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Clinics ; 76: e3549, 2021. tab, graf
Article in English | LILACS | ID: biblio-1350602


OBJECTIVES: In this ancillary analysis of a multicenter, double-blinded, randomized, placebo-controlled trial, we investigated the effect of a single high dose of vitamin D3 on the length of hospital stay of patients with severe 25-hydroxyvitamin D deficiency and COVID-19. METHODS: The primary outcome was length of hospital stay, defined as the total number of days that patients remained hospitalized from the date of randomization until the date of hospital discharge. Secondary outcomes included serum levels of 25-hydroxyvitamin D, mortality during hospitalization, number of patients admitted to the intensive care unit, and number of patients who required mechanical ventilation. NCT04449718. RESULTS: Thirty-two patients were included in the study. The mean (SD) age was 58.5 (15.6) years, body mass index was 30.8 (8.6) kg/m2, and 25-hydroxyvitamin D level was 7.8 (1.6) ng/mL. No significant difference was observed in the median interquartile range of length of hospital stay between the vitamin D3 group (6.0 [4.0-18.0] days) versus placebo (9.5 [6.3-15.5] days) (log-rank p=0.74; hazard ratio, 1.13 [95% confidence interval (CI), 0.53-2.40]; p=0.76). Vitamin D3 significantly increased serum 25-hydroxyvitamin D levels in the vitamin D3 group compared with that in the placebo group (between-group difference, 23.9 ng/mL [95% CI, 17.7-30.1]; p<0.001). CONCLUSIONS: A dose of 200.000 IU of vitamin D3 did not significantly reduce the length of hospital stay of patients with severe 25-hydroxyvitamin D deficiency and COVID-19.

Humans , Middle Aged , Vitamin D Deficiency/drug therapy , COVID-19 , Vitamin D/analogs & derivatives , Double-Blind Method , Cholecalciferol , SARS-CoV-2 , Length of Stay
Braz. j. infect. dis ; 25(3): 101598, 2021. tab
Article in English | LILACS | ID: biblio-1339421


ABSTRACT Hypovitaminosis D is now considered a pandemic, especially among more vulnerable populations and in HIV-infected subjects, with 80% presenting levels below 30 ng/mL. As there is no consensus on the more adequate dosage needed to correct such deficiency, the objective of this study was to evaluate 25 (OH) vitamin D supplementation in HIV-1 patients deficient of vitamin D. A total of 73 HIV-1-infected patients were included, drawn from a cohort of 435 patients; 37 patients were randomized to the active group, supplemented once a week with 50,000 UI vitamin D by mouth (group 1) and 36 to the placebo group (group 2). The study period ranged from June 2016 to September 2017. Variables involved in vitamin D metabolism and risk factors associated with hypovitaminosis were evaluated. The mean age was 45 years and 31.5 % were women. Vitamin D supplementation was effective in normalizing serum levels after six months in group 1 (mean 35 ng/mL compared to 21 ng/mL for the placebo group; p= 0.04). No patient reached blood levels considered toxic (>100 UI). Efavirenz use can negatively influence vitamin D levels and supplementation is necessary as a likely adjunct to improving CD4+ T cells, resulting in greater effectiveness of the treatment. A weekly oral dose of 50,000 IU of vitamin D was sufficient to normalize the vitamin deficiency, safely and with good adherence among persons living with HIV/AIDS in Brazil.

Humans , Female , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/epidemiology , Acquired Immunodeficiency Syndrome/drug therapy , Vitamin D , Brazil , Dietary Supplements , Middle Aged
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1444-1448, Oct. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136162


SUMMARY OBJECTIVE: To conduct a review of articles which have evaluated the relationship between vitamin D and cardioprotection in adult. METHODS: A literature search was performed in the Pubmed and Scielo databases. The results were extracted from primary and secondary sources and will be presented in the form of a bibliographic review. RESULTS: Twenty-three articles were identified from the electronic search that reported on physiological mechanisms relating the vitamin D axis and the cardiovascular system through receptors. Of the ten studies that evaluated the therapeutic effect of vitamin D in cardiovascular diseases, none reported significant results. CONCLUSION: The articles assessed in this review did not demonstrate a cardioprotective effect of vitamin D, despite the epidemiological correlation of vitamin D deficiency with a higher prevalence of cardiovascular diseases.

Humans , Adult , Vitamin D Deficiency/complications , Vitamin D Deficiency/prevention & control , Vitamin D Deficiency/drug therapy , Vitamin D , Vitamins/therapeutic use , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/epidemiology , Prevalence
Arch. endocrinol. metab. (Online) ; 64(5): 498-506, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131136


ABSTRACT The effects of vitamin D on the musculoskeletal system are well established. Its deficiency causes osteomalacia, secondary hyperparathyroidism, and an increased risk for fractures and falls. However, clinical and experimental evidence points to extra-skeletal actions of vitamin D, including on immune and respiratory systems. Thus, during this COVID-19 pandemic, a possible deleterious role of vitamin D deficiency has been questioned. This paper aims to present a brief review of the literature and discuss, based on evidence, the role of vitamin D in the lung function and in the prevention of respiratory infections. Relevant articles were searched in the databases MEDLINE/PubMed and SciELO/LILACS. The mechanisms of vitamin D action in the immune system response will be discussed. Clinical data from systematic reviews and meta-analyses show benefits in the prevention of respiratory infections and improvement of pulmonary function when vitamin D-deficient patients are supplemented. At the time of writing this paper, no published data on vitamin D supplementation for patients with COVID-19 have been found. Vitamin D supplementation is recommended during this period of social isolation to avoid any deficiency, especially in the context of bone outcomes, aiming to achieve normal values of 25(OH)D. The prevention of respiratory infections and improvement of pulmonary function are additional benefits observed when vitamin D deficiency is treated. Thus far, any protective effect of vitamin D specifically against severe COVID-19 remains unclear. We also emphasize avoiding bolus or extremely high doses of vitamin D, which can increase the risk of intoxication without evidence of benefits.

Humans , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/epidemiology , COVID-19 , Vitamin D , Dietary Supplements , Pandemics/prevention & control , SARS-CoV-2
J. bras. nefrol ; 42(2): 238-244, Apr.-June 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1134823


Abstract Fortification of food products with vitamin D was central to the eradication of rickets in the early parts of the 20th century in the United States. In the subsequent almost 100 years since, accumulating evidence has linked vitamin D deficiency to a variety of outcomes, and this has paralleled greater public interest and awareness of the health benefits of vitamin D. Supplements containing vitamin D are now widely available in both industrialized and developing countries, and many are in the form of unregulated formulations sold to the public with little guidance for safe administration. Together, this has contributed to a transition whereby a dramatic global increase in cases of vitamin D toxicity has been reported. Clinicians are now faced with the challenge of managing this condition that can present on a spectrum from asymptomatic to acute life-threatening complications. This article considers contemporary data on vitamin D toxicity, and diagnostic and management strategies relevant to clinical practice.

Resumo A suplementação de produtos alimentares com vitamina D foi fundamental para a erradicação do raquitismo no início do século XX nos Estados Unidos. Nos quase 100 anos subsequentes, o acúmulo de evidências vinculou a deficiência de vitamina D a uma variedade de desfechos, e isso tem levantado grande interesse público e conscientização dos benefícios à saúde da vitamina D. Os suplementos que contêm vitamina D estão agora amplamente disponíveis tanto nos países desenvolvidos quanto naqueles em desenvolvimento, e muitos estão na forma de formulações não regulamentadas, vendidas ao público com poucas orientações para uma administração segura. Juntos, isso contribuiu para uma transição na qual um aumento global dramático nos casos de toxicidade da vitamina D tem sido relatado. Médicos agora enfrentam o desafio de tratar essa condição que pode apresentar um espectro de complicações assintomáticas a agudas, com risco de vida. Este artigo considera dados atualizados sobre a toxicidade da vitamina D e estratégias de diagnóstico e manejo relevantes para a prática clínica.

Humans , Male , Aged , Rickets/prevention & control , Vitamin D/toxicity , Dietary Supplements/toxicity , Acute Kidney Injury/chemically induced , Rickets/epidemiology , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Treatment Outcome , Dietary Supplements/supply & distribution , Withholding Treatment , Acute Kidney Injury/therapy , Hypercalcemia/complications , Hypercalcemia/diagnosis , Hypercalcemia/chemically induced , Hypercalcemia/therapy
Prensa méd. argent ; 105(4): 228-234, jun 2019. tab
Article in English | LILACS, BINACIS | ID: biblio-1046179


Introduction. With age, there is a growing risk of vitamin D deficiency and cognitive impairment. Maintaining the older people's health is socially relevant to health systems in the light of the population ageing trend. The study was aimed at identifying the relationship of vitamin D levels and symptoms of moderate cognitive impairment in older people. Methods. The authors conducted a cross-sectional screening of vitamin D status and cognitive impairment using the memory impairment screen (MIS) questionnaire, as well as the clinical, placebo-controlled study of vitamin D intake at a dose of 2,000 IU/day for 6 months. Results. The frequency of vitamin D deficiency in older patients with signs of cognitive impairment totaled 90.91 %, which was significantly more frequently compared with the group without cognitive impairment, where vitamin D deficiency was found only in 11.36 % of cases. In the dynamics on the background of the vitamin D intake for 6 months, the concentration in the intervention group amounted to 52.34 ± 2.43 ng/ml vs 14.71 ± 1.54 ng/ ml in the placebo group. The results of the study of cognitive impairment using MIS for the treatment group were 3.63 ± 0.01 points, which was significantly higher compared with the placebo group ­ 1.78 ± 0.22 points. A correlation analysis of vitamin D levels and MIS points showed a strong positive relationship, with a correlation coefficient of 0.92. Conclusion. The study identified a positive relationship of increasing vitamin D levels and reducing the symptoms of mild cognitive impairment in older people. Achieving vitamin D levels of over 40 ng/ ml greatly reduces the symptoms of cognitive impairment identified by the MIS questionnaire, however, the issue of treatment of impaired cognitive functions with vitamin D remains debatable.

Humans , Aged , Aged, 80 and over , Vitamin D/administration & dosage , Vitamin D Deficiency/drug therapy , Cross-Sectional Studies , Treatment Outcome , Outcome Assessment, Health Care , Controlled Clinical Trial , Cognitive Dysfunction/therapy
Int. braz. j. urol ; 45(2): 340-346, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002204


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.

Humans , Male , Female , Aged , Vitamin D/therapeutic use , Vitamin D Deficiency/etiology , Vitamin D Deficiency/drug therapy , Vitamins/therapeutic use , Calcium/urine , Urolithiasis/urine , Parathyroid Hormone/blood , Vitamin D/administration & dosage , Vitamin D/blood , Retrospective Studies , Dietary Supplements , Hypercalciuria/complications , Middle Aged
Rev. chil. pediatr ; 90(1): 94-101, 2019. tab
Article in Spanish | LILACS | ID: biblio-990891


Resumen: El mejor entendimiento sobre la actividad global de la vitamina D, ha llevado a una intensa búsque da de sus implicancias en enfermedades no esqueléticas. En este artículo se presenta una revisión actualizada de la relación entre la vitamina D y la patología respiratoria pediátrica. Se realizó una búsqueda bibliográfica en PUBMED utilizando términos libres y MESH: vitamina D, enfermedades del sistema respiratorio, asma, bronquiolitis. Se seleccionó estudios en humanos menores de 18 años y animales, publicados en inglés y español hasta el 2017. Se encontraron 507 artículos, de los cuales se incluyeron 43. Evidencia indirecta apunta hacia un rol de la vitamina D y la maduración pulmonar fetal. En relación a la patología pulmonar pediátrica, los estudios son escasos y poco concluyentes. Nuevos meta - análisis, con evaluación individualizada de los participantes, muestran un importante rol protector de la suplementación en la prevención de exacerbaciones asmáticas severas e infecciones virales agudas. En bronquiolitis los resultados son contradictorios, sin relación clara entre niveles plasmáticos y severidad. No existe suficiente evidencia que evalué los beneficios en fibrosis quística y tuberculosis. Recientemente se ha propuesto una relación directa entre la severidad de los trastornos respiratorios del sueño y los niveles plasmáticos de vitamina D, aunque se desconoce los mecanismos exactos involucrados a esta asociación. La información actual permite suponer que la suplementación de vitamina D puede representar una estrategia costo - efectiva en la reducción de importantes causas de morbimortalidad infantil.

Abstract: The better understanding of the global activity of vitamin D has led to an intense search for its involvement in non-skeletal diseases. This article presents an updated review of the relationship between vitamin D and pediatric respiratory pathology. A literature search was performed in PUBMED using free terms and MESH terms: vitamin D, asthma, respiratory system diseases, and bronchiolitis. Stu dies in human patients younger than 18 years and animals, published in English and Spanish until 2017 were included. 507 articles were found, of which 43 were included. Indirect evidence suggests a role of vitamin D and fetal lung maturation. In relation to pediatric pulmonary pathology, studies are scarce and inconclusive. Recent meta-analyses performed with individualized evaluation of the participants shows an important protective role of vitamin D supplementation in the prevention of severe asthma exacerbations and acute viral infections. In bronchiolitis, the results are contradictory, with no clear relationship between plasma levels and severity. There is not enough evidence to assess the benefits of vitamin D supplementation in cystic fibrosis and tuberculosis. A direct relationship between the severity of sleep-related breathing disorders and vitamin D plasma levels has recently been proposed, although the exact mechanisms involved in this association are unknown. Current information suggests that vitamin D supplementation may represent a cost-effective strategy in redu cing important causes of infant morbidity and mortality.

Humans , Child , Respiratory Tract Diseases/etiology , Vitamin D Deficiency/complications , Pediatrics , Respiratory Tract Diseases/prevention & control , Respiratory Tract Diseases/drug therapy , Vitamin D/physiology , Vitamin D/blood , Vitamin D/therapeutic use , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/blood , Vitamins/physiology , Vitamins/blood , Vitamins/therapeutic use , Biomarkers/blood , Risk Factors , Dietary Supplements , Lung/embryology
Arch. argent. pediatr ; 116(3): 445-450, jun. 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-950024


La hipertensión endocraneana idiopàtica se asocia infrecuentemente con la hipovitaminosis A y D. Se presenta el caso de una paciente femenina de 8 años con visión borrosa de 24 horas y papiledema bilateral. Resonancia magnética nuclear normal. Presión de apertura de líquido cefalorraquídeo: 260 mm^O. Presentó déficit de vitamina A y D, e inició un tratamiento sustitutivo. El segundo caso corresponde a un paciente masculino de 12 años con fiebre y odinofagia de 3 días. Con antecedente de glomerulonefritis y sobrepeso. Presentaba edema bipalpebral y papiledema. Tomografia axial computada de la órbita: aumento de líquido en la vaina de ambos nervios ópticos. Resonancia magnética nuclear: aracnoidocele intraselar. Presión de apertura de líquido cefalorraquídeo: 400 mm^O. Presentó déficit de vitamina D y B6, e inició el tratamiento sustitutivo. La elevación de la presión intracraneal desencadena mecanismos de compensación que, al fallar, pueden comprometer la vida o provocar graves discapacidades neurológicas. Reconocer la causa para un enfoque terapéutico preciso es clave para disminuir la morbimortalidad asociada a esta patología.

Idiopathic endocranial hypertension is infrequently associated with hypovitaminosis A and D. The case of an 8-year-old female with 24-hour blurred vision and bilateral papilledema is presented. Nuclear magnetic resonance was normal. Opening pressure of cerebrospinal fluid: 260 mm^O. She presented vitamin A and D deficiency and started replacement therapy. The second case corresponds to a 12-year-old male with fever and odynophagia of 3 days. History of glomerulonephritis and overweight. He had bipalpebral edema and papilledema. Computed tomography scan of the orbit: increase of fluid in the sheath of both optic nerves. Nuclear magnetic resonance: intrasellar arachnoidocele. Opening pressure of cerebrospinal fluid: 400 mmH2O. He presented vitamin D and B6 deficiency and started replacement treatment. The elevation of intracranial pressure triggers compensation mechanisms that, when they fail, can compromise life or cause serious neurological disabilities. Recognizing the cause for an accurate therapeutic approach is key to reduce the morbidity and mortality associated with this pathology.

Humans , Male , Female , Child , Vitamin B 6 Deficiency/complications , Vitamin A Deficiency/complications , Vitamin D Deficiency/complications , Pseudotumor Cerebri/diagnosis , Vitamin B 6 Deficiency/drug therapy , Vision Disorders/etiology , Vitamin A/administration & dosage , Vitamin A Deficiency/drug therapy , Vitamin D/administration & dosage , Vitamin D Deficiency/drug therapy , Pseudotumor Cerebri/etiology , Magnetic Resonance Imaging , Tomography, X-Ray Computed/methods , Papilledema/etiology , Intracranial Hypertension/diagnosis , Intracranial Hypertension/etiology , Vitamin B 6/administration & dosage
Arch. endocrinol. metab. (Online) ; 62(2): 193-200, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-887652


ABSTRACT Objective To study the effect of using a one time high dose "stoss therapy" of vitamin D2 (ergocalciferol: VD2) on indices of insulin sensitivity {whole body sensitivity index: WBISI} and secretion {insulinogenic index: IGI} measured during an oral glucose tolerance test (OGTT) in obese adolescents with VDD (25 OHD; serum metabolite of vit D: < 30 ng/dL). Subjects and methods In a randomized placebo controlled cross over design 20 obese adolescents with vitamin D deficiency (VDD) had baseline OGTT. Arm A received one time high dose 300,000 IU of ergocalciferol and Arm B received placebo. After 6 weeks the adolescents were reassigned to Arm A if they were in Arm B and vice versa. 25OHD, calcium, parathyroid hormone, comprehensive metabolic panel, urine calcium creatinine ratio were measured at each study visit. OGTTs to assess indices of sensitivity and secretion were done at baseline, 6 weeks and 12 weeks respectively. Results Adolescents were obese and insulin resistant (mean ± SD: mean age = 15.1 ± 1.9 years; BMI: 32.7 ± 9.8; homeostatic model of insulin resistance: HOMA-IR: 4.2 ± 2.8). Stoss therapy with VD2 increased 25OHD from baseline (16.7 ± 2.9 to 19.5 ± 4.5; p = 0.0029) when compared to the placebo. WBISI (2.8 ± 1.9) showed a trend towards improvement in Rx group (p = 0.0577) after adjustment for covariates. IGI (3 ± 2.2) showed an improvement in both Rx and placebo groups. Conclusions Our study demonstrated that using a high dose of VD2 (300,000 IU) did not have any beneficial effect on insulin sensitivity (whole body sensitivity index {WBISI}) and secretory indices (insulinogenic index {IGI}) in obese adolescents. High dose "stoss therapy" of VD2 did not appear to have any beneficial effect on glucose homeostasis on obese adolescents.

Humans , Male , Female , Adolescent , Vitamin D Deficiency/drug therapy , Vitamins/administration & dosage , Ergocalciferols/administration & dosage , Pediatric Obesity/blood , Vitamin D Deficiency/complications , Vitamin D Deficiency/blood , Blood Glucose/drug effects , Insulin Resistance , Body Mass Index , Cross-Over Studies , Pediatric Obesity/complications , Glucose Tolerance Test , Homeostasis/drug effects
Rev. bras. reumatol ; 57(5): 466-471, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-899456


Abstract The objective of this systematic review was to analyze clinical trials carried out for the investigation of the effect of vitamin D supplementation on systemic lupus erythematosus. The research was performed from August to September 2016, without limits regarding year of publication, restriction of gender, age, and ethnicity. For the guiding question, the PICO strategy was employed. To evaluate the quality of the publications the PRISMA protocol and Jadad scale were used. The risk of bias analysis of the clinical trials was performed using the Cochrane collaboration tool. After the process of article selection and removal of duplicates, four articles were identified as eligible. The results of three studies showed a positive effect of supplementation on disease activity reduction and significant improvement in levels of inflammatory markers, fatigue, and endothelial function. Only one study showed no improvement in disease activity after supplementation. Moreover, all studies showed an increase in serum vitamin D levels. The data from this review provide evidence on the benefits of vitamin D supplementation in patients with lupus and vitamin D insufficiency/deficiency. However, it is still necessary to elucidate whether vitamin D acts in the protection against this metabolic disorder, as well as the standardization of the type, dose and time of vitamin D supplementation.

Resumo O objetivo desta revisão sistemática foi analisar ensaios clínicos feitos na investigação do efeito da suplementação com vitamina D sobre o lúpus eritematoso sistêmico. A pesquisa foi feita nas bases de dados Scopus, PubMed e Biblioteca Cochrane, de agosto a setembro de 2016, sem limite de ano de publicação, restrição de gênero, idade e etnicidade. Para a questão norteadora foi empregada a estratégia Pico. Para avaliar a qualidade das publicações usaram-se o protocolo Prisma e a escala de Jadad. A análise do risco de viés dos ensaios clínicos ocorreu pela ferramenta de colaboração Cochrane. Após o processo de seleção e remoção de artigos duplicados, quatro artigos foram identificados como elegíveis. Os resultados de três estudos mostraram efeito positivo da suplementação na redução da atividade da doença e melhoria significativa nos níveis de marcadores inflamatórios, fadiga e função endotelial. Em apenas um estudo não houve melhoria na atividade da doença após a suplementação. Ademais, todos os estudos apresentaram aumento dos níveis séricos de vitamina D. Os dados desta revisão fornecem evidências dos benefícios da suplementação com vitamina D sobre o lúpus em pacientes com insuficiência/deficiência. Contudo, ainda é necessário elucidar a atuação do nutriente na proteção contra esse distúrbio metabólico, bem como a padronização do tipo, da dose e do tempo de suplementação com vitamina D.

Humans , Vitamin D/therapeutic use , Vitamin D Deficiency/drug therapy , Vitamins/therapeutic use , Lupus Erythematosus, Systemic/complications , Vitamin D Deficiency/complications , Treatment Outcome , Dietary Supplements
Article in English | LILACS | ID: lil-785233


ABSTRACT Objective To compare the prevalence of vitamin D deficiency and fracture history in nursing home residents and community-dwelling elderly subjects and to explore the association of vitamin D levels with various characteristics. Materials and methods Sixty-six nursing home residents and 139 community-dwelling elderly subjects participated. Marital status, medical history, medication including vitamin D supplements, smoking, past fractures were assessed. Weight and height were measured and body mass index calculated. Serum 25-hydroxyvitamin D (25-OHD), PTH, Ca, phosphate, creatinine and eGFR were determined. Results In the nursing home residents 25-OHD was lower (17.8 nmol/l, [9.4-28.6] vs. 36.7 nmol/l, [26.9-50], p < 0.001), PTH was higher (5.6 pmol/l, [3.9-8.9] vs. 4.7 pmol/l [3.6-5.8], P = 0.003) and 25-OHD deficiency was more prevalent (65.2% [53.7-76.7] vs. 22.3% [15.4-29.2], p < 0.001) as was elevated PTH (23% [12.8-33] vs. 5.8% [2-10], p = 0.001). 25-OHD correlated negatively with PTH (institutionalized r = -0.28, p = 0.025 and community-dwelling r = -0.36, p < 0.001). Hip fractures were reported by 8% of the residents and 2% of the independent elderly. The only predictor for hip fracture was elevated PTH (OR = 7.6 (1.5-36.9), p = 0.013). Conclusion The prevalence of vitamin D deficiency and secondary hyperparathyroidism was high in the institutionalized subjects. Hip fracture risk was associated with elevated PTH and not directly with vitamin D levels or the residency status.

Humans , Male , Female , Middle Aged , Aged , Vitamin D/analogs & derivatives , Vitamin D Deficiency/epidemiology , Independent Living/statistics & numerical data , Hip Fractures/epidemiology , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Parathyroid Hormone/blood , Seasons , Vitamin D/blood , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Vitamins/therapeutic use , Bulgaria/epidemiology , Calcium/blood , Prevalence , Cross-Sectional Studies , Hip Fractures/etiology , Hyperparathyroidism, Secondary/etiology , Hyperparathyroidism, Secondary/epidemiology
Rev. chil. pediatr ; 86(6): 393-398, dic. 2015. graf, tab
Article in Spanish | LILACS | ID: lil-771656


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.

Humans , Male , Female , Child, Preschool , Child , Adolescent , Vitamin D/analogs & derivatives , Vitamin D Deficiency/drug therapy , Cerebral Palsy/drug therapy , Dietary Supplements , Phosphates/blood , Vitamin D/administration & dosage , Vitamin D Deficiency/etiology , Cerebral Palsy/complications , Chile , Calcium/blood , Prospective Studies , Alkaline Phosphatase/blood
Salud colect ; 11(3): 351-365, jul.-sep. 2015.
Article in Spanish | LILACS | ID: lil-761806


En este artículo se analizan los debates parlamentarios de la Ley 26743 de Identidad de Género y de la Ley 26862 de Fertilización Asistida, desarrollados en el Congreso Nacional argentino entre los años 2011 y 2013. A través de la técnica de análisis de contenido cualitativo se analizan las versiones taquigráficas de los debates parlamentarios con el fin de responder los siguientes interrogantes: ¿cómo fue caracterizado el problema público al cual ambas leyes darían respuesta?, ¿cómo fue conceptualizada la misión de ambas leyes?, ¿en qué medida dicha definición implicó poner en entredicho las nociones de salud y enfermedad con relación a la cobertura de tratamientos de optimización o modificación corporal por parte del sistema público de salud? El proceso de sanción de ambas leyes implicó tensionar los conceptos de salud y enfermedad como categorías morales. En dicho marco emergió una noción ampliada del concepto de salud integral que incluyó los deseos reproductivos y corporales de los ciudadanos y ciudadanas.

In this paper we present an analysis of the parliamentary debates of the Gender Identity Law (No. 26743) and the Assisted Fertilization Law (No. 26862) carried out in the Argentine National Congress between 2011 and 2013. Using a qualitative content analysis technique, the stenographic records of the debates were analyzed to explore the following questions: How was the public problem to which each law responds characterized? How was the mission of each law conceptualized? To what extent did those definitions call into question ideas of health and illness, in including in the public health system coverage for certain medical treatments of body optimization or modification? In the process of sanctioning both laws, the concepts of health and disease were put into dispute as moral categories. In this context, an expanded concept of comprehensive health arose, in which desires regarding reproduction and the body were included.

Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Cholecalciferol/therapeutic use , HIV Infections/complications , Vitamin D Deficiency/drug therapy , Botswana , Cholecalciferol/administration & dosage , Double-Blind Method , HIV Infections/blood , Pilot Projects , Prospective Studies , Treatment Outcome , Viral Load , Vitamin D Deficiency/blood , Vitamin D Deficiency/complications , Vitamin D/analogs & derivatives , Vitamin D/blood
Rev. chil. pediatr ; 86(3): 182-188, jun. 2015. graf, tab
Article in Spanish | LILACS | ID: lil-760112


En población austral existe un alto riesgo de deficiencia de vitamina D (VD) que puede tratarse mediante suplementación nutricional. El exceso de peso (EP) podría afectar la respuesta a su suplementación. Objetivos: Estudiar la prevalencia de deficiencia de VD y el efecto de la suplementación con colecalciferol (VD3) en niños sanos de Punta Arenas, Chile, y evaluar la posible asociación con el estado nutricional. Metodología: Se obtuvieron datos demográficos, antropométricos y medición sérica de 25-hidroxivitamina-D (25OHD) y parámetros de metabolismo óseo. Luego se suplementó a los niños con VD3 1.600 UI/día por un mes y se reevaluó 25OHD sérica. Resultados: Se estudiaron 108 niños, 50% hombres, edad promedio 9,6 ± 0,5 años. Un 39% eran eutróficos, 46% con sobrepeso y 15% obesos. La mediana de 25OHD fue 10,9 ng/ml: 96,3% tenían deficiencia (< 20 ng/ml) y 3,7% insuficiencia (20 a 29 ng/ml). Se pesquisó deficiencia severa (< 12 ng/ml) en 62%. La concentración basal de 25OHD no varió según estado nutricional. Luego de la suplementación, la mediana de 25OHD fue 17,5 ng/ml: 62% con deficiencia, 36% insuficiencia y 2% suficiencia (> 30 ng/ml). Los niños con EP tuvieron un alza de 25OHD significativamente menor que niños eutróficos (5 ± 5,5 vs. 7,7 ± 4,9, p = 0,03). Niños con EP requerirían dosis de VD 32% mayores que niños eutróficos para lograr la misma concentración de 25OHD. Conclusiones: Niños escolares de Punta Arenas presentan alta prevalencia de EP, deficiencia de VD y la mayoría en rango de deficiencia severa. El EP interfiere en la respuesta a suplementación farmacológica, logrando menor alza de 25OHD.

There is a high risk of vitamin D (VD) deficiency in the population of southern Chile that can be treated with VD supplements. Weight excess (WE) can influence the response to supplements. Objectives: To study the prevalence of VD deficiency and the effect of cholecalciferol (VD3) supplements in healthy children from Punta Arenas, Chile, and evaluate a possible association with nutritional status. Methodology: Demographic and anthropometric data, as well as laboratory assessment of serum 25-hidroxyvitamin D (25OHD) and other bone metabolism parameters were evaluated. After baseline evaluation, children were supplemented with VD3 1600 IU/day for one month, after which 25OHD was retested. Results: Of the 108 children studied, 50% were boys, and had a mean age of 9.6 ± 0.5 years. Nutritional assessment showed that 39% had normal weight, 46% were overweight, and 15% were obese. Median 25OHD was 10.9 ng/ml: 96.3% had deficiency (< 20 ng/ml) and 3.7% insufficiency (20-29 ng/ml). Severe deficiency was found in 62% (< 12 ng/ml). Baseline 25OHD was not affected by nutritional status. After supplementation, median 25OHD was 17.5 ng/ml: 62% had deficiency, 36% insufficiency, and 2% sufficiency (>30 ng/ml). Children with WE had a significantly lower increase in 25OHD than children with normal weight (5 ± 5.5 vs. 7.7 ± 4.9, p = 03). Children with WE may require 32% higher VD dose than normal weight children to attain the same 25OHD concentration. Conclusions: Chilean schoolchildren from Punta Arenas have high prevalence of WE and VD deficiency, with a majority in the range of severe VD deficiency. WE interferes in the response to VD supplementation, leading to a lower increase in 25OHD.

Humans , Male , Female , Child , Vitamin D Deficiency/epidemiology , Nutritional Status , Cholecalciferol/administration & dosage , Dietary Supplements , Vitamin D/analogs & derivatives , Vitamin D/blood , Vitamin D Deficiency/drug therapy , Nutrition Assessment , Chile/epidemiology , Prevalence , Prospective Studies , Treatment Outcome , Overweight/complications , Overweight/epidemiology , Obesity/complications , Obesity/epidemiology
Arq. bras. endocrinol. metab ; 58(5): 411-433, 07/2014. tab, graf
Article in Portuguese | LILACS | ID: lil-719199


Objetivo Apresentar uma atualização sobre o diagnóstico e tratamento da hipovitaminose D baseada nas mais recentes evidências científicas. Materiais e métodos O Departamento de Metabolismo Ósseo e Mineral da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) foi convidado a conceber um documento seguindo as normas do Programa Diretrizes da Associação Médica Brasileira (AMB). A busca dos dados foi realizada por meio do PubMed, Lilacs e SciELO e foi feita uma classificação das evidências em níveis de recomendação, de acordo com a força científica por tipo de estudo. Conclusão Foi apresentada uma atualização científica a respeito da hipovitaminose D que servirá de base para o diagnóstico e tratamento dessa condição no Brasil. .

Objective The objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence. Materials and methods The Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Brazilian Medical Association (AMB) Guidelines Program. Data search was performed using PubMed, Lilacs and SciELO and the evidence was classified in recommendation levels, according to the scientific strength and study type. Conclusion A scientific update regarding hypovitaminosis D was presented to serve as the basis for the diagnosis and treatment of this condition in Brazil. .

Humans , Calcifediol/blood , Cholecalciferol/therapeutic use , Ergocalciferols/therapeutic use , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/drug therapy , Bariatric Surgery/adverse effects , Brazil/epidemiology , Calcium, Dietary/therapeutic use , Databases, Bibliographic , Evidence-Based Medicine/standards , Hyperparathyroidism/etiology , Malabsorption Syndromes/etiology , Osteoporosis/diet therapy , Osteoporotic Fractures/diet therapy , Parathyroid Hormone/blood , Risk Factors , Vitamin D Deficiency/epidemiology