Association of vitamin D receptor gene polymorphisms with type 2 diabetes mellitus in Taif population: a case-control study / Associação de polimorfismos do gene do receptor de vitamina D com diabetes mellitus tipo 2 na população Taif: um estudo de caso-controle

Abstract Several reasons may underlie the dramatic increase in type2 diabetes mellitus. One of these reasons is the genetic basis and variations. Vitamin D receptor polymorphisms are associated with different diseases such as rheumatoid arthritis and diabetes. The aim of this study is to investigate the possible association of two identified mutations ApaI (rs7975232) and TaqI (rs731236). Eighty-nine healthy individuals and Fifty-six Type 2 Diabetic (T2D) patients were investigated using RFLP technique for genotyping and haplotyping as well. The distribution of Apal genotypes was not statistically significant among the control (P=0.65) as well as for diabetic patients (P=0.58). For Taql allele frequencies of T allele was 0.61 where of G allele was 0.39. The frequency distribution of Taql genotypes was not statistically significant among the control (P=0.26) as well as diabetic patients (P=0.17). Relative risk of the allele T of Apa1 gene is 1.28 and the odds ratio of the same allele is 1.53, while both estimates were < 1.0 of the allele G. Similarly, with the Taq1 gene the relative risk and the odds ratio values for the allele T are 1.09 and 1.27 respectively and both estimates of the allele C were 0.86 for the relative risk and 0.79 for the odds ratio. The pairwise linkage disequilibrium between the two SNPs Taq1/apa1 was statistically significant in control group (D = 0.218, D' = 0.925 and P value < 0.001) and similar data in diabetic groups (D = 0.2, D' = 0.875 and P value < 0.001). These data suggest that the T allele of both genes Apa1 and Taq1 is associated with the increased risk of type 2 diabetes. We think that we need a larger number of volunteers to reach a more accurate conclusion.

Resumo Várias razões podem estar subjacentes ao aumento dramático da diabetes mellitus tipo 2. Um desses motivos é a base genética e variações. Os polimorfismos do receptor da vitamina D estão associados a diferentes doenças, como artrite reumatoide e diabetes. O objetivo deste estudo é investigar a possível associação de duas mutações identificadas ApaI (rs7975232) e TaqI (rs731236). Oitenta e nove indivíduos saudáveis ​​e 56 pacientes com diabetes tipo 2 (T2D) foram investigados usando a técnica RFLP para genotipagem e haplotipagem também. A distribuição dos genótipos Apal não foi estatisticamente significativa entre o controle (P = 0,65), bem como para os pacientes diabéticos (P = 0,58). Para as frequências do alelo Taql, o alelo T foi de 0,61, onde o alelo G foi de 0,39. A distribuição de frequência dos genótipos Taql não foi estatisticamente significativa entre o controle (P = 0,26), bem como os pacientes diabéticos (P = 0,17). O risco relativo do alelo T do gene Apa1 é 1,28 e a razão de chances do mesmo alelo é 1,53, enquanto ambas as estimativas foram < 1,0 do alelo G. Da mesma forma, com o gene Taq1, os valores de risco relativo e razão de chances para o alelo T são 1,09 e 1,27, respectivamente, e ambas as estimativas do alelo C foram de 0,86 para o risco relativo e 0,79 para o odds ratio. O desequilíbrio de ligação par a par entre os dois SNPs Taq1 / apa1 foi estatisticamente significativo no grupo de controle (D = 0,218, D' = 0,925 e valor P < 0,001) e dados semelhantes em grupos diabéticos (D = 0,2, D' = 0,875 e valor P < 0,001). Esses dados sugerem que o alelo T de ambos os genes Apa1 e Taq1 está associado ao aumento do risco de diabetes tipo 2. Achamos que precisamos de um número maior de voluntários para chegar a uma conclusão mais precisa.

25-Hydroxyvitamin D as a biomarker of vitamin D status in plaque psoriasis and other dermatological diseases: a cross-sectional study

ABSTRACT BACKGROUND: Hypovitaminosis D is a public health problem associated with several chronic inflammatory and immunological diseases, including psoriasis. OBJECTIVES: This study aimed to determine the prevalence of hypovitaminosis D in patients with plaque psoriasis. A comparison was made between vitamin D levels in patients with psoriasis and those with other non-inflammatory dermatoses without photosensitivity. In addition, it evaluated the effects of the patients' Fitzpatrick skin phototype and the season of the year on the serum levels of vitamin D. DESIGN AND SETTINGS: A retrospective cross-sectional study was conducted at an outpatient clinic in a university center in Juiz de Fora (MG), Brazil. METHODS: A review of dermatology patients' demographic data, including skin phototype and serum levels of 25-hydroxyvitamin D [25(OH)D], over 12 months in 2016. RESULTS: This study included 554 patients: 300 patients allocated to the plaque psoriasis group and 254 control patients with other dermatological diseases. Regarding the season of the year, 229, 132, 62, and 131 participants were evaluated in summer, autumn, winter, and spring, respectively. As for the skin phototype, 397, 139, and 18 patients had phototypes III, IV, and V, respectively. The serum levels of 25(OH)D were significantly lower in the psoriasis group (24.91 ± 7.16 ng/mL) than in the control group (30.37 ± 8.14 ng/mL). CONCLUSIONS: Hypovitaminosis D (< 30 ng/mL) was present in 76.66% of patients with psoriasis versus 53.94% of control patients. Vitamin D deficiency (< 20 ng/mL) was observed in 25% of the patients with psoriasis versus 8.66% in the control group (P < 0.001). The season and patient's skin phototype were independent predictors of serum vitamin D levels.

Osteometabolic profile and bone mass in the transition phase: ethnic differences in Brazilians treated with somatropin during childhood

Abstract Objective: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. Methods: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. Results: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. Conclusion: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring

Untreated caries and serum vitamin D levels in children and youth of the United States: NHANES 2013-2014

Abstract This study aimed to investigate the association between serum vitamin D levels and untreated caries and determining factors in children and youth. Methodology: This cross-sectional study used data from the National Health and Nutrition Examination Survey (2013-2014). In total, 3,072 participants with ages ranging from 1 to 19 years were included in our sample. The main dependent variable, untreated caries, was defined as having at least one untreated carious surface in any tooth. Serum concentration of 25-hydroxyvitamin D [25(OH)D] was categorized into four groups: ≥75 nmol/ml, 50-74.9 nmol/ml, 25-49.9 nmol/ml, and <25 nmol/ml. Data were analyzed using a binary logistic regression. Results: For children aged 1-5 years, age (OR = 1.68, 95% confidence intervals (95% CI) 1.38-2.04) and low levels of vitamin D (25-49.9 nmol/ml, and <25 nmol/ml: OR = 2.55, 95% CI 1.06-6.13) were associated with untreated caries. For children aged 6-11 years, low levels of vitamin D (50-74.9 nmol/ml: OR=1.45, 95% CI 1.16-1.82) remained associated with untreated caries. No associations were found in those between 12 and 19 years of age. Conclusion: Our findings show an association between low levels of 25(OH)D and untreated caries in children between 1 and 11 years of age, suggesting that this nutrient might interfere in the caries process.

Resumo Este estudo teve como objetivo investigar a associação entre os níveis séricos de vitamina D e cárie dentária não-tratada e fatores determinantes em crianças e jovens. Metodologia: Este estudo transversal utilizou dados da Pesquisa Nacional de Saúde e Nutrição (2013-2014). No total, 3.072 participantes com idades entre 1 e 19 anos foram incluídos em nossa amostra. A principal variável dependente, cárie não-tratada, foi definida como pelo menos uma superfície de cárie não-tratada em qualquer dente. A concentração sérica de 25-hidroxivitamina D [25(OH)D] foi categorizada em quatro grupos: ≥75 nmol/ml, 50-74,9 nmol/ml, 25-49,9 nmol/ml e <25 nmol/ml. Os dados foram analisados ​​por meio de regressão logística binária. Resultados: Para crianças de 1 a 5 anos, idade (OR = 1,68, intervalo de confiança de 95% (IC 95%) 1,38 a 2,04) e baixos níveis de vitamina D (25 a 49,9 nmol/ml e <25 nmol/ml: OR = 2,55, IC 95% 1,06-6,13) foram associados a cárie não-tratada. Para crianças de 6 a 11 anos, baixos níveis de vitamina D (50 a 74,9 nmol/ml: OR = 1,45, IC 95% 1,16 a 1,82) permaneceram associados à cárie não-tratada. Não foram encontradas associações naqueles entre 12 e 19 anos de idade. Conclusão: Nossos achados mostram uma associação entre baixos níveis de 25(OH)D e cárie não-tratada em crianças de 1 a 11 anos, sugerindo que este nutriente pode interferir no processo da cárie dentária .

Vitamin D deficiency in bedridden elderly people at home

SUMMARY OBJECTIVE: The aim of this study was to evaluate serum 25(OH)D concentrations in the homebound elderly people and relate them to level of dementia, nutritional risk, and route of dietary administration. METHODS: This is a cross-sectional study involving 207 bedridden elderly people assisted by the Home Care Service in the city of Santo André - SP, from June to December 2016. The following factors were evaluated: dietary intake of vitamin D, arm circumference, triceps skin fold thickness, calf circumference, nutritional risk by Mini-Nutritional Assessment, level of dementia by the adapted Clinical Dementia Rating questionnaire, and laboratory tests such as serum concentrations of 25(OH)D, ultrasensitive C-reactive protein, alkaline phosphatase, serum calcium, and parathormone. RESULTS: The mean age of the elderly people was 81.6 (9.2) years. Deficiency of 25(OH)D was observed in 76.3% of the elderly people. There was an inverse correlation between serum concentrations of 25(OH)D: parathormone (r=-0.418, p<0.001) and alkaline phosphatase (r=-0.188, p=0.006) and a direct correlation with serum calcium (r=-0.158, p=0.022). Logistic regression showed that vitamin D deficiency was directly and independently associated with oral feeding (odds ratio 7.71; 95%CI 2.91-20.40). CONCLUSION: Bedridden households showed high prevalence of vitamin D deficiency without association with nutritional risk and level of dementia. Oral diet was associated with vitamin D deficiency, possibly due to low consumption of source foods.

Associação entre nível sérico de vitamina D e resistência à insulina em adolescentes com excesso de peso / Association between serum vitamin D level and insulin resistance in overweight adolescents

A manutenção da homeostase glicêmica e da secreção de insulina tem sido considerada um dos efeitos metabólicos da vitamina D (VD). Tradicionalmente, a obesidade é a principal causa de resistência insulínica (RI) e um importante fator de risco para a deficiência de VD. Portanto, adolescentes com obesidade e deficiência de VD podem estar diante de uma condição de dupla carga de risco para apresentar RI. Objetivou-se avaliar a associação entre os níveis séricos de 25-hidroxivitamina D [25(OH)D] e parâmetros de RI em adolescentes com excesso de peso. Trata-se de um estudo observacional em 42 adolescentes, com excesso de peso, acompanhados em serviço de atenção secundária. O excesso de peso foi definido pelos critérios da Organização Mundial da Saúde e os níveis séricos de 25(OH)D foram categorizados em normal (≥ 30 ng/mL) e baixa (< 30 ng/mL) de acordo com a Sociedade Brasileira de Nutrologia. Na avaliação da RI foram utilizados o modelo homeostático de avaliação da RI (HOMA-IR), a relação glicose/ insulina e a insulinemia de jejum. O grupo estudado caracterizou-se por ser predominantemente de adolescentes jovens (88,1% entre 10 e 14 anos), estar na puberdade (83,5%) e ter obesidade central (80%) e hipovitaminose D (85,7%). Os adolescentes com VD baixa apresentaram maior ocorrência de RI pelo índice de HOMAR IR (teste Fisher unicaudal, p < 0,05), sugerindo uma relação entre o status de vitamina D e à sensibilidade à insulina, houve associação positiva entre VD baixa e HOMA-IR elevada.

The maintenance of glycemic homeostasis and insulin secretion is considered one of the metabolic effects of vitamin D (VD). Traditionally, obesity is the main cause of insulin resistance (IR) and an important risk factor for VD deficiency. Therefore, adolescents with obesity and VD deficiency may be faced with a doubled risk of developing IR. The objective of this study was to evaluate the association between serum levels of 25-hydroxyvitamin D [25(OH)D] and IR parameters in overweight adolescents. This is an observational study of 42 overweight adolescents followed in a secondary care service. Overweight was defined by the criteria of the World Health Organization and serum levels of 25(OH)D were categorized as normal (≥ 30 ng/mL) and low (< 30 ng/mL) according to the Brazilian Society of Nutrology. In the assessment of IR, the homeostatic model of IR assessment (HOMA-IR), the glucose/insulin ratio and fasting insulinemia were used. The studied group was characterized as being predominantly young adolescents (88.1% between 10 and 14 years old), in puberty (83.5%), and having central obesity (80%), and hypovitaminosis D (85.7%). Adolescents with low VD showed a higher occurrence of IR according to the HOMAR IR index (one-tailed Fisher test, p <0.05), suggesting a relationship between vitamin D status and insulin sensitivity; hence, there was a positive association between low VD and high HOMA-IR.

Brief communication: Vitamin D serum levels in American tegumentary leishmaniasis from an endemic area in Northeast Brazil

Abstract Introduction The pathogenesis of cutaneous and mucosal leishmaniasis is associated with different immune responses. Vitamin D may modulate the immune system. Here we evaluate the association of vitamin D levels with the severity of the clinical forms of cutaneous and mucosal leishmaniasis. Methods We conducted an observational study evaluating the association between vitamin D levels, disease severity and therapeutic response in patients with cutaneous and mucosal leishmaniasis. Additionally, we conducted a cross-sectional study to compare vitamin D levels in patients with leishmaniasis and healthy subjects. Hypovitaminosis D was defined as a serum level of 25 (OH) D < 30 ng/mL. Results In patients with leishmaniasis, vitamin D serum levels were 38.5 ± 11.54 ng/mL, and 37.5 ± 10.43 ng/mL in healthy subjects The prevalence of hypovitaminosis D was 23.3% and 20.0%, respectively (p = 0.72). There was no correlation between vitamin D serum levels, disease severity, and healing time in the mucosal leishmaniasis group. Conclusion Vitamin D levels are not associated with neither susceptibility nor severity of tegumentary leishmaniasis.

Association of sun exposure and seasonality with vitamin D levels in Brazilian children and adolescents / Associação da exposição solar e da sazonalidade com os níveis de vitamina D em crianças e adolescentes brasileiros

Abstract Objective: This study aimed to verify vitamin D concentration in children and adolescents during the seasons of the year and to compare vitamin D concentration between children engaged in outdoor activities and those engaged in indoor activities. Methods: This is a cross-sectional study with a sample of 708 children and adolescents (aged 6-18 years), excluding 109 (16 were over 19 years old; 39 had a disease that required continuous treatment; 20 were on continuous medication; and 34 had no vitamin D data), ending with 599. The plasma concentration of 25-hydroxyvitamin D2 was measured with commercial kits following manufacturer instructions. Results: Participants who engaged in outdoor activities, as well as those who had data collected during summer and spring, had higher levels of vitamin D. According to the Poisson regression, the proportion of participants with inadequate levels of vitamin D was greater in the participants whose vitamin D was measured during spring (PR 1.15, 95%CI 1.03-1.29) and winter (PR 1.18, 95%CI 1.05-1.32). Also, a greater proportion of inadequate vitamin D was observed for those engaged in indoor activities (PR 1.08, 95%CI 1.01-1.15). Conclusions: Participants who measured the vitamin during the summer and autumn had a lower prevalence of hypovitaminosis D. Even in regions with high solar incidence throughout the year, vitamin D levels can vary significantly during the period's seasons.

Resumo Objetivo: Verificar a concentração de vitamina D em crianças e adolescentes durante as estações do ano e comparar essa concentração entre crianças praticantes de atividades ao ar livre e aquelas praticantes de atividades em ambiente fechado. Métodos: Trata-se de estudo transversal com amostra de 708 crianças e adolescentes (seis a 18 anos), excluindo-se 109, pois 16 eram maiores de 19 anos; 39 tinham doença que exigia tratamento contínuo; 20 estavam em uso de medicação contínua; e 34 não tinham dados de vitamina D. Terminou-se, assim, com 599 pacientes. A concentração plasmática de 25-hidroxivitamina D2 foi medida com kits comerciais, seguindo as instruções do fabricante. Resultados: Os participantes que realizaram atividades ao ar livre, assim como aqueles que tiveram dados coletados durante o verão e a primavera, apresentaram níveis mais elevados de vitamina D. De acordo com a regressão de Poisson, a proporção de participantes com níveis inadequados de vitamina D foi maior naqueles cuja medição foi realizada durante a primavera (razão de prevalência — RP 1,15, intervalo de confiança — IC95% 1,03-1,29) e o inverno (RP 1,18, IC95% 1,05-1,32). Além disso, maior proporção de vitamina D inadequada foi observada para aqueles envolvidos em atividades internas (RP 1,08, IC95% 1,01-1,15). Conclusões: Participantes que mediram a vitamina durante o verão e o outono tiveram menor prevalência para hipovitaminose D. Mesmo em regiões com alta incidência solar ao longo do ano os níveis de vitamina D podem variar significativamente durante as estações.

Conservative treatment and vitamin d levels in patients with spinal fractures / Tratamento conservador e níveis de vitamina d em pacientes com fraturas toracolombares / Tratamiento conservador y niveles de vitamina d en pacientes con fracturas toracolumbares

ABSTRACT Objectives: Evaluate the evolution of pain, functional capacity, and vitamin D levels in conservatively treated patients with low-energy spinal fractures. Methods: Between January 2017 and March 2021, patients older than 40 years old affected by these fractures were selected and treated conservatively for six months. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores and Cobb angle were evaluated pre- and post-treatment. Serum vitamin D levels were also measured at the first outpatient visit, and it was investigated whether the patient had a previous diagnosis of osteoporosis or previous fractures. Results: A total of 105 patients were analyzed, 70.5% of whom were women, with a mean age of 73.1 years. The average vitamin D level was 25.3 ng/mL, and hypovitaminosis was found in 75% of patients. Eight patients (7.62%) had a previous diagnosis of osteoporosis, and ten (9.52%) reported the occurrence of previous fractures. Regarding the VAS score, there was a mean reduction of 5.5 points of pain; for ODI, there was an average increase of 1 percentage point and an average increase of 4.3º of kyphosis in the fractured segment between pre- and post-treatment. Conclusion: The treatment improved pain, and patients maintained their functional capacity. Low levels of vitamin D were associated with more complex fractures. Level of evidence III; Retrospective Study.

Resumo: Objetivos: Avaliar a evolução da dor, capacidade funcional e níveis de vitamina D em pacientes com fraturas toracolombares por trauma de baixa energia tratados conservadoramente. Métodos: No período de janeiro de 2017 a março de 2021, pacientes com mais de 40 anos acometidos por estas fraturas foram selecionados e tratados conservadoramente durante 6 meses. As pontuações da Escala Visual Analógica (VAS), do Índice de Incapacidade de Oswestry (ODI) e o ângulo de Cobb foram avaliados no pré e pós tratamento. Dosagem sérica de vitamina D no primeiro retorno ambulatorial também foi realizada e o paciente foi questionado se tinha diagnóstico prévio de osteoporose ou fraturas prévias. Resultados: Foram avaliados 105 pacientes, sendo 70,5% mulheres, cuja idade média foi de 73,1 anos. O nível sérico médio de vitamina D foi de 25,3 ng/mL, sendo que uma hipovitaminose foi encontrada em 75% dos pacientes. Oito pacientes (7,62%) tinham diagnóstico prévio de osteoporose e dez (9,52%) relataram a ocorrência de fraturas prévias. Em relação à pontuação de VAS, observou-se uma redução média de 5,5 pontos da dor, para ODI houve um aumento médio de 1 ponto percentual e um aumento médio de 4,3º de cifose no segmento fraturado entre o pré e pós tratamento. Conclusão: O tratamento se mostrou eficaz na melhora da dor e os pacientes mantiveram sua capacidade funcional. Baixos níveis de vitamina D estavam associados a fraturas mais complexas. Nível de evidência III; Estudo Retrospectivo.

Resumen: Objetivos: Evaluar la evolución del dolor, capacidad funcional y los niveles de vitamina D en los pacientes con fracturas toracolumbares por trauma de baja energía tratados conservadoramente. Métodos: Entre enero de 2017 y marzo de 2021, los pacientes con más de 40 años afectados por estas fracturas fueran seleccionados y tratados de forma conservadora por 6 meses. Las puntuaciones de la escala analógica visual (VAS), el índice de discapacidad de Oswestry (ODI) y el ángulo de Cobb antes y después del tratamiento fueron evaluados. También se realizó la determinación del nivel sérico de vitamina D en la primera consulta y se preguntó al paciente si tenía diagnóstico previo para la osteoporosis o fracturas previas. Resultados: 105 pacientes fueran evaluados, de los cuales 70,5% eran mujeres, con edad promedio de 73,1 años. La media del nivel sérico de vitamina D fue de 25,3 ng/mL y la hipovitaminosis fue encontrada en 75% de los pacientes. Ocho pacientes (7,62%) tenían diagnóstico previo de osteoporosis y diez (9.52%) reportaron la ocurrencia de fracturas previas. Cuanto a la puntuación VAS, hubo una reducción promedio de 5,5 puntos en el dolor, para ODI hubo un aumento promedio de 1 punto porcentual y un aumento promedio de 4,3º de cifosis en el segmento fracturado entre pre y post tratamiento. Conclusión: El tratamiento demostró ser efectivo para mejorar el dolor y los pacientes mantuvieron su capacidad funcional. Los niveles bajos de vitamina D se asociaron con fracturas más complejas. Nivel de evidencia III; Estudio Retrospectivo.

Is vitamin D status relevant to psoriasis and psoriatic arthritis? A retrospective cross-sectional study

Abstract BACKGROUND: Psoriasis is a systemic, immune-mediated disease characterized by inflammatory manifestations in the skin and joints. Vitamin D deficiency is currently considered a pandemic and is associated with comorbidities including psoriasis and psoriatic arthritis (PsA). OBJECTIVES: To determine the prevalence of hypovitaminosis D [25(OH)D] in patients with plaque psoriasis, with and without PsA, and of independent predictors of serum 25(OH)D levels. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, Minas Gerais, Brazil. METHODS: Demographic and clinical data (psoriasis area and severity index [PASI], family history, age at onset, disease duration, and the presence of PsA according to Classification Criteria for Psoriatic Arthritis), skin phototype, and season of the year were reviewed. RESULTS: Hypovitaminosis D (< 30 ng/mL) was highly prevalent in patients with psoriasis with and without PsA (82.2% and 74.9%, respectively). An inverse correlation between PASI and vitamin D was found (without PsA r = -0.59 and, PsA r = -0.52, P < 0.001), and multivariate regression revealed that hypovitaminosis D was associated with disease severity, season, and phototype. It was confirmed by binary logistic regression between PASI and vitamin D deficiency (< 30 ng/mL), (odds ratio, OR 1.78 CI: -0.20-0.53, P < 0.001). CONCLUSION: Hypovitaminosis D (< 30 ng/mL) was highly prevalent in psoriatic patients with and without PsA. Season and skin phototype were associated with 25(OH)D levels. An inverse association between PASI and serum 25(OH)D levels was established.

Determinants of poor sleep quality in adults during the coronavirus disease pandemic: COVID-Inconfidentes, a population-based study

ABSTRACT BACKGROUND: The coronavirus disease (COVID-19) pandemic has adversely affected the health of the global population, with sleep quality being one of the affected parameters. OBJECTIVES: To evaluate sleep quality and its associated factors in adults during the COVID-19 pandemic in Brazil. DESIGN AND SETTING: A population-based cross-sectional serological survey of 1,762 adults in the Iron Quadrangle region of Brazil. METHODS: The Pittsburgh Sleep Quality Index was used to assess sleep quality. Sociodemographic variables, health conditions, health-related behaviors, anxiety, vitamin D levels, weight gain/loss, and pandemic characteristics were assessed using a structured questionnaire. Univariate and multivariate analyses using Poisson regression with robust variance were performed to identify factors associated with sleep quality. RESULTS: More than half of the participants reported poor sleep quality (52.5%). Multivariate analysis revealed that the factors associated with poor sleep quality included living alone (prevalence ratio [PR] = 1.34; 95% confidence interval [CI]: 1.04-1.73), anxiety disorder (PR = 1.32; 95% CI: 1.08-1.62), 5.0% weight loss (PR = 1.21; 95% CI: 1.02-1.44), 5.0% weight gain (PR = 1.27; 95% CI: 1.03-1.55), vitamin D deficiency (PR = 1.16; 95% CI: 1.01-1.35), and COVID-19 symptoms (PR = 1.29; 95% CI: 1.10-1.52). CONCLUSIONS: Our study revealed that more than half of the participants experienced poor sleep quality during the COVID-19 pandemic. Factors associated with poor sleep quality included vitamin D deficiency and weight changes related to the pandemic.

Vitamina D: Brevíssimas considerações sobre sua bioquímica, patologias relacionadas e saúde pública / Vitamin D: Very brief considerations on its biochemistry, related pathologies and public health / Vitamina D: Breves consideraciones sobre su bioquímica, patologías relacionadas y salud pública

Na atualidade, vasta são as produções e pesquisas, que analisam os inúmeros benefícios emanados pela vitamina D no organismo humano, se constituindo enquanto uma das principais questões na atualidade, geradora de reflexões e análises sistemáticas, em relação a este verdadeiro hormônio corporal, necessário à nossa existência e sobrevivência, com qualidade.1-10 Nesse sentido, a vitamina D se compõem enquanto constituinte, do que conhecemos enquanto "secosteroides", ou seja, compostos do tipo químico, que são derivados de um tipo de esteroide, que são provenientes de estruturas que tiveram a sua separação, desenvolvidas em suas outras ligações.

Application progress in the role of vitamin D3 in transplantation immunity / 器官移植

Vitamin D3 is a kind of vitamin that plays important roles in maintaining the normal physiological function of the human body, and its metabolites and analogues exhibit strong anti-inflammatory activity. Vitamin D3 could be activated and converted into 1α, 25-dihydroxyvitamin D3, a kind of steroid hormone, in the human body, which participates in the regulation of cellular metabolism by activating vitamin D receptor (a kind of transcription factor), thus exerting immunomodulatory effects. This is essential for maintaining the physiological health of the body. Currently, there is a growing number of studies that suggest important roles for 1α, 25-dihydroxyvitamin D3 in organ transplantation immunomodulation and tolerance. Therefore, we reviewed the overview and physiological effects of 1α, 25-dihydroxyvitamin D3, the immunomodulatory effects of vitamin D3 and the application of vitamin D3 in clinical organ transplantation, and summarized the value of applying vitamin D3 in inducing immune tolerance in transplantation, with the aim of providing a reference for promoting the application of vitamin D3 in transplantation immunity.

Nutritional status on vitamin A, vitamin D and its relation with height among primary and middle school students in poor rural areas of Enshi from 2012 to 2021 / 中国学校卫生

Objective@#To investigate the status of physical development, vitamin A and vitamin D among primary and middle school students in poor rural areas in Hubei, to evaluate the implementation effectiveness of the Nutrition Improvement Program for Rural Compulsory Education Students (abbreviated to the program) from 2012 to 2021.@*Methods@#In Enshi City, a pilot monitoring county of the program in Hubei, and a total of 2 554 students from one primary school and one junior middle school were randomly selected. During September to October in 2012-2021, height was measured, and fasting venous blood was collected from students, and serum vitamin A and vitamin D were detected.@*Results@#From 2012 to 2021, height, serum vitamin A and serum vitamin D concentration increased by 2.7 cm, 96.7 μg/L and 8.6 ng/mL. Growth retardation rate decreased by 1.0%. The subclinical and clinical deficiency of serum vitamin A decreased by 37.3% and 6.2%. The subclinical and clinical deficiency of serum vitamin D decreased by 45.7% and 8.5%. Height was positively correlated with serum vitamin A status and negatively correlated with serum vitamin D status ( r =0.08,-0.08, P <0.01).@*Conclusion@#The pilot counties of the program in Enshi, has witnessed improvement in height, serum vitamin A and vitamin D status among primary and secondary students. However, future efforts remains essential as subclinical deficiency of vitamin A and vitamin D are noted in some students. Serum vitamin A is positively associated with height, and vitamin D is negatively associated with height.Considering the correlation between serum vitamin A and vitamin D status with height, continued efforts should be implemented in poor rural areasto strengthen targeted nutrition intervention for students in Hubei.

Factors affecting osteoporosis among physical examination populations aged over 35 years in urban areas of Hangzhou City / 预防医学

Objective@#To investigate the development of osteoporosis (OS) and its influencing factors among physical examination populations aged over 35 years in urban areas of Hangzhou City, so as to provide insights into OP prevention.@*Methods@#Subjects aged over 35 years that underwent physical examinations in Wenhui Street Community Health Service Center of Gongshu District, Hanghzhou City during the period between April and July, 2022 were enrolled. Subjects' demographic characteristics and physical examination data were collected, and the bone mineral density and serum vitamin D levels were measured. The factors affecting the development of OP were identified using a logistic regression model.@*Results@#A total of 1 561 subjects were recruited, including 616 males (39.46%) with a median (interquartile range) age of 62 (18) years, and 945 females (60.54%) with a median (interquartile range) age of 62 (19) years. The prevalence of OP was 43.69% among the study subjects. Multivariable logistic regression analysis identified women (OR=1.367, 95%CI: 1.105-2.979) and increased age (OR=1.057, 95%CI: 1.044-1.069) as risk factors for OP and elevated serum 25-hydroxy-vitamin D levels as a protective factor for OP (OR=0.969, 95%CI: 0.954-0.985).@*Conclusions@#The prevalence of OP was 43.69% among physical examination populations aged over 35 years in urban areas of Hangzhou City, and gender, age and serum 25-hydroxy-vitamin D were factors affecting the development of OP.

The effect of vitamin D deficiency on the retinal microvasculature: an observational case-control study / O efeito da deficiência de vitamina D nos microvasos da retina: um estudo caso-controle observacional

ABSTRACT Purpose: To determine the effects of vitamin D deficiency on retinal microvascularity using optical coherence tomography angiography. Methods: This study was designed as an observational case-control study. Ninety-eight eyes of patients with vitamin D deficiency and 96 eyes of healthy participants with serum vitamin D level >30 ng/mL were studied. Macula centered, 6.00 × 6.00 mm scan size images were taken. The vessel densities in the superficial and deep retinal capillary plexus, foveal avascular zone area, and choriocapillaris flow area were measured. Results: The groups were comparable in terms of best-corrected visual acuity, sex, axial length, refractive error, age, and adjusted intraocular pressure. The average vitamin D level was significantly lower in the study group (p=0.021). The whole, parafoveal, and perifoveal vessel densities in the deep capillary plexus were considerably higher in the study group than in the control group (p=0.012, p=0.014, and p=0.023, respectively). The foveal avascular zone area and the choriocapillaris flow area were similar in both groups (p=0.37 and p=0.27, respectively) there was a strong negative correlation between the serum vitamin D level and vessel density in the whole image, parafoveal, and perifoveal regions of the deep capillary plexus in the study group (Spearman's rho=-0.71, p=0.043; Spearman's rho= -0.79, p=0.011; and Spearman's rho = -0.74, p=0.032; respectively). Conclusion: An increase in vessel density might originate from vascular structural changes caused by vitamin D deficiency. The increased vessel density, especially in the deep capillary plexus, can enable early diagnosis of vitamin D-associated vasculopathy.

RESUMO Objetivo: Determinar os efeitos da deficiência de vitamina D nos microvasos da retina usando angiotomografia de coerência óptica. Métodos: Este estudo foi planejado para ser do tipo caso-controle observacional. Foram avaliados 98 olhos de pacientes com deficiência de vitamina D e 96 olhos de participantes saudáveis com nível sérico de vitamina D superior a 30 ng/mL. Foram adquiridas imagens de varredura centralizadas na mácula, com um tamanho de 6,00 × 6,00 mm. Mediram-se a densidade dos vasos nos plexos capilares superficial e profundo da retina, a área da zona avascular foveal e a área do fluxo coriocapilar. Resultados: Os grupos mostraram-se semelhantes em relação à melhor acuidade visual corrigida, ao gênero, ao comprimento axial, ao erro refrativo, à idade e à pressão intraocular ajustada. O nível médio de vitamina D foi significativamente menor no grupo de estudo (p=0,021). As densidades total, parafoveal e perifoveal do plexo capilar profundo foram significativamente maiores no grupo de estudo que no grupo controle (respectivamente, p=0,012, p=0,014 e p=0,023). As áreas da zona avascular foveal e do fluxo coriocapilar foram semelhantes nos dois grupos (respectivamente, p=0,37 e p=0,27). Além disso, houve uma forte correlação negativa do nível sérico de vitamina D com as densidades vasculares medidas em toda a imagem e nas regiões parafoveais e perifoveais do plexo capilar profundo no grupo de estudo (respectivamente, ρ de Spearman = −0,71, p=0,043; ρ de Spearman = −0,79, p=0,011; e ρ de Spearman = −0,74, p=0,032). Conclusão: Pode ocorrer um aumento na densidade vascular da retina devido a alterações estruturais dos vasos causadas pela deficiência de vitamina D. O aumento da densidade vascular, especialmente no plexo capilar profundo, pode ser usado para o diagnóstico precoce da vasculopatia associada à deficiência de vitamina D.

Therapeutic Effect of the Correction of Vitamin D Deficiency in Patients with Benign Paroxysmal Positional Vertigo - A Randomized Clinical Trial

Abstract Introduction Benign paroxysmal positional vertigo (BPPV) appears during the same age group in which vitamin D and calcium deficiencies are evident. Vitamin D deficiency could predispose to BPPV, since these two entities share a demineralization process. Objective To establish the otological impact of vitamin D supplementation in patients with its deficiency who suffer from BPPV. Methods This was a randomized clinical trial. A total of 35 patients with vitamin D deficiency (< 30ng/ml) and BPPV were divided into 2 groups: Group 1 (control group): treatment with repositioning maneuvers; and Group 2: treatment with repositioning maneuvers and vitamin D supplementation. Results A follow-up of between 6 and 13 months and a log rank test revealed that the probability of recurrence between the experimental groups was significantly different, with group 2 having a decreased recurrence of vertigo (p = 0.17). Scores in the Dizziness Handicap inventory (DHI) in patients treated with vitamin D supplementation were smaller (10 ± 9) when compared with a score of 36 ± 9 in the control group. Conclusion Plasmatic values of 25-hydroxyvitamin D have an impact in patients with BPPV, who present an improvement in their quality of life when their vitamin D levels are replaced with supplementation. Benign paroxysmal positional vertigo could stop being perceived as a purely otologic disease.

Níveis séricos de vitamina D e alterações hepáticas em pacientes com malária na região Amazônica / Serum levels of vitamin d and hepatic changes in patients with malaria in the Amazon region / Niveles séricos de vitamina d y alteraciones hepáticas en pacientes con malaria en la Amazonia

Vários estudos sugerem a importância da vitamina D ­ 25(OH)D ­ na evolução clínica dos pacientes com malária. Entretanto, a prevalência de deficiência de 25(OH)D na população amazônica é pouco conhecida, havendo também poucos estudos com pacientes diagnosticados com malária. Assim, o objetivo deste estudo foi avaliar os níveis séricos de 25(OH)D em pacientes com malária e sua relação com dados epidemiológicos, parasitológico e provas de função hepática. Para tanto, foi realizado um estudo transversal analítico com um grupo de pacientes com malária e um grupo controle no município de Itaituba (PA), Brasil, no período de janeiro de 2018 a outubro de 2019. Elaborou-se um protocolo para avaliação dos dados sociodemográficos, parasitológicos e laboratoriais, adotando-se o nível de significância de 5%. A prevalência de deficiência de 25(OH)D foi observada nos pacientes com malária (28,5%) e no grupo controle (24,6%), sem diferença estatística; porém, entre os residentes no garimpo, os níveis séricos foram estatisticamente menores nos pacientes com malária. Os níveis séricos de transaminase glutâmico-pirúvica (TGP) apresentaram correlação inversa com os de 25(OH)D. As provas de função hepática foram significativamente maiores no grupo com malária. Dessa forma, este estudo evidenciou a deficiência de 25(OH)D em Itaituba. Alterações hepáticas pela infecção plasmodial podem ter contribuído para a correlação inversa observada entre os níveis de TGP e 25(OH)D.

Several studies suggest the importance of vitamin D ­ 25(OH)D ­ in the clinical evolution of patients with malaria. However, the prevalence of 25(OH)D deficiency in the Amazonian population is little known, and studies with patients diagnosed with malaria are scarce. Thus the objective of this study is to evaluate the serum levels of 25(OH)D in patients with malaria and its relationship with epidemiological and parasitological data and liver function tests. To that end, an analytical cross-sectional study was carried out with a group of patients with malaria and a control group in the municipality of Itaituba (PA), Brazil, from January 2018 to October 2019. A protocol was elaborated for the evaluation of sociodemographic, parasitological, and laboratory data, adopting a significance level of 5%. Results: The prevalence of 25(OH)D deficiency was observed in patients with malaria (28.5%) and in the control group (24.6%), with no statistical difference; however, among residents in the mining, serum levels were statistically lower in patients with malaria. The glutamic-pyruvic transaminase (GPT) serum levels showed an inverse correlation with 25(OH)D levels. Liver function tests were significantly higher in the malaria group. Thus, this study evidenced 25(OH)D deficiency in Itaituba. Hepatic changes due to plasmodial infection may have contributed to the inverse correlation observed between GPT and 25(OH)D levels.

Diversos estudios sugieren la importancia de la vitamina D ­[25(OH)D]­ en la evolución clínica de pacientes con malaria. Sin embargo, la prevalencia de la deficiencia de 25(OH)D en la población amazónica es poco conocida y existen pocos estudios en pacientes con malaria. Ante esto, el objetivo de este estudio fue evaluar los niveles séricos de 25(OH)D en pacientes con malaria y su relación con datos epidemiológicos, parasitológicos y pruebas de función hepática. Para ello, se realizó un estudio transversal analítico en el grupo de pacientes con malaria y en un grupo control en el municipio de Itaituba (PA), Brasil, de enero de 2018 a octubre de 2019. Se elaboró un protocolo para la evaluación de datos sociodemográficos, parasitológicos y de laboratorio, adoptando un nivel de significancia del 5%. La prevalencia de deficiencia de 25(OH)D se observó en pacientes con malaria (28,5%) y en el grupo control (24,6%), sin diferencia estadística; sin embargo, entre los residentes en la minería, los niveles séricos fueron estadísticamente inferiores en pacientes con malaria. Los niveles séricos de transaminasa glutámico pirúvica (TGP) mostraron una correlación inversa con los niveles de 25(OH)D. Las pruebas de función hepática fueron significativamente más altas en el grupo de malaria. De esta manera, se evidenció deficiencia de 25(OH)D en la población de Itaituba. Los cambios hepáticos debido a la infección plasmodial pueden haber contribuido a la correlación inversa observada entre los niveles de TGP y 25(OH)D.

Componentes de fragilidad, sarcopenia y su asociación con insuficiencia de vitamina D. Estudio transversal analítico / Components of frailty, sarcopenia and their association with vitamin D deficiency. Cross-sectional, analytical study

Resumen Introducción: En adultos mayores, la asociación de fragilidad y sarcopenia con deficiencia de vitamina D es conocida, pero poco se ha estudiado la asociación de los componentes del síndrome de fragilidad. Objetivo: Determinar la asociación entre los componentes de fragilidad, sarcopenia e insuficiencia de vitamina D en adultos mayores. Métodos: Se estudiaron adultos de quienes se registró edad, escolaridad, estado civil, antecedentes de fracturas, hospitalizaciones, indicadores antropométricos, sarcopenia, índice de Charlson, polifarmacia, fenotipo de fragilidad de Fried y vitamina D plasmática; cifras < 30 ng/mL se consideraron indicativas de insuficiencia de vitamina D. Para el análisis estadístico se utilizó estadística descriptiva e inferencial. La asociación fue determinada mediante regresión logística binaria. Resultados: Se estudiaron 175 adultos con un promedio de edad de 71.7 ± 6.7 años (IC 95 % = 60-90 años). La regresión logística binaria demostró que las variables asociadas a insuficiencia de vitamina D fueron agotamiento (RM = 2.6, IC 95 % = 1.0-6.5, p = 0.03), fragilidad (RM = 9.2, IC 95 % = 2.5-34.1, p = 0.001) y prefragilidad (RM = 4.6, IC 95 % = 2.1-10.0, p < 0.001). Conclusión: Los fenotipos frágil, prefrágil y agotamiento se asocian a insuficiencia de vitamina D.

Abstract Introduction: In older adults, the association of frailty and sarcopenia with vitamin D deficiency is well known, but the association of the components of frailty syndrome has been poorly studied Objective: To determine the association of the components of frailty and sarcopenia with vitamin D insufficiency in older adults. Methods: Adults were studied, in whom age, education, marital status, history of fractures, hospitalizations, anthropometric indicators, sarcopenia, Charlson index, polypharmacy, Fried's frailty phenotype, and plasma vitamin D were recorded; figures < 30 ng/mL were considered indicative of vitamin D insufficiency. Descriptive and inferential statistics were used for statistical analysis. The association was determined by binary logistic regression. Results: One-hundred and seventy-five adults with a mean age of 71.7 ± 6.7 years (95% CI = 60-90 years) were studied. Binary logistic regression showed that the variables associated with vitamin D deficiency were exhaustion (OR = 2.6, 95% CI = 1.0-6.5, p = 0.03), frailty (OR = 9.2, 95% CI = 2.5-34.1, p = 0.001) and pre-frailty (OR = 4.6, 95% CI = 2.1-10.0, p < 0.001). Conclusion: The frail and pre-frail phenotypes, as well as exhaustion, are associated with vitamin D insufficiency.

Treatment options in hypoparathyroidism

ABSTRACT Hypoparathyroidism remains the single endocrine deficiency disease that is not habitually treated with the missing hormone. In this article, we aim to provide a review of the conventional approach and the novel therapies as well as an overview of the perspectives on the treatment of this rare condition. We conducted a literature review on the conventional therapy using vitamin D analogs and calcium salts, indications for thiazide diuretics and phosphorus binders, PTH analogs history and usage, and the drugs that are currently being tested in clinical trials. Conventional treatment involves calcium salts and vitamin D analogs. Thiazide diuretics can be used to reduce hypercalciuria in some cases. A low-phosphate diet is recommended, and phosphate binders are rarely needed. During pregnancy, a careful approach is necessary. The use of PTH analogs is a new approach despite the limitation of high cost. Studies have included modified PTH molecules, calcilytics, microencapsulation of human parathyroid cells, and allotransplantation.