• Korean Journal of Clinical Laboratory Science
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• v.50 no.4
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• pp.484-491
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• 2018

Primer $Sj{\ddot{o}}gren's$ Syndrome (pSS) is an autoimmune/inflammatory illness. The platelet indices (PIs) indicate the inflammatory response and activity/severity of many diseases. A vitamin D deficiency is accompanied by the increased tendency of autoimmune diseases. This study investigated whether the vitamin D levels are related to the altered platelet indices in pSS. A total of 261 individuals were included in this analytical cross-sectional study. The laboratory data of pSS patients were evaluated and the relationship between the PIs and vitamin D status was examined. According to these findings, in patients with pSS, the vitamin D levels were lower than the healthy control group (P<0.05). The vitamin D levels were negatively associated with PDW (P=0.012), but positively correlated with PCT (P<0.001). The cut-off point was obtained with receiver operating characteristics (ROC) curves for PDW: 12.53 (AUC 0.921, sensitivity 90%, specificity 85%), for PCT; 0.29 (AUC 0.660, sensitivity 68%, specificity 55%). In multivariate linear regression analysis, the most significant parameters for the effects of PDW are the following: vitamin D (${\beta}=-0.373$; t=-2.626; sig.=0.013) and plateletcrit (${\beta}=-0.308$; t=-2.13; sig.=0.040). A vitamin D deficiency may be accompanied by changes in PIs in pSS. A higher PDW and lower PCT supports the underlying inflammation, which may be vitamin D related useful parameters to consider in approaching to pSS.

• Clinical and Experimental Pediatrics
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• v.53 no.5
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• pp.661-665
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• 2010

Anemia caused by vitamin B12 deficiency resulting from inadequate dietary intake is rare in children in the modern era because of improvements in nutritional status. However, such anemia can be caused by decreased ingestion or impaired absorption and/or utilization of vitamin B12. We report the case of an 18-year-old man with short stature, prepubertal sexual maturation, exertional dyspnea, and severe anemia with a hemoglobin level of 3.3 g/dL. He had a history of small bowel resection from 50 cm below the Treitz ligament to 5 cm above the ileocecal valve necessitated by midgut volvulus in the neonatal period. Laboratory tests showed deficiencies of both vitamin B12 and iron. A bone marrow examination revealed dyserythropoiesis and low levels of hemosiderin particles, and a cytogenetic study disclosed a normal karyotype. After treatment with parenteral vitamin B12 and elemental iron, both anemia and growth showed gradual improvement. This is a rare case that presented with short stature and delayed puberty caused by nutritional deficiency anemia in Korea.

• Journal of Nutrition and Health
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• v.49 no.1
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• pp.28-35
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• 2016

Purpose: Vitamin D status is associated with several chronic diseases related to obesity. In this study, we evaluate the nutritional status of vitamin D and its relation to obesity indices in Korean women. Methods: A total of 156 healthy women participated. Vitamin D status (serum $25-OH-vitamin\;D_3$ level) and obesity indices (body mass index, body fat mass, waisthip ratio, and body fat percentage etc.) and serum lipid profiles and serum adipokine (leptin and adiponectin) levels were analyzed. Results: The $25(OH)D_3$ level showed an extremely skewed distribution from 4.1 ng/ml to 24.4 ng/ml and mean $25(OH)D_3$ level was $9.0{\pm}4.0ng/ml$. With cut-off level for vitamin D deficiency (< 12.0 ng/ml), insufficiency (12-19.9 ng/ml) and sufficiency (${\geq}20ng/ml$), 77.6%, 19.2%, and 3.2% of subjects showed vitamin D deficiency, insufficiency, and sufficiency status, respectively. The $25(OH)D_3$ level showed positive correlation with weight (r = 0.2461, p < 0.01), body mass index (r = 0.2913, p < 0.001), body fat contents (r = 0.1691, p < 0.05), fat free mass (r = 0.2330, p < 0.01), and waist hip ratio (r = 0.1749, p < 0.05) after adjusted by age. The $25(OH)D_3$ level showed no significant correlation with serum lipid profiles and adipokine levels. Conclusion: Most subjects (76.6%) in this study, who had a vitamin D deficient status and serum $25(OH)D_3$ level, showed positive correlation with several obesity indices, however further research based on a large Korean population is needed to confirm the relationship.

• Clinical and Experimental Pediatrics
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• v.54 no.7
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• pp.298-303
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• 2011

Purpose: To evaluate the clinical characteristics of vitamin D deficiency and its association with iron deficiency anemia (IDA). Methods: A total of 171 children aged less than two years underwent 25-hydroxyvitamin $D_3$ tests between January 2007 and July 2009. The study was classified into two groups: normal and vitamin D insufficiency, by their vitamin 25-hydroxyvitamin $D_3$ levels. Results: In total, 120 children were in the normal group (mean age, body weight and heights $12.5{\pm}7.0$, $9.3{\pm}0.9$ kg and $76.8{\pm}1.1$ cm), and 51 children in the vitamin D insufficiency group ($9.9{\pm}5.4$ months, $9.0{\pm}0.9$ kg and $75.1{\pm}0.9$ cm). Vitamin D insufficiency was most commonly diagnosed in the spring (44%). The proportion of complete breast-feeding was higher in the insufficiency (92%), and 25.5% of the children in the deficient group also experienced IDA compared that 12% of normal group. Ten children in the insufficiency group experienced bony changes. Six children received calcitriol medication in the normal group, in whom the mean vitamin 25-hydroxyvitamin $D_3$ level increased from $39.6{\pm}14.6$ ng/mL (pre-medication) to $41.8{\pm}17.2$ ng/mL (post-medication), and 13 in the insufficiency group, in whom the mean vitamin 25-hydroxyvitamin $D_3$ increased from $20.7{\pm}7.0$ ng/mL to a mean post-treatment level of $43.7{\pm}23.8$ ng/mL. Conclusion: This study demonstrated that approximately 30% of children aged ${\leq}2$ years experienced vitamin D insufficiency associated with subclinical rickets. Many children also experienced concurrent IDA. Guidelines for vitamin D supplement in such children must therefore be established.

• Childhood Kidney Diseases
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• v.10 no.1
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• pp.58-64
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• 2006

In the clinical state of vitamin D deficiency, it is possible that associated phosphate depletion, parathyroid hormone excess, and hypocalcemia may all depress the proximal tubular reabsorption of bicarbonate, in addition to abnormal skeletal modeling or remodeling, Although nutritional rickets is considered a rare disease in developed countries nowadays, cases of vitamin D deficient rickets caused by various unhealthy lifestyles such as insufficient exposure to sunlight, breast feeding infants without giving vitamin D supplements, unbalanced vegetarian diets of breast feeding mothers, low-birth weight, and maternal deficiency of vitamin D or calcium are increasing. Here, we present the case of an 8 month old girl, who was completely breastfed without any weaning diet or infant vitamin supplements. She visited our emergency room with hypocalcemic seizure and subsequently was diagnosed with vitamin D deficient rickets accompanied by overt bone changes and proximal renal lobular acidosis. After intravenous(IV) and oral calcium replacement therapy(IV calcium gluconate injection 1 mEq/kg/day for 6 days, 2 mEq/kg/day for 4 days followed by oral calcium gluconate administration 4 g/day for 3 days) with vitamin D supplement(Alfacalcidol 0.5 mcg/day) during admission, serum calcium level was normalized with clinical improvement. Oral sodium bicarbonate(0.6 g/day) was administered from the $2^{nd}$ hospital day for 2 weeks, which normalized the serum bicarbonate(measured by $tCO_2$) level. Calcium and vitamin D replacement were continued for 2 weeks and 3 months each. After discontinuing medications, follow up laboratory findings showed good maintenance of serum calcium, alkaline phosphate and bicarbonate levels with complete improvement of bone X-ray findings.

• Toxicological Research
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• v.33 no.1
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• pp.49-54
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• 2017

Vitamin D3 is a fat-soluble secosteroid responsible for enhancing intestinal absorption of calcium, iron, and other materials. Vitamin D3 deficiency, therefore, can cause health problems such as metabolic diseases, and bone disorder. Female sex hormones including estrogen and progesterone are biosynthesized mainly in the granulosa cells of ovary. In this study, we isolated granulosa cells from porcine ovary and cultured for the experiments. In order to examine the effect of vitamin D3 on the ovarian granulosa cells, the mRNA and protein levels of genes were analyzed by real-time PCR and Western blot assay. The production of estrogen from the granulosa cells was also measured by the ELISA assay. Genes associated with follicle growth were not significantly altered by vitamin D3. However, it increases expression of genes involved in the estrogen-biosynthesis. Further, estrogen concentrations in porcine granulosa cell-cultured media increased in response to vitamin D3. These results showed that vitamin D3 is a powerful regulator of sex steroid hormone production in porcine granulosa cells, suggesting that vitamin D deficiency may result in inappropriate sexual development of industrial animals and eventually economic loss.

• Nutrition Research and Practice
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• v.14 no.1
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• pp.12-19
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• 2020

BACKGROUND/OBJECTIVES: Vitamin D is a pleiotropic hormone that affects various body organ systems. We evaluated the prevalence of a vitamin D deficiency (VDD) and its potential role in the clinical condition of critically ill Korean children. SUBJECTS/METHODS: Patients under 18 years old with a 25(OH) vitamin D measurement on the first day of PICU admission were included from among the children admitted to the pediatric intensive care unit (PICU) of our tertiary children's hospital between October 2017 and January 2019. RESULTS: A total of 172 pediatric patients were enrolled. The mean 25(OH) vitamin D level was 17.5 ± 12.8 ng/mL. There was a 65.1% prevalence of VDD (25(OH) vitamin D level < 20 ng/mL). VDD was associated with age at PICU admission, gastrointestinal/hepatobiliary disorders, International Society of Thrombosis and Hemostasis disseminated intravascular coagulation (ISTH DIC) score, pediatric multiple organ dysfunction syndrome (pMODS) score and with several laboratory test findings including hemoglobin, platelet, C-reactive protein, serum albumin, total bilirubin, prothrombin time, and anti-thrombin III levels. Most of these parameters also showed significant linear correlations with the 25(OH) vitamin D level (P < 0.05). However, no statistically meaningful association was found between VDD and other clinical conditions such as the need for a mechanical ventilator, requirement for vasoactive drugs, duration of the PICU and hospital stays, or PICU mortality. CONCLUSION: There is a high prevalence of VDD in critically ill Korean children. There were significant associations between the 25(OH) vitamin D level and gastrointestinal/hepatobiliary disorders, the pMODS score and with coagulation related factors. Further large-scale studies with more specific subgroup analyses are required to more precisely assess the clinical implications of VDD in critically ill pediatric patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.1
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• pp.41-46
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• 2017

Purpose: Vitamin D deficiency is common in Crohn disease (CD). The aim of the study was to examine the prevalence of vitamin D deficiency and evaluate the association between vitamin D status and growth outcome in Korean pediatric CD patients. Methods: In this retrospective study, 17 children younger than 18 years old diagnosed with CD were enrolled and their serum 25-hydroxy vitamin D (25[OH]D) was checked between 2011 and 2015. We categorized the patients into two groups, Group 1 and Group 2. Group 1 included patients with serum 25(OH)D levels below 10 ng/mL, and Group 2 was for patients with a 25(OH)D serum levels between 10 ng/mL and 30 ng/mL. The z-scores for height (Htz), weight (Wtz), and body mass index (BMIz) were measured at baseline, 6 months, and 12 months. Results: The mean serum 25(OH)D levels of the total 65 CD patients and 17 enrolled patients were $15.64{\pm}6.9ng/mL$ and $13.1{\pm}5.1ng/mL$, respectively. There was no correlation at the beginning of the study between vitamin D level and growth parameters (Htz, Wtz, BMIz) or other variables including laboratory data and Pediatric Crohn Disease Activity Index. The Htz, Wtz, and BMIz in Group 1 showed no significant improvement at 6 months and 12 months follow-up. In Group 2, Wtz and BMIz showed significant improvements sustained until 12 months of follow-up. Htz showed no significant improvement at 6 months but there was significant improvement at 12 months. Conclusion: It seems that baseline vitamin D status affects growth outcome in pediatric CD.

• Clinical and Experimental Pediatrics
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• v.48 no.6
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• pp.665-668
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• 2005

"Rickets" is the term applied to impaired mineralization at epiphyseal growth plate, resulting in deformity and impaired linear growth of long bones. Rickets may arise as a result of vitamin D deficiency or abnormality in metabolism. Vitamin D-dependent rickets(VDDR) is rare autosomal recessive disorder in which affected individuals have clinical features of vitamin D deficiency. In 1961, Prader first described this disorder including severe clinical features of rickets, such as hypophosphatemia, hypocalcemia, muscle weakness and seizure. Two distinctive hereditary defects, type I VDDR and type II VDDR have been recognized in vitamin D metabolism. Type I VDDR may be due to congenital defects of renal 1 ${\alpha}$-hydroxylase, the enzyme responsible for conversion of $25(OH)D_3$. These patients have low to detectable $1,25(OH)_2D_3$ in presence of normal to raised $25(OH)D_3$. In type II VDDR, renal production of $1,25(OH)_2D_3$ is intact but $1,25(OH)_2D_3$ is not used effectively and target organ resistant to $1,25(OH)_2D_3$ is respectively derived from the abnormality in the vitamin D receptor. We report a case of a 25 month-old girl with typical clinical features of VDDR type I rickets, hypocalcemia, increased alkaline phosphatase and secondary hyperparathyroidism.

• Nutrition Research and Practice
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• v.15 no.sup1
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• pp.32-40
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• 2021

BACKGROUND/OBJECTIVES: Considering the high number of deaths from coronavirus disease 2019 (COVID-19) in Latin American countries, together with multiple factors that increase the prevalence of vitamin D deficiency, we aimed to determine 25-hydroxyvitamin D (25[OH]D) levels and its association with mortality in patients with critical COVID-19. SUBJECTS/METHODS: This was a prospective observational study including adult patients with critical COVID-19. Data, including clinical characteristics and 25(OH)D levels measured at the time of intensive care unit admission, were collected. All patients were followed until hospital discharge or in-hospital death. The patients were divided into those surviving and deceased patient groups, and univariate and multivariate logistic regression analyses were performed to determine independent predictors of in hospital mortality. RESULTS: The entire cohort comprised 94 patients with critical COVID-19 (males, 59.6%; median age, 61.5 years). The median 25(OH)D level was 12.7 ng/mL, and 15 (16%) and 79 (84%) patients had vitamin D insufficiency and vitamin D deficiency, respectively. The median serum 25(OH)D level was significantly lower in deceased patients compared with surviving (12.1 vs. 18.7 ng/mL, P < 0.001). Vitamin D deficiency was present in 100% of the deceased patients. Multivariate logistic regression analysis revealed that age, body mass index, other risk factors, and 25(OH)D level were independent predictors of mortality. CONCLUSIONS: Vitamin D deficiency was present in 84% of critical COVID-19 patients. Serum 25(OH)D was independently associated with mortality in critical patients with COVID-19.