(Preventing) two birds with one stone: improving vitamin D levels in the elderly

BACKGROUND AND CONTEXT: A majority of adults have sub-optimal vitamin D levels in the winter in southern New Zealand. This is associated with an increased risk of falls and fragility fractures in the elderly, with long-term adverse outcomes likely. Vitamin D supplementation decreases the risks of both falls and fractures. ASSESSMENT OF PROBLEM: An intervention was undertaken by a small urban general practice to increase the number of elderly patients receiving vitamin D supplementation by linking vitamin D prescription to the annual flu vaccination campaign. RESULTS: Uptake of the supplementation was high and costs to the practice low. Thirty-eight patients were identified for whom long-term supplementation with vitamin D was indicated. STRATEGIES FOR IMPROVEMENT: The study could have been strengthened by incorporating a more formal method of evaluating uptake. LESSONS: Encouraging patients to take supplements as a population-based strategy is a realistic intervention, and linking it to the flu vaccination campaign is both seasonally appropriate and efficient. KEYWORDS: Vitamin D deficiency; elderly; vitamin D supplementation; cholecalciferol; prevention; fragility fractures; intervention

Download Full-text

Vitamin D Deficiency in Older Patients—Problems of Sarcopenia, Drug Interactions, Management in Deficiency

Nutrients ◽

10.3390/nu13041247 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1247

Author(s):

Małgorzata Kupisz-Urbańska ◽

Paweł Płudowski ◽

Ewa Marcinowska-Suchowierska

Keyword(s):

Vitamin D ◽

Plasma Concentration ◽

Vitamin D Deficiency ◽

Bone Fractures ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Adverse Outcomes ◽

Vitamin D Metabolism ◽

Increased Risk ◽

Vitamin D Levels

Vitamin D deficiency frequently occurs in older people, especially in individuals with comorbidity and polypharmacotherapy. In this group, low vitamin D plasma concentration is related to osteoporosis, osteomalacia, sarcopenia and myalgia. Vitamin D levels in humans is an effect of the joint interaction of all vitamin D metabolic pathways. Therefore, all factors interfering with individual metabolic stages may affect 25-hydroxyvitamin D plasma concentration. The known factors affecting vitamin D metabolism interfere with cytochrome CYP3A4 activity. There is another group of factors that impairs intestinal vitamin D absorption. The phenomenon of drugs and vitamin D interactions is observed first and foremost in patients with comorbidity. This is a typical situation, where the absence of “hard evidence” is not synonymous with the possible lack of adverse effects. Osteoporosis and sarcopenia (generalized and progressive decrease of skeletal muscle mass and strength) are some of the musculoskeletal consequences of hypovitaminosis D. These consequences are related to an increased risk of adverse outcomes, including bone fractures, physical disabilities, and a lower quality of life. This can lead not only to an increased risk of falls and fractures but is also one of the main causes of frailty syndrome in the aging population. Generally, Vitamin D plasma concentration is significantly lower in subjects with osteoporosis and muscle deterioration. In some observational and uncontrolled treatment studies, vitamin D supplementation resulted in a reduction of proximal myopathy and muscle pain. The most conclusive results were found in subjects with severe vitamin D deficiency and in patients avoiding large doses of vitamin D. However, the role of vitamin D in muscle pathologies is not clear and research has provided conflicting results. This is plausibly due to the heterogeneity of the subjects, vitamin D doses and environmental factors. This report presents data on some problems with vitamin D deficiency in the elderly population and the management of vitamin D deficiency D in successful or unsuccessful aging.

Download Full-text

Serum levels of 25(OH)D are not associated with venous thromboembolism in the elderly population

Thrombosis and Haemostasis ◽

10.1160/th15-02-0148 ◽

2016 ◽

Vol 115 (01) ◽

pp. 169-175 ◽

Cited By ~ 1

Author(s):

Aurélien Delluc ◽

Marie-Pierre Moineau ◽

Cécile Tromeur ◽

Maelenn Gouillou ◽

Karine Lacut ◽

...

Keyword(s):

Vitamin D ◽

Venous Thromboembolism ◽

Seasonal Variations ◽

Elderly Population ◽

Serum Levels ◽

The Elderly ◽

Vitamin D Status ◽

Increased Risk ◽

Vitamin D Levels ◽

Walking Capacity

SummaryThe prevalence of both vitamin D deficiency and venous thromboembolism (VTE) is important in the elderly. Previous studies have provided evidence for a possible association between vitamin D status and the risk of VTE. Thus, we aimed to investigate the association between vitamin D levels and VTE in the population aged 75 and over included in the EDITH case-control study. The association between vitamin D status and VTE was analysed. We also analysed the monthly and seasonal variations of VTE and vitamin D. Between May 2000 and December 2009, 340 elderly patients (mean age 81.5 years, 32 % men) with unprovoked VTE and their controls were included. The univariate and multivariate analysis found no significant association between serum levels of vitamin D and the risk of unprovoked VTE. In the unadjusted analysis, a higher BMI was statistically associated with an increased risk of VTE (OR 1.09; 95 % CI 1.05–1.13) whereas a better walking capacity and living at home were associated with a decreased rate of VTE: OR 0.57; 95 % CI 0.36–0.90 and 0.40; 95 % CI 0.25–0.66, respectively. Although not significant, more VTE events occurred during winter (p=0.09). No seasonal variations of vitamin D levels were found (p=0.11). In conclusion, in contrast with previous reports our findings suggest that vitamin D is not associated with VTE in the elderly population.

Download Full-text

Vitamin D and Cardiovascular Risk: Which Implications in Children?

International Journal of Molecular Sciences ◽

10.3390/ijms21103536 ◽

2020 ◽

Vol 21 (10) ◽

pp. 3536 ◽

Cited By ~ 3

Author(s):

Silvia Savastio ◽

Erica Pozzi ◽

Francesco Tagliaferri ◽

Roberta Degrandi ◽

Roberta Cinquatti ◽

...

Keyword(s):

Vitamin D ◽

Cardiovascular Risk ◽

Pediatric Patients ◽

Cardiovascular Effects ◽

Vitamin D Supplementation ◽

Risk Markers ◽

Randomized Controlled ◽

Increased Risk ◽

Vitamin D Levels ◽

Lipid Parameters

Vitamin D (25OHD) pleiotropic effects are widely recognized and studied. Recently, vitamin D cardiovascular effects are gaining interest, especially in children, although the studies present conflicting data. Some randomized controlled trials (RCTs) have demonstrated that cardiovascular risk markers, such as lipid parameters, inflammation markers, blood pressure, and arterial stiffness, are unaffected by vitamin D supplementation. By contrast, other studies show that low vitamin D levels are associated with higher risk of cardiovascular disease (CVD) and mortality, and support that increased risk of these diseases occurs primarily in people with vitamin D deficiency. An update on these points in pediatric patients is certainly of interest to focus on possible benefits of its supplementation.

Download Full-text

Prevalence of 25-hydroxyvitamin D deficiency in subgroups of elderly persons with anemia: association with anemia of inflammation

Blood ◽

10.1182/blood-2010-09-309708 ◽

2011 ◽

Vol 117 (10) ◽

pp. 2800-2806 ◽

Cited By ~ 69

Author(s):

Todd S. Perlstein ◽

Reena Pande ◽

Nancy Berliner ◽

Gary J. Vanasse

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Serum Levels ◽

The Elderly ◽

Vitamin D Supplementation ◽

World Health ◽

Elderly Persons ◽

Increased Risk ◽

Health Organization ◽

Anemia Of Inflammation

AbstractAnemia and vitamin D deficiency are conditions that both result in significant morbidity and increase with age. The potential relationship between them remains poorly understood, particularly in the elderly. We used the Third National Health and Nutrition Examination Survey to examine the association of vitamin D deficiency with anemia subtypes in persons aged ≥ 60 years. Vitamin D deficiency was defined as serum levels < 20 ng/mL, and anemia was defined according to World Health Organization criteria. Vitamin D deficiency was associated with anemia prevalence independent of age, sex, or race/ethnicity (odds ratio, 1.47; 95% confidence interval, 1.06-2.05; P = .02) and varied significantly by anemia subtype (P overall = .003). The prevalence of vitamin D deficiency was 33.3% in the nonanemic population, 56% in anemia of inflammation (AI; P = .008), and 33.0% in unexplained anemia (P = .55). Non-Hispanic blacks had a 7-fold increased risk of AI compared with whites, and this was partially attenuated after adjusting for vitamin D deficiency. These data show that vitamin D deficiency is associated with specific subtypes of anemia in the elderly, especially in those with AI. Vitamin D may suppress inflammatory pathways, and studies to determine whether vitamin D supplementation ameliorates AI are warranted.

Download Full-text

Low Vitamin D Levels Predict Mortality in Ankylosing Spondylitis Patients: A Nationwide Population-Based Cohort Study

Nutrients ◽

10.3390/nu12051400 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1400

Author(s):

Niv Ben-Shabat ◽

Abdulla Watad ◽

Aviv Shabat ◽

Nicola Luigi Bragazzi ◽

Doron Comaneshter ◽

...

Keyword(s):

Vitamin D ◽

Cohort Study ◽

Ankylosing Spondylitis ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

Health Maintenance ◽

Increased Risk ◽

Vitamin D Levels ◽

All Cause Mortality

In this study, we aimed to examine the effect of vitamin D deficiency on all-cause mortality in ankylosing spondylitis (AS) patients and in the general population. This is a retrospective-cohort study based on the electronic database of the largest health-maintenance organization in Israel. AS patients who were first diagnosed between 2002–2007 were included. Controls were matched by age, gender and enrollment-time. Follow-up continued until death or end of study follow-up on 1 July 2019. Laboratory measures of serum 25-hydroxyvitamin-D levels during the entire follow-up period were obtained. A total of 919 AS patients and 4519 controls with a mean time of follow-up of 14.3 years were included. The mean age at the time of enrollment was 52 years, and 22% of them were females. AS was associated with a higher proportion of vitamin D deficiency (odds ratio 1.27 [95% confidence-interval (CI) 1.03–1.58]). In AS patients, insufficient levels of vitamin D (<30 ng/mL) were significantly associated with increased incidence of all-cause mortality (hazard ratio (HR) 1.59 [95% CI 1.02–2.50]). This association was more prominent with the decrease in vitamin D levels (< 20 ng/mL, HR 1.63 [95% CI 1.03–2.60]; <10 ng/mL, HR 1.79 [95% CI 1.01–3.20]) and among male patients (<30 ng/mL, HR 2.11 [95% CI 1.20–3.72]; <20 ng/mL, HR 2.12 [95% CI 1.19–3.80]; <10 ng/mL, HR 2.23 [95% CI 1.12–4.43]). However, inadequate levels of vitamin D among controls were not associated with an increased all-cause mortality. Our study has shown that vitamin D deficiency is more common in AS patients than controls and is linked to an increased risk for all-cause mortality. These results emphasize the need for randomized-controlled trials to evaluate the benefits of vitamin D supplementation as a secondary prevention of mortality in patients with chronic inflammatory rheumatic disease.

Download Full-text

Prevalence of vitamin D deficiency in pregnancy and its relation with adverse pregnancy outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203845 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3718

Author(s):

Jyoti Prabha ◽

Abhijeet Kumar

Keyword(s):

Vitamin D ◽

Pregnant Women ◽

Vitamin D Deficiency ◽

Preterm Labour ◽

Adverse Pregnancy Outcome ◽

Adverse Outcomes ◽

Strong Positive Correlation ◽

Pregnant Females ◽

Increased Risk ◽

Vitamin D Levels

Background: Vitamin D deficiency is widely prevalent in all parts of the world. Pregnant women and neonates are highly vulnerable to vitamin D deficiency. Pregnant women receive very less amount of sunlight especially in parts of Southeast Asia due to traditional norms and customs. A strong positive correlation was found between low maternal vitamin D levels with gestational hypertension/preeclampsia, gestational diabetes mellitus, preterm labour, low birth weight, intra uterine growth restriction, neonatal intensive care unit admission and Apgar score. Therefore, the present study was designed to know the prevalence of vitamin D deficiency in pregnant females and to evaluate adverse effects associated with it.Methods: Total 250 nulliparous pregnant females attending Tirath Ram Shah Hospital for delivery and carrying a viable (>/28 weeks) singleton pregnancy were selected. Women with serum 25-hydroxy vitamin D level <10 ng/ml, 10-20 ng/ml and <20 ng/ml, were diagnosed as vitamin D deficient, insufficient and sufficient groups respectively and the adverse outcomes was correlated.Results: In this study, out of 250 cases, 159 cases (63.6%) had vitamin D deficiency, 43 cases (17.2%) had insufficiency, and 48 cases (19.2%) had sufficient vitamin D levels (vitamin D ≥20 ng/ml). And, Vitamin D deficiency was associated with preeclampsia, preterm labour and increased risk of caesarean section.Conclusions: This study indicates that vitamin D deficiency is highly prevalent in pregnant females thus implicating the need of a uniform strategy of vitamin D supplementation to pregnant females.

Download Full-text

Changes in vitamin D levels and depressive symptoms in later life in England

Scientific Reports ◽

10.1038/s41598-021-87432-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Giorgio Di Gessa ◽

Jane P. Biddulph ◽

Paola Zaninotto ◽

Cesar de Oliveira

Keyword(s):

Vitamin D ◽

Depressive Symptoms ◽

Later Life ◽

Vitamin D Supplementation ◽

Cross Sectional ◽

Logistic Regression Models ◽

Representative Study ◽

Increased Risk ◽

Vitamin D Levels

AbstractInadequate vitamin D levels have been associated with increased risk of depression. However, most of these studies are cross-sectional and failed to investigate the effect of changes in vitamin D levels. This study aimed to investigate the longitudinal association of changes in serum 25-hydroxyvitamin D levels with depressive symptoms in 3365 participants of the English Longitudinal Study of Ageing, a large nationally-representative study of older adults. Based on their vitamin D levels at baseline and follow-up (sufficient ≥ 50 nmol/L; insufficient < 50 nmol/L), participants were classified as follows: with sufficient levels at both waves; with sufficient levels at baseline but not at follow-up; with insufficient levels at baseline but ≥ 50 nmol/L at follow-up; and with levels < 50 nmol/L at each time point. Depressive symptoms were measured using the 8-point CES-D scale. Data were analysed using logistic regression models. Compared with those with sufficient levels of vitamin D at both waves, only those with insufficient levels throughout were more likely to report elevated depressive symptoms (OR = 1.39, 95% CI = 1.00–1.93). Becoming or no longer being vitamin D deficient was, in the short term, not associated with elevated depressive symptoms. Further evidence is required on whether vitamin D supplementation might contribute to the prevention or treatment of depression as well as on the duration of time for changes in vitamin D levels to lead to detectable changes in depressive symptoms.

Download Full-text

The relative contributions of obesity, vitamin D, leptin, and adiponectin to multiple sclerosis risk: A Mendelian randomization mediation analysis

Multiple Sclerosis Journal ◽

10.1177/1352458521995484 ◽

2021 ◽

pp. 135245852199548 ◽

Cited By ~ 1

Author(s):

Adil Harroud ◽

Despoina Manousaki ◽

Guillaume Butler-Laporte ◽

Ruth E Mitchell ◽

George Davey Smith ◽

...

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Mediation Analysis ◽

Mendelian Randomization ◽

Vitamin D Supplementation ◽

Hydroxyvitamin D ◽

Increased Risk ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

Underlying Mechanisms

Background: Obesity is associated with increased risk of multiple sclerosis (MS); however, the underlying mechanisms remain unclear. Objective: To determine the extent to which decreased vitamin D bioavailability and altered levels of adiponectin and leptin mediate the association between obesity and MS. Methods: We performed Mendelian randomization (MR) analyses to estimate the effects on MS of body mass index (BMI), 25-hydroxyvitamin D (25OHD), adiponectin, and leptin levels in a cohort of 14,802 MS cases and 26,703 controls. We then estimated the proportion of the effect of obesity on MS explained by these potential mediators. Results: Genetic predisposition to higher BMI was associated with increased MS risk (odds ratio (OR) = 1.33 per standard deviation (SD), 95% confidence interval (CI) = 1.09–1.63), while higher 25OHD levels reduced odds of MS (OR = 0.72 per SD, 95% CI = 0.60–0.87). In contrast, we observed no effect of adiponectin or leptin. In MR mediation analysis, 5.2% of the association between BMI and MS was attributed to obesity lowering 25OHD levels (95% CI = 0.3%–31.0%). Conclusions: This study found that a minority of the increased risk of MS conferred by obesity is mediated by lowered vitamin D levels, while leptin and adiponectin had no effect. Consequently, vitamin D supplementation would only modestly reverse the effect of obesity on MS.

Download Full-text

Prospective Evaluation of Vitamin D Supplementation on Peripheral Neuropathy in Type 2 Diabetes Mellitus -A Review

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i45a32742 ◽

2021 ◽

pp. 260-266

Author(s):

Faisal Suliman Algaows ◽

Fatema Abdullah Althkerallah ◽

Norah Abdulmohsen Alsuwailem ◽

Amnah Abdulnasser Mawlan Ahmed ◽

Razan Fahad Alwagdani ◽

...

Keyword(s):

Type 2 Diabetes ◽

Vitamin D ◽

Peripheral Neuropathy ◽

Vitamin D Insufficiency ◽

Vitamin D Supplementation ◽

Vitamin D Levels

Diabetic neuropathy is a long-term consequence of diabetes that can cause significant morbidity and a decline in quality of life in many individuals. Low vitamin D levels, in addition to causing rickets in infants and chondrosteoma in adults, may have a role in the development of DM and its underlying disorders, according to a growing body of evidence. Vitamin D deficiency has been linked to type 1 or type 2 diabetes, as well as the microvascular and macrovascular problems that come with it. Vitamin D insufficiency has been linked to diabetic peripheral neuropathy (DPN) as an independent risk factor. Vitamin D, both topical and oral, has been shown to considerably improve DPN symptoms and pain.

Download Full-text

Vitamin D in Gambian children with discordant tuberculosis (TB) infection status despite matched TB exposure: a case control study

European Journal of Pediatrics ◽

10.1007/s00431-021-04272-z ◽

2021 ◽

Author(s):

Lisa Stockdale ◽

Basil Sambou ◽

Muhamed Sissoko ◽

Uzochukwu Egere ◽

Abdou K. Sillah ◽

...

Keyword(s):

Vitamin D ◽

Child Death ◽

Paediatric Population ◽

Case Control ◽

Vitamin D Supplementation ◽

High Exposure ◽

Asymptomatic Children ◽

Increased Risk ◽

Vitamin D Levels ◽

Large Phase

AbstractUsing a matched case control design conducted at MRC Gambia in 2015, we measured vitamin D levels in pairs of asymptomatic children with discordant tuberculin skin test status despite the same sleeping proximity to the same adult TB index case. Median ages of groups (infected; 10.0 years, uninfected 8.8 years) were not significantly different (p = 0.13). Mean vitamin D levels were 2.05 ng/mL (95% CI − 0.288 to 4.38) higher in 24 highly TB-exposed uninfected children compared with 24 matched highly TB-exposed infected children (p = 0.08). The findings warrant further investigation in larger studies to understand the implications and significance. Conclusion: Vitamin D levels were higher in TB-uninfected children compared with TB-infected despite equal high exposure to a TB case. What is Known:• Paediatrics TB represents one of the leading causes of child death globally.• Current literature shows an inconsistent relationship between vitamin D deficiency and increased risk of TB disease however a large Phase 3 trial of vitamin D supplementation in (largely vitamin D deficient) Mongolian children did not find any association with TB infection rates. What is New:• This study adds to the literature in a vitamin D sufficient paediatric population whereby children with equal exposure to a household TB case with no evidence of TB infection have higher levels of vitamin D compared with matched children with TB infection.

Download Full-text