Cytokine Dysregulation in Diabetic Foot Infection Relates to Severe Vitamin D Deficiency

Vitamin D has been recognised as a potent immunomodulator and its deficiency is common in different population groups including patients with diabetic foot infection. Diabetic foot infection reflects the altered immune status of the host. As cytokine regulation plays a significant role in infection and wound-healing processes, the present study aimed to evaluate the association between vitamin D status and inflammatory cytokine profiles in patients with diabetic foot infection. The serum concentrations of vitamin D (25-hydroxyvitamin D), IL-1β, IL-6, TNF-α and interferon-γ (IFN-γ) were measured in 112 diabetic foot infection cases and 109 diabetic controls. Severe vitamin D deficiency (25-hydroxyvitamin D concentration < 25 nmol/l) was more common in cases than in controls (48·2v.20·5 %). Although age, duration of diabetes, HbA1C(glycosylated Hb) concentration and BMI were similar, cases had significantly higher concentrations of IL-6 (P≤ 0·001), IL-1β (P≤ 0·02) and TNF-α (P≤ 0·006) than controls. A significant negative correlation was also observed between 25-hydroxyvitamin D concentration and circulating concentrations of IL-1β (r− 0·323;P≤ 0·001) as well as IL-6 (r− 0·154;P≤ 0·04), but not between 25-hydroxyvitamin D and TNF-α and IFN-γ concentrations. Furthermore, a significant difference in IL-1β (P≤ 0·007) and IL-6 (P≤ 0·02) concentrations was observed in patients with severe 25-hydroxyvitamin D deficiency compared with patients with 25-hydroxyvitamin D concentration ≥ 25 nmol/l, and this difference was remarkable for TNF-α. In conclusion, severe vitamin D deficiency is associated with elevated inflammatory cytokine concentrations in diabetic patients, particularly in those with foot infection. A 25-hydroxyvitamin D concentration value < 25 nmol/l is suggested as the ‘cut-off’ for such immunological alterations in patients with diabetes mellitus.

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Prevalence and severity of vitamin D deficiency in patients with diabetic foot infection

British Journal Of Nutrition ◽

10.1017/s0007114512000578 ◽

2012 ◽

Vol 109 (1) ◽

pp. 99-102 ◽

Cited By ~ 27

Author(s):

Shalbha Tiwari ◽

Daliparthy D. Pratyush ◽

Balram Gupta ◽

Awanindra Dwivedi ◽

Sandeep Chaudhary ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Diabetic Foot ◽

Vitamin D Supplementation ◽

Diabetic Patients ◽

Similar Data ◽

Diabetic Foot Infection ◽

Hydroxyvitamin D ◽

Severe Vitamin ◽

Diabetic Foot Infections

The aim of the present research was to study the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection. Patients were enrolled in two groups: diabetic patients with foot infection (n 125) as cases and diabetic patients without the infection as controls (n 164). Serum 25-hydroxyvitamin D (25(OH)D) was measured by RIA. Data were presented as means and standard deviations unless otherwise indicated and were analysed by SPSS. Results revealed that 25(OH)D (nmol/l) was significantly lower (40·25 (sd 38·35) v. 50·75 (sd 33·00); P < 0·001) in cases than in controls. Vitamin D inadequacy (25(OH)D < 75 nmol/l) was equally common in cases and controls (OR 1·45, 95 % CI 0·8, 3·0; P = 0·32), but cases had a greater risk of vitamin D deficiency (25(OH)D < 50 nmol/l) than controls (OR 1·8, 95 % CI 1·1, 3·0; P = 0·02). Risk of severe vitamin D deficiency (25(OH)D < 25 nmol/l) was significantly higher in cases than in controls (OR 4·0, 95 % CI 2·4, 6·9; P < 0·0001). Age, duration of diabetes and HbA1c were significantly higher in cases than in controls and therefore adjusted to nullify the effect of these variables, if any, on study outcome. The study concluded that vitamin D deficiency was more prevalent and severe in patients with diabetic foot infection. This study opens up the issue of recognising severe vitamin D deficiency ( < 25 nmol/l) as a possible risk factor for diabetic foot infections and the need for vitamin D supplementation in such patients for a better clinical outcome. This could be substantiated by similar data from future studies.

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Clinical case of a patient with severe tertiary hyperparathyroidism, osteitis fibrosa cystica and osteomalacia as a consequence of severe vitamin D deficiency

Bone Abstracts ◽

10.1530/boneabs.3.pp402 ◽

2014 ◽

Author(s):

Elena Peretokina ◽

Natalya Mokrysheva

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Clinical Case ◽

Osteitis Fibrosa ◽

Tertiary Hyperparathyroidism ◽

Osteitis Fibrosa Cystica ◽

Severe Vitamin

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Strong correlation between prevalence of severe vitamin D deficiency and population mortality rate from COVID-19 in Europe

Wiener klinische Wochenschrift ◽

10.1007/s00508-021-01833-y ◽

2021 ◽

Author(s):

Isaac Z. Pugach ◽

Sofya Pugach

Keyword(s):

Vitamin D ◽

Mortality Rate ◽

Vitamin D Deficiency ◽

Strong Correlation ◽

Severe Vitamin ◽

Population Mortality

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Vitamin D and Cardiovascular Disease: An Updated Narrative Review

International Journal of Molecular Sciences ◽

10.3390/ijms22062896 ◽

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.

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Association between vitamin D deficiency and prostate cancer: Prospective case-control study

Journal of Clinical Urology ◽

10.1177/2051415821993606 ◽

2021 ◽

pp. 205141582199360

Author(s):

Ghanshyam Kumawat ◽

Vijay Chaudhary ◽

Anurag Garg ◽

Nishkarsh Mehta ◽

Gagan Talwar ◽

...

Keyword(s):

Prostate Cancer ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Case Control Study ◽

Serum Vitamin ◽

P Value ◽

Serum Vitamin D ◽

Severe Vitamin ◽

Vitamin D Levels ◽

Control Study

Objective: We aimed to find out the association of low serum vitamin D levels with the incidence of prostate cancer through a prospective case-control study. Material and methods: This study was carried out in the tertiary care hospital (India). All newly diagnosed patients of prostate cancer and age-matched controls were included. Serum vitamin D levels were measured in all of them. Vitamin D status (ng/mL) was classified as severe deficiency <10, moderate deficiency 10–<30, normal 30–100, and toxicity >100. Normality of the data was tested by the Kolmogorov–Smirnov test, statistical analysis was done with Statistical Package for the Social Sciences version 26.0, p-value of <0.05 was considered significant. Results: In our study, 320 cases and 320 controls were included. The mean vitamin D levels in cases and controls were 15.71 ± 6.5 (ng/mL) and 17.63 ± 4.54 (ng/mL), respectively, ( p-Value <0.01). Patients with severe vitamin D deficiency (73.58%) had a Gleason score ⩾8 on biopsy and 79.24% of them had a serum prostate specific antigen (PSA) level >20 ng/mL. Conclusion: We had concluded that there was no significant association between vitamin D deficiency and increased risk of prostate cancer, although patients with higher-grade prostate cancer and with higher PSA level had severe vitamin D deficiency. Level of evidence: Not applicable for this multicentre audit.

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