Prevalence, determinants and clinical correlates of vitamin D deficiency in patients with Chronic Obstructive Pulmonary Disease in London, UK

Jolliffe, David A.; James, Wai Yee; Hooper, Richard; Barnes, Neil; Greiller, Claire; Islam, Kamrul; Bhowmik, Angshu; Timms, Philip; Rajakulasingam, Raj K; Choudhury, Aklak; Simcock, David E; Hyppönen, Elina; Walton, Robert; Corrigan, Christopher; Griffiths, Christopher J.; Martineau, Adrian R.

doi:10.1016/j.jsbmb.2017.01.019

Cited by 36 publications

(33 citation statements)

References 24 publications

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“…In addition, FFM and FFMI were not correlated with 25(OH)D concentration at either seasonal time point. Mean BMI at both seasonal time points was within the overweight category (BMI 25.0–29.9 kg/m 2 ), which has been associated with poor vitamin D status in some studies,41,42 including COPD populations 43. Nonetheless, BMI cannot distinguish between fat mass (FM) and FFM, which is particularly important in COPD patients, who are at risk of sarcopenia22 or sarcopenic obesity (normal BMI but with low FFM and increased FM) 44.…”

Section: Discussionmentioning

confidence: 97%

Vitamin D status is associated with muscle strength and quality of life in patients with COPD: a seasonal prospective observation study

Carson¹,

Pourshahidi²,

Madigan³

et al. 2018

COPD

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BackgroundOwing to hospitalization, reduced functional capacity and consequently, less sunlight exposure, suboptimal vitamin D status (25-hydroxyvitamin D [25(OH)D]⩽50 nmol/L) is prevalent among COPD patients.ObjectiveThis study aimed to investigate seasonal changes in vitamin D status and any associated changes in fat-free mass (FFM), muscle strength and quality of life (QoL) in COPD patients.Patients and methodsCOPD patients living in Northern Ireland (n=51) completed study visits at the end of winter (March/April) and at the end of summer (September/October), corresponding to the nadir and peak of vitamin D status, respectively. At both time points, serum concentration of 25(OH)D was quantified by liquid chromatography-tandem mass spectrometry, FFM (kg) was measured using bioelectrical impedance and muscle strength (kg) was measured using handgrip dynamometry. QoL was assessed using the validated St George’s Respiratory Questionnaire.ResultsMean±SD 25(OH)D concentration was significantly higher at the end of summer compared to the end of winter (52.5±30.5 nmol/L vs 33.7±28.4 nmol/L, P<0.001); and house- bound patients had significantly lower 25(OH)D concentration compared to nonhousebound patients at the end of summer (42.9±4.2 vs 57.2±9.9 nmol/L; P⩽0.001). Muscle strength (at both time points) and QoL (end of summer only) were positively predicted by 25(OH)D concentration, independent of age, sex and smoking status.ConclusionThis study highlights the need for health policies to include a recommendation for year-round vitamin D supplementation in housebound COPD patients, and wintertime supplementation in nonhousebound patients, to maintain optimal 25(OH)D concentrations to protect musculoskeletal health. Furthermore, an optimal vitamin D status may have potential benefits for QoL in these patients.

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Section: Discussionmentioning

confidence: 97%

Vitamin D status is associated with muscle strength and quality of life in patients with COPD: a seasonal prospective observation study

Carson¹,

Pourshahidi²,

Madigan³

et al. 2018

COPD

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“…However, subgroup analysis revealed clinically and statistically significant protective effects of vitamin D supplementation among patients with baseline circulating 25(OH)D concentrations of less than 25 nmol/L. Given the high prevalence of profound vitamin D deficiency in people with COPD,26 and the large reduction in exacerbation rates seen with vitamin D supplementation in this group, our findings support a strategy of routinely testing vitamin D status in patients with COPD who experience exacerbations and offering supplementation to those with circulating 25(OH)D concentrations of less than 25 nmol/L.…”

Section: Discussionmentioning

confidence: 97%

Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials

Jolliffe

Greenberg

Hooper

et al. 2019

Thorax

146

110

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BackgroundRandomised controlled trials (RCTs) of vitamin D to prevent COPD exacerbations have yielded conflicting results.Individual participant data meta-analysis could identify factors that explain this variation.MethodsPubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched from inception up to and including 5 October 2017 to identify RCTs of vitamin D supplementation in patients with COPD that reported incidence of acute exacerbations. Individual participant data meta-analysis was performed using fixed effects models adjusting for age, sex, Global Initiative for Chronic Obstructive Lung Disease spirometric grade and trial.ResultsFour eligible RCTs (total 560 participants) were identified; individual participant data were obtained for 469/472 (99.4%) participants in three RCTs. Supplementation did not influence overall rate of moderate/severe COPD exacerbations (adjusted incidence rate ratio (aIRR) 0.94, 95% CI 0.78 to 1.13). Prespecified subgroup analysis revealed that protective effects were seen in participants with baseline 25-hydroxyvitamin D levels <25 nmol/L (aIRR 0.55, 95% CI 0.36 to 0.84) but not in those with baseline 25-hydroxyvitamin D levels ≥25 nmol/L (aIRR 1.04, 95% CI 0.85 to 1.27; p for interaction=0.015). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (adjusted OR 1.16, 95% CI 0.76 to 1.75).ConclusionsVitamin D supplementation safely and substantially reduced the rate of moderate/severe COPD exacerbations in patients with baseline 25-hydroxyvitamin D levels <25 nmol/L but not in those with higher levels.Trial registration numberCRD42014013953.

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“…However, based on previous studies in patients with reparatory disease [28] and in order to quickly and safely increase serum 25(OH)D levels, we recommend patients with low circulating levels (below 50 nmol/L) should be offered vitamin D supplementation of 50,000 IU twice a week at the diagnosis (100,000 IU total). Overall, doses [32] 420 patients ≥65 years old admitted to rehabilitation centers Deficiency: <50 nmol/L Insufficiency: 50-75 nmol/L 94.3% 81.2% United States [33] 26010 adults in the National Health and Nutrition Examination Survey 2001-2010 Deficiency: <50 nmol/L Insufficiency: 50-75 nmol/L 28.9% 41.4% France [34] 297 subjects studied in January and February 2015 Deficiency: <50 nmol/L 75.1% United Kingdom [35] 278 patients with chronic obstructive pulmonary disease, aged 41-92 years in London…”

Section: Suggested Plan Of Actionmentioning

confidence: 99%

Perspective: improving vitamin D status in the management of COVID-19

2020

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Prevalence, determinants and clinical correlates of vitamin D deficiency in patients with Chronic Obstructive Pulmonary Disease in London, UK

Cited by 36 publications

References 24 publications

Vitamin D status is associated with muscle strength and quality of life in patients with COPD: a seasonal prospective observation study

Vitamin D status is associated with muscle strength and quality of life in patients with COPD: a seasonal prospective observation study

Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials

Perspective: improving vitamin D status in the management of COVID-19

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