Frequency of Hypovitaminosis D in 6 - 59 Month Children with Severe Malaria in the Pediatrics Unit of the Teaching Hospital of Parakou (CHUD/BA) in Benin in 2016

Introduction: Vitamin D’s action outside of bone, especially on immunity, is widely reported in the international scientific literature over the last years. Objective: Calculate the frequency of hypovitaminosis D in children aged 6 to 59 months suffering from severe malaria in the CHUD-P pediatric unit in 2016. Setting and Methods: This research work is a cross-sectional study with descriptive and analytical purposes. Data gathering was prospective. The study involved children aged 6 to 59 months hospitalized for severe malaria in the CHUD-P pediatric unit. The said children were HIV-uninfected, eutrophic and had not received vitamin D supplementation during the last 6 months. Vitamin D dose was measured using the High Performance Liquid Chromatography (HPLC) technique. Results: A total of 80 subjects were involved in the survey. Mean age was 26.08 months, sex ratio was 0.8 and average weight was 10.80 kg. Hypovitaminosis D frequency was 83.8% (67 cases out of 80 children investigated during the survey) with an average plasma concentration of vitamin D estimated at 21.57 ng/ml ± 7.34 with two extremes (11.24 - 42.32) ng/ml. The minimum parasitaemia was 202 P/μl and the maximum was 580,000 P/μl. Conclusion: Hypovitaminosis D is common in children suffering from severe malaria;this result suggests conducting a large-scale community-based study to decide on vitamin D inclusion in national supplementation policies and severe malaria management.

Hypovitaminosis D in 6 - 59-Month Children in the District of Parakou (Benin) in 2017

Introduction: Nutritional rickets is the visible tip of the iceberg formed by the diseases caused by hypovitaminosis. Vitamin D plasma is essentially influenced by the level of sunlight which is significant in Sub-Saharan Africa and in Benin. However, there are factors likely to impede endogenous production of that vitamin in children in our environment. This research work was conducted with the view to investigate hypovitaminosis D prevalence and associated factors in children aged 6 to 59 months in the District of Parakou in 2017. Methods: This research work was a cross-sectional study with prospective collection of data carried out in community in the District of Parakou in 2017. The study involved euthrophic and non-HIV infected children aged 6 to 59 months who did not benefit from vitamin D supplementation during the past three months. Vitamin D plasma concentration was obtained using “Radioimmunoassay” after cluster random sampling in accordance with WHO guidelines. According to Schwartz formula, nominal minimum sample size was 321. In this study, hypovitaminosis D was defined as a plasma level lower than 30 ng/l. Data processing was carried out using softwares such as EPI INFO version 7.2 and SPSS 21. Results: In total, 400 children were involved in the survey. Hypovitaminosis prevalence was 9.5% (38 out of 400 cases). In our research work, the factors associated with hypovitaminosis were child’s age (p = 0.0470), mother’s age (p = 0.0000), weaning age lower than 6 months (p = 0.0466) and mother’s occupation out of direct sunlight (p = 0.0012). Conclusion: Nearly one out of ten children suffers from hypovitaminosis D in the District of Parakou in 2017. The associated factors were age of child and mother, early weaning and mother’s professional occupation held out of direct sunlight. This research work should be continued and improved by a nationwide multicentre study. This could lead to the adoption of measures for hypovitaminosis D prevention among children in Benin.

Factors Associated with Hypovitaminosis D in People Living with HIV/AIDS (PLWHA) Followed up in Porto-Novo in 2019

Background: Vitamin D deficiency is very common among PLWHA compared to the general population and is promoted by several factors. Aim: To identify the factors associated with hypovitaminosis D in people living with HIV/AIDS (PLWHA) followed up in Porto-Novo in 2019. Methods: This was a cross-sectional, descriptive and analytical study. PLWHA who were monitored on an outpatient basis and who gave their consent were included in this work. Subjects unable to answer questions or under ongoing vitamin D supplementation or suffering from chronic liver diseases were not included. Hypovitaminosis D was defined by a blood level of 25 hydroxy-vitamin D less than 30 ng/mL. Results: A total of 270 PLWHA were included in the study. The mean age of the patients was 39.51 ± 6.85 years with a female predominance (73.3%). The frequency of hypovitaminosis D was 56%. Hypertension, low protein intake, anemia and low glomerular filtration rate were associated with vitamin D deficiency. Conclusion: Vitamin D deficiency is common among PLWHA, which justifies routine screening, especially among those at risk.

Risk Factors Predicting Hypovitaminosis D in Children in South-East Region of Bangladesh

Background: Hypovitaminosis D (serum concentration of 25(OH)D Methods: This was a cross sectional observational study having conducted at a paediatric clinic in Chittagong Metropolitan City from July, 2012 to December, 2017 including 524 children of 0 - 18 years by convenient sampling. The relevant data were assessed using standard case record form and lab parameter of 25(OH)D assay. Serum level of 25(OH)D of Results: The prevalence of Hypovitaminosis D was 50.57%. Compared with the infancy age group the odds of Hypovitaminosis D is 1.36 times more likely in >5 yrs children. The odds of association (odds ratio or OR = 0.19) of rural population with Hypovitaminosis D is lower than urban population. The formula fed children had less chance of association (OR = 0.32) of developing hypovitaminosis D in comparison to exclusively breastfed babies. Occasional Sun exposed group was 1.40 times more likely to develop hypovitaminosis D in comparison to daily sun exposure group. The odds of Hypovitaminosis D were 1.9 times more in winter season than summer season. School going children had double the chance of Hypovitaminosis D than children with no education. Subjects with high weight for age were 3.65 times increased risk of suffering from hypovitaminosis D compared with normal weight for age. Girls had a little bit more chance of hypovitaminosis D than boys. Children coming from family with monthly Income > 10,000 BDT are associated with more Hypovitaminosis D. Among clinical variables only wheeze has significant association (OR = 1.83). Conclusion: Hypovitaminosis D (<20 ng/ml) prevails significantly among Infants and children of South-East region of Bangladesh. Age, area of residence, feeding pattern, sun exposure practice, seasons, schooling pattern, weight for age have strong association with Hypovitaminosis D.

High Prevalent Hypovitaminosis D Is Associated with Dysregulation of Calcium-parathyroid Hormone-vitamin D Axis in Patients with Chronic Liver Diseases

Background and Aims:Although hypovitaminosis D is common among patients with chronic liver disease(CLD),the data are inconsistent on its prevalence and its relationship with CLD.This study aimed to estimate the prevalence of hypovitaminosis D among patients with CLD and to determine the relationship between hypovitaminosis D and severity of liver dysfunction,and calcium(Ca),phosphate(PO4)and parathyroid hormone(PTH)levels in CLD.Methods:The study included 236 CLD patients attending the Department of Hepatology,Rajiv Gandhi Government General Hospital(Chennai,India).Serum levels of 25-hydroxyvitamin D(25(OH)D),PTH,Ca,and PO4 were estimated.Severity of liver dysfunction was graded using the Child-Turcotte-Pugh(CTP)score.Results:The first report from our population showed that 162 of 236(68.6%)CLD patients had hypovitaminosis D(25(OH)D levels of<30 ng/mL),with higher frequency(124/162)76.5%among CTP B,C patients.Significant negative correlation(r=-0.288,p=0.0001)between 25(OH)D and CTP scores was noted in hypovitaminosis D conditions.Level of 25(OH)D was correlated negatively with PTH(r=-0.537,p=0.0001),positively with Ca(r=0.657,p=0.0001),and positively with PO4(r=0.477,p=0.0001)in sufficient vitamin D conditions.Conclusions:Hypovitaminosis D is associated with higher CTP scores and is strongly associated with dysregulation of the Ca-PTH-vitamin D axis in CLD.Timely measurement of vitamin D levels is essential,along with levels of PTH,Ca and PO4,to manage CLD patients.

Metabolic syndrome:A review of the role of vitamin D in mediating susceptibility and outcome

Despite the well-recognised role of vitamin D in a wide range of physiological processes,hypovitaminosis is common worldwide(prevalence 30%-50%) presumably arising from inadequate exposure to ultraviolet radiation and insufficient consumption.While generally not at the very low levels associated with rickets,hypovitaminosis D has been implicated in various very different,pathophysiological processes.These include putative effects on the pathogenesis of neoplastic change,inflammatory and demyelinating conditions,cardiovascular disease(CVD) and diabetes.This review focuses on the association between hypovitaminosis D and the metabolic syndrome as well as its component characteristics which are central obesity,glucose homeostasis,insulin resistance,hypertension and atherogenic dyslipidaemia.We also consider the effects of hypovitaminosis D on outcomes associated with the metabolic syndrome such as CVD,diabetes and non-alcoholic fatty liver disease.We structure this review into 3 distinct sections; the metabolic syndrome,vitamin D biochemistry and the putative association between hypovitaminosis D,the metabolic syndrome and cardiovascular risk.

The Effect of Short Term Vitamin D Supplementation on the Inflammatory and Oxidative Mediators of Arterial Stiffness

Background: Vitamin D deficiency has been implicated as a potential risk factor for cardiovascular disease. The high rate of vitamin D deficiency ( 25) African Americans with elevated blood pressure (130 - 150/85 - 100 mmHg) and low serum vitamin D level (10 - 25 ng/ml). Results: There was a significant increase in the serum 25(OH)D levels to a mean level of 34.5 ng/ml (SD = 7.1) with the intervention (p < 0.001). The increase in 25(OH)D levels was associated with a significant decrease in the serum level of intact PTH (p = 0.02), mean urinary isoprostane (p = 0.02) and adipocyte cytokine expression. Although the increase in the 25(OH)D levels was not associated with any significant change in the Pulse Wave Velocity (PWV) in the overall study sample, it was associated with a significant decrease in the augmentation index among the participants with the highest tertile of urinary isoprostane (p = 0.007). Conclusion: We concluded that vitamin D supplementation increased serum 25(OH)D levels, decreased intact PTH level and the levels of select inflammatory and oxidative stress mediators of arterial stiffness. Longer term prospective studies are warranted to evaluate the effect of high dose vitamin D supplementation on arterial stiffness.

Valproic acid therapy decreases serum 25-hydroxyvitamin D level in female infants and toddlers with epilepsy-a pilot longitudinal study

To evaluate if valproic acid(VPA)therapy is associated with vitamin D deficiency among infants and toddlers with epilepsy,a cross-sectional clinical study was conducted in 25 children with epilepsy taking VPA.Blood levels of calcium,phosphorus,alkaline phosphatase,and 25-hydroxy vitamin D[25(OH)D]and plasma VPA level were measured at 1-to 3-month intervals.At the initial and final measurements,vitamin D deficiency or insufficiency was recognized in 8(32%)and 12(42%),respectively.In girls,a decreasing trend in serum25(OH)D levels(P<0.05)was observed.Polytherapy had a significant negative effect on the longitudinal change of 25(OH)D(P<0.05)in girls.In conclusion,our study indicates that a high proportion of girls after VPA therapy had hypovitaminosis D.

Vitamin D and spine surgery

Vitamin D is crucial for musculoskeletal health, maintenance, and function. Vitamin D insufficiency is common among patients undergoing spine surgery and the ideal vitamin D level for spine surgery has yet to be investigated. There is a high prevalence of hypovitaminosis D in patients with musculoskeletal pain regardless of surgical intervention. With the frequency and costs of spine surgery increasing, it is imperative that efforts are continued to reduce the impact on patients and healthcare services. Studies into vitamin D and its associations with orthopaedic surgery have yielded alarming findings with regards to the prevalence of vitamin D deficiency. Importantly, altered vitamin D status also contributes to a wide range of disease conditions. Therefore, future investigations are still essential for better understanding the relationship between vitamin D and spine surgery outcomes. Whilst further research is required to fully elucidate the extent of the effects of hypovitaminosis D has on surgical outcomes, it is strongly advisable to reduce the impacts by appropriate vitamin D supplementation of deficient and at-risk patients.

Management of vitamin D deficiency in young women with 1-year follow up

Vitamin D deficiency is very frequently observed among young women. This study reports the follow up of 68 women over a period of 1 year. The objective of this study was to observe doses of vitamin D can correct and preserve blood levels of vitamin D near 75 nmol/L. It was found that large amounts of vitamin D are needed to correct and then maintain vitamin D blood levels (≥530,000 units), particularly in veiled women (~720,000 units). Parathyroid hormone (PTH) levels decreased as blood levels of vitamin D increased. Quality of life measured with the SF12? Health Survey questionnaire, improved when the patients’ vitamin D deficiencies were corrected. This work highlights the need for the development of guidelines to treat and correct vitamin D deficiency for the long term in young adult women.

Vitamin D Deficiency and Pseudofractures in Child-Bearing Egyptian Women: Successful Medical Treatment Helps to Avoid Fractures and Surgical Interference

Background: Recent evidence for the effects of vitamin D and recognition of the high prevalence of its deficiency has increased the interest in it. Vitamin D-sub nutrition may contribute to the risk of a wide range of disorders. Methods: The females in the child-bearing period attending the endocrinology and orthopedic out-patient clinics complaining of pain and/or tenderness at the groin were evaluated. Patients with chronic metabolic or skeletal illness, primary hyperparathyroidism, and patients receiving drugs that interfere with bone mineral metabolisms were excluded. One hundred accepted and consented to participation in the study. All the participants were subjected to full history taking, clinical evaluation, laboratory investigations including serum Ca, Ph, PTH, ALP, TSH, F T4, F T3, Cortisol level, and 25(OH)D level. Plain X-ray was done for the regions of bony tenderness. The subjects were divided into 2 groups based on the presence or absence of pseudo-fractures (looser zones). They were treated and followed up till normalization of the laboratory parameters and healing of the looser zones. Results: The mean age for patients was 30.45 ± 5.8, their mean 25(OH) vitamin D level was 14.7 ± 5.9 ng/ml, the mean PTH was 195.7 ± 162.6, and looser zones were evident in the X-rays of 34 patients. The serum 25(OH)D showed significant negative correlations with veiling, parity, localized hip pain, and tenderness, ALP, PTH, but, a significant positive correlation with sun exposure, dairy products consumption, vitamin D supplementation, and serum calcium levels. The independent factors associated with hypovitaminosis D were the lack of sun exposure, lack of vitamin D supplementation, and the presence of pseudo- fracture (p ≤ 0.009, 0.038, and 0.001 respectively). No surgery was required in any of our patients. Conclusions: Vitamin D deficiency is common in our region. The main risk factors are decreased sun exposure, low dairy products consumption, and lack of vitamin D supplementation. Successful medical treatment may be helpful to satisfy the patient, avoid true fracture and further major surgical treatments.