The vitamin D paradox: high prevalence of deficiency in sunny Athens (Greece)

Kyriakaki, Argyro; Fragkoulis, Evangelos

doi:10.21037/arh.2019.06.02

Cited by 5 publications

(4 citation statements)

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“…Vitamin D deficiency and insufficiency are prevalent on a global scale [9], and our findings align with previous studies conducted among both general and local populations [10][11][12][13]. However, a discrepancy arises when different clinical decision points are used to assess vitamin D status [14,15]. In our study, we adopted the clinical decision points established by the ES, but we also compared them to those specified by two other organizations.…”

Section: Discussionsupporting

confidence: 84%

Vitamin D distribution by month, sex, and season in Turkey, Niğde province: A retrospective cohort study

Bayram,

Ayan,

Balcı

et al. 2024

J Surg Med

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Background/Aim: Epidemiological investigations consistently indicate a widespread deficiency and insufficiency of vitamin D on a global scale. Vitamin D deficiency can lead to various acute and chronic diseases, including pre-eclampsia, autoimmune disorders, cardiovascular diseases, certain cancers, type 2 diabetes, and neurological disorders. However, the relationship between vitamin D status and its implications for global and public health has not been comprehensively explored. Notably, the differing clinical decision thresholds for diagnosing vitamin D deficiency and insufficiency established by various associations can create diagnostic confusion. Therefore, our study aimed to assess the distribution of vitamin D levels in Niğde province, considering variations by month, gender, and season, with respect to the clinical decision thresholds defined by different associations. Methods: The study sample comprised 57,731 cases (71% women and 19% men) admitted to our hospital between January 2021 and December 2022. We retrospectively evaluated 25-hydroxyvitamin D (25(OH)D) levels based on months, seasons, age, and gender. Additionally, we examined 25(OH)D levels separately using the clinical decision thresholds set by the Vitamin D Council, the Endocrine Society, and the Food and Nutrition Board. Patients with chronic renal insufficiency, hepatic insufficiency, and gastrointestinal malabsorption were excluded from the study, encompassing patients of all age groups. Furthermore, we categorized patients into different age decades and analyzed their vitamin D levels. We compared the same months in 2021 and 2022, monitoring changes in vitamin D levels throughout the year. Vitamin D levels were measured using the electrochemiluminescence assay (ECLIA) on a Roche Cobas E801 instrument. Results: When comparing the same months in 2021 and 2022, there was no statistically significant decrease or increase in 25(OH)D levels (The P-values for January and December were 0.066, 0.395, 0.907, 0.465, 0.705, 0.541, 0.625, 0.860, 0.695, 0.549, 0.892, and 0.838, respectively). Vitamin D insufficiency was observed in 70.3% of women and 29.7% of men. Participants under one year of age exhibited the highest mean 25(OH)D level (34.9 ng/mL), while participants between 20 and 29 years of age had the lowest mean 25(OH)D level (15.7 ng/mL). The lowest mean 25(OH)D level was recorded in April 2022 (15.6 ng/mL), whereas the highest mean 25(OH)D level was observed in July 2021 (22.7 ng/mL). There was a slight negative correlation between age and 25(OH)D levels (r=-0.038, P<0.001). The Vitamin D Council classification identified the highest number of patients with vitamin D deficiency (n=50,833; 88%). The Food and Nutrition Board included the lowest number of patients with vitamin D deficiency (n=15,049; 26.1%). Conclusion: Vitamin D deficiency is prevalent in Niğde province, particularly among women, and remains a significant public health concern. We advocate for the adoption of a unified clinical decision threshold and the expansion of the national vitamin D supplementation program to encompass adolescents and adults.

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Section: Discussionsupporting

confidence: 84%

Vitamin D distribution by month, sex, and season in Turkey, Niğde province: A retrospective cohort study

Bayram,

Ayan,

Balcı

et al. 2024

J Surg Med

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“…Studies examining vitamin D status in Europe observe that vitamin D deficiency is more frequent in Southern than in Northern Europe, a rather unexpected finding considering that ultraviolet light exposure is higher in Southern than in Northern European countries [ 22 ]. This is particularly evident in the elderly population, such as women with osteoporosis, in countries like Italy and Greece [ 23 , 55 , 56 ]. Unfortunately, recent legislation in Italy has limited the use of vitamin D to specific high-risk groups [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

et al. 2021

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Little information is available on the beneficial effects of cholecalciferol treatment in comorbid patients hospitalized for COVID-19. The aim of this study was to retrospectively examine the clinical outcome of patients receiving in-hospital high-dose bolus cholecalciferol. Patients with a positive diagnosis of SARS-CoV-2 and overt COVID-19, hospitalized from 15 March to 20 April 2020, were considered. Based on clinical characteristics, they were supplemented (or not) with 400,000 IU bolus oral cholecalciferol (200,000 IU administered in two consecutive days) and the composite outcome (transfer to intensive care unit; ICU and/or death) was recorded. Ninety-one patients (aged 74 ± 13 years) with COVID-19 were included in this retrospective study. Fifty (54.9%) patients presented with two or more comorbid diseases. Based on the decision of the referring physician, 36 (39.6%) patients were treated with vitamin D. Receiver operating characteristic curve analysis revealed a significant predictive power of the four variables: (a) low (<50 nmol/L) 25(OH) vitamin D levels, (b) current cigarette smoking, (c) elevated D-dimer levels (d) and the presence of comorbid diseases, to explain the decision to administer vitamin D (area under the curve = 0.77, 95% CI: 0.67–0.87, p < 0.0001). Over the follow-up period (14 ± 10 days), 27 (29.7%) patients were transferred to the ICU and 22 (24.2%) died (16 prior to ICU and six in ICU). Overall, 43 (47.3%) patients experienced the combined endpoint of transfer to ICU and/or death. Logistic regression analyses revealed that the comorbidity burden significantly modified the effect of vitamin D treatment on the study outcome, both in crude (p = 0.033) and propensity score-adjusted analyses (p = 0.039), so the positive effect of high-dose cholecalciferol on the combined endpoint was significantly amplified with increasing comorbidity burden. This hypothesis-generating study warrants the formal evaluation (i.e., clinical trial) of the potential benefit that cholecalciferol can offer in these comorbid COVID-19 patients.

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“…Some populations are at increased risk for low VitD levels ( 10 – 12 ). The modern lifestyle in big cities, with high buildings, air pollution, and low insolation of streets; everyday commuting by closed vehicles and predominantly indoor work and leisure activities (without enough outdoor activities and direct exposure to the sun), leads to an increased prevalence of VitD insufficiency/deficiency among populations ( 10 , 13 ) where it was not expected to appear (e.g., in regions with low latitude and high insolation) ( 14 , 15 ). Some professions and working conditions are more associated with low VitD levels.…”

Section: Introductionmentioning

confidence: 99%

Vitamin D Status and Its Correlation With Anthropometric and Biochemical Indicators of Cardiometabolic Risk in Serbian Underground Coal Miners in 2016

et al. 2021

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The status of vitamin D in underground working coal miners and its association with their cardiometabolic health is rarely studied. This study aimed to examine vitamin D (VitD) status in Serbian underground coal miners and to correlate it with anthropometric and laboratory indicators of cardiometabolic risk. Nutritional data (food frequency questionnaire, FFQ, and two times repeated 24 h recall), anthropometric data (including segmental analysis by bio-impedance analyzer TANITA BC-545N), arterial tension, and biochemical and hematological data of 103 coal miners (aged 22–63 years) were correlated with their late summer (early September) serum 25 (OH)D levels (measured by HPLC). 68.9% of the studied coal miners were overweight/obese, and 48.5% had metabolic syndrome. Their mean VitD nutritional intakes were low: 5.3 ± 3.8 μg/day (FFQ) and 4.9 ± 8 μg/day (24 h recalls), but their mean serum 25 (OH)D levels were surprisingly high (143.7 ± 41.4 nmol/L). Only 2.9% of the coal miners had 25(OH)D levels lower than 75 nmol/L (indicating an insufficient/deficient status), while 63.2% had values above 125 nmol/L (upper optimal limit), and even 10.7% had values above 200 nmol/L. There were no statistical differences in 25 (OH)D levels in the coal miners with or without metabolic syndrome (or overweight/obesity). Interestingly, 25(OH)D levels had significant positive correlations with body mass index (BMI), fat mass (FM), fat mass percentage (FM%), limbs FM%, serum triglycerides, GGT, AST, ALT, and ALT/AST ratio, and had significant negative correlations with serum HDL-cholesterol and age. All these correlations were lost after corrections for age, FM, FM%, and legs FM%. In Serbian coal miners, high levels of early September VitD levels were observed, indicating sufficient non-working-hour sun exposure during the summer period. Furthermore, the unexpected positive correlations of VitD levels with anthropometric and biochemical parameters indicative of obesity, metabolic syndrome, and fatty liver disease were found. More research is needed on the VitD status of coal miners (particularly in the winter period) and its relationship with their cardiometabolic status.

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The vitamin D paradox: high prevalence of deficiency in sunny Athens (Greece)

Cited by 5 publications

References 0 publications

Vitamin D distribution by month, sex, and season in Turkey, Niğde province: A retrospective cohort study

Vitamin D distribution by month, sex, and season in Turkey, Niğde province: A retrospective cohort study

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

Vitamin D Status and Its Correlation With Anthropometric and Biochemical Indicators of Cardiometabolic Risk in Serbian Underground Coal Miners in 2016

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