Search

Summary: Background: Obesity is associated with suboptimal levels in vitamin D, a nutrient important for bone health and immune function. Seasonal variation in vitamin D may exacerbate this deficiency in persons with obesity, as exposure to ultraviolet B rays in sunlight is necessary for the conversion of vitamin D to its active form in the body. The aim of this study was to determine the relationship between season and vitamin D levels in persons with obesity pursuing bariatric surgery. Materials and Methods: This retrospective cohort study from a single academic medical center investigated adult patients undergoing either primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) over a 20-year period. Demographics and serum 25-hydroxyvitamin D3 levels were collected from the first presenting visit to the bariatrics center. Continuous vitamin D3 levels were compared across seasons using a one-way Analysis of Variance (ANOVA). Vitamin D3 categories were examined across seasons using a Chi square test of independence. Results: 1,256 persons pursuing bariatric surgery (SG: N=697, RYGB: N=559) met the inclusion criteria. Baseline vitamin D values were available in 1,071 of the eligible patients. Overall, serum 25-hydroxyvitamin D3 levels showed a significant variation across the seasons of the year (P

Dietary factors account for a large proportion of human cancers, particularly overnutrition that results in weight gain and obesity. The evidence linking diet and cancer has been developing since the early 1900s, beginning with early laboratory studies and ecologic studies of cancer rates in different parts of the world. More modern epidemiologic methods, including case–control studies, cohort studies, and randomized controlled trials have helped define in detail the associations between specific dietary factors and cancer. Factors with strong links to an increased risk of various cancers include: overnutrition/obesity, alcohol, red meat, and salt. Factors with strong links to a decreased risk include: fruits, vegetables, fiber, vitamin D, calcium, and folate.

Objective: Among other regulatory functions, vitamin D has a role in modulating the inflammatory process of periodontal disease. Therefore, this retrospective study aimed to assess the relationship between vitamin D levels and periodontal health in dental patients from the Eastern Province of Saudi Arabia. Methods: Radiographs and serum vitamin D levels of patients seeking dental treatment were collected. Exclusion criteria were systemic disease, smoking, recent vitamin D supplementation, and previous periodontal surgery. Gender, age, and alveolar crest height (ACH) were recorded. A total of 67 patients were categorized into three groups according to their serum vitamin D level ( 20 ng/mL) and their bone loss compared. Results: Differences in means were compared by t-test. ANOVA was used to compare vitamin D groups and the corresponding ACH, as well as the correlation (p 20 ng/mL demonstrated a mean ACH of 1.6 mm. The mean ACH was 3.1 mm for those with vitamin D levels

Aim: of the work to determine serum levels of vitamin D and Milk fat globule-epidermal growth factor 8 (MFG-E8) in rheumatoid arthritis (RA) and primary knee osteoarthritis (OA) compared to healthy controls and their possible associations. Patients and methods: The study included 30 RA and 30 primary knee OA patients as well as 25 control. The disease activity was measured by disease activity score 28 (DAS28) in RA. The functional status was estimated by Western Ontario and McMaster Universities index (WOMAC index) in OA. While the assessment of pain was measured by the visual analog scale (VAS) in both RA and OA. Serum vitamin D and MFG-E8 levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: The mean age of RA patients was 41.1 ± 9.2 years; 25 females and 5 males (F:M 5:1) and a disease duration of 6.9 ± 4.6 years. The mean age of OA patients was 48.7 ± 8.3 years; 28 females and 2 males (F:M 14:1) and disease duration was 5.4 ± 3.3 years. The mean vitamin D was significantly lower in RA (9.7 ± 5.04 ng/ml) than OA (16.4 ± 4 ng/ml) and controls (17.7 ± 3.4 ng/ml), p

Insulin-resistance (IR) is one of the most important precursors of type 2 diabetes (T2D). Recent evidence suggests an association of depression with the onset of T2D. Accumulating evidence shows that depression and T2D share common biological origins, and DNA methylation examination might reveal the link between lifestyle, disease risk, and potential therapeutic targets for T2D. Here we hypothesize that integrative mining of IR and depression cohort data will facilitate predictive biomarkers identification for T2D. We utilized a newly proposed method to extract gene-level information from probe level data on genome-wide DNA methylation array. We identified a set of genes associated with IR and depression in clinical cohorts. By overlapping the IR-related nutraceutical-gene network with depression networks, we identified a common subnetwork centered with Vitamin D Receptor (VDR) gene. Preliminary clinical validation of gene methylation set in a small cohort of T2D patients and controls was established using the Sequenome matrix-assisted laser desorption ionization-time flight mass spectrometry. A set of sites in the promoter regions of VDR showed a significant difference between T2D patients and controls. Using a logistic regression model, the optimal prediction performance of these sites was AUC = 0.902，and an odds ratio = 19.76. Thus, monitoring the methylation status of specific VDR promoter region might help stratify the high-risk individuals who could potentially benefit from vitamin D dietary supplementation. Our results highlight the link between IR and depression, and the DNA methylation analysis might facilitate the search for their shared mechanisms in the etiology of T2D.

Background Group-specific component (GC) and cytochrome P450 Family 2 Subfamily R Member 1 (CYP2R1) genes are one of the vital genes involved in the vitamin D (vitD) metabolic pathway. Association of genetic polymorphisms in these two genes with 25-hyroxyvitamin D (25(OH)D) level has been reported in several studies. However, this association has been reported to be discrepant among populations from different ethnicities. Therefore, we aimed in this study to investigate association of the two major single nucleotide polymorphisms (SNP) in GC (rs4588 and rs7014) and a SNP (rs12794714) in CYP2R1 in postmenopausal women in Saudi Arabia. Methods This study randomly selected 459 postmenopausal women (aged ≥50 years) of multiple ethnicities in Jeddah, Saudi Arabia. Blood samples were collected from all participating women for DNA extraction and for assessment of serum levels of total 25(OH)D, directly measured free 25(OH)D and other biochemical parameters. SNPs in selected vitD related genes (rs4588 in GC, c.1364G > T with transcript ID: NM_001204307.1 and rs7041 in GC, c.1353A > C with transcript ID NM_001204307.1 and rs12794714 in CYP2R1, c.177G > A with transcript ID NM_024514.4) were determined in DNA samples using Sanger DNA sequencing. Results Minor allele frequency for rs4588, rs7041 and rs12794714 were 0.25, 0.44 and 0.42 respectively. Genotypes of rs7041 showed significant difference in total 25(OH)D level but not in free 25(O)D level (P = 0.023). In comparison, genotypes of rs4588 and rs12794714 did not show any significant difference neither in total nor in free 25(OH)D level. Post hoc test revealed that total 25(OH)D was lower in the rs7041 TT allele compared to the GG allele (P = 0.022). Chi-square test showed that vitD status was associated with rs7041 genotypes (P = 0.035). In addition, rs7041 minor alleles were found to have an association with vitD deficiency with a statistical significant odds ratio (>1) of 2.24 and 3.51 with P = 0.006 and P = 0.007 for TG and GG genotypes respectively. Conclusion The rs7041 SNP in GC was associated with total 25(OH)D level in postmenopausal women in Saudi Arabia, while rs4588 in GC and rs12794714 in CYP2R1 did not show association with total 25(OH)D. Further studies exploring additional variants in vitD related genes are needed to understand genetic factors underlying vitD deficiency in Saudi population.

Introduction Patterns of testing, treatment, and retesting following treatment for disorders of chronic kidney disease mineral bone disorder (CKD-MBD) have not been explored using a large electronic database. Methods To determine concordance with CKD-MBD management guidelines, we used 2010 to 2019 data from an electronic health record (>50 million patients) to create cohorts of incident CKD stage 3, 4, and 5 patients using diagnosis codes and estimated glomerular filtration rates. The CKD-MBD test ordering and relevant drug prescribing were assessed during follow-up. We estimated cumulative incidence of posttreatment retesting (death as competing risk). We used multivariable Cox regression to examine baseline characteristics and pretreatment test results as predictors of retesting. Results For 215,553 stage 3, 43,576 stage 4, and 11,407 stage 5 CKD patients, the mean follow-up was 2.3, 1.7, and 0.6 years, respectively. Only 46% of stage 4 and 41% of stage 5 patients underwent parathyroid hormone (PTH) testing, 74% and 73% had phosphorus testing, and 38% and 25% had 25D testing. By 1 year after vitamin D sterol treatment, only 50%, 53%, and 60% of stage 3, 4, and 5 patients had been retested for PTH. By 1 year after treatment with ergocalciferol or cholecalciferol, only 46%, 49%, and 55% had 25D reassessed. Pretreatment levels of PTH and 25D were not associated in a graded fashion with likelihood of retesting after treatment. Rates of retesting were not highest for patients with the highest and lowest pre-treatment PTH and 25D levels, respectively. Conclusion Frequency of testing for CKD-MBD abnormalities and posttreatment retesting appears to be suboptimal., Graphical abstract

Vitamin D deficiency and periodontitis are commonly prevalent among Saudi adults. However, the association between periodontitis and vitamin D status has not been well documented. This study aims to examine the association between periodontitis and vitamin D status among adults in the Albaha region of Saudi Arabia. A case-control study of 123 Saudi adults was conducted; 60 had severe or moderate periodontitis, and 63 were periodontally healthy. Data was collected by an online self-reported sociodemographic questionnaire. All participants then underwent a full periodontal examination. Blood samples were also provided to assess participants’ vitamin D statuses through serum levels of 25-hydroxyvitamin D (25(OH)D). A total of 60 cases and 63 controls matched for BMI (30.2 ± 4.86 kg/m2), age (40.01 ± 7.73 years), and sex (46.3% and 53.7% male and female, respectively) participated in the study. Mean levels of 25(OH)D were significantly lower in periodontitis participants than in controls (25.03 ± 8.55 ng/ml, 29.19 ± 12.82 ng/ml, p = 0.037, respectively). Lower odds of periodontitis were detected per unit of 25(OH)D level (OR 0.964, 95% CI; 0.931–0.999, p = 0.043). In conclusion, periodontitis is significantly associated with deficient and insufficient levels of vitamin D among Saudi adults in the Albaha region. Future longitudinal research with a larger sample size may be suggested to confirm these results.

Summary Background Sufficient levels of vitamin D (25-hydroxyvitamin D, 25(OH)D) are required during pregnancy to maintain fetal developmental and reduce adverse outcomes in fetus/neonates and mother. The present study aimed to determine the levels of vitamin D in pregnant women and neonates and evaluate the corresponding effects of vitamin D supplementations. Materials and Methods This descriptive-analytical study, conducted in Asali Hospital, Khorramabad, included 77 pregnant women, between 15–45 years of the age, presented with the gestational age of 37–42. 5cc of the blood samples were obtained from the mothers during the labor and umbilical cord, postpartum. Demographic and medical data were obtained from the patients and results from the lab findings, based on the levels of 25(OH)D, were recorded in the questionnaire. Results The mean concentration of 25(OH)D in pregnant women was 13 ng/ml and their neonates was 15 ng/ml. Overall, 60.9% of the mothers and neonates were reported to be 25(OH)D deficient whereas, 89% of the mothers and their newborns had insufficient vitamin D levels. The levels of 25(OH)D in the umbilical cord had a significant relationship with serum vitamin D levels. Maternal age, gestational age, body mass index and occupational status had no effect on maternal and neonatal vitamin D levels. Women under vitamin D supplementations (4000IU/day) had higher levels of vitamin D levels. conclusions The mean concentration of vitamin D in pregnant women and infants is low and it is a direct correlated with umbilical cord blood vitamin D levels.

Background Vitamin D is a steroid hormone that exerts its actions through ligation of the vitamin D receptor (VDR), a transcription factor of the nuclear receptor family. VDR has not only physiologic actions in calcium metabolism but also several other cellular effects through extensive binding to the DNA and modification of genome expression. In cancer, it has neoplasia-suppressive effects and various mechanisms of action mediating cancer cell inhibition have been described. Vitamin D deficiency has been linked to increased risk of breast cancer. A role of the vitamin once the disease has been diagnosed is also probable. Methods A systematic review and meta-analysis of studies that report on vitamin D levels (in the form of its main circulating metabolite, 25-hydroxyvitamin D [25-OHD]) in patients with newly diagnosed breast cancer was performed. Outcomes of interest included the levels of serum 25-OHD in patients with breast cancer, those of matched controlled, in studies that included controls, as well as respective percentages of patients and controls with deficient and insufficient 25-OHD levels. Results A total of 25 studies (10 with controls and 15 without controls) provided data on the outcomes of interest. Populations from all continents, besides Australia, were represented in the studies. The mean level of 25-OHD in patients with breast cancer was 26.88 ng/mL (95% CI 22.8–30.96 ng/mL) and the mean level of 25-OHD in control patients was 31.41 ng/mL (95% CI 19.31–43.5 ng/mL). In the patients with breast cancer group, 45.28% (95% CI 24.37%–53.51%) had levels of 25-OHD below 20 ng/mL, whereas this percentage was 33.71% (95% CI 21.61%–45.82%) in controls. Similarly, 67.44% (95% CI 48.32%–86.55%) of patients with breast cancer had a baseline level of 25-OHD below 30 ng/mL, whereas this percentage was 33.71% (95% CI 21.61%–45.82%) in controls. Conclusion A high prevalence of vitamin D insufficiency is observed in patients with newly diagnosed breast cancer and may be linked pathophysiologically with breast cancer development or progression. Therapeutic benefits may be provided by manipulation of the vitamin D pathway in breast cancer.

The genesis of the Benign Paroxysmal Positional Vertigo (BPPV) seems to be related to some metabolic factors. These factors, such as vitamin D, glucocorticoids, and even thyroid and growth hormones, can affect bone metabolism and the mineralization of otoconia. It also seems to link to factors related to aging or nutritional habits. Besides, since the incidence of BPPV is quantitatively higher in women than in men, female sex steroids could be associated with this process. It could be useful to understand how these factors act in otoconial mineralization if we want to develop treatments aimed at preventing or delaying BPPV recurrences. In this review, we will analyze the role of these metabolic and hormonal factors in otoconial mineralization and in the treatment of BPPV.

الملخص: أهداف البحث: يرتبط داء السكري بإجهاد تأكسدي يؤدي إلى التهاب واعتلال الكلية السكري. تهدف هذه الدراسة إلى ملاحظة التأثير المحتمل لمضادات الأكسدة، الميلاتونين وفيتامين د وفيتامين هـ لحماية الكلى لفئران التجارب المصابة بالسكري. طرق البحث: شملت الدراسة ١٠٨ فأرا قسموا إلى ١٢ مجموعة. المجموعة ١ مجموعة ضابطة من فئران طبيعية لم تتلق أي دواء. المجموعات من ٢ إلى ٤ هي لفئران طبيعية عولجت كالتالي: المجموعة ٢ بميلاتونين، والمجموعة ٣ بفيتامين هـ، والمجموعة ٤ بفيتامين د. المجموعات من ٥ إلى ١٢ هي لفئران مصابة معمليا بالسكري ثم عولجت كما يلي: المجموعة ٥ لم تتلق أي دواء، والمجموعة ٦ بالأنسولين، والمجموعة ٧ بالميلاتونين، والمجموعة ٨ بالميلاتونين والأنسولين، والمجموعة ٩ بفيتامين هـ، والمجموعة ١٠ بفيتامين هـ مع الأنسولين، والمجموعة ١١ بفيتامين د، أما المجموعة ١٢ فعولجت بفيتامين د مع الأنسولين. استمر العلاج لشهرين ثم جمعت عينات الكلى للفحص النسيجي، وعينات مصل الدم للفحص الكيميائي لقياس مستويات: سكر الدم، الإجهاد التأكسدي، وظائف الكلى، الهوموسستاين وعامل التنخر الورمي-الفا. النتائج: أظهرت النتائج زيادة ذات دلالة إحصائية للقدرة الكلية لمضادات الأكسدة في مجموعات ٢، ٧، ٨، ١٠ و١١. زاد عامل التنخر الورمي-الفا في المجموعة ٢ ولكنه نقص في باقي المجموعات. أظهرت النتائج زيادة ذات دلالة إحصائية للكرياتينين في المجموعات ٥، ٦، ٧، ٨، ٩، ١١، ١٢. الفحص النسيجي للكلى أظهر زيادة في سمك الغشاء المبطن للأوعية الشعرية مع تصلب منتشر في الأغشية المبطنة وتصلب عقدي في الكبيبات الكلوية. العلاج بالميلاتونين أظهر تحسن ملموس في حماية الكلى بينما لم يُحدث العلاج بفيتامين د وفيتامين هـ نفس الأثر. الاستنتاجات: أظهر الميلاتونين سواء مع الأنسولين أو بدونه نشاطا مفيدا مضادا للأكسدة كيميائيا مع حماية لأنسجة الكلى، بينما فشل فيتامين د وفيتامين هـ في إظهار هذه التأثيرات. Abstract: Objectives: Diabetes mellitus is associated with oxidative stress that leads to inflammation and diabetic nephropathy. This study aimed to determine the possible renoprotective effects of the antioxidants melatonin, vitamin D and vitamin E in diabetic rats. Methods: We divided 108 albino rats into 12 groups. G1 group was fed a normal diet and did not receive any medication. G2 to G4 consisted of non-diabetic rats that were treated as follows: G2 with melatonin; G3 with vitamin E; G4 with vitamin D. Groups G5 to G12 consisted of diabetic rats that were treated as follows: G5 received no medication; G6 treated with insulin; G7 treated with melatonin; G8 treated with melatonin and insulin; G9 treated with vitamin E; G10 treated with vitamin E and insulin; G11 treated with vitamin D and G12 treated with vitamin D and insulin. Two months after treatment commenced, histological and biochemical examinations of glucose profile, oxidative stress status, renal function, homocysteine and TNF-α were performed. Results: Total antioxidant capacity (TAC) increased significantly in groups G2, 7, 8, 10 and 11. TNF-α significantly increased in G2, but decreased in all other groups. Creatinine increased significantly in groups G5, 6, 7, 8, 9, 11 and 12. In the kidneys of the diabetic rats, thickened capillary basement membrane, diffuse mesangial sclerosis and nodular glomerulosclerosis was observed. Rats treated with melatonin showed marked improvement in these symptoms. However, in those treated with vitamin D and E, thickened capillary basement membrane and mesangial sclerosis was still present. Conclusions: Melatonin, administered either with or without insulin had a significant biochemical antioxidant effect and histological renoprotective effect. Conversely, vitamin D and E did not appear to have any effects on the parameters measured.

This study aimed at investigating the vitamin D status of pediatric patients with upper limb fractures and finding out the influences of age, gender, season and fracture sites. 695 patients were admitted for upper limb fractures between November 1st 2014 and October 31st 2015. 224 healthy children were included during the same period. Serum 25(OH)D was measured at the time of visit and their demographic data were recorded. Generally fracture patients had significant lower vitamin D level than the healthy children. The average serum 25(OH)D of the patients was 24.5 ng/ml, compared to 28.1 ng/ml in healthy children. Vitamin D status worsened with the increase of age and adolescents had a deficiency rate of as high as 68.6%. Gender and fracture sites had no influence on vitamin D level. This study revealed high prevalence of vitamin D deficiency and insufficiency in pediatric patients with upper limb fractures. Adolescents had such high rate of vitamin D deficiency that called for vast attention.

It has been demonstrated that vitamin D (Vit D) included in diets offers a beneficial effect by improving innate immune responses in chickens. However, its mechanisms of action and the effect on immunosuppressive pathogens, such as infectious bursal disease virus, are not yet known. In the present study, we have studied the immunomodulatory effect of Vit D on the innate immune response in 3 cell lines: fibroblast cells (DF-1), macrophages (HD11), and B cells (DT-40) infected with IBDV (intermediate vaccine) at 2 multiplicity of infections (MOI) (1 and 0.1). Genes associated with innate immune responses (TLR-3, TLR-21, MDA-5, MyD88, TRIF, IRF-7, INF-α, INF-β, PKR, OAS, viperin, IL-1β, IL-6, and IL-12) were evaluated at different time points (3, 6, 12, 24, and 36 h after infection, h.p.i). Virus production reached a maximum at 24 h.p.i., which was significantly (P < 0.05) higher in DF-1 cells, followed by HD-11 and DT-40 cells. Mainly in HD-11 cells, there was a significant (P < 0.05) effect of Vit D supplementation on receptors TLR-3, TLR-21, and MDA-5 after 12 h.p.i, independent of MOI. DT-40 cells showed the highest antiviral activity, with a significant (P < 0.05) effect on IRF-7, IFN-β, OAS, and PKR gene expression, where expression of IRF-7 and IFN-β correlated positively with Vit D supplementation, while OAS and PKR were independent of Vit D. Proinflammatory cytokines were significantly (P < 0.05) upregulated and found to be Vit D and MOI dependent. In conclusion, this study demonstrated the capacity of IBDV to trigger a strong innate immune response in chicken cells and contributes to the understanding of the activation pathways of innate immunity induced by IBDV and further shows the benefitial effect of Vit D supplementation as an immunomodulator.

Low levels of vitamin D have been linked with increased adiposity and diminished muscle strength. Whether it is also related to fat deposition in muscle tissues is not studied well. This study explored the associations between circulating 25-hydroxyvitamin D (25(OH)D) and fat deposition in muscle tissues of adult Arab males. A total 465 adult Saudi males were included in this cross-sectional study. Anthropometrics, body composition and muscle strength were assessed. Serum 25(OH)D was determined and quantified enzymatically. They were grouped according to vitamin D status: deficient (25(OH)D 50 nmol/l)140 (30.1%). Mean level of lean/height2, lean-arm-legs and lean-arms-legs/height2 were significantly higher in 25(OH)D deficient participants (p-values 0.03; 0.05 and 0.01 respectively). Thigh strength was significantly higher in 25(OH)D sufficient participants than their deficient counterparts (p = 0.02). In all participants, a significant correlation between 25(OH)D was observed with age and thigh-strength (p-values

Objectives: To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs. Source of data: Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019. Summary of data: A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI = 0.25-0.41; I 2 = 92%, p < 0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI = 0.21-0.47; I 2 = 86%, p < 0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI = 0.40-0.64; I 2 = 76%, p < 0.01). Conclusions: Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present. Resumo Objetivos: Mensurar a prevalência de deficiência de vitamina D (através do metabólito 25-hidroxivitamina D) em pacientes pediátricos em uso de fármacos antiepilépticos. Fonte dos dados: Metanálise de estudos identificados por meio de pesquisa nas bases de dados Pubmed, Embase, LILACS e Cochrane em 19 de fevereiro de 2019. Síntese dos dados: Foram identificados 748 artigos, dos quais 29 mostraram-se relevantes aos objetivos deste estudo. A prevalência de deficiência de vitamina D encontrada foi de 0,32 (IC 95% = 0,25-0,41) (I2 = 92%, p < 0,01). Nas análises por subgrupos, os resultados mais expressivos foram observados no grupo de pacientes em uso de fármacos antiepilépticos indutores do citocromo P450, que apresentou prevalência de 0,33 (IC 95% = 0,21-0,47) (I2 = 86%, p < 0,01). Considerou-se o delineamento dos estudos, no subgrupo de estudos de coorte, com prevalência de 0,52 (IC 95% = 0,40-0,64) (I2 = 76%, p < 0,01). Conclusões: Levando-se em consideração os efeitos deletérios da deficiência de vitamina D na saúde óssea dos sujeitos em uso de fármacos antiepilépticos, sugere-se incluir em seu atendimento, o monitoramento de 25-hidroxivitamina D, suplementação com colecalciferol e tratamento de deficiência quando existente.

H syndrome is a rare autosomal recessive disorder that occurs because of mutations in the SLC29A3 gene, encoding the human equilibrative nucleoside transporter, which is a protein located in endosomes, lysosomes, and mitochondria.1, 2, 3, 4, 5 It was first named by Molho-Pessach et al in 2008.1 To date, fewer than 120 cases of this rare disease have been reported worldwide.5 It is characterized by the presence of hyperpigmented indurated patches with overlying hypertrichosis symmetrically involving the inner aspects of the thighs, which may extend to the posterior aspects of the lower limbs, abdomen, and back, while sparing the knees and buttocks. Other important features of H syndrome include sensorineural hearing loss, hyperglycemia/insulin-dependent diabetes mellitus, heart anomalies, hypogonadism, low height (short stature), and hepatosplenomegaly.1, 2, 3, 4, 5, 6 Currently, many investigators consider H syndrome as a novel form of histiocytosis.4,7 In this case series, 3 cases are reported with findings consistent with H syndrome, in addition to new findings that have not been reported in the literature. All 3 of our patients have low bone mineral density associated with musculoskeletal pain, they also have hypovitaminosis D with secondary hyperparathyroidism, and they responded well to vitamin D supplements.

Rickets is a common bone disease worldwide that is associated with disturbances in calcium and phosphate homeostasis and can lead to short stature and joint deformities. Rickets can be diagnosed based on history and physical examination, radiological features, and biochemical tests. It can be classified into 2 major groups based on phosphate or calcium levels: phosphopenic and calcipenic. Knowledge of categorization of the type of rickets is essential for prompt diagnosis and proper management. Nutritional rickets is a preventable disease through adequate intake of vitamin D through both dietary and sunlight exposure. There are other subtypes of rickets, such as vitamin D–dependent type 1 rickets and vitamin D–dependent type 2 rickets (due to defects in vitamin D metabolism), renal rickets (due to poor kidney function), and hypophosphatemic rickets (vitamin D–resistant rickets secondary to renal phosphate wasting wherein fibroblast growth factor-23 (FGF-23) often plays a major role), which requires closer monitoring and supplementation with activated vitamin D with or without phosphate supplements. An important development has been the introduction of burosumab, a human monoclonal antibody to FGF-23, which is approved for the treatment of X-linked hypophosphatemia among children 1 year and older.

Aim of the work It was to estimate the carotid intima-media thickness (CIMT), lipid profile, serum amyloid A and vitamin D in Familial Mediterranean Fever (FMF) patients and to explore the relationship between CIMT and FMF. Patients and methods The study comprised forty-five FMF patients diagnosed during the attack free period and 40 healthy children with similar demographic features as control. The diagnosis of the FMF cases was confirmed by clinical, laboratory assessments and confirmed by the molecular diagnosis. The CIMT, lipid profile, complete blood picture, serum amyloid A (SAA) levels, vitamin D and the growth pattern were investigated. Results The study showed no significant difference of CIMT among patients and controls, significant decrease of vitamin D levels, while lipid profile parameters, triglyceride (TG) to HDL-Cholesterol (HDL-C) ratio, serum amyloid A were significantly increased. A significant correlation was present between the CIMT with the serum cholesterol, low density lipoprotein and triglycerides as well as between SAA and the number of attacks. In addition, vitamin D levels showed significant negative correlation with colchicine. M694I mutation was the most prevalent among FMF patients. Growth parameters were normal in FMF cases. Conclusion This study sheds light that the normal CIMT in the FMF patients makes it difficult to describe the children as having subclinical atherosclerosis although the higher TG/HDL ratio reflects their risk of atherosclerosis. Moreover, significant decrease of vitamin D in FMF patients was observed. The growth parameters of the FMF patients on regular treatment of colchicine were not affected.

This study aimed to assess the relationship between vitamin D [25(OH)D] status and parathyroid hormone (PTH) in Saudi adults to determine the optimum 25(OH)D cut-off in the Saudi adult population. A total of 1093 apparently healthy Saudi subjects (720 women and 373 men) aged 50.7 ± 13.9 years were included in this cross-sectional study. Serum 25(OH)D, PTH, calcium and albumin levels were determined. The over-all prevalence of 25(OH)D deficiency (

Vitamin D is essential for the metabolism of calcium (Ca) and phosphorus (P) in birds. The objective of the study was to evaluate the effect of different isoforms of dietary vitamin D on Ca and P utilization, egg quality, and bone mineralization of laying hens. A total of 42 Lohmann white laying hens at 57 wk of age were randomly assigned to 7 dietary treatments for 6 wk. Dietary treatments were: 3,000 IU/kg Vit D3 as control, and control with additional 3,000 IU/kg 25-hydroxyvitamin D3 (T1), 9,000 IU/kg 25-hydroxyvitamin D3 (T2), 3,000 IU/kg vitamin D3 (T3), 9,000 IU/kg vitamin D3 (T4), 3,000 IU/kg of vitamin D2 (T5), or 9,000 IU/kg of vitamin D2 (T6). Egg production and egg quality were measured weekly. Fecal samples were collected at weeks 2 and 6 to measure Ca and P utilization. After 6 wk, the left tibia and femurs were collected to measure bone mineral density (BMD) and bone mineral content (BMC). A 1-way ANOVA with Tukey HSD means separation test was used for statistical analysis. There were no significant differences in egg production, egg quality, BMD, or BMC of tibia and femurs among the treatments (P > 0.05). T6 significantly reduced feed intake (P < 0.05). The apparent total tract digestibility (ATTD) of Ca was higher (P < 0.012) in treatments supplemented with additional vitamin D, irrespective of forms. The ATTD of P was higher (P < 0.0001) in T5 compared to the other treatments at both time points. The utilization of Ca and P by laying hens can be improved through the addition of different isoforms of vitamin D in diets. However, additional vitamin D supplementation to laying hens, regardless of forms, had no effect on either bone mineralization or measures of egg quality.

Statins are a class of drugs for managing elevated concentration of low-density lipoprotein (LDL) cholesterol, main risk factor of cardiovascular diseases. Despite these drugs are well tolerated, muscular symptoms and toxicity remain a cause for discontinuation. Statin Associated Muscle Symptoms (SAMS) comprehend discomfort (myalgia), muscle weakness (myopathy), tenderness to palpation, with or without muscle inflammation (myositis), and/or myonecrosis. The cause and mechanisms of SAMS are unknown and remain elusive. Statins act through the block of hydroxy-3-methyl-Glutaryl-coenzyme A reductase (HMG-CoAR) thereby reducing cholesterol synthesis and its by-products. One of them is vitamin D, and its decrease has been studied as a possible cause of SAMS, but the findings are controversial. This chapter aims to address new and old biomarkers of muscle damage in relation to SAMS and vitamin D levels.

Anemia is a highly prevalent complication in patients with chronic kidney disease (CKD) and its severity and prevalence increase with increasing CKD severity. Many factors contribute to anemia in CKD, of which a hallmark feature is erythropoietin deficiency. The availability of erythropoietin-stimulating agents (ESAs) has revolutionized anemia management in CKD patients in the last two decades. However, the cardiovascular safety of ESA treatment in CKD came into question some years ago when ESA trials that targeted hemoglobin (Hb) >13 g/dL showed greater risks for death, cardiovascular events, and stroke than a lower Hb target. This led to revision of the recommended Hb target by the different international guidelines to no more than 11.5–12 g/dL for CKD 3–5D patients. On the other hand, the discovery of the hypoxia-inducible factor (HIF) transcription complex in 1992 has unfolded important novel mechanisms that regulate erythropoietin gene and erythropoietin production in the kidneys in response to hypoxia or anemia. This led to development of a new class of drugs called HIF stabilizers, or HIF prolyl hydroxylase domain (PHD) inhibitors that prevent the proteasomal degradation of HIF-α, thereby inducing upregulation of erythropoietin gene. The PHD inhibitors can be orally administered and represent a novel paradigm for anemia management in CKD. Currently, several of them are undergoing phase III clinical trials in adults. The PHD inhibitors may have better cardiovascular safety profile in that they induce lower erythropoietin production, lower hepcidin levels, increase iron absorption and mobilization, lower cholesterol level, and have a neutral effect on blood pressure than ESA. However, the long-term safety of this new class of drugs remains to be tested as the PHD inhibitors also stimulate angiogenic factors such as vascular endothelial growth factor and glycolytic factors. In this chapter, we also review other key nutrition factors involved in anemia in CKD, including iron, carnitine, vitamin C, vitamin D, folate, and several other B group vitamins. We specifically review iron homeostasis, iron balance and management, interrelations between the HIF pathway and iron, and hepcidin. We also discuss erythropoietin hyporesponsiveness in CKD patients.

Highlights • Vitamin D deficiency is multifactorial in the cystic fibrosis population. • Vitamin D deficiency can adversely affect multiple organ systems in the cystic fibrosis population. • In the cystic fibrosis population in the United States, we aim to treat to serum 25-hydroxyvitamin D levels over 30 ng/ml. • Cholecalciferol is used in preference to ergocalciferol. • Daily or once weekly dosing regimens are chosen according to patient preference and compliance., Vitamin D deficiency is common in the general population, and even more so in patients with cystic fibrosis. Deficiency is exacerbated in cystic fibrosis patients because of a myriad of causes including malabsorption, decreased fat mass, reduced 25-hydroxylation of vitamin D, reduced exposure to sunlight, decreased vitamin D binding protein, and exposure to drugs that increase catabolism. In turn, vitamin D deficiency can contribute to poor bone health. Additionally, it may contribute to pulmonary decline in the form of worsening pulmonary function, increased colonization with pathogens, and increased pulmonary exacerbation. Because vitamin D deficiency is correlated with negative clinical effects in multiple organ systems of patients with cystic fibrosis, it is important to screen for and treat deficiency in these patients. The Cystic Fibrosis Foundation has issued guidelines for the treatment of vitamin D deficiency, targeting serum levels of 25-hydroxyvitamin D of at least 30 ng/ml. The guidelines offer age-specific escalating dose regimens depending on serum vitamin D levels, with monitoring at 12- week intervals after changing therapy. They address the literature on alternative vitamin D sources, such as UV lamps, ideal formulations (cholecalciferol in preference to ergocalciferol), and optimal vehicles of administration. Despite these detailed recommendations, most centers are still unable to achieve in-target serum vitamin D levels for many of their patients. Future research examining ideal treatment regimens to achieve serum targets and maximize clinical effects are needed. Moreover, it is unknown whether vitamin D sufficiency will be easier to achieve on new triple therapy cystic fibrosis drug combinations, and how these drugs will contribute to vitamin D-related clinical outcomes.

Background and purpose There is sufficient evidence to support vitamin D's noncalcemic effects and the role of vitamin D deficiency in the development of a wide range of neurological disorders. This study aimed to evaluate whether serum 25(OH)D and 1,25(OH) 2 D could be used as biomarkers to differentiate between healthy subjects (HS), multiple system atrophy (MSA) and Parkinson's disease (PD) patients of both genders. Methods A total of 107 subjects were included in this study, divided into three groups: 1- HS (n = 61), 2- MSA patients (n = 19), and 3- PD patients (n = 27). The patients were assessed using UMSARS II, UPDRS III, H&Y, MMSE and MoCA rating scales. The levels of 25(OH)D and 1,25(OH) 2 D in serum were determined using the radioimmunoassay technique. Results The levels of 25(OH)D and 1,25(OH) 2 D in HS were 26.85 +/− 7.62 ng/mL and 53.63 +/− 13.66 pg/mL respectively. 25(OH)D levels were lower in both MSA and PD by 61% and 50%, respectively (P = 0.0001 vs. HS). 1,25(OH) 2 D levels were lower in MSA by 29%(P = 0.001 vs HS). There was a correlation between 25(OH)D and 1,25(OH) 2 D in MSA and PD, but not in HS. 1,25(OH) 2 D regressed with MMSE (β = 0.476, P = 0.04, R 2 = 0.226) in MSA, and with UPDRS III (β = −0.432, P = 0.024, R 2 = 0.187) and MoCA (β = 0.582, P = 0.005,R 2 = 0.279) in PD. 25(OH)D displayed considerable differentiative strength between HS and MSA (Wald = 17.123, OR = 0.586, P = 0.0001; AUC = 0.982, sensitivity and Youden index = 0.882, P = 0.0001) and PD (Wald = 18.552, OR = 0.700, P = 0.0001; AUC = 0.943, sensitivity = 0.889, YI = 0.791, P = 0.0001). 1,25(OH) 2 D distinguished MSA from PD (Wald 16.178, OR = 1.117, P = 0.0001; AUC = 0.868, sensitivity = 0.926, Youden index =0.632, P = 0.0001). H&Y exhibited the highest sensitivity, AUC, and significant distinguishing power between MSA and PD. Conclusions Serum 25(OH)D and 1,25(OH) 2 D could be useful biomarkers for MSA and PD. 25(OH)D and H&Y provided the highest sensitivity and group classification characteristics., Highlights • Low serum 1,25(OH)2D and 25(OH)D concentrations in MSA, whereas only low 25(OH)D in PD. • The decrement of serum 1,25(OH)2D concentration is higher in MSA than in PD. • In MSA, 25(OH)D correlate with 1,25(OH)2D, UMSARS and H&Y. • In PD, 25(OH)D correlate with 1,25(OH)2D and H&Y. • 25(OH)D and H&Y display the highest diagnostic performance as binary classifier for PD and MSA.

Background and Aims: Nonalcoholic fatty fiver disease (NAFLD) is a multisystemic disease that can affect several systems and tissues. Recently, low bone mass density (BMD) and vitamin D deficiency were been associated with the severity of NAFLD and there has been significant scientific interest in the relationship between vitamin D, BMD and NAFLD. This study aimed to assess the status of vitamin D and BMD in liver fibrosis and in NAFLD. Methods: Adults without vitamin D replacement and with established risk factors for the development of NAFLD were selected, such as: obesity, dyslipidemia, type 2 diabetes and metabolic syndrome. The non-invasive assessment of NAFLD and degrees of fibrosis was performed by ultrasound (US-FLI) and ultrasound elastography. BMD was measures with dual energy X-ray absorptiometry (DXA). The 25(OH)D3 was determined using chemiluminescent immunoassay technology. Results: A total of 42 participants were enrolled and hepatic steatosis was present in 24. All data are presented as median (IQR) or n (%). Age 66 (52-61) years, 36 (85.7%) were women. The median of 25(OH)D3 levels was 21 (18-28) ng/mL. The frequency of liver fibrosis, low levels of vitamin D (< 20 ng/mL) and low BMD was, respectively: 29%, 44% and 61%. We found 5.5% osteoporosis, 50% osteopenia and 5.5 low BMD for age. Conclusion: The frequency of low BMD and low Vit D levels is higher in the population with steatosis and high incidence of liver fibrosis than in the general Brazilian population.

25-hydroxyvitamin D [25(OH)D] is an important immunomodulator, whose deficiency may aggravate the incidence and outcome of infectious complications in patients admitted to the intensive care unit. The most recognized extra-skeletal action of vitamin D is the regulation of immune function. Host defense against intracellular pathogens depends upon both innate and adaptive immunity. It has been suggested that vitamin D regulates the pro-inflammatory endothelial response to lipopolysaccharide, rendering it a role in the sepsis cascade. Recent studies have indicated that vitamin D deficiency may be associated with worse outcomes in patients with coronavirus disease 2019 (COVID-19), such as more severe disease and higher mortality rates. To this end, clinical trials with vitamin D supplementation are being carried out in an effort to improve COVID-19 outcomes. In this review, we will discuss the role of vitamin D in the immune response, and more specifically its effect on immune cells. Subsequently, we will provide an overview of the studies that have investigated the predictive value of vitamin D in critical illness outcomes, and its therapeutic value as a supplement in critically ill patients. Finally, the emerging role of vitamin D deficiency in COVID-19 infection risk, and worse outcomes will be discussed.

Objective: To determine the prevalence of low vitamin D (

Background: Paediatric outpatient prescription (POP) monitoring is pivotal to identify inadequate prescriptions and optimize drug use. We aimed at describing recent trends in POPs in France. Methods: All reimbursed dispensations of outpatient prescribed drugs (excluding vaccines) were prospectively collected for the paediatric population (

Background: Low vitamin D (VitD) status is becoming a global health issue. Previous heterogenous results are urging a meta-analysis to delineate a panorama of VitD conditions in the general population in Mainland of China. Methods: We performed a systematic review and meta-analysis by searching PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, WanFang, and VIP databases up to June 4, 2021. The inclusion criteria were as follows: (1) original articles or dissertations focused on VitD status of people in Mainland of China; and (2) studies were population-based, cross-sectional, or longitudinal cohort with baseline data. The outcomes were serum 25(OH)D concentration and the prevalence of low VitD status. Low VitD status included VitD deficiency (

Rationale & Objective Mineral and bone disorder in chronic kidney disease (CKD) is associated with progression of coronary artery calcification (CAC). Mineral and bone disorder often is treated with calcitriol and other vitamin D receptor activators, including paricalcitol, agents that may have differential effects on calcium, phosphate, and parathyroid hormone levels. Accordingly, we investigated whether these agents have differential effects on CAC progression in patients with CKD. Study Design Randomized, double-concealed, 48-week clinical trial. Setting & Participants CKD stage 3 or 4 with secondary hyperparathyroidism with CAC score > 0 and no prior treatment with activated vitamin D. Intervention Calcitriol versus paricalcitol. Outcomes The primary outcome was log-transformed CAC change. Secondary outcomes included percent change in CAC volume, valvular calcifications, and bone mineral metabolism markers. Results Among 44 individuals randomly assigned, mean age was 65 years and mean estimated glomerular filtration rate was 27 mL/min/1.73 m2. Median CAC score was 140 (IQR, 55-277) Agatston units at baseline. There was no significant difference in CAC progression between treatment arms (P = 0.06). After adjustment for baseline CAC score (log), treatment group remains nonsignificant (P = 0.08). Further adjustment for creatinine level and/or CKD stage did not change the association. In secondary analyses adjusting for dose level of activated vitamin D, treatment group was significant (P = 0.01), and when dose level was also included in the model, the coefficient for individuals in the paricalcitol group was significantly associated with CAC progression (P = 0.02). An interaction term between dosing level and CKD stage was significant at the highest dosing level (P = 0.04). Limitations Pilot single-center study. Conclusions In patients with CKD with secondary hyperparathyroidism naive to activated vitamin D therapy, there was no difference in CAC or valvular progression in participants receiving calcitriol compared with paricalcitol during a 48-week period. Funding Abbvie, Inc. Trial Registration NCT00752102, Graphical abstract

Due to abnormalities in bone metabolism and an inability to produce normal vitamin D levels in the skin, patients with extensive burns often present with hypocalcemia, not hypercalcemia. In this report, we present a rare case of acute hypercalcemia caused by silver-containing calcium alginate fibers as a dressing in a patient with extensive burn injury. The patient had been treated with oral calcium formulation because of hypocalcemia. We applied silver-containing calcium alginate fibers to raw surface area after the first skin grafting surgery, and the calcium level corrected for the serum albumin level continued to rise up to 15.4 mg/dl with this dressing form even after discontinuation of oral calcium preparations. Cessation of the use of this dressing resulted in a sharp drop in blood calcium levels. Therefore, we concluded that the cause of the hypercalcemia was the absorption of calcium ions eluted from the silver-containing calcium alginate fibers. Our findings suggest that dressings may cause hypercalcemia in patients with extensive burns, and that physicians should be attentive to the dressings used in burn wound care. Keywords: Hypercalcemia, Silver-containing calcium alginate fibers, Extensive burn

Resumen: La hipercalciuria idiopática (HI) se define como aquella situación clínica en la que se comprueba un incremento en la eliminación urinaria de calcio, en ausencia de hipercalcemia y de otras causas conocidas de hipercalciuria. En los últimos años, su diagnóstico en la edad pediátrica ha sido más frecuente debido a que se ha conocido que puede comenzar con síntomas muy diversos, en ausencia de formación de cálculos renales. El descubrimiento de las ratas hipercalciúricas ha permitido vislumbrar el mecanismo fisiopatológico de la HI ya que muestran muchos datos en común con los humanos con HI, como niveles normales de calcemia, hiperabsorción intestinal de calcio, incremento de la resorción ósea y un defecto en la reabsorción tubular renal de calcio. En 1993, se demostró que en esos animales existe un incremento en el número de receptores de la vitamina D (VDR) del intestino, lo que favorece un aumento de la capacidad funcional de los complejos calcitriol-VDR que explica el incremento en el transporte intestinal de calcio. Lo mismo ocurre a nivel óseo produciéndose una mayor resorción. En nuestra opinión, la HI es una «anomalía metabólica» o, mejor, una característica metabólica constitutiva heredable. En este sentido, lo que los pacientes con HI heredarían es la disponibilidad de tener en sus células un mayor número de VDR que aquellas personas con calciurias normales. La HI no se puede considerar una enfermedad sensu stricto, por lo que el tratamiento farmacológico debe ser individualizado. Abstract: Idiopathic hypercalciuria (IH) is defined as that clinical situation in which an increase in urinary calcium excretion is observed, in the absence of hypercalcemia and other known causes of hypercalciuria. In recent years, its diagnosis in pediatric age has been more frequent because it has been known that it can debut with very different symptoms, in the absence of kidney stone formation. The discovery of genetic hypercalciuric stone-forming rats has allowed us to glimpse the pathophysiological mechanism of IH since they show many data in common with humans with IH as normal levels of blood calcium, intestinal calcium hyperabsorption, increased bone resorption and a defect in the renal tubular calcium reabsorption. In 1993, it was shown that in these animals there is an increase in the number of vitamin D receptors (VDR) in the intestine, which favors an increase in the functional capacity of calcitriol-VDR complexes that explains the increase in intestinal transport of calcium. The same happens at the bone level producing a greater resorption. In our opinion, IH is a ‘metabolic anomaly’ or, better, an inheritable constitutive metabolic characteristic. In this sense, what patients with IH would inherit is the availability of having a greater number of VDRs in their cells than those with normal urinary calcium excretion. IH cannot be considered a sensu stricto disease, so pharmacological treatment must be individualized. Palabras clave: Hipercalciuria idiopática, Receptor de la vitamina D, Litiasis urinaria, Densidad mineral ósea, Infección de vías urinarias, Keywords: Idiopathic hypercalciuria, Vitamin D receptor, Urinary lithiasis, Bone mineral density, Urinary tract infection

Objective: The aim of this study was to evaluate the rates of vitamin D deficiency in adolescent pregnants and its influence on the obstetric outcomes. Materials and methods: A total of 300 singleton pregnant women aged between 14 and 20 years, were divided into three groups according to their gestational weeks (100 pregnant adolescents from each trimester). Randomly selected 300 singleton pregnant women older than 20 years of age with the similar gestational ages were designed as the control group at the same time period. We divided serum 25(OH)D levels into three categories deficiency, inadequacy and adequate levels according to the Endocrine Society guidelines. Serum 25(OH)D levels were also evaluated according to age, seasons and gestational periods. Adverse obstetric outcomes were recorded. Results: Overall, 86% of the subjects were found to have deficient 25(OH)D levels (

Background: The finding of hypovitaminosis in pregnancy D has prompted the debate about its supplementation. The objective of the study was to measure the prevalence of hypovitaminosis D in mothers and newborns. Methods: A one-year observational study was conducted including the measuring of vitamin D levels in mothers and in the umbilical cord blood of newborns. An analysis was made of the variables as regards maternal characteristics, delivery and sun exposure. Results: Values lower than 20 ng/mL were found in 64.4% of 745 mothers and 41.3% of 560 newborns, and less than 30 ng/mL in 88.7% and 67.1%, respectively. Mean levels were higher in summer–autumn than in winter–spring (21.73 and 13.70 ng/mL in mothers and 29.04 and 20.49 ng/mL in cord), and higher in the umbilical cord than in the maternal plasma. Multiple pregnancies (OR: 6.29) and non-European origin (OR: 13.09) were risk factors for maternal hypovitaminosis, while maternal supplementation (OR: 0.19), physical activity (OR: 0.57), and sun exposure (OR: 0.46) had a preventive effect. Conclusions: The high rates of hypovitaminosis support the policy of giving dietary supplements to newborns. The high level of hypovitaminosis found supports the extension of screening and supplementation to all pregnant women, and not only to those with risk factors. The greater difference between mothers and newborns in seasons of low sun exposure can be interpreted as a protective effect. Resumen: Introducción: El hallazgo de hipovitaminosis D en el embarazo ha impulsado el debate acerca de su suplementación. El objetivo del estudio fue medir la prevalencia de hipovitaminosis D en gestantes y recién nacidos. Métodos: Se realizó un estudio observacional de un año de duración midiendo los niveles de vitamina D en madres y en sangre de cordón umbilical de recién nacidos. Se registraron variables relacionadas con las características de la madre, el parto y la exposición al sol. Resultados: Se encontraron valores menores de 20 ng/ml en el 64,4% de 745 madres y el 41,3% de 560 recién nacidos y menores de 30 ng/ml en el 88,7% y 67,1% respectivamente. Los niveles medios fueron más altos en verano-otoño que en invierno-primavera (21,73 y 13,70 ng/ml en madres y 29,04 y 20,49 ng/ml en cordón) y mayores en el cordón umbilical que en el plasma materno. Los embarazos múltiples (OR: 6,29) y el origen no europeo (OR: 13,09) fueron factores de riesgo de hipovitaminosis materna mientras que la suplementación materna (OR: 0,19), la actividad física (OR: 0,57) y la exposición al sol (OR: 0,46) tuvieron un efecto preventivo. Conclusiones: Las altas tasas de hipovitaminosis respaldan la política de dar suplementos dietéticos a los recién nacidos. El alto nivel de hipovitaminosis encontrado apoya la extensión del cribado y suplementación a todas las embarazadas y no solamente a aquellas con factores de riesgo. La mayor diferencia entre madre e hijo en las temporadas de baja exposición solar puede interpretarse como un efecto protector.

Background and aims: It has been demonstrated that 1,25-hydroxyvitamin-D3-24-hydroxylase, encoded by CYP24A1 gene, is a key enzyme that neutralizes the active vitamin D3 metabolite 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] in response to hepatitis C virus (HCV) infection. This study aimed to investigate whether CYP24A1 genetic variation is associated with HCV infection outcomes. Methods: 848 HCV chronically infected subjects, 507 natural clearance subjects, and 1017 uninfected controls were enrolled. Nine single nucleotide polymorphisms (SNPs) in theCYP24A1 gene were genotyped using the Sequenom MassARRAY platform. Results: After adjusting for age, gender, and routes of infection, logistic regression analyses showed that rs6013897-A was associated with an elevated risk of HCV infection (P

Summary Group 3 innate lymphoid cells (ILC3) play key roles in protective immunity and mucosal barrier maintenance. Here we showed that vitamin D/vitamin D receptor (VDR) signaling regulates gut ILC3. VDR deletion or 1,25-dihydroxyvitamin D deficiency in mice led to a marked reduction in colonic ILC3 populations at steady state and impaired ILC3 responses following Citrobacter rodentium infection, resulting in substantial increases in intestinal bacterial growth and mouse mortality. VDR regulation of ILC3 was independent of T and B lymphocytes or gut microflora. Correction of 1,25-dihydroxyvitamin D deficiency rescued the ILC3 defects. Mechanistically, VDR deletion or 1,25-dihydroxyvitamin D deficiency markedly reduced colonic Ki67+ ILC3 populations, and in vivo and in vitro studies confirmed that vitamin D hormone directly stimulated ILC3 proliferation. Therefore, vitamin D/VDR signaling is required for ILC3-mediated innate immunity through regulation of ILC3 proliferation., Graphical Abstract, Highlights • VDR or 1,25(OH)2D3 deficiency reduces ILC3 populations and impairs ILC3 immunity • Vitamin D/VDR signaling is required for proper ILC3 proliferation • Vitamin D regulation of ILC3 is independent of T and B cells or gut microflora, Biomolecules; Immunology; Immune Response; Components of the Immune System

Introduction and Objectives There are inconsistent findings on the association between human non-alcoholic fatty liver disease (NAFLD) and vitamin D, perhaps due to insufficient specificity for gender and obesity status. We aimed to assess whether serum levels of 25-hydroxyvitamin D are associated with unexplained elevated alanine aminotransferase (ALT) in general population across gender and body mass index (BMI) levels. Materials and methods A cross-sectional analysis of a population-based cohort with a nationwide-distribution using electronic medical database. The population consisted of individuals aged 20–60 years who underwent blood tests for ALT and vitamin D. Results A total of 82,553 subjects were included (32.5% men, mean age 43.91 ± 10.15 years). The prevalence of elevated ALT was higher among men and women with vitamin D insufficiency or deficiency, but in multivariate analysis, adjusting for: age, BMI, serum levels of glucose, total cholesterol, triglycerides, statin use and season, only the association among men remained significant for the vitamin D deficiency category (OR = 1.16, 95%CI 1.04–1.29, P = 0.010). Stratification by BMI revealed that only among normal weight and overweight men vitamin D deficiency was associated with elevated ALT (OR = 1.27, 95%CI 1.01–1.59, P = 0.041 and OR = 1.27, 95%CI 1.08–1.50, P = 0.003, respectively). No independent association was shown among women at all BMI categories. Conclusions In a “real-life” general population, the association between vitamin D deficiency and unexplained elevated ALT is specific for non-obese men. The clinical significance of vitamin D for human NAFLD should be further elucidated with attention for a modifying effect of gender and adiposity.

Summary: Vitamin D, a fat soluble vitamin, is well known for calcium homeostasis. In recent years, many researchers have suggested that vitamin D performs multiple functions extending far beyond mineral homeostasis. The vitamin D synthesis machinery and related receptor have been reported in multiple tissues, where they play a key role in immune system modulation. Deficiency of vitamin D is not linked only with rickets or osteomalacia but with many other infectious and metabolic disorders. Emerging evidences suggest the relation of vitamin D deficiency in establishing tuberculosis. High prevalence of vitamin D deficiency in pulmonary TB patients indicates that vitamin D is a risk factor for the development of active tuberculosis. Therefore, maintaining vitamin D status in TB patients might be helpful to control tuberculosis. The level of vitamin can be maintained in reference limit by changing life style and use of multivitamin supplements. This review outlines the role of vitamin D in infectious diseases like tuberculosis and also effect of supplementation on treatment of TB; however, more studies are needed due to the clinical changes observed in patients with tuberculosis after vitamin D supplementation. Keywords: Vitamin D, Vitamin D 25-hydroxylase, Hypovitaminosis D, Infectious diseases, Tuberculosis

Vitamin D has been considered to regulate calcium and phosphorus homeostasis and to preserve skeletal integrity. Serum 25-hydroxyvitamin D (25(OH)D) is the best indicator of vitamin D levels. The association of serum 25(OH)D deficiency with increased risk of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) is controversial. We investigated serum 25(OH)D2 and 25(OH)D3 levels in diabetes patients by using liquid chromatography tandem mass spectrometry (LC-MS/MS). Serum 25(OH)D2 and 25(OH)D3 levels were measured with liquid chromatography tandem mass spectrometry in electrospray ionization positive mode. Chromatograms were separated using an ACE5 C18 column on a gradient of methanol. The total 25(OH)D levels were calculated as the sum of 25(OH)D3 and 25(OH)D2 levels. A total of 56 patients with T1DM and 41 patients with T2DM were enrolled in this study. There were 42 and 28 non-diabetic, age-matched volunteers who participated as the T1DM controls and the T2DM controls, respectively. The total 25(OH)D levels were lowest in the 21–40 age group. The levels of both 25(OH)D3 and the total 25(OH)D were significantly higher in the T1DM and T2DM groups than in the controls (p

Background: The prevalence of Vitamin D deficiency remains high in cystic fibrosis despite daily supplementation. Vitamin D as an immunomodulator has been related to lower respiratory tract infections in children. The present study was undertaken to examine the association between vitamin D status and markers of cystic fibrosis-related pulmonary disease including exacerbations, bacterial colonization and pulmonary function. Methods: The study includes review of records of 51 cystic fibrosis patients. Baseline patient variables and serum vitamin D levels were recorded. Based on vitamin D levels study patients were divided into three groups: vitamin-D sufficient (≥20 ng/mL), vitamin-D insufficient (12 to 20 ng/mL), and vitamin D-deficient (≤12 ng/ml). Results: The proportion of children with deficient, insufficient and sufficient vitamin D levels were 47.1%, 15.7%, and 37.2%, respectively. Female sex, bacterial colonization and a greater number of exacerbations were associated with highest odds of developing vitamin D deficiency in patients with CF with 1.77 (0.22–4.61) (p = 0.002), 2.9(0.57−14.82) (p = 0.011), and 5.12 (1.28−20.50) (p = 0.021) respectively. The comparison of vitamin-D levels taken during exacerbations, colonization and during routine follow-up were significant [16.04 (7.42−27.91), 24.3 (15.5−32.4) and 48.54 (18.37−78.7) ng/ml, p

Objective: The aim of this study was to assess the association between serum concentration of vitamin D, vitamin K, and osteocalcin with coronary atherosclerosis in patients undergoing angiography. Design: In this case-control study, 138 people who referred to Bushehr Heart Center for routine examination participated. Demographic information of the participants was registered by using a standard questionnaire. Before undergoing the angiographic processes, venous blood samples were obtained via venipuncture from the antecubital vein into gel and clot activator tubes and stored at – 80 °C until the analysis. After the angiography process was over, the normal participants entered the control group and those with coronary atherosclerosis plaque placed in the case group. Finally, serum levels of vitamin K2 and Osteocalcin were measured in the samples, by using ELISA kits and the serum level of vitamin D was measured by using HPLC. Result: serum levels of vitamin D in the case group were significantly lower than in the control (p = 0.009) and, serum levels of osteocalcin in the case group were significantly higher than in the control (P = 0.019). There was no difference in K2 level between the two groups (P = 0.84). By separating the three factors like age, sex and T2DM in the two groups, a significant synergistic was found between the concentration of osteocalcin, vitamin D (just in

Kidney international / Reports 4(2), 267-274 (2019). doi:10.1016/j.ekir.2018.10.004, Published by Elsevier, Amsterdam

Summary: Objective: Obesity is classically associated with vitamin D deficiency. The aim of this study was to investigate the association of vitamin D with serum adiponectin concentration and insulin resistance in normal weight and obese individuals. Research methods and procedures: Cross-sectional analysis was performed in 76 participants without diabetes (40 obese and 36 normal weight) from a convenience sample of a health counseling center in Belo Horizonte, MG, Brazil. All participants self-reported their skin color as white. Body weight and height were used to calculate body mass index (BMI). Serum insulin, glycemia, vitamin D (25OHD), and adiponectin were evaluated after 12 h fasting. Body fat percentage by electric bioimpedance and waist circumference were analyzed. Pearson's or Spearman's correlation coefficients were calculated. Age- and gender-adjusted associations by multivariate logistic regression were used. Multiplicative interaction terms between 25OHD/adiponectin and BMI were calculated. Results: Participant's mean age was 35 ± 9.5 years; 75% were female, and 65.8% were vitamin D insufficient (25OHD

Calcium and phosphorus are essential minerals required for many critical biologic functions including cell signaling, energy metabolism, skeletal growth and integrity. Calcium and phosphate homeostasis are maintained primarily by regulation of epithelial calcium and phosphate cotransport in the kidney and intestine, processes that are tightly regulated by hormones including 1,25 dihydroxyvitamin D (1,25(OH)2D), fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH). In patients with chronic kidney disease (CKD), as renal function declines, disruption of feedback loops between these hormones have adverse consequences on several organ systems, including the skeleton, heart and vascular system. CKD-associated mineral and bone disorder (CKD-MBD) is defined as a systemic disorder of mineral and bone metabolism due to CKD manifested by abnormalities of calcium, phosphorus, PTH or vitamin D metabolism, abnormalities of bone turnover, mineralization and volume, and ectopic soft tissue calcification. Complications of CKD-MBD include vascular calcification, stroke, skeletal fracture and increased risk of death. Increased FGF23 and PTH concentrations, and 1,25(OH)2D deficiency contribute to the pathogenesis of CKD-MBD. Therefore, treatment of patients with CKD-MBD is focused on restoring the feedback loops to maintain normal calcium and phosphate balance to prevent skeletal and cardiovascular complications., Highlights • CKD-MBD is manifested by abnormal biochemistries, bone turnover and mineralization, and ectopic calcification. • Secondary hyperparathyroidism is a component of CKD-MBD. • Renal osteodystrophy is defined as abnormalities in bone morphology associated with CKD as determined by bone biopsy. • Goals of CKD-MBD management are to promote optimal skeletal health and prevent skeletal and cardiovascular complications. • Precise recommendations for target levels of biochemistries are lacking posing challenges to management of CKD-MBD.

Background Headache is the most encountered manifestation of pain in childhood. The purpose of this study was to investigate the incidence and clinical characteristics of primary headaches. Further, the factors associated with primary headache were examined. Materials and methods A retrospective study was conducted among young children and adolescents over 3 years at a tertiary referral teaching hospital in North Jordan. Relevant patient information was obtained by reviewing patients' medical records. Results This study included 194 children (95 males, 99 females). The incidence rate of primary headache in the current study was 2.815 per 1000 children visited pediatric clinic. The mean age of patients at the time of headache onset was 10 years, and about half of them were males (95/194; 49%). Approximately 30% (56/194) had a family history of headache. Migraine headaches were the most commonly reported types (87/194; 44.8%) and only 17/194; 8.7% suffered from tension type headaches. Approximately, 40% (84/194) of patients reported severe headache and a third of them (67/194; 34.5%) complained of daily headaches. Pain location was reported as bilateral in most patients (153/194; 78.9%). About one fifth (41/194; 21.1%) stated that their headache was precipitated by sleep deprivation. Abnormal serum level of vitamin D and family history of headache were significantly associated with primary headache (p, Highlights • Incidence of primary headache in Jordan was relatively low. • Migraine headaches were the most commonly reported headache types. • Abnormal serum level of vitamin D was significantly associated with primary headache. • Family history of headache also was significantly associated with primary headache. • Screening vitamin D for children presented with primary headaches is essential.