High Prevalence Of Hypovitaminosis Research Articles

Best Laboratory Screening in Diagnosing Secondary Osteoporosis and Fracture Risk Assessment Tool and the National Osteoporosis Guideline Group Performance in Determining Clinical Risk: A Cross-Sectional Evaluation of the Bone Health in Postmenopausal Brazilian Women.

Identifying postmenopausal women with a high risk of having osteoporosis and fractures is a current challenge. This study aimed to assess the diagnostic performance of biochemical tests in identifying secondary osteoporosis and the fracture risk assessment tool (FRAX) in identifying fracture risk. Data from biochemical tests and bone densitometry of postmenopausal women were analyzed. Additionally, the FRAX result was obtained and the patients were classified according to the National Osteoporosis Guideline Group (NOGG). A total of 646 women were evaluated, of whom 201 (31.1%) had osteoporosis or a previous frailty fracture. These women had statistically different parathyroid hormone (PTH) and alkaline phosphatase serum levels (p<0.01 and p=0.02, respectively) than those without osteoporosis or fracture. However, those at high risk had a higher prevalence of hypovitaminosis D (46% vs. 36%) and hypocalciuria (17% vs. 9%). The FRAX showed an area under the curve of 0.757 (p<0.01) and 0.788 (p<0.01) for identifying women at risk for "major fractures" and "hip," respectively. The NOGG categorization had a sensitivity of 19% to identify high-risk women, a specificity of 91.3% for low-risk women, with a positive predictive value of 57.4% and a negative predictive value of 64.6%. The evaluation of PTH, 25-hydroxy-vitamin D, serum calcium, and 24-hr urinary calcium proved adequate for initial osteoporosis screening. The FRAX tool has a regular ability to screen women at risk for fracture, and the NOGG method has high specificity to identify those at low risk.

Vitamin D and Sjögren's Disease: Revealing the Connections-A Systematic Review and Meta-Analysis.

The aim of the present review was to summarize the current evidence about the impact of vitamin D deficiency on pathology and clinical manifestations of Sjögren's disease (SD). Databases PubMed, Web of Science, Scopus, and Cochrane library were searched for studies assessing the levels of vitamin D in SD patients using the following keywords: (vitamin D OR calciferol OR cholecalciferol OR 25-hydroxyvitamin D OR 25-hydroxycholecalciferol OR calcidiol OR calcitriol OR 1,25-dihydroxycholecalciferol) AND (Sjögren's Syndrome OR Sjögren's disease) accessed on 20 September 2022. Out of 248 retrieved studies, following the systematic review methodology and defined inclusion and exclusion criteria, 9 clinical studies were eligible to be included in the present review: 4 of them case-control, 4 cross-sectional, and 1 cohort study. Nine studies totaling 670 SD patients and 857 healthy controls were eligible for meta-analysis with moderate to high methodological quality as determined by the Newcastle-Ottawa Quality Scale (NOS). According to the obtained results, a high prevalence of hypovitaminosis D was observed in SD patients when compared to healthy controls (95% CI -10.43, -2.39; p < 0.01). Available evidence points to lower levels of vitamin D in patients with SD in comparison to healthy controls. However, further studies are necessary to understand the underlying mechanisms associated with the role of vitamin D in the development and disease severity of SD.

Vitamin D levels and their association with oxidative stress and inflammation markers in patients with cystic fibrosis.

Introduction: cystic fibrosis is a disease that causes inflammation, oxidative stress and metabolic changes that lead to nutrient deficiency, such as vitamin D deficiency. On the other hand, it is suggested that vitamin D has anti-inflammatory and antioxidant actions. Objective: to evaluate the prevalence of hypovitaminosis D and the association between serum 25 hydroxyvitamin D levels with markers of oxidative stress and inflammation in patients with cystic fibrosis. Method: a cross-sectional study was carried out with 48 patients with cystic fibrosis including children, adolescents and adults in the northeast region of Brazil. Blood collection was performed for analysis of 25-hydroxyvitamin D, calcium, parathyroid hormone, inflammatory process (C-reactive protein (CRP) and alpha-1-acid glycoprotein-A1 (A1GPA)) and oxidative stress (malondialdehyde (MDA) and total antioxidant capacity (CAOT)). The statistical analysis was performed using the "Statistical Package for the Social Sciences", adopting a significance level of p < 0.05. Results: Vitamin D insufficiency/deficiency was found in 64.6 % of patients. After multiple linear regression analysis, MDA showed an inverse association with blood values of 25-Hydroxyvitamin D (p < 0.05) conditioned by the presence of inflammatory process markers. When only oxidative stress was evaluated, this association disappeared. Conclusion: in conclusion, there was a high prevalence of hypovitaminosis D, with 25(OH)D levels associated with greater oxidative stress when combined with inflammatory markers. Improved vitamin D levels may be an alternative to reduce the damage caused by excess oxidative stress and inflammation in CF patients.

Correlation between Vitamin D Status and Antithyroid Antibody Levels in Patients with Newly Diagnosed Hashimoto Thyroiditis: Case-Control Study in Tlemcen (Algeria)

Introduction: Hashimoto thyroiditis (HT) is characterized by the presence of antithyroid antibodies with lymphocyte infiltration of the thyroid gland. Its etiology results from the interaction between environmental factors and genetic susceptibility traits. One of the factors most recently involved in autoimmunity is vitamin D. The principal aim of our study was to investigate a possible relationship between vitamin D status and antithyroid antibody levels in patients with newly diagnosed Hashimoto diseases, from Tlemcen. Materials and methods: Cross-sectional case-control study, including 310 subjects, divided into two groups: a group of cases (n = 155) with newly diagnosed HT and a group of apparently healthy controls (n = 155). The 02 groups were matched by sex, age ± 02 years, body mass index (BMI) and the same season (blood collection period). All subjects benefited from hormonal assays, anti-thyroid antibodies and biochemical parameters (Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), anti-peroxydase antibody (anti-TPO), anti-thyroglobulin antibody (anti-Tg), 25 hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), calcemia, phosphoremia, albuminemia and alkaline phosphatases). Results: High prevalence of hypovitaminosis D in our study population: 98% at the threshold of 25(OH)D &lt; 30 ng/mL, 89% at the threshold &lt; 20 ng/mL. The most significant risk factors associated with low levels of 25(OH)D are lack of sun exposure, season, skin color and lack of physical activity. The 25(OH)D deficit is more pronounced in the HT group than in the control group with a significant difference (11.45 ± 5.16 vs 13.02 ± 7.45; p = 0.03). In the HT group, the correlation between the status of 25(OH)D and the anti-TPO is inverse and significant (r = - 0.185; p = 0.02), relationship confirmed by multivariate analysis by linear regression where the 02 variables statistically related to anti-TPO are Vit D and TSH. Moreover, no correlation between 25(OH)D and anti-Tg and not between 25(OH)D and the degree of depth of biological hypothyroidism. Conclusion: There is an inverse and significant statistical relationship between serum levels of 25(OH)D and anti-TPO in the case group, however the exact involvement of vitamin D in the immunopathogenesis of Hashimoto’s diseases remains to be substantiated.

High Prevalence of Hypovitaminosis D in Adolescents Attending a Reference Centre for the Treatment of Obesity in Switzerland.

Background: Hypovitaminosis D is common in populations with obesity. This study aimed at assessing (1) the prevalence of hypovitaminosis D and (2) the associations between vitamin D levels and cardiovascular risk factors in adolescents attending a reference centre for the treatment of obesity. Design: Cross-sectional pilot study conducted in the paediatric obesity unit of the Lausanne university hospital, Switzerland. Methods: Participants were considered eligible if they (1) were aged between 10 to 16.9 years and (2) consulted between 2017 and 2021. Participants were excluded if (1) they lacked vitamin D measurements or (2) the vitamin D measurement was performed one month after the base anthropometric assessment. Hypovitaminosis D was considered if the vitamin D level was <30 ng/mL (<75 nmol/L). Severe obesity was defined as a BMI z-score > 3 SD. Results: We included 52 adolescents (31% girls, mean age 13 ± 2 years, 33% with severe obesity). The prevalence of hypovitaminosis D was 87.5% in girls and 88.9% in boys. The vitamin D levels were inversely associated with BMI, Spearman r and 95% CI: −0.286 (−0.555; −0.017), p = 0.037; they were not associated with the BMI z-score: −0.052 (−0.327; 0.224), p = 0.713. The vitamin D levels were negatively associated with the parathormone levels (−0.353 (−0.667; −0.039), p = 0.028) and positively associated with the calcium levels (0.385 (0.061; 0.708), p = 0.020), while no association was found between vitamin D levels and blood pressure and lipid or glucose levels. Conclusion: almost 9 out of 10 adolescents with obesity in our cohort presented with hypovitaminosis D. Hypovitaminosis D does not seem to be associated with a higher cardiovascular risk profile in this group.

High Prevalence of Hypovitaminosis D in Cutaneous and Systemic Lupus Erythematosus Patients and Its Associated Factors: A Cross-Sectional Study in Thailand.

ObjectiveTo investigate the prevalence of low vitamin D levels in patients with cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE) in Thailand and determine the influential factors associated with inadequate levels.MethodsThe medical records of patients diagnosed with SLE and/or CLE and evaluated for serum 25-OH vitamin D were retrospectively reviewed from January 2014 to January 2021. Vitamin D deficiency (<20 ng/mL) and insufficiency (21–29 ng/mL) were indicated, and predictors of hypovitaminosis D were identified by multiple linear regression analysis.ResultsIn total, 414 patients with SLE and/or CLE were included in the study. Vitamin D deficiency was predominant in the CLE-only group (33.3%), followed by SLE without CLE (15.6%) and SLE with CLE (8%), p < 0.001. Likewise, vitamin D insufficiency was more prevalent in the CLE-only group (44.4%) compared to SLE with (35.8%) and without CLE (40%). Multivariate analysis showed that a higher SLEDAI-2K score and female sex had a negative association with vitamin D levels, while an intake of every 10,000 IU of vitamin D2 per week increased serum vitamin D levels by up to 2.37 ng/mL. Furthermore, forty-five percent of patients continued to have vitamin D depletion despite commencing the recommended doses of vitamin D replacement.ConclusionApproximately half of Thai patients with SLE and 80% of CLE had vitamin D inadequacy. Vitamin D replacement is a good predictor of high serum vitamin D levels, while lower serum levels were associated with higher disease severity. Therefore, serum vitamin D monitoring and supplementation are suggested for all lupus erythematosus cases, especially those with CLE.

Vitamin D is associated with body composition and fat intake, but not with cardiometabolic parameters in adults with obesity

Adults with obesity are at higher risk for developing hypovitaminosis D. Some studies suggest that reduced levels of serum 25-hydroxyvitamin D (25(OH)D) may also be related to disorders in cardiometabolic parameters. However, because of the association between 25(OH)D and obesity, we hypothesized that body composition can be a confounding factor in the association of 25(OH)D with cardiometabolic parameters, and that 25(OH)D is inversely associated with body composition and cardiometabolic parameters and directly associated with fat intake. The aim of this study was to analyze the associations between 25(OH)D with body composition, fat intake, and cardiometabolic parameters in adults with obesity. This cross-sectional study consisted of 52 adults with obesity (61.53% female; 37.50 ± 6.88 years; body mass index [BMI]: 33.60 ± 2.89 kg/m2). Cardiometabolic parameters (fasting blood glucose, insulin resistance index, C-reactive protein, blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and cholesterol), body mass, BMI, waist circumference, body fat percentage, and fat intake were evaluated. Body mass was negatively associated with 25(OH)D (β=-0.108; P=.048; and R²=0.090) and BMI (β=-0.621; P=.031; and R²=0.103), both adjusted for fat intake. 25(OH)D was positively associated with fat intake (β=0.129; P=.045 and R²=0.078) adjusted for sex, age, and skin color. Cardiometabolic parameters were not associated with 25(OH)D, even after adjusted by body composition variables. However, the high prevalence of hypovitaminosis D (75%) and the negative association between 25(OH)D and body composition reinforce the importance of analyzing and monitoring vitamin D status in this population.

Correlation of Serum Ferritin, Vitamin D Levels, and Severity of Clinical Symptoms in Patients with COVID-19

: Nowadays, the world is experiencing the COVID-19 pandemic. Iron deficiency anemia and vitamin D deficiency are two of the world's most prevalent health problems. Severe COVID-19 patients were found with elevated serum ferritin and decreased vitamin D levels. There is a need to investigate the possible roles of micronutrients in the severity and mortality of COVID-19. This descriptive-analytical cross-sectional study was conducted on 437 COVID-19 patients who were hospitalized from April to August 2020. Demographic, clinical, and laboratory data of the patients were collected. Medical experts determined the severity of the infection based on the severity of the clinical symptoms and the extent and degree of the lung infection. The data were analyzed using SPSS statistical software Version 16. The mean age of the participants was 60.74 ± 16.70 years old, and the most common comorbidities were diabetes type II (15.1%) and hypertension (12%). Shortness of breath (58.6%), anosmia (55.1%), and ageusia (45.1%) were the most common presenting symptoms. The mean serum vitamin D level was 28.86 ± 15.69 ng/mL, and vitamin D deficiency was found in 53% of patients. The mean serum ferritin level was 125.32 ± 97.99 for males and 302 ± 73.6 for females. Significant correlations were observed between serum vitamin D levels, lower oxygen saturation rate, and COVID–19 severity. A significant relationship was found between the serum ferritin levels and hospitalization duration (P &lt; 0.05). Our findings indicated that COVID-19 patients treated in the hospital had a high prevalence of hypovitaminosis D. The severity of the disease was increased in patients with vitamin D deficiency and elevated serum ferritin levels.

Vitamin D: A Role Also in Long COVID-19?

Coronavirus disease 2019 (COVID-19) has quickly become a global pandemic. Reports from different parts of the world indicate that a significant proportion of people who have recovered from COVID-19 are suffering from various health problems collectively referred to as “long COVID-19”. Common symptoms include fatigue, shortness of breath, cough, joint pain, chest pain, muscle aches, headaches, and so on. Vitamin D is an immunomodulatory hormone with proven efficacy against various upper respiratory tract infections. Vitamin D can inhibit hyperinflammatory reactions and accelerate the healing process in the affected areas, especially in lung tissue. Moreover, vitamin D deficiency has been associated with the severity and mortality of COVID-19 cases, with a high prevalence of hypovitaminosis D found in patients with COVID-19 and acute respiratory failure. Thus, there are promising reasons to promote research into the effects of vitamin D supplementation in COVID-19 patients. However, no studies to date have found that vitamin D affects post-COVID-19 symptoms or biomarkers. Based on this scenario, this review aims to provide an up-to-date overview of the potential role of vitamin D in long COVID-19 and of the current literature on this topic.

Prevalence of hypovitaminosis D in the adult population of the Republic of Belarus

Hypovitaminosis D in both adults and children is detected with high frequency in various geographic zones of our planet. At the same time, vitamin D has a number of positive effects on human health and is an important micronutrient for prevention of some diseases. The purpose of this study is to identify the incidence of vitamin D deficiency and insufficiency in the adult population of the Republic of Belarus. We analyzed the laboratory results on total vitamin D that was produced in 2019 and 2020 in persons over 18 years old living in the Republic of Belarus. The vitamin D status was assessed according to international guidelines. The average level of vitamin D in the surveyed population during the study period did not reach normal values in all age groups in both men and women. The highest frequency of hypovitaminosis D was observed in the autumn-winter period and reached 81.6 % in January 2019 and 77.8 % in January 2020. In the summer months, normal levels of vitamin D were observed in less than 50 % of those surveyed: the maximum values were 40.7 % in July 2019 and 45.8 % in July 2020. Due to the high prevalence of hypovitaminosis D, it is advisable to carry out measures for prevention and treatment of DVD in the residents of the Republic of Belarus at the population level.

Hypovitaminosis D and risk factors in pediatric epilepsy children

BackgroundAnti-seizure medication (ASM) treatment is one of the significant risk factors associated with abnormal vitamin D status in epilepsy patients. Multiple studies have shown that adult epilepsy patients can exhibit vitamin D deficiency. However, there are few reports investigating pediatric epilepsy patients. In this study, we aimed to identify risk factors related to hypovitaminosis D in pediatric epilepsy patients in Thailand.MethodsA cross-sectional retrospective cohort study was conducted in 138 pediatric epilepsy patients who received anticonvulsants from April 2018 to January 2019. Demographic data, seizure types, puberty status, physical activity, duration, and types of anti-seizure medications were analyzed. Patients with abnormal liver function, abnormal renal function, and who received vitamin D supplements or ketogenic diet containing vitamin D were excluded. Levels of serum vitamin D (25(OH)D) were measured.ResultsAll 138 subjects were enrolled, the age ranged from 1.04 – 19.96 years; (mean = 9.65 ± 5.09), the mean serum 25(OH) D level was 26.56 ± 9.67 ng/ml. The prevalence of vitamin D deficiency was 23.2% and insufficiency was 47.8% respectively. Two risk factors—puberty status (OR 5.43, 95% CI 1.879-15.67) and non-enzyme-inhibiting ASMs therapy (OR 3.58, 95% CI 1.117-11.46)—were significantly associated with hypovitaminosis D, as shown by multivariate analyses.ConclusionsOur study reports the high prevalence of hypovitaminosis D in pediatric epilepsy patients in Thailand despite being located in the tropical zone. These findings can guide clinicians to measure vitamin D status in pediatric epilepsy patients particularly when they reach puberty and/or are using non-enzyme-inhibiting ASMs therapy. Early detection of vitamin D status and prompt vitamin D supplementation can prevent fractures and osteoporosis later in life.Trial registrationTCTR20210215005 (http://www.clinicaltrials.in.th/).

Investigating the Role of Functional Polymorphism of Maternal and Neonatal Vitamin D Binding Protein in the Context of 25-Hydroxyvitamin D Cutoffs as Determinants of Maternal-Neonatal Vitamin D Status Profiles in a Sunny Mediterranean Region.

Recent results indicate that dysregulation of vitamin D-binding protein (VDBP) could be involved in the development of hypovitaminosis D, and it comprises a risk factor for adverse fetal, maternal and neonatal outcomes. Until recently, there was a paucity of results regarding the effect of maternal and neonatal VDBP polymorphisms on vitamin D status during pregnancy in the Mediterranean region, with a high prevalence of hypovitaminosis D. We aimed to evaluate the combined effect of maternal and neonatal VDBP polymorphisms and different maternal and neonatal 25-hydroxyvitamin D (25(OH)D) cut-offs on maternal and neonatal vitamin D profile. Blood samples were obtained from a cohort of 66 mother–child pairs at birth. Our results revealed that: (i) Maternal VDBP polymorphisms do not affect neonatal vitamin D status at birth, in any given internationally adopted maternal or neonatal cut-off for 25(OH)D concentrations; (ii) neonatal VDBP polymorphisms are not implicated in the regulation of neonatal vitamin D status at birth; (iii) comparing the distributions of maternal VDBP polymorphisms and maternal 25(OH)D concentrations, with cut-offs at birth, revealed that mothers with a CC genotype for rs2298850 and a CC genotype for rs4588 tended to demonstrate higher 25(OH)D (≥75 nmol/L) during delivery (p = 0.05 and p = 0.04, respectively), after adjustments for biofactors that affect vitamin D equilibrium, including UVB, BMI and weeks of gestation. In conclusion, this study from Southern Europe indicates that maternal and neonatal VDBP polymorphisms do not affect neonatal vitamin D status at birth, whereas mothers with CC genotype for rs2298850 and CC genotype for rs4588 demonstrate higher 25(OH)D concentrations. Future larger studies are required to establish a causative effect of these specific polymorphisms in the attainment of an adequate (≥75 nmol/L) maternal vitamin D status during pregnancy.

Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study.

ABSTRACTBackground: Critically ill Indian children have a higher prevalence of vitamin D deficiency. However, there is not much data available on the subgroup with sepsis. It has been reported that there is an impaired response of parathyroid hormone (PTH) to vitamin D deficiency in critically ill children and adults. Hence, we also sought to analyze the PTH response to vitamin D among the subgroup of critically ill children with sepsis.Patients and methods: Vitamin D and PTH levels of 84 critically ill children with sepsis (cases) and 84 controls were compared between November 2018 and February 2020. Hypovitaminosis D was defined as levels <30 ng/mL.Results: The median (IQR) of vitamin D for cases was 26 (21.30–29.95) ng/mL and that for controls 39.3 (33.65–50.2) ng/mL; p <0.001. Cases had a higher prevalence of hypovitaminosis D as compared to controls (79.7 vs 9.5%; p <0.001). Among the cases, mortality was 24.6% in the 65 children with hypovitaminosis D and 10.5% in those with sufficient vitamin D; the differences were not statistically significant (p = 0.339). There were no significant differences in the duration of pediatric intensive care unit (PICU) stay, serum calcium, PTH, and disease severity among the aforementioned groups. Out of the 65 children with hypovitaminosis D, only 9 (13.8%) were PTH responders. There were no statistically significant differences in mortality, the PICU stay, or disease severity at admission between PTH responders and nonresponders.Conclusions: Hypovitaminosis D was more prevalent among critically ill children with sepsis compared to controls. Parathyroid gland response to hypovitaminosis D was impaired in children with sepsis.How to cite this article: Kubsad P, Ravikiran SR, Bhat KG, Kamath N, Kulkarni V, Manjrekar PA, et al. Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study. Indian J Crit Care Med 2021;25(8):923–927.

Vitamin D deficiency as a predictor of severity in patients with COVID-19 infection.

As an immune modulator, vitamin D has been implicated in the coronavirus disease 2019 (COVID-19) severity. This study aimed to investigate the association between vitamin D levels and the severity of COVID-19 infection. A cross-sectional study, which included 124 patients diagnosed with COVID-19 and were selected from Ain Shams University Hospitals and assigned to two groups; mild and severe COVID-19. All patients underwent detailed history taking, clinical data, and different laboratory investigations as complete blood count, blood urea nitrogen, serum creatinine, liver enzymes, C-reactive protein, D-dimer, ferritin and serum vitamin D concentration. In addition to findings of initial chest computed tomography (CT) were recorded. COVID-19 Reporting and Data System (CO-RADS) and CT chest severity scores (CT SS) were reported. In this study of 124 COVID-19-positive individuals, a high prevalence of hypovitaminosis D was found (97.6%). Lower vitamin D levels were significantly associated with more severe COVID-19 cases (p-value < 0.001), higher blood levels of inflammatory markers including (D-dimer, CRP, and ferritin), a higher CT SS and longer disease duration. Serum vitamin D can be used as a predictor for the severity of COVID-19 infection with a specificity of 96.6%, and sensitivity of 45.5%. The high frequency of hypovitaminosis D in severe COVID-19 patients provides further evidence of a potential link to poor prognosis and severity of the disease, so vitamin D deficiency may be a marker of poor prognosis in these patients.

Hypocalcemia in COVID-19: Prevalence, clinical significance and therapeutic implications.

COVID-19 extra-pulmonary features include several endocrine manifestations and these are becoming strongly clinically relevant in patients affected influencing disease severity and outcomes.At the beginning of COVID-19 pandemic no population data on calcium levels in patients affected were available and in April 2020 a first case of severe acute hypocalcemia in an Italian patient with SARS-CoV-2 infection was reported. Subsequently, several studies reported hypocalcemia as a highly prevalent biochemical abnormality in COVID-19 patients with a marked negative influence on disease severity, biochemical inflammation and thrombotic markers, and mortality. Also a high prevalence of vertebral fractures with worse respiratory impairment in patients affected and a widespread vitamin D deficiency have been frequently observed, suggesting an emerging “Osteo-Metabolic Phenotype” in COVID-19.To date, several potential pathophysiological factors have been hypothesized to play a role in determining hypocalcemia in COVID-19 including calcium dependent viral mechanisms of action, high prevalence of hypovitaminosis D in general population, chronic and acute malnutrition during critical illness and high levels of unbound and unsaturated fatty acids in inflammatory responses.Since hypocalcemia is a frequent biochemical finding in hospitalized COVID-19 patients possibly predicting worse outcomes and leading to acute cardiovascular and neurological complications if severe, it is reasonable to assess, monitor and, if indicated, replace calcium at first patient hospital evaluation and during hospitalization.

Impact of vitamin D level on glycemic control in diabetes mellitus type 2 in Duhok

BackgroundVitamin D deficiency is prevalent in most parts of the world. Its insufficiency or deficiency is implicated in bone diseases, some cancers, infectious diseases, heart disease, autoimmune and metabolic diseases including type 2 diabetes mellitus. ResultsThe mean age of patients was 49.94 ± 9.36, while the mean age the controls was 48.95 ± 10.56. Females constituted 56.1% and males 43.9% in the cases group, while for the control group females were 54.8% and males were 43.9%. Low vitamin D levels were detected in 110 (71%) of cases and 63 (40.6%) of controls. There was a significant difference in vitamin D levels among cases and controls (p < 0.001), vitamin D level was lower among females compared to males, p < 0.001 and those living in urban areas compared to rural areas, p < 0.001, BMI and dyslipidemia had a significant effect on vitamin D levels among diabetics, p values 0.002 and < 0.001 respectively. The serum 25(OH)-D level was significantly lower in patients with poor glycemic control compared to those with good glycemic control and in patients with a diabetes duration greater than 5 years, p values < 0.001 and 0.002 respectively. No significant correlation was detected with age and smoking, p values 0.181 and 0.260 respectively. ConclusionThere is a high prevalence of hypo-vitaminosis D among patients with type-2 diabetes, particularly among patients with poor glycemic control and in those with longer diabetes durations. Vitamin-D deficiency is more prevalence in females, and those living in urban areas, those with obesity and patients with dyslipidemia.

High Prevalence of Hypovitaminosis D among Schoolchildren of Shimla in Himachal Pradesh

Title of the article: High prevalence of hypovitaminosis D among schoolchildren of Shimla in Himachal Pradesh. Context: Acquisition of optimal bone mineral health in childhood and adolescence is essential for adequate bone mass during adulthood and old age, as 40-50% of total skeletal mass is accumulated so early in life. Aims: To estimate the prevalence of vitamin D deficiency among the school children of Shimla Settings and Design: A total of 300 children and adolescents of class V1 to X11 of various schools in Shimla were enrolled during July 1, 2015 to September 30, 2015. Methods and Material: After written informed consent, blood samples for 25(OH) D were collected and measured by radioimmunoassay. Statistical analysis: Data analyzed the data using EpiInfo 7.0.9.7 for windows. Results: Among all enrolled cases, 151(50.33%) were girls and 149 (49.76%) boys. Serum 25(OH) D level was significantly lower in girls 11.70± 4.03ng/ml as compared to boys 13.57 ±7.06ng/dl (p=0.0000001). Hypovitaminosis D was present in 98.66% cases, out of which 93.33% had deficient and 5.33% had insufficient 25 (OH) D levels. A total of 34.33% children had severe deficiency, however 4 (1.33%) had sufficient levels and were boys. Conclusions: Prevalence of hypovitaminosis D in apparently healthy schoolchildren in India is high. Awareness needs to be generated about benefits accrued by direct sunlight exposure.

Association of Pre-Operative Vitamin D Levels and Severity of Fracture among Orthopedic Trauma Patients in A Single, Tertiary-Level Hospital

Background/Purpose The high prevalence of hypovitaminosis D among trauma patients have been related to risk of fractures, falls, non-union and poor operative outcomes. There is limited evidence that ties up Vitamin D levels with fracture severity. The objective of this study is to determine the association of pre-operative Vitamin D levels and fracture severity. Methods This was a retrospective, cross-sectional study of patients with extremity fractures classified according to the AO Trauma classification system with baseline pre-operative vitamin D levels. The association between vitamin D levels and fracture severity of surgically treated trauma patients were analyzed. Sub-group analysis was performed on patients without osteoporosis and those patients who suffered from low-energy trauma. Results Ninety-six (96) patients were included. Those with severe fractures (AO -C fractures, 31B1.3/B2.3 and 31A3) were associated with lower Vitamin D levels (µ = 17.87 µg/mL) (p &lt; 0.001). There was a strong, positive significant correlation ( rs (4) = .426, p = &lt; 0.001) between hypovitaminosis D and increasing fracture severity. This significant association of hypovitaminosis D with worse fracture patterns remains in the patient sub-group without osteoporosis ( p = 0.030), and in those who sustained low-mechanism injuries (­ p­ &lt; 0.001). Conclusion We present initial evidence that low pre-operative Vitamin D level is associated with increasing fracture severity at the time of injury. Early detection, surveillance and management of low vitamin D levels can lead to drastic changes in the holistic approach to fracture prevention and treatment.

Principaux facteurs de l’hypovitaminose D chez des enfants âgés de 6 à 12 ans non supplémentés dans un milieu urbain à Alger

Introduction. Hypovitaminosis D is a global public health problem. It affects children of all ages. Objective. To determine the risk factors of hypovitaminosis D in children. Population and methods. Cross-sectional study of non-supplemented children (n=123), 54 girls, and 69 boys, aged between 6-12 years. The thresholds were defined as adequacy 30 ng/mL, and deficiency 10 ng/mL. Seasons, daily sunshine duration, gender, exogenous Vit. D intakes, phototype, and body mass index (BMI) were analysed. The study was carried out during 12 months (January 2018-January 2019) with samples taken during the four seasons. Results. The median age was 8.16 ±1.82 years. Hypovitaminosis D was noted in 79.6% versus 20.4% adequacy. The average BMI was 16.80 ± 3.29kg/m2 [11.89 -30.70]. Vit. D daily intakes &lt; 400 IU/d was noted in 52.9% of children, 75.6% of them were insufficiently exposed to sun. After multivariate analysis, and adjustment, the influencing factors were seasons (pa &lt;0,0001, OR=11.22), and sun exposure (pa &lt;0,001, OR=3.56). The lowest rates were present in winter, and when sunshine was &lt; 30 min/d. There was a significant negative correlation between Vit. D values and parathormone (PTH) rate (p &lt;0,001, r= -0.49). Conclusion. There is a high prevalence of hypovitaminosis D in scholar age children. Sun exposure could be insufficient in this urban city. Children should have adequate outdoor activities with sunlight, according to Word Health Organization (WHO) recommendations. Vit.D supplementation should be intensified, especially in winter, and diet should be enriched in Vit. D

Prevalence of Vitamin D Insufficiency and Deficiency in Young, Female Patients With Lower Extremity Musculoskeletal Complaints.

Low levels of vitamin D have well-known impacts on bone health, but vitamin D also has a more global role throughout many tissues, including skeletal muscle. The high prevalence of hypovitaminosis D and the vast physiological features of vitamin D have led researchers to examine the influence of vitamin D on physical performance and injury. Because of the critical role of vitamin D in maintaining musculoskeletal health and function, a high rate of hypovitaminosis D among female patients with a variety of musculoskeletal issues could be of high clinical relevance. There is a high prevalence of low vitamin D in female patients with both acute and overuse sports-related issues of both soft tissue and bone. Prospective cohort study. Level 3. Female patients, aged 16 to 40 years, presenting with lower extremity injury diagnosed within the past 4 weeks, no use of multivitamin or vitamin D supplement, and no history of malabsorption syndrome met the inclusion criteria. Vitamin D levels were assessed and categorized as normal (≥32 ng/mL) and low, which includes insufficient (20.01-31.9 ng/mL) and deficient (≤20 ng/mL). Of the 105 patients enrolled, 65.7% had low vitamin D. Within the low vitamin D cohort, 40.6% were deficient and 59.4% were insufficient. Injuries were grouped into overuse or acute with 74 overuse injuries and 31 acute injuries, exhibiting low vitamin D prevalence of 60.8% and 77.4%, respectively. Patients with ligamentous/cartilaginous injuries exhibited the highest percentage of low vitamin D (76.5%), followed by those with patellofemoral-related complaints (71.0%), muscle/tendon injuries (54.6%), and bone stress injuries (45.5%). In univariable analysis, older age, non-White race, less physical activity, less high-intensity interval training days, less endurance training days, and more rest days showed an association with low vitamin D, but none showed an independent association in multivariable analysis. The prevalence of low vitamin D in female patients with various musculoskeletal complaints was high. Clinicians should evaluate for low vitamin D in both acute and overuse injuries. In addition to screening, this study suggests that clinicians should evaluate for low vitamin D levels beyond bone stress injuries in the setting of acute and overuse injuries.