Mild Vitamin Research Articles

Use of an Antifibrinolytic Agent and Vitamin K As Alternative to Platelet Transfusions in Autologous Hematopoietic Cell Transplantation

BackgroundManaging thrombocytopenia with a prophylactic strategy was previously recommended for patients with impaired bone marrow function, hematological malignancies, and recipients of HCT when platelet counts declined to under 10,000/uL. However, the updated 2018 ASCO guidelines now suggest a place for a therapeutic i.e., after a bleeding event rather than a prophylactic platelet transfusion strategy for patients with hematologic malignancies undergoing autologous HCT. Studies show a lack of significant difference between trial groups in hemostatic outcomes, such as the number of WHO grade 2-4 bleeds, and number of days with bleeding events. Platelet transfusions increase risks of infectious and non-infectious complications as well as inducing a platelet refractory state. Our Transfusion Free Medicine Program has now performed over 200 autologous hematopoietic stem cell transplants (HCT) in Jehovah's Witnesses who due to religious convictions, do not accept red cell or platelet transfusions.Vitamin K is a fat-soluble vitamin that is required for normal blood clotting. Autologous HCT patients are at risk for vitamin K deficiency from multiple reasons including malnutrition, frequent use of antibiotics, chemotherapy induced gastrointestinal toxicity leading to malabsorption and colitis. The prothrombin test lacks the sensitivity and specificity to detect mild deficiency. A mild vitamin K deficiency may be underdiagnosed in our transplant patients adding to bleeding risk. With the effective use of antifibrinolytic agents and Vitamin K as an alternative to platelet transfusions we believe this may enhance hemostasis and prove a valuable adjunct to a therapeutic approach.MethodsPatients in our study were those who were of the Jehovah's Witness faith undergoing autologous HCT for Multiple Myeloma and Lymphoma. Patients received aminocaproic acid as an alternative to platelet transfusion to enhance hemostasis at a dose of 1 g every 4 hours or prophylactically for platelet counts less than 30,000 /uL. Titration to 4 g every 4 hours intravenously was required for platelet counts less than 10,000/ul or clinical bleeding. Vitamin K 10 mg orally or subcutaneous was also started at this time.ResultsTable 1 illustrates the low number of bleeding events especially grade 3 or 4 that occurred. There were no Grade 3 or 4 bleeding events in patients with platelet counts above 5000/uL. No patient had residual long term effects nor was there an increase in thromboembolic events.ConclusionsThese data add to the body of literature supporting a therapeutic platelet transfusion strategy in an experienced center for autologous HCT patients and challenges the prophylactic platelet count of 10,000 /uL suggesting instead 5000/uL. The safety and efficacy of antifibrinolytic agents and Vitamin K as an alternative to platelet transfusions to enhance hemostasis in autologous stem cell transplant patients may prove beneficial not only in JW patients but also in those transplant centers wishing to offer a therapeutic platelet transfusion approach and as a strategy to manage platelet refractoriness. [Display omitted] DisclosuresNo relevant conflicts of interest to declare. OffLabel Disclosure:Aminocaproic Acid is an antifibrinolytic agent approved for treatment of bleeding in surgical patients and hematological bleeding disorders. Vitamin K is approved for use in reversal of anticoagulation from Warfarin, vitamin K deficiency without liver disease and in the newborn.

Prevalence of Vitamin D Deficiency and its Awareness and Knowledge Among Parents

Introduction: Role of vitamin D in bone related diseases has a long history but mounting scientific evidences now show serious consequences on overall health of children. Despite the close link of vitamin D with child’s health, its inadequacy is not widely recognised as a problem in our population. This study is aimed to find out the prevalence of vitamin D deficiency in children and its awareness among parents. Methods: It is a prospective, cross-sectional study conducted in paediatric outpatient department of Kathmandu Medical College and Hospital from January to May 2020. Children of one to 15 years were included and 295 samples were taken. A pre-designed questionnaire was given to all participants.Vitamin D3 levels were tested with Chemiluminiscence Immuno Assay (CLIA) technique. The status of vitamin D was defined as deficient if vitamin D3 level less than 50 nmol/l. Results: Vitamin D deficiency were observed in 76.9% and among which 21%, 44.7% and 11.2% were mild, moderate and severe vitamin D deficiency respectively. Vitamin D level was observed significantly higher in males, younger children, those with presence of knowledge of vitamin D and those with adequate sun exposure. On the other hand factors like skin colour, time of exposure and exposed body parts to sun did not influence vitamin D level. Conclusions: This study shows high prevalence of vitamin D deficiency among children but awareness among parents regarding vitamin D and its deficiency was low.

Retinoic Acid Signaling Modulates Recipient Gut Barrier Integrity and Microbiota After Allogeneic Hematopoietic Stem Cell Transplantation in Mice.

Graft-versus-host disease (GVHD) remains a major complication after allogeneic hematopoietic stem cell transplantation (HSCT). An impaired intestinal epithelial barrier is an important component of GVHD pathogenesis. However, contributing host factors that modulate mucosal barrier integrity during GVHD are poorly defined. We hypothesized that vitamin A and retinoic acid (RA) exert positive impacts on maintaining intestinal barrier function after HSCT, thus preventing or dampening GVHD severity. Unexpectedly, we found that exogenous RA increased intestinal permeability of recipient mice after allogeneic HSCT. Serum bacterial endotoxin levels were significantly higher in GVHD mice fed a vitamin A-high (VAH) diet compared to those fed a vitamin A-normal (VAN) diet, indicating a more compromised intestinal barrier function. Furthermore, VAH mice showed more severe lung GVHD with increased donor T cell infiltration in this tissue and died significantly faster than VAN recipients. 16S rRNA sequencing of fecal samples revealed significant differences in the diversity and composition of gut microbiota between VAN and VAH transplant recipients. Collectively, we show that retinoic acid signaling may negatively impact intestinal barrier function during GVHD. Mild vitamin A supplementation is associated with increased lung GVHD and more profound gut dysbiosis. Micronutrients such as vitamin A could modulate complications of allogeneic HSCT, which may be mediated by shaping gut microbiota.

High early pregnancy serum 25-hydroxy vitamin D level, within a sub-optimal range, is associated with gestational diabetes mellitus: a prospective cohort study.

BACKGROUND/OBJECTIVESLow early pregnancy serum 25-hydroxy vitamin D (25[OH]D) levels can increase gestational diabetes mellitus (GDM) risk, although inconsistent findings related to that association have been reported. This study examined the association of serum vitamin D with GDM and the possible influencers on this association.SUBJECTS/METHODSThis study included 259 pregnant women within the Seremban Cohort Study (SECOST). Blood samples at < 14 weeks of gestation were drawn to determine serum 25(OH)D levels. GDM diagnosis was made at 24 to 32 weeks of gestation using a standard procedure. Association between serum vitamin D and GDM was tested using binary logistic regression.RESULTSNearly all women (90%) had mild (68.3%) or severe (32.2%) vitamin D deficiency (VDD). Non-GDM women with mild VDD had a significantly higher mean vitamin D intake than GDM women with mild VDD (t = 2.04, p < 0.05). Women with higher early pregnancy serum vitamin D levels had a greater risk of GDM. However, this significant association was only identified among those with a family history of type 2 diabetes mellitus (T2DM) and in women with a body mass index indicating overweight or obese status.CONCLUSIONSThe high prevalence of VDD in this sample of pregnant women underscores the need for effective preventive public health strategies. Further investigation of this unexpected association between serum vitamin D level and GDM risk in predominantly VDD pregnant women and the potential effects of adiposity and family history of T2DM on that association is warranted.

The female mouse is resistant to mild vitamin B3 deficiency

PurposeVitamin B3 provides nicotinamide adenine dinucleotide (NAD+), an essential coenzyme in oxidoreductase reactions. Severe vitamin B3 deficiency leads to the disease Pellagra, while mild vitamin B3 deficiency has been linked to age-related and metabolic diseases. Mild vitamin B3 deficiency is understudied, especially in females. Therefore, we examined how female mice responded to a diet that induced mild vitamin B3 deficiency in male mice.MethodsFemale C57BL/6RccHsd mice were subjected for 18 weeks to a diet without vitamin B3 and low but sufficient tryptophan (0.115%) (0NR) and were compared to control female mice on the same diet with the reference dose of vitamin B3 (30NR, 30 mg nicotinamide riboside/ kg diet).ResultsIn the female mice, no differences between the two dietary groups were found in liver nicotinamide mononucleotide (NMN) levels, body composition, whole body energy and substrate metabolism measured by indirect calorimetry, or liver triacylglycerol metabolism. Expression of seven genes that previously were shown to respond to mild vitamin B3 deficiency in male white adipose tissue were not differentially expressed between the female dietary groups, neither was insulin sensitivity.ConclusionWe concluded that the female 0NR mice were not vitamin B3 deficient; the role of age, sex and health status is discussed. Demonstrated by clear differences between females and males, the latter showing mild deficiency under the same conditions, this study highlights the importance of studying both sexes.

A critical update on the role of mild and serious vitamin D deficiency prevalence and the COVID-19 epidemic in Europe

ObjectivesCoronavirus disease 2019 (COVID-19) has emerged as a pandemic, affecting nearly 180 million people worldwide as of June 22, 2021. Previous studies have examined the association between the mean vitamin D (Vit D) concentration of each country and COVID-19 infection and mortality rate in European countries. The aim of the present study was to critically evaluate the relationship between prevalence of mild and severe Vit D deficiency in each country and COVID-19 infection, recovery, and mortality using updated data and a different methodological approach. MethodsInformation on Vit D concentration or deficiency for each country was retrieved through a literature search. COVID-19 infections and mortalities per million people and total recoveries, as of June 22, 2021, were obtained. The associations between Vit D deficiency and COVID-19 infection, recovery, and mortality were explored using correlation coefficients and scatterplots. ResultsNon-significant correlations were observed between both number of COVID-19 infections (r = 0.363, P = 0.116) and number of recoveries (r = 0.388, P = 0.091) and the prevalence of mild Vit D deficiency (<50 nmol/L). Similarly, non-significant correlations were observed between both infections (r = 0.215, P = 0.392) and recoveries (r = 0.242, P = 0.332) and the prevalence of severe Vit D deficiency (<30 nmol/L). Significant correlations were found between COVID-19 mortality and prevalence of both mild Vit D deficiency (r = 0.634, P = 0.003) and severe Vit D deficiency (r = 0.538, P = 0.021). ConclusionsThe prevalence of neither mild nor severe Vit D deficiency was associated with the number of COVID-19 infections in European countries. Thus, it is an important parameter to consider when implementing preventive measures to face COVID-19.

Assessment of Relationship Between Serum Vitamin D Levels and Metabolic Syndrome Components in Hemodialysis Patients

Aim: This study is aimed to evaluate the relationship between serum vitamin D levels and metabolic syndrome in hemodialysis patients.&#x0D; Materials and Methods: This study was conducted with participation of 80 patients undergoing hemodialysis for more than 6 months three times a week, aged &gt; 18 years. Their height, dry weight, waist circumference were measured. Biochemical parameters such as serum 25-hydroxyvitamin D, lipid profile, and fasting blood glucose were analyzed. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Severe vitamin D deficiency, 25 (OH) vitamin D &lt; 5 ng/ml; mild vitamin D deficiency, 25 (OH) vitamin D 5-15 ng/ml; vitamin D insufficiency, 25 (OH) vitamin D 16-30 ng/ml, and vitamin D sufficiency, 25 (OH) vitamin D &gt; 30 ng/ml were categorized. Statistical analysis of the data was performed with the use of SPSS version 21.0.&#x0D; Results: 48.4% of hemodialysis patients were identified to have metabolic syndrome. According to the serum levels of vitamin D; 35.0% of patients had severe vitamin D deficiency, 37.4% of patients had mild vitamin D deficiency, 18.8% of patients had vitamin D insufficiency and 8.8% of patients had vitamin D sufficiency (&gt; 30 ng/ml). Vitamin D insufficiency was significantly associated with metabolic syndrome and central obesity.&#x0D; Conclusions: Deficiency/insufficiency is observed in serum 25-hydroxyvitamin D levels in hemodialysis patients. Vitamin D insufficiency is associated with metabolic syndrome.

Frequency of Vitamin-D deficiency in children with Urinary tract infection: A descriptive cross-sectional study.

Objective:To determine Vitamin-D status in children with urinary tract infection.Methods:A Cross-sectional study was done at Pediatric Department, Liaquat University Hospital Hyderabad, from July 2019 to March 2020. A total of 172 children of either gender from 2 to 60 months of age with confirmed urinary tract infection (UTI) (having positive urine C/S report) were included in the study. The child who received antibiotics 48 hours prior or already on immunosuppressive drugs and steroids from previous health record or by taking clinically relevant history), children with CKD on vitamin-D supplementation, and known case of Vitamin-D deficiency were also excluded from the study. All study participants were evaluated for vitamin-D level by high performance liquid chromatography. Urine sample was collected for C/S and 1 cc venous blood was taken for Vitamin D status (ng/ml). The mean ± standard deviation (SD) and stratification was calculated for age, duration of urinary tract infection and vitamin-D level. Post stratification chi-square test was applied for all categorical variables at 95% confidence interval (CI) and P-value ≤0.05 was considered significant.Results:The average age of the patients was 41.51±18.34 months. There were 130 (75.58%) females and 40 (23.25%) males. Most common complaint of the children was fever 150 (87.21%). Vomiting was present in 31 (18.02%), abdominal pain 22 (12.79%) and dysuria in 15 (8.72%) children. A total of 129 (75%) children had pyelonephritis and 15 (25%) had cystitis. (Frequency of vitamin-D deficiency in children with diagnosed UTI was 45.93% (79/172). Mild vitamin D deficiency was present in 42 (53.16%) children, while moderate deficiency in 55 (69.62%) children. E. Coli was the most common pathogen in both mild and moderate vitamin D deficiency i.e., 20 (47.61) and 31 (56.36%) respectively.Conclusion:The frequency of urinary tract infection is more common in children having vitamin D deficiency.

Clinical significance of serum 25 hydroxyvitamin D in breast cancer: An Indian scenario

Recent evidences suggest a protective mechanism of vitamin D signaling against breast cancer by the autocrine/paracrine manner and may modestly reduce the risk of breast cancer. Despite lots of sunshine, vitamin D deficiency is widespread in India. Moreover, there are limited studies from Indian population regarding circulatory 25(OH) D and breast cancer risk. Thus, the aim of the present study is to investigate circulatory 25(OH) D in relation to breast cancer risk and its association with various clinico-pathological parameters from Indian population. Total 297 subjects, comprising of 157 controls and 140 breast cancer patients were enrolled for the study. Circulatory 25(OH) D was analyzed by HPLC. Statistical analysis was carried out by SPSS software version 15. Further, subjects were categorized into severe, moderate, mild vitamin D deficiency and sufficiency. The prevalence of severe and moderate 25(OH) D deficiency was higher in breast cancer patients as compared to controls. Mean values of 25(OH) D were lower in breast cancer patients as compared to controls in mild, moderate and severe deficient groups (p = 0.07, p = 0.003 and p = 0.001). Moreover, 25(OH) D was significantly lower in postmenopausal breast cancer patients as compared to premenopausal breast cancer patients, particularly in severe deficient group. The levels of 25(OH) D were lower in ER and PR negative receptor status as compared to the positive receptor in severe deficient category (p = 0.06 and p = 0.09 respectively). Whereas, the mean values of 25(OH) D were lower in HER 2 negative receptor status as compared to positive receptor status in the moderate deficient category (p = 0.09). Further, severe deficient group showed significantly lower levels of 25(OH) Din TNBC as compared to luminal A subtype (p = 0.01). Thus, Results indicate that 25(OH) D deficiency might be associated with increased risk of breast cancer. Moreover, severe 25(OH) D deficiency is associated with aggressive behavior of breast cancer.

VITAMIN D INSUFFICIENCY IN FOUR MAJOR HOSPITALS OF PUNJAB

VITAMIN D INSUFFICIENCY IN FOUR MAJOR HOSPITALS OF PUNJAB

Association of level serum 25-hydroxy vitamin D in benign and malignant breast disease in a tertiary care center in North India

Background: The study was to compare 25-hydroxy vitamin D levels in women with benign and malignant breast disease patients to the age-matched controls in a tertiary care center in North India.Methods: This was a prospective study carried out in the Department of Surgery, S.R.N. Hospital associated with M.L.N. Medical College, Allahabad. The levels of vitamin D are measured by electrochemiluminescence and the serum levels divided into normal, mild, moderate, and severe vitamin D deficiency.Results: Overall 60 patients were included. 30 was having malignant breast disease and 30 having benign breast disease. On comparing the mean value of serum vitamin D level between malignant breast disease and controls, the serum vitamin D level was found to be lesser in the former group and the difference was highly significant. On comparing the mean value of serum vitamin D level between benign breast disease and controls, the serum vitamin D level was found to be elevated in the former group, the difference was nonsignificant.Conclusions: Our study supports the hypothesis that vitamin D deficiency is an important risk factor in the development of malignant breast disease. The study was also concluded that vitamin D is not associated with the etiogenesis of benign breast diseases. There is also a possibility of using 25-hydroxy vitamin D as an adjuvant therapy during the treatment of breast malignancy.

Electrochemical sensing of vitamin B12 deficiency marker methylmalonic acid using PdAu-PPy tailored carbon fiber paper electrode

Vitamin B12 is very important for human metabolism and its deficiency can cause anemia and the production of large red blood cells. An increased concentration of methylmalonic acid (MMA) is detected much before the transformation of blood cells, which thereby is an early indicator for mild or serious Vitamin B12 deficiency. A simple electrochemical sensor based on Palladium–Gold (PdAu) was developed by electrodeposition of PdAu nanoparticles on Polypyrrole (PPy) modified carbon fiber paper (CFP) electrode. The modified electrodes were characterized by High resolution transmission electron microscopy (HRTEM), Field emission scanning electron microscopy (FESEM) with energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS) and electroanalytical techniques. Differential Pulse Voltammetric (DPV) studies have established that under optimum conditions, the developed sensor exhibits a broad linear dynamic range (4.01 pM - 52.5 nM) with a very low detection limit (1.32 pM). The proposed method was effectively applied in the non-enzymatic determination of MMA at an ultralow level in human blood serum and urine samples. The method displayed high selectivity toward MMA in the presence of other interfering substances.

Serum Levels of Vitamin D in Diabetic Patients With and Without Retinopathy.

PurposeTo evaluate the levels of vitamin D in the serum of diabetic patients with and without diabetic retinopathy (DR).MethodsThirty patients with DR and thirty diabetic patients without retinopathy were included in this cross-sectional study. Based on ophthalmic examination, patients with DR were categorized into having non-proliferative retinopathy (NPDR) and proliferative retinopathy (PDR). Patients were tested for fasting blood sugar (FBS), hemoglobin A1C (HbA1C), 25-hydroxy vitamin D (25 (OH) D), and creatinine levels in the serum, and for urine protein. Vitamin D deficiency was defined as a serum 25 (OH) D level 20 ng/mL.ResultsWe found that all diabetic patients had mild vitamin D deficiency (serum 25 (OH) D level = 10–20 ng/mL). The mean serum 25 (OH) D concentration in patients with DR was lower than in those without DR (12.10 14.62 ng/mL vs 15.61 9.40 ng/mL, respectively, P = 0.012). Trace or more proteinuria was frequently present in patients with DR than in those without DR (56% in DR vs 30% in non-DR; P = 0.037). There were no significant differences in the FBS, HbA1C, and serum creatinine levels between patients with or without retinopathy.ConclusionThe present study demonstrated that patients with DR had lower levels of serum vitamin D compared with those without retinopathy.

EP22 Teriparatide use in the real world: can we expect cost savings with a switch to generic version?

Abstract Background Teriparatide is an effective treatment option for osteoporosis, however NICE restricts its use to patients with a high disease burden. This was based on a cost effectiveness evaluation of the originator (Forsteo®) and would be different for recently introduced generic preparation. We wished to evaluate the current prescribing behaviour prior to a potential switch to the generic version and associated cost savings. Methods All patients prescribed teriparatide since the commencement of specialist osteoporosis service in Aug 2014 at our University teaching hospital covering a population of 350,000 were included. Data were extracted from an electronic database with full access to demographics, population characteristics, disease parameters and medication history. Results 113 patients were prescribed teriparatide over five years. Mean age of participants was 76 yrs (53-96). They had on average three comorbidities (0-8) with most common being hypertension (n = 44, 38.9%) and inflammatory arthritis (n = 21, 18.5%). Sixteen (14.1%) individuals had concurrent corticosteroids. Median number of fractures prior to therapy were four (0-12). Prior treatments included oral therapy (n = 90,79.6%), IV zoledronate (n = 22, 19.4%) and denosumab (n = 19, 16.8%). 66 (58.4%) of patients only had one prior bone active medication. Mean duration of prior therapy was 62.4 months (9-192 months). 17 (15.0%) patients had chronic kidney disease with lowest eGFR of 38. 41 (36.2%) had Vit D level between 40-75 nmol/L. Median T score was -3.8 (-2.1 - -6.0) which improved to -3.4 (-2.9 - -3.9) after two years. Conclusion Our real-world study shows that teriparatide is used predominantly in complex, multi-morbid older individuals with several prior fractures. Despite that teriparatide remains effective for a wide range of individuals including those with inflammatory arthritis and/or concurrent steroid use. Neither moderate CKD nor mild vitamin D insufficiency seems to impact its efficacy. This is in line with recent meta-analysis of real life teriparatide use in complex osteoporosis with multimorbidity. Though NICE stipulates minimum two fractures requirement (unless T score &amp;lt;-4.0), in practice most patients have had more than two fractures perhaps suggesting that clinicians are reserving it for high disease burden or there is a delay in referral and diagnosis. Our study should enhance clinicians’ confidence in its prescribing. It’s notable that the use is higher than current estimates based on NICE cost effectiveness analysis for eligibility of teriparatide. Instead of annual predicted use of 4.8/100,000 population, it was prescribed to 6.4/100,000. This could potentially have a cost impact however the introduction of a generic version would mitigate against it. We calculated our savings to be over £125,000 if all patients were switched. These savings at national level would hopefully improve access to a wider patient cohort and perhaps allow earlier use in the treatment paradigm. Disclosures T. Akram None. M. Siddique None. H.A. Javed None. J. Fourmy None. M.K. Nisar None.

Assessment of Vitamin D Status in Egyption Boys Aged 2-10 Years

Abstract Background Vitamin D plays an essential role in calcium homeostasis and bone metabolism. Recent evidence suggests that vitamin D may also be important for a variety of non-skeletal outcomes including neuromuscular function, immunomodulation, and control of other hormonal system. It is well known that exposure of skin to direct sunlight is the most important source of vitamin D, so that according to many causes like fear of skin cancer, traditional clothing and spending most of the time indoors many Egyptian girls are exposed to vitamin D deficiency. Hypovitaminosis D is a widespread disorder in developing countries across all age groups, regardless of their latitude. Objective The aim of this study was to evaluate the magnitude of vitamin D deficiency/sufficiency in a sample of Egyptian boys children. Subjects and Methods The present study was conducted on 80 boys age from (2-10) years old randomly selected from outpatient clinic of Ain Shams University and their healthy relative. We excluded girls, boys whose age&amp;lt;2 years or &amp;gt; 10 years, boys suffering from chronic illness or on drugs as corticosteroid and anti-epileptic drugs. Results The results demonstrate that all boys studied have vitamin D deficiency with (36.25%of them with mild vitamin D deficiency, 46.25%of them have moderate vitamin D deficiency, and 17.50% of them have severe vitamin D deficiency. There was positive correlation between vitamin D and sun exposure.

The inter-relationship between marginal vitamin D deficiency and muscle.

We review the recent literature on the interplay between mild vitamin D deficiency and skeletal muscle strength and performance. Preclinical studies indicate that vitamin D is important in muscle proliferation, differentiation and mitochondrial function, whereas some epidemiological studies demonstrate associations with muscle strength and low physical performance. Recent studies have implicated vitamin D deficiency in the development of frailty and sarcopenia in the older population. Some small studies have assessed its impact on muscle function in special circumstances such as elite sport and critical illness. Advances in liquid chromatography/mass spectrometry technologies have allowed the inter-relationships between the vitamin D metabolome and muscle phenotype to be characterized. There is evidence of distinct effects on human skeletal muscle gene expression between vitamin D metabolites. Large-scale clinical trials with well defined cohorts and outcomes are needed to provide clinically meaningful insights into this area. Care should be taken to stratify participants by vitamin D status at baseline and over follow-up in addition to observing a range of measures of muscle function.

Effects of milk powder intervention on bone mineral density and indicators related to bone metabolism in Chinese adolescents

SummaryThe study is to determine the effects of milk powder on bone density and metabolism in healthy adolescents. Vitamin D and calcium supplements increased IGF-1 but did not affect bone mineralization or turnover. Higher vitamin D in combination with sufficient calcium supplementation in such populations requires attention.IntroductionBoth calcium and vitamin D play an important role in bone mineralization in adolescents.MethodsIn this one and a half-year randomized controlled trial, 232 participants (aged 12–15 years) were randomly assigned to three intervention groups receiving milk powder fortified with vitamin D 400 IU plus calcium 300, or 600, or 900 mg [Ca3D (n = 54), Ca6D (n = 56), and Ca9D (n = 49)], or one control group maintaining habitual diet [control (n = 73)]. Bone turnover markers, serum intact PTH, 25(OH)D, and IGF-1 levels were measured at baseline and one and a half years, and bone mineral contents and bone areal mineral density were measured by Dual-energy X-ray absorptiometry (DXA) at baseline, one year, and one and a half years.ResultsBaseline average serum 25(OH)D level and calcium intake were 29.4 nmol/L and 363.5 mg/day, respectively. There was a significant increase in bone turnover, total body, hip, lumbar spine bone mineral density (BMD), and total body BMC as well as slight fluctuations in 25(OH)D levels over one and a half years without between-group differences. Significantly decreased serum PTH level was only observed in the Ca6D group (31%, p < 0.0001), in which the intervention effect was also significant (p = 0.0029) compared with the control group. IGF-1 levels increased significantly in all intervention groups (18.5 to 22.8%, p < 0.05) but decreased in the control group (16.5%, p < 0.05), and the group by time interaction was also significant (p = 0.0029).ConclusionsOur study showed that in healthy adolescents with low vitamin D status and calcium intake, mild vitamin D and mild to modest calcium supplements increased IGF-1 but did not affect bone mineralization or turnover. Higher vitamin D in combination with sufficient calcium supplementation in such populations requires attention.

Transcriptional Response of White Adipose Tissue to Withdrawal of Vitamin B3.

ScopeDistinct markers for mild vitamin B3 deficiency are lacking. To identify these, the molecular responses of white adipose tissue (WAT) to vitamin B3 withdrawal are examined.Methods and resultsA dietary intervention is performed in male C57BL/6JRccHsd mice, in which a diet without nicotinamide riboside (NR) is compared to a diet with NR at the recommended vitamin B3 level. Both diets contain low but adequate level of tryptophan. Metabolic flexibility and systemic glucose tolerance are analyzed and global transcriptomics, qRT‐PCR, and histology of epididymal WAT (eWAT) are performed. A decreased insulin sensitivity and a shift from carbohydrate to fatty acid oxidation in response to vitamin B3 withdrawal are observed. This is consistent with molecular changes in eWAT, including an activated MEK/ERK signaling, a lowering of glucose utilization markers, and an increase in makers of fatty acid catabolism, possibly related to the consistent lower expression of mitochondrial electron transport complexes. The synthesis pathway of tetrahydropteridine (BH4), an essential cofactor for neurotransmitter synthesis, is transcriptionally activated. Genes marking these processes are technically validated.ConclusionThe downregulation of Anp32a, Tnk2 and the upregulation of Mapk1, Map2k1, Qdpr, Mthfs, and Mthfsl are proposed as a WAT transcriptional signature marker for mild vitamin B3 deficiency.

Serum vitamin D levels among patients with chronic low back pain attending BGS-GIMS hospital, Bangalore, India

Introduction: In India, chronic low back pain is normally seen in adults. Studies suggests that serum vitamin D levels is directly or indirectly related to low back pain. We determined the serum vitamin D levels among patients with chronic low back pain. Materials and Methods: A cross-sectional study was conducted during 2015-16 at a tertiary hospital in Bangalore. Patients were enrolled for the study based on a standard criteria. Serum vitamin D levels were estimated by using mass spectrometry. Results: A total of 39 patients with low back pain were enrolled. The proportion of severe, moderate and mild vitamin D deficiency were found to be 11(28%), 8 (20%) and 20 (52%) respectively. Conclusion: Majority of patients had some degree of vitamin D deficiency. Supplementation of vitamin D can be considered for all patients with chronic low back pain. Keywords: Vitamin D, Chronic Low back pain, India.

Profiling of Alzheimer’s disease related genes in mild to moderate vitamin D hypovitaminosis

A vast majority of the elderly population shows a mild to moderate vitamin D deficiency. Besides the well-known function of vitamin D, vitamin D receptor is also expressed in brain and is discussed to regulate several genes. However very little is known whether genes are regulated, associated with Alzheimer’s disease (AD). Here we investigate 117 genes, known to be affected in AD, in mouse brain samples with a mild vitamin D hypovitaminosis comparable to the vitamin D status of the elderly population (20%–30% deficiency). The 117 genes include two positive controls, Nep and Park7, already known to be affected by both AD and vitamin D hypovitaminosis. The 25 most promising candidates were verified in a second independent mouse cohort, resulting in eleven genes further evaluated against three additional housekeeping genes. Three of the remaining eight significantly altered genes are involved in APP homeostasis (Snca, Nep, Psmb5), and each one gene in oxidative stress (Park7), inflammation (Casp4), lipid metabolism (Abca1), signal transduction (Gnb5) and neurogenesis (Plat). Our results tighten the link of vitamin D and AD and underline that vitamin D influences several genes also in brain, highlighting that a strong link not only to AD but also to other neurodegenerative diseases might exist.