Maternal vitamin D status in pregnancy and offspring brain development: the forgotten (but essential) needs of vitamin D era

International audienc

Vascular burden as a substrate for higher-level gait disorders in older adults. A review of brain mapping literature

Vascular brain burden, evaluated as white matter hyperintensities (WMH), may explain in part the higher-level gait disorders found in older adults. However, the magnitude and location of WMH as a determinant of higher-level gait disorders remain unknown. The purpose of this review was to determine if the magnitude and distribution of WMH would be associated with the presence of gait disorders in older adults. Medline was searched using the following keywords: "gait", "gait disorders, neurologic", "walking", "cerebrovascular disorders", "leukoaraiosis", "leukoencephalopathies" and "aged". Additional references were reviewed from the bibliographies, and from citation searches on key articles. Observational studies, without language restriction, published between 1995-2011 and exploring simultaneously WMH on MRI and gait performance were selected. Twenty-one studies met the selection criteria. The number of participants per study ranged from 14 to 3301 (35% to 75% female). The total WMH burden was associated with gait disorders in all studies. The largest WMH fractions associated with gait disorders were found in the frontal lobe, the centrum semiovale, the posterior limb of internal capsule, the genu and the splenium of corpus callosum. Gait velocity, stride length and step width were the gait parameters most commonly affected in the presence of WMH. The brain mapping literature supports the hypothesis that a high WMH burden is associated with gait disorders in the course of aging. This could give rise to new strategies for the prevention of higher-level gait disorders and falls in the elderly based on the management of cerebrovascular disease

Vitamin D and white matter abnormalities in older adults: a cross-sectional neuroimaging study.

BACKGROUND AND PURPOSE: Morphological brain changes related to hypovitaminosis D have been poorly studied. In particular, the age-related decrease in vitamin D concentrations may explain the onset of white matter abnormalities (WMA) in older adults. Our objectives were (i) to investigate whether there was an association between serum 25-hydroxyvitamin D (25OHD) concentration and the grade of WMA in older adults and (ii) to determine whether the location of WMA was associated with 25OHD concentration. METHODS: One hundred and thirty-three Caucasian older community-dwellers with no clinical hydrocephalus (mean 71.6 ± 5.6 years; 43.6% female) received a blood test and a magnetic resonance imaging scan of the brain. The grades of total, periventricular and deep WMA were scored using semiquantitative visual rating scales from T2-weighted fluid-attenuated inversion recovery images. The association of WMA with as-measured and deseasonalized 25OHD concentrations was evaluated with the following covariates: age, gender, body mass index, use of anti-vascular drugs, number of comorbidities, impaired mobility, education level, Mini-Mental State Examination score, medial temporal lobe atrophy, serum concentrations of calcium, thyroid-stimulating hormone and vitamin B12, and estimated glomerular filtration rate. RESULTS: Both as-measured and deseasonalized serum 25OHD concentrations were found to be inversely associated with the grade of total WMA (adjusted β = -0.32, P = 0.027), specifically with periventricular WMA (adjusted β = -0.15, P = 0.009) but not with deep WMA (adjusted β = -0.12, P = 0.090). Similarly, participants with 25OHD concentration33% higher grade of periventricular WMA than those with 25OHD ≥75 nM (P = 0.024). No difference in average grade was found for deep WMA (P = 0.949). CONCLUSIONS: Lower serum 25OHD concentration was associated with higher grade of WMA, particularly periventricular WMA. These findings provide a scientific basis for vitamin D replacement trials

Serum vitamin D status is associated with the presence but not the severity of primary open angle glaucoma.

OBJECTIVES: Vitamin D is involved in visual health and function. Our objective was to determine whether age-related vitamin D insufficiency was associated with the presence and the severity of primary open angle glaucoma (POAG) in a case-control study of older adults. STUDY DESIGN: Case-control study. MAIN OUTCOME MEASURES: One hundred fifty cases diagnosed with moderate-to-severe POAG (mean, 75.1±8.5 years; 42.0% female) and 164 healthy controls (mean, 73.0±7.9 years; 59.8% female) were included. POAG diagnosis was based on classical diagnostic criteria of optic nerve cupping and/or RNFL thinning, measured with optical coherence tomography. Severe POAG was defined as Humphrey visual field mean deviation (MD) worse than -12dB. Vitamin D insufficiency was defined as serum 25OHD≤75nmol/L. Age, gender, mean arterial pressure, vitamin D supplementation, visual acuity, and intraocular pressure were used as potential confounders. RESULTS: POAG cases had lower mean serum 25OHD concentration than controls (42.9±25.7nmol/L versus 49.4±29.5nmol/L, P=0.039) and a greater prevalence of vitamin D insufficiency (90.7% versus 82.3%, P=0.032). Increased mean serum 25OHD concentrations were associated with lower POAG frequency, even after adjustment for potential confounders (OR=0.89 per 10nmol/L of 25OHD, P=0.045). Similarly, vitamin D insufficiency was associated with POAG (OR=2.09, P=0.034). Among POAG cases, no 25OHD difference was observed between moderate and severe POAG cases (respectively, 39.2±23.3nmol/L versus 45.1±26.7nmol/L, P=0.188); and no between-group difference regarding the prevalence of vitamin D insufficiency (88.9% versus 94.0%, P=0.313). CONCLUSIONS: Decreased serum 25OHD concentration was associated with POAG. There was no 25OHD difference between moderate and severe POAG

The ‘Action-Research’ philosophy: from bedside to bench, to bedside again

International audienc

Dietary Vitamin D and AMD

International audienc

Vitamin D in adults: update on testing and supplementation

Hypovitaminosis D, a frequent condition in adults, is accompanied by adverse skeletal and non-skeletal events. The objective of the present article was to propose an update on the indications and use of vitamin D testing and supplementation in adults. Among healthy middle-aged adults, the serum 25-hydroxyvitamin D (25(OH)D) target concentration is 50 nmol/L. Natural intakes (sun exposure and diet) are sufficient, and there is no indication for systematic blood test or supplementation. In middle-aged adults who are either sick or dependent or frail, natural intakes are generally insufficient but should be encouraged. In this population, the loading phase of the supplementation targets a 25(OH)D concentration of 75 nmol/L, and the pattern of supplementation (200,000 to 400,000 IU orally over 2 months) depends on the measure of circulating 25(OH)D (which is not reimbursed outside the scope defined by the French national authority for health). In adults over 65 years of age, the loading phase of the supplementation should be systematic and targets a concentration of 75 nmol/L (pattern of 300,000 IU orally over 3 months). Regardless of age, the loading phase should be followed by a long-term maintenance phase of supplementation to maintain the 25(OH)D concentration above the target. A measure of serum 25(OH)D is useful after 9 months of supplementation to adjust the frequency or dosage of supplements if necessary