Validation Protocol of Vitamin D Supplementation in Patients with HIV-Infection

Hypovitaminosis D and secondary hyperparathyroidism are frequent among HIV-infected patients. As there are no data about the best supplementation therapy both in treatment and in maintenance, we conducted an observational study of 300 HIV-infected patients for whom vitamin D and parathormone (PTH) had been measured in order to validate a protocol of vitamin D supplementation in patients with HIV-infection. Patients with vitamin D deficiency (defined as 25(OH)D < 10 ng/mL), insufficiency (defined as 25(OH)D < 20 ng/mL), or hyperparathyroidism (PTH > 65 pg/mL) were supplemented with cholecalciferol 16.000IU (0.266 mg) weekly (if deficiency) or fortnightly (if insufficiency or high PTH levels). Rates of normalization of 25(OH)D (levels above 20 ng/mL) and PTH levels (<65 pg/mL) were analyzed. Multivariate analysis of factors related to normalization was carried out. With a median follow-up of 2 years, 82.1% of patients with deficiency and 83.9% of cases with insufficiency reached levels above 20 ng/mL. However, only 67.2% of individuals with hyperparathyroidism at baseline reached target levels (<65 pg/mL). Independent factors for not achieving PTH objective were tenofovir (TDF) and protease inhibitors use. In HIV-infected patients with hypovitaminosis, the protocol of cholecalciferol supplementation normalized vitamin D levels regardless of antiretroviral regimen in a high proportion of patients but it was less effective to correct hyperparathyroidism.

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AB0806 DOES VITAMIN D INFLUENCE THE ACTIVITY OF THE DISEASE IN PATIENTS WITH PSORIATIC ARTHRITIS?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4625 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1704.1-1705

Author(s):

L. Montolio-Chiva ◽

A. V. Orenes Vera ◽

M. Aguilar-Zamora ◽

C. Vergara-Dangond ◽

I. Vázquez-Gómez ◽

...

Keyword(s):

Vitamin D ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Functional Capacity ◽

Inverse Correlation ◽

Hypovitaminosis D ◽

Joint Involvement ◽

Average Value ◽

Vitamin D Levels

Background:Several studies have shown an inverse relationship between vitamin D levels (25OHD) and disease activity in patients with rheumatoid arthritis (RA). However, the existing data in patients with psoriatic arthritis (PsA) are poor, and they use the DAS28 index as a peripheral joint activity marker by extrapolation with RA.Objectives:To analyze the relationship between 25OHD levels, disease activity and functional capacity in patients with PsA.Methods:Transversal, observational, descriptive study. We included PsA patients with peripheral joint involvement. We collected demographic variables (gender, age), clinical variables [follow-up, received treatments, TJC (68), SJC (68), VAS] and analytical variables (25OHD, CRP, ESR). We usedDisease activity in psoriatic arthritis(DAPSA) score to measure disease activity, and theHealth assessment questionnaire(HAQ) to determine functional capacity. Levels of 25 OHD <20 ng/ml and between 20-30 ng/ml were considered deficient and insufficient, respectively. Statistical analysis was made with SPSS 22.0. The descriptive analysis results were expressed as percentage and mean ± SD. We used Pearson’s correlation to assess the association between quantitative variables and T test to compare means between dichotomous variables.Results:125 patients were included, the majority women (60.8%), with an average age of 55.4 (SD 12.2) years. The average follow-up was 75.5 (SD 68.3) months. 97.6% of patients had received DMARDs and 40.8% biologics, and almost half of the patients (42.7%) took calcium and 25OHD supplements. The average value of 25OHD was 27.1 (SD 12.1) ng/ml, with 30% of patients having 25OHD deficit and 63.3% insufficiency. The majority of patients had an acceptable disease control, with a mean DAPSA of 10.5 (SD 7,9); and mean of CRP, ESR, TJC and SJC was 6.1 (SD 3.7) mg/l, 10.2 (SD 9.9) mm/h, 1.3 (SD 2.5) and 0.7 (SD 2.1), respectively. The average value of HAQ was 0.6 (SD 0.7). We observed an inverse correlation between 25OHD levels and joint counts, TJC (p=0.02) and SJC (p=0.03). On the other hand, patients with hypovitaminosis D presented a tendency to get higher scores in DAPSA index (P=0.07). We do not observe any relationship between 25OHD and HAQ.Conclusion:As can be seen in our sample, low values of 25OHD are related to increased disease activity in patients with PsA.Disclosure of Interests:L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

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Vitamin D status and 3-month Glasgow Outcome Scale scores in patients in neurocritical care: prospective analysis of 497 patients

Journal of Neurosurgery ◽

10.3171/2017.2.jns163037 ◽

2018 ◽

Vol 128 (6) ◽

pp. 1635-1641 ◽

Cited By ~ 3

Author(s):

Jian Guan ◽

Michael Karsy ◽

Andrea A. Brock ◽

Ilyas M. Eli ◽

Gabrielle M. Manton ◽

...

Keyword(s):

Vitamin D ◽

Logistic Regression ◽

Vitamin D Deficiency ◽

Glasgow Outcome Scale ◽

Neurocritical Care ◽

Care Center ◽

Hypovitaminosis D ◽

Simplified Acute Physiology Score ◽

Vitamin D Supplementation ◽

Vitamin D Levels

OBJECTIVEVitamin D deficiency has been associated with a variety of negative outcomes in critically ill patients, but little focused study on the effects of hypovitaminosis D has been performed in the neurocritical care population. In this study, the authors examined the effect of vitamin D deficiency on 3-month outcomes after discharge from a neurocritical care unit (NCCU).METHODSThe authors prospectively analyzed 25-hydroxy vitamin D levels in patients admitted to the NCCU of a quaternary care center over a 6-month period. Glasgow Outcome Scale (GOS) scores were used to evaluate their 3-month outcome, and univariate and multivariate logistic regression was used to evaluate the effects of vitamin D deficiency.RESULTSFour hundred ninety-seven patients met the inclusion criteria. In the binomial logistic regression model, patients without vitamin D deficiency (> 20 ng/dl) were significantly more likely to have a 3-month GOS score of 4 or 5 than those who were vitamin D deficient (OR 1.768 [95% CI 1.095–2.852]). Patients with a higher Simplified Acute Physiology Score (SAPS II) (OR 0.925 [95% CI 0.910–0.940]) and those admitted for stroke (OR 0.409 [95% CI 0.209–0.803]) or those with an “other” diagnosis (OR 0.409 [95% CI 0.217–0.772]) were significantly more likely to have a 3-month GOS score of 3 or less.CONCLUSIONSVitamin D deficiency is associated with worse 3-month postdischarge GOS scores in patients admitted to an NCCU. Additional study is needed to determine the role of vitamin D supplementation in the NCCU population.

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Determinants of Vitamin D Levels in Children and Adolescents with Down Syndrome

International Journal of Endocrinology ◽

10.1155/2015/896758 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 17

Author(s):

Stefano Stagi ◽

Elisabetta Lapi ◽

Silvia Romano ◽

Sara Bargiacchi ◽

Alice Brambilla ◽

...

Keyword(s):

Vitamin D ◽

Down Syndrome ◽

Autoimmune Diseases ◽

Hypovitaminosis D ◽

Outdoor Exposure ◽

Dietary Intakes ◽

Vitamin D Levels ◽

Cholecalciferol Supplementation ◽

Age And Sex ◽

D Value

Background. Poor studies have evaluated 25-hydroxycholecalciferol (25(OH)D) levels in Down syndrome (DS).Objective. To assess in DS subjects serum 25(OH)D value, to identify risk factors for vitamin D deficiency, and to evaluate whether a normal 25(OH)D value can be restored with a 400 I.U. daily supplement of cholecalciferol in respect to controls.Methods. We have longitudinally evaluated 31 DS patients (aged 4.5–18.9 years old) and 99 age- and sex-matched healthy controls. In these subjects, we analysed calcium, phosphate, parathyroid hormone (PTH), 25(OH)D concentrations, and calcium and 25(OH)D dietary intakes, and we quantified outdoor exposure. After 12.3 months (range 8.1–14.7 months) of 25(OH)D supplementation, we reevaluated these subjects.Results. DS subjects showed reduced 25(OH)D levels compared to controls (P<0.0001), in particular DS subjects with obesity (P<0.05) and autoimmune diseases history (P<0.005). PTH levels were significantly higher in DS subjects than controls (P<0.0001). After cholecalciferol supplementation, 25(OH)D levels were significantly ameliorated (P<0.05), even if reduced compared to controls (P<0.0001), in particular in DS subjects with obesity (P<0.05) and autoimmune diseases (P<0.001).Conclusions. Hypovitaminosis D is very frequent in DS subjects, in particular in presence of obesity and autoimmune diseases. In these subjects, there could be a need for higher cholecalciferol supplementation.

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Impact of Vitamin D Therapy on the Progress COVID-19: Six Weeks Follow-Up Study of Vitamin D Deficient Elderly Diabetes Patients

Proceedings of Singapore Healthcare ◽

10.1177/20101058211041405 ◽

2021 ◽

pp. 201010582110414

Author(s):

Amin R. Soliman ◽

Tarek Samy Abdelaziz ◽

Ahmed Fathy

Keyword(s):

Vitamin D ◽

Large Scale ◽

Clinical Laboratory ◽

Vitamin D Supplementation ◽

Chronic Obstructive ◽

Vitamin D Levels ◽

Significant Difference ◽

Patients With Diabetes ◽

Diabetes Patients

Background Coronavirus disease-19 (COVID-19) is an ongoing pandemic causing considerable fatalities worldwide. Vitamin D modulates the immune response through effects on various cells, such as: macrophages, B and T lymphocytes, neutrophils, and dendritic cells. Aim To explore whether supplementation of vitamin D, in the form of a single intramuscular cholecalciferol injection, to patients with diabetes, COVID-19, and low vitamin D levels could improve the prognosis of those patients. Methods This was a placebo-controlled randomized prospective study. The study has two arms as follows: the intervention arm (40 vitamin D deficient diabetes elderly patients that acquired SARS-CoV-2), compared to the control arm (16 elderly diabetes patients, with deficient vitamin D with SARS-CoV-2). Patients in the intervention arm were given vitamin D as a single intramuscular injection (200,000 IU); patients in the control arm were given placebo. The primary outcome was mortality within 6 weeks of the diagnosis of COVID-19. Clinical, laboratory, treatment, and outcome data were recorded after 6 weeks of follow-up. Results No significant difference in 6 weeks mortality was observed between patients who received vitamin D and patients who received placebo (17.5% vs 18.8%, p = 0.838). Age, presence of hypertension, and chronic obstructive pulmonary disease were independent predictors of mortality at 6 weeks. Conclusion Vitamin D supplementation did not reduce the severity or mortality of COVID-19 at 6 weeks. Further large scale studies are required to explore the effect of vitamin D therapy on survival in patients with diabetes mellitus who acquire COVID-19.

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VITAMIN D STATUS IN A HEALTHY TUNISIAN POPULATION

Journal of Medical Biochemistry ◽

10.5937/jomb0-30247 ◽

2022 ◽

Author(s):

Asma KRIR ◽

Afef BAHLOUS ◽

Mehdi MRAD ◽

BOUKSILA Mouna ◽

KALAI Safa ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Rural Areas ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Tunisian Population ◽

Diabetic Patients ◽

Dietary Intakes ◽

Vitamin D Status ◽

Vitamin D Levels

Vitamin D deficiency is one of the most common medical conditions worldwide. In Tunisia, several studies evaluated Vitamin D status, but this was concerning specific populations (pregnant women, obese or diabetic patients and children with asthma). The only study that evaluated Vitamin D status in a healthy Tunisian population was conducted by Meddeb and al. in 2002. The update of data available, based on the currently recommended limits, is necessary. This study aimed to estimate the prevalence of hypovitaminosis D in a healthy Tunisian population, and correlate the values with potential risk factors. It was conducted on 209 Tunisian healthy subjects. Data collected included clinical characteristics and dietary intakes. We measured 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), glycemia, creatinine, calcium, phosphorus, proteins and alkaline phosphatase levels. Hypovitaminosis D was retained for 25(OH)D concentrations <30ng/ml. Vitamin D deficiency was defined by 25(OH)D concentrations <10 ng/ml. The prevalence of hypovitaminosis D and vitamin D deficiency were respectively 92.3% and 47.6%. The main factors that were significantly associated with low vitamin D levels in our multivariate analysis were veiling, living in rural areas and sunscreen use. However, sex, age, socioeconomic level, phototype, solar exposure score, smoking and bone mass index, were not statistically associated with hypovitaminosis D. The study of relationship between vitamin D status and serum PTH levels showed a significative and negative correlation (p< 0.005). Given the high prevalence of vitamin D, an adapted health policy is essential. A widespread vitamin D supplementation and food fortification seems to be necessary in Tunisia.

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The Effect of Vitamin D Supplementation on The Outcome of Treatment with Bevacizumab in Diabetic Macular Edema: A Randomized Clinical Trial

10.21203/rs.3.rs-920607/v1 ◽

2021 ◽

Author(s):

Sahba Fekri ◽

Masoud Soheilian ◽

Sepehr Roozdar ◽

Seyed-Hossein Abtahi ◽

Hosein Nouri

Keyword(s):

Vitamin D ◽

Visual Acuity ◽

Macular Edema ◽

Vitamin D Deficiency ◽

Diabetic Macular Edema ◽

Serum Vitamin ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Vitamin D Levels ◽

Group 2

Abstract Purpose: Concomitant vitamin D deficiency (VDD) is speculated to aggravate diabetic macular edema (DME). We aimed to determine the effect of hypovitaminosis D correction on the outcome of treatment with intravitreal bevacizumab (IVB) in DME eyes.Methods: 83 eyes of 83 patients with DME were recruited and divided into three groups: normal vitamin D levels + IVB administration (Group 1 ), vitamin D insufficient/deficient + IVB administration (Group 2), and vitamin D insufficient/deficient + IVB administration+ oral vitamin D supplementation (Group 3). Visual (corrected distance visual acuity, CDVA) and anatomical (central macular thickness, CMT) outcomes of intervention were evaluated 1, 3, and 6 months after the triple IVB injections were completed. Serum vitamin D levels were measured 1 and 6 months after the third IVB administration. Results: In months 1, 3, and 6, after the basic triple IVB injection, visual acuity and CMT improved in all three groups, but improvements (both functional and anatomical) in groups 1 and 3 (sufficient vitamin D and corrected hypovitaminosis D) in month 6 were more significant than in group 2 (uncorrected hypovitaminosis D) (p <0.001). The mean number of IVB injections during follow-up was 5.33 (range: 4-7), which did not differ between the groups.Conclusion: Correction of vitamin D deficiency in DME patients with type 2 diabetes and vitamin D deficiency, in addition to IVB injections, may play a role in improving CDVA and CMT. However, this beneficial effect seems to be delayed by several months.Trial registration: Iranian Registry of Clinical Trials (IRCT), IRCT20200407046978N1, registered on April 11, 2020, - retrospectively registered. https://en.irct.ir/trial/46999

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Vitamin D Merging into Immune System-Skeletal Muscle Network: Effects on Human Health

Applied Sciences ◽

10.3390/app10165592 ◽

2020 ◽

Vol 10 (16) ◽

pp. 5592

Author(s):

Clara Crescioli

Keyword(s):

Skeletal Muscle ◽

Vitamin D ◽

Immune System ◽

Human Health ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Whole Body ◽

Protective Effects ◽

Skeletal Muscle Function ◽

Vitamin D Levels

The concept that extra-skeletal functions of vitamin D impact on human health have taken place since quite ago. Among all, the beneficial effects of vitamin D on immune regulation, skeletal muscle function, and metabolism are undeniable. Adequate vitamin D levels maintain the immune system and skeletal muscle metabolism integrity, promoting whole-body homeostasis; hypovitaminosis D associates with the important decline of both tissues and promotes chronic inflammation, which is recognized to underlie several disease developments. Growing evidence shows that the immune system and skeletal muscle reciprocally dialogue, modulating each other’s function. Within this crosstalk, vitamin D seems able to integrate and converge some biomolecular signaling towards anti-inflammatory protective effects. Thus, vitamin D regulation appears even more critical at the immune system-muscle signaling intersection, rather than at the single tissue level, opening to wider/newer opportunities in clinical applications to improve health. This paper aims to focus on the immune system-skeletal muscle interplay as a multifaceted target for vitamin D in health and disease after recalling the main regulatory functions of vitamin D on those systems, separately. Some myokines, particularly relevant within the immune system/skeletal muscle/vitamin D networking, are discussed. Since vitamin D supplementation potentially offers the opportunity to maintain health, comments on this issue, still under debate, are included.

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Inflammatory activity and vitamin D levels in an MS population treated with rituximab

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217319826598 ◽

2019 ◽

Vol 5 (1) ◽

pp. 205521731982659 ◽

Cited By ~ 1

Author(s):

Johan Linden ◽

Gabriel Granåsen ◽

Jonatan Salzer ◽

Anders Svenningsson ◽

Peter Sundström

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Magnetic Resonance ◽

Vitamin D Supplementation ◽

Inflammatory Activity ◽

T2 Lesions ◽

Vitamin D Levels ◽

25 Hydroxy Vitamin D ◽

Multiple Sclerosis Patients

Background Most multiple sclerosis patients on disease-modifying treatment at Umeå University Hospital are treated with rituximab and the prevalence of vitamin D supplementation has increased over time. Follow-up studies of these off-label treatments are needed. Objective To study inflammatory activity and adverse effects in rituximab-treated multiple sclerosis patients, and associations with 25-hydroxy-vitamin D levels. Methods Retrospectively collected data on repeated estimates of relapses, disability, side effects, magnetic resonance imaging, laboratory measures including 25-hydroxy-vitamin D levels and self-perceived health. Results In 272 multiple sclerosis patients with a mean follow-up of 43 months, we identified seven possible relapses during active rituximab treatment. On magnetic resonance imaging examination, new T2 lesions were seen in 1.3% (10 out of 792 scans), and 0.25% (two out of 785 scans) showed contrast enhancement. Adjusted 25-hydroxy-vitamin D levels in samples drawn close to all magnetic resonance images with new T2 lesions were lower compared to the remainder (62 vs. 81 nmol/l; P = 0.030). Levels of 25-hydroxy-vitamin D were associated with self-perceived health ( r = 0.18, P = 0.041, n = 130) and C-reactive protein ( r = –0.13, P = 0.042) but not with the risk of side effects. Conclusion The inflammatory activity in this rituximab-treated multiple sclerosis population that increasingly used vitamin D supplementation was extremely low. Higher 25-hydroxy-vitamin D levels were associated with beneficial outcomes.

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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.

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Clinically sufficient vitamin D levels at breast cancer diagnosis and survival outcomes in a prospective cohort of 3,995 patients after a median follow-up of 10 years.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10510 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10510-10510

Author(s):

Song Yao ◽

Haiyang Sheng ◽

Marilyn L. Kwan ◽

Qianqian Zhu ◽

Janise M. Roh ◽

...

Keyword(s):

Breast Cancer ◽

Vitamin D ◽

Prospective Cohort ◽

Breast Cancer Survivors ◽

Breast Cancer Diagnosis ◽

Vitamin D Supplementation ◽

Stage Disease ◽

Vitamin D Levels ◽

Sufficient Vitamin

10510 Background: There have been suggestive findings for better cancer survival with vitamin D supplementation in the recent VITAL trial. The findings are consistent with meta-analyses based on earlier randomized trials testing daily supplement vitamin D intake. As there is no ongoing or planned randomized trial of vitamin D supplementation in sight for women after breast cancer diagnosis, we evaluated relationships between serum levels of vitamin D and breast cancer outcomes in a large prospective cohort of breast cancer survivors. Methods: We measured 25-hydroxyvitamin D (25OHD) levels in serum samples collected at the time of diagnosis from 3,995 women with incident breast cancer enrolled in the Pathways Study, a large prospective cohort established in 2006 at Kaiser Permanente Northern California with active follow-up (FU). Potential determinants of 25OHD levels, including a polygenic score, were examined. Vitamin D levels were categorized based on clinical cutoffs as deficient ( < 20 ng/ml), insufficient (20 to < 30 ng/ml), or sufficient (≥30 ng/ml). These levels were then evaluated in relation to overall survival (OS), breast cancer-specific survival (BCSS), recurrence-free survival (RFS), and invasive disease-free survival (IDFS). Cox proportional hazards models were adjusted for non-clinical, clinical, and treatment factors and were further stratified by stage, estrogen receptor (ER) status, and body mass index (BMI). Results: Vitamin D supplement use, lower BMI, and self-reported white race were the strongest determinants of higher 25OHD levels. The polygenic score was significantly associated with 25OHD levels but explained only 0.3% of the variance. The median FU was 9.6 years (range: 0.3-13). Compared to those with deficient vitamin D levels, patients with sufficient levels had significantly better survival outcomes, which remained after controlling for various covariates (OS: HR [95% CI] = 0.73 [0.58-0.91]; BCSS: HR = 0.78 [0.56-1.09]; RFS: HR = 0.79 [0.65-0.97]; IDFS: HR = 0.82 [0.68-0.99]). Associations were similar by ER status, but stronger among patients with more advanced stage disease and those with under-weight or normal BMI. Black patients had the lowest 25OHD levels, which contributed to their poorer survival compared to white patients. Adding 25OHD levels to the Cox model of OS lowered the HR associated with Black vs. white race from 2.03 (1.57-2.62) to 1.79 (1.37-2.32). Conclusions: Sufficient vitamin D levels at the time of diagnosis were associated with improved breast cancer prognosis. Consistent with results from randomized trials, our findings from a large observational cohort of breast cancer survivors with long FU provide the strongest evidence to date for maintaining sufficient vitamin D levels in breast cancer patients, including among Black women and those with more advanced stage disease.

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