Evaluation of clinical symptoms and dietary habits in children aged 9-13 years with vitamin D deficiency

Osteoporosis is the most common cause of low bone mineral density (BMD) and low-traumatic fractures in adults. However, differential diagnosis should also consider other causes of decreased BMD, including osteomalacia, as treatment for these conditions vary significantly. Osteomalacia is a systemic disorder characterized by decrease in bone strength due to of excessive accumulation of non-mineralized osteoid and uncoupling between bone matrix formation and mineralization. Osteomalacia in adults mostly develops due to severe vitamin D deficiency of any etiology, less often along with kidney pathology, mesenchymal tumors secreting fibroblast growth factor 23 or hereditary metabolic bone diseases. Clinical symptoms of osteomalacia are nonspecific and mostly manifest by generalized diffuse bone pain, muscle weakness, skeletal deformities and often go unnoticed at initial stage of the disease. Histomorphometric examination is the most accurate method of the diagnosis, which allows assessment of bone formation rate and calcification. The utmost priority of the treatment of osteomalacia of any etiology is the elimination of vitamin D deficiency, hypocalcemia, hypophosphatemia and prevention of bone deformities progression and muscle hypotension.

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Studies of the Porcine Intestinal Calcitriol Receptor in Pseudo-Vitamin D Deficiency Rickets Type I

Clinical Science ◽

10.1042/cs0790409 ◽

1990 ◽

Vol 79 (4) ◽

pp. 409-414 ◽

Cited By ~ 6

Author(s):

B. Schröder ◽

R. Kaune ◽

J. Harmeyer

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Rate Constant ◽

Clinical Symptoms ◽

Binding Capacity ◽

Relative Molecular Mass ◽

Type I ◽

Binding Properties ◽

Deficiency Rickets ◽

And Control

1. Calcitriol (1,25-dihydroxyvitamin D3) concentrations in plasma of humans and pigs with pseudo-vitamin D deficiency rickets type I (PVDRI) have been reported to be significantly lower than in normal subjects and animals. Sometimes, however, calcitriol concentrations are relatively high in these subjects and animals (50–80 pmol/l) and nevertheless clinical symptoms of rickets develop. We have studied whether or not the development of rachitic lesions in piglets with PVDRI is due to altered binding properties of the intestinal calcitriol receptor in addition to the defective renal production of calcitriol. PVDRI piglets with clinical and biochemical symptoms of rickets (hypocalcaemia, increased activity of alkaline phosphatase) and with calcitriol concentrations in plasma of 83.7 ± 4.2 pmol/l (n = 7) were used. They were compared with unaffected piglets with normal calcitriol concentrations (178.0 ± 17.7 pmol/l, n = 9). 2. The equilibrium dissociation constant (Kd) of the receptor in the PVDRI piglets (0.31 ± 0.05 nmol/l) and in control piglets (0.33 ± 0.05 nmol/l) and the maximum binding capacity (Bmax.) (674 ± 103 and 719 ± 122 fmol/mg of protein, respectively) were not different (n = 9). 3. The association rate constant (kass) at 4°C [0.15 × 107 and 0.24 × 107 (mol/l)−1 min−1] and the dissociation rate constant (kdiss) (0.40 × 10−3 and 0.48 × 10−3 min−1; half-life of dissociation = 24.1 and 28.9 h, respectively) were also not different between diseased and control piglets. 4. No differences between PVDRI and control piglets were also found for the relative molecular mass (47 500 and 47700, respectively) and the Stokes' radius (3.04 and 3.05 nm, respectively) of the calcitriol receptor. 5. It is concluded that the intestinal calcitriol receptor of this animal model functions normally and that changes in binding properties and concentration of the intestinal calcitriol receptor do not contribute to the development of rachitic lesions in PVDRI piglets.

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A prospective single center study from a developing country to evaluate the prevalence of vitamin-D deficiency in patients with de novo hematologic malignancies.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e18004 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e18004-e18004

Author(s):

Nishitha Shetty ◽

Manju Sengar ◽

Hari Menon ◽

Uma Bhaskar Dangi ◽

Meera Ghadge ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Dietary Habits ◽

De Novo ◽

Performance Status ◽

Response To Therapy ◽

Haematological Malignancies ◽

Vitamin D Receptors ◽

Poor Outcome ◽

High Prevalence

e18004 Background: Vitamin-D deficiency is a global problem due to lack of sunlight exposure or dietary deficiency. Few studies have correlated vitamin-D deficiency with poor outcome in patients with diffuse large B-cell lymphomas and chronic lymphocytic leukemia. Expression of vitamin-D receptors on both normal and malignant hematopoietic cells suggests its possible role in pathogenesis, response to therapy and as a potential therapeutic target in haematological cancers. Given the high prevalence of malnutrition in our country and the potential impact of vitamin-D deficiency in haematological malignancies we conducted this prospective study to identify its prevalence in this subset of patients. Methods: Consecutive patients (15-50 years) with de novo haematological cancers who were registered at our centre over a three months period were evaluated. Patients who had received bisphosphonates or calcium and vitamin-D supplementation were excluded. Demographic variables, performance status, lifestyle (sedentary or non-sedentary), diet (vegetarian or mixed), consumption of milk products, serum 25 (OH) D, albumin and calcium levels were recorded. Levels <30ng/ml and <20ng/ml were considered as insufficient and deficient respectively. Results: A total of 126 patients (70% males) were enrolled. Median age was 35 years. Distribution as per histology was acute leukemia-59, lymphomas-53, chronic myeloid leukemia-14. 78% patients had non-sedentary life style and were consuming mixed diet and milk. 90% patients had performance status ≤2. Serum albumin>3.5 gm/dL and normal calcium levels were seen in 90%. Vitamin-D deficiency was seen in 12% patients whereas 73% patients were vitamin D insufficient. Keeping the cut-off <25 ng/mL, 82% patients were deficient. Deficiency did not correlate with age, underlying diagnosis, lifestyle or dietary habits. Conclusions: Our study identified a very high prevalence of vitamin-D deficiency in patients with haematological malignancies. This could be one of the factors responsible for the aggressive nature of disease and poor outcome in our patients.

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The Predictive Power of Serum Vitamin D for Poor Outcomes in COVID-19 Patients

10.21203/rs.3.rs-140417/v1 ◽

2021 ◽

Author(s):

Hoda Derakhshanian ◽

Hadith Rastad ◽

Sanjoy Ghosh ◽

Marjan Zeinali ◽

Tara Khoeini ◽

...

Keyword(s):

Vitamin D ◽

Mechanical Ventilation ◽

Vitamin D Deficiency ◽

Predictive Power ◽

Complete Blood Count ◽

Clinical Symptoms ◽

Invasive Mechanical Ventilation ◽

Serum Vitamin ◽

Serum Vitamin D ◽

Poor Outcomes

Abstract Background: Considering the high prevalence of vitamin D deficiency worldwide and its relationship with immune response to viral infections, this study attempted to identify the predictive power of serum vitamin D for poor outcomes among the COVID-19 patients.Methods: This retrospective cohort study included all patients with confirmed COVID-19 hospitalized between 20 February 2020 and 20 April 2020 at a designated COVID-19 hospital, located in Tehran province, Iran. General characteristics, medical history, and clinical symptoms were recorded by trained physicians. Blood parameters including complete blood count, creatinine, lactate dehydrogenase, creatine phosphokinase, erythrocyte sedimentation rate, C-reactive protein, and vitamin D were tested. Results: This study included 290 hospitalized patients with COVID-19 (the mean age (SD): 61.6 (16.9), 56.6% males), of whom 142 had vitamin D concentrations less than 20 ng/ml, defined as vitamin D deficiency. COVID-19 patients with vitamin D deficiency were more likely to die (Crude OR (95% CI): 2.30 (1.25-4.26)), require ICU care (2.06 (1.22-3.46)) and invasive mechanical ventilation (2.03 (1.04-3.93)) based on univariate logistic regression results. However, after adjusting for potentials confounders such as gender and age, the association between vitamin D and need to invasive mechanical ventilation lost its significance.Conclusion: Vitamin D deficiency can be considered as a predictor of poor outcomes and mortality in COVID-19 patients. Therefore, checking serum 25 (OH) D on admission and taking vitamin D supplements according to the prophylactic or treatment protocols is recommended for all COVID-19 patients.

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Vitamin D Deficiency Among Patients with COVID-19 : Case Series and Recent Literature Review

10.21203/rs.3.rs-29473/v1 ◽

2020 ◽

Cited By ~ 4

Author(s):

Rizaldy Taslim Pinzon ◽

Angela Angela ◽

Andryawan Wahyu Pradana

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Clinical Symptoms ◽

Clinical Signs ◽

Case Series ◽

Hypovitaminosis D ◽

Vitamin D Insufficiency ◽

Laboratory Method ◽

Vitamin D Status ◽

Vitamin D Supplements

Abstract Background The world is now challenging the pandemic of COVID-19 infection. Previous studies showed the plausibility of Vitamin D prophylaxis and therapy for COVID-19, particularly in settings where hypovitaminosis D is frequent. Recent study from Indonesian showed that prevalence of vitamin D deficiency were 23.0%. The examination of Vitamin D status is not a routine in Indonesian clinical setting. Methods This study is a Case Series from confirmed cases of COVID-19 in Bethesda hospital Yogyakarta Indonesia. The data of clinical symptoms, clinical signs, and laboratory examination were obtained from electronic medical record. The vitamin D status was measured by standardized laboratory method. We searched PubMed and Google Scholar for studies that included terms for Vitamin D and COVID-19. Results The data was obtained from 10 participants consist of 50% male and 50% female. The mean of age was 49.6 years. The prevalence of vitamin D deficiency in this case was 90% and 10% of insufficiency. Patients in this case had various symptom and also had various chronic disease as comorbidity. Conclusions The prevalence of vitamin D deficiency in this case series in Bethesda hospital Yogyakarta, Indonesia is 90% and 10% vitamin D insufficiency. We found no clinical evidence that vitamin D supplements are beneficial in preventing or treating COVID-19. Randomized controlled trials need to determine and evaluated this recommendation.

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Asymptomatic Severe Hypocalcemia Secondary to Vitamin D Deficiency in an Elderly Patient

Case Reports in Endocrinology ◽

10.1155/2011/830952 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Saleh Aldasouqi ◽

Crystal M. Glassy ◽

Matthew S. Glassy ◽

Anxhela Treska ◽

Molly Caldwell-McMillan ◽

...

Keyword(s):

Elderly Patient ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Clinical Symptoms ◽

Hypovitaminosis D ◽

Serum Levels ◽

The Elderly ◽

Caucasian Woman ◽

Normal Range ◽

Endocrinology Clinic

Objective. To describe an asymptomatic presentation of severe hypocalcemia secondary to vitamin D deficiency in an elderly patient.Methods. We describe the presentation and clinical course of an elderly woman with asymptomatic severe hypocalcemia referred to an endocrinology clinic for hyperparathyroidism.Results. The patient is an 83-year-old Caucasian woman who presented to an endocrinology clinic for evaluation of hyperparathyroidism, with an intact PTH of 462 pg/mL (normal range 14–72 pg/mL). The same lab report included a serum calcium of 5.2 mg/dL (normal range 8–10.5 mg/dL). She displayed no signs or symptoms of hypocalcemia. Given the extreme severity of hypocalcemia and her age, she was hospitalized. Vitamin D deficiency was suspected and was subsequently confirmed with undetectable serum levels. The patient remained asymptomatic throughout her hospital stay. Total and ionized calcium levels at discharge were 7.2 mg/dL and 1.03 mmol/L (normal range 1.1–1.4 mmol/L), respectively.Conclusion. Physicians should exercise prudent management with respect to the vitamin D status of the elderly patient, as certain patients may exhibit severe hypovitaminosis D and hypocalcemia without apparent clinical symptoms.

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Vitamin D deficiency among patients with COVID-19: case series and recent literature review

Tropical Medicine and Health ◽

10.1186/s41182-020-00277-w ◽

2020 ◽

Vol 48 (1) ◽

Cited By ~ 1

Author(s):

Rizaldy Taslim Pinzon ◽

Angela ◽

Andryawan Wahyu Pradana

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Clinical Symptoms ◽

Case Series ◽

Hypovitaminosis D ◽

Vitamin D Insufficiency ◽

Vitamin D Status ◽

Vitamin D Levels ◽

Laboratory Examinations ◽

The Mean

Abstract Background The world is now challenging the pandemic of COVID-19 infection. This is the third and most extensive pandemic. Previous studies showed the plausibility of vitamin D prophylaxis and therapy for COVID-19, particularly in settings where hypovitaminosis D is frequent. Recent study from Indonesian showed that the prevalence of vitamin D deficiency was 23.0%. The examination of vitamin D status is not a routine in the Indonesian clinical setting. Methods This study is a case series from confirmed cases of COVID-19 in Bethesda Hospital Yogyakarta Indonesia. The data of clinical symptoms, signs and laboratory examinations were obtained from the electronic medical records. The vitamin D status was measured by Enzyme-Linked Fluorescent Assay (ELFA) method. We searched PubMed and Google Scholar for studies that included terms for Vitamin D and COVID-19. Results The data were obtained from 10 participants consisting of 50% male and 50% female. The mean age was 49.6 years. The prevalence of vitamin D deficiency in this study was 90% (vitamin D levels < 20 ng/mL) and 10% of insufficiency (vitamin D levels < 30 ng/mL). Patients in this study had various symptoms such as fatigue (60%), fever (50%), dry cough (40%), non-specific headache (10%), and diarrhea (10%); have no symptoms (20%); and also had the various chronic diseases as comorbidity such as hypertension (40%), diabetes (10%), COPD (10%), and post stroke (10%). Conclusions All of the COVID-19 patients in this study had hypovitaminosis D. The prevalence of vitamin D deficiency in this case series is 90% and only 1 patient (10%) had vitamin D insufficiency. There are many health benefits of vitamin D and very few adverse effects. Randomized controlled trials need to determine and evaluate this recommendation in preventing or treating COVID-19. Clinicians should continue to treat people with vitamin D deficiency especially in managing COVID-19 patients.

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A CASE OF SEVERE FAMILIAL VITAMIN D DEFICIENCY

Osteoporosis and Bone Diseases ◽

10.14341/osteo2015336-39 ◽

2015 ◽

Vol 18 (3) ◽

pp. 36-39

Author(s):

E A Pigarova ◽

Z N Abdulvapova ◽

A A Petrushkina ◽

L Ya Rozhinskaya

Keyword(s):

Vitamin D ◽

Family History ◽

Socioeconomic Factors ◽

Vitamin D Deficiency ◽

Clinical Features ◽

Clinical Symptoms ◽

Lower Extremities ◽

Hydroxylase Deficiency ◽

Severe Vitamin ◽

Hereditary Syndromes

Clinical symptoms of vitamin D deficiency may be quite misleading and masked as rare hereditary syndromes. We describe a family, sister and brother presented with the pain in lower extremities at the age of 14 and 16years accordingly, with severe vitamin D deficiency that was misdiagnosed in the course of the disease with pseudohypoparathyroidism and 1-alpha-hydroxylase deficiency. They benefited from treatment with alfacalcidol and ossein-hydroxyapatite complex supplement which were further discontinued due to socioeconomic factors. At presentation after 2 years without treatment extremely low 25(OH)D levels were revealed. The patients' family history was remarkable for the same clinical features in mother and her Indian ancestry. Thus we describe an uncommon manifestation of severe vitamin D deficiency in a familial setting which emphasizes the necessity of vitamin D testing in calcium or parathyroid disorders.

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The prevalence of vitamin D deficiency between Saudis and non-Saudis in Al-Madinah Al-Munawarah a cross-sectional study

10.1101/613729 ◽

2019 ◽

Author(s):

Muhammed Hassan Nasr ◽

Noordin Othman ◽

Bassam Abdulrasol Hassan ◽

Mahmathi Karoppannan ◽

Noorizan Binti Abdulaziz ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Dietary Habits ◽

Cross Sectional Study ◽

Health Concern ◽

Sectional Study ◽

Cross Sectional ◽

Vitamin D Levels ◽

The Difference ◽

Pleiotropic Functions

BackgroundVitamin D, or the “sunshine” hormone became an attractable topic that recently captivates many researchers. The increased prevalence of vitamin D deficiency became an alarming health concern despite the accumulative evidence exploring its crucial role not only in bone metabolism, but also in a variety of pleiotropic functions throughout the various body organs. The aim of this study is to compare the prevalence that might influence vitamin D deficiency among Saudi and non-Saudi nationalities in Almadinah Almunawarh, Saudi Arabia, and to study the different factors that may have an influence in the difference of this prevalence like the marital status, occupation, smoking, sunlight exposure, education, and dietary habits.MethodsThe study was a cross sectional study done in the medical care unit in Taiba University Almadina Almunawarah in which, 65 healthy male individuals from different nationalities (Saudis and non-Saudis), aged 18 - 65 years were divided into 2 groups, 33 Saudis and 32 non-Saudis. A sociodemographic questionnaire was filled by the study participants and 25-OH vitamin D3 (25(OH)D3) concentrations were detected by electrochemiluminescence immunoassay.ResultsResults showed a Significant percentage of the participants in the Saudi group (n = 30, 91%) suffered from deficiency in vitamin D levels [25 (OH) D < 20 ng/ml] 12.57 ± 4.82 (mean ± SD), compared to only 47% (n = 15) in the non-Saudi group [21.56 ± 6.82 (mean ± SD)]. Vitamin D deficiency was found to be significantly higher in the Saudi group than the non-Saudi group with P = 0.001.ConclusionResults showed a significant increase in vitamin D deficiency in Saudi population than the non-Saudis P = 0.001. The occupation status was found to be the only factor positively correlated with vitamin D deficiency.

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Has vitamin D had its day? An audit of vitamin D, prolactin and HBA1C monitoring over one year in an in-patient secure service

BJPsych Open ◽

10.1192/bjo.2021.868 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S330-S331

Author(s):

Oleg Lujanschi ◽

Toral Thomas

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Best Practice ◽

Clinical Symptoms ◽

Vitamin D Supplementation ◽

Service Users ◽

Reference Ranges ◽

Mineral Density ◽

Increased Risk ◽

One Year

AimsTo ensure that service users in in-patient secure services have prolactin, vitamin D and HbA1c monitoring as per current best practice guidance.BackgroundService users prescribed antipsychotic medication are at risk of developing raised prolactin levels and metabolic syndrome. In both sexes, long-standing hyperprolactinaemia can lead to low bone mineral density with an increased risk of developing osteoporosis.In recent years there has been increasing controversy on the increase in Vitamin D monitoring despite the poor evidence for complications from vitamin D deficiency in adults. Not undertaking this test in the absence of symptoms will potentially reduce anxiety for service users could save £17 per test and £50 for a 12-week course of Vitamin D supplementation. Local and national guidance indicate Vitamin D monitoring should only be done in symptomatic people.MethodFifty-five service users in the five in-patient wards had their electronic records and pathology results reviewed over a one-year period. All service users were expected to have a minimum of an annual HbA1c and prolactin level but to only have vitamin D monitoring if symptomatic for deficiency.ResultAlthough 100% of service users in MSU were tested, vitamin D testing was consistently undertaken without documented clinical evidence of deficiency. The ranges across all units were: prolactin (72- 1384mU/L), HbA1c (30–90 mmol/mol) and vitamin D (15–124 nmol/L). Local reference ranges are prolactin (53- 360mU/L), HbA1c (<48 mmol/mol) and Vitamin D (50–120 nmol/L).Prolactin levels were highest on the male medium secure wards.The other two units had significantly less testing with prolactin and HbA1c levels being the least measured (18% of service users on male LSU and 23% on the female ward respectively). Vitamin D testing on these two wards were 38% on the female ward and 18% on the male ward for both tests.ConclusionNorthside House has a dedicated physical health team and this is likely to explain its 100% score. However, vitamin D testing was being undertaking automatically rather than based on symptoms.The recommendation is to add prolactin and HbA1c to the physical screens done before CPA meetings for all service users prescribed an antipsychotic but to stop Vitamin D testing in the absence of clinical symptoms of vitamin D deficiency.

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