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      Age, Gender and Season Are Good Predictors of Vitamin D Status Independent of Body Mass Index in Office Workers in a Subtropical Region

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          Abstract

          This study aimed at determining the prevalence and predictors of hypovitaminosis D (serum 25-hydroxyvitamin D < 30 ng/mL) among office workers in a subtropical region from an electronic hospital database. Totally, 2880 office workers aged 26–65 years who received health examinations with vitamin D status and total calcium concentrations at a tertiary referral center were retrospectively reviewed. Subjects were divided into groups according to genders, age (i.e., 26–35, 36–45, 46–55, 56–65), body-mass index (BMI) (i.e., obese BMI ≥ 30, overweight 25 ≤ BMI < 30, normal 20 ≤ BMI < 25, and underweight BMI < 20) and seasons (spring/winter vs. summer/autumn) for identifying the predictors of hypovitaminosis D. Corrected total calcium level <8.4 mg/dL is considered as hypocalcemia. Multivariate logistic regression demonstrated that females (AOR 2.33, (95% CI: 1.75, 3.09)), younger age (4.32 (2.98, 6.24), 2.82 (1.93, 4.12), 1.50 (1.03, 2.17)), and season (winter/spring) (1.55 (1.08, 2.22)) were predictors of hypovitaminosis D, whereas BMI was not in this study. Despite higher incidence of hypocalcemia in office workers with hypovitaminosis D ( p < 0.001), there was no association between vitamin D status and corrected total calcium levels. A high prevalence (61.9%) of hypovitaminosis D among office workers in a subtropical region was found, highlighting the importance of this occupational health issue.

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          Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease.

          Hyperphosphatemia, calcitriol deficiency, and secondary hyperparathyroidism (SHPT) are common complications of chronic kidney disease (CKD). Fibroblast growth factor-23 (FGF-23) is a novel phosphaturic hormone that also inhibits renal 1alpha-hydroxylase activity and thus may be involved in the pathogenesis of SHPT. Several hypotheses were tested: that FGF-23 increases as renal function declines; is linearly associated with serum phosphate levels; is associated with increased phosphaturia independent of parathyroid hormone (PTH); and is associated with decreased calcitriol levels independent of renal function, hyperphosphatemia, and vitamin D stores. FGF-23, PTH, 25(OH)D3, calcitriol, calcium, phosphate, and urinary fractional excretion of phosphate (Fe(PO4)) were measured in 80 CKD patients. Multiple linear regression was used to test the hypotheses. FGF-23 and PTH were inversely associated with estimated GFR (eGFR), whereas calcitriol levels were linearly associated with eGFR. Hyperphosphatemia and hypocalcemia were present in only 12 and 6% of patients, respectively, all of whose eGFR was <30. Increased Fe(PO4) was associated with decreased eGFR, and both increased FGF-23 and PTH were independently associated with increased Fe(PO4). Increased FGF-23 and decreased 25(OH)D3 were independent predictors of decreased calcitriol, but the effects on calcitriol levels of renal function itself and hyperphosphatemia were completely extinguished by adjusting for FGF-23. It is concluded that FGF-23 levels increase early in CKD before the development of serum mineral abnormalities and are independently associated with serum phosphate, Fe(PO4), and calcitriol deficiency. Increased FGF-23 may contribute to maintaining normal serum phosphate levels in the face of advancing CKD but may worsen calcitriol deficiency and thus may be a central factor in the early pathogenesis of SHPT.
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            Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004.

            Vitamin D insufficiency is associated with suboptimal health. The prevalence of vitamin D insufficiency may be rising, but population-based trends are uncertain. We sought to evaluate US population trends in vitamin D insufficiency. We compared serum 25-hydroxyvitamin D (25[OH]D) levels from the Third National Health and Nutrition Examination Survey (NHANES III), collected during 1988 through 1994, with NHANES data collected from 2001 through 2004 (NHANES 2001-2004). Complete data were available for 18 883 participants in NHANES III and 13 369 participants in NHANES 2001-2004. The mean serum 25(OH)D level was 30 (95% confidence interval [CI], 29-30) ng/mL during NHANES III and decreased to 24 (23-25) ng/mL during NHANES 2001-2004. Accordingly, the prevalence of 25(OH)D levels of less than 10 ng/mL increased from 2% (95% CI, 2%-2%) to 6% (5%-8%), and 25(OH)D levels of 30 ng/mL or more decreased from 45% (43%-47%) to 23% (20%-26%). The prevalence of 25(OH)D levels of less than 10 ng/mL in non-Hispanic blacks rose from 9% during NHANES III to 29% during NHANES 2001-2004, with a corresponding decrease in the prevalence of levels of 30 ng/mL or more from 12% to 3%. Differences by age strata (mean serum 25[OH]D levels ranging from 28-32 ng/mL) and sex (28 ng/mL for women and 32 ng/mL for men) during NHANES III equalized during NHANES 2001-2004 (24 vs 24 ng/mL for age and 24 vs 24 ng/mL for sex). National data demonstrate a marked decrease in serum 25(OH)D levels from the 1988-1994 to the 2001-2004 NHANES data collections. Racial/ethnic differences have persisted and may have important implications for known health disparities. Current recommendations for vitamin D supplementation are inadequate to address the growing epidemic of vitamin D insufficiency.
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              Tight junction proteins claudin-2 and -12 are critical for vitamin D-dependent Ca2+ absorption between enterocytes.

              Ca(2+) is absorbed across intestinal epithelial monolayers via transcellular and paracellular pathways, and an active form of vitamin D(3), 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D(3)], is known to promote intestinal Ca(2+) absorption. However, the molecules driving the paracellular Ca(2+) absorption and its vitamin D dependency remain obscure. Because the tight junction proteins claudins are suggested to form paracellular channels for selective ions between neighboring cells, we hypothesized that specific intestinal claudins might facilitate paracellular Ca(2+) transport and that expression of these claudins could be induced by 1alpha,25(OH)(2)D(3). Herein, we show, by using RNA interference and overexpression strategies, that claudin-2 and claudin-12 contribute to Ca(2+) absorption in intestinal epithelial cells. We also provide evidence showing that expression of claudins-2 and -12 is up-regulated in enterocytes in vitro and in vivo by 1alpha,25(OH)(2)D(3) through the vitamin D receptor. These findings strongly suggest that claudin-2- and/or claudin-12-based tight junctions form paracellular Ca(2+) channels in intestinal epithelia, and they highlight a novel mechanism behind vitamin D-dependent calcium homeostasis.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                05 September 2020
                September 2020
                : 12
                : 9
                : 2719
                Affiliations
                [1 ]Department of Anesthesiology, Chi Mei Medical Center, Tainan 71004, Taiwan; anesth@ 123456gmail.com (L.-K.W.); ed102605@ 123456gmail.com (K.-C.H.); anekevin@ 123456hotmail.com (Y.-T.L.); 0201day@ 123456yahoo.com.tw (Y.-J.C.); aneswu@ 123456gmail.com (Z.-F.W.)
                [2 ]Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
                [3 ]Center of General Education, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
                [4 ]College of Health Sciences, Chang Jung Christian University, Tainan 71101, Taiwan
                [5 ]Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan
                [6 ]Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan; ho.c.hank@ 123456gmail.com
                [7 ]Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
                Author notes
                [* ]Correspondence: chenjenyin@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-8640-8231
                https://orcid.org/0000-0002-4507-8085
                https://orcid.org/0000-0001-6376-9085
                https://orcid.org/0000-0001-5925-8477
                https://orcid.org/0000-0003-2313-5701
                Article
                nutrients-12-02719
                10.3390/nu12092719
                7551941
                32899512
                046b765f-3391-4884-a677-022170b1fffa
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 July 2020
                : 02 September 2020
                Categories
                Article

                Nutrition & Dietetics
                occupational health,hypovitaminosis d,hypocalcemia,subtropical,season,gender,age
                Nutrition & Dietetics
                occupational health, hypovitaminosis d, hypocalcemia, subtropical, season, gender, age

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