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BACKGROUND: Chronic low-grade inflammation is common in obesity and related chronic conditions, including type 2 diabetes. Vitamin D has been proposed to have anti-inflammatory properties; however the effect of vitamin D supplementation on inflammation in type 2 diabetes has not been established. AIM: We conducted a systematic review and meta-analysis to examine the effect of vitamin D supplementation on inflammatory markers compared to placebo or usual care in patients with type 2 diabetes, and to identify relevant knowledge gaps. METHODS: Medline, CINAHL, EMBASE and All EBM were systematically searched (from inception to 25 January 2017) for randomized controlled trials (RCTs) investigating the effects of vitamin D supplementation on inflammatory markers in type 2 diabetes patients. Two independent reviewers screened all full text articles (no date or language limits) for RCTs of vitamin D supplementation (any form, route, duration, and co-supplementation) compared to placebo or usual care on all inflammatory marker outcomes in patients with type 2 diabetes (on any treatment regimen and with or without comorbidities). Meta-analyses and meta-regression were conducted using random-effects models to calculate standardized mean differences (SMD) and 95%CIs. Two independent reviewers extracted data and assessed risk of bias and quality using the grading of recommendations, assessment, development and evaluation (GRADE) approach.RESULTS: Twenty-nine RCTs (n=1,780) met the inclusion criteria, 20 of which had available data for pooling. In meta-analyses of 20 RCTs (n=1,270), vitamin D-supplemented groups had lower follow-up levels of C-reactive protein (SMD: -0.23 mg/L (-0.37,-0.09); p=0.002), tumor necrosis factor-alpha (SMD: -0.49 pg/ml (-0.84,-0.15); p=0.005), and erythrocyte sedimentation rate (SMD: -0.47 mm/hr (-0.89,-0.05); p=0.03), and higher levels of leptin (SMD: 0.42 u00b5g/L (0.04, 0.81); p=0.03), compared to placebo. No differences were observed for adiponectin, interleukin-6, or E-selectin (all p>0.05). In meta-regression and subgroup analyses, age, sex, BMI, diabetes duration, baseline vitamin D status, and supplementation dose and duration did not alter the results. There was no evidence of heterogeneity (p>0.1) or publication bias (p>0.1) and most studies were low to moderate risk of bias. CONCLUSIONS: Our meta-analysis provides level one evidence that vitamin D supplementation may improve chronic low-grade inflammation in patients with type 2 diabetes. Further studies are needed to establish whether improved inflammation following vitamin D supplementation would translate into improved health outcomes for patients with type 2 diabetes. PROSPERO registration number: CRD42016047755.
BACKGROUND: Systemic inflammation is common in obesity and is a key risk factor in the development and progression of type 2 diabetes. In vitro and animal studies suggest that vitamin D has anti-inflammatory functions, which are thought to occur via inhibition of the nuclear factor kappa-B (NFu03baB) pathway. However, existing clinical trials of vitamin D supplementation are limited by short durations, low doses of vitamin D, and variability in participantsu2019 vitamin D deficiency status, and no previous trials have investigated the effect of vitamin D supplementation on NFu03baB activity in vivo in humans. AIMS: We conducted a double-blind randomized placebo-controlled trial to investigate whether vitamin D supplementation, provided in a sufficient dose and duration to vitamin D-deficient individuals, would improve plasma inflammatory markers as well as reduce NFu03baB activity in peripheral blood mononuclear cells (PBMCs), compared to placebo.METHODS: Sixty-five overweight or obese (body mass index (BMI)u2265 25 kg/m2), vitamin D-deficient (25-hydroxyvitamin D (25(OH)D)u2264 50 nmol/l) adults were randomized to either a bolus oral dose of 100,000 IU followed by 4,000 IU daily of cholecalciferol, or matching placebo for 16 weeks. Before and after intervention, we measured anthropometry: BMI, waist-to-hip ratio (WHR) and % body fat by dual energy X-ray absorptiometry; serum 25-hydroxyvitamin D (25(OH)D) concentrations (chemiluminescent immunoassays); plasma inflammatory markers: high sensitivity C-reactive protein (hsCRP; rate turbidimetry), tumor necrosis factor-alpha (TNF-u03b1), monocyte chemoattractant protein-1 (MCP-1), and interleukins (IL)-1u03b2, -6, -8, -10, -12, -18, -23 and -33 (multiplex assay; flow cytometry); and NFu03baB activity in PBMCs (DNA-binding assays). Questionnaires were used to collect data on sun exposure habits and dietary vitamin D intake (3-day food record).RESULTS: Fifty-four participants completed the study (35 males/ 19 females; age= 31.9 u00b1 8.5 years; BMI= 30.9 u00b1 4.4 kg/m2 (mean u00b1 SD)). There were no differences in demographic, anthropometric, or biochemical parameters between vitamin D and placebo groups at baseline. Serum 25(OH)D concentrations increased with vitamin D supplementation compared with placebo (57.0 u00b1 21.3 versus 1.9 u00b1 15.1 nmol/l, p
Vitamin D and Health, Volume 109 reviews the versatility of vitamin D in enhancing the immune system and its potential role in combating many chronic diseases. While vitamin D’s role in enhancing bone health is well established, recent studies demonstrated the safety and efficacy of peri-operative vitamin D supplementation in cardiac patients and its impact on post-operative outcomes. Chapters in this new release include discussions on Vitamin D and Immune Function, Vitamin D and Bone Heath, Vitamin D and Cardiovascular Disease, Vitamin D and Cancer, Vitamin D and Diabetes, Vitamin D and Neurological Diseases, Vitamin D and Celiac Disease, and much more. Provides the latest information on the possible mechanisms of action by the active metabolite of vitamin D, 1,25(OH) in immune cells Covers the beneficial roles of vitamin D in bone health, cardiovascular disease, diabetes, cancers, and celiac disease Discusses vitamin D's ability to reduce the risk of severity and death from viral diseases such as influenza, COVID-19, and the respiratory syncytial virus (RSV)
This dissertation, "Systematic Review of the Effectiveness of Vitamin D Supplement for Type 2 Diabetes Mellitus Patients" by Jing, Xu, 许静, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Background Worldwide, as of 2010, about 285 million people suffered diabetes mellitus (DM), with type 2 constituting about 90% of the cases. DM is more common, in particular, type 2 diabetes mellitus (T2DM) in developed countries. The greatest increase in prevalence appears in Asia and Africa. More important, it associated with complications including uremia, heart disease and diabetic retinopathy. Recent research has investigated whether there would have effect of vitamin D (VD) supplementation in addition to other treatment or/and relevant interventions that would improve health outcomes of patients diagnosed with T2DM. Furthermore, the costs of using VD supplements are relatively low. Methods A systematic review was conducted by searching for relevant studies published from the year of 2004 to 2014 (all the studies were randomized controlled trials) from database of PubMed with specified keywords. All studies were conducted in Asia and all subjects were T2DM patients. Studies were included when they were in relation to the association between VD supplementation and T2DM patients. After filtering, ten trials were identified to be relevant and adopted in this systematic review. The effects of calcium intake were also explored whenever applicable. Results Ten studies were included, with all of them conducted in Asia. In seven trials, VD supplementation indicated insignificantly differences of VD effects on T2DM through impact of metabolic parameters such as glycated hemoglobin (HbA1c), Fasting plasma glucose (FPG), insulin, insulin resistance (IR).etc. However, three trials revealed significant differences in HbA1c, FPG, insulin, IR and insulin sensitivity (IS) with VD supplementation. Conclusions There were insufficient evidences concerning the effectiveness of VD supplementary for T2DM patients in Asian populations, in terms of improving their health outcomes. It could be likely to be useful for our Hong Kong Chinese population. Because some included trials were subject to small sample sizes, incompletely follow up, and/or low methodological quality, these might influence the validity of the findings. Future studies on the effectiveness of VD for T2DM would be warranted for Chinese population. Subjects: Non-insulin-dependent diabetes Vitamin D - Therapeutic use
While the skeletal effects of vitamin D are well-documented, the role and importance of vitamin D outside of bone health has not been well-established. Vitamin D receptors are located in nearly every tissue of the body, and low levels of vitamin D are associated with a range of various diseases. This book provides an in-depth examination of these extraskeletal effects of vitamin D and the associations between vitamin D deficiency and various disease states. Beginning with a review of the biochemistry and physiology of vitamin D, subsequent chapters investigate its relationship to autoimmune and infectious diseases, various forms of cancer, endocrine issues such as diabetes, obesity and reproductive function, cardiovascular disease and muscle weakness. Concluding chapters discuss the role of vitamin D in neurological disorders, including Alzheimer's Disease, and cognitive function. Focusing on extraskeletal effects only across a range of conditions, Extraskeletal Effects of Vitamin D will be an important resource for clinical endocrinologists and primary care physicians.
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This dissertation, "Effects of Vitamin D Deficiency and Supplementation on Vascular Function in Patients With Type II Diabetes" by Yuen-fung, Yiu, 饒元豐, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Despite the medical advances in recent decades, cardiovascular disease (CVD) remains one of the leading causes of mortality in most developing countries. Ongoing efforts have been focused on evaluating new strategies targeting on novel risk factors. Vitamin D deficiency, a previously neglected condition, has recently attracted much attention from the scientific community with its potential extra-skeletal effects. There is accumulating evidence from epidemiological studies that a suboptimal 25-hydroxyvitamin D [25(OH)D] level is associated with all-cause and cardiovascular mortality, increased risk of coronary heart disease, stroke and peripheral vascular disease, and various traditional CVD risk factors including hypertension, diabetes mellitus (DM) and metabolic syndrome. Several theories have been proposed to explain these relationships but none receive universal recognition. There is recent laboratory evidence that vitamin D may exert specific effects in patients with DM. However, relationships between vitamin D deficiency and supplementation on vascular function in this group of patients are unclear. In this dissertation, I sought to explore the effects of vitamin D deficiency on vascular function in patients with type II DM in a cross-sectional study. In the later part, the results of a randomized controlled trial investigating the effects of daily vitamin D supplementation in type II DM patients are presented and discussed. The cross-sectional study (Chapter 3) investigated the association of vitamin D status with endothelial function as measured by brachial flow-mediated dilation (FMD) and circulating endothelial progenitor cell (EPC) numbers in 280 patients with type II DM. The results showed that suboptimal vitamin D status was more common among patients with DM. Furthermore, patients with vitamin D deficiency had significantly lower brachial FMD (mean difference = -1.43%, 95% CI: -2.31 to -0.55, P = 0.001) and CD133/KDR+ EPC counts (mean difference = -0.12%, 95% CI: -0.21 to -0.02, P = 0.022) than those with sufficient vitamin D after adjustment for age, sex and cardiovascular risk factors, including HbA1c levels. Based on these positive results, the objectives of the randomized controlled trial (Chapter 4) were to study and confirm the effects of daily oral vitamin D supplementation on the vascular function in this group of patients. Over a 12-week period, 100 DM patients with suboptimal vitamin D status were randomized to receive 5,000 IU/day vitamin D or placebo. There were no reported adverse events including hypercalcemia, although a slight increase in serum ionized calcium (treatment effect 0.037 mmol/L, P = 0.018) was recorded in the vitamin D group. Despite a significant improvement in serum 25(OH)D in the treatment group, supplementation of vitamin D did not result in any significant improvement in vascular function as determined by FMD, circulating EPC count or arterial stiffness (all P > 0.05). Furthermore, the serum level of high-sensitivity C-reactive protein, oxidative stress markers, low- and high-density lipoprotein and glycated haemoglobin were also similar between two groups (all P > 0.05). The results of this study did not support a therapeutic role of supplementation with vitamin D for cardiovascular benefits. In conclusion, the results of these studies demonstrated that deficiency of vit
Vitamin D deficiency is a worldwide problem linked to numerous diseases affecting men, women, and children of all ages. Enormous progress in the study of vitamin D has been made since the first edition of this highly-acclaimed book was published nearly 20 years ago, and current research continues to draw headlines. Feldman and Pike’s Vitamin D, Fifth Edition continues to build on the successful formula from previous editions, taking the reader from the basic elements of fundamental research to the most sophisticated concepts in therapeutics. The two comprehensive volumes provide investigators, clinicians, and students with a comprehensive, definitive, and up-to-date compendium of the diverse scientific and clinical aspects of vitamin D, where each area is covered by both basic and clinical experts in the field. In Volume I: Biochemistry, Physiology and Diagnostics, international experts in endocrinology, bone biology, and human physiology take readers through the basic research of vitamin D. This impressive reference presents a comprehensive review of the multi-faceted actions of vitamin D relating both to skeletal and extra-skeletal action. Researchers from all areas of vitamin D will gain insight into how clinical observations and practices can feed back into the research cycle and will, therefore, be able to develop more targeted genomic and proteomic insights into the mechanisms of disease. Volume II: Health, Disease and Therapy authoritatively covers the evidence for new roles of vitamin D, ranging from organ transplantation to cancer, diabetes, inflammatory bowel disease, multiple sclerosis, and renal disease. The coverage is appropriately broad, drawing on aspects of internal medicine, pediatrics, nutrition, orthopedics, oncology, neurology, obstetrics and gynecology, and immunology, as well as, new areas for vitamin D including sports medicine, opthalmology, veterinary medicine and ICU care – including COVID-19. Clinical researchers will gain a strong understanding of the molecular basis for a particular disease and better understand future directions for research in this still-growing field. A comprehensive reference ranging from basic biochemistry, cell biology, and physiology principles to the clinical diagnostic and management implications of vitamin D Saves researchers and clinicians time in quickly accessing the very latest details on the diverse scientific and clinical aspects of vitamin D, as opposed to searching through thousands of journal articles Chapters written by the most prominent and well-published names in the field