25-OH Vitamin D3 Research Articles

215. MALNUTRITION AND VITAMIN DEFICIENCIES AFTER ONCOLOGICAL GASTRIC OR ESOPHAGEAL RESECTION

Abstract Background Patients receiving oncological esophagectomy or gastrectomy are known to be at high risk for vitamin and micronutrient deficiency before, during and after surgery. However, there are no clear guidelines for these cancer patients regarding postoperative vitamin supplementation. preoperative malnutrition has been shown to be associated with a higher risk of perioperative complications. In addition, malnutrition has shown to be an independent risk factor for reduced survival in cancer patients and early cancer recurrence. Methods This meta-analysis examines the prevalence of postoperative malnutrition, vitamin, and micronutrient deficiencies in patients who underwent gastrectomy or esophagectomy. A computer-based literature search was performed in several different databases with the The following search terms were used: vitamin, nutrition, deficienc*, malnutrition, osteoporos*, sarcopenia, esophagectom*, oesophagectom*, gastrectomy*, gastric, surg*, resect*, operat*, removal, excision, neoplas*, tumor, tumour, cancer, malign*adenocarcinom* squamous cell carcinom*. Out of 1611 studies, 42 documented relevant information, but only 17 provided 95% confidence intervals. After excluding seven studies due to insufficient data, the meta-analysis included 947 patients from 10 studies. Results The studies recorded vitamin and micronutrient blood levels from 3 months to 10 years post-surgery. The analysis found significant deficiencies in 25-OH Vitamin D3, Vitamin B12, and Serum Calcium levels. Patients had significantly lower Vitamin D3 levels compared to the healthy population, with mean levels in the lower normal range or lower. Serum Calcium levels were also significantly lower than the mean levels of the healthy population but stayed within the normal range. Mean Serum B12 levels were significantly lower than mean B12 levels in the standard population, but standard deviations stayed within the normal range. Serum albumin levels showed no signs of deficiency when compared to the healthy population. Similarly, no deficiency was detected in serum ferritin levels. Other vitamins and micronutrients studies included serum phosphorous, Vitamin A and Vitamin E, but data was insufficient for metanalysis. Discussion The study underscores the need for further research and guidelines to address postoperative nutritional deficiencies in these patients. Particularly, patients often develop a deficiency in Vitamin D3 after surgery, despite supplementation. Vitamin D3 insufficiency may increase perioperative risk and is concerning given the reduced calcium levels and bone marrow density. In conclusion there is a clear need for Vitamin D3 supplementation, both postoperatively and during the perioperative period. The study supports previous data indicating a high prevalence of postoperative micronutrient deficiency in esophagectomy patients. Given the high risk of malnutrition, screening should be a routine part of follow-up care. More data, particularly regarding deficiencies and supplementation after esophagectomy, is necessary.

Association between Vitamin D Levels During Pregnancy and Postpartum Depression: A Narrative Reviews.

Postpartum Depression (PPD) is a serious depression that develops in the first year, with unknown explained reasons. Many studies evaluated the impact of Vitamin D (VD) levels on depression during pregnancy and postnatal. This narrative review aims to review any association between serum VD levels during pregnancy and the development of PPD. PPD data from published trials and research articles (period from 2012 to 2022) were assessed through PubMed, Scopus, Science Direct, and Google Scholar using the following terms: Depression, pregnancy, 25-hydroxyvitamin D (25OH VD), vitamin D deficiency (VDD) and postpartum (PP). Articles were selected manually and with careful tracking to avoid duplication. Articles that investigated any association between VD levels during pregnancy and PPD in the time frame were included in the study, while articles investigating VD levels of PP without depression were excluded. In this narrative review, five out of seven studies showed an association between PPD and VDD during pregnancy. Danish National Birth Cohort (DNBC), Edinburgh Postnatal Depression Scale (EPDS) and Center for Epidemiologic Studies Depression Scale (CES-D) enrolled among different studies from 3 days to 1 year PP to assess PPD. Pregnant women with VDD are significantly associated with PPD. Longitudinal follow-up studies are needed to evaluate the association between VDD with PPD. Screening VD levels among pre-postnatal mothers may be essential for awareness programs that can be implemented to promote remission of postnatal depression.

Optimal dual calcium and cholecalciderol dosages for osteoporotic fracture risk patients

Background: Vitamin D is crucial for musculoskeletal health, promoting calcium absorption, osteoid tissue mineralization, and muscle function. Insufficient levels can lead to bone dystrophy, muscle weakness, and osteoporotic fractures. Aims: This research investigates the correlation between bone mineral density and osteoporotic fracture risk, including positive and negative influences, and aims to determine the optimal vitamin D level. Methods: This retrospective observational study examined 206 Jordanian rehabilitation and rheumatology clinic patients from September to November 2021. The participants were post-menopausal women and men over 60. The Age-adjusted Charlson Co-Morbidity Index and Functionality Grade system was used to assess participants' co-morbidity burden and functionality. DEXA scans assessed participants' proximal femoral hip and anteroposterior spine. Participants were divided into two Vit D groups: those below 30 ng/ml and those above 30. Results were compared using a Chi Square test. The study examined correlations, total variations, and Vit D prediction quality using logistic regression analyses. SPSS 23.0 was used for statistical analysis with a 5% significance level. Results: A binary logistic regression model was employed to simulate the correlation between the vitamin D levels of patients and their bone mineral density. The model indicated a 61.39% likelihood of having a fH_BMD (femoral head bone mineral density) equal to or greater than 0.755 g/cm2 when the vitamin D level is at its optimal value of 27.25 ng/ml. The model indicated a 27.25% likelihood of a fHOPF risk-free tool with a value of ≥3% when the optimal vitamin D level is 27.25 ng/ml. The model indicated a 17.74% likelihood of experiencing a significant osteoporotic fracture within the next 10 years. Conclusion: The findings of our study demonstrated a direct correlation between elevated levels of vitamin D and improved bone mineral quality indices that were examined. The serum 25-OH Cholecalciferol levels are more likely to have a beneficial effect on bone health status.

Beyond the Tropics: Unraveling the Complex Relationship between Sun Exposure, Dietary Intake, and Vitamin D Deficiency in Coastal Malaysians.

Despite Malaysia's year-round sunny climate, vitamin D deficiency is surprisingly common among Malaysians. However, we hypothesise that vitamin D levels among coastal populations are above average. Thus, we aim to investigate vitamin D levels and correlate them with the potential contributing factors from three selected coastal villages in Johor, Melaka, and Negeri Sembilan. Convenient sampling was employed to recruit 120 Malay male and female participants, and dried blood spots (DBS) were obtained to measure 25 (OH) vitamin D3 levels via immunoassay. Participants also completed two questionnaires: the Sun Exposure and Protection Index (SEPI) and a validated food frequency questionnaire for Malaysians. The participant pool comprised 35.20% males and 64.80% females who completed all questionnaires and underwent DBS sampling. Our analysis revealed a significant difference (p < 0.05) based on skin tones, impacting various facets of the SEPI, including sunscreen usage, protective clothing utilisation, and the adoption of protective headwear. Furthermore, gender emerged as another pivotal factor, demonstrating significant distinctions in these SEPI components. Nevertheless, there is a weak correlation between SEPI scores and vitamin D levels. Subsequent regression analysis did produce statistically significant results (p = 0.018), yet the associated low R2 value indicated a weak correlation between dietary vitamin D intake that impacts vitamin D levels. In conclusion, our preliminary findings indicate that sun exposure and dietary factors are not the sole determinants of 25-OH vitamin D3 levels. However, we require more samples from various coastal locations for a definitive justification.

Malnutrition and vitamin deficiencies after surgery for esophageal and gastric cancer: A metanalysis

Background&AimsPatients receiving oncological esophagectomy or gastrectomy are known to be at high risk for vitamin and micronutrient deficiency before, during and after surgery. However, there are no clear guidelines for these cancer patients regarding postoperative vitamin supplementation. MethodsWe conducted a metanalysis consisting of 10 studies regarding vitamin and micronutrient deficiencies after oncological gastric or esophageal resection. 5 databases were searched. ResultsData was sufficient regarding Vitamins B12 and 25-OH D3 as well as calcium. We were able to show deficiencies in 25-OH Vitamin D3 levels (p <0.001) and lower levels of Vitamin B12 and calcium (bit p<0.001) when compared to the healthy population. ConclusionsPatients from these groups are at risk for vitamin deficiencies. A guideline on postoperative supplementation is needed.

Vitamin D deficiency and oral candidiasis in patients with HIV infection: A case‒control study.

Oral candidiasis is a common opportunistic infection in patients with human immunodeficiency virus (HIV). In addition, most of these patients suffer from vitamin D deficiency. This study aimed to investigate the association between vitamin D levels and oral candidiasis in patients with HIV infection. This case‒control study was conducted on HIV-infected patients. Cases were patients with oral candidiasis diagnosed based on physical examinations. Controls were age- and sex-matched individuals without oral candidiasis. The levels of 25-OH vitamin D and other laboratory markers (CD4 count and viral load) were compared between the case and control groups. A total of 104 cases and 102 controls were included in the study. The cases had significantly lower 25-OH vitamin D3 levels (MD = 33.86 ng/mL, 95% CI= (31.85, 35.87), P < 0.001) and CD4 counts (MD = 267.48 cells/mm3, 95% CI= (189.55, 345.41), P < 0.001) than the controls. In addition, viral load was significantly higher in cases than in controls (MD = 7.03 × 105 copies/mL, 95% CI= (4.46 × 105, 9.61 × 105), P < 0.001). The multivariate logistic regression analysis revealed that educational status (OR = 0.032, 95% CI= (0.002, 0.100), P < 0.001), current HAART (OR = 0.005, 95% CI= (0.001, 0.014), P < 0.001), history of oral candidiasis (OR = 20.114, 95% CI= (18.135, 21.957), P < 0.001), CD4 count (OR = 0.004, 95% CI= (0.001, 0.006), P < 0.001), viral load (OR = 12.181, 95% CI= (1.108, 133.392), P < 0.001), and vitamin D level (OR = 0.011, 95% CI= (0.008, 0.015), P < 0.001) were significantly associated with the risk of developing oral candidiasis. Based on the findings, most patients with HIV infection suffer from vitamin D deficiency, especially those with oral candidiasis. Hypovitaminosis D was significantly associated with an increased risk of oral candidiasis. Thus, vitamin D supplementation may assist HIV-positive patients in improving their oral health and preventing oral candidiasis.

Effect of soluble dietary fiber on soy protein isolate emulsion gel properties, stability and delivery of vitamin D3

Emulsion gels with denser network microstructure and stronger mechanical properties have attracted increasing attentions for delivering lipophilic compounds. In this study, the effect of three distinct soluble dietary fiber (inulin (IN), resistant dextrin (RD) and stachyose (ST)) on the rheological, mechanical and microstructural properties of soy protein isolate (SPI) emulsion gel were firstly investigated. Compared with RD and IN, ST significantly accelerated water holding capacity and thermal stability, which exhibited more compact microstructure and more uniform emulsified oil droplets. Subsequently, the stability and bioavailability of vitamin D3 (VD3) in different delivery systems (medium chain triglycerides (MCT) embedding, SPI-ST emulsion embedding, SPI emulsion gel embedding and SPI-ST emulsion gel embedding) were continue evaluated. In vitro simulated digestion experiment demonstrated that the bioaccessibility of encapsulated VD3 in SPI-ST emulsion gel (69.95 %) was much higher than that of free embedding (48.99 %). In vivo pharmacokinetic experiment revealed that the bioavailability of VD3 was significantly enhanced in SPI-ST gel (p < 0.05), with the AUC0-24h value of 25-OH VD3 (the main circulating form of VD3) were 1.34-fold, 1.23-fold higher than that of free embedding, MCT embedding, respectively. These findings provide a possible approach for the development of high protein/fiber functional foods containing enhanced hydrophobic bioactives.

P-12 Postpartum vertebral compressive fractures in a young female with osteoporosis - A case report

Abstract Introduction Osteoporosis is а metabolic disorder characterized by low bone mass and deep changes in bone architecture that lead to an increased vertebral or hip fracture in elderly. Osteoporosis in young population is a very rare condition especially when is associated with compressive fractures. Pregnancy and postpartum-related osteoporosis is condition that occurs in the last trimester of pregnancy оr in the first months of lactation. It is self-limited condition that return to normal after 12-18 months. In rare cases leаds to spinal compressive fractures. Clinical Case We present a 33-year-old female with back pain that occurs after birth during the early lactation period. In consultation with an orthopedic surgeon, an X-ray was made on the thoracolumbar spinal column with a finding of vertebral compressive fractures. A DEXA scan (double energy-X rays of absorptiometry) is also made with the finding of vertebral osteoporosis and hip osteopenia. We calculate BMI and perform blood tests for vitamin D3, calcium, hormones and markers for bone metabolism. This was our patient's first birth, she was thin with height 157 cm, weight 42 kg and calculated BMI-17. Blood test showed very low concentration of vitamin D3- 16 ng/ml (20-44) with normal level of calcium- 1,20 mmol/l (1,10-1,40) and PTH-31,01 pg./ml (15-65). Thyroid, gonadal and adrenal axis was with normal function. We told the patient to stop the lactation and to take a supplementation of vitamin D3 2000 IE, Calcium 1000 mg and bisphosphonates (alendronate). After two years of treatment, we made a control DEXA scan. Our patient now has vertebral osteopenia, normal serum concentration of vitamin D (44 ng/ml) and her weight is 48 kg. She feels good, has no pain and no new fractures. Conclusion Pregnancy and lactation increase need for calcium and this condition is complemented by increased intestinal absorption of calcium and increased bone resorption of the mother's skeleton. Risk factors for low bone density are deficit of 1-25 OH vitamin D3, malnutrition, low body mass index, treatment with low dose of enoxaparin (LMWH), physical inactivity. Our patient has an increased risk of low bone density (she has a low body mass index, low serum concentration of 1–25 OH vitamin D3 and this was her first pregnancy). Normal serum level 1–25 OH vitamin D concentration is required to establish calcium metabolism and prevent low bone density, osteopenia or osteoporosis. Antiresorptive therapy with bisphosphonates lead to rapid improvement in bone density, prevent new fractures and relieves pain. Treatment of postpartum osteoporosis is debatable because this condition is reversible, so when we decide to treat or not to treat, we must consider present of fractures, pain and plan for future pregnancy.

Serum sclerostin is associated with recurrent kidney stone formation independent of hypercalciuria.

Kidney stones are frequent in industrialized countries with a lifetime risk of 10 to 15%. A high percentage of individuals experience recurrence. Calcium-containing stones account for more than 80% of kidney stones. Diet, environmental factors, behavior, and genetic variants contribute to the development of kidney stones. Osteocytes excrete the 21kDa glycoprotein sclerostin, which inhibits bone formation by osteoblasts. Animal data suggests that sclerostin might directly or indirectly regulate calcium excretion via the kidney. As hypercalciuria is one of the most relevant risk factors for kidney stones, sclerostin might possess pathogenic relevance in nephrolithiasis. We performed a prospective cross-sectional observational controlled study in 150 recurrent kidney stone formers (rKSF) to analyse the association of sclerostin with known stone risk factors and important modulators of calcium-phosphate metabolism. Serum sclerostin levels were determined at the first visit. As controls, we used 388 non-stone formers from a large Swiss epidemiological cohort. Sclerostin was mildly increased in rKSF in comparison to controls. This finding was more pronounced in women compared to men. Logistic regression indicated an association of serum sclerostin with rKSF status. In hypercalciuric individuals, sclerostin levels were not different from normocalciuric patients. In Spearman correlation analysis we found a positive correlation between sclerostin, age, and BMI and a negative correlation with eGFR. There was a weak correlation with iPTH and intact FGF 23. In contrast, serum sclerostin levels were not associated with 25-OH Vitamin D3, 1,25-dihydroxy-Vitamin D3, urinary calcium and phosphate or other urinary lithogenic risk factors. This is the first prospective controlled study investigating serum sclerostin in rKSF. Sclerostin levels were increased in rKSF independent of hypercalciuria and significantly associated with the status as rKSF. It appears that mechanisms other than hypercalciuria may be involved and thus further studies are required to elucidate underlying pathways.

A-086 Vitamin D and its Variation in a Pandemic Context: Pre-pandemic—Intra-pandemic—Post-pandemic Analysis in the Province of Buenos Aires - Argentina

Abstract Background The determination of 25 OH Vitamin D3 is a frequently requested measurement for the purpose of evaluating its deficiency, which would be related to various diseases. The behavior of monthly mean values (X̅) was analyzed in 984 514 patients from Buenos Aires (Argentina) in the period from January 2014 to December 2022, in order to evaluate how seasonality influences and verify the effect of the mandatory isolation due to the SARS-CoV-2 virus pandemic in 2020. Methodology We used the Chemiluminescence Assay (QLIA) ADVIA Centaur Vitamin D Total Assay (Siemens) on an Advia Centaur (2014–2020) and Aliniti I 25 OH VITAMINE D3 (Abbott Diagnostics) on an Aliniti I (2020–2022), reference values are Optimal: &amp;gt;30.0 ng/mL, Insufficiency: 20.0–30.0 ng/mL Deficiency: &amp;lt;20.0 ng/mL. Results Conclusions From the analysis of the data, a decrease in the winter months is observed, as already described, caused by less exposure to sunlight. In 2020, it was also observed that due to confinement, there was a slight increase in mean values (26.40 ng/mL (P &amp;lt; .001)), which was the highest of the years analyzed. One hypothesis is that this could be caused by the increased free time of the population resulting in greater exposure to sunlight. At the same time, the insufficiency of Vitamin D3 in the studied population is evident, as only in 2 out of the 108 months analyzed did it slightly exceed the optimal level of 30.0 ng/mL. We believe that it would be important to evaluate the implementation of a Vitamin D3 supplementation policy for the general population and subsequently conduct further studies of this type to verify the effectiveness of such implementation.

OA11 Osteoporosis, denosumab, and hypocalcaemia in multimorbid renal impairment

Abstract Introduction Osteoporosis affects approximately 30% of patients with chronic kidney disease (CKD) at stages 3-5, with 10% of women and 5% of men experiencing a fragility fracture within a given three-year follow up period. First-line management of osteoporosis with bisphosphonates is often precluded in CKD, with alendronate and zoledronate being contraindicated in creatinine clearances of &amp;lt; 35mL/min, and risedronate if &amp;lt; 30mL/min. Denosumab, a RANK-ligand inhibiting monoclonal antibody, can be used in cases of poorer renal function, however causes hypocalcaemia more commonly than bisphosphonates. Concomitant CKD compounds this risk if creatinine clearance falls below 30mL/min, presenting additional challenges for management. Case description A 75-year old woman with known osteoporosis and chronic kidney disease secondary to hypertension and a pauci-immune necrotising glomerulonephritis was found to have a serum calcium of 2.08mmol/L approximately three months after commencing six-monthly denosumab. Her lumbar spine T-score on dual x-ray absorptiometry showed severe osteoporosis at −2.9, with a fragility fracture of the humerus sustained four years prior. Her baseline eGFR was 23mL/min/1.73m2, and creatinine clearance was 22mL/min. Her past medical history was extensive and included secondary hyperparathyroidism due to CKD and resulting vitamin D deficiency, with a PTH of 23.0pmol/L, serum calcium of 2.26mmol/L, and a serum 25-OH vitamin D3 level of 33.5nmol/L four months prior to denosumab therapy. The history also included Sjögren’s syndrome on long-term daily prednisolone 7.5mg, alternate-day hydroxychloroquine 200mg, and daily leflunomide 10mg for accompanying synovitis of the hands, hypothyroidism controlled with daily levothyroxine 50mcg, hypertension controlled with daily 2.5mg bisoprolol, peripheral neuropathy secondary to vitamin B12 deficiency on three-monthly hydroxocobalamin, myocardial infarction with percutaneous coronary intervention to three arteries, diverticular disease with abscess perforation requiring laparotomy and intensive care admission, and a previous deep vein thrombosis on long-term anticoagulation with apixaban. The patient had received risedronate in the past while her creatinine clearance still permitted this. Her vitamin D deficiency had been managed orally with Adcal-D3 and colecalciferol 800IU once daily, which was uptitrated to 1600IU once daily prior to commencing denosumab. However, despite the patient’s serum vitamin D levels rising from 33.5 to 37.2nmol/L in the months preceding her first denosumab infusion, serum calcium had fallen below normal range on post-infusion blood tests. Serum phosphate returned at 0.91mmol/L, and vitamin D had fallen to 23.1nmol/L in the three months following denosumab treatment. Consequently, the patient was commenced on longer term intensive vitamin D supplementation. Discussion This case raises the issue of multifactorial hypocalcaemia against a backdrop of osteoporosis, persistent vitamin D deficiency, and medical comorbidity limiting management options. The significance of CKD in this case highlights the importance of monitoring and replacing vitamin D. While the hypocalcaemia detected at three months post-infusion may have occurred in part due to the direct effect of denosumab, the patient’s vitamin D deficiency no doubt also played a role in this, and failing to detect the deficiency may have resulted in premature termination of denosumab treatment. This case also highlights the extended timeframe in which such hypocalcaemia may present. Case-series literature describes hypocalcaemia manifesting at, on average, eight days post-infusion in patients with CKD-associated hyperparathyroidism. However we demonstrate here that extended lag times up to twelve weeks are possible; the patient was symptomatic with leg cramping at the time of clinic follow up. Future practice may benefit from establishing monitoring regimes for those with CKD and osteoporosis receiving denosumab, or bisphosphonates toward the lower end of permitted renal function. Key learning points Chronic kidney disease both limits available management options in osteoporosis, and increases the likelihood of complications from the remaining available agents – illustrated here with hypocalcaemia. Hypocalcaemia in a patient with chronic kidney disease and osteoporosis may be driven by several factors: hyperphosphataemia, vitamin D deficiency, and the effect of denosumab to prevent mobilisation of calcium from bone to serum can all be culprits. Calcium, phosphate, and vitamin D all need to be tightly monitored in medically complex patients on treatment for osteoporosis.

The protective effects of Vitamin D against Cadmium-induced nephrotoxicity

BackgroundCadmium (Cd) is retained in the kidneys in large amounts thus inducing oxidative damage. Vitamin D (VD) is a potent antioxidant that is postulated to reverse the Cd-induced oxidative effects. AimThe present study aimed at investigating the effect of VD administration on reversing Cd-induced renal toxicity. Material and methodsTwenty-four male rats were assorted into three equal groups: Negative control (NC) group receiving drinking water only, Positive control (PC) group receiving Cadmium chloride (CdCl2) and VD group receiving VD injections in addition to CdCl2. The serum levels of creatinine, urea and 25-OH VD as well as renal tissue concentration of glutathione peroxidase (GPX) and malondialdehyde (MDA) were measured. Tissue sections were examined for signs of renal injury, immunostained for Vitamin D receptor (VDR), Cyp24a1 and Cyp27b1 and the apoptotic index was measured. ResultsCd administration resulted in higher serum levels of creatinine and urea as well as lower serum 25-OH VD level in addition to higher MDA and lower GPX renal concentration. VD supplementation showed improved renal functions, a remarkable improvement in the renal tissue with enhanced expression of VDR and Cyp27b1, lower Cyp24a1 expression and a lower apoptotic index. ConclusionVD administration can ameliorate Cd-induced nephrotoxicity.

The vitamin- D quantity versus bone quality: A logistic based regression modeling in Jordanian cohort who at higher risk of osteoporotic fracture

Background: Several studies validated the positive impacts of Cholecalciferol derivatives; including dietary and non-dietary sources, on the bone architectural contents and the overall skeleton densities. We primarily aimed in this study to explore the optimal thresholds for the studied patients’ 25-OH Cholecalciferol levels that are correlated with the higher probabilities for having lumbar bone mineral density (LBMD) exceeding 0.835 g per cm2 and femoral hip bone mineral density (fH_BMD) exceeding 0.755 g per cm2. Methods: An observational retrospective study was conducted for patients, who are at risk of osteoporotic fracture, Firstly, a Binary Logistic Regression analysis was separately conducted for the investigated patients’ vitamin D levels against the patients’ fH_BMD ≥0.755 (Positive state) vs &lt;0.755 (Negative state) and against the patients’ LBMD≥ 0.835 (Positive state) vs &lt;0.835 (Negative state). Both the Receiver Operating Characteristic and the Sensitivity analyses were thereafter be conducted and the performances indices were explored. Results: Our constructed BLgR models, that logistically integrated the binary correlation between the investigated patients’ Vit D levels and their femoral hip or lumbar bone mineral densities, respectively, were constructed as [= e (--1.455+0.109× Vit D) /1+ e (--1.455+0.109× Vit D)] or [= e (--22.127+0.829× Vit D) /1+ e (--22.127+0.829× Vit D)], respectively. Conclusion: The optimal Vitamin D levels for our investigated Jordanian cohort to have a higher probability of lumber and femoral hip bone mineral; densities were identified at 27.05 ng/ml and 27.25 ng/ml, respectively.

Plasminogen Activator Inhibitor-1 and Vitamin D Association in the Overweight and Obese Pediatric Population.

Childhood overweight and obesity have been described by the World Health Organization as noncommunicable diseases and among the greatest public health threats since they have reached epidemic proportions. A child with obesity risks becoming an adult with obesity and developing metabolic and hemostatic disorders which are the basis for the development of coronary heart diseases. Recently, a number of clinical reports have demonstrated that both an increase in plasminogen activator inhibitor-1 (PAI-1) and a deficiency in 25OH-vitamin D3 (VD) are associated with an increase in thrombotic episodes. PAI-1 and VD levels were measured in 259 clinically overweight and obese children aged between 2 and 18 years enrolled in the Nutritional Education Program of the Bambino Gesù Children's Hospital and Research Institute of Rome (Italy) and 80 normal-weight subjects. We observed increased HOMA-IR, PAI-1, and other inflammation indices associated with decreased VD levels when compared to normal-weight children. Our results demonstrated that overweight and obesity are correlated with higher levels of the inflammation index. Moreover, our patients show high PAI-1 and low VD levels, confirming the high thrombotic risk in our pediatric population.

Genetic susceptibility of vitamin D receptor gene polymorphisms on autosomal recessive primary microcephaly patients in Pakistani population: a case-control and in-silico study.

Autosomal recessive primary microcephaly (MCPH) is a rare genetic disorder that leads to reduced cerebral cortex caused by a mutation in corticogenesis. The expression of the Vitamin D receptor (VDR) gene is involved in the proliferation and differentiation of neural stem cells, and VDR polymorphisms have been associated with various neurological disorders. However, their relationship with MCPH has not been explored. This study aimed to investigate the association of VDR polymorphisms with MCPH due to its role in Wnt signaling pathway and its In-silico analysis. Blood samples of 64 MCPH patients and 52 controls were collected to genotype VDR SNPs (TaqI (rs731236), FokI (rs2228570) and BsmI (rs1544410). In-silico tools were also used to assess the effects of exonic SNPs on mRNA and protein structure and pathogenicity of exonic and intronic SNPs. The study found that serum 25-OH vitamin D3 levels were significantly different in MCPH patients and healthy controls (P = 0.000). The genetic analysis showed that VDR polymorphisms of FokI and BsmI were seven times more frequent in MCPH patients than in controls (P < 0.05) and the recessive model for TaqI and dominant model for BsmI polymorphisms were also associated with the pathogenesis of MCPH. In-silico analysis showed that the pathogenicity effects of rs2228570 and rs1544410 are neutral while rs731236 causes a silent mutation which has no effect on VDR protein. VDR polymorphisms of FokI and BsmI are associated with the risk of MCPH. These findings suggest that VDR polymorphisms play a role in MCPH, which could provide important insights for understanding the molecular mechanisms of the disease.

Automated LC-MS/MS: Ready for the clinical routine Laboratory?

BackgroundLiquid chromatography-tandem mass spectrometry (LC-MS/MS) is a sensitive method with high specificity. However, its routine use in the clinical laboratory is hampered by its high complexity and lack of automation. Studies demonstrate excellent analytical performance using the first fully automated LC-MS/MS for 25-hydroxy vitamin D and immunosuppressant drugs (ISD) in hospital routine laboratories. ObjectivesOur objectives were (1) to verify the suitability of an automated LC-MS/MS in a commercial laboratory, which differs from the needs of hospital laboratories, and (2) examine its usability among operators with various professional backgrounds. MethodsWe assessed the analytical assay performance for vitamin D and the ISDs cyclosporine A and tacrolimus over five months. The assays were compared to an identical analyzer in a hospital laboratory, to in-house LC-MS/MS methods, and to chemiluminescent microparticle immunoassays (CMIA). Nine operators evaluated the usability of the fully automated LC-MS/MS system by means of a structured questionnaire. ResultsThe automated system exhibited a high precision (CV < 8%), accuracy (bias < 7%) and good agreement with concentrations of external quality assessment (EQA) samples. Comparable results were obtained with an identical analyzer in a hospital routine laboratory. Acceptable median deviations of results versus an in-house LC-MS/MS were observed for 25-OH vitamin D3 (-10.6%), cyclosporine A (-4.3%) and tacrolimus (-6.6%). The median bias between the automated system and immunoassays was only acceptable for 25-OH vitamin D3 (6.6%). All users stated that they had had a good experience with the fully automated LC-MS/MS system. ConclusionsA fully automated LC-MS/MS can be easily integrated for routine diagnostics in a commercial laboratory.

Profilassi con vitamina D nel lattante: l’importanza di capirsi bene

The paper describes a case of intoxication from vitamin D in a 35-day infant of exclusive breastfeeding life who was administered 8000 IU of vitamin D per day over 4 weeks. There was an important linguistic barrier with her mother. The clinical picture was exclusively characterized by constipation, with adequate growth. Laboratory investigations showed calcemia at upper limits (11.1 mg/dl), elevated levels of 25-OH vitamin D3 (25-OH), equal to 375 µg/l, and renal ultrasound finding compatible with microlithiasis. The clinical picture was resolved with an intravenous hydration and suspension of vitamin supplementation. The case shows that in a situation in which there is a condition of family vulnerability it is necessary to make sure that any prescription has been correctly understood.

Vitamin D Levels and Microvascular Complications in Type 2 Diabetes Mellitus Patients: A Study from North Keral

Introduction: Vitamin D plays an important role in glucose metabolism. Several pleiotropic effects of Vitamin D have been studied like regulation of cell proliferation, suppression of cell mediated immunity, Glial cell line-derived neurotrophic factor, stimulation of nerve growth factor, suppression of Renin-angiotensin-aldosterone system (RAAS), reduction of albuminuria, immunomodulatory effects, and anti-inflammatory effects.(1)Thus, vitamin D is implicated in the pathogenesis of retinopathy, neuropathy and nephropathy.&#x0D; Materials and Methods: A Cross-sectional case-control study of 206 patients (&gt;30 years), who met the American Diabetes Association, 2011 criteria (2) for type 2 DM, was conducted. Subjects were evaluated for the presence of microvascular complications by clinical evaluation, urine examination, fundus examination, clinical neuropathy scoring, and various biochemical tests. 25-OH cholecalciferol levels were done and cut off level for vitamin D deficiency was 30 ng/ml. 72 Vitamin D sufficient and 134 Vitamin D deficient cases were studied.&#x0D; Results: A total of 134 T2DM cases with Vitamin D deficiency were studied. 72 age matched T2DM patients with sufficient Vitamin D levels served as controls. The mean age of cases under study was 47.58 ± 9.63 years compared to 51.24 ± 8.75 years of controls. 61.2% were females, whereas 38.8% were males in the case group while in the control group, 69.4% were males, and 30.5% were females. The mean duration of diabetes in the cases studied was 57.08 ± 18.13 months. It was 52.69 ± 17.98 months in the Vitamin D sufficient controls. Significant statistical associations were established using Chi square test between Vitamin D status and development of microvascular complications like Diabetic nephropathy, retinopathy and neuropathy in Type 2 Diabetes Mellitus at p &lt; 0.05.&#x0D; Conclusion and Implication: Vitamin D is an important factor in modifying the risk of Type 2 DM and its microvascular complications, especially Diabetic retinopathy, neuropathy and nephropathy. Administration of vitamin D supplements may prove to be a beneficial adjuvant therapy in mitigating microvascular complications. Frequent Monitoring of Vitamin D status can decrease the burden of co-morbidities in T2DM and thus can decrease the mortality rate associated with T2DM. However; the exact role of vitamin D in these processes requires further investigations.&#x0D; Keywords:&#x0D; Diabetes, Nephropathy, Neuropathy, Retinopathy, Vitamin D

Inverse Correlation Between Bone Mineral Density and Systemic Immune Inflammation Index in Postmenopausal Turkish Women.

In this study, the correlation between the change in bone mineral density (BMD) and the numerical value of the systemic immune inflammation index (SII) in postmenopausal Turkish women was investigated. The study comprised patients who had undergone menopause for at least one year and whose blood samples were examined by dual-energy X-ray absorptiometry (DEXA) on the same day. A retrospective evaluation of 527 postmenopausal women was performed. Age, body mass index (BMI), BMD,t score, neutrophil-lymphocyte-platelet-monocyte counts, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and SII (platelet count x neutrophil count/lymphocyte count) values were calculated andrecorded. When the data were analyzed with the Statistical Package for the Social Sciences (SPSS; IBM SPSS Statistics for Windows, version 26.0. Armonk, NY: IBM Corp.), neutrophil (p<0.001), lymphocyte (p=0.004), monocytes (p=0.002), platelet distribution width (PDW) (p=0.02), procalcitonin (PCT) (p=0.04), erythrocyte sedimentation rate (ESR) (p=0.001), C-reactive protein (CRP) (p=0.001), NLR (p=0.001), PLR (p=0.004), MLR (p=0.003), and SII (p=0.001) values were found to be higher in the postmenopausal osteoporosis (PMO) group than in the normal and osteopenia groups (p<0.05). When the platelet (p=0.15), mean platelet volume (MPV) (p=0.07), and 25-OH vitamin-D (p=0.15) values were compared, no correlation was found between the groups (normal, osteopenia, and PMO) (p>0.05). This study revealed that NLR, PLR, MLR, and SII values were inversely correlated with the change in BMD in postmenopausal Turkish women. These biomarkers, which are obtained from a simple, affordable, and accessible routine blood examination, may play an effective role in the early diagnosis and prevention of PMO in the future.

Examination of correlations between vitamin D and melatonin levels with sleep among women aged 18-49 years.

Although clinical research is still going on to determine any relationship between vitamin D and sleep regulation, only few studies have identified the role of vitamin D metabolism in sleep disorders. The current study aims to examine the incidence of vitamin D deficiency/insufficiency in the sample group and its effects on sleep quality and melatonin level. A cross-sectional study was designed. A total of 79 women aged 18-49 years who applied to the research and training hospital between 1 October and 30 November 2021 participated in the study. Data were collected using a socio-demographic questionnaire prepared by the authors and the Pittsburgh Sleep Quality Index (PSQI). Blood samples were taken from the participants, also, 25-OH-vitamin D3 and melatonin levels in serum samples were measured by ELISA. The participants (n = 79) were aged 29.61 ± 11.14 years. The mean total PSQI scores of the participants were calculated as 5.77 ± 2.70. We determined that 64.6% of the participants had vitamin D deficiency, 21.5% had vitamin D insufficiency, and 13.9% of the participants were vitamin D sufficient. The mean melatonin level was found to be 24.77 ± 27.77 ng/L. We determined that an increase in the melatonin levels decreases the risk of vitamin D deficiency. Besides, our findings showed a good positive correlation between serum melatonin and 25 OH vitamin D3 levels (r = 0.544, p < 0.001). Our results indicate that the correction of vitamin D insufficiency can positively affect melatonin levels, therefore, it may positively contribute to the treatment of sleep disorders related to melatonin deficiency.