Concern about the prevention and treatment of parathyroid hyperfunction or hyperparathyroidism associated metastatic vascular calcification or calcinosis universalis / 中华内分泌外科杂志

Metastatic vascular calcification and calcinosis universalis, as severe complications of parathyroid hyperfunction and hyperparathyroidism, have attracted more attention in patients with renal secondary hyperparathyroidism and primary hyperparathyroidism. But, they are of little concern in patients with long-term negative calcium balance related parathyroid hyperfunction or hyperparathyroidism caused by calcium and/or vitamin D insufficiency (CVI). CVI is common in the population. Relatively low level of serum calcium and negative calcium balance caused by long-term CVI result in parathyroid hyperfunction or hyperparathyroidism, which may cause secretion of PTH beyond the physiological level, leading to bone absorption and release of a large amount of bone calcium into the blood. It may not only cause bone loss and osteoporosis, but also form metastatic vascular calcification or calcinosis universalis presented by cardiovascular diseases and other multi-organ lesions. Early calcium deposition can gradually fade after reasonable treatment, but middle arterial calcification is not easy to fade once it occurs. Therefore, vascular calcification and calcium deposition should be actively prevented and early screened and diagnosed. The early prevention, diagnosis and treatment of parathyroid hyperfunction or hyperparathyroidism can prevent, delay, or even reverse the occurrence and development of metastatic vascular calcification and calcinosis universalis, which is significant for disease prevention and protecting the patients' health influenced by these diseases.

One case report of patient with repeated kidney stone and urine crystal was cured after strengthening calcium supplementation / 中华内分泌外科杂志

The lifetime prevalence of nephrolithiasis is 15% for men, with a 5-year recurrence rate of 35% to 50% after an initial event. Although it was initially recommended to limit calcium intake in these patients, a number of studies have reported association between lower total dietary calcium intake and increased risk of incident kidney stones, and that increased calcium intake might reduce the risk of incident kidney stones. We report a 35-year-old male who presented recurrent 8-years of nephrolithiasis and urine crystal with calcium intake restriction, and had no recurrence after 5 years of follow-up after intensive calcium and vitamin D supplementation.

Prevention and treatment of parathyroid hyperfunction or hyperparathyroidism associated osteoporosis / 中华内分泌外科杂志

Osteoporosis (OP) is a common systemic bone disease which has become a serious public health problem in China. In clinical practice, we found that some primary osteoporosis may be due to parathyroid hyperfunction (subclinical hyperparathyroidism) or hyperparathyroidism which is the result of negative calcium balance and hypocalcemia caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency, which is preventable and controllable. Therefore, we call this kind of osteoporosis parathyroid hyperfunction or hyperparathyroidism associated osteoporosis. The daily calcium intake of Chinese people is generally insufficient, and vitamin D deficiency/insufficiency is also a worldwide public health problem. Parathyroid hyperfunction or hyperparathyroidism associated osteopenia and osteoporosis which are results of hypocalcemia and negative calcium balance caused by long-term insufficient calcium intake and/or vitamin D deficiency/insufficiency exist extensively in clinical practice. Its prevention and treatment can effectively prevent and treat osteopenia and osteoporosis, so as to effectively prevent and treat diseases such as short stature, rachiokyphosis, backache, fatigue, bone pain, fracture, metastatic vascular calcification and systemic calcinosis, improve people’s health and help achieve the goal of "Healthy China 2030" .

Vitamin D status in Mexican women at reproductive age, Ensanut 2018-19 / Estado de vitamina D en mujeres en edad reproductiva, Ensanut 2018-19

Abstract Objective: To describe the prevalence of deficiency (VDD) and insufficiency (VDI) of vitamin D (VD), by sociodemographic factors, obesity and physical activity in a probabilistic sample of Mexican women participating in Ensanut 2018-19. Materials and methods: In 1 262 women aged 20 to 49 years, the prevalence of VDD/IVD was estimated and the factors associated with it were evaluated with a multinomial regression model. Results: The prevalence of VDI was 46.1% and of VDD was 31.6%. The probability of presenting VDI and VDD was higher for residents of urban areas, in tertiles 2 and 3 of socioeconomic status, and with obesity, while was lower in women with moderate physical activity. Conclusión: The prevalence of vitamin D in Mexican women continues to be a public health problem in Mexico despite the high availability of sunlight in the country. It is necessary to promote healthy sun exposure in the population and consider fortifying foods with vitamin D.

Resumen Objetivo: Describir la prevalencia de deficiencia (VDD) e insuficiencia (VDI) de vitamina D (VD) por factores sociodemográficos, obesidad y actividad física, en una muestra probabilística de mujeres mexicanas participantes de la Encuesta Nacional de Salud y Nutrición 2018-19. Material y métodos: En 1 262 mujeres se estimó la prevalencia de VDD y VDI y se evaluaron los factores asociados con ellas con un modelo de regresión multinomial. Resultados: La prevalencia de VDI fue de 46.1% y de VDD fue 31.6%. La probabilidad de presentar VDI y VDD fue mayor en residentes de áreas urbanas, en terciles más altos de nivel socioeconómico y con obesidad, mientras que fue menor en mujeres con actividad física moderada. Conclusión: La prevalencia de VDI y VDD en mujeres mexicanas continúa siendo un problema de salud pública en México a pesar de la alta disponibilidad de luz solar en el país. Es necesario fomentar en la población una saludable exposición solar y considerar la fortificación de alimentos con vitamina D.

Prevention and treatment of calcium and/or vitamin D insufficiency associated parathyroid hyperfunction and hyperparathyroidism / 中华内分泌外科杂志

Hyperparathyroidism is a common endocrine disease that seriously affects human health, depending on its etiology, which can be divided into three types: primary, secondary and tertiary. In clinical practice, we found that some primary hyperparathyroidism may be secondary or tertiary hyperparathyroidism caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency, and become a common type of hyperparathyroidism. The daily calcium intake of Chinese people is generally insufficient. Vitamin D can promote the absorption of calcium, but vitamin D deficiency/insufficiency is also a worldwide public health problem. Long-term hypocalcemia will stimulate parathyroid hyperplasia and secrete excessive parathyroid hormone, resulting in parathyroid hyperfunction (pre-hyperparathyroidism) and then secondary hyperparathyroidism, both of which may damage bone and release calcium into blood, leading to diseases of multiple organs and tissues. The detection of bone metabolism indexes such as calcium, magnesium, phosphorus, parathyroid hormone and vitamin D may be helpful for the early diagnosis of pre-hyperparathyroidism and hyperparathyroidism. Supplementation of calcium and vitamin D in early stage can control the development of the disease and change "unpreventable and uncontrollable" into "preventable and controllable" . The health screening of bone metabolism indexes and parathyroid ultrasonography should be advocated, and the prevention and treatment of calcium and/or vitamin D insufficiency associated parathyroid hyperfunction and hyperparathyroidism should be strengthened, so as to greatly improve the bone health, urinary calculus, metastatic vascular calcification and systemic abnormal calcium migration and precipitation in the population.

Prevalence of Vitamin D insufficiency and deficiency among seborrheic dermatitis patients: A cross-sectional study at Makati Medical Center

Introduction@#Seborrheic dermatitis is a chronic and recurrent inflammatory dermatosis affecting different age groups with a prevalence rate of 1–5% among Asian adults. Due to its immune-modulatory and anti-inflammatory properties, vitamin D has been correlated with inflammatory dermatoses such as seborrheic dermatitis.@*Objectives@#To determine the prevalence of vitamin D insufficiency, deficiency and severe deficiency among Filipino adult pa- tients with moderate to severe seborrheic dermatitis.@*Methods@#A single-center, analytical, cross-sectional study at Makati Medical Center, which included Filipino patients aged 18– 60 years, diagnosed with moderate-to-severe seborrheic dermatitis based on Investigator's Static Global Assessment (ISGA) with serum vitamin D levels classified as normal, insufficient, deficient and severely deficient.@*Results@#We included 61 patients, 5 patients (8%) of whom presented with normal Vitamin D levels. Twenty-one patients (34%) pre- sented with vitamin D insufficiency, 32 patients (52%) presented with vitamin D deficiency, while 3 patients (5%) presented with se- vere deficiency. Vitamin D insufficiency and deficiency were more prevalent among patients in the younger age group (p = 0.001), with predominant scalp lesions (p = 0.006), and those who are single (p = 0.015). There was no statistically significant difference in the prevalence of vitamin D insufficiency and/or deficiency based on seborrheic dermatitis severity as per ISGA scale (p = 0.126).@*Conclusion@#Seborrheic dermatitis in Filipinos has been associated with vitamin D insufficiency, deficiency and severe defi- ciency. The prevalence of vitamin D deficiency is seen in almost half of patients while vitamin D insufficiency is seen in almost one-third of patients with seborrheic dermatitis. While topical and oral medications have been the treatment of choice for seb- orrheic dermatitis, the role of oral vitamin D supplementation as adjunct treatment may be studied.

Prevalence of vitamin D deficiency in exclusively breastfed infants at a tertiary healthcare facility in Nairobi, Kenya

ABSTRACT Objective: To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined. Subjects and methods: Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05). Results: The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042). Conclusions: The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.

Prevalence of vitamin D deficiency in pregnancy and its relation with adverse pregnancy outcome

Background: Vitamin D deficiency is widely prevalent in all parts of the world. Pregnant women and neonates are highly vulnerable to vitamin D deficiency. Pregnant women receive very less amount of sunlight especially in parts of Southeast Asia due to traditional norms and customs. A strong positive correlation was found between low maternal vitamin D levels with gestational hypertension/preeclampsia, gestational diabetes mellitus, preterm labour, low birth weight, intra uterine growth restriction, neonatal intensive care unit admission and Apgar score. Therefore, the present study was designed to know the prevalence of vitamin D deficiency in pregnant females and to evaluate adverse effects associated with it.Methods: Total 250 nulliparous pregnant females attending Tirath Ram Shah Hospital for delivery and carrying a viable (>/28 weeks) singleton pregnancy were selected. Women with serum 25-hydroxy vitamin D level <10 ng/ml, 10-20 ng/ml and <20 ng/ml, were diagnosed as vitamin D deficient, insufficient and sufficient groups respectively and the adverse outcomes was correlated.Results: In this study, out of 250 cases, 159 cases (63.6%) had vitamin D deficiency, 43 cases (17.2%) had insufficiency, and 48 cases (19.2%) had sufficient vitamin D levels (vitamin D ≥20 ng/ml). And, Vitamin D deficiency was associated with preeclampsia, preterm labour and increased risk of caesarean section.Conclusions: This study indicates that vitamin D deficiency is highly prevalent in pregnant females thus implicating the need of a uniform strategy of vitamin D supplementation to pregnant females.

Association of vitamin D deficiency and bone mass with liver and heart iron overload in transfusion dependent thalassemia

Background: Transfusion dependent thalassemia patients are reported to have Vitamin D insufficiency/deficiency in many countries. Vitamin D hydroxylation occurs in the liver; whether liver iron overload interferes with this step has not been addressed till date. This study helps to establish an association between liver iron concentration (LIC) and heart iron concentration (MIC) with vitamin D levels and Bone Mass Density in these patients.Methods: A cross sectional study was done by including transfusion dependent Thalassemia patients (TM) if they had an assessment of Liver and cardiac iron done by T2*MRI and bone mineral density by DEXA. Clinical data regarding age, gender, type of iron chelation therapy and laboratory data of S. ferritin and Vitamin D was collected. Data was assessed using appropriate statistical methods.Results: Among 40 TM patients were taken and mean age was 17.6 years. Vitamin D deficiency was identified in 26(65%). 20 out of them had an LIC>7mg/g DW and 6 had MIC>1.65mg/g DW. There was a significant association between LIC>7mg/g and vitamin D level<20 ng/ml and a significant inverse correlation between LIC and vitamin D, suggesting that liver iron overload may indeed affect vitamin D metabolism. Osteopenia was present in 32.5% and osteoporosis was present in 27.5 % of all TM patients. Reduced Bone Mass Density was also found to be linked with iron over load.Conclusions: Regular monitoring of vitamin D levels and supplementation is required in patients with severe liver and heart iron load. More studies are needed to confirm these results.

The prevalence rate of vitamin D insufficiency in a random sample of individuals visiting the orthopedic unit in Al-Diwanyah Teaching Hospital, Iraq

Vitamin d deficiency state is a global public health issue that has been linked in addition to bone problems to a number of disordes affecting the cardiovascular syste, the development of neoplastic disords and autoimmune diseases. However, the prevalence rate of vitamin D deficiency in daily clinical practice in our province in the Mid-Euphrates region of Iraq is poorly defined. The current study was planned and conducted, taking into consideration the aim of estimating a hospital base prevalence rate of vitamin D and relate vitamin D insufficiency state to a number of demographic factors. The current crosssectionalk study was carried out in the orthopedic unit at Al-Diwaniyah Teaching Hospital, Mid Euphrates rgion, Iraq. The study included a random sample of 141 individuals from the pool of patientes daily visiting the orthopedic unit. The study started in January 2018 and ended on June 2019. Serum estimation of vitamin D was carried out to all particpants in addition to the inclusion of the fowling variables in the questionnaire form: age gender, residency, occupation, education level, and economic status. The results of the current study revealed that the serum level of vitamin D ranged from 4.80 to 70.00 ng/dl and it averaged 18.57±11.59 ng/dl; its median and inter-quartile range level was 15.83 (14.40) ng/dl. According to a cutoffvalue of < 20 ng/dl defining the vitamin D deficiency status according to some literature, the prevalence rate was 64.5%. Whereas, considering the cutoff value to be < 30 ng/dl, the prevalence rate of vitamin deficiency was 87.9%. Serum vitain D level was not significantly correlated to any of the demographic characteristics included in the study. In view of the available data from the current study and previous reports, vitamin D deficiency is a common health issue in daily clinical practice and strategies ust be adipted by our health institutes to overcome this health problem and associated disorders (AU)

Vitamin D status of Filipino high school students in selected schools in Quezon City

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Vitamin D deficiency has been documented as a frequent problem in almost every region of the world even in the tropical countries and its health consequences are enormous. Infancy and adolescence are age groups particularly at risk of developing vitamin D deficiency. However, there are no data on the Vitamin D status of Filipino adolescents.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> To determine the serum 25-hydroxyvitamin D levels in Filipino high school students in selected schools in Quezon City</p><p style="text-align: justify;"><strong>METHODS:</strong> A cross-sectional study of Filipino high school students was undertaken. A total of 97 boys and girls aged 11- 18 years old, attending selected private and public secondary schools in Quezon City participated in the study after parents' consent and students' assent were taken. Serum 25(OH)D levels were determined by electrochemiluminescence immunoassay (ECLIA) using Roche HITACHI Cobas e immunoassay analyzer.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The total serum 25-hydroxyvitamin D levels of the students ranged from 19.92 nmol/L to 88.63 nmol/L with a mean of 52.43 nmol/L. Among the 97 high school students, there was a prevalence of hypovitaminosis D (serum 25 (OH)D <50nmol/L) of 41.2% with 20.6% having deficient (</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Hypovitaminosis D is highly prevalent among Filipino adolescents in secondary school despite abundance of sunlight. Appropriate interventions are needed to address the problem of poor vitamin D status in schoolchildren.</p>

Differences in the prevalence of vitamin D deficiency and hip fractures in nursing home residents and independently living elderly

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.

Effect of multivitamin on serum 25-hydroxy vitamin D level in postmenopausal women: A randomized, double-blind, placebo-controlled trial

OBJECTIVE: To determine the effects of multivitamin vitamin D 300 or 600 units on serum 25 hydroxyvitamin D (25(OH)D) level after 4 weeks of supplementation in postmenopausal women with vitamin D insufficiency. STUDY DESIGN: Randomized double-blind, placebo-controlled trial. METHODS: Postmenopausal women who had vitamin D insufficiency were recruited into the study. The participants were randomized to 3 groups of 4-week treatment period with multivitamin (GPO, Governmental Pharmacy Organization) 2 tablets (contained vitamin D2 amount 600 units), multivitamin 1 tablet (contained vitamin D2 amount 300 units) or placebo. At baseline and after 4 weeks of supplementation, serum 25(OH)D were determined with electrochemilumines-cence immunoassay (Cobas, Roche Diagnostics) and level change of 25(OH)D level were compared among the groups. RESULTS: Out of 144 participants, 49.3% had vitamin D deficiency (<20 ng/ml) and 50.7% had vitamin D insufficiency (<30 ng/ml). However, after 4 weeks of the GPO oral multivitamin, serum 25(OH)D levels significantly increased from 19.4 ± 6.3 ng/ml at baseline to 22.2 ± 5.2 ng/ml (P = 0.01) and from 19.5 ± 5.0 ng/ml to 23.3 ± 5.2 ng/ml (P < 0.01) in the groups receiving vitamin D 300 IU and 600 IU/day, respectively. Approximately, 10% of those who took vitamin D had serum 25(OH)D level above the insufficiency level within 4 weeks. There was no significant changes of serum 25(OH)D after 4 weeks in the placebo group. CONCLUSION: Daily supplementation of the generic multivitamin containing vitamin D2 300 and 600 IU daily for 4 weeks significantly increased mean serum 25(OH)D from baseline up above the deficiency level.

Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors

BACKGROUND: The objective of this study was to assess the serum 25-hydroxyvitamin D (25OHD) status and evaluate the associated factors in a Korean pediatric population aged 0-18 yr. METHODS: Serum 25OHD levels were retrospectively analyzed in 13,236 Korean children and adolescents. 25OHD tests by chemiluminescent immunoassay were requested from 332 medical institutions nationwide in Korea between January 2014 and December 2014. Prevalence of vitamin D deficiency (VDD) and insufficiency (VDI) and the associated factors were analyzed. VDD and VDI were defined as serum 25OHD levels of <20.0 ng/mL and 20.0-29.9 ng/mL, respectively. RESULTS: The 25OHD levels negatively correlated with age (r=-0.4033, P<0.001). Overall, 79.8% boys and 83.8% girls had hypovitaminosis D (VDI or VDD). The Odds ratios (ORs) of being in the VDD/VDI category as against the reference category of VDS (vitamin D sufficiency) were as follows: increase in age by 1 yr (OR=1.42/1.25, all P<0.001); girls (OR=1.32/1.16, P<0.001/P=0.004) compared to boys, spring (OR=1.61/1.80), fall (OR=1.31/1.28), and winter (OR=1.44/2.03, all P<0.001) compared to summer season; living in urban areas (OR=1.23, P<0.001) compared to rural areas. CONCLUSIONS: VDD and VDI are highly prevalent in children and adolescents in Korea. Serum 25OHD levels decreased significantly according to increasing age. Winter and spring seasons, increasing age, female sex, and living in urban areas are the factors associated with a high risk of VDD or VDI.

Low Vitamin D Status of Northern Italian Children in Pediatric Primary Care Setting: What to Do.

Aims: To analyze vitamin D status in a group of children living in Northeastern Italy cared by a “family pediatrician”. Study Design: Cross-sectional study. Place and Duration of Study: Pediatric primary care in a rural area near Padua (Italy, 45°N latitude), between November 2010 and September 2012. Methodology: The study was conducted with 113 children (41 girls and 72 boys), aged between 1 and 15 years old. The serum level of 25-hydroxyvitamin D [25(OH)D] was measured using a chemiluminescence immunoassay methodology. Serum 25(OH)D test was included in a panel of laboratory tests ordered for different reasons. A correlation was researched between 25(OH)D level and the following variables: class of age, gender, ethnicity, skin colour, period of blood withdrawal, BMI category, results in other laboratory tests and presence of comorbidity. Results: Only 26.5% of children had a normal level of 25(OH)D (> 30 ng/ml); in 66.4% of all patients 25(OH)D level was 10-29 ng/ml while 7.1% of children had 25(OH)D < 10 ng/ml. About 40% of all children had 25(OH)D < 20 ng/ml. Non-Italian ethnicity, nonwhite skin and blood withdrawal in January-March and April-June were significantly associated with hypovitaminosis D [25(OH)D < 30 ng/ml] at univariate level. Both non- Italian ethnicity (P = 0.029) and period of blood withdrawal (P = 0.0062) were also significant at multivariate analysis. The combination of chronic disease or non-white skin could identify only 50% of children with 25(OH)D < 10 ng/ml and 29% of children with 25(OH) < 20 ng/ml. Conclusion: We noted a high incidence of hypovitaminosis D in asymptomatic children without risk factors. In our region cholecalciferol supplementation should be implemented for all children between October and April. Appropriate dose for children of Northern Italy is debated.

Efficacy and Safety of Weekly Alendronate Plus Vitamin D3 5600 IU versus Weekly Alendronate Alone in Korean Osteoporotic Women: 16-Week Randomized Trial

Vitamin D (vit-D) is essential for bone health, although many osteoporosis patients have low levels of 25-hydroxy-vit-D [25(OH)D]. This randomized, open-label study compared the effects of once weekly alendronate 70 mg containing 5600 IU vit-D3 (ALN/D5600) to alendronate 70 mg without additional vit-D (ALN) on the percent of patients with vit-D insufficiency [25(OH)D <15 ng/mL, primary endpoint] and serum parathyroid hormone (PTH, secondary endpoint) levels in postmenopausal, osteoporotic Korean women. Neuromuscular function was also measured. A total of 268 subjects were randomized. Overall, 35% of patients had vit-D insufficiency at baseline. After 16-weeks, there were fewer patients with vit-D insufficiency in the ALN/D5600 group (1.47%) than in the ALN group (41.67%) (p<0.001). Patients receiving ALN/D5600 compared with ALN were at a significantly decreased risk of vit-D insufficiency [odds ratio=0.02, 95% confidence interval (CI) 0.00-0.08]. In the ALN/D5600 group, significant increases in serum 25(OH)D were observed at weeks 8 (9.60 ng/mL) and 16 (11.41 ng/mL), where as a significant decrease was recorded in the ALN group at week 16 (-1.61 ng/mL). By multiple regression analysis, major determinants of increases in serum 25(OH)D were ALN/D5600 administration, seasonal variation, and baseline 25(OH)D. The least squares mean percent change from baseline in serum PTH in the ALN/D5600 group (8.17%) was lower than that in the ALN group (29.98%) (p=0.0091). There was no significant difference between treatment groups in neuromuscular function. Overall safety was similar between groups. In conclusion, the administration of 5600 IU vit-D in the ALN/D5600 group improved vit-D status and reduced the magnitude of PTH increase without significant side-effects after 16 weeks in Korean osteoporotic patients.

Vitamin D Status in Korea

The majority of the vitamin D in our body is produced by cutaneous synthesis in response to sunlight. As more and more people live in cities and spend the bulk of their time indoors, it can be difficult to get sufficient sun exposure for adequate cutaneous production of vitamin D. Therefore, vitamin D insufficiency has become a very common health problem worldwide. The Korea National Health and Nutrition Examination Survey IV 2008 showed that the prevalence of vitamin D insufficiency, defined as a serum 25-hydroxyvitamin D [25(OH)D] level below 50 nmol/L, was 47.3% in males and 64.5% in females. Only 13.2% of males and 6.7% of females had a serum 25(OH)D level of greater than 75 nmol/L. In Korea, vitamin D insufficiency was more prevalent in young adults than in elderly people, likely due to the indoor lifestyle of younger people. Compared with the United States and Canada, Korea has a lower mean 25(OH)D level and a higher prevalence of vitamin D insufficiency. To improve the vitamin D status of the Korean population, more aggressive policies on food fortification and vitamin D supplementation are needed.

Subclinical Vitamin D Insufficiency in Korean School-aged Children / 대한소아소화기영양학회지

PURPOSE: Recently, vitamin D insufficiency has increased and has been correlated to growth and puberty in children. This study was conducted to find the prevalence of subclinical vitamin D insufficiency and its influence on school-aged children in Korea. METHODS: The subjects of this study were 397 children aged 7 to 15 years who had been tested for 25-OH vitamin D3 among the outpatients of the Department of Pediatrics in Eulji General Hospital from March 2007 to February 2011. Data for age, sex, comorbidities, serum 25-OH vitamin D3, height, weight, body mass index (BMI), and sunlight exposure time were collected before and after 3 months of vitamin D administration, retrospectively. RESULTS: Vitamin D insufficiency was present in 343 (86%) of the subjects. In the vitamin D insufficient group, chronological age was 8.96+/-1.72 years, mean height (z-score [z]) was 0.51+/-1.26, mean BMI (z) was 0.81+/-2.20, and bone age was 10.26+/-1.75 years. In the vitamin D sufficient group, chronological age was 9.61+/-1.77 years, mean height (z) was-0.66+/-0.98, mean BMI (z) was-0.01+/-1.16, and bone age was 9.44+/-2.12 years. A paired t-test showed that three months after vitamin D administration, the mean 25-OH vitamin D3 level in the insufficient group increased to 24.38 +/-10.03 ng/mL and mean BMI (z) decreased to 0.67+/-1.06. CONCLUSION: In Korean school-aged children, vitamin D insufficiency were relatively higher and may be closely related with higher BMI. Insufficient rise of the level of vitamin D after supplementation suggest the new supplementation guidelines, especially for Korean children.

Vitamina D: infecciones, atopia y asma / Vitamin D: infections, atopy and asthma

Data on vitamin D insufficiency are expanding to include evidence on its role in asthma, allergic disorders, and atopic dermatitis, vitamin D is now recognized as an immunomodulator. In addition epidemiologic studies have identified a link between inadequate vitamin D concentrations and infectious disease. Furthermore, their contribution in host defense against infection has been elucidated. Vitamin D plays an important role in innate and adaptive immune response. Several clinical studies exist supporting a relationship between vitamin D status and atopic dermatitis, asthma, asthma exacerbations, pulmonary function. The effect of vitamin D supplementation is still being studied and may be a promise.

La información sobre la deficiencia de vitamina D y su rol en el asma, desordenes alérgicos y dermatitis atópica, está en aumento. Además estudios epidemiológicos han identificado la relación entre concentraciones inadecuadas de vitamina D y enfermedades infecciosas. Su contribución a la inmunidad ha sido aclarada. La vitamina D juega un importante rol en la inmunidad innata y adaptativa y se le reconoce una acción inmunomoduladora. Varios estudios clínicos confirman que su status se relaciona con Dermatitis Atópica, Asma, exacerbaciones asmáticas y función pulmonar. El efecto de la suplementación con vitamina D esta aun en investigación y constituye una promesa.

Prevalência de deficiência e insuficiência de vitamina D e sua correlação com PTH, marcadores de remodelação óssea e densidade mineral óssea, em pacientes ambulatoriais / Prevalence of vitamin D deficiency and its correlation with PTH, biochemical bone turnover markers and bone mineral density, among patients from ambulatories

A deficiência de vitamina D (VD) leva ao raquitismo e à osteomalacia e sua insuficiência, caracterizada pelo hiperparatireoidismo secundário, pode resultar osteoporose. Apesar de amplamente prevalente, a insuficiência de VD ainda é pouco reconhecida e subtratada. Os autores estudaram 180 pacientes atendidos em ambulatório de endocrinologia em Belo Horizonte, que tiveram os níveis de 25(OH)VD mensurados, correlacionando-os com paratormônio (PTH), marcadores de remodelação óssea e densidade mineral óssea. Para caracterização de níveis insuficientes de VD, foram correlacionados os níveis de 25(OH)VD com os de PTH, definindo-se, nesta série, ponto de corte de 25(OH)VD de 32 ng/ml. Foi encontrada correlação inversa e significativa entre 25(OH)VD e PTH e entre 25(OH)VD e C-telopeptídeo. A prevalência de insuficiência de VD na população estudada foi de 42,4 por cento. Conclui-se que a insuficiência de VD tem alta prevalência entre pacientes que freqüentam nossos consultórios, alertando para a importância da sua investigação na prática clínica e na instituição de políticas para sua prevenção.

Consequences of VD deficiency include rickets and osteomalacia. However, marginal concentrations of 25-hydroxyvitamin D (25(OH)VD) are associated with secondary hyperparathyroidism and osteoporosis. In this context, levels of 25(OH)VD capable to elevate parathyroid hormone (PTH) could be considered as insufficient. The VD insufficiency, although widely prevalent, is still under-recognized and under-treated. The authors have studied 180 patients followed in a endocrinology clinic in Belo Horizonte, who had 25(OH)VD measured, correlating it with PTH, biochemical bone turnover markers and bone mineral density. To determine the sufficiency of VD, 25(OH)VD was correlated with PTH and the cutoff found was of 32ng/ml. CTX-1 and PTH were significantly negative correlated to 25(OH)VD and the prevalence of VD insufficiency was 42 percent. One concludes that the VD insufficiency is widely prevalent among patients who frequently come to our offices, alerting us for the importance to assess VD status more often and to practice politics for prevention of VD insufficiency.