The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression.

OBJECTIVE: Vitamin D (vitD) deficiency is a global childhood health problem. Food fortification is a promising strategy to curb vitD deficiency. We aimed to assess the effectiveness of utilizing vitD fortification in staple foods to improve 25hydroxyvitamin D (25(OH)D) concentration and to reduce the prevalence of vitD deficiency among healthy children. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of vitD fortified food products compared to no fortification among healthy children aged 1-18 years old. We searched Medline, Embase, Global Health, and Cochrane (CENTRAL) databases from database inception until May 2019. Independently, six reviewers in pairs screened titles and abstracts, assessed the full text for eligibility, and performed data extraction and quality assessment. The primary outcome is the impact of fortification on 25(OH)D concentration. The secondary outcomes included the impact of fortification on the prevalence of vitD deficiency, school performance, cognitive function, school absences, infection rate, hospital admission length, and compliance with fortified food product consumption. RESULTS: We identified 2229 articles. After assessing eligibility, 20 RCTs met the inclusion criteria. The eligible RCTs assessed the fortification of milk, cereal, juice, bread, yogurt, and cheese compared with no fortification. All RCTs, except for three, had a low risk of bias. Food fortification improved 25(OH)D concentration by a mean difference (MD) of 15.51 nmol/L (95% confidence interval (CI) 6.28, 24.74; I2 = 99%), which resulted in a mean increase of 3 nmol/l for every 100 IU of vitD, when adjusted for baseline 25(OH)D concentration and country latitude. Additionally, the prevalence of vitD deficiency decreased by a risk ratio of 0.53 (95% CI 0.41, 0.69; I2 = 95%), and cognitive function improved by a MD of 1.22 intelligence quotient (IQ) points (95% CI 0.65, 1.79; I2 = 0%). The overall evidence quality was high. CONCLUSION: VitD food fortification is an effective way to improve 25(OH)D concentration, prevent vitD deficiency, and improve IQ levels. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017057631.

Associations of foot ulceration with quality of life and psychosocial determinants among patients with diabetes; a case-control study.

BACKGROUND: Patients with diabetic foot ulcers may have a lower quality of life. The objective was to compare the quality of life and its psychosocial determinants among patients with and without diabetic foot ulcers. METHODS: A case-control study was conducted in 2017 among patients with (cases) and without (controls) diabetic foot ulcers. The study tools included the World Health Organization's Quality of Life scale (WHOQOL-BREF), the Hospital Anxiety and Depression (HAD) scale for anxiety and depression, the Patient Health Questionnaire Physical Symptoms (PHQ-15) for the severity of somatic symptoms, and the Summary of Diabetes Self-Care Activities (SDSCA) measure for self-management. RESULTS: A total of 209 patients (45 cases and 164 controls) were included. The average age was 56.2 ± 11.7 years, and 55.5% were female. The average scores of WHOQOL-BREF, PHQ-15, and SDSCA were 74.4% ± 12.1% and 8.1 ± 6.1, and 30.4 ± 21.8, respectively. The prevalence of anxiety and depression were 19.6 and 24.9%, respectively. SDSCA was the only psychosocial determinants higher in cases than controls (mean difference = 15.0, 95% CI = -8.0-22.0). The correlation coefficients of WHOQOL-BREF scores with anxiety, depression, and PHQ-15 scores in all patients were - 0.559 (p < 0.001), - 0.582 (p < 0.001), and - 0.532 (p < 0.001), respectively, with similar numbers in both groups. In multivariate analysis, only the association between quality of life and depression was maintained. CONCLUSION: Quality of life and psychosocial determinants with the exception of self-management were not associated with diabetic foot ulcers. Depressive symptoms were independent determinant of poor quality of life, irrespective of the status of diabetic foot ulcers.

Bilateral Cochlear Implantation in Vogt-Koyanagi-Harada Syndrome: A Case Report.

OBJECTIVE: To evaluate cochlear implantation in Vogt-Koyanagi-Harada syndrome with regard to surgical difficulties and hearing outcomes. PATIENTS: Single case report. INTERVENTION(S): Therapeutic complete electrode insertion during surgery despite evident intra-cochlear fibrosis. MAIN OUTCOME MEASURE(S): Postoperative speech audiometry, categories of auditory performance, and speech intelligibility rating. RESULTS: Vogt-Koyanagi-Harada syndrome is a multisystem autoimmune disease that affects tissues containing melanin. It is characterized by bilateral uveitis with auditory, vestibular, and dermatologic manifestations. Standard treatment comprises aggressive administration of systemic corticosteroids.This report describes the use of bilateral cochlear implants in a 30-year-old Saudi woman who presented with uveitis and was diagnosed with Vogt-Koyanagi-Harada syndrome. She had progressive hearing loss in both ears and experienced minimal improvement with hearing aids. The patient underwent sequential cochlear implantation, which was challenging because it was difficult to insert the electrode in the right ear due to intra-cochlear fibrosis. After more than 5 years of follow-up, she has good hearing in both ears, despite the advancement of ocular disease and recurring visual complaints. CONCLUSION: This study suggests that patients with Vogt-Koyanagi-Harada syndrome could develop intra-cochlear fibrosis during cochlear implantation due to the autoimmune nature of disease. Moreover, cochlear implantation becomes more difficult with disease advancement. Therefore, it is essential that healthcare professionals consider early detection and prompt treatment of hearing loss in patients with this syndrome.