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Decreased vitamin D levels associated with greater risk of infection in surgery patients

Decreased vitamin D levels associated with greater risk of infection in surgery patients

Friday, December 6, 2013. An article published online on November 27, 2013 in the American Medical Association journal JAMA Surgery reveals a greater risk of hospital-acquired infection among gastric bypass surgery patients with diminished levels of vitamin D.

Sadeq A. Quarishi, MD, MHA, of Massachusetts General Hospital and colleagues conducted a retrospective analysis of 770 obese adults who underwent Roux-en-Y gastric bypass surgery. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured within 30 days prior to the procedure. Hospital-acquired infection, including surgical site infection, catheter-related urinary tract infection, pneumonia or bacteremia, occurred in 41 men and women between two and thirty days after admission.

Among subjects whose 25-hydroxyvitamin D levels were less than 30 nanograms per milliliter (ng/mL) the risk of acquiring an infection while hospitalized was three times as great as the risk experienced by those whose levels were higher. For surgical site infections, the risk among those with decreased vitamin D concentrations was four times as great in comparison with those who had higher levels. The authors observe that innate and adaptive immune system cells express the vitamin D receptor and respond to stimulation by 1,25-dihydroxyvitamin D, the active form of the vitamin. Vitamin D also upregulates the expression of antimicrobial peptides, one of which is active against a variety of infectious agents.

"Our results suggest that low preoperative 25(OH)D levels are associated with a higher risk for postoperative infections," the authors conclude. "We hypothesize that higher levels of vitamin D sufficiency are associated with optimal expression of endogenous antimicrobial peptides and that this may attenuate the effect of barrier site disruptions that are characteristic of postoperative hospital acquired infections. Prospective studies are needed to validate our findings, assess the potential benefit of optimizing preoperative vitamin D status, and identify the mechanism by which vitamin D sufficiency may confer protection against nosocomial infections."

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Reduced vitamin D levels linked to pneumonia

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A short report published online on April 17, 2013 in the Journal of Epidemiology and Community Health reveals a protective effect for higher vitamin D levels against the risk of developing pneumonia.

The current study included 723 men and 698 women between the ages of 53 and 73 enrolled in the Kuopio Ischemic Heart Disease Risk Factor Study. Subjects were free of pneumonia and other pulmonary diseases at the beginning of the current investigation. Blood samples obtained upon enrollment were analyzed for serum 25-hydroxyvitamin D3 levels, which averaged 43.5 nanomoles per liter (17.43 ng/mL). The participants were followed for an average of 9.8 years, during which 73 subjects were hospitalized at least once due to pneumonia.

A greater risk of pneumonia was observed in association with increasing age. Researchers Alex Aregbesola and his colleagues at the University of Eastern Finland Institute of Public Health and Clinical Nutrition found that men and women whose serum 25-hydroxyvitamin D3 levels were among the lowest one-third of participants had 2.6 times the risk of contracting pneumonia in comparison with those whose levels were highest. Men were likelier to develop pneumonia than women, and smokers more than nonsmokers. Adjustment of the data for several factors failed to modify the results.

The current study is the first to demonstrate an association between insufficient vitamin D levels and a greater risk of pneumonia among aging individuals in the general population. The findings corroborate those of previous research which indicated that reduced vitamin D levels are associated with an increased risk of infection. In northern countries such as Finland, sun exposure is insufficient during winter, necessitating vitamin D supplementation. The authors suggest that vitamin D deficiency is a public health issue, and recommend further research.

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