Vitamin d levels and lipid profile in patients undergoing bariatric surgery / Níveis de vitamina d e perfil lipídico em pacientes submetidos à cirurgia bariátrica

ABSTRACT BACKGROUND: Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences. AIMS: To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery. METHODS: Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery. RESULTS: A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery. CONCLUSIONS: It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.

RESUMO RACIONAL: Deficiências vitamínicas, minerais e metabólicas ocorrem no pós-operatório de cirurgia bariátrica, a curto e longo prazo, sendo intercorrências preocupantes. OBJETIVOS: Avaliar a associação dos níveis séricos de vitamina D com o perfil lipídico, em pacientes obesos submetidos à cirurgia bariátrica. MÉTODOS: Série de casos de pacientes atendidos de 2010 até 2018, em hospital privado de média e alta complexidade, submetidos à cirurgia bariátrica pelas técnicas da gastrectomia vertical e derivação gástrica em Y de Roux, acompanhados pelo mesmo cirurgião. Foram coletados dados sociodemográficos, clínicos, dados laboratoriais e antropométricos no pré-operatório, 6 meses, 12 meses e 24 meses após cirurgia. RESULTADOS: Foram acompanhados 156 indivíduos, maioria sexo feminino (75,6%), comorbidades mais frequentes foram esteatose hepática (76,3%) e hipertensão (48,27). Em relação aos níveis de vitamina D pré-operatórios, apenas 18,9% da população apresentaram níveis satisfatórios (=30 ng/mL). Observou-se redução do peso e melhora do perfil lipídico pós-cirúrgico. Sobre as correlações entre o perfil lipídico e concentração de vitamina D foram observadas correlações significativas apenas na amostra que passou pela técnica cirúrgica derivação gástrica em Y de Roux: correlação negativa entre o colesterol total e vitamina D após 2 anos de cirurgia; correlação positiva entre triglicerídeo e vitamina D 1 ano pós-operatório; e correlação negativa entre HDL e vitamina D 2 anos pós-operatório. CONCLUSÕES: é essencial acompanhar os níveis de vitamina D e perfil lipídico no pré e pós-operatório de forma rotineira a fim de evitar danos relacionados a deficiência dessa vitamina.

Negative association between 25-hydroxyvitamin D and inflammatory markers in rheumatologic diseases / Asociación negativa entre 25-hidroxi vitamina D y los marcadores inflamatorios en enfermedades reumatológicas

Objective: The main purpose of this study was to evaluate serum 25-hydroxyvitamin D (25OHD) levels and its association with in"ammatory markers in patients with rheumatologic diseases (RD). Methods: A cross-sectional study in 154 women with RD (rheumatoid arthritis, spondyloarthritis and other connective tissue diseases) and 112 healthy individuals as a control group (CG) was carried out. Results: No differences in serum and urine calcium, serum phosphate, and urinary deoxypyridinoline were found. RD group had lower 25OHD and higher PTH compared to CG. RD group had higher C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) compared to CG. The overall mean level of 25OHD (ng/ml) was 26.3±12.0 in the CG and 19.4±6.8 in the RD group (p<0.0001). Moreover, CG had lower percentage of individuals with 25OHD de!ciency compared to RD (29.9% vs 53.2%). The femoral neck BMD was signi!cantly lower in postmenopausal RD women compared to CG. 25OHD levels signi!cantly correlated with ESR and CRP as in"ammatory markers. Age, BMI, presence of RD, and CRP were signi!cantly and negatively associated with 25OHD levels through linear regression analysis. According to univariate logistic regression analysis for 25OHD deficiency (<20 ng/ml), a significant and negative association with BMI, presence of RD, ESR and CRP were found. Conclusion: Patients with RD had lower 25OHD levels than controls and the presence of a RD increases by 2.66 the risk of vitamin D de!ciency. In addition, 25OHD has a negative correlation with ESR and CRP as in"ammatory markers. (AU)

Objetivo El objetivo principal de este estudio fue evaluar los niveles séricos de 25-hidroxivitamina D (25OHD) y su asociación con marcadores inflamatorios en enfermedades reumatológicas. Materiales y métodos: Se realizó un estudio transversal en 154 mujeres con enfermedades reumatológicas (artritis reumatoide, espondiloartritis y otras enfermedades del tejido conectivo) y 112 individuos sanos como grupo control (GC). Resultados: No se encontraron diferencias en el calcio sérico y urinario, el fosfato sérico y la desoxipiridinolina urinaria entre el GC y los sujetos con enfermedades reumatológicas. El grupo de pacientes con enfermedades reumatológicas tenía 25OHD más bajo y PTH más alto en comparación con el GC. Asimismo, el grupo de individuos con enfermedades reumatológicas tenía proteína C reactiva (PCR) y velocidad de eritrosedimentación (VES) más altas en comparación con el GC. El nivel de 25OHD (ng/ml) fue 26,3±12,0 en el GC y 19,4±6,8 en el grupo con enfermedades reumatológicas (p<0,0001). Además, el GC presentó un porcentaje menor de deficiencia de 25OHD en comparación con el grupo con enfermedades reumatológicas (29,9% vs 53,2%). La DMO del cuello femoral fue significativamente menor en las mujeres posmenopáusicas con enfermedades reumatológicas en comparación con el GC. La 25OHD correlacionó significativamente con la VES y la PCR como marcadores inflamatorios. El análisis de regresión lineal mostró que la edad, el IMC, la presencia de una enfermedad reumatológica y la PCR se asociaron significativa y negativamente con los niveles de 25OHD. Mientras que el análisis de regresión logística univariada mostró que la deficiencia de 25OHD (<20 ng/ml), se asoció significativa y negativamente con el IMC, la presencia de una enfermedad reumatológica, la VES y los niveles de PCR. Conclusiones: Los pacientes con enfermedades reumatológicas tenían niveles de 25OHD más bajos que los controles y la presencia de una enfermedad reumatológica aumenta en 2.66 el riesgo de deficiencia de vitamina D. Además, la 25OHD mostró correlación negativa con la VES y la PCR como marcadores inflamatorios. (AU)

Alta prevalencia de hipovitaminosis D en personas infectadas con HIV atendidas en un centro ambulatorio de la ciudad de Buenos Aires / High prevalence of hypovitaminosis D in HIV-infected persons attending an outpatient clinic, Buenos Aires city

La hipovitaminosis D es frecuente en el mundo. Según estudios realizados entre 1987 y 2015, en Argentina la prevalencia fue > 40%. En personas con infección por HIV variaría entre 20 y 90%, pero en nuestro medio no se conoce con precisión. Nuestro objetivo fue determinar la prevalencia de hipovitaminosis D en una cohorte de adultos con infección por HIV asistidos en forma ambulatoria en la ciudad de Buenos Aires. Se analizaron retrospectivamente las historias clínicas de 814 sujetos mayores de 18 años HIV positivos con al menos una determinación de vitamina D. La mediana de edad fue 44 años (rango intercuartílico 21-80), 746 (91.6%) eran hombres y 813 (99.9%) recibían tratamiento antirretroviral. Se realizó análisis uni y multivariado para determinar asociación entre hipovitaminosis D y valores de CD4, carga viral para HIV y terapia antirretroviral. La prevalencia de hipovitaminosis D fue 79.7% (insuficiencia 34.2%, deficiencia 45.5%). No se encontró asociación con el uso de efavirenz o inhibidores de la proteasa (p = 0.86 en ambos casos), con el recuento de linfocitos CD4, ni con la carga viral plasmática (p = 0.81 y 0.74, respectivamente). El presente estudio muestra que, en nuestro medio, la hipovitaminosis D es muy frecuente en personas con infección por HIV. Aun cuando no revela evidencia de relación con carga viral para HIV, estado inmune, ni tratamiento antirretroviral, es necesaria la búsqueda sistemática de hipovitaminosis D en esta población, en vista de la alta frecuencia de osteopenia y osteoporosis y el mayor riesgo de fracturas descripto en personas HIV positivas.

Hypovitaminosis D is frequent worldwide. In Argentina, according to studies conducted between 1987 and 2015, prevalence was > 40% in the general population. In people living with HIV it may vary between 20 and 90%, but the prevalence in our environment is not known. Our objective was to determine the prevalence of hypovitaminosis D in a cohort of adults with HIV infection in the city of Buenos Aires. We analyzed retrospectively medical records of 814 HIV positive subjects older than 18 years with at least one determination of vitamin D. The median age was 44 years (interquartile range 21-80), 746 (91.6%) were men, and 813 (99.9%) were on antiretroviral treatment. Univariate and multivariate analyses were performed to determine the association of hypovitaminosis D with CD4 values, viral load for HIV, and antiretroviral therapy. The present study shows that, in our environment, hypovitaminosis D is very common in people with HIV infection. Although it does not reveal evidence of a relationship with viral load for HIV, immune status, or antiretroviral treatment, the systematic search for hypovitaminosis D is mandatory in this population, taking into account its high frequency and the increased risk of osteopenia, osteoporosis and fractures, as described in people with HIV.

Effect of vitamin D supplementation on 24-hour urine calcium in patients with calcium Urolithiasis and vitamin D deficiency

ABSTRACT Purpose: Hypercalciuria is one of the risk factors for calcium kidney stone formation (the most common type of urinary stones). Although vitamin D deficiency is prevalent among urolithiasis patients, the effect of vitamin D supplementation on urine calcium in these patients is still unclear. Materials and Methods: In this retrospective study, medical and laboratory tests records of 26 patients with recurrent calcium kidney stones and vitamin D deficiency treated with 50000IU vitamin D per week for 8-12 weeks were analyzed. The changes in 24-hour urine calcium (24-h Ca), serum 25-hydroxyvitamin D (25 (OH) D), serum parathormone (PTH), other 24-hour urine metabolites and calculated relative supersaturations of calcium oxalate (CaOxSS), calcium phosphate (CaPSS) and uric acid (UASS) were assessed. Moreover, correlations between changes in 24-h Ca and other aforementioned variables were assessed. Results: Serum 25 (OH) D and 24-h Ca increased after vitamin D supplementation, while serum PTH decreased (p < 0.001, for all analyses). The levels of 24-hour urine sodium and urea increased significantly (p = 0.005 and p = 0.031, respectively). The levels of CaOxSS and CaPSS increased, but the changes were not significant (p = 0.177, and p = 0.218, respectively). There were no correlations between the changes in 24-h Ca and serum 25 (OH) D or PTH. Conclusions: The result of current study suggests that although urine Ca increased in vitamin D supplemented patients, this increase was not associated with the increase in serum vitamin D and may be due to other factors such as dietary factors. Further randomized clinical trials considering other factors associated with urine Ca are warranted.

Estudio Descriptivo: Niveles de 25 ­ Hidroxi Vitamina D en la Población que Acude al Servicio de Endocrinología del Instituto Ecuatoriano de Seguridad Social, Azogues ­ Ecuador, 2017 / Restrospective Research: Levels of 25 - Hydroxy Vitamin D in the population that goes to the Endocrinology Service of the Ecuadorian Institute of Social Security, Azogues - Ecuador, 2017

INTRODUCCIÓN: La Vitamina D es considerada una hormona, siendo químicamente liposoluble y se le relaciona con enfermedades inmunológicas, cardiometabólicas y cáncer. El objetivo es evaluar los niveles de 25 hidroxi vitamina D en los pacientes que acudieron al servicio de endocrinología. MÉTODOS: Se trata de un estudio retrospectivo, se tomaron 122 pacientes que acudieron al servicio de endocrinología del Instituto Ecuatoriano de Seguridad Social, durante el periodo durante el periodo de julio a septiembre del 2017. RESULTADOS: El promedio de vitamina D 23.99 ± 9.12 ng/ml, el 22 % presentaron vitamina D en rango normal (≥ 30 ng/ml) y el 78 % en insuficiencia/deficiencia (< 30 ng/ml). Los niveles de calcio y paratiroides no presentaron correlación con las disminuciones de vitamina D. CONCLUSIONES: Existe una importante disminución de la vitamina D en la población que acudió al servicio de Endocrinología durante el periodo estudiado, pese a la exposición solar directa que reciben los pobladores de la zona.

BACKGROUND: Vitamin D is considered a hormone, being chemically lipid soluble and is related to immunological, cardiometabolic and cancer diseases. This aim to evaluate the levels of 25 hydroxy vitamin D in the patients who attended the endocrinology service. METHODS: This was a retrospective study, taking 122 patients who attended the endocrinology service of the Ecuadorian Social Security Institute, during the period during the period from July to September 2017. RESULTS: The average of vitamin D was 23.99 ± 9.12 ng / ml, 22 % of vitamin D in normal range (≥ 30 ng / ml) and 78 % of insufficiency / deficiency (≥ 30 ng / ml). Calcium and parathyroid levels show no correlation with decreases in vitamin D. CONCLUSIONS: There is a significant decrease in the population in the population that went to the Endocrinology service during the period studied, to the direct solar incidence that the inhabitants of the area.

Vitamin d deficiency and paratohommonium increase in late postoperative gastric bypass in roux-en-y / Deficiência de vitamina d e elevação do paratohôrmonio no pós-operatório tardio de bypass gástrico em y-de- roux

ABSTRACT Background : Roux-en-Y gastric bypass patients can experience changes in calcium metabolism and hyperparathyroidism secondary to vitamin D deficiency. Aim : To evaluate nutritional deficiencies related to the calcium metabolism of patients undergoing gastric bypass with a 10-year follow-up. Method : This is a longitudinal retrospective study of patients submitted to Roux-en-Y gastric bypass at a multidisciplinary clinic located in the Brazilian southeast region. The study investigated the results of the following biochemical tests: serum calcium, ionized calcium, vitamin D, and parathormone (PTH). The generalized estimating equations (GEE) determined the nutritional deficiencies using a significance level of 5%. Results : Among the patients who finished the study (120 months), 82.86% (n=29) had vitamin D deficiency, and 41.94% (n=13) had high PTH. Postoperative time had a significant effect on PTH (p=0.0059). The percentages of patients with vitamin D, serum calcium, and ionized calcium deficiencies did not change significantly over time. Conclusion : One of the outcomes was vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of monitoring the bone metabolism of patients submitted to Roux-en-Y gastric bypass. HEADINGS: Calcium deficiency. Vitamin D deficiency. Secondary hyperparathyroidism.

Resumo Racional: Pacientes submetidos ao bypass gástrico em Y-de-Roux, podem apresentar alterações do metabolismo do cálcio e hiperparatireoidismo secundário à deficiência de vitamina D. Objetivo: Avaliar as deficiências nutricionais relacionadas ao metabolismo do cálcio de pacientes submetidos à bypass gástrico em Y-de-Roux, com seguimento de 10 anos. Método: Um estudo retrospectivo longitudinal foi conduzido com pacientes submetidos à bypass gástrico em Y-de-Roux, em uma Clínica Multidisciplinar no Sudeste do Brasil. Investigou-se a frequência do acompanhamento médico e nutricional e os exames bioquímicos de cálcio sérico, cálcio iônico, vitamina D e paratormônio (PTH). Para a análise das deficiências nutricionais, foram utilizadas as Equações de Estimativas Generalizadas (EEG), com nível de significância de 5%. Resultados: Dos pacientes que permaneceram no estudo até o final (120 meses), 82,86% (29), apresentaram níveis de deficiência de vitamina D e 41,94% (13) apresentaram PTH elevado. O efeito do tempo foi significativo para o PTH (p=0,0059). Para a vitamina D, cálcio sérico e cálcio iônico, o percentual de deficiência manteve-se constante ao longo do tempo, sem diferença significativa entre os tempos. Conclusão: A deficiência de vitamina D, associada ao hiperparatireoidismo secundário, foi um desfecho encontrado. Tais achados reafirmam a importância do cuidado com o metabolismo ósseo, em pacientes submetidos à bypass gástrico em Y-de-Roux.

Do infants with cow's milk protein allergy have inadequate levels of vitamin D? / Lactentes com alergia à proteína do leite de vaca apresentam níveis inadequados de vitamina D?

Abstract Objective: To verify whether infants with cow's milk protein allergy have inadequate vitamin D levels. Methods: This cross-sectional study included 120 children aged 2 years or younger, one group with cow's milk protein allergy and a control group. The children were recruited at the pediatric gastroenterology, allergology, and pediatric outpatient clinics of a university hospital in the Northeast of Brazil. A questionnaire was administered to the caregiver and blood samples were collected for vitamin D quantification. Vitamin D levels <30 ng/mL were considered inadequate. Vitamin D level was expressed as mean and standard deviation, and the frequency of the degrees of sufficiency and other variables, as proportions. Results: Infants with cow's milk protein allergy had lower mean vitamin D levels (30.93 vs.35.29 ng/mL; p = 0.041) and higher deficiency frequency (20.3% vs.8.2; p = 0.049) than the healthy controls. Exclusively or predominantly breastfed infants with cow's milk protein allergy had higher frequency of inadequate vitamin D levels (p = 0.002). Regardless of sun exposure time, the groups had similar frequencies of inadequate vitamin D levels (p = 0.972). Conclusions: Lower vitamin D levels were found in infants with CMPA, especially those who were exclusively or predominantly breastfed, making these infants a possible risk group for vitamin D deficiency.

Resumo Objetivo: Verificar se lactentes com alergia à proteína do leite de vaca (APLV) apresentam níveis inadequados de vitamina D. Métodos: Estudo transversal, envolveu 120 crianças de até dois anos, um grupo com APLV e outro de comparação, captadas dos ambulatórios de Gastroenterologia Pediátrica, Alergologia Pediátrica e Puericultura de um hospital universitário, no Nordeste brasileiro. Foi aplicado um formulário e foram coletadas amostras sanguíneas para a análise da vitamina D, foram considerados inadequados os níveis < 30 ng/mL. Níveis de vitamina D foram expressos em média e desvio padrão e a frequência dos graus de suficiência e demais variáveis, em proporções. Resultados: Lactentes com APLV, quando comparados com os saudáveis, apresentaram uma menor média do nível da vitamina D (30,93 vs. 35,29 ng/mL) (p = 0,041) e maior frequência de deficiência (20,3% vs. 8,2) (p = 0,049). Maior frequência de níveis inadequados de vitamina D foi observada nas crianças com APLV que estavam em aleitamento materno exclusivo/predominante (p = 0,002). Independentemente do período de exposição solar, a frequência de um status inadequado de vitamina D foi semelhante entre os grupos (p = 0,972). Conclusões: Menores níveis de vitamina D foram observados em lactentes com APLV, especialmente naqueles em aleitamento materno exclusivo/predominante, que configura esse como um possível grupo de risco para essa deficiência.

La vitamina D y su relación con algunos elementos del síndrome metabólico en población de edad mediana / Vitamin D and its relationship with some elements of the metabolic syndrome in middle-aged population

Introducción: la deficiencia o insuficiencia de vitamina D es una pandemia mundial que afecta aproximadamente 1 000 millones de personas. Investigaciones indican, que entre las funciones no clásicas de la vitamina D, se incluye su rol en enfermedades cardiovasculares y el síndrome metabólico. Objetivos: determinar si existe deficiencia de vitamina D en la población de edad mediana, y su posible asociación con algunos elementos del síndrome metabólico. Métodos: estudio descriptivo transversal que incluyó 17 hombres y 42 mujeres, de agosto de 2014 a abril de 2016. Se determinaron los niveles de 25­hidroxi vitamina D (normal ≥ 30, deficiencia < 30 ng/mL), y se vincularon con elementos clínicos y bioquímicos del síndrome metabólico. Resultados: el 47,46 por ciento presentó deficiencia de vitamina D. La media estuvo disminuida (29,36 ng/mL) en personas obesas. Se encontró correlación inversa significativa (p= 0,039), entre la circunferencia de cintura aumentada en mujeres y los niveles de vitamina D. También hubo correlación positiva significativa (p= 0,015), cuando se asociaron niveles de tensión arterial diastólica en personas con HTA sistodiastólica y niveles de vitamina D. El 62,5 por ciento de personas obesas presentó deficiencia de vitamina D. La comparación de medias entre niveles deficientes de vitamina D y niveles más elevados de glucemias, resultó estadísticamente significativa (p= 0,013). Conclusiones: resultó frecuente la deficiencia de vitamina D en las personas estudiadas. Una mayor circunferencia de cintura en mujeres, se asocia con niveles más bajos de vitamina D. Niveles más altos de vitamina D, se asocian con cifras más elevadas de tensión arterial diastólica. La deficiencia de vitamina D se asocia con niveles más elevados de glucemia(AU)

Introduction: Vitamin D deficiency or insufficiency is a world pandemic affecting roughly 1 billion people. Several research studies reveal that Vitamin D has as a non-classical function its role in cardiovascular diseases and in the metabolic syndrome. Objectives: to determine whether there is Vitamin D deficiency in the middle-aged population and its possible association with some elements of the metabolic syndrome. Methods: descriptive and cross-sectional study of 17 men and 42 women conducted from August 2014 to April 2016. The levels of 25-hydroxyl Vitamin D (normal ≥ 30, deficiency < 30 ng/mL), were also determined and linked to clinical and biochemical elements of the metabolic syndrome. Results: in the group, 47.46 percent presented with Vitamin D deficiency. The mean was reduced in obese people (29.36 ng/mL). Significant inverse correlation was found (p= 0.039) between the increased waist circumference in women and the Vitamin D levels. Significant positive correlation (p= 0.015) was also observed when levels of diastolic blood pressure were associated in persons with systolic-diastolic blood hypertension with levels of Vitamin D. In the group, 62.5 percent of obese persons had Vitamin D deficiency. The mean comparison between levels of Vitamin D and higher levels of glycemia was statistically significant (p= 0.013). Conclusions: Vitamin D deficiency was common in the studied persons. Increased waist circumference in women is associated with lowest levels of Vitamin D whereas higher levels of Vitamin D are associated with higher diastolic blood pressure values. Vitamin D deficiency is related to higher levels of glycemia(AU)

Hypovitaminosis D in patients undergoing kidney transplant: the importance of sunlight exposure

OBJECTIVES: Recent studies have shown a high prevalence of hypovitaminosis D, defined as a serum 25-hydroxyvitamin D level less than 30 ng/ml, in both healthy populations and patients with chronic kidney disease. Patients undergoing kidney transplant are at an increased risk of skin cancer and are advised to avoid sunlight exposure. Therefore, these patients might share two major risk factors for hypovitaminosis D: chronic kidney disease and low sunlight exposure. This paper describes the prevalence and clinical characteristics of hypovitaminosis D among patients undergoing kidney transplant. METHODS: We evaluated 25-hydroxyvitamin D serum levels in a representative sample of patients undergoing kidney transplant. We sought to determine the prevalence of hypovitaminosis D, compare these patients with a control group, and identify factors associated with hypovitaminosis D (e.g., sunlight exposure and dietary habits). RESULTS: Hypovitaminosis D was found in 79% of patients undergoing kidney transplant, and the major associated factor was low sunlight exposure. These patients had higher creatinine and intact parathyroid hormone serum levels, with 25-hydroxyvitamin D being inversely correlated with intact parathyroid hormone serum levels. Compared with the control group, patients undergoing kidney transplant presented a higher prevalence of 25-hydroxyvitamin D deficiency and lower serum calcium, phosphate and albumin but higher creatinine and intact parathyroid hormone levels. CONCLUSIONS: Our results confirmed the high prevalence of hypovitaminosis D in patients undergoing kidney transplant. Therapeutic strategies such as moderate sunlight exposure and vitamin D supplementation should be seriously considered for this population.

Alta prevalencia de deficiencia de vitamina D en niños con enfermedad renal crónica y trasplante renal / High prevalence of vitamin D deficiency among children with chronic kidney disease and kidney transplant

Introducción. la deficiencia de vitamina D (25OHD) es muy común en pacientes con enfermedad renal crónica (ERC). Los obj etivos de este trabajo fueron determinar la prevalencia del déficit de 25OHD en niños con ERC e identificar factores de riesgo. Se estableció la correlación entre 25OHD y paratohormona molécula intacta. Población y métodos. Estudio transversal realizado entre enero de 2013 y diciembre de 2015. Se incluyeron pacientes menores de 19 años con y sin ERC. Resultados. Se incluyeron 167 pacientes. Grupo 1 (controles sanos): 32 participantes; grupo 2 (ERC, estadios 2-4, filtrado glomerular entre 89 y 15 ml/min/1,73 m²): 34 pacientes; grupo 3 (estadio 5, en diálisis): 46 pacientes; y grupo 4 (trasplantados renales): 55 pacientes. Presentaron deficiencia de 25OHD 12,5% de los controles sanos y 32% de los pacientes con ERC (p= 0,025). El 23% de los pacientes del grupo 2, el 51% del grupo 3 y el 22% del grupo 4 presentaron deficiencia de 25OHD; el valor medio de 25OHD de los pacientes en diálisis fue significativamente menor que en el resto de los grupos. Los predictores de deficiencia de 25OHD fueron la hipoalbuminemia, ERC avanzada y la procedencia de la región Noroeste. La paratohormona molécula intacta fue significativamente más elevada en el grupo de pacientes con deficiencia y mostró una correlación inversa con los valores de 25OHD. Conclusión. El 32% de los pacientes con ERC presentó deficiencia de 25OHD; en el estadio 5 (diálisis), alcanzó el 51%. Los predictores de deficiencia fueron hipoalbuminemia, ERC avanzada y la procedencia del noroeste.

Introduction. Vitamin D (25(OH)D) deficiency is common among patients with chronic kidney disease (CKD). Our objective was to establish the prevalence of 25(OH)D deficiency among children with CKD and identify risk factors. A correlation was observed between 25(OH)D and parathormone intact molecule. Population and methods. Cross-sectional study conducted between January 2013 and December 2015. Patients younger than 19 years old with and without CKD were included. Results. One hundred and sixty-seven patients were included. Group 1 (healthy controls): 32 participants; group 2 (stage 2-4 CKD, glomerular filtration rate between 89 and 15 mL/min/1.73 m²): 34 patients; group 3 (stage 5 CKD, dialysis): 46 patients; and group 4 (kidney transplant recipients): 55 patients. Deficiency of 25(OH)D was detected in 12.5% of healthy controls and 32% of CKD patients (p= 0.025). Also, 23% of patients in group 2, 51% in group 3, and 22% in group 4 had 25(OH)D deficiency; the mean 25(OH)D level of dialysis patients was significantly lower than that of the rest of the groups. Predictors of 25(OH)D deficiency included hypoalbuminemia, advanced CKD, and place of origin from the Northwest region of Argentina. The parathormone intact molecule was significantly higher in the group of patients with deficiency and was inversely correlated with 25(OH)D levels. Conclusion. Among CKD patients, 32% had 25(OH)D deficiency, which reached 51% among those with stage 5 CKD (dialysis). Predictors of deficiency included hypoalbuminemia, advanced CKD, and place of origin from the Northwest region of Argentina.

Prevalência de hipovitaminose D em um grupo de pacientes com doenças autoimunes / Prevalence of vitamin D deficiency in a group of patients with autoimmune diseases

Introdução: Doenças autoimunes afetam cerca de 7% da população mundial, chegando a ser consideradas um problema de saúde pública. Além do importante papel relacionado à homeostase óssea, estudos atuais têm relacionado a hipovitaminose D com várias doenças autoimunes, pois o calcitriol possui diversas atividades no corpo humano, entre elas imunomoduladores, visto que os linfócitos T e B possuem o receptor de ligação de vitamina D. O objetivo desta pesquisa é avaliar os níveis de vitamina D e realizar a classificação mediante o resultado da avaliação. Método: Estudo do tipo transversal descritivo, por meio de revisão de prontuários, sendo selecionados um grupo de pacientes com doenças autoimunes, avaliando os níveis séricos de 25-OH-Vit.D, 1,25-(OH)2-Vit.D3 e PTH molécula inteira. Resultados: O número de prontuários coletados foi de 384 pacientes, 275 do sexo masculino (71,61%) e 109 do sexo feminino (28,39%), com idade média de 43,9±11,8 anos. A prevalência de hipovitaminose D no grupo avaliado foi de 89,06%, sendo classificados em níveis deficiente e insuficiente cerca de 13,5% e 75,5%, respectivamente. Aproximadamente 82% dos pacientes apresentaram níveis de 1,25-hidroxivitamina2D3 dentro dos valores de referência, porém este não é considerado um bom parâmetro de avaliação, em razão de possuir um curto tempo de meia-vida e sofrer influência dos níveis séricos de cálcio e paratormônio. Em relação aos níveis de paratormônio PTH, foi observado que todos pacientes estão dentro dos valores de referência (15,0 ­ 65,0 pg/ml). Conclusão: Foi demonstrado que os pacientes com doenças autoimunes analisados apresentam um nível evidente de hipovitaminose D, o que pode ser considerado um agravante à autoimunidade.(AU)

Introduction: Autoimmune diseases affect about 7% of the world, coming to be considered a public health problem. Besides the important role related to bone homeostasis, recent studies have related vitamin D deficiency with several autoimmune diseases because calcitriol has several activities in the human body, including immunomodulators, as the T and B lymphocytes have the vitamin D receptor binding. The objective of this research is to assess the levels of vitamin D and perform the classification by the evaluation result. Methods: Study of descriptive cross-sectional through chart review and selected a group of patients with autoimmune diseases, evaluating serum levels of 25-OH-Vit.D, 1,25- (OH) 2 Vit.D3 and PTH entire molecule. Results: The number of records was collected from 384 patients, 275 were male (71.61%) and 109 females (28.39%) with a mean age of 43.9±11.8 years. The prevalence of vitamin D deficiency in the studied group was of 89.06% when classified as deficient and insufficient levels about 13.5% and 75.5% respectively. Approximately 82% of patients had levels of 1,25-hidroxivitamina2D3 within the reference values, but this is not considered a good parameter to assess, due to have a short half-life and be influenced by serum calcium levels and parathyroid hormone. Related to the levels of parathyroid hormone PTH was observed that all patients are within the reference range (15.0 - 65.0 pg / ml). Conclusion: It has been demonstrated that patients with autoimmune diseases analyzed present one evident level of vitamin D deficiency, which can be regarded as an aggravating autoimmunity.(AU)

Alert for bone alterations and low serum concentrations of vitamin D in patients with intestinal inflammatory disease / Alerta para alterações ósseas e baixas concentrações séricas de vitamina D em pacientes com doença inflamatória intestinal

Summary Background: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are characterized by chronic inflammation of the intestine that can reduce the absorption of nutrients such as vitamin D and calcium. Objective: To investigate bone alterations and serum levels of vitamin D in patients with IBD. Method: This was a cross-sectional study based on a review of medical records of patients from a private office in Curitiba, PR, Brazil. Serum levels of vitamin D and bone densitometry were measured at diagnosis of IBD. A total of 105 patients were included; 38 (58.4%) with CD; 27 (41.6%) with UC and 40 with irritable bowel syndrome (IBS) as comparison group. Results: When compared to patients with UC, CD patients showed a higher prevalence of bone alterations, being 15.8% with osteoporosis and 36.8% with osteopenia. In UC, bone alterations occurred in 29.6% of cases, 3.7% with osteoporosis and 25.9% with osteopenia. As for vitamin D levels, among CD patients, 10.5% had vitamin deficiency, 65.8% insufficiency and 23.7% were sufficient. In UC, 7.4% of cases had deficiency, 74.1% insufficiency and 18.5% had sufficient serum levels of vitamin D. In the group with IBS, deficiency was observed in 17.5% of cases, insufficiency in 55% and sufficiency in 27.5% of them. There was no significant difference between groups. Conclusion: IBD patients have a high prevalence of bone changes, especially those with CD. Serum levels of vitamin D are below the recommended in all the evaluated groups.

Resumo Introdução: A doença inflamatória intestinal (DII), como a doença de Crohn (DC) e a retocolite ulcerativa (RU), caracterizam-se pela inflamação crônica no intestino, que pode reduzir a absorção de vitamina D e cálcio. Objetivo: Investigar as alterações ósseas presentes em pacientes com DII e as dosagens séricas de vitamina D. Método: Estudo transversal analítico baseado na revisão de prontuários de pacientes com DII de um consultório privado de Curitiba, PR. Em todos os pacientes, foram dosadas as concentrações séricas de vitamina D e foi feita a densitometria óssea. Cento e cinco pacientes foram incluídos no estudo, dos quais 38 (58,4%) foram diagnosticados com DC, 27 (41.6%) com RU e 40 com síndrome do intestino irritável (SII) como grupo de comparação. Resultados: Quando comparados com pacientes com RU, os pacientes com DC apresentaram maior prevalência de alterações ósseas, sendo 15,8% com osteoporose e 36,8% com osteopenia. Na RU, as alterações ósseas ocorreram em 29,6% dos casos, 3,7% com osteoporose e 25,9% com osteopenia. Em relação às dosagens de vitamina D, dentre os pacientes com DC, 10,5% apresentavam deficiência, 65,8%, insuficiência e 23,7%, suficiência. Na RU, 7,4% dos casos tinham deficiência, 74,1%, insuficiência e 18,5%, suficiência. No grupo com SII, observaram-se deficiência em 17,5%, insuficiência em 55% e suficiência em 27,5%. Não foi observada diferença significativa entre os grupos. Conclusão: Pacientes com DII apresentaram alta prevalência de alterações ósseas, principalmente aqueles com DC. As concentrações séricas de vitamina D estão abaixo do recomendado em todos os grupos avaliados.

Hipovitaminosis D en pacientes hospitalizados por trastornos por consumo de sustancias en Unidad de Adicciones del Hospital Clínico Universidad de Chile / Hypovitaminosis D in patients hospitalized for substance use disorders in the Addictions Unit of the Hospital Clínico Universidad de Chile

The pathological consumption of alcohol and other drugs is associated with calcium metabolism disfunction through different pathways. Hypovitaminosis D contributes to acute a chronic neuronal injury in alcohol dependent patients. We do not have national evidence regarding the presence of hypovitaminosis D in addicted patients and there is a lack of information in the literature regarding polysubstance users. In this retrospective study, we evaluate the presence of hypovitaminosis of D in Substance Use Disorder inpatients treated in the Psychiatric Clinic of the University during the months of August to November 2017 and we described their main characteristics. 24 patients were evaluated, 19 of whom presented levels lower than 30 ng/ml of Vitamin D. Of those patients with hypovitaminosis 79% were men and 90% of them consumed alcohol, although in only 26% alcohol was the main substance. The main substance reported by the patients was cocaine (37%), smokable cocaine (32%) and marijuana (5%). Despite the methodological limitations of the study and the high prevalence of Hypovitaminosis D reported in the Chilean population, the results of this study suggest the need for a systematic evaluation of Vitamin D levels in patients hospitalized for addictions to adequately supplement those who require it. (AU)

Déficit de vitamina D en niños ingresados en cuidados intensivos pediátricos / Vitamin D deficiency in children admitted to the paediatric intensive care unit

Introducción: La vitamina D posee múltiples acciones sobre el organismo: es necesaria para la salud ósea, la función cardiovascular y del sistema inmune. En adultos críticos, el déficit de vitamina D (DVD) es frecuente y se ha asociado a sepsis y a desenlaces clínicos desfavorables. Objetivos: Determinar la prevalencia del DVD y establecer su asociación con desenlaces clínicos relevantes en niños ingresados a una Unidad de Cuidados Intensivos Pediátricos (UCIP) en Concepción, región del centro-sur de Chile. Pacientes y método: Estudio de cohorte prospectivo observacional en 90 niños. Los niveles plasmáticos de vitamina D fueron medidos al ingreso en la UCIP. Se analizaron características demográficas, escalas de gravedad (PRISM, PELOD, VIS) y desenlaces clínicos. El déficit de 25OHD se definió como niveles < 20 ng/mL. Se determinó la asociación entre el DVD y desenlaces relevantes mediante el cálculo del riesgo relativo (RR). Resultados: El valor promedio (DE) de la vitamina D en toda la cohorte fue de 22,8 (1,0) ng/mL. La prevalencia del DVD fue del 43,3%. El DVD se asoció significativamente con el uso de fármacos vasoactivos (RR 1,6; IC 95%: 1,2-2,3; p < 0,01), ventilación mecánica (RR 2,2; IC 95%: 1,2-3,9; p < 0,01), shock séptico (RR 1,9; IC 95%: 1,3-2,9; p < 0,001) y necesidad de fluidos de reanimación > 40 ml/kg en las primeras 24 h (RR 1,5; IC 95%: 1,1-2,1; p < 0,05). Conclusiones: En este estudio, el DVD al ingreso en UCIP fue prevalente en pacientes pediátricos críticos y se asoció a desenlaces clínicos adversos. Se requieren más ensayos para determinar si la restauración rápida de los niveles de vitamina D permitiría mejorar los desenlaces clínicos en niños críticamente enfermos.

Introduction: Vitamin D is essential for bone health, as well as for cardiovascular and immune function. In critically ill adults vitamin D deficiency (VDD) is common, and is associated with sepsis and higher critical illness severity. Objectives: To establish the prevalence of VDD and its association with clinically relevant outcomes in children admitted to a Paediatric Intensive Care Unit (PICU) in Concepcion, Chile. Patients and method: Prospective observational cohort study in 90 consecutive children admitted to the PICU in a university general hospital. Blood was collected on admission to PICU and analysed for 25-OH-D levels. Severity of illness and vasopressor use were assessed using PRISM, PELOD, and vasoactive-inotropic score (VIS) score. VDD was defined as a serum 25-OH-D level < 20 ng/ml. Relative risks (RR) were calculated to determine the association between VDD and relevant clinical outcomes. Results: Mean (SD) serum vitamin D (25-OH-D) level in the cohort was 22.8 (1.0) ng/ml. The prevalence of VDD was 43.3%. VDD was associated with vasopressors use (RR 1.6; 95%CI: 1.2-2.3; P<.01), mechanical ventilation (RR 2.2; 95%CI: 1.2-3.9, P<.01), septic shock (RR 1.9; 95%CI: 1.3-2.9, P<.001), and fluid bolus > 40 ml/kg in the first 24 h of admission (RR 1.5; 95%CI: 1.1-2.1, P<.05). Conclusions: In this study, VDD at PICU admission was prevalent in critically ill children and was associated with adverse clinical outcomes. Further studies are needed to assess the potential benefit of optimizing vitamin D status in the PICU.

Salud ósea en pacientes sometidos a trasplante de precursores hematopoyéticos: un nuevo problema a considerar / Vitamin D and parathyroid hormone levels and bone mineral density in patients undergoing hematopoietic cell transplantation

Background: Patients undergoing hematopoietic cell transplantation (HCT) are at increased risk of developing osteoporosis. Aim: To determine the frequency and severity of Vitamin D deficiency, secondary hyperparathyroidism and low bone mass in patients undergoing HCT. Patients and Methods: Analysis of the database of patients undergoing HCT in our institution in the 2010-2015 period. We searched for patients with measurements of 25-OH vitamin D (25OHD), parathyroid hormone (PTH) and bone densitometry by double beam X ray absorptiometry (DXA) prior and up to one year after HCT. Results: Ninety patients were included, 53 were evaluated prior to HCT and 37 after HCT. They represent 73% of all patients undergoing HCT in the period. Median 25OHD was 12 ng/ml (range 4-41.4). Ninety seven percent of patients had levels considered insufficient and 85% compatible with deficiency. Median PTH was 60.5 pg/ml (range 21-186). Forty five percent of patients had secondary hyperparathyroidism. DXA was performed in 65 patients (prior to HCT in 54 and after HCT in 11). Of these, 11% had had a low bone mineral density. Conclusions: Patients undergoing HCT have a high risk of vitamin D deficiency, secondary hyperparathyroidism and low bone mineral density.

Vitamin D status in a Brazilian cohort of adolescents and young adults with perinatally acquired human immunodeficiency virus infection

The purpose was to determine the prevalence and related factors of vitamin D (VitD) insufficiency in adolescents and young adults with perinatally acquired human immunodeficiency virus. A cohort of 65 patients (17.6 ± 2 years) at the Federal University of Rio de Janeiro, Brazil, were examined for pubertal development, nutrition, serum parathormone and serum 25-hydroxyvitamin D [s25(OH)D]. s25(OH)D levels < 30 ng/mL (< 75 nmol/L) were defined as VitD insufficiency. CD4+ T-cell counts and viral load, history of worst clinical status, immunologic status as nadir, current immunologic status, and antiretroviral (ART) regimen were also evaluated as risk factors for VitD insufficiency. Mean s25(OH)D was 37.7 ± 13.9 ng/mL and 29.2% had VitD insufficiency. There was no difference between VitD status and gender, age, nutritional status, clinical and immunological classification, and type of ART. Only VitD consumption showed tendency of association with s25(OH)D (p = 0.064). Individuals analysed in summer/autumn season had a higher s25(OH)D compared to the ones analysed in winter/spring (42.6 ± 14.9 vs. 34.0 ± 11.9, p = 0.011). Although, the frequency of VitD insufficiency did not differ statistically between the groups (summer/autumn 17.9% vs. winter/spring 37.8%, p = 0.102), we suggest to monitor s25(OH)D in seropositive adolescents and young adults, especially during winter/spring months, even in sunny regions.

LOWER LEVELS OF VITAMIN D CORRELATE WITH CLINICAL DISEASE ACTIVITY AND QUALITY OF LIFE IN INFLAMMATORY BOWEL DISEASE

Background - Inflammatory bowel disease, comprising Crohn's disease and ulcerative colitis, is a group of debilitating conditions associated with deregulated mucosal immune response. Vitamin D has been implicated in immune response and gastrointestinal function. Objectives - To investigate the correlation between serum vitamin D levels and disease activity and quality of life in patients with inflammatory bowel disease. Methods - This cross-sectional study enrolled ambulatory patients with inflammatory bowel disease and assessed clinical disease activity and quality of life (Short Inflammatory Bowel Disease Questionnaire [SIBDQ]). Vitamin D levels were determined via serum 25-hydroxyvitamin D measurement; deficiency was defined as values <20 ng/mL. Statistical analysis was performed with SPSS vs 20.0. Results - A total of 76 patients were enrolled, 19 with ulcerative colitis (25%) and 57 with Crohn's disease (75%). Overall, mean serum 25-hydroxyvitamin D levels were low (26.0±10.0 ng/mL), while those in patients with Crohn's disease were significantly lower than ulcerative colitis (24.6±8.0 vs 30.0±12.5 ng/mL; P=0.032). Vitamin D deficiency was found in 30% of patients. Patients who were in clinical remission were found to have higher levels of vitamin D than those who were not in remission (28.0±10.3 vs 21.6±6.0 ng/mL, P=0.001). Inflammatory bowel disease patients with SIBDQ scores <50 were found to have significantly lower mean vitamin D levels compared with patients who had SIBDQ scores ≥50 (23.4±6.9 vs 27.9±10.8 ng/mL, P=0.041). Conclusions - A high proportion of patients with inflammatory bowel disease were vitamin D deficient, particularly patients with Crohn's disease. Both clinical disease activity and quality of life correlated significantly with lower levels of vitamin D, illustrating a clear need for supplementation in patients with inflammatory bowel disease.

Contexto - A doença inflamatória intestinal, que compreende a doença de Crohn e a colite ulcerosa, é um grupo de entidades incapacitantes associada a uma resposta imunitária desregulada. A vitamina D tem sido associada à resposta imune e funções gastrointestinais. Objetivo - Investigar a correlação entre os níveis séricos de vitamina D, a atividade clínica da doença e a qualidade de vida em doentes com doença inflamatória intestinal. Método - Estudo transversal que incluiu doentes em ambulatório com doença inflamatória intestinal avaliando a atividade clínica da doença e a qualidade de vida (Short Inflammatory Bowel Disease Questionnaire [SIBDQ]). Os níveis séricos de vitamina D foram determinados através dos níveis de 25-hidroxivitamina D; a deficiência de vitamina D foi definida para valores <20 ng/mL. Resultados - Foram incluídos 76 doentes, 19 com colite ulcerosa (25%) e 57 com doença de Crohn (75%). No global, os valores séricos médios de 25-hidroxivitamina D foram baixos (26,0±10,0 ng/mL), os doentes com doença de Crohn apresentaram níveis mais baixos do que os doentes com colite ulcerosa (24,6±8,0 vs 30,0±12,5 ng/mL; P=0,032). O défice de vitamina D foi identificado em 30% dos doentes. Os doentes em remissão clínica apresentaram níveis mais elevados de vitamina D (28,0±10,3 vs 21,6±6,0 ng/mL, P=0,001). Doentes com SIBDQ <50 apresentaram níveis significativamente inferiores de vitamina D em comparação com doentes com SIBDQ ≥50 (23,4±6,9 vs 27,9±10,8 ng/mL, P=0,041). Conclusão - Uma percentagem elevada de doentes apresentou deficiência de vitamina D, em particular doentes com doença de Crohn. A atividade clínica e a qualidade de vida dos doentes com doença inflamatória intestinal correlacionou-se com níveis mais baixos de vitamina D, ilustrando uma clara necessidade de suplementação desta vitamina em doentes com doença inflamatória intestinal.

Efecto de la suplementación con vitamina D en monodosis en niños con parálisis cerebral: Estudio preliminar controlado y aleatorizado / Effect of supplementation with a single dose of vitamin D in children with cerebral palsy: Preliminary randomised controlled study

Introducción: Los niños con parálisis cerebral (PC) tienen mayor riesgo de deficiencia de vitamina D (VD). Aunque existen bastantes estudios sobre VD en PC, hay limitada información sobre suplementación con VD en estos pacientes. Objetivo: Evaluar el efecto de la suplementación con VD en monodosis en las concentraciones plasmáticas de 25-hidroxi-vitamina-D (25OHD) en niños con PC. Pacientes y método: Estudio controlado, prospectivo y aleatorizado. Se estudiaron 30 niños chilenos (19 varones) con PC, mediana de edad de 9,9 años (6,2-13,5). Se registraron las variables clínicas y bioquímicas incluyendo 25OHD (tiempo 0 y 8 semanas). El grupo suplementado (S) recibió 100.000 UI D3 oral (tiempo 0), comparado con el grupo placebo (P). Resultados: Entre las características clínicas destaca: gastrostomizados (60%), desnutrición (30%), postración (93,3%), uso de antiepilépticos (70%) y uso de antiepilépticos inductores del metabolismo de VD (43,3%). Las mediciones basales de variables bioquímicas fueron normales. La 25OHD fue insuficiente en 4/30 y deficiente en 6/30. No hubo asociación de 25OHD con las variables estudiadas. Completaron el estudio 8 pacientes en el grupo S y 10 en el P. En ambos grupos no se observaron diferencias significativas en las variables basales. A las 8 semanas la calcemia, la fosfemia y la fosfatasa alcalina fueron normales en ambos grupos, la 25OHD en el grupo P fue normal en 6/10 e insuficiente + deficiente en 4/10 y normal en 8/8 en el grupo S (test exacto de Fisher, p = 0,07). Conclusiones: Una monodosis de 100.000 UI de VD podría normalizar las concentraciones de 25OHD en niños con PC. Se necesitan más estudios para confirmar estos resultados.

Introduction: Children with cerebral palsy (CP) have an increased risk of vitamin D (VD) deficiency. Although there are many studies on VD and CP, there is limited information about VD supplementation in these patients. Objective: To evaluate the effect of supplementation with a single dose of VD on the plasma concentrations of 25-hydroxy-vitamin-D (25OHD) in children with CP. Patients and method: Prospective-randomised-controlled-trial, including 30 Chilean children (19 males) with CP, median age 9.9 years (6.2-13.5). Clinical and biochemical variables including 25OHD, were recorded (time 0 and 8 weeks). Patients were allocated to the supplemented (S) group receiving 100,000 IU oral D3 at baseline, and compared with the placebo (P) group. Results: Among clinical features are highlighted: gastrostomy (60%), underweight (30%), bedridden (93.3%), antiepileptic drugs (70%), and 43.3% used VD metabolism inducing antiepileptics. Baseline biochemical measurements were normal. The 25OHD was insufficient in 4/30 and deficient in 6/30. 25OHD levels were not associated with the variables studied. Eight patients completed the study in the S group, and 10 in P group. The placebo and supplementation groups had no significant difference in baseline variables. Serum calcium, phosphate, and alkaline phosphatase levels at 8 weeks were normal in both groups, with no statistically significant differences. 25OHD in the P group was normal in 6/10, and insufficient + deficient in 4/10, and the S group was normal in all (8/8) (exact Fisher test P = .07). Conclusions: A single dose of 100,000 IU VD could normalise the concentrations of 25OHD after 8 weeks of supplementation in Children with CP, but more studies are required to confirm these results.

Risk factors associated with hypovitaminosis D in HIV/aids-infected adults / Fatores de risco associados à hipovitaminose D em indivíduos adultos infectados pelo HIV/aids

Objective To investigate risk factors associated with hypovitaminosis D in adult patients infected with HIV/aids, at a referral hospital in Maceió, Brazil. Subjects and methods This cross-sectional study involved 125 patients evaluated from April to September 2013 by means of interviews, review of medical records, physical examination, and laboratory tests. The data were analyzed using the SPSS® software, version 17.0; the prevalence of hypovitaminosis D and mean levels of vitamin D were determined. The association between hypovitaminosis D and the independent variables was assessed using the Chi-square or the Fisher’s exact tests; mean vitamin D concentrations were analyzed using Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests. The level of significance was set at 5% across tests. Results The prevalence of hypovitaminosis D was 24%, with a significant association with higher household income (p < 0.05). Higher vitamin D levels were associated with female gender (p < 0.001), no use of sunscreen (p < 0.05), and previous opportunistic infections (p < 0.01). Lower values were associated with the use of antiretroviral medication (p < 0.05), overweight and obesity (p < 0.01). Conclusion Lower vitamin D concentrations were significantly associated with well-known risk factors for hypovitaminosis D: use of sunscreen, antiretroviral medication, overweight, and obesity. The prevalence of hypovitaminosis D in this study, considering values > 20 ng/mL or > 30 ng/mL as vitamin D sufficiency, was lower to that of previous studies with HIV-infected patients, a fact that might be related to the low latitude and high intensity of solar radiation of the location of the present study. .

Objetivo Investigar fatores de risco associados à hipovitaminose D em pacientes adultos infectados por HIV/aids, num centro de referência em Maceió-AL. Sujeitos e métodos Por meio de desenho transversal, 125 pacientes foram avaliados por entrevista, revisão de prontuário, exame físico e laboratorial, no período de abril a setembro de 2013. Os dados foram analisados por meio do software SPSS®, versão 17.0, sendo determinados a prevalência de hipovitaminose D e os níveis médios de vitamina D. Para avaliação da associação entre hipovitaminose D e as variáveis pesquisadas, foram utilizados o teste Qui-quadrado ou o teste exato de Fisher, enquanto para os níveis médios de vitamina D foram utilizados os testes Kolmogorov-Smirnov, Mann-Whitney e Kruskal-Wallis. O nível de significância foi de 5% para todos os testes. Resultados Foi observada prevalência de hipovitaminose D de 24% com associação significativa com maior renda familiar (p < 0,05); níveis de vitamina D mais altos nas mulheres (p < 0,001), em pacientes que não faziam uso de filtro solar (p < 0,05) e naqueles com infecções oportunistas pregressas (p < 0,01). Valores mais baixos foram associados ao uso de antirretrovirais (p < 0,05), sobrepeso e obesidade (p < 0,01). Conclusão Níveis mais baixos de vitamina D estiveram significativamente associados com tradicionais fatores de risco para hipovitaminose D como uso de filtro solar e antirretrovirais, sobrepeso e obesidade. A prevalência de hipovitaminose encontrada, considerando suficiência de vitamina D tanto para valores acima de 20 ng/mL quanto de 30 ng/mL, foi inferior a estudos anteriores em pacientes infectados pelo HIV, fato que pode estar relacionado às características da localidade do estudo, com baixa latitude e elevada incidência solar. .