Severe Hypovitaminosis Research Articles

Gender-related impact of vitamin D status on severity of coronary artery disease

Abstract Funding Acknowledgements None. Background Vitamin D has cardioprotective properties. A status of hypovitaminosis D, defined as vitamin D ≤ 20 ng/ml, was found to have a comparable effect to diabetes mellitus (DM) in terms of adverse outcomes in patients with acute myocardial infarction (AMI). To date, it is known that hypovitaminosis D is more frequent in women than men but there is still a paucity of data on how gender differences in vitamin D levels are associated with the extent of coronary heart disease (CAD). Purpose To evaluate the relationship between vitamin D status on CAD incidence and severity in patients with AMI. Methods Blood samples were obtained from 1484 patients with AMI on hospital admission. Levels of vitamin D ≤ 10 ng/ml were considered as severe hypovitaminosis D. CAD was defined as the presence of at least one coronary vessel stenosis greater than 50%, while severe CAD was defined as left main disease and/or three-vessel disease. The endpoint was all-cause mortality. Results The cohort's mean age was 66.25 (11.47) years, the majority were male (71.8%) and 24.3% of patients had DM. Overall, 86.2% of patients had CAD and 32.9% severe CAD. The median vitamin D concentration was 17.25 [10.3 - 24.7] ng/ml, and 23.6% of patients had severe hypovitaminosis D. In female patients, hypovitaminosis D was significantly more common in whom with severe CAD (74.1% vs 58.1%, p=0.002), but not in men (61.3% vs 57.1%, p=0.193). On the other hand, severe hypovitaminosis D was significantly more frequent in patients with severe CAD in both genders (male and female respectively 26.6% vs 17.9%, p=0.005; 40.5% vs 26.4%, p=0.001). In female patients, severe CAD was predicted by hypovitaminosis D (OR: 1.85 [1.14 – 3.03], p=0.013) along with DM and older age after correction for confounders as GFR<60 mL/min/1.73 m2, higher cholesterol levels and body mass index. However, hypovitaminosis D was not an independent predictor of severe CAD in men. Moreover, a composite of hypovitaminosis D and DM was identified as a predictor of severe CAD when compared to patients with neither hypovitaminosis D nor DM (OR: 3.56 [1.8 – 7.03], p=0.021) only in female patients. Conclusions The identification of an association between hypovitaminosis D and severe CAD in women but not in men is a novelty in this field. Furthermore, we found that the presence of both hypovitaminosis D and DM has a greater contribution to severe CAD in female patients with AMI.

Vitamin D and Ceramide Metabolomic Profile in Acute Myocardial Infarction.

Sphingolipids (SLs) influence several cellular pathways, while vitamin D exerts many extraskeletal effects in addition to its traditional biological functions, including the modulation of calcium homeostasis and bone health. Moreover, Vitamin D and SLs affect the regulation of each others' metabolism; hence, this study aims to evaluate the relationship between the levels of 25(OH)D and ceramides in acute myocardial infarction (AMI). In particular, the blood abundance of eight ceramides and 25(OH)D was evaluated in 134 AMI patients (aged 68.4 ± 12.0 years, 72% males). A significant inverse correlation between 25(OH)D and both Cer(d18:1/16:0) and Cer(d18:1/18:0) was found; indeed, patients with severe hypovitaminosis D (<10 ng/mL) showed the highest levels of the two investigated ceramides. Moreover, diabetic/dyslipidemic patients with suboptimal levels of 25(OH)D (<30 ng/mL) had higher levels of both the ceramides when compared with the rest of the population. On the other hand, 25(OH)D remained an independent determinant for Cer(d18:1/16:0) (STD Coeff -0.18, t-Value -2, p ≤ 0.05) and Cer(d18:1/18:0) (-0.2, -2.2, p < 0.05). In light of these findings, the crosstalk between sphingolipids and vitamin D may unravel additional mechanisms by which these molecules can influence CV risk in AMI.

The Relationship between Vitamin D Levels and Blood Glucose and Cholesterol Levels.

Vitamin D deficiency has reached epidemic proportions globally. Observational data link low vitamin D status to diabetes, dyslipidemia, and metabolic syndrome, but interventional trials on the effects of supplementation are limited. We investigated associations between serum 25-hydroxyvitamin D (25(OH)D) levels and metabolic markers in Saudi adults. This retrospective cross-sectional study analyzed the clinical records of 476 patients from Saudi Arabia, aged 15-78 years. According to 25(OH)D levels, participants were stratified as vitamin D-sufficient (≥30 ng/mL), -insufficient (21-29 ng/mL), or -deficient (≤20 ng/mL). The outcomes were diabetic status (fasting glucose, HbA1c) and lipid panel results. Higher diabetes prevalence was significantly associated with lower 25(OH)D levels (10.1% in the sufficient group, 11.6% in the insufficient group, and 18.3% in the deficient group). Similarly, worse lipid profiles were associated with more severe hypovitaminosis D, including a total cholesterol level of ≥240 mg/dL (5.3% in participants with normal vitamin D levels vs. 18.9% in those with deficient levels) and LDL ≥ 160 mg/dL (6.9% in participants with normal vitamin D levels vs. 13.2% in those with deficient levels). Vitamin D deficiency disproportionately affected women and adults > 45 years old. Vitamin D deficiency is endemic in Saudi Arabia and strongly linked to worsened metabolic markers. Optimizing vitamin D status through screening and correcting the deficiency may provide a cost-effective approach to confronting the regional diabetes epidemic and reducing cardiovascular disease risk.

265 PROGNOSTIC ROLE OF VITAMIN D DEFICIENCY IN STEMI PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Abstract Background and Aims The pandemic proportion of vitamin D deficiency has raised particular concerns on its association with mortality and cardiovascular disease (CVD). However, the independent and causative role of hypovitaminosis D in CVD is still debated. Few data have been reported, so far, among STEMI patients undergoing primary percutaneous coronary intervention (pPCI), that was therefore the aim of the present study. Methods A consecutive cohort of patients admitted for STEMI treated with pPCI were included. The levels of 25(OH)D were assessed at admission by chemiluminescence immunoassay kit LIAISON® Vitamin D assay (Diasorin Inc). Hypovitaminosis D was defined for 25(OH)D &amp;lt; 10 ng/ml. The primary study endpoint was net adverse cardiovascular events (a composite of death, recurrent MI and target vessel revascularization) at the longest available follow-up. Secondary endpoints were overall mortality, major bleedings or the individual components of the primary endpoint. Results We included 136 patients divided according to tertiles values of 25(OH)D (&amp;lt; 12.98 ng/ml, n=44; 12.98-22.1 ng/ml, n=41; ≥ 22.1 ng/ml, n=51). The prevalence of renal failure (p=0.047) and coronary calcifications inversely related with vitamin D. Lower vitamin D levels were associated with “no reflow” (10.3% vs 6.7% vs 0%, p=0.04), with increased use of adenosine. At a mean follow-up of 305± 217 days (mean + SD), the primary endpoint (NACE) was slightly increased in patients with lower vitamin D values (adjusted HR [95% CI] = 3.07 [0.85-11.1], p = 0.09). Similar results were observed for ischemic events (MACE: adjusted HR [95% CI] = 2.78 [0.68-11.48], p = 0.16). However, when considering separately patients with severe hypovitaminosis D (&amp;lt;10 ng/ml), we found a significant increase in the risk of NACE and MACE (adjusted HR [95% CI] = 5.17 [1.42-18.8], p = 0.01 and HR = 4.75 [1.14-19.7], p = 0.03, respectively). Conclusion The present study shows that among patients with STEMI undergoing pPCI, extremely low levels of vitamin D are independently associated with impaired outcomes. Future dedicated studies will shed light on the prognostic implications of hypovitaminosis D in these patients and the potential therapeutic perspectives.

The First Documented Case of Marchiafava-Bignami Disease with Concurrent Bilateral Deep Vein Thrombosis

Marchiafava-Bignami Disease (MBD) presents as a rare neurological disease characterized by demyelination and necrosis in the corpus callosum. Most MBD cases are secondary to severe alcohol abuse and hypovitaminosis. MRI and other forms of neuroradiological imaging is necessary to confirm the diagnosis. We herein present an atypical case of a MBD and history of alcohol abuse who developed deep vein thrombosis in his bilateral lower extremities. This novel case represents the first documented report of MBD with concurrent DVT. Furthermore, we hypothesize that DVT may be a long-term complication associated with MBD

Severe hypovitaminosis D in pregnant refugees arriving in Europe: neonatal outcomes and importance of prenatal intervention.

Adequate vitamin D levels are particularly important in pregnant women for both maternal and neonatal health. Prior studies have shown a significantly high prevalence of vitamin D deficiency (VDD) among refugees. However, no study has addressed the prevalence of VDD in pregnant refugees and its effects on neonatal health. In this study, we examined the prevalence of VDD in refugee pregnant women living in Greece and compared our results with Greek pregnant inhabitants. VDD was frequent in both groups but was significantly more common in refugees (92.2 vs 67.3% of Greek women, P = 0.003) with 70.6% of refugees having severe hypovitaminosis D (<10 ng/mL). As a result, most newborns had VDD, which affected refugee newborns to a greater extent. Our results suggest a need to screen newcomer children and pregnant women for VDD in all host countries around the world. Such a screen will appropriately guide early and effective interventions with the goal to prevent adverse neonatal and maternal outcomes.

The structure of nutrition of Russian students as a risk factor for the development of nutritional diseases

The paper analyzes the literature data on the peculiarities of nutrition of students studying in higher educational institutions of various regions of Russia, and the risks of developing food-related diseases. They are largely associated with the adaptation of students to study at a university, the lack of self-organization skills and a lack of knowledge in matters of rational nutrition. The actual nutrition of students, on the one hand, is characterized by a lack of macronutrients and micronutrients intake, on the other hand, by excessive consumption of substances that contribute to the development of obesity. The results of numerous studies show a general pattern of unbalanced nutrition of students in terms of the ratio of saturated and polyunsaturated fatty acids, insufficient consumption of dietary fiber, full-fledged proteins, and excessive intake of simple carbohydrates. Dietary fiber deficiency can lead to changes in the composition of the microbiocenosis of the digestive tract, a deficiency of omega-3 fatty acids, and consequently, the imbalance of fatty acid composition of the blood cell membrane. 20–40 % of Russian students show signs of severe hypovitaminosis, especially calciferol, which is caused not only by its deficiency in the diet, but also by physical, geographical, climatic and seasonal factors. The analysis of the content of the main minerals in students shows a sufficient content of calcium in the body, an excess of sodium and a lack of magnesium, potassium and iron, which is due to both the composition of the food consumed and the peculiarities of the accumulation and excretion of these ions. An analysis of the actual nutrition of students shows the need for counseling young people, especially in the first years of study. The introduction of an educational program on optimal nutrition is possible through the practice of curatorial work during the adaptation of the first-year students to student’s life.

Serum Vitamin D as a Marker of Impaired Information Processing Speed and Early Disability in Multiple Sclerosis Patients.

Slowed information processing speed (IPS) is the hallmark and first cognitive domain to be altered in multiple sclerosis (MS) patients. Insufficient serum vitamin D was previously associated with disease development, relapses, and progression, but little is reported on cognition. However, vitamin D and cognitive impairment (CI) in other neurodegenerative diseases have already been linked. We explored the possible correlation between vitamin D and IPS at diagnosis and early disability at last follow-up in 81 MS patients. At diagnosis, we collected vitamin D levels and performed a Symbol Digit Modalities Test (SDMT). Raw scores were adjusted for age, gender, and educational level. Early disability was evaluated with MS severity score (MSSS) and age-related MSSS (ARMSS). A total of 71 patients (86.58%) showed hypovitaminosis D (19.71 ± 8.76 ng/mL) and 18 patients (21.95%) had CI. Patients with CI showed severe hypovitaminosis D (p = 0.004). No patients with sufficient vitamin D levels had CI. We found a positive correlation between vitamin D levels at diagnosis and (1) SDMT raw and z-score that persisted after correction for sunlight exposure and MRI baseline characteristics, and (2) EDSS, MSSS, and ARMSS after a mean 2 year follow-up. Low vitamin D levels may affect both cognition and early disability in newly diagnosed MS patients.

Обеспеченность витаминами В1, В2 организма коренных северян, ведущих полукочевой и оседлый образ жизни

The Komi Republic is one of the regions with large communities of reindeer herders. As a result of the active development of northern territories, the indigenous population is shifting from nomadic to sedentary lifestyle, which is accompanied by significant changes in their traditional way of life and diet. As a result, representatives of the same ethnic group can have different dietary patterns. This paper compares the status of vitamins B1 and B2 between the groups of northerners leading a seminomadic and sedentary lifestyle. Indigenous inhabitants – children (aged 7–17 years, n = 395) and adults (aged 18–57 years, n = 370) – living in the Komi Republic (65–67°N) were examined. The group of reindeer herders consisted of workers of reindeer-herding teams travelling with the herd and their children (either attending boarding schools or living with their families). The control group was represented by indigenous northerners not involved in reindeer herding and permanently living in settlements. The vitamins B1 and B2 status was measured by the activity of vitamin-dependent red cell enzymes. We found a high prevalence of vitamin deficiency (over 40 % for vitamin B1 and over 30 % for vitamin B2) among the indigenous population of the North. The total prevalence of vitamin deficiency among reindeer herders was similar to that in the population leading a sedentary lifestyle; however, severe hypovitaminosis was more than twice as common among the latter. The vitamin status of reindeer herders’ children attending boarding schools and those living with their families during the academic year did not differ significantly from the status of children whose families lead a permanent sedentary lifestyle.

Hypovitaminosis D in migrant children in Switzerland: a retrospective study

Cholecalciferol (vitamin D3) is essentially known for its role in the phosphocalcic metabolism and its associated pathologies, such as rickets. In Switzerland, 35 to 50% of children are vitamin D deficient. Due to skin colour, poor nutrition, living conditions and cultural practices, migrant population is particularly at risk. Our aim is to attest the prevalence of hypovitaminosis D in children arriving in Switzerland. We retrospectively assessed 528 children’s vitamin D status and parathyroid hormone, phosphate and calcium levels between 2015 and 2018 by electrochemiluminescence and spectrophotometry. Cholecalciferol was considered insufficient under 50 nmol/L and severely deficient below 25 nmol/L. Seventy-three percent of children showed hypovitaminosis D and 28% had a severe deficiency. Highest prevalence of deficiency was found in children from Eastern Mediterranean (80%) and African regions (75%). Severe deficiency was more prevalent in the South East Asian (39%) and Eastern Mediterranean regions (33%) and more frequent in females. Deficiency was more frequent and more severe in winter. Hypovitaminosis D increased with age. Two children presented with all three biological manifestations associated to severe hypovitaminosis D (hyperparathyroidism, hypocalcaemia and hypophosphatemia).Conclusion: A majority of migrant children presented with hypovitaminosis D. They should be supplemented to prevent complications. A strategy could be to supplement all children at arrival and during wintertime without regular vitamin D level checks.What is Known:Hypovitaminosis D is frequent in children and can lead to bone-related complications.Migrant children are particularly at risk of deficiency.What is New:Three-quarters of migrant children evaluated at our migrant clinic in Geneva’s children hospital are deficient in vitamin D, one third severely.A strategy to correct the deficiency would be to supplement all migrant children at arrival and in winter.

Serum Vitamin D Level among Multiple Sclerosis Patients in the Tropics: Experience from a Private Clinic in Addis Ababa, Ethiopia.

Multiple sclerosis (MS) is an immune mediated disabling neurological disorder. Very little is known about MS in Ethiopia. The objective of this study was to determine the prevalence of hypovitaminosis D and associated factors in cohort of MS patients in Ethiopia. A cross-sectional observational study was conducted among 25 multiple sclerosis patients at Yehuleshet Specialty Clinic, Addis Ababa, Ethiopia. The prevalence of vitamin D deficiency was 96% (n=24). The average serum vitamin D was 14.8 (±10.4) ng/mL. The mean age was 35.8 (±10) years. Females accounted for 80% (n=20). Relapsing and remitting MS was the commonest variant. Motor, sensory, and mixed symptoms accounted for 40% (n=10), 20% (n=5), and 24% (n=6), respectively. Cold or hot weather and stress were reported as worsening factors in 24% (n=6). Relapse rate was 44% (n=11). Fatigue and seizure disorder were reported by 80% (n=20) and 16% (n=4) respectively. Steroid is the commonest prescribed medication for the patients. A negative correlation was found between serum vitamin D and age (r = -0.062, p = 0.7). Similarly, a negative association was observed between vitamin D and duration of illness (r = -0.311, p = 0.1). Fatigue was reported by those with moderate hypovitaminosis compared to those having severe hypovitaminosis (p=0.002). Seizure was reported more by those with vitamin D below 10ng/mL compared to those having above 10 ng/mL (p=0.004). Our study demonstrates a high prevalence of hypovitaminosis D in Ethiopian MS patients. Hypovitaminosis D was associated with increment in age and duration of illness.

Reducing Risks from COVID-19: Cost-Effective Ways of Strengthening Individual's and the Population Immunity with Vitamin D

In addition to being involved in the regulation of calcium and phosphate metabolism and the musculoskeletal functions, vitamin D has immune modulatory effects through several independent pathways. Its active hormone, calcitriol [1,25(OH)2D] effect both innate and adaptive immune systems essential for optimal immune functions. Vitamin D deficiency exacerbates immune-related disorders, including type 1 diabetes, multiple sclerosis, rheumatoid arthritis, psoriasis, respiratory infections, including COVID-19. In those with COVID-19, complications and the number of deaths is higher in those who are older than 70 years, persons with a darker skin colour and/or ethnic minorities living in colder climatic regions, institutionalized persons, and with pre-existing chronic diseases. These groups of people have exceedingly high prevalence of severe vitamin D deficiency and thereof weaker immune systems. Collectively, these increases the vulnerability to microbial infections, particularly respiratory viruses, and for developing severe complications and deaths. Vitamin D related immune protective effects includes, the generation of anti-microbial peptides cathelicidin and defensins and antibodies against invading pathogens; the initiation of immune defences via natural killer cells, macrophages, and epithelial cells; the enhanced expression of angiotensin-converting enzyme 2 (ACE-2) and diminish expression of inflammatory cytokines; and reduce replication and enhance elimination of viruses from the body. The severity of complications and deaths associated with COVID-19 markedly increases in the presence of severe hypovitaminosis D: serum 25(OH)D concentration of less than 10 ng/mL. Excess complications and deaths from COVID-19 can be cost-effectively prevented with rapidly boosting the immunity using upfront loading, high doses of vitamin D; this will create an equivalent of internal “body armour”-defence system, that protects against COVID-19.

Vitamin D Deficiency and Psoriasis: A Cross-Sectional study of Iranian Population in Yazd Province

Objective: Psoriasis is an inflammatory disease of the skin and the joints. Psoriatic patients sometimes suffer from vitamin D deficiency and hypocalcemia. The aim of our study was to evaluate the level of calcium and vitamin D in patients with psoriasis. Materials and Methods: In this analytical cross sectional study, 110 cases of psoriasis that were referred to Shohadaye Mehrab clinic during 2015 and 110 non-psoriatic patients enrolled. Serum levels of calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase (ALK) and 25- hydroxy vitamin D3 [(25OH) D3] were measured in both groups. Data were analyzed using SPSS software version 19. Chi square test and T-test were used for statistical analysis. Results: Among110 patients with psoriasis 74 (67.3%) were men and 36 (32.75%) were women. There was no significant difference in the serum level of calcium (P-value: 0.563), phosphorus (P-value: 0.381), PTH (P-value: 0.364) and ALK (P-value: 0.639) between two groups. Vitamin D deficiency was found in 64.5% of psoriatic patients and 60% of the controls (P-value= 0.45); However 30.9% of psoriatic and 17.3% of the controls suffered from severe hypovitaminosis D. This difference was statistically significant (Pvalue= 0.014).Conclusion: We found a significant relationship between severe hypovitaminosis D and psoriasis. This finding revealed the need for evaluation of psoriatic patients for the presence of vitamin D deficiency.

Vitamin D levels condition the outcome benefits of renin-angiotensin system inhibitors (RASI) among patients undergoing percutaneous coronary intervention

BackgroundVitamin D deficiency is estimated as the most common medical condition worldwide, with severe implications on survival and on several inflammatory, immune-mediated and thrombotic disorders, and especially for cardiovascular disease.Recent studies have suggested that vitamin D could directly regulate the Renin-Angiotensin System (RAS) activity, therefore potentially interfering with the pharmacological effects of RAS Inhibitors (RASI), an issue that has seldom been explored. Therefore, the aim of the present study was to evaluate the prognostic impact of the use of RASI according to vitamin D levels among patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). MethodsConsecutive patients undergoing PCI were included. Main clinical features and chemistry parameters were assessed at admission. Vitamin D levels were measured by chemiluminescence immunoassay kit LIAISON® Vitamin D assay (Diasorin Inc). Severe deficiency was defined for 25(OH)D < 10 ng/mL. The primary study endpoint was defined as the occurrence of major cardiovascular events (MACE, a composite of death, recurrent Myocardial Infarction (MI) and target vessel revascularization) at the longest available follow-up. ResultsWe included a total of 705 patients, that were divided according to vitamin D tertiles (< 12.7 ng/mL; 12.7–21.59 ng/mL; ≥21.6 ng/mL) and use of RASI. RASI therapy was significantly associated to arterial hypertension, creatinine, lower 25(OH)D, use of statins, diuretics, ASA and ticagrelor across vitamin D tertiles. At a median follow-up of 996 [377–1552] days, MACE occurred in 174 (24.7 %) patients. Severe hypovitaminosis D was significantly associated with a higher rate of MACE (HR[95 %CI] = 0.75[0.62−0.91], p = 0.004). The use of RASI significantly lowered the rate of MACE in patients with lower vitamin D (I tertile: 41.3 % vs 25.9 %, adjusted HR[95 %CI] = 0.43[0.26−0.73], p = 0.002); whilst a non-significant effect was observed for II and III tertiles values (18.6 %vs 29.5 %, adjusted HR[95 %CI] = 1.16[0.57−2.34], p = 0.69, and 21.2 % vs 12.6 %, adjusted HR[95 %CI] = 1.1[0.46−2.62], p = 0.83) (p int = 0.04).A similar prognostic interaction for RASI and vitamin D was observed for cardiovascular mortality and MI (p int = 0.03). ConclusionAmong patients undergoing PCI, the use of RASI was associated with lower risk of MACE only among patients with lower levels of vitamin D. Future larger studies are certainly warranted in order to define the prognostic implications of vitamin D supplementation on the RAS system modulation, especially among patients treated with RASI.

LEVELS OF VITAMIN C IN CHAIN SMOKERS

Introduction: Cigarette smoking induces many chronic illnesses, but in developed countries it is a preventable risk factor. However, by increasing the protective protection mechanism, it may be possible to alleviate the smoke-induced damage. As smoking risk is minimised by vitamin C intake, it is recommended that smokers should take more vitamin C. This inverse correlation between both vitamin C intake and serum levels and smoking was independent of age, sex, body weight, ethnicity, and consumption of alcoholic beverages. The negative association between cigarette smoking and serum vitamin C levels continued, following further adjustment for dietary vitamin C intake. The risk of severe hypovitaminosis C, especially when not accompanied by vitamin supplementation, has been increased in smokers. These data indicate that the inverse relationship between smoking and serum vitamin C levels exists independently of dietary intake, while smoking adversely affects preferences for vitamin C rich foods.&#x0D; Methods: A survey method was performed, with 50 smokers (S) receiving either 500 mg of vitamin C or placebo (P) daily for 4 weeks, and 50 non-smokers receiving vitamin C without supplementation. All finished the hearing. Both groups were equal and C: 14.2 + /- 1.8 pack-years was the amount of cigarettes smoked. Concentrations of plasma vitamin C increased significantly (p &lt; 0.005) only in the vitamin C supplement community. &#x0D; Results: At SMHRC Hospital Nagpur, we examined the relationship between smoking and vitamin C status, dietary and serum vitamin C levels of 100 participants. Smokers of 20 cigarettes a day had the lowest dietary intake of vitamin C and serum levels, whereas smokers of 1-19 cigarettes a day had lower intake of vitamin C and serum levels (compared to respondents who had never smoked. This inverse correlation between vitamin C and smoking intake and serum levels was independent of age, sex, body weight, race, and consumption of alcoholic beverages. The negative association between cigarette smoking and serum vitamin C levels continued, following further adjustment for dietary vitamin C intake. In smokers, the risk of severe hypo-vitaminosis C, particularly when not accompanied by vitamin supplementation, has increased.&#x0D; Conclusion: These data indicate that the inverse relationship between smoking and serum vitamin C levels exists independently of dietary intake, while smoking adversely affects preferences for vitamin C rich foods. A balanced diet for smokers will obtain a hearty recommendation at this time, but guidelines should remain cautious about high-dose nutrition supplements.&#x0D; Keywords: Chain Smoker, Vitamin C, hypo-vitaminosis C and cigarette.

Effect of vitamin D supplementation on TSH levels in euthyroid subjects with autoimmune thyroiditis.

The impact of vitamin D supplementation on thyroid function is not clear and the relationship between hypovitaminosis D and autoimmune thyroiditis (ATD) incidence and evolution is still a matter of debate. The aim of this study was to retrospectively evaluate the impact of vitamin D supplementation on thyroid function in subjects with and without ATD. One hundred and ninety-eight euthyroid subjects, with diagnosis of "hypovitaminosis D" (<30 ng/mL) who had been taking supplementation therapy with cholecalciferol for different time periods, were included. They were divided in two groups according to the previous diagnosis of ATD: "ATD-neg" group including subjects without ATD [n = 103 (52%)]; "ATD-pos" group including subjects with a confirmed diagnosis of ATD [n = 95 (48%)]. For both groups, we considered TSH and 25 hydroxyvitamin D (25OHD) levels before (T0) and after (T1) cholecalciferol supplementation. We also considered the treatment duration and the monthly dose of cholecalciferol expressed as IU/month. In hypovitaminosis D subjects with ATD, TSH levels significantly decreased after therapy with cholecalciferol 100.000 IU/month [mean ± SD, TSH at T0: 2.67 ± 1.21 vs. TSH at T1: 2.28 ± 0.86, p = 0.028]. No significant TSH variation was observed in ATD-neg group, irrespective of treatment dose and duration. As expected, 25OHD levels significantly improved with all monthly doses and especially in the group receiving 100.000 IU/month. Cholecalciferol supplementation improved thyroid function in euthyroid ATD-pos subjects affected with severe hypovitaminosis D. In particular, a significant reduction in TSH levels was observed in subjects with very low baseline 25OHD levels, after taking high monthly doses of cholecalciferol.

Vitamin D and Postoperative Delirium After Coronary Artery Bypass Grafting: A Prospective Cohort Study

Postoperative delirium is the most common neuropsychiatric complication after cardiac surgery. Vitamin D contributes to numerous brain processes, regulation of neurotrophic factors, neuroprotection, neuroplasticity, and brain development, which could play a role in delirium pathophysiology. The authors evaluated the association of admission serum levels of 25-hydroxyvitamin D [25(OH)D] with the occurrence of delirium after coronary artery bypass surgery. A prospective cohort study. University hospital. Coronary artery bypass surgery patients. Serum levels of 25(OH)D were measured for 398 patients upon admission. Delirium was measured using the confusion assessment method for the intensive care unit. Postoperative delirium was detected in 17% (n = 68) of the patients. 25(OH)D deficiency (less than 20 ng/dL) was found in 41.2% (n = 164) of the patients. The median serum level of 25(OH)D was 21 ng/dL (12.8-32.85) in delirium and 24.2 ng/dL (14.4-42.5) in nondelirium patients (p = 0.04). Multivariate regression analysis adjusted by other risk factors indicated that admission severe hypovitaminosis D was associated with the occurrence of delirium (odds ratio = 3.18; 95% confidence interval: 1.29-7.78; p = 0.01). Preoperative severe vitamin D deficiency was associated with the occurrence of delirium after coronary artery bypass grafting surgery.

Severe nutritional deficiencies and osteopenia in a dog fed a homemade raw diet

A seven-month-old male entire Bulldog presented for a three-week history of progressive lethargy, exercise intolerance, hindlimb paresis, muscle atrophy and hyperaesthesia. The dog had initially been raised on the bitch’s...

Daily oral vitamin D3 regimen in similar cumulative doses is more effective than weekly oral vitamin D3 regimen in patients with vitamin D deficiency

Context: Vitamin D deficiency is a common health problem worldwide, especially in the Middle Eastern region. Although various dosing regimens of vitamin D have been used for the treatment of vitamin D deficiency, it is still unclear as to which dosing regimen can efficiently increase the serum level of vitamin D in different patient population. Aim: This study was designed to compare the efficacy of weekly and daily regimens of vitamin D3 in patients with vitamin D deficiency. Settings and Design: A randomized clinical trial was conducted in the autumn and winter of 2016 and 2017, Hamadan, Iran. Materials and Methods: A total of 130 patients with moderate to severe hypovitaminosis D were allocated into two groups: weekly 50,000 IU (routine recommended dose for vitamin deficiency treatment) or daily 4,000 IU (safe upper limit dose of vitamin D per day) of oral vitamin D3 for 8 and 14 weeks, respectively. The serum levels of 25-OH-vitamin D were measured in all patients at baseline and at the end of the treatment period. Results: Results of this study showed that though both dosing regimens can be effective in increasing the serum level of 25-OH-vitamin D, higher percentage of the subjects in the daily regimen group achieved the sufficient serum level of 25-OH-vitamin D when compared to the weekly regimen group. Conclusion: Accordingly, probably owing to better bioavailability of daily regimen of vitamin D3 and establishment of a more steady serum concentration compared with weekly regimen, it can be recommended as the preferred dosing regimen for effective treatment of vitamin D deficiency.

144P - Severe hypovitaminosis D in metastatic gastric cancer patients from the Northern and Southern hemispheres: Data from the EXPAND phase III trial

BackgroundOur primary goal was to evaluate the association between vitamin D (25-OHD) plasma levels and overall survival (OS) in metastatic gastric cancer patients receiving first-line chemotherapy in the international phase III EXPAND study (EudraCT 2007-004219-75). Here we report on 25-OHD plasma levels and OS according to geographic hemisphere of residence. Methods25-OHD pre-therapeutic plasma levels were measured in 630 patients using chemiluminescent immunoassay (Abbott Laboratories, Illinois). All patients were treated with chemotherapy based on capecitabine and cisplatin ± cetuximab. The Cox proportional hazard regression model was used to analyse the association between 25-OHD and survival in both treatment arms. Results549 and 73 patients were recruited in the Northern and Southern hemispheres, respectively. The majority had severe hypovitaminosis D at baseline prior to start of treatment. Only 9.2% of patients had a normal 25-OHD plasma levels (applying accepted criteria of 25-OHD insufficiency with plasma levels < 75 nmol/l; deficiency defined as < 50 nmol/l). Median 25-OHD plasma level was 38.2 nmol/l (IQR 25.8; 58.9) and mean was 43.5 nmol/l. Patients from the Southern versus Northern hemisphere had slightly higher 25-OHD levels (median 45.6 vs. 37.4 nmol/l; p = 0.0172; mean 48.92 vs. 42.74; p = 0.03 ). This difference persists when adjusting for season in a linear regression model. As expected, we observed the highest levels of 25-OHD in samples drawn during the summer season and the lowest values in winter. No proof for a negative impact of hypovitaminosis D on survival or treatment response was detected and no difference in OS was seen between patients from the Southern vs. Northern hemisphere (median 8.3 months [95%CI 7.4-10.6] vs. 10.5 [95%CI 9.4-11.3]; Hazard Ratio = 1.195; p = 0.2001). ConclusionsNo prognostic value of vitamin D deficiency was found in the EXPAND cohort. However, the majority of patients with metastatic gastric cancer have a severe vitamin D deficiency with only minor differences comparing Southern versus Northern hemisphere of residency. Legal entity responsible for the studyMasaryk Memorial Cancer Institute. FundingMasaryk Memorial Cancer Institute, University Leipzig. DisclosureR. Obermannova: Advisory / Consultancy, Speaker Bureau / Expert testimony: Servier; Advisory / Consultancy, Research grant / Funding (self): Merck; Advisory / Consultancy, Speaker Bureau / Expert testimony: Eli Lilly. F. Lordick: Advisory / Consultancy, Speaker Bureau / Expert testimony: Amgen, AstraZeneca, Astellas, Biontech, BMS, Eli Lilly, Elsevier, Excerpta Medica, Imedex, Infomedica, Iomedico AG, Medscape, MedUpdate GmbH, Merck Sharp Dohme, Merck Serono, Oncovis Gmbh, Promedicis, Springer Nature Group, StreamedUp!, Zymeworks; Research grant / Funding (institution): BMS. All other authors have declared no conflicts of interest.