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Higher quality of life associated with higher levels of vitamin D

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QOL computation based on 400-850 IU Vitamin D – Oct 2014

Finding the Optimum Scenario in Risk-benefit Assessment: An Example on Vitamin D

European Journal of Nutrition & Food Safety, ISSN: 2347-5641 ,Vol.: 4, Issue.: 4 (October-December)
F. L. Berjia1*, J. Hoekstra2, H. Verhagen2,3, M. Poulsen4, R. Andersen5 and M. Nauta1
1Division of Epidemiology and Risk Modeling, The National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, 2860 Søborg, Denmark.
2National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
3University of Ulster, Northern Ireland Centre for Food and Health (NICHE), Cromore Road, Coleraine, BT52 1SA, Northern Ireland
4Division of Toxicology and Risk Assessment, The National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, 2860 Søborg, Denmark.
5Division of Nutrition, The National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, 2860 Søborg, Denmark.

Background: In risk-benefit assessment of food and nutrients, several studies so far have focused on comparison of two scenarios to weigh the health effect against each other. One obvious next step is finding the optimum scenario that provides maximum net health gains.

Aim: This paper aims to show a method for finding the optimum scenario that provides maximum net health gains.

Methods: A multiple scenario simulation. The method is presented using vitamin D intake in Denmark as an example. In addition to the reference scenario, several alternative scenarios are simulated to detect the scenario that provides maximum net health gains. As a common health metric, Disability Adjusted Life Years (DALY) has been used to project the net health effect by using the QALIBRA (Quality of Life for Benefit Risk Assessment) software.

Results: The method used in the vitamin D example shows that it is feasible to find an optimum scenario that provides maximum net health gain in health risk-benefit assessment of dietary exposure as expressed by serum vitamin D level. With regard to the vitamin D assessment, a considerable health gain is observed due to the reduction of risk of other cause mortality, fall and hip fractures when changing from the reference to the optimum scenario.

Conclusion: The method allowed us to find the optimum serum level in the vitamin D example. Additional case studies are needed to further validate the applicability of the approach to other nutrients or foods, especially with regards to the uncertainty that is usually attending the data.

Equation
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Data - 400-850 IU
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QOL Systematic Review – Jan 2015

Vitamin D Supplementation and Health-Related Quality of Life: A Systematic Review of the Literature.
J Acad Nutr Diet. 2015 Jan 6. pii: S2212-2672(14)01604-9. doi: 10.1016/j.jand.2014.10.023. [Epub ahead of print]
Hoffmann MR, Senior PA, Mager DR.

Vitamin D deficiency and insufficiency are highly prevalent worldwide and thought to potentiate a variety of chronic disease states, including diabetes, cancer, and depression. Routine vitamin D supplementation is often needed to meet vitamin D requirements. Little is known regarding the effect of vitamin D supplementation on quality of life. The purpose of this article was to systematically review the literature regarding quality-of-life outcomes from vitamin D supplementation in healthy and clinical populations. Clinical trials of vitamin D supplementation, where quality-of-life outcomes were reported, were selected from Medline and Web of Science databases. Inclusion criteria were English language articles available online (published between 1950 and May 2014), primary research articles, studies conducted on human beings, and treatment/supplementation with vitamin D. Articles were excluded if they involved topical vitamin D application or implicit cotreatment with other vitamins (eg, multivitamins). Articles selected for review were examined for process and methodologic quality using validated methodologies. A total of 15 articles met the inclusion criteria for review. Interventions were highly variable in terms of study population (eg, healthy/diseased, children/elderly, and baseline vitamin D status) vitamin D dose, and duration of follow-up. Vitamin D supplementation ranged from 400 IU/day for an average of 7.1 years, to a single 300, 000 IU dose. The main tools used to capture quality of life were adaptations of validated, questionnaires (Medical Outcomes Study Short Form 36-item questionnaire and EuroQOL five dimension questionnaire). Vitamin D supplementation was not associated with significant changes in quality of life. Studies that reported changes in quality of life as a result of vitamin D supplementation were in clinical populations on short-term vitamin D. Most articles reviewed displayed poor methodologic quality (eg, no randomization/blinding, dropout description, or vitamin D assessment). Current evidence indicates that vitamin D supplementation may have a small to moderate effect on quality of life when used on a short-term basis in diseased populations. However, the evidence for a beneficial effect of long-term vitamin D supplementation on health-related quality of life is lacking.

PMID: 25573654


Elderly QOL 2X better if high vitamin D Sept 2014

Associations of serum 25-hydroxyvitamin D concentrations with quality of life and self-rated health in an older population.
J Clin Endocrinol Metab. 2014 Sep;99(9):3136-43. doi: 10.1210/jc.2013-4431. Epub 2014 Jun 2.
Rafiq R1, Swart KM, van Schoor NM, Deeg DJ, Lips P, de Jongh RT.
1Department of Internal Medicine and Endocrinology (R.R., P.L., R.T.d.J.), VU University Medical Center, and Department of Epidemiology and Biostatistics (K.M.A.S., N.M.v.S., D.J.D., P.L.), EMGO Institute for Health and Care Research, VU University Medical Center, VU University Medical Center, 1081 BT Amsterdam, The Netherlands.

CONTEXT:
Vitamin D deficiency has been associated with impaired physical functioning, depression, and several chronic diseases and might thereby affect quality of life and self-rated health.

OBJECTIVE:
The aim of this study was to assess relationships of serum 25-hydroxyvitamin D [25(OH)D] with quality of life and self-rated health and to examine whether physical performance, depressive symptoms, and number of chronic diseases mediate these relationships.

DESIGN:
We analyzed data from the Longitudinal Aging Study Amsterdam, an ongoing population-based cohort study of older Dutch individuals.

MAIN OUTCOME MEASURES:
Serum 25(OH)D was classified into the following categories: less than 25, 25-50, and 50 nmol/L or greater. We assessed quality of life (QOL) using the Short Form-12 Health Survey (SF-12; n = 862) and self-rated health (SRH) with a single question, dichotomized into good vs poor SRH (n = 1248).

RESULTS:
Individuals with serum 25(OH)D less than 25 nmol/L scored lower on the physical component score of the SF-12 and had a lower odds on good SRH score compared with individuals with serum 25(OH)D greater than 50 nmol/L (β (95% confidence interval) -3.9 (-6.5 to -1.3) for SF-12, and odds ratio [95% confidence interval) 0.50 (0.33-0.76) for SRH]. Physical performance, depressive symptoms, and the number of chronic diseases were associated with vitamin D status, QOL, and SRH. Adding all these potential mediators to regression models attenuated associations of 25(OH)D less than 25 nmol/L with QOL with 78% and SRH with 32%.

CONCLUSION:
Lower 25(OH)D status is related to lower scores on QOL and SRH. A large part of the association with QOL can statistically be explained by physical performance, depressive symptoms, and the number of chronic diseases.

PMID: 24885628


Seniors with higher vitamin D levels have higher quality of life - June 2014

Associations of serum 25-hydroxyvitamin D concentrations with quality of life and self-rated health in an older population.
J Clin Endocrinol Metab. 2014 Jun 2:jc20134431. [Epub ahead of print]
Rafiq R1, Swart KM, van Schoor NM, Deeg DJ, Lips P, de Jongh RT.
1Department of Internal Medicine and Endocrinology, VU University Medical Center..

Context: Vitamin D deficiency has been associated with impaired physical functioning, depression and several chronic diseases and might thereby affect quality of life and self-rated health.

Objective: The aim of this study was to assess relationships of serum 25-hydroxyvitamin D (25(OH)D) with quality of life and self-rated health, and to examine whether physical performance, depressive symptoms and number of chronic diseases mediate these relationships.

Design: We analysed data from the Longitudinal Aging Study Amsterdam, an ongoing population-based cohort study of older Dutch individuals. Main outcome measures: Serum 25(OH)D was classified into categories: <25, 25-50 and ≥50 nmol/L. We assessed quality of life (QoL) using the SF-12 Health Survey (n=862) and self-rated health (SRH) with a single question, dichotomized into good versus poor SRH (n=1248).

Results: Individuals with serum 25(OH)D<25 nmol/l scored lower on the physical component score of the SF-12 and had a lower odds on good SRH score compared to individuals with serum 25(OH)D>50 nmol/l (Beta(95%CI): -3.9(-6.5 to -1.3) for SF-12, and odds ratio(95%CI): 0.50(0.33 to 0.76) for SRH). Physical performance, depressive symptoms and number of chronic diseases were associated with vitamin D status, QoL and SRH. Adding all these potential mediators to regression models attenuated associations of 25(OH)D<25 nmol/L with QoL with 78% and SRH with 32%.

Conclusion: Lower 25(OH)D status is related to lower scores on QoL and SRH. Large part of the association with QoL can statistically be explained by physical performance, depressive symptoms and number of chronic diseases.

PMID: 24885628


Low Quality of life if premenopausal women have < 30 ng (March 2013)

J Endocrinol Invest. 2013 Mar 19.; Ecemis GC, Atmaca A.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Ondokuz Mayis University School of Medicine, Kurupelit Samsun 55139 TURKEY.

Background: Vitamin D deficiency may be more common in premenopausal women than previously thought and it may impair quality of life (QoL).

Aim: The aim of this study is to evaluate QoL in premenopausal women with vitamin D deficiency and insufficiency.

Subjects and Methods: This is a cross-sectional study in which subjects were enrolled between September 1st and November 30th, 2011.
Healthy premenopausal women with weakness, fatigue and nonspecific pain were assigned into three groups according to their 25-hydroxyvitamin D (25-OHD) levels:

  1. ≤ 20 ng/ml (vitamin D deficient, n = 30),
  2. 21-29 ng/ml (vitamin D insufficient, n = 30) and
  3. ≥ 30 ng/ml (vitamin D sufficient, n = 20).

Short form-36 (SF-36) scores, age, calcium (Ca), phosphorus (P) and PTH levels were compared among the groups and correlations of SF-36 scores with age, serum 25-OHD, Ca, P and PTH were done.

Results: There were significant differences among the groups with regard to

  • PTH ( p = 0.008),
  • physical component score (p = 0.02),
  • mental component score (p = 0.035),
  • physical functioning score (p = 0.0001) and
  • vitality score (p = 0.05).

Apart from PTH and physical functioning score, the results were significant when vitamin D insufficient and sufficient women were compared.
Serum 25-OHD, but not PTH was correlated with some of the scales of SF-36.

Conclusions: Some components of QoL are impaired not only in vitamin D deficient but also in insufficient premenopausal women and impairment is related to 25-OHD rather than PTH levels.

PMID: 23511484


Improvements with 50,000 IU weekly intervention (if < 20 ng) - April 2013

Improvement of Pain, Sleep, and Quality of Life in Chronic Pain Patients With Vitamin D Supplementation
Clinical Journal of Pain:April 2013 - Volume 29 - Issue 4 - p 341–347, doi: 10.1097/AJP.0b013e318255655d
Huang, Wei MD, PhD*,†; Shah, Shivani DO†; Long, Qi PhD‡; Crankshaw, Alicia K. MD†; Tangpricha, Vin MD, PhD§,∥

Objectives: To evaluate the effects of vitamin D supplementation in outpatient veterans with multiple areas of chronic pain.

Methods: A case series was performed as an outpatient vitamin D supplementation quality improvement project. A total of 28 US veterans with multiple areas of chronic pain and low serum 25-hydroxyvitamin D [25(OH)D] (<30 ng/mL) concentrations at baseline were identified in a major Veterans Affairs Medical Center from May 2009 till November 2010. They were supplemented with vitamin D 1200 IU daily if serum 25(OH)D was in the insufficient range (20 to 29 ng/mL) or 50,000 IU weekly if serum 25(OH)D was in the deficient range (<20 ng/mL). Standardized outcome measures were assessed before and after supplementation, including pain assessed by the 0 to 10 pain score and the bodily pain domain score of the Veterans Rand 36 item, sleep by the Pittsburgh Sleep Quality Index, and quality of life (QoL) by the Veterans Rand 36 item.

Results: Participants reported no side effects during the study. Relative to baseline, pain, sleep, and QoL all improved except for role-functioning emotional. The improvements remained significant in pain score (P<0.001), sleep latency (P=0.019), sleep duration (P=0.012), bodily pain (P=0.014), general health (P=0.006), vitality (P=0.048), and social functioning (P=0.017) after controlling for age, sex, race, body mass index, season, baseline serum 25(OH)D concentration subgroup, and whether or not participants received additional procedural intervention during the supplementation period.

Conclusions: Standardized vitamin D supplementation in veterans with multiple areas of chronic pain can be effective in improving their pain levels, sleep, and various aspects of QoL.


Screen or supplement to prevent falls? - 2013

Comparison of Cost-Effectiveness of Vitamin D Screening with That of Universal Supplementation in Preventing Falls in Community-Dwelling Older Adults
Journal of the American Geriatrics Society, Vol. 61 Issue 4, DOI: 10.1111/jgs.12213
Richard H. Lee MD, MPH1,2,*, Thomas Weber MD1, Cathleen Colón-Emeric MD, MHS2,3

Objectives: To compare the cost-effectiveness of population screening for vitamin D insufficiency with that of universal vitamin D supplementation in community-dwelling older adults.

Design: A Markov decision model simulating follow-up over a 36-month period. Published data were used to estimate values for the model, including costs (measured in 2011 U.S. dollars), utilities (measured in quality-adjusted life years (QALYs)), and probabilities.

Setting: Decision analysis simulation from a societal perspective.

Participants: Hypothetical cohort of community-dwelling women and men aged 65 to 80.
Measurements: Net monetary benefit (NMB) was calculated by subtracting the incremental cost of the strategy from the product of incremental QALYs and willingness-to-pay threshold. A higher NMB indicates greater cost-effectiveness.

Results: In women aged 65 to 80, population screening was slightly more cost-effective than universal supplementation, with an incremental NMB of $224 compared with $189 (P < .001). Population screening in men was also more cost-effective than universal supplementation (incremental NMB $298 vs $260, P < .001). Results differed according to age group. In those aged 65, population screening had cost-effectiveness similar to that of universal supplementation in women ($59 vs $71) and men ($114 vs $120), whereas in those aged 80, population screening was substantially more cost-effective than universal supplementation in women ($563 vs $428) and men ($703 vs $571).

Conclusion: Population screening and universal supplementation for vitamin D insufficiency are cost-effective strategies in community-dwelling older women and men.
In the oldest old, population screening may be more cost-effective than universal supplementation.
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Many QoL measures improved when raise vitamin D > 30 ng (June 2013)

The Effect of Vitamin D Supplementation on Health-Related Quality of Life Among Patients with Low Vitamin D; Poster Board MON-254
Odessa Tolentino Wilson *1 and Carolyn Navarcan Montano 2 (ENDO June 2013)
1 Makati Medical Center, Makati City, Philippines, 2Makati Medical Hospital, Makati, Philippines

BACKGROUND: Vitamin D deficiency was flagged as a major health concern in South Asia(2). Aside from bone-related problems, patients may present with nonspecific signs and symptoms, sometimes, complicating management of some diseases. A level ≤ 20 ng/ml is considered as Vitamin D Deficiency while a level of 21-29 ng/ml is considered as Vitamin D insufficiency(1).

OBJECTIVE: To determine the effect of Vitamin D level on Health-realted Quality of Life (HRQoL).

METHODS: The study was a prospective cohort that included 76 patients from Makati Medical Center (MMC), Philippines, with a baseline Vitamin D level below 30ng/ml who were prescribed with Vitamin D supplementation between 2000 IU to 6000 IU daily for eight weeks. Included patients answered the FACIT system questionnaire on Functional Assessment of Non-life threatening (FANLT) conditions (5) at baseline and after 8 weeks of Vitamin D supplementation.

RESULTS: The increase in Vitamin D level from baseline to 8 weeks was significant (p-value <0.0001).

  • Physical well-being (PWB),
  • Social and Family well-being (SFWB),
  • Emotional well-being (EWB),
  • Functional well-being (FWB) and
  • total HRQoL scores

all increased from baseline and after 8 weeks and were all significant (p-value <0.0001). Vitamin D level at the start of the study and the total HRQoL score of the patients showed significant correlation (r=0.2599, p-value = 0.0234).
But when analyzed separately, only PWB showed significant correlation with Vitamin D levels at the start of the study (r= 0.2241, p-value of=0.0561). The results after 8 weeks showed significant correlation in the improvement of Vitamin D level in percent change from baseline, with regards to the improvement in PWB, SFWB, and total HRQoL (r = 0.2310, p-value = 0.0447; r = 0.3643, p-value= 0.0012; r= 0.2560, p-value = 0.0256, respectively). However, EWB did not show correlation with improvement in Vitamin D level while FWB showed negative correlation ( r= 0.0034, p-value of 0.1342, r= -0.1734, p-value 0.9764, respectively).

CONCLUSION: This study showed that when Vitamin D deficiency or insufficiency was corrected, there was indeed a positive effect on physical, social and family well-being and overall HRQoL of patients. The result of this study suggests benefit in achieving a normal Vitamin D level in improving quality of life of patients.
References

  1. Holick, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. JCEM 2011; 1911-1930.
  2. Widespread vitamin D deficiency a concern in Asia. 2011 International Osteoporosis Foundation - Last Editorial Review, January 2011.
  3. Fauci, et, al., Harrison’s Principle of Internal Medicine 17th edition.
  4. Melmed, et al, Williams Textbook of Endocrinology 12th edition.
  5. FACIT measurement system: Functional Assessment of Non-life threatening conditions (FANLT) questionnaire
  6. Merlo, C. et.al. Prevalence and symptoms of Vitamin D deficiency in general practice. Praxis (Bern 1994). 2012 Oct 31;101(22):1417-22.
  7. Pathak, S. Case-series. Endocrine Society 94th annual meeting, Houston, Texas.
  8. Huang, W. et.al., Improvement of Pain, Sleep, and Quality of Life in Chronic Pain Patients With Vitamin D Supplementation. Clin J Pain. 2012 Jun 13.

Poorer health in seniors associated with lower vitamin D – no data in abstract – Sept 2015

The vitamin D status and its effects on life quality among the elderly in Jinan, China
Archives in Gerontology and Geriatrics, DOI: http://dx.doi.org/10.1016/j.archger.2015.09.002
Xiaoyu Feng1, Tao Guo1, Yan Wang, Donghong Kangcorrespondenceemail, Xuanqiang Che, Hongmei Zhang, Wei Cao, Ping Wang
Department of Endocrinology, Qianfoshan Hospital, Shandong University, Jinan 250014, China
1These authors contributed to the work equally and should be regarded as co-first authors

Highlights
•We selected subjects who were representative of the local elderly population and then explored their vitamin status and the association of vitamin D status with their life quality. The results showed that vitamin D status in the elderly was severely inadequate, which decreased their life quality and cause adverse effect on their health.

A challenge for researchers is that vitamin D has many functions in the body, and vitamin D status across the world is not optimistic. There was little data regarding insufficient vitamin D status and its adverse effect on health of elderly Chinese people. So we selected 686 subjects (310 men and 376 women) aged 60 to 89 years to explore the correlation between vitamin D status and their life quality in a community-based osteoporosis prevention study at Qianfoshan Hospital of Shandong University from 2009 to 2010.
All subjects were divided into three groups: vitamin D

Participants were requested to complete SF–36 health survey. The regression models were used to evaluate respectively the association between 25(OH)D levels and parameters of SF–36. As a result, serum 25(OH)D levels were 58.60 nmol/L in male [95% confidence interval (95% CI): 56.7–60.5 nmol/L] and 54.17 nmol/L in female (95%CI: 52.8–55.8 nmol/L). Vitamin D adequacy was in 19.4% of male and 14.4% of female.
With aging, proportions of insufficient vitamin D increased significantly in male (P= 0.004), and in female (P< 0.001). The elderly with hypovitaminosis D got lower scores (life quality?) than that with vitamin D adequacy (almost P< 0.01). Regression analysis showed that vitamin D appeared a positive association with parameters of SF–36 (almost P< 0.001).

In conclusion, vitamin D status in the elderly was severely inadequate, which decreased their life quality and cause adverse effect on their health.


Quick estimates of Vitamin D QUALY by VitaminDWiki

#1) Assume that taking 5000 IU/d of vitamin D3 for 75 years costs $750
Assume this results in two extra high quality of life years
Cost/QALY = $325 per year of quality of life added
# 2) Assume a person starts mid-life and takes 50,000 IU a week at a cost of $8 a year,
Assume that 50 out of 1000 people will live 5 years longer
Cost of vitamin D for 30 years for 1000 People = $8 X 30 * 1000 = $240,000
Number of QALY saved = 100 X 1/2 5 year = 250 QALY s saved
Cost/QALY = $240,000/250 = approx $1000

Note: Both quick estimates need to add cost of education, testing, etc.


Cost of 500 innovations in terms of COST OF LIFE SAVED (not QOL)

 Download the PDF from VitaminDWiki.
Average cost per quality of life year saved $50,000
Example of costs per life saved
Prenatal care for pregnant women $2,900
Flashing lights at railroad crossings $43,000
Collapsible steering wheels $67,000
Child restraint systems in cars $73,000
Smoke detectors $210,000
Neonatal Care for low-birth weight infants $270,000
Signal arms on school buses $420,000
Ground Fault Circuit interrupters $1,400,000


Short url = http://is.gd/QUALYD

Attached files

ID Name Comment Uploaded Size Downloads
4885 Cost-Effectiveness of Vitamin D Screening.pdf PDF 2013 admin 14 Jan, 2015 02:29 1.37 Mb 458
4884 QOL data.jpg admin 14 Jan, 2015 02:08 108.18 Kb 1137
4883 QOL equation.jpg admin 14 Jan, 2015 02:08 114.64 Kb 1116
4882 51-optimum risk-benefit vit D Berjia.pdf PDF 2014 admin 14 Jan, 2015 02:08 1.01 Mb 387
2565 Cost of a QALY - June 2010.pdf admin 08 Jun, 2013 17:38 71.16 Kb 696
2564 Cost per life saved.pdf admin 08 Jun, 2013 17:37 1.58 Mb 965
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