What is known about the effects of vitamin D in neuropsychiatric lupus?

Abstract Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect several organs and systems. The central and/or peripheral nervous system can suffer from complications known as neuropsychiatric lupus (NPSLE). Studies have associated the manifestations of SLE or NPSLE with vitamin D deficiency. It has been shown that hypovitaminosis D can lead to cognition deficits and cerebral hypoperfusion in patients with NPSLE. In this review article, we will address the main features related to vitamin D supplementation or serum vitamin D levels with neuropsychiatric manifestations, either in patients or in animal models of NPSLE.

Vitamin D status in 5-15 years old children attending pediatric OPD in tertiary care hospital in Jammu and Kashmir, North India: a cross sectional study

Background: Vitamin D is vital in children mainly because of its profound effect on growth, development, immune system and importantly bone health. Recent evidence suggests maintaining 25 (OH) D levels above 20 ng/ml for maximizing health benefits. Objectives were to assess the vitamin D status in children in the age group of 5-15 years attending a tertiary care teaching institute of North India and to analyze the factors which can contribute to vitamin D deficiency in these children. Methods: It was a cross-sectional study. 5-15 years old children attending the outpatient department were included in the study. Children with co morbid conditions that affect vitamin D metabolism and those children on chronic drug treatment and on vitamin D supplementation were excluded from the study. Results: Average age of study population was 8.93±2.02. In the study 170 (18.47%) children among a total of 920 had a normal vitamin D status while the rest 750 children (81.52%) had insufficient vitamin D status (25 hydroxy vitamin D <30 ng/ml). Among these children 190 (26.38%) had suboptimal vitamin D levels, 300 (40%) were deficient, 143 (19.06%) had severe and 117 (15.6%) had very severe deficiency of vitamin D. The average vitamin D level among the study population was 12.33±11.13 ng/ml. There was significant statistical association between vitamin D deficiency and stunting (p=0.003). No statistically significant association was found between outdoor activity. Conclusions: Vitamin D insufficiency was documented in 81.52% of 5-15 years old children and there was a significant association between stunting and vitamin D deficiency.

HYPOVITAMINOSIS D EXACERBATES TYPE 2 DIABETIC COMORBIDITIES

Vitamin D deficiency is one of the prominent nutritional deficiencies in India that needs special attention. The effects of hypovitaminosis D on skeletal and cardiovascular functions are well known. However, its effect on metabolic disorders like type 2 diabetes mellitus (T2DM) is still left unexplored. In the present study, our primary aim is to find out the potential effect of hypovitaminosis D in T2DM patients. The study was conducted on 250 T2DM patients mainly from Madhya Pradesh, India. Among them, 125 had hypovitaminosis D (case group) and were compared against the control group of 125 patients with normal serum vitamin D. We were mainly investigating the major T2DM-related complications including chronic kidney disease (CKD), coronary heart disease (CHD and recurrent infections. Major organ functions including liver, kidney, and cardiac functions were affected by hypovitaminosis D in T2DM patients when compared to control counterparts. We also noticed an association between hypovitaminosis D and the exacerbation of T2DM comorbidities. Our findings show the importance of maintaining normal serum vitamin D levels in T2DM patients to avoid further complications.

Hypovitaminosis D causes suboptimal glycemic control in type 2 diabetic patients

Background: Vitamin D deficiency and associated complications are widely prevalent in the Indian subcontinent. Hypovitaminosis D is known to play deleterious effects on cardiovascular and skeletal functions in human beings. Yet, its effect on carbohydrate metabolism and diabetes mellitus (DM) is less known. Aim and Objectives: In the current case– control study, our primary aim is to find out the potential effect of hypovitaminosis D on glycemic control in type 2 DM (T2DM) patients. Materials and Methods: The study population comprised 250 T2DM patients recruited primarily from Madhya Pradesh, India. The case group of 125 T2DM patients with hypovitaminosis D was compared with a control group of 125 T2DM patients with sufficient vitamin D. We mainly investigated the effect of hypovitaminosis D (both deficiency and insufficiency) on glycemic control in T2DM patients. Results: We observed that both fasting and 2-h postprandial blood glucose were found to be elevated significantly in T2DM patients with hypovitaminosis D (P < 0.01). The glycated hemoglobin level was also elevated (P < 0.01) in the case group suggesting impaired glycemic control for a chronic period. An inverse association is found between glycemic status and serum vitamin D (OH)D3 levels. Conclusions: Our results show the significance of maintaining sufficient plasma vitamin D levels, along with hypoglycemic medication in T2DM patients to improve their glycemic control and avoid diabetic comorbidities.

A Review on Correlation of Vitamin A and D in Hypertensive Disorder of Pregnancy: Current Concepts

Vitamin A is essential for the health of the mother as well as for the health and development of the fetus. Vitamin A deficiency has affected 19 million pregnant women with the highest burden found in the WHO regions of Africa and South-East Asia. Vitamin A is available in multiple vitamin formulations for prenatal care in some countries. When provided alone, the compounds most commonly used are retinyl palmitate and retinyl acetate in tablet form or oil-based solutions. Hypertension is common in pregnancy and causes high maternal mortality. This includes gestational hypertension, preeclampsia, severe preeclampsia, and pregnancy with chronic hypertension. Preeclampsia is a high-mortality disease among the common complication of hypertensive disorder of pregnancy. in particular, severe preeclampsia possess a serious threat to the safety of mothers and children, and there are great difficulties in the treatment of hypertensive disorders of pregnancy during clinical work. therefore, we are adequate in dealing with hypertensive disorders of pregnancy. Any adverse pregnancy outcomes associated with hypovitaminosis D should be accessed through the perspective of immune dysregulation both at the systemic and placental levels. It signifies the supplementation of vitamin D in pregnancy have a role in the improvement of maternal hypertensive complication and improve the fetal outcome.

Recurrencia de vértigo y discapacidad autopercibida en pacientes con hipovitaminosis D / Recurrencia de vértigo y discapacidad autopercibida en pacientes con hipovitaminosis D / Recurrence of vertigo and self-perceived disability in patients with hypovitaminosis D

El propósito de este estudio fue analizar el efecto de la deficiencia de vitamina D sobre la recurrencia de vértigo y la discapacidad auto percibida en pacientes diagnosticados con Vértigo Postural Paroxístico Benigno en un hospital de tercer nivel de la Ciudad de México. Se trata de un estudio retrospectivo y descriptivo. Se revisaron expedientes electrónicos (enero 2017 ­ diciembre 2019), de pacientes previamente diagnosticados, que presentaran valores deficientes de vitamina D sérica. Se contabilizó la cantidad de episodios de vértigo reportados, así como, la puntuación obtenida en el Dizzines Handicap Inventory para determinar el nivel de discapacidad auto percibida al momento del diagnóstico y a los 6 meses de seguimiento. Los niveles de vitamina D sérica de los pacientes seleccionados (n=30), demostraban hipovitaminosis (media de 17.1 ng/mL) al momento del diagnóstico. Seis meses después y habiendo recibido tratamiento con maniobras de reposicionamiento los pacientes reportaron desde ausencia absoluta de recurrencias (7 pacientes, 23.3%) hasta 8 recurrencias (1 paciente, 3.3%) en el mismo periodo. En cuanto al nivel de discapacidad auto percibida en la evaluación inicial predominó la discapacidad moderada (60%), mientras que, en la evaluación final, la preponderante fue la discapacidad leve (73.3%). No se encontró diferencia estadísticamente significativa entre la deficiencia de vitamina D y la recurrencia de episodios de vértigo. Se concluye que los resultados obtenidos posiblemente se deben a que la insuficiencia de vitamina D es muy común en la población mexicana, incluso en individuos sanos

The purpose of this study was to analyze the effect of vitamin D deficiency on vertigo recurrence and self-perceived disability in patients diagnosed with Benign Paroxysmal Postural Vertigo in a tertiary care hospital in Mexico City. This is a retrospective and descriptive study. Electronic records (January 2017 - December 2019) of previously diagnosed patients who presented deficient values of serum vitamin D were reviewed. The number of reported episodes of vertigo was counted, as well as the score obtained in the Dizzines Handicap Inventory to determine the level of self-perceived disability at the time of diagnosis and at 6-month follow-up. The serum vitamin D levels of the selected patients (n=30) showed hypovitaminosis (mean 17.1 ng/mL) at the time of diagnosis. Six months later and having received treatment with repositioning maneuvers, the patients reported from absolute absence of recurrences (7 patients, 23.3%) to 8 recurrences (1 patient, 3.3%) in the same period. Regarding the level of self-perceived disability in the initial evaluation, moderate disability predominated (60%), while, in the final evaluation, the predominant one was mild disability (73.3%). No statistically significant difference was found between vitamin D deficiency and recurrence of vertigo episodes. It is concluded that the results obtained are possibly due to the fact that vitamin D insufficiency is very common in the Mexican population, even in healthy individuals.

Treatment of chronic generalized periodontitis in patients with underlying hypovitaminosis D: randomized comparative clinical trial

Abstract Objectives This study aims to evaluate the dynamics of clinical and laboratory indicators of the periodontal state and hemodynamics in patients receiving pharmaceutical intervention for the treatment of vitamin D deficiency as a part of the complex therapy of chronic generalized periodontitis. Methodology This was a randomized prospective comparative clinical trial. It involved 110 patients with moderate generalized periodontitis and vitamin D deficiency (25(OH)<50 nmol/L) who were divided into two experimental groups. One experimental group received conventional treatment, whereas the other group received conventional treatment with pharmaceutical intervention for the treatment of vitamin D deficiency(vitamin D3 + calcium). Results A significant reduction in periodontal inflammation was observed across all study groups starting from day 14 of treatment. However, in a longer perspective (12 and 18 months after treatment), the indices analyzed remained fairly stable and corresponded to the chronic periodontitis clinical stabilization stage in both groups. The conventional treatment group demonstrated a marked tendency for all indicators to return to the baseline. Conclusions Pharmacotherapy of vitamin D deficiency contributed to the normalization of periodontal microcirculation (the σ and Kv values approached those of healthy periodontium) as evidenced by the immediate and long-term follow-up results. Clinical observation of patients suffering from moderate chronic generalized periodontitis with underlying hypovitaminosis D makes an argument to the use of vitamin D supplementation for the correction of vitamin D deficiency as a part of the complex treatment. Trial registration number: NCT67823273

Vitamin D status and prevalence of hypovitaminosis D in different genders throughout life stages: A Brazilian cross-sectional study

OBJECTIVES: To evaluate the mean concentration of 25-hydroxivitamin D [25(OH) D] and prevalence of hypovitaminosis D in individuals residing in Rio de Janeiro, Brazil. METHODS: The data of 80,000 consecutive individuals who had 25(OH) D measurements performed by electrochemiluminescence between 1/2/2018 and 2/5/2018 were selected. Patients who reported the use of therapies/supplements were excluded. Levels of 25(OH) D ≥20 ng/mL (ages <60 years) and ≥30 ng/mL (ages ≥60 years) were considered adequate. RESULTS: We analyzed the data of 24,074 individuals (1-95 years old, 64.7% female). Descriptive curves showed that, in both sexes, the mean values of 25(OH) D decreased from the first years of life until adolescence, then slightly increased, and then tended to stabilize during adulthood. Levels of 25(OH) D <20 ng/mL were observed in 6% of girls versus 3.6% of boys and in 13.6% of adolescent girls versus 12.6% of adolescent boys and 11% of adults. The percentage of seniors with serum levels of 25(OH) D <20 ng/mL was 13.6% in women and 12.7% in men; 53.2% of women and 50.6% of men had levels <30 ng/mL. CONCLUSIONS: Mean 25(OH) D values were higher in children and lower in adolescents and women. Approximately 90% of non-seniors and presumably healthy residents of the urban metropolitan region of Rio de Janeiro presented satisfactory levels of 25(OH) D during the summer months; however, in over half of the elderly, the serum concentrations of 25(OH) D were inadequate. Therefore, strategies for the prevention of hypovitaminosis D should be considered in the senior population.

Hipovitaminosis D en niños y adultos en un prestador de salud del Uruguay y su relación con el uso de antiepilépticos / The effect of antiepileptic drugs in adult and child hypovitaminosis D in a Uruguayan health institution / Hipovitaminose D em crianças e adultos em um provedor de saúde uruguaio e sua relação com o uso de medicamentos antiepilépticos

Resumen: Introducción: la hipovitaminosis D se encuentra ampliamente extendida a nivel mundial, con consecuencias clínicas a nivel óseo y extraóseo. Entre los factores que la causan se encuentran los antiepilépticos (AE). En Uruguay no se conoce su prevalencia en niños ni en pacientes que reciben AE. Objetivos: conocer la prevalencia de hipovitaminosis D de niños y adultos en un prestador de salud y compararla con la prevalencia en pacientes bajo tratamiento con AE. Método: estudio descriptivo, transversal, realizado entre marzo y diciembre de 2017. Las variables analizadas fueron: niveles de vitamina D, calcio, fósforo, fosfatasa alcalina y parathormona intacta. Se consideró insuficiencia de vitamina D niveles menores de 30 ng/ml y déficit niveles menores de 20 ng/ml. Resultados: se incluyeron 113 pacientes, 60 niños y 53 adultos. La prevalencia global de insuficiencia de vitamina D fue de 89% y déficit de 60%. En niños expuestos a AE, la media de vitamina D fue 17,5 ng/ml, y en niños no expuestos 19,6 ng/ml. En adultos la media de vitamina D fue de 18,1 en expuestos a AE y 16,9 en no expuestos. La diferencia de medias no fue estadísticamente significativa en niños ni en adultos. Se observaron niveles de calcemia significativamente descendidos en niños y adultos con AE. Conclusiones: la insuficiencia de vitamina D fue cercana a 90% y el déficit superó el 50%. No se encontraron diferencias significativas entre grupos en hipovitaminosis D, pero se observaron niveles de calcemia reducidos en los expuestos a AE. Es necesario continuar analizando los factores que la causan y sus consecuencias clínicas.

Summary: Introduction: hypovitaminosis D is a highly spread condition worldwide, with clinical consequences that affect bone directly, among other manifestations. Antiepileptic drugs are among factors that cause this deficiency. In Uruguay, there is no information about hypovitaminosis D in children or patients who receive antiepileptic drugs. Objectives: to learn about the prevalence of hypovitaminosis D in children and adults in a health institution and to compare it with the prevalence in patients receiving antiepileptic drugs. Method: descriptive, transversal study conducted from March through December, 2017. The following variables were analysed: vitamin D, calcium, phosphorous, alkaline phosphatase and intact parathyroid hormone. Vitamin D insufficiency was defined as vitamin D levels of less than 30 ng per mL and deficiency as D levels of less than 20 ng per mL. Results: 113 patients were included in the study, 60 of which were children and 53 adults. Global prevalence of vitamin D insufficiency was 89% and deficiency was 60%. In children taking antiepileptic drugs, the average vitamin D value was 17.5 ng/ml and it was 19.6 ng/ml for those not exposed to those drugs. In adults, the average vitamin D value was 18.1 in the population taking antiepileptic drugs and 16.9 in patients not taking that medication. The difference between average values was not statistically significant in children or adults. Calcemia levels observed were significantly lower in both children and adults taking antiepileptic drugs. Conclusions: vitamin D insufficiency was close to 90% and deficiency was over 50%. No significant differences were found between hypovitaminosis D groups, although reduced calcemia was observed in patients exposed to antiepileptic drugs. Further studies are necessary to analyse factors that cause this condition and its clinical consequences.

Resumo: Introdução: a hipovitaminose D está amplamente difundida em todo o mundo, com consequências clínicas a nível ósseo e extraósseo. Entre os fatores que a causam estão os medicamentos antiepilépticos (AE). No Uruguai, sua prevalência em crianças ou em pacientes adultos recebendo AE não é conhecida. Objetivos: conhecer a prevalência de hipovitaminose D em crianças e adultos em um prestador de serviços de saúde e compará-la com a prevalência em pacientes em tratamento com AE. Método: estudo transversal descritivo realizado entre março e dezembro de 2017. As variáveis analisadas foram: níveis de vitamina D, cálcio, fósforo, fosfatase alcalina e paratormona intacta. Níveis menores que 30 ng / ml e níveis de déficit menores que 20 ng / ml foram considerados como insuficiência de vitamina D. Resultados: foram incluídos 113 pacientes, 60 crianças e 53 adultos. A prevalência global de insuficiência de vitamina D foi de 89% e déficit de 60%. Em crianças expostas à AE, a média de vitamina D foi de 17,5 ng / ml e em crianças não expostas de 19,6 ng / ml. Em adultos, a média de vitamina D foi de 18,1 nos expostos ao AE e de 16,9 nos não expostos. A diferença nas médias não foi estatisticamente significativa nas crianças nem nos adultos. Níveis de cálcio significativamente diminuídos foram observados em crianças e adultos com EA. Conclusões: a insuficiência de vitamina D foi próxima a 90% e o déficit ultrapassou 50%. Não foram encontradas diferenças significativas entre os grupos na hipovitaminose D, mas níveis reduzidos de cálcio foram observados naqueles expostos a EA. É necessário continuar analisando os fatores que o causam e suas consequências clínicas.

Association of low serum vitamin D level among pulmonary tuberculosis patients

Background: Recent studies suggest that the incidence and severity of tuberculosis is associated with low levels of Vitamin D, this is especially important in developing countries like India which carries a major portion of global Tuberculosis burden. Therefore, this study aimed to determine the prevalence of Vitamin D deficiency in newly diagnosed tuberculosis patients in our institute. Aims and objective is to study the deficiency of Vitamin D In newly diagnosed sputum positive pulmonary TB and to compare the level of Vitamin d with that of age matched healthy control population.Methods: This was a descriptive cross-sectional case control study to asses Vitamin D deficiency among 140 cases which included 2 categories of patients (a) Group 1: 70 sputum AFB positive newly diagnosed pulmonary TB patients, (b) Group 2: 70 apparently healthy people who came to the hospital with regular checkup.Results: Mean age of study groups and control in years were, Control: 40.3857±10.231, Cases: 36.885±11.076. Mean BMI was significantly higher in controls when compared with new TB cases (19.27±2.455 vs 15.215±1.774) kg/m2 p <0.05).There was significant decrease in mean Vitamin D3 value when new cases TB patients were compared with controls (18.212±9.3027 vs 36.1267±8.410 p <0.05).Conclusions: Patients with tuberculosis are significantly Vitamin D deficient as compared to normal people. This deficiency is more marked in females and those with low BMI. The present finding favours the role of Vitamin D in the prevention and treatment of tuberculosis in developing countries like India.

Prophylactic Vitamin D Supplementation Practices for Infants: A Survey of Pediatricians From Delhi

This survey was conducted among 125 pediatricians working inpublic and private child care facilities of Delhi. Prescription ratesof routine vitamin D supplementation varied between 70-100%for various groups of infants, despite non-availability ofgovernment guidelines. Pediatricians in private practice morefrequently prescribed vitamin D supplementation to term healthyinfants as compared to government pediatrician (91.4% vs71.6%; P=0.005).

Vitamin D: role of vitamin D in human health beyond skeleton

Deficiency of vitamin D is now considered as epidemic in Indian subcontinent, with a prevalence of 70-94% in the general population. Like in US, Indian dairy products are rarely fortified with vitamin D. Socioreligious and cultural practices followed in India do not facilitate adequate sun exposure, thereby negating potential benefits of plentiful sunshine resulting in vitamin D deficiency. Deficiency is highly prevalent in both urban and rural settings. Vitamin D deficiency can lead to rickets, osteoporosis, cardiovascular diseases, diabetes, cancer and infections. In present review authors have revisited the details pertaining to vitamin D to increase the awareness on Vitamin D efficiency.

Study of correlation between maternal and cord blood vitamin D3 levels

Background: Vitamin D deficiency during pregnancy and in newborn period is common in this country. Vitamin D status of the mother is known to influence the vitamin D levels in the neonate, however how closely the maternal vitamin D level correlates with the cord blood Vitamin D is not clearly understood. To study the correlation between maternal and neonatal serum Vitamin D3 levels by as indicated by cord blood 25(OH)D levels and find out if there is a significant variation of cord blood 25(OH)D levels in Vitamin D sufficient and insufficient mothers.Methods: Healthy pregnant women between 18-45 years of age with no known history of chronic disease or long-term medication, consenting for the study were enrolled. Maternal blood sample was collected in peripartum period, cord blood sample was obtained after delivery from the umbilical cord after clamping. Vitamin D3 levels were measured by RIA and paired maternal and cord blood levels were statistically analyzed.Results: 569 paired samples of maternal and cord blood were analyzed. The mean maternal serum 25(OH)D level was 35.63ng/ml (sd 6.18, range 9.2-39.8) as compared to 13.52ng/ml (sd 3.79, range 7.9-27) for the neonates. 457 of the mothers were found to have sufficient, 101(18%) insufficient and 11(2%) deficient Vitamin D levels as per Endocrinological Society guidelines. In comparison, 535(94%) of the neonates had deficient levels, none of the neonates had sufficient Vitamin D levels, 34(5.99%) had insufficient levels. No significant correlation was found between maternal and neonatal serum vitamin 25(OH)D levels (r=0.007, P=0.85).Conclusions: Maternal and Cord blood serum Vitamin D3 levels were found to be poorly correlated in this study.

Prevalence and risk factors for Hypovitaminosis D among healthy adolescents in Kota Bharu, Kelantan / Journal of the ASEAN Federation of Endocrine Societies

@#Objective. We aim to study the prevalence and risk factors of hypovitaminosis D among healthy adolescents in Kota Bharu, Kelantan based on the most recent Paediatric Consensus guideline. Methodology. Ten public schools were selected from Kota Bharu, Kelantan. We analysed their demography (age, gender, ethnicity, income), measured their anthropometry (height, weight, BMI) and finally analysed their vitamin D and intact- Parathyroid hormone levels. Results. The prevalence of hypovitaminosis D was 16.9% among healthy teenagers with mean age of 15.9±1.39 years. Multivariate analysis showed female gender (adjusted OR, 95% CI): 23.7 (5.64, 100.3) and Chinese 0.24 (0.07, 0.84) were the significant predictors for hypovitaminosis D. Conclusion. The prevalence of healthy adolescents with hypovitaminosis D in Kota Bharu, Kelantan was 16.9% using the most recent cut off value of 30 nmol/L from the global consensus 2016. Female and Malay were the significant risk factors associated with hypovitaminosis D. Higher cut off value would result in overestimation of prevalence rate of hypovitaminosis D.

Seasonal Variation in Serum 25-hydroxy Vitamin D and its Association with Clinical Morbidity in Healthy Infants from Northern India

Objective: To evaluate the seasonal change in serum 25-hydroxyvitamin D (25-OHD) level inhealthy infants and to relate it to common childhood morbidities. Methods: 72 healthybreastfed infants residing in Delhi were enrolled at the end of summer and followed till the endof winter [mean (SD) duration 200 (10) d]. Serum 25-OHD was estimated at baseline andfollow-up. Infants were monitored for common childhood diseases. Results: Mean (SD)serum 25-OHD level was lower at the end of winter (20.7 (8.02) ng/mL) than summer (22.9(8.70) ng/mL) [mean difference (95% CI) –2.14 ng/mL (–3.36, –1.06), P<0.001). Theseasonal distribution of children according to vitamin D status in summer and winter -Deficient(15.3%, 12.5%), Insufficient (19.4%, 30.6%) and Sufficient(65.3%, 56.9%),respectively was comparable P=0.17). The morbidity profile remained unaffected by changein vitamin D status from summer to winter. Conclusions: Seasonal changes in vitamin Dlevels do not have significant clinical effect or effect on overall vitamin D status in apparentlyhealthy infants from North India. This may have implications for results of population surveysfor vitamin D status, irrespective of the season when they are conducted.

Hormonal risk factors for breast cancer in Morocco: case-control study

Background: The purpose of the study is to investigate hormonal risk factors and their impact on the development of this cancer.Methods: This is a case-control study conducted at the Mohammed VI Centre for Cancer Treatment in Casablanca.Results: The average age of the patients is 50.43 years with a standard deviation of 11.21. Exposure to endogenous estrogens appears to have an impact on the occurrence of breast cancer in the population. The early age of menarche in patients is on average 13.31±1.69 years compared to 13.65±1.54 years in controls, with a significant difference (p = 0.01). Parity is on average 2.54 children in cases versus 2.94 in controls with a significant difference (p = 0.02). Regarding the distribution of the cumulative duration of breastfeeding, 19.3% of patients compared to 12.3% of controls breastfed their children for less than one year; 80.7% of cases compared to 87.7% of controls breastfed their children for more than one year (OR=0.58; 95% CI: 0.35 - 0.97; P trend=0.03). In addition, hypovitaminosis D was noted in 2.3% of patients compared to 0.3% of controls with OR=7.14; 95% CI: 0.87 - 58.39; P trend=0.06. In addition, the supply of exogenous estrogen would also be incriminated. The risk of breast cancer appears to be influenced mainly by oral contraceptive use, which was found in 60% of cases vs. 41.3% of controls with OR=2.07; 95% CI: 1.50 - 2.86; P trend=0.0001.Conclusions: The results highlighted that breast cancer risk is highly dependent on early and prolonged exposure to estrogenic impregnation. This effect would be modulated by ovarian activity, puberty or menopause age, parity and breastfeeding.

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.

Prevalence of vitamin D deficiency in postmenopausal women and its association with fasting blood sugar

Background: Vitamin D is indispensable for human body as it caters for both skeletal as well as extra-skeletal needs, especially in postmenopausal women. Aim of this study was to know the prevalence of vitamin D deficiency among apparent healthy postmenopausal women and to find its association with fasting blood sugar.Methods: This was a cross-sectional observational study of postmenopausal women attending Gynae OPD of Sri Ram Murti Smarak Institute of Medical Sciences, Bareilly, over a period of six months. Apparently healthy postmenopausal women were selected after satisfying inclusion-exclusion criteria and were subjected to fasting blood sugar and serum 25-hydroxy-vitamin D level. They were categorized as vitamin D deficient, insufficient or sufficient according to corresponding levels of <20ng/ml, 20-30ng/ml or >30ng/ml respectively. Upper reference level for fasting blood sugar was taken as 110mg/dl. Statistical analysis was done to see the association between vitamin D deficiency and fasting blood sugar.Results: Mean age of study group was 56.9 years and the average age of attainment of menopause was 50.3 years. Prevalence of vitamin D deficiency (57.4%) including insufficiency (13%) among postmenopausal women was high 70.4%, but there was no association between hypovitaminosis D and fasting blood sugar (p=0.949).Conclusions: Despite high prevalence of vitamin D deficiency among Indian postmenopausal women, there is no correlation between it and fasting blood sugar.

On the genetic determinants of hypovitaminosis D

Hypovitaminosis D, defined by low serum levels of 25(OH)D, is a recognized worldwide public health problem. The most accepted definition considers that deficiency occurs with serum levels fall below 12 ng/ml of 25(OH)D. Long term vitamin D deficiency results in decreased bone mineralization, secondary hyperparathyroidism, increased cortical bone loss (pathogenesis of osteoporosis and hip fractures), differentiation and division of various cell types, muscle strength, diabetes type 2, blood pressure, etc. Twin- and family-based studies indicate that genetic factors influence serum 25(OH)D levels. Genetic studies have shown single-nucleotide polymorphisms (SNPs) are linked to low serum 25(OH)D concentrations through changes in the activity of the enzymes of the 1α,25(OH)2D metabolic pathway. Carriers of high genetic risk scores would need a h igher amount of vitamin D supplementation to achieve adequate serum 25(OH)D concentrations. Clinicians would not need to indicate studies to identify patients with vitamin D insufficiency of genetic origin. They should instruct their patients on their own care, to control the intake of vitamin D and the serum 25(OH)D levels until the latter are adequate. Overall, the literature reveals that the consequences of hypovitaminosis D on bone health are observed in old and infrequently in young subjects. A probable explanation for the latter is: if the rate of bone remodeling allows it, bone tissue has endogenous (genetics, hormones) and exogenous determinants (diet, physical activity) that may compensate the variables of bone health. The consequences of vitamin D deficit on bone health, has not been completely uncovered.

La hipovitaminosis D, definida por bajos niveles séricos de 25(OH)D (<12 ng/ml), es un reconocido problema de salud pública mundial. La deficiencia de vitamina D a largo plazo resulta en una disminución de la mi neralización ósea, hiperparatiroidismo secundario, pérdida de hueso cortical (patogénesis de la osteoporosis y fracturas de cadera), diferenciación y división de varios tipos de células, fuerza muscular, diabetes tipo 2, pres ión arterial, etc. Estudios genéticos han demostrado que algunos "polimorfismos de un solo nucleótido" (SNP) están relacionados con bajas concentraciones séricas de 25(OH)D a través de reducción en la actividad de las enzimas implicadas en la síntesis de 1α,25(OH)2D. Los médicos no necesitan indicar un estudio genético para identificar a la insuficiencia de vitamina D de causa genética. Bastará con instruir a los pacientes sobre su propio cuidado y controlar la ingesta de vitamina D y los niveles séricos de 25(OH)D hasta que estos últimos sean adecuados. En general, la literatura revela que las consecuencias de la hipovitaminosis D sobre la salud ósea se observan en las personas añosas y con poca frecuencia en sujetos jóvenes. Una explicación probable para esta situación es: si la tasa de remodelación ósea lo permite, el tejido óseo tiene factores endógenos (genéticos, hormonales) y exógenos (dieta, actividad física) que pueden compensar las variables de la salud ósea. Las consecuencias del déficit de vitamina D sobre la salud ósea aún no se conocen completamente.

Spectrum of Chronic Kidney Disease-Mineral Bone Disorders in Newly Detected Advanced Renal Failure Elderly Patients (CKD Stage 4 and 5)

Introduction: CKD MBD remains a complex issue in elderlypatients that has yet to be clearly defined. We aimed to evaluatethe disturbances in mineral bone disease in newly detected,untreated stage 4 and 5 elderly chronic kidney disease patients.Material and Methods: A cross-sectional observational studywith total of 93 newly detected patients underwent clinicalevaluation, biochemical assessment [serum albumin, calcium,intact parathyroid hormone(iPTH), 25- hydroxyvitamin D,phosphorus, alkaline phosphatase(ALP), creatinine], BMDmeasurement by dual-energy X-ray absorptiometry(DXA)and Lateral Abdominal X ray for aortic calcification(AAC).Results: Symptoms related to CKD-mineral bone disorderwere seen in 33.6% of the study patients. Prevalence ofhypocalcemia, hyperphosphatemia, hyperparathyroidism,and hypovitaminosis D were 64.2%, 81.1%, 49.5%,and 89.5%, respectively. Prevalence and severity ofhyperphosphatemia, hyperparathyroidism, hypocalcemia andraised ALP increases from stage 4 to stage 5 CKD, whilehypovaitaminosis D is equally prevalent in both stages.Secondary hyperparathyroidism is most common form ofCKD MBD in untreated elderly CKD population. BMD byDXA showed a low bone mass in 26.81% of our patients atdistal forearm. Patients older than 75 years more commonlyhad osteoporosis, lower ALP, phosphorus and iPTH. AAC wasseen in 13.98% of study group. Patients with AAC had higherphosphorus, iPTH and ALP. Compared to non diabetic CKDpatients, lower levels of phosphorus, ALP and iPTH wereobserved in diabetic CKD patients.Conclusion: Our study shows CKD MBD is prevalent inelderly population where symptoms alone are not enough todiagnose the bone disease.