Low Vitamin D Levels Predict Mortality in Ankylosing Spondylitis Patients: A Nationwide Population-Based Cohort Study

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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Changes in vitamin D levels and depressive symptoms in later life in England

Scientific Reports ◽

10.1038/s41598-021-87432-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Giorgio Di Gessa ◽

Jane P. Biddulph ◽

Paola Zaninotto ◽

Cesar de Oliveira

Keyword(s):

Vitamin D ◽

Depressive Symptoms ◽

Later Life ◽

Vitamin D Supplementation ◽

Cross Sectional ◽

Logistic Regression Models ◽

Representative Study ◽

Increased Risk ◽

Vitamin D Levels

AbstractInadequate vitamin D levels have been associated with increased risk of depression. However, most of these studies are cross-sectional and failed to investigate the effect of changes in vitamin D levels. This study aimed to investigate the longitudinal association of changes in serum 25-hydroxyvitamin D levels with depressive symptoms in 3365 participants of the English Longitudinal Study of Ageing, a large nationally-representative study of older adults. Based on their vitamin D levels at baseline and follow-up (sufficient ≥ 50 nmol/L; insufficient < 50 nmol/L), participants were classified as follows: with sufficient levels at both waves; with sufficient levels at baseline but not at follow-up; with insufficient levels at baseline but ≥ 50 nmol/L at follow-up; and with levels < 50 nmol/L at each time point. Depressive symptoms were measured using the 8-point CES-D scale. Data were analysed using logistic regression models. Compared with those with sufficient levels of vitamin D at both waves, only those with insufficient levels throughout were more likely to report elevated depressive symptoms (OR = 1.39, 95% CI = 1.00–1.93). Becoming or no longer being vitamin D deficient was, in the short term, not associated with elevated depressive symptoms. Further evidence is required on whether vitamin D supplementation might contribute to the prevention or treatment of depression as well as on the duration of time for changes in vitamin D levels to lead to detectable changes in depressive symptoms.

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Vitamin D and Vascular Disease

Current Vascular Pharmacology ◽

10.2174/1570161118666200317151955 ◽

2020 ◽

Vol 19 (3) ◽

pp. 250-268 ◽

Cited By ~ 1

Author(s):

Ioanna Gouni-Berthold ◽

Heiner K. Berthold

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

Plasma Vitamin ◽

Cvd Risk ◽

Vitamin D Receptors ◽

Cell Proliferation And Differentiation ◽

Increased Risk ◽

Vitamin D Levels

: Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Vitamin D deficiency has been identified as a potential risk factor for a number of diseases unrelated to the classical skeletal pathophysiology, such as cancer and CVD, but the effects of vitamin D supplementation are less clear. Purpose of this narrative review is to discuss the evidence suggesting an association between vitamin D status and CVD as well as the results of supplementation studies. Vitamin D deficiency has been associated with CVD risk factors such as hypertension, dyslipidemia and diabetes mellitus as well as with cardiovascular events such as myocardial infarction, stroke and heart failure. While vitamin D deficiency might contribute to the development of CVD through its association with risk factors, direct effects of vitamin D on the cardiovascular system may also be involved. Vitamin D receptors are expressed in a variety of tissues, including cardiomyocytes, vascular smooth muscle cells and endothelial cells. Moreover, vitamin D has been shown to affect inflammation, cell proliferation and differentiation. While observational studies support an association between low plasma vitamin D levels and increased risk of CVD, Mendelian randomization studies do not support a causal association between the two. At present, high quality randomized trials do not find evidence of significant effects on CVD endpoints and do not support supplementation of vitamin D to decrease CVD events.

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Vitamin D and schizophrenia: 20 years on

Molecular Psychiatry ◽

10.1038/s41380-021-01025-0 ◽

2021 ◽

Author(s):

Xiaoying Cui ◽

John J. McGrath ◽

Thomas H. J. Burne ◽

Darryl W. Eyles

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

First Episode ◽

Gamma Aminobutyric Acid ◽

Behavioral Phenotypes ◽

Ongoing Research ◽

Increased Risk ◽

Vitamin D Levels

AbstractMany epidemiological studies have highlighted the link between vitamin D deficiency and schizophrenia. In particular, two prominent studies report an association between neonatal vitamin D deficiency and an increased risk of schizophrenia. In parallel, much has been learnt about the role of vitamin D in the developing central nervous system over the last two decades. Studies in rodent models of developmental vitamin D (DVD)-deficiency describe how brain development is altered leading to a range of neurobiological and behavioral phenotypes of interest to schizophrenia. While glutamate and gamma aminobutyric acid (GABA) systems have been little investigated in these models, alterations in developing dopamine systems are frequently reported. There have been far more studies reporting patients with schizophrenia have an increased risk of vitamin D deficiency compared to well controls. Here we have conducted a systematic review and meta-analysis that basically confirms this association and extends this to first-episode psychosis. However, patients with schizophrenia also have poorer general health, poorer diets, are frequently less active and also have an increased risk of other medical conditions, all factors which reduce circulating vitamin D levels. Therefore, we would urge caution in any causal interpretation of this association. We also summarize the inconsistent results from existing vitamin D supplementation trials in patients with schizophrenia. In respect to animal models of adult vitamin D deficiency, such exposures produce subtle neurochemical alterations and effects on cognition but do not appear to produce behavioral phenotypes of relevance to schizophrenia. We conclude, the hypothesis that vitamin D deficiency during early life may increase the risk of schizophrenia remains plausible and warrants ongoing research.

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Prevalence of vitamin D deficiency and effect of vitamin D supplementation on feto-maternal outcome in tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184939 ◽

2018 ◽

Vol 7 (12) ◽

pp. 4912

Author(s):

Munmun Yadav ◽

Mahendra Kumar Verma ◽

Mohan Bairwa ◽

Govardhan Meena ◽

Lata Rajoria

Keyword(s):

Vitamin D ◽

Pregnant Women ◽

Vitamin D Deficiency ◽

Tertiary Care ◽

Serum Vitamin ◽

Vitamin D Supplementation ◽

Serum Vitamin D ◽

Increased Risk ◽

Vitamin D Levels ◽

Risk Of Preeclampsia

Background: Vitamin D deficiency is widely prevalent throughout the world. Pregnant women, neonates and infants form most vulnerable groups for vitamin D deficiency. Hypovitaminosis D in pregnancy has been reported to cause various fetomaternal effect, i.e. increased risk of preeclampsia (PE), gestational diabetes mellitus (GDM), caesarean section, hypocalcemia, subclinical myopathy, neonatal tetany, hyperbilirubinemia congenital rickets and infantile rickets, etc. Only few Indian studies are available in this regard. The objectives are to find prevalence of vitamin D deficiency in pregnant women and to evaluate the effect of supplementation with cholecalciferol in improving vitamin D levels in pregnant women and evaluate its correlation with feto-maternal outcome.Methods: A prospective observational was conducted on 120 Pregnant women on their first visit to hospital irrespective of gestational age were offered the test and on the basis of inclusion and exclusion criteria are included in study and vitamin D level was done to know the prevalence of vitamin D deficiency. Apart from routine obstetrical investigation, serum vitamin D (total) level was estimated. All results were recorded and analyzed statically.Results: Out of 120 patients 101 (84.1%) were found to be vitamin D deficient. Mean age of vitamin D deficient group was 28.31±3.86 and sufficient group was 26.37±2.83.81 (67.5%) were vegetarian and 39 (32.5%) were nonvegetarian.75 (92.59%) vegetarian and 26 (66.66%) non-vegetarian found to be vitamin D deficient. (p<0.05). Vitamin D supplementation has been observed to reduce risk of preeclampsia. (p<0.05) and vitamin D sufficiency associated with reduced risk of low birth weight babies.Conclusions: Vitamin D supplementation reduces risk of maternal comorbidities and helps improve neonatal outcomes.

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Vitamin D Deficiency and Sarcopenia in Older Persons

Nutrients ◽

10.3390/nu11122861 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2861 ◽

Cited By ~ 21

Author(s):

Francesca Remelli ◽

Aurora Vitali ◽

Amedeo Zurlo ◽

Stefano Volpato

Keyword(s):

Skeletal Muscle ◽

Vitamin D ◽

Older People ◽

Vitamin D Deficiency ◽

Older Persons ◽

Randomized Clinical Trials ◽

Vitamin D Supplementation ◽

Geriatric Syndrome ◽

Increased Risk ◽

Vitamin D Levels

Vitamin D deficiency is a common health problem worldwide, in particular among older people. Vitamin D regulates and modulates the physiology and function of multiple human systems, including the skeletal muscle. The effect of vitamin D on the muscle has been widely investigated, suggesting that this hormone can stimulate the proliferation and differentiation of skeletal muscle fibers, maintaining and improving muscle strength and physical performance. Older persons have a higher prevalence of low Vitamin D levels as a consequence of low dietary intake and reduced ultraviolet irradiation of the skin. Therefore, older people with vitamin D deficiency might be at risk of sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength often complicated by adverse events, such as falls, disability hospitalization and death. Several randomized clinical trials have been conducted to investigate the effect of oral vitamin D supplementation in older patients to prevent or treat sarcopenia, but results are still controversial. In this narrative review we summarize the biological, clinical and epidemiological evidence supporting the hypothesis of a causal association between Vitamin D deficiency and an increased risk of sarcopenia in older people.

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667 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.283 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S178-S179

Author(s):

Sara Calder ◽

Asia N Quan ◽

Suzanne Osborn ◽

Virginia Nisbet ◽

Karen J Richey ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Total Body Surface Area ◽

Retrospective Chart Review ◽

Vitamin D Supplementation ◽

High Dose ◽

Burn Patients ◽

Burn Center ◽

Increased Risk ◽

Vitamin D Levels

Abstract Introduction The potential consequences of vitamin D insufficiency/deficiency (I/D) in critically ill patients include: increased ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen. Methods A retrospective chart review was performed on all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one 25-hydroxy vitamin D level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml. Results Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly negatively correlated with increasing % total body surface area (TBSA) burn size (p< 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days, requiring an average of 116,125 units cholecalciferol weekly. Time to reach therapeutic levels was also positively correlated with increasing burn size (p< 0.05). Many patients, however, were discharged prior to reaching therapeutic levels. Conclusions Vitamin D I/D is present in over 90% of burn center patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted. Applicability of Research to Practice This study documents common and severe vitamin D deficiency in burn patients, and difficulty in correcting this deficiency.

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Vitamin D Deficiency in Older Patients—Problems of Sarcopenia, Drug Interactions, Management in Deficiency

Nutrients ◽

10.3390/nu13041247 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1247

Author(s):

Małgorzata Kupisz-Urbańska ◽

Paweł Płudowski ◽

Ewa Marcinowska-Suchowierska

Keyword(s):

Vitamin D ◽

Plasma Concentration ◽

Vitamin D Deficiency ◽

Bone Fractures ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Adverse Outcomes ◽

Vitamin D Metabolism ◽

Increased Risk ◽

Vitamin D Levels

Vitamin D deficiency frequently occurs in older people, especially in individuals with comorbidity and polypharmacotherapy. In this group, low vitamin D plasma concentration is related to osteoporosis, osteomalacia, sarcopenia and myalgia. Vitamin D levels in humans is an effect of the joint interaction of all vitamin D metabolic pathways. Therefore, all factors interfering with individual metabolic stages may affect 25-hydroxyvitamin D plasma concentration. The known factors affecting vitamin D metabolism interfere with cytochrome CYP3A4 activity. There is another group of factors that impairs intestinal vitamin D absorption. The phenomenon of drugs and vitamin D interactions is observed first and foremost in patients with comorbidity. This is a typical situation, where the absence of “hard evidence” is not synonymous with the possible lack of adverse effects. Osteoporosis and sarcopenia (generalized and progressive decrease of skeletal muscle mass and strength) are some of the musculoskeletal consequences of hypovitaminosis D. These consequences are related to an increased risk of adverse outcomes, including bone fractures, physical disabilities, and a lower quality of life. This can lead not only to an increased risk of falls and fractures but is also one of the main causes of frailty syndrome in the aging population. Generally, Vitamin D plasma concentration is significantly lower in subjects with osteoporosis and muscle deterioration. In some observational and uncontrolled treatment studies, vitamin D supplementation resulted in a reduction of proximal myopathy and muscle pain. The most conclusive results were found in subjects with severe vitamin D deficiency and in patients avoiding large doses of vitamin D. However, the role of vitamin D in muscle pathologies is not clear and research has provided conflicting results. This is plausibly due to the heterogeneity of the subjects, vitamin D doses and environmental factors. This report presents data on some problems with vitamin D deficiency in the elderly population and the management of vitamin D deficiency D in successful or unsuccessful aging.

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Implications of Vitamin D Research in Chickens can Advance Human Nutrition and Perspectives for the Future

Current Developments in Nutrition ◽

10.1093/cdn/nzab018 ◽

2021 ◽

Author(s):

Matthew F Warren ◽

Kimberly A Livingston

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

The Body ◽

Human Nutrition ◽

Vitamin D Metabolites ◽

Vitamin D Metabolism ◽

Related Research ◽

Vitamin D Intake ◽

Increased Risk

Abstract The risk of vitamin D insufficiency in humans is a global problem that requires improving ways to increase vitamin D intake. Supplements are a primary means for increasing vitamin D intake, but without a clear consensus on what constitutes vitamin D sufficiency, there is toxicity risk with taking supplements. Chickens have been used in many vitamin D-related research studies, especially studies involving vitamin D supplementation. Our state-of-the-art review evaluates vitamin D metabolism and how the different hydroxylated forms are synthesized. We provide an overview with how vitamin D is absorbed, transported, excreted, and what tissues in the body store vitamin D metabolites. We also discuss a number of studies involving vitamin D supplementation with broilers and laying hens. Vitamin D deficiency and toxicity are also described and how they can be caused. The vitamin D receptor (VDR) is important for vitamin D metabolism. However, there is much more that can be understood with VDR in chickens. Potential research aims involving vitamin D and chickens should explore VDR mechanisms which could lead to newer insights with VDR. Utilizing chickens in future research to help with elucidating vitamin D mechanisms has great potential to advance human nutrition. Finding ways to increase vitamin D intake will be necessary because the coronavirus 2019 disease (COVID-19) pandemic is leading to increased risk of vitamin D deficiency in many populations. Chickens can provide a dual purpose with addressing pandemic-caused vitamin D deficiency: 1) vitamin D supplementation gives chickens added value with possibly leading to vitamin D-enriched meat and egg products; and 2) chickens’ use in research provides data for translational research. Expanding vitamin D-related research in chickens to include more nutritional aims in vitamin D status has great implications with developing better strategies to improve human health.

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Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-16-0576 ◽

2017 ◽

Vol 176 (1) ◽

pp. 1-9 ◽

Cited By ~ 19

Author(s):

Olaf M Dekkers ◽

Erzsébet Horváth-Puhó ◽

Suzanne C Cannegieter ◽

Jan P Vandenbroucke ◽

Henrik Toft Sørensen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Cardiovascular Events ◽

Population Based ◽

Arterial Embolism ◽

Registration System ◽

Increased Risk ◽

All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

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To Supplement or not to Supplement? The Rationale of Vitamin D Supplementation in Systemic Lupus Erythematosus

The Open Rheumatology Journal ◽

10.2174/1874312901812010226 ◽

2018 ◽

Vol 12 (1) ◽

pp. 226-247 ◽

Cited By ~ 1

Author(s):

Alessandra Nerviani ◽

Daniele Mauro ◽

Michele Gilio ◽

Rosa Daniela Grembiale ◽

Myles J. Lewis

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Vitamin D Supplementation ◽

Current Evidence ◽

Systemic Lupus ◽

Vitamin D Receptors ◽

Vitamin D Levels

Background: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterised by abnormal activation of the immune system, chronic inflammation and organ damage. Lupus patients are more prone to be vitamin D deficient. However, current evidence is not conclusive with regards to the role played by vitamin D in SLE development, progression, and clinical manifestations. Objective: Here, we will summarise the current knowledge about vitamin D deficiency prevalence, risk factors, molecular effects, and potential pathogenic role in SLE. We will focus on the link between vitamin D deficiency and lupus clinical manifestations, and on the clinical trials assessing the effects of vitamin D supplementation in SLE. Method: A detailed literature search was performed exploiting the available databases, using “vitamin D and lupus/SLE” as keywords. The relevant interventional trials published over the last decade have been considered and the results are reported here. Conclusion: Several immune cells express vitamin D receptors. Thus, an immunomodulatory role for vitamin D in lupus is plausible. Numerous observational studies have investigated the relationship between vitamin D levels and clinical/serological manifestations of SLE with contrasting results. Negative correlations between vitamin D levels and disease activity, fatigue, renal and cardiovascular disease, and anti-dsDNA titres have been described but not conclusively accepted. In experimental models of lupus, vitamin D supplementation can improve the disease. Interventional trials have assessed the potential therapeutic value of vitamin D in SLE, but further larger studies are needed.

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