Revisiting vitamin D status and supplementation for in-patients with intellectual and developmental disability in the North of England, UK

Aims and method To re-evaluate vitamin D testing and supplementation among in-patients with intellectual and developmental disability (IDD) and examine any correlates with physical health conditions, including COVID-19. Records of all in-patients between January 2019 and July 2020 (n = 78) were examined for 25-hydroxyvitamin D (25(OH)D) level, ward area, supplementation status, test seasonality, medication and health status. Results The mean 25(OH)D level for supplemented (800 IU/day) patients was 75 nmol/L (s.d. = 20), compared with 40 nmol/L (s.d. = 19) in the non-supplemented group (P < 0.001). Thirty-eight percent of those who were in-patients during the first wave of the COVID-19 pandemic developed symptoms, but the small sample size could not establish vitamin D levels as a predictor of outcome. Clinical implications Vitamin D (800 IU/day) supplementation is effective but the adequacy of the nationally recommended dose of 400 IU/day is unclear. Links to COVID-19 merit further research.

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Revisiting vitamin D status and supplementation for inpatients with intellectual and developmental disability in the north of England, UK

BJPsych Open ◽

10.1192/bjo.2021.95 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S14-S14

Author(s):

Vlad Ciausu ◽

Marcin Ostrowski ◽

Bethany Dudley ◽

Iain McKinnon ◽

Chris Ince

Keyword(s):

Vitamin D ◽

Physical Health ◽

Developmental Disability ◽

Small Sample Size ◽

Vitamin D Supplementation ◽

Small Sample ◽

Inpatient Service ◽

Intellectual And Developmental Disability ◽

Vitamin D Levels ◽

Secure Unit

AimsVitamin D deficiency is common among people with Intellectual and Developmental Disability (IDD) and is linked to worse health outcomes.Our aims were to re-evaluate vitamin D testing and supplementation among inpatients with IDD, examine any correlates with physical health conditions including COVID-19 and make recommendations for the current regime of supplementation and testing within inpatient IDD services.MethodThe study population comprised inpatients who were in any of the Northgate Hospital IDD inpatient services in Northumberland, UK. The wards sampled were the Medium Secure Unit, Low Secure Unit, Hospital Based Rehabilitation Wards and Specialist Autism Inpatient Service. Records of all inpatients between January 2019 and July 2020 were examined for 25-hydroxyvitamin D [25(OH)D] level, ward area, supplementation status, test seasonality, medication, and health status.We performed a correlation to see whether there was an association between vitamin D level and length of time on treatment. In addition, comparison of the replete and inadequate group for age, ethnicity, seasonality, ward location and psychotropic medication was undertaken.Data on physical health risk factors, obesity and COVID-19 infection were also collected. The physical comorbidities were described in order to evaluate whether any emerging patterns relating to COVID-19 infection were emerging.ResultThere were 67 inpatients in Northgate IDD services on 1 January 2019, with 11 further patients admitted up to the end of the sampling period on 31 July 2020. Nineteen patients were discharged during that period, so the sample comprised 78 patients.Ages were comparable across three of the ward areas, except for an older group of patients in the hospital-based rehabilitation setting. Mean 25(OH)D level for supplemented (800IU/day) patients was 75nmol/l (SD 20) compared to 40nmol/l (SD 19) in the non-supplemented group (p < 0.001).Thirty-eight percent of those who were inpatients during the first wave of the COVID-19 pandemic developed symptoms, but the small sample size could not establish vitamin D levels as a predictor of outcome.ConclusionOur findings show that clinicians continue to offer vitamin D supplementation for inpatients, at a dose of 800IU (20μg) per day.The mean vitamin D levels we observed were higher for those on supplements compared to our 2013 baseline data, whereas patients not on supplementation now had levels akin to those found previously. Vitamin D (800IU/day) supplementation is effective but adequacy of the nationally recommended dose of 400IU/day is unclear. Links to COVID-19 merit further research.

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To screen or not to screen? Vitamin D deficiency in chronic mental illness

Australasian Psychiatry ◽

10.1177/1039856217726717 ◽

2017 ◽

Vol 26 (1) ◽

pp. 56-59

Author(s):

Ivana Goluza ◽

Jay Borchard ◽

Nalin Wijesinghe ◽

Kishan Wijesinghe ◽

Nagesh Pai

Keyword(s):

Vitamin D ◽

Length Of Stay ◽

P Value ◽

Hydroxyvitamin D ◽

Psychiatric Setting ◽

Retrospective Audit ◽

Vitamin D Levels ◽

Significant Difference ◽

25 Hydroxyvitamin D ◽

The Mean

Objectives: The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting. Method: A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described. Results: The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value <0.001 and 0.017, respectively. In addition, a simple linear regression indicated a weak association between length of stay and vitamin D levels. Conclusion: This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.

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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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Prognostic effects of 25-hydroxyvitamin d levels in gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14653 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14653-e14653

Author(s):

Chao Ren ◽

Rui-hua Xu

Keyword(s):

Gastric Cancer ◽

Vitamin D ◽

Gastric Cancer Cell ◽

Clinical Stage ◽

Epidemiologic Studies ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

The Mean ◽

Stored Blood

e14653 Background: Results from large epidemiologic studies on the association between vitamin D and gastric cancer are controversial. Vitamin D significantly promotes apoptosis in the undifferentiated gastric cancer cell, but the prognostic effects of its levels are unknown. Methods: 197 gastric carcinoma patients who received treatment in the cancer centre of Sun Yat-sen University from January 2002 to January 2006 were involved in the study. The stored blood drawn before any treatment was assayed for 25-hydroxyvitamin D levels. The clinicopathologic data were collected to examine the prognostic effects of vitamin D. Results: The mean vitamin D levels of the 197 gastric patients was 49.85±23.68nmol/L, among whom 114(57.9%) were deficient in Vitamin D(<50nmol/L), 67(34%) were insufficient (50-75nmol/L) and 16(8.1%) were sufficient (>75nmol/L). Clinical stage (p=0.004) and lymph node metastasis classification (p=0.009) were inversely associated with vitamin D levels. The patients with high vitamin D levels group (≥50nmol/L) had a higher overall survival compared with the low vitamin D levels group (<50nmol/L)(p=0.018). Multivariate analysis indicated that vitamin D levels were an independent prognostic factor of gastric cancer (p=0.019). Conclusions: Vitamin D deficiency may be associated with poor prognosis in gastric cancer.

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LEVELS OF 25-HYDROXYVITAMIN D IN PATIENTS WITH PSORIASIS- A CROSS SECTIONAL OBSERVATIONAL CASE- CONTROL STUDY

10.36106/gjra/4203095 ◽

2021 ◽

pp. 17-18

Author(s):

Harshima Harshima ◽

Ashok S Hogade

Keyword(s):

Vitamin D ◽

Plaque Psoriasis ◽

Chronic Plaque Psoriasis ◽

Hydroxyvitamin D ◽

Increased Risk ◽

Vitamin D Levels ◽

Study Results ◽

25 Hydroxyvitamin D ◽

The Mean ◽

Age And Sex

Background: Psoriasis is a common, immunologically mediated, inammatory disease characterized by skin inammation, epidermal hyperplasia, and increased risk of painful and destructive arthritis and cardiovascular morbidity and psychosocial challenges. Recent studies have shown higher prevalence of vitamin D deciency in patients with psoriasis than in control groups. It has been recently discovered that, vitamin D has role in modulation of Type 1 helper T cell (Th1) pathway. Thus low levels of vitamin D is believed to have an important implication in pathogenesis of psoriasis. Aims and objectives: To determine the 25-hydroxyvitamin D status of patients with chronic plaque psoriasis in comparison with age and sex matched controls. Materials and Methods: Thirty consecutive consenting patients with chronic plaque psoriasis and 30 age and sex matched controls with minor dermatological diseases were recruited in this study. Results: The age of the subjects ranged from 18yrs to 62yrs. The number of males was more than females. The overall prevalence of vitamin D in the study sample was 75%. Eighty percent cases and 70% controls had deciency of vitamin D. This study reveals that, the mean vitamin D was 16.23ng/do in case group and 19.29ng/dl in control group. The mean vitamin D was less in the cases as compare to controls, but it was not statistical signicant. Conclusion: Due to high overall prevalence of vitamin D deciency in India, many of the cases and controls had shown deciency. Not statistically signicant difference could be established between cases and controls with respect to serum vitamin D levels.

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Fall in Vitamin D Levels during Hospitalization in Children

International Journal of Pediatrics ◽

10.1155/2014/291856 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Devi Dayal ◽

Suresh Kumar ◽

Naresh Sachdeva ◽

Rakesh Kumar ◽

Meenu Singh ◽

...

Keyword(s):

Vitamin D ◽

Hospital Stay ◽

Vitamin D Supplementation ◽

Healthcare Associated Infection ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

The Mean ◽

The Difference ◽

Healthcare Associated

Plasma levels of 25-hydroxyvitamin D [25(OH)D] were measured by competitive Electrochemiluminescence Immunoassay (ECLIA) in 92 children (67 boys, 25 girls) aged 3 months to 12 years at admission to hospital (timepoint 1, T1) and at discharge (timepoint 2, T2). There was a significant fall in the mean 25(OH)D from T1 (71.87 ± 27.25 nmol/L) to T2 (49.03 ± 22.25 nmol/L) (mean change = 22.84 nmol/L,Pvalue = 0.0004). Proportion of patients having VDD (levels <50 nmol/L) at admission (25%, 23/92) increased significantly at the time of discharge (51.09%, 47/92) (P=0.0004). There was a trend towards longer duration of hospital stay, requirement of ventilation and inotropes, development of healthcare-associated infection, and mortality in vitamin D deficient as compared to nondeficient patients though the difference was statistically insignificant. In conclusion, vitamin D levels fall significantly and should be monitored during hospital stay in children. Large clinical studies are needed to prospectively evaluate the effect of vitamin D supplementation in vitamin D deficient hospitalized children on various disease outcome parameters.

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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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Absence of a relationship between thyroid hormones and vitamin D levels

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0210 ◽

2016 ◽

Vol 29 (6) ◽

Cited By ~ 2

Author(s):

Ping Zhou ◽

Jinny Cai ◽

Morri Markowitz

Keyword(s):

Vitamin D ◽

Thyroid Hormones ◽

Serum Levels ◽

Population Based ◽

Thyroid Stimulating Hormone ◽

Normal Group ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

The Mean

AbstractVitamin D is an immune modulator that may play a role in thyroid related autoimmunity.We analyzed a US population based dataset to determine the relationship between serum 25-hydroxyvitamin D (25OHD) and thyroid hormones while assessing the effects of autoimmunity and BMI.25OHD did not correlate significantly with any thyroid related measure. 25OHD levels stratified by thyroid antibody status were not statistically different between antibody positive and negative groups. The mean 25OHD levels of lean, overweight, and obese groups defined by BMI were lower than those of the normal group. Only the mean thyroid stimulating hormone (TSH) value in the obese group was significantly higher than the normal group.We conclude that thyroid related measures and 25OHD serum levels are not related.

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Vitamin D in patients with intellectual and developmental disability in secure in-patient services in the North of England, UK

BJPsych Bulletin ◽

10.1192/bjb.2017.8 ◽

2018 ◽

Vol 42 (1) ◽

pp. 24-29 ◽

Cited By ~ 3

Author(s):

Iain McKinnon ◽

Thomas Lewis ◽

Naomi Mehta ◽

Shahed Imrit ◽

Julie Thorp ◽

...

Keyword(s):

Vitamin D ◽

Developmental Disability ◽

Vitamin D Insufficiency ◽

Rehabilitation Services ◽

Intellectual And Developmental Disability ◽

The North ◽

Anticonvulsant Medication ◽

Vitamin D Levels ◽

Medium Security

Aims and methodTo assess the benefits of the introduction of routine vitamin D serum sampling for all patients admitted to a secure in-patient hospital in the North of England providing medium security, low security and rehabilitation services for offenders with intellectual and developmental disability. The vitamin D levels of 100 patients were analysed at baseline. Those with insufficient or deficient levels were offered treatment and retested after 1 year. Vitamin D levels were analysed in the context of level of security, seasonality of test and co-prescription of psychotropic medications.ResultsEighty-three per cent of patients had suboptimal vitamin D levels at initial test (41% deficient and 42% insufficient). This was seen among established patients and new admissions. Regression analysis of baseline vitamin D levels revealed no differences for levels of security, seasonality, whether patients were taking antipsychotic or anticonvulsant medication, or length of stay. Patients with deficiency or insufficiency were all offered supplementation. Those who opted in had significantly higher vitamin D levels at follow-up, compared with those who declined treatment.Clinical implicationsEstablished and newly admitted patients in our secure mental health services had substantial levels of vitamin D insufficiency. In the light of the morbidities that are associated with deficient vitamin D levels, routine screening and the offer of supplementation is advisable.Declaration of interestNone.

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Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

Journal of Neuromuscular Diseases ◽

10.3233/jnd-200625 ◽

2021 ◽

pp. 1-7

Author(s):

Naomi Vather-Wu ◽

Matthew D. Krasowski ◽

Katherine D. Mathews ◽

Amal Shibli-Rahhal

Keyword(s):

Vitamin D ◽

Retrospective Cohort ◽

Vitamin D Supplementation ◽

Hydroxyvitamin D ◽

Frequent Monitoring ◽

25 Hydroxyvitamin D ◽

The Mean ◽

Stable Maintenance ◽

Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to < 30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

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