Introduction Vitamin D status is an important public health issue due to the high prevalence of vitamin D insufficiency and deficiency, especially in high latitude areas. Furthermore, it has been reported to be associated with a number of diseases. In a previous umbrella review of meta-analyses of randomized clinical trials (RCTs) and of observational studies, it was found that plasma/ serum 25-hydroxyvitamin D (25(OH)D) or supplemental vitamin D has been linked to more than 130 unique health outcomes. However, the majority of the studies yielded conflicting results and no association was convincing. Aim and Objectives The aim of my PhD was to comprehensively explore the association between vitamin D and multiple outcomes. The specific objectives were to: 1) update the umbrella review of meta-analysis of observational studies or randomized controlled trials on associations between vitamin D and health outcomes published between 2014 and 2018; 2) conduct a systematic literature review of previous Mendelian Randomization studies on causal associations between vitamin D and all outcomes; 3) conduct a systematic literature review of published phenome wide association studies, summarizing the methods, results and predictors; 4) create a polygenic risk score of vitamin D related genetic variants, weighted by their effect estimates from the most recent genome wide association study; 5) encode phenotype groups based on electronic medical records of participants; 6) study the associations between vitamin D related SNPs and the whole spectrum of health outcomes, defined by electronic medical records utilising the UK Biobank study; 7) explore the causal effect of 25- hydroxyvitamin D level on health outcomes by applying novel instrumental variable methods. Methods First I updated the vitamin D umbrella review published in 2015, by summarizing the evidence from meta-analyses of observational studies and meta-analyses of RCTs published between 2014 and 2018. I also performed a systematic literature review of all previous Mendelian Randomizations studies on the effect of vitamin D on all health outcomes, as well as a systematic review of all published PheWAS studies and the methodology they applied. Then I conducted original data analysis in a large prospective population-based cohort, the UK Biobank, which includes more than 500,000 participants. A 25(OH)D genetic risk score (weighted sum score of 6 serum 25(OH)D-related SNPs: rs3755967, rs12785878, rs10741657, rs17216707, rs10745742 and rs8018720, as identified by the largest genome wide association study of 25(OH)D levels) was constructed to be used as the instrumental variable. I used a phenotyping algorithm to code the electronic medical records (EMR) of UK Biobank participants into 1853 distinct disease categories and I then ran the PheWAS analysis to test the associations between the 25(OH)D genetic risk score and 950 disease outcome groups (i.e. outcomes with more than 200 cases). For phenotypes found to show a statistically significant association with 25(OH)D levels in the PheWAS or phenotypes which were found to be convincing or highly suggestive in previous studies, I developed an extended case definition by incorporating self-reported data collected by UK Biobank baseline questionnaire and interview. The possible causal effect of vitamin D on those outcomes was then explored by the MR two-stage method, inverse variance weighted MR and Egger's regression, followed by sensitivity analyses. Results In the updated systematic literature review of meta-analyses of observational studies or RCTs, only studies on new outcomes which had not been covered by the previous umbrella review were included. A total of 95 meta-analyses met the inclusion criteria. Among the included studies there were 66 meta-analyses of observational studies, and 29 meta-analyses of RCTs. Eighty-five new outcomes were explored by meta-analyses of observational studies, and 59 new outcomes were covered by meta-analyses of RCTs. In the systematic review of published Mendelian Randomization studies on vitamin D, a total of 29 studies were included. A causal role of 25(OH)D level was supported by MR analysis for the following outcomes: type 2 diabetes, total adiponectin, diastolic blood pressure, risk of hypertension, multiple sclerosis, Alzheimer's disease, all-cause mortality, cancer mortality, mortality excluding cancer and cardiovascular events, ovarian cancer, HDL-cholesterol, triglycerides and cognitive functions. For the systematic literature review of published PheWAS studies and their methodology, a total of 45 studies were included. The processes for implementing a PheWAS study include the following steps: sample selection, predictor selection, phenotyping, statistical analysis and result interpretation. One of the main challenges is the definitions of the phenotypes (i.e., the method of binning participants into different phenotype groups). In the phenotyping step, an ICD curated phenotyping was widely used by previous PheWAS, which I also used in my own analysis. By applying the ICD curated phenotyping, 1853 phenotype groups were defined in the participants I used. In PheWAS, only phenotype groups with more than 200 cases were analysed (920 phenotypes). In the PheWAS, only associations between rs17216707 (CYP24A1) and "calculus of ureter" (beta = -0.219, se = 0.045, P = 1.14*10-6), "urinary calculus" (beta = -0.129, se = 0.027, P = 1.31*10-6), "alveolar and parietoalveolar pneumonopathy" (beta = 0.418, se = 0.101, P = 3.53*10-5) survived Bonferroni correction. Nine outcomes, including systolic blood pressure, diastolic blood pressure, body mass index, risk of hypertension, type 2 diabetes, ischemic heart disease, depression, non-vertebral fracture and all-cause mortality were explored in MR analyses. The MR analysis had more than 80% power for detecting a true odds ratio of 1.2 or larger for binary outcomes. None of explored outcomes were statistically significant. Results from multiple MR methods and sensitivity analyses were consistent. Discussion Vitamin D and its association with multiple outcomes has been widely studied. More than 230 outcomes have been linked with vitamin D by meta-analyses of observational studies and RCTs. On the contrary, evidence from Mendelian Randomization studies is lacking. In particular I identified only 20 existing MR studies and only 13 outcomes were suggested to be causally related to vitamin D. In the systematic literature review of previous PheWAS studies, I summarized the applied methods, predictors and results. Although phenotyping based on ICD codes provided good performance and was widely applied by previous PheWAS studies, phenotyping can be improved if lab data, imaging data and medical notes can be incorporated. Alternative algorithms, which takes advantage of deep learning and thus enable high precision phenotyping, needs to be developed. From the PheWAS analysis, the score of vitamin D related genetic variants was not statistically significantly associated with any of the 920 phenotypes tested. In the single variant analysis, only rs17216707 (CYP24A1) was shown to be associated with calculus outcomes statistically significantly. Previous studies reported associations between vitamin D and hypercalcemia, hypercalciuria, nephrolithiasis and nephrocalcinosis, may be due to the role of vitamin D in calcium homeostasis. In the MR analysis, I found no evidence of large to moderate (OR > 1.2) causal associations of vitamin D on a very wide range of health outcomes. These included SBP, DBP, hypertension, T2D, IHD, BMI, depression, non-vertebral fracture and allcause mortality which have previously been proposed to be influenced by low vitamin D levels. Further, even larger studies, probably involving the joint analysis of data from several large biobanks with future IVs that explain a higher proportion of the trait variance, will be required to exclude smaller causal effects which could have public health importance because of the high population prevalence of low vitamin D levels in some populations.

Introdução: Uma elevada prevalência de deficiência de vitamina D (DVD) em crianças tem sido observada em todo o mundo, mas poucos são os estudos com relação ao estado nutricional da vitamina D (VD) em lactentes saudáveis. A principal causa da deficiência em crianças saudáveis é o aleitamento materno sem suplementação e a falta ou insuficiência de exposição solar. Objetivos: Determinar as concentrações séricas de VD e verificar sua associação com concentrações de paratormônio (PTH), fosfatase alcalina (FA), cálcio (Ca), fósforo (P) e albumina e uso da suplementação de VD em lactentes saudáveis com idades entre >= 6 e <= 24 meses atendidos em duas Unidades Básicas de Saúde do município de Ribeirão Preto, SP, Brasil. Métodos: Estudo transversal, observacional e analítico em que foram determinadas as concentrações séricas de 25 (OH)D, PTH, FA, Ca, P e albumina de 155 lactentes saudáveis. Informações sobre exposição solar, aspectos sociodemográficos das mães e características clínico-nutricionais dos lactentes foram obtidas por entrevistas com os responsáveis dos lactentes. Concentrações séricas de 25(OH)D maiores que 20ng/ml foram consideradas adequadas, entre 12 a 20ng/ml insuficientes e < 12ng/ml deficientes. Resultados: Dez lactentes (6,5%, Intervalo de Confiança 95% 3,5-11,4) apresentaram insuficiência de VD e nenhum apresentou DVD. Nenhuma alteração nas concentrações séricas de P, Ca e albumina foram detectadas. Apenas um lactente apresentou aumento nas concentrações séricas de PTH e 35,5% dos lactentes apresentaram FA elevada, porém nenhum apresentou DVD ou insuficiência de VD. Não foram encontradas associações entre as concentrações séricas de 25(OH)D e as de FA, Ca e albumina. Houve associação entre concentrações séricas de 25(OH)D e PTH mesmo após ajuste para sexo, idade e Índice de Massa Corporal; também foi observada associação entre concentrações séricas de 25(OH)D e P apenas após o ajuste pelas covariáveis. Não foram verificadas associações entre insuficiência de VD, exposição solar e suplementação de VD. Conclusões: Uma baixa prevalência de concentrações insuficientes de 25(OH)D foi observada. Não foram encontradas associações entre as concentrações séricas de 25(OH)D e PTH, FA, Ca, P e albumina. Da mesma forma, não foram encontradas associações entre de concentrações séricas de 25(OH)D, exposição solar e suplementação de VD. / Introduction: A high prevalence of vitamin D deficiency (VDD) in children has been observed worldwide, but there are few studies on the nutritional status of vitamin D (VD) in healthy infants. The main cause of deficiency in healthy children is breastfeeding without supplementation and lack or insufficiency of sun exposure. Objective: To determine serum concentrations of VD and verify its association with parathyroid hormone (PTH) levels and use of VD supplementation in healthy infants aged >= 6 to <= 24 months attended at two Basic Health Units in Ribeirão Preto city, São Paulo, Brazil. Methods: A cross-sectional, observational and analytical study was performed in which were determined serum concentrations of 25 (OH) D, PTH, alkaline phosphatase (AP), calcium (Ca), phosphorus (P) and albumin of 155 healthy infants. Information of sun exposure, sociodemographic aspects of mothers and clinical and nutritional characteristics of infants were obtained through interviews with responsible for infants. Serum concentrations of 25(OH)D greater than 20ng / ml were considered adequate, between 12 to 20ng / ml insufficient and <12ng/ml, deficient. Results: Ten infants (6.5%, 95% Confidence Interval 3.5-11.4) presented VD insufficiency and none presented DVD. Only one infant had an increase in PTH serum concentrations and 35.5% of infants had high AP but none presented DVD or VD insufficiency. No changes in serum P, Ca and albumin concentrations were detected. No associations were found between serum concentrations of 25 (OH) D and AP, Ca and albumin. There was an association between serum concentrations of 25(OH)D and PTH even after adjusting for sex, age and body mass index; an association between serum concentrations of 25(OH)D and P was observed only after adjustment for covariates. There were no associations between VD insufficiency, sun exposure and VD supplementation. Conclusions: A low prevalence of insufficient concentrations of 25 (OH)D was observed. No associations were found between serum concentrations of 25 (OH)D and PTH, FA, Ca, P and albumin. Likewise, no associations were found between serum concentrations of 25 (OH)D, sun exposure and VD supplementation.

Bakgrund: Det finns många faktorer som är viktiga för att bygga upp och bibehålla ett starkt skelett. En belastande fysisk aktivitet, framförallt i ungdomsåren, har ett positivt samband med en ökad styrka i skelettet. Dock kan hög fysisk aktivitet kombinerat med en rad riskfaktorer istället leda till osteoporos och ökad risk för stressfrakturer. Stressfrakturer är vanligt bland idrottare och har sats i samband med riskfaktorer som ett lågt energiintag, många sprungna mil per vecka och ett lågt intag av kalcium och D-vitamin. Syfte: Syftet med studien var att undersöka energi- och näringsintaget hos idrottare som drabbats av stressfraktur samt vilken information de fått om kost vid träning. Metod: Totalt rekryterades sex personer varav fyra valde att fullfölja studien. Uppskattat energi och näringsintag undersöktes med hjälp av kosthistoriska intervjuer vilka sträckte sig en månad bakåt i tiden från intervjutillfället. Även information om en typisk matdag innan skadan samlades in genom en retrospektiv 24-h intervju. Alla intervjuer genomfördes 2-5 år efter skadetillfället. Insamlad data sammanställdes och analyserades i programmet Dietist XP. Resultat: Respondenterna hade ett rapporterat energiintag som låg i linje med det beräknade energibehovet både före och efter skadetillfället. De flesta näringsämnena var enligt det rapporterade intaget över eller precis under de rekommendationer som finns i Nordiska näringsrekommendationer. Det enda näringsämne där flertalet av respondenterna hade ett för lågt intag var D-vitamin. Från föreningarna gavs en mycket knapp information om kost för att optimera träningen och minska risken för skador. Slutsats: I denna studie täcktes beräknat energi- och näringsbehovet relativt väl hos fyra idrottare, både före och efter skadan, med undantag av D-vitamin. Ett lågt D-vitaminintag skulle kunna vara en bidragande orsak till idrottarnas stressfraktur. Kostinformationen från föreningarna till idrottarna var bristfällig. Informationen var otillräcklig för att kunna optimera prestationen och undvika skador orsakade av ett för lågt energi- och/eller näringsintag. Mer information och kunskap behöver spridas på detta område.

Thesis (M.S.)--University of Missouri-Columbia, 2009. / Thesis advisor: Dr. Catherine Peterson. The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. "May 2009" Includes bibliographical references.

Submitted by Maike Costa (maiksebas@gmail.com) on 2017-01-30T13:13:55Z No. of bitstreams: 1 arquivototal.pdf: 1609665 bytes, checksum: da6c68742692612b2a2ac9bd26b047b0 (MD5) / Made available in DSpace on 2017-01-30T13:13:55Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1609665 bytes, checksum: da6c68742692612b2a2ac9bd26b047b0 (MD5) Previous issue date: 2016-03-16 / Introduction: Vitamin D has important functions in bone metabolism and in the pathophysiology of various chronic diseases. Vitamin D deficiency has been reported worldwide and several determinants may be related to this phenomenon. Objective: To estimate the prevalence and factors associated with vitamin D deficiency / deficiency in school adolescents from a capital city in the northeast region of Brazil. Methodology: This was a cross-sectional epidemiological study in adolescents aged 15 to 19 from public schools in Joao Pessoa-PB / Brazil. Serum levels of 25 (OH) D were measured by blood samples. Sociodemographic and behavioral data were obtained through a semistructured questionnaire, where they were included in the independent variables: sex, skin color, social benefits, mother's schooling, hours of sleep per day, daily solar exposition, physical activity exposed to the sun, Activity or physical inactivity, food consumption, nutritional status and biochemical analyzes of calcium and serum PTH. The nutritional status was evaluated according to the recommendations of the WHO (World Health Organization). The analysis of factors associated with vitamin D deficiency was performed by simple and multivariate Poisson Regression. Results: The prevalence of 25 (OH) D deficiency / deficiency was 57.3%, with the female population showing a higher prevalence (p = 0.000) than the male sex. In no analyzed variables, the female sex presented average vitamin D levels higher than 30 ng / dL (reference value). After the categorization of the sample by sex, in the final model, the nutritional status (RP: 2.78, p = 0.006) was associated with 25 (OH) D deficiency / deficiency in male adolescents and serum calcium (RP: 1 , 32, p = 0.018) in females. Conclusion: Data from the present study estimate a high prevalence of vitamin D deficiency / deficiency in a population of school adolescents in northeastern Brazil, especially females, and the associated factors were different among the groups analyzed. The data from the study suggest that strategies such as obligatory fortification in food sources of vitamin D and the possible supplementation of individuals in adolescence, especially in the female sex, are considered by the public health organizations of Brazil and the World. / Introducao: A vitamina D apresenta funcoes importantes no metabolismo osseo e na fisiopatogenese de diversas doencas cronicas. A deficiencia de vitamina D tem sido relatada em todo o mundo e diversos determinantes podem estar relacionados a esse fenomeno. Objetivo: Estimar a prevalencia e os fatores associados com a insuficiencia/deficiencia de vitamina D em adolescentes escolares de uma capital da regiao nordeste do Brasil. Metodologia: Tratou-se de um estudo epidemiologico transversal em adolescentes de 15 a 19 anos de escolas da rede publica de Joao Pessoa-PB/Brasil. Niveis sericos de 25(OH)D foram mensurados por amostras sanguineas. Dados sociodemograficos e comportamentais foram obtidos atraves de um questionario semiestruturado, onde foram incluidas nas variaveis independentes: sexo, cor da pele, recebimento de beneficios sociais, escolaridade da mae, horas de sono por dia, exposicao solar diaria, atividade fisica exposta ao sol, atividade ou inatividade fisica, consumo alimentar, estado nutricional e analises bioquimicas de calcio e PTH serico. O estado nutricional foi avaliado de acordo com as recomendacoes da OMS (Organizacao Mundial da Saude). A analise dos fatores associados a deficiencia de vitamina D foi realizada por Regressao de Poisson simples e multivariada. Resultados: A prevalencia de insuficiencia/deficiencia de 25(OH)D foi de 57,3%, tendo a populacao feminina apresentado maior prevalencia (p=0,000) que o sexo masculino. Em nenhuma variavel analisada, o sexo feminino apresentou niveis medios de vitamina D superiores a 30 ng/dL (valor de referencia). Apos categorizacao da amostra por sexo, no modelo final, o estado nutricional (RP: 2,78; p=0,006) esteve associada a insuficiencia/deficiencia de 25(OH)D nos adolescentes do sexo masculino e o calcio serico (RP: 1,32; p=0,018) nas do sexo feminino. Conclusao: Os dados do presente estudo estimam uma alta prevalencia de insuficiencia/deficiencia de vitamina D em uma populacao de adolescentes escolares no nordeste do Brasil especialmente do sexo feminino e os fatores associados foram distintos entre os grupos analisados. Os dados do estudo sugerem que estrategias como a fortificacao obrigatoria em alimentos fonte de vitamina D e a possivel suplementacao de individuos na adolescencia, sobretudo no sexo feminino, sejam consideradas pelas organizacoes de saude publica do Brasil e do Mundo.

The changes of the seasons are a phenomenon we as people in many cases are affected by multiple times a year. However, how much this change affects us differs from where in the world you live. In the northern hemisphere, life can change drastically when the sun goes from shining the majority of the day to the day being mostly in darkness during wintertime. Most people are affected by this change somehow, especially the change from brighter days to darker. This is when feelings of community, hopefulness and happiness can be switched out with feelings of loneliness, malaise and even depression. This paper shows that although not all people experience the changes in these black-or-white ways, it is clear that the gray area between not being affected at all or shutting down completely is large and sometimes hard to define.  In this study, we have examined the general outlook towards winter darkness and the experiences of students at Umeå University, Sweden, who moved here from a more southern part of Sweden where the darkness is not as drastically changing during wintertime. We also interviewed the student health team at Umeå University to gain knowledge about however this is something they are working actively against or not. / Förändringarna i årstid är något vi människor utsätts för flera gånger varje år, men hur denna förändring ser ut skiljer sig väldigt mycket beroende på var i världen man bor. I den nordliga delen av världen förändras livet väldigt mycket då man går från sol större delen av dagen till mörker större delen av dagen under vintertid.  De flesta människor påverkas av denna förändring i årstid, framförallt den förändring där vi går ifrån ljusare tider mot mörkare. Här kan känslor av gemenskap, hoppfullhet och lycka bytas ut mot känslor av ensamhet, nedstämdhet och depression. Uppsatsen visar att alla människor självklart inte lider av säsongsförändringarna på detta svart-eller-vitt sätt. I spektrumet av att inte påverkas alls till att sluta fungera på grund av säsongsförändringar så är det tydligt att det finns flera olika svar på hur människor påverkas.  I vår studie har vi undersökt inställningen till vintermörkret och upplevelserna hos studenter på Umeå universitet som flyttat upp till Norrland samt att vi har intervjuat Studenthälsan på Umeå Universitet för att se huruvida detta är något de arbetar aktivt mot.

Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-11-19T13:39:09Z No. of bitstreams: 1 CristinadeJesusSousaDissertacaoParcial2018.pdf: 780979 bytes, checksum: d8b80ee196a8840b1efaee7d6dcb18f5 (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-11-19T13:39:46Z (GMT) No. of bitstreams: 1 CristinadeJesusSousaDissertacaoParcial2018.pdf: 780979 bytes, checksum: d8b80ee196a8840b1efaee7d6dcb18f5 (MD5) / Made available in DSpace on 2018-11-19T13:39:46Z (GMT). No. of bitstreams: 1 CristinadeJesusSousaDissertacaoParcial2018.pdf: 780979 bytes, checksum: d8b80ee196a8840b1efaee7d6dcb18f5 (MD5) Previous issue date: 2018-07-30 / This is a quantitative, cross-sectional and descriptive study whose general objective was to evaluate the bone quality of elderly women with more than 60 years of age attending a general gynecology clinic in the Distrito Federal, through the application of the FRAX Tool. The study site was a private general gynecological clinic and the sample consisted of 147 were elderly women (60 to 90 years). For the data collection, three instruments were used: a sociodemographic questionnaire, the FRAX tool and the FRAQ-Brazil instrument. Comparisons of proportions between two independent groups were performed using Fisher's exact test. Categorical variables were described with counts and proportions. Quantitative variables of normal and asymmetric distribution were described as mean ? standard deviation and median (interquartile range) respectively. Normality was assessed by visual inspection of histograms. The R software was used in the statistical analysis of data. All probabilities of significance are bilateral and values less than 0.05 are considered statistically significant. The results obtained are found in articles 1 and 2. The research allowed an intense literature review to contribute to an understanding of which factors limit the use of the FRAX Tool, and which groups of older people should be better and more carefully analyzed for orientation. We found a mean and high risk of osteoporotic fractures assessed by applying the FRAX tool in non-elderly patients by 0.3%, in elderly patients up to 79 years old was found in 3,7% and in 45,5% of the elderly women above of 80 years. It can be concluded that the FRAX tool, despite some limitations, is important for the early identification and screening of individuals at risk of fractures due to its simplicity of application, allowing early and safe therapeutic decision making. It was also concluded that there is a significant increase in the risk of osteoporotic fractures with advancing age. / Trata-se de um estudo quantitativo, transversal e descritivo cujo objetivo geral foi avaliar a qualidade da massa ?ssea de idosas com mais de 60 anos frequentadoras de uma cl?nica de ginecologia geral no Distrito Federal, por meio da aplica??o da Ferramenta FRAX. O local do estudo foi uma cl?nica particular de ginecol?gica geral e a amostra foi constitu?da 147 mulheres idosas (60 a 90 anos). Para a coleta de dados, utilizaram-se tr?s instrumentos: um question?rio sociodemogr?fico, a Ferramenta FRAX e o instrumento FRAQ-Brasil. Compara??es de propor??es entre dois grupos independentes foram efetuadas utilizando-se teste exato de Fisher. Vari?veis categ?ricas foram descritas com contagens e propor??es. Vari?veis quantitativas de distribui??o normal e assim?trica foram descritas como m?dia ? desvio padr?o e mediana (intervalo interquartil) respectivamente. Normalidade foi avaliada com a inspe??o visual de histogramas. O software R foi utilizado na an?lise estat?stica de dados. Todas as probabilidades de signific?ncia apresentadas s?o do tipo bilateral e valores menores que 0.05 considerados estatisticamente significantes. Os resultados obtidos encontram-se nos artigos 1 e 2. A pesquisa permitiu a realiza??o de uma intensa revis?o de literatura visando contribuir para uma compreens?o de quais fatores limitam o uso da Ferramenta FRAX, e quais grupos de idosos devem ser melhores e mais cuidadosamente analisados para a orienta??o. Encontrou-se m?dio e alto risco de fraturas osteopor?ticas avaliado atrav?s da aplica??o da Ferramenta FRAX nas pacientes idosas aos 79 anos o percentual encontrado foi de 3,7% e em 45,5% nas idosas acima dos 80 anos. Pode-se concluir que a Ferramenta FRAX, apesar de algumas limita??es, ? importante para a identifica??o precoce e o rastreamento de indiv?duos com risco de fraturas, devido ? sua simplicidade de aplica??o, permitindo uma tomada de decis?o terap?utica precoce e segura. Concluiuse tamb?m que h? um aumento importante do risco de fraturas osteopor?ticas com o avan?ar da idade.

Introdução: O transplante de células tronco hematopoiéticas é reconhecidamente uma opção terapêutica para doenças neoplásicas hematológicas, tumores sólidos, deficiências imunológicas e doenças metabólicas. É um procedimento associado a uma alta freqüência de complicações agudas e crônicas, causadas pela toxicidade do regime de condicionamento, dentre elas a mucosite, Doença do Enxerto versus Hospedeiro - DECH e infecções. Essas complicações podem causar grandes mudanças na composição corporal através de mudanças no metabolismo, piorando o estado nutricional. Um adequado consumo de alguns micronutrientes como zinco, vitamina D e ferro, tem sido investigado como forma de evitar ou minimizar essas complicações. Objetivo: Avaliar em pacientes submetidos a transplante de células tronco hematopoiéticas os níveis séricos de zinco, vitamina D e ferritina e o seu impacto nos desfechos do TCTH alogênico e os níveis de ingestão de zinco, vitamina D e ferro. Métodos: Foram avaliadas as dosagens séricas de zinco, vitamina D e ferritina, e os níveis de ingestão de zinco, vitamina D e ferro, os tipos de condicionamento, o grau de DECH e mucosite, a presença de infecções e o estado nutricional. Resultado: Foram incluídos na análise 32 pacientes. Não foi encontrado associação significativa entre a deficiência sérica de Zinco e mucosite e os níveis elevados de ferritina sérica com a ocorrência de infecções. Deficiência sérica de vitamina D aos 45 dias pós transplante foi associado com o desenvolvimento de DECH. Conclusão: Os nossos resultados reforçam a importância dos pacientes manterem os níveis adequados de micronutrientes e reforçam o papel da vitamina D na prevenção de DECH durante o TCTH. / Introduction: The transplantation of hematopoietic stem cells is recognized as a treatment option for hematological neoplastic diseases, solid tumors, immune deficiencies and metabolic diseases. It is a procedure associated with a high frequency of acute and chronic complications caused by the toxicity of the conditioning regimen, among them mucositis, Graft-versus-Host Disease - GVHD and infections. These complications can cause major changes in body composition through changes in metabolism, worsening the nutritional status. An adequate intake of some micronutrients such as zinc, vitamin D and iron, has been investigated as a way to avoid or minimize these complications. Objective: To evaluate in patients undergoing hematopoietic stem cell transplantation serum levels of zinc, vitamin D and ferritin and its impact on the outcomes of allogeneic HSCT and zinc intake levels of vitamin D and iron. Method: The following aspects were evaluated: serum levels of zinc, vitamin D and ferritin, and zinc intake levels of vitamin D and iron, the conditioning types, the degree of GVHD and mucositis, the presence of infections, the nutritional status. Result: The analysis included 32 patients. No significant association has been found between zinc serum deficiency and mucositis and elevated levels of serum ferritin with the occurrence of infections. The serum deficiency of vitamin D at 45 days post-transplantation has been associated with the development of GVHD. Conclusion: Our results reinforce that it is important for the patients to maintain adequate levels of micronutrients and reinforce the role of vitamin D in the prevention of GVHD during the HSCT. Keywords: hematopoietic stem cell transplantation, GVHD, mucositis, infections, Vitamin D, ferritin, zinc, nutritional status.

Introdução: O transplante de células tronco hematopoiéticas é reconhecidamente uma opção terapêutica para doenças neoplásicas hematológicas, tumores sólidos, deficiências imunológicas e doenças metabólicas. É um procedimento associado a uma alta freqüência de complicações agudas e crônicas, causadas pela toxicidade do regime de condicionamento, dentre elas a mucosite, Doença do Enxerto versus Hospedeiro - DECH e infecções. Essas complicações podem causar grandes mudanças na composição corporal através de mudanças no metabolismo, piorando o estado nutricional. Um adequado consumo de alguns micronutrientes como zinco, vitamina D e ferro, tem sido investigado como forma de evitar ou minimizar essas complicações. Objetivo: Avaliar em pacientes submetidos a transplante de células tronco hematopoiéticas os níveis séricos de zinco, vitamina D e ferritina e o seu impacto nos desfechos do TCTH alogênico e os níveis de ingestão de zinco, vitamina D e ferro. Métodos: Foram avaliadas as dosagens séricas de zinco, vitamina D e ferritina, e os níveis de ingestão de zinco, vitamina D e ferro, os tipos de condicionamento, o grau de DECH e mucosite, a presença de infecções e o estado nutricional. Resultado: Foram incluídos na análise 32 pacientes. Não foi encontrado associação significativa entre a deficiência sérica de Zinco e mucosite e os níveis elevados de ferritina sérica com a ocorrência de infecções. Deficiência sérica de vitamina D aos 45 dias pós transplante foi associado com o desenvolvimento de DECH. Conclusão: Os nossos resultados reforçam a importância dos pacientes manterem os níveis adequados de micronutrientes e reforçam o papel da vitamina D na prevenção de DECH durante o TCTH. / Introduction: The transplantation of hematopoietic stem cells is recognized as a treatment option for hematological neoplastic diseases, solid tumors, immune deficiencies and metabolic diseases. It is a procedure associated with a high frequency of acute and chronic complications caused by the toxicity of the conditioning regimen, among them mucositis, Graft-versus-Host Disease - GVHD and infections. These complications can cause major changes in body composition through changes in metabolism, worsening the nutritional status. An adequate intake of some micronutrients such as zinc, vitamin D and iron, has been investigated as a way to avoid or minimize these complications. Objective: To evaluate in patients undergoing hematopoietic stem cell transplantation serum levels of zinc, vitamin D and ferritin and its impact on the outcomes of allogeneic HSCT and zinc intake levels of vitamin D and iron. Method: The following aspects were evaluated: serum levels of zinc, vitamin D and ferritin, and zinc intake levels of vitamin D and iron, the conditioning types, the degree of GVHD and mucositis, the presence of infections, the nutritional status. Result: The analysis included 32 patients. No significant association has been found between zinc serum deficiency and mucositis and elevated levels of serum ferritin with the occurrence of infections. The serum deficiency of vitamin D at 45 days post-transplantation has been associated with the development of GVHD. Conclusion: Our results reinforce that it is important for the patients to maintain adequate levels of micronutrients and reinforce the role of vitamin D in the prevention of GVHD during the HSCT. Keywords: hematopoietic stem cell transplantation, GVHD, mucositis, infections, Vitamin D, ferritin, zinc, nutritional status.

Introdução: O transplante de células tronco hematopoiéticas é reconhecidamente uma opção terapêutica para doenças neoplásicas hematológicas, tumores sólidos, deficiências imunológicas e doenças metabólicas. É um procedimento associado a uma alta freqüência de complicações agudas e crônicas, causadas pela toxicidade do regime de condicionamento, dentre elas a mucosite, Doença do Enxerto versus Hospedeiro - DECH e infecções. Essas complicações podem causar grandes mudanças na composição corporal através de mudanças no metabolismo, piorando o estado nutricional. Um adequado consumo de alguns micronutrientes como zinco, vitamina D e ferro, tem sido investigado como forma de evitar ou minimizar essas complicações. Objetivo: Avaliar em pacientes submetidos a transplante de células tronco hematopoiéticas os níveis séricos de zinco, vitamina D e ferritina e o seu impacto nos desfechos do TCTH alogênico e os níveis de ingestão de zinco, vitamina D e ferro. Métodos: Foram avaliadas as dosagens séricas de zinco, vitamina D e ferritina, e os níveis de ingestão de zinco, vitamina D e ferro, os tipos de condicionamento, o grau de DECH e mucosite, a presença de infecções e o estado nutricional. Resultado: Foram incluídos na análise 32 pacientes. Não foi encontrado associação significativa entre a deficiência sérica de Zinco e mucosite e os níveis elevados de ferritina sérica com a ocorrência de infecções. Deficiência sérica de vitamina D aos 45 dias pós transplante foi associado com o desenvolvimento de DECH. Conclusão: Os nossos resultados reforçam a importância dos pacientes manterem os níveis adequados de micronutrientes e reforçam o papel da vitamina D na prevenção de DECH durante o TCTH. / Introduction: The transplantation of hematopoietic stem cells is recognized as a treatment option for hematological neoplastic diseases, solid tumors, immune deficiencies and metabolic diseases. It is a procedure associated with a high frequency of acute and chronic complications caused by the toxicity of the conditioning regimen, among them mucositis, Graft-versus-Host Disease - GVHD and infections. These complications can cause major changes in body composition through changes in metabolism, worsening the nutritional status. An adequate intake of some micronutrients such as zinc, vitamin D and iron, has been investigated as a way to avoid or minimize these complications. Objective: To evaluate in patients undergoing hematopoietic stem cell transplantation serum levels of zinc, vitamin D and ferritin and its impact on the outcomes of allogeneic HSCT and zinc intake levels of vitamin D and iron. Method: The following aspects were evaluated: serum levels of zinc, vitamin D and ferritin, and zinc intake levels of vitamin D and iron, the conditioning types, the degree of GVHD and mucositis, the presence of infections, the nutritional status. Result: The analysis included 32 patients. No significant association has been found between zinc serum deficiency and mucositis and elevated levels of serum ferritin with the occurrence of infections. The serum deficiency of vitamin D at 45 days post-transplantation has been associated with the development of GVHD. Conclusion: Our results reinforce that it is important for the patients to maintain adequate levels of micronutrients and reinforce the role of vitamin D in the prevention of GVHD during the HSCT. Keywords: hematopoietic stem cell transplantation, GVHD, mucositis, infections, Vitamin D, ferritin, zinc, nutritional status.