Vitamina D: entre el brillo del sol y la oscuridad de la depresión / Vitamin D: Between the Brightness of the sun and the Darkness of Depression

RESUMEN Introducción: La literatura científica indica que hay relación entre la vitamina D (VitD) y el inicio, el tratamiento y el pronóstico de la depresión. Sin embargo, esta línea de investigación continúa siendo motivo de controversia. El propósito del trabajo es analizar la relación entre la depresión y los valores de VitD, controlando por la influencia de la estación. Material y métodos: Estudio observacional y transversal. La muestra quedó conformada por 150 voluntarias adultas (edad, 28-78 arios). Se estratificó la muestra en 3 grupos: depresión sin tratamiento, depresión en tratamiento con antidepresivos y sin depresión (control). Se compararon los valores de VitD. Resultados: Se hallaron diferencias significativas entre los 3 grupos de comparación. El grupo con depresión sin tratamiento obtuvo los valores de VitD más bajos (media, 18,62 ± 8,42 ng/ml), compatibles con una insuficiencia grave. El grupo de participantes con depresión en tratamiento obtuvo valores más altos que el grupo anterior, aunque en la franja de insufi ciencia (23,80 ± 11,30 ng/ml). El tercer grupo (control) obtuvo los valores más altos y acordes con el intervalo deseable (30,19 ± 10,21 ng/ml). No hubo diferencias de edad entre los grupos. Al controlar por posibles efectos de la estación del año, las diferencias previas de VitD entre los 3 grupos se mantuvieron, con un descenso ostensible de todas las medias en el periodo invernal. Conclusiones: La depresión se asocia con valores de VitD insuficientes. El tratamiento con antidepresivos mejora esos valores, aunque continúan siendo insuficientes. Los hallazgos de este estudio refuerzan la evidencia de una asociación entre la depresión y la VitD.

ABSTRACT Introduction: The scientific literature suggests a relationship between vitamin D (VitD) and the onset, treatment and prognosis of depression. However, this line of research continues to be controversial. The aim of the study was to analyse the relationship between depression and VitD values, controlling for the influence of the season. Material and methods: Observational and cross-sectional study. The sample was made up of 150 adult female volunteer participants (aged between 28 and 78 years). The sample was stratified into three groups: a) depression without treatment, b) depression under treat ment with antidepressants, and c) without depression (control). VitD values (ng/ml) were compared. Results: Significant differences were found between the three groups surveyed. The group of participants with depression without treatment obtained the lowest VitD values (mean 18.62 ng/ml; SD 8.42), compatible with severe insufficiency. The group of participants with depression in treatment obtained higher values than the previous group, although in an insufficient range (mean 23.80 ng/ml; SD 11.30). The third group (control) obtained the hig hest values and in accordance with the desirable range (mean 30.19 ng/ml; SD 10.21). There were no age differences between the groups. When controlling for possible effects of the season, the previous differences in VitD between the three groups were maintained, with an evident decrease of all the mean levels in the winter period. Conclusions: Depression is associated with insufficient VitD values. Treatment with antidepressants improves these values, although they continue to be insufficient. The findings of this study reinforce the evidence for an association between depression and VitD.

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.

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.