Increased intakes of vitamin D during pregnancy may reduce the development by about 25 per cent, suggests a study with over 20,000 Norwegian women.

The risk of pre-eclampsia was 27 per cent lower in women who consumed vitamin D supplements with daily doses of 10 to 15 micrograms, compared to women who did not take supplements, according to researchers from the Norwegian Institute of Public Health.

However, a correlation between vitamin D intake and omega-3 fatty acid intake was observed, and the researchers noted that “further research is needed to disentangle the separate effects of these nutrients”.

Pre-eclampsia, affecting two to three per cent of all pregnancies, occurs when a mother’s blood pressure rises to the hypertensive range, and excretion of protein in the urine becomes too high. It is estimated to be responsible for about 60,000 deaths worldwide.

It is not known why some expectant mothers develop pre-eclampsia, although oxidative stress has been proposed to play a part. The role of antioxidants to reduce oxidative stress had been supported by a small clinical trial that linked vitamin C and E intake to fewer biomarkers for pre-eclampsia for predominantly low-risk participants.

However, subsequent studies, including a study published in The New England Journal of Medicine (Vol. 354, pp. 1796-1806) and a Cochrane Systematic Review (2007, Issue 4), found that vitamins C and E had no effects on the risk of pre-eclampsia.

The new study, published in Epidemiology suggests that vitamin D supplementation may reduce the risk of developing the potentially fatal condition.

Led by Helle Margrete Meltzer, the researchers examined the relationship between vitamin D intakes during pregnancy and the risk of pre-eclampsia in 23,423 would-be first time mothers participating in the Norwegian Mother and Child Cohort Study.

The women answered a general health questionnaire at the fifteenth week of pregnancy and again at the thirtieth week, while a food frequency questionnaire was administered at week 22.

According to the Norwegian findings, women with a daily intake of between 15 and 20 micrograms of vitamin D from diet and supplements had a 24 per cent lower risk of developing pre-eclampsia compared to women who consumed less than 5 micrograms per day.

The overriding benefits were observed for vitamin D from supplements, with a daily dose of 10 to 15 micrograms linked to a 27 per cent reduction, compared to women who did not take supplements.

“These findings are consistent with other reports of a protective effect of vitamin D on pre-eclampsia development,” wrote Meltzer and her co-workers.

“However, because vitamin D intake is highly correlated with the intake of long chain omega-3 fatty acids in the Norwegian diet, further research is needed to disentangle the separate effects of these nutrients,” they concluded.

Source: Epidemiology
September 2009, Volume 20, Issue 5, Pages 720-726, doi: 10.1097/EDE.0b013e3181a70f08
“Vitamin D Supplementation and Reduced Risk of Preeclampsia in Nulliparous Women”
Authors: M. Haugen, A.L. Brantsaeter, L. Trogstad, J. Alexander, C. Roth, P. Magnus, H.M. Meltzer

Survey Finds 64% of Americans Unaware Sunscreen Inhibits Vitamin D Production

Nearly 64 percent of Americans surveyed are unaware sunscreen hinders the body's ability to produce vitamin D - a nutrient found to support the immune system, bone strength, colon health and more.* The survey was conducted by WELLESSE, manufacturers of a liquid vitamin D3 supplement.

"Vitamin D is important to overall health. People need to be aware that sunscreen, even at SPF15, blocks more than 90 percent of the sun's rays used to produce this vital vitamin," warns Dr. Michael Holick, MD, PhD of Boston University.

The American Academy of Dermatology recommends that the public obtain vitamin D from nutritional sources and dietary supplements, and not from unprotected exposure to ultraviolet (UV) radiation from the sun or indoor tanning devises, as UV radiation is a known risk factor for the development of skin cancer. (1)

For optimal health, regular sunscreen users should consider nutritional vitamin D sources from their diet. But often dietary sources, including mackerel, sardines, salmon or fortified milk are not frequently consumed by Americans in the amounts needed to satisfy the daily allowance. An option is a liquid supplement such as Wellesse Liquid Vitamin D3 which is easy to swallow and provides flexible dosing for the whole family. The Recommended Daily Value for Vitamin D is 400 IU for adults. Holick notes, "Myself and other experts in vitamin D research recommend between 1000-2000 IU/day depending on your age and diet."

Vitamin D deficiency has garnered the attention of leading scientific and public health organizations. In April, The Archives of Internal Medicine reported that over 75 percent of Americans have vitamin D insufficiency.(2) Last fall, The American Public Health Association called Vitamin D deficiency/insufficiency "a major public health concern for both children and adults in the United States." (3)

Populations who may need additional vitamin D, according to the National Institutes of Health Office of Dietary Supplements include breastfed infants, people ages 50 and older, those with limited sun exposure, with dark skin, with fat mal-absorption and the obese.

Wellesse liquid Vitamin D3 is convenient for the whole family. It is available at Walgreens, Costco, Vitacost.com, Drugstore.com, and Amazon.com. Suggested retail price is $6.89 for a 16-ounce bottle.

Researchers Say More Aggressive Vitamin D Supplementation Needed in Obese Cancer Patients

CHICAGO, June 15, 2009-Body mass index (BMI) should be taken into account when assessing a cancer patient’s vitamin D status, according to researchers at Cancer Treatment Centers of America (CTCA), who found that obese cancer patients had significantly lower levels of vitamin D compared to non-obese patients.

The association between vitamin D and obesity remains unsettled with studies reporting conflicting findings on the relationship between the two. This association assumes even greater importance in cancer because of the alleged role of vitamin D in cancer.

"Currently, the dietary recommendations for vitamin D do not take into account a patient’s BMI," said Carolyn Lammersfeld, national director of nutrition for CTCA and a principal investigator in the study. "We investigated the relationship between vitamin D and BMI in a large sample of cancer patients and found that as BMI groups increased from normal to overweight or obese classifications, there was a significant decrease in vitamin D."

The researchers evaluated a group of 740 cancer patients seen at CTCA from January 2008 to June 2008. Of the 740 patients, 303 were male and 437 female, with a mean age at presentation of 55.7 years (SD = 10.2). The mean BMI was 27.9 kg/m2 (SD = 6.7). The most common cancers were lung (134, 18.1%), breast (131, 17.7%), colorectal (97, 13.1%), pancreatic (86, 11.6%), prostate (45, 6.1%) and ovarian (39, 5.3%). The mean vitamin D (serum 25(OH)D) was 21.9 ng/ml (SD = 13.5).

The study concluded that obese cancer patients (BMI >=30 kg/m2) had significantly lower levels of vitamin D compared to non-obese patients (BMI <30 kg/m2). BMI should be taken into account when assessing a patient’s vitamin D status and more aggressive vitamin D supplementation should be considered in obese cancer patients, researchers determined.

This study was presented at the American Society of Clinical Oncology (ASCO) annual meeting, May 29-June 2, 2009, and was publicly released on ASCO’s Web site, www.asco.org, on May 14, 2009.

Study Suggests Vitamin D Screening and Appropriate Supplementation Indicated for All Cancer Patients

CHICAGO, June 15, 2009-Vitamin D deficiency was found to be prevalent in cancer patients regardless of nutritional status, according to the results of a recent study conducted at Cancer Treatment Centers of America (CTCA). Based on these results, CTCA researchers determined that screening for vitamin D deficiency and aggressive vitamin D repletion should be considered for all people with cancer.

"While emerging evidence suggests the protective role of vitamin D in cancer, vitamin D status is not routinely assessed in cancer patients despite the high prevalence of malnutrition in this population," said Carolyn Lammersfeld, national director of nutrition for CTCA and a principal investigator in the study.

During the study, a consecutive case series of 737 cancer patients (302 male and 435 female) seen at CTCA between January - June 2008, were assessed for nutritional status and categorizes into three distinct classes of nutritional status: well nourished, moderately malnourished and severely malnourished. The mean age at presentation was 55.7 years (SD = 10.2) and the most common cancer types were lung (133, 18%), breast (131, 17.8%), colorectal (97, 13.2%), pancreatic (86, 11.7%), prostate (44, 6%) and ovarian (38, 5.2%).

Before the study, the researchers hypothesized that malnutrition could contribute to vitamin D deficiency and therefore expected mean serum 25-hydroxy-vitamin D [25(OH)D] levels to be significantly lower in malnourished oncology patients. However contrary to what they expected, vitamin D deficiency was found to be prevalent in cancer regardless of nutritional status.

This study was presented at the American Society of Clinical Oncology (ASCO) annual meeting, May 29-June 2, 2009, and was publicly released on ASCO’s Web site, www.asco.org, on May 14, 2009.

Vitamin D deficiency may raise caesarean risk

Joene Hendry, Reuters
Published: Thursday, April 16, 2009

NEW YORK (Reuters Health) - Women with insufficient vitamin D intake during pregnancy may be at increased risk for birth by caesarean section, study findings suggest.

Of 253 women who gave birth in a Boston, Massachusetts hospital, those deficient in vitamin D were nearly 4-times more likely to deliver by caesarean section than women with higher levels of vitamin D, report Dr. Michael F. Holick and colleagues.

Women with insufficient vitamin D intake during pregnancy may be at increased risk for birth by caesarean section, study findings suggest.

Ted Rhodes

"Vitamin D is critically important for muscle function," Holick, of Boston University School of Medicine, told Reuters Health.

Thus, it is not at all surprising that pregnant women, who are at very high risk for vitamin D deficiency, have an associated increased risk for caesarean birth, Holick said.

Individual vitamin D levels vary according to supplementation and the skin's ability to convert direct sunlight exposure to 25-hydroxyvitamin D in blood.

In this study, Holick and colleagues assessed post-delivery blood vitamin D levels among women who were about 25 years old on average and lived in the Boston area for their entire pregnancy.

One-hundred thirty of the women were Hispanic, 29 were non-Hispanic white, and 94 were non-Hispanic black, the researchers report

Holick's group defined vitamin D deficiency at the Centers for Disease Control and Prevention level of less than 37.5 nanomoles per liter (15 nanograms per milliliter) of 25-hydroxyvitamin D in blood.

According to a report in the Journal of Clinical Endocrinology and Metabolism, the investigators noted caesarean delivery among 28 percent of the women deficient in vitamin D, but in just 14 percent of those with vitamin D levels above 37.5 nanomoles per liter.

Holick's team also noted lower average vitamin D levels among women who had caesarean versus vaginal delivery.

In a separate study, Holick's team identified vitamin D deficiency among more than three-quarters of moms and newborns despite the moms' daily ingestion of prenatal vitamins and 2 glasses of milk during pregnancy.

Holick and colleagues call for further investigations to determine whether increasing vitamin D intake among pregnant women will reduce caesarean delivery rates.

SOURCE: Journal of Clinical Endocrinology and Metabolism, April 2009

AFP/File – A sunrise in Florida. Teens with lower levels of vitamin D have a higher risk of heart disease and diabetes …

DALLAS – New research in teenagers links low levels of vitamin D to high blood pressure and high blood sugar, which can lead to ominous early health problems. The "sunshine" vitamin is needed to keep bones strong, but recent research has linked vitamin D to other possible health benefits. The teen study confirms results seen in adults, linking low levels with risk factors for heart disease, the researchers said.

Teens in the study with the lowest vitamin D levels were more than twice as likely to have high blood pressure and high blood sugar. They were also four times more likely to have metabolic syndrome, defined as have three of more conditions that contribute to heart disease and diabetes — including high blood pressure, high blood sugar, big waists and high cholesterol.
The study's leader, Jared Reis of Johns Hopkins Bloomberg School of Public Health, said more research will be needed to determine if vitamin D is really behind the health problems and whether getting more would make a difference.

"We're showing strong associations that need to be followed up," he said.
The findings were being presented Wednesday at an American Heart Association conference in Palm Harbor, Fla.

A former president of the heart group said there's much to be learned about the apparent connection.

"We're at the tip of the iceberg," said Dr. Robert Eckel.
The body makes vitamin D when exposed to sunlight's ultraviolet rays. Getting about 15 minutes of sunlight a few times a week is generally enough. Vitamin D is also in fortified foods like milk and in salmon and other oily fish.

The American Academy of Pediatrics recently doubled its recommended amount of vitamin D for children and teens to 400 units daily — the equivalent of drinking four cups of milk. The pediatricians group said kids who don't get enough should take vitamin supplements.
The teen study looked at about 3,600 boys and girls ages 12 to 19 who took part in a government health survey from 2001 to 2004. The researchers used measurements of vitamin D from blood tests.

On average, none of the teens were getting enough vitamin D. Whites had the highest levels, blacks had the lowest levels and Mexican-Americans had levels in between.

One reason for the difference, experts say, could be that it takes fair skin less time to absorb vitamin D from the sun than darker skin. Also, Reis said, blacks may be skipping milk because they are more likely to be lactose intolerant.

Dr. Randal Thomas, director of the cardiovascular health clinic at the Mayo Clinic in Rochester, Minn., said that it's likely that vitamin D deficiencies in teens stem from unhealthy diets and lack of exercise outdoors.

"If their diet includes chips and soft drinks, they're probably not getting enough vitamin D," said Thomas.

Experts say there are many questions that still need to be answered about vitamin D, including how much people need.

"As time goes on, we're getting a better idea of what we need and how it's functioning in our bodies," said Adrian Gombart, a vitamin D researcher at Oregon State University.

http:/www.americanheart.org

Glucose Tolerance and Vitamin D: Effects of Treating Vitamin D Deficiency

Tai K, Need AG, Horowitz M, Chapman IM.
University of Adelaide, Department of Medicine, Royal Adelaide Hospital, Adelaide, South Australia , Australia. kamilia.tai@gmail.com

OBJECTIVE: We investigated the effects of vitamin D treatment on plasma glucose, serum insulin, and insulin sensitivity in vitamin D-deficient individuals without diabetes mellitus

METHODS: Thirty-three adults with vitamin D insufficiency (serum 25-hydroxyvitamin D concentration < or = 50 nmol/L) and without diabetes (12 with impaired glucose tolerance) were given two oral doses of 100 000 IU of cholecalciferol, 2 wk apart. Before the first dose and 2 wk after the second dose, a 75-g oral glucose tolerance test was performed. Plasma glucose, serum insulin, 25-hydroxyvitamin D, and parathyroid hormone concentrations were measured and insulin sensitivity was calculated from the oral glucose tolerance test.

RESULTS: Mean serum 25-hydroxyvitamin D increased from 39.9 +/- 1.5 (SEM) to 90.3 +/- 4.3 nmol/L (P < 0.0001) and mean serum parathyroid hormone decreased from 6.7 +/- 1.2 to 4.5 +/- 0.6 pmol/L (P = 0.055). There was no change in blood glucose mean of 0-120 min (6.1 +/- 0.3 before versus 6.2 +/- 0.3 mmol/L, P = 0.63) or insulin mean of 0-120 min (47.8 +/- 5.35 versus 48.9 +/- 5.22 mU/L, P = 0.67) concentrations, and no change in insulin sensitivity (Avignon's insulin sensitivity index [SiM], P = 0.97; insulin sensitivity index at 0 and 120 min [ISI(0,120)], P = 0.74; Quantitative Insulin Sensitivity Check Index [QUICKI], P = 0.88; homeostasis model assessment [HOMA], P = 0.99) after vitamin D treatment. Results did not differ between subjects, with and without, impaired glucose tolerance. CONCLUSION: In adults without diabetes, correction of vitamin D deficiency is not associated with any effect on blood glucose or insulin concentrations or insulin sensitivity as assessed during an oral glucose tolerance test. These observations do not support an association between glucose/insulin homeostasis and vitamin D, at least in the short term.
PMID: 18653316 [PubMed - indexed for MEDLINE]

Diabetes and the Vitamin D connection
Holick MF

Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Boston University School of Medicine, 715 Albany Street, M-1013, Boston, MA 02118, USA. mfholick@bu.edu

Vitamin D deficiency, which is common in children and adults, causes rickets, osteomalacia, and osteoporosis. Most organs and immune cells have a vitamin D receptor, and some also have the capacity to metabolize 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. 1,25-Dihydroxyvitamin D is a potent immunomodulator that also enhances the production and secretion of several hormones, including insulin. Vitamin D deficiency has been associated with increased risk of type 1 diabetes. Glycemic control and insulin resistance are improved when vitamin D deficiency is corrected and calcium supplementation is adequate. 25-Hydroxyvitamin D (measure of vitamin D status) of less than 20 ng/mL is vitamin D deficiency and 21 to 29 ng/mL is insufficiency. Children and adults need at least 1000 IU of vitamin D per day to prevent deficiency when there is inadequate sun exposure.
PMID: 18778589 [PubMed - indexed for MEDLINE]

Role of vitamin D in the pathogenesis of type 2 diabetes mellitus.

Palomer X, González-Clemente JM, Blanco-Vaca F, Mauricio D.
Institut de Recerca, Hospital de Santa Creu i Sant Pau, Barcelona, Spain.

Vitamin D deficiency has been shown to alter insulin synthesis and secretion in both humans and animal models. It has been reported that vitamin D deficiency may predispose to glucose intolerance, altered insulin secretion and type 2 diabetes mellitus. Vitamin D replenishment improves glycaemia and insulin secretion in patients with type 2 diabetes with established hypovitaminosis D, thereby suggesting a role for vitamin D in the pathogenesis of type 2 diabetes mellitus. The presence of vitamin D receptors (VDR) and vitamin D-binding proteins (DBP) in pancreatic tissue and the relationship between certain allelic variations in the VDR and DBP genes with glucose tolerance and insulin secretion have further supported this hypothesis. The mechanism of action of vitamin D in type 2 diabetes is thought to be mediated not only through regulation of plasma calcium levels, which regulate insulin synthesis and secretion, but also through a direct action on pancreatic beta-cell function. Therefore, owing to its increasing relevance, this review focuses on the role of vitamin D in the pathogenesis of type 2 diabetes mellitus.
PMID: 18269634 [PubMed - indexed for MEDLINE]

Vitamin D2 Is As Effective As Vitamin D3 In Maintaining Concentrations Of 25-hydroxyvitamin D, Study Suggests

ScienceDaily — Researchers from Boston University School of Medicine (BUSM) have found that vitamin D2 is equally as effective as vitamin D3 in maintaining 25-hydroxyvitamin D status.

Researchers studied healthy adults aged 18-84 who received either placebo, 1,000 International Units (IU) of vitamin D3, 1,000 IU of vitamin D2, or 500 IU of vitamin D2 plus 500 IU of vitamin D3 daily for three months at the end of winter to establish what effect it had on circulating levels of total 25 (OH)D as well as 25(OH)D2 and 25(OH)D3. Sixty percent of the adults were vitamin D deficient at the start of the study.

Adults who received the placebo capsule daily for three months demonstrated no significant change in their total 25(OH)D levels during the winter and early spring. Adults who ingested 1,000 vitamin D2/d gradually increased their total 25(OH)D levels during the first six weeks. Adults who ingested 1,000 IU of vitamin D3 had a baseline 25(OH)D that was statistically no different from the baselines of either the placebo group or the groups that took 1,000 IU of vitamin D2/d or 500 IU vitamin D2 plus 500 IU vitamin D3/d. The vitamin D3 group increased their serum 25(OH)D levels similar to that of the group that ingested vitamin D2.

The circulating levels of 25-hydroxyvitamin D increased to the same extent in the groups that received 1,000 IU daily as vitamin D2, vitamin D3, or a combination of 500 IU vitamin D2 and 500 IU vitamin D3. The 25-hydroxyvitamin D3 levels did not change in the group that received 1,000 IU vitamin D2 daily. One thousand IU of vitamin D2 or vitamin D3 did not raise 25-hydroxyvitamin D levels in vitamin D deficient subjects above 30 ng/ml.

According to BUSM researchers, vitamin D2 has been the main stay for the prevention and treatment of vitamin D deficiency in children and adults and as little as 100 IU of vitamin D2 was found to be effective in the prevention of rickets. Both vitamin D2 and vitamin D3 form 25-hydroxyvitamin D.

Michael Holick, PhD, MD, director of the General Clinical Research Center and professor of medicine, physiology and biophysics at BUSM and senior author of this study, is an internationally recognized expert in vitamin D and skin research. Most recently, he gave the keynote address to the Indian Endocrine Society in India.

“The maintenance of the serum 25(OH)D3 levels was most likely due to the release of vitamin D3 stored in the body fat since skin synthesis of vitamin D3 does not occur during the winter in Boston,” said Holick, who is also director of the Bone Healthcare Clinic and the vitamin D, Skin and Bone Research Laboratory at Boston University Medical Center.

“One thousand IU of vitamin D2 daily was as effective as 1,000 IU of vitamin D3 in maintaining serum 25-hydroxyvitamin D levels and did not negatively influence serum 25-hydroxyvitamin D levels,” said Holick. “Therefore, vitamin D2 is equally as effective as vitamin D3 in maintaining 25-hydroxyvitamin D status.”

The study appears online in the December 2007 issue of the Journal of Clinical Endocrinology & Metabolism.

Vitamin D intakes in North America and Asia-Pacific countries are not sufficient to prevent vitamin D insufficiency.

Whiting SJ, Green TJ, Calvo MS.
College of Pharmacy and Nutrition, University of Saskatchewan , 110 Science Place, Saskatoon, SK, Canada S7N 5C9 . susan.whiting@usask.ca

Worldwide, vitamin D status is suboptimal relative to circulating levels of 25-hydroxyvitamin D (25OHD) needed to prevent a variety of chronic conditions, however, it has long been assumed that dietary intake is sufficient to meet needs when sun exposure is limited. In the USA, mean vitamin D intake from foods is close to 5 microg, the Dietary Reference Intake (DRI) recommendation for persons up to 50 years; however, the amount of vitamin D needed to maintain a sufficient 25OHD level during winter is >12.5 microg, and that needed for darkly pigmented, veiled, or sun protected persons is >50 microg. In the USA , most vitamin D intake from foods is provided by fortification. Canada and New Zealand have fewer fortified choices, and intakes are correspondingly lower. Supplement use can increase mean intake to >12.5 microg but does not always reach those who need it most. Serum 25OHD levels in New Zealand reveal much more insufficiency than expected, especially for Pacific people and Mäori; low serum 25OHD concentrations are seen throughout the Asia-Pacific region. Fortification and supplementation may be effective to achieve intakes of 12.5 microg vitamin D in some of the population, but for many achieving the amount needed in the absence of skin synthesis requires intakes above the current upper level for vitamin D of 50 microg.
PMID: 17218094 [PubMed - indexed for MEDLINE]