High-dose vitamin D May Improve Heart Function in Some CHF Patients

MedicalResearch.com Interview with:

Dr Klaus Witte MD, FRCP, FESC, FACC Associate Professor and Consultant Cardiologist Lead Clinician for Cardiology University of Leeds and Leeds Teaching Hospitals NHS Trust

Dr. Klaus Witte

Dr Klaus Witte MD, FRCP, FESC, FACC
Associate Professor and Consultant Cardiologist
Lead Clinician for Cardiology
University of Leeds and Leeds Teaching Hospitals NHS Trust 

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Witte: Chronic heart failure (CHF) is a condition of heart muscle weakness that despite optimal treatment often leaves patients with ongoing symptoms of breathlessness and fatigue.

Vitamin D has a large number of effects in the body beyond its known effects on the skeleton.

Patients with  Chronic heart failure are frequently deficient in vitamin D, but until now there were no data demonstrating a benefit from supplements.

We conducted a randomised, placebo-controlled study of a non-calcium-based vitamin D supplement providing 4000IU or 100mcg per day of vitamin D3 (VINDICATE).

Endpoints included 6-minute walk distance and cardiac function. We saw no improvement in 6 minute walk distance but a large and significant improvement in heart function (left ventricular ejection fraction) and heart size (left ventricular dimensions and volumes) after on year. We saw no significant adverse effects and the tablets were well tolerated.

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Deeply Tanned Skin May Prevent Optimal Vitamin D Formation

MedicalResearch.com-Interview with:

Francisco Bandeira,M.D.,PhD.,F.A.C.E. Professor of Medicine and Chairman, Division of Endocrinology, Agamenon Magalhães Hospital, University of Pernambuco Medical School

Dr. Francisco Bandeira

Francisco Bandeira,M.D.,PhD.,F.A.C.E.
Professor of Medicine and Chairman, Division of Endocrinology, Agamenon Magalhães Hospital,
University of Pernambuco Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Bandeira: We had the opportunity to evaluate a population with very high rates of sun exposure in daily life at a tropical region with abundant sunlight (UV index of 5 at 7 am and more than 10 at midday). We found that more exposure to the sun, less vitamin D deficiency, so nature “works”. But more sun exposure led to more tanned skins and despite these very high rates of sun exposure, most people were not able to achieve optimal blood levels of 25OHD (> 30 ng/ml).

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Vitamin D Supplements Did Not Slow Knee Cartilage Loss in Osteoarthritis

MedicalResearch.com Interview with:

Changhai Ding, MBBS, MMED, MD Australian Research Council Future Fellow Associate Director (International), Menzies Institute for Medical Research Professor, University of Tasmania, Australia Honorary Professor, University of Sydney, Australia

Dr. Changhai Ding

Changhai Ding, MBBS, MMED, MD
Australian Research Council Future Fellow
Associate Director (International), Menzies Institute for Medical Research
Professor,  University of Tasmania, Australia
Honorary Professor, University of Sydney, Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Ding: Vitamin D can reduce bone turnover and cartilage degradation, thus potentially preventing the development and progression of knee osteoarthritis. Observational studies suggest that vitamin D supplementation is associated with benefits for knee osteoarthritis, but current evidence from clinical trials is contradictory.

We  conducted a randomised clinical trial in Hobart, Tasmania and Melbourne, Victoria in Australia. We randomly assigned 413 patients with symptomatic knee osteoarthritis and low 25-hydroxyvitamin D to receive monthly treatment with oral vitamin D3 (50,000 IU; n = 209) or an identical placebo (n = 204) for 2 years.

Of 413 enrolled participants (average age, 63 years; 50 percent women), 340 (82 percent) completed the study. Vitamin D supplementation significantly increased blood 25-hydroxyvitamin D levels over 2 years compared with placebo treatment; however, vitamin D supplementation, compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or a measure of knee pain over 2 years. There were also no significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions.

Post-hoc analyses indicated that vitamin D supplementation might improve knee physical function and reduce another measure of knee pain and increases in bone marrow lesion.

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Vitamin D Deficiency in Pregnancy May Raise Risk of Multiple Sclerosis In Offspring

MedicalResearch.com Interview with:
Kassandra Munger, Sc.D.
Harvard T.H. Chan School of Public Health

MedicalResearch.com: What is the background for this study?

Dr. Munger: Previous work has shown that adequate vitamin D nutrition is associated with a lower risk of multiple sclerosis (MS).  Results from studies examining whether adequate vitamin D exposure during early-life are also associated with a lower risk of MS have been mixed.  One study reported that daughters of mothers with high dietary vitamin D intake during their pregnancy had a reduced risk of multiple sclerosis, while two studies measuring 25-hydroxy vitamin D either in a blood sample from the pregnant mother or from a sample taken from the neonate, were not associated with future multiple sclerosis risk in the child.

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Trial Tests Effect of Vitamin D Supplementation During Pregnancy On Wheezing in Children

More on Asthma on MedicalResearch.com

Professor of Pediatrics Hans Bisgaard, MD, DMSc Copenhagen Prospective Studies on Asthma in Childhood Herlev and Gentofte Hospital, University of Copenhagen, Denmark.

Prof. Bisgaard

MedicalResearch.com Interview with:
Hans Bisgaard, MD, DMSc
Professor of Pediatrics
The Faculty of Health Sciences
University of Copenhagen
Head of the Copenhagen Prospective Studies on Asthma in Childhood
University  of Copenhagen and Naestved Hospital

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Bisgaard: Vitamin D deficiency has become a common health problem in westernized societies, possibly caused by a more sedentary indoor lifestyle and decreased intake of vitamin D containing foods. Vitamin D possesses a range of immune regulatory properties, and it has been speculated that vitamin D deficiency during pregnancy may affect fetal immune programming and contribute to asthma pathogenesis. Asthma often begins in early childhood and is the most common chronic childhood disorder. Observational studies have suggested that increased dietary vitamin D intake during pregnancy may protect against wheezing in the offspring, but the preventive effect of vitamin D supplementation to pregnant women is unknown. In our double-blind, single-center, randomized clinical trial conducted within the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort we supplemented 2800 IU/d of vitamin D3 during the third trimester of pregnancy compared with 400 IU/d in the control group. Although the maternal supplementation did not result in a statistically significant reduction of risk of persistent wheeze in the offspring through age 3 years, the interpretation of the study is limited by a wide confidence interval that includes a clinically important protective effect.

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Does Prenatal Supplementation With Vitamin D Affect Childhood Asthma?

Augusto A. Litonjua, MD, MPH Associate Professor Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115 USA

Dr. Augusto Litonjua

MedicalResearch.com Interview with:
Augusto A. Litonjua, MD, MPH
Associate Professor
Channing Division of Network Medicine
and Division of Pulmonary and Critical Care Medicine
Department of Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02115 USA 

Medical Research: What is the background for this study? What are the main findings?

Response: Vitamin D deficiency has been hypothesized to contribute to the asthma and allergy epidemic.  Vitamin D has been shown to affect lung development in utero. However, observational studies have shown mixed results when studying asthma development in young children. Since most asthma cases start out as wheezing illnesses in very young children, we hypothesized that vitamin D supplementation in pregnant mothers might prevent the development of asthma and wheezing illnesses in their offspring.  We randomly assigned 881 pregnant women at 10 to 18 weeks’ gestation and at high risk of having children with asthma to receive daily 4,000 IU vitamin D plus a prenatal vitamin containing 400 IU vitamin D (n = 440), or a placebo plus a prenatal vitamin containing 400 IU vitamin D (n = 436). Eight hundred ten infants were born during the study period, and 806 were included in the analyses for the 3-year outcomes. The children born to mothers in the 4,400 IU group had a 20% reduction in the development of asthma or recurrent wheeze compared to the children born to mothers in the 400 IU group (24% vs 30%, respectively; an absolute reduction of 6%).  However, this reduction did not reach statistical significance (p=0.051).

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Vitamin D Status May Influence Bariatric Surgery Outcomes

Leigh A. Peterson, PhD, MHS Post-doctoral fellow Department of Surgery - Bayview Johns Hopkins School of Medicine

Dr. Leigh Peterson

MedicalResearch.com Interview with:
Leigh A. Peterson, PhD, MHS

Post-doctoral fellow
Department of Surgery – Bayview
Johns Hopkins School of Medicine

Medical Research: What is the background for this study? What are the main findings?
Dr. Peterson: From our previous study published in Obesity Surgery earlier this year, we knew that vitamin D deficiency and insufficiency was very common in our bariatric surgery candidates (71.4% < 20 ng/ml and 92.9% < 30 ng/ml). We wanted to explore the effect of this deficiency on adverse outcomes after bariatric surgery such as wound healing, infection, and extended hospital stay.

We turned to the Nationwide Inpatient Sample to answer this question, as it would contain enough surgeries to detect changes in even less frequent outcomes such as wound infection. But blood concentration of vitamin D is not available, so we used a traditional method to estimate group vitamin D status with season and geography. Vitamin D comes from the sun, so people have the most vitamin D in summer and in sunnier places.

In 932,091 records of bariatric surgeries from 2001 to 2010, we saw that more adverse outcomes occurred during winter—January to March, the time of lowest vitamin D status—compared to summer or even spring or fall. Additionally, most adverse outcomes occurred in northern latitudes (≥ 37°N) compared to sunnier southern latitudes.

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Vitamin D Level Likely Has No Impact on Sleep Apnea

Ken M. Kunisaki , MD Associate Professor of Medicine Pulmonary, Allergy, Critical Care and Sleep Medicine University of Minnesota

Dr. Kunisaki

MedicalResearch.com Interview with:
Ken M. Kunisaki , MD
Associate Professor of Medicine
Pulmonary, Allergy, Critical Care and Sleep Medicine
University of Minnesota 

Medical Research: What is the background for this study? What are the main findings?

Dr. Kunisaki : Obstructive sleep apnea (OSA) is a very common condition that is the result of recurrent complete or partial closure of the upper airway during sleep.  OSA leads to poor sleep quality and excessive daytime sleepiness.

A previous study suggested that OSA is more common in the winter, but there were no vitamin D measurements in that study, which seemed potentially relevant since many people have lower vitamin D levels in the winter, due to less sunlight exposure in the winter.  Several studies have also shown that people with low vitamin D levels have worse muscle function.  Since muscles are partially responsible for keeping the upper airway open during sleep, we wondered whether people with low vitamin D levels might have weaker upper airway muscles and therefore be more prone to having OSA.

In our study, we found that indeed, persons with OSA had lower vitamin D levels than those without OSA, but this was explained by obesity.  In other words, the low vitamin D levels seen in OSA patients is likely just a marker of obesity and not likely related to the presence or absence of OSA.
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Vitamin D and May Improve Exercise Performance

Dr Emad Al-Dujaili Reader in Biochemistry and Nutrition, Queen Margaret University Department of Health Science Queen Margaret UniversityMedicalResearch.com Interview with:
Dr Emad Al-Dujaili
Reader in Biochemistry and Nutrition,
Queen Margaret University
Department of Health Science
Queen Margaret University

Medical Research: What is the background for this study? What are the main findings?

Dr. Al-Dujaili: Recent studies have implicated vitamin D deficiency as a risk factor for Cardiovascular disease and its deficiency is a potential biological predictor of increased rates of CVD. We have done 2 earlier studies investigating the effects of Vitamin D intake on Blood pressure and the stress hormone level cortisol and found that people taking the supplement of Vitamin D had reduced systolic and diastolic blood pressure compared to those who took the placebo. Vitamin D deficiency has also been associated with hypertension, obesity, diabetes mellitus and oxidative stress and reduced exercise performance. For instance, the Framingham offspring study proved that low levels of vitamin D are independently related to Cardiovascular disease incidence. In this placebo-controlled study, We have observed that people given 50ug of Vitamin D daily for 2 weeks showed a significantly reduced systolic and diastolic blood pressure, reduced urinary free cortisol (the hormone that produces stress and high blood pressure if its levels are high. Moreover, the distance cycled in 20 minutes significantly increased by 30% with slightly less efforts compared with that before Vitamin D supplement.

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Calcium Supplements Linked To Increased Risk of Kidney Stones

MedicalResearch.com Interview with:
Christopher Loftus M.D. candidate
Cleveland Clinic Lerner College of Medicine

Medical Research: What is the background for this study? What are the main findings?

Response: Most kidney stones are made, at least partially, of calcium composite. In a prospective study of nurses in the post-menopausal age, it was found that diets that contained high amounts of calcium were beneficial in preventing kidney stones in this population. In the gut, calcium can bind to oxalate which prevents it from being absorbed into the body and decreases the concentration of calcium in the urine. However there has been debate as to whether supplemental calcium (calcium pills) has the same beneficial effects as calcium in the diet. Supplemental calcium enters the gut in large quantities all at once so it may enter the blood stream in higher concentrations over smaller amounts of time. By the same token, vitamin D plays a role in the management and balance of calcium in the body and could potentially have an effect on stone formation as well.  It has also been debated whether vitamin D supplementation has major effect on patients who are known to be stone formers.  So we reviewed CT scans of patients and 24 hour urine collections (both male and female of adult age) who were known to have kidney stones and measured the growth of stones over a period of time.

Our main findings were that supplementary calcium increased the rate of stone formation in these patients. We also found that vitamin D had a protective effect and patients taking only vitamin D had a slower rate of stone progression.

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Low Vitamin D Associated With Accelerated Cognitive Decline

Joshua W. Miller, PhD Professor and Chair Dept. of Nutritional Sciences Rutgers The State University of New Jersey New Brunswick, NJ 08901

MedicalResearch.com Interview with:
Joshua W. Miller, PhD

Professor and Chair Dept. of Nutritional Sciences Rutgers
The State University of New Jersey
New Brunswick, NJ 08901 

Medical Research: What is the background for this study? What are the main findings?

Response: In recent years, there has been a growing scientific literature on the associations between low vitamin D status in older adults and risk of Alzheimer’s disease/dementia, cognitive impairment and decline, and brain atrophy.  The vast majority of these studies have been conducted in predominantly white populations.  The relatively unique aspect of our study was that over half of the cohort consisted of African Americans and Hispanics.  What we found in our cohort (mean age ~75y, n=382 at baseline) was that participants with vitamin D deficiency (serum 25-hydroxyvitamin D <12 ng/ml) or vitamin D insufficiency (serum 25-hydroxyvitamin D between 12 ng/ml and <20 ng/ml) on average experienced faster rates of cognitive decline in episodic memory and executive function than participants with adequate vitamin D status.  Importantly, the association between vitamin D status and the rate of decline in cognitive function was independent of race/ethnicity.  However, the prevalence of low vitamin D status in the study participants was significantly higher in the African American and Hispanic participants compared with the White participants.  This is most likely due to the fact that darker skin pigmentation reduces the ability of sunlight to induce vitamin D synthesis in the skin.  It may also reflect differences in dietary intake of vitamin D and supplement use between the different race/ethnicity groups, though we did not assess this in our study.  Thus, though the rate of cognitive decline in African Americans and Hispanics does not seem to be more or less affected by low vitamin D status than in Whites, because African Americans and Hispanics have a higher prevalence of low vitamin D status, as subpopulations they may be more prone to rapid cognitive decline in old age.  Further studies addressing this possibility are needed.

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Vitamin D Did Not Improve Bone or Muscle Health in Post-Menopausal Women

MedicalResearch.com Interview with:
Karen E. Hansen, M.D., M.S.
Associate Professor of Medicine
University of Wisconsin School of Medicine and Public Health
Madison, WI 53705-2281

Medical Research: What is the background for this study?

Dr. Hansen: The USPTF says to older community dwelling adults, “don’t bother taking vitamin D”, the Endocrine Society says “take 2,000-4,000 IU daily” and the Institute of Medicine gave an RDA of 600-800 IU daily. The Endocrine Society argues that optimal vitamin D levels are 30 ng/mL and higher, while the Institute of Medicine concludes that 20 ng/mL and higher indicates optimal vitamin D status. The disagreement between experts prompted my study.

Medical Research: What are the main findings?

Dr. Hansen: Among postmenopausal women whose vitamin D level was ~21 ng/mL at baseline, there was no benefit of high-dose or low-dose vitamin D, compared to placebo, on spine/hip/total body bone mineral density, muscle fitness by 5 sit to stand test or Timed Up and Go, or falls. We did see a small 1% increase in calcium absorption in the high-dose vitamin arm, but this small increase did not translate into clinically meaningful changes in bone density or muscle tests.

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Many US Infants Found To Be Vitamin D Deficient

Katherine Ahrens Ph.D. MPH National Center for Health Statistics Centers for Disease Control and Prevention Hyattsville, MDMedicalResearch.com Interview with:
Katherine Ahrens Ph.D. MPH

National Center for Health Statistics
Centers for Disease Control and Prevention
Hyattsville, MD

Medical Research: What is the background for this study?

Dr. Ahrens: In 2008, the American Academy of Pediatrics (AAP) revised their recommended minimum daily intake of vitamin D for infants and children to 400 IU.

Medical Research: What are the main findings?

Dr. Ahrens: Approximately one quarter of US infants aged 0 to 11 months met the 2008 AAP vitamin D recommendations on a given day in 2009 to 2012. Fewer than 1 in 5 breastfed infants met the vitamin D recommendations compared to nearly 1 in 3 non-breastfed infants. Continue reading

Exercise May Be More Effective Than Vitamin D In Reducing Falls

MedicalResearch.com Interview with:
Kirsti Uusi-Rasi, PhD, Adjunct Professor
Senior Researcher
UKK Institute for Health Promotion Research
Tampere Finland

Medical Research: What is the background for this study? What are the main findings?

Dr. Kirsti Uusi-Rasi: Falls are the leading cause of unintentional injuries and fractures in
older adults, head injuries and fractures being the most severe
consequences. Therefore, falls prevention is important when trying to
prevent injuries. There is strong high-quality evidence from previous
studies that exercise that includes strength and balance training can
reduce the risk of falling in older adults. However, there are also
studies that have reported no benefit in reducing the actual incidence
of falls. Effects of vitamin D have also been studied widely, and
vitamin D is known to be vital for bone metabolism and health.
However, results regarding effects on falls and fractures are
inconsistent. Furthermore, persons with low vitamin D levels (serum
25OHD) have been associated with lower physical performance and
greater decline in physical functioning, but clinical trials exploring
the role of vitamin D in reducing falls and fractures and in improving
physical functioning are inconclusive. Because there is hardly any
evidence about exercise and vitamin D together, we investigated the
separate and combined effects of multimodal exercise training and
vitamin D supplementation in reducing falls and injurious falls among
older women at risk for falling.

We assigned 409 participants randomly to one of four groups with:
1)vitamin D 800 IU/day and exercise
2) placebo and exercise
3) vitamin D 800 IU/day without exercise
4) placebo without exercise.

Exercise consisted of strength, balance, mobility and agility group training.

At the end of two years, exercise seemed to be more effective in
reducing injurious falls in this age group, with or without vitamin D.
Exercise also improved physical functioning (strength, balance and
mobility). In general, the training program was well tolerated with no
severe adverse effects or injuries. Vitamin D helped maintain femoral
neck BMD and increased trabecular bone density at the tibia. Our study
also suggests that the current vitamin D recommendation (800 IU/d for
older people) is adequate.

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Women With Low Vitamin D More Likely To Report Depression

David C.R. Kerr Ph.D. Sch of Psychological Science Associate Professor College of Liberal Arts Oregon State UniversityMedicalResearch.com Interview with:
David C.R. Kerr Ph.D.
Sch of Psychological Science Associate Professor
College of Liberal Arts Oregon State University

Medical Research: What is the background for this study? What are the main findings?

Dr. Kerr: Many people assume we already know that low levels of vitamin D contribute to depression, especially in winter. However, studies have not found consistent evidence for this, and most studies have focused on people in late life or with serious medical conditions. We focused on apparently healthy young women living in the Pacific Northwest. We found that women with low blood levels of vitamin D were more likely to report clinically significant depressive symptoms. This link existed even when we considered other factors that might explain both problems, such as diet, obesity, and time of year. Continue reading

Genetic Vitamin D Metabolism Linked To Fatal Prostate Cancer

Irene Shui ScD MPH Staff Scientist Fred Hutchinson Cancer Research Center Seattle, WA 98109MedicalResearch.com Interview with
Irene Shui ScD MPH
Staff Scientist
Fred Hutchinson Cancer Research Center
Seattle, WA 98109

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Shui: Given the high prevalence of prostate cancer and the wide international variation in vitamin D status, identifying causal links between the two could have a large public health impact. Evidence from experimental animal and cell line studies support anti-cancer properties of vitamin D. However, the results from human epidemiologic studies for prostate cancer risk have been equivocal. Few studies have addressed risk of fatal prostate cancer prostate cancer. One recent study reported a 57% reduction in the risk of fatal prostate cancer in men with the highest vs. lowest vitamin D levels.  The purpose of this study was to follow-up on these findings in a large cohort consortium with over 500 cases of fatal prostate cancer.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Shui: We did not find consistent evidence among 5 cohort studies to support an increased or decreased risk of dying from prostate cancer based on a man’s levels of circulating vitamin D. However, we observed some evidence that common genetic variation in genes involved in vitamin D metabolism and signaling may modify this association. Patients should discuss their vitamin D status with their health care provider as it is important for bone health, immune function, and may prevent other diseases.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Shui: Studies of Vitamin D should consider if variation in genes involved in vitamin D metabolism and signaling could modify disease associations.

Citation:

Shui, I. M., Mondul, A. M., Lindström, S., Tsilidis, K. K., Travis, R. C., Gerke, T., Albanes, D., Mucci, L. A., Giovannucci, E., Kraft, P. and for the Breast and Prostate Cancer Cohort Consortium Group (2015), Circulating vitamin D, vitamin D–related genetic variation, and risk of fatal prostate cancer in the National Cancer Institute Breast and Prostate Cancer Cohort Consortium. Cancer. doi: 10.1002/cncr.29320

MedicalResearch.com Interview with, Irene Shui ScD MPH (2015). Genetic Vitamin D Metabolism Linked To Fatal Prostate Cancer 

Low Vitamin D in Childhood Linked To Early Atherosclerosis

MedicalResearch.com Interview with:
Markus Juonala, MD, PhD
University of Turku Finland

Medical Research: What is the background for this study? What are the main findings?

Response: Earlier studies suggest that low vitamin D levels may be associated with cardiovascular disease. We wanted to study whether low childhood vitamin levels predict carotid intima-media thickness, a marker of early atherosclerosis, in adulthood. We observed that those children with vitamin D in lowest quartile had increased risk for high carotid intima-media thickness.

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Genetically Low Vitamin D Levels Linked To Increased Mortality

MedicalResearch.com Interview with:
Børge G Nordestgaard, MD, DMSc

Professor, University of Copenhagen
Chief Physician, Herlev Hospital, Copenhagen University Hospital
Dept. Clinical Biochemistry Herlev Ringvej Herlev, Denmark

Medical Research: What is the background for this study? What are the main findings?

Prof. Nordestgaard: Many people take vitamin D supplements with the hope of reducing morbidity and mortality. However, it is unclear whether low vitamin D per se is a direct cause of increased mortality or whether it is simply a marker of poor lifestyle in general and/or underlying hidden disease. Our study involved 95,766 white participants of Danish descent from three cohorts in Copenhagen, who had genetic variants known to affect vitamin D levels. We found that genetically low vitamin D levels were associated with increased all-cause mortality, cancer mortality, and other mortality, but not with cardiovascular mortality. This is important as such genetics studies cannot be explained by poor lifestyle or hidden disease, as neither can change your genes.

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Modified-Release Calcifediol Corrects Vitamin D Deficiency, Secondary Hyperparathyroidism in Chronic Kidney Disease

Stuart M. Sprague, DO, FACP, FASN, FNKF Chairperson, Division of Nephrology and Hypertension NorthShore University HealthSystem Evanston, Illinois 60201MedicalResearch.com Interview with:with
Stuart M. Sprague, DO, FACP, FASN, FNKF
Chairperson, Division of Nephrology and Hypertension
NorthShore University HealthSystem
Evanston, Illinois 60201

Medical Research: Congratulations, Dr. Sprague, on your presentation of another successful phase 3 clinical trial program at the recently concluded Annual Meeting of the American Society of Nephrology. Your presentation unveiled a new vitamin D repletion therapy that effectively controls secondary hyperparathyroidism in chronic kidney disease. Can you give us a little background for the presented studies?

Dr. Sprague: Thanks! Vitamin D insufficiency is a big problem in chronic kidney decease (or CKD): it afflicts more than 20 million adults in the United States who have stages 1 through 4 CKD. Its prevalence increases with CKD severity and it drives secondary hyperparathyroidism. The studies which I presented evaluated a novel therapy to treat secondary hyperparathyroidism (SHPT) arising from vitamin D insufficiency in patients diagnosed with stage 3 or 4 CKD. This new therapy is a modified-release formulation of calcifediol.

Medical Research: Can you tell us more about vitamin D insufficiency?

Dr. Sprague: Vitamin D insufficiency is a condition in which the body has low vitamin D stores. It is characterized by inadequate blood levels of the vitamin D, known as 25-hydroxyvitamin D. An estimated 70-90% of CKD patients have vitamin D insufficiency, which can lead to SHPT and resultant debilitating bone diseases. Vitamin D insufficiency has also been associated with increased mortality in CKD.
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Vitamin D Levels Lower In Children Who Drink Non-Cow’s Milk

Jonathon Maguire MD MSc FRCPC Pediatrician and Scientist  Department of Pediatrics Li Ka Shing Knowledge Institute St. Michael’s Hospital University of TorontoMedicalResearch.com: Interview with:
Jonathon Maguire MD MSc FRCPC
Pediatrician and Scientist  Department of Pediatrics
Li Ka Shing Knowledge Institute
St. Michael’s Hospital University of Toronto

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Maguire: One of the main health benefits of cow’s milk is vitamin D.  We were interested to know if non-cow’s milk supports children’s vitamin D blood levels as well as cow’s milk.
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Effect of High-Dose Vitamin D Supplementation In Critically Ill Patients

Karin Amrein, MD, MSc Assistant Professor Department of Internal Medicine Division of Endocrinology and Metabolism Medical University of Graz 8036 Graz, AustriaMedicalResearch.com Interview with:
Karin Amrein, MD, MSc
Assistant Professor Department of Internal Medicine
Division of Endocrinology and Metabolism
Medical University of Graz
8036 Graz, Austria

Medical Research: What are the main findings of the study?

Dr. Amrein: This is the first large clinical trial on vitamin D in critical care. In a double-blind, randomized, placebo-controlled clinical trial, a population of mixed adult ICU patients with vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] level ≤ 20ng/ml) was assigned to receive either vitamin D3 or placebo. We used a high loading dose of vitamin D3 followed by monthly maintenance doses of 90,000 IU for a total of 5 months. Because of a substantially increased risk for skeletal complications below 12ng/ml of 25-hydroxyvitamin D, we used this threshold for a predefined subgroup analysis.

Overall, high-dose vitamin D3 compared with placebo did not reduce hospital length of stay (primary endpoint), intensive care unit (ICU) length of stay, hospital mortality, or 6 month-mortality

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Study Questions Supplemental Vitamin D for Heart Disease Prevention

MedicalResearch.com Interview with
Esther Ooi &
Børge G Nordestgaard, MD, DMSc
Professor, University of Copenhagen
Chief Physician, Herlev Hospital, Copenhagen University Hospital
Dept. Clinical Biochemistry Herlev Ringvej 75, DK-2730 Herlev, Denmark

Medical Research: What are the main findings of the study?

Answer: Our findings suggest that low 25(OH)D levels observationally is simply a marker for elevated atherogenic lipoproteins, and thus question a role for vitamin D supplementation in the prevention of cardiovascular disease.
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Study Examines Vitamin D and Cancer Prognosis

Adetunji Toriola, MD, PhD, MPH  Assistant Professor Division of Public Health Sciences Department of Surgery Washington University School of Medicine Siteman Cancer Center St. Louis, MO MedicalResearch.com Interview with:
Adetunji Toriola, MD, PhD, MPH
Assistant Professor Division of Public Health Sciences
Department of Surgery
Washington University School of Medicine
Siteman Cancer Center St. Louis, MO

MedicalResearch: What are the main findings of the study?

Dr. Toriola: Very little is known about the impact of vitamin D in prognosis among cancer patients. This knowledge is of importance because of the increasing number of people living cancer and the high prevalence of vitamin D deficiency among cancer patients. We conducted a systematic review of studies published to date on the association of circulating vitamin D (25-OHD) levels with prognosis among cancer patients. This review suggests that higher circulating vitamin D levels may improve overall survival among breast and colorectal cancer patients but there is paucity of information on the role of circulating vitamin D levels in prognosis among patients with other cancer types.

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Vitamin D Linked to Better Outcomes in Several Types of Cancer

Hui Wang, M.D., Ph.D., Professor Principal Investigator Director, Food Safety Research Center Institute for Nutritional Sciences, SIBS, CASMedicalResearch.com Interview with:
Hui Wang, M.D., Ph.D., Professor
Principal Investigator
Director, Food Safety Research Center
Institute for Nutritional Sciences, SIBS, CAS


MedicalResearch.com: What are the main findings of the study?


Dr. Wang: 
This meta-analysis has systematically reviewed 25 relevant studies composed of 17,332 cancer cases to give a comprehensive perspective on the relationship between vitamin D and cancer patient outcomes. Our result demonstrated that vitamin D levels are linked to better outcomes in several types of cancer patients. The strongest link was found in breast cancer, lymphoma and colorectal cancer. There was less evidence of a connection in people with lung cancer, gastric cancer, prostate cancer, leukemia, melanoma or Merkel cell carcinoma, but the available data were positive. We also found that a 10 nmol/L increase in vitamin D levels was tied to a 4 percent increase in survival among people with cancer.

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Calcium – Vitamin D Supplementation: Effect on Heart Disease and Mortality?

Joshua Lewis, Ph.D Raine Foundation / Alan Robson Fellow Bone and Vascular Research Group School of Medicine and Pharmacology University of Western Australia Department of Endocrinology and Diabetes Sir Charles Gairdner HospitalMedicalResearch.com Interview with:
Joshua Lewis, Ph.D
Raine Foundation / Alan Robson Fellow
Bone and Vascular Research Group
School of Medicine and Pharmacology
University of Western Australia
Department of Endocrinology and Diabetes
Sir Charles Gairdner Hospital

MedicalResearch.com: What are the main findings of the study?

Dr. Lewis: We tested the hypothesis raised by others that calcium supplementation with or without vitamin D increases coronary heart disease and mortality risk in elderly women. To do this we undertook a meta-analysis of published and unpublished data from patient level and cluster randomized controlled trials of calcium supplements with or without vitamin D in elderly women. Importantly all events included in this large meta-analysis were verified by clinical review, hospital record or death certificate. We did not observe any significant increase in all-cause mortality or coronary heart disease events that included myocardial infarction, angina pectoris and acute coronary syndromes and chronic coronary heart disease.
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Vitamin D Did Not Alter Risk of Falls

MedicalResearch.com Interview with:
Dr Mark Bolland, PhD
Bone and Joint Research Group, Department of Medicine
University of Auckland, Auckland, New Zealand

MedicalResearch.com: What are the main findings of the study?

Prof. Bolland: In a meta-analysis of 20 randomized clinical trials, there was no effect of vitamin D with or without calcium on falls.  In a trial sequential analysis of these trials, the effect estimate for vitamin D with or without calcium on falls lay within the futility boundary, providing reliable evidence that vitamin D supplementation does not alter the relative risk of falls by ≥15% and suggesting that future trials that are similar in design to current trials are unlikely to change that conclusion.

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Severe Obesity Linked to Vitamin D Deficiency

MedicalResearch.com Interview with:
Tomás Ahern MB, BCh, BAO
St Columcille’s Hospital and St Vincent’s University Hospital
Dublin, Ireland

MedicalResearch.com: What are the main findings of the study?

Answer: More than 40% of severely obese people, who make up 6.5% of American adults, are at risk of vitamin D deficiency.

Severely obese people with low vitamin D levels are less active and have worse physical function than those with healthy vitamin D levels. Other investigators have found that poor physical function predicts premature death – whether this is the case in people with severe obesity remains to be determined.

MedicalResearch.com: Were any of the findings unexpected?

Answer: Yes. Other studies, of people without severe obesity, have shown that people with low vitamin D levels have higher blood sugar levels and are more likely to have diabetes. We did not find such a relationship in this study of people with severe obesity.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: Determining serum 25-hydroxyvitamin D levels in severely obese people is appropriate because low levels are common and associated with poor physical activity and poor physical function.

The finding of a low 25-hydroxyvitamin D level should be a portal to interventions that improve physical function and should lead to consideration of vitamin D supplementation. Vitamin D supplementation can take the form of spending more time outdoors or chewing calcium and vitamin D tablets daily.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Ahern: We feel that this study generates the imperative to determine the effects of vitamin D supplementation in severely obese people at risk of vitamin D deficiency. We feel it likely that vitamin D supplementation in this group will result in improvement in physical function and possibly improvement in other markers of increased mortality.

Citation:

Association between Vitamin D Status and Physical Function in the Severely Obese

T. Ahern, A. Khattak, E. O’Malley, C. Dunlevy, M. Kilbane, C. Woods, M. J. McKenna, D. O’Shea. Association Between Vitamin D Status and Physical Function in the Severely Obese. The Journal of Clinical Endocrinology & Metabolism, 2014; jc.2014-1704 DOI: 10.1210/jc.2014-1704

 

Vitamin D: Evidence for Widespread Supplementation Weak

Evropi Theodoratou School of Molecular, Genetic and Population Health Sciences University of EdinburghMedicalResearch.com Interview with:
Evropi Theodoratou
School of Molecular, Genetic and Population Health Sciences
University of Edinburgh

MedicalResearch.com: What are the main findings of the study?

Answer: We identified 268 studies either meta-analyses or systematic reviews of plasma vitamin D concentrations or meta-analyses of randomised trials of vitamin D supplementation.

The relation between vitamin D and 137 outcomes has been explored, covering a wide range of skeletal, malignant, cardiovascular, autoimmune, infectious, metabolic, and other diseases.

Ten outcomes were examined by both meta-analyses of observational studies and meta-analyses of randomised trials, but the direction of the effect and level of statistical significance was concordant only for birth weight.

Despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable: birth weight, dental caries in children, maternal vitamin D concentrations at term, and parathyroid hormone concentrations in chronic kidney disease patients requiring dialysis.

Finally, despite the vast volume of published studies, this review highlights the absence of meta-analyses in relation to autoimmune disease (either of observational studies or randomised clinical trials), and the absence of meta-analyses of randomised clinical trials of vitamin D supplementation in respect to cancer, cognitive and infectious disease outcomes.

MedicalResearch.com: Were any of the findings unexpected?

Answer: In contrast to previous reports, evidence does not support the notion that vitamin D only supplementation increases bone mineral density or reduces the risk of fractures or falls in older people.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: The lack of convincing associations and the relative dearth of probable associations suggest that evidence for benefits that may be reaped from population-wide vitamin D supplementation is weak at least for supplementation levels considered by studies included in this review.

Probable associations, for which highly significant effects appear in randomised trials, hold the most promise for clinical translation, but they pertain to specific populations (children, pregnant women, patients with chronic kidney disease).

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: As universal conclusions about vitamin D benefits cannot be drawn, further studies and better designed trials (in relation to dose and vitamin D only supplementation) especially for cancer and autoimmune related outcomes are needed.

Citation:

Chronic Urticaria: Supplemental Vitamin D3 for Hives Management

Dr. Jill A Poole MD Pulmonary, Critical Care, Sleep, and Allergy Division, Department of Medicine College of Medicine, University of Nebraska Medical Center The Nebraska Medical Center, Omaha, NebraskaMedicalResearch.com Interview with:
Dr. Jill A Poole MD
Pulmonary, Critical Care, Sleep, and Allergy Division, Department of Medicine
College of Medicine, University of Nebraska Medical Center
The Nebraska Medical Center, Omaha, Nebraska

MedicalResearch.com: What are the main findings of the study?

Dr. Poole:  Our study found that adding vitamin D 4000 IU daily to a cocktail of anti-allergy medications resulted in a further 40% reduction in hive symptom scores at 3 months.  There was no further reduction in hive symptoms when 600 IU of vitamin D was added to the anti-allergy medications.  The anti-allergy regimen utilized was triple drug therapy with cetirizine (twice daily), ranitidine (twice daily), and montelukast (once daily).  No adverse reactions occurred.
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Pre-Op Vitamin D and Infection Risk Following Gastric Bypass Surgery

Sadeq A. Quraishi, MD, MHA Massachusetts General Hospital, Harvard Medical School Boston, MassachusettsMedicalResearch.com Interview with:
Sadeq A. Quraishi, MD, MHA
Massachusetts General Hospital, Harvard Medical School
Boston, Massachusetts


MedicalResearch.com: What are the main findings of the study?

Dr. Quraishi: Our retrospective study suggests that there is an association between pre-operative 25-hydroxyvitamin D [25(OH)D] levels and the risk of hospital-acquired infections after gastric bypass surgery. In particular, patients with 25(OH)D levels <30 ng/ml before surgery were almost 4 times more likely to develop a surgical site infection within 30 days of surgery than patients with pre-operative 25(OH)D levels at 30 ng/ml or higher.

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