Vitamin D deficiency

Abstract: Signaling pathways of the vitamin D receptor (VDR) and the triggering receptor expressed on myeloid cells (TREM) have been independently implicated in the biology of numerous of cutaneous pathologies. There is substantial evidence for possible crosstalk between these pathways, though the relationship between VDR and TREMs remains unclear. In this study, we characterize the effects of vitamin D-deficiency and sufficiency on the cutaneous expression of TREM-1, TREM-2, VDR, HMGB1, and RAGE. Cutaneous tissue isolated from Yucatan mi- croswine were immunohistochemically evaluated for epidermal expression of TREM-1, TREM-2, VDR, HMGB1, and RAGE. The swine were fed a vitamin D-deficient or vitamin D-sufficient diet to examine the role of vitamin D state on levels of these markers. In vitamin D-sufficient animals, keratinocytes exhibited elevated levels of TREM-1, TREM-2. Additionally, TREM-1 expression predominated in basal cells, whereas TREM-2 levels were higher in keratinocytes, regardless of vitamin D state. Levels of HMGB1 and RAGE did not differ by vitamin D state. VDR expression was consistently higher in the cytoplasm and nuclei of basal cells, when compared to keratinocytes. Our findings sug- gest a role of vitamin D in signaling of TREM pathways. Additionally, the TREM ratio may play a role in keratinocyte differentiation and should be explored further. Possible signaling crosstalk between these pathways has a potential role in progression of cutaneous malignancies and other inflammatory pathologies.

compensatory extramedullary hemopoeisis resulting in hepatosplenomegaly. This is reversible after therapy with vitamin D, as was shown in our patient. The case reported herein had severe rickets and myelofibrosis which reversed after twelve weeks of the therapy with alphacalcidiol. We are inclined to agree with other authors 3 that rickets take a longer time to get treated in the severly malnourished. We conclude that, since vitamin D deficiency is so common in our part of the world, clinicians must be aware of its diverse functions and rare complications like myelofibrosis. Prevention of vitamin D deficiency should be emphasized by dietary supplementation and adequate sunlight exposure.

Results: In all 175 PSC patients, mean 25-OH D levels were low (24 ng/mL ±11 SD) com- pared with age/sex-matched standards. Significant differences in 25-OH D levels were noted between PSC subjects taking/not taking calcium supplements, systemic steroids, osteoporosis medications, etc. Alone, smoking status and calcium channel blockers and/or topical steroids use made no significant difference in PSC subjects 25-OH D levels, but two or more of these factors were associated with lowered levels of 25-OH D (P,0.001). Low vitamin D was cor- related with female sex, autoimmune disease, and non-skin cancer diagnosis, but not with age, or other comorbidities or medication use. In five early-stage PSC patients taking 5,000 IU of 25-OH D daily for vitamin D deficiency, there was resolution of their cataracts during the 2-year follow-up period.

Free/ionic calcium in all the subjects or in the vitamin D-deficient sub-group of pregnant women was signifi- cantly related to vitamin D. The mechanistic basis of ionic calcium homeostasis is still not completely estab- lished. However, the roles of the important individual players of calcium homeostasis aid in hypothesizing that serum levels of free/ionized calcium may be reciprocally regulated by parathyroid hormone (PTH) and 1, 25- dihydroxyvitamin D, with the former one serving to in- crease serum level of calcium and the latter to suppress it. PTH causes net bone loss (resorption) and increases blood calcium levels by stimulating osteoclasts. High levels of vitamin D have been shown to inhibit PTH syn- thesis in vitro and in vivo [27, 28]. Vitamin D deficiency is implicated in reduced serum albumin concentrations [29]. Hence, serum ionic/free calcium, which is non- albumin bound calcium, is expected to be higher in vita- min D deficiency conditions.

The lack of a prospective study design means further work is needed to answer the question of causality; how- ever, in the meantime it is important that primary and secondary health care professionals are aware of the high rates of vitamin D deficiency in people with established psychosis. This is particularly so, given that people with psychotic illnesses residing in the geographical area where this work was carried out, have a life span short- ened by up to 18 years [37]. This reduced life expectancy is largely due to cardiovascular disease, for which vita- min D deficiency is a known risk factor in the general population [31, 18]. It is also clinically noteworthy that vitamin D deficiency may exacerbate the effects of lower bone mineral density and increased osteoporosis seen in psychosis [38, 39], particularly as osteoporosis is more prevalent in black patients [40]. This may partially ac- count for the fact that people with schizophrenia have more fractures than the general population [41].

Deficiency of vitamin D is important for health of the fetus and the newborn. Moreover, maternal vitamin D deficiency is a risk factor for vitamin D deficiency in infants and childhood.Gartner et al., reported that human milk includes vitamin D at concentration of 25 IU/L or less (44). Therefore, sufficient intake of vitamin D can’t be provided by human milk as the sole origin of vitamin D for the breastfeeding infant (45). It seems that infants who are breastfed and don’t get vitamin D supplement or sufficient sunlight are at increased risk of vitamin D deficiency and rickets (45-49). The peak incidence of rickets is between 3 - 18 months of age (3) and it is related to vitamin D deficiency (15). Furthermore, children, particularly infants, may need less sun exposure than adults for producing sufficient vitamin D concentration due to greater surface area to volume ratio and increased ability to produce vitamin D than older people (27). According to Specker et al., if infants have exposure to sunlight for 30 min/week in diaper and 2 hour /week for fully clothed, vitamin D levels will get greater than 11ng/dL(2). Another Study showed that limited sunlight exposure can prohibit rickets in most of breastfed infants (50, 51). Lee reported risk factors for vitamin D deficiency in infants as follows: decreased dietary intake, malabsorption, dark skin, and inadequate sunlight exposure, (e.g.,

Phosphorus Excretion Index in Vitamin D Deficiency Rickets in South African Bantu PARATHYROID FUNCTION IN VITAMIN D DEFICIENCY RICKETS: I. http://pediatrics.aappublications.org/content/[r]

Fresh effort is recommended to address the needs of the at risk population for education about Vitamin D deficiency and ways of avoiding it. This should address both suggested lifestyle modifications and symptoms, which warrant consultation with the GP. A third of par- ticipants had received information about Vitamin D from family or friends. While the social connections of older at-risk people may differ from this group, commu- nity networks appear to be a promising vector for the dissemination of education about this important pro- blem. The group with greatest need for education are also more likely than the general population to consult their GP, and this may also prove an important source of education.

In today world, Vitamin D deficiency is increasing day by day due to unawareness of the peoples regarding sun exposure and Vitamin D-enriched food intake. This deficiency is common in all age groups, and various factors aggravate the condition and lead to insufficiency. Exposure to sunlight is having the major role in providing sufficient amount of Vitamin D. Everyone should sit in the sun at least for 15 min daily without applying sunscreen so that UV B rays reach to the skin and Vitamin D production will be there. Some plant and animal sources are also there in which a sufficient amount of Vitamin D is present such as fishes, mushroom, and milk products. Different dosage forms are available in the market for the treatment of the hypovitaminosis D such as tablets, capsules, injectables, suspensions, sachets, transdermal patches, nanostructured lipid carriers, and emulsions.

This differs from the 400 IU per day that has been recommended in previous editions of the Pediatric Nutrition Handbook of the American Academy of Pe- diatrics (AAP). The new NAS guidelines for infants are based on data primarily from the United States, Norway, and China, which show that an intake of at least 200 IU per day of vitamin D will prevent phys- ical signs of vitamin D deficiency and maintain se- rum 25-hydroxy-vitamin D at or above 27.5 nmol/L (11 ng/mL). Although there are generally less data available for older children and adolescents, the NAS has come to the same conclusions for this popula-

Relationship of Parathyroid Function to Bone Changes and Incidence of Tetany in PARATHYROID FUNCTION IN VITAMIN D DEFICIENCY RICKETS: II. The[r]

Vitamin D deficiency is common in children with nephrotic syndrome even after the remission of proteinuria with mean vitamin D levels of 20.35ng/ml. There was no significant difference of Vitamin D levels in different age groups and sex. Levels of vitamin D were lower among the patients with higher number of relapses as compared to patient with less number of relapses. Frequent relapsers had lower mean value of Vitamin D levels (13.87ng/ml) as compared to infrequent relapsers (23.25ng/ml) and 1st episode of nephrotic syndrome (26.74ng/ml). This could be explained due to repeated exposure to corticosteroids in frequent relapsers. Hypocalcaemia was seen in 88.23% of the patients, with mean calcium levels of (7.83mg/dl) and there was positive correlation between calcium and Vitamin D levels. Hyperphosphatemia was present in 47.06% of patients with mean phosphate levels of 5.28mg/dl which was in normal range. Alkaline Phosphatase was increased in 50% of the patients, but mean levels (156IU/L) were almost normal. This could be due to Alkaline Phosphatase levels may be affected by other factors. Four children had clinical features of hypocalcaemia in form of muscle spasm and muscle cramps. In conclusion, patients with increased duration and number of relapses have more Vitamin D deficiency, hence would benefit from supplements.

Background: Vitamin D deficiency has been targeted as a cause of the in- creased incidence of allergic rhinitis. Many factors, including sun exposure, influence vitamin D levels. Indonesia is a country with abundant sunshine exposure throughout the year; therefore, Indonesian residents are not ex- pected to have inadequate vitamin D levels. Objective: This study aimed to investigate whether vitamin D deficiency levels are correlated with disease spectrum among allergic rhinitis patients. Material and Method: A cross-sec- tional study was conducted in the Rhino-Allergy ORL-HNS Clinic at Dr. Ha- san Sadikin General Hospital in Bandung, Indonesia, from March-June 2016. All subjects underwent skin prick tests and serum 25-hydroxy vitamin D le- vels examination. To measure the association between vitamin D deficiency level and severity of allergic rhinitis, a Rank-Spearman correlation test was used and significance level was determined when the p-value is <0.05. Results: A total of 46 allergic rhinitis patients (19 males, 27 females, aged 28.3 ± 6 years) were included in this study. 63% of allergic rhinitis patients had a severe vitamin D deficiency and 50% of them classified as having persistent moderate-severe based on ARIA-WHO classification. Vitamin D deficiency was found to be significantly correlated with severity of allergic rhinitis status (r s = −0.321; p = 0.005). Conclusion: We found vitamin D deficiency was

Because of life style and dietary habits and the low vi- tamin D content in the diet, osteomalacia is common. In addition to calcium metabolism and bone turn-over, vita- min D contributes in lowering the risk of overall mortal- ity, cancer, diabetes, autoimmune disease, cardiovascular disease, hypertension, sleep disorders and musculoskel- etal disorders (26-31). Future research should be done to determine the prevalence of vitamin D deficiency in the general population. This would be a first step toward measures to improve public health care for musculoskel- etal functioning, cardiovascular, autoimmune and neo- plastic disease. Because of the high prevalence of vitamin D deficiency in patients with nonspecific musculoskel- etal pain, we suggest that vitamin D should be measured in all patients with musculoskeletal pain. Because the ha- bitual diet consumed by our participants does not cover the recommended vitamin D requirements, we suggest that foods such as milk, yogurt or cereals should be forti- fied with vitamin D.

ABSTRACT: Vitamin D has skeletal as well as non-skeletal effects including those on the endocrine system. Diabetes Mellitus, a leading cause of morbidity and mortality, has recently been linked to vitamin D status. It has been suggested that vitamin D deficiency is one of the modifiable risk factors for diabetes. We therefore designed this study to look at the relationship between vitamin D levels and diabetes control in type 2 South Asian diabetics from Pakistan. The objective of the study was to determine if correcting vitamin D deficiency improves diabetes control in type 2 diabetics. This analytical cross-sectional study, with prospective follow-up, included 200 subjects with type 2 diabetes (age range 27-76 years), who were deficient in vitamin D. 100 of these were treated with vitamin D and were assigned to the study group, while the rest did not receive treatment with vitamin D and so were placed in the control group. The subjects had their history taken and underwent clinical examination, after which, fasting blood was analyzed for HbA1C (using high performance liquid chromatography) and vitamin D levels (by the chemiluminescence technique) at baseline. Then the subjects in the study group only, were given vitamin D treatment for three months, after which, HbA1C and vitamin D levels were rechecked in both groups. In the study group, compared to baseline, the vitamin D levels at 3 months (following vitamin D supplementation) had significantly increased (p < 0.001) accompanied by significant decrease in HbA1C values (P < 0.001). In the control group, at three months, there was no significant change (p = 0.219) in vitamin D levels, but there was significant increase in HbA1C levels (p < 0.001) compared to baseline. These results indicate that correcting vitamin D deficiency improves diabetes control in type 2 diabetics. Larger prospective studies are required in the SouthAsian population to corroborate our findings.

This study aimed to evaluate the prevalence of hypovitaminosis D and the possible risk factors in Thai athletes. This cross-sectional study was conducted in 96 student athletes (73 males, 23 females) at the Institute of Physical Education Udonthani Thailand. Vitamin D (25(OH)D) deficiency (<20 ng/mL) or insufficiency (20-30 ng/mL) was determined using a standard blood test. The mean±SD age was 20.8±1.4 years. The prevalence of hypovitaminosis D was 42.7% (8.3% for vitamin D deficiency, 34.4% for vitamin D insufficiency). Factors related to hypovitaminosis D included being a female (OR=2.7, 95% CI 1.0-7.0, P=0.04), and sun exposure of 30 min or less per day (OR=3.1, 95% CI 1.2-8.0, P=0.01). However, types of sport, sunscreen application, and consumption of high vitamin D foods were not significantly related to hypovitaminosis D prevalence. The relatively high prevalence of hypovitaminosis D in student athletes suggests these sport athletes (particularly the females) should consider increasing their exposure to vitamin D producing mechanisms.

Epidemiological studies suggest that the development of sys- temic autoimmune disease is affected by geographical areas and lifestyle. Presumably, in these processes, vitamin D is a significant environmental factor. Vitamin D deficiency has been linked to several different diseases, including malignant and immune-pathogenetic disorders. Age, gender, lifestyle, geo- graphical areas, sunlight, and vitamin D supplementation are important determinants of vitamin D levels. In countries with temperate climates, such as Hungary, serum vitamin D con- centrations rise and fall throughout each year in parallel with sun exposure [30-33]. The prevalence of vitamin D deficiency is much higher in Europe than in Asia, Australia, or the US. In Hungary, a high prevalence of hypovitaminosis D in healthy postmenopausal women has been described [34].

risk groups (including unsupplemented African American breastfeeding infants, children who have low intakes of milk and dairy products, and infants who live in northern areas where colder winter weather precludes outdoor activities) with alkaline phosphatase levels to detect asymptomatic affected infants. Elevated alkaline phosphatase levels then would prompt additional investigation for subclini- cal vitamin D deficiency as in our case. However, 2 studies in children with subclinical rickets demon- strated that alkaline phosphatase levels did not cor- relate with the presence of metaphyseal changes. In the first study, only 9 of 22 children with radiograph- proven subclinical rickets (defined as loss of the me- taphyseal definition of the radius and ulna) had ele- vated alkaline phosphatase levels. 11 Another study

Background and aims: Vitamin D deficiency (25-hydroxyvitamin D - VitDD) affects over one billion people worldwide. VitDD results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of VitDD in Pakistan despite appreciable levels of sunshine. However, none have assessed VitDD across all age groups, genders, incomes and locations to guide future strategies. Methods: Questionnaire and blood sampling among 4830 randomly selected citizens. Results: High levels of VitDD among all age groups, genders, income levels and locations. 53.5% had VitDD, 31.2% had insufficient Vitamin D and only 15.3% normal Vitamin D. Conclusion: High rates of VitDD in Pakistan despite high levels of sunshine and previous Food Acts asking for food fortification with Vitamin D. Public health strategies are needed to address high VitDD rates, including food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature. This will involve all key stakeholder groups.

liver oil or other suitable sources of vitamin D was rec- ommended and was widely practiced. When the feeding of formulas, which in the United States have long been fortified with vitamin D, replaced breastfeeding, vitamin D supplements were no longer needed. With the return to breastfeeding beginning in the early 1970s, vitamin D supplementation was not resumed for reasons that are unknown. Beginning in the 1980s, reports began to appear of vitamin D deficiency rickets in breastfed in- fants. The great majority of cases have involved infants and toddlers with dark skin pigmentation and/or those who consumed strict vegetarian diets ( 3–5,14,31–40 ). How-