The importance of optimal 25-hydroxyvitamin D levels in the glycemic control of older adults with type 2 Diabetes Mellitus: Data from the study on aging and longevity EELO

INTRODUCTION: Optimal serum levels of vitamin D are of great importance, especially in populations with comorbidities such as Diabetes Mellitus (DM). OBJECTIVE: The study evaluated the relationship between hypovitaminosis D and glycemic control in older adults with type 2 DM. METHODS: Cross-sectional and prospective study, part of the EELO project (Study on Aging and Longevity), conducted in Southern Brazil. Glycated hemoglobin (diabetes ≥6.5%) and serum levels of vitamin D (25(OH)D) were evaluated. Hypovitaminosis D was determined using cutoff points <20 and <30 ng/mL). Multivariate logistic regression was used to assess the risk of having uncontrolled DM. RESULTS: Of the 120 older adults included in the study, aged between 60 and 87 years, 74.2% were women, 66.7% used hypoglycemic medications and 75.8% exhibited uncontrolled diabetes. An inverse correlation was observed between the levels of 25(OH) D and glycated hemoglobin (rS=-0.19, p=0.037), suggesting that low levels of vitamin D are associated with poor glycemic control in diabetic individuals. The prevalence of hypovitaminosis D when using the cutoff points of <20 and <30 ng/mL were 34.2% and 75.0%, respectively. The odds ratio (OR) analysis showed that individuals with 25(OH)D<20ng/mL have almost 4 times more risk of having uncontrolled DM (OR:3.94; CI95%:1.25-12.46, p=0.02) when compared to the older adults with sufficient levels of vitamin D. CONCLUSION: The results indicate that the optimal serum levels currently recommended for 25(OH)D should preferably be 30 ng/mL or higher to contribute to better glycemic control in older adults with type 2 DM.

INTRODUÇÃO: Os níveis séricos ideais de vitamina D são de grande importância, especialmente na população com comorbidades como o Diabetes Mellitus (DM). OBJETIVO: O estudo avaliou a relação entre hipovitaminose D e controle glicêmico em idosos com DM tipo 2. MÉTODOS: Estudo transversal e prospectivo, parte do projeto EELO (Estudo sobre Envelhecimento e Longevidade), no Sul do Brasil. A hemoglobina glicada (diabetes ≥6,5%) e os níveis séricos de vitamina D (25(OH)D) foram avaliados. Hipovitaminose D foi determinada usando ponto de corte <20 e <30 ng/mL. Regressão logística multivariada foi utilizada para avaliar o risco de ter DM descompensado. RESULTADOS: Dos 120 idosos incluídos no estudo, idade entre 60 a 87 anos, 74,2% eram mulheres, 66,7% faziam uso de medicamentos hipoglicemiantes e 75,8% apresentavam diabetes descompensada. Uma correlação inversa foi observada entre os níveis de 25(OH)D e hemoglobina glicada (rS=-0,19; p=0.037), sugerindo que baixos níveis de vitamina D está associado a um pior controle glicêmico em diabéticos. A prevalência de hipovitaminose D quando se utiliza ponto de corte <20 e <30 ng/mL foi de 34,2% e 75,0%, respectivamente. A análise Odds ratio (OR) mostrou que indivíduos com 25(OH)D<20 ng/mL tem quase 4 vezes mais risco de ter DM descompensado (OR:3,94; IC95%:1,25­12,46; p=0,02) quando comparado aos idosos com níveis suficientes de vitamina D. CONCLUSÃO: Os resultados indicam que os níveis sérios ideais atualmente recomendados para 25(OH)D maior ou igual a 30 ng/ml contribuem para o melhor controle glicêmico na população idosa com DM tipo 2.

Decreased circulatory levels of Vitamin D in Vitiligo: a meta-analysis

Abstract Background: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. Methods: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. Results: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Study limitations: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. Conclusions: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

Decreased circulatory levels of Vitamin D in Vitiligo (ViViD Study): a meta-analysis

Abstract Background: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. Methods: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. Results: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Study limitations: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. Conclusions: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

Decreased circulatory levels of Vitamin D in Vitiligo: a meta-analysis.

BACKGROUND: The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo. METHODS: Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively. RESULTS: This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = -1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = -0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. STUDY LIMITATIONS: Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses. CONCLUSIONS: This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

Vitamin D in Colombian patients with systemic lupus erythematosus and its correlation with disease activity.

INTRODUCTION: Patients with systemic lupus erythematosus (SLE) frequently present low levels of vitamin D. However, studies that have evaluated its association with disease activity have generated contradictory results. METHODS: A cross-sectional study was carried out on patients diagnosed with SLE in two hospitals in Manizales, Colombia. Disease activity was evaluated by the SLE disease activity index 2000 (SLEDAI-2K) and serum concentration of 25-hydroxyvitamin D (25(OH)D) was measured by chemiluminescence. The correlation analysis was accomplished with the Spearman correlation coefficient. RESULTS: The study included 51 patients. The median SLEDAI-2K score was 8 points. The mean serum level of 25(OH)D was 24.5 ng/ml. Of the participants, 37.3% had vitamin D insufficiency and 35.3% had deficiency. An inverse correlation was found between the levels of the 25(OH)D and the SLEDAI-2K score (r = -0.578, p < 0.001), being greater in late-onset lupus, with absence of polyautoimmunity and in patients using glucocorticoids. CONCLUSIONS: Low levels of vitamin D are frequent in SLE, presenting an inverse correlation with the disease activity. This is influenced by the use of glucocorticoids, the presence of late-onset lupus and the absence of polyautoimmunity.

A higher circulating concentration of 25-hydroxyvitamin-D decreases the risk of renal cell carcinoma: a case-control study

ABSTRACT Objective: To investigate the relationship between vitamin D status, using circulating 25-hydroxyvitamin D [25 (OH) D], and renal cell carcinoma (RCC) risk in a case-control study, because the association between the two is unclear in China. Materials and Methods: A total of 135 incident RCC cases were matched with 135 controls by age and sex. The blood samples were collected on the first day of hospitalization before surgery to measure plasma 25 (OH) D. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) with adjustment for several confounders (e.g. age, gender, smoking and season of blood draw). Furthermore, the association of RCC with 25 (OH) D in units of 10 ng / mL as a continuous variable were also examined. Results: The average plasma 25 (OH) D concentrations in RCC were significantly lower compared with those of the controls (21.5 ± 7.4 ng / mL vs. 24.1 ± 6.6 ng / mL, respectively; P = 0.003). In the adjusted model, inverse associations were observed between circulating 25 (OH) D levels and RCC risk for 25 (OH) D insufficiency (20-30 ng / mL) with OR of 0.50 (95% CI: 0.29-0.88; P = 0.015) and a normal 25 (OH) D level (≥ 30 ng / mL) with OR of 0.30 (95% CI: 0.13-0.72; P = 0.007), compared with 25 (OH) D deficiency (< 20 ng / mL). Furthermore, results with 25 (OH) D as a linear variable indicated that each 10 ng / mL increment of plasma 25 (OH) D corresponded to a 12% decrease in RCC risk. Conclusions: This case-control study on a Chinese Han population supports the protective effect of a higher circulating concentration of 25 (OH) against RCC, whether the confounding factors are adjusted or not.

A higher circulating concentration of 25-hydroxyvitamin-D decreases the risk of renal cell carcinoma: a case-control study.

OBJECTIVE: To investigate the relationship between vitamin D status, using circulating 25-hydroxyvitamin D [25 (OH) D], and renal cell carcinoma (RCC) risk in a case-control study, because the association between the two is unclear in China. MATERIALS AND METHODS: A total of 135 incident RCC cases were matched with 135 controls by age and sex. The blood samples were collected on the first day of hospitalization before surgery to measure plasma 25 (OH) D. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confi dence intervals (95% CIs) with adjustment for several confounders (e.g. age, gender, smoking and season of blood draw). Furthermore, the association of RCC with 25 (OH) D in units of 10 ng / mL as a continuous variable were also examined. RESULTS: The average plasma 25 (OH) D concentrations in RCC were signifi cantly lower compared with those of the controls (21.5 ± 7.4 ng / mL vs. 24.1 ± 6.6 ng / mL, respectively; P = 0.003). In the adjusted model, inverse associations were observed between circulating 25 (OH) D levels and RCC risk for 25 (OH) D insuffi ciency (20-30 ng / mL) with OR of 0.50 (95% CI: 0.29-0.88; P = 0.015) and a normal 25 (OH) D level (≥ 30 ng / mL) with OR of 0.30 (95% CI: 0.13-0.72; P = 0.007), compared with 25 (OH) D deficiency (< 20 ng / mL). Furthermore, results with 25 (OH) D as a linear variable indicated that each 10 ng / mL increment of plasma 25 (OH) D corresponded to a 12% decrease in RCC risk. CONCLUSIONS: This case-control study on a Chinese Han population supports the protective effect of a higher circulating concentration of 25 (OH) against RCC, whether the confounding factors are adjusted or not.

Efeito de doses elevadas de vitamina D3 associada à suplementação de cálcio em modelo experimental de nefrolitíase / Effect of vitamin D3 overdose and calcium supplementation in experimental nephrolithiasis model

Introdução: Há poucos dados na literatura sobre a suplementação de vitamina D e cálcio e o desenvolvimento de cálculos renais. Objetivo: Avaliar o efeito de doses elevadas de vitamina D3 (V), com suplemento de cálcio (Ca) no desenvolvimento de litíase em modelo experimental. Métodos: Pastilhas foram inseridas na bexiga de ratos, que receberam V com ou sem Ca. Ratos foram divididos em seis grupos: 1. Sham; 2. Controle com pastilha, 3. Controle com V, 4. Pastilha + V, 5. Pastilha + Ca e 6. Pastilha + Ca + V. Resultados: Observou-se 50% e 17% de redução na formação de cálculos, respectivamente nos grupos 5 e 6 em comparação ao grupo 2 (p < 0,005). Não foram observadas hipercalcemia ou hipercalciúria em todos os grupos. Encontramos no grupo 6 (p = 0,03) uma redução significativa na calciúria. Conclusão: A administração de V associada com Ca diminuiu significantemente a formação de cálculos e reduziu significantemente a calciúria, sugerindo uma interferência benéfica na fisiopatologia litogênica. .

Introduction: There is little information in the literature relating supplementary oral usage of vitamin D and calcium to the development of kidney stones. Objective: To evaluate the effect of high dose, 200 IU of vitamin D3 (V) with calcium supplementation (Ca). Methods: Experimental model consists of insertion of pellets into the bladder of rats. V was administered for 30 days with or without Ca. The rats were divided in 6 groups: 1. Sham, 2. Pellets control; 3. V control; 4. Pellets + V; 5. Pellets + Ca and 6. Pellets + Ca + V. Results: 50% and 17% decreases bladder stones formation in groups 5 and 6, p < 0.005 comparing with the group 2 were observed. There was no hypercalcemia or hypercalciuria in all groups. We observed a significant decrease in calciuria in group 6 (p = 0.03). Conclusion: The administration of the V associated with Ca significantly decreased the formation of stones and caused a significant reduction in urinary calcium, suggesting a protection in the lithogenic pathophysiology. .

Vitamin D and Kidney disease: what we know and what we do not know / Vitamina D e doença renal: o que nós sabemos e o que nós não sabemos

Vitamin D deficiency is common in the chronic kidney disease (CKD) population. CKD has been recognized as a significant public health problem and CKD patients are at increased risk of total and cardiovascular morbidity and mortality. There are increasing epidemiological data suggesting that vitamin D deficiency may play a role in overall morbidity and mortality associated with CKD. The vitamin D hormonal system is classically implicated in the regulation of calcium homeostasis and bone metabolism but there is ample evidence to support the claim that extra renal conversion of 25(OH)D to 1.25(OH)2 has significant biological roles beyond those traditionally ascribed to vitamin D. Based on the current state of evidence this review intends to give an update on novel biological and clinical insights with relevance to the steroid hormone vitamin D specifically in patients with kidney disease.

A deficiência de vitamina D é um achado comum em pacientes com doença renal crônica (DRC). A DRC é reconhecida como um problema de saúde pública importante, com elevado risco de morbimortalidade total e cardiovascular. Inúmeras publicações epidemiológicas sugerem que a morbimortalidade nesses pacientes pode estar associada à deficiência de vitamina D. O sistema hormonal da vitamina D é classicamente implicado na regulação do metabolismo ósseo e da homeostase do cálcio; entretanto, há uma grande evidência de que a conversão de 25(OH)D para 1.25(OH)2 tem um papel biológico significante além daquele tradicionalmente descrito. Baseada em atual evidência, esta revisão pretende ressaltar os aspectos clínicos e biológicos relevantes no sistema hormonal da vitamina D especificamente em pacientes com doença renal.

Hipercalcemia e lesão renal aguda causadas por abuso de um composto veterinário parenteral contendo vitaminas A, D e E / Hypercalcemia and acute kidney injury caused by abuse of a parenteral veterinary compound containing vitamins A, D, and E

Um rapaz de 19 anos, previamente hígido, procurou o hospital com queixas de anorexia, náuseas e vômitos. Exames laboratoriais revelaram hipercalcemia (valor máximo do cálcio de 14,8 mg/dL) e lesão renal aguda (valor máximo da creatinina de 2,88 mg/dL). O paciente admitiu utilizar uma formulação parenteral de vitaminas A, D e E de uso exclusivo veterinário, contendo 20.000.000 UI de vitamina A; 5.000.000 UI de vitamina D3 e 6.800 UI de vitamina E, por ampola de 100 mL. Ele refere ter usado cerca de 300 mL do produto no último ano. O jovem não estava interessado na quantidade maciça de vitaminas contida no produto, mas apenas no efeito local do veículo oleoso; o edema provocado pela injeção simulava um aumento de massa muscular. O produto, no entanto, foi absorvido e causou hipervitaminose. O nível sérico de 25(OH) vitamina D estava claramente elevado em 150 ng/mL (referência de 30 a 60 ng/mL), mas não tanto quanto em outros casos publicados de intoxicação por vitamina D. A maioria dos casos de hipercalcemia por hipervitaminose D se associa a níveis de 25 (OH)D bem maiores do que 200 ng/mL. O PTH estava indetectável, e outras causas de hipercalcemia foram excluídas. Deste modo, conclui-se que a gravidade da hipercalcemia encontrada neste caso foi resultado do efeito sinérgico da intoxicação pelas vitaminas A e D. O paciente foi tratado com soro fisiológico, furosemida e ácido zolendrônico e evoluiu com normalização rápida dos níveis séricos de cálcio e da função renal.

A previously healthy 19 year-old male presented to the hospital with anorexia, nausea, and vomiting. Laboratory studies were significant for hypercalcemia (peak calcium value of 14.8 mg/dL) and acute kidney injury (peak serum creatinine of 2.88 mg/dL). He admitted to using a parenteral formulation of vitamins A, D and E restricted for veterinary use containing 20,000,000 IU of vitamin A; 5,000,000 IU of vitamin D3; and 6,800 IU of vitamin E per 100 mL vial. The patient stated to have used close to 300 mL of the product over the preceding year. Interestingly, the young man was not interested in the massive amounts of vitamins that the product contained; he was only after the local effects of the oily vehicle. The swelling produced by the injection resulted in a silicone-like effect, which gave the impression of bigger muscles. Nevertheless, the product was absorbed and caused hypervitaminosis. The serum level of 25(OH) vitamin D was clearly elevated at 150 ng/mL (reference range from 30 to 60 ng/mL), but in most published cases of vitamin D toxicity, serum levels have been well above 200 ng/mL. His PTH level was undetectable and other potential causes of hypercalcemia were excluded. Therefore, we posit that the severity of the hypercalcemia observed in this case was the result of a synergistic effect of vitamins A and D. The patient was treated with normal saline, furosemide and zolendronic acid, with rapid normalization of calcium levels and renal function.