Introdução: Portadores de fibrose cística têm uma susceptibilidade à deficiência de vitamina D devido à má absorção de nutrientes. Os estudos da prevalência de hipovitaminose D em pacientes com fibrose cística apresentam resultados extremamente variáveis e não há dados a respeito da população não pediátrica no Brasil. Objetivos: Avaliar a prevalência de hipovitaminose D em pacientes não pediátricos portadores de fibrose cística e os fatores associados com as concentrações séricas de 25-hidroxivitamina D. Metodologia: Realizado estudo transversal. A população em estudo foi composta por pacientes maiores que 16 anos acompanhados no Ambulatório de Fibrose Cística do Hospital de Clínicas de Porto Alegre. Foi avaliada a prevalência de deficiência de vitamina D, definida como 25-hidroxivitamina D < 30ng/mL, de acordo com a Cystic Fibrosis Foundation, bem como os fatores clínicos e laboratoriais associados com o valor sérico desta. Foram avaliados o estado nutricional e internações hospitalares. Foi realizada coleta de dados em prontuário, entrevista com os pacientes e colheita de sangue. As análises laboratoriais foram realizadas no Laboratório de Patologia Clínica do Hospital. Foram dosados os valores séricos de proteína C-reativa, cálcio, fosfato, magnésio, albumina, 25-hidroxivitamina D (método: quimiluminescência) e paratormônio (método: imunoensaio para PTH intacto). A função pulmonar foi avaliada por espirometria e escores clínicos e radiológicos. O nível de significância estatística foi estabelecido como P<0,05. Resultados: A prevalência de hipovitaminose D foi de 61,0%, com valores séricos de 25-hidroxivitamina D de 28,42±10,94 ng/mL. Os pacientes com insuficiência pancreática apresentaram uma tendência a ter concentrações mais altas de vitamina D. Dezesseis pacientes apresentavam doença pulmonar grave, com FEV1% do predito inferior a 40%. Após análise multivariada, índice de massa corporal e hospitalizações no último mês permaneceram significativamente associados negativamente aos valores séricos de 25-hidroxivitamina D. Conclusões: A prevalência de hipovitaminose D no presente estudo foi inferior a previamente relatada. A insuficiência de vitamina D continua sendo um problema nos pacientes com fibrose cística, mesmo naqueles recebendo suplementação. / Introduction: Cystic fibrosis patients have a susceptibility to vitamin D deficiency due to nutrient malabsorption. Prevalence studies of hypovitaminosis D in patients with cystic fibrosis have highly variable results and there is no data about the non pediatric population in Brazil. Objectives: To evaluate the prevalence of hypovitaminosis D in non pediactric cystic fibrosis patients and the factors associated with serum 25-hydroxyvitamin D levels. Methods: Cross-sectional study. The study population was composed of patients older than 16 years accompanied in the Cystic Fibrosis Ambulatory of the Hospital de Clínicas de Porto Alegre. We evaluated the prevalence of vitamin D deficiency defined as 25-hydroxyvitamin D < 30 ng/mL, as suggested recently by the Cystic Fibrosis Foundation, and clinical and laboratory factors associated with its serum levels. Nutritional status and hospital admissions were evaluated. Data was collected from medical records and interviews with patient, blood was collected. Laboratory analisys were performed at Clinical Pathology Laboratory of the Hospital. Serum C-reactive protein, calcium, phosphate, magnesium, albumin, 25-hydroxyvitamin D (method: chemiluminescence), and parathyroid hormone levels (method: sandwich immunoassay to intact PTH) were measured. Lung function was evaluated by spirometry and clinical and chest radiographic scores were assessed. Statistical significance level was set at P<0.05. Results: Prevalence of hypovitaminosis D was 61.0 %, with serum 25-hydroxyvitamin D levels of 28,42±10,94 ng/mL. Patients with pancreatic insufficiency had a trend to have higher vitamin D levels. Sixteen patients had severe lung disease with FEV1% predicted below 40%. After multivariable analysis, body mass index and hospitalization in the last month remained significantly associated negatively with serum 25-hydroxivitamin D levels. Conclusions: The prevalence of hypovitaminosis D in the present study was inferior to previously related. Vitamin D insufficiency is still a problem in cystic fibrosis patients, even in those receiving supplementation.

60 % of Canadians have suboptimal vitamin D (<75 nmol/L) and 25% are obese. Obesity has been reported to be a risk factor for low vitamin D, but there is uncertainty about the magnitude of the association. Linear regression was performed using data from the nationally representative cross-sectional Canadian Health Measures Survey (2007-2009). Height, weight, waist circumference (WC), and vitamin D levels were directly measured. There were 5298 participants aged 6 to 79 years. Using a conservative p value of 0.001, body mass index (BMI) category obese / obese I was positively associated and WC was inversely associated with vitamin D level in crude analysis. WC was inversely associated with vitamin D level in multivariate analysis. The pattern of relationship is not the same as other studies, yet this was a large study with direct measurements. There may be issues with linearity of relationships or subgroups disturbing the relationship.

Indiana University-Purdue University Indianapolis (IUPUI) / Vitamin D deficiency has been linked to chronic pain and increased opioid use. Realworld data such as electronic medical records and administrative claim data contain large amounts of clinical data and present an opportunity to study the relationship of serum 25- hydroxyvitamin D [25(OH)D] with pain intensity and opioid use. The first study assessed the association between serum 25(OH)D) levels and pain intensity. Compared to patients with normal 25(OH)D levels, those who had insufficient or deficient levels were more likely to experience moderate or severe pain, with multivariable-adjusted odds ratios (95% confidence intervals) of 1.19 (1.05-1.36) and 1.51 (1.28-1.79), respectively. Similar findings were obtained using propensity scores in the matched analyses. In the second study, we investigated the association between serum 25(OH.)D levels and opioid use among opioid-naïve patients. We revealed that those who had insufficient or deficient levels of 25(OH)D were more likely to receive an opioid prescription, with multivariableadjusted odds ratios of 1.10 (1.02-1.17) and 1.18 (1.09-1.28), respectively, compared to patients with normal 25(OH)D levels. Vitamin D deficiency was also associated with a longer duration of opioid use. In the third study, we performed machine learning to identify patient characteristics associated with persistent moderate-to-severe pain (PMSP), explicitly investigating if low serum 25(OH)D levels were a risk factor for heightened pain intensity among obese patients. Low levels of 25(OH)D were consistently identified as a key predictor from a large number of candidate variables in the machine learning models. We detected a significant positive association between serum 25(OH)D levels and PMSP in the logistic regression analysis. Compared to patients with normal levels of 25(OH)D, those who had insufficient or deficient levels of 25(OH)D were more likely to report PMSP, with multivariable-adjusted OR (95% CIs) of 1.15 (1.10-1.21) and 1.28 (1.21-1.35) respectively. We replicated the findings in the first study in a different cohort that showed that low serum 25(OH)D levels might play a role in pain perception. This research contributes to an improved understanding of the role of vitamin D on pain, and opioid use. Individuals who experience pain and need opioid therapy may benefit from optimizing their serum 25(OH)D levels.

No description available.

O diabetes mellitus (DM) é uma doença com prevalência e morbidade elevadas em todo o mundo, sendo que o DM1 é responsável por 5-10% dos casos. A vitamina D, hormônio de ação pleiotrópica, pode melhorar o curso do DM1, embora os mecanismos não estejam completamente elucidados. Dessa forma, ampliar o conhecimento sobre a ação desse hormônio pode auxiliar no prognóstico, bem como na compreensão dos possíveis mecanismos envolvidos na prevenção do DM. Neste trabalho, foram avaliados os efeitos fisiológicos da suplementação de vitamina D (800 UI/dia/sete dias; via oral) em camundongos machos (n=31; linhagem C57BL/6) distribuídos em quatro grupos: Controle + Água (CA; n=9); Controle + Vitamina D (CV; n=9); Diabético + Água (DA; n=6) e Diabético + Vitamina D (DV; n=7). Os camundongos tornados diabéticos (aloxana, 60 mg/Kg, intravenosa), quando comparados aos controles, exibiram redução do peso corporal e concentrações plasmáticas de glicose mais elevadas durante o período experimental de 10 dias (características do estado insulinopênico). Entretanto, a suplementação com vitamina D não alterou essa condição. Camundongos tornados diabéticos, em relação aos controles, exibiram redução do peso corporal (p<0,05) e concentrações plasmáticas de glicose (p<0,001) mais elevadas durante o período experimental. Animais suplementados com vitamina D apresentaram, em relação aos controles, níveis de 25(OH)D mais elevados (CA vs CV, p<0,001; DA vs DV, p<0,001). Níveis séricos maiores de ureia (CA vs DA, p<0,05; CA vs DV, p<0,01; CV vs DA, p<0,05; CV vs DV, p<0,01) e creatinina (CA vs DA, p<0,001; CA vs DV, p<0,001; CV vs DA, p<0,001; CV vs DV, p<0,001), espessamento da cápsula de Bowman, hipertrofia glomerular e destruição de hepatócitos foram observados em camundongos diabéticos em relação aos controles. Entretanto, a suplementação com vitamina D não alterou estas condições. O grupo DA apresentou menor nível sérico de albumina em relação aos grupos CA (p<0,05) e CV (p<0,05); níveis inferiores de hemoglobina (p<0,05) e hematócrito (p<0,05) em relação ao grupo DV; e menor leucometria (p<0,05) e mononucleares sanguíneos (p<0,05) em relação ao grupo CA. Os resultados sugerem que a vitamina D possa influenciar a resposta imunológica em animais diabéticos, modulando hematócrito, hemoglobina, bem como os níveis séricos de albumina / Diabetes mellitus (DM) is a disease with high prevalence and morbidity worldwide, and the DM1 is responsible for 5-10% of cases. The vitamin D hormone pleiotropic action, can improve the course of T1DM, although the mechanisms are not fully elucidated. Thus, better understanding the action of this hormone can aid in prognosis as well as in understanding the possible mechanisms involved in the prevention of diabetes. We evaluated the physiological effects of vitamin D (800 IU/day/seven days, v.o.) in male mice (n=31, C57BL/6 strain) divided into four groups: Control + Water (CW, n=9); Control Vitamin D + (CV n=9); Diabetic + Water (DW, n=6) Diabetic + Vitamin D (VD, n=7). The mice induced-diabetes by alloxan (60 mg/kg, i.v.), when compared to controls, exhibited reduced body weight and plasma glucose concentrations were higher during the experimental period of 10 days (features insulinopenic state). However, vitamin D supplementation did not alter this condition. Diabetic mice, compared to controls, exhibited reduced body weight (p<0,05) and plasma glucose concentrations (p <0.001) higher during the trial period. Animals supplemented with vitamin D showed higher levels of 25 (OH) D than controls (CW vs CV, p <0,001; DW vs DV, p<0,001). Higher serum urea (CW vs. DW, p <0,05; CW vs DV, p <0,01; CV vs DA, p <0,05; CV vs DV, p <0,01) and creatinine (CW vs. DW, p <0,001; CW vs DV, p <0,001; CV vs DW, p <0,001; CV vs DW, p <0,001), thickening of Bowman\'s capsule, glomerular hypertrophy and destruction of hepatocytes were observed in diabetic mice compared to controls. However, vitamin D supplementation did not alter these conditions. The DW group showed lower serum albumin compared to CW (p<0,05) and CV (p<0,05) groups; lower hemoglobin (p<0,05) and hematocrit (p <0,05) compared to the DV group; and lower leukocyte counts compared to CW (p <0,05) and mononuclear blood (p <0,05) compared to the CW group. The results suggest that Vitamin D may influence the immune response in diabetic animals, modulating hematocrit, hemoglobin and serum albumin

O diabetes mellitus (DM) é uma doença com prevalência e morbidade elevadas em todo o mundo, sendo que o DM1 é responsável por 5-10% dos casos. A vitamina D, hormônio de ação pleiotrópica, pode melhorar o curso do DM1, embora os mecanismos não estejam completamente elucidados. Dessa forma, ampliar o conhecimento sobre a ação desse hormônio pode auxiliar no prognóstico, bem como na compreensão dos possíveis mecanismos envolvidos na prevenção do DM. Neste trabalho, foram avaliados os efeitos fisiológicos da suplementação de vitamina D (800 UI/dia/sete dias; via oral) em camundongos machos (n=31; linhagem C57BL/6) distribuídos em quatro grupos: Controle + Água (CA; n=9); Controle + Vitamina D (CV; n=9); Diabético + Água (DA; n=6) e Diabético + Vitamina D (DV; n=7). Os camundongos tornados diabéticos (aloxana, 60 mg/Kg, intravenosa), quando comparados aos controles, exibiram redução do peso corporal e concentrações plasmáticas de glicose mais elevadas durante o período experimental de 10 dias (características do estado insulinopênico). Entretanto, a suplementação com vitamina D não alterou essa condição. Camundongos tornados diabéticos, em relação aos controles, exibiram redução do peso corporal (p<0,05) e concentrações plasmáticas de glicose (p<0,001) mais elevadas durante o período experimental. Animais suplementados com vitamina D apresentaram, em relação aos controles, níveis de 25(OH)D mais elevados (CA vs CV, p<0,001; DA vs DV, p<0,001). Níveis séricos maiores de ureia (CA vs DA, p<0,05; CA vs DV, p<0,01; CV vs DA, p<0,05; CV vs DV, p<0,01) e creatinina (CA vs DA, p<0,001; CA vs DV, p<0,001; CV vs DA, p<0,001; CV vs DV, p<0,001), espessamento da cápsula de Bowman, hipertrofia glomerular e destruição de hepatócitos foram observados em camundongos diabéticos em relação aos controles. Entretanto, a suplementação com vitamina D não alterou estas condições. O grupo DA apresentou menor nível sérico de albumina em relação aos grupos CA (p<0,05) e CV (p<0,05); níveis inferiores de hemoglobina (p<0,05) e hematócrito (p<0,05) em relação ao grupo DV; e menor leucometria (p<0,05) e mononucleares sanguíneos (p<0,05) em relação ao grupo CA. Os resultados sugerem que a vitamina D possa influenciar a resposta imunológica em animais diabéticos, modulando hematócrito, hemoglobina, bem como os níveis séricos de albumina / Diabetes mellitus (DM) is a disease with high prevalence and morbidity worldwide, and the DM1 is responsible for 5-10% of cases. The vitamin D hormone pleiotropic action, can improve the course of T1DM, although the mechanisms are not fully elucidated. Thus, better understanding the action of this hormone can aid in prognosis as well as in understanding the possible mechanisms involved in the prevention of diabetes. We evaluated the physiological effects of vitamin D (800 IU/day/seven days, v.o.) in male mice (n=31, C57BL/6 strain) divided into four groups: Control + Water (CW, n=9); Control Vitamin D + (CV n=9); Diabetic + Water (DW, n=6) Diabetic + Vitamin D (VD, n=7). The mice induced-diabetes by alloxan (60 mg/kg, i.v.), when compared to controls, exhibited reduced body weight and plasma glucose concentrations were higher during the experimental period of 10 days (features insulinopenic state). However, vitamin D supplementation did not alter this condition. Diabetic mice, compared to controls, exhibited reduced body weight (p<0,05) and plasma glucose concentrations (p <0.001) higher during the trial period. Animals supplemented with vitamin D showed higher levels of 25 (OH) D than controls (CW vs CV, p <0,001; DW vs DV, p<0,001). Higher serum urea (CW vs. DW, p <0,05; CW vs DV, p <0,01; CV vs DA, p <0,05; CV vs DV, p <0,01) and creatinine (CW vs. DW, p <0,001; CW vs DV, p <0,001; CV vs DW, p <0,001; CV vs DW, p <0,001), thickening of Bowman\'s capsule, glomerular hypertrophy and destruction of hepatocytes were observed in diabetic mice compared to controls. However, vitamin D supplementation did not alter these conditions. The DW group showed lower serum albumin compared to CW (p<0,05) and CV (p<0,05) groups; lower hemoglobin (p<0,05) and hematocrit (p <0,05) compared to the DV group; and lower leukocyte counts compared to CW (p <0,05) and mononuclear blood (p <0,05) compared to the CW group. The results suggest that Vitamin D may influence the immune response in diabetic animals, modulating hematocrit, hemoglobin and serum albumin

<p>Recent evidence suggests that vitamin D may be important for immune function. Canadian studies have reported varying prevalences of low levels of vitamin D. Whether these low vitamin D levels are associated with susceptibility to respiratory tract infections (RTIs) and infection severity remains unclear given the inconsistent association in recent studies. Influenza virus as a cause of RTI is of particular interest given its prevalence, morbidity and economic burden. Vaccination is a key strategy in prevention, but little is known about the effect of vitamin D on influenza vaccine response.</p> <p>A prospective cohort study of children 3 to 15 years old living in Hutterite communities in Alberta, Saskatchewan and Manitoba was conducted to assess the prevalence and predictors of low vitamin D levels and evaluate the association between vitamin D and the incidence and severity of laboratory proven respiratory tract infections. In those who received influenza vaccination, the relationship between vitamin D and influenza vaccine immunogenicity was examined.</p> <p>A total of 743 children were included in the study. The median serum 25-hydroxyvitamin D level (25[OH]D) was 62.0 nmol/L (interquartile range 51.0, 74.0). Levels lower than 50 nmol/L were present in 152 children (20.5%) and lower than 75 nmol/L in 565 children (76%). Lower serum 25(OH)D levels were associated with increased risk of RTI. No association was found between serum 25(OH)D level and disease severity. There was also no relationship found between serum 25(OH)D level and seroprotection or seroconversion from inactivated influenza vaccine.</p> <p>In conclusion, low serum 25(OH)D levels are a significant problem in Canadian Hutterite communities. Furthermore, low serum 25(OH)D levels were associated with increased risk of proven upper RTIs. Studies evaluating the role of vitamin D supplementation to reduce the burden of disease are warranted, and strategies to improve vitamin D status in rural communities in Canada are needed.</p> / Master of Science (MSc)

No / Vitamin D deficiency is thought to impair insulin action and glucose metabolism; however, previous studies have not examined ethnic differences or the influence of calcium and parathyroid hormone. We investigated this in a cohort of predominantly white European and south Asian women during pregnancy. Methods: In this cross-sectional study from an urban population in northern England (53.8°N), 1467 women were recruited when undergoing glucose tolerance testing (75 g oral glucose tolerance test) at 26 weeks' gestation. Results: Gestational diabetes mellitus (GDM) was diagnosed in 137 women (9.3%). Median 25-hydroxyvitamin D concentration for the study population was 9.3 ng/mL (interquartile range 5.2, 16.9) and was higher in European [15.2 ng/mL (10.7, 23.5)] than in south Asian women [5.9 ng/mL (3.9, 9.4), P < .001]. After appropriate adjustment for confounders, 25-hydroxyvitamin D showed a weak inverse association with fasting plasma glucose (FPG; mean difference 1.0% per 1 SD; the ratio of geometric means (RGM) 0.99, 95% confidence interval (CI) 0.98, 1.00), and PTH was weakly associated with FPG (RGM 1.01, 95% CI 1.00, 1.02), but neither was associated with fasting insulin, postchallenge glucose, or GDM. Serum calcium (albumin adjusted) was strongly associated with fasting insulin (RGM 1.06; 95% CI 1.03, 1.08), postchallenge glucose (RGM 1.03, 95% CI 1.01, 1.04), and GDM (odds ratio 1.33, 95% CI 1.06, 1.66) but not with FPG. Associations were similar in European and south Asian women. Conclusions: These findings do not indicate any important association between vitamin D status and glucose tolerance in pregnancy. Relationships between circulating calcium and glucose metabolism warrant further investigation.

Introdução: A vitamina D tem ações pleiotrópicas em muitas doenças crônicas. A expressão do receptor da vitamina D (VDR - vitamin D receptor) em diversas células do sistema imune reforça a possível influência da vitamina D nas doenças autoimunes. Polimorfismos genéticos localizados no gene VDR podem determinar alterações nos mecanismos de ação da vitamina D, porém com resultados ainda pouco conhecidos. O polimorfismo BsmI do gene VDR foi associado com lúpus eritematoso sistêmico (LES) em pacientes asiáticos. Estudos com pacientes lúpicos no Brasil ainda não foram realizados. Objetivos: Investigar a possibilidade dos polimorfismos BsmI e FokI do gene VDR aumentarem o risco para o desenvolvimento do LES e avaliar a possível associação destes polimorfismos com manifestações clínicas e laboratoriais da doença. Determinar os níveis séricos da 25-hidroxivitamina D [25(OH)D)] nos pacientes e investigar a possível associação das suas concentrações com os polimorfismos estudados e expressões clínicas e laboratoriais do LES. Materiais e métodos: Estudo caso-controle envolvendo 195 pacientes com LES e 201 controles saudáveis da mesma área geográfica. Foram pesquisados os polimorfismos BsmI e FokI do gene VDR. Os níveis séricos da 25(OH)D foram dosados nos casos. A genotipagem foi realizada por Restriction Fragment Length Polymorphism-Polimerase Chain Reaction (RFLP-PCR), usando primers e enzimas de restrição específicas para cada polimorfismo. A dosagem da 25(OH)D foi realizada por quimioluminescência. Os dados clínicos e laboratoriais foram coletados dos prontuários. Resultados: Não houve diferença estatisticamente significativa nas frequências genotípicas e alélicas dos polimorfismos BsmI e FokI entre casos e controles eurodescendentes. Não houve associação entre as manifestações clínicas e laboratoriais do LES e os polimorfismos estudados. Os níveis séricos médios da 25(OH)D foram de 25,51±11,43 ng/ml nos pacientes com LES. Quando os pacientes foram classificados pelo estado de vitamina D, a seguinte distribuição foi observada: 55 (30,4%) normais (≥30 ng/ml), 63 (34,8%) insuficientes (20-30 ng/ml), 52 (28,7%) deficientes (<20 ng/ml) e 11 (6,1%) com níveis criticamente baixos (<10 ng/ml). Cinquenta e seis por cento dos pacientes com deficiência estavam usando pelo menos 800 UI de vitamina D por dia. Baseada na distribuição genotípica, a concentração da 25(OH)D foi significativamente maior nos pacientes com genótipo f/f, quando comparados com os pacientes com genótipo F/F (31,614,1 ng/ml versus 23,09,2 ng/ml, p=0,004). Níveis de vitamina D não foram associados com aspectos clínicos e laboratoriais do LES. Conclusões: Os polimorfismos BsmI e FokI não apresentaram associação com LES nos nossos pacientes eurodescendentes estudados. O polimorfimo FokI mostrou influência significativa nos níveis da 25(OH)D, o que reforça o papel deste polimorfismo na atividade funcional do VDR. Este achado poderia ser considerado em futuros estudos clínicos e experimentais envolvendo dosagem da vitamina D. A concentração da 25(OH)D necessária para manter o bom funcionamento do sistema musculoesquelético, cardiovascular e imunológico deveria ser individualizada para cada paciente e novas orientações sobre a suplementação de vitamina D poderiam ter que levar em consideração a ancestralidade genética. Assim, estudos adicionais são necessários para estabelecer definições dos níveis ideais de vitamina D geneticamente especificados. / Introduction: Vitamin D has pleiotropic actions on many chronic diseases. The expression of the VDR (vitamin D receptor) in various cells of the immune system strengthens the possible influence of vitamin D on autoimmune diseases. Genetic polymorphisms located in VDR gene may determine changes in the mechanisms of action of vitamin D, but with results still unknown. The BsmI VDR polymorphism was associated with systemic lupus erythematosus (SLE) in Asian patients. Studies with SLE patients in Brazil have not been conducted. Objectives: To investigate the possibility of BsmI and FokI polymorphisms of VDR gene causing increased risk for development of SLE and to evaluate the possible association of these polymorphisms with clinical and laboratory manifestations of the disease. To determine serum levels of 25-hydroxyvitamin D [25(OH)D)] in patients and to investigate the possible association of their concentrations with the studied polymorphisms and clinical and laboratory expressions of SLE. Materials and methods: Case-control study involving 195 SLE patients and 201 healthy controls from the same geographical area. The BsmI and FokI polymorphisms of VDR gene were studied. Serum 25(OH)D levels were measured in the cases. Genotyping was performed by Restriction Fragment Length Polymorphism-Polymerase Chain Reaction (RFLP-PCR), using primers and restriction enzymes specific for each polymorphism. The measurement of 25(OH)D was performed by chemiluminescence. The clinical and laboratory data were collected from medical records. Results: There was no statistically significant difference in genotypic and allelic frequencies of BsmI and FokI polymorphisms among European-derived cases and controls. There was no association between clinical and laboratory features in SLE patients and the studied polymorphisms. The mean serum levels of 25(OH)D were 25.51±11.43 ng/ml in SLE patients. When patients were classified according to vitamin D status, the following distribution was observed: 55 (30.4%) had normal (≥30 ng/ml), 63 (34.8%) insufficient (20-30 ng/ml), 52 (28.7%) deficient (<20 ng/ml) and 11 (6,1%) critically low serum levels (<10 ng/ml). Fifty six percent of patients with deficiency received at least 800 IU of vitamin D per day. Based on genotype distribution, 25(OH)D levels were significantly higher in patients carrying the f/f genotype, when compared to patients carrying the F/F genotype (31.614.1 ng/ml versus 23.09.2 ng/ml, p=0.004). Vitamin D levels were not associated with clinical and laboratory features of SLE. Conclusions: The BsmI and FokI polymorphisms did not present association with SLE in our European-derived studied patients. The FokI polymorphism showed significant influence on 25(OH)D levels, reinforcing its role in functional activity of VDR. This finding may be considered in future clinical and experimental studies involving vitamin D measurements. Serum concentrations of 25(OH)D required to maintain optimal musculoskeletal, cardiovascular and immune health should be individualized for each patient and new guidelines about vitamin D supplementation may have to take into consideration the individual genetic background. Genetic-specific definitions of ideal levels of vitamin D in SLE should therefore be established in future studies.

Introdução: A vitamina D tem ações pleiotrópicas em muitas doenças crônicas. A expressão do receptor da vitamina D (VDR - vitamin D receptor) em diversas células do sistema imune reforça a possível influência da vitamina D nas doenças autoimunes. Polimorfismos genéticos localizados no gene VDR podem determinar alterações nos mecanismos de ação da vitamina D, porém com resultados ainda pouco conhecidos. O polimorfismo BsmI do gene VDR foi associado com lúpus eritematoso sistêmico (LES) em pacientes asiáticos. Estudos com pacientes lúpicos no Brasil ainda não foram realizados. Objetivos: Investigar a possibilidade dos polimorfismos BsmI e FokI do gene VDR aumentarem o risco para o desenvolvimento do LES e avaliar a possível associação destes polimorfismos com manifestações clínicas e laboratoriais da doença. Determinar os níveis séricos da 25-hidroxivitamina D [25(OH)D)] nos pacientes e investigar a possível associação das suas concentrações com os polimorfismos estudados e expressões clínicas e laboratoriais do LES. Materiais e métodos: Estudo caso-controle envolvendo 195 pacientes com LES e 201 controles saudáveis da mesma área geográfica. Foram pesquisados os polimorfismos BsmI e FokI do gene VDR. Os níveis séricos da 25(OH)D foram dosados nos casos. A genotipagem foi realizada por Restriction Fragment Length Polymorphism-Polimerase Chain Reaction (RFLP-PCR), usando primers e enzimas de restrição específicas para cada polimorfismo. A dosagem da 25(OH)D foi realizada por quimioluminescência. Os dados clínicos e laboratoriais foram coletados dos prontuários. Resultados: Não houve diferença estatisticamente significativa nas frequências genotípicas e alélicas dos polimorfismos BsmI e FokI entre casos e controles eurodescendentes. Não houve associação entre as manifestações clínicas e laboratoriais do LES e os polimorfismos estudados. Os níveis séricos médios da 25(OH)D foram de 25,51±11,43 ng/ml nos pacientes com LES. Quando os pacientes foram classificados pelo estado de vitamina D, a seguinte distribuição foi observada: 55 (30,4%) normais (≥30 ng/ml), 63 (34,8%) insuficientes (20-30 ng/ml), 52 (28,7%) deficientes (<20 ng/ml) e 11 (6,1%) com níveis criticamente baixos (<10 ng/ml). Cinquenta e seis por cento dos pacientes com deficiência estavam usando pelo menos 800 UI de vitamina D por dia. Baseada na distribuição genotípica, a concentração da 25(OH)D foi significativamente maior nos pacientes com genótipo f/f, quando comparados com os pacientes com genótipo F/F (31,614,1 ng/ml versus 23,09,2 ng/ml, p=0,004). Níveis de vitamina D não foram associados com aspectos clínicos e laboratoriais do LES. Conclusões: Os polimorfismos BsmI e FokI não apresentaram associação com LES nos nossos pacientes eurodescendentes estudados. O polimorfimo FokI mostrou influência significativa nos níveis da 25(OH)D, o que reforça o papel deste polimorfismo na atividade funcional do VDR. Este achado poderia ser considerado em futuros estudos clínicos e experimentais envolvendo dosagem da vitamina D. A concentração da 25(OH)D necessária para manter o bom funcionamento do sistema musculoesquelético, cardiovascular e imunológico deveria ser individualizada para cada paciente e novas orientações sobre a suplementação de vitamina D poderiam ter que levar em consideração a ancestralidade genética. Assim, estudos adicionais são necessários para estabelecer definições dos níveis ideais de vitamina D geneticamente especificados. / Introduction: Vitamin D has pleiotropic actions on many chronic diseases. The expression of the VDR (vitamin D receptor) in various cells of the immune system strengthens the possible influence of vitamin D on autoimmune diseases. Genetic polymorphisms located in VDR gene may determine changes in the mechanisms of action of vitamin D, but with results still unknown. The BsmI VDR polymorphism was associated with systemic lupus erythematosus (SLE) in Asian patients. Studies with SLE patients in Brazil have not been conducted. Objectives: To investigate the possibility of BsmI and FokI polymorphisms of VDR gene causing increased risk for development of SLE and to evaluate the possible association of these polymorphisms with clinical and laboratory manifestations of the disease. To determine serum levels of 25-hydroxyvitamin D [25(OH)D)] in patients and to investigate the possible association of their concentrations with the studied polymorphisms and clinical and laboratory expressions of SLE. Materials and methods: Case-control study involving 195 SLE patients and 201 healthy controls from the same geographical area. The BsmI and FokI polymorphisms of VDR gene were studied. Serum 25(OH)D levels were measured in the cases. Genotyping was performed by Restriction Fragment Length Polymorphism-Polymerase Chain Reaction (RFLP-PCR), using primers and restriction enzymes specific for each polymorphism. The measurement of 25(OH)D was performed by chemiluminescence. The clinical and laboratory data were collected from medical records. Results: There was no statistically significant difference in genotypic and allelic frequencies of BsmI and FokI polymorphisms among European-derived cases and controls. There was no association between clinical and laboratory features in SLE patients and the studied polymorphisms. The mean serum levels of 25(OH)D were 25.51±11.43 ng/ml in SLE patients. When patients were classified according to vitamin D status, the following distribution was observed: 55 (30.4%) had normal (≥30 ng/ml), 63 (34.8%) insufficient (20-30 ng/ml), 52 (28.7%) deficient (<20 ng/ml) and 11 (6,1%) critically low serum levels (<10 ng/ml). Fifty six percent of patients with deficiency received at least 800 IU of vitamin D per day. Based on genotype distribution, 25(OH)D levels were significantly higher in patients carrying the f/f genotype, when compared to patients carrying the F/F genotype (31.614.1 ng/ml versus 23.09.2 ng/ml, p=0.004). Vitamin D levels were not associated with clinical and laboratory features of SLE. Conclusions: The BsmI and FokI polymorphisms did not present association with SLE in our European-derived studied patients. The FokI polymorphism showed significant influence on 25(OH)D levels, reinforcing its role in functional activity of VDR. This finding may be considered in future clinical and experimental studies involving vitamin D measurements. Serum concentrations of 25(OH)D required to maintain optimal musculoskeletal, cardiovascular and immune health should be individualized for each patient and new guidelines about vitamin D supplementation may have to take into consideration the individual genetic background. Genetic-specific definitions of ideal levels of vitamin D in SLE should therefore be established in future studies.