Hypovitaminosis D in acutely injured pediatric burn patients

PROBLEM: The prevalence of vitamin D insufficiency, its etiology, and associated sequelae among acutely injured burn patients is unknown. OBJECTIVE: This study assessed vitamin D and endocrine status, as well as the effect of anabolic agents, in pediatric patients who had sustained burns in excess of 25% total body surface area (TBSA). SUBJECTS: Sixty-nine patients with a mean TBSA burn of 50.6+/-2.2% (range 27% to 94%) and full thickness injury of 41.3+/-3.0% (range 0% to 94%) were studied. Subjects ranged in age from 0.6 to 18 years (mean, 5.8+/-0.6 years).Main outcome measures Blood samples were obtained for serum 25-hydroxyvitamin D (D25), 1,25-dihydroxyvitamin D (D1,25), albumin, cortisol, triiodothyronine (T3), tetraiodothyronine (T(4)), thyroid stimulating hormone (TSH), and parathormone (PTH). RESULTS: Two hundred eighty morning blood samples of D25 and D1,25 demonstrated that 45% and 26.2% were low and 8.9% and 11% were very low, respectively. At least one low D25 or D1,25 level occurred in 62.3% of all subjects. Very low levels were noted in 23.2% of all patients. There was an increased incidence of hyperparathyroidism in patients with very low serum D25. Vitamin D25 and D1,25 levels were lower in subjects with larger burns or inhalation injury, as well as those treated with thyroxine or oxandrolone. Serum albumin, cortisol, T(4), and TSH were not correlated with concentration of vitamin D. CONCLUSIONS: Demonstration of a high incidence of low serum vitamin D indicates vitamin D status may be significantly compromised in burned children. It is unclear why vitamin D deficiency exists in this population. The most effective way to improve vitamin D status remains elusive at this time.     

Hypovitaminosis D: a veiled diagnosis]

Four cases of hypovitaminosis D were seen in a general practitioner's population in the Netherlands: a Somalian veiled woman aged 53 and her 11-year-old daughter, a dark-skinned Surinam woman aged 31, and a veiled Moroccan woman aged 56 years. This cause of myopathy has only been recently recognised and is more prevalent than often thought, especially in high-risk groups such as veiled and dark-skinned immigrants who lack sunlight in the Netherlands. Symptoms are muscle pain and mainly proximal muscle weakness resulting in difficulties in ascending a staircase or getting up out of a chair. The diagnosis is made on the basis of a detailed history and measurement of serum 25-hydroxyvitamin D. Calcium and serum alkaline phosphatase activity may be normal. Treatment with ergocalciferol is effective and cheap. As diagnosis and treatment are relatively simple, finding and treating hypovitaminosis D is a rewarding challenge to primary health care practitioners in the Netherlands.     

Hypovitaminosis D in the elderly: From bone to brain

Conclusion  There is a growing consensus that vitamin D recommended daily intakes for the elderly are far too low, and that all individuals should take as much vitamin D as needed to raise levels to between 32 to 40 ng/ml (80 to 100 nmol/L) (5, 108, 109). Supplementation will likely be necessary in most elderly, since according to current lifestyles, diet and sunlight alone are inadequate sources of vitamin D (17). We believe that to raise and maintain 25(OH) vitamin D levels at a minimum of 32 ng/ml (80 nmol/L), most elderly will require at least 2,000 IU of cholecalciferol per day. But many questions remain. Are other biological markers preferable to 25(OH) vitamin D to assess repletion? Do the current estimates of optimal serum levels provide health benefits for all conditions, or do optimal vitamin D levels differ depending on the target tissue? How much vitamin D, cholecalciferol, or ergocalciferol, should be given to maintain these levels? What are the molecular mechanisms by which vitamin D influences health and disease? Cross-sectional studies have suggested that low vitamin D levels not only predict nursing home admission but also are associated with increased mortality (1, 2). Further knowledge of the mechanisms of vitamin D action and prospective clinical trials designed to determine if supplementation resulting in vitamin D levels higher than those shown to reduce the risk of falls and fractures is also effective in reducing the burden of various medical conditions could help validate a cost-effective intervention that will provide greater quality of life and longevity and have a major public health impact.     

Hypovitaminosis D and elevated serum alkaline phosphatase in elderly Irish people

The vitamin D status of 181 elderly Irish community-dwelling and institutionalized subjects was studied during Winter-Spring. The mean serum 25-hydroxyvitamin D level was 10 nmol/L (95% range less than 5.0-59 nmol/L); values were below 25 nmol/L in 79 percent of subjects. A significant seasonal variation of serum 25-hydroxyvitamin D levels was noted in elderly community-dwelling subjects. The previously documented age-related increase in serum alkaline phosphatase activity was significantly less in vitamin D replete subjects than in vitamin D deplete subjects in this study (P less than 0.005). The higher serum alkaline phosphatase values found in the vitamin D deplete subjects may represent mild secondary hyperparathyroidism or osteomalacia. The relationship of vitamin D status to both dietary intake and effective sunlight (latitude) is examined.     

Hypovitaminosis D is common in both veiled and nonveiled Bangladeshi women

The present cross-sectional study was designed to evaluate the vitamin D status in three groups of women in Bangladesh by using serum 25-hydroxyvitamin D (S-25-OHD), alkaline phosphatase (S-ALP), calcium (S-Ca) and phosphate (S-P). Sampling was undertaken at three locations in the city of Dhaka, Bangladesh. Representative subjects of three groups of women aged 18-60 years were studied. Study subjects included nonveiled young women = group A (N = 36, mean+/- SD age 22.3 +/- 1.9 years), veiled women =group B (N = 30, mean+/- SD age 47.7+/- 9.4 years) and nonveiled diabetic women = group C (N = 55, mean +/- SD age 50.2 +/- 5.9 years). The mean value of S-25-OHD was not significantly different in the groups. The distribution of S-25-OHD concentration in all groups was shifted overall toward the lower limit of the normal range. Vitamin D deficiency (serum 25-OHD level <25 nmol/l) was detected in 39% of young women (university students), 30% in veiled women and 38% in diabetic women, respectively. Vitamin D insufficiency defined as serum 25-OHD concentration <40 nmol/l was detected in 78% of group A, 83% in group B and 76% in group C, respectively. As indicated, prevalence of vitamin D insufficiency was a bit higher in group B compared with the other groups studied although it was not statistically significant (P > 0.05). In the present study, there were several independent predictors of serum 25-OHD, i.e. both increasing parity (r = 0.286; P < 0.005) and increasing time spent outdoors (r = 0.515; P < 0.001) were associated with significant increase in serum 25-OHD. A strongly significant inverse correlation between serum ALP and 25-OHD (r = -0.303;P<0.001) was observed. The results showed that women in Bangladesh, regardless of different age-groups, lifestyle and clothing, were at risk of developing hypovitaminosis D.The results emphasize the appropriate health message for vitamin D needs in Bangladeshi women, since vitamin D insufficiency significantly affects bone integrity.     

原发性膝骨关节炎患者骨质疏松及维生素D缺乏症患病率研究

目的探讨正常人群与原发性膝骨关节炎(OA)患者骨质疏松症(OP)及维生素D缺乏症患病情况。方法选择某医院收治的原发性OA 98例,选择同期健康人108例作为正常对照组。对两组进行双能力线吸收法(DXA)扫描观察骨密度水平,采集血液样本进行血清维生素D测定。分析骨密度水平、血清维生素D3水平与原发性OA的相关性。结果骨密度水平与原发性OA显著相关,血清维生素D3水平与OA显著相关(P0.05)。血清维生素D3水平与年龄间无相关性(P0.05),与性别、骨密度存在显著相关性(P0.01)。结论 OP在正常人群和OA患者中患病率较高,维生素D3缺乏症在OA患者中发病率较高,且与骨密度相关。     

Hypovitaminosis D3 in menopausal women in a tertiary care hospital in Delhi

Blood samples from 126 menopausal women, seeking treatment for different ailments at a tertiary care, multidisciplinary hospital in Delhi, India, were examined for their vitamin D(3), quantified by 25-hydroxvitamin D (25-OH-D) level. Using a direct ELISA kit, the 25-OH-D levels were measured and were found to be sufficient in 30 (23.8%) cases, adequate in 10 cases (7.9%) and deficient in 86 cases (68.2%). Severe hypo-vitaminosis in menopausal women in the Indian subcontinent ought to be treated with oral or parenteral supplementation. Point-of-care assay formats are needed for quantification of 25-OH-D levels at healthcare centers.     

Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction

BACKGROUND: Although the role of vitamin D in type 2 diabetes is well recognized, its relation to glucose metabolism is not well studied. OBJECTIVE: We investigated the relation of 25-hydroxyvitamin D [25(OH)D] concentrations to insulin sensitivity and beta cell function. DESIGN: We enrolled 126 healthy, glucose-tolerant subjects living in California. Insulin sensitivity index (ISI) and first- and second-phase insulin responses (1stIR and 2ndIR) were assessed by using a hyperglycemic clamp. RESULTS: Univariate regression analyses showed that 25(OH)D concentration was positively correlated with ISI (P < 0.0001) and negatively correlated with 1stIR (P = 0.0045) and 2ndIR (P < 0.0001). Multiple regression analyses confirmed an independent correlation between 25(OH)D concentration and ISI (P = 0.0007). No independent correlation was observed between 25(OH)D concentration and 1stIR or 2ndIR. However, an independent negative relation of 25(OH)D concentration with plasma glucose concentration was observed at fasting (P = 0.0258), 60 min (P = 0.0011), 90 min (P = 0.0011), and 120 min (P = 0.0007) during the oral-glucose-tolerance test. Subjects with hypovitaminosis D (<20 ng/mL) had a greater prevalence of components of metabolic syndrome than did subjects without hypovitaminosis D (30% compared with 11%; P = 0.0076). CONCLUSIONS: The data show a positive correlation of 25(OH)D concentration with insulin sensitivity and a negative effect of hypovitaminosis D on beta cell function. Subjects with hypovitaminosis D are at higher risk of insulin resistance and the metabolic syndrome. Further studies are required to explore the underlying mechanisms.     

Hypovitaminosis D in an Italian population of healthy subjects and hospitalized patients.

The present study aimed to investigate the prevalence and seasonal variation of hypovitaminosis D (defined as serum 25-hydroxyvitamin D level below 30 nmol/l) among healthy subjects and hospitalized patients living in central Italy. We studied 297 subjects, 131 in February 1997 and 166 in July 1997, subdivided into four groups: (a) young healthy blood donors; (b) healthy postmenopausal women; (c) inpatients with various medical diseases and (d) inpatients engaged in long-term rehabilitation programmes because of various neurological disorders. In all subjects and patients serum levels of 25-hydroxyvitamin D were measured by radioimmunoassay. We found a significant seasonal variation (P < 0.0001) of serum 25-hydroxyvitamin D levels, mean values being higher in summer in all groups, except in patients with a longer hospitalization time (group (d)). In each group, a significantly higher prevalence of hypovitaminosis D was found in winter compared with summer time (P < 0.001), being unexpectedly high in postmenopausal women (winter 32% and summer 4.5%); furthermore, in both seasons, inpatients were characterized by the highest incidences of hypovitaminosis, particularly those in group (d) (winter 82.3% and summer 57.8%). The results of the present study emphasize the importance of 25-hydroxyvitamin D measurement, and the need to increase vitamin D intake in Italy; foodstuff fortification and supplement use must be considered in order to prevent negative effects of vitamin D deficiency on skeletal integrity.     

Hypovitaminosis D-induced pain

Vitamin D deficiency is a problem of considerable magnitude that has reemerged as a major public health issue in the United States and several other developed countries. Vitamin D plays a crucial role in calcium homeostasis in the body. Hypovitaminosis D leads to osteomalacia and increased risk of fractures, especially in the elderly. Preliminary research suggests that vitamin D can prevent certain types of cancer and autoimmune diseases. A recent large study has shown the association between severe hypovitaminosis D and persistent, non-specific musculoskeletal pain, further suggesting that patients with no apparent cause of pain should be assessed and possibly treated for vitamin D deficiency.     

Hypovitaminosis D is associated with reductions in serum apolipoprotein A-I but not with fasting lipids in British Bangladeshis

BACKGROUND: Although hypovitaminosis D has been suggested to increase the risk of heart disease, its relation to components of the fasting lipid profile has not been clarified for specific ethnic groups. OBJECTIVE: The objective was to determine the relation of circulating 25-hydroxyvitamin D [25(OH)D] concentrations to fasting lipid concentrations in South Asian subjects at risk of hypovitaminosis D. DESIGN: The present study was conducted in 170 British Bangladeshi adults, 69 men and 101 women, from east London who were free of known diabetes or chronic disorders. Vitamin D repletion was assessed by measuring fasting serum 25(OH)D concentrations. Fasting lipid profiles were measured as part of a study of the risk factors for type 2 diabetes and ischemic heart disease, which included hypovitaminosis D. RESULTS: A univariate analysis showed that total cholesterol, LDL cholesterol, and both apolipoprotein (apo) A-I and apo B concentrations correlated directly with serum 25(OH)D concentrations. However, a multiple regression analysis, which included all the documented risk factors for diabetes and ischemic heart disease, showed that the 25(OH)D concentration (vitamin D status) was an independent predictor of increasing apo A-I concentrations (standardized coefficient beta = 0.3; P < 0.001) but not of fasting lipid concentrations. CONCLUSIONS: In this study of British South Asians, the data showed a positive relation of fasting apo A-I concentrations to serum 25(OH)D concentrations, independent of glycemia and other dietary, anthropometric, and lifestyle risk factors for type 2 diabetes and ischemic heart disease after multiple regression analyses. Subjects with hypovitaminosis D are likely to have an increased risk of ischemic heart disease independent of their increased risk of type 2 diabetes.