Vitamin D in Clinical Practice: Current Perspectives

India is a heliophobic country; despite ample sunshine, almost 490 million people are vitamin D deficient in the country. Additionally, the Indian diet has not been successful in providing the daily need for vitamin D, leading to a vitamin D deficiency. The need to fortifying food with vitamin D has been raised several times. Besides, there have been discussions about whether vitamin D is a hormone or a vitamin? In this review, the authors have reviewed vitamin D deficiency and its status in India, assessment and screening, the role of vitamin D in various disease conditions, dosage recommendation and regimen.

Vitamin D in Clinical Practice: Current Perspectives

India is a heliophobic country; despite ample sunshine, almost 490 million people are vitamin D deficient in the country. Additionally, the Indian diet has not been successful in providing the daily need for vitamin D, leading to a vitamin D deficiency. The need to fortifying food with vitamin D has been raised several times. Besides, there have been discussions about whether vitamin D is a hormone or a vitamin? In this review, the authors have reviewed vitamin D deficiency and its status in India, assessment and screening, the role of vitamin D in various disease conditions, dosage recommendation and regimen.

Biochemical markers and anthropometric profile of children enrolled in public daycare centers

Abstract Objective: The nutritional status resultant from dietary habits along with socioeconomic conditions and the school environment are directly related to the individual's health condition not only in their childhood but also throughout adulthood. The aim of this study was to evaluate the effects of socioeconomic factors on the anthropometric profile and to analyze a probable association between this profile and biochemical markers in children attending public daycare centers. Methods: It is a transversal study developed in a probability sample of clusters of children from 6 months to 5 years old. Anthropometric and socioeconomic data were gathered at the CMEIs, questionnaires on the nutritional status were applied and blood was collected at the Family Health Units (USFs). Results: Female children are three times more likely to be underweight; in families with five members, it is 1/3 more likely that children of higher-educated parents are overweight. Among the results of the biochemical tests, hypervitaminosis A was a relevant aspect, positively correlating with copper (p=0.005) and zinc (p=0.008). Conclusion: Therefore, since the influence of the family is an important predictor of overweight and its future outcomes related to nutritional deficiencies and inadequate dietary intake, educational interventions are vital as a way to pave the path to prevention.

Alteración de las vitaminas en pacientes con cáncer: un estudio comparativo prospectivo / Vitamins disturbance in cancerous patients: A prospective comparison study

Cancers are a complex diseases that involve abnormal cell growth pattern and it is the leading cause of morbidity and mortality worldwide. The chemotherapy is one of the most common treatments for cancer. Cancer cause malnutrition and deficiencies of vitamins, in addition chemotherapy causes those deficiencies by induced anorexia, stomatitis, and alimentary tract disturbances. The study aims to determined and assessed the levels of serum vitamins (A, B12, B6, B9, E, D, and K) before and after chemotherapy administration. A prospective study carried out on newly diagnosed cancerous patients whom receiving chemotherapy. Fifty patients enrolling and recruited. Follow up will be recorded after the first, third, and sixth cycles of chemotherapy. The panel used for evaluation of vitamins concentration included the following six kits: Human Vitamin AV, E, VB6, B12, VD3 DIY, VK and FOLR3 ELISA kits. 38 females and 12 males included, with mean age was 48.35±15.28 years. The mostly distributed age group was belong to fifth decades. The mean body mass index (BMI) was 33.12±5.51 m2 /Kg. The majority of the sample treated were breast cancers females about 26(52%). Regarding chemotherapy regimens, the AC+Taxen protocol was mostly used. The mean level of vitamin A found to be declined to the half from (69.23±24.66 µg/dL) at C0 to (35.73±18.89 µg/dL) at C6. Normal mean value of vitamin B12 level was presented in the most of patients pre- and post- chemotherapy. Vitamin B6 concentrations in the most of patients risen by double post-chemotherapy. Vitamin D concentration not changed in pre- and post- chemotherapy. We observed a statistically significant differences among vitamin E concentration pre- and post- chemotherapy (ANOVA=3.213, P=0.033). In this study, most of patients pre-chemotherapy period had normal folate level, whereas it to decreased from (6.23±3.12 ng/mL) to reached (3.33±2.72 ng/mL) after anti-cancer, with strong statistically significant differences (ANOVA=6.56, P=0.012). In addition, vitamin K concentration was unchanged throughout chemotherapy cycles. Many factors in cancerous participants lead to vitamins deficiencies. Several vitamins remained within normal concentration throughout anti-cancer course might be due to vitamins supplement taken by persons during their regimens. Almost always vitamins concentration dropped during cycles, but still within normal value, except vitamin E, which was deficient in last cycle of chemotherapy. Vitamins replacement are mandatory for substitution dropping level because off those are essential for many body processes and regulation.

Study on correlation between 25-hydroxyvitamin D level and seasons among 13 502 children in Guangzhou area / 实用医学杂志

Objective The age and seasonal variation in children's serum 25-hydroxyvitamin D (25(OH) D] were analyzed retrospective and to provide some guides on clinical application.Methods The serum 25(OH) D level was detected by using enzyme-linked immunosorbent assay kit in 13 502 children that took health examination in Guangzhou Women and Children's Medical Center in February,march,September and October from 2009 to 2011.The cases were divided into five age groups.The average levels,deficiency and overdose of vitamin D (VD),were analyzed.Results The average 25(OH)D in serum was (80.81±42.39) nmol/L in 13 502 cases,(72.71 ± 33.47) nmol/L in Feb.and Mar.group,(89.91 ± 49.01) nmol/L in Sep.and Oct.group.There was statistically significant difference on serum 25 (OH)D level between seasons and between boys and girls for 6 years older groups.The serum 25 (OH) D levels significantly decreased with increasing age.There were statistically significant differences in serum 25 (OH) D levels and between the VD deficiency and the lack of number of cases in the 5 age groups of the two seasons.The number of VD deficiency was 482 cases (3.57％) whose 25 (OH) D ＜ 37.5 nmol/L,and 1850 cases (13.7％) whose 25 (OH) D ＜ 50.0 nmol/L.The VD deficiency in each age group was 8.19％,13.97％,37.72％,52.63％,57.92％ in Spring,and 2.38％,4.15％,10.36％,16.85％,27.47％ in Summer.The number of lack of VD was in 6 973 cases (51.64％);Excessive and poisoning of VD were 34 cases (0.25％) and 35 cases (0.26％).Conclusions Children had a relatively low level of VD in Guangzhou area,especially in the spring and school-age children with more severe VD deficiency.It is necessary to supplyVD timely in accordance with the age and season,and children were encouraged to spend more time outdoors.

Hypercalcaemia secondary to Hypervitaminosis A in a patient with chronic renal failure / Hipercalcemia secundaria a la Hipervitaminosis A en un paciente con insuficiencia renal crónica

Vitamin A toxicity is a well-described medical condition with a multitude of potential presenting signs and symptoms. It can be divided into acute and chronic toxicity. Serum vitamin A concentrations are raised in chronic renal failure even with ingestion of less than the usual toxic doses. Hypercalcaemia can occasionally be associated with high levels of vitamin A but it is rare. In this report, we describe a 67-year old female patient with chronic kidney disease who was taking vitamin A supplements for approximately 10 years. The patient had worsening of her chronic kidney disease over the last years and developed chronic hypercalcaemia. Her vitamin A level was elevated with a daily intake of 7000 IU. The vitamin A supplement was stopped. A few months later, vitamin A level diminished substantially and serum calcium levels returned to normal.

La toxicidad de la vitamina A es una condición médica bien descrita que presenta un sinnúmero de potenciales signos y síntomas. Puede ser dividida en toxicidad aguda y crónica. Las concentraciones séricas de vitamina A se elevan con la insuficiencia renal crónica, incluso con la ingestión de dosis tóxicas por debajo de lo habitual. En ocasiones, la hipercalcemia puede estar asociada con altos niveles de vitamina A, pero esto raramente ocurre. En este informe, describimos a una paciente de 67 años de edad con enfermedad renal crónica, que estuvo tomando suplementos de vitamina A por aproximadamente 10 años. La paciente sufrió un empeoramiento de su enfermedad renal crónica en los últimos años, y desarrolló hipercalcemia crónica. Su nivel de vitamina A se elevó con una ingesta diaria de 7000 UI. El suplemento de vitamina A fue suspendido. Unos meses más tarde, el nivel de vitamina A nivel disminuyó sustancialmente, y los niveles de calcio sérico volvieron a la normalidad.

Hipervitaminose D em animais / Vitamin D poisoning in animals

Por meio de revisão da literatura, são apresentados dados referentes ao metabolismo da vitamina D, bem como aos principais aspectos toxicológicos, clínicos, bioquímicos, macroscópicos, microscópicos, ultraestruturais, imuno-histoquímicos e radiográficos de animais intoxicados natural e experimentalmente por essa vitamina, em diferentes espécies. Este estudo objetiva demonstrar a existência de muitas lacunas no conhecimento sobre mineralização fisiológica e patológica, em especial na mediação hormonal do fenômeno, bem como alertar para os riscos de ocorrência dessa intoxicação.

Through revision of the literature, data are presented about vitamin D metabolism and the toxicological, clinical, biochemical, macro and microscopic, ultrastructural, immunhistochemical and radiographic aspects in animals of different species poisoned natural and experimentally by the vitamin. We aimed to show the existence of many lacunae in the knowledge of physiological and pathological tissue mineralization, especially regarding the hormonal metabolism of vitamin D, and to alert for risk of the poisoning.

Neurofibromatosis, Pathological Fracture and Hypervitaminosis-D.

Pathologic fractures in children may be due to various causes. Rarely, it may be the presenting symptom of neurofibromatosis. A misdiagnosis of Rickets and Vitamin D supplementation in such a case may wreak havoc in the form of iatrogenic hypervitaminosis D. We report one such case.

Aspectos toxicológico, clínico-patológico e ultraestrutural das intoxicações iatrogênica e experimental por vitamina D em coelhos / Toxicological, clinic-pathological and ultrastructural aspects of iatrogenic and experimental poisoning by vitamin D in rabbits

São descritos aspectos toxicológicos, clínico-patológicos e ultraestruturais de coelhos intoxicados iatrogênica e experimentalmente por vitamina D por via subcutânea. Clinicamente, os animais evidenciaram sinais de insuficiência cardiovascular como ascite e edema pulmonar, hiporexia, anorexia, diarréia mucosa, emagrecimento e apatia. As clássicas alterações de mineralização e, por vezes, osseificação, do sistema cardiovascular, bem como as alterações de rins, pulmões, estômago, entre outros órgãos, foram reproduzidas com administrações subcutâneas de solução oleosa de colecalciferol (vitamina D3 não-ativada).

Toxicological, clinic-pathological and ultrastructural aspects of iatrogenic and experimental subcutaneous poisoning in rabbits by vitamin D are described. Clinically the animals showed signs of cardiovascular insufficiency, as ascite and lung edema, hyporexia, anorexia, mucous diarrhoea, loss of weight and apathy. The classical alterations of minera-lization and, occasionally, ossification of the cardiovascular system, as well the lesions of kidneys, lungs, stomach, among other organs, were reproduced by the subcutaneous administration of an oily solution of cholecalciferol (non-activated vitamin D3).

Alteraciones clínicas y bioquímicas en ratas tratadas con dosis altas de vitamina A / Clinical and biochemical alterations in rats treated with high doses of vitamin A

En el presente trabajo se estudió el efecto de la administración intramuscular de 30.000, 50.000 y 100.000 UI de palmitato de vitamina A/día, durante 7 días, respectivamente, sobre la actividad enzimática hepática en 45 ratas Wistar machos, de 12 semanas de edad, con pesos entre 180 y 200 gramos. El grupo control estuvo integrado por 15 ratas Wistar sanas, con género, edad y peso similares a los animales tratados. El consumo de alimentos y de agua, y el peso de las ratas se determinó al finalizar el período experimental. Las ratas se examinaron en busca de manifestaciones clínicas de toxicidad. Al final el estudio, las ratas se sacrificaron bajo anestesia con éter y se tomaron muestras de tejido hepático para la determinación de la actividad enzimática. La administración de vitamina A en exceso incrementó de manera significativa (p menor que 0,05) el contenido hepático del retinol, determinó diversos y variados signos clínicos (tales como: anorexia, pérdida de peso, alopecia, conjuntivitis, hemorragias internas y externas, alteraciones cutáneas y muerte de los animales) e incrementó (p menor que 0,05) la actividad de las siguientes enzimas: alanina aminotransferasa, aspartato aminotransferasa, maltasa ácida (alfa-1,4-glucosidasa ácida), proteasas ácidas, lactato dehidrogenasa y fosfatasa alcalina mientras que las actividades de la glucosa-6-fosfatasa, glucógeno fosforilasa, alfa-amilasa, colinesterasa y arginasa disminuyeron (p menor que 0,05) al comparar con los controles no tratados. Estos cambios son proporcionales a las dosis inyectadas de vitamina A. En conclusión, nuestros resultados proporcionan evidencias que la administración de dosis altas de vitamina A a corto plazo determina diversos y variados signos clínicos y produce una marcada alteración de la actividad enzimática hepática.

In the present work the effect of intramuscular administration of 30.000, 50.000 and 100.000 IU of vitamin A palmitate daily for seven days, respectively, on the liver enzyme activity in 45 white male Wistar rats, aged 12 weeks and weighing 180-200 g, have been studied. The group control was integrated by 15 healthy rats with similar characteristics (strain, gender, age and weight) to treated animals. Food and water consumption and body weights were recorded at the end of the experimental period. Rats were observed for clinical signs of toxicity. At the end of the study, rats were sacrificed under ether anesthesia. Liver samples were taken for the determination of enzyme activity. Administration of excess of vitamin A produced a significant (p menor 0.05) increase in the content of liver vitamin A, determined diverse and variable clinical signs (such as, anorexia, loss of body weight, alopecia, conjunctivitis, external and internal hemorrhages, skin abnormalities and death) and increased (p menor que 0.05) the activity of the following enzymes: alanine aminotransferase, aspartate aminotransferase, acid maltase (acid alfa-1,4-glucosidase), acid proteases, lactate dehydrogenase and alkaline phosphatase while glucose-6-phosphatase, glycogen phosphorylase, alfa-amylase, cholinesterase and arginase decreased (p menor que 0.05) as compared with untreated controls. These changes depend on the doses given of vitamin A. In conclusion, our results provide evidence that short-term administration of high doses of vitamin A determined diverse and variable clinical signs and produces a marked alteration of activity of liver enzymes.