Association of Vitamin D Deficiency and Insufficiency with Pathology in Hospitalized Patients
Sandica Bucurica, Ioana Prodan, Mihaela Pavalean, Corina Taubner, Ana Bucurica, Calin Socol, Roxana Calin, Florentina Ionita-Radu, Mariana Jinga
Diagnostics, doi:10.3390/diagnostics13050998
Vitamin D deficiency is one of the most common medical conditions, with approximately one billion people having low vitamin D levels. Vitamin D is associated with a pleiotropic effect (immunomodulatory, anti-inflammatory and antiviral), which can be essential for a better immune response. The aim of this research was to evaluate the prevalence of vitamin D deficiency/insufficiency in hospitalized patients focusing on demographic parameters as well as assessing the possibility of its associations with different comorbidities. Of 11,182 Romanian patients evaluated in the study over 2 years, 28.83% had vitamin D deficiency, 32.11% insufficiency and 39.05% had optimal vitamin D levels. The vitamin D deficiency was associated with cardiovascular disorders, malignancies, dysmetabolic disorders and SARS-CoV2 infection, older age and the male sex. Vitamin D deficiency was prevalent and showed pathology association, while insufficiency of vitamin D (20-30 ng/mL) had lower statistical relevance and represents a grey zone in vitamin D status. Guidelines and recommendations are necessary for homogeneity of the monitoring and management of inadequately vitamin D status in the risk categories.
References
Adenote, Dumic, Madrid, Barusya, Nordstrom et al., Infection, a Nuanced Relationship, Can. J. Gastroenterol. Hepatol,
doi:10.1155/2021/5556354
Aggarwal, Akhthar, Jain, Coronary artery disease and its association with Vitamin D deficiency, J. Midlife Health,
doi:10.4103/0976-7800.185334
Alkhatatbeh, Abdul-Razzak, Khasawneh, Saadeh, High Prevalence of Vitamin D Deficiency and Correlation of Serum Vitamin D with Cardiovascular Risk in Patients with Metabolic Syndrome, Metab. Syndr. Relat. Disord
Alkundi, Momoh, Musa, Nwafor, Vitamin D intoxication and severe hypercalcaemia complicating nutritional supplements misuse, BMJ Case Rep,
doi:10.1136/bcr-2022-250553
Alsafar, Grant, Hijazi, Uddin, Alkaabi et al., COVID-19 Disease Severity and Death in Relation to Vitamin D Status among SARS-CoV-2-Positive UAE Residents, Nutrients,
doi:10.3390/nu13051714
Amrein, Scherkl, Hoffmann, Neuwersch-Sommeregger, Köstenberger et al., deficiency 2.0: An update on the current status worldwide, Eur. J. Clin. Nutr,
doi:10.1038/s41430-020-0558-y
Caprio, Infante, Calanchini, Mammi, Fabbri et al., Not just the bone. Evidence for beneficial pleiotropic extraskeletal effects, Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes,
doi:10.1007/s40519-016-0312-6
Cashman, Dowling, Škrabáková, Gonzalez-Gross, Valtueña et al., Vitamin D deficiency in Europe: Pandemic?, Am. J. Clin. Nutr
Chirita-Emandi, Socolov, Haivas, Calapis, Gheorghiu et al., Vitamin D Status: A Different Story in the Very Young versus the Very Old Romanian Patients, PLoS ONE,
doi:10.1371/journal.pone.0128010
Christakos, Dhawan, Verstuyf, Verlinden, Carmeliet et al., Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects, Physiol. Rev,
doi:10.1152/physrev.00014.2015
Cosentino, Campodonico, Milazzo, De Metrio, Brambilla et al., Vitamin D and Cardiovascular Disease: Current Evidence and Future Perspectives, Nutrients,
doi:10.3390/nu13103603
Cuomo, Maina, Bolognesi, Rosso, Crescenzi et al., Prevalence and Correlates of Vitamin D Deficiency in a Sample of 290 Inpatients With Mental Illness, Front. Psychiatry,
doi:10.3389/fpsyt.2019.00167
Da Silveira, Moura, Castro, Kac, Hadler et al., Prevalence of Vitamin D and Calcium Deficiency and Insufficiency in Women of Childbearing Age and Associated Risk Factors: A Systematic Review and Meta-Analysis, Nutrients,
doi:10.3390/nu14204351
Dudenkov, Yawn, Oberhelman, Fischer, Singh et al., Changing Incidence of Serum 25-Hydroxyvitamin D Values above 50 ng/mL: A 10-Year Population-Based Study, Mayo Clin. Proc,
doi:10.1016/j.mayocp.2015.02.012
Elizondo-Montemayor, Castillo, Rodríguez-López, Villarreal-Calderón, Gómez-Carmona et al., Seasonal Variation in Vitamin D in Association with Age, Inflammatory Cytokines, Anthropometric Parameters, and Lifestyle Factors in Older Adults, Mediat. Inflamm,
doi:10.1155/2017/5719461
Ene, Terþiu, Vrâncianu, Chifiriuc, Vitamin D Status in Adult and Pediatric Romanian Population
Feldman, Krishnan, Swami, Giovannucci, Feldman, The role of vitamin D in reducing cancer risk and progression, Nat. Rev. Cancer,
doi:10.1038/nrc3691
Finstad, Murphy, Markey, Connor, Murphy, Prevalence of vitamin D3 deficiency among women with early breast cancer receiving chemotherapy in an oncology dayward, Ann. Oncol,
doi:10.1093/annonc/mdz240.106
Fontanive, Dick, Valente, Laranjeira, Antunes et al., Seasonal variation of vitamin D among healthy adult men in a subtropical region, Rev. Assoc. Med. Bras,
doi:10.1590/1806-9282.66.10.1431
Gaksch, Jorde, Grimnes, Joakimsen, Schirmer et al., Vitamin D and mortality: Individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium, PLoS ONE,
doi:10.1371/journal.pone.0170791
Giustina, Bouillon, Binkley, Sempos, Adler et al., Controversies in Vitamin D: A Statement From the Third International Conference, JBMR Plus
Gois, Ferreira, Olenski, Seguro, Vitamin D and Infectious Diseases: Simple Bystander or Contributing Factor?, Nutrients,
doi:10.3390/nu9070651
Graedel, Merker, Felder, Kutz, Haubitz et al., Deficiency Strongly Predicts Adverse Medical Outcome Across Different Medical Inpatient Populations: Results from a Prospective Study, Medicine,
doi:10.1097/MD.0000000000003533
Griffin, Wall, Blake, Griffin, Robinson et al., Vitamin D Status of Adults in the Community, in Outpatient Clinics, in Hospital, and in Nursing Homes in the West of Ireland, J. Gerontol. Ser. A,
doi:10.1093/gerona/glaa010
Gupta, Vashi, Trukova, Lis, Lammersfeld, Prevalence of serum vitamin D deficiency and insufficiency in cancer: Review of the epidemiological literature, Exp. Ther. Med,
doi:10.3892/etm.2011.205
Hays, Flores, Kothari, Bilek, Geske et al., Vitamin D Status and Seasonal Variation: A Retrospective Single Institution Database Study of Patients Pursuing Metabolic/Bariatric Surgery, Clin. Nutr. Open Sci,
doi:10.1016/j.nutos.2021.11.002
Holick, Binkley, Bischoff-Ferrari, Gordon, Hanley et al., Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline, Med. J. Clin. Endocrinol. Metab,
doi:10.1210/jc.2011-0385
Holick, High Prevalence of Vitamin D Inadequacy and Implications for Health, Mayo Clin. Proc,
doi:10.4065/81.3.353
Hopkins, Owen, Ahearn, Fedirko, Flanders et al., Effects of Supplemental Vitamin D and Calcium on Biomarkers of Inflammation in Colorectal Adenoma Patients: A Randomized, Controlled Clinical Trial, Cancer Prev. Res,
doi:10.1158/1940-6207.CAPR-11-0105
Huang, Lu, Chen, Zeng, Xu, The efficacy of vitamin D supplementation for irritable bowel syndrome: A systematic review with meta-analysis, Nutr. J,
doi:10.1186/s12937-022-00777-x
Janoušek, Pilařová, Macáková, Nomura, Veiga-Matos et al., Sources, physiological role, biokinetics, deficiency, therapeutic use, toxicity, and overview of analytical methods for detection of vitamin D and its metabolites, Crit. Rev. Clin. Lab. Sci,
doi:10.1080/10408363.2022.2070595
Kantas, Capriles, Babor, Tamdin, Al-Rihani et al., Relationship between Chronic Kidney Disease Staging and Vitamin D Deficiency: A Retrospective Study, Cureus,
doi:10.7759/cureus.r55
Khadilkar, Kajale, Oza, Oke, Gondhalekar et al., Vitamin D status and determinants in Indian children and adolescents: A multicentre study, Sci. Rep,
doi:10.1038/s41598-022-21279-0
Kovalenko, Zhang, Cui, Clinton, Fleet, 1,25 dihydroxyvitamin D-mediated orchestration of anticancer, transcript-level effects in the immortalized, non-transformed prostate epithelial cell line, RWPE1. BMC Genom,
doi:10.1186/1471-2164-11-26
Kweder, Eidi, Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status, Avicenna J. Med,
doi:10.4103/ajm.AJM_20_18
Lahoz, Sánchez, Górriz, Calmarza, Comparative study of two immunoassays used for the determination of serum vitamin D, Pract. Lab. Med,
doi:10.1016/j.plabm.2021.e00242
Li, Liu, Luo, Huang, Zhang et al., Vitamin D deficiency associated with Crohn's disease and ulcerative colitis: A meta-analysis of 55 observational studies, J. Transl. Med,
doi:10.1186/s12967-019-2070-5
Lips, Cashman, Lamberg-Allardt, Bischoff-Ferrari, Obermayer-Pietsch et al., Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: A position statement of the European Calcified Tissue Society, Eur. J. Endocrinol,
doi:10.1530/EJE-18-0736
Mahdavi, A brief review of interplay between vitamin D and angiotensin-converting enzyme 2: Implications for a potential treatment for COVID-19, Rev. Med. Virol,
doi:10.1002/rmv.2119
Malinovschi, Masoero, Bellocchia, Ciuffreda, Solidoro et al., Severe vitamin D deficiency is associated with frequent exacerbations and hospitalization in COPD patients, Respir. Res,
doi:10.1186/s12931-014-0131-0
Manson, Bassuk, Buring, Vital Research, Group, Principal results of the VITamin D and OmegA-3 TriaL (VITAL) and updated meta-analyses of relevant vitamin D trials, J. Steroid Biochem. Mol. Biol,
doi:10.1016/j.jsbmb.2019.105522
Manson, Cook, Lee, Christen, Bassuk et al., Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease, N. Engl. J. Med,
doi:10.1056/NEJMoa1809944
Mc Williams, Golestany, Sharma, Nejati, Cyrus-Murden et al., Correlation of admitted nursing home residents' hospital length of stay and vitamin D levels, J. Community Hosp. Intern. Med. Perspect,
doi:10.3402/jchimp.v1i3.6313
Melamed, Thadhani, Vitamin D Therapy in Chronic Kidney Disease and End Stage Renal Disease, Clin. J. Am. Soc. Nephrol,
doi:10.2215/CJN.04040411
Mensah, Wei, Sorlie, Fine, Rosenberg et al., Decline in Cardiovascular Mortality: Possible Causes and Implications, Circ. Res
Merker, Amsler, Pereira, Bolliger, Tribolet et al., Vitamin D deficiency is highly prevalent in malnourished inpatients and associated with higher mortality, Medicine
Moore, Kiebzak, Suboptimal vitamin D status is a highly prevalent but treatable condition in both hospitalized patients and the general population, J. Am. Acad. Nurse Pract,
doi:10.1111/j.1745-7599.2007.00277.x
Niculescu, Capatina, Dusceac, Caragheorgheopol, Ghemigian et al., Seasonal variation of serum vitamin D levels in Romania, Arch. Osteoporos,
doi:10.1007/s11657-017-0407-3
Nimavat, Singh, Singh, Singh, Sinha, Vitamin D deficiency and COVID-19: A case-control study at a tertiary care hospital in India, Ann. Med. Surg,
doi:10.1016/j.amsu.2021.102661
Obi, Hamano, Isaka, Prevalence and Prognostic Implications of Vitamin D Deficiency in Chronic Kidney Disease, Dis. Markers,
doi:10.1155/2015/868961
Okan, Okan, Demir, Relation of Vitamin D Status with Season, Living Place, Age Gender and Chronic Disease, Erciyes Med. J,
doi:10.14744/etd.2019.45577
Petrelli, Oldani, Borgonovo, Cabiddu, Dognini et al., Vitamin D3 and COVID-19 Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses, Antioxidants,
doi:10.3390/antiox12020247
Pinzariu, Sova, Maranduca, Filip, Drochioi et al., Vitamin D Deficiency in Both Oral and Systemic Manifestations in SARS-CoV-2 Infection: Updated Review, Medicina,
doi:10.3390/medicina59010068
Pludowski, Takacs, Boyanov, Belaya, Diaconu et al., Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement, Nutrients,
doi:10.3390/nu14071483
Schleicher, Sternberg, Looker, Yetley, Lacher et al., National Estimates of Serum Total 25-Hydroxyvitamin D and Metabolite Concentrations Measured by Liquid Chromatography-Tandem Mass Spectrometry in the US Population during 2007-2010, J. Nutr,
doi:10.3945/jn.115.227728
Schöttker, Hagen, Zhang, Gào, Holleczek et al., Serum 25-Hydroxyvitamin D Levels as an Aging Marker: Strong Associations With Age and All-Cause Mortality Independent From Telomere Length, Epigenetic Age Acceleration, and 8-Isoprostane Levels, J. Gerontol. Ser. A,
doi:10.1093/gerona/gly253
Souberbielle, Massart, Brailly-Tabard, Cavalier, Chanson, Prevalence and determinants of vitamin D deficiency in healthy French adults: The VARIETE study, Endocrine,
doi:10.1007/s12020-016-0960-3
Tazzyman, Richards, Trueman, Evans, Grant et al., Vitamin D associates with improved quality of life in participants with irritable bowel syndrome: Outcomes from a pilot trial, BMJ Open Gastroenterol,
doi:10.1136/bmjgast-2015-000052
Tebben, Singh, Kumar, Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment, Endocr. Rev,
doi:10.1210/er.2016-1070
Tomaschitz, Pilz, Ritz, Grammer, Drechsler et al., Independent association between 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D and the renin-angiotensin system: The Ludwigshafen Risk and Cardiovascular Health (LURIC) study, Clin. Chim. Acta,
doi:10.1016/j.cca.2010.05.037
Varikasuvu, Thangappazham, Vykunta, Duggina, Manne et al., COVID-19 and vitamin D (Co-VIVID study): A systematic review and meta-analysis of randomized controlled trials, Expert Rev. Anti Infect. Ther,
doi:10.1080/14787210.2022.2035217
Venkatram, Chilimuri, Adrish, Salako, Patel et al., Vitamin D deficiency is associated with mortality in the medical intensive care unit, Crit. Care,
doi:10.1186/cc10585
Wang, Chen, Li, Yin, Zhang et al., Vitamin D and Chronic Diseases, Aging Dis
Wang, Yang, Zhou, Zhang, Yi, Effects of Vitamin D Supplementation on Renal Function, Inflammation and Glycemic Control in Patients with Diabetic Nephropathy: A Systematic Review and Meta-Analysis, Kidney Blood Press. Res,
doi:10.1159/000498838
Wintermeyer, Ihle, Ehnert, Stöckle, Ochs et al., Crucial Role of Vitamin D in the Musculoskeletal System, Nutrients,
doi:10.3390/nu8060319
Wu, Liu, Deng, The Role of Vitamin D in Immune System and Inflammatory Bowel Disease, J. Inflamm. Res,
doi:10.2147/JIR.S363840
Zierold, Nehring, Deluca, Nuclear receptor 4A2 and C/EBPβ regulate the parathyroid hormone-mediated transcriptional regulation of the 25-hydroxyvitamin D3-1α-hydroxylase, Arch. Biochem. Biophys,
doi:10.1016/j.abb.2006.11.028
Zittermann, Trummer, Theiler-Schwetz, Lerchbaum, März et al., Vitamin D and Cardiovascular Disease: An Updated Narrative Review, Int. J. Mol. Sci,
doi:10.3390/ijms22062896