Death and serious complications more likely in patients with vitamin D deficiency, study suggests
Patients with low blood levels of vitamin D are at increased risk of death and serious complications after noncardiac surgery, suggests a study in Anesthesia & Analgesia.

"Vitamin D concentrations were associated with a composite of in-hospital death, serious infections, and serious cardiovascular events," according to the new research by Dr Alparslan Turan and colleagues of the Cleveland Clinic. They believe their results warrant further study to see if giving vitamin D supplementation before surgery can reduce the risk of these adverse outcomes.

Lower Vitamin D Levels Linked to Higher Surgical Risk

The researchers analyzed the relationship between vitamin D level and surgical outcomes in approximately 3,500 patients who underwent operations other than heart surgery between 2005 and 2011. Only patients who had available data on vitamin D levels around the time of surgery-from three months before to one month afterward-were included in the study.

The concentration of vitamin D (specifically, 25-hydroxyvitamin D) in blood samples was analyzed as a risk factor for death, cardiovascular events, or serious infections while in the hospital. The analysis included adjustment for other factors such as demographic characteristics, medical conditions, and type and duration of surgery.

Most patients did not meet the recommended 25-hydroxyvitamin D concentration of greater than 30 nanograms per milliliter (ng/mL). The median vitamin D level was 23.5 ng/mL-more than 60 percent of patients were in the range of vitamin D insufficiency (10 to 30 ng/mL). Nearly 20 percent had vitamin D deficiency (less than 10 ng/mL).

"Higher vitamin D concentrations were associated with decreased odds of in-hospital mortality/morbidity," the researchers write. For each 5 ng/mL increase in 25-hydroxyvitamin D level, the combined risk of death, cardiovascular events, or serious infections decreased by seven percent.


Further Study Needed to Determine Cause and Effect

"Vitamin D deficiency is a global health problem," according to Dr Turan and coauthors. In addition to protective cardiovascular and neurological effects, vitamin D plays an important role in the immune system.

The high rates of vitamin D insufficiency and deficiency in the surgical patients studied are consistent with previous findings in the general population. In recent years, studies have suggested that vitamin D levels may affect a wide range of health outcomes.

Patients undergoing surgery are at risk of cardiovascular and infectious complications, both of which may be aggravated by vitamin D deficiency. Previous studies found no increased risk of adverse outcomes related to vitamin D levels in patients undergoing cardiac surgery. It may be that the tissue injury and inflammation associated with heart surgery overwhelms any potential protective effect of vitamin D.

However, Dr Turan and colleagues note that their study had some important limitations of their study-especially the fact that it included only patients who had recent measurements of vitamin D levels. They may represent a less-healthy group, introducing a potential source of selection bias.

The study can't determine whether there is any cause-and-effect relationship between vitamin D levels and the risk of adverse outcomes. Dr Turan and colleagues suggest a formal randomized trial to evaluate whether preoperative vitamin D supplementation can reduce the risk of serious complications and death after surgery.

A new study shows that vitamin B12 may protect against Alzheimer's disease, adding more evidence to the scientific debate about whether the vitamin is effective in reducing the risk of memory loss. The research will be published in the October 19, 2010, issue of Neurology®, the medical journal of the American Academy of Neurology.

"Our findings show the need for further research on the role of vitamin B12 as a marker for identifying people who are at increased risk of Alzheimer's disease," said study author Babak Hooshmand, MD, MSc, with Karolinska Institutet in Stockholm, Sweden. "Low levels of vitamin B12 are surprisingly common in the elderly. However, the few studies that have investigated the usefulness of vitamin B12 supplements to reduce the risk of memory loss have had mixed results."

For the seven-year study, researchers took blood samples from 271 Finnish people age 65 to 79 who did not have dementia at the start of the study. During that time, 17 people developed Alzheimer's disease. Blood samples were tested for levels for homocysteine, an amino acid associated with vitamin B12, and for levels of the active portion of the vitamin, called holotranscobalamin. Too much homocysteine in the blood has been linked to negative effects on the brain, such as stroke. However, higher levels of vitamin B12 can lower homocysteine.

The study found that for each micromolar increase in the concentration of homocysteine, the risk of Alzheimer's disease increased by 16 percent, whereas each picomolar increase in concentration of the active form of vitamin B12 reduced risk by two percent. The results stayed the same after taking into account other factors, such as age, gender, education, smoking status, blood pressure and body mass index. The addition of folate did not appear to raise or lower the risk of Alzheimer's disease.

"More research is needed to confirm these findings before vitamin B12 should be used solely as a supplement to help protect memory," said Hooshmand.

Vitamin B12 can be found in fish, poultry and other meat products.

A study conducted in more than 100 Mongolian schoolchildren found that daily treatment with a vitamin D supplement significantly reduced the symptoms of winter-related atopic dermatitis, a type of eczema. Led by a Massachusetts General Hospital (MGH) physician, the report in the October issue of the Journal of Allergy and Clinical Immunology supports the results of a preliminary study that showed similar results in a small group of children in Boston.

"While we don't know the exact proportion of patients with atopic dermatitis whose symptoms worsen in the winter, the problem is common," says Carlos Camargo, MD, DrPH, MGH Department of Emergency Medicine. "In this large group of patients, who probably had low levels of vitamin D, taking daily vitamin D supplements - which are inexpensive, safe and widely available - proved to be quite helpful." Camargo led both the earlier Boston pilot study and the current investigation, which was performed in collaboration with investigators from the Health Sciences University of Mongolia.

A chronic inflammatory disorder of the skin, atopic dermatitis is uncomfortable and makes patients more vulnerable to bacterial infection. Symptoms of the disorder - most commonly seen in children - often worsen during wintertime. While controlled administration of ultraviolet light, which can stimulate the production of vitamin D in the skin, is a common treatment for severe atopic dermatitis, the possibility that vitamin D deficiency contributes to the seasonal worsening of symptoms had received little consideration prior to the Boston study. That investigation involved only 11 children but provided preliminary support for the hypothesis.

The current study, conducted in collaboration with the National Dermatology Center in Mongolia, enrolled 107 children, ages 2 to 17, from nine outpatient clinics in the capital city of Ulaanbaatar. The participants - all of whom had a history of atopic dermatitis symptoms worsening either during cold weather or around the transition from autumn to winter - were randomly divided into two groups. One group received a daily vitamin D dose of 1000 IU while the other received a placebo - both delivered in odorless, colorless and tasteless drops. Neither the children's parents nor the study investigators knew to which group participants had been assigned.


Standard evaluations of atopic dermatitis symptoms were conducted at the outset of the trial and at the end of the month-long study period, and parents were also asked whether they saw any improvement in their child's condition. At the end of the month, children receiving the vitamin D supplement had an average 29 percent improvement on the primary assessment tool used, compared with 16 percent improvement in the placebo group. Additional assessments - including the report from parents - also showed significantly greater improvement among children receiving vitamin D.

While data gathered at the outset of the study could not determine whether or not participating children were deficient in vitamin D, the authors note that an even larger study of Ulaanbaatar children conducted at the same time found significant vitamin D deficiency in 98 percent of participants, supporting the probability that the children in this study were also deficient. While future studies are needed to assess the value of vitamin D treatment in adults and in children with year-round symptoms, Camargo - a professor of Medicine at Harvard Medical School - says that parents of children with symptoms that worsen in the winter should try a vitamin D supplement for a few weeks when symptoms flare to see if it helps. He encourages parents to discuss this study and their plan with their primary care provider.

A recent study presented at the Gerontological Society of America's 62nd Annual Scientific Meeting shows that a combination of vitamins and nutriceuticals improves memory and cognitive performance in community-dwelling adults.

A team of researchers at the University of Massachusetts Lowell tested the efficacy of a specially designed formulation on cognitive performance in healthy adults. The nutriceutical formulation includes vitamin B12, folate, vitamin E, S-Adenosyl L-methionine (SAM-e), Acetyl-L-carnitine (ALCAR) and N-acetyl cysteine (NAC).

Study participants were randomly assigned to receive either the nutriceutical formulation or the placebo. Using standardized cognitive tests, the researchers concluded that the nutriceutical formulation can improve cognitive performance in healthy adults.


The standardized cognitive tests assessed for changes for simple memory (Digit-Recall test and CVLT II) and executive function (Trail-making test). The researchers concluded that the nutriceutical formulation enhances cognitive performance in healthy adults based on the statistically significant improvements in their scores. In addition, participants declined to their baseline performance level when the nutriceutical formulation was discontinued and achieved similar improvement following resumption of the nutriceutical formulation. The research team concluded that continued consumption of the nutriceutical formulation is required to maintain the beneficial cognitive effects.

"These findings suggest that people taking the nutriceutical formulation on a regular basis may be able to carry out complex mental tasks more quickly and more efficiently," said Dr. Ruth Remington from the University of Massachusetts Lowell team. "This is very exciting news in the area of cognitive health and shows an approach that healthy adults can take to stay sharp as they age," she continued.

Study participants were adults with no known dementia or clinical memory conditions. This is particularly noteworthy because, while this combination of vitamins and nutriceuticals has demonstrated effectiveness for cognitive health in patients diagnosed with Alzheimer's disease or dementia, this study shows a positive effect in individuals with no known memory problems.

Tiny RNAs shed by tumours can transform healthy cells into cancerous ones.

When a cancer cell throws out its trash, it can turn healthy neighbours into fellow tumour cells, researchers have found.

Many cells, including cancerous ones, shed thousands of tiny membrane-bound vesicles called exosomes that contain proteins, DNA and RNA. The process is thought to be a waste-management system, but it may also facilitate cell-to-cell communication: some of these vesicles can then merge with other cells and dump their payload inside.

In a study published online on 23 October in Cancer Cell1, researchers show that when human breast-cancer exosomes can cause tumours when mixed with normal cells then injected into mice. The results could pave the way to finding markers to monitor the progression of cancer, and possibly even point to targets for therapies.

“It’s amazing — these vesicles were considered garbage cans,” says Khalid Al-Nedawi, a cancer researcher at McMaster University in Hamilton, Canada. “This paper really brings us closer to harnessing the potential of these tiny vesicles.”

Previous studies had shown that cancer cells crank out more exosomes than normal cells2. Cancer researcher Raghu Kalluri of the MD Anderson Cancer Center in Houston, Texas, and his colleagues therefore decided to look into how the two types of exosome might differ. They isolated exosomes from cells grown in culture and found that, unlike normal exosomes, those from cancer cells contained the building blocks required to produce the short fragments of RNA called microRNA that can shut off the expression of target genes.

Exposure to the cancer exosomes altered gene expression in the normal cells. Those cells then caused tumours when injected into mice. Exosomes from normal cells did not yield tumours, however, and tumour growth was reduced in cells exposed to cancer exosomes in which the microRNA-producing molecular machinery had been disabled.

The team also collected exosomes from the blood of 8 healthy individuals and 11 people with breast cancer. Five of the 11 exosome samples from the patients induced tumour growth when mixed with normal cells and injected into mice; none of the exosome samples from healthy people did so.

It is unclear how far exosomes can travel in the body, says Kalluri, but the fact that the team could isolate them from blood suggests that they could be quite mobile. And even if their effect is only local, they could still make nearby cancer cells more aggressive, or transform healthy cells into cancerous ones, he says.