Calcidiol Levels Research Articles

Vitamin D as a Possible COVID-19 Prevention Strategy.

Vitamin D is no longer considered an agent only affecting calcium phosphate metabolism. A number of studies over the past few years have demonstrated its role in immunomodulation and its influence on the development and functioning of the brain and nervous system. In the current epidemiological crisis caused by coronavirus disease 2019 (COVID-19), the immunoprotective role of vitamin D has been discussed by some authors regarding whether it contributes to protection against this serious disease or whether its use does not play a role. Non-standard approaches taken by laboratories in examining the serum levels of the vitamin D metabolite calcidiol have contributed to inconsistent results. We examined the serum of 60 volunteers in the spring and autumn of 2021 who declared whether they were taking vitamin D at the time of sampling. Furthermore, the tested participants noted whether they had experienced COVID-19. A newly developed liquid chromatography–tandem mass spectrometry (LC-MS/MS) method was used to measure calcidiol levels. The analysis of variance (ANOVA) model of Statgraphics Centurion 18 statistical software from Statgraphics Technologies was used for calculations. The results of this study showed that those who took vitamin D suffered significantly less often from COVID-19 than those who did not take vitamin D.

Vitamin D Status Among Children With Juvenile Idiopathic Arthritis: A Multicenter Prospective, Non-randomized, Comparative Study.

BackgroundJuvenile idiopathic arthritis (JIA) is a chronic autoimmune disease characterized by destructive and inflammatory damage to the joints. The aim in this study was to compare vitamin D levels between children and adolescents, 1–18 years of age, with juvenile idiopathic arthritis (JIA) and a health control group of peers. We considered effects of endogenous, exogenous, and genetic factors on measured differences in vitamin D levels among children with JIA.MethodsOur findings are based on a study sample of 150 patients with various variants of JIA and 277 healthy children. The blood level of vitamin D was assessed by calcidiol level. The following factors were included in our analysis: age and sex; level of insolation in three regions of country (center, south, north); assessment of dietary intake of vitamin D; effect of prophylactic doses of cholecalciferol; a relationship between the TaqI, FokI, and BsmI polymorphisms of the VDR gene and serum 25(OH)D concentration.ResultsWe identified a high frequency of low vitamin D among children with JIA, prevalence of 66%, with the medial level of vitamin D being within the range of “insufficient” vitamin D. We also show that the dietary intake of vitamin D by children with JIA is well below expected norms, and that prophylactic doses of vitamin D supplementation (cholecalciferol) at a dose of 500–1,000 IU/day and 1,500–2,000 IU/day do not meet the vitamin D needs of children with JIA. Of importance, we show that vitamin D levels among children with JIA are not affected by clinical therapies to manage the disease nor by the present of VDR genetic variants.ConclusionProphylactic administration of cholecalciferol and season of year play a determining role in the development of vitamin D deficiency and insufficiency.

Acanthosis Nigricans Is a Strong Predictor of Low Blood Calcidiol Levels in Children and Adolescents.

Background: Clinical consensus differs as to when blood vitamin D (VD) levels should be measured in children. Obesity and metabolic syndrome are risk factors for low VD levels and are also associated with acanthosis nigricans (AN). Objectives: To test whether the clinical diagnosis of AN is a strong predictor for vitamin D deficiency (VDD) in children. Methods: Within the study period (2015-2020), we identified 677 consecutive individuals (age <18 years) with available calcidiol measurements and compared those with (n = 273) and without (n = 404) AN. Bivariate associations and the occurrence of AN were tested using the chi-squared test. Multivariate logistic regression was performed to control for confounding variables, and adjusted odds ratios with 95% confidence intervals (CI) were reported. Multiple regression analysis was performed, and unstandardized beta coefficients, standard errors, and standardized beta coefficients were reported. Results: Individuals with AN had 3.6 times higher odds of VDD than those without (95% CI: 1.38-9.51, P = 0.009). Males had 0.41 times lower odds of having AN than females (95% CI: 0.21-0.79, P = 0.008). Individuals with vitamin D sufficiency (VDS) were much less likely to be diagnosed with metabolic syndrome compared with those who were vitamin D deficient (P = 0.011), even after adjusting for body mass index z-scores. Conclusion: Children and adolescents with AN are at a higher risk of VDD and should likely be tested for low calcidiol levels.

Vitamin D Supplementation Improves Mitochondrial Function and Reduces Inflammation in Placentae of Obese Women.

BackgroundAbout 30% of women entering pregnancy in the US are obese. We have previously reported mitochondrial dysregulation and increased inflammation in the placentae of obese women. Vitamin D (VitD) is a major player in calcium uptake and was shown to modulate mitochondrial respiration and the immune/inflammation system. Studies show decreased VitD levels in obese individuals; however, the effect of maternal obesity on VitD metabolism and its association with placental function remains understudied.MethodsMaternal and cord blood plasma and placental samples were collected upon C-section from normal-weight (NW, body mass index [BMI]<25) and obese (OB, BMI>30) women with uncomplicated pregnancies at term. We measured 25(OH)D3 (calcidiol) levels in maternal and cord blood plasma using ELISA. We assessed the expression of CYP27B1, an activator of calcidiol, and Vitamin D receptor (VDR) in placentae from NW and OB, and women with gestational diabetes and preeclampsia. In addition, we examined the effects of VitD supplementation on mitochondrial function and inflammation in trophoblasts from NW and OB, using the Seahorse Bioanalyzer and Western blot, respectively.ResultsVitamin D levels in blood from OB but not NW women and in cord blood from babies born to NW and OB women showed a significant inverse correlation with maternal pre-pregnancy BMI (r=-0.50, p<0.1 and r=-0.55, p=0.004 respectively). Cord plasma VitD levels showed a positive correlation with placental efficiency, i.e., the ratio between fetal and placental weight, as well as with maternal blood VitD levels (r=0.69 and 0.83 respectively, p<0.00). While we found no changes in CYP27B1 in OB vs. NW women, VDR expression were decreased by 50% (p<0.03) independent of fetal sex. No changes in VDR expression relative to BMI-matched controls were observed in the placentae of women with gestational diabetes or preeclampsia. Cytotrophoblasts isolated from placentae of OB women showed a dose-dependent increase in VDR expression after 24-hour treatment with calcitriol (10 nM and 100 nM), an active form of VitD. Trophoblasts isolated from OB women and treated with calcitriol improved mitochondrial respiration (p<0.05). We also found a two-fold increase in expression of the NLRP3 inflammasome and the pro-inflammatory cytokine IL-18 in trophoblasts isolated from placentae of OB women (p<0.05), with IL-18 expression being reversed by calcitriol treatment (100 nM).ConclusionsWe show that VitD deficiency is at least partially responsible for mitochondrial dysfunction and increased inflammation in the placentae of obese women. Vitamin D supplementation could be beneficial in improving placental dysfunction seen in obese women.

Hypothesis: Mutual dependency of ascorbate and calcidiol for optimal performance of the immune system

For a proper functioning, immune cells require sufficient levels of ascorbate and calcidiol in the blood. Upon activation, immune cells increase their internal conversion of calcidiol to calcitriol. In general, calcitriol can affect the expression of ca. 3% of the genes in the human genome. Among the gene products are a number of Fe(II)- and 2-oxoglutarate-dependent dioxygenases functioning as demethylases of histones, DNA, RNA and ribosomes in epigenetic gene regulation. These dioxygenases require millimolar concentrations of ascorbate for activity. Immune cells contain 1–4 mM ascorbate. It is hypothesized here that there is a mutual dependency of ascorbate and calcidiol for optimal performance of the human immune system. Early signs for this thesis are in literature, but were not yet recognized. Daily intake of both compounds to keep the plasma levels to ca. 75 µM for ascorbate and to at least 75 nM for calcidiol, will reduce the risk of serious disease after infections. This applies in particular to infected individuals with prolonged elevated levels of neutrophils. Reports state that such subjects are often deficient in either ascorbate (vitamin C) or calcidiol (vitamin D3), but none of the studies considered the levels of both at the same time.

БРОНХОЛЁГОЧНАЯ ДИСПЛАЗИЯ У ГЛУБОКО НЕДОНОШЕННЫХ МЛАДЕНЦЕВ И ОБЕСПЕЧЕННОСТЬ ВИТАМИНОМ D: ПЕРИНАТАЛЬНЫЕ ОСОБЕННОСТИ

Background. In recent decades, many studies have been carried out showing the relationship between the development, severity, frequency of exacerbations of various diseases and insufficient supply of vitamin D. There is more and more data on the role of vitamin D in lung maturation and surfactant formation, which is very important for children with bronchopulmonary dysplasia (BPD) which develops mainly in extremely premature newborns. The aim of the study is to establish the supply of vitamin D in extremely premature infants with bronchopulmonary dysplasia in the perinatal period. Material and methods. We examined 75 extremely premature infants, determined the level of calcidiol in the blood serum at 1-2 days of life in all children, analyzed the maternal history of vitamin D intake. 38 infants developed bronchopulmonary dysplasia (1 main group), the second group consisted of 37 premature infants who did not develop BPD. Results. We established the frequency of taking preparations containing vitamin D during the last month before childbirth (63.2% in group 1 and 84.7% in group 2) by women; and also the analysis of the received dosage of cholecalciferol was carried out: only 18.4% of women of the 1st group received vitamin D in a dosage of more than 1000 IU. The level of 25 (OH) D in blood serum in patients of both groups at birth was determined: 13.9 (6.4; 37.1) ng/ml and 30.6 (11.8; 54.3) ng/ml in groups 1 and 2, respectively, p=0.031. A negative correlation was found between the content of 25 (OH) D in blood serum at birth and the severity of BPD (rs = -0.39; p=0.013). Conclusions. The serum calcidiol content at birth in BPD patients is statistically significantly lower than in infants without BPD: 13.9 (6.4; 37.1 ng/ml) versus 30.6 (11.8; 54.3) ng/ml, p = 0.031. The median vitamin D content in children with severe BPD at birth was 8.5 (3.2; 20.9) ng/ml; with moderate BPD - 13.6 (6.4; 35.0) ng/ml; in newborns with mild BPD - 41.4 (16.3; 64.6) ng/ml, p &lt;0.05. The vast majority of mothers of infants with BPD (81.6%) received vitamin D at a dose of less than 1000 IU.

A single-oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve outcomes in the COVID-19 disease: the COVID-VIT-D\u2014a randomised multicentre international clinical trial

BackgroundVitamin D status has been implicated in COVID-19 disease. The objective of the COVID-VIT-D trial was to investigate if an oral bolus of cholecalciferol (100,000 IU) administered at hospital admission influences the outcomes of moderate-severe COVID-19 disease. In the same cohort, the association between baseline serum calcidiol levels with the same outcomes was also analysed.MethodsThe COVID-VIT-D is a multicentre, international, randomised, open label, clinical trial conducted throughout 1 year. Patients older than 18 years with moderate-severe COVID-19 disease requiring hospitalisation were included. At admission, patients were randomised 1:1 to receive a single oral bolus of cholecalciferol (n=274) or nothing (n=269). Patients were followed from admission to discharge or death. Length of hospitalisation, admission to intensive care unit (ICU) and mortality were assessed.ResultsIn the randomised trial, comorbidities, biomarkers, symptoms and drugs used did not differ between groups. Median serum calcidiol in the cholecalciferol and control groups were 17.0 vs. 16.1 ng/mL at admission and 29.0 vs. 16.4 ng/mL at discharge, respectively. The median length of hospitalisation (10.0 [95%CI 9.0–10.5] vs. 9.5 [95%CI 9.0–10.5] days), admission to ICU (17.2% [95%CI 13.0–22.3] vs. 16.4% [95%CI 12.3–21.4]) and death rate (8.0% [95%CI 5.2–12.1] vs. 5.6% [95%CI 3.3–9.2]) did not differ between the cholecalciferol and control group. In the cohort analyses, the highest serum calcidiol category at admission (>25ng/mL) was associated with lower percentage of pulmonary involvement and better outcomes.ConclusionsThe randomised clinical trial showed the administration of an oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve the outcomes of the COVID-19 disease. A cohort analysis showed that serum calcidiol at hospital admission was associated with outcomes.Trial registrationCOVID-VIT-D trial was authorised by the Spanish Agency for Medicines and Health products (AEMPS) and registered in European Union Drug Regulating Authorities Clinical Trials (EudraCT 2020-002274-28) and in ClinicalTrials.gov (NCT04552951).

Association of High Calcitriol Serum Levels and Its Hydroxylation Efficiency Ratio with Disease Risk in SLE Patients with Vitamin D Deficiency.

Vitamin D (calcidiol) deficiency in systemic lupus erythematosus (SLE) is more frequent than in healthy subjects (HS); it is associated with clinical activity and damage in SLE. Although calcidiol is considered the best indicator of the vitamin D serum status, its deficiency could not reflect its hydroxylation efficiency ratio and calcitriol serum status. This study was aimed at assessing the association of calcidiol and calcitriol serum levels and its hydroxylation efficiency ratio with the risk to clinical and renal disease activities in SLE patients. A cross-sectional study was conducted in 308 SLE and HS women; calcidiol and calcitriol serum levels were evaluated by immunoassays. SLE patients showed lower calcidiol serum levels vs. HS (21.2 vs. 24.2 ng/mL; p < 0.001). Active SLE patients presented higher calcidiol/calcitriol ratio scores vs. inactive SLE patients (2.78 vs. 1.92 pg/ng; p = 0.02), and SLE patients with renal disease activity showed a pattern of calcidiol-deficient levels (19.5 vs. 25.3 ng/mL; p < 0.04) with higher calcitriol levels (47 pg/mL vs. 41.5 pg/mL; p = 0.02) and calcidiol/calcitriol ratio scores (2.13 vs. 1.54 pg/ng; p < 0.02) compared to SLE patients without renal disease activity. Calcidiol levels were negatively correlated with calcitriol levels (r = −0.26; p = 0.001) and urine proteins (mg/dL) (r = −0.39; p < 0.01). Regarding calcitriol levels, it was positively correlated with the blood lymphocyte count (r = 0.30; p < 0.001) and negatively correlated with the glomerular filtration rate (r = −0.28; p = 0.001). Moreover, the calcitriol/calcidiol ratio was positively correlated with urine proteins (r = 0.38; p < 0.01). The calcidiol deficiency (OR = 2.27; 95% CI = 1.15-4.49; p < 0.01), high calcitriol levels (T3rd, OR = 4.19, 95% CI = 2.23-7.90; p < 0.001), and a high calcitriol/calcidiol ratio score (T3rd, OR = 5.93, 95% CI: 3.08-11.5; p < 0.001) were associated with the risk for SLE. In conclusion, a pattern of calcidiol deficiency with high calcitriol serum levels and a high vitamin D hydroxylation efficiency ratio was associated with disease risk in SLE patients.

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

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

The association between vitamin D deficiency and metabolic syndrome in Ukrainian adolescents with overweight and obesity.

PurposeThis work aims to determine the association between vitamin D deficiency and metabolic syndrome in overweight and obese adolescents from Ukraine.MethodsAnthropometric measurements were taken and general and biochemical examinations were performed on 136 obese and overweight adolescents and 60 adolescents with normal body weight. The vitamin D status was determined using 25-hydroxyvitamin D (25(OH)D) (calcidiol) levels in blood serum. To establish the factors influencing vitamin D status, the subjects were asked to answer a questionnaire and 2007 International Diabetes Federation diagnostic criteria were used to determine the incidence of metabolic syndrome. All research results were processed statistically.ResultsA calcidiol sufficiency level was found in 3.9% of obese adolescents and 6.7% of overweight adolescents. Metabolic syndrome was found in 64.4% of obese adolescents with vitamin D deficiency, and in 26.2% of overweight adolescents. Factors associated with an increased risk of developing vitamin D deficiency in adolescents with metabolic syndrome included male sex (P=0.042), low income per family member (P=0.040), daily milk consumption of up to 1 cup per day (P=0.001), physical activity (P=0.001), duration of outdoor stays (P=0.001), and passive rest in front of a computer or television (P=0.001). Adolescents with metabolic syndrome were found predominance of body mass index (P<0.001), waist circumference (P<0.001), fasting blood glucose level (P<0.001), and decreased calcidiol level (P=0.022). Among metabolic syndrome components, vitamin D deficiency was strongly associated with waist circumference and increased fasting blood glucose (P<0.05).ConclusionsVitamin D deficiency is prevalent in overweight and obese adolescents from Ukraine. Vitamin D deficiency is associated with metabolic syndrome criteria in overweight and obese adolescents.

Differentiated approach to correcting low vitamin D status in adolescent girls in Moscow

Introduction. The work is devoted to the study of vitamin D status in adolescent girls and the selection of adequate doses for its correction.Study objective. To study the dynamics of calcidiol concentration in the blood serum against vitamin D3 intake and evaluate the effectiveness of correcting doses of vitamin in adolescent girls from Moscow.Study design. A double-blind, placebo-controlled, prospective, randomized clinical study.Materials and methods. The study involved adolescent girls aged from 11 to 17 years (n = 218) from I-II health groups, with determined serum level of 25(OH)D. Participants were randomly assigned to the main and control groups. The adolescent girls in the study group received vitamin D3 tablets, and the control group received a placebo. Study duration was 6 months. The dose of vitamin D3 was dependent on baseline serum caLcidioL levels and ranged from 800 IU to 2000 IU. Vitamin D status was redetermined in the girls who completed the treatment (n = 192).Results. Initially, 96.4% of girls had a low vitamin D status, while vitamin D insufficiency was observed in 26.6%, deficiency in 57.8%, deep deficiency in 12%. The median level of 25(OH)D in the main group before taking the vitamin was 16.25 ng/ml, after taking - 24.1 ng/ml, in the control group - 17.9 and 11.4 ng/ml, respectively (p &lt; 0.001). In the main group, an increase in the content of the metabolite was observed in 94.9% of the subjects, the initially identified pronounced deficit was completely absent.Conclusions. A differentiated approach to prescribing different doses of cholecalciferon, depending on the baseline level of 25(OH)D, BMI and age, is an effective method for replenishing vitamin D deficiency in adolescents. The high probability of normalization of vitamin D status in certain age groups, mainly with the appointment of low corrective doses of cholecalciferol justifies the possibility of their use for 6 months or more in adolescents during puberty period.

Specific levels of calcidiol, calcitriol, cathelicidin and interferon gamma in diabetic patients with TB infection in Jakarta, Indonesia; Case control study

Vitamin D plays a role in regulating the immune system via Vitamin D receptors, expressed by T-helper cells (Th). Cathelicidin LL-37 is an antimicrobial peptide that acts as the primary barrier against the Mycobacterium tuberculosis bacterial infection, which is induced by calcitriol, the active form of Vitamin D3. Interferon gamma (IFN-γ) is a cytokine released by Th-1 cells, and is essential for the elimination of M. tuberculosis. This study aims to determine the state of, and correlation between, calcidiol, calcitriol, cathelicidin and IFN-γ levels, as well as other clinical factors among patients with Type 2 Diabetes Mellitus (T2DM) with active TB coinfection. Further analysis is also performed to study the differences between T2DM patients with active tuberculosis, latent TB and without TB infection.

Консервативне лікування порушень метаболізму кісткової тканини у хворих на вітамін-D-залежний рахіт ІІ типу з генетичним ушкодженням формування колагену І типу

Мета дослідження: визначити вплив консервативної терапії на генетично зумовлені порушення метаболізму кісткової тканини у хворих на D-залежний рахіт ІІ типу з генетичним ушкодженням формування колагену І типу. Матеріали та методи. На базі консультативно-поліклінічного відділу ДУ «Інститут травматології та ортопедії НАМНУ» було обстежено та проліковано 13 пацієнтів із діагнозом вітамін-D-залежного рахіту ІІ типу з генетичним ушкодженням формування колагену І типу (ВДЗР(COL1)). Консервативне лікування пацієнтів з даним рахітоподібним захворюванням проводилось у 4 етапи. Перший етап включав повне обстеження пацієнта щодо рівня кальцію, фосфору крові та сечі, кальцидіолу та кальцитріолу крові, показників паратиреоїдного гормону та остеокальцину, а також маркера кісткоутворення P1NP і маркера остеорезорбції β-CTx. На першому етапі в обов’язковому порядку діти проходили генетичне дослідження для виявлення змін (поліморфізму) в алелях рецепторів до вітаміну D та колагену І типу. Обстеження на наступних етапах проводилось у повному обсязі, окрім генетичних досліджень. Результати. Виявлено, що генетично зумовлене порушення рецепції вітаміну D призводить до значного акумулювання активного метаболіту вітаміну D у сироватці крові, що при поєднанні даної патології з генетично детермінованим порушенням формування колагену І типу вірогідно впливало на процеси кісткоутворення/кісткоруйнування із залученням механізмів компенсації остеомаляційного процесу (система «паратгормон — вітамін D — остеокальцин»). Всебічне вивчення метаболізму вітаміну D та біохімічних показників життєдіяльності кісткової тканини у хворих на ВДЗР(COL1) дозволило впритул підійти до розуміння деяких питань патогенезу та сутності остеомаляційних, а в подальшому — остеопоротичних змін різного ступеня, об’єктивувати ці зміни у відповідних показниках біохімічного дослідження та залежно від змін розробити різні схеми медикаментозної корекції порушень кісткового обміну при даному захворюванні. Висновки. Порушення рецепції до кальцитріолу в поєднанні з генетично зумовленим порушенням формування колагену І типу відображає найбільш тяжкі порушення метаболізму кісткової тканини при вітамін-D-залежному рахіті, що, у свою чергу, викликає в організмі дитини, яка росте, прискорення кісткового обміну та прогресування остеомаляційних процесів поряд зі значним прискоренням розсмоктування кісткової тканини. Це, на нашу думку, пов’язано з формуванням недосконалого колагену, який організм дитини намагається перебудувати, хоча дане припущення потребує подальшого вивчення.

Обеспеченность витамином D и минеральная плотность костной ткани у больных ювенильным ревматоидным артритом

Актуальность. Мониторирование минеральной плотности костной ткани (МПКТ) у больных ювенильным ревматоидным артритом (ЮРА), дополненное определением сывороточного уровня кальцидиола (25(ОН)D) является индикатором системности процессов катаболизма и критерием успешности терапии. Цель. Оценка показателей денситометрии, уровня кальцидиола у больных ЮРА для определения остеопенического синдрома, целесообразности назначения дополнительных доз витамина D. Материалы и методы. Оценено значение 25(ОН)D и МПКТ у 65 больных ЮРА. Данные обработаны с применением xи-квадрата Пирсона и рангового корреляционного анализа по Спирмену. Результаты. У 92 % больных ЮРА определяется нарушение обеспеченности витамином D. При проведении двухэнергетической рентгеновской абсорбциометрии (DXA) выявлено, что 60 % больных имеют вторичный остеопенический синдром (Z-score ≤ –2 SD). У пациентов, которые получали иммунобиологические препараты в комплексном лечении, наблюдаются достоверно более высокие показатели МПКТ (р &lt; 0,01). Показатель МПКТ имеет сильную негативную корреляционную зависимость от степени активности болезни (коэффициент корреляции (r Spearman’s) равен –0,72), умеренную зависимость от уровня 25(ОН)D (r Spearman’s равный 0,39). Выводы. В процессе наблюдения и мониторинга лечения больных ЮРА необходимо контролировать уровень 25(ОН)D и МПКТ. 68 % больных ЮРА, которые в качестве базисной терапии получают плановое лечение иммунобиологическими препаратами, имеют нормальную МПКТ.

Association of Perioperative Complications with Vitamin D Levels in Major Head and Neck Surgery.

To investigate the association of vitamin D level and perioperative complications in patients undergoing major head and neck surgery. Retrospective Cohort Study. A retrospective chart review was performed for all patients undergoing reconstructive head and neck surgery between December 2017 and December 2019. Data regarding patient demographics, serum 25-hydroxyvitamin D (calcidiol) level, hospital course, prior radiation, and fistula formation were collected. Patients were categorized by serum calcidiol level as deficient (<20 ng/mL) or sufficient (≧20 ng/mL) and outcomes were compared between groups. Fifty-seven patients were included in the analysis. Average age at time of surgery was 62.6 ± 10.6 years. Patients with vitamin D levels <20 ng/mL were considered deficient and ≧20 ng/mL were considered sufficient. Individuals in the deficient group (n=29) had a mean serum calcidiol level of 13.95 ± 3.95 ng/mL, whereas those in the sufficient group (n=28) had a mean calcidiol level of 28.53 ± 5.73 ng/mL. The rate of fistula was 41.4% in the deficient group, whereas patients in the sufficient group had a rate of fistula of 14.3% (P= .038). On multivariate analysis, higher serum calcidiol level above 20 ng/mL was associated with a lower likelihood of developing fistulae with an odds ratio 0.830 (95% confidence interval: 0.718-0.960, P= .012). Vitamin D deficiency may play a role in development of fistula after major head and neck surgery. 4 Laryngoscope, 132:578-583, 2022.

Patterns of renal osteodystrophy 1 year after kidney transplantation.

Renal osteodystrophy is considered common, but is not well characterized in contemporary kidney transplant recipients. This study reports extensively on bone phenotype by bone histomorphometry, bone densitometry and novel bone biomarkers 1 year after kidney transplantation. A transiliac bone biopsy and dual-energy X-ray absorptiometry scans were performed in 141 unselected kidney transplant recipients in this observational cohort study. Blood and 24-h urine samples were collected simultaneously. The median age was 57 ± 11 years, 71% were men and all were of Caucasian ethnicity. Bone turnover was normal in 71% of patients, low in 26% and high in just four cases (3%). Hyperparathyroidism with hypercalcaemia was present in 13% of patients, of which only one had high bone turnover. Delayed bone mineralization was detected in 16% of patients, who were characterized by hyperparathyroidism (137 versus 53 ρg/mL), a higher fractional excretion of phosphate (40 versus 32%) and lower levels of phosphate (2.68 versus 3.18 mg/dL) and calcidiol (29 versus 37 ng/mL) compared with patients with normal bone mineralization. Osteoporosis was present in 15-46% of patients, with the highest prevalence at the distal skeleton. The proportion of osteoporotic patients was comparable across categories of bone turnover and mineralization. The majority of kidney transplant recipients, including patients with osteoporosis, have normal bone turnover at 1-year post-transplant. Low bone turnover is seen in a substantial subset, while high bone turnover is rare. Vitamin D deficiency and hypophosphataemia represent potential interventional targets to improve bone health post-transplant.

Mortality in Hemodialysis Patients with COVID-19, the Effect of Paricalcitol or Calcimimetics.

Background. In COVID-19 patients, low serum vitamin D (VD) levels have been associated with severe acute respiratory failure and poor prognosis. In regular hemodialysis (HD) patients, there is VD deficiency and markedly reduced calcitriol levels, which may predispose them to worse outcomes of COVID-19 infection. Some hemodialysis patients receive treatment with drugs for secondary hyperparathyroidism, which have well known pleiotropic effects beyond mineral metabolism. The aim of this study was to evaluate the impact of VD status and the administration of active vitamin D medications, used to treat secondary hyperparathyroidism, on survival in a cohort of COVID-19 positive HD patients. Methods. A cross-sectional retrospective observational study was conducted from 12 March to 21 May 2020 in 288 HD patients with positive PCR for SARS-CoV2. Patients were from 52 different centers in Spain. Results. The percent of HD patients with COVID-19 was 6.1% (288 out of 4743). Mortality rate was 28.4% (81/285). Three patients were lost to follow-up. Serum 25(OH)D (calcidiol) level was 17.1 [10.6–27.5] ng/mL and was not significantly associated to mortality (OR 0.99 (0.97–1.01), p = 0.4). Patients receiving active vitamin D medications (16/94 (17%) vs. 65/191(34%), p = 0.003), including calcimimetics (4/49 (8.2%) vs. 77/236 (32.6%), p = 0.001), paricalcitol or calcimimetics (19/117 (16.2%) vs. 62/168 (36.9%); p < 0.001), and also those on both paricalcitol and calcimimetics, to treat secondary hyperparathyroidism (SHPTH) (1/26 (3.8%) vs. 80/259 (30.9%), p < 0.001) showed a lower mortality rate than patients receiving no treatment with either drug. Multivariate Cox regression analysis confirmed this increased survival. Conclusions. Our findings suggest that the use of paricalcitol, calcimimetics or the combination of both, seem to be associated with the improvement of survival in HD patients with COVID-19. No correlation was found between serum VD levels and prognosis or outcomes in HD patients with COVID-19. Prospective studies and clinical trials are needed to support these findings.

FC 124PATTERNS OF RENAL OSTEODYSTROPHY ONE YEAR AFTER KIDNEY TRANSPLANTATION

Abstract Background and Aims Bone disease after kidney transplantation is an issue of growing concern, as prolonged graft survival and older age of recipients necessitate focus on long-term health burdens such as osteoporosis and fractures. Pre-existing type of renal osteodystrophy, post-transplant immunosuppressive treatment, and de novo disturbances of mineral metabolism all contribute to bone disease in kidney transplant recipients. The current pattern of renal osteodystrophy after kidney transplantation is not well characterized. This study reports histomorphometric findings of protocolled bone biopsies in a large cohort of kidney transplant recipients 1 year post-transplant. Method Histomorphometric analysis of transiliac bone biopsies with prior tetracycline labelling was performed in 141 kidney transplant recipients. Biochemical measurements included bioactive parathyroid hormone (PTH), total calcium, phosphate, calcidiol, bicarbonate, and sclerostin. Kruskal-Wallis and Wilcoxon signed rank tests were used to evaluate differences across categories and between groups, respectively. Stepwise multivariate linear regression was performed to identify key demographic and biochemical determinants of bone turnover (bone formation rate, BFR), mineralization (mineralization lag time, Mlt), and volume (Bone area, BAr). Results Mean age was 57±11 years, 71% were men, and all were Caucasian. Mean eGFR was 49±16 (range 19 to 106) ml/min/1.73 m². Hyperparathyroidism (PTH &amp;gt; 1.5xUNL) was seen in 48%, hypercalcemia (&amp;gt;10.3 mg/dL) in 18%, hypophosphatemia (&amp;lt;2.3 mg/dl) in 12%, and vitamin D deficiency (&amp;lt;15 ng/mL) in 4% of patients. Categorization of bone turnover, mineralization, and volume is shown in Figure 1. Bone turnover was normal in the vast majority (71%). Patients with low turnover (26%) had received a higher cumulative steroid dose (2.78 vs 2.34g in low vs non-low turnover; p=0.02). Patients with delayed mineralization (16%) were younger (52 vs 58 yrs, p=0.02) and had received a higher cumulative steroid dose (2.85 vs 2.36g, p=0.003). They had higher levels of PTH (124 vs 53 ng/L, p&amp;lt;0.001), and lower levels of phosphate (2.68 vs 3.18 mg/dL, p&amp;lt;0.001), calcidiol (29 vs 37ug/L, p=0.02), bicarbonate (21.3 vs 23.3 mmol/L, p=0.004), and sclerostin (493 vs 594 pg/mL, p=0.03) compared to patients with normal mineralization. Patients with low bone volume tended to be older (61 vs 56 years, p=0.07). Independent determinants of BFR were PTH (β=0.68, p&amp;lt;0.001) and cumulative steroid dose (β = -0.22, p=0.02). Determinants of Mlt were phosphate (β=-0.48, p=0.001) and cumulative steroid dose (β=0.18, p=0.004), and determinants of BAr were age (β=-0.15, p=0.002), and BMI (β=0.33, p=0.002). Conclusion Bone turnover is normal in the majority of kidney transplant recipients at 1 year post-transplant, despite a high prevalence of hyperparathyroidism. Low levels of bicarbonate, phosphate, and calcidiol may contribute to delayed bone mineralization in kidney transplant recipients.

Role of vitamin D in pre-school children’s health

Vitamin D has pleiotropic effects, including maintaining calcium and phosphate homeostasis, and affecting the immune and endocrine systems. The article summarizes data on the expected biological effects of vitamin D on children’s health. The results of randomized clinical trials evaluating the effect of vitamin D supplementation on the incidence of acute respiratory tract infections are reviewed in detail. It has been shown that daily intake of vitamin D at a dose of 10 to 25 mcg/day (400–1000 IU/day) compared with placebo leads to a significant decrease in the proportion of children and adolescents who have had at least one episode of acute respiratory infection. The criteria for the provision of calciferol and the gradation of the status of vitamin D deficiency and deficiency in different countries are discussed. It has been shown that in the interpretation of the 25 (OH) D results there is a consensus on two points: calcidiol levels below 12 ng/ml (30 nmol/L) are considered clearly insufficient, and levels above 30 ng/ml (75 nmol/L) are considered sufficient in all regions. The incidence of hypovitaminosis D has been reported in children aged 3 to 7 years, where the overall combined assessment, regardless of age group, ethnic composition and breadth of the studied populations, showed that 13% of European children had a serum calcidiol concentration of less than 12 ng/ml (&lt;30 nmol/L), and about 40% had a level of less than 30 ng/ml (&lt;75 nmol/L). The data on the physiological need and the recommended daily dose of vitamin D for preschool children have been analyzed. In each country, the recommended intake of vitamin D is set (from 400 to 4000 IU), depending on the target concentration of serum calcidiol, the level of insolation, and nutritional characteristics. The necessity of conducting clinical studies in the age group from 3 to 7 years to determine an adequate, effective and safe preventive dose of vitamin D for preschool children in the Russian Federation is emphasized.

ВНЕДРЕНИЕ НАЦИОНАЛЬНОЙ ПРОГРАММЫ ПО ПРОФИЛАКТИКЕ И КОРРЕКЦИИ ГИПОВИТАМИНОЗА D У ДЕТЕЙ: ПЕРВЫЕ РЕЗУЛЬТАТЫ В ГРУППЕ РАННЕГО ВОЗРАСТА

To date, the most discussed issue is the rational dosage and duration of cholecalciferol preparations course for the correction and prevention of hypovitaminosis D. Objective of the research: to compare the structure of provision and the median 25 (OH) D before (2013–2016) and during the introduction into clinical practice (2018–2019) of the National Program Vitamin D Deficiency in Children and Adolescents in the Russian Federation: Modern approaches to correction» in young children. Materials and methods: the study had two stages. The first stage took place as a part of the RODNICHOK2 study from 2013 to 2016 before the implementation of the National Program «Vitamin D Deficiency in Children and Adolescents in the Russian Federation: Modern Approaches to Correction». The second stage of the study took place in 2018–2019 during the implementation of the National Program in clinical practice. The study participants were 246 children aged from 1 month to 3 years who took cholecalciferol preparations. The assessment of calcidiol concentration in the blood serum was assessed by the method of chemiluminescence immunoassay (CLIA) using reagents Liaison® 25OH Vitamin D Total Assay on the Liaison Dia Sorin Pleutschland GmbH device in the centralized laboratory of Scientific Center EFIS Ltd, Moscow. Results: during the introduction into clinical practice of the National Program, the frequency of prescribing a dosage of 500 IU/day significantly decreased to 4,9% (χ2=80,4, p&lt;0,001), 1000 IU/day – statistically significantly increased to 71% (χ2=53,5; p&lt;0,001), and a dose of 1500 IU/day was taken by 24% of children, mainly in the second and third years of life. In children examined in 2013–2016, the median serum calcidiol was 29,1 [22,8; 39,5] ng/ml, statistically significantly lower than in 2018– 2019, – 51,3 [38,1; 61,5] ng/ml (p&lt;0,001). Hypovitaminosis D in young children in southern Russia until 2018 was diagnosed in 54,9%, statistically significantly more often than during the implementation of the National Program – in 12.2% of children (χ2=24,3, p&lt;0,001). The number of children with a calcidiol level of more than 30 ng/ml, on the contrary, statistically significantly increased from 45,1 to 87,8% (χ2=39,9, p&lt;0,001). There was a statistically significant decrease in the number of children with vitamin D deficiency – only 10 (12,2%) cases, while earlier their number was 62 (37,8%) (χ2=17,3, p&lt;0,001). Among children examined in 2018–2019, it was possible to completely eliminate severe deficiency (calcidiol level less than 10 ng/ml) and vitamin D deficiency (10–20 ng/ml), while previously it was revealed in 6 (3,7%) (χ2=220,8, p&lt;0,001) and 22 (13,4%) children (χ2=167,9, p&lt;0,001). In 2013–2016 the indicator of the recommended average daily dosage of vitamin D was 73,3 [51,6; 103,1] IU/kg per day, while in 2018–2019. During the implementation of the recommendations set out in the National Program – 125,0 [102,0; 148,7] IU/kg per day (p&lt;0,0001). Conclusion: the study confirmed daily doses per kilogram of body weight in the range from 100 to 150 IU/kg, included in the main provisions of the recommendations for prophylactic intake of vitamin D preparations at an early age. The introduction of the recommendations on the prophylactic course of vitamin D supplementation described in the National Program «Vitamin D Deficiency in Children and Adolescents in the Russian Federation: Modern Approaches to Correction» into wide clinical practice allowed to achieve a significant increase in the number of children receiving additional vitamin D supplements. The recommended average daily dose in comparison with the period before the implementation of the National Program has increased statistically significantly.