Simon Vanlint

Vitamin D and Obesity

Obesity is a significant health problem world-wide, particularly in developed nations. Vitamin D deficiency is pandemic, and has been implicated in a wide variety of disease states. This paper seeks to examine the consistently reported relationship between obesity and low vitamin D concentrations, with reference to the possible underlying mechanisms. The possibility that vitamin D may assist in preventing or treating obesity is also examined, and recommendations for future research are made. There is a clear need for adequately-powered, prospective interventions which include baseline measurement of 25D concentrations and involve adequate doses of supplemental vitamin D. Until such studies have been reported, the role of vitamin D supplementation in obesity prevention remains uncertain.

Does vitamin D sufficiency equate to a single serum 25-Hydroxyvitamin D level or are different levels required for non-skeletal diseases?

Objective: Clarify the concept of vitamin D sufficiency, the relationship between efficacy and vitamin D status and the role of Vitamin D supplementation in the management of non-skeletal diseases. We outline reasons for anticipating different serum vitamin D levels are required for different diseases. Method: Review the literature for evidence of efficacy of supplementation and minimum effective 25-hydroxyvitamin D (25-OHD) levels in non-skeletal disease. Results: Evidence of efficacy of vitamin supplementation is graded according to levels of evidence. Minimum effective serum 25-OHD levels are lower for skeletal disease, e.g., rickets (25 nmol/L), osteoporosis and fractures (50 nmol/L), than for premature mortality (75 nmol/L) or non-skeletal diseases, e.g., depression (75 nmol/L), diabetes and cardiovascular disease (80 nmol/L), falls and respiratory infections (95 nmol/L) and cancer (100 nmol/L). Conclusions: Evidence for the efficacy of vitamin D supplementation at serum 25-OHD levels ranging from 25 to 100 nmol/L has been obtained from trials with vitamin D interventions that change vitamin D status by increasing serum 25-OHD to a level consistent with sufficiency for that disease. This evidence supports the hypothesis that just as vitamin D metabolism is tissue dependent, so the serum levels of 25-OHD signifying deficiency or sufficiency are disease dependent.

Efficacy and tolerability of calcium, vitamin D and a plant-based omega-3 oil for osteopenia: A pilot RCT

OBJECTIVES Our pilot study tested the efficacy, acceptability and tolerability of DHA supplementation in addition to calcium and vitamin D in individuals with osteopenia. STUDY DESIGN 40 participants were randomised to either algal oil containing 400mg docosahexanoic acid (DHA) daily or placebo. All participants received 1200 mg calcium carbonate with vitamin D(3) 1000 IU daily. MAIN OUTCOME MEASURES Bone mineral density (BMD) was measured at baseline and 12 months. Bone turnover was assessed with serum c-terminal telopeptides (CTx) at baseline and 12 months. Tolerability and acceptability were assessed using a validated questionnaire. RESULTS Mean CTx was suppressed after 12 months for all participants (p=0.04) with no difference in effect size between DHA and control groups (p=0.53). Changes in CTx at 12 months were significantly correlated with changes in BMD at the lumbar spine (p=0.01) and total proximal femur (TPF) (p=0.03). There was a non-significant trend towards rising BMD at 12 months. Participants rated the supplements as tolerable and acceptable, with few adverse events. CONCLUSIONS The combination of oral calcium, vitamin D(3) and DHA was safe, tolerable and acceptable when used for 12 months by osteopenic individuals in this pilot study. The combination had a positive effect on bone health as indicated by serum CTx, with no effect demonstrated from the addition of DHA 400mg. Changes in BMD at the lumbar spine and TPF were significantly correlated with changes in CTx, which may be useful in monitoring bone health and response to treatment.

Understanding patient perspectives on management of their chronic pain: Online survey protocol

Background It is widely recognized that both doctors and patients report discontent regarding pain management provided and received. The impact of chronic pain on an individual’s life resonates beyond physical and mental suffering; equal or at times even greater impact is observed on an individual’s personal relationships, ability to work, and social interactions. The degree of these effects in each individual varies, mainly because of differences in biological factors, social environment, past experiences, support, and belief systems. Therefore, it is equally possible that these individual patient characteristics could influence their treatment outcome. Research shows that meeting patient expectations is a major challenge for health care systems attempting to provide optimal treatment strategies. However, patient perspectives and expectations in chronic pain management have not been studied extensively. The aim of this study is to investigate the views, perceptions, beliefs, and expectations of individuals who experience chronic pain on a daily basis, and the strategies used by them in managing chronic pain. This paper describes the study protocol to be used in a cross sectional survey of chronic pain patients. Methods and analysis The study population will comprise of individuals aged ≥18 years, who have experienced pain for ≥3 months with no restrictions of sex, ethnicity, or region of residence. Ethics approval for our study was obtained from Humans research ethics committees, University of Adelaide and University of South Australia. Multinomial logistic regression will be used to estimate the effect of duration and character of pain, on patient’s perception of time to recovery and supplement intake. Logistic regression will also be used for estimating the effect of patient-provider relationship and pain education on patient-reported recovery and pain intensity. Discussion Knowledge about the perceptions and beliefs of patients with chronic pain could inform future policies, research, health care professional education, and development of individualized treatment strategies.

A guide for the assessment and management of vitamin D status in people with intellectual disability (developed as an AADDM Working Party initiative).

Vitamin D insufficiency has been associated with adverse health consequences, principally increased falls, osteoporosis, and fractures. Associations have also been proposed between vitamin D insufficiency and diseases of the immune system, cancer, psychiatric disease, respiratory disease, cardiovascular disease and abnormalities of glucose metabolism. For a number of reasons, vitamin D insufficiency is relatively common in people with intellectual disability (ID). A study of 410 people with ID in Sydney showed that 43% had vitamin D levels of less than 50 nmol/l (Law, Durvasula, & McElduff, 2005), as did 57% of a largely institution-based group of people with ID in Adelaide (Vanlint & Nugent, 2006). This is likely to partly explain the relatively high incidence of fractures seen in the population with ID when compared to the general population (Glick, Fischer, Heisey, Leverson, & Mann, 2005; Vanlint & Nugent, 2006). The following is intended to be a practical guide for clinicians, family members and support workers who care for people with ID. It has been prepared by a Working Party consisting of Australian clinicians and researchers with an interest in the care of people with ID (and endorsed by the Australian Association of Developmental Disability Medicine). Recommendations for the detection and management of vitamin D insufficiency have been developed for general practitioners, and will be published in a separate article by the same authors in Australian Family Physician (Vanlint, Nugent, Durvasula, Downs, & Leonard, 2008). The Working Party reviewed the limited literature which specifically pertains to vitamin D and ID, as well as the large body of literature pertaining to vitamin D in general, especially in the elderly. Two recent Australian papers are of special note, and are commended to readers: the recent Position Statement released by the Working Party of the Australia and New Zealand Bone and Mineral Society (Diamond, Eisman, et al., 2005), and the Recommendations from the Calcium and Vitamin D Forum held in Melbourne in July 2005 (Ebeling & Eisman, 2005).

Exploring effect of pain education on chronic pain patients’ expectation of recovery and pain intensity

Abstract Background and aims: Chronic pain affects an estimated 1 in 10 adults globally regardless of age, gender, ethnicity, income or geography. Chronic pain, a multifactorial problem requires multiple interventions. One intervention which demonstrates promising results to patient reported outcomes is pain education. However, patient perspective on pain education and its impact remains fairly unknown. A cross-sectional study involving individuals with chronic pain examined their perspectives on pain education; did it change their understanding about their pain and self-management and did it have any impact on their perceived pain intensity and recovery. Methods: The study complied with CHERRIES guidelines and the protocol was locked prior to data collection. Primary outcomes were pain intensity and participants’ expectation of recovery. Univariate and multiple logistic regressions were used to analyze the data. Results: Five hundred and seventy three people participated; full data sets were available for 465. Participants who observed changes in their pain cognition and self-management following pain education reported lower pain intensity and greater expectation of recovery than participants who did not observe changes to cognition and management. Conclusions: The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. Implications: Pain intensity and expectations about recovery are primary considerations for people in pain. What influences these factors is not fully understood, but education about pain is potentially important. The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. The results from this study highlight the importance of effective pain education focused on reconceptualization of pain and its management.

Factors Associated with Vitamin D Testing, Deficiency, Intake, and Supplementation in Patients with Chronic Pain

ABSTRACT Vitamin D deficiency is a public health issue, with reports of six- to twenty-five–fold rise in vitamin D testing. Vitamin D deficiency has been linked to many chronic diseases such as diabetes mellitus, cardiovascular disease, depression, and chronic pain. Identifying factors associated with risk of deficiency in individuals with chronic pain will help minimize time and cost. This study aims to examine the factors associated with vitamin D testing, intake, and physician-advised supplementation in individuals with chronic pain. Using a cross-sectional design, data were collected from 465 individuals with chronic pain. These data were analyzed using penalized logistic regression with the LASSO technique. Fifty-seven percent reported being tested for vitamin D, about 40% reported being diagnosed with vitamin D deficiency, and of those who had been tested, 60% reported taking vitamin D supplementation. The findings suggest older age (OR 3.12, CI [1.02, 9.50]) and higher mean pain intensity score (OR 2.02, CI [1.13, 3.59]) increased an individuals chance of being vitamin D deficient. Unemployment or on leave due to pain (OR 1.79, [CI 1.03, 3.11]), part-time employment (OR 1.86, CI [1.02, 3.39]), and being a resident of Australia (OR 2.32, CI [1.13, 4.72]) increased chances of being tested for vitamin D. Being diagnosed with vitamin D deficiency (OR 6.67, CI [2.75, 16.19]), unemployed or on leave due to pain (OR 3.71, CI [1.25, 11.00]), and in part-time employment (OR 2.69, CI [0.86, 8.38]) were associated with physician-advised vitamin D supplementation. Our results may have practical implications, as identifying pretest risk factors may assist in identifying who is at risk of vitamin D deficiency, whom to test, and when to treat.