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Butzkueven H, Ponsonby AL, Stein MS, Lucas RM, Mason D, Broadley S, Kilpatrick T, Lechner-Scott J, Barnett M, Carroll W, Mitchell P, Hardy TA, Macdonell R, McCombe P, Lee A, Kalincik T, van der Walt A, Lynch C, Abernethy D, Willoughby E, Barkhof F, MacManus D, Clarke M, Andrew J, Morahan J, Zhu C, Dear K, Taylor BV. Vitamin D did not reduce multiple sclerosis disease activity after a clinically isolated syndrome. Brain 2024; 147:1206-1215. [PMID: 38085047 PMCID: PMC10994527 DOI: 10.1093/brain/awad409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/08/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 04/06/2024] Open
Abstract
Low serum levels of 25-hydroxyvitamin D [25(OH)D] and low sunlight exposure are known risk factors for the development of multiple sclerosis. Add-on vitamin D supplementation trials in established multiple sclerosis have been inconclusive. The effects of vitamin D supplementation to prevent multiple sclerosis is unknown. We aimed to test the hypothesis that oral vitamin D3 supplementation in high-risk clinically isolated syndrome (abnormal MRI, at least three T2 brain and/or spinal cord lesions), delays time to conversion to definite multiple sclerosis, that the therapeutic effect is dose-dependent, and that all doses are safe and well tolerated. We conducted a double-blind trial in Australia and New Zealand. Eligible participants were randomized 1:1:1:1 to placebo, 1000, 5000 or 10 000 international units (IU) of oral vitamin D3 daily within each study centre (n = 23) and followed for up to 48 weeks. Between 2013 and 2021, we enrolled 204 participants. Brain MRI scans were performed at baseline, 24 and 48 weeks. The main study outcome was conversion to clinically definite multiple sclerosis based on the 2010 McDonald criteria defined as either a clinical relapse or new brain MRI T2 lesion development. We included 199 cases in the intention-to-treat analysis based on assigned dose. Of these, 116 converted to multiple sclerosis by 48 weeks (58%). Compared to placebo, the hazard ratios (95% confidence interval) for conversion were 1000 IU 0.87 (0.50, 1.50); 5000 IU 1.37 (0.82, 2.29); and 10 000 IU 1.28 (0.76, 2.14). In an adjusted model including age, sex, latitude, study centre and baseline symptom number, clinically isolated syndrome onset site, presence of infratentorial lesions and use of steroids, the hazard ratios (versus placebo) were 1000 IU 0.80 (0.45, 1.44); 5000 IU 1.36 (0.78, 2.38); and 10 000 IU 1.07 (0.62, 1.85). Vitamin D3 supplementation was safe and well tolerated. We did not demonstrate reduction in multiple sclerosis disease activity by vitamin D3 supplementation after a high-risk clinically isolated syndrome.
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Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Mark S Stein
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville, VIC 3010, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 0200, Australia
| | - Deborah Mason
- Department of Neurology, Christchurch Hospital, Christchurch 8011, New Zealand
| | - Simon Broadley
- Department of Neurology, School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Trevor Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - Michael Barnett
- Brain and Mind Research Institute University of Sydney, Sydney, NSW 2050, Australia
| | - William Carroll
- Department of Neurology, Sir Charles Gairdner Hospital and Centre for Neuromuscular and Neurological Disorders and Perron Institute, University of Western Australia, WA 6009, Australia
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC 3010, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, Sydney, NSW 2139, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Melbourne, VIC 3084, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010Australia
| | - Pamela McCombe
- University of Queensland, Centre for Clinical Research, Brisbane, QLD 4029, Australia
| | - Andrew Lee
- Department of Neurology, Flinders University College of Medicine and Public Health, Adelaide, SA 5042, Australia
| | - Tomas Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC 3010, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Chris Lynch
- Midland Neurology, Hamilton, Waikato 3240, New Zealand
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Wellington 6021, New Zealand
| | - Ernest Willoughby
- Department of Neurology, Auckland Hospital, Auckland 1023, New Zealand
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam 1081 HV, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, WC1N 3BG, UK
| | - David MacManus
- University College London Queen Square Institute of Neurology, Queen Square MS Centre, London WC1N 3BG, UK
| | - Michael Clarke
- Metabolomics Australia (WA), School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Julie Andrew
- Neurosciences Trials Australia, North Melbourne, VIC 3051, Australia
| | - Julia Morahan
- Multiple Sclerosis Australia, North Sydney, NSW 2059, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Keith Dear
- Department of Statistics, School of Public Health, University of Adelaide, SA 5005, Australia
| | - Bruce V Taylor
- MS Research Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
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Hirunsai M, Srikuea R. Differential effects of cholecalciferol and calcitriol on muscle proteolysis and oxidative stress in angiotensin II-induced C2C12 myotube atrophy. Physiol Rep 2024; 12:e16011. [PMID: 38627219 PMCID: PMC11021198 DOI: 10.14814/phy2.16011] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
Renin-angiotensin system activation contributes to skeletal muscle atrophy in aging individuals with chronic diseases. We aimed to explore the effects of cholecalciferol (VD3) and calcitriol (1,25VD3) on signaling of muscle proteolysis and oxidative stress in myotubes challenged with angiotensin II (AII). The mouse C2C12 myotubes were assigned to vehicle, AII, AII + VD3, AII + 1,25VD3, and AII + losartan groups. The expression levels of muscle-specific E3 ubiquitin ligase proteins, autophagy-related proteins, and oxidative stress markers were investigated. We demonstrated the diverse effects of VD3 and 1,25VD3 on AII-induced myotube atrophy. The myotube diameter was preserved by treatment with 100 nM VD3 and losartan, while 1 and 10 nM 1,25VD3 increased levels of FoxO3a, MuRF1, and atrogin-1 protein expression in myotubes exposed to AII. Treatment with AII + 10 nM 1,25VD3 resulted in the upregulation of LC3B-II, LC3B-II/LC3B-I, and mature cathepsin L, which are autophagic marker proteins. The p62/SQSTM1 protein was downregulated and vitamin D receptor was upregulated after treatment with AII + 10 nM 1,25VD3. A cellular redox imbalance was observed as AII + 10 nM 1,25VD3-induced reactive oxygen species and NADPH oxidase-2 overproduction, and these changes were associated with an inadequate response of antioxidant superoxide dismutase-1 and catalase proteins. Collectively, these findings provide a translational perspective on the role of vitamin D3 in alleviating muscle atrophy related to high levels of AII.
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Affiliation(s)
- Muthita Hirunsai
- Department of Biopharmacy, Faculty of PharmacySrinakharinwirot UniversityNakhon NayokThailand
| | - Ratchakrit Srikuea
- Department of Physiology, Faculty of ScienceMahidol UniversityBangkokThailand
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3
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O’Sullivan B, Ounpraseuth S, James L, Majure M, Lang J, Hu Z, Simon A, Bickel S, Ely B, Faricy L, Garza M, Greer M, Hsia D, Jefferson A, Knight L, Lee J, Liptzin D, Abul MH, Perry TT, Prior F, SanGiovanni C, Tam-Williams J, Wu B, Snowden J. Vitamin D Oral Replacement in Children With Obesity Related Asthma: VDORA1 Randomized Clinical Trial. Clin Pharmacol Ther 2024; 115:231-238. [PMID: 37926939 PMCID: PMC10990434 DOI: 10.1002/cpt.3086] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 11/07/2023]
Abstract
Children with asthma and obesity are more likely to have lower vitamin D levels, but the optimal replacement dose is unknown in this population. The objective of this study is identifying a vitamin D dose in children with obesity-related asthma that safely achieves serum vitamin D levels of ≥ 40 ng/mL. This prospective multisite randomized controlled trial recruited children/adolescents with asthma and body mass index ≥ 85% for age/sex. Part 1 (dose finding), evaluated 4 oral vitamin D regimens for 16 weeks to identify a replacement dose that achieved serum vitamin D levels ≥ 40 ng/mL. Part 2 compared the replacement dose calculated from part 1 (50,000 IU loading dose with 8,000 IU daily) to standard of care (SOC) for 16 weeks to identify the proportion of children achieving target serum 25(OH)D level. Part 1 included 48 randomized participants. Part 2 included 64 participants. In Part 1, no SOC participants achieved target serum level, but 50-72.7% of participants in cohorts A-C achieved the target serum level. In part 2, 78.6% of replacement dose participants achieved target serum level compared with none in the SOC arm. No related serious adverse events were reported. This trial confirmed a 50,000 IU loading dose plus 8,000 IU daily oral vitamin D as safe and effective in increasing serum 25(OH)D levels in children/adolescents with overweight/obesity to levels ≥ 40 ng/mL. Given the critical role of vitamin D in many conditions complicating childhood obesity, these data close a critical gap in our understanding of vitamin D dosing in children.
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Affiliation(s)
- Brian O’Sullivan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Song Ounpraseuth
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Laura James
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marc Majure
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jason Lang
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Zhuopei Hu
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Alan Simon
- National Institutes of Health Office of the Director, Bethesda, Maryland, USA
| | - Scott Bickel
- Norton Children’s and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Brian Ely
- West Virginia University, Morgantown, West Virginia, USA
| | - L.E. Faricy
- University of Vermont, Burlington, Vermont, USA
| | - Maryam Garza
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melody Greer
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Daniel Hsia
- Pennington Biomedical Research Institute, Baton Rouge, Louisiana, USA
| | - Akilah Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lisa Knight
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Jeannette Lee
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Mehtap Haktanir Abul
- Hasbro Children’s Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tamara T. Perry
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Fred Prior
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | | - Brian Wu
- Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, USA
| | - Jessica Snowden
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Ganmaa D, Khudyakov P, Buyanjargal U, Tserenkhuu E, Erdenenbaatar S, Achtai CE, Yansanjav N, Delgererekh B, Ankhbat M, Tsendjav E, Ochirbat B, Jargalsaikhan B, Enkhmaa D, Martineau AR. Vitamin D supplements for fracture prevention in schoolchildren in Mongolia: analysis of secondary outcomes from a multicentre, double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2024; 12:29-38. [PMID: 38048799 DOI: 10.1016/s2213-8587(23)00317-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Vitamin D supplementation has been shown to increase total hip areal bone mineral density in healthy children and adolescents. We aimed to investigate whether supplementing schoolchildren living in Mongolia with weekly vitamin D3 for 3 years affected fracture risk. METHODS We did a multicentre, double-blind, randomised, placebo-controlled trial across 18 public schools in Ulaanbaatar, Mongolia. Schoolchildren were eligible if they were aged 6-13 years at screening, had a negative QuantiFERON-TB Gold In-tube assay (QFT) result, were not hypersensitive to vitamin D or immunocompromised, did not use vitamin D supplements, did not have clinical signs of rickets, and had no intention of leaving Ulaanbaatar within 3 years. Participants were randomly assigned (1:1) to receive either vitamin D (oral dose of 14 000 international units [IU] vitamin D3, once per week) or placebo for 3 years using permuted block randomisation stratified by school of attendance. Participants, care providers, and all trial staff were masked to group assignment during the intervention. Prespecified secondary outcomes were incidence of fractures and adverse events, ascertained using questionnaires. The fracture and safety analyses included participants who completed at least one follow-up fracture questionnaire. We estimated adjusted risk ratios (RRs) and 95% CIs using generalised linear models with binomial distribution and a log link function with adjustment for school of attendance. The trial is registered with ClinicalTrials.gov, NCT02276755, and the intervention ended in May, 2019. FINDINGS Between Sept 2, 2015, and March 20, 2017, 11 475 children were invited to participate in the study and 8851 were recruited and randomly assigned to receive either vitamin D (n=4418) or placebo (n=4433). 8348 participants were included in the fracture and safety analyses (4176 [94·5%] in the vitamin D group and 4172 [94·1%] in the placebo group). Of these, 4125 (49·4%) were female, 4223 (50·6%) were male, and 7701 (92·2%) were of Khalkh ancestry. Median age was 9·2 years (IQR 8·0-10·7) and 7975 (95·5%) participants had baseline serum 25-hydroxyvitamin D concentrations less than 50 nmol/L. During a median follow-up of 3·0 years (IQR 2·9-3·1), 268 (6·4%) participants in the vitamin D group and 253 (6·1%) in the placebo group reported one or more fractures (adjusted RR 1·10, 95% CI 0·93-1·29; p=0·27). Incidence of adverse events did not differ between study groups. INTERPRETATION Oral vitamin D supplementation at a dose of 14 000 IU/week for 3 years was safe, but did not influence fracture risk in schoolchildren living in Mongolia who had a high baseline prevalence of vitamin D deficiency. FUNDING US National Institutes of Health.
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Affiliation(s)
- Davaasambuu Ganmaa
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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5
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Jenssen M, Furberg AS, Jorde R, Wilsgaard T, Danielsen K. Effect of Vitamin D Supplementation on Psoriasis Severity in Patients With Lower-Range Serum 25-Hydroxyvitamin D Levels: A Randomized Clinical Trial. JAMA Dermatol 2023; 159:518-525. [PMID: 36988936 PMCID: PMC10061314 DOI: 10.1001/jamadermatol.2023.0357] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/01/2023] [Indexed: 03/30/2023]
Abstract
Importance Topical vitamin D analogues are routine treatment for psoriasis, but the effect of oral supplementation has not been established. Objective To examine the effect of vitamin D supplementation on psoriasis severity throughout the winter. Design, Setting, and Participants This randomized, double-blind placebo-controlled clinical trial with 2 parallel groups was performed through 2 winter seasons (2017 to 2018 and 2018 to 2019). Randomization was computer generated. All participants, health care clinicians, and outcome assessors were masked to group assignment. Each participant was followed for 4 months. The presented analyses were conducted in May 2022. The trial was conducted at the clinical research unit of the University Hospital of North Norway (Tromsø; Norway). Adults from the general population in Tromsø with active plaque psoriasis and 25-hydroxyvitamin D (25[OH]D) levels of less than 24 ng/mL (to convert to nmol/L, multiply by 2.496) were included. Intervention Vitamin D (cholecalciferol, 100 000 IU, loading dose, followed by 20 000 IU/week) or placebo for 4 months. Main outcomes and Measures Psoriasis Area Severity Index (PASI) (primary outcome), Physician Global Assessment, self-administered PASI, and Dermatology Life Quality Index scores (secondary outcomes). Results A total of 122 participants (46 women [37.7%]; mean [SD] age, 53.6 [10.0] years; mean [SD] PASI score, 3.1 [2.0]; mean [SD] serum 25(OH)D, 14.9 [3.9] ng/mL) were included. Of these, 60 (49.2%) were randomized to the vitamin D group and 62 (50.8%) to the placebo group. A total of 120 participants (59 vitamin D [49.2%]/61 placebo [51.8%]) completed the study. By completion, mean (SD) 25(OH)D levels were 29.7 (5.2) ng/mL (vitamin D) and 12.0 (3.8) ng/mL (placebo). There was no significant difference in change in PASI score between the groups (adjusted difference, 0.11; 95% CI, -0.23 to 0.45). There was no significant difference in change in Physician Global Assessment score (adjusted odds ratio, 0.66; 95% CI, 0.27-1.63), self-administered PASI (adjusted difference, -0.60; 95% CI, -1.76 to 0.55) or Dermatology Life Quality Index (adjusted difference, -0.86; 95% CI, -1.9 to 0.19) between the groups. No adverse effects of the intervention were registered. Conclusion and Relevance The results of this randomized clinical trial showed that vitamin D supplementation did not affect psoriasis severity. Low baseline severity scores may explain the lack of measurable effect. Levels of 25(OH)D in the intervention group increased to a less-than-expected degree based on previous experimental data from the same source population, and this may have affected the results. Trial Registration ClinicalTrials.gov Identifier: NCT03334136.
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Affiliation(s)
- Marita Jenssen
- Department of Dermatology, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne-Sofie Furberg
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Rolf Jorde
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kjersti Danielsen
- Department of Dermatology, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Courbebaisse M, Bourmaud A, Souberbielle JC, Sberro-Soussan R, Moal V, Le Meur Y, Kamar N, Albano L, Thierry A, Dantal J, Danthu C, Moreau K, Morelon E, Heng AE, Bertrand D, Arzouk N, Perrin P, Morin MP, Rieu P, Presne C, Grimbert P, Ducloux D, Büchler M, Le Quintrec M, Ouali N, Pernin V, Bouvier N, Durrbach A, Alamartine E, Randoux C, Besson V, Hazzan M, Pages J, Colas S, Piketty ML, Friedlander G, Prié D, Alberti C, Thervet E. Nonskeletal and skeletal effects of high doses versus low doses of vitamin D 3 in renal transplant recipients: Results of the VITALE (VITamin D supplementation in renAL transplant recipients) study, a randomized clinical trial. Am J Transplant 2023; 23:366-376. [PMID: 36695682 DOI: 10.1016/j.ajt.2022.12.007] [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: 09/09/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023]
Abstract
Vitamin D sufficiency is associated with a reduced risk of fractures, diabetes mellitus, cardiovascular events, and cancers, which are frequent complications after renal transplantation. The VITALE (VITamin D supplementation in renAL transplant recipients) study is a multicenter double-blind randomized trial, including nondiabetic adult renal transplant recipients with serum 25-hydroxy vitamin D (25(OH) vitamin D) levels of <30 ng/mL, which is randomized 12 to 48 months after transplantation to receive high (100 000 IU) or low doses (12 000 IU) of cholecalciferol every 2 weeks for 2 months and then monthly for 22 months. The primary outcome was a composite endpoint, including diabetes mellitus, major cardiovascular events, cancer, and death. Of 536 inclusions (50.8 [13.7] years, 335 men), 269 and 267 inclusions were in the high-dose and low-dose groups, respectively. The serum 25(OH) vitamin D levels increased by 23 versus 6 ng/mL in the high-dose and low-dose groups, respectively (P < .0001). In the intent-to-treat analysis, 15% versus 16% of the patients in the high-dose and low-dose groups, respectively, experienced a first event of the composite endpoint (hazard ratio, 0.94 [0.60-1.48]; P = .78), whereas 1% and 4% of patients in the high-dose and low-dose groups, respectively, experienced an incident symptomatic fracture (odds ratio, 0.24 [0.07-0.86], P = .03). The incidence of adverse events was similar between the groups. After renal transplantation, high doses of cholecalciferol are safe but do not reduce extraskeletal complications (trial registration: ClinicalTrials.gov; identifier: NCT01431430).
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Affiliation(s)
- Marie Courbebaisse
- Paris University; Physiology Department, European Georges-Pompidou Hospital, APHP; INSERM U1151. Paris, France.
| | - Aurelie Bourmaud
- APHP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC 1426, F-75019 Paris, France; Université de Paris, ECEVE UMR 1123, INSERM. F-75010 Paris, France
| | - Jean-Claude Souberbielle
- Service des explorations fonctionnelles hôpital Necker-Enfants Malades, DMU Biophygen, GHU Centre Université de Paris APHP. Paris, France
| | - Rebecca Sberro-Soussan
- Université de Paris; Service de Transplantation Rénale et Néphrologie, Hôpital Necker Enfant Malades, APHP. Paris, France
| | - Valérie Moal
- Aix-Marseille Université - AP-HM - Hôpital Conception - Centre de Néphrologie et Transplantation Rénale. Marseille, France
| | - Yannick Le Meur
- Department of Nephrology, CHU de Brest; UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, Labex IGO. Brest, France
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR -BMT, University Paul Sabatier. Toulouse, France
| | - Laetitia Albano
- Service de Transplantation Rénale, CHU de Nice. Nice, France
| | - Antoine Thierry
- Service de Néphrologie, INSERM U1082 et Fédération Hospitalo-Universitaire BIOSUPORT. Poitiers, France
| | - Jacques Dantal
- CRTI (Centre de Recherche en Transplantation et Immunologie) INSERM UMR1064, Université de Nantes, Centre Hospitalier Universitaire de Nantes. Nantes, France
| | - Clément Danthu
- Department of Nephrology, Limoges University hospital; UMR INSERM 1092, RESINFIT, Limoges University hospital 2. Limoges, France
| | - Karine Moreau
- Unité de transplantation rénale, Hôpital Pellegrin, CHU de Bordeaux. Bordeaux, France
| | - Emmanuel Morelon
- Service de transplantation, néphrologie et immunologie clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon; INSERM U1111, Université Claude Bernard Lyon1. Lyon, France
| | - Anne-Elisabeth Heng
- Service de Néphrologie, Dialyse, Transplantation, CHU de Clermont-Ferrand; Université Clermont Auvergne. F-63000 Clermont-Ferrand, France
| | - Dominique Bertrand
- Nephrology, dialysis and kidney transplantation, Rouen University Hospital. Rouen, France
| | - Nadia Arzouk
- Service de Transplantation Rénale, hôpital La Pitié-Salpétrière, APHP. Paris, France
| | - Peggy Perrin
- Department of Nephrology and Transplantation, Strasbourg University Hospital; Fédération de Médecine Translationnelle, INSERM U1109, LabEx TRANSPLANTEX. Strasbourg, France
| | | | - Philippe Rieu
- Division of Nephrology, Reims university hospital, CRNS UMR 7369 MEDyC laboratory. Reims, France
| | - Claire Presne
- Nephrology Internal Medicine Dialysis Transplantation Department, Amiens University Hospital. Amiens France
| | - Philippe Grimbert
- Nephrology and Transplant Department, CHU Henri-Mondor, APHP; Université Paris Est Créteil, INSERM U955. Paris, France
| | - Didier Ducloux
- Department of Nephrology, CHU Besançon. Besançon, France
| | - Matthias Büchler
- Department of Nephrology and Transplantation, CHU Tours; University of Tours, EA4245 Transplantation, Immunology, Inflammation; FHU SUPORT. Tours, France
| | | | - Nacéra Ouali
- Nephrology department, SINRA, Hôpital Tenon. Paris, France
| | - Vincent Pernin
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Montpellier University hospital; Institute for Regenerative Medicine & Biotherapy (IRMB), INSERM U1183. Montpellier, France
| | - Nicolas Bouvier
- Service de Néphrologie-Dialyse-Transplantation, CHU Caen Normandie; Université de Caen Normandie. Caen, France
| | - Antoine Durrbach
- Université Paris Saclay, France; INSERM UMR 1186, Gustave Roussy. Villejuif, France; Nephrology Department, Bicêtre Hospital APHP. Le Kremlin-Bicêtre, France
| | - Eric Alamartine
- CHU de Saint Etienne et CIRI - INSERM U1111 - CNRS UMR5308 - ENS Lyon/UCBL1/Université St Etienne. Saint Etienne, France
| | - Christine Randoux
- Service de Néphrologie, CHU Bichat Claude Bernard, APHP.Nord. Paris, France
| | - Virginie Besson
- Service de Néphrologie-Dialyse-transplantation, CHU d'Angers. Angers, France
| | - Marc Hazzan
- Université de Lille, INSERM, CHU Lille, U1286 - Infinite - Institute for Translational Research in Inflammation. F-59000 Lille, France
| | - Justine Pages
- APHP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie Clinique, INSERM, CIC 1426. F-75019 Paris, France
| | - Sandra Colas
- Unité de Recherche Clinique Necker-Cochin, APHP. Paris, France
| | - Marie-Liesse Piketty
- Service des explorations fonctionnelles hôpital Necker-Enfants Malades, DMU Biophygen, GHU Centre Université de Paris APHP. Paris, France
| | | | - Dominique Prié
- Université de Paris; INSERM U1151, service des explorations fonctionnelles hôpital Necker-Enfants Malades, DMU Biophygen, GHU Centre Université de Paris APHP. Paris, France
| | - Corinne Alberti
- APHP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC 1426, F-75019 Paris, France; Université de Paris, ECEVE UMR 1123, INSERM. F-75010 Paris, France
| | - Eric Thervet
- Paris University; Nephrology Department, European Georges-Pompidou Hospital, APHP; INSERM UMR 970, Paris Cardiovascular Research Center. Paris, France
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7
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Abstract
Atopic dermatitis (AD) is a multifactorial disease with underlying barrier disruption and altered microbial flora, resulting in dry skin and eczematous inflammation with persistent pruritis. Mouse models have been heavily used to investigate AD pathophysiology. Among various AD mouse models, AD-like inflammation induced by topical calcipotriol, a vitamin D3 analog referred to as MC903 in experimental settings, is a versatile model that can be applied to any strain of mice, which can be used for immunologic and morphologic studies. Herein, we provide basic protocols for the topical application of MC903 and approaches to assess phenotypes. After inducing AD-like inflammation, the skin is harvested for flow cytometry analysis, as well as for histologic and immunofluorescence microscopy analyses. The combination of these approaches enables accurate characterization of the degree of inflammation, type of inflammatory infiltrate, and localization of immune infiltrates. Published 2023. This article is a U.S. Government work and is in the public domain in the USA. Basic Protocol 1: Application of MC903 and gross phenotype assessment Basic Protocol 2: Processing skin for flow cytometry analysis Support Protocol: Skin immune cell surface staining and flow cytometry analysis Basic Protocol 3: Harvesting skin for histologic analysis Basic Protocol 4: Immunofluorescence staining to identify immune cell infiltrates.
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Affiliation(s)
- Keiko Sakamoto
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Keisuke Nagao
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health
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8
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Méndez-Sánchez L, Clark P, Winzenberg TM, Tugwell P, Correa-Burrows P, Costello R. Calcium and vitamin D for increasing bone mineral density in premenopausal women. Cochrane Database Syst Rev 2023; 1:CD012664. [PMID: 36705288 PMCID: PMC9881395 DOI: 10.1002/14651858.cd012664.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/28/2023]
Abstract
BACKGROUND Osteoporosis is a condition where bones become fragile due to low bone density and impaired bone quality. This results in fractures that lead to higher morbidity and reduced quality of life. Osteoporosis is considered a major public health concern worldwide. For this reason, preventive measurements need to be addressed throughout the life course. Exercise and a healthy diet are among the lifestyle factors that can help prevent the disease, the latter including intake of key micronutrients for bone, such as calcium and vitamin D. The evidence on whether supplementation with calcium and vitamin D improves bone mineral density (BMD) in premenopausal women is still inconclusive. In this age group, bone accrual is considered to be the goal of supplementation, so BMD is relevant for the future stages of life. OBJECTIVES To evaluate the benefits and harms of calcium and vitamin D supplementation, alone or in combination, to increase the BMD, reduce fractures, and report the potential adverse events in healthy premenopausal women compared to placebo. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 12 April 2022. SELECTION CRITERIA We included randomised controlled trials in healthy premenopausal women (with or without calcium or vitamin D deficiency) comparing supplementation of calcium or vitamin D (or both) at any dose and by any route of administration versus placebo for at least three months. Vitamin D could have been administered as cholecalciferol (vitamin D3) or ergocalciferol (vitamin D2). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Outcomes included total hip bone mineral density (BMD), lumbar spine BMD, quality of life, new symptomatic vertebral fractures, new symptomatic non-vertebral fractures, withdrawals due to adverse events, serious adverse events, all reported adverse events and additional withdrawals for any reason. MAIN RESULTS We included seven RCTs with 941 participants, of whom 138 were randomised to calcium supplementation, 110 to vitamin D supplementation, 271 to vitamin D plus calcium supplementation, and 422 to placebo. Mean age ranged from 18.1 to 42.1 years. Studies reported results for total hip or lumbar spine BMD (or both) and withdrawals for various reasons, but none reported fractures or withdrawals for adverse events or serious adverse events. Results for the reported outcomes are presented for the three comparisons: calcium versus placebo, vitamin D versus placebo, and calcium plus vitamin D versus placebo. In all comparisons, there was no clinical difference in outcomes, and the certainty of the evidence was moderate to low. Most studies were at risk of selection, performance, detection, and reporting biases. Calcium versus placebo Four studies compared calcium versus placebo (138 participants in the calcium group and 123 in the placebo group) with mean ages from 18.0 to 47.3 years. Calcium supplementation may have little to no effect on total hip or lumbar spine BMD after 12 months in three studies and after six months in one study (total hip BMD: mean difference (MD) -0.04 g/cm2, 95% confidence interval (CI) -0.11 to 0.03; I2 = 71%; 3 studies, 174 participants; low-certainty evidence; lumbar spine BMD: MD 0 g/cm2, 95% CI -0.06 to 0.06; I2 = 71%; 4 studies, 202 participants; low-certainty evidence). Calcium alone supplementation does not reduce or increase the withdrawals in the trials (risk ratio (RR) 0.78, 95% CI 0.52 to 1.16; I2 = 0%; 4 studies, 261 participants: moderate-certainty evidence). Vitamin D versus placebo Two studies compared vitamin D versus placebo (110 participants in the vitamin D group and 79 in the placebo group), with mean ages from 18.0 to 32.7 years. These studies reported lumbar spine BMD as a mixture of MDs and percent of change and we were unable to pool the results. In the original studies, there were no differences in lumbar BMD between groups. Vitamin D alone supplementation does not reduce or increase withdrawals for any reason between groups (RR 0.74, 95% CI 0.46 to 1.19; moderate-certainty evidence). Calcium plus vitamin D versus placebo Two studies compared calcium plus vitamin D versus placebo (271 participants in the calcium plus vitamin D group and 270 in the placebo group; 220 participants from Woo 2007 and 50 participants from Islam 2010). The mean age range was 18.0 to 36 years. These studies measured different anatomic areas, one study reported total hip BMD and the other study reported lumbar spine BMD; therefore, data were not pooled for this outcome. The individual studies found no difference between groups in percent of change on total hip BMD (-0.03, 95% CI -0.06 to 0; moderate-certainty evidence), and lumbar spine BMD (MD 0.01, 95% CI -0.01 to 0.03; moderate-certainty evidence). Calcium plus vitamin D supplementation may not reduce or increase withdrawals for any reason (RR 0.82, 95% CI 0.29 to 2.35; I2 = 72%; 2 studies, 541 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Our results do not support the isolated or combined use of calcium and vitamin D supplementation in healthy premenopausal women as a public health intervention to improve BMD in the total hip or lumbar spine, and therefore it is unlikely to have a benefit for the prevention of fractures (vertebral and non-vertebral). The evidence found suggests that there is no need for future studies in the general population of premenopausal women; however, studies focused on populations with a predisposition to diseases related to bone metabolism, or with low bone mass or osteoporosis diagnosed BMD would be useful.
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Affiliation(s)
- Lucía Méndez-Sánchez
- Clinical Epidemiology Unit, Children's Hospital of Mexico Federico Gomez-Faculty of Medicine UNAM, Mexico City, Mexico
- Cochrane Mexico UNAM (Universidad Nacional Autónoma de México), Cochrane Mexico, Mexico City, Mexico
| | - Patricia Clark
- Clinical Epidemiology Unit, Children's Hospital of Mexico Federico Gomez-Faculty of Medicine UNAM, Mexico City, Mexico
- Cochrane Mexico UNAM (Universidad Nacional Autónoma de México), Cochrane Mexico, Mexico City, Mexico
| | - Tania M Winzenberg
- Menzies Institute for Medical Research and Faculty of Health, University of Tasmania, Hobart, Australia
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paulina Correa-Burrows
- Department of Human Nutrition, Institute of Nutrition & Food Technology, University of Chile, Santiago de Chile, Chile
| | - Rebecca Costello
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, USA
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9
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Guo L, Wang Y, Li S, Zhou L, Li D. GALNT3 protects against phosphate-induced calcification in vascular smooth muscle cells by enhancing active FGF23 and inhibiting the wnt/β-catenin signaling pathway. Cell Signal 2022; 100:110477. [PMID: 36162588 DOI: 10.1016/j.cellsig.2022.110477] [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: 07/30/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
Vascular calcification (VC) acts as a notable risk factor in the cardiovascular system. Disorder of phosphorus (Pi) metabolism promotes VC. Recent findings show that polypeptide N-acetylgalactosaminyltransferase 3(GALNT3) is Pi responsive and with potent effects on Pi homeostasis. However, whether GALNT3 is involved in high Pi-induced VC remains unclear. The present study investigated the potential role of GALNT3 as a novel regulator of VC. In vitro, human aortic smooth muscle cells (HASMCs) calcification was induced by inorganic Pi, while in vivo, C57BL/6 J mice were used to determine the effects of GALNT3 on Vitamin D3-induced medial arterial calcification. Alizarin red staining, Von Kossa staining, calcium and alkaline phosphatase (ALP) activity were performed to test VC. We showed that expression of GALNT3 was increased in the calcified HASMCs and aortas of the calcified mice.In vitro, overexpression of GALNT3 increased the levels of active full-length FGF23, accompanied by suppression of the osteoblast-related factors (Runx2 and BMP2), and further inhibited the formation of calcified nodules. Moreover, the protein levels of Wnt3a and active β-catenin were determined and it was found that GALNT3 significantly inhibited their expression. LiCl, a Wnt/β-catenin signaling activator, was observed to reverse the protective effect of GALNT3 overexpression. The opposite results were observed in the GALNT3 knockdown cells. In vivo, overexpression of GALNT3 by adeno-associated virus decreased the serum Pi and slowed the formation of aortic calcification in the calcified mice. In conclusion, our results indicate that GALNT3 counteracts high Pi-induced osteoblastic differentiation of VSMCs and protects against the initiation and progression of VC by inhibiting the Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Liwei Guo
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, Henan, China; Xinxiang Key Laboratory of Metabolism and Integrative Physiology, Xinxiang, Henan, China.
| | - Yikai Wang
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, Henan, China; Xinxiang Key Laboratory of Metabolism and Integrative Physiology, Xinxiang, Henan, China
| | - Shijie Li
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, Henan, China; Xinxiang Key Laboratory of Metabolism and Integrative Physiology, Xinxiang, Henan, China
| | - Lulu Zhou
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, Henan, China; Xinxiang Key Laboratory of Metabolism and Integrative Physiology, Xinxiang, Henan, China
| | - Duan Li
- School of Basic Medicine, Xinxiang Medical University, Xinxiang, Henan, China.
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10
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Abstract
RATIONALE There are many causes of hypercalcemia, with hyperparathyroidism and malignancy accounting for 90% of cases. Sarcoidosis and the intake of vitamin D supplements may also cause hypercalcemia, although the occurrence rate is low if only one is involved. We herein report a sarcoidosis patient who developed hypercalcemia after taking cholecalciferol (vitamin D supplement) for a year. PATIENT CONCERN A 62-year-old Japanese man presented with hypercalcemia and acute kidney injury along with symptoms of fatigue and appetite loss while being followed up for sarcoidosis. DIAGNOSES We determined that a combination of cholecalciferol supplementation and sarcoidosis had led to hypercalcemia for several reasons. First, hypercalcemia had not been noted when this patient had first been admitted due to sarcoidosis-related respiratory failure several years earlier, which we presumed that was the highest sarcoidosis disease activity. Second, low serum 25-OH Vit.D3 and high 1,25-(OH)2 Vit.D3 levels were noted despite cholecalciferol supplementation for a year, suggesting that 1-α-hydroxylase overexpression caused by sarcoidosis accelerated the conversion from 25-OH Vit.D3 to 1,25-(OH)2 Vit.D3. INTERVENTIONS Although initially resistant to preservative management, the hypercalcemia promptly improved after starting corticosteroid treatment. OUTCOMES Hypercalcemia and acute kidney injury were normalized after corticosteroid treatment. LESSONS We should be aware of patients' medications, especially in patients with granulomatosis disease. The concomitant measurement of 25-OH Vit.D3 and 1,25-(OH)2 Vit.D3 levels is useful for determining the cause of hypercalcemia.
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Affiliation(s)
- Kimito Mio
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kotaro Haruhara
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
- *Correspondence: Kotaro Haruhara, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan (e-mail: )
| | - Akihiro Shimizu
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Oshiro
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Rena Kawai
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masato Ikeda
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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11
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Amon U, Yaguboglu R, Ennis M, Holick MF, Amon J. Safety Data in Patients with Autoimmune Diseases during Treatment with High Doses of Vitamin D3 According to the “Coimbra Protocol”. Nutrients 2022; 14:nu14081575. [PMID: 35458137 PMCID: PMC9033096 DOI: 10.3390/nu14081575] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 12/29/2022] Open
Abstract
Background: In 2013, the group of Cicero Coimbra, Brazil, reported the clinical efficacy of high doses of vitamin D3 in patients suffering from autoimmune skin disorders (“Coimbra protocol”, CP). However, hypercalcemia and the subsequent impaired renal function may be major concerns raised against this protocol. Methods: We report for the first time for a broad spectrum of autoimmune diseases in 319 patients (mean age (±SD) 43.3 ± 14.6 years, 65.5% female, 34.5% male) safety data for high doses of orally applied vitamin D3 (treatment period: up to 3.5 years) accompanied by a strict low-calcium diet and regular daily fluid intake of at least 2.5 L. Results: Mean vitamin D3 dose was 35,291 ± 21,791 IU per day. The measurement of more than 6100 single relevant laboratory parameters showed all mean values (±SD) within the normal range for total serum calcium (2.4 ± 0.1 mmol/L), serum creatinine (0.8 ± 0.2 mg/dL), serum creatinine associated estimated GFR (92.5 ± 17.3 mL/min), serum cystatin C (0.88 ± 0.19 mg/L), serum TSH (1.8 ± 1 mIU/L), and for 24 h urinary calcium secretion (6.9 ± 3.3 mmol/24 h). We found a very weak relationship between the dosage of oral vitamin D3 and the subsequent calcium levels, both in serum and in urinary excretion over 24 h, respectively. Conclusions: Our data show the reliable safety of the CP in autoimmune patients under appropriate supervision by experienced physicians.
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Affiliation(s)
- Ulrich Amon
- International Centre for Skin Diseases DermAllegra, Coimbra Protocol Certified Center, Am Markgrafenpark 6, 91224 Pommelsbrunn-Hohenstadt, Germany; (R.Y.); (J.A.)
- Correspondence: ; Tel.: +49-9154-914056; Fax: +49-9154-914058
| | - Raul Yaguboglu
- International Centre for Skin Diseases DermAllegra, Coimbra Protocol Certified Center, Am Markgrafenpark 6, 91224 Pommelsbrunn-Hohenstadt, Germany; (R.Y.); (J.A.)
| | - Madeleine Ennis
- The Wellcome-Wolfson Institute for Experimental Medicine, Queens University of Belfast, Belfast BT7 1NN, UK;
| | - Michael F. Holick
- Endocrinology, Diabetes, Nutrition & Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Julian Amon
- International Centre for Skin Diseases DermAllegra, Coimbra Protocol Certified Center, Am Markgrafenpark 6, 91224 Pommelsbrunn-Hohenstadt, Germany; (R.Y.); (J.A.)
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12
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Gordon RJ, Wells R, Johansen C, Liu S, Dahlberg SE, Snapper SB, Rufo PA. Efficacy and Safety of High-dose Cholecalciferol in Patients With Inflammatory Bowel Disease Receiving Infliximab. J Pediatr Gastroenterol Nutr 2022; 74:476-483. [PMID: 35045559 DOI: 10.1097/mpg.0000000000003386] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Vitamin D deficiency is prevalent in patients with inflammatory bowel disease (IBD). The goal of this study was to assess the efficacy and safety of high-dose, interval cholecalciferol administration in patients with IBD receiving infliximab. METHODS This prospective, longitudinal, open-label study enrolled pediatric and young adult patients with IBD and vitamin D deficiency. Subjects received 50,000 IU every 4 to 5 weeks (n = 11) or 100,000 IU every 6 to 8 weeks (n = 32) of oral cholecalciferol for 1 year. Dosing was directly observed and administered in conjunction with infliximab infusions. The primary endpoint was vitamin D sufficiency, defined as a 25-hydroxy-vitamin D (25-OHD) level ≥30 ng/mL. RESULTS Forty-three participants constituted the primary analysis population. 25-OHD levels reached steady-state after the third dose, and mean increases in 25-OHD levels were 8 vs. 4.5 ng/mL in the 100,000 IU vs. 50,000 IU treatment groups, respectively. Only 43.8% of patients receiving 100,000 IU and 18.2% of patients receiving 50,000 IU achieved sufficiency. There was no difference in the 25-OHD level responsiveness in patients with Crohn disease versus those with ulcerative colitis (P = 0.72). There was no correlation between 25-OHD levels and clinical disease activity in patients with Crohn disease (P = 0.85) or ulcerative colitis (P = 0.24). CONCLUSIONS Supplementation with cholecalciferol was well-tolerated and direct observation is a promising paradigm for ensuring compliance with therapy. Patients with IBD, however, appear to require high doses of cholecalciferol, with less than half of patients (37% overall) achieving vitamin D sufficiency. Additional studies are necessary to determine the optimal treatment regimens.
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Affiliation(s)
| | - Reeder Wells
- Division of Gastroenterology, Hepatology, and Nutrition, Inflammatory Bowel Disease Center
| | - Camille Johansen
- Division of Gastroenterology, Hepatology, and Nutrition, Inflammatory Bowel Disease Center
| | - Shanshan Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Suzanne E Dahlberg
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Scott B Snapper
- Division of Gastroenterology, Hepatology, and Nutrition, Inflammatory Bowel Disease Center
| | - Paul A Rufo
- Division of Gastroenterology, Hepatology, and Nutrition, Inflammatory Bowel Disease Center
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13
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Маганева ИС, Пигарова ЕА, Шульпекова НВ, Дзеранова ЛК, Еремкина АК, Милютина АП, Поваляева АА, Жуков АЮ, Богданов ВП, Рожинская ЛЯ, Мокрышева НГ. [Vitamin D metabolite and calcium phosphorus metabolism in in patients with primary hyperparathyroidism on the background of bolus therapy with colecalciferol]. Probl Endokrinol (Mosk) 2021; 67:68-79. [PMID: 35018763 PMCID: PMC9753807 DOI: 10.14341/probl12851] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vitamin D (25-hydroxyvitamin D [25(ОН)D]) deficiency (<20 ng/mL) and insufficiency (20-29 ng/mL) are common in primary hyperparathyroidism (PHPT), but data regarding the vitamin D metabolism in this population is limited. AIM The aim of this study is to estimate the vitamin D metabolites and their relationship with the main parameters of phosphorus-calcium metabolism in patients with PHPT at baseline and on the background of a single dose of cholecalciferol 150,000 IU. MATERIALS AND METHODS A single-center interventional, dynamic, prospective, comparative study has been carried out. The study included 54 participants, divided into two groups: the 1st group included 27 patients with confirmed PHPT, the 2nd control group (n = 27), matched on gender (p = 0.062). The study included 4 visits; the baseline laboratory examination and a bolus dose of cholecalciferol were performed at the visit 1, the subsequent visits included a dynamic laboratory examination. RESULTS Vitamin D deficiency (<20 ng/ml) was detected in 69% of patients with PHPT. In the PHPT group (before cholecalciferol therapy), there was a direct association of 1.25(OH)2 D3 with albumin-corrected and ionized calcium, as well as between the 25(OH)D3 /24.25(OH)2 D3 ratio with PTH and magnesium. After taking of cholecalciferol, the levels of 1.25(OH)2 D3 and 25(OH)D3 /24.25(OH)2 D3 were significantly increased, and the levels of 25(OH)D3 /1.25(OH)2 D3 were significantly declined at all visits among patients with PHPT. The common 25(OH)D level was comparable to the control group, however the levels of 1,25(OH)2 D3 in patients with PHPT were 55% higher at baseline, and after taking of cholecalciferol 150,000 IU. They remained increased by 3-7 days by an additional 23-36%, significantly higher than those in the control group: 44%, 74% and 65%, at visits 2, 3 and 4, respectively (p<0.05). The taking of 150,000 IU cholecalciferol in the PHPT group did not lead to a significant increase in hypercalcemia and hypercalciuria, which indicates the safety of this dose in patients with mild hypercalcemia (albumin corrected calcium <3 mmol/l). None of the study participants experienced any side effects. CONCLUSION The completely comprehensive assessment of vitamin D metabolites was carried out for the first time in patients with PHPT before and after using a bolus dose of cholecalciferol. The results confirmed the differences of vitamin D metabolism in chronic excessive secretion of PTH compared to control group, which is new data in the pathogenesis of the disease, and can be used to develop optimal regimens for cholecalciferol taking in this population.
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Affiliation(s)
- И. С. Маганева
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. А. Пигарова
- Национальный медицинский исследовательский центр эндокринологии
| | | | - Л. К. Дзеранова
- Национальный медицинский исследовательский центр эндокринологии
| | - А. К. Еремкина
- Национальный медицинский исследовательский центр эндокринологии
| | - А. П. Милютина
- Национальный медицинский исследовательский центр эндокринологии
| | - А. А. Поваляева
- Национальный медицинский исследовательский центр эндокринологии
| | - А. Ю. Жуков
- Национальный медицинский исследовательский центр эндокринологии
| | - В. П. Богданов
- Национальный медицинский исследовательский центр эндокринологии
| | - Л. Я. Рожинская
- Национальный медицинский исследовательский центр эндокринологии
| | - Н. Г. Мокрышева
- Национальный медицинский исследовательский центр эндокринологии
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14
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Grübler MR, Zittermann A, Verheyen ND, Trummer C, Theiler-Schwetz V, Keppel MH, Malle O, Richtig G, Gängler S, Bischoff-Ferrari H, Scharnagl H, Meinitzer A, März W, Tomaschitz A, Pilz S. Randomized trial of vitamin D versus placebo supplementation on markers of systemic inflammation in hypertensive patients. Nutr Metab Cardiovasc Dis 2021; 31:3202-3209. [PMID: 34629245 DOI: 10.1016/j.numecd.2021.07.028] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Animal and cell models indicated that vitamin D modulates inflammatory activity, which is considered relevant in the pathogenesis of arterial hypertension and cardiovascular diseases. We therefore aimed to investigate the effect of vitamin D supplementation on systemic markers of inflammation in a cohort of hypertensive patients. METHODS AND RESULTS The Styrian Vitamin D Hypertension Trial is a single-centre, double-blind, placebo-controlled study conducted from 2011 to 2014 in Austria. We enrolled 200 study participants with arterial hypertension and 25-hydroxy-vitamin-D (25(OH)D) concentration below 30 ng/mL. Study participants were randomized to receive either 2800 IU of vitamin D3 per day or placebo for 8 weeks. The present investigation is a post-hoc analysis using analysis of co-variance (ANCOVA). Outcome measures were biomarkers of inflammation including CRP, leukocytes including subtypes and leukocyte-to-lymphocyte ratio, leucine and kynurenic acid. A total of 187 participants (mean age 60.1 ± 11.3years; 47% women; mean baseline 25(OH)D 21.1 ± 5.6 ng/mL) completed the trial. ANCOVA revealed a mean treatment effect for none of the respective outcomes and no significant results were detected in various subgroup analyses. CONCLUSION Vitamin D3 supplementation in hypertensive patients with insufficient 25(OH)D concentrations has no significant effect on lowering markers of systemic inflammation. Further studies investigating the effect of vitamin D on other inflammatory pathways and in populations with severe vitamin D deficiency and a significant inflammatory burden are required. REGISTRATION ClinicalTrials.gov Identifier: NCT02136771; EudraCT No. 2009-018,125-70. Start Date: 2011-04-06.
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Affiliation(s)
- Martin R Grübler
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria; Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland.
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Nicolas D Verheyen
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Verena Theiler-Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Oliver Malle
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Georg Richtig
- Otto Loewi Research Center, Pharmacology Section, Medical University of Graz, Graz, Austria; Department of Oncology, Medical University of Graz, Graz, Austria
| | - Stephanie Gängler
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
| | - Heike Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Winfried März
- Synlab Academy, Synlab Services GmbH, Mannheim, Germany; Vth Department of Medicine, (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Basyreva LY, Vakhrusheva TV, Letkeman ZV, Maximov DI, Fedorova EA, Panasenko ОM, Ostrovsky EM, Gusev SA. Effect of Vitamin D3 in combination with Omega-3 Polyunsaturated Fatty Acids on NETosis in Type 2 Diabetes Mellitus Patients. Oxid Med Cell Longev 2021; 2021:8089696. [PMID: 34721760 PMCID: PMC8556114 DOI: 10.1155/2021/8089696] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/27/2021] [Indexed: 01/13/2023]
Abstract
An understanding of the consequences of oxidative/halogenative stress triggered by neutrophil activation is impossible without considering NETosis. NETosis, formation of neutrophil extracellular traps (NETs), is known to promote microthrombus formation and impair wound healing in type 2 diabetes mellitus (T2DM) patients. Therefore, there is a need to search for drugs and treatment approaches that could prevent excessive NET formation. We aimed to evaluate the effect of vitamin D3 in combination with omega-3 polyunsaturated fatty acids (vitamin D3/omega-3 PUFAs) on NETosis in T2DM patients with purulent necrotizing lesions of the lower extremities. Patients and healthy subjects had vitamin D3 deficiency. Patients received, beyond standard treatment, 6000 IU of vitamin D3 and 480 mg of omega-3 PUFAs, and healthy subjects 1000 IU of vitamin D3 and 240 mg of omega-3 PUFAs daily for seven days. Neutrophil activation in ex vivo blood by phorbol-12-myristate-13-acetate (PMA) was used as a NETosis model. The percentage of blood NETs relative to leukocytes (NETbackground) before vitamin D3/omega-3 PUFA supplementation was 3.2%-4.9% in healthy subjects and 1.7%-10.8% in patients. These values rose, respectively, to 7.7%-9.1% and 4.0%-17.9% upon PMA-induced NETosis. In addition, the leukocyte count decreased by 700-1300 per 1 μL in healthy subjects and 700-4000 per 1 μL in patients. For both patients and healthy subjects, taking vitamin D3/omega-3 PUFAs had no effect on NETbackground but completely inhibited PMA-induced NET formation, though neutrophils exhibited morphological features of activation. Also, leukocyte loss was reduced (to 500 per 1 μL). For patients on standard treatment alone, changes occurred neither in background NETs and leukocytes nor in their amount after PMA stimulation. The decreased ability of neutrophils to generate NETs, which can be achieved by vitamin D3/omega-3 PUFA supplementation, could have a positive effect on wound healing in T2DM patients and reduce the incidence and severity of complications.
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Affiliation(s)
- Liliya Yu. Basyreva
- Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow 119435, Russia
| | - Tatyana V. Vakhrusheva
- Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow 119435, Russia
| | - Zoya V. Letkeman
- Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow 119435, Russia
| | - Dmitry I. Maximov
- Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow 119435, Russia
| | - Evgeniya A. Fedorova
- Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow 119435, Russia
| | - Оleg M. Panasenko
- Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow 119435, Russia
| | - Evgeny M. Ostrovsky
- Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow 119435, Russia
| | - Sergey A. Gusev
- Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow 119435, Russia
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Abdelaal MA, Abdelaziz HM, Ahmed KA, Elsaie ML. Comparative Study of Intralesional Vitamin D3 Injection and Candida Albicans Antigen in Treating Plantar Warts. J Drugs Dermatol 2021; 20:546-549. [PMID: 33938709 DOI: 10.36849/jdd.5264] [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: 11/09/2022]
Abstract
BACKGROUND Warts, or verrucae, are mucosal human papilloma virus (HPV) infections that are very challenging to treat. OBJECTIVE To compare the safety and efficacy of intralesional injection of vitamin D3 versus intralesional injection of candida albicans antigen for plantar warts. METHODS Forty patients were included in the study and were divided into two groups (A&B) with 20 patients each. Group A received intralesional vitamin D3 while Group B received intralesional Candida antigen. Injection was done every 3 weeks until clearance of warts or a maximum of three treatments. RESULTS Nine patients showed complete clearance in group A (45%), while 6 patients (30%) showed partial response and no response in 5 patients (25%) of group (A). As for group (B), complete clearance of the treated warts was observed in 8 patients (40%), partial response in 6 patients (30%) while no response was observed in 6 patients (30%). No superiority of one treatment to the other was observed nor was any statistical significance in both groups’ responses noted. CONCLUSION Treatment of multiple warts by intralesional injection of candida antigen or vitamin D3 is safe and effective, with good cure rates, has an excellent safety profile, with minimal recurrences and statistically equivalent. J Drugs Dermatol. 2021;20(5):546-549. doi:10.36849/JDD.5264.
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Alshahawey M, El Borolossy R, El Wakeel L, Elsaid T, Sabri NA. The impact of cholecalciferol on markers of vascular calcification in hemodialysis patients: A randomized placebo controlled study. Nutr Metab Cardiovasc Dis 2021; 31:626-633. [PMID: 33594986 DOI: 10.1016/j.numecd.2020.09.014] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/20/2020] [Accepted: 09/12/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Vascular calcification is an independent risk factor for cardiovascular diseases and all-cause mortality in end stage renal disease, and particularly in hemodialysis patients. Vitamin D deficiency has been shown to be associated with vascular calcification among this category of patients. Cholecalciferol or vitamin D3; the native inactivated 25-hydroxy vitamin D [25(OH)D], has been proposed to have a good impact on vascular calcification and vitamin D deficiency. However, clinical data is still limited. METHODS AND RESULTS A prospective, randomized, placebo-controlled study was carried out to evaluate the effect of oral cholecalciferol on vascular calcification and 25(OH)D levels in hemodialysis patients. A total of sixty eligible hemodialysis patients were randomly assigned to either a treatment group (Oral 200.000IU Cholecalciferol per month) or a placebo group, for 3 months. Serum 25-hydroxy vitamin D (25(OH)D), fetuin-A, fibroblast growth factor (FGF-23), osteoprotegerin (OPG), calcium, phosphorus, their product (CaXP) and intact parathyroid hormone (iPTH) levels, were all assessed at baseline and at the end of the study. ClinicalTrials.gov registration number: NCT03602430. Cholecalciferol significantly increased serum levels of 25(OH)D and fetuin-A in the treatment group (p-value < 0.001), while no significant difference was observed in the placebo group. Cholecalciferol administration showed no effect on either FGF-23 or OPG. None of the treatment group patients experienced any adverse effects. CONCLUSION Cholecalciferol was shown to be an effective, tolerable, inexpensive pharmacotherapeutic option to overcome vitamin D deficiency, with a possible modulating effect on fetuin-A, among hemodialysis patients. CLINICALTRIALS. GOV REGISTRATION NUMBER NCT03602430.
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Affiliation(s)
- Mona Alshahawey
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Radwa El Borolossy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Lamia El Wakeel
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Tamer Elsaid
- Department of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Nagwa Ali Sabri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
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Yu L, Gao R, Song X, Li X, Zhu J. Cardio-protective and Anti-atherosclerosis Effect of Crocetin on Vitamin D3 and HFD-induced Atherosclerosis in Rats. J Oleo Sci 2021; 70:1447-1459. [PMID: 34615830 DOI: 10.5650/jos.ess21168] [Citation(s) in RCA: 3] [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] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular disease (CVD) is a chronic disease and causes the highest rate of death globally. CVD-related deaths account for 80% of all deaths in low and middle-income countries, such as China. Crocetin (CT), a carotenoid phytoconstituent already confirm their anti-inflammatory and antioxidant effects in various diseases animal models. In the study, we make effort to access the cardio-protective effect of Crocetin against vitamin D3 and high fat induced atherosclerosis in rats and scrutinize the underlying mechanism. Sprague Dawley (SD) rats were used in this study and rats were divided into different groups and high fat diet and vitamin D was used for induction the atherosclerosis. The rats were received oral administration of crocetin (5, 10 and 15 mg/kg) and simvastatin (0.5 mg/kg) until 30 days. At the end of the experimental period, lipid, cardiac markers, anti-inflammatory, antioxidant, pro-inflammatory cytokines and atherogenic index were estimated. The mRNA expression of Intercellular adhesion molecule-1 (ICAM-1), Monocyte Chemoattractant Protein-1 (MCP-1) and vascular cell adhesion molecule 1 (VCAM-1) in aortic tissue of the atherosclerotic rats. Crocetin significantly reduced the aortic membrane thickness and platelet aggregation rates. Crocetin also dose-dependently reduced total cholesterol (TC), very low-density lipoprotein (VLDL), triacylglycerol (TG), low-density lipoprotein (LDL) and augmented the level of high-density lipoprotein (HDL) level. Additionally, Crocetin significantly (p < 0.001) abridged the level of malonaldehyde (MDA) and augmented the level of superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH) and glutathione peroxidase (GPx). Furthermore, Crocetin significantly (p < 0.001) dose-dependently reduced the levels of pro-inflammatory cytokines and inflammatory mediators. Crocetin attenuated mRNA expression of VCAM-1, ICAM-1 and MCP-1. Crocetin had anti-atherosclerosis and cardio-protective effects on vitamin D3 and high fat induced atherosclerosis in rats through anti-inflammatory and antioxidant mechanisms.
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Affiliation(s)
- Laizeng Yu
- Internal Medicine of Traditional Chinese Medicine, Shandong Xinzhonglu Hospital of Traditional Chinese Medicine
| | - Ruihua Gao
- Nursing College, Nanchang Medical College
| | - Xuewen Song
- Internal Medicine of Traditional Chinese Medicine, Shandong Xinzhonglu Hospital of Traditional Chinese Medicine
| | - Xuechao Li
- Department of Traditional Chinese Medicine, Fenghuangling Street Hospital
| | - Jiacheng Zhu
- Internal Medicine of Traditional Chinese Medicine, Shandong Xinzhonglu Hospital of Traditional Chinese Medicine
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Geng P, Xu X, Gao Z. Sinomenine Suppress the Vitamin D3 and High Fat Induced Atherosclerosis in Rats via Suppress of Oxidative Stress and Inflammation. J Oleo Sci 2021; 70:1815-1828. [PMID: 34866111 DOI: 10.5650/jos.ess21255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/13/2022] Open
Abstract
Atherosclerosis (AS) is a cardiovascular disease that arise due to dysfunction of lipid deposition and metabolism. AS is causes the mortality and morbidity worldwide. Sinomenine isolated from the Sinomenium acutum is used extensively against the various cardiac diseases in China. However, the anti-atherosclerosis effect of sinomenine still not explore. In this study, we explore the cardioprotective and anti-atherosclerosis effect of sinomenine against Vitamin D3 and High fat induced atherosclerosis in rats. Sprague Dawley (SD) rats were used in this study. The rats were received the vitamin D (60000) and High fat diet to induce the atherosclerosis and divided into groups and received the oral administration of sinomenine (2.5, 5 and 10 mg/kg) and simvastatin (5 mg/kg). Body weight, organ weight and biochemical parameters were estimated. The mRNA expression of MyD88, TLR4, NF-κB and IκB were estimated. Sinomenine treated rats significantly (p<0.001) suppressed the body weight and modulated the organ weight (hepatic, renal and heart). Sinomenine significantly (p<0.001) decreased the level of triacylglycerols (TG), low density lipoprotein cholesterol (LDL-c), total cholesterol (TC), very low-density lipoprotein cholesterol (VLDL-c) and augmented the level of high-density lipoprotein cholesterol (HDL-c). Sinomenine treatment also reduced the level of atherogenic index (TC/HDL-c and LDL-c/HDL-c). Sinomenine treatment decrease the ratio of HMG CoA/Mevalonate and level of collagen and total protein. Sinomenine significantly (p<0.001) altered the level of heart parameters, antioxidant parameters and inflammatory cytokines. Sinomenine significantly (p<0.001) reduced the expression of MyD88, TLR4, NF-κB and IκB. Taken together, sinomenine exhibited the protective effect against the atherosclerosis via alteration of TLR4/NF-κB signaling pathway.
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Affiliation(s)
- Pengbo Geng
- Department of Cardiology, Xi'an XD Group Hospital
| | - Xiaohui Xu
- Department of Cardiology, Xi'an XD Group Hospital
| | - Zhao Gao
- Department of Cardiology of Heart Disease Hospital, XI'AN International Medical Center Hospital
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Kruschitz R, Wakolbinger M, Schindler K, Prager G, Hoppichler F, Marculescu R, Ludvik B. Effect of one-anastomosis gastric bypass on cardiovascular risk factors in patients with vitamin D deficiency and morbid obesity: A secondary analysis. Nutr Metab Cardiovasc Dis 2020; 30:2379-2388. [PMID: 32981799 DOI: 10.1016/j.numecd.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/20/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Bariatric patients often suffer from vitamin D (VD) deficiency, and both, morbid obesity and VD deficiency, are related to an adverse effect on cardiovascular disease (CVD) risk. Therefore, we assessed the change of known CVD risk factors and its associations during the first 12 months following one-anastomosis gastric bypass (OAGB). METHODS AND RESULTS In this secondary analysis, CVD risk factors, medical history and anthropometric data were assessed in fifty VD deficient (25-hydroxy-vitamin D (25(OH)D) <75 nmol/l) patients, recruited for a randomized controlled trial of VD supplementation. Based on previous results regarding bone-mass loss and the association between VD and CVD risk, the study population was divided into patients with 25(OH)D ≥50 nmol/l (adequate VD group; AVD) and into those <50 nmol/l (inadequate VD group; IVD) at 6 and 12 months (T6/12) postoperatively. In the whole cohort, substantial remission rates for hypertension (38%), diabetes (30%), and dyslipidaemia (41%) and a significant reduction in CVD risk factors were observed at T12. Changes of insulin resistance markers were associated with changes of total body fat mass (TBF%), 25(OH)D, and ferritin. Moreover, significant differences in insulin resistance markers between AVD and IVD became evident at T12. CONCLUSION These findings show that OAGB leads to a significant reduction in CVD risk factors and amelioration of insulin resistance markers, which might be connected to reduced TBF%, change in 25(OH)D and ferritin levels, as an indicator for subclinical inflammation, and an adequate VD status. REGISTERED AT CLINICALTRIALS.GOV: (Identifier: NCT02092376) and EudraCT (Identifier: 2013-003546-16).
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Affiliation(s)
- Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Division of Internal Medicine, General Public Hospital of the Order of Saint Elisabeth, Klagenfurt, Austria
| | - Maria Wakolbinger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Austria.
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology and Nutrition - SIPCAN, Salzburg, Austria; Division of Internal Medicine, General Public Hospital of the Brothers of Saint John of God Salzburg, Austria
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Department of Medicine 1, Karl Landsteiner Institute for Obesity and Metabolic Disorders, Rudolfstiftung Hospital, Vienna, Austria
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Jukic AMZ, Zuchniak A, Qamar H, Ahmed T, Mahmud AA, Roth DE. Vitamin D Treatment during Pregnancy and Maternal and Neonatal Cord Blood Metal Concentrations at Delivery: Results of a Randomized Controlled Trial in Bangladesh. Environ Health Perspect 2020; 128:117007. [PMID: 33226277 PMCID: PMC7682582 DOI: 10.1289/ehp7265] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/06/2020] [Accepted: 10/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Vitamin D improves absorption of calcium; however, in animal studies vitamin D also increases the absorption of toxic metals, such as lead and cadmium. OBJECTIVES We examined maternal and neonatal cord blood levels of lead, cadmium, manganese, and mercury after supplementation with vitamin D during pregnancy. METHODS The Maternal Vitamin D for Infant Growth trial was a randomized, placebo-controlled, multi-arm study of maternal vitamin D supplementation during pregnancy in Dhaka, Bangladesh (NCT01924013). Women were randomized during their second trimester to blinded weekly doses of placebo or 4,200, 16,800, or 28,000 IU of vitamin D3 throughout pregnancy. Each group had 118-239 maternal blood specimens and 100-201 cord blood samples analyzed. Metals were measured using inductively coupled plasma mass spectrometry. Unadjusted estimates from linear regression models were expressed as percentage differences. Cord blood cadmium was analyzed as detectable or undetectable with log-binomial regression. RESULTS Maternal cadmium, mercury, and manganese levels were nearly identical across groups. Maternal lead levels were 6.3%, 7.4%, and 6.0% higher in the treatment groups (4,200, 16,800, and 28,000 IU, respectively) vs. placebo; however, 95% confidence intervals (CIs) showed that differences from 4.1% lower to 20% higher were compatible with the data. In treatment groups (4,200, 16,800, 28,000 IU) vs. placebo, neonatal cord blood lead levels were 8.5% (95% CI: - 3.5 , 22), 16% (95% CI: 3.3, 30), and 11% (95% CI: 0.4, 23) higher and had higher risk of detectable cadmium, relative risk ( RR ) = 2.2 (95% CI: 1.3, 3.7), RR = 1.4 (95% CI: 0.8, 2.5), RR = 1.7 (95% CI: 1.0, 2.9). DISCUSSION Vitamin D supplementation from the second trimester of pregnancy did not influence maternal cadmium, mercury, or manganese levels at delivery. Vitamin D was associated with nonsignificant increases in maternal lead and with significant increases in cord blood lead and cadmium. These associations were not dose dependent. Given that there are no safe levels of metals in infants, the observed increases in cord blood lead and cadmium require further exploration. https://doi.org/10.1289/EHP7265.
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Affiliation(s)
- Anne Marie Z. Jukic
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, North Carolina, USA
| | - Anna Zuchniak
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Huma Qamar
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abdullah Al Mahmud
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Daniel E. Roth
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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22
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Forno E, Bacharier LB, Phipatanakul W, Guilbert TW, Cabana MD, Ross K, Covar R, Gern JE, Rosser FJ, Blatter J, Durrani S, Han YY, Wisniewski SR, Celedón JC. Effect of Vitamin D3 Supplementation on Severe Asthma Exacerbations in Children With Asthma and Low Vitamin D Levels: The VDKA Randomized Clinical Trial. JAMA 2020; 324:752-760. [PMID: 32840597 PMCID: PMC7448830 DOI: 10.1001/jama.2020.12384] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [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: 12/18/2022]
Abstract
IMPORTANCE Severe asthma exacerbations cause significant morbidity and costs. Whether vitamin D3 supplementation reduces severe childhood asthma exacerbations is unclear. OBJECTIVE To determine whether vitamin D3 supplementation improves the time to a severe exacerbation in children with asthma and low vitamin D levels. DESIGN, SETTING, AND PARTICIPANTS The Vitamin D to Prevent Severe Asthma Exacerbations (VDKA) Study was a randomized, double-blind, placebo-controlled clinical trial of vitamin D3 supplementation to improve the time to severe exacerbations in high-risk children with asthma aged 6 to 16 years taking low-dose inhaled corticosteroids and with serum 25-hydroxyvitamin D levels less than 30 ng/mL. Participants were recruited from 7 US centers. Enrollment started in February 2016, with a goal of 400 participants; the trial was terminated early (March 2019) due to futility, and follow-up ended in September 2019. INTERVENTIONS Participants were randomized to vitamin D3, 4000 IU/d (n = 96), or placebo (n = 96) for 48 weeks and maintained with fluticasone propionate, 176 μg/d (6-11 years old), or 220 μg/d (12-16 years old). MAIN OUTCOMES AND MEASURES The primary outcome was the time to a severe asthma exacerbation. Secondary outcomes included the time to a viral-induced severe exacerbation, the proportion of participants in whom the dose of inhaled corticosteroid was reduced halfway through the trial, and the cumulative fluticasone dose during the trial. RESULTS Among 192 randomized participants (mean age, 9.8 years; 77 girls [40%]), 180 (93.8%) completed the trial. A total of 36 participants (37.5%) in the vitamin D3 group and 33 (34.4%) in the placebo group had 1 or more severe exacerbations. Compared with placebo, vitamin D3 supplementation did not significantly improve the time to a severe exacerbation: the mean time to exacerbation was 240 days in the vitamin D3 group vs 253 days in the placebo group (mean group difference, -13.1 days [95% CI, -42.6 to 16.4]; adjusted hazard ratio, 1.13 [95% CI, 0.69 to 1.85]; P = .63). Vitamin D3 supplementation, compared with placebo, likewise did not significantly improve the time to a viral-induced severe exacerbation, the proportion of participants whose dose of inhaled corticosteroid was reduced, or the cumulative fluticasone dose during the trial. Serious adverse events were similar in both groups (vitamin D3 group, n = 11; placebo group, n = 9). CONCLUSIONS AND RELEVANCE Among children with persistent asthma and low vitamin D levels, vitamin D3 supplementation, compared with placebo, did not significantly improve the time to a severe asthma exacerbation. The findings do not support the use of vitamin D3 supplementation to prevent severe asthma exacerbations in this group of patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02687815.
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Affiliation(s)
- Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leonard B. Bacharier
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St Louis Children’s Hospital, Washington University at St Louis, St Louis, Missouri
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theresa W. Guilbert
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Michael D. Cabana
- Division of General Pediatrics, Department of Pediatrics, University of California, San Francisco Benioff Children’s Hospital, University of California, San Francisco
| | - Kristie Ross
- Division of Pediatric Pulmonology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Ronina Covar
- Division of Allergy and Immunology, Department of Pediatrics, National Jewish Health, University of Colorado, Denver
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison
| | - Franziska J. Rosser
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joshua Blatter
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St Louis Children’s Hospital, Washington University at St Louis, St Louis, Missouri
| | - Sandy Durrani
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Juan C. Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
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Ganmaa D, Uyanga B, Zhou X, Gantsetseg G, Delgerekh B, Enkhmaa D, Khulan D, Ariunzaya S, Sumiya E, Bolortuya B, Yanjmaa J, Enkhtsetseg T, Munkhzaya A, Tunsag M, Khudyakov P, Seddon JA, Marais BJ, Batbayar O, Erdenetuya G, Amarsaikhan B, Spiegelman D, Tsolmon J, Martineau AR. Vitamin D Supplements for Prevention of Tuberculosis Infection and Disease. N Engl J Med 2020; 383:359-368. [PMID: 32706534 PMCID: PMC7476371 DOI: 10.1056/nejmoa1915176] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [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: 12/15/2022]
Abstract
BACKGROUND Vitamin D metabolites support innate immune responses to Mycobacterium tuberculosis. Data from phase 3, randomized, controlled trials of vitamin D supplementation to prevent tuberculosis infection are lacking. METHODS We randomly assigned children who had negative results for M. tuberculosis infection according to the QuantiFERON-TB Gold In-Tube assay (QFT) to receive a weekly oral dose of either 14,000 IU of vitamin D3 or placebo for 3 years. The primary outcome was a positive QFT result at the 3-year follow-up, expressed as a proportion of children. Secondary outcomes included the serum 25-hydroxyvitamin D (25[OH]D) level at the end of the trial and the incidence of tuberculosis disease, acute respiratory infection, and adverse events. RESULTS A total of 8851 children underwent randomization: 4418 were assigned to the vitamin D group, and 4433 to the placebo group; 95.6% of children had a baseline serum 25(OH)D level of less than 20 ng per milliliter. Among children with a valid QFT result at the end of the trial, the percentage with a positive result was 3.6% (147 of 4074 children) in the vitamin D group and 3.3% (134 of 4043) in the placebo group (adjusted risk ratio, 1.10; 95% confidence interval [CI], 0.87 to 1.38; P = 0.42). The mean 25(OH)D level at the end of the trial was 31.0 ng per milliliter in the vitamin D group and 10.7 ng per milliliter in the placebo group (mean between-group difference, 20.3 ng per milliliter; 95% CI, 19.9 to 20.6). Tuberculosis disease was diagnosed in 21 children in the vitamin D group and in 25 children in the placebo group (adjusted risk ratio, 0.87; 95% CI, 0.49 to 1.55). A total of 29 children in the vitamin D group and 34 in the placebo group were hospitalized for treatment of acute respiratory infection (adjusted risk ratio, 0.86; 95% CI, 0.52 to 1.40). The incidence of adverse events did not differ significantly between the two groups. CONCLUSIONS Vitamin D supplementation did not result in a lower risk of tuberculosis infection, tuberculosis disease, or acute respiratory infection than placebo among vitamin D-deficient schoolchildren in Mongolia. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02276755.).
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Affiliation(s)
- Davaasambuu Ganmaa
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Buyanjargal Uyanga
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Xin Zhou
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Garmaa Gantsetseg
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Baigali Delgerekh
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Davaasambuu Enkhmaa
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Dorjnamjil Khulan
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Saranjav Ariunzaya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Erdenebaatar Sumiya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Batbileg Bolortuya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Jutmaan Yanjmaa
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Tserenkhuu Enkhtsetseg
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Ankhbat Munkhzaya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Murneren Tunsag
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Polyna Khudyakov
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - James A Seddon
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Ben J Marais
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Ochirbat Batbayar
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Ganbaatar Erdenetuya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Bazarsaikhan Amarsaikhan
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Donna Spiegelman
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Jadambaa Tsolmon
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Adrian R Martineau
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
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Abstract
BACKGROUND Sickle cell disease (SCD) is a genetic chronic haemolytic and pro-inflammatory disorder. With increased catabolism and deficits in energy and nutrient intake, individuals with SCD suffer multiple macro- and micro-nutritional deficiencies, including vitamin D deficiency. This is an update of a previous review. OBJECTIVES To investigate the effects of vitamin D supplementation in children and adults with SCD and to compare different dose regimens. To determine the effects of vitamin D supplementation on general health (e.g. growth status and health-related quality of life), on musculoskeletal health (including bone mineral density, pain crises, bone fracture and muscle health), on respiratory health (including lung function, acute chest syndrome, acute exacerbation of asthma and respiratory infections) and the safety of vitamin D supplementation. SEARCH METHODS We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 19 March 2020. We also searched database such as PubMed, clinical trial registries and the reference lists of relevant articles and reviews. Date of last search: 14 January 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs comparing oral administration of any form of vitamin D supplementation at any dose and for any duration to another type or dose of vitamin D or placebo or no supplementation in people with SCD, of all ages, gender, and phenotypes. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed the risk of bias of the included studies. They used the GRADE guidelines to assess the quality of the evidence. MAIN RESULTS Vitamin D versus placebo One double-blind RCT (n = 39) compared oral vitamin D3 (cholecalciferol) supplementation (20 participants) to placebo (19 participants) for six weeks. Only 25 participants completed the full six months of follow-up. The study had a high risk of bias due to incomplete outcome data, but a low risk of bias for randomisation, allocation concealment, blinding (of participants, personnel and outcome assessors) and selective outcome reporting; and an unclear risk of other biases. Vitamin D supplementation probably led to higher serum 25(OH)D levels at eight weeks, mean difference (MD) 29.79 (95% confidence interval (CI) 26.63 to 32.95); at 16 weeks, MD 12.67 (95% CI 10.43 to 14.90); and at 24 weeks, MD 15.52 (95% CI 13.50 to 17.54) (moderate-quality evidence). There was little or no difference in adverse events (tingling of lips or hands) between the vitamin D and placebo groups, risk ratio 3.16 (95% CI 0.14 to 72.84) (low-quality evidence). Vitamin D supplementation probably caused fewer pain days compared to the placebo group at eight weeks, MD -10.00 (95% CI -16.47 to -3.53) (low-quality evidence), but probably led to a lower (worse) health-related quality of life score (change from baseline in physical functioning PedsQL scores); at both 16 weeks, MD -12.56 (95% CI -16.44 to -8.69) and 24 weeks, MD -12.59 (95% CI -17.43 to -7.76), although this may not be the case at eight weeks (low-quality evidence). Vitamin D supplementation regimens compared Two double-blind RCTs (83 participants) compared different regimens of vitamin D. One RCT (n = 62) compared oral vitamin D3 7000 IU/day to 4000 IU/day for 12 weeks, while the second RCT (n = 21) compared oral vitamin D3 100,000 IU/month to 12,000 IU/month for 24 months. Both RCTs had low risk of bias for blinding (of participants, personnel and outcome assessors) and incomplete outcome data, but the risk of selective outcome reporting bias was high. The bias from randomisation and allocation concealment was low in one study but not in the second. There was an unclear risk of other biases. When comparing oral vitamin D 100,000 IU/month to 12,000 IU/month, the higher dose may have resulted in higher serum 25(OH)D levels at one year, MD 16.40 (95% CI 12.59 to 20.21) and at two years, MD 18.96 (95% CI 15.20 to 22.72) (low-quality evidence). There was little or no difference in adverse events between doses (low-quality evidence). There were more episodes of acute chest syndrome in the high-dose group, at one year, MD 0.27 (95% CI 0.02 to 0.52) but there was little or no difference at two years, MD 0.09 (95% CI -0.04 to 0.22) (moderate-quality evidence). At one year and two years there was also little or no difference between the doses in the presence of pain (moderate-quality evidence) or forced expiratory volume in one second % predicted. However, the high-dose group had lower values for % predicted forced vital capacity at both one and two years, MD -7.20% predicted (95% CI -14.15 to -0.25) and MD -7.10% predicted (95% CI -14.03 to -0.17), respectively. There were little or no differences between dose regimens in the muscle health of either hand or the dominant hand. The study comparing oral vitamin D3 7000 IU/day to 4000 IU/day (21 participants) did not provide data for analysis, but median serum 25(OH)D levels were reported to be lower in the low-dose group at both six and 12 weeks. At 12 weeks the median serum parathyroid hormone level was lower in the high-dose group. AUTHORS' CONCLUSIONS We included three RCTs of varying quality. We consider that the current evidence presented in this review is not of sufficient quality to guide clinical practice. Until further evidence becomes available, clinicians should consider the relevant existing guidelines for vitamin D supplementation and dietary reference intakes for calcium and vitamin D. Well-designed RCTs of parallel design, are required to determine the effects and the safety of vitamin D supplementation as well as to assess the relative benefits of different doses in children and adults with SCD.
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Affiliation(s)
- Htoo Htoo Kyaw Soe
- Department of Community Medicine, Faculty of Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Adinegara Bl Abas
- Department of Community Medicine, Melaka-Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia
| | - Nan Nitra Than
- Department of Community Medicine, Faculty of Medicine, Melaka-Manipal Medical College (MMMC), Manipal Academy of Higher Education(MAHE), Melaka, Malaysia
| | - Han Ni
- Faculty of Medicine, SEGi University, Sibu, Malaysia
| | - Jaspal Singh
- Faculty of Medicine, Melaka-Manipal Medical College, Melaka, Malaysia
| | | | - Ifeyinwa Osunkwo
- Comprehensive Sickle Cell Program, Aflac Cancer and Blood Disorders Service, Emory University School of Medicine, Atlanta, Georgia, USA
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Vitale C, Marangella M, Bermond F, Fabbrini L, Tricerri A. Metabolic effects of cholecalciferol supplementation in patients with calcium nephrolithiasis and vitamin D deficiency. World J Urol 2020; 39:597-603. [PMID: 32367158 DOI: 10.1007/s00345-020-03222-y] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION In this paper, we investigated whether cholecalciferol supplementation may increase the risk of stone recurrence in patients with calcium nephrolithiasis and Vitamin D deficiency. METHODS Thirty-three stone formers (56 ± 17 years old, 12 males) with 25(OH)D < 20 ng/mL were considered. Calcium excretion and urine supersaturation with calcium oxalate (ßCaOx) and brushite (ßbsh) were evaluated, both before and after cholecalciferol supplementation. Values of ß > 1 mean supersaturation. Cholecalciferol was prescribed as oral bolus of 100,000-200,000 IU, followed by weekly (5000-10,000 IU) or monthly (25,000-50,000 IU) doses. Calcium intake varied between 800 and 1000 mg/day. In urine, total nitrogen (TNE) was taken as an index of protein intake, sodium as a marker of dietary intake, and net acid excretion (NAE) as an index of acid-base balance. RESULTS TNE, sodium, and NAE did not change during the study (p = ns). Compared to baseline values, after cholecalciferol, both serum calcium and phosphate did not vary (p = ns); 25(OH)D increased from 11.8 ± 5.5 to 40.2 ± 12.2 ng/mL (p < 0.01); 1.25(OH)2D increased from 41.6 ± 17.6 to 54 ± 16 pg/mL (p < 0.01); PTH decreased from 75 ± 27.2 to 56.7 ± 21.1 pg/mL (p < 0.01); urinary calcium increased from 2.7 ± 1.5 to 3.6 ± 1.6 mg/Kg b.w. (p < 0.01); ßbsh increased from 0.9 ± 0.7 to 1.3 ± 1.3 (p = 0.02); whereas ßCaOx varied but not significantly. Before cholecalciferol supplementation, 6/33 patients were hypercalciuric (i.e., urine Ca ≥ 4 mg/Kg b.w.) and increased to 13/33 after cholecalciferol supplementation (pX2 = 0.03). CONCLUSIONS Cholecalciferol supplementation may increase calcium excretion, or reveal an underlying condition of absorptive hypercalciuria. This may increase both urine supersaturation with calcium salts and stone-forming risk.
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Affiliation(s)
- Corrado Vitale
- S.C. Nefrologia e Dialisi, A.O. Ordine Mauriziano di Torino, Largo Turati, 62, 10128, Turin, Italy.
| | - Martino Marangella
- Fondazione Scientifica Mauriziana ONLUS, Largo Turati 62, 10128, Turin, Italy
| | - Francesca Bermond
- S.C. Nefrologia e Dialisi, A.O. Ordine Mauriziano di Torino, Largo Turati, 62, 10128, Turin, Italy
| | - Laura Fabbrini
- S.C. Nefrologia e Dialisi, A.O. Ordine Mauriziano di Torino, Largo Turati, 62, 10128, Turin, Italy
| | - Alberto Tricerri
- S.C. Nefrologia e Dialisi, A.O. Ordine Mauriziano di Torino, Largo Turati, 62, 10128, Turin, Italy
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26
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Ginde AA, Brower RG, Caterino JM, Finck L, Banner-Goodspeed VM, Grissom CK, Hayden D, Hough CL, Hyzy RC, Khan A, Levitt JE, Park PK, Ringwood N, Rivers EP, Self WH, Shapiro NI, Thompson BT, Yealy DM, Talmor D. Early High-Dose Vitamin D 3 for Critically Ill, Vitamin D-Deficient Patients. N Engl J Med 2019; 381:2529-2540. [PMID: 31826336 PMCID: PMC7306117 DOI: 10.1056/nejmoa1911124] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [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: 12/14/2022]
Abstract
BACKGROUND Vitamin D deficiency is a common, potentially reversible contributor to morbidity and mortality among critically ill patients. The potential benefits of vitamin D supplementation in acute critical illness require further study. METHODS We conducted a randomized, double-blind, placebo-controlled, phase 3 trial of early vitamin D3 supplementation in critically ill, vitamin D-deficient patients who were at high risk for death. Randomization occurred within 12 hours after the decision to admit the patient to an intensive care unit. Eligible patients received a single enteral dose of 540,000 IU of vitamin D3 or matched placebo. The primary end point was 90-day all-cause, all-location mortality. RESULTS A total of 1360 patients were found to be vitamin D-deficient during point-of-care screening and underwent randomization. Of these patients, 1078 had baseline vitamin D deficiency (25-hydroxyvitamin D level, <20 ng per milliliter [50 nmol per liter]) confirmed by subsequent testing and were included in the primary analysis population. The mean day 3 level of 25-hydroxyvitamin D was 46.9±23.2 ng per milliliter (117±58 nmol per liter) in the vitamin D group and 11.4±5.6 ng per milliliter (28±14 nmol per liter) in the placebo group (difference, 35.5 ng per milliliter; 95% confidence interval [CI], 31.5 to 39.6). The 90-day mortality was 23.5% in the vitamin D group (125 of 531 patients) and 20.6% in the placebo group (109 of 528 patients) (difference, 2.9 percentage points; 95% CI, -2.1 to 7.9; P = 0.26). There were no clinically important differences between the groups with respect to secondary clinical, physiological, or safety end points. The severity of vitamin D deficiency at baseline did not affect the association between the treatment assignment and mortality. CONCLUSIONS Early administration of high-dose enteral vitamin D3 did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D-deficient patients. (Funded by the National Heart, Lung, and Blood Institute; VIOLET ClinicalTrials.gov number, NCT03096314.).
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Affiliation(s)
- Adit A Ginde
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Roy G Brower
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Jeffrey M Caterino
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Lani Finck
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Valerie M Banner-Goodspeed
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Colin K Grissom
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Douglas Hayden
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Catherine L Hough
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Robert C Hyzy
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Akram Khan
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Joseph E Levitt
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Pauline K Park
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Nancy Ringwood
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Emanuel P Rivers
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Wesley H Self
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Nathan I Shapiro
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - B Taylor Thompson
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Donald M Yealy
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Daniel Talmor
- The affiliations of the members of the writing committee are as follows: the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G., L.F.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B.); the Department of Emergency Medicine, Ohio State University, Columbus (J.M.C.); the Departments of Anesthesia, Critical Care, and Pain Medicine (V.M.B.-G., D.T.) and Emergency Medicine (N.I.S.), Beth Israel Deaconess Medical Center, and the Biostatistics Center (D.H.) and the Department of Medicine (N.R., B.T.T.), Massachusetts General Hospital - all in Boston; the Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City (C.K.G.); the Department of Medicine, University of Washington, Seattle (C.L.H.); the Departments of Medicine (R.C.H.) and Surgery (P.K.P.), University of Michigan, Ann Arbor; the Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit (E.P.R.); the Department of Medicine, Oregon Health and Science University, Portland (A.K.); the Department of Medicine, Stanford University, Palo Alto, CA (J.E.L.); the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville (W.H.S.); and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
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de Boer IH, Zelnick LR, Ruzinski J, Friedenberg G, Duszlak J, Bubes VY, Hoofnagle AN, Thadhani R, Glynn RJ, Buring JE, Sesso HD, Manson JE. Effect of Vitamin D and Omega-3 Fatty Acid Supplementation on Kidney Function in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA 2019; 322:1899-1909. [PMID: 31703120 PMCID: PMC6865245 DOI: 10.1001/jama.2019.17380] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [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: 12/11/2022]
Abstract
IMPORTANCE Chronic kidney disease (CKD) is a common complication of type 2 diabetes that can lead to end-stage kidney disease and is associated with high cardiovascular risk. Few treatments are available to prevent CKD in type 2 diabetes. OBJECTIVE To test whether supplementation with vitamin D3 or omega-3 fatty acids prevents development or progression of CKD in type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial with a 2 × 2 factorial design conducted among 1312 adults with type 2 diabetes recruited between November 2011 and March 2014 from all 50 US states as an ancillary study to the Vitamin D and Omega-3 Trial (VITAL), coordinated by a single center in Massachusetts. Follow-up was completed in December 2017. INTERVENTIONS Participants were randomized to receive vitamin D3 (2000 IU/d) and omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid; 1 g/d) (n = 370), vitamin D3 and placebo (n = 333), placebo and omega-3 fatty acids (n = 289), or 2 placebos (n = 320) for 5 years. MAIN OUTCOMES AND MEASURES The primary outcome was change in glomerular filtration rate estimated from serum creatinine and cystatin C (eGFR) from baseline to year 5. RESULTS Among 1312 participants randomized (mean age, 67.6 years; 46% women; 31% of racial or ethnic minority), 934 (71%) completed the study. Baseline mean eGFR was 85.8 (SD, 22.1) mL/min/1.73 m2. Mean change in eGFR from baseline to year 5 was -12.3 (95% CI, -13.4 to -11.2) mL/min/1.73 m2 with vitamin D3 vs -13.1 (95% CI, -14.2 to -11.9) mL/min/1.73 m2 with placebo (difference, 0.9 [95% CI, -0.7 to 2.5] mL/min/1.73 m2). Mean change in eGFR was -12.2 (95% CI, -13.3 to -11.1) mL/min/1.73 m2 with omega-3 fatty acids vs -13.1 (95% CI, -14.2 to -12.0) mL/min/1.73 m2 with placebo (difference, 0.9 [95% CI, -0.7 to 2.6] mL/min/1.73 m2). There was no significant interaction between the 2 interventions. Kidney stones occurred among 58 participants (n = 32 receiving vitamin D3 and n = 26 receiving placebo) and gastrointestinal bleeding among 45 (n = 28 receiving omega-3 fatty acids and n = 17 receiving placebo). CONCLUSIONS AND RELEVANCE Among adults with type 2 diabetes, supplementation with vitamin D3 or omega-3 fatty acids, compared with placebo, resulted in no significant difference in change in eGFR at 5 years. The findings do not support the use of vitamin D or omega-3 fatty acid supplementation for preserving kidney function in patients with type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01684722.
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Affiliation(s)
- Ian H. de Boer
- Division of Nephrology, Department of Medicine, University of Washington, Seattle
- Kidney Research Institute, University of Washington, Seattle
- Puget Sound VA Healthcare System, Seattle, Washington
| | - Leila R. Zelnick
- Division of Nephrology, Department of Medicine, University of Washington, Seattle
- Kidney Research Institute, University of Washington, Seattle
| | - John Ruzinski
- Kidney Research Institute, University of Washington, Seattle
| | - Georgina Friedenberg
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Julie Duszlak
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Vadim Y. Bubes
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew N. Hoofnagle
- Division of Nephrology, Department of Medicine, University of Washington, Seattle
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Ravi Thadhani
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert J. Glynn
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Julie E. Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Howard D. Sesso
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Byrn MA, Adams W, Penckofer S, Emanuele MA. Vitamin D Supplementation and Cognition in People with Type 2 Diabetes: A Randomized Control Trial. J Diabetes Res 2019; 2019:5696391. [PMID: 31781666 PMCID: PMC6875298 DOI: 10.1155/2019/5696391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022] Open
Abstract
AIM Type 2 diabetes increases the risk of cognitive decline which adversely impacts self-management of the disease. Evidence also supports a relationship between low serum 25(OH)D levels and poor cognition. The purpose of this trial was to assess vitamin D supplementation on cognitive executive functioning in persons living with type 2 diabetes. METHODS This was a double-blinded RCT where participants were randomized to receive either weekly vitamin D3 supplementation (50,000 IUs) or a matching comparator (5,000 IUs) for three months. The primary outcome was a battery of neuropsychological tests. Serum 25(OH)D was measured by liquid chromatography/tandem mass spectrometry. Repeated assessments of cognitive measures were collected over 12 weeks using alternative testing forms to minimize practice effects. RESULTS Thirty participants were randomized to either the low-dose allocation (n = 15) or the high-dose allocation (n = 15). Most participants were female (83%) and identified as Black (57%). For all cognition measures, there was no statistically significant finding between participants who received high-dose vitamin D supplementation and those who received low-dose supplementation. However, when assessing cognitive function in both groups over time, minimal improvement on the Symbol-Digits, the Stroop Interference Test, and the Trail Making Test Part B was observed. CONCLUSIONS To our knowledge, this is the first randomized control trial to examine the effects of vitamin D supplementation on cognitive function in people with type 2 diabetes. However, no significant differences in cognitive outcomes between participants who received high-dose therapy and those who received low dose were found.
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Porto CM, de Paula Santana da Silva T, Sougey EB. Contribuições da vitamina D no tratamento de sintomas depressivos e fatores de risco cardiovascular: protocolo de estudo para um ensaio clínico randomizado, duplo-cego e controlado por placebo. Trials 2019; 20:583. [PMID: 31601274 PMCID: PMC6788094 DOI: 10.1186/s13063-019-3699-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/04/2019] [Indexed: 01/31/2023] Open
Abstract
ABSTRATO FUNDO: A depressão é uma das principais causas de incapacidade crônica em todo o mundo e um importante fator de risco cardiovascular, aumentando o risco relativo de doença arterial coronariana, bem como as taxas de morbimortalidade cardiovascular. Concomitantemente à alta prevalência de depressão, houve uma redução na exposição à luz solar com o aumento da urbanização e do uso de protetores solares, o que levou a uma redução nos níveis séricos de 25-hidroxivitamina D. Portanto, este artigo descreve uma protocolo para um ensaio clínico com o objetivo de avaliar os efeitos da suplementação de vitamina D na depressão e fatores de risco cardiovascular para contribuir com evidências sobre a influência potencial da suplementação na regulação do humor. MéTODOS: Este estudo de protocolo foi orientado pelos itens de protocolo padrão: recomendações para ensaios intervencionistas. Um ensaio clínico randomizado, controlado por placebo, duplo-cego será realizado envolvendo 224 adultos (faixa etária de 18 a 60 anos) com depressão que estão tomando antidepressivos e não têm histórico de suplementação de vitamina D, comorbidades psiquiátricas, doença renal crônica, hipercalcemia, ou neoplasia. Os participantes serão recrutados nos ambulatórios psiquiátricos de duas universidades do nordeste do Brasil. Os participantes elegíveis que fornecerem consentimento por escrito serão designados aleatoriamente para o grupo de intervenção (n = 112; suplementação de vitamina D 50.000 UI por semana durante 6 meses) ou para o grupo controle (n = 112; placebo tomado semanalmente por 6 meses). Medidas para monitorar sintomas depressivos, exames clínicos e exames laboratoriais para avaliar fatores de risco cardiovascular e níveis séricos de vitamina D serão realizadas antes e após o período de intervenção. DISCUSSãO: Até onde sabemos, este será o primeiro ensaio clínico com o objetivo de testar a eficácia da suplementação de vitamina D na redução do risco cardiovascular e como um adjuvante à terapia da depressão por um período prolongado (6 meses). Os resultados contribuirão para a compreensão dos efeitos terapêuticos da suplementação de vitamina D no tratamento da depressão e podem ajudar a orientar políticas públicas direcionadas à suplementação de vitamina para a redução do risco cardiovascular. REGISTRO DE TESTE Registro Brasileiro de Ensaios Clínicos, RBR-6yj8sj/ Número Universal de Ensaios (UTN) U1111-1217-9237 . Registrado em 23 de julho de 2018.
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Affiliation(s)
- Catarina Magalhães Porto
- Neuropsiquiatria e Ciências do Comportamento, Universidade Federal de Pernambuco (UFPE), Av. Moraes Rego, 1235, Cidade Universitária, Recife, PE CEP: 50670-901 Brasil
| | - Tatiana de Paula Santana da Silva
- Neuropsiquiatria e Ciências do Comportamento, Universidade Federal de Pernambuco (UFPE), Av. Moraes Rego, 1235, Cidade Universitária, Recife, PE CEP: 50670-901 Brasil
| | - Everton Botelho Sougey
- Neuropsiquiatria e Ciências do Comportamento, Universidade Federal de Pernambuco (UFPE), Av. Moraes Rego, 1235, Cidade Universitária, Recife, PE CEP: 50670-901 Brasil
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Lerchbaum E, Trummer C, Theiler-Schwetz V, Kollmann M, Wölfler M, Pilz S, Obermayer-Pietsch B. Effects of Vitamin D Supplementation on Body Composition and Metabolic Risk Factors in Men: A Randomized Controlled Trial. Nutrients 2019; 11:nu11081894. [PMID: 31416155 PMCID: PMC6723889 DOI: 10.3390/nu11081894] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 07/02/2019] [Revised: 08/02/2019] [Accepted: 08/12/2019] [Indexed: 12/11/2022] Open
Abstract
Vitamin D might play a role in metabolic processes and obesity. We therefore examined vitamin D effects on metabolic markers and obesity in a randomized controlled trial (RCT). This is a post-hoc analysis of the Graz Vitamin D&TT-RCT, a single-center, double-blind, randomized placebo-controlled trial. We included 200 healthy men with serum 25-hydroxyvitamin D (25(OH) D) levels <75 nmol/L. Subjects received 20,000 IU of vitamin D3/week (n = 100) or placebo (n = 100) for 12 weeks. Outcome measures were metabolic markers, anthropometric measures, and body composition assessed by Dual-energy X-ray absorptiometry. One-hundred and ninety-two men completed the study. We found a significant treatment effect on fasting glucose/fasting insulin ratio (−5.3 (−10.4 to −0.2), p = 0.040), whereas we observed no significant effect on the remaining outcome parameters. In subgroup analyses of men with baseline 25(OH)D levels <50 nmol/L (n = 80), we found a significant effect on waist circumference (1.6 (0.3 to 2.9) cm, p = 0.012), waist-to-hip ratio (0.019 (0.002 to 0.036), p = 0.031), total body fat (0.029 (0.004 to 0.055) %, p = 0.026), and android fat (1.18 (0.11 to 2.26) %, p = 0.010). In middle-aged healthy men, vitamin D treatment had a negative effect on insulin sensitivity. In vitamin D deficient men, vitamin D has an unfavorable effect on central obesity and body composition.
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Affiliation(s)
- Elisabeth Lerchbaum
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Christian Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Verena Theiler-Schwetz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Martina Kollmann
- Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14/1, 8036 Graz, Austria
| | - Monika Wölfler
- Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14/1, 8036 Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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Chatterjee R, Erban JK, Fuss P, Dolor R, LeBlanc E, Staten M, Sheehan P, Pittas A. Vitamin D supplementation for prevention of cancer: The D2d cancer outcomes (D2dCA) study. Contemp Clin Trials 2019; 81:62-70. [PMID: 31048088 PMCID: PMC6570503 DOI: 10.1016/j.cct.2019.04.015] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/19/2019] [Accepted: 04/25/2019] [Indexed: 02/08/2023]
Abstract
Evidence on biological plausibility from mechanistic studies and data from observational studies suggest that vitamin D may be linked to risk of several types of cancer. However, evidence from clinical trials evaluating the effect of vitamin D supplementation on cancer risk is limited. The Vitamin D and Type 2 Diabetes (D2d) study is a multi-center, randomized, placebo-controlled clinical trial conducted to examine the causal relationship between oral vitamin D supplementation and development of diabetes among overweight adults with prediabetes. The D2d study provides a unique opportunity to assess the effect of vitamin D supplementation at a higher dose (4000 IU/day) than has been used in other clinical trials with cancer outcomes, in a population at higher than average risk for cancer. This paper provides: Krishnan and Feldman (2011) a) baseline characteristics of the D2d population included in the D2d cancer outcomes secondary study (D2dCA) and comparison to other large trials of vitamin D supplementation and cancer risk; Leyssens et al. (2013) b) description of data that are being collected during the trial and the planned statistical analyses to test whether vitamin D supplementation at a dose of 4000 IU/day has an effect on incident cancer overall, on incidence of certain types of cancer, and on incidence of precancerous lesions. Results of D2dCA will help guide future research and clinical recommendations related to vitamin D and cancer risk.
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Affiliation(s)
- Ranee Chatterjee
- Division of General Internal Medicine, 200 Morris Street, 3(rd) Floor, Box 104427, Durham, NC 27701, USA.
| | - John K Erban
- Cancer Center, Tufts Medical Center, 800 Washington St, Box 245, Boston, MA 02111, USA.
| | - Paul Fuss
- Division of Endocrinology, Tufts Medical Center, 800 Washington Street, Box 268, Boston, MA 02111, USA.
| | - Rowena Dolor
- Division of General Internal Medicine, 200 Morris Street, 3(rd) Floor, Box 104427, Durham, NC 27701, USA.
| | - Erin LeBlanc
- Kaiser Permanente Center for Health Research NW, 3800 N Interstate, Portland, OR 97229, USA.
| | - Myrlene Staten
- Kelly Government Services for the National Institute of Diabetes and Digestive and Kidney Diseases, 6701 Democracy Boulevard, Room 6107, Bethesda, MD 20817, USA.
| | - Patricia Sheehan
- Spaulding Rehabilitation Network, 300 1(st) Ave, Charlestown, MA 02129, USA.
| | - Anastassios Pittas
- Division of Endocrinology, Tufts Medical Center, 800 Washington Street, Box 268, Boston, MA 02111, USA.
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DeGiorgio CM, Hertling D, Curtis A, Murray D, Markovic D. Safety and tolerability of Vitamin D3 5000 IU/day in epilepsy. Epilepsy Behav 2019; 94:195-197. [PMID: 30970298 DOI: 10.1016/j.yebeh.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/10/2018] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Preclinical and early clinical research indicates that Vitamin D3 may reduce seizures in both animal models and open-label clinical trials. METHODS This is an initial report of an ongoing pilot study of oral Vitamin D3 5000 IU/day in subjects with drug-resistant epilepsy. After Institutional Review Board (IRB) approval and informed consent, subjects with ;less than one focal onset or generalized tonic-clonic seizure per month were enrolled. Subjects entered a 4-week baseline, followed by a 12-week treatment period. Serum 25, OH Vitamin D3, Blood Urea Nitrogen (BUN), creatinine, and calcium levels were monitored at baseline and at 6 and 12 weeks. RESULTS High-dose Vitamin D3 5000 IU/day was well tolerated. Serum 25, OH Vitamin D3 levels increased significantly at six and twelve weeks. Vitamin D insufficiency, defined as a 25, OH Vitamin D3 level of <20 ng/ml normalized in all subjects with insufficient vitamin D levels. Median seizure frequency declined from 5.18 seizures per month to 3.64 seizures per month at 6 weeks and to 4.2 seizures per month at 12 weeks. The median percent change in seizure frequency was -26.9% at six weeks, and -10.7% at 12 weeks (not significant, Wilcoxon Signed Rank Test, P > 0.34). CONCLUSIONS High-dose oral Vitamin D3, 5000 IU/day was safe and well tolerated in subjects with epilepsy. Vitamin D levels increased significantly at 6 and 12 weeks but never exceeded potentially toxic levels, defined as >100 ng/ml. To reduce variability, we will now recruit subjects who only have three or more seizures per month.
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Affiliation(s)
- Christopher M DeGiorgio
- Department of Neurology, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA.
| | - Dieter Hertling
- Department of Neurology, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Ashley Curtis
- Department of Neurology, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Diana Murray
- Department of Neurology, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Daniela Markovic
- Department of Neurology, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
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McCullough PJ, Lehrer DS, Amend J. Daily oral dosing of vitamin D3 using 5000 TO 50,000 international units a day in long-term hospitalized patients: Insights from a seven year experience. J Steroid Biochem Mol Biol 2019; 189:228-239. [PMID: 30611908 DOI: 10.1016/j.jsbmb.2018.12.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 10/02/2018] [Revised: 12/23/2018] [Accepted: 12/31/2018] [Indexed: 11/16/2022]
Abstract
Vitamin D3 is a secosteroid hormone produced in the skin in amounts estimated up to 25,000 international units (IUs) a day by the action of UVB radiation on 7-dehydrocholesterol. Vitamin D deficiency is common due to both lack of adequate sun exposure to the skin, and because vitamin D is present in very few food sources. Deficiency is strongly linked to increased risk for a multitude of diseases, several of which have historically been shown to improve dramatically with either adequate UVB exposure to the skin, or to oral or topical supplementation with vitamin D. These diseases include asthma, psoriasis, rheumatoid arthritis, rickets and tuberculosis. All patients in our hospital have been routinely screened on admission for vitamin D deficiency since July 2011, and offered supplementation to either correct or prevent deficiency. During this time, we have admitted over 4700 patients, the vast majority of whom agreed to supplementation with either 5000 or 10,000 IUs/day. Due to disease concerns, a few agreed to larger amounts, ranging from 20,000 to 50,000 IUs/day. There have been no cases of vitamin D3 induced hypercalcemia or any adverse events attributable to vitamin D3 supplementation in any patient. Three patients with psoriasis showed marked clinical improvement in their skin using 20,000 to 50,000 IUs/day. Analysis of 777 recently tested patients (new and long-term) not on D3 revealed 28.7% with 25-hydroxyvitaminD3 (25OHD3) blood levels < 20 ng/ml, 64.1% < 30 ng/ml, a mean 25OHD3 level of 27.1 ng/ml, with a range from 4.9 to 74.8 ng/ml. Analysis of 418 inpatients on D3 long enough to develop 25OHD3 blood levels > 74.4 ng/ml showed a mean 25OHD3 level of 118.9 ng/ml, with a range from 74.4 to 384.8 ng/ml. The average serum calcium level in these 2 groups was 9.5 (no D3) vs 9.6 (D3), with ranges of 8.4 to 10.7 (no D3) vs 8.6 to 10.7 mg/dl (D3), after excluding patients with other causes of hypercalcemia. The average intact parathyroid hormone levels were 24.2 pg/ml (D3) vs. 30.2 pg/ml (no D3). In summary, long-term supplementation with vitamin D3 in doses ranging from 5000 to 50,000 IUs/day appears to be safe.
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Affiliation(s)
- Patrick J McCullough
- Department of Psychiatry, Wright State University School of Medicine, Dayton, OH, 45435, United States; Summit Behavioral Healthcare, Cincinnati, OH, 45237, United States.
| | - Douglas S Lehrer
- Department of Psychiatry, Wright State University School of Medicine, Dayton, OH, 45435, United States; Summit Behavioral Healthcare, Cincinnati, OH, 45237, United States
| | - Jeffrey Amend
- Summit Behavioral Healthcare, Cincinnati, OH, 45237, United States
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Fajardo VC, de Oliveira FLP, Machado-Coelho GLL, Pimenta FAP, de Freitas SN, Ribeiro ALP, Soares MMS, Lauria MW, Farias RDC, França IB, do Nascimento Neto RM. Effects of vitamin D supplementation on cardiovascular risk factors in shift workers: Study protocol for randomized, double-blind, placebo-controlled clinical trial. Medicine (Baltimore) 2019; 98:e15417. [PMID: 31045798 PMCID: PMC6504534 DOI: 10.1097/md.0000000000015417] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The present clinical study aims to describe protocol to evaluate the effects of vitamin D3 supplementation on the cardiovascular risk factors in a population of rotating shift workers. DESIGN A randomized, double-blind, placebo-controlled, parallel group clinical trial testing 2 oral dosages of cholecalciferol (14,000 IU and 28,000 IU per week) for 12 months. SETTING The primary outcome for evaluation is an 18% reduction in hypertriglyceridemia (≥150 mg/dL) between pre and postintervention measurements. Baseline characteristics of the study population will be summarized separately within each randomized group, and will use tests for continuous and categorical variables. For all tests, a P < .05 will be considered significant. The analysis of primary and secondary outcomes will use an intention-to-treat population and a per-protocol population. The primary and secondary outcomes will be compared separately between each treatment group and placebo, using binary logistic regression or regressão de Poisson for proportions (for binary outcomes) and using linear regression for differences in means (for continuous endpoints), with 95% confidence intervals. PARTICIPANTS Rotating shift workers, adults aged between 18 and 60 years, with hypovitaminosis D and alterations in at least 1 of the following parameters: fasting glucose, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol, blood pressure, and waist circumference. CONCLUSION This clinical trial aims to contribute to the gap in knowledge about the potential, dose, and time of vitamin D supplementation to generate beneficial effects on triglycerides in a population at increased risk for hypertriglyceridemia and vitamin D deficiency.
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Affiliation(s)
- Virginia Capistrano Fajardo
- Applied Science to Adult Health Postgraduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte
| | | | | | | | | | | | | | - Marcio Weissheimer Lauria
- Department of Clinical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte
| | - Rosielle da Costa Farias
- Applied Statistics and Biometrics Postgraduate Program, Department of Statistics, Federal University of Viçosa, Viçosa, MG
| | - Ive Bahia França
- School of Medicine, University Center of Espirito Santo. Colatina, ES, Brazil
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Ng K, Nimeiri HS, McCleary NJ, Abrams TA, Yurgelun MB, Cleary JM, Rubinson DA, Schrag D, Miksad R, Bullock AJ, Allen J, Zuckerman D, Chan E, Chan JA, Wolpin BM, Constantine M, Weckstein DJ, Faggen MA, Thomas CA, Kournioti C, Yuan C, Ganser C, Wilkinson B, Mackintosh C, Zheng H, Hollis BW, Meyerhardt JA, Fuchs CS. Effect of High-Dose vs Standard-Dose Vitamin D3 Supplementation on Progression-Free Survival Among Patients With Advanced or Metastatic Colorectal Cancer: The SUNSHINE Randomized Clinical Trial. JAMA 2019; 321:1370-1379. [PMID: 30964527 PMCID: PMC6459117 DOI: 10.1001/jama.2019.2402] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [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: 12/14/2022]
Abstract
IMPORTANCE In observational studies, higher plasma 25-hydroxyvitamin D (25[OH]D) levels have been associated with improved survival in metastatic colorectal cancer (CRC). OBJECTIVE To determine if high-dose vitamin D3 added to standard chemotherapy improves outcomes in patients with metastatic CRC. DESIGN, SETTING, AND PARTICIPANTS Double-blind phase 2 randomized clinical trial of 139 patients with advanced or metastatic CRC conducted at 11 US academic and community cancer centers from March 2012 through November 2016 (database lock: September 2018). INTERVENTIONS mFOLFOX6 plus bevacizumab chemotherapy every 2 weeks and either high-dose vitamin D3 (n = 69) or standard-dose vitamin D3 (n = 70) daily until disease progression, intolerable toxicity, or withdrawal of consent. MAIN OUTCOMES AND MEASURES The primary end point was progression-free survival (PFS) assessed by the log-rank test and a supportive Cox proportional hazards model. Testing was 1-sided. Secondary end points included tumor objective response rate (ORR), overall survival (OS), and change in plasma 25(OH)D level. RESULTS Among 139 patients (mean age, 56 years; 60 [43%] women) who completed or discontinued chemotherapy and vitamin D3 (median follow-up, 22.9 months), the median PFS for high-dose vitamin D3 was 13.0 months (95% CI, 10.1 to 14.7; 49 PFS events) vs 11.0 months (95% CI, 9.5 to 14.0; 62 PFS events) for standard-dose vitamin D3 (log-rank P = .07); multivariable hazard ratio for PFS or death was 0.64 (1-sided 95% CI, 0 to 0.90; P = .02). There were no significant differences between high-dose and standard-dose vitamin D3 for tumor ORR (58% vs 63%, respectively; difference, -5% [95% CI, -20% to 100%], P = .27) or OS (median, 24.3 months vs 24.3 months; log-rank P = .43). The median 25(OH)D level at baseline for high-dose vitamin D3 was 16.1 ng/mL vs 18.7 ng/mL for standard-dose vitamin D3 (difference, -2.6 ng/mL [95% CI, -6.6 to 1.4], P = .30); at first restaging, 32.0 ng/mL vs 18.7 ng/mL (difference, 12.8 ng/mL [95% CI, 9.0 to 16.6], P < .001); at second restaging, 35.2 ng/mL vs 18.5 ng/mL (difference, 16.7 ng/mL [95% CI, 10.9 to 22.5], P < .001); and at treatment discontinuation, 34.8 ng/mL vs 18.7 ng/mL (difference, 16.2 ng/mL [95% CI, 9.9 to 22.4], P < .001). The most common grade 3 and higher adverse events for chemotherapy plus high-dose vs standard-dose vitamin D3 were neutropenia (n = 24 [35%] vs n = 21 [31%], respectively) and hypertension (n = 9 [13%] vs n = 11 [16%]). CONCLUSIONS AND RELEVANCE Among patients with metastatic CRC, addition of high-dose vitamin D3, vs standard-dose vitamin D3, to standard chemotherapy resulted in a difference in median PFS that was not statistically significant, but with a significantly improved supportive hazard ratio. These findings warrant further evaluation in a larger multicenter randomized clinical trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01516216.
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Affiliation(s)
- Kimmie Ng
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Halla S. Nimeiri
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | | - Rebecca Miksad
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Dan Zuckerman
- St Luke’s Mountain States Tumor Institute, Boise, Idaho
| | - Emily Chan
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Chen Yuan
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | - Hui Zheng
- Massachusetts General Hospital, Boston
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Urashima M, Ohdaira H, Akutsu T, Okada S, Yoshida M, Kitajima M, Suzuki Y. Effect of Vitamin D Supplementation on Relapse-Free Survival Among Patients With Digestive Tract Cancers: The AMATERASU Randomized Clinical Trial. JAMA 2019; 321:1361-1369. [PMID: 30964526 PMCID: PMC6459116 DOI: 10.1001/jama.2019.2210] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [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: 12/31/2022]
Abstract
IMPORTANCE Randomized clinical trials of vitamin D supplementation for secondary prevention in patients with cancer are needed, given positive results of observational studies. OBJECTIVE To determine whether postoperative vitamin D3 supplementation can improve survival of patients with digestive tract cancers overall and in subgroups stratified by 25-hydroxyvitamin D (25[OH]D) levels. DESIGN, SETTING, AND PARTICIPANTS The AMATERASU trial, a randomized, double-blind, placebo-controlled trial conducted at a single university hospital in Japan. Enrollment began in January 2010 and follow-up was completed in February 2018. Patients aged 30 to 90 years with cancers of the digestive tract from the esophagus to the rectum, stages I to III, were recruited. Of 439 eligible patients, 15 declined and 7 were excluded after operation. INTERVENTIONS Patients were randomized to receive oral supplemental capsules of vitamin D (2000 IU/d; n = 251) or placebo (n = 166) from the first postoperative outpatient visit to until the end of the trial. MAIN OUTCOMES AND MEASURES The primary outcome was relapse-free survival time to relapse or death. The secondary outcome was overall survival time to death due to any cause. Subgroups analyzed had baseline serum 25(OH)D levels of 0 to less than 20 ng/mL, 20 to 40 ng/mL, and greater than 40 ng/mL; because of small sample size for the highest-baseline-level group, interactions were tested only between the low- and middle-baseline-level groups. RESULTS All 417 randomized patients (mean age, 66 years; male, 66%; esophageal cancer, 10%; gastric cancer, 42%; colorectal cancer, 48%) were included in the analyses. There was 99.8% follow-up over a median 3.5 (interquartile range, 2.3-5.3) years, with maximal follow-up of 7.6 years. Relapse or death occurred in 50 patients (20%) randomized to vitamin D and 43 patients (26%) randomized to placebo. Death occurred in 37 (15%) in the vitamin D group and 25 (15%) in the placebo group. The 5-year relapse-free survival was 77% with vitamin D vs 69% with placebo (hazard ratio [HR] for relapse or death, 0.76; 95% CI, 0.50-1.14; P = .18). The 5-year overall survival in the vitamin D vs placebo groups was 82% vs 81% (HR for death, 0.95; 95% CI, 0.57-1.57; P = .83). In the subgroup of patients with baseline serum 25(OH)D levels between 20 and 40 ng/mL, the 5-year relapse-free survival was 85% with vitamin D vs 71% with placebo (HR for relapse or death, 0.46; 95% CI, 0.24-0.86; P = .02; P = .04 for interaction). Fractures occurred in 3 patients (1.3%) in the vitamin D group and 5 (3.4%) in the placebo group. Urinary stones occurred in 2 patients (0.9%) in the vitamin D group and 0 in the placebo group. CONCLUSIONS AND RELEVANCE Among patients with digestive tract cancer, vitamin D supplementation, compared with placebo, did not result in significant improvement in relapse-free survival at 5 years. TRIAL REGISTRATION UMIN Identifier: UMIN000001977.
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Affiliation(s)
- Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Taisuke Akutsu
- Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Shinya Okada
- Department of Pathology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Masaki Kitajima
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
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Minisola S, Pepe J, Donato P, Vigna E, Occhiuto M, Ferrone F, Biamonte F, Cecchetti V, Danese VC, Sonato C, BIondi P, Colangelo L, Cipriani C. Replenishment of vitamin D status: theoretical and practical considerations. Hormones (Athens) 2019; 18:3-5. [PMID: 29949127 DOI: 10.1007/s42000-018-0040-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy.
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Pietro Donato
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Evelina Vigna
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Marco Occhiuto
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Federica Ferrone
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Federica Biamonte
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Veronica Cecchetti
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Vittoria Carmela Danese
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Chiara Sonato
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Piergianni BIondi
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Luciano Colangelo
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Rome, Italy
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Perry TA, Parkes MJ, Hodgson R, Felson DT, O’Neill TW, Arden NK. Effect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis. BMC Musculoskelet Disord 2019; 20:76. [PMID: 30764805 PMCID: PMC6376763 DOI: 10.1186/s12891-019-2424-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Data from a recent clinical trial of vitamin D therapy in knee OA suggests that, compared to placebo, vitamin D therapy may be associated with a reduction in effusion-synovitis. Our aim was, using contrast-enhanced (CE) magnetic resonance imaging (MRI), to examine the effect of vitamin D therapy on synovial tissue volume (STV) and also subchondral bone marrow lesion (BML) volume in men and women with symptomatic knee OA. METHODS Data was acquired from participants who took part in a randomised placebo-controlled trial (UK VIDEO) investigating the effect of vitamin D therapy (800 IU cholecalciferol daily) on radiographic joint space narrowing. A subsample had serial CE MRI scans acquired during the trial. Subjects with serial images were assessed (N = 50) for STV and subchondral BML volume. The difference in the mean change from baseline in these structural outcomes between intervention and placebo groups was assessed using random-effects modelling. RESULTS The mean age of the 50 subjects (24 active group, 26 placebo group) who contributed data to the analysis was 63.3 years (SD 6.5) and 74% were female. There was no significant difference at 2 years follow-up between the vitamin D and placebo groups in the mean change from baseline for STV (93.9 mm3, 95% CI -1605.0 to 1792.7) and subchondral BML volume (- 313.5 mm3, 95% CI -4244.7 to 3617.7). CONCLUSIONS Vitamin D supplementation does not appear to have an effect on synovitis or BML volume in patients with symptomatic knee OA. TRIAL REGISTRATION VIDEO was registered with EudraCT: ref. 2004-000169-37. The protocol for the trial can be accessed at https://www.ctu.mrc.ac.uk/studies/all-studies/v/video/.
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Affiliation(s)
- Thomas A. Perry
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Research in Osteoarthritis Manchester (ROAM), Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, School of Biological Sciences, Stopford Building, Oxford Road, Manchester, M13 9PT UK
| | - Matthew J. Parkes
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Research in Osteoarthritis Manchester (ROAM), Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, School of Biological Sciences, Stopford Building, Oxford Road, Manchester, M13 9PT UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Hodgson
- Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Manchester, UK
| | - David T. Felson
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
- Clinical Epidemiology Research and Training Unit Boston University School of Medicine, Boston, MA USA
| | - Terence W. O’Neill
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Research in Osteoarthritis Manchester (ROAM), Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, School of Biological Sciences, Stopford Building, Oxford Road, Manchester, M13 9PT UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Nigel K. Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical School, University of Sydney, Sydney, Australia
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Soubrier M, Lambert C, Combe B, Gaudin P, Thomas T, Sibilia J, Dougados M, Dubost JJ. A randomised, double-blind, placebo-controlled study assessing the efficacy of high doses of vitamin D on functional disability in patients with rheumatoid arthritis. Clin Exp Rheumatol 2018; 36:1056-1060. [PMID: 30148432] [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] [Received: 11/23/2017] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the short-term efficacy of vitamin D (cholecalciferol) supplementation on functional disability in RA patients. METHODS 1) Patients: RA (ACR 1987 revised criteria) in non-remission (DAS28 >2.6) whose treatment was not expected to be changed over a 3-month period following inclusion and presenting with vitD deficits (serum 25OHD <30ng/mL). 2) Study design: prospective randomised placebo-controlled trial (NCT02243800). 3) Study arms: either vitD ampoules (cholecalciferol 100,000IU) or placebo. 4) Outcome measures: primary: improvement in patients' functional disability using the Health Assessment questionnaire (HAQ); secondary: improvement in DAS28ESR, DAS28CRP, ESR, CRP, RAID score, fatigue (EVA and FACIT), and SF36. RESULTS Overall, 59 patients were included, 83.1% females, aged 59.8±10.9 years on average, with RA for 17.0±9.7 years. Thirty patients received placebo and 29 vitD. At 6 months, HAQ scores tended to be increased in the placebo group (+0.08±0.25), while slightly numerically decreased in the vitD group (-0.03±0.23) (p=0.11). After adjusting for age, gender, season, and initial vitD status, the between-group difference achieved statistically significance (p=0.046). After adjusting for age, gender, season, and initial vitD status, there was no significant difference in the secondary criteria between the 2 groups except for ESR and CRP (p=0.002 and 0.04, respectively). CONCLUSIONS In this randomised, double-blind, placebo-controlled clinical trial in patients with RA and VitD deficiency, high doses of cholecalciferol resulted in a statistically significant improvement in functional disability at month 6, which, however, was clinically not relevant.
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Affiliation(s)
- Martin Soubrier
- Rheumatology Department, CHU Gabriel-Montpied, Clermont-Ferrand, France.
| | - Céline Lambert
- Biostatistics Unit, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Bernard Combe
- Rheumatology Department, CHRU Montpellier, Montpellier University, France
| | | | | | - Jean Sibilia
- Rheumatology Department, CHRU Strasbourg, France
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Chemouny JM, Sannier A, Hanouna G, Champion L, Vrtovsnik F, Daugas E. Malakoplakia as a cause of severe hypercalcemia through ectopic 25-hydroxyvitamin D3 1-alpha-hydroxylase expression: A case report. Medicine (Baltimore) 2018; 97:e12090. [PMID: 30290590 PMCID: PMC6200547 DOI: 10.1097/md.0000000000012090] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Malakoplakia is a rare disease characterized by the presence of nongranulomatous macrophage infiltration. In most cases, it affects the urinary tract. Malakoplakia can cause acute kidney injury when it is localized in the kidneys. PATIENT CONCERNS Here, we report the case of a 65-year-old female patient with renal malakoplakia responsible for hypercalcemia. During her initial assessment, she was also diagnosed 25-OH vitamin D insufficiency, for which she was prescribed oral cholecalciferol. Three months later, she developed severe hypercalcemia with normal 25-OH vitamin D and parathyroid hormone levels and high 1,25-dihydroxyvitamin D levels. DIAGNOSES After a superimposed granulomatous disease was excluded, malakoplakia cells were suspected to be responsible for the abnormal 25-hydroxyvitamin D3 1-alpha-hydroxylase activity, which was confirmed by immunohistochemistry. INTERVENTIONS Cholecalciferol was stopped, the patient was rehydrated with intravenous physiological saline, and prednisone was initiated to decrease the enzyme activity. OUTCOMES Six months later, she displayed normal serum calcium, 25-OH vitamin D and 1,25-dihydroxyvitamin D levels. LESSONS This case illustrates that malakoplakia may exhibit ectopic 25-hydroxyvitamin D3 1-alpha-hydroxylase activity and cause severe hypercalcemia upon vitamin D supplementation. Therefore, such supplementation should not be given in malakoplakia patients without an actual deficiency and requires careful monitoring of serum calcium.
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Affiliation(s)
- Jonathan Maurice Chemouny
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire
- INSERM, Centre de Recherche sur l’Inflammation
- Université Paris Diderot, Sorbonne Paris Cité
| | - Aurélie Sannier
- Université Paris Diderot, Sorbonne Paris Cité
- Laboratoire d’anatomopathologie et de cytologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Guillaume Hanouna
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire
- INSERM, Centre de Recherche sur l’Inflammation
| | | | - Francois Vrtovsnik
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire
- INSERM, Centre de Recherche sur l’Inflammation
- Université Paris Diderot, Sorbonne Paris Cité
| | - Eric Daugas
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire
- INSERM, Centre de Recherche sur l’Inflammation
- Université Paris Diderot, Sorbonne Paris Cité
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Vitale C, Tricerri A, Bermond F, Fabbrini L, Guiotto C, Marangella M. [Metabolic effects of Cholecalciferol supplementation in kidney stone formers with vitamin D deficiency]. G Ital Nefrol 2018; 35:35-5-2018-10. [PMID: 30234237] [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: 06/08/2023]
Abstract
INTRODUCTION In this paper we investigated whether cholecalciferol supplementation, prescribed to treat vitamin D deficiency in patients with nephrolithiasis, increased the risk of stone recurrence. METHODS Calcium excretion and urine supersaturation with calcium oxalate (βCaOx) and brushite (βbsh) were evaluated in 33 kidney stone formers (aged 56±17; 12 males), both before and after therapy with cholecalciferol, prescribed as oral bolus of 100.000-200.000 UI, followed by maintenance doses, repeated every week (5.000-10.000 UI) or month (25.000-50.000 UI). During the study, patients followed a dietary regimen which included a daily calcium intake of about 800-1000 mg. RESULTS Urinary nitrogen, sodium and ash-acid excretion did not significantly change during the study. After cholecalciferol supplementation, the main results were as follows: both serum calcium and phosphate did not vary significantly; 25(OH)VitD₃ increased from 11,8±5,5 to 40,2±12,2 ng/mL (p<0,01); 1,25(OH) ₂ VitD₃ increased from 41,6±17,6 to 54,0±16,0 pg/mL (p<0,01); PTH decreased from 75,0±27,2 to 56,7±21,1 pg/mL (p<0,01); daily urinary calcium increased from 2,7±1,5 to 3,6±1,6 mg/Kg b.w. (p<0,01), whereas fasting urinary calcium did not change significantly. After therapy, βbsh increased from 0,9±0,7 to 1,3±1,3 (p=0,02) and βCaOx did not vary significantly. Before cholecalciferol supplementation, 6/33 patients (18.2%) were hypercalciuric, whereas 13/33 patients (39,4%) showed hypercalciuria after supplementation (pX²=0,03). CONCLUSIONS Cholecalciferol supplementation for vitamin D deficiency may increase both urinary calcium and urine supersaturation in stone formers. If vitamin D supplements are needed in these patients, a careful monitoring of urine metabolic profile is warranted, in order to customize the metaphylaxis accordingly (hydration, potassium citrate, thiazides).
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Affiliation(s)
- Corrado Vitale
- S.C. Nefrologia e Dialisi, A.O. Ordine Mauriziano di Torino
| | | | | | - Laura Fabbrini
- S.C. Nefrologia e Dialisi, A.O. Ordine Mauriziano di Torino
| | - Cristina Guiotto
- S.C. Laboratorio Analisi Cliniche e Microbiologiche, A.O. Ordine Mauriziano di Torino
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Greco D, Kocyigit D, Adorni MP, Marchi C, Ronda N, Bernini F, Gurses KM, Canpinar H, Guc D, Oguz SH, Gurlek A, Strazzella A, Simonelli S, Tokgozoglu L, Zimetti F. Vitamin D replacement ameliorates serum lipoprotein functions, adipokine profile and subclinical atherosclerosis in pre-menopausal women. Nutr Metab Cardiovasc Dis 2018; 28:822-829. [PMID: 29954641 DOI: 10.1016/j.numecd.2018.04.010] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 03/22/2018] [Accepted: 04/23/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Low vitamin D (vitD) has been linked to increased cardiovascular (CV) risk, but the effects of vitD supplementation are not clarified. We evaluated the impact of vitD normalization on HDL cholesterol efflux capacity (CEC), which inversely correlates with CV risk, the proatherogenic serum cholesterol loading capacity (CLC), adipokine profile and subclinical atherosclerosis. METHODS AND RESULTS Healthy premenopausal women with vitD deficiency (n = 31) underwent supplementation. Subclinical atherosclerosis was evaluated by flow-mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AIx), measured with standard techniques. HDL CEC and serum CLC were measured by a radioisotopic and fluorimetric assay, respectively. Malondialdehyde (MDA) in HDL was quantified by the TBARS assay. Pre-β HDL was assessed by 2D-electrophoresis. Serum adipokines were measured by ELISA. VitD replacement restored normal levels of serum 25-hydroxyvitamin D (25OHD) and significantly improved FMD (+4%; p < 0.001), PWV (-4.1%: p < 0.001) and AIx (-16.1%; p < 0.001). Total CEC was significantly improved (+19.5%; p = 0.003), with a specific increase in the ABCA1-mediated CEC (+70.8%; p < 0.001). HDL-MDA slightly but significantly decreased (-9.6%; p = 0.027), while no difference was detected in pre-β HDL. No change was observed in aqueous diffusion nor in the ABCG1-mediated CEC. Serum CLC was significantly reduced (-13.3%; p = 0.026). Levels of adiponectin were increased (+50.6%; p < 0.0001) and resistin levels were decreased (-24.3%; p < 0.0001). After vitD replacement, an inverse relationship was found linking the ABCA1-mediated CEC with pre-β HDL (r2 = 0.346; p < 0.001) and resistin (r2 = 0.220; p = 0.009). CONCLUSION Our data support vitD supplementation for CV risk prevention.
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Affiliation(s)
- D Greco
- Biopharmanet-Tec Center, University of Parma, Parma, Italy
| | - D Kocyigit
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M P Adorni
- Department of Food and Drug, University of Parma, Parma, Italy
| | - C Marchi
- Department of Food and Drug, University of Parma, Parma, Italy
| | - N Ronda
- Department of Food and Drug, University of Parma, Parma, Italy
| | - F Bernini
- Department of Food and Drug, University of Parma, Parma, Italy.
| | - K M Gurses
- Department of Cardiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - H Canpinar
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - D Guc
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - S H Oguz
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - A Gurlek
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - A Strazzella
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - S Simonelli
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - L Tokgozoglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F Zimetti
- Department of Food and Drug, University of Parma, Parma, Italy
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Ikemoto Y, Kuroda K, Nakagawa K, Ochiai A, Ozaki R, Murakami K, Jinushi M, Matsumoto A, Sugiyama R, Takeda S. Vitamin D Regulates Maternal T-Helper Cytokine Production in Infertile Women. Nutrients 2018; 10:nu10070902. [PMID: 30011861 PMCID: PMC6073370 DOI: 10.3390/nu10070902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 06/12/2018] [Revised: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 12/31/2022] Open
Abstract
Vitamin D (VD) deficiency is associated with reproductive failure. However, the relationship between VD and maternal immunity remains unclear. We investigated the clinical efficacy of VD in maternal T-helper (Th) cytokines in 276 infertile women and examined for Th1 and Th2 cells based on the deficient, insufficient, and sufficient serum 25-hydroxyvitamin D3 (25[OH]VD) levels (<12, 12–30, and >30 ng/mL, respectively). Most infertile women had a low-level of VD (87.3%). Immunological tests of pre-/post-VD supplementation were performed in patients who were deficient and insufficient in VD. Of 23 patients, 11 (47.8%) exhibited sufficient VD levels after supplementation. Th1/Th2 cell ratio in patients with insufficient VD was significantly decreased after supplementation (p = 0.004). After supplementation, serum 25(OH)VD levels of the patients: 11 in the sufficient group showed significant decreases in Th1 cell level and Th1/Th2 cell ratio (p = 0.032 and 0.010, respectively), whereas no significant differences in Th1/Th2 cell ratio were recognized in the insufficient group. Furthermore, mid-luteal endometrial biopsies (n = 18) were processed for primary cultures and measured interferon [IFN]-γ and interleukin [IL]-4 in condition media. Decidualizing cultures with 1,25-dihydroxvitamin D3 (1,25[OH]2VD) decreased IFN-γ. Sufficient VD supplementation in women with insufficient VD may optimize maternal T-helper cytokines during pregnancy via rebalancing the Th1/Th2 cell ratio.
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Affiliation(s)
- Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 1160023, Japan.
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 1160023, Japan.
| | - Asako Ochiai
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Rie Ozaki
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Keisuke Murakami
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Makoto Jinushi
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Akemi Matsumoto
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 1160023, Japan.
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
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Liao EY, Zhang ZL, Xia WB, Lin H, Cheng Q, Wang L, Hao YQ, Chen DC, Tang H, Peng YD, You L, He L, Hu ZH, Song CL, Wei F, Wang J, Zhang L. Calcifediol (25-hydroxyvitamin D) improvement and calcium-phosphate metabolism of alendronate sodium/vitamin D 3 combination in Chinese women with postmenopausal osteoporosis: a post hoc efficacy analysis and safety reappraisal. BMC Musculoskelet Disord 2018; 19:210. [PMID: 29970059 PMCID: PMC6030763 DOI: 10.1186/s12891-018-2090-y] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/15/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vitamin D (VD) insufficiency or deficiency is a frequent comorbidity in Chinese women with postmenopausal osteoporosis (PMO). The present study aimed to investigate 25-hydroxyvitamin D [25(OH) D] improvement and calcium-phosphate metabolism in Chinese PMO patients treated with 70 mg of alendronate sodium and 5600 IU of vitamin D3 (ALN/D5600). METHODS Chinese PMO women (n = 219) were treated with 12-month ALN/D5600 (n = 111) or calcitriol (n = 108). Changes in 25(OH) D at month 12 were post hoc analyzed by the baseline 25 (OH) D status using the longitudinal analysis. The main safety outcome measures included serum calcium and phosphate and 24-h urine calcium, and the repeated measures mixed model was used to assess the frequencies of the calcium-phosphate metabolic disorders. RESULTS Absolute change in mean serum 25(OH) D level was the greatest in VD-deficient patients and least in VD-sufficient patients at months six and 12 (both, P < 0.01). Serum calcium level remained significantly lower in the ALN/D5600 treatment group than in the calcitriol treatment group throughout the 12 months. Mean 24-h urine calcium slightly increased in the ALN/D5600 treatment group and significantly increased in the calcitriol treatment group (+ 1.1 and + 0.9 mmol/L at months six and 12; both, P < 0.05). Calcitriol treatment was associated with more frequent hypercalciuria at month six (9.4% vs. 18.5%, P = 0.05), but not at month 12 (12.3% vs. 13.0%). CONCLUSION Baseline VD status predicted 25(OH) D improvement in PMO patients on 12-month ALN/D5600 treatment. The daily use of 0.25 μg of calcitriol was associated with more frequent hypercalciuria at month six, compared to ALN/5600 treatment, necessitating the safety re-evaluation of calcitriol at a higher dosage.
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Affiliation(s)
- Er-Yuan Liao
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhen-Lin Zhang
- The Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wei-Bo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730 China
| | - Hua Lin
- Nanjing Drum Tower Hospital, Nanjing, China
| | - Qun Cheng
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Li Wang
- Tianjin Hospital, Tianjin, China
| | | | - De-Cai Chen
- West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Hai Tang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Li You
- The First People’s Hospital, Shanghai, China
| | - Liang He
- Beijing Jishuitan Hospital, Beijing, China
| | - Zhao-Heng Hu
- Peking University People’s Hospital, Beijing, China
| | - Chun-Li Song
- Peking University Third Hospital, Beijing, China
| | - Fang Wei
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Jue Wang
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Lei Zhang
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
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Tripto-Shkolnik L, Jaffe A, Liel Y. The impact of vitamin D status and parameters of calcium metabolism in patients with primary hyperparathyroidism. QJM 2018; 111:97-101. [PMID: 29462468 DOI: 10.1093/qjmed/hcx200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is ample evidence associating vitamin D deficiency in primary hyperparathyroidism (PHP) patients with more severe disease manifestations and increased risk of postoperative hypocalcemia. Yet, there is limited data regarding the safety of vitamin D repletion in these patients. AIM To assess the safety of vitamin D repletion in PHP patients in a real-world setting. DESIGN We included patients with asymptomatic PHP and few symptomatic patients who declined surgery, followed in our clinic, and treated on a routine basis with 2000 IU/day of vitamin D3. METHODS Serum calcium (sCa), PTH, 25-hydroxyvitamin D, and 24 h urinary calcium (uCa) and creatinine collections were compared between the lowest and the highest vitamin D time points. RESULTS There were 40 patients of a mean age was 63 ± 10 years. 25(OH)D at lowest and highest vitamin D time points was 15.5 ± 6.2 ng/ml and 33.2 ± 8, respectively (P < 0.001). Serum calcium was not affected by the changes in vitamin D levels. In none of the patients did sCa exceed 11.5 mg/dL. uCa was 220 ± 110 mg/24 h at the lowest vitamin D time point and 260 ± 140 at the highest vitamin D time point (P = 0.14). uCa exceeded 400 mg/24 h in two vs. five patients (P = 0.23) at the lowest and highest vitamin D time points, respectively. PTH was not significantly different between the different vitamin D time points. DISCUSSION/CONCLUSION Vitamin D repletion in PHP seems safe. Considering the documented adverse influence of vitamin D deficiency in PHP, particularly on skeletal manifestations and on the postoperative course, vitamin D repletion is warranted.
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Affiliation(s)
| | - A Jaffe
- Endocrine Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Y Liel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Felício KM, de Souza ACCB, Neto JFA, de Melo FTC, Carvalho CT, Arbage TP, de Rider Brito HA, Peixoto AS, de Oliveira AF, de Souza Resende F, Reis SS, Motta AR, da Costa Miranda H, Janau LC, Yamada ES, Felicio JS. Glycemic Variability and Insulin Needs in Patients with Type 1 Diabetes Mellitus Supplemented with Vitamin D: A Pilot Study Using Continuous Glucose Monitoring System. Curr Diabetes Rev 2018; 14:395-403. [PMID: 28618984 DOI: 10.2174/1573399813666170616075013] [Citation(s) in RCA: 15] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/04/2017] [Accepted: 06/06/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent studies suggest that glycemic variability could influence the risk of complications in Type 1 Diabetes Mellitus (T1DM). There are no data about the action of Vitamin D (VD) on glycemic variability. Our pilot study aims to evaluate glycemic variability and insulin needs in patients with T1DM supplemented with VD. METHODS 22 Patients received doses of 4000 and 10000 IU/day of cholecalciferol for 12 weeks, according to the patient's baseline VD levels and underwent continuous glucose monitoring system. RESULTS Correlations were found between percentage variation (Δ) of glycemia standard deviation (ΔSDG), calculated using continuous glucose monitoring, with Δ of basal (r = 0.6; p <0.01) and total insulin dose (r = 0.6; p <0.01). Correlations between VD status after supplementation and Δ of prandial (r = 0.5; p <0.05) and total insulin dose (r = 0.4; p <0.05) were found, suggesting that the dose of insulin needed by patients is lower when VD status is better. We divided patients in two subgroups: SDG improved (subgroup 1; N = 12 (55%)) and SDG worsened (subgroup 2; N = 10 (45%)). Group 1, compared to subgroup 2, required a lower insulin dose (Δbasal insulin dose = -8.0 vs. 6.3%; p <0.05) and had a lower frequency of hypoglycemia (27% vs. 64%, hypoglycemias/days evaluated; p <0.01). CONCLUSION Our study suggests a relation between VD supplementation, improved glycemic variability, lower insulin needs and lower frequency of hypoglycemia in patients with T1DM.
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Affiliation(s)
- Karem Mileo Felício
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Ana Carolina Contente Braga de Souza
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Joao Felicio Abrahao Neto
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Franciane Trindade Cunha de Melo
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Carolina Tavares Carvalho
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Thais Pontes Arbage
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Hana Andrade de Rider Brito
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Amanda Soares Peixoto
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Alana Ferreira de Oliveira
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Fabricio de Souza Resende
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Scarlatt Sousa Reis
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Ana Regina Motta
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Henrique da Costa Miranda
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Luisa Correa Janau
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Elizabeth Sumi Yamada
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
| | - Joao Soares Felicio
- University Hospital Joao de Barros Barreto, Federal University of Para, Endocrinology Division, Mundurucus Street, 4487, Guama, Belem, Para, 66073-000, Brazil
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Sluyter JD, Camargo CA, Stewart AW, Waayer D, Lawes CMM, Toop L, Khaw KT, Thom SAM, Hametner B, Wassertheurer S, Parker KH, Hughes AD, Scragg R. Effect of Monthly, High-Dose, Long-Term Vitamin D Supplementation on Central Blood Pressure Parameters: A Randomized Controlled Trial Substudy. J Am Heart Assoc 2017; 6:e006802. [PMID: 29066444 PMCID: PMC5721873 DOI: 10.1161/jaha.117.006802] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/16/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The effects of monthly, high-dose, long-term (≥1-year) vitamin D supplementation on central blood pressure (BP) parameters are unknown. METHODS AND RESULTS A total of 517 adults (58% male, aged 50-84 years) were recruited into a double-blinded, placebo-controlled trial substudy and randomized to receive, for 1.1 years (median; range: 0.9-1.5 years), either (1) vitamin D3 200 000 IU (initial dose) followed 1 month later by monthly 100 000-IU doses (n=256) or (2) placebo monthly (n=261). At baseline (n=517) and follow-up (n=380), suprasystolic oscillometry was undertaken, yielding aortic BP waveforms and hemodynamic parameters. Mean deseasonalized 25-hydroxyvitamin D increased from 66 nmol/L (SD: 24) at baseline to 122 nmol/L (SD: 42) at follow-up in the vitamin D group, with no change in the placebo group. Despite small, nonsignificant changes in hemodynamic parameters in the total sample (primary outcome), we observed consistently favorable changes among the 150 participants with vitamin D deficiency (<50 nmol/L) at baseline. In this subgroup, mean changes in the vitamin D group (n=71) versus placebo group (n=79) were -5.3 mm Hg (95% confidence interval [CI], -11.8 to 1.3) for brachial systolic BP (P=0.11), -2.8 mm Hg (95% CI, -6.2 to 0.7) for brachial diastolic BP (P=0.12), -7.5 mm Hg (95% CI, -14.4 to -0.6) for aortic systolic BP (P=0.03), -5.7 mm Hg (95% CI, -10.8 to -0.6) for augmentation index (P=0.03), -0.3 m/s (95% CI, -0.6 to -0.1) for pulse wave velocity (P=0.02), -8.6 mm Hg (95% CI, -15.4 to -1.9) for peak reservoir pressure (P=0.01), and -3.6 mm Hg (95% CI, -6.3 to -0.8) for backward pressure amplitude (P=0.01). CONCLUSIONS Monthly, high-dose, 1-year vitamin D supplementation lowered central BP parameters among adults with vitamin D deficiency but not in the total sample. CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Unique identifier: ACTRN12611000402943.
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Affiliation(s)
- John D Sluyter
- School of Population Health, University of Auckland, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Debbie Waayer
- School of Population Health, University of Auckland, New Zealand
| | | | - Les Toop
- Department of General Practice, The University of Otago, Christchurch, New Zealand
| | - Kay-Tee Khaw
- Department of Public Health, University of Cambridge, United Kingdom
| | - Simon A McG Thom
- International Centre for Circulatory Health, Imperial College London, London, United Kingdom
| | - Bernhard Hametner
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Robert Scragg
- School of Population Health, University of Auckland, New Zealand
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McCullough P, Amend J. Results of daily oral dosing with up to 60,000 international units (iu) of vitamin D3 for 2 to 6 years in 3 adult males. J Steroid Biochem Mol Biol 2017; 173:308-312. [PMID: 28012936 DOI: 10.1016/j.jsbmb.2016.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 01/21/2023]
Abstract
In the 1930's and 1940's, vitamin D was reported to be an effective treatment for a number of diseases, including asthma, psoriasis, rheumatoid arthritis, rickets and tuberculosis. High doses were used, 60,000 to 300,000 IU a day for asthma, and 200,000 to 600,000 IU a day for rheumatoid arthritis. Toxicity from hypercalcemia occurred after prolonged oral dosing with these supraphysiologic doses. Assays for measuring vitamin D in the blood were not available, and blood levels of vitamin D associated with hypercalcemia were unknown. A 2011 report on vitamin D toxicity showed that hypercalcemia resolved when 25-hydroxyvitamin D (25OHD) blood levels dropped below 400ng/ml in 2 patients with blood levels ranging from 645ng/ml to 1220ng/ml after accidental ingestion of massive doses of vitamin D. We now know that vitamin D is made in the skin in amounts ranging up to 25,000 IU a day with exposure to UVB radiation. There is little data on the safety and blood levels of 25OHD and calcium after prolonged daily intake of amounts of vitamin D in this range. In this report, one subject took increasing daily doses of vitamin D3 for 6 years starting in April 2009: 6500 IU for 6 months; increasing to 10,000 IU for 13 months; 20,000 IU for 24 months; 40,000 IU for 12 months; 50,000 IU for 10 months, and 60,000 IU since October 2014. 25OHD blood levels were 28, 81, 204, 216, 225, 166, and 218ng/ml. Subject 2 began 10,000 IU in Nov 2011, increased to 20,000 IU in Feb 2014, 25,000 IU in June 2014, and 30,000 IU in Oct 2014, and then decreased to 20,000 IU in June 2015. 25OHD blood levels were 96.6, 161.1 and 106.9ng/ml. He reported marked clinical improvement in his asthma. Subject 3 started on daily 10,000 IU in Sept 2013, increasing to 20,000 IU on Nov 2013. 25OHD blood levels were 31.4, 102, 164, 148, and 143ng/ml. No one developed hypercalcemia or any adverse events. The major finding of this case series is prolonged daily dosing of vitamin D3 with doses of 10,000 to 60,000 IU was safely tolerated.
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Affiliation(s)
- Patrick McCullough
- Department of Psychiatry, Wright State University, School of Medicine, Dayton, OH, 45435, United States; Summit Behavioral Healthcare, Cincinnati, OH, 45237, United States.
| | - Jeffrey Amend
- Summit Behavioral Healthcare, Cincinnati, OH, 45237, United States.
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Kendrick J, Andrews E, You Z, Moreau K, Nowak KL, Farmer-Bailey H, Seals DR, Chonchol M. Cholecalciferol, Calcitriol, and Vascular Function in CKD: A Randomized, Double-Blind Trial. Clin J Am Soc Nephrol 2017; 12:1438-1446. [PMID: 28784657 PMCID: PMC5586569 DOI: 10.2215/cjn.01870217] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/07/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES High circulating vitamin D levels are associated with lower cardiovascular mortality in CKD, possibly by modifying endothelial function. We examined the effect of calcitriol versus cholecalciferol supplementation on vascular endothelial function in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a prospective, double-blind, randomized trial of 128 adult patients with eGFR=15-44 ml/min per 1.73 m2and serum 25-hydroxyvitamin D level <30 ng/ml at the University of Colorado. Participants were randomly assigned to oral cholecalciferol (2000 IU daily) or calcitriol (0.5 μg) daily for 6 months. The primary end point was change in brachial artery flow-mediated dilation. Secondary end points included changes in circulating markers of mineral metabolism and circulating and cellular markers of inflammation. RESULTS One hundred and fifteen patients completed the study. The mean (SD) age and eGFR of participants were 58±12 years old and 33.0±10.2 ml/min per 1.73 m2, respectively. There were no significant differences between groups at baseline. After 6 months, neither calcitriol nor cholecalciferol treatment resulted in a significant improvement in flow-mediated dilation (mean±SD percentage flow-mediated dilation; calcitriol: baseline 4.8±3.1%, end of study 5.1±3.6%; cholecalciferol: baseline 5.2±5.2%, end of study 4.7±3.6%); 25-hydroxyvitamin D levels increased significantly in the cholecalciferol group compared with the calcitriol group (cholecalciferol: 11.0±9.5 ng/ml; calcitriol: -0.8±4.8 ng/ml; P<0.001). Parathyroid hormone levels decreased significantly in the calcitriol group compared with the cholecalciferol group (median [interquartile range]; calcitriol: -22.1 [-48.7-3.5] pg/ml; cholecalciferol: -0.3 [-22.6-16.9] pg/ml; P=0.004). CONCLUSIONS Six months of therapy with calcitriol or cholecalciferol did not improve vascular endothelial function or improve inflammation in patients with CKD.
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Affiliation(s)
- Jessica Kendrick
- Divisions of Renal Diseases and Hypertension and
- Department of Medicine, Denver Health Medical Center, Denver, Colorado; and
| | | | - Zhiying You
- Divisions of Renal Diseases and Hypertension and
| | - Kerrie Moreau
- Geriatrics, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Douglas R. Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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Sudfeld CR, Manji KP, Duggan CP, Aboud S, Muhihi A, Sando DM, Al-beity FMA, Wang M, Fawzi WW. Effect of maternal vitamin D 3 supplementation on maternal health, birth outcomes, and infant growth among HIV-infected Tanzanian pregnant women: study protocol for a randomized controlled trial. Trials 2017; 18:411. [PMID: 28870263 PMCID: PMC5584035 DOI: 10.1186/s13063-017-2157-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vitamin D has significant immunomodulatory effects on both adaptive and innate immune responses. Observational studies indicate that adults infected with HIV with low vitamin D status may be at increased risk of mortality, pulmonary tuberculosis, and HIV disease progression. Growing observational evidence also suggests that low vitamin D status in pregnancy may increase the risk of adverse birth and infant health outcomes. As a result, antiretroviral therapy (ART) adjunct vitamin D3 supplementation may improve the health of HIV-infected pregnant women and their children. METHODS/DESIGN The Trial of Vitamins-5 (ToV5) is an individually randomized, double-blind, placebo-controlled trial of maternal vitamin D3 (cholecalciferol) supplementation conducted among 2300 HIV-infected pregnant women receiving triple-drug ART under Option B+ in Dar es Salaam, Tanzania. HIV-infected pregnant women of 12-27 weeks gestation are randomized to either: 1) 3000 IU vitamin D3 taken daily from randomization in pregnancy until trial discharge at 12 months postpartum; or 2) a matching placebo regimen. Maternal participants are followed-up at monthly clinic visits during pregnancy, at delivery, and then with their children at monthly postpartum clinic visits. The primary efficacy outcomes of the trial are: 1) maternal HIV disease progression or death; 2) risk of small-for-gestational age (SGA) births; and 3) risk of infant stunting at 1 year of age. The primary safety outcome of the trial is incident maternal hypercalcemia. Secondary outcomes include a range of clinical and biological maternal and child health outcomes. DISCUSSION The ToV5 will provide causal evidence on the effect of vitamin D3 supplementation on HIV progression and death, SGA births, and infant stunting at 1 year of age. The results of the trial are likely generalizable to HIV-infected pregnant women and their children in similar resource-limited settings utilizing the Option B+ approach. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02305927 . Registered on 29 October 2014.
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Affiliation(s)
- Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1103C, Boston, MA 02115 USA
| | - Karim P. Manji
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Christopher P. Duggan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1103C, Boston, MA 02115 USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - David M. Sando
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1103C, Boston, MA 02115 USA
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Fadhlun M. Alwy Al-beity
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Molin Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1103C, Boston, MA 02115 USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
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