Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort

Background

Vitamin D plays an important role in the mineral and bone disorder seen in chronic kidney disease (CKD). Deficiency of 25-hydroxyvitamin D (25OHD) is highly prevalent in the adult CKD population.

Methods

The prevalence and determinants of 25OHD deficiency (defined as a level <20 ng/ml) were examined longitudinally in 506 children in the CKiD cohort. Predictors of secondary hyperparathyroidism and the determinants of 1,25-dihydroxyvitamin D (1,25(OH)₂D) levels were also evaluated.

Results

Deficiency of 25OHD was observed in 28 % of the cohort at enrollment. Significant predictors of 25OHD deficiency were older age, non-white race, higher body mass index, assessment during winter, less often than daily milk intake, non-use of nutritional vitamin D supplement and proteinuria. Lower values of glomerular filtration rate (GFR), serum 25OHD, calcium and higher levels of FGF23 were significant determinants of secondary hyperparathyroidism. Lower GFR, low serum 25OHD, nephrotic-range proteinuria, and high FGF23 levels were significant determinants of serum 1,25(OH)₂ D levels.

Conclusions

Deficiency of 25OHD is prevalent in children with CKD and is associated with potentially modifiable risk factors such as milk intake, nutritional vitamin D supplement use, and proteinuria. 25OHD deficiency is a risk factor for secondary hyperparathyroidism and decreased serum 1,25(OH)₂D in children with CKD.

     

25-Hydroxycholecalciferol response to single oral cholecalciferol loading in the normal weight,overweight, and obese

Summary

After a single cholecalciferol load, peak serum 25-hydroxycholecalciferol (25OHD) is lower in individuals with a higher body mass index (BMI), probably due to it being distributed in a greater volume. Its subsequent disappearance from the serum is slower the higher the individual’s BMI, probably due to the combination of a larger body volume and a slower release into the circulation of vitamin D stored in adipose tissue.

Introduction

The aim of the study is to examine 25-hydroxycholecalciferol (25OHD) response to a single oral load of cholecalciferol in the normal weight, overweight, and obese.

Methods

We considered 55 healthy women aged from 25 to 67 years (mean?±?SD, 50.8?±?9.5) with a BMI ranging from 18.7 to 42 kg/m² (mean?±?SD, 27.1?±?6.0). The sample was divided into three groups by BMI: 20 were normal weight (BMI?≤?25 kg/m²), 21 overweight (25.1?≤?BMI?≤?29.9 kg/ m²), and 14 obese (BMI?≥?30 kg/m²). Each subject was given 300,000 IU of cholecalciferol orally during lunch. A fasting blood test was obtained before cholecalciferol loading and then 7, 30, and 90 days afterwards to measure serum 25OHD, 1,25 dihydroxyvitamin D [1,25 (OH)₂D], parathyroid hormone (PTH), calcium (Ca), and phosphorus (P). Participants’ absolute fat mass was measured using dual energy X-ray absorptiometry (DEXA).

Results

The fat mass of the normal weight subjects was significantly lower than that of the overweight, which in turn was lower than that of the obese participants. Serum 25OHD levels increased significantly in all groups, peaking 1 week after the cholecalciferol load. Peak serum 25OHD levels were lower the higher the individuals’ BMI. After peaking, the 25OHD levels gradually decreased, following a significantly different trend in the three groups. The slope was similar for the overweight and obese, declining significantly more slowly than in the normal weight group. In the sample as a whole, there was a weakly significant negative correlation between fat mass and baseline 25OHD level, while this correlation became strongly significant at all time points after cholecalciferol loading.

Conclusions

The lower peak 25OHD levels seen in the obese and overweight is probably due to the cholecalciferol load being distributed in a larger body volume. The longer persistence of 25OHD in their serum could be due to both their larger body volume and a slower release into the circulation of the vitamin D stored in their adipose tissue.

     

Low 1,25-dihydroxyvitamin D level is associated with erythropoietin deficiency and endogenous erythropoietin resistance in patients with chronic kidney disease

Purpose

Erythropoietin (EPO) deficiency and resistance to endogenous EPO is an important pathophysiological feature in anemia of chronic kidney disease (CKD). Low 1,25 dihydroxyvitamin D [1,25(OH)₂D] level is known to contribute to anemia of CKD. We aimed to investigate the associations between serum 1,25(OH)₂D and anemia, EPO deficiency, and endogenous EPO resistance in patients with CKD.

Methods

This study included 409 patients with CKD [glomerular filtration rate (GFR)?<?60 ml/min/1.73 m²] who were not on dialysis therapy. Patients on exogenous EPO therapy and patients with iron deficiencies were excluded. Endogenous EPO resistance was assessed by calculating the ratio of endogenous EPO to hemoglobin (Hb) (endogenous EPO/Hb ratio). The associations of Hb level, endogenous EPO level, and the endogenous EPO/Hb ratio with clinical and laboratory variables were investigated by univariate and multivariate analyses.

Results

In univariate analysis, serum 1,25(OH)₂D level was correlated with the Hb level, endogenous EPO level, and the endogenous EPO/Hb ratio. Multiple regression analysis revealed that the serum 1,25(OH)₂D level remained significantly associated with the Hb level (β?=?0.532, P?<?0.001), endogenous EPO level (β?=?0.149, P?=?0.010), and the endogenous EPO/Hb ratio (β?=???0.187, P?=?0.002), even after adjusting for other confounding factors, including the levels of parathyroid hormone and the inflammatory marker C-reactive protein.

Conclusion

The serum 1,25(OH)₂D level exhibited significant associations with anemia, EPO deficiency, and endogenous EPO resistance in CKD patients. These associations were independent of secondary hyperparathyroidism and inflammation status.

     

Association of 25-hydroxyvitamin D with areal and volumetric measures of bone mineral density and parathyroid hormone: impact of vitamin D-binding protein and its assays

Summary

A comparison of the association of different forms of 25-hydroxyvitamin D [25(OH)D] with parathyroid hormone (PTH) and with areal and volumetric bone mineral density (BMD) demonstrated that bioavailable and free 25(OH)D do not provide a better index of vitamin D status in terms of bone health compared to total 25(OH)D.

Introduction

This study aims to compare measures of vitamin D-binding protein (DBP) using a monoclonal versus polyclonal ELISA and assess correlations of total versus estimated free and bioavailable 25(OH)D with BMD and PTH concentrations.

Methods

DXA and peripheral quantitative CT (pQCT) scans were obtained in 304 adults (158 black, 146 white), ages 21–80 years. Free and bioavailable 25(OH)D were calculated from total 25(OH)D, DBP, and albumin concentrations. Multivariable linear regression with standardized beta coefficients was used to evaluate associations of bone measures and PTH with total, free, and bioavailable 25(OH)D.

Results

Measures of DBP obtained using a monoclonal versus polyclonal ELISA were not correlated (r _s?=?0.02, p?=?0.76). Free and bioavailable 25(OH)D based on the polyclonal assay were lower in black versus white participants (p?<?0.0001); this race difference was not evident using the monoclonal assay. Adjusted for age, sex, calcium intake, and race, all forms of 25(OH)D were negatively associated with PTH, but the absolute coefficient was greatest for total 25(OH)D (?0.34, p?<?0.001) versus free/bioavailable 25(OH)D (?0.18/?0.24 depending on DBP assay, p?≤?0.003). In analyses stratified on race, none of the measures of 25(OH)D were associated with BMD across DXA and pQCT sites.

Conclusions

The monoclonal versus polyclonal ELISA yielded highly discrepant measures of DBP, particularly among black individuals, likely related to established race differences in DBP polymorphisms. Contrary to prior studies, our findings indicate that using DBP to estimate bioavailable and free 25(OH)D does not provide a better index of vitamin D status in terms of bone health.

     

Effect of concomitant vitamin D deficiency or insufficiency on lumbar spine volumetric bone mineral density and trabecular bone score in primary hyperparathyroidism

Summary

Lower vitamin D and higher parathyroid hormone (PTH) levels are associated with higher volumetric BMD and bone strength at the lumbar spine as measured by central quantitative computed tomography in primary hyperparathyroidism (PHPT), but there are no differences in bone microarchitecture as measured by trabecular bone score (TBS).

Introduction

The purpose of this study was to evaluate the association between 25-hydroxyvitamin D (25OHD) and volumetric bone mineral density (vBMD) and the TBS at the lumbar spine (LS) in PHPT.

Methods

This is a cross-sectional analysis of PHPT patients with and without low 25OHD. We measured vBMD with quantitative computed tomography (cQCT) and TBS by dual-energy X-ray absorptiometry (DXA) at the LS in 52 and 88 participants, respectively.

Results

In the cQCT cohort, those with lower vitamin D (<20 vs. 20-29 vs. ≥30 ng/ml) tended to be younger (p?=?0.05), were less likely to use vitamin D supplementation (p?<?0.01), and had better renal function (p?=?0.03). Those with 25OHD <20 ng/ml had 80 and 126 % higher serum PTH levels respectively vs. those with 25OHD 20–29 ng/ml (p?=?0.002) and 25OHD ≥30 ng/ml (p?<?0.0001). Covariate-adjusted integral and trabecular vBMD were higher in those with 25OHD 20–29 vs. those with 25OHD ≥30 ng/ml, but those with 25OHD <20 did not differ. Because there were few participants with 25OHD deficiency, we also compared those with vitamin D <30 vs. ≥30 ng/ml. Covariate-adjusted integral and trabecular vBMD were 23 and 30 % higher respectively (both p?<?0.05) in those with vitamin D <30 vs. ≥30 ng/ml. TBS was in the partially degraded range but did not differ by vitamin D status.

Conclusion

In mild PHPT, lower 25OHD is associated with higher PTH, but vitamin D deficiency and insufficiency using current clinical thresholds did not adversely affect lumbar spine skeletal health in PHPT. Further work is needed to determine if higher vBMD in those with lower vitamin D is due to an anabolic effect of PTH.

     

MRI visible Fe<Subscript>3</Subscript>O<Subscript>4</Subscript> polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures

Introduction and hypothesis

To demonstrate mesh magnetic resonance imaging (MRI) visibility in living women, the feasibility of reconstructing the full mesh course in 3D, and to document its spatial relationship to pelvic anatomical structures.

Methods

This is a proof of concept study of three patients from a prospective multi-center trial evaluating women with anterior vaginal mesh repair using a MRI-visible Fe₃O₄ polypropylene implant for pelvic floor reconstruction. High-resolution sagittal T2-weighted (T2w) sequences, transverse T1-weighted (T1w) FLASH 2D, and transverse T1w FLASH 3D sequences were performed to evaluate Fe₃O₄ polypropylene mesh MRI visibility and overall post-surgical pelvic anatomy 3 months after reconstructive surgery. Full mesh course in addition to important pelvic structures were reconstructed using the 3D Slicer® software program based on T1w and T2w MRI.

Results

Three women with POP-Q grade III cystoceles were successfully treated with a partially absorbable MRI-visible anterior vaginal mesh with six fixation arms and showed no recurrent cystocele at the 3-month follow-up examination. The course of mesh in the pelvis was visible on MRI in all three women. The mesh body and arms could be reconstructed allowing visualization of the full course of the mesh in relationship to important pelvic structures such as the obturator or pudendal vessel nerve bundles in 3D.

Conclusions

The use of MRI-visible Fe₃O₄ polypropylene meshes in combination with post-surgical 3D reconstruction of the mesh and adjacent structures is feasible suggesting that it might be a useful tool for evaluating mesh complications more precisely and a valuable interactive feedback tool for surgeons and mesh design engineers.

     

Serum 25-hydroxyvitamin D level and diabetic nephropathy in patients with type 2 diabetes mellitus

Objective

Patients with chronic kidney disease have a very high prevalence of deficiency of 25-hydroxyvitamin D [25(OH)D]. We evaluate the association between 25(OH)D and diabetic nephropathy (DN) in a Chinese sample with type 2 diabetes mellitus.

Method

The subjects were patients with diabetes mellitus who were hospitalized at our hospital during the period from June 2012 to July 2014. Serum levels of 25(OH)D were tested at admission. DN was defined as a urinary albumin-to-creatinine ratio ≥30 mg/g in a random spot urine sample. Multivariate analyses were performed using logistic regression models.

Results

We found that serum 25(OH)D levels were significantly lower in diabetes with DN as compared to without DN [8.5 (IQR 6.8–11.3) vs. 13.9 (IQR 11.2–18.2) ng/ml, P < 0.0001]. Based on the ROC curve, the optimal cutoff value of serum 25(OH)D levels as an indicator for diagnosis of DN was projected to be 10.5 ng/ml, which yielded a sensitivity of 82.6 % and a specificity of 72.7 %, with the area under the curve at 0.807 [95 % confidence interval (CI) 0.764–0.849]. Multivariate logistic regression analysis adjusted for common risk factors showed that with serum 25(OH)D level ≤10.5 ng/ml was an independent indicator of DN [odds ratio (OR) = 6.559; 95 % CI 2.864–11.368].

Conclusions

Our findings suggested that diabetes with DN had lower serum 25(OH)D levels and that determination of 25(OH)D statuses might be used to identify patients at increased risk of developing nephropathy complications.

     

Vitamin D in incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study

Background

Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation.

Methods

Multicenter longitudinal study of children (2–18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later.

Results

Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D?<?20 ng/ml at diagnosis. Twenty-seven (53 %) had 25(OH)D?<?20 ng/ml at follow-up. Fourteen (28 %) children were steroid resistant. Univariate analysis showed that children prescribed vitamin D supplements were less likely to have 25(OH)D deficiency at follow-up (OR 0.2, 95 % CI 0.04, 0.6). Steroid response, age, and season did not predict 25(OH)D deficiency. Multivariable linear regression modeling showed higher 25(OH)D levels at follow-up by 13.2 ng/ml (SE 4.6, p?<?0.01) in children supplemented with vitamin D.

Conclusions

In this incident idiopathic NS cohort, all children at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2–4 months. Supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up, supporting a role for supplementation in incident NS.

     

Serum 25-hydroxyvitamin D,parathyroid hormone,calcium intake,and bone mineral density in Spanish adults

Summary

Vitamin D insufficiency is very common among Spanish community-dwelling adult subjects. A threshold of serum 25(OH)D around 30 ng/ml would be necessary for the prevention of secondary hyperparathyroidism and hip bone loss in our population, regardless of the dairy calcium ingestion.

Introduction

This study aims to assess 25-hydroxyvitamin D—25(OH)D—status in Spanish adult subjects and to analyze its relationships with serum PTH levels, calcium intake, and bone mineral density (BMD).

Methods

A total of 1811 individuals (1154 postmenopausal women and 657 men) aged 44–93 years participated in the study. Serum 25(OH)D, intact parathyroid hormone (PTH), aminoterminal propeptide of type I collagen (P1NP), and C-terminal telopeptide of type I collagen (β-CTX) levels were measured by electrochemiluminescence. BMD was determined by dual x-ray absorptiometry (DXA) at lumbar spine, femoral neck, and total hip.

Results

Serum 25(OH)D levels were below 10, 20, and 30 ng/ml in 5, 40, and 83 % of participants, respectively. There was a significant seasonal difference in mean serum 25(OH)D, with higher levels in summer–autumn. In multivariate analysis, 25(OH)D levels were negatively correlated with age, serum PTH and creatinine, body mass index, smoking, alcohol intake, and a number of chronic diseases, but positively with dairy calcium intake. The magnitude of the difference in serum PTH according to 25(OH)D quartiles was not influenced by calcium intake. A threshold of serum 25(OH)D around 30 ng/ml was observed for serum PTH and hip BMD.

Conclusions

Vitamin D insufficiency is very common among Spanish community-dwelling adult subjects. A threshold of serum 25(OH)D around 30 ng/ml would be necessary for the prevention of secondary hyperparathyroidism and hip bone loss in our population, regardless of the dairy calcium ingestion. Programs to improve vitamin D status may be required in our country.

     

Low bone mineral density for age/osteoporosis in triple A syndrome—an overlooked symptom of unexplained etiology

Summary

Triple A syndrome (alacrima, achalasia, adrenal failure, progressive neurodegenerative disease) is caused by mutations in the AAAS gene which encodes the protein alacrima achalasia adrenal insufficiency neurologic disorder (ALADIN). Our investigation suggests that low bone mineral density (BMD) for age/osteoporosis could be a common but overlooked symptom of unexplained etiology in this rare multisystemic disease.

Introduction

The purpose of this study is to evaluate incidence and etiology of BMD for age/osteoporosis, a possibly overlooked symptom in triple A syndrome.

Methods

Dual-energy X-ray absorptiometry (DXA) of the femoral neck, total hip, lumbar spine, and radius, bone turnover markers, minerals, total alkaline phosphatase (ALP), 25-hydroxy vitamin D (25-OHD), 1,25-dihydroxy vitamin D (1,25-OH2D), intact parathyroid hormone (PTH), and adrenal androgens (dehydroepiandrosterone sulfate (DHEAS) and androstenedione) were measured in five male and four female patients.

Results

At time of diagnosis, low BMD for age was suspected on X-ray in seven of nine patients aged 2–11 years (not performed in two patients); normal levels of minerals and ALP were found in nine patients and low levels of adrenal androgens in eight patients (not measured in one patient). Reevaluation 5–35 years after introduction of 12 mg/m²/day hydrocortisone showed low BMD for age in two children, osteopenia in one, and osteoporosis in six adults. Normal levels of minerals, ALP, PTH, 1,25-OH2D, procollagen type 1, crosslaps, and osteocalcin were found in all patients. Low levels of adrenal androgens were found in all and 25OHD deficiency in six patients. Body mass index was <25 % for age and sex in eight of nine patients.

Conclusion

Low BMD for age/osteoporosis in our patients probably is not a result of glucocorticoid therapy but could be the consequence of low level of adrenal androgens, neurological impairment causing physical inactivity, inadequate sun exposure, and protein malnutrition secondary to achalasia. Considering ubiquitous ALADIN expression, low BMD/osteoporosis may be a primary phenotypic feature of the disease. Besides optimizing glucocorticoid dose, physical activity, adequate sun exposure, appropriate nutrition, and vitamin D supplementation, therapy with DHEA should be considered.

     

Low serum 25-hydroxyvitamin D is associated with increased risk of stress fracture during Royal Marine recruit training

Summary

The aim of this study was to investigate vitamin D status and stress fracture risk during Royal Marine military training. Poor vitamin D status was associated with an increased risk of stress fracture. Vitamin D supplementation may help to reduce stress fracture risk in male military recruits with low vitamin D status.

Introduction

Stress fracture is a common overuse injury in military recruits, including Royal Marine (RM) training in the UK. RM training is recognised as one of the most arduous basic training programmes in the world. Associations have been reported between serum 25-hydroxyvitamin D (25(OH)D) and risk of stress fracture, but the threshold of 25(OH)D for this effect remains unclear. We aimed to determine if serum 25(OH)D concentrations were associated with stress fracture risk during RM training.

Methods

We prospectively followed 1082 RM recruits (males aged 16–32 years) through the 32-week RM training programme. Troops started training between September and July. Height, body weight and aerobic fitness were assessed at week 1. Venous blood samples were drawn at weeks 1, 15 and 32. Serum samples were analysed for 25(OH)D and parathyroid hormone (PTH).

Results

Seventy-eight recruits (7.2 %) suffered a total of 92 stress fractures. Recruits with a baseline serum 25(OH)D concentration below 50 nmol L^?1 had a higher incidence of stress fracture than recruits with 25(OH)D concentration above this threshold (χ² ₍₁₎?=?3.564, p?=?0.042; odds ratio 1.6 (95 % confidence interval (CI) 1.0–2.6)). Baseline serum 25(OH)D varied from 47.0?±?23.7 nmol L^?1 in February, to 97.3?±?24.6 nmol L^?1 in July (overall mean 69.2?±?29.2 nmol L^?1, n?=?1016). There were weak inverse correlations between serum 25(OH)D and PTH concentrations at week 15 (r?=??0.209, p?<?0.001) and week 32 (r?=??0.214, p?<?0.001), but not at baseline.

Conclusion

Baseline serum 25(OH)D concentration below 50 nmol L^?1 was associated with an increased risk of stress fracture. Further studies into the effects of vitamin D supplementation on stress fracture risk are certainly warranted.

     

Vitamin D deficiency and seasonal variation over the years in São Paulo,Brazil

Summary

Brazil is a tropical/subtropical geographic area with elevated ultraviolet (UV) radiation. We report very high prevalence of vitamin D deficiency in a large database of Brazilian subjects and show seasonal and reciprocal relationship between vitamin D and parathyroid hormone (PTH) over the years in this tropical area.

Introduction

We aim to examine the prevalence of vitamin D deficiency, characterize the temporal relationship between 25-hydroxyvitamin D levels (25(OH)D) and intact PTH (iPTH) according to seasons, and investigate potential associations between 25(OH)D levels and extra-skeletal outcomes in a Brazilian population.

Methods

We retrospectively determined population weekly mean concentrations of unpaired 25(OH)D and iPTH using 39,004 laboratory results of Brazilian individuals of both genders aged 2 to 95 years. The 25(OH)D and iPTH distributions were normalized, and the means fit with a sinusoidal function. Potential associations between 25(OH)D serum levels and inflammatory markers, fasting glucose, HbA1c and Homeostasis Model Assessment index (HOMA) were examined.

Results

Of the samples, 33.9 % had 25(OH)D serum concentrations lower than 20 ng/mL, while the vast majority (70.7 %) were found to be vitamin D deficient or insufficient (<30 ng/mL). Vitamin D deficiency was significantly higher during the winter as compared to the summer (38.4 % <20 ng/mL and 75.5 % <30 ng/mL versus 23.3 % <20 ng/mL and 62.5 % <30 ng/mL, respectively; p?<?0.001). Seasonal variation was observed for both 25(OH)D and iPTH. 25(OH)D peaks occurred in March and troughs in September. iPTH levels showed an inverted pattern of peaks and troughs with a delay of 1?±?5 week. 25(OH)D was significantly associated with inflammatory markers but not with glucose homeostasis.

Conclusions

A sinusoidal interrelationship has been detected between vitamin D and PTH in this tropical population. A large percentage of the individuals showed vitamin D deficiency. Public health strategies are needed to better understand and manage this very high and apparently contradictory prevalence of vitamin D deficiency.

     

The vitamin D status in ankylosing spondylitis in relation to intestinal inflammation,disease activity,and bone health: a cross-sectional study

Summary

We assessed the vitamin D status in ankylosing spondylitis (AS) patients and healthy controls in the late winter when no vitamin D is produced by the sunlight. The vitamin D status was often poor, but not lower in AS and not associated with disease activity or signs of gut inflammation.

Introduction

The aims of the study were to investigate the vitamin D levels attained mainly by dietary intake in ankylosing spondylitis (AS) in comparison with healthy controls and in relation to gut inflammation, measured indirectly by fecal calprotectin, disease activity, osteoproliferation, bone mineral density (BMD), and vertebral fractures.

Methods

Serum 25-hydroxy vitamin D (25(OH)D) was measured in 203 AS patients and 120 healthy controls at the end of “the vitamin D winter,” when the out-door UVB irradiation is too low to allow synthesis of vitamin D₃ in the skin at the latitude of Gothenburg, Sweden. Fecal calprotectin was measured in stool samples. Disease activity was assessed with CRP, ESR, ASDAS_CRP, BASDAI, BAS-G, BASFI, and BASMI. Lateral spine radiographs were scored for osteoproliferation and vertebral fractures using the mSASSS and Genant scores. BMD was measured in the lumbar spine and femoral neck.

Results

Vitamin D insufficiency (a serum 25(OH)D <50 nmol/L) was found in approximately 50 % of the AS patients, but serum 25(OH)D was not different from healthy controls and not significantly correlated with fecal calprotectin, gastrointestinal symptoms, disease activity parameters, mSASSS, BMD, or vertebral fractures.

Conclusions

The vitamin D status was often poor in the late winter in AS but not different from the healthy controls. No evidence for a connection between subclinical gut inflammation, malabsorption, and hypovitaminosis D was found. Serum 25(OH)D was not associated with disease activity, osteoproliferation, BMD, or vertebral fractures. We suggest that the lower vitamin D levels in AS, previously found by others, may be caused by reduced out-door UVB exposure.

     

Comparison Between Different Intramuscular Vitamin B<Subscript>12</Subscript> Supplementation Regimes: a Retrospective Matched Cohort Study

Background

The incidence of vitamin B₁₂ deficiency after bariatric surgery can range from 26 to 70 %. There is no consensus on optimal vitamin B₁₂ supplementation in postbariatric patients. The objective of this study was to compare three different regimes.

Methods

In this retrospective matched cohort study, we included 63 patients with methylmalonic acid (MMA) levels ≥300 nmol/L. Group A (n?=?21) received 6 intramuscular (im) vitamin B₁₂ injections including a loading dose, group B (n?=?21) received 3 im vitamin B₁₂ injections without loading dose and group C (n?=?21) received no im vitamin B₁₂ injections.

Results

The total post-bariatric patient population consisted of 14 males (22.2 %) and 49 women (77.8 %) with a mean current body mass index of 30.6?±?8.0 kg/m². There was no significant difference in vitamin B₁₂ and MMA levels between 3 groups at baseline. There was a significant difference in follow-up vitamin B₁₂ levels of group A compared to group B (p?=?0.02) and group A compared to group C (p?=?0.03). In the follow-up results, there is also a significant decrease in MMA levels of group A compared to group B (p?=?0.02), group A compared to group C (p?<?0.001), and group B compared to group C (p?<?0.01).

Conclusions

In this study, a shorter injection regime is probably not sufficient to treat a vitamin B₁₂ deficiency. An injection regime with 6 injections recovered all vitamin B₁₂ deficiencies biochemically. MMA levels cannot recover spontaneously over time without additional im injection regime.

     

Oral Vitamin B<Subscript>12</Subscript> Supplementation After Roux-en-Y Gastric Bypass: a Systematic Review

Background

Many respectable guidelines recommend lifelong vitamin B₁₂ injections for Roux-en-Y gastric bypass (RYGB) patients in the absence of lack of consensus on the efficacy of oral route of prophylaxis and the appropriate doses needed for this purpose. The purpose of this review was to examine the published English language scientific literature in accordance with PRISMA principles to find out if orally given vitamin B₁₂ is adequate for prophylactic purposes in RYGB patients and the appropriate dosages needed for this purpose if it is.

Methods

We examined the PubMed database for all English language articles examining various doses of oral vitamin B₁₂ supplementation after proximal RYGB in adult patients. The search revealed 19 such articles.

Results

The data suggest that oral vitamin B₁₂ supplementation doses of ≤?15 μg daily are insufficient to prevent deficiency in RYGB patients. Higher supplementation doses show better results and it appears that a dose of 600.0 μg vitamin B₁₂ daily is superior to 350.0 μg daily suggesting an incremental dose-response curve. It further appears that supplementation doses of 1000.0 μg vitamin B₁₂ daily lead to an increase in B₁₂ levels and are sufficient for the prevention of its deficiency in most RYGB patients.

Conclusion

The review finds that oral supplementation doses of ≤?15 μg vitamin B₁₂ daily are inadequate for prophylaxis of vitamin B₁₂ deficiency in adult RYGB patients but doses of 1000 μg vitamin B₁₂ daily might be adequate. Future studies need to examine this and even higher oral doses for vitamin B₁₂ supplementation for patients undergoing RYGB.

     

Long-term effect of thermoablative fractional CO<Subscript>2</Subscript> laser treatment as a novel approach to urinary incontinence management in women with genitourinary syndrome of menopause

Introduction and hypothesis

The aim of this study was to evaluate the long-term effect of thermoablative fractional CO₂ laser (TACO2L) as an alternative treatment for early stages of stress urinary incontinence (SUI) in postmenopausal women with genitourinary syndrome of menopause.

Methods

A total of 161 postmenopausal patients (age 53.38 ± 5.1 years, range 45–65 years) with a clinical diagnosis of mild SUI were prospectively enrolled in the study. Patients received one treatment with TACO2L every 30–45 days, each treatment comprising four sessions, followed in all patients by a yearly treatment session at 12, 24 and 36 months. SUI was evaluated using the International Continence Society 1-h pad test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after TACO2L treatment.

Results

TACO2L treatment was associated with a significant improvement in ICIQ-UI SF scores and 1-h pad weight test at 12 months (both p < 0.001), 24 months (both p < 0.001) and 36 months (both p < 0.001). Improvements were maintained for up to 36 months without the need for any further intervention. The results were confirmed by significant histological changes related to trophic restoration of the vagina, responsible for extrinsic and intrinsic mechanisms involved in urinary continence.

Conclusions

Our results suggest that TACO2L is an efficient and safe novel treatment strategy in patients with mild SUI. Further investigation to confirm the long-term results presented here is still warranted.

     

Serum 25-Hydroxyvitamin D in Obese Spanish Adults: the Camargo Cohort Study

Objectives

To describe the 25(OH)D status in Spanish obese postmenopausal women and men ≥?50 years, to compare their results with those of the overweight or normal weight population, and to determine whether differences are observed between both sexes and with seasonal variation throughout the year.

Patients and Methods

We studied 2597 subjects (1826 postmenopausal women and 771 men ≥?50 years). Serum concentrations of 25(OH)D, intact parathyroid hormone (PTH), aminoterminal propeptide of type I collagen (PINP), and C-terminal telopeptide of type I collagen (CTX) were determined by electrochemiluminiscence (Elecsys 2010, Roche). Bone mineral density (BMD) was measured by DXA. Participants were divided according to body mass index (BMI) groups (normal ≥?20 and <?25 kg/m², overweight ≥?25 and?<?30 kg/m², or obese ≥?30 kg/m²).

Results

Obese people had lower serum 25(OH)D values (20.9?±?8.2 ng/ml) than overweight (23.3?±?8.8 ng/ml; p?<?0.0001) or normal-weight subjects (24.4?±?8.9 ng/ml; p?<?0.0001). They have also lower levels of both PINP and CTX. In contrast, PTH concentrations and BDM values were higher in obese individuals. When stratifying by sex, the difference in serum concentration of 25(OH)D remained significant in women, but not in men, persisted throughout the year, and was inversely correlated with BMI and waist circumference.

Conclusions

Despite lower serum 25(OH)D concentrations and higher PTH levels, obese and overweight women have higher lumbar spine and hip BMD and lower bone remodeling markers than normal weight women, suggesting that low serum 25(OH)D levels do not negatively affect bone health.