The Association of Vitamin D3 With Early Anastomotic Leakage in Patients Undergoing Hemicolectomy Surgery

Background Anastomotic leak (AL) is one of the most important postoperative complications after hemicolectomy with stapled anastomosis. This study aimed to evaluate the association of preoperative vitamin D3 with early anastomotic leakage after right colon cancer surgery with stapled anastomosis. Method In this prospective cohort study, 535 patients who underwent right colon cancer surgery (right hemicolectomy) with stapled anastomosis were enrolled. A subset of 315 patients was included in the study after meeting the inclusion criteria. Preoperative vitamin D level was measured and analyzed for association with early AL using univariable and multivariable logistic regression analyses. Result This study included 315 cases; among them, 18 (5.71%) patients developed early AL. Vitamin D3 was significantly higher among patients without early AL ( P < .001). Low vitamin D3 status was reported among 111 patients (35.2%) and 204 (64.8%) of patients did not have low vitamin D3 status (sufficient level = 30-100 ng/mL). Sufficient vitamin D3 levels before right colon cancer surgery with stapled anastomosis was associated inversely with early AL (crude OR = .89, 95% CI = .85-.94, P < .001 and adjusted OR = .89, 95% CI = .82-.98, P = .02). Conclusion The vitamin D3 level has a protective association with early AL. As a result, low vitamin D3 status may be a risk factor for early AL development, suggesting that it can be one of the predictors of early AL occurrence.

Vitamin D Supplementation is Associated with Slower Epigenetic Aging

Adverse effects of low vitamin D level on mortality and morbidity are controversially discussed. Especially older people are at risk for vitamin D deficiency and therefore exposed to its potentially harmful influence on the aging process. A way of measuring differences in the biological age is through DNA methylation age (DNAm age) and its deviation from chronological age, DNAm age acceleration (DNAmAA). We previously reported on an association between vitamin D deficiency and higher 7-CpG DNAmAA in participants of the Berlin Aging Study II (BASE-II).In this study, we employ a quasi-interventional study design to assess the relationship between DNAmAA of five epigenetic clocks and vitamin D supplementation. Longitudinal data were available for 1,036 participants of BASE-II that were reexamined on average 7.4 years later in the GendAge study (mean age at follow-up: 75.6 years, SD = 3.8 years, age range: 64.9 – 94.1 years, 51.9 % female). DNAmAA was estimated with the 7-CpG clock, Horvath’s clock, Hannum’s clock, PhenoAge and GrimAge. Methylation data were obtained through methylation-sensitive single nucleotide primer extension (MS-SNuPE) or Illumina’s Infinium “MethylationEPIC” array.Vitamin D deficient participants who chose to start vitamin D supplementation after baseline examination showed a 2.6 year lower 7-CpG DNAmAA (p=0.011) and 1.3-year lower Horvath DNAmAA (p=0.042) compared to untreated and vitamin D deficient participants. DNAmAA did not statistically differ between participants with successfully treated vitamin D deficiency and healthy controls (p>0.16).Therefore, we conclude that intake of vitamin D supplement is associated with lower DNAmAA in participants with vitamin D deficiency. Additionally, our findings suggest that sufficient vitamin D supplementation can compensate and potentially reverse the increase in 7-CpG DNAmAA that we found in in vitamin D deficient participants.

Femoral Cartilage Thickness in Patients with Systemic Sclerosis and Its Relation to Vitamin D

Background Systemic sclerosis (SSc) is a connective tissue disease characterized by different degrees of skin fibrosis and visceral organ involvement. The etiology of SSc remains obscure; the disease appears to be the result of a multistep and multifactorial process, including immune system alterations, under the influence of genetic and exogenous factors. The aim of this work is to study levels of vitamin D in relation to the femoral cartilage thickness (FCT) in patients with SSc and to analyze the associations between the (FCT), vitamin D levels, SSc- disease severity score. Patients and methods This is a cross sectional study which included 40 adult systemic sclerosis patients diagnosed according to ACR/EULAR (2013) classification criteria of systemic sclerosis. Patients were categorized into two groups according to vitamin D sufficiency; Group I: n = 14, sufficient vitamin D (level ≥ 30 ng/ml), Group II: n = 26, insufficient vitamin D (level &lt; 30 ng/ml). Serum levels of 25-hydroxyvitamin D (25[OH] D) were assessed by (ELISA). The thickness of femoral articular cartilage was measured by muscloskeletal ultrasound. Three measurements were taken from each knee: lateral femoral condyle (LFC), femoral intercondylar area (ICA) and medial femoral condyle (MFC). Results The majority of patients (60%) had thin femoral cartilage of knee joint, we found that (35%) of patients had sufficient vitamin D level while (65%) of patients had insufficient vitamin D level. We compared the insufficient vitamin D level group with sufficient vitamin D level group according to femoral cartilage thickness, and concluded that vitamin D level related to femoral cartilage thickness at left medial condylar area and left lateral condyle, meanwhile we found no relation between disease severity and cartilage thickness or vitamin D level. There was significant relation between vitamin D sufficiency and sex of studied patients more in females, also showed significant inverse correlation between parity in females and femoral cartilage thickness at Rt intercondylar area and Rt medial condyle. There was highly significant statistical relation between disease severity grades and proximal muscle weakness among studied patients. Conclusion Vitamin D level has significant relation with femoral cartilage thickness in SSc patients in two of six of measured cartilage areas and proximal muscle weakness was associated with vitamin D insufficiency and disease severity.

To Compare Serum Vitamin D Levels with Severity of Liver Cirrhosis According to Child-Pugh Score in Amritsar, Punjab

BACKGROUND Cirrhosis of liver and its extrahepatic manifestations like hepatic osteodystrophy has been linked to vitamin D deficiency, and has been proposed as a potential therapeutic target. Its metabolism to 25-hydroxylation, makes liver necessary for its activation. In this study sources of vitamin D, functions and its metabolism with a focus on its variation with severity of liver cirrhosis is discussed. METHODS This is an observational study conducted on 60 patients with liver cirrhosis. The severity of liver cirrhosis was assessed according to the Modified CPS. By technique of enhanced chemiluminscence values of vitamin D were obtained. The results were statistically analyzed using SPSS Statistics-20.0 version. Association among different variables were calculated using Chi-Square Test and One Way ANOVA. Results were considered significant if p value obtained was below 0.05 and highly significant if it was below 0.001. RESULTS Mean age group of study population was 54.83 ± 13.56 years. 27 patients had Alcoholic cirrhosis, 11 patients were HCV positive, 2 patients were HBsAg positive and 20 patients had cirrhosis due to other etiologies. Mean vitamin D level of the study population was 35.34 ± 22.4. 27 patients (45 %) had sufficient vitamin D, 18 patients (30 %) were deficient and 14 patients had insufficient vitamin D levels. 1 patient had vitamin D toxicity. There was no significant correlation between mean vitamin D and etiology of liver cirrhosis (P value = 0.457; Not Significant). There was significant correlation between vitamin D levels with severity of liver disease (p value < 0.001). CONCLUSIONS In conclusion, low concentrations of 25 (OH) D are correlated with severity of liver dysfunction irrespective of the etiology. KEYWORDS Child-Pugh Score, Liver cirrhosis, Serum Vitamin D

Vitamin D and Dentistry

Vitamin D deficiency is a pandemic issue due to decreased vitamin D intake from food and lessened sunlight exposure. Attention is drawn to vitamin D and its role learned in notable clinical disorders such as diabetes, cardiovascular disease and cancers including oral ones. Vitamin D is also very effective along with minerals in the protection of oral health. Vitamin D helps maintain the calcium-phosphate balance and contributes to the shaping of the bone. It is reported that with sufficient vitamin D level, the onset and progression of caries in the tooth structure can be stopped, the formation of caries can be reduced and enamel loss can be prevented. Vitamin D also affects the disease and health conditions of the periodontium. Anti-inflammatory and immunomodulatory functions have a role in the pathogenesis of periodontal disorders. It can reduce bone resorption and suppress the inflammatory outcome related to periodontal diseases by increasing mineral density. Vitamin D has been linked with tooth decay, gingivitis, and tooth loss. Vitamin D, in particular, as a promising oral health-protective agent, is said to lessen the incidence of caries and periodontitis.

Association between serum 25-hydroxyvitamin D concentrations and mortality among adults with prediabetes

Objectives To investigate the association of circulating 25-hydroxyvitamin D [25(OH)D] levels with mortality among adults with prediabetes. Methods This retrospective cohort study included 15195 adults with prediabetes (aged ≥20 years) from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 2001-2014. Mortality from all causes, cardiovascular disease (CVD), and cancer was linked to National Death Index mortality data. Results The median (interquartile range) concentration of serum 25(OH)D was 60.5 (45.3, 77.4) nmol/L, and only 23.1% had sufficient vitamin D (≥75 nmol/L). Elevated serum 25(OH)D concentrations were significantly associated with lower levels of insulin, HOMA-IR, triglyceride, and C-reactive protein, and higher levels of high-density lipoprotein at baseline (all Ptrend&lt;0.05). During a median follow up of 10.7 years, 3765 deaths (including 1080 CVD deaths and 863 cancer deaths) were identified. Compared with participants with 25(OH)D &lt;30 nmol/L, the multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for participants with 25(OH)D ≥75 nmol/L were 0.66 (0.53, 0.82) for all-cause mortality (Ptrend&lt;0.001), 0.66 (0.48, 0.89) for CVD mortality (Ptrend=0.001), and 0.82 (0.49, 1.35) for cancer mortality (Ptrend=0.32). For per unit increment in ln-transformed 25(OH)D, there was a 27% lower risk of all-cause mortality and a 34% lower risk of CVD mortality (both P&lt;0.01). Conclusions These findings suggested that higher serum 25(OH)D concentrations were associated with lower all-cause and CVD mortality among individuals with prediabetes.

A retrospective observational study of vitamin D levels in patients within the Tameside and Glossop early intervention in psychosis team

AimsGrowing evidence indicates that Vitamin D deficiency is associated with psychotic symptoms. Although evidence suggesting a causal relationship is limited, theories regarding neuro-inflammatory modulation are promising. Alternatively, deficiency may signify chronic illness or poor functioning. Nevertheless, Vitamin D levels below 50nmol/L increase the risk of osteoporosis, muscle weakness, falls and fractures, thus identification and treatment are important.The association between Vitamin D levels in patients within the Tameside Early Intervention in Psychosis Team (EIT) was studied, hypothesising a strong correlation.MethodThe records of all patients in the EIT as of 01/07/2020, over the age of 16 years old (n = 183), were studied. The first Vitamin D level taken while under the EIT and the CGI scores closest to the date of this level were recorded. Vitamin D levels of 25nmol/L and under were classified as deficient, levels of 25.1 - 50nmol/L were insufficient.Result45.90% (n = 84) of patients did not have their levels recorded. Of the 55% (n = 99) patients who had Vitamin D levels recorded, 49.50% (n = 49) were insufficient and 22.22% (n = 22) were deficient. Therefore, only 28.28% (n = 28) had either optimal or sufficient Vitamin D levels. The majority of Vitamin D levels were taken in Autumn (36.46% n = 36).75.76% (n = 75) of patients had both vitamin D levels and CGI scores recorded, with an average of 35.65 days between date level and score recorded. A weak negative correlation between overall CGI scores and vitamin D level was calculated, producing Spearman R Correlation Coefficient of -0.15.ConclusionAlmost 3/4 of the studied patients being assessed for psychotic symptoms had either insufficient or deficient levels of Vitamin D. The correlation between symptom severity and Vitamin D level was weak however. While we cannot comment on the causality of the relationship, it appears that there is an association between our studied patient group and Vitamin D insufficiency.The evidence to suggest that supplementation can reduce psychotic symptoms is limited however, supplementation can reduce the risk of osteoporosis and falls, therefore would improve patient care. Only 55% of the patients within the EIT had their Vitamin D levels tested. As a result of this study, the authors recommend that all patients in the EIT have their Vitamin D levels tested as part of their psychosis assessment.The study is limited due to low numbers of patients studied and the fact that recorded CGI scores were often recorded at a later date to Vitamin D levels.

Vitamin D monitoring and management in the inpatient services – reaudit

AimsTo survey the prevalence of monitoring of vitamin D on an inpatient ward.To audit the treatment if there is identified vitamin D deficiency or insufficiencyTo compare differences between findings in auditsMethodAll inpatients admitted to Milford centre between August 2019 and August 2020 were selected as part of the sample size.Data were collected by FY1 and FY2Patients’ laboratory results were accessed to determine vitamin D levels.E-notes were used to conclude who were vitamin D sufficient or deficient for treatmentThe standard for the audit were as per:Management of vitamin D deficiency or insufficiency in adults – CKS (2018)The above was based on National Osteoporosis Society (NOS) guideline Vitamin D and bone health: a practical clinical guideline for patient management [National Osteoporosis Society, 2013] and Scientific Advisory Committee on Nutrition (SACN) guidelineResult201748/188 patients had vitamin D levels measured36/48 patients had sufficient vitamin D levels12/48 patients were either deficient or insufficient12/12 patients were treated where found deficient or insufficient202090/115 patients had vitamin D levels measured47/90 patients had sufficient vitamin D Levels43/90 patients had either insufficient or deficient vitamin D levels22/43 patients had treatment documented in noted where found deficient or insufficientConclusionDifficult to make comparisons with previous audit due to difference in number of patients testedVitamin D is routinely tested on Milford ward on admission hence the large number compared to the last audit52% had noted to have sufficient levels of vitamin DConcerning were results that only 51% of those deemed to have insufficient or deficient were treated based on notesPotential reasons could be:Prescribed in medication card and not documented in notes.Vitamin D results checked in another ward, no supplementation given, and then transferred to Milford house.Patients refused treatment but not documented adequately.Patient discharged before results were received due to quick aroundResults were deemed insufficient in terms of the range but very close to normal hence decision made not to start supplementationResults to be disseminated with medical and nursing colleaguesRe-audit in September 2021