Lower 25OHD Levels Research Articles

Vitamin D Status and the Risk of Anemia in Community-Dwelling Adults: Results from the National Health and Nutrition Examination Survey 2001-2006.

Low vitamin D status has been implicated in several chronic medical conditions and unfavorable health outcomes. Our goal was to investigate whether serum 25-hydroxyvitamin D (25OHD) levels are a potentially modifiable risk factor for anemia in a nationally representative cohort of community-dwelling individuals in the United States.We performed a cross-sectional study of 5456 individuals (≥17 years) from the National Health and Nutrition Examination Survey from 2001 to 2006. Locally weighted scatterplot smoothing (LOWESS) was used to graphically depict the relationship between serum 25OHD levels and the cumulative frequency of anemia. Multivariable logistic regression models were then used to assess the independent association of 25OHD levels with anemia, while controlling for age, sex, race, body mass index, chronic kidney disease, as well as serum levels of C-reactive protein, ferritin, iron, vitamin B12, and folic acid.The mean (standard error) 25OHD and hemoglobin levels in the analytic group were 23.5 (0.4) ng/mL and 14.4 (0.1) g/dL, respectively. Prevalence of anemia was 3.9%. Locally weighted scatterplot smoothing analysis demonstrated a near-linear relationship between vitamin D status and cumulative frequency of anemia up to 25OHD levels of approximately 20 ng/mL. With increasing 25OHD levels, the curve flattened out progressively. Multivariable regression analysis demonstrated an inverse association of 25OHD levels with the risk of anemia (adjusted odds ratio 0.97; 95% confidence interval 0.95–0.99 per 1 ng/mL change in 25OHD). Compared to individuals with ≥20 ng/mL, individuals with 25OHD levels <20 ng/mL were more likely to be anemic (adjusted odds ratio 1.64; 95% confidence interval 1.08–2.49).In a nationally representative sample of community-dwelling individuals in the United States, low 25OHD levels were associated with increased risk of anemia. Randomized controlled trials are needed to determine whether optimizing vitamin D status can reduce the burden of anemia in the general population.

Vitamin D status in youth with type 1 and type 2 diabetes enrolled in the Pediatric Diabetes Consortium (PDC) is not worse than in youth without diabetes.

To describe vitamin D levels and prevalence of vitamin D sufficiency, insufficiency and deficiency in a large, ethnically/racially diverse population of youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) in comparison to national data and examine the associations between clinical/demographic factors and vitamin D levels. 25-hydroxy vitamin D (25OHD) levels were measured in 215 youth with T1D and 326 youth with T2D enrolled in the Pediatric Diabetes Consortium (PDC). These levels were compared with those of youth of the same age without diabetes from the 2005-2006 NHANES Survey. Vitamin D deficiency (<21 ng/mL) was present in 36% of PDC participants, and insufficiency (21-29 ng/mL) was present in an additional 34%. About 36% of age-matched youth in the NHANES Survey were vitamin D deficient and an additional 41% were insufficient. Deficiency or insufficiency varied by race/ethnicity, being highest in African-Americans (86%), intermediate in Hispanics (77%), and lowest in non-Hispanic whites (47%). Lower 25OHD levels were observed in African-American and Hispanic youth, during fall and winter, and at sites in the northern United States (all p-values < 0.001). Youth with T2D had significantly lower 25OHD levels than youth with T1D (p < 0.001), but this difference was largely eliminated after adjusting for race/ethnicity and socio-economic status. Vitamin D deficiency/insufficiency is present in a substantial proportion of youth with diabetes, particularly minorities, but the prevalence appears similar to that in youth without diabetes. Further studies are needed to examine whether youth with diabetes would benefit from vitamin D supplementation.

Serum 25-Hydroxyvitamin D and Osteoarthritis in Older People: The Progetto Veneto Anziani Study.

Recent work has shown that low 25-hydroxyvitamin D (25OHD) levels are associated with the presence of osteoarthritis (OA), but these studies focused on radiographical changes of OA, investigated only one joint, and did not consider the association with OA-related pain. In this study, we aimed to examine the relationship between 25OHD levels and any presence of OA and pain in a cohort of older people. This study was part of the Progetto Veneto Anziani (Pro.V.A), a population-based cohort study in older people. In this cross-sectional work, we considered 2756 subjects (1102 males and 1654 females) with a mean age of 74.2 ± 7.1 years. OA and OA-related pain were defined using a standardized algorithm investigating disease history, medical documentation, symptoms, and physical examination of the joints. On logistic regression analysis, taking those in the highest 25OHD quartile for reference, those in the lowest quartile had significantly higher odds of OA involving the hands (odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.15-1.38 in the sample as whole; 1.36, 95% CI 1.15-1.60 in men and 1.22, 95% CI 1.09-1.37 in women), and pain (OR = 1.18, 95% CI 1.06-1.32 in the sample as whole; 1.52, 95% CI 1.21-1.90 in men and 1.15, 95% CI 1.03-1.29 in women). Similar results were found for the hip. For the knee, low 25OHD levels were associated with the presence of OA in the sample as a whole, and in women, and with the presence of pain in the sample as a whole. In conclusion, low 25OHD levels are associated with the presence of OA and with OA-related pain, particularly when the hand and hip are involved.

Threshold Effects of Vitamin D Status on Bone Health in Chinese Adolescents With Low Calcium Intake.

There is no consensus on the definition of vitamin D deficiency for bone health based on serum 25-hydroxyvitamin D (25OHD) levels. Our objective was to determine whether thresholds exist for associations between 25OHD levels and bone outcomes and if low 25OHD levels have adverse effects on bone health. This is a cross-sectional study. This study included secondary school students in Beijing, China, aged 12-15 years. We measured serum 25OHD; bone mineral density (BMD) of total body, hip, and lumbar spine (LS); serum PTH; bone alkaline phosphatase (BAP); and tartrate-resistant acid phosphatase 5b (TRAP5b) in 222 healthy adolescents (111 girls, 111 boys). The prevalence of low 25OHD was 61% (<30 nmol/liter) and 97% (<50 nmol/liter) (mean 25OHD, 30 nmol/liter). Dietary calcium intake was low (294 and 307 mg/d for boys and girls, respectively). In girls, break-points for 25OHD (nmol/liter) were: total body BMD 20 (95% confidence interval [CI], 14-27), hip BMD 25 (17-34), LS BMD 22 (14-30), TRAP5b 37 (22-52), and PTH 31 (23-38). In boys, break-points were: total body BMD 39 (24-55), TRAP5b 33 (20-45), and PTH 35 (27-43); no break-points were identified for hip and LS BMD. No break-points were identified for BAP in either gender. Below these break-points, higher 25OHD is associated with increased total body BMD, reduced PTH, and TRAP5b, whereas above these break-points, no such relationship exists. Vitamin D deficiency and insufficiency is common in healthy Chinese adolescents. Attaining serum 25OHD levels of more than 20-37 nmol/liter in girls and 33-39 nmol/liter in boys had positive influences on BMD and bone remodelling markers. However, estimates may be affected by low calcium intake and low serum 25OHD levels, with 97% of adolescents having levels below 50 nmol/liter.

The relationship of vitamin D with bone mineral density in Parkinson's disease patients

ObjectivesThe purposes of the present study were to evaluate bone mineral density (BMD) and vitamin D status in Parkinson's disease (PD) and to identify the correlation of vitamin D with BMD and disease related parameters. MethodsFifty-two patients with PD and 39 controls were recruited in study. Hoehn and Yahr (HY) staging scale, parts II and III of the Unified Parkinson's Disease Rating Scale (UPDRS) were used to assess disease stage, daily living activities, and motor activity, respectively. BMD of lumbar spine and femoral neck were assessed by dual energy X-ray absorptiometry. Serum 25-hydroxyvitamin D (25OHD) levels were measured. ResultsSeventeen patients (32.7%) were osteoporotic and 22 (42.3%) osteopenic. Female and male PD patients had significantly lower T scores and BMD values at femoral neck, whereas only female patients showed significant differences in T scores and BMD values at lumbar spine compared to controls. The mean 25OHD levels were significantly lower in PD patients compared with controls. 25OHD levels showed a positive correlation with T scores and BMD values of lumbar spine and femoral neck and a negative correlation with UPDRS part II, UPDRS part III, and HY stage. In partial correlation analysis performed to adjust disease duration, 25OHD levels were also correlated with lumbar and femoral neck BMD values, femoral neck T scores, but not with other studied parameters. ConclusionsThis study demonstrated that PD patients had lower 25OHD levels and decreased BMD values compared to controls and detected significant association of 25OHD levels with BMD values.

Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort.

Vitamin D plays an important role in the mineral and bone disorder seen in chronic kidney disease (CKD). Deficiency of 25-hydroxyvitamin D (25OHD) is highly prevalent in the adult CKD population. The prevalence and determinants of 25OHD deficiency (defined as a level <20ng/ml) were examined longitudinally in 506 children in the CKiD cohort. Predictors of secondary hyperparathyroidism and the determinants of 1,25-dihydroxyvitamin D (1,25(OH)2D) levels were also evaluated. Deficiency of 25OHD was observed in 28% of the cohort at enrollment. Significant predictors of 25OHD deficiency were older age, non-white race, higher body mass index, assessment during winter, less often than daily milk intake, non-use of nutritional vitamin D supplement and proteinuria. Lower values of glomerular filtration rate (GFR), serum 25OHD, calcium and higher levels of FGF23 were significant determinants of secondary hyperparathyroidism. Lower GFR, low serum 25OHD, nephrotic-range proteinuria, and high FGF23 levels were significant determinants of serum 1,25(OH)2 D levels. Deficiency of 25OHD is prevalent in children with CKD and is associated with potentially modifiable risk factors such as milk intake, nutritional vitamin D supplement use, and proteinuria. 25OHD deficiency is a risk factor for secondary hyperparathyroidism and decreased serum 1,25(OH)2D in children with CKD.

Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study.

BackgroundObservational studies have demonstrated an association between decreased vitamin D level and risk of multiple sclerosis (MS); however, it remains unclear whether this relationship is causal. We undertook a Mendelian randomization (MR) study to evaluate whether genetically lowered vitamin D level influences the risk of MS.Methods and FindingsWe identified single nucleotide polymorphisms (SNPs) associated with 25-hydroxyvitamin D (25OHD) level from SUNLIGHT, the largest (n = 33,996) genome-wide association study to date for vitamin D. Four SNPs were genome-wide significant for 25OHD level (p-values ranging from 6 × 10−10 to 2 × 10−109), and all four SNPs lay in, or near, genes strongly implicated in separate mechanisms influencing 25OHD. We then ascertained their effect on 25OHD level in 2,347 participants from a population-based cohort, the Canadian Multicentre Osteoporosis Study, and tested the extent to which the 25OHD-decreasing alleles explained variation in 25OHD level. We found that the count of 25OHD-decreasing alleles across these four SNPs was strongly associated with lower 25OHD level (n = 2,347, F-test statistic = 49.7, p = 2.4 × 10−12). Next, we conducted an MR study to describe the effect of genetically lowered 25OHD on the odds of MS in the International Multiple Sclerosis Genetics Consortium study, the largest genetic association study to date for MS (including up to 14,498 cases and 24,091 healthy controls). Alleles were weighted by their relative effect on 25OHD level, and sensitivity analyses were performed to test MR assumptions. MR analyses found that each genetically determined one-standard-deviation decrease in log-transformed 25OHD level conferred a 2.0-fold increase in the odds of MS (95% CI: 1.7–2.5; p = 7.7 × 10−12; I 2 = 63%, 95% CI: 0%–88%). This result persisted in sensitivity analyses excluding SNPs possibly influenced by population stratification or pleiotropy (odds ratio [OR] = 1.7, 95% CI: 1.3–2.2; p = 2.3 × 10−5; I 2 = 47%, 95% CI: 0%–85%) and including only SNPs involved in 25OHD synthesis or metabolism (ORsynthesis = 2.1, 95% CI: 1.6–2.6, p = 1 × 10−9; ORmetabolism = 1.9, 95% CI: 1.3–2.7, p = 0.002). While these sensitivity analyses decreased the possibility that pleiotropy may have biased the results, residual pleiotropy is difficult to exclude entirely.ConclusionsA genetically lowered 25OHD level is strongly associated with increased susceptibility to MS. Whether vitamin D sufficiency can delay, or prevent, MS onset merits further investigation in long-term randomized controlled trials.

Low vitamin D levels are associated with higher opioid dose in palliative cancer patients--results from an observational study in Sweden.

BackgroundVitamin D deficiency is common among palliative cancer patients and has been connected to an increased risk for pain, depressions and infections. Therefore we wanted to test the hypothesis that low 25-hydroxyvitamin D (25OHD) levels are associated with higher opioid dose, higher infectious burden and impaired quality of life in palliative cancer patients. The secondary aim was to investigate the association between 25OHD-levels and survival time.MethodIn this prospective, observational study in palliative cancer-patients (n = 100) we performed univariate and multiple linear regression analysis to assess the association of 25OHD levels with opioid dose, infectious burden (antibiotic consumption), quality of life (Edmonton Symptom Assessment Scale, ESAS) and survival time, controlling for potential confounding factors.ResultsThe median 25OHD level was 40 nmol/L (range 8-154 nmol/L). There was a significant association between 25OHD levels and opioid dose, beta coefficient -0.67; p=0.02; i.e. a low 25OHD level was associated with a higher opioid dose. This association remained significant after adjustment for stage of the cancer disease in a multivariate analysis, beta coefficient -0.66; p = 0.04. There was no association between 25OHD levels and antibiotic use or quality of life. Univariate cox regression analysis showed a weak correlation between survival time and 25OHD levels (p<0.05). However, decreased albumin levels and increased CRP levels were superior markers to predict survival time; p<0.001 for both analyses.ConclusionLow 25OHD-levels are associated with increased opioid consumption in palliative cancer patients. Future interventional studies are needed to investigate if pain can be reduced by vitamin D supplementation in these patients. In addition, this study confirms previous findings that low albumin and increased CRP levels are useful markers for survival time in palliative cancer patients.

The Association of Vitamin D Status with Acute Respiratory Morbidity in Preterm Infants

To assess the association between serum 25-hydroxyvitamin D (25OHD) levels and outcomes in preterm infants (<32 weeks gestation). Serum 25OHD was measured in mothers and their infants within 24 hours of birth, before the start of enteral vitamin D supplementation, and at discharge from the neonatal intensive care unit. We evaluated the associations between vitamin D status and various early preterm outcomes. Ninety-four preterm infants and their mothers were included; 92% of the infants had a 25OHD level≤50 nmol/L (20 ng/mL), and 64% had a 25OHD level<30 nmol/L (12 ng/mL). A low 25OHD level (<30 nmol/L) in preterm infants at birth was associated with increased oxygen requirement (P=.008), increased duration of intermittent positive-pressure ventilation during resuscitation at delivery (P=.032), and greater need for assisted ventilation (P=.013). We observed a high prevalence of low 25OHD (<30 nmol/L), and found an association between vitamin D status and acute respiratory morbidity in preterm infants after birth.

MP41-13 VITAMIN D REPLACEMENT IN RECURRENT RENAL STONE FORMERS WITH HYPERCALCIURIA DOES NOT INCREASE URINE CALCIUM EXCRETION OR RENAL STONE GROWTH

You have accessJournal of UrologyStone Disease: Medical Therapy1 Apr 2015MP41-13 VITAMIN D REPLACEMENT IN RECURRENT RENAL STONE FORMERS WITH HYPERCALCIURIA DOES NOT INCREASE URINE CALCIUM EXCRETION OR RENAL STONE GROWTH Luke McGuinness, Robert Calvert, and Vinita Mishra Luke McGuinnessLuke McGuinness More articles by this author , Robert CalvertRobert Calvert More articles by this author , and Vinita MishraVinita Mishra More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1641AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Reduced vitamin D levels are found in up to 50% of recurrent renal stone patients. Reluctance to replace vitamin D in these patients exists due to a theoretical risk of increased intestinal calcium absorption and subsequent renal excretion. Recent evidence suggests that increased absorption might be offset by increased bone deposition with no effect on urine excretion. We aim to assess the effect of pharmacological correction of low vitamin D in hypercalciuric renal stone formers compared to those with adequate vitamin D in a metabolic stone clinic. METHODS Retrospective review of 30 recurrent renal stone formers with hypercalciuria was undertaken. Serum 25 hydroxyvitamin D (25OHD) and 24hr urine biochemistry were measured in all patients at baseline and during follow-up. Renal stone growth was assessed with abdominal x-rays. Hypercalciuria was treated with diet and diuresis advice and pharmacotherapy (thiazide/ potassium citrate/allopurinol). Those with low 25OHD levels (¡Ü50nmol/L) were prescribed vitamin D replacement (VDR). Outcomes of 24hr urine biochemistry and new stone growth were compared between those on VDR (n= 17) and those with adequate 25OHD levels (n= 13). RESULTS Nine patients (30%) had vitamin D deficiency (¡Ü30nmol/L), 8 (27%) had insufficiency (>30 and ¡Ü50nmol/L) and 13 (43%) had adequate levels (>50nmol/L). 17 patients were prescribed vitamin D replacement (mean duration 14 months). 13 patients with adequate levels had mean follow-up of 22 months. No significant difference in baseline 24hr urine biochemistry was seen. Patients on VDR had an increase in 25OHD (33.6 to 74.7nmol/L, p<0.001) whilst 24hr urine calcium levels reduced non-significantly (9.33 to 8.78mmol/24hr, p>0.1). Patients with adequate 25OHD level (64.7nmol/L) had a significant decrease in urinary calcium (10.6 to 8.28mmol/24hr, p=0.003). No other significant changes were seen on urine biochemistry. The mean decrease in urine calcium in those on VDR (0.43mmol/24hr) compared to those with adequate 25OHD (2.28mmol/24hr) was not significant (p=0.15). 10 patients had new stone growth; 6 patients (35%) on VDR and 4 patients (31%) with adequate 25OHD (p>0.5). CONCLUSIONS Low vitamin D levels are present in more than half of hypercalciuric stone formers. Vitamin D replacement does not adversely affect urine calcium levels in patients with low vitamin D status or increase renal stone risk compared to those with adequate levels. Furthermore a beneficial effect may exist due to increased bone mineralisation but further evaluation is required. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e505 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke McGuinness More articles by this author Robert Calvert More articles by this author Vinita Mishra More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Vitamin D insufficiency in obese children and relation with lipid profile

Vitamin D (25OHD) deficiency is reported in obese children. Low 25OHD levels are associated with dyslipidemia and increased risk of cardiovascular complication in adulthood. Within an observational study, 120 obese subjects in pediatric age were enrolled: 59 had 25OHD <20 ng/ml (group A) while 61 had 25OHD >20 ng/ml (group B). Group A versus Group B showed elevated total cholesterol (TC), p = 0.017, low-density lipoprotein cholesterol (LDL-C), p = 0.045, and parathormone (PTH), p = 0.008. Apolipoprotein B (ApoB) showed a similar trend, p = 0.074. Negative correlations were found between 25OHD and the following parameters: TC (ρ = −0.22, p = 0.01), LDL (ρ = −0.22; p = 0.03), ApoB (ρ = −0.20; p = 0.03), and PTH (ρ = −0.33, p = 0.003). No differences in High Lipoprotein Cholesterol (HDL-C) were found. In multivariate regression the most powerful predictor for explaining 25OHD variation were TC (p = 0.048) and PTH (p = 0.055). Within a pediatric obese population an association between 25OHD low levels and unfavourable lipid patterns has been found.

Association between serum 25-hydroxyvitamin D level and pulmonary exacerbations in cystic fibrosis.

To identify effects of vitamin D status, as defined by circulating 25-hydroxyvitamin D (25-OHD) levels on the annual frequency of pulmonary exacerbations (Pex) and hospitalizations, on standard measures of pulmonary function, and to identify determinants of 25-OHD levels in pediatric patients with cystic fibrosis (CF). Higher levels of serum 25-OHD would be associated with fewer Pex and hospitalizations, and improved lung function based on pulmonary function tests (PFTs). Retrospective chart review of 53 pediatric patients from January 2011 to December 2011. Significant relationships were examined using linear and logistic regression analyses. Patients ages 5 through 22 years followed at the CF Care Center and Clinic at Yale-New Haven Hospital, New Haven, CT., who had at least four clinic visits and at least one 25-OHD measurement between January 1, 2011 and December 31, 2011. Serum 25-OHD level and gender were strong independent determinants of the annual number of Pex (P < 0.01, with lower 25-OHD level and female gender associated with Pex). There was a significant influence of gender (P < 0.05) and a near-significant influence of serum 25-OHD (P < 0.08) on hospitalization rate. There was no effect of 25-OHD levels on PFTs. Other candidate factors (age, season, gender, pancreatic sufficiency, or severity of genetic mutation) did not significantly effect 25-OHD level. The annual number of Pex in pediatric CF patients is significantly associated with 25-OHD levels and gender, raising the consideration that maintaining vitamin D sufficiency may lead to decreased incidence of Pex and hospitalizations requiring antibiotic therapy.

Vitamin D and parathyroid hormone status in a representative population living in Macau, China

Associations between documented sun-exposure, exercise patterns and fish and supplement intake and 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) were investigated in a random household survey of Macau residents (aged 18–93). Blood samples (566) taken in summer were analyzed for 25OHD and PTH.In this Chinese population, 55% were deficient (25OHD <50nmol/L: median (interquartile range)=47.7 (24.2) nmol/L). Vitamin D deficiency was greatest in those aged <50 years: median (interquartile range)=43.3 (18.2) nmol/L, females: median (interquartile range)=45.5 (19.4) nmol/L and those with higher educational qualifications: median (interquartile range)=43.1 (18.7) nmol/L.In the total Macau population, statistically significant (p<0.01) modifiable associations with lower 25OHD levels were sunlight exposure (β=0.06), physical activity (PA) (measured as hours(hrs)/day: β=0.08), sitting (measured as hrs/day β=−0.20), intake of fish (β=0.08) and calcium (Ca) supplement intake (β=0.06) [linear regression analysis adjusting for demographic risk factors]. On similar analysis, and after adjustment for 25OHD, the only significant modifiable associations in the total population with PTH were sitting (β=−0.17), Body Mass Index (β=0.07) and Ca supplement intake (β=−0.06).In this Macau population less documented sun exposure, fish and Ca supplement intake and exercise were associated with lower 25OHD levels, especially in the younger population, along with the interesting finding that more sitting was associated with both lower 25OHD and high PTH blood levels.In conclusion, unlike findings from Caucasian populations, younger participants were significantly more vitamin D deficient, in particular highly educated single females. This may indicate the desire of young females to be pale and avoid the sun. There are also big differences in lifestyle between the older generation and the younger, in particular with respect to sun exposure and PA.This article is part of a Special Issue entitled '17th Vitamin D Workshop'.

Serum 25-Hydroxy Vitamin D Levels in Bulgarian Patients with Prostate Cancer: a Pilot Study

The antiproliferative effect of the active form of vitamin D on cancer cells and its ability to induce cell differentiation and suppression of tumor-induced angiogenesis in the last decade has provoked enormous research for the elucidation of its role in the prevention of different types of cancer and in slowing down the malignancy progression. The aim of the present pilot study was to determine the circulating 25-hydroxy vitamin D (25OHD) levels in Bulgarian prostate cancer (PCa) patients and to investigate their relationship with various determinants associated with the severity and progression of the disease. A total of 53 male patients (mean age 67.0 ± 7.1 years) with clinical suspicion for PCa were enrolled in the study. All patients were subjected to systemic transrectal ultrasound-guided tru-cut prostate biopsies (10 cores at least). Detected tumors were graded using the Gleason grading system. Prostate specific antigen (PSA) serum levels were measured immunochemically. The 25OHD assay was performed by a validated HPLC-UV method. Other covariates (BMI, age, family history of PCa) were collected by interview at the time of hospitalization. One-way ANOVA with Kruskal Wallis statistics was used for comparison of medians of different parameters. The level of significance was set at p < 0.05. Significantly lower 25OHD levels were detected in PCa patients compared to those with benign prostate hyperplasia (BPH) (p < 0.05). Patients with high grade tumors (Gleason score ≥ 7) showed significantly lower 25OHD levels, while those with low grade tumors (Gleason score < 7) revealed better 25OHD status (50.49 vs. 63.17 nmol/L, p < 0.05). A moderate negative correlation between 25OHD levels and the Gleason score was established (Spearman r = -0.46, p < 0.05). Significant seasonal variations in 25OHD levels, both for PCa and BPH patients, were detected (p < 0.01). This preliminary study shows an association between 25OHD status and classical markers characterizing the severity of PCa. The results might suggest a potential beneficial role of vitamin D for PCa patients. Further prospective studies are needed to strengthen the interrelationships between 25OHD levels and variables related with PCa and to test them for causality.

The Relationship between Vitamin D, Insulin Resistance and Infertility in PCOS Women

It has been speculated that the majority of individuals in the India are deficient in Vitamin D and that Vitamin D deficiency has become an epidemic in our country. There is widespread prevalence of varying degrees (50- 90%) of Vitamin D deficiency with low dietary calcium intake in Indian population according to various studies published earlier. A deficiency of Vitamin D not only causes poor bone mineralization but also has been implicated in numerous us chronic diseases. Vitamin D deficiency is common in women with polycystic ovary syndrome (PCOS), with the 67-85% of women with PCOS having serum concentrations of 25-hydroxy Vitamin D (25OHD) <20 ng/ml. Vitamin D deficiency may intensify symptoms of PCOS, with observational studies showing lower 25OHD levels were associated with insulin resistance, ovulatory and menstrual irregularities, lower pregnancy success rate, hirsutism, hyper-androgenism, obesity and elevated cardiovascular disease risk factors. There is some, but limited, evidence for beneficial effects of Vitamin D supplementation on menstrual dysfunction and insulin resistance in women with PCOS. Vitamin D deficiency may play a role in exacerbating PCOS, and there may be a place for Vitamin D supplementation in the management of this syndrome, but current evidence is limited and additional randomized controlled trials are required to confirm the potential benefits of Vitamin D supplementation in this population.

Age As an Independent Clinical Predictor for Vitamin D Deficiency in Sickle Cell Disease

Background: Vitamin D deficiency (VDD) is highly prevalent among patients with sickle cell disease (SCD). Although little is known about the risk factors for VDD in SCD, it has been shown that VDD is associated with chronic pain, bone fragility, and pulmonary function in SCD. In this study we investigated the potential clinical predictors for VDD in patients with SCD.Method: In a retrospective, cross-sectional analysis, a total of 167 adults with SCD treated at the University of Illinois Medical Center with a baseline 25-hydroxy vitamin D (25-OHD) measurement were screened. Clinical variables were recorded from a clinic visit at least four weeks from a vaso-occlusive pain episode or red blood cell transfusion. Statistical association between 25-OHD and other clinical parameters were investigated.Results: After stratifying the patients based on 25-OHD levels, we observed the median age was significantly younger in patients with lower 25-OHD levels (Table 1). When analyzing different age groups by Kruskal Wallis analysis, 25-OHD levels were significantly elevated in patients ≥ 40 years old (Figure 1). When using Spearman correlation analysis, the 25-OHD levels as a continuous variable positively correlated with increasing age (p<0.001); they also showed a significant negative relationships with creatinine clearance, total bilirubin, platelet count, and white blood cell count (Table 2). Using ordinal logistic regression, age was an independent predictor of 25-OHD levels, as a three-categorical variable, in SCD (OR 0.55, 95% CI: 0.38 – 0.81; p =0.002) after adjusting for gender, creatinine clearance, and vitamin D supplementation (Table 3), which means that younger patients has higher chance of VDD. In the patients with VDD (25-OHD <20 ng/mL), weekly supplementation with oral ergocalciferol (50,000 units for twelve weeks) substantially improved 25-OHD levels (9.9 vs 23.7 ng/mL, p<0.0001, N=24). During a median of 40-month follow-up (range 0 to 96 months), thirteen patients died, but the log rank test or multivariate Cox regression analysis failed to show statistical significance between 25-OHD levels and mortality after adjusting ESRD and baseline vitamin D supplementation, likely due to a short follow-up period and a small sample size.Summary: Lower 25-OHD levels were associated with younger age in patients with SCD, especially patients younger than 40 years old. One possible explanation is that lower 25-OHD levels may be linked to higher mortality in SCD, but future research is needed to clarify the association between VDD and mortality in SCD. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Association between vitamin d levels and adolescent idiopathic scoliosis

Objective: To compare the levels of 25-hydroxyvitamin D in patients with AIS and a control group. Methods: The patients were recruited from the outpatient clinic of our institution during the year of 2013. Children diagnosed with scoliosis before 10 or after 18 years of age, and those suffering from neurological or muscular disorders, congenital malformations or genetic syndromes were excluded. The 25-OHD levels were determined by a fully automated electrochemiluminescence test. The appropriate level of 25-OHD was defined as greater than 30 ng/mL. The results were compared to a group of healthy individuals. Results: In group 1 (control) 63,3% showed abnormal vitamin D levels, while 91% of patients with AIS presented a low level of vitamin D. The mean BMI was 19.6 kg/m2 for controls and 20.3 kg/m2 for group 2. Statistical analysis showed significant difference (p&amp;lt;0.0001) between the levels of vitamin D. The average and minimum levels of vitamin D were respectively 27 and 13.6 ng/mL for group 1 and 18.8 and 3.13 ng/mL for AIS group. Conclusions: Patients with AIS had statistically significant lower levels of 25-OHD than healthy patients. Further research should be conducted to investigate the actual impact of serum vitamin D levels on the pathophysiology of AIS.

Vitamin D deficiency predicts cognitive decline in older men and women: The Pro.V.A. Study.

To test the hypothesis that hypovitaminosis D is associated with a higher risk of cognitive decline over a 4.4-year follow-up in a large sample of older adults. This research was part of the Progetto Veneto Anziani (Pro.V.A.), an Italian population-based cohort study of 1,927 elderly subjects. Serum 25-hydroxyvitamin D (25OHD) levels were measured at the baseline. Global cognitive function was measured with the Mini-Mental State Examination (MMSE); scores lower than 24 were indicative of cognitive dysfunction, and a decline of 3 or more points on the MMSE over the follow-up was considered as clinically significant. Analyses were adjusted for relevant confounders, including health and performance status. Participants with 25OHD deficiency (<50 nmol/L) or insufficiency (50-75 nmol/L) were more likely to have declining MMSE scores during the follow-up than those who were 25OHD sufficient (≥75 nmol/L). Among participants cognitively intact (baseline MMSE scores ≥24 and without diagnosis of dementia), the multivariate adjusted relative risk (95% confidence interval [CI]) of the onset of cognitive dysfunction was 1.36 (95% CI: 1.04-1.80; p = 0.02) for those with vitamin D deficiency and 1.29 (95% CI: 1.00-1.76; p = 0.05) for those with vitamin D insufficiency by comparison with individuals with normal 25OHD levels. The results of our study support an independent association between low 25OHD levels and cognitive decline in elderly individuals. In cognitively intact elderly subjects, 25OHD levels below 75 nmol/L are already predictive of global cognitive dysfunction at 4.4 years.

Association between circulating 25-hydroxyvitamin D levels and medication use in patients scheduled for cardiac surgery

Background and aimLow vitamin D status, i.e. circulating 25-hydroxyvitamin D (25OHD) levels <50 nmol/l, is independently associated with increased CVD risk. Medication use may influence 25OHD levels. We therefore investigated the association of circulating 25OHD with medication use in patients scheduled for cardiac surgery. Methods and resultsA total of 11,256 patients were included in this cross-sectional study. We compared 25OHD levels of medication users (18 groups of continuously used and 5 groups of intermittently used medications) with levels of non-users. Moreover, we assessed variables (medications, demographic and clinical parameters) that were independently associated with 25OHD levels <50 nmol/l. The prevalence of 25OHD levels <50 nmol/l was 65.7%. The use of statins and immunosuppressive agents was significantly associated with higher 25OHD levels and lower odds ratios of 25OHD levels <50 nmol/l. The use of ACE-inhibitors, catecholamines and antibiotics was associated with lower 25OHD levels and higher odds ratios of 25OHD levels <50 nmol/l. However, only use of antibiotics, immunosuppressive agents and catecholamines showed clinically relevant differences in 25OHD levels, i.e. differences of more than +4 nmol/l or −4 nmol/l, compared with respective non-users. These medications were prescribed either intermittently (antibiotics, catecholamines) and/or infrequently (<2%; immunosuppressive agents, catecholamines) and/or its causal relationship with circulating 25OHD is questionable (antibiotics). Female sex and blood drawing during wintertime were associated with the highest odds ratios of 25OHD levels <50 nmol/l. ConclusionData indicate that in patients with high cardiovascular risk profile medication use does not substantially contribute to 25OHD levels <50 nmol/l.

Abstract 4126: The association of serum 25-hydroxyvitamin D with breast cancer characteristics and prognosis in the Pathways Study

Abstract Background: Vitamin D may be protective against breast cancer (BC), yet current evidence from epidemiologic studies is inconsistent. We previously reported lowest serum 25-hydyroxyvitamin D (25OHD) levels in premenopausal women with the triple-negative (TN) subtype. We aimed to validate our findings in an independent cohort and to further investigate 25OHD levels in association with breast cancer prognosis. Methods: Using a case-cohort design, 1664 invasive breast cancer patients were selected from the Pathways Study, a prospective cohort at Kaiser Permanente Northern California (KPNC). 25OHD levels were measured by immunochemiluminometric assay in blood samples collected close to diagnosis. Demographic and lifestyle information at baseline came from in-person interviews, and information on cancer characteristics, treatment, recurrence and death were obtained from KPNC cancer registries and clinical databases. We examined quartiles of 25OHD in association with BC characteristics (stage, grade, estrogen receptor status, TN subtype) using logistic regression, and with disease-free survival (DFS) and overall survival (OS) using Cox proportional hazards regression with covariate adjustment. Pending analyses will account for sampling in which biospecimens from all minorities, all non-Lum A subtypes (Lum B/TN/HER2-overexpressing), and a subset (30%) of white Lum A subtypes were selected. Results: Blood collection in winter-spring, younger age, obesity, black or Hispanic race/ethnicity, current smoking, low moderate-vigorous physical activity, no vitamin D supplement use, and low dietary vitamin D intake were associated with low serum 25OHD levels. In premenopausal women, 25OHD levels were associated inversely with cancer stage and grade, and those with the TN subtype had the lowest levels (Q4: adjusted OR vs. Lum A=0.41, 95% CI=0.19-0.86). Among white women after a median follow-up time of 5.9 y (range 2.5-7.8 y), high 25OHD levels were associated with longer DFS (Q4: adjusted HR=0.67, 95% CI=0.45-0.98), as well as OS (Q4: adjusted HR=0.58, 95% CI=0.36-0.92). Additional adjustment for stage, grade, subtype and treatment received had minimal effects on the above associations. The associations with DFS and OS appeared stronger in premenopausal women than in postmenopausal women. Conclusion: In a large prospective cohort of breast cancer patients, we validated our previous findings of 25OHD levels being associated with lower odds of TN tumor subtype in premenopausal patients. Moreover, preliminary results indicate that high 25OHD levels at the time of diagnosis were associated with longer DFS and OS, the relationships were independent of cancer characteristics and treatment, and may be stronger in premenopausal women. These findings support potential benefits of maintaining sufficient vitamin D levels for improved breast cancer prognosis. Citation Format: Song Yao, Chi-Chen Hong, Marilyn L. Kwan, Ting-Yuan Cheng, Li Tang, Susan E. McCann, Isaac J. Ergas, Janise M. Roh, Warren Davis, Christine B. Ambrosone, Lawrence H. Kushi. The association of serum 25-hydroxyvitamin D with breast cancer characteristics and prognosis in the Pathways Study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4126. doi:10.1158/1538-7445.AM2014-4126