Routine Vitamin Supplementation Research Articles

39-Year-Old Woman With Severe Weakness

39-Year-Old Woman With Severe Weakness

Vitamin D status and serum vitamin D binding protein levels in Nigerian children with nephrotic syndrome

Introduction: Nephrotic syndrome is a chronic relapsing condition associated with urinary loss of albumin and other proteins such as vitamin D binding protein (DBP). We determined vitamin D status and serum DBP levels in children with nephrotic syndrome and compared them to healthy controls. Methods: A cross-sectional study was performed over a six-month period in children less than 18 years of age. The children with nephrotic syndrome were categorised by disease status as either newly diagnosed, in remission, resistant to therapy, or in relapse. Vitamin D levels were regarded as sufficient if ≥75 nmol/L, insufficient if <75 nmol/L but ≥50 nmol/L, deficient if <50 nmol/L, and severely deficient if <25 nmol/L. Serum DBP was also measured. Results: Fifty-five children with nephrotic syndrome and 24 controls were included in the study. There was no significant difference between the median ages of the cases (72.0 months, interquartile range (IQR) 48.0–120.0 months) and the controls (84.0 months, IQR 39.0–129.0 months). Severe vitamin D deficiency, deficiency and insufficient levels were documented in 54.5%, 41.8% and 3.6% of cases, respectively, significantly lower than the controls (P = 0.003). Vitamin D levels were higher in children with nephrotic syndrome in remission than in those who were not (30.3 ± 15.2 nmol/L vs 19.6 ± 11.0 nmol/L, P = 0.004). In the groups who were in remission, newly diagnosed, relapsing, and resistant, the median vitamin D levels were 30.3 nmol/L, 20.1 nmol/L, 19.2 nmol/L and 9.4 nmol/L, respectively (P = 0.031). Conclusions: Hypovitaminosis D occurs frequently in Nigerian children with nephrotic syndrome as well as in apparently healthy controls. Routine supplementation of vitamin D should be considered in children with nephrotic syndrome irrespective of whether the disease is in remission or not, or whether it is steroid-sensitive or not. Keywords: nephrotic syndrome, vitamin D deficiency, vitamin D binding protein

Any Role of High-Dose Vitamin C for Septic Shock in 2021?

While the use of vitamin C as a therapeutic agent has been investigated since the 1950s, there has been substantial recent interest in the role of vitamin C supplementation in critical illness and particularly, sepsis and septic shock. Humans cannot synthesize vitamin C and rely on exogenous intake to maintain a plasma concentration of approximately 70 to 80 μmol/L. Vitamin C, in healthy humans, is involved with antioxidant function, wound healing, endothelial function, and catecholamine synthesis. Its function in the human body informs the theoretical basis for why vitamin C supplementation may be beneficial in sepsis/septic shock.Critically ill patients can be vitamin C deficient due to low dietary intake, increased metabolic demands, inefficient recycling of vitamin C metabolites, and loss due to renal replacement therapy. Intravenous supplementation is required to achieve supraphysiologic serum levels of vitamin C. While some clinical studies of intravenous vitamin C supplementation in sepsis have shown improvements in secondary outcome measures, none of the randomized clinical trials have shown differences between vitamin C supplementation and standard of care and/or placebo in the primary outcome measures of the trials. There are some ongoing studies of high-dose vitamin C administration in patients with sepsis and coronavirus disease 2019; the majority of evidence so far does not support the routine supplementation of vitamin C in patients with sepsis or septic shock.

Vitamin D: Magic Bullet or Much to Do About Nothing

ABSTRACT Vitamin D is a generic term that encompasses a group of fat-soluble compounds. Very few foods naturally contain vitamin D. Assessing serum 25-hydroxy-vitamin D (25(OH)D) is the only way to make the diagnosis of vitamin D deficiency, whose prevalence varies based on how deficiency is defined. Given the current evidence, the benefits of large screening programs to detect vitamin D deficiency are not recommended. The clinical manifestations of vitamin D deficiency depend upon the severity and duration of the deficiency and appears restricted to the muscular-skeletal system. Two treatment modalities currently exist for vitamin D deficiency: sunlight and vitamin D supplementation. With regards to SARS-CoV-2 infection there is no clear evidence that supplementation reduces the risk, severity of infection, length of hospital stay or mortality. Due to the lack of good quality RCTs, routine supplementation of vitamin D for extra-skeletal benefits is NOT recommended.

Management of Vitamin D Deficiency in Children: An Update

Vitamin D is a steroid hormone that plays a major role in maintaining skeletal health and it also has a role in disorders other than bone metabolism. In the paediatric population, vitamin D deficiency has emerged as a significant public health problem throughout the world and majority of children has vitamin D deficiency in spite of wide availability of sunlight. Vitamin D deficiency status is defined as deficiency when 25(OH)D level is less than 30 ng/mL (75 nmol/L) The manifestations of deficiency may vary from hypocalcemic seizures and tetany in infancy, florid rickets in toddlers, and pain in adolescent. Vitamin D deficiency is associated with other different clinical diseases, such as, insulin resistance, metabolic syndrome, respiratory tract infections, asthma, and autoimmune diseases. It is also associated with prematurity, obesity, malabsorption, extreme latitudes and little sunlight exposure. Routine supplementation of vitamin D starting from newborn period is endorsed by various international organizations. Prevention by adequate sunlight exposure, food fortification and routine supplementation are the currently available options for this nutritional deficiency. In conclusion, vitamin D deficiency is highly prevalent in the paediatric age group. Aim of this review article is to discuss the health benefits of vitamin D and to provide recommendations for the prevention and treatment of vitamin D deficiency.
 Bangladesh J Child Health 2019; VOL 43 (3) :165-173

Prevalence and predictors of hypocalcaemia in severe acute malnutrition.

To determine the prevalence and predictors of hypocalcaemia in under-five children (1-59months) hospitalised with severe acute malnutrition (SAM). A cross-sectional study was designed to determine the prevalence of hypocalcaemia among children hospitalised with SAM. Serum Ca and 25-hydroxycholecalciferol (25-(OH)D) were estimated. Hypocalcaemia was defined as serum Ca (albumin-adjusted) <2·12mmol/l. To identify the clinical predictors of hypocalcaemia, a logistic regression model was constructed taking hypocalcaemia as a dependent variable, and sociodemographic and clinical variables as independent variables. A tertiary care hospital in Delhi, between November 2017 and April 2019. One-hundred and fifty children (1-59 months) hospitalised with SAM were enrolled. Hypocalcaemia was documented in thirty-nine (26 %) children hospitalised with SAM, the prevalence being comparable between children aged <6 months (11/41, 26·8 %) and those between 6 and 59 months (28/109, 25·7 %) (P = 0·887). Vitamin D deficiency (serum 25-(OH)D <30nmol/l) and clinical rickets were observed in ninety-eight (65·3 %) and sixty-three (42 %) children, respectively. Hypocalcaemia occurred more frequently in severely malnourished children with clinical rickets (OR 6·6, 95 % CI 2·54, 17·15, P < 0·001), abdominal distension (OR 4·5, 95 % CI 1·39, 14·54, P = 0·012) and sepsis (OR 2·6, 95 % CI 1·00, 6·57, P = 0·050). Rickets and hypocalcaemia are common in children with SAM. Routine supplementation of vitamin D should be considered for severely malnourished children. Ca may be empirically prescribed to severely malnourished children with clinical rickets, abdominal distension and/or sepsis.

Prevalence of Vitamin D Deficiency Amongst Indian Orthopaedic Surgeons.

Vitamin D deficiency is a widely prevalent condition with patients in both symptomatic and asymptomatic spectrum. With the lack of routine screening there exists an unknown population of Indian Orthopaedic surgeons who are deficient in Vitamin D and lead to an unexplained loss of quality of work and increased susceptibility to various other diseases. The easiest access to resources for supplementation is available to this group of treating physicians however its use for their personal cure is rarely recognised. This study aims to highlight this endemic disease and to find out its correlation with other parameters. It is a prospective observational study including 150 practicing orthopaedic surgeons from entire India who visited our centre during 3months duration for various educational meetings. Venous sample was collected after due informed consent and analysed at a single laboratory for 25-OH Cholecalciferol levels by a chemiluminescent assay. All the samples were analysed and a questionnaire was sent to the participants via google forms regarding various parameters under study. The mean serum Vitamin D levels were 18.6 ± 9.67ng/ml in the sample studied. 17 out of 150 participants (11.3%) were found to have sufficient serum levels of 25(OH) Cholecalciferol. 105 participants (70%) were having deficient levels and 28 (18.7%) had insufficient levels of Vitamin D. Overall 88.7% participants had Vitamin D deficiency among the sample studied. This widespread prevalence of Vitamin D deficiency warrants frequent screening and routine supplementation of Vitamin D in orthopaedic surgeons thereby providing a low cost solution to improve the troublesome situation among healthcare providers.

Genetic predisposition for vitamin D deficiency is not associated with adverse outcome of very low birth weight infants: A cohort study from the German Neonatal Network.

ObjectivePostnatal vitamin D supplementation is standard of care in neonates and preterm infants. Despite routine supplementation of vitamin D, a wide range of complications related to vitamin D deficiency has been described in the literature. Since standard vitamin D supplementation might be not sufficient in preterm infants with a genetic predisposition for vitamin D deficiency, we investigated the outcome of preterm infants with regard to their genetic estimated vitamin D levels.MethodsPreterm infants with a birth weight below 1500 grams were included in the German Neonatal Network at the time of their birth and tested at the age of five. The vitamin D level was genetically calculated based on three single nucleotide polymorphisms (SNPs: rs12794714, rs7944926 and rs2282679) which alter vitamin D synthesis pathways. Specific alleles of these polymorphisms are validated markers for low plasma vitamin D levels. Outcome data were based on baseline data at the time of birth, typical complications of prematurity, body measurements at the age of five and occurrence of bone fractures. T-test and Fisher’s exact test were used for statistical comparison.ResultsAccording to their genetic predisposition, 1,924 preterm infants were divided into groups of low (gsVitD < 20. Percentile), intermediate and high vitamin D level estimates. Low genetic vitamin D level estimates could not be shown to be associated with any adverse outcome measures examined. The analyses covered data on aforementioned determinants.ConclusionLow genetic vitamin D level estimates could not be shown to be associated with previously described adverse outcome in preterm infants.

Knowledge, attitude and practice of Iraqi mothers towards Vitamin D supplementation to their infants in Baghdad Al -Rusafa 2016

Background: Routine supplementation of vitamin D to infants is justifiable since vitamin D deficiency, and its consequences are highly prevalent not only in developing countries but worldwide. Maintaining a normal level of vitamin D is crucial in order to have a normal skeletal, as well as, extra-skeletal health. Knowledge of mothers regarding importance of vitamin D supplementation affect the health of their babies in a positive manner if accompanied by appropriate practice.&#x0D; Objective: To determine the level of knowledge, attitude and practice of Iraqi mothers of under or equal 12 months old infants in Baghdad, AL-Rusafa, regarding vitamin D supplementation for their infants.&#x0D; Type of the study: A cross-sectional study.&#x0D; Methods: A descriptive cross sectional, questionnaire-based study conducted at six primary health care centers in Baghdad AL-Rusafa. 400 mothers of under or equal 12 months old infants attending primary health care centers (PHCC)for routine vaccination and follow up of their infants were included in the study from the 10th of February 2016 till the 10th of June 2016.&#x0D; Results: A total of 400 mothers enrolled in the study, with a mean age of 27.11years ±6.65572, Only (45%) (n=180) of them had given their infants vitamin D drops, with a mean score of vitamin D supplementation practice of 1.26±1.51265 from 4 which was significantly correlated with their knowledge score which was 3.6100±2.14987 from 9 and their attitude score which was 3.6275±1.89644 from 6.&#x0D; Conclusion: The study revealed poor knowledge, fair attitude and poor practice among mothers regarding vitamin D supple­ment for their infants. &#x0D;

Prevalence of Vitamin D Deficiency in Pregnant Diabetic Patients in Western Libya

Despite the relative abundance of sunny weather, surprisingly, there is increasing evidence that vitamin D deficiency is extremely prevalent in females of reproductive age in Middle East countries. There is also increasing interest in the non-classical roles of vitamin in health and disease including its relation to incidence of gestational diabetes, its impact on glycaemic control in diabetes mellitus, and its association with some complications of pregnancy like preeclampsia. The objective of this study was to estimate the prevalence of Vitamin D deficiency in pregnant diabetic patients in west Libya and analyse potential links to socioeconomic and cultural factors. This is a cross sectional observational study. Random plasma was collected form expected mothers attending the Antenatal Diabetes Clinic at Tripoli’s Main Maternity Hospital. Demographics and socioeconomic and cultural factors were recorded at the same time. Samples were analysed for vitamin D level and biochemical screening panel. Vitamin D level was obtained from 160 patients (mean age 35 years). Over all 95 % of the study population had vitamin D levels below normal (defined as vitamin D level of 30 ng/ml, only 1.3%, 2 patients). All patients were taking daily vitamin D Supplements at a dose of 400 IU as per hospital policy. Vitamin D deficiency is extremely prevalent in pregnant diabetic patients in Libya. There is no clear association with socioeconomic risk factors like employment, type of accommodation or geographic distribution. However, most of the study population had life style characterized by minimal exposure to direct sun light. Routine supplementation of Vitamin D in doses of 400 IU/day does not appear to ameliorate the severity of vitamin D deficiency in this group.

In healthy adults, does routine vitamin supplementation reduce the incidence of respiratory infections?

EVIDENCE-BASED ANSWER Vitamin C does not reduce incidence of the common cold in the general population, but appears to have a protective effect in strenuous athletes (SOR: A, metaanalysis of RCTs). Daily dosing of vitamin D, but not bolus dosing, reduces respiratory tract infections (RTIs) in the general population (SOR: B, meta-analysis of heterogeneous RCTs). Neither multivitamin nor vitamin E supplementation reduces the incidence of RTI in healthy older adults (SOR: B, single RCT).

Nutritional Implications of Bariatric Surgery and the Role of Registered Dietitians

A S THE NUMBER OF INDIVIDUALS WITH OBESITY continues to increase, so has the prevalence of bariatric surgery in the United States and worldwide. Bariatric surgery is currently the only knownmethod that offers both considerable and long-termweight loss. Depending on the surgical procedure, patients can expect to lose between 29% and 87% of excess bodyweight 1 to 2 years postsurgery. Despite the substantial weight loss and improvements in comorbid conditions observed after bariatric surgery, these procedures are notwithout nutritional risk, which underscores the importance of registered dietitians (RDs) to the bariatric surgical care team. Nutritional deficiencies after bariatric surgery can arise from a variety of factors, including surgical modifications of the gastrointestinal tract that reduce dietary intake and/or promote malabsorption, or because of poor patient compliance with treatment recommendations (eg, diet and multivitamin supplementation). In this issue, MoizE and colleagues prospectively evaluated long-term nutritional deficiencies and dietary patterns after both sleeve gastrectomy and Rouxen-Y gastric bypass (RYGB). They demonstrated that nutritional deficiencies anddietary intake patternswere similar up to 5 years after sleeve gastrectomy and RYGB. Insufficient or deficient 25-hydroxyvitamin D appeared to be the most common problem before and up to 5 years after both surgeries, despite implementing a vitamin D supplementation protocol and living in aMediterranean climate (insufficiency defined by MoizE and colleges as 10 to 29 ng/mL [25 to 72 nmol/L] and deficiency defined as 10 ng/mL [ 25 mmol/L]). Considering that amajority of patients in theMoizE and colleagues studywere either insufficient or deficient before surgery suggests that routine supplementation of vitamin D should occur preoperatively. Moreover, the results from MoizE and colleagues and others highlight the importance of vitamin D supplementation in the bariatric surgery patient population and suggest that the frequently recARTICLE INFORMATION

History of Vitamin A Supplementation Reduces Severity of Diarrhea in Young Children Admitted to Hospital with Diarrhea and Pneumonia

Background: Although the role of vitamin A in childhood pneumonia in association with diarrhea is not fully proven, we did not find any published data demonstrating the impact of lack of vitamin A supplementation in under-five children who present with the co-morbidities of pneumonia and diarrhea. This study examined whether previous vitamin A supplementation was associated with reduced severity and duration of diarrhea and pneumonia for children presenting with both illnesses. Methods: All admitted children (n = 189) aged 0 - 59 months to the Special Care Ward of the Dhaka Hospital of icddr,b with diarrhea and radiological pneumonia from September-December 2007 were enrolled. We compared clinical features of the children who received (n = 96) and did not receive (n = 93) high potency capsule vitamin A supplementation during previous immunization according to EPI schedule. Results: In logistic regression analysis, after adjusting for potential confounders such as respiratory rate, lower chest wall in-drawing, severe wasting and systolic blood pressure, vitamin A non-supplemented children with pneumonia and diarrhea more often presented in their early infancy (95% CI 1.01 - 1.09), had duration of diarrhea for >4 days (95% CI 1.79 - 11.88), had clinical dehydration (95% CI 1.2 - 5.63), and more often required hospitalization for >7 days (95% CI 1.03 - 8.87). But, there was no significant difference in the clinical features of pneumonia, such as history of cough, respiratory rate, lower chest wall in-drawing, nasal flaring, head nodding, grunting respiration, cyanosis, and inability to drink between the groups. Conclusion: Lack of vitamin A supplementation in under-five children with radiological pneumonia and diarrhea is independently associated with young infancy, duration of diarrhea for >4 days, dehydration and hospitalization for >7 days which underscores the importance of routine supplementation of vitamin A in young infancy. However, lack of vitamin A supplementation did not influence any clinical signs of pneumonia.

708 Prevalence of Fat-Soluble Vitamin Deficiencies in Children with Cystic Fibrosis

BackgroundMalabsorption of fat-soluble vitamins is likely in most patients with cystic fibrosis, particularly those who are pancreatic insufficient. Low vitamin levels are associated with poorer clinical status, and reduced lung...

1349 Treating Infants of Vitamin D Deficient Mothers - is Routine Supplementation with Abidec Alone Sufficient

Background and AimsInfants with maternal vitamin D deficiency are at increased risk of low vitamin D levels. Cholecalciferol is the usual treatment for such infants. We wanted to see whether...

Adrenal insufficiency following bariatric surgery

A 35-year-old woman with morbid obesity and amenorrhoea underwent a bilo-pancreatic diversion (BPD). Surgery was successful with good weight loss, restoration of menstruation and almost immediately she conceived for the first time. She was commenced on routine vitamin supplements after surgery but failed to attend follow-up clinic. Five years later, she presented with limb girdle pains, lethargy, night blindness, skin pigmentation, amenorrhoea and dizziness. She had stopped taking supplements prescribed after the surgery. Investigations showed severe vitamin A and D deficiency along with iron and calcium deficiency. Her cholesterol was low at 3.5 mmol L⁻¹. Despite aggressive vitamin replacement, she continued to complain of lethargy and dizziness. Subsequently, three short adrenocorticotropic hormone-stimulation tests were suboptimal (basal cortisol: 196, 185 and 223 nmol L⁻¹; 30 min cortisol: 421, 453 and 435 nmol L⁻¹). She was subsequently commenced on adrenal replacement and her symptoms resolved and she conceived. We describe for the first time in the literature the unexpected finding of adrenal insufficiency following a BPD.

Dietary vitamin A intake and serum retinol concentrations of preschool children from different socio-economical levels in İzmir, Turkey

Vitamin A deficiency (VAD), especially in its subclinical form, is a world health problem in young children. The aim of this study was to determine the prevalence of VAD among preschool children in various socio-economic groups in Izmir, Turkey. One hundred and one children aged 24-59 months were selected for the study with cluster sampling method. A questionnaire was completed by the parents, and the dietary pattern was assessed by using a 3-day dietary record method. Mean serum retinol concentration of the children was 28.3 ± 10.2 μg/dL. Serum vitamin A concentration of two children (2%) was below 10 μg/dL (VAD), whereas 18 (18%) children had vitamin A concentrations between 10 and 20 μg/dL (subclinical deficiency). We did not find any relationship between mean serum retinol concentrations and the independent variables such as socio-economical levels, age groups, birth weight and gestational age. However, there was a statistically significant positive correlation between serum retinol concentrations and weight-for-age and weight-for-height Z scores of the children (p < 0.05). Because one-fifth of the children under 5 years have VAD in Izmir, Turkey, nutrition education must be given to the families during well-child care visits, and routine vitamin supplementation should be considered especially in children with malnutrition.

Peripheral polyneuropathy after bariatric surgery for morbid obesity

A patient with peripheral polyneuropathy after bariatric surgery for morbid obesity is reported. She suffered from frequent episodes of vomiting and abdominal pain after surgery. Muscle weakness in her lower limbs developed 5 months later and she experienced difficulty in walking and standing. Wrist drop, foot drop, and marked distal limb muscle atrophy were found bilaterally. Electromyography showed the presence of sensorimotor axonal polyneuropathy. Nutritional deficiencies may play an important role in pathogenesis. This uncommon neurological complication might be due to rapid weight loss and vitamin deficiency. Physicians who take care for patients after bariatric surgery should have a high index of awareness for the neurologic complications, and routine vitamin supplementation might be useful for these patients.

Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery

Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involvement. After treatment with immunoglobulin and vitamin supplementation, rapid clinical and neurophysiologic recovery was observed. We describe the clinical and electroneuromyographic features of this case, stressing the difficulty of initial diagnosis, particularly in the differential diagnosis with Guillain-Barré syndrome. We discuss the importance of nutritional follow-up and the eventual indication of routine vitamin supplementation in these patients.

A New Wrinkle on Topical Vitamin E and Photo-inflammation: Mechanistic Studies of a Hydrophilic γ-Tocopherol Derivative Compared with α-Tocopherol

The antioxidant function of vitamin E is thought to mediate its photo-protective effects. Cyclooxygenase-2 (COX-2) is an important mediator of early photo-inflammation. Thus, the ability of gamma-tocopherol to inhibit COX-2 activity independently of its antioxidant function raises important questions regarding potential roles that this form of vitamin E plays in photo-protection and skin cancer chemoprevention.