Vitamin D Deficiency Strongly Predicts Adverse Medical Outcome Across Different Medical Inpatient Populations

Graedel, Lena; Merker, Meret; Felder, Stefan; Kutz, Alexander; Haubitz, Sebastian; Faessler, Lukas; Kaeslin, Martha; Huber, Andreas; Müeller, Beat; Schuetz, Philipp

doi:10.1097/md.0000000000003533

Cited by 14 publications

(7 citation statements)

References 59 publications

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“…These associations tempt us to believe that improvement in nutritional status by the use of nutritional interventions also leads to improvements in patient outcomes. However, similar findings have been reported for nutritional factors, such as vitamin D, where associations suggested harmful effects, but intervention research failed to find benefit [ 15 , 16 ]. Still, from a pragmatic standpoint, despite having few rigorously designed nutritional intervention trials in acute care patients, there remain several reasons to support the current approach of systematically screening inpatients for malnutrition and commencing nutritional therapy in those identified.…”

Section: Nutritional Therapysupporting

confidence: 62%

Food for thought: why does the medical community struggle with research about nutritional therapy in the acute care setting?

Schuetz

2017

BMC Med

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Although clinical nutrition is a frequently used intervention in inpatient care, high quality trials proving its effectiveness and safety when used in the acutely-ill polymorbid medical inpatient population are largely lacking. From an evolutionary perspective, illness-related low appetite is protective and part of the host response to improve recovery from disease. Large and well performed trials in the intensive care setting have shown deleterious effects of (parenteral) feeding strategies aiming at higher caloric intakes compared to lower intakes, raising the question of whether feeding per se may be simply maladaptive in acute severe illness. Outside critical care, similar large-scale studies are lacking with basic clinical questions regarding the optimal amount/composition of nutrition and best patient selection remaining largely unanswered. Also, the interplay of nutritional interventions and its influence on the microbiome remains largely unclear. Given the magnitude of morbidity caused by malnutrition and the high number of affected patients, it is surprising how little the medical community has invested in better understanding ways to improve this condition. It is now time to perform high-quality trials to better understand how to best deal with this condition in the acute care setting. Such trials will allow change from a one-size-fits-all approach, to more evidence-based, personalized nutritional interventions, ultimately improving patient outcomes. While there is ongoing discussion about definition of malnutrition, we should rather focus on the identification of patients who do or do not benefit from nutritional interventions.

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Section: Nutritional Therapysupporting

confidence: 62%

Food for thought: why does the medical community struggle with research about nutritional therapy in the acute care setting?

Schuetz

2017

BMC Med

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“…Earlier studies suggested an association between vitamin D and certain conditions associated with increased resource use, such as chronic conditions, falls [ 1 ], frailty [ 30 , 31 ], and fractures [ 32 , 33 ]. Prior studies have suggested that vitamin D deficiency is associated with increased risk of hospital re-admission, nursing home admission, and increased hospital LOS [ 34 , 35 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D and Hospital Admission in Older Adults: A Prospective Association

et al. 2021

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The health effects of vitamin D are well documented, with increasing evidence of its roles beyond bone. There is, however, little evidence of the effects of vitamin D on hospitalisation among older adults. This study aimed to prospectively determine the relationship of vitamin D status in older adults with hospital admission and emergency department (ED) attendance. Trinity University of Ulster Department of Agriculture (TUDA) is a large cross-sectional study of older adults with a community population from three disease-defined cohorts (cognitive dysfunction, hypertension, and osteoporosis). Participants included in this analysis were recruited between 2008 and 2012. ED and hospital admission data were gathered from the date of TUDA participation until June 2013, with a mean follow up of 3.6 years. Of the 3093 participants, 1577 (50.9%) attended the ED during the period of follow-up. Attendees had lower mean serum 25(OH)D concentrations than non-attendees (59.1 vs. 70.6 nmol/L). Fully adjusted models showed an inverse association between vitamin D and ED attendance (Hazard Ratio (HR) 0.996; 95% Confidence Interval (CI) 0.995–0.998; p < 0.001). A total of 1269 participants (41%) were admitted to hospital during the follow-up. Those admitted had lower mean vitamin D concentrations (58.4 vs. 69.3 nmol/L, p < 0.001). In fully adjusted models, higher vitamin D was inversely associated with hospital admission (HR 0.996; 95% CI 0.994–0.998; p < 0.001) and length of stay (LOS) (β = −0.95, p = 0.006). This study showed independent prospective associations between vitamin D deficiency and increased hospitalisation by older adults. The need for further evaluation of current recommendations in relation to vitamin D supplementation, with consideration beyond bone health, is warranted and should focus on randomised controlled trials.

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“…Results from a recent review by Grädel et al [10] showed that high-quality evidence from interventional trials on the benefits of vitamin D supplementation in inpatients is currently lacking. The authors concluded that vitamin D screening and supplementation for the medical inpatient population in an acute care setting cannot be recommended based on current available evidence.…”

Section: Discussionmentioning

confidence: 99%

Impact of Vitamin D deficiency on Rehabilitation Outcome

Wee¹,

Galinato²,

Lolong³

et al. 2016

J Diabetes Metab

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Vitamin D deficiency, which can result from inadequate sun exposure, dietary intake, or problems with absorption, is rarely documented in the rehabilitation literature. Most likely, it is rarely thought of by the rehabilitation profession. This is problematic because vitamin D deficiency can present as musculoskeletal pain, which is commonly seen in both outpatient clinics and inpatient rehabilitation units. The populations with the greatest risk include the homebound elderly, people with pigmented skin, people with cultural and social avoidance of the sun, people who live in wintertime in climates above and below latitudes of 35 degrees, and people with gastrointestinal absorption.Vitamin D deficiency should be included in the differential diagnosis in the evaluation of musculoskeletal pain complaints in the rehabilitation setting, and treatment of any identified deficiency should be considered a potentially important component of the treatment regimen.

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Vitamin D Deficiency Strongly Predicts Adverse Medical Outcome Across Different Medical Inpatient Populations

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 59 publications

Food for thought: why does the medical community struggle with research about nutritional therapy in the acute care setting?

Food for thought: why does the medical community struggle with research about nutritional therapy in the acute care setting?

Vitamin D and Hospital Admission in Older Adults: A Prospective Association

Impact of Vitamin D deficiency on Rehabilitation Outcome

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