Vitamin D Insufficiency in a Sunshine-Sufficient Area: Southern Ethiopia

Gebreegziabher, Tafere; Stoecker, Barbara J.

doi:10.1177/156482651303400408

Cited by 33 publications

(16 citation statements)

References 24 publications

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“…[32,33] Ethiopia is located in east Africa close to the equator (3 degree N to 14.8 degree latitude) and there is abundant sunshine to form vitamin D all year round. [34] This study was conducted in Addis Ababa, the capital city of Ethiopia, located at latitude 9 degree N. In the present study, we found no significant influence of seasonal variation (rainy versus dry seasons) on plasma 25 (OH)D 3 concentrations. Our finding is consistent with previous findings from countries located near the equator.…”

Section: Discussioncontrasting

confidence: 43%

Prevalence and risk factors for efavirenz-based antiretroviral treatment–associated severe vitamin D deficiency

et al. 2016

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Initiation of efavirenz-based combination antiretroviral therapy (cART) is associated with Vitamin D deficiency, but the risk factors including efavirenz pharmacokinetics for cART-induced severe vitamin D deficiency (SVDD) and the impact of anti-tuberculosis (TB) cotreatment are not explored. We investigated the prevalence of SVDD in HIV and TB-HIV coinfected patients and associated risk factors for treatment-induced SVDD.Treatment-naïve Ethiopian HIV patients with (n = 102) or without (n = 89) TB co-infection were enrolled prospectively and received efavirenz-based cART. In TB-HIV coinfected patients, rifampicin-based anti-TB treatment was initiated 4 or 8 weeks before starting cART. Plasma 25-hydroxyvitamin D (25 [OH]D), cholesterol and 4-beta hydroxycholesterol concentrations were measured at baseline, 4th, 16th, and 48th week of cART. Plasma efavirenz concentrations were determined at 4th and 16th weeks of cART.TB-HIV patients had significantly lower plasma 25 (OH)D3 levels than HIV-only patients at baseline. TB co-infection, low Karnofsky score, high viral load, and high CYP3A activity as measured by plasma 4β-hydroxycholesterol/cholesterol ratios were significant predictors of low 25 (OH)D3 levels at baseline. In HIV-only patients, initiation of efavirenz-based cART increased the prevalence of SVVD from 27% at baseline to 76%, 79%, and 43% at 4th, 16th, and 48th weeks of cART, respectively. The median 25 (OH)D3 levels declined from baseline by −40%, −50%, and −14% at 4th, 16th, and 48th weeks of cART, respectively.In TB-HIV patients, previous anti-TB therapy had no influence on 25 (OH)D3 levels, but the initiation of efavirenz-based cART increased the prevalence of SVDD from 57% at baseline to 70% and 72% at the 4th and 16th weeks of cART, respectively. Median plasma 25 (OH)D3 declined from baseline by −17% and −21% at week 4 and 16 of cART, respectively.Our results indicate low plasma cholesterol, high CYP3A activity, and high plasma efavirenz concentrations as significant predictors of early efavirenz-based cART-induced vitamin D deficiency. Low plasma 25 (OH)D3 level at baseline is associated with TB co-infection and HIV diseases progression. Initiation of efavirenz-based cART is associated with high incidence of SVDD, whereas rifampicin based anti-TB therapy co-treatment has no significant effect. Supplementary vitamin D during cART initiation may be beneficial for HIV patients regardless of TB coinfection.

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Section: Discussioncontrasting

confidence: 43%

Prevalence and risk factors for efavirenz-based antiretroviral treatment–associated severe vitamin D deficiency

et al. 2016

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“…It would be interesting to determine whether lower VD status would predict development of CM. Although individuals in tropical malaria regions may not suffer from low sunlight exposure, VD deficiency is still prevalent in tropical climates despite high amounts of sunlight (41–43). Vitamin D production in the skin following UV exposure is significantly less in dark skin and dietary sources for vitamin D is uncommon in most parts of the world.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Inhibits the Occurrence of Experimental Cerebral Malaria in Mice by Suppressing the Host Inflammatory Response

Yan

Zhu

et al. 2014

The Journal of Immunology

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In animal models of experimental cerebral malaria (ECM), neuropathology is associated with an overwhelming inflammatory response and sequestration of leucocytes and parasite-infected red blood cells in the brain. Here we explored the effect of vitamin D (VD, cholecalciferol) treatment on host immunity and outcome of ECM in C57BL/6 mice during Plasmodium berghei ANKA (PbA) infection. We observed that oral administration of VD both before and after PbA infection completely protected mice from ECM. VD administration significantly dampened the inducible systemic inflammatory responses with reduced circulating cytokines IFN-γ and TNF and decreased expression of these cytokines by the spleen cells. Meanwhile, VD also resulted in decreased expression of the chemokines CXCL9 and CXCL10 and cytoadhesion molecules (ICAM-1, VCAM-1 and CD36) in the brain, leading to reduced accumulation of pathogenic T cells in the brain and ultimately substantial improvement of the blood-brain barriers of PbA-infected mice. In addition, VD inhibited the differentiation, activation and maturation of splenic dendritic cells. Meanwhile, regulatory T cells and IL-10 expression levels were upregulated upon VD treatment. These data collectively demonstrated the suppressive function of VD on host inflammatory responses, which provides significant survival benefits in the murine ECM model.

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“…We have previously reported that vitamin D deficiency is prevalent among Ethiopian schoolchildren both in urban and rural settings accounting for 61.8% and 21.2%, respectively [ 25 ]. Other studies conducted on pregnant women and women of reproductive age group also showed that vitamin D deficiency is prevalent in Ethiopia [ 26 , 27 , 28 ]. There have been a few studies examining the prevalence of overweight and/or obesity and its associated risk factors among schoolchildren in different parts of Ethiopia [ 29 , 30 , 31 , 32 ]; however, none looked at whether vitamin D deficiency was associated with overweight and/or obesity among schoolchildren.…”

Section: Introductionmentioning

confidence: 94%

Vitamin D Deficiency is Associated with Overweight and/or Obesity among Schoolchildren in Central Ethiopia: A Cross-Sectional Study

2016

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Childhood and adolescent obesity is an international public health problem leading to an increased risk of adulthood obesity, mortality and morbidity. Its prevalence is increasing in low-income populations, and we hypothesized it may be associated with vitamin D deficiency. Low vitamin D status is a worldwide public health issue including in Ethiopia; however, no one has examined overweight/obesity in Ethiopian schoolchildren with regard to vitamin D status. The Analyses of a data set from a school-based cross-sectional study conducted in Adama Town (n = 89) and in rural Adama Woreda (n = 85) was carried out to determine vitamin D deficiency and its association with overweight and/or obesity. Data on a total of 174 schoolchildren aged 11–18 years was used for these analyses. The overall prevalence of overweight and/or obesity was 10.3%, with 8.5% overweight and 2.3% obese; the prevalence of underweight was 19%. In the multivariable logistic regression model, vitamin D deficiency, being in the higher age group, female sex and urban residence of students, their mothers’ occupation of being employed and their households’ high and middle socioeconomic status were significantly associated with overweight and/or obesity. We concluded that vitamin D deficiency is an independent predictor significantly associated with overweight and/or obesity among schoolchildren from rural and urban settings in Ethiopia. The results imply the need for behavior change communications on the importance of exposure to sunlight to produce adequate vitamin D to curb this emerging health problem of overweight/obesity following economic growth and globalization in Ethiopia. As this study only highlighted the association, prospective studies and randomized controlled trials are required to establish causality.

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Vitamin D Insufficiency in a Sunshine-Sufficient Area: Southern Ethiopia

Abstract: Vitamin D insufficiency is a serious problem in the study population, and living near the Equator does not assure adequate vitamin D status.

Cited by 33 publications

References 24 publications

Prevalence and risk factors for efavirenz-based antiretroviral treatment–associated severe vitamin D deficiency

Prevalence and risk factors for efavirenz-based antiretroviral treatment–associated severe vitamin D deficiency

Vitamin D Inhibits the Occurrence of Experimental Cerebral Malaria in Mice by Suppressing the Host Inflammatory Response

Vitamin D Deficiency is Associated with Overweight and/or Obesity among Schoolchildren in Central Ethiopia: A Cross-Sectional Study

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