Article

Vitamin D and Menopause–a narrative review

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Abstract

There is accumulating evidence that vitamin D (VD) has important effects besides its well-known role in calcium and bone metabolism. Hypovitaminosis D is associated with cardiovascular disease, the metabolic syndrome, type 2 diabetes mellitus, cancer as well as with increased mortality. Further, VD deficiency is related to depression and impaired cognitive function. Increasing age and elevated body fat mass contribute to an increased risk of VD deficiency. Further, some studies report a relationship between VD and estrogen metabolism. During menopause, the decline of estrogens results in increased bone turnover, a decrease in bone mineral density and elevated fracture risk. Musculoskeletal discomfort might impair quality of life, mood disturbances do frequently occur and the risk of metabolic and cardiovascular disease increases. Moreover, body composition changes including increased fat mass and decreased lean mass, which results in an increased risk of VD deficiency. Conversely, VD deficiency might aggravate discomfort as well as diseases that occur during menopause. There are precise recommendations regarding a sufficient VD intake in order to prevent bone loss in peri- and postmenopausal women. Considering the fact that VD deficiency and menopause share risk factors beyond bone health such as cardiovascular, metabolic, cognitive and affective disorders, a sufficient VD status should be obtained in all peri- and postmenopausal women. This might be beneficial not only considering bone health but also regarding cognitive, affective, metabolic and cardiovascular health of women.

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... Na fase da pós-menopausa, uma das importantes mudanças no organismo feminino corresponde às alterações nos níveis de vitamina D. A diminuição deste nutriente é considerada um problema de saúde pública, seja no climatério, seja em outras patologias, tendo em vista a alta prevalência mundial. Além disso, tal redução pode ainda contribuir para a ocorrência de inúmeras doenças agudas e crônicas, incluindo o câncer, deficiência cognitiva, diabetes e doenças cardiovasculares (Pérez-López et al., 2012;Lerchbaum, 2014;Chedraui & Pilz, 2020). ...
... A vitamina D é conhecida por desempenhar um importante papel na manutenção da homeostase de outros nutrientes essenciais ao organismo, como o cálcio e o fósforo, além de participar na promoção da mineralização óssea. Nesse sentido, entende-se a importância de níveis suficientes de vitamina D para a funcionalidade do corpo (Lerchbaum, 2014). ...
... Em mulheres na pós-menopausa, relata-se a ocorrência de uma alta prevalência de doenças relacionadas à vitamina D, especificamente com alterações no metabolismo deste nutriente, como uma diminuição da síntese cutânea de vitamina D ou modificações na composição corporal, que são relevantes para a fisiologia e estado geral do nutriente Chedraui & Pilz, 2020). Desta maneira, compreende-se que a menopausa e a deficiência de vitamina D são problemas intimamente relacionados, e que proporcionam diversos resultados adversos à saúde da mulher, o que inclui a perda óssea, distúrbios do humor, associação com a síndrome metabólica, aumento do risco de doenças cardiovasculares e câncer (Lerchbaum, 2014;Schmitt et al., 2017;Kim, 2018). ...
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Article
A menopausa é definida como a interrupção permanente do ciclo menstrual, sendo diagnosticada após um período de 12 meses consecutivos de amenorreia. Mulheres na pós-menopausa, os níveis de vitamina D podem ser alterados. Desta forma, alguns estudos têm sugerido a suplementação exógena desse nutriente como alternativa terapêutica. O objetivo foi realizar uma revisão de literatura sobre a suplementação exógena isolada e/ou combinada de vitamina D em mulheres na pós-menopausa. Reuniu-se diversos artigos publicados entre 2016 e 2020. Utilizou-se como descritores: “pós-menopausa”, “suplementação nutricional” e “vitamina D”, definidos conforme plataforma dos Descritores em Ciências da Saúde – DeCS. As bases de dados utilizadas foram: Scielo, LILACS e PUBMED. A seleção dos artigos seguiu critérios de inclusão e exclusão, previamente estabelecidos. Um total de 21 artigos foi incluído no estudo, sendo a maior parte deles publicada em 2018 (n=9, 42,85%). Os estudos selecionados avaliaram os efeitos desta suplementação em diferentes aspectos. Comparou-se as altas e baixas doses da suplementação, analisou-se os efeitos de uma combinação da vitamina D com outros nutrientes, bem como a influência de um processo educativo sobre o tema com as participantes. Estas mulheres foram avaliadas quanto à tal terapia, considerando a prática de atividade física, o perfil sérico de hormônios sexuais, o risco de câncer em fumantes, bem como quanto aos parâmetros musculares e inflamatórios. Diante do exposto, observou-se a suplementação exógena com vitamina D é uma opção terapêutica em constante avaliação. Foi constatado ainda que a suplementação combinada foi a abordagem mais desenvolvida entre os estudos.
... This study revealed that the 25(OH)D concentration is related to MetS-related variables, such as BMI, FG, TGs, and HDL-C, which is consistent with the results of previous studies. 2,3,21 The association between vitamin D concentration and MetS is well established. Vitamin D plays roles in various pathways, including adiposity, abnormal lipidemia and glucose homeostasis as well as insulin secretion and sensitivity, which are critical risk factors for MetS. ...
... Vitamin D plays roles in various pathways, including adiposity, abnormal lipidemia and glucose homeostasis as well as insulin secretion and sensitivity, which are critical risk factors for MetS. 2,21 According to a meta-analysis of 28 studies, a high level of vitamin D was observed to reduce MetS risk by 51%, 22 and some have suggested that maintaining a proper level of vitamin D would help cure or prevent risk factors for MetS. 21 After being divided by menopausal status, postmenopausal women with vitamin D deficiency showed a significant difference in both MetS-related variables and the risk of obesity and MetS compared with the same parameters in those with sufficient vitamin D, but this difference was not found in premenopausal women. ...
... 2,21 According to a meta-analysis of 28 studies, a high level of vitamin D was observed to reduce MetS risk by 51%, 22 and some have suggested that maintaining a proper level of vitamin D would help cure or prevent risk factors for MetS. 21 After being divided by menopausal status, postmenopausal women with vitamin D deficiency showed a significant difference in both MetS-related variables and the risk of obesity and MetS compared with the same parameters in those with sufficient vitamin D, but this difference was not found in premenopausal women. The results of our study regarding postmenopausal women were consistent with the findings of previous studies, [5][6][7] which reported that 25(OH)D concentration is associated with MetS. ...
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Article
Background and objectives: To assess whether the consumption of dietary macronutrient could change metabolic syndrome (MetS) related to vitamin D deficiency according to menopausal status. Methods and study design: In a cross-sectional study of 8326 Korean women from the Korean National Health and Nutrition Examination Survey V (2010-2012), we investigated the combined interaction effect of serum 25-hydroxyvitamin D [25(OH)D] concentration and menopausal status on MetS-related variables. Results: The prevalence rates of 25(OH)D deficiency (vitamin D <50 nmol/L) among premenopausal and postmenopausal women were 84.5% and 67.9%, respectively. Significant differences in MetS-related variables such as body mass index (P<0.001), waist circumference (P=0.005), fast glucose (P=0.048), triglycerides (P=0.001), and high-density lipoprotein cholesterol (P=0.027) based on 25(OH)D concentration were observed among postmenopausal women but not among premenopausal women. Among the postmenopausal women with high consumption of dietary carbohydrate, the adjusted odds ratios (ORs) [95% confidence intervals (95% CIs)] of MetS among participants with 25(OH)D deficiency increased 1.380-fold (95% CI = 1.086-1.753) using the 25(OH)D-sufficient group as a reference. In contrast, the participants with 25(OH)D deficiency showed an increased risk of MetS [OR (95% CI) = 1.313 (1.041-1.655)] with low-fat consumption. However, the aforementioned findings did not differ among premenopausal women. Conclusion: Thus, MetS due to 25(OH)D deficiency among postmenopausal women may be modified by the consumption of dietary macronutrient.
... It is plausible that in premenopausal and postmenopausal women, estrogen deficiency together with Vitamin D deficiency results in increased risk of metabolic and cardiovascular complications. 15 In the present study significant decreased levels of Vitamin D was found in postmenopausal women that may be due to the decreased levels of estrogen and progesterone, as compared to premenopausal women. Also the 34% premenopausal women having BMI greater than 25 and 66% women having BMI less than 25. ...
... The typical gynoid distribution of body fat of premenopausal women gradually turns into the android type distribution characterized by fat accumulation in the abdomen. 15 In this study, more than 50% of women working in nonmanual jobs were overweight or obese, and both BMI and the percentage of body fat did not differ significantly between the three groups studied. However, an increased waist-hip ratio (WHR) was more common in early premenopausal and postmenopausal women compared with late premenopausal women. ...
... 19,20 One of the possible explanations could be reduced bioavailability of Vitamin D due to sequestration in excess adipose tissue. 15 However, Andreozzi et al. 21 concluded that Vitamin D fat sequestration applied only to individuals with very large amounts of adipose tissue and also showed a negative correlation between serum Vitamin D levels and waist circumference, as well as the android fat to gynoid fat (A/G) ratio, but not with BMI. ...
... Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women. [19] Menopause is a unique experience. It is not a type of disease, but rather a stage in biological and physiological development. ...
... [8,11,14,16,17] There are precise recommendations regarding a suffi cient Vitamin D intake in order to prevent, bone, loss in menopause and postmenopausal women. [11,19,20] Considering the fact that Vitamin D defi ciency and menopause share risk factors beyond bone health such as cardiovascular, metabolic, cognitive and affective disorders, a suffi cient Vitamin D status should be obtained in all peri-and postmenopausal women. This might be benefi cial not only considering bone health but also regarding cognitive, affective, metabolic and cardiovascular health of women. ...
... [20] Furthermore, a number of studies revealed a positive association between serum 25OHD level and BMD. [11,[19][20][21][22][23][24] This is confi rmastive with the present study outcome. ...
... Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women. [19] Menopause is a unique experience. It is not a type of disease, but rather a stage in biological and physiological development. ...
... [8,11,14,16,17] There are precise recommendations regarding a suffi cient Vitamin D intake in order to prevent, bone, loss in menopause and postmenopausal women. [11,19,20] Considering the fact that Vitamin D defi ciency and menopause share risk factors beyond bone health such as cardiovascular, metabolic, cognitive and affective disorders, a suffi cient Vitamin D status should be obtained in all peri-and postmenopausal women. This might be benefi cial not only considering bone health but also regarding cognitive, affective, metabolic and cardiovascular health of women. ...
... [20] Furthermore, a number of studies revealed a positive association between serum 25OHD level and BMD. [11,[19][20][21][22][23][24] This is confi rmastive with the present study outcome. ...
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Article
Background: The reported association between vitamin D level and loss of Bone mineral densitometry measurements (BMD) has been controversial. Objective: The objectı;ve of the current study was to determine whether low vitamin D level and BMD are associated with depresive symptoms as burden in Arab women during the menopausal and postmenopausal period. Design and Setting: A cross-sectional descriptive study design was used at the Primary Health Care (PHC) Centers in Qatar. Subjects: A multi-stage sampling design was used and a representative sample of 1436 women aged 45-65 years were included during July 2012 and November 2013 and 1106 women agreed to participate (77.2%) and responded to the study. Materials and Methods: BMD (g/m 2) was assessed at the BMD unit using a Lunar Prodigy DXA system (Lunar Corp., Madison, WI). The antero-posterior lumbar spine (L2-L4) and the mean of the proximal right and left femur were be measured by two technician and then reviewed by one radiologist. Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes. Results: Of the 1436 women living in urban and rural areas, 1106 women agreed to participate (77.0%) and responded to the study. The mean age and standard deviation of the subjects was 53.8 ± 3.2. The median age of natural menopausal in the present study was 49 years (mean and standard deviation 49.5 ± 3.1 and postmenopausal was 58.1 ± 3.3). There were statistically significant differences between menopausal stages with regards to ethnicity, education level, systolic and dialostic blood pressure, parity, sheesha smoking and depressive symptoms. Overall 30.4% of women were affected with osteopenia/osteoporosis in premenopausal and postmenopausal (24.4% vs 35.7%; P = 0.0442). Osteopenia in premenopausal and postmenopausal (18.7% vs 29.3%; P = 0.030) and Osteoporosis (9.9% vs 15.9%; P = 0.049) were significantly higher in post-menopausal women than in premenopausal women (P = 0.046). Similarly, vitamin D deficiency was more prevalent among postmenopausal women than menopausal women. Overall, only 15.1% of women had optimum vitamin D level and 15.5% had severe, 33.2% had moderate vitamin D insufficiency and 36.3% had mild vitamin D insufficiency in menopausal and post menopausal women (P = 0.021). The study revealed that vitamin D level, hemoglobin level, serum iron fasting plasma glucose, calcium, triglycerides, high density lipid (HDL) cholesterol, low density lipid (LDL) Cholesterol, alkaline phosphate and magnesium were considerably lower in postmenopausal compared to menopausal women (P < 0.001). Conclusion: The current study revealed that there was a strong association between vitamin D level and BMD in Arab women during the menopausal and post-menopausal period.
... In their review, Tokmak 30 indicated an association between vitamin consumption and reduced sleep disorders and night sweats, and Bertone-Johnson et al. 24 found a relationship between adequate intake of vitamin D and reduced depressive symptoms. Inadequate vitamin D intake may aggravate menopausal symptoms, cognitive, affective, cardiovascular, and metabolic disorders in postmenopausal women 65 . Similar results have been reported for inadequate intake of vitamin A, B complex, and E 66,67 . ...
... Similar results have been reported for inadequate intake of vitamin A, B complex, and E 66,67 . Such consequences may happen because vitamin D is involved in the metabolism of estrogen and serotonin, as well as having an effect on the action of insulin 65 . ...
Article
Despite literature pointing to a relation between dietary intake and menopausal symptoms, most studies have evaluated either only supplements or only specific nutrients or foods. Therefore, this study aimed to provide a systematic review of the literature regarding the association between dietary intake and menopausal symptoms in postmenopausal women. A systematic search was conducted across PubMed/Medline, Web of Science, Scopus, and Embase to identify studies published between 2009 and 2019. We identified 3828 studies; after screening, 73 studies were reviewed and 19 of these investigated nutrient and food intake and eating patterns associated with the intensity of menopausal symptoms. Studies evaluating diet quality or dietary patterns showed an association between lower intensity of psychological symptoms, sleep disorders, and vasomotor, urogenital, and somatic symptoms and higher consumption of vegetables, whole grains, and unprocessed foods. Also, the intensity of these symptoms is associated with high-processed foods, saturated fats, and sugars. Regarding nutrient and/or specific food, the studies indicated an association between caffeine intake and type of fat intake and the intensity of menopausal symptoms. Dietary intake was found to be associated with the severity of menopausal symptoms; however, evidence for the association between dietary intake and menopausal symptoms is inconsistent and inconclusive, and is provided by a small number of studies.
... 4 The limited number of studies reported that vitamin D decreases hot flashes by preserving the level of serotonin, which is an effective neurotransmitter over thermoregulation; increases the blood flow of sexual organs during sexual relations by increasing the production of nitric oxide; increases the production of hormones associated with testosterone and because it decreases the frequency of depression with receptors found in regions of depression like the thalamus and hypothalamus in the brain, it can positively affect sexual function. [3][4][5] Vitamin D has been shown experimentally to provide protection against the reduction of serotonin, which is effective on thermoregulation. 5 Therefore, vitamin D may be used in the treatment of vasomotor symptoms in menopausal women. ...
... 5 Therefore, vitamin D may be used in the treatment of vasomotor symptoms in menopausal women. 5 The decrease in the sexual function of menopausal women affects their lives negatively, and considering the serious side effects of the drugs used for treatment, alternative therapies are needed to improve sexual function in the menopausal period. 4 The aim of this study was to investigate the effect of vitamin D levels on sexual functions and menopausal symptoms. ...
Article
Objective: To determine whether vitamin D levels correlate with menopausal symptoms and female sexual functions. Study design: A cross-sectional study. Place and duration of study: Izmir Katip Celebi University Hospital, Izmir, Turkey, between February and October 2017. Methodology: Menopausal and sexual active ladies aged 40-70 years were inducted. Those with psychiatric disorders, endocive abnormalities, related therapy, and malignancy were excluded. Menopause Rating Scale (MRS), and the Female Sexual Function Index (FSFI) were used to collect data. Also blood samples were collected from the patients. The study's data were examined with logistic and linear regression models. Results: Total MRS scale scores of the 303 subjects with one of the following conditions had a higher menopause symptom score; chronic disease, vaginal discharge, chronic pain, unsatisfied with sex, sleep problems, and low vitamin D level (p=0.023, p=0.007, p<0.001, p<0.001, p=0.017, and p<0.001; respectively). It was found that those who have middle income level were more likely to have better sexual function (OR: 0.209, 95% CI: 0.065; 0.671) compared to those who have low income level. It was found that those with higher MRS somatic complaint (OR: 1.274; 95% CI: 1.087; 1.494) and urogenital complaint (OR: 1.670; 95% CI: 1.326; 2.102) and ones with lower vitamin D levels (OR: 0.963; %95 CI: 0.941; 0.987) were more likely to report complaints for sexual function disorders. Conclusion: Vitamin D of all women in menopause should be evaluated. High vitamin D levels should reduce menopausal symptoms and positively affect sexual function.
... Furthermore, there are accumulating evidence that vitamin D deficiency contributes to pathologic conditions that can be presented as hematuria such as urinary stone [22], infection [23] and malignancy [24]. The present study is the first to examine this correlation using data of a nationwide population-based survey, stratified by sex and menopause status as these parameters are known to be important in analyzing the effects of vitamin D deficiency [25,26]. ...
... The subsequent analysis showed that the correlation between hematuria and vitamin D deficiency was predominant in postmenopausal women but not in premenopausal women. The different effects of vitamin D deficiency according to menopausal status have been previously reported [10,26,30], but the mechanisms have not been clearly determined. Vitamin D is one of the steroid hormones and it is closely related to sex hormones such as estrogen and testosterone, levels of which may vary with menopausal status, thereby affecting the relationship with disease risk. ...
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Article
Background Vitamin D deficiency is an important health concern because it is related to several comorbidities and mortality. However, its relationship with the risk of hematuria remains undetermined in the general population. In this study, we analyzed the association between vitamin D deficiency and hematuria. Methods We conducted cross-sectional analysis using data of participants from the Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2014. A total of 20,240 participants, aged ≥18 years old, were analyzed. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured in a central laboratory and hematuria was defined as ≥1+ on a dipstick test. Multivariate logistic regression was conducted to calculate the odds ratio (OR) of hematuria risk according to serum 25(OH)D quartiles, after adjusting several covariates. Results A total 3144 (15.5%) participants had hematuria. The mean 25(OH)D level was 17.4 ± 6.2 ng/mL (median, 16.6 ng/mL (interquartile range, 13.1–20.8 ng/mL)). The 3rd and 4th quartiles had a higher risk of hematuria than the 1st quartile, with adjusted ORs 1.26 (1.114–1.415) and 1.40 (1.240–1.572) in the 3rd and 4th quartiles, respectively. However, this relationship was only significant in women, not in men. When stratified analyses were conducted according to menopausal status, there was a significant increase of hematuria risk according to quartiles in postmenopausal but not in premenopausal women. Conclusion We found that vitamin D deficiency is correlated with hematuria in women, particularly after menopause. Further interventional studies are warranted to address whether correcting vitamin D deficiency can lower the risk of hematuria.
... 1 The emerging evidence highlights the importance of normalizing vitamin D levels in the general population, as it may prevent long-term health problems, including cardiovascular events, metabolic syndrome, cancer, overall health, anxiety and depression, and overall mortality, although controversies in the literature are common and the data is inconclusive. 2,3 Our own previous experience from a cross-sectional study with 100 postmenopausal metabolic women revealed a favorable correlation between vitamin D concentrations and mean blood pressure and high density lipoproteins. 4 We showed that normalizing vitamin D level may lower the mean blood pressure. ...
... Vitamin D deficiency (<50 nmol/L) is a worldwide epidemic with multiple implications on human health, due to its role in various physiological systems. 14 It is generally considered that vitamin D plays an important role in overall health and it is important to have adequate vitamin D. 2 The overall enthusiasm to search and to find links between disease and vitamin D deficiency has changed with the evolving paradox: the optimistic findings from observational studies were not supported by interventional studies. 5,15 This may be explained by the study duration, design and sample size, as it may take a longer time for the cardiovascular outcome to occur than the duration of a clinical trial. ...
Article
Background: The evidence highlights the importance of improving vitamin D levels in the general population for the prevention of adverse long-term health risks, including cardiovascular events, metabolic syndrome, cancer, anxiety and depression, and overall mortality, although controversies in the research are common. Objectives: The purpose of this study was to investigate the relationship between vitamin D and vascular and bone health among postmenopausal metabolic women, controlling for traditional cardiovascular factors, and thus seeking to explore their plausible relation. The secondary aim was to look specifically for the relation between artery stiffness and bone health. Material and methods: This is a cross-sectional study designed to evaluate the relation between vitamin D level and vascular and bone health among women with metabolic syndrome. Two hundred and ten women visiting a cardiologist were recruited consecutively into the study. The study variables included clinical examination, laboratory findings, measurements of vascular stiffness, and bone turnover markers. Results: We found 126 (60%) metabolic women with a vitamin D deficiency (50 nmol/L) among the study group. We discovered no statistically significant correlation between vitamin D and vascular stiffness. Vitamin D was not associated neither with femoral neck bone mineral density (BMD) and T score, nor with lumbar spine BMD and T score. Nevertheless, there was an indirect weak correlation between vascular stiffness, in particular the augmentation index (AIx), and all bone health markers, including BMD and T score in both the femur head and lumbar spine. Conclusions: We showed a high proportion of postmenopausal metabolic women with a vitamin D deficiency, but there was no relation between vitamin D and vascular health or vitamin D and bone health. Nevertheless, the relation between vascular health and bone health exists, although the role of vitamin D in this link has not yet been established.
... Midwives should implement an overall strategy that includes healthy lifestyle changes to protect the health of women in menopause.In this context, midwives should be trained and supported in terms of exercising, healthy and balanced nutrition of women, and should be informed about yoga, meditation, and reflexology (Coşkun, 2012;Ünsal Atan and Yiğitoğlu, 2015). The patient should be made aware of regular fluid intake, the importance of sunbathing times and intervals should be explained as the sun activates vitamin D, and vitamin D supplements should be made if necessary (Lerchbaum, 2014;Sullivan et al.2017). ...
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In the study, the concept of pain in different periods of women's life such as menstruation, pregnancy, childbirth, postpartum, menopause is detailed.
... D deficiency is very frequent in Spain, involving approximately 40% of the adult population (33). Vitamin D is necessary for intestinal calcium absorption and bone and muscle homeostasis, and can help reduce menopausal-related symptoms and improve sexual function and bone health in perimenopausal women (34). However, it should be noted that the most important source of vitamin D is sun exposure, and that only a modest quantity can be obtained from foods such as fatty fish, dairy products or eggs (35). ...
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Article
BackgroundA healthy diet when approaching menopause could prevent some of the symptoms associated with the climacteric. Few studies examine adherence to current healthy dietary recommendations in middle-aged premenopausal women. Our objective was to analyze the diet quality and the adherence to the Spanish Society of Community Nutrition (SENC) dietary recommendations in middle-aged Spanish premenopausal women, and to identify the associated sociodemographic and lifestyle factors.Methods This is a cross-sectional study based on 1251 premenopausal women, aged 39–50, who attended to Madrid City Council Medical Diagnostic Center. Women completed an epidemiological and a food frequency questionnaire. Degree of adherence to the SENC recommendations was estimated with a score that evaluated null (0 points) and full (1 point) adherence of each specific recommendation. Associations were explored using an ordinal logistic multivariable regression model.ResultsRegarding food groups, the worst adherence was found for sweets, red/processed meat, olive oil and eggs. Most of the participants exceeded the recommended caloric intake from proteins and fats, and practically all of them showed vitamin D intake deficiency. The overall score ranged from 2 to 12 (out of 15), with a median of 6.0 (interquartile range: 5.0–7.0). Former smokers (OR: 1.38; 95%CI: 1.08–1.78), as well as those with higher educational level (ORSSecondary:1.68; 95%CI: 0.97–2.93, ORUniversity:1.82; 95%IC: 1.05–3.14), with two or more children (OR: 1.31; 95%IC: 1.00-1.72), with higher caloric intake (OR>2188.2kcal/day: 8.22; 95%CI: 6.19–10.92) and with greater physical activity (OR≥21METS−h/week: 1.29; 95%CI: 0.95-1.76) showed greater adherence.Conclusions Almost two-thirds of middle-aged premenopausal participants showed low or moderate compliance with SENC recommendations. Education, smoking, parity, and physical activity were associated with the degree of adherence to these recommendations.
... In postmenopausal women, vitamin D is important in QuOL not only because of its effect on bone mineral density but also because of the increase in the risk of other diseases in its deficiency. 3 The fact that vitamin D deficiency is preventable in majority of the patients who approached the primary care creates the priority of the subject for family medicine. ...
... In females with systemic sclerosis there is a report of higher risk to associate estrogen-related conditions like low rate of fertility, premature ovarian failure, low ovarian reserve, early menopause; all of these with negative effects on vitamin D, but, also, on bone metabolism; the pathogenic elements varies from autoimmune-related anomalies, chronic inflammation, low body mass index, microvascular impairment etc. (63)(64)(65)(66)(67)(68). ...
Article
Scleroderma (systemic sclerosis) represents a challenging condition, usually requiring a multi-disciplinary team due to multi-organ involvement; it is mostly considered an autoimmune disease; the signature of the malady is the extensive fibrosis at the level of skin and multiple organs, associating endothelial/vessel damage and anomalies of immune response. We point out a few aspects concerning scleroderma-related osteoporosis. This is a literature review. Patients might associate low bone mineral density (the underling mechanisms are not entirely understood), thus an increased risk of fractures; so early recognition and treatment is mandatory for a better outcome. Some data showed that particularly vertebral fractures are prone to the condition. Almost half of individuals with the malady have osteoporosis (female prevalence, especially post-menopausal) and one third of them have an osteoporotic fracture. Older age and associated vitamin D deficiency increases the risk of fracture. Vitamin D has pleomorphic distribution, also targeting the immune modulation, cytokines puzzle, and the muscle-bone crosstalk in scleroderma. Hypovitaminosis D might be expected in these patients, while general D-supplementation has controversial benefits effects. Chronic inflammatory rheumatic conditions might benefit from the TBS use as fracture risk indicator through micro-architecture evaluation. It seems that patients with systemic sclerosis and malnutrition have lower TBS; high Dkk-1 serum levels (Dickkopf-1) is correlated with reduced TBS and advanced disease; TBS is correlated to the extent of microvascular complications; exposure to glucocorticoids (certain high-dose regimes) supplementary lowers TBS. Gastrointestinal complications are presented in 90% of patients with systemic sclerosis, involving fibrosis at any level which is a poor prognostic factor; malabsorption of nutrients and weight loss correlates with reduced bone formation while esophageal and gastric anomalies contraindicate the use of oral bisphosphonates for osteoporosis. Other abnormal elements of skeleton frame include: premature ovarian failure, serotonin system anomalies, chronic inflammation, potential side effects of immunosuppressant drugs. In patients with systemic sclerosis, the choices of medication targeting osteoporosis are limited; the use of intravenous bisphosphonates remains first line option (if renal function is adequate); the consideration of skin and esophageal anomalies is mandatory in the management of osteoporosis. Overall, the landscape of bone domain in systemic sclerosis is multi-leveled and some areas are still waiting for clear answers.
... This is consistent with the literature which suggests that the relationship between vitamin D and cognitive performance is stronger for women [1]. There are physiological interactions between the effects of vitamin D and oestrogen [22], such that the postmenopausal depletion of oestrogen may render women more vulnerable to the effects of vitamin D deficiency [46]. ...
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Article
Low vitamin D status has been linked to adverse cognitive outcomes in older adults. However, relationships at higher levels remain uncertain. We aimed to clarify patterns of association between vitamin D status and cognitive performance, using flexible regression methods, in 4872 middle- to older-aged adults (2678 females) from the Busselton Healthy Ageing Study. Cross-sectional associations of serum levels of 25-hydroxyvitamin D (25OHD) and performance in cognitive domains were modelled using linear regression and restricted cubic splines, controlling for demographic, lifestyle, and health factors. Mean ± SD serum 25OHD levels were 78 ± 24 nM/L for women and 85 ± 25 nM/L for men. Increasing levels in women were associated with better global cognition (linear trend, p = 0.023) and attention accuracy (continuity of attention), with improvement in the latter plateauing around levels of 80 nM/L (nonlinear trend, p = 0.035). In men, increasing levels of serum 25OHD were associated with better attention accuracy (linear trend, p = 0.022), but poorer semantic verbal fluency (linear trend, p = 0.025) and global cognition (nonlinear trend, p = 0.015). We identified patterns of association between serum 25OHD levels and cognitive performance that may reflect early dose–response relationships, particularly in women. Longitudinal analyses extending through to older ages may help to clarify the nature, strength, and temporality of these relationships.
... This study sought to evaluate potentially influential factors in serum levels of vitamin D 3 , 25(OH)D 3 , 1,25(OH) 2 D 3 , 24,25(OH) 2 D 3 , and the four VMRs directly connected by a substrate/product relationship (25(OH)D 3 /VitD 3 , 1,25(OH) 2 D 3 /25(OH)D 3 , 24,25(OH) 2 D 3 / 25(OH)D 3 , and 24,25(OH) 2 D 3 /1,25(OH) 2 D 3 ) in middle-aged women close to menopause, a period with higher risk of developing vitamin D deficiency [18]. The knowledge of the vitamin D status and its metabolism in this group of women, as well as the sociodemographic factors and lifestyles that are associated, is of great interest to prevent or mitigate bone loss and other conditions related to both menopause and vitamin D deficiency. ...
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The most representative indicator of vitamin D status in clinical practice is 25(OH)D3, but new biomarkers could improve the assessment of vitamin D status and metabolism. The objective of this study is to investigate the association of serum vitamin D metabolites and vitamin D metabolite ratios (VMRs) with potentially influential factors in premenopausal women. This is a cross-sectional study based on 1422 women, aged 39–50, recruited from a Madrid Medical Diagnostic Center. Participants answered an epidemiological and a food frequency questionnaire. Serum vitamin D metabolites were determined using an SPE–LC–MS/MS platform. The association between participant’s characteristics, vitamin D metabolites, and VMRs was quantified by multiple linear regression models. Mean 25(OH)D3 concentration was 49.2 + 18.9 nmol/L, with greater deficits among obese, nulliparous, dark-skinned women, and with less sun exposure. A lower R2 ratio (1,25(OH)2D3/25(OH)D3) and a higher R4 (24,25(OH)2D3/1,25(OH)2D3) were observed in nulliparous women, with high sun exposure, and those with low caloric intake or high consumption of calcium, vitamin D supplements, or alcohol. Nulliparous women had lower R1 (25(OH)D3/Vit D3) and R3 (24,25(OH)2D3/25(OH)D3), and older women showed lower R3 and R4. Vitamin D status modified the association of the VMRs with seasons. VMRs can be complementary indicators of vitamin D status and its endogenous metabolism, and reveal the influence of certain individual characteristics on the expression of hydroxylase enzymes.
... 13,14 In the presence of normal serum calcium concentrations, PTH promotes bone metabolism homeostasis through bone demineralization while at the same time increasing calcium concentrations in the blood and maintaining a balance between calcium and phosphorus concentrations. 13,15 The fortification of foods with vitamin D alone or in combination with calcium has been used as a dietary strategy to promote bone homeostasis 16 and reduce the risk of bone fractures in postmenopausal women. 17,18 Overall, this strategy is used to control micronutrient deficiency. ...
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Context Foods containing vitamin D reduce the deficiency of this vitamin and improve bone turnover. Objective To discuss effects of the intake of vitamin D–fortified foods in isolated form or associated with calcium on bone remodeling in postmenopausal women. Data Sources PubMed, Lilacs, Scopus, and Bireme databases. OpenThesis and Google Scholar were searched as “grey literature”. Medical subject headings or similar terms related to food fortified with vitamin D and bone in postmenopausal women were used. Data Extraction Information was collected on study methodology and characteristics of studied populations; dosage; the food matrix used as the fortification vehicle; duration of intervention; dietary intake; 25-hydroxyvitamin D [25(OH)D] levels; serum parathyroid hormone (PTH) concentrations; bone resorption and/or formation markers (ie, carboxy terminal cross-linked telopeptide of type I collagen [CTX], tartrate-resistant acid phosphatase isoform 5b [TRAP5b], and procollagen type 1 N-terminal propeptide [P1NP]); main results; and study limitations. Data Analysis Five randomized controlled trials involving postmenopausal women were included. The mean ages of participants ranged from 56.1 to 86.9 years. Daily consumption of soft plain cheese fortified with 2.5 µg of vitamin D3 and 302 mg of calcium for 4 weeks resulted in a mean increase of 0.8 ng/mL in 25(OH)D and 15.9 ng/mL in P1NP levels compared with baseline, and decreased CTX, TRAP5b, and PTH values. A similar intervention for 6 weeks, using fortified cheese, showed a reduction only in TRAP5b values (−0.64 U/L). Yogurt fortified with 10 µg of vitamin D3 and 800 mg of calcium did not change P1NP values after 8 weeks of intervention, but was associated with decreases of 0.0286 ng/mL and 1.06 U/L in PTH and TRAP5b, respectively. After 12 weeks of eating the fortified yogurt, 25(OH)D levels increased by a mean of 8.8 ng/mL and PTH levels decreased in by a mean of 0.0167 ng/mL. Conclusions The interventions contributed toward the improvement of the bone resorption process but not to the bone formation process in postmenopausal women. PROSPERO registration number CRD42019131976.
... For the diagnosis of vitamin D insufficiency, 30 ng /ml value is used as the cut-off value of serum 25-OH vitamin D level (36). In another study, it was revealed that the serum 25-OH vitamin D level should be below 20 ng/mL in order to meet vitamin D deficiency (37). Vitamin D deficiency is a common finding accompanying obesity, increasing age, and unhealthy lifestyle. ...
... During menopause, the decline of oestrogens results in increased bone turnover, a decrease in bone mineral density, and an elevated fracture risk. Therefore, calcium and vitamin D must be integrated since sun exposure is not enough and its presence in food is low [8,9]. Vitamin D has extraskeletal effects, including metabolic properties, regulation of cell proliferation, skin differentiation, reproduction, and vascular, muscle, and immune system function [1]. ...
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Vitamin D is necessary for normal bone development and conservation. Moreover, it has extraskeletal effects, which play a pivotal role as a modulator of innate and adaptive immune responses. Many studies have highlighted the beneficial effect of vitamin D in protecting against acute respiratory viral infection, including COVID-19. Within this context, we described the effect of vitamin D supplementation in the immunological response to SARS-CoV-2 infection. Long-term IgG SARS-CoV-2 antibody responses were assessed in a cohort of twenty-two subjects diagnosed with COVID-19 by chemiluminescence assay (CLIA). Among them, a 61-year-old nurse undergoing vitamin D therapy showed a positive IgG response against SARS-CoV-2 nucleocapsid over nine months after infection, suggesting vitamin D played a role in modulating early antibody response against SARS-CoV-2. This result provides evidence of a positive effect of vitamin D on the decrease of functional humoral immunity.
... In this study, an association was clear between vitamin D deficiency and different types of cancer. High percentage of gastrointestinal tract cancer patients have vitamin D deficiency (OR 3.41, 95% CI 1.4 to 8.25) which is consistent with several studies established this point 19) . Several studies have stated that vitamin D deficiency is a risk sign of developing breast cancer, and another study have stated that most of their study group were vitamin D deficient which is consistent to our findings (OR 3.51, 95% CI 1.85 to 6.7) 5,8,20) . ...
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Background Vitamin D roles in human health and wellbeing have been extensively studied in recent years. It has essential roles in homeostasis and maintaining many physiological functions. These roles are vital in the immune system, respiratory system, cardiovascular system, and reproductive system. Deficiency in this vitamin has been correlated with many diseases in the body, and it has been correlated with developing cancer. Objective This study aimed to investigate levels of total vitamin D (25-hydroxycholecalciferol) in cancer patients. Design Retrospective. Settings: Taif city- King Faisal Hospital (KFH) Patients and methods: serum levels of 25-hydroxycholecalciferol were classified into normal, insufficient, and deficiency group, patients were grouped according to these classes.156 patients were included in this study, 128 females and 28 males, 100 healthy participants were included. Cancer patients were as follows, gastrointest tumors patients were 27, breast cancer patients were 73, female genital tract patients were 43, head and neck cancer patients were 6 and respiratory tract patients were 7. Sample size: 256 participants were 100 healthy controls and 156 cancer patients Results Deficiency was detected in most of the patients from both genders and in both pre- and post-menopausal female patients.
... Vitamin D is one of the essential substances in metabolic and physiological processes in the body [19]. Recent literature has reported the role of low level of vitamin D in many pathological conditions including cardiovascular disease, type 2 diabetes mellitus, metabolic syndrome, cancer, and increased mortality, as well as its role in calcium and bone metabolism [20]. Recent research has also shown that vitamin D3 may be useful in preventing vaginal atrophy. ...
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Background: Menopause is associated with changes in sexual function which are partly due to vaginal atrophy in response to estrogen reduction. Estrogen administration temporarily reduces the symptoms of vaginal dryness, but long-term exposure to this drug is likely to be associated with serious complications. Considering the promising results of previous studies concerning the effect of vitamin D on vaginal dryness, the proposed study will investigate the effect of vitamin D vaginal suppository on the sexual function of postmenopausal women. Methods: In a randomized, controlled clinical trial, 105 postmenopausal women will be randomly assigned to three groups receiving vitamin D vaginal suppository, placebo vaginal suppository, or control (no intervention). Vitamin D vaginal suppositories contain 1000 units of vitamin D3. The timing of the use of vitamin D vaginal suppositories and placebo suppositories will be every night in the first 2 weeks, and every other night in the following 6 weeks (8 weeks in total). The primary outcome will be the sexual function of participants which will be assessed using the Female Sexual Function Index (FSFI) before and immediately after the intervention, and at 1 and 2 months after the end of the intervention. The side effects of these suppositories will be examined as a secondary consequence of the study. Data will be analyzed using SPSS software version 25. In the case of normal distribution of data, the mean score of sexual function will be compared between the groups using a repeated measurements ANOVA. If statistical analysis leads to significant results, the post-hoc test will be used to determine the differences between the groups. Comparison of demographic and fertility characteristics of the women will be carried out using statistical tests such as chi-squares and t-tests. A significance level of p < .05 will be used for statistical analyses. Discussion: If vitamin D vaginal suppositories improve sexual function among premenopausal women with long-term effects and minimum side effects, the suppositories will be considered a safe complementary and alternative choice for alleviating sexual dysfunction among this group. Trial registration: IRCT20180704040346N1 at 2018-10-13 prospectively registered.
... Vitamin D deficiency has been associated with several metabolic and cardiovascular abnormalities, including hypertension, diabetes mellitus, metabolic syndrome, obesity, vascular inflammation, left ventricular hypertrophy and congestive heart failure (6)(7)(8). During menopause, women may be particularly susceptible to the consequences of vitamin D deficiency since in this period of life oestrogen decreases, resulting in decreased bone mineral density (BMD) and lean mass, increased fat mass, and an increased risk of metabolic syndrome (MS) and cardiovascular morbidities (9)(10)(11)(12). According to the International Diabetes Federation (IDF), the diagnosis of MS requires the presence of abdominal obesity associated with two of the following criteria: arterial hypertension, hypertriglyceridemia, reduced HDL-cholesterol, and elevated fasting glycaemia (13). ...
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Objective We investigated changes in body composition and nutritional and metabolic parameters in a group of postmenopausal women who were classified as sufficient, insufficient and deficient in vitamin D. Subjects and methods A total of 106 postmenopausal women were included in this cross-sectional study and classified according to their serum levels of 25-OH-vitamin D as sufficient (≥ 30 ng/mL; group S), insufficient (20.1 and 29.9 ng/mL; group I) or deficient (≤ 20 ng/mL; group D) in vitamin D. Body composition was measured by dual-energy X-ray absorptiometry (DXA); dietary recall questionnaires were completed; and blood samples were analysed to compare the metabolic and nutritional status of the study groups. Results Eleven (10.4%) of the women were classified in group S, 50 (47.2%) in group I and 45 (42.4%) in group D, with a mean serum level for 25-OH-D of 21.1 ± 7.0 ng/mL in all participants. Body composition did not differ among the groups. Serum levels of 25-OH-D were negatively correlated with serum levels of triglycerides, total cholesterol and LDL cholesterol. Conclusions Vitamin D insufficiency and deficiency were highly prevalent in our group of postmenopausal women, showing an association with an unfavourable lipid profile.
... Whether vitamin D may be an elisir able to improve quality of life remain an unsolved question, since available evidence are inconsistent (Callegari et al., 2017). Data from a cross-sectional analysis of the Iowa Women's Health Study showed that women who consumed at least 400 IU/day of vitamin D showed slightly higher mental health related QoL scores compared to women who consumed less than 400 UI/day ( Motsinger et al., 2012;Michelle et al., 2015;Lerchbaum, 2014 Although the key role of vitamin D in human biology and pathophysiology, whether quality of life may depend directly from vitamin D status was not supported from our study and we hypotized that a poorer quality of life observed in subjects with lower vitamin D levels may merely be the indirect manifestation of a poorer health status. ...
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Quality of life (QoL) represents a dramatic issue in an aging population. Vitamin D has been consistently associated with several diseases. Thus, vitamin D may be considered a hallmark of health status. Our aim was to investigate whether vitamin D could be a determinant of self-perceived quality of life. The 36-Item Short Form Health Survey (SF-36) for quality of life, the Hamilton Anxiety Rating Scale (HAM-A), the Beck Depression Inventory II edition (BDI-2 MARTINO et al. II), in addition with multiple clinical risk factors for fractures and FRAX score, BMD at lumbar spine and femoral neck, were evaluated in a group of 177 postmenopausal women referring to an outpatients clinic for the prevention of osteoporosis. Serum levels of vitamin D [25(OH)D], indicative of vitamin D status, were detected by high-performance liquid chromatography. Scores of each dimension of the SF-36 were significantly related with the measurements of anxiety and depression by HAM-A and BDI-II respectively. Moreover role emotional, vitality, general health and bodily pain were significantly associated with vitamin D status. However, at a stepwise multiple regression analysis the physical component summary, obtained from SF-36, was not independently predicted from vitamin D. In conclusion we found an association between vitamin D status and QoL, thus we suggest physicians to consider vitamin D levels as a marker of QoL. Further studies testing the impact of vitamin D administration in improving QoL over time are needed.
... [12][13][14] However, given the complex interplay between bone metabolism, vitamin D deficiency, metabolic syndrome, and osteoporosis, there are likely multiple interactions contributing to pseudarthrosis. [15][16][17][18][19][20] The added value in identifying and treating metabolic disorders in these patients extends well beyond improving their surgical outcome, but provides a comprehensive evaluation for conditions like osteoporosis and vitamin D deficiency, and measures for fracture risk reduction. 21,22 The aims of this study were to (1) report 1-year patient-reported outcomes (PRO's) in patients undergoing revision surgery for symptomatic pseudarthrosis, (2) describe preexisting metabolic and endocrine disorders in this subgroup, and (3) in patients referred for endocrinology evaluation, identify any new endocrine and metabolic diagnoses and treatments initiated specifically through this referral. ...
Article
Study design: Retrospective Cohort. Objective: Establish 1-year patient-reported outcomes after spine surgery for symptomatic pseudarthrosis compared with other indications. In the subgroup of pseudarthrosis patients, describe preexisting metabolic and endocrine-related disorders, and identify any new diagnoses or treatments initiated by an endocrine specialist. Summary of background: Despite surgical advances in recent decades, pseudarthrosis remains among the most common complications and indications for revision after fusion spine surgery. A better understanding of the outcomes after revision surgery for pseudarthrosis and risk factors for pseudarthrosis are needed. Methods: Using data from our institutional spine registry, we retrospectively reviewed patients undergoing elective spine surgery between October 2010 and November 2016. Patients were stratified by surgical indication (pseudarthrosis vs. not pseudarthrosis), and 1-year outcomes for satisfaction, disability, quality of life, and pain were compared. In a descriptive subgroup analysis of pseudarthrosis patients, we identified preexisting endocrine-related disorders, frequency of endocrinology referral, and any new diagnoses and treatments initiated through the referral. Results: Of 2721 patients included, 169 patients underwent surgery for pseudarthrosis. No significant difference was found in 1-year satisfaction between pseudarthrosis and nonpseudarthrosis groups (77.5% vs. 83.6%, respectively). A preexisting endocrine-related disorder was identified in 82% of pseudarthrosis patients. Endocrinology referral resulted in a new diagnosis or treatment modification in 58 of 59 patients referred. The most common diagnoses identified included osteoporosis, vitamin D deficiency, diabetes, hyperlipidemia, sex-hormone deficiency, and hypothyroidism. The most common treatments initiated through endocrinology were anabolic agents (teriparatide and abaloparatide), calcium, and vitamin D supplementation. Conclusions: Patients undergoing revision spine surgery for pseudarthrosis had similar 1-year satisfaction rates to other surgical indications. In conjunction with a bone metabolic specialist, our descriptive analysis of endocrine-related disorders among patients with a pseudarthrosis can guide protocols for workup, indications for endocrine referral, and guide prospective studies in this field.
... Interestingly, vitamin D supplementation decreases body fat mass without any change in body weight or waist circumference [222]. Further, physical activity and thus sun exposure, which is essential for vitamin D production in the skin [223], decline during menopause [224]. ...
Book
Vitamin D is one of the steroid hormones. The precursor of vitamin D, 7-dehydrocholesterol, which is an intermediary for cholesterol pathway, is available in the skin. Ultraviolet B (UVB) radiation makes the transformation of 7-dehydrocholesterol to provitamin D3, which automatically isomerizes to cholecalciferol (vitamin D3). Vitamin D3 is secreted into blood circulation and carried by the vitamin D–binding protein (VDBP). Around 80–90% of vitamin D is from sunlight-derived production in the skin. A little amount of vitamin D in the human body is also extracted from foods and/or additional supplementation. This may be extracted from foods with ergocalciferol (vitamin D2) or fatty fish containing this vitamin. Vitamin D has been well known for its function in maintaining calcium and phosphorus homeostasis and promoting bone mineralization. Accumulating evidence from animal and human studies suggests that in addition to sex steroid hormones, the classic regulators of human reproduction, vitamin D also modulates reproductive processes in women and men and is involved in many functions of the reproductive system. Vitamin D receptor (VDR) and vitamin D–metabolizing enzymes are found in reproductive tissues of women and men. This chapter presents an up-to-date review for describing the function of vitamin D in female reproduction throughout reproductive ages from menarche to menopause, during pregnancy and lactation, and some disorders affecting women and also the role of vitamin D applied to male fertility.
... The lack of a similar response in women suggests a role for female sex hormones in vitamin D regulation. In particular, oestrogens negatively influence vitamin D homeostasis in post-menopausal women and remain unaffected by CPAP treatment [76,77]. ...
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Obstructive sleep apnoea syndrome (OSAS) is a common disorder of multifactorial pathogenesis and is associated with obesity, diabetes and cardiovascular disease. Vitamin D is a fat-soluble vitamin with an important function in calcium absorption and homeostasis, which is also implicated in several nonskeletal conditions. The prevalence of vitamin D deficiency is increasing worldwide and is associated with similar metabolic disturbances to OSAS. Moreover, recent data suggest that in OSAS patients serum levels of vitamin D are lower compared with non-apnoeic subjects. However, the mechanisms linking vitamin D deficiency and OSAS are not completely understood and several hypotheses have been advanced. To date, a limited number of studies have assessed the association between lower serum concentrations of vitamin D and OSAS, and have reported inconsistent results. Similarly, contradictory results have been produced by studies which evaluated the effect of continuous positive airway pressure treatment on serum vitamin D levels. The aim of this review is to summarise current knowledge on the association between OSAS and vitamin D levels. Key points: Vitamin D insufficiency prevalence is increasing worldwide and presents with similar comorbidities and risk factors to OSAS.The nonskeletal actions of vitamin D may contribute to the development of OSAS through immune system modulation, myopathy and inflammation.Studies evaluating serum vitamin D concentrations in OSAS patients and the effect of CPAP treatment report contradictory results, often influenced by confounding factors, such as obesity.There appears to be potential for use of vitamin D supplementation in OSAS patients as a means of reducing the incidence of cardiovascular disease, a comorbidity common in both conditions. Educational aims: To assess the potential association between OSAS and serum levels of vitamin D.To discuss the pathogenetic mechanisms linking OSAS and vitamin D insufficiency.To illustrate the effect of CPAP treatment on vitamin D concentration in OSAS patients.
... Perhaps it could be more effective than the traditional approach in patients with the most severe symptoms, such as in obese African-Americans with vitamin D deficiency. It could also be treated as a type of add-back therapy during gonadotropin releasing hormone (GnRH) analog treatment [148], such as to prevent bone loss [149] or negative effect on mood or cognition [150] caused by estrogen deficiency. Similar studies performed on other substances such as GnRH analogs, for example, leuprolide, goserelin, elagolix or relugolix, might constitute the next step. ...
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This article provides a detailed review of current knowledge on the role of vitamin D and its receptor in the biology and management of uterine fibroids (UFs). Authors present ideas for future steps in this area. A literature search was conducted in PubMed using the following key words: "uterine fibroid" and "vitamin D". The results of the available studies, published in English from January 2002 up to April 2018, have been discussed. Vitamin D is a group of steroid compounds with a powerful impact on many parts of the human body. This vitamin is believed to regulate cell proliferation and differentiation, inhibit angiogenesis, and stimulate apoptosis. Nowadays, hypovitaminosis D is believed to be a major risk factor in the development of UFs. In many studies vitamin D appears to be a powerful factor against UFs, resulting in inhibition of tumor cell division and a significant reduction in its size, however, the exact role of this compound and its receptor in the pathophysiology of UFs is not fully understood. According to available studies, vitamin D and its analogs seem to be promising, effective, and low-cost compounds in the management of UFs and their clinical symptoms, and the anti-tumor activities of vitamin D play an important role in UF biology. The synergy between vitamin D and selected anti-UF drugs is a very interesting issue which requires further research. Further studies about the biological effect of vitamin D on UF biology are essential. Vitamin D preparations (alone or as a co-drugs) could become new tools in the fight with UFs, with the additional beneficial pleiotropic effect.
... Most obese individuals in our study were postmenopausal women. During menopause a decline in estrogens affects numerous metabolic processes such as changes in body composition [71]. LeBlanc et al. [72] suggested that low vitamin D may be a predisposition for fat accumulation as higher vitamin D levels have been found to be associated with a lower gain in weight. ...
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Background: Depression and obesity are widespread and closely linked. Brain-derived neurotrophic factor (BDNF) and vitamin D are both assumed to be associated with depression and obesity. Little is known about the interplay between vitamin D and BDNF. We explored the putative associations and interactions between serum BDNF and vitamin D levels with depressive symptoms and abdominal obesity in a large population-based cohort. Methods: Data were obtained from the population-based Study of Health in Pomerania (SHIP)-Trend (n = 3,926). The associations of serum BDNF and vitamin D levels with depressive symptoms (measured using the Patient Health Questionnaire) were assessed with binary and multinomial logistic regression models. The associations of serum BDNF and vitamin D levels with obesity (measured by the waist-to-hip ratio [WHR]) were assessed with binary logistic and linear regression models with restricted cubic splines. Results: Logistic regression models revealed inverse associations of vitamin D with depression (OR = 0.966; 95% CI 0.951-0.981) and obesity (OR = 0.976; 95% CI 0.967-0.985). No linear association of serum BDNF with depression or obesity was found. However, linear regression models revealed a U-shaped association of BDNF with WHR (p < 0.001). Conclusion: Vitamin D was inversely associated with depression and obesity. BDNF was associated with abdominal obesity, but not with depression. At the population level, our results support the relevant roles of vitamin D and BDNF in mental and physical health-related outcomes.
... Las investigaciones han demostrado que el proceso de la menopausia está asociado con factores que inciden en el aumento del acúmulo de grasa corporal subcutánea y visceral, dado que los estrógenos inciden significativamente en la lipolisis y lipogénesis en los adipocitos viscerales; al disminuirse los niveles circulantes de estrógenos esta regulación decrece y se puede dar el fenómeno de aumento del índice de masa corporal (IMC), que finalmente se traducirá como sobrepeso u obesidad. La obesidad, en este grupo de riesgo, ha sido asociada con bajos niveles de vitamina D en mujeres postmenopáusicas, aunque persiste el debate dado que se plantea una relación causal contraria, es decir que es la hipovitaminosis la que conduce al incremento en el IMC 48 . ...
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Objective. Systematize, describe and analyze literature published since 2007, in which it is reported, the prevalence of low serum levels of vitamin D, either as deficit or insufficiency, in postmenopausal women. Materials and methods. Systematic evaluation process for which searches were ahead in PubMed, Scholar Google and Science Direct and Scholar Google data, according to keywords defined in the design of subsequent publications to 2006. Results. were found 34 structured studies, four of them developed in Colombia, that reported prevalence of inadequate serum levels of vitamin D ranging from 32,2% to 95% approximately. It was estimated an overall prevalence of 71,28% in postmenopausal women. Conclusion. The high prevalence leads to consider the deficit and insufficient vitamin D as a serious public health problem that invites to the definition of intervention measures including regulated and controlled exposure to sunlight, in addition to the therapeutic supplementation. KEYWORDS: Vitamin D, Post menopause, Osteoporosis. (DeCS)
... Sequedad vaginal, el descenso de estrógenos durante esta etapa genera que el epitelio vaginal se adelgace, produciendo disminución de la capacidad de lubricación y dispareunia, además de afectar la transmisión de los impulsos nerviosos al clítoris y vagina, reduciendo el deseo sexual en la mujer (20)(21)(22). ...
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Menopause is a hormonal transition associated to ovarian senescence, usually presenting between 45 and 59 years after a progressive decrease in the reproductive capacity until termination, the menopause is marked by the absence of menstrual periods after 12 consecutive months. It is characterized by a broad clinical profile, including hot flashes (flushing), dyspareunia, sleep disorders, among others. Despite much research there is no clear evidence about a treatment which overcome the effectiveness of hormone replacement therapy (HRT). A field that has become the target of current research is the genetic polymorphisms and their relation to changes in the presentation of the different conditions associated with menopause such as cardiovascular risk, osteoporosis and breast cancer.
... [5] and higher PTH [6,7] concentrations. Further, in older women, better cardiorespiratory fitness is associated with higher 25(OH)D concentrations [8], indicating that an ageassociated decline in cardiorespiratory fitness may be related to concomitant decreases in 25(OH)D.Approximately 18% of women will be diagnosed with gestational diabetes mellitus (GDM) during their pregnancy [9]. ...
Article
The purpose of this study was to compare plasma 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH), VO2max, bone (by DXA), and metabolic outcomes across age and race-matched postmenopausal women (54±1 years; mean±SEM): 1) with previous gestational diabetes (GDM) (32±1 kg/m2; n=17), 2) without previous GDM, but with a similar BMI to GDM (32±1 kg/m2; n=17), and 3) without previous GDM, but with a higher BMI than GDM (36±1 kg/m2; n=17; p<0.01). The prevalence of 25(OH)D insufficiency and deficiency was high (~80%), but not different across groups, while PTH tended to be ~30% lower in women with a history of GDM (p=0.09). Women with a history of GDM had lower HDL cholesterol and higher diastolic blood pressure and fasting and 2-h glucose levels (by oral glucose tolerance test) (vs. groups 2 and 3; p<0.05). Bone mineral density (BMD) tended to be slightly higher in women with prior GDM than the BMI matched women with no prior GDM (p=0.09). Overall, higher PTH was associated with lower femoral neck (r=- 0.33) and (r=- 0.38) (p <0.05), while lower 25(OH)D was associated with lower VO2max (r=0.25, p=0.05) and higher fasting glucose (r=- 0.14) and insulin (r=- 0.29 (p <0.05). We observed that the poor metabolic profiles of postmenopausal women with a history of GDM are independent of 25(OH)D and PTH. However, due to associations between 25(OH)D and PTH with bone and metabolic outcomes, maintaining recommended 25(OH)D and PTH concentrations is important regardless of a previous history of GDM. © Georg Thieme Verlag KG Stuttgart · New York.
... 2 Indeed, estrogens negatively influence vitamin D homeostasis, particularly in postmenopausal women. 5 In our study female OSA-R group was prevalently constituted by postmenopausal women, since OSA is more frequent in those patients. 6 Moreover, female OSA-R group did not count patients taking exogenous estrogens therapy. ...
... Although we controlled our analyses for age, it has been suggested that age is an independent predictor of vitamin D levels in women but not in men [36]. Previous studies have found differences in vitamin D levels among pre-and postmenopausal women [38][39][40]. Interestingly, the menopause onset varies within females [41][42][43] and this may be altering our results, but we did not collect such information. ...
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Background: Vitamin D deficiency is a public health problem around the world. Diabetes has been associated with vitamin D deficiency. We aimed to examine the association between the vitamin D status and diabetes in a clinic based sample of Hispanic adults in Puerto Rico. Methods: Demographics and laboratory test results for serum 25(OH)D, Fasting Blood Glucose (FBG), and Haemoglobin A1C (HbAlc) were extracted from medical records. Vitamin D status was classified as deficient (<12 ng/ml); inadequate (12-20 ng/ml); insufficient (21-29 ng/ml) and optimal (?30 ng/ml) using serum 25(OH)D levels. Results: A total of 716 records were included in the analyses. Most were females (63.3%), with mean age of 54.1?14.9 y, mean BMI 30.1?6.3 kg/m2 and mean serum 25(OH)D levels of 24.3?8.6 ng/ml. Most were classified as diabetics (41.1%). Those with diabetes had lower 25(OH)D levels compared to pre-diabetic and normal glucose status (p<0.05). Serum 25(OH) D levels were inversely correlated to FBG and HbA1c in the total sample and in men (p<0.05). After adjusting for age, gender, BMI and seasonality, there was a greater risk of diabetes, but not prediabetes, in those with serum 25(OH)D levels <30 ng/ml. This risk increased from 1.8 times in those with vitamin D insufficiency to 4.2 times in those with vitamin D deficiency (<12 ng/ml). Conclusion: Diabetes risk significantly increased as serum 25(OH)D levels decreased in this group of Hispanic adults, underscoring the importance of routinely screening high risk individuals for vitamin D deficiency and offer supplementation to normalize serum levels.
... Although we controlled our analyses for age, it has been suggested that age is an independent predictor of vitamin D levels in women but not in men [36]. Previous studies have found differences in vitamin D levels among pre-and postmenopausal women [38][39][40]. Interestingly, the menopause onset varies within females [41][42][43] and this may be altering our results, but we did not collect such information. ...
... It prevents bone loss and reduces the risk of fractures (Zhao et al. 2013;Lee et al. 2013;Whedon 1981). Estrogen also improves calcium absorption in the intestinal tract and reduces the loss of calcium through urine (Terauchi 2011;Heaney et al. 1987), raises the active form of D vitamin, stimulates the circulation and production of calcitonin, which prevents the removal of calcium from bone (Lerchbaum 2014;Simonelli et al. 2005;Richart and Lindsay 1984). Therefore, the aim of this study was to examine the effects of estrogen and phenol red depletion on the proliferation, differentiation, and toxicity of mesenchymal stromal cells differentiated into osteoblasts to obtain an effective interference free culture medium for in vitro studies, focused on non-previously studied ER. ...
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Article
To design an estrogen and phenol red free medium for cell culture and check its effectiveness and safety on osteoblast growth it is necessary to maintain the estrogen receptors free for tests. For this purpose, we tested some modifications of the traditional culture media: estrogen depleted fetal bovine serum; estrogen charcoal stripped fetal bovine serum and phenol red free α-MEM. The aim of this work is to examine the effects of its depletion in the proliferation, differentiation, and toxicity of mesenchymal stromal cells differentiated into osteoblasts to obtain an effective interference free culture medium for in vitro studies, focused on non-previously studied estrogen receptors. We performed viability tests using the following techniques: MTT, alkaline phosphatase specific activity, formation of mineralized matrix by Alizarin technique and analysis of SEM/EDX of mineralized nodules. The results showed that the culture media with estrogen free α-MEM + phenol red free α-MEM did not impact viability, alkaline phosphatase activity and mineralization of the osteoblasts culture compared to control. In addition, its nodules possess Ca/P ratio similar to hydroxyapatite nodules on the 14th and 21st day. In conclusion, the modified culture medium with phenol red free α-MEM with estrogen depleted fetal bovine serum can be safely used in experiments where the estrogen receptors need to be free.
... Hypovitaminosis D is also associated with cardiovascular disease, metabolic syndrome, diabetes mellitus type 2, various malignancies, increased mortality, depression, impaired cognitive function, personality traits and a deterioration of general health and well-being [3][4][5]. Therefore, optimum levels of serum calcium and vitamin D should be maintained [6]. However, in India, vitamin D deficiency is highly prevalent in asymptomatic women from different socioeconomic groups [7]. ...
Article
Objective To assess the effects of tibolone on serum calcium and vitamin D3 levels, the effects on health-related quality of life (HRQOL), and the relationship between these variables. Methods An open-label, prospective, parallel-arm study was conducted at S.C. Das Memorial Medical and Research Center, Kolkata, India, between July 2012, and June 2013. Women aged 34–55 years were eligible when they were experiencing surgical menopause and were symptomatic. Group A comprised patients who chose to receive tibolone (2.5 mg daily for 6 months) and group B comprised those who refused treatment. At baseline and 6 months, body mass index (BMI), serum calcium and vitamin D3 levels and HRQOL were assessed. Results Of 79 participants, 53 were in group A and 26 in group B. After 6 months, BMI had increased significantly in both groups. The vitamin D3 level had increased significantly from baseline in group A (P= 0.02), and was higher than that in group B (P= 0.01). HRQOL had also improved significantly from baseline in group A (P= 0.001), and was significantly better than that in group B (P< 0.001). In group A, a significant correlation was found between HRQOL improvement and vitamin D3 levels (P< 0.001). Conclusion Tibolone significantly increases the serum vitamin D3 level and improves HRQOL in menopausal women. Clinical Trial Registry India: CTRI/2012/06/002752.
Article
Introduction. Vitamin D is intensively studied during the last years. The most useful instrument to assess the vitamin D status is serum 25-hydroxy vitamin D (25-OH D). Material and method. This is a cross sectional study in menopausal women, between 2008 and 2013 with inclusion criteria: at least 1 year since menopause, age between 40 and 80 years; exclusion criteria: specific therapy for osteoporosis, previous diagnosis of osteomalacia and rickets, primary hyperparathyroidism. Results. 471 subjects were: group 1 with osteopenia and osteoporosis (N = 328) and group 2 with normal DXA (N = 143) which were statistically significant (SS) different regarding the age, body mass index (BMI), years since menopause, bone markers osteocalcin and CrossLaps, with no SS differences between 25-OH D. In group 1: the linear regression coefficient (r) between alkaline phosphatase and 25-OH D was -0.14 (p = 0.01). In group 2: the BMI distribution showed: normal weighted subjects (BMI ≤ 24.9 kg/m2, N = 22, 15%, av. 25-OH D = 19.69 ng/mL), overweighed females (BMI = 25-29.9 kg/m2, N = 56, 39%, av. 25-OH D = 15.11 ng/mL ), obese (BMI ≥ 30 kg/m2, N = 65, 46%, av. 25-OH D = 12.11 ng/mL), with SS differences between any 2 subgroups. 25-OH D is not SS different between the subgroups based on decades of years since menopause, regardless the DXA score. Conclusion. Based on our observations, a prevalent low level of vitamin D is registered in menopausal women regardless they have or not osteoporosis and in women with normal DXA the vitamin D level is lower in obsesses versus normal or overweighed patients.
Article
Cardiovascular disease (CVD) is a major cause of global mortality [1]. Similarly, the frequency of vitamin D (VD) deficiency is increasing and a number of epidemiological and clinical studies have suggested that there is an increased risk of CVD among people with depletion of this vitamin [2]. This is no different in postmenopausal women (PMW), observational studies have shown that low levels of VD are linked to cardiovascular risk factors as well as to cardiovascular events [3,4]. Despite a possible relationship between VD and cardiovascular protection PMW studies are few and inconclusive. A study evaluating 478 Korean PMW, reported that low serum VD were significantly associated with the presence of metabolic syndrome and metabolic components, especially hypertriglyceridemia and hypertension [5]. Chon., et al. evaluating 4,364 PMW, from Korean NHANES data from 2008-2010, and did not observe a significant association between serum levels of VD and the prevalence of metabolic syndrome. However, women in the highest percentile VD concentration showed lower prevalence of hypertension, hypertriglyceridemia and reduced HDL, compared with those of lower percentile [6]. In a randomized, double-blind, placebo-controlled clinical study with 160 PMWs, with isolated daily supplementation with VD for 9 months in younger PMW was associated with a reduction in inflammatory markers. The authors hypothesis is that VD supplementation may reduce circulating immune-inflammatory markers suggesting a role as anti-inflammatory therapy treatment of cardiometabolic diseases [7]. In other randomized controlled study, the authors suggesting VD supplementation in combination with weight-loss of at least 5% of baseline weight was associated with significant reductions in levels of biomarkers [8]. A review with one hundred six articles, including 18 double-blind, placebo-controlled, randomized clinical trials, observed an association between low VD status and increased blood pressure, endothelial and renal dysfunction; however, the authors report that clinical trials have inconsistent findings, like the differences in features of participants, their adherence to the supplements, study duration, various dosage regimes, the concomitant calcium intake [9]. Although there are countless studies of observational data and a variety of confounding variables strengthening the cardioprotective effect of VD, this effect is uncertain and recommends caution with excessive VD supplementation in treatment of cardiometabolic disease [9]. Bibliography 1. A Nitsa., et al. "Vitamin D in Cardiovascular Disease". In Vivo 32.5 (2018): 977-981. 2. CG Mihos., et al. "Vitamin D Deficiency and Supplementation in Cardiovascular Disorders". Cardiology in Review 25.4 (2017): 189-196. 3. P Pludowski., et al. "Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-A review of recent evidence". Autoimmunity Reviews 12.10 (2013): 976-989. 4. E Lerchbaum. "Vitamin D and menopause-A narrative review". Maturitas 79.1 (2014): 3-7. 5. HR Song and CH Park. "Low serum vitamin D level is associated with high risk of metabolic syndrome in post-menopausal women". Journal of Endocrinological Investigation 36.10 (2013): 791-796.
Conference Paper
Estradiol decreases in postmenopausal women cause several changes in the physical, physiological, and psychological aspects. Consequently, various complaints emerged and affected women's quality of life (QoL). Vitamin D [25(OH)D] is an alternative to relieve menopausal complaints. This study aimed to examine the relationship between estradiol, 25(OH)D, and the QoL among postmenopausal women. This study applied a descriptive-analytic and consecutive sampling technique. The inclusion criteria were postmenopausal and physiological menopause women who were willing to participate in this study. The exclusion criteria were postmenopausal women with severe illness and under steroid treatments. ELISA, ECLIA, and MENQOL were used to examine 25(OH)D, estradiol, and QoL, respectively. The data were analyzed using SPSS version 23.0. The results showed thirty-nine postmenopausal women participated in this study. The average estradiol level was 5.68 pg/mL (SD ± 2.20), ranged from 5 to 16.07 pg/mL. There was a significant correlation between estradiol levels and QoL (r = −0.349; p = 0.029), and 25(OH)D and QoL (r = −0.383; p = 0.016). In conclusion, estradiol and 25(OH)D have a notable role in postmenopausal complaints. The QoL is a maJor consideration in postmenopausal women's life.
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Optimal vitamin D status is very important for reflecting not only bone but overall woman’s health. The aim of the study was to determine pharmacokinetic variability of 25-hydroxy vitamin D, to reveal and quantify the most significant factors that affect its variability in the population of healthy non-menopausal women using the population pharmacokinetic (PopPK) approach. The study population consisted of 74 healthy reproductive women aged from 35 to 50 years, without the use of any supplement. A population pharmacokinetics analysis was conducted using a nonlinear mixed-effects model software. A total of 35 factors were assessed: demographic, clinical, biochemical data and lifestyle factors. The average age and bodyweight of our participants were 40.11 ± 4.35 years 65.30 ± 6.80 kg, respectively. The observed mean serum concentration of 25- hydroxy vitamin D was 26.51 ± 13.49 ng/mL with a wide range of 6.97 to 59.89 ng/mL. Development final PopPK model of the clearance of 25-hydroxy vitamin D showed that only the average daily dose of vitamin D intake from food had a significant influence, with a magnitude of its effects of 0.00401. These results could help when individualizing vitamin D intake in the form of supplements, especially during the wintertime, in healthy reproductive women.
Article
Estrogen replacement therapy (ERT) has been proven to relieve menopausal-related mental disorders including depression in postmenopausal women. However, the unsafety of ERT hinders its clinical use. In this study, we would evaluate whether vitamin D (VD), a hormone with optimal safety profile, could relieve the depressive-like symptom in ovariectomized (OVX) rats. Furthermore, we would determine whether vitamin D and 17β-estradiol (E2) exert neurological function through their immunomodulatory effect in OVX rats. Middle-aged female SD rats were randomly divided into four groups, namely, control (SHAM), OVX, OVX + VD, and OVX + E2. Vitamin D (calcitriol, 100 ng/kg) and 17β-estradiol (30 μg/kg) had been daily gavaged in the OVX + VD and OVX + E2 group, respectively. After 10-week administration, vitamin D and 17β-estradiol both showed anti-depressive-like activity in the OVX rats. Using the method of immunofluorescent staining and western blot, vitamin D and 17β-estradiol were demonstrated to upregulate each other's receptors, including VDR, ERα, and ERβ in the hippocampus of OVX rats. Additionally, the upregulation of VDR, calbindin-D28k, and calbindin-D9k suggested that the vitamin D signaling system was amplified by vitamin D and 17β-estradiol. Vitamin D and 17β-estradiol showed neuroprotective effects by decreasing OVX-induced apoptosis and neuronal damage, regulating the AMPK/NF-κB signaling pathway, and reducing the proinflammatory cytokines (IL-1β, IL-6, and TNFα), as well as iNOS and COX-2 in the hippocampus of OVX rats. Collectively, the present study demonstrated that vitamin D and 17β-estradiol could upregulate each other's receptors and regulate the AMPK/NF-κB pathway to relieve the OVX-induced depressive-like state. The results could stimulate translational research towards the vitamin D potential for prevention or treatment of menopause-related depression.
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Observational research suggests that micronutrients may be protective for sarcopenia, a key health issue during ageing, potentially via effects on hormone synthesis and metabolism. We aimed to carry out a systematic review of RCTs investigating effects of increasing dietary or supplemental micronutrient intake on sex hormones and IGF-1 in individuals aged 45 years or older. We searched MEDLINE, EMBASE and Cochrane databases for RCTs reporting the effects of different micronutrients (vitamins A, C, D, or E; carotenoids; iron; copper; zinc; magnesium; selenium; and potassium) on sex hormones or IGF-1. Of the 26 RCTs identified, nine examined effects of vitamin D, nine of multi-nutrients, four of carotenoids, two of selenium, one of zinc, and one of vitamin E. For IGF-1 increasing vitamin D (MD: −0.53 nmol/L, 95% CI: −1.58, 0.52), multi-nutrients (MD: 0.60 nmol/L, 95% CI −1.12 to 2.33) and carotenoids (MD −1.32 nmol/L; 95% CI −2.76 to 0.11) had no significant effect on circulating concentrations. No significant effects on sex hormones of other micronutrients were found, but data were very limited. All trials had significant methodological limitations making effects of micronutrient supplementation on sex hormones unclear. Further high quality RCTs with physiological doses of micronutrients in people with low baseline intakes or circulating concentrations, using robust methodology, are required to assess effects of supplementation adequately.
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Article
Observational research suggests that micronutrients may be protective for sarcopenia, a key health issue during ageing, potentially via effects on hormone synthesis and metabolism. We aimed to carry out a systematic review of RCTs investigating effects of increasing dietary or supplemental micronutrient intake on sex hormones and IGF-1 in individuals aged 45 years or older. We searched MEDLINE, EMBASE and Cochrane databases for RCTs reporting the effects of different micronutrients (vitamins A, C, D, or E; carotenoids; iron; copper; zinc; magnesium; selenium; and potassium) on sex hormones or IGF-1. Of the 26 RCTs identified, nine examined effects of vitamin D, nine of multi-nutrients, four of carotenoids, two of selenium, one of zinc, and one of vitamin E. For IGF-1 increasing vitamin D (MD: −0.53 nmol/L, 95% CI: −1.58, 0.52), multi-nutrients (MD: 0.60 nmol/L, 95% CI −1.12 to 2.33) and carotenoids (MD −1.32 nmol/L; 95% CI −2.76 to 0.11) had no significant effect on circulating concentrations. No significant effects on sex hormones of other micronutrients were found, but data were very limited. All trials had significant methodological limitations making effects of micronutrient supplementation on sex hormones unclear. Further high quality RCTs with physiological doses of micronutrients in people with low baseline intakes or circulating concentrations, using robust methodology, are required to assess effects of supplementation adequately.
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The major source of vitamin D in humans is represented by the ultraviolet radiation which induces dermal synthesis of cholecalciferol, however, low vitamin D status is common in Europe even at mid-latitude. The UV radiation that reached the earth surface near Milan between May 2016 and December 2018 was retrieved from the TEMIS database and compared with the corresponding serum vitamin D levels from 30.400 people living in the same area. The results showed a high percent of insufficient vitamin D levels (< 20 ng/mL) throughout the years. During the “vitamin D winter” (November to March) up to 40% of the population are below the recommended minimal level and it was explained by the difficulty to obtain the recommended UV vitamin D doses. In contrast, the warm season provides plenty of ultraviolet radiation, but one out of three people still shows insufficient vitamin D levels. The circannual vitamin D variations were less evident in the female groups which, in the cold season, show values higher than the corresponding male groups probably due to the strongly recommended vitamin D intake for post-menopausal women. In conclusion, increasing the medical advices for vitamin D intake are strongly recommended to improve the vitamin D status at European mid-latitude. Our findings suggest that UV availability alone cannot explain the population’s vitamin D status which instead is likely to be influenced by several other factors related to both the people lifestyle and their personal characteristics. A desirable vitamin D range considering the time of the year and sun exposure, but also including UVR not-related factors, would probably result in a more accurate diagnosis of the patients’ vitamin D status. Despite the relatively large time interval, no evident effects due to climate changes were observed on the vitamin D levels during the almost 13 years analyzed.
Article
Background: Menopause and deficiency in vitamin D (VD) are two health problems usually associated with aging women. Objective: We aimed to study inflammation in visceral adipose tissue when bilateral ovariectomy is combined with dietary restriction in VD. Methods: We studied 60 female C57BL/6 mice 3 months of age. Half of the animals had bilateral ovariectomy (Ovx group, n = 30) and half a sham procedure (Control [C] group, n = 30), and half of each Ovx or C group were fed a standard diet containing VD or a diet restricted in VD (D–) for an additional 12 weeks. Therefore, four groups were formed (n = 15 each group): C, C(D–), Ovx, and Ovx(D–). After sacrifice, the periovarian adipose tissue (PAT) was investigated. Results: In PAT, we observed different levels of hypertrophied adipocytes, enhanced proinflammatory cytokines, activation of inflammatory markers, and components of the extracellular signal-regulated kinase. The most affected PAT was seen in the Ovx(D–) group, followed by the Ovx group, the C(D–) group, and the C group (the least altered). Conclusion: The results demonstrate that ovariectomy and dietary restriction of VD are inducers of adverse effects on mouse visceral adipose tissue. When combined, these insults might enhance PAT inflammation.
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Osteoporosis is characterised by reduced bone mineral density (BMD), increased bone fragility and risk of fractures. We investigated clinical significance of bone turnover biomarkers determination for the prediction of fracture risk and response to therapy. We performed three months follow-up study in 48 women with osteoporosis. During the follow-up period 32 patients were on antiresorptive and 16 patients received anabolic therapy. Serum alkaline phosphatase (ALP), osteocalcin, C-terminal telopeptide of collagen type I and vitamin D were measured before and 3 months after initiation of the therapy. Higher osteocalcin and ALP levels were significantly associated with increased risk of BMD loss. Following antiresorptive therapy levels of C-terminal telopeptide (P
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Background Increasing age, increased body mass index (BMI), and abnormal lipid profiles contribute to an increased risk of vitamin D deficiency. Women who have a perimenopausal and postmenopausal reduction in estrogen levels are a high-risk group for vitamin D deficiency. The aims of this study were to compare the serum vitamin D levels, lipid profile, and BMI between perimenopausal and postmenopausal women in non-manual employment, and to determine whether there were any interdependent factors. Material/Methods Three hundred women in non-manual employment, aged between 44–66 years, were divided into three groups: early perimenopausal; late perimenopausal; and postmenopausal. Laboratory tests included measurement of serum lipid profiles and vitamin D levels, the BMI, waist-hip ratio (WHR) and body fat were measured. Statistical analysis included F-test analysis of variance and the least significance difference (LSD) test was used for multiple comparisons. Results For the 300 women who were in non-manual employment, and in the early and late perimenopausal and postmenopausal periods, serum vitamin D levels were reduced (mean 16.8±8.7 ng/mL); 29% of women had abdominal obesity; 41% had excessive body fat accumulation; and 56% had an increased body mass index (BMI) (>25 kg/m²) with raised total cholesterol, low-density lipoprotein (LDL) cholesterol, LDL/high-density lipoprotein (HDL), and total cholesterol/HDL ratios (p<0.05). Conclusions The findings of this study showed that in perimenopausal and postmenopausal women in non-manual employment, serum vitamin D levels were associated with serum lipid profile and degrees of obesity.
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This study primarily evaluated serum 25-hydroxy vitamin D levels in postmenopausal women with vitamin D insufficiency who received different dosages and intervals of vitamin D2 supplementation. We secondarily evaluated the percentages of those who achieved vitamin D sufficiency level (Defined as ≥30 ng/ml).
Article
The easy access to measurement of serum 25-hydroxyvitamin D (vitD) levels created a surge in interest to learn more of its potential health benefits and its association with prevention of chronic diseases. VitD effects on bone and fracture risk were studied extensively, resulting in clinical guides that stress the need for adequate vitD supplementation. In addition, data are accumulating on its relevance to cardiovascular disease, cancer, cognition and other health domains. Recent studies and meta-analyses seem to lower this enthusiasm concerning the expected good outcomes of higher vitD levels in regard to reduction of risk for major chronic diseases in the general population. However, data are more supportive on various benefits in the case of vitamin D deficiency states, especially in older people. The following article is a short review of the latest developments in this regard.
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Objective: To assess pair-wise differences between placebo, estrogen, and each of three estrogen-progestin regimens on selected symptoms. Methods: This was a 3-year, multicenter, double-blind, placebo-controlled trial in 875 postmenopausal women aged 45-64 years at baseline. Participants were assigned randomly to one of five groups: 1) placebo, 2) daily conjugated equine estrogens, 3) conjugated equine estrogens plus cyclical medroxyprogesterone acetate, 4) conjugated equine estrogens plus daily medroxyprogesterone acetate, and 5) conjugated equine estrogens plus cyclical micronized progesterone. Symptoms were self-reported using a checklist at 1 and 3 years. Factor analysis reduced 52 symptoms to a set of six symptom groups. Results: In intention-to-treat analyses at 1 year, each active treatment demonstrated a marked, statistically significant, protective effect against vasomotor symptoms compared with placebo (odds ratios [ORs] 0.17-0.28); there was no additional benefit of estrogen-progestin over estrogen alone. Only progestin-containing regimens were significantly associated with higher levels of breast discomfort (OR 1.92-2.27). Compared with placebo, women randomized to conjugated equine estrogens reported no increase in perceived weight. Those randomized to medroxyprogesterone acetate reported less perceived weight gain (OR 0.61-0.69) than placebo. Anxiety, cognitive, and affective symptoms did not differ by treatment assignment. Analyses restricted to adherent women were not materially different than those using intention-to-treat, except that women adherent to medroxyprogesterone acetate and micronized progesterone regimens reported fewer musculoskeletal symptoms (OR 0.62-0.68). Conclusion: These results confirm the usefulness of postmenopausal hormone therapy for hot flashes, show convincingly that estrogen plus progestin causes breast discomfort, and demonstrate little influence of postmenopausal hormones on anxiety, cognition, or affect.
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BACKGROUND Lifestyle changes around the time of menopause have the potential to impact on morbidity and eventual mortality. Here we review this topic to identify how such changes may improve health at perimenopause and beyond. METHODS Searches were performed in Medline and other databases. Each subject summary was presented to the ESHRE Workshop Group, where omissions or disagreements were resolved by discussion. RESULTS Body weight increases because the decline in physical activity during the perimenopause is greater than the concomitant decline in energy intake. It is imperative to stop smoking before menopause because the risk of acute myocardial infarction rises sharply thereafter. Cardiovascular events can be reduced by managing risk factors, such as hypertension and increased lipids and body weight. Breast cancer risk is increased to a similar extent by hormone use, decreased physical activity, increased calorie intake and alcohol use, all reflecting lifestyle decisions. Smoking, alcohol and exercise may increase or decrease risk of aging brain disorders, especially dementia and Parkinson's disease, while stress is consistently associated with increased risk and a prudent diet is consistently associated with reduced risk. Osteoarthritis frequency increases after 50 years of age and risk is elevated 3-fold by obesity, while risk of osteoporosis can be minimized by smoking cessation, adequate vitamin D intake and regular weight-bearing exercise. CONCLUSIONS Lifestyle changes around the time of the perimenopause can reduce the likelihood and severity of heart disease and chronic illness in later years and the cost of care of elderly women.
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Women are at a higher risk than men to develop mood disorders and depression. The increased risk is associated with fluctuating estrogen levels that occur during reproductive cycle events, particularly during the menopausal transition, a time characterized by drastic fluctuations in estrogen levels and increases in new onset and recurrent depression. Conversely, recent data show that hormone therapy, particularly transdermal estradiol formulations, may prevent mood disorders or even serve as a treatment regimen for women with diagnosed mood disturbances via estrogen regulation. While the exact mechanism is unknown, there is compelling scientific evidence indicating the neuromodulatory and neuroprotective effects of estrogen, which are directly relevant to mood symptomotology. Specifically, affective regulation has been linked to neural structures rich in estrogen receptors and estrogenic regulation of neurotransmitters. While a wealth of basic science, observational and clinical research support this rationale, potential mediating variables, such as estrogen formulation, proximity of administration to menopause, and the addition of progestins should be considered. Furthermore, the nature of postmenopausal exogenous hormone formulations in relation to premenopausal endogenous levels, as well as the ratio of estrone to estradiol warrant consideration.
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In recent years, vitamin D has been received increased attention due to the resurgence of vitamin D deficiency and rickets in developed countries and the identification of extraskeletal effects of vitamin D, suggesting unexpected benefits of vitamin D in health and disease, beyond bone health. The possibility of extraskeletal effects of vitamin D was first noted with the discovery of the vitamin D receptor (VDR) in tissues and cells that are not involved in maintaining mineral homeostasis and bone health, including skin, placenta, pancreas, breast, prostate and colon cancer cells, and activated T cells. However, the biological significance of the expression of the VDR in different tissues is not fully understood, and the role of vitamin D in extraskeletal health has been a matter of debate. This report summarizes recent research on the roles for vitamin D in cancer, immunity and autoimmune diseases, cardiovascular and respiratory health, pregnancy, obesity, erythropoiesis, diabetes, muscle function, and aging.
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Background: Vitamin D concentrations are linked to body composition indices, particularly body fat mass. Relationships between hypovitaminosis D and obesity, described by both BMI and waist circumference, have been mentioned. We have investigated the effect of a 12-week vitamin D3 supplementation on anthropometric indices in healthy overweight and obese women. Methods: In a double-blind, randomized, placebo-controlled, parallel-group trial, seventy-seven participants (age 38 ± 8.1 years, BMI 29.8 ± 4.1 kg/m²) were randomly allocated into two groups: vitamin D (25 μg per day as cholecalciferol) and placebo (25 μg per day as lactose) for 12 weeks. Body weight, height, waist, hip, fat mass, 25(OH) D, iPTH, and dietary intakes were measured before and after the intervention. Results: Serum 25(OH)D significantly increased in the vitamin D group compared to the placebo group (38.2 ± 32.7 nmol/L vs. 4.6 ± 14.8 nmol/L; P<0.001) and serum iPTH concentrations were decreased by vitamin D3 supplementation (-0.26 ± 0.57 pmol/L vs. 0.27 ± 0.56 pmol/L; P<0.001). Supplementation with vitamin D3 caused a statistically significant decrease in body fat mass in the vitamin D group compared to the placebo group (-2.7 ± 2.1 kg vs. -0.47 ± 2.1 kg; P<0.001). However, body weight and waist circumference did not change significantly in both groups. A significant reverse correlation between changes in serum 25(OH) D concentrations and body fat mass was observed (r = -0.319, P = 0.005). Conclusion: Among healthy overweight and obese women, increasing 25(OH) D concentrations by vitamin D3 supplementation led to body fat mass reduction.
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Background: Obesity is associated with vitamin D deficiency, and both are areas of active public health concern. We explored the causality and direction of the relationship between body mass index (BMI) and 25-hydroxyvitamin D [25(OH)D] using genetic markers as instrumental variables (IVs) in bi-directional Mendelian randomization (MR) analysis. Methods and findings: We used information from 21 adult cohorts (up to 42,024 participants) with 12 BMI-related SNPs (combined in an allelic score) to produce an instrument for BMI and four SNPs associated with 25(OH)D (combined in two allelic scores, separately for genes encoding its synthesis or metabolism) as an instrument for vitamin D. Regression estimates for the IVs (allele scores) were generated within-study and pooled by meta-analysis to generate summary effects. Associations between vitamin D scores and BMI were confirmed in the Genetic Investigation of Anthropometric Traits (GIANT) consortium (n = 123,864). Each 1 kg/m(2) higher BMI was associated with 1.15% lower 25(OH)D (p = 6.52×10⁻²⁷). The BMI allele score was associated both with BMI (p = 6.30×10⁻⁶²) and 25(OH)D (-0.06% [95% CI -0.10 to -0.02], p = 0.004) in the cohorts that underwent meta-analysis. The two vitamin D allele scores were strongly associated with 25(OH)D (p≤8.07×10⁻⁵⁷ for both scores) but not with BMI (synthesis score, p = 0.88; metabolism score, p = 0.08) in the meta-analysis. A 10% higher genetically instrumented BMI was associated with 4.2% lower 25(OH)D concentrations (IV ratio: -4.2 [95% CI -7.1 to -1.3], p = 0.005). No association was seen for genetically instrumented 25(OH)D with BMI, a finding that was confirmed using data from the GIANT consortium (p≥0.57 for both vitamin D scores). Conclusions: On the basis of a bi-directional genetic approach that limits confounding, our study suggests that a higher BMI leads to lower 25(OH)D, while any effects of lower 25(OH)D increasing BMI are likely to be small. Population level interventions to reduce BMI are expected to decrease the prevalence of vitamin D deficiency.
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Background: Weight loss (WL) is associated with a decrease in calcium absorption and may be one mechanism that induces bone loss with weight reduction. Objective: Because vitamin D supplementation has been shown to increase true fractional calcium absorption (TFCA), the goal of this study was to examine the effect of vitamin D during WL or weight maintenance (WM). Design: A randomized, placebo-controlled, double-blind 6-wk study was conducted in 82 postmenopausal women [BMI (in kg/m(2); ±SD): 30.2 ± 3.7] with 25-hydroxyvitamin D [25(OH)D] concentrations <70 nmol/L during either WL or WM. All women were given 10 μg vitamin D(3)/d and 1.2 g Ca/d and either weekly vitamin D(3) (375 μg) or a placebo equivalent to 63 μg (2500 IU)/d and 10 μg (400 IU)/d, respectively. We measured TFCA with the use of dual-stable isotopes, 25(OH)D, parathyroid hormone, estradiol, calcitriol, and urinary calcium at baseline and 6 wk in weight loss and vitamin D(3)-supplementation (WL-D; n = 19), weight maintenance and vitamin D(3)-supplementation (WM-D; n = 20), weight loss and placebo (n = 22), and weight maintenance and placebo (n = 21) groups. Results: WL groups lost 3.8 ± 1.1% of weight with no difference between vitamin D(3) supplementation and the placebo. The rise in serum 25(OH)D was greatest in the WL-D group (19.8 ± 14.5 nmol/L) compared with in WM-D (9.1 ± 10.3 nmol/L) and placebo groups (1.5 ± 10.9 nmol/L). TFCA increased with vitamin D(3) supplementation compared with placebo treatment (P < 0.01) and decreased during WL compared with WM. Serum 25(OH)D or 1,25-dihyroxyvitamin D did not correlate with TFCA. Conclusion: These data show that vitamin D supplementation increases TFCA and that WL decreases TFCA and suggest that, when calcium intake is 1.2 g/d, either 10 or 63 μg vitamin D/d is sufficient to maintain the calcium balance. This trial was registered at clinicaltrials.gov as NCT00473031.
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Accumulating evidence from experimental and epidemiological studies suggests that vitamin D deficiency might be a causal risk factor for cancer and therewith associated mortality. We performed a systematic review in Medline up to February 2012 to identify prospective studies on 25-hydroxyvitamin D (25[OH]D) and cancer mortality as well as on 25(OH)D and survival in cancer patients. Our search retrieved 13 studies on cancer-specific mortality and 20 studies on overall mortality in cancer patients. Data on 25(OH)D and cancer mortality were mainly derived from general populations. The results were inconsistent and yielded either no, inverse or positive associations. By contrast, the majority of studies in cancer patients showed that patients with higher 25(OH)D levels had a decreased risk of mortality. This relationship was particularly evident in cohorts of colorectal cancer patients. In contrast, there was no indication for increased mortality risk with higher vitamin D levels in any cancer cohort. In conclusion, the relationship of vitamin D status and cancer-specific mortality is still unclear and warrants further studies. Our results provide a strong rationale to perform prospective randomized controlled studies to document a potential effect of vitamin D supplementation on survival in cancer patients.
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The results of meta-analyses examining the relationship between vitamin D supplementation and fracture reduction have been inconsistent. We pooled participant-level data from 11 double-blind, randomized, controlled trials of oral vitamin D supplementation (daily, weekly, or every 4 months), with or without calcium, as compared with placebo or calcium alone in persons 65 years of age or older. Primary end points were the incidence of hip and any nonvertebral fractures according to Cox regression analyses, with adjustment for age group, sex, type of dwelling, and study. Our primary aim was to compare data from quartiles of actual intake of vitamin D (including each individual participant's adherence to the treatment and supplement use outside the study protocol) in the treatment groups of all trials with data from the control groups. We included 31,022 persons (mean age, 76 years; 91% women) with 1111 incident hip fractures and 3770 nonvertebral fractures. Participants who were randomly assigned to receive vitamin D, as compared with those assigned to control groups, had a nonsignificant 10% reduction in the risk of hip fracture (hazard ratio, 0.90; 95% confidence interval [CI], 0.80 to 1.01) and a 7% reduction in the risk of nonvertebral fracture (hazard ratio, 0.93; 95% CI, 0.87 to 0.99). By quartiles of actual intake, reduction in the risk of fracture was shown only at the highest intake level (median, 800 IU daily; range, 792 to 2000), with a 30% reduction in the risk of hip fracture (hazard ratio, 0.70; 95% CI, 0.58 to 0.86) and a 14% reduction in the risk of any nonvertebral fracture (hazard ratio, 0.86; 95% CI, 0.76 to 0.96). Benefits at the highest level of vitamin D intake were fairly consistent across subgroups defined by age group, type of dwelling, baseline 25-hydroxyvitamin D level, and additional calcium intake. High-dose vitamin D supplementation (≥800 IU daily) was somewhat favorable in the prevention of hip fracture and any nonvertebral fracture in persons 65 years of age or older. (Funded by the Swiss National Foundations and others.).
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Accumulating evidence suggests that vitamin D may play a role for cardiovascular health. Expression of the vitamin D receptor (VDR) and enzymes for vitamin D metabolism have been identified in the vasculature as well as in the heart. VDR knock-out mice suffer from cardiovascular disease (CVD) and even selective VDR deletion in cardiomyocytes causes myocardial hypertrophy. Many, but not all observational studies showed that vitamin D deficiency is associated with CVD and its risk factors. Low concentrations of 25-hydroxyvitamin D (25(OH)D) are an independent risk factor for cardiovascular events, in particular for strokes and sudden cardiac deaths. Only few randomized controlled trials (RCTs) are available on this topic. These RCTs are frequently limited by the additional supplementation of calcium which may increase the risk of CVD events. RCTs with pure vitamin D supplementation have partially but not consistently shown beneficial effects on cardiovascular risk factors such as arterial hypertension. A number of large RCTs on the impact of vitamin D supplementation on cardiovascular events and mortality have already started but limitations of the study designs such as inclusion of individuals with relatively high 25(OH)D concentrations have to be considered. At present, the evidence is not sufficient for general recommendations to supplement vitamin D in order to prevent and treat CVD. It should, however, be noted that justification for the prevention and treatment of vitamin D deficiency comes from evidence based benefits of vitamin D supplementation on musculoskeletal health.
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Low levels of 25-hydroxyvitamin D [25(OH)D] and free testosterone (FT) are both associated with increased mortality. Experimental studies show a complex interplay of vitamin D and androgen metabolism suggesting that a deficiency of both hormones may be associated with a particularly adverse clinical outcome. To evaluate the impact of parallel FT and 25(OH)D deficiency in a large cohort of older men. We measured total testosterone (TT), sex hormone-binding globulin and 25(OH)D levels in 2069 men who were routinely referred for coronary angiography (1997-2000). Cox proportional hazard ratios (HRs) (with 95% confidence intervals) for mortality from all causes, cardiovascular and noncardiovascular causes according to combined deficiency of FT and 25(OH)D. In multivariate-adjusted analyses, we found an increased risk for all-cause mortality, cardiovascular and noncardiovascular mortality for men in the lowest FT [HR 1·26 (1·03-1·54), 1·24 (0·96-1·60) and 1·39 (1·00-1·93), respectively] and 25(OH)D quartile [HR 1·77 (1·47-2·13), 1·65 (1·29-2·10) and 1·89 (1·38-2·60) respectively] compared with men in higher FT and 25(OH)D quartiles. There was no independent association of TT levels with mortality. Multivariate-adjusted HRs progressively increased with the number of hormones (FT and 25(OH)D) in the lowest quartile [0 vs 2 hormone deficiencies: 2·11 (1·60-2·79) for all cause, 1·77 (1·23-2·55) for cardiovascular and 2·33 (1·45-3·47) for noncardiovascular mortality, respectively]. A combined deficiency of FT and 25(OH)D is significantly associated with fatal events in a large cohort of men referred for coronary angiography.
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Objective To test the efficacy of supplemental vitamin D and active forms of vitamin D with or without calcium in preventing falls among older individuals. Data sources We searched Medline, the Cochrane central register of controlled trials, BIOSIS, and Embase up to August 2008 for relevant articles. Further studies were identified by consulting clinical experts, bibliographies, and abstracts. We contacted authors for additional data when necessary. Review methods Only double blind randomised controlled trials of older individuals (mean age 65 years or older) receiving a defined oral dose of supplemental vitamin D (vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol)) or an active form of vitamin D (1α-hydroxyvitamin D3 (1α-hydroxycalciferol) or 1,25-dihydroxyvitamin D3 (1,25-dihydroxycholecalciferol)) and with sufficiently specified fall assessment were considered for inclusion. Results Eight randomised controlled trials (n=2426) of supplemental vitamin D met our inclusion criteria. Heterogeneity among trials was observed for dose of vitamin D (700-1000 IU/day v 200-600 IU/day; P=0.02) and achieved 25-hydroxyvitamin D3 concentration (25(OH)D concentration: <60 nmol/l v ≥60 nmol/l; P=0.005). High dose supplemental vitamin D reduced fall risk by 19% (pooled relative risk (RR) 0.81, 95% CI 0.71 to 0.92; n=1921 from seven trials), whereas achieved serum 25(OH)D concentrations of 60 nmol/l or more resulted in a 23% fall reduction (pooled RR 0.77, 95% CI 0.65 to 0.90). Falls were not notably reduced by low dose supplemental vitamin D (pooled RR 1.10, 95% CI 0.89 to 1.35; n=505 from two trials) or by achieved serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l (pooled RR 1.35, 95% CI 0.98 to 1.84). Two randomised controlled trials (n=624) of active forms of vitamin D met our inclusion criteria. Active forms of vitamin D reduced fall risk by 22% (pooled RR 0.78, 95% CI 0.64 to 0.94). Conclusions Supplemental vitamin D in a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19% and to a similar degree as active forms of vitamin D. Doses of supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.
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Vitamin D may plausibly reduce the occurrence of depression in postmenopausal women; however, epidemiologic evidence is limited, and few prospective studies have been conducted. We conducted a cross-sectional and prospective analysis of vitamin D intake from foods and supplements and risk of depressive symptoms. Study participants were 81,189 members of the Women's Health Initiative (WHI) Observational Study who were aged 50-79 y at baseline. Vitamin D intake at baseline was measured by food-frequency and supplement-use questionnaires. Depressive symptoms at baseline and after 3 y were assessed by using the Burnam scale and current antidepressant medication use. After age, physical activity, and other factors were controlled for, women who reported a total intake of ≥800 IU vitamin D/d had a prevalence OR for depressive symptoms of 0.79 (95% CI: 0.71, 0.89; P-trend < 0.001) compared with women who reported a total intake of <100 IU vitamin D/d. In analyses limited to women without evidence of depression at baseline, an intake of ≥400 compared with <100 IU vitamin D/d from food sources was associated with 20% lower risk of depressive symptoms at year 3 (OR: 0.80; 95% CI: 0.67, 0.95; P-trend = 0.001). The results for supplemental vitamin D were less consistent, as were the results from secondary analyses that included as cases women who were currently using antidepressant medications. Overall, our findings support a potential inverse association of vitamin D, primarily from food sources, and depressive symptoms in postmenopausal women. Additional prospective studies and randomized trials are essential in establishing whether the improvement of vitamin D status holds promise for the prevention of depression, the treatment of depression, or both.
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Women with polycystic ovary syndrome (PCOS) frequently suffer from metabolic disturbances including insulin resistance (IR), which might be related to vitamin D metabolism. We aimed to investigate the association of polymorphisms in the vitamin D receptor (VDR) gene as well as vitamin D level-associated genes with metabolic and endocrine parameters in PCOS women. Moreover, we examined whether there are associations with PCOS susceptibility. Metabolic, endocrine, and anthropometric measurements and oral glucose tolerance tests were performed in 545 PCOS and 145 control women. Genotyping of VDR (Cdx2, Bsm-I, Fok-I, Apa-I, and Taq-I), GC, DHCR7, and CYP2R1 polymorphisms was performed. 25-Hydroxyvitamin D (25(OH)D) levels showed significant negative correlation with IR and positive correlation with insulin sensitivity (P<0.05 for all) in PCOS women. In PCOS women, the VDR Cdx2 'AA' genotype was associated with lower fasting insulin (P=0.039) and homeostatic model assessment-IR (P=0.041) and higher quantitative insulin-sensitivity check index (P=0.012) and MATSUDA index (P=0.003). The VDR Apa-I 'AA' genotype was associated with lower testosterone (P=0.028) levels. In PCOS women, 170 women (31.2%) presented with 25(OH)D levels <20 ng/ml. PCOS women carrying the GC 'GG' genotype and the DHCR7 'GG' genotype had a significantly higher risk for 25(OH)D levels <20 ng/ml (OR 2.53 (1.27-5.06), P=0.009, and OR 2.66 (1.08-6.55), P=0.033 respectively) compared with PCOS women carrying the GC 'TT' genotype and DHCR 'TT' genotype in multivariate analyses. We observed no association of genetic variations and PCOS susceptibility. VDR and vitamin D level-related variants are associated with metabolic and endocrine parameters including 25(OH)D levels in PCOS women.
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To test the efficacy of supplemental vitamin D and active forms of vitamin D with or without calcium in preventing falls among older individuals. We searched Medline, the Cochrane central register of controlled trials, BIOSIS, and Embase up to August 2008 for relevant articles. Further studies were identified by consulting clinical experts, bibliographies, and abstracts. We contacted authors for additional data when necessary. Review methods Only double blind randomised controlled trials of older individuals (mean age 65 years or older) receiving a defined oral dose of supplemental vitamin D (vitamin D(3) (cholecalciferol) or vitamin D(2) (ergocalciferol)) or an active form of vitamin D (1alpha-hydroxyvitamin D(3) (1alpha-hydroxycalciferol) or 1,25-dihydroxyvitamin D(3) (1,25-dihydroxycholecalciferol)) and with sufficiently specified fall assessment were considered for inclusion. Eight randomised controlled trials (n=2426) of supplemental vitamin D met our inclusion criteria. Heterogeneity among trials was observed for dose of vitamin D (700-1000 IU/day v 200-600 IU/day; P=0.02) and achieved 25-hydroxyvitamin D(3) concentration (25(OH)D concentration: <60 nmol/l v >or=60 nmol/l; P=0.005). High dose supplemental vitamin D reduced fall risk by 19% (pooled relative risk (RR) 0.81, 95% CI 0.71 to 0.92; n=1921 from seven trials), whereas achieved serum 25(OH)D concentrations of 60 nmol/l or more resulted in a 23% fall reduction (pooled RR 0.77, 95% CI 0.65 to 0.90). Falls were not notably reduced by low dose supplemental vitamin D (pooled RR 1.10, 95% CI 0.89 to 1.35; n=505 from two trials) or by achieved serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l (pooled RR 1.35, 95% CI 0.98 to 1.84). Two randomised controlled trials (n=624) of active forms of vitamin D met our inclusion criteria. Active forms of vitamin D reduced fall risk by 22% (pooled RR 0.78, 95% CI 0.64 to 0.94). Supplemental vitamin D in a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19% and to a similar degree as active forms of vitamin D. Doses of supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.
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Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. Central obesity plays a major role in the pathophysiology of PCOS. However, there is little information on the impact of subcutaneous adipose tissue (SAT) on metabolic disturbances in PCOS. The aim of this study was to investigate whether SAT topography influences insulin resistance, impaired glucose tolerance and metabolic parameters in women with PCOS. 36 women aged 16-41 years with PCOS and 87 healthy women aged 20-34 years were examined using lipometry, metabolic and hormonal measurements, oral glucose tolerance tests, hirsutism scores, and questionnaires. The homeostasis model assessment (HOMA) index was used for determination of insulin resistance. SAT measurement points on the trunk showed significant positive correlation with the HOMA index. A negative correlation between calf SAT and the HOMA index was seen. Multiple regression analysis detected a positive association between the HOMA index and lower-abdomen SAT and upper-back SAT, whereas hip SAT showed a negative association with the HOMA index. In overweight/obese patients with PCOS, lower-abdomen and upper-back SAT showed significant positive correlations with insulin resistance. There was no correlation of SAT topography with insulin resistance in lean women with PCOS. Compared with PCOS women with normal glucose tolerance, patients with glucose intolerance had significantly increased trunk obesity and decreased leg fat. Increased SAT layers on the trunk were related to an unfavorable serum lipid profile, whereas increased leg fat correlated positively with HDL cholesterol. Increased SAT layers on the trunk are associated with insulin resistance, impaired glucose tolerance and an unfavorable lipid profile in women suffering from PCOS. Increased thickness of leg SAT emerges as being protective against metabolic disturbances in PCOS.
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To assess pair-wise differences between placebo, estrogen, and each of three estrogen-progestin regimens on selected symptoms. This was a 3-year, multicenter, double-blind, placebo-controlled trial in 875 postmenopausal women aged 45-64 years at baseline. Participants were assigned randomly to one of five groups: 1) placebo, 2) daily conjugated equine estrogens, 3) conjugated equine estrogens plus cyclical medroxyprogesterone acetate, 4) conjugated equine estrogens plus daily medroxyprogesterone acetate, and 5) conjugated equine estrogens plus cyclical micronized progesterone. Symptoms were self-reported using a checklist at 1 and 3 years. Factor analysis reduced 52 symptoms to a set of six symptom groups. In intention-to-treat analyses at 1 year, each active treatment demonstrated a marked, statistically significant, protective effect against vasomotor symptoms compared with placebo (odds ratios [ORs] 0.17-0.28); there was no additional benefit of estrogen-progestin over estrogen alone. Only progestin-containing regimens were significantly associated with higher levels of breast discomfort (OR 1.92-2.27). Compared with placebo, women randomized to conjugated equine estrogens reported no increase in perceived weight. Those randomized to medroxyprogesterone acetate reported less perceived weight gain (OR 0.61-0.69) than placebo. Anxiety, cognitive, and affective symptoms did not differ by treatment assignment. Analyses restricted to adherent women were not materially different than those using intention-to-treat, except that women adherent to medroxyprogesterone acetate and micronized progesterone regimens reported fewer musculoskeletal symptoms (OR 0.62-0.68). These results confirm the usefulness of post-menopausal hormone therapy for hot flashes, show convincingly that estrogen plus progestin causes breast discomfort, and demonstrate little influence of postmenopausal hormones on anxiety, cognition, or affect.
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The aims of this study were to investigate myopathy in relation to vitamin D status, and to study the muscular effects of vitamin D treatment on vitamin D-deficient individuals. Further, hypovitaminosis D myopathy was investigated in relation to alkaline phosphatase (ALP), the most commonly used marker for hypovitaminosis D osteopathy. Eight patients with osteomalacia had an isokinetic dynamometer test of all major muscle groups before and after 3 months of vitamin D treatment. The most pronounced improvements in muscle power were seen in the weight-bearing antigravity muscles of the lower limbs. A cross-sectional study was performed among 55 vitamin D-deficient veiled Arab women living in Denmark and 22 Danish controls. An isometric dynamometer model was used for determination of quadriceps muscle power. Both maximal voluntary contraction (MVC) and electrically stimulated values (single twitch, maximal production rate (MPR), and maximal relaxation rate (MRR)) were determined. The women underwent high-dose vitamin D treatment and were retested after 3 and 6 months. Prior to vitamin D treatment all parameters of muscle function in the group of vitamin D-deficient Arab women were significantly reduced compared with Danish controls. MVC: 259.4 ± 11.0 N (Newton) versus 392.6 ± 11.4 N (P −6), single twitch: 47.0 ± 1.8 N versus 74.6 ± 2.2 N (P −5), MPR 8.9 ± 0.3 N/10 ms versus 14.3 ± 0.4 N/10 ms (P −6), MRR 4.5 ± 0.2 N/10 ms versus 6.2 ± 0.2 N/10 ms (P −6). Muscle function was affected to a similar degree in women with and without bone involvement (as indicated by elevated ALP). After 3 months of vitamin D treatment all muscle-related parameters improved significantly. After 6 months only MVC was reduced compared with Danish controls (320.7 ± 14.3 N (P
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Testosterone concentrations in men gradually decrease with age. Whether this reduction in androgen levels is a pathological process or a physiological event remains to be determined. The age-related decrease in testosterone levels is, however, frequently accompanied by adverse health consequences including low bone and muscle mass, increased fat mass, type 2 diabetes mellitus and the metabolic syndrome. Moreover, low androgen levels are associated with increased mortality. Testosterone treatment should be performed in men with low androgen levels as well as clinical signs and symptoms of hypogonadism. In premenopausal women, hyperandrogenemia is associated with several cardiovascular risk factors. The most common cause of hyperandrogenemia in women is polycystic ovary syndrome (PCOS). PCOS women are affected by hyperandrogenism, infertility and metabolic disturbances, such as insulin resistance, central obesity and dyslipidemia. Androgen levels decrease with menopausal transition in women. Hyperandrogenemia is associated with insulin resistance and type 2 diabetes in postmenopausal women. Whether this hyperandrogenemia results in increased mortality is, however, less clear. Moreover, the impact of androgen supplementation in postmenopausal women with hypoandrogenemia is open.
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This study aims to determine whether vitamin D levels are associated with menopause-related symptoms in older women. A randomly selected subset of 1,407 women, among 26,104 potentially eligible participants of the Women's Health Initiative Calcium and Vitamin D trial of postmenopausal women aged 51 to 80 years, had 25-hydroxyvitamin D [25(OH)D] levels measured at the Women's Health Initiative Calcium and Vitamin D trial baseline visit. Information about menopause-related symptoms at baseline was obtained by questionnaire and included overall number of symptoms and composite measures of sleep disturbance, emotional well-being, and energy/fatigue, as well as individual symptoms. After exclusions for missing data, 530 women (mean [SD] age, 66.2 [6.8] y) were included in these analyses. Borderline significant associations between 25(OH)D levels and total number of menopausal symptoms were observed (with P values ranging from 0.05 to 0.06 for fully adjusted models); however, the effect was clinically insignificant and disappeared with correction for multiple testing. No associations between 25(OH)D levels and composite measures of sleep disturbance, emotional well-being, or energy/fatigue were observed (P's > 0.10 for fully adjusted models). There is no evidence for a clinically important association between serum 25(OH)D levels and menopause-related symptoms in postmenopausal women.
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Apart from the well known effects of vitamin D on maintaining calcium homeostasis and promoting bone mineralization, there is some evidence suggesting that vitamin D also modulates human reproductive processes. We will review the most interesting and relevant studies on vitamin D and female fertility published over the past year. In the past year, several observational studies reported a better in-vitro fertilization outcome in women with sufficient vitamin D levels (≥30 ng/ml), which was mainly attributed to vitamin D effects on the endometrium. One randomized controlled trial found an increased endometrial thickness in women with polycystic ovary syndrome (PCOS) receiving vitamin D during intrauterine insemination cycles. Further, vitamin D supplementation had a beneficial effect on serum lipids in PCOS women. Vitamin D treatment improved endometriosis in a rat model and increased vitamin D intake was related to a decreased risk of incident endometriosis. Vitamin D was also favorably associated with primary dysmenorrhea, uterine leiomyoma, and ovarian reserve in late reproductive aged women. In women undergoing in-vitro fertilization, a sufficient vitamin D level (≥30 ng/ml) should be obtained. Vitamin D supplementation might improve metabolic parameters in women with PCOS. A high vitamin D intake might be protective against endometriosis.
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The objective of this study was to evaluate whether increased serum 25-hydroxyvitamin D3 (25OHD3) concentrations, in response to calcium/vitamin D (CaD) supplementation, are associated with improved lipids in postmenopausal women. The parent trial was a double-blind, randomized, placebo-controlled, parallel-group trial designed to test the effects of CaD supplementation (1,000 mg of elemental calcium + 400 IU of vitamin D3 daily) versus placebo in postmenopausal women. Women from the general community, including multiple sites in the United States, were enrolled between 1993 and 1998. This cohort included 300 white, 200 African-American, and 100 Hispanic participants who were randomly selected from the Women's Health Initiative CaD trial. Serum 25OHD3 and lipid (fasting plasma triglycerides [TG], high-density lipoprotein cholesterol [HDL-C], and calculated low-density lipoprotein cholesterol [LDL-C]) levels were assessed before and after CaD randomization. There was a 38% increase in mean serum 25OHD3 concentrations after 2 years (95% CI, 1.29-1.47, P < 0.001) for women randomized to CaD (24.3 ng/mL postrandomization mean) compared with placebo (18.2 ng/mL). Women randomized to CaD had a 4.46-mg/dL mean decrease in LDL-C (P = 0.03). Higher concentrations of 25OHD3 were associated with higher HDL-C levels (P = 0.003), along with lower LDL-C and TG levels (P = 0.02 and P < 0.001, respectively). Supplemental CaD significantly increases 25OHD3 concentrations and decreases LDL-C. Women with higher 25OHD3 concentrations have more favorable lipid profiles, including increased HDL-C, lower LDL-C, and lower TG. These results support the hypothesis that higher concentrations of 25OHD3, in response to CaD supplementation, are associated with improved LDL-C.