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Abstract

To define the relationship between vitamin D status and employee presenteeism in a large sample of health care employees. Prospective observation study of 10,646 employees of a Midwestern-integrated health care system who completed an on-line health risk appraisal questionnaire and were measured for 25-hydroxyvitamin D. Measured differences in productivity due to presenteeism were 0.66, 0.91, and 0.75 when comparing employees above and below vitamin D levels of 20 ng/mL, 30 ng/mL, and 40 ng/mL, respectively. These productivity differences translate into potential productivity savings of 0.191%, 0.553%, and 0.625%, respectively, of total payroll costs. Low vitamin D status is associated with reduced employee work productivity. Employee vitamin D assessment and replenishment may represent a low-cost, high-return program to mitigate risk factors and health conditions that drive total employer health care costs.

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... Another study by Jancin [32] involving 35 internal medicine house staff at Oregon Health Sciences University, Portland, revealed that 51.4 % of them were vitamin D deficient. A study conducted in health care professionals in Minnesota showed that nearly 30 % of the health care workers tested had serum 25-OH vitamin D levels lower than 20 ng/mL and additional 60 % had vitamin D levels <30 ng/mL [33]. ...
... Health care professionals, who are aware of their own vitamin D status, are more likely to actively screen their patients for vitamin D deficiency. A study conducted in health care professionals in Minnesota concluded that low vitamin D status is associated with reduced employee work productivity [33]. Increasing levels of 25-OH vitamin D were associated with significantly improved on-the-job productivity in the study, with the best response at serum 25-OH vitamin D levels greater than 40 ng/mL [33]. ...
... A study conducted in health care professionals in Minnesota concluded that low vitamin D status is associated with reduced employee work productivity [33]. Increasing levels of 25-OH vitamin D were associated with significantly improved on-the-job productivity in the study, with the best response at serum 25-OH vitamin D levels greater than 40 ng/mL [33]. The high prevalence of vitamin D deficiency in the present study points towards urgent need of an integrated approach to detect vitamin D deficiency among health care professionals and treat it appropriately. ...
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Information on vitamin D status of Indian health care professionals is limited. Among 2,119 subjects studied, just 6 % were found to be sufficient in vitamin D status. There is urgent need of an integrated approach to detect and treat vitamin D deficiency among health care professionals to improve on-the-job productivity. Vitamin D deficiency is prevalent worldwide. India has been reported to be one of the worst affected countries. Several single-center studies from India have shown high prevalence of vitamin D deficiency. Little is known regarding the vitamin D status of Indian health care professionals. This study aimed to determine prevalence of vitamin D deficiency among health care professionals in different regions of India. In this cross-sectional, multicenter study, we enrolled 2,119 medical and paramedical personnel from 18 Indian cities. Blood samples were collected from December 2010 to March 2011 and analyzed in a central laboratory by radioimmunoassay. Vitamin D deficiency was defined as 25-hydroxyvitamin D [25(OH)D] <20 ng/mL or <50 nmol/L, insufficiency as 25(OH)D = 20-30 ng/mL or 50-75 nmol/L, and sufficiency as 25(OH)D >30 ng/mL or >75 nmol/L. Mean (±SD) age of subjects was 42.71 ± 6.8 years. Mean (±SD) 25(OH)D level was 14.35 ± 10.62 ng/mL (median 11.93 ng/mL). Seventy-nine percent of subjects were deficient, 15 % were insufficient, and just 6 % were sufficient in vitamin D status. No significant difference was found between vitamin D status in southern (25(OH)D = 13.3 ± 6.4 ng/mL) and northern (25(OH)D = 14.4 ± 8.5 ng/mL) parts of India. Our study confirms the high prevalence of vitamin D deficiency all across India in apparently healthy, middle-aged health care professionals.
... [8] Similarly, a study conducted among health-care professionals in Minnesota revealed that nearly 90% had Vitamin D levels below 30 ng/mL. [9] Interestingly, even health-care professionals who are expected to be aware of vitamin deficiencies and take measures to ensure adequate levels experience similar or higher rates of deficiency compared to the general population, as shown in these studies. In addition to the factors contributing to VDD in the general population, HCWs face additional risks, particularly those working in emergency settings. ...
... [2] Plotnikoff et al., through their study among HCWs, found that low Vitamin D status is associated with reduced work productivity. [9] They concluded that assessing and replenishing employee Vitamin D levels could be a cost-effective program to mitigate risk factors and health conditions that contribute to total employer health-care costs. ...
Article
Background The importance of vitamin D in maintaining overall health cannot be overstated, as its deficiency is a significant contributor to mortality and morbidity. There is a paucity of literature on vitamin D deficiency among healthcare workers (HCWs) in India, especially those working in emergency settings and day-night shifts. Aims and Objectives This prospective cross-sectional study aimed to assess the levels of vitamin D among emergency healthcare workers (HCWs) and evaluate their knowledge, attitudes, and practices (KAP) regarding vitamin D deficiency. The study sought to address the limited literature on vitamin D deficiency among HCWs in emergency settings in India. Materials and Methods A total of 105 randomly selected healthy HCWs from the emergency department of a tertiary care hospital in north India participated in the study. A structured questionnaire was administered to collect demographic information and assess the participants' knowledge, attitudes, and practices related to vitamin D. Serum vitamin D levels were measured using a 2 ml venous blood sample. Results The mean serum vitamin D level was 15.08 ± 8.52 ng/ml, indicating a high prevalence of vitamin D deficiency (94.3%) among the participants. While most participants were aware of the active form of vitamin D, its sources and critical functions, knowledge about non-skeletal manifestations and measurable forms of vitamin D deficiency was limited. A majority of the participants (85.3%) recognized the importance of vitamin D as a micronutrient, and 69.3% expressed the need for education on its role. However, only 48.5% emphasized regular vitamin D intake. Conclusion This study highlights the high prevalence of vitamin D deficiency among HCWs in the emergency department and identifies knowledge gaps regarding its critical functions. There is a need for an effective system to identify and address vitamin D-related health issues among HCWs, which could potentially enhance their overall efficiency.
... Despite this, the high incidence of deficiency can be accounted by other important factors like traditional clothing, air pollution and poor exposure to sunlight. Similar studies have also been reported in Boston, Minnesota and Portland [21][22][23] by reports on health care professionals. However, none of them specifically focus on orthopaedic surgeons. ...
... This study could also be used for routine timely supplementation of Vitamin D to residents and young surgeons who are frequently most severely affected by the burden of this pandemic. There is an immediate need to educate the surgeons regarding this deficiency situation and a need for adequate supplementation to improve on the job productivity [23]. Although the parameter of the amount of time spent in the OR did not have a statistically significant association with the magnitude of Vitamin D insufficiency, it does provide an indirect estimation of the number of hours spent indoors which correlates with the reduced sunlight exposure. ...
Article
Background Vitamin D deficiency is a widely prevalent condition with patients in both symptomatic and asymptomatic spectrum. With the lack of routine screening there exists an unknown population of Indian Orthopaedic surgeons who are deficient in Vitamin D and lead to an unexplained loss of quality of work and increased susceptibility to various other diseases. The easiest access to resources for supplementation is available to this group of treating physicians however its use for their personal cure is rarely recognised. This study aims to highlight this endemic disease and to find out its correlation with other parameters Methods It is a prospective observational study including 150 practicing orthopaedic surgeons from entire India who visited our centre during 3 months duration for various educational meetings. Venous sample was collected after due informed consent and analysed at a single laboratory for 25-OH Cholecalciferol levels by a chemiluminescent assay. All the samples were analysed and a questionnaire was sent to the participants via google forms regarding various parameters under study. Results The mean serum Vitamin D levels were 18.6 ± 9.67 ng/ml in the sample studied. 17 out of 150 participants (11.3%) were found to have sufficient serum levels of 25(OH) Cholecalciferol. 105 participants (70%) were having deficient levels and 28 (18.7%) had insufficient levels of Vitamin D. Overall 88.7% participants had Vitamin D deficiency among the sample studied. Conclusion This widespread prevalence of Vitamin D deficiency warrants frequent screening and routine supplementation of Vitamin D in orthopaedic surgeons thereby providing a low cost solution to improve the troublesome situation among healthcare providers.
... Some studies on the relationship between presenteeism and nutrients have been reported. For example, vitamin D deficiency has been reported as a factor in work productivity loss (Plotnikoff, Finch, and Dusek, 2012). To our knowledge, this is the first report to show that dietary intervention could improve presenteeism among office workers. ...
Article
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Presenteeism is a major issue faced by workplaces around the world. While nutritional education has been well studied for its resolution, few studies have reported its effectiveness. Promoting worker health is also a major issue. To solve these problems, we developed a novel dietary intervention using nutritionally balanced meals, “COMpletely Balanced meal (COMB meal)”. Two single-arm open-label trials were conducted; employees at two major companies consumed these meals every weekday for four weeks, replacing breakfast and lunch. The comprehensive score of the Work Limitation Questionnaire-Japanese version was significantly improved in one trial and it was significantly improved in the presenteeism subgroup of both trials. Body weight, Body Mass Index, waist circumference, and visceral fat decreased and the number of defecations increased significantly in both trials. Serious adverse effects were not observed. This study is the first to show multiple effects of dietary interventions, including improvement in presenteeism.
... While few studies have been conducted on the consequences of vitamin D deficiency in wage workers specifically, recent reports have confirmed the correlation between vitamin D deficiency in workers and their Framingham score, a cardiovascular risk score [46]. In a cross-sectional study of 10,646 health care workers, a correlation between vitamin D levels and presenteeism (the problem of workers' being at their workplace but not fully functioning due to temporary illness or massive stress) was also confirmed, suggesting that vitamin D deficiency has the potential to undermine the productivity of workers [47]. ...
Article
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Vitamin D deficiency is increasing worldwide. However, few studies have attempted to examine the vitamin D status of wage workers and the correlation between vitamin D deficiency and working conditions. Hence, we aimed to evaluate the prevalence of vitamin D deficiency and the association between occupational conditions and vitamin D deficiency among Korean wage workers. Wage workers aged 20-65 years from the 5th Korea National Health and Nutrition Examination Survey (KNHANES 2010-2012; n = 5409) were included in our analysis. We measured the prevalence of vitamin D deficiency and identified the correlations with the working conditions of these subjects. The prevalence of vitamin D deficiency in male and female subjects was 69.5% and 83.1%, respectively. Among the male subjects, a significant correlation between vitamin D deficiency and working conditions was observed among shift workers, office workers, and permanent workers. No significant correlation with any type of working conditions was observed among female subjects. The prevalence of vitamin D deficiency among Korean wage workers was very high and was found to correlate significantly with working conditions, likely because of insufficient exposure to sunlight associated with certain types of work. Wage workers require more frequent outdoor activity and nutrition management to maintain sufficient vitamin D level.
... 5 Deficiency also appears closely related to increased health care costs. [6][7][8][9] Peiris et al 10 recently described a relationship between vitamin D status and monitoring, and survival in veterans diagnosed with bladder cancer. ...
Article
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Prostate cancer remains the second most commonly diagnosed cancer among the male population worldwide. Vitamin D deficiency has been linked to prostate cancer and its aggressiveness. Herein, we initiated a retrospective study to evaluate vitamin D status and monitoring in veterans with prostate cancer, and to examine the potential link between vitamin D and survival status and length of survival in this population. We found that veterans who were initially vitamin D deficient were significantly less likely to survive than those who were not initially deficient, and that both initial and follow-up vitamin D deficiency were associated with decreased likelihood of survival after prostate cancer diagnosis. We recommend that vitamin D deficiency be replaced in veterans with prostate cancer.
... 8 In a study of 10 646 fully insured healthcare employees (>90% white) in the upper Midwest, 30% had levels less than 20 ng/mL and 6% had levels less than 10 ng/mL. 9 Although one IOM leader has put in writing that most people in the United States have a baseline level of less than the 20 ng/mL IOM recommendation, 10 she continues to urge clinician inaction. 11 The recommendation is that clinicians wait until results of the $20 million National Institutes of Health (NIH)-funded VITAL study (the VITamin D and OmegA-3 TriaL: www.vitalstudy.org) ...
Article
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In 1998, the British Medical Journal boldly stated in an editorial headline, "Vitamin D Deficiency: Time for Action."(1) The urgency was clear: vitamin D deficiency was going undiagnosed and untreated in large numbers of people. Patients were at risk and suffering needlessly. A simple, extremely low-cost, low-toxicity intervention was readily available. All that was required was vitamin D advocacy.
Article
The issues of improving efficiency of health care institutions are increasingly becoming the center of scientific discussions. The purpose of the study is to examine the subjective assessments of medical organizations staff regarding factors of labor productivity. Objectives of the study: to analyze the existing approaches to the study of labor productivity factors of medical personnel, to study the opinion of medical organizations staff regarding labor productivity factors, to identify the most significant of them, and to conduct a comparative analysis of the data obtained in the course of sociological research in medical organizations providing medical care to patients with cardiovascular diseases in the Kemerovo Region – Kuzbass. The authors have studied the conclusions and findings of selected foreign and domestic experts in this field of research. The presented study identifies the key factors that can increase labor productivity of all categories of personnel on the example of two medical institutions providing care to patients with cardiovascular diseases, namely: presence of a system of material (non-material) incentives, level of material and technical support, moral and psychological climate, working conditions, and regular professional development. Common and special features of two organizations have been shown. Differences in assessing labor productivity factors in different professional categories have been found. The results obtained can be used as a basis for improving personnel policy in direction of increasing labor productivity in health care and medical science institutions.
Article
Unlabelled: Despite being close to equator and receiving sufficient sun rays, evidences revealed that Indians have severe deficiency of vitamin D (vit D) ranging from 41 to 100% in different geographical locations. Therefore, in this study levels of 25(OH)D (physiologically measurable form) along with other bone metabolism associated biochemical markers were determined in serum sample of 300 apparently healthy study subjects (rural) from Doiwala block of Dehradun district in the state of Uttarakhand. Demographic data was also obtained based on a structured questionnaire to establish an association between 25(OH)D levels and various dietary and socio-cultural factors. Results demonstrated that of all study subjects, 197 (65%) had 25(OH)D levels below < 12 ng/mL (deficient) and 65 (21%) had 25(OH)D levels between 12 and 20 ng/mL (insufficient) with all other markers falling within respectively established reference ranges. Further, in univariate analysis, gender, occupation (indoor and outdoor), education were independently associated with vitamin D status. Additionally, parathyroid hormone associated significantly with gender and occupation, while calcium associated significantly with gender, occupation and education. Lastly, regression analysis revealed that gender and occupation independently associated with vitamin D status of subjects. In conclusion, apparently healthy subjects showed considerable vitamin D deficiency thereby generating an urgent need for formulating and implementing better government policies for enrichment of vitamin D levels among rural adults of Uttarakhand in future. Supplementary information: The online version contains supplementary material available at 10.1007/s12291-022-01048-6.
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Abstract Background Vitamin D deficiency is prevalent worldwide, but some groups are at greater risk. We aim to evaluate vitamin D levels in different occupations and identify groups vulnerable to vitamin D deficiency. Methods An electronic search conducted in Medline, Embase, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text generated 2505 hits; 71 peer-reviewed articles fulfilled the inclusion criteria. Occupations investigated included outdoor and indoor workers, shiftworkers, lead/smelter workers, coalminers, and healthcare professionals. We calculated the pooled average metabolite level as mean ± SD; deficiency/insufficiency status was described as % of the total number of subjects in a given category. Results Compared to outdoor workers, indoor workers had lower 25-hydroxyvitamin D (25-(OH)D) levels (40.6 ± 13.3 vs. 66.7 ± 16.7 nmol/L; p
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Objective: Vitamin D is an essential hormone in calcium, phosphor and bone metabolism. Skin synthesizes great amount of vitamin D in sun light, it can also be taken by diet. Vitamin D deficiency may occur in settings with low sunlight exposure. Medical personal are under risk for vitamin D deficiency, especially who works at night shifts and in low sun-exposed buildings. Our aim was to determine vitamin D levels of medical personal and evaluate effect of working time and place on vitamin D levels. Materials and Methods: Ninety-six Medical persons in Istanbul Medical Faculty of Istanbul University, between 1 April to 30 May 2014 were grouped in respect to working shift and place. Mean vitamin D levels are compared between groups. Participants were asked about doing periodical sport activities, sun creme usage and history of bone fractures. According to 25 (OH) Vitamin D levels they were classified as Vitamin D deficiency ( 30 ng/ml) respectively. Results: Mean 25 (OH) Vitamin D level of all participants was 12.5±0.6 ng/mL. Where 85 (88.5%) of all cases showed deficiency of vitamin D, 10 (10.5%) had insufficient and 1 (1%) sufficient. Mean 25 (OH) Vitamin D level was 14.6±7.5 ng/mL (4.1-34.3) in males and 11.8±5.7 ng/mL (2.4-29.3) in females, there was no statistical significance between both sexes. Nurses and other medical stuff had statistical lower vitamin D levels than doctors (p<0.05). There was no difference between vitamin D levels in personal working mainly night or day shift. Medical personal working in emergency-intensive care units showed no difference in vitamin D levels compared to worker in ambulatory settings. Conclusion: Medical personal has low levels of vitamin D and are at risk for vitamin D deficiency
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ÖZET Amaç: D vitamini vücudumuzda kalsiyum, fosfor metabolizması ve iskelet sistemi üzerine etkili olan, önemli miktarı güneş ışınları ile deride sentezlenen ve diyetle alınabilen bir hormondur. Güneşe maruziyetin yetersiz olduğu ortamlarda çalışmak D vitamini eksikliğine neden olabilir. Yetersiz güneş alan binalarda ve gece nöbetlerinde çalışmaları nedeniyle sağlık çalışanları önemli risk grubunu oluşturur. Çalışmada, sağlık çalışanlarının D vitamini düzeyleri üzerine, çalışma ortamlarının ve zamanlarının etkilerini belirlemeyi amaçladık. Gereç ve Yöntem: 1 Nisan-30 Mayıs 2014 tarihleri arasında, İstanbul Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Kliniği'nde çalışan 96 sağlık personeli, çalıştıkları yere ve vardiyaya göre gruplandırıldı. Grupların D vitamini düzeyi ortalamaları karşılaştırıldı. Spor yapma, güneş kremi kullanımı ve kırık öyküsü olanların D vitamini düzeyleri irdelendi. Serum 25-Hidroksivitamin D (25-OH D) düzeyinin <20 ng/mL olması eksiklik, 21-29 ng/mL arası yetersizlik, >30 ng/mL arası yeterlilik olarak kabul edildi. Bulgular: Tüm katılımcıların 25-OH D düzeyi ortalaması 12,5±0,6 ng/mL iken, katılımcıların 85'inde (%88,5) eksiklik, 10'unda (%10,5) yetersizlik ve 1'inde (%1) yeterlilik izlendi. Erkeklerde 25-OH D düzeyi ortalama 14,6±7,5 ng/mL (4,1-34,3), kadınlarda 11,8±5,7 ng/mL (2,4-29,3) olarak saptandı. Erkekler ve kadınlar arasında 25-OH D düzeyleri açısından anlamlı farklılık saptanmadı. Hemşire ve yardımcı sağlık personellerinin 25-OH D düzeyleri doktorlara göre istatistiksel açıdan anlamlı derecede (p<0,05) daha düşüktü. Gece ve gündüz vardiyasında çalışan grupların her ikisinde ortalama 25-OH D düzeyleri düşüktü ve aralarında anlamlı farklılık yoktu. Acil-yoğun bakım çalışanları ve servis çalışanlarının oluşturduğu grupların 25-OH D düzeyi arasında istatistiksel olarak anlamlı farklılık gözlenmedi. Sonuç: Sonuç olarak, sağlık çalışanları arasında vitamin D eksikliği ve yetersizliği oldukça yaygındır. Çalışmamızın sonuçları bu meslek gurubunun D vitamini eksikliği açısından bir risk faktörü olabileceğini düşündürmektedir. Anahtar Kelimeler: D vitamini; sağlık çalışanları; kapalı ortam ABSTRACT Objective: Vitamin D is an essential hormone in calcium, phosphor and bone metabolism. Skin synthesizes great amount of vitamin D in sun light, it can also be taken by diet. Vitamin D deficiency may occur in settings with low sunlight exposure. Medical personal are under risk for vitamin D deficiency, especially who works at night shifts and in low sun-exposed buildings. Our aim was to determine vitamin D levels of medical personal and evaluate effect of working time and place on vitamin D levels. Materials and Methods: Ninety-six Medical persons in Istanbul Medical Faculty of Istanbul University, between 1 April to 30 May 2014 were grouped in respect to working shift and place. Mean vitamin D levels are compared between groups. Participants were asked about doing periodical sport activities, sun creme usage and history of bone fractures. According to 25 (OH) Vitamin D levels they were classified as Vitamin D deficiency (<20 ng/ml), insufficiency (21-29 ng/ml) and sufficiency (>30 ng/ml) respectively. Results: Mean 25 (OH) Vitamin D level of all participants was 12.5±0.6 ng/mL. Where 85 (88.5%) of all cases showed deficiency of vitamin D, 10 (10.5%) had insufficient and 1 (1%) sufficient. Mean 25 (OH) Vitamin D level was
Article
Full-text available
ZET Amaç: D vitamini vücudumuzda kalsiyum, fosfor metabolizması ve iskelet sistemi üzerine etkili olan, önemli miktarı güneş ışınları ile deride sentezlenen ve diyetle alınabilen bir hormondur. Güneşe maruziyetin yetersiz olduğu ortamlarda çalışmak D vitamini eksikliğine neden olabilir. Yetersiz güneş alan binalarda ve gece nöbetlerinde çalışmaları nedeniyle sağlık çalışanları önemli risk grubunu oluşturur. Çalışmada, sağlık çalışanlarının D vitamini düzeyleri üzerine, çalışma ortamlarının ve zamanlarının etkilerini belirlemeyi amaçladık. Gereç ve Yöntem: 1 Nisan-30 Mayıs 2014 tarihleri arasında, İstanbul Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Kliniği'nde çalışan 96 sağlık personeli, çalıştıkları yere ve vardiyaya göre gruplandırıldı. Grupların D vitamini düzeyi ortalamaları karşılaştırıldı. Spor yapma, güneş kremi kullanımı ve kırık öyküsü olanların D vitamini düzeyleri irdelendi. Serum 25-Hidroksivitamin D (25-OH D) düzeyinin <20 ng/mL olması eksiklik, 21-29 ng/mL arası yetersizlik, >30 ng/mL arası yeterlilik olarak kabul edildi. Bulgular: Tüm katılımcıların 25-OH D düzeyi ortalaması 12,5±0,6 ng/mL iken, katılımcıların 85'inde (%88,5) eksiklik, 10'unda (%10,5) yetersizlik ve 1'inde (%1) yeterlilik izlendi. Erkeklerde 25-OH D düzeyi ortalama 14,6±7,5 ng/mL (4,1-34,3), kadınlarda 11,8±5,7 ng/mL (2,4-29,3) olarak saptandı. Erkekler ve kadınlar arasında 25-OH D düzeyleri açısından anlamlı farklılık saptanmadı. Hemşire ve yardımcı sağlık personellerinin 25-OH D düzeyleri doktorlara göre istatistiksel açıdan anlamlı derecede (p<0,05) daha düşüktü. Gece ve gündüz vardiyasında çalışan grupların her ikisinde ortalama 25-OH D düzeyleri düşüktü ve aralarında anlamlı farklılık yoktu. Acil-yoğun bakım çalışanları ve servis çalışanlarının oluşturduğu grupların 25-OH D düzeyi arasında istatistiksel olarak anlamlı farklılık gözlenmedi. Sonuç: Sonuç olarak, sağlık çalışanları arasında vitamin D eksikliği ve yetersizliği oldukça yaygındır. Çalışmamızın sonuçları bu meslek gurubunun D vitamini eksikliği açısından bir risk faktörü olabileceğini düşündürmektedir. Anahtar Kelimeler: D vitamini; sağlık çalışanları; kapalı ortam ABSTRACT Objective: Vitamin D is an essential hormone in calcium, phosphor and bone metabolism. Skin synthesizes great amount of vitamin D in sun light, it can also be taken by diet. Vitamin D deficiency may occur in settings with low sunlight exposure. Medical personal are under risk for vitamin D deficiency, especially who works at night shifts and in low sun-exposed buildings. Our aim was to determine vitamin D levels of medical personal and evaluate effect of working time and place on vitamin D levels. Materials and Methods: Ninety-six Medical persons in Istanbul Medical Faculty of Istanbul University, between 1 April to 30 May 2014 were grouped in respect to working shift and place. Mean vitamin D levels are compared between groups. Participants were asked about doing periodical sport activities, sun creme usage and history of bone fractures. According to 25 (OH) Vitamin D levels they were classified as Vitamin D deficiency (<20 ng/ml), insufficiency (21-29 ng/ml) and sufficiency (>30 ng/ml) respectively. Results: Mean 25 (OH) Vitamin D level of all participants was 12.5±0.6 ng/mL. Where 85 (88.5%) of all cases showed deficiency of vitamin D, 10 (10.5%) had insufficient and 1 (1%) sufficient. Mean 25 (OH) Vitamin D level was
Article
In Reply We agree with Dr Plotnikoff that people need sufficient vitamin D to prevent osteoporotic fracture, but we disagree with his call for routine population-wide screening of vitamin D blood levels and with the implication that investigators conducting clinical trials of vitamin D intentionally undertreat participants to maintain low blood levels in the placebo group. With respect to vitamin D testing, no major US medical organization, including the IOM¹ and the US Preventive Services Task Force (USPSTF),² endorses routine, universal screening. Regarding clinical trials, those in progress allow background intake up to the recommended dietary allowance (RDA) of vitamin D to ensure that bone health is not sacrificed among those assigned to the placebo group.³
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To the Editor The Surgeon General’s 2004 report on bone health stated that osteoporosis “is a major threat to Americans” that is “largely preventable” and recommended: “Make sure you get enough vitamin D.”¹ In contrast, the Viewpoint by Drs Manson and Bassuk² suggested that vitamin D supplementation “threatens to jeopardize the ability of researchers to conduct randomized trials in ‘usual-risk’ populations.”
Article
To determine the prevalence of vitamin D deficiency (VDD) (25-hydroxyvitamin D level <20 ng/mL) and severe VDD (25[OH]D level <10 ng/mL) in a Minnesota immigrant and refugee population. This retrospective study evaluated a cohort of adult immigrants and refugees seen at Health Partners Center for International Health in St Paul, Minnesota. Study participants were all patients seen from August 1, 2008, through July 31, 2009, with a first vitamin D screen (N=1378). Outcomes included overall prevalence of VDD and severe VDD. Covariates included country of origin, sex, age, month of test, and body mass index (BMI). Vitamin D deficiency was significantly more prevalent in our Minnesota clinic immigrant and refugee population than among US-born patients (827 of 1378 [60.0%] vs 53 of 151 [35.1%]; P<.001). Severe VDD was also significantly more prevalent (208 of 1378 [15.1%] vs 12 of 151 [7.9%]; P=.02). Prevalence of VDD varied significantly according to country of origin (42 of 128 Russian patients [32.8%] vs 126 of 155 Ethiopian patients [81.3%]; P<.001). The BMI correlated negatively with VDD (488 of 781 [62.5%] when BMI was ≥25 vs 292 of 520 [56.2%] when BMI was <25; P=.02). Vitamin D deficiency was present in 154 of 220 individuals (70.0%) 16 to 29 years old vs 123 of 290 (42.4%) in those older than 66 years (P<.001). Immigrants and refugees in a Minnesota clinic have a substantially higher rate and severity of VDD when compared with a US-born population. Country of origin, age, and BMI are specific risk factors for VDD and should influence individualized screening practices.
Article
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Vitamin D, the sunshine vitamin, has been made on earth for at least 750 million years. Vitamin D evolved during this time into a hormone not only for regulating calcium and bone metabolism, but also for a variety of noncalcemic actions that have been related to decreasing risk of common cancers, autoimmune diseases, infectious diseases and heart disease. Vitamin D requires hydroxylations in the liver and kidneys to be activated to 1,25-dihydroxyvitamin D (1,25(OH)2D). 1,25(OH)2D interacts with its vitamin D receptor in target tissues to enhance intestinal calcium absorption, mobilize calcium from the skeleton and have a wide range of other genomic effects. 1,25(OH)2D3 is not only made in the kidneys, but made in many other tissues throughout the body for regulating cell proliferation, decreasing cellular malignancy and controlling the production of as many as 200 different gene products. Vitamin D status is determined by measuring serum 25-hydroxyvitamin D (25(OH)D). A blood level of 25(OH)D > 30 ng/ml is considered to be vitamin D sufficient, whereas < 20 ng/ml is deficient, and 21-29 is insufficient. Sun exposure is a major source of vitamin D for most humans. In the absence of sun exposure, at least 25 µg (1,000 IU) of vitamin D3 is required to satisfy the body's requirement.
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This article summarizes the new 2011 report on dietary requirements for calcium and vitamin D from the Institute of Medicine (IOM). An IOM Committee charged with determining the population needs for these nutrients in North America conducted a comprehensive review of the evidence for both skeletal and extraskeletal outcomes. The Committee concluded that available scientific evidence supports a key role of calcium and vitamin D in skeletal health, consistent with a cause-and-effect relationship and providing a sound basis for determination of intake requirements. For extraskeletal outcomes, including cancer, cardiovascular disease, diabetes, and autoimmune disorders, the evidence was inconsistent, inconclusive as to causality, and insufficient to inform nutritional requirements. Randomized clinical trial evidence for extraskeletal outcomes was limited and generally uninformative. Based on bone health, Recommended Dietary Allowances (RDAs; covering requirements of ≥97.5% of the population) for calcium range from 700 to 1300 mg/d for life-stage groups at least 1 yr of age. For vitamin D, RDAs of 600 IU/d for ages 1-70 yr and 800 IU/d for ages 71 yr and older, corresponding to a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/liter), meet the requirements of at least 97.5% of the population. RDAs for vitamin D were derived based on conditions of minimal sun exposure due to wide variability in vitamin D synthesis from ultraviolet light and the risks of skin cancer. Higher values were not consistently associated with greater benefit, and for some outcomes U-shaped associations were observed, with risks at both low and high levels. The Committee concluded that the prevalence of vitamin D inadequacy in North America has been overestimated. Urgent research and clinical priorities were identified, including reassessment of laboratory ranges for 25-hydroxyvitamin D, to avoid problems of both undertreatment and overtreatment.
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The aim of this study was to estimate the prevalence and determinants of vitamin D deficiency in patients with rheumatoid arthritis (RA) as compared to healthy controls and to analyze the association between 25-hydroxyvitamin D (25(OH)D) with disease activity and disability. The study includes 1,191 consecutive RA patients (85% women) and 1,019 controls, not on vitamin D supplements, from 22 Italian rheumatology centres. Together with parameters of disease activity, functional impairment, and mean sun exposure time, all patients had serum 25(OH)D measured in a centralized laboratory. A total of 55% of RA patients were not taking vitamin D supplements; the proportion of these with vitamin D deficiency (25(OH)D level <20 ng/ml) was 52%. This proportion was similar to that observed in control subjects (58.7%). One third of supplemented patients were still vitamin D deficient. In non-supplemented RA patients 25(OH)D levels were negatively correlated with the Health Assessment Questionnaire Disability Index, Disease Activity Score (DAS28), and Mobility Activities of daily living score. Significantly lower 25(OH)D values were found in patients not in disease remission or responding poorly to treatment, and with the highest Steinbrocker functional state. Body mass index (BMI) and sun exposure time were good predictors of 25(OH)D values (P < 0.001). The association between disease activity or functional scores and 25(OH)D levels remained statistically significant even after adjusting 25(OH)D levels for both BMI and sun exposure time. In RA patients vitamin D deficiency is quite common, but similar to that found in control subjects; disease activity and disability scores are inversely related to 25(OH)D levels.
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Low serum 25-hydroxyvitamin D (25(OH)D) and elevated parathyroid hormone (PTH) levels have been linked with depressive symptoms among adults in various clinical settings. Data in generally healthy, community-dwelling individuals remain inconclusive. We investigated whether depression was associated with 25(OH)D and/or PTH in a sample of middle-aged and older men (n = 3369; mean age 60 ± 11) participating in the European Male Ageing Study, and whether any associations were explained by lifestyle and health factors. The Beck Depression Inventory-II (BDI-II) was used to screen for depression, and serum 25(OH)D and PTH levels measured by radioimmunoassay. Univariate analysis revealed that 25(OH)D levels were lower (p < 0.001) and PTH higher (p = 0.004) in people with depression. In age- and centre-adjusted linear regressions a higher BDI-II score was significantly associated with lower levels of 25(OH)D (p = 0.004). After adjustment for lifestyle and health factors this relationship was attenuated but remained significant (p = 0.01). Using multivariable logistic regression the odds for depression increased approximately 70% across decreasing 25(OH)D quartiles (p (trend) = 0.04). There was no independent association between PTH and depression in any of the multivariable regressions. Our results reveal an inverse association between 25(OH)D levels and depression, largely independent of several lifestyle and health factors. Further studies are required to determine whether higher levels of vitamin D have an antidepressant effect in older adults.
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Declining serum concentrations of 25-hydroxyvitamin D seen in the fall and winter as distance increases from the equator may be a factor in the seasonal increased prevalence of influenza and other viral infections. This study was done to determine if serum 25-hydroxyvitamin D concentrations correlated with the incidence of acute viral respiratory tract infections. In this prospective cohort study serial monthly concentrations of 25-hydroxyvitamin D were measured over the fall and winter 2009-2010 in 198 healthy adults, blinded to the nature of the substance being measured. The participants were evaluated for the development of any acute respiratory tract infections by investigators blinded to the 25-hydroxyvitamin D concentrations. The incidence of infection in participants with different concentrations of vitamin D was determined. One hundred ninety-five (98.5%) of the enrolled participants completed the study. Light skin pigmentation, lean body mass, and supplementation with vitamin D were found to correlate with higher concentrations of 25-hydroxyvitamin D. Concentrations of 38 ng/ml or more were associated with a significant (p<0.0001) two-fold reduction in the risk of developing acute respiratory tract infections and with a marked reduction in the percentages of days ill. Maintenance of a 25-hydroxyvitamin D serum concentration of 38 ng/ml or higher should significantly reduce the incidence of acute viral respiratory tract infections and the burden of illness caused thereby, at least during the fall and winter in temperate zones. The findings of the present study provide direction for and call for future interventional studies examining the efficacy of vitamin D supplementation in reducing the incidence and severity of specific viral infections, including influenza, in the general population and in subpopulations with lower 25-hydroxyvitamin D concentrations, such as pregnant women, dark skinned individuals, and the obese.
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To our knowledge, no rigorously designed clinical trials have evaluated the relation between vitamin D and physician-diagnosed seasonal influenza. We investigated the effect of vitamin D supplements on the incidence of seasonal influenza A in schoolchildren. From December 2008 through March 2009, we conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D(3) supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen. Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D(3) group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36; 95% CI: 0.17, 0.79; P = 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P = 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D(3) compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006). This study suggests that vitamin D(3) supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren. This trial was registered at https://center.umin.ac.jp as UMIN000001373.
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To examine cross-sectional associations of serum vitamin D [25-hydroxyvitamin D, 25(OH)D] concentration with insulin resistance (IR) and beta-cell dysfunction in 712 subjects at risk for type 2 diabetes. Serum 25(OH)D was determined using a chemiluminescence immunoassay. Insulin sensitivity/resistance were measured using the Matsuda insulin sensitivity index for oral glucose tolerance tests (IS(OGTT)) and homeostasis model assessment of insulin resistance HOMA-IR. beta-Cell function was determined using both the insulinogenic index (IGI) divided by HOMA-IR (IGI/IR) and the insulin secretion sensitivity index-2 (ISSI-2). RESULTS Linear regression analyses indicated independent associations of 25(OH)D with IS(OGTT) and HOMA-IR (beta = 0.004, P = 0.0003, and beta = -0.003, P = 0.0072, respectively) and with IGI/IR and ISSI-2 (beta = 0.004, P = 0.0286, and beta = 0.003, P = 0.0011, respectively) after adjusting for sociodemographics, physical activity, supplement use, parathyroid hormone, and BMI. Vitamin D may play a role in the pathogenesis of type 2 diabetes, as 25(OH)D concentration was independently associated with both insulin sensitivity and beta-cell function among individuals at risk of type 2 diabetes.
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Although there is evidence that vitamin D inadequacy may be linked to adverse cognitive outcomes, results from studies on this topic have been inconsistent. The aim of this trial was to examine the association between 25-hydroxyvitamin D (25(OH)D) levels and cognitive performance in middle-aged and older European men. This population-based cross-sectional study included 3,369 men aged 40-79 years from eight centres enrolled in the European Male Ageing Study. Cognitive function was assessed using the Rey-Osterrieth Complex Figure (ROCF) test, the Camden Topographical Recognition Memory (CTRM) test and the Digit Symbol Substitution Test (DSST). Serum 25(OH)D levels were measured by radioimmunoassay. Additional assessments included measurement of physical activity, functional performance and mood/depression. Associations between cognitive function and 25(OH)D levels were explored using locally weighted and linear regression models. In total, 3,133 men (mean (+/-SD) age 60+/-11 years) were included in the analysis. The mean (+/-SD) 25(OH)D concentration was 63+/-31 nmol/l. In age-adjusted linear regressions, high levels of 25(OH)D were associated with high scores on the copy component of the ROCF test (beta per 10 nmol/l = 0.096; 95% CI 0.049 to 0.144), the CTRM test (beta per 10 nmol/l = 0.075; 95% CI 0.026 to 0.124) and the DSST (beta per 10 nmol/l = 0.318; 95% CI 0.235 to 0.401). After adjusting for additional confounders, 25(OH)D levels were associated with only score on the DSST (beta per 10 nmol/l = 0.152; 95% CI 0.051 to 0.253). Locally weighted and spline regressions suggested the relationship between 25(OH)D concentration and cognitive function was most pronounced at 25(OH)D concentrations below 35 nmol/l. In this study, lower 25(OH)D levels were associated with poorer performance on the DSST. Further research is warranted to determine whether vitamin D sufficiency might have a role in preserving cognitive function in older adults.
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Recent studies suggest a role for vitamin D in innate immunity, including the prevention of respiratory tract infections (RTIs). We hypothesize that serum 25-hydroxyvitamin D (25[OH]D) levels are inversely associated with self-reported recent upper RTI (URTI). We performed a secondary analysis of the Third National Health and Nutrition Examination Survey, a probability survey of the US population conducted between 1988 and 1994. We examined the association between 25(OH)D level and recent URTI in 18 883 participants 12 years and older. The analysis adjusted for demographics and clinical factors (season, body mass index, smoking history, asthma, and chronic obstructive pulmonary disease). The median serum 25(OH)D level was 29 ng/mL (to convert to nanomoles per liter, multiply by 2.496) (interquartile range, 21-37 ng/mL), and 19% (95% confidence interval [CI], 18%-20%) of participants reported a recent URTI. Recent URTI was reported by 24% of participants with 25(OH)D levels less than 10 ng/mL, by 20% with levels of 10 to less than 30 ng/mL, and by 17% with levels of 30 ng/mL or more (P < .001). Even after adjusting for demographic and clinical characteristics, lower 25(OH)D levels were independently associated with recent URTI (compared with 25[OH]D levels of > or =30 ng/mL: odds ratio [OR], 1.36; 95% CI, 1.01-1.84 for <10 ng/mL and 1.24; 1.07-1.43 for 10 to <30 ng/mL). The association between 25(OH)D level and URTI seemed to be stronger in individuals with asthma and chronic obstructive pulmonary disease (OR, 5.67 and 2.26, respectively). Serum 25(OH)D levels are inversely associated with recent URTI. This association may be stronger in those with respiratory tract diseases. Randomized controlled trials are warranted to explore the effects of vitamin D supplementation on RTI.
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This article reviews 6 selected cases of improvement/resolution of chronic back pain or failed back surgery after vitamin D repletion in a Canadian family practice setting. Pub Med was searched for articles on chronic back pain, failed back surgery, and vitamin D deficiency. Chronic low back pain and failed back surgery may improve with repletion of vitamin D from a state of deficiency/insufficiency to sufficiency. Vitamin D insufficiency is common; repletion of vitamin D to normal levels in patients who have chronic low back pain or have had failed back surgery may improve quality of life or, in some cases, result in complete resolution of symptoms.
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Vitamin D deficiency is a highly prevalent condition, present in approximately 30% to 50% of the general population. A growing body of data suggests that low 25-hydroxyvitamin D levels may adversely affect cardiovascular health. Vitamin D deficiency activates the renin-angiotensin-aldosterone system and can predispose to hypertension and left ventricular hypertrophy. Additionally, vitamin D deficiency causes an increase in parathyroid hormone, which increases insulin resistance and is associated with diabetes, hypertension, inflammation, and increased cardiovascular risk. Epidemiologic studies have associated low 25-hydroxyvitamin D levels with coronary risk factors and adverse cardiovascular outcomes. Vitamin D supplementation is simple, safe, and inexpensive. Large randomized controlled trials are needed to firmly establish the relevance of vitamin D status to cardiovascular health. In the meanwhile, monitoring serum 25-hydroxyvitamin D levels and correction of vitamin D deficiency is indicated for optimization of musculoskeletal and general health.
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Evidence is accumulating for a role of vitamin D in maintaining normal glucose homeostasis. However, studies that prospectively examined circulating concentrations of 25-hydroxyvitamin D (25-[OH] D) in relation to diabetes risk are limited. Our objective is to determine the association between maternal plasma 25-[OH] D concentrations in early pregnancy and the risk for gestational diabetes mellitus (GDM). A nested case-control study was conducted among a prospective cohort of 953 pregnant women. Among them, 57 incident GDM cases were ascertained and 114 women who were not diagnosed with GDM were selected as controls. Controls were frequency matched to cases for the estimated season of conception of the index pregnancy. Among women who developed GDM, maternal plasma 25-[OH] D concentrations at an average of 16 weeks of gestation were significantly lower than controls (24.2 vs. 30.1 ng/ml, P<0.001). This difference remained significant (3.62 ng/ml lower on average in GDM cases than controls (P value = 0.018)) after the adjustment for maternal age, race, family history of diabetes, and pre-pregnancy BMI. Approximately 33% of GDM cases, compared with 14% of controls (P<0.001), had maternal plasma 25-[OH] D concentrations consistent with a pre-specified diagnosis of vitamin D deficiency (<20 ng/ml). After adjustment for the aforementioned covariates including BMI, vitamin D deficiency was associated with a 2.66-fold (OR (95% CI): 2.66 (1.01-7.02)) increased GDM risk. Moreover, each 5 ng/ml decrease in 25-[OH] D concentrations was related to a 1.29-fold increase in GDM risk (OR (95% CI): 1.29 (1.05-1.60)). Additional adjustment for season and physical activity did not change findings substantially. Findings from the present study suggest that maternal vitamin D deficiency in early pregnancy is significantly associated with an elevated risk for GDM.
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Background: Numerous observational studies have found supplemental calcium and vitamin D to be associated with reduced risk of common cancers. However, interventional studies to test this effect are lacking. Objective: The purpose of this analysis was to determine the efficacy of calcium alone and calcium plus vitamin D in reducing incident cancer risk of all types. Design: This was a 4-y, population-based, double-blind, randomized placebo-controlled trial. The primary outcome was fracture incidence, and the principal secondary outcome was cancer incidence. The subjects were 1179 community-dwelling women randomly selected from the population of healthy postmenopausal women aged >55 y in a 9-county rural area of Nebraska centered at latitude 41.4°N. Subjects were randomly assigned to receive 1400–1500 mg supplemental calcium/d alone (Ca-only), supplemental calcium plus 1100 IU vitamin D3/d (Ca + D), or placebo. Results: When analyzed by intention to treat, cancer incidence was lower in the Ca + D women than in the placebo control subjects (P < 0.03). With the use of logistic regression, the unadjusted relative risks (RR) of incident cancer in the Ca + D and Ca-only groups were 0.402 (P = 0.01) and 0.532 (P = 0.06), respectively. When analysis was confined to cancers diagnosed after the first 12 mo, RR for the Ca + D group fell to 0.232 (CI: 0.09, 0.60; P < 0.005) but did not change significantly for the Ca-only group. In multiple logistic regression models, both treatment and serum 25-hydroxyvitamin D concentrations were significant, independent predictors of cancer risk. Conclusions: Improving calcium and vitamin D nutritional status substantially reduces all-cancer risk in postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00352170.
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To determine the prevalence of hypovitaminosis D in primary care outpatients with persistent, nonspecific musculoskeletal pain syndromes refractory to standard therapies. In this cross-sectional study, 150 patients presented consecutively between February 2000 and June 2002 with persistent, nonspecific musculoskeletal pain to the Community University Health Care Center, a university-affiliated inner city primary care clinic in Minneapolis, Minn (45 degrees north). Immigrant (n = 83) and nonimmigrant (n = 67) persons of both sexes, aged 10 to 65 years, from 6 broad ethnic groups were screened for vitamin D status. Serum 25-hydroxyvitamin D levels were determined by radioimmunoassay. Of the African American, East African, Hispanic, and American Indian patients, 100% had deficient levels of vitamin D (< or = 20 ng/mL). Of all patients, 93% (140/ 150) had deficient levels of vitamin D (mean, 12.08 ng/mL; 95% confidence interval, 11.18-12.99 ng/mL). Nonimmigrants had vitamin D levels as deficient as immigrants (P = .48). Levels of vitamin D in men were as deficient as in women (P = .42). Of all patients, 28% (42/150) had severely deficient vitamin D levels (< or = 8 ng/mL), including 55% of whom were younger than 30 years. Five patients, 4 of whom were aged 35 years or younger, had vitamin D serum levels below the level of detection. The severity of deficiency was disproportionate by age for young women (P < .001), by sex for East African patients (P < .001), and by race for African American patients (P = .006). Season was not a significant factor in determining vitamin D serum levels (P = .06). All patients with persistent, nonspecific musculoskeletal pain are at high risk for the consequences of unrecognized and untreated severe hypovitaminosis D. This risk extends to those considered at low risk for vitamin D deficiency: nonelderly, nonhousebound, or nonimmigrant persons of either sex. Nonimmigrant women of childbearing age with such pain appear to be at greatest risk for misdiagnosis or delayed diagnosis. Because osteomalacia is a known cause of persistent, nonspecific musculoskeletal pain, screening all outpatients with such pain for hypovitaminosis D should be standard practice in clinical care.
Article
The objective of the present study was to examine the cross-sectional relation between serum 25-hydoxyvitamin D (25(OH)D) levels and depression in obese subjects, and to assess the effect of vitamin D supplementation on depressive symptoms. 441 subjects (body mass index 28 - 47 kg/m ² , 159 men and 282 women, aged 21 - 70 years) were recruited by advertisements or from the out-patient clinic at the University Hospital of North Norway, and in a double blind controlled trial randomized to 20.000 or 40.000 IU vitamin D per week versus placebo for 1 year. Subjects with serum 25(OH)D levels < 40 nmol/L scored significantly higher (more depressive traits) than those with serum 25(OH)D levels ≥ 40 nmol/L on the Beck Depression Inventory (BDI) total (6.0 (0 - 23) versus 4.5 (0 - 28) (median and range)) and the BDI subscale 1 - 13 (2.0 (0 - 15) versus 1.0 (0 - 29.5)) (P < 0.05). In the two groups given vitamin D, but not in the placebo group, there was a significant improvement in BDI scores after one year. There was a significant decrease in serum parathyroid hormone in the two vitamin D groups, without a concomitant increase in serum calcium. It appears to be a relation between serum levels of 25(OH)D and symptoms of depression. Supplementation with high doses of vitamin D seems to ameliorate these symptoms, indicating a possible causal relationship.
Article
Vitamin D is both a vitamin and a hormone and has diverse actions. The major biologically active metabolite, 1,25-dihydroxyvitamin D, plays a central part in maintaining calcium and phosphate homoeostasis and also has antiproliferative, prodifferentiation, and immunosuppressive effects; its receptors are distributed in various tissues, including bone, pancreas, stomach, gonads, brain, skin, and breast.1 Vitamin D is essential for skeletal health, and severe deficiency is associated with defective mineralisation resulting in rickets or its adult equivalent, osteomalacia. More subtle degrees of insufficiency lead to secondary hyperparathyroidism and increased bone turnover, which play an important part in age related bone loss and osteoporotic fractures.Over recent decades a wealth of evidence has accumulated documenting vitamin D deficiency in elderly populations in Europe and elsewhere. 2 3 A recent study from the United States has added further evidence that vitamin D deficiency continues to be neglected and also raised questions about how best to combat it.4Vitamin D status is most commonly assessed by measuring serum concentrations of 25-hydroxyvitamin D (25-OHD), the major circulating form of …
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This article has no abstract; the first 100 words appear below. Vitamin D is an essential precursor of 1,25-dihydroxyvitamin D, the steroid hormone required not only for bone development and growth in children and maintenance of bone in adults, but also for the prevention of osteoporosis and fractures in the elderly. Although rickets and osteomalacia — the consequences of severe vitamin D deficiency — have largely disappeared, there is increasing evidence of widespread vitamin D deficiency in old and sick people. The findings by Thomas et al. in this issue of the Journal ¹ of low serum 25-hydroxyvitamin D concentrations in 57 percent of 290 patients hospitalized on a medical service indicate . . . Robert D. Utiger, M.D.
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Reduced vitamin D levels may play a significant role in the development of fractures and musculoskeletal pains reported in patients on aromatase inhibitors (AIs) for breast cancer. In this study, we evaluated the vitamin D status in postmenopausal women with non-metastatic breast cancer who were about to start AI therapy. This study was conducted on community dwelling postmenopausal subjects, aged 35-80 years, with early non-metastatic breast cancer (up to stage IIIA), who were about to start therapy using third generation AIs. Symptoms of joint and muscle pains were obtained using a modified Leuven menopausal questionnaire. 25-hydroxyvitamin D [25(OH)D] was evaluated by radioimmunoassay while bone mineral density (BMD) of the lumbar spine and the proximal femur by dual energy x-ray absorptiometry (DXA). Of the 145 participants (mean age = 60.96 ± 0.88 years), 63 of 145 (43.5%) had baseline levels of 25(OH)D of < 20 ng/mL (deficient), 50 of 145 (34.5%) had levels between 20 and 29 ng/mL (insufficient), and only 32 of 145 (22%) had ≥ 30 ng/mL (sufficient); thus, 113 of 145 (78%) had low 25(OH)D levels (i.e., < 30 ng/mL). Arthralgias and myalgias were found in 61.3% and 43% of patients, respectively; and of those, 83.3% and 88.1% had 25(OH)D of < 30 ng/mL, respectively. Prevalence of vitamin D deficiency is high in breast cancer women and this may increase the risk of bone loss and fractures in those who are going to start AIs. Moreover, musculoskeletal pains are common in breast cancer women, even before the initiation of AIs and in association with low vitamin D in the majority. Future studies may be needed to establish the contribution of low vitamin D, if any, on the prevalence of musculoskeletal pains in women on AIs.
Article
25-hydroxy-vitamin D (25-OH-D) insufficiency/deficiency is increasingly prevalent and has been associated with many chronic diseases, including rheumatoid arthritis (RA). Our purpose was to define the prevalence and associations of 25-OH-D insufficiency/deficiency in a cohort of US veterans with RA. vitamin D status (25-OH-D) was assessed in patients with RA using radioimmunoassay on banked plasma collected at enrollment. Insufficiency was defined as concentrations < 30 ng/ml and deficiency as < 20 ng/ml. Associations of 25-OH-D insufficiency/deficiency with patient characteristics obtained at enrollment were examined using multivariate logistic regression, adjusting for age, sex, season of enrollment, and race. patients (850 men, 76% Caucasian) had a mean (SD) age of 64 (SD 11.3) years. The prevalences of 25-OH-D insufficiency and deficiency were 84% and 43%, respectively. After multivariate adjustment, both insufficiency and deficiency were more common with anti-cyclic citrullinated peptide antibody positivity and non-Caucasian race, and in the absence of vitamin D supplementation. 25-OH-D deficiency, but not insufficiency, was independently associated with higher tender joint counts and highly sensitive C-reactive protein levels. in a predominantly elderly, male RA population, 25-OH-D insufficiency was highly prevalent. With the increasing adverse health outcomes associated with hypovitaminosis D, screening and supplementation, particularly among minority, seropositive patients with RA, should be performed routinely.
Article
Vitamin D is a steroid hormone with important skeletal and non-skeletal biologic functions. Vitamin D deficiency is common and manifests with musculoskeletal symptoms. In rheumatoid arthritis (RA), vitamin D deficiency may be associated with increased disease activity and disability. We aimed to estimate the relationship between Vitamin D level and disease activity, pain, and disability in RA. Data were drawn from 62 RA patients seen in an academic arthritis clinic. 25(OH)D levels were evaluated along with markers of RA disease activity, physician and patient global assessments, pain (VAS) and HAQ. DAS-28 was calculated. Vitamin D deficiency was defined as 25(OH)D levels<30ng/ml. Sixty-one percent of RA patients were classified as vitamin D deficient. In patients with active RA (DAS 28 score≥2.6), 25(OH)D was moderately and inversely associated with DAS 28 (-0.38), pain (-0.49) and HAQ (-0.54) (p<0.01). However, no significant associations were found between 25(OH)D and these variables in patients in remission (DAS 28<2.6). Vitamin D deficient patients with active RA had six times the odds (OR=6.0, 95% CI 1.2-31.2) of being moderately or severely disabled (HAQ≥1.25). Vitamin D deficiency was common in this RA group. In patients with moderate to high disease activity, vitamin D deficiency was associated with higher DAS scores, pain and disability. Clinicians in northern climates may wish to monitor vitamin D status in their RA patients.
Article
Depressive symptoms and fatigue are frequent and disabling symptoms of multiple sclerosis (MS). Depression and fatigue have been associated with a poor vitamin D status, and a poor vitamin D status is often found in MS. Assess whether vitamin D status contributes to depressive symptoms and fatigue in MS. Patients with MS that participated in previous studies in which depression and fatigue were assessed and of whom serum 25-hydroxyvitamin D (25(OH)D) levels were available within a timeframe of less than one half-life of 25(OH)D were included. Depression and fatigue were assessed with the Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory.   Fifty-nine patients were included. Mean scores of fatigue and depression were 14.6 (SD 4.2) and 6.2 (SD 4.4), respectively. The mean vitamin D status was 62.3 nm (SD 27.8). Vitamin D status correlated negatively with depression (r=-0.326, P=0.006). No significant correlation was found between vitamin D status and fatigue. In a multiple regression model, vitamin D status was not a significant contributor to depression, after controlling for age Expanded Disability Status Scale score and fatigue (P=0.078). Alternatively, depression and fatigue did not contribute to vitamin D status. This study shows a negative correlation between vitamin D status and depressive symptoms in patients with MS. Although multiple confounders exist, we observed an indication that vitamin D status might contribute to the presence of depressive symptoms in MS. Therefore, further studies on vitamin D in MS should include depressive symptoms as outcome measures to confirm these findings.
Article
Vitamin D recently has been proposed to play an important role in a broad range of organ functions, including cardiovascular (CV) health; however, the CV evidence-base is limited. We prospectively analyzed a large electronic medical records database to determine the prevalence of vitamin D deficiency and the relation of vitamin D levels to prevalent and incident CV risk factors and diseases, including mortality. The database contained 41,504 patient records with at least one measured vitamin D level. The prevalence of vitamin D deficiency (≤30 ng/ml) was 63.6%, with only minor differences by gender or age. Vitamin D deficiency was associated with highly significant (p <0.0001) increases in the prevalence of diabetes, hypertension, hyperlipidemia, and peripheral vascular disease. Also, those without risk factors but with severe deficiency had an increased likelihood of developing diabetes, hypertension, and hyperlipidemia. The vitamin D levels were also highly associated with coronary artery disease, myocardial infarction, heart failure, and stroke (all p <0.0001), as well as with incident death, heart failure, coronary artery disease/myocardial infarction (all p <0.0001), stroke (p = 0.003), and their composite (p <0.0001). In conclusion, we have confirmed a high prevalence of vitamin D deficiency in the general healthcare population and an association between vitamin D levels and prevalent and incident CV risk factors and outcomes. These observations lend strong support to the hypothesis that vitamin D might play a primary role in CV risk factors and disease. Given the ease of vitamin D measurement and replacement, prospective studies of vitamin D supplementation to prevent and treat CV disease are urgently needed.
Article
To review the current literature on vitamin D and asthma, discussing the possible roles of vitamin D on asthma pathogenesis and the potential consequences of vitamin D deficiency. PubMed database was searched from 1950 to 2009. Keywords used included asthma, vitamin D, inflammation, airway smooth muscle and cytokines. Articles were selected based on relevance to the subject. Vitamin D deficiency has been associated with epidemiologic patterns observed in the asthma epidemic. Vitamin D deficiency is more common with obesity, African American ethnicity, and westernization of countries with higher-risk populations for asthma. Evidence suggests that vitamin D deficiency is associated with increased airway hyperresponsiveness, lower pulmonary functions, worse asthma control, and possibly steroid resistance. Lung epithelial cells express high baseline levels of 1alpha-hydroxylase. This allows the conversion of inactive calcidiol to active calcitriol locally within the lung. Calcitriol has been shown to inhibit the synthesis and release of certain cytokines, such as RANTES, platelet-derived growth factor, and matrix metalloproteinases, from bronchial smooth muscle cells, thereby leading to decreased lung inflammation and smooth muscle cell proliferation. Vitamin D also increases synthesis of interleukin 10 by CD4+CD25+Foxp3+ T-regulatory cells and dendritic cells, while concurrently inhibiting dendritic cell activation by downregulating expression of costimulatory molecules CD40 and CD80/86. Vitamin D is also capable of inducing the expression of several anti-infective molecules, such as cathelicidin. Thus, vitamin D has a number of biologic effects that are likely important in regulating key mechanisms in asthma. We hypothesize that vitamin D supplementation may lead to improved asthma control by inhibiting the influx of inflammatory cytokines in the lung and increasing the secretion of interleukin 10 by T-regulatory cells and dendritic cells.
Article
This review examines the scientific evidence behind the hypothesis that vitamin D plays a role in the pathogenesis of allergic diseases, along with a focus on emerging data regarding vitamin D and atopic dermatitis. Elucidated molecular interactions of vitamin D with components of the immune system and clinical data regarding vitamin D deficiency and atopic diseases are discussed. The rationale behind the sunshine hypothesis, laboratory evidence supporting links between vitamin D deficiency and allergic diseases, the clinical evidence for and against vitamin D playing a role in allergic diseases, and the emerging evidence regarding the potential use of vitamin D to augment the innate immune response in atopic dermatitis are reviewed.
Article
To investigate vitamin D levels in patients with non-specific musculoskeletal pain, headache, and fatigue. A cross-sectional descriptive study. A health center in Oslo, Norway, with a multi-ethnic population. A total of 572 patients referred by a general practitioner (GP) for an examination of hypovitaminosis D who reported musculoskeletal pain, headache, or fatigue. The patients' native countries were: Norway (n = 249), Europe, America, and South-East Asia (n = 83), and the Middle East, Africa, and South Asia (n = 240). Both genders and all ages were included. Vitamin D levels (25-hydroxyvitamin D) in nmol/L. Hypovitaminosis D (25-hydroxyvitamin D < 50 nmol/L) was found in 58% of patients. One-third of ethnic Norwegians had hypovitaminosis D, while 83% of patients from the Middle East, Africa, and South Asia had hypovitaminosis D with minimal seasonal variation of levels. One in two women from these countries had a vitamin D level below 25 nmol/L. Mean vitamin D level was lower in patients with headaches compared with patients with other symptoms. Some 15% of patients with low (< 50 nmol/L) vitamin D levels reported headaches, compared with 5% of those with normal vitamin D levels. Our study shows a high prevalence of hypovitaminosis D in patients with non-specific musculoskeletal pain, headache, or fatigue for whom the GP had suspected a low vitamin D level. Hypovitaminosis D was not restricted to immigrant patients. These results indicate that GPs should maintain awareness of hypovitaminosis D and refer patients who report headaches, fatigue, and musculoskeletal pain with minimal sun exposure and a low dietary vitamin D intake for assessment.
Article
There is increasing evidence that, in addition to the well-known effects on musculoskeletal health, vitamin D status may be related to a number of non-skeletal diseases. An international expert panel formulated recommendations on vitamin D for clinical practice, taking into consideration the best evidence available based on published literature today. In addition, where data were limited to smaller clinical trials or epidemiologic studies, the panel made expert-opinion based recommendations. Twenty-five experts from various disciplines (classical clinical applications, cardiology, autoimmunity, and cancer) established draft recommendations during a 2-day meeting. Thereafter, representatives of all disciplines refined the recommendations and related texts, subsequently reviewed by all panelists. For all recommendations, panelists expressed the extent of agreement using a 5-point scale. Recommendations were restricted to clinical practice and concern adult patients with or at risk for fractures, falls, cardiovascular or autoimmune diseases, and cancer. The panel reached substantial agreement about the need for vitamin D supplementation in specific groups of patients in these clinical areas and the need for assessing their 25-hydroxyvitamin D (25(OH)D) serum levels for optimal clinical care. A target range of at least 30 to 40 ng/mL was recommended. As response to treatment varies by environmental factors and starting levels of 25(OH)D, testing may be warranted after at least 3 months of supplementation. An assay measuring both 25(OH)D(2) and 25(OH)D(3) is recommended. Dark-skinned or veiled individuals not exposed much to the sun, elderly and institutionalized individuals may be supplemented (800 IU/day) without baseline testing.
Article
To systematically review and quantitatively synthesize the effect of vitamin D therapy on fall prevention in older adults. Systematic review and meta-analysis. MEDLINE, CINAHL, Web of Science, EMBASE, Cochrane Library, LILACS, bibliographies of selected articles, and previous systematic reviews through February 2009 were searched for eligible studies. Older adults (aged > or = 60) who participated in randomized controlled trials that both investigated the effectiveness of vitamin D therapy in the prevention of falls and used an explicit fall definition. Two authors independently extracted data, including study characteristics, quality assessment, and outcomes. The I(2) statistic was used to assess heterogeneity in a random-effects model. Of 1,679 potentially relevant articles, 10 met inclusion criteria. In pooled analysis, vitamin D therapy (200-1,000 IU) resulted in 14% (relative risk (RR)=0.86, 95% confidence interval (CI)=0.79-0.93; I(2)=7%) fewer falls than calcium or placebo (number needed to treat =15). The following subgroups had significantly fewer falls: community-dwelling (aged <80), adjunctive calcium supplementation, no history of fractures or falls, duration longer than 6 months, cholecalciferol, and dose of 800 IU or greater. Meta-regression demonstrated no linear association between vitamin D dose or duration and treatment effect. Post hoc analysis including seven additional studies (17 total) without explicit fall definitions yielded smaller benefit (RR=0.92, 95% CI=0.87-0.98) and more heterogeneity (I(2)=36%) but found significant intergroup differences favoring adjunctive calcium over none (P=.001). Vitamin D treatment effectively reduces the risk of falls in older adults. Future studies should investigate whether particular populations or treatment regimens may have greater benefit.
Article
Type 1 (T1D) and type 2 (T2D) diabetes are considered multifactorial diseases in which both genetic predisposition and environmental factors participate in their development. Many cellular, preclinical, and observational studies support a role for vitamin D in the pathogenesis of both types of diabetes including: (1) T1D and T2D patients have a higher incidence of hypovitaminosis D; (2) pancreatic tissue (more specifically the insulin-producing beta-cells) as well as numerous cell types of the immune system express the vitamin D receptor (VDR) and vitamin D-binding protein (DBP); and (3) some allelic variations in genes involved in vitamin D metabolism and VDR are associated with glucose (in)tolerance, insulin secretion, and sensitivity, as well as inflammation. Moreover, pharmacologic doses of 1,25-dihydroxyvitamin D (1,25(OH)(2)D), the active form of vitamin D, prevent insulitis and T1D in nonobese diabetic (NOD) mice and other models of T1D, possibly by immune modulation as well as by direct effects on beta-cell function. In T2D, vitamin D supplementation can increase insulin sensitivity and decrease inflammation. This article reviews the role of vitamin D in the pathogenesis of T1D and T2D, focusing on the therapeutic potential for vitamin D in the prevention/intervention of T1D and T2D as well as its complications.
Article
Hypovitaminosis D and depressive symptoms are common conditions in older adults. We examined the relationship between 25-hydroxyvitamin D [25(OH)D] and depressive symptoms over a 6-yr follow-up in a sample of older adults. This research is part of a population-based cohort study (InCHIANTI Study) in Tuscany, Italy. A total of 531 women and 423 men aged 65 yr and older participated. Serum 25(OH)D was measured at baseline. Depressive symptoms were assessed at baseline and at 3- and 6-yr follow-ups using the Center for Epidemiological Studies-Depression Scale (CES-D). Depressed mood was defined as CES-D of 16 or higher. Analyses were stratified by sex and adjusted for relevant biomarkers and variables related to sociodemographics, somatic health, and functional status. Women with 25(OH)D less than 50 nmol/liter compared with those with higher levels experienced increases in CES-D scores of 2.1 (P = 0.02) and 2.2 (P = 0.04) points higher at, respectively, 3- and 6-yr follow-up. Women with low vitamin D (Vit-D) had also significantly higher risk of developing depressive mood over the follow-up (hazard ratio = 2.0; 95% confidence interval = 1.2-3.2; P = 0.005). In parallel models, men with 25(OH)D less than 50 nmol/liter compared with those with higher levels experienced increases in CES-D scores of 1.9 (P = 0.01) and 1.1 (P = 0.20) points higher at 3- and 6-yr follow-up. Men with low Vit- D tended to have higher risk of developing depressed mood (hazard ratio = 1.6; 95% confidence interval = 0.9-2.8; P = 0.1). Our findings suggest that hypovitaminosis D is a risk factor for the development of depressive symptoms in older persons. The strength of the prospective association is higher in women than in men. Understanding the potential causal pathway between Vit- D deficiency and depression requires further research.
Article
We aimed to establish the relationship between serum vitamin D levels and disease activity and health status in rheumatoid arthritis. Sixty-five patients with RA fulfilling ACR criteria for the classification of rheumatoid arthritis and forty healthy controls were included in this study. Disease activity was assessed according to the Disease Activity Score including 28 joint counts. C-reactive protein (CRP, mg/dl) was determined by the nephelometric method. Erythrocyte sedimentation rate (ESR, mm/h) was determined by the Westergren method. Rheumatoid factor (RF, IU/ml) was also determined by the nephelometric method, and RF > 20 IU/ml was defined as positive. 25-OH Vitamin D EIA Kit was used to measure serum 25-OH Vitamin D levels. We found that the mean of the 25-OH D vitamin levels of the patients with RA was not different than that of controls (P = 0.936). We divided patients with RA into three groups according to DAS28 as low activity group (group 1, n = 25), moderate activity group (group 2, n = 25), and high activity group (group 3, n = 15). 25-OH vitamin D levels of the patients in the high activity group (group 3) were found to be the lowest (P < 0.001), and the patients with moderate disease activity had lower levels than those in the mild group (P = 0.033). Serum 25-OH vitamin D levels were significantly negatively correlated with DAS28, CRP, and HAQ (respectively, r = -0.431, P = 0.000, r = -0.276, P = 0.026, and r = -0.267, P = 0.031). Serum vitamin D levels in patients with RA were similar those in the healthy controls, while it significantly decreases in accordance with the disease activity and decreasing functional capacity.
Article
Patients with asthma exhibit variable response to inhaled corticosteroids (ICS). Vitamin D is hypothesized to exert effects on phenotype and glucocorticoid (GC) response in asthma. To determine the effect of vitamin D levels on phenotype and GC response in asthma. Nonsmoking adults with asthma were enrolled in a study assessing the relationship between serum 25(OH)D (vitamin D) concentrations and lung function, airway hyperresponsiveness (AHR), and GC response, as measured by dexamethasone-induced expression of mitogen-activated protein kinase phosphatase (MKP)-1 by peripheral blood mononuclear cells. A total of 54 adults with asthma (FEV(1), 82.9 +/- 15.7% predicted [mean +/- SD], serum vitamin D levels of 28.1 +/- 10.2 ng/ml) were enrolled. Higher vitamin D levels were associated with greater lung function, with a 22.7 (+/-9.3) ml (mean +/- SE) increase in FEV(1) for each nanogram per milliliter increase in vitamin D (P = 0.02). Participants with vitamin D insufficiency (<30 ng/ml) demonstrated increased AHR, with a provocative concentration of methacholine inducing a 20% fall in FEV(1) of 1.03 (+/-0.2) mg/ml versus 1.92 (+/-0.2) mg/ml in those with vitamin D of 30 ng/ml or higher (P = 0.01). In ICS-untreated participants, dexamethasone-induced MKP-1 expression increased with higher vitamin D levels, with a 0.05 (+/-0.02)-fold increase (P = 0.02) in MKP-1 expression observed for each nanogram per milliliter increase in vitamin D, a finding that occurred in the absence of a significant increase in IL-10 expression. In asthma, reduced vitamin D levels are associated with impaired lung function, increased AHR, and reduced GC response, suggesting that supplementation of vitamin D levels in patients with asthma may improve multiple parameters of asthma severity and treatment response. Clinical trials registered with www.clinicaltrials.gov (NCT00495157, NCT00565266, and NCT00557180).
Article
The Centers for Disease Control and Prevention's latest data show markedly high prevalence rates of severe vitamin D deficiency among Americans of all ages. Because of the numerous negative health consequences associated with vitamin D deficiency, we must consider all potential causes including insufficient exposure to the sun's ultraviolet B radiation. This article presents data from the National Weather Service that documents how few days in Minnesota offer the opportunity to make vitamin D. Thus, even Minnesotans who spend a significant amount of time outdoors and consider themselves to have sufficient sun exposure may still be at risk for vitamin D deficiency. This is especially true for the elderly, those with high melanin content in their skin, and those with a higher body mass index, all of whom require significantly more sun to achieve adequate levels of vitamin D. Given the lack of sufficient ultraviolet B radiation people in Minnesota get from the sun between October and April, measurement of vitamin D status is required for rational replenishment and maintenance dosing. The goal of replenishment should be at least 32 ng/mL and, ideally, more than 50 ng/mL.
Article
A 20-year-old vegetarian man was admitted to our hospital complaining of muscle weakness and gait disturbances of 4 years duration. For the past 5 years, he had major depression and had confined himself at home. He exhibited tenderness upon palpation of the chest, sternum and proximal muscles. Hypocalcemia, hypophosphatemia, vitamin D deficiency, increased levels of alkaline phosphatase, and intact parathyroid hormone were noted. An x-ray skeletal survey revealed generalized osteopenia, multiple vertebral and costal fractures, and a pelvis deformed into the shape of a triangle. A diagnosis of osteomalacia secondary to vitamin D deficiency from lack of exposure to sunlight and to inadequacy of the diet was made. The patient was started on a treatment with 20,000 IU of vitamin D3 once a week plus 1 g/d of calcium. Eight months later, gait disturbances have significantly improved and laboratory findings have all normalized.
Article
Vitamin D deficiency has potential roles in breast cancer etiology and progression. Vitamin D deficiency has also been associated with increased toxicity from bisphosphonate therapy. The optimal dose of vitamin D supplementation is unknown, but daily sunlight exposure can generate the equivalent of a 10,000-IU oral dose of vitamin D(3). This study therefore aimed to assess the effect of this dose of vitamin D(3) in patients with bone metastases from breast cancer. Patients with bone metastases treated with bisphosphonates were enrolled into this single-arm phase 2 study. Patients received 10,000 IU of vitamin D(3) and 1000 mg of calcium supplementation each day for 4 months. The effect of this treatment on palliation, bone resorption markers, calcium metabolism, and toxicity were evaluated at baseline and monthly thereafter. Forty patients were enrolled. No significant changes in bone resorption markers were seen. Despite no change in global pain scales, there was a significant reduction in the number of sites of pain. A small but statistically significant increase in serum calcium was seen, as was a significant decrease in serum parathyroid hormone. Treatment unmasked 2 cases of primary hyperparathyroidism, but was not associated with direct toxicity. Daily doses of 10,000 IU vitamin D(3) for 4 months appear safe in patients without comorbid conditions causing hypersensitivity to vitamin D. Treatment reduced inappropriately elevated parathyroid hormone levels, presumably caused by long-term bisphosphonate use. There did not appear to be a significant palliative benefit nor any significant change in bone resorption.
Article
The association between low serum 25-hydroxyvitamin D [25(OH)D] concentration and cognitive decline has been investigated by only a few studies, with mixed results. The objective of this cross-sectional population-based study was to examine the association between serum 25(OH)D deficiency and cognitive impairment while taking confounders into account. The subjects, 752 women aged > or =75 years from the Epidémiologie de l'Ostéoporose (EPIDOS) cohort, were divided into 2 groups according to serum 25(OH)D concentrations (either deficient, <10 ng/mL, or nondeficient, > or =10 ng/mL). Cognitive impairment was defined as a Pfeiffer Short Portable Mental State Questionnaire (SPMSQ) score <8. Age, body mass index, number of chronic diseases, hypertension, depression, use of psychoactive drugs, education level, regular physical activity, and serum intact parathyroid hormone and calcium were used as potential confounders. Compared with women with serum 25(OH)D concentrations > or =10 ng/mL (n = 623), the women with 25(OH)D deficiency (n = 129) had a lower mean SPMSQ score (p < 0.001) and more often had an SPMSQ score <8 (p = 0.006). There was no significant linear association between serum 25(OH)D concentration and SPMSQ score (beta = -0.003, 95% confidence interval -0.012 to 0.006, p = 0.512). However, serum 25(OH)D deficiency was associated with cognitive impairment (crude odds ratio [OR] = 2.08 with p = 0.007; adjusted OR = 1.99 with p = 0.017 for full model; and adjusted OR = 2.03 with p = 0.012 for stepwise backward model). 25-Hydroxyvitamin D deficiency was associated with cognitive impairment in this cohort of community-dwelling older women.
Article
Employers are becoming concerned with the costs of presenteeism in addition to the healthcare and absenteeism costs that have traditionally been explored. But what is the true impact of health conditions in terms of on-the-job productivity? This article examines the literature to assess the magnitude of presenteeism costs relative to total costs of a variety of health conditions. Searches of MEDLINE, CINAHL and PubMed were conducted in July 2008, with no starting date limitation, using 'presenteeism' or 'work limitations' as keywords. Publications on a variety of health conditions were located and included if they assessed the total healthcare and productivity cost of one or more health conditions. Literature on presenteeism has investigated its link with a large number of health conditions ranging from allergies to irritable bowel syndrome. The cost of presenteeism relative to the total cost varies by condition. In some cases (such as allergies or migraine headaches), the cost of presenteeism is much larger than the direct healthcare cost, while in other cases (such as hypertension or cancer), healthcare is the larger component. Many more studies have examined the impact of pharmaceutical treatment on certain medical conditions and the resulting improvement in on-the-job productivity. Based on the research reviewed here, health conditions are associated with on-the-job productivity losses and presenteeism is a major component of the total employer cost of those conditions, although the exact dollar amount cannot be determined at this time. Interventions, including the appropriate use of pharmaceutical agents, may be helpful in improving the productivity of employees with certain conditions.
Article
Changes in serum 25-hydroxyvitamin D [25(OH)D] concentrations in the US population have not been described. We used data from the National Health and Nutrition Examination Surveys (NHANES) to compare serum 25(OH)D concentrations in the US population in 2000-2004 with those in 1988-1994 and to identify contributing factors. Serum 25(OH)D was measured with a radioimmunoassay kit in 20 289 participants in NHANES 2000-2004 and in 18 158 participants in NHANES III (1988-1994). Body mass index (BMI) was calculated from measured height and weight. Milk intake and sun protection were assessed by questionnaire. Assay differences were assessed by re-analyzing 150 stored serum specimens from NHANES III with the current assay. Age-adjusted mean serum 25(OH)D concentrations were 5-20 nmol/L lower in NHANES 2000-2004 than in NHANES III. After adjustment for assay shifts, age-adjusted means in NHANES 2000-2004 remained significantly lower (by 5-9 nmol/L) in most males, but not in most females. In a study subsample, adjustment for the confounding effects of assay differences changed mean serum 25(OH)D concentrations by approximately 10 nmol/L, and adjustment for changes in the factors likely related to real changes in vitamin D status (ie, BMI, milk intake, and sun protection) changed mean serum 25(OH)D concentrations by 1-1.6 nmol/L. Overall, mean serum 25(OH)D was lower in 2000-2004 than 1988-1994. Assay changes unrelated to changes in vitamin D status accounted for much of the difference in most population groups. In an adult subgroup, combined changes in BMI, milk intake, and sun protection appeared to contribute to a real decline in vitamin D status.
Article
The objective of the present study was to examine the cross-sectional relation between serum 25-hydroxyvitamin D [25-(OH) D] levels and depression in overweight and obese subjects and to assess the effect of vitamin D supplementation on depressive symptoms. Cross-sectional study and randomized double blind controlled trial of 20,000 or 40,000 IU vitamin D per week versus placebo for 1 year. A total of 441 subjects (body mass index 28-47 kg m(-2), 159 men and 282 women, aged 21-70 years) recruited by advertisements or from the out-patient clinic at the University Hospital of North Norway. Beck Depression Inventory (BDI) score with subscales 1-13 and 14-21. Subjects with serum 25(OH)D levels < 40 nmol L(-1) scored significantly higher (more depressive traits) than those with serum 25(OH)D levels > or = 40 nmol L(-1) on the BDI total [6.0 (0-23) versus 4.5 (0-28) (median and range)] and the BDI subscale 1-13 [2.0 (0-15) versus 1.0 (0-29.5)] (P < 0.05). In the two groups given vitamin D, but not in the placebo group, there was a significant improvement in BDI scores after 1 year. There was a significant decrease in serum parathyroid hormone in the two vitamin D groups without a concomitant increase in serum calcium. It appears to be a relation between serum levels of 25(OH)D and symptoms of depression. Supplementation with high doses of vitamin D seems to ameliorate these symptoms indicating a possible causal relationship.
Article
Vitamin D deficiency rickets, once considered the most common disease of early childhood, was reported to have disappeared by the 1960s. However, during a recent 18-month period, seven cases of nutritional rickets were diagnosed in the Twin Cities metropolitan area. All of the patients were born at term and were breastfed without supplementation vitamins. Three of the patients were Caucasian, three were African American, and one was biracial. This case series demonstrates the risk of nutritional rickets in breastfed infants in our northern climate, regardless of race. In hopes of eradicating this completely preventable disease, we advocate a uniform policy of vitamin D supplementation to breastfed infants.
Article
The construct validity of a quantitative work productivity and activity impairment (WPAI) measure of health outcomes was tested for use in clinical trials, along with its reproducibility when administered by 2 different methods. 106 employed individuals affected by a health problem were randomised to receive either 2 self-administered questionnaires (self administration) or one self-administered questionnaire followed by a telephone interview (interviewer administration). Construct validity of the WPAI measures of time missed from work, impairment of work and regular activities due to overall health and symptoms, were assessed relative to measures of general health perceptions, role (physical), role (emotional), pain, symptom severity and global measures of work and interference with regular activity. Multivariate linear regression models were used to explain the variance in work productivity and regular activity by validation measures. Data generated by interviewer-administration of the WPAI had higher construct validity and fewer omissions than that obtained by self-administration of the instrument. All measures of work productivity and activity impairment were positively correlated with measures which had proven construct validity. These validation measures explained 54 to 64% of variance (p less than 0.0001) in productivity and activity impairment variables of the WPAI. Overall work productivity (health and symptom) was significantly related to general health perceptions and the global measures of interference with regular activity. The self-administered questionnaire had adequate reproducibility but less construct validity than interviewer administration. Both administration methods of the WPAI warrant further evaluation as a measure of morbidity.
Article
The purpose of this study was to examine the effects of summer sun exposure on serum 25-hydroxyvitamin D [25(OH)D], calcium absorption fraction, and urinary calcium excretion. Subjects were 30 healthy men who had just completed a summer season of extended outdoor activity (e.g. landscaping, construction work, farming, or recreation). Twenty-six subjects completed both visits: after summer sun exposure and again approximately 175 d later, after winter sun deprivation. We characterized each subject's sun exposure by locale, schedule, and usual attire. At both visits we measured serum 25(OH)D, fasting urinary calcium to creatinine ratio, and calcium absorption fraction. Median serum 25(OH)D decreased from 122 nmol/liter in late summer to 74 nmol/liter in late winter. The median seasonal difference of 49 nmol/liter (interquartile range, 29-67) was highly significant (P < 0.0001). However, we found only a trivial, nonsignificant seasonal difference in calcium absorption fraction and no change in fasting urinary calcium to creatinine ratio. Findings from earlier work indicate that our subjects' sun exposure was equivalent in 25(OH)D production to extended oral dosing with 70 micro g/d vitamin D(3) (interquartile range, 41-96) or, equivalently, 2800 IU/d (interquartile range, 1640-3840). Despite this input, at the late winter visit, 25(OH)D was less than 50 nmol/liter in 3 subjects and less than 75 nmol/liter in 15 subjects.
Article
Initial assessment involved 360 patients (90% women and 10% men) attending spinal and internal medicine clinics over a 6-year period who had experienced low back pain that had no obvious cause for more than 6 months. The patients ranged in age from 15 to 52 years. To investigate the contribution of vitamin D deficiency as a cause for idiopathic chronic low back pain, to find a simple and sensitive test for screening patients with low back pain for vitamin D deficiency, and to determine the correlation between the vitamin deficiency and pain. A biochemical assay of serum calcium, phosphate, alkaline phosphatase, and 25-hydroxy vitamin D level was performed before and after treatment with vitamin D supplements. Findings showed that 83% of the study patients (n = 299) had an abnormally low level of vitamin D before treatment with vitamin D supplements. After treatment, clinical improvement in symptoms was seen in all the groups that had a low level of vitamin D, and in 95% of all the patients (n = 341). Vitamin D deficiency is a major contributor to chronic low back pain in areas where vitamin D deficiency is endemic. Screening for vitamin D deficiency and treatment with supplements should be mandatory in this setting. Measurement of serum 25-OH cholecalciferol is sensitive and specific for detection of vitamin D deficiency, and hence for presumed osteomalacia in patients with chronic low back pain.
Article
A multi-employer database that links medical, prescription drug, absence, and short term disability data at the patient level was analyzed to uncover the most costly physical and mental health conditions affecting American businesses. A unique methodology was developed involving the creation of patient episodes of care that incorporated employee productivity measures of absence and disability. Data for 374,799 employees from six large employers were analyzed. Absence and disability losses constituted 29% of the total health and productivity related expenditures for physical health conditions, and 47% for all of the mental health conditions examined. The top-10 most costly physical health conditions were: angina pectoris; essential hypertension; diabetes mellitus; mechanical low back pain; acute myocardial infarction; chronic obstructive pulmonary disease; back disorders not specified as low back; trauma to spine and spinal cord; sinusitis; and diseases of the ear, nose and throat or mastoid process. The most costly mental health disorders were: bipolar disorder, chronic maintenance; depression; depressive episode in bipolar disease; neurotic, personality and non-psychotic disorders; alcoholism;, anxiety disorders; schizophrenia, acute phase; bipolar disorders, severe mania; nonspecific neurotic, personality and non-psychotic disorders; and psychoses. Implications for employers and health plans in examining the health and productivity consequences of common health conditions are discussed.
Article
Physicians in the United States rarely screen for hypovitaminosis D and rarely prescribe vitamin D, even when medically indicated. This is of particular concern in Minnesota. The sun's intensity at Minnesota's latitudes limits vitamin D production, at best, to March through October. A variety of lifestyle situations, including long work hours, may preclude adequate sun exposure. Additionally, people of Northern European background may avoid sun exposure to reduce risk of skin cancer and premature aging. And people of Asian and African heritage may not have sufficient vitamin D production due to increased skin pigmentation. This brief article summarizes key points regarding the importance of vitamin D, including its action as a steroid hormone and its role in cancer, hypertension, and autoimmune disease as well as in perinatal and prenatal health. The potential benefit of hypovitaminosis D screening and vitamin D supplementation is discussed, as are the populations most likely to need screening and supplementation.