Crucial Role of Vitamin D in the Musculoskeletal System

Wintermeyer, Elke; Ihle, Christoph; Ehnert, Sabrina; Stöckle, Ulrich; Ochs, Gunnar; Zwart, Peter de; Flesch, Ingo; Bahrs, Christian; Nüssler, Andreas K.

doi:10.3390/nu8060319

Cited by 177 publications

(146 citation statements)

References 128 publications

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“…We subsequently analyzed the change in serum concentration of 25(OH) vitamin D and IGF1,both of which have been reported to be associated with loss of skeletal muscle . Baseline IGF1 levels and IGF1 z scores were lower in patients with L‐carnitine supplementation compared to controls ( P = 0.08 for IGF1 levels; P = 0.06 for IGF1 z scores) (Fig.…”

Section: Resultsmentioning

confidence: 99%

L‐Carnitine Suppresses Loss of Skeletal Muscle Mass in Patients With Liver Cirrhosis

Ohara

Ogawa

Suda

et al. 2018

Hepatology Communications

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Liver cirrhosis (LC) is a major cause of secondary sarcopenia. Sarcopenia makes the prognosis worse; thus, novel therapeutic options for sarcopenia in patients with LC are urgently required as they are currently limited. In this retrospective study, 158 patients with LC were screened, and 35 of those patients who were treated with L‐carnitine for more than 6 months and for whom skeletal muscle mass changes could be evaluated by computer tomography were enrolled. Of the 158 patients, 79 patients who did not receive L‐carnitine supplementation served as controls. Cases and controls were propensity score matched for age, sex, presence of hepatocellular carcinoma, and branched chain amino acid administration, and changes in skeletal muscle mass and clinical data were compared. The 35 patients who received L‐carnitine supplementation and 35 propensity score‐matched patients who did not receive carnitine supplementation comprised the final enrollment. Compared with control patients, patients who received L‐carnitine had significantly worse liver function, which is associated with rapid progress of skeletal muscle depletion. However, loss of skeletal muscle mass was significantly suppressed in patients receiving L‐carnitine, and a significant effect was observed in patient subgroups stratified by age, sex, presence of hepatocellular carcinoma, and branched chain amino acid administration. The change ratios of most laboratory data, including vitamin D and insulin‐like growth factor 1 levels, were similar in the two groups, but ammonia levels were significantly less in those receiving L‐carnitine. However, even in patients receiving L‐carnitine but not showing an ammonia decrease, loss of skeletal muscle was significantly suppressed. Conclusion: L‐carnitine suppresses loss of skeletal muscle mass and may therefore be a novel therapeutic option for sarcopenia in patients with LC. (Hepatology Communications 2018; 00:000‐000)

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Section: Resultsmentioning

confidence: 99%

L‐Carnitine Suppresses Loss of Skeletal Muscle Mass in Patients With Liver Cirrhosis

Ohara

Ogawa

Suda

et al. 2018

Hepatology Communications

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“…114,115 Likewise, the data on vitamin D supplementation in improving outcomes are not robust but the data regarding poor outcomes in cirrhosis with vitamin D deficiency are compelling. 116,117 Research experience in the elderly suggests that vitamin D supplementation may have benefits on musculoskeletal system (eg increased bone density, muscle strength and physical activity) 118,119 ; however, whether these findings can be extrapolated for those with cirrhosis is unknown.…”

Section: Hormones and Micronutrient Replacementmentioning

confidence: 99%

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Bunchorntavakul

Reddy

2019

Aliment Pharmacol Ther

143

131

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Summary Background Malnutrition/sarcopenia and frailty are common in patients with cirrhosis and are associated with poor outcomes. Aim To provide an overview of data on the importance, assessment and management of malnutrition/sarcopenia and frailty in cirrhosis. Methods A literature search was conducted in PubMed and other sources, using the search terms “sarcopenia,” “muscle,” “malnutrition,” “cirrhosis,” “liver” and “frailty” from inception to April 2019, to identify the relevant studies and international guidelines. Results The prevalence of malnutrition/sarcopenia in cirrhosis is 23%‐60%. Frailty generally overlaps with malnutrition/sarcopenia in cirrhosis, leading to increased morbidity and mortality. Rapid nutritional screening assessment should be performed in all patients with cirrhosis, and more specific tests for sarcopenia should be performed in those at high risk. The pathogenesis of malnutrition/sarcopenia in cirrhosis is complex/multifactorial and not just reduction in protein/calorie intake. Hyperammonemia appears to be the main driver of sarcopenia in cirrhosis through several molecular signalling pathways. Nutritional management in malnourished patients with cirrhosis should be undertaken by a multidisciplinary team to achieve adequate protein/calorie intake. While the role of branched‐chained amino acids remains somewhat contentious in achieving a global benefit of decreasing mortality‐ and liver‐related events, they, and vitamin supplements, are recommended for those with advanced liver disease. Novel strategies to reverse sarcopenia such as hormone supplementation, long‐term ammonia‐lowering agents and myostatin antagonists, are currently under investigation. Conclusions Malnutrition/sarcopenia and frailty are unique, inter‐related and multi‐dimensional problems in cirrhosis which require special attention, prompt assessment and appropriate management as they significantly impact morbidity and mortality.

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“…22 There is research indicating the practice of physical activity in outdoor settings, but they do not mention the importance of vitamin D. 17,23 Similarly, there are studies on the synthesis of vitamin D from the incidence of sun rays on the skin, but they do not mention physical activity with sun exposure. 24 Why not consider outdoor physical activity in view of the benefits of such activity along with the possibility of vitamin D synthesis from skin exposure to ultraviolet B? It is important to establish if this type of activity, in outdoor environment, would be the only one capable of increasing vitamin D plasma levels ( Figure 2).…”

Section: Physical Activitymentioning

confidence: 99%

Association between physical activity and vitamin D: A narrative literature review

Fernandes

Barreto²

2017

Rev. Assoc. Med. Bras.

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This narrative review of the medical literature assessed whether outdoor and indoor physical activity would increase the plasma levels of vitamin D. Synthesis of this liposoluble vitamin is mainly mediated by sunlight on the skin, where it is activated to perform its main action, which is to control the serum levels of calcium as soon as the element is absorbed in the intestines, assisting in the regulation of bone metabolism. Physical activity is any body movement that results in energy expenditure, while outdoor physical activity refers to physical activity carried out at public parks or other open spaces, as is the case of the popular practice of taking walks. Exercising outdoors would have both the benefits of physical activity and of sun exposure, namely the synthesis of vitamin D. However, according to the studies analyzed, increased plasma concentration of vitamin D occurs with physical activity both indoors and outdoors.

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Crucial Role of Vitamin D in the Musculoskeletal System

Cited by 177 publications

References 128 publications

L‐Carnitine Suppresses Loss of Skeletal Muscle Mass in Patients With Liver Cirrhosis

L‐Carnitine Suppresses Loss of Skeletal Muscle Mass in Patients With Liver Cirrhosis

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Association between physical activity and vitamin D: A narrative literature review

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