Nutritional Outlook

Nutritional Outlook, April 2018

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■ NUTRITIONAL OUTLOOK 42 APRIL 2018 Vitamins to 36.07 ng/ml at the end of eight weeks. Aver- age scores for pain assessed on a visual analog scale (VAS) at baseline were 81. T ese scores decreased progressively over the supplemen- tation and follow-up period to averages of 61, 45, and 36 at 2, 3, and 6 months, respectively. T ere was a corresponding signif cant im- provement in physical function at all three time points as well, indicating that vitamin D repletion and supplementation may be ef- fective for reducing pain and improving func- tional ability in those with chronic lower back pain. In an earlier published study, Turkish re- searchers evaluated 83 women suf ering from chronic widespread pain by assessing the association of pain with vitamin D sta- tus. 7 Women with an average age greater than 50 were included in the study and di- vided into two groups based on serum 25-hy- droxyvitamin D3 levels either above or below the cutof for def ciency of 20 ng/ml. Based on this cutof , 50 patients were assigned to the low–vitamin D group, and 33 were as- signed to the normal–vitamin D group. Sub- ejcts were then assessed for pain using a VAS score, verbal rating scale (six words denoting pain intensity ranging from no pain to un- bearable pain), and face pain scale (visual di- agrams representing six dif erent faces with expressions ranging from smiling to crying). T e Nottingham Health Prof le was included to evaluate quality of life, while nerve con- duction studies were also conducted. T ose with low vitamin D levels had sig- nif cantly higher pain intensity on all scales and a decreased quality of life when com- pared to those with normal vitamin D status, highlighting the association of chronic pain with vitamin D def ciency. As a follow on to the initial investigation, the same research group performed an inter- vention study in vitamin D–def cient women suf ering from chronic widespread pain. Dur- ing the study, 33 women with 25-hydroxyvi- tamin D levels below 10 ng/ml were given vitamin D at a dose of 50,000 IU/week for eight weeks, followed by a maintenance dose of 2,000 IU/day. 8 Pain was assessed using the same scales as the original study, and quality of life was measured using the Nottingham Health Prof le. Nerve conduction studies were also performed. Vitamin D levels improved from an aver- age of 6.69 ng/ml at baseline to 42.94 ng/ml after eight weeks of supplementation. All pain measures decreased signif cantly from baseline to eight weeks, while Nottingham Prof le scores, including the pain, emotional reactions, and physical function subscores, showed signif cant reductions, indicating improvements in quality of life. Nerve con- duction studies showed no signif cant dif er- ences from baseline values; however, over- all, the pilot study indicated the benef ts of vitamin D repletion on several indicators of chronic pain. In another study, researchers from Tel- Aviv University (Tel-Aviv, Israel) randomized 74 adults aged 18 and older suf ering from chronic musculoskeletal pain greater than 6 months in duration into two groups; one received 4,000 IU vitamin D per day for 12 weeks, while the other group received a place- bo. 9 Patients were already receiving their regu- lar analgesic regimen at the time of inclusion, and vitamin D status measurements found that 73% were insuf cient at baseline (def ned as concentrations lower than 30 ng/ml). Visual analog scale scores for pain de- creased signif cantly from baseline in the vitamin D–supplemented group at week 6 and week 12, while no such signif cant changes were noted with placebo. Serum inf ammatory markers, including TNF- and prostaglandin E2, showed decreases in the vitamin D group by 54% and 39%, respectively, while these values increased in the placebo group by an average of 16% each. T e need for analgesic rescue medi- cation was also substantially lower in the vitamin D–supplemented group, indicating potential benef ts of vitamin D in those with chronic musculoskeletal pain. Vitamin D and Infl ammation In addition to the clinical evidence suggest- ing vitamin D repletion improves param- eters of pain associated with chronic condi- tions, several clinical studies demonstrate its anti-inf ammatory ef ects in a diverse range of health states. Alexander Rodriguez and colleagues from Monash University (Melbourne, Australia) recently conducted a meta-analysis including seven randomized controlled clinical trials which assessed the ef ect of vitamin D supplementation on in- f ammatory markers in patients with heart failure. 10 While the results of their analysis did not f nd changes in all inf ammatory markers assessed, they showed a signif cant decrease attributable to vitamin D in the pro- inf ammatory cytokine TNF- . Furthermore, a current study by an Iranian research group looked to evaluate the anti- inf ammatory ef ects of high-dose vitamin D supplementation in adolescent girls. 11 In the nine-week study, 580 adolescent girls were asked to supplement with 50,000 IU/week of vitamin D3. C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio were evalu- ated as markers of systemic inf ammation before and after supplementation. T e inves- tigators found statistically signif cant reduc- tions in CRP as well as neutrophil count at the end of the study, indicating vitamin D's ability to reduce systemic inf ammation. Another model of chronic inf ammation in which vitamin D has been investigated is inf ammatory bowel disease. Led by Am- rollah Sharif , a group from Tehran Univer- sity of Medical Sciences (Tehran, Iran) con- ducted a randomized placebo-controlled trial to evaluate the ef ects of vitamin D3 on inf ammation in ulcerative colitis pa- tients. 12 Ninety individuals with ulcerative colitis who were in remission received an intramuscular dose of 300,000 IU vitamin D3 or a saline placebo and were evaluated at baseline and after 90 days. T e results of the study showed that CRP levels and erythrocyte sedimentation rate (ESR) were Several clinical studies demonstrate vitamin D's anti-inf ammatory ef ects in a diverse range of health states.

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