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van den Heuvel EG, Lips P, Schoonmade LJ, Lanham-New SA, van Schoor NM. Comparison of the Effect of Daily Vitamin D2 and Vitamin D3 Supplementation on Serum 25-Hydroxyvitamin D Concentration (Total 25(OH)D, 25(OH)D2, and 25(OH)D3) and Importance of Body Mass Index: A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100133. [PMID: 37865222 PMCID: PMC10831883 DOI: 10.1016/j.advnut.2023.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/23/2023] [Accepted: 09/26/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Two previous meta-analyses showed smaller differences between vitamin D3 and vitamin D2 in raising serum 25-hydroxyvitamin D [25(OH)D] and a consistently high heterogeneity when only including daily dosing studies. OBJECTIVE This study aimed to compare more frequently dosed vitamin D2 and vitamin D3 in improving total 25(OH)D and determine the concomitant effect of response modifiers on heterogeneity, and secondly, to compare the vitamin D2-associated change in 25(OH)D2 with the vitamin D3-associated change in 25(OH)D3. METHODS PubMed, EMBASE, Cochrane, and the Web of Science Core collection were searched for randomized controlled trials of vitamin D2 compared with vitamin D3, daily or once/twice weekly dosed. After screening for eligibility, relevant data were extracted for meta-analyses to determine the standardized mean difference when different methods of 25(OH)D analyses were used. Otherwise, the weighted mean difference (WMD) was determined. RESULTS Overall, the results based on 20 comparative studies showed vitamin D3 to be superior to vitamin D2 in raising total 25(OH)D concentrations, but vitamin D2 and vitamin D3 had a similar positive impact on their corresponding 25(OH)D hydroxylated forms. The WMD in change in total 25(OH)D based on 12 daily dosed vitamin D2-vitamin D3 comparisons, analyzed using liquid chromatography-tandem mass spectrometry, was 10.39 nmol/L (40%) lower for the vitamin D2 group compared with the vitamin D3 group (95% confidence interval: -14.62, -6.16; I2 = 64%; P < 00001). Body mass index (BMI) appeared to be the strongest response modifier, reducing heterogeneity to 0% in both subgroups. The vitamin D2- and vitamin D3-induced change in total 25(OH)D lost significance predominantly in subjects with a BMI >25 kg/m2 (P = 0.99). However, information on BMI was only available in 13/17 daily dosed comparisons. CONCLUSIONS Vitamin D3 leads to a greater increase of 25(OH)D than vitamin D2, even if limited to daily dose studies, but vitamin D2 and vitamin D3 had similar positive impacts on their corresponding 25(OH)D hydroxylated forms. Next to baseline 25(OH)D concentration, BMI should be considered when comparing the effect of daily vitamin D2 and vitamin D3 supplementation on total 25(OH)D concentration. This study was registered in PROSPERO as CRD42021272674.
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Affiliation(s)
| | - Paul Lips
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine, Endocrine section, Amsterdam, The Netherlands
| | - Linda J Schoonmade
- Vrije Universiteit Amsterdam, Medical Library, Amsterdam, The Netherlands
| | - Susan A Lanham-New
- Department of Nutrition, Food & Exercise Sciences, University of Surrey, Faculty of Health & Medical Sciences, School of Biosciences, United Kingdom.
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
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Indhavivadhana S, Boonyachan W, Rattanachaiyanont M, Wongwananuruk T, Techatraisak K, Sa-Nga-Areekul N. Effectiveness of vitamin D2 supplementation on high-sensitivity C-reactive protein and other metabolic indices in menopausal Thai women: a randomized-controlled trial. Gynecol Endocrinol 2022; 38:83-89. [PMID: 34704877 DOI: 10.1080/09513590.2021.1988560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness of vitamin D2 supplementation with ergocalciferol on high-sensitivity C-reactive protein (hsCRP) level and other cardio-metabolic indices in menopausal Thai women. MATERIALS AND METHODS A double-blind, randomized, placebo-controlled trial was conducted at the menopause clinic of a university hospital in Thailand from May 2017 to 2018. Participants were 80 postmenopausal women randomly assigned to treatment (N = 40, receiving vitamin D2 40,000 IU/week) or control (N = 40, receiving placebo) for 12 weeks. The primary outcome was hsCRP level, and secondary outcomes were cardio-metabolic profiles and 10-year risk of developing cardiovascular disease using the Framingham risk score. The changes from baseline to week-12 (Δ) of all outcomes were analyzed using a modified intention-to-treat (ITT) population. RESULTS The vitamin D2 (N = 39) and placebo (N = 37) groups were comparable in all baseline characteristics. The hsCRP level was significantly reduced in the vitamin D2 group (Δ of -0.39 ± 1.30 mg/L, p = .024) but not in the placebo group (Δ of -0.15 ± 1.15 mg/L, p = .521). However, the Δ of hsCRP had no statistical difference between groups; neither did the Δ of other cardio-metabolic parameters. CONCLUSION In menopausal Thai women, vitamin D2 supplementation with ergocalciferol 40,000 IU/week for 12 weeks can reduce hsCRP level; and the treatment might be superior to placebo. However, the hsCRP levels after 12 weeks between both groups were not statistically different. Clinical Trial Registration: Thai Clinical Trials Registry (TCTR20161216001).
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Affiliation(s)
- Suchada Indhavivadhana
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Worawat Boonyachan
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manee Rattanachaiyanont
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanyarat Wongwananuruk
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kitirat Techatraisak
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nutchaya Sa-Nga-Areekul
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Meshkini F, Soltani S, Clark CCT, Tam V, Meyre D, Toupchian O, Saraf-Bank S, Abdollahi S. The effect of vitamin D supplementation on serum levels of fibroblast growth factor- 23: A systematic review and meta-analysis of randomized controlled trials. J Steroid Biochem Mol Biol 2022; 215:106012. [PMID: 34710560 DOI: 10.1016/j.jsbmb.2021.106012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/18/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022]
Abstract
Previous studies of the effect of vtamin D on serum levels of fibroblast growth factor- 23 (FGF-23) have yeilded an inconsistent findings. This systematic review and meta-analysis of randomized controlled trials (RCTs) sought to investigate the effect of vitamin D supplementation on serum levels of FGF-23. PubMed, Scopus, ISI Web of Science, and the Cochrane Library were searched, from database inception to November 2020, for RCTs that evaluated the effects of native or active vitamin D supplementation on serum levels of FGF-23 in adults. Weighted mean difference (WMD) were calculated and random effects meta-analysis was used to estimate the overall effects. Twenty-seven trials were included in the meta-analysis. Supplementation with native vitamin D (23 studies, n = 2247 participants; weighted mean difference [WMD] = 0.5 pg/mL, 95 % CI: -0.52 to 1.51, P = 0.33; I2 = 29.9 %), and active vitamin D (5 studies, n = 342 participants, WMD = 29.45 pg/mL, 95 % CI: -3.9 to 62.81, P = 0.08; I2 = 99.3%) had no significant effects on serum FGF-23 concentration. In subgroup analyses, supplementation with ergocalciferol (3 studies, n = 205 participants; WMD = 18.27 pg/mL, 95 % CI: 5.36-31.17, P = 0.006), and daily dosing regimens (9 studies, n = 1374 participants; WMD = 0.41 pg/mL, 95 % CI: 0.22 to 0.59, P < 0.001) increased serum FGF-23 levels compared to control. Overall, our findings revealed no significan effect of vitamin D supplementation on serum FGF-23 concentration. However, further high quality, large-scale studies are needed to better elucidate this relationship.
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Affiliation(s)
- Fatemeh Meshkini
- Department of Biochemistry, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Vivian Tam
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - David Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Omid Toupchian
- Department of Nutrition, School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sahar Saraf-Bank
- Food Security Research Center, Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shima Abdollahi
- Department of Nutrition, School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran.
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Arenas Jimenez MD, González-Parra E, Riera M, Rincón Bello A, López-Herradón A, Cao H, Hurtado S, Collado S, Ribera L, Barbosa F, Dapena F, Torregrosa V, Broseta JJ, Soto Montañez C, Navarro-González JF, Ramos R, Bover J, Nogués-Solan X, Crespo M, Dusso AS, Pascual J. Mortality in Hemodialysis Patients with COVID-19, the Effect of Paricalcitol or Calcimimetics. Nutrients 2021; 13:nu13082559. [PMID: 34444716 PMCID: PMC8401800 DOI: 10.3390/nu13082559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In COVID-19 patients, low serum vitamin D (VD) levels have been associated with severe acute respiratory failure and poor prognosis. In regular hemodialysis (HD) patients, there is VD deficiency and markedly reduced calcitriol levels, which may predispose them to worse outcomes of COVID-19 infection. Some hemodialysis patients receive treatment with drugs for secondary hyperparathyroidism, which have well known pleiotropic effects beyond mineral metabolism. The aim of this study was to evaluate the impact of VD status and the administration of active vitamin D medications, used to treat secondary hyperparathyroidism, on survival in a cohort of COVID-19 positive HD patients. METHODS A cross-sectional retrospective observational study was conducted from 12 March to 21 May 2020 in 288 HD patients with positive PCR for SARS-CoV2. Patients were from 52 different centers in Spain. RESULTS The percent of HD patients with COVID-19 was 6.1% (288 out of 4743). Mortality rate was 28.4% (81/285). Three patients were lost to follow-up. Serum 25(OH)D (calcidiol) level was 17.1 [10.6-27.5] ng/mL and was not significantly associated to mortality (OR 0.99 (0.97-1.01), p = 0.4). Patients receiving active vitamin D medications (16/94 (17%) vs. 65/191(34%), p = 0.003), including calcimimetics (4/49 (8.2%) vs. 77/236 (32.6%), p = 0.001), paricalcitol or calcimimetics (19/117 (16.2%) vs. 62/168 (36.9%); p < 0.001), and also those on both paricalcitol and calcimimetics, to treat secondary hyperparathyroidism (SHPTH) (1/26 (3.8%) vs. 80/259 (30.9%), p < 0.001) showed a lower mortality rate than patients receiving no treatment with either drug. Multivariate Cox regression analysis confirmed this increased survival. CONCLUSIONS Our findings suggest that the use of paricalcitol, calcimimetics or the combination of both, seem to be associated with the improvement of survival in HD patients with COVID-19. No correlation was found between serum VD levels and prognosis or outcomes in HD patients with COVID-19. Prospective studies and clinical trials are needed to support these findings.
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Affiliation(s)
- María Dolores Arenas Jimenez
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
- Fundación Renal Iñigo Alvarez de Toledo, 28003 Madrid, Spain
- Correspondence:
| | | | - Marta Riera
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Abraham Rincón Bello
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Ana López-Herradón
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Higini Cao
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Sara Hurtado
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Silvia Collado
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Laura Ribera
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Francesc Barbosa
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Fabiola Dapena
- Department of Nephrology, Consorci Sanitari Alt Penedes Garraf, 08800 Barcelona, Spain; (F.D.); (J.-J.B.)
| | - Vicent Torregrosa
- Department of Nephrology and Kidney Transplantation, Hospital Clinic, 08036 Barcelona, Spain; (V.T.); (C.S.M.)
| | - José-Jesús Broseta
- Department of Nephrology, Consorci Sanitari Alt Penedes Garraf, 08800 Barcelona, Spain; (F.D.); (J.-J.B.)
| | - Carlos Soto Montañez
- Department of Nephrology and Kidney Transplantation, Hospital Clinic, 08036 Barcelona, Spain; (V.T.); (C.S.M.)
| | - Juan F. Navarro-González
- Research Division and Department of Nephrology, Hospital Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38010 Tenerife, Spain
- Red de Investigación Renal (REDINREN–RD16/0009/0022), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Rosa Ramos
- Fresenius Medical Care, Dirección Médica FMC, 28760 Madrid, Spain; (A.R.B.); (A.L.-H.); (S.H.); (L.R.); (R.R.)
| | - Jordi Bover
- Department of Nephrology, Hospital Can Ruti, 08916 Barcelona, Spain;
| | - Xavier Nogués-Solan
- Department of Internal Medicine, Hospital del Mar, Institut Mar for Medical Research, CIBERFES, 08003 Barcelona, Spain;
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
| | - Adriana S. Dusso
- Bone and Mineral Research Unit, Instituto de Investigaciones Sanitarias del Principado de Asturias, 33011 Oviedo, Spain;
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, RD16/0009/0013 (ISCIII FEDER REDinREN), 08003 Barcelona, Spain; (M.R.); (H.C.); (S.C.); (F.B.); (M.C.); (J.P.)
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Ding Y, Hu P, Yang Y, Xu F, Li F, Lu X, Xie Z, Wang Z. Impact of Maternal Daily Oral Low-Dose Vitamin A Supplementation on the Mother-Infant Pair: A Randomised Placebo-Controlled Trial in China. Nutrients 2021; 13:nu13072370. [PMID: 34371880 PMCID: PMC8308679 DOI: 10.3390/nu13072370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The nutritional status of vitamin A in lactating mothers and infants is still not optimistic. Due to the dietary habits and dietary restrictions of postpartum customs in China, vitamin A supplementation has been advocated as a potential strategy to improve vitamin A status of lactating mothers with inadequate dietary vitamin A intake. Existing clinical trials are limited to single or double high-dose maternal administrations. However, in China, vitamin A supplements are readily available in the form of daily oral low-dose supplements, and the effect of these is unknown. This study aimed to evaluate the effects of daily oral low-dose vitamin A supplementation on the retinol levels in the serum and breast milk of lactating mothers and the health status of infants in China. METHODS Lactating mothers who met the inclusion criteria and planned to continue exclusive breastfeeding were randomly assigned to receive either daily oral vitamin A and D drops (one soft capsule of 1800 IU vitamin A and 600 IU vitamin D2), or a matching placebo for 2 months. Before and after the intervention, dietary intake was investigated by instant photography, and the retinol concentration in maternal serum and breast milk was determined by ultra-high performance liquid chromatography-tandem mass spectrometry. During the trial, the health status of infants was diagnosed by a paediatrician or reported by lactating mothers. A total of 245 participants completed the study, with 117 in the supplementation group and 128 in the control group. RESULTS After the 2-month intervention, maternal serum retinol concentrations increased in the supplementation group with no change in the control group. Although breast milk retinol concentrations decreased significantly in both groups, the decrease in the supplementation group was significantly lower than that in the control group. However, maternal vitamin A supplementation was not associated with a lower risk of infant febrile illness, respiratory tract infection, diarrhoea, and eczema. CONCLUSIONS Daily oral low-dose vitamin A supplementation is helpful in improving maternal vitamin A status, despite having no effect on infant health status through breast milk.
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Mimura LAN, Fraga-Silva TFDC, de Oliveira LRC, Ishikawa LLW, Borim PA, Machado CDM, Júnior JDADCEH, da Fonseca DM, Sartori A. Preclinical Therapy with Vitamin D3 in Experimental Encephalomyelitis: Efficacy and Comparison with Paricalcitol. Int J Mol Sci 2021; 22:ijms22041914. [PMID: 33671896 PMCID: PMC7918993 DOI: 10.3390/ijms22041914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS). MS and its animal model called experimental autoimmune encephalomyelitis (EAE) immunopathogenesis involve a plethora of immune cells whose activation releases a variety of proinflammatory mediators and free radicals. Vitamin D3 (VitD) is endowed with immunomodulatory and antioxidant properties that we demonstrated to control EAE development. However, this protective effect triggered hypercalcemia. As such, we compared the therapeutic potential of VitD and paricalcitol (Pari), which is a non-hypercalcemic vitamin D analog, to control EAE. From the seventh day on after EAE induction, mice were injected with VitD or Pari every other day. VitD, but not Pari, displayed downmodulatory ability being able to reduce the recruitment of inflammatory cells, the mRNA expression of inflammatory parameters, and demyelination at the CNS. Lower production of proinflammatory cytokines by lymph node-derived cells and IL-17 by gut explants, and reduced intestinal inflammation were detected in the EAE/VitD group compared to the EAE untreated or Pari groups. Dendritic cells (DCs) differentiated in the presence of VitD developed a more tolerogenic phenotype than in the presence of Pari. These findings suggest that VitD, but not Pari, has the potential to be used as a preventive therapy to control MS severity.
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Affiliation(s)
- Luiza Ayumi Nishiyama Mimura
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil; (T.F.d.C.F.-S.); (L.R.C.d.O.); (L.L.W.I.); (A.S.)
- Correspondence:
| | - Thais Fernanda de Campos Fraga-Silva
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil; (T.F.d.C.F.-S.); (L.R.C.d.O.); (L.L.W.I.); (A.S.)
| | - Larissa Ragozzo Cardoso de Oliveira
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil; (T.F.d.C.F.-S.); (L.R.C.d.O.); (L.L.W.I.); (A.S.)
| | - Larissa Lumi Watanabe Ishikawa
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil; (T.F.d.C.F.-S.); (L.R.C.d.O.); (L.L.W.I.); (A.S.)
| | - Patrícia Aparecida Borim
- Botucatu Medical School, Department of Tropical Diseases and Image Diagnosis, São Paulo State University (UNESP), Botucatu 18618-687, Brazil;
| | - Carla de Moraes Machado
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil; (C.d.M.M.); (J.d.A.d.C.eH.J.)
| | - José de Anchieta de Castro e Horta Júnior
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil; (C.d.M.M.); (J.d.A.d.C.eH.J.)
| | - Denise Morais da Fonseca
- Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo (USP), São Paulo 05508-000, Brazil;
| | - Alexandrina Sartori
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil; (T.F.d.C.F.-S.); (L.R.C.d.O.); (L.L.W.I.); (A.S.)
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Massimetti C, Bellasi A, Feriozzi S. [Cholecalciferol supplementation improves secondary hyperparathyroidism control in hemodialysis patients]. G Ital Nefrol 2020; 37:37-03-2020-11. [PMID: 32530156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction: Vitamin D deficiency is common among hemodialysis (HD) patients and is an important component in the pathogenesis of secondary hyperparathyroidism (SHPT). We herein report our experience on the impact of cholecalciferol supplementation on PTH levels in a group of HD patients. Patients and methods: We selected 122 HD patients. The main selection criteria were 25- hydroxyvitamin D (25(OH)D) levels ≤30 ng/mL and SHPT defined as PTH levels >300 pg/mL or PTH levels between 150-300 pg/mL during therapy with cinacalcet or paricalcitol. 82 patients agreed to receive cholecalciferol at the fixed dose of 25,000 IU per week orally for 12 months, while the remaining 40 represented the control group. The main endopoints of the study were the reduction in PTH levels ≥30% compared to baseline values and the increase of 25(OH)D levels to values >30 ng/mL. Results: At follow-up PTH levels decreased in the supplemented group from 476 ±293 to 296 ± 207 pg/mL (p<0.001), 25(OH)D levels increased from 10.3 ± 5.7 to 33.5 ± 11.2 ng/mL (p<0.001), serum calcium increased from 8.6 ± 0.5 to 8.8 ± 0.6 mg/dL (p<0.05) while serum phosphorus did not change. In this group the mean doses of paricalcitol were significantly reduced, from 8.7 ± 4.0 to 6.1 ± 3.9 µg/week (p<0.001). Moreover, in this group there were a significant increase of hemoglobin levels, from 11.6 ± 1.3 to 12.2 ± 1.1 g/dL (p <0.01) and a significant reduction of erythropoietin doses (p<0.05). In the control group the 25(OH)D and PTH levels did not change, while cinacalcet doses increased from 21 ±14 to 43 ± 17 mg/d (p<0.01). Conclusions: Vitamin deficiency is very common in HD patients. Cholecalciferol treatment significantly increased serum 25(OH)D levels, significantly decreased PTH levels and paricalcitol doses, concurrently entailing a better control of anemia.
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Affiliation(s)
- Carlo Massimetti
- Centro di Riferimento di Nefrologia e Dialisi, Ospedale Belcolle, Viterbo, Italy
| | - Antonio Bellasi
- Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sandro Feriozzi
- Centro di Riferimento di Nefrologia e Dialisi, Ospedale Belcolle, Viterbo, Italy
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Ahmed LHM, Butler AE, Dargham SR, Latif A, Robay A, Chidiac OM, Jayyousi A, Al Suwaidi J, Crystal RG, Atkin SL, Abi Khalil C. Association of vitamin D 2 and D 3 with type 2 diabetes complications. BMC Endocr Disord 2020; 20:65. [PMID: 32414363 PMCID: PMC7227254 DOI: 10.1186/s12902-020-00549-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/10/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Vitamin D measurement is a composite of vitamin D2 (25(OH)D2) and D3 (25(OH)D3) levels, and its deficiency is associated with the development of type 2 diabetes (T2DM) and diabetic complications; vitamin D deficiency may be treated with vitamin D2 supplements. This study was undertaken to determine if vitamin D2 and D3 levels differed between those with and without T2DM in this Middle Eastern population, and the relationship between diabetic microvascular complications and vitamin D2 and vitamin D3 levels in subjects with T2DM. METHODS: Four hundred ninety-six Qatari subjects, 274 with and 222 without T2DM participated in the study. Plasma levels of total vitamin D2 and D3 were measured by LC-MS/MS analysis. RESULTS All subjects were taking vitamin D2 and none were taking D3 supplements. Vitamin D2 levels were higher in diabetics, particularly in females, and higher levels were associated with hypertension and dyslipidemia in the diabetic subjects (p < 0.001), but were not related to diabetic retinopathy or nephropathy. Vitamin D3 levels measured in the same subjects were lower in diabetics, particularly in females (p < 0.001), were unrelated to dyslipidemia or hypertension, but were associated with retinopathy (p < 0.014). Neither vitamin D2 nor vitamin D3 were associated with neuropathy. For those subjects with hypertension, dyslipidemia, retinopathy or neuropathy, comparison of highest with lowest tertiles for vitamin D2 and vitamin D3 showed no difference. CONCLUSIONS In this Qatari cohort, vitamin D2 was associated with hypertension and dyslipidemia, whilst vitamin D3 levels were associated with diabetic retinopathy. Vitamin D2 levels were higher, whilst vitamin D3 were lower in diabetics and females, likely due to ingestion of vitamin D2 supplements.
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Affiliation(s)
| | - Alexandra E Butler
- Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), PO Box 34110, Doha, Qatar.
| | | | - Aishah Latif
- Antidoping Laboratory Qatar, PO Box 27775, Doha, Qatar
| | - Amal Robay
- Weill Cornell Medicine-Qatar, PO Box 24144, Doha, Qatar
| | | | | | | | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell Medicine, New York, USA
| | - Stephen L Atkin
- Weill Cornell Medicine-Qatar, PO Box 24144, Doha, Qatar
- Royal College of Surgeons Ireland, Busaiteen, Bahrain
| | - Charbel Abi Khalil
- Weill Cornell Medicine-Qatar, PO Box 24144, Doha, Qatar
- Department of Genetic Medicine, Weill Cornell Medicine, New York, USA
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9
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Proserpio C, Lavelli V, Gallotti F, Laureati M, Pagliarini E. Effect of Vitamin D 2 Fortification Using Pleurotus ostreatus in a Whole-Grain Cereal Product on Child Acceptability. Nutrients 2019; 11:nu11102441. [PMID: 31614966 PMCID: PMC6835449 DOI: 10.3390/nu11102441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Cristina Proserpio
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy.
| | - Vera Lavelli
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy.
| | - Francesca Gallotti
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy.
| | - Monica Laureati
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy.
| | - Ella Pagliarini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy.
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10
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Rodríguez-Rodríguez E, Aparicio Vizuete A, Sánchez-Rodríguez P, Lorenzo Mora AM, López-Sobaler AM, Ortega RM. [Vitamin D deficiency in Spanish population. Importance of egg on nutritional improvement]. NUTR HOSP 2019; 36:3-7. [PMID: 31368328 DOI: 10.20960/nh.02798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Vitamin D is an essential nutrient whose deficiency has been associated with the risk of various chronic diseases such as osteoporosis, hypertension, cardiovascular disease, diabetes, some types of cancer and even overweight and obesity. Although vitamin D can be synthesized at the skin from exposure to sunlight, this source is not always sufficient to meet the needs. For example, the use of sunscreen or the low exposition to the sunlight limits the syntheses. In fact, studies have found that at least half of the Spanish population has vitamin D deficits. Therefore, the dietary contribution is fundamental. Although there are different foods fortified in this vitamin, few products are natural source of it, as fatty fish and eggs. However, according to different studies carried out in the Spanish population, there is a low consumption of this food group. In this way, it would be advisable to promote egg consumption among the population, since this food, in addition to having many nutrients, contains a high amount of vitamin D, which contributes to avoid the appearance of deficiencies and the consequences health consequences that this implies.
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11
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Abstract
OBJECTIVE To investigate whether vitamin D supplementation is associated with lower mortality in adults. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, and the Cochrane Central Register from their inception to 26 December 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials comparing vitamin D supplementation with a placebo or no treatment for mortality were included. Independent data extraction was conducted and study quality assessed. A meta-analysis was carried out by using fixed effects and random effects models to calculate risk ratio of death in the group receiving vitamin D supplementation and the control group. MAIN OUTCOME MEASURES All cause mortality. RESULTS 52 trials with a total of 75 454 participants were identified. Vitamin D supplementation was not associated with all cause mortality (risk ratio 0.98, 95% confidence interval 0.95 to 1.02, I2=0%), cardiovascular mortality (0.98, 0.88 to 1.08, 0%), or non-cancer, non-cardiovascular mortality (1.05, 0.93 to 1.18, 0%). Vitamin D supplementation statistically significantly reduced the risk of cancer death (0.84, 0.74 to 0.95, 0%). In subgroup analyses, all cause mortality was significantly lower in trials with vitamin D3 supplementation than in trials with vitamin D2 supplementation (P for interaction=0.04); neither vitamin D3 nor vitamin D2 was associated with a statistically significant reduction in all cause mortality. CONCLUSIONS Vitamin D supplementation alone was not associated with all cause mortality in adults compared with placebo or no treatment. Vitamin D supplementation reduced the risk of cancer death by 16%. Additional large clinical studies are needed to determine whether vitamin D3 supplementation is associated with lower all cause mortality. STUDY REGISTRATION PROSPERO registration number CRD42018117823.
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Affiliation(s)
- Yu Zhang
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Fang Fang
- West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Jingjing Tang
- Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Lu Jia
- Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yuning Feng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Ping Xu
- Sichuan University Library, Chengdu, Sichuan, China
| | - Andrew Faramand
- University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
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12
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Abstract
OBJECTIVES To assess the effect of vitamin D2 and to elucidate the underlying mechanisms on acute myocardial injury induced by isoproterenol (ISO) in diabetic rats. METHODS Rats were divided into control rats, diabetic rats (DM), diabetic rats received ISO (DM-ISO), and diabetic rats pretreated with vitamin D2 and received ISO (DM-D2-ISO). RESULTS Vitamin D2 pretreatment significantly decreased fasting glucose and myocardial malondialdehyde, associated with increased insulin, myocardial glutathione and superoxide dismutase in DM-D2-ISO versus DM-ISO. The serum triglycerides, total cholesterol, and LDL were significantly decreased, along with increased HDL and adiponectin. Poly-ADP ribose polymerase, cyclooxygenase-2, tumour necrosis factor alpha, interleukin-6, caspase-3, BAX, and p53 were significantly downregulated in myocardium of DM-D2-ISO versus DM-ISO. Histological studies showed diminished inflammatory cells infiltration in myocardium of DM-D2-ISO versus DM-ISO. CONCLUSION Vitamin D2 ameliorates hyperglycaemia, dyslipidaemia, redox imbalance, inflammatory and apoptotic processes, protecting the myocardium of diabetic rats against acute myocardial infarction.
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Affiliation(s)
- Sahar M El Agaty
- a Physiology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt
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13
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Larner DP, Jenkinson C, Chun RF, Westgate CSJ, Adams JS, Hewison M. Free versus total serum 25-hydroxyvitamin D in a murine model of colitis. J Steroid Biochem Mol Biol 2019; 189:204-209. [PMID: 30710745 PMCID: PMC6502676 DOI: 10.1016/j.jsbmb.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/03/2018] [Accepted: 01/24/2019] [Indexed: 01/04/2023]
Abstract
Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn's disease have been linked to vitamin D-deficiency. Using a dextran sodium sulphate (DSS)-induced model of IBD we have shown previously that mice raised on vitamin D-deficient diets from weaning have lower serum 25-hydroxyvitamin D (25OHD) levels and develop more severe colitis compared to vitamin D-sufficient counterparts. We have also shown in vitro that immune responses to 25OHD may depend on 'free' rather than total serum concentrations of 25OHD. To investigate the possible effects of free versus total 25OHD on anti-inflammatory immune responses in vivo we have studied DSS-induced colitis in wild type C57BL/6 mice raised from weaning on diets containing vitamin D2 (D2) or vitamin D3 (D3) only (both 1000 IU/kg feed). 25OHD2 has lower binding affinity for the vitamin D binding protein than 25OHD3 which results in higher levels of free 25OHD2 relative to free 25OHD3 in mice raised on a D2-only diet. Total serum 25OHD concentrations, measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), showed that D2 mice had significantly lower levels of 25OHD than D3 mice (6.85 ± 2.61 nmol/L vs. 49.16 ± 13.8 nmol/L for D2 and D3 respectively). Despite this, direct ELISA measurement showed no difference in free serum 25OHD levels between D2 and D3 mice (13.62 ± 2.26 pmol/L vs. 14.11 ± 2.24 pmol/L for D2 and D3 respectively). Analysis of DSS-induced colitis also showed no difference in weight loss or disease progression between D2 and D3 mice. These data indicate that despite D2-fed mice being vitamin D-deficient based on serum total 25OHD concentrations, these mice showed no evidence of increased inflammatory colitis disease relative to vitamin D-sufficient D3 mice. We therefore propose that free, rather than total serum 25OHD, may be a better marker of immune responses to vitamin D in vivo.
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Affiliation(s)
- D P Larner
- Institute of Metabolism and Systems Research, the University of Birmingham, Birmingham, B15 2TT, UK
| | - C Jenkinson
- Institute of Metabolism and Systems Research, the University of Birmingham, Birmingham, B15 2TT, UK
| | - R F Chun
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - C S J Westgate
- Institute of Metabolism and Systems Research, the University of Birmingham, Birmingham, B15 2TT, UK
| | - J S Adams
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - M Hewison
- Institute of Metabolism and Systems Research, the University of Birmingham, Birmingham, B15 2TT, UK.
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14
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Villa-Bellosta R, Mahillo-Fernández I, Ortíz A, González-Parra E. Questioning the Safety of Calcidiol in Hemodialysis Patients. Nutrients 2019; 11:nu11050959. [PMID: 31035488 PMCID: PMC6566618 DOI: 10.3390/nu11050959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022] Open
Abstract
Background. Epidemiological studies have suggested a survival benefit for hemodialysis patients on paricalcitol or calcitriol, but nutritional vitamin D supplementation of patients already on vitamin D receptor (VDR) activators is controversial. Methods. This observational retrospective cohort study was conducted with prospectively collected data from all consecutive patients with chronic kidney disease (CKD) who underwent hemodialysis under routine clinical practice conditions for two years. Results. Of the 129 patients, 89 were treated with calcidiol, paricalcitol, and/or calcitriol. The patients with any vitamin D formulation had higher serum concentrations of 25-hydroxy vitamin D and fibroblast growth factor-23 and tended to have higher mortality rates (42% vs. 25%, p = 0.07). On subgroup analysis, any calcidiol treatment or calcidiol combined with paricalcitol associated with significantly higher mortality rates than no treatment (47% and 62.5%, p = 0.043 and 0.008, respectively). The association between calcidiol/paricalcitol treatment and elevated mortality remained significant after adjusting for age, sex, diabetes, C-reactive protein, and hemodialysis vintage. Any calcidiol and calcidiol/paricalcitol treatment exhibited a dose-response relationship with mortality (p for trend: 0.002 and 0.005, respectively). Conclusions. These data draw attention to the hitherto unexplored safety of calcidiol supplementation in patients on hemodialysis, especially in those already on vitamin D. Until clinical trials demonstrate the safety and efficacy of this approach, caution should be exercised when prescribing these patients ≥0.5 calcidiol mg/month.
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Affiliation(s)
- Ricardo Villa-Bellosta
- Renal Division, Fundación Instituto de Investigación Sanitaria Fundación Jiménez Díaz (FIIS-FJD), Avenida Reyes Católicos 2, 29040, Madrid, Spain.
| | - Ignacio Mahillo-Fernández
- Biostatistics and Epidemiology Unit, Fundación Instituto de Investigación Sanitaria Fundación Jiménez Díaz (FIIS-FJD), 29040, Madrid, Spain.
| | - Alberto Ortíz
- Renal Division, Fundación Instituto de Investigación Sanitaria Fundación Jiménez Díaz (FIIS-FJD), Avenida Reyes Católicos 2, 29040, Madrid, Spain.
- Fundación Renal, Íñigo Álvarez de Toledo, 28003 Madrid, Spain.
- Renal Division, IIS-Fundación Jiménez Díaz y Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain.
| | - Emilio González-Parra
- Renal Division, Fundación Instituto de Investigación Sanitaria Fundación Jiménez Díaz (FIIS-FJD), Avenida Reyes Católicos 2, 29040, Madrid, Spain.
- Renal Division, IIS-Fundación Jiménez Díaz y Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain.
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15
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Massimetti C, Imperato G, Feriozzi S. [Correction of secondary hyperparathyroidism with paricalcitol in renal transplant improves left ventricular hypertrophy]. G Ital Nefrol 2019; 36:36-1-2019-10. [PMID: 30758155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is common in renal transplant recipients (RTRs), and persistent secondary hyperparathyroidism (SHPT) is considered to be one of the main causes of its pathogenesis. In this study we evaluated if the control of SHPT with paricalcitol is associated with a reduction of LVH in RTRs. METHODS For this purpose we selected 24 RTRs with LVH and SHPT. Secondary hyperparathyroidism was defined as PTH levels 1.5 times higher than the high normal limits, while LVH was defined as a left ventricular mass index (LVMi) >95g/m2 in females, and >115g/m2 in males. Treatment with paricalcitol started at mean dose of 1µg/day and lasted 18 months. The dose of paricalcitol was reduced to 1µg on the other day when serum calcium was >10.5mg/dl and/or fractional excretion of calcium was >0.020%; administration was temporarily stopped when serum calcium was >11 mg/dl. RESULTS At follow-up PTH levels decreased from 198 ± 155 to 105 ± 43pg/ml, and LVMi decreased from 134 ± 21 to 113 ± 29g/m2; the presence of LVH decreased from 100% at baseline to 54% at F-U. Serum calcium levels showed a modest and not significant increase. Renal function was stable in all patients. CONCLUSIONS Secondary hyperparathyroidism seems to play an important role in the development and maintenance of LVH and its correction with paricalcitol has a favorable impact on its progression.
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Affiliation(s)
- Carlo Massimetti
- Centro di Riferimento di Nefrologia e Dialisi, Ospedale Belcolle, Viterbo
| | - Gea Imperato
- Centro di Riferimento di Nefrologia e Dialisi, Ospedale Belcolle, Viterbo
| | - Sandro Feriozzi
- Centro di Riferimento di Nefrologia e Dialisi, Ospedale Belcolle, Viterbo
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16
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Bashardoust B, Zakeri A, Fouladi N, Izadi Z, Hosseini F. Treatment Effect of Ergocalciferol on Bone Metabolism Indexes and Parathyroid Hormone in Hemodialysis Patients. Iran J Kidney Dis 2018; 12:359-363. [PMID: 30595565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/05/2018] [Accepted: 05/19/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Vitamin D deficiency is a common problem in end-stage renal disease patients under hemodialysis. Both active and nutritional vitamin D supplementation have been recommended for its treatment. In this study we aimed to evaluate the effects of treatment with ergocalciferol on bone metabolism indexes in hemodialysis patients. MATERIALS AND METHODS In a randomized controlled trial, 40 hemodialysis patients were randomly allocated to the intervention (n = 20) and placebo (n = 20) groups. During the study, 4 patients in the placebo and 1 in the intervention group were excluded. Patients received calcitriol, 0.25 mg/d, with ergocalciferol, 50 000 IU, or placebo weekly for 3 months. Serum levels of 25-hydroxyvitamin D, calcium, parathyroid hormone, and alkaline phosphatase were measured before and after treatment. RESULTS 25-hydroxyvitamin D levels were significantly improved in the intervention group (12.00 ± 4.90 ng/mL versus 29.89 ± 9.48 ng/mL, P < .001), but the placebo group had no improvement (14.23 ± 7.62 ng/mL versus 13.87 ± 8.04 ng/mL, P > .05). There was no significant changes in serum calcium, parathyroid hormone, or alkaline phosphatase levels in each group. Eight patients (42.1%) in the intervention compared to zero cases in the placebo group had normal 25-hydroxyvitamin D levels after treatment (P = .004). No cases of hypercalcemia were seen in the studied patients. CONCLUSIONS Treatment with ergocalciferol could significantly improve vitamin D deficiency with no significant effects of serum calcium or parathyroid hormone levels.
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Affiliation(s)
| | | | | | - Zeinab Izadi
- Department of Internal Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
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17
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Fountzilas C, Javle M, Tan W, Ma Y, Fetterly G, Iyer R, Johnson C. A phase 1, open-label, dose escalation study of intravenous paricalcitol in combination with gemcitabine in patients with advanced malignancies. Cancer 2018; 124:3890-3899. [PMID: 30299542 PMCID: PMC11009835 DOI: 10.1002/cncr.31676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/17/2018] [Accepted: 06/11/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Calcitriol, the active analogue of vitamin D, is antiproliferative and enhances the cytotoxicity of several anticancer agents, including gemcitabine. The vitamin D receptor (VDR) is expressed in the tumor stroma and treatment with VDR ligands results in stromal remodeling and increased intratumoral gemcitabine delivery. Furthermore, calcitriol can decrease the activity of the gemcitabine deactivating enzyme cytidine deaminase (CDD). Because hypercalcemia has been the most worrisome calcitriol-related adverse event, the less hypercalcemic agent paricalcitol may be preferred for further investigation. METHODS The authors undertook a phase 1 study of gemcitabine in combination with escalating doses of paricalcitol administered weekly intravenously in patients with advanced cancers. A standard 3+3 dose escalation schema was used. Pharmacokinetic assessment of gemcitabine and its metabolite 2',2'-difluorodeoxyuridine (dFdU) was performed. Pharmacodynamic assessment of paricalcitol was performed by measurement of CDD activity in peripheral blood mononuclear cells. RESULTS A total of 44 patients were enrolled. Somnolence was the main dose-limiting toxicity. The highest dose of paricalcitol administered was 10.5 µg/kg. Hypercalcemia was infrequent and mild in severity. Paricalcitol did not appear to affect the pharmacokinetics of gemcitabine and dFdU. Evaluation of CDD activity was available for 9 patients; no clear trend for CDD activity after treatment with paricalcitol was established. The overall response rate was 4%; the rate of disease control was 67% in patients who were pretreated with gemcitabine. Progression-free and overall survival were 3.4 months and 6.5 months, respectively. CONCLUSIONS Paricalcitol can be administered safely in doses up to 7 µg/kg weekly with fixed dose rate gemcitabine without dose-limiting hypercalcemia. To the best of the authors' knowledge, the maximum tolerated dose has not been formally established to date. Preliminary clinical activity deserves further exploration.
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Affiliation(s)
- Christos Fountzilas
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Tan
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Yingyu Ma
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Gerald Fetterly
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Renuka Iyer
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Candace Johnson
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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18
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Duffy SK, Kelly AK, Rajauria G, Jakobsen J, Clarke LC, Monahan FJ, Dowling KG, Hull G, Galvin K, Cashman KD, Hayes A, O'Doherty JV. The use of synthetic and natural vitamin D sources in pig diets to improve meat quality and vitamin D content. Meat Sci 2018; 143:60-68. [PMID: 29715661 DOI: 10.1016/j.meatsci.2018.04.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/28/2018] [Accepted: 04/16/2018] [Indexed: 01/14/2023]
Abstract
This study investigated the effects of synthetic and natural sources of vitamin D biofortification in pig diets on pork vitamin D activity and pork quality. One hundred and twenty pigs (60 male, 60 female) were assigned to one of four dietary treatments for a 55 d feeding period. The dietary treatments were (1)50 μg vitamin D₃/kg of feed; (2)50 μg of 25-hydroxvitamin D₃/kg of feed (25-OH-D₃); (3)50 μg vitamin D₂/kg of feed; (4)50 μg vitamin D₂-enriched mushrooms/kg of feed (Mushroom D₂). The pigs offered the 25-OH-D₃ diet exhibited the highest (P < 0.001) serum total 25-hydroxyvitamin D concentration and subsequently exhibited the highest (P < 0.05) Longissimus thoracis (LT) total vitamin D activity. Mushroom D2 and 25-OH-D3 supplementation increased pork antioxidant status. The vitamin D₂-enriched mushrooms improved (P < 0.05) pig performance, carcass weight and LT colour. In conclusion, 25-OH-D₃ is the most successful source for increasing pork vitamin D activity, while Mushroom D2 may be a new avenue to improve animal performance and pork quality.
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Affiliation(s)
- Sarah K Duffy
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Alan K Kelly
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gaurav Rajauria
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Jette Jakobsen
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Louise C Clarke
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Frank J Monahan
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Kirsten G Dowling
- Cork Centre for Vitamin D and Nutritional Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - George Hull
- Cork Centre for Vitamin D and Nutritional Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Karen Galvin
- Cork Centre for Vitamin D and Nutritional Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutritional Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Aoife Hayes
- Cork Centre for Vitamin D and Nutritional Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - John V O'Doherty
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland.
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Jakobsen J, Andersen EAW, Christensen T, Andersen R, Bügel S. Vitamin D Vitamers Affect Vitamin D Status Differently in Young Healthy Males. Nutrients 2017; 10:E12. [PMID: 29295513 PMCID: PMC5793240 DOI: 10.3390/nu10010012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 01/25/2023] Open
Abstract
Dietary intake of vitamin D includes vitamin D3 (vitD3), 25-hydroxyvitamin D3 (25OH-D3), and vitamin D2 (vitD2). However, the bioactivity of the different species has not been scientifically established. The hypothesis in this study was that vitD3, 25OH-D3, and vitD2 have an equal effect on 25-hydroxyvitamin D in serum (vitamin D status). To test our hypothesis, we performed a randomized, crossover study. Twelve young males consumed 10 µg/day vitD3 during a four-week run-in period, followed by 3 × 6 weeks of 10 µg/day vitD3, 10 µg/day 25OH-D3, and 10 µg/day vitD2. The content of vitD3, vitD2, 25OH-D3, and 25-hydroxyvitamin D2 (25OH-D2) in serum was quantified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The hypothesis that the three sources of vitamin D affect vitamin D status equally was rejected. Based on the assumption that 1 µg vitD3/day will show an increase in vitamin D status of 1.96 nmol/L, the results showed that 23 µg vitD2 and 6.8 µg 25OH-D3 was similar to 10 µg vitD3. These results demonstrate that further investigations are necessary to determine how to quantify the total vitamin D activity based on chemical quantification of the individual vitamin D metabolites to replace the total vitamin D activity assessed in biological rat models.
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Affiliation(s)
- Jette Jakobsen
- National Food Institute, Technical University of Denmark, 2800 Lyngby, Denmark.
| | | | - Tue Christensen
- National Food Institute, Technical University of Denmark, 2800 Lyngby, Denmark.
| | - Rikke Andersen
- National Food Institute, Technical University of Denmark, 2800 Lyngby, Denmark.
| | - Susanne Bügel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark.
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Ciebiera M, Łukaszuk K, Męczekalski B, Ciebiera M, Wojtyła C, Słabuszewska-Jóźwiak A, Jakiel G. Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids-An Up-to-Date Review. Int J Mol Sci 2017; 18:ijms18122586. [PMID: 29194370 PMCID: PMC5751189 DOI: 10.3390/ijms18122586] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/18/2023] Open
Abstract
Uterine fibroids (UFs) are the most common tumors of the female genital tract. The effect of UFs on the quality of life and the overall cost of treatment are significant issues worldwide. Tumor size and location are the two specific factors which influence the occurrence of symptoms, the need for, and method of, treatment (some tumors require surgery while some can be treated with selected drugs). Primary prevention and treatment of early UF disease are worthy goals that might have a great impact on health care systems. Several treatments and prophylactic methods can be used in this endeavor. This publication presents current data about lesser-known substances which may have a beneficial effect on the treatment or prophylaxis of UFs and can be administered orally, serving as an alternative to (or complement of) surgery or selective progesterone receptor modulators (SPRMs). Early prevention and treatment of UFs in women from high-risk groups should be our priority. Innovative forms of UF management are under intensive investigation and may be promising options in the near future. Many of them evaluated vitamin D, paricalcitol, epigallocatechin gallate (EGCG), elagolix, aromatase inhibitors (AIs), and cabergoline and deemed them to be safe and effective. The next step in such projects should be properly constructed randomized control trials (RCTs), carried out by successive phases.
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Affiliation(s)
- Michał Ciebiera
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Krzysztof Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland.
- INVICTA Fertility and Reproductive Center, 80-172 Gdansk, Poland.
| | - Błażej Męczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-513 Poznan, Poland.
| | - Magdalena Ciebiera
- Students' Scientific Association at the I Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Cezary Wojtyła
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Aneta Słabuszewska-Jóźwiak
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Grzegorz Jakiel
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
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Abstract
BACKGROUND Vitamin D deficiency is often reported in people with chronic liver diseases. Therefore, improving vitamin D status could have a beneficial effect on people with chronic liver diseases. OBJECTIVES To assess the beneficial and harmful effects of vitamin D supplementation in people with chronic liver diseases. SEARCH METHODS We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded, and Conference Proceedings Citation Index - Science. We also searched databases of ongoing trials and the World Health Organization International Clinical Trials Registry Platform. We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials. All searches were up to January 2017. SELECTION CRITERIA Randomised clinical trials that compared vitamin D at any dose, duration, and route of administration versus placebo or no intervention in adults with chronic liver diseases. Vitamin D could have been administered as supplemental vitamin D (vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol)), or an active form of vitamin D (1α-hydroxyvitamin D (alfacalcidol), 25-hydroxyvitamin D (calcidiol), or 1,25-dihydroxyvitamin D (calcitriol)). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. We contacted authors of the trials to ask for missing information. We conducted random-effects and fixed-effect meta-analyses. For dichotomous outcomes, we calculated risk ratios (RRs), and for continuous outcomes, we calculated mean differences (MD), both with 95% confidence intervals (CI) and Trial Sequential Analyses-adjusted CIs. We calculated Peto odds ratio (OR) for rare events. We considered risk of bias in domains to assess the risk of systematic errors. We conducted Trial Sequential Analyses to control the risk of random errors. We assessed the quality of the evidence with GRADE. MAIN RESULTS We included 15 randomised clinical trials with 1034 participants randomised. All trials had a parallel group design. Nine trials were conducted in high-income countries and six trials in middle-income countries. All trials were at high risk of bias. Six trials included participants with chronic hepatitis C, four trials included participants with liver cirrhosis, four trials included participants with non-alcoholic fatty liver disease, and one trial included liver transplant recipients. All included trials reported the baseline vitamin D status of participants. Participants in six trials had baseline 25-hydroxyvitamin D levels at or above vitamin D adequacy (20 ng/mL), while participants in the remaining nine trials were vitamin D insufficient (less than 20 ng/mL). All trials administered vitamin D orally. Mean duration of vitamin D supplementation was 0.5 years and follow-up was 0.6 years. Eleven trials (831 participants; 40% women; mean age 52 years) tested vitamin D3, one trial (18 men; mean age 61 years) with three intervention groups tested vitamin D2 and 25-dihydroxyvitamin D in separate groups, and three trials (185 participants; 55% women; mean age 55 years) tested 1,25-dihydroxyvitamin D. Seven trials used placebo, and eight trials used no intervention in the control group.The effect of vitamin D on all-cause mortality at the end of follow-up is uncertain because the results were imprecise (Peto OR 0.70, 95% CI 0.09 to 5.38; I2 = 32%; 15 trials; 1034 participants; very low quality evidence). Trial Sequential Analysis on all-cause mortality was performed based on a mortality rate in the control group of 10%, a relative risk reduction of 28% in the experimental intervention group, a type I error of 2.5%, and type II error of 10% (90% power). There was no diversity. The required information size was 6396 participants. The cumulative Z-curve did not cross the trial sequential monitoring boundary for benefit or harm after the 15th trial, and the Trial Sequential Analyses-adjusted CI was 0.00 to 2534.The effect of vitamin D on liver-related mortality (RR 1.62, 95% CI 0.08 to 34.66; 1 trial; 18 participants) and on serious adverse events such as hypercalcaemia (RR 5.00, 95% CI 0.25 to 100.8; 1 trial; 76 participants), myocardial infarction (RR 0.75, 95% CI 0.08 to 6.81; 2 trials; 86 participants), and thyroiditis (RR 0.33 95% CI 0.01 to 7.91; 1 trial; 68 participants) is uncertain because the results were imprecise. The evidence on all these outcomes is of very low quality. The effect of vitamin D3 on non-serious adverse events such as glossitis (RR 3.70, 95% CI 0.16 to 87.6; 1 trial; 65 participants; very low quality of evidence) is uncertain because the result was imprecise.Due to few data, we did not conduct Trial Sequential Analysis on liver-related mortality, and serious and non-serious adverse events.We found no data on liver-related morbidity and health-related quality of life in the randomised trials included in this review. AUTHORS' CONCLUSIONS We are uncertain as to whether vitamin D supplements in the form of vitamin D3, vitamin D2, 1,25-dihydroxyvitamin D, or 25-dihydroxyvitamin D have important effect on all-cause mortality, liver-related mortality, or on serious or non-serious adverse events because the results were imprecise. There is no evidence on the effect of vitamin D supplementation on liver-related morbidity and health-related quality of life. Our conclusions are based on few trials with an insufficient number of participants and on lack of data on clinically important outcomes. In addition, the analysed trials are at high risk of bias with significant intertrial heterogeneity. The overall quality of evidence is very low.
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Affiliation(s)
- Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
- Clinical Centre NisClinic of Gastroenterology and HepatologyBoulevard Dr Zorana Djindjica 48NisSerbia18000
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Marko Bjelakovic
- University of NisMedical FacultyBoulevard Dr Zorana Djindjica 81NisSerbia18000
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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McCullough P, Heaney R. Correction of vitamin D deficiency using sublingually administered vitamin D2 in a Crohn's disease patient with mal-absorption and a new ileostomy. J Steroid Biochem Mol Biol 2017; 173:211-214. [PMID: 28049025 DOI: 10.1016/j.jsbmb.2016.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/21/2022]
Abstract
Vitamin D deficiency has been shown to be associated with many adverse health problems. Studies have shown that patients with Crohn's disease who have low vitamin D levels have a poorer quality of life than those with more adequate levels. It has also been shown that patients with mal-absorption problems have a difficult time achieving normal vitamin D levels in spite of aggressive supplementation, and that exposure to UVB radiation may be the most effective treatment option for these patients. We present a case in which 25-hydroxyvitamin D levels were normalized within 2 weeks in a severely vitamin D deficient patient with Crohn's disease with mal-absorption and a new ileostomy, utilizing sublingually administered vitamin D2. A 58 year-old white female was admitted with a new ileostomy following partial bowel resection due to complications from Crohn's disease. She was found to be severely vitamin D deficient at the time of admission, with a level of 6.1ng/ml on hospital day 3. Her treatment with vitamin D was delayed for a few days. She was initially treated with 5000 units of vitamin D3 orally twice a day for 3days (days 7-10). After discussion with the patient and obtaining her consent, vitamin D3 was stopped, and she was then treated with a total of 8 doses of 50,000 units of vitamin D2 administered sublingually. She was given the first 3 doses on alternating days (days 11, 13, 15), and then 5 more doses on consecutive days (days 17-21). The rise in her 25-hydroxyvitamin D level in response to treatment with sublingual vitamin D2 was significant. On day 10, after receiving 3days of orally administered vitamin D3, her level was 9.8ng/ml. One week later, after receiving 3 sublingual doses of vitamin D2, it rose to 20.3ng/ml. It was then measured on alternating days twice over the next 4days, and it rose to 45.5ng/ml, and then to 47.4ng/ml on the day of discharge to home. The major finding of this study is that sublingual administration of vitamin D2 appears to work effectively when intestinal absorption is impaired. The optimal dosing regimen still needs to be determined for the average Crohn's disease patient.
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Affiliation(s)
| | - Robert Heaney
- Creighton University, Omaha, NE, 68102, United States
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23
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King RJ, Chandrajay D, Abbas A, Orme SM, Barth JH. High-dose oral colecalciferol loading in obesity: impact of body mass index and its utility prior to bariatric surgery to treat vitamin D deficiency. Clin Obes 2017; 7:92-97. [PMID: 28146321 DOI: 10.1111/cob.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/07/2016] [Accepted: 11/20/2016] [Indexed: 12/18/2022]
Abstract
Obesity is associated with lower vitamin D levels compared with normal weight subjects, and if levels are not replaced prior to bariatric surgery, this can increase fracture risk as bone density typically falls post-operatively. We analysed the effect of body mass index (BMI) on vitamin D levels in response to 300 000 IU of colecalciferol in patients with vitamin D deficiency (<30 nmol L-1 ). Patients were grouped according to their BMI as normal weight (20-24.9 kg m-2 ), overweight (25-29.9 kg m-2 ), obese class I (30-34.9 kg m-2 ) and obese class II and above (>35 kg m-2 ). The records were retrospectively analysed to investigate the effects of BMI on vitamin D (total 25-hydroxy vitamin D [25(OH)D]), serum Ca2+ and parathyroid hormone (PTH) levels at 6, 12, 26 and 52 weeks compared with baseline. Compared with normal weight subjects, overweight and obese patients achieved lower mean peak total 25(OH)D levels (6 weeks post-loading), which was most significant in the class II and above group (mean total 25(OH)D levels 96.5 ± 24.2 nmol L-1 and 72.42 ± 24.9 nmol L-1 , respectively; P = 0.003). By 26 weeks, total 25(OH)D levels fell in all groups; however, there was now a significant difference between the normal weight subjects and all other groups (mean total 25(OH)D levels 84.1 ± 23.7 nmol L-1 ; 58 ± 20 nmol L-1 , P = 0.0002; 62.65 ± 19.2 nmol L-1 , P = 0.005; 59.2 ± 21 nmol L-1 , P = 0.005, respectively). Far fewer patients in the overweight and obese groups maintained levels above the recommended level of 75 nmol L-1 52 weeks post-loading (93%; 20%, P = 0.0003; 23%, P = 0.01; and 14%, P = 0.001, respectively). Alternative regimes for the treatment of vitamin D deficiency are needed in overweight and obese patients, especially those in whom bariatric surgery is planned.
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Affiliation(s)
- R J King
- Department of Endocrinology, St. James' University Hospital, Leeds, UK
| | - D Chandrajay
- Department of Endocrinology, St. James' University Hospital, Leeds, UK
- Department of Clinical Biochemistry, St. James' University Hospital, Leeds, UK
| | - A Abbas
- Department of Endocrinology, St. James' University Hospital, Leeds, UK
| | - S M Orme
- Department of Endocrinology, St. James' University Hospital, Leeds, UK
| | - J H Barth
- Department of Endocrinology, St. James' University Hospital, Leeds, UK
- Department of Clinical Biochemistry, St. James' University Hospital, Leeds, UK
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Jean G, Souberbielle JC, Chazot C. Vitamin D in Chronic Kidney Disease and Dialysis Patients. Nutrients 2017; 9:nu9040328. [PMID: 28346348 PMCID: PMC5409667 DOI: 10.3390/nu9040328] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022] Open
Abstract
Vitamin D deficiency (<20 ng/mL) and insufficiency (20–29 ng/mL) are common among patients with chronic kidney disease (CKD) or undergoing dialysis. In addition to nutritional and sunlight exposure deficits, factors that affect vitamin D deficiency include race, sex, age, obesity and impaired vitamin D synthesis and metabolism. Serum 1,25(OH)2D levels also decrease progressively because of 25(OH)D deficiency, together with impaired availability of 25(OH)D by renal proximal tubular cells, high fibroblast growth factor (FGF)-23 and decreased functional renal tissue. As in the general population, this condition is associated with increased morbidity and poor outcomes. Together with the progressive decline of serum calcitriol, vitamin D deficiency leads to secondary hyperparathyroidism (SHPT) and its complications, tertiary hyperparathyroidism and hypercalcemia, which require surgical parathyroidectomy or calcimimetics. Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease Improving Global Outcomes (KDIGO) experts have recognized that vitamin D insufficiency and deficiency should be avoided in CKD and dialysis patients by using supplementation to prevent SHPT. Many vitamin D supplementation regimens using either ergocalciferol or cholecalciferol daily, weekly or monthly have been reported. The benefit of native vitamin D supplementation remains debatable because observational studies suggest that vitamin D receptor activator (VDRA) use is associated with better outcomes and it is more efficient for decreasing the serum parathormone (PTH) levels. Vitamin D has pleiotropic effects on the immune, cardiovascular and neurological systems and on antineoplastic activity. Extra-renal organs possess the enzymatic capacity to convert 25(OH)D to 1,25(OH)2D. Despite many unanswered questions, much data support vitamin D use in renal patients. This article emphasizes the role of native vitamin D replacement during all-phases of CKD together with VDRA when SHPT persists.
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Affiliation(s)
- Guillaume Jean
- NephroCare Tassin Charcot, Sainte Foy les Lyon, 69110, France.
| | - Jean Claude Souberbielle
- Service d'explorations fonctionnelles, Hôpital Necker-Enfants malades, AP-HP, Paris 75015, France.
| | - Charles Chazot
- NephroCare Tassin Charcot, Sainte Foy les Lyon, 69110, France.
- F-CRIN, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialist, Vandoeuvre-lès-Nancy 54500, France.
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Torino C, Pizzini P, Cutrupi S, Tripepi G, Mallamaci F, Thadhani R, Zoccali C. Active vitamin D treatment in CKD patients raises serum sclerostin and this effect is modified by circulating pentosidine levels. Nutr Metab Cardiovasc Dis 2017; 27:260-266. [PMID: 28017524 DOI: 10.1016/j.numecd.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/06/2016] [Accepted: 11/14/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS 1,25(OH)2Vitamin D increases the expression of the sclerostin gene. Whether vitamin D receptor activation (VDRA) influences serum sclerostin in CKD and whether compounds interfering with VDRA like Advanced Glycosylation End Products (AGEs) may alter the sclerostin response to VDRA is unknown. METHODS AND RESULTS Eighty-eight stage G3-4 CKD patients randomly received 2 μg paricalcitol (PCT)/day (n = 44) or placebo (n = 44) for 12 weeks. Sclerostin, a major AGE compound like pentosidine, and bone mineral disorder biomarkers were measured at baseline, at 12 weeks and 2 weeks after stopping the treatments. At baseline, in the whole study population sclerostin correlated with male gender (P = 0.002), BMI (P < 0.001), waist circumference (P < 0.001), serum pentosidine (P = 0.002) and to a weaker extent, with diabetes (P = 0.04), 1,25(OH)2Vitamin D (r = 0.22, P = 0.04) and serum phosphate (r = -0.26, P = 0.01). Sclerostin increased during PCT treatment (average + 15.7 pg/ml, 95% CI: -3.0 to +34.3) but not during placebo (P = 0.03) and the PCT effect was abolished 2 weeks after stopping this drug. The increase in sclerostin levels induced by PCT was modified by prevailing pentosidine levels (P = 0.01) and was abolished by statistical adjustment for simultaneous changes in PTH but not by FGF23 changes. CONCLUSIONS VDRA by paricalcitol causes a moderate increase in serum sclerostin in CKD patients. Such an effect is abolished by adjustment for PTH, suggesting that it may serve to counter PTH suppression. The sclerostin rise by PCT is attenuated by pentosidine, an observation in keeping with in vitro studies showing that AGEs alter the functioning of the VDRA.
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Affiliation(s)
- C Torino
- CNR-IFC & Nephrology and Renal Transplantation Unit, Reggio Calabria, Italy
| | - P Pizzini
- CNR-IFC & Nephrology and Renal Transplantation Unit, Reggio Calabria, Italy
| | - S Cutrupi
- CNR-IFC & Nephrology and Renal Transplantation Unit, Reggio Calabria, Italy
| | - G Tripepi
- CNR-IFC & Nephrology and Renal Transplantation Unit, Reggio Calabria, Italy
| | - F Mallamaci
- CNR-IFC & Nephrology and Renal Transplantation Unit, Reggio Calabria, Italy
| | - R Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - C Zoccali
- CNR-IFC & Nephrology and Renal Transplantation Unit, Reggio Calabria, Italy.
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Penckofer S, Byrn M, Adams W, Emanuele MA, Mumby P, Kouba J, Wallis DE. Vitamin D Supplementation Improves Mood in Women with Type 2 Diabetes. J Diabetes Res 2017; 2017:8232863. [PMID: 29082262 PMCID: PMC5610883 DOI: 10.1155/2017/8232863] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/27/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the effect of vitamin D supplementation on improving mood (depression and anxiety) and health status (mental and physical) in women with type 2 diabetes mellitus (T2DM). METHODS Fifty women with T2DM and significant depressive symptomology were enrolled into the "Sunshine Study," where weekly vitamin D supplementation (ergocalciferol, 50,000 IU) was given to all participants for six months. The main outcomes included (1) depression (Center for Epidemiologic Studies Depression, CES-D, and Patient Health Questionnaire, PHQ-9), (2) anxiety (State-Trait Anxiety), and (3) health status (Short Form, SF-12). RESULTS Forty-six women (92%) completed all visits. There was a significant decrease in depression (CES-D and PHQ-9, p < 0.001) and anxiety (state and trait, p < 0.001). An improvement in mental health status (SF-12, p < 0.001) was also found. After controlling for covariates (race, season of enrollment, baseline vitamin D, baseline depression (PHQ-9), and body mass index), the decline in depression remained significant (CES-D, p < 0.001). There was a trend for a better response to supplementation for women who were not taking medications for mood (antidepressants or anxiolytics) (p = 0.07). CONCLUSIONS Randomized trials to confirm that vitamin D supplementation can improve mood and health status in T2DM women are needed.
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Affiliation(s)
- Sue Penckofer
- Loyola University Chicago, Health Sciences Campus, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Mary Byrn
- Loyola University Chicago, Health Sciences Campus, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - William Adams
- Loyola University Chicago, Health Sciences Campus, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Mary Ann Emanuele
- Loyola University Chicago, Health Sciences Campus, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Patricia Mumby
- Loyola University Chicago, Health Sciences Campus, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Joanne Kouba
- Loyola University Chicago, Health Sciences Campus, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Diane E. Wallis
- Advocate Medical Group, 3825 Highland Avenue, Suite 400, Downers Grove, IL 60515, USA
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Abstract
Falls are a major health problem in elderly individuals. Although intensive physical therapy and management of hazards in the home can reduce falls by 25%, long-term practicality limits their use. Interest in vitamin D as a medical therapy has led to many trials; however, results using daily oral doses of vitamin D have been inconsistent. In the past 5 years, studies on the effect of bolus doses of vitamin D have produced surprising results. Bolus doses of vitamin D, given annually (at a dose of 300,000 IU or 500,000 IU) or monthly (at a dose of 24,000 IU or 60,000 IU) - equivalent to approximate daily doses of 800 IU, 1400 IU and 2,000 IU - result in a significant increase in the number of falls and fractures associated with serum levels of 25-hydroxyvitamin D greater than 40-45 ng/ml (equivalent to 100-112 nmol/l). These unexpected results show increased falls and fractures are adverse events related to vitamin D administration. Until further safety data is available, bolus dosing or daily doses should not exceed 3,000 IU and serum levels of 25-hydroxyvitamin D should not exceed 40-45 ng/ml (equivalent to 100-112 nmol/l) in elderly individuals.
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Affiliation(s)
- J Christopher Gallagher
- Bone Metabolism Unit, Division of Endocrinology, Creighton University School of Medicine, 601 North 30th Street, Omaha, Nebraska 68131, USA
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Shieh A, Chun RF, Ma C, Witzel S, Meyer B, Rafison B, Swinkels L, Huijs T, Pepkowitz S, Holmquist B, Hewison M, Adams JS. Effects of High-Dose Vitamin D2 Versus D3 on Total and Free 25-Hydroxyvitamin D and Markers of Calcium Balance. J Clin Endocrinol Metab 2016; 101:3070-8. [PMID: 27192696 PMCID: PMC4971338 DOI: 10.1210/jc.2016-1871] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Controversy persists over: 1) how best to restore low serum 25-hydroxyvitamin D (25D) levels (vitamin D2 [D2] vs vitamin D3 [D3]); 2) how best to define vitamin D status (total [protein-bound + free] vs free 25D); and 3) how best to assess the bioactivity of free 25D. OBJECTIVE To assess: 1) the effects of D2 vs D3 on serum total and free 25D; and 2) whether change in intact PTH (iPTH) is more strongly associated with change in total vs free 25D. DESIGN Participants previously enrolled in a D2 vs D3 trial were matched for age, body mass index, and race/ethnicity. Participants received 50 000 IU of D2 or D3 twice weekly for 5 weeks, followed by a 5-week equilibration period. Biochemical assessment was performed at baseline and at 10 weeks. SETTING AND PARTICIPANTS Thirty-eight adults (19 D2 and 19 D3) ≥18 years of age with baseline 25D levels <30 ng/mL were recruited from an academic ambulatory osteoporosis clinic. OUTCOME MEASURES Serum measures were total 25D, free 25D (directly measured), 1,25-dihydroxyvitamin D, calcium, and iPTH. Urine measure was fasting calcium:creatinine ratio. RESULTS Baseline total (22.2 ± 3.3 vs 23.3 ± 7.2 ng/mL; P = .5) and free (5.4 ± 0.8 vs 5.3 ± 1.7 pg/mL; P = .8) 25D levels were similar between D2 and D3 groups. Increases in total (+27.6 vs +12.2 ng/mL; P = .001) and free (+3.6 vs +6.2 pg/mL; P = .02) 25D levels were greater with D3 vs D2. Percentage change in iPTH was significantly associated with change in free (but not total) 25D, without and with adjustment for supplementation regimen, change in 1,25-dihydroxyvitamin D, and change in calcium. CONCLUSIONS D3 increased total and free 25D levels to a greater extent than D2. Free 25D may be superior to total 25D as a marker of vitamin D bioactivity.
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Affiliation(s)
- Albert Shieh
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Rene F Chun
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Christina Ma
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Sten Witzel
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Briana Meyer
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Brandon Rafison
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Leon Swinkels
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Tonnie Huijs
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Sam Pepkowitz
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Brett Holmquist
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Martin Hewison
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - John S Adams
- Department of Medicine, Division of Geriatrics (A.S.), and Department of Orthopaedic Surgery (R.F.C., S.W., B.M., B.R., J.S.A.), University of California, Los Angeles, Los Angeles, California 90095; David Geffen School of Medicine (C.M.), Los Angeles, California 90095; Future Diagnostics (L.S., T.H.), 6603 BN Wijchen, The Netherlands; Esoterix, Inc. (S.P., B.H.), Austin, Texas 78744; and Institute of Metabolism and Systems Research (M.H.), The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
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Sprague SM, Covic AC, Floege J, Ketteler M, Botha J, Chong EM, Rastogi A. Pharmacodynamic Effects of Sucroferric Oxyhydroxide and Sevelamer Carbonate on Vitamin D Receptor Agonist Bioactivity in Dialysis Patients. Am J Nephrol 2016; 44:104-12. [PMID: 27434393 DOI: 10.1159/000447600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/08/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many patients with chronic kidney disease are prescribed vitamin D receptor agonists (VDRAs) for the management of secondary hyperparathyroidism. Oral phosphate binders may interact with, and potentially reduce the therapeutic activity of, oral VDRAs. This post hoc analysis of a Phase 3 study evaluated the pharmacodynamic effects of the iron-based phosphate binder sucroferric oxyhydroxide (SFOH) and sevelamer (SEV) carbonate on VDRA activity in dialysis patients. METHODS One thousand and fifty nine patients were randomized to SFOH 1.0-3.0 g/day (n = 710) or SEV 2.4-14.4 g/day (n = 349) for up to 52 weeks. Potential interactions of SFOH and SEV with VDRAs were assessed using serum intact parathyroid hormone (iPTH) concentrations as a pharmacodynamic biomarker. Three populations of SFOH- and SEV-treated patients were analyzed: Population 1 (n = 187), patients taking concomitant stable doses of oral VDRAs only; Population 2 (n = 250), patients taking no concomitant VDRAs; Population 3 (n = 68), patients taking concomitant stable doses of intravenous paricalcitol only. Populations were compared using a mixed-effects model to obtain the least squares mean change in iPTH from baseline to Week 52. Differences between treatment groups were also compared. RESULTS In Population 1, iPTH decreased from baseline to Week 52 in the SFOH group (-25.3 pg/ml) but increased in the SEV group (89.8 pg/ml) (p = 0.02). In Population 2, iPTH increased to a similar extent in both treatment groups. In Population 3, iPTH concentrations in both treatment groups decreased to a similar degree (-29.6 and -11.4 pg/ml for SFOH and SEV, respectively; p = 0.87). CONCLUSIONS In contrast with SEV, SFOH did not appear to impact the iPTH-lowering effect of oral VDRAs.
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Affiliation(s)
- Stuart M Sprague
- NorthShore University Health System, University of Chicago, Chicago, Ill., USA
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Forouhi NG, Menon RK, Sharp SJ, Mannan N, Timms PM, Martineau AR, Rickard AP, Boucher BJ, Chowdhury TA, Griffiths CJ, Greenwald SE, Griffin SJ, Hitman GA. Effects of vitamin D2 or D3 supplementation on glycaemic control and cardiometabolic risk among people at risk of type 2 diabetes: results of a randomized double-blind placebo-controlled trial. Diabetes Obes Metab 2016; 18:392-400. [PMID: 26700109 PMCID: PMC4950066 DOI: 10.1111/dom.12625] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 11/30/2015] [Accepted: 12/17/2015] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the effect of short-term vitamin D supplementation on cardiometabolic outcomes among individuals with an elevated risk of diabetes. METHODS In a double-blind placebo-controlled randomized trial, 340 adults who had an elevated risk of type 2 diabetes (non-diabetic hyperglycaemia or positive diabetes risk score) were randomized to either placebo, 100,000 IU vitamin D2 (ergocalciferol) or 100,000 IU vitamin D3 (cholecalciferol), orally administered monthly for 4 months. The primary outcome was change in glycated haemoglobin (HbA1c) between baseline and 4 months, adjusted for baseline. Secondary outcomes included: blood pressure; lipid levels; apolipoprotein levels; C-reactive protein levels; pulse wave velocity (PWV); anthropometric measures; and safety of the supplementation. RESULTS The mean [standard deviation (s.d.)] 25-hydroxyvitamin D [25(OH)D]2 concentration increased from 5.2 (4.1) to 53.9 (18.5) nmol/l in the D2 group, and the mean (s.d.) 25(OH)D3 concentration increased from 45.8 (22.6) to 83.8 (22.7) nmol/l in the D3 group. There was no effect of vitamin D supplementation on HbA1c: D2 versus placebo: -0.05% [95% confidence interval (CI) -0.11, 0.02] or -0.51 mmol/mol (95% CI -1.16, 0.14; p = 0.13); D3 versus placebo: 0.02% (95% CI -0.04, 0.08) or 0.19 mmol/mol (95% CI -0.46, 0.83; p = 0.57). There were no clinically meaningful effects on secondary outcomes, except PWV [D2 versus placebo: -0.68 m/s (95% CI -1.31, -0.05); D3 versus placebo -0.73 m/s (95% CI -1.42, -0.03)]. No important safety issues were identified. CONCLUSIONS Short-term supplementation with vitamin D2 or D3 had no effect on HbA1c. The modest reduction in PWV with both D2 and D3 relative to placebo suggests that vitamin D supplementation has a beneficial effect on arterial stiffness.
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Affiliation(s)
- N G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - R K Menon
- Blizard Institute, Queen Mary University of London, London, UK
| | - S J Sharp
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - N Mannan
- Blizard Institute, Queen Mary University of London, London, UK
| | - P M Timms
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - A R Martineau
- Blizard Institute, Queen Mary University of London, London, UK
| | - A P Rickard
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - B J Boucher
- Blizard Institute, Queen Mary University of London, London, UK
| | - T A Chowdhury
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Healthcare NHS Trust, London, UK
| | - C J Griffiths
- Blizard Institute, Queen Mary University of London, London, UK
| | - S E Greenwald
- Blizard Institute, Queen Mary University of London, London, UK
| | - S J Griffin
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - G A Hitman
- Blizard Institute, Queen Mary University of London, London, UK
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Nimitphong H, Samittarucksa R, Saetung S, Bhirommuang N, Chailurkit LO, Ongphiphadhanakul B. The Effect of Vitamin D Supplementation on Metabolic Phenotypes in Thais with Prediabetes. J Med Assoc Thai 2015; 98:1169-1178. [PMID: 27004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the effects of vitamin D supplement for three months on anthropometric and glucose homeostatic measures in Thai adults with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). MATERIAL AND METHOD Forty-seven IFG and/or IGT subjects enrolled in the study. Subjects were randomized into three groups, control (n = 18), vitamin D₂ (20,000 IU weekly, n = 19) or vitamin D₃ (15,000 IU weekly, n = 10). Anthropometric variables were obtained at baseline and at 3-month. Oral glucose tolerance test was performed at baseline and at 3-month. Total serum 25(OH)D, 25(OH)D₃, and 25(OH)D2 were measured by LC-MS/MS. Insulin resistance (HOMA-IR) and insulin secretion index (HOMA%B) were calculated by the homeostasis model assessment. RESULTS The total 25(OH)D levels significantly increased from baseline in both the vitamin D₂ and the vitamin D₃ groups, while there was no change in the control group. D₃ supplementation raised 25(OH)D₃ significantly (+13.7 ± 4.9 ng/mL, p < 0.01) while D2 increased 25(OH)D2 levels (+25.9?4.2 ng/mL, p<0.001) but with a decrease in 25(OH)D3 (-13.1?3.1 ng/mL, p<0. 001). Subjects were classified into two groups, i.e., control (n = 18) and D₂ or D₃ supplementations (n = 29). After three months, waist circumference (WC) significantly decreased in subjects of vitamin D supplementation group. Body weight (BW p = 0.05), systolic blood pressure (SBP, p = 0.05), body mass index (BM, p = 0.06), and HOMA-IR (p = 0.09) also tended to decrease. Subjects with an increase of total 25(OH)D levels > 10 ng/mL (23 of 29 subjects) had significant decrease in HOMA-IR and increase in disposition index. Using robust regression analysis, we found the use of D3 was associated with a larger decrease in WC (coefficient = -3.5, p < 0.001) independent of the change in total 25(OH)D and baseline BMI. No difference between D₂ and D₃ was observed for other metabolic measures. CONCLUSION Weekly supplementations of vitamin D₂ (20,000 IU) or vitamin D₃ (15,000 IU) improve metabolic phenotypes in subjects with prediabetes. D₃ supplement may decrease waist circumference more than D₂ supplement.
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Bunyaratavej N. Study of the Safe Dosage of Ergocalciferol. J Med Assoc Thai 2015; 98 Suppl 8:S13-S15. [PMID: 26529808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Vitamin D2 or ergocalciferol can replace vitamin D3, but its dosage must be a higher international unit: one unit of vitamin D3 is equal to 4 units ofvitamin D2. A proper interval of administration should take 200,000 IUper day. The 123 cases enrolled for study, every case had blood levels of 25 (OH) D and blood calcium checked before intake of vitamin D2 followed by a second check after 2 months. The means of before-intake group was 31.92 ng/ml and after-intake group was 48.62 ng/ml; the pair sample mean was 0.001. We found the level of 25 (OH) D was greater than 70 ng/ml (max = 90), 3.2 percent. Twelve cases showed no response, 9.6 percent. No cases of hypercalcemia or allergic phenomenon were noted. Before the study, we tried a random dosage of 200,000 IU per week and found the pair mean showed nothing significant (p = 0.052). In practice, the dosage of 200,000 IU of vitamin D2 is suitable for treatment of vitamin D deficiency, but for long-term treatment, dosage should be adjusted by monitoring the levels of 25 (OH) D from time to time.
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Thimachai P, Supasyndh O, Chaiprasert A, Satirapoj B. Efficacy of High vs. Conventional Ergocalciferol Dose for Increasing 25-Hydroxyvitamin D and Suppressing Parathyroid Hormone Levels in Stage III-IV CKD with Vitamin D Deficiency/Insufficiency: A Randomized Controlled Trial. J Med Assoc Thai 2015; 98:643-648. [PMID: 26267985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Vitamin D deficiency/insufficiency is common in chronic kidney disease (CKD) patients and it contributes to secondary hyperparathyroidism, which occurs early in CKD. It is not clear whether the Kidney Disease Outcomes Quality Initiative (K/DOQI) recommended doses of ergocalciferol are adequate for correction of vitamin D insufficiency and hyperparathyroidism. OBJECTIVE To evaluate the parathyroid hormone (PTH)-lowering effect, safety, and tolerability of high-dose ergocalciferol compared with conventional-dose ergocalciferol in CKD subjects. MATERIAL AND METHOD We enrolled CKD stage III-IV patients who had 25-hydroxyvitamin D (25-OH-D) level <30 ng/mL. The patients were randomized into two groups, control group treated with ergocalciferol as recommended by K/DOQI guidelines, and treatment group treated with double dosage of ergocalciferol from the recommendation. We compared serum 25-OH-D, intact-PTH, phosphate, calcium, and bone biomarker levels, during the 8-week intervention. RESULTS Sixty-eight patients were included (34 controls and 34 treatments). Baseline characteristics of both groups were similar except calcium level 9.12 ± 0.56 mg/dL in control group and 9.44 ± 0.38 mg/dL in treatment group (p = 0.009), but not clinically significant. At the end of the 8-week, the mean 25-OH-D level significantly increased from 20.99 ± 6.68 to 33.41 ± 8.92 ng/mL in the treatment group (p = 0.001) and increased from 20.84 ± 7.21 to 23.42 ± 7.89 ng/mL in the control group (p = 0.026). There was also a significantly greater increase of 25-OH-D levels in the treatment group. Additionally, PTH levels significantly decreased from 90.75 ± 67.12 to 76.40 ± 45.97 at 8 weeks (p = 0.024) in the treatment group, and there was no change in the control group (97.14 ± 83.52 vs. 101.13 ± 95.03 pg/mL, p = 0.546). Serum calcium, phosphate, and adverse effects did not significantly change in either group throughout the study. CONCLUSION In addition to improving vitamin D levels, oral high-dose ergocalciferol was safe and had a beneficial effect in decreasing PTH in patients with stage III-IV of CKD.
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Stavenuiter AWD, Arcidiacono MV, Ferrantelli E, Keuning ED, Vila Cuenca M, ter Wee PM, Beelen RHJ, Vervloet MG, Dusso AS. A novel rat model of vitamin D deficiency: safe and rapid induction of vitamin D and calcitriol deficiency without hyperparathyroidism. Biomed Res Int 2015; 2015:604275. [PMID: 25815325 PMCID: PMC4359872 DOI: 10.1155/2015/604275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/19/2015] [Indexed: 12/11/2022]
Abstract
Vitamin D deficiency is associated with a range of clinical disorders. To study the mechanisms involved and improve treatments, animal models are tremendously useful. Current vitamin D deficient rat models have important practical limitations, including time requirements when using, exclusively, a vitamin D deficient diet. More importantly, induction of hypovitaminosis D causes significant fluctuations in parathyroid hormone (PTH) and mineral levels, complicating the interpretation of study results. To overcome these shortcomings, we report the successful induction of vitamin D deficiency within three weeks, with stable serum PTH and minerals levels, in Wistar rats. We incorporated two additional manoeuvres compared to a conventional diet. Firstly, the vitamin D depleted diet is calcium (Ca) enriched, to attenuate the development of secondary hyperparathyroidism. Secondly, six intraperitoneal injections of paricalcitol during the first two weeks are given to induce the rapid degradation of circulating vitamin D metabolites. After three weeks, serum 25-hydroxyvitamin D3 (25D) and 1,25-dihydroxyvitamin D3 (1,25D) levels had dropped below detection limits, with unchanged serum PTH, Ca, and phosphate (P) levels. Therefore, this model provides a useful tool to examine the sole effect of hypovitaminosis D, in a wide range of research settings, without confounding changes in PTH, Ca, and P.
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Affiliation(s)
- Andrea W. D. Stavenuiter
- Department of Molecular Cell Biology & Immunology, VU University Medical Center, 1081 BT Amsterdam, Netherlands
| | | | - Evelina Ferrantelli
- Department of Molecular Cell Biology & Immunology, VU University Medical Center, 1081 BT Amsterdam, Netherlands
| | - Eelco D. Keuning
- Department of Molecular Cell Biology & Immunology, VU University Medical Center, 1081 BT Amsterdam, Netherlands
| | - Marc Vila Cuenca
- Department of Molecular Cell Biology & Immunology, VU University Medical Center, 1081 BT Amsterdam, Netherlands
| | - Piet M. ter Wee
- Department of Nephrology, VU University Medical Center, 1007 MB Amsterdam, Netherlands
| | - Robert H. J. Beelen
- Department of Molecular Cell Biology & Immunology, VU University Medical Center, 1081 BT Amsterdam, Netherlands
| | - Marc G. Vervloet
- Department of Nephrology, VU University Medical Center, 1007 MB Amsterdam, Netherlands
| | - Adriana S. Dusso
- Division of Experimental Nephrology, IRBLleida, 25198 Lleida, Spain
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Barengolts E, Manickam B, Eisenberg Y, Akbar A, Kukreja S, Ciubotaru I. EFFECT OF HIGH-DOSE VITAMIN D REPLETION ON GLYCEMIC CONTROL IN AFRICAN-AMERICAN MALES WITH PREDIABETES AND HYPOVITAMINOSIS D. Endocr Pract 2015; 21:604-12. [PMID: 25716637 DOI: 10.4158/ep14548.or] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This double-blind, randomized, controlled trial evaluated whether 12 months of high-dose vitamin D2 supplementation improved insulin sensitivity and secretion and glycemic status. METHODS African-American males (AAM) with prediabetes (glycosylated hemoglobin [A1C] 5.7-6.4%), hypovitaminosis D (25-hydroxyvitamin D [25OHD] 5-29 ng/mL), and prevalent medical problems were supplemented with vitamin D3 (400 IU/day) and then randomized to weekly placebo or vitamin D2 (50,000 IU). The primary outcome was the change in oral glucose insulin sensitivity (OGIS, from an oral glucose tolerance test [OGTT]) after 12 months of treatment. Secondary outcomes included other glycemic indices, A1C, and incident diabetes. RESULTS Baseline characteristics were similar in vitamin D-supplemented (n = 87) and placebo (n = 86) subjects completing the trial with average concentrations 14.4 ng/mL, 362 mL × min(-1) × m(-2), and 6.1% for 25OHD, OGIS and A1C, respectively. After 12 months, the vitamin D-supplemented group had a change in serum 25OHD +35 versus +6 ng/mL for placebo, P<.001; OGIS +7.8 versus -16.0 mL × min(-1) × m(-2) for placebo, P = .026; and A1C -0.01 versus +0.01% for placebo, P = .66. Ten percent of subjects in both groups progressed to diabetes. A posthoc analysis of participants with baseline impaired fasting glucose (IFG) showed that more subjects in the vitamin D subgroup (31.6%) than placebo (8.3%) returned to normal glucose tolerance, but the difference did not reach significance (P = .13). CONCLUSION The trial does not provide evidence that 12 months of high-dose D2 repletion improves clinically relevant glycemic outcomes in subjects with prediabetes and hypovitaminosis D (NCT01375660).
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Sahin I, Ozkaynak B, Sar M, Biter HI, Mert B, Okuyan E, Kayalar N, Can MM, Güngör B, Erentug V, Dinckal MH. Paricalcitol counteracts the increased contrast induced nephropathy caused by renin-angiotensin-aldosterone system blockade therapy in a rat model. Eur Rev Med Pharmacol Sci 2014; 18:2895-2902. [PMID: 25339484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The effect of vitamin D and renin-angiotensin-aldosterone system blockade medications in pathophysiology of contrast induced nephropathy (CIN) is controversial. The effects of paricalcitol (active vitamin D analogue) and losartan treatments in an experimental model of CIN were investigated in this study. MATERIALS AND METHODS Thirty-six male Wistar albino rats were examined in five treatment groups. Placebo group (Group A; n = 4) received no active medication; control group (Group B; n = 8) received only contrast media (CM); Group C (n = 8) received paricalcitol; Group D (n = 8) received losartan and Group E (n = 8) received paricalcitol plus losartan. CIN was induced by NG-nitro-L-arginine methyl ester and indomethacin before iohexol injection. Renal histopathological findings were categorized and renal immunohistochemical examinations by caspase-3 rabbit primary antibody were performed. RESULTS Creatinine and cystatin C levels significantly increased in the treatment groups, compared to Group A. However, creatinine levels were not significantly increased in Groups C, D and E compared to Group B. Compared to Group B, a significant increase of cystatin C levels was observed in Group D (p < 0.01). In Group E, when paricalcitol treatment was added to losartan treatment, cystatin C levels were similar to Group B (p = 1.00). In histopathological and immunohistochemical examination frequency of Grade 2/3 tubular necrosis and renal caspase 3 activity scores were significantly higher in the losartan treatment group compared to the other treatment groups. The histopathological effects related to losartan treatment were found to be reversed when paricalcitol treatment was combined. CONCLUSIONS Our findings suggest that paricalcitol treatment counteracts increased contrast induced nephropathy caused by losartan. These findings warrant further clinical studies to investigate the benefit of paricalcitol in CIN prophylaxis.
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Affiliation(s)
- I Sahin
- Department of Cardiology, Bagcilar Training and Research Hospital, Istanbul, Turkey.
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Carpenter TO, Olear EA, Zhang JH, Ellis BK, Simpson CA, Cheng D, Gundberg CM, Insogna KL. Effect of paricalcitol on circulating parathyroid hormone in X-linked hypophosphatemia: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 2014; 99:3103-11. [PMID: 25029424 PMCID: PMC4154090 DOI: 10.1210/jc.2014-2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Hyperparathyroidism occurs frequently in X-linked hypophosphatemia (XLH) and may exacerbate phosphaturia, potentially affecting skeletal abnormalities. OBJECTIVE The objective of the study was to suppress elevated PTH levels in XLH patients. DESIGN This was a prospective, randomized, placebo-controlled, double-blind, 1-year trial of paricalcitol, with outcomes measured at entry and 1 year later. SETTING PATIENTS were recruited from the investigators' clinics or referred from throughout the United States. Data were collected in an in-patient hospital research unit. PATIENTS Subjects with a clinical diagnosis of XLH and hyperparathyroidism were offered participation and were eligible if they were 9 years old or older and not pregnant, and their serum calcium level was less than 10.7 mg/dL, their 25-hydroxyvitamin D level was 20 ng/mL or greater, and their creatinine level was 1.5 mg/dL or less. INTERVENTION The intervention for this study was the use of paricalcitol or placebo for 1 year. MAIN OUTCOME MEASURES Determined prior to trial onset was the change in PTH area under the curve. Secondary outcomes included renal phosphate threshold per glomerular filtration rate, serum phosphorus, serum alkaline phosphatase activity, and (99m)Tc-methylenediphosphonate bone scans. RESULTS PTH area under the curve decreased 17% with paricalcitol, differing (P = .007) from the 20% increase with placebo. The renal phosphate threshold per glomerular filtration rate increased 17% with paricalcitol and decreased 21% with placebo (P = .05). Serum phosphorus increased 12% with paricalcitol but did not differ from placebo. Paricalcitol decreased alkaline phosphatase activity in adults by 21% (no change with placebo, P = .04). Bone scans improved in 6 of 17 paricalcitol subjects, whereas no placebo-treated subject improved. Hypercalciuria developed in six paricalcitol subjects and persisted from baseline in one placebo subject. CONCLUSIONS Suppression of PTH may be a useful strategy for skeletal improvement in XLH patients with hyperparathyroidism, and paricalcitol appears to be an effective adjunct to standard therapy in this setting. Although paricalcitol was well tolerated, urinary calcium and serum calcium and creatinine should be monitored closely with its use.
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Affiliation(s)
- Thomas O Carpenter
- Departments of Pediatrics (Endocrinology) (T.O.C., E.A.O., B.K.E.), Internal Medicine (Endocrinology) (C.A.S., K.L.I.), Orthopaedics and Rehabilitation (T.O.C., C.M.G.), and Diagnostic Radiology (Nuclear Medicine) (D.C.), Yale University School of Medicine, New Haven, Connecticut 06520; and the Veterans Administration Cooperative Studies Program Coordinating Center (JHZ), Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut 06516
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Pappa HM, Mitchell PD, Jiang H, Kassiff S, Filip-Dhima R, DiFabio D, Quinn N, Lawton RC, Bronzwaer MES, Koenen M, Gordon CM. Maintenance of optimal vitamin D status in children and adolescents with inflammatory bowel disease: a randomized clinical trial comparing two regimens. J Clin Endocrinol Metab 2014; 99:3408-17. [PMID: 24926949 PMCID: PMC4154083 DOI: 10.1210/jc.2013-4218] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT Vitamin D promotes bone health and regulates the immune system, both important actions for pediatric patients with inflammatory bowel disease (IBD). The supplementation dose that would maintain optimal serum 25-hydroxyvitamin D concentration (25OHD ≥ 32 ng/mL) is unknown. OBJECTIVE The objective of the study was to compare two supplementation regimens' efficacy and safety in maintaining optimal 25OHD in children with IBD. DESIGN This was a randomized, not blinded, controlled trial. SETTING The trial was conducted in the Boston Children's Hospital Clinical and Translational Study Unit. PARTICIPANTS Sixty-three patients, aged 8-18 years with IBD and baseline 25OHD greater than 20 ng/mL were enrolled; 48 completed the study, and one withdrew for adverse events. INTERVENTION Arm A received 400 IU of oral vitamin D2 daily (n = 32). Arm B received 1000 IU daily in the summer/fall and 2000 IU in the winter/spring (n = 31). MAIN OUTCOME The main outcome was the probability of maintaining 25OHD of 32 ng/mL or greater in all trimonthly visits for 12 months. RESULTS Three participants in arm A (9.4%) and three in arm B (9.7%) achieved the primary outcome (P = .97). The incidence of adverse events, all minor, did not differ. More participants in arm A developed C-reactive protein level of 1 mg/dL or greater (31% vs 10%, P = .04) and IL-6 greater than 3 pg/mL (54% vs 27%, P = .05). CONCLUSIONS Daily oral vitamin D2 doses up to 2000 IU were inadequate to maintain optimal 25OHD but were well tolerated. The finding of lower incidence of elevated inflammatory markers and cytokines among participants receiving higher vitamin D2 doses merits further study.
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Affiliation(s)
- Helen M Pappa
- Center for Inflammatory Bowel Diseases (H.M.P., S.K.), Clinical Research Center Design and Analysis Core (P.D.M., H.J., R.F.-D.), and Clinical and Translational Study Unit (D.D., N.Q.), Children's Hospital Boston, Boston, Massachusetts 02115; Center for Psychosocial Research in GI, Northwestern University Feinberg School of Medicine (R.C.L.), Chicago, Illinois 60611; Academic Medical Center (M.E.S.B., M.K.), 1105 AZ Amsterdam, The Netherlands; and Divisions of Adolescent Medicine and Endocrinology, Hasbro Children's Hospital and Alpert Medical School of Brown University (C.M.G.), Providence, Rhode Island 02903
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Dreyer G, Tucker AT, Harwood SM, Pearse RM, Raftery MJ, Yaqoob MM. Ergocalciferol and microcirculatory function in chronic kidney disease and concomitant vitamin d deficiency: an exploratory, double blind, randomised controlled trial. PLoS One 2014; 9:e99461. [PMID: 25006678 PMCID: PMC4090117 DOI: 10.1371/journal.pone.0099461] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/13/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Vitamin D deficiency and endothelial dysfunction are non-traditional risk factors for cardiovascular events in chronic kidney disease. Previous studies in chronic kidney disease have failed to demonstrate a beneficial effect of vitamin D on arterial stiffness, left ventricular mass and inflammation but none have assessed the effect of vitamin D on microcirculatory endothelial function. STUDY DESIGN We conducted a randomised controlled trial of 38 patients with non diabetic chronic kidney disease stage 3-4 and concomitant vitamin D deficiency (<16 ng/dl) who received oral ergocalciferol (50,000 IU weekly for one month followed by 50,000 IU monthly) or placebo over 6 months. The primary outcome was change in microcirculatory function measured by laser Doppler flowmetry after iontophoresis of acetylcholine. Secondary endpoints were tissue advanced glycation end products, sublingual functional capillary density and flow index as well as macrovascular parameters. Parallel in vitro experiments were conducted to determine the effect of ergocalciferol on cultured human endothelial cells. RESULTS Twenty patients received ergocalciferol and 18 patients received placebo. After 6 months, there was a significant improvement in the ergocalciferol group in both endothelium dependent microcirculatory vasodilatation after iontophoresis of acetylcholine (p = 0.03) and a reduction in tissue advanced glycation end products (p = 0.03). There were no changes in sublingual microcirculatory parameters. Pulse pressure (p = 0.01) but not aortic pulse wave velocity was reduced. There were no significant changes in bone mineral parameters, blood pressure or left ventricular mass index suggesting that ergocalciferol improved endothelial function independently of these parameters. In parallel experiments, expression of endothelial nitric oxide synthase and activity were increased in human endothelial cells in a dose dependent manner. CONCLUSIONS Ergocalciferol improved microcirculatory endothelial function in patients with chronic kidney disease and concomitant vitamin D deficiency. This process may be mediated through enhanced expression and activity of endothelial nitric oxide synthase. TRIAL REGISTRATION Clinical trials.gov NCT00882401.
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Affiliation(s)
- Gavin Dreyer
- Department of Renal Medicine, Barts Health NHS Trust, London, United Kingdom
- Department of Translational Medicine and Therapeutics, Queen Mary University of London, London, United Kingdom
| | - Arthur T. Tucker
- Ernest Cooke Microvascular Unit, Barts Health NHS Trust, London, United Kingdom
| | - Steven M. Harwood
- Department of Translational Medicine and Therapeutics, Queen Mary University of London, London, United Kingdom
| | - Rupert M. Pearse
- Department of Critical Care Medicine, Barts Health NHS Trust, London, United Kingdom
| | - Martin J. Raftery
- Department of Renal Medicine, Barts Health NHS Trust, London, United Kingdom
| | - Muhammad M. Yaqoob
- Department of Renal Medicine, Barts Health NHS Trust, London, United Kingdom
- Department of Translational Medicine and Therapeutics, Queen Mary University of London, London, United Kingdom
- * E-mail:
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Sansanayudh N, Wongwiwatthananukit S, Phetkrajaysang N, Krittiyanunt S. Comparative efficacy and safety of different doses of ergocalciferol supplementation in patients with metabolic syndrome. Int J Clin Pharm 2014; 36:771-8. [PMID: 24853094 DOI: 10.1007/s11096-014-9958-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 05/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vitamin D deficiency is a common problem worldwide. Several studies have shown an association between vitamin D deficiency and the increased risk of metabolic syndrome. No previous study has compared the efficacy and safety of ergocalciferol at 40,000 versus 20,000 IU/week in patients with metabolic syndrome. OBJECTIVE To evaluate the efficacy of ergocalciferol supplementation on serum 25-hydroxyvitamin D [25(OH)D] concentrations and to examine safety parameters in metabolic syndrome patients. SETTING Outpatient department of Phramongkutklao Hospital, Bangkok, Thailand. METHOD A randomized, double-blinded, parallel study was conducted in metabolic syndrome patients with vitamin D deficiency [25(OH)D <20 ng/mL]. Ninety patients were randomly assigned into three groups of 30 patients each. Group 1 was given two capsules of placebo/week, group 2 was given ergocalciferol 20,000 IU/week, and group 3 was given ergocalciferol 40,000 IU/week for 8 weeks. MAIN OUTCOME MEASURE serum 25(OH)D concentrations, serum calcium, safety, and corrected QT (QTc) interval. RESULTS Of the 90 patients enrolled, 84 patients completed the study. At the end of the study, the mean serum 25(OH)D in groups 2 and 3 significantly increased from the baseline (15.1 and 14.3 to 26.8 and 30.0 ng/mL, respectively). The increase in serum 25(OH)D in groups 2 and 3 were comparable and significantly greater than that of the placebo group. The percentage number of patients achieving normal vitamin D levels in groups 1, 2 and 3 were 3.3, 33.3, and 60.0 %, respectively, which were significantly different between groups (p < 0.001). Adverse reactions in both ergocalciferol treatment groups were not different from the placebo group (p > 0.05). Serum calcium levels did not change within and between groups of treatment. No significant change in QTc was observed in any patient. CONCLUSIONS Both 20,000 and 40,000 IU/week of ergocalciferol supplementation for 8 weeks were able to increase serum 25(OH)D concentrations significantly. However, more patients in the ergocalciferol 40,000 IU/week treatment group achieved a normal serum 25(OH)D level than in the group which received 20,000 IU/week. Clinicians would have informed of choosing the dosing regimen of ergocalciferol in metabolic syndrome patients.
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Affiliation(s)
- Nakarin Sansanayudh
- Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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Mariani LH, White MT, Shults J, Anderson CAM, Feldman HI, Wolf M, Reese PP, Denburg MR, Townsend RR, Lo JC, Cappola AR, Carlow D, Gadegbeku CA, Steigerwalt S, Leonard MB. Increasing use of vitamin D supplementation in the chronic renal insufficiency cohort study. J Ren Nutr 2014; 24:186-93. [PMID: 24613295 PMCID: PMC4023561 DOI: 10.1053/j.jrn.2014.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/24/2013] [Accepted: 01/26/2014] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE This study examined rates and determinants of vitamin D supplementation among Chronic Renal Insufficiency Cohort (CRIC) participants and determined the association between dose and 25-hydroxyvitamin D (25(OH)D) level. The 2010 Institute of Medicine Report noted a significant increase in vitamin D supplementation in the general population, but use in chronic kidney disease (CKD) is unknown. METHODS CRIC is a multicenter prospective observational cohort study of 3,939 participants with a median baseline age of 60 and an estimated glomerular filtration rate (eGFR) of 42.1 mL/minute per 1.73 m2. Of the cohort, 54.9% was male, 42.1% were Black, and 48.4% were diabetic. Multivariable logistic generalized estimating equations were used to examine determinants of supplementation use assessed annually between 2003 and 2011. Cross-sectional linear regression models, based on a subset of 1,155 participants, assessed associations between supplement dose and 25(OH)D level, measured by high-performance liquid chromatography coupled with tandem mass spectrometry. RESULTS The proportion of participants reporting supplement use increased (P < .0001), from 10% at baseline to 44% at 7-year follow-up visits. This was largely due to initiation of products containing only ergocalciferol or cholecalciferol. The odds of supplementation were greater in older, female, non-Black, married participants with greater education and lower body mass index. Among participants taking supplementation, dose was positively associated with 25(OH)D level, adjusted for race, season, diabetes, dietary intake, eGFR, and proteinuria. Only 3.8% of non-Black and 16.5% of Black participants taking a supplement were deficient (<20 ng/mL), whereas 22.7% of non-Black and 62.4% of black participants not reporting supplement use were deficient. CONCLUSIONS Vitamin D supplementation rates rose significantly among CRIC participants over 7 years of follow-up and were associated with greater serum 25(OH)D levels. Studies of vitamin D levels on clinical outcomes in CKD and future vitamin D interventional studies should consider these changes in supplementation practices.
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Affiliation(s)
- Laura H Mariani
- University of Michigan Medical School and Arbor Research Collaborative for Health, Ann Arbor, Michigan.
| | - Matthew T White
- The Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts
| | - Justine Shults
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cheryl A M Anderson
- University of California-San Diego School of Medicine, San Diego, California
| | - Harold I Feldman
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Myles Wolf
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Peter P Reese
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle R Denburg
- Department of Pediatrics, Perelman School of Medicine, and the University of Pennsylvania Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joan C Lo
- Kaiser Permanente, Oakland, California
| | - Anne R Cappola
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dean Carlow
- Department of Pediatrics, Perelman School of Medicine, and the University of Pennsylvania Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Mary B Leonard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, and the University of Pennsylvania Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Yan Y, Qian J, Chen N, Huang Z, Jiang G, Li X, Lin H, Liu L, Wang M, Xing C, Yu X, Zuo L, Amdahl M, Khan S. Efficacy and initial dose determination of paricalcitol for treatment of secondary hyperparathyroidism in Chinese subjects. Clin Nephrol 2014; 81:20-9. [PMID: 24131674 DOI: 10.5414/cn107762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2013] [Indexed: 02/08/2023] Open
Abstract
AIM Prevalence of secondary hyperparathyroidism (SHPT), a renal disease complication, is increasing in China. Available therapies may not optimally control SHPT, particularly in patients with hypercalcemia, hyperphosphatemia, and parathyroid hyperplasia. This study examined efficacy and safety of two dosing regimens of selective vitamin D receptor activator paricalcitol. MATERIALS AND METHODS Subjects with SHPT (n = 216) undergoing hemodialysis were treated with paricalcitol i.v. for 12 weeks. One group was treated according to the EU paricalcitol package insert (PI) (initial μg dose based on iPTH/80), and the other was treated according to the US PI (initial dose of 0.04 μg/kg). Dose titration was based on iPTH and serum calcium (Ca) and phosphorus (P) levels. RESULTS The primary endpoint of two consecutive ≥ 30% iPTH decreases was achieved by 88.6% and 55.9% of subjects in the EU and US PI groups, respectively. Noninferiority of the EU PI group vs. the US PI group was demonstrated (lower bound of the 1-sided 97.5% CI = 21.3%). Superiority of the EU PI group was shown (lower limit > 0%) and confirmed by Fisher's exact test (p < 0.001); both groups showed similar achievement of recommended KDIGO iPTH levels. Ca and P levels were relatively constant. CONCLUSION Both EU and US PI paricalcitol dosing strategies effectively reduced iPTH levels in Chinese subjects with SHPT, with minimal impact on Ca and P levels.
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Milovanova LI, Dobrosmyslov IA, Milovanov IS. [Experience with active vitamin D metabolites in phosphorus-calcium metabolic disorders in patients with predialysis chronic kidney disease]. TERAPEVT ARKH 2014; 86:52-56. [PMID: 25095656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To evaluate the efficacy and safety of alfacalcidol and paracalcitol used to correct impaired phosphorus-calcium metabolism (PCM) in patients with predialysis chronic kidney disease (CKD). SUBJECTS AND METHODS Examinations were made in 128 patients with Stages III-V CKD, including 89 (69.5%) patients with chronic glomerulonephritis, 30 (23.4%) with chronic tubulointerstitial nephritis, and 9 (7.1%) with hypertensive nephrosclerosis. Impaired PCM was detected in 90 (70.3%) of the examined patients. According to the pattern of the previous therapy, all the 90 CKD patients with PCM disorders were divided into 3 groups: 1) 32 patients with Stages IIIB-V CKD who had taken oral alfacalcidol 0.25 microg/day; 2) 28 patients with Stages IIIB-V CKD who had used oral paricalcitol 1 microg/day; 3) 30 patients with Stages IIIB-V CKD who had not received, as self- motivated, active vitamin D metabolites at the predialysis stage. RESULTS Alfacalcidol and paricalcitol were quite satisfactorily tolerated by the patients. After 3 months of initiation of the use of these agents, Groups 1 and 2 patients with predialysis CKD and baseline elevated blood intact parathyroid hormone (iPTH) levels could not only achieve, but also maintain target blood iPTH levels. In the patients taking paricalcitol, the urinary protein level decreased more promptly; moreover, by the end of month 6 the reduction in blood pressure (BP) was more significant than in those using alfacalcidol (p < 0.05). Comparison of the effects of angiotensin-converting enzyme inhibitors in combination with alfacalcidol or paricalcitol on BP changes and left ventricular mass index indicated that the most pronounced positive changes occurred when angiotensin-converting enzyme inhibitors were used in combination with paricalcitol. CONCLUSION The use of paricalcitol in predialysis CKD with PTH hyperproduction results in not only normalization of the levels of both PTH and osseous isoenzyme of alkaline phosphatase, but also in significantly reduced daily proteinuria and regression of left ventricular hypertrophy and chronic heart failure.
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Nieman DC, Gillitt ND, Shanely RA, Dew D, Meaney MP, Luo B. Vitamin D2 supplementation amplifies eccentric exercise-induced muscle damage in NASCAR pit crew athletes. Nutrients 2013; 6:63-75. [PMID: 24362707 PMCID: PMC3916849 DOI: 10.3390/nu6010063] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/04/2013] [Accepted: 12/17/2013] [Indexed: 02/07/2023] Open
Abstract
This study determined if 6-weeks vitamin D2 supplementation (vitD2, 3800 IU/day) had an influence on muscle function, eccentric exercise-induced muscle damage (EIMD), and delayed onset of muscle soreness (DOMS) in National Association for Stock Car Auto Racing (NASCAR) NASCAR pit crew athletes. Subjects were randomized to vitD2 (n = 13) and placebo (n = 15), and ingested supplements (double-blind) for six weeks. Blood samples were collected and muscle function tests conducted pre- and post-study (leg-back and hand grip dynamometer strength tests, body weight bench press to exhaustion, vertical jump, 30-s Wingate test). Post-study, subjects engaged in 90 min eccentric-based exercise, with blood samples and DOMS ratings obtained immediately after and 1- and 2-days post-exercise. Six weeks vitD2 increased serum 25(OH)D2 456% and decreased 25(OH)D3 21% versus placebo (p < 0.001, p = 0.036, respectively), with no influence on muscle function test scores. The post-study eccentric exercise bout induced EIMD and DOMS, with higher muscle damage biomarkers measured in vitD2 compared to placebo (myoglobin 252%, 122% increase, respectively, p = 0.001; creatine phosphokinase 24 h post-exercise, 169%, 32%, p < 0.001), with no differences for DOMS. In summary, 6-weeks vitD2 (3800 IU/day) significantly increased 25(OH)D2 and decreased 25(OH)D3, had no effect on muscle function tests, and amplified muscle damage markers in NASCAR pit crew athletes following eccentric exercise.
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Affiliation(s)
- David C. Nieman
- Human Performance Laboratory, Appalachian State University, North Carolina Research Campus, Kannapolis, NC 28081, USA; E-Mails: (R.A.S.); (D.D.); (M.P.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-828-773-0056
| | - Nicholas D. Gillitt
- Dole Nutrition Research Laboratory, North Carolina Research Campus, Kannapolis, NC 28081, USA; E-Mail:
| | - R. Andrew Shanely
- Human Performance Laboratory, Appalachian State University, North Carolina Research Campus, Kannapolis, NC 28081, USA; E-Mails: (R.A.S.); (D.D.); (M.P.M.)
| | - Dustin Dew
- Human Performance Laboratory, Appalachian State University, North Carolina Research Campus, Kannapolis, NC 28081, USA; E-Mails: (R.A.S.); (D.D.); (M.P.M.)
| | - Mary Pat Meaney
- Human Performance Laboratory, Appalachian State University, North Carolina Research Campus, Kannapolis, NC 28081, USA; E-Mails: (R.A.S.); (D.D.); (M.P.M.)
| | - Beibei Luo
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China; E-Mail:
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Zittermann A, Ernst JB, Gummert JF, Börgermann J. Vitamin D supplementation, body weight and human serum 25-hydroxyvitamin D response: a systematic review. Eur J Nutr 2013; 53:367-74. [PMID: 24292820 DOI: 10.1007/s00394-013-0634-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/21/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE There is considerable variation in incremental circulating 25-hydroxyvitamin D (25OHD) levels on vitamin D supplements, even when similar age groups and identical vitamin D doses are compared. We therefore aimed to investigate the importance of body weight for the dose-response relation in circulating 25OHD. METHODS We performed a systematic review of randomized placebo-controlled vitamin D supplementation trials in all age groups ≥10 years to clarify the influence of body weight and other parameters on incremental circulating 25OHD levels (difference between baseline and in-study values) in vitamin D-deficient and non-deficient individuals. RESULTS We included 144 cohorts from 94 independent studies, published from 1990 to November 2012, in our systematic review. There was a logarithmic association between vitamin D dose per kg body weight per day and increment in circulating 25OHD. In multivariable regression analysis, vitamin D dose per kg body weight per day could explain 34.5% of variation in circulating 25OHD. Additional significant predictors were type of supplement (vitamin D2 or vitamin D3), age, concomitant intake of calcium supplements and baseline 25OHD, explaining 9.8, 3.7, 2.4 and 1.9%, respectively, of the variation in circulating 25OHD. CONCLUSIONS This systematic review demonstrates that body weight is an important predictor of variation in circulating 25OHD in cohorts on vitamin D supplements. Our model provides an estimate of the daily vitamin D dose that is necessary for achieving adequate circulating 25OHD levels in vitamin D-insufficient or vitamin D-deficient individuals/cohorts with different body weights and ages.
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Affiliation(s)
- Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia (NRW), Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany,
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Lehmann U, Hirche F, Stangl GI, Hinz K, Westphal S, Dierkes J. Bioavailability of vitamin D(2) and D(3) in healthy volunteers, a randomized placebo-controlled trial. J Clin Endocrinol Metab 2013; 98:4339-45. [PMID: 24001747 DOI: 10.1210/jc.2012-4287] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND The bioequivalence of the different forms of vitamin D, ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3), has been questioned. Earlier studies have suggested that vitamin D2 is less biologically active than vitamin D3. OBJECTIVE AND DESIGN In a parallel study, we tested the effects of supplementation with 50-μg/d doses of vitamin D2 or D3 or a placebo over a period of 8 weeks on 25(OH)D2, 25(OH)D3, their sum 25(OH)D (primary outcome variables), and PTH in healthy volunteers applying a double-blind, randomized study design. The study was conducted during the winter of 2012 in Halle (Saale), Germany, at latitude 51°47N, when UVB irradiation is virtually absent. Blood samples for the determinations of vitamin D status and PTH were collected at baseline and after 4 and 8 weeks of supplementation. RESULTS In the placebo group (n = 19), 25(OH)D3 decreased from 39.4 ± 14.2 to 31.1 ± 12.4 nmol/L after 8 weeks (P < .01). In the vitamin D3 group (n = 42), the concentrations of 25(OH)D3 increased from 41.5 ± 22.8 nmol/L at baseline to 88.0 ± 22.1 nmol/L after 8 weeks (P < .01). In the group receiving vitamin D2 (n = 46), the 25(OH)D2 concentrations increased significantly, whereas the 25(OH)D3 concentration fell from 36.4 ± 13.3 nmol/L at baseline to 16.6 ± 6.3 nmol/L after 8 weeks (P < .01). The total 25(OH)D was not different between the groups at baseline but differed significantly between the groups after 4 and 8 weeks (P < .001). CONCLUSIONS Vitamin D3 increases the total 25(OH)D concentration more than vitamin D2. Vitamin D2 supplementation was associated with a decrease in 25(OH)D3, which can explain the different effect on total 25(OH)D.
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Affiliation(s)
- Ulrike Lehmann
- PhD, Department of Clinical Medicine, P.O. Box 7804, N-5020 Bergen, Norway.
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Menon RK, Rickard AP, Mannan N, Timms PM, Sharp SJ, Martineau A, Boucher BJ, Chowdhury TA, Griffiths CJ, Griffin SJ, Hitman GA, Forouhi NG. The effects of vitamin D₂ or D₃ supplementation on glycaemic control and related metabolic parameters in people at risk of type 2 diabetes: protocol of a randomised double-blind placebo-controlled trial. BMC Public Health 2013; 13:999. [PMID: 24152375 PMCID: PMC3819003 DOI: 10.1186/1471-2458-13-999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 10/14/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The global prevalence of type 2 diabetes is increasing. Effective strategies to address this public health challenge are currently lacking. A number of epidemiological studies have reported associations between low concentrations of 25-hydroxy vitamin D and the incidence of diabetes, but a causal link has not been established. We investigate the effect of vitamin D supplementation on the metabolic status of individuals at increased risk of developing type 2 diabetes. METHODS/DESIGN In a randomised double-blind placebo-controlled trial individuals identified as having a high risk of type 2 diabetes (non-diabetic hyperglycaemia or positive diabetes risk score) are randomised into one of three groups and given 4 doses of either placebo, or 100,000 IU Vitamin D₂ (ergocalciferol) or 100,000 IU Vitamin D₃ (cholecalciferol) at monthly intervals. The primary outcome measure is the change in glycated haemoglobin level between baseline and 4 months. Secondary outcome measures include blood pressure, lipid levels, apolipoproteins, highly sensitive C-reactive protein, parathyroid hormone (PTH) and safety of supplementation. and C-reactive protein. The trial is being conducted at two sites (London and Cambridge, U.K.) and a total of 342 participants are being recruited. DISCUSSION Trial data examining whether supplementation of vitamin D improves glycaemic status and other metabolic parameters in people at risk of developing type 2 diabetes are sparse. This trial will evaluate the causal role of vitamin D in hyperglycaemia and risk of type 2 diabetes. Specific features of this trial include recruitment of participants from different ethnic groups, investigation of the relative effectiveness and safety of vitamin D₂ and D₃ and an evidence based approach to determination of the dose of supplementation. TRIAL REGISTRATION EudraCT2009-011264-11; ISRCTN86515510.
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Affiliation(s)
- Ravi K Menon
- Blizard Institute, Queen Mary University of London, London, UK
| | - Anna P Rickard
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nasima Mannan
- Blizard Institute, Queen Mary University of London, London, UK
| | - Peter M Timms
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Stephen J Sharp
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Adrian Martineau
- Centre for Health Sciences, Queen Mary University of London, London, UK
| | | | | | | | - Simon J Griffin
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Graham A Hitman
- Blizard Institute, Queen Mary University of London, London, UK
- Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
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Wongwiwatthananukit S, Sansanayudh N, Phetkrajaysang N, Krittiyanunt S. Effects of vitamin D(2) supplementation on insulin sensitivity and metabolic parameters in metabolic syndrome patients. J Endocrinol Invest 2013; 36:558-63. [PMID: 23385553 DOI: 10.3275/8817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vitamin D deficiency has been linked to many of the characteristics of metabolic syndrome, but whether supplementation with vitamin D2 would improve insulin sensitivity or metabolic risk factors is not known. AIM To investigate effects of vitamin D2 supplementation on insulin sensitivity and metabolic parameters in metabolic syndrome patients. SUBJECTS AND METHODS An 8-week, prospective randomized, double-blind, double-dummy, parallel trial was conducted in patients with metabolic syndrome. Ninety patients were equally randomized to receive vitamin D2 40,000 IU per week, vitamin D2 20,000 IU per week, or placebo. Outcomes were assessed at baseline and at the end of the study. RESULTS At week 8, serum 25(OH)D concentrations were increased significantly in both vitamin D2 groups (i.e., 20,000 IU and 40,000 IU) when compared with placebo group (11.72 ng/ml vs 2.80 ng/ml; p<0.001 and 15.74 ng/ml vs 2.80 ng/ml; p<0.001, respectively). Serum 25(OH)D concentrations in both vitamin D2 treatment groups were also significantly different (p=0.04). Insulin sensitivity assessed by homeostasis model assessment of insulin resistance (HOMA-IR) at week 8 in the three groups was not significantly different (p=0.36). CONCLUSIONS Vitamin D2 20,000 IU per week and 40,000 IU per week given for 8 weeks, were able to increase serum 25(OH)D concentrations significantly more than placebo group. However, HOMA-IR was not significantly different in the three groups. Our results do not support a positive effect of vitamin D2 on metabolic risk factors.
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Affiliation(s)
- S Wongwiwatthananukit
- Department of Pharmacy Practice, College of Pharmacy, University of Hawaii at Hilo, Hilo, USA
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Rianthavorn P, Boonyapapong P. Ergocalciferol decreases erythropoietin resistance in children with chronic kidney disease stage 5. Pediatr Nephrol 2013; 28:1261-6. [PMID: 23420502 DOI: 10.1007/s00467-013-2431-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Vitamin D insufficiency is related to erythropoietin resistance in chronic kidney disease (CKD). This study was conducted to evaluate the effect of ergocalciferol on the dose of erythrocyte-stimulating agent (ESA) administered to children with CKD stage 5 and vitamin D insufficiency. METHODS Twenty patients aged <18 years with CKD stages 5 or 5D and vitamin D insufficiency were divided into two groups. During the 12-week study, ten patients received oral ergocalciferol (treatment) whereas the other ten patients did not (control). The ESA dosage was recorded monthly. RESULTS There were no significant differences in demographic data, ESA dosages, and laboratory data, including corrected calcium, phosphorus, parathyroid hormone, hemoglobin, ferritin, 25-hydroxyvitamin D (25D), and transferrin saturation levels, between the two groups at baseline. At the completion of the study, serum 25D levels in the treatment group were significantly increased from baseline (p = 0.02) and were significantly higher than the serum 25D levels in the controls (p < 0.005). The ESA dosage in the treatment group was significantly decreased when compared to baseline (p = 0.04). CONCLUSIONS Vitamin D deficiency should be routinely detected and treated. Our results show that the administration of ergocalciferol in conjunction with 1,25-dihydroxyvitamin D3 reduced the dose of ESA required to treat children with CKD stages 5 and 5D and may decrease erythropoietin resistance.
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Affiliation(s)
- Pornpimol Rianthavorn
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
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Wagner CL, McNeil RB, Johnson DD, Hulsey TC, Ebeling M, Robinson C, Hamilton SA, Hollis BW. Health characteristics and outcomes of two randomized vitamin D supplementation trials during pregnancy: a combined analysis. J Steroid Biochem Mol Biol 2013; 136:313-20. [PMID: 23314242 PMCID: PMC4365419 DOI: 10.1016/j.jsbmb.2013.01.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 12/06/2012] [Accepted: 01/01/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the safety and health effects of vitamin D supplementation during pregnancy. METHODS AND DESIGN Datasets from two randomized clinical trials were first analyzed separately then combined for this analysis using a common data dictionary. In the NICHD trial, women were randomized to 400, 2000, or 4000IU vitamin D3/day, stratified by race. In the Thrasher Research Fund trial, participants were randomized to 2000 or 4000IU vitamin D3/day. Study drugs were from the same manufacturing lot for both trials. Identical questionnaires were given for comparable sociodemographics & clinical characteristics. Outcome measures were: [1] maternal and neonatal 25(OH)D achieved, and [2] maternal comorbidities of pregnancy (COP). SAS 9.3 was used for all analyses. RESULTS In the combined cohort, there were 110 controls, 201 in the 2000IU group, and 193 in the 4000IU group. No differences between groups in baseline 25(OH)D were found; however, delivery and cord blood values were greater in the 4000IU group (p<0.0001), an effect that persisted even after controlling for race and study. A greater percent were vitamin D replete in the 4000IU group (p<0.0001). There was a trend where the 4000IU group had decreased rates of comorbidities of pregnancy. There was a strong association between COP and final maternal 25(OH)D; an effect that persisted even after controlling for race and study (p=0.006). CONCLUSIONS Supplementation with 4000IU/day was associated with lower risk of hypovitaminosis D than Control and 2000IU groups. While not statistically significant, there was a trend toward lower rates of COP as supplementation dose increased. Maternal delivery 25(OH)D was inversely associated with any comorbidity of pregnancy, with fewer events as 25(OH)D increased. Future studies are needed to confirm these findings and determine the mechanisms of action of such effects. This article is part of a Special Issue entitled 'Vitamin D Workshop'.
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Affiliation(s)
- Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States.
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