Prevalence Of Severe Deficiency Research Articles

Screening Questionnaire for Vitamin D Insufficiency in Children with Obesity.

Non-invasive screening tools to identify children at high risk of vitamin D (VitD) deficiency are proactive measures in preventive care. Recently, a validated questionnaire (Evaluation dEficieNCy Questionnaire, EVIDENCe-Q) for identifying newly diagnosed VitD-insufficient adults has been developed. We tested the EVIDENCe-Q modified for children with obesity and evaluated the correlation between VitD and questionnaire scores to adapt this tool to the pediatric population. We enrolled 120 children with obesity (BMI ≥ 2). Clinical evaluation and VitD levels were considered. The modified EVIDENCe-Q included information regarding factors affecting control of VitD, with scores ranging between 0 (best) and 36 (worst). VitD and adiposity indices were inversely correlated. The threshold values for identifying severe deficiency (<10 mg/dL), deficiency (<20 mg/dL) and insufficiency (<30 mg/dL) were scores of 21, 19 and 23, respectively. According to those thresholds, the prevalence of severe deficiency, deficiency and insufficiency was 47.5%, 69.2% and 23.3%, respectively; the best accuracy was obtained with a questionnaire score cut-off of 19 for the VitD deficiency level. A novel simple screening tool such as the modified EVIDENCe-Q would be useful in clinical practice to identify potential cases of hypovitaminosis D and select at-risk patients. Considering the limited accuracy and specificity of our results, for the pediatric population a dedicated tool should be created. Phases of childhood and the role of adipose tissue could be considered in the definition of a questionnaire intended for pediatric patients with obesity.

Development of a Short Questionnaire for the Screening for Vitamin D Deficiency in Italian Adults: The EVIDENCe-Q Project.

Background: To develop and validate a questionnaire for the screening of Vitamin D in Italian adults (Evaluation Vitamin D dEficieNCy Questionnaire, EVIDENCe-Q). Methods: 150 participants, attending the 11Clinical Nutrition and Dietetics Operative Unit, Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri IRCCS, of Pavia were enrolled. Demographic variables and serum levels of vitamin D were recorded. The EVIDENCe-Q included information regarding factors affecting the production, intake, absorption and metabolism of Vitamin D. The EVIDENCe-Q score ranged from 0 (the best status) to 36 (the worst status). Results: Participants showed an inadequate status of Vitamin D, according to the current Italian reference values. A significant difference (p < 0.0001) in the EVIDENCe-Q score was found among the three classes of vitamin D status (severe deficiency, deficiency and adequate), being the mean score higher in severe deficiency and lower in the adequate one. A threshold value for EVIDENCe-Q score of 23 for severe deficiency, a threshold value of 21 for deficiency and a threshold value of 20 for insufficiency were identified. According to these thresholds, the prevalence of severe deficiency, deficiency and insufficiency was 22%, 35.3% and 43.3% of the study population, respectively. Finally, participants with EVIDENCe-Q scores <20 had adequate levels of vitamin D. Conclusions: EVIDENCe-Q can be a useful and easy screening tool for clinicians in their daily practice at a reasonable cost, to identify subjects potentially at risk of vitamin D deficiency and to avoid unwarranted supplementation and/or costly blood testing.

MON-129 Analysis of Omega3 PUFAs Status Among the Female and Male Population of the Moscow Region

INTRODUCTION:All humans have levels of EPA+DHA that if methodologically correctly assessed in erythrocytes, are optimal more than 8%. Omega-3 polyunsaturated fatty acids (PUFAs), namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are permanent subjects of interest not only in relation to the protection of cardiovascular health and the prevention of the incidence of both ventricular and atrial arrhythmias, but also many serious health issues that can be prevented by optimal levels. OBJECTIVE: The aim of this study was to assess in a retrospective study the omega-3 PUFAs status at Moscow region according age and sex.SUBJECTS AND METHODS:In this retrospective study, the records of 1349 patients who presented with various complaints in the period from 2013 to 2017 aged 1 to 91 were examined. Fatty acids within the red blood cell membranes were analyzed as methyl ethers after trans-esterification with sodium methylate using GC-MS followed by omega-3 index calculation.RESULTS:Deficiency of omega-3 PUFAs was found in 68.5% of patients. The most severe deficiency was noted in children and adolescents aged 0 to 17 years (in girls to a greater extent). In age groups of 18–44 and 45–59 years, the prevalence of severe (<4%) and moderate (4–8%) deficiency was comparable in males and females: among 18–44-year-old men severe deficiency was noted in 5.6%, moderate – in 29.4%, at the age of 45–59 years – in 7 and 23%, respectively; among women – 6.4, 24.4, 8.4 and 20%, respectively. In the age group of 60-74 years, prevalence of severe deficiency was significantly higher in men, who had severe deficiency in 9.2% of cases, whereas in women of the same age it was found only in 4.8% of cases, the prevalence of moderate deficiency is 23 and 23.8%, respectively.CONCLUSIONS:Such high prevalence of severe omega-3 PUFA deficiency in girls under 17 is likely due to girls’ and their parents’ concerns about weight, diet and veganism, and requires the inclusion of omega-3 index analysis in adolescent girls’ screening. Thus, during the most important period – the period of puberty – 25% of girls have metabolic and hypoxic disorders due to deficiency of omega-3 PUFA and are at risk of not only diseases associated with metabolic disorders, but also reproductive disorders (infertility, miscarriage, fetal malformations). The obtained data is indicative of the necessity to choose dosages of omega-3 PUFAs, considering not only the patients age, but also their gender.

High prevalence of vitamin D deficiency in patients with acute myocardial infarction: An Iraqi single-center study

Background: Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide despite current advances in primary preventive and state-of-the art interventional strategies for effective CAD treatment. The major manifestation of CAD is the acute myocardial infarction (AMI). Vitamin D deficiency is associated with an increased risk of coronary atherosclerosis and AMI. Objectives: The major aim of this study was to determine the association of Vitamin D deficiency with AMI in Iraqi patients living in this region. Materials and Methods: Vitamin D level status was determined in 148 patients presented with AMI and 148 of healthy controls. Measurement of serum 25-hydroxyvitamin D (25(OH) D) levels was performed using enzymatic immunoassay method. Normal serum 25(OH) D level is = 30 ng/ml, while patients with level of 20–30 ng/ml was classified as insufficient, and those with level 10–20 ng/ml as deficient. The severe Vitamin D deficiency in patients was defined when serum 25(OH) D level was = 10 ng/ml. Results: The mean of 25(OH) D level was significantly lower in patients with AMI (8.73 ng/ml) as compared to healthy controls (13.60 ng/ml). Notably, the prevalence of severe deficiency of 25(OH) D level (

Adult serum 25(OH)D3 in Gansu province, northwest China: a cross-sectional study.

This analytical cross-sectional study investigated the prevalence of vitamin D deficiency and its association with metabolic risk factors in the adult population of Gansu Province, China. In total, 11,157 healthy participants (4,740 men and 6,417 women) were enrolled. A questionnaire was used to assess general characteristics and personal habits. We detected 25-hydroxyvitamin D and associated metabolic parameters through electrochemiluminescence immunoassays. The prevalence of severe deficiency (<10 ng/mL), deficiency (10-20 ng/mL), insufficiency (20-30 ng/mL), and sufficiency (>=30 ng/mL) among the participants was 17.3%, 64.6%, 11.8%, and 6.3%, respectively. Vitamin D deficiency was more prevalent in women than in men (82.5% vs 81.1%, p<0.001). The significant predictors of vitamin D deficiency included younger age and female sex (p<0.05), whereas sun exposure, physical activity, and calcium (Ca) supplementation were associated with less vitamin D deficiency (p<0.05). Serum 25(OH)D3 was inversely associated with parathyroid hormone (r=-0.279, p<0.001) and positively associated with serum Ca (r=0.239, p<0.001), serum P (r=0.090, p=0.018), LDL cholesterol (r=0.100, p=0.008), and BMI (r=0.093, p=0.014). No significant association was observed between serum 25(OH)D3 and metabolic disorders. Vitamin D deficiency is highly prevalent among the adult population of Gansu Province, northwest China, especially young physically inactive and overweight women with limited sunlight exposure, whose biomarkers put them at greater risk of osteoporosis and cardiovascular disease.

Vitamin D status and its associated risk factors among healthy adults in Gansu province

Objective To investigate the prevalence of vitamin D deficiency and its associated metabolic risk factors in the healthy adults in Gansu Province, a western province of China. Methods Through stratified, multistage probability population sampling, 11 300 adults (4 740 men and 6 417 women aged 18-79 years) who had been living in their current residence for at least 5 years were arbitrarily chosen from seven representative geographical cities in Gansu Province from June 2014 to December 2015. The data obtained from a questionnaire-based survey, anthropometric and biochemical assessments, and areal bone mineral density measurement were collected and analyzed. Results The overall mean serum 25(OH)D was (16.07±9.40) μg/L. The prevalence of severe deficiency ( 0.05). Conclusions Vitamin D deficiency is highly prevalent among adult populations in Gansu, northwestern of China, and is largely attributed to younger age and female sex. The cumulative effects of factors including sun exposure, physical activity, and calcium supplementation play an influential role in maintaining vitamin D levels. Key words: Hydroxycholecalciferols; Vitamin D deficiency; Adult

Low socio-economic status is a newly identified independent risk factor for poor vitamin D status in severely obese adults.

Hypovitaminosis D is very prevalent, especially in the obese population. However, the degree of severity and the parameters involved in vitamin D deficiency in this population are still unclear. The present study aimed to identify, from among the factors known to influence vitamin D status in a healthy population, those impacting the same parameter in obese population. Serum 25-OH-D concentration was measured in 564 patients with class III obesity [i.e. severe and morbid obesity; mean (SD) body mass index (BMI) 42.04(6.92)kgm-2 ] and their demographic, clinical, biological, anthropometric, dietary and socio-economic data were collected. We observed that 96% of the obese patients had serum 25-OH-D lower than 30ngmL-1 . Severe vitamin D deficiency (serum 25-OH-D concentration <10ngmL-1 ) affected 35% of this population. We found an inverse relationship between 25-OH-D levels and BMI (P=0.012), fat mass (P=0.041), metabolic syndrome (P<0.0001), fasting blood glucose (P=0.023), homeostasis model assessment for insulin resistance (P=0.008), waist circumference (P=0.001), and fasting blood triglycerides (P=0.002) and C-reactive protein (P=0.005). Low socio-economic status independently increased the risk of severe vitamin D deficiency [odds ratio (OR)=1.98; 95% confidence interval (CI) 1.25-3.13], especially in the autumn-winter season (OR=2.94; 95% CI 1.98-4.36), morbid obesity (OR=3.19; 95% CI 1.49-6.82), metabolic syndrome (OR=1.6; 95% CI 1.06-2.42) and inflammation (OR=1.03; 95% CI 1.01-1.06). Vitamin D deficiency is extremely common among obese patients, and the prevalence of severe deficiency is high. The association of adiposity, high body mass index, metabolic syndrome and inflammation with vitamin D status is marked, whereas low socio-economic status appears to be a major risk factor for severe vitamin D deficiency, suggesting that vitamin D deficiency may at least in part be responsible for the greater health vulnerability of populations with low socio-economic status.

Hypovitaminosis D in adolescents living in the land of sun is correlated with incorrect life style: a survey study in Campania region.

The aim of this study is to investigate in a population of adolescents living in Regione Campania, undergoing sun exposure at least 9 months per year the prevalence of severe deficiency (<20 ng/ml) or insufficiency (21-29 ng/ml) of 25-Hydroxyvitamin D (25(OH)D) levels and its relationship with individual body weight, use of smoking, and exercise performance. From October 2012 to October 2013, 373 healthy subjects (153 girls, 223 boys 11-20 years) without chronic diseases were consecutively enrolled in a campaign to prevent metabolic, cardiovascular, and oncological diseases. 25(OH)D assay, BMI, and lifestyle habitudes (smoking and exercise indoor or outdoor) were assessed. In this population, median 25(OH) level was 25.0 ng/ml (95 %CI 23.8-25.2) without any difference between girls (25.0 (95 %CI 23.1-25.7)) and boys (24.3 (95 %CI 23.8-25.2)). Severe deficiency was found in 6 girls (0.02 %), while insufficiency was found in 296 patients (110 girls, 79.3 %). Normal levels were found in 71 patients (37 girls, 19 %). Vitamin D levels were significantly correlated with BMI (r = -0.429, p < 0.0001), smoking (r = -0.241; p < 0.0001), and exercise performance (r = 0.791; p < 0.0001). At the multistep regression analysis, Vitamin D levels were best predicted by exercise performance (t = 19.6, p < 0.0001), less smoking addiction (t = -4.97, p < 0.001), and lower BMI (t = -4.69, p < 0.0001). The current study demonstrates that Vitamin D levels are commonly unsatisfactory in adolescents. Lower levels were found in overweight or obese adolescent, smokers and with low or absence of physical activity outdoors.

Vitamin A supplementation every 6 months with retinol in 1 million pre-school children in north India: DEVTA, a cluster-randomised trial

SummaryBackgroundIn north India, vitamin A deficiency (retinol <0·70 μmol/L) is common in pre-school children and 2–3% die at ages 1·0–6·0 years. We aimed to assess whether periodic vitamin A supplementation could reduce this mortality.MethodsParticipants in this cluster-randomised trial were pre-school children in the defined catchment areas of 8338 state-staffed village child-care centres (under-5 population 1 million) in 72 administrative blocks. Groups of four neighbouring blocks (clusters) were cluster-randomly allocated in Oxford, UK, between 6-monthly vitamin A (retinol capsule of 200 000 IU retinyl acetate in oil, to be cut and dripped into the child's mouth every 6 months), albendazole (400 mg tablet every 6 months), both, or neither (open control). Analyses of retinol effects are by block (36 vs 36 clusters). The study spanned 5 calendar years, with 11 6-monthly mass-treatment days for all children then aged 6–72 months. Annually, one centre per block was randomly selected and visited by a study team 1–5 months after any trial vitamin A to sample blood (for retinol assay, technically reliable only after mid-study), examine eyes, and interview caregivers. Separately, all 8338 centres were visited every 6 months to monitor pre-school deaths (100 000 visits, 25 000 deaths at ages 1·0–6·0 years [the primary outcome]). This trial is registered at ClinicalTrials.gov, NCT00222547.FindingsEstimated compliance with 6-monthly retinol supplements was 86%. Among 2581 versus 2584 children surveyed during the second half of the study, mean plasma retinol was one-sixth higher (0·72 [SE 0·01] vs 0·62 [0·01] μmol/L, increase 0·10 [SE 0·01] μmol/L) and the prevalence of severe deficiency was halved (retinol <0·35 μmol/L 6% vs 13%, decrease 7% [SE 1%]), as was that of Bitot's spots (1·4% vs 3·5%, decrease 2·1% [SE 0·7%]). Comparing the 36 retinol-allocated versus 36 control blocks in analyses of the primary outcome, deaths per child-care centre at ages 1·0–6·0 years during the 5-year study were 3·01 retinol versus 3·15 control (absolute reduction 0·14 [SE 0·11], mortality ratio 0·96, 95% CI 0·89–1·03, p=0·22), suggesting absolute risks of death between ages 1·0 and 6·0 years of approximately 2·5% retinol versus 2·6% control. No specific cause of death was significantly affected.InterpretationDEVTA contradicts the expectation from other trials that vitamin A supplementation would reduce child mortality by 20–30%, but cannot rule out some more modest effect. Meta-analysis of DEVTA plus eight previous randomised trials of supplementation (in various different populations) yielded a weighted average mortality reduction of 11% (95% CI 5–16, p=0·00015), reliably contradicting the hypothesis of no effect.FundingUK Medical Research Council, USAID, World Bank (vitamin A donated by Roche).

Population screening for glucose-6-phosphate dehydrogenase deficiencies in Isabel Province, Solomon Islands, using a modified enzyme assay on filter paper dried bloodspots

BackgroundGlucose-6-phosphate dehydrogenase deficiency poses a significant impediment to primaquine use for the elimination of liver stage infection with Plasmodium vivax and for gametocyte clearance, because of the risk of life-threatening haemolytic anaemia that can occur in G6PD deficient patients. Although a range of methods for screening G6PD deficiency have been described, almost all require skilled personnel, expensive laboratory equipment, freshly collected blood, and are time consuming; factors that render them unsuitable for mass-screening purposes.MethodsA published WST8/1-methoxy PMS method was adapted to assay G6PD activity in a 96-well format using dried blood spots, and used it to undertake population screening within a malaria survey undertaken in Isabel Province, Solomon Islands. The assay results were compared to a biochemical test and a recently marketed rapid diagnostic test.ResultsComparative testing with biochemical and rapid diagnostic test indicated that results obtained by filter paper assay were accurate providing that blood spots were assayed within 5 days when stored at ambient temperature and 10 days when stored at 4 degrees. Screening of 8541 people from 41 villages in Isabel Province, Solomon Islands revealed the prevalence of G6PD deficiency as defined by enzyme activity < 30% of normal control was 20.3% and a prevalence of severe deficiency that would predispose to primaquine-induced hemolysis (WHO Class I-II) of 6.9%.ConclusionsThe assay enabled simple and quick semi-quantitative population screening in a malaria-endemic region. The study indicated a high prevalence of G6PD deficiency in Isabel Province and highlights the critical need to consider G6PD deficiency in the context of P. vivax malaria elimination strategies in Solomon Islands, particularly in light of the potential role of primaquine mass drug administration.

Vitamin A deficiency in Bangladesh: a review and recommendations for improvement.

This article provides a comprehensive review of the change in vitamin A status and the extent of vitamin A deficiency among different population groups in Bangladesh up to the present time. The result of experience with different strategies and interventions designed to improve vitamin A status are then reviewed, leading to a discussion of key options for action, as well as important areas for research and evaluation. All the available data have been examined in detail, including data from nationally representative samples and nationwide surveys, as well as small studies in different population groups. Reports on the effectiveness of different intervention programmes have been used. Over the past three decades a number of studies, which include national nutrition surveys, have been carried out to investigate the prevalence of vitamin A deficiency among different population groups in Bangladesh, and they have demonstrated a significant public health problem. Studies have shown that the prevalence of severe deficiency, based on the prevalence of night blindness in preschool children, decreased from 3.6% in 1982-83 to 1.78% in 1989 and 0.6% in 1996. However, there is still a high prevalence of subclinical vitamin A deficiency, based on the biochemical assessment of serum retinol levels in preschool children, estimated mainly from hospital-based groups. Night blindness and Bitot's spot are also found to exist among school-age children and adolescents. Recent reports indicate that night blindness among rural mothers is as high as 1.4%. Only a limited number of studies, with small sample sizes, are available where serum retinol has been reported for school-age children, adolescents and pregnant women. Nevertheless, these studies confirm the presence of low levels of serum retinol and hence, the existence of subclinical vitamin A deficiency. Furthermore, the dietary intake of vitamin A in each population group has been found to be less than the Recommended Daily Allowance (RDA), indicating a significant risk of deficient intakes of vitamin A. To address the problem of vitamin A deficiency, the government of Bangladesh started the Nutritional Blindness Programme in 1973. The main activities of the programme include vitamin A capsule (VAC) supplementation to children of 6 months to 6 years old, nutrition education to increase the production and consumption of vitamin A rich foods, and training of primary health-care workers on the clinical diagnosis and treatment of vitamin A deficiency, VAC distribution and nutrition education. Since 1988, as a long-term strategy, Helen Keller International has been implementing community home gardening promotion projects. To date, the possibility that foods may be fortified with vitamin A, has not been explored as a possible approach in Bangladesh. Although short- to long-term prevention and control programmes are to some extent in place, to improve the situation of vitamin A deficiency, Bangladesh needs a more appropriate mix of interventions for the entire population. More operational research and evaluation are needed if a fully effective programme to alleviate the problem of vitamin A deficiency is to be developed. Finally, to achieve the goal of virtual elimination of vitamin A deficiency will require an integrated approach which brings together appropriate actions at every level, within and across the many sectors of society.

The influence of habitat on the prevalence of mental handicap.

The influence of habitat on the frequency and characteristics of mental handicap in Galicia (NW Spain) has been studied by means of a survey of registered mentally handicapped people. Higher prevalence is observed in rural, inland, mountainous, isolated and socioeconomically and culturally depressed areas with low population density, high migration rates and a high degree of endogamy. In these areas the prevalence of severe deficiency among the mentally handicapped is also higher due to CNS infections, cranial traumatisms and goitre and to the infrequent use of birth control methods. The expectation of rehabilitation in these areas is nil, though in some cases occupational adaptation is possible.