Pilot Study Evaluating Efficacy of 2 Regimens for Hypovitaminosis D Repletion in Pediatric Inflammatory Bowel Disease Impact of dietary and lifestyle on vitamin D in healthy student girls aged 11-15 years. Higher serum 25-hydroxyvitamin D concentrations are associated with active pulmonary tuberculosis in hospitalised HIV infected patients in a low income tropical setting: a cross sectional study Association of low serum 25-hydroxyvitamin D levels and high arterial blood pressure in the elderly. Vitamin D status in healthy Moroccan men and women aged 50 years and older: a cross-sectional study Treatment of hypovitaminosis D in infants and toddlers. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. Hypovitaminosis D in the Middle East and North Africa Effectiveness of Prenatal Vitamin D Deficiency Screening and Treatment Program: A Stratified Randomized Field Trial Impact of cholecalciferol treatment on biomarkers of inflammation and myocardial structure in hemodialysis patients without hyperparathyroidism.
Objectives : Vitamin D is critical for skeletal health ; hypovitaminosis D is common in pediatric inflammatory bowel disease ( IBD ) , yet optimal repletion therapy is not well studied . We aim ed to conduct a pilot trial comparing the efficacy of 2 vitamin D regimens of weekly dosing for the repletion of hypovitaminosis D in pediatric IBD . Methods : Subjects identified from our IBD clinic with 25-hydroxyvitamin D ( 25[OH]D ) concentrations < 30 ng/mL were r and omized to 10,000 ( n = 18 ) or 5000 ( n = 14 ) IU of oral vitamin D3/10 kg body weight per week for 6 weeks  . Serum 25(OH)D , Ca , and parathyroid hormone concentrations were measured at baseline , week 8 , and week 12 . Results : In the higher dosing group , serum 25(OH)D increased from 23.7 ± 8.5 ng/mL at baseline to 49.2 ± 13.6 ng/mL at 8 weeks ; P < 0.001 . In the lower dosing group , serum 25(OH)D increased from 24.0 ± 7.0 ng/mL at baseline to 41.5 ± 9.6 ng/mL at 8 weeks ; P < 0.001 . At 12 weeks , serum 25(OH)D concentrations were 35.1 ± 8.4 and 30.8 ± 4.2 ng/mL for the higher and lower dose regimens , respectively . Mean serum Ca and parathyroid hormone concentrations did not significantly change during the study . No patient exhibited hypercalcemia , and no serious adverse events occurred . Conclusions : Both treatment arms were safe and effective at normalizing vitamin D nutriture in pediatric IBD . Although significant repletion of 25(OH)D concentration was achieved in both dosing groups at 8 weeks , this effect was lost by the 12-week follow-up . Maintenance vitamin D therapy following initial repletion is likely required to maintain long-term normalized vitamin D status OBJECTIVE To study daily intake of calcium , phosphorus and vitamin D , to determine the biochemical findings of rickets and the effect of sunlight exposure and vitamin D supplementation in school girls with hypovitaminosis D. METHODS A cross-sectional study was conducted on school girls aged 11 - 15 years selected r and omly from various areas of Tehran , Iran .  Dietary information and amount of sunlight exposure were estimated by a 7 day recalling method using self-reported question naire . Hypovitaminosis D defined as low serum 25-hydroxyvitamin D concentration with two or more others abnormal biochemical findings . Girls with hypovitaminoses D were r and omly divided into two groups . The faces and h and s of girls in group 1 were exposed to sunlight for one hour per day for twenty days , while those in group 2 were administered vitamin D capsules , 50,000 IU per day for the same period . RESULTS four-hundred fourteen girls evaluated , mean daily calcium intake , sunlight exposure and vitamin D acquirement were 360 mg , 10 minutes and 119 IU , respectively . Mean serum 25-hydroxyvitamin D concentration was 30 ng/ml among all girls whereas in 15 ( 3.63 % ) of 414 girls was 7.8 ng/ml . Abnormal biochemical findings in these girls included hypocalcemia ( n=4 ) , hypophosphatemia ( n=5 ) , raised serum alkaline phosphatase ( n=13 ) , and parathyroid hormone ( n=15 ) . After intervention , mean serum 25-hydroxyvitamin D concentration  in sunlight exposure ( n=8 ) and vitamin D ( n=7 ) supplementation increased to 14.4+/-4 ng/ml and 23+/-4 ng/ml respectively . There was a significant difference between the two groups ( p<0.05 ) . CONCLUSION Vitamin D deficiency developed in rapid growth period of girls without clear clinical rickets in sunny temperate climate city in Iran which vitamin D supplementation improved biochemical findings better than sunlight exposure Background The inherent risk of developing tuberculosis ( TB ) in HIV- infected individuals is further enhanced by hypovitaminosis D. Interventions that offset HIV-associated immune deterioration potentially arrest disease progression and incidence of opportunistic infections including TB . Despite conflicting reports on association between vitamin D deficiency ( VDD ) and risk of TB , vitamin D ( VD ) supplementation remains a promising intervention . Methods We conducted a comparative cross-sectional study on 145 HIV+/pulmonary TB+ ( PTB ) and 139 HIV+/PTB− hospitalised patients to investigate association of vitamin D status and risk of PTB . Stratified r and om sampling was used to select archived serum specimens from participants enrolled in a r and omised controlled trial ( RCT ) conducted to investigate the impact of using a point-of-care urine lipoarabinomannan strip test for TB diagnosis . PTB status was confirmed using sputum smear microscopy , culture or GeneXpert MTB/RIF .  Serum 25-hydroxyvitamin D [ 25(OH ) D ] concentrations  were assayed by competitive chemiluminescent immunoassay prior to commencement of anti-TB treatment . Effect of VD status on duration of hospital stay and patient outcomes on follow up at 8 weeks were also investigated . Median serum 25(OH ) D concentrations were compared using Mann-Whitney test and covariates of serum VD status were assessed using logistic regression analysis . Results Overall VDD prevalence in the cohort was 40.9 % ( 95 % CI : 35.1–46.8 ) . Median serum 25(OH)D concentrations were significantly higher in HIV+/PTB+ group ( 25.3 ng/ml , IQR:18.0–33.7 ) compared to the HIV+/PTB− group ( 20.4 ng/ml , IQR:14.6–26.9 ) , p = 0.0003 . Patients with serum 25(OH ) D concentration ≥ 30 ng/ml were 1.9 times more likely to be PTB+ compared to those with serum 25(OH ) D concentrations < 30 ng/ml ( odds ratio ( OR ) 1.91 ; 95 % CI 1.1–3.2 ) . PTB-related death was associated with higher odds of having 25(OH ) D levels≥30 ng/ml . Age , gender , CD4 + count , combination antiretroviral therapy ( cART ) status , efavirenz based cART regimen and length of hospital stay were not associated with vitamin D status . Conclusions The finding of an association between higher serum 25(OH ) D concentrations and active PTB and TB-related mortality among hospitalised HIV-infected patients in the present study is at variance with the commonly reported association of hypovitaminosis and susceptibility to TB . Our findings though , are in concordance with a small pool of reports from other setting BACKGROUND Vitamin D and calcium metabolism are involved in vascular smooth muscle cell proliferation , endothelial function and blood pressure ( BP ) regulation . Their physiopathology has been a matter of intensive clinical investigation with variable and sometimes contradictory results . Vitamin D insufficiency is highly prevalent in the general population , particularly among the elderly . We evaluated the association between serum 25(OH)-D levels and arterial BP in this population . METHODS An epidemiological cross-sectional study was design ed to analyse the prevalence of hypovitaminosis D ( ' D'AVIS ' study ) in our reference area . The study was performed on a representative r and om sample of the population over 64 years of age obtained from five primary health care areas . A medical record , arterial BP and biological analysis : serum 25(OH)-D , iPTH , creatinine , urea , calcium , albumin were obtained . RESULTS A total of 237 subjects ( 53 % women ) , aged between 64 and 93 ( mean 71.7 + /- 5.3 ) , were evaluated . The mean serum 25(OH)-D levels were 17.21 + /- 7.57 ng/ml ( interval 5 - 54 ; 86 % had < 25 ng/ml ) . The mean BP was 138.8 + /- 14/80 + /- 7.4 mmHg , and 46 % were on antihypertensive treatment . A significant negative association was observed between serum 25(OH)-D levels and systolic ( r = -0.153 , P = 0.018 ) and diastolic BP ( r = -0.152 , P = 0.019 ) . This association persisted after controlling for possible confounders in the multivariate analyses . CONCLUSIONS Low serum 25(OH)-D levels were inversely and independently associated with BP . Supplemental measures to prevent hypovitaminosis D in this population would be important , not only to protect the skeletal system but also for the possible beneficial effects on the cardiovascular system and the BP regulation Summary This study aim ed to compare the  vitamin D status  in healthy Moroccan men and women aged 50 years and older . A total of 186 Moroccan women and 68 men , who had no previous diagnosis of osteoporosis , were recruited prospect ively . We found in this study a high prevalence of hypovitaminosis D with no difference between men and women . Purpose The main purpose of this study was to describe and compare the  vitamin D status , parathormone , calcium , and phosphate  of healthy Moroccan men and women aged 50 years and older . Methods We conducted two cross-sectional studies , in postmenopausal women from October 2008 to November 2009 and in men over 50 years old , from December 2009 to August 2010 . A total of 186 Moroccan women and 68 men , who had no previous diagnosis of osteoporosis , were recruited prospect ively . For the definition of hypovitaminosis D , the preferred level for 25-hydroxyvitamin D ( 25(OH)D ) insufficiency , which is now recommended by many experts , is 30 ng/mL ( 75 nmol/L ) , and the levels below 10 ng/ml ( 25 nmol/L ) indicate deficiency . Results The prevalence of vitamin D deficiency in men and women was 4.4 and 8.6 % , respectively , and the prevalence of vitamin D(25(OH ) D ) insufficiency in men and women were 85.2 and 77.4 % , respectively . In men and women , no correlations were found between intact parathormone ( PTHi ) and 25(OH ) D ( r = 0.056 ) . Conclusions Despite a sunny environment , we found in this study a high prevalence of hypovitaminosis D ( insufficiency + deficiency ) in Moroccan men over 50 years old and postmenopausal women CONTEXT Hypovitaminosis D appears to be on the rise in young children , with implication s for skeletal and overall health . OBJECTIVE The objective of the study was to compare the safety and efficacy of vitamin D2 daily , vitamin D2 weekly , and vitamin D3 daily , combined with supplemental calcium , in raising serum 25-hydroxyvitamin D [ 25(OH)D ] and lowering PTH concentrations . DESIGN This was a 6-wk r and omized controlled trial . SETTING The study was conducted at an urban pediatric clinic in Boston . SUBJECTS Forty otherwise healthy infants and toddlers with hypovitaminosis D [ 25(OH)D < 20 ng/ml ] participated in the study . INTERVENTIONS Participants were assigned to one of three regimens : 2,000 IU oral vitamin D2 daily , 50,000 IU vitamin D2 weekly , or 2,000 IU vitamin D3 daily . Each was also prescribed elemental calcium ( 50 mg/kg.d ) . Infants received treatment for 6 wk . MAIN OUTCOME MEASURES Before and after treatment , serum measurements of 25(OH)D , PTH , calcium , and alkaline phosphatase were taken . RESULTS All treatments approximately tripled the 25(OH)D concentration . Preplanned comparisons were nonsignificant : daily vitamin D2 vs. weekly vitamin D2 ( 12 % difference in effect , P = 0.66 ) and daily D2 vs. daily D3 ( 7 % , P = 0.82 ) . The mean serum calcium change was small and similar in the three groups . There was no significant difference in PTH suppression . CONCLUSIONS Short-term vitamin D2 2,000 IU daily , vitamin D2 50,000 IU weekly , or vitamin D3 2,000 IU daily yield equivalent outcomes in the treatment of hypovitaminosis D among young children . Therefore , pediatric providers can individualize the treatment regimen for a given patient to ensure compliance , given that no difference in efficacy or safety was noted among these three common treatment regimens CONTEXT Public health authorities around the world recommend widely variable supplementation strategies for adults , whereas several professional organizations , including The Endocrine Society , recommend higher supplementation . METHODS We analyzed published r and omized controlled clinical trials to define the optimal intake or vitamin D status for bone and extraskeletal health . CONCLUSIONS The extraskeletal effects of vitamin D are plausible as based on pre clinical data and observational studies . However , apart from the beneficial effects of 800 IU/d of vitamin D3 for reduction of falls in the elderly , causality remains yet unproven in r and omized controlled trials ( RCTs ) . The greatest risk for cancer , infections , cardiovascular and metabolic diseases is associated with 25-hydroxyvitamin D ( 25OHD ) levels below 20 ng/mL. There is ample evidence from RCTs that calcium and bone homeostasis , estimated from serum 1,25-dihydroxyvitamin D and PTH , calcium absorption , or bone mass , can be normalized by 25OHD levels above 20 ng/mL. Moreover , vitamin D supplementation ( 800 IU/d ) in combination with calcium can reduce fracture incidence by about 20 % . Such a dose will bring serum levels of 25OHD above 20 ng/mL in nearly all postmenopausal women . Based on calculations of the metabolic clearance of 25OHD , a daily intake of 500 - 700 IU of vitamin D3 is sufficient to maintain serum 25OHD levels of 20 ng/mL. Therefore , the recommendations for a daily intake of 1500 - 2000 IU/d or serum 25OHD levels of 30 ng or higher for all adults or elderly subjects , as suggested by The Endocrine Society Task Force , are premature . Fortunately , ongoing RCTs will help to guide us to solve this important public health question Background : The Middle East and North Africa ( MENA ) region registers some of the highest rates of hypovitaminosis D worldwide . Aim : We systematic ally review ed the prevalence of hypovitaminosis D , rickets and osteomalacia , their predictors and impact on major outcomes , in the region . Methods : Medline , Pubmed and Embase search engines , entering keywords and concepts , combined with individual countries of interest , were used . Search was limited years 2000–2012 ; and review articles were used for the period preceding year 2000 . Results : Rickets and osteomalacia still occur in this sunny region . Hypovitaminosis D prevails , with rates varying 30–90 % , considering a desirable serum 25 hydroxy-vitamin D [ 25(OH)D ] of 20 ng/ml . Advancing age , female gender , multi-parity , clothing style , season , socio-economic status and urban living are recognized predictors of hypovitaminosis D in adults . Prolonged breastfeeding without vitamin D supplementation and low dietary calcium intake are the recognized risk factors for rickets and hypovitaminosis D in children .. Associations with pain score and disease activity in rheumatologic disorders , viral load and interleukins in hepatitis C , BMI , lipids and insulin sensitivity , blood pressure , heart failure and mortality are described . Sun exposure in adults decreased prevalence of metabolic syndrome in one study . Few r and omized vitamin D trials revealed that the majority of mothers or children failed to achieve a desirable 25(OH)D level , even with doses by far exceeding current recommendations . A trial in adolescent girls reveals substantial bone and lean mass increments . Conclusion : Hypovitaminosis D is prevalent in MENA . The lack of population s based studies , gaps in studies in infants , pre-pubertal children and pregnant women , hinder the development of region specific guidelines and constitute a major obstacle to impact this chronic and most often sub clinical disease Context Despite evidence on the association between hypovitaminosis D and adverse pregnancy outcomes and the positive impact of vitamin D supplementation , no evidence exists supporting a universal screening program in pregnancy as part of routine prenatal care . Objective We sought to determine the effectiveness of a prenatal screening program on optimizing 25-hydroxyvitamin D [ 25(OH)D ] levels and preventing pregnancy complications . Also , to identify a safe regimen , we compared several regimens in a subgroup of vitamin D-deficient pregnant women . Design Two cities of Masjed-Soleyman and Shushtar from Khuzestan province , Iran , were selected as the screening and nonscreening arms , respectively . Within the screening arm , a r and omized controlled trial was conducted on 800 pregnant women . Setting Health centers of Masjed-Soleyman and Shushtar cities . Patients or Participants Pregnant women aged 18 to 40 years . Intervention Women with moderate [ 25(OH)D , 10 to 20 ng/mL ] and severe [ 25(OH)D , < 10 ng/mL ] deficiency were r and omly divided into four subgroups and received vitamin D3 ( D3 ) until delivery . Main Outcome Measure Maternal concentration of 25(OH)D at delivery and rate of pregnancy complications . Results After supplementation , only 2 % of the women in the nonscreening site met the sufficiency level ( > 20 ng/mL ) vs 53 % of the women in the screening site . Adverse pregnancy outcomes , including preeclampsia , gestational diabetes mellitus , and preterm delivery , were decreased by 60 % , 50 % , and 40 % , respectively , in the screening site . A D3 injection in addition to monthly 50,000 IU maintenance therapy contributed the most to achievement of sufficient levels at delivery . Conclusions A prenatal vitamin D screening and treatment program is an effective approach in detecting deficient women , improving 25(OH)D levels , and decreasing pregnancy adverse outcomes INTRODUCTION Vitamin D ( 25-hydroxyvitamin D , 25(OH)D ) deficiency , hypovitaminosis D , is highly prevalent in chronic kidney disease patients and is potentially involved with complications in the hemodialysis ( HD ) population . The aim of this study was to evaluate the impact of cholecalciferol supplementation on biomarkers of mineral metabolism , inflammation , and cardiac function in a group of HD patients presenting with hypovitaminosis D and low intact parathyroid hormone ( iPTH ) levels . MATERIAL AND METHODS HD patients with iPTH levels of < 300 pg/mL , not receiving vitamin D therapy , and presenting with 25(OH)D levels of < 30 ng/mL were enrolled in this prospect i ve study . Oral cholecalciferol was prescribed once a week in the first 12 weeks ( 50,000 IU ) and in the last 12 weeks ( 20,000 IU ) of the study . High-sensitivity C-reactive protein , interleukin-6 , and serum albumin were used as inflammatory markers .  Echocardiograms were performed on a midweek interdialytic day at baseline and after 6 months of cholecalciferol supplementation . RESULTS In all , 30 patients were included in the final analysis . We observed a significant increase in serum 25(OH)D levels after 3 months ( 46.2 ± 14.4 ng/mL vs. 18.1 ± 6.6 ng/mL ; P < .001 ) and after 6 months ( 40.4 ± 10.4 ng/mL vs. 18.1 ± 6.6 ng/mL ; P < .001 ) of cholecalciferol supplementation . There were no significant changes in alkaline phosphatase , iPTH , phosphorus , and serum albumin levels , but there was a slight but significant increase in calcium levels after 6 months of cholecalciferol supplementation ( 9.4 ± 0.6 mg/dL vs. 9.0 ± 0.6 mg/dL ; P = .02 ) . Additionally , we observed a significant reduction in high-sensitivity C-reactive protein levels after 3 months ( median : 0.62 [ 0.05 to 29.6 ] mg/L vs. 0.32 [ 0.02 to 3.13 ] mg/L ; P = .02 ) and after 6 months ( median : 0.62 [ 0.05 to 29.6 ] mg/L vs. 0.50 [ 0.02 to 5.66 ] mg/L ; P = .04 ) of cholecalciferol supplementation , as well as a significant reduction in interleukin-6 levels ( median : 6.44 pg/mL vs. 3.83 pg/mL ; P = .018 ) after 6 months of supplementation . Left ventricular mass index was significantly reduced at the end of supplementation ( 159 ± 55 g/m(2 ) vs. 175 ± 63 g/m(2 ) ; P = .03 ) . CONCLUSIONS Cholecalciferol supplementation in HD patients was found to be safe and efficient to correct hypovitaminosis D and established little impact on mineral metabolism markers . Additionally , we observed a reduction in important surrogate markers of cardiovascular risk , namely systemic inflammation and left ventricular hypertrophy , suggesting an anti-inflammatory action and possibly an improvement of cardiac dysfunction
Neither latitude , region of the world , nor laboratory methodology were found to be associated with the prevalence of hypovitaminosis
BACKGROUND Hypovitaminosis D is considered a global public health issue .
Knowledge of its true dimensions will allow us to design interventions and plan preventive measures that can have a significant impact on human health .
OBJECTIVES The aim of this study was to evaluate the prevalence of hypovitaminosis D , defined as a serum 25-hydroxyvitamin D concentration < 30 ng/ml , in postmenopausal women around the world , as well as to identify the potential associated factors .