Suboptimal Vitamin Research Articles

A 3‐D approach to personalised nutrition

A <scp>3‐D</scp> approach to personalised nutrition

Role of Vitamin D on cognitive performance among healthy volunteers of SANSCOG cohort

<h2>Summary</h2><h3>Background and aims</h3> Nutrients such as vitamin D play an important role in aging and dementia and evidence on the effect of vitamin D on cognition among healthy aging adults especially in rural India is sparse. Our aim was to observe the effect of vitamin D on cognition. <h3>Methods</h3> Using a cross-sectional study design we examined cognitive performance between vitamin D sufficient, vitamin D insufficient and vitamin D deficient groups among the cognitively healthy volunteers of SANSCOG cohort. <h3>Results</h3> Our analysis revealed that two thirds (74.5%) had suboptimal vitamin D levels (Insufficiency-38.3% and Deficiency-36.2%) and women were more affected than men. Vitamin D levels affected subject's depression scores and diabetes status negatively, however no effect was found on cognitive performance. <h3>Discussion</h3> It may be postulated that vitamin D plays an indirect role on cognitive performance. Large proportion of suboptimal vitamin D levels in the rural population warrants proactive public health measures.

Pre- and Postnatal Vitamin D Status and Allergy Outcomes in Early Childhood

The dramatic increase in the prevalence of allergic disease in recent decades reflects environmental and behavioural changes that have altered patterns of early immune development. The very early onset of allergic diseases points to the specific vulnerability of the developing immune system to environmental changes and the development of primary intervention strategies is crucial to address this unparalleled burden. Vitamin D is known to have immunomodulatory functions. While allergic disease is multifactorial, associations with reduced sunlight exposure have led to the hypothesis that suboptimal vitamin D levels during critical early periods may be one possible explanation. Interventions to improve vitamin D status, especially in early life, may be the key to allergic disease prevention.

Effect of Vitamin D Supplementation on the Fetal Growth Rate in Pregnancy Complicated by Fetal Growth Restriction.

Background: Fetal growth restriction (FGR) increases the risk of intrauterine fetal death, infant death and complications in childhood, and diseases that appear in adulthood. Vitamin D may affect fetal vascular flow. The aim of the study was to check if the rate of fetal growth in pregnant women with FGR differs depending on whether the patient was supplemented with vitamin D in the recommended dose of 2000 IU, not supplemented at all, or supplemented with vitamin D in low doses. Methods: Patients were divided into two groups: suboptimal vitamin D dosage and an accurate dosage of 2000 IU. Fetal growth progress was observed for 14 days. Results: Fetal weight was higher at the beginning, after 1 and 2 weeks of observation in the optimal vit. D group compared with the suboptimal group. The analysis was adjusted to the mother’s age, gestational week, and the number of pregnancies. Conclusions: Greater fetal weight gain can be observed in women with FGR (fetal growth restriction) who intake vitamin D at the recommended dose of 2000 IU compared with women with FGR and with a vitamin D intake dosage lower than 500 IU.

Maternal Vitamin B12 Levels During Pregnancy and Their Effects on Maternal Neurocognitive Symptoms: A Systematic Review.

Vitamin B12 deficiency has been linked to neurocognitive symptoms. Vitamin B12 deficiency in pregnancy may be associated with antenatal or postpartum depression along with other neurocognitive symptoms including restless leg syndrome. The objective of this study was to systematically review the literature regarding vitamin B12 deficiency and insufficiency in pregnancy and its effects on maternal neurocognitive symptoms. MEDLINE, Embase, and SCOPUS were searched from inception to October,2020. Observational studies and randomized controlled trials of singleton pregnancies involving vitamin B12 deficiency and reporting maternal neurocognitive outcomes were identified. Data were synthesized and are presented narratively. The 5 studies included in the analysis did not demonstrate a statistically significant link between vitamin B12 deficiency or insufficiency and either restless leg syndrome or depression in pregnancy. To date, evidence is lacking that would support a causal link between suboptimal vitamin B12 serum levels and maternal restless leg syndrome or depression.

Suicide Risk in Rheumatoid Arthritis Patients is Associated With Suboptimal Vitamin D Levels.

Background/ObjectiveRheumatoid arthritis (RA) patients might experience anxiety and depressive symptoms. Deficient vitamin D levels may be a trigger for these conditions. The aim of this study was to determine the frequency of depression, anxiety symptoms, and suicidal risk or ideation in patients with RA associated with vitamin D serum levels.MethodsIn this cross-sectional study, we recruited RA patients older than 18 years, classified into 3 groups according to serum vitamin D levels: sufficient, ≥30 ng/mL; insufficient, 20–29 ng/mL; and deficient, <20 ng/mL. Based on the self-reported Plutchik and the Hospital Anxiety and Depression Scale, we evaluated the association of suicidal risk, depression, and anxiety with the vitamin D levels in RA and the Rheumatoid Arthritis Quality-of-Life Questionnaire.ResultsWe studied 72 patients with RA between January and October 2019. We found an inverse correlation between Plutchik score and suicidal risk with inadequate vitamin D levels, but not with the Hospital Anxiety and Depression Scale. Suicidal ideation was associated with a higher score on the Rheumatoid Arthritis Quality-of-Life Questionnaire.ConclusionsDespite the high prevalence of depressive and anxiety symptoms in RA patients, a Plutchik low correlation coefficient with inadequate serum levels of vitamin D was found. However, in the analysis of covariance, we were able to find that vitamin D levels remain associated with a reduction of suicide ideation. Further studies are needed to identify a risk profile for early psychological interventions to improve the quality of life in RA patients.

The Association Between Active Transportation and Serum Total 25-Hydroxyvitamin D Levels Among US Childbearing-Aged Women.

Serum total 25-hydroxyvitamin D (25[OH]D) and physical activity (PA) both play important roles in maternal-fetal health. However, a high prevalence of vitamin D and PA insufficiency has been observed in women of childbearing age. Active transportation may increase overall PA levels and potentially boost serum 25(OH)D levels. Data from the National Health and Nutrition Examination Survey between 2007 and 2014 were used. A total of 5601 women aged 18-49 years were included. Transportation PA (TPA) was quantified as metabolic equivalents of task and serum 25(OH)D levels was measured. Multivariable logistic regression models adjusted for potential confounders were conducted. The corresponding adjusted odds ratios associated with vitamin D insufficiency (<50nmol/L) were 1.09 (95% confidence interval, 0.87-1.37) for 1 to 499 MET minutes per week of TPA, 0.69 (0.52-0.91) for 500 to 1000 MET minutes per week of TPA, and 0.95 (0.72-1.26) for >1000 MET minutes per week of TPA, respectively, compared with no TPA. Using vitamin D deficiency (<30nmol/L) as the outcome led to similar results. The association between TPA and serum 25(OH)D levels was more robust in high sedentary time. A moderate level of TPA is related to lower odds of suboptimal vitamin D status among women of childbearing age.

Vitamin D and its association with symptom severity in knee osteoarthritis: a cross sectional study at a national referral hospital in Uganda

BackgroundVitamin D deficiency is highly prevalent among patients with osteoarthritis. It is associated with joint pain, stiffness and worse physical function. Whether vitamin D deficiency is associated with osteoarthritis is controversial. We investigated serum vitamin D levels and its association with symptom severity in patients with knee osteoarthritis.MethodsBetween January 2020 to March and May 2020, we conducted a cross sectional study at a national referral hospital in Uganda. Using the American College of Rheumatology clinical criteria, 107 consenting adults were diagnosed with knee osteoarthritis. A questionnaire captured patient demographics and clinical characteristics. Joint pain, stiffness and physical function severity were assessed and graded based on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). We determined serum vitamin D levels by electrochemilumniscence immunoassay. The data were analysed and adjusted for age, sex, education, occupation, family history, body mass index (BMI) and calcium supplementation.ResultsOf the 107 patients, 92 (86%) patients were females, mean (SD) age was 58.1 (12.6) years. Nearly 65% of the patients had suboptimal serum vitamin D levels < 30 ng/ml. The median (Q1, Q3) WOMAC joint scores were as follows: pain 8.0 (5, 11), stiffness 1 (0, 2), physical function 29.0 (16, 41) and total WOMAC 39.0 (21, 54). Spearman correlations between serum vitamin D levels with symptom severity were as follows: joint pain (r = 0.18, p = 0.06), stiffness (r = 0.13, p = 0.17), physical function (r = 0.09, p = 0.36) and total WOMAC (r = 0.13, p = 0.19).ConclusionSerum vitamin D levels are not associated with joint pain, stiffness and physical function severity. Older age and higher BMI are associated with vitamin D deficiency in patients with knee osteoarthritis attending a national referral hospital rheumatology clinic in Uganda. Suboptimal vitamin D is an independent risk factor for total mortality in the general population. Clinical guidelines and further studies to determine age and BMI ranges required for vitamin D screening are needed in patients with osteoarthritis in Uganda. Patients are advised to keep a normal BMI.

Role of Vitamin D in Systemic Sclerosis: A Systematic Literature Review

Background Systemic sclerosis (SSc) is a chronic multisystem autoimmune condition defined by a complex pathobiology, comprising excessive fibrosis of skin and internal organs, peripheral vasculopathy with endothelial cell dysfunction, inadequate vascular repair and neovascularization, and aberrant immunity. Vitamin D is a steroid hormone with pleiotropic effects beyond its traditional role in calcium and bone homeostasis. Since vitamin D has immunomodulatory, cardioprotective, and antifibrotic properties, it could potentially interfere with SSc pathogenesis. Suboptimal vitamin D levels are classically recognized in scleroderma, irrespective of clinical and serological phenotype. Aim This systematic review is aimed at investigating and clarifying the role of vitamin D in SSc and emphasizing the association of vitamin D status with different clinical settings. Methods and Results A systematic online search was performed, using PubMed databases to collect articles on the topic of vitamin D in SSc. The final analysis included 40 eligible articles. Conclusions Hypovitaminosis D is common in SSc patients and could be associated with clinical and serologic patterns of the disease. Intervention for low serum vitamin D levels in SSc pathogenesis remains controversial, as well as the significance of vitamin D supplementation in such patients.

Vitamin C Differentially Impacts the Serum Proteome Profile in Female and Male Mice.

A suboptimal blood vitamin C (ascorbate) level increases the risk of several chronic diseases. However, the detection of hypovitaminosis C is not a simple task, as ascorbate is unstable in blood samples. In this study, we examined the serum proteome of mice lacking the gulonolactone oxidase (Gulo) required for the ascorbate biosynthesis. Gulo-/- mice were supplemented with different concentrations of ascorbate in drinking water, and serum was collected to identify proteins correlating with serum ascorbate levels using an unbiased label-free liquid chromatography-tandem mass spectrometry global quantitative proteomic approach. Parallel reaction monitoring was performed to validate the correlations. We uncovered that the serum proteome profiles differ significantly between male and female mice. Also, unlike Gulo-/- males, a four-week ascorbate treatment did not entirely re-establish the serum proteome profile of ascorbate-deficient Gulo-/- females to the optimal profile exhibited by Gulo-/- females that never experienced an ascorbate deficiency. Finally, the serum proteins involved in retinoid metabolism, cholesterol, and lipid transport were similarly affected by ascorbate levels in males and females. In contrast, the proteins regulating serum peptidases and the protein of the acute phase response were different between males and females. These proteins are potential biomarkers correlating with blood ascorbate levels and require further study in standard clinical settings. The complete proteomics data set generated in this study has been deposited to the public repository ProteomeXchange with the data set identifier: PXD027019.

Genetic Link Determining the Maternal-Fetal Circulation of Vitamin D.

Vitamin D is an essential micronutrient whose demand is heightened during pregnancy to support the growth of the fetus. Furthermore, the fetus does not produce vitamin D and hence relies exclusively on the supply of maternal vitamin D through the placenta. Vitamin D inadequacy is linked with pregnancy complications and adverse infant outcomes. Hence, early predictive markers of vitamin D inadequacy such as genetic vulnerability are important to both mother and offspring. In this multi-ethnic Asian birth cohort study, we report the first genome-wide association analysis (GWAS) of maternal and fetal vitamin D in circulation. For this, 25-hydroxyvitamin D (25OHD) was measured in the antenatal blood of mothers during mid gestation (n=942), and the cord blood of their offspring at birth (n=812). Around ~7 million single nucleotide polymorphisms (SNPs) were regressed against 25OHD concentrations to identify genetic risk variants. About 41% of mothers had inadequate 25OHD (≤75nmol/L) during pregnancy. Antenatal 25OHD was associated with ethnicity [Malay (Β=−22.32nmol/L, p=2.3×10−26); Indian (Β=−21.85, p=3.1×10−21); reference Chinese], age (Β=0.47/year, p=0.0058), and supplement intake (Β=16.47, p=2.4×10−13). Cord blood 25OHD highly correlated with antenatal vitamin D (r=0.75) and was associated with ethnicity [Malay (Β=−4.44, p=2.2×10−7); Indian (Β=−1.99, p=0.038); reference Chinese]. GWAS analysis identified rs4588, a missense variant in the group-specific component (GC) gene encoding vitamin D binding protein (VDBP), and its defining haplotype, as a risk factor for low antenatal (Β=−8.56/T-allele, p=1.0×10−9) and cord blood vitamin D (Β=−3.22/T-allele, p=1.0×10−8) in all three ethnicities. We also discovered a novel association in a SNP downstream of CYP2J2 (rs10789082), a gene involved in 25-hydroxylation of vitamin D, with vitamin D in pregnant women (Β=−7.68/G-allele, p=1.5×10−8), but not their offspring. As the prevention and early detection of suboptimal vitamin D levels are of profound importance to both mother and offspring’s health, the genetic risk variants identified in this study allow risk assessment and precision in early intervention of vitamin D deficiency.

Histone deacetylase inhibitors regulate vitamin C transporter functional expression in intestinal epithelial cells

Intestinal absorption of vitamin C in humans is mediated via the sodium-dependent vitamin C transporters (hSVCT1 and hSVCT2). hSVCT1 and hSVCT2 are localized at the apical and basolateral membranes, respectively, of polarized intestinal epithelia. Studies have identified low plasma levels of vitamin C and decreased expression of hSVCT1 in patients with several inflammatory conditions including inflammatory bowel disease (IBD). Investigating the underlying mechanisms responsible for regulating hSVCT1 expression are critical for understanding vitamin C homeostasis, particularly in conditions where suboptimal vitamin C levels detrimentally affect human health. Previous research has shown that hSVCT1 expression is regulated at the transcriptional level, however, little is known about epigenetic regulatory pathways that modulate hSVCT1 expression in the intestine. In this study, we found that hSVCT1 expression and function were significantly decreased in intestinal epithelial cells by the histone deacetylase inhibitors (HDACi), valproic acid (VPA), and sodium butyrate (NaB). Further, expression of transcription factor HNF1α, which is critical for SLC23A1 promoter activity, was significantly down regulated in VPA-treated cells. Chromatin immunoprecipitation (ChIP) assays showed significantly increased enrichment of tetra-acetylated histone H3 and H4 within the SLC23A1 promoter following VPA treatment. In addition, knockdown of HDAC isoforms two, and three significantly decreased hSVCT1 functional expression. Following VPA administration to mice, functional expression of SVCT1 in the jejunum was significantly decreased. Collectively, these in vitro and in vivo studies demonstrate epigenetic regulation of SVCT1 expression in intestinal epithelia partly mediated through HDAC isoforms two and three.

Prevalence of Suboptimal Vitamin D Level and Mean Serum Level of 25-Hydroxy Vitamin D in Different Patient Groups at Chulabhorn Hospital: Retrospective Study

Objective: To study the prevalence of suboptimal vitamin D level (vitamin D insufficiency and vitamin D deficiency) and mean blood level of 25-hydroxy vitamin D in different patient groups at Chulabhorn Hospital. Materials and Methods: The present study was a retrospective descriptive study. Data of all patients who visited Chulabhorn Hospital and were tested for serum 25-hydroxy vitamin D level between August 1st, 2016 and September 31st, 2018 were collected from the computer database. The primary outcome was the prevalence of suboptimal vitamin D level at Chulabhorn Hospital. The secondary outcome was the prevalence of suboptimal vitamin D level and mean serum level of 25-hydroxy vitamin D in different patient groups. Results: Data from 1,211 patients were obtained from the database. The prevalence of suboptimal vitamin D level was 71.4%. The mean serum 25-hydroxy vitamin D (25(OH)D) level was 25.6 ng/ml. The mean serum 25(OH)D level was higher in the outpatient department group than the intensive care unit and inpatient department group with statistical significance and practical significance (p&lt;0.001, effect size 0.58). Conclusion: Suboptimal level of vitamin D was common at Chulabhorn Hospital. Keywords: Vitamin D deficiency, Vitamin D insufficiency, Suboptimal vitamin D level, Chulabhorn Hospital, Thailand

Insufficient Assessment and Treatment of Vitamin D in the Medical Management of Adolescents with Anorexia Nervosa

PurposeSuboptimal vitamin D levels are implicated in low bone mineral density, a common medical complication of anorexia nervosa. This study aimed to examine the frequency of vitamin D assessment and treatment for adolescents with anorexia nervosa in outpatient medical management. Design and methodsRetrospective chart review was used to examine 179 adolescents (M age = 15.5 years, SD = 2.2), newly diagnosed with anorexia nervosa at a tertiary care medical center in the United States between January 2000 and July 2016. ResultsOnly 16% of patients (n = 29) received serum vitamin D assessments following diagnosis, of whom 52% had suboptimal vitamin D levels (n = 15). Only three patients with suboptimal vitamin D were advised to begin supplementation. No patients in our sample were encouraged to begin prophylactic vitamin D supplementation. Conclusions/practice implicationsFindings from this study highlight the critical need for widespread care team education about vitamin D assessment and treatment in the medical management of adolescents with anorexia nervosa, particularly in light of the potentially serious consequences of bone mineral density.

Effects of a 2-Week 5000 IU versus 1000 IU Vitamin D3 Supplementation on Recovery of Symptoms in Patients with Mild to Moderate Covid-19: A Randomized Clinical Trial.

Objective: Vitamin D deficiency has been associated with an increased risk of COVID-19 severity. This multi-center randomized clinical trial aims to determine the effects of 5000 IU versus 1000 IU daily oral vitamin D3 supplementation in the recovery of symptoms and other clinical parameters among mild to moderate COVID-19 patients with sub-optimal vitamin D status. Study Design and Setting: A total of 69 reverse transcriptase polymerase chain reaction (RT-PCR) SARS-CoV-2 positive adults who were hospitalized for mild to moderate COVID-19 disease were allocated to receive once daily for 2 weeks either 5000 IU oral vitamin D3 (n = 36, 21 males; 15 females) or 1000 IU oral vitamin D3 (standard control) (n = 33, 13 males; 20 females). Anthropometrics were measured and blood samples were taken pre- and post-supplementation. Fasting blood glucose, lipids, serum 25(OH)D, and inflammatory markers were measured. COVID-19 symptoms were noted on admission and monitored until full recovery. Results: Vitamin D supplementation for 2 weeks caused a significant increase in serum 25(OH)D levels in the 5000 IU group only (adjusted p = 0.003). Within-group comparisons also showed a significant decrease in BMI and IL-6 levels overtime in both groups (p-values < 0.05) but was not clinically significant in between-group comparisons. Kaplan–Meier survival analysis revealed that the 5000 IU group had a significantly shorter time to recovery (days) than the 1000 IU group in resolving cough, even after adjusting for age, sex, baseline BMI, and D-dimer (6.2 ± 0.8 versus 9.1 ± 0.8; p = 0.039), and ageusia (loss of taste) (11.4 ± 1.0 versus 16.9 ± 1.7; p = 0.035). Conclusion: A 5000 IU daily oral vitamin D3 supplementation for 2 weeks reduces the time to recovery for cough and gustatory sensory loss among patients with sub-optimal vitamin D status and mild to moderate COVID-19 symptoms. The use of 5000 IU vitamin D3 as an adjuvant therapy for COVID-19 patients with suboptimal vitamin D status, even for a short duration, is recommended.

Vitamin D Metabolic Profiles in Premenopausal Women Wearing Niqab and Hijab in Sunny Basrah.

BackgroundConservative clothing like niqab and hijab may affect the wearer’s vitamin D metabolic parameters even in predominantly sunny areas of the world (i.e., areas with adequate sunlight exposure throughout the year). Our objective was to evaluate the effect of wearing the niqab or hijab on different vitamin D3 metabolic parameters in a sample of premenopausal women from Basrah.MethodologyThis was a cross-sectional observational study on premenopausal women who wore a niqab (n = 64), with a comparable age-matched group of women who wore the hijab (n = 60). Biochemical evaluation of the vitamin D3 metabolic profile involved 25-hydroxycholecalciferol (25-OH)-vitamin D, corrected serum calcium, parathyroid hormone (PTH), phosphorus, and alkaline phosphatase estimation. Statistical comparison of these parameters was made using the independent sample t-test and Mann-Whitney-U test.ResultsThe two groups of women were age- and weight-matched, with a median age of 39 and median body mass index (BMI) of 31.8 kg/m2. Overall, age, marital status, and BMI of women in both groups had no significant relationship with the vitamin D3 metabolic parameters (low 25-OH-vitamin D, low corrected calcium, and high PTH). The subgroup analysis for women wearing the niqab showed the same results.ConclusionsWearing niqab or hijab in premenopausal women was not associated with any significant statistical relationship or difference in vitamin D3 metabolic parameters. Conservative dress styles like niqab and hijab are practical barriers to sun exposure and contribute to suboptimal vitamin D levels, affecting subsequent metabolic pathways. Healthcare professionals should advise women who wear niqab or hijab to increase their vitamin D3 levels through culturally appropriate alternative mechanisms.

Greater Adherence to Treatment After Bariatric Surgery by the Implementation of a Standardized Protocol for Delivering Care

Bariatric surgery reference centers adopt different protocols of postoperative care including vitamins and minerals supplementation, since there is no consensus in the literature supporting the best approach. We sought to assess the impact of implementing a standardized postoperative care protocol on the adherence to a multidisciplinary team follow-up and the use of vitamin and mineral supplementation for one year after bariatric surgery in a tertiary care public hospital. This study compared a retrospective cohort of patients [n=70; usual care (UC)] who had undergone Roux-en-Y gastric bypass (RYGB) between April 2017 and April 2018 with a prospective cohort of patients [n=64; standardized postoperative protocol (SPP)] who had undergone RYGB between May 2018 and May 2019. The protocol included (1) a pre-scheduled calendar for one-year appointments with surgeons, nutritionists, and endocrinologists, (2) a systematic follow-up trough phone calls by a trained nurse, (3) a standardized vitamins/minerals supplementation during one year, and (4) pre-scheduled laboratory assessment. The initial approach started in the day after the surgery, when the nurse explained post-operative procedures and delivered printed material with the information and schedules. Patients received a standard supplementation free of charge (daily multivitamins with minerals, calcium carbonate 1,500 mg/day, vitramin D 20,000 IU/week, and 5,000 µg of intramuscular vitamin B12 if serum levels were lower than 400 pg/mL). This study was approved by the local Ethics Committee (2018-0183). Among the 134 patients, 86.7% were women, 42.4 ± 10.1 years-old, with preoperative body mass index of 48.5 ± 8.2 kg/m². Adherence to the postoperative care (multidisciplinary team follow-up and laboratory analyses) was 96.9% in the SPP and 81.7% in the UC (p = .003). The SPP attended a greater number of appointments (11 ± 2 vs. 7 ± 2, p <.001), showed a lower prevalence of suboptimal vitamin B12 at 3 months (18.7% vs. 39.5%, p = .03), and had a higher serum vitamin D levels at 3, 6, and 12 months (p <.001). Prevalence of vitamin D deficiency (lower than 20 ng/mL) one year after surgery was 1.6% vs. 24.3% (p <.001) in the SPP and UC, respectively. Only 18.3%, 26.8% and 41% of patients were using vitamin D supplements in the UC after 3, 6 and 12 months, respectively. We conclude that the proposed standardized protocol led to a greater adherence to the postoperative bariatric surgery care, adding attendance to appointments and reducing the incidence of vitamin deficiencies. Further cost-effectivity analysis may be needed to evaluate properly the implementation feasibility of the protocol in other centers. Financial support: CNPq, CAPES, FIPE (HCPA)

Vitamin D, rickets and child abuse: controversies and evidence.

Suboptimal vitamin D status is a global health issue that affects children and adults worldwide. The prevalence of vitamin D deficiency and insufficiency has been well documented in the pediatric population in the United States. Although vitamin D deficiency is common, radiographic findings are uncommon and can be subtle. Additionally, because of the high prevalence of pediatric vitamin D insufficiency, it is commonly identified in young children with fractures. However, the majority of pediatric fractures are caused by trauma to healthy bones. Some, especially in infants and toddlers, are caused by non-accidental trauma. A small percentage is related to medical disease, including those associated with disorders of collagen, disorders of mineralization, and non-fracture mimics. Despite the scientific evidence, among disorders of mineralization, non-rachitic disorders of vitamin D have become a popular non-scientific theory to explain the fractures identified in abused children. Although infants and young children with rickets can fracture bones, the vast majority of fractures identified in abused infants are not caused by bone disease. Here we present a review of the literature on bone disease in the setting of accidental and non-accidental trauma. This context can help physicians remain vigilant about identifying vulnerable young children whose injuries are caused by non-accidental trauma.

Dietary intake and growth in children with Prader-Willi syndrome.

The management of Prader-Willi Syndrome (PWS) requires strict dietary supervision to prevent obesity, avoid micronutrient deficiencies and ensure optimal growth. The present study aimed to examine the growth and dietary intake of children with PWS. All children with genetically confirmed PWS attending Children's Health Ireland (CHI) at Tallaght (n=44) were invited to participate. Anthropometry was performed and body composition measured using bioelectrical impedance analysis. Three-day food diaries were used to evaluate dietary intake and the presence of early feeding issues was assessed. Serum haemoglobin, ferritin and vitamin D levels were measured. Nineteen children participated, with a mean (range) age of 7.6(0.6-18.1)years. Most were female (n=14, 74%). Twenty-percent (n=3) were underweight, 60% (n=9) were healthy weight, n=1 was overweight and n=2 were obese. Mean (range) percentage body fat was 25.7% (10%-40%). Eigthy-three percent reported early feeding issues. Ninety-four percent (n=16) achieved ≤100% of estimated average requirement (EAR) for energy. Mean daily energy intake for ≤5years old was 722kcal (9kcalcm-1 /72-112% EAR); for those ≥12years, it was 1203kcal (8.3kcalcm-1 /41%-82% EAR). Suboptimal calcium, vitamin D, iron, zinc and fibre intake was evident. Iron deficiency anaemia and vitamin D insufficiency occurred in two children. The present study provides the first Irish data for PWS and shows that energy intake does not appear to be excessive, with four in five patients being underweight or of a normal BMI. Suboptimal dietary intake of several micronutrients was evident and biochemical nutrient deficiencies were present.

Effect of latitude on seasonal variations of vitamin D and some cardiometabolic risk factors: national food and nutrition surveillance.

Despite a remarkable reduction in the occurrence of many micronutrient deficiencies in most countries, vitamin D deficiency has remained a global problem. Age-adjusted disability-adjusted life years lost due to cardiovascular disease in the Eastern Mediterranean Region, including in the Islamic Republic of Iran, are higher than the global average. To assess the effects of latitude and season on vitamin D status in the Iranian population and the association between vitamin D status and certain cardiometabolic risk factors. A sample of 1111 participants aged 19-65 years was randomly selected from 6 regions with latitudes ranging from 29º.0 N to 37.5º N. All anthropometric and biochemical assessments were performed twice a year, summer and winter during 2013 to 2014. Overall mean 25(OH)D concentration was 26.9 [standard deviation (SD) 17.8] nmol/L in winter and 43.4 (SD 32.9 nmol/L in summer (P < 0.001). Poor vitamin D status was noticeable in both seasons (90.1% and 69.2%, respectively). Being male (B, 7.6; 95% CI: 4.3 to 10.8; P < 0.001) and living at a latitude higher than 33 ° were positive predictors, and serum 25(OH)D concentration in winter (B, -0.2; 95% CI: -2.9 to -0.11; P < 0.001) was a negative predictor of changes of 25(OH)D concentrations. We found a high prevalence of suboptimal vitamin D status in Iranian adults throughout the year, irrespective of latitude and season. Improvement of mean circulating 25(OH)D concentrations in the community to 50+ nmol/L through a fortification programme is likely to engender healthy cardiometabolic changes.