Tharhan Rao (M15091017)

Assignment 1 (ESAP)

ASSIGNMENT 1 (CRITICAL REVIEW)

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Tharhan Rao s/o Krishnamoorthy

M15091017
MBBS / Batch 21
Year 1 / Semester 1
UNIV 31002 English for Specific and Academic
Purposes
Critical Review
Vitamin D effects on musculoskeletal health,
immunity, autoimmunity, cardiovascular disease,
cancer, fertility, pregnancy, dementia and mortality
Ms. Kasturi Krishnan

Tharhan Rao (M15091017)

Assignment 1 (ESAP)

Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular

disease, cancer, fertility, pregnancy, dementia and mortalityA review of recent
evidence. (2013). Science Direct, Volume 12(Issue 10), pp.976 to 989.

Introduction
Vitamin D, also known as 25-hydroxyvitamin D (25-OH D), is a non-essential
vitamin in human body as it can be synthesized with sufficient exposure to
sunlight but its adequacy is very significant in maintaining a good health.
Following recent scientific researches, many ill health conditions have been
related with the deficiency of Vitamin D level in the body which includes
cardiovascular diseases, chronic kidney diseases, bone health problems, mental
disorders and respiratory problems. I have chosen five articles to support and my
findings will be summarised in this essay.

Vitamin D Status Is Associated With Arterial Stiffness and

Vascular Dysfunction in Healthy Humans
This study, by Al Mheid et al., which was grounded on a community-based
asymptomatic population within a large multi-ethnic society, has demonstrated
an association between Vitamin D status and several indexes of vascular health,
including arterial stiffness and endothelial function. Measurements of higher
Augmentation Index (AIX) and Pulsatile Wave Velocity (PWV) as well as lower
Subendocardial Viability Ratio (SEVR) caused by arterial stiffness has been
associated with lower levels of 25-OH D. On the other hand, lower levels of 25OH D has been associated with the abnormalities in the indexes of vascular
function of lower endothelium-dependant brachial artery flow-mediated dilation
(FMD) and reactive hyperemia index (RHI).[1] I have chosen this article because
the results were very reliable as this study was based on a large sample size of
554 participants and there were no obvious biasness throughout the research
work. The patients had a significant improvement after a 6 month therapeutic
follow up to normalize their vitamin D level. Consequently, it leads to the need
for more researches to be carried out on therapeutic treatment of vitamin D to
prevent cardiovascular disease in hypovitaminosis D patients.

Vitamin D Deficiency and Psychotic Features in Mentally Ill

Adolescents: A Cross-Sectional Study
Plenty of researches have been published on correlation of Vitamin D deficiency
and psychotic features in adults but none involving adolescents. Gracious et al.
took this opportunity to conduct a research to study the association of vitamin D
deficiency and psychotic features in adolescents. Adolescents were assessed
based on inputs from the parents/legal guardians regarding the symptoms of
psychotic features and a laboratory analysis was done to detect the vitamin D
status. The data collection showed that adolescents with vitamin D deficiency
were 3.5 times more likely to have psychotic feature although the results may be
biased by limiting factors of small sample size and ignored family history.[2] I

Tharhan Rao (M15091017)

Assignment 1 (ESAP)
chose this article because study is original in reporting the link of psychosis and
vitamin D deficiency in adolescents. It is to be confirmed that vitamin D
supplementation in adolescents plays a role in their psychotic status. Many other
factors have been taken into consideration during this study including family
history, medication exposure, seasonal differences, and other demographic
factors. Prospective studies have to be done to confirm the researches
correlating vitamin D deficiency and psychotic features by understanding the
mechanisms involved regardless of the age group to reduce the risk of mental
health problems among any individuals in future.

Vitamin D Status and Mortality in Chronic Kidney Disease

Stefan Pilz et al. examined a sample of 444 patients with estimated glomerular
filtration rate (eGFR) of less than 60mL/min/1.73m 2 from the Ludwigshafen Risk
and Cardiovascular Health Study which included patients without primary kidney
disease but were routinely referred to coronary angiography. Patients were
categorised according to severity of the kidney damage by placing them into
stages 3-5. After a median follow-up time of 9.4 years, it was found that majority
of deaths among the chronic kidney disease (CKD) patients were associated with
cardiovascular disease (CVD). An inversely proportional relationship between the
levels of 25-OH D and risk of all-cause and cardiovascular mortality was found.
The mortality in patients with chronic kidney disease is not solely due to renal
problems but the discovery of correlation of vitamin D and mortality in CKD
patients has brought forward other research questions which require more
studies to be done.[3] This research paper adds on to the girth of the study done
by Al Mheid et al. which correlates vitamin D deficiency and CVD.[1]
Nevertheless, more research has to be done to comprehend the mechanisms of
vitamin D and its therapeutic significance on CKD patients. The authors effort to
relate their research work and gather more information through other published
studies made this article a good choice.

Predictors and Correlates of Vitamin D Status in Children

and Adolescents with Osteogenesis Imperfecta
Proper development and maintenance of the skeletal system of the body is
affected by the role of Vitamin D. Its deficiency has been highly prevalent among
patients suffering from bone fragility disorders. Edouard et al. conducted a
research on vitamin D status in children and adolescents with osteogenesis
imperfecta (OI). This retrospective study was targeted on patients with a
diagnosis of OI type I,III, or IV aged between 1.1-17.9 years. Analysis of the data
showed that more than a quarter (27%) of patients were vitamin D deficit.[4]
Currently patients are considered to be sufficient if the serum concentration of
25-OH D is in the range of between 50 nmol/L to 80 nmol/L. The vitamin D level
was affected by other factors like age, gender, and seasonal variation which
affect the accuracy of the results. Experimental studies showed that by raising
25-OH D levels, the LS-aBMD z-scores increased in young OI patients. Thus,
supplementation with higher Vitamin D improves the patients condition but
measures have to be taken into consideration to understand the safety profile of
vitamin D. This requires further trials to assess whether higher doses of

Tharhan Rao (M15091017)

Assignment 1 (ESAP)
supplementation of Vitamin D are beneficial in children and adolescents with OI. I
chose this study because the authors not only linked deficiency to the disease
but also showed an improvement in the patients condition when vitamin D levels
were normalized.

Vitamin D Levels, Lung Function, and Steroid Response in

Adult Asthma
Inhaled corticosteroids (ICS) which are glucocorticoids (GC) are being used as a
therapeutic treatment to cure patients with persistent asthma. It is hypothesized
that vitamin D exerts effects on phenotype and glucocorticoid (GC) response in
asthma. Sutherland et al. studied the effect of vitamin D levels on phenotype and
GC response in asthma by examining the serum 25-OH D concentrations, lung
function, airway hyper responsiveness (AHR), and GC response in non-smoking
adults with asthma. I chose this study because it showed positive results as the
authors were able to produce a relationship of serum 25-OH D concentration on
lung function, AHR and GC response.[5] Patients supplemented with vitamin D
responded with greater lung function, lower degree of AHR and increased GC
response. This suggests that supplementation of vitamin D in patients with
asthma may result in improvement on the severity and treatment response. This
study uses a small sample size which may lead to biased results and there was a
deviation from the aim when the authors mentioned the correlation of vitamin D
and body mass index (BMI).

Critical Summation
In conclusion, the above studies have shown the numerous effects on health due
to vitamin D deficiency. This shows that vitamin D plays a role in the overall
health of an individual since its deficiency adversely affects various body
systems. Further research needs to be done in order to explore the mechanisms
by which vitamin D deficiency results in diseases so appropriate therapeutic
responses can be made.
[Word count: 1238 words]

References
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Al Mheid, I., et al., Vitamin D status is associated with arterial stiffness and
vascular dysfunction in healthy humans. Journal of the American College of
Cardiology, 2011. 58(2): p. 186-92.
Gracious, B.L., et al., Vitamin D deficiency and psychotic features in
mentally ill adolescents: a cross-sectional study. BMC Psychiatry, 2012.
12: p. 38.
Pilz, S., et al., Vitamin D status and mortality in chronic kidney disease.
Nephrology Dialysis Transplantation, 2011. 26(11): p. 3603-9.
Edouard, T., F.H. Glorieux, and F. Rauch, Predictors and correlates of
vitamin D status in children and adolescents with osteogenesis

Tharhan Rao (M15091017)

Assignment 1 (ESAP)

5.

imperfecta. Journal of Clinical Endocrinology & Metabolism, 2011. 96(10):

p. 3193-8.
Sutherland, E.R., et al., Vitamin D levels, lung function, and steroid
response in adult asthma. American Journal of Respiratory & Critical Care
Medicine, 2010. 181(7): p. 699-704.