Modifiable factors of vitamin D status among a Brazilian osteoporotic population attended a public outpatient clinic / Fatores modificáveis do status de vitamina D em uma população brasileira de osteoporóticos assistidos em um ambulatório público

Objectives To evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian osteoporotic patients and the modifiable factors of vitamin D status in this population. Subjects and methods In a cross-sectional study, 363 community-dwelling patients who sought specialized medical care were evaluated between autumn and spring in São Paulo, Brazil. Serum levels of 25(OH)D and parathormone (PTH), biochemical and anthropometric measurements, and bone density scans were obtained. The group was assessed using two questionnaires: one questionnaire covered lifestyle and dietary habits, skin phototype, sun exposure, medical conditions, and levels of vitamin D supplementation (cholecalciferol); the other questionnaire assessed health-related quality-of-life. Logistic regression and a decision tree were used to assess the association between the variables and the adequacy of vitamin D status. Results The mean age of the overall sample was 67.9 ± 8.6 years, and the mean 25(OH)D concentration was 24.8 ng/mL. The prevalence of inadequate vitamin D status was high (73.3%), although 81.5% of the subjects were receiving cholecalciferol (mean dose of 8,169 IU/week). 25(OH)D was positively correlated with femoral neck bone mineral density and negatively correlated with PTH. In the multivariate analysis, the dose of cholecalciferol, engagement in physical activity and the month of the year (September) were associated with improvement in vitamin D status. Conclusions In this osteoporotic population, vitamin D supplementation of 7,000 IU/week is not enough to reach the desired 25(OH)D concentration (≥ 30 ng/mL). Engagement in physical activity and the month of the year are modifiable factors of the vitamin D status in this population. .

Objetivos Avaliar a concentração sérica de 25-hidroxivitamina D [25(OH)D] em pacientes osteoporóticos brasileiros e os fatores modificáveis do status de vitamina D nesta população. Sujeitos e métodos Em um estudo transversal, 363 pacientes, residentes na comunidade, que procuravam atendimento médico especializado, foram avaliados entre o outono e a primavera, em São Paulo, Brasil. Níveis séricos de 25(OH)D e paratormônio (PTH), avaliações bioquímicas e antropométricas e exames de densitometria óssea foram obtidos. O grupo foi avaliado por meio de dois questionários: um questionário abordou estilo de vida e hábitos alimentares, fototipo de pele, exposição solar, problemas médicos e os níveis de suplementação de vitamina D (colecalciferol); o outro questionário avaliou a qualidade de vida relacionada à saúde. Regressão logística e árvore de decisão foram utilizadas para avaliar a associação entre as variáveis e a adequação do status de vitamina D. Resultados A idade média da amostra foi de 67,9 ± 8,6 anos e a concentração média de 25(OH)D foi de 24,8 ng/mL. A prevalência de um status de vitamina D inadequado foi elevada (73,3%), apesar de 81,5% dos indivíduos receberem colecalciferol (dose média de 8.169 UI/semana). 25(OH)D correlacionou-se positivamente com a densidade mineral óssea do colo de fêmur e negativamente com PTH. Nas análises multivariadas, a dose de colecalciferol, a prática de exercícios físicos e o mês do ano (setembro) foram associados com a melhora do status de vitamina D. Conclusões Nesta população osteoporótica, a suplementação de 7.000 UI/semana não é suficiente para atingir a concentração desejada ...

Hábitos de exposição de lactentes ao sol / Habits of infants sunlight exposure

Objetivo Conhecer os hábitos e motivos que determinam a exposição de lactentes ao sol. Métodos Quatrocentos e três mães de crianças de 1 a 6 meses, residentes na região de Campinas-SP, responderam a recordatório da última semana, acerca de frequência, tempo, horário, roupa e local de exposição dos bebês ao sol. A amostra foi calculada a partir de piloto. A coleta ocorreu em semanas com ao menos 4 dias de sol. Foram avaliadas características dos binômios, orientações recebidas (vitamina, sol) e conceitos (benéficos ou maléficos) que a mãe possui sobre o sol. Para as análises, foram empregados os testes Qui-Quadrado, Mann-Whitney e o modelo de Regressão Logística (?? 5%). Resultados Conhecer o efeito benéfico triplica a chance (razão de chance de 2,7, p=0,0001) de a mãe expor o filho ao sol. A terça parte delas foi orientada a tanto ?para melhorar icterícia?, e não mais o fazem, pois ?a criança não está amarela?. As mães conhecem mais efeitos deletérios (89,6%) do que benéficos (79,0%), e referem ter adquirido essa informação na mídia (52,5%). O efeito ruim mais citado foi câncer de pele (56,7%). Na análise de regressão não houve associação entre conhecer esse efeito e ter exposto o filho ao sol. Da amostra, 32,8% não colocaram o filho ao sol. A exposição associou-se à cor da pele. A maioria das crianças foi exposta entre 5 e 15 minutos, antes das 10h ou após as 16h, com roupa e ao ar livre, enquanto 16,9% o fizeram dentro de casa, inclusive através de vidro. Conclusão Deve-se não só prescrever, mas informar a respeito dos benefícios do sol. A fala deve salientar o efeito imediato desejado, mas também os benefícios em longo prazo

Objective This study investigated the habits and reasons for mothers sunbathing infants. Methods A total of 403 mothers of infants aged 1 to 6 months living in the region of Campinas, SP, answered a questionnaire to determine how often and how long their infants sunbathed in the past week, the clothes they wore and sunbath location. The sample was based on a pilot. Data collection occurred in weeks with less than 4 sunny days. The following were assessed: mother and infant characteristics, advice they received (vitamin, sun) and their concepts (positive or negative) about the sun. The data were treated by the chi-square and Mann-Whitney tests and logistic regression (??5%). Results Mothers are three times more likely to sunbathe their infants if they know its beneficial effects (odds ratio of 2.7, p=0.0001). One-third of the mothers were advised to sunbathe their infants to improve jaundice but they stopped doing so when the child was no longer jaundiced. Mothers are more familiar with the negative effects (89.6%) of sunbathing than the positive ones (79.0%), and blame the media for this information (52.5%). The negative effect mentioned most often was skin cancer (56.7%). Regression analysis showed no association between this information and sunbathing the infant. Almost one-third (32.8%) of the mothers did not sunbathe their infants. Sunbathing was associated with skin color. Most children sunbathed from 5 to 15 minutes before 10 in the morning or 4 in the afternoon, with clothes on and outdoors, while 16.9% sunbathed indoors, sometimes through glass. Conclusion Sunbaths should not only be prescribed, but mothers should be informed about their benefits. It is necessary to emphasize not only their immediate effects, but also the long-term effects

Sunlight exposure and development of rickets in indian toddlers.

Objective. To study the role of sunlight exposure in determining the vitamin D status of underprivileged toddlers. Methods. Height and weight were measured, clinical examination was performed, Food Frequency Questionnaire was administered and history of sunlight exposure was obtained in all (61) toddlers attending daytime crèche (Group B). Ionised calcium (iCa), inorganic Phosphorous (iP), alkaline phosphatase activity (ALP), serum parathyroid hormone (PTH) and 25 Hydroxy vitamin D (25OHD) were measured. Data were compared with results of a survey measuring similar parameters in 51 (of 251 eligible) toddlers from the same slum (Group A). Results. 111 children (mean age 2.6 yr (0.7), boys 56) were studied. Prevalence of hypovitaminosis D was 77% in group B toddlers (46 of 60) and 16.4% (10 of 61) had rickets, while none of the group A toddlers had 25OHD levels below 30nmol/L. Four children (7.8%) from Group A as against 24 (42.9%) from Group B, had sunshine exposure of < 30 minutes per day. Conclusion. Underprivileged toddlers who were deprived of sunlight had a much greater incidence of hypovitaminosis D and frank rickets. The study has important public health implications and underscores the necessity for sunlight exposure in young children.