Correlations of patients’ muscle pain and weakness, fatigue, body mass index (BMI), and age with 25(OH)D serum concentrations.

<p>VAS, Visual analogue scale, BMI, body mass index;</p><p>^a Spearman’s rho,</p><p>^b Spearman’s rank test</p><p>Correlations of patients’ muscle pain and weakness, fatigue, body mass index (BMI), and age with 25(OH)D serum concentrations.</p

Mean muscle pain and weakness, fatigue, body mass index (BMI), and age in 25(OH)D deficient (<50 nmol/l) and non-deficient (>50 nmol/l) patients.

<p>VAS, Visual analogue scale, BMI, body mass index;</p><p>^at test</p><p>Mean muscle pain and weakness, fatigue, body mass index (BMI), and age in 25(OH)D deficient (<50 nmol/l) and non-deficient (>50 nmol/l) patients.</p

Vitamin D Deficiency in Unselected Patients from Swiss Primary Care: A Cross-Sectional Study in Two Seasons

<div><p>Background</p><p>As published data on 25-hydroxy-cholecalciferol (25(OH)D) deficiency in primary care settings is scarce, we assessed the prevalence of hypovitaminosis D, potential associations with clinical symptoms, body mass index, age, Vitamin D intake, and skin type in unselected patients from primary care, and the extent of seasonal variations of serum 25(OH)D concentrations.</p><p>Methodology/Principal Findings</p><p>25(OH)D was measured at the end of summer and/or winter in 1682 consecutive patients from primary care using an enzyme-linked immunosorbant assay. Clinical symptoms were assessed by self-report (visual analogue scale 0 to 10), and vitamin D deficiency was defined as 25(OH)D concentrations < 50 nmol/l. 25(OH)D deficiency was present in 995 (59.2%) patients. 25(OH)D deficient patients reported more intense muscle weakness (visual analogue scale 2.7, 95% confidence interval 2.5 to 2.9) and had a higher body mass index (25.9kg/m², 25.5 to 26.2) than non-deficient patients (2.5, 2.3 to 2.7; and 24.2, 23.9 to 24.5, respectively). 25(OH)D concentrations also weakly correlated with muscle weakness (Spearman’s rho -0.059, 95% confidence interval -0.107 to -0.011) and body mass index (-0.156, -0.202 to -0.108). Self-reported musculoskeletal pain, fatigue, and age were not associated with deficiency, nor with concentrations. Mean 25(OH)D concentrations in patients with vitamin D containing medication were higher (60.6 ± 22.2 nmol/l) than in patients without medication (44.8 ± 19.2 nmol/l, p < 0.0001) but still below the targeted level of 75 nmol/l. Summer and winter 25(OH)D concentrations differed (53.4 ± 19.9 vs. 41.6 ± 19.3nmol/l, p < 0.0001), which was confirmed in a subgroup of 93 patients who were tested in both seasons (p = 0.01).</p><p>Conclusion/Significance</p><p>Nearly 60% of unselected patients from primary care met the criteria for 25(OH)D deficiency. Self-reported muscle weakness and high body mass index were associated with lower 25(OH)D levels. As expected 25(OH)D concentrations were lower in winter compared to summer.</p></div

Characteristics of the study populations assessed end of summer (month of September) and end of winter (month of March).

<p>No significant differences were found between variables assessed end of summer and end of winter (p > 0.05)</p><p>Characteristics of the study populations assessed end of summer (month of September) and end of winter (month of March).</p

Significant difference of 25-hydroxy 25(OH)D concentrations end of summer and end of winter (53.4 ± 19.9 vs. 41.6 ± 19.3 nmol/l, p<0.0001).

<p>Significant difference of 25-hydroxy 25(OH)D concentrations end of summer and end of winter (53.4 ± 19.9 vs. 41.6 ± 19.3 nmol/l, p<0.0001).</p

Prognostic value of DHEA, DHEAS, basal cortisol, stimulated, delta cortisol, and the ratios cortisol/DHEA and cortisol/DHEAS for functional outcome after 1 year.

*<p>adjusted for gender, age and charlson index.</p

Prognostic value of DHEA, DHEAS, basal cortisol, stimulated cortisol, delta cortisol, and the ratios cortisol/DHEA and cortisol/DHEAS for mortality after 1 year.

*<p>adjusted for gender, age and charlson index.</p

Kaplan Meier Survival Curves.

<p>A. Survival in relation to median cortisol level of 475 nmol/L. p = 0.0014, Hazard Ratio 0.35, 95% CI 0.19–0.67. B. Survival in relation to median stimulated cortisol level of 742 nmol/L. p = 0.015, Hazard Ratio 0.4496, 95% CI 0.24–0.86. C. Survival in relation to median dehydroepiandrosterone level of 15.5 nmol/L. p = 0.0236, Hazard Ratio 2.09, 95% CI 1.104 to 3.955. D. Survival in relation to median dehydroepiandrosterone-sulfate level of 2.4 umol/L. p = 0.1490, Hazard Ratio 1.60, 95% CI 0.85–3.80. E. Survival in relation to median cortisol/DHEA level of 27 nmol/nmol. p = 0.0002, Hazard Ratio 0.32, 95% CI 0.17–0.61. F: Survival in relation to median cortisol/DHEAS level of 203 nmol/micromol. p = 0.0004, Hazard Ratio 0.31, 95% CI 0.17–0.59.</p

ROC of adrenal values.

<p>Dehydroepiandrosterone (DHEA): Area 0.59, Std. Error 0.05, 95% CI 0.49–0.69, p = 0.07 Dehydroepiandrosterone-sulfate (DHEAS): Area 0.60, Std. Error 0.04, 95% CI 0.51–0.69, p = 0.048. Basal cortisol: Area 0.71, Std. Error 0.05, 95% CI 0.61–0.80, p<0.0001. Stimulated cortisol: Area 0.67, Std. Error 0.05, 95% CI 0.57–0.77, p = 0.001. Cortisol/DHEA: Area 0.70, Std. Error 0.05, 95% CI 0.61–0.79, p<0.0001. Cortisol/DHEAS: Area 0.71, Std. Error 0.05, 95% CI 0.63–0.81, p<0.0001.</p

Baseline characteristics.

<p>n = 231.</p