scholarly journals Nutrition Support in Liver Transplantation and Postoperative Recovery: The Effects of Vitamin D Level and Vitamin D Supplementation in Liver Transplantation

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3677
Author(s):  
Junshi Doi ◽  
Amika Moro ◽  
Masato Fujiki ◽  
Bijan Eghtesad ◽  
Cristiano Quintini ◽  
...  
Keyword(s):  
Vitamin D ◽  
Liver Transplantation ◽  
Vitamin D Deficiency ◽  
Solid Organ Transplantation ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Solid Organ ◽  
Skeletal Health ◽  
Post Transplant ◽  
Serum Vitamin D

Vitamin D plays an important role in the arena of liver transplantation. In addition to affecting skeletal health significantly, it also clinically exerts immune-modulatory properties. Vitamin D deficiency is one of the nutritional issues in the perioperative period of liver transplantation (LT). Although vitamin D deficiency is known to contribute to higher incidences of acute cellular rejection (ACR) and graft failure in other solid organ transplantation, such as kidneys and lungs, its role in LT is not well understood. The aim of this study was to investigate the clinical implication of vitamin D deficiency in LT. LT outcomes were reviewed in a retrospective cohort of 528 recipients during 2014–2019. In the pre-transplant period, 55% of patients were vitamin-D-deficient. The serum vitamin D level was correlated with the model for end-stage liver disease (MELD-Na) score. Vitamin D deficiency in the post-transplant period was associated with lower survival after LT, and the post-transplant supplementation of vitamin D was associated with a lower risk of ACR. The optimal vitamin D status and vitamin D supplementation in the post-transplant period may prolong survival and reduce ACR incidence.

scholarly journals Influence of Supplementary Vitamin D on the Prognostic Pathway of Type1 Diabetes Among Children

2021 ◽  
Vol 14 (1) ◽  
pp. 303-309
Author(s):  
Mostafa Hassan Ragab ◽  
Eman Monir Sherif ◽  
Nadia Badawy Abd- El Gawad ◽  
Safaa Mohamed Elserougy ◽  
Eman Essam Shaban ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Oral Vitamin ◽  
Intake Assessment ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Egyptian Children ◽  
The Impact

Diabetes is one of the commonest chronic diseases worldwide. Vitamin D deficiency showed to be increasing, and have a potential role in autoimmune diseases among which in type 1 diabetes. The aim The aim of the study was to assess the impact of oral vitamin D supplementation on blood glucose (HbA1C) in T1DM patients and to find out the role of vitamin D as a biomarker for follow of T1DM patients compared to HbA1C. Subjects and methods: A randomized interventional clinical study was designed. The study enrolled 60 children patients with T1DM. Only 45 children continued to the end of study. Initial (pre-intake) assessment included history taking, clinical examination, and measurement of serum 25-OH vitamin D3 and serum HbA1C. These children received oral vitamin D supplements for 3 months then post-intake assessment were done again. Results: The study showed that serum vitamin D was deficient among Egyptian children and adolescents with T1DM (mean 11.4±3.4 ng/ml). , 53.33% of the patients had vitamin D deficiency with a 35.6% had insufficiency and 11.11% were VD sufficient. Patients received oral vitamin D supplementation for 3 months after which marked improvement in the levels of serum vitamin D levels and HA1C, 87.5% and 86.5% respectively.

scholarly journals Attenuation of Oxidative Stress, Interleukin-6, High-Sensitivity C-Reactive Protein, Plasminogen Activator Inhibitor-1, and Fibrinogen with Oral Vitamin D Supplementation for Six Months in Patients with Type 2 Diabetes Mellitus having Vitamin D Deficiency

2021 ◽  
Author(s):  
Pullaiah Pasupuleti ◽  
M.M. Suchitra ◽  
Aparna R. Bitla ◽  
Alok Sachan
Keyword(s):  
Oxidative Stress ◽  
Vitamin D ◽  
Cardiovascular Risk ◽  
Vitamin D Deficiency ◽  
Repeated Measures ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Pai 1

Abstract Objectives Type 2 diabetes mellitus (T2DM) associated with oxidative stress and inflammation causes endothelial dysfunction, which promotes cardiovascular risk. Vitamin D with its pleiotropic effect is said to protect against cardiovascular risk. However, with vitamin D deficiency being more prevalent in T2DM, the cardiovascular risk may get compounded. Materials and Methods An interventional study was conducted on 100 patients with T2DM having vitamin D deficiency (vitamin D < 20 ng/mL), who were given oral supplementation of 2,000 IU/day of vitamin D for a period of 6 months. Serum vitamin D, biomarkers of oxidative stress, malondialdehyde (MDA), oxidized LDL (OxLDL), ferric reducing ability of plasma (FRAP), biomarkers of inflammation, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), and fibrinogen were measured at baseline and at the end of the third and sixth month of vitamin D supplementation. Statistical Analysis Repeated measures analysis of variance (ANOVA) was applied for comparison between baseline and third- and sixth-month data after vitamin D supplementation. Linear regression by generalized estimating equations (GEE), which grouped repeated measures for each subject and accounted for correlations that may occur from multiple observations within subjects, was applied. Results Serum vitamin D levels reached normal levels with a significant decrease in OxLDL, hsCRP, IL-6, PAI-1, and fibrinogen levels, with a significant increase in FRAP (p = 0.001) levels at the end of 6 months of vitamin D supplementation. These changes were observed even after correction with glycemic control (HbA1c). However, a significant decrease in MDA was observed only at the end of the sixth month of vitamin D supplementation. Vitamin D levels showed a significant negative association with Ox-LDL, Hs-CRP, IL-6, PAI-1, and fibrinogen, even after adjusting for BMI and statin use (p = 0.001). Conclusion Supplementation of vitamin D for a period of 6 months in patients with T2DM having vitamin D deficiency is beneficial in the attenuation of oxidative stress and inflammation.

scholarly journals Vitamin D Deficiency in South Sharqiya in Oman and its Impact in ENT Patients- A Retrospective Study

2016 ◽  
Vol 24 (3) ◽  
pp. 122-128
Author(s):  
Hasan Abdul Cader Segana ◽  
Reghunandanan Nair ◽  
Fahim Ahmed Shah
Keyword(s):  
Vitamin D ◽  
Retrospective Study ◽  
Vitamin D Deficiency ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Socioeconomic Background ◽  
Vitamin D Metabolism ◽  
Serum Vitamin D ◽  
Vitamin D Levels

Introduction Vitamin D deficiency has multitude of causes and can present with varying clinical manifestations. Studies show that it can lead on to recurrent respiratory infections, ear infections and deafness. Vitamin D also has immunomodulant action. Here we discuss the varying features concerning an Otolaryngologist in general as far as Vitamin D metabolism is concerned. Materials and Methods This retrospective study was performed on 800 patients 152 males and 648 females of different socioeconomic background at secondary level regional referral hospital under Ministry of Health in Sultanate of Oman. The patients attending the outpatient clinic with various complaints and not responding to conventional treatment were advised for assessment of vitamin D [25 (OH) D] level in blood. The patients were evaluated with general history, blood samples of serum calcium, phosphate, alkaline phosphatase and serum vitamin D level were measured by the most standardized laboratory of the country. Results Out of 800 patients, 275 cases had Vitamin D levels below 20 ng/ml and 167 patients had values greater than 30 ng/ml in serum.81% patients with vitamin D deficiency were females.56.25% patients were between third and sixth decade. Otolaryngologic manifestations were acute and recurrent URTI (n=352) 44%. 7% of the patients presented with recurrent ear infection (otitis externa). The rest of them presented to a lesser extent with deafness, otosclerosis. Discussion Vitamin D deficiency has been reported worldwide as one of the commonest deficiency diseases. It can lead to autoimmune dysfunctions, Beta cell dysfunction in pancreas, Multiple sclerosis, recurrent chest infections and congestive cardiac failure. Studies have shown the involvement of cochlea with sensorineural hearing loss and otosclerosis. Conclusion Vitamin D deficiency has multi system implications as patients presenting with different signs and symptoms. Mass level screening and vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health. Adequate vitamin D supplementation and sensible sunlight exposure to reach optimal vitamin D status are among the front line factors of prophylaxis for spectrum of disorders.

Vitamin D status in infants during the first 9 months of age and its effect on growth and other biochemical markers: A Prospective Cohort Study

2016 ◽  
Vol 62 (5) ◽  
pp. 19
Author(s):  
Manish Gutch ◽  
Sukriti Kumar ◽  
Uday Kumar Mandal
Keyword(s):  
Vitamin D ◽  
Cohort Study ◽  
Vitamin D Deficiency ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
The Body ◽  
Serum 25Ohd ◽  
Serum Vitamin D

Background and aim. We planned this prospective cohort study in term newborn babies, with the objective to determine the incidence of vitamin D deficiency in infancy and to determine the level of vitamin D which triggers the physiological PTH axis of the body so as to differentiate truly deficient from sufficient vitamin D status.Methods. 96 participants at birth were enrolled and followed up till 9 months of age. Serum25OHD was estimated in cord blood at birth and at 14 ± 1 weeks of life. 77 participants were followed up at 9 months for estimation of serum 25OHD, PTH, Alkaline phosphatase (ALP), calcium and phosphorus. Vitamin D deficiency was defined as serum 25OHD <15 ng/mL as per USIOM guidelines.Results. Serum 25OHD levels at 9 months of age (15.78±8.97ng/mL) were significantly increased in comparison to the level of 3 months of age (14.04±7.10ng/mL) and at birth (8.94±2.24ng/mL).At birth all the participants (77) were deficient in 25OHD levels. It was found that 16/94 (17%)and 19/77 (24.7%) participants at 3 and 9 months of age respectively became vitamin D sufficient without any vitamin D supplementation. There was a significant inverse correlation between serum 25OHD and PTH concentration (r=-0.522, p<0.001), serum 25OHD and ALP(r=-.501, p<0.001). It was found that reduction in serum vitamin D level to below 10.25 ng/mL results in surge of serum PTH.Conclusion: Vitamin D deficiency is common from birth to 9 months of age but incidence decreases spontaneously even without supplementation. Also large number of babies may be falsely labelled as vitamin D deficient with currently followed cutoffs. So a new cutoff for vitamin D deficiency needs to be established for neonates and infants.

scholarly journals SERUM VITAMIN D DEFICIENCY, A NEW EPIDEMIC

2010 ◽  
Vol 17 (01) ◽  
pp. 111-116
Author(s):  
AHMED BILAL ◽  
Muhammad Irian ◽  
MUHAMMAD OWAIS FAZAL ◽  
Sadia Khan ◽  
FRAZ SAEED QURESHI ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Calcium ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Normal Serum ◽  
P Value ◽  
Published Data ◽  
Serum Vitamin D ◽  
Alkaline Phosphate

Introduction: Vitamin D deficiency has profound adverse effects on health. Serum calcium, phosphorus and even alkalinephasphatase cannot predict underlying vitamin D deficiency. Objectives: 1. To determine the frequency of vitamin D deficiency in outpatientprivate clinic 2. To determine the relation of vitamin D deficiency with the presenting symptom of bone or body aches. To see the relation ofits deficiency to the serum calcium, alkaline phosphate and phosphate levels. Study design: Descriptive study. Setting: One of the local privateclinic. Materials and Methods: 800 patients who presented to the clinic due to any ailment, having presenting complains with bone or bodyaches or not, were included in this study. The duration of study was 7 months from June to December 2008. Results: The study showed amongtotal 33% (n=264) were male and 67% (n=536) were female. 33 patients (4.1 %) were below age of 20 years, 364 patients (45.2%) were havingage between 20-40 years, 252 (31.5%) were between 41 -60 years, 143 (17.8%) were between 61 -80 years and only 8 patients (1 %) were above80years. Over all vitamin D present in sufficient amount (>30 ng/ml) in only 4 patients (0.5%), reaming patients (n=796,99.5%) were deficientin vitamin D were further divided into those who were having deficiency (serum level <20 ng/ml) (n=636, 79%) and insufficiency (serum levelbetween 21-29 ng/ml) (n=160,20%). All the deficient patients were having normal serum calcium and phosphate levels and only 33 patientswere having modestly raised serum alkaline phosphate. Among the sample only 318 (39.7%) were having bone or body aches as a presentingfeature while remaining 482 (60.3%) were having no pains. More ever pain has got insignificant relation to any level of serum vitamin D level(p-value=0.201), however younger deficient patients were having lesser chance of bone or body aches as compared to age more then 60 year(p-value<0.001). Conclusions: Vitamin D deficiency is more prevalent in our community, as compared to published data, targeting youngpopulation. Vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health.

scholarly journals Prevalence of vitamin D deficiency and effect of vitamin D supplementation on feto-maternal outcome in tertiary care centre

2018 ◽  
Vol 7 (12) ◽  
pp. 4912
Author(s):  
Munmun Yadav ◽  
Mahendra Kumar Verma ◽  
Mohan Bairwa ◽  
Govardhan Meena ◽  
Lata Rajoria
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Tertiary Care ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Serum Vitamin D ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
Risk Of Preeclampsia

Background: Vitamin D deficiency is widely prevalent throughout the world. Pregnant women, neonates and infants form most vulnerable groups for vitamin D deficiency. Hypovitaminosis D in pregnancy has been reported to cause various fetomaternal effect, i.e. increased risk of preeclampsia (PE), gestational diabetes mellitus (GDM), caesarean section, hypocalcemia, subclinical myopathy, neonatal tetany, hyperbilirubinemia congenital rickets and infantile rickets, etc. Only few Indian studies are available in this regard. The objectives are to find prevalence of vitamin D deficiency in pregnant women and to evaluate the effect of supplementation with cholecalciferol in improving vitamin D levels in pregnant women and evaluate its correlation with feto-maternal outcome.Methods: A prospective observational was conducted on 120 Pregnant women on their first visit to hospital irrespective of gestational age were offered the test and on the basis of inclusion and exclusion criteria are included in study and vitamin D level was done to know the prevalence of vitamin D deficiency. Apart from routine obstetrical investigation, serum vitamin D (total) level was estimated. All results were recorded and analyzed statically.Results: Out of 120 patients 101 (84.1%) were found to be vitamin D deficient. Mean age of vitamin D deficient group was 28.31±3.86 and sufficient group was 26.37±2.83.81 (67.5%) were vegetarian and 39 (32.5%) were nonvegetarian.75 (92.59%) vegetarian and 26 (66.66%) non-vegetarian found to be vitamin D deficient. (p<0.05). Vitamin D supplementation has been observed to reduce risk of preeclampsia. (p<0.05) and vitamin D sufficiency associated with reduced risk of low birth weight babies.Conclusions: Vitamin D supplementation reduces risk of maternal comorbidities and helps improve neonatal outcomes.

scholarly journals Determination of serum vitamin D status of mothers and newborns and related outcomes

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Ufuk Ayşe Kepkep ◽  
Ayla Gulden Pekcan
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Anthropometric Measurements ◽  
Health Concern ◽  
Serum Vitamin D ◽  
Severe Deficiency ◽  
Vitamin D Levels

AbstractVitamin D deficiency (VDD) has been associated with severe adverse health outcomes during pregnancy is increasingly recognised as a public health concern and maternal and infant VDD is closely associated. The aim of this study was to evaluate the magnitude of VDD and associated factors in pregnant women and newborns in the postpartum period. A cross-sectional study was carried out in a total of 66 pregnant women at > 37 weeks of gestation and newborns at the Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology in Gaziantep, Turkey. Demographic characteristics, 24-h dietary recalls, intake of food supplements were determined in pregnant women, maternal and newborn anthropometric measurements and serum (25-OHD) levels were assessed. Mean age (± SD) of pregnant women was 28.8 ± 6.9 years. Although Turkey has “National Vitamin D Supplementation Programme for Pregnant Women” only 33.3% of women had VD supplementation during pregnancy, not all in the recommended levels (1200 IU/day). Mean (± SD) serum 25(OH)D levels in pregnant women and cord blood of newborns were 17.3 ± 9.0 ng/mL [non-supplemented women (NSW): 16.5 ± 7.9 ng/mL; supplemented women (SW): 18.8 ± 11.0 ng/mL] and 16.6 ± 9.9 ng/mL [newborns of non-supplemented women (NNSW): 13.9 ± 8.7 ng/mL and newborns of supplemented women (NSW): 22.1 ± 10.1 ng/mL], respectively. Vitamin D severe deficiency (< 10 ng/dL) was noted in 22.7%, deficiency (11–19 ng/mL) 51.5%, insufficiency (20–29 ng/mL) 15.2% and sufficiency (≥ 30 ng/mL) 10.6% of the women whereas severe deficiency, deficiency, insufficiency and sufficiency respectively, were determined in 33.3%, 39.5%, 13.6% and 13.6% of newborns (NNSW vs NSW, p = 006, p < 0.05). Median serum VD levels of NSW were statistically higher than NNSW (p = 0.000, p < 0.05). Out of total, 86.4% of women were dressing traditionally covered, and had lower serum VD level (p = 0.049, p > 0.05). SW had higher median body weight (p = 0.026) and body mass index (BMI) (p = 0.036) levels than NSW (p < 0.05). No statistically significant differences were found between anthropometric measurements of NNSW and NSW groups, although birth weights of NNSW and NSW groups were determined as 3005.1 ± 456.1 g and 3153 ± 422.5 g (p > 0.05), respectively. Maternal serum vitamin D levels strongly were correlated with newborn levels. Maternal vitamin D deficiency is a great problem and “National Vitamin D Supplementation Programme for Pregnant Women and Infants” should be effectively implemented and monitored. Also fortification programme should be a national policy.

scholarly journals Vitamin D Deficiency Manifested by Premature Ventricular Complexes from RVOT: A Report on Two Twins

2021 ◽  
Vol 11 (2) ◽  
pp. 220-223
Author(s):  
Gabriel Cismaru ◽  
Cecilia Lazea ◽  
Daniela Iacob ◽  
Simona Cainap
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Right Ventricular Outflow Tract ◽  
Structural Heart Disease ◽  
Vitamin D Supplementation ◽  
Normal Serum ◽  
The Body ◽  
Premature Ventricular Contractions ◽  
Serum Vitamin D

Vitamin D receptor is present in almost every cell of the body. Although some studies have suggested that values >30ng/ml would be sufficient, there is no consensus on the optimal values of serum vitamin D. Vitamin D deficiency can lead to “benign” manifestations, such as back pain, joint pain, fatigue, and heavy sweating. Premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT) are considered “benign,” as they occur in patients without structural heart disease and their exact cause remains unknown. We describe the case of a 10-year-old boy with frequent PVCs and vitamin D deficiency that was corrected after vitamin D supplementation. On the contrary, his twin brother had normal serum vitamin D and no PVCs. The disappearance of PVCs occurred after treatment with vitamin D 2000 IU/day.

scholarly journals Vitamin D deficiency in patients with tuberculosis and its correlation with glycemic status

2019 ◽  
Vol 8 (1) ◽  
pp. 239
Author(s):  
Ritu Karoli ◽  
Shobhit Shakya ◽  
Prem Shanker Singh
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Cross Sectional Study ◽  
Vitamin D Supplementation ◽  
Glycemic Status ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Patients With Diabetes

Background: Comorbidity of diabetes and tuberculosis has serious health implications. Presence of diabetes at least three times increases the risk of tuberculosis which may be mediated by an abnormal innate immune response due to hyperglycaemia or low vitamin D levels.Aim of the study- Present study was carried out to investigate whether lower serum 25(OH) D might be associated with higher prevalence of pulmonary or extra pulmonary tuberculosis which might provide an evidence for a role of vitamin D in the comorbidity of these two diseases and does it have any correlation with glycemic status.Methods: In a hospital based cross sectional study, 264 patients with newly diagnosed tuberculosis were enrolled and according to glycemic status they were divided into three groups. They were assessed for vitamin D deficiency in addition to routine laboratory and biochemical parameters.Results: The patients with diabetes had significantly lower vitamin D levels. The prevalence of severe vitamin D deficiency was highest in patients who had diabetes with tuberculosis. There was negative correlation between vitamin D levels and Hba1C and extensiveness of pulmonary tuberculosisConclusions: Serum vitamin D levels were significantly lower in tuberculosis patients with pre-diabetes and type 2 diabetes compared with those, who had normal glycemic status. We suggest that there is a need to pay more attention to vitamin D status in this country and if there is coexisting diabetes or impaired glucose intolerance, emphasis on vitamin D supplementation can be of utmost importance.

scholarly journals Distribution of vitamin D status in the UK: a cross-sectional analysis of UK Biobank

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e038503
Author(s):  
Liang-Yu Lin ◽  
Liam Smeeth ◽  
Sinead Langan ◽  
Charlotte Warren-Gash
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Uk Biobank ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
The Uk

ObjectiveNo recent large studies have described the distribution of vitamin D status in the UK. Understanding the epidemiology of vitamin D deficiency is important to inform targeted public health recommendations. This study aimed to investigate the distribution of factors associated with serum vitamin D status in a large national cohort.DesignA cross-sectional study.SettingThe UK Biobank, a prospective cohort study following the health and well-being of middle-aged and older adults recruited between 2006 and 2010.ParticipantsA total of 449 943 participants aged 40–69 years with measured serum vitamin D status were eligible for the analysis. Participants completed a questionnaire about sex, age, ethnic background, vitamin D supplementation, smoking, drinking and socioeconomic status.Primary and secondary outcome measuresWe investigated the distribution of serum vitamin D status and the association between demographic factors and vitamin D deficiency or insufficiency. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D level <25 nmol/L. Multivariable logistic regression was used to assess the association between demographic factors and vitamin D status.ResultsAsian (n=4297/8000, 53.7%) and black (n=2459/7046, 34.9%) participants had a higher proportion of vitamin D deficiency than white participants (n=50 920/422 907, 12%). During spring and winter, the proportion of vitamin D deficiency was higher across the UK and higher in the north than in the south. Male sex, abnormal body mass index, non-white ethnic backgrounds, smoking and being more socioeconomically deprived were associated with higher odds of vitamin D deficiency. Increasing age, taking vitamin D supplements and drinking alcohol were associated with lower odds of deficiency.ConclusionsVitamin D status varied among different ethnic groups and by season and geographical area within the UK. Taking supplements was associated with a lower risk of vitamin D deficiency. These findings support the vitamin D supplementation recommendations of Public Health England.

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