Widespread vitamin D deficiency among Indian health care professionals

Summary

Information on vitamin D status of Indian health care professionals is limited. Among 2,119 subjects studied, just 6?% were found to be sufficient in vitamin D status. There is urgent need of an integrated approach to detect and treat vitamin D deficiency among health care professionals to improve on-the-job productivity.

Introduction

Vitamin D deficiency is prevalent worldwide. India has been reported to be one of the worst affected countries. Several single-center studies from India have shown high prevalence of vitamin D deficiency. Little is known regarding the vitamin D status of Indian health care professionals.

Aim

This study aimed to determine prevalence of vitamin D deficiency among health care professionals in different regions of India.

Method

In this cross-sectional, multicenter study, we enrolled 2,119 medical and paramedical personnel from 18 Indian cities. Blood samples were collected from December 2010 to March 2011 and analyzed in a central laboratory by radioimmunoassay. Vitamin D deficiency was defined as 25-hydroxyvitamin D [25(OH)D] <20?ng/mL or <50?nmol/L, insufficiency as 25(OH)D?=?20?C30?ng/mL or 50?C75?nmol/L, and sufficiency as 25(OH)D >30?ng/mL or >75?nmol/L.

Results

Mean (±SD) age of subjects was 42.71?±?6.8?years. Mean (±SD) 25(OH)D level was 14.35?±?10.62?ng/mL (median 11.93?ng/mL). Seventy-nine percent of subjects were deficient, 15?% were insufficient, and just 6?% were sufficient in vitamin D status. No significant difference was found between vitamin D status in southern (25(OH)D?=?13.3?±?6.4?ng/mL) and northern (25(OH)D?=?14.4?±?8.5?ng/mL) parts of India.

Conclusion

Our study confirms the high prevalence of vitamin D deficiency all across India in apparently healthy, middle-aged health care professionals.     

25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates

Summary

We assessed vitamin D status and its correlates in the population-based Canadian Multicentre Osteoporosis Study (CaMos). Results showed that serum 25-hydroxyvitamin D levels <75?nmol/L were common. Given Canada??s high latitude, attention should be given to strategies for enhancing vitamin D status in the population.

Introduction

Inadequate vitamin D has been implicated as a risk factor for several clinical disorders. We assessed, in a Canadian cohort, vitamin D status and its correlates, based on serum 25-hydroxyvitamin D [25(OH)D], the best functional indicator of vitamin D status.

Methods

We studied 577 men and 1,335 women 35+ years from seven cities across Canada in the randomly selected, population-based Canadian Multicentre Osteoporosis Study (CaMos). Participants completed a comprehensive questionnaire. Serum 25(OH)D was measured by immunoassay. Multivariate linear regression modeling assessed the association between 25(OH)D and determinants of vitamin D status.

Results

Participants (2.3%) were deficient in 25(OH)D (<27.5?nmol/L); a further 18.1% exhibited 25(OH)D insufficiency (27.5?C50?nmol/L). Levels <75?nmol/L were evident in 57.5% of men and 60.7% of women and rose to 73.5% in spring (men) and 77.5% in winter (women); 25(OH)D <50?nmol/L was ??10% year round for those supplementing with ??400?IU vitamin D/day but was 43.9% among those not supplementing in winter and spring. The strongest predictors of reduced 25(OH)D for both men and women were winter and spring season, BMI ??30, non-white ethnicity, and lower vitamin D supplementation and its modification by fall and winter.

Conclusions

In this national Canadian cohort, vitamin D levels <75?nmol/L were common, particularly among non-white and obese individuals, and in winter and spring. Vitamin D intake through diet and supplementation and maintenance of normal weight are key modifiable factors for enhancing vitamin D status and thus potentially influencing susceptibility to common chronic diseases.     

A global representation of vitamin D status in healthy populations

Purpose

This paper visualizes the available data on vitamin D status on a global map, examines the existing heterogeneities in vitamin D status and identifies research gaps.

Methods

A graphical illustration of global vitamin D status was developed based on a systematic review of the worldwide literature published between 1990 and 2011. Studies were eligible if they included samples of randomly selected males and females from the general population and assessed circulating 25-hydroxyvitamin D [25(OH)D] levels. Two different age categories were selected: children and adolescents (1?C18?years) and adults (>18?years). Studies were chosen to represent a country based on a hierarchical set of criteria.

Results

In total, 200 studies from 46 countries met the inclusion criteria, most coming from Europe. Forty-two of these studies (21?%) were classified as representative. In children, gaps in data were identified in large parts of Africa, Central and South America, Europe, and most of the Asia/Pacific region. In adults, there was lack of information in Central America, much of South America and Africa. Large regions were identified for which the mean 25(OH)D levels were below 50?nmol/L.

Conclusions

This study provides an overview of 25(OH)D levels around the globe. It reveals large gaps in information in children and adolescents and smaller but important gaps in adults. In view of the importance of vitamin D to musculoskeletal growth, development, and preservation, and of its potential importance in other tissues, we strongly encourage new research to clearly define 25(OH)D status around the world.     

Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women

Summary

The various factors that may contribute to vitamin D deficiency or insufficiency were examined among healthy Saudi pre- and postmenopausal women. Vitamin D deficiency was highly prevalent among studied Saudi women with obesity, poor sunlight exposure, poor dietary vitamin D supplementation and age as the main risk factors.

Introduction

The various factors that may contribute to vitamin D deficiency or insufficiency in relation to bone health among Saudi women are not known. The main objectives of the present study were to determine the factors influencing vitamin D status in relation to serum 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (PTH), bone turnover markers (BTMs), bone mineral density (BMD), and vitamin D receptor genotype (VDR) in healthy Saudi pre- and postmenopausal women.

Methods

A total number of 1,172 healthy Saudi women living in the Jeddah area were randomly selected and studied. Anthropometric parameters, socioeconomic status, sun exposure index together with serum levels of 25(OH)D, calcitriol, intact PTH, Ca, PO4, Mg, creatinine, albumin, and biochemical BTMs were measured. BMD was measured by a dual energy X-ray absorptiometry and VDR genotypes were also determined.

Results

About 80.0% of Saudi women studied exhibited vitamin D deficiency (serum 25(OH)D?<?50.0?nmol/L) with only 11.8% of all women were considered with adequate vitamin D status (serum 25(OH)D?>?75?nmol/L). Secondary hyperparathyroidism was evident in 18.5% and 24.6% in pre- and postmenopausal women with 25(OH)D?<?50?nmol/L. Serum 25(OH)D was lower (P?<?0.001) and intact PTH higher (P?<?0.001) in the upper quintiles of body mass index (BMI) and waist-to-hip ratio (WHR). Multiple linear regression analysis showed that BMI, sun exposure index, poor dietary vitamin D supplementation, WHR, and age were independent positive predictors of serum 25(OH)D values.

Conclusions

Vitamin D deficiency is highly prevalent among healthy Saudi pre-and postmenopausal women and largely attributed to obesity, poor exposure to sunlight, poor dietary vitamin D supplementation, and age.     

Vitamin D deficiency in UK South Asian Women of childbearing age: a comparative longitudinal investigation with UK Caucasian women

Summary

This is the first 1-year longitudinal study which assesses vitamin D deficiency in young UK-dwelling South Asian women. The findings are that vitamin D deficiency is extremely common in this group of women and that it persists all year around, representing a significant public health concern.

Introduction

There is a lack of longitudinal data assessing seasonal variation in vitamin D status in young South Asian women living in northern latitudes. Studies of postmenopausal South Asian women suggest a lack of seasonal change in 25-hydroxy vitamin D [25(OH)D], although it is unclear whether this is prevalent among premenopausal South Asians. We aimed to evaluate, longitudinally, seasonal changes in 25(OH)D and prevalence of vitamin D deficiency in young UK-dwelling South Asian women as compared with Caucasians. We also aimed to establish the relative contributions of dietary vitamin D and sun exposure in explaining serum 25(OH)D.

Methods

This is a 1-year prospective cohort study assessing South Asian (n?=?35) and Caucasian (n?=?105) premenopausal women living in Surrey, UK (51° N), aged 20–55 years. The main outcome measured was serum 25(OH)D concentration. Secondary outcomes were serum parathyroid hormone, self-reported dietary vitamin D intake and UVB exposure by personal dosimetry.

Results

Serum 25(OH)D?<25 nmol/L was highly prevalent in South Asians in the winter (81 %) and autumn (79.2 %). Deficient status (below 50 nmol/L) was common in Caucasian women. Multi-level modelling suggested that, in comparison to sun exposure (1.59, 95 %CI?=?0.83–2.35), dietary intake of vitamin D had no impact on 25(OH)D levels (?0.08, 95 %CI?=??1.39 to 1.23).

Conclusions

Year-round vitamin D deficiency was extremely common in South Asian women. These findings pose great health threats regarding the adverse effects of vitamin D deficiency in pregnancy and warrant urgent vitamin D public health policy and action.     

Low serum vitamin D is associated with increased mortality in elderly men: MrOS Sweden

Summary

In elderly man, low serum 25-hydroxyvitamin D (25(OH)D) was associated with a substantial excess risk of death compared to 25(OH)D values greater than 50?C70?nmol/l, but the association attenuated with time.

Introduction

The aim of the present study was to determine whether poor vitamin D status was associated with an increase in the risk of death in elderly men.

Methods

We studied the relationship between serum 25(OH)D and the risk of death in 2,878 elderly men drawn from the population and recruited to the MrOS study in Sweden. Baseline data included general health and lifestyle measures and serum 25(OH)D measured by competitive RIA. Men were followed for up to 8.2?years (average 6.0?years).

Results

Mortality adjusted for comorbidities decreased by 5% for each SD increase in 25(OH)D overall (gradient of risk 1.05; 95% confidence interval 0.96?C1.14). The predictive value of 25(OH)D for death was greatest below a threshold value of 50?C70?nmol/l, was greatest at approximately 3?years after baseline and thereafter decreased with time.

Conclusions

Low serum 25(OH)D is associated with a substantial excess risk of death compared to 25(OH)D values greater than 50?C70?nmol/l, but the association attenuates with time. These findings, if causally related, have important implications for intervention in elderly men.     

The relationship between obesity and the increase in serum 25(OH)D levels in response to vitamin D supplementation

Summary

This study examines the relationship between obesity and the increase in serum 25(OH)D levels in response to vitamin D supplementation among adults with baseline serum 25(OH)D levels <50 nmol/L. This study revealed that the increase in serum 25(OH)D in response to vitamin D supplementation was higher in lean subjects as compared to obese subjects.

Introduction

Serum 25(OH)D is lower among obese than non-obese. This study examines the relationship between obesity and the increase in serum 25(OH)D in response to vitamin D supplementation in a large sample of adults with baseline serum 25(OH)D <50 nmol/L, relatively long average treatment duration and large average daily cholecalciferol.

Methods

The computerized database of the Clalit Health Services, which the largest nonprofit health maintenance organization in Israel, was retrospectively searched for all subjects aged ≥20 years who performed serum 25(OH)D test in 2011. Subjects with more than one test at different occasions in 2011 were identified and were included if the result of the first test was <50 nmol/L, and were treated with cholecalciferol between the first and the last test in 2011 (n?=?16,540 subjects).

Results

The mean increase in serum 25(OH)D level after treatment was 28.7 (95 % confidence interval (CI), 28.0–29.4)?nmol/L, 23.6 (23.0–24.2)?nmol/L, and 20.1 (19.6–20.6)?nmol/L in subject with BMI of <25, 25–29.9, and ≥30 kg/m², respectively (P?<?0.001). The results were similar after adjustment for the potential confounders. Similarly, the proportion of subjects who achieved serum 25(OH)D?≥?50 nmol/L after treatment was inversely associated with BMI; 65.1, 58.3, and 49.1 % for BMI of <25, 25–29.9, and?≥?30 kg/m², respectively. Compared to BMI of ≥30 kg/m², the adjusted odds ratio for achieving levels of ≥50 nmol/L were 2.12 (95 % CI, 1.94–2.31) and 1.42 (1.31–1.54) for BMI of <25 kg/m², and BMI of 25–29.9 kg/m², respectively.

Conclusions

BMI is inversely associated with the increase in serum 25(OH)D levels in response to vitamin D supplementation.     

Correlation between 25-hydroxyvitamin D levels and latitude in Brazilian postmenopausal women: from the Arzoxifene Generations Trial

Summary

We investigated vitamin D status in Brazilian cities located at different latitudes. Insufficiency (<50 nmol/L) was common (17 %), even in those living in a tropical climate. Vitamin D insufficiency increased as a function of latitude. Mean 25-hydroxyvitamin D (25(OH)D) levels in each site and latitude correlation were very high (r?=??0.88; p?<?0.0001).

Introduction

Inadequate vitamin D, determined by low levels of 25(OH)D, has become very common despite the availability of sunlight at some latitudes. National data from a country that spans a wide range of latitudes would help to determine to what extent latitude or other factors are responsible for vitamin D deficiency. We investigated vitamin D status in cities located at different latitudes in Brazil, a large continental country.

Methods

The source is the Brazilian database from the Generations Trial (1,933 osteopenic or osteoporotic postmenopausal women (60 to 85 years old) with 25(OH)D measurements). 25(OH)D below 25 nmol/L (10 ng/mL) was an exclusion criterion. Baseline values were between fall and winter. The sites included Recife, Salvador, Rio de Janeiro, São Paulo, Curitiba, and Porto Alegre. Mean and standard deviation of 25(OH)D, age, spine and femoral neck T-score, calcium, creatinine, and alkaline phosphatase were calculated for each city. Pearson correlation was used for 25(OH)D and latitude.

Results

Insufficiency (<50 or <20 ng/mL) was common (329 subjects, 17 %). Vitamin D insufficiency increased as a function of latitude, reaching 24.5 % in the southernmost city, Porto Alegre. The correlation between mean 25(OH)D levels in each site and latitude was very high (r?=??0.88, p?<?0.0001).

Conclusion

There is a high percentage of individuals with vitamin D insufficiency in Brazil, even in cities near the equator, and this percentage progressively increases with more southern latitudes.     

The high prevalence of vitamin D inadequacy and dress style of women in the sunny UAE

Summary

In the UAE, 255 women with different dressing styles (veiled and non-veiled) underwent assay for vitamin D₃. The vitamin level was suboptimal in all groups including those dressed in Western style. The contribution of hypovitaminosis D to osteoporosis was less impressive compared to that of age factor.

Introduction

Vitamin D deficiency is attributed to several causes including clothing styles that hinder exposure to sunlight. This work represents our experience of such issue and its relevance to osteoporosis.

Methods

Two hundred and fifty-five women either fully covered (96, group G1), covered but face and hands exposed (104, group G2) or dressed in Western style (55, group G3) all underwent immunoassay of 25(OH)D; 78?% of them were Middle Easterners and North Africans. The mean age was 44.8?±?14.6?years.

Results

In the entire cohort, hypovitaminosis D prevalence was found to be 90.5?% (mean of 25(OH)D, 19.3?±?9.35?ng/ml). The prevalence was 90.5, 94 and 83?% (all p?=?not significant (NS)), with a mean value of 17.6?±?5.45, 16?±?5.23 and 18.6?±?6.18?ng/ml in the three groups, respectively. Significant differences in the mean value were observed between G1 vs. G2 (p?=?0.04) and G2 vs. G3 (p?=?0.01). Fifty-one women in G1 had longer adherence to their dressing habit than 68 in G2, yet the mean level of 25(OH)D was significantly lower in the latter (p?=?0.008). Osteoporosis was found in 45/202 (22?%): 24.5, 22.5 and 14.5?% in the three groups, respectively (all p?=?NS). Patients with osteoporosis were significantly older than others with normal dual X-ray absorptiometry outcome. Values of serum calcium, phosphorus, alkaline phosphatase, mild to moderate secondary hyperparathyroidism and low 25(OH)D were comparable in the two groups.

Conclusions

The pattern and longevity of dressing style should not be used as pretext for the hypovitaminosis D before other factors are being examined or considered.     

Vitamin D status in children with chronic kidney disease

Background

The role of vitamin D status in patients with renal insufficiency and its relation to dietary intake and parathyroid hormone (PTH) secretion is of utmost interest given the morbidity and mortality associated with the disordered mineral metabolism seen in chronic kidney disease (CKD).

Methods

We conducted a cross-sectional study of 100 pediatric patients with a diagnosis of CKD stage 1–5 at Children's Hospital Boston, measuring blood levels of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)₂D], and parathyroid hormone and obtaining data on nutrient intake and other variables related to vitamin D status.

Results

Subjects ranged in age from 6 months to 18?years, and 60 were male, 40 female. Of the 100 patients, 16 % were deficient in 25(OH)D (≤20?ng/mL) and another 24 % were insufficient (≤30?ng/mL), with 40 % in the suboptimal range. Serum 25(OH)D and dietary vitamin D intake were not correlated.

Conclusions

We found a high prevalence of hyperparathyroidism in early-stage CKD and a significant relationship between 25(OH)D and PTH regardless of calcitriol level. Our study results support the suggestion that optimization of vitamin D levels may provide additional benefit in preventing or improving hyperparathyroidism in patients with early CKD and likely remains important as an adjunctive therapy in children with advanced CKD.     

Calcium and vitamin D intake maintained from preovariectomy independently affect calcium metabolism and bone properties in Sprague Dawley rats

Summary

The interaction of habitual Ca and vitamin D intake from preovariectomy to 4 months postovariectomy on bone and Ca metabolism was assessed. Higher Ca intake suppressed net bone turnover, and both nutrients independently benefitted trabecular structure. Habitual intake of adequate Ca and ~50 nmol/L vitamin D status is most beneficial.

Introduction

Dietary strategies to benefit bone are typically tested prior to or after menopause but not through menopause transition. We investigated the interaction of Ca and vitamin D status on Ca absorption, bone remodeling, Ca kinetics, and bone strength as rats transitioned through estrogen deficiency.

Methods

Sprague Dawley rats were randomized at 8 weeks to 0.2 or 1.0 % Ca and 50, 100, or 1,000 IU (1.25, 2.5, or 25 μg) vitamin D/kg diet (2?×?3 factorial design) and ovariectomized at 12 weeks. Urinary ⁴⁵Ca excretion from deep-labeled bone was used to assess net bone turnover weekly. Ca kinetics was performed between 25 and 28 weeks. Rats were killed at 29 weeks. Femoral and tibiae structure (by μCT), dynamic histomorphometry, and bone Ca content were assessed.

Results

Mean 25(OH)D for rats on the 50, 100, 1,000 IU vitamin D/kg diet were 32, 54, and 175 nmol/L, respectively. Higher Ca intake ameliorated net bone turnover, reduced fractional Ca absorption and bone resorption, and increased net Ca absorption. Tibial and femoral trabecular structures were enhanced independently by higher Ca and vitamin D intake. Tibial bone width and fracture resistance were enhanced by higher vitamin D intake. Dynamic histomorphometry in the tibia was not affected by either nutrient. A Ca × vitamin D interaction existed in femur length, tibial Ca content, and mass of the soft tissue/extracellular fluid compartment.

Conclusions

Adequate Ca intake and serum 25(OH)D level of 50 nmol/L provided the most benefit for bone health, mostly through independent effects of Ca and vitamin D.     

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.

     

Vitamin D status is associated with physical performance: the results of three independent cohorts

Summary

This study, on the association between vitamin D status and physical performance and its decline, shows that vitamin D status is associated with physical performance in several older age groups. However, vitamin D status does not predict a decline in physical performance in individuals aged 55–65 years.

Introduction

Previous research in the Longitudinal Aging Study Amsterdam (LASA) showed an association of vitamin D status with physical performance and its decline in persons aged 65 years and older. The current study aims to determine these associations in younger individuals and to replicate previous research of LASA.

Methods

Data from three independent cohorts were used: two cohorts of LASA (LASA-II with measurements in 2002 (n?=?707) and 2009 (n?=?491), LASA-I-2009 (n?=?355)) and the baseline measurement of the B-Vitamins for the Prevention of Osteoporotic Fractures (B-PROOF) study (n?=?2,813). Participants performed three tests (walking test, chair stands, and tandem stand; range total score 0–12), except in LASA-II-2002 (only walking and chair stands tests; range total score 0–8). Multiple linear and logistic regression were used to assess whether vitamin D status was associated with total physical performance and its decline, respectively.

Results

The mean age of the participants was 60.0 (SD 3.0), 65.9 (2.9), 78.4 (5.3), and 74.4 (6.8) years for LASA-II-2002, LASA-II-2009, LASA-I-2009, and B-PROOF, respectively. Vitamin D status was not predictive of a clinical decline in total physical performance score in the LASA-II-2002 cohort (aged 55–65 years). After adjustment for confounding, participants with serum 25(OH)D?<?50 nmol/L scored 0.8 (95 % confidence interval 0.4–1.2), 0.9 (0.3–1.5), 1.5 (0.8–2.3), and 0.6 (0.3–0.9) points lower on total physical performance than participants with serum 25(OH)D?≥?75 nmol/L.

Conclusion

Our study confirmed that serum 25(OH)D is associated with physical performance. However, vitamin D status did not predict a clinical decline in physical performance in individuals aged 55–65 years.     

Vitamin D status of schoolchildren in Northern Algeria,seasonal variations and determinants of vitamin D deficiency

Summary

There are no published data on the vitamin D status of children living in North Africa. In 435 healthy Algerian children 5–15 years old, we found that vitamin D insufficiency (serum 25-hydroxyvitamin D (25OHD) <50 nmol/L) was frequent, especially in winter. Low vitamin D status was associated with increased parathyroid hormone (PTH) and leg deformation

Introduction

As there are no published data on the vitamin D status of children living in North Africa, we evaluated the 25OHD concentration of healthy Algerian children at the end of summer and at the end of winter. As secondary objectives, we studied the various determinants of vitamin D status and the PTH-25OHD relationship in these subjects.

Methods

Four hundred thirty-five children 5–15 years old were examined and had a blood sample in September 2010. Of them, 408 were sampled again in March 2011.

Results

Median 25OHD concentration in the whole group was 71.4 nmol/L in September and 52.9 nmol/L in March. In September, 58.4, 29.9, and 8.1 % had a 25OHD concentration below 75, 50, and 30 nmol/L respectively. In March, these percentages increased to 65.2, 41.4, and 17.4 % for the 75, 50, and 30 nmol/L threshold, respectively. In multivariate analysis, older age, darker skin phototype, low daily vitamin D and calcium intake, poor socioeconomic status, and short daily sun exposure remained significantly associated with a 25OHD <50 nmol/L at both visits. In 72 (16.6 %) children, genu varum/valgum was present. Compared to the 363 children without leg deformation, they presented more frequently with the risk factors of vitamin D insufficiency. They also had lower 25OHD concentrations and higher PTH and tALP. Serum PTH and 25OHD concentrations were negatively and significantly correlated (r?=??0.43; p?<?0.001) without a 25OHD threshold above which PTH does not decrease anymore.

Conclusion

Despite a sunny environment, vitamin D insufficiency is frequent in healthy Algerian children.     

Older age and lower adiposity predict better 25-hydroxy vitamin D concentration in Inuit adults: International Polar Year Inuit Health Survey, 2007�C2008

Summary

Our aim was to determine the prevalence and correlates of serum 25-hydroxy vitamin D (25(OH)D) concentration in Inuit adults. Low 25(OH)D concentration (<50?nmol/L) was common; the strongest positive predictors were older age and healthy waist circumference. Nutritional health promotion and interventions along with longitudinal nutritional assessments are needed.

Purpose

While 25(OH)D concentration of Canadian Inuit has not been examined on a large scale, Nutrition Canada Survey (1973) suggested that Inuit have low intakes of vitamin D. Our main purpose was to determine the prevalence and correlates of 25(OH)D concentration in a recent Inuit Health Survey.

Methods

Inuit adults (??18?years) participated in the 2007?C2008 International Polar Year Inuit Health Survey conducted in the months of August to October. Households were selected randomly in 36 communities. Dietary intake was assessed using a 24-h recall and a food frequency questionnaire. Anthropometric measurements, household living conditions, supplement use, and health status were assessed. In fasting samples, serum 25(OH)D and parathyroid hormone were measured using chemiluminesent assays (Diasorin, Liaison).

Results

Of the 2,595 participants, serum 25(OH)D was available on 2,207, of whom 67.4% and 42.2% had concentrations below 75 and 50?nmol/L, respectively. Further, 27.2% had values <37.5?nmol/L. Older adults (??51?years) consumed higher quantities of traditional food and consequently had higher vitamin D intake than younger adults (18?C30 and 31?C50?years) (p?Conclusions This is the first population assessment of dietary vitamin D and 25(OH)D concentration in Inuit adults. The high prevalence of suboptimal 25(OH)D concentration noted in the late summer and early fall raises concerns of greater prevalence and more severe inadequacies in the winter.     

Effect of vitamin D supplementation on bone health parameters of healthy young Indian women

Summary

There is a huge prevalence of hypovitaminosis D in the Indian population. We studied the efficacy and safety of oral vitamin D supplementation in apparently healthy adult women. Monthly cholecalciferol given orally, 60,000 IU/month during summers and 120,000 IU/month during winters, safely increases 25-hydroxyvitamin D (25(OH)D) levels to near normal levels.

Introduction

There is a huge burden of hypovitaminosis D in the Indian population. The current recommendation for vitamin D supplementation is not supported by sufficient evidence.

Methods

Study subjects included 100 healthy adult women of reproductive age group from hospital staff. They were randomized into group A (control) and group B (supplement) by simple randomization. Group B received 60,000 IU of cholecalciferol/month administered orally for 3 months, and then group A received 60,000 IU and group B 120,000 IU/month for 6 months.

Results

Mean baseline 25(OH)D level was 4.5?±?3.1 ng/ml and parathyroid hormone level was 50?±?25 pg/ml. In group B, 25(OH)D levels increased from 4.8?±?3.5 to 31.6?±?15.5 ng/ml (P?<?0.001) in 3 months. Interestingly, the increase, although of lower magnitude, was also observed in control group A, from 4.5?±?3.4 ng/ml (in spring) to 10.8?±?7.2 ng/ml (in summer; P?<?0.001). In group A (60,000 IU/month), mean 25(OH)D level had increased to 22.3?±?12.4 ng/ml (P?<?0.001) at 9 months (winter). In group B (120,000 IU/month), 25(OH)D levels were maintained at 30.7?±?12.8 ng/ml at 9 months (winter).

Conclusion

Our data show that monthly administration of 60,000 IU cholecalciferol in healthy subjects with hypovitaminosis D may suffice in summer months, but higher doses may be more appropriate during winter months.     

Vitamin D status in women with pelvic floor disorder symptoms

Introduction and hypothesis

Our aim was to characterize the relationship between 25-hydroxyvitamin D [25(OH)D] status with pelvic floor symptom distress and impact on quality of life.

Methods

A retrospective chart review was performed in women with a 25(OH)D level drawn within 1 year of their gynecology/urogynecology visit. Validated questionnaires including the Colorectal?CAnal Distress Inventory (CRADI)-8 and Incontinence Impact Questionnaire (IIQ-7) were used. Multivariate analyses characterized pelvic floor disorder (PFD) symptom differences among women by vitamin D status.

Results

We studied 394 women. Mean ± standard deviation (SD) 25(OH)D levels were higher in women without than with PFD symptoms (35.0?±?14.1 and 29.3?±?11.5 ng/ml, respectively (p?<?0.001)]. The prevalence of vitamin D insufficiency was 51% (136/268). CRADI-8 and IIQ-7 scores were higher among women with vitamin D insufficiency (p?=?0.03 and p?=?0.001, respectively). Higher IIQ-7 scores were independently associated with vitamin D insufficiency (p?<?0.001).

Conclusions

Insufficient vitamin D is associated with increased colorectal symptom distress and greater impact of urinary incontinence on quality of life.     

The impact of dietary calcium intake and vitamin D status on the effects of zoledronate

Summary

We investigated whether baseline dietary calcium intake or vitamin D status modified the effects of zoledronate. Neither variable influenced the effect of zoledronate on bone mineral density, bone turnover, or risk of acute phase reaction, suggesting that co-administration of calcium and vitamin D supplements with zoledronate may not always be necessary.

Introduction

Calcium and vitamin D supplements are often co-administered with bisphosphonates, but it is unclear whether they are necessary for therapeutic efficacy or minimizing side effects of bisphosphonates. We investigated whether baseline dietary calcium intake or vitamin D status modified the effect of zoledronate on bone mineral density (BMD) or bone turnover at 1 year, or the risk of acute phase reactions (APR).

Methods

Data were pooled from two trials of zoledronate in postmenopausal women without vitamin D deficiency in which calcium and vitamin D were not routinely administered. The cohort (zoledronate n?=?154, placebo n?=?68) was divided into subgroups by baseline dietary calcium intake (<800 vs. ≥800 mg/day) and vitamin D status [25-hydroxyvitamin D (25OHD) <50 vs. ≥50 nmol/L, and <75 nmol/L vs. ≥75 nmol/L] and treatment?×?subgroup interactions tested.

Results

There were 52, 86, and 36 % of the zoledronate group and 64, 94, and 46 % of the placebo group that had dietary calcium intake ≥800 mg/day, 25OHD ≥50 nmol/L, and 25OHD ≥75 nmol/L, respectively. There were no significant interactions between treatment and either baseline dietary calcium or baseline vitamin D status for lumbar spine BMD, total hip BMD, the bone turnover markers P1NP and β-CTx, or the risk of an APR. There was also no three-way interaction between baseline dietary calcium intake, baseline vitamin D status, and treatment for any of these variables.

Conclusions

Baseline dietary calcium intake and vitamin D status did not alter the effects of zoledronate, suggesting that co-administration of calcium and vitamin D with zoledronate may not be necessary for individuals not at risk of marked vitamin D deficiency.     

Vitamin D deficiency in HIV-infected postmenopausal Hispanic and African-American women

Summary

We evaluated vitamin D status in HIV+ and HIV? postmenopausal African-American (AA) and Hispanic women. Most women (74-78%) had insufficient 25-hydroxyvitamin D (25OHD) levels, regardless of HIV status. 25OHD was lower in AA women and women lacking supplement use, providing support for screening and supplementation. Among HIV+ women, 25OHD was associated with current CD4 but not type of antiretroviral therapy.

Introduction

To evaluate vitamin D status and factors associated with vitamin D deficiency and insufficiency in HIV-infected (HIV+) postmenopausal minority women.

Methods

In this cross-sectional study, 89 HIV+ and 95 HIV? postmenopausal women (33% AA and 67% Hispanic) underwent assessment of 25OHD, 1,25-dihydroxyvitamin D, parathyroid hormone, markers of bone turnover and bone mineral density by dual energy X-ray absorptiometry.

Results

The prevalence of low 25OHD did not differ by HIV status; the majority of both HIV+ and HIV? women (74-78%) had insufficient levels (<30?ng/ml). Regardless of HIV status, 25OHD was significantly lower in AA subjects, and higher in subjects who used both calcium and multivitamins. In HIV+ women on antiretroviral therapy (ART), 25OHD was directly associated with current CD4 count (r?=?0.32; p?<?0.01) independent of age, ethnicity, BMI, or history of AIDS-defining illness. No association was observed between 1,25(OH)₂D and CD4 count or between serum 25OHD, 1,25(OH)₂D or PTH and type of ART.

Conclusions

In postmenopausal minority women, vitamin D deficiency was highly prevalent and associated with AA race and lack of supplement use, as well as lower current CD4 cell count. These results provide support for screening and repletion of vitamin D in HIV+ patients.