Status of Vitamin D among People Visiting a Tertiary Care Center of Eastern Nepal: A Hospital-Based Study

Background: Vitamin D deficiency is a serious health-problem worldwide and the estimation of its plasma concentration is crucial. The study aims to determine the circulating levels of vitamin D in patients visiting Birat Medical College Teaching Hospital, one of the tertiary care centers of Eastern Nepal. Materials and Methods: It was descriptive cross-sectional study conducted in the Department of Biochemistry at Birat Medical College Teaching Hospital, Nepal. From the hospital registry, clinical data of 250 patients including their age, gender and serum 25-hydroxy vitamin D was retrieved for the four months of May – August, 2021. The vitamin D status was classified as deficiency (<10 ng/mL), insufficiency (10–30ng/mL), sufficiency ≥ 30ng/mL) and toxicity (≥ 100 ng/mL). Results: Out of total subjects (n=250), none of them showed toxic serum concentrations of vitamin D, 38% had sufficient, 57% had insufficient and 5% had deficient levels of this vitamin. Among affected individuals, vitamin D insufficiency had predominated in 41% population who were 41-60 years old. Gender-wise comparison of vitamin D status in the insufficiency group showed around 33% males and 67% females having insufficient levels of this vitamin. Conclusion: With the vitmain D inssufficieny present in more than half of the study population, it becomes paramount to further scrutinize the associated factors apart from the age and gender. To this end, further studies are needed.

A systematic review of vitamin D status and dietary intake in various Slovenian populations

Aim Vitamin D (VitD) is involved in calcium and phosphate homeostasis, bone health, and normal functioning of the immune system. VitD status is monitored using serum 25-hydroxy-vitamin D (25(OH)D) as a biomarker. Serum 25(OH)D concentrations below 30 nmol/L indicate VitD deficiency and below 50 nmol/L indicate insufficiency. VitD can be synthesised endogenously in human skin when exposed to ultraviolet B (UVB) radiation. In the absence of sufficient UVB-light exposure, VitD intake becomes the main source of VitD, with a recommended daily intake of 20 μg. The aim of this study was to conduct a review and meta-analysis on the abovementioned topics, focusing on scientific studies in various Slovenian populations. Methods We conducted a systematic review and meta-analysis of published scientific papers, academic theses, or conference contributions reporting serum 25(OH)D status and VitD intake across various Slovenian populations. A search was carried out using Web of Science, Scopus, Medline, and the Slovenian library database. Results We identified 43 pertinent studies that addressed 25(OH)D status and 16 that addressed VitD intake. Serum 25(OH)D status was generally low across all populations, and notable seasonal variability was observed. VitD intakes were below 5 μg in all studies. Conclusions A general observation is that various population groups across Slovenia are at high risk of vitamin D insufficiency and deficiency, particularly during wintertime. Regarding vitamin D intake, all included studies reported daily intakes below the recommended level. We also identified key research gaps that need to be addressed to support further public health decision-making.

Vitamin D Deficiency is Associated With Elevated Blood Concentrations of Ethylene Oxide

Ethylene oxide has been associated with increased oxidative stress and related disorders in recent studies, while vitamin D is a widely recognized antioxidant. Whether vitamin D deficiency is related to elevated blood concentrations of ethylene oxide is still unknown. We aimed to explore the relationship between vitamin D deficiency and blood concentrations of ethylene oxide in the general population. A total of 4125 adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2013–2016 were analyzed. Participants were divided into 3 groups: vitamin D sufficiency (≥75.0 nmol/L), insufficiency (50–74.9 nmol/L), and deficiency (<50.0 nmol/L). Adjusted linear and restricted cubic spline regression models were performed to evaluate the associations between vitamin D levels and blood concentrations of ethylene oxide. Compared with participants with vitamin D sufficiency, the adjusted mean ethylene oxide level was approximately 0.08 and 0.23 log2-units higher in the presence of vitamin D insufficiency and vitamin D deficiency (P for trend <0.001). The adjusted percent difference with a 95% confidence interval in ethylene oxide per interquartile range increase in vitamin D was -1.13 (-1.68, -0.57). A restricted cubic spline model demonstrated that vitamin D levels are nonlinearly and inversely associated with blood concentrations of ethylene oxide (P for nonlinearity =0.021). Further research is warranted to understand how vitamin D may have a role in reducing blood concentrations of ethylene oxide.

Vitamin D Insufficiency Predicts Susceptibility of Parathyroid Hormone Reduction after Total Thyroidectomy in Thyroid Cancer Patients

Objective. Given its role in the regulation of calcium and PTH levels, vitamin D was presumed as a potential predictor of postoperative hypoparathyroidism. However, the reports about their association were controversial. This study aims to reveal the relationship between preoperative vitamin D and postoperative parathyroid hormone (PTH). Methods. A total of 242 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy (TT) during the period from June 2016 to December 2017 at our hospital were enrolled. Patients were divided into two groups, HypoP and Non-HypoP groups, based on postoperative PTH < 15.0 or ≥15.0 pg/mL, and ΔPTH50+ and ΔPTH50− groups, based on postoperative PTH reduction ratio ≥ 50% or <50%. Clinicopathological features and laboratory data were compared between two sets of groups. Results. Preoperative PTH level was lower in the HypoP group than in the Non-HypoP group (42.83 vs. 47.52 pg/mL, p = 0.018 ). No significant difference of vitamin D insufficiency was found between the HypoP and Non-HypoP groups (80.8% vs. 74.1%, p = 0.226 ). The rate of vitamin D insufficiency was higher in the ΔPTH50+ group than in the ΔPTH50− group (82.6% vs. 68.4%, p = 0.010 ). By multivariate logistic regression analysis, vitamin D insufficiency was an independent predictor of postoperative PTH reduction ratio ≥ 50% (OR = 2.2, p = 0.017 ). Conclusion. Vitamin D insufficiency is not associated with postoperative PTH in PTC patients undergoing TT. However, vitamin D insufficiency is an independent predictor of postoperative PTH reduction ratio.

Bile Acid Malabsorption as a Consequence of Cancer Treatment: Prevalence and Management in the National Leading Centre

The aim was to establish prevalence of bile acid malabsorption (BAM) and management in patients who underwent treatment for malignancy. Retrospective evaluation of data in patients seen within six months (August 2019–January 2020) was carried out. Demographic, nuclear medicine (Selenium Homocholic Acid Taurine (SeHCAT) scan result), clinical (previous malignancy, type of intervention (medication, diet), response to intervention) and laboratory (vitamin D, vitamin B12 serum levels) data were searched. In total, 265 consecutive patients were reviewed. Out of those, 87/265 (33%) patients (57 females, 66%) were diagnosed with BAM. Mean age was 59 +/− 12 years. The largest group were females with gynaecological cancer (35), followed by haematology group (15), colorectal/anal (13), prostate (9), upper gastrointestinal cancer (6), another previous malignancy (9). Severe BAM was most common in haematology (10/15; 67%) and gynaecological group (21/35; 60%). Medication and low-fat diet were commenced in 65/87 (75%), medication in 10/87 (11%), diet in 6/87 (7%). Colesevelam was used in 71/75 (95%). Symptoms improved in 74/87 (85%) patients. Vitamin D insufficiency/deficiency was diagnosed in 62/87 (71%), vitamin B12 deficiency in 39/87 (45%). BAM is a common condition in this cohort however treatments are highly effective.

Vitamin D Status in Pediatric and Young Adult Cystic Fibrosis Patients. Are the New Recommendations Effective?

Introduction: In recent years, guidelines for vitamin D supplementation have been updated and prophylactic recommended doses have been increased in patients with cystic fibrosis (CF). Objective: To evaluate safety and efficacy of these new recommendations. Results: Two cohorts of pancreatic insufficient CF patients were compared before (cohort 1: 179 patients) and after (cohort 2: 71 patients) American CF Foundation and European CF Society recommendations were published. Cohort 2 patients received higher Vitamin D doses: 1509 (1306–1711 95% CI) vs 1084 (983–1184 95% CI) IU/Day (p < 0.001), had higher 25 OH vitamin D levels: 30.6 (27.9–33.26 95% CI) vs. 27.4 (25.9–28.8 95% CI) ng/mL (p = 0.028), and had a lower prevalence of insufficient vitamin D levels (<30 ng/mL): 48% vs 65% (p = 0.011). Adjusted by confounding factors, patients in cohort 1 had a higher risk of vitamin D insufficiency: OR 2.23 (1.09–4.57 95% CI) (p = 0.028). Conclusion: After the implementation of new guidelines, CF patients received higher doses of vitamin D and a risk of vitamin D insufficiency decreased. Despite this, almost a third of CF patients still do not reach sufficient serum calcidiol levels.

Vitamin D supplementation in chronic spinal cord injury (VitD-SCI): study protocol for a randomised controlled trial

IntroductionVitamin D insufficiency, a vitamin D status or serum 25(OH)D concentration of ≤75 nmol/L, is highly prevalent in individuals with a spinal cord injury (SCI). Vitamin D is important for the functioning of the musculoskeletal, immune and respiratory systems, which are relevant determinants of secondary health conditions in SCI. An insufficiency should be treated with vitamin D supplementation. However, there is a lack of evidence regarding the optimal dosage and duration of vitamin D supplementation for individualised and long-term management of the vitamin D status in the context of SCI. This paper presents the protocol for the vitamin D supplementation in chronic spinal cord injury (VitD-SCI) trial that aims to investigate the effect of a 12-month intake of vitamin D supplementation on vitamin D status as well as on several secondary parameters among individuals with a chronic SCI.Methods and analysesThe VitD-SCI trial is a randomised, placebo-controlled, double-blinded, parallel-group, superiority trial, conducted at the Swiss Paraplegic Centre. A total of 45 participants living with an SCI for at least 3 years (chronic SCI) and a vitamin D insufficiency at the first study visit, will be randomly assigned to one of three intervention groups. Participants receive either a monthly dosage of 24 000 IU or 48 000 IU vitamin D or a placebo for 12 months. Measurements taking place every 3 months include the assessment of vitamin D status (primary outcome) as well as bone mineral density, handgrip strength, fatigue, mood, pain and pressure injuries (secondary outcomes). Safety and tolerance of vitamin D supplementation will also be evaluated.Ethics and disseminationThe Swiss Ethics Committee for Northwest/Central Switzerland (EKNZ, 2020–01493) and the Swiss Agency for Therapeutic Products (Swissmedic, 2020DR3150) approved this study. Findings will be disseminated through peer-reviewed publications.Trial registration numbersNCT04652544 and SNCTP000004032.

Vitamin D Deficiency and Adverse Results in COVID-19

Aim: The goal of this study is to find out how common vitamin D deficiency is in patients with corona virus disease and what the consequences are. Study Design: Observational /Prospective Place and Duration: Institute of Basic medical sciences, Khyber Medical University (KMU), Jan 2021-Oct 2021. Materials & Methods: This study included 120 patients of both genders who had been diagnosed with covid-19. Patients ranged in age from 15 to 75 years. After receiving written agreement, demographically detailed such as age, sex, and BMI were recorded. All of the patients had a 5 mL blood sample obtained to check their vitamin D levels. 25(OH)D < 25 nmol/L (10 ng/dL) was considered severe Vitamin D insufficiency. The prevalence of vitamin D insufficiency as well as negative effects were investigated. SPSS 23.0 was used to analyse the data. Results: The mean age of the 120 patients was 40.11±8.64 years, with 68 (56.7%) males and 52 (43.3%) females. There were 52 patients (43.3%) with severe vitamin D insufficiency. There were 17 deaths of the total number of patients in the study. Vitamin D deficiency was associated with a higher mortality rate in patients with covid-19 disease than in those who had normal levels of vitamin D, a finding that was statistically significant at the 0.05 level. Conclusion: It was found that severe deficiency of vitamin D and death in individuals with covid-19 illness had a strong association. Keywords: Mortality, Vitamin D Deficiency, Covid-19,

Vitamin D Insufficiency as Risk Factor of Severe Pneumonia in Children

Severe pneumonia is an infectious disease with high morbidity and mortality in children under five. Several risk factors of severe pneumonia have been established, one of them is vitamin D insufficiency. Risk factors for severe pneumonia can help clinicians to provide better quality of life. This research aimed to prove that vitamin D insufficiency is a risk factor for severe pneumonia in children. This analytical study with case-control design performed in children aged 2 months until 59 months old. Case consisted of 42 subjects who suffered severe pneumonia, while control consisted of 42 subjects who suffered pneumonia. Both groups fulfilled the eligibilities and matched proportionally based on age. The study was conducted from June 2019 to March 2021, level of 25(OH) D was checked in both groups. Data was analyzed by Chi-square test and logistic regression with significant level set at p<0, 05. Total eighty-four subjects with median age 11, 5 month were included in this study and most of them were male (59, 5%). The risk factors of severe pneumonia was vitamin D insufficiency with adjusted odds ratio 4.71 (CI95% 1.15-19.31, p=0.031) and exposure of cigarette smoke with adjusted odds ratio 5.19 (CI95% 1.76-15.31, p=0.003). There was no association of gender, mild malnutrition, non-exclusive breastfeeding and incomplete immunization in this study. Vitamin D insufficiency is a risk factor for severe pneumonia in children.