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Wielders JPM, Porpiglia NM, Schellenberg F, Deenmamode J, Delanghe J, Anton RF, Bortolotti F, Siebelder C, Tagliaro F, Weykamp C, Helander A. Recommendations on the measurement and use of the alcohol consumption biomarker CDT. A position paper from the IFCC Working Group on CDT standardisation. Clin Chim Acta 2024; 555:117800. [PMID: 38309557 DOI: 10.1016/j.cca.2024.117800] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Carbohydrate deficient transferrin (CDT) is a biomarker for excessive alcohol consumption utilized in clinical and forensic medicine and workplace testing. Previously, many different analytical methods for CDT were used and the measurand varied considerably, making direct comparison of test results difficult. To end this confusion, the IFCC established a working group on CDT standardisation (WG-CDT) which completed its tasks in 2017. METHODS This IFCC position paper by the WG-CDT summarizes state of the art information about the measurand and the analytical methods and gives concise recommendations for its utilization. RESULTS The results achieved by the CDT standardisation process led to accuracy improvements in national external quality assessment schemes over the years. A brief review of ROC based comparison studies with the traditional biomarkers (GGT, MCV, ALT and AST) discusses the bias resulting from inadequate study populations. In large groups of the general population the superior diagnostic performance of CDT is confirmed. CONCLUSION The relationship between alcohol intake versus resulting CDT is discussed as well as the cutoff and measurement uncertainty. Concerning the application in practice, potential pitfalls are considered and recommendations handling both analytical and preanalytical caveats are given. Finally, some examples of serious misunderstandings in publications about CDT are addressed.
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Affiliation(s)
- J P M Wielders
- Joseph Peter Marie Wielders, Amersfoort, the Netherlands.
| | - N M Porpiglia
- Nadia Maria Porpiglia, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy.
| | | | | | - J Delanghe
- Joris Delanghe, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - R F Anton
- Raymond Francis Anton, Medical University of South Carolina, Charleston, SC, USA
| | - F Bortolotti
- Federica Bortolotti, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - C Siebelder
- Carla Siebelder, MCA Laboratory, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - F Tagliaro
- Franco Tagliaro, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - C Weykamp
- Cas Weykamp, MCA Laboratory, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - A Helander
- Anders Helander, Karolinska Institutet, Karolinska University Laboratory, Stockholm, Sweden
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Bijvoet GP, van der Sijs-Bos CJM, Wielders JPM, Groot OA. Fatal hyperammonaemia due to late-onset ornithine transcarbamylase deficiency. Neth J Med 2016; 74:36-39. [PMID: 26819360] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this case report we describe a 67-year-old male, admitted to the ICU with pneumonia who unexpectedly developed a fatal coma due to hyperammonaemia. At postmortem the diagnosis late-onset ornithine transcarbamylase deficiency was made. The non-specific clinical presentation, the rapid deterioration and incidentally the fatal outcome all underline the importance of recognition and knowledge of this genetic disorder. Several measures to treat and prevent potentially fatal episodes of hyperammonaemia are available, if only the disorder is recognised in time. In retrospect, several clues to the diagnosis were available in this fatal case, such as voluntary protein avoidance, as well as several male family members who died at a young age of an unknown cause. After his death, two daughters were discovered to be carriers of an OTC gene mutation, as well as his infant grandson. We emphasise the importance of obtaining ammonia levels in all patients with unexplained coma, seizures or cerebral oedema, irrespective of their age, especially in patients in the ICU or in an otherwise catabolic state.
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Affiliation(s)
- G P Bijvoet
- Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands
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Mwangi MN, Roth JM, Smit MR, Trijsburg L, Mwangi AM, Demir AY, Wielders JPM, Mens PF, Verweij JJ, Cox SE, Prentice AM, Brouwer ID, Savelkoul HFJ, Andang'o PEA, Verhoef H. Effect of Daily Antenatal Iron Supplementation on Plasmodium Infection in Kenyan Women: A Randomized Clinical Trial. JAMA 2015; 314:1009-20. [PMID: 26348751 DOI: 10.1001/jama.2015.9496] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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: 11/14/2022]
Abstract
IMPORTANCE Anemia affects most pregnant African women and is predominantly due to iron deficiency, but antenatal iron supplementation has uncertain health benefits and can increase the malaria burden. OBJECTIVE To measure the effect of antenatal iron supplementation on maternal Plasmodium infection risk, maternal iron status, and neonatal outcomes. DESIGN, SETTING, AND PARTICIPANTS Randomized placebo-controlled trial conducted October 2011 through April 2013 in a malaria endemic area among 470 rural Kenyan women aged 15 to 45 years with singleton pregnancies, gestational age of 13 to 23 weeks, and hemoglobin concentration of 9 g/dL or greater. All women received 5.7 mg iron/day through flour fortification during intervention, and usual intermittent preventive treatment against malaria was given. INTERVENTIONS Supervised daily supplementation with 60 mg of elemental iron (as ferrous fumarate, n = 237 women) or placebo (n = 233) from randomization until 1 month postpartum. MAIN OUTCOMES AND MEASURES Primary outcome was maternal Plasmodium infection at birth. Predefined secondary outcomes were birth weight and gestational age at delivery, intrauterine growth, and maternal and infant iron status at 1 month after birth. RESULTS Among the 470 participating women, 40 women (22 iron, 18 placebo) were lost to follow-up or excluded at birth; 12 mothers were lost to follow-up postpartum (5 iron, 7 placebo). At baseline, 190 of 318 women (59.7%) were iron-deficient. In intention-to-treat analysis, comparison of women who received iron vs placebo, respectively, yielded the following results at birth: Plasmodium infection risk: 50.9% vs 52.1% (crude difference, -1.2%, 95% CI, -11.8% to 9.5%; P = .83); birth weight: 3202 g vs 3053 g (crude difference, 150 g, 95% CI, 56 to 244; P = .002); birth-weight-for-gestational-age z score: 0.52 vs 0.31 (crude difference, 0.21, 95% CI, -0.11 to 0.52; P = .20); and at 1 month after birth: maternal hemoglobin concentration: 12.89 g/dL vs 11.99 g/dL (crude difference, 0.90 g/dL, 95% CI, 0.61 to 1.19; P < .001); geometric mean maternal plasma ferritin concentration: 32.1 µg/L vs 14.4 µg/L (crude difference, 123.4%, 95% CI, 85.5% to 169.1%; P < .001); geometric mean neonatal plasma ferritin concentration: 163.0 µg/L vs 138.7 µg/L (crude difference, 17.5%, 95% CI, 2.4% to 34.8%; P = .02). Serious adverse events were reported for 9 and 12 women who received iron and placebo, respectively. There was no evidence that intervention effects on Plasmodium infection risk were modified by intermittent preventive treatment use. CONCLUSIONS AND RELEVANCE Among rural Kenyan women with singleton pregnancies, administration of daily iron supplementation, compared with administration of placebo, resulted in no significant differences in overall maternal Plasmodium infection risk. Iron supplementation led to increased birth weight. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01308112.
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Affiliation(s)
- Martin N Mwangi
- Cell Biology and Immunology Group, Wageningen University, Wageningen, the Netherlands2School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Johanna M Roth
- Cell Biology and Immunology Group, Wageningen University, Wageningen, the Netherlands3KIT Biomedical Research, Royal Tropical Institute, Amsterdam, the Netherlands
| | - Menno R Smit
- Cell Biology and Immunology Group, Wageningen University, Wageningen, the Netherlands
| | - Laura Trijsburg
- Cell Biology and Immunology Group, Wageningen University, Wageningen, the Netherlands
| | - Alice M Mwangi
- Applied Nutrition Programme, University of Nairobi, Nairobi, Kenya
| | - Ayşe Y Demir
- Laboratory for Clinical Chemistry, Meander Medical Centre, Amersfoort, the Netherlands
| | - Jos P M Wielders
- Laboratory for Clinical Chemistry, Meander Medical Centre, Amersfoort, the Netherlands
| | - Petra F Mens
- KIT Biomedical Research, Royal Tropical Institute, Amsterdam, the Netherlands
| | - Jaco J Verweij
- Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands
| | - Sharon E Cox
- MRC International Nutrition Programme, London School of Hygiene and Tropical Medicine, England8MRC International Nutrition Programme, Medical Research Council, Keneba, the Gambia
| | - Andrew M Prentice
- MRC International Nutrition Programme, London School of Hygiene and Tropical Medicine, England8MRC International Nutrition Programme, Medical Research Council, Keneba, the Gambia
| | - Inge D Brouwer
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Huub F J Savelkoul
- Cell Biology and Immunology Group, Wageningen University, Wageningen, the Netherlands
| | - Pauline E A Andang'o
- School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Hans Verhoef
- Cell Biology and Immunology Group, Wageningen University, Wageningen, the Netherlands7MRC International Nutrition Programme, London School of Hygiene and Tropical Medicine, England8MRC International Nutrition Programme, Medical Research Council, Keneba, t
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de Haar-Holleman A, Musson REA, Eelkman Rooda SJ, Wielders JPM, Demir AY. [Unusual causes of hyperprolactinaemia]. Ned Tijdschr Geneeskd 2015; 159:A9051. [PMID: 26443113] [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: 06/05/2023]
Abstract
Pituitary adenoma is the main cause of hyperprolactinaemia; however, physicians should be aware that the pituitary is not always to blame. There are many other physiological and pathological causes for hyperprolactinaemia, and the contribution of stress, medication and the presence of macroprolactin should not be overlooked. We describe three patients - a 19-year-old female, a 28-year-old female and a 20-year-old male - in whom hyperprolactinaemia was due to medication use, physical stimulation of the nipple and a combination of macroprolactianaemia with a microadenoma, respectively. The first two case reports show that conducting a thorough patient history can prevent unnecessary imaging and laboratory costs. The third case illustrates that macroprolactinaemia and true hyperprolactinaemia may coexist. While early screening for macroprolactinaemia in an asymptomatic patient can save money, finding macroprolactinaemia in a symptomatic patient still warrants further workup.
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Wielders JPM, Carter GF, Eberl H, Morris G, Roth HJ, Vogl C. Automated Competitive Protein-Binding Assay for Total 25-OH Vitamin D, Multicenter Evaluation and Practical Performance. J Clin Lab Anal 2014; 29:451-61. [PMID: 25132191 PMCID: PMC6807057 DOI: 10.1002/jcla.21793] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022] Open
Abstract
Background The Roche Elecsys Vitamin D Total competitive protein‐binding assay uses recombinant vitamin D binding protein for measuring 25‐hydroxyvitamin D (25‐OHD), which is different from commonly used antibody assays. Methods The assay, standardized against LC‐MS/MS, was tested at four sites. Evaluation included precision; between‐laboratory variability; functional sensitivity; correlation to LC‐MS/MS, HPLC, and immunoassays; as well as robustness, traceability, and EQAS performance. Results Precision testing showed within‐run coefficient of variations (CVs) of ≤7%, within‐laboratory CVs of <9.5%, between‐laboratory precision CVs of ≤10.1%, and a functional sensitivity below 9.8 nmol/l (at CV 12.9%). The assay showed equivalent 25‐OHD levels for matched serum and plasma samples, good reagent lot‐to‐lot consistency in pooled sera over time, and good agreement with HPLC (relative bias −8.8%). Comparison with LC‐MS/MS methods yielded relative biases of −15.4, −13.5, −10.2, and 3.2%. Comparison against immunoassays showed a relative bias of 14.5% (DiaSorin Liaison) and −58.2% (IDS‐iSYS). The overall mean results in 2 years DEQAS was 102% of the ALTM. In a certified reference patient panel, the average bias was <4% for the sum of 25‐OHD2 and 25‐OHD3. Conclusion The Elecsys Vitamin D Total assay demonstrated good overall performance and is, according to present standards, very suitable for automated measurement of 25‐OHD.
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Affiliation(s)
| | | | | | - Gary Morris
- Southern IML Pathology, Wollongong, New South Wales, Australia
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Emmen JMA, Wielders JPM, Boer AK, van den Ouweland JMW, Vader HL. The new Roche Vitamin D Total assay: fit for its purpose? Clin Chem Lab Med 2013; 50:1969-72. [PMID: 23113978 DOI: 10.1515/cclm-2011-0085] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 05/10/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Measurement of serum 25-hydroxyvitamin D [25(OH)D] is used to assess vitamin D status. We evaluated the analytical performance of a new automated assay, Elecsys Vitamin D Total (Roche Diagnostics, Mannheim, Germany), based on competitive protein binding. METHODS The Elecsys assay was tested for imprecision, linearity and functional sensitivity at three test-sites and compared to a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method, a high-performance liquid chromatography (HPLC) method and the Liaison 25(OH) Vitamin D Total immunoassay (Diasorin). RESULTS Imprecision testing with human serum specimens showed within-run CVs of ≤6% and between-run CVs of ≤8%. The assay was linear from 33 up to at least 111 nmol/L and showed equivalent 25(OH)D levels for matched serum and heparinized plasma samples. The assay correlated reasonable to well with LC-MS/MS (r=0.93; y=1.07x-5.04 nmol/L), HPLC (r=0.91, y=0.90x+3.03 nmol/L) and the Liaison assay (r=0.86, y=1.19x+2.80 nmol/L). Some of the samples showed large between-method differences. CONCLUSIONS The new Elecsys assay fulfilled present analytical performance requirements and showed close agreement to other well-established methods for 25(OH)D analysis, making it fit for routine assessment of vitamin D status.
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Affiliation(s)
- Judith M A Emmen
- Laboratory for Clinical Chemistry, Máxima Medical Center, Veldhoven, The Netherlands.
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Kox M, van den Berg MJW, van der Hoeven JG, Wielders JPM, van der Ven AJ, Pickkers P. Vitamin D status is not associated with inflammatory cytokine levels during experimental human endotoxaemia. Clin Exp Immunol 2013; 171:231-6. [PMID: 23286950 DOI: 10.1111/cei.12006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 12/31/2022] Open
Abstract
Vitamin D has been shown to modulate innate immune responses in vitro and ex vivo; however, human in-vivo data are lacking. At high latitudes, seasonal vitamin D deficiency is common due to alternating ultraviolet (UV)-B radiation exposure. In the present study, we investigated whether levels of 25 hydroxyvitamin D(3) [25(OH)D(3) ] and its active metabolite 1,25 dihydroxyvitamin D(3) [1,25(OH)(2) D(3) ] are subject to seasonal variation and whether plasma levels of these vitamin D metabolites correlate with the in-vivo cytokine response during experimental human endotoxaemia [administration of lipopolysaccharide (LPS) in healthy volunteers]. Plasma levels of 25(OH)D(3) and 1,25(OH)(2) D(3) were determined in samples obtained just prior to administration of an intravenous bolus of 2 ng/kg LPS (derived from Escherichia coli O:113) in 112 healthy male volunteers. In the same subjects, plasma levels of the inflammatory cytokines tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were analysed serially after endotoxin administration. Plasma levels of 1,25(OH)(2) D(3) , but not 25(OH)D(3) , were subject to significant seasonal variation, with lower levels in autumn and winter. 25(OH)D(3) and 1,25(OH)(2) D(3) levels did not correlate with plasma cytokine responses. Furthermore, 25(OH)D(3) deficient subjects (< 50 nmol/l) displayed an identical cytokine response compared with sufficient subjects. In conclusion, plasma levels of vitamin D are not correlated with the LPS-induced TNF, IL-6 and IL-10 cytokine response in humans in vivo. These findings question the direct role of vitamin D in modulation of the innate immune response.
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Affiliation(s)
- M Kox
- Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Wijnia JW, Wielders JPM, Lips P, van de Wiel A, Mulder CL, Nieuwenhuis KGA. Is Vitamin D Deficiency a Confounder in Alcoholic Skeletal Muscle Myopathy? Alcohol Clin Exp Res 2012; 37 Suppl 1:E209-15. [DOI: 10.1111/j.1530-0277.2012.01902.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 05/19/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Jan W. Wijnia
- Rijnmond Care Group, Location Slingedael; Center for Korsakoff and Psychogeriatrics; Rotterdam; The Netherlands
| | - Jos P. M. Wielders
- Department of Clinical Chemistry; Meander Medical Center; Amersfoort; The Netherlands
| | - Paul Lips
- Endocrine Section; Department of Internal Medicine; VU University Medical Center; Amsterdam; The Netherlands
| | - Albert van de Wiel
- Department of Internal Medicine; Meander Medical Center; Amersfoort; The Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry; Research Center O3; Erasmus University Medical Center; Rotterdam; The Netherlands
| | - K. Gerrit A. Nieuwenhuis
- Rijnmond Care Group, Location Slingedael; Center for Korsakoff and Psychogeriatrics; Rotterdam; The Netherlands
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9
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Janssen MJW, Wielders JPM, Bekker CC, Boesten LSM, Buijs MM, Heijboer AC, van der Horst FAL, Loupatty FJ, van den Ouweland JMW. Multicenter comparison study of current methods to measure 25-hydroxyvitamin D in serum. Steroids 2012; 77:1366-72. [PMID: 22925701 DOI: 10.1016/j.steroids.2012.07.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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: 03/20/2012] [Revised: 07/06/2012] [Accepted: 07/29/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Measurement of serum 25-hydroxyvitamin D [25(OH)D] is generally considered to be a reliable indicator of vitamin D status. The recent increase in diversity of 25(OH)D assays prompted us to evaluate the performance of chromatographic methods (two in-house ID-LC-MS/MS and HPLC (ClinRep, Recipe)), a protein binding method (Cobas-25(OH)D-total, Roche) and immunochemical methods (Liaison and RIA (Diasorin), iSYS (IDS), ADVIA Centaur (Siemens), and Architect i1000 and i2000 (Abbott)). METHODS Blood was drawn from randomly selected outpatients (N=60) at one site after informed consent. DEQAS and SRM 972 samples were obtained from the scheme organizer and NIST, respectively. Serum aliquots were prepared, frozen and transported to participating centers. Method comparison was performed according to CLSI-EP9 specifications. RESULTS With these patient samples, and in comparison with ID-LC-MS/MS, Deming regression parameters slope, intercept and R were found to be within the ranges [0.57-1.07], [-1.7 to 6.9 nmol/L] and [0.88-0.98], respectively. 25(OH)D2 in DEQAS and SRM samples was fully recognized by chromatographic methods, but only partially by protein binding and immunochemical methods. Chromatographic methods, and to a lesser extent the protein binding assay, showed cross-reactivity with 3-epi-25(OH)D3. Agreement of 25(OH)D assays to ID-LC-MS/MS in sorting patients into distinct 25(OH)D categories varied between 53% and 88%. CONCLUSIONS Significant bias exists between ID-LC-MS/MS and many, but not all, other 25(OH)D assays. The variable response among different assays for 25(OH)D metabolites impedes the use of uniform cut-off values for defining vitamin D status. Our results indicate the need towards further standardizing assays for 25(OH)D measurement.
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Affiliation(s)
- Marcel J W Janssen
- Laboratory of Clinical Chemistry and Haematology, VieCuri Medical Center, Venlo, The Netherlands.
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Emmen JMA, Wielders JPM, Boer AK, van den Ouweland JMW, Vader HL. The new Roche Vitamin D Total assay: fit for its purpose? Clin Chem Lab Med 2012; 0:1-4. [PMID: 22752789 DOI: 10.1515/cclm-2012-0085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 05/10/2012] [Indexed: 11/15/2022]
Abstract
Abstract Background: Measurement of serum 25-hydroxyvitamin D [25(OH)D] is used to assess vitamin D status. We evaluated the analytical performance of a new automated assay, Elecsys Vitamin D Total (Roche Diagnostics, Mannheim, Germany), based on competitive protein binding. Methods: The Elecsys assay was tested for imprecision, linearity and functional sensitivity at three test-sites and compared to a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method, a high-performance liquid chromatography (HPLC) method and the Liaison 25(OH) Vitamin D Total immunoassay (Diasorin). Results: Imprecision testing with human serum specimens showed within-run CVs of ≤6% and between-run CVs of ≤8%. The assay was linear from 33 up to at least 111 nmol/L and showed equivalent 25(OH)D levels for matched serum and heparinized plasma samples. The assay correlated reasonable to well with LC-MS/MS (r=0.93; y=1.07x-5.04 nmol/L), HPLC (r=0.91, y=0.90x+3.03 nmol/L) and the Liaison assay (r=0.86, y=1.19x+2.80 nmol/L). Some of the samples showed large between-method differences. Conclusions: The new Elecsys assay fulfilled present analytical performance requirements and showed close agreement to other well-established methods for 25(OH)D analysis, making it fit for routine assessment of vitamin D status.
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Polinder-Bos HA, Kok EE, van de Wiel A, Spiering W, Wielders JPM, Bloemendal HJ. Severe hypertriglyceridaemia associated with the use of capecitabine. Neth J Med 2012; 70:104. [PMID: 22418760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Bours PHA, Wielders JPM, Vermeijden JR, van de Wiel A. Seasonal variation of serum 25-hydroxyvitamin D levels in adult patients with inflammatory bowel disease. Osteoporos Int 2011; 22:2857-67. [PMID: 21113577 PMCID: PMC3186887 DOI: 10.1007/s00198-010-1484-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 11/01/2010] [Indexed: 12/12/2022]
Abstract
UNLABELLED Patients with inflammatory bowel disease (IBD) are at risk of osteoporosis. Vitamin D (vitD) deficiency is known as a risk factor of osteoporosis. We observed low vitD blood levels in adult IBD patients both at the end of summer and winter. Furthermore, effects of oral vitD supplementation in (generally low) daily dosages were poor. INTRODUCTION Patients with IBD are at risk of osteoporosis. This study evaluates seasonal vitD status, determinants of vitD deficiency and effects of vitD supplementation in adult IBD patients. METHODS Patients were screened for vitD deficiency at the end of summer and winter using serum 25OHD(3) (cut-off point, <50 nmol/L) combined with routine laboratory tests. A standardized questionnaire was used for demographic/lifestyle data i.e. IBD activity, health behaviour and vitD intake through diet and ultraviolet light. RESULTS Late-summer, 39% of the included 316 patients were vitD deficient. Late-winter, 57% of the follow-up patients (n=281) were deficient. Independent protective determinants of vitD deficiency were oral vitD supplementation (summer/winter: odds ratio [OR], 0.52 [95% confidence interval [CI], 0.29-0.94]/OR, 0.44 [95% CI, 0.26-0.75]), recent sun holiday (summer: OR, 0.42 [95% CI, 0.24-0.74]) and regular solarium visits (summer/winter: OR, 0.28 [95% CI, 0.13-0.63]/OR, 0.17 [0.06-0.50]). IBD activity (p=0.031), red blood cell distribution width (RDW; p=0.04) and erythrocyte sedimentation rate (p=0.03) were associated with low vitD levels using univariate analyses of the extreme 25OHD quartiles. In a subgroup with vitD supplementation, still 30% (late-summer) and 44% (late-winter) were vitD deficient. CONCLUSION VitD deficiency is common in IBD patients, but prevalence might be comparable with the general population. Ultraviolet light is essential for adequate vitD levels. Effects of oral vitD supplementation in (generally low) daily dosages are poor. Determinants for low vitD levels were IBD activity and elevated inflammatory markers, suggesting that increased risk of osteoporosis in IBD might be more related to the inflammation than to vitD deficiency.
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Affiliation(s)
- P H A Bours
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands.
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Veenemans J, Mank T, Ottenhof M, Baidjoe A, Mbugi EV, Demir AY, Wielders JPM, Savelkoul HFJ, Verhoef H. Protection against diarrhea associated with Giardia intestinalis Is lost with multi-nutrient supplementation: a study in Tanzanian children. PLoS Negl Trop Dis 2011. [PMID: 21666789 DOI: 10.137/journal.pntd.0001158.epub] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Asymptomatic carriage of Giardia intestinalis is highly prevalent among children in developing countries, and evidence regarding its role as a diarrhea-causing agent in these settings is controversial. Impaired linear growth and cognition have been associated with giardiasis, presumably mediated by malabsorption of nutrients. In a prospective cohort study, we aim to compare diarrhea rates in pre-school children with and without Giardia infection. Because the study was conducted in the context of an intervention trial assessing the effects of multi-nutrients on morbidity, we also assessed how supplementation influenced the relationship between Giardia and diarrhoea rates, and to what extent Giardia modifies the intervention effect on nutritional status. METHODS AND FINDINGS Data were collected in the context of a randomized placebo-controlled efficacy trial with 2×2 factorial design assessing the effects of zinc and/or multi-micronutrients on morbidity (n=612; height-for-age z-score <-1.5 SD). Outcomes measures were episodes of diarrhea (any reported, or with ≥3 stools in the last 24 h) and fever without localizing signs, as detected with health-facility based surveillance. Giardia was detected in stool by enzyme-linked immunosorbent assay. Among children who did not receive multi-nutrients, asymptomatic Giardia infection at baseline was associated with a substantial reduction in the rate of diarrhea (HR 0.32; 0.15-0.66) and fever without localizing signs (HR 0.56; 0.36-0.87), whereas no such effect was observed among children who received multi-nutrients (p-values for interaction 0.03 for both outcomes). This interaction was independent of age, HAZ-scores and distance to the research dispensary. There was no evidence that Giardia modified the intervention effect on nutritional status. CONCLUSION Although causality of the Giardia-associated reduction in morbidity cannot be established, multi-nutrient supplementation results in a loss of this protection and thus seems to influence the proliferation or virulence of Giardia or associated intestinal pathogens.
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Affiliation(s)
- Jacobien Veenemans
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
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14
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Veenemans J, Mank T, Ottenhof M, Baidjoe A, Mbugi EV, Demir AY, Wielders JPM, Savelkoul HFJ, Verhoef H. Protection against diarrhea associated with Giardia intestinalis Is lost with multi-nutrient supplementation: a study in Tanzanian children. PLoS Negl Trop Dis 2011; 5:e1158. [PMID: 21666789 PMCID: PMC3110167 DOI: 10.1371/journal.pntd.0001158] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [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: 11/21/2010] [Accepted: 03/07/2011] [Indexed: 11/19/2022] Open
Abstract
Background Asymptomatic carriage of Giardia intestinalis is highly prevalent among children in developing countries, and evidence regarding its role as a diarrhea-causing agent in these settings is controversial. Impaired linear growth and cognition have been associated with giardiasis, presumably mediated by malabsorption of nutrients. In a prospective cohort study, we aim to compare diarrhea rates in pre-school children with and without Giardia infection. Because the study was conducted in the context of an intervention trial assessing the effects of multi-nutrients on morbidity, we also assessed how supplementation influenced the relationship between Giardia and diarrhoea rates, and to what extent Giardia modifies the intervention effect on nutritional status. Methods and Findings Data were collected in the context of a randomized placebo-controlled efficacy trial with 2×2 factorial design assessing the effects of zinc and/or multi-micronutrients on morbidity (n = 612; height-for-age z-score <−1.5 SD). Outcomes measures were episodes of diarrhea (any reported, or with ≥3 stools in the last 24 h) and fever without localizing signs, as detected with health-facility based surveillance. Giardia was detected in stool by enzyme-linked immunosorbent assay. Among children who did not receive multi-nutrients, asymptomatic Giardia infection at baseline was associated with a substantial reduction in the rate of diarrhea (HR 0.32; 0.15–0.66) and fever without localizing signs (HR 0.56; 0.36–0.87), whereas no such effect was observed among children who received multi-nutrients (p-values for interaction 0.03 for both outcomes). This interaction was independent of age, HAZ-scores and distance to the research dispensary. There was no evidence that Giardia modified the intervention effect on nutritional status. Conclusion Although causality of the Giardia-associated reduction in morbidity cannot be established, multi-nutrient supplementation results in a loss of this protection and thus seems to influence the proliferation or virulence of Giardia or associated intestinal pathogens. Giardia intestinalis is a well-known cause of diarrhea in industrialized countries. In children in developing countries, asymptomatic infections are common and their role as cause of diarrhea has been questioned. In a cohort of rural Tanzanian pre-school children, we assessed the association between the presence of Giardia at baseline and subsequent diarrhea risk. The study was conducted in the context of a randomised trial assessing the effect of supplementation with zinc and other micro-nutrients on malaria, and half of the children daily received a multi-nutrient supplement. Surprisingly, we found that the presence of Giardia at baseline was associated with a substantial reduction in diarrhea risk. Multivariate statistical analysis showed that this protection could not be explained by differences in age or walking distance to the dispensary between children with and without Giardia. Because we cannot exclude that children differed in other (unmeasured) characteristics, we cannot draw firm conclusions about the causality of the observed association, but our findings support the view that the parasite is not an important cause of diarrhea in highly endemic settings. Striking was that the Giardia-associated protection was lost when children received multi-nutrients. Our data do not provide information about the mechanisms involved, but suggest that multi-nutrients may influence the compositionor pathogenicity of intestinal biota.
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Affiliation(s)
- Jacobien Veenemans
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
| | - Theo Mank
- Department of Parasitology, Public Health Laboratory, Haarlem, The Netherlands
| | - Maarten Ottenhof
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amrish Baidjoe
- Department of Parasitology, Public Health Laboratory, Haarlem, The Netherlands
| | - Erasto V. Mbugi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ayse Y. Demir
- Laboratory for Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Jos P. M. Wielders
- Laboratory for Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Huub F. J. Savelkoul
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
| | - Hans Verhoef
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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15
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Helander A, Wielders JPM, Jeppsson JO, Weykamp C, Siebelder C, Anton RF, Schellenberg F, Whitfield JB. Toward standardization of carbohydrate-deficient transferrin (CDT) measurements: II. Performance of a laboratory network running the HPLC candidate reference measurement procedure and evaluation of a candidate reference material. Clin Chem Lab Med 2010; 48:1585-92. [PMID: 21034250 DOI: 10.1515/cclm.2010.322] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Carbohydrate-deficient transferrin (CDT) is a descriptive term used for a temporary change in the transferrin glycosylation profile caused by alcohol, and used as a biomarker of chronic high alcohol consumption. The use of an array of methods for measurement of CDT in various absolute or relative amounts, and sometimes covering different transferrin glycoforms, has complicated the comparability of results and caused confusion among medical staff. This situation prompted initiation of an IFCC Working Group on CDT standardization. This second publication of the WG-CDT covers the establishment of a network of reference laboratories running a high-performance liquid chromatography (HPLC) candidate reference measurement procedure, and evaluation of candidate secondary reference materials. The network laboratories demonstrated good and reproducible performance and thus can be used to assign target values for calibrators and controls. A candidate secondary reference material based on native human serum lyophilized with a cryo-/lyoprotectant to prevent protein denaturation was found to be commutable and stable during storage. A proposed strategy for calibration of different CDT methods is also presented. In an external quality assurance study involving 66 laboratories and covering the current routine CDT assays (HPLC, capillary electrophoresis and immunoassay), recalculation of observed results based on the nominal values for the candidate calibrator reduced the overall coefficient of variation from 18.9% to 5.5%. The logistics for distribution of reference materials and review of results were found to be functional, indicating that a full reference system for CDT may soon be available.
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Affiliation(s)
- Anders Helander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
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16
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Tostmann A, Wielders JPM, Kibiki GS, Verhoef H, Boeree MJ, van der Ven AJAM. Serum 25-hydroxy-vitamin D3 concentrations increase during tuberculosis treatment in Tanzania. Int J Tuberc Lung Dis 2010; 14:1147-1152. [PMID: 20819260] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
SETTING Vitamin D deficiency is associated with susceptibility to active tuberculosis (TB) in many settings. In vitro studies and studies on human volunteers showed that two of the first-line anti-tuberculosis drugs, isoniazid and rifampicin, reduce 25-hydroxy vitamin D (25[OH]D) concentrations. OBJECTIVE To study changes in vitamin D status during treatment of Tanzanian hospitalised patients with pulmonary TB (PTB). DESIGN We compared serum 25[OH]D concentrations in 81 Tanzanian PTB patients before and after 2 months of treatment. RESULTS Median serum 25[OH]D concentrations increased from 91 nmol/l at baseline to 101 nmol/l after 2 months of TB treatment (median increase 6.0 nmol/l, IQR -0.7-25.0, P = 0.001). Median serum parathyroid hormone concentrations increased from 1.6 to 2.0 pmol/l (median increase 0.46, IQR -0.2-1.1, P < 0.001). CONCLUSION 25[OH]D serum concentrations increased during the first 2 months of TB treatment in 81 PTB patients in northern Tanzania. Improved dietary intake and increased sunlight exposure may have contributed to the increased 25[OH]D concentrations.
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Affiliation(s)
- A Tostmann
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. a
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17
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Wielders JPM, Muskiet FAJ, van de Wiel A. [Shedding new light on vitamin D--reassessment of an essential prohormone]. Ned Tijdschr Geneeskd 2010; 154:A1810. [PMID: 21176256] [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: 05/30/2023]
Abstract
Vitamin-D deficiency is no longer to be seen only as a cause of osteomalacia, rickets and osteoporosis. There is a causal relationship with muscle function and also with the functioning of our immune system. Furthermore, vitamin-D deficiency is associated with a higher risk of autoimmune diseases and several forms of malignancy, such as prostate, colon and breast cancer. Optimal serum concentration is under discussion which has already led to modification of the recommendations on vitamin-D supplementation. At present, European consensus on 25-hydroxyvitamin-D serum concentrations seems to be a minimum of 50 nmol/l and a target of 75 nmol/l. The majority of the elderly and of non-Western immigrants are deficient or severely deficient in vitamin D and correction of such a deficiency with bolus therapy should be considered. Awareness of a vitamin-D deficiency is needed in unexplained complaints of muscle weakness or muscle pain, and in the risk groups, such as the elderly, non-Western immigrants, the chronically ill, indoor living and institutionalized, those who habitually use sun protection cream, and severely obese patients.
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18
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Koch BCP, van der Putten K, Van Someren EJW, Wielders JPM, Ter Wee PM, Nagtegaal JE, Gaillard CAJM. Impairment of endogenous melatonin rhythm is related to the degree of chronic kidney disease (CREAM study). Nephrol Dial Transplant 2009; 25:513-9. [PMID: 19767630 DOI: 10.1093/ndt/gfp493] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The nocturnal endogenous melatonin rise, which is associated with the onset of sleep propensity, is absent in haemodialysis patients. Information on melatonin rhythms in chronic kidney disease (CKD) is limited. Clear relationships exist between melatonin, core body temperature and cortisol in healthy subjects. In CKD, no data are available on these relationships. The objective of the study was to characterize the rhythms of melatonin, cortisol and temperature in relation to renal function in patients with CKD. METHODS From 28 patients (mean age 71 years) with various degrees of renal function, over a 24-h period, blood samples were collected every 2 h. An intestinal telemetric sensor was used to measure core temperature. The presence of diurnal rhythms was examined for melatonin, temperature and cortisol. Correlation analysis was performed between Cockcroft-Gault GFR (GFR), melatonin, cortisol and temperature parameters. RESULTS The mean GFR was 57 +/- 30 ml/min. The subjects exhibited melatonin (n = 24) and cortisol (n = 22) rhythms. GFR was significantly correlated to melatonin amplitude (r = 0.59, P = 0.003) and total melatonin production (r = 0.51, P = 0.01), but not to temperature or cortisol rhythms. Interestingly, no associations were found between the rhythms of temperature, melatonin and cortisol. CONCLUSIONS As melatonin amplitude and melatonin rhythm decreased with advancing renal dysfunction, follow-up research into circadian rhythms in patients with CKD is warranted.
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Affiliation(s)
- Birgit C P Koch
- Department of Clinical Pharmacy, Meander MC, The Netherlands. Amersfoort.
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19
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20
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van de Wiel A, Wielders JPM. [biological markers for alcohol abuse]. Ned Tijdschr Geneeskd 2009; 153:818-823. [PMID: 19469215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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21
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van den Broek D, Keularts IMLW, Wielders JPM, Kraaijenhagen RJ. Benefits of the iQ200 automated urine microscopy analyser in routine urinalysis. Clin Chem Lab Med 2009; 46:1635-40. [PMID: 19012529 DOI: 10.1515/cclm.2008.317] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Urine microscopic analysis is hampered by its lack in standardisation and semi-quantitative reports, resulting in limited reliability. Automation of urinalysis could overcome these problems. METHODS We compared the performance of the iQ200 with traditional microscopy and strip analysis in routine urinalysis. A total of 1482 routine samples, positive in dipstick testing, were evaluated for erythrocytes, leukocytes, casts, dysmorphic erythrocytes and bacteria using the iQ200 and traditional microscopy. The results of 320 of these samples were linked to underlying urological pathology as well as results from bacterial culturing. RESULTS Analytically, the iQ200 surpasses traditional microscopy. The identification of casts and dysmorphic erythrocytes in routine samples improves when using the iQ200, although the sub-classification of casts required well-trained technicians. The auto-classification of particles was least reliable for yeast and bacterial cocci. The quantitative reports, and therefore the use of precise cut-off points allowed earlier and improved detection of urinary tract pathology. CONCLUSIONS The performance of the iQ200 is equal to traditional microscopy, but it strongly improves the reliability of urinalysis by standardisation, quantitative reports and improved workflow. From a clinical point of view, renewed attention and improvement of routine urinalysis aids in the efficient detection of renal and urinary tract pathology.
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Affiliation(s)
- Daan van den Broek
- Meander Medisch Centrum, Klinisch Chemisch Laboratorium, Amersfoort, The Netherlands.
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22
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van der Meer IM, Boeke AJP, Lips P, Grootjans-Geerts I, Wuister JD, Devillé WLJM, Wielders JPM, Bouter LM, Middelkoop BJC. Fatty fish and supplements are the greatest modifiable contributors to the serum 25-hydroxyvitamin D concentration in a multiethnic population. Clin Endocrinol (Oxf) 2008; 68:466-72. [PMID: 17941903 DOI: 10.1111/j.1365-2265.2007.03066.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [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: 11/29/2022]
Abstract
OBJECTIVE Because vitamin D synthesis is lower in a heavily pigmented skin than in a lighter skin, the relative contribution of determinants to the vitamin D concentration might differ between ethnic groups. The aim of this study was to assess the prevalence of vitamin D deficiency and the relative contribution of vitamin D consumption and exposure to sunlight to the vitamin D concentration in a multiethnic population. DESIGN Cross-sectional study. PATIENTS A total of 613 adults aged 18-65 years from a random sample from general practices in the Netherlands (52 degrees N, 2003-05), stratified according to gender and ethnic group. MEASUREMENTS Serum 25-hydroxyvitamin D [25(OH)D], PTH, ethnic group, sunlight exposure, consumption of foods and supplements rich in vitamin D. RESULTS The prevalence (95% confidence interval) of vitamin D deficiency [serum 25(OH)D < 25 nmol/l] was higher in Turkish (41.3%; 32.5-50.1), Moroccan (36.5%; 26.9-46.1), Surinam South Asian (51.4%; 41.9-60.9), Surinam Creole (45.3%; 34.0-56.6), sub-Saharan African (19.3%; 9.1-29.5) and other adults (29.1%; 17.1-41.1) compared to the indigenous Dutch (5.9%; 1.3-10.5). Modifiable, significant determinants (standardized regression coefficients) for serum 25(OH)D concentration were: consumption of fatty fish (0.160), use of vitamin D supplements (0.142), area of uncovered skin (highest category 0.136; middle category 0.028), use of tanning bed (0.103), consumption of margarine (0.093) and preference for sun (0.089). We found no significant modification of ethnic group on the effect of sunlight determinants. CONCLUSION Of the modifiable determinants, fatty fish and supplements are the greatest contributors to the serum 25(OH)D concentration in a multiethnic population.
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Affiliation(s)
- Irene M van der Meer
- Department of Epidemiology, Municipal Health Service of The Hague, The Hague, The Netherlands.
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23
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Prins J, van der Meijden BB, Kraaijenhagen RJ, Wielders JPM. Inherited Chronic Obstructive Pulmonary Disease: New Selective-Sequencing Workup for α1-Antitrypsin Deficiency Identifies 2 Previously Unidentified Null Alleles. Clin Chem 2008; 54:101-7. [DOI: 10.1373/clinchem.2007.095125] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground: α1-Antitrypsin (α1AT) deficiency predisposes individuals to chronic obstructive pulmonary disease (COPD) and/or liver disease. Phenotyping of the protein by isoelectric focusing is often used to characterize α1AT deficiency, but this method may lead to misdiagnosis (e.g., by missing null alleles). We evaluated a workup that included direct sequencing of the relevant parts of the gene encoding α1AT, SERPINA1 [serpin peptidase inhibitor, clade A (alpha-1 antiproteinase, antitrypsin), member 1], for patients with α1AT concentrations ≤1.0 g/L.Methods: During a 5-year period, we identified 66 patients with α1AT concentrations ≤1.0 g/L and amplified and sequenced exons 2, 3, and 5 of the α1AT gene in these patients. To ensure that no relevant genotypes were missed, we sequenced the same exons in 48 individuals with α1AT concentrations between 1.0 and 1.5 g/L.Results: Sequence analysis revealed 18 patients with combinations of disease-associated α1AT alleles: 8 homozygous for the deficient Z allele and 10 compound heterozygotes for various deficient or null alleles. We identified and named 2 new null alleles, Q0soest (Thr102→delA, which produces a TGA stop signal at codon 112) and Q0amersfoort (Tyr160→stop). No relevant disease-associated allele combinations were missed at a 1.0-g/L threshold.Conclusions: Up to 22% of the alleles in disease-associated α1AT allele combinations may be missed by conventional methods. Genotyping by direct sequencing of samples from patients with α1AT concentrations ≤1.0 g/L detected these alleles and identified 2 new null alleles.
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Affiliation(s)
| | | | - Rob J Kraaijenhagen
- Department of Clinical Chemistry, Meander Medical Center, Amersfoort, The Netherlands
| | - Jos P M Wielders
- Department of Clinical Chemistry, Meander Medical Center, Amersfoort, The Netherlands
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Jeppsson JO, Arndt T, Schellenberg F, Wielders JPM, Anton RF, Whitfield JB, Helander A. Toward standardization of carbohydrate-deficient transferrin (CDT) measurements: I. Analyte definition and proposal of a candidate reference method. Clin Chem Lab Med 2007; 45:558-62. [PMID: 17439340 DOI: 10.1515/cclm.2007.107] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An alcohol-associated change in the serum transferrin glycoform pattern, carbohydrate-deficient transferrin (CDT), is used as a biomarker of chronic moderate to heavy alcohol consumption. A current limitation in CDT analysis is the lack of standardization, which hampers clinical and analytical comparison between studies. This situation prompted initiation of a Working Group (WG) on CDT Standardization under the auspices of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). The standardization work aims to define and validate the analyte, select a reference method, work out procedures for the production of reference materials, and make suggestions for the clinical usage of CDT. The first recommendation of the WG is that disialotransferrin should be the primary target molecule for CDT measurement and the single analyte on which CDT standardization is based. It is further recommended that HPLC should be the analytical principle considered as the basis of an interim reference method until a suitable mass spectrometric reference method is established. In clinical use, CDT should be expressed in a relative amount (% CDT), to compensate for variations in the total transferrin concentration.
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Delanghe JR, Helander A, Wielders JPM, Pekelharing JM, Roth HJ, Schellenberg F, Born C, Yagmur E, Gentzer W, Althaus H. Development and multicenter evaluation of the N latex CDT direct immunonephelometric assay for serum carbohydrate-deficient transferrin. Clin Chem 2007; 53:1115-21. [PMID: 17412797 DOI: 10.1373/clinchem.2006.084459] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Carbohydrate-deficient transferrin (CDT) is a promising biomarker of alcohol abuse. We describe the development and multicenter evaluation of N Latex CDT (Dade Behring), an automated, particle-enhanced, homogeneous immunonephelometric assay for directly determining CDT. METHODS N Latex CDT uses a monoclonal antibody that recognizes the structure of transferrin glycoforms lacking 1 or 2 complete N-glycans [i.e., disialo-, monosialo-, and asialotransferrins (CDT glycoforms)] in combination with a simultaneous assay for total transferrin. The Dade Behring BN II and BN ProSpec systems automatically calculate the CDT value as a percentage of total transferrin (%CDT). No preanalytical sample treatment is used. RESULTS Total imprecision values for serum pools containing 1.8%-8.7% CDT were 3.4%-10.4% (mean, 6.8%). The mean (SD) %CDT for 561 serum samples from healthy control individuals was 1.76% (0.27%; range, 1.01%-2.85%). No marked sex or age differences were noted. The 97.5th percentile was at 2.35%. Transferrin genetic variants did not interfere with measurements. High transferrin concentrations did not falsely increase %CDT values, but increased %CDT values were noted for some samples with transferrin concentrations <1.1 g/L. N Latex CDT results correlated with those of a commercial CDT immunoassay involving column separation (r(2) = 0.862) and an HPLC candidate reference method (r(2) = 0.978). CONCLUSION N Latex CDT is the first direct immunoassay for quantifying %CDT in serum. The specificity of N Latex CDT for identifying alcohol abuse may be higher than for immunoassays that use column separation, because transferrin genetic variants do not interfere with measurements.
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Affiliation(s)
- Joris R Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium.
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26
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Wielders JPM, van Dormaël PD, Eskes PF, Duk MJ. [Severe vitamin-D deficiency in more than half of the immigrant pregnant women of non-western origin and their newborns]. Ned Tijdschr Geneeskd 2006; 150:495-9. [PMID: 16553049] [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: 05/07/2023]
Abstract
OBJECTIVE To determine the prevalence of vitamin-D deficiency in pregnant women and their newborns. DESIGN Descriptive. METHOD During the period of one year (April 2004-April 2005) 545 pregnant women of Dutch/European origin and 131 pregnant women of non-Western origin (mainly Turkish and Moroccan) were studied during their 10th and/or 30th week of pregnancy for calcidiol (vitamin-D) and calcium levels. The study took place in the Amersfoort region in the center of the Netherlands. In addition, cord blood samples were taken for vitamin-D and calcium levels from the 442 and 81 Dutch/European and non-Western newborns respectively. RESULTS A severe deficiency was found (calcidiol < 20 nmol/l) in 55% of non-European women compared to 5% of Dutch/West-European women. From the cord blood samples, a severe vitamin-D deficiency (calcidiol < 13 nmol/l) was found in 54% of the newborns of non-European origin compared to 6% of the Dutch/West-European newborns. Vitamin-D concentrations in pregnant women at term were strongly correlated to the concentrations in the newborns' cord blood (R = 0.84). The calcium levels of pregnant women and newborns did not differ significantly between both population groups. CONCLUSION More than half of the non-European pregnant women and their newborns had a severe vitamin-D deficiency. Screening for vitamin D deficiency and adequate suppletion for this risk group appears to be necessary. The causes and consequences of vitamin-D deficiency in pregnancy are discussed.
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Affiliation(s)
- J P M Wielders
- Meander Medisch Centrum, Utrechtseweg 160, 3818 ES Amersfoort.
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27
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Helander A, Wielders JPM, Te Stroet R, Bergström JP. Comparison of HPLC and Capillary Electrophoresis for Confirmatory Testing of the Alcohol Misuse Marker Carbohydrate-Deficient Transferrin. Clin Chem 2005; 51:1528-31. [PMID: 16040850 DOI: 10.1373/clinchem.2005.050732] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anders Helander
- Department of Clinical Neuroscience, Karolinska Institutet and University Hospital, Stockholm, Sweden.
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28
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Veeninga AT, Wielders JPM, Oosterink J. [A pilot study of vitamin D in psychogeriatric patients: 82% is (severely) deficient]. Tijdschr Gerontol Geriatr 2004; 35:203-6. [PMID: 15597913] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In a group of 34 psychogeriatric patients (mean age 79 years) the prevalence of hypovitaminosis D was found to be 82%, taking 30 nmol/l as cut-off for calcidiol. We found 47% of the whole group to be severely deficient having values lower than 20 nmol/l. Results of related test are presented and discussed. Patient were treated with oral calcium and vitamin D3 medication. Origin, presentation and risks of hypovitaminosis D, including muscle weakness and the aggravating role of low calcium intake, are discussed with special attention to psychogeriatric patients. Suppletion of vitamin D and calcium is suggested for this patient group.
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Sabelis LWE, Senden PJ, Zonderland ML, van de Wiel A, Wielders JPM, Huisveld IA, van Haeften TW, Mosterd WL. Determinants of insulin sensitivity in chronic heart failure. Eur J Heart Fail 2004; 5:759-65. [PMID: 14675854 DOI: 10.1016/s1388-9842(03)00156-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 10/26/2022] Open
Abstract
OBJECTIVE To describe the determinants of insulin sensitivity (IS) in chronic heart failure (CHF), we created a model in which the influence of lifestyle factors and etiology of heart failure on IS were incorporated concomitantly with age, left ventricular ejection fraction (LVEF) and parameters of body composition. DESIGN Observational cohort study. SETTING Outpatient clinic for chronic heart failure. PATIENTS Fifty-seven male CHF patients [NYHA class II-III, age 61+/-9 years, body mass index (BMI) 26.9+/-3.3 kg/m2 (mean+/-S.D.)]. INTERVENTIONS Euglycemic hyperinsulinemic clamp, cycle ergometry, anthropometric measurements, LVEF and a physical activity questionnaire. MAIN OUTCOME MEASURES A model explaining the variance of IS in CHF. RESULTS IS was 18.2+/-8.6 microg.kg(-1).min(-1).mU(-1).l(-1), fasting insulin level was 15.9+/-11.0 mU/l and fasting glucose level was 5.5+/-0.6 mmol/l. Peak VO2 was 19.1+/-4.9 ml.kg(-1).min(-1) and LVEF 26.2+/-7.1%. IS was inversely associated with fasting insulin concentration (r=-0.50, P<0.001) and BMI (r=-0.54, P<0.001). After controlling for BMI, IS also revealed a correlation with age (r=-0.36, P<0.01). The model explained 60% of variance in IS: BMI contributed 20%, smoking 17%, age 17% and physical activity in daily life (DPA) 16% (all P<0.05) to the variance of IS, whereas LVEF (9%) and etiology of heart failure (8%) contributed moderately. CONCLUSIONS In CHF patients, IS is for a major part predicted by BMI, smoking, age, daily physical activity, LVEF and etiology of heart failure.
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Affiliation(s)
- L W E Sabelis
- Department of Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
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Grootjans-Geerts I, Wielders JPM. [A pilot study of hypovitaminosis D in apparently healthy, veiled, Turkish women: severe vitamin D deficiency in 82%]. Ned Tijdschr Geneeskd 2002; 146:1100-1. [PMID: 12085562] [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: 02/25/2023]
Abstract
A pilot study was performed in March 2001 in order to estimate the prevalence of hypovitaminosis D in veiled women in the Netherlands. In a group of 51 Turkish women aged 14-63 years, 42 (82%) were severely deficient (25-hydroxyvitamin D (25-(OH)D) < 20 nmol/l), and 4 (8%) were moderately deficient (25(OH)D: 20-30 nmol/l). About half of the deficient women complained of muscle pain, muscle weakness or fatigue. These results confirm the presence of a serious public health problem with regard to vitamin D amongst veiled women.
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Affiliation(s)
- I Grootjans-Geerts
- Ziekenhuis Eemland, locatie De Lichtenberg, Utrechtseweg 160, 3818 ES Amersfoort
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Hegge HHM, Wielders JPM, Slaets JPJ. [Zinc deficiency in geriatric patients. A study on a geriatric department's wheeling and dealing]. Tijdschr Gerontol Geriatr 2002; 33:64-9. [PMID: 12012944] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We studied the prevalence of zinc deficiency in patients who were hospitalised in a geriatric ward and its association with risk factors for this deficiency and the possible symptoms. The serum zinc level was measured from 45 consecutive admissions to a geriatric ward and patient characteristics were collected. A peer group of healthy subjects originating from a population survey was used as a control group. The serum zinc measured in the admitted patients was significantly lower than the reference value for adults (65.8% had a lowered zinc level) and the serum zinc for healthy elderly. There was no association found with possible causes of zinc deficiency. In an univariate analysis lethargy was the only significant association to zinc deficiency. There was a reverse relationship between the sum of the number of present symptoms and the zinc proportion A lower zinc level is associated with symptoms of zinc deficiency. As more symptoms appear the probability of zinc deficiency is greater. The importance for the clinical practice based on present knowledge is discussed.
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Affiliation(s)
- H H M Hegge
- Klinisch geriater in opleiding, Academisch Ziekenhuis Groningen, Postbus 30.001, 9700 RB Groningen
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