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Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: A national, population-based study
Abstract
Vitamin D deficiency is recognized as a global public health problem, but the population-based prevalence of deficiency and its determinants in Australian adults is not known. This study evaluated the vitamin D status of Australian adults aged ≥25 years and risk factors associated with vitamin D deficiency in this population. Design and
We studied a national sample of 11,247 Australian adults enrolled in the 1999/2000 Australian Diabetes, Obesity and Lifestyle (AusDiab) study drawn from 42 randomly selected districts throughout Australia.
Serum concentrations of 25-hydroxyvitamin D [25(OH)D] were measured by immunoassay. Vitamin D deficiency was defined as a concentration <50 nmol/l. Information on demographic and lifestyle factors was derived from interview-administered questionnaires.
The mean serum 25(OH)D concentration was 63 nmol/l (95% CI: 59-67 nmol/l). Only 4% of the population had a level <25 nmol/l, but the prevalence of vitamin D deficiency (<50 nmol/l) was 31% (22% men; 39% women); 73% had levels <75 nmol/l. The prevalence of vitamin D deficiency increased significantly with age, was greater in women, in those of non-Europid origin, in the obese and those who were physically inactive and with a higher level of education. Deficiency was also more common during winter and in people residing in southern Australia (latitude >35°S); 42% of women and 27% of men were deficient during summer-autumn, which increased to 58% and 35%, respectively, during winter-spring.
Vitamin D deficiency is common in Australia affecting nearly one-third of adults aged ≥25 years. This indicates that strategies are needed at the population level to improve vitamin D status of Australians.
... The amount of VitD formed in the skin by UVB radiation depends on various environmental and personal factors, such as latitude, season, time of day, skin pigmentation, age, or use of sunscreen (17)(18)(19)(20)(21)(22)(23). It has already been established that constitutive skin pigmentation and/or skin phototype is an important predictor of VitD status when comparing people from different ethnic backgrounds (24)(25)(26)(27)(28)(29), but how different levels of constitutive pigmentation affect VitD status in Caucasians has not yet been well described. To date, there has been only one study focusing on Caucasians, and its results contrast with studies of different ethnic backgrounds, where darker skin types seem to be more prone to deficiency (30). ...
... BMI was also confirmed as a significant variable in repeated measures analyses of seasonal changes in serum 25(OH) D concentration (Table 4). BMI has previously been described as a predictor of VitD status (25,26,28,62,67,(70)(71)(72) and of seasonal differences in serum 25(OH)D concentration (62). Several factors could contribute to the lower 25(OH)D concentration in individuals with a higher BMI, including a larger pool for the accumulation of VitD in adipose tissues, and lifestyle covariates (i.e., less outdoor activity due to lower mobility), but the association remains controversial (71,73). ...
... In some studies, although sex was reported as a significant predictor of VitD status, the direction of the effect may be in the opposite direction (61). However, in the NH study (1) and some other studies (25,26), lower VitD status was found in women. ...
Introduction
Inadequate vitamin D status is a worldwide public health issue. In humans, vitamin D status is affected by diet, and even more by exposure to ultraviolet B (UVB) light and consequential endogenous synthesis. Various personal and environmental factors influence endogenous synthesis. Factors affecting vitamin D status were investigated in a prospective longitudinal cohort study with a summer and winter observation period.
Methods
The final sample included 292 adults, of those 111 (38%) males and 181 (62%) females, with a mean age of 38.2 (±11.8) years from Slovenia who were not supplementing vitamin D. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured in both periods; vitamin D intake, self-reported body mass index (BMI), and protective behaviors against sun were also recorded. Other measured parameters included measurements of constitutive skin color using the objective individual typology angle (ITA), and difference in the melanin index (ΔMI) for assessment of objective sun exposure.
Results
In winter a high prevalence (63.4%) of insufficient vitamin D status (< 50 nmoL/L) was observed with higher odds ratios (OR) for insufficiency in those with a higher BMI and light ITA. During summer, insufficiency prevalence was low (5.5%), but half of the participants (50.0%) had suboptimal 25(OH)D concentration (< 75 nmol/L). In summer OR for suboptimal status were higher in those with obesity, lower ΔMI, light ITA, low vitamin D intake, and protective clothing behaviors.
Conclusion
Using a series of measures, we showed that vitamin D status is hugely affected by several personal factors such as BMI, ITA, vitamin D intake, ΔMI, and protective behavior against the sun. This conclusion questions the usefulness of generalized population-level recommendations since personal factors are a major predictor of vitamin D status.
... It has been estimated that about one billion people have vitamin D (Vit. D) deficiency around the world [1] ranging from 10 to 70% across different countries including Iran [2][3][4][5][6]. Based on the second National Integrated Micronutrient Survey (NIMS) the prevalence of vitamin D deficiency was 23.3% in infants aged 15-23 months, 76% in adolescents, 59.1% in adults, and 85.3% in pregnant women [6]. ...
... 364.2 − 365. 5 1 [34]. BAI was calculated using the equation (hip circumference (cm)/ height (m) 1.5 ) − 18) [35]. ...
Background
This study sought to determine the accuracy of several anthropometric parameters in association with serum Vit. D concentrations and to compare the novel indices with the conventional ones.
Methods
A total of 947 individuals referred to the cardiology clinic who have not used statin or take low-dose statin were evaluated through a cross-sectional study. Data on demographic information, anthropometric indices, and biochemical measurements were gathered using a checklist. Both the multivariable regression modeling and the area under the receiver-operating characteristic (ROC) were employed for the analysis.
Results
Considering novel indices, BRI (Body Roundness Index) showed the most powerful correlation with serum Vit. D levels among both genders. Among conventional ancient indices, WC (Waist Circumference) had the strongest association in both men and women groups. Based on the confounding factors-adjusted model, the highest odds ratio (OR) for the presence of Vit. D deficiency belonged to WHtR (Waist to Height Ratio) in women (OR, 0.347 (0.171–0.704), P = 0.003). None of the indices predicted Vit. D deficiency significantly among men. A Vit. D concentration of 4.55 ng/ml was found as a cutoff based on the metabolic syndrome status.
Conclusion
The most powerful association with serum Vit. D levels were detected for BRI in both genders among newly developed indices. In addition, WHtR predicted Vit. D deficiency independent of confounding factors among women.
... Vitamin D deficiency is predominantly attributed to inadequate exposure to sunlight. As a result, though VDD is prevalent globally [1,[4][5][6][7][8][9][10][11][12][13][14], people living in tropical regions, such as South Asia where there is sunlight available for more than 12 h a day [15], have been assumed to exhibit lower VDD prevalence and consequently fewer health impacts. Yet, there is a growing body of evidence indicating that VDD is becoming more prevalent even in such regions [10][11][12][13][14]. ...
... Comparatively, the reported VDD prevalence in developed countries using the same cut-off value (< 20.0 ng/ mL) ranged from 20 to 32%. For instance, in the USA, the prevalence was 24% in 2016, 32% in Canada in 2012/2013, and 31% in Australia in 2012 [5][6][7]. Further, in Northern European populations, it averaged below 20%, and in Western, Eastern and Southern European countries, it ranged from 30 to 60% [34]. This relatively lower burden of VDD in developed countries, despite the inadequate exposure to its major determinant-sunlight, may be attributed to well-established national vitamin D supplementation and food fortification programs that enabled such countries to control VDD encountered in the past [8]. ...
Background
Vitamin D deficiency (VDD) is conventionally associated with inadequate sunlight exposure. Ironically, recent evidence suggests a rising prevalence in urban areas of tropical regions like Sri Lanka, where comprehensive data are unavailable. This study aimed to estimate the prevalence of low vitamin D status in urban adults and its impact on serum calcium.
Methods
A population-based cross-sectional study was conducted among 1260 adults aged 35–74 years, living in Colombo, the most urban district in Sri Lanka. They were recruited from 63 administrative divisions, using multi-stage, probability-proportionate-to-size, cluster sampling. Non-fasting venous blood was collected without tourniquet. Low vitamin D (< 30.0 ng/mL), VDD (< 20 ng/mL) and vitamin D insufficiency (20.0–29.9 ng/mL) were determined using chemiluminescence assay method, and serum calcium using Calcium Gen2 reagent.
Results
Among the population (53.3% females; mean age = 51.8 years), the prevalence of low vitamin D was 93.9% (95% CI: 92.5–95.2). This was primarily due to VDD (67.5%; 95% CI: 64.9.0–70.1%), with some insufficiency (26.4%; 95% CI: 24.0–28.9%). Most VDD cases (53.9.0%) were 'mild' (10.0- < 20.0 ng/mL) in severity, with fewer 'moderate' (12.8%) and 'severe' (0.8%) cases. Prevalence of VDD was highest in females, aged 35–44-years, living in 'highly urban' areas and of Tamil ethnicity. Further, VDD showed a decreasing trend with older age groups, while it was significantly more prevalent in females than males (72.6% vs. 61.7%; p < 0.01), across all age groups. Low serum calcium levels were observed in 9.8% of adults with low vitamin D, compared to 22.4% with normal vitamin D, implying that there could be factors other than vitamin D in maintaining serum calcium levels.
Conclusions
Colombo District, representing urban settings in Sri Lanka faces a high prevalence of low vitamin D, primarily VDD, with higher rates in females, younger individuals and highly urban areas. These findings challenge assumptions about tropical regions being guaranteed of optimal vitamin D levels; and underscore the need for national vitamin D supplementation and food fortification programs, especially in high-risk urban settings in South Asian countries like Sri Lanka.
... This is not surprising, given that most vitamin D is generated in the skin following UVB exposure with little vitamin D available from the average unfortified diet (59,60). Given an observed drop in 25(OH)D levels between seasons, a higher target (∼75 nmol/L) may be required at the end of summer to allow for the anticipated 10 to 25 nmol/L drop during the winter months (61). For example, in a sunny country, such as Australia, the prevalence of vitamin D deficiency (<50 nmol/L) is as high as 36% during winter and as low as 14% in summer (62). ...
... In Lebanon, another sunny country, mean serum 25(OH)D levels were 12 to 15 nmol/L higher in summer to fall compared to winter (63). In this regard, measurement of serum 25(OH)D levels at the end of winter or in early spring would increase the detection of low 25(OH)D levels in the general population (61). ...
The 6th International Conference, "Controversies in Vitamin D," was convened to discuss controversial topics, such as vitamin D metabolism, assessment, actions, and supplementation. Novel insights into vitamin D mechanisms of action suggest links with conditions that do not depend only on reduced solar exposure or diet intake and that can be detected with distinctive noncanonical vitamin D metabolites. Optimal 25-hydroxyvitamin D (25(OH)D) levels remain debated. Varying recommendations from different societies arise from evaluating different clinical or public health approaches. The lack of assay standardization also poses challenges in interpreting data from available studies, hindering rational data pooling and meta-analyses. Beyond the well-known skeletal features, interest in vitamin D's extraskeletal effects has led to clinical trials on cancer, cardiovascular risk, respiratory effects, autoimmune diseases, diabetes, and mortality. The initial negative results are likely due to enrollment of vitamin D-replete individuals. Subsequent post hoc analyses have suggested, nevertheless, potential benefits in reducing cancer incidence, autoimmune diseases, cardiovascular events, and diabetes. Oral administration of vitamin D is the preferred route. Parenteral administration is reserved for specific clinical situations. Cholecalciferol is favored due to safety and minimal monitoring requirements. Calcifediol may be used in certain conditions, while calcitriol should be limited to specific disorders in which the active metabolite is not readily produced in vivo. Further studies are needed to investigate vitamin D effects in relation to the different recommended 25(OH)D levels and the efficacy of the different supplementary formulations in achieving biochemical and clinical outcomes within the multifaced skeletal and extraskeletal potential effects of vitamin D.
... VD deficiency is now considered a global health problem [17,22,23]. In the U.S., it is estimated that 36% of the general population has VD deficiency, and among pregnant women, VD deficiency prevalence is 27-91% [17]. ...
... Populations with increased risk of VD deficiency included pregnant women, people of color (e.g. African Americans, Hispanics), obese patients, people with little sun exposure, and those who are physically inactive [22,23]. In a prospective study including 40 healthy pregnant women in Boston, even with VD supplements throughout the pregnancy (average 600 international units (IUs) daily), Lee et al. reported 50% of mothers and 65% of their newborn infants as VD deficient with a blood level < 20 ng/mL [25]. ...
Over three years since the World Health Organization (WHO) declared COVID-19 a pandemic, it is still a global burden. Vaccines against COVID-19, caused by SARS-CoV-2, are available and effective for preventing disease. However, their protective effects are not 100%. Currently, the U.S. Food and Drug Administration (FDA) has only approved a limited number of inpatient treatments for COVID-19, such as remdesivir, baricitinib, and tocilizumab. These medications have indications and contraindications applicable to a select patient population. Finding additional effective therapies that are widely available with limited risk could be vital in optimizing treatment strategies for this viral illness. Some vitamins and supplements have been identified as potential options for managing COVID-19. Vitamin D (VD) deficiency has been associated with respiratory tract infections. Moreover, alpha-lipoic acid (ALA) is a powerful antioxidant and helps reduce inflammatory responses in many pathologic conditions. This review aims to analyze the current evidence regarding the effectiveness of VD and alpha-lipoic acid in COVID-19 infection in both outpatient and hospitalized patients.
Relevant randomized controlled trials (RCTs) were identified via the PubMed database from January 1, 2021, to December 31, 2023. Inclusion criteria were as follows: the study design was a randomized controlled trial (RCT), the usage of a constant dose during the intervention period without any additional boluses, and a research ethics committee approved it. Exclusion criteria included a lack of an outcome or apparent intervention, additional boluses, or a single-dose regimen in all the interventional groups. There were 11 studies with a total sample size of 35,717 patients that met the criteria for this review.
A total of 10 RCTs examined the efficacy of VD, and one RCT that reviewed the efficacy of ALA was identified. All of the articles investigated the use of VD or ALA during the treatment of COVID-19. The endpoints of each study varied, including length of stay in hospital, viral load, SARS-CoV-2 infection rate, mechanical ventilation, inflammatory markers, clinical symptoms, Sequential Organ Failure Assessment (SOFA) score, and mortality. In 8/10 VD supplementation trials, significant differences were identified between the interventional and placebo groups in the aforementioned parameters. In 2/10 VD supplementation trials, no significant differences were identified. The ALA supplementation RCT found no differences between the interventional and placebo groups in the SOFA score and 30-day all-cause mortality rate.
The current literature suggests that VD can potentially reduce the SARS-CoV-2 infection rate, oxygen requirements, inflammatory markers, clinical symptoms, and mortality. Regarding ALA, although there was a suggestion of benefit, it was not statistically significant. Common limitations among the different studies included relatively small sample sizes, different geographical patient locations among studies, and differences in dosages. Trials investigating the effects of higher doses of VD supplementation on SARS-CoV-2 infection should be conducted. More research is needed to define best practices and optimal dosing protocols for the use of VD in COVID-19.
... Vitamin D has been produced under the influence of solar radiation for more than 500 million years (1). Vitamin D deficiency has been recognised since the late 20th century as a pandemic affecting all age groups in the developed world (1,2). However, the importance of prudent sun exposure tends to be overlooked, which is responsible for the global pandemic of vitamin D deficiency (1). ...
... The significant difference in mean concentrations between genders, with males showing a better vitamin D status, is widely reported in the literature from almost all regions of the world, although in all cases the strength of the association was not reported (2,17). However, there are studies where the mean total calcidiol concentration did not differ significantly between genders (19). ...
Background:
Vitamin D deficiency is recognised as a pandemic in the developed world. However, the importance of prudent sun exposure tends to be overlooked, which is responsible for this pandemic.
Methods:
We investigated the vitamin D status in 326 adults, 165 females and 161 males: 99 Osteoporosis patients, 53 Type 1 Diabetes patients, 51 Type 2 Diabetes patients, and 123 Athletic Healthy individuals, from Northern Greece, through the measurement of total calcidiol in winter and summer by immunoenzymatic assay.
Results:
In the Whole Sample 23.31% had severe deficiency, 13.50% mild deficiency, 17.48% insufficiency, and 45.71% adequacy at the end of winter. Mean concentrations differed significantly (p <0.001) between males and females. The prevalence of deficiency in the young was significantly lower than in the middle-aged (p = 0.004) and in the elderly (p <0.001), while it was significantly lower (p = 0.014) in the middle-aged than in the elderly. The best vitamin D status was found in the Athletic Healthy individuals, followed by the Type 1 and Type 2 Diabetic patients, while Osteoporotic patients had the poorest status. The difference in mean concentrations between winter and summer was significant (p <0.001).
Conclusions:
Vitamin D status deteriorated with increasing age and it was better in males than in females. Our findings suggest that outdoor physical activity in a Mediterranean country can cover the vitamin D needs of the young and the middle-aged, but not of the elderly, without the need for dietary supplements.
... The condition of 25OHD deficiency undoubtedly represents a significant public health problem [17][18][19][20][21][22][23]. Numerous studies have reported that vitamin D insufficiency is widespread in pregnant women, obese individuals, and subjects who, for various reasons, cannot regularly expose themselves to sunlight [24][25][26]. ...
Background: The condition of vitamin D (25OHD) deficiency represents an important public health problem. In Europe, hypovitaminosis is common not only in the elderly population but also between 50 and 70 years, both in males and females. Data regarding vitamin D intake in the Italian population are very limited. In a recent paper, reporting data collected by a specific Frequency Food Questionnaire (FFQ), we observed in a small group of healthy subjects that the dietary consumption of vitamin D, both in females and males, was far below the average. Methods: With the aim of expanding our preliminary data, we conducted a survey on a large cohort of subjects from different areas of Northern, Central, and Southern Italy. The FFQ contained 11 different questions regarding the amount and type of intake of foods containing ergocalciferol and cholecalciferol. It was submitted to 870 subjects, 627 females and 243 males, with an age range from 40 to 80 years; 31.6% of the studied population was apparently in good health, while 68.4% were affected by different pathologies. Results: The present data confirm previous observations: the global quantity of vitamin D intake in 14 days was 70.8 μg (±1.8 SE, ±54.4 SD) in females and 87.5 μg (±1.9 SE, ±57.1 SD) in males; the mean daily intake of vitamin D in females and males was 5.05 μg (±0.5 SE, ±3.8 SD) and 6.25 μg (±0.21 SE, ±4.1 SD), respectively. In healthy subjects, a gradual decrease was observed in the overall intake of vitamin D in both females and males according to an increase in age bracket, ranging from 74.5 μg and 103.8 μg in the 40–50 age group to 54.5 μg and 87.8 μg in the 71–80 age group, respectively. Conclusions: In conclusion, the present data, collected in a large Italian cohort, underscore that the daily intake of vitamin D is far below the recommended daily average, thereby contributing to the development of potential hypovitaminosis.
... The condition of vitamin D deficiency undoubtedly represents a significant public health problem [17][18][19][20][21][22][23]. Numerous studies reported that vitamin D deficiency is widespread in pregnant women, obese individuals, and subjects who, for various reasons, cannot regularly expose themselves to sunlight [24][25][26]. ...
The condition of vitamin D deficiency represents a significant public health problem. In Europe, hypovitaminosis is common not only in the elderly population but also between 50 and 70 years, both in males and females. Data regarding vitamin D intake in the Italian population are very limited. In a recent report performed to validate a specific Frequency Food Questionnaire (FFQ), we observed in a small group of healthy subjects that the dietary intake of vitamin D, both in females and males, was far below the average. With the aim of expanding our preliminary data, we conducted a survey on a large cohort of subjects from different areas of Northern, Central, and Southern Italy. The FFQ contained 11 different questions regarding the type and amount of intake of foods containing vitamin D. It was submitted to 870 subjects, 627 females and 243 males, with age ranged from 40 to 80 years; 31.6% of the studied population was apparently in good health, while 68.4% were affected by different pathologies. Present data confirm previous observations: the global amount of vitamin D intakes in 14 days were 70.8 μg + 1.8 (SE) in females and 87.5 μg + 1.9 (SE) in males; the mean daily intakes of vitamin D in females and males were 5.05 μg + 0.17 (SE) and 6.25 μg + 0.21 (SE) for females and males, respectively. In healthy subjects, a gradual decrease was observed in the overall intake of vitamin D in both females and males according to increase in age bracket, ranging from 74.5 μg and 103.8 μg in the 40-50 age group to 54.5 μg and 87.8 μg in the 71-80 age group, respectively. In conclusion, present data collected in a large Italian cohort underscore that the daily intake of vitamin D is far below the recommended daily average, so contributing to the development of potential hypovitaminosis.
... Coinvolge donne in gravidanza, soggetti obesi sia adulti che bambini, soggetti di razza nera oppure ispanica caratterizzati da un elevato contenuto di melanina nella cute, e anche tutti quei soggetti che per vari motivi non si espongono con regolarità all'irraggiamento solare [7]. È stato stimato che circa il 30% e il 60%, rispettivamente, dei bambini e degli adulti nel mondo sviluppano una condizione di carenza di vitamina D [8]. A questa condizione contribuisce in misura sostanziale un inadeguato apporto alimentare di vitamina D. Come indicato nella Tabella 1, i pesci e i funghi rappresentano la fonte principale di vitamina D, mentre l'uovo, i formaggi, la carne e il latte sono alimenti che contengono vitamina D in misura modesta [9]: peraltro, per numerosi motivi questi alimenti non vengono sempre assunti in modo regolare. ...
Sommario
Il fabbisogno di vitamina D è garantito per l’80% dall’irraggiamento solare e per il 20% dall’introito alimentare. La vitamina D3 è presente nei pesci, fegato, uova, latte e derivati, funghi. Il carente apporto alimentare di vitamina D può favorire l’ipovitaminosi D. Abbiamo rilevato che l’apporto medio giornaliero di vitamina D in Italia è di 204 IU ± 137 nella donna e 185 IU ± 49 SD nell’uomo. Un’estensione di questo studio, ha potuto confermare questo aspetto. Il carente apporto alimentare di vitamina D contribuisce significativamente alla realizzazione di un insufficiente stato vitaminico D.
... Estrogen and progesterone supplements, frequently prescribed to female participants, have been demonstrated in several instances to alter jaw kinematics [2]. Vitamin D deficiency, contributing to 14.97% of the incidences of jaw clicking in the current study, affects one third of the Australian population [30]. Deficiencies can impact musculoskeletal health, leading to issues such as masticatory muscle weakness, premature spasm, and degradation of bone quality. ...
Background: The influence of medical and dental factors on jaw clicking within the South Australian population remains unexplored, and there is a lack of research on the impact of occlusal therapy on dynamic jaw movement parameters in this population. Purpose: This study investigated the potential significant associations between specific aspects of patient histories, occlusal therapy, and self-reported or observed jaw clicking in a population from the state of South Australia. Methods: Seventy individuals aged 18 to 65 participated in a cross-sectional study. Data collection included comprehensive medical, social, and dental histories, followed by evaluations of jaw function. Twenty-six out of the seventy individuals reported jaw clicking. Electrognathography assessed maximum mouth opening, surface electromyography evaluated masticatory muscle function, and joint vibration analysis measured individual joint vibration amplitudes and integrals. Logistic regression models analysed overall variable effects, while sub-models focused on predictors related to occlusal therapy, specifically orthodontic intervention. Independent t-tests and Mann–Whitney U tests compared jaw functions between participants who received occlusal therapy and those who did not. Results: The number of third molars extracted, vitamin D deficiency, and self-reported mental health disorders (R2 = 0.414, p = 0.048) emerged as significant predictors for jaw clicking. Factors associated with occlusal therapy showed no significant association with jaw clicking (R2 = 0.59, p = 0.027). Furthermore, there were no significant differences observed in mouth opening (t-stat = −0.439, p = 0.662), muscle activity, and joint vibration analysis between participants who underwent occlusal therapy and those who did not. Conclusions: Within the selected study population and limited sample size, the number of third molars extracted, vitamin D deficiency, and self-reported mental health disorders were associated with jaw clicking.
... The research conducted by R.M. Daly et al. [19] proves that vitamin D deficiency is by 3 or 4 times more severe during winter and spring as compared to summer, and is twice as severe for people residing at 35 0 of latitude along the parallel. A. Fares examined 12 research papers on the disease seasonal occurrence during 1971-2006 in 11 countries [20]. ...
120 exposed children/adolescents (75 children and 45 adolescents) from the multi-drug resistant tuberculosis sites underwent the complex clinical radiological and immunological examination. Insignificant functional disorders of cellular response (immunoregulatory processes) caused by the prevalence of suppressor and cytotoxic reactions by 1.3 times and by the prevalence of pro-inflammatory cytokines in the regulatory system (2.0 times above the norm, TNF-α/IL 10.0. р<0.01) were revealed in the infected children/adolescents from the multi-drug resistant tuberculosis sites, while their СD3+. СD3+СD4+. СD3+СD8+ were within norm. The evident disorders of the regulatory system and cell immune system were eliminated after the completion of the autumn-spring BI-V course. The non-specific immune regulator BI-V is efficient for the prevention of multi-drug resistant tuberculosis for the exposed children/adolescents from the multi-drug tuberculosis sites. Consequently, the latent TB infection grew into the active form by 2.8 times less often in the children that took BI-V as compared to the infected children who did not take the drug.
... [17] The most frequently identified deficiency was vitamin D deficiency, and its high occurrence concurs with the findings of earlier reports. [18] This was anticipated because vitamin D deficiency is slowly being documented as a serious public health problem from a global perspective. [19] This deficiency is generally linked to the usage of sunscreen and the tendency to avoid the sun. ...
A BSTRACT
Background
Patients with diabetes are at risk for developing diabetic foot ulcers (DFUs). It is recognized that type 2 diabetes (T2D) is distinguished by the loss of vitally important micronutrients because of the metabolic nature of this disease and its associated complexities.
Objective
This study was performed to determine the level of micronutrients in patients with DFUs in Saudi Arabia. From February to May 2022, this descriptive study was conducted, adopting the cross-sectional design and a group of 88 patients with T2D.
Materials and Methods
Applying the convenience sampling method, this study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Data collection was conducted through a standard questionnaire, and details regarding the demographic variables and micronutrient deficiency were collected.
Results
Among the nutritional deficiencies identified, the one with the highest frequency was vitamin D, observed in 43.2% of the patient population; after vitamin D, in order of descent, were low ferritin levels (29.5%), B12 (13.6%), and the folic acid deficiency (12.5%). Folic acid showed a statistically significant difference among patients with cardiovascular disease (CVD) ( P = 0.041). Moreover, vitamin B12 showed a significant association among patients who have charcot foot ( P = 019) and previous amputation ( P = 0.029).
Conclusion
Vitamin B12 deficiency is significantly associated with patients who had an amputation; having charcot foot and folic acid revealed a vital relationship among patients with DFUs having CVD. Comprehensive research is a pressing need to enable deeper awareness of micronutrient deficiencies in patients with diabetes.
... Globally, there is a lack of awareness and education about vitamin D, which may be a contributing cause to the widespread prevalence of vitamin D insufficiency. [20,21] Vitamin D insufficiency is frequent in Saudi Arabia. The inability to acquire sufficient sun exposure has a significant impact on vitamin D levels. ...
Vitamin D deficiency is a common health problem among adults in Saudi Arabia, particularly females. Vitamin D deficiency is associated with many diseases, including cardiovascular diseases, diabetes, autoimmune diseases, neurological disorders, and cognitive decline. This study aimed to assess the knowledge, awareness and practice of vitamin D deficiency among female students in Jazan University as well as to determine the sociodemographic related factors. A cross-sectional study was conducted among 204 female undergraduate and postgraduate students (18 years of age and older) in March 2022 from Saudi Arabia. Students completed a web-based survey about vitamin D and their demographic characteristics. Statistical analyses were conducted using Statistical Package for the Social Sciences software. Descriptive statistics, the Chi-squared test of homogeneity, and univariate and multivariate logistic regression were used. The results revealed that the participants had limited knowledge related to vitamin D normal level (49.5%), and the recommended daily amount of vitamin D (26.5%). Most of the participants were unaware of its benefits for vision, muscle integrity, weakness, and fatigue. Most of them recognized the importance of sunlight for maintaining suitable levels of vitamin D (94.1%). However, only 43.1% identified that decreased intake of foods rich in vitamin D is a cause of vitamin D deficiency. Participants (33.7%) preferred exposure to sunlight to improve their vita-min D levels, and 32.4% used vitamin D supplements. However, only 39.2% had ever examined their vitamin D status. Univariate and multivariate logistic regression models demonstrated a significant association between knowledge, and residence, and source of information (odds ratios = 3.48 and 2.79, respectively, P < .05). Most respondents had a basic understanding of vitamin D, vitamin D insufficiency, and the environmental and dietary factors contributing to it. Given the findings obtained, cognitive interventions need to be carried out.
... Vitamin D deficiency (VDD) is still one of the major clinical concerns of public health, which is one of the preventable health concerns worldwide [1]. Most of the adult population has reported to have various metabolic diseases along with depression, cognitive outcomes, obesity, immune disorders, brain dysfunction, cancer, and many more, which are reported to be linked with VDD [2]. ...
Combined test formulations including extract, minerals and vitamins are extensively used worldwide for wide range of disorders. A novel proprietary formulation was designed that consist of minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, alpha tocopherol, cyanocobalamin, and cholecalciferol), Panax ginseng extract, β-carotene, and cannabidiol isolate. This formulation was tested and evaluated for the impact of Consciousness Energy Healing/Blessing Treatment (the Trivedi Effect®) on a novel test formulation in male Sprague Dawley (SD) rats, fed with vitamin D3 deficiency diet (VDD) for immunomodulatory activity. The novel test formulation was divided into two parts, one section was defined as the untreated test formulation, while the other part was defined as the Biofield Energy Treated/Blessed sample, which received the Biofield Energy Healing Treatment/Blessing by renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. Platelet counts were increased by 12.43% in the Biofield Energy Treated test formulation from day -15 (G7) group as compared with the G4 group. Total cholesterol was decreased by 15.01%, 12.34%, and 14.80% was reported in the G5, G6, and G9 groups, respectively as compared with the G4 group. The level of LDL was significantly reduced by 40.66% (p≤0.05), 33.38% (p≤0.05), 36.75% (p≤0.05), 27.37%, and 20.54% in the test groups viz. G5, G6, G7, G8, and G9 groups, respectively as compared with the G4 group. VLDL was significantly decreased by 10.31% and 37.63% (p≤0.01) in the G5 and G6 groups, respectively as compared with the G4. The level of triglycerides was significantly (p≤0.01) reduced by 38.13% in the G6 group as compared with the G4 group. Calcium level was significantly (p≤0.001) improved by 16.01%, 18.91%, and 14.7% in the G5, G7, and G8 groups, respectively as compared with the G4 group. Hormonal profile data suggested that testosterone was showed increased by 603.56%, 155.39%, 334.30%, 174.24%, and 224.39% in the G5, G6, G7, G8, and G9 groups, respectively while, serum corticosterone level was reported to be decreased by 13.94%, 23.61%, and 22.13% in the G6, G8, and G9 groups, respectively as compared with the G4 group. Organ histopathological analysis suggested that findings were spontaneous or incidental in nature, representing the normal physiological/metabolic or congenital changes encountered all the experimental groups. Altogether, the Biofield Treated test formulation and Biofield Energy Treatment per se significantly improved the immune-related parameters along with hormones like testosterone and corticosterone, which might be beneficial for the management of immune-compromised patients as well as to boost-up the immunity in healthy peoples. Overall, the results showed the significant slowdown the disease progression and disease-related all other complications/symptoms in the preventive Biofield Energy Treatment group per se and/or Biofield Energy Treated Test formulation groups (viz. G6, G7, G8, and G9) comparatively with the disease control group.
... Vitamin D deficiency (VDD) is still one of the major clinical concerns of public health, which is one of the preventable health concerns worldwide [1]. Most of the adult population has reported to have various metabolic diseases along with depression, cognitive outcomes, obesity, immune disorders, brain dysfunction, cancer, and many more, which are reported to be linked with VDD [2]. ...
Combined test formulations including extract, minerals and vitamins are extensively used worldwide for wide range of disorders. A novel proprietary formulation was designed that consist of minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, alpha tocopherol, cyanocobalamin, and cholecalciferol), Panax ginseng extract, β-carotene, and cannabidiol isolate. This formulation was tested and evaluated for the impact of Consciousness Energy Healing/Blessing Treatment (the Trivedi Effect®) on a novel test formulation in male Sprague Dawley (SD) rats, fed with vitamin D3 deficiency diet (VDD) for immunomodulatory activity. The novel test formulation was divided into two parts, one section was defined as the untreated test formulation, while the other part was defined as the Biofield Energy Treated/Blessed sample, which received the Biofield Energy Healing Treatment/Blessing by renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. Platelet counts were increased by 12.43% in the Biofield Energy Treated test formulation from day -15 (G7) group as compared with the G4 group. Total cholesterol was decreased by 15.01%, 12.34%, and 14.80% was reported in the G5, G6, and G9 groups, respectively as compared with the G4 group. The level of LDL was significantly reduced by 40.66% (p≤0.05), 33.38% (p≤0.05), 36.75% (p≤0.05), 27.37%, and 20.54% in the test groups viz. G5, G6, G7, G8, and G9 groups, respectively as compared with the G4 group. VLDL was significantly decreased by 10.31% and 37.63% (p≤0.01) in the G5 and G6 groups, respectively as compared with the G4. The level of triglycerides was significantly (p≤0.01) reduced by 38.13% in the G6 group as compared with the G4 group. Calcium level was significantly (p≤0.001) improved by 16.01%, 18.91%, and 14.7% in the G5, G7, and G8 groups, respectively as compared with the G4 group. Hormonal profile data suggested that testosterone was showed increased by 603.56%, 155.39%, 334.30%, 174.24%, and 224.39% in the G5, G6, G7, G8, and G9 groups, respectively while, serum corticosterone level was reported to be decreased by 13.94%, 23.61%, and 22.13% in the G6, G8, and G9 groups, respectively as compared with the G4 group. Organ histopathological analysis suggested that findings were spontaneous or incidental in nature, representing the normal physiological/metabolic or congenital changes encountered all the experimental groups. Altogether, the Biofield Treated test formulation and Biofield Energy Treatment per se significantly improved the immune-related parameters along with hormones like testosterone and corticosterone, which might be beneficial for the management of immune-compromised patients as well as to boost-up the immunity in healthy peoples. Overall, the results showed the significant slowdown the disease progression and disease-related all other complications/symptoms in the preventive Biofield Energy Treatment group per se and/or Biofield Energy Treated Test formulation groups (viz. G6, G7, G8, and G9) comparatively with the disease control group.
... Vitamin D deficiency (VDD) is still one of the major clinical concerns of public health, which is one of the preventable health concerns worldwide [1]. Most of the adult population has reported to have various metabolic diseases along with depression, cognitive outcomes, obesity, immune disorders, brain dysfunction, cancer, and many more, which are reported to be linked with VDD [2]. ...
Combined test formulations including extract, minerals and vitamins are extensively used worldwide for wide range of disorders. A novel proprietary formulation was designed that consist of minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, alpha tocopherol, cyanocobalamin, and cholecalciferol), Panax ginseng extract, β-carotene, and cannabidiol isolate. This formulation was tested and evaluated for the impact of Consciousness Energy Healing/Blessing Treatment (the Trivedi Effect®) on a novel test formulation in male Sprague Dawley (SD) rats, fed with vitamin D3 deficiency diet (VDD) for immunomodulatory activity. The novel test formulation was divided into two parts, one section was defined as the untreated test formulation, while the other part was defined as the Biofield Energy Treated/Blessed sample, which received the Biofield Energy Healing Treatment/Blessing by renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. Platelet counts were increased by 12.43% in the Biofield Energy Treated test formulation from day -15 (G7) group as compared with the G4 group. Total cholesterol was decreased by 15.01%, 12.34%, and 14.80% was reported in the G5, G6, and G9 groups, respectively as compared with the G4 group. The level of LDL was significantly reduced by 40.66% (p≤0.05), 33.38% (p≤0.05), 36.75% (p≤0.05), 27.37%, and 20.54% in the test groups viz. G5, G6, G7, G8, and G9 groups, respectively as compared with the G4 group. VLDL was significantly decreased by 10.31% and 37.63% (p≤0.01) in the G5 and G6 groups, respectively as compared with the G4. The level of triglycerides was significantly (p≤0.01) reduced by 38.13% in the G6 group as compared with the G4 group. Calcium level was significantly (p≤0.001) improved by 16.01%, 18.91%, and 14.7% in the G5, G7, and G8 groups, respectively as compared with the G4 group. Hormonal profile data suggested that testosterone was showed increased by 603.56%, 155.39%, 334.30%, 174.24%, and 224.39% in the G5, G6, G7, G8, and G9 groups, respectively while, serum corticosterone level was reported to be decreased by 13.94%, 23.61%, and 22.13% in the G6, G8, and G9 groups, respectively as compared with the G4 group. Organ histopathological analysis suggested that findings were spontaneous or incidental in nature, representing the normal physiological/metabolic or congenital changes encountered all the experimental groups. Altogether, the Biofield Treated test formulation and Biofield Energy Treatment per se significantly improved the immune-related parameters along with hormones like testosterone and corticosterone, which might be beneficial for the management of immune-compromised patients as well as to boost-up the immunity in healthy peoples. Overall, the results showed the significant slowdown the disease progression and disease-related all other complications/symptoms in the preventive Biofield Energy Treatment group per se and/or Biofield Energy Treated Test formulation groups (viz. G6, G7, G8, and G9) comparatively with the disease control group.
... The prevalence of Vit. D de ciency is reported in a wide range of 10%-70% in different countries (2)(3)(4)(5). It is well-known that Vit. ...
Background:This study sought to determine the accuracy of several anthropometric parameters in association with serum vitamin D (Vit. D) Concentrations and to compare the novel indices with the ancient ones.
Methods: A total of 947 patients referred to the cardiology clinic were evaluated through a cross-sectional study. Data on demographic information, anthropometric indices, and biochemical measurements were gathered using a checklist. Both the multivariable regression modeling and area under the receiver-operating characteristic (ROC) were employed for the analysis.
Results:Considering novel indices, BRI (Body Roundness Index) showed the most powerful correlation with serum Vit. D levels among both genders. Among ancient indices, WC (Waist Circumference) had the strongest association in both men and women groups. Based on the confounding factors-adjusted model, the highest odds ratio (OR) for the presence of Vit. D deficiency belonged to WHtR (Waist to Height Ratio) in women (OR, 0.347 (0.171-0.704) , P=0.003) while none of the indices predicted Vit. D deficiency significantly among men. A Vit. D concentration of 4.55 ng/ml was found as a cutoff based on the metabolic syndrome status.
Conclusion: The most powerful association with serum Vit. D levels was detected for BRI in both genders among newly developed indices. In addition, only WHtR predicted Vit. D deficiency independent of confounding factors among women.
... Based on this cutoff, it has been reported that approximately 30% of children and adults worldwide have vitamin D deficiency. Consistently, Robin et al. showed that 31% of Australian adults aged 25 years and older were vitamin D deficient [22]. The prevalence of low levels of vitamin D was highest in Asia, the Middle East, and Africa [23]. ...
The relationship between vitamin D deficiency and sensitivity to thyroid hormones was unclear. We aimed to explore the association of 25-hydroxyvitamin D (25(OH)D) levels with thyroid hormone sensitivity in euthyroid adults. A total of 3143 subjects were included. The serum 25(OH)D, free thyroxine (FT3), free thyrotropin (FT4), thyroid-stimulating hormone (TSH), and other clinical variables were measured. Vitamin D deficiency was defined as 25(OH)D < 20 ng/mL. Thyroid feedback quantile-based index (TFQI), parametric thyroid feedback quantile-based index (PTFQI), thyroid-stimulating hormone index (TSHI), thyrotrophic thyroxine resistance index (TT4RI), and FT3/FT4 were calculated to assess thyroid hormone sensitivity. Results showed that 58.8% of the participants had vitamin D deficiency. They had significantly higher levels of triglyceride, insulin, FT3, FT4, TSH, TFQI, PTFQI, TSHI, and TT4RI and lower levels of high-density lipoprotein cholesterol than those with sufficient vitamin D (all p < 0.05). Logistic regression analysis showed that the risk of impaired sensitivity to thyroid hormones evaluated by TFIQ, PTFQI, TSHI, and TT4RI increased by 68% (OR: 1.68; 95%CI: 1.45–1.95; and p < 0.001), 70% (OR: 1.70; 95%CI: 1.46–1.97; and p < 0.001), 66% (OR: 1.66; 95%CI: 1.43–1.92; and p < 0.001), and 50% (OR: 1.50; 95%CI: 1.30–1.74; and p < 0.001), respectively, in participants with vitamin D deficiency compared with those with sufficient vitamin D after adjusting for multiple confounders. In conclusion, in euthyroid populations, vitamin D deficiency was associated with impaired sensitivity to thyroid hormones.
... Although the results obtained in this study showed that vitamin D supplementation had a positive effect on improving vitamin D status, VDD is still considered a prevalent health problem in Iran (30). Studies conducted in other nations, such as Finland and Australia, showed that once vitamin D policies were put in place, vitamin D status increased considerably (31,32). On the other hand, studies in some other countries showed that despite the existence of vitamin D programs, vitamin D status was undesirable (33, 34). ...
Aim
Iran has a higher prevalence of vitamin D deficiency (VDD) than the global level. This study aimed to assess VDD prevention policies in Iran through a policy analysis of agenda setting using the multiple streams framework (MSF).
Methods
Using Kingdon's MSF model, this qualitative analytical study performed a policy analysis on vitamin D-related policies in Iran. The policy documents were reviewed, and in-depth interviews were conducted with stakeholders (n = 27) using the framework analysis method. To categorize data and extract the related themes, MAXQDA version 10 was used.
Results
According to Kingdon's MSF theory, the problem stream included the high prevalence of VDD among Iranian infants (23.3%), adolescents (76%), and adults (59.1%). The policy stream was identified to focus on preventing programs for non-communicable diseases in the health sector. The political stream indicated that national and international support could provide a political climate for this issue.
Conclusion
According to our results, a window of opportunity for policymaking on VDD prevention has opened. However, there are some challenges related to the implementation of these policies. These include the dominance of a treatment-based view rather than a prevention-based approach in the health sector, economic problems, and restricted access to health services due to the outbreak of coronavirus disease 2019 (COVID-19). To strengthen and implement VDD prevention policies, the stakeholders need support from high-level policymakers.
... Epidemiologic studies worldwide estimate vitamin D deficiency rates to be between 13% and 79% [44][45][46][47][48][49]. In the USA, 28.9-66% of individuals may be vitamin D deficient, with vitamin D insufficiency occurring at an even higher rate [44,45]. ...
Photorefractive keratectomy (PRK) is a safe and popular corneal surgery performed worldwide. Nevertheless, there is potential risk of corneal haze development after surgery. Proper management of post PRK haze is important for good visual outcome. We performed a comprehensive review of the literature on the various risk factors and treatments for PRK haze, searching the PubMed, Google Scholar, SCOPUS, ScienceDirect, and Embase databases using relevant search terms. All articles in English from August 1989 through April 2023 were reviewed for this study, among which 102 articles were chosen to be included in the study. Depending on the characteristics of and examination findings on post PRK haze, different management options may be preferred. In the proposed framework, management of PRK haze should include a full workup that includes patient's subjective complaints and loss of vision as well as visual acuity, biomicroscopy, anterior segment optical coherence tomography, epithelial mapping, and Scheimpflug densitometry. Topical steroid treatment for haze should be stratified based on early- or late-onset haze. Mechanical debridement or superficial phototherapeutic keratectomy (PTK) may be used to treat superficial corneal haze. Deep PTK and/or PRK can be used to treat deep corneal haze. Mitomycin-C and topical steroids are prophylactic post-surgery agents to prevent recurrence of haze.
... 23 Another study showed that female children are more prone to have VDD. 24 Notable inclination in the occurrence of VDD was observed in the younger age groups. Ziegler EE et al analyzing breastfed infants showed that infants were most affected with VDD. 25 Another study shared that 76% breastfeeding infants had VDD. ...
Objective: To find out the frequency of vitamin D deficiency (VDD) in healthy children. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, Sahiwal Teaching Hospital, Sahiwal. Period: July 2022 to December 2022. Material & Methods: A total of 80 healthy children of either gender aged 6 to 36 months visiting outpatients department of pediatrics during the study period adopting convenient sampling technique were included. At the time of enrollment, demographic information was recorded and blood sample was obtained and sent for vitamin D analysis. The frequency of VDD was noted. Results: In a total of 80 children, 48 (60.0%) were boys and 32 (40.0%) girls. The mean age was of 14.4±6.2 months. Residential status of 47 (58.3%) children was rural. Evaluation of vitamin D status revealed that 16 (20.0%) children had sufficient levels while deficiency and severe deficiency were noted in 44 (55.0%) and 20 (25.0%) children respectively. Younger age group was having significant linkage with VDD (p=0.0135). Conclusion: The frequency of vitamin D deficiency was very high among healthy children visiting a tertiary care health facility of Punjab, Pakistan. Younger age groups had significant association with the occurrence of vitamin D deficiency.
... It is estimated that one billion people globally are deficient in vitamin D (25(OH)D concentrations less than 50 nmol/L) with a prevalence of up to or over 50% being reported in some population-based studies [5]. For example, studies have reported vitamin D deficiency to be in approximately 25% of the population in Canada, 31% in Australia, 45-52% in New Zealand, 22-36% in the USA, and 47-65% in Republic of Korea [6]. A large-scale assessment of vitamin D status in Thailand reported a incidence rate of 45.2% for vitamin D insufficiency (25(OH)D less than 75 nmol/L) and 5.7% for vitamin D deficiency (25(OH)D less than 50 nmol/L) [7]. ...
This study investigated the vitamin D level of nine species of cultivated mushrooms and three species of wild mushrooms commonly consumed in Thailand and the effect of cooking on their vitamin D content. Cultivated mushrooms were obtained from three wholesale markets, while wild mushrooms were collected from three trails in a conservation area. Mushrooms from each source were separated into four groups: raw, boiled, stir-fried, and grilled. Different forms of vitamin D were analyzed using liquid chromatography with tandem mass spectrometry (LC-MS/MS). The analyzed method demonstrated good linearity, accuracy, and precision, as well as being low in the limit of detection and limit of quantitation. Results showed that vitamin D2 and ergosterol (provitamin D2) were the major forms of vitamin D found in the mushrooms. Both raw cultivated and wild mushrooms had wide ranging ergosterol contents (7713–17,273 µg/100 g edible portion, EP). Lung oyster mushroom and termite mushroom contained high levels of vitamin D2 (15.88 ± 7.31 and 7.15 ± 0.67 µg/100 g EP, respectively), while other mushroom species had negligible amounts (0.06 to 2.31 µg per 100 g EP). True retention (TR) levels of vitamin D2 after boiling, stir-frying, and grilling were not significantly different (p > 0.05) (with estimated marginal means ± standard error 64.0 ± 2.3%, 58.8 ± 2.3%, and 64.7 ± 3.6% TR, respectively). Consuming cooked lung oyster mushrooms, in particular, along with regular exposure to sunlight should be promoted to reduce the incidence of vitamin D deficiency.
... Дослідження R.M. Daly та співавт. [19] свідчать, що дефіцит вітаміну D в 3-4 рази вищий у зимовий і весняний період, ніж улітку, та вдвічі більший в осіб, які проживають на широті 35°. Проаналізувавши 12 досліджень сезонності захворювань у 1971-2006 рр. ...
Objective — to study the need of using the natural immunomodulator ВІ-V for contact children and adolescents from focies of multidrug-resistant tuberculous infection (MDR-TBI) for a non-specific immunoprevention of tuberculosis (TB). Materials and methods. A retrospective analysis of the medical records of 120 contacts (75 children and 45 adolescents) from focies of MDR-TBI and 102 adult with TB, who became the source of infection was carried out. Microbiological examination in adults included the detection of Mycobacterium tuberculosis (MBT) in sputum by smear microscopy, sowing of material on Levenstein—Jensen medium, typing of isolated MBT on BACTEC MGIT 960, determination of the drug susceptibility test (DST) of MBT to antimycobacterial drugs (AMBDs) of first- and second-line, as well as molecular genetic researched of sputum, in particular by the method of GeneXpert MTB/RIF and linear probe analysis. In the contact children from focies of MDR-TBI the determination of the population and subpopulation composition of blood lymphocytes was carried out among 25 children before and among 22 children after immunoprevention. Results and discussion. Most contact children and adolescents (61.7 %) from focies of MDR-TBI had concomitant diseases. The prophylactic administration of the BI-V immunomodulator reduced the frequency of acute respiratory viral infections and exacerbations of non-specific bronchopulmonary diseases by 2.0 times, the development of an active process from the latent tuberculous infection by 2.6 times, the frequency of transformation of latent tuberculosis infection into an active process by 2.6 times, improved appetite, memory, learning outcomes and increased physical activity. The latent tuberculous infection based on the Mantoux test results was found in 82.5 % (99) children. The quantiferon test confirmed the presence of a latent form of tuberculosis in 104 (86.7 %) contacts, the rest of the test results were negative. In children who received ВІ-V, latent tuberculous infection turned into an active process 2.8 times less often than in infected children who did not take this immunomodulator. The existing deviations into the regulatory system and the cellular response system disappeared after the autumn-spring course of ВІ-V. Conclusions. Immunomodulator ВІ-V is an effective preventive means for bronchopulmonary diseases, including MDR-TB among contact children and adolescents from focies of MDR-TBI.
... A study conducted in Australia in which 11,247 adults from 42 randomly selected districts were studied and exhibited 31% deficiency (Daly et al., 2012). Recent studies demonstrate safety and efficacy of community-based vitamin D supplementation trials and food staple fortification introduced in countries without fortification policies. ...
Background: world over. There is relative lack of prevalence data in Southern Punjab, study is carried out to assess the prevalence of vitamin D deficiency in Southern Punjab population of Pakistan. Study Design: conducted fr Materials and Methods subjects were collected in EDTA tube and plasma was separated via centrifugation at 4,000 rpm for 5 minutes. The test principle is based on chemiluminescent emission which is measured by photomultiplier. The reaction mixture is aspirated into the me onto the surface of the electrode. Unbound substances are then removed with Procell. was done using Chi Results 64(14.22%) of the total sample size. The mean age of respondents was 44.53 years (age range 10 .Levels of 25(OH)D level in ng/ml was measured in four categories. In total no's (both males and femal the vitamin D deficient range (<10ng/ml) was 148(32.88%), the insufficient range(10 173(38.44%), 59(13.11%) subjects. In the total subjects the deficiency of vit D observed was 88.33% in females and 78.11% in males. A significant gender showing higher prevalence of deficiency compared to men (distribution showed that deficiency was higher in persons in age ranging from 50 age ranging from 10 Conclusion: vitamin D deficiency was greater in females as compared to males. The vit D deficiency was higher in people above 50y. There is a need to take immediate measures to t Copyright©2016, Rubaida Mahmood et al. This is an open access article distributed under the Creative Commons Att use, distribution, and reproduction in any medium, provided the original work is properly cited.
... In the United States and Canada, 24% and 37%, respectively, are vitamin D-deficient [34]. Over one-third of Australia's population suffers from vitamin D deficiency [35]. ...
Interest in the immunomodulatory function of vitamin D has grown since the COVID-19 pandemic started. Our study investigated the possible association between vitamin D deficiency and COVID-19 severity, intensive care needs, and mortality in patients hospitalized with COVID-19. A prospective cohort study was performed on 2342 COVID-19 hospitalized patients between April 2020 and May 2022 in a Romanian tertiary hospital for infectious diseases. A multivariate generalized linear model for binary data was fit with dependent variables: severe/critical form of COVID-19, intensive care need, and fatal outcome as a function of vitamin D deficiency, controlling for age, comorbidities, and vaccination status. More than half of the patients (50.9%) were classified with vitamin D deficiency based on a serum concentration of less than 20 ng/mL. There was a negative association between vitamin D and age. Vitamin D-deficient patients presented with more cardiovascular, neurological, and pulmonary diseases, as well as diabetes, and cancer. In multivariate logistic regression models, vitamin D-deficient patients had higher odds of severe/critical forms of COVID-19 [OR = 1.23 (95% CI 1.03–1.47), p = 0.023] and higher odds of death [OR = 1.49 (95% CI 1.06–2.08), p = 0.02]. Vitamin D deficiency was associated with disease severity and death outcome in hospitalized COVID-19 patients.
... The relation between sex differences in the status of VD is a new concept, and the independence investigations have been rarely carried out [10,11]. A few study suggested that significant VD abnormality in female sex [11,12]. ...
... Around 60-70% population in Southeast Asia and 70% in South Asia are affected by vitamin D deficiency (Lee et al. 2015). Among the developing countries of South Asia, India occupies a larger share of the vitamin D deficient population, where poverty and malnutrition prevail in most society and further exacerbate the magnitude of an epidemic (Daly et al. 2012). South Asian countries are relatively more affected with vitamin D deficiency for certain predominant factors like lifestyle, socio-economic and cultural taboos, genetic factors, and inadequate dietary intake of vitamin D (Hossein et al. 2013). ...
... Especially the elderly people are at high risk for deficiency (6,14). In our study, the average vitamin D values of our patients were found to be below our reference laboratory Our study has resulted in a similar way in this respect with studies in the literature showing a higher rate of moderate vitamin D insufficiency in women (15)(16)(17). ...
Objective: 25-OH Vitamin D is well known that has an important role in the perception of pain. Vitamin D insufficiency is important health problem all over the world. Most of the research related to vitamin D and pain is about chronic pain. In this study, it was investigated whether there is an association between Vitamin D levels and acute postoperative pain.Methods: Preoperative Vitamin D levels were measured in patients who underwent elective hip replacement. Patients undergoing spinal anesthesia were administered patient-controlled analgesia (PCA). Patients whose pain assessment was performed with the postoperative visual analog scale (VAS), the time of initial analgesic administration, the number of analgesic needs, the number of bolus opioid use and additional NSAID use were evaluated. Results: It has seen that a negative correlation between the vitamin D values and postoperative VAS scores. It was determined that patients with low vitamin D had earlier postoperative first analgesic administration time. It was also determined that as the vitamin D values decreased, the number of bolus opioids and total analgesic requirements used was higher. Conclusion: In postoperative pain, low preoperative vitamin D level caused an increase in VAS scores and analgesic need and patients have low vitamin D also had earlier analgesic administration time.
... Participants were asked to specify their highest levels of education completed and responses were coded into three categories: (a) none, primary or some high school, (b) completed high school, year 12 or equivalent, or (c) completed university, TAFE, or equivalent. Previous classifications for ethnicity utilised in this dataset, characterised by 'Europid' or 'non-Europid' , were employed [45,46]. Europids included those both in Australia, Canada, USA, New Zealand and Northern Europe, whereas non-Europids included individuals born in Southern Europe, the Middle East, Asia, India and Sri Lanka, Africa, Pacific Islands, and South and Central America. ...
Background
Mounting evidence highlights the importance of combined modifiable lifestyle factors in reducing risk of cognitive decline and dementia. Several a priori additive scoring approaches have been established; however, limited research has employed advanced data-driven approaches to explore this association. This study aimed to examine the association between data-driven lifestyle profiles and cognitive function in community-dwelling Australian adults.
Methods
A cross-sectional study of 4561 Australian adults (55.3% female, mean age 60.9 ± 11.3 years) was conducted. Questionnaires were used to collect self-reported data on diet, physical activity, sedentary time, smoking status, and alcohol consumption. Cognitive testing was undertaken to assess memory, processing speed, and vocabulary and verbal knowledge. Latent Profile Analysis (LPA) was conducted to identify subgroups characterised by similar patterns of lifestyle behaviours. The resultant subgroups, or profiles, were then used to further explore associations with cognitive function using linear regression models and an automatic Bolck, Croon & Hagenaars (BCH) approach.
Results
Three profiles were identified: (1) “Inactive, poor diet” (76.3%); (2) “Moderate activity, non-smokers” (18.7%); and (3) “Highly active, unhealthy drinkers” (5.0%). Profile 2 “Moderate activity, non-smokers” exhibited better processing speed than Profile 1 “Inactive, poor diet”. There was also some evidence to suggest Profile 3 “Highly active, unhealthy drinkers” exhibited poorer vocabulary and verbal knowledge compared to Profile 1 and poorer processing speed and memory scores compared to Profile 2.
Conclusion
In this population of community-dwelling Australian adults, a sub-group characterised by moderate activity levels and higher rates of non-smoking had better cognitive function compared to two other identified sub-groups. This study demonstrates how LPA can be used to highlight sub-groups of a population that may be at increased risk of dementia and benefit most from lifestyle-based multidomain intervention strategies.
Background
The relationship between vitamin D and depression has garnered significant attention in recent years. However, the efficacy of vitamin D in ameliorating depression among specific subgroups of older patients remains controversial. This study aimed to assess the impact of vitamin D supplementation on depressive symptoms and the prevalence of depression in older adults. Additionally, the study sought to examine potential moderating factors, including differences among population subgroups and various supplementation strategies.
Methods
A systematic literature search was conducted in the databases PubMed, EMBASE, Web of Science, and the Cochrane Library up to March 2024. The RevMan 5.3 software was utilized to calculate the standardized mean difference (SMD) and to evaluate the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The objective was to determine the efficacy of vitamin D supplementation in alleviating depressive symptoms or treating depression in older adults.
Results
This meta-analysis encompassed eleven studies, comprising a total of 21,561 participants. The findings did not indicate a statistically significant therapeutic benefit of vitamin D supplementation for depression in older patients [SMD: −0.10; 95% CI: (−1.19, 0.00); p = 0.05]. Subgroup analyses revealed that the efficacy of vitamin D intervention in geriatric depression correlated with several factors, including baseline serum 25(OH)D levels, the dosage of the intervention, gender, and the initial presence of depressive symptoms or a diagnosis of depression.
Conclusion
The current evidence is insufficient to conclusively establish the significant efficacy of vitamin D supplementation in alleviating depressive symptoms among older patients. Consequently, additional randomized controlled trials are warranted to further validate the relationship between vitamin D supplementation and depression in the older adults.
Purpose
To investigate the associations between circulating micronutrients (vitamins A, C, D, E, and carotenoids) and the risk of myopia.
Methods
A total of 1,620 adolescents from the 2003–2006 National Health and Nutrition Examination Survey (NHANES) were included. Logistic regression was used to analyze the associations of micronutrients with myopia and high myopia. Restricted cubic spline analysis was employed to assess the potential nonlinear relationships.
Results
Among the 1,620 adolescents, 549 were diagnosed with myopia. After adjusting for multiple covariates, only cis-β-carotene was significantly associated with the risk of myopia (OR 1.19, 95% CI 1.03–1.39) and high myopia (OR 1.44, 95% CI 1.03–2.03). No significant associations were found between vitamins A, D, E, C, α-carotene, trans-β-carotene, lutein zeaxanthin, and myopia. No nonlinear relationships were observed between any of the micronutrients and myopia.
Conclusion
Cis-β-carotene is significantly associated with an increased risk of myopia and high myopia. Further research is needed to understand the underlying mechanisms and potential impact of cis-β-carotene on ocular health.
Osteoporosis is a major global health problem. The increase in the incidence of osteoporosis in the elderly poses a challenge to treat and also results in an economic burden for the nation. Osteoporosis has been given more importance in females, and there is an urgent need to address this disease in males. Various drugs, such as nitrogen-containing phosphonates, RANK ligand inhibitors, parathormones, and alendronate, have been used for effective treatment of osteoporosis. Alendronate (alendronic acid), a nitrogen-containing bisphosphonate that inhibits bone resorption by osteoclasts, was synthesized during the 1970s. In the present review, we discuss the pharmacokinetics, mechanism of action, adverse effects, contraindications, and toxicity monitoring of alendronate. The drug may be effectively used for the treatment of male osteoporosis in order to increase bone mineral density and prevent fractures.
Polyphenol is a plant compound that can act as an antioxidant and neutralize free radicals that cause damage to body cells and cause cancer and other diseases. Regular consumption of polyphenols is believed to improve digestion and increase brain health, as well as protect the body against various diseases such as type 2 diabetes and heart disease. Dark chocolate, tea, and berries are among the most well-known sources of polyphenols. This compound can act as an antioxidant and neutralize free radicals that damage body cells and cause cancer and other diseases. Also, reducing inflammation can prevent the occurrence of many chronic diseases. Flavonoids are a diverse group of plant compounds found in many fruits and vegetables. For example, plant products such as tea and chocolate are good sources of flavonoids. Flavonoids have strong antioxidant properties that play a prominent role in eliminating toxins and fighting oxidative stress. Eating foods rich in flavonoids is an excellent way to improve health and reduce the risk of diabetes, cancer, and cardiovascular disease.
Food is a source of carbohydrates, proteins, lipids, vitamins, and minerals that are necessary for growth and maintaining human health. Food bioactive compounds (FBCs) are present in small quantities in a complex matrix and are difficult to extract, isolate, and identify for their appropriate utilization. For the extraction, advanced green technologies such as ultrasound-assisted extraction (UAE), microwave-assisted extraction (MAE), supercritical-fluid extraction (SFE), and enzyme-assisted extraction (EAE) are commonly applied, and for the isolation and purification of these FBCs, medium-pressure liquid chromatography (MPLC), counter-current chromatography (CCC), preparative-high performance liquid chromatography (prep-HPLC), column chromatography, and preparative-thin layer chromatography are successfully applied. After isolation, these FBCs are identified by spectroscopic techniques such as UV–visible spectroscopy, FT-IR, NMR, and mass spectroscopy. This chapter comprises basic methods and techniques applied for the extraction, isolation, purification, and identification of FBCs from different food sources.
The aim of the study - to study the feasibility of using the natural immunomodulator BIVEL (conditionally called BI-V) as a nonspecific immunoprevention of tuberculosis (TB) among contacted children from the focies of chemodrug-resistant tuberculosis infection on the basis of clinical and immunological researches. Research metods. The object of study was 120 contacted from multidrug-resistant tuberculosis infection (FsMDR-TBI) including 75 children and 45 adolescents. The first contact group included 95 children/adolescents who did not receive BI-V and the second one ‒ 25 infected children/adolescents who received BI-V. Immunological studies determining the state of the phagocytic reactivity of immunity (phagocytic number and index, testes redox activity of neutrophils and non-enzymatic cationic lysosomal proteins of granulocytic leukocytes; cellular (CD3+, CD56+, CD3+HLA-DR+, CD4+, CD8+, CD4+/CD8+, CD4+45RA, CD16/56+) and humoral (CD19+, IgA, IgM, IgG, CIC) immunity; interleukins (TNF-α, IL-6, IL-10) and specific immunity (tuberculin diagnostics, Quantiferon test). Statistical analysis of the results obtained based on the software package Excel Results and discussion. On the background of non-specific preventive with the BI-V immunomodulator among contact infected children, normalization of blood phagocytic activity indicators was noted in the form of an increase in phagocytic number, phagocytic index, non-enzymatic cationic lysosomal proteins of granulocytic leukocytes and a decrease in HST test compared to children who had not yet received preventive BI-V. In infected children/adolescents from FsMDR-TBI, while maintaining normal values of CD3+, CD3+CD4+, CD3+CD8+, insignificant functional disorders of the cell response were revealed at the level of immunoregulatory processes due to the dominance of suppressor-cytotoxic reactions were revealed (decrease by 1.3 times IRI CD3+CD4+/CD3+CD8+, p<0.05, relative to donors), balance shift in the regulatory system of pro- and anti-inflammatory cytokines towards pro-inflammatory cytokines (increase by 2.0 times TNF-α/IL-10, p<0.01, relative to normal). The existing deviations in the regulatory system and the cellular response system disappeared after the completion of the autumn-spring BI-V course. Among the children from FsMDR-TBI who took a BI-V preventive course 8% people fell ill with various forms of primary pulmonary TB, among the children who BI-V was not prescribed ‒ 22.1%, p<0.05 during the 4-year observation. The maximum TB level occurred in the first two years of observation in both groups. Conclusions. The results of the appointment of a non-specific immunomodulator BI-V confirmed the feasibility of using this immunomodulator for contacted children and adolescents from FsMDR-TBI.
Introduction
Vitamin D deficiency is the most common nutritional deficiency worldwide. Chronic vitamin D deficiency causes immune system dysfunction, which increases susceptibility to pathogens such as bacteria, especially intracellular parasites, and viruses. Chlamydia trachomatis (C. t) is an obligate intracellular parasitic bacterium that causes a variety of sequelae. We speculated that vitamin D might be associated with C. t infection. This study aimed to address this gap in knowledge by investigating the relationship between vitamin D and C. t infection using both in vitro and in vivo models.
Methods and results
The addition of calcitriol to McCoy cell culture in vitro delayed and reduced the quantity and volume of inclusions compared to the control group. Macrophages of peritoneally lavaged mice co-cultured with McCoy decreased the infection rate and delayed the appearance of inclusions. In mice models of vitamin D deficiency, mice in the VD-group exhibited more severe genital tract inflammation and a longer duration of infection after inoculation with C. t in the genital tract. Supplementing these mice with vitamin D3 during treatment enhanced the therapeutic effect of antibiotics. We also conducted a case-control study involving 174 C. t-positive patients (95 males and 79 females) and 380 healthy volunteers (211 males and 169 females) aged 20–49 from January 2016 to March 15, 2017. Serum 25-(OH)D concentration was measured by assessing morning fasting blood samples of healthy volunteers and C. t-positive patients 1 day before antibiotic treatment and the next day after one course of treatment. The patients were followed up for 1 month and evaluated for recovery. The results showed that vitamin D deficiency was a risk factor for C. t infection and treatment failure.
Conclusion
In summary, findings from experimental and clinical studies indicate a close association between vitamin D levels and C. t infection and treatment outcomes. Given the affordability and safety of vitamin D, both healthy individuals and patients should focus on vitamin D intake. Vitamin D supplementation could enhance treatment success and should be used as an adjunctive therapy alongside antibiotic therapy for C. t infections, pending confirmation in larger, prospective, randomized controlled trials.
Prevalensi defisiensi vitamin D di negara maju dan negara berkembang berkisar antara 30%-75% dengan peningkatan risiko defisiensi pada wanita, lansia, obesitas dan individu dengan paparan sinar matahari yang rendah. Nelayan merupakan kelompok pekerja yang banyak mendapat paparan sinar matahari. Walaupun demikian, penelitian terdahulu melaporkan bahwa 4 dari 5 nelayan mengalami defisiensi vitamin D. Penelitian ini bertujuan untuk menilai kecukupan asupan vitamin D dan paparan sinar matahari pada nelayan. Penelitian potong lintang ini melibatkan kelompok nelayan di wilayah kerja beberapa puskesmas di Mataram dan Lombok Barat. Subyek terbagi menjadi dua kelompok yakni kelompok nelayan dan bukan nelayan. Variabel utama penelitian ini adalah asupan vitamin D dan paparan sinar ultra violet (UV). Sebanyak 1 dari 2 nelayan dan 3 dari 4 partisipan bukan nelayan mengalami kekurangan asupan vitamin D. Jumlah ikan yang dikonsumsi oleh kelompok nelayan dan bukan nelayan adalah 937 gram dan 652 gram perminggu. Jenis ikan terbanyak yang dikonsumsi adalah tongkol. Asupan ikan sebesar 937 gram perminggu setara dengan asupan vitamin D sebesar ~12 μg perhari dan kadar vitamin D kelompok nelayan diprediksi sebesar 23,6 nmol/L. Mayoritas subyek pada kedua kelompok tidak dapat mencapai radiasi UVB yang optimal. Kekurangan asupan vitamin D dan tidak optimalnya paparan sinar matahari didapatkan pada kelompok nelayan dan bukan nelayan.
Background: Vitamin D is a basic nutrient and plays a very crucial role in preventing various diseases, so it is known as an indicator of health and survival. Objective: This study was conducted to determine the serum level of vitamin D in women receiving vitamin supplementation in Persian Guilan cohort study (PGCS). Methods: In this analytic cross-sectional study that was conducted on PERSIAN Guilan cohort, 614 subjects from 5633 women aged 35 to 70 years old who were taking vitamin D supplements were selected through census method. Required data were collected in two sections of demographic and social characteristics and serum measurement 25-hydroxy vitamin D3 at three levels of deficient (<10), insufficient (10-20) and sufficient (>20 ng/ml). Data analysis was done using descriptive and inferential statistics. P <0.05 was considered statistically significant. Results: The mean age of people was 50.3±8.7 years, of which 5.2 % of the subjects had vitamin D deficiency, 29.5% had insufficient serum level and 65.4% subjects with sufficient serum levels. Based on the results, there was a significant relationship between employment status, place of residence and housing area with vitamin D level (P<0.05), and non-employed persons (P=0.044), living in the city (P=0.002) and a residential house with a higher area (P=0.014) had higher levels of vitamin D. There was no significant association between serum vitamin D levels with age, body mass index, marital status, alcohol consumption, level of education and how to take vitamin D supplementation. Conclusion: In the present study, about one third of vitamin consumers did not have a sufficient serum level despite taking the supplement, so it is expected that the country's health system, health officials, and policymakers pay attention to the education program of optimum consumption as well as appropriate prescription of vitamin D supplement.
Vitamin D research can vary geographically, as vitamin D status is influenced by latitude, season, dietary intake, body mass index, ethnicity, and public health initiatives. Over the last two decades, research on vitamin D has increased in Australia, where the potential for sun exposure (a major source of vitamin D) is high. We aimed to identify key topics and gaps in vitamin D research in Australia using a data-driven approach. A literature search limited to Australian studies was conducted in the Web of Science Core Collection database. Citation network analysis was conducted to identify clusters and sub-clusters, depicted using word clouds. Topic analysis of each cluster and sub-cluster was conducted to identify topics and sub-topics, respectively. From 934 publications (over the period 1984–2022), nine topics and 60 sub-topics were identified. The nine topics were: vitamin D in vulnerable populations and its impact on child development; impact of sun exposure and ultraviolet-B radiation on various health conditions; vitamin D and falls and fractures in older adults; vitamin D and its association with health outcomes; vitamin D from sun exposure; testing of vitamin D status in Australia; vitamin D, calcium, and musculoskeletal health; vitamin D status and knee osteoarthritis; and vitamin D status and exercise performance in athletes. There were limited publications on vitamin D in Aboriginal and Torres Strait Islander peoples and dietary vitamin D. We have provided an overview of vitamin D research in Australia. The research trends and knowledge gaps identified can guide future research to better inform public health initiatives in Australia.
Objective
To investigate the correlation between serum 25(OH)D and plasma fatty acid levels and the clinical stage, tumor markers, histopathology and lymph node metastasis of patients with solid tumors, so as to further understand the potential impact of vitamin D and fatty acids on breast and stomach tumors.
Methods
A real world study, cross sectional study was conducted on patients with breast malignant tumor, benign breast tumor and gastric malignant tumor who were treated in Liaoning Cancer Hospital & Institute, from April 2020 to May 2021. The general clinical data of the patients, the laboratory data of serum vitamin D and plasma fatty acid levels were collected, and the effects of serum vitamin D and plasma fatty acid levels on solid tumors were statistically analyzed.
Results
The serum 25 (OH) D level and plasma fatty acid level of tumor patients were abnormal compared with their corresponding normal standard values. The expression level of 25 (OH) D in breast malignant tumors was significantly different according to tumor stage and molecular classification (P < 0.05), indicating that the pathological features such as tumor stage and molecular classification of breast cancer may be related to the expression level of serum 25 (OH) D. Multivariate analysis showed that carcinoembryonic antigen was a significant difference between breast malignant tumors and benign breast tumors, and 25 (OH) D and eicosapentaenoic acid (DPA) were significant differences between breast malignant tumors and benign breast tumors (P < 0.1).
Conclusion
Vitamin D deficiency and deficiency are common in tumor patients. The level of serum 25 (OH) D is correlated with the course of breast tumor, tumor stage and molecular classification. 25 (OH) D is a significant difference between breast malignant tumor and breast benign tumor. There is abnormal level of plasma free fatty acid in tumor patients. DPA is a significant difference between breast malignant tumor and benign breast tumor, which may be related to the pathological degree of breast tumor.
Background
There is accumulating evidence that Vitamin D deficiency contributes to the occurrence of stroke, including ischemic and hemorrhagic strokes. However, the relationship between Vitamin D levels and the risk of hemorrhage stroke was less conclusive.
Aim
This prospective study is aimed for relationship between Vitamin D status and specific nonlobar hemorrhagic stroke in a Taiwanese cohort.
Methods
A prospective study of 44 adult patients (32 males and 12 females; 27 aged <65 years and 17 ≥65 years) with acute nonlobar spontaneous intracerebral hemorrhage (sICH) was undertaken for 24 months (December 2017–November 2019) in a general reference teaching hospital. The serum 25-hydroxyvitamin D (25(OH) D) level was examined within 1 day of the stroke. The associations between Vitamin D status, age, low-density lipoprotein levels, and hemorrhagic stroke were analyzed using the Chi-squared test for comparisons. Statistical significance was set at P < 0.05.
Results
The mean serum concentration of (25(OH) D) was 20.30 ng/ml. There were 14 patients with Vitamin D insufficiency (<30 ng/ml), and 23 with Vitamin D deficiency (<20 ng/ml). There was no age dependence to the Vitamin D deficiency and insufficiency in patients with acute nonlobar sICH. We also found no significant correlation between Vitamin D deficiency and low-density lipoprotein concentration.
Conclusion
A particularly high prevalence of Vitamin D deficiency was found in Taiwanese patients with specific hemorrhagic stroke, acute nonlobar sICH, and this was independent of age or serum low-density lipoprotein levels.
Background: The status of iron and vitamin D (VD) is essential to health. Previous studies have shown that iron homeostasis has a potential effect on VD metabolism, but the mechanism is not fully understood.
Objectives: To explore the relationship between VD metabolism and iron metabolism, as well as the regulatory mechanism of iron on VD metabolism.
Methods: Methods: 40 male rats were fed adaptively for 7 days and randomly divided into control (C, n=6 normal diet) group and model (M, n=24 iron deficient diet) group according to body weight, the latter was used to establish iron deficiency anemia (IDA) model. After 6 weeks of feeding, the M group was randomly divided into: deficiency iron group (DFe), low iron group (LFe), medium iron group (MFe) and high iron group (HFe) according to the level of hemoglobin (Hb). Different doses of iron dextran (based on iron content (100g·bw·d)): 0, 1.1, 3.3 and 9.9mg were given respectively. After 4 weeks, the rats were anesthetized with 8% chloral hydrate, blood was collected from the abdominal aorta, liver and kidney tissues were collected. The serum and tissues were separately packed and frozen at -80℃ for testing.
Results: The results showed that the levels of Hb, RBC, serum iron (SI), liver iron, and kidney iron DFe group were lower than those in the other four groups, while the levels of total iron-binding capacity (TIBC), transferrin (TF) and transferrin receptor (Tfr) in DFe group were higher than those in other groups; The serum levels of 25-(OH)D3 and 1,25-(OH)2D3 in DFe group were significantly lower than those in C group (P < 0.05). The correlation analysis showed that the levels of 25-(OH)D3 and 1,25-(OH)2D3 were negatively correlated with TIBC, TF and Tfr no correlation with SI. Western blot, immunofluorescence, and q-PCR results showed that compared with C group, the protein and gene expressions of CYP2R1, CYP27A1, and CYP24A1 in DFe group were down-regulated, and the expression of CYP27B1 protein and gene was up-regulated in DFe group.
Conclusion: Therefore, iron may be involved in the metabolism of VD3 by regulating the expression of VD3 hydroxylase, suggesting that appropriate iron supplementation can promote the activation of VD3.
Background: Vitamin D has received considerable interest from the medical community and the public because of recent evidence for the nonskeletal effects of vitamin D combined with the finding of widespread global deficiency. It has been estimated that almost 1 billion people worldwide suffer from vitamin D deficiency or insufficiency. In addition, neurobiological and neuroendocrinological substrates have been identified that indicate a link between hypovitaminosis D and several psychiatric conditions, including depression. Objectives: This study aimed to assess vitamin D level in patients with depressive disorders and to compare it with normal individuals. Materials & Methods: This cross-sectional type of comparative study was carried out in the Department of Physiology, Rajshahi Medical College, Rajshahi, in collaboration with the outpatient department of Psychiatry Rajshahi Medical College Hospital over 12 months from January 2019 to December 2019 among the Depressive patients and healthy individuals to find out and compare the vitamin D level between the two groups. Approval from the Ethical Review Committee (ERC) was obtained before the commencement of the study. A pA pre-designed, validated, structured questionnaire was used to gather information from 108 respondents by purposive sampling. Out of the 54 were newly diagnosed depressive patients, and 54 were healthy persons. In addition, a blood sample was collected to measure 25(OH)D level, and all values were analyzed statistically. Results: The Result showed a significant difference in mean plasma 25(OH)D level between the patients with depressive disorder and the healthy individuals. Circulating 25(OH)D level was found to be significantly low in the group of patients with depression. Conclusion: The present study demonstrated a significant correlation between hypovitaminosis D in patients with depressive disorders. It is suggested that possible factors such as hypovitaminosis D should be done as a routine investigation to reduce the incidence of depression. Furthermore, vitamin D supplementation might be a complementary treatment for depression. TAJ 2022; 35: No-2: 159-168
The role that vitamin D plays in the cognitive and clinical characteristics of bipolar disorder (BD) is unclear. We examined differences in the levels and deficiency status of vitamin D in an Australian sample of BD patients compared to healthy controls; and determined the extent to which vitamin D is associated with clinical variables and cognitive function in the sample. 22 healthy controls and 55 stable outpatients with a diagnosis of BD and low-grade mood symptomatology provided a sample of blood and completed cognitive tests and clinical measures. Plasma concentrations of 25-hydroxyvitamin D (vitamin D) were assayed and used to segregate participants into subgroups with sufficient or deficient levels of vitamin D. Subgroups were then compared in terms of global cognition and a range of sociodemographic and clinical factors (number of past mood episodes, illness duration, seasonal mood pattern, mood symptom severity), while mean levels of vitamin D were compared between patients and controls. Although almost 27% of the current sample were vitamin D deficient, no significant differences in mean vitamin D levels or the prevalence of vitamin D deficiency were evident between BD patients and controls. Vitamin D was not associated with global cognition in either patients or controls, nor any of the clinical measures assessed in the study. In conclusion, we observed no difference in the vitamin D levels and deficiency status of an Australian sample of healthy individuals and BD patients with low grade mood symptomatology compared to controls. Clinical symptoms and global cognition also appear to be independent of vitamin D levels in BD.
SummaryThis review describes the vitamin D status in different regions of the world with the objective of understanding the scope
of hypovitaminosis D and the factors related to its prevalence that may contribute to the pathogenesis of osteoporosis and
fragility fractures.
IntroductionVitamin D status has been linked to the pathogenesis of hip fractures as well as other skeletal and non-skeletal disorders.
The purpose of this review is to provide a global perspective of vitamin D status across different regions of the world and
to identify the common and significant determinants of hypovitaminosis D.
MethodsSix regions of the world were reviewed—Asia, Europe, Middle East and Africa, Latin America, North America, and Oceania—through
a survey of published literature.
ResultsThe definition of vitamin D insufficiency and deficiency, as well as assay methodology for 25-hydroxyvitamin D or 25(OH)D,
vary between studies. However, serum 25(OH)D levels below 75nmol/L are prevalent in every region studied whilst levels below
25nmol/L are most common in regions such as South Asia and the Middle East. Older age, female sex, higher latitude, winter
season, darker skin pigmentation, less sunlight exposure, dietary habits, and absence of vitamin D fortification are the main
factors that are significantly associated with lower 25(OH)D levels.
ConclusionReports from across the world indicate that hypovitaminosis D is widespread and is re-emerging as a major health problem globally.
Adequate 25(OH)D levels are required to prevent adverse effects on bone health. Population-based data on factors associated with 25(OH)D levels of people with MS have been lacking.
To examine the prevalence and determinants of vitamin D insufficiency in a population-based sample of MS cases and controls, and to compare 25(OH)D status between MS cases and controls, taking into account case disability.
We conducted a population based case-control study in Tasmania, Australia (latitude 41-43 degrees S) on 136 prevalent cases with MS confirmed by magnetic resonance imaging and 272 community controls, matched on sex and year of birth. Measurements included serum 25(OH)D, sun exposure, skin type, dietary vitamin D intake and disability including EDSS.
A high prevalence of vitamin D insufficiency was found in MS cases and controls. Among MS cases, increasing disability was strongly associated with lower levels of 25(OH)D and with reduced sun exposure. Cases with higher disability (EDSS > 3) were more likely to have vitamin D insufficiency than controls (OR = 3.07 (1.37, 6.90) for 25(OH)D </= 40 nmol/l), but cases with low disability were not (OR = 0.87 (0.41, 1.86)).
The strong associations between disability, sun exposure and vitamin D status indicate that reduced exposure to the sun, related to higher disability, may contribute to the high prevalence of vitamin D insufficiency found in this population-based MS case sample. Active detection of vitamin D insufficiency among people with MS and intervention to restore vitamin D status to adequate levels should be considered as part of the clinical management of MS.
The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency.
The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration.
Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes.
Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.
To examine whether serum 25-hydroxyvitamin D (25OHD) and dietary calcium predict incident type 2 diabetes and insulin sensitivity.
A total of 6,537 of the 11,247 adults evaluated in 1999-2000 in the Australian Diabetes, Obesity and Lifestyle (AusDiab) study, returned for oral glucose tolerance test (OGTT) in 2004-2005. We studied those without diabetes who had complete data at baseline (n = 5,200; mean age 51 years; 55% were women; 92% were Europids). Serum 25OHD and energy-adjusted calcium intake (food frequency questionnaire) were assessed at baseline. Logistic regression was used to evaluate associations between serum 25OHD and dietary calcium on 5-year incidence of diabetes (diagnosed by OGTT) and insulin sensitivity (homeostasis model assessment of insulin sensitivity [HOMA-S]), adjusted for multiple potential confounders, including fasting plasma glucose (FPG).
During the 5-year follow-up, 199 incident cases of diabetes were diagnosed. Those who developed diabetes had lower serum 25OHD (mean 58 vs. 65 nmol/L; P < 0.001) and calcium intake (mean 881 vs. 923 mg/day; P = 0.03) compared with those who remained free of diabetes. Each 25 nmol/L increment in serum 25OHD was associated with a 24% reduced risk of diabetes (odds ratio 0.76 [95% CI 0.63-0.92]) after adjusting for age, waist circumference, ethnicity, season, latitude, smoking, physical activity, family history of diabetes, dietary magnesium, hypertension, serum triglycerides, and FPG. Dietary calcium intake was not associated with reduced diabetes risk. Only serum 25OHD was positively and independently associated with HOMA-S at 5 years.
Higher serum 25OHD levels, but not higher dietary calcium, were associated with a significantly reduced risk of diabetes in Australian adult men and women.
Vitamin D status in the Korean population has not been adequately determined.
To investigate the vitamin D status and the prevalence of vitamin D insufficiency in the Korean population, and also identify the predictors for vitamin D insufficiency in Korea.
The Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) in the Korean population conducted in 2008.
3,047 males and 3,878 females aged 10 years and older selected in all the 16 administrative districts of South Korea.
Serum 25-hydroxyvitamin D [25(OH)D] levels and the prevalence of vitamin D insufficiency defined as serum 25(OH)D level of less than 20 ng/ml.
Vitamin D insufficiency was found in 47.3% of males and 64.5% of females, whereas only 13.2% of male and 6.7% of female population had a serum 25(OH)D level of greater than 30 ng/ml. Vitamin D insufficiency was most prevalent in the age of 20-29, with a rate of 65.0% in males and 79.9% in females, and least prevalent in the age of 60-69 in males and 50-59 in females. Those who work usually indoors were more predisposed to vitamin D insufficiency. In the adult population, predictors for vitamin D insufficiency included young age groups, spring and winter seasons, living in an urban area, and indoor occupations.
Vitamin D insufficiency is very common, and it is now a greater threat to the younger generation in Korea. Current recommendations for vitamin D intakes for Koreans are inadequate, especially for the youth.
This article summarizes the new 2011 report on dietary requirements for calcium and vitamin D from the Institute of Medicine (IOM). An IOM Committee charged with determining the population needs for these nutrients in North America conducted a comprehensive review of the evidence for both skeletal and extraskeletal outcomes. The Committee concluded that available scientific evidence supports a key role of calcium and vitamin D in skeletal health, consistent with a cause-and-effect relationship and providing a sound basis for determination of intake requirements. For extraskeletal outcomes, including cancer, cardiovascular disease, diabetes, and autoimmune disorders, the evidence was inconsistent, inconclusive as to causality, and insufficient to inform nutritional requirements. Randomized clinical trial evidence for extraskeletal outcomes was limited and generally uninformative. Based on bone health, Recommended Dietary Allowances (RDAs; covering requirements of ≥97.5% of the population) for calcium range from 700 to 1300 mg/d for life-stage groups at least 1 yr of age. For vitamin D, RDAs of 600 IU/d for ages 1-70 yr and 800 IU/d for ages 71 yr and older, corresponding to a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/liter), meet the requirements of at least 97.5% of the population. RDAs for vitamin D were derived based on conditions of minimal sun exposure due to wide variability in vitamin D synthesis from ultraviolet light and the risks of skin cancer. Higher values were not consistently associated with greater benefit, and for some outcomes U-shaped associations were observed, with risks at both low and high levels. The Committee concluded that the prevalence of vitamin D inadequacy in North America has been overestimated. Urgent research and clinical priorities were identified, including reassessment of laboratory ranges for 25-hydroxyvitamin D, to avoid problems of both undertreatment and overtreatment.
We assessed vitamin D status and its correlates in the population-based Canadian Multicentre Osteoporosis Study (CaMos). Results showed that serum 25-hydroxyvitamin D levels <75 nmol/L were common. Given Canada's high latitude, attention should be given to strategies for enhancing vitamin D status in the population.
Inadequate vitamin D has been implicated as a risk factor for several clinical disorders. We assessed, in a Canadian cohort, vitamin D status and its correlates, based on serum 25-hydroxyvitamin D [25(OH)D], the best functional indicator of vitamin D status.
We studied 577 men and 1,335 women 35+ years from seven cities across Canada in the randomly selected, population-based Canadian Multicentre Osteoporosis Study (CaMos). Participants completed a comprehensive questionnaire. Serum 25(OH)D was measured by immunoassay. Multivariate linear regression modeling assessed the association between 25(OH)D and determinants of vitamin D status.
Participants (2.3%) were deficient in 25(OH)D (<27.5 nmol/L); a further 18.1% exhibited 25(OH)D insufficiency (27.5-50 nmol/L). Levels <75 nmol/L were evident in 57.5% of men and 60.7% of women and rose to 73.5% in spring (men) and 77.5% in winter (women); 25(OH)D <50 nmol/L was ≤10% year round for those supplementing with ≥400 IU vitamin D/day but was 43.9% among those not supplementing in winter and spring. The strongest predictors of reduced 25(OH)D for both men and women were winter and spring season, BMI ≥30, non-white ethnicity, and lower vitamin D supplementation and its modification by fall and winter.
In this national Canadian cohort, vitamin D levels <75 nmol/L were common, particularly among non-white and obese individuals, and in winter and spring. Vitamin D intake through diet and supplementation and maintenance of normal weight are key modifiable factors for enhancing vitamin D status and thus potentially influencing susceptibility to common chronic diseases.
Vitamin D deficiency is a global health problem, but little is known about the vitamin D status of Canadians.
The data are from the 2007 to 2009 Canadian Health Measures Survey, which collected blood samples. Descriptive statistics (frequencies, means) were used to estimate 25-hydroxyvitamin D [25(OH)D] concentrations among a sample of 5,306 individuals aged 6 to 79 years, representing 28.2 million Canadians from all regions, by age group, sex, racial background, month of blood collection, and frequency of milk consumption. The prevalence of deficiency and the percentages of the population meeting different cut-off concentrations were assessed.
The mean concentration of 25(OH)D for the Canadian population aged 6 to 79 years was 67.7 nmol/L. The mean was lowest among men aged 20 to 39 years (60.7 nmol/L) and highest among boys aged 6 to 11 (76.8 nmol/L). Deficiency (less than 27.5 nmol/L) was detected in 4% of the population. However, 10% of Canadians had concentrations considered inadequate for bone health (less than 37.5 nmol/L) according to 1997 Institute of Medicine (IOM) Standards (currently under review). Concentrations measured in November-March were below those measured in April-October. White racial background and frequent milk consumption were significantly associated with higher concentrations.
As measured by plasma 25(OH)D, 4% of Canadians aged 6 to 79 years were vitamin D-deficient, according to 1997 IOM standards (currently under review). Based on these standards, 10% of the population had inadequate concentrations for bone health.
Vitamin D is unique among the vitamins in that man can synthesise it via the action of UV radiation upon the skin. This combined with its ability to act on specific target tissues via vitamin D receptors (VDR) make its classification as a steroid hormone more appropriate. While vitamin D deficiency is a recognised problem in some northern latitude countries, recent studies have shown that even in sunny countries, such as Australia, vitamin D deficiency may be more prevalent than first thought. Vitamin D is most well known for its role in bone health; however, the discovery of VDR on a wide variety of tissue types has also opened up roles for vitamin D far beyond traditional bone health. These include possible associations with autoimmune diseases such as multiple sclerosis and inflammatory bowel diseases, cancer, CVD and muscle strength. First, this paper presents an overview of the two sources of vitamin D: exposure to UVB radiation and food sources of vitamin D, with particular focus on both Australian and international studies on dietary vitamin D intake and national fortification strategies. Second, the paper reviews recent epidemiological and experimental evidence linking vitamin D and its role in health and disease for the major conditions linked to suboptimal vitamin D, while identifying significant gaps in the research and possible future directions for research.
Vitamin D insufficiency is associated with suboptimal health. The prevalence of vitamin D insufficiency may be rising, but population-based trends are uncertain. We sought to evaluate US population trends in vitamin D insufficiency.
We compared serum 25-hydroxyvitamin D (25[OH]D) levels from the Third National Health and Nutrition Examination Survey (NHANES III), collected during 1988 through 1994, with NHANES data collected from 2001 through 2004 (NHANES 2001-2004). Complete data were available for 18 883 participants in NHANES III and 13 369 participants in NHANES 2001-2004.
The mean serum 25(OH)D level was 30 (95% confidence interval [CI], 29-30) ng/mL during NHANES III and decreased to 24 (23-25) ng/mL during NHANES 2001-2004. Accordingly, the prevalence of 25(OH)D levels of less than 10 ng/mL increased from 2% (95% CI, 2%-2%) to 6% (5%-8%), and 25(OH)D levels of 30 ng/mL or more decreased from 45% (43%-47%) to 23% (20%-26%). The prevalence of 25(OH)D levels of less than 10 ng/mL in non-Hispanic blacks rose from 9% during NHANES III to 29% during NHANES 2001-2004, with a corresponding decrease in the prevalence of levels of 30 ng/mL or more from 12% to 3%. Differences by age strata (mean serum 25[OH]D levels ranging from 28-32 ng/mL) and sex (28 ng/mL for women and 32 ng/mL for men) during NHANES III equalized during NHANES 2001-2004 (24 vs 24 ng/mL for age and 24 vs 24 ng/mL for sex).
National data demonstrate a marked decrease in serum 25(OH)D levels from the 1988-1994 to the 2001-2004 NHANES data collections. Racial/ethnic differences have persisted and may have important implications for known health disparities. Current recommendations for vitamin D supplementation are inadequate to address the growing epidemic of vitamin D insufficiency.
• The main source of vitamin D for Australians is exposure to sunlight. Thus, levels of serum 25‐hydroxyvitamin D3, the indicator of vitamin D status, vary according to the season and are lower at the end of winter.
• In Australia and New Zealand, the prevalence of vitamin D deficiency varies, but is acknowledged to be much higher than previously thought. One study found marginal deficiency in 23% of women, and another frank deficiency in 80% of dark‐skinned and veiled women. The groups at greatest risk of vitamin D deficiency in Australia are dark‐skinned and veiled women (particularly in pregnancy), their infants, and older persons living in residential care.
• Only a few foods (eg, fish with a high fat content) contain significant amounts of vitamin D. In Australia, margarine and some milk and milk products are currently fortified with vitamin D.
• The average estimated dietary intake of vitamin D for men is 2.6–3.0 µg/day and for women is 2.0–2.2 µg/day. The estimated dietary requirement of vitamin D is at least 5.0 µg/day and may be higher for older people.
• Adequate intake of vitamin D is unlikely to be achieved through dietary means, particularly in the groups at greatest risk, although vitamin D‐fortified foods may assist in maintaining vitamin D status in the general population.
• An appropriate health message for vitamin D needs to balance the need for sunshine against the risk of skin cancer.
To measure the prevalence of obesity in Australian adults and to examine the associations of obesity with socioeconomic and lifestyle factors.
AusDiab, a cross-sectional study conducted between May 1999 and December 2000, involved participants from 42 randomly selected districts throughout Australia.
Of 20,347 eligible people aged > or = 25 years who completed a household interview, 11,247 attended the physical examination at local survey sites (response rate, 55%).
Overweight and obesity defined by body mass index (BMI; kg/m(2)) and waist circumference (cm); sociodemographic factors (including smoking, physical activity and television viewing time).
The prevalence of overweight and obesity (BMI > or = 25.0 kg/m(2); waist circumference > 80.0 cm [women] or > or = 94.0 cm [men]) in both sexes was almost 60%, defined by either BMI or waist circumference. The prevalence of obesity was 2.5 times higher than in 1980. Using waist circumference, the prevalence of obesity was higher in women than men (34.1% v 26.8%; P < 0.01). Lower educational status, higher television viewing time and lower physical activity time were each strongly associated with obesity, with television viewing time showing a stronger relationship than physical activity time.
The prevalence of obesity in Australia has more than doubled in the past 20 years. Strong positive associations between obesity and each of television viewing time and lower physical activity time confirm the influence of sedentary lifestyles on obesity, and underline the potential benefits of reducing sedentary behaviour, as well as increasing physical activity, to curb the obesity epidemic.
The goal of this study was to assess the associations of physical activity time and television (TV) time with risk of "undiagnosed" abnormal glucose metabolism in Australian adults.
This population-based cross-sectional study using a stratified cluster design involving 42 randomly selected Census Collector Districts across Australia included 8,299 adults aged 25 years or older who were free from new type 2 diabetes and self-reported ischemic disease and did not take lipid-lowering or antihypertensive drugs. Abnormal glucose metabolism (impaired fasting glycemia [IFG], impaired glucose tolerance [IGT], or new type 2 diabetes) was based on an oral glucose tolerance test. Self-reported physical activity time and TV time (previous week) were assessed using interviewer-administered questionnaires.
After adjustment for known confounders and TV time, the odds ratio (OR) of having abnormal glucose metabolism was 0.62 (95% CI 0.41-0.96) in men and 0.71 (0.50-1.00) in women for those engaged in physical activity >or=2.5 h/week compared with those who were sedentary (0 h/week). The ORs of having abnormal glucose metabolism were 1.16 (0.79-1.70) in men and 1.49 (1.12-1.99) in women who watched TV >14 h/week compared with those who watched <or=7.0 h/week. Higher TV viewing (>14 h/week) was also associated with an increased risk of new type 2 diabetes in men and women and IGT in women compared with those watching <14 h/week. Total physical activity of >or=2.5 h/week was associated with a reduced risk of IFG, IGT, and new type 2 diabetes in both sexes; however, only the association with IGT in women was statistically significant.
These findings suggest a protective effect of physical activity and a deleterious effect of TV time on the risk of abnormal glucose metabolism in adults. Population strategies to reduce risk of abnormal glucose metabolism should focus on reducing sedentary behaviors such as TV time, as well as increasing physical activity.
Most circulating 25-hydroxyvitamin D originates from exposure to sunlight; nevertheless, many factors can impair this process, necessitating periodic reliance on dietary sources to maintain adequate serum concentrations. The US and Canadian populations are largely dependent on fortified foods and dietary supplements to meet these needs, because foods naturally rich in vitamin D are limited. Fluid milk and breakfast cereals are the predominant vehicles for vitamin D in the United States, whereas Canada fortifies fluid milk and margarine. Reports of a high prevalence of hypovitaminosis D and its association with increased risks of chronic diseases have raised concerns regarding the adequacy of current intake levels and the safest and most effective way to increase vitamin D intake in the general population and in vulnerable groups. The usual daily intakes of vitamin D from food alone and from food and supplements combined, as estimated from the US third National Health and Nutrition Examination Survey, 1988-1994, show median values above the adequate intake of 5 microg/d for children 6-11 y of age; however, median intakes are generally below the adequate intake for female subjects > 12 y of age and men > 50 y. In Canada, there are no national survey data for estimation of intake. Cross-sectional studies suggest that current US/Canadian fortification practices are not effective in preventing hypovitaminosis D, particularly among vulnerable populations during the winter, whereas supplement use shows more promise. Recent prospective intervention studies with higher vitamin D concentrations provided evidence of safety and efficacy for fortification of specific foods and use of supplements.
Vitamin D has captured attention as an important determinant of bone health, but there is no common definition of optimal vitamin D status. Herein, we address the question: What is the optimal circulating level of 25-hydroxyvitamin D [25(OH)D] for the skeleton? The opinions of the authors on the minimum level of serum 25(OH)D that is optimal for fracture prevention varied between 50 and 80 nmol/l. However, for five of the six authors, the minimum desirable 25(OH)D concentration clusters between 70 and 80 nmol/l. The authors recognize that the average older man and woman will need intakes of at least 20 to 25 mcg (800 to 1,000 IU) per day of vitamin D(3 )to reach a serum 25(OH)D level of 75 nmol/l. Based on the available evidence, we believe that if older men and women maintain serum levels of 25(OH)D that are higher than the consensus median threshold of 75 nmol/l, they will be at lower risk of fracture.
Vitamin D plays an important role in bone health. Our purpose was to measure serum 25-hydroxyvitamin D concentrations and their determinants in a national sample (n=2,946) of New Zealanders aged 15 years and over.
Mean (99% CI) serum 25-hydroxyvitamin D concentrations were 47 (45-50) nmol/l in women and 52 (49-55) nmol/l in men. Mean concentrations in New Zealand European and Others (NZEO, n=2,440), Māori (n=370), and Pacific (n=136) were 51 (49-53), 42 (38-46) and 37 (33-42) nmol/l, respectively. Three percent of New Zealanders had serum 25-hydroxyvitamin D concentrations indicative of deficiency (<or=17.5 nmol/l); 48% and 84% were insufficient based on cutoffs of <or=50 and <or=80 nmol/l. Determinants of serum 25-hydroxyvitamin D concentrations in women were age, ethnicity, obesity, latitude and season; determinants in men were ethnicity and season. Serum 25-hydroxyvitamin D in women declined with age; mean concentration was 13 (8-18) nmol/l lower in women 65 years or older and 9 (5-13) nmol/l lower in women 45-64 years compared with women 15-18 years. Spring to summer differences in serum 25-hydroxyvitamin D were 31 (28-34) and 28 (25-31) nmol/l in women and men, respectively. Obese women had lower vitamin status than normal-weight women by 6 (3-10). Women living in the South Island had a mean serum 25-hydroxyvitamin D that was 6 (3-9) nmol/l lower than women living in the North Island. Ethnicity and season are the major determinants of serum 25-hydroxyvitamin D in New Zealanders.
The high prevalence of vitamin D insufficiency in New Zealanders, particularly in older women, may warrant strategies to improve vitamin D status.
Inadequate sun exposure and dietary vitamin D intake can result in vitamin D insufficiency. However, limited data are available on actual vitamin D status and predictors in healthy individuals in different regions and by season.
We compared vitamin D status [25-hydroxyvitamin D; 25(OH)D] in people < 60 years of age using data from cross-sectional studies of three regions across Australia: southeast Queensland (27 degrees S; 167 females and 211 males), Geelong region (38 degrees S; 561 females), and Tasmania (43 degrees S; 432 females and 298 males).
The prevalence of vitamin D insufficiency (<or= 50 nmol/L) in women in winter/spring was 40.5% in southeast Queensland, 37.4% in the Geelong region, and 67.3% in Tasmania. Season, simulated maximum daily duration of vitamin D synthesis, and vitamin D effective daily dose each explained around 14% of the variation in 25(OH)D. Although latitude explained only 3.9% of the variation, a decrease in average 25(OH)D of 1.0 (95% confidence interval, 0.7-1.3) nmol/L for every degree increase in latitude may be clinically relevant. In some months, we found a high insufficiency or even deficiency when sun exposure protection would be recommended on the basis of the simulated ultraviolet index.
Vitamin D insufficiency is common over a wide latitude range in Australia. Season appears to be more important than latitude, but both accounted for less than one-fifth of the variation in serum 25(OH)D levels, highlighting the importance of behavioral factors. Current sun exposure guidelines do not seem to fully prevent vitamin D insufficiency, and consideration should be given to their modification or to pursuing other means to achieve vitamin D adequacy.
Background:
In cross-sectional studies, low serum levels of 25-hydroxyvitamin D are associated with higher prevalence of cardiovascular risk factors and disease. This study aimed to determine whether endogenous 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are related to all-cause and cardiovascular mortality.
Methods:
Prospective cohort study of 3258 consecutive male and female patients (mean [SD] age, 62 [10] years) scheduled for coronary angiography at a single tertiary center. We formed quartiles according to 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels within each month of blood drawings. The main outcome measures were all-cause and cardiovascular deaths.
Results:
During a median follow-up period of 7.7 years, 737 patients (22.6%) died, including 463 deaths from cardiovascular causes. Multivariate-adjusted hazard ratios (HRs) for patients in the lower two 25-hydroxyvitamin D quartiles (median, 7.6 and 13.3 ng/mL [to convert 25-hydroxyvitamin D levels to nanomoles per liter, multiply by 2.496]) were higher for all-cause mortality (HR, 2.08; 95% confidence interval [CI], 1.60-2.70; and HR, 1.53; 95% CI, 1.17-2.01; respectively) and for cardiovascular mortality (HR, 2.22; 95% CI, 1.57-3.13; and HR, 1.82; 95% CI, 1.29-2.58; respectively) compared with patients in the highest 25-hydroxyvitamin D quartile (median, 28.4 ng/mL). Similar results were obtained for patients in the lowest 1,25-dihydroxyvitamin D quartile. These effects were independent of coronary artery disease, physical activity level, Charlson Comorbidity Index, variables of mineral metabolism, and New York Heart Association functional class. Low 25-hydroxyvitamin D levels were significantly correlated with variables of inflammation (C-reactive protein and interleukin 6 levels), oxidative burden (serum phospholipid and glutathione levels), and cell adhesion (vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 levels).
Conclusions:
Low 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are independently associated with all-cause and cardiovascular mortality. A causal relationship has yet to be proved by intervention trials using vitamin D.
The decline in vitamin D status among older people is probably due to decreased synthesis of vitamin D by sun-exposed skin and/or decreased outdoor activity. The authors examined the association between outdoor leisure physical activity and serum 25-hydroxyvitamin D in the Third National Health and Nutrition Examination Survey (1988-1994) (n = 15,148 aged >/=20 years). The mean 25-hydroxyvitamin D concentration declined with increasing age, with 79, 73, and 68 nmol/liter for persons aged 20-39, 40-59, and 60 or more years. The proportion that engaged in outdoor activity in the past month was 80% for persons aged 20-39 and 40-59 years but 71% for those aged 60 or more years. In contrast, the mean difference in 25-hydroxyvitamin D between those who participated in outdoor activities daily compared with those who did not participate in the past month was similar for the youngest and oldest age groups: 13 and 16 nmol/liter, respectively. Those persons aged 60 or more years who participated in daily outdoor activities had a mean 25-hydroxyvitamin D concentration similar to that of persons aged 20-39 years: 77 versus 79 nmol/liter, respectively. These nationally representative data suggest that persons aged 60 or more years can synthesize enough vitamin D from daily outdoor activities to maintain vitamin D levels similar to those of young adults.
Background: Obesity is associated with vitamin D insufficiency and secondary hyperparathyroidism.
Objective: This study assessed whether obesity alters the cutaneous production of vitamin D3 (cholecalciferol) or the intestinal absorption of vitamin D2 (ergocalciferol).
Design: Healthy, white, obese [body mass index (BMI; in kg/m²) ≥ 30] and matched lean control subjects (BMI ≤ 25) received either whole-body ultraviolet radiation or a pharmacologic dose of vitamin D2 orally.
Results: Obese subjects had significantly lower basal 25-hydroxyvitamin D concentrations and higher parathyroid hormone concentrations than did age-matched control subjects. Evaluation of blood vitamin D3 concentrations 24 h after whole-body irradiation showed that the incremental increase in vitamin D3 was 57% lower in obese than in nonobese subjects. The content of the vitamin D3 precursor 7-dehydrocholesterol in the skin of obese and nonobese subjects did not differ significantly between groups nor did its conversion to previtamin D3 after irradiation in vitro. The obese and nonobese subjects received an oral dose of 50000 IU (1.25 mg) vitamin D2. BMI was inversely correlated with serum vitamin D3 concentrations after irradiation (r = −0.55, P = 0.003) and with peak serum vitamin D2 concentrations after vitamin D2 intake (r = −0.56, P = 0.007).
Conclusions: Obesity-associated vitamin D insufficiency is likely due to the decreased bioavailability of vitamin D3 from cutaneous and dietary sources because of its deposition in body fat compartments.
OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. Process: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management. Language: en
Vitamin D is largely obtained through sun-induced skin synthesis and less from dietary sources, but during Canadian winters, skin synthesis is non-existent. The objective of this study was to estimate vitamin D intakes in Canadians from food sources. Data used in this study included food intakes of Canadians reported in the 2004 Canadian Community Health Survey Cycle 2.2 (CCHS 2.2), a nationally representative sample of 34,789 persons over the age of 1 year. The mean+/-SD dietary intake of vitamin D from food of Canadians was 5.8+/-0.1 microg/day, with males 9-18 years having the highest mean intakes (7.5+/-0.2 microg/day) and females 51-70 years having the lowest intakes (5.2+/-0.3 microg/day). Males in all age groups had higher intakes than females and White Canadians had higher vitamin D intakes than Non-Whites in most age sex groups. Milk products contributed 49% of dietary vitamin D followed by meat and meat-alternatives (31.1%). The majority of Canadians consume less than current recommended intake of vitamin D from food. Consideration should be given to strategies to improve vitamin D intake of Canadians by increasing both the amount of vitamin D added to foods and range of foods eligible for fortification.
Logistic regression is used frequently in cohort studies and clinical
trials. When the incidence of an outcome of interest is common in the study
population (>10%), the adjusted odds ratio derived from the logistic regression
can no longer approximate the risk ratio. The more frequent the outcome, the
more the odds ratio overestimates the risk ratio when it is more than 1 or
underestimates it when it is less than 1. We propose a simple method to approximate
a risk ratio from the adjusted odds ratio and derive an estimate of an association
or treatment effect that better represents the true relative risk.
The IOM recommendations for vitamin D fail in a major way on logic, on science, and on effective public health guidance. Moreover, by failing to use a physiological referent, the IOM approach constitutes precisely the wrong model for development of nutritional policy.
Parathyroid hormone (PTH) is only one measurable index of skeletal health, and we reasoned that a histomorphometric analysis of iliac crest biopsies would be another and even more direct approach to assess bone health and address the required minimum 25-Hydroxyvitamin D [25(OH)D] level. A cohort from the northern European population with its known high prevalence of vitamin D deficiency therefore would be ideal to answer the latter question. We examined 675 iliac crest biopsies from male and female individuals, excluding all patients who showed any signs of secondary bone diseases at autopsy. Structural histomorphometric parameters, including osteoid indices, were quantified using the Osteomeasure System according to ASBMR standards, and serum 25(OH)D levels were measured for all patients. Statistical analysis was performed by Student's t test. The histologic results demonstrate an unexpected high prevalence of mineralization defects, that is, a pathologic increase in osteoid. Indeed, 36.15% of the analyzed patients presented with an osteoid surface per bone surface (OS/BS) of more than 20%. Based on the most conservative threshold that defines osteomalacia at the histomorphometric level with a pathologic increase in osteoid volume per bone volume (OV/BV) greater than 2% manifest mineralization defects were present in 25.63% of the patients. The latter were found independent of bone volume per trabecular volume (BV/TV) throughout all ages and affected both sexes equally. While we could not establish a minimum 25(OH)D level that was inevitably associated with mineralization defects, we did not find pathologic accumulation of osteoid in any patient with circulating 25(OH)D above 75 nmol/L. Our data demonstrate that pathologic mineralization defects of bone occur in patients with a serum 25(OH)D below 75 nmol/L and strongly argue that in conjunction with a sufficient calcium intake, the dose of vitamin D supplementation should ensure that circulating levels of 25(OH)D reach this minimum threshold (75 nmol/L or 30 ng/mL) to maintain skeletal health.
An evaluation of surgically obtained skin (age range, 8-92 yr) revealed that there is an age-dependent decrease in the epidermal concentrations of provitamin D3 (7-dehydrocholesterol). To ascertain that aging indeed decreased the capacity of human skin to produce vitamin D3, some of the skin samples were exposed to ultraviolet radiation and the content of previtamin D3 was determined in the epidermis and dermis. The epidermis in the young and older subjects was the major site for the formation of previtamin D3, accounting for greater than 80% of the total previtamin D3 that was produced in the skin. A comparison of the amount of previtamin D3 produced in the skin from the 8- and 18-yr-old subjects with the amount produced in the skin from the 77- and 82-yr-old subjects revealed that aging can decrease by greater than twofold the capacity of the skin to produce previtamin D3. Recognition of this difference may be extremely important for the elderly, who infrequently expose a small area of skin to sunlight and who depend on this exposure for their vitamin D nutritional needs.
Logistic regression is used frequently in cohort studies and clinical trials. When the incidence of an outcome of interest is common in the study population (>10%), the adjusted odds ratio derived from the logistic regression can no longer approximate the risk ratio. The more frequent the outcome, the more the odds ratio overestimates the risk ratio when it is more than 1 or underestimates it when it is less than 1. We propose a simple method to approximate a risk ratio from the adjusted odds ratio and derive an estimate of an association or treatment effect that better represents the true relative risk.
For adults, the 5-microg (200 IU) vitamin D recommended dietary allowance may prevent osteomalacia in the absence of sunlight, but more is needed to help prevent osteoporosis and secondary hyperparathyroidism. Other benefits of vitamin D supplementation are implicated epidemiologically: prevention of some cancers, osteoarthritis progression, multiple sclerosis, and hypertension. Total-body sun exposure easily provides the equivalent of 250 microg (10000 IU) vitamin D/d, suggesting that this is a physiologic limit. Sailors in US submarines are deprived of environmentally acquired vitamin D equivalent to 20-50 microg (800-2000 IU)/d. The assembled data from many vitamin D supplementation studies reveal a curve for vitamin D dose versus serum 25-hydroxyvitamin D [25(OH)D] response that is surprisingly flat up to 250 microg (10000 IU) vitamin D/d. To ensure that serum 25(OH)D concentrations exceed 100 nmol/L, a total vitamin D supply of 100 microg (4000 IU)/d is required. Except in those with conditions causing hypersensitivity, there is no evidence of adverse effects with serum 25(OH)D concentrations <140 nmol/L, which require a total vitamin D supply of 250 microg (10000 IU)/d to attain. Published cases of vitamin D toxicity with hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are known, all involve intake of > or = 1000 microg (40000 IU)/d. Because vitamin D is potentially toxic, intake of >25 microg (1000 IU)/d has been avoided even though the weight of evidence shows that the currently accepted, no observed adverse effect limit of 50 microg (2000 IU)/d is too low by at least 5-fold.