship was not statistically significant (p > 0.05). Conclusions: These findings suggest that vitamin D (25(OH)D3) deficiency may contribute to a more severe course of oropharyngeal infections, increasing the need for invasive treatments and prolonging hospitalization. This highlights the importance of monitoring vitamin D (25(OH)D3) levels and the potential benefits of supplementation in preventing and managing severe upper respiratory tract infections.

Mesenchymal stem cell-specific Sirt1 overexpression prevents sarcopenia induced by 1,25-dihydroxyvitamin D deficiency

Sarcopenia, characterized by an age-related decline in skeletal muscle mass and function, is closely linked to vitamin D deficiency. This study examines the role of Sirtuin 1 (Sirt1) and its regulation by vitamin D in preventing sarcopenia. Utilizing wild-type, 1α-hydroxylase knockout (1α(OH)ase-/-), and Sirt1 transgenic (Sirt1Tg) 1α(OH)ase-/- mice, we investigated muscle Sirt1 levels, muscle mass, fiber type, and senescence markers. Our results demonstrated that 1,25-Dihydroxyvitamin D (1,25(OH)2D3) upregulated Sirt1 and myogenic factor MyoD1 expression in C2C12 myoblasts via VDR-mediated transcription. Sirt1 overexpression in mesenchymal stem cells (MSCs) significantly mitigated muscle mass reduction, improved fiber cross-sectional area, and increased type II fiber numbers in 1α(OH)ase-/- mice. Mechanistically, 1,25(OH)2D3 promoted muscle cell health by enhancing Sirt1 expression, which in turn reduced muscle cell senescence and the senescence-associated secretory phenotype (SASP) through decreased levels of acetylated nuclear p53 and p65, maintaining their cytoplasmic localization. Additionally, Sirt1 overexpression accelerated muscle regeneration post-injury by increasing embryonic myosin heavy chain expression and cell proliferation. These findings underscore the therapeutic potential of targeting vitamin D and Sirt1 pathways to prevent sarcopenia, suggesting that supplementation with active vitamin D and consequent Sirt1 activation could be effective strategies for managing age-related muscle wasting.

The prevalence and outcomes of pre-admission vitamin D levels in the management of proximal femur fractures

Objectives

The prevalence of low Vitamin D levels (<30 nmol/L) is about 15.7% globally. The aim of this study was to examine the prevalence of vitamin D deficiency in elderly patients with fragility fractures of the hip by estimating 25-hydroxyvitamin D levels and to assess whether low vitamin D levels at the time of admission affect functional outcomes at 3 months and mortality at 28 days and 1 year.

Methods

We conducted a retrospective study of all patients admitted with a fracture of the neck of the femur between January 2018 and March 2022. Data were obtained from the National Hip Fracture Database (NHFD) and Medway software. A total of 1440 patients were included. Patient demographics, including age, sex, fracture pattern, vitamin D levels at the time of admission, functional status at 120 days, and mortality at 1 month and 1 year, were analyzed.

Results

The average age of the patients was 81.91 years (range 60-108). Of the patients, 1009 (70%) were female and 431 (30%) were male. Vitamin D levels were low in 796 patients (55.3%). Mobility significantly declined in patients with vitamin D deficiency within 3 months after surgery for proximal femur fractures. The 28-day and one-year mortality rates were 6.7% and 30.3%, respectively, in patients with low vitamin D levels, compared to 4.7% and 22.3% in those with normal levels. Patients with low vitamin D levels at the time of admission had higher mortality rates at both 28 days and 1 year compared to those with normal levels.

Conclusion

Our study demonstrates that low vitamin D levels at the time of admission for proximal femur fractures are associated with poorer functional mobility and higher perioperative and 1-year mortality rates.

Pharmacological Treatment of Obesity in Older Adults

Obesity is a complex health issue with growing prevalence worldwide. It is also becoming more prevalent in the population of older adults (i.e., 65 years of age and older), affecting frequency and severity as well as other comorbidities, quality of life and consequently, life expectancy. In this article we review currently available data on pharmacotherapy of obesity in the population of older adults and its role in obesity management. Even though there is growing evidence, in particular in the general population, of favourable efficacy and safety profiles of glucagon-like peptide-1 (GLP-1) receptor agonists liraglutide and semaglutide, and recently dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist tirzepatide, concise guidelines for older adults are not available to this day. We further discuss specific approaches to frequently represented phenotype of obesity in older adults, in particular sarcopenic obesity and rationale when to treat and how. In older adults with obesity there is a need for more drug trials focusing not only on weight loss, but also on geriatric endpoints including muscle mass preservation, bone quality and favourable fat distribution changes to get enough data for evidence-based recommendation on obesity treatment in this growing sub-population.

The Effects of Vitamin D on Movement and Cognitive Function in Senile Mice After Sevoflurane Anaesthesia

BACKGROUND

Vitamin D (VD) is a neuroactive steroid involved in many brain functions, such as neurotrophic, neuroimmune control and neurotransmission, which affects the growth and function of the brain. The purpose of this study is to explore the effect of VD on motor and cognitive function of aged mice after sevoflurane anesthesia.

METHOD

We established sevoflurane anesthesia model and VD(-) and VD(+) mice model. The VD concentration of mice in each group was determined by enzyme-linked immunosorbent assay (ELISA). An open-field test was used to evaluate the mice's capacity for movement and exploration. A Y-maze test was used to gauge the mice's short-term memory. The primary purpose of the water-maze experiment was to examine mice's long-term spatial memory.

RESULTS

The ELISA results showed that the model was successfully constructed. In the open-field test, VD increased the exercise distance of mice (P < .05). In the Y-maze experiment, VD improved short-term memory impairment in mice (P < .05). In the water-maze test, VD increased the activity time and platform crossing number of mice in the target quadrant. (P < .05).

CONCLUSION

Sevoflurane anesthesia caused cognitive dysfunction in aged mice, including reduced learning ability, memory loss, lower motor and exploratory abilities and depression, and VD deficiency aggravated these impairments. By supplementing with VD, learning ability and long-term memory were enhanced, motor and exploratory abilities were improved, and depression levels were reduced. Anxiety was also improved.

Emulsification and stabilisation technologies used for the inclusion of lipophilic functional ingredients in food systems

Food industry is increasingly using functional ingredients to improve the food product quality. Lipid-containing functional ingredients are important sources of nutrients. This review examines the current state of emulsification and stabilisation technologies for incorporating lipophilic functional ingredients into food systems. Lipophilic functional ingredients, such as omega-3 fatty acids, carotenoids, and fat-soluble vitamins, offer numerous health benefits but present challenges due to their limited solubility in water-based food matrices. Emulsification techniques enable the dispersion of these ingredients in aqueous environments, facilitating their inclusion in a variety of food products. This review highlights recent advances in food emulsion formulation, emulsification methods and stabilisation techniques which, together, improve the stability and bioavailability of lipophilic compounds. The role of various emulsifiers, stabilizers, and encapsulation materials in enhancing the functionality of these ingredients is also explored. Furthermore, the review discusses different stabilisation techniques which can yield in emulsion in a solid or liquid state. By providing a comprehensive overview of current technologies, this review aims to guide future research and application in the development of functional foods enriched with lipophilic ingredients.

Obstructive sleep apnea and vitamin D level: Has the dust settled?

Obstructive sleep apnea and vitamin D deficiency are associated with multiple complications with increased morbidity and mortality. However, the relationship between these two entities remains unclear, with clinical studies demonstrating contradictory results. This narrative review aims to present the current evidence and understanding of this relationship and discuss the possible mechanisms linking these two disease entities. Finally, we summarize and propose areas of opportunity for future research.

Impact of Vitamin D on Osseointegration in Dental Implants: A Systematic Review of Human Studies

This systematic review evaluates the impact of Vitamin D levels on dental implant osseointegration, hypothesizing that optimal Vitamin D enhances success rates, and aims to synthesize data on its relationship with clinical outcomes in implantology. A comprehensive search across PubMed, Cochrane Library, and Web of Science databases included seven peer-reviewed articles meeting the criteria for the review. These studies, conducted between 2008 and 2021, included human subjects and explicitly correlated serum Vitamin D levels with dental implant outcomes, following PRISMA guidelines. The selected studies involved 1462 participants and examined 4450 dental implants. Key findings included a varied implant loss rate ranging from 3.9% to 11.4% across the studies. One study reported a 9.8% implant loss rate, yet found no significant association between Vitamin D receptor polymorphism and implant success. Another study indicated successful implantation following Vitamin D3 supplementation, even in severe deficiency cases. The highest implant loss rate (11.1%) was observed in severely Vitamin D-deficient patients, particularly when compounded by risk factors such as smoking and periodontal disease. Additionally, one study noted significantly improved bone density following post-surgical Vitamin D supplementation for up to 12 weeks. The review supports a link between sufficient Vitamin D levels and successful dental implant osseointegration, suggesting Vitamin D deficiency as a potential risk factor for increased failure and advocating for Vitamin D evaluations in pre-surgical planning to potentially enhance implantology outcomes.

Neuropathic Pain in Aged People: An Unresolved Issue Open to Novel Drug Approaches, Focusing on Painful Diabetic Neuropathy

A majority of older patients suffer from neuropathic pain (NP) that significantly alters their daily activities and imposes a significant burden on health care. Multiple comorbidities and the risk of polypharmacy in the elderly make it challenging to determine the appropriate drug, dosage, and maintenance of therapy. Age-dependent processes play a contributing role in neuropathy given that diabetic neuropathy (DN) is the most common form of neuropathy. This narrative review is mainly focused on the drug treatment approach for neuropathy-associated pain in aged people including both drugs and dietary supplements, considering the latter as add-on mechanism-based treatments to increase the effectiveness of usual treatments by implementing their activity or activating other analgesic pathways. On one hand, the limited clinical studies assessing the effectiveness and the adverse effects of existing pain management options in this age segment of the population (> 65), on the other hand, the expanding global demographics of the elderly contribute to building up an unresolved pain management problem that needs the attention of healthcare providers, researchers, and health authorities as well as the expansion of the current therapeutic options.

Obstructive sleep apnea and vitamin D: an updated systematic review and meta-analysis

PURPOSE  : Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder which leads to increased cardiovascular risks. Vitamin D deficiency is associated with various cardiometabolic complications, including increased cardiovascular morbidity and mortality. We aimed to analyze the difference in serum 25-hydroxyvitamin D (25-OHD) level, prevalence of vitamin D insufficiency and deficiency, and the effect of CPAP treatment on serum 25-OHD levels among adult patients with OSA.

METHODS

We pooled data from 18 observational studies involving 5592 individuals. Baseline parameters that might have contributed to the significant differences observed were also analyzed.

RESULTS

Patients with OSA had significantly lower serum 25-OHD levels (pooled d +  - 0.74 [95% CI: - 1.19 to - 0.28], p < 0.01) and higher prevalence of vitamin D deficiency (pooled log (odds ratio) 0.98 [95% CI: 0.30 to 1.67], p < 0.01) compared to those without OSA. Subgroup analysis demonstrated that these differences were significant only in moderate OSA and severe OSA. Neither age nor BMI nor geographical latitude contributed significantly to the differences observed in serum 25-OHD levels. The use of CPAP did not lead to significant changes in serum 25-OHD levels.

CONCLUSION

Patients with OSA have lower serum 25-OHD levels with a higher prevalence of vitamin D deficiency, regardless of age or BMI, pointing to an independent association between vitamin D and OSA.

Vitamin D Status among the Population Visiting Jigme Dorji Wangchuck National Referral Hospital, Bhutan

Objective

To study the vitamin D status among the Bhutanese population visiting the Jigme Dorji Wangchuck National Referral Hospital in Thimphu, Bhutan.

Materials and Methods

This is a retrospective descriptive study involving the extraction of data from a hospital database. Records of Bhutanese patients who had taken vitamin D tests in the last two years (2020-2021) were included in the study.

Result

A total of 1175 individuals took the vitamin D test during the study period, and the age ranged between 1 day and 94 years. Over 60% of the participants were females. The study found that over 83% of our study population had serum vitamin D levels lower than the normal range/deficient. Around 18% of the participants had severe deficiency.

Conclusion

The study found that most participants, including children, had vitamin D deficiency, and the finding was homogenous across gender and age groups. Further studies are required to validate these findings and identify the factors associated with vitamin D deficiency in the population for targeted public health interventions.

Vitamin D as a predictor of negative outcomes in hospitalized COVID-19 patients: An observational study

Introduction

Serum vitamin D deficiency is thought to be associated with worse clinical outcomes in COVID-19 patients.

Methods

This single-centre observational study evaluated the association between serum vitamin D levels and negative outcomes in hospitalized COVID-19 patients in Ukraine. We included hospitalized patients with COVID-19 confirmed by PCR and serum vitamin D measurement on admission. Patients were divided into two groups based on their serum vitamin D level: with adequate vitamin D (≥ 30 ng/ml) and with low vitamin D (<30 ng/ml). Outcomes such as death and the need for respiratory support were recorded.

Results

A total of 70 patients were included. The gender; severity of COVID-19; comorbidities such as hypertension, diabetes mellitus type 2, obesity; type of respiratory support, and the length of hospital stay did not differ in both groups. Patients with low serum vitamin D levels have higher C-reactive protein levels 26.14 mg/L [Q1, Q3: 16.61, 57.79] compared to another group 13.43 mg/L [Q1, Q3: 8.84, 27.58]. Low vitamin D level was associated with an increased risk of respiratory support need OR [Odds ratio] 2.925 [95% CI, 1.0839 to 7.8931]. However, after adjustment for age, gender, and common comorbidities, it did not remain significant. Vitamin D serum levels did not significantly differ in patients who died during hospitalization compared to those who survived.

Conclusion

The role of vitamin D as a sole predictor of mortality and respiratory support appears to be overestimated. Low vitamin D levels may have a greater impact on COVID-19 outcomes in hospitalized elderly patients with comorbidities.

No Significant Association between 25-OH Vitamin D Status and SARS-CoV-2 Antibody Response after COVID-19 Vaccination in Nursing Home Residents and Staff

Vitamin D is an essential nutrient for various physiological functions, including immunity. While it has been suggested that higher vitamin D levels/supplementation are associated with a better immune response to COVID-19 vaccination, conflicting data exist. Therefore, we aimed to investigate the association between vitamin D (25-hydroxyvitamin D) deficiency/supplementation, and SARS-CoV-2 antibody responses post-vaccination in nursing home residents (NHRs) and staff (NHS). Blood samples were collected from 115 NHRs and 254 NHS at baseline and 14 days after primary course BNT162b2 vaccination. Baseline samples were assessed for serum 25-hydroxyvitamin D levels, while follow-up samples were analyzed for spike protein S1 receptor-binding domain (S1RBD) IgG antibody concentrations and 50% pseudoneutralization titers. Vitamin D supplementation status was obtained from NHRs medical records. We compared immune responses between (severe) vitamin D-deficient and -sufficient NHRs/NHS and between supplemented and non-supplemented NHRs, stratified for history of SARS-CoV-2 infection and participant type. No significant differences in either binding or neutralizing COVID-19 vaccine antibody response were found between groups. The prevalence of vitamin D deficiency (<20 ng/mL) was 45% (95% CI: 36-54%) among NHRs and 60% (95% CI: 54-66%) among NHS. Although we showed that vitamin D status may not be related to a better COVID-19 vaccine antibody response, addressing the high prevalence of vitamin D deficiency in the nursing home population remains important.

Serum Vitamin D Status in Older Adults: A Cohort Study

Background

Vitamin D is best known as a key regulator of bone metabolism and calcium and phosphate homeostasis. This study aimed to assess the effect of different factors on the five-year changes in serum vitamin D concentration among older adults.

Methods

This cohort study was conducted on adults aged ≥60 years living in Amirkola, in the North of Iran, from 2012 to 2017. Serum 25-hydroxyvitamin D (25-OH vitamin D) concentrations of <20, 20-29.99, and ≥30 ng/mL, respectively, were used to designate vitamin D deficiency, insufficiency, and sufficiency. Any variation between the second and baseline values of the 25-OH vitamin D concentration was reported as a five-year difference. Data were analyzed using SPSS version 17.0, and Chi square, t test, one-way ANOVA, and Tukey HSD post hoc tests were employed. P values less than 0.05 were considered statistically significant.

Results

The mean serum concentration of 25-OH vitamin D at baseline and follow-up examination in 1011 individuals was 34.68±33.18 and 23.88±14.91, respectively (P<0.001). Following a five-year follow-up, vitamin D deficiency, insufficiency, and sufficiency were found in 452 (44.7%), 334 (33.0%), and 225 (22.3%) cases, respectively. The reduction in serum 25-OH vitamin D concentration after five years was significantly influenced by the administration of vitamin D (P=0.013) and calcium (P=0.007) supplements, serum profile of parathyroid hormone (PTH) (P=0.010), calcium (P=0.021), and phosphorous (P=0.021). However, age, sex, body mass index, metabolic syndrome, and physical activity had no significant impact (P>0.05).

Conclusion

Regardless of age, sex, body mass index, metabolic syndrome, or physical activity, the mean serum concentration of vitamin D decreased over a five-year follow-up.

Association of Vitamin D Deficiency and Insufficiency with Pathology in Hospitalized Patients

Vitamin D deficiency is one of the most common medical conditions, with approximately one billion people having low vitamin D levels. Vitamin D is associated with a pleiotropic effect (immunomodulatory, anti-inflammatory and antiviral), which can be essential for a better immune response. The aim of this research was to evaluate the prevalence of vitamin D deficiency/insufficiency in hospitalized patients focusing on demographic parameters as well as assessing the possibility of its associations with different comorbidities. Of 11,182 Romanian patients evaluated in the study over 2 years, 28.83% had vitamin D deficiency, 32.11% insufficiency and 39.05% had optimal vitamin D levels. The vitamin D deficiency was associated with cardiovascular disorders, malignancies, dysmetabolic disorders and SARS-CoV2 infection, older age and the male sex. Vitamin D deficiency was prevalent and showed pathology association, while insufficiency of vitamin D (20-30 ng/mL) had lower statistical relevance and represents a grey zone in vitamin D status. Guidelines and recommendations are necessary for homogeneity of the monitoring and management of inadequately vitamin D status in the risk categories.

Effect of Vitamin D analog supplementation on levator ani strength and plasma Vitamin D receptor expression in uterine prolapse patients

Uterine prolapse is a pathological condition that can negatively impact women's quality of life. It is caused by weakening of the pelvic floor muscles. Function of levator ani muscle and other striated muscles is thought to be influenced by Vitamin D levels. Vitamin D exerts its biological effects by adhering to Vitamin D receptors (VDRs) present in striated muscles. We aim to analyze the effect of Vitamin D analog supplementation on levator ani muscle strength in uterine prolapse patients. This was a quasi-experimental study with a pre-post design on 24 postmenopausal women diagnosed with grade III and IV uterine prolapse. Vitamin D levels, VDR, levator ani muscle, and hand grip muscle strength were measured before and after three months of Vitamin D analog supplementation. We found that Vitamin D level, VDR serum level, levator ani muscle strength, and hand grip muscle strength all significantly increase (p < 0.001) following Vitamin D analog supplementation. The correlation coefficient between levator ani muscle and handgrip muscle strength was 0.616 and with p value of 0.001. To conclude, Vitamin D analog supplementation can significantly increase levator ani muscle strength in uterine prolapse patients. We propose that determining Vitamin D level in postmenopausal women and replenishing its deficiency with Vitamin D analog supplementation might aid in preventing POP progression.

Oxidative imbalance increases the risk for colonic polyp and colorectal cancer development

BACKGROUND

The role of oxidative stress in the pathogenesis of colorectal carcinoma (CRC) has garnered considerable interest recently. Specific oxidative factors have been implicated in the pathogenesis of adenomatous polyps and ultimately adenocarcinoma.

AIM

To evaluate the effect of oxidative imbalance as quantified by specific serological markers in the development of sporadic colon adenocarcinoma.

METHODS

A total of 170 patients that underwent endoscopy of the lower gastrointestinal tract in a tertiary center within 3 years were included in the study. They were allocated in three groups; those with sporadic colon adenocarcinoma (n = 56, 32.9%), those with colonic polyps (n = 33, 19.4%) and healthy controls (n = 81, 47.7%). All patients were evaluated for oxidant activity and antioxidant capacity with serum measurements of specific markers such as vitamins A, 25(OH) D3, E, C, B12, folic acid, glutathione, selenium (Se), zinc (Zn), free iron (Fe²⁺), and malondialdehyde and results were compared between groups.

RESULTS

Serum levels of vitamins C, E, D, Se, Zn, vitamin B12 and total antioxidant capacity were significantly lower in the combined neoplasia/polyp group than in the control group (P = 0.002, P = 0.009, P < 0.001, P < 0.001, P < 0.001, P = 0.020 and P < 0.001, correspondingly). Increased levels of vitamin E (P = 0.004), vitamin D (P < 0.001), Se (P < 0.001) and Zn (P < 0.001) seem to bestow a protective effect on the development of CRC. For vitamin D (P < 0.001) and Zn (P = 0.036), this effect seems to extend to the development of colon polyps as well. On the other hand, elevated serum levels of malondialdehyde are associated with a higher risk of CRC (OR = 2.09 compared to controls, P = 0.004). Regarding colonic polyp development, increased concentrations of vitamin Α and Fe²⁺ are associated with a higher risk, whereas lower levels of malondialdehyde with a lower risk.

CONCLUSION

Increased oxidative stress may play an important role in the pathogenesis and progression of CRC. Antioxidants’ presence may exert a protective effect in the very early stages of colon carcinogenesis.

Clinical Identification of Hypovitaminosis D among Elderly Attending Primary Care Centre in Saudi Arabia

Background

A large proportion of elderly people suffer from hypovitaminosis D, and depending on the severity of the condition, they develop complications that are detrimental to their health.

Objective

To determine the consistency between the results of the vitamin D level in the blood compared to the result with the score of a simple questionnaire (Physician Vitamin D Status Predictor - VDSP) for elderly patients. Subjects and methods. This is a cross-sectional study conducted during the period between October 2018 and November 2019 in 3 primary health care centres (PHCCs) in Jeddah, Saudi Arabia. The subjects for this study were patients aged 60 or older. Data were collected in two phases: a questionnaire approach as the first phase, while the second phase involved blood testing for vitamin D levels. The validated questionnaire used in this study was the Physician`s Vitamin D Status Predictor (VDSP).

Results

The study included 335 participants who ranged between 60 and 107 years old with a mean age of 68.2 years and standard deviation (SD) of 7.3 years. Females represented 66.9% of the total participants. The prevalence of vitamin D deficiency was 60.8%; among them, 7.2% were categorized as severe deficiency, whereas the prevalence of vitamin D insufficiency was 29.9%. The outcomes of VDSP survey were not directly associated with serum 25(OH)D levels in elderly people, except for the number of medications. In addition, vitamin D supplementation was associated with serum 25(OH)D levels among those patients.

Conclusion

Vitamin D supplementation was significantly associated with serum 25(OH)D levels. Moreover, this study showed a significant association between serum 25(OH)D levels and the number of medications taken by the participants.

Fat-soluble vitamins: updated review of their role and orchestration in human nutrition throughout life cycle with sex differences

Age and Gender are vital determinants for the micronutrient demands of normal indviduals. Among these micronutrients are vitamins that are required in small amounts for optimum metabolism, homeostasis, and a healthy lifestyle, acting as coenzymes in several biochemical reactions. The majority of previous studies have examined such issues that relates to a specific vitamin or life stage, with the majority merely reporting the effect of either excess or deficiency. Vitamins are classified into water-soluble and fat-soluble components. The fat-soluble vitamins include vitamins (A, D, E, and K). Fat-soluble vitamins were found to have an indisputable role in an array of physiological processes such as immune regulation, vision, bone and mental health. Nonetheless, the fat-soluble vitamins are now considered a prophylactic measurement for a multitude of diseases such as autism, rickets disease, gestational diabetes, and asthma. Herein, in this review, a deep insight into the orchestration of the four different fat-soluble vitamins requirements is presented for the first time across the human life cycle beginning from fertility, pregnancy, adulthood, and senility with an extensive assessment ofthe interactions among them and their underlying mechanistic actions. The influence of sex for each vitamin is also presented at each life stage to highlight the different daily requirements and effects.

Factors Associated with Low Vitamin D Status among Older Adults in Kuwait

Low vitamin D levels among older people represent a significant health problem worldwide. This study aimed to examine the factors associated with vitamin D deficiency in older people (aged ≥ 65) in the Kuwaiti population. A cross-sectional study was conducted in seven primary healthcare centers across Kuwait (November 2020 to June 2021). The participants (n = 237) had their serum vitamin D (25(OH)D) concentrations (analyzed using LC-MS) classified as sufficiency 75 nmol/L (30 ng/mL) or deficiency < 75 nmol/L (below 30 ng/mL). The data were collected using self-administered questionnaires and face-to-face interviews with participants in geriatric clinics. Binomial logistic regression analysis was applied to assess factors associated with vitamin D deficiency. Vitamin D deficiency was found to be present in two thirds of the participants (n = 150, 63%), with a higher prevalence of deficiency in participants who did not receive vitamin D supplements, compared to those who did (84% vs. 16%, p = 0.001). The results from the binary logistic regression showed that a low duration of sun exposure (OR = 0.24, 95% C.I. [0.08−0.7], p = 0.011), dark skin pigmentation (OR = 4.46, 95% [1.35−20.49], p = 0.026), and lower caloric intake (OR = 0.9, 95% C.I. [0.85−0.96], p = 0.001) were risk factors for vitamin D deficiency. Furthermore, a significant inverse relationship was found between vitamin D levels and parathyroid hormone (PTH) levels (OR = 1.16, 95% C.I. [1.04−1.31], p = 0.016). These findings support the recommendation that vitamin D supplementation and adequate sunlight exposure are necessary for raising low vitamin D levels in older people in Kuwait.

Relationship between serum vitamin D and hip fracture in the elderly: a systematic review and meta-analysis

INTRODUCTION

This study investigated the relationship between serum 25-hydroxyvitamin D (25OHD) levels and the occurrence of hip fractures in the elderly using a systematic review and meta-analysis approach.

MATERIALS AND METHODS

PubMed, Web of Science, and Scopus were used to identify studies that outlined an association between serum 25OHD and the occurrence of a hip fracture in a geriatric patient. The analysis calculated odds ratios (OR) for a hip fracture using a random-effects model.

RESULTS

In this study, 28 studies were included, 61,744 elderlies and 9767 cases (15.81%) of hip fractures. In the lowest vs. highest categories of vitamin D in the elderly, pooled OR of hip fractures was 1.80 (95% CI 1.56-2.07, P ≤ 0.001), and modified OR was equal to 1.40 (95% CI 1.20-1.63 P ≤ 0.001). A subgroup analysis showed that the OR of a hip fracture was 2.16 (1.49-3.11, P ≤ 0.001) in case-control studies; 1.52 (1.29-1.79, P = 0.001) in cohort studies; and 1.41 (1.18-1.70, P ≤ 0.001) in case-cohort studies.

CONCLUSION

Low serum vitamin D levels in the elderly are associated with an increase in the odds of hip fracture.

Vitamin D Deficiency and Comorbidities as Risk Factors of COVID-19 Infection: A Systematic Review and Meta-analysis

OBJECTIVES

Extensive evidence links low vitamin D status and comorbidities with coronavirus disease 2019 (COVID-19) outcomes, but the results of published studies are contradictory. Therefore, we investigated the association of lower levels of vitamin D and comorbidities with the risk of COVID-19 infection.

METHODS

We searched MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for articles published until August 20, 2021. Sixteen eligible studies were identified (386 631 patients, of whom 181 114 were male). We included observational cohort and case-control studies that evaluated serum levels of vitamin D in COVID-19-positive and COVID-19-negative patients. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

RESULTS

Significantly lower vitamin D levels were found in COVID-19-positive patients (MD, -1.70; 95% CI, -2.74 to -0.66; p=0.001), but with variation by study design (case-control: -4.04; 95% CI, -5.98 to -2.10; p<0.001; cohort: -0.39; 95% CI, -1.62 to 0.84; p=0.538). This relationship was more prominent in female patients (MD, -2.18; 95% CI, -4.08 to -0.28; p=0.024) than in male patients (MD, -1.74; 95% CI, -3.79 to 0.31; p=0.096). Male patients showed higher odds of having low vitamin D levels (odds ratio [OR], 2.09; 95% CI, 1.38 to 3.17; p<0.001) than female patients (OR, 1.17; 95% CI, 0.74 to 1.86; p=0.477). Comorbidities showed inconsistent, but generally non-significant, associations with COVID-19 infection.

CONCLUSIONS

Low serum vitamin-D levels were significantly associated with the risk of COVID-19 infection. This relationship was stronger in female than in male COVID-19 patients. Limited evidence was found for the relationships between comorbidities and COVID-19 infection, warranting large population-based studies to clarify these associations.

Correlation of vitamin D level with the clinical-radiological severity of COVID-19 in geriatric patients

Objective: This study was planned to investigate the effect of 25-OH-Vitamin D (Vit D) deficiency on clinical and radiological findings of coronavirus disease-2019 (COVID-19) in geriatric patients hospitalized due to COVID-19. Material and Method: Seventy-five patients who were treated for COVID-19 were reviewed retrospectively, and grouped in relation with their ages [(1) 65-74, (2) 75-84, (3) >84 years] and the severity of Vit D deficiency [(1) severe deficiency: 30 ng/mL]. The complaints on admission, comorbidities, intensive care unit (ICU) need, length of hospital stay, laboratory data, and mortality of the ones who had and did not have Vit D replacement (n=18/75) were recorded. The patients were analyzed for COVID-19 severity using radiological and clinical markers. Results: Moderate Vit D deficiency (10-20 ng/mL) was frequently detected. When the disease severity and Vit D levels were analyzed, it was found that the disease was more severe (46.6%) in the Vit D 30 ng/ml group, but there was no statistically significant difference among the groups. Low or high Vit D levels did not show any significant correlations with the severity of pneumonia or the thorax CT findings. The intensive care unit (ICU) admission rate was significantly lower in those who had Vit D replacement (p

Role of vitamin D deficiency and comorbidities in COVID-19

Recent manuscripts described the incidence of vitamin D hypovitaminosis in coronavirus disease 2019 (COVID-19) patients. Vitamin D deficiency is also common in patients with comorbidities that are associated with a poor COVID-19 prognosis. In this letter, we review the literature regarding the association of comorbidities, vitamin D deficiency, and COVID-19.

Correlation Analysis of Serum Vitamin D Levels and Postoperative Cognitive Disorder in Elderly Patients With Gastrointestinal Tumor

PURPOSE

Vitamin D prevents hypocalcaemia, osteoporosis, and infections, among other problems, and is involved in the prevention and treatment of cardiovascular and neurological diseases. Recently, vitamin D was shown to improve cognitive dysfunction caused by Alzheimer's disease and vascular dementia. This study aims to explore the correlation between preoperative serum vitamin D and postoperative cognitive disorder (POCD) occurrence in elderly patients with gastrointestinal tumors to guide perioperative medication use and promote early patient recovery.

METHODS

This study recruited 238 elderly patients (65 ≤ age ≤ 85) who underwent gastrointestinal tumor surgery; 117 cases were enrolled, and 55 controls of the same age and education level as the cases were included. Blood samples were taken preoperatively and at 7, 15, 30, and 90 days postoperatively, and plasma vitamin D (25OH-D3) and glutathione (GSH) was measured. Different from the previous diagnosis of POCD was obtained by telephone interview through Cognitive Status Modified Telephone Interview (TICS-m), mainly for memory impairment, a series of neuropsychological tests was used to evaluate cognitive function, Picture Recollect Test, Stroop Color-word Test, and Digit Symbol Substitution Test were used to comprehensively evaluate the three domains of cognitive function of patients, namely memory, attention and information processing ability. All neuropsychiatric assessments were performed at the bedside and completed face-to-face by the assessment staff and the patient.

RESULTS

A total of 65.8% (77/117) of elderly patients undergoing gastrointestinal tumor surgery had preoperative vitamin D deficiency (serum 25OH-D concentration < 12 ng/ml), of whom 46.7% (36/77, 7 days after surgery), 31.2% (24/77, 15 days after surgery), 15.6% (12/77, 30 days after surgery), and 9% (7/77, 90 days after surgery) of patients developed POCD; 7.5% (3/40) of patients without vitamin D deficiency developed PNDs, which was detected only on the 7th day after surgery.

CONCLUSIONS

Vitamin D deficiency can increase neurocognitive disorder risk in elderly patients during the perioperative period, possibly because low vitamin D levels cannot effectively inhibit the postoperative oxidative stress increase.

TRIAL REGISTRATION

This experiment was approved and registered by the China Clinical Trial Registration Center, registration number ChiCTR2100046900 (30/05/2021).

Vitamin D3 Supplementation Attenuates Surgery-Induced Neuroinflammation and Cognitive Impairment by Regulating NLRP3 Inflammasome in Mice

Neuroinflammation plays a dominant role in the progression of postoperative cognitive dysfunction (POCD). Vitamin D has been known to have important regulatory functions in inflammation and immune response. The NOD-like receptor protein 3 (NLRP3) is an essential inflammasome in the inflammatory response and could be activated by anesthesia and surgery. In this study, male C57BL/6 mice aged 14-16 months were given VD3 for 14 days straight before having an open tibial fracture surgery. The animals were either sacrificed to obtain the hippocampus or tested in a Morris water maze test. Western blot was employed to estimate the levels of NLRP3, ASC, and caspase-1, immunohistochemistry was used to identify microglial activation, and an enzyme-linked immunosorbent assay was used to measure the expression of IL-18 and IL-1β, while using the corresponding assay kits to assess ROS and MDA levels to reflect the oxidative stress status. We showed that VD3 pretreatment significantly improved surgery-induced memory and cognitive dysfunctions in aged mice, which was linked to the inactivation of the NLRP3 inflammasome and the inhibition of neuroinflammation. This finding provided a novel preventative strategy for clinically reducing postoperative cognitive impairment in elderly surgical patients. This study has some limitations. Gender differences in the effects of VD3 were not considered, and only male mice were used. Additionally, VD3 was given as a preventative measure; however, it is unknown whether it has any therapeutic benefits for POCD mice. This trial is registered with ChiCTR-ROC-17010610.

Association of Sarcopenia with Osteopenia and Osteoporosis in Community-Dwelling Older Korean Adults: A Cross-Sectional Study

Sarcopenia and bone disorders, such as osteopenia and osteoporosis, are common musculoskeletal disorders in older adults. Therefore, this study aimed to establish the association between sarcopenia and bone disorders such as osteoporosis and osteopenia according to sex. We analyzed 3077 participants from the 2008-2011 Korean National Health and Nutrition Examination Survey aged 65 years or older. After adjusting for all covariates, such as physical examinations, exercise, and nutrient intake (model 4), the odds ratios for the association between sarcopenia and bone disorders were 2.051 (95% confidence interval [CI]: 1.498-2.808) in osteopenia and 2.258 (95% CI: 1.584-3.218) in osteoporosis. However, when sex was analyzed separately, the odds ratio was significantly different in men (osteopenia-2.068, 95% CI: 1.462-2.924; osteoporosis-3.247, 95% CI: 1.953-5.399), but not in women. Therefore, the results of this study show an association between sarcopenia and bone disorders in older Korean adults. Sarcopenia is significantly related to osteopenia and osteoporosis, especially in men, when stratified by sex.

1,25-Dihydroxyvitamin D deficiency induces sarcopenia by inducing skeletal muscle cell senescence

To determine if 1,25(OH)₂D deficiency can induce age-related sarcopenia, the skeletal muscular phenotype of male wild-type (WT) and Cyp27b1 knockout (KO) mice were compared at 3 and 6 months of age. We found that muscle mass, grip strength and muscle fiber size were significantly decreased in aging Cyp27b1 KO male mice. The expression levels of genes related to mitochondrial metabolic activity, and antioxidant enzymes including SOD1, catalase, Nqo1 and Gcs were significantly down-regulated in skeletal muscle tissue of Cyp27b1 KO male mice; in contrast, the percentage of p16⁺ and p21⁺ myofibers, and the expression of p16, p19, p21, p53, TNFα, IL6 and MMP3 at mRNA and/or protein levels were significantly increased. We then injected tibialis anterior muscle of WT and Cyp27b1^+/- male mice with BaCl₂, and analyzed the regenerative ability of skeletal muscle cells 7 days later. The results revealed that the numbers of newly formed regenerating central nucleated fibers (CNF), the percentage of BrdU⁺ cells and the expression of MyoD, MyHC and Myf5 at mRNA levels were significantly down-regulated in the injured skeletal muscle tissue of Cyp27b1^+/- mice. In summary, our studies indicate that 1,25(OH)₂D deficiency can result in the development of age-related sarcopenia by inducing oxidative stress, skeletal muscular cell senescence and SASP, and by inhibiting skeletal muscle regeneration. Cyp27b1 KO mice can therefore be used as an animal model of age-related sarcopenia in order to investigate the pathogenesis of age-related sarcopenia and potentially to test intervention measures for treatment of sarcopenia.

Impact of Vitamin D3 Deficiency on Phosphatidylcholine-/Ethanolamine, Plasmalogen-, Lyso-Phosphatidylcholine-/Ethanolamine, Carnitine- and Triacyl Glyceride-Homeostasis in Neuroblastoma Cells and Murine Brain

Vitamin D3 hypovitaminosis is associated with several neurological diseases such as Alzheimer's disease, Parkinson's disease or multiple sclerosis but also with other diseases such as cancer, diabetes or diseases linked to inflammatory processes. Importantly, in all of these diseases lipids have at least a disease modifying effect. Besides its well-known property to modulate gene-expression via the VDR-receptor, less is known if vitamin D hypovitaminosis influences lipid homeostasis and if these potential changes contribute to the pathology of the diseases themselves. Therefore, we analyzed mouse brain with a mild vitamin D hypovitaminosis via a targeted shotgun lipidomic approach, including phosphatidylcholine, plasmalogens, lyso-phosphatidylcholine, (acyl-/acetyl-) carnitines and triglycerides. Alterations were compared with neuroblastoma cells cultivated in the presence and with decreased levels of vitamin D. Both in cell culture and in vivo, decreased vitamin D level resulted in changed lipid levels. While triglycerides were decreased, carnitines were increased under vitamin D hypovitaminosis suggesting an impact of vitamin D on energy metabolism. Additionally, lyso-phosphatidylcholines in particular saturated phosphatidylcholine (e.g., PC aa 48:0) and plasmalogen species (e.g., PC ae 42:0) tended to be increased. Our results suggest that vitamin D hypovitaminosis not only may affect gene expression but also may directly influence cellular lipid homeostasis and affect lipid turnover in disease states that are known for vitamin D hypovitaminosis.

Pharmacologic Interventions for Fracture Risk Reduction in the Oldest Old: What Is the Evidence?

With an increasingly older population, the proportion of patients 85 years or older seeking interventions to protect their musculoskeletal health is growing. Osteoporosis in the geriatric population presents unique diagnostic and therapeutic challenges. Multimorbidity, frailty, falls, polypharmacy, and other neurobehavioral factors influence our approach to fracture prevention in this population. The vast majority of the evidence from clinical trials establish pharmacologic fracture efficacy in postmenopausal women. The evidence is scarce for the oldest old men and women, a population also at risk for adverse events and mortality. Most studies show continued efficacy of pharmacologic interventions in this age group, although they are largely limited by small sample sizes. We herein review the available evidence of pharmacologic interventions for fracture risk reduction in this population and explore the emerging senotherapeutic interventions in the pipeline. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Age and Gender-related Variations of Molecular and Phenotypic Parameters in A Cohort of Sicilian Population: from Young to Centenarians

People are living longer, but lifespan increase does not coincide with a boost in health-span. Thus, improving the quality of life of older people is a priority. Centenarians reach extreme longevity in a relatively good health status, escaping or delaying fatal or strongly invalidating diseases. Therefore, studying processes involved in longevity is important to explain the biological mechanisms of health and well-being, since knowledge born from this approach can provide valuable information on how to slow aging. We performed the present study in a well characterized very homogeneous sample of 173 people from Western Sicily, to update existing literature on some phenotypic aspects of aging and longevity and to propose a range of values for older people. We classified 5 age groups, from young adults to centenarians, to understand the age and gender-related variations of the different parameters under study. We collected anamnestic data and performed anthropometric, bioimpedance, molecular, haematological, oxidative, and hematochemical tests, adopting a multidimensional analysis approach. An important evidence of the present study is that there are differences related to both age and gender in several biomarkers. Indeed, gender differences seem to be still poorly considered and inadequately investigated in aging as well as in other medical studies. Moreover, we often observed comparable parameters between young and centenarians rather than non-agenarians and centenarians, hypothesizing a sort of slowdown, almost followed by a reversal trend, in the decay of systemic deterioration. The study of centenarians provides important indications on how to slow aging, with benefits for those who are more vulnerable to disease and disability. The identification of the factors that predispose to a long and healthy life is of enormous interest for translational medicine in an aging world.

Sarcopenia versus cancer cachexia: the muscle wasting continuum in healthy and diseased aging

Muscle wasting is one of the major health problems in older adults and is traditionally associated to sarcopenia. Nonetheless, muscle loss may also occur in older adults in the presence of cancer, and in this case, it is associated to cancer cachexia. The clinical management of these conditions is a challenge due to, at least in part, the difficulties in their differential diagnosis. Thus, efforts have been made to better comprehend the pathogenesis of sarcopenia and cancer cachexia, envisioning the improvement of their clinical discrimination and treatment. To add insights on this topic, this review discusses the current knowledge on key molecular players underlying sarcopenia and cancer cachexia in a comparative perspective. Data retrieved from this analysis highlight that while sarcopenia is characterized by the atrophy of fast-twitch muscle fibers, in cancer cachexia an increase in the proportion of fast-twitch fibers appears to happen. The molecular drivers for these specificmuscle remodeling patterns are still unknown; however, among the predominant contributors to sarcopenia is the age-induced neuromuscular denervation, and in cancer cachexia, the muscle disuse experienced by cancer patients seems to play an important role. Moreover, inflammation appears to be more severe in cancer cachexia. Impairment of nutrition-related mediators may also contribute to sarcopenia and cancer cachexia, being distinctly modulated in each condition.

A systematic review and meta-analysis of effect of vitamin D levels on the incidence of COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a disease primarily affecting the respiratory tract, however due to the nature of the pathogenesis it is able to affect the whole body. So far, no causative treatment has been found and the main strategy when dealing with COVID-19 relies on widespread vaccination programs and symptomatic treatment. Vitamin D due to its ability to modulate the immunological system has been proposed as a factor playing role in the organism response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Therefore, we decided to perform this meta-analysis which aimed to establish a connection between vitamin D status and COVID-19 infection.

METHODS

Study was designed as a systematic review and meta-analysis. PubMed, EMBASE, Web of Science, Cochrane Collaboration Databases and Scopus electronic databases were searched for relevant studies from database inception to May 10th, 2021. Mean differences (MDs) with their 95% confidence intervals (CI) were calculated.

RESULTS

Thirteen studies providing data for 14,485 participants met the inclusion criteria. Mean vitamin D levels in SARS-CoV-2 negative patients was 17.7 ± 6.9 ng/mL compared to SARS-CoV-2 positive patients 14.1 ± 8.2 ng/mL (MD = 3.93; 95% CI 2.84-5.02; I2 = 99%; p < 0.001).

CONCLUSIONS

Low serum vitamin D levels are statistically significantly associated with the risk of COVID-19 infection. Supplementation of vitamin D especially in the deficiency risk groups is indicated.

Vitamin D and Cytokine Profiles in Patients With Systemic Sclerosis

INTRODUCTION

Hypovitaminosis D has been frequently described in systemic sclerosis (SSc). Cytokines are important mediators of tissue damage and clinical dysfunction in SSc and may be influenced by vitamin D levels.

OBJECTIVE

To evaluate the serum levels of vitamin D and its correlation with the clinical features and cytokine profiles in SSc patients.

METHODS

Case-control study, including 50 SSc patients and 35 healthy non matched controls. Serum levels of 25(OH) vitamin D were measured by chemiluminescence assay, and serum concentrations of interleukin 2 (IL-2), IL-4, IL-6, IL-10, tumor necrosis factor, and interferon γ were determined by flow cytometry.

RESULTS

Fourteen patients (28%) had diffuse cutaneous SSc, 94% were female, 80% European derived, with a mean age of 57.2 ± 12.8 years. The serum vitamin D levels in SSc patients were 23.9 ± 8.5 ng/mL and 30.2 ± 6.2 ng/mL in the control group (standardized mean difference -6.19; 95% confidence interval, -9.9 to -2.3; p = 0.002), despite the more frequent supplementation of vitamin D in SSc patients (p = 0.014). No significant associations were found among vitamin D concentrations and cytokine levels. Serum levels of IL-6 were significantly elevated in SSc patients (p = 0.024) and were positively correlated with the modified Rodnan skin score (rs = 0.291, p =0.041).

CONCLUSIONS

Despite lower vitamin D levels in SSc patients, there was no clear association with any cytokine. Serum levels of IL-6 were significantly elevated and positively correlated with the extent of skin involvement in SSc patients.

Relationship between Vitamin D Deficiency and Periodontitis in Korean Adults Aged ≥60 Years: Analysis of Data from the Korea National Health and Nutrition Examination Survey (2013-2014)

There have been contradictory reports on the effects of vitamin D in the prevention of periodontitis. We analyzed the association between vitamin D status (levels of plasma 25(OH)D) and periodontitis using the Korea National Health and Nutrition Examination Survey (KNHANES) 2013–2014 database. Among the participants in the KNHANES (2013–2014), only those aged ≥60 years who completed a health interview survey, periodontal examination, and blood test were included in the study. Thus, data from 701 participants were used in the final analysis. Periodontal status was evaluated using the Community Periodontal Index (CPI), and periodontitis was defined as having a CPI score of 3 or 4. Plasma 25(OH)D levels were classified according to two criteria: 20 ng/mL and quartile value. The chi-square test and multivariate logistic regression analyses were performed to analyze the prevalence of periodontitis according to plasma 25(OH)D levels. Univariate analyses showed that periodontitis was not significantly associated with plasma 25(OH)D levels. In the multivariate logistic regression model adjusted for sociodemographic characteristics, the difference in the prevalence of periodontitis between those with a normal range of 25(OH)D and those with low plasma of 25(OH)D levels was not statistically significant. Vitamin D intake has been reported to have benefits in maintaining periodontal health; however, total plasma 25(OH)D levels showed no significant association with periodontitis based on CPI scores in this study. Additionally, these findings reaffirmed the importance of toothbrushing and smoking cessation to prevent periodontitis in people aged ≥60 years.

Vitamin D and parathyroid hormone status in community-dwelling elderly patients with mild-to-moderate kidney impairment

INTRODUCTION

Evidence on vitamin D and parathyroid hormone (PTH) status in patients with early kidney impairment is limited. We aimed to determine the associations among kidney function, vitamin D, and PTH status in community-dwelling elderly patients with mild-to-moderate kidney impairment.

METHODS

Community-dwelling elderly patients were enrolled in this Institutional Review Board approved cross-sectional study. The eligibility criteria were as follows: age > 60 years, no recent hospitalization within the past 12 months, no conditions that affect vitamin D status including vitamin D supplementation, and eGFR > 30 mL/min/1.73 m². Serum 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) levels were assessed.

RESULTS

A total of 226 patients were enrolled. Data were expressed as mean ± SD. The mean serum 25(OH)D was 26.61 ± 10.44 ng/mL and the mean serum PTH was 50.67 ± 22.67 pg/mL. The prevalence of vitamin D deficiency [25(OH)D < 20 ng/mL] and secondary hyperparathyroidism [PTH > 65 pg/mL] were 25.3% and 18.1%, respectively. Patients with eGFR 30- < 60 mL/min/1.73m² had significantly higher prevalence of 25(OH)D < 20 ng/mL (33.7% versus 19.4%, p < 0.05) than patients with eGFR ≥ 60 mL/min/1.73 m². Multiple regression analysis showed independent negative association of serum PTH level with eGFR (mL/min/1.73 m², β: - 0.261, 95% CI [- 0.408, - 0.114]) and serum 25(OH)D (ng/mL, β: - 0.499, 95% CI [- 0.775, - 0.223], adjusted for possible confounders).

CONCLUSIONS

The prevalence of vitamin D deficiency was higher in patients with eGFR 30 - < 60 mL/min/1.73 m² than those with eGFR ≥ 60 mL/min/1.73 m². Both decreased serum 25(OH)D levels and decreased eGFR were independently associated with increased serum PTH levels among these patients.

The implications of vitamin D deficiency on COVID-19 for at-risk populations

Novel coronavirus disease 2019 (COVID-19) has spread to > 10 000 000 individuals in a short time. With no pharmacological agents successfully implemented to control the outbreak, the use of less invasive nonpharmacological agents, such as vitamin D, are increasingly being studied. This purpose of this article is to determine the current knowledge about the risk of COVID-19 development for populations at risk for vitamin D deficiency, including individuals living with overweight and obesity, those of older age, and racial or ethnic minorities. Despite the documented impact of vitamin D on viral disease prevention, many subgroups at risk for contracting COVID-19 are also known to have increased rates of vitamin D deficiency. Because vitamin D is most commonly obtained from sunlight, when interpreted alongside the stay-at-home orders, the importance of identifying safe approaches to obtain sufficient vitamin D is apparent. Furthermore, elucidating the cause-and-effect relationship between vitamin D and COVID-19, including optimal dosing for COVID-19 outcomes, is also warranted for immediate investigation.

Independent Role of Severe Obesity as a Risk Factor for COVID-19 Hospitalization: A Spanish Population-Based Cohort Study

OBJECTIVES

This study analyzed the association between severe obesity and coronavirus disease 2019 (COVID-19) hospitalization and severe disease.

METHODS

The incidence of hospitalization for laboratory-confirmed COVID-19 was evaluated in a prospective population-based cohort of 433,995 persons aged 25 to 79 years in Spain during March and April of 2020. Persons with and without class 3 obesity were compared using Poisson regression to estimate the adjusted relative risk (aRR) from class 3 obesity of COVID-19 hospitalization and of severe disease (intensive care unit admission or death). Differences in the effect by age, sex, and chronic conditions were evaluated.

RESULTS

Individuals with class 3 obesity had a higher risk of hospitalization (aRR = 2.20, 95% CI: 1.66-2.93) and developing severe COVID-19 (aRR = 2.30, 95% CI: 1.20-4.40). In people younger than 50 years, these effects were more pronounced (aRR = 5.02, 95% CI: 3.19-7.90 and aRR = 13.80, 95% CI: 3.11-61.17, respectively), whereas no significant effects were observed in those aged 65 to 79 years (aRR = 1.22, 95% CI: 0.70-2.12 and aRR = 1.42, 95% CI: 0.52-3.88, respectively). Sex and chronic conditions did not modify the effect of class 3 obesity in any of the outcomes.

CONCLUSIONS

Severe obesity is a relevant risk factor for COVID-19 hospitalization and severity in young adults, having a magnitude similar to that of aging. Tackling the current obesity pandemic could alleviate the impact of chronic and infectious diseases.

Effects of Monthly Intramuscular High-Dose Vitamin D2 on Serum 25-Hydroxyvitamin D and Immune Parameters in Very Elderly Chinese Patients with Vitamin D Deficiency

PURPOSE

Vitamin D deficiency is highly prevalent among the very elderly and is associated with a wide variety of clinical conditions other than musculoskeletal diseases. This study aims to ascertain the efficacy and safety of high-dose intramuscular vitamin D2 in very elderly Chinese patients with vitamin D deficiency.

METHODS

Very elderly (aged 80 years or over) Chinese patients with vitamin D deficiency were recruited to receive monthly intramuscular injections of 600,000 IU vitamin D2 until their serum 25-hydroxyvitamin D (25(OH)D) reached ≥30 ng/mL. The serum levels of 25(OH)D2, 25(OH)D3, iPTH, BTMs, immune parameters, and other biochemical parameters were measured at baseline and one month after each dose.

RESULTS

Of the 30 very elderly Chinese patients who had been recruited into the study, 27 (90.0%) had their vitamin D deficiency corrected, and 26 (86.7%) reached vitamin D sufficiency. The mean time (±SD) was 3.1 (±1.3) months for vitamin D deficiency to be corrected, and 6.1 (±0.8) months for vitamin D sufficiency to be reached. The mean (±SD) serum level of 25(OH)D2 increased from 0.69 (±1.51) ng/mL to 29.07 (±5.68) ng/mL, while the mean (±SD) serum level of 25(OH)D3 decreased from 9.82 (±2.75) ng/mL to 5.30 (±3.09) ng/mL (both P < 0.001). The total T cells in serum remained unchanged (P > 0.05), and the CD4 and B cells (CD19+) were increased significantly (both P < 0.05). In addition, no significant change was observed in the serum levels of iPTH and BTMs.

CONCLUSION

Monthly intramuscular injection of 600,000 IU vitamin D2 is an effective and safe dosing regimen to reach vitamin D sufficiency and enhances immune function in the very elderly Chinese patients with vitamin D deficiency.

Twelve-Week Daily Consumption of ad hoc Fortified Milk with ω-3, D, and Group B Vitamins Has a Positive Impact on Inflammaging Parameters: A Randomized Cross-Over Trial

Background and Aim: A state of chronic, subclinical inflammation known as inflammaging is present in elderly people and represents a risk factor for all age-related diseases. Dietary supplementation with ad hoc fortified foods seems an appealing strategy to counteract inflammaging. The purpose of this study was to test the efficacy of elderly-tailored fortified milk on inflammaging and different health parameters. Methods: A double-blind randomized cross-over study was performed on forty-eight volunteers aged 63–80 years. The fortified milk was enriched with ω-3 polyunsaturated fatty acids (eicosapentaenoic acid, EPA; docosahexaenoic acid, DHA), vitamins (25-hydroxyvitamin D, E, C, B6, B9, B12), and trace elements (zinc, selenium). The two intervention periods lasted for 12 weeks, with a 16-week washout intermission. Results: Compared to placebo, the consumption of fortified milk increased the circulating levels of different micronutrients, including vitamins and the ω-3 index of erythrocyte membranes. Conversely, it reduced the amount of arachidonic acid, homocysteine, and ω-6/ω-3 ratio. Conclusion: Twelve-week daily consumption of adhoc fortified milk has an overall positive impact on different health parameters related to inflammaging in the elderly.

Age-Related Changes and Sex-Related Differences in Brain Iron Metabolism

Iron is an essential element that participates in numerous cellular processes. Any disruption of iron homeostasis leads to either iron deficiency or iron overload, which can be detrimental for humans' health, especially in elderly. Each of these changes contributes to the faster development of many neurological disorders or stimulates progression of already present diseases. Age-related cellular and molecular alterations in iron metabolism can also lead to iron dyshomeostasis and deposition. Iron deposits can contribute to the development of inflammation, abnormal protein aggregation, and degeneration in the central nervous system (CNS), leading to the progressive decline in cognitive processes, contributing to pathophysiology of stroke and dysfunctions of body metabolism. Besides, since iron plays an important role in both neuroprotection and neurodegeneration, dietary iron homeostasis should be considered with caution. Recently, there has been increased interest in sex-related differences in iron metabolism and iron homeostasis. These differences have not yet been fully elucidated. In this review we will discuss the latest discoveries in iron metabolism, age-related changes, along with the sex differences in iron content in serum and brain, within the healthy aging population and in neurological disorders such as multiple sclerosis, Parkinson's disease, Alzheimer's disease, and stroke.

Hypovitaminosis D in the Greek Elderly Population Doesn't Concern Only Patients with Hip Fracture

Introduction

Vitamin D (VD) deficiency seems to be an underestimated public health issue, especially in countries with a significant duration of sunlight throughout the year, as in this sunny Mediterranean region where this cross-sectional observational study was held. This study was conducted to assess the hypothesis that a higher prevalence of hypovitaminosis D exists in the elderly population with a hip fracture as compared with patients with knee/hip osteoarthritis or lumbar spondylosis in a south-western Mediterranean region.

Methods

This study included 61 consecutive patients with a mean age of 83 years who sustained a hip fracture (Group A). Sixty patients, with an average age of 73 years, who suffered from degenerative hip/knee osteoarthritis or lumbar spondylosis were subsequently selected as the control group (Group B). Parathyroid hormone (PTH) and 25-hydroxy VD blood levels were measured.

Results

Ninety-six point seven percent (96.7%; 59/61) of the individuals with hip fracture and 81.7% (49/60) in the controls were found with abnormal VD values (<30 ng/ml). The comparison of vitamin D values between the total samples of group A and B revealed a statistically significant difference (unpaired t-test, p<0.0001) while both male (p=0.0049) and female (p<0.0001) individuals in group A also showed statistically significant lower VD levels than their counterparts did. In addition, increased levels of parathormone were observed in women of group A (p=0.0016) and, therefore, for group A in the total sample (p=0.0004) while no statistical significance was observed in males (p=0.7712). Age was found to be an independent risk factor for VD deficiency in both groups (Group A p=0.04, Group B p=0.043). It is noteworthy that only four patients from group B (6, 67%) and none from group A had undergone blood tests for VD and PTH evaluation before hospital admission.

Conclusions

Τhe results confirmed the initial hypothesis of the study. Although VD hypovitaminosis concerns the majority of elderly living in this south-western Mediterranean region, the authors suggest VD and PTH measurements regardless of annual insolation, to identify and counsel the elderly with an increased risk of hip fracture and to avoid perioperative complications in patients who undergo elective orthopedic surgeries.

Effects of vitamin D supplementation on 25(OH)D levels and blood pressure in the elderly: a systematic review and meta-analysis

Background: Hypertension and vitamin D deficiency are prevalent among the elderly. This study evaluated the effects of vitamin D supplementation on changes in serum 25-hydroxyvitamin D (25(OH)D) levels and blood pressure (BP) in the elderly (age > 60 years). Methods: Randomized controlled trials from electronic databases on the elderly taking oral vitamin D, until the end of March 2019, were selected. Two reviewers independently screened the literature on the basis of specific inclusion criteria. The primary outcomes were serum 25(OH)D level, systolic BP (SBP), and diastolic BP (DBP) changes. Results: Our analysis revealed significant differences in serum 25(OH)D level changes between the vitamin D and control groups (mean difference [MD] = 13.84; 95% confidence interval [CI] = 10.21-17.47; P < 0.000). There were no significant differences in SBP and DBP changes between the vitamin D and control groups. Subgroup analysis revealed significant differences in SBP changes between the hypertensive and vitamin D-deficient subgroups (MD = -4.01; 95% CI = -7.45 to -0.57; P = 0.02 and MD = -1.91; 95% CI = -3.48 to -0.34; P = 0.02, respectively), and DBP changes only in the hypertensive subgroup (MD = -2.22; 95% CI = -4.1 to -0.34; P = 0.02). Conclusions: Vitamin D supplementation significantly increases 25(OH)D levels and seems beneficial in lowering BP, specifically in the elderly with elevated BP and vitamin D deficiency.

Effects of vitamin D supplementation on 25(OH)D levels and blood pressure in the elderly: a systematic review and meta-analysis

Background: Hypertension and vitamin D deficiency are prevalent among the elderly. This study evaluated the effects of vitamin D supplementation on changes in serum 25-hydroxyvitamin D (25(OH)D) levels and blood pressure (BP) in the elderly (age > 60 years). Methods: Randomized controlled trials from electronic databases on the elderly taking oral vitamin D, until the end of March 2019, were selected. Two reviewers independently screened the literature on the basis of specific inclusion criteria. The primary outcomes were serum 25(OH)D level, systolic BP (SBP), and diastolic BP (DBP) changes. Results: Our analysis revealed significant differences in serum 25(OH)D level changes between the vitamin D and control groups (mean difference [MD] = 13.84; 95% confidence interval [CI] = 10.21-17.47; P < 0.000). There were no significant differences in SBP and DBP changes between the vitamin D and control groups. Subgroup analysis revealed significant differences in SBP changes between the hypertensive and vitamin D-deficient subgroups (MD = -4.01; 95% CI = -7.45 to -0.57; P = 0.02 and MD = -1.91; 95% CI = -3.48 to -0.34; P = 0.02, respectively), and DBP changes only in the hypertensive subgroup (MD = -2.22; 95% CI = -4.1 to -0.34; P = 0.02). Conclusions: Vitamin D supplementation significantly increases 25(OH)D levels and seems beneficial in lowering BP, specifically in the elderly with elevated BP and vitamin D deficiency.

Effects of vitamin D supplementation on 25(OH)D concentrations and blood pressure in the elderly: a systematic review and meta-analysis

Background: Hypertension and vitamin D deficiency are prevalent among the elderly. This study evaluated the effects of vitamin D supplementation on changes in serum 25-hydroxyvitamin D (25(OH)D) concentrations and blood pressure (BP) in the elderly (age > 60 years). Methods: Randomized controlled trials from electronic databases on the elderly taking oral vitamin D, until the end of March 2019, were selected. Two reviewers independently screened the literature on the basis of specific inclusion criteria. The primary outcomes were serum 25(OH)D level, systolic BP (SBP), and diastolic BP (DBP) changes. Results: Our analysis revealed significant differences in serum 25(OH)D concentrations changes between the vitamin D and control groups (mean difference [MD] = 13.84; 95% confidence interval [CI] = 10.21-17.47; P < 0.000). There were no significant differences in SBP and DBP changes between the vitamin D and control groups. Subgroup analysis revealed significant differences in SBP changes between the hypertensive and vitamin D-deficient subgroups (MD = -4.01; 95% CI = -7.45 to -0.57; P = 0.02 and MD = -1.91; 95% CI = -3.48 to -0.34; P = 0.02, respectively), and DBP changes only in the hypertensive subgroup (MD = -2.22; 95% CI = -4.1 to -0.34; P = 0.02). Conclusions: Vitamin D supplementation significantly increases 25(OH)D concentrations and seems beneficial in lowering BP, specifically in the elderly with elevated BP and vitamin D deficiency.

Effect of Vitamin D2 Fortification Using Pleurotus ostreatus in a Whole-Grain Cereal Product on Child Acceptability

Vitamin D₂ deficiency is one of the most common micronutrient insufficiencies among children. Few foods, mainly those derived from animal sources, naturally contain this vitamin. The basidiomycete mushroom Pleurotus ostreatus could be used as an innovative and sustainable ingredient for food fortification with vitamin D₂. This study was aimed at exploring children’s acceptance of a whole-cereal-based product (breadsticks) combined with increasing concentrations of P. ostreatus powder rich in vitamin D₂. The food neophobia trait (fear of trying unfamiliar and new food) on sample acceptability was also investigated. One hundred and three children (47 girls and 56 boys, aged 9–11 years) were recruited, and breadstick-liking was studied in relation to gender and neophobic traits. Results showed that the samples enriched in vitamin D₂ were well accepted by children even if liking decreased with increasing concentration of mushroom powder. Generally, neophilic subjects gave higher liking scores compared with the neophobic ones, especially for the modified samples. New, well-accepted fortified products could be developed using an adequate concentration of mushroom powder to deal with the increasing vitamin D₂ deficiency among children.