scholarly journals The Association Between Ambient UVB Dose and ANCA-associated Vasculitis Relapse and Onset

2021 ◽  
Author(s):  
Jennifer Scott ◽  
Enock Havyarimana ◽  
Albert Navarro-Gallinad ◽  
Arthur White ◽  
Jason Wyse ◽  
...  
Keyword(s):  
Vitamin D ◽  
Logistic Regression ◽  
Kidney Disease ◽  
Study Design ◽  
Ultraviolet B ◽  
Clear Relationship ◽  
Relapse Risk ◽  
Anca Associated Vasculitis ◽  
Increased Risk ◽  
Multi Level

Abstract Background The etiology of ANCA-associated vasculitis (AAV) and triggers of relapse are poorly understood. Vitamin D (vitD) is an important immunomodulator, potentially responsible for the observed latitudinal differences between granulomatous and non-granulomatous AAV phenotypes. A narrow ultraviolet B spectrum induces vitD synthesis (vitD-UVB) via the skin. We hypothesised that prolonged periods of low ambient UVB (and by extension vitD deficiency) are associated with the granulomatous form of the disease and an increased risk of AAV relapse. Methods Patients with AAV recruited to the Irish Rare Kidney Disease (RKD) (n = 439) and UKIVAS (n = 1961) registries were studied. Exposure variables comprised latitude and measures of ambient vitD-UVB, including cumulative weighted UVB dose (CW-D-UVB), a well-validated vitD proxy. An n-of-1 study design was used to examine relapse risk. Multi-level models and logistic regression were used to examine the effect of predictors on AAV relapse risk, phenotype and serotype. Results Residential latitude was positively correlated (OR:1.41, 95% CI 1.14–1.74, p = 0.002) and average vitD-UVB negatively correlated (0.82, 0.70–0.99, p = 0.04) with relapse risk, with a stronger effect when restricting to winter measurements (0.71, 0.57–0.89, p = 0.002). However, these associations were not restricted to granulomatous phenotypes. We observed no clear relationship between latitude, vitD-UVB or CW-D-UVB and AAV phenotype or serotype. Conclusion Our findings suggest that low winter ambient UVB and prolonged vitD status contribute to AAV relapse risk across all phenotypes. However, development of a granulomatous phenotype does not appear to be directly vitD-mediated. Further research is needed to determine whether sufficient vitD status would reduce relapse propensity in AAV.

scholarly journals Exposure to Vitamin D Fortification Policy in Prenatal Life and the Risk of Childhood Asthma: Results From the D-Tect Study

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 924
Author(s):  
Thorsteinsdottir ◽  
Maslova ◽  
Jacobsen ◽  
Frederiksen ◽  
Keller ◽  
...  
Keyword(s):  
Vitamin D ◽  
Study Design ◽  
Childhood Asthma ◽  
Proportional Hazards ◽  
Epidemiological Studies ◽  
Vitamin D Insufficiency ◽  
Cox Proportional Hazards ◽  
Small Sample ◽  
Increased Risk ◽  
Small Sample Sizes

Prenatal vitamin D insufficiency may be associated with an increased risk of developing childhood asthma. Results from epidemiological studies are conflicting and limited by short follow-up and small sample sizes. The objective of this study was to examine if children born to women exposed to the margarine fortification policy with a small dose of extra vitamin D during pregnancy had a reduced risk of developing asthma until age 9 years, compared to children born to unexposed women. The termination of a Danish mandatory vitamin D fortification policy constituted the basis for the study design. We compared the risk of inpatient asthma diagnoses in all Danish children born two years before (n = 106,347, exposed) and two years after (n = 115,900, unexposed) the termination of the policy. The children were followed in the register from 0–9 years of age. Data were analyzed using Cox proportional hazards regression. The Hazard Ratio for the first inpatient asthma admission among exposed versus unexposed children was 0.96 (95%CI: 0.90–1.04). When stratifying by sex and age, 0–3 years old boys exposed to vitamin D fortification showed a lower asthma risk compared to unexposed boys (HR 0.78, 95%CI: 0.67–0.92). Prenatal exposure to margarine fortification policy with extra vitamin D did not affect the overall risk of developing asthma among children aged 0–9 years but seemed to reduce the risk among 0–3 years old boys. Taking aside study design limitations, this could be explained by different sensitivity to vitamin D from different sex-related asthma phenotypes in children with early onset, and sex differences in lung development or immune responses.

scholarly journals 338. Multicenter Evaluation of Superinfection Occurrence and Impact on Clinical Outcomes in Patients with COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S273-S274
Author(s):  
Taryn A Eubank ◽  
Katherine Perez ◽  
William L Musick ◽  
Kevin W Garey
Keyword(s):  
Chronic Kidney Disease ◽  
Logistic Regression ◽  
Kidney Disease ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Treatment Algorithm ◽  
Occurrence Rate ◽  
Stepwise Logistic Regression ◽  
Increased Risk ◽  
Baseline Characteristics

Abstract Background The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread globally throughout late 2019. During this pandemic, concern for bacterial and fungal superinfections has been present during the treatment of these patients. Methods Hospitalized, adult patients with laboratory confirmed and symptomatic COVID-19 disease admitted between March 12, 2020 and May 31, 2020 were eligible for inclusion in this study. Data was obtained from electronic medical records and the hospital system’s clinical surveillance program including demographics, comorbidities, hospitalization dates, laboratory values, mechanical ventilation, positive blood and respiratory cultures, treatment administration for COVID-19 as defined by the system’s fluid treatment algorithm, and discharge disposition. Outcomes of this analysis include overall bacterial and fungal superinfection occurrence rate within 28 days of admission, patient characteristics that correlate with a higher risk of a superinfection, and the effect on 28-day mortality. Patient Population Flow diagram of patient inclusion. Results A total of 404 patients were included in the study analyses of which 56 (13.9%) had a documented superinfection within 28-days from admission. The most common superinfection organisms observed were Staphylococcus spp. (36.9%), Candida spp. (16.7%), and Klebsiella spp. (13.1%). Mortality was significantly higher in patients with superinfections (12.1% vs 5.8%, p < 0.001). To best assess characteristics that place patients at a higher risk of superinfection, a backwards, stepwise, multivariable logistic regression was performed. Black ethnicity, chronic kidney disease, intensive care unit (ICU) upon admission, lymphocytopenia, and receipt of tocilizumab were found to more likely have a superinfection within 28-days from admission. Baseline Characteristics Comparison and analysis of baseline characteristics in patients with or without superinfection present. 28-day Mortality Day-28 mortality comparison in patients with or without superinfection. Mortality was observed in 7/58 patients with a superinfection versus 20/346 patients without superinfection present (p < 0.001). Multivariable analysis results for increased superinfection risk. All baseline characteristics with univariate analysis resulting in a p value of < 0.2 were included in the backwards, stepwise logistic regression model. Conclusion In conclusion, our retrospective cohort study reports a superinfection rate of 13.9%. Presence of a superinfection significantly increases the likelihood of mortality within 28-days from admission. Characteristics that have a significant correlation to increased risk of superinfections include Black ethnicity, chronic kidney disease, ICU upon admission, and receipt of tocilizumab. Disclosures Kevin W. Garey, Pharm.D., M.S., FASHP, Summit Therapeutics (Research Grant or Support)

scholarly journals Ultraviolet B Phototherapy Intervention in Patients with Multiple Sclerosis: A Prospective, Randomized Pilot Trial

2019 ◽  
Vol 3 (1) ◽  
pp. 12-25
Author(s):  
Robert W. Motl ◽  
Grace M. Niemiro ◽  
Michael De Lisio ◽  
Sarah Sommer ◽  
Barry J. Riskin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Pilot Trial ◽  
Serum Vitamin ◽  
Ultraviolet B ◽  
Serum Vitamin D ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
Uvb Phototherapy

Background There is substantial evidence, from well-conducted epidemiological studies, that low vitamin D levels are correlated with increased risk for MS, and multiple case control studies have implicated the involvement of vitamin D deficiency in MS etiology. Narrow-band Ultraviolet B (NB-UVB; 300nm - 311 nm) induced vitamin D production has not previously been studied in a multiple sclerosis (MS) randomized placebo-controlled trial (RCT). Objectives To investigate NB-UVB induced vitamin D production, immunomodulation and MS symptomology following NB-UVB phototherapy in a MS cohort. Methods Using a blinded RCT study design, twelve individuals 18 years or older with MS were enrolled and assigned (1:1) into individualized NB-UVB dose (10-30kJ/m) phototherapy, or into placebo treatment, delivered 3 times per week, for 8-weeks. Serum vitamin D levels, walking performance, strength, cognitive function, mood and circulating progenitor cells (CPCs: CD34+CD45dim), monocyte populations (Intermediate CD14+CD16+, Classical CD14+CD16-), and T regulatory cell (CD4+/CD25+/FoxP3+Tregs) count were assesed. The data were analyzed by 2 x 3 mixed factor ANOVA. Results A statistically significant condition by time interaction on vitamin D levels (F=7.14, p<.005, partial η2=.42) was identified. NB-UVB phototherapy may provide immunomodulation in a select group of MS individuals. Conclusion UVB phototherapy corrects vitamin D deficiency. This study adds to the growing research investigating UVB treatment in MS.

Kidney and Mortality Outcomes Associated with Ondansetron in Critically Ill Patients

2022 ◽  
pp. 088506662110735
Author(s):  
Matthew Gray ◽  
Priyanka Priyanka ◽  
Sandra Kane-Gill ◽  
Lirong Wang ◽  
John A. Kellum
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Multivariate Logistic Regression ◽  
Increased Risk ◽  
Secondary Outcomes

Background: Ondansetron is a preferred anti-emetic in critical care to treat nausea and vomiting, and has historically been considered a largely safe option. A recent pharmacoepidemiology study reported that ondansetron may be associated with an increased risk for acute kidney injury (AKI). Methods: We interrogated the High-Density Intensive Care (HiDenIC-15) database containing intensive care data for 13 hospitals across Western Pennsylvania between Oct 2008-Dec 2014. AKI was defined using the Kidney Disease, Improving Global Outcomes 2012 guidelines. Ondansetron use was considered as receiving any form of ondansetron within 24 h of admission. The subsequent 48 h (hours 25-72 after admission) were analyzed for outcomes. Primary outcome was development of AKI; secondary outcomes included 90-day mortality and time to AKI. Propensity-matched, multivariate logistic regression was applied for both outcomes. Comparator groups were metoclopramide and prochlorperazine using the same exposure criteria. Results:AKI occurred in 965 (5.6%), 12 (3.0%), and 61 (6.5%) patients receiving ondansetron, prochlorperazine, and metoclopramide, respectively. In the adjusted analysis, no anti-emetic was associated with a significant change in the odds of developing AKI. Ondansetron was associated with a 5.48% decrease (CI −6.17–−4.79) in death within 90 days of ICU-admission, which was independent of AKI status; an effect not seen with other anti-emetics. Anti-emetic usage was not associated with a change in the time to first AKI. Conclusion:Anti-emetic usage did not alter AKI risk. Ondansetron was associated with a significant decrease in 90-day mortality that was not seen by other anti-emetics, which requires further exploration.

P0422RED BLOOD CELL DISTRIBUTION WIDTH AND OUTCOME IN SUBJECTS WITH BIOPSY-PROVEN GLOMERULOPATHIES WITHOUT ANEMIA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Otilia Popa ◽  
Tudor Popa ◽  
Ana Stanciu ◽  
Nicoleta Petre ◽  
Eugen Mandache ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Kidney Disease ◽  
Lupus Nephritis ◽  
Blood Cell ◽  
Cerebrovascular Disease ◽  
Independent Predictor ◽  
Cell Distribution ◽  
Distribution Width ◽  
Increased Risk

Abstract Background and Aims Red blood cell distribution width (RDW) is a marker of anisocytosis and is mainly modified in anemia. However, elevated RDW has recently been reported to predict cardiovascular risk, was correlated with disease activity in inflammatory conditions such as systemic lupus erythematosus, rheumatoid arthritis and, not the least, was associated with increased risk of end stage kidney disease and proteinuria in chronic kidney disease (CKD) subjects. The current study aims to assess if RDW is an independent predictor for renal replacement therapy (RRT) and mortality in subjects with glomerulopathies (GP). Method This retrospective, single-center study, included 467 subjects with hemoglobin &gt;12 g/dL at presentation, who were histologically diagnosed with primary and secondary glomerulopathies between 1st Jan. 2008 and 31st Dec. 2017 and who were followed for a mean of 52.8 (95%CI 50.7-55) months, until 31st May 2018. Subjects with inadequate biopsy sample were excluded. Those who deceased until the end of the follow-up were not included in the kidney survival analysis. Predictors of mortality were assessed by logistic regression. Kaplan-Meier method was used to evaluate kidney survival. Patients were stratified in two groups according to the median RDW value: low RDW group (RDW≤15%; n=342) and high RDW group (RDW&gt;15%; n=125). RRT initiation and all-cause mortality were the primary endpoints of the study. Results Subjects with high RDW were older [53 (95%CI 48-56) vs. 45 (95%CI 43-47) years; p=0.03], had more frequent cerebrovascular disease (9.7% vs. 2.7%; p=0.003), congestive heart failure (8.1% vs. 1.8%; p=0.002), connective tissue disease (11.3% vs. 3%; p=0.001) and non-hematologic neoplasia (4.8% vs. 0.9%, p=0.01). Furthermore, they had more severe inflammation as suggested by higher erythrocyte sedimentation rate [54.5 (95%CI 43-60) vs. 35 (95%CI 30-40) mm/hour; p=0.002], fibrinogen [630 (95%CI 562-701) vs. 540 (95%CI 514-585 mg/dL; p=0.02], and C reactive protein [3 (95%CI 2-4) vs. 2 (95%CI 2-3); p=0.03], had lower hemoglobin [13.7 (95%CI 13.4-14) vs. 14.1 (95%CI 13.9-14.4) g/dL); p=0.008], and higher proteinuria [4.2 (95%CI 3.1-5.2) vs. 2.4 (95%CI 2.1-2.8) g/g creatinine; p=0.002]. However, the kidney function between the two groups was similar (56.5 vs. 55 ml/min MDRD; p=0.1). Secondary GP were more frequent encountered in high RDW group (42.4% vs. 18.1%; p&lt;0.001), especially amyloidosis (19.2% vs. 4.7%; p&lt;0.001) and lupus nephritis (9.6% vs. 3.5%; p=0.01). During the follow-up period, in high RDW group 26.4% of the subjects died, compared to 11.4% from the other group (p&lt;0.001). In a multivariate logistic regression model, RDW was an independent predictor for mortality [OR 1.5 (95%CI 1.2-15); p=0.007]. Other independent predictors were older age [OR 1.06 (95%CI 1.03-1.08); p&lt;0.001], presence of cerebrovascular disease [OR 3.31 (95%C I1.01-10.8); p=0.04], lower serum albumin [OR 0.48 (95%CI 0.43-0.70), p&lt;0.001] and higher serum creatinine [OR 1.29 (95%CI 1.06-1.57); p&lt;0.001]. There was no difference regarding the frequency of RRT initiation between groups (18% in high RDW group vs. 11% in low RDW group; p=0.07) and the time to kidney death was similar [79.7 (95%CI 72.8-86.6) vs. 87.8 (95%CI 84-91.6) months; log rank p=0.1]. Conclusion In non-anemic subjects with biopsy-proven glomerular disease, a higher RDW seems associated with a higher risk of mortality, but not with kidney survival. In addition, RDW above 15% might point out to a secondary GP, like amyloidosis and lupus nephritis.

scholarly journals Predicting relapse in ANCA-associated vasculitis: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Catherine King ◽  
Katie L Druce ◽  
Peter Nightingale ◽  
Ellen Kay ◽  
Neil Basu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Significant Risk ◽  
Term Treatment ◽  
Individual Risk ◽  
Relapse Risk ◽  
Anca Associated Vasculitis ◽  
Increased Risk ◽  
Long Term Treatment

Abstract Objectives Relapses affect 30-50% of patients with anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV) over 5 years, necessitating long term treatment. Whilst there have been studies looking at predictors of relapse in AAV, this research has yet to translate clinically into guidance on tailored therapy. The aim of this systematic review was to identify and meta-analyse existing risk factors from the literature and produce a model to calculate individualised patient relapse risk. Method A search strategy was developed to include all studies identifying predictors of AAV relapse using multivariate analysis. Individual risk factors were extracted, and pooled hazard ratios (HRs) calculated. A model to predict time to first relapse based on identified risk factors was retrospectively tested using a cohort of patients with AAV. Results The review of 2,674 abstracts identified 117 papers for full text review, with 16 eligible for inclusion. Pooled HRs were calculated from significant risk factors including PR3 ANCA positivity HR 1.69 (1.46-1.94), cardiovascular involvement HR 1.78 (1.26-2.53), creatinine &gt;200µmol/l (relative to creatinine ≤100) HR 0.39 (0.22-0.69) and creatinine 101-200µmol/l HR 0.81 (0.77-0.85). Using data from 182 AAV patients to validate the model gave a C-statistic of 0.61. Conclusion PR3 ANCA positivity, lower serum creatinine and cardiovascular system involvement are all associated with an increased risk of relapse and a combination of these risk factors can be used to predict an individual’s relapse risk. In order to produce a clinically useful model to stratify risk, we need to identify more risk factors with a focus towards robust biomarkers.

scholarly journals Treatment of mineral-bone disorders in chronic kidney disease

2020 ◽  
Vol 29 (4) ◽  
pp. 85-90
Author(s):  
I.T. Murkamilov ◽  
K.A. Aitbaev ◽  
V.V. Fomin ◽  
Zh.A. Murkamilova ◽  
F.A. Yusupov
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Fibroblast Growth Factor 23 ◽  
Ectopic Calcification ◽  
Serum Parathyroid Hormone ◽  
Adynamic Bone Disease ◽  
Bone Disorders ◽  
Increased Risk ◽  
Adynamic Bone

Mineral-bone disorders (MBD) in chronic kidney disease (CKD) manifest by hyperphosphatemia, vitamin D deficiency, overproduction of fibroblast growth factor-23, and secondary hyperparathyroidism. CKD-MBD also results in bone resorp-tion and ectopic calcification that is associated with an increased risk of cardiovascular events and mortality. Diet is the initial and obligatory approach to treatment for CKD-MBD. Sevelamer is frequently used for correction of hyperphosphatemia in patients with renal failure who present with calcification of arteries, adynamic bone disease and/or stably low serum parathyroid hormone levels. Calcimimetics, that is, cinacalcet and evocalcet, are widely used in hemodialysis patients who do not respond to treatment with vitamin D.

scholarly journals Vitamin D deficiency: a global perspective

2006 ◽  
Vol 50 (4) ◽  
pp. 640-646 ◽  
Author(s):  
Francisco Bandeira ◽  
Luiz Griz ◽  
Patricia Dreyer ◽  
Catia Eufrazino ◽  
Cristina Bandeira ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D3 ◽  
Skin Pigmentation ◽  
Hypovitaminosis D ◽  
Good Health ◽  
Time Of Day ◽  
Ultraviolet B ◽  
Global Perspective ◽  
Increased Risk

Vitamin D is essential for the maintenance of good health. Its sources can be skin production and diet intake. Most humans depend on sunlight exposure (UVB 290315 nm) to satisfy their requirements for vitamin D. Solar ultraviolet B photons are absorbed by the skin, leading to transformation of 7-dehydrocholesterol into vitamin D3 (cholecalciferol). Season, latitude, time of day, skin pigmentation, aging, sunscreen use, all influence the cutaneous production of vitamin D3. Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risk for other morbidities such as cardiovascular disease, type 1 and type 2 diabetes mellitus and cancer, especially of the colon and prostate. The prevalence of hypovitaminosis D is considerable even in low latitudes and should be taken into account in the evaluation of postmenopausal and male osteoporosis. Although severe vitamin D deficiency leading to rickets or osteomalacia is rare in Brazil, there is accumulating evidence of the frequent occurrence of subclinical vitamin D deficiency, especially in elderly people.

Vitamin D: a potential role in reducing suicide risk?

2011 ◽  
Vol 23 (3) ◽  
Author(s):  
Muhammad M. Tariq ◽  
Elizabeth A. Streeten ◽  
Helen A. Smith ◽  
Aamar Sleemi ◽  
Baharak Khabazghazvini ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Potential Role ◽  
Suicide Attempts ◽  
Ultraviolet B ◽  
Hydroxyvitamin D ◽  
Increased Risk ◽  
25 Hydroxyvitamin D ◽  
Low Levels ◽  
Time Of Year

Abstract Suicide attempts are known to peak in the spring, overlapping with the time of year when 25-hydroxyvitamin D [25(OH)D] levels are at their nadir in the northern hemisphere because of negligible skin production of vitamin D owing to low levels of ultraviolet B radiation. Low levels of 25(OH)D, the vitamin D metabolite used to diagnose vitamin D deficiency, have been associated with certain pro-suicidal factors such as exacerbation of depression, anxiety, psychosis, and certain medical conditions. Therefore, we hypothesize that vitamin D deficiency could also be associated with increased risk of completed suicides. Here, we briefly review the literature on vitamin D, its deficiency, and its reported association with certain risk factors for suicide.

No effect of vitamin D supplementation on metabolic parameters but on lipids in patients with type 2 diabetes and chronic kidney disease

2020 ◽  
pp. 1-10
Author(s):  
Jiwoon Kim ◽  
Ji Sun Nam ◽  
Heejung Kim ◽  
Hye Sun Lee ◽  
Jung Eun Lee
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Vitamin D Supplementation ◽  
Lipid Profiles ◽  
Metabolic Parameters ◽  
Injection Group ◽  
Different Doses

Abstract. Background/Aims: Trials on the effects of cholecalciferol supplementation in type 2 diabetes with chronic kidney disease patients were underexplored. Therefore, the aim of this study was to investigate the effects of two different doses of vitamin D supplementation on serum 25-hydroxyvitamin D [25(OH)D] concentrations and metabolic parameters in vitamin D-deficient Korean diabetes patients with chronic kidney disease. Methods: 92 patients completed this study: the placebo group (A, n = 33), the oral cholecalciferol 1,000 IU/day group (B, n = 34), or the single 200,000 IU injection group (C, n = 25, equivalent to 2,000 IU/day). 52% of the patients had less than 60 mL/min/1.73m2 of glomerular filtration rates. Laboratory test and pulse wave velocity were performed before and after supplementation. Results: After 12 weeks, serum 25(OH)D concentrations of the patients who received vitamin D supplementation were significantly increased (A, -2.4 ± 1.2 ng/mL vs. B, 10.7 ± 1.2 ng/mL vs. C, 14.6 ± 1.7 ng/mL; p < 0.001). In addition, the lipid profiles in the vitamin D injection group (C) showed a significant decrease in triglyceride and a rise in HDL cholesterol. However, the other parameters showed no differences. Conclusions: Our data indicated that two different doses and routes of vitamin D administration significantly and safely increased serum 25(OH)D concentrations in vitamin D-deficient diabetes patients with comorbid chronic kidney disease. In the group that received the higher vitamin D dose, the lipid profiles showed significant improvement, but there were no beneficial effects on other metabolic parameters.

Sign in / Sign up

Export Citation Format

Share Document