Vitamin D status in patients with chronic obstructive pulmonary disease at Chris Hani Baragwanath Hospital, Johannesburg, South Africa
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Abstract
Background. There has been a growing interest in nutritional/lifestyle factors, including vitamin D, that may affect chronic obstructive pulmonary disease (COPD). Most data are from Caucasian populations and temperate climates, with minimal African data.
Objectives. The primary objective was to determine the prevalence of vitamin D deficiency (25-hydroxyvitamin D (25(OH)D) ≤20 ng/mL) and insufficiency (25(OH)D 21 - 29 ng/mL) among patients with COPD. Secondary objectives were to investigate the association between vitamin D and demographic/lifestyle factors, lung function parameters, markers of COPD severity and corticosteroid use.
Methods. A prospective, cross-sectional study of 76 patients with COPD was conducted at a tertiary hospital in Johannesburg, South Africa. Patients were interviewed regarding demographic/lifestyle factors, COPD severity markers and corticosteroid therapy. The most recent spirometry result was recorded. Blood samples were taken for measurement of calcium, alkaline phosphatase and vitamin D levels. Patients were stratified according to vitamin D status (deficiency and non-deficiency (25(OH)D >20 ng/mL, i.e. combined insufficiency and adequate levels)), and statistical analysis was performed to assess for associations.
Results. The sample included 72% males and 63% black African patients. The prevalences of vitamin D deficiency and insufficiency were 48% (95% confidence interval (CI) 42 - 54) and 35% (95% CI 30 - 41), respectively. A Modified Medical Research Council (mMRC) dyspnoea score ≥2 was associated with a relative risk of 1.34 (95% CI 1.05 - 1.7) for vitamin D deficiency in univariate analysis. In multivariate regression analysis, only sunlight exposure (<1 hour/day) was an independent predictor of vitamin D deficiency (odds ratio 2.4; 95% CI 1.3 - 4.5).
Conclusion. There was a high prevalence of suboptimal vitamin D levels in this COPD sample population. A higher mMRC score was associated with an increased risk of vitamin D deficiency, while low sunlight exposure was the only independent predictor of vitamin D deficiency.
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References
1. Soriano JB, Abajobir AA, Abate KH, et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990 - 2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 2017;5(9):691-706. https://doi. org/10.1016/S2213-2600(17)30293-X
2. Jung JY, Kim YS, Kim SK, et al. Relationship of vitamin D status with lung function and exercise capacity in COPD. Respirology 2015;20(5):782-789. https://doi.org/10.1111/ resp.12538
3. Malinovschi A, Masoero M, Bellocchia M, et al. Severe vitamin D deficiency is associated with frequent exacerbations and hospitalisation in COPD patients. Respir Res 2014;15(1):131. https://doi.org/10.1186/s12931-014-0131-0
4. JanssensW,BouillonR,ClaesB,etal.VitaminDdeficiencyishighlyprevalentinCOPD and correlates with variants in the vitamin D-binding gene. Thorax 2010;65(3):215-220. https://doi.org/10.1136/thx.2009.120659
5. BurkesRM,CeppeAS,DoerschukCM,etal.Associationsamong25-hydroxyvitaminD levels, lung function, and exacerbation outcomes in COPD. Chest 2020;157(4):856-665. https://doi.org/10.1016/j.chest.2019.11.047
6. Kunisaki KM, Niewoehner DE, Connett JE. Vitamin D levels and risk of acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012;185(3):286-290. https://doi.org/10.1164/rccm.201109-1644OC
7. JolliffeDA,JamesWY,HooperRL,etal.Prevalence,determinantsandclinicalcorrelates of vitamin D deficiency in patients with chronic obstructive pulmonary disease in London, UK. J Steroid Biochem Mol Biol 2018;175:138-145. https://doi.org/10.1016/j. jsbmb.2017.01.019
8. Hyun DG, Oh YM, Lee SW, Lee SD, Lee JS. Clinical phenotypes, comorbidities, and exacerbations according to serum 25-OH vitamin D and plasma fibrinogen levels in chronic obstructive pulmonary disease. J Korean Med Sci 2019;34(29):e195. https://doi. org/10.3346/jkms.2019.34.e195
9. Kentson M, Leanderson P, Jacobson P, Persson HL. The influence of disease severity and lifestyle factors on the peak annual 25(OH)D value of COPD patients. Int J Chron Obstruct Pulmon Dis 2018;13:1389-1398. https://doi.org/10.2147/COPD.S156121
10. Puhan MA, Siebeling L, Frei A, Zoller M, Bischoff-Ferrari H, ter Riet G. No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD. Chest 2014;145(1):37-43. https://doi.org/10.1378/chest.13-1296
11. Ferrari D, Lombardi G, Banfi G. Concerning the vitamin D reference range: Pre- analytical and analytical variability of vitamin D measurement. Biochem Med (Zagreb) 2017;27(3):030501. https://doi.org/10.11613/BM.2017.030501
12. Jones G. Interpreting vitamin D assay results: Proceed with caution. Clin J Am Soc Nephrol 2015;10(2):331-334. https://doi.org/10.2215/CJN.05490614
13. Kokturk N, Baha A, Oh YM, Young Ju J, Jones PW. Vitamin D deficiency: What does it mean for chronic obstructive pulmonary disease (COPD)? A comprehensive review for pulmonologists. Clin Respir J 2018;12(2):382-397. https://doi.org/10.1111/crj.12588
14. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357(3):266-281. https://doi. org/10.1056/NEJMra070553
15. Tenforde MW, Yadav AM, Dowdy DW, et al. Vitamin A and D deficiencies associated with incident tuberculosis in HIV-infected patients initiating antiretroviral therapy in multinational case-cohort study. J Acquir Immune Defic Syndr 2017;75(3):e71-e79. https://doi.org/10.1097/QAI.0000000000001308
16. KamphuisLS,Bonte-MineurF,vanLaarJA,vanHagenPM,vanDaelePL.Calciumand vitamin D in sarcoidosis: Is supplementation safe? J Bone Miner Res 2014;29(11):2498- 2503. https://doi.org/10.1002/jbmr.2262
17. Kalichuran S, van Blydenstein SA, Venter M, Omar S. Vitamin D status and COVID-19 severity. South Afr J Infect Dis 2022;37(1):359. https://doi.org/10.4102/sajid.v37i1.359
18. Persson LJP, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, Eagan TML. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PLoS ONE 2012;7(6):e38934. https://doi.org/10.1371/journal.pone.0038934
19. Singh D, Agusti A, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD science committee report 2019. Eur Respir J 2019;53(5):1900164. https://doi.org/10.1183/13993003.00164-2019
20. Avci E, Demir S, Aslan D, Nar R, Şenol H. Assessment of Abbott Architect 25-OH vitamin D assay in different levels of vitamin D. J Med Biochem 2020;39(1):100-107. https://doi.org/10.2478/jomb-2019-0039
21. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96(7):1911-1930. https://doi.org/10.1210/jc.2011-0385
22. Gawron G, Trzaska-Sobczak M, Sozańska E, Śnieżek P, Barczyk A. Vitamin D status of severe COPD patients with chronic respiratory failure. Adv Respir Med 2018;86(2):78-85. https://doi.org/10.5603/ARM.2018.0010
23. Mogire RM, Mutua A, Kimita W, et al. Prevalence of vitamin D deficiency in Africa: A systematic review and meta-analysis. Lancet Glob Health 2020;8(1):e134-e142. https:// doi.org/10.1016/S2214-109X(19)30457-7
24. Moberg M, Elango P, Ferrucci L, Spruit MA, Wouters EF, Rutten EPA. Vitamin D deficiency and airflow limitation in the Baltimore Longitudinal Study of Ageing. Eur J Clin Invest 2015;45(9):955-963. https://doi.org/10.1111/eci.12498