Low vitamin D linked to sepsis, mortality

http://www.vitamindcouncil.org/low-vitamin-d-linked-to-sepsis-mortality/

25 January 2013

Research reported at the Society of Critical Care Medicine meeting found that people who are vitamin D deficient have an increased risk of developing sepsis – a severe blood infection – and an increased risk of death if they develop sepsis.

Kenneth Christopher, MD, of Brigham and Women’s Hospital in Boston reported that people who had low vitamin D levels prior to being admitted to the hospital were significantly more likely to develop sepsis after hospitalization compared to patients with normal vitamin D levels. Among patients who developed sepsis, the odds of dying within 30 days was greater for people with deficient or insufficient vitamin D blood levels.

Dr Christopher and colleagues analyzed data from 3,400 adult patients who received care in the ICU at two Boston hospitals from 1998 to 2011 who had vitamin D blood test up to a year prior to hospitalization. Within 12 months, 26% of patients died. The authors found that the mortality rate was higher for those with sepsis, reaching 44.6%. Vitamin D deficiency pre-admission was significantly associated with sepsis, an association which remained after correcting for confounders.

Another study presented by Bryan Nguyen, MD, of Loma Linda University in California offered support to the Boston research.

Dr Nguyen and colleagues uncovered a related link between vitamin D status and an increased mortality risk in patients with sepsis. They analyzed the link between vitamin D levels in the first 72 hours of hospitalization and 30-day mortality in patients with sepsis. The study included 91 emergency room patients who were admitted to the ICU. Eleven percent of the patients died within 30 days.

The patients who died had significantly lower vitamin D levels at admission, compared to those who survived the first 30 days (p=0.04). Interestingly, parathyroid hormone levels were significantly higher among patients who died within the first 3 days in the ICU.

The researchers are cautious to celebrate vitamin D as a cure-all for sepsis, but they support its potential ability to expedite recovery time.

Nguyen concludes that the study “does suggest that 1,25(OH)₂D may be a viable therapeutic target in the design of future sepsis clinical trials while we're trying to tease out the various mechanisms of vitamin D deficiency in these patients."

Source

Neale T. Low vitamin D tied to poor sepsis outcomes. Medpage Today. Jan 23, 2013.

Page last edited: 25 January 2013

Dr Michael Holick: What does the sun do for me?

January 22, 2013

Are you ready for the second Grassroots Health webinar?




Today at 10am PST Dr Michael Holick will be discussing the question: "What does the sun do for me?"




Register here for today's webinar! Have a vitamin D question? You can submit your questions for Dr Holick when you register.

Treatment of D deficiency: Oral supplement or vitamin D3 injection?

http://www.vitamindcouncil.org/treatment-of-d-deficiency-oral-supplement-or-vitamin-d3-injection/

6 January 2013

Researchers recently conducted arandomized controlled trialassessing the effectiveness and practicality of oral vitamin D supplements compared to intramuscular vitamin D supplement injections in the treatment of vitamin D deficiency.

Researchers in Iran randomized 92 patients with vitamin D deficiency (< 30 ng/ml) to receive 300,000 IU vitamin D3, either intramuscularly as a single injection or orally in six divided doses over a 3 month period (about the equivalent to 3,300 IU/day). Vitamin D blood levels were measured at baseline, three, and six months.

The researchers found that both treatment regimens significantly increased vitamin D blood levels. Vitamin D status at 3 months was significantly higher in oral than in the injection group, with levels at 36 and 23.5 ng/ml respectively (p=0.03). At 6 months, levels were similar (20.8 and 24.8 ng/ml respectively).

The researchers conclude that both regimens are safe, effective, and practical, “Although we revealed superiority of oral route, at least at early short time, the way of treatment may depend on the patient's choice, compliance and availability of various forms of the drug in any regions.”

Source

Zabihiyeganeh M, Jahed A, Nojomi M. Treatment of hypovitaminosis D with pharmacologic doses of cholecalciferol, oral vs intramuscular; an open labeled RCT. Clinical Endocrinology. January 2013.

Page last edited: 16 January 2013

Vitamin D: Most popular vitamin of 2012

http://blog.vitamindcouncil.org/2013/01/19/vitamin-d-most-popular-vitamin-of-2012/

Posted on January 19, 2013 by Dr William Grant

There were 3600 publications with vitamin D in the title or abstract in 2012 according to PubMed.gov. This brings the total number of publications on vitamin D listed at PubMed to 33,800 (http://www.ncbi.nlm.nih.gov/pubmed). This total compares to 35,100 on vitamin C or ascorbic acid, 21,700 on vitamin E, 19,100 on vitamin A, 17,600 on folate, and 12,000 on vitamin B12. However, since the beginning of 2000, there have been 20,500 publications on vitamin D but only 16,300 publications on vitamin C or ascorbic acid. Thus, vitamin D is the most popular vitamin even though strictly speaking it is not a vitamin. Instead, it is a necessary hormone that can be made in the body through the action of ultraviolet-B (UVB) light. However, it can also be obtained orally through the diet or supplements.

Top 16 Vitamin D Papers of 2012

The following list of top vitamin D papers for 2012 was selected from a search at PubMed.gov at the end of 2012. The list started out with 60 of candidate papers. This list was then sent to a panel of vitamin D researchers and advocates, who added a few more papers, then voted on the entire list. The final list has papers from a variety of health effects. Many other fine papers could not be included due to space limitations.

4,000 IU vitamin D3 was of great help during pregnancy

A topic that generated considerable interest this year was the role of vitamin D during pregnancy. In a pair of papers, researchers from the Medical University of South Carolina discussed the findings and implications of their randomized controlled trial of vitamin D supplementation during pregnancy.^{1, 2} Over 300 women were enrolled in the study. Women were assigned to take supplements containing 400, 2000, or 4000 IU/d vitamin D3 or a placebo. No adverse effects were found such as hypercalcemia or hypercalcuria. This study found that it took 4000 IU/d to raise serum 25-hydroxyvitamin D [25(OH)D] levels to about 40 ng/ml (To convert to nmol/l, multiple ng/ml by 2.5.), a nearly optimal level of 1,25-dihydroxyvitamin D. 1,25-dihydroxyvitamin D is the active or hormonal metabolite of vitamin D which among other things controls the expression of several hundred genes. (See Hossein-nezhad and Holick [2012] for a summary of the effects of vitamin D on fetal development.³) In the study, those taking the higher vitamin D doses had significantly reduced risk of primary Cesarean section delivery and pre-eclampsia. Other adverse pregnancy outcomes occur with vitamin D deficiency such as premature delivery and low birth weight, but too few women were enrolled in this study to find statistically significant results on these conditions.

Mounting evidence that vitamin D deficiency is an important risk factor for autism

A study from Saudi Arabia examined the relation between serum 25(OH)D level and anti-myelin-associated glycoprotein (anti-MAG) auto-antibodies in autistic children near the age of eight years.⁴ There was a very strong inverse relation between the two levels (r = -0.86).

Low vitamin D during pregnancy is associated with childhood language impairment

A study in Perth, Australia measured serum 25(OH)D levels at 18 weeks into pregnancy, and then measured language impairment of the offspring at 5 and 10 years of age. It found that women with serum 25(OH)D levels below 18 ng/ml had children with twice the risk of clinically significant language difficulties compared to those with 25(OH)D levels above 28 ng/ml.⁵ Exactly why is not currently known, but there are many possibilities. It is noted that in the United States in the early 2000s, white women of childbearing age had mean 25(OH)D level of 26 ng/ml while black women of childbearing age had mean 25(OH)D level of 14 ng/ml. Both of these levels are low by current standards. As explained below, skin color is directly relevant to serum vitamin D levels produced by exposure to sunlight.

Higher vitamin D is associated with lower all-cause mortality rates

A topic of interest at the other end of life was the relation of mortality rate to serum 25(OH)D levels. A meta-analysis of 11 observational studies and 60,000 individuals found a reduction in risk over about 10 years for highest vs. lowest category of 25(OH)D level of mortality of 29%.⁶Comparing graded levels of intake, the reduction in risk was 14% for an increase of 5 ng/ml, 23% for an increase of 10 ng/ml, and 39% for an increase of 20 ng/ml in plasma levels of 25(OH)D, starting from a median of ~11 ng/ml. The participants starting with the lowest levels of serum 25(OH)D received the greatest benefits. Those who started with higher serum levels, closer to optimal (30-40 ng/ml), received less benefit from additional vitamin D. This relation between starting serum 25(OH)D levels and health outcome is not surprising because it is similar to many other health studies. Since 25(OH)D levels likely changed over the duration of the studies, and some participants died of unrelated causes, the actual effect of serum 25(OH)D level on mortality rate is greater than these estimates.

And less cardiovascular disease

Cardiovascular disease is an important contributor to mortality rates. A study of 11,000 patients in Kansas was reported. The patients had a mean age of 58±15 years, a body mass index of 30±8 kg/m², and a mean serum 25(OH)D level of 24±14 ng/ml.⁷ Serum 25(OH)D levels below 30 ng/ml was significantly associated with several cardiovascular-related diseases, including hypertension, coronary artery disease, cardiomyopathy, and diabetes. After a period of 5.5 years, those with serum 25(OH)D levels below 30 ng/ml had twice the mortality rate of those with higher 25(OH)D levels.

And less risk of diabetes mellitus type 2

In a 2.7-year study of 2000 prediabetics, participants with the highest third of 25(OH)D levels (median, 30.1 ng/ml) had a reduction in risk of 28% for developing diabetes mellitus type 2 compared with participants in the lowest third (median, 12.8 ng/ml).⁸

. . . and less diabetes mellitus type 1 (T1DM)

An observational study on insulin-dependent diabetes mellitus (T1DM) was based on 1000 U.S. military service personnel who developed this disease between 2002 and 2011.⁹ They had provided blood samples between one and ten years prior to developing T1DM. They were carefully matched with another thousand service personnel who did not develop T1DM. There was a reduction in risk of 78% for developing T1DM for those with serum 25(OH)D levels above 24 ng/ml compared to those with levels below 24 ng/ml. This finding is highly statistically significant and is one of the strongest studies of its type.

Fewer bacterial and viral infections

The effect of vitamin D in reducing risk of infections is a topic of increasing interest. Vitamin D reduces risk of infections primarily by strengthening the innate immune system, primarily by inducing production of cathelicidin, a polypeptide with antimicrobial and antiendotoxin properties. It also shifts production of cytokines, a type of cell signaling molecule, away from proinflammatory ones, and has a number of other actions on both the innate and adaptive immune system.¹⁰ While the effects of vitamin D have been found mostly for bacterial infections, some have also been reported for viral infections such as influenza, HIV, and hepatitis C.¹⁰ In a supplementation study in Sweden involving 140 patients with frequent respiratory tract infections (RTIs) using 4000 IU/d vitamin D3, those in the supplementation group increased their serum 25(OH)D level to 53 ng/ml while those in the placebo group had levels near 27 ng/ml.¹¹ Those taking vitamin D3 had a 23% reduction in RTIs and a 50% reduction in the number of days using antibiotics.

The benefits of vitamin D in reducing risk of cancer

One of the important and well-documented effects of vitamin D is reduced risk of cancer and increased survival after cancer diagnosis. There were 400 publications on vitamin D and cancer in 2012 according to PubMed.gov. Evidence from ecological, observational and laboratory studies have identified over 15 types of cancer for which higher solar UVB light and/or serum 25(OH)D levels are associated with reduced risk. Two of the papers are especially noteworthy. One, a study from Norway involving 658 patients with either breast, colon, lung, or lymphoma with serum 25(OH)D levels determined within 90 days of cancer diagnosis were followed for up to nine years.¹² Compared to those with levels 32 ng/ml had a reduction in risk for dying from cancer of 66%. To a cancer patient, this would be a lifeline.

Another cancer paper reported the results of supplementation with 4000 IU/d vitamin D3 of those with low-grade biopsy-assayed prostate cancer.¹³ Forty four patients successfully completed the one-year study. Twenty four of the subjects (55%) showed a decrease in the amount of cancer; five subjects (11%) showed no change; 15 subjects (34%) showed an increase. In comparison, with a historical group of 19 patients, only 4 (21%) had reductions in the amount of cancer, 3 (16%) showed no changes, and 12 (63%) showed an increase in cancer. Thus optimal vitamin D supplementation appears to be useful for treating those with cancer.

Falls and fractures

The classical role of vitamin D is to regulate calcium and phosphate absorption and metabolism, leading to strong bones. A pooled analysis of 31,000 persons (mean age, 76 years; 91% women) participating in randomized controlled trials of vitamin D supplementation who developed ~1000 incident hip fractures and ~3800 nonvertebral fractures found that those with the highest intake (median 800 IU/d; range 792-2000) had a 30% reduction in risk of hip fracture and a 14% reduced risk of nonvertebral fracture.¹⁴ The role of vitamin D in neuromuscular control also plays an important role in reducing risk of falls and fractures.

Skin pigment adapts slowly to changed ultraviolet environment

Jablonski and Chaplin have published a series of papers on human skin pigmentation and its relation to solar ultraviolet radiation (UVR).¹⁵ Their primary thesis is that human skin pigmentation has adapted to UVR conditions where a group of people live for 50 generations, or about a thousand years. UVR from mid-day sunlight produces vitamin D, which provides important protection against many diseases, but sunlight also causes skin cancer and destruction of folate. Dark skin protects against free radical production, damage to DNA, cancer, and loss of folate. Thus, dark skin is best in the tropical planes regions while pale skin is best at high latitude regions. Those with skin adapted to UVB between 23° and 46° have the ability to tan, which is an adaptation to seasonal changes in solar UVB doses. However, in recent times, people have moved or traveled to regions where their skin pigmentation is not suited to the local UVR conditions. They discuss three examples: nutritional rickets, multiple sclerosis and melanoma. Their abstract concludes with this observation: “Low UVB levels and vitamin D deficiencies produced by changes in location and lifestyle pose some of the most serious disease risks of the twenty-first century.”

Vitamin D levels for traditionally living Africans

A study on traditionally living Africans near the equator provides information on “normal” 25(OH)D levels. A paper was published on serum 25(OH)D levels of the Masai and the Hadzabe living near 4° S in Tanzania.¹⁶ They have skin type VI (very dark), wear a moderate amount of clothing, spend the major part of the day outdoors, but avoid direct exposure to sunlight when possible. The mean serum 25(OH)D levels of Maasai and Hadzabe were 48 (range 23-67) ng/ml and 44 (range 28-68) ng/ml, respectively. This finding suggests that serum 25(OH)D levels in the range of 40-50 ng/ml may be optimal for human health, which is generally consistent with observational studies for a number of health outcomes.

Vitamin D is made by exposure to sunlight to a significant degree only when the sun is 45 degrees or more above the horizon. At the latitudes of North America and Europe, this is summer midday sunlight between the hours of 11 a.m. and 3 p.m. In the early morning or late afternoon, light-skinned individuals may tan but they hardly get any vitamin D from sunlight. And in the winter, nobody gets much vitamin D from the sun. This explains the health benefits of taking supplements of vitamin D.

Summary and Conclusion

Thus, the evidence that serum 25(OH)D levels above 30-40 ng/ml are required for optimal health continues to mount. It takes 1000-4000 IU/d vitamin D3 to reach these levels in the absence of significant UVB exposure. The evidence comes from a variety of studies including observational and laboratory studies and randomized controlled trials (RCTs). While RCTs are required to demonstrate effectiveness and lack of harm for pharmaceutical drugs which, by definition, are artificial compounds, they should not be required for vitamin D since it is a natural compound important for all animal life including humans. In addition, RCTs on vitamin D are difficult to conduct due to other sources of vitamin D and reduced conversion of vitamin D to 25(OH)D level at higher serum levels. It will take five years or more before large-scale RCTs testing vitamin D supplements are completed and reported. The adverse effects of oral intake of up to 4000 IU/d vitamin D3 and serum 25(OH)D levels up to 100 ng/ml are practically non-existent except for those individuals with conditions that may lead to hypercalcemia. Thus, there seems to be little reason to wait for the RCTs before implementing vitamin D policies of higher oral intake and/or moderate UVB exposure and serum 25(OH)D levels. Everyone in North America and Europe should take a supplement of 1000-4000 IU/d of vitamin D in the winter, and those with dark skin or office jobs should take vitamin D all year long. Supplementation with vitamin D is an inexpensive and very effective way to produce huge health benefits.

For further information on vitamin D, the interested reader is directed to these websites:http://www.Grassrootshealth.net, http://www.VitaminDCouncil.org, andhttp://www.VitaminDWiki.com. Dr. Grant is director of http://www.sunarc.org.

References:

1. Hollis BW, Wagner CL. Vitamin D and pregnancy: Skeletal effects, nonskeletal effects, and birth outcomes. Calcif Tissue Int. 2012 May 24. [Epub ahead of print]
2. Wagner CL, Taylor SN, Dawodu A, Johnson DD, Hollis BW. Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients. 2012;4(3):208-30.
3. Hossein-nezhad A, Holick MF. Optimize dietary intake of vitamin D: an epigenetic perspective. Curr Opin Clin Nutr Metab Care. 2012;15(6):567-79.
4. Mostafa GA, Al-Ayadhi LY. Reduced serum concentrations of 25-hydroxy vitamin D in children with autism: relation to autoimmunity. J Neuroinflammation. 2012;9:201.
5. Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Kusel MM, Hart PH. Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics. 2012;129(3):485-93.
6. Zittermann A, Iodice S, Pilz S, Grant WB, Bagnardi V, Gandini S. Vitamin D deficiency and mortality risk in the general population: A meta-analysis of prospective cohort studies. Am J Clin Nutr. 2012;95(1):91-100.
7. Vacek JL, Vanga SR, Good M, Lai SM, Lakkireddy D, Howard PA. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol. 2012;109(3):359-63.
8. Pittas AG, Nelson J, Mitri J, Hillmann W, Garganta C, Nathan DM, Hu FB, Dawson-Hughes B; Diabetes Prevention Program Research Group. Plasma 25-hydroxyvitamin D and progression to diabetes in patients at risk for diabetes: an ancillary analysis in the Diabetes Prevention Program. Diabetes Care. 2012;35(3):565-73.
9. Gorham ED, Garland CF, Burgi AA, Mohr SB, Zeng K, Hofflich H, Kim JJ, Ricordi C. Lower prediagnostic serum 25-hydroxyvitamin D concentration is associated with higher risk of insulin-requiring diabetes: a nested case-control study. Diabetologia. 2012 Dec;55(12):3224-7.
10. Lang PO, Samaras N, Samaras D, Aspinall R. How important is vitamin D in preventing infections? Osteoporos Int. 2012 Nov 17. [Epub ahead of print]
11. Bergman P, Norlin AC, Hansen S, Rekha RS, Agerberth B, Bj”rkhem-Bergman L, Ekstr”m L, Lindh JD, Andersson J. Vitamin D3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study. BMJ Open. 2012;2(6). pii: e001663.
12. Tretli S, Schwartz GG, Torjesen PA, Robsahm TE. Serum levels of 25-hydroxyvitamin D and survival in Norwegian patients with cancer of breast, colon, lung, and lymphoma: a population-based study. Cancer Causes Control. 2012;23(2):363-70.
13. Marshall DT, Savage SJ, Garrett-Mayer E, Keane TE, Hollis BW, Host RL, Ambrose LH, Kindy MS, Gattoni-Celli S. Vitamin D3 supplementation at 4000 international units per day for one year results in a decrease of positive cores at repeat biopsy in subjects with low-risk prostate cancer under active surveillance. J Clin Endocrinol Metab. 2012;97(7):2315-24.
14. Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, St„helin HB, Theiler R, Dawson-Hughes B. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367(1):40-9.
15. Jablonski NG, Chaplin G. Human skin pigmentation, migration and disease susceptibility. Philos Trans R Soc Lond B Biol Sci. 2012;367(1590):785-92.
16. Luxwolda MF, Kuipers RS, Kema IP, Janneke Dijck-Brouwer DA, Muskiet FA. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. Br J Nutr. 2012;108(9):1557-61.

About Dr William Grant

Dr. William Grant is an epidemiologist and founder of the nonprofit organization Sunlight, Nutrition and Health Research Center (SUNARC). He has written over 140 peer-reviewed articles and editorials on vitamin D and health. Dr. Grant is the Science Director of the Vitamin D Council and also serves on their Board. He holds a Ph.D. in Physics from UC Berkeley.

View all posts by Dr William Grant →

Sun exposure: Is just a little bit enough?

http://blog.vitamindcouncil.org/2013/01/16/sun-exposure-is-just-a-little-bit-enough/

Posted on January 16, 2013 by John Cannell, MD

Some experts opine that brief sun exposure will supply all the vitamin D that one needs. However, there has never been a study of how much vitamin D such exposure generates.

Recently, researchers in Korea decided to find out. Dr. Sang-Hoon Lee and colleagues from the Ajou University School of Medicine in South Korea studied the effect of brief sun exposure on vitamin D levels in 20 young women for four weeks.

Lee SH, Park SJ, Kim KM, Lee DJ, Kim WJ, Park RW, Joo NS. Effect of sunlight exposure on serum 25-hydroxyvitamin d concentration in women with vitamin D deficiency: using ambulatory lux meter and sunlight exposure questionnaire. Korean J Fam Med. 2012 Nov;33(6):381-9.

The study was conducted between October and November at latitude 37 degrees north, about the latitude of Washington DC. Initial mean 25(OH)D levels were 11 ng/ml and no woman had levels greater than 20 ng/ml to begin the study. The women were told to get 20 minutes of midday sun exposure on their hands, forearms and face every weekday for four weeks. Facial sunblock and sunglasses were permitted.

Guess how much 25(OH)D levels increased after a month of daily sun exposure? Vitamin D levels did not increase at all; in fact, they were a little lower than when the study began!

Why? I think four reasons may explain the finding.

Perhaps the women did not go outside as often as required. Second is the latitude; I think less UVB is available in October and November than many people think at such latitudes. Perhaps the vitamin D winter begins in the fall at latitude 37 degrees. Third, perhaps forearms, face and hands are just not enough skin surface to make meaningful amount of vitamin D. And four, such brief sun exposure may not be long enough to make meaningful amount of vitamin D.

Our hunter-gatherer equatorial ancestors had very dark skin but wore no or little clothing and were outside most or all of the day. Recent studies indicate such people had vitamin D levels around 50 ng/ml. This indicates a vitamin D input of about 5,000 to 10,000 IU/day.

Vitamin D status in indigenous populations: Part 1. Posted on August 27, 2012 by John Cannell, MD

That’s why the Vitamin D Council recommends full body sunbathing, not incidental sun exposure. Make sure your shadow is shorter than you are so you know you are making vitamin D. Also, since most people can’t sunbath every day, and because the vitamin D winter is so severe, we recommend 5,000 IU/day on the days you don’t sunbathe.

About John Cannell, MD

Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical field as a general practitioner, itinerant emergency physician, and psychiatrist.

View all posts by John Cannell, MD →

Vitamin D status of exlusively breastfed infants

https://blog.vitamindcouncil.org/2013/01/20/vitamin-d-status-of-exlusively-breastfed-infants/

Posted on January 20, 2013 by John Cannell, MD

Dr Clare Wall and colleagues of the University of Auckland recently reported in an interesting paper the vitamin D levels of exclusively breastfed infants in New Zealand.

Are you at risk for D deficiency during pregnancy?

https://blog.vitamindcouncil.org/2013/01/23/are-you-at-risk-for-d-deficiency-during-pregnancy/

Posted on January 23, 2013 by Kate Saley

Vitamin D deficiency during pregnancy is relatively common and may cause significant adverse health issues for both mother and child. Studied health issues associated with low vitamin D status during pregnancy include preeclampsia, gestational diabetes, post postpartum depression, and low birth weight.

Recent research reports that having given birth two or more times, giving birth to more than one child at a time (e.g. twins), and non-tanned skin are  significant risk factors for vitamin D deficiency during pregnancy.

Dr Andersen and colleagues in Denmark recruited 1,108 pregnant women who took part in the prospective “Odense Child Cohort.” Participants completed a questionnaire reporting skin tone, country of birth, pregnancy height and weight, and sun exposure habits. The researchers received information about body mass index (BMI), smoking habits, and the number of pregnancies the woman has had from examination notes. Between the 8^th and 16^th week of gestation, blood samples were drawn to assess vitamin D status.

The researchers found that 27.8% of the participants were vitamin D insufficient, while 3.5% were deficient or severely deficient. However, it must be pointed out that the researchers considered vitamin D insufficiency as < 20 ng/ml and deficiency < 10 ng/ml. If the authors used a cutoff point of 30 ng/ml, 70% of participants would be considered insufficient.

The authors report:

“Adjusted predictors of vitamin D insufficiency were overweight and smoking, whereas having a self-reported ‘darker white’ skin compared to ‘pale white’ or ‘white’ and being nulliparous [first pregnancy] were protective. The association between darker self-reported skin tone to higher vitamin D levels in an almost exclusive Caucasian population is interpreted as a result of tanning (increased UVB-exposure) rather than race-dependent darker skin.”

Interestingly, the number of times a woman has given birth was inversely correlated with vitamin D levels, regardless of season. The researchers also found that increased maternal age was surprisingly associated with increased vitamin D levels, particularly during winter months.

A small percentage of participants in the study were of non-European origin (classified as having one parent born outside Europe). Not surprisingly, non-European origin was associated with an increased risk of vitamin D deficiency during the summer season, most-likely due to decreased vitamin D synthesis compared to women of European origin. The vitamin D levels of the two groups were not significantly different during winter months.

In regards to smoking, insufficiency among smokers was most prevalent during the winter, but not summer months, suggesting smokers had lower overall supplemental and/or dietary intake of vitamin D.

The present study does have numerous limitations including small sample size, lack of generalizability (participants are mainly of European descent), the use of self-reported data in regards to skin tone, and lack of information on supplementation and dietary vitamin D intake.

The researchers suggest that evaluation of current supplement guidelines is needed to decrease the risk of health problems as a result of D deficiency during pregnancy.

Source

Andersen L, Abrahamsen B, Dalgard C, et al. Parity and tanned white skin as novel predictors of vitamin d status in early pregnancy: A population-based cohort study. Clin Endocrinol. Jan 2013.

Court Orders New Trial in 2005 Shaken Baby Case

http://www.wsaw.com/home/headlines/Court-Orders-New-Trial-in-2005-Shaken-Baby-Case-186482781.html

A new trial date has been set for the Athens man convicted of shaking his four-month-old daughter to death.

An appeals court upheld a decision to give Quentin Louis a new trial based on information about what causes symptoms associated with shaken baby syndrome.

During his jury trial in June 2006, an investigator took the stand and said Louis said his daughter, Madelyn wouldn't stop crying so he held her up and shook her. That's when she stopped breathing. It happened on March 18, 2005 at his home in Athens. She died at a hospital three days later from severe brain trauma.

In 2006, Quentin Louis was sentenced to 20 years in prison for the crime.

He will face a jury all over again at the end of October.

Doc mocks accused baby killer's defense as 'hard to believe'

• BY CHRISTINA CARREGA
• Last Updated: 6:22 PM, January 15, 2013
• Posted: 6:22 PM, January 15, 2013

A former Queens pediatrician mocked an accused baby killer’s defense today, testifying that it’s “hard to believe” a slight head bump could cause a two-month-old’s death.

Dr. Rusly Harsono worked at Flushing Hospital’s ICU in October 2007 the night Annie Li was rushed to the emergency room unresponsive, to her parents, Ying and Hang Bin Li.

"The father's explanation of a head bump is hard to believe, although I want to believe it, it’s hard to," Annie’s attending physician Harsono told Queens Supreme Court jurors.

The doctor ruled the tot's death a "non-accidental severe head trauma" and declared her brain dead on Oct 26, 2007.

Hang Bin, 28, is currently on trial for the murder, manslaughter and endangering the welfare of a child charges.

Ying's case was dismissed after doctors discovered that Annie's injuries were "so severe" no matter what time she called it wouldn't have saved her life.

"Annie had no brain action, severe edema resulting from the brain shifting, splitting of the retinas, put it all together and this has to be an inflicting severe head injury," said the doctor, testifying for prosecutors.

The witness said little Annie did not die from the genetic, brittle-bone disease osteogenesis imperfecta -- as the defense contends is possible -- but instead was the victim of Shaken Baby Syndrome.

Although Hang Bin carries the gene for that condition, Annie didn't show any "clinical evidence of OI" to test her while she was alive, according to the doctor.

Harsono, who has since left Queens and now practices in Arizona, snapped at defense lawyer Cedric Ashley, who suggested his client only bumped Annie’s head on the side of a table, by accident.

"You want me to believe that hitting a baby on the side of a table would cause all those injuries? I find that hard to believe," Harsono shot back at the defense.

Ashley probed the doctor about new medical findings published in the Academic Forensic Pathology Journal in July 2011 that discussed "shaken babies die of neck trauma not brain trauma."

Annie's autopsy report showed that she didn't suffer any neck injuries.

http://www.nypost.com/p/news/local/queens/doc_mocks_accused_baby_killer_defense_Tb3SUtioy6R7SXWe9U9zLJ

Italian Court Rules MMR Vaccine Causes Autism

We present here a professional medical translation of the full text of the decision of the Italian Court of Rimini holding that the MMR vaccine causes autism in children. First a few observations.

The MMR vaccines used in Italy prior to 2007 were is Merck’s MMR II, GSK’s Priorix and Morupar, from Chiron [until the latter was withdrawn urgently on short notice by W.H.O. because it was unsafe. Morupar is a Urabe mumps virus strain containing vaccine, which is the type abandoned unilaterally and urgently in the UK in September 1992 by the manufacturer [a GSK company] for legal reasons because of the high levels of all kinds of adverse reactions it causes. It was done so urgently that the UK’s Department of Health was not even given a week to break the news. However, the kind of MMR vaccine Hannah Poling in the US received with 8 other vaccines on the same day would have been Merck’s MMR vaccine containing the Jeryl Lynn strain of mumps virus. [US Government In US$20 million Legal Settlement For Vaccine Caused Autism Case] https://childhealthsafety.wordpress.com/2010/09/21/us20m-hannah-poling-vaccine-autism-case/

And here is the key part of the Italian Court’s judgement:

The medicolegal and auxilary medicolegal assessments must be conducted according to their merits, which, on the basis of an in depth examination of the case in the light of the specialist literature to date, has conclusively established that the young child is suffering from AUTISTIC DISORDER ASSOCIATED WITH MEDIUM COGNITIVE DELAY ascribed with reasonable scientific probability due to the administration of the vaccine MMR occurring on the date 26\3\2004 at the ALS of Riccione

It should also be acknowledged that the auxiliary evaluation pursuant to the Medical Commission has expressed the view that there is a permanent impairment of physical and mental integrity established, ascribed to the first category of Table A, attached to the DPR 30 \ 12 \ 81 n.834.

Now a further point to be made is that in common law jurisdictions like England, Australia, Canada and the USA and many more, a finding of fact by a Court of first instance is extremely difficult to overturn except in the case of manifest error or some other factor like fraud.

Additionally, it appears the judgement of the Italian Court was by consent, which also appears to mean 1) the Italian health authorities did not contest the findings and 2) they cannot appeal. If a qualified Italian lawyer might like to comment here on CHS on whether that is a correct intepretation of the judgement that would be appreciated. The relevant part of the judgement is:

The case, informed through the production of documents and the testing of medical-legal advice, was discussed at today’s public hearing as a consent decree.

The English translation provided here has been kindly provided by Dr JLM Donegan.

Dr Donegan is the only English medical practitioner whose advice on vaccination issues has been found in a three week UK General Medical Council legal trial in August 2007 to the standard of beyond a reasonable doubt to be based on valid medical and scientific literature, not to be misleading and unaffected by any personal views Dr Donegan may hold – in other words Dr Donegan’s advice is independent, objective and unbiased. The findings in the case were most unusual. Instead of finding that the GMC prosecution’s case was not proven, the hearing panel made a positive finding and found in Dr Donegan’s favour to the standard of beyond a reasonable doubt that her defence was proven.

More information can be found here:

UK’s GMC, Dr Jayne Donegan’s Story, Vaccines & MMR

The hearing came about after Lord Justice Sedley in the English Court of Appeal condemned Dr Donegan’s evidence to the English Family Court as “junk science”. This was without Dr Donegan even being present, given any opportunity for comment or being represented. [So much for English justice].

The GMC’s expert witness at the GMC trial, Dr David Elliman, then of Great Ormond Street Hospital spent 5 months preparing an expert report against Dr Donegan for the August 2007 hearing for the purpose of having Dr Donegan’s medical licence revoked, only to be forced to admit in cross-examination that he was “quibbling” over a few details.

Interestingly, whilst Dr Elliman was spending all this time on his report for the GMC prosecution there were problems in the unit he managed at Gt Ormond St Hospital. Despite being warned by his professional staff he took no management action. This matter came to a head with what has become known as the scandal of the death of “Baby P”. In short a child died, killed as a result of extensive injuries over many months caused by child abuse by the partner of the child’s mother.

Dr Elliman has never been charged by the General Medical Council with anything nor has his licence to practise medicine been revoked. The UK’s General Medical Council appears to have done nothing whatsoever about this despite their main purpose being to regulate the conduct and practice of medical doctors to protect the public. Well, they did not protect “Baby P” and by doing nothing they will not protect all the other “Baby P’s” there may be in future. They did however spend millions of pounds getting Dr Wakefield’s licence revoked and now it appears that all along Dr Wakefield was right.

Here follows the translated judgement. Any observations on or suggestions for improvements to the translation or typographical or other errors would be appreciated as this has been prepared as rapidly as reasonably possible:

Italian Republic

On behalf of the Italian people

The Ordinary Court of Rimini

Civil Division, Labour Section

With a single judge presiding in the person of Judge Lucius ARDIGO’ pronounces

JUDGMENT

in the civil case, with the ritual of work, registered as N.474 \ 10 RGL brought forward by:

XXXX and XXXX on their own behalf and as parents exercising parental authority in the case of their son, a minor xxxx (child)

represented and defended by the lawyer. VENTALORO LUCA with an address for service in Viale Principe Amedeo 12 47900 RIMIN at the Chambers of. VENTALORO LUCA

-APPLICANT-

AGAINST

MINISTRY OF HEALTH (CF80242255589), with the ADVOCACY of the lawyer DISTRICT STATE ADVOCATE electively domiciled in Via Guido Reni 4 40125 BOLOGNA at the Chambers of. DISTRICT STATE ADVOCATE

-AGREED-

Concerning

Compensation under Article 2, paragraph 1, of Law no. 210, 1992

GROUNDS FOR DECISION

By application filed 8 \ 06 \ 2012 XXXX and XXXX on behalf of themselves and in their capacity as parents exercising parental authority over the child xxxx agreed to press charges against the Ministry of Health, applying that they be ordered to pay compensation for irreversible damages from complications caused by compulsory vaccination

The basis for the application stated that on 26 \ 03 \ 2004 the minor (child) xxxx was subjected to prophylactic trivalent MMR at the AUSL (Local Health Authority) of Riccione.

The same daily worrying symptoms arose daily (diarrhoea, nervousness) between 2004 and 2005. xxxx (the child) experienced signs of serious psychological and physical discomfort as far as the date of 31 \ 08 \ 2007 when the recognition took place that he was invalided totally and permanently to a level of 100%

Only on the date 27 \ 06 \ 2008, did the specialist Dr. Niglio attest as to how the reported damages to the minor (child) were attributable to the vaccination carried out, this theory was definitively confirmed on the date 25 \ 07 \ 2009 by the specialist Dr. MONTANARI.

Therefore on the date 28 \ 04 \ 2008 the parents, the applicants, submitted an application for verification of eligibility requirements for the compensation provided for the benefit of those harmed by the irreversible complications due to mandatory, vaccinations, but on the date 13 \ 10 \ 2008 the Medical Hospital Commission refused the application because the MMR vaccination did not turn out to be compulsory by law or ordinance of Health Authority.

The case, informed through the production of documents and the testing of medical-legal advice, was discussed at today’s public hearing as a consent decree.

In a preliminary ruling it was asserted that the the capacity to be sued of the Ministry was exempted under the provisions of Article D of .114> L.vo No. 112 of 1998, regarding the contribution to the Region of the functions and administrative tasks relating to Health, Article 123. This same decree explicitly recognized the retention by the State of the duties relating to appeals (to be understood both as administrative and judicial, in the absence of normative distinction) for the payment of compensation in favour of those harmed by the irreversible complications due to vaccinations, compulsory medical treatment and the like.

The latter theory shared by the most recent and prevailing case law of the Supreme Court of Cassation (Highest Court of Appeal) which has clarified how in the case of especially the capacity to be sued, it is exclusively the responsibility of the Ministry of Health (see most recently Cass. Sec. L n. 29311 of 28 \ 12 \ 2011 Rv. 620379; Compliant same section 13 \ 10 \ 2009 n. 21702, n.21703, n.21704 of 3 \ 11 \ 2009 n. 23216, n. 23217, by 5 \ 11 \ 2009 n. 23434, the 6 \ 11 \ 2009 n. 23588).

In point of law it is considered that the fact that the alleged permanent impairment of physical or mental integrity is due to a compulsory vaccination cannot be an impediment to the recognition of compensation required.

Referred to herein and in fact, to the judgment of the Constitutional Court. 27 \ 1998 and 423 \ 2000 that it was declared unconstitutional by violation of Articles 2 and 32 Constitution, Article 1, paragraph 1, I. February 25, 1992 No 210 (Compensation for those harmed by complications of an irreversible type because of mandatory vaccination, blood transfusion and the administration of blood products), in so far as it provided no entitlement to compensation under the conditions specified therein, of those who were subjected to non-compulsory vaccinations against Hepatitis B and Poliomyelitis as a result of campaigns by the Health Authority to legally promote the dissemination of these vaccinations.

The aforementioned vaccinations, like the trivalent MMR vaccination in question, had been strongly encouraged by the state while not imposing a legal obligation: it is not constitutionally permissible in the light of Articles 2:32 of the Constitution, to require that the individual puts his own health at risk for the collective interest, without collective being willing to share, if you will, the weight of the negative consequences, there is no reason to differentiate from point of view of the aforesaid principle, the case where medical treatment is required by statute and that in which it is according to a law promoted by public authorities, in view of its widespread distribution in society.

The medicolegal and auxilary medicolegal assessments must be conducted according to their merits, which, on the basis of an in depth examination of the case in the light of the specialist literature to date, has conclusively established that the young child is suffering from AUTISTIC DISORDER ASSOCIATED WITH MEDIUM COGNITIVE DELAY ascribed with reasonable scientific probability due to the administration of the vaccine MMR occurring on the date 26\3\2004 at the ALS of Riccione

It should also be acknowledged that the auxiliary evaluation pursuant to the Medical Commission has expressed the view that there is a permanent impairment of physical and mental integrity established, ascribed to the first category of Table A, attached to the DPR 30 \ 12 \ 81 n.834.

As for the ascertainment, on the part of the parents, of the actual knowledge of the cause of disability, it should be noted that in none of the medical records examined was the clinical picture established definitely as post-vaccine, in the sense of, caused by inoculation of the vaccine, and that the causal relationship is indicated for the first time only in the medical report on 27 \ 06 \ 2008 of the specialist Dr. Niglio.

In particular, we should highlight as the starting point, not reckoned in the knowledge of the diagnosis, or by the mere suspicion of an origin from compulsory vaccination, but from the moment when, on the basis of medical records, the claimant is found to have had knowledge of the damage, that awareness of the aetiological relationship between irreversible injury (including ascribability table) and the cause from vaccination (which entitles you to compensation).

As reiterated by the Supreme Court in the analogous issue of knowledge of occupational disease indemnification, it is not sufficient that the employee is informed of the mere professional/ occupational origin of the disease but it is also necessary that the same is aware of the importance of sequelae so as to provide an impairment higher than threshold percentage fixed for the recognition of pension entitlement (see in this sense civil Cassation section. Lav., April 3, 1993, No. 4031, in Riv. In fort. and mal. Prof. in 1993, II, 111; Supreme Court as well as civil sez. Lav., January 8, 1996, n. 63 INAIL Bulgari c rv 495 260)

Therefore, a deadline of two years from knowledge of the cause of the damage is enforced(Article 3 of Law no. 210, 1992), being the permanent impairment of psycho-physical integrity due to 1 / \ category in Table A attached to the DPR 30 \ 12 \ 81 n.834, and should be entitled to compensation provided for under Articles 1 and 2 of Law 210 \ 1992 comprised therein for the payment of the One off payment of Article 2 paragraph 2 of that law.

Under the combined provision in the Article 429 c.p.c. and 16. paragraph 6 of Law 30 December 1991, No. 412, the amount due in respect of statutory interest on pension claims is used to offset any amounts payable for the restoration of greater damages for the diminished value of the claim, which is why an adjustment for inflation becomes operational only for periods of time which the amount of interest is not sufficient to cover the full damage due to devaluation.

The court costs are settled on a payment formula accepted by the Ministry according to the general criterion of negative outcomes.

For this same reason they are definitively accepted by the Ministry as are the costs of CTU, to the extent already settled by a separate decree.

FOR THESE REASONS

THE ORDINARY COURT OF RIMINI

with a single judge presiding in the function of judge of the work

pronouncing definitively on the application brought by XXXX and XXXX as parents exercising parental authority over the child xxxx with an application lodged on 8 \ 06 \ 2012, dismissing all other claims, objections or inferences, will thus provide, in adversarial proceedings with the Ministry of Health:

1) I verify that (child) xxxx has been irreversibly damaged by complications caused by vaccination (prophylaxis trivalent MMR) with a right to compensation referred to in Articles 1 and 2 of Law no. 210, 1992, ( lifetime pension backdated for fifteen years), I order the Ministry of Health in the person of the Minister in charge to pay to (child) xxxx the compensation provided for by Articles 1 and 2 of Law 210/1992 including the payment of the One off payment of Article 2 paragraph 2 of that Act (for the arrears plus interest accrued in so far as legally possible and the second monetary revaluation ISTAT indexes, as required by law for payment of the application);

1. I Order the Ministery of Health to pay the court fees in settlement a total of Euro 2.500,00 in addition LVA, CPA and reimbursement of the general charges as required by law;

2. I definitively place the burden on the Ministry of Health to meet expenses of CTU (Expert witnesses).

Thus decided in Rimini, public hearing on the 15 \ 03 \ 2012.

THE JUDGE
Lucio ARDIGO ‘

Translated by JLM Donegan 23 May 2012
http://www.ageofautism.com/2012/05/italian-court-rules-urabe-mumps-strain-of-mmr-causes-autism.html