Introduction: Vitamin D deficiency is prevalent among older adults in long-term care (LTC) contributing to increased risk of falls and fractures, and decreased quality of life. The primary factors include limited dietary sources containing vitamin D, poor dietary intake, and low sunlight exposure. Vitamin D supplementation is recommended in LTC; however this practice varies across Canada. Objectives: The objectives of this study were to 1) examine the perceptions of LTC health professionals, staff, and visitors (family and friends) regarding vitamin D supplementation in LTC facilities; and (2) determine what barriers exist in providing vitamin D supplementation to all residents in LTC facilities. Methods: The study was conducted in two phases. Phase 1: Five focus group sessions (9-12 health professionals per group) were conducted in 5 LTC facilities within a Manitoba Regional Health Authority. Each focus group session was audio recorded to assist in generating themes. Phase 2: A self-administered nutrition survey was completed by LTC staff, health professionals, and visitors (family and friends) in all five recruited LTC facilities. Descriptive statistical analyses were conducted. Results: Phase 1: A total of 51 individuals participated (mean age = 46.7 years ± 10.3; female = 90.2%). The majority of participants consisted of Registered Nurses, Health Care Aides, Clinical Dietitians, Pharmacists, Social Workers, Recreation Therapists, and Administrators. Phase 2: A total of 102 individuals participated with an average age of 48.4 ± 13.8 years and were predominately (87.3%) female. Eighty-five percent of participants were LTC health professionals and staff, and 14.7% were visitors (family or friend) of a LTC resident. The results from both phases found that perceptions were positive about providing vitamin D supplementation to residents. Eighty-two percent (phase 1) and 92.2% (phase 2) of participants thought that receiving a supplement would make a difference to the overall health of LTC residents. The major barriers to vitamin D supplementation were: cost (healthcare cost, cost of the supplement, and cost of laboratory tests for serum vitamin D levels), the complexity of residents due to swallowing problems and reluctance with taking medications, polypharmacy, physician resistance, and differences between participants’ knowledge and education on vitamin D. Conclusions: Providing vitamin D supplementation to LTC residents was deemed important and would improve their overall health, but more education is needed to prevent vitamin D deficiency in LTC.

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The possible advantages of vitamin D supplementation on various cardiometabolic conditions have been examined over the past few years. Vitamin D supplementation has possibly shown effects on each of the individual components of the metabolic syndrome i.e.: obesity, hypertension, dyslipidaemia and glucose intolerance. The aim of this systematic review was to ascertain whether or not vitamin D supplementation has any effect on any of the components of the metabolic syndrome. We searched the (Cochrane Central Register of Controlled Trails (Central), Medline, Science direct, ISI Web of knowledge and Scopus during 2010 (repeated search in 2012). We found four randomized controlled trials that met our inclusion and exclusion criteria. Three hundred and seventy three patients were included in these four randomized controlled trails comparing vitamin D supplementation with placebo. Duration of treatment was a minimum of 4 weeks, through to a maximum of on-year. The different trials looked at various components of the metabolic syndrome as outcomes. The results were not consistent amongst the trials and the results could not be combined in a meta-analysis due to heterogeneity in study design and outcomes measured. The current systematic review highlights the shortcomings in the published data and we recommend further trials be undertaken before vitamin D supplementation can be recommended as beneficial for patients with the metabolic syndrome. / AFRIKAANSE OPSOMMING: Die moontlike voordele van vitamien D-aanvullings op verskillende kardiometaboliese toestande is oor die afgelope paar jaar ondersoek. Daar is aangetoon dat vitamien Daanvullings uitwerkings het op elk van die individuele komponente van die metaboliese sindroom naamlik vetsug, hipertensie, dislipidemie en glukose-intoleransie. Die doel van hierdie sistematiese oorsig was om vas te stel of vitamien D-aanvullings enige uitwerking het op enige van die komponente van die metaboliese sindroom of nie. Ons het gedurende 2010 soektogte uitgevoer op die Cochrane Sentrale register van gekontroleerde proewe (Central), Medline, Science Direct, ISI Web of Knowledge en Scopus (soektog is in 2012 herhaal). Ons het vier verewekansigde gekontroleerde proewe wat aan ons insluiting- en uitsluitingskriteria voldoen het, opgespoor. Driehonderd drie en sewentig pasiënte is by die vier proewe ingesluit. Al vier proewe het vitamien D-aanvullings met plasebo vergelyk. Die duur van behandeling het van 4 weke tot een jaar gestrek. Die verskillende proewe het gekyk na verskillende komponente van die metaboliese sindroom as uitkomste. Die resultate van die onderskeie proewe was nie konsekwent nie. Die huidige sistematiese oorsig belig die tekortkominge in die gepubliseerde data en ons beveel aan dat verdere proewe onderneem word om vas te stel of dit nuttig is om vitamien D aanvullings vir pasiënte met die metaboliese sindroom aan te beveel, en of dit dalk skadelik kan wees.

Objectives: Vitamin D deficiency is highly prevalent and has been linked to increased morbidity and mortality. There has been an increase in testing for vitamin D with a concomitant increase in costs. While individual factors are significantly linked to vitamin D status, prior studies have not yielded a model predictive of vitamin D status or 25(OH)D levels. The purpose of this investigation was to determine if a prediction model of vitamin D could be developed using extensive demographic data and laboratory parameters. Methods: Patient data from 6 Veterans Administration Medical Centers were extracted from medical charts. Results: For the 14,920 available patients, several factors including triglyceride level, race, total cholesterol, body mass index, calcium level, and number of missed appointments were significantly linked to vitamin D status. However, these variables accounted for less than 15% of the variance in vitamin D levels. While the variables correctly classified vitamin D deficiency status for 71% of patients, only 33% of those who were actually deficient were correctly identified as deficient. Conclusion: Given the failure to find a sufficiently predictive model for vitamin D deficiency, we propose that there is no substitute for laboratory testing of 25(OH)D levels. A baseline vitamin D 3 daily replacement of 1000-2000 IU initially with further modification based on biannual testing appears to factor in the wide variation in dose response observed with vitamin D replacement and is especially important in high-risk groups such as ethnic minorities.

Vitamin D deficiency due to, e.g., nutritional and life style reasons is a health concern that is gaining increasing attention over the last two decades. Vitamin D3, the most common isoform of vitamin D, is only available in food derived from animal sources. However, mushrooms and yeast are rich in ergosterol. This compound can be converted into vitamin D2 by UV-light, and therefore act as a precursor for vitamin D. Vitamin D2 from UV-irradiated mushrooms has become an alternative source of vitamin D, especially for persons pursuing a vegan diet. UV-irradiated baker’s yeast (Saccharomyces cerevisiae) for the production of fortified yeast-leavened bread and baked goods was approved as a Novel Food Ingredient in the European Union, according to Regulation (EC) No. 258/97. The Scientific Opinion provided by the European Food Safety Authority Panel on Dietetic Products, Nutrition, and Allergies has assessed this Novel Food Ingredient as safe under the intended nutritional use. However, recent findings on the formation of side products during UV-irradiation, e.g., the photoproducts tachysterol and lumisterol which are compounds with no adequate risk assessment performed, have only been marginally considered for this EFSA opinion. Furthermore, proceedings in analytics can provide additional insights, which might open up new perspectives, also regarding the bioavailability and potential health benefits of vitamin D-fortified mushrooms and yeast. Therefore, this review is intended to give an overview on the current status of UV irradiation in mushrooms and yeast in general and provide a detailed assessment on the potential health effects of UV-irradiated baker’s yeast.

Vitamin D deficiency due to, e.g., nutritional and life style reasons is a health concern that is gaining increasing attention over the last two decades. Vitamin D3, the most common isoform of vitamin D, is only available in food derived from animal sources. However, mushrooms and yeast are rich in ergosterol. This compound can be converted into vitamin D2 by UV-light, and therefore act as a precursor for vitamin D. Vitamin D2 from UV-irradiated mushrooms has become an alternative source of vitamin D, especially for persons pursuing a vegan diet. UV-irradiated baker’s yeast (Saccharomyces cerevisiae) for the production of fortified yeast-leavened bread and baked goods was approved as a Novel Food Ingredient in the European Union, according to Regulation (EC) No. 258/97. The Scientific Opinion provided by the European Food Safety Authority Panel on Dietetic Products, Nutrition, and Allergies has assessed this Novel Food Ingredient as safe under the intended nutritional use. However, recent findings on the formation of side products during UV-irradiation, e.g., the photoproducts tachysterol and lumisterol which are compounds with no adequate risk assessment performed, have only been marginally considered for this EFSA opinion. Furthermore, proceedings in analytics can provide additional insights, which might open up new perspectives, also regarding the bioavailability and potential health benefits of vitamin D-fortified mushrooms and yeast. Therefore, this review is intended to give an overview on the current status of UV irradiation in mushrooms and yeast in general and provide a detailed assessment on the potential health effects of UV-irradiated baker’s yeast.

Vitamin D deficiency is common in individuals diagnosed with HIV and is known for its detrimental health effects. Its recognition as a potent immune-modulator with possible immune health implications in HIV disease progression was the main impetus for this study. The association between Vitamin D and CD4 count falls short of being consistent and is too weak to allow conclusions. Similarly, the literature is inconsistent with regard to the impact of Vitamin D supplementation on CD4. This observational, retrospective chart review study aimed to explore the relationship between Vitamin D deficiency and CD4 count/percent, and to evaluate whether changes in Vitamin D levels after supplementation corresponds with significant changes in CD4 count/percent in a cohort of African American, HIV-infected men who attended an HIV clinic in southeast Michigan (N = 70). The conceptual framework was based on the role of Vitamin D in regulating the immune responses through Vitamin D nuclear receptors on the CD4 cells. It postulated that an increase in Vitamin D level might enhance immune function, promote cellular anti-inflammatory state, and decelerate CD4 destruction. Data analysis included descriptive statistics, bivariate correlation, logistic and linear regression, t test, repeated measures ANOVA, and ANCOVA. Findings of the study did not support the hypotheses of significant correlation between Vitamin D and CD4 count (p = 0.458) and percent (p = 0.776), or of any impact of supplementation on CD4 count (p = 0.216) and percent (p = 0.918). Social change implications include providing health professionals, researchers, and policymakers with knowledge to tailor health promotion interventions aiming to reduce Vitamin D deficiency in favor of improving the overall health of HIV patients, especially high-risk groups such as African American HIV-infected patients.

Background Hypovitaminosis D is becoming recognised as an emerging threat to health, even in countries like New Zealand which enjoy plentiful sunshine. The evidence for a role for vitamin D deficiency in the aetiology of a plethora of diseases continues to accumulate, including type 2 diabetes, and the preceding insulin resistance. Objectives The primary objective of the Surya Study was to investigate the effect of improved vitamin D status (through supplementation) on insulin resistance. The secondary objectives were to investigate the vitamin D status and bone mineral density of South Asian women living in New Zealand, and to investigate the effect of vitamin D supplementation on bone turnover as measured by biochemical markers of bone resorption and formation. Method Women of South Asian origin, ≥20 years old, living in Auckland (n = 235) were recruited for the study. All were asked to complete a 4-day food diary, invited to have a bone scan, and were screened for entry into the intervention phase which required insulin resistance (HOMA-IR >1.93) and serum 25(OH)D < 50 nmol/L. Eighty-one completed a 6-month randomised controlled trial with 4000 IU vitamin D3 (n = 42) or placebo (n = 39). Primary endpoint measures included insulin resistance, insulin sensitivity (HOMA2%S), fasting C-peptide and markers of bone turnover, osteocalcin (OC) and collagen C-telopeptide (CTX). Ninety-one of the 239 had a bone scan and bone mineral density (BMD) was measured in the proximal femur and lumbar spine. Results Adequate serum 25(OH)D concentrations (>50 nmol/L) were observed in only 16% of subjects screened. Median (25th, 75th percentile) serum 25(OH)D increased significantly from 21 (11,40) to 75 (55,84) nmol/L with supplementation. Significant improvements were seen in insulin sensitivity and insulin resistance (P = 0·003, P = 0·02 respectively), and circulating serum insulin decreased (P = 0·02) with supplementation compared to placebo. There was no change in C-peptide with supplementation. Insulin resistance was most improved when endpoint serum 25(OH)D =80 nmol/L. In post-menopausal women OC and CTX levels increased in the placebo arm but CTX decreased from 0.39±0.15 to 0.36±0.17 (P = 0.012) with supplementation. Osteoporosis (T score <-2.5) was present in 32% of postmenopausal, and 3% of premenopausal women. Women 20 – 29 years (n=10) had very low BMD, calcium intake and serum 25(OH)D Conclusions Improving vitamin D status in insulin resistant women resulted in improved insulin resistance and sensitivity but no change in insulin secretion. Optimal 25(OH)D concentrations for reducing insulin resistance were shown to be ≥80 nmol/L. The prevalence of low 25(OH)D concentrations in this population was alarmingly high, especially in younger women. In post-menopausal women, vitamin D supplementation appeared to ameliorate increased bone turnover attributed to oestrogen deficiency.