P49 An audit of baseline vitamin D level tests for newly diagnosed paediatric haematology/oncology patients against trust guidelines

Aim100% of patients should have their vitamin D levels checked at diagnosis’ as stated in the current trust guideline for the management of vitamin D deficiency Treatment and Prevention.100% of patients who had a baseline vitamin D level had these acted upon if necessary following the recommendations in the trust guideline.All of the patients who were given treatment had been prescribed were given an appropriate dose as stated in the trust guideline.These standards are supported by the recommendations in 2016 by Public Health England (PHE) that everyone (regardless of age and ethnicity) needs vitamin D equivalent to an average daily intake of 10 micrograms via supplementation.2 3MethodThis retrospective audit was conducted using internal clinical and prescribing programmes to access patient records and medical histories to retrieve data. The inclusion criteria for patients included in this audit were all new diagnoses of malignant haematological and oncological disease over a 6 month period, from April 2018-October 2018. The data collected for these patients were: if they had been tested for Vitamin D, the date of the test and their level of total vitamin D level Serum total 25-hydroxyvitamin D concentration. Patient data from the electronic prescribing system was utilised to check if patients had been prescribed vitamin D. Once data completed, patients with vitamin D levels, assessed against trust guidelines to determine if appropriately treated.ResultsA total of 78 patients met the inclusion criteria, where 56% of patients were tested for vitamin D during admission. Of the 78 patient, 43 were oncology patients and 33 haematology patients.In the oncology cohort (n=15) only 35% were tested whereas 83% of haematology patients (n=28) were tested. Of the haematology cohort of patients who were tested (83%): 69% had sufficient levels of vitamin D (serum total 25-hydroxyvitamin D concentration >50 nmol/L); 11% had insufficient levels (25–50 nmol/L) and 3% were deficient (< 25 nmol/L). Of the oncology cohort who were tested (35%): 28% had sufficient levels of vitamin D; 5% of patients had insufficient levels; 2% were deficient. 6% of haematology patients and 5% of oncology patients with sufficient levels of vitamin D received treatment that was not indicated. Furthermore, the 5% of oncology patients with insufficient levels of vitamin D did not receive any treatment.ConclusionThe standards set for this audit were not met. It is concerning that those with low levels were not treated effectively and are at risk of complications. Although the findings of this audit may not be a true reflection of the entire patient population due to the small cohort size; the insight into at risk patients suggests there is a need to improve practice and reach 100% for all the aims of this audit.To improve smart and efficient prescribing of medication, clinicians should adhere to the revised trust ‘Guideline for the Management of vitamin D deficiency’ to guide their decisions on initiating therapy. Pharmacists should check vitamin D levels for all new admissions and follow up as appropriate for any pending tests. Having a default test built into the current new prescribing system will also support in improving the results.ReferencesHolick, M. ( 2019). Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. [online]Available at: https://academic.oup.com/ajcn/article/79/3/362/4690120Public Health England. Statistical Summary: National Diet and Nutrition Survey: results from Years 1 and 9 (combined) of the Rolling Programme (2008/09 – 2016/17). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/772430/NDNS_Y1-9_statistical_summary.pdfGOV.UK. ( 2019). SACN vitamin D and health report. [online]Available at: https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-reportGreat Ormond Street Hospital Trust guideline for the management of Vitamin D deficiency Treatment and Prevention.

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Role of Vitamin D Supplements in Prevention of Hungry Bone Syndrome after Successful Parathyroidectomy for Primary Hyperparathyroidism: A Prospective Study

Scandinavian Journal of Surgery ◽

10.1177/1457496920962601 ◽

2020 ◽

pp. 145749692096260

Author(s):

M. A. Salman ◽

A. Rabiee ◽

A. Salman ◽

A. Youssef ◽

H. E.-D. Shaaban ◽

...

Keyword(s):

Vitamin D ◽

Primary Hyperparathyroidism ◽

Vitamin D Deficiency ◽

Statistical Significance ◽

Mineral Density ◽

Hydroxyvitamin D ◽

Group I ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

Vitamin D Supplements

Background: We postulated that the preoperative correction of vitamin D levels can significantly reduce the incidence of hunger bone syndrome among patients undergoing parathyroidectomy for primary hyperparathyroidism. Methods: We performed a prospective, randomized, open-label study on 102 patients with primary hyperparathyroidism and coexisting vitamin D deficiency who were scheduled to undergo parathyroidectomy. Patients were divided into the following two groups: group I which included 52 patients who did not receive preoperative vitamin D supplementation; and group II which included 50 patients who received cholecalciferol 1000–2000 IU daily or 50000 IU weekly until they achieve vitamin D levels >20 ng/mL (group IIa = 25 patients) or vitamin D levels >30 ng/mL (group IIb = 25 patients). Results: The incidence of hunger bone syndrome in group IIb was lower than group I and group IIa (8% versus 16% versus 23%, respectively); however, this difference did not reach the level of statistical significance (p = 0.22). Patients with hunger bone syndrome were significantly younger and had higher serum phosphorus, alkaline phosphatase, magnesium, and bone mineral density at baseline than patients without hunger bone syndrome. On the other hand, patients with hunger bone syndrome had significantly lower 25-hydroxyvitamin D at baseline than patients without hunger bone syndrome (p = 0.001). The ROC curve showed that the baseline level of serum 25-hydroxyvitamin D was not an independent discriminator of hunger bone syndrome (area under curve = 0.21 (95% CI: 0.06–0.34); p = 0.011). Conclusion: Preoperative course of vitamin D supplements has no preventive role on the postoperative incidence of hunger bone syndrome among patients with primary hyperparathyroidism and coexisting vitamin D deficiency undergoing parathyroidectomy.

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The Prevalence of 25-Hydroxyvitamin D Deficiency in Post-HSCT Pediatric Patients.

Blood ◽

10.1182/blood.v112.11.2139.2139 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2139-2139

Author(s):

Christine Duncan ◽

Lynda Vrooman ◽

Lori Bechard ◽

Elly Barry ◽

Leslie E. Lehmann

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Pediatric Patients ◽

Bone Marrow Failure ◽

Long Term Effects ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

The Mean ◽

25 Oh Vitamin D

Abstract Children undergoing HSCT are at risk for vitamin D deficiency due to lack of sun exposure, the recommended use of sunscreen, dietary insufficiency, and the effects of medications such as glucocorticoids and calcineurin inhibitors. We assessed the prevalence of 25-hydroxyvitamin D (25-OH vitamin D) deficiency in pediatric post-HSCT patients in an outpatient oncology clinic during 4 weeks in May 2008. Patients found to have low 25-OH vitamin D levels were referred for dietary counseling and given supplementation or repletion as needed. 25-OH vitamin D and parathyroid hormone (PTH) levels were measured in 62 (88.6%) of 70 eligible patients. 83.8% of patients had a 25-OH vitamin D level less than the institutional lower limit of normal, 30 ng/mL. 29% of patients were 25-OH vitamin D insufficient with levels 20–29 ng/mL (range of 20–29). 54.8% of patients were 25-OH vitamin D deficient with levels <20 ng/mL (range 5–19). The prevalence of insufficiency and deficiency was similar between male (87.8%; 57.6%) and female patients (57.6%; 55.2%).The mean duration of days following transplant was 532.6 days (median 251.5 days). The mean age at transplant was 3.7 years (median 3.5 years). 47% of patients were female. 75.8% were Caucasian. 90.3% received allogeneic transplants. The underlying diseases were as follows: ALL (27.4%), AML/MDS (24.2%), bone marrow failure (11.3%), nonmalignant hematologic diagnosis (8.1%), solid tumor (8.1%), immunodeficiency (6.5%), lymphoma (6.5%), and other diagnoses (8.1%). 8 patients regularly took either an over-the-counter multivitamin or vitamin D supplement and all 8 patients had 25-OH levels less than 30 ng/mL. There was a negative inverse correlation of (r= −0.3, p=0.029) between PTH and 25-OH vitamin D. There were no significant associations between 25-OH vitamin D level and any of the following: corticosteroid or calcineurin inhibitor use in the preceding year, time from transplant, age at transplant, current age, or graft-versus-host disease. 25-OH vitamin D insufficiency and deficiency are common following pediatric HSCT. We recommend vitamin D screening for all post-HSCT pediatric patients. Further investigation is needed to identify potential risk factors for vitamin D deficiency and the long-term effects of deficiency on bone health and development.

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Association between Vitamin D Level and Acne, and Correlation with Disease Severity: A Meta-Analysis

Dermatology ◽

10.1159/000517514 ◽

2021 ◽

pp. 1-8

Author(s):

Yusuf Hasamoh ◽

Kunlawat Thadanipon ◽

Premjit Juntongjin

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Meta Analysis ◽

Inverse Association ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

Newcastle Ottawa Scale ◽

25 Hydroxyvitamin D ◽

The Relationship ◽

Ottawa Scale

Background: Vitamin D deficiency is frequently associated with several medical conditions. However, a comprehensive meta-analysis assessing the association between vitamin D level and acne is lacking. Objective: To determine the relationship between vitamin D level and acne, and to assess the association between vitamin D level and acne severity. Methods: This meta-analysis was assessed by using the PubMed, EMBASE, Cochrane, and Scopus databases following the PRISMA guidelines. Serum/plasma 25-hydroxyvitamin D (25[OH]D) level, vitamin D deficiency, and the severity association between acne patients and healthy controls (HCs) were evaluated. The quality assessment was performed by using the Newcastle-Ottawa Scale. Results: Thirteen articles with a total of 1,362 acne patients and 1,081 HCs were included. The circulating 25(OH)D levels were significantly lower in patients with acne than in HCs (pooled MD = –9.02 ng/mL, 95% CI = –13.22 to –4.81, p < 0.0001). Vitamin D deficiency was more prevalent in acne patients than in HCs (pooled OR = 2.97, 95% CI = 1.68–5.23, I2 = 72%). Also, vitamin D levels were negatively correlated with acne severity. Conclusion: This meta-analysis demonstrated the significantly low vitamin D levels in acne patients. Also, there was evidence of an inverse association between vitamin D levels and acne severity. Therefore, vitamin D might be involved in the pathogenesis of acne.

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Optimal vitamin D levels in Crohn's disease: a review

Proceedings of The Nutrition Society ◽

10.1017/s0029665114001591 ◽

2014 ◽

Vol 74 (1) ◽

pp. 56-66 ◽

Cited By ~ 26

Author(s):

Tara Raftery ◽

Maria O'Sullivan

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Vitamin D Deficiency ◽

Innate And Adaptive Immunity ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

Colon Cancer Prevention ◽

25 Hydroxyvitamin D ◽

Skeletal Effects

Vitamin D deficiency is common among patients with Crohn's disease. Serum 25-hydroxyvitamin D (25(OH)D) is the best measure of an individual's vitamin D status and current cut-off ranges for sufficiency are debatable. Several factors contribute to vitamin D deficiency in Crohn's disease. These include inadequate exposure to sunlight, inadequate dietary intake, impaired conversion of vitamin D to its active metabolite, increased catabolism, increased excretion and genetic variants in vitamin D hydroxylation and transport. The effects of low 25(OH)D on outcomes other than bone health are understudied in Crohn's disease. The aim of the present review is to discuss the potential roles of vitamin D and the possible levels required to achieve them. Emerging evidence suggests that vitamin D may have roles in innate and adaptive immunity, in the immune-pathogenesis of Crohn's disease, prevention of Crohn's disease-related hospitalisations and surgery, in reducing disease severity and in colon cancer prevention. The present literature appears to suggest that 25(OH)D concentrations of ≥75 nmol/l may be required for non-skeletal effects; however, further research on optimal levels is required.

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Evaluation of Maternal Serum 25-Hydroxyvitamin D Levels in Patients with Hyperemesis Gravidarum at Early Gestational Weeks

Eurasian Journal of Family Medicine ◽

10.33880/ejfm.2020090302 ◽

2020 ◽

Vol 9 (3) ◽

pp. 123-130

Author(s):

Burcu Kayılı ◽

Muhammet Ali Oruç ◽

Yasemin Alan ◽

Murat Alan ◽

Deniz Can Öztekin

Keyword(s):

Vitamin D ◽

Pregnant Women ◽

Vitamin D Deficiency ◽

Hyperemesis Gravidarum ◽

Control Group ◽

Hydroxyvitamin D ◽

Severe Deficiency ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

The Mean

Aim: The aim of this study was to compare vitamin D levels between pregnant women with hyperemesis gravidarum before 12 weeks of gestation and healthy pregnant women at similar ages. Methods: Sixty pregnancies with hyperemesis gravidarum and 60 age compatible healthy pregnancies applied to our facility were included in the study. Demographic characteristics, maternal thyroid function tests and 25-Hydroxyvitamin D levels were evaluated. Student t test was used for the variables with normal distribution and Mann-Whitney U test was used to analyze the variables without normal distribution. Results: Only one pregnant woman had normal vitamin D levels (>30ng/ml), whereas 71 patients had deficiency (10-30 ng/ml), and 48 had severe deficiency (<10 ng/ml). The mean vitamin D level of the total 120 pregnancies was 11.9±5.00 ng/ml (9.92±3.67 ng/ml in case group, 13.88±5.38 ng/ml in control group). The mean value of vitamin D was found to be significantly lower in hyperemesis gravidarum. 45% (n=27) of the pregnant women had vitamin D deficiency, whereas 55% (n=33) of them had severe deficiency. Free T3 and T4 levels were significantly higher than the control group, and thyroid-stimulating hormone level was significantly lower. Conclusion: Vitamin D levels of pregnant women with hyperemesis gravidarum were significantly lower. Vitamin D deficiency should be considered in patients with hyperemesis gravidarum. Keywords: pregnancy, hyperemesis gravidarum, Vitamin D deficiency

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Association of Vitamin D Status and Physical Activity with Lipid Profile in Korean Children and Adolescents: A Population-Based Study

Children ◽

10.3390/children7110241 ◽

2020 ◽

Vol 7 (11) ◽

pp. 241

Author(s):

Kyungchul Song ◽

Gihong Park ◽

Youngha Choi ◽

Jun Suk Oh ◽

Han Saem Choi ◽

...

Keyword(s):

Physical Activity ◽

Vitamin D ◽

Lipid Profile ◽

Children And Adolescents ◽

Vitamin D Deficiency ◽

Korean Children ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

Low Hdl ◽

25 Hydroxyvitamin D

Dyslipidemia is one of the important influencing factors of cardiovascular health in the youth, and thus, assessment of its etiology is important. We aimed to investigate the association of dyslipidemia with vitamin D and physical activity in Korean children and adolescents. Data of 3183 subjects aged 12–18 years in the Korea National Health and Nutrition Examination Survey were analyzed. Participants were divided into subgroups according to sex, body mass index, 25-hydroxyvitamin D levels, and lipid profile. The mean 25-hydroxyvitamin D level was 16.15 ng/mL, which was below normal. In total, 79.3% of the subjects had vitamin D deficiency. Females had lower vitamin D levels and a higher incidence of dyslipidemia compared to males. Vitamin D deficiency was significantly associated with high density lipoprotein cholesterol (HDL-C) levels. The low HDL-C group consisted of a higher proportion of subjects with vitamin D deficiency and low physical activity. This study suggests that vitamin D deficiency is prevalent in Korean children and adolescents. Vitamin D deficiency and low physical activity are related with low HDL-C levels. Maintaining sufficient vitamin D levels and physical activity may help prevent dyslipidemia.

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25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort

Neurology ◽

10.1212/wnl.0000000000004489 ◽

2017 ◽

Vol 89 (15) ◽

pp. 1578-1583 ◽

Cited By ~ 34

Author(s):

Kassandra L. Munger ◽

Kira Hongell ◽

Julia Åivo ◽

Merja Soilu-Hänninen ◽

Heljä-Marja Surcel ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Conditional Logistic Regression ◽

Sample Collection ◽

Serum Samples ◽

Hydroxyvitamin D ◽

Relative Risks ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

Broad Public Health

Objective:To determine whether and to what extent vitamin D deficiency is associated with multiple sclerosis (MS) risk.Methods:We conducted a prospective nested case-control study among women in the Finnish Maternity Cohort (FMC). The FMC had 1.8 million stored serum samples taken during the pregnancies of over 800,000 women at the time of this study. Through linkages with hospital and prescription registries, we identified 1,092 women with MS diagnosed between 1983 and 2009 with at least 1 serum sample collected prior to date of MS diagnosis; ≥2 serum samples were available for 511 cases. Cases were matched to up to 3 controls (n = 2,123) on date of birth (±2 years) and area of residence. 25-Hydroxyvitamin D (25[OH]D) levels were measured using a chemiluminescence assay. We used conditional logistic regression adjusted for year of sample collection, gravidity, and parity to estimate relative risks (RRs) and 95% confidence intervals (CIs).Results:A 50 nmol/L increase in 25(OH)D was associated with a 39% reduced risk of MS (RR 0.61, 95% CI 0.44–0.85), p = 0.003. Women with 25(OH)D levels <30 nmol/L had a 43% higher MS risk (RR 1.43, 95% CI 1.02–1.99, p = 0.04) as compared to women with levels ≥50 nmol/L. In women with ≥2 samples, MS risk was 2-fold higher in women with 25(OH)D <30 nmol/L as compared to women with 25(OH)D ≥50 nmol/L (RR 2.02, 95% CI 1.18–3.45, p = 0.01).Conclusions:These results directly support vitamin D deficiency as a risk factor for MS and strengthen the rationale for broad public health interventions to improve vitamin D levels.

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Vitamin D Binding Protein Impact on 25-Hydroxyvitamin D Levels under Different Physiologic and Pathologic Conditions

International Journal of Endocrinology ◽

10.1155/2014/981581 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 77

Author(s):

Pegah Yousefzadeh ◽

Sue A. Shapses ◽

Xiangbing Wang

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Race And Ethnicity ◽

Binding Protein ◽

Vitamin D Binding Protein ◽

Total Vitamin ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

High Prevalence ◽

25 Hydroxyvitamin D

There is a high prevalence of vitamin D deficiency worldwide, but how to define vitamin D deficiency is controversial. Currently, the plasma concentration of total 25-hydroxyvitamin D [25(OH)D] is considered an indicator of vitamin D status. The free hormone hypothesis states that protein-bound hormones are inactive while unbound hormones are free to exert biological activity. The majority of circulating 25(OH)D and 1,25(OH)2D is tightly bound to vitamin D binding protein (DBP), 10–15% is bound to albumin, and less than 1% of circulating vitamin D exists in an unbound form. While DBP is relatively stable in most healthy populations, a recent study showed that there are gene polymorphisms associated with race and ethnicity that could alter DBP levels and binding affinity. Furthermore, in some clinical situations, total vitamin D levels are altered and knowing whether DBP is also altered may have treatment implications. The aim of this review is to assess DBP concentration in different physiological and pathophysiological conditions. We suggest that DBP should be considered in the interpretation of 25(OH)D levels.

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Prevalence of Vitamin D Deficiency among Patients Attending a General Otolaryngology Clinic in South Auckland

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940911800502 ◽

2009 ◽

Vol 118 (5) ◽

pp. 326-328 ◽

Cited By ~ 5

Author(s):

Jim Bartley ◽

David Reid ◽

Randall P. Morton

Keyword(s):

Vitamin D ◽

Statistical Analysis ◽

Vitamin D Deficiency ◽

Prospective Observational Study ◽

Vitamin D Status ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

Relationship Of ◽

The Relationship

Objectives: We performed a prospective observational study to estimate the prevalence of vitamin D deficiency in patients attending a general otolaryngology clinic in South Auckland, New Zealand. Methods: From July 21, 2008, to August 7, 2008, all new patients presenting to otolaryngology clinics at which one of the authors (D.R.) was present had their vitamin D status assessed by measurement of their plasma 25-hydroxyvitamin D [25(OH)D] level. Results: Of 48 patients, 2% had 25(OH)D levels of 17.5 nmol/L or less (a level associated with osteomalacia), 58% had 25(OH)D levels of 50 nmol/L or less (a level associated with vitamin D deficiency), and 100% had 25(OH)D levels of 80 nmol/L or less. Conclusions: Most of the patients attending a general otolaryngology clinic in South Auckland are vitamin D–deficient. It is unclear whether low vitamin D levels are associated more directly with otolaryngological disorders or skin type, because the small size of this study and the broad range of conditions seen precluded a meaningful statistical analysis. Further research into the relationship of vitamin D to specific otolaryngological presentations is required.

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Study on Serum Vitamin D in Alopecia Areata Patients

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v17i01.1475 ◽

2019 ◽

Vol 17 (01) ◽

pp. 21-25

Author(s):

Suchana Marahatta ◽

Sudha Agrawal ◽

Seraj Khan

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Alopecia Areata ◽

Serum Vitamin ◽

Control Group ◽

Healthy Controls ◽

Hydroxyvitamin D ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D

Background: Alopecia areata is the commonest cause of non-scarring alopecia. Few previous studies have found correlation between AA and vitamin D deficiency, suggesting that vitamin D deficiency can be a risk factor for Alopecia areata. To compare serum vitamin D level between Alopecia areata patients and healthy controls; and to assess the relation between serum vitamin D levels and AA disease severity.Methods: This case control study included 30 newly diagnosed Alopecia areata patients. Thorough history was taken, detail examination was done and relevant findings were recorded in the standardized pro-forma. Their serum vitamin D (25-hydroxyvitamin D) levels were determined by competitive chemiluminescence methods; and were compared with that of age and sex matched healthy controls. Chi square test and Spearman’s rho correlation test were used for the inferential statistics using SPSS version 11.5. Results: There were 30 AA patients with mean age 28.37+10.07 years. Mean Severity of Alopecia Tool score was 3.56+3.50. Prevalence of 25-hydroxyvitamin D [25(OH)D] deficiency was significantly higher in AA group (83.3%) compared to the control group (53.3%) (P=0.01). Similarly, serum 25(OH)D level was reduced more in Alopecia areata group (12.84, IQR=8.87-20.47) than the control group (29.5, IQR=19.85-41.27) (P=0.06). There was inverse co-relation between serum 25(OH)D level and SALT score.Conclusions: Prevalence of serum 25(OH)D deficiency was significantly higher in Alopecia areata group compared to the control, with inverse co-relation between its level and Alopecia areata disease severity. Keywords: Alopecia areata; Nepal; SALT Score; Vitamin D.

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