Prevention of vitamin D deficiency in children following cardiac surgery: study protocol for a randomized controlled trial Vitamin D for health: a global perspective. Effect of vitamin D supplementation on inflammation: protocol for a systematic review Effect of vitamin D and calcium on periodontitis. National Institutes of Health State-of-the-Science Conference Statement: Multivitamin/Mineral Supplements and Chronic Disease Prevention Vitamin D supplementation in the prevention and management of major chronic diseases not related to mineral homeostasis in adults: research for evidence and a scientific statement from the European society for clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO) Impact of Anesthesia and Surgery for Congenital Heart Disease on the Vitamin D Status of Infants and Children: A Prospective Longitudinal Study Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity. Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food Maternal vitamin D supplementation during pregnancy EMAS position statement: Vitamin D and postmenopausal health. Influence of vitamin D mushroom powder supplementation on exercise-induced muscle damage in vitamin D insufficient high school athletes Prevalence of vitamin D deficiency and its associated factors in three regions of Saudi Arabia Improving autism perinatal risk factors: A systematic review. Vitamin D deficiency and prognostics among patients with pancreatic adenocarcinoma Role of Vitamin D in Insulin Secretion and Insulin Sensitivity for Glucose Homeostasis Serum parathyroid hormone predicts time to fall independent of vitamin D status in a frail elderly population. Prevalence of vitamin B12 deficiency in spinal cord injury. Improving the vitamin D status of vitamin D deficient adults is associated with improved mitochondrial oxidative function in skeletal muscle.
Background Vitamin D is a pleiotropic hormone important for the recovery of organ systems after critical illness . Recent observational studies have suggested that three out of every four children are vitamin D deficient following cardiac surgery , with inadequate preoperative intake and surgical losses playing important contributory roles . Observed associations between postoperative levels , cardiovascular dysfunction and clinical course suggest that perioperative optimization of vitamin D status could improve outcome . With this two-arm , parallel , double blind , r and omized controlled trial ( RCT ) , we aim to compare immediate postoperative vitamin D status in children requiring cardiopulmonary bypass for congenital heart disease who receive preoperative daily high dose vitamin D supplementation ( high-dose arm ) with those who receive  usual intake ( low-dose arm ) . Methods / Design Eligibility requirements include age ( > 36 weeks , < 18 years ) and a congenital heart defect requiring cardiopulmonary bypass surgical correction . Enrollment of 62 participants will take place at a single Canadian tertiary care center over a period of 2 years . Children r and omized to the high-dose group will receive age-based dosing that was informed by the Institute of Medicine ( IOM ) daily tolerable upper intake level ( < 1 year old = 1,600 IU/day , > 1 year old = 2,400 IU/day ) . Children in the low-dose arm will receive usual care based on IOM recommendations ( < 1 year old = 400 IU , > 1 year old = 600 IU ) . The primary outcome measure is immediate postoperative vitamin D status , using blood 25(OH)D. Discussion Maintaining adequate postoperative vitamin D levels following surgery could represent an effective therapy to speed recovery following CHD surgery . The proposed research project will determine whether preoperative supplementation with a dosing regimen based on the IOM recommended daily upper tolerable intake will prevent postoperative vitamin-D deficiency in the majority of children . The results will then be used to inform the design of a large international RCT exploring whether preoperative optimization of vitamin D status might improve short and long-term outcomes in this vulnerable population .Trial Registration Clinical trials.gov Identifier - NCT01838447 Date of registration : 11 April It is now generally accepted that vitamin D deficiency is a worldwide health problem that affects not only musculoskeletal health but also a wide range of acute and chronic diseases . However , there remains cynicism about the lack of r and omized controlled trials to support the association studies regarding the nonskeletal health benefits of vitamin D. This review was obtained by search ing English- language studies published up to April 1 , 2013 , in PubMed , MEDLINE , and the Cochrane Central Register of Controlled Trials ( search terms : vitamin D and supplementation ) and focuses on recent challenges regarding the definition of vitamin D deficiency and how to achieve optimal serum 25-hydroxyvitamin D concentrations from dietary sources , supplements , and sun exposure . The effect of vitamin D on fetal programming epigenetics and gene regulation could potentially explain why vitamin D has been reported to have such wide-ranging health benefits throughout life . There is potentially a great upside to increasing the vitamin D status of children and adults worldwide for improving musculoskeletal health and reducing the risk of chronic illnesses , including some cancers , autoimmune diseases , infectious diseases , type 2 diabetes mellitus , neurocognitive disorders , and mortality Introduction The extraskeletal role of vitamin D is being increasingly recognised . This has important clinical implication s , as vitamin D deficiency has reached epidemic proportions worldwide . Vitamin D has proposed anti-inflammatory properties , yet the role of vitamin D supplementation in reducing inflammation remains largely unknown . The purpose of this review is to investigate the impact of vitamin D supplementation on inflammation , and to identify relevant knowledge gaps in the field . Methods and analysis Medline , CINAHL , EMBASE and All EBM will be systematic ally search ed for r and omised controlled trials ( RCTs ) and systematic review s of RCTs , comparing vitamin D supplementation with placebo , usual care or other pharmacological or non-pharmacological interventions . One review er will assess articles for eligibility according to prespecified selection criteria , after which 2 independent review ers will perform data extraction and quality appraisal . Meta-analyses will be conducted where appropriate . Ethics and dissemination Formal ethical approval is not required as no primary data is collected . This systematic review will identify potential clinical implication s of vitamin D deficiency and supplementation , and will be disseminated through a peer- review ed publication and at conference meetings , to inform future research on the efficacy of vitamin D supplementation for inflammation and inflammatory diseases . PROSPERO registration number CRD42016037104 The anthropological record indicates that we are exposed to considerably less ultraviolet radiation ( required for the synthesis of vitamin D ) and consume considerably less calcium than did our early ancestors . Most U.S. citizens have calcium intakes and serum levels of vitamin D far below recommended values . This is despite there having been extensive evidence that optimal calcium and vitamin D intakes not only benefit our postcranial bone health but also have many other health benefits . Numerous articles indicate that vitamin D and calcium deficiencies result in bone loss and increased inflammation , which are well recognized symptoms of periodontal disease . For more than 40 years , investigators have suggested that calcium intake may be associated with alveolar bone resorption , and more recently there have been a number of studies in which investigators have suggested that calcium and vitamin D may benefit periodontal health , and it has been suggested that calcium deficiency may be a risk factor for periodontal disease . There has not , however , been a vitamin-D-calcium-periodontitis clinical trial in which r and omization and masking were carefully controlled , the periodontal disease status of patients known , periodontal disease measures were the primary outcomes , and levels of intake optimized to produce maximal effects . Such research might demonstrate that calcium and vitamin D are important adjuncts to st and ard treatments for preventing and treating periodontal disease National Institutes of Health ( NIH ) consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of 1 ) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality ( AHRQ ) , 2 ) presentations by investigators working in areas relevant to the conference questions during a 2-day public session , 3 ) questions and statements from conference attendees during open discussion periods that are part of the public session , and 4 ) closed deliberations by the panel during the remainder of the second day and the morning of the third . This statement is an independent report of the panel and is not a policy statement of the NIH or the federal government . The statement reflects the panel 's assessment of medical knowledge available at the time the statement was written . Thus , it provides a snapshot in time of the state of knowledge on the conference topic . When reading the statement , keep in mind that new knowledge is inevitably accumulating through medical research . At least half of American adults take a dietary supplement , the majority of which are multivitamin/multimineral ( MVM ) supplements . As more and more Americans seek strategies for maintaining good health and preventing disease , and as the marketplace offers an increasing number of products to fulfill that desire , it is important that consumers have the best possible information to make their choices . Assessing the available scientific evidence on the benefits of MVM supplement use for chronic disease prevention , identifying the gaps in the evidence , and recommending an appropriate research agenda to meet the shortfalls are subjects considered in this report . The word vitamine was coined in 1912 , as an abbreviated term meant to capture the notion of important factors in the diet , or vital amines . This was preceded more than 150 years earlier by British navy physician James Lind 's discoveryin the first recorded controlled trialthat citrus juice , a good source of what was found 2 centuries later to be vitamin C , could prevent scurvy in sailors . In 1913 , the first vitamin was isolated : thiamin , the deficiency of which caused beriberi . Thirteen vitamins and 15 essential minerals have now been identified as important to human nutrition . Large-scale fortification of diets began in the United States with the addition of iodine to table salt in 1924 to prevent goiter , followed by the addition of vitamin D to milk in 1933 to prevent rickets and the addition of thiamin , riboflavin , niacin , and iron to flour in 1941 . Multivitamin/multimineral products providing more than vitamins A and D became available in pharmacies and grocery stores in the mid-1930s . In the early 1940s , the first MVM tablet was introduced . Although clinical deficiency of vitamins or minerals , other than iron , is now uncommon in the United States , growth in supplement use has accelerated rapidly with marketing spurred by cl aims some based on scientific studies that chronic conditions could be prevented or treated by supplement use . Annual sales of supplements to Americans are now reported at about $ 23 billion , a substantial share of which is spent on vitamins and minerals . Because of such widespread use of MVM , increasing public and medical confusion over apparently contradictory results from studies , and reports of possible adverse effects from overuse in certain circumstances , the Office of Dietary Supplements and the Office of Medical Applications of Research of the NIH convened a State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention , held on 1517 May 2006 , in Bethesda , Maryl and . The goal of the conference was to assess the evidence available on MVM use and outcomes for chronic disease prevention in the generally healthy population of adults and to make recommendations for future research . The conference focused on vitamins and minerals and did not deal with botanicals , hormones , or other supplements . It also did not address the treatment of vitamin or mineral deficiencies . Except for considerations of safety , the conference also did not review issues of primary relevance to pregnant women or children . Specifically , the conference explored the following key questions : 1 ) What are the current patterns and prevalence of the public 's use of MVM supplements ? 2 ) What is known about the dietary nutrient intake of MVM users versus nonusers ? 3 ) What is the efficacy of single vitamin/mineral supplement use in chronic disease prevention ? 4 ) What is the efficacy of MVM  in chronic disease prevention in the general population of adults ? 5 ) What is known about the safety of MVM  for the generally healthy population ? and 6 ) What are the major knowledge gaps and research opportunities regarding MVM use ? During the first 2 days of the conference , experts presented information on each of the key questions . After weighing the scientific evidence , including the data presented by the speakers and a formal evidence report commissioned through AHRQ , an independent panel prepared and presented a draft of this state-of-the-science statement addressing the conference questions . The evidence report prepared for the conference is available at www.ahrq.gov/clinic/tp/multivittp.htm . For the purpose of this statement , the term MVM refers to any supplement containing 3 or more vitamins and minerals but no herbs , hormones , or drugs , with each component at a dose less than the tolerable upper level determined by the Food and Nutrition Boardthe maximum daily intake likely to pose no risk for adverse health effects . Our review also included studies of the relationship of single-nutrient supplements and 2-nutrient supplements to certain disease outcomes . The term primary prevention refers to preventing the development of disease in a person who does not have the disease in question . The chronic conditions assessed include cancer ; age-related sensory loss ; and cardiovascular , endocrine , neurologic , musculoskeletal , gastroenterologic , renal , and pulmonary diseases . A word is warranted about the nature of the evidence base considered by the panel . The range of vitamins and minerals of possible interest was so broad that the conference planning committee chose to focus the evidence report on nutrients for which the potential for impact had been most strongly suggested and on conditions for which supplements were thought to have the most potential influence . The planning committee also limited the scope of the evidence report to consideration of r and omized , controlled trials ( RCTs ) , which are generally considered the gold st and ard for evidence -based decision making . These are studies in which participants are allocated by chance alone to receive or not to receive 1 of 2 or more clinical interventions . For example , while folate supplementation was initially shown to decrease the risk for neural tube defects in animal studies , outcome data in nonhuman models were not considered sufficient evidence on which to base policy recommendations . At the next level of evidence , observational studies in humans suggested efficacy of folate supplementation to prevent such defects . However , these were criticized because they were not r and omized and were potentially subject to bias . Not until these findings were confirmed by RCTs in humans was public policy implemented , including fortification of cereal grains with folate . An observational study is one in which the exposure or treatment of interest is not assigned to the participant by the investigator . Such studies suggested that -carotene intake might protect against the development of some types of cancer . However , RCTs of -carotene supplementation not only showed no benefit , they also found an increased risk for lung cancer in persons who smoked cigarettes or who were exposed to asbestos . These examples illustrate both the risk of relying only on observational studies and the advantage of RCTs in identifying both benefits and risks of MVM supplementation . Limiting the focus of our statement to RCTs has some inherent limitations , given the potential of other types of studies to provide important insights . Observational studies , for example , are particularly useful for generating hypotheses , defining adverse effects , and documenting long-term treatment consequences . They are often essential precursors to the well-conducted RCTs important for policy formation . Our principal recommendations focus on the compelling research activities that must be supported to better inform the decisions that millions of Americans are making each day to use or not to use MVM supplements to prevent chronic disease . At the same time , mindful of the constraints of the available evidence base , we have also taken care not to make premature recommendations about whether generally healthy Americans should or should not take MVM supplements . Because of the need for more reliable information on MVMs , we have made strong recommendations for research and for increased U.S. Food and Drug Administration ( FDA ) oversight of the MVM industry . 1 . What Are the Current Patterns and Prevalence of the Public 's Use of MVM Supplements ? More than half of American adults take dietary supplements in the belief that they will make them feel better , give them greater energy , improve their health , and prevent and treat disease . The use of supplements has been steadily increasing , and growth appears likely to continue . Currently , users spend more than $ 23 billion per year on supplements , and among this supplement-using population , MVM is the major category of supplements , used by about one third of Americans . Uncertainty remains in estimating prevalence of use because of problems defining these products ; increasing complexity in the formulation of supplements , including more non-MVM components and specialized formulas ; and varying frequency of use . It appears that use is higher Introduction Optimal vitamin D status promotes skeletal health and is recommended with specific treatment in individuals at high risk for fragility fractures . A growing body of literature has provided indirect and some direct evidence for possible extraskeletal vitamin D-related effects . Purpose and Methods Members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis have review ed the main evidence for possible proven benefits of vitamin D supplementation in adults at risk of or with overt chronic extra-skeletal diseases , providing recommendations and guidelines for future studies in this field . Results and conclusions Robust mechanistic evidence is available from in vitro studies and in vivo animal studies , usually employing cholecalciferol , calcidiol or calcitriol in pharmacologic rather than physiologic doses . Although many cross-sectional and prospect i ve association studies in humans have shown that low 25-hydroxyvitamin D levels ( i.e. , < 50 nmol/L ) are consistently associated with chronic diseases , further strengthened by a dose-response relationship , several meta-analyses of clinical trials have shown contradictory results . Overall , large r and omized controlled trials with sufficient doses of vitamin D are missing , and available small to moderate-size trials often included people with baseline levels of serum 25-hydroxyvitamin D levels  > 50 nmol/L , did not simultaneously assess multiple outcomes , and did not report overall safety ( e.g. , falls ) . Thus , no recommendations can be made to date for the use of vitamin D supplementation in general , parental compounds , or non-hypercalcemic vitamin D analogs in the prevention and treatment of extra-skeletal chronic diseases . Moreover , attainment of serum 25-hydroxyvitamin D levels well above the threshold desired for bone health can not be recommended based on current evidence , since safety has yet to be confirmed . Finally , the promising findings from mechanistic studies , large cohort studies , and small clinical trials obtained for autoimmune diseases ( including type 1 diabetes , multiple sclerosis , and systemic lupus erythematosus ) , cardiovascular disorders , and overall reduction in mortality require further confirmation Background : Vitamin D is recognized as a pleiotropic hormone important for the functioning of organ systems , including those central to critical illness pathophysiology . Recent studies have reported associations between vitamin D status and outcome among critically ill adults and children . Preoperative vitamin D status , impact of operative techniques , and relationship between immediate postoperative vitamin D levels and clinical course have not been described in the pediatric congenital heart disease ( CHD ) population . The objective of this study was to describe the impact of CHD surgery on vitamin D status and relationship between postoperative levels and clinical course . Methods : A prospect i ve cohort study was conducted from 2009 to 2011 at a single tertiary care pediatric hospital . A total of 58 children with CHD were enrolled and  blood collected preoperatively , intraoperatively , and postoperatively .  Serum 25-hydroxyvitamin D ( 25OHD ) was measured using liquid chromatography – mass spectrometry . Results : The mean preoperative 25OHD was 58.0 nM ( SD , 22.4 ) , with 42 % being deficient ( < 50 nM ) . Postoperatively , we identified a 40 % decline in 25OHD to 34.2 nM ( SD , 14.5 ) with 86 % being deficient . Intraoperative measurements determined that initiation of cardiopulmonary bypass coincided with abrupt decline . CHD patients requiring catecholamines had lower postoperative 25OHD ( 38.2 vs. 26.5 nM , P = 0.007 ) , findings confirmed through multivariate logistic regression . Lower postoperative 25OHD was associated with increased fluid requirements and intubation duration . Conclusions : Most CHD patients are vitamin-D deficient postoperatively due to low preoperative levels and a significant intraoperative decline . Interventional studies will be required to determine whether prevention of postoperative vitamin D deficiency improves outcome Osteoporotic fractures , falls and obesity are major health problems in developed nations . Evidence suggests that there are antenatal factors predisposing to these conditions . Data are emerging from Australia and elsewhere to suggest that maternal vitamin D status in pregnancy affects intrauterine skeletal mineralisation and skeletal growth together with muscle development and adiposity . Given that low levels of vitamin D have been documented in many urbanised population s , including those in countries with abundant sunlight , an important issue for public health is whether maternal vitamin D insufficiency during pregnancy has adverse effects on offspring health . The developing fetus may be exposed to low levels of vitamin D during critical phases of development as a result of maternal hypovitaminosis D. We hypothesise that this may have adverse effects on offspring musculoskeletal health and other aspects of body composition . Further research focused on the implication s of poor gestational vitamin D nutrition is warranted as these developmental effects are likely to have a sustained influence on health during childhood and in adult life . We suggest that there is a clear rationale for r and omised clinical trials to assess the potential benefits and harmful effects of vitamin D supplementation during pregnancy Background Iron and vitamin D deficiencies are two of the most widespread nutritional disorders in the world . Our aim was to know whether the consumption of an iron-fortified fruit juice modifies bone remodelling and the possible influence of baseline vitamin D status on the recovery of iron status in a group of iron-deficient women . Methods  Iron biomarkers , 25-hydroxyvitamin D levels and dietary intake  were measured in 123 iron-deficient menstruating women . A subgroup ( n = 41 ) participated in a r and omised double-blind placebo-controlled study of 16-weeks during winter . They consumed a placebo fruit juice ( P ) or iron-fortified fruit juice ( F ) . Dietary intake , 25-hydroxyvitamin D , parathormone ( PTH ) , bone alkaline phosphatase ( ALP ) , aminoterminal telopeptide of collagen I ( NTX ) and iron biomarkers were determined . Results Ninety-two per cent of the iron-deficient women were vitamin D deficient or insufficient . Transferrin saturation and 25-hydroxyvitamin D were positively correlated . Iron status improved in F , 25-hydroxyvitamin D decreased in F and P , and PTH , ALP and NTX levels were within the normal range and did not vary . Women with 25-hydroxyvitamin D ≥ 50 nmol/L compared with 25-hydroxyvitamin D < 50 nmol/L showed a higher increase in transferrin saturation ( a marker of iron supply to tissues ) during iron recovery . Conclusion The prevalence of vitamin D deficiency or insufficiency is very high in iron-deficient women . The recovery of iron status by consuming an iron-fortified food does not affect 25-hydroxyvitamin D levels ; however , the increase in iron supply to tissues is lower if the women also present vitamin D deficiency . Although bone health does not seem to be affected in this group of women , correction of iron and vitamin D deficiencies should be promoted in young women to improve present and future health Introduction Maternal vitamin D status in pregnancy has been linked to many health outcomes in mother and offspring . A wealth of observational studies have reported on both obstetric outcomes and complications , including pre-eclampsia , gestational diabetes , mode and timing of delivery . Many foetal and childhood outcomes are also linked to vitamin D status , including measures of foetal size , body composition and skeletal mineralization , in addition to later childhood outcomes , such as asthma . Sources of data Synthesis of systematic and narrative review s. Areas of agreement and controversy The findings are generally inconsistent in most areas , and , at present , there is a lack of data from high- quality intervention studies to confirm a causal role for vitamin D in these outcomes . In most areas , the evidence tends towards maternal vitamin D being of overall benefit , but often does not reach statistical significance in meta-analyses . Growing points and areas timely for developing research The most conclusive evidence is in the role of maternal vitamin D supplementation in the prevention of neonatal hypocalcaemia ; as a consequence the UK department of health recommends that pregnant women take 400 IU vitamin D daily . High- quality r and omized placebo-controlled trials , such as the UK-based MAVIDOS trial , will inform the potential efficacy and safety of vitamin D supplementation in pregnancy across a variety of outcomes INTRODUCTION There is emerging evidence on the widespread tissue effects of vitamin D. AIMS To formulate a position statement on the role of vitamin D in postmenopausal women . MATERIAL S AND METHODS Literature review and consensus of expert opinion . RESULTS AND CONCLUSIONS Epidemiological and prospect i ve studies have related vitamin D deficiency with not only osteoporosis but also cardiovascular disease , diabetes , cancer , infections and neurodegenerative disease . However the evidence is robust for skeletal but not nonskeletal outcomes where data from large prospect i ve studies are lacking . The major natural source of vitamin D is cutaneous synthesis through exposure to sunlight with a small amount from the diet in animal-based foods such as fatty fish , eggs and milk . Vitamin D status is determined by measuring serum 25-hydroxyvitamin D [ 25(OH)D ] levels . Optimal serum 25(OH)D levels are in the region of 30 - 90 ng/mL ( 75 - 225 nmol/L ) though there is no international consensus . Levels vary according to time of the year ( lower in the winter ) , latitude , altitude , air pollution , skin pigmentation , use of sunscreens and clothing coverage . Risk factors for low serum 25(OH)D levels include : obesity , malabsorption syndromes , medication use ( e.g. anticonvulsants , antiretrovirals ) , skin aging , low sun exposure and those in residential care . Fortified foods do not necessarily provide sufficient amounts of vitamin D. Regular sunlight exposure ( without sunscreens ) for 15 min , 3 - 4 times a week , in the middle of the day in summer generate healthy levels . The recommended daily allowance is 600 IU/day increasing to 800 IU/day in those aged 71 years and older . Supplementation can be undertaken with either vitamin D2 ( ergocalciferol ) or vitamin D3 ( cholecalciferol ) with monitoring depending on the dose used and the presence of concomitant medical conditions such as renal disease Abstract Incidence of vitamin D deficiency is increasing worldwide . The purpose of this study was to determine if supplementation with vitamin D2 from Portobello mushroom powder would enhance skeletal muscle function and attenuate exercise-induced muscle damage in low vitamin D status high school athletes . Participants were r and omised to Portobello mushroom powder ( 600 IU/d vitamin D2 ) or placebo for 6 weeks . Participants then completed a 1.5-h exercise session design ed to induce skeletal muscle damage . Blood sample s and measures of skeletal muscle function were taken pre-supplementation , post-supplementation/pre-exercise and post-exercise . Six weeks supplementation with vitamin D2 increased serum 25(OH)D2 by 9.9-fold and decreased serum 25(OH)D3 by 28 % . Changes in skeletal muscle function and circulating markers of skeletal muscle damage did not differ between groups . In conclusion , 600 IU/d vitamin D2 increased 25(OH)D2 with a concomitant decrease in 25(OD)D3 , with no effect on muscular function or exercise-induced muscle damage in high school athletes Objectives : To measure prevalence of vitamin D deficiency in Saudi Arabia , unveil the life style , nutritional habits and status , as well as identify the potential risk factors . Method : A school-based survey targeting Saudi school students and employees was conducted during the period from 2013 to 2014 using multistage cluster r and om sample in Central , Western and Eastern regions . The prevalence of vitamin D deficiency and difference between various population subgroups were calculated . Logistic regression analysis was used to determine the predictors of potential risk factors . Results : Prevalence of vitamin D deficiency was 49.5 % in students and 44 % in employees .  Life style was not adequate to protect against vitamin D depletion . Unhealthy nutritional habits were widespread , some manifested in childhood while others manifested later in life . Living in the Eastern region , females , 16 - 19 years of age , low economic class , obese and lack of omega 3 supplements were risk factors in students . Employees living in the Eastern region , females , middle-income class , carbonated soft drink consumers , and lack of multivitamin supplements were at higher risk . Conclusion : There is a need for a health awareness program using evidence -based recommendations . Screening for early detection and correction of the condition should be proposed to be part of the national health strategy . There is need for identifying the burden of vitamin D deficiency on other diseases to control and improve the prognosis of these conditions BACKGROUND Current underst and ing of the etiology of autism is based on the interaction of multiple genes with each other and with environmental factors , leading to a neurodevelopmental process that results in the expression of autism spectrum disorder ( ASD ) in the child . This suggests that it might be possible to strengthen resilience to environmental stressors during the perinatal period to improve outcomes and possibly prevent the development of ASD . METHODS We search ed the MEDLINE data base for multiple perinatal factors associated with the development of ASD published between January 1 , 2005 and July 1 , 2018 . The search terms used were " autism " crossed with either " perinatal , " " prenatal , " " gestational , " or " pregnancy , " and crossed again with each perinatal risk factor highlighted in this review including topics on parental health , infections , medications , and environmental stressors . We then search ed interventions that may improve neurodevelopmental outcome before and during pregnancy , including supplements , breastfeeding , and postpartum stress reduction . We identified recent or unique metanalyses and systematic review s of the identified focus and on r and omized controlled trials and summarized these using the most recent and comprehensive review s. RESULTS Folate , omega-3 , vitamin D3 , environmental toxin avoidance , correcting deficiencies , immune boosting , and prolonged breast feeding are all reported to be linked to the possible reduction of adverse pregnancy outcomes including ASD . CONCLUSIONS Studies of individual components for improving pregnancy outcomes and several uncontrolled preconception to infancy medical practice s suggest that multiple interventions might improve the outcomes of pregnancies where there is risk for developing ASD Background The prevalence of vitamin D deficiency among patients with cancer has been previously reported . Because vitamin D is fat soluble , patients with pancreatic adenocarcinoma may have an especially high risk of vitamin D deficiency in association with ongoing and varying degrees of malabsorption . However , little is known about the correlation between vitamin D status and prognosis in these patients . Methods We conducted a retrospective review of vitamin D status in patients with pancreatic adenocarcinoma who were treated at Siteman Cancer Center . Patients ’ demographic information , clinical staging at the time of vitamin D assessment , vitamin D levels , and survival data were collected . Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D ( 25[OH]D ) level of less than 20 ng/mL , and vitamin D insufficiency was defined as a 25(OH)D level of between 20 ng/mL and 30 ng/mL. Results Between December 2007 and June 2011 , 178 patients with pancreatic adenocarcinoma had their vitamin D levels checked at the time of initial visit at this center . Of these 178 patients , 87 ( 49 % ) had vitamin D deficiency , and 44 ( 25 % ) had vitamin D insufficiency . The median 25(OH)D level was significantly lower among nonwhite patients and among patients with stage I and II disease . A 25(OH)D level of less than 20 ng/mL was found to be associated with poor prognosis ( p = 0.0019 ) in patients with stage III and IV disease . Conclusions  Vitamin D insufficiency and deficiency were prevalent among patients with pancreatic adenocarcinoma . The  vitamin D level  appears to be prognostic for patients with advanced pancreatic adenocarcinoma , and its effects should be further examined in a prospect i ve study Vitamin D functions are not limited to skeletal health benefits and may extend to preservation of insulin secretion and insulin sensitivity . This review summarizes the literature related to potential vitamin D influences on glucose homeostasis and insulin sensitivity . Cross-sectional data provide some evidence that circulating 25-hydroxyvitamin D ( 25(OH)D ) is inversely associated with insulin resistance , although direct measurements of insulin sensitivity are required for confirmation . Reported associations with insulin secretion , however , are contradictory . Available prospect i ve studies support a protective influence of high 25(OH)D concentrations on type 2 diabetes mellitus risk . There is a general lack of consistency in vitamin D intervention outcomes on insulin secretion and sensitivity , likely due to differences in subject population s , length of interventions , and forms of vitamin D supplementation . Vitamin D receptor gene polymorphisms and vitamin D interactions with the insulin like growth factor system may further influence glucose homeostasis . The ambiguity of optimal vitamin D dosing regimens and optimal therapeutic concentrations of serum 25(OH)D limit available intervention studies . Future studies , including cross-sectional and prospect i ve , should be performed in population s at high risk for both vitamin D deficiency and type 2 diabetes mellitus . Well- design ed , placebo-controlled , r and omized intervention studies are required to establish a true protective influence of  vitamin D on glucose homeostasis Very frail older people constitute an increasing proportion of ageing population s and often have vitamin D deficiency . Falls are frequent in this population and have usually been associated with vitamin D deficiency . In this prospect i ve study we measured serum 25-hydroxyvitamin D ( 25OHD ) , serum PTH , and falls in 637 ambulatory subjects living in institutional aged care facilities ( intermediate-care hostels or nursing homes ) . The study sample comprised 121 men ( mean age , 82.1 yr ) and 516 women ( mean age , 86.7 yr ) . Two hundred and seventy-four subjects fell one or more times over a mean duration of follow-up of 10.2 months . Vitamin D deficiency , defined as a serum 25OHD level below 39 nmol/liter was present in 73.6 % . Baseline serum 25OHD and PTH were significantly associated with falls in univariate analyses . In multivariate analyses that also corrected for balance and health status , PTH remained a significant predictor of falls independent of 25OHD . Serum PTH is a predictor of time to first fall in the frail elderly independent of vitamin D status and measures of general health OBJECTIVE To assess the prevalence of vitamin B(12 ) deficiency in persons with spinal cord injury ( SCI ) or disease ( SCD ) . DESIGN Cross-sectional study with prospect i ve blood collection and retrospective medical record review . SETTING Regional Veterans Affairs SCI service . PARTICIPANTS One hundred six adult men with chronic SCI or SCD and without other acute medical or surgical complications ; most had SCI or SCD due to trauma or cervical spinal stenosis . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  Fasting blood sample s were obtained at annual evaluation for serum B(12 ) , folic acid , methylmalonic acid ( MMA ) , and homocysteine . Serum levels were analyzed graphically and associated with patient variables by using statistical tests . RESULTS The vitamin B(12 ) level was subnormal in 5.7 % of subjects ; of those , all had supranormal MMA levels , all were age 40 to 59 , most had complete SCI , and 67 % had symptoms suggestive of B(12 ) deficiency . Low-normal B(12 ) levels were associated with a high prevalence of supranormal MMA . Subjects with either subnormal B(12 ) or low normal B(12 ) with supranormal MMA , both suggestive of vitamin B(12 ) deficiency , comprised 13.3 % of the total group of subjects . CONCLUSION Vitamin B(12 ) deficiency is most common in middle-aged SCI or SCD persons with complete or near-complete spinal cord involvement ( ie , American Spinal Injury Association class A-C injuries ) . Treatment with either parenteral or oral B(12 ) replacement may optimize health and prevent irreversible neuropsychiatric complications in those with subnormal and low-normal B(12 ) levels OBJECTIVE Suboptimal mitochondrial function has been implicated in several disorders in which fatigue is a prominent feature . Vitamin D deficiency is a well-recognized cause of fatigue and myopathy . The aim of this study was to examine the effects of cholecalciferol therapy on skeletal mitochondrial oxidative function in symptomatic , vitamin D-deficient individuals . DESIGN This longitudinal study assessed mitochondrial oxidative phosphorylation in the gastrosoleus compartment using phosphorus-31 magnetic resonance spectroscopy measurements of phosphocreatine recovery kinetics in 12 symptomatic , severely vitamin D-deficient subjects before and after treatment with cholecalciferol .  All subjects had serum assays before and after cholecalciferol therapy to document serum 25-hydroxyvitamin D ( 25OHD ) and bone profiles . Fifteen healthy controls also underwent (31)P-magnetic resonance spectroscopy and serum 25OHD assessment . RESULTS The phosphocreatine recovery half-time ( τ1/2PCr ) was significantly reduced after cholecalciferol therapy in the subjects indicating an improvement in maximal oxidative phosphorylation ( 34.44 ± 8.18 sec to 27.84 ± 9.54 sec , P < .001 ) . This was associated with an improvement in mean serum 25OHD levels ( 8.8 ± 4.2 nmol/L to 113.8 ± 51.5 nmol/L , P < .001 ) . There was no difference in phosphate metabolites at rest . A linear regression model showed that decreasing serum 25OHD levels was associated with increasing τ1/2PCr ( r = -0.41 , P = .009 ) . All patients reported an improvement in fatigue  after cholecalciferol therapy . CONCLUSIONS Cholecalciferol therapy augments muscle mitochondrial maximal oxidative phosphorylation after exercise in symptomatic , vitamin D-deficient individuals . This finding suggests that changes in mitochondrial oxidative phosphorylation in skeletal muscle could at least be partly responsible for the fatigue experienced by these patients . For the first time , we demonstrate a link between vitamin D and the mitochondria in human skeletal muscle
In conclusion , this review supports the hypothesis that hypovitaminosis D is associated with adverse outcomes after diverse surgical procedures .
The importance of vitamin D for musculoskeletal health has long been recognized , and awareness of significant extra-skeletal effects in health and disease is rapidly emerging .
Although it has been possible for many decades to quantify serum markers of vitamin D deficiency , and to correct deficiency at low cost and with high safety , the influence of vitamin D status on post-surgical outcomes has only recently been identified as a research topic of interest .
To the present , these data have not been the subject matter of formal review .
Accordingly , we conducted a systematic review to assess the association between perioperative vitamin D status and outcomes after surgery .