Abstracts
Cardiomyopathy/deficiency
Cardiomyopathy/deficiency
A five-month-old boy presented with severe dilated cardiomyopathy, requiring intravenous inotropes as part of the initial management. He was found to have hypocalcemia due to vitamin D deficiency rickets. His cardiac function recovered completely after six months of vitamin D supplementation.
Mustafa A, Bigras JL, McCrindle BW: Dilated cardiomyopathy as a first sign of nutritional vitamin D deficiency rickets in infancy, Can J Cardiol 1999 Jun;15(6):699-701
Deficiency/ Fracture risk
Deficiency/ Fracture risk
Deficiency in vitamin D has been linked to an increased risk of bone fracture, according to this study on 98 post-menopausal women. Thirty of these women had a hip fracture, and 50% of these were deficient in vitamin D. Of the 68 women undergoing elective hip replacement, 17 suffered from osteoporosis, also indicating a vitamin D deficiency, since vitamin D is necessary for the absorption of calcium. Researchers note that supplementation of vitamin D, in doses of about 800 IU, may be necessary to reduce fractures in the winter, when patients are less likely to absorb sunlight, a vital source of the vitamin.
LeBoff, Meryl MD, et al: JAMA, Apr. 1999; 282:1505-1511
Excess vitamin D
Excess vitamin D
To evaluate subclinical health effects of excess vitamin D, a cross-sectional study was conducted of persons consuming milk from a dairy that had overfortified milk for at least 4 years. Milk consumption, sunlight exposure, medical symptoms, serum 25-hydroxyvitamin D (25[OH]D), serum and urinary calcium, and indicators of renal function were measured. Increased milk consumption was associated with increased serum 25(OH)D and urinary calcium. However, the prevalences of elevated serum 25(OH)D and calcium were no greater than expected, and data indicated normal renal function. It was concluded that most persons exposed to excess vitamin D exhibited no measurable adverse subclinical effects.
Scanlon-KS: Subclinical health effects in a population exposed to excess vitamin D in milk. Am-J-Public-Health. 1995 Oct; 85(10): 1418-22.
Fat-soluble vitamins
Fat-soluble vitamins
The identification of fat-soluble vitamins at the beginning of this century had a major impact on human health. The classical deficiency symptoms could be treated with effective means. After a period of rather low interest in fat-soluble vitamins, we are now in the midst of a new wave of research on these vitamins, with a large number of reports in influential international journals. It has been demonstrated that the fat-soluble vitamins have many more functions than previously known, and suboptimal status has been linked to several diseases. In this review, we describe these new aspects of the fat-soluble vitamins A, D, E and K.
[Fat-soluble vitamins in clinical practice] Blomhoff-R; Drevon-CA. Tidsskr-Nor-Laegeforen. 1995 Feb 10; 115(4): 481-5.
Migration
Migration
A case of severe vitamin D deficiency in a family of immigrants is presented. All had secondary hyperparathyroidism and the children had hypocalcaemia. Symptoms and pathogenesis including dark skin pigmentation and vegetarianism are discussed. It is recommended that the whole family be screened if a deficiency of vitamin D caused by skin pigmentation or eating habits is found in one of the family members.
[Severe vitamin D deficiency in an immigrant family] Jensen-JE. Ugeskr-Laeger. 1995 Jan 30; 157(5): 595-6.
Fogelman-Y et al: High prevalence of vitamin D deficiency among Ethiopian women immigrants to Israel: exacerbation during pregnancy and lactation [see comments] Isr-J-Med-Sci. 1995 Apr; 31(4): 221-4.
Osteoporosis
Osteoporosis
According to this study, vitamin D aids in the prevention of osteoporosis because of its ability to assist calcium absorption, thereby improving bone density. Other vitamins important in preventing and treating osteoporosis include vitamin C, B6, and K. Epidemiological studies report a positive association between vitamin C intake and bone density. Vitamin B6 could function as a cofactor to build up cross-links. Recent research also points to a role of vitamin K in bone metabolism.
Weber P: The role of vitamins in the prevention of osteoporosis--a brief status report, Int J Vitam Nutr Res 1999 May;69(3):194-7
Prostate Cancer
Examined the relationship between the intake of various carotenoids, retinol, fruits, and vegetables and the risk of prostate cancer.
Between 1986 and 1992, 812 new cases of prostate cancer, including 773 non-stage Al cases, were documented. Intakes of the carotenoids beta-carotene, alpha-carotene, lutein, and beta-cryptoxanthin were not associated with risk of non-stage Al prostate cancer; only Lycopene intake was related to lower risk. Of 46 vegetables and fruits or related products, four were significantly associated with lower prostate cancer risk; of the four--tomato sauce, tomatoes, and pizza, but not strawberries--were primary sources of lycopene.
Combined intake of tomatoes, tomato sauce, tomato juice, and pizza (which accounted for 82% of lycopene intake) was inversely associated with risk of prostate cancer, for consumption frequency greater than 1 0 versus less than 1. 5 servings per week.
Findings suggest that intake of lycopene or other compounds in tomatoes may reduce prostate cancer risk, but other measured carotenoids are unrelated to risk.
Tomato-based foods may be especially beneficial regarding prostate cancer risk.
Giovannucci E et al: Intake of carotenoids and retinol in relation to risk of prostate cancer. J Natl Cancer Inst, 1995 Dec 6, 87:23, 1767-76.
Ventricular function/deficiency
Ventricular function/deficiency
Vitamin D deficiency (rickets) can lead to the malabsorption of calcium, thereby causing cardiomyopathy, according to this study conducted on 27 infants with diagnosed rickets. Electrocardiograms and echocardiographic studies were undertaken in all patients. Before rickets treatment, the echocardiographic studies revealed left ventricular dysfunction and an increase in the ratio of interventricular septal thickness to left ventricular posterior wall thickness in eight patients. This returned to normal after treatment of the rickets. While these results indicate a tendency for left ventricular dysfunction in rickets patients, these findings are not significant enough to suggest the possibility of cardiac failure.
Uysal S, Kalayci AG, Baysal K: Cardiac functions in children with vitamin D deficiency rickets, Pediatr Cardiol 1999 Jul-Aug;20(4):283-6
Rickets
Rickets
Calcium deficiency, rather than vitamin D deficiency may be the main cause of nutritional rickets in children living in Nigeria. In a clinical study, only 19% of the children taking only vitamin D reached the required level of being cured from rickets. However, 61% and 58% of children undergoing calcium monotherapy or combination therapy respectively reached those levels. Therefore calcium or a combination of calcium and vitamin D may be more effective in curing rickets than vitamin D alone.
Thacher TD, et al.: A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children. N Engl J Med. 1999 Aug 19;341(8):563-8.
Tuberculosis & Vitamin D
Tuberculosis
According to this comment article, low levels of vitamin D may increase the risk for tuberculosis infection. The author argues this hypothesis with three points: 1) TB tends to occur during the winter months when people spend less time in the sun and therefore synthesize less vitamin D, 2) patients with untreated TB have low vitamin D levels, and 3) people with low vitamin D levels (elderly, uremic patients, Asian immigrants) have a higher incidence of TB than healthy subjects.
Chan TY: Vitamin D deficiency and susceptibility to tuberculosis, Calcif Tissue Int 2000 Jun;66(6):476-8
Deficiency in Arab Children
Deficiency in Arab Children
Arab women and their newborn infants exhibit deficiencies in vitamin D despite adequate sunshine, according to this study conducted on 51 hospitalized children and their mothers. Both mothers and infants had low vitamin D levels, with half of the mothers and a quarter of the infants exhibiting deficiency. Supplementation with vitamin D corrected deficiency in both mothers and infants. The authors call for better availability of vitamin D supplements and education about the importance of sun exposure.
Dawodu A, et al: Diet, clothing, sunshine exposure and micronutrient status of Arab infants and young children, Ann Trop Paediatr 2001 Mar;21(1):39-44
Breast Cancer & Vitamin D
Breast Cancer
To substantiate claims that vitamin D is helpful in the fight against breast cancer, this study evaluated the correlation between polymorphisms in the vitamin D receptor (VDR) gene and increased risk of breast cancer. The study was conducted on 422 caucasian females living in the UK, including 241 healthy women and 181 women diagnosed with breast cancer. The Bsm I VDR polymorphism was associated with a higher risk of cancer, while the 5' VDR gene variant Fok I was not. A variable length poly(A) sequence near the Bsm I polymorphism was also found to be connected to increased risk of cancer.
Bretherton-Watt D, Given-Wilson R, Mansi JL, Thomas V, Carter N, Colston KW: Vitamin D receptor gene polymorphisms associated with breast cancer risk in a UK Caucasian population, Br J Cancer 2001 Aug;85(2):171-5
Pregnant Orthodox Jews in Israel
Pregnant orthodox Jews in Israel
Orthodox Jewish women in Israel wear very modest clothing, which puts them at risk of vitamin D deficiency due to under-exposure to the sun. This study compared the vitamin D nutritional status of orthodox mothers to non-orthodox mothers living in the same metropolitan area in Israel. In the summer of 1998 and the spring of 1999, serum was collected from 341 Jewish Israeli mothers 48-72 hours after childbirth, and their levels of 25-Hydroxyvitamin D (25-OHD) were measured by competitive protein-binding radioassay. The
levels of 25-OHD in the orthodox mothers were significantly lower than those in the non-orthodox mothers. Vitamin D deficiency (less than 5 ng/mL) occurred in 5.1% of the orthodox mothers, compared to 2.7% of the non-orthodox mothers. Also, vitamin D insufficiency (less than 10 ng/mL) occurred in 19.7% more orthodox mothers than non-orthodox mothers. In groups of women given daily supplementation of 400 units of vitamin D during pregnancy, vitamin D deficiency and insufficiency were less common. It was also found that vitamin D insufficiency was only more common in the winter than in the summer in non-orthodox mothers.
Mukamel MN, Weisman Y, Somech R, Eisenberg Z, Landman J, Shapira I, Spirer Z, Jurgenson U: Vitamin D deficiency and insufficiency in Orthodox and non-Orthodox Jewish mothers in Israel, Isr Med Assoc J 2001 Jun;3(6):419-21
Tooth Loss, Calcium & Vitamin D
Tooth Loss, Calcium and Vitamin D
Elderly subjects who take calcium and vitamin D supplements may retain their teeth longer than those who do not, according to this randomized, placebo-controlled study. Calcium and vitamin D supplements were given to 145 healthy subjects over the age of 65 for three years, and follow-up was continued for two years after the supplements were discontinued. Tooth retention of each subject was analyzed at eighteen months and at five years. An oral examination was also conducted at the five-year mark to assess each participant's oral hygiene and record the presence of caries and periodontal disease. The average number of teeth remaining at the beginning of the study was 22, and during the study 13% of those taking supplements lost one or more teeth compared to 27% of those taking placebo. During the two years of follow-up, 40% of the participants who had a total calcium intake of at least 1000 mg per day lost one or more teeth compared to 59% of those who consumed less calcium.
Krall EA, Wehler C, Garcia RI, Harris SS, Dawson-Hughes B: Calcium and vitamin D supplements reduced tooth loss in the elderly, Am J Med 2001 Oct 15;111(6):452-6
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