Vitamin D Deficiency Research Articles

Can vitamin D deficiency be considered a risk factor be considered a risk factor in luminal breast cancer?

e24122 Background: The relationship of vitamin D (VD) with cancer is controversial. Its antiproliferative function by inhibiting the cell cycle has been described, as well as its characteristics as an inhibitor of angiogenesis, inducer of apoptosis and its ability to reduce inflammation, invasion and metastasis. Deficiency of this vitamin is very prevalent, affecting 40% of the population under 65 years of age, and there are some studies that relate it to the increase in the incidence of breast cancer (BC), colon or prostate cancer. VD deficiency is defined as a serum level of 25-hydroxy VD < 20 ng/mL. We analyzed whether VD deficiency can be considered a risk factor for BC, given that it is the most frequent tumor in the world. Methods: A single-center, retrospective, descriptive and analytical study of female patients diagnosed with localized luminal BC (stage I-II and III) in the year 2023 and a control group of healthy women. Baseline VD levels were determined in both groups. Statistical analysis (IBM SPSS Statistics 22) of demographic and clinical characteristics and multivariate analysis using a logistic regression model for the study of VD deficiency, according to the variables age, menopausal status and previous chemotherapy. Results: We analyzed 231 patients (p) with luminal BC and a control group of 324 healthy women. In the BC group the median age was 62 years (range 34 - 88 years), 72% (168 p) in postmenopausal stage. 52% (121 p) had stage I, 37% (86 p) stage II, and 11% stage III. 59.7 % (138 p) had luminal A phenotype and 40.2 % luminal B phenotype. 27.7 % (64 p) had received chemotherapy. In the control group the median age was 65 years (range 45 - 78 years), 90% (287 women) in postmenopausal state. VD deficiency was present in 50.6 % of the BC group with a mean VD value of 21 ng / ml. In the control group the deficit was 33 % with a mean VD value of 24 ng / ml. Therefore, this deficit is significantly higher in breast cancer patients than in healthy patients, with OR of 2.08 with 95% CI (1.4 - 2.7). In the overall multivariate analysis postmenopausal women have 5.1 more risk of presenting VD deficit, with p = 0.04. The variable age did not reach statistical significance. Logistic regression was performed to determine the effects of age, menopausal status, and having received previous chemotherapy, on the probability of BC patients presenting a VD deficit, without reaching statistical significance. Conclusions: VD deficiency is more prevalent in women with BC than the normal population, which is consistent with previous studies. Further well-designed studies are needed to assess the effect of VD supplementation in the female population as prevention of BC.

Seasonal patterns in immunotherapy outcomes.

e14684 Background: Immune checkpoint inhibitors (ICIs) allow the immune system to target cancer cells. The immune system is affected by seasonal factors e.g. viruses, allergens, vaccines and ultraviolet exposure. There is evidence that some immune-related adverse events are more common in winter and that higher vitamin D (VD) levels and VD supplementation are associated with longer overall survival (OS). This study aimed to determine if season of ICI initiation was associated with OS. Methods: We evaluated patients who received ICI treatment at The Christie Hospital, UK, between 2017 and 2022. Season of ICI initiation was categorised as: (i) Nov-Apr vs May-Oct and (ii) Dec-Feb vs Jun-Aug (i.e. winter vs summer). For each category, median OS (mOS) was estimated using the Kaplan-Meier method. Adjusted Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals for associations of season of ICI initiation with OS and to test for interactions with ICI and diagnosis. Where data were available, associations of baseline VD levels and VD supplements with OS were estimated along with the association between season of ICI initiation and OS in patients with normal VD and/or receiving VD supplements. Results: 3010 patients were included and 1804 OS events occurred during 36.4 months [m] median follow-up. ICI indications included pembrolizumab or atezolizumab for advanced non-small cell lung cancer (NSCLC, 1st line n 304, median OS [mOS] 17.0 m; 2nd line n 197, mOS 10.7 m), pembrolizumab plus chemotherapy for advanced NSCLC (n 288, mOS 16.3 m), pembrolizumab or nivolumab for melanoma (advanced n 211, mOS 25.2 m; adjuvant n 226, mOS not reached), and ipilimumab + nivolumab for melanoma (n 203, mOS 45.4 m) or renal cancer (n 129, mOS 38.6 m). Confounders were balanced across seasons of ICI initiation, including sex (48% Nov-Apr vs 52% May-Oct), age (median 66.7 vs 67.2 years), PS 0/1 (83% vs 84%), body mass index (median 26.0 vs 25.7 kg/m2) and setting (adjuvant 13.0% vs advanced 12.4%). Season of ICI initiation was not associated with OS (Nov to Apr vs May to Oct mOS 20.8 vs 20.5 m, HR 1.01, 0.92-1.11; Dec-Feb vs Jun-Aug mOS 20.0 vs 21.3 m, HR 0.97, 0.85-1.10). Interactions with ICI and diagnosis were not significant. 214 patients had baseline VD levels and 96 received VD supplements before ICI initiation. VD deficiency was highest in February (23.6%) and lowest in August (1.1%). Among 209 patients with normal VD levels or receiving VD supplements, season of initiation was not associated with OS (Nov to Apr vs May to Oct mOS 45.4 vs 43.4 m; HR 0.98, 0.63-1.53). However, VD deficiency (n 37) was associated with shorter OS (HR 2.06, 1.21-3.52) and VD supplementation with longer OS (HR 0.69, 0.52-0.92). Conclusions: While VD deficiency and VD supplementation were associated with OS, season of ICI initiation was not. These results provide reassurance the OS benefits of ICIs remain similar irrespective of time of year of initiation despite seasonal factors that may influence the immune system.

Vitamin-D Deficiency & Depression: Is There an Association? Average Data From Gulf Cooperation Council Countries

Vitamin-D Deficiency & Depression: Is There an Association? Average Data From Gulf Cooperation Council Countries

Effect of long-term proton pump inhibitors on phosphocalcium metabolism and bone mineral density.

Aim: Although Proton pump inhibitors (PPIs) are well-tolerated, their long-term use may be associated with decreased bone mass. Methods: This is a case-control study including patients treated with PPIs (>1year) and control subjects who have not received PPIs treatment. Results: A total of 90 patients and 90 matched controls were included. PPIs use was associated with hypocalcemia and hypomagnesemia. Vitamin D3 deficiency and hyperparathyroidism were associated with PPIs use. Long-term PPIs use was significantly associated with decreased bone density. Risk factors of decreased bone mineral density (BMD) included age >50years, menopause, lack of sun exposure, double PPIs dose, daily intake, post-meal intake and association with a mucoprotective agent. Conclusion: Our results highlight the risk of decreased BMD in patients on long-term PPIs treatment.

Major Pancreatic Resection Increases Bone Mineral Density Loss, Osteoporosis, and Fractures.

To assess whether long-term survivors of pancreatic surgery show increased risk to develop impaired bone mineral density, osteoporosis, and vitamin D deficiency. Pancreatic resection poses a risk for malabsorption of fat-soluble vitamins and other micronutrients essential for bone mineralization. Here, we evaluated the long-term effects of pancreatic resection on bone mineral density (BMD) and its clinical sequelae. This was a two-pronged analysis of post-pancreatectomy patients with a follow-up period greater than 3 years comprising (1) a large, propensity score-matched, cohort study based on a multinational federated research network (FRN) and (2) a retrospective single institution review of clinical and radiographic patient data. In the FRN analysis, an initial cohort of 8,423 post-pancreatectomy patients were identified and propensity score-matched with normal controls. The primary endpoint was the 10-year risk of developing osteoporotic pathological fractures and secondary endpoints included diagnosis of osteoporosis, vitamin-D deficiency, and related therapies. The single institution retrospective analysis identified 224 patients who underwent pancreatic resection between 2005 and 2019. BMD was quantified in CT images acquired before and after surgery. BMD trends and related factors were assessed in a time-series mixed effect linear regression model. A total of 8,080 propensity score-matched pairs were included in the FRN analysis. The analysis revealed a 2.4-fold increase in pathological fractures (P<0.0001) and 1.4-1.5 fold increase in osteoporosis/osteomalacia (P<0.0001) and vitamin-D deficiency (P<0.0001) in post-pancreatectomy patients. Vitamin-D supplements were more common in the pancreatectomy group (OR 1.4, 95% CI 1.28-1.53, P<0.0001), as were specific osteoporosis/osteomalacia treatments such as calcitonin, denosumab, romosozumab, abaloparatide, and teriparatide (OR 2.24, 95%CI 1.69-2.95, P<0.0001). Retrospective analysis of CT imaging revealed that BMD declined more rapidly following pancreatic resection compared to normal historical controls (P=0.015). Older age, pancreatic cancer, and pancreaticoduodenectomy were associated with increased rates of BMD loss (P<0.05, each). After pancreatic resection, patients are at higher risk for BMD loss and subsequent fractures. As the cohort of pancreatic resection survivorship grows, attention will need to be paid to focused prevention efforts to reduce BMD loss, osteoporosis, and fractures in these vulnerable patients, with specific attention to the pancreatic cancer population.

1,25-Dihydroxyvitamin D3 Suppresses Prognostic Survival Biomarkers Associated with Cell Cycle and Actin Organization in a Non-Malignant African American Prostate Cell Line.

Vitamin D3 is a steroid hormone that confers anti-tumorigenic properties in prostate cells. Serum vitamin D3 deficiency has been associated with advanced prostate cancer (PCa), particularly affecting African American (AA) men. Therefore, elucidating the pleiotropic effects of vitamin D on signaling pathways, essential to maintaining non-malignancy, may provide additional drug targets to mitigate disparate outcomes for men with PCa, especially AA men. We conducted RNA sequencing on an AA non-malignant prostate cell line, RC-77N/E, comparing untreated cells to those treated with 10 nM of vitamin D3 metabolite, 1α,25(OH)2D3, at 24 h. Differential gene expression analysis revealed 1601 significant genes affected by 1α,25(OH)2D3 treatment. Pathway enrichment analysis predicted 1α,25(OH)2D3- mediated repression of prostate cancer, cell proliferation, actin cytoskeletal, and actin-related signaling pathways (p < 0.05). Prioritizing genes with vitamin D response elements and associating expression levels with overall survival (OS) in The Cancer Genome Atlas Prostate Adenocarcinoma (TCGA PRAD) cohort, we identified ANLN (Anillin) and ECT2 (Epithelial Cell Transforming 2) as potential prognostic PCa biomarkers. Both genes were strongly correlated and significantly downregulated by 1α,25(OH)2D3 treatment, where low expression was statistically associated with better overall survival outcomes in the TCGA PRAD public cohort. Increased ANLN and ECT2 mRNA gene expression was significantly associated with PCa, and Gleason scores using both the TCGA cohort (p < 0.05) and an AA non-malignant/tumor-matched cohort. Our findings suggest 1α,25(OH)2D3 regulation of these biomarkers may be significant for PCa prevention. In addition, 1α,25(OH)2D3 could be used as an adjuvant treatment targeting actin cytoskeleton signaling and actin cytoskeleton-related signaling pathways, particularly among AA men.

Correlation between Vitamin D Levels and Antimicrobial Peptide LL-37 in Pediatric Patients Diagnosed with Sepsis

Abstract Objective Our objective was to examine potential differences in inflammatory markers, specifically antimicrobial peptide (AMP) LL-37 and interleukin-6 (IL-6), in the bloodstream of children with sepsis who had varying levels of vitamin D3. Methods A total of 59 pediatric patients diagnosed with sepsis from January 2021 to November 2021 were enrolled in this study. The pediatric patients with sepsis were categorized into three groups based on their levels of vitamin D3, and AMP LL-37, IL-6, and procalcitonin (PCT) were compared among the three groups. Discussion The LL-37 level in the group with vitamin D3 deficiency was notably lower than in the other two groups (p deficiency group vs. insufficiency group = 0.019, p deficiency group vs. normal group = 0.034), whereas the disparity between the group with vitamin D3 insufficiency and the group with normal vitamin D3 levels was not statistically significant. There was a positive correlation between the level of vitamin D3 and LL-37 in pediatric patients with sepsis (r = 0.324, p = 0.012). On the other hand, the level of IL-6 in pediatric patients with sepsis showed a positive correlation with both LL-37 (r = 0.474, p = 0.000) and PCT (r = 0.527, p = 0.000). Conclusion Pediatric patients with sepsis typically exhibit low levels of vitamin D3, which are positively correlated with the levels of serum LL-37. Furthermore, the presence of higher levels of serum LL-37 is positively correlated with higher levels of IL-6.

Additive Interaction Between Insulin Resistance, Chronic Low-Grade Inflammation and Vitamin D Deficiency on the Risk of Type 2 Diabetes Mellitus: A Cohort Study

Objectives The aim of this study was to explore, on an additive scale, the combined effect of the association between insulin resistance (IR), chronic low-grade inflammation (CLGI) and vitamin D deficiency (VDD) on the risk of type 2 Diabetes Mellitus (T2DM). Methods This is a cohort study, including 1484 non-diabetic subjects, followed for a period of four years. 25 hydroxy-vitamin D (25OHD), hypersensitive C-reactive protein (HsCRP) and triglyceride-glucose index were assessed. Based on VDD and CLGI, the population was subdivided into 4 exposure groups. Analysis was performed both in the case of IR and without IR. Cox proportional regression and additive interaction were applied to explore cumulative effects of exposure. Results At follow-up, 162 newly diagnosed cases of T2DM were identified. TYG index (RR = 4.0[2.8–5.6]), HsCRP (RR = 1.6 [1.4–1.7]) and 25OHD (RR = 0.96 [0.39–0.98]) were all significantly associated with the risk of T2DM (p < 0.01). The highest excess risk was recorded in patients cumulating simultaneously IR, CLGI and VDD (RR= 8.4[3.6–19.8], p < 0.0001). The additive interaction was significant, the excess risk linked to the interaction RERI = 10.5[1.43–19.7], the proportion attributable to the combined effect: AP = 0.61[0.37–0.85], and the interaction was synergistic: synergy index: 2.8[1.42–5.69]. Conclusion Baseline levels of TYG index, 25OHD and HsCRP are strongly predictive of future T2DM, and their joint effects are additive and synergistic. Interventional studies are therefore warranted in order to evaluate whether vitamin D supplementation, combined with appropriate anti-inflammatory therapies, is effective as a preventive strategy to reduce the risk of T2DM.

The effect of vitamin D provision on biomarkers of inflammation in bronchial asthma in children

Introduction. Asthma is a widespread disease in childhood and has a persistent tendency to increase. Therefore, the search for factors influencing this process, as well as biomarkers reflecting the degree of asthma control, is an urgent problem. Objective. To study the relationship of vitamin D levels with the serum periostin and TGF-β1 concentration in children with asthma. Materials and methods. The cross-sectional (one-stage) study included 80 children aged 6 to 17 years (average age — 12 ± 3.2 g). The subjects were divided into 2 groups: children with asthma — group 1 (n = 40); group 2 — the control group (n = 40). In all children, the assessment of the concentration of 25(OH)D, periostin and TGF-β1 in the blood serum was studied. Results. Median (Me) 25(OH) in patients with asthma was statistically significantly lower than in children of the comparison group (16.7 ng/ml, versus 25.7 ng/ml, p = 0.017), and did not depend on the severity of the disease, corresponded to a deficiency condition in both mild (16.2 ng/ml) and with an average severity of asthma (16.8 ng/ml) (p = 0.041). Me of periostin in 1st group was within the normal range (730.2 ng/ml), but statistically significantly exceeded the indicator of 2nd group (539.7 ng/ml, p &lt; 0.05) and did not depend on the age and duration of asthma. High rates of periostin were observed in children with moderate severity of asthma with a disease experience of 4–6 years (617.2 ng/ml). Me of TGF-β1 in both groups corresponded to normal values (309.0 and 369.6 pg/ml, respectively, p &gt; 0.05) and did not depend on the age and duration of asthma. Conclusions. VD deficiency is registered in children with asthma 2 times more often than in healthy children in Ryazan region. The serum concentration of periostin increased in proportion to the severity of asthma. Vitamin D deficiency can be one of the risk factors for the development of asthma and lead to an imbalance in the periostin and TGF-β system.

Vitamin D and it’s Association with FokI VDR Polymorphism in Patients with Asthma-COPD Overlap

Background: Asthma-COPD overlap is a new phenotype in respiratory ailments. It has been shown that this group of patients might possess vitamin D3 deficiency. The association of vitamin D receptor (VDR) gene polymorphism with serum vitamin D status in ACO patients has not been investigated yet. Objective: To assess the association of VDR gene polymorphism (FokI) with serum vitamin D status in patients with Asthma-COPD overlap. Methods: This cross-sectional study was carried out in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2018 to July 2018 on 23 (twenty-three) patients (aged ≥40 years) with ACO. For comparison, 24 (twenty-four) apparently healthy age, smoking duration and BMI matched subjects were selected. For all participants single nucleotide polymorphism of VDR gene FokI (rs10735810) was done by DNA extraction, polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Vitamin D3 was measured by using automated analyzer: ARCHITECT Plus ci4100. The results were expressed as mean with standard error (mean±SEM) and frequency distribution. The data were statistically analyzed by Graphpad prism (Version 7) using independent sample ‘t’ test, two sample proportion test, Fisher exact test and ANOVA test. In the interpretation of results, ≤0.05 level of probability (p) was accepted as significant. Results: The mean±SEM of serum 25(OH)D were 16.37±0.78 and 18.46±1.01 ng/ml in control and study groups, respectively. The frequency distribution of FokI genotype was 86.95% (FF), 8.69% (Ff), 4.35% (ff) and 91.66% (FF), 4.17% (Ff), 4.17% (ff) in ACO patients and healthy subjects, respectively. When FoKI VDR SNP was analyzed with serum vitamin D status in patients with ACO, statistically no association was seen. Conclusions: FokI VDR SNP is not associated with serum vitamin D status in patients with ACO. J Rang Med Col. March 2024; Vol. 9, No. 1: 22-27

Risk factors and outcomes of vitamin D deficiency in very preterm infants

BackgroundVitamin D is essential for bone health and immune system. Vitamin D deficiency (VDD) poses a high-risk to very preterm (VP) infants. This study aimed to evaluate the risk factors associated with VDD in VP infants and its potential clinical outcomes. MethodsA retrospective cohort study was conducted on VP infants admitted to the neonatal intensive care unit of a specialized tertiary hospital in Seoul, Republic of Korea, between January 2018 and June 2022. Serum 25-hydroxyvitamin D (25(OH)D) levels and other biochemical parameters were measured between 4 and 6 weeks of age. VDD was defined as a serum 25(OH)D level <20 ng/mL. Prenatal and postnatal risk factors and clinical outcomes were compared between the VDD and non-VDD groups. ResultsOf the 82 VP infants analyzed, 27 (32.9%) were diagnosed with VDD. The VDD group exhibited a significantly longer duration of parenteral nutrition (PN) compared to the non-VDD group (adjusted odds ratio [OR] = 1.12; 95% confidence interval [CI]: 1.008–1.245). Breast milk intake was lower in the VDD group than in the non-VDD group (adjusted OR = 0.976, 95% CI, 0.955–0.999). Notably, calcium levels were significantly lower in the VDD group, while parathyroid hormone levels were significantly higher, compared with the non-VDD group. Additionally, the rickets severity score was higher in the VDD group than in the non-VDD, although the difference was not statistically significant. ConclusionsProlonged PN duration and low breast milk intake significantly increased the risk of VDD in VP infants.

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

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

Rhabdomyolysis Associated with Sedentary Lifestyle, Strenuous Exercise, and Vitamin D3 Deficiency: A Rare Case Report

Rhabdomyolysis can lead to variable clinical presentation and complications putting life at risk. Patients with preexisting low serum 25(OH) Vitamin D are at high risk of exertional rhabdomyolysis during strenuous activities. This aimed to study the pathophysiology of rhabdomyolysis associated with sedentary lifestyle, strenuous exercise, and Vitamin D3 deficiency. A 26-year-old male with chief complaints of cramps in thigh muscles, reduced urine output, and dark coffee-colored urine was presented at Bawa Hospital, Ludhiana. The patient has a history of strenuous exercise and Vitamin D deficiency. Serum creatinine kinase, liver enzymes, and myoglobin in urine were evaluated. The patient was treated with intravenous fluids, sodium bicarbonate, and diuretic. The case was diagnosed as rhabdomyolysis and was treated accordingly. The recovery after 5 days was good following early treatment with fluids and forced alkaline diuresis. The kidney function tests remained normal throughout the treatment period. Aggressive fluid resuscitation is the key management for rhabdomyolysis.

Development and validation of a questionnaire in Hindi language to assess Parental Knowledge, Attitude and Practices regarding Calcium and Vitamin D deficiency in children

Background: Despite being in temperate zone, India is endemic to nutritional rickets. However, very little has been studied on knowledge, perception and cultural practices of Indian communities, towards calcium and vitamin-D deficiency in children. Aim &amp; Objective: The study aimed to develop and validate a questionnaire in Hindi language for the assessment of knowledge, attitude, and practices of parents towards calcium and vitamin D deficiency among children. Methodology: We searched electronic databases for item generation. The questionnaire was developed in Hindi language by five experts in the field of pediatrics, pediatric orthopaedics and community medicine using Delphi method. After language correction from Hindi language experts, a convenient sample of 30 participants filled the questionnaire and tested for internal consistency and test-retest reliability. Results: The overall Cronbach’s alpha value for the finalized 46-item scale indicated an acceptable reliability (alpha = 0.91). The internal consistency reliability for six domains created was acceptable. The results revealed ‘high’ test-retest reliability, and there was no statistically significant difference noted between any of the first test and re-test corresponding values (p&gt;0.05). Conclusion: The present questionnaire developed in Hindi Language to assess knowledge, attitude and practices (KAP) of parents towards Calcium &amp; Vitamin-D deficiency in children, has a good validity and reliability. This newly developed instrument could prove its use to highlight the gaps that may exist among parents. The use of this tool may help clinicians, health educators and policy makers to identify key areas of intervention with regards to Calcium &amp; Vitamin-D deficiency in children.

Correlational study of Vitamin-D deficiency levels and its severity of community-acquired pneumonia in patients admitted into a tertiary care hospital

Background: Recent studies have emphasized that people who have low levels of Vitamin D are more prone to the development of infectious diseases, particularly of a community-acquired nature, which has differential morbidity and mortality. Aims &amp; objectives: The present study aimed to determine the correlation between different levels of vitamin D deficiency and severity and outcomes in patients diagnosed with community-acquired pneumonia. Methods: In this study, the serum level of Vitamin D of 100 consecutively admitted community-acquired pneumonia patients was measured. Depending on the level of Vitamin D deficiency, patients diagnosed with community-acquired pneumonia (CAP) were assessed for severity of illness by CURB-65 score. Results &amp; Discussion: In the study population, out of 100 patients, 82% of the study sample had deficient serum vitamin D levels. In the study sample, 41 patients with higher deficiency levels of serum Vitamin D have severe illness and scored high on CURB- 65, which is in the range of three to four on the scale. 59 patients with low deficiency levels of serum Vitamin D had low scores of one or two on the CURB-65. On severity assessment in patients with severe deficiency of Vitamin D, the mean length of hospital admission was 12.30±8.47 days compared to patients with mild deficiency of Vitamin D, where the average hospital stay was 8.58±4.04 days. Conclusion: As the severity of deficiency of Vitamin D increases, the frequency of CAP increases, and it is also observed that a severe degree of deficiency is associated with severe illness and prolonged hospital stay.

Association between vitamin D levels and insulin resistance in patients with type 2 diabetes mellitus

Background: Insulin resistance (IR) is a major contributor to type 2 diabetes mellitus (T2DM) and is associated with various metabolic disorders. Vitamin D deficiency (VDD) has been linked to an increased risk of T2DM, but the relationship between vitamin D status and IR in T2DM patients remains unclear. This study explores this association in a male population with T2DM in Baghdad, Iraq.Methods: A case-control study was conducted on 190 male participants: 40 healthy controls and 150 patients categorized into different groups; 40 diabetic patients, 55 with coronary artery disease (CAD) and T2DM (CAD+DM), and 55 with only CAD. Physicians diagnosed them, and they were evaluated by physical and full medical history. All the sample set parameters were measured in the fasting state for each group. The biochemical tests included body mass index (BMI), vitamin D levels, insulin levels, fasting tests glucose (FBG), and HbA1c were measured. Insulin resistance was calculated using the HOMA-IR model.Results: Vitamin D levels were significantly lower in all diabetic groups (DM, CAD+DM) compared to the control group (p&lt;0.001). All diabetic patients had insulin resistance. BMI was significantly higher in the CAD and CAD+DM groups compared to controls (p&lt;0.00001, p&lt;0.004). FBG, HbA1c, insulin levels, and HOMA-IR were all significantly higher in diabetic patients compared to controls (p&lt;0.001 for all). Furthermore, increased HbA1c, fasting insulin, and homeostatic model assessment for insulin resistance (HOMA-IR) were associated with CAD progression in T2DM patients (p &lt; 0.001).Conclusion: This study suggests that vitamin D deficiency may contribute to insulin resistance in male T2DM patients in Baghdad, Iraq. Maintaining optimal vitamin D levels may be beneficial in diabetes management in this population. Incorporating vitamin D screening into routine check-ups for T2DM patients could aid in early detection and prevention of insulin resistance-associated complications.Keywords: Diabetes mellitus; Insulin resistance; Vitamin D; Coronary artery disease

The Correlation between Maternal and Neonatal Vit D (25(OH)D) Levels in Greece: A Cross-Sectional Study.

Few studies have correlated maternal and neonatal Vit D (25(OH)D) levels at birth in Greece. We investigated this potential association, taking into account the administration or not of low doses (400-800 IU) of prenatal Vit D supplements. Our study contributes evidence not only to the small amount of existing literature regarding the above correlation, but also to the topic of maternal and neonatal vitamin D deficiency (VDD) during pregnancy in Mediterranean countries, such as Greece. A cross-sectional study was conducted on 248 neonates and their mothers from September 2019 to January 2022. Blood samples of 25(OH)D were studied at the time of delivery. Frequency counts and percentages were registered, and logistic regression was used to investigate the independent factors associated with maternal Vit D status. The Chi-square test and the Pearson coefficient were used to demonstrate a possible association between maternal and neonatal 25(OH)D levels. Our findings show a high prevalence of VDD in Greek women and their newborns at birth. This was observed not only in women who did not receive Vit D supplements, but also in all the study groups, especially in the autumn and winter months. We observed that mothers who received low doses (400-800 IU) of prenatal Vit D supplements increased both their own 25(OH)D concentrations and those of their newborns; however, the latter did not seem to be completely covered by the prenatal administration of Vit D because, although their 25(OH)D concentrations increased, they never reached sufficient 25(OH)D levels, unlike their mothers who reached sufficient concentrations. Overall, this study highlights the strong association between maternal and neonatal 25(OH)D concentrations at the end of gestation. However, neonates tended to show even lower 25(OH)D concentrations relative to maternal 25(OH)D concentrations. The same phenomenon was observed irrespective of the administration of Vit D supplements during pregnancy. Moreover, this is what was observed concerning the administration of formulations with 400-800 IU of Vit D, which the doctors in our clinic used in the present study. In any case, more clinical studies related to the administration of higher doses of Vit D supplementation to pregnant women would lead to more reliable conclusions. Without a doubt, the measurement of maternal vitamin D status during pregnancy provides opportunities for preventive and therapeutic interventions in the mother-infant pair.

Relationship between Vitamin D3 Deficiency, Metabolic Syndrome and VDR, GC, and CYP2R1 Gene Polymorphisms.

The presence of vitamin D3 deficiency associated with the presence of metabolic syndrome (MS) has important public health effects. This study aims to investigate the relationship between vitamin D3 deficiency, MS and vitamin D3 receptor (VDR), GC Vitamin D binding protein (GC), and cytochrome P450 family 2 subfamily R member 1 (CYP2R1) gene polymorphisms, and genes whose encoded proteins are responsible for vitamin D3 metabolism and transport. A total of 58 participants were included in this study (age 39 ± 12 years) and were selected over a 12-month period. They were divided into four groups, depending on the presence of polymorphisms in VDR, GC, and CYP2R1 genes and their weight status. At baseline, in months 3, 6, and 12, biochemical parameters including 25(OH)D3, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and homeostatic model assessment (HOMA index), the insulin resistance indicator were measured. Our results show that all subjects in the polymorphism group supplemented with vitamin D3 reached an optimal level of vitamin D3 associated with high concentrations of 25(OH)D3. Weight loss was most significant in patients in the POW group (overweight patients).

Vitamin D(3) auto-/paracrine system in rat brain relating to vitamin D(3) status in experimental type 2 diabetes mellitus

Growing evidence suggests that vitamin D3 (D3, cholecalciferol) deficiency and impaired signaling of the hormonally active form of D3, 1α,25(OH)2D3 (1,25D3), through its cellular receptor (VDR) can be significant risk factors for the development of numerous multifactorial diseases, including diabetes. Our investigation was aimed at researching the D3 status in relation to the state of the D3 auto-/paracrine system in the brain and clarifying the effectiveness of the therapeutic use of D3 as a neuroprotective agent in experimental type 2 diabetes mellitus (T2DM). T2DM was induced in male Wistar rats by a combination of a high fat diet and a low dose of streptozotocin (25 mg/kg BW). Diabetic animals were treated with or without cholecalciferol (1,000 IU/kg BW, 30 days). The content of 25-hydroxyvitamin D3 (25D3) in blood serum and brain tissue was determined by ELISA. Analysis of mRNA expression of CYP24A1 and CYP27B1 genes was performed by RT-PCR. Protein levels of VDR, vitamin D3 binding protein (VDBP), CYP27B1 and CYP24A1 were investigated by Western blotting. A significant T2DM-associated decrease in the content of 25D3 in the blood serum was revealed, which correlated with a reduced content of this metabolite in the brain tissue. Impaired D3 status in animals with T2DM was accompanied by an increase in the levels of mRNA and protein of both 25D3 lα-hydroxylase (CYP27B1) and 1,25-hydroxyvitamin D3-24-hydroxylase (CYP24A1), which, respectively, provide local formation and degradation in the nervous tissue of the hormonally active form of D3 – 1,25D3. At the same time, a significant T2DM-induced down-regulation of the brain content of VDBP was shown. In addition, diabetes caused a slight increase in the protein expression of the VDR, through which the auto-/paracrine effects of 1,25D3 are realized in the brain. We have established a complete or partial corrective effect of cholecalciferol on D3 status, its bioavailability in the CNS and the level of protein expression of CYP27B1 and CYP24A1 in the brain of rats with T2DM. Abnormal D3 status in animals with T2DM was accompanied by compensatory changes in the expression of key components of the auto-/paracrine vitamin D3 system. Cholecalciferol was demonstrated to be partially effective in counteracting the impairments caused by T2DM. Keywords: 25-hydroxyvitamin D3, brain, type 2 diabetes, vitamin D3, vitamin D3 auto-/paracrine system

Extended-Release Calcifediol: A Data Journey from Phase 3 Studies to Real-World Evidence Highlights the Importance of Early Treatment of Secondary Hyperparathyroidism.

Early secondary hyperparathyroidism (SHPT) diagnosis and treatment are crucial to delay the progression of SHPT and related complications, in particular, cardiovascular events and bone fractures. Extended-release calcifediol (ERC) has been developed for the treatment of SHPT in patients with stage 3/4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI). This review compares baseline characteristics and treatment responses of SHPT patients receiving ERC in phase 3 studies with those treated with ERC in a real-world study. Mean ± standard deviation baseline parathyroid hormone (PTH) levels were 147 ± 56 pg/mL and 148 ± 64 pg/mL in the phase 3 ERC cohorts, and 181 ± 98 pg/mL in the real-world study. Other baseline laboratory parameters were consistent between the clinical and real-world studies. ERC treatment increased 25-hydroxyvitamin D (25(OH)D) and significantly reduced PTH levels, regardless of baseline CKD stage, in all studies. In the pooled phase 3 per-protocol populations, 74% of the ERC cohort were uptitrated to 60 μg/day after 12 weeks at 30 μg/day, 97% attained 25(OH)D levels ≥30 ng/mL, and 40% achieved ≥30% PTH reduction. Despite a much lower rate of uptitration in the real-world study, 70% of patients achieved 25(OH)D levels ≥30 ng/mL, and 40% had a ≥30% reduction in PTH. These data establish a "continuum" of clinical and real-world evidence of ERC effectiveness for treating SHPT, irrespective of CKD stage, baseline PTH levels, and ERC dose. This evidence supports early treatment initiation with ERC, following diagnosis of SHPT, VDI, and stage 3 CKD, to delay SHPT progression.