Large Doses Of Vitamin Research Articles

DEFICIENCY AND TOXICITY OF VITAMINS

Vitamins are substances necessary to sustain life, with many functions. Vitamins must be obtained from food, as they are either not made in the body at all or are not made in sufficient quantities for growth, vitality and wellbeing. Lack of a particular vitamin can lead to incomplete metabolism, fatigue and other important health problems. Deficiency of a vitamin causes symptoms which can be cured by that vitamin. Large doses of vitamins may slow or ever reverse diseases such as cancer, osteoporosis, nerve degeneration and heart disease.

Genetic factors help explain the variable responses of young children with cystic fibrosis to vitamin D supplements.

Children with cystic fibrosis (CF) are susceptible to fat-soluble vitamin deficiencies unless supplemented, but even large doses of vitamin D may not prevent low 25-hydroxyvitamin D (25OHD) concentrations. The explanation for these vitamin D non-responders has been elusive. We utilized data from whole genome sequencing (WGS) to test the hypothesis that genetic variations predict responsiveness to vitamin D supplementation in a prospective cohort study of children with CF in the first 3 years of life. One hundred and one infants born during 2012-2017 and diagnosed with CF through newborn screening were studied. Serum 25OHD concentrations and vitamin D supplement doses were assessed during early infancy and annually thereafter. WGS was performed, the resultant variant calling files processed, and the summary statistics from a recent genome-wide association study were utilized to construct a polygenic risk score (PRS) for each subject. Overall, the prevalence of vitamin D insufficiency (<30ng/mL) was 21% in the first 3 years of life. Among the 70 subjects who always adhered to vitamin D supplement doses recommended by the US CF Foundation guidelines, 89% were responders (achieved vitamin D sufficiency) by 3 years of age, while 11% were transient or non-responders. Multiple regression analysis revealed that PRS was a significant predictor of 25OHD concentrations (p<0.001) and the likelihood of being an earlier responder in the first 3 years of life (p<0.01). A limited SNP analysis revealed variants in four important genes (GC, LIPC, CYP24A1, and PDE3B) that were shown to be associated with 25OHD concentrations and vitamin D responder status. Other determinants included vitamin D supplement dose, season at 25OHD measurement, and pancreatic functional status. Applying WGS in conjunction with utilizing a PRS approach revealed genetic variations that partially explain the unresponsiveness of some children with CF to vitamin D supplementation. Our findings suggest that a nutrigenomics strategy could help promote personalized treatment in CF.

Witamin D in children population - benefits and threats

Introduction Nowadays, it has become fashionable to use dietary supplements containing large doses of vitamin D available without a prescription. In the case of children, dietary supplementation with a properly selected dose of vitamin D is extremely important and brings many benefits, of which it is important to prevent rickets in the pediatric population, attention is also drawn to its toxicity and consequences in the event of an overdose of vitamin D preparations, to which infants and young children are most exposed, examples of risks are hypercalcemia, hypercalciuria and nephrocalcinosis. The aim of the study Showing the benefits and dangers of vitamin D supplementation. Material and methods The research was conducted using PubMed articles and on: vitamin D supplementation in children, vitamin D overdose, vitamin D deficiency. Description of the state of knowledge Vitamin D is the generic name for ergocalciferol and cholecalciferol that we can find in foods, however, food and supplementation are not its only sources, it should be borne in mind that it is possible to synthesize vitamin D in the skin after exposure to ultraviolet reproduction (UV-B). The concentration of 25(OH)D in childhood serum is influenced by the amount and frequency of vitamin D consumed, sun exposure, body weight and body fat levels. The main risk of vitamin D deficiency in children is rickets and defromation of the osteoarticular system and metabolic disorders, and long-term use of its high doses can lead to hypercalcemia and nephrocalcinosis. Summary It is very important to educate parents about the importance of vitamin D supplementation in a dose properly selected for the newborn along with an explanation of the possible consequences of deficiency, as well as overdose.

Review Article: Vitamin C Progress Apoptosis in Breast Cancer

The cancer of breast is virulence in female and is curable in ~70–80% of patients. The vitamin type C is an essential vitamin and consider as an anti-oxidant, so this vitamin could recover the supply for oxygen, stopping the destroy of DNA and other impact necessary in cancer processing. The vitamin C indicate as an active anticancer as the concentricity were monitor in this cancer therapy. The concentricity of this vitamin has a main function in cancer-rising or cancer suppression. These studies have shown a relationship between the vitamin and increase death-rate of breast cancer, so it’s important to detect the anticancer prospective of vitamin C to detect the different among its effect in healthy and damage cells, especially these studies conducted that this difference could depend on the vitamin c concentration. These studies indicate that large doses of vitamin c could decrease the effect of some cancer therapy such as radiation and chemotherapy.

Statement of the Committee of Human Nutrition Science of the Polish Academy of Sciences on the use of dietary supplements containing vitamins and minerals by adults.

The use of dietary supplements (supplementation) is the individual enrichment of the diet with ingredients naturally occurring in food. As a rule, dietary supplements should be used periodically. In nutritional practice, there are many indications for dietary supplementation, but the decision to take dietary supplements should be made by consumers wisely and only in justified situations, when there is a risk that the usual diet does not provide vitamins and minerals in an amount adequate to meet dietary recommendations. However, we should remember about the real dangers of taking too large doses of vitamins and minerals. Many people using dietary supplements, especially several types at the same time, may experience undesirable side effects and deterioration of health, and in addition, people taking medicines may seriously disrupt or weaken the effect of the drug, or even lack the therapeutic effect of the drug. The document presents 10 steps and rules for the use of dietary supplements available on the market, which are addressed to the general population.

Potential Role of Vitamins and Zinc on Acute Respiratory Infections Including Covid-19.

Background. Vitamin C, E, D, A, zinc are considered to be essential in preventing and treating of acute respiratory infections (ARI) including COVID-19. Methods. We reviewed published studies evaluating the potential roles of these vitamin and zinc for ARIs and COVID-19 using Medline database, medRxiv, and bibliographic references. Results. Vitamins C, D, and E did not reduce incidence of common cold in general, but vitamin C reduced by half in population with physical and environment stresses. Vitamins C and E shortened duration and reduced severity of common cold. A large-dose vitamin A had no effect on recovery from pneumonia. Zinc improved clinical deterioration and pneumonia duration in under five. The effect on preventing COVID-19 morbidity and related-death was lacking. Conclusions. Although the effects of vitamins and zinc on ARIs including COVID-19 were inconclusive, taking these for a short period during pandemic may be beneficial when there is risks of deficiency.

Perspective: Integration to Implementation (I-to-I) and the Micronutrient Forum—Addressing the Safety and Effectiveness of Vitamin A Supplementation

ABSTRACTAn ongoing challenge to our ability to address the role of food and nutrition in health promotion and disease prevention is how to design and implement context-specific interventions and guidance that are safe, efficacious, and avoid unintended consequences. The integration to effective implementation (I-to-I) concept is intended to address the complexities of the global health context through engagement of the continuum of stakeholders involved in the generation, translation, and implementation of evidence to public health guidance/programs. The I-to-I approach was developed under the auspices of the Micronutrient Forum and has been previously applied to the question of safety and effectiveness of interventions to prevent and treat nutritional iron deficiency. The present article applies the I-to-I approach to questions regarding the safety and utility of large-dose vitamin A supplementation programs, and presents the authors’ perspective on key aspects of the topic, including coverage of the basic and applied biology of vitamin A nutrition and assessment, clinical implications, and an overview of the extant data with regard to both the justification for and utility of available intervention strategies. The article includes some practical considerations based on specific country experiences regarding the challenges of implementing vitamin A–related programs. This is followed by an overview of some challenges associated with engagement of the enabling communities that play a critical role in the implementation of these types of public health interventions. The article concludes with suggestions for potential approaches to move this important agenda forward.

Magnesium Supplementation in Vitamin D Deficiency.

Vitamin D and magnesium (Mg) are some of the most studied topics in medicine with enormous implications for human health and disease. Majority of the adults are deficient in both vitamin D and magnesium but continue to go unrecognized by many health care professionals. Mg and vitamin D are used by all the organs in the body, and their deficiency states may lead to several chronic medical conditions. Studies described in the literature regarding these disease associations are contradictory, and reversal of any of these conditions may not occur for several years after adequate replacement. One should consider the supplementation therapy to be preventative rather than curative at this time. PubMed search of several reported associations between vitamin D and Mg with diseases. Vitamin D and Mg replacement therapy in elderly patients is known to reduce the nonvertebral fractures, overall mortality, and the incidence of Alzheimer dementia. Vitamin D screening assay is readily available, but the reported lower limit of the normal range is totally inadequate for disease prevention. Based on the epidemiologic studies, ∼75% of all adults worldwide have serum 25(OH)D levels of <30 ng/mL. Because of the recent increase in global awareness, vitamin D supplementation has become a common practice, but Mg deficiency still remains unaddressed. Screening for chronic magnesium deficiency is difficult because a normal serum level may still be associated with moderate to severe deficiency. To date, there is no simple and accurate laboratory test to determine the total body magnesium status in humans. Mg is essential in the metabolism of vitamin D, and taking large doses of vitamin D can induce severe depletion of Mg. Adequate magnesium supplementation should be considered as an important aspect of vitamin D therapy.

Vitamin D supplementation decreases the expression of TGF-β1 in rats with asthma and thereby suppressing airway remodeling

Objective To investigate the preventive and therapeutic effects of 1, 25-(OH)2D3 on airway remodeling in asthmatic rats, and to explore the effect of 1, 25-(OH)2D3 on the expression of transforming growth factor-β1 (TGF-β1) and the related mechanism between them. Methods Seventy male Sprague Dawley (SD) rats were randomly divided into seven groups: normal control group (group A, n=10), asthmatic group (group B, n=10), dexamethasone group (group C, n=10), 1, 25-(OH)2D3 2 μg/(kg·d) group (group D, n=10), 1, 25-(OH)2D3 4 μg/(kg·d) group (group E, n=10), 1, 25-(OH)2D3 8 μg/(kg·d) group (group F, n=10), 1, 25(OH)2D3 16 μg/(kg·d) group (group G, n=10). Rats were sensitized and challenged with ovalbumin (OVA) to establish the asthmatic model in B, C, D, E, F, G group respectively. Rats in group B and group C were fed with normal saline 10 ml/(kg·d) and dexamethasone 2 mg/(kg·d) before atomization. While group D-G was 1, 25- (OH)2D3 intervention group, rats were fed with vitamin D 2, 4, 8, 16 μg/(kg·d) before atomization. The number of total and different cells of the bronchoalveolar lavage fluid (BALF) from the 7 groups was counted for analysis; The change of the thickness, the area of airway wall and the number of ASMC nucleus and pulmonary tissue changes were observed by microscope. The protein and mRNA expression of TGF-β1 in the lung tissue was measured by immunochemistry and real-time polymerase chain reaction (RT-PCR). Results ⑴ The airway remodeling and pulmonary inflammatory exudation in the B group were significantly heavier than those in the A, C and G groups (P<0.01); and the difference between groups of different doses of vitamin D [D group (minimum dose) and G group(the maximum dose) ] was statistically significant (P<0.01). ⑵ The results of TGF-β1 mRNA and protein levels in rats of each group showed that the expression level of TGF-β1 mRNA and integrated option density (IOD) value in A group were significantly lower than those in other groups (P<0.01); the expression level of TGF-β1 mRNA and IOD value in B group was higher than the other groups (P<0.01); Compared with the B group, the expression level of TGF-β1 mRNA and IOD value in G group (large dose vitamin D group) was decreased, with statistically difference. Conclusions In the rat model of asthma, 1, 25-(OH)2D3 may alleviate airway remodeling by regulating the expression of TGF- beta 1 and play its opposite biological effect in the prevention and treatment of asthma. Key words: Asthma; Rats; Transforming growth factor beta1; Vitamin D; Airway remodeling

The differential role of reactive oxygen species in early and late stages of cancer.

The large doses of vitamins C and E and β-carotene used to reduce reactive oxygen species (ROS) production and oxidative damages in cancerous tissue have produced disappointing and contradictory results. This therapeutic conundrum was attributed to the double-faced role of ROS, notably, their ability to induce either proliferation or apoptosis of cancer cells. However, for a ROS-inhibitory approach to be effective, it must target ROS when they induce proliferation rather than apoptosis. On the basis of recent advances in redox biology, this review underlined a differential regulation of prooxidant and antioxidant system, respective to the stage of cancer. At early precancerous and neoplastic stages, antioxidant activity decreases and ROS appear to promote cancer initiation via inducing oxidative damage and base pair substitution mutations in prooncogenes and tumor suppressor genes, such as RAS and TP53, respectively. Whereas in late stages of cancer progression, tumor cells escape apoptosis by producing high levels of intracellular antioxidants, like NADPH and GSH, via the pentose phosphate pathway to buffer the excessive production of ROS and related intratumor oxidative injuries. Therefore, antioxidants should be prohibited in patients with advanced stages of cancer and/or undergoing anticancer therapies. Interestingly, the biochemical and biophysical properties of some polyphenols allow them to selectively recognize tumor cells. This characteristic was exploited to design and deliver nanoparticles coated with low doses of polyphenols and containing chemotherapeutic drugs into tumor-bearing animals. First results are encouraging, which may revolutionize the conventional use of antioxidants in cancer.

Prevention and Treatment of Vitamin D and Calcium Deficiency in Children and Adolescents: Indian Academy of Pediatrics (IAP) Guidelines.

Vitamin D deficiency (VDD) is being increasingly reported from India from all age-groups. Reports suggest that VDD affects all age groups, from neonates to adolescents. Further, habitually low calcium intakes are also reported in Indian children. Given the multiple guidelines, peculiarities of Indian circumstances, changing lifestyles, and lack of fortification, the Indian Academy of Pediatrics (IAP) felt the need for a Practice Guideline for Pediatricians for the prevention and treatment of vitamin D and calcium deficiency in children and adolescents. The 'Guideline for Vitamin D and Calcium in Children' committee was formed by the IAP in September 2016. A consultative committee meeting was held in November 2016 in Mumbai. Evidence from Indian and international studies and other previous published recommendations, which were pertinent to the Indian circumstances, were collated for the preparation of these guidelines. To present a practice guideline for pediatricians for the prevention and treatment of deficiency of vitamin D and calcium in the Indian context. For the prevention of rickets in premature infants, 400 IU of vitamin D and 150-220 mg/kg of calcium, and in neonates, 400 IU of vitamin D and 200 mg of calcium are recommended daily. For prevention of rickets and hypocalcemia in infants (after neonatal period) upto 1 year of age, and from 1-18 years, 400 IU and 600 IU vitamin D/day and 250-500 mg/day and 600-800 mg/day of calcium, respectively, are recommended. For treatment of rickets in premature neonates, infants upto 1 year and from 1-18 years, 1000 IU, 2000 IU and 3000-6000 IU of vitamin D daily, respectively, and elemental calcium of 70-80 mg/kg/day in premature neonates and 500-800 mg daily for all children over that age are recommended. Larger doses of vitamin D may be given from 3 months to 18 years of age as 60,000 IU/week for 6 weeks.

Effect of Circular ANRIL on the Inflammatory Response of Vascular Endothelial Cells in a Rat Model of Coronary Atherosclerosis

Background/Aims: This study aims to investigate the role of circular antisense non-coding RNA at the INK4 locus (cANRIL) in the inflammatory response of vascular endothelial cells (ECs) in a rat model of coronary atherosclerosis (AS). A rat model of AS was established with rats that were injected with a large dose of vitamin D₃ and fed a high-fat diet. Methods: Sixty Wistar rats were randomly assigned into control, model, empty vector, over-expressed cANRIL and low-expressed cANRIL groups (12 rats in each group). Sixteen weeks later, the ultrastructure of their coronary arteries was observed via transmission electron microscopy. Rat serum lipid levels were analyzed using an automatic biochemical analyzer, and their atherogenic index (AI) values were calculated. Hematoxylin and eosin staining was used to observe the endothelial morphology of rats. Additionally, rat EC apoptosis was tested via a TUNEL assay. Enzyme-linked immunosorbent assays (ELISAs) were applied to measure serum levels of interleukin-1 (IL-1), IL-6, matrix metalloproteinase-9 (MMP-9) and C-reactive protein (CRP). The cANRIL, Bax, bcl-2 and caspase-3 mRNA expression levels were measured with a quantitative real-time polymerase chain reaction (qRT-PCR). The protein expression levels of Bax, bcl-2 and caspase-3 were detected using immunohistochemistry. Results: In the control group, ECs were closely arranged with normal structures, and there was no proliferation. In the model, empty vector and over-expressed cANRIL groups, some cells were not present, and atherosclerotic plaques and thrombi appeared. However, in the under-expressed cANRIL group, the cells had a normal structure. Compared with the model and empty vector groups, the levels of total cholesterol (CHOL), triglycerides (TGs), low density lipoprotein (LDL), IL-1, IL-6, MMP-9, CRP, cANRIL, Bax, and caspase-3, AI values, and rates of EC apoptosis decreased in the low-expressed cANRIL group, while HDL (high density lipoprotein) levels and mRNA and protein expression levels of bcl-2 were increased. The changes in expression levels in the over-expressed cANRIL group were the opposite of those in the low-expressed cANRIL group. Conclusions: Our study provides evidence that reduced cANRIL expression could prevent coronary AS by reducing vascular EC apoptosis and inflammatory factor expression.

69-Year-Old Woman With Confusion and Fatigue

Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN (H.M.K.); Advisor to resident and Consultant in Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN (A.E.K.). A 69-year-old woman presented to her primary care physicianwith a 4-day history of fatigue and dizziness. She was 45 minutes late for her appointment because she had trouble driving to the office. She reported no motor or sensory deficits but had difficulty with coordination. Review of systems was positive for dysuria and urinary frequency. She did not have fever, chills, weight or appetite changes, respiratory, cardiac, or gastrointestinal symptoms, or recent head trauma. The patient’s medical history was remarkable for hypertension, hyperlipidemia, type 2 diabetes mellitus, osteoporosis, and gastroesophageal reflux disease. Medications included metoprolol tartrate, lisinopril with hydrochlorothiazide, lovastatin, cholecalciferol, and as-needed calcium carbonate. She had smoked half a pack of cigarettes per day for 40 years but had quit smoking 6 years previously. She didnot use alcohol or illicit drugs. On examination, the patient was afebrile with a blood pressure of 104/67 mm Hg, heart rate of 76 beats/min, respiratory rate of 17 breaths/min, oxygen saturation of 94% while breathing room air, and body mass index (calculated as weight in kilograms divided by height inmeters squared) of 39 kg/m. Shewas alert and oriented to person, place, and time. Her speech was dysarthric, and she had difficulty following simple commands. Her coordination was impaired with symmetric dysmetria on finger-to-nose testing, heel-kneeshin testing, and rapid alternating movements. Cranial nerves II through XII were intact. Results of motor and sensory examinations were within normal limits. Reflexes were symmetric. Lymph node, thyroid, cardiac, respiratory, gastrointestinal, musculoskeletal, and skin examinations identified no abnormalities.

Exposure to excessive oral vitamin D in youth: a risk factor for celiac disease in later life?

Celiac disease is an autoimmune disease initiated by an allergic reaction to gliadin a component of the protein gluten that is found in wheat and other grains. Vitamin D is a prohormone with a number of biochemical functions including immunomodulatory functions in its active form. Supplementation with large doses of vitamin D induces symptoms that are similar to celiac disease in some of the population. Some researchers have noted that consumption of large doses of oral vitamin D early in life is associated with increased incidence of allergic diseases later in life. An examination of celiac disease suggests that an allergy is fundamental to its development and it features Th2 cytokine elevations which typically characterize allergic diseases. In addition it has comorbidity with allergic diseases where exposure to large doses of vitamin D early in life is a risk factor. This raises the possibility that large doses of vitamin D early in life could be a risk factor for inducing celiac disease later in life as well. The comorbidity between Williams syndrome, which is characterized by spikes in blood levels of vitamin D, and celiac disease gives additional credence to this hypothesis. Epidemiological evidence supports this hypothesis as well. Vitamin D consumption among the young and celiac disease prevalence are high in Sweden, Finland, and the United States. Vitamin D consumption among the young and celiac disease prevalence are low in Russia and Germany. The timing of the increases in prevalence in the United States and Sweden also coincides with increasing vitamin D consumption. This is most striking in Sweden where a law required significant vitamin D fortification of food starting in 1983 and the start of the celiac epidemic in Sweden has been independently dated from 1984. This hypothesis also provides a potential explanation for some seemingly contradictory results in the literature regarding breastfeeding and risk of celiac disease.

Maternal vitamin D supplementation and its impact on allergy.

To the Editor, With great interest, we read the recent article by Gur et al. (1), “The effect of place of residence and lifestyle on vitamin D deficiency in pregnancy: Comparison of eastern and western parts of Turkey”. The authors discussed the prevalence and the predictive factors of vitamin D deficiency in pregnancy and the compliance with “The National Vitamin D Support Program” in Turkey’s easternmost and westernmost provinces. They found that clothing style, seaside holiday duration, consuming fish, living in high-altitude cold regions, and 1200 IU/day vitamin D supplementation affected vitamin D levels. They also showed that vitamin D deficiency in pregnancy is high in Turkey. They recommended increasing compliance with “The National Vitamin D Support Program” at the follow-up of all pregnant women. Vitamin D supplementation in early life is recommended to prevent vitamin D deficiency in many countries, raising important questions about the safety and benefit for immune development and the implications for allergic risk. The impact of vitamin D deficiency on the risk of developing an allergy and a child’s immune status in childhood has been controversial and lacking. We want to mention that vitamin D supplementation during pregnancy may promote the evolution of allergic diseases in offspring during childhood. In recent studies, vitamin D was found to be positively associated with the risk for the development of allergic diseases in children during their first 2 years of life. Weisse et al. demonstrated that in pregnancy and at birth, higher levels of vitamin D may contribute to a higher risk for allergic outcomes. A questionnaire was answered by parents during pregnancy and yearly thereafter about children’s atopic findings in the first 2 years of life. They also found a positive association between maternal and cord blood vitamin D concentrations with children’s risk for food allergy within the first years of life (2). In a prospective study, 596 pregnant women’s vitamin D concentrations were evaluated in pregnancy, and their children were followed about allergic diseases and growth parameters. An association was not found between maternal vitamin D level and the child’s anthropometric data or intelligence. Children whose mothers had a higher concentration of vitamin D had an increased risk of atopic dermatitis and asthma compared to children whose mothers had a lower concentration of vitamin D (3). Rothers et al. (4) found that those with cord blood vitamin D ≥100 nmol/L, when compared to children with cord vitamin D 50–74.9 nmol/L, had a greater risk of a positive response to a skin prick test. They also reported a non-linear relationship between cord vitamin D and IgE (allergen-specific and total).The highest levels of IgE were identified in children with a cord vitamin D concentration <50 nmol/L and ≥100 nmol/L. Increased risk of aeroallergen sensitization and elevated total IgE levels are associated with both low and high levels of vitamin D in cord blood. Nielsen et al. (5) reported that postpartum depression is associated with high levels of 25(OH)D3. They speculated that 24-hydroxylase is the main determinant of this situation. High levels of 25(OH)D3 stimulate the 24-hydroxylase enzyme, which degrades the active form of vitamin D, 1,25(OH)2D3, to the inactive 1,24,25-trihydroxyvitamin D3 metabolite. This results in low concentrations of intracellular 1,25(OH)2D3. So, they propose that either a low level of 25(OH)D3 or high level of 25(OH)D3 cause a low level of 1.25(OH)2D and subsequent insufficient stimulation of vitamin D receptors. Although the data to support this are still limited and heterogeneous, according to data, especially large doses of vitamin D supplementation during pregnancy should be used carefully. We hope that the items mentioned above will add to the value of the well-written article of Gur et al. (1) regarding vitamin D deficiency in pregnancy.

Osteomalacia or Osteoporosis - Case Report / Osteomalacija Ili Osteoporoza - Prikaz Slučaja

Summary The aim of the paper was to show the diagnostic and therapeutic approaches to a patient suffering from osteomalacia, as well as differential diagnosis with osteoporosis. Osteomalacia (OM) is a metabolic disease of bones which appears as a result of defective mineralization of newly formed bone matrix in adults. Diagnosis of disease may represent a big problem. A 67-year-old female patient from Pirot was examined in an outpatient unit by a rheumatologist in the Niška Banja Institute in December 2012. The patient reported pain along the vertebral column and inability to get out of bed. Radiography showed vertebral compression fractures and the patient had previously received surgical care at Orthopedics Ward of General Hospital Pirot due to the left femur fracture. Orthopedist, neurologist, physiatrist and practicing rheumatologist suspected osteoporosis. The diagnosis of osteomalacia was established in February, 2013. The treatment was initiated by introducing large doses of vitamin D and advising bisphosphonates. After eighth months, the patient's general condition was improved. This was demonstrated by her independent mobility.

Vitamin D and diabetes mellitus.

The vitamin D endocrine system in now recognized as subserving a wide range of fundamental biological functions in cell differentiation, inhibition of cell growth as well as immunomodulation. Both forms of immunity, namely adaptive and innate, are regulated by 1,25(OH)2D3. The immune-modulatory properties of vitamin D suggest that it could play a potential therapeutic role in prevention of type 1 diabetes mellitus (T1DM). It is postulated that large doses of vitamin D supplementation may influence the pattern of immune regulation and subsequent progression to T1DM in a genetically susceptible individual. More studies are required to substantiate the relation between T1DM and vitamin D/vitamin D analogues in the pattern of immune regulations in susceptible individuals. In type 2 diabetes mellitus (T2DM), vitamin D may influence both insulin secretion and sensitivity. An inverse relationship between T2DM and vitamin D is postulated from cross-sectional and prospective studies, though conclusive proof is as yet lacking. Available studies differ in their design and in the recommended daily allowances (RDA) of vitamin D in non-skeletal diseases and β-cell function. Large, well designed, controlled, randomized interventional studies on the potential role of vitamin D and calcium in prevention and management of T2DM are required to clarify the relationship between vitamin D and glucose homeostasis in T2DM.

Protection from vascular endothelial dysfunction in acute glycemic load-induced primary hypertension by vitamin C and E.

This study aimed to investigate the influence of acute glycemic load on vascular endothelial function in patients with hypertension and to evaluate the protective effect of vitamins C and E during the acute glycemic phase. We randomly selected 39 hypertensive patients and 21 normal subjects and divided them into 3 groups: 75 g oral glucose (glycemic load group), 75 g glucose+0.9 g vitamin C (VC group), 75 g glucose+2 g vitamin C+0.8 g vitamin E (VC+VE group). Extravascular color Doppler ultrasound was used to detect brachial artery flow-mediated vasodilation at 0, 1, 2, and 3 h, and, at the same time, serum anti-oxidant products were measured. Basic endothelial functions in patients with hypertension were decreased in the glycemic load group (9.48±3.33 versus 13.09±6.78%, P<0.05), and was even more depressed in the hypertensive group (9.48±3.33 versus 14.20±6.48%, P<0.05). Antioxidant vitamins played a dose-dependent protective role on acute damage of endothelial function due to glycemic load. Acute high blood sugar damaged vascular endothelial functions, especially in hypertensive patients, but this effect can be reversed by large doses of vitamin C and E.

Pharmacologic Therapy for Nonalcoholic Fatty Liver Disease

Weight loss via lifestyle modification remains the most efficient treatment for NAFLD. Weight loss and exercise are the cornerstones of therapy, but achieving long-term lifestyle modification is not free from difficulties. Pharmacologic therapy should be considered for patients with NAFLD unable to achieve or maintain lifestyle-induced weight loss. Unfortunately, there is no approved drug for NAFLD currently. Current treatment methods for NAFLD can be divided roughly into those methods that target components of metabolic syndrome using weight reduction and insulin sensitizers (pioglitazone) and those that use antioxidants (Vitamin E) to benefit the liver. Pioglitazone has been shown to improve steatosis, hepatocellular ballooning, and inflammation and also to reduce the risk of fibrosis progression in several randomized-controlled trials (RCTs). In a large RCT, large doses of vitamin E improved all histological lesions except for fibrosis. Compared with a placebo, Metformin lowered ALT, but did not improveliver histology. Recently, novel anti-diabetic agents (GLP-1 analogues, DPP IV inhibitors) and probiotics that alter the gutmicrobiome were shown to mildly benefit ALT and liver histology. In this report, we systemically review current pharmacologic therapies and other promising agents that were not considered in the most recent guidelines for the treatment of NAFLD. (Korean JMed 2014;86:425-431)

Vitamin C supplementation does not alter high-intensity endurance training-induced mitochondrial biogenesis in rat epitrochlearis muscle

The purpose of this study was to investigate whether vitamin C supplementation prevents high-intensity intermittent endurance training-induced mitochondrial biogenesis in the skeletal muscle. Male Wistar-strain rats were assigned to one of five groups: a control group, training group, small dose vitamin C supplemented training group, middle dose vitamin C supplemented training group, and large dose vitamin C supplemented training group. The rats of the trained groups were subjected to intense intermittent swimming training. The vitamin C supplemented groups were administrated vitamin C for the pretraining and training periods. High-intensity intermittent swimming training without vitamin C supplementation significantly increased peroxisome proliferator-activated receptor-γ coactivator-1α protein content and citrate synthase activity in the epitrochlearis muscle. The vitamin C supplementation did not alter the training-induced increase of these regardless of the dose of vitamin C supplementation. The results demonstrate that vitamin C supplementation does not prevent high-intensity intermittent training-induced mitochondrial biogenesis in the skeletal muscle.