scholarly journals A21 VITAMIN D DEFICIENCY AND ITS ASSOCIATION WITH CLINICAL OUTCOMES IN PRIMARY SCLEROSING CHOLANGITIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 24-26
Author(s):  
S Wang ◽  
A J Montano-Loza ◽  
M Ebadi
Keyword(s):  
Vitamin D ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Vitamin D Deficiency ◽  
Sclerosing Cholangitis ◽  
Adverse Outcomes ◽  
Vitamin D Status ◽  
Event Free Survival ◽  
Free Survival ◽  
University Of Alberta

Abstract Background Primary sclerosing cholangitis (PSC) is a progressive cholestatic disease involving chronic inflammation and fibrosis of intra- and extra-hepatic ducts. Vitamin D is a secosteroid implicated in anti-inflammatory and anti-fibrotic pathways, and its deficiency has been associated with worse outcomes in chronic liver disease. Vitamin D status may also influence the course of PSC but studies evaluating this link are scarce. Aims To determine the association of vitamin D deficiency with the development of cirrhosis, mortality, and need for liver transplantation in patients with PSC. Methods Ninety-four patients with the diagnosis of PSC were evaluated and followed by the autoimmune liver disease clinic at the University of Alberta, Edmonton, Canada. Clinical data were recovered from medical charts. Vitamin D status was defined by the serum concentration of 25-hydroxyvitamin D3. Patients with levels <50 nmol/L (10 ng/ml) were defined as deficient. Univariate and multivariate analyses were constructed using the Cox proportional hazards regression models. Event-free survival was defined as time from vitamin D assessment to the time of liver transplant or death. Results Mean age at PSC diagnosis was 32±14 years, with 67% of patients being male. The mean vitamin D level was 69±33 nmol/L (range, 4–163 nmol/L) and 26 patients (28%) had vitamin D deficiency (<50 nmol/L). Among 85 patients without cirrhosis at diagnosis, 43 patients (51%) developed cirrhosis. By univariate Cox analysis, serum ALP, albumin, bilirubin and vitamin D deficiency were predictors of cirrhosis development. Vitamin D deficiency was independently associated with higher risk of developing cirrhosis (HR 2.11, 95% CI 1.002–4.44, P=0.049) after adjusting for other predictors. Median time to develop cirrhosis was shorter in patients with vitamin D deficiency (6.8 years; 95% CI, 1.7–11.8) compared to those without (10.8 years; 95% CI, 9.2 -12.4; P=0.007). Over a median follow-up period of 5.6 years, adverse outcomes (liver transplant or death) were observed in 34 patients (36%). Serum levels of albumin, ALP, bilirubin, INR, platelet count, ascites, variceal bleeding and vitamin D deficiency were associated with adverse outcomes in univariate analysis. Vitamin D deficiency was independently associated with higher risk of adverse endpoints (HR 2.87, 95% CI, 1.16–7.12, P=0.02) after adjusting for confounding factors. Event-free survival was shorter in the patients with vitamin D deficiency compared to those without deficiency (7.1 years; 95% CI, 2.4–11.9 vs. 11.4 years; 95% CI, 8.9–13.9, P=0.03, Figure 1). Conclusions Vitamin D deficiency was frequent in patients with PSC and was associated with higher risk of progression to cirrhosis, as well as decreased time to death and liver transplantation. The possibility of improving outcomes in PSC by vitamin D supplementation awaits further investigation. Funding Agencies Food and Health Innovation Initiative (Vitamin Fund), University of Alberta

25-OH-Vitamin-D Deficiency Impairs Rituximab-Mediated Cellular Cytotoxicity and Is Associated With An Inferior Outcome Of Elderly DLBCL Patients Treated With Rituximab

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1819-1819 ◽  
Author(s):  
Joerg Thomas Bittenbring ◽  
Bettina Altmann ◽  
Frank Neumann ◽  
Marina Achenbach ◽  
Joerg Reichrath ◽  
...  
Keyword(s):  
Vitamin D ◽  
Overall Survival ◽  
Vitamin D Deficiency ◽  
Multivariable Analysis ◽  
Serum Levels ◽  
Event Free Survival ◽  
Free Survival ◽  
Vitamin D Levels ◽  
25 Oh Vitamin D ◽  
The Impact

Abstract Background To investigate the impact and underlying mechanisms of vitamin-D-deficiency (VDD) on outcome of elderly (61 to 80 year-old) DLBCL patients. Methods Pretreatment 25-OH-vitamin-D serum levels from 359 patients treated in the prospective multicenter RICOVER-60 trial with 6 or 8 cycles of CHOP-14 with and without 8 cycles rituximab and 63 patients in the RICOVER-noRT study treated with 6xCHOP-14 + 8xR were determined determined by LIASION®, a commercially available chemoluminescent immunoassay. Results RICOVER-60 patients with VDD (defined as serum levels ≤8 ng/m l) and treated with rituximab had a 3-year event-free survival of 59% compared to 79% in patients with >8 ng/ml; 3-year overall survival was 70% and 82%, respectively. These differences were significant in a multivariable analysis adjusting for IPI risk factors with a hazard ratio of 2.1 [p=0.008] for event-free survival and 1.9 [p=0.040] for overall survival. In patients treated without rituximab 3-year EFS was not significantly different in patients with vitamin-D levels ≤8 and >8 ng/ml (HR 1.2; p=0.388). These results were confirmed in an independent validation set of 63 patients treated within the RICOVER-noRT study. Rituximab-mediated cellular toxicity (RMCC) against the CD20+ cell line Daudi as determined by LDH release assay increased significantly (p<0.005) in 5/5 vitamin-D-deficient individuals after vitamin-D substitution and normalization of their vitamin-D levels. Conclusions VDD is a significant risk factor for elderly DLBCL patients treated with rituximab. Our results show that VDD impairs RMCC and that RMCC can be improved by vitamin-D substitution. This together with the differential effect of VDD in patients treated with and without rituximab suggests that vitamin-D substitution might result in a better outcome of these patients when treated with CHOP plus rituximab. Supported by a grant from Deutsche Krebshilfe. Disclosures: No relevant conflicts of interest to declare.

Abstract 20661: Vitamin D Deficiency, Tumor Necrosis Factor-Alpha, and Event-Free Survival in Patients With Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Eun Kyeung Song ◽  
Debra K Moser ◽  
Terry A Lennie
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Tumor Necrosis ◽  
Event Free Survival ◽  
Necrosis Factor Alpha ◽  
Free Survival ◽  
Tnf Α ◽  
Patients With Heart Failure ◽  
Factor Alpha ◽  
Necrosis Factor

Background: Vitamin D is related to tumor necrosis factor-alpha (TNF-α), a proinflammatory cytokine that predicts cardiovascular disease. However, whether low vitamin D intake is associated with TNF-α and event-free survival in patients with heart failure (HF) has not been examined. Purpose: To determine whether association of TNF-α with event-free survival differs between patients with vitamin D adequacy and deficiency. Methods: A total of 146 patients with HF (age 63±11 years, 34% female) provided blood to measure serum TNF-α and were divided into 2 groups by median value. Nutrition Analysis program was used to determine intake of vitamin D through a 3-day food diary. Patients with > 80% probability of deficiency were defined as having a diet deficient in vitamin D. Covariate data on age, gender, body mass index, etiology, NYHA class, ejection fraction, comorbidities, and prescribed medications were obtained from review of medical records. Patients were followed for 1 year to determine time to first event of hospitalization or death. Hierarchical logistic and Cox regression was used to address purpose. Results: Eighty-five patients (58%) had vitamin D deficiency. During 1-year, 40 patients (27%) were hospitalized or died. Vitamin D deficiency was associated with higher level of TNF-α (OR=3.10, 95% CI=1.32-7.26). In patients with vitamin D deficiency, higher level of TNF-α (HR=3.08, 95% CI=1.06-8.89) predicted shorter event-free survival after controlling for all covariates, whereas there was no difference in event-free survival between higher and lower level of TNF-α in patients with vitamin D adequacy ( p = .985) . Conclusions: The data suggest that one possible mechanism by which vitamin D deficiency contributed to poor health outcomes is through inflammatory pathways in HF patients. Future study is required to determine whether vitamin D adequacy could play a protective role in the impact of proinflammatory cytokines on event-free survival in HF patients.

Vitamin D Deficiency Is Associated with Inferior Event-Free and Overall Survival in Diffuse Large B-Cell Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1952-1952
Author(s):  
Matthew T Drake ◽  
Matthew J Maurer ◽  
Brian K Link ◽  
Ivana N Micallef ◽  
Thomas M Habermann ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Vitamin D ◽  
Overall Survival ◽  
Vitamin D Deficiency ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Event Free Survival ◽  
Free Survival ◽  
Large B Cell Lymphoma

Abstract Abstract 1952 Poster Board I-975 Background: Vitamin D is a naturally occurring steroid hormone. In addition to its well-established role in maintaining serum calcium homeostasis, vitamin D has effects on cellular differentiation, proliferation, apoptosis, and angiogenesis. Vitamin D3 is naturally produced in skin in response ultraviolet-B (UVB) radiation from the sun. Several recent studies, however, have shown that a high proportion of community-dwelling subjects in both tropical and temperate climates are deficient in vitamin D, and that subjects in northern latitudes often require dietary supplementation to maintain vitamin D sufficiency. Further, several reports now suggest that vitamin D sufficiency is protective against the development of several cancers, including non-Hodgkin lymphoma (NHL). However, it is not known whether vitamin D impacts prognosis in diffuse large B-cell lymphoma (DLBCL), the most common NHL subtype. Methods: We evaluated serum vitamin D concentrations in two cohorts of DLBCL patients. The first cohort consisted of 374 patients newly diagnosed from September 2002-February 2008 who were prospectively enrolled in the University of Iowa/Mayo Clinic Lymphoma SPORE Molecular Epidemiology Resource, an observational study in which neither therapeutic nor diagnostic management is prescribed. All serum was obtained within 120 days of diagnosis, and was prior to treatment in 221 (59%). In the second study, 62 patients newly diagnosed from February 2006-August 2007 were enrolled on NCCTG clinical trial N0489, and all serum was obtained before the first course of therapy. Central pathology review was performed on all patients to confirm the diagnosis of DLBCL. Serum 25-hydroxyvitamin (25-OH-VitD) levels were measured by the gold standard method for vitamin D determination: liquid chromatography tandem mass spectroscopy (LC-MS/MS). Vitamin D deficiency was defined as total serum 25-OH-VitD < 25 ng/mL (62.5 nmol/L). SPORE patients were followed per a standard protocol for event-free (progression, retreatment, or death due to any cause) and overall survival (EFS and OS, respectively); N0489 patients were followed in a similar way per the clinical trial protocol. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CI). Results: SPORE patients were primarily treated with immunochemotherapy (83%); all N0489 patients were treated with epratuzumab + R-CHOP21. The median age at diagnosis was 62 years (range, 19-93) for SPORE patients and 61 years (range, 21-82) for N0489 patients. Median follow-up for SPORE patients was 36 months (range, 1-77) with 95 deaths and 131 events; median follow-up for N0489 patients was 24 months (range, 7-39) with 13 deaths and 18 events. Vitamin D deficiency was identified in 188 SPORE patients (50%) and 15 N0489 patients (24%). There were no differences in the prevalence of vitamin D deficiency by age, IPI, or whether serum was obtained prior to starting treatment (all p > 0.28). Vitamin D deficiency was associated with inferior overall (HR=2.33, 95% CI 1.53-3.57, logrank p = 0.0001) and event-free survival (HR=1.71, 95% CI 1.20-2.44, logrank p = 0.003) in the SPORE cohort. These associations remained significant after adjusting for IPI and treatment: OS HR=1.97, 95% CI 1.27-3.07; EFS HR=1.47, 95% CI 1.02-2.21. These results were similar for the subset of SPORE patients who were treated with R-CHOP. The HRs for vitamin D deficiency and event-free survival were consistent in the N0489 patients (HR=1.63, 95% CI 0.61-4.35, IPI adjusted HR=1.43, 95% CI 0.53-3.85), although these results lacked precision due to a smaller sample size. We were unable to evaluate OS in N0489 due to the small number of deaths. Conclusions: Approximately 50% of all DLBCL patients in this northern US latitude population are vitamin D deficient at the time of diagnosis and treatment. Vitamin D deficient patients have an inferior event-free and overall survival compared to patients with vitamin D levels within the normal range. Vitamin D supplementation during treatment of DLBCL patients with vitamin D deficiency should be evaluated in a clinical trial setting. Disclosures: No relevant conflicts of interest to declare.

Abstract 14937: Depressive Symptoms Were Not Associated With Cardiac Event-free Survival in Heart Failure Patients With Adequate Intake of Vitamin D

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Eun Kyeung Song ◽  
Seok-Min Kang ◽  
Debra K Moser ◽  
Terry A Lennie
Keyword(s):  
Heart Failure ◽  
Vitamin D ◽  
Depressive Symptoms ◽  
Vitamin D Deficiency ◽  
Cardiac Event ◽  
Event Free Survival ◽  
Adequate Intake ◽  
Food Diary ◽  
Free Survival ◽  
The Impact

Introduction. Low levels of vitamin D and severe depressive symptoms have been associated with increased proinflammatory cytokines that predict cardiovascular disease. However, little is known about the relationships among depressive symptoms, vitamin D deficiency, and cardiac events in patients with heart failure (HF). Hypothesis. We hypothesized that the link of depressive symptoms to cardiac event-free survival would differ between patients with vitamin D adequacy and deficiency. Methods. A total of 232 patients with HF (age 66±8 years, 34% female) completed the Patient Health Questionnaire-9 to assess depressive symptoms and were split into 2 groups using the standard PHQ-9 cutoff point of 10. Nutrition Analysis program was used to determine average daily intake of vitamin D through a 3-day food diary. Patients with > 85% probability of deficiency were defined as having a diet deficient in vitamin D. Covariate data on age, gender, body mass index, NYHA class, ejection fraction, comorbidities, and prescribed medications were obtained from review of medical records. Patients were followed for 2 years to determine time to first event of hospitalization or death. Hierarchical Cox proportional regression was used to examine our hypothesis. Results. 106 patients (46%) had depressive symptoms and 116 patients (50%) had vitamin D deficiency. During 2 years, 88 patients (38%) were hospitalized or died due to cardiac problems. Depressive symptoms were associated with vitamin D deficiency ( X 2 =4.45, p = .035). In patients with vitamin D deficiency, depressive symptoms (HR=2.56, 95% CI=1.28-5.21) predicted shorter event-free survival after controlling for all covariates, whereas there was no difference in cardiac event-free survival between patients with depressive symptoms and no depressive symptoms in patients with vitamin D adequacy ( p = .185) . Conclusions. The data suggest that depressive symptoms were not associated with cardiac event-free survival in HF patients with adequate intake of vitamin D. Future study is required to determine whether vitamin D adequacy could play a protective role in the impact of depressive symptoms on cardiac event-free survival in patients with HF.

Vitamin D Deficiency in Patients with Acute Myocardial Infarction: An Italian Single-Center Study

2015 ◽  
Vol 85 (1-2) ◽  
pp. 23-30 ◽  
Author(s):  
Aneta Aleksova ◽  
Rita Belfiore ◽  
Cosimo Carriere ◽  
Salam Kassem ◽  
Salvatore La Carrubba ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Primary Source ◽  
Sun Exposure ◽  
Female Gender ◽  
Developed Countries ◽  
Vitamin D Status ◽  
High Exposure

Abstract. Background: Hypovitaminosis D is a vitamin deficiency that has been increasing in developed countries; it was also suggested as an emerging risk factor for developing of atherosclerosis and acute myocardial infarction. The primary source of vitamin D is its cutaneous synthesis under exposure to sunlight. It has been suggested that 30 min of sun exposure twice weekly leads to sufficient vitamin D synthesis. The residents of Trieste (Italy) are well-known for their high exposure to sunlight in all seasons. We aimed to investigate the vitamin D status in subjects with acute myocardial infarction living in this area. Methods: Vitamin D status was identified in 478 subjects diagnosed with acute myocardial infarction. Results: The median serum 25-hydroxyvitamin D concentration was 14.5 [7.8 - 22.7] ng/mL. Vitamin D deficiency and insufficiency were present in 324 (68 %) and 107 (22 %) subjects, respectively. Vitamin D deficiency was less frequent among subjects enrolled in the period from July to the end of September (p < 0.001). In a multivariate analysis vitamin D deficiency was predicted by older age (p = 0.02), female gender (p = 0.002), higher body mass index (p = 0.05), autumn/winter sampling (p < 0.001), increased parathyroid hormone (p = 0.03) and alkaline phosphatase (p = 0.003). Conclusions: We observed very high prevalence of vitamin D deficiency among subjects with myocardial infarction in all seasons of enrollment. However, it was lower in the summer when sun exposure is higher. The exposure to sunlight may be a cost-saving therapeutic strategy for the management of vitamin D deficiency.

Vitamin D Deficiency/Insufficiency and Challenges in Developing Global Vitamin D Fortification and Supplementation Policy in Adults

2012 ◽  
Vol 82 (4) ◽  
pp. 237-259 ◽  
Author(s):  
Moshe Ben-Shoshan
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Search Strategy ◽  
Epidemiologic Studies ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Societal Burden ◽  
Time Period ◽  
New Guidelines ◽  
In Cis

This review summarizes studies discussing vitamin D status in adults and reveals that vitamin D deficiency/insufficiency is highly prevalent in adults and that current fortification and supplementation policies are inadequate. Background and aims: Studies suggest a crucial role for adequate vitamin D status in various health conditions including bone metabolism, cancer, cardiovascular diseases, and allergies. However, relatively little is known about poor vitamin D status and unmet needs in adults. This report aims to highlight the contribution of epidemiologic studies (through the identification of health effects and societal burden) to the development of vitamin D fortification and supplementation policies and reveal unmet global challenges in adults. Methods: In order to assess worldwide vitamin D status in adults, the search strategy combined the medical literature database MEDLINE (using PubMed) for the time period between January 1, 1980 and February 28, 2011, using the key words “vitamin D” “deficiency” and “insufficiency”, and included articles in which access to full text was possible and in which healthy adults were assessed according to one of four commonly used vitamin D threshold classifications. Results: This report reveals that vitamin D deficiency occurs in 4.10 % [95 % CI (confidence interval), 3.93 %, 4.27 %] to 55.05 % (54.07 %, 56.03 %) of adults, while insufficiency occurs in 26.07 % (24.82 %, 27.33 %) to 78.50 % (77.85 %, 79.16 %), depending on the classification used. However, lack of overlap in CIs and high value of I2 statistics indicate considerable heterogeneity between studies. Further, certain populations (i. e. dark-skinned individuals, immigrants, and pregnant women) may be at higher risk for poor vitamin D status. Conclusion: Current policies for vitamin D supplementation and fortification are inadequate and new guidelines are required to improve vitamin D status in adults.

scholarly journals Vitamin D and Cardiovascular Disease: An Updated Narrative Review

2021 ◽  
Vol 22 (6) ◽  
pp. 2896
Author(s):  
Armin Zittermann ◽  
Christian Trummer ◽  
Verena Theiler-Schwetz ◽  
Elisabeth Lerchbaum ◽  
Winfried März ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Vitamin D ◽  
High Risk ◽  
General Population ◽  
Vitamin D Deficiency ◽  
Specific Gene ◽  
Vitamin D Status ◽  
Cvd Risk ◽  
Severe Vitamin ◽  
Increased Risk

During the last two decades, the potential impact of vitamin D on the risk of cardiovascular disease (CVD) has been rigorously studied. Data regarding the effect of vitamin D on CVD risk are puzzling: observational data indicate an inverse nonlinear association between vitamin D status and CVD events, with the highest CVD risk at severe vitamin D deficiency; however, preclinical data and randomized controlled trials (RCTs) show several beneficial effects of vitamin D on the surrogate parameters of vascular and cardiac function. By contrast, Mendelian randomization studies and large RCTs in the general population and in patients with chronic kidney disease, a high-risk group for CVD events, largely report no significant beneficial effect of vitamin D treatment on CVD events. In patients with rickets and osteomalacia, cardiovascular complications are infrequently reported, except for an increased risk of heart failure. In conclusion, there is no strong evidence for beneficial vitamin D effects on CVD risk, either in the general population or in high-risk groups. Whether some subgroups such as individuals with severe vitamin D deficiency or a combination of low vitamin D status with specific gene variants and/or certain nutrition/lifestyle factors would benefit from vitamin D (metabolite) administration, remains to be studied.

scholarly journals Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1339
Author(s):  
Moustapha Dramé ◽  
Cécilia Cofais ◽  
Maxime Hentzien ◽  
Emeline Proye ◽  
Pécory Souleymane Coulibaly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Clinical Outcomes ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Adverse Outcomes ◽  
Aged Patients ◽  
Aged People ◽  
Severity Of The Disease

Background: Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. Methods: A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. Results: In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). Conclusion: This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.

Alcoholic liver disease and vitamin D deficiency

2018 ◽  
Vol 109 (5) ◽  
Author(s):  
Gianni Testino ◽  
Silvia Leone ◽  
Sharmila Fagoonee
Keyword(s):  
Vitamin D ◽  
Liver Disease ◽  
Vitamin D Deficiency ◽  
Alcoholic Liver Disease
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